The Dr. Hyman Show - Getting to the Root Cause of Autoimmune Disease: A Functional Medicine Approach

Episode Date: April 3, 2024

View the Show Notes For This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Functional Medicine offers patients many things, especially hope and understanding. Autoimmune disease is a prime example: Rather than condemning patients to a lifetime of symptom management through medication, functional practitioners dig to find the “why,” to address the underlying causes with individualized, multimodal support to create lasting improvement and systemic healing. My guest today, Dr. Sara Gottfried, is a physician, researcher, author, and educator passionate about changing the way we view and treat autoimmunity.  In this episode, we discuss: What is a “trauma signature” and what is its role in autoimmunity? (5:55) Hidden autoimmunity triggers you might be surprised to learn about (21:30) The go-to test panel Sara runs on her patients (27:33) Sara’s stack for reducing cortisol and why trauma has to be considered (39:00) How Trauma biologically impacts you through the PINE system (41:40) Psychedelic therapy and other healing states of consciousness, plus Sara’s personal experience using them (48:10) What Sara wishes she told her 20-year-old self about life (1:15:45) When we dig deeper, we always find out there is more going on below the surface. I know you’ll love this conversation as much as I did.  This episode is brought to you by Rupa Health, Cozy Earth, and Magnesium Breakthrough.  Streamline your lab orders with Rupa Health. Access more than 3,000 specialty lab tests and register for a FREE live demo at RupaHealth.com. Right now, you can save 40% when you upgrade to Cozy Earth sheets. Just head over to CozyEarth.com and use code DRHYMAN. Tackle an overlooked root cause of stress with Magnesium Breakthrough. Visit bioptimizers.com/hyman and use code HYMAN10 to save 10% + free gifts with purchase.

Coming up on this episode of The Doctor's Pharmacy. In a group of people from San Diego who were members of Kaiser Permanentes, they found that when they take these people age 40 to 65 and they ask them about adverse childhood experiences using this questionnaire, a score of zero was no trauma, but a score of one or higher was associated with a greater risk of chronic disease. Hey everyone, it's Dr. Mark. As functional medicine practitioners, we understand the importance of accurate data in uncovering the root causes behind our patients' health concerns. But let's face it, ordering labs to get the data you need can be an administrative nightmare. Luckily, Rupa Health is here with a solution. With their revolutionary platform, you can order

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and I want to share it with you today. Cozy Earth Sheets. Let me tell you, they're simply amazing. They feel like heaven to the touch and their premium fabric regulates your body temperature no matter the season, making them perfect for any time of year. Cozy Earth offers a variety of luxury pillows, sheets, and blankets and more backed by a lengthy warranty. Plus all their products are made from responsibly sourced viscose from bamboo so you can feel good about your purchase knowing you're supporting a truly ethical company. Right now, Cozy Earth is providing an exclusive offer for my listeners. You can get 40% off site-wide when you use the code Dr. Hyman. Just go to CozyEarth.com and use the code Dr. Hyman. And now, let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark

Hyman. That's pharmacy with an F place for conversations that matter. In today's conversation with Dr. Sarah Gottfried, I think you're going to find fascinating because it dives deep into the topic of inflammation, autoimmunity, and hormonal balance. So we have an incredible expert here today. She's a certified physician, researcher, author, and educator. She graduated from Harvard Medical School and MIT. She completed her residency at UCSF, but is more likely to prescribe a continuous glucose monitor and personalized nutrition plan than the latest pharmaceutical. She's a global keynote speaker

and the author of four New York Times bestselling books about hormones, nutrition, and health. And her latest book called The Autoimmune Cure is really great. And we're going to talk about that today. She's a clinical assistant professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University and the Director of Precision Medicine at the Marcus Institute of Integrative Health. She takes care of executives and professional athletes. Her focus is at the interface of mental and physical health, end-of-one trial design, and personalized molecular profiling, and the use of wearables and how to leverage those tools to improve your health outcomes.

Now, in this conversation, we cover a wide range of topics. She's a brilliant physician and scientist. We discuss a lot about her new book, The Autoimmune Cure, talking about the prevalence of autoimmune disease, what causes it, why we're seeing such an explosion of it, and how we begin to think about treating it and how trauma plays a big role in dysregulation of our immune systems and creating inflammation in the body, which is something that we all are experiencing a lot of trauma. And also she talks about the program that she created to break the vicious cycle of autoimmune disease, to reset your immune system, restore your health, a multi-step program. We talked about diagnostics needed and lots more.

So I hope you love this upcoming conversation with the brilliant Dr. Sarah Gottfried. So Sarah, welcome back to the Dr. Swanstein podcast. It's so great to have you here. Hey, Mark. So happy to be here. Now, you've been on quite a journey, my friend. We've known each other a long time, and we had dinner last night, and we talked about a lot of stuff, a lot of personal stuff about our lives and the transformations that happen throughout our life cycle and some of the big insights we've had about healing and medicine and how we deal with the issues around autoimmune disease and trauma

and use of psychedelics and functional medicine. We had this wide-ranging conversation talking about things that are causing so much suffering for so many people. There's so many people who have autoimmune disease, who suffer from trauma, who struggle with all the consequences of our toxic food environment, environmental toxins, and challenges of chronic stress. And living in the 21st century in 2024 is not a simple experience for most humans. We're meant to be out there in caves hunting

and gathering, and we're just inundated with all sorts of inputs that have dysregulated our nervous system, our hormones, our brain chemistry, our moods. And so we're seeing sort of this global epidemic of chronic disease. And one of the most disturbing things, and this is something I've seen in my practice, is the explosion of autoimmune diseases. You had your health challenges and you had a high level of something called an ACE score. And so did I, by the way. I forgot, it wasn't horrible, but it wasn't fun when I was a kid. And it was divorce and there was abuse and incest

and lots of things that are very problematic, let's say, that trigger some type of cellular memory that gets registered in your biology. Carolyn May says your biography becomes your biology. Meaning what happens to you in your life gets transmuted into biological changes that can create health or disease. And so- And maybe your mission. Yeah. Yeah. Maybe my mission for sure. Yeah. So I think in the book, The Autoimmune Cure, you talk a lot about trauma and maybe a little about your own

trauma and what happened to you in your childhood and how that affected you and how you didn't really figure it out until your 50s. and you didn't even know you had this sort of trauma signature you call it and I think that you know we're gonna get into the role of trauma and autoimmunity a little bit deeper right now and I think it's something we don't really talk about you know we talk about leaky gut we talked about nutritional factors and elimination diets and toxins and heavy metals but you know the sort of psycho-emotional-spiritual aspect of our lives that drive disease kind of gets short-stripped a little bit.

But they actually may be front and center and maybe some of the most important things. So what kind of was your story that led to your autoimmunity? Let's talk about that. And tell us a little bit about the ACE score and, um, and how, and how you've kind of uncovered all that and what you've done about it and what you learned in that process. I can tell you, Mark, from taking care of patients for the past 30 years, that I was typical in that I would tell someone if they were taking a medical history

that my childhood was quite happy. But when you look under the hood, when you actually use a validated questionnaire, like the Adverse Childhood Experiences or ACE questionnaire. Yeah, which is online. We'll link to it in the show notes. You can go take it right now. And I really, you know, if you learn nothing else today, I hope you go take the ACE questionnaire. Not while you're driving, if you're listening to this driving, but just go home and get on your computer and take the ACE score. You're going to be enlightened. Yeah. Yeah. So this is one of those tests that you

don't want a high score on. You really want a zero. That means that you are not exposed to significant childhood trauma. So the ACE questionnaire is a 10-point questionnaire, at least the one that was originally studied by the Centers for Disease Control and Kaiser Permanente. So on this questionnaire, they're asking about things like you mentioned, divorce, physical abuse, sexual abuse, having a parent who was in an addictive process, having a parent who went to jail. So not everything is covered in terms of childhood adverse experiences. And it can be mild stuff like did your parents swear at you?

