The Dr. Hyman Show - Boost Immune Resilience with These Simple Steps | Dr. Elroy Vojdani

Episode Date: August 21, 2024

In a world where chronic illness and unexplained health issues are on the rise, understanding the root causes behind immune dysfunction is more important than ever. In this episode of "The Doctor's Farmacy," I'm joined by Dr. Elroy Vojdani to explore the critical issue of immune resilience and its connection to chronic illness. Dr. Vojdani shares groundbreaking insights from his father’s work on immune health, along with practical strategies to boost your immune system, tackle long COVID, and reverse chronic conditions through personalized, functional medicine approaches. In this episode, we discuss: The Decline of Immune Resilience The Role of the Gut in Immune Health The Impact of Long COVID on the Immune System Molecular Mimicry and Autoimmunity The Connection Between Mitochondrial Dysfunction and Chronic Illness View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal This episode is brought to you by Rupa Health, Pendulum, Neurohacker, Our Place, and Manukora Honey. Streamline your lab orders with Rupa Health. Access more than 3,500 specialty lab tests and register for a FREE live demo at RupaHealth.com. Pendulum is offering listeners 20% off their first membership order at pendulumlife.com/farmacy. Discount applied at checkout. Decrease your "zombie cells" with Qualia Senolytic. Visit QualiaLife.com/Hyman to get 50% off and use code HYMAN for an additional 15% off your order. Upgrade your cookware, appliances and more with Our Place. Head over to FromOurPlace.com and enter code HYMAN at checkout to receive 10% off site-wide. Get your Manukora Honey Starter Kit today! Just head to Manukora.com/Hyman, to get $25 off.

Coming up on this episode of The Doctor's Pharmacy. Think about it from the immune system's perspective. If its job is to defend us from threat and we are constantly pouring threat into ourselves, I think it was only a matter of time until we saw what we are seeing now. Hey everyone, it's Dr. Mark. As a functional medicine professional,

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high-fat foods. That's powerful stuff, so why not give it a try and take control of your appetite and your health today? Take 20% off your first membership order at PendulumLife.com slash pharmacy. That's P-E-N-D-U-L-U-M-L-I-F-E.com forward slash F-A-R-M-A-C-Y. That's Pharmacy with an F. Before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If

you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Welcome to Doctors Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy with an F, a place for conversations that matter. If you struggle with autoimmune disease, with long COVID, and a dysfunctional immune system, you're going to love this podcast because it's with one of the deep thinkers and scientists

in this area, Dr. Elroy Vajdani. He's a pioneer in the field of functional medicine and research. He's the founder of Regenera Medical, a concierge functional medicine practice in Los Angeles. He graduated from USC Keck School of Medicine and is certified as an Institute for Functional Medicine Practitioner. He's done lots of research for decades with more than 25 publications in many journals. And he's world-renowned for his research in the development of state-of-the-art lab testing in the field of immunology. In a book recently called When Food Bites Back

about how food reactions cause autoimmune disease, we're gonna get into all that and more, including long COVID, what is causing it, why they're seeing an increase in autoimmune disease in these patients, and how do we start to deal with our lack of immune resilience? So I'm really excited about this podcast.

So let's jump right in. Welcome, Elroy, to The Doctor's Pharmacy. It's great to have you. I've been looking forward to this for a long time. This is a thrill. Thank you for having me. You know, you're somebody I've known over a bit of time, but not well. But I know your father really well, because your father, Risto Vajdani, an Iranian Jew,

escaped Iran during the fall of the Shah and the rise of the sort of current regime in Ayatollahs and made his way to America and was instrumental in my education as a young functional medicine doctor trying to figure out what to do with complex cases, people who are suffering from chronic fatigue, immune issues, mold toxicity, Lyme disease. And I used to use his lab all the time, immunosciences. And I think probably then you were a little boy. But now you're a doctor, an MD, you have a thriving practice in LA, a little too thriving, unfortunately, because there's not that many of us out there who can really deal with these complex chronic cases and are willing to dig and find out what's going on.

And you do that really well. And your father was someone who just wanted to know what was going on in the human body and really took over the immunology space in functional medicine and was a key part of a lot of our curricula and education. I remember a patient I had very well who came in with chronic fatigue syndrome. And it was early on and she had told me a story about her house having some mold in it. And so we had the mold checked and it was right in her bedroom. And her daughter put in another bedroom and had juvenile rheumatoid arthritis. And the two of them were pretty sick.

And they each had their molds identified in the house by mold inspectors who were able to go in and identify the exact species and strain of the mold that was in their room, that was behind their walls in the bedroom. And we did the testing through immunosciences through your dad's lab. And the exact molds that were in their bodies with the antibodies were the

ones that were found in the room. And they were different than their rooms and end up getting a million dollars in settlement to clean the house and fix the mold problem. But then unfortunately, the insurance companies didn't like that because they have to pay for this mold. And no, people don't want to cover mold issues. I went through that in my own house and the insurance wouldn't cover it. And eventually the lab kind of had to shut down that line of testing, but they're still around and they're still doing great stuff.

And, you know, your work is really also kind of ventured in the world of immunology. And we're chatting a bit before we started the podcast about this concept that is, I think it's really important to talk about, which is the decline of our immune resilience is how you phrase it. And we're seeing this sort of explosion of autoimmune diseases, allergic diseases, asthma, post-COVID syndrome, chronic fatigue syndrome, and long COVID has

really been a huge thing after the acute viral infection. People stay sick and have very significant symptoms and consequences that it goes way past the original infection. And so you spend a lot of time thinking about this concept of declining immune resilience and what to do about it. So maybe you can start off by defining what is immune resilience? Why have we seen this massive decline in our immunity and our immune function, or not even decline, but dysregulation? Because some parts are underactive and some parts are overactive, right? And so we're seeing increasing cancers and increasing autoimmune disease, right? So those are both not enough and too much sometimes. Yeah. So it's something that I think

about all the time, because in clinical practice, we're seeing this dramatic increased rate of chronic inflammatory autoimmune diseases. So it's always kind of sitting back there, like, what is going on? What is happening? The world, yes, it's changing. It's definitely changing. But there seems like there's a dramatic difference in the way that we interact with the world. And that's accelerating at a pace that's very, very difficult to understand because, I mean, if you look at the rates of autoimmune disease,

you know, we're increasing at an 8 to 10% rate per year. That's crazy. It's crazy. I mean, if you look at, let's say, 25 years ago, so 1999, 2000, about 3% of the U.S. population had a known diagnosed autoimmune disease. Today, we sit solidly in the 10% to 11% range of a known diagnosed autoimmune disease. And you might say- I thought it was more when you add up all the different diseases, and it's like 50, 60 million Americans or more. It's a very conservative estimate. Autoimmune diseases have also, in their nature nature a bit of a lag time between the

onset of the immunological injury and the autoimmune process and then the actual diagnosis of the full-blown clinical disease, right? So let's say it's five to eight years there. So we're talking about, you know, if you kind of count those people, likely 15, 20% of Americans. It's a humongous number. And the rate, unfortunately, is continuing to increase. You know, thinking about what's at the root of that, it's, again, a lack of the immune system doing what it's supposed to do. If you want to think of that as immune resilience, it's essentially a loss of the balance and

function of the immune system. So we're losing our capacity to do what the immune system is intended to do, which is to defend us from all of the threats in the environment. It's no longer capable of doing that. And in that inability, it's turning against our own bodies by mistake. So not only did we see like this massive rate of death and hospitalization from COVID in America, where we're 4% of the world's population, but we were 16% of the cases and deaths and hospitalizations, which is like literally four times what it should have been,

or even probably more considering we have the quote, best healthcare system in the world. So on one hand, we weren't able to fight this infection. And on the other hand, post-infection, we're seeing the opposite, the reactivation of the immune system, but not attacking the virus, attacking us. And we're seeing this whole phenomenon of long COVID, which is estimated to be anywhere from 10 to 30% of the people who've had COVID. And that's a lot of humans. That's a lot of humans. That's a lot. It's like millions and millions and tens of millions of humans walking around with their lives affected in some small

or large way from symptoms that were directly related to the dysregulation of their immune system by this virus. And going back to immune resilience, can you talk about what are the things that help us have immune resilience? about what are the things that help us have immune resilience? And what are the things that have changed in our environment, our life, our lifestyle that have actually made our immune systems be dysregulated? Yeah, the most important cell in the immune system is something called a T-regulatory cell.

