Dhru Purohit Show - The Top Causes of Leaky Gut and How to Fix Them with Dr. Elroy Vojdani

Episode Date: May 26, 2022

This episode is brought to you by InsideTracker and Pendulum. Most of us do not recognize the degree to which digestive problems can wreak havoc in the entire body, leading to allergies, arthritis, autoimmune disease, rashes, acne, chronic fatigue, mood disorders, autism, dementia, cancer, and more. So having a healthy gut means more than simply being free of annoyances like bloating or heartburn; it is absolutely central to your health. Your gut is connected to everything that happens in your body. That is why Functional Medicine almost always starts helping people treat chronic health problems by fixing their gut. Today on The Dhru Purohit Podcast, Dhru talks to Dr. Elroy Vojdani about why the gut is so heavily involved in immune regulation, how leaky gut (also known as intestinal permeability) happens, and what to do about it.  Dr. Vojdani is the founder of Re-genera Medical, a boutique Functional Medicine practice in Los Angeles, California, and the author of When Food Bites Back: Taking Control of Autoimmune Disease. Dr. V began his career as an interventional radiologist, diagnosing and treating complex, late-stage cancers, and other extremely debilitating diseases. Today, he continues in his father’s footsteps–pioneering to find answers to medical conditions that go undiagnosed and untreated.   In this episode, we dive into:   -The top ailments where leaky gut is part of the equation (3:15) -The connection between leaky gut and brain health (11:17) -What can create the onset of leaky gut besides food (22:30) -How antibiotics impact the gut (32:34) -How food additives can aggravate leaky gut (41:21) -The top foods that can cause leaky gut (50:05) -Why autoimmune conditions are more common in women (53:33) -At-home tests for leaky gut (1:05:24) -The five most common foods that people will develop antibodies to (1:10:11) -How to heal a leaky gut (1:19:00) For more on Dr. Elroy Vojdani, follow him on Instagram @regeneramedical, Facebook @regeneramedical, Twitter @regeneramedical, YouTube @elroyvojdani, and through his website, regeneramedical.com. Get his book, When Food Bites Back: Taking Control of Autoimmune Disease, here. This episode is brought to you by InsideTracker and Pendulum. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 20% off. Just go to insidetracker.com/DHRU to get your discount and try it out for yourself. Pendulum is the first company to figure out how to harness the amazing benefits of Akkermansia in a probiotic capsule. To receive 20% off your first purchase of Pendulum’s Akkermansia probiotic supplement, go to Pendulumlife.com and use code DHRU20. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

If someone has an impact, an inflammatory impact at the gut barrier, they are very likely to have an impact at the blood-brain barrier. I see leaky gut. I'm thinking leaky brain at the same time. Welcome to the Drew Prod podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Elroy, Vichdani, and we're talking all about leaky gut, also known as intestinal permeability. What is it? How does it happen?

meaning what are the top causes of it and why does it matter if you're trying to avoid leaky brain which is connected to cognitive decline and Alzheimer's and dementia as well as why is leaky gut so key to understand and to fix if you have an autoimmune condition what's the relationship between leaky gut and autoimmune and a whole host of other issues like brain fog and low energy

and bad skin leaky gut Kiki gut is connected to almost everything that we face today as a society when it comes to chronic disease or the symptoms that we just call normal aging that are not necessarily normal. Dr. Vigdani is going to help us walk through that. Now, a little bit about Dr. Elroy Vigdani. He's the founder of Regenera Medical, a boutique functional medicine practice here in Los Angeles. And by the way, in the podcast I mentioned that they are so busy, they don't have room for taking on new patients, but he just mentioned to me that they have recently brought on a nurse

practitioner and can take on additional patients. So feel free to check him out in the show notes. A little bit more about Dr. Vajani. Upon graduating medical school from the University of Southern California and completing his residency at the USC Keck School of Medicine, Dr. Vigdani began his career as an interventional radiologist, diagnosing and treating complex late-stage cancers and extremely debilitating diseases. While this experience gave him unique insights, into hospital-based medicine, his desire to stop disease before it reached the point of becoming a chronic illness remained of the core of his desire to practice medicine. He's also been the patient.

He's been on the other side of things. Dr. Vizdani himself is not only qualified to speak about leaky gut because he's a medical doctor and deep in the research in the space, like actual research, they do, him and his father, do research in this category, but he suffered from leaky gut as well that was primarily caused by a few food culprits. And he talks about that on today's podcast. Dr. Verzani has co-authored over 20 articles in the scientific literature and continues an integral role in research related to autoimmune, neurodegenerative,

and auto-inflammatory conditions. He's also the co-author of a medical textbook entitled Food Associated Autoimmunity. And recently, he published his first book for the lay person. That means all of us. most of us anyway. I know there's some practitioners that listen to, and it's called When Food Bites Back, link inside of the show notes to get it on Amazon. I think you're going to enjoy today's interview, especially if you care about your gut health.

Stay tuned. Elroy, welcome back to the podcast. It's pleasure to have you here. I want to jump right in, and we were chatting a little bit beforehand, but we were talking about the top things that if somebody, your clinic is right down the street from here, somebody walks in your clinic today and says, you know, Doc, I'm sorry. struggling with X, Y, and Z, what are those top ailments, diagnoses, or diseases where you immediately think leaky gut is part of the equation? Give us a few. Yeah. So the intestinal

barrier, obviously it's in the intestinal system. It's in the gut. So sometimes we get a little bit too honed into the idea that this is going to be a gut-centered process. Right. Like, it's only going to be people who are having bloating or distension or irritable bowel disease But leaky gut affects so many different things. It is that the core of the systemic immune system. So I am looking for systemic issues when I highly suspect that someone has intestinal permeability or leaky gut. So someone who is getting sick way too often, that's kind of the first red flag for

me. They're getting too many viral infections. They're impacting them for longer periods of time. They're not rebounding the way that they're supposed to. Even by the way, I'm still seeing, we're kind of still early in it, but I'm seeing people that got COVID early. got it again. And then are now still in this new wave have gotten it first in January and then just got it for a second time. Yeah. That could be one of those instances as well. Absolutely. Right. You know, yes, reinfections occur under ideal circumstances with a balanced, fully functional systemic immune system, you should be pretty well protected. We are seeing people who were infected with BA1, now getting BA2 infections three months later. If you have a good immune system, that should not be happening. Right. Because you have the natural immunity that's not just, you know, local for like, COVID is through the history of a lot of different viral, even the flu, right?

If you get the flu, you're more likely not to get the flu for that season at least. Okay, great. So I kind of went off on a tangent. What are a couple other ones? So the first one is if somebody's getting sick often, colds, COVID, whatever it might be, the flu. What is another thing in that mix? A very diminished metabolic reserve. So this is a otherwise healthy, relatively young person should be able to have the energy to go out and do what they want to do.

they just don't have it. They can't work out as much as they want to. They can't go to social events as much as they want to. They need way more rest than they should. Got it. So anything that is typically taxing and exercise is a taxing. It's a stress on our body, but it's a good stress. Leads to all sorts of other positive reactions from that.

But anything that's taxing in the body, they're noticing they can't handle that tax in the same way as normal. Right. And could that also include every so often people have. You just had your 40th birthday, by the way. congratulations thank you i'm sure you ate and drank a couple things that maybe you don't typically eat and drink i was a little taxed after that that's that's part of life yep but somebody and and you know we don't always need to be perfect nor is it really likely that we could do that especially if we've

made changes in our diet or we avoid sugar other things like that so sometimes we'll eat foods or drink things that we don't always have so if you get really thrown off by those could that be an example of what you're talking about as well yeah i think having prolonged bad days after after an exposure to something that you're not usually exposed to, definitely a sign that your overall reserve capacity is not what it's supposed to be. Whether it's antioxidant reserve, mitochondrial reserve, immune reserve, something there, your tank is not full. You don't have the ability to replenish. Okay. And we're going to go into why and why these examples and unpack them. You had a third one and it has to do actually with our brain health. How is our brain health

connected to leaky gut? They are directly connected to each other. So the barrier at the intestinal lining, the leaky gut intestinal barrier, is very, very structurally similar to the blood-brain barrier. So if someone has an impact, an inflammatory impact at the gut barrier, they are very likely to have an impact at the blood-brain barrier. According to our own study, it was 60 to 70 percent overlapping prevalence of having both leaky gut and leaky brain. So I see leaky gut, I'm thinking leaky brain at the same time. Wow. That's fascinating. And like in your office, if somebody's sitting in front of you and they're talking about it. So one example of a leaky brain or like your brain's not working as well could be what?

What are some examples either early symptoms or diagnoses that somebody's dealing with? It's usually on the early side very subtle thing. So you know, you're talking to a 40-something-year-old, 50-something or 60-something-year-old. And they're going to tell you about things that they notice about themselves, that they're going to brush off as being related to normal aging. So they don't recall names as well as they used to. They can't follow, you know, mathematical tasks the way that they used to. They can't do the crossword puzzle the way that they used to, right? Oh, I'm just getting old.

