Autoimmune Disease: The Shocking Triggers You Need to Know | Dr. Robert Rountree

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 antibody. When you meet the criteria, we don't care how you feel, but when you meet the criteria, then we give you a drug. So, Bob, welcome to the podcast. Great to have you. Hi, Mark, Great to be here. Listen, you know, we've known each other for better part. Three decades. And you were this kind of iconic figure when I first met you, in 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 think, you know, the topic today is one that is affecting more people than almost any other health condition, probably, except metabolic syndrome and pre diabetes and the whole phenomena of poor metabolic health. And 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, 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. 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 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. And I think, you know, you've been really one of the key thought leaders, thinkers, kind of concoctors of the model. And in fact, you lead the light concoction. Yeah, the immune. Immune module at the Institute for Functional Medicine, which trains doctors on how to think about this. But, you know, why are we seeing so much of a rise in autoimmune conditions like lupus, rheumatoid arthritis, Ms. colitis, Crohn's disease, hushing motos? Why are these on the rise? Why are we seeing this whole phenomena of this disease where the body's 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. That's 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 that 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, 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. 30% of the population. We're testing the population. 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. There's auto. It wasn't that prevalent back then. Didn't seem to be. Didn't seem to be that prevalent. We weren't 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, but then the feedback you might get around that is, well, isn't that the same with autism? Yeah. Right. Do we really have more autism now? 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. Where the latest stuff that the researchers are saying is that maybe we all get autoimmune disease, that this. All of us have something. We all get it to some degree. Sort of an autoimmune condition. Aging is kind of an autoimmune condition. Right. Because anti nuclear antibody levels, the titers go up. Yeah. 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 Vujdani and the teen, they've done some very interesting studies on antibodies and against toxins. Toxins like mold. 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. And all these people are making antibodies. Yeah. So, you know, we start with this observation that there's antibodies against nuclear material. What else are there antibodies against? Yeah, 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. Who cares about the trigger? You have psoriatic arthritis. Yes. You have rheumatoid arthritis. It means you meet these diagnostic criteria that are set up by the. The American College of Rheumatology or something like that. All the academies that are on high that say, okay, if you have this. Disease lupus, you've got these five criteria, and you gotta meet those five criteria. But it doesn't tell you anything about the why. And functional medicine is all about the why. Why do you have this problem? Why is the body attacking itself? And so they really have a very archaic way, in my view, very almost frightening way of dealing with these diseases, which is using very powerful drugs. Yep. Things like prednisone, immune suppressants, tnf, alpha Blockers, things that tend to have serious side effects, and they can be life saving 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 tack rules of medicine. If you're standing on a tack, 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. Right. So I'd love you to sort of unpack how in, in functional medicine we begin to think about the root causes. Because. And maybe I even shouldn't say functional medicine, because if you look at the scientific literature, it's all there. It's all there. Like when you just talked about with the immune system. Right. There's a whole series of, of, of chemicals that our body is causing an autoimmune response to. And this is a phenomena called immunotoxicity. Yes. And, and it happens at very, very low levels of these chemicals that are ubiquitous forever. Chemicals that we're exposed to, whether it's plastic, you know, phthalates, petrochemicals, pesticides, herbicides, heavy metals. Pharmaceuticals. Pharmaceuticals. Okay, we'll get into that. Yeah, there is, I know there's some articles that caught autoimmunity, but, but, you know, this is stuff that we, we don't really pay attention to in traditional medicine yet. The science is all there. So can you just sort of at 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 Mississippi is 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. Yeah. So you get antibodies against Covid that antibodies. That's from 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 wherein you start thinking that way is that there's aberrant functioning. Right. Apparent. 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. So 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 antibody. Yeah. 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 distance, distant, sort of misty past. Right. The disti Pass. Right. So who cares about what the triggers might be? Yeah. 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 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 pathway. Yeah. And why the heck do we get into all that physiologic. Why does it matter? Why did you 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 sort of. 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. Interesting. So you might think, oh, it's leaky God, or it'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. Right. So that opens up knee bones connected. To the shin bone. Everything is connected in a very mysterious systems biology kind of way. Which is what? Functional medicine is applied systems biology. Exactly. Right. So if you start thinking that 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 activate certain enzymes. And these enzymes are called the pad enzymes. The PAD enzymes, right. Peptidyl, arginine deaminases. Everybody quiz on that, 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 alone. 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. Right. 