Healing Autoimmune Disease Using A Functional Medicine Approach with Dr. Sunjya Schweig

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

The food and drink that we take in by our mouth is by far the biggest factor of information that is hitting that immune system in the gut.

Hey everybody, it's Dr. Mark. I'm all about streamlining my daily health routine to be as powerful and yet simple as possible. And that's why I love AG1 from Athletic Greens. Because when it comes to my health, I want it all. I want my gut to function great, my brain to feel sharp, my immune system to be strong, my body to feel energized and able. And being in my line of work, I know that means I need optimal levels of nutrients. Which is one scoop of AG1, I get 75 high quality vitamins, minerals, whole food source superfoods, probiotics and adaptogens to support my entire body. Even with a really healthy diet, it's hard to hit the mark for all our nutrient needs. So I feel better knowing that I have some extra help from AG1. Unlike other supplements and powders out there, AG1 is third party tested and made without GMOs, nasty chemicals or artificial anything, and it tastes great, kind of like a tropical green drink. I like it on its own mixed with water, but it also works really well in most smoothies. If you're curious about trying AG1 from Athletic Greens for yourself right now, they're offering my community 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com/ forward slash Hyman. Again, that's athleticgreens.com forward slash Hyman to take ownership over your health and pick up the ultimate daily nutritional insurance.

You're unique, which means your health and.

Wellness plans should be unique too.

But it can be tough to optimize your health and nutrition programs because it's.

Often difficult to get the data you need.

And even if you do get your numbers, you actually have to understand them and then be able to make meaningful action based on them. this is where Inside Trackers comes in. Inside Tracker is a wellness tracker that uses science and technology to deliver ultra personalized healthcare guidance. They can analyze your blood, your DNA, your lifestyle habits, and give you actionable recommendations to help you meet your health and wellness goals. They'll tell you what you need to do and why, and you can track your progress and adjust your plan based on real time feedback from your own body. Since 2009, their science team at Harvard Tufts and MIT have been bringing personalized nutrition and wellness to the world with their powerful evidence based digital platform. InsideTracker is simple, customizable, and most importantly, it's based on you and your body. If you're curious about getting your own health program dialed in to meet your unique needs, I highly recommend checking out InsideTracker. Right now they're offering my community 20% off at InsideTracker.com/DrHyman. That's I-N-S-I-D-E-T-R-A-C-K-E-R.com/D-R-H-Y-M-A-N and you'll see the discount.

Code in your cart. Hey everybody, it's Dr. Mark Hyman. Welcome to a special episode of the Doctor's Pharmacy that I call House Call. And in this series, I sit down with colleagues in the field of functional medicine talking about topics that I think are gonna interest you all, which is how do you deal with all this chronic stuff we're dealing with as a society that is not getting better using traditional care approaches. And today I'm joined by Sinja Schubach, who's a friend of mine who went to the same residency program I did in family practice in Santa Rosa, California many years ago. and we're gonna talk about how we as functional medicine doctors tackle specific conditions that we see every day. Dr. Schwag is a family doctor. He is a leader in this field of functional medicine and he's done really great work in establishing with Chris Kresser, this California Center for Functional Medicine, which he now heads up and the website is ccfmed.com, you can learn more about what they're doing there. He's also developed the Functional Medicine Research and Technology Center, which is fxmedresearch.org to help prevent an adverse chronic illness through research and education innovation. And I'm glad to have you on this house call podcast.

Mark, it's great to see you again. Yeah, thanks so much for having me. It's a pleasure to be here.

That's great. Well, today we're going to talk about a topic which is probably one of the most important causes of suffering and disability and dysfunction today. And it's something which we really are very poor at dealing with, and it's probably the number one condition facing us other than probably obesity and metabolic syndrome, which is autoimmune disease. Collectively, autoimmune disease represents more people than heart disease, cancer, and diabetes combined. And we, that's all comers, right? Hashimoto's, thyroid, MS, rheumatoid arthritis, colitis, all the autoimmune diseases, which are all divided up into specialties. And each specialty takes care of their own autoimmune disease. And unfortunately, that's really not a very good way of thinking about it because as we're going to discuss today on the podcast, there are specific causes of autoimmune disease that if you deal with, you can deal with all these various different autoimmune diseases rather than having to slice the body up in all these organs and parts and specialties.