No, that's not the way biological aging is supposed to occur in those decades, right? There is something hindering structural cell performance in the brain, and that thing is usually an inflammatory cascade. So that's one example of like early, but also to the full-blown aspect is that at your practice here in Los Angeles, you guys also see like, full-on cognitive decline. And you are trained in the Bredison protocol. We've had Dr. Dale Bredison on the podcast before, does a lot of work and research in the space of Alzheimer's and cognitive decline. So how is it that leaky gut can be connected to something as early as like full-blown cognitive decline? So again, the intestinal barrier is the gateway to the systemic immune system, the gateway to the local enteric nervous system, and can be connected to the brain directly

via the systemic blood and also via the vagus nerve. So when you have things happening at the localized gut level for a prolonged period of time, that is without question going to at some point down the road impact the brain directly, either through the blood or by transmitting something up through the vagus nerve. So that could be many, many things, right? Let's say it is intestinal permeability, leaky gut

related to a gluten sensitivity, something that we see very commonly. That person is ingesting a food that's damaging the lining. The immune system starts reacting to that food locally at the gut. You create a prolonged inflammatory cascade. And what should be an open and shut barrier now remains open. And what is on the inside of the gut can just pass through that barrier into the blood. What do we have plenty of inside of our gut?

Bacteria. So a bacterial toxin. something that's part of the normal structure of the bacteria living inside the gut will now make its way into the blood in a quantity and also frequency that it was never intended to, you know, beat to happen. So you have a bacterial toxin in the blood, eventually downstream going to go enter the blood brain barrier from there, enter the brain. We have great examples of that in the medical literature very well understood. One of them is the effect of lipopolysaccharide a gut bacterial outer surface protein toxin that in Alzheimer's patients, for example,

enter in very large concentration through the blood brain barrier and into the brain and end up at the center of amyloid plaques. So there is no greater illustration of a gut brain access disruption. You know, you have something that originated in the gut, went through the barrier, made its way into the bloodstream, from the bloodstream, went to the brain, through the barrier in the brain, then in the middle of the brain, right? And it was clinically silent the entire time. That was going on for 15, 20, 25 years. The person had no idea until they had Alzheimer's disease, right? What were you taught about leaky gut in medical school

early on? And, you know, how did you end up learning the truth about leaky gut and how central intestinal permeability, by the way, for everybody listening, I think most people know this by now, leaky gut intestinal permeability, kind of like go hand in hand together. that the same thing. But what did you learn about it in medical school? Well, we learned about the possibility for what you call transcellular or paracellular permeability. So transcellular would be something passing directly through the barrier cell. And then pericellular would be something happening in the gap between the cell.

So leaky gut is pericellular permeability, the opening of that gap, essentially. We learned that that was basically impossible. that the paracillular part of cells themselves were stuck together. I remember very clearly learning that that was essentially concrete or glue, right? And I started med school in 2000. This was essentially the same time that Dr. Fasano was publishing his initial research on zonulin and intestinal permeability and learning that that is not true. This is not concrete.

This is a physiological part of our immune cells. system. We open up those barriers so we can send white blood cells into the gut lumen, check out what's going on, pull them back, send that information to the rest of the immune system. So we open and close the paraccellular barrier on purpose all the time. And, you know, we talked a little bit about your background and your father's work on the last podcast, but just as a little tiny refresher, you had a firsthand experience with leaky gut intestinal permeability in your own life. Just if you could refresh our audience, because not only are you the doctor that's helping people,

you actually were the patient at one point in time in a way. Yeah. Yeah. So going to my first couple of years in med school, I struggled a lot physically in completely unexplained, you know, unexpected ways. I was getting sinus infections nonstop, literally every single month on the dot. I would start getting a sinus infection, go see the local doc, you know, at the medical school clinic take an antibiotic, it would resolve, and the hamster wheel would begin over and over and over

again. Going back to your first sign of somebody who regularly has autoimmune type things or leaky gut, getting sick often. Absolutely. I was much more fatigued than I expected to be. I'm 19, 20 years old at this point, right? We have med school from at that time 8 a.m. to 5 p.m. You know, you had the rest of the time to yourself. Sure, we studied for a couple hours. But you know, it wasn't as demanding as medicine would be later on in life, especially during internship and residency. And I was struggling a lot. You know, it wasn't sleeping well. I had a hard time keeping up with the load. And though at Berkeley, an undergrad, I did very well, didn't have, you know, a difficult time. The cognitive load of everything was also difficult for me to. And I guess,

fortunately for me, you know, maybe the universe shined on me a little bit at this time. This was when my dad was developing his next generation food sensitivity testing and also looking at, you know, what's going on with the gut. We didn't have zonel in at that time, right, because Dr. Fasano was really just understanding and learning about this. But, you know, my dad started looking at gut mucosal dysfunction as well, as well as food sensitivities. And, And part of growing up with a brilliant immunologist as a dad is that he's going to draw blood from you all the time. And he would usually draw my blood to try to use me as a control for something that he was

developing. And, you know, I told him everything that was going on. He said, you know, come into the lab. I went to USC. So I was back here at home and his lab was in Beverly Hills and said, come into the lab, let me draw some blood from you and let's just see what's going on. And, you know, he called me afterwards and said, you have a dairy sensitive. You know, at the time, especially in med school, you know, young, early 20s, I didn't believe it.

You know, this was not something that I thought was possible, as I mentioned to you, leaky gut was being told to me as being not possible, right? So he tells me I have these issues, food sensitivities, gut mucosal immune problems. You know, initially he says pull out the dairy, pull out the gluten. I didn't even know what gluten was at the time. Right. So I said, okay, I'll start with one of them. You know, you're a smart guy. You know, I know you have my interested heart here.

I'll listen to what I have to say. Let's try it out. Right. So I eliminated dairy. And what I remember was immediately breaking the cycle of the sinus infections. done no more sinus infections no more monthly visits no more recurrence and I was convinced that you know what he was saying to me was real so followed with gluten and the immediate thing I remember in the week after I removed gluten was

that I slept like an absolute baby for the first time in a long time and I would wake up sharp refreshed ready to hit class ready to hit the boat and just started absorbing everything like a sponge again. So I look back on that and, you know, really that's a huge turning point for me, right? It allowed me to reach my potential in med school, allowed me to, you know, continue on in residency and fellowship and function at a high level without issue. I mean, I definitely was the med student who everybody looked at and said, what in the world are you doing with the way that you eat? This is weird, right?

But I didn't care because I knew how I felt. Right. And 20 years ago, it was difficult to execute a gluten-a-dairy-free diet. It's much easier now. So I'm enjoying the progress that the world has made in that time. But it was worth it to me because I felt a night and day difference. You know, I felt the way I should have felt when I was 22, 23, 24, right? Even though I had a lot going on, I was able to meet that demand.

Now, part of today's podcast is that we're helping people understand not only what leaky gut is, but also signs that if they're suffering for, from having a leaky gut or intestinal permeability. And I think it's always beautiful when, especially physicians like yourself, open up about their own stories that have suffered from it because anybody can become, just because you're highly educated in one area or another, it doesn't mean that you can't suffer from the trappings of the modern world.

Now, one of the things that you mentioned that was a key factor, it seems, in your intestinal permeability was food sensitivities. So we're going to get back to foods in a second. But just high level, What are some other things that are there in addition to food that can create the onset of leaky gut in somebody's body? And by the way, you have a new book out. We talked about it last time, but it's available on Amazon.

It's called When Food Bites Back. We have a link in the show notes as well. And people can check it out and goes deep in the topic of food. We're going to be unpacking some of the stuff that you wrote about in here. But before we get back to food, a couple other things high level that can create the onslaught of leaky gut. Okay. I want to start off by saying that I want to have respect for the idea and notion that we don't fully understand this yet, right? You know, though I understand a lot more than some other physicians, we still don't fully have this mapped out. What I have seen in the medical literature that also seems to ring true in clinic with the thousands of people I've seen at this point is I think they're outside of the foods. Stress is a huge part. of leaky gut. Chronic emotional stress, which we all experience at some point, I kind of think of as a primer, right? Two medications. And there's a few in that medication category, but two big ones

that stand out to me, non-steroidal anti-inflammatories are very, very potent triggers of intestinal permeability, and antibiotics are very potent triggers of intestinal permeability. And then the third category is chemicals. You and I were having a chat before we started about food additives, food coloring, gums, glues, right, the way that we grow our food, having lots of pesticides and glyphosate associated with them. There are, you know, so many things in that list as potential very strong triggers of intestinal permeability. It's hard to keep track, but I'll say chemicals, particularly glyphosate to me, is a very big trigger. So, you know, you're living in the modern world. You're getting lots of exposures to these things all the time. We experience lots of

emotional stress. It's very difficult to pinpoint one. I think it's really all of those things that we talked about. Let's, so just to recap those for the audience, we have stress. You had chemicals as well, and then drugs, and you gave a couple particular types of drugs. Yeah. Let's, uh, just to recap those. look at those. So what is stress doing to the body like both chronic stress where somebody's experiencing a heavy load of stress in their life from work or from some sort of situation that might be in, but also like very key stressful moments. I often hear from friends that I refer to people's practices. You know, I've sent some people to your practice, other practices before, I said, you know, it's the first time a doctor asked me, what was going on your life

emotionally when that disease or for those symptoms first started for you? So why do you ask questions like that? And what is stress doing that would be impacting that barrier inside of our body? All right. I'll answer the first part. So then we'll go on to the immunological mechanisms. why do I ask that question of my patients? One of it, part of it is experience. I think the more that you spend time in the healing arts trying to work on something purely scientific, purely physiologic, purely, let's say, just immune system,

you're going to find yourself hitting roadblocks over and over again with that patient that don't make sense on paper, or at least don't make sense immunologically. And the thing that you have to understand is that we as human beings are very complicated. And we are physiologically impacted by the way we feel and perceive our world. So if I'm going to be effective as a healer, I have to understand that and incorporate that into my treatment algorithm, into the way that I approach this. This is a complicated human being who's had a life who has emotions about many things,