Did they yell at you? Did they insult you? Did they put you down? Neglect, maltreatment. Right, neglect. So it may not even be like sexual abuse or something like that. But it can be like, you know, my stepfather was a rageaholic and it was like terrifying. So that registered in my nervous system.

It does. And, you know, what was striking about this original study that was done in 1998 is that they found in a group of people from San Diego who were members of Kaiser Permanente, so mostly middle-class folks, they found that when they take these people age 40 to 65 and they ask them about adverse childhood experiences using this questionnaire. A score of zero was no trauma, but a score of one or higher was associated with a greater risk of chronic disease. So not just what you might imagine, like depression, post-traumatic stress disorder, anxiety, but actually the chronic diseases that kill us, more than 45 of them. So coronary heart disease, cancer, autoimmune disease for sure.

Alcohol use disorder, obesity. Diabetes. Diabetes, so many different conditions. And that was really the first time that we were connecting the dots between childhood trauma and the risk of chronic disease later. Yeah, yeah, and it's so important. So what was your particular story in this way? Do you want to share it? dots between childhood trauma and the risk of chronic disease later. Yeah. Yeah. And it's so important.

So what was your particular story in this way? Do you want to share it? Yeah, sure. So the punchline is my ACE score is six. So it's pretty high. And I've got an increased risk of pretty much all of those chronic diseases, all 45 of them. And the way that I came into this work was that I had a falling out with a family member, someone that I adore and love. And we had a disagreement and we became estranged

for about a year. And this was about five years ago. And it was right around the time that we started to see some of the data coming out on MDMA-assisted therapy. And we were starting to see that some of these novel treatments for trauma are about double as effective as the gold standard. Or more. Or more. And so that really got my attention as a scientist. And I applied it to my own situation. I thought, if there are things in my history that are driving my behavior and relationships,

and I have the opportunity to heal them, I'm going to do it. So yes, I want to reduce my risk of these 45 chronic diseases, especially autoimmune disease. But I also want to heal this relationship. And I want to do everything on my side of the street to show up as the best possible person who's not driven by behaviors that I learned as a child. Which pretty much is how we all operate. We think we're grownups, but there's actually that little kid inside of us that wasn't loved enough, that wasn't seen, that wasn't acknowledged, that was maybe beaten or worse. And that's the human that we tend to be as we get older, even though we get gray hair, we get wrinkles, we basically still are that little kid and are responding from that adapted

process. And I developed some very successful adaptive strategies as a child to stay safe, right? Can we talk about that? Because this, I think, I'm going to get a little quieter here because it's vulnerable. It's really tender. But there are so many ways that people like you and me get exposed to trauma. And the way that we get attention, the way that we get love as children is to- Going to Harvard and Cornell.

Well, certainly is to achieve and also to start to sacrifice authenticity to remain connected and attached. To not tell the truth. To not tell the truth and to become hyper-independent, self-reliant, a lot of different behaviors that may be lauded by our culture and lead to a lot of educational success, but they may not really work in terms of your biology. No, no, no. And you and I have both been sick and we both had to deal with it.

And I want to get into what happened to you. And this just reminded me of a story about my childhood. I was someone who had to just be completely self-reliant. My mother was depressed. My father was absent. My stepfather was a rageaholics. I literally had to take care of myself physically and emotionally. At what age?

Like starting at five. Yeah. Incredibly young. Yeah like starting at five yes incredibly young yeah starting at five and uh it just and and i realized you know i just always took care of everybody else yes and managed everybody else and didn't really have anybody watch out for me or take care of me and after my one of my divorces i was sitting and i was on vacation with a bunch of friends in nantucket and we were sitting in the kitchen and there's a friend of mine who had for since college and his wife i've known since college and you know there's very good friends and we're sitting at the kitchen counter and it was like lunchtime she says hey mark you want

do you want me to make you a sandwich and i burst into tears i literally burst into tears because no one had ever asked to make me a sandwich oh mark hyman i want to make you a sandwich and I burst into tears I literally burst into tears because no one had ever asked to make me a sandwich oh Mark Hyman I want to make you a sandwich don't worry I got a buffet I got like I've got a seven course ten course tasting meal going on in my life now I'm good yes you do I'm good but I I it was like such a shock that to kind of recognize that that was my internal architecture and how I needed to really shift that and and to look at that and heal that and see what that was about and that was sort of a beginning of a real journey for me over the last 10 years to sort of unpack all this and and what we know I had chronic fatigue syndrome I had mold toxicity I developed

autoimmune disease I had ulcerative colitis I had positive ANAs I had a fatigue syndrome. I had mold toxicity. I developed autoimmune disease. I had ulcerative colitis. I had positive ANAs. I had the whole kit and caboodle. And don't worry, guys. I'm fine. I'm like good as new, better than average, and certainly better than I was for the last three years. I'm healthier and stronger and happier than ever. You're the best I've ever seen you, Mark.

Yeah, I'm good. And I've seen also when you look at the data from 100 years ago, and you look at the data from now around the prevalence of diseases, then it was mostly infectious diseases, tuberculosis, and people died from all sorts of measles, all the, we have now vaccine preventable diseases. And at the same time, as those diseases have gone down, we've seen this incredible explosion, almost exponential growth of autoimmune disease, allergic disorders, inflammatory diseases. And that is kind of a puzzle for

modern medicine. And one of the things that we haven't really answered is why. So as doctors in the healthcare system, we're like a bunch of janitors mopping up the floor while the sink's overflowing and nobody's thinking well why is this happening and how do we turn this faucet off so the floor doesn't keep getting wet i don't think mopping up the floor with powerful drugs and medications and interventions and surgeries and so you and i both have you know had conventional training i went to cornell undergraduate you went to i don't know, Harvard or something like that, some third-rate school in Boston. And we've both come to understand that our current medical paradigm is deeply flawed

and that it doesn't address the root cause of disease, and it doesn't create health for patients. It just mitigates symptoms in ways that often don't really relieve a lot of the suffering. They may help ameliorate some of the symptoms from here and there, but they don't really deal with the problem. And so you and I both kind of landed up in this universe of systems biology, systems medicine, functional medicine, rethinking the operating system of healthcare and medicine and biology and understanding the laws of nature when it comes to biology.

We were talking last night about the nature of nature and the mind of God and how we finally have insight into the way our biology works, just like we had this transformation in physics at the turn of the last century with Einstein and Bohr and Heisenberg changing our whole conception of space and time. We are now at that moment in medicine

and nobody's really kind of aware of it. It's like a secret. I mean, the few of us- Well a secret. Well, you and I. A few of us weirdos out there are doing this and talking about it. And what we've seen by applying this model is nothing short of miraculous. We're going to share some stories and some cases of our practical clinical experience as a way of illustrating that there is a way out of this. Like we're not doomed to suffer from chronic disease.

We're not doomed to suffer from the ravages of autoimmune disease. And there's a way out. So we're going to get deep into this today. I know I'm going on a little bit of monologue, but I'll let you talk in a minute. I love it. And I know one of the things that sort of we don't recognize in medicine is that disease doesn't just start like that. It's not like one day you're fine and the next day you have rheumatoid arthritis or

one day you're fine and the next day you have MS or one day you're fine and the next day you have ulcerative colitis or lupus or whatever autoimmune disease you have. That there's this gradual shift in your biology towards dysregulation, inflammation, and there's a continuum from wellness to disease. And along that continuum, we can intervene earlier. And I co-founded a company called Function Health. And we've now collected over 3 million data points on almost 30,000 patients. And it's something people can access themselves. They go to functionhealth.com forward slash mark. You can get in past the waiting list. This is 150,000 people on the waiting list and get your labs done. And what we're finding is that 30% of the people

have positive ANA. 30% have positive marker for autoimmune disease. Huge increase in the last three decades. This is one third of the population, yeah. Yes. And 46% have high elevations in C-reactive protein, which is a cytokine marker for inflammation. So I'm like, whoa, this is bad. And this is not necessarily even an average sample of the American population, which is a lot sicker than this cohort.

