The Dr. Hyman Show - Dr. Sidney M. Baker, MD on Learning About Disease by Traveling the World

Episode Date: August 8, 2018

My guest in this episode of The Doctor’s Farmacy is the unsung hero of the transformation of health care, Dr. Sidney Baker, MD. Dr. Baker started his career after graduating from Yale Medical. He is a former assistant professor of medical computer sciences, a Peace Corps volunteer, the Director of the Gesell Institute, the founder of Defeat Autism Now!, a Linus Pauling Award recipient, and the associate editor of Integrative Medicine. He is the also the author of several books, including Detoxification and Healing, The Circadian Prescription, and, with Jon Pangborn, Autism: Effective Biomedical Treatments, as well as various journal articles. He is currently a family practitioner practicing Functional Medicine in Sag Harbor, NY. Tune into this brand new episode of The Doctor’s Farmacy for more! Don't forget to leave a review if you love this podcast - it helps more people find us! For more great content, find me everywhere: facebook.com/drmarkhyman youtube.com/drhyman instagram.com/markhymanmd

Hi, welcome to the doctor's pharmacy. That's F-A-R-M-A-C-Y. And I'm Dr. Mark Hyman. I'm really thrilled to be here today with one of my mentors and one of the most incredible thought leaders in medicine today, who's pretty much the unsung hero of the transformation of healthcare. And you're going to learn why. This is Dr. Sidney Baker.

He graduated from Yale Medical School, and he was a former assistant professor of medical computer sciences back when a five-megabyte computer weighed about 4,000 pounds in the 60s. He was a Peace Corps volunteer and learned a lot from his time in Africa. He's a family doctor, a pediatrician. He was the Giselle Medical Institute director and the founder of Defeat Autism Now, which is really a new way of thinking about how we get to the root cause of autism. So stay tuned. That conversation is coming up next on The Doctor's Pharmacy.

I'm just honored to have you here today with us, Dr. Baker. Well, thank you, Mark. It's an honor and a pleasure to be with my dear friend here talking about stuff that we believe in. So I have to really let people know, full disclosure, that it's really because, in large part, because of you that I do what I do and that I've succeeded in what I do. Because when I was a young whippersnapper doctor who didn't know anything, I heard about you, I heard you lecture, and I called you up out of the blue, and I said, can I come please sit at your feet and learn from you?

And you're like, sure, come on down. So I drove down to Connecticut, in southern Connecticut, and I sat in your office and watched patient after patient come through, and I watched how you worked with them. I watched how you thought about disease. I watched how you synthesized information, how you track your data, how you really were very systematic and thinking that I'd never seen before in a doctor. And I just was sort of blown away by it. And over the years, you have been, I don't know that people would agree with me, but I certainly

think that you're kind of the Einstein of medicine because you've distilled some of the most difficult, challenging, complex ideas into simple principles, sort of like the E equals MC squared. Simple concepts like in order to get healthy, you need to get rid of the bad stuff and get the good stuff, put in the good good stuff i use that every day in my practice you've talked about how we label diseases we name diseases and then we think that's the cause of the disease and have completely kind of got swallowed up by this taxonomy of diagnoses which has nothing to do with the actual disease and it's not a thing that we get like a cold, but it's very different. And that's huge. You talked about the TAC rules, which is an

important concept I use every day. And if you're standing on a TAC, it takes a lot of aspirin to make it feel better. If you've got migraine headaches, you can take migraine pills all day. But if you're eating gluten or you have a mitochondrial issue or your gut biome is off, it's causing your migraines. You're not going to get better by just taking migraine medicine so these are fundamental concepts in functional medicine and i want to start by asking you how do you come up with these beautiful simple elegant ways of thinking that change everything about what we believed about disease and health it's hard to say how i come up with it i I must say it's just simple-mindedness, really. I think that I started with a very simple principle from the first doctor that I studied with, so to speak. He was a guy who was working in a mission hospital in Kathmandu, Nepal.

And I fetched up there because of the directions of two old ladies I met in Indonesia who wondered why I was sitting there with a Chinese guy who was my history of art professor at Yale. And we were going around the world studying history of art. And they came over to the table and said, young man, what are you doing here? Because in Indonesia at that time, Americans were not popular and neither were Chinese people. So the young American with a Chinese guy was kind of... And they were China missionaries who were coming around the world the other direction. They've been thrown out of China.

And then I said, well, I want to be a doctor. And then when I said, what do I want to be when I grow up, which is a popular question for old ladies. And then I said, I want to be a doctor. He said, you know what you should do? You should go see Dr. Miller in Kathmandu. I said, okay. I didn't know what I was going to do after finishing this nine-month of studying history of art with Nelson Wu,

who was a Chinese-born professor at Yaleu who was a chinese born professor at yale who was on a fulbright scholarship and we ended up going up to nepal and knocking on the door and the ladies at the mission hospital said well you don't we don't want you here but then he finally came back to town after i sat around for a few days and said oh i'd love to have you and hang out with me so we would see patients together in these little one-room clinics in the valley of Kathmandu seeing beautiful Nepalese people. This was 1959, so a long time ago. Nepal had just opened up to the outside world.

Before the hippie tyrant came through, right? Nobody could go there. But we were just in the first couple of years of that and during the same year the tibetans began coming over the mountains because they were having trouble with china but uh and uh edgar was a retired uh cardiologist from wilmington delaware um with his, who had decided that after being in practice till age 65, it was time for them to go and do something that they always wanted to do, and that was to go out and do something out in the world which was for the good of the world.