And the dominant population of T-regulatory cells in an adult lives in the lining of the gut. So the gut is the center of immune resilience. Those regulatory cells are responsible for, you know, kind of balancing all the different sides, making sure that, you know, in an inflammatory attack against something that we should be attacking, we don't end up in that mistake of attacking ourselves. So the gut is absolutely the center of the immune system and immune resilience. So the gut, the gut is a big problem and we've messed up our gut, right? The increasing rates of C-sections, lack of breastfeeding, early use of antibiotics, all the gut busting drugs we use like acid blockers and

anti-inflammatories and steroids and hormones, and the depletion of our microbiome by the glyphosate that we're all exposed to. 80% of Americans have glyphosate in their urine, which is a natural antibiotic that kills, well, not natural, it's a synthetic antibiotic that kills your microbiome. And on top of that, our diets change dramatically. We've reduced our fiber. We've increased ultra-processed food. We take emulsifiers that damage our gut lining and cause leaky gut. So we have a whole cascade of things that have happened in our environment, we call the exposome, that have really caused massive damage to our gut, which is where 60% of the immune system is.

And then that's led to, I think, a lot of the rise in chronic illness in general because the gut's not linked to everything from psychiatric disease to cardiac disease to diabetes, metabolic health, cancer, and obviously autoimmune disease and allergic disorders and asthma, not to mention just the gut issues that people have like IBS and all that stuff.

So this is a massive problem. It's causing huge amounts of disability and disease. And it's not something that traditional medicine does a very good job of thinking about diagnosing or treating. And I've been involved with academic centers with these long COVID clinics, and it's kind of embarrassing, honestly, to see how little they know and how little they're doing. And yet, there's so much that's known that we can actually do something about. And I mean, we were just chatting a little earlier about these different lab tests, for example, in Germany that they're looking at that are common in post-COVID patients, which are autoantibodies against your autonomic nervous system that affects your ability to regulate your blood pressure and gives you dizziness when you stand up or POTS, postural orthostatic hypertension syndrome. And we're seeing other autoantibodies against different tissues. And it's kind of scary. And there's techniques to actually fix it, heal it. We talked a little bit about plasmapheresis,

which they're looking at in Europe, which basically filters out all the bad stuff in your blood and cleans your blood. And it's used for a lot of immune diseases. So talk about, if we have this problem with immune resilience, what are we seeing with that? What is, we're seeing the rise in autoimmune disease and can you kind of help us connect the dots between the decline in our immune resilience, the rise in autoimmunity,

and then what's happened with this long COVID phenomena? Yeah, absolutely. So, you know, 25 years of research now kind of starting to look at what is really happening here from a physiologic perspective, right? You know, intestinal permeability, leaky gut, you know, you've covered that many times on the podcast and in your books, but, you know, it's hard to understate how important that process is in chronic inflammatory disease, autoimmune disease, neurodegenerative disease. The more and more and more we look at it, the more we're finding that

it is centered to all of these. So though we do keep talking about it, it's rightfully an incredibly important topic of conversation. So you listed all of the things in the environment that we are consciously or unconsciously exposed to on a regular basis as a population. Think about it from the immune system's perspective. and we are constantly pouring threat into ourselves, again, knowingly or unknowingly, I think it was only a matter of time until we saw what we are seeing now, massive explosions. Viruses that I think five or six years ago didn't pose such a tremendous threat to us as an adult population. We talked about, you know, RSV, this last cold and flu season was horrendous. You know, adenoviruses and rhinoviruses, things that typically cause like three, four or five days of regular cold, causing two or three weeks of pro, you know, prolonged congestion, you know, lots of secondary

infections, you know, just, you're just seeing the immune system just completely failing. So it's because I think of what we're continuously exposing ourselves to, what that does to the center of the immune system. And then we see all the ramifications of it now 15, 20, 25 years down the road in a population that's dramatically suffering. And the current medical infrastructure has zero answer for this. five years down the road, and a population that's dramatically suffering. And, you know, the current medical infrastructure has zero answer for this. You know, it's what other biologic medications can we come up with to try to, you know, kind of suppress, right? And now

we're getting to the point where, you know, we have patients with three, four, five autoimmune diseases, and every biologic under the sun can't control what's going on with them. So it's a huge problem. It's progressive. And the only way that we're going to get out of it is to acknowledge that and to start making conscious choices that limit those continuous exposures to our gut. Yeah. So healing the gut is a big part of healing from autoimmune disease, for sure. And that's been something I've done in my practice in functional medicine for 30 years in the Ulcer Wellness Center. And you do that in your practice as a core strategy to help reset people's immune system because it does start in the gut. But there's other phenomena happening. When you look at people who have COVID, they did a study of over a million and a half people and it was published in Nature. Out of

the one and a half million people that they studied in a study that was published in Nature, they found a 46% higher chance of getting an autoimmune disease, which is astounding after having COVID. Absolutely. So why is that happening? That's happening, again, because I think of the dramatic loss of immune resilience that we have as a population. So, you know, again, to go over those numbers, that was a huge, very well done retrospective analysis, a million and a half people, two different studies combined, showing a very large increase in autoimmunity. And that was in a six to 12 month window after the infection.

More and more studies are coming out showing that everything from rheumatoid arthritis, lupus, type one diabetes, you know, virtually every autoimmune disease under the sun can be triggered by COVID. So again, why is that? It's because our immune systems have lost their fundamental ability to be able to appropriately defend us against viruses in the short term and then also in the long term, you know, to be able to, resilience is an ability to defend yourself and then return to normal, return to balance, to say the threat is gone. Everything is okay. We've handled this. Let's go back to the balance that we're supposed to be in. And that part is completely gone as well, too.

People stay in very prolonged chronic inflammatory states. I mean, the average long COVID patient has dramatic symptoms for 12 to 24 months or more, you know, and part of that is because I think, you know, the infrastructure isn't addressing things appropriately, but part of that just speaks to how much from a population perspective, immune systems are broken and immune resilience is completely gone. Yeah, no, it's so true. And the symptoms for long COVID are just astounding. Like there's over 200 symptoms described, new ones every day. I'm hearing stories from my patients about all sorts of different neurologic issues and gut issues, autoimmune issues, cognitive issues, you know, brain fog, autonomic dysfunction.

