The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Understanding Autoimmunity

Episode Date: May 31, 2022

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Hey podcast community, Dr. Mark here. I'm so excited to offer you a seven-day free trial of my revolutionary new platform called Dr. Hyman Plus. For seven days you get special access to all the private content included in Dr. Hyman Plus entirely free. It's so easy to sign up. Just go to Apple Podcast on your phone and click try free button on the Doctors Pharmacy podcast. You'll get exclusive access to ad-free Doctors Pharmacy podcast episodes and functional medicine deep dives where a practitioner dives into topics like heart health, muscle health, insulin resistance, and more to help you understand the root cause of specific ailments and walk you through the steps to improve your health today. You'll also get access to all my Ask Mark Anything Q&As,

where I answer the community's biggest health and wellness questions. Because I'm so sure you're going to love this platform, I'm offering you free access to all of this content for seven days and a teaser of my brand new functional medicine deep dive episode, diving deep into one of the most important topics in health. Head on over to the Doctors Pharmacy podcast on Apple podcast and sign up for your free trial right now. Okay, here we go. Hello, my name is Dr. Alroy Vojdani.

I am a physician practicing in Los Angeles. Our clinic is dedicated to treating chronic complex autoimmune conditions. And appropriately for today's deep dive, we are going to be looking into the world of autoimmunity. So our objectives for this lecture are first and foremost to really understand what an autoimmune disease is. It's important to understand that autoimmunity is something that is dramatically on the rise in today's modern society. Conservative projections have us at about 15% of the current population suffering from a known diagnosed autoimmune disease, and those numbers are rapidly escalating.

For reasons that we'll go through in this lecture, we expect another big push in that direction, unfortunately. So we need to understand the mechanisms of these diseases and what we can do to push back against this growing epidemic. Our second objective is to see how malfunctions in the necessary defense and repair mechanisms of our body caused by the environment are responsible for the induction of autoimmune disease. To understand that, like many complex disorders, autoimmune diseases take many years to develop. That's very important in understanding the entire path to autoimmunity because as we'll see, many autoimmune diseases have paths that include 10 or 15 years between the development of the

initial problem and the development of symptoms, which provides a beautiful window of opportunity in which we can intervene to prevent that end debilitating state from ever occurring. We just need to know what to look for and what causes the abnormality so we know more importantly what to do about it. So what is an autoimmune disease? Autoimmunity is the failure of an organism to recognize its own constituent parts as self, right? We consider this the primal sin of the immune system. More than anything, our immune system has to be able to decide self versus non-self. So friend versus foe. If it attacks friend as foe, then you're attacking your own tissue. And that is a major dysfunction of this very complex part

of us that is designed to protect us. So if you attack your own self, that results in an immune response against your own cells and your own tissue. This is a disease from within. So your own defense mechanism, making a mistake, attacking your own tissue, and the term for this immune response is an autoimmune disease. There are many autoimmune diseases that we know of currently, more than 80 known autoimmune diseases. That list is growing continuously as we identify that many of the chronic inflammatory diseases that we know of actually have very significant autoimmune components. A good example of that is that we're learning that there is a subset of patients who suffer from IBS that actually has an autoimmune component to it. Other things that we're learning have autoimmunity associated with them are neurodegenerative diseases like Alzheimer's

and Parkinson's. So this list will continue to expand as we understand these processes more and more. All right. As I alluded to in one of the prior slides, autoimmune disease has a very big window of disease development to symptom development. So we simplify that window into discussing three stages of autoimmune disease. Stage one is called silent autoimmunity. This is where the immune system has created the error due to an external influence, and it is now producing antibodies against its own tissue, right? It is silent because those antibodies haven't resulted yet in significant inflammation or significant tissue damage or destruction. So it's not something that one can necessarily feel because the symptoms of the actual autoimmune disease

haven't presented themselves, right? Typically, patients will have other vague chronic inflammatory issues that suggest that perhaps silent autoimmunity itself is present. So chronic digestive complaints, brain fog, lack of energy, joint pain, skin rashes. These are all signs of an activated immune response and the potential for there to then be silent autoimmunity. The most important thing, as we'll discuss in the next slide, is to make sure you're identifying this process as early as you can. So when physicians in my field see patients who have these chronic complaints, of course we want to identify them and work on them, but we want to make sure that this patient isn't walking towards an autoimmune disease without them knowing. So understanding that those vague complaints may actually be related to an underlying autoimmune

process is perhaps the most important thing to take away from this lecture. So stage two of autoimmunity is called autoimmune reactivity. So the antibodies have been floating around in the bloodstream. So they're attacking and attaching themselves to your own tissue. And now inflammation is starting to follow that. And the inflammation is what we feel, the aggression from the immune system. So let's take an autoimmune joint disease. So those auto antibodies have been circulating. Now they're slowly starting to bind to the joints. And as they bind to the joints, they recruit immune response. We send out chemical signals saying, hey, there's something going on here. There's a fight happening. And we feel those signals. So that's where we get the pain, the burning sensation, and everything else that

follows. So stage three is a full-blown clinical autoimmune disease, right? So depending on the autoimmune disease, this problem has been going on for five, 10, or 15 years. Now there is joint destruction. The typical autoimmune markers will start to become positive here. And that's where someone will go into a doctor's office and say, you know, the doctor will turn around and say, blood testing and everything suggests that you have this autoimmune disease, rheumatoid arthritis, Hashimoto's disease, celiac disease. The problem with this is that by the time you're discovered and it's stage three, there already has been some irreversible tissue loss,

tissue destruction has occurred. So the earlier you identify the process, the more successful the treatment outcome will be. And that's what this graphical representation is really meant to show, right? That these stages mean that autoimmunity has different phases, right? You start from the green portion of the graph as healthy, normal functioning, no problem, the immune system is doing what it's supposed to do. And then all of a sudden a trigger comes along, right? Whether that's a reaction to a food that you didn't know about, a viral or bacterial infection that your immune system struggled with and you didn't realize that it was, you were exposed to some cumulative chemicals, environmental toxins, heavy metals, and, you know,