And so they ended up in this missionary hospital. They were Methodists, devout, but they were accepting of my sort of more liberal inclinations. And so he said, yeah, sure, come on. But he would, we saw all sorts of what medical students would call pathology, sick people, one after another, with things that were common in a country which was quite excluded from the rest of the world and yet had soldiers from the the gurkhas who were enrolled in the british army for generations so they brought a lot of sort of nasty things back to nepal and so there were a lot of sort of what you call interesting diseases if you're a medical student and he would turn to me after each patient and say sydney have we done everything we can for this patient and he said it in a repeated way but it wasn't spooky that he said it over and over

again it sort of went with the rhythm of things so when i went to medical school i this was now between my junior and senior years at yale and when i went home i finished my senior year and then i went to medical school in medical school i said have we done everything we can for this disease disease right at an early stage in my education i found myself on the fork in the road that says that the patient is the target of treatment and then they turns out that patients are all individual and whereas diseases are kind of groups and really not things anyway they're just ideas well let me just stop you there for a minute that is a very big statement that diseases aren't things they're just ideas we have about

things exactly and and this is what's gotten us into trouble in medicine we say someone has autism or rheumatoid arthritis or diabetes but the truth is that those aren't all uniform and there are many different causes for those same diseases in different people and in fact if we don't have the right map, we can't figure out how to fix it. And you have been the map maker in functional medicine helping us navigate. Well, the point is that the giving of a diagnosis

makes the doctors look good. Like, I know what you've got. That's what we're trained to do. We're trained to basically make a diagnosis and not think about the why, but just what disease people have. And if it's sprained ankle or a strep throat i've got no argument about that that's fine that's an acute disease but we have not in a generation when chronic illness has become the main burden of people these days one out of every two americans we haven't shifted our

language out of the acute illness model, like I know what you've got, it's a sprained ankle, I know how to fix that, or nature will fix it for you if we put a bandage on it, to one in which I know what you've got, it's autism. And then the parents who are already in a pretty anxious state about what's wrong with our child who can't talk and can't behave. And I think, oh God, I'm so glad you know what it is. And then I think, well, but what do we do about it? Well, and it depends on the doctor, but in the way I was educated, the doctor basically says, we don't know.

For a generation, the doctor would say, well, it's his mother's fault. But fortunately, I wasn't caught in that generation, although I was educated that way at Yale. Yeah, I'm sure you were. At Yale in 1960. Refrigerator mothers. Refrigerator. And they showed a movie to the medical students

in my second year of medical school in the psychiatry department of a dignified doctor sitting behind the big mahogany desk with the parents sitting over there in lower chairs. And the kid was out of the room. And the doctor said, well, George and Mary, I'm sorry to tell you that your child has autism and there's nothing to do about it.

And so don't look for answers. Actually, those were the words in this video. This is for training medical students how to talk to the parents of a child who has a chronic illness. Don't look for answers and of course that was a little bit better than it's your mother it's the mother's fault because she's something cold mother that was way they were taught before then but it shows you how completely off base but then look what has evolved then since then when we began to look at autism uh and say 25 years ago more carefully by because seeing now a larger and larger number of children from one in 5,000 to one in 68 yeah almost one in four boys and and as the as the

the numbers built up there was a lot of denial about it not being a real increase that was oh just we recognizing them better it's all kinds of hiding places where experts went and hid themselves from the reality that this was a real epidemic so so then uh along along came the word spectrum and of course it turns out to be a very important word in medicine because it as it happens you and I agree that all illnesses are a spectrum. Absolutely. But autism was the first illness to wear that in popular language as a garment to come to the party with, I'm in a spectrum. And meaning there's a large range of different kinds of manifestations of it from one end of the spectrum to the other.

And then at that point, instead of, and then of course, the relief that parents felt very transiently, like, I'm glad you have the diagnosis. We didn't know, we thought he was retarded, we didn't know what it was. Now it's autism. But then it changed to, well well he's in a spectrum now the doctor feels better because the doctor's kind of off the hook in terms of the specificity of it but now the parents feel lost because there's this broad range can he move on the spectrum what does that mean and but because the doctor has lost the kind of pretension of specificity

and like, I know what the deal is, it's like, well, it's a spectrum. And then that is incapacitating to the parents, like, well, what do we do about that? And then, of course, there were very wide differences of opinion and still are among so-called experts in regard to how to think about this particular child who has this particular label. Yeah. Well, it's interesting, you know, you talk about, you know,

the diagnosis and in autism, you know, there's certain characteristic features like lack of social connection, interaction, interaction repetitive behaviors language challenges and we go oh you have these characteristics that means you have autism but that doesn't tell you the cause the cause of the autism it just tells you the name of the autism the name of the disease which doesn't help you to figure out what's going on and you know we're at the annual conference of the institute for functional medicine and this morning dr alio Fasano got up and who's a Harvard professor, one of the world's leading researchers in gluten and autoimmunity got up in front of 1500 physicians and healthcare providers and said, we did a study with fecal transplants in autistic kids. And we saw not only did their GI symptoms get better and their gut