This is a health-forward group who's interested in their health, who wants to be proactive, who probably has more or less a healthy lifestyle. Not everybody, obviously, but we're talking about 30,000 people who don't necessarily represent the sickest of the sick. They're the early adopters. Yeah. And that group, we're seeing 30% have some level of autoimmunity. We call it pre-autoimmune disease, or maybe some have more. 13% have Hashimoto's, which is an autoimmune thyroid condition, and they don't know it. And this inflammation levels are out of control. Hey everyone, it's Dr. Mark. Magnesium is one of the most important minerals for all aspects of our health. It participates in over 600 different biochemical

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you get using the promo code hymen10, Bioptimizers is now offering you a special gift with purchase. Go to bioptimizers.com forward slash hymen and use the code hymen10. That's bioptimizers, B-I-O-P-T-I-M-I-Z-E-R-S.com forward slash hymen and use the code hymen10 at checkout to get your gift today. And this offer is only for a limited time. So Sarah, why don't you tell us, why do you think we're seeing, you know, this incredible explosion, you know, this condition, autoimmune disease, and it's grouped together. It's probably, you know, when you add in all of them, you know, because they're all in different specialties, so we don't really think of them as a group, when you add them all together,

the number of people suffering with autoimmunity is greater than the number of people with cancer, heart disease, and diabetes combined, right? I would say that if we go back to first principles with functional medicine and we look at root causes, and we invoke Alessio Fasano, and what he has found with autoimmune disease. He talks about a three-legged stool that's required to develop autoimmune disease.

He's a, for those, as people don't know who he is, he's been on the podcast. We'll link to the show notes of his podcast, but he's the world's expert on celiac disease and he's at Harvard. He's just a brilliant Italian scientist. Yes, pediatric gastroenterologist. And so he talks about how you have to have genetic predisposition combined with increased intestinal permeability, so-called leaky gut, and then a trigger. And I would say those latter two are the two that I get interested in because that's where the empowerment comes in because you can do something about it. So leaky gut, we've got lots of treatments that we can use to deal with that. But the triggers are where things get more interesting. Because for some people that could be an infection, like we just made it through the pandemic, it could be infection with COVID. It could be infection with COVID. It could be a hormonal change, such as pregnancy, postpartum, perimenopause.

Those are really common triggers and lead to a fair amount of dysregulation in people. It could also be toxic stress and trauma, which is what I was seeing in my practice. Yeah, that's right. As a functional medicine doctor, we have a different set of questions we ask. We don't ask what disease you have. We ask why do you have that disease. And why, rather than asking the question of, okay, you've got an inflammation that's out of control and your body's attacking itself, let's give you a drug to shut off your inflammation,

like a steroid or a cancer drug that we use, like methotrexate or worse, Humira, which is an immune modulator that can potentially lead to unrelenting infections and death and cancer growth. So there's no free ride here. And there are $50,000 a year to take these drugs. Rather than saying that, we say, why is this happening? And why is my immune system so pissed off? And you listed a whole bunch of reasons. Our diet, which changed our microbiome, that changes in our food supply, like the changes in wheat that's caused all sorts of damage to our gut through increased gluten molecules and leaky gut. We have toxins that are all around us. There's more toxic exposures than we've ever had in history of humanity and we're trying to deal with that. And those are immunotoxins, and they can cause autoimmunity. We have infections,

like you mentioned COVID. So post-infectious autoimmunity is very common, and we're seeing a lot of that with COVID. And we can actually measure those antibodies. We have other things like Lyme or mold cause autoimmunity. So it's not like there's one thing, but it's many things, right? And stress and trauma, We're going to talk about that. So you add all that in. It's this incredible soup that creates a perfect storm for all this autoimmunity. But the good news, as you said, is it's actually treatable. We can actually do something about these things.

And now we're just victimized. And that's one of the things that drives me crazy with traditional rheumatology is like, oh, you've got this autoimmune disease. You're going to have it for life. Right. Let's manage your symptoms. Right. Let's manage your symptoms. Right. There's no way back.

Like, okay, sorry, Charlie, you just got MS or you just got rheumatoid arthritis or you just got lupus or you just got whatever. And there's no way to reverse this. So we're going to have to just manage it. And that's such a disempowering message. You know, I just really feel for people who are sitting in that rheumatology office and they're being told with their rheumatoid arthritis that, you know, here's your life sentence of taking pharmaceuticals. And no one's talking about an elimination diet. No one's talking about some of these other immune modulators that you could consider.

So that frustration is something I really resonate with. And as you described, it's not like a switch that goes off and you go from perfectly healthy and normal to rheumatoid arthritis or one of the other hundred autoimmune diseases. It's this progression. And I'm one of those people, the 30% that you just described, who's got those positive anti-nuclear antibodies. So making antibodies against the nucleus of my cells. And so that's when you want to intervene. You want to intervene as early as possible and do the kind of testing that you and I

offer so that you can get a glimpse at what's going on with the immune system and intervene as early as you can. Yeah, it's true. We don't know how to get to the answer with our traditional approach. I was with Eric Topol yesterday, who's one of the giants in medicine in San Diego. And he sort of talks about AI in medicine and the doctors of the future. And he's just sort of a medical futurist, a brilliant scientist at Scripps Translational Research Institute. And, you know, we're talking about how do we, how do we build a system where people can, like with function, how do you build a system where we can program into the AI, the future paradigm of medicine, not just how to give better drug or how to match the drug to the person

in a more appropriate way, which is important, but how do we actually get to the right answer? So if someone comes in with, let's say rheumatoid arthritis, the rheumatologist isn't doing heavy metal testing, isn't looking at the microbiome and doing stool testing, isn't looking at food sensitivities, isn't looking at the chronic infections that could be triggering it like Lyme or maybe post-COVID. They're not paying attention to those things. So they're like, okay, you just have an autoimmune disease. You have these antibodies, you have these symptoms. This is what you got. I gave you your condition name. That's what's causing your symptoms. But it's not the cause, it's just a name that we give to people who share a collection of symptoms. And so we have to think

differently about this. And that's what functional medicine is, is a different way of thinking or navigating the landscape of disease to get to the root cause. So we do a lot of different things, and we do a lot of different things that actually helped us to figure out the root cause. So when someone comes in to see you and they've got, let's say, MS, or they've got lupus, or they've got alopecia areata, which is you'll lose hair everywhere in your body, your eyebrows, your pubic hair, your head hair, everything.

What do you do for that patient? How do you start to approach that patient? Well, first first a history. So in functional medicine, we take a particular type of history. We're building out a timeline of what's been the progression to this point. And we're looking at antecedents. What are some of the genetic issues that might be important for this person? What are some of the triggers? And then what are some of the mediators that might be important for this person? What are some of the triggers? And then what are some of the mediators that could be affecting their symptoms, the constellation of symptoms that they have? With triggers, what I'm always listening for,

and I was taught this at the Institute for Functional Medicine, I was fine until blank, blank, dot, dot, dot. So that's the moment that I'm really listening for in a history. And then I work in a, I'm the director of precision medicine at the Marcus Institute of Integrative Health. So there I do a lot of testing because I'm mostly seeing executives and professional athletes who also are suffering with autoimmune conditions. And so I do genetic testing, I do biomarker testing, and that includes stool testing, looking for heavy metals, nutritional testing, the full gamut. Hormones, of course, I'm looking at. I use Dutch Plus for most of my patients, male and female. So that's kind of the panel. And part of the biomarkers, and this has changed for me in the past 20 years, I run an autoimmune panel on every single patient.