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 stranger danger. It's stranger danger, stranger. Autoimmune. That's what autoimmune disease is, is these innate immune cells get this signal, stranger danger, stranger danger. And then they go to the naive lymphocytes that are not programmed and say, you guys better watch out. There's a war coming. Yeah, the bad guys are here. Now, the, the, 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. Right. And play with it, with food, with nutrients, with various compounds, various interventions that we use. But, but I, I just 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 are changing in. Our society in parallel with the rise in all kinds of diseases, not just autoimmune diseases. Right. So immunotoxicity is a big category. What's. Environmental toxins is a big trigger of autoimmune disease. I see this all the time. I've seen. I remember I actually had a case of a guy with ulcerative colitis years ago. And I tried all the normal functional medicine stuff. Fictus gut, 5R 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 thinking about needing 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 of 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. His gut 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? Okay, so heavy metals, definitely up there. One that people don't think about a lot is arsenic. Right. Arsenic is definitely implicated in autoimmune diseases. There's certain countries and certain parts of the United States where arsenic levels in the water supply are pretty elevated. And you know, we could spend an hour or two talking 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, your pressure. Treated lumber when 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. Yeah. Right. And again, of course, they can cause. Their wine because all the pressure treated lumber post that the wine grapevines are into and that goes to the soil and the grapes are contaminated. So wine is actually red wine. Source of. Yeah. Watch where you're getting this. Right. So it's like green wood. When you see wood with a greenish tint to it, that's when you need to worry about. So toxins. Okay. Whatever. Metal, heavy metals, arsenic, cadmium, lead. Still with us. Yeah, still a problem. And there are a lot of mechanisms by which that can happen. The metals can, can cause free radicals, 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. Yeah. You know, tolerance is the state of normalcy for the immune system. Yeah. You're able to, you're able to detect friend from foe and not react to everything in your environment. Like, you know, 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. Right. But their immune systems lost tolerance for that. Or food. Right, right. And that tolerance. 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 is essentially what is going on. And, and, you know, 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, with immunotoxicity, it's not like that. It's. It's very low levels and create a massive reaction. And, 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 just like a car horn wouldn't stop. We all ran out, saw there was a young guy slumped across the wheel, fell base 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 up, 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 just smelled the molecules in the fish. I didn't eat it. The molecules in the air from cooking the. Across the room. Yeah. And it triggered an inflective reaction. He could feel it coming on. He knew he wouldn't wait, make it for the ambulance to come. So he got his car and drove two miles to the emergency room. And that taught me that infinitesimally small amount of an insult can create a massive reaction. Massive reaction. It's not just. Yeah, so. 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. But it's. It's really a huge issue. So besides B. The small quantities that are the problem. Right. And that the term for that is hormesis. It's a great term, you know. Well, right. And that came from work by a guy named Ed Calabrese, who probably met or interviewed, you know, who talked about the fact that in higher doses things may not be very toxic, but especially certain compounds with hormonal like properties. Yeah, right. Become what's called endocrine disruptors. Yeah, well, these are immune disruptors. Right. Well, immune disruptors and immune disruptors are the same chemicals. Yeah, they're 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% 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. Microplastics have been found in the stool in higher quantities in people with ulcerative colitis. And now there's nanoplastics, which are worse than microplastics. Micro, but basically plastic. You can't see without a microscope. Yeah. We don't really understand the mechanism of toxicity of these. I mean, they are toxins. Right? Yeah. But they're doing other things that are irritating. Yeah, Quite understand. That's a scary thing because they found it in organic foods. Yeah, Right. Or in bottled water. Yeah. You find these microplastics. So. Yeah, I think. I think the nanoplastic data just came out too. It was even more terrifying because the volumes are much higher and we're getting exposed to much more of these than we thought, even just drinking a bottled water. Okay. So toxins sucks. Besides toxins. So microbes. Microbes. But. 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 tribes that had never contacted the outside world. Right. I can't remember the name of the doc, but it was 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, which I thought, like paleo poop. How on earth. The people that were there, how did they take that? Right. When 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 have they found? Parasites, worms, spirochetes, all this stuff that we looked in our patient's stool and we found that we'd say, oh, my God, you need to be on a dozen drugs. You know, parasite cleanse. You got. You need a cleanse. You know, hold the Clark, you've got. But these people had no autoimmune diseases. Yeah. And no. Allergies they had no allergy to autoimmune disease. No heart disease, no asthma. They, you know, I mean, only inflammatory diseases of chronic illness. Right. Yeah. I mean, they were dying from snake bites, falling out of trees, getting bit by, you know. Sure. 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, back to the cells that line the dot. 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 cop. 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. There's a whole book on that. Yeah, there's a whole. Really good book. Yeah, it talks about this. Fascinating. Yeah, yeah. Epidemic of using worms to actually treat autoimmune disease, which is now happening in even conditions. 