The Autoimmune Cure: Healing the Trauma & Triggers that Turn Your Body Against You | Dr. Gottfried

I think it's pausing and loving yourself enough to look at these drivers of autoimmunity, to ask the question in an unbiased way, am I contributing or am I potentially decreasing my risk of autoimmune disease with the way that I'm living my life?

Hey everybody, Dr. David Perlmutter here. Welcome again to The Empowering Neurologist. You know, autoimmune conditions are incredibly common these days, more so than ever, and we really need to try to unpack why that is happening. What are we seeing? What is causing this virtual explosion of autoimmune conditions? Our guest today, my good friend Dr. Sarah Gottfried, has written this wonderful book. We're going to be talking about The Autoimmune Cure with Dr. Gottfried. You have seen her on this program before. Hi, David. But let me tell you a little bit more about her. Sara Gottfried, MD, is a physician, researcher, author, and educator. She graduated from Harvard Medical School and MIT and completed her residency at University of California, San Francisco. She is the author of 4 New York Times bestselling books about hormones, nutrition, and health, and is clinical assistant professor in the Department of Integrative Medicine and Nutrition Services at Thomas Jefferson University, as well as Director of Precision Medicine at the Marcus Institute of Integrative Health. Her focus is at the interface of mental and physical health, comma— Hmm, I'll do that part again. Her focus is at the interface of mental and physical health, N-of-1 trial design, personalized molecular profiling, use of wearables, and how to leverage these tools to improve health outcomes. I'm very excited to get right into this discussion, so let's do so now. Well, hi, Dr. Gottfried. It's so great to see you, and welcome back to our show.

Hi, Dr. Perlmutter. Happy to be with you, as always.

We're so formal, you know. If people knew we just spent half an hour catching up, a lot of love in the room. Feels really good. Let's start by, you know, here, this is a wonderful book called The Autoimmune Cure. Why write a book about autoimmunity? What's going on?

Well, autoimmunity is increasing in prevalence. It's one of those conditions where people are failed by the conventional medical system. And I think the way that we think about it, the way that we address it, the way that we diagnose it needs to change.

Well, interesting, as I was reading the book, There are a lot of parallels with how I see Alzheimer's, not just because people are talking about autoimmunity in Alzheimer's, but, you know, the paradigm is live your life however you choose, and then suddenly when you're cognitively impaired on your way to Alzheimer's, why, we're going to develop something. And it really seems like that's the approach to autoimmune issues, whether, you know, it's thyroid or Sjögren's or rheumatoid or whatever it may be. That, you know, all the other lifestyle choices are not even considered in keeping people from getting these things in the first place. And you've done such an amazing job in letting us know that, God, what we do day to day is really relevant in terms of reining in the balance of our immune system. So where do we start? I mean, how valuable are these lifestyle choices then in allowing us to establish a good set point for immune function.

I appreciate the parallel with Alzheimer's disease. You know, I've learned from you about how Alzheimer's is not a disease of old age. It's a disease that starts maybe in your 20s, but certainly by middle age. And that's the time to address it. And I would say, when it comes to autoimmune disease, Autoimmunity, the earliest signs of it, also predate the diagnosis of autoimmune disease by maybe not quite as long as Alzheimer's disease, but somewhere around 7 to 14 years. So how do we approach it? You know what, when I say that people are failed by the conventional medical system, what I mean is typically they suffer with vague symptoms. for somewhere around 4 to 7 years before they receive a correct diagnosis. They'll see 4 to 6 physicians on average before they're correctly diagnosed. And so these are the gaps that need to be addressed.

And let me just say, the thoughts going through my mind right now, I am paying attention, but I've had a coffee. So, you know, the idea that, you know, again, we are the arbiters of our health and our future health. And what you're saying here is long before we test positive with various antibody studies for this or that, that we're sort of, if we're making not such great choices, laying the groundwork for disrupting our immune balance that then manifests, and that the mainstream approaches to these problems is really more focused perhaps on symptom management and not really at the underlying problem Which unfortunately is of our making.

