The Dr. Hyman Show - Heal Your Autoimmune Disease: What's Causing It and How to Stop It | Dr. Robert Rountree

Episode Date: August 7, 2024

What if the key to overcoming your autoimmune disease lies in your lifestyle? In this episode of "The Doctor's Farmacy," I’m joined by Dr. Robert Rountree to examine the alarming rise of these chronic conditions. We’ll dissect the root causes and holistic solutions to stop your suffering now. Tune in to discover how personalized lifestyle changes and functional medicine can offer hope and healing. In this episode, we discuss: How toxins like heavy metals can trigger autoimmune responses and affect overall health The role of dietary triggers and food sensitivities in the development and management of autoimmune diseases The importance of gut health in autoimmune conditions, including the impact of microbial imbalances and the gut microbiome The significant role of stress and sleep in modulating immune responses and managing autoimmune conditions The importance of individualized lifestyle changes, including diet, stress management, and exercise, in managing and potentially reversing autoimmune conditions View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal This episode is brought to you by Rupa Health, Butcher Box, BIOptimizers, and Sunlighten.  Streamline your lab orders with Rupa Health. Access more than 3,500 specialty lab tests and register for a FREE live demo at RupaHealth.com. ButcherBox is giving new members two pounds of wild-caught salmon for FREE plus $30 off. Visit ButcherBox.com/Farmacy and use code FARMACY30. Get Magnesium Breakthrough for FREE. Just go to magbreakthrough.com/hymanfree and get your FREE bottle today. Right now, you can save up to $600 on a Sunlighten infrared sauna. Just go to sunlighten.com/mark-hyman and mention my name.

Coming up on this episode of The Doctor's Pharmacy. People develop these symptoms like joint aches or rashes, things like that. They go see the doctor. The doctor says, okay, you've got these antibodies or maybe you don't have any antibodies at all, in which case you don't qualify. You don't have the disease. Come back in a year. Yeah.

Come back when you're sicker. Yeah. Come back when you're sicker and we'll do the test and we'll see if you got the antibodies. Yeah. When you meet the criteria, we don't care how you feel. But when you meet the criteria, then we can give you a drug. Hey, everyone. It's Dr. Mark.

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do what I do. Make the switch to Rupa Health. Sign up free at rupahealth.com and take control of your lab ordering process today. That's rupahealth.com. Hey everyone, it's Dr. Mark here. I'm always talking about the health benefits of wild-caught salmon, and it's one of the easiest ways to up your intake of protein and healthy omega-3 fats. And eating it twice a week can cut your risk of a heart attack, stroke, high blood pressure, and high triglycerides. But it has to be top-quality salmon. And sadly, most salmon you find online or in grocery stores, the salmon is double frozen, meaning it's frozen whole, thawed out for

processing, then refrozen before it's sold to you. This process often results in lower quality fish when it comes to taste and texture. And that's why I love ButcherBox. Not only do they make it really easy to get healthy meats and like 100% grass-fed beef and organic free-range chicken, but they also partner with responsible fisheries to source some of the best wild-caught, sustainably harvested Alaskan salmon on the planet. ButcherBox is giving new members two pounds of wild-caught salmon free plus $30 off. Visit butcherbox.com slash pharmacy and use the code pharmacy30. That's F-A-R-M-A-C-Y 3-0 at the checkout. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for

me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. And if you're in need of deepening your knowledge around your health journey, well, check out my membership community, Dr. Hyman Plus. And if you're looking for curated, trusted supplements and health products for your health journey, visit my website, drhyman.com, for my website store and a summary of my favorite and thoroughly tested products. Welcome to the doctor's pharmacy. I'm Dr. Mark Hyman. That's pharmacy with F, a place for conversations that matter. And if you or anyone you know has suffered from autoimmune

diseases, I would listen up because we're going to get a deep insight today into this whole explosion of autoimmune diseases happening in our society with one of my mentors and an incredible physician, Dr. Robert Roundtree. He graduated with magna cum laude from the University of North Carolina at Greensboro in 1976. He has his medical degree from UNC School of Medicine at Chapel Hill in 1980 and has done a residency in family and community medicine. And he's just a brilliant dude. He's been practicing family medicine in Boulder since 1983, and he's done a lot in his career. He's really, really one of the main thinkers

that has been behind the development of functional medicine. He's written many, many books and many chapters and books on integrative nutritional medicine, including the textbook of functional medicine, the clinical natural medicine handbook, and so forth. He's an amazing scientist. He's a comedian when he gets up on stage. Uh, he's a good friend.

He won the Linus Pauling award in, in 2015. Uh, and it's just a legend in this field. So, uh, Bob and I get deep into the conversation about autoimmune disease. We're seeing this being the number one condition affecting Americans today. When you aggregate them all together, uh. There is really something that is going on here that nobody's really talking about, which is why. And functional medicine is all about why. And Bob and I get into the why.

Why are these diseases on the rise? What causes them? What are the most prevalent ones? How toxins play a significant role in them as well, in immunotoxicity, and how these conditions are treated with functional medicine. So I encourage you to listen up. He's a brilliant guy. It's going to be a great conversation. And I hope you enjoy this conversation with Dr. Bob Rountree. So Bob, welcome to the podcast. Great to have you. Hi, Mark. Great to be here.

Listen, we've known each other for a better part of three decades. uh you were this kind of iconic figure when i first mentioned my mind this guy who got up on stage and unraveled the mysteries of human biology in ways that just left me in awe and left me rolling on the floor laughing and hopefully we'll do both of those today and i i think you know the topic today is one that is affecting more people than almost any other health condition, probably except metabolic syndrome and prediabetes and the whole phenomena of poor metabolic health. It's autoimmune disease. Yes.

And if you look at it collectively, autoimmune disease affects more people than cancer, heart disease, and diabetes combined. It's over 80 million Americans who have some form or another, serious or less serious. And it's gone crazy. I mean, when you look at the data from 100 years ago, we didn't have these autoimmune diseases.

I've been traveling out to remote areas in the jungles in Ecuador, to remote areas where people live in traditional ways, and they don't have autoimmune disease. They don't have allergy. And so something's kind of gone wacky. And, you know, as part of a company that I co-founded Function Health, we've been tracking people's data. We've done over 3 million data points on

over 25,000 people. And we're looking at the biomarkers that pop up that are, you know, abnormal and 30%, and this is a health forward population 30 of the people who test at function health have a positive a and a which is staggering to me yeah i mean it's one third of people are walking around with either some form of autoimmunity or pre-autoimmunity yep and you know it's it's affecting so many of us in so many ways i've had autoimmune diseases i've had positive antibodies i've had ulcerative colitis i've had all kinds of inflammatory synd many ways. I've had autoimmune diseases, I've had positive antibodies, I've had ulcerative colitis, I've had all kinds of inflammatory syndromes, and I've had to learn about it from the inside out.

And I've been able to heal myself by using the model of functional medicine. I think you've been really one of the key thought leaders, thinkers, kind of concoctors of the model. And in fact, you lead the- Like concoction. Yeah, the immune module at the Institute for Functional Medicine, which trains doctors on how to think about this. But why are we seeing so much of a rise in autoimmune conditions like

lupus, rheumatoid arthritis, MS, colitis, Crohn's disease, Hashimoto's? Why are these on the rise? Why are we seeing this whole phenomena of this disease where the body is attacking itself? Well, you have to start with where we were 100 years ago. There was a Dr. Paul Ehrlich who's considered the founder of modern immunology. Right. And Dr. Ehrlich said autoimmune disease is incompatible with life. You cannot have it. And if you did have it.

That's not true. And if you did have it, you would not true. And if you did have it, you would call it the horror autotoxicus. Horror autotoxicus. Sounds like a lot of people's life without immune disease. Horror autotoxicus, because if the body's immune system attacked itself, everything would fall apart and you would die.

Right? And Dr. Ehrlich was a big head honcho. You know, no one disagreed with him. And so he said, it doesn't exist. And everyone looked the other way. Yeah. Even though they knew for a long time about anti-nuclear antibodies. Yeah. For example. That's the positive test that I was talking about. It's 30% of the population we're testing. Yeah. So it wasn't until around the 1940s or 50s that it began to be acknowledged

that autoimmune disease exists, right? So we start from it doesn't exist at all. The crazy. Okay, maybe a few people have. It wasn't that prevalent back then. It didn't seem to be. Didn't seem to be that prevalent. We were checking for it the same way we're checking for it now, right?

So part of it could be that we didn't believe it. We weren't looking for it. And so now we have ways to look for it. We can investigate. So that might be part of it could be that we didn't believe it, we weren't looking for it, and so now we have ways to look for it. We can investigate. So that might be part of it. But then the feedback you might get around that is, well, isn't that the same with autism? Do we really have more autism now, or are we just better at looking for it? I think there's more to it.

And I think the more to it, which has actually gotten to the point now where the latest stuff that the researchers are saying is that maybe we all get autoimmune. That this all has some degree of autoimmune. We all get it to some degree. So is aging a sort of an autoimmune condition? Aging is kind of an autoimmune condition, right? Because anti-nuclear antibody levels, the titers, go up with aging. What are anti-nuclear antibodies they're antibodies against the nucleus of the cell which could be any material in the cell against the dna yeah

or the proteins that wrap around the dna right why would we add that yeah right something's got to be damaging the cells so that the cellular contents, specifically the nuclear contents, are getting out into the bloodstream. And then the immune system sees that and starts making antibodies. Now our friends, Aristo Vazhdani and Dati Skorazian, they've done some very interesting studies on antibodies against toxins. Toxins, like mold toxins. Right, they go to people that live in a manufactured home facility, right,

where there's a lot of, you know, formaldehyde and other kind of chemicals there, and they measure antibodies against the common materials that are found in those homes. All these people are making antibodies. So, you know, we start with this observation that there's antibodies against nuclear material. What else are there antibodies against? All kinds of things. And why do we make antibodies? Yeah.

