Dr. Sidney M. Baker, MD on Learning About Disease by Traveling the World

Hi, welcome to the Doctor's Pharmacy. That's F-A-R-M-A-C-Y. And I'm Dr. Mark Hyman. I'm really thrilled to be here today with one of my mentors and one of the most incredible thought leaders in medicine today who's pretty much the unsung hero of the transformation of healthcare and you're gonna learn why. This is Dr. Sidney Baker. He graduated Yale Medical School and he was a former assistant professor of medical computer sciences back when A five megabyte computer weighed about 4,000 pounds in the 60s. He was a Peace Corps volunteer and learned a lot from his time in Africa. He's a family doctor, a pediatrician. He was the Gisele Medical Institute director and the founder of Defeat Autism Now, which is really a new way of thinking about how we get to the root cause of autism. So stay tuned. That conversation is coming up next on the Doctors Pharmacy. I'm just honored to have you here today with us, Dr. Baker.

Well, thank you, Mark. It's an honor and a pleasure to be with my dear friend here talking about stuff that we believe in.

So I have to really let people know, full disclosure, that it's really because, in large part, because of you that I do what I do and that I've succeeded in what I do. because when I was a young whippersnapper doctor who didn't know anything, I heard about you, I heard your lecture, and I called you up out of the blue and I said, Can I come please sit at your feet and learn from you? And you're like, Sure, come on down. So I drove down to Connecticut in southern Connecticut and I sat in your office and watched patient after patient come through and I watched how you were with them. I watched how you thought about disease. I watched how you synthesize information, how you track your data, how you really were very systematic in thinking that I'd never seen before in a doctor. And I just was sort of blown away by it. And over the years, you have been, I don't know, you know, people would agree with me, but I certainly think you're kind of the Einstein of medicine because you've distilled some of the most difficult, challenging, complex ideas into simple principles, sort of like the E equals MC squared. Simple concepts like in order to get healthy, you need to get rid of the bad stuff and get the good stuff, you know, put in the good stuff. I use that every day in my practice. You've talked about how we label diseases. We name diseases, and then we think that's the cause of the disease and have completely kind of got swallowed up by this taxonomy of diagnoses, which has nothing to do with the actual disease. That it's not a that we get like a cold, but it's very different. And that's huge. You talked about the TAC rules, which is an important concept I use every day. And if you're standing on a TAC, it takes a lot of aspirin to make it feel better. If you've got migraine headaches, you can take migraine pills all day, but if you're eating gluten or you have a mitochondrial issue or your gut microbiome is off, it's causing your migraines, you're not gonna get better by just taking migraine medicine. So these are fundamental concepts in functional medicine. And I wanted to start off by asking you, how do you come up with these beautiful, simple, elegant ways of thinking that changed everything about what we believed about disease and health.

It's hard to say how I come up with it. I must say it's just simple-mindedness, really. I think that I started with a very simple principle from the first doctor that I studied with, so to speak. He was a guy who was working in a mission hospital in Kathmandu, Nepal. And I fetched up there because of the directions of two old ladies I met in Indonesia who wondered why I was sitting there with a Chinese guy who was my history of art professor at Yale. We were going around the world studying history of art. And they came over to the table and said, young man, what are you doing here? Of course, in Indonesia at that time, Americans were not popular and neither were Chinese people. So it's a young American with a Chinese guy was kind of, and they were China missionaries who were coming around the world the other direction. They've been thrown out of China. And then I said, well, I want to be a doctor. And then when I said, what do I want to be when I grow up, which is a popular question for old ladies. And then I said, I want to be a doctor. I said, you know what you should do? You should go see Dr. Miller in Kathmandu. But okay, I didn't know what I was gonna do after finishing this nine month of studying history of art with Nelson Wu, who was a Chinese born professor at Yale, who was on a Fulbright scholarship. And I ended up going up to Nepal and knocking on the door. And the ladies at the mission hospital said, well, we don't want you here. But then he finally came back to town after I sat around for a few days. And o I'd love to have you and hang out with me So we would see patients together in these little little one room clinics in the Vlley of Kamandu, seeing beautiful Nepalese people. this was nineteen fifty nine, so a long time ago Napo had just opened up to the outside world. Before then before a hippy tyraate,body could go there, but we were just in the first couple of years of that, and during the same year the Tibetans began coming over the mountains because they were having trouble with China. And Edgar was a retired cardiologist from Wilmington, Delaware, with his wife who had decided that after being in practice till age 65, it was time for them to go and do something that they always wanted to do. And that was to go out and do something out in the world, which was for the good of the world.

Yeah.

And so they ended up in this missionary hospital. They were Methodists, devout, but they were accepting of my sort of more liberal inclinations. And so he said, yeah, sure, come along. But we saw all sorts of what medical students would call pathology, sick people, one after another, with things that were- Pretty serious diseases. Common in a country which was quite excluded from the rest of the world and yet had soldiers from the Gurkhas who were enrolled in the British Army for generations. So they brought a lot of sort of nasty things back to Nepal. And so there were a lot of sort of what you call interesting diseases if you're a medical student. And he would turn to me after each patient and say, Sydney, have we done everything we can for this patient? And he said it in a repeated way, but it wasn't spooky that he said it over and over again. It sort of went with the rhythm of things. So when I went to medical school, this was now between my junior and senior years at Yale, and when I went home, I finished my senior year, and then I went to medical school. And medical school, they said, have we done everything we can for this?