get better, but there was persistent behavioral improvements by changing the poop in these kids now that is totally kind of turns our idea of autism upside down from being a brain problem to being a systemic problem that affects the brain exactly and as you can imagine in that connection the doctors who had a specialty, such as child psychiatry or psychology, which is kind of the first places where children with these developmental problems would end up, is referring to doctors with those kinds of training. Those are generally doctors who are not

very friendly with poop. Yeah. Well, they're working on the brain. They're psychologists or they're psychologists. As a matter of taste. We're looking at the wrong end of the business there. They're not supposed to talk about poop. In fact, my best friend is a psychologist and we were talking about one of his difficult patients and i said well is he constipated he said well i don't know i don't ask my patients such things yeah i thought randy that's crazy yeah well i remember sitting in your office you know over 20 years ago and you're asking every parent about their child's poop and it was fascinating to hear the results of that question which was well it's different it's autistic kids have different poop they're sticky they're smelly they're strange they're pasty and they're very different than

everybody else's poop how could not not be relevant to what's happening absolutely absolutely i should just take a little diversion in terms of the first questions to ask to explore with the parents of people that we're talking about and this is true of all patients no matter what's wrong with them is that the first thing that we want to know is what are your strengths you go to the doctor's office whether you're a a fancy lawyer and getting millions of dollars for your work and being brilliant in new york city and you go to the doctors and you're wearing this Johnny coat and all the things that are wrong with you, the doctor wants to know about. Now, the lawyer can maybe withstand that.

For parents of a child, the important thing to begin with, the first question is, what are his strengths? So in my questionnaire, I want to know up top all the different and you check off the different strengths and it turns out the kid has lots of strengths and some of them have extraordinary strengths i mean really strengths of a genius yeah but which a little bit hidden in a child who can't talk very well so when i see children who come to my office i happen to have an office which is in my house which is that people seem to be accepting of that but i have a swing outside one of these rope swings we as a seat that's very comfortable and wooden edge and child can sit there come feel very secure and i get him

a gentle push and then a little bit bigger push and a little bit bigger push now i can see the parents faces because they're facing the child and he's facing them and then pretty soon i see the parents faces smile and i know the child is smiling like this swing is pretty cool because this is on a 50 rope, so you can visit a nearby planet. And so I get it really going. And this child is now feeling wonderful and doing a great job. And then when he gets down and is ready to go to the office, then I said, Charlie, you are great with a swing. You're a terrific swinger yeah so he

gets to hear something good about himself yeah he has been to doctor's offices where he listened to conversations yeah about all sorts of things he can't do right and so this is all about healing and healing comes from the strengths that our bodies have and you can you can stimulate it a little bit just about talking about the strengths and make him feel like yeah i'm not such a loser and uh so before we get to the poops uh we we have to begin with with that but you're right when we began to see when i began to see a lot of children with autism and i felt quite overwhelmed because it was a foreign territory to me the first the first my first experience with a child in the in the so-called spectrum was when i was a consultant for a sort of institutional setting

people were you know stayed there all the time for people near new haven yeah and uh and i had to do an annual physical on a young man who the nurse told me he was autistic and i'd never met a kid with autism before and i was as a pediatrician yeah even my pediatric training it was so rare and it was rare in fact in in the psychiatry department say well this is what autism is all about but you'll never see one. But there I was, and I was supposed to do an annual physical, and I must have been a little bit nervous about, well, he's autistic, what does that mean? And I didn't take off my glasses, which I always do when I look through the ophthalmoscope, you know, to look in your eye. And so I put my hand on the back of

his head as I do to sort of get the contact right. And he hauled off and he stalked me right in the middle of my forehead. My eyeglasses went in two pieces onto the floor. And I thought, my God, what accuracy. This was the most scientifically thrown blow to the head that you could imagine. And thinking about it later, I thought, well, he was sending me a message, non-verbal message, like, Dr. Baker, you're looking into me, but you're not seeing me. I mean, he was a non-verbal kid about 14 years old and and he sent me a message that was really important in my development as a doctor because i just often think wow what is this all about it's not that he's unskilled he's in fact ready for the ring and yet he rang my bell

and made me think well this is something I should learn more about. So you have this quality, which is very rare, which most doctors see what they believe. They don't believe what they see. And, you know, some people see things and actually don't ask the questions about what's going on underneath it and that's really an extraordinary talent that has allowed so many of us like me and others in functional medicine to actually be able to sort of incorporate these ideas into our practice well thank you it it is um it's like that that quote you know you see what everybody else has seen but think what nobody else has thought yes that's an amazing quality

well some of the thoughts can be quite simple but some of the guidance that i have gotten has all been from my patients my the stories that people tell me we live in a world where we have meetings like this and people talk about double blind placebo control you know scientific studies to prove this or that but really most of us have learned what we know from stories. From our patients. And when I left my full-time faculty job at the Yale Medical School, kept my appointment in medical computer sciences, but I was a full part-time.

