Bugs to Brain: How Infectious Diseases May Precipitate Neurodegeneration with Dr. Jay Lombard

Coming up on this week's episode of the Doctor's Pharmacy.

There's very strong compelling evidence at this point that bacteria are the cause of neurodegenerative diseases.

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Welcome to the Doctor's Pharmacy. This is Dr. Mark Hyman. That's Pharmacy with an F-A-R-M-A-C-Y. It's a place for conversations that matter. And if you care about your brain, today's conversation will matter to you because it's with Dr. Jay Lombard, who's an extraordinary physician, neurologist, psychiatrist, author, speaker and friend of mine who I met probably, gosh, close to 15 years ago. I don't even know. It seems like a long time ago. And you were teaching a course on a functional medicine approach to neurodegenerative disease. And sitting there listening to you, my mind was just completely blown. And we're going to go through what we learned then and what we know now, almost a decade plus later, about how to fix and treat very tough brain diseases, things that there really is no good treatment for in conventional medicine, things like ALS and Alzheimer's, Parkinson's, MS, all these horrible diseases that we really struggle dealing with. So he's integrating a whole series of things that are pretty unusual for a doctor. He's written a book called the Mind of God about spirituality, faith, medicine. He integrates understanding of the biology of our human being, our psychological components, our existential components, in a very complete holistic treatment of the person. He's a very unique guy, and he's written a lot about all sorts of things, including the Brain Wellness Program, which was a great book he wrote years ago, which is How I Got to Meet Him, and recently the Mind of God, which was featured in the New York Times, a great article about you in the New York Times. Very good, congratulations. Exploring the difference in the relationship between faith and science. He's appeared on lots of TV radio shows, including Larry King Live, that was a while ago. Yes. CBS News, the Food Network, Dr. Oz. And he's been the chief of neurology at Westchester Square Medical Center, the Bronx Lebanon Hospital and clinical assistant professor at New York Presbyterian and Albert Einstein College of Medicine.

And he has a practice in Tarrytown, New York, which is fantastic.

So welcome, Dr. Lombard. Two disclaimers.

I'm not a psychiatrist and I really know nothing about the brain.

Oh, wow.

Okay. Well, I thought you said you were trained in psychiatry. I was trained in psychiatry. Yes, I'm not a psychiatrist. So, you're not technically a psychiatrist, but you learned enough about psychiatry. Just enough to be dangerous.

Yeah, well, you know, psychiatry used to.

Be brainless and now it's mindless.

Right, exactly.

Exactly.

You try to bring those two things.

Together and I think that's the problem. I tried and failed. so we were discussing, and we've talked over the years, about the challenges of dealing with this sort of epidemic of broken brains, brain disorders that we in medicine really struggle with. A typical line for neurologists was adios, diagnose and adios. You know, you can diagnose the disease, but not much we can do. We'll see you later. And good luck. But now that's all changing. and you're doing pioneering work looking at the relationship between things like inflammation and our gut microbiome and mitochondria and all sorts of stuff that just seems sort of marginal in medicine, but now has come to the center and is allowing us to think about these conditions in a new way and treat patients in a new way. And you are at the leading edge of that. You have thought differently about this than almost any neurologist I've met. I mean, we've had David Perlmutter on the show and others, but You know, this is your sweet spot is the sort of intersection of all this emerging science, emerging therapies, and putting them together for patients in a way that really help to make them better.

So I think you're- that's the goal. That's the goal.

All right, so just to dig in a little bit, let's start at 30,000 feet. Why have we failed so miserably at addressing these neurodegenerative diseases that are affecting literally millions and millions of people United States and around the world and causing untold suffering to patients and their families.

That's a very simple answer. We're treating symptoms, not pathophysiology. That's why I love IFM.

Yeah. So functional medicine is really about treating the cause.

Exactly.

And not the symptom. Right. And that's what we're good at in medicine is treating symptoms, but the disease process continues underneath those symptoms. even though the symptoms are suppressed, right?

Right, exactly.

So it's fine if you have a broken leg and you wanna take painkiller, you don't care if your leg's still broken, you don't wanna hurt. Right. But for these kind of conditions, we just spent so much money and research in the wrong direction.

100%.

So what is really the root of these things? You were sharing with me before we got on the show that Parkinson's and ALS and MS and Alzheimer's, there's so much in common. They're almost the same disease with different manifestations, like the same tree trunk with lots of different branches. Right.

That's right.

How does that work?

Well, I think that, you know, there's been a lot of research recently, really quite frankly, from IFM, which kind of.

Led into- the Institute for Functional Medicine.

Right.

Yeah.

Right.

That basically talking about, you know, the role of the microbiome in chronic disease. So, I'd be honest with you, I was very skeptical of that whole thing until I saw my first patient with ALS who told me that he had CBO.

Yes.

Okay. And I'm like, okay.

What is that?

Right.

I was like, what is CBO?

You're a neurologist, anything that happens south of the neck, you're like, what? I don't know.

Right. So I said to him, I go look, CBO there, ALS here. He goes, no, my ALS is being caused by my SIBO.

And what is SIBO?

He didn't know, I didn't know at the time what SIBO was. Okay, that's, I gotta, well I get to the punch line, so what is SIBO? Good question, so what is SIBO? But I sort of started thinking like a microbiologist instead of a neurologist, meaning that my patient's telling me he has an infectious disease that's associated with ALS, since he's one person, instead of trying to divide and conquer, that he has, you know, SIBO and has ALS. What if SIBO and ALS were somehow related? That was the first question I started with when addressing this particular patient. Most people don't know what SIBO is.

So what is it? What is SIBO?

It's a small intestinal bacterial overgrowth.

So it means bacteria are growing in your small intestine.

Well, you asked me that question. You want me to answer that question.

I'm sorry. Who knows what SIBO is, right?

Sounds like a SIBO.