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. It was. No, it was. I got it from Thailand. Oh, th. 100. Yeah, yeah, 100. Yeah. Yeah. I gave it his. His Ultra FL went away for a year. That's the same. Same. He stopped everything. He stopped all of his drugs, everything. He was fine right then. And then it came back. 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 taking. It's almost like, you know, historically we had an immune system that was used to dealing with all these bugs, worms and parasites and. And then we took them all away. They called 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 should react to, and that's when you get allergies and autoimmunity. So. Right. I don't know. The Answer for salt. 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, there's no. I mean, there's still interesting research. Weinstock is still doing research on that. Yeah. You know what they're asking is, what is it the worms do? Yeah. 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 to not 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. And lungs. Gut and lungs. So microbes that are. Are mainly not infections, although some infections obviously cause rheumatoid arthritis, like yersinia or antimoeba histolytic, that's been mapped to causing rheumatoid arthritis in certain subtypes. Proteus, perhaps, according to Dr. Ever Heard. And there's some, you know, we call it, you know, infectious arthropathies, which we learned about medical school, like, from, you know. Yeah. Reiter syndrome, it's called R E I T E R. Yeah. And this whole phenomenon, these kind of bugs that aren't necessarily terrible infections, but they do cause autoimmune. Klebsiella, yersinia. 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. Barrier and. 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 laid out flat, that is one cell. Think about that for a minute. Yeah, it's huge. Yeah. Huge. And it's one cell. Visualize your gut like it's a tennis court. It's big. And what's going on on that tennis court. And it's only one cell thick. It's like you're basically one cell away from a sewer. Yeah, yeah. And from all these foreign food proteins yeah, yeah. So tell us what happens. It's all the way from a sewer. So tell those 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. Yeah. That mucin. And one of the things that's necessary for maintenance is certain kinds of bacteria. There's one called Hakermansia mucenophylla, which. I know that's 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 grow. 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, 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. Yeah. And measured people's got flora. And one of the things they measured was Akkermanzia. Yeah. And they went on the Oz cleanse smoothie. I think I helped. Went way up. I think I helped them develop that, actually. Right. Yeah. Hey. So Akramonte went through the roof, but then as soon as they stop the smoothie, the Akkermansia disappeared. Yeah. So we want to maintain Akkermansia because it helps with the turnover of the mucin length. Yeah. So that's an important concept because most people just think, well, it's a cellular layer. That's all there is. But when was the last time you went to the rheumatologist and they checked your toxins or looked for Akkermansia levels. Or even acknowledge that I had poop. Right, right. Oh, yeah. That there was something to look at. And, yeah, your rheumatologist should be doing stool tests, but they don't do that. No, no. It's probably the. I mean, if you're a rheumatologist. It's probably the most important test you. Probably the most important test you could. Do that is celiac. What's the mix of their. So the other part of it is that we know that the cells that line 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 know, remember, you know, Game of Thrones? Right, yeah, of course. You know, remember the Northern wall? Yeah. To keep the night walkers out. That's a complicated wall. And they had little doors that are going in and out. Well, if that wall, the. The lining, if it's completely tight, nothing ever gets in. You don't absorb nutrients. Yeah. So you got to be able to open and close it at will. You know, you imagine little bods with levers in there, opening these levers. I think it was like a coffee filter. Right. Because basically the food. 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 that's what causes the problem. That's called a leaky gut. 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 it was. People used to laugh at us for talking about it. Now it's in the mainstream literature, and it all came from functional medicine. But then we acknowledge that. But it's. Now it's on the mainstream journal. But I 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 clawdins and occludens and all the different proteins involved. And then along comes alessia. Yeah, right. 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. It 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. Is a protein that's Expressed in the body. That's something the body makes when 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, gluten. And that's. And that. And I think that's a big factor. 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. It's way up there. Yeah. There's no one comes in with an inflammatory condition or of any type or of any type or any autoimmune 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 glidin antibodies. IgA, Ig, TTG, IgA and Ig. These are really important to look at and, 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 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 code normal range, it means one, you've been exposed to gluten, two, you have somewhat of a leaky gut. Yeah. Because it's gone through. And three, your immune system pissed off to some degree about it. Yeah. 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, you know, the amount of flour and gluten we have and the kind of gluten we have is very different. And I think that's western gluten. Yeah. It's like the dwarf wheat, which is when they breed. When they breed wheat plants. They breed plants. Not 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. Like, I'm good with the math. Right. And. 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. And you're getting. Which is what is actually happening. So all these anti very inflammatory glide and 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 from glyphosate to dry it out so they could harvest it easier. And that glyphosate is a microbiome killer. So then you're doing a double whammy. Yeah. 