That's right. So, but there's also an empowering message here because lifestyle is such an important thing to regulate. And it's often, you know, I feel like what I'm learning with my gray hairs, David, is that, um, We all have areas of vulnerability. We all do. And so some of that is genetically determined, some of it is environmentally determined, often it's the interface of the two. And that's certainly true when it comes to autoimmune disease. So there's a genetic predisposition, usually combined with increased intestinal permeability, and then some type of trigger. And that trigger varies. It can be toxic stress, a traumatic experience, as it commonly is with certain autoimmune diseases. It could be an infection. It could be exposure to glyphosate. There's so many different types of triggers that can occur. And often, you don't know until you have a wake-up call that there's this level of dysregulation. Happening below the radar. And so part of what I really hope to do is to broaden the concept of what that dysregulation might look like and how we now have access to measure it, whether it's looking at your heart rate variability or it's looking at your blood sugar or it's looking at your uric acid or, you know, one of these other indicators of dysregulation, especially In what I think of as the pine network, the psychoimmunoneuroendocrine network.

Well, you mentioned trauma, and I shouldn't have been surprised after I read that section, but trauma as the harbinger for ultimately disrupting the immune system. Yeah, I get it. You know, I remember the work of Candace Pert from so many years ago. And yet, you know, to think that trauma can lead you down the path of an autoimmune disease like lupus, or rheumatoid arthritis or Hashimoto's thyroiditis. It's, you know, it's— if you go to mainstream doctor, he or she is gonna, you know, say, well, who cares? Uh, you've got the problem now. I'm here to deal with it. End of story. But I think that, you know, the notion of how we process trauma and how we deal with it or expose ourselves to certain situations is actually very valuable. At the end of our time together, I was planning to go to— I'm going to bring it up right now. Because surprisingly for some, you talk about psychedelics and in fact dedicate the latter part of the book to the— just a few pages of the idea or the potential for the use of ketamine, psilocybin, et cetera, for unraveling these neuropsychological issues that may underpin neuroimmunological issues, autoimmune conditions. So, um, did you— how did you first— we'll get into each and every one, but how did you feel about it when you first conceived the idea, well, I'm gonna, I'm gonna broach the psychedelic, uh, uh, topic? And, uh, I mean, did you, did you labor over whether you're gonna include it or not? And then ultimately you did. How did that come about?

I love how your questions just go to the heart of my process of writing. I feel that there's a bias with psychedelic medicine in the sense that there is a focus on the mental health consequences of trauma and the use of psychedelic-assisted medicine to address it. And I feel like that leaves many of us who have other types of more physical dysregulation or even spiritual dysregulation without a place to call home. So what I'm interested in and what I saw in my medical practice is the way that trauma or toxic stress dysregulates these homeostatic, you know, these states of balance that we have in the body. And I really felt, and multiple randomized trials have have proven this, I felt like there was nothing like psychedelic-assisted therapy to address some of the dysregulation. So the randomized trials that have been published, the 2 phase 3 trials that have been published on MDMA-assisted therapy, are looking at post-traumatic stress disorder. And, you know, what I like to really focus on as someone— I'm not a psychiatrist, I really want for people to understand that trauma can get under the skin and it can affect relationships, it can affect blood sugar, it can affect your risk of diabetes and Alzheimer's disease. We now know from the initial studies looking at the Adverse Childhood Experiences questionnaire done, you know, the study done by the Centers for Disease Control and Kaiser Permanente, that there's about 45 different chronic health conditions associated with trauma. So how did I get interested in psychedelics? I feel like they are a critical modulator of the pineal system, and not just one's psychology, but your immune system, your neurological system, your endocrine system.

Um, might the response to trauma explain why autoimmune conditions are so much more common in women in comparison to men?

I think it could explain it. So, women, once again, get the short end of the stick when it comes to trauma. So, we know from those initial studies that were published in 1998 that women have higher rates of trauma. So, somewhere around 50% of men experience trauma in childhood, and for women, it's higher. It's about 10% higher. We also know that when men and women are exposed to the same trauma, such as being in the military and surviving a ghastly event, that women have higher rates of post-traumatic stress disorder compared to men. So yes, I feel that the higher rates of autoimmunity that we see in women could relate to this trigger of trauma. But I also think it's important to say that not everyone with autoimmune disease has the experience of trauma, and not everyone with trauma is going to develop autoimmune disease. So there's a particular correlation that I'm addressing in this book, but it's common.