Everyone knows what SIBO is. Isn't that the convenience stores in the airport, Cibo or something? No, no. Cibo means that you've got bacteria growing in your small intestine where it's not supposed to be. It's supposed to be in the large intestine. And when you eat food, it ferments quickly and you feel bloated, distended, what we call food baby, and it can cause a whole host of other problems. It's been linked to fibromyalgia, to depression, to heart disease, I mean pretty much everything, right? So, okay, so now-- so now I'm.

Thinking about can a bacteria be the cause of ALS? Now this is at this point, you know, a completely unfounded theory that, you know, people have told me to this day, I'm still crazy for thinking this, okay?

So anyway-- I don't think so. Good.

So my second patient with ALS had ulcerative colitis and ALS.

Oh.

And I said, oh, this is interesting. So I started looking at ulcerative colitis. And I was like, wow, ulcerative colitis looks like it's immune mediated, not that it's autoimmune, but immune mediated from bacteria. So I'm looking at all this gastroenterology.

Literature about ulcerative colitis and Crohn's.

I'm going, oh my God, it's the same bacteria.

Yep. So the best- I got ulcerative colitis from C. diff.

Right.

Exactly.

Exactly.

Almost died from it.

And it made my brain not work. Wow, it's just amazing that you're sharing.

That with me because, you know, I, look, I'm a neurologist, I don't think about ulcerative colitis, I don't think about Crohn's, I don't think about fecal transplants, I don't think any of that, right? All of a sudden I'm like, okay, I'm thrown into this thing where if I believe that C. diff is the cause of ALS, I gotta kill this disease, man. I'm like a disease hunter.

I'm gonna nail this disease, right?

So what happens?

You like the Indiana Jones of medicine.

I mean, Indiana Jones of medicine, right? You're screwing my patient, I'm gonna get you first. And my best friend is like a former FBI agent, so it's like, that's like when they follow serial killers, that's what they do, right?

They get all the evidence and then.

They kill them, or they arrest them at least. Yeah, right. First they hopefully arrest them, then they try them. But it's C. Diff, you gotta kill, not arrest. That's a whole separate conversation. But anyway, so I started putting together how C. Diff neuropathologically can produce motor neuron disease. Because I had to sort of establish what those pathways were in order to convince my colleagues that they should look into this.

I kind of connect the dots between stuff that goes wrong south of the border there in the gut-- To the nervous system-- and what happens to your brain. Correct. They're actually connected, right? There's a whole thing called the second brain, which is your gut. Yes.

And your brain brain, which is your brain. Right. And they're all connected through all kinds of hard wiring.

It's one body. Right.

We have one body. Isn't that holistic medicine?

The idea that you treat the patient. That's why I joke. I always say I'm a holistic doctor because I take care of people with.

A whole list of problems. They're all connected.

They're all connected. Why? Because you have all those problems, right? I mean, there's this horrible phrase in medicine. It's called comorbidity. Right. Which means you have multiple chronic diseases that aren't related. Like, oh, you have heart failure and diabetes and hypertension and you have kidney failure and you have, you know, this and that and Alzheimer's. They're not related. They just happen to be showing up in the same person at the same time. Oh, it's a coincidence. Nonsense. They're all connected.

Just like it was a coincidence, I was walking down the street and I saw an old doctor who actually his son was a patient of mine. Like, oh, that's not a coincidence. There has to be something of value for that. But yes, it's not a coincidence that these diseases occur in one person because they're interrelated to each other.

So I started asking that question.

How are these separate conditions? What's the mechanism? What's the mechanism? So here's the mechanism. The mechanism is protein aggregation.

That's a fancy word.

What does that mean? Protein aggregation means that chronic disease, by definition, whether it's neurological or cardiovascular even, or even cancer, these are where proteins are malformed. The proteins. The funny looking proteins.

The proteins have- They get damaged. Or injured or produced in ways that are funky.

Right.

And that's the common factor in every neurodegenerative disease, meaning that they're misfolded proteins. Amyloid and Alzheimer's. Amyloid, tau, alpha-synuclein, all of the different proteins that are associated with their pathology for those diseases, they're all protein misfolding disorders. I said, okay, well, why are they misfolding? What's stopping them from folding properly?

And what controls protein folding? Because it's not only the amino acid structure of a protein that matters. It's the three-dimensional structure of the protein. And how that interacts with receptors and how it interacts with other proteins and how it interacts with your cell membranes.

Everything is a three-dimensional world. It's not two-dimensional. So I started thinking, okay, what is causing the proteins to misfold? And I think this is well known, it's not something I discovered, so this is actually well known, that misfolded proteins are caused by microtubule dysfunction. Microtubule dysfunction is caused by other things. There's actually lots of things that cause microtubular dysfunction, but guess what bacteria produces primary microtubular dysfunction as its pathology.

C. diff. 100%.

C. diff.

But many other bacteria might do that too.

I looked for that question and I could not find as strong an evidence of a direct A to Z link between Clostridium. Clostridium actually makes a toxin that you can actually test for. called Rho kinase. So Rho kinase, I said, what does Rho kinase do? Well, how is Rho kinase producing the lethality? The lethality, is that the right way?

It's good enough.

Yeah, lethality.

Deadliness.

Deadliness, right, of cells. And it does it by poisoning microtubule-associated.

Proteins that- what's a microtubule?

Microtubule is like the architecture of this house. Think about all of the scaffolds and all of the walls, everything, makes this house. All the framing. The framing, it's the framing of the cell, but it's not just the framing of the cell, it's in charge of all of the export-import, the border control. Plus the trading company. Right, and reproduction. I mean, how cool is it that it has that function, right? It's all about reproduction for microtubules as well. So it has interface not just with ALS, but also cancer. So if you look at the cancer data, A, these are protein aggregation disorders as well, different proteins obviously, right, but possibly the same mechanism was causing those misfolded proteins. So I was like, okay, I'm not ready yet for this, I mean, like even this conversation, but I've not begun to look at evidence of C. diff and cancer yet, because right now I have to focus just on neurodegenerative diseases. But in that case, so we're at the potential issue that, how do we prove this, basically?