And the scariest part of it, I don't know what you've seen recently, but you know know, I think the early batch of long COVID was, was predictable, whereas those who were going to get really severe hospitalized forms of COVID, you know, they were going to have really big struggles afterwards. Now, you know, it's like 45 year old dad walks into the clinic, metabolically healthy, not smoking, you know, not a heavy drinker, very mild COVID, all of a sudden horrendous long COVID afterwards, right? That again, speaks to how broken the immune system of the population is. So is long COVID an autoimmune disease in and of itself, or is it just one of the aspects of it? Well, in the research that my dad and I have done on long COVID so far, we've found specific autoimmunity in a large percentage of them, but it's certainly not

everybody. You know, whether it's, you know, cardiolipin autoimmunity, neurological autoimmunity, a lot of joint-related autoimmunity, sometimes thyroid as well. That's certainly, I think, one of the signatures, along with something called viral reactivation, which in the chronic fatigue space, we've known about for a very long time. Yeah. I mean, that's an important thing. I want you to unpack that, because what we're seeing with long COVID is that dormant infections kind of rise up from the dead and tend to get reactivated, causing problems. And whether it with. HHV-6, you know, which is roseola, something that we typically get by the time we're three years old, not a big deal. If you are symptomatic, you've got a fever for a couple of days, you have rashes. Epstein-Barr virus, the majority of adults are asymptomatic from the infection, same with CMV as well too. These viruses are genius in their long-term evolution against us.

They have figured out how to evade complete immune eradication by hiding in tissue after the acute infection. But with a normal immune system, they stay in dormancy. They wouldn't dare step out into the wild and get eradicated by the immune system. But what we're finding is that if you have a herpes cold sore, it only comes out when you're under stress. It's not there all the time, but the virus is there, just sleeping. It wakes up when there's some kind of insult. Correct. Right. It's not, it's not rolling around in the bloodstream active all day long. But a very, very large percentage of long COVID cases, long COVID patients have viral reactivation as a

core of their clinical symptom set and clinical disease. So again, that poses the question, what in the world is happening with the immune system in the short and long term following a COVID viral infection? It's not meeting the demands in the short term and then not balancing itself in the long term as well, which provides a beautiful open window for these reactivated viruses. And are there good diagnostics immunologically to help map out what's going on with these patients? Because long COVID is a bucket, but it's truly probably many, many, many different kinds of problems. And each individual responds to the insult with different manifestations and many different kinds of treatments. Let's go over the buckets, if you don't mind. So currently, with what we understand right now,

I break it into five buckets. So there's viral persistence, which is essentially somebody never fully clears the initial COVID infection. They've got this very low-level infection that just keeps on going and going and going and going. There's something called superantigen activation, which is parts of COVID have an ability to just dramatically, I'll just say, piss off the immune system. There's the mitochondrial dysfunction and loss of autophagy that happens there. There's the microbiome and gut permeability dysfunction, and then there's the autoimmunity component. So if you're going to talk about diagnostics to be able to accurately pick up what's happening with long COVID, you basically have to say, okay, which one of these five buckets is the

person living in? Everyone is going to have some unique spectrum of those five, though the majority will have, let's say, three or four of them. So we don't have diagnostics for the mitochondrial part, maybe on the research side. There are some, but they're hard to get. They're very hard to get. Like the seahorse analysis. Yeah, I use an IGL lab in Germany that does a detailed mitochondrial assessment. It's mitoswab. It looks at mitochondrial stuff, but it's organic acids, but it's definitely hard. You and I know that stuff, right? But not every physician out there in the United States, right? And then-

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Indulge and try some honey with superpowers from Manukora. The viral reactivation stuff, I think, you know, rather straightforward antibodies, IgM, IgG antibodies to different targets of Epstein-Barr virus, HHV-6, CMV. There's no diagnostics for COVID persistence, if that is in case what's going on. I mean, you can look at, you know, whether there's very high levels of COVID antibody production for long periods of time, and you can infer that there's COVID persistence there. The autoimmune part of it, you brought up the lab in Germany that's doing an autoimmune panel specifically for long COVID.

In our studies as well, neurological targets like myelin basic protein, myelo-oligodendrocyte glycoprotein. The blood-brain barrier is a very common target that was demonstrated in mouse literature. So you're basically seeing autoantibodies, basically your own immune system attacking aspects of your brain. Exactly. The most important defense of your brain, which is the blood-brain barrier, disrupted in football players, boxers, Alzheimer's, Parkinson's. So that same kind of core defense layer of the brain gets damaged by COVID. You can look at those markers in the blood. And then the specific neurological proteins like myelin basic protein, which is traditionally damaged in something like multiple sclerosis.

And so these are lab tests that you can do to help sort of sort things out and tell which type of the sort of five buckets people go in? Yeah. You know, make an attempt to try to, you know, on this kind of early leading edge side of things, identify how much of each one of them they're dealing with. I mean, you've published a lot on this. You publish in Nature, which is a major journal and other journals looking at autoimmunity and the exposome and COVID. And I think it might be helpful for us to sort of dig into how did this persistence of long COVID symptoms, what's the underlying biology that's happening here? Is it an overactivation of cytokines? Is it autoantibodies? Is it damage to the gut? Is it endothelial problem, which is all the blood vessel linings, which affects everything, which is why maybe you have symptoms everywhere because it affects everything.

How does it all sort of fit together for people? It's tough because it's multiple pieces. But if I was going to break it down to what I think the core of it is, the acquired mitochondrial damage and the associated lack of autophagy to me is really core there. So mitochondria are the powerhouse of the body. We know that for energy production. But I think it's underappreciated how much a damaged mitochondria will lead to a pro-inflammatory

dysfunctional immune phenotype, meaning somebody who has a dysfunctional immune system just as the result of the damaged mitochondria. And then from there, there are neurological immune cells called glial cells. They will enter something called glial activation and end up with a pro-inflammatory immune subset in the brain. So you can see- Brain's on fire. Brain on fire. Exactly. So tired, dysfunction it on fire, brain on fire, exactly. So tired, dysfunctional immune system, brain on fire, strictly from the mitochondrial damage that comes from the viral infection. And, you know, of course in the United States with all the

metabolic dysfunction that exists, you already have mitochondrial issues, massive mitochondrial issues to begin with. Right. So that's, that's why we're seeing a bigger problem with it here, both in the short term and the long term. So just unpack that a little bit. Mitochondria for everybody, those are those little organelles. There's thousands of them in every cell that take food and oxygen, turn into energy, and form ATP that our body uses to fuel everything. So when you basically think about that, it's your engine.

And if you run out of gas, you're in trouble. And so everything doesn't work in the And if you run out of gas, you're in trouble. And so everything doesn't work in the body when you run out of gas. And so what you're saying is the COVID virus somehow affects the mitochondria in ways that make them less functional and less able to produce energy. And then it has this huge downstream effect that even affects the immune system. Absolutely. Because not a lot of people talk about the connection between the immune system and the mitochondria. What do we know about that?

It's clear. So if mitochondria can run either on something called oxidative phosphorylation, sorry for the fancy words, but, you know, to- It's burning carbs. Yeah, right. Burning oxygen and carbs. But that's an efficient form of, you know, converting food into energy. It's kind of like a diesel truck. Yeah, right?