Yeah, I think you said that 80% of people have emotional distress prior to the presentation of an autoimmune condition. One thing that, as you were listing the various autoimmune conditions and then going through each and every one of them, you included long COVID as an almost prototypic autoimmune condition. When I say prototypic, because there are the presence of autoantibodies. If that's going to be, you know, our working definition, then indeed it falls into that category. So how did you come upon that, and what are the implications that some of the if not many of the problems people are suffering from with long COVID may be related to this dysregulation of their immune systems?

Well, COVID, I mean, I want to talk about this in a couple of ways. One is, I believe at this point in our lives and in the world that very few of us have been untouched by trauma, significant trauma. And I'm not saying that to disempower or to, you know, shift the focus elsewhere, but especially the experience of the pandemic, I think, has led to this global traumatic response. And in some ways, it's not what your trauma was, like what exactly the exposure was, whether it was COVID or— You know, your parents got divorced. What matters is the way that it lives on in your body. What matters is whether you could, you know, talk to someone sympathetic and process that upset that you had when the trauma occurred. And so the way that it lives on the body, I think, is is really important. And when you put the COVID the SARS. virus together with trauma, I think it's led to this epidemic of long COVID. And I'm not someone who specializes in long COVID. I've done the IFM course, which I think is outstanding, but I feel like the kind of attention that long COVID requires really necessitates experts and people who specialize in it and do it almost all day, every day. But certainly, the way that the immune reaction is ongoing and the signature kind of stays in the immune system is similar to other autoimmune diseases. There's, as you know, there's the classic autoimmune diseases. You've mentioned many of them: Hashimoto's thyroiditis, rheumatoid arthritis, lupus, type 1 diabetes, psoriasis. And then there's the more non-classical conditions where we're attacking tissues. And that's where I would put long COVID. It's also where I would put— we can debate this— Alzheimer's disease. And I would also put certain types of irritable bowel syndrome and endometriosis, among others.

And maybe celiac?

Well, I think of celiac as more of a classic autoimmune disease, but—

But in terms of attacking particular tissues?

Yes, yes, for sure.

Kind of, again, molecular mimicry situation.

Yes,

yes. And perhaps ankylosing spondylitis as well, you know, a particular tissue. Thyroid, you mentioned, and it's incredible. Is it my imagination? I didn't look this up in anticipation of our time together, but it seems to me that that is incredibly prevalent right now in women, is thyroid dysfunction. And a lot of it being Hashimoto's.

That's true. So, it affects women at about somewhere around 7 to 10 times the rate that it affects men. So, women certainly suffer with Hashimoto's thyroiditis, which is the number one cause of hypothyroidism. So, it does feel like the prevalence is increasing. I'm not sure. I mean, I would say anecdotally, I've seen in my practice so many positive antibodies, and I see it so commonly in patients that I didn't even imagine would have positive antibodies. Although I haven't seen studies sort of tracking this over time observationally, although we do know that the prevalence of positive Antinuclear antibodies, so making antibodies against the nucleus of the cell in your body, that those have increased in prevalence over the past 20 to 30 years. In

general?

That's right.

And could there be, aside from SARS-CoV-2, other infectious agents like Lyme and Borrelia and other common infections these days related to increasing immune responsiveness in this regard?

I think that's probably a common cause. You know, I love talking to you about functional medicine things, and I love it when you ask me questions that I think you're even more equipped to answer than I am. So what do you think about that? I think yes.

Yeah, I think at least in terms of the conversion to the positivity of these autoantibodies, I think that's something we've observed. And again, you know, immune— the immune functionality is walking a tightrope. We don't want hyperimmunity and we don't want hypoimmunity. People think, well, I had an immune response or inflammation, it's always conjured up as being a negative thing. No, it's life-sustaining, that's for sure. But when we try to understand how sensitive that must be and fine-tuned, it's no wonder that people are in such trouble these days because our immune systems are exposed to so many things to which they haven't been able to adapt genetically. And a lot of it, I think, is coming from something you mentioned earlier, and that would be bowel permeability. I think we are exposing our gut-associated lymphoid tissue to things that would not normally have been presented to those cells for processing. By virtue of gut permeability, by virtue of imbalances of and lack of functionality of our gut bacterial microbiome as a consequence of things that we are consuming, be it inappropriate foods and/or medications or chlorinated water, what have you. So I think, you know, those things kind of set the stage. The good news from your perspective is you unpack all of that and make it very clear that, okay, that's What's going on here, here's how to fix it. So why don't we go back there? Why don't we go back to the microbiome and the gut and just focus on that a little bit in more depth in terms of what's going on, how that stimulates the immune system, and then what should we be doing to rebuild patency of that barrier, if you will?