So then what causes besides C. diff though? There's other things, right? that cause it, right?

Inflammation and- well, inflammation as a result of infection.

You're saying there's one cause, which is C. Diff for all neurodegenerative diseases?

In order to prove that hypothesis, two things have to happen going forward, two things. The first is we have to establish that there is C. Diff in the brains of patients with Alzheimer's disease. Guess what? That study's been done.

Yeah.

It also showed that there was some- Poop for brains. Hoop for Brains. Is that like a true website or something? I thought Rudy made that up.

Hoop for Brains.

Well, there's another way to say it, but more importantly, clinically, clinically, I mean, look, people can say, oh, it's an epiphenomena, right? Like the brain is already decomp, composing, and of course you're gonna have the bacteria emerging when the person's dead. Fair argument, right? Maybe it's not that cluster B is causing the disease, but it's there for the ride as it eats your brain up after you're dead, right?

That's sort of the meaning. Meaning they find an autopsy, but maybe.

It'S- It doesn't mean that it was there when they were living, right? So fair enough, what that means is that we have to demonstrate- so they.

Ran for the hills as soon as.

A person died, is that it? I guess, I don't know. I said, that's true. Probably unlikely, right? Yeah, unlikely. Exactly, yeah. But in fairness to that sort of counter punch, what the medical community would ask for going forward is especially clinically. We make a decision that we think that this is definitely C. difficile in a patient with a disease like Alzheimer's, right? To make that conclusion clinically, you have to have absolute 100% evidence that that bacteria is actually causing that disease. With some, you know, Obviously, not every disease is gonna test positive. And not only is the challenge here that the majority of patients who test for C. Difficile, who have dementia, Parkinson's, Alzheimer's, and what have you, have negative tests for C. Diff.

In their stool.

In their stools, right. And so people that are sort of looking at this picture with me, if you will, are saying exactly that. Well, it can't be C. Diff because we're testing C. Diff in the stool. and it's not there. I say, well, guess what? It went uptown. Okay? It used to live downtown, but it likes uptown more.

Why?

Because A, we give them PPIs, which they love that alkaline environment.

Acid blockers.

Acid blockers.

Like Pepcid.

And what do we give them that they love most of all? Antibiotics. C. Diff loves antibiotics.

It's actually an antibiotic-associated. Infection.

Exactly.

That's how I got it. I took an antibiotic for my bad tooth and I ended up getting C. diff. Yep.

That's, I mean, if that's not a word of warning to all the listeners, I don't know what it is. Yes, exactly right. Basically, it's called antibiotic-associated C. diff. So I started asking patients with neurodegenerative diseases if they had a prodrome when they first started getting sick.

And all across the board, I mean like symptoms that happened before they got.

Of course, well you ask questions like that. I wanna know like what they did as a baby basically, you know? Even though they're 70 years old, why ask, I don't know if I've asked my mom that question. But you know, younger patients, you can ask them that question 'cause they're with their parents. And I say to them, you know, I ask them three questions. I go, did you have a lot of antibiotic exposure before you got sick sick? 100%, it's like not, it's like, I know the answer before I even ask the question. It's just a question of how many antibiotics they had. and what course antibiotics they had. And the second question that's worthwhile to ask clinically is do you have trouble actually mounting a fever? So that's a question that I was surprised by the answer that most, I mean not most, but my patients basically have said, no, you know what, I've noticed I really never get a fever. I'm like, oh, okay, so.

Which is not necessarily a good thing.

That's right, it's not a good thing at all. because the only thing that actually will treat spores, right, is heat. Heat.

If you look at- that's why we get a fever, right? You get a fever because it's your body's mechanism for killing infections.

I make a joke with people, I say them all the time, I said, name one disease that humans have cured. Cured. Like, oh, you know, they always mention infectious diseases because that is the truth. We've cured infectious disease. But the only thing that actually cures disease is our endogenous mechanisms. You know, fever and sleep, basically, are the two endogenous mechanisms of holistic medicine.

And endogenous means stuff that you do yourself.

Your body does it for you. Your body's doing it for you, but you have to help the body do that. You can't be staying up late and.

Taking PPIs to watch, you know, Seinfeld episodes. You can't have your pizza followed by your Prilosec. and stay up all night watching Game of Thrones.

Correct. Now in perfect disclosure, I've done all of those, except I actually do eat the pizza when I'm watching those shows. I gotta work on myself, basically. Doctor, treat yourself.

Yeah.

Right, but anyway, yes.

So this whole conversation is fascinating to me because from a functional medicine perspective, many roads lead to Rome. In other words, just because you know the name of the diagnosis of the disease you have, doesn't mean you know.

What'S wrong with you.

Exactly. And the truth is there can be a 10 or 20 causes for the same disease.

Right.

And I think that's probably true even of neurodegenerative diseases like Alzheimer's. So, I just wanna make sure that we're not saying that every single person with Alzheimer's has C. Diff or that that's the cause, 'cause it could be something else. Exactly. Could be Lyme disease or.

100%. It could be.

Heavy metal, some resistance.

No, but I think the sort of like the devil's in the details, if you will, right? Meaning that, yes, I think there's very strong compelling evidence at this point that bacteria are the cause of neurodegenerative diseases.

Not my, yeah, we talked about Rudy Tanzi, who's a Harvard scientist, one of the discoverers of some of the presenilin genes, which are the genes that show that people at risk for early Alzheimer's, he actually said they were discovering all these microbes in the brain, which we thought was sterile and that we had this blood-brain barrier that protects us. And you're saying and he's saying that that barrier is not always 100% and that stuff can leak through. Not only can you have a leaky gut, but you can have a leaky brain.