Because as you described with function, there are so many people who've got pre-autoimmune conditions or pre-autoimmunity, and we want to start to address it. What are you doing for the autoimmune markers that you look at to screen? Well, I look at inflammation, so inflammatory tone, high sensitivity C-reactive protein. I'm looking at the neutrophil to lymphocyte ratio and LR. So the white blood cells, yeah. White blood cells. I'm looking at sometimes sed rate, ESR.

I look at… And that's a marker for how basically thick your blood is and how long it takes to settle. And if it's high, it means you've got inflammation in your blood. Exactly. So I run anti-nuclear antibodies. I look for Hashimoto's because it's so common, especially in women. So thyroid peroxidase antibodies, antithyroclobulin.

And then I usually run a rheumatoid factor. And depending on whether they've got some joint issues, a few other tests. That's where I start in the blood. And then I'm also looking in the stool for bacteria that are associated with autoimmunity. I'm looking for dysbiosis and imbalance of the good and bad bacteria. I'm looking at gut function. Yeah. Yeah, That's exactly what I do. And I think, you know, the one thing I do add often in addition to those autoimmune markers, and by the way, ANA, anti-nuclear antibodies means you're attacking your own nucleus. It's

like you're attacking your own body. That's what autoimmune is. You're basically rejecting yourself. There's some level of self-rejection. We're going to get into the sort of more sort of psychological, metaphysical framework around that because I think there's something to it. And around trauma and our past history and who gets autoimmunity. But I think we also look at a celiac panel. We look at gluten antibodies.

So on function health panel, all those things are included. Celiac you can get as an add-on, but essentially all those things you mentioned are just standard and they're not done by your traditional doctor at, your annual physical. Right? And so it's important to get a sense of what's happening. And like you said, we're looking, we're finding.

And I think that just speaks to the level of sickness in our population and the need to do something about it. And then you have to start digging, like you said, to the root causes. And we do a lot of different things to help people. We do elimination diets. We treat the heavy metals. We fix the gut.

We do all this stuff. We'll get into that. But I sort of want to go sideways a little bit and talk about what's sort of unspoken. And I think when you mention history, and history is so important in a medical evaluation because you want to know a person's story. And history, right? His story or her story, right? And so that's so critical. You want to know like what their ancestors were like,

you know, did their parents, you know, were they survivors of, were they children of survivors of Auschwitz, for example, where there's epigenetic changes that program in things to your biology. What was your mother eating during pregnancy? Did you breastfeed? Did you have a C-section? Did you take antibiotics as a kid?

Did you have colic? Did you have eczema? These are all clues. Did you have allergies? Did you have bowel syndrome? And then we start to see this pattern in these patients. And I'm sure you've seen the same thing where they all kind of have a similar story of like this sort of low, slow breakdown and increasing inflammation where it ends up with an autoimmune disease when they

get in their, you know, 20s, 30s, 40s. And it's kind of a striking pattern. And one of the things we often do, and you mentioned this in your book, The Autoimmune Cure, which I think everybody needs to pick up a copy. It's available now. Get it everywhere. It's a really profound book that explains autoimmune disease in a way that I don't think ever has been explained in a very comprehensive way that looks at all the things we just talked about and the psycho-emotional states and trauma and how to deal with those things with novel ways and novel treatments that we're going to get into in a little bit.

So if you stay tuned, you'll hear all about that. But tell us your story. What was your story and what happened to you health-wise and how did you connect the dots back to the trauma? Maybe it was the ACE question or maybe it was something else, but I think it was really important to hear what did you go through and how did you navigate it and how did you heal? What was your path? My story is a bit different from yours and definitely there's a female lens to it. So I would say the way that

I started to track my trauma without realizing that I was tracking my trauma was in my 30s. So I had my first baby and I really struggled postpartum. So I had depression, postpartum depression. I had weight loss resistance. I just couldn't lose the baby fat. I had a lot of belly fat. I just felt way too young to feel so old. That's a great line. I felt way too young to feel way so old. How many of you out there feel that?

Oh my gosh. Well, I was 33. And at 33, you don't want to feel like an old lady. And so I didn't sleep for about a year. I remember my mother saying to me and pretty much everyone I talked to, sleep while the baby sleeps. And I just couldn't. My system was just so wired, so revved up that I just couldn't. And so I remember going to my doctor with my list of woes.

And he said, probably hormones, why don't you go on a birth control pill, and how about you exercise more and eat less, and how about a selective serotonin reuptake inhibitor? Prozac, how many of you all heard that when you go to the doctor? Take Prozac, take a drug, it's your fault you're overweight because you're not eating the right way

and you're not exercising enough, right? Right, right, and it's your fault you're overweight because you're not eating the right way and you're not exercising enough. Right. Right. And it's, you know, at the moment. It's a little victim blaming a little bit. It's a bit of blaming, but it was also such a turning point for me because I realized after I got over kind of the humiliation, the flush of shame with what he was offering and suggesting to me, I then got angry, the kind of righteous indignation that leads to a change in conceptual model. And so I left his office, I went to the lab, and I ran my first hormone panel on myself. My cortisol was three times what it should have been in my blood. Wow, that's your stress hormone. My stress hormone was super high. My glucose was about 110 and I was fasting.

That's pre-diabetic. That's pre-diabetes. My insulin was in the 20s. Wow, girl. I had thyroid function that wasn't up to snuff. My TSH was like three. And I was around the time of ovulation. My estrogen was on the high side.

My progesterone was nowhere to be seen. It was super low, like 0.1. And so I had this constellation of symptoms that I've written quite a bit about. It was sort of my portal to writing. Yeah, you wrote a book called Hormone Cure. I don't know about mood and food and hormones in women, right? That's right. But I would say if we look upstream, there was a level of dysregulation

that was driving those hormone imbalances. There was a level of nervous system dysregulation, and it turns out, I learned later, immune system dysregulation. So when we think about the vulnerability of the human body, I like to conceptualize it as the pine network, the psychoimmunoneuroendocrine network. So your hormones are part of the story, as I described. But if I also was measuring my heart rate variability at that time, I imagine it would be really low. And I didn't check my anti-nuclear antibodies at that time. But there was this backstory in my system of dysregulation. Because by the way, doctors were trained not to test those things unless someone already has a disease. That's right.

That's right. Yeah, the paradigm is shifting. Yeah. So that was really my first insight into dysregulation. And I started to look for it in my patients and I was surprised to find like 98% of them had dysregulation of some degree. I focused on hormones, that was kind of my way into this work, but the hormones are just the beginning.

Yeah, just beginning. But you know, Sarah, it's important what you said, that you checked all these different hormones in ways that are not typically checked by your regular doctor. You checked insulin, you checked cortisol, you checked your thyroid function in a different way. You looked at thyroid antibodies, you looked at various markers that are not part of a typical checkup or panel.