Because something is perturbing the immune system. Yeah. Right? Yeah. What you're really talking about is this phenomena where the body is attacking itself. Yes. And there's got to be some trigger. But in traditional medicine,

we're just really good at describing the symptoms and the pathology. You have psoriatic arthritis. You have rheumatoid arthritis. It means you meet these diagnostic criteria that are set up by the, you know, governing bodies. American College of Rheumatology or something like that. By all the academies that are on high that say, okay, if you have this disease. Lupus, you've got these five criteria. You've got to meet those five criteria. And so, but it doesn't tell you anything about the why. No.

And functional medicine is all about the why. Why do you have this problem? Why is the body attacking itself? And so they really, you know, have a very archaic way, in my view, very almost frightening way of dealing with these diseases, which is using very powerful drugs, things like prednisone, immune suppressants, TNF alpha blockers, things that tend to have serious side effects. And they can be lifesaving and they can help people relieve suffering and they can relieve pain.

And they're not a problem to use in every case. But what I'm suggesting is that they're missing the point. You know, one of our mentors, Sidney Baker, always said that we should pay attention to what we call the TAC roles of medicine. Standing on a TAC, it takes a lot of aspirin to feel better. If you're eating gluten and that's causing your autoimmune disease, it takes a lot of prednisone to suppress that immune response. Why wouldn't you just get rid of the gluten in the first place?

Right, right. So I'd love you to sort of unpack how in functional medicine we begin to think about the root causes. Because, and maybe I even shouldn't in functional medicine, we begin to think about the root causes. And maybe I even shouldn't say functional medicine, because if you look at the scientific literature, it's all there. Like when you just talked about with the immune system, right? There's a whole series of chemicals that our body is causing an autoimmune response to. And this is a phenomenon called immunotoxicity. Yes.

And it happens in very, very low levels of these chemicals that are ubiquitous forever chemicals that we're exposed to, whether it's plastic, phthalates, petrochemicals, pesticides, herbicides, heavy metals. Pharmaceuticals. Pharmaceuticals. Okay, we'll get into that. Yeah, I know there's some articles that call it autoimmunity, but this is stuff that we don't really pay attention to in traditional medicine the science is all there so can you sort of in a high level

breakdown what are the top causes of things that make our immune system so pissed off because that's what's different about functional medicine it's not like okay your immune system pissed off let's find the drug to calm it down it's like no we're going to find out why your immune system is pissed off so in order to get across the mechanism of this root cause thing, I've got to talk a little bit about the immune system. Please. Right. Two major parts of the immune system that we know, the innate immune system, which is the ancient part. Jellyfish have an innate immune system. The jellyfish immune system. The jellyfish immune system and then the acquired immune system, which is the part that gets activated with exposure to a virus or vaccines

or things like that. So you get antibodies against COVID. You get antibodies, that's from B-lymphocytes, that's the evolved immune system. And so if you look through the literature on autoimmune disease, it's all about the acquired immune system. The drugs that were developed to treat autoimmune disease are all drugs targeted at T lymphocytes or B lymphocytes. So they're all working on only one part of the immune system. Only one part of the immune system and so the assumption or in you start thinking that way is that there's aberrant functioning right? Aberrant what

does that mean? Right it means that you're walking down the street and one day rheumatoid arthritis falls out of the sky and hits your T lymphocytes or your B lymphocytes, and you start making antibodies against rheumatoid factor, right? Right. It's the IgM against IgG. And so that kind of sets you up, right, for this lifelong problem and the sort of joke that I tell is that people develop these symptoms like joint aches or rashes things like that they go see the doctor the doc says okay you've got these antibodies or maybe you don't have any antibodies at all in which case you don't

qualify you don't have the disease come back in a year yeah come back when you're sicker yeah come back when you're sicker and we'll do the test and we'll see if you got the end when you meet the criteria we don't care how you feel but when you meet the criteria then we give you a drug then we give you the drug and you've made the team you've made the team rheumatoid arthritis you've made the team multiple sclerosis you've made the team hashimoto's yeah right but what they don't tell you is that the jersey for the team is welded to your back for life yeah because now you've got it you're stuck with it yeah so that's all based on the premise that this is an acquired immune system dysfunction yeah that has mysterious origins we don't know why maybe something in the environment

maybe a virus like epstein-barr virus triggered this right but that's all out in the distant sort of misty past, right? The disty past, right? So who cares about what the triggers might be? But if you bring in the innate immune system and you begin to realize that the innate immune system actually programs the acquired immune system, right? So everything that the T lymphocytes are doing, that B lymphocytes are doing, they're doing it because antigen presenting cells like dendritic cells, macrophages, etc. Sampled something from the environment, displayed it to a naive lymphocyte and programmed it to go down a particular path. Yeah. And why the heck do we get into all that physio? Why does it matter?

Yeah. Why did you just confuse the heck out of everybody? Why did I just confuse the heck out of you? Because that innate immune system, that's the part that is sensing the external world. Yeah. Right? That's what's in touch with what you eat. Yeah. That's what's in touch with what you breathe. It's the first line of defense.

It's the undifferentiated response to bad stuff. To bad stuff. Yeah. Okay. So let's back up a little bit and say, what's the number one risk factor for getting rheumatoid arthritis cigarette smoking and rising so you might think oh it's leaky God there's gluten or something like that but actually the best research risk factor for RA is smoking and number two to that is air pollution interesting so maybe rheumatoid arthritis starts in the lungs hmm all right

so that opens up me bones connected to the shin bone everything is connected yeah in a very mysterious systems biology kind of way which is what functional medicine is applied systems biology exactly yeah right so if you start thinking way, then you want to ask the question, well, what happened to the lungs exactly? And now we know what is going on is that inflammation in the lungs caused by the cigarette smoke or free radicals, right, activate certain enzymes. And these enzymes are called the PAD enzymes, the PAD enzymes, right? Peptidyl arginine deaminases. Why is that there? Everybody write that down because the drug companies are making drugs right now to inhibit

this. So rather than saying, well, maybe you shouldn't smoke or maybe you should get a good air filter. Instead, they're saying, here's a drug you could take that would turn off the enzyme that stopped the process that led to all these things downstream. So here's the deal. The cigarette smoke causes inflammation, activates those enzymes. The enzymes cause a change in the molecular structure of the proteins that line the lung. So sticking out of those proteins is an amino acid we've all heard of called arginine yeah the enzyme cuts off the arginine and puts on an amino acid called citrulline and that changes the whole

structure this changes everything yeah suddenly it's a freak molecule it looks foreign it looks foreign right yeah it's this is something that the immune system doesn't recognize. So it goes, wait a minute, this is a stranger. And I think it's a dangerous stranger. That's what the immune system is looking for. Stranger danger. Stranger danger. Stranger danger. That's what autoimmune disease is.

That's what autoimmune disease is. Is that these innate immune cells get this signal, stranger danger, stranger danger. And then they go to the naive lymphocytes that are off program and say, you guys better watch out, there's a war coming. Yeah. The bad guys are here. Now, the way in which I think about this is that, you know, that's the underlying immunology that happens,

which is important to understand if you want to kind of figure out how to work with it and play with it with food, with nutrients, with various compounds, various interventions that we use. But I kind of want to back up a little bit more because you mentioned a few things one you mentioned air pollution yes it's smoking these are causative factors right that are modifiable and changing in our society in parallel with the rise and all kinds of diseases not just right so immunotoxicity is a big category. Yeah. What's environmental toxins has a big trigger about immune disease?

And I see this all the time. I remember I actually had a case of a guy who had ulcerative colitis years ago, and I tried all the normal functional medicine stuff, fictus gut, 5-R program, elimination diet, the whole thing. All my best tricks. Didn't get better. Was losing weight. You know, it's really sick. I was going to about need to be on some serious drugs.

And I said, well, you know what? I'm going to remember what Sid said. And have I forgot anything about this patient? Is there something I missed? Is there something I didn't think of? How do I think about the problem? Something good or something to get? Yeah, is there something he needs to get rid of that's bothering him

or something he needs to get to get better? And it turned out he had extremely high levels of mercury. Oh, yeah. And we did a heavy metal chelation protocol with him. We got rid of all the mercury. It got completely normalized, and he's completely fine years later. And so that kind of made it really clear to me that toxins were a big factor. What else are the big factors that are the causative factors for autoimmune disease?

So heavy metals definitely up there. One that people don't think about a lot is arsenic, right? Arsenic has definitely implicated autoimmune diseases. There's certain countries and certain parts of the United States where arsenic about all the mechanisms by which that happens. It doesn't really matter. The fact is that arsenic is really widespread. They used to put it in the wood in picnic tables. Picnic tables or your deck and your pressure-treated lumber. Then it rains, and you go and you lay on your deck afterwards when it's still wet, and the arsenic is absorbed through your skin, right?

And again, arsenic can cause... And wine, because all the pressure-treated lumber posts that the wine grapevines are pinned to, and that goes to the soil, and the grapes are contaminated. So wine is actually a red wine source of... Dr. Yeah, well, that's where you're getting that from, right? So it's like green wood. When you see wood with a greenish tint to it, that's when you need the work. Yeah. Today's episode is brought to you by Bioptimizers, a company dedicated to enhancing your health

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which that can happen the metals can can cause free radical, which is oxygen rusting, basically, oxygen damaging molecules. But they can also bind the enzymes. They can bind to molecular compounds and cause freak molecules. So that all leads to what's called break intolerance. Tolerance is the state of normalcy for the immune system. You're able to detect friend from foe and not react to everything in your environment. Like people have allergies to pollen, well they shouldn't, or cat dinner, they shouldn't. They're overreacting to something in the environment that's harmless. But their immune system's lost tolerance for that, or food, right?