Look, bacteria, don't have to scare people. Bacteria love the brain. Why? 25% of the body's glucose is used by the brain. They know where to eat. They go into Le Pan, where that fancy restaurant is downtown. Everyone else is eating downtown. They're getting our brains.

Bacteria live on ketones?

100%. But not, wait, that's very important. They prefer simple sugars. Why? Because they're lazy, right? They want instant gratification. so they like sugar better than ketones.

But ketones in ketogenic diets work for some of these neurodegenerative diseases like Alzheimer's and even LS and brain cancer.

That's right. That's right. And I think one of the mechanisms, to be honest with you, is that ketones actually improve, first of all, they improve mitochondrial function, but they're not a good substrate for bacteria. They're a great substrate for us. Bacteria don't like them because they like eating fast food, basically.

Yeah.

So, eat them sugar, we eat fat.

That's right.

Okay, so this is just a breakthrough idea. And this isn't just an idea. You've actually treated patients using this approach and seen some really extraordinary things.

Yes.

So, can you share with us a little bit about this case you were sharing with me earlier about ALS, which is a horrible condition. Stephen Hawking had it. It was called Lou Gehrig's disease after baseball player, essentially is where your nervous system is affected by the killing of the neurons in your spinal cord, which makes you basically paralyzed. You got fasciculation, which is twitching. You eventually can't move your arms and legs. You're in a wheelchair, you need a respirator.

You wouldn't wash it off on your worst enemy, you would not.

It's like slowly getting paralyzed, right?

Yep, that's right.

Never has there been a treatment that has stopped or reversed it. And you're saying that you've seen patients where this has actually happened?

So, well, we are in the process of validating that data, yes.

So, yes, we need more studies. Yes, we need to do research on multiple patients. But even if there's one patient, Where you've seen a change, it raises the.

Question of-- oh, by the way, it's made me go crazy, by the way, because, you know, I am so-- I'm finally glad to be a neurologist. You know, being a neurologist is like being a nihilist or a masochist. Diagnosing adios, right? Well, it's worse than that. It's like diagnose and let me not tell the patient that they have ALS. Let me treat them for, you know, like a CIDP picture because they don't want to actually make that diagnosis for people. It's the hardest diagnosis you could make for for a patient, because everyone knows ALS is incurable disease, right? I mean, it's 100%, even pancreatic cancer is better. Well, you have a 5% chance of living with pancreatic cancer. You have zero chance of living through this disease, zero.

So based on your hypothesis that it's infectious, that plays a big role, if not is the main role. I personally shared on this podcast that I went to a place in Mexico called San Diego, where I and my wife both went through this treatment called hyperthermia, which essentially is where they heat you up to 107 degrees, which sounds crazy and is scary. But actually, we did both fine and it killed a lot of infections that we had.

Oh, my mesh is amazing.

My wife, her viral loads of very tough to treat infection called CMV came plummeting down. She felt much better. I felt much better. And so this is a therapy that is not much used in the United States, but is used widely in Europe, is used in Mexico and other countries as the therapy for some of these types of infectious diseases and even cancer. Right. So how does the theory work behind this with something like ALS?

Well, the idea is that fever, is the way of actually denaturing spores.

That's a big sentence. Can you unpack that?

Sure. So human cells have their proteins that either fold properly or not fold properly at a certain temperature. Bacteria have their own temperature zone, like their ideal climate. And spores have another ideal climate, meaning that to kill a spore- A spore.

Is like a baby bacteria.

A spore is a baby bacteria. And that's what I believe personally is the reason that patients have amyloid accumulation, that the spores are creating this protective cover against antibiotics that actually is in fact the amyloid being produced.

The amyloid is like the armor for the bacteria.

Yes, they're like the bomb shelter. The biofilm is the bomb shelter for these little baby bacteria. Yep.

And so how does hyperthermia work to disrupt that? Oh, and so what is that procedure? Because.

Well, so it works, hyperthermia works by, it's a very narrow window of temperature. Meaning if you give too much temperature, you can actually hurt normal cells as much as, you know, bacterial cells. If you don't give enough temperature, you've done nothing.

So it's like Goldilocks.

It's like Goldilocks.

You gotta get it just right.

You have to get it exactly right. And that's part of the way that the hyperthermia technology has been developed is by really understanding that the brain itself can provide feedback on the tolerability for human cells because brain cells are going to tell the brain, hey, this is pretty hot in here.

You don't want to fry your brain.

Can you turn the thermostat off now? part of the device actually is to get the brain temperature back into the feedback system where it's self-regulating so that you never reach a point where the temperature is harmful to your own cells.

And so, often in places where they do this, they'll give at the peak of the temperature, they'll give antibiotics or antivirals.

Right.

Does that make sense?

To give antivirals?

Or, yeah, to give antimicrobial treatment to patients when they're at the peak of the fever, because the idea is that.

It sort of flops- oh, I see. Yes, for acute infection, yes. I would argue that- or Lyme or? Well, if Lyme is acute, certainly. I mean, I don't think that, I mean, I think you gotta be weary of the issue that by, you know, robbing Peter to pay Paul, for instance. Let's say that C. diff is, let's say, for argument's sake, say this is a polymicrobial disease. As opposed to a- Like lots of different bugs. Lots of different bugs, as opposed to just one ringleader that everyone else is following. So, Lombard believes that C. Diff is the ringleader, and all these other guys, Lyme, HSV, they're just tagging a ride, because it's such a great killer that it's like, okay, great, we'll take the leftovers, no problem here. We'll take the leftovers. So, my concern is clinically that if we start treating patients with bacterial drugs like Roseffin, whatever it is for chronic Lyme, yes, you're dressing chronic Lyme.

I mean, the C. Diff gets worse.

Yes, exactly. Exactly.

So the heat alone is enough to disrupt the C. Diff?

Well, we haven't demonstrated that yet, to be quite frank, but what's been demonstrated is that by applying hypothermia, that we're able to actually see improvement in clinical symptoms of patients with ALS.