I think very often underappreciated as far as impact to the immune system, a significant life stress will occur, right? Stress has tremendous negative impact on the immune system. So if you couple something environmental with an emotional stressful event, that's oftentimes a formula for the autoimmune, for the immune system to move itself into autoimmunity and for this process to begin. So in yellow, we have autoimmune activation. Ideally, we would identify everybody in this phase, right? That takes a lot of knowledge on the practitioner's front to understand that this is a moment

in which we need to investigate what's happening. And, you know, I don't think that we're there yet at the moment, but the goal is for, with continual education, continual advocating for this, that we look to identify these issues as early as they can. Next, we have stage two and three, the pre-symptomatic and then the symptomatic phase, where you'll see red is labeled the dynamic symptom threshold, right? As long as the auto immunity is identified before there is tissue destruction, you can save the individual or rescue the individual from a debilitating chronic state, right? Once you get into the purple stage three, there is tissue destruction that you can't do anything about. You can do everything you can

to limit further attack and further loss of tissue and further loss of function, but what has been lost at that point has been lost. So we do everything we can to identify the disease in as early of a process that we can. So in order to do that, we need to understand where autoimmune diseases come from, right? You know, what is it that is causing this abnormal signal to the immune system? You have to understand the process deeply in order to know how to look for it and how to do something about it. As I mentioned, autoimmune disease has a very large symptomatic threshold, right? So the understanding that it takes years from the onset of the development of an antibody from the immune

system against serum tissue, in essence, the primal development of an autoimmune disease in the blood versus the actual autoimmune disease on a daily basis takes years, sometimes decades. And that depends quite a bit on the autoimmune disease itself. You know, looking at rheumatoid arthritis, it's almost 14 years. Lupus is about eight. Type one diabetes is 10 years. Autoimmune thyroid disease, seven years. Adrenal autoimmunity, 10 years. Primary biliary cirrhosis, PBC, 18 or 19 years. Sjogren, seven years. Crohn's and ulcerative colitis are a little bit shorter, four and a half years, but really across the board here, we're talking about big windows of opportunity before we get to that dynamic symptom threshold, before there is end tissue destruction that we can no longer do something about. So identifying this process, understanding where it comes from deeply is the

most important thing. And if you identify it early, do something about it by understanding what in the environment triggers that abnormal process. It can make dramatic difference, not only to the patient's life, but the overall burden of chronic illness on our society. So this brings us to the importance of identifying early events. Autoimmune disease is dictated by early events, right? So detecting the immunological response specific to inciting agents is critical for identifying the early events that are necessary for the induction of autoimmunity and other disease. So we believe that the elucidation of the exposome-induced antibody response will provide insights into early events necessary for the creation and expansion of autoreactive T and B cells, a cardinal feature of the autoimmune

disease. So what does this really mean, right? It's just preaching what I've been talking about. The earlier we identify the immunological abnormality, the more likely we are to have clinical success for the person in front of us. And again, there are also downstream ramifications to the burden to society of a chronic debilitating illness, right? So this is in everyone's interest to identify early and treat. Now, the second portion, the elucidation of the exposome-induced antibody response. What does that mean, right? So let's go into that a bit. The exposome is a way of discussing the effect of the internal and external environment on the body, right? So environmental exposure as the major trigger

for an autoimmune disease, right? That might sound relatively straightforward and simple. The truth is that the environment is a very big thing. So how do we understand the interplay between the environment and our immune system? This is a great article from Frontiers in Immunology recently published in 2020, talking about the gut and autoimmune disease, right? In the world of functional medicine, we put a tremendous amount of emphasis on what we eat, why we're eating what we're eating, the impact of the internal state of the intestinal tract on overall health, right? Why is that? That's because the data is very clear and the clinical experience day-to-day for those of us on the practitioner side is very clear. When you make

profound change in a positive direction, as far as what you consume, you make profound change on the immune system itself, right? That's because when we talk about the impact of the environment on the immune system, there is nothing more that the immune system sees than what you eat and the composition of the bacteria inside the gut. It's looking at it all the time, every day, every time you eat, right? So it makes sense that this is the highest yield area where if you make a modification, you'll see success. So this article states that dysbiosis of the gut microbiome is another important environmental factor that has been linked to the onset of different autoimmune diseases.

Altered microbiota composition is associated with impaired intestinal barrier function and dysregulation of the mucosal immune system. The most challenging aspect of autoimmunity is to identify the early events that trigger immune dysregulation and autoimmunity. So two very important things here that we're going to dive further into. The impact of the environment on the immune system is clear. The gut is a very primary place to look for the impact of the environment on the immune system. And when you're talking about environment gut immune impact, you have to look at barrier function and dysregulation of the immune system at the barrier itself.

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