And it's definitely part of what we do in functional medicine. It's what we offer on the standard panel in function health. And we're finding stuff like exactly like what you're talking about. And it's disturbing because it means there's a lot of people walking around there suffering who don't need to suffer. That there are simple ways to understand how these things go awry and how to fix them. So in your case, how did you come to understand what to do and what happened when you did those things and what were those things that helped you get back to health because honestly you look better than i've ever seen you too so it's like we're just both getting older we've been knowing each other for like over i

don't know 10 15 years yeah and it's like i'm like wow she looks great and we feel better than we feel yeah you vibrant shiny happy i'm like yeah yeah your skin looks different i mean you just look great and i'm like wow something she's doing is working yeah well thank you for that and same back to you so i you know that kicked off i turned left from conventional medicine i'd always sort of had this thread of integrative medicine i grew up with a great grandmother who took me to yoga class and was a whole foodist. So I always had a thread of that. I went to Kripalu all through medical school just to survive the trauma of that. I know. I was there all the time. So I had a sense that there was another way of being. And especially, I would say out of all of those things, the cortisol and the

prediabetes worried me the most. So I was at that time a board certified gynecologist. And so topping off my progesterone, taking some herbs to do that, like Chaseberry, that was pretty easy. But this cortisol and insulin issue really got my attention. And I started to research, okay, what are the randomized trials, multiple randomized trials that are concordant that can help me with this cortisol and insulin problem. And I changed the way I ate. So I started, I never found that the Mediterranean diet was a good fit for me. It was just too many grains, too many carbs. And so I started to modify and personalize the Mediterranean diet, more low carb, more

healthy fat, that seemed to make a difference. This is before we were using continuous glucose monitors and non-diabetics. That'll come later. And what I found, which I think is interesting and relevant for our listeners is that I could improve my cortisol significantly. So I picked up meditation again, I became a certified yoga teacher, I took phosphatidylserine, I got religious about taking fish oil, all the things that have been shown to reduce cortisol. And I would take three steps forward. And then I'd have a conflict in my marriage, and I'd take two steps back. And I started to notice that these changes that I could make with my hormones, with cortisol and with insulin were not durable. Yeah. And it was that lack of durability that I noticed in myself and in others.

In your patients, yeah. That I got to this point where I felt like we've got to look deeper. What about trauma? Could trauma be the through line that leads to people improving and then backsliding? Yeah. Interesting. Interesting. Interesting.

And you talk about this sort of deep connection in your book, The Autoimmune Care. Like I said, everybody gets that book because it's not just about autoimmunity. It's really about what's happening in our society with our food and environmental toxins and trauma and functional medicine and as a way of navigating any chronic illness. You could be called the anything cure, basically. And you talk about the sort of discovery, as you just mentioned, between trauma and autoimmunity. And we kind of knew

that from the literature, but there's mechanisms we now understand. And you talk about this four primary ways to connect the dots between trauma and autoimmunity through this thing you just briefly mentioned, the pine thing, you just kind of whiz through it. But psychology, immune system, your nervous system, your endocrine system, and you can even add your microbiome, so it's pinum, maybe. Right, yes. And all of those things are basically transducers, transmitters of the kind of psychopharmacology of your brain.

And that leads to systemic dysregulation. Unless you fix that software, and you can fix it. And by the way, in medicine, as a doctor, psychiatry is sort of in the dark ages and we have really crummy ways for dealing with people with trauma, PTSD, with not even PTSD degree trauma, but just kind of garden variety trauma, which most of us have to some degree. We have drugs that really don't work that well, that have tons of side effects. And all of a sudden,

like we're beginning to understand there are different ways through. So talk about the way trauma actually does biologically impact you through this pine, let's say I'll call it pine-um system. Pine-um, yes, yes. But yeah, talk about that.

Well, there's a number of different ways that it can change the signals of the body. That's kind of how I think of it, that you've got this vast communication process in your body. And when the signals become disrupted or dysregulated, that's when it leads in the future to some of these chronic health conditions. So that could be the insulin signal, it could be the way that your immune system is regulated, it could be the way that your vagus nerve fires. So there's lots of different ways that the signal becomes dysregulated. I think the way I

think of it is, I'm going to describe Gabor Mate's way of thinking about trauma. He talks about how it's not so much what happened to you, you know, my A score of six, your A score of whatever it was. It's the way that the adverse experience, this overwhelming experience, lives on in your body. This trauma's signature. And so this is where- He also talks about it's not the thing that happened to you, it's the meaning you make from what happened to you. The meaning you make, also the people you were surrounded by. Some people have a lot of trauma exposure, but they've got adults who are incredibly helpful at processing that trauma in the moment

with them or shortly thereafter. So there's a lot of different factors than just what's your ACE score. But I think it's critical that, and I want to challenge our listeners to have a sense of, do I have dysregulation in my body right now? Is my immune system as healthy and optimized as it's meant to be? Is my nervous system functioning correctly? And one of the ways I track it is with my ring. Is my endocrine system, is it the wind at my back? Because that's really what it's meant to be. It's not meant to be this bully like cortisol that's just wreaking havoc throughout your system. Yeah, a hormone that's supposed to help you, right?

So you have to kind of look at these sort of mechanisms that our body uses to listen to the thoughts that we have. Every cell in your body is listening to your thoughts and it's registering those thoughts and it's changing their is listening to your thoughts. And it's registering those thoughts. And it's changing their function based on those thoughts. So it changes your microbiome. Your thoughts change your immune system. They change your hormones.

They change, obviously, your neurotransmitters and your neurologic function. And so when you realize that, then the question is, how do you tame the monkey in the mind? Because once you have the insight, oh, okay, I've done everything I can for this patient, and they're not getting better, and I don't freaking get why, and I've done all the normal things, and everything looks good, but this patient just stays in this stuck cycle. And you know those patients. We've had those patients. And you're like well

gosh i you know this normally works for people so why didn't this work and and if you go down the trauma rabbit hole you usually find something you start asking the right questions if you create a safe space to do that and if you understand that then then you know you, what do you do? Because therapy doesn't seem to work. And a lot of people do therapy and it's like, okay, you need psychoanalysis five days a week for the next 40 years and then you're going to be okay. I'm like, well, I don't know about that. Can I do something else? And so, you know, we're seeing a whole new era of thinking about how we deal with the well psychological and emotional and spiritual effects of trauma but but i would suspect that we're going to see the medicines that we're using for that which we'll talk about in a minute

also work for other conditions we had a little brief conversation about that last night i want to get into that because i'd never heard anybody say that and I want to get into that. But what we're talking about is psychedelic medicine. And I want you, before you get into that, I want you to talk about why pharmaceuticals and talk therapy kind of may not be enough and that we really need to think differently about our approach to trauma and particularly linked to autoimmunity. When I was in my 20s, I started talk therapy. And I've done decades of talk therapy, as well as couples therapy. And what I found was that talking about my relationship with my mother, relationship with father, it just seemed to reinforce the trauma instead of actually healing it.

Like you relive all that stuff. Yeah, you relive it. And that's what's been found in the research, that there's an understanding part of the brain that is different and separate from the healing part of the brain where the trauma resides. And so when you keep that in mind, I looked at the gold standard for post-traumatic stress disorder. I don't take care of a lot of patients with PTSD, but I have a lot of people with partial or sub-threshold PTSD. And the gold standard at the time that I wrote the book was talk therapy, sometimes trauma-informed, but mostly talk therapy,

with or without selective serotonin reuptake inhibitors. Talk therapy can actually make it worse sometimes, right? That's right, yeah. So when I looked at the efficacy of these interventions, they were around 30%. And I feel like if I was told in my 20s- By the way, that's about how much you get from a placebo. Exactly.

And if people are told if they're really given informed consent before they start talk therapy i mean there's some talk therapy that's incredibly helpful but if they're told like in my 20s if i was told you've got a 30 efficacy you're going to come once a week you're going to spend thousands and thousands of dollars it'll take decades and 70% chance it's not going to work. I never would have done it. So that doesn't work. And it sets us up to start to reimagine what might work. Yeah. So what are we reimagining in 2024 about how to deal with not just the psychological aspects of trauma, but maybe some insights into the biological benefits of these new therapies. Tell us where you're going

with your life, what you're doing, and why you've come upon this sort of whole world of psychedelic therapy. Well, I would broaden it to healing states of consciousness. I think there are ways that you can use breath work, you can use EMDR. There's lots of therapies that can be very effective. Meditating in a cave for 40 years. Meditating in a cave for 40 years. And yet, I would say that the most effective, the greatest accelerator that I've seen is psychedelic assisted medicine. Yeah. So what's happened is that I was a total square.