People's muscle strength, this is a progressive disease, so it gets worse and worse and worse, every visit they're worse. You're seeing patients that it stops or.

Gets better, which never happened.

Correct. So this is a major breakthrough. I think so. Major breakthrough. And this is not something new, this has been around for a long time. So where in the world is most.

Of the research being done on hyperthermia?

For ALS?

Period.

I mean, it's- oh, most of the.

Research on hypothermia actually is cancer research. So they call it chemothermia, chemohypothermia. So people can look up a lot of data on how hypothermia affects cancer, but as far as I know, there's zero data until now applying hypothermia for ALS. We will be the first people to actually talk about applying hypothermia for treatment of ALS.

What about things like Alzheimer's or Parkinson's or MS?

The difference in those diseases are that in Alzheimer's, it's very difficult to induce hypothermia in a patient with Alzheimer's disease. Why? Because you need to be compliant. The treatment itself is, it's fairly rigorous as you know from your experience. They put me to sleep.

They put you to sleep, right?

We don't want to put them to sleep though, right? Because we're concerned about protecting their brain. So, if you have a patient who's got end-stage Alzheimer's disease, for instance, I don't see how this is going to be helpful for them. But early, 100%.

Early.

Early. In fact, I will talk later, not about the case now, because we're really just in the beginnings of this case. But yeah, I think it would be applicable for Alzheimer's disease as well.

Have you seen any patients reported or.

In the literature or anywhere? No, definitely not.

But you serve as a theory.

Yes, still a theory.

And MS, what about MS?

MS, there's data on actually the opposite, right? Which is how do you induce hypothermia, right? Because in MS, it's an inflammatory disease obviously, right? Which by the way, I also believe is caused by Clostridium, but not C. Diff, where it's especially important to actually identify at that stage that this is bacterial. So, I don't know what they're- yeah.

So what, what, what- is the idea with MS, that you wouldn't want to use hyperthermia, that you wouldn't want to.

Use heat because it makes it worse? Well, because remember, when you heat up a patient with MS, what happens? They usually get worse.

So the trick is- But maybe not enough, right? Maybe it's not enough.

That's right. Maybe you haven't reached the threshold to actually, you know, use the body's fever.

Mechanisms against MS. 'Cause there's links to MS and Epstein-Barr virus and other infections. There's links to- Alzheimer's and herpes virus infections. Right.

So yes, the whole principle is applicable for all those diseases, but we don't know yet if it is applicable yet until we clinically demonstrate that.

Right.

But yeah, I think that this is going to be a treatment that's going to be very important for a lot of different diseases, Mark.

So there's this whole theory that the body has a mechanism for dealing with this and it has its own proteins that are produced in response to heat. And there are things we learned about in medical school, they're called heat shock proteins.

I learned something very important about heat shock proteins from Dr. Lesler because we remember that, you know, people looking at how to induce hypothermia, right? So there's all sorts of research, there's actually even a drug in clinic for ALS that is the mechanism of action is based upon increasing heat shock protein through a pharmaceutical medical agent. So I was at this lecture and I thought I knew everything, basically, and I learned that actually you could induce-.

Because you thought MD stood for medical deity, is that it?

Medical deity. Yes, exactly.

We all got that draining. The truth is we know close to nothing.

That's why I said at the beginning of this talk, thanks for inviting me, but I really know nothing. Just disclaimer. But anyway, so yes, actually in MS, the goal is to induce heat shock protein through hypothermia. Hypothermia.

So you get people cold.

Not people, the brain.

The brain.

Right. How do we do that?

Chill the brain.

Chill the brain.

How do you do that? Ice blocks around the head? No.

No. Well, I'll invite you up and you could see for yourself what that looks like.

All right. Dunk your head in ice water.

Nope. Nope. None of the above.

Okay, so we have to be in mystery here.

A mystery about what the device looks like you mean? Yeah. It's basically the same concept as building a hyperthermia device, except remember now the technology itself was developed basically for anesthesiologists. So this was developed at Yale by Dr. Abreu, who's the person who actually discovered a way of measuring brain temperature objectively externally. Okay, so that's kind of where this whole thing started from, to be honest with you.

You don't just stick electrode in your brain, you can literally map it out from the outside.

You can map it out from the outside. So the ability to do that now allows a clinician to not only heat the body to create hyperthermic states, but through other types of modalities to actually cool the brain safely externally in the same way. meaning that you can actually apply a small device to a region of the skin, it's periorbital location, and you can actually change the temperature of the brain through this, what's called a brain thermal tunnel. And that also creates heat shock protein 70. Old shock protein. And I didn't know that until I was in Australia.

That's amazing. So, you're hopeful about the future of neurology, it sounds like.

It's the first time I've been hopeful about anything in my life, to be honest with you.

That's a big statement.

Yes. It's true.

Yeah. Well, this is a fundamental shift in our thinking and treatment. Yes. So besides treating, for example, these ALS patients with hyperthermia, there's a whole lot of other things you do. What are the other things that seem to be effective or that are working?

That I do?

Yeah.

So I'm at the stage in my life where I, well, I shouldn't say anything political, but I realize that I can sort of, you know, I have to stay in my swim lane, meaning as a neurologist, you know, I always thought like, okay, I'm only gonna see patients with neurological problems. And I had to get my head around that that's, I'm holding myself back.

From- There is no such thing as neurology.

There really isn't, right?

We're just one human organism.

That's right. And everyone needs, this is a good motto that My friend Jennifer told me I should put everyone needs a neurologist. Would that be a good tagline?

Everyone needs a neurologist? Because everyone has a brain?

That's right.

Fair enough.

So anyway, so I started thinking about pediatric brain cancer. And I have a very dear friend of mine who I was supposed to meet today and she lost her son to pediatric, it's called DIPG, which is a brain stem glioma that's inoperable.

It's terrible.