Right, and that tolerance, the important thing to understand about tolerance is that it's an active process. It's not a passive process. So our immune cells don't just ignore what's there. They're paying attention, but they're, you know, this is anthropomorphic. They're actually choosing not to react. And there's a lot that goes on inside of the cell that keeps that happening. Right. And part of it is the balance of the free radicals what's called the redox potential inside the cells that's got to be in perfect balance or these

dendritic cells that we talked about you know the immune sensing cells the immune sensing cells will start getting out of whack yeah and start reacting in a very aberrant way yeah so it's an abnormal reaction to a normal thing. It's essentially what is going on. And toxins we think of as poisons that can poison cells and poison various cellular mechanisms and mitochondria, but, and it's sort of dose dependent. You know, the more the poison, the worse the effect.

But with immunotoxicity, it's not like that. It's very low levels and create a massive reaction. And the explanation I always give for that is this case I had when I was a, I think I was a medical resident. I was in the ER and this big, loud horn going off in front of the ER doors and like a car horn wouldn't stop. We all ran out, saw, and there was a young guy slumped across the wheel, face down. And he was basically dead.

We dragged him out of the car. We threw him on a stretcher. We ran him into the ER. We paddled him with the cardiac paddles. We pumped him full of epinephrine, pumped him full of steroids. Got him to wake up, woke up. Like, what happened? He's like, well, I'm allergic to fish.

And I was in my friend's apartment. And he was cooking fish. And I was in my friend's apartment, and he was cooking fish. And I just smelled the molecules in the fish. I didn't eat it. I ate the molecules in the air from cooking the fish across the room. And it triggered an anaphylactic reaction. You could feel it coming on. He knew he wouldn't make it for the ambulance to come.

So he got in his car and drove two miles to the bird's room. And that taught me that an infinitesimally small amount of an insult can create a massive reaction. Massive reaction. It's not just, yeah, so the environmental toxins are like that. It's not like you have to have a load of them, and we all, by the way, do, but it's really a huge issue. So it actually may be the small quantities that are the problem, right? And the term for that is hormesis it's a great term you know well yeah right and that came from work if i got an ed calabrese we probably met or

interviewed you know who talked about the fact that in higher doses things may not be very toxic yeah but especially certain compounds with hormonal like properties yeah right become what's called endocrine disruptors yeah well these are immune disruptors right well disruptors and immune disruptors same chemical yeah that's very much the same chemicals but in particular ones that have an effect that is like estrogen yeah right so who gets most of the autoimmune yeah interesting 80 90 percent women interest right so it turns out the same enzymes that process estrogen in the woman's gets most of the autoimmune. Yeah, interesting. 80, 90% women. Interesting. Right? So it turns out the same enzymes that process estrogen

in the woman's body also process these xeno, which is foreign, xenoestrogens. Interesting. So the xenoestrogens are immune toxins and endocrine disruptors at the same time. So we get it. We get toxins are bad. What else is on the list of things that cause autoimmune? Well, I guess you would call them toxins, but microplastics. Microplastics have

been found in the stool in higher quantities than people with ulcerative colitis. And now there's nanoplastics, which are worse than microplastics. But basically plastics you can't see without a microscope. We don't really understand the mechanism of toxicity of these. I mean, they are toxins, right? But they're doing other things that are irritating that we don't quite understand. It's scary. That's a scary thing because they found it in organic foods, right? Or in bottled water.

You find these microplastics. I think the nanoplastic data just came out, too. It was even more terrifying because the volumes are much higher and uh really exposed to much more of these than we thought even just drinking a bottle of water okay so toxin sexes what besides so microbes microbes right so you said you have been like all over the jungles of ecuador and i'm sure you know about the research that was done in venezuela you know with the the tribes that had never contacted the outside world right um i can't remember the name of the the doc but it was uh blazer's wife i think was the one that did this research these anthropologists descend from the sky on this remote jungle tribe and sample their stools.

Yeah, paleo poop. Which I thought, like, how on earth did the people that were there, how did they take that? Right? You know, they've never met people from the outside world, and all they're interested in is doing these stool samples, these poop samples, right? So they do these poop samples. Yeah. And what do they find? Parasites. Worms.

Worms. Spirochetes. All the stuff that we look in our patient's stool, and we found that, we'd say, oh my God, you need to be on a dozen drugs. You need a parasite cleanse. You need a cleanse. You know, all the clark you've got.

But these people had no autoimmune diseases. Yeah, and no allergies. They had no allergy to autoimmune diseases.immune disease, no heart disease, no asthma. They had, you know, I mean... None of the inflammatory diseases of chronic illness. Right. Yeah. I mean, they were dying from snake bites, falling out of trees, getting bit by, you know, big lizard, something like that.

So they were dying from trauma, but they weren't dying from chronic disease. And so the point is, and this is what Dr. Blazer says in Missing Microbes, is that it's not the presence of something as much as it is the absence of something, right? That there were microbes that were normally there when we were babies, the first year of life. And those microbes send a signal to the dendritic cells again they move back to the cells that line the gut they send a signal and say you know it's okay to have some foreigners here yeah it's okay to have strangers here as long as they're not dangerous strangers that are causing injury to the lining of the cot yeah Yeah. So there's two parts to this microbe thing.

One is the good guys, sort of good guys that are missing, but not even good guys, right? Just they weren't causing a problem. Yeah, they call it the epidemic of absence. Yeah, the epidemic is a whole... Book on that. Yeah, there's a whole book on that. It talks about it.

It's fascinating, yeah. Yeah, epidemic of absence. And then using worms to actually treat autoimmune disease, which is now happening in even conventional medicine. Okay, big confession. I have given worms to patients with autoimmune diseases and seen beneficial effects. Yeah.

I had a guy with ulcerative colitis. I gave him a certain kind of worm egg. HDCs? No, I got it from Thailand. Oh, the TH100? Yeah, yeah. Oh, TH100? Yeah.

TSO100. TSO100, yeah, yeah yeah yeah yeah i gave it his his ultra place went away for a year that's the same he stopped everything he stopped all of his drugs everything he was fine right then and then it came back and he stopped taking it yeah he stopped taking it and it came back you keep you have to keep taking you have to keep taking it right i mean you don't have to keep doing it it's almost like you, historically we had an immune system that was used to deal with all these bugs, worms and parasites. And then we took them all away. They call it the hygiene hypothesis. Yes, yes.

And all of a sudden the immune system is kind of looking for something to do. Yes. And it starts reacting to stuff that it shouldn't react to. And that's when you get allergies and autoimmunity. So I don't know the answer for us all to kind of eat dirt and take worms and, you know, well, maybe when you're older, maybe eating dirt's not such a good idea. But you know, the worm eggs are not, I mean, there's still interesting research. Weinstock is still doing research on that. You know, what they're asking is what is it the worms do? Right. It turns out they secrete a glycoprotein a protein that's bound to a sugar that's an immune

regulator yeah it's to their advantage that i get kicked out of the apartment yeah they don't want to get evicted so they've made these chemicals and we know what some of them are now and the chemicals say okay i know i'm a foreigner but just ignore me yeah leave me alone so that's part of the puzzle so so gut is a big issue. Gut is a huge issue. And lungs. Gut and lungs. So microbes that are mainly not infections,

although some infections obviously cause rheumatoid arthritis like Yersinia or entomoeba histolytica that's been mapped to causing rheumatoid arthritis in certain subtypes of genes. Proteus, perhaps, according to Dr. Hebringer. There's some, you know, we call it infectious arthropathies, which we learned about in medical school, like from Ryder syndrome, it's called, R-E-I-T-E-R. And this whole phenomenon, these kind of bugs

that aren't necessarily terrible infections, but they do cause autoimmunity, klebsiella, or sinia. You know, in functional medicine, we take a look at the whole ecosystem of the gut and we try to optimize it. And that's a key way we treat issue. But it's not just that there's bad bugs. There's other things that happen, right? That are going on in the gut that drive it. And you talk a lot about the barrier functions.

The barrier. And the barriers that help us sift through and determine what's friend from foe, right? You have a gut lining that's, you know, arguably the size of a tennis court if you lay it out flat. Yep. That is one cell thick. Think about that for a minute. Yeah.

It's huge. Yeah. Huge. And it's one cell. You visualize your gut like it's a tennis court. It's big. And what's going on in that tennis court? And it's only one cell thick.

Right. It's like you're basically one cell away from the sewer. Yeah, yeah. And from all these foreign food proteins. Yeah, yeah, yeah. So tell us what happens. One cell away from the sewer. So tell us what happens when that lining breaks down, why it breaks down, how it breaks down,

and what happens, and why that's linked to autoimmune disease. Robert Frost, the famous physician, said good fences make good neighbors. Yeah. Right? Yeah. So the whole idea is that certain bugs or chemicals don't cause a problem if they're in the right compartment. Right? So as long as they stay in your gut, it's not an issue.

But what would affect that thin lining in such a way that it becomes leaky? Yeah. Well, first of all, now we know that there's this mucus layer, and there are a lot of things that go into maintaining a healthy mucus layer. I mean, it's a very complicated material, that mucin. And one of the things that's necessary for maintenance is certain condom bacteria. There's one called Hockermansia buscetifilla, which I know is a good friend of yours. Yes, good friend of mine. I lost him for a while, actually.