But I went out to be a real doctor because that's what I figured I was quite good at. And I had a patient who was a serious guy, a regular businessman. They wanted a family doctor, and I was the appointed family doctor for this health care plan. And so I was going through a history with him you know have you had any operations or illnesses or allergies and he said yeah i have an allergy i said what is it egg so oh really i saw i wrote down egg allergy and then we had pretty much time at that point

in the beginning of this health plan to stop and chat a bit. I said, well, what happens if you eat eggs? He says, well, supposing I go to a dinner at somebody's house and I tell the cook, the lady or gentleman, whoever is making dinner, I can't have any egg at all. I'm very allergic to it. But it happens that the cook stirs something, a pot on the stove that has a little egg in it, and then uses the same fork to stir something else. And he has a taste of that when he's at the dinner table. And a few minutes later, he ends up on the floor

with violent vomiting and diarrhea and basically out of it. And I thought to myself, holy, you know what? This is amazing. This is a real guy and he's telling me a real story. There's no doubt about it. And I think, well, what if there are other people out there who are so sensitive to eggs, but that doesn't quite produce the spectacular symptom that allowed him pretty soon in life to figure out what was the connection between what I just ate and where I am on the floor here. And so I thought, well, there must be people out there with sensitivities to things that are hidden.

And that gave me the idea that if somebody is chronically ill, maybe there's something that they need to avoid. And if they did, then nature would do the healing. Yeah. What a novel concept. Because I thought, well, this is pretty rare. This doesn't happen very often. But it turns out it's almost always the case

of people with chronic illness. I mean, to be able to spot what it is that they're sensitive to. And it can be many things, right? It can be toxins, allergens, microbes, gut bacteria, stress, poor diet. It's a long list, but really, when it comes right down to it,

it's not that difficult to even scope it out by having a conversation with somebody about, well, when does it happen and how often? You know, be a little detective. Yeah. I mean, there are fancy blood tests and skin tests and things for all that, and I've done all those things, but really an intelligent conversation is a good place to start. What an idea.

Talk to people. Yeah, and get them to think about it in these terms and uh because a lot of people have sensitivities and haven't really thought that this could be from something they're eating or they're exposed to or the paint that they just i mean this is still not really accepted in medicine that there are things that are disturbing us that we need to avoid to feel better and particularly food i mean we know if you have celiac gluten if you have lactose intolerance you avoid lactose but for the most part most physicians don't consider food as a trigger for illness and yet it's probably the biggest trigger it really would it put me at odds with my yale colleagues they didn't want to talk about this, well, send them to the allergy clinic.

You know, that was, then the allergy clinic, they didn't really believe in food allergy. So, but, so now there's another patient, a lovely woman from Cape Verde Islands with two kids. She's joined the healthcare plan where I'm working because now she has insurance and she can see a doctor

and she has the worst migraine headaches in the world she's just every every month monthly cycle she's crippled with a migraine headache and i think i'm being brilliant to say well this is a migraine headache because it causes this wicked one-sided special kind of pain migraine's not the cause of the pain it's the name of the pain. Right, exactly. But I thought at that point, wow, you know, I know the name of it, smart me. I said, I knew what you should do, go see the neurologist. So she goes to the neurologist, and he says, yeah, you have a migraine. And they gave her migraine medicine and made her sick. And everything, in those days, there were only a handful of migraine medicines, and they all made her sick. So time went by, and she back to me and she said, well, I figured it out.

And I said, what happened? She said, well, I went to see the chiropractor. And in those days, no longer me, but in those days, a Yale graduate would have thought a chiropractor was the devil's work. But of course, now I admire my chiropractic friends and colleagues tremendously. And the chiropractor tested her and said,

you should take magnesium and vitamin B6. And she did, and the migraines went away like that, and I was educated. Yeah, you're kind of the father of magnesium. I remember I learned that from you. So then I would tell my friends at Yale, smart people, obviously, and I'd say, you know, I have this patient who has this wicked migraine, and this happened and that happened,

and it turned out that she took magnesium and vitamin B6 and the migraines went away. Do you mean to tell me that you think that migraines are caused by not having enough magnesium and b6 i said no i'm talking about this woman had this problem this one individual had this relationship with magnesium and b6 and but there must be other people sort of like that and of course there are there's a big story magnesium and b6 but my colleagues were so hard on me because I had a label for it, and they knew what that label meant.

This is just so classic for how we think about disease, that we just get so stuck on it, and we can't believe that something simple like magnesium makes a difference. And it's really the thinking that's different, and it's challenging the paradigm. And now we know that. I mean, I remember learning that from you, how important magnesium was for anything that twitches or spasms.

That's what you taught me. And so whether it's constipation or muscle cramps or headaches or palpitations or anxiety or insomnia, anything that's sort of irritable or twitchy. And I had this one woman, she was a radiation oncology resident at Mayo Clinic, and she had the most treatment resistant migraines. The only thing that would barely touch it if she took Oxycontin and Zofran, which are narcotics and anti-nausea medication, she would go into the bathroom and throw up and try to get through it, and she barely could function. And she came to see me and I said, well, why don't you,

we talked about it. She had anxiety, she had constipation she had palpitation all the other magnesium soon i said why don't you try magnesium she needed like 2 000 milligrams of magnesium and then her migraines completely went away her constipation went away and then over time she needed less and less but you know it was it's such a simple thing but you know it doesn't mean that every patient with migraines has a magnesium problem it It's that patient. Exactly. And you're sort of the original gangster OG guy on personalized medicine, which now is the in thing.