Yeah, you can't resect out of the pons. So I started thinking about, okay, well, if we can do this for ALS, let's think about if we can do this for cancer, basically. But those are very early innings in terms of thinking out what that means.

And what happened? Did you try?

No, nothing yet. This is all theoretical at this point. I'm just sharing with you where I'm going with this.

But you take a patient with ALS. So if I, as a functional medicine doctor, would take a patient with ALS, I would look at everything. 'cause it's a disease of inflammation, it's a disease of oxidative stress, it's a disease of often challenges with the gut microbiome.

Right.

Right, so I would look at everything. Maybe heavy metals are involved, maybe there's environmental toxins that are triggering it. I rarely think it's just one thing. I would challenge you think, I think it's probably Clostridia and.

Okay.

Right?

Right.

And so what else do you do for these patients? besides thinking about this kind of innovative treatment, what are the things that you would do to help? Well, I'm still thinking about how to.

Eliminate Clostridium, to be honest with you, but orally.

Fecal transplants.

Well, fecal transplants.

Okay, so that was the- that's the thing that works. For people who are listening, the disease C. diff is a terrible infectious disease, causes diarrhea and it kills 30,000 people a year. Most antibiotics are not that effective. and even the ones that work are not really fully effective. Whereas when you do a fecal transplant, basically taking the poop out of a healthy person and putting some of this disease, it literally is like 98% effective on the first try.

My concern is that if these infections are primarily colonized bacteria, let's say C. diff, N. h. pylori, and whatever other bacteria it is, It's fecal transplant may not be the way of addressing C. diff in the ileum. Why? Because the good bacteria don't, they're not really good climbers. They're not good rock climbers. They like hanging out, you know, where they used to hanging out, right? So you put in a transplant of all this healthy bacterium, they like it. They're not going up north. They're perfectly comfortable going down south, which means that the bad guys may never get a look at the good guys in those patients. So I spoke to this with, of course, FMT surgeons because I wanted to ask them this question. So there's a lot of data for FMT being looked at right now using oral FMT, basically.

Poop pills.

Poop pills, right. And so I asked the question that a good immunologist would ask them, which is, okay, how do we know if you put a good guy in a bad neighborhood, you got it, right? And you know what the answer was? That we've seen exacerbations in our studies of patients with ulcerative colitis when we've tried that.

With autoimmune diseases. That's right.

So in other words, this is complicated stuff. It's very complicated.

So yeah, I remember I had a patient with MS once years ago and she reported to me, you know, and I think as a doctor your job is to listen carefully. not to come in with a bunch of preconceived ideas about what you learned in medical school, it's true or not true, because often it's not true. And this patient had an incredible exacerbation or worsening of her MS symptoms whenever her gut started to becoming wacky. She started bloating, getting distended, was uncomfortable, and then her MS symptoms would get worse. And I was like, oh, this is not a coincidence. This is important data.

Exactly.

And I knew if I treat her gut, I treat her gut and her MS got better. Like I didn't know what I was doing at the time. I just like, well, I know how to make people's gut healthy. You're an empirical doctor, right? So I'm like, well, let's try this because it's not gonna hurt you and.

It could help you.

So let's see what happens. And it's so striking when you start to apply these foundational principles of restoration of health and balance in the system, all sorts of things get better. Yep. And in a way, you're resetting the equilibrium through things like hyperthermia and these other treatments, right?

Right.

Because at that stage, look-- But you use diet, use supplements, use other lifestyle factors, exercise, sleep. Like what else do you do as.

A neurologist when you see these complicated patients who have all these diseases? I have a mentor who's now teaching me that. So, because quite frankly, I'm in sort of that model of kill the disease, find the magic bullet, And we're done, right? But I understand a lot of what should be done. I can tell you the thing that I'm most interested in as far as neuro protection. If you said to me that there's one molecule that you could be king of metagenics or king of whatever that you would promote.

Okay, listen up. This is important, guys. The one molecule.

The one molecule.

Save your life.

Well, no, let's not say that either, because I'd be sort of in the magic bullet frame.

Of course.

But it's torodeoxycholic acid.

Well, that's a big word. What is that stuff? And you buy it at GNC or?

I don't know. Probably after this podcast, I'm sure we will. Not with my label on it, by the way. But yeah, so Tudca is actually something that Rutanze is studying for ALS. So let's give credit where credit's due. And what Tudca is secondary bile acid.

Yeah.

Right.

So bile acids are the things that help you digest fat but they also where all the toxins come out of your body through your liver, right?

Exactly. And the other.

So this is helping you eliminate toxins?

100%. And the other fancy part of the secondary bile acid is that it's attached to taurine, which is my favorite amino acid in neurology. Whenever I give IFM talks, they say, what's your top supplement that you recommend? It's always taurine.

Which is very relaxing for the brain, calms it down, right?

Well, it affects aquaporin receptors, right, which affects sleep. Sleep hygiene is something that I do educate patients on. So, I don't want to think that people, I'm not totally holistic, 'cause I am, you know. What about food, too? Food, too? Yeah, I think food is- Bagel Nox. Bagel Nox. Only in my own diet. I don't remember there's any patient, trust me. no, no, what are we talking about here? No, I think that the ketogenic diet is a very important augmentation strategy for patients with neurodegenerative diseases 100%. So have you used it in patients with these diseases? No, because don't forget, I've only been in practice now for, you know, I only have like four patients at this stage of my life.

What do you mean?

Weren't you a practicing neurologist forever? I was, but you know, I left and I, you know, I did other things in my life basically, you know, genamin and things like that. So I'm back, clinically really only the last year. So I feel like a student again, which is kind of cool, right? To be like a student.

But you take very difficult cases.

I only take the most difficult cases. If you have like your- you-'re like.

The Sherlock Holmes of neurology.

Right, and yeah, my assistant decided on a Sherlock Holmes icon for my website, but yeah, you like that too?

Yeah.

You do? Okay.

What about Dr. Watson?

Dr. Watson. Okay, I like that too.