When I was sick a few years ago, I got ulcerative colitis. It went away. And I was like, it was gone. And I had to get him back. And it was a big project. I got looking for him and hard to find. But I was able to grow him back, back actually by using food, polyphenols. So there was a really interesting study that was done a few years back

where they actually got Mehmet Oz's signature smoothie and measured people's gut flora. And one of the things they measured was acromantia. And they went on the Oz Flynn smoothie. I think I helped them. And acromantia went way up. I think I helped them develop that, actually. You helped them develop the smoothie, right?

Yeah. Right. So acromantia went through the roof. Yeah. But then as soon as they stopped the smoothie, the acromantia disappeared. Yeah. So we want to maintain acromantia because it helps with the turnover of the mucin link. Yeah.

So that's an important concept because most people just think well it's a cellular layer that's all there is but what was the last time you went to the rheumatologist and they checked your toxins or looked for acromantia levels or even acknowledge that i had poop right right oh yeah if there was something to look at in there yeah your rheumatologist should be doing stool tests but they don't do that no no it's probably i mean if you're a rheumatologist it's probably the most important test you probably the most important test you could do. Probably the most important test you could do. That and a celiac pill. What's the mix of there? So the other part of it is that we know that the cells that lie in the gut have these junctions called tight junctions, right? And when you look at them under a microscope,

or especially electron microscope, you realize that it's a very complicated scenario that's going on. You don't remember, you know, Game of Thrones, right? Yeah, of course. Remember the northern wall to keep the Nightwalkers out? That's a complicated wall, and they had little doors that are going in and out. Well, if that wall, the lining,

if it's completely tight, nothing ever gets in. You don't absorb nutrients. Yeah. So you've got to be able to open and close it at will. You know, you imagine these little guys with levers in there opening these levers. I think it was like a coffee filter, right? Because basically the food and the nutrients are supposed to go through the cells and not in between the cells. Yes.

And when these tight junctions break down, the food and bacterial toxins and proteins leak in between the cells. Yes. And when these tight junctions break down, the food and bacterial toxins and proteins leak in between the cells. Yes. And that's what causes the problem. That's called a leaky gut. Yeah, leaky gut. And intestinal permeability increase or whatever you want to call it.

I think, you know, it's amazing to me that we've been talking about leaky gut and people used to laugh at us for talking about it. Now it's in the mainstream literature. It's in all the journals. And it all came from functional medicine, but they don't even acknowledge that. But's now it's all the mainstream journal but it's got it from leo gallen 40 years ago right and again the mainstream docs the gastroenterologists say leaky gut what kind of problem is that what a joke yeah right right

you know and now we've got electron microscopy that shows what's going on we know about clodons and occludens and all the different proteins involved. And then along comes Alessio. Yeah. Dr. Fasano. We've had him on the podcast. Yeah. Alessio Fasano, who had the gall to actually study the mechanism involved in this. And he tells a great story about it, that it was all about cholera, right? Cholera, yeah. He was trying to figure out what caused that intense diarrhea you would get with cholera and discovered this protein called zonulin. Yeah. Right?

And zonulin changed everything, wouldn't you say? Yeah, yeah. It basically is a protein that's expressed in the body. It's something the body makes. When there was some insult that required you to kind of adapt to some bad circumstance like cholera. Yep. there was some insult that required you to kind of adapt to some bad circumstance like cholera yep but but what we now know is that the other main trigger for increasing zonulin is gluten gluten gluten yeah and that's and that and i think that's a big factor uh what would you say in terms of the sort of hierarchy of things that you see in autoimmune disease that are at the top? Is it

gluten? Gluten is definitely in the top 10, if not the top five. Yeah, it's way up there. Yeah, there's no one comes in with an inflammatory condition or of any type or any autoimmune disease of any type that doesn't get a full celiac panel workup. And not just a normal one you get from the doctor's office, which is ttg which is barely ever positive but a full panel of you know anti-glide antibodies iga igg ttg iga and idg these are really important to look at and then you know it's a lot of words and a lot of mumbo jumbo we offer this testing at function health which allows you to get access to your labs and it's gives you a really detailed view it's something your doctor may not want to look at or order but

it's essential to know because if you have any antibodies, and I learned this from Alessio, if you have any antibody level, even within the quote normal range, it means one, you've been exposed to gluten. Two, you have somewhat of a leaky gut because it's gotten through.

And three, your immune system pissed off to some degree about it. It may not be full-blown celiac, but there's something going on inflammatory-wise. And many of us can tolerate a little bit, but the amount of flour and inflammatory-wise. And many of us can tolerate a little bit. But, you know, the amount of flour and gluten we have and the kind of gluten we have is very different.

Western gluten. Yeah, it's like the dwarf wheat, which is when they breed wheat plants, they breed plants like humans where you get 23 pairs of chromosomes, you know, one for your mom and your dad. It would be like, you know, instead of we got each person has 46, it would be like having 46 plus 46, which would be 92, if I'm good with the math. Set that up, right? And so all of a sudden you've got all these extra chromosomes, which means extra genes, which means extra proteins, which means sometimes different proteins than you're getting, which is what is actually happening. So there's all these very inflammatory glycogen proteins now in wheat

that we didn't even have 100 years ago. Yes. And so that may be part of it as well. And then they throw glyphosate on there when they, a lot of it, not all, but a lot of the wheat crops, they throw glyphosate to dry it out so they can harvest it easier. And that glyphosate is a microbiome killer. So then you're doing a double whammy.

So do you think, to me, I think gluten is sort of like the gateway drug in a way. It's like it causes the initial insult, damages the gut, but then we see all these other foods that people start reacting to, right? Right. So can you talk about like not just- You've got cross-reactivity. Yeah. It's called bystander, it's a bystander intolerance.

Yeah. Bystander effect. This is not really well accepted by traditional medicine that there's these food sensitivities. They're not true allergies. They're not like a peanut allergy. It is showing up in the literature now. It is. It's a different part of your immune system. It's kind of a slow reacting

part as opposed to a fast reacting part like the guy told a story about with anaphylaxis with the fish smoke. But a lot of people start to have other foods. Dairy and fast-reacting part like the guy told a story about with anaphylaxis with the fish smoke or whatever the fish molecule. Yeah, yeah, yeah. But a lot of people start to have other foods that react to dairy and nightshades and nuts and other kinds of stuff that may be a healthy food, but actually they're reacting to. So how does that play a role in autoimmune disease? Okay.

So there's two things going on here. One is there's a concept called epitope spreading. Okay. That's a pretty important concept. So when you say your immune system is reacting to gluten or to gliadin, you know, type of protein called prolimin, right, it's because there is recognition like a lock and a key of a certain sequence of amino acids, right? So your immune cells your native immune cells you know they recognize that and then again they pass

on that recognition to the acquired immune cells and then they start making clones of themselves right and then they start making antibodies against tissue transglutaminase etc but then that damages tissue in the surrounding areas so if you make antibodies against tissue transglutaminase, which is an important enzyme, and you start damaging the tissue, say, in the vicinity of the gut, now you get what Pauli Mazinger, the famous immunologist, said, a dangerous stranger. So you get a dangerous stranger, and suddenly other structures that maybe look a little bit like the gliadin, but not quite,

you know, they're close enough that the immune cells start going, well, maybe that's a bad guy too. Maybe that's a bad guy. Maybe that's a bad guy. So one example of this is not quite about the food thing, but, you know, I've seen patients that would get diagnosed with celiac disease. And I'd say, how's your thyroid? And they go, why are you asking about your thyroid? I don't have a thyroid problem. I've just got a gut problem, right?

I got a gut problem. Like, we need to check your thyroid. Well, I don't have a thyroid problem. Okay, let's check your thyroid. So, you know, you do a TSA, a tenofreq. And sure enough, they've got antibodies against TPO. Yeah, I would say it's about a third of my Hashimoto's patients, which is the most common autoimmune disease we have,

have some level of thyroid problem. They'll have gluten antibodies. So it starts with the gluten, or maybe the other way around, I don't know. But typically what I would see is that patient that's got celiac, or maybe they didn't know they had celiac. They just had some weird symptoms. Maybe they's of joint aches or a weird rash there's one called dermatitis herpetiformis yeah right it looks like herpes and then you check them for celiac antibodies and they're positive

that's right but then you've got to start checking for antibodies to other tissue yeah so I saw one patient that started out with celiac, and then it spread to her thyroid. She got thyroiditis, and then she got multiple sclerosis. Yeah. Right? So the question that gets raised is, is gluten the trigger for all those diseases? Or is gluten causing leaky gut?

And the leaky gut sets you up for all those diseases. I think it's both. Or is it both? I think it's both. Or is it both? Dr. Pisano says both. Yeah. I mean, I actually had a patient at Cleveland Clinic who had three auto's both. Or is it both? I think it's both. Dr. Pisano says both. Yeah, I mean,

I actually had a patient at Cleveland Clinic who had three autoimmune diseases. How was that possible? Treating with all these different things. I'm like, has anybody checked your gluten?

Anybody's like, no. We checked it. He had full-blown celiac. Like not... And they hadn't even looked. And they didn't look. And it's staggering to me because this is not something

that's in, you know, some crazy alternative, you know, handbook of medicine. It's in the scientific literature. It's right there. National Library of Medicine, it's all the evidence points to this, and it's like a blind spot in traditional medicine,

which makes me so frustrated because autoimmune disease is really a horrible condition. I mean, I can tell you when I was sick, because I had a long story. I had a root canal. I saw it on the podcast before. I had a root canal, it went bad, I needed to take an antibiotic, after I got my tooth, it was infected, I took clindamycin, I got C. difficile, that didn't go away, the C. difficile went away, but it turned into full-blown ulcerative colitis, and I was taking... And you didn't get a poop transplant at the time? Well, no, I did not get a poop transplant, it's hard to, you know, I was standing on the corner, poop, I did not. We had a poop transplant. It was hard to, you know, standing on the corner, poop, anybody got the poop?