But you were thinking that way way before anybody even was talking about it. Yeah, but where did I learn it? I learned it from listening to my patients. You know, it's these stories that taught me a lesson that was enduring which is enduring and now as far as magnesium is concerned while we're on that subject the the incidence the prevalence of unmet needs for magnesium to put it you know it's fancy talk but unmet need is a little bit different from deficiency yeah because the needs are different in different people. So unmet needs for magnesium, which gives this picture of being uptight, either muscular tightness or mental tightness,

like anxiety or muscle cramps or, as you say just now, constipation. And so if somebody's constipated and they're going taking all these things from the drugstore to poop, the idea is to get some magnesium citrate and take it in increasing doses until you're pooping good maybe a little too much and then back off and but till you're having two good poops a day and then see what happens to the rest of your stuff but the prevalence of unmet needs for magnesium in the population that we take care of is enormous it's and a normal blood test don't help us that much and that's the thing that doctors don't know

about it because no way to test it right the only way to test it is to get a 24-hour urine and see how much magnesium is coming out and without changing your diet or supplements at all you take another 24-hour urine but after giving a big shot of magnesium in each butt yeah and then you see how much magnesium is retained by the person so it's a magnesium loading test well you can't do that in kids no and the magnesium magnesium doesn't come out it means you're deficient because your body's yeah and i would when i started doing these tests which i was you know taught to do this by herman baker who was a professor of medicine at university at new jersey state medical school was called in those days and uh and you and people who would retain a hundred percent of the magnesium that you gave them, like their body is saying, wow, I really needed that. But if you just took a whole bunch of people

who are walking around and you measured their magnesium retention as a measure of how much they needed it, most of them will be abnormal. So why are we all so deficient in magnesium? Because we don't getient in magnesium because um we don't get enough in our diet which comes from because magnesium comes from all different foods but it all comes from natural foods not purified foods so sugar of course is the the main culprit

here and so um once you get behind on magnesium you the behinder you get, the more behind you get. So the losers end up to be disadvantaged. So we have a deficient diet in magnesium, which is a lot of greens and beans and nuts and seeds. And then we do things like caffeine and alcohol and sugar and processed foods and stress, all of which deplete magnesium. Yeah. And then the magnesium expresses itself, as you said a few minutes ago, in all of these different symptoms of being uptight.

Everything from high blood pressure to high tension in your brain to all kinds of heartbeat things and cold hands and feet and menstrual cramps and you know all kinds of different things anything that cramps or twitches or spazzes yeah it's pretty much magnesium and if you deal with that then bingo you get you get a lot of like a genius feedback yeah and i thought that you know getting a prescription pad was a big deal when i got out of medical school oh boy my signature will conquer the world but really most of the things that are effective are natural things yeah but so in this experience with the woman from cape verde islands

and for the guy who is the businessman what i had was a situation where i began to realize well there's these two questions that you referred to. Does this person, we're talking about the person, not the disease, does this person have an unmet special, because everybody's different, unmet special need to get something which, if supplied, would favor nature's buoyant impulse toward healing? What are the raw materials for healing? Yeah, and many people in current culture have special unmet needs. And there's not too many things on that list, so it's not rocket science.

Magnesium is way up there. There are certain vitamins too. So that's one of them. And then the other question is, does this person have a special unmet need to get rid of or stay away from something that if taken care of would favor nature's impulse toward healing and that involves both things that are that you're sort of allergic to but also toxins and so so after five decades of doing this yeah almost six now what are the five things that are most commonly found that people need to get rid of and what are the five or so things that people most commonly don't have enough of and need to get the things

they don't have enough of are magnesium i put at the top that's so it's such a common thing and then um i think in in our current culture the next thing is essential fatty acids that is the omega-3 fish oils omega-3 oils that's a really big issue that uh is uh is something that for practical purposes you really need to take a supplement, but you should be careful in shopping for them because oils are very, you know, a lot of the serious toxins in our environment are soluble in oils. And so if you have a crop from which you're extracting oils, you're going to be extracting some of the pesticides and other yucky things so that you need to be careful to shop for the right brands of

yeah tested yeah yeah tested good reputation and all that so then um i think that another important thing to at least uh scope out in a person with a chronic illness has to do with vitamin b12 and this is tricky because vitamin b12 is made in your digestive tract by germs that make the right ones yeah that make funny b12 so and if you send it to a laboratory to your blood level this is oh you got plenty of b12 here because the normal blood normal laboratories don't distinguish between what's called pseudo b12 that is b12 that's made by germs but they don't make a good kind that we want it's a certain variation on it a counter counterfeit, so to speak. So the simple blood test for B12 doesn't tell you much. So that means that how are you going to test for it?

Well, you could send it to the one laboratory where they test for real B12, which is a laboratory in New Jersey. But the other way to do it is give people a shot of B12. To test it, you can't just swallow it because the doses isn't high enough to really give you a thumbs up if you're if you're on the right path so so gps give people b12 shots that was a good idea yeah when i i used to hear from my professors oh people give b12 shots but then i had one professor who was actually a practitioner in at y I mean, practitioner in town, but he was on the faculty, and these snide remarks about,

oh, doctors who give people shots of B12. He said, no, no, no, it really works, but you have to just try it and see. And then you have to believe the patient, you know, because if they feel better, but I think that it's a fairly common uh difficulty in in our population but it does quake it's just a little tiny bright red shot uh with a tiny needle it doesn't hurt much and um but it it's one of those things that you have to

number one believe the patient when they say yeah they really work number two you have which we don't think is a valid response in general in medicine for the patient. The patient's perspective is not that... What do they know? Their body, well, what about that? But the point is that if you have a response to B12, then there's a really important point. It turns out that the shot of B12 wasn't a treatment.