All of that needs to be addressed if we're going to work on their immune system. So experience has given me that humble lesson that I'm going to be at my best. I'm going to help the person in front of me the most if I address their emotional state and their immunological physiological state. That's backed by literature, by the way. I remember one of the studies that kind of opened my eyes a little bit about this was a retrospective study on MS patients from the University of Pittsburgh. I can't remember the exact year, but a very high percentage of the flares of their MS patients

were triggered by a significant emotional event prior to the flare. So, you know, the effect of the emotional state on the immunological state to me is one-to-one. Yeah, like if you have all of a sudden a death in the family, how is that not going to impact your health? Right. We all know that you can become. become so stressed that you can get an ulcer. Right. Right.

But you can also get so stressed that your body becomes in total panic mode. And if that stress continues with other insults, dietary, chemicals, food exposures, whatever it might be, that can have some serious impact on your body. Yeah. So let's take the ulcer example because it's a good segue into the physiology of this. Though I don't think we really understand it very well. But, you know, the classic stress responses, the adrenal stress response and a big release of cortisol as part of that fight or flight mechanism. Cortisol being a potent steroid will have immune modulating effect.

You know, depending on the amount in the context, typically you're either going to upregulate the immune system for a short period of time or if it's a very large release, you're going to suppress the immune system. you also change metabolic dynamics as well too increasing the amount of glycogen output from the liver to increase the amount of glucose in the blood you know i think that there have to be very significant stress induced changes to the more advanced part of the immune system as well too though there are some suggestions of how that occurs we don't have full understanding of those mechanisms To me, I think people who have very significant day-to-day emotional stressors, you'll see very wiped out immune systems for them. You'll see their T cells depleted. And specifically, the big, I don't know, traffic cop of the T-cells, which is a T-regulatory cell, you'll oftentimes see very dysfunctional.

That's the thing that's trying to control all of the sides and create balance. And it's unable to do so because it's very deficient. One thing I like in your book is that you go through and you share all these different patient stories that are there, little case studies, reports, you know, maybe changing or only keeping the patient's first name or putting a different name for their privacy. Is there a patient that you can remember in your thousands of patients you've seen over the years who it was very clear that this stressful situation that happened to them, whatever it might be, was the beginning of what ultimately led to the unraveling of all these symptoms. that were later for them. Anything that comes to mind that you can share with our audience here today, like a particular situation, event, something in their life that they knew they went through. They knew it was a stressful situation, but they didn't make that connection between that and then their disease state that was there. Yeah, I can think, as you're saying that,

I have like a flood of memories of different patients where that's occurred. I have a particular patient who was very, very dear to me, a woman in her 50s, a few autoimmune conditions. very difficult to kind of say how much work went into this from a lifestyle perspective, but let's say years of work in lifestyle medicine trying to help control, you know, I think, some of the autoimmune issues. And it wasn't until that patient gave me the honor of discussing some of the trauma from the past and that she got a chance to connect the dots that her father's death three months before the onset of autoimmunity was the trigger for her that we actually started making major headway. Right. And it's not that we're saying that, okay, somebody passes

away in your family and immediately you're going to get an autoimmune disease. It's just though, in her case, that might have been, you know, in functional medicine, they use this analogy of like a cup filling up, drip, drip, drip, another drip of water. And slowly that cup fills up over a time. So it could be in her case. You know, you mentioned she was 50 when you saw her. She maybe didn't have the best diet. And that's a few drips that are there. Then she has some food sensitivities. then there's some chemical exposure, then other aspects that are there. And then you're maybe not working out as much. And who knows what all the combination of things are for her?

And then you get a major stressor that comes in, the passing of a father in this instance. And then that's that final pourer, then the whole glass of water ends up overpouring. Absolutely. The immune system works on cascade levels, cascade layers, right? So you've got all of these things that happened on the road to that event that put the immune system in the unfortunate perfect situation to be tipped over. And that tipping over event for some people could be an antibiotic. It could be extended use of a non-seroidal.

It could be a food poisoning event or it could be an emotional stressor, a very significant emotional stressor. They're all equivalent to the immune system. It sees all of them the same. Whether we understand them from a physical perspective or we don't, to the immune system they end up being the same thing. You mentioned drugs is another category that we talked about. And we've done a lot of episodes on this podcast.

And I think there's a lot more awareness in the community, in the health community as a whole, that antibiotics, right, have so many positive aspects to them and were a major part of keeping humanity healthy and other stuff. Then there became the overuse of antibiotics. In the cases of antibiotics being a key aspect of somebody's journey of inducing, leaky gut. What are some examples of why somebody might have continued or been exposed to antibiotics as one drug to treat one thing, but nobody told them that it could cause something else? Are there examples of diseases, issues, something that people are trying to treat with regular

antibiotic usage? To me, the most common area where that pitfall occurs is sinus infections. Sinus infections. Yeah. And oftentimes somebody will be experiencing a sinus infection or what's suspected to be a sinus infection giving an additional or initial round of an antibiotic you know 14 days later they've taken antibiotic hey doc my symptoms are still there oh the problem is we didn't use a strong enough antibiotic right then a second one is implemented for 14 days symptoms are still there we just didn't use it for long enough right then you get another 14 days sometimes the third antibiotic to follow that and we're talking about oral systemic antibiotics for a localized mucosal immune system. So what has happened in that situation is you have created

an extraordinary amount of damage to the microbiome, created intestinal barriers that are open. And who knows if you triggered that immunological cascade or not, but the likelihood is going to be high. So let's connect the dots for people. So you're taking an antibiotic, right? In this case, you're talking about people getting prescribed from their doctor. Again, well-intentioned, not following the latest and the best science that's out there, but, you know, hey, that's not the doctor's fault. It's not being taught in medical school. Absolutely.

So they're being given an antibiotic. So what is the role of bacteria when it comes to that barrier in our body? And how do our bacteria keep us healthy and safe? So the entire mucosal immune system, particularly the small intestinal epithelial layer, that barrier contains signal receptors. So it is, let's say, constantly putting an antenna out to survey the internal environment. And it is looking for patterns. They are called pattern associated receptors or pattern recognition, right? So what patterns is it looking for? It's looking for the presence of healthy immune cells and the presence of healthy microorganisms, whether they are

bacteria or yeast or vice versa, the lack of healthy immune cells or dysbiotic organisms. And if it senses a lack of healthy immune cells and disbiotic organisms, it is going to upregulate all of the immune system in the mucosal barrier, which makes someone much more prone or likely to end up with a permeability event and that permeability event being prolonged rather than being able to resolve. So kind of like I came back from travel abroad, come back into the country, you have to go through customs, and just to use a crude analogy here, but let's say there's a breakdown of the border at the airport for where customs is.

To determine, again, keeping politics and everything else aside, just talking about basic country borders, all countries have borders, there is a customs that's trying to say, okay, hey, are you a citizen in this country, or do you have a valid reason to be here, or do you have a visa, whatever. So we're saying in a way, those protections which are bacteria can be a part of, if they're not there, or if they're not a part of the equation

to help keep that border safe, then the hawkish individuals in charge will say, hey, we need to line up a bunch of more soldiers and let's be on high alert because we could be being attacked from invaders from the outside. Yeah. And a couple of innocent.

and bystanders, they're going to get picked up along with the bad guys along the way, because when everything is so heightened and they're looking for a problem, they're going to get not only the bad guys, but some of the good guys do. Totally. I'm brown. Hey, let's go shoot everybody who's brown. And it's like, hey, hold on. I'm Indian.