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 start. People start reacting to. Right, right. So can you talk about like you mentioned cross reactivity? It's called bystander. It's a bystander intolerance. Yeah. So what effect. You know, 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. Well, it is showing up in the literature now. It is, it's a different part of your immune system. Right. It's kind of a slow reacting part as opposed to like 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 nightshades and nuts and other kinds of stuff that may be a healthy food, but actually they're reacting to. So how did 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 prolamin. 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, et cetera, but then that damages tissue in the surrounding area. 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 Polly Matzinger, the famous immunologist, said. A dangerous stranger. Yeah. 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. I've seen facets that would get diagnosed with celiac disease, and I'd say, how's your thyroid? And I 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. Yeah, well, I don't have a thyroid problem. Okay, let's check your thyroid. So you, you know, you do a tshinophytic, and sure enough, they got antibodies against tpo. Yeah. I would say it's about a third of my Hashimoto's patients, which is the most common, I think, autoimmune disease we have, have some level of thyroid problem. Thyroid problem. They'll have. Have gluten antibodies, have gluten. So it starts with the gluten or maybe the other way around. I don't know. But, you know, typically what I would see is that patient that's got celiac, or maybe they didn't know they had celiac. You know, they just had some weird symptoms. Maybe they had some joint aches or a weird rash. There's one called dermatitis or piniformis. Yeah, right. That 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. 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? Or is it both? Dr. Pisano says both. Yeah, I mean, I actually had a patient at Cleveland Clinic who had three autoimmune diseases, and they were. How is that possible, treating all these different things? I'm like, has anybody checked your gluten antibodies? He's like, no, we checked. He had full blown celiac, like not. And they hadn't even looked and looked. Yeah. 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, it's in the scientific literature. It's right there, National Library of Medicine. It's all the evidence points to this. And yet it's like a blind spot in traditional medicine, which makes me so frustrated because, you know, autoimmune disease is really a horrible condition. I mean, I, I, I can tell you when I was sick because I had a long story. I had a root canal, fell in the pod hospital. I had a root canal, it went bad. I need to take an antibiotic. After I got my tooth because it was infected. I. Clindamycin. I got C. Difficile colitis. That didn't go away. The C. Difficile went away, but it turned into full blown ulcerative colitis. And I was, and you didn't get. A poop transplant at the time? Well, I know I did not get a poop transplant. It's hard to, you know, standing on the corner, poop. Anybody got the poop? Why don't you? Yeah, yeah, yeah. But, but I, I ended up, I ended up being really sick and I saw one of the top GI docs and in, in ibd, inflammatory bowel disease at Harvard and really nice guy and you know, he was looking at all kinds of know, actually alternative therapies and diet and I tried everything I knew, like through the kitchen sink. And what I, I literally saved, I would say, 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 bowel movements a day. I was in bed. I lost £30. Oh, no. Yeah, I was, I was in bad shape. I was like near death. Yeah. And they were about to put me on one of those big heavy duty, you know, TNF alpha blockers or other drugs. And I was like, no, I'm just doing, I'm going to do a Hail Mary here. Yeah. And I know I've got some massive inflammatory process going on, so I'm just going to basically do a bunch of stuff. Like I basically took iv, a lot of IV Nutrients. Yeah. High dose vitamin C. I did IV ozone, which sounds crazy, but it's It's a powerful anti infectious agent, that immune modulator. And I did hyperbaric oxygen. Okay. Literally within days it went away. In days? In days. Yeah. So like, and, and, and so, you know, and not all immunos are 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 with, 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. The drug isn't really changing what's going on. I just stop gluten. Then people get better. Sometimes it's a little more complicated to reset their gut microbiome. Like I had this one little girl, Isabel, who was 10 years old. She had a mixed connective tissue disorder. And she was on 1200 milligrams IV of Solu Medrol every three weeks, which is like a horse dose of a massive steroid. And she was on methotrexate, which is a chemo drug. And she was on a pile of other drugs to deal with the symptoms, like nefdipine for Reynolds 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 auto antibody you can imagine. She had muscle enzymes that were high, she had high aldolay, she had high rheumatoid factor, high ana, high anti rnp. I mean, you name the antibody and they were just like a little bit elevated, but they were like off the chart elevated. And we, and we learned, by the way, in medicine, if those antibodies are high, you check them once and I'd say, you know what? You right. Why do you need to check them again? They're going to have this for life, right? Like they're going to have this disease for. Who cares if your ANA goes up or down or anything. You 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, 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, 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 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 elimination diet. I gave her a multivitamin fish oil, vitamin D and probiotics. And I got her eventually chelated with. 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 ten years later, and she's fine. So, you know, it just tell. Tells you that, you know, what we're doing is so off base. Right. In traditional medicine and we have to. So downstream. So the antibodies are downstream. Right. You know, that we put. We're putting all our attention on the antibodies and 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, etc have to do with getting your innate immune cells happy. Yeah. So I got to tell you, I have. I have my UC story. Yeah. Yeah, that's great. Because I had a patient that I had dealt with a couple years. Years and had bad ulcerative colitis. You know, 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 they said, okay, we've done a lot of other things. You're a lot better. You know, you're. You're still not off your meds, though. I put this guy on Indigo and then I forgot about. 