At first it was a test. And there's so many things that you and I do where we give something to somebody and it seems like, well, we're giving them pills to see, you know, if this is, we think this might be the right treatment. But it's very important for me to explain to my patients, look, I want you to try this for a week or two. And if it's completely safe, which is most of the things we use are safe, and then after a week or two, they come back with their thumbs up,

like, hey, since I started that, I feel so much better. Then I call that a thumbs test and and then if if they feel bad from it and it's something that shouldn't make you feel bad then now we've learned something that we need to explore further sometimes you get one thumb up and one thumb down if you get thumb sideways then means like it's a wash we don't we didn't learn anything except that wasn't wasn't the pick was the opposite of what we would train in medical school was it shall be based on evidence and that the patient's response or the patient's feedback is not really evidence it's just subjective which is a pejorative term and in fact it's probably the most important thing and i i

agree that the way i've learned medicine is not from the textbooks or from conferences it's from listening to the patients and listening to what works and what doesn't whether i get a thumbs up or a thumbs down i'm like oh and i learned things that are surprising like recently i had a patient who had type 2 diabetes really poorly controlled was trying to do well i changed his diet he did great but not perfect his sugar was still a little bit high and he also had a lot of gut issues and he was having all this bloating and distension, and he just reached out to me and as an emergency measure, I said, why don't you take charcoal just to see if you can absorb some of the gas and the bloating and see what happens. And he said, he called me the next time, he said, it was the most amazing thing, my sugars

went completely to normal by taking charcoal. I'm like, well, wow. And then he begins to make you think, why is that? And how did that happen? And what are the metabolic toxins that are driving his blood sugar up? And how are those maybe being absorbed by charcoal? And how do we even rethink how we're approaching? So not everybody with diabetes needs charcoal,

but some people with diabetes caused by a leaky gut and gut inflammation and bad bacteria might benefit from it, right? Activated charcoal is such an important diagnostic tool yeah for a thumbs testing like this it it's very important in a certain approach that i take based on people who have yeast problems that is yeast is before you get into the yeast thing dr baker you know you has really been the leader in educating us about yeast. Everybody talks about Canada and I have Canada. And I think a lot of that is over-diagnosed,

but where those patients was really an issue, it's profound what happens. And you sort of have discovered this through your work in particular with autistic kids and others. Well, it's a big deal. The yeasts are funguses. They are used for making bread and beer and wine. Human beings began using yeast for fermentation and for baking 10,000 years ago for fermentation and a little bit more recently for knowing how to bake raised bread. But the same germ that is in there has cousins which also like to live in the human body and they especially like to live in the human body if the human body is eating sugar which people eat a lot of and yeast like to eat sugar and then when they eat the sugar

they say to the person eat more and so it makes the crave people crave sugar and they get into a sort of vicious cycle and moreover when you take antibiotics it kills germs in your digestive tract that invite the yeast to come and picnic there and that picnic ground in your digestive tract and so everybody knows the takeover yeah and everybody knows that i think everybody knows that if you take antibiotics, if you're a woman, you're likely to get a vaginal yeast infection. And that's mainstream medicine.

That's not a strange idea, not a strange observation, but it's well known. So could it not be that people who have yeast growing in their gut have mischief made by it? And the answer is yes. And if you look across the board, just to generalize about it, if you look across the board of chronic illness,

which is mostly based on what we call a loss of tolerance, that is your body is supposed to tolerate most things in the world. Your immune system is supposed to tolerate when if you breathe a little dust or a lot of things that are perfectly harmless, like pollen in the atmosphere or peanut in your food, these things shouldn't bother people. And if you go to some parts of the world, there's nobody there who is bothered by these things. When I was in Africa for two years, I never saw a single person who had an allergic or autoimmune problem. Autoimmune simply being you can't tolerate something that's living in your own body. You're kind of allergic to your own joints or something.

And allergic, of course, is the other side of the external world so there the epidemic of chronic illness that we have now is from the best way to put it i think is from the loss of immune tolerance so now we can't detect self from other exactly and we can't detect friend from foe in our food or an environment yeah the immune system has this extremely valuable gift this property of tolerance and tolerance in any complex system whether it's a social system or a political system or a mechanical system tolerance and diversity are two really important property so the human being should be able to tolerate all kinds of stuff unless it's a strep germ or a TB germ or something that really should be targeted as an enemy.

So people living in our culture have lost tolerance. And one of the chief reasons for that is that they have, from eating, getting antibiotics, it changes the germs that live in your digestive tract, or too much sugar, which changes what's in your digestive tract. Or even flour. Yeah, or even flour. Which is like sugar.

Yeah. They have too many yeast growing in them. And this makes the immune system crazy, and it makes it crazy in the way of losing tolerance. Now, the good reason for... So that means you react to more things and you have more allergies and more food reactions. Yeah, you get sensitive to all kinds of things. And that sensitivity can be all sorts of allergies.