We're peaceful. Chill. But I'm going to get shot anyway because the immune system is super ramped up. Yes. So that's good for people to understand because we often want to see the human body is like these individual little silos that don't communicate with each other. And like you said, we don't fully understand it, but we know enough to know there is a deep intelligence that's going on where all these systems are relying on each other. So the idea that we can take an antibiotic, again, well intention, incorrect, but well

intention for, let's say sinuses, sinus infection, and it not have an impact in some sort of other area is actually kind of crazy when you look at it through the lens of functional medicine. Yeah, especially when you want to even zoom out a little bit and say, okay, well, the antibiotic was going to work if there indeed was a bacterial infection in the sinuses and that bacteria was uniquely responsible for the inflammation of the sinus and was also susceptible to the antibiotic that you gave. Right. But we have no mechanism to determine if the bacterial agent is actually the cause of the inflammation of the sinuses. and in fact, many things can inflame a sinus and create the perception of a sinus infection, and you would be getting the antibiotic for what purpose in that reason in that situation, right? Even though sometimes, you know, sometimes people do get an antibiotic and they feel a little bit better. Right.

In the case of a sinus infection, what is actually happening in that situation where they do feel a little bit better? Again, there's overuse and that leads to degradation of the gut and that, and it may not even be the best solution. The best solution to be, hey, why are you getting so sick so often? For sure. What's going on in the first place? Right. The appropriately functioning balanced mucosal immune system that lives just next to that layer of your sinuses is to clear out bad bacteria, bad yeast, viruses, whatever. So you should be asking a question about what is holding the mucosal immune system back from doing what it's supposed to do, right?

my whole idea is how do I get this person's body backed to doing what nature designed for it to do incredibly well and when it comes to why antibiotics work sometimes for sinus infections even though it may not have been a bacterial infection yeah well what does the Z-pack work for a cold sometimes right it's a very very good question is itromycin doxycycline many other antibiotics have actual immune modulating property. So they will take an overly active immune system and decrease its activity in the way you feel that is inflammation presence, inflammation gone. So your presumption, if you connect those two dots, is though it must have been bacteria. But you're forgetting that the drug itself has anti-inflammatory property. How does it exhibit those anti-inflammatory

properties? We don't entirely know. I think one of the most reasonable theories is that In our modern world, we have very overpopulated disbiotic guts. And if you take an antibiotic, you're going to temporarily relieve the burden of that. The immune system will see that. We'll calm down for a period of time and there'll be systemic anti-inflammatory effect. The drugs themselves may also have direct impact on the immune system as well. It's a little bit of a debate. Probably both are true.

But just because you took an antibiotic doesn't mean you killed a bacteria that caused the sinus infection. Yeah, it's an important point. And I think it's part of the world and medicine. And this has happening in a lot of different categories is that both aspects can be true. It can work in these small instances, but is that really the root issue? And then what are the total harms that are coming along with it? And now I think we're waking up to the fact that, again, you know, we talked about it before. Antibiotics can very much part of our history, everything like that.

You know, we're very thankful for them, but where are they doing more damage than good? Yeah. So let's go back to chemicals, right? We talked a lot about glyphosate, but we were chatting about food additives. How is it that certain food additives? And many of them actually banned in other countries, but we still allow here because of corporate input and lobby and the FDA and everything like that. but how is it that certain chemically set up food additives could be responsible behind either aggravating leaky gut and in some people who are more sensitive because everybody's

body's body is different. I was just telling you about a friend of mine who's been on the podcast before, Vonie Hari the food babe. And for her in particular, food additives were a major part of her eczema and skin issues that she had. So what's going on in that situation? inside of the body that would be disrupting the gut? I think there's two kind of clear scenarios.

One is the food additive, whether it's an artificial dye or sweetener or filler or gum, is directly causing permeability, breakdown, leaky gut, and therefore damaging the immune system in that kind of direct way. You know, we're consuming it, so the gut lining is going to be exposed to it if it directly damages the gut lining. That's pretty straightforward. And the damage that it's doing, does it also mean that sometimes it could be acting like its own little antibiotic in that area? Or is it inflammation? Like, how is that actual damage? Like, how is it killing off the healthy stuff that we have there inside of our gut? Do we know? It depends on the chemical. So some of the chemicals do have actual septic effects so they can, an antiseptic effect so they can cleanse the bacteria of the healthy bacteria or cleanse the gut of healthy bacteria. So acting like an antibiotic. some of them will directly open the barrier.

Gums are a very good example of something that will directly open the barrier. The problem with gums specifically, which I think is the big culprit in the food additive world, is some of them don't even need to be labeled. And just so people are clear, because some people are like, wait, is he talking about chewing gum? Like, what is he talking about?

Okay, so when you say gums, what are gums and what are some common food products? And then what would be on the label that we would often be looking at to see does this product have this gum inside it? Thanks for asking. So gums are emulsifiers or thickening agents. So think of chewing gum, but, you know, trying to create that elasticity or thickness to food. And there are many different forms of gums, guar gum, carogun, caroginen, xanthan gum, locust bean gum.

These are all examples of different thickening agents or emulsifiers that are used in the food industry to provide essentially texture. differences to food, right? To create that mouth feel that often people are looking for. Yes, right. I'll give you a great example of where they're used very widely, ice cream, in particularly vegan ice cream, because you're not going to get that, you know, like thick milk fat consistency by using almond milk or coconut milk or whatever it is you decide to use. So to recreate that experience to the mind and the body to convince you that you're having regular cow's milk ice cream, gums are used to thicken. Yeah. There was a really amazing.

I'm not vegan, but it's a vegan ice cream I came across here at Air One, one of our favorite stars locally. The Money Pit. The Money Pit. And I came across it there. and it was a chalk I love the fact that I had just a couple of ingredients inside right had like cacao sea salt water and alulose

which you know we'll talk about in a second but it's a non-sugar sweetener alternative and a lot of health products are using it I'd love to get your take on the situation and it had xantham gum in it and I tried it and I loved it because we do a lot of episodes on blood sugar like wow this is great because it has alulose in it's not spiking my blood sugar

I don't eat ice cream all the time. And I emailed the founders and I said, hey, listen, just want to share myself, Dr. Hyman, a lot of the experts that have been on our podcast, we're not usually the biggest fan of Xanthum gum. You know, do we think it's the worst thing in the world? No, you're just trying to balance everything out. But long term for a health-aware audience, if possible, it would be a good thing to look at some alternatives in the manufacturing process.

And they were so sweet. They were like, oh, my gosh, we didn't know. We'll definitely look into it. Let's see what other alternatives are there. But you're right. They're in a lot of vegan products that are there. So in the case of these gums, right? And you mentioned a few of them that are out there. Do we understand exactly the ways that they're creating disruption going back to the last question I asked? Is it like a cleansing effect? Is it like sort of antiseptic effect? Or are we not really fully sure? I think there's two big ways that it can cause an immunological problem that we're sure about. I am sure that there are many that we don't know about. in totality. One will be direct damage to the barrier.

So gums can directly go in, let's say like gluten and just, you know, activate the zonelin pathway, create leaky gut, essentially. The other way is that some individuals will actually create immune responses to gums. So again, let's say somebody has non-celiac gluten sensitivity. That's an issue where the immune system is inappropriately identifying a food as a target and creating an immune response, including antibodies to it, whenever you ingest it. The same thing can happen to a gum. Got it.

So you can either immune attack or it'll open up your barriers or both, right? And there are plenty of other things that it can do. There is one gum product that's out there that I believe is not in the same category of the gums. And a lot of wellness products use it like a lot of the functional medicine products. It's called acacia gum. Yeah. And that's just straight up, acacia fiber. Yeah.

But I think they have to call it gum on the label. Correct. That's not what you're talking about here. No. Okay. No. So, Ekesha gum, sun fiber, you know, whatever term you're going to use. Let's call that a prebiotic.

Right. Those are prebiotics. This is a direct emulsifier, thickening agent, texture modifier for food. Though they can act as prebiotics in some situations, they're mostly directly harmful. I asked you about alulose. Yeah. What are your thoughts about alulose? I think alulos is a little hit or miss depending on the individual.

I think some people, again, you know, it's very hard to predict how a microbiome is going to react to something? Is it going to digest it and ferment it rapidly and create a large amount of gas and that gas caused discomfort? Or is the microbiome not going to be able to ferment it at all and it'll just pass through? It's very individual. For people who can tolerate it, my blessings, for sure. It's interesting because, and again, for those that are not familiar, alulose is a non-sugar, doesn't spike your blood sugar. It can be extracted from, I believe, figs, kiwi, a lot of things. But there's an area where a lot of people are like cautiously optimistic.