Disease.

Disease. Right. At an early stage in my education, I found myself on the fork in the road that says that the patient is the target of treatment. And then it turns out that patients are all individual. And whereas diseases are kind of groups and really not things anyway, they're just ideas.

Let me just stop you there for a minute. That is a very big statement that diseases aren't things, they're just ideas we have about things.

Exactly.

And this is what's gotten us into trouble in medicine. We say someone has autism or rheumatoid arthritis or diabetes, but the truth is that those aren't all uniform and there are many different causes for those same diseases in different people. In fact, if we don't have the right map, we can't figure out how to fix it. And you have been the map maker in functional medicine helping us navigate.

Well, the point is that that the giving of a diagnosis makes the doctor look good. Like, I know what you've got. Well, that's what we're trained to do.

We're trained to basically make a diagnosis and not think about the why, but just what disease people have.

And if it's sprained ankle or a strep throat, I've got no argument about that. That's fine. That's acute disease. But we have not in a generation when chronic illness has become the main burden of people these days.

One out of every two Americans.

We haven't shifted our language out of the acute illness model. Like, I know what you've got, it's a sprained ankle, I know how to fix that, or nature will fix it for you if we put a bandage on it, to one in which I know what you've got, it's autism. And then the parents who are already in a pretty anxious state about what's wrong with their child who can't talk and can't behave, and they think, oh God, I'm so glad you know what it is. And then they think, well, but what do we do about it? Well, and it depends on the doctor, but in the way I was educated, the doctor basically says, we don't know. For a generation, the doctor would say, well, it's his mother's fault.

Right.

But fortunately, I I wasn't caught in that generation, although I was educated that way.

Yeah, I'm sure you were.

At Yale in 19... Refrigerator mothers. Refrigerator and they showed a movie to the medical students in my second year of medical school in the psychiatry department of a dignified doctor sitting behind the big mahogany desk with the parents sitting over there in lower chairs. And the kid was out of the room and the doctor said, well, George and Mary, I'm sorry to tell you that your child has autism and there's nothing to do about it. And so don't look for answers. Actually, those were the words in this video. Don't look for answers. This is for training medical students how to talk to them. Parents who has a chronic illness. Don't look for answers. And of course, that was a little bit better than it's the mother's fault. because she's something cold mother, that was the way they were taught before then. But it shows you how completely off base. But then look what has evolved since then, when we began to look at autism in, say, 25 years ago, more carefully, because seeing now a larger and larger number of children- From 1 in.

5,000 to 1 in 68. Yeah, almost 1 in 4 boys.

And as the, The numbers built up, there was a lot of denial about it not bringing a real increase. It was, oh, just we're recognizing them better. It's all kinds of hiding places where experts went and hid themselves from the reality that this was a real epidemic. So then along came the word spectrum. And of course, it turns out to be a very important word in medicine because as it happens, you and I agree that all illnesses our spectrum.

Absolutely.

But autism was the first illness to wear that in popular language as a garment to come to the party with, I'm in a spectrum. Meaning there's a large range of different kinds of manifestations of it from one end of the spectrum to the other. And then at that point, instead of, and then of course the relief that parents felt very transiently with like, I'm glad you have the diagnosis. We didn't know what we thought he was retarded. We didn't know what it was. Now it's autism. But then it changed to, well he's in a spectrum. Now the doctor feels better because the doctor is kind of off the hook in terms of the specificity of it. But now the parents feel lost because there's this Broad range of- Can he.

Move on the spectrum?

What does that mean? And but because the doctor has lost the kind of pretension of specificity and like, I know what the deal is.

Yeah.

It's like, well, it's a spectrum. And then that is incapacitating to the parents. Like, what do we do about that? And then, of course, there were very wide differences of opinion and still are.

Yeah.

So-Called experts in regard to how to think about this particular child who has this particular label.

Yeah. Well, it's interesting, you know, you talk about, you know, the diagnosis and, and in autism, you know, there's certain characteristic features like lack of social connection, interaction, repetitive behaviors, language challenges. And we go, oh, you have these characteristics. That means you have autism. But that doesn't tell you the cause of the autism, it just tells you the name of the autism, the name of the disease, which doesn't help you to figure out what's going on. And we're at the annual conference of the Institute for Functional Medicine, and this morning, Dr. Alessio Fasano got up and who's a Harvard professor, one of the world's leading researchers in gluten and autoimmunity, got up in front of 1,500 physicians and healthcare providers and said, we did a study with fecal transplants in autistic kids, and we saw Not only did their GI symptoms get better and their gut get better, but there was persistent behavioral improvements by changing the poop in these kids. Now, that totally kind of turns our idea of autism upside down from being a brain problem to being a systemic problem that affects the brain.

Exactly. And as you can imagine in that connection, the doctors who had a specialty such as child psychiatry or psychology, which is kind of the first places where children with these developmental problems would end up is referring to doctors with those kinds of training. Those are generally doctors who are not very friendly with poop.

Yeah, well they're working on the brain, they're psychiatrists or they're psychologists.

But as a matter of taste, We're.

Looking at the wrong end of the business.

They're not supposed to talk about poop. In fact, my best friend is a psychologist and we were talking about one of his difficult patients and I said, well, is he constipated? He said, well, I don't know. I don't ask my patients such things. I thought, Randy, that's crazy.