It also can be sensory sensitivities. That is, the word sense is a good word because it crosses an important bridge between our nervous system, which runs our vision, taste, touch, smell, our senses. But those senses become more sensitive in a bad way. And you see this in children with autism. Yeah, they become more irritable. They can't stand loud noises or bright lights or taste of certain foods or touch and so that their whole nervous system is awakened in the same way that their immune system is awakened and their immune

system and the nervous system are really all just one one one department i remember listening to you speak about that in some cassette tape i had 20 years ago how you know we have our sensory systems right the nervous system senses the macro world the immune system senses the micro world yeah and people when they lose tolerance they both of these things happen together get more too sensitive now so losing tolerance is an important way to help us think, because then comes another really important word, is restoration. How do you restore tolerance? Yeah, if you go to a doctor, the doctor is usually going to give you something that your body's never had before, a pill.

But if you go to the doctor and the doctor says, well, I'm going to restore something to you that you've lost. Hey, that's a bargain. Because it's not that you're getting something new your body's never seen before, but you're getting something fixed that has gotten out of whack by way of being too sensitive you've lost tolerance and now we're going to do something the restoration of immune tolerance that's the and how do you do that with people how do you let's just talk about that we have a few minutes left so i want to get into some of the practicalities you want to you want to fix the germs that live in the digestive tract and there's two fixes for it one is to get rid of the yeasts and there's a there's a there's a of all things there's a yeast that kills other yeasts now it's got a long fancy name

yeah saccharomyces boulardii and if you if you happen to belong to a crime family you know there's certain families that are in the criminal business. And a few of them is patients. And let's say one of them is, you know, named George. And it turns out that George has to be killed because there's one way of dealing with people who step out of line in a crime family. He's working for the other guys. And so how are you going to kill george we get george's cousin to do the hit because he can get in the back door yeah so here's a yeast

called a yeast that's called saccharomyces which stands for sugar fungus in latin and and it's saccharin right yes saccharin is like the word for sugar but saccharin is that it means the the sugar fungus is the fancy word that we call saccharomyces and that's the name for baker's yeast and brewer's yeast but there's a cousin of baker's yeast and brewer's yeast a close cousin has just a little bit different last name. And it was discovered in what used to be called Vietnam in the old days, when it was a French colony, by somebody who knew that you could get this Saccharomyces boulardii from lychee nuts and give them to people with cholera and it would cure the cholera and the word got around and finally he took it back to france and this is something you can buy

pills called saccharomyces boulardii now this kills yeast better than anything else because it's a yeast that knows how to kill other yeast and it does a brutal job of it and this is where the charcoal comes in if you take the saccharomyces boulardii and it gives you all kinds of weird symptoms you didn't want, that's because it's working. Because the toxins are coming out. Now you take the charcoal, you feel better. And now this has been a thumbs test. And that's where you get your own body to tell you what is going on.

And it's even more important than a lab test. So the loss of immune tolerance. And thumbs tests are cheap exactly very cheap and safe too safe you can have some symptoms but then you know why you're getting the symptoms and do the charcoal so the point is that the word restoration then comes restoration of the immune tolerance by restoring what restoring the microbiome which is the name for all the germs that live in your gut and it has become um it has become broken in a way because the good too many the good germs that live there have a burden of too many yeast that are living in there

so they mess your immune system up and make you sensitive. So that's one way that they restore the microbiome is the name of all these. How do you decide if someone needs an antifungal or saccharomyces? I mean, what are the things you look for other than them getting a vaginal yeast infection? Well, if they're very sensitive to a lot of things. Basically, if they live in America and and eat like americans and they've taken antibiotics they probably got some time in their life or they eat sugar they crave sugar there's

certain particular symptoms that are kind of tip-offs then i've seen in my practice it's been extraordinarily helpful to treat it and i do worry about giving prescription antifungals because of resistance and other, any fungal agents that can grow as a result. Well, the nice thing is with the Saccharomyces boulardii, you can get it at the health food store. It is a potent yeast killer. And if you get negative symptoms from it, then you know you're on board.

And then you have to navigate that, but it's not rocket science. So you get all the results from your own body. You don't have to believe in something on a piece of paper. Then if you get really a good response, but you need to double down on it, you can use prescription antifungals, and they sometimes are miraculous. And I don't think we have time for another story about that because i want to talk about one other issue here and the other so there's one thing about the germs that live in your gut there's too many yeast and then there's another side to it that we have lost certain things that belong in our gut that the presence of which is restorative of immune tolerance. And that is things that we call parasites. But parasite is the wrong word.

And they are a gift from nature that have been with us since the beginning of time. And over the last few generations, in people living in our culture, we have lost these commensal organisms, that is, this natural presence of these things. So I learned about this when I was in Africa as a Peace Corps volunteer in the 1960s. I saw thousands of beautiful people. I mean, the people that I took care of in Chad were beautiful people, beautiful skin, hair, eyes, teeth, everything.

They were living the old-fashioned way. They were not living in these big, you see now on TVs, around big cities, these slums with all these tar paper shacks or acres and acres of poor people. These are people living out in the countryside, living the old-fashioned way, which means no soap and water.

They have water, but no soap, and they don't have regular toilets and stuff like that. And they have what we taught in medical school to be called parasites, different kind of worms. It turns out that if you have those, you do not have these sensitivities, autoimmune disease, and you don't have allergies. I saw thousands of different healthy people. Some of them were really sick with all kinds of things that we took care of.