And the cautious part primarily comes from this is that most of the alulosis on the market today is extracted from what I understand from wheat and corn. It doesn't have any wheat and corn inside of it and the company's test and everything else like that. So it doesn't show up on any of these sensitivities. but that's the easiest way to get the chemical extraction out for this chemical compound that is similar to sugar but is not sugar in the body. If I have a little bit and I have a product that has a little bit in it, totally fine because I'm always trying things and I know I'm an end of one situation. I added a lot to a latte that I was making one time, like two tablespoons of like pure

or like three tablespoons of like pure allulose. And I had what would be sort of like a little bit of like digestive. upset. Hey, it's a health podcast so we could say, I basically had diarrhea. So some things can be good a little bit and maybe some things a lot may not be good and it might very different people. But it does seem that people are cautiously optimistic because it seems to be that if we can get people off of some sugar in some instances, it could be beneficial. And then again, a lot of functional medicine doctors also say that, look, it's not that we should be afraid of sugar. We just don't really have.

having it for breakfast, lunch, and dinner. So the occasional sugar here and there is totally fine. We also don't want to be having allulose breakfast lunch and dinner. So that's the whole alulose monologue that I have. I like it. I agree with it. I'm on board with your model. We talked about food.

And, you know, food is a big part of your book here when food bites back. In the instance of top foods that people are eating today that we know are connected to leaky gut in one way or another. You mentioned two right off the bat. You talked about dairy and gluten. Would you put those two in, let's say, your list of top, you know, 10 foods that are often linked with leaky gut? Yeah, those are number one and two without question. And not just link with leaky gut, but link with systemic autoimmunity, specific systemic autoimmunity.

So those are the Kings of the Hill, no question. And autoimmunity, you know, a few years ago when we were first were, when I first got in the space of functional medicine, Before I started working with Dr. Hyman, I had another business partner. You know, I heard people talking about autoimmunity a lot at the functional medicine conferences, different doctors and things like that. I thought, you know, autoimmunity is so rare. Like, why is it being talked about so much? Then I finally looked up the stats. It's not rare at all.

Tell us about how popular autoimmunity is. And why is it that in particular, which is going to be really interesting for this audience, my audience is probably about 80% women. Why is this topic so important for especially women to pay attention to? Yeah. So depending on the statistic metric that you want to look at, somewhere between 10 to 15% of the current U.S. population has a known diagnosed autoimmune disease. Nuts. The reason that's if you want to put that together with, let's say, Alzheimer's disease or cardiovascular disease, you know, we're talking about equal portions of the problem. population actively impacted. There's a couple of reasons why that isn't palpable day to day or

it doesn't get talked about that much. The biggest of which is that autoimmune diseases get segmented into different subspecialties of medicine. In other words, there is no quote-unquote auto-immunologist in medicine. There is no autoimmunology residency. You don't go to an auto-immunologist. Because they think of them all as separate things. Right. You have Hashimoto's. You go to an You have Crohn's, you go to a GI doctor, you have MS, you go to a neurologist. So we lose the ability to think of this as an immunological disease, which it is. Not that those people aren't, you know, good at treating them. It's you forget that this is a very, very big bucket.

Now, those are conservative estimates. And on average, an autoimmune disease from when it is formed in the bloodstream, so when you start developing the antibodies against the tissue and the person gets diagnosed with the autoimmune disease is about eight to 10 years. So if those metrics are conservative, they're also reflective of what was going on actively in our bloodstream 10 years ago. So I think those of us in this world who live and breathe it every day think that that number is probably closer to 20%. If you look at good studies that look at the nationwide zero prevalence of autoimmune markers like a positive A&A or positive cardiolipin. We had that at about 11% 10 years ago. I think again, that number is probably

15 or 20% right now. It is a huge, huge problem. Women, why is autoimmunity a topic that everybody should pay attention to, but women in particular? It's mostly conjecture at this point, right? We kind of look at the past and say, well, what's the day? difference between, you know, men and women to explain this, right? We know autoimmune disease is an environmental disease, right? So that means that let's put over two-thirds of the risk of autoimmunity is environment versus genes. And environment means everything from food to chemicals to stress, like the larger environment that we're surrounding. Everything we've been talking about, right? Put a huge number of things into that bucket, but the environment. And women are unfortunately exposed to more

in the environment than men are. That's most likely secondary to cosmetics. And on top of it, hormonal changes influence the immune system, right? A perfect example of that is, let's say a woman unfortunately has psoriasis, goes into pregnancy. Typically in the second and third trimester as a pregnancy, that psoriasis will, on its own, reduce its activity because hormones have an impact on the immune system. So of course, you know, women have a more diverse range of sex hormones. There is more influence of the immune system. There's more fluctuation intrammonth of their sex hormones. So that's likely the secondary kicker there is why women experience three times more autoimmunity than men. Right. In your book, you know, you open it up with 70 to 80 percent of almost all autoimmune

diagnoses fall on women. Yeah. You mentioned makeup. Talk about makeup for a second cosmetics. Makeup is one category of that, but just let's go cosmetics, stuff we put on our hair, stuff we put elsewhere. Obviously, there's such a burden that's placed on just the way that the world works on women and their appearance. And there's actually a really good book. If anybody's interested in, there's a PhD researcher. Her name is Luen Brisdine. She wrote a book called The Female Brain. She also wrote a book called The Male Brain. And she talks about why from a young age, biologically female brain, biologically male brain, why is it that certain, you know, a brain would pay attention to more, you know, this aspect or another aspect,

why is it that men have more neuro connections front to back and women have more from one hemisphere to another hemisphere? How does that play out in evolutionary biology? But cosmetics, how do those impact the body. And the gut, which ultimately impacts autoimmune. Yeah. Let's do the gut part first. Okay. So you're putting an individual is putting things on their skin on a daily basis. Those, you know, the skin is, again, an analog to what's going on inside of the gut from a physiological perspective. We're covered in epithelial cells here. We're covered in epithelial cells down there. What you do to the epithelial cells here, impact them here, and vice versa. So what you put on your skin on a daily basis can impact the health of your gut. They're the same style of

cells and the immune system connects the two areas. So something can disrupt the barrier on your skin. It can disrupt the barrier in your gut. And if there's something that has antimicrobial effect on your skin and you're using it every day, it's going to have some cumulative antimicrobial effect on your gut. And those chemicals directly in cosmetics, have. they have an incredible amount of stress to the immune system associated with them. And one of the aspect is that, you know, people like to talk about a lot of industries being unregulated. Cosmetics is completely unregulated.

That's the biggest problem. You're going to, if I'm going to list off the list of things that are bad in, let's say, mascara or foundation or lipstick or lotion, right? There are going to be things that you can find that are in there that are listed and there are going to be things that are not listed because they're not mandated to be listed. that also includes fragrances as well absolutely we don't really know what's inside of them you know they seem very innocent they seem very you know like wow it's just a fragrance like what's the big deal there's all sorts of thallates chemicals things that we have no idea and they are trade secrets

because these companies don't want anybody to know right we have no idea what's inside of them and they also want to protect them because they don't want somebody else to copy it um but we as a consumer end up suffering. Yeah. And, you know, outside of cosmetics, unfortunately, there is a tremendous amount of societal pressure on biological females in our society to continue to look good, continue to look young, not even going into the injectable or plastic surgery world, but there's a tremendous amount of chemical exposure that happens there as well, too. So in the short run, women are really unfortunately impacted by our world. It's on the positive side, it's great to see so many cleaner cosmetics show up and organizations

like environmental working group, having a database. And there's another company that, you know, I was an advisor to a nonprofit that helps sort of vet a lot of these. It's called Made Safe. Yep. And they're doing some really great work. So I'm excited that in all the messiness and the craziness of the world, there are people that are stepping up that say, okay, great. People want to look good.

You know, men want to look good. Women want to look good. Let's flag products as being safer for them, which we definitely need more of in this world. And let's also say that if that risk doesn't come in, let's say the decades of 30, 40 or 50 as an autoimmune disease, Yes. Women are also three times more likely to experience neurodegeneration and a neurodegenerative disease than men. Right.

Your body can say, ouch, in different ways. One way of saying, ouch, is an autoimmune disease, which, again, most people don't say I have an autoimmune disease. They'll say I have Graves disease. I have Hashimoto's. I have, you know, something, another MS. And if it doesn't end up happening as an autoimmune disease, it could end up happening as something else.

We had brain researcher on the podcast, Dr. Lisa Mascone. And she wrote a book called the XX brain and talked about, why is it that women are more likely to get Alzheimer's. You know, what's going on in this instance? And it's not because women live longer. We used to think it was that. But it's actually because of all the reasons that you had listed a little bit earlier. So I want to go back to leaky gut and autoimmunity.

You know, those two things are very much connected. And question that I have for the audience, can somebody develop autoimmune issues or or eventually a diagnosis of some of the diseases that we mentioned, and there's many others. I think there's total like more than 80 plus different diseases that fall under the bucket of autoimmunity. Can someone get an autoimmune disease without having leaky gut? I think the answer to that is yes. It is not necessary for leaky gut to be a part of autoimmunity.