Less fuel, more miles, right? And the more miles you get out of the amount of fuel, the less antioxidants or less oxidative injury is produced by the mitochondria. In metabolic dysfunction, like insulin resistance, the mitochondria are not running on diesel. They're running on the least efficient fuel on the planet. So one gallon will get them a mile. And in doing so, they burn through all of their antioxidant reservoir because the mitochondrial production relies on this continuous balance between producing things that require

us to produce antioxidants to neutralize. Otherwise, the mitochondria damages itself, right? So you imagine somebody with insulin resistance running on that very inefficient fuel system. They're teetering on the edge, barely making it with the antioxidants, all of a sudden a huge oxidative injury like COVID comes along, tipping point. Now the mitochondria cannot function anymore because you don't have enough antioxidants to meet what it's producing. And essentially what happens is it structurally becomes damaged, and it will release its own unique DNA into the cytoplasm, which signals to the immune system, I'm in trouble.

What does the immune system do when you're in trouble? It says, okay, we've got something we need to fight. It puts itself into fighting mode, which is a pro-inflammatory mode. The nervous system, the glial cells cells know when macrophages, which are a kind of primal defense cell, are in this white blood cell, are in this fight, and they will convert themselves into glial activation and put themselves into this neuroinflammatory fight response, all from the powerhouse of the cell. But that makes perfect sense.

That's a domino effect. Yeah, but it's the most important part of you. Of course that's going to happen. If it gets damaged to the point that it can't function anymore, you need to fight whatever's doing that. I mean, you know, most people have had the flu or bad cold or some virus and they're achy, they're tired, they have brain fog, they have no energy. And it's in part because of how the virus is affecting the mitochondria. Yeah. Right. Absolutely. And so, so with COVID, it just persists. It doesn't get better. Like if you get a cold, it gets better.

You feel fine the next week. With COVID, it seems to kind of persist. And I actually had an experience after COVID where I got a pretty bad case of COVID. And I was coughing a lot for a couple of weeks. And that kind of got better. And then I developed arthritis. Yeah. Like my hand swelled up. I got joint pain and it was kind of scary. Uh, and, and, um, you know,

I, I aggressively did a bunch of things that helped fix it like plasma phoresis and ozone and literally in one plasma phoresis session, which is basically where you filter your blood and take out all the bad icky stuff in the plasma and throw it out and give yourself a new albumin and put your blood cells back in literally within hours. hours, it was better. And the next day I was like all better. It had plenty of energy. And I was like, whoa. Did you do it in Europe or in the US? No, I did it in the US. Because it's actually pretty common practice in Europe, right? Switzerland in particular, like they're very big on that. Around long COVID, you mean? Or in general? In general and specifically for long COVID.

And it makes total logical sense, right? Like you're filtering out a lot of the inflammatory cells. You're filtering out a lot of the antibodies that are being produced against your own tissue. Yeah. And you're giving your immune system a breather, basically. Right? And in that breather, you're allowing all of these antioxidant balances to restore themselves. And then you can go back to the way things were supposed to be.

So let's just sort of just pretend I'm a long COVID patient. I'm, you know, pretty healthy guy, but I got COVID and then I'm suffering. Like I have headaches, brain fog. I have, you know, stomach is not right. Muscle aches, have no energy. And my joints are a little sore. Where do you start with someone like that? What are you going to do diagnostically? What are the kinds of steps you're going to take to help me get better? Even before the diagnostics, I'm starting with a very, very strong gut-centric approach. So I'm looking very carefully at what they're eating. Obviously, you know,

many times they're not eating what, you know, you and I know to be a healthy diet, a whole foods diet, rich with phytonutrients, you know, pulling the grains, you know, sometimes in certain situations, pulling the dairy out of their diet as well, to shoring things up with specific probiotics. And then, you know, depending on what the response is in a very short period of time, then I'll start adding the diagnostics. So, you know, I want to know again, is there a microbiome dysfunction? Do they have intestinal permeability, leaky gut? Is the viral reactivation part of it there? And in my experience, when they have that real acute chronic fatigue picture, like they cannot get out of bed, they try their best to take a walk around the block, it crashes

them. The viral reactivation will be there usually in those cases. Like Epstein-Barr or CMV? Epstein-Barr virus, HHV-6. In a recent study that we just did, 90 patients, long COVID, 90 normal controls, we found actually that HHV-6 IgM was one of the most predictive markers for long COVID. Because such a high percentage of people will have HHV-6 reactivation, which has been very classically described in viral-induced chronic fatigue. So, again, not a surprise. Just something that we're learning is specifically applicable to long COVID. So you look at the gut, you're looking for reactivation of viruses, what else are you looking at? And then it's, you know, blood-brain barrier, neurological antibodies.

Again, in that recent study, we found that blood-brain barrier protein and myelin basic protein, IgM antibodies, which are more of an acute antibody, were very good predictors of long COVID. So you can get these tests through specialty labs like immunosciences, like your dad's lab or Cyrix somewhat. Yeah, immunosciences has a specific long COVID panel, which includes COVID antibodies, HHV-6, and EBV. And yet that's not really easily accessible to most people, right? No. No. I mean, Quest. Conventional doctors won't typically do these tests. There's access to it, right? Quest and LabCorp, they all run EBV, HHV-6. We could make an argument

about whether it's not the best version of it in the world, but at least you're getting some sense, right? And insurance will typically pay for them. Doctors need to know that EBV and HHV-6 reactivation are very common in long COVID, and you have to look for them. And then also they need to know what to do about it. Exactly. Well, that's the hard part. You don't look for anything that you don't know what to do about, right? Exactly. So what do we do about it in that situation if you do find the viral reactivation? In our clinic, we're doing a lot of high-dose IV vitamin C to get them kick-started, oftentimes IV L-lysine to pair with it as well.

Which is sort of an amino acid that has an antiviral component. Exactly. And then just pairing that with a lot of antiviral supplements, monolaurin, lauracidin, olive leaf extract, quercetin, NAC, zinc, you know, just making sure that they have as much of an antiviral fighting capacity on a daily basis as they possibly can have. Hyperbarics are showing a lot of promise in long COVID. So recommending patients go get hyperbaric treatment, and there's a very good study out of Tel Aviv. You know, you have to know that that study, they use 2.4 atmospheres this is a hard chamber exactly hard chamber so they need to go to hard chamber facilities and i think it was 40 out of

80 days yeah um so it's it's an investment obviously of time and money and money but it works yeah right and then getting your life back is worth it absolutely right you know and you're investing in your short-term and long-term health. You know, if you're having long COVID symptoms, something is dramatically wrong with your immune system. Rescuing yourself from that is not just rescuing yourself from long COVID. It's doing something for yourself in the future. Yeah. I mean, cause otherwise people sort of tend to have this forever. Sure. Right. And I, I mean, I personally had chronic fatigue syndrome and I know what it's like, and it's the worst feeling in the world. You feel like, you know, you haven't slept for three days even if you just slept and

you're walking through a fog and every step is an effort and you can't really function and you have to fake it. Yeah. If you can get out of bed. Yeah. And it's something that it's unfortunate that traditional medicine just has very poor treatments for and also very poor understanding of. And the multi kind of factorial cause of these conditions is important to understand because it's not just one thing. Like with autoimmunity, it can be a lot of things, right?