Well, this is where I love to riff with you, David.

Great. Love it. It's great.

Yes. Where's your guitar? So—

In my other studio.

I love it when you play your guitar on social media. So one of the first patients that I became fascinated by was someone who developed autoimmune disease and he tracked about 500 microbiome tests over time. His name is Larry Smarr, and he's featured in the book. And I think he might have even been at one of the thought leaders consortiums that I went to with you.

He was at one. And actually, he has a 3-dimensional— this is a great story— he has a 3-dimensional copy of his intestine that we looked at.

Yes.

Let me just tell you one quick story. We were at his lab in San Diego, and he presented on a huge screen all of his laboratory studies. And I said, why don't we just take a step back and try to see what's going on here? And he said, well, you mean encompass everything? I said, no, let's literally go to the back of the auditorium and just look at everything and get a feeling for what's going on here with your your laboratory studies. And we did. We walked to the back. And it was very moving because you could see how things had changed over time. Yeah, he's an amazing guy.

He's an amazing person. I love hearing that you went to his theater with all of his screens, his biomarkers, and, you know, his high sensitivity C-reactive protein, his Secretory IgA, his lactoferrin, and what happened over time. You know what? What's interesting when you look at Larry is that he—we suspect that he had a shift in his microbiome right around the time that he got diagnosed with colonic. Crohn's disease. So the details of it are a bit complex, but in short, his diversity got reduced and he had an increase in pathogenic E. coli and he also had a flare of archaea. So How is this relevant to other people? We think that there are fundamental changes that are happening in the microbiome that then show up later as symptoms. And it's a completely different way of thinking about, you know, the phenotype of health, sort of the picture of health and how it shifts to pre-disease, how it shifts To disease like inflammatory bowel disease or Crohn's disease like Larry has. So one of the things that's so interesting about Larry, because the only other person who's got as many stool samples as him is Rob Knight at UCSD. Right. But Rob is healthy. Rob in some ways is less interesting because Larry keeps having these perturbations that really teach us about things like the microbiome. So I'm going to pause there because I imagine you've got some things to say.

No, I'm just thinking back. And, you know, I had dinner at his house and he ends up storing his samples. But maybe we shouldn't go there. I'll just— we won't go there. But anyway, I don't think there's anybody on the planet who has been studied as much as Larry. And he does it. know, as this N-of-1— interestingly, you describe yourself as an N-of-1 researcher— uh, as this incredible N-of-1 saying basically, you know, I have this issue, I'm going to do my damnedest to find out about it and tell the world. And I sure honor him for that. It's, uh,

yes,

it's really quite wonderful. I mean, you know, what a mind as well to, to be— that he can dedicate to this. I mean, he's in, you know, his world is astrophysics, and yet look what he's doing to Well, hi everyone, Dr. David Perlmutter here. We hope you're enjoying this content, and if you would do so, go ahead and hit the like button. And if you're not already a subscriber to our channel, please consider doing so. We're really grateful to have you as part of our community. So let's get right back to the presentation. I wanted to— you have a list of symptoms checklist that I was looking through. And some of them were a little bit surprising. And I want to just put on my glasses, if I may. And we talked about anxiety and depression, but visual changes you talked about, and also rapid or irregular heartbeat as symptoms that might clue us in that there's something autoimmune going on. Let's first go to visual. How would visual be involved in autoimmunity or as a harbinger?

Well, the first thing I think of is multiple sclerosis and how vision can be affected. And you're a neurologist, so I feel like this is a symptom that you probably have tracked pretty carefully over time. You know, there's also some of these more systemic autoimmune diseases can have an effect on the visual system. So I think it goes both ways. The other thing I think about is that Migraines and the way that migraines affect your vision. Migraines, once again, I think, are part of that non-classic category of potentially autoimmune attack. So let's riff together. What do you think of when it comes to the visual system in autism?