I think you're going to be hard pressed to find an autoimmune disease. that doesn't in at least the medical literature have an association between the gut abnormality and the systemic autoimmune disease, but they definitely don't have to overlap. I think it's just incredibly common. And at the end of the day, you know, I think you're also going to be very hard pressed to find a human being who has not had intestinal permeability at some point in their life. You know, I came into your office a few months ago because I was like, I'm starting to know a little bit of notice a little bit of dryness on my skin, a couple other things. I had had a flag of some thyroid

antibodies being up a couple years ago. I was like, you know what? Let me go to the expert. Let me go to the man. So I came to you and I said, can we run some of these top, you know, leaky gut intestinal permeability panels? So can you talk about big picture like what test did you run for me? And how did you look into that? Sure, sure. So Dr. Fisano is the brilliant pediatric GI who discovered zonulin. It wasn't his intention, by the way, he was looking into infectious disease that debilitated third world children and was studying Vibrio cholera, but, you know, ended up in understanding Vibrio learning about zonelan. So, um, and his work was a huge part of the reason that people start to understand that you could have non-celiac sensitivity

to things. Correct. Before it was like either you are celiac, which means you have a gluten intolerance, like for real, like it's like there in your body, you cannot handle it or you're not. And then his work really changed the game with that space. Absolutely. It gave us a completely different look at autoimmunity and the gut and the role between the two of them. So he looked specifically for the proteins onylin, right? And I think that the first generation of leaky gut testing was looking essentially to mirror what happened in his laboratory setting. So they were doing Zonelan levels either in stool or blood. Now, the research setting is not the same thing as the clinical setting, right? If you find something that is relevant and meaningful in the research

world, it doesn't always mean it's going to be a great metric in a clinic because it won't meet the very strict criteria of being reliable enough. That happened, in my opinion, with Zonulin, and also according to research I did with my dad. Basically, what we found was that when there is a leaky gut issue and you release zonulin either into the blood or into the stool, most likely into the blood, it fluctuates too much over the course of 24 hours for it to be a really reliable diagnostic marker. Now, sometimes the immune system can help you out by doing something it's not supposed to be doing. In that situation, you're releasing zonulin into the blood, that's a protein that the immune system has never seen before. So it's going to start

reacting to it. And it'll start creating antibodies. Antibodies are fortunately very stable over periods of time. We don't release a lot, then release a little, or release a lot. We release steady streams of them based on exposure. And they're very easily detectable using the gold standard antibody detection technique from the 80s called the lysa. So if you look for antibodies to zonulin, you will therefore have a much more stable, reliable pathway of trying to measure whether that person has leaky gut by looking for antibodies to the actual protein zonelin. So that's what we did for you. And a study that we published looking at the utility of antibodies to zonelan versus zonelan levels was published in 2017 in the World General of

gastroenterology, confirming that it was about twice more sensitive than zonelan levels themselves. Well, the good news is you ran mine, and I didn't have any kind of flags that were there. We didn't really find anything, which was knock on wood, a good situation for me. And I still went to go dig into a little bit of the reasons why I might have some dry patchy skin. And you know, my wife always got humor. She's like, babe, you just need to use lotion. Like, that might be right. That might be right. That could be the reason why my hands are dry all the time.

Plus, the world has been washing its hands and everywhere you go. That could be a part of the reason that that was the case. In those instances, you know, you write about this in the book. And I think this is worth talking about here is that you cannot go online. And if you're in the world of health or you're watching YouTube ads and you've looked at health videos before, at some point in time, you're going to see a video from somebody. saying, hey, great, get this at-home test and you can go and figure out if you have issues with your gut. And we're going to tell you exactly what to do and what foods you're sensitive to. Talk about some of your challenges with some of those tests that are out there and what you want people to know about them.

I'll tell you first of all that I even thought about doing that got so far as, you know, even creating the company working with a business partner and starting to actually test out that idea and software algorithms to help execute them. And at the end of the day, there is no replacement for a human being who knows how to look at your life, all of the things that you've experienced in the environment and then put that data to the person, right? There's no way a software algorithm can ever do that effectively the way human being can. Sorry to anyone who's developing that idea out there. Right. Maybe one day. We're just not there yet. We're not there. We're not there yet. And by the way, this isn't a pitch to get people to come see you or take a test or whatever.

Your practice is full, basically. You know, you're not affiliated with this testing company besides you and your dad doing research. He is an advisor. Help them develop some of these tests. This is more just a public service announcement that, unfortunately, and we will be there one day, right? Science will catch up and there'll be better ways and we'll get better testing and other things. The idea that a test can tell you exactly what you're sensitive to, we're not there yet. And I can tell you, like, which foods to eat, which foods not to eat, we're just not there yet. Yeah. And that happens a lot with food sensitivity testing, right? At home, pinprick food sensitivity testing, find out what causes you're bloating or you're cramping or whatever. That is not what food sensitivity testing tells you.

Yeah. What does it tell you? Because you guys will sometimes look. And one of the tests that you did for me was looking at the test that were there, but you weren't so much focused on the individual food. You were looking for bigger patterns. Patterns. What patterns were you looking for?

Okay, so let me caveat this first by saying that the quality of material put into the test always dictates the quality of output. And when you find relatively inexpensive finger prick tests at home versus, you know, what's considered gold standard, much more expensive versions that are done, those two tests mean different things. Right. Right. And in the case, you know, just so we're all clear and transparent and everything, the test that you ran on me, what's called Syrex. Syrex array 10. And you can't just order it as like an individual. You have to work with the practitioner. Correct. I don't know if they have a list on their website where people can go and find practitioners for autoimmunity screening. But if you don't, Syrex and you're listening,

please go and create that because a lot of people want to know what doctor they can be working with to look at screening and addressing the root issues of intestinal permeability and looking at those bigger picture patterns for food sensitivity. Most IFM certified docs will know about Syrex. So you could always go to IFM.org and find a practitioner. Institute of Functional Medicine. Yeah. Okay, great. All right. So when the immune system inappropriately creates an antibody to a food protein,

you really want to try to understand what group of food proteins are you attacking because it tells you something about the underlying issue, right? It's not that every individual food that the person has an antibody to is the culprit. it. And if you go through the list of everything that's read and you remove them, you're going to be a completely different person the next day. You're really trying to say, okay, is it, you know, gluten, dairy, corn, or is it going into bigger pictures? Am I starting to react to multiple things in the lectin category, for example, right? Am I having a problem with food additives? Food colorings, food glue, gums. We haven't even talked about food glue yet, by the way. But you know, you want to get some

sense of what groups is the immune system having issue with? Because that tells you what group of issues may be coming from that or have come from that problem and where the issue actually originates from. Right. For example, you mentioned some of the things that you had reactions to in the beginning with your symptoms, dairy, right, and gluten removing them. But often people who have sensitivities there, it's not uncommon that they might also have an egg sensitivity. How does eggs fit in? And would that be a part of one group that you would often find together? Yeah. So in my mind, you know, I kind of call this the top five. So gluten, dairy, corn, soy, and eggs. And it's not that you can never eat those foods. It's not that those foods are bad. It's just that these foods are

commonly associated with some of these increased antibody levels, which is a byproduct of intestinal permeability. Yeah, correct. In most situations, there are other ways they can come about. But yeah, so these are the five most common foods that people will develop antibodies to through the mechanism of a loss of oral tolerance. So in other words, a food that in the first three years of life, you programmed your immune system to say these are good, and then at some point down the road in your adult life, you lost that memory or programming, and now you identify them as bad. Your body does. Your body does, and that typically happens in the gut through intestinal permeability.

So why gluten, dairy, and eggs, those kind of fit into their own subcategory, they all have proteins in them that have some molecular similarity. So I think gluten is much, much, much more likely to be the initial problem, right? The initiator of the intestinal permeability, the first food protein that the immune system starts reacting to. And if you continue to eat that food because you don't know that you're having an issue because the inflammation is subclinical, the immune system again lives on these cascades will up its ante and will say, okay, well, my attack against this problem, protein sequence isn't working. Let me expand a little bit. And it'll go to other protein sequences

that look somewhat like the original one, but aren't exactly the same. Kaysen. Dairy protein. Looks very similar, molecularly on paper to gluten, similar enough that if the immune system wanted to expand its horizon, it'll pick it. All right. Egg protein, egg albumin, very similar as well too. Corn and soy go into different categories. So corn has its own inflammatory protein that the immune system has a tendency to react to aquaporins, very similar to a blood-brain protein that we carry called aquaporins. And then soy, soy is problematic for different reasons, but it contains a group of proteins called agglutinins, which are the bigger, broader group of lectins and many human beings have an issue with soy glutenin.

So they're the top five, mostly because they're going to spread downstream from an initial gluten sensitivity, and that gluten sensitivity wasn't caught early enough to prevent that spread. And I think this is a good time to pause and talk about something that you talked about on the podcast last time, just in the context of it. You have one side of the debate that's out there, and it often ends up being many people that are on the plant-based side, right? vegans, vegetarians who feel like any talk about lectins and them being bad for the body is hogwash and it's fearmongering and it's total bullshit, right?