So long COVID can be one piece, but it's this lack of immune resilience that's causing the problem, really. Because if we were basically healthy, we would be able to handle a lot of this. I think it's the most of immune resilience that's causing the problem, really. Because if we were basically healthy, we would be able to handle a lot of this. I think it's the most important part of us. I'm biased in that, right? But with a healthy immune system, you're really protecting yourself from everything. Yeah. And the immunity stuff is significant because, you know, everything that's happening across the board now with almost all diseases in America is the upregulation of our immune system and inflammation, whether it's heart disease or cancer or dementia or diabetes or obviously autoimmune diseases. They're all inflammatory problems. And we're kind of a nation on fire and increasingly a global population on fire. And that is something

that we're really not great at diagnosing or treating with traditional medicine. So if I'm that patient who comes to you, you're fixing my gut, you're fixing my diet. You wrote a book called When Food Bikes Back, how to treat autoimmune disease using food, which is great. Everybody should get a copy. But there's a lot of steps that we know how to do in functional medicine to help people recover from autoimmune disease and from long COVID. So can you kind of talk about how you would start to sort of, you know, take care of me in addition to the basic things you mentioned? Yeah, so that book was really written as a primer for creating, you know, immune resilience in the gut, and then also providing people a map for what specific foods do you need to pay attention to for specific autoimmune diseases.

And the reason I wrote it was because, as you and I were chatting about before we started recording, you know, when you're on the physician side of this, sometimes it just feels like the people that need your help is a never-ending just, you know, sea of sick people out there. And if I worked 24 hours a day, seven days a week, I wouldn't put a dent in it. So I thought I just owed it to everybody to put my hat into this knowledge and just, you know, say, hey, this is what I've seen and done so far. So in the book, we talk about the restoration of oral tolerance, which is a gut-centered approach. That's essentially what we mean by immune resilience. To be able to convince the immune system that attacking your own tissue or being in a continuous pro-inflammatory state is not the way that we want to be. So all the supplements that have very good data behind them that you

can use to restore oral tolerance, immune resilience are in the book, everything from vitamin A, vitamin D, short chain fatty acids, specific probiotics, fish oil, everything is in the book. And, you know, also all the tests that I like to use. And the idea behind that was, you know, although functional medicine is growing dramatically, thanks to pioneering efforts from physicians like yourself, pioneers like my dad, Jeff Bland, all these other people who have really, like you, put yourselves out there at a very early time. And I benefit from that, so thank you. You know, sometimes you're going to live in a neighborhood or, you know,

where there is no functional medicine doctor, or they're just not available. And if you have a physician who's empathetic and caring and wants to go to bat for you, you can always go to them and say, hey, listen, like, these are the tests that were recommended. Why don't we do them? We can learn together. Let's see what we get out of this. Yeah. You want a doctor who's willing to be a partner. Yeah. Right. And a good doctor, I believe, will be very willing to engage because we're supposed to be continuous learners. That's right. That's right.

Absolutely. And I think, sadly, it's not the case most of the time because we get stuck in a paradigm and we don't learn much about autoimmune disease in the sense of what's really the root cause of it or how to deal with it other than just using immune-suppressive medications, which are often very expensive and have significant side effects. You know, I want to kind of loop back

on what you talked about around oral tolerance, because this is such an important issue. And I want to sort of kind of lean into it through this lens of food sensitivities, because, you know, when you eat something that is from your diet, your body shouldn't be pissed off about it. It should be thankful and it should absorb it and get rid of the stuff it doesn't want, but keep the stuff that it needs. And what's happened is that there's been a disruption

in the normal way in which our immune system starts to build tolerance for all these foreign molecules that we eat pounds a day. Like it's the most amount of foreign stuff that we're exposed to every day is what we stick in our mouth. Right. And, and our body has to determine if it's friend or foe. And when we don't have a proper functioning gut immune system, what is should be a friend turns into a foe. I remember I had a patient way back when, she had intractable migraines for like 30 years, was in bed multiple days every week.

And we did a food sensitivity testing and she had super high score of eggs. I was like, well, why don't you try to stop eggs? She did and her migraines went away. And so a lot of people are doing food allergy or food sensitivity testing and people are kind of confused about it. And I'd love to sort of unpack this because it sort of helps us to kind of understand one, why, why we're seeing this increase in food reactions and two, what we can do about it.

And I just want to sort of put my stake in the ground by saying a lot of people do these food-sensitive testing and they think, oh, I can never eat this. I'm allergic to this. Instead of going, oh, I have all these reactions to foods, I have a leaky gut. How do I not become so sensitive? Why am I so sensitive? And how do I reset my immune system so I'm not so sensitive? Yeah. reset my immune system. So I'm not so sensitive. So that's what I'd love you to talk about because oral tolerance is a really important concept that allows us to be in the world without getting sick

from it. Yeah. So I'm going to back up real quickly and just make the distinction between food allergy and food immune reaction or food sensitivity. Yes. Because it's very confusing. So food allergy is a IgE-mediated, just traditional allergic response to food. I always say, just think about a kid with a peanut allergy. Exactly. It happens in minutes, right? And the symptoms are, you know, ishiness. Extreme. Yes. Extreme life-threatening, right? A food immune reaction or food sensitivity revolves around different antibodies, IgA and IgG antibodies, which are part of a different branch of the immune system. Symptoms from food immune reactivity or food sensitivity are basically the symptoms that we talk about with leaky gut because they're the result of a chronically leaky gut.

Essentially, the intestinal barrier, which has this incredibly difficult task that we talked about of friend, fooe, friend-foe, because of it, it breaks down structurally, doesn't have that ability to make that distinction anymore because the breakdown basically convinces you that you're in some continuous threat. So you just start attacking everything, right? So food immune reactivity testing, more than anything, thematically just tells you what's happening with the immune system, right? Getting a food sensitivity test and seeing everything in red, removing it, that's not the point. Yeah, which most people honestly think it is the point. And it gets me kind of a little upside down because I'm like, no, no, no. This does not

mean you have to avoid these foods for life. It means that something else is going on we need to fix. You and I both get up in arms about that, for sure. We share that in common. It is, it's a state of a particular part of the immune system. It's saying your intestinal immune system is pissed off. It doesn't know whether food is something it should attack or not. That's a huge problem, right? Then in food immune reactivity, there are very traditional trigger foods

where the actual presence of the reactivity is continuing the process of the permeability. And it's very important to understand. Right, it's a self-perpetuating cycle. Exactly. So there are select ones that if you remove in the right case, the healing of the gut back to normal is going to happen much more quickly. And that's why we talk about gluten so much because it's number one, two, three, four, and five on that list.

It certainly is. Yeah. Right. Dairy, corn, soy, eggs. Those are other common, you know, culprits. Eggs, as you mentioned in that case is a pretty common one. Yeah. But the rest of them, you know, it mentioned in that case, is a pretty common one. But the rest of them, it's like, I've got a food sensitivity to cucumber. All my problems are going to be solved by eliminating cucumber. No. No, no. You're not solving anything there.