Oh, sure, wasn't this side- oh, Watson was a sidekick?

Yeah. So called the Watson Clinics.

People think I discovered DNA.

It's perfect.

Or what's on? The Watson Clinics. That's great. So I think that we're in a.

Real new era in neurology. And truthfully, I don't want to be sort of, you know, making light of this conversation. As a neurologist, look, I, you know, I chose the wrong profession, to be honest with you, because I'm a very sensitive person. I take every person's problems to heart. Too much so, where I've become depressed when people die with these diseases. And that's a depressing place to be because I'm blaming myself. It's not my fault that they're dying, right? But I still blame myself. I couldn't fix them. I couldn't fix them, correct. And so when you say, are you happy now? I am more than happy, meaning that I finally feel like I have tools to treat patients with with these kinds of diseases that will die without treatments basically. So I'm very, very optimistic for patients that have these diseases, especially not that I don't think they're applicable for all stages of these diseases, because I think it's much, much more difficult to reverse a patient with end-stage Alzheimer's. It's almost like, you know, it's like, I'm sorry.

If someone needs a new heart, if their heart's all damaged from a heart attack, it's hard to to fix that, yeah.

That's right. But I'm very optimistic, both about Dale's work on sort of understanding the risk factors and how to intervene before disease, and also what we can do once patients have onset of those diseases as well.

So.

In these conditions, there is a way forward. And the hyperthermia concept is fascinating. How far are we from actually being able to do that in America? It's happening in Europe, it's happening in Mexico at scale. What are the obstacles and opportunities that are ahead in using hyperthermia and neurology and other conditions in America?

Well, I think the obstacles, in my opinion, are to establish clinical validity for these conditions.

Like, are we doing research on it? Is it happening in America?

Research is happening. Yes.

And doctors and scientists are starting to look at this.

Yes.

So how far are we from actually seeing this in the news or as a treatment in America?

Very close.

Very close. So if you're listening and you know someone with ALS or you know someone with MS or Alzheimer's or Parkinson's, there is hope is what you're saying.

100%.

Yeah.

And in functional medicine, we do make a lot of progress, but I think There are things we just don't know. And I think this whole connection between the inflammatory pathways, the microbiome and the brain is this uncharted territory that we're now exploring. And there are a lot of ways to intervene, including the idea of hyperthermia, there's other therapies, poop pills maybe. But, you know, we have a whole new way of thinking about these conditions.

And we always have to, right? Medicine has to be iterative, can't be static.

So let's back up a little bit because I don't think people really understand how you get a leaky brain and what that is and how does that connect to a leaky gut and what are those things?

Right. I was having that conversation earlier today, by the way, so I'm very fresh up on this concept. So leaky gut is both a cause and a consequence of dysbiosis, right?

Which is?

The SIBO, which is small intestinal bacterial overgrowth, which is full of bad bacteria that are looking to make things worse, not only in the gut but also in the bloodstream.

So, dysbiosis is basically your happy garden in your gut has been taken over by weeds. Exactly.

Causing havoc.

That's right. And those weeds- and it's crowding out.

The good stuff and causing all kinds of problems. Right. And those weeds want to grow. And guess what prevents them from growing.

Is the mucosal barrier.

Right?

So like, okay, well-- that's the lining in your gut.

Right. So they basically release, you know, certain protease enzymes that break down the proteins in our gut so they can actually go into other places looking for their food or if it's a weed analogy to grow beyond just the gut.

The little Pac-Man, they're gonna chew up-- They're chewing up the intestines.

All the intestinal lining so they can.

Sneak through and get into the rest of the body. That's right. That's right. And that doesn't, you know, when you.

Got bacteria and nasty proteins in your blood, your body doesn't like that. That's right.

It creates what?

Well, it produces inflammation, but it also produces disease.

Yeah.

And I'll tell you an interesting story.

Which is secondary to the inflammation.

Right, right. So one of my interesting stories about ALS is that they asked me, they said, this is like a really crazy hypothesis, right? That somehow claustidium is causing ALS. I said, I realize it's crazy right now, but but it won't be crazy for long.

Well, it's like that guy, Dr. Barry from Australia, who decided that H. Pylori.

Was the cause of ulcers. And I was advised to do the exact same thing. I was like, I'm sorry, I'm not eating, you know, Proton Pump Inhibitors to get ALS. I'm not that desperate to show that this is the right thing.

Howitzer, he did that for H. Pylori. I'm sure he would say, Do not do that. But people thought he was crazy because they were like, oh, this bacteria was around, like just like it's around in Alzheimer's, ALS and people thought, oh, it's just a secondary thing. It's not the real thing. So they kind of ignored it and they laughed at him when he said, just these bacteria are causing ulcers.

Right.

And he won the Nobel Prize.

Not only that, I'm going to prove it to you by drinking a speaker of these bacteria, getting an ulcer, curing on the antibiotic.

And yeah, you're right. For that he won the Nobel Prize. See, I'm afraid that they won't give me a Nobel Prize unless I do it for myself. Okay, here's C. diff. Okay, I'll skip that. Can we speed up Alzheimer's, you know, whatever else? and then I'll prove it's in my bloodstream or through CSF, whatever biomarker you need to know that I'm infected.

No thank you. No, thank you. That's a little too risky, yeah.

That's right. But you can do it in animal models, you can do it in other. So, well, there are animal models that actually show this. So I think that's already been established as well, that there are animal models that if you give them bacterial infections that you can recapitulate or reproduce, if you will, the pathological changes that occur, in neurodegenerative diseases. So that's already there.

How does that connect to the leaky brain?

Right, okay.

So let me tell you a little bit. This was like in medical school, this was like, this is an inviolable barrier. Like nothing gets through except nutrients, the blood-brain barrier.