I was telling you at dinner last night, like I never smoked pot. I never took any mushrooms in college, like nothing. I was in the library. I know it's, it's sad, but I, I got to it at 50. Oh my God. I got to it at 50 and I got to it at 50. And maybe that's what I needed. That's my divine timing.

So I've become certified in psychedelic-assisted treatment. I've gone through probably somewhere around 15 rounds once a quarter of MDMA-assisted therapy. I've got- Wait, wait, did you say 15 rounds once a quarter of MDMA assisted therapy. I've got- Wait, wait, did you say 15 rounds once a quarter? Once a quarter, yes. For yourself? Yes. That's a lot, wow.

Well, I had some trauma to excavate and to process and sort of re-pattern in my system. And I felt, based on the the data that nothing was effective, as effective as MDMA-assisted therapy. And I did it with a psychologist. But it's also, I feel like we should be somewhat circumspect here. There's an above-ground way of doing psychedelic-assisted treatment. And ketamine is the main thing that is above ground and FDA-approved, although it's used off-label. We hope, we expect that MDMA is going to be FDA-approved

for the treatment of trauma for post-traumatic stress disorder sometime in the next year. And then a lot of these other treatments, such as ayahuasca, psilocybin, are for the most part below ground. Although there's some states like Oregon and Colorado. Yeah, amazing. And so these compounds, ketamine is interesting

because it's one of the things that's approved for treatment-resistant depression. Yes. And you take one dose and it lasts for a long time, which is really fascinating because if you have high blood pressure, you need to take the drug every day. It's a completely different way of thinking about medications. And it doesn't make sense to us, right? It's like, how do you take a drug

one time or two times and have profound long lasting effects? What's going on with that? And how does it work? And it's sort of interesting to me that these drugs aren't just working on your psychology, they're working on your biology. That's right. So can you talk about how we can think about using those to address trauma, how people start to think about it, where can they kind of learn more? And what are the kinds of things you're seeing? Maybe you can share a few stories from your practice about what has happened both to you as a result, and then also what's happened to your patients as a result of exploring these therapies, which very soon will be legal.

I promise you all that. There's billions of dollars in the space of research. There's many FDA applications for new drug applications for these things. There's lots of people working on this in a massive scale. So even though it sounds like, oh my God, drugs and psychedelics and oh my God, you can take LSD and jump off a building and run up a train. Well, that's not true. Well, they're safer than alcohol. They're safer than horse riding. That's like a David Nutt quote.

Yeah. Oh, damn. I love horse riding. I mean, yeah, I just came back from cow herding in Argentina, which was a lifelong dream on beautiful horses, cow herding cattle in the Argentinian ranches. But yeah, the safety is quite interesting. There's something called the LD50 in medicine, which is what is half of the lethal dose? Like what's the dose that kills half the animals getting the drug? And they're like, basically is none.

It's like, they're just safe. Yes. Yeah, so with ketamine, you mentioned these people who take ketamine maybe for depression or some other indication and they've got these benefits. There's a lot of people who do ketamine for six weeks, like a weekly treatment.

But what's interesting about ketamine is that we think it increases neuroplasticity. So it's not just a psychological effect. It seems to take, you know, if you think of downhill skiing and the grooves that you create, and maybe you just keep going down the same grooves on the mountain, we're getting to fresh powder. And that's super exciting. So to be able to go down the mountain of your life on fresh powder, do you like to ski? I like to snowboard and I love powder.

I love powder. Yeah. So what have I found? I found that I'll tell you about one patient in particular. Wait, wait, start with you. Start with me. Okay, bring me back here. What happened when you went through that in terms of your own,

not just psychology and getting free of those old stories and patterns and well-worn grooves, but what happened to your health and biology? So I'm a total nerd, as you know, and I like to track things pretty carefully. And I can tell you that when I take ketamine, when I do ketamine-assisted treatment, my physiology changes. My blood sugar is better. My heart rate variability is improved for the days afterwards, weeks afterwards. There's a lightness of being that just feels lovely. With psilocybin, similar results. So really stable blood sugar. I noticed that there's kind of this lift that lasts for a long time and that's been shown in randomized trials with people who've got a fatal cancer diagnosis and are using

psilocybin in trials that are done at NYU. We know it's also helpful for depression. There's a JAMA paper that was published last year on this. MDMA-assisted therapy, what is so striking to me is the way that it changes how trauma drives my behavior. I'm just less reactive. I'm much more in the present moment. And another thing that it did for me that was inspired by a conversation with a friend is that it got me to realize, you know, I knew a lot about secure attachment, avoidant attachment, anxious attachment. And I felt in my body after MDMA as therapy, I want secure attachment. It's enough already.

I don't want to just have the book learning and the cognitive understanding. I want to feel it throughout my body. I want the regulation of that. I want to be in a relationship where we've got that co-regulation. Like a mother does with the baby you can have that in a relationship absolutely so that was a huge Paradigm shift for me amazing to realize okay I want secure attachment and so that changed everything really yeah and you know my vulnerability is this cortisol insulin issue that I mentioned I've got the positive anti-nuclear antibodies. And what I've done is test myself, science myself all through this process of using psychedelic-assisted

treatments. I now have negative anti-nuclear antibodies. My blood sugar, mean glucose is less than 95. The variability is less. I don't spike like I used to. I feel more embodied. I used to spend all my time upstairs and also a little functionally dissociated, which, frankly, we select for in medicine. Yeah, right. Like it's really helpful to be functionally dissociated. If you kind of ignore your body, it's actually an asset because you have to drive it into the ground to get through medical school. Right. So I'm not dissociated anymore.

I am in my body. I just, I feel everything, which, you know, at times can be difficult because I'm really sensitive. But, you know, the thing about sensitivity and being so present is that, you know, we're like orchids, people with this kind of sensitivity. and when an orchid has the right environment has the right light is facing north gets the right amount of water gets kind of spritzed they bloom and they bloom and they bloom and they bloom yeah and that's what i feel in my body and that's what i want that's for my patients or for people who are on this journey yeah you know it's a lot of the doctors who are in this space have had these challenges, right? And they're like, well, gee, everything I learned in medical school isn't quite working and I don't know what to do, but I'm going to find something else. And

sometimes it's a kind of wandering in the dark and the desert for decades, but we get there and you got there and you were able to, I mean, reverse a lot of the things that were happening to you and do something that isn't quote possible in medicine, which is reverse autoimmune antibodies. And I've seen that over and over. So tell us a patient story where you've seen this, whether it's just the combination, because it's not just like, oh, you can still have heavy metals and eat tons of gluten if you're sensitive and your gut can be a mess. But if you just do psychedelics, you're going to be fine. You can't just do that. Yeah, it's a holistic approach, right?

And you talk about that in the book. I want to talk about how you break the vicious cycle of autoimmune disease and reset your system and reset your immune system and restore your health. But I want you to sort of start with maybe a story of that. And by the way, everybody listening, there's been many podcasts I've done with people in the psychedelic space, from Michael Pollan to Gabor Mate talking about trauma, to Paul Stamets talking about mushrooms, to Tony Bosses and Rick Doblin who's talked about MDMA therapy. So there's a lot of content on the Dr. Stamets podcast if you want to dive deeper into these topics. But we're doing this from a medical perspective, which is a little bit different. And I think it's an important conversation because it's not being had in the halls of academia. It's not really being had in doctor's offices around the country.

But it is one of the most crucial conversations we need to be having with our patients about how do we deal with this as part of their therapy. So talk about a patient's story and what you found and what kind of made you kind of wake up and go, wow, this really is something. One of the patients who inspired me the most is a woman named Christina. She's in the book. And she's someone that I met at a yoga studio in Northern California where I live. She was in her early 40s and ran this yoga studio. And she discovered that her husband was having an affair with her best friend. So she had this profound betrayal.