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 just to react the protein. That's normal. That can't be. And he goes, I went into complete remission two weeks after starting this Indigo. And. Wow. Oh. So. So every now and then, and you know, I'm not talking about magic bullets here, but every now and then you find something for that one person that really makes a difference. I think that's an important point, Bob, because people listening might go, I'm going to take. That's the one I want is the enemy. It's actually. It's that guy. It's that guy 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, it doesn't mean you know what's going on. This means you know the symptoms. I like the name and blame. Yeah. You know, it makes me feel good. Yeah. Yeah, that's right. That's relevant. You know what you used to say about neurologists, diagnose and audios. Yeah. Treat them as freedom. Treat them and treat them. Diagnose and audio. Right. Yeah. But we, we really have a different model in functional medicine, and we take a look at all these factors unpacking a little more. We talked about toxins, we talked about. We talked about the microbiome, we talked about certain food reactions, but there are also other microbes that are playing well. And one of the things that I'm seeing a lot now is the consequence of long Covid, the autoimmune reaction. Right. And reactivation of other signing off all those antibodies. But we know, we know in traditional medicine that many infections can cause autoimmunity. Lyme, Epstein, bar. It's been linked to, for example, nams. I've seen bar. Yep. But, you know, long covet 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 hypertension, where you get dizzy when you stand up or you can't stand for long periods. Yep. So. So there's. There's a whole realm of infections that, that often are a cause. Right. And you know, like viral infections in particular. Seems like viral and tick infection, I think. Yeah, tick infections. And tick infections. Lyme, obesity, Barnal. 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, right. But it happened. It's caused all this autoimmune antibody. Right. So we got to really dig. The other thing I think is, is, is really important is, is sleep and stress. So those are really. I thought you might bring that up. I don't know why. Those are big factors and they're, you know, there's. That's the 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. And. And so I think just because I wrote 19 books doesn't mean I, I don't Sleep. But the, the, the immune modulation is really interesting with our, with our stress response. So. Right. You might have a trigger like gluten or a toxin or, or some virus, but it doesn't really do anything until there's some triggering event, like a stressful event. Right. And I, I noticed, I, I saw this happen to me as well. And I see many of my patients and, and so that trigger can be modulated. And I, I remember the work of. I think it's a Langer or somebody else, but it was where they did journaling, just simple journaling about you. 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, you know, hard B outcome biomarkers for rheumatoid arthritis and for asthma. Yeah. After. I think it was like 12 weeks. And it went down. It went down. Okay. And they got better. So I got to use that new iPhone app. Right. Journal. It's just come out of the iPhone, so it's a plug for those. 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. Or they're stressed about being on stage 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 your 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 DNA. They have rickettsIAL DNA 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. Spotted fever or something like that. But mitochondria are made from Ria. 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 tumor necrosis factor alpha interleukin 1. So I say, well, okay, you can take a drug that knocks out TNF alpha or 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. And I'm not saying if somebody is really inflamed, I'm not going to tell them, don't do the biologic. No, I'd never say that. Yeah. But you know, in the long run, is that important? It's important to manage. So your lifestyle, stress, relationships, sleep, all those things modulate your immune response. 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, poor diet. Right. Trauma. Trauma. 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 you need to get rid of, you know, to actually be healthy. Right. Because, well, there is vitamin D, right. So as you mentioned, so vitamin D. There is omega 3 fatty acids. Yes. Right. And 80% are 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 inflammatory balance, they're not usually checking this stuff. So why is this concept so hard? It's not that hard. 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 them are 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 forever. Yeah. With good science in the New England Journal of Medicine. And he's just like, hey, take vitamin D. Oh no. Yeah, right. Oh, we can't do that. We can take this $50,000 drug, right. Because this drug is only $5,000 a month IV and it might give you tuberculosis. Yeah, right. But avoid this Vitamin that's pennies a day. Still take vitamin D, it 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, you know, for example, those who have low vitamin D are higher risk for Ms. That's why it's at higher northern latitudes where there's low vitamin D exposure to the sun, and so they get more. Vitamin D deficiency. Yeah. And vitamin A is important, too. I think, like, vitamin A has gotten a bad rep. Right. Oh, you can get toxic from it. It can cause osteoporosis, et cetera. But in reasonable quantities, regular vitamin a, you know, five, 10,000 units a day, it doesn't take a lot. But I'm talking about real vitamin A, not beta carotene. Yeah. 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. It's. So I'm a big fan. Yeah. So. So we can use nutrients when they're optimistic, 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? Immune cells 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 reemphasize. I said earlier, is that we were all trained in traditional medicine that it's a terminal illness. Like, you got ms, but you got it. You got. You got rheumatoid arthritis, you got lupus. Jersey'S welded to your back. Yeah, it's. 