So, welcome to the podcast. Yeah, thanks again. And it's great to be here. I love having this conversation. Autoimmune disease is just. Such an incredibly important topic. And as you know, and as many of us functional medicine doctors know, it's really one of the most rewarding areas that we work in because of the opportunity that we have to really dig deep and to look at so many different factors that affect the triggering, the onset, the propagation of inflammation and autoimmune. So it's really a favorite of mine.

Yeah, it is too for me. And it's one of those really satisfying areas of functional medicine where you know, we see real results and real Transformations. I remember, you know, a number of patients have come to me, for example, about to take their colon out for colitis, and then these people get completely better very quickly. I had one, one young woman, she was 30 years old, and she was sent by her uncle, who was, you know, a fairly prominent guy, and she didn't really believe in what I was doing. She lived in New Orleans, in Louisiana. She really just she said she'd tried because they were about to take her colon out. She was 30 years old and I was on all these medications. Nothing was working. And she came back and I talked to her six weeks later. She says, well, I'm completely cured. I didn't believe this was going to work, but completely cured. And I feel fine and I'm not taking any medication. So we see that level of change, which you just don't think about as possible, particularly in our, in our traditional medical approach, which is focused on just suppressing inflammation. So. So tell us about the root causes because rather than saying how are we gonna shut off and inhibit and block or tamp down inflammation, the question really should be what's causing the inflammation in the first place? So from a functional medicine perspective, what are the causes of autoimmune disease and why is it so much on the rise these days? Because it really wasn't as prevalent decades ago. It's now increasing dramatically over time.

Yeah, not as prevalent decades ago and still not as prevalent in societies that still adhere to more traditional lifestyle, you know, balances and diet, sleep, nutrition, stress, exposure to light, exposure to screens, all these factors that are throwing our bodies out of balance. And that's really, I think, the key thing. Why are autoimmune diseases on the rise? I think it really has to deal a lot with the fact that we're increasingly living out of balance and we're not respecting how our bodies have evolved over millions and millions of years, right? And so we think about when we're looking at functional medicine approach to autoimmune, the key areas to consider are really all of those lifestyle factors, you know, the health of our gut. What are we eating? How are we eating? When are we eating? Super important concept that we'll dig into today of intestinal permeability or leaky gut, the lay term of leaky gut, I prefer the the more scientific term of intestinal permeability. Huge, huge, key topic. If you go to PubMed where all of our research articles are and you type in intestinal permeability, more than 14,000 articles show up. And if you type in intestinal permeability in autoimmune, you get also a ton of other articles. So the gut chronic infections in our bodies in the gut, but also systemic persistent chronic infections. We'll talk about that some today. exposure to environmental toxins and stressors, stress on our brain, stress on our body, trauma, these all trigger inflammation and dysregulated hormonal pathways and propagate autoimmune diseases, inadequate or poor quality sleep, really, really important. We'll go through any and all of these in more detail as we dig into our discussion.

You touched upon the gut and permeability, but the diet is a big part of that. Our modern diet has really driven our microbiome into disarray, and that's caused a whole host of downstream consequences to our health, not just autoimmune diseases, but cardiovascular disease, obesity, mental health issues, and lots more. So this is a big deal, and I think diet plays such a big role. And in fact, you know, when I had patients, you know, often go to the rheumatologists who were working with me, they go, oh, diet has nothing to.

Do with your rheumatoid arthritis or your.

Lupus or whatever it is. I'm like, what? Although it's changing, I had a rheumatologist who I talked to at UCLA at Cedars Sinai. I was like, oh, thank God you're called. I'm really excited about this. I can tell you my work has gotten so much better with my patients since I started incorporating diet and their outcomes are so much better. I'm like, yeah, it makes a big difference. So what actually is autoimmune disease and.

What are the most prevalent autoimmune problems people are facing? Yeah, so autoimmune disease is really, you know, this idea of, I think of it as like the immune system gone haywire, right? And you mentioned the word inflammation. inflammation is really one of the core concepts, right? And so we think about several main factors. Genetics, of course, are important, right? But really that's a minority. We think genetics and the contribution that they have to autoimmune disease is maybe only a third of really what's going on. And the other factors are, again, diet, lifestyle, environmental triggers, infections. The genetic factors, again, can create a predisposition, almost like this fuel, But then that spark and also more fuel can get stacked on there from the environment, from chronic infection, from these lifestyle factors to then activate these processes and make the autoimmune disease more clinically apparent. There's probably over a hundred different autoimmune diseases. 10 most common or you mentioned some of them, but rheumatoid arthritis, Hashimoto's, autoimmune thyroiditis, celiac disease, Graves