So there's that one side, not everybody in that group, but that's a very vocal side. And there's another side of the spectrum that's saying, you know, lectins are the cause of a lot of it. And primarily that's, you know, friend of ours, you know, we don't necessarily agree with everything, but he's been on the podcast before, Dr. Gundry. And he may say that lectins are a big responsibility for a lot of issues. And what I love about your perspective, which is really the perspective of functional medicine, is basically what?

What's your perspective on the topic of lectins? It's all individual, right? You have to take the information and apply it to the individual. There is no this is the problem for everyone. There is no, this is the diet for everyone. I'm sure that's going to offend the internet diet street gangs as. it did last time. Now you're going to have everybody attack you. That's fine. I've got thick skin. But yeah, I think the most rational way to think about this is what problem are you trying to

solve with the dietary intervention? Let's say, for example, it's somebody who has joint pain and they've got a positive rheumatoid factor. I think to myself, what does a positive rheumatoid factor actually mean. It's not just a line on a blood test. It means something physiologically. What a rheumatoid factor is, is aggregates of antibodies joining to each other. So that's called agglutination. Very similar to agglutinins in food. So it would make sense to me in that context that if the person has immune reactivity to something in the lectin or a glutenin world, and they have a positive rheumatoid factor, they are the candidate for following a lectin

and a glutenin-free diet. It makes sense in their context, right? Is it correct for everyone? No, right? Carnivore diets. Everybody on the internet loves talking about carnivore diets. There are definitely applications where a carnivore diet makes sense.

Microbiome, in complete disarray, you do everything you can to try to control that dysbiotic state. you're getting nowhere. They've got T regulatory cells, which are programming cells that help tip the balance towards TH1, TH17, which are the pro-automunity immunophino type. They're being driven by whatever the person eats. You can put them on pure autoimmune paleo. You can do everything under the sun, but they don't respond to any of it.

You need to just reset everything. provide them zero fiber, zero input to the microbiome, let everything settle down. That's exactly what a carnivore diet does. Makes sense. Is it a long-term sustainable option for everybody on the planet and we're all ridiculous for not following a carnivore diet? No. Each diet has an application for an individual.

It is the job of a seasoned and humble healer to learn who's the right candidate for the right diet. And the thing I love about functional medicine doctors is that it's not political for them in the politics of vegan, not vegan, carnivore, this. It's like, what do we need to do to get you to heal? So if you're seeing that somebody might have reactivity towards lectins, which actually was the case for me when I had a lot of my gut issues. And I would just notice it. I grew up on a primarily Indian vegetarian diet. And lentils were a big staple. Now, I'm so fortunate.

that my mom from just knowing how to cook through traditions, whenever we would have a lot of nuts in our diet, she would always soak them at home. It just was part of our tradition. Right? We'd use the pressure cooker a lot. Yep. Right. We would do a lot of things. And even though there was a lot of eggplant and there was a lot of tomato in our diet and a lot of peppers and other things like that, generally those things were either slow cooked or cooked in a pressure cooker. And in our tradition, I'm from the Gujarathari region of India, stews are a big part of it. We call them shock or sub-Zi. And those foods would do really well.

And when I got to college and I would eat a lot of those foods, I actually became vegan in college. And I would eat those same foods out is the first time that I started noticing I had major gut disruption. And I was not feeling great. And I just was like, I cannot eat Indian food. It just like totally messes me. up. So I realized that I might have had a sensitivity before, but actually getting off of those foods temporarily. And then this is the question that I have for you, I was able to, over the course of a period of time, heal my leaky gut. Yeah. And I want to hear your top supplements, foods, other stuff,

programs that you recommend for people for that. And then some of those same foods that I had sensitivities for, largely most of them have gone away, but some still remain. If I have I have a lot of it, I will notice that I don't feel that good and my gut is disrupted. I have distension, bloating. Is that pretty common in that experience that once somebody heals their gut? There might be some aspects of those foods. In this case, we're talking about lectins that people can enjoy in some cases, right? Would you say that you see that sometimes?

Yeah, absolutely. I think that's the standard, actually. Okay. I know that if, you know, in functional medicine we follow, detect, remove, repair, five, R's, you know, whatever version of that you want to talk about. But the most important thing is accurately detecting what the problem is. What are the triggers of the intestinal barrier disruption of leaky gut so that you know what to remove, right? So that's very, very important, get that map out, whether you're doing it through an elimination diet

or you're doing it through testing or, you know, whatever means you want to figure that out, get a very accurate map. And then you want to follow a remove and repair protocol for, let's say, at least three months of time, see where you are, and then do a reassessment. And, you know, as far as what I like in the repair protocol, I think I'm thinking about this immunologically. So I'm trying to create a Zen state of the gut immune system. Again, that all revolves around those T regulatory cells and making sure that the barriers are closed. So, I use a lot of megasporebiotic, spore-based probiotics, because I think they do a great job at the barrier and also with T-regs. I'm always using, you know, a healing amino acid supplement, you know, the basic gut repair stuff, something with glutamine and marshmallow extract and other demulcants in them just to provide the building blocks for restoration of the epithelial cell.

I really, really like serum bovine immunoglobulins. Yeah. Right. So using a lot of SBI protect, basically the way I think about this is two and one. You're binding pathogenic organisms inside the gut and giving your immune system an opportunity to clear them slowly. So not using an antimicrobial to nuke the landscape, but picking apart, you know, bad players in there one by one slowly over time. And again, the immune system lives on pattern recognition. When it sees large amounts of immunoglobulins inside the gut, it calms down and enters a Zen state.

I really like postbiotics for that too. It's my new kind of favorite. Like buterate, things like that. Yeah. Specifically tributerine or buterin products, you know, with that hard outer shell to make sure they get delivered to the distal small intestine and large colon where they're effective. You know, coline, colic acid derivatives, tutka. is another good example of that. And then pomegranate extract, uralithin A, is another very good postbiotic that works wonders

as well, too. So I'm thinking, again, immune system. So I think, you know, in the repair side, we used to just like bombard the gut with, you know, more and more and more glutamine and more and more probiotics. You know, I think it's becoming more tailored specifically to that immune dysregulation and the mucosal immune system and trying to push against that. Is that protocol inside of the book? Do you have it?

Yeah, most of it is. Okay, most of it's inside of the book. Yeah. Great. We'll have a link to some of those items as well, too. So those are some of the things that are helpful in the restorative process. I want to go back to testing for a second. Do you think that most people, you know, knowing that most individuals don't have access to a functional medicine doctor, it's still quite expensive, unfortunately, because our health care system doesn't pay for it, right?

It's the best return on investment that the health care system could actually pay for, get people healthy now. spend a little bit more money and save a lot of money later down the road. Don't get me started on that. Don't get you started. For two hours, ranting about that. Okay. So for most people who are not going to have access to a functional medicine doctor,

they're not going to have access to some of the expense of testing. Are there some basic things that they can be asking themselves to see if they suffer from a leaky gut intestinal permeability? Is it pretty easy for like a self-assessment for them? Yeah. I think, again, you need to look at how does your immune system function? day to day. What is the intention of your immune system? It is to help you in your war against external pathogens. So how often are you getting sick? Does a cold last two to three days and you're, you know,

sick for basically a day in the middle of that and then you bounce back right away and you're good to go? Or is it, you know, a 10 to 14 day butt kicking? I think those are really good telltale signs of how your immune system is doing. If it's a 10 to 14 day bud kicking and you're getting five or six of them a year, it's time to look in the mirror and say my immune system is not doing what it's supposed to do and my gut is the probable cause of that dysfunction let me do something for my gut give me three months of you know time and dedication to this and then see what immune system i have on the other end of that i think you also look in the mirror and say you're a human being that is very resilient you have a very complicated robust body that has a complicated immune system that can be rejuvenated if you

give it the right input. So give yourself the honor of that three month period of time. You don't need testing. Okay. I think as long as you're going to buy into, I'm doing something for myself and for my immune system. And yes, it's going to be hard. Yes, it's going to be changed, but I'm going to follow through this until I see what's on the other end. You definitely don't need the testing. So follow a good, clean elimination diet, Whole 30, paleo, whichever version of it you want to follow, I think that either of those will do quite well for you. And, um, you know, you don't need to take supplements either. Bone broth has plenty of great stuff for gut restoration in it, um, plenty of glutamine and collagen and other things that are good for you. You don't

need to take probiotics. You can eat fermented foods. And as long as, um, you're dedicated to it and you understand why, you're, you're putting that investment in yourself so that you see what you get out of that investment. And you see the follow through of that. I think anybody could do this at home. You know, we were talking about cognitive decline when we first started the episode. And we were talking about how a leaky gut often corresponds to a leaky brain and can play a role in cognitive decline, one of the aspects that are there. because you work with a lot of patients that fall into that category and being, you know,

certified in the Bredesen protocol, any case studies that come up to you or any stories that you've heard of through your work with Dale Bredison in that group or just do you work on your own where somebody starts to repair the gut and they actually can think clear. They can remember things better. Anything come to mind? Any stories that you've come across? For sure. I have the honor of having a very well-known female singer in my practice. You know, I think she's in her 70s, but very highly functioning and still touring and still doing her thing and still gifting the world with her voice. but not only she but also the people around her started noticing pretty dramatic cognitive

impairment in her. So I ran a cyrix panel, which is meant to be a gut brain panel. It's called Alzheimer's Links. It has Alzheimer's in the title, but I think it really should be a neurodegenerative gut brain axis diagnostic panel, and that's a mouthful. So they went with Alzheimer's Links. But essentially, after the research that we... did that was basically inspired by Dale and also Dave Perlmutter, looking into trying to identify

the common things that trigger gut brain access disruption and then how to identify that disruption, that's the panel that we did for this individual and found very clear gut access, gut brain access disruption, early markers of neuroinflammation, markers of neurodegenerative plaque formation, And food sensitivities, predominantly gluten for this individual. So, you know, I think the tough part there is explaining that whole picture, right? It's a lot of information. The person on the other end needs to understand it. You are giving them information so they are empowered to make a difference in their life.