Well, I remember sitting in your office over 20 years ago and you asking every parent about their child's poop and it was fascinating to hear their results of that question, which was, well, it's different. Autistic kids have different poop. They're sticky, they're smelly, they're strange, they're pasty, and they're very different than everybody else's poop.

How could that not be relevant to what's happening? Absolutely. Absolutely. I should just take a little diversion in terms of the first questions to ask to explore with the parents, the people that we're talking about. And this is true of all patients, no matter what's wrong with them. is that the first thing that we want to know is what are your strengths? You go to the doctor's office, whether you're a fancy lawyer and getting millions of dollars for your work and being brilliant in New York City, and you go to the doctor's and you're wearing this Johnny coat and all the things that are wrong with you that the doctor wants to know about. Now, the lawyer can maybe that for parents of a child, the important thing to begin with, the first question is, what are his strengths? So in my questionnaire, I want to know up top all the different, and then you check off the different strengths. And it turns out the kid has lots of strengths, and some of them have extraordinary strengths. I mean, really, strengths of a genius, but which are a little bit hidden in a child who can't talk very well. So when I see children who come to my office, I happen to have an office which is in my house, which is that people seem to be accepting of that. But I have a swing outside, one of these rope swings, a seat that's very comfortable and wooden edge, and child can sit there, feel very secure, and I get him a gentle push and then a little bit bigger push and a little bit bigger push. Now I can see the parents' faces because they're facing the child and he's facing them. And then pretty soon I see the parents' faces smile and I know the child is smiling. This swing is pretty cool because this is on a 50-foot rope. So you can visit a nearby planet. And so I get it really going and this child is now in feeling wonderful and doing a great job. And then when he gets down and is ready to come to go to the office, then I said, Charlie, you are great with a swing. You're a terrific swinger. So he gets to hear something good about himself. He has been to doctors' offices where he listens to conversations about all sorts of things he can't do. And so this is all about healing. And healing comes from the strengths that our bodies have. and you can stimulate it a little bit just about talking about the strengths and make him feel like, yeah, I'm not such a loser. And so before we get to the poops, we have to begin with that. But you're right, when we began to see, when I began to see a lot of children with autism, and I felt quite overwhelmed because it was foreign territory to me. The first, my first experience with a child in the so-called spectrum was when I was a consultant for a sort of institutional setting. People were, you know, stayed there all the time for people near New Haven. And I had to do an annual physical on a young man who the nurse told me he was autistic and I'd never met a kid with autism before.

Even as a pediatrician?

Yeah, even my pediatric training, it was so rare in those days. It was rare. In fact, in the psychiatry department, they say, well, this is what autism is all about. But you'll never see one. Yeah. But there I was, and I was supposed to do an annual physical, and I must have been a little bit nervous about, well, he's autistic, what does that mean? And I didn't take off my glasses, which I always do when I look through the ophthalmoscope, you know, to look in their eye. And so I put my hand on the back of his head as I do to sort of get the contact right. And he hauled off and he stalked me right in the middle of my forehead. My eyeglasses went in two pieces onto the floor. And I thought, my God, what accuracy. This was the most scientifically thrown blow to the head that you could imagine. And in thinking about it later, I thought, well, He was sending me a message, nonverbal message, like, Dr. Baker, you're looking into me, but you're not seeing me. I mean, he was a nonverbal kid, about 14 years old, and he sent me a message that was really important in my development as a doctor because I had to stop and think, wow, what is this all about? It's not that he's unskilled. He's in fact ready for the ring. and yet he rang my bell and made me think, well, this is something I should learn more about.

So, you have this quality, which is very rare, which most, most doctors see what they believe. They don't believe what they see. And, you know, some people see things and, and actually don't ask the questions about what's going on underneath it, and that's really an extraordinary talent that has allowed so many of us, like me and others in functional medicine, to actually be able to sort of incorporate these ideas into our practice.

Well, thank you.

It is- It's like that quote, you know, you see what everybody else has seen, but think what nobody else has thought. Yes. And that's an amazing quality.

Well, some of the thoughts can be quite simple, but some of the guidance that I have gotten has all been from my patients, my the stories that people tell me. We live in a world where we have meetings like this and people talk about double-blind, placebo-controlled scientific studies to prove this or that. But really, most of us have learned what we know from stories.

From our patients. And.

When I left my full-time faculty job at the Yale Medical School, kept my appointment in medical computer sciences, but I was a part-time. But it went out to be a real doctor because that's what I figured I was quite good at. And I had a patient who was a serious guy, a regular businessman, they wanted a family doctor and I was the appointed family doctor for this health care plan. And and so I was going through a history with him, you know, have you had any operations or illnesses or allergies? And he said, yo, I have an allergy. I said, what is it? Egg. I said, oh, really? So I wrote down egg allergy. And then we had pretty much time at that point in this beginning of this health plan to stop and chat a bit. I said, well, what happens if you eat eggs? He says, well, supposing I go to a dinner at somebody's house and I tell the cook, the lady or gentleman, whoever is making dinner, I can't have any egg at all. I'm very allergic to it. But it happens that the cook stirs something, a pot on the stove that has a little egg in it, and then uses the same fork to stir something else. And he has a taste of that when he's at the dinner table, and a few minutes later he ends up on the with violent vomiting and diarrhea and basically out of it. And I thought to myself, holy, you know what? This is amazing. This is a real guy and he's telling me a real story. There's no doubt about it. And I think, well, what if there are other people out there who are so sensitive to eggs but it doesn't quite produce the spectacular symptom that allowed him pretty soon in life to figure out what was the connection between what I just ate and where I am on the floor here. And so I thought, well, there must be people out there with sensitivities to things that are hidden. And that gave me the idea that if somebody is chronically ill, maybe there's something that they need to avoid. And if they did, then nature would do the healing.