Yeah, yeah, yeah. But I ended up being really sick, and I saw one of the top GI docs in IBD, inflammatory bowel disease, at Harvard, and really nice guy. And, you know, he was looking at all kinds of, you know, actually alternative therapies and diet. And I tried everything I knew, like I threw the kitchen sink. I literally saved, I would say kitchen sink at what I literally say. I was saying dozens of patients from having their colon removed and I couldn't fix mine.

Yeah. Yeah. Yeah. And I was like, so sick. I took like 60 milligrams of prednisone first. Oh, wow. Didn't touch it. Wow.

Didn't touch it. I was having 20 painful bloody bones a day. I was in bed. I lost 30 pounds. Oh no. Yeah. I was, I was in bad shape. I was like near death yeah uh

and they were about to put me on one of those big heavy duty you know tina valvo blockers or other drugs and I was like no I'm gonna just do it I'm gonna do a hail mary here yeah and I know I've got some massive inflammatory process going on so I'm just gonna basically do a bunch of stuff like I basically took uh ivy a lot of IV nutrients, high dose vitamin C. I did IV ozone, which sounds crazy, but it's a powerful anti-infectious agent, an immune modulator.

And I did hyperbaric oxygen. Literally within days it went away. Within days. In days. In days. Yeah. And not all of me is really simple, but I just remember how horrible it was to be in that state. So like, and so, you know, and not all of me is really simple, but I just remember how horrible it was to be in that state.

Yeah. So many people are suffering and they're taking so many of these drugs without actually getting to the root cause. And often it's sometimes simple. Like I, you know, we've had cases where you just do one thing and it's gone. Well, the drug isn't really changing what's going on. Right. You just stop gluten and people get right right so this

is a little more complicated to reset their gut microbiome like i had this one little girl uh isabel who was 10 years old she had a mixed connective tissue disorder and she was on 1200 milligrams iv of solumidrol every three weeks which is like a horse dose of a nasa steroid and she was on methotrexate, which is a keynote drug. And she was on a pile of other drugs to deal with the symptoms, like nifedipine for her Raynaud's and acid blockers for reflux and aspirin for the blood vessel clotting she had. So she was a mess of things.

And she had every autoantibody you can imagine. She had muscle enzymes that were high. She had high aldolase. She had high rheumatoid factor, high ANA, high anti-RNP. I mean, you name the antibodies. And they weren't just like a little bit elevated, but they were like off the chart elevated. And we learned, by the way, in medicine, if those antibodies are high, you check them once and that's it. Right.

Why do you need to check them again? Because they're going to have this for life. Right. Like they're going to have this disease for life. Who cares if your ANA goes up or down or anything? Right. You've got it. I think it's important for everybody listening to understand that when you have an autoimmune disease, it's not a life sentence, even though traditional medicine says it's a life sentence.

And when you get to the root causes, things that Bob and I are talking about, it literally can be undone like it was with me. And this girl, I found out she loved the sugar and dairy. She loved tuna sushi. She ate a ton of it as a little girl. And when we did her a lab, she was very low in vitamin D. She had high mercury. She had gluten antibodies.

She had high calprotectin, which is a measure of inflammation in her gut, even though she had no gut symptoms. And we just basically put her on an elimination diet. I gave her a multivitamin, fish oil, vitamin D, and probiotics. And I got her eventually chelated with DMSA for heavy metals. And within two months, she was dramatically better. Within a year, she was off all her medications and had normal antibodies. And was completely cured.

Right. And I talked to her 10 years later and she's fine. So, you know, it just tells you that, you know, what we're doing is so off base. Right. In traditional medicine. And we have to. So down street. So down street. So the antibodies are down street.

Right. You know, we're putting all our attention to the antibodies. So they're helpful diagnostically, right? Yeah. But the antibodies don't tell you about root cause. The root cause is in the innate immune system, right? Yeah. If the innate immune system is generating this problem, then the things you're changing

with lifestyle, et cetera, have to do with getting your innate immune cells happy. Yeah. So I got to tell you, I have like UC story. Yeah, yeah. That's great because I had a patient that I had dealt with a couple of years and had bad ulcerative colitis. We got it reasonably under control, but not in remission. And then somebody told me about these two Israeli gastroenterologists

that were doing research on an old compound in Chinese medicine called indigo. Oh, yeah. And they were combining indigo with curcumin. And I said, okay, we've done a lot of other things. You're a lot better. You know, you're still not off your meds, though. I put this guy on indigo, and then I forgot about it. Right?

And then, I don't know, about a month later, I get his routine labs, and all of his markers were normal. And I called him up, and I said, I think they got the wrong blood. I think they got the wrong blood. Your C-reactive protein is normal. That can't be. And he goes I went in a complete remission it's two weeks after starting this indigo and wow wow oh so every now and then and you know I'm not talking about magic bullets here every now and then you find something for that one

person yeah that really makes a difference I think that's an important point Bob because people listening I go I'm gonna take it that's the one I want but it's actually it's that guy it's that guy buddy that everything works right so like I always say if you know the name of the disease you don't know what's wrong with you right right if you say I have ulcerative colitis it doesn't mean you know what's going on right just means you know the symptoms I like the name and blame yeah I you know it makes me feel good yeah yeah well that's right that's right did you used to say about neurologists? Diagnose and adios. Yeah, treat them as treat them.

Treat them as treat them, diagnose and adios. Right, right, right. Right? Yeah, but we really have a different model in functional medicine. And so we take a look at all these factors. Unpacking a little more, we talked about toxins. We talked about foods. We talked about the microbiome.

The gut. We talked about certain food reactions. But there are also other microbes that are playing a role. And one of the things that I'm seeing a lot now is the consequence of long COVID. The autoimmune reaction. And reactivation of other viruses. Signing off all those antibodies. But we know in traditional medicine that many infections can cause autoimmunity.

Lyme. Epstein-Barr. It's been linked to, for example, NAMme, Epstein-Barr. It's been linked to, for example, MMS, Epstein-Barr. But, you know, long COVID now seems to be showing up with a lot of autoimmune antibodies, particularly to your autonomic nervous system, which is causing

people to have POTS, which is orthostatic hypotension, where you get dizzy when you stand up or you can't stand for long periods. So there's a whole realm of infections uh that that often are a cause right and uh you know like viral infections in particular seems like viral and tick infections i think yeah tick infections and tick infections lyme obesity burnout and so you know part of functional medicine workup is looking for those things yeah you know you don't have rheumatoid arthritis you have lyme disease right right but it happened it's caused all these autoimmune antibodies right so we got to really dig um the

other thing i think is is is really important is is sleep and stress so uh those are really i thought you might bring that up i don't know why those are big factors yeah and they're you know there's a guy who never sleeps right no i sleep are you kidding i'm like i'm in bed about eight and a half to nine hours a night yeah and uh and so i, just because I wrote 19 books doesn't mean I don't sleep. But the immune modulation is really interesting with our stress response. So you might have a trigger like gluten or a toxin or some virus, but it doesn't really do anything until there's some triggering event, like a stressful event. And I noticed, I saw this happen to me as well, and I've seen it in many of my patients.

And so that trigger can be modulated. And I remember the work of, I think it was Langer or whoever, I remember somebody else, but it was where they did journaling. It was simple journaling about, you're not just like what I did for today, I think it was Langer or whoever, I don't remember somebody else, but it was where they did journaling. It was simple journaling about, you're not just like what I did for today, I went to the grocery store, but like your inner experience. Yeah.

At 20 minutes a day, and they measured hard outcome biomarkers for rheumatoid arthritis and for asthma. Yeah. And after like, it was like 12 weeks. And it went down. It went down. Okay.

And they got better. So we got to use that new iPhone app, right? Journal, it's just come out of the iPhone. So it's applied for the, I don't work for Apple. Okay. And they got better. We got to use that new iPhone app, right? Journal. It's just come out of the iPhone. So it's applied for the, I don't work for Apple. Okay. Okay. So did you know that when you're really stressed, you release mitochondrial contents into your bloodstream? No. In huge quantities. Wow. Tell me. They've been shown when people go on stage, right? And they're stressed about being on stage, you can actually measure mitochondrial fragments in their bloodstream. Now, where are mitochondria? They're bacteria. Wow. Right? So it's essentially the same as if you had bacterial fragments in your bloodstream.

So it causes this low-level endotoxemia. It's like metabolic endotoxemia. So you're saying the body doesn't recognize mitochondria as self oh not at all because no they got to be in the right compartment if you're mitochondria inside your cells that's great because they have different but if your cells open up right they have different dna they have rickettsial dna your mother's dna rickettsial they have rickettsial dna as a tick kind of that's where mitochondria came from is rickettsial DNA. Rickettsia as a tick kind of. That's where mitochondria came from is rickettsia. Really?

So rickettsia, for those who are not aware, is a really rare, unusual infection that you can get out west. But it's where you live. Rocky Mountain spotted fever or something like that. But mitochondria are made from rickettsia. Wow. And when you're stressed, you release that into your bloodstream. Right? Your immune cells see that.

And you may not go into septic shock, but they get activated and you start making cytokines. So why bring that up? Because the hot drugs in rheumatology now are the biologics, right? Which go after cytokines like tuberculosis factor alpha, interleukin one. so I say well okay you can take a drug that knocks out TNF alpha where you can meditate and do heart math and tai chi and get more sleep think about it which one would you prefer right yeah yeah I'm not saying if somebody is a really inflamed I'm not gonna tell them don't do the biologic you would never say that yeah but you know in the long run, is that really a good idea? It's important to be managed.