They are going to take their ship and put it in a completely different direction. and they need to know in what direction they're steering and why they're doing it. So it takes a long time, I think, to kind of tell that story. But once they understand it and they get it, they're going to be on board. So shared the story with her, showed her exactly what was going on, gave her that same protocol that's gut repair with food sensitivity, with the gluten elimination added to it, and then also put a couple of anti-neuroinflammatory supplements,

things like resveratrol, you know, membrane replacement, therapy, which is PC, foster total coline. And three months later, she did incredibly well. And she stole my patients, still check in with her every once in a while. Still, you know, cognitively back to where she was a few years ago, nobody notices any, you know, change or loss for her. She's still touring, still going all over the place. And, and that's a remarkable change, I think.

And, you know, there are probably millions of people out there who could benefit from something like that. an inspiring story, but I love asking these stories and I love all them that are featured in the book because it gives people hope because as you mentioned earlier, these issues and challenges and diagnoses and symptoms that people have, they weren't created overnight. They've been building up for years often. And because of that, people have habits that they've built up for years. And food is so emotional. It's connected so much to culture. It's connected so much to our sense of who we are. Childhood, memories, other stuff. It's actually, I've had a friend say to me one time, it's like,

it's harder sometimes to have people change their diet than it is their change their religion. You know, some people you're going into, it's like you're trying to get them to convert to a completely different religion. And they're like, what the heck? Yeah. You know, I'm, you know, Christian, you're trying to tell me I should be a Muslim now or you're trying to this and I'm a Buddhist and you're trying to tell me to be that. It's a whole ordeal. You're kind of upending their world. Yeah. But I think hearing these stories is important because people feel like there's hope on the other end of it. What do you think in your opinion are the top things? You know, when I told you that I wanted to work with you to see if I had any major flags in my autoimmune

panels, you said, listen, I'll work with you, but you just have to commit that you're going to do what it takes because I'm not going to go easy on you. I know what creates health and I know when it doesn't work. For the people it doesn't work for, what are the things that get in their way that prevent them with following through with the plan that you put together? Again, I think it's not understanding why they're making the specific interventions. So the why? The why, right? And that holds them back from following it for enough time. There are plenty of stories of people out there who, again, like me when I was 23 years old, felt like a completely different person two weeks after I made a food elimination happen.

But that is definitely the minority of cases. Right. Right. The immune system takes years to go to a certain direction. It's going to take time to push it into the other direction. And sometimes we don't have the patience or persistence to allow. our body to heal. And it's not that the path isn't correct. You know, it is, again, the ability to follow it until it gets you to where it's supposed to get you to. And that's why I wrote the book,

right? It's not, like, if you want to Google, you know, what diet to be on if you have autoimmune disease, easy, right? You're going to get an AIP cookbook and textbook and you're going to follow an AIP diet. And, you know, I think if you don't have that why, you're going to burn out in three weeks because it's a tremendous amount of effort. It is a humongous amount of effort to make that lifestyles switch, as you mentioned, changing your religion essentially. You're going to get questions from your friends. You're going to get questions from your parents. You're going to get your other doctors looking at you like, what are you talking about? This is, you know, baloney. This is quackery, you know, like everything under the sun. Everything around you is going to challenge

your desire to make this change. So you have to push through every single one of those challenges and make it to the other end. And the why is the thing that allows you to push through every single one of those challenges. You're not doing it for everybody else. You're doing it for yourself. And if you understand why you're doing it for yourself,

you'll make it there. And it seems like there's like a couple layers to the why. Why is the first part, which is what today's interview is your book is, which is the education. You have to understand. That doesn't mean you have to be a doctor. I don't even have.

I tell people all the time and I'm so proud. And I have to tell people because they see I'm Indian. I'm hosting this podcast. They immediately assume that I'm a doctor. I can't tell you how many emails start off with me to, hey, Dr. Drew. And I'm like, hey, I'm actually proud that, number one, I'm not a doctor. Not that I wouldn't want to be, but that's not my path. That wasn't the journey for me.

But I also, I love sharing with people that I don't even have a college degree. I dropped at a school when I started my first businesses. Yes, my family always. valued education. I always read. I did always things. I'm a big fan of education. But this doesn't mean that you have to have an advanced degree to understand all this stuff. We're talking about basic pattern recognition. And actually, sometimes people are so smart for their own good that they can't understand this stuff. They focus too much on the individual little mechanisms of this and that instead of zooming out and seeing the big picture of things and tapping into common sense.

Actually, common sense is a huge part of what will help you on your path of healing and getting better. That's a lot of what functional medicine uses. So that's the first why, right, is understanding why do all these things connect together? How is the body a whole system? And really that the body doesn't make mistakes. Everything it does, it does for a reason. Everything the body does, even things that we think that are so messed up like getting diseases, it does for a reason. The second why is why are you doing this? What's your driver? What's the thing that you're working towards. Is it often wanting to be there, you know, this woman that you're taking care of, this well-known singer? Is it that she wants to be there for her grandkids or her community that so reveres

her work? Is it that you have some sort of project or business that you want to start? And you have to feel well enough to do it. I've had so many people that have stopped and given up on their dreams because they don't feel well. They don't feel like they have the energy. So understanding that why of why you want to do it, in addition to understanding the why of why, all this is going down. Do you talk to your patients at all about that second why? And are there some questions that or some nudging that you do that's kind of like a little bit of life coach? Yeah. It's very much like a life coach. And yes, I do a lot of nudging in that direction. I think that's something that builds as you build the therapeutic relationship with somebody as a

healer. Oftentimes the tissue box will come out as you start asking those questions. So you've got to be kind of, you have to create the energy to allow that to occur. Mm. Right. And, you know, I really, I think, nudge more in the direction of whatever that Y is, you know, first and foremost, you deserve to feel as good as you possibly can. You know, it's about, to me, a lot about self-worth, them being deserving of the health that is going to come at the end of this.

And oftentimes that will kind of, you know, project you into some of the bigger questions as to why they don't have the self-worth or don't have, you know, the goals that they otherwise would have. It's been a great conversation, Dr. Vajani. Is there anything else big picture that you feel that we left out? I mean, I told you already, we could do a thousand of these episodes. You live right around here. We can dissect every, we could do a whole episode on just gum,

a whole episode on just the healthcare system and why it's so messed up. In the context of leaky gut and healing from leaky gut, is there anything else that you feel contextually is good to talk about for today's podcast? Yeah, I think one thing that I want everyone out there to kind of understand is we talk about leaky gut as being one thing or simplistic or like, you know, everybody has it, right? like everything in the body, it's complicated. Like everything in the body, it has individual aspects to it. One person's leaky gut is not another person's leaky gut. Being told that you have leaky gut or have a test showing that you have leaky gut

is the beginning of a journey, the beginning of a road. And, you know, be welcoming of what that journey is going to look like. Try to understand what your next steps are going to be. And don't try to compare your path. to anyone else's path. I put the stories in there, you know, I think really, again, as you mentioned, to just show people that they're not alone. A lot of times people are having these thoughts or understandings about their own health and feeling like, you know, they're the only one in their circle that are, you know, dealing with these issues. So the world is a big place. Many people have

gone through their own versions of the journey and have gone to the other end of it. So the stories are there to remind people that there are other people who have gone through this and have healed but your version is your version. It's a great reminder. You are on your own race. You're on your own path. You could take inspiration from everybody, but ultimately this is your journey.

This is your experience that's there. Thank you so much for coming back on the podcast. And we're going to link to the book. It's out now. The Fore was in Pre-order. And you can get a great hardcover, as I enjoy to read from. When food bites back,

taking control of autoimmune disease, which a major portion of that is leaking gut. I hope you find this book useful. Elroy, thank you for coming on the podcast. I really appreciate it. Thank you, Drew.