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 practice experience, this is not the case. There are people who've had it and don't have it. Right, right. Who've completely recovered from it. Right. It might not be that they're still not predisposed to it 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 reversible? And again, my response is, how far along is it? How much destruction of tissue is there? You know, I mean, particularly with a disease like rheumatoid arthritis. Yeah. If your joints are gone, your joints are gone. Yeah, if your joints are gone, your joints are gone. But some things like, you know, ulcerative colitis, your gut can regenerate. Right. Complete regeneration. Yeah. I have seen people go into remission. I mean, I. Many times I had. My God, I had a scope top and bottom at Harvard. Full red gastritis all the way down, full colitis all the way through. There was like. It was just like a red carpet. It's not the one you want to walk on. Yeah. And. And it's all gone. It's 100% normal. My CalProjectin was like a thousand. Now it's perfect. Right. So I've experienced that we remake our. Bodies every seven years for something new. Cells and Ms. You know, we have a colleague, Terry Walls. Yeah. Terry Williams was in a wheelchair. In a wheelchair and could not walk. And. 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 brain's. Jerry's moving around. I mean, she's got function. Yeah. But her brain scan shows scarring. Yeah. So 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. You're taking a detailed history. So I think. Yeah. Okay. So that's probably the most important thing that we teach in Functional medicine. Yeah. Is you. 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 it? Where were you born? Were you breastfed? Right. C section. When you're a kid, they're like, I'm 60 years old. You're asking me if I had colic, 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. I mean, did you eat tuna fish every day for six years? I mean, I, I did. I had tuna fish sandwich every day, lunch, you know, like, did you. 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 her, 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 expect. You got to be very specific. Right. So I like to start really simple. Yeah. And we've talked about Sid Baker a couple times. I trained with Sid 40 years ago. Yeah, right. So you know, Sid's basic principle. What does a person need to get and what do they need to avoid? We've said that a few times, but you cannot stress that enough. Yeah, that's, that's the crux of how. I 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. Somebody comes in, they've gone rheumatoid, arthritis or ms, they need to see. Just give them the grocery bag and they walk out with the cart. But 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 looking at the whole system, so what's off in the system? So what's the outer layer? What's obviously off here is a person not getting, you know, the 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, 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. Yeah. Am I going to do a gut microbiome test quite frequently? I do. Yeah. You know, so I'll do the standard test, the blood count, the metabolic panel, the antibodies of basic immune. Do you look for toxins on everybody now that everybody knows heavy metals? I mean, if you have a history of someone. If I've got a history, if I have any reason to suspect that, I'll. Do, like, if you're a vegan and don't have fillings, you basically, yeah. Then I'm not going to do. 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 honest. You know, there used to be a few labs where you could do really comprehensive things like look for glyphosate. Should I look for a 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 a restaurant. Don't. Don't 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. Oh, I'm thinking some kind of organophosphate. You don't actually have 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. Were you a C section? Yeah. Did you breastfeed? Did you have antibiotics when you're out? Did you have colic? 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 irrelevant bowel in your Account. 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, it sort of progresses. By the time you're in their 30s or 40s, it becomes autoimmune disease. Yeah. And often it traces back to the gut and the damage that we've done to the gut through the diet, through the antibiotics, through lack of breastfeeding, through C sections, through all of the ways we sort of deal with, with our toxic diet and all the environmental chemicals which by the way, all affect the gut. So I, I think your history point is really important. And, and then I always make sure I, I check for, you know, have you been exposed to tick infections, tick bites? Do you have mold in your house? Do you, do you eat a lot of fish? What kind of fish? So I take a very detailed history. Any flooding? Yeah, exactly right. And then you got. Okay, well then you know where to find things. So what are the top diagnostics? You mentioned a celiac panel, you mentioned stool testing. 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 immunoglobulin. So there's a G, D, M, E. Right. But the A. You know, people know that you make IGA and you're spin and your tears, etc, and you know, it's, 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 congenital deficiency of IgA, but also an induced deficiency of IgA, so it's really worth testing for that along. 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 A and A, like, you know, you should just do it. Standard biomarker. A and A 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, ana, 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, way, you know, you people don't 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, you know, we talked about some of the diagnostics, and there's lots more. You can hear 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, that make it so much easier. Exactly. Yeah. And you certainly do a vitamin D level. You know, why do you level an omega 3 level? Something I measure, the law is oxidized LDL. Yeah. Right. Cleveland does it. Cleveland Heartland does it. And so it's 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, a patient with Ms. Recently and. And she said, what kind of blood test do you want to do? Let's get an OX ldl. Why would you want to do that? Well, you know, explain. Planet Tour makes a whole lot of sense. Ebv, you know, is one that I would really single out. Like to do EBV panels. Yeah, Quite a bit. So basically, you're looking for toxins, allergens, microbes. Right. For mole, you're looking for, you know, dietary