So your lifestyle, stress, relationships, sleep, all those things modulate your immune response. Yeah. So basically, high level, the way I think about it, like what are the things that are pissing off your immune system, right? It's toxins, allergens, microbes, stress,

or diet, right? Trauma. Trauma. Yeah. And then psychological stress, physical stresses. But there's also things we're missing, right? Souma. Trauma. Yeah. And then psychological stress, physical stresses. But there's also things we're missing, right? So we know, for example, that, you know, if you're like the Sid Baker model of what do you need to get to be healthy and what do you need to get rid

of, you know, to actually be healthy, right? Well, there is vitamin D. Right. So vitamin D. There is omega-3 fatty acids, right? And 80% or lower or deficient or just insufficient in vitamin D. Probably 90 plus percent are insufficient or low in omega-3 fats in America. And this is an epidemic. And yet, you know, when you go to your rheumatologist or your gastroenterologist with an inflammatory bowel disease, they're not actually checking this stuff. Why is this concept so hard? It's not that hard. It's vitamin D. It's cheap, right?

It's really non-toxic. You have to take a lot of it to get sick from it. I mean, a lot of it. Over 10,000 units a day for a long period of time to get into toxic levels. And even then, you stop it and your calcium levels go down. So why is there so much resistance from rheumatologists, from endocrinologists, to just doing this simple thing? Michael Hogg's been talking about this yeah ever yeah with good science in the new england journal of medicine

yeah and he's just saying hey take vitamin d oh no yeah right oh we can't do that we can take this fifty thousand dollar drug right because this drug is only five thousand dollars a month iv and it might give you tuberculosis yeah right but to avoid but avoid this vitamin It's a penny's a day. They'll take vitamin D. They could make you sick Right, you could get toxic and the press puts an article out about this like once a week. Yeah, I don't get it Yeah, so there's something like with MS We know for example those who have low vitamin D or higher risk for MS why it's a higher northern latitudes or this low by me Exposure to the sun and so they had

more vitamin e deficiency yeah and vitamin a is important too i think like vitamin a has gotten a bad rap right oh you can get toxic chroma it can cause osteoporosis etc but in reasonable quantities regular vitamin a you know five ten thousand units a day it doesn't take a lot yeah but i'm talking about real vitamin a not beta carotene. Because a significant percentage of the population doesn't convert beta carotene into retinol, which is vitamin A. So, a lot of people leave that out,

but it induces immune tolerance. Yeah. So I'm a big fan. Yeah, so we can use nutrients when they're optimized to help regulate our immunity. We know that vitamin A and vitamin D and zinc and selenium and vitamin C all are part of our immune system. Yeah, yeah. Right? And help modulate things.

So why not? Immunotransforms are like any other cell in your body. They need a whole range of nutrients. I want to sort of now talk about, so that we've covered the causes. Yeah. How we begin to approach people and treat them because people are going okay i get it now what you know what do i have to do diagnostically what are the kind of options for me therapeutically so that i can reduce the level of inflammation reduce my symptoms feel

better deal with the cause and actually maybe even reverse the problem yeah and by the way i just just want to re-emphasize i said, is that we were all trained in traditional medicine that it's a terminal illness. Like you've got MS. But you got it. You've got rheumatoid arthritis. You've got lupus. The jersey's welded to your back, right? That's right.

And there's no way back. Maybe you can modify it, reduce it. It comes and goes. But it's a lifelong sentence. In our experience, and I think in many functional medicine practitioners' experience, this is not the case. There are people who had it and don't have it. Right.

Right? Who's completely recovered from it. Right. It might not be that they're still not predisposed and if they don't take care of themselves, but that it's something that can be reversed and the autoimmune antibody can be reversed. And again, it's something that we just don't see.

So I just want to emphasize that. So, yeah. So what they always ask is, is autoimmune disease reversed? And again response is how far along is and how much destruction of tissue is there you know I mean particularly with the disease like rheumatoid arthritis yeah if your joints are gone you're doing yeah if your joints are gone your attention but some things like you know ulcer colitis your gut can regenerate right complete regeneration yeah i've seen people go

into remission i mean i any time i had my god because i had a scope top and bottom at harvard full red gastritis all the way down full uh colitis all the way through there was like it was just like a red carpet yeah not the one you want to walk on. Yeah. And it's all gone. Yeah. It's 100% normal. My Cal projector was like 1,000. Now it's perfect. Right?

So I've experienced... So how often do we remake our bodies? Every seven years for something? New cells? And MS. You know, we have a colleague, Terry Walls. Yeah. Terry Walls.

Terry Walls was in a wheelchair. In a wheelchair. And could not walk. Yeah. Go dancing with her. And now, done dancing with her. She rides her bike 20 miles a day. And she's been able to reverse her MS using a functional medicine approach and something that Terry has said that's important if you

look at her brain scan then you might say well I don't know if it's really gone away so you're treating the brain scan or the person well the brains right Terry's moving around I mean she's got function yeah but her brain scan shows scarring. Yeah. Well, sometimes scarring you can't get rid of, right? Right. The scarring you can't get rid of, but the brain can rewire itself around the scarring.

Exactly. So when someone comes to you and they have rheumatoid arthritis or they have ulcerative colitis or they have MS, how do you start to think about approaching a patient like that? Yeah, well, I think I start focusing on anything that might be obvious. Right? Do they smoke cigarettes? Right? Do they live in a polluted area?

So I think, okay, so that's probably the most important thing that we teach in functional medicine. Yeah. Is you take the most detailed history you can imagine. You know, we have like a 10-page form that people pull out. Where were you born? How long was that? Where were you born? Were you breastfed? Right. Did you have colic when you were a kid? They're like I'm 60 years old you're asking me if I had colic? You know did you take antibiotics? Did you have otitis media when you're six months old? Like I want to know about all these things and you know that's really critical information so the history is a huge part of it. I mean did you eat tuna fish every day for

six years? I mean I did, I had tuna fish sandwiches every day at lunch. You know like did you have exposure to other environmental chemicals? You got to be careful. I mean I had a patient with MS where I'm telling you you got to eat more fish right? So then she goes out and starts eating tuna every day. And I'm like, oh, I didn't spend. You got to be very specific. Right. So I like to start really simple.

Yeah. And we've talked about Sid Baker a couple of times. I trained with Sid 40 years ago. Right. So, you know, Sid's basic principle, what does a person need to get and what do they need to avoid? We said that a few times, but you cannot stress that yeah that's right that's the crux of how always start with that is there anything obvious that this person needs to get you know maybe they just need to get more love yeah right they're in a bad relationship so i try to do the obvious stuff

first yeah and and i'm making a point about this because sometimes people have the idea functional medicine is all about the grocery bag of supplements. Yeah. Right? Definitely not. Somebody comes in, they've got rheumatoid arthritis or MS, then you just give them the grocery bag and they walk out with the cart. It's not like that at all.

Now, it may evolve to that point. You know, they may end up on quite a few things if you start tweaking yeah right they still don't take as many supplements as i do right right or you do yeah right it's a thinking the problem is functional medicine corrects the thinking so i'm looking at the whole system right so what's off in the system so what's the outer layer? What's obviously off here? Is the person not getting, you know, problems with lifestyle factors, not getting enough sleep, not getting enough exercise, not getting enough fresh air, all those things. Really obvious, maybe to you and me.

Yeah, yeah. But, you know, it wouldn't be obvious to a rheumatologist to say, well, get some houseplants, get an air purifier, clean up your gut. And then the next layer is going to be to talk about diet, you know, the gluten, the dairy, et cetera. Am I going to test for gluten sensitivity? There's a high likelihood that I will. Am I going to do a gut microbiome test? Quite frequently I do. You know, so I'll do the standard test, the blood count, the metabolic panel, the antibodies of basic immune stuff. Do you look for toxins on everybody?

Not on everybody, no. Heavy metals? I mean, if you have a history of someone... If I've got a history, if I have any reason to suspect it, I'll do it. Like if you're a vegan and don't have fillings, you basically... Yeah, then I'm not going to do that. You don't need to worry about it. I don't do that. But I mean, if you've always been a vegan. It's gotten harder to test for toxins, to be. You know there used to be a few labs where you could do really comprehensive things like look for glyphosate. Should I look for Roundup in everybody? Yeah. Well everybody's got Roundup. I got it. I tested myself. I know me too. It scared me. I'm

like what do I do? Well maybe I just shouldn't test for this. Don't eat at restaurants. Don't go out to eat. Don't drink anything out of a bottle. Then you'll be fine test for this don't eat at restaurants don't still go out to eat don't drink anything out of a bottle then you'll be fine so I don't do it unless there's a big red flag that says okay here's the person that say was well and they went up and sprayed their yard yeah and they went downhill after that yeah well I'm thinking some kind of organophosphate yeah so yeah you don't actually have to touch that. You know, I think I just want to emphasize what you said about history because it's so important. And I think, I'm sure you've seen this because I've seen this in patient after patient.

You take the history starting from birth. Yeah. Where you see section. Yeah. Did you breastfeed? Did you have antibiotics for your own? Yeah. Did you have colic?

Yeah. Did you take antibiotics? Yeah. And did you have acne and take antibiotics for that? Were you on the birth control pills again? So you start to get a story. Did you have irritable bowel when you were a kid? Did you have asthma? Did you have allergies?

Did you have eczema? And you start to see they have this sort of low-grade inflammatory nonsense that starts to accumulate over their lifetime. And it sort of progresses by the time you're in their 30s or 40s. It becomes autoimmune disease. And often it traces back to the gut and the damage that we've done to the gut through the diet through the antibiotics or lack of breastfeeding through c-sections through all of the ways we sort of deal with with our toxic diet on the

environmental chemicals which by the way all affect the gut so i i think your history point is really important right and and then i always make sure i check for uh you know have you been exposed to tick infections, to get bite, so you have mold in your house, do you eat a lot of fish, what kind of fish? So I take a very detailed history. Any flooding. Yeah, exactly. And then you go, okay, well, then you know where to find things.