Well, let's just first, you know, go to the visual system as it may be compromised in multiple sclerosis. And You know, where my mind goes is, you know, back in my early days, we had very little in terms of therapeutic intervention except for just turning the immune system off. You know, we would use Cytoxan chemotherapy in some aggressive MS patients to turn their immune systems off. We would use plasmapheresis to try to take out bad things from their blood. And of course, steroids were first-line treatment if a person's having an acute flare-up. Interestingly, now, you know, I've been studying something called the NRF2 system for probably about 18 years as a way of modulating inflammation, detoxification, and immune stabilization. And now we see a couple of drugs that are used in multiple sclerosis therapy that are based on this platform, NRF2. activators. And, you know, in our work, we're looking at activation of the NRF2 pathway through things that we'd all be interested in, like nutrition, understanding that this is how— why cruciferous— one of the reasons cruciferous vegetables are so good for us, and physical exercise activating this NRF2 pathway to regulate immune response. And, you know, gratefully, on the top of the list of the NRF2 activators is coffee. And I think it may explain why, you know, beyond caffeine— everybody focuses on caffeine, Why coffee and the more than 80 bioactive chemicals that it contains maybe actually, you know, we can understand its potency. So I think that the fact that mainstream medicine is exploring and developing approaches through this pathway, NRF2, that we know is extremely responsive to our nutrition is good. I mean, they're as is so often the case, using drugs to modulate a pathway that we can modulate with nutrition. But I think that will help us bring back into balance, you know, immunity. I think more importantly, though, from my perspective as it relates to immune regulation, is the changes in the phenotype of various of our immune cells. And, you know, broadly speaking, there, at least with respect to macrophages, we can look at 2 major groups, which we call M1 and M2, and understand that a single macrophage, or in the brain, a single microglial cell can, as it relates to multiple sclerosis, can change between being the good twin versus the evil twin. That same cell can morph itself between being one that is supportive of the neurons to one that is digesting away myelin that we see in multiple sclerosis. And it's based upon its state of mitochondrial function that influences that shift from being the good supportive microglial cell to the evil twin. And so therefore, when we get that, we can begin to understand how targeting mitochondrial function then might be a really good entrée to regulating the immune system throughout the body, macrophages peripherally and microglia centrally. Things like fasting and ketogenic diet and urolithin A and AMPK activation and, you know, various things that we do, berberine, glucophage if need be, to regulate these pathways may be acting to regulate the immune system. It may be why rapamycin is effective. You know, ultimately, that was, I mean, originally an immunosuppressant. That's how we all remember it. Now, of course, being popularized for anti-aging because of its ability to help with immune regulation on the one hand. You know, certainly, it's senolytic as well, ridding the body of cells that are less functional. But I don't want to go off too much. I want to ask my questions.

No, this is really Yeah. But it's super juicy, David. I want to ask a follow-up question because you and I are at this interface as we're talking right now where you have deep experience, decades as a neurologist. You've got deep experience paying attention to nutrition and mitochondrial function and NRF2 activation. And I'm originally trained as a gynecologist. One of the things that I'm so curious about is how women of a certain age, so typically perimenopause, sometime between about 35 and 50, they have a large uptick in diagnosis of autoimmune disease. And so, I think of something like multiple sclerosis. And with what you described with immunomodulation and with mitochondrial function, And then thinking of Lisa Mosconi's work and how she's shown the slowdown in brain energy, the cerebral hypometabolism that occurs in 80% of women over the age of 40, and how that seems to be related to mitochondrial function. So, I wonder too, just as those women, the 80% that are having the cerebral hypometabolism or brain slowdown, Those women who then have more symptoms of perimenopause, hot flashes, night sweats, mood changes, sleep disruption, could that also be one of the drivers of an increase in certain autoimmune conditions like lupus?

And Alzheimer's, for that matter.

And Alzheimer's.