nutritional deficiencies. You're basically doing that whole algorithm of what do you need to get rid of and what do you get. Right, right. And then once you get all that data, and it is really. It's really personalized. Not like you don't treat everybody who comes in the 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, 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 then. Some of these things people can do on their own, they don't even need a doctor for. But what are the things that you. Think are the most really simple thing is to have a person do a modified bass. And there are a lot of different ways to do that. Yeah. You know, there's been a lot of protein powders that have been around for years, and especially somebody that's hurting. Yeah. You know, 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 you pull everything out and you just give them a non 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 of a patient I had. Bob. Yeah. Years ago. Her name was Judy. I remember her. She, she said she was listening to my advice because I said, I want you to be in a gluten free diet. Diet. I want you to. She'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 used to use a lot. And it's hypoallergenic and it's got nutrients in it and basically you can live on. Yeah. Everything went away in this. And then she got it. Yeah. Then she. And then she lost her. I could have had a V8. Her rheumatoid drives went away. So it's a very powerful, It's a very powerful strategy and it's very inexpensive and it's something that anybody can do. Yeah. You know, I think we'll put in the show notes some of the ways you can do 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. Yeah. That actually do water fast for long periods of time, sometimes for weeks. I'm like, don't try this at home. Right. They do this under supervision. But, you know, I'm an editor of a journal and we published some of their articles and they've had some remarkable results. Yeah. And you go, wait a minute, this isn't supposed to be good for you. You're supposed to lose your muscles. And 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 yeah, you're going to get better. Yeah. So there's a whole movement out there of elimination diets. Right. There's Many different kinds. Right. 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 essentially no grains, no beans, no dairy, no sugar, no processed food, protein, vegetables, nuts, seeds and berries, lots of fat. And they remove also nightshades, they remove nuts and they remove eggs. Yeah. So it's a, it's a pretty restrictive diet. Right. But it's been shown in peer review journals to actually very effective for treat disease. And it's often where I'll start. And you know, some of these people say, well, just eliminate one thing. Like just get rid of gluten and see how you do. Or get rid of dairy. Like. No, because you don't know. You could, you could have five different things you're reacting to and if you. Take four of them away. Yeah. You still react. You still have to be a minimum of like five to ten things. Yeah, that's the, 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, right. So you've got to actually find all the things that are pissing your immune system up. So I, I tend to do more aggressive elimination diets and then add things back. But what do you think about, you know, things like an autoimmune paleo or the lectin free diets? And is that, is that, you know, something we should. Well, that's a whole can of worms. Right. Just don't go edge deep on that. I, I mean, 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 30 things I'm reacted to. Like most people don't have that many reactions unless they got leaky Gut. In which case you treat the leaky gut. Right. Right after that it's not. 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 in the stream. 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 the next step. Right. Is that your next step? That's like the first step after diet in terms of. And that's part of the diet is fixing the gut is how do you, how do you start with thinking about the gut? Go after the gut wall. Like use a lot of glutamine. I, I like ns. Acetyl glucosamine, Nag Gray compound. It's been around forever. It comes from shrimp, from chitin. Right, Right. So it's pretty safe. Yeah. To use. I've had a few people be allergic to it, but otherwise it's completely non toxic. So I use that, I use zinc, I like curcumin. I mean what, what could go wrong with curcumin? Right. It does increase bile flow because, you know, it's a colorectic compound. So people will say, hey, my poo is a little bit greener, but okay, you can live with that. Yeah, yeah. So you know, there's some basic go tos that I would use like that for the gut. So there are some. But we have a whole protocol in functional medicine called the 5R program. 5R program. Yeah. I don't necessarily do them in order. Right, yeah, right. I mean I want to know what's going on in the gut microbiome. 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, but it's like basically the concept take away the bad stuff, right? Yeah, yeah. This one's removed. So we've got bad foods reactive to it. Could be bad bugs, bacterial overgrowth, yeast. Maybe it's a parasite, something you know, like anti salytica you might need to treat. And then you, you know, then I. Go for the prebiotics because I think prebiotics onto the. That's the big thing that's really changed in our understanding of the gut. Yeah. Prebiotics. Now is getting really specific with prebiotics. I remember reading you posting something about Bob's potato flour. Yeah, Bob's red mill potato flour. Like, was that 10 years ago? That's right. Probiotics are like what he's talking about. Potato starch. You gotta be kidding me, right? Well, the data is pretty good. Yeah. And they'll have everybody on it. Yeah, yeah, that's right. That's right. That's right. I remember that. Yeah. So. So there's prebiotics that are fertilizing the good bug. So that's the second R is. Is kind of. That's a good long term thing, you know, that explains why when people do that smoothie thing for three days, aquamancy goes up and comes back down again. It's like, well, we really need to feed it for a long time. You know what thing I think changed in my thinking a lot, Bob? Was. Was. I understand. Prebiotic fibers. Yes. Polyphenols. Yes. Colorful compounds. Yeah. Matcha. Yeah. For, you know, like when I had. No Akkermansia, I took a lot of concentrated cranberry. Yep. Not like sherry cranberry juice, but cranberry 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. Yeah. Yeah. It was quite, 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 hurt 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. Yeah. Now it makes total sense. Well, I don't hear the gastroenterologist talking about digestive enzymes. Right. You have exocrine pancreatic deficiency. And maybe you could take creon or something like that. They have cystic fibrosis. Or you're fine. Or you're fine. Otherwise everybody else is fine. Well, wait a minute. What about Beno? Yeah. You know, is there a problem with Benoit? Wait until you were talking about farts, Bob. 