Wow. Profound toxic stress and trauma as she went through this discovery and confrontation and processing. And so she left the marriage. And within about a year, she started to notice elbow pain and kind of this crackling and discomfort in her elbows. She's a yoga teacher, so this is a big deal. It's really dysfunctional. Right.

And so she went to her nurse practitioner. You're a downward dog when your elbows hurt. It's hard to do. You can't do much of anything yin yoga maybe so she went to her nurse practitioner who ran a few tests she had a really elevated uh c-reactive protein she had um rheumatoid factor that was really high and so she uh the nurse practitioner, I'm going to send you to a rheumatologist, made the referral. And this woman has private insurance, good insurance, but it was a six-month wait before she could see the rheumatologist. And so, in the meantime, she did a couple of things. She reached out to me to see if I could help her. And then she also made an ultrasound appointment

to take a look at her joints. So this is before the six month appointment with the rheumatologist. So we started a number of different things. We ran the blood testing, the genetic testing, the stool testing, nutritional panels. We found that her cortisol was dysregulated. And she was in the early stages of perimenopause. And that was something that we addressed. But we changed the way that she was eating. She's a yoga teacher. So she had a pretty healthy diet. But we started to reduce some of those things that are more immunogenic, like certain proteins. She was having a pea protein shake every day. And it was a little

too much for her immune system. So we went through this process. It took about three months in her case of helping her get to a place where she was feeling much better and she was able to teach yoga again. She had the ultrasound. And the ultrasound basically showed that she was relatively normal. Wow. A little bit of inflammation, but nothing like what she had when she first started to come see me. And then she went to the rheumatologist. She had the appointment.

And the rheumatologist said, yeah, your ultrasound doesn't look too bad, but you've got rheumatoid arthritis. Here are your options in terms of drugs. Yeah. Which one do you want to take? Wow. And so she left his office. She never took the medication. And she was never officially diagnosed with rheumatoid arthritis, although she had certainly the constellation of symptoms and signs. And now she is relatively free of this elbow pain that she had.

And throughout this process, she was doing a number of psychedelic-assisted therapies. Oh, interesting. I wasn't delivering them to her, but she did a few different things, Bufo and a few others that really helped her with processing. Bufo is what they call the toad. It's from the Sonoran Desert toad, and it's basically called the god molecule. Yes. from the Sonoran Desert Toad, and it's basically called the God Molecule 5-MEO-DMT, which is releasing your brain at birth and at death. And it's quite a remarkable experience.

I don't know if you've tried it, Sarah, but- I haven't tried it yet. I did, and it was the most profound experience. It lasts just 20 minutes, but I was wearing my aura ring and my heart variability went up five fold. Yes. Five fold. Exactly. This is the kind of physical change. What is going on here? This is how the pine system is changed by these medicines. It's such an important point. It's not just your psychology. It's also the way that you regulate, such as your heart rate variability. Which is a measure of your stress response and your,

your resilience to stress. And it's an important biomarker for so many different outcomes in your health. And it's something you can measure with various devices, even your iPhone. You can use your finger on the camera. There's different apps. You can buy an aura ring. There's a lot of ways to do it, but it's a very important biomarker. It is. And I would say, you know, as our listeners kind of start to build out a dashboard of the things they want to pay attention to related to their pine network, I would say HRV is critical.

Yeah. Yeah. So she used psychedelic medicine to resolve the way that trauma was still living on in her body. And she changed the course of this potential autoimmune disease. to resolve the way that trauma was still living on in her body. And she changed the course of this potential autoimmune disease. Yeah, that's incredible. That's incredible. So it was a combination of functional medicine interventions

and psychedelic assisted therapy and treatments that helped her heal the trauma and rewire some of the brain. And I've seen data around psychedelics increasing BDNF and other neurotrophic factors. It increases neuroplasticity and neurogenesis and really restructures your brain. So it changes the structure and the function of your brain. So it's not just that you have an insight and you kind of feel better. It literally changes the gray matter essentially.

And I'm sure it regulates immune cells and lots of things we haven't even been able to measure. And I think we're just beginning to start to unpeel the onion here around what these compounds do biologically. And they've been used for thousands of years by humans across cultures and every place. And I think they've used to heal. They've been used to have spiritual awakenings or used as part of cultural rituals

to decide on what to do and how to do it. And it's just a very integral part of many, many cultures. And I just visited shamans in Ecuador and deep in the headwaters of the Amazon, sort of vanishing tribes, the Oshawa tribe and the Sapara tribes. There's just a few of them left and they're still practicing their traditional medicines and their traditional ways. And I i mean it was a profound experience to sort of witness how connected they are to the earth and how they listen and how they experience things differently and they see things differently and they relate to things differently and and i think you know they have their struggles for sure but these medicines have been around for a long, long time.

I mean, even animals use them. That's right. And I think you're making an important point, which is there's this indigenous context in which we've learned about psychedelic medicine, and then there's the more recent medicalization that's happening. And I feel like we need both. The other piece that I think is critical is that we're not just talking about psychedelic medicine for people who've got the

disposable income for it. Indigenous cultures give psychedelic medicine in group contexts. And I think groups are a really important way that we're going to change public health and we're going to help resolve trauma, especially among groups that experience trauma. That's my hope, that it's not just this one-on-one experience, which is certainly delightful, but that we think more on a population level and on a group level. Yeah. Actually, one of the people I had on my podcast was a Canadian doctor, Pam, who's married to Paul Stamets and she's an MD who does psychedelic assisted therapy and is approved by the government and they do it in groups and they see these incredible transformations. So she has a whole curriculum on how to do this

and how to actually help people through this journey. And it's sort of average people, it's not like a bunch of hippies or new age people or lots of silicon billionaires. It's the average person who really struggles and doesn't have a way out for a lot of these things. So I think it's just an incredible moment to be alive in medicine. We're seeing both an understanding of the deep biology that we are now understanding around systems and networks and functional medicine. And we're also sort of understanding the doorway to the mind and our beliefs and our constructs and the traumas that inform our biology and how to work with those

in new ways. So it's this beautiful intersection. And I, you know, in my book, Young Forever, I did talk about psychedelic medicine as a therapy for longevity. So it's kind of interesting. So just to kind of wrap up, you know, you have a whole program in your book, The Autoimmune Curb, and it's really about breaking the vicious cycle. And it's not just one thing. And I think that's the problem with traditional medicine. It's one thing. You have autoimmune disease, take this one drug or these two or three drugs.

It's not dealing with the entire spectrum of things you have to do to regulate your biology. And in functional medicine, and this is a lesson from Sydney Baker, one of our mentors, who said, get rid of the stuff that's bugging you and get the stuff that you need to thrive. Get rid of the bad stuff, put in the good stuff. It's so simple. It's quite simple. It's quite simple. It takes a lot of sometimes investigation and thinking to find out what the bad stuff is. Maybe you have heavy metals. Maybe you have some parasite.

Maybe you have some Lyme disease. Maybe there's some mold. You have to dig a little bit. And you have to find out what you're missing. You have to look at your nutritional levels, your hormone levels, all the things you mentioned. So take us through your approach, which is this sort of multimodal, multidimensional approach to dealing with people in a deep way to reset their biology and reset their psychology? It starts with food. So we know, I mean, the data on rheumatoid arthritis and elimination diets goes back decades. And yet I think very few people are offered

an elimination diet. So I like to start with an elimination provocation diet. So it's where you eliminate the things that tend to trigger the immune system, gluten, dairy, nightshades, nuts and seeds. A lot of us don't like that one, but it can be really triggering. And you and I actually share a patient, I haven't talked to you about this, who just went on an elimination diet, cut out nuts and seeds, and her gastrointestinal symptoms went away in 24 hours. Yeah, right. So start with food. And then there's the way that you architect your life.