And the gluten thing is important because it's kind of the gateway drug. Because what it does, and we've had Alessio Fasano on the podcast, is it increases the production of a compound called zonulin, which is a really important molecule that is increased in certain diseases like cholera, but it seems to also be increased with exposure to gluten. And what that protein does is it breaks down the stickiness that the cells have together, we call tight junctions, basically like Legos are stuck together. And so the cells sort of come apart. Literally, the lining of your gut gets like a sieve, and it's like a coffee filter with

holes in it, let's say. And so then all these food and bacterial toxins and proteins leak in, creating all this inflammatory system. So gluten, often if you get rid of gluten, it will help the gut start to heal. Yeah. Gluten, vitamin A, vitamin D, probiotics, short chain fatty acids, fish oil. Yeah. Take all the leaky gut offending crap out of your life. And it's a pretty good formula for restoring your immune resilience. And that doesn't mean that everybody's gluten sensitive and everybody should be gluten free. It just means that in people who are sick,

it's like you said, number one to five things to think about if they have an inflammatory or autoimmune problem. Yeah, it's just really common. It's not going to be the case for everyone, but if you're playing the odds, it's a pretty good card to play. So then when we're seeing these sort of decrease in oral tolerance because of all the factors we talked about earlier, the destroyer, gut microbiome,

um, we see this sort of increasing in reactions to foods and, and it's something we test for. Um, but the tests are, are, are confusing for people because they get all these lists of things that they think they're allergic to, but it's not really an allergy. Uh, and so, so what, what do you do then in terms of repairing the gut? You talked about some of the basic stuff, removing the foods like dairy, gluten, maybe soy, eggs, and then giving certain compounds like fish oil or glutamine or short-chain fatty acids or quercetin, the things that kind of we know help repair the gut. But is there more to it than that? Is there a way to kind of really look even deeper at what you call in some of your papers the exposome?

Because maybe there's something wrong with a virus or a toxin or something else. I know that happened with me, for example. I had terrible leaky gut, reacted to everything. And it was the mercury that was destroying my ability to maintain my gut integrity and poison all the enzymes in my gut. And I got a leaky gut. And I would eat almost anything and I would get a rash or a sore on my tongue or my eyes would swell up or I would have like not classic IgE reactions, but weird things happening. Right. Yeah. And anything in the environment can be something that triggers intestinal permeability, leaky gut. Right. And so the exposome is a very big thing. Uh, food is the most common thing think, in the exposome that we're exposed to.

You know, we're literally taking something from the outside environment and internalizing it by eating it. But pathogens, bacteria, fungus, viruses, other unusual organisms, they're very common triggers of autoimmunity, as we discussed with COVID. But let's say the bacteria from food poisoning can be very common triggers. And then environmental chemicals are a huge contributor. And unfortunately, I think probably the largest growing group of contribution to autoimmunity. And chemicals create autoimmunity in a very unusual way in certain people. They create something called a neoantigen. So if you just kind of like think about this, it's horrifying what chemicals do to human beings. A neoantigen is when something comes

along from the environment, binds to your own tissue, and modifies the structure of the tissue to the point that your own immune system doesn't recognize your tissue as yours anymore and attacks it. And that's a very traditional way in which chemicals cause autoimmunity. Yeah, they're called autogens, right? Yes. And autoimmune inducing toxins. And they can be heavy metals like mercury. And I had autoimmunity from that. It can be the plastics and petrochemicals we see. It can be viruses. It can be foods.

So there's so many things that disrupt our immune system. And the problem in our modern societies is many of us have many of them, right? We have latent viruses. We have exposure to environmental toxins. We eat all this crap in our diet that causes leaky gut. We have modern wheat, which has way more glide in antibodies that drives more leaky gut. So you've got this whole cascade effect. Yeah. But the good news is, Alroy, is that with functional medicine,

we actually can help people dig out of this hole. Absolutely. Because from traditional medicine, it's like, oh, shit. You know, like, I don't know what to do with this patient. Let's create a clinic called the Long COVID Clinic, and we'll figure out how to give them symptomatic treatment for their drugs. But they're not doing any of the stuff we're talking about. No.

And so tell us sort of some cases of patients you've had come in with long COVID who you've sort of identified some of these findings and what you've done for them and what their outcomes have been. Because I think people need to hear some hopeful stories because it's bad out there. And by the way, a lot of the stuff that we do,

you know, you can do on your own and get better without actually having to do a lot of expensive stuff. That do, you know, you can do on your own and get better without actually having to do a lot of expensive stuff. That's the goal. Yeah. Right. And, and, and, and, and, you know, I think it's such a big issue that I wrote up a whole guide, a solution guide on COVID and long COVID for, for people, because I was getting a question like every day for people. And the spirit of functional medicine is empowerment of the people on the other side, right? It's about giving people the ability to step back into the driver's seat and drive their health in the direction that they want, right? So whether you're doing it with a practitioner or you're doing gentleman, three kids, extremely metabolically healthy, exercise fanatic. It was his third COVID infection, extremely mild.

We're talking about the sniffles for three days. The only reason he knew it was COVID was because everybody else in the house, including the kids were testing positive for COVID. Two weeks on the dot after the infection, bed bound, just could not get up, couldn't eat, wasn't exercising, just like was a completely different person. I saw him in clinic because he came and said, I need your help. And it just looked like, like hell, like sunken eyes. I was just shocked because he was so healthy before. Um, ran all of the usual tests,

found out he had a really significant case of EBV reactivation and, um, Epstein-Barr. Epstein-Barr virus. And you can just check that by seeing antibody levels and increase in certain patterns, right? Quest and LabCorp will run it if that's what you need to do. And we gave him a few rounds of IV vitamin C and some antiviral supplements. And I think it was three months later, he was back to himself 100%. Wow. But what I tell them afterwards is, great, we got you out of this long COVID state. Now let's ask the question, why the hell this

happened to you? Because on paper, it never should have, right? He had been a patient for a very long time, had really significant intestinal permeability, identified that gluten was a very big problem for him, did the whole restoration thing. He had dropped out of the kind of continuous care in the clinic during COVID for a while and went back to his normal eating. Yeah. You know, didn't have any of the usual symptoms that we started all that for, but he, you know, he was eating gluten and dairy regularly, you know, wasn't being mindful, I think. And ran an intestinal permeability panel on him because I was, you know, my curiosity says, I need to know why this happened to you. Right. And it was, you know, a 10 out of 10. of 10 it was you know both the zonulin issue and then you

mentioned the bacterial toxins really really severe endotoxemia are you talking about the cyrex 2 panel yeah cyrex array 2 yeah and this is cyrex is a lab that does a lot of immunological testing and antibodies and your dad's been involved with that lab and helping them develop a lot of their tests and i i use it a lot clinically in our practice at the ultra wellness center it's true you can see when people have a lot of these auto antibodies against zonulin which is the gluten protein or against lipopolysaccharides which are the toxins from bacteria you can tell that all this crap literally is getting into their immune system yeah and their body's reacting to it yeah so you know so this this is this is your story.