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 oligo di monosaccharides and polyols. Right. People eat these foods, they get gassy. Is that a problem for inflammation and if they are, should you avoid them? So a lot of people eat those foods. They get a lot of gas, they get bloating, they get sibo or sebo, 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. Yeah, yeah, right. And they recorded the gas. So of course, the people in the Mediterranean diet just had lots and lots of gas. You know, they're eating beans, they were eating beans, booms, you know, all kinds of stuff. Right? Yeah. Then they looked at their microbiome. The people in the low fodmap diet, their microbiome went to hell. Yeah, interesting. With the 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 Akkermansia. But I wonder if, like if you have someone with really bad bacterial overgrowth and you give them five maps, that makes them worse. So. Yeah, so that's a harder diet. Right. It's just not a long term diet because we're talking about what diets, you know, 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. You know, it's a, it's an elimination diet. Right. Because I want the person to 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 FODMAPs because it turns out FODMAPs are prebiotics. Right, exactly. That's why they, that's why they cause them. Yeah, that's why they cause it, 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 that, so then we've sort of gone through that and then we did the next step. Right. Which is reinocular, which is probiotics. Yeah, probiotics from when we started to now is because. Become so much sophisticated. Complicated, sophisticated. Our understanding. We thought we Knew a lot. We know. 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. Yeah, right. Some probiotics work for some people, some in the tub. Yeah. Really well, some of the time. Yeah. And then there's Akkermansia. Probiotics 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, but now they do. And then you met. We mentioned, like, the repair part, which a lot of things we're talking about, like zinc and glutamine, vitamin A and fish oil and other compounds. So we have a whole approach. We 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. That's. It's kind of the 80%, maybe 90% of people. And then those who don't get better, I dig a little more. I look for lime. I look for heavy metals. I look for mole. They cut it like viruses. Post Covid. And, you know, we got questions from X and we. We posted. We were gonna do this podcast with you, and everybody started kind of asking, okay, why not Bob about this now? But we've kind of actually. Actually answered most of the questions around, you know, long Covid and Covid causing autoimmunity, vaccines causing autoimmunity, environmental connections and trauma from childhood. So we talked a lot about these things in. In the podcast. So I think we've covered a lot of it. I think. You know, 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, 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 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 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 cleaning clinic. Our rheumatologist there were so forward thinking and were so progressive and really understood this. In fact, we did a retrospective analysis of some 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 analyzed our data and their matched cohort data and we outperformed them in terms of better improvement outcomes using functional medicine compared to the top rheumatologists. Not saying they're not amazing doctors. They are. They were using the best tools available, but they weren't dealing with the, the root causes. And they had the wrong map for the territory of illness that they were navigating. I think that's what functional medicine's a different map that we can use and it can create profound changes. I, I'm talking, I remember this one case. I had a 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 Celera, $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 for I mean like everything. You're like polyphenols, not polypharmacy. Holy cow, there you go. And I'm like, okay, well let's see. What do all these problems you have in common have in common? Depression is inflammation in the brain. Yeah. Obviously reflux and neuro bowel are inflammatory gut diseases. Yeah. Migraines are inflammation, psoriasis, inflammation, arthritis inflammation. 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 growth and dysbiosis, and she has use over growth. 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 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 to see what's going on. Comes back in six weeks, says, well, I stopped on my medications. I lost £20. I don't need more migraines. I'm not depressed. I don't have reflux. I don't remember about. And my psoriasis and arthritis went away and I stopped on 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're often have the wrong Mac. And that's why, you know, I really was so excited about this conversation with you today because it's. This is such a big issue for people. Autoimmune disease is the. Is the number one scourge for modern society. We think it's heart disease and diabetes, but it's actually, it's autoimmune. It's so. 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 do 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, but it's still. It's like so slow and it's frustrating and so many 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? Yeah. Well, LinkedIn, the Institute for Functional Medicine. What about your practice? Actually not taking new people. Oh, gosh, okay. Too busy. His wife is jumping up and down. Yeah, it's tough because, you know, 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, Bob. You've taught me so much over the years. You're just incredible physician and a great asset to this whole field. And I think if, 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. Treadmill. Is that your brand, Bob? All right, thanks everybody listening. Thanks. If you love that last video, you're going to love the next one. Check it out here. Sa.