Often it needs to be redesigned. You need to get adequate sleep. I like two hours of deep sleep every night. That's what works for my system. Sometimes you've got to track these things so that you've got objective data about them. And then you've got to get embodied. You've got to come downstairs. If you're someone who tends to be really cognitive in how you face the world, you need to create that integration and not just kind of stop at the neck. You need that mind-body connection. Sometimes it takes me walking for 15 miles to get there, but yeah. Me too. Yeah, and there are ways that really make a difference there.

Things like Hakomi therapy, which is a somatic mindfulness-based form of self-exploration. There's things like EMDR. And at Thomas Jefferson, we study the neuromotional technique. There's a lot of ways of working with embodiment and creating some safety around that. Safety is really critical. It's a critical through line through this. And then I would say immune modulators, of which there are many. And we probably don't have time to get into the details of them.

But things like vitamin D, curcumin. I use low-dose naltrexone a fair amount. I imagine you do as well. And you talk about black cumin. Black cumin, which we've got now four randomized trials showing that it's helpful in Hashimoto's thyroiditis. It's where I start. And COVID.

And COVID, absolutely. I mean, one of the things that's interesting to me, because like you, I see a lot of patients in whom I start working and they may not have a diagnosis of hypothyroidism, but they're starting to make antibodies against their thyroid. And that's a situation where black cumin can be very helpful. Amazing. Yeah. And like I said earlier on function health in this large cohort of people, we're seeing 13% of people have autoimmune thyroid disease. 13%. 13%.

13%. That's a lot. Yeah. And they're on this on-ramp toward dysfunction with their thyroid. And the thyroid is critical for really living your life as fully as possible and as fully expressed as you can be. Yeah. I mean, think about it.

If your thyroid's not working, everything's like slowed down. It's like the thermostats turn way down. Yeah. You're tired. Cold. Muscle aches. It's like the thermostats turn way down. Yeah, you're tired. Cold. Muscle aches. You're fatigued. You can't sleep.

You don't have a sex drive. You're depressed. You have memory issues. Your hair falls out. Your hair falls out. Nobody wants that. Your skin's dry. It's like a whole bunch of stuff. Your nails are cracking.

So basically, this is something that is so common and so missed and so subtle for some people that even if their thyroid levels are in the quote normal range, according to traditional medicine, they're not really optimal and they're not really good. And doing the things you mentioned are so powerful. The thing you didn't mention was microbiome. That's a big part of fixing the gut. You mentioned earlier at the beginning, leaky gut was a big factor. Yes. Yeah. So I like to use L-glutamine, aloe vera. There's a lot of different things that can be helpful for increased intestinal permeability.

It's something I see so commonly. I used to test for it, and I don't test for it like I used to. Every professional athlete I work with has increased intestinal permeability. So I treat that. And with microbiome rehabilitation, that's a more interesting area that I think is still changing. We get sort of ideas that we fall in love with, and then we discover that maybe that's not the whole story. That's what keeps happening in my understanding of the microbiome. Yeah, for sure we do.

Yeah. But I also have a patient, a guy named Larry Smar, so he's public about this. Oh, I know Larry. It's about violating HIPAA. You know Larry. That's great, yeah. He's super interesting. He's the most measured guy in the world, apparently.

He's got 500 stool samples over a period of time, not just when he was healthy, which is less interesting, but he had Crohn's disease. Yeah. And so we know about how has microbiome shifted with things like having a smoothie with 57 different species of fruits and vegetables every day. So there are ways that you can rehab your microbiome that can be very effective. Yeah, phytochemicals are really important.

Phytochemicals. Yeah. It was something I didn't realize until recently when I had ulcerative colitis. It was one of the things that got me better was realizing I had low levels of this molecule, this bacteria called Ackermansia mucinifolia, which is critical to preventing leaky gut. And I just didn't have any. And a lot of the people I see who are sick don't have any. And you can't like take it. It's left the building. I mean, now there's a company that makes it and you can buy it and take it as a probiotic, but back then there wasn't. So I was like researching, researching. I was like,

oh, it loves pomegranate and green tea. And cranberries. And cranberries, and wow. So I'm just gonna like take this concentrate. So I'm not eating cranberry juice, because that's full of sugar, but I'm basically putting that concentrate in a smoothie and a little drink.

And it was quite amazing. I took it every day. And it really helped heal my gut from autoimmune disease, from resetting my gut. When do you start with the psychedelic therapies in the course of treatment with patients without immunity? Well, I don't start at the first visit. I am developing a relationship.

Here's your vitamin D and here's your magic mushroom. I don't do that. For me, it's about developing a relationship with the person, getting a sense of their values. There are some people for whom psychedelic medicine is not the right fit. They're afraid of it. They've got a negative experience. And so I want to honor that. There are many ways to create a healing state of consciousness. But I would say over time, as we get to know each other, I ask everyone to fill out an ACE

questionnaire at the first visit. And then we're talking about it. So every visit we're talking about trauma. It's a new vital sign. It's like your blood pressure, your blood sugar, your heart rate, temperature, your ACE questionnaire. Everybody go right now after this podcast over, go online, Google adverse childhood events or ACE questionnaire and take the quiz. It's 10 questions and quickly you'll get a score

and you'll go, oh geez, I better deal with myself. And I have a link to it that we could stick in the show notes. Yeah, we'll put the link in the show notes for sure. Yeah, it's easy to get to. So you start this after you've already done the groundwork of helping the biology get better through the principles of functional medicine and building a rapport with the patient. And then you sort of start to open them to the idea

that this might be something helpful. That's right. I like to look at the base case. So what's your baseline in terms of your pine network? What's your baseline in terms of the systems that we study in functional medicine? And once you know where the dysregulation is, that's where you get a sense of whether something like psychedelic assisted medicine is going to be helpful. Amazing. So Sarah, last question. What would you have told your 20 or 30-year-old self going back and looking back that you wish you'd told yourself about how to live your life? I wish I got that message about secure attachment earlier. I think that would have changed everything.

So I can't really say that I would have told my 20-year-old self to do psychedelic-assisted medicine because I just was too square. healing states of consciousness and the path that that can take you on, that sort of transformation that can occur as a result of that, how it downstreams into regulation and biology that can really support you. I wish I knew that in my 20s. Yeah, that's true. I think that's a really important thing. There's a book called Attached and we'll link to it in the show notes that's very short, but it describes what is secure attachment, anxious attachment, what is avoidant attachment, how those influence your life, your relationships, your choices, your business, everything. And it's something that we all should know about because those styles are not because you're a bad person or you're screwed up or they're things that we learn as adaptive strategies as children that no longer serve us.

And we can either carry them on our back like a big weight our whole life or we can learn how to shed them and reimagine a new way of being in our world, a new way of being in a relationship, being in a relationship with ourselves. So it's important. And I think your work is just, it's so beautiful to watch how your work has evolved over the last decades and the things you've come to and the things we're all sort of coming to in this space. And it's, it's very hopeful. It's a very hopeful message. Like despite the fact that we're all suffering from chronic disease and have autoimmunity and trauma, there now are really clear pathways for people to get better. And a lot of it has to do with self-care that you can do. And sometimes you need extra help, but your your book the autoimmune cure says it all everybody go get a copy you can follow sarah on social media at sarah godfrey md

on instagram at dr godfrey on facebook twitter and youtube so check her work out she's got lots of other books on hormone regulation and one called the hormone cure and uh it's just been just a joy to talk to you and have this conversation. And I know we can talk for about three more hours and not even cover what we want to cover. So thanks for being on the podcast again, Zara. Thank you, Mark. Thanks for listening today.

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