Yeah. And a novel concept.

And because I thought, well, this is pretty rare. This doesn't happen very often. But it turns out it's almost always the case in people with chronic illness. To be able to spot what it is that they're sensitive to.

It can be many things, right? It can be toxins, allergens, microbes, Gut bacteria, stress, diet.

It's a long list, but really, when it comes right down to it, it's not that difficult to even scope it out by having a conversation with somebody about, well, when does it happen and how often and get to be a little detective. Yeah, I mean, there are fancy blood tests and skin tests and things for all that, and I've done all those things, but really, an intelligent conversation is a good place to start.

What an idea, talk to people.

Yeah, and get them to think about it in these terms. and because a lot of people have sensitivities and haven't really thought that this could be from something they're eating or they're exposed to or the paint that they just. I mean, this is still not really accepted in medicine that there are things.

That are disturbing us that we need to avoid to feel better. And particularly food. I mean, we know if you have celiac, you should avoid gluten. If you have lactose intolerance, you should avoid lactose. But for the most part, most Physicians don't consider food as a trigger for.

Illness, and yet it's probably the biggest trigger. It really would, it put me at odds with my Yale colleagues. They didn't want to talk about this. They said, well, send them to the allergy clinic. You know, that was, and then the allergy clinic, they didn't really believe in food allergy. So, but, so now there's another patient, a lovely woman from Cape Verde Islands with two kids. She joined the health care plan where I'm working because now she has insurance and she can see a doctor. and she has the worst migraine headaches in the world. She's just, every monthly cycle, she's crippled with a migraine headache. And I think I'm being brilliant to say, well, this is a migraine headache because it causes this wicked, one-sided special kind of pain. Migraine's not the cause of the pain.

It'S the name of the pain.

Right, exactly. But I thought at that point, wow, you know, I know the name of it's Martin Me. So I said, Dan, what you should do is go see the neurologist. So she goes to see the neurologist and he says, yeah, you have a migraine. And they gave her migraine medicine and made her sick. and everything in those days there were only a handful of migraine medicines and they all made her sick. So time went by and she came back to me and she said, well, I figured it out. And I said, what happened? She said, well, I went to see the chiropractor. And in those days, no longer.

Chiropractors.

But in those days, a Yale graduate would have thought a chiropractor was the devil's work. But of course now I admire my chiropractic friends and colleagues tremendously. And the chiropractor tested her and said, you should take magnesium and vitamin B6. And she did. And the migraines went away like that. And I was educated.

Yeah, you're kind of the father of magnesium. I remember I learned that from you.

So then I would tell my friends at Yale, smart obviously. And I say, you know, I have this patient who has this wicked migraine and this happened and that happened. It turned out that she took magnesium and vitamin B6 and the migraines went away. Do you mean to tell me that you think that migraines are caused by not having enough magnesium and B6? I said, no, I'm talking about this woman had this problem. This one individual had this relationship with magnesium and B6. But there must be other people sort of like that, and of course there are, there's a big story about B6. But my colleagues were so hard on me because I had a label for it and they knew what that label meant.

This is just so classic for how we think about disease that we just get so stuck on it and we can't believe that something simple like magnesium makes a difference and it's really thinking that's different and challenging the paradigm. I mean, now, you know, we know that. I mean, I remember learning that from you, how important magnesium was for anything that twitches or spasms. That's what you taught me. Exactly. And so, whether it's constipation or muscle cramps or headaches or palpitations or anxiety or insomnia, anything that's sort of irritable or twitchy, and I had this one woman who was a radiation oncology resident at Mayo Clinic, and she had the most treatment resistant migraines. the only thing that would barely touch it is she took OxyContin and Zofran, which are narcotics and anti-nausea medication. She would go into the bathroom and throw up and try to get through it, and she barely could function. And she came to see me, and I said, well, why don't you. We talked about it. She had anxiety. She had constipation. She had a palpitation. She had all the other magnesium. Soon I said, why don't you try magnesium? She needed, like, 2, 000 milligrams of magnesium. And then her migraines completely went away. Her constipation went away, and then over time, she needed less. less. But, you know, it was, it's such a simple thing, but, you know, it doesn't mean that every patient with migraines has a magnesium problem. It's that patient. Exactly. And you're sort of the original gangster OG guy on personalized medicine, which now is the in thing. But you were thinking that way way.

Before anybody even was talking about it. Yeah, but where did I learn it? I learned it from listening to my patients. You know, it's these stories that taught me a lesson that was, which is enduring. And now, as far as magnesium is concerned, while we're on that subject, the incidence, the prevalence of unmet needs for magnesium, to put it, you know, it's fancy talk, but unmet need is a little bit different from deficiency. Yeah. Because the needs are different in different people.

Sure.

So unmet needs for magnesium, which gives this picture of being uptight, either muscular tightness or mental tightness, like anxiety, anxiety or muscle cramps or as you say, just now, constipation. And so if somebody's constipated and they're going taking all these things from the drugstore to poop, the idea is to get some magnesium citrate and take it in increasing doses until you're pooping good, maybe a little too much and then back off until you're having two good poops a day and then see what happens to the rest of your stuff. but the prevalence of unmet needs for magnesium in the population that we take care of is enormous.