So what are the top diagnostics? You mentioned a celiac panel. You mentioned stool testing. Yeah, I do a celiac panel. I do a stool test. Those are all pretty high up. You know, I find a lot of weird immunodeficiency syndromes in people too. So IGA is probably one that people would never think about, right? But IGA, one of the standard immunoglobulins, so there's A, G, D, and E, right?

But the A, you know, people know you make IgA in your spit and your tears, et cetera. And, you know, it's present, but what's the problem if it's not there? Yeah. Very high incidence of autoimmune disease. Yeah. And it's really common to see a congenital deficiency of IgA, but also an induced deficiency of IgA. So it's really worth testing for that a lot. So, you know, I have a batter of immune tests.

I do the CCP test, the cyclic citrullinated peptide test. I do that a lot. I do ANA, like, you know, you should just do it. Standard biomarker. ANA should be a biomarker for everybody. Yeah, we use that on the standard function panel which your doctor's not going to do but we check all these things vitamin d we check for inflammation we check rheumatoid factor a and a all those things that help people get a sense and we're shockingly finding 30 of people have this phenomenon and so in a way you know people will have to wait till they get an

autoimmune disease they can have pre-autoimmunity. And I want to get into that in a minute. But I want to kind of talk about, we talked about some of the diagnostics. And there's lots more. You can look for Lyme disease. You can look for tick infections. You can look for viruses. You can look for...

And there are labs that do standard panels. Exactly. Now, they make it so much easier. Exactly. And certainly do a vitamin D level. Vitamin D level. And omega-3 level. Omega-3s.

Something I measure a lot is oxidized LDL. Yeah. Right? But you know, Cleveland does it. Cleveland Heart Lab does it. And so it's a really easy test to do. And there are studies showing that when people live in polluted areas, their ox LDL goes up. That's basically rancid fat.

It's rancid fat. It's probably the best, simplest marker there is out there. Yeah. So, you know, I had a patient with MS recently, and she said, what kind of blood test do you want to do? I said, let's get an ox LDL. Why would you want to do that? Well, you know, explain it to her. It makes a whole lot of sense.

EBV, you know, is one that I really single out. I like to do EBV kind of quite a bit on people. So basically, you're looking for toxins, allergens, microbes, for mold, you're looking for dietary and nutritional efficiencies, you're basically doing that whole algorithm of what do you need to get rid of and what do you get. And then once you get all that data,

and it's really personalized, and you don't treat everybody who comes in with rheumatoid arthritis the same way, or everybody with lupus the same way or everybody with colitis the same way. Everybody gets a different treatment depending on what their particularly unique characteristics of causes are or imbalances are. Right. So where do you start with a patient in terms of the intervention?

You mentioned diet a little bit. So maybe kind of take us through the thinking about the approach to treatment. There's so many things people can do on their own. They don't even need a doctor for it. But what are the things that you think are the most important? You know, a really simple thing is to have a person do a modified BAS. And there are a lot of different ways to do that.

Yeah. There's been a lot of protein powders that have been around for years. And especially somebody that's hurting, you know, a person with RA or a person with ulcerative colitis they're having a lot of symptoms you rest their gut you do it for three days maybe five days rest their gut and see if anything changes yeah and the reason i like that is because it gets their attention yeah right right right right because they you pull everything out and you just give them a blood allergenic protein drink this you know a couple scoops of this powder two or

three times a day and two days later they go whoa yeah what's going on here I feel different yeah right it really gets their attention and then you start working with diet in a really specific way that's interesting it reminds me a patient I had Bob years ago I think was was Judy. I don't remember her. She said she was listening to my advice because I said, I want you to be on a gluten-free diet, a gluten-free diet. I want you to just, it's like, I am, I am. I'm not getting better.

I'm not getting better. I'm like, okay, well, how about we just do 10 days of Ultra Clear Plus, which is basically a metagenic rice protein powder, which we just use a lot. And it's hypoallergenic. It's got nutrients in it. And basically you can live on. Yeah. Everything went away. Yeah.

And then she got it. Yeah. And then she, and then she lost it. I could have had a V8. Right. Her rheumatoid arthritis went away. So it's,

it's a very powerful, it's a very powerful strategy and it's, it's very inexpensive and it's something that anybody can do. You know, I think we'll put in the show notes some of the ways you can do a modified fast using some of these protein things. But I think you can't live on that forever. No, no. And I do want to add to that. There is a clinic out in California.

I think there's a couple that actually do water fasts for long periods of time, sometimes for weeks. I'm like, don't try this at home, right? They give this under supervision. But, you know, I'm an editor of a journal and we publish some of their articles and they've had some remarkable results. And you go, wait a minute, this isn't supposed to be good for you. You're supposed to lose your muscles. Well, food is one of the causes of inflammation. If you have a leaky gut and you're eating foods that you're reacting to, then then yeah you're going to get better yeah um so there's a whole movement out there of elimination diets right there's many different kinds right um there's the autoimmune paleo diet right aip

yeah which essentially is basically what there's nothing nothing no no it's basically what i wrote in my 10-day detox diet book which was which was essentially no grains, no beans, no dairy, no sugar, no processed food, protein, vegetables, nuts, seeds, and berries, lots of that. And they remove also nightshades, they remove nuts, and they remove eggs. Yeah. So it's a pretty restrictive diet. Right. But it's been shown in peer-reviewed journals to actually be very effective for treating

disease. And it's often where I'll start. And some of the people say, well, just eliminate one thing. Just get rid of gluten and see how you do. Or get rid of dairy. No, well just eliminate one thing, like just get rid of gluten and see how you do. Or get rid of dairy and stuff. No, because you don't know, you could have five different things you're reacting to and if you take four of them away,

you still have a problem. There's got to be a minimum of like five to 10 things. Yeah, and that's the second rule of Sid Baker, which is the second tack rule, is if you're standing on two tacks, taking one of them out doesn't make you 50% better, right? So you've got to actually find all the things that are pissing your immune system off. So I tend to do more aggressive elimination diets and then add things back.

But what do you think about things like an autoimmune paleo or the lectin-free diets? Is that something we should pay attention to? Well, that's a whole can of worms, right? Go to interesting about that. So the AIP, I do use that in people. There is some published research on it. Yeah. So it's not totally made up.

The thing I like about it is it basically just takes anything that might be a problem and says, okay, rather than trying to figure this out and sort through it, let's do it. Now, a lot of people just find it too restrictive. They can't do it. But at least they've been there. They've been down on that pathway, and they've said, okay, I've explored that. You know, let's liberalize just a little bit. Right?

But I think most people are sensitive to a relatively limited number of foods. You know, so that's just it. People get really confused about it. And they say, well, there are 30 things I'm reactive to. Like, most people don't have that many reactions unless they got leaky gut, in which case you treat the leaky gut. Right. So after that.

It's not what foods are you sensitive to, but why are you so sensitive? Why are you so sensitive to that? And I think that's the next step, right? So you do the elimination diet. You find all these simple causes you can fix. And then you have to fix the gut. I think it's the next step, right? Is that your next step? You've got to fix the gut i think the next step right is that is that is that your next step to fix it because that's like the first step after diet in terms of

that's part of the diet is fixing gut is how do you how do you start with thinking about go after the gut wall i use a lot of glutamine i i like n-acetylglucosamine n-a-g the gray compound um it's been around forever. It comes from shrimp, from chitin. So it's pretty safe to use. I've had a few people be allergic to it, but otherwise it's completely non-toxic. I use that. I use zinc.

I like curcumin. I mean, what can go wrong with curcumin, right? It does increase bioflow because it's a choloretic component so people will say hey my poo is a little bit greener but okay okay you can live with that yeah yeah so you know there's some basic go-to's that i would use like that for the gut so there are some but we have a whole protocol unfortunately called the 5r program five-hour program yeah i don't

necessarily do them in order right yeah right i mean i I want to know what's going on in the gut microbiome. Yeah. Right. So I might go after a particular bug first if I find it. Yeah. But if I don't find a pathogen, I don't necessarily think, you know, the person needs to be on, you know, some kind of potent antimicrobial. No, no, no.

But it's like basically the concept of take away the bad stuff, right? Yeah, yeah. It's supposed to remove. So we've got bad food, it could be bad bugs, bacterial overgrowth, no. But it's like basically the concept of take away the bad stuff, right? Yeah, yeah. You're supposed to remove. So we've got bad food you're negative to. It could be bad bugs, bacterial overgrowth, yeast. Maybe it's a parasite, something, you know, like entomobasalitica you might need to treat. And then you, you know. Then I go for the prebiotics because I think prebiotics are part of the,

that's the big thing that's really changed in our understanding of the gut. Yeah, prebiotics. And now it's getting really specific with prebiotics. I remember reading you posting something about Bob's potato flour, Bob's red mill potato flour, like, was that 10 years ago? That's right, prebiotic starch. I'm like, what? He's talking about potato starch?

You've got to be kidding me. Well, that data's pretty good, actually. I know everybody on that. Yeah, yeah. That's right. That's I know everybody on that. Yeah, yeah. That's right. That's right. That's right. I remember that.

Yeah, so there's prebiotics that are fertilizing the good bug. So that's the second R is kind of replaced. And that's a good long-term thing. You know, that explains why when people do that smoothie thing for three days, the acromantzy goes up and comes back down again. It's like, well, we really need to feed it for a long time yeah you know one thing i think changed in my thinking a lot bob was was i understand prebiotic fibers yes polyphenols yes colorful yes yeah matcha yeah for you know like when i had no

acromantzy i took a lot of concentrated cranberry yeah not like sugary cranberry juice but every concentrate pomegranate concentrate right and green tea powder, and a lot of other polyphenol powders every day in a smoothie. And that's what actually reset my gut, too. It was quite amazing. And so the replace is replacing things like prebiotics and polyphenols. And enzymes. Enzymes, yeah. Enzymes, which is an old naturopathic thing.