Tropical diseases, yes. But we didn't see anybody with autoimmune and allergic problems. And this, in the 1960s, was an observation that could be made pretty easily by trained eyes. I mean, you talk to a missionary and say, you know, he's been there in the country for 30 years and he's never seen anybody with asthma who's a Chadian. Whereas, you know, in the United States, everybody has asthma now. So, but by the 1990s, it became mainstream science that people who had these organisms living in their gut because of having those they don't lose tolerance so that their immune systems were terrific at not

becoming too sensitive so nowadays we have a way of raising a certain kind of little creature that has been is like the things that have been with us for since the beginning of agriculture and we can put them in a little vial and send them to people and they take a couple and their allergies and their autoimmune things go away yeah i did that with one patient it was very allergic and he had a level of GE, which is the antibody that fights allergies, of like over 1,000. And within a few weeks, it came down to normal. And I was like, wow, this is interesting.

When it works, it really works. And the nice thing is that they're safe. The principle, I think, is a good word for people to learn, is BROCS, B-R-O-C-S. B stands for benefit. R stands for risk. O stands for the odds. What's the likelihood this thing is going to work? C stands for cost. And S stands for stakes. And a lot of times when doctors and patients make decisions together, they don't think about the stakes so much. They

say, what are the odds that this is going to work? But the stakes are really important. Let's say you have something well they're just a favorite subject of mine these days is alopecia your hair is all falling out and and bunches and it's very it's not especially yeah it's very bad for women especially but it's nobody likes to have hair looking really weird and this is an autoimmune problem with antibodies to your hair follicles. And the stakes are really high. I mean, if you could fix that, that would be great. Huge.

And so if people take these little dudes that I call them, these little organisms, and their hair grows back, well, then their autoimmune problem has been cured by taking these little things. And the cost of it isn't reasonable the stakes are high the odds are good 50 50 anyway in young people their odds are not a little longer in older people because their thing is more established and the risk is really zero and so the benefit is huge so the brox comes out to mean, yeah, let's just try it.

You know, you need to take maybe six doses to know whether you're on the right track. And so we get to see these two things functioning in the world of illness in our culture, where there's a lot of autoimmune and allergic problems, in which the restoration of the microbiome, the germs that live in the digestive tract, restores immune tolerance. And that is, the two sides of that is either needing to take something to kill the yeast or taking these little critters to go and live in your stomach, in your intestines for a little while and establish immune tolerance and the thing that is striking about this model of alopecia is that here is a

classic autoimmune problem with antibodies against your hair follicles so it's you know it's pretty well established that that's what it is and now i have patients who have been cured by taking one of these either one of these treatments either the antifungal thing yeah that's where i started years ago maybe 20 years ago yeah a boy who came to see me from rhode island and you're not gonna be gluten too and with uh yeah but with but with just with an antifungal medicine his hair grew back in patches over the next two years we were very slow because those days there's this new antifungal was new on the market it's really now very benign but i didn't have much experience with it then his hair grew back in patches and he now he's he's a he doesn't he didn't need any more treatment now he's's a famous musician and he has full head of hair.

You got to be long-haired to have a rock star. Yeah. And that's the same condition that the loss of your hair with other patients has been just from the little dudes that I was talking about. Had a little girl come down from Connecticut. Her hair was all falling out. And I said, here, you can take some antifungal medicine and take the dudes. And six months later, I called her mom.

She'd been taking these during this time. I said, well, how is she doing? How's Isabella? Oh, we're so happy. Thank you so much. Her hair has all come in now, and we're so pleased. And then she kept taking it for another six months. And then they figured, well, the hair is doing fine.

Let's just stop. And she's cured. So the word cure and autoimmunity don't really go together. So that's a... Well, you've always been pushing the way we think, whether it's magnesium or omega-3 fats or the gut or yeast or now helminths and worms for autoimmune disease uh even throughout your whole life you've never stopped asking the questions and that's what's so extraordinary

about you dr baker and i'm just thrilled that you've been here on the doctor's pharmacy a place for conversations that matter i want to leave you with one last question which is if you were king for a day and you could change something in healthcare, what would it be? Or how we think about medicine? Well, I put you in charge of everything. No, no, I don't want the job, please. You have become the leader in our field of medicine

and I am so proud of you. I love you so much for what you have done. It is really a stunning job that you've done. Only on your shoulders, Dr. Baker. Without you, I don't think I'd be anywhere because all the ideas that I had were not original. they all came from you but you you climbed aboard that stallion and you have you wrote it in the rodeo and you have you have tamed the beast you have really gotten now to secure the position of this kind of thinking in the public square where we all want to be able to do good for the world that's true i was just at cleveland clinic meeting with

the head of cleveland clinic in florida he said i can't believe how many times in the last month i've heard people talking to us our patients about functional medicine and this just wasn't the case yeah nothing your what your thing has what your career has done so far i mean this is just you're just getting started i can't wait to see the rest of it but it is the perfect example of the lovely hebrew expression tikka molam for the good of the world prepare the world to kunalam yeah yeah it is um it is a really uh a treat to be your friend and mentor and uh admirer it's just uh you're you're put together the most remarkable bouquet of skills to build this uh thank you wonderful wonderful outcome for all of us thank you well i really appreciate you dr baker and uh

our friendship over the last few decades and what i've learned from you is really helped thousands and millions of patients literally millions of patients and you're kind of the unsung hero and I'm just honored to have this conversation with you. Please leave a review or comment. We'd love to hear from you and it matters. Also, if you like this podcast, share with your friends and family and subscribe on iTunes. And we'll see you next time on The Doctor's Pharmacy, a place for conversations that matter.