In a normal blood test, don't help us that much.

And that's the thing, that doctors don't know about it because there's no way to test it. The only way to test it is to get a 24-hour urine and see how much magnesium is coming out, and without changing your diet or supplements at all, you take another 24-hour urine. after giving a big shot of magnesium in each butt. And then you see how much magnesium is retained by the person. So it's a magnesium loading test. Well, you can't do that in kids.

No. And- if magnesium doesn't come out, it means you're deficient 'cause your body's holding onto it.

Yeah, and when I started doing these tests, which I was, you know, taught to do this by Herman Baker, who was a professor medicine at New Jersey State Medical School, it was called in those days. And people who would retain 100% of the magnesium that you gave them, like their body is saying, wow, I really needed that. But if you just took a whole bunch of people who were walking around and you measured their magnesium retention as a measure of how much they needed it. Most of them will be abnormal.

So why are we all so deficient in magnesium?

Because we don't get enough in our diet.

Which comes from?

Because magnesium comes from all different foods, but it all comes from natural foods, not purified foods. So sugar, of course, is the main culprit here. And so once you get behind on magnesium, the behind her you get, the more behind you get. So the losers end up to be disadvantaged. So we have a decision disadvantage. Yeah, yeah, yeah.

Beans and nuts and seeds. And then, you know, we do things like caffeine and alcohol and sugar and processed foods and stress, all of which deplete magnesium. Yeah.

And then the magnesium expresses itself, as you said a few minutes ago, in all of these different symptoms of being uptight. everything from high blood pressure to high tension in your brain to all kinds of heart heartbeat things and cold hands and feet and menstrual cramps and you know all kinds of different things.

Cramps or twitches or spasms or whatever is pretty much magnesium.

And if you deal with that then bingo you get a lot of- you-.

Look like a genius.

Feedback. Yeah. And I thought that you know getting a prescription pad was a big deal when I got out of medical school. Oh boy my signature will conquer the world. but really most of the things that are effective are natural things. But so in this experience with the woman from Cape Verde Islands and for the guy who is the businessman, what I had was a situation where I began to realize, well, there's these two questions that you refer to. Does this person, we're talking about the person, not the disease, does this person have an unmet special because everybody's different, unmet special need to get something which, if supplied, would favor nature's buoyant impulse toward healing.

What are the raw materials for healing?

Yeah. So, and many people in current culture have special unmet needs. And there's not too many things on that list. So it's not rocket science. Magnesium is way up there. There's certain vitamins too. So that's one of them. And then the other question is, does this person have a special unmet need to get rid of or stay away from something that, if taken care of, would favor nature's impulse toward healing? And that involves both things that you're sort of allergic to, but also toxins.

So after five decades of doing this, maybe almost six now, I don't know. What are the five things that are most commonly found that people need to get rid of and what are the five or so things that people most commonly don't have enough of and need to get?

The things they don't have enough of are magnesium, I put at the top. It's such a common thing. And then I think in our current current culture, the next thing is essential fatty acids, that is the omega-3 fish oils, omega-3 oils. That's a really big issue that is something that for practical purposes you really need to take a supplement, but it should be careful in shopping for them because oils are very, you know, a lot of the serious toxins in our environment are soluble in oils. And so if you have a crop from which you're extracting oils, you're going to be extracting some of the pesticides and other yucky things. So that you need to be careful to shop for the right brands of essential oils.

Yeah, they need to be distilled or purified and tested.

Yeah, it's a good reputation and all that. So then, I think that another important thing to at least scope out in a person with a chronic illness has to do with vitamin B12. And this is tricky because vitamin B12 is made in your digestive tract by germs that make- you- have the right ones. Yeah, that make funny B12. So if you send it to a laboratory into your blood level. It says, oh, you've got plenty of B12 here because the normal blood, normal laboratories don't distinguish between what's called pseudo B12, that is B12 that's made by germs, but they don't make a good kind that we want. It's a certain variation on it, a counterfeit, so to speak. Yeah. So the simple blood test for B12 doesn't tell you much. So that means that how are you going to test for it? well, you could send it to the one laboratory where they test for real B12, which is a laboratory in New Jersey. But the other way to do it is give people a shot of B12. To test it, you can't just swallow it because the dose isn't high enough to really give you a thumbs up if you're on the right path.

So, so GP used to give people B12 shots, that was a good idea.

Yeah, when I used to hear from my professors, oh, people give B12 shots, But then I had one professor who was actually a practitioner at Yale, I mean, practitioner in town, but he was on the faculty. And these snide remarks about old doctors who give people shots at B12. He said, no, no, no. It really works, but you have to just try it and see. And then you have to believe the patient, you know? Yeah. Because if they feel better, but I think that it's a fairly common difficulty in our population, but it does crack. It's just a little tiny bright red shot with a tiny needle. It doesn't hurt much. But it's one of those things that you have to, number one, believe the patient when they say, yeah, they really work. Number two, you have to, which we.

Don'T think is a valid response in general in medicine from the patient. The patient's perspective is not that way.