I mean, I heard about this. I heard Bernard Jensen talk when I was in medical school, right? The old- old naturopathic thing i mean i heard about this i heard bernard jensen talk when i was in medical school right the old time naturopath and i thought well this guy's really obsessed with his bowels right he's like that's all he wants to talk about is good bowel health etc using enzymes and now it makes total sense well i don't hear the gastroenterologist talking about digestive enzymes right exocrine pancreatic deficiency, and maybe you could take Creon or something like that. Yeah, you have cystic fibrosis or you're fine. Or you're fine. Otherwise, everybody else is fine.

Well, wait a minute. What about Beano? Yeah, Beano. Is there a problem with Beano? I was waiting until you were talking about farts, Bob. Yeah, yeah, yeah. Well, it's okay. There's a reason I bring this up.

It's because they did a study a few years ago, and I think it was in Italy, where the question is, are FODMAPs good for you or bad for you? So the fermentable oligodime monosaccharides and polyols, right? Yeah. People eat these foods. They get gassy. Is that a problem for inflammation? Hmm. And if they are so should you can if

they are should you would have so a lot of people eat those foods they get a lot of gas they get bloating they get SIBO or SIBO whatever you want to call it and so the assumption is well this is a bad thing right well this study that was done in Europe they actually put people on a low FODMAP diet and then put other people in a Mediterranean diet with a lot of fiber. And they had them record the amount of gas that they're... They gave them little clickers.

And they recorded the gas. So, of course, the people on the Mediterranean diet just had lots and lots of gas. They were eating beans. They were eating beans, booms, all kinds of stuff, right? Then they looked at their microbiome. The people in the low FODMAP diet, their microbiome went to hell.

Yeah, interesting. Went to hell. The people on the Mediterranean diet who were having all the gas and maybe a little discomfort, their microbiome had all the good stuff, the acromantia. But I wonder if you have someone with really bad bacterial overgrowth and you give them FODMAPs, that makes them worse. So that's a starter diet, right? It's just not a long-term diet because we're talking about what diets are you going to do for long-term for the gut to get the gut healthy.

And a low FODMAP diet is not part of that. It's an elimination diet. Because I want the person to know, well, I can't eat leeks, garlic, and onions. That's just a no-no for know well I can't eat leeks garlic and onions that's just a no-no for me I can't eat that but don't avoid all FODMAP because it turns out FODMAPs are prebiotics right exactly that's why that's really cause of yeah that's why they causing the gas and so here's this real trade-off the person's got bloating maybe they got SIBO and they're saying I should eat low FODMAP yeah but that might kick off your autoimmune disease

in the long run because then you get dysbiosis. Yeah. Right, so it's a really important concept there. So then we've sort of gone through that and then the next step, right, which is re-inoculate, which is probiotics. Yeah, probiotics. From when we started to now it's become

so much more sophisticated. Complicated, sophisticated, our understanding, we thought we knew a lot, we know it. Now we know we know so little, but we know enough. And there's a lot of data on probiotics. We know probiotics make a difference. Some probiotics work for some people, some at the top. Really well some at the top.

Yeah, and then there's acromantia probiotics that people can take, so it's interesting. I take them. Yeah, when I was sick I couldn't take them because they didn't even exist. Yeah, yeah. And then we mentioned the repair part, which a lot of things we were talking about, like zinc and glutamate and

vitamin A and fish oil and other compounds. So we have a whole approach to kind of reset the gut. And you know, for me, in my practice, I know it's like for you, but when I do the dietary stuff and the resetting the gut, it often works for a lot of people. It's kind of the core. 80%, maybe

90% of people. And then those who don't get better, I dig a little more. I look for Lyme, I look for heavy metals, I look for mold, I cut it like viruses,

post-COVID. And we got questions from X and we posted we were going to do this podcast with you and everybody started kind of asking,

okay, why not ask Bob about this and that? But we've kind of actually answered most of the questions around lung COVID and COVID causing autoimmunity, vaccines causing autoimmunity, environmental connections, and

trauma from childhood. So we talked a lot about these things in the podcast. So I think we've covered a lot of it. I think what I kind of want to leave people with is that this isn't just Bob and I being two quacks doing functional medicine for 30 years. We've thought about this. We're carrying notes. Bob, we're at the Integrative Health Symposium in New York City, and Bob just was on stage giving a tremendous lecture with an incredible amount of scientific evidence that backs this up. And what often frustrates me, and I'm sure it frustrates you, Bob, is in traditional medicine, there's enormous swaths of scientific evidence that is just ignored

because it doesn't fit the current model of thinking. Yeah. You know, okay, well, okay, I'm a rheumatologist. It says that I should be paying attention to toxins and poop, but I have no clue. I was never trained in this. I don't know how to look at a stool test. I don't know what to do if I find it.

And I don't have time. I don't have time. I don't even know what to do. So it's like, I'm just going to do what I do. And I think it's unfortunate. And now there's more and more traditional doctors who are coming over to the other side and actually understanding this, even at a high conceptual level, they get that things are changing.

And I saw this at clinic to clinic. Our rheumatologists there were so forward thinking and were so progressive and really understood this. In fact, we did a retrospective analysis of several of our patients who had rheumatoid arthritis and psoriatic arthritis in our clinic at Cleveland Clinic Center for Functional Medicine. And we had a fellow from the rheumatology department, not one of us, but one of their fellows, analyze our data and their matched cohort data. And we outperformed them in terms of better improvement outcomes using functional medicine

yeah compared to the top rheumatologists nothing they're not amazing doctors they are they were using the best tools available but they weren't dealing with the uh the root causes and they had the wrong map for the territory of illness that they were navigating yeah i think that's what functional medicine is a different map that we can use and it can create profound changes i know i'm talking remember this one case i had at Cleveland Clinic, a woman, she was like a 50-year-old coach, business coach, she had everything. She was depressed, she had pre-diabetes, she was overweight, she had migraine headaches, she was severely affected by irritable bowel syndrome, bloating, and she had reflux. She also had psoriatic arthritis, so she had terrible psoriasis,

plus arthritis that went with it. She was on this drug that was like Solera, a $50,000 a year drug, and she was on drugs for the psychiatrist, drugs from the GI doctor, drugs from the migraine doctor, drugs from the psychiatrist, I mean, like everything. You're like polyphenols, not polypharmacy. Holy cow. there you go and and uh and i'm like okay well let's see what do all these problems you have in common have in common depression is inflammation of the brain yeah obviously reflux

and neuro bowel inflammatory gut diseases yeah uh migraines are inflammation yeah psoriasis inflammation arthritis inflammation yeah yeah, yeah, yeah. And so I just said, I think she's got really, and she's been on tons of steroids in the past and antibiotics. I'm like, I'm just going to guess. But I think she has really bad SIBO, which is bacterial overgrowth. Yeah, yeah.

And dysbiosis, and she has yeast overgrowth. So I'm going to clear out her gut. Yeah. I'm going to give her some probiotics and some fish oil and vitamin D and put her on an elimination diet. And we'll see what happens. Yeah.

I said, don't stop any of your medications. Come back and see me in six weeks. We'll go through the test and see what's going on. I was back in six weeks. She says, well, I stopped all my medications. I lost 20 pounds. I don't have any more migraines. I'm not depressed. I don't have reflux. I don't have a bowel. And my psoriasis and arthritis went away. And I stopped all my medications. I'm like, oh, okay. Yeah. So sometimes it's that easy. It's not always that easy. But the point is that we often have the wrong map. And that's why I really was so excited about this conversation with you today

because it's such a big issue for people. Autoimmune disease is the number one scourge for modern society. We think it's heart disease and diabetes, but it's actually, it's autoimmune. And it's heart disease and diabetes, but it's actually autoimmune, and it's so poorly addressed. I mean, we know that if you eat better and exercise, you can reverse diabetes.

I mean, most doctors think that. It's not like a puzzle. But autoimmune disease is like a black box, and it really isn't. And we want to accelerate the adoption of the scientific knowledge that we have now. I mean, we've been doing this for 30 years, and we knew this 30 years ago. Yeah, yeah, yeah. But still, it's like so slow and it's frustrating and some people out there are frustrated. And I think people need to understand

that we have this opportunity to really rethink medicine, rethink disease and particularly autoimmunity. So if you're suffering with autoimmune disease out there, I encourage you to check out this approach. Bob, where can they find more about you? About me? Well, LinkedIn, the Institute for Functional Medicine. What about your practice?

I'm actually not taking new people. Oh gosh, okay. I know. Too busy. His wife is jumping up and down. This is like. Yeah, it's tough, because you're probably like me. When someone comes in, I have this and that,

you go, oh, I know how to fix that in five minutes. Right. They've been seeing doctor after doctor. Right, it's like, oh, take some of this, okay. Yeah, but now there's the Institute for Functional Medicine. You can go find a practice. Yeah, yeah. So I'm training the doctors, the next generation,

so that they can serve the people that need it. Yeah. It's amazing. You've taught me so much over the years. You're just an incredible physician and a great asset to this whole field. And I think if people really understood what's possible, they wouldn't just passively accept that this is a chronic issue that they have to live with and manage, that this is actually treatable and reversible.

Yeah, absolutely. Well, Bob, thanks for being on the podcast. You're a superstar in my view, and great to have you as a friend and colleague for so many decades. Pleasure, my friend. Keep up with that Bob's Red Mill. Is that your brand, Bob? All right, thanks everybody for listening. Thanks.

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