You know, we cleaned things up. You did great. Understandably, I think human beings fall off the wagon sometimes. You fell off the wagon. Something relatively innocuous was a huge problem, and it led to further immunological problems. So we take care of the first layer, and then we take care of the intestinal permeability,

and then we make sure this never happens to you again. And so this seems like a pretty straightforward case where he just was sort of hit pretty hard with fatigue, and he had leaky gut, and he had some sort of reactivated viruses. Are there patients that come in with full-blown autoimmune disease that you see? Absolutely. And what are those stories like? They're longer cases. They're more complicated. Yeah. Oh, we got a few minutes. Yeah. A 35-year-old that comes to mind, this gentleman had seen many practitioners across

the country suffering from long COVID for 12 months by the time I saw him. So it'd been a really long time. His case was quite unique. A lot of neurological symptoms. So much so that neurologists were constantly working him up for MS. Spinal taps and MRIs coming back negative, thankfully, but he had really dominant visual and motor neurological symptoms, a lot of numbness, tingling, and a lot of visual disturbances, along with the fatigue, the brain fog, the muscle pain. So I went deep dive. Those people, they've been to 10 people before they come to see you. You really need to figure, I think, all the pieces out in that situation, as you know. Like be a detective, yeah. Yes. So he had extremely elevated COVID antibodies that stayed elevated no matter what over,

let's say, a six-month time frame. They were continuously high. Epstein-Barr virus reactivation, classic with something called an early antigen antibody, which is the classic antibody that tells you that that's the situation. And very high neurological antibodies. Myelin basic protein, synapsin, and tubulin, I think were the three. These are autoimmune antibodies against your brain, basically. Exactly. So he's got what looks like COVID persistence, Epstein-Barr virus reactivation, and now he's attacking his own

neurological tissue as a consequence of the initial viral infection. Which is showing up almost like an autoimmune MS condition. Exactly. Exactly. So not diagnostic for MS at this point, but certainly looks like he's in that spectrum. So he did also have intestinal permeability, gluten and dairy sensitive. Dairy is very cross-reactive with neurological tissue, as is gluten. So what that means is, if you do have leaky gut and permeability, and you're eating those foods, you might actually be contributing to the neurological autoimmunity. So by removing them, you can kind of lower the fire a little bit. So remove those foods, start it on the oral tolerance protocol,

start it on the IV vitamin C for the Epstein-Barr virus, kind of hitting as many of these things as we possibly can. Things get better for sure in a very quick time. I'd say 12 weeks later, he was going from, he would call himself two out of 10 functional to seven out of 10 functional. And then what you mentioned, plasmapheresis. Yeah. He started contacting on his own different clinics and actually brought to me the idea of doing plasmapheresis. And, you know, you and I know a lot of people in the country, but I think one in particular that does this in Tennessee. Oh, sent it to David. Yeah, it's sent up to David. And after plasmapheresis did remarkably well. And, you know, I think that that took a while for sure to kind of get in motion. And he suffered for a really long time. But it was a case where if you identify every piece appropriately, you make dramatic progress when progress isn't being made. Yeah, so I think it's really important. I mean, I think there's a whole spectrum of severity along COVID, right?

And I think a lot of the basic things can work to get people better, like fixing your gut, cleaning up your diet, a few extra supplements, maybe a few nutritional IVs, which are affordable for most people. But then there's those cases which are more serious and you need to kind of go a little bit further

diagnostically and therapeutically. And there's been a lot of work out of Europe around diagnosing a lot of these autoantibodies against the autonomic nervous system and other things that happen in the body. And they use plasmapheresis there. And I found it very effective in actually reducing some of these neurological and also kind of long COVID symptoms. So I think we have a lot of things in our toolkit that aren't part of traditional medicine, whether it's diet, lifestyle interventions, supplements, intravenous nutrition, things like plasmapheresis, ozone therapy, hyperbaric oxygen therapy. There's a whole toolkit.

Peptides can be used. And so when you're suffering out there, I want you to know there is hope and there is a pathway. Now, sometimes it's not a straight line. Sometimes you have to go find the right practitioner. But I think it's really important to understand that there's an array of understanding that's pretty deep about this. And you've written some great papers. We're going to link to the papers in the show notes, your dad and you have written others in major journals. And they're really quite in-depth discussing how the mechanisms work and written others in major journals. And they're really quite in-depth discussing how the mechanisms work and what to do about it. And I think that there's no

lack of literature now on this. There's just a lack of cohesive approach to systematically figure out what's going on with each individual patient and treating them uniquely. Because like you said, there's no, or like I said, I'm not going to tell too long COVID patients that are the same. And so it's really about personalized medicine. It's really about understanding each person's unique biology and then customizing the treatment to match what their particular issues are. The sort of comment you brought up a little bit earlier was this sort of, you kind of didn't say the words, but there's a phenomenon that happens where our immune system gets confused, whether it's an environmental toxin or a virus or a food or something that we react to that we probably should react to because it's foreign. Right. But then it's like kind of a mass mass shooting, you know, like instead of like just targeting that thing, it's like the bullets spray

everywhere and start targeting your own tissue. So that's when you sort of get auto antibodies and attacking your own tissues, which is, which is a whole phenomenon that happens in autoimmune disease. And we call this molecular mimicry where, so can you kind of unpack that a little bit and how, how that happens? Cause it's like,

well, wait a minute. He's talking about the gut. Oh, wait a minute. He's talking about a virus. Oh, wait a minute.

He's talking about like a toxin. Oh, wait a minute. It's a little confusing. Right. And you call this the exposome, which is the sum total of all the things that our biology is exposed to over a lifetime and what washes over us and determines our phenotype, which is the expression of who we are in any moment. I think probably the most important thing to understand first is it's very, very difficult for autoimmune disease to occur if you just think about all

the safety measures that are built into our own immune systems for this not to happen. Yeah. The immune system has to be essentially tricked into attacking your own tissue. The basis of that trickery is something called molecular mimicry. That means that a protein or peptide sequence that exists in the environment gets attacked by your own immune system, and it looks similar enough to your own tissue that your immune system can, after that attack, no longer distinguish between the two of them. So let's say again I mentioned dairy and myelin basic protein or myelo oligodendrocyte glycoprotein neurological protein targets right like dairy casein protein which is what the immune system always reacts to a protein yeah looks

similar to neurological tissue. So basically your cow protein looks similar to your own brain tissue. Your own brain tissue. So if you attack the cow protein, the attack is not specific enough to be able to say when it comes across your brain protein, hey, that's brain protein, not cow protein, and it attacks it by accident. That's the fundamental basis of autoimmunity. So everything in the environment where there's an amino acid sequence that looks close enough to your own tissue has that potential. And the work of my dad has been actually trying to map that crossover, the proteins and amino acids in the exposome and the amino acids in our own body, where do they match so that we have a real legend or map

as a practitioner or as people to be able to get specific and say, this is the autoimmune disease I have. These are what we call the cross-reactive epitopes or the proteins in the environment that look similar. Those are the places I need to look. Because otherwise the environment is a humongous, humongous category, right? You're, you're, you're going to be fishing forever if you're just going through the list ad nauseum. Yeah. Yeah. I mean, I, I, I think, you know, getting that specific is amazing. And if we can do that, that's great because it helps diagnostically. But you know, when I see a patient with autoimmune disease, I'm thinking, okay, leaky gut. What foods do they react to? Gluten is top of my list.

Do they have exposure to petrochemicals, other environmental toxins, heavy metals? What about tick infections? What about mold exposure? What about viruses? So this is sort of the list we go down in the functional medicine model to think about root causes. Because you cannot treat someone with an autoimmune disease unless you address the root cause, which is something that we don't do in traditional medicine. And I think that's, you know, there's a, you know, of all the things that we do in functional medicine,

autoimmunity is one of the most satisfying because it's one of those things that actually can get better, which is something we don't think about in traditional medicine. Once you've gotten autoimmune disease, you got it for life. Like rheumatoid arthritis, lupus, MS, like there's, it's a one-way street. Yeah. You're going to cycle through medications. That's basically what your future looks like. You're going to be on Humira for three to five years and then cycle on to the new one and then the new one and the new one. And that's, that's all that's really offered you. I mean, I had a horrible autoimmune disease. I mean, I got autoimmunity when I had chronic fatigue, which was sort of positive A&A and low-grade things, not specific.