What do they know? their body. Well, what about that? So, but the point is that if you have a response to B12, then it, this is a really important point. It turns out that the shot of B12 wasn't a treatment. At first it was a test. And there's so many things that you and I do where we give something to somebody and it seems like we're giving them pills. to see if we think this might be the right treatment. But it's very important for me to explain to my patients, Look, I want you to try this for a week or two. And if it's completely safe, which is most of the things we use are safe. And then after a week or two, they come back with their thumbs up, like, Hey, since I started that, I feel so much better. then I call that a thumbs test. And then if they feel bad from it and it's something that shouldn't make you feel bad, then now we've learned something that we need to explore further. Sometimes you get one thumb up and one thumb down. If you get thumbs sideways, then it's like it's a wash. We didn't learn anything except that wasn't the pick.

It was the opposite of what we were trained in medical school was it should all be based on evidence and that the patients response of the patient's feedback is not really evidence. It's just subjective, which is a pejorative term. And in fact, it's probably the most important thing. And I agree with you. The way I've learned medicine is not from the textbooks or from conferences. It's from listening to the patients and listening to what works and what doesn't, whether I get a thumbs up or a thumbs down. I'm like, oh, and I learned things that are surprising. Like recently I had a patient who had type 2 diabetes, really poorly controlled, was trying to do well. I changed his diet. He did great. but not perfect. His sugar was still a little bit high. And he also had a lot of gut issues. And he was having all this bloating and distension. And he just reached out to me and as an emergency measure, I said, why don't you take charcoal just to see if you can absorb some of the gas and the bloating and see what happens? And he called me the next time, he said, It was the most amazing thing. My sugars went completely to normal by taking charcoal. I'm like, well, wow. And then he begins to make you think, why is that? And how did that happen? And what are the metabolic toxins that are driving his blood sugar up and how are those maybe being absorbed by charcoal and how do we even rethink how we're approaching. So not everybody with diabetes needs charcoal, but some people with diabetes caused by a leaky gut and gut inflammation and bad bacteria might benefit from it, right?

Activated charcoal is such an important diagnostic tool for a thumbs testing like this. It's very important and a certain approach that I take based on people who have yeast problems. That is yeast is a fungus.

Before you get into the yeast thing. Dr. Baker, you know, has really been the leader in educating us about yeast. And everybody talks about Candida and I have Candida and I think a lot of that is over diagnosed. But where those patients where it's really an issue, it's profound what happens. And you sort of have discovered this through and particularly with autistic kids and others?

Well, it's a big deal. The yeasts are funguses. They are used for making bread and beer and wine. Human beings began using yeast for fermentation and for baking 10,000 years ago for fermentation and a little bit more recently for knowing how to bake raised bread. But the same germ that is in there has cousins, which also like to live in the human body, and they especially like to live in the human body if the human body is eating sugar, which people eat a lot of, and yeast like to eat sugar. And then when they eat the sugar, they say to the person, eat more. So it makes the crave, people crave sugar. And they get into a sort of vicious cycle. And moreover, when you take antibiotics, it kills germs in your digestive tract that invite their yeast to come and picnic there in that picnic ground in your digestive tract. And so everybody knows. Yeah. And everybody knows it. I think everybody knows that if you take antibiotics, if you're a woman, you're likely to get a vaginal yeast infection. And that's main, that's mainstream medicine. That's not, it's not a strange idea, a strange observation, but it's, it's well known. So could it not be that people who have yeast growing in their gut have mischief made by it? And the answer is yes. And if you look across the board, just to generalize about it, if you look across the board of chronic illness, which is mostly based on what we call a loss of tolerance, that is your body is supposed to tolerate most things in the world. Your immune system is supposed to tolerate when if you breathe a little dust or a lot of things that are perfectly harmless like a peanut pollen in the atmosphere or a peanut in your food. These things shouldn't bother people. And if you go to some parts of the world, there's nobody there who is bothered by these things. When I was in Africa for two years, I never saw a single person who had an allergic or autoimmune problem. Autoimmune simply being you can't tolerate something that's living in your own body. You're kind of allergic to your own joints or something. And allergic, of course, is the other side of external world. So the epidemic of chronic illness that we have now is from the best way to put it, I think, is from the loss of immune tolerance.

So now- We can't detect self from other.

Exactly.

And we can't detect friend from foe in our food or in our environment.

Yeah, the immune system has this extremely valuable gift, this property of tolerance. And tolerance in any complex system, whether it's a social system or a political system or a mechanical system, tolerance and diversity are two really important property. So the human beings should be able to tolerate all kinds of stuff unless it's a strep germ or a TB germ or something that really should be targeted as an enemy. So people living in our culture have lost tolerance. And one of the chief reasons for that is that they have from eating, getting antibiotics that changes the germs that live in your digestive tract. or too much sugar, which changes what's in your digestive tract.

Or even flour.

Yeah, or even flour. Yeah, they have too many yeast growing in them. And this makes the immune system crazy and it makes it crazy in the way of losing tolerance. Now, the good reason- so that means.

You react to more things and you.

Have more- yeah, you get sensitive to all kinds of things and that sensitivity can be all sorts of allergies. It also can be sensory sensitivities. That is, the word sense is a good word because it crosses an important bridge between our nervous system, which runs our vision, taste, touch, smell, our senses. But those senses become more sensitive in a bad way. And you see this in children with autism. They become more aware. They can't hear loud noises or bright lights or taste of certain foods or touch. And so that their whole nervous system is awakened in the same way that their immune system is awakened. And the immune system and the nervous system are really all just one department.

I remember listening to you speak about that in some cassette tape I had 20 years ago. How, yeah. We have our sensory systems, right? The nervous system senses the macro world, the immune system senses the micro world.