You know, the ratio of men to women with respect to Alzheimer's is the same as it is for autoimmune conditions. In Alzheimer's, we quote generally twice as many women compared to men. And I think you'd see similar findings as it relates to autoimmunity. And, you know, I think a lot of what you just mentioned converges on nitric oxide functionality that declines with age. And I think dramatically after menopause seems to decline in women in terms of its availability and its function. And, you know, the awarding of the Nobel Prize in 1988 happened because of the identification of nitric oxide being this endothelial factor that had therefore traction in the world of cardiovascular disease and hypertension. But since then, identified has been other roles as a neurotransmitter, but a fundamental role in insulin functionality in the brain. Brain. And such that, you know, we now see strong correlations between healthy aged, young versus healthy aged versus the continuum of 5 stages of Alzheimer's, direct linear decline in brain perfusion, cortical perfusion of blood flow through the internal carotid artery, nitric oxide availability as well. So it's a very strong correlation. That was described actually back in 2019. So that while we understand that and the role of nitric oxide in mitochondrial functionality and immune regulation, it gives us tools. What can we do then now to allow us to upregulate this nitric oxide to preserve and even enhance brain metabolism? You know, so much in Alzheimer's has been focused on treating, when you mentioned earlier that these things begin 20 years earlier, and as Lisa Mosconi has mentioned many times, this hypometabolism of the brain is something seen long before memory issues or clinical manifestations of cognitive decline, that these are the harbingers that are present long before we would begin to think about PET scanning for beta amyloid accumulation, for example. And the abject, to be fair, failure of drugs targeting either the formation of beta amyloid via targeting the secretase enzyme, or even drugs designed monoclonal antibodies to rid the brain of beta amyloid. They do, they get rid of the amyloid in the brain, but the cognitive decline continues. And until such time as we focus on enhancing cerebral metabolism that you've brought our attention to, I don't think we're going to get anywhere. We're beginning an interventional trial very soon in established Alzheimer's patients by using a patented pharmaceutical to increase nitric oxide to target brain metabolism. And I think we're going to see some pretty— I'm hoping some dramatic results that are not expensive, that are not threatening to cause these MRI abnormalities called ARIAS, amyloid-related imaging abnormalities, which are hemorrhages and edema, which are common in the drugs that are used. So, and I think in so doing, it will also balance immune issues and reestablish mitochondrial health and therefore help revert those M2— M1, rather, microglia the evil twin back to the friendly, supportive microglia that can support neurons, that can support synapses, that can help digest beta amyloid if, you know, if that's important. So, you know, there's a lot— there's a lot going on and there's a— the field just got much, much bigger in terms of opportunities and areas of interest to pursue. So, you know, as we get older, it's getting much more exciting because so many of these ideas that we've had about metabolism and lifestyle and interventions based on lifestyle are really now bearing fruit. So it's a great time to be still in the game, that's for sure.

Absolutely. Absolutely. And I just want to honor you for describing a very complex topic, you know, the immune cascade, the role of M1, M2, The evil twin versus the more friendly twin. I always learn from you, David. Oh my goodness. I always learn a way of describing a complex topic without oversimplifying, with, you know, being able to share it with people so that they also can feel empowered to think about, okay, what's going on with my immune system? How do I navigate this? How do I You know, make it through perimenopause and menopause without an autoimmune condition? What are some of the pieces? And I just really wanted to honor you for your evil twin summary.

I have to say, it's incredible that we've gotten as far as we have, that, you know, this whole immune system has evolved over— if you want to take it back to primates, then I don't want to go to that plate, but let's say an awful long time, 8 million years perhaps, to be responsive to a pretty static environment. You know, yes, there have been changes in climate and people have migrated, but pretty much the things that we have confronted our immune system with have never changed until just a millisecond ago in our history. when suddenly we are confronting this incredibly delicate system with so many xenobiotics or toxins that— and we would expect our immune systems to be able to respond appropriately and still keep us healthy and preserve our lives. It's asking an awful lot. And I think that what— you've got a book written here because of the simple fact that that's not occurring. That we're not getting away with it, and that's what's you know really behind all of this. And you know it's just so breathtaking that you took the time to write a book saying, "Hey, as a matter of fact, it's not that you're short on steroids or you need this or that drug to suppress your immune system. Here's what's really going on in the background, despite what you may." be hearing from your immunologist or rheumatologist, as it were. And it takes a bit of courage on your part, and you've done it. You've done it time and time again. And every time we do these interviews and you write these books, I'm always taken by the amount of courage that you have to stand up to the mainstream because the mainstream is falling short. You've made it very clear, and I think that people in general feel that they've been left out to dry a little bit by the mainstream approach. You know, I've watched it in neurology and Alzheimer's. And incredibly, Biogen took Aduhelm off the market, as in a couple of weeks ago, saying that, you know what, we give up. This is just not happening. We're not fixing Alzheimer's patients and finally admitting that. And so I've always enjoyed that about our time together, that you are out there. And every time you make a statement, you think, oh my gosh, how could she say that? There's a wonderful peer-reviewed scientific citation in the book that says, I actually didn't say it. This is what really good researchers are talking about. You need to know it. This is hard science going on in the background that you, through your work, have brought to the surface. And I just commend you for it. And I've always, I've always so looked forward to our time together just because of these moments. And there's a lot going on right now, I think, that our viewers are feeling. It always happens when we talk. And I, you know, I feel very full in my heart.