But then I got full-blown ulcerative colitis after a C. diff infection and mold exposure. And it was awful. I mean, I have to tell you, it was awful. And I tried everything that I had in my toolkit that I knew of from functional medicine. It didn't work. And I tried traditional medicine. I took 60 milligrams of prednisone for six weeks. I didn't touch it.

They wanted to put me on biologics. I did not want to go on biologics. And I finally said, all right, I've got to do something crazy. And that's when I really doubled down and said, what could I do that would be a reset for my immune system and to kill anything that's in there? And I did intravenous ozone therapy and I did high dose IV vitamin C and glutathione and minerals, vitamins, and I did hyperbaric oxygen. And that combo of those three things all at once kind of kicked me out of that cycle. And it was quite amazing to see.

And I was like, that's amazing. And now I'm like, perfect. I don't have an autoimmune disease. But typically people with Crohn's disease or colitis, it's an on and off thing. They're never really better. And like a traditional doc will tell them like what you eat makes zero difference in the disease.

Oh, yeah. Especially if you have a digestive disorder. What you eat makes no difference. No difference. Which is just, it's theological. What a concept. Like it's like one organ

you're putting pounds of stuff in every day. But I think it's changing. I think the New England Journal just launched a series called Nutrition Medicine, which I'm extremely excited about. And they talked about the food

and the microbiome. I mean, I'm thinking, wow, this is like, you never would have seen that 10 years ago. So I think things are changing. I think all the work we're doing is really making things move forward. I think the sort of kind of last thing I want you to really dive into is, you know, if I was like a basically more or less average American and I, and I came to see you and I said,

look, I've been hearing about this rise in autoimmunity. I've been hearing about the reduced immune resilience. I'm scared about, you know, COVID or the next pandemic. And I want to fix my immune system. What do I do? Because if you go to a regular doctor, they're going to go, wait till you're sick and then I'll give you a drug, right? But what can you do for people? What can we do as a functional medicine community to educate people about how they can build this immune resilience? Well, there's a lot of options there. You know, I think you have written a bunch of really wonderful books. Functional medicine in general does a really good job about just teaching the concept of nourishing the gut and the microbiome being an incredibly influential way to create that immune resilience. So don't discard just how often that will work for the

average person out there. Fixing your gut. Fixing your gut. Just getting to the fundamentals. Let's say your diet, your exercise, your sleep, your socialization. Incredibly effective really across the board. There are certain cases where you need to go a little bit beyond that and you need to start using objective data. And that's where we have a lot of newer things like immunophenotype testing, where you get to look at the entire spectrum of your immune system and say, you know what, yes, there's intestinal permeability, but the specific dysfunction of the immune system is this for this person. You know, in other words, like you're starting to practice that highly personalized end of one. And you do different things for different things you'd find on the immune.

Absolutely. Right. Like if somebody is in TH1 or TH2 dominance, which are particular types of immune states, they get completely different interventions. Yeah. Right. Like the supplement list for the two of them is completely different. The foods are going to be different in that situation. If it's Th17, Mark, for example, we see Th17 abnormalities. These are T means T cells, which are white blood cells. Helper. A lot of different kinds of T cells. It's like different divisions of the military.

Exactly. We're talking about Th1, Th2, Th17. And Th17 is a part of the military that is typically involved with unusual organisms like fungal organisms. So if I see, when I phenotype somebody, a massive TH17 abnormality, I'm going very deep into the questionnaire about what type of living environment are you in? What office do you work in? Exactly. What were your prior homes? And then we're really looking for

where that, that mycotoxin or mold exposure came from. Yeah. One of the last time you checked your HVAC system and you'll find it. Yeah. Right. You know, so in, in, if you're using this, the tools today, um, there, there is a really highly personalized ability to practice this just for you version of medicine, which is all the power in the world. But I think fundamentally what you said at the beginning was key. We don't really think about how we take care of our inner garden. And our microbiome just relates to everything.

So whether it's mental health or autoimmunity or obesity or whatever, it's literally the root, root, root, root for so many. And yeah, there are things from the outside that can affect it like toxins or certain infections and so forth. But a lot of times it's a dysregulation of the ecosystem in our gut. And so in functional medicine, we have a really coherent methodology for addressing it called the 5R program. And we'll put that in the show notes. I've had podcasts about it and solo podcasts you can go back and listen to, but we'll link to those as well notes. I've had podcasts about it and solo podcasts you can go back and listen to, but we'll link to those as well. But I think that the reality is that traditional medicine has no idea how to reset your gut,

but functional medicine really has a clear path, which is to remove the bad stuff, food sensitivities, food reactions, gluten, bad bugs in there, overgrowth of bacteria, yeast, parasites, whatever, and then kind of replace missing things like enzymes and prebiotics and phytochemicals. And I think a lot of phytochemicals are really prebiotics that we haven't really realized before. Re-inoculate with healthy bacteria, repair with some of the things you mentioned like, you know, stretching fatty acids and glutamine and zinc and vitamin A and fish oil, and then kind of restore the nervous system because the gut and the nervous system are connected through kind of dealing with the psycho-emotional pieces of your life to reduce

stress. And so it works pretty well and it doesn't require a doctor most of the time. And you can kind of follow along. Now, sometimes you do need to go check a stool test. You need to do different things, but it's one of those most rewarding things because you fix the gut and often a lot of other stuff gets better and and it's sort of like kind of shocking when you see when you see how central it is and yet it's it's just kind of absent from medicine it's it's the easiest place in medicine to practice not not because of the lack of challenge right right? You constantly have to just embrace that there's something new that you have to learn every day. But the results that you get in medical practice are unbelievable. And the gratitude that you get just from knowing that you're making those improvements is enough to propel you forward through whatever difficulty you're going through. It's an incredibly

rewarding experience. Contrast that to my prior medical practice, which was being a full-time interventional radiologist in the hospital, dealing with the complete opposite end of the spectrum, chronic disease in the hospital, renal failure, dementia, you name it, where no matter what I did or what fancy tool I was using, I didn't make a dent right. Versus the other side, you know, you feel like you can completely change someone's trajectory and life. Um, so amazing. Yeah, it's amazing. Well, this is very hopeful. And I think

those listening out there with autoimmune disease or long COVID, I just know there are answers and that, you know, we've had a number of podcasts on this with Dr. Lev Galland and others, and now with you. And I think it's one of the most important things we can think about is how do we create immunorejuvenation, immunoresilience. Jeff Blant talks a lot about strategies of immunorejuvenation, which is something we should be thinking about. And it's kind of an exciting moment, but it's also a fraught moment because so many people are now suffering. And, you know, we were talking earlier, but like my practice is, with me, is pretty full. I have plenty of physicians at the Ultra Wellness Center that can see your practice is pretty full. So, you know, the educational stuff you put out, like your book, When Food

Bites Back, Taking Control About Immune Disease, certainly you should get that. Everybody should get a copy and check it out because it does provide a roadmap of how to think about this differently. And we're entering a new era, so don't lose hope. There's a way out. And Elroy, thank you for what you've done and kind of continue the work of your father in immunology. I've learned so much from both of you.

And everybody, check out the papers if you want to learn more. And we'll see you next time in The Doctor's Pharmacy. Thank you, Mark. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health

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