Yeah, and people, when they lose tolerance, both of these things happen together, get more too sensitive. Now, so losing tolerance is an important way to help us think, because then comes another really important word is restoration.

To restore tolerance.

Yeah. If you go to a doctor, the doctor is usually going to give you something that your body's never had before, a pill. But if you go to the doctor and the doctor says, well, I'm going to restore something to you that you've lost. Hey, that's a bargain. Because it's not that you're getting something new your body's never seen before, but you're getting something that has gotten out of whack by way of being too sensitive. You've lost tolerance, and now we're going to do something, the restoration of immune tolerance.

That's the, and how do you do that with people? How do you, let's talk about that. We have a few minutes left, so I want to get into some of the practicalities.

You want to fix the germs that live in the digestive tract. And there's two fixes for it. One is to get rid of the yeasts. And there's a, of all things, there's a yeast that kills other yeasts.

Now, It's got a long, fancy name.

Yeah, Saccharomyces boullardi. And if you happen to belong to a crime family, you know, there's certain families that are in the criminal business.

And a few of them are patients.

And let's say one of them is, you know, named George. And it turns out that George has to be killed because that's one way of dealing with people who step out of line and a crime family. He's working for the other guys. And so how are you going to kill George? Well, you get George's cousin to do the hit because he can get in the back door. So here's a yeast called Saccharomyces. which stands for sugar fungus in Latin.

Saccharin, right?

Yeah, saccharin is like the word for sugar, but saccharo means the sugar fungus is the fancy word that we call saccharomyces. And that's the name for baker's yeast and brewer's yeast. But there's a cousin of baker's yeast and brewer's yeast, a close cousin, has just a little bit different last name. and it was discovered in what was used to be called Vietnam in the old days, and when it was a French colony, by somebody who knew that you could get this Saccharomyces boulardi from leechy nuts and give them to people with cholera and it would cure the cholera. And the word got around and finally he took it back to France and this is something you can buy pills called Saccharomyces boulardi. Now this kills yeast better than anything else because it's a yeast that knows how to kill other yeast and it does a brutal job of it. And this is where the charcoal comes in. If you take the Saccharomyces boulardi and it gives you all kinds of weird symptoms you didn't want, that's because it's working. Because the toxins are coming out. Now you take the charcoal, you feel better and now this has been a thumbs test.

Yeah.

And that's where you get your own body to tell you what is going on. It's more even, more important than a lab test. So the loss of immune tolerance- and.

Thumbs tests are cheap.

Exactly, very cheap. And safe too, safe. You can have some symptoms, but then you know why you're getting the symptoms and you do the charcoal. So the point is that the word restoration then comes restoration of the immune tolerance by restoring what? Restoring the microbiome, which is the name for all the germs that live in your gut. and it has become broken in a way because the good germs that live there have a burden of too many yeast that are living in there. So they mess your immune system up and make you sensitive. So that's one way that you restore the microbiome is the name of all these germs.

How you decide if someone needs an antifungal or saccharomyces or I mean, what are the things you look for other than them getting a vaginal yeast infection?

Well, if they're very sensitive to a lot of things. Basically, if they live in America and eat like Americans and they've taken antibiotics, they've probably got some time in their life where they eat sugar, they crave sugar. There are certain particular symptoms that are kind of tip-offs.

And I've seen in my practice it's been extraordinarily helpful to treat it. I do worry about giving prescription antifungals because of resistance and other any fungal agents that can grow as a result.

But the nice thing is with the Saccharomyces boulardi, you can get it at the health food store. It is a potent yeast killer. And if you get negative symptoms from it, then you know you're on board. And then you have to navigate that, but it's not rocket science. So you get your you get all the results from your own body. You don't have to believe in something on a piece of paper. Then if you get really a good response, but you need to double down on it, you can use prescription antifungals and they sometimes are miraculous. And I could, I don't think we have time for another story about that, because I want to talk about one other issue here. And the other, so there's one thing about the germs that live in your gut, there's too many yeast. And then there's another side to it that we have lost certain things that belong in our gut, that the presence of which is restorative of immune tolerance. That is a very big thing that we call parasites.

Yeah.

But parasite is the wrong word. And they are a gift from nature that have been with us since the beginning of time. and over the last few generations in people living in our culture, we have lost these commensal organisms, that is, this natural presence of these things. So I learned about this when I was in Africa as a Peace Corps volunteer in the 1960s. I saw thousands of beautiful people. I mean, the people that I took care of in Chad were beautiful people. beautiful skin, hair, eyes, teeth, everything. They were living the old-fashioned way. They were not living in these big, you see now on TVs, around big cities, these slums with all these tar paper shacks for acres and acres of poor people. These are people living out in the countryside, living the old-fashioned way, which means no soap and water. They have water, but no soap, and they don't have regular toilets and stuff like that. and they have what we taught in medical school to be called parasites, different kind of worms. It turns out that if you have those, you do not have these sensitivities, autoimmune disease, and you don't have allergies. Or allergies. All those things, I saw thousands of different healthy people. Some of them were really sick with all kinds of things that we took care of, tropical diseases, yes. But we didn't see anybody with autoimmune and allergic problems. And this in the 1960s was an observation that could be made pretty easily by trained eyes. I mean, you talk to a missionary and say, you know, he's been there in the country for 30 years and he's never seen anybody with asthma who's a Chadian, whereas, you know, in the United States, everybody has asthma now. So, but by the 1990s, it became mainstream science that people who had these organisms living in their gut, because of having those, they don't lose tolerance. So that their immune systems were terrific at not becoming too sensitive. So nowadays we have a way of raising a certain kind of little creature that has been, it's like the things that have been with us since the beginning of agriculture and we can put them in a little vial and send them to people and they take a couple and their allergies and their autoimmune things go away.

Yeah, I did that with one patient who was very allergic and he had a level of IgE, which is the, yeah. Antibody that fights allergies of like over a thousand and within a few weeks it came down to normal.

Yeah.

I was like, wow, this is interesting.

When it works, it really works. And the thing is that they're safe and they, they principle I think it's a good word for people to learn is BROCS. B-R-O-C-S. B stands for benefit, R stands for risk, O stands for the odds, what's the likelihood this thing is going to work. C stands for cost, and S stands for stakes. And a lot of times when doctors and patients make decisions together, they don't think about the stakes so much. They say, what are the odds that this is going to work? But the stakes are really important. Let's say you have something, well, just a favorite subject of mine these days is alopecia. Your hair is all falling out in bunches. And it's not especially, very bad for women especially. But nobody likes to have hair looking really weird. And this is an autoimmune problem with antibodies to your hair follicles. And so, and the stakes are really high. I mean, if you could fix that, that would be great. and so if people take these little dudes that I call them, these little organisms, and their hair grows back, well, then their autoimmune problem has been cured by taking these little things. And the cost of it isn't reasonable. The stakes are high. The odds are good, 50-50 anyway, in young people. Their odds are not a little longer in older people because they're thing is more established. And the risk is really zero. And so the benefit is huge. So the brochs comes out to mean, yeah, let's just try it. You know, you need to take maybe six doses to know whether you're on the right track. And so we get to see these two things functioning in the world of illness in our culture, where there's a lot of autoimmune and allergic problems. in which the restoration of the microbiome, the germs that live in the digestive tract, restores immune tolerance. And that is the two sides of that is either needing to take something to kill the yeast or taking these little critters to go and live in your stomach, in your intestines for a little while and establish immune tolerance. And the thing that is striking about this model of alopecia is that here is a classic autoimmune problem with antibodies against your hair follicles. So it's, you know, it's pretty well established that that's what it is. And now I have patients who have been cured by taking one of these, either one of these treatments, either the antifungal thing. Yeah. That's where I started years ago, maybe 20 years ago. A boy who came to see me from Rhode Island.

He offered me gluten too.

But with just with an antifungal medicine, his hair grew back in patches over the next two years. We were very slow because those days this new antifungal was new on the market. It's really now very benign, but I didn't have much experience with it then. His hair grew back in patches and now he's a, he doesn't, he didn't need any more treatment. Now he's a famous musician and he has full head of hair.

You gotta be a long hair to have a rock star.

Yeah. And that's the same condition that the loss of your hair with other patients has been just from the little dudes that I was talking about. Had a little girl come down from Connecticut, her hair was all falling out. And I said, Here you can take some antifungal medicine and take the dudes. and six months later, I called her mom, she'd been taking these during this time. I said, well, how's she doing? How's Isabella? Oh, we're so happy, thank you so much. Her hair has all come in now and we're so pleased. And then she kept taking it for another six months. And then they figured, well, the hair is doing fine, let's just stop. And she's cured. So the word cure and autoimmunity don't really go together. Go together, right. So that's a, well, you've always been.

Pushing, the way we think, whether it's magnesium or omega-3 fats or the gut or yeast or now helmets and worms for autoimmune disease. Even throughout your whole life, you've never stopped asking the questions. And that's what's so extraordinary about you, Dr. Baker. And I'm just thrilled that you've been here on the Doctor's Pharmacy, a place for conversations that matter. I want to leave you with one last question, which is if you were king for a day and you could change something in healthcare, what would it be? Or how we think about medicine?

Well, I put you in charge of everything.

No, no, I don't want the job, please.

You have become the leader in our field of medicine. And I am so proud of you. I love you so much for what you have done. It is really a stunning job that you've done.

Only on your shoulders, Dr. Baker. Without you, I don't think I'd be anywhere, 'cause all the ideas that I had were not original. They all came from you.

But you climbed aboard that stallion and you rode it in the rodeo. And you have tamed the beast. You have really gotten now to secure the position of this kind of thinking. in the public square where we all want to be able to do good for the world.

That's true. I was just at Cleveland Clinic meeting with the head of Cleveland Clinic in Florida. He said, I can't believe how many times in the last month I've heard people talking to us, our patients, about functional medicine and it just wasn't the case.

Yeah. Nothing, what your career has done so far, I mean, this is just, you're just getting started. I can't wait to see the rest of it, but it is, the perfect example of the lovely Hebrew expression, tikun olam, for the good of the world. Yeah, it is a really a treat to be your friend and mentor and admirer. It's just, you have put together the most remarkable bouquet of skills to fill this wonderful, wonderful outcome for all of us.

Thank you. I really appreciate you, Dr. Baker, and our friendship over the last few decades. And what I've learned from you has really helped thousands and millions of patients, literally millions of patients. And you're kind of the unsung hero, and I'm just honored to have this conversation with you. Please leave a review or comment. We'd love to hear from you, and it matters. Also, if you like this podcast, share with your friends and family, and subscribe on iTunes. And we'll see you next time on the Doctor's Pharmacy, a place for conversations that matter. Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven-day free trial.