Absolutely. And the connection I feel with you is, is really, it's a through line of the kind of lifestyle changes that we are talking about. Not to minimize in any way the incredible learning that I've experienced from you. And I think it's pausing and loving yourself enough to look at these drivers of autoimmunity, to ask the question in an unbiased way, am I contributing or am I potentially decreasing my risk of autoimmune disease with the way that I'm living my life? Well,

you said something now that is really profound. You know, we've heard, love thy neighbor as thyself. It isn't going to start until you love yourself. Then you can love your neighbor. So that sets the bar, as thyself, as you have now established with thyself. And I think that, you know, we are so removed removed from that in our modern worlds. We offload everything to the experts who, you know, insinuate their messages into our lives via social media and television in terms of what our choices should be. And I think, you know, the notion of empowerment is one in gaining the information then to make better choices and reclaim That ability based upon utilizing this prefrontal cortex that allows us to bring in all kinds of great information and then make a choice, as opposed to being at the mercy of a 60-second soundbite that says, for your rheumatoid arthritis or for your psoriatic arthritis, you should take— use XYZ. Not even listen to the small print where they say, you know, that this can lead to serious problems. Death has even occurred. You know, all kinds of things, you know, progressive multifocal leukoencephalopathy, what they call in the TV commercials PML, like people are going to know what that means. It's a fatal neurologic condition that can occur when these drugs are used to suppress the immune system. So that's what we're up against. And, you know, getting back to your book, I'm going to hold it up because I really— this is A, the proof. This isn't the actual— it's basically the actual book. And it's one of the perks of doing a podcast. I get to read this stuff before anybody else, which makes me so happy. But anyhow, Healing the Trauma and Other Triggers That Have Turned Your Body Against You. Wow, I need help with that. And you give us that help. There's a quote that you have in your book from Dr. Alberto Villoldo. I'm gonna read it in my notes. It's in bringing others the healing gifts we've received that the benefits of these gifts become truly ours. So it's the giving of our gifts to others. And that's Sarah Gottfried, in my opinion. That's— you are the personification of that. You always have been. Thank you. And you're courageous and It's just great information. And I, I was so taken that you used a quote from Alberto Villoldo that we were visiting, what, 3 days ago in Chile, and I've known for, for an awful long time. So gosh, we were supposed to cover a lot more about the book,

but

we got sidetracked. But I still think people are going to love, love our time together. I mean, I think Like Alberto said, we're going to share these gifts. That's for sure.

Well, I love, I love sharing the gifts with you, David. I'm so grateful for the way that you serve your audience so deeply. And I don't feel like I get sidetracked with you. I feel like we end up at exactly the right place.

I agree.

And that there's a synchronicity to Our conversations, even if we don't stick to a particular agenda, it's a lot more interesting in my mind and my heart when we don't.

I, I'll tell you, I have a whole 2 pages of notes right here that I would refer to in interviewing. I don't think I covered a single— except I think I covered a couple of them. But, um, thanks again. I think I'm gonna see you really soon. Are you going to New York?

Yes.

Oh my God, yes.

I'll see you. I think I'll see you dinner. Dinner on Thursday.

That's right. I'm so excited. I can't wait. I can't wait.

Me too. Well,

anyway, thank you for being with us today, and I can't. I'm looking forward to seeing you. You're the best.

Thank you, David. Appreciate it.

Wow! What an interesting conversation again. Seeing an awful lot of autoimmune conditions, and who knew that all of these factors are playing a role in determining why we're having such issues with? regulating our immune systems. Again, thanks to Dr. Gottfried. I'm Dr. David Perlmutter. We will be back with the Empowering Neurologists Program soon. Bye-bye for now.