Yeah, right. Okay. You've got a wall between, you know. So what people need to understand, actually when I lectured at IFM, I always talk about this to the practitioners, is that leaky gut and leaky brain are synonymous. They're basically the same anatomical structures that exist both in the brain. You know, it's endothelial cells that, you know. It's barriers. It's a barrier, right? And the barrier has exactly the same types of glial cells that regulate what's going in or not. They're sort of the.

Gatekeepers.

The security guards, right? Saying, hey, bad bacteria, don't go in here. So what happens is the bacteria actually are smarter than us. quite frankly, meaning that I'll tell you how much smarter they are than us by an anecdote, which is that one of my patients who I presented this theory to said, if you think that this bacteria is causing ALS, why don't you call the CDC? I said, good idea. So I got a call. Right. She didn't know that I would actually call when she was in the office, right? But I did. I called the CDC. I said, yeah, right, great. Yeah, call the CDC. Okay, no problem. Ding, ding, ding, ding, ding. So I end up speaking to someone there. And he was very respectful. He said to me, I'm gonna take this back to my working group, and I'll let you know what they think of your insane hypothesis that C. diff is causing ALS. I said, okay, great. Give me a call back whenever you feel like it. There's no time, for me it's like-.

And did he call you?

He called me back, and this is what he said. He said that the group doesn't feel that C. diff has enough evidence of it being anything other than an enteral pathogen. I said, Really?

That means it only affects your gut.

Only affects the gut.

Use all these big words. I keep having to translate. Sorry, that's right.

But I said, it only belongs in the gut.

Yeah.

I said, well, how about other Clostridium species? Do you think those are only enteral pathogens? And he said, no. I said, well, guess what? Neither is C. diff. It's not only an enteral pathogen. And the way that it becomes, the way that it moves from the gut into the bloodstream is through leaky gut. I said, have you seen the leaky gut data? I never heard of leaky gut data. I'm like, okay, so let me ask you one last question before I hang up this phone. I said, do you not believe that other enteral pathogens, like E. Coli, can produce meningitis? Of course they can. I go, well, you're just contradicting yourself. You're saying that an enteral pathogen can't produce meningitis, And the same breath you're saying, oh, but of course E. Coli is an enteropathogen that produces meningitis. Which way do you, you're at the CDC, man.

Right.

I'm not, I'm just some crazy neurologist.

Come on, answer that question. And of course, that was the last time they took any of my phone calls.

True.

Well, don't confuse me with the facts, right? They, yes. It's tough. Paradigms are tough to break. They're very much so. And you spent, you know, billions of dollars in decades building up paradigm, which turns out to be really false. The paradigm of medicine today, which is siloed, it's segregated, it's not understanding those interconnections. And I think we're in this convergence right now, which is super exciting, which is the tremendous amount of understanding we're having about systems biology and what we call network medicine, which I also call functional medicine, the emergency of our understanding of the omics revolution, right? the genomics, the metabolomics, the proteomics, and the microbiome, which is blowing a lid off all of our conception of disease, artificial intelligence, which enables us to gather all that data, we call big data, and crunch it in ways that make sense of it where we can't even see. I mean, the average doctor, you look at your blood work, you got 20, 30 other things you look at, fine. What if I gave you a million data points to look at? Oh, forget it. The doctor is not gonna be able to do it, but a computer can do it. and then you get quantified self metrics where you can measure things that the body's doing, and you put all that together and it's changing the way we're going to be practicing medicine going forward. And we're going to be able to sort of make much more rapid evolution of understanding of things like what you're talking about.

Well, I agree except that I think AI is double-edged sword because my concern with AI is that if doctor, let's say AI comes up with the ideal formula for treating every disease, let's say. It's an AI.

You need AI too.

Thank you.

Human intelligence.

We need human intelligence.

A filter. It just gives you stuff to think about, and then you have to make your decision.

Thank you.

I 100% agree. We don't want computers treating us, but we do want them to help crunch the data and look at patterns that otherwise we can't see. All you're talking about is that you've noticed a pattern in the literature that connects bacteria to neurodegenerative disease and ALS. And then you're following that trail, and you noticed it, but a computer might be able to notice it a lot faster than you just had the luck of the insight. But the truth is that we can actually start to use computers to start to look at all this data, map it out, read every study, connect the dots in ways that we just can't.

You're saying AI may help me confirm that C. Diff's the root of all these diseases.

Absolutely. who do I call? Ghostbusters.

Watson, with Cole Watson.

So this is really an amazing moment in, in medicine where scientists and doctors like you are starting to connect the dots about diseases that were really hopeless and for which we felt helpless and now are hopeful. So thank you.

Thank you.

So thank you. You're listening to the doctor's Pharmacy. This is Dr. Mark Hyman. And we've been with Dr. Jay Lombard. You can learn more more about his work at drjlombard.com, that's D-R-J-L-O-M-B-A-R-D.com, you can learn about his practice in Tarrytown, New York, which I certainly would see him if I had a neurological problem, and you can also get his book, which is called the Mind of God: Neuroscience, Faith, and Search for the Soul, which we didn't have too much time to talk about, but it's a fantastic book that maps out the connections between purpose and meaning and health which we now know is actually scientifically driving healthy disease. In fact, there was an article a couple of weeks ago in the Journal of the American Medical Association that said if you had more purpose in your.

Life, you live longer. Who knew?

Purpose is life. Yes, purpose is life. So thank you. You've been listening to Dr. Pharmacy. If you love this podcast, we'd love to have you leave a comment and hear from you. We would also love you to share it on Facebook and social media, Instagram with your friends and family. and if you subscribe to podcast, please subscribe to your this podcast and listen every week. And we'll see you next week on the doctor's pharmacy.

Hi, everyone. It's Dr. Mark Hyman. So two quick things. Number one, thanks so much for listening to this week's podcast. It really means a lot to me. If you love the podcast, I'd really appreciate you sharing with your friends and family. Second, I want to tell you about a brand new newsletter I started called Mark's Picks. Every week, I'm going to send out a list of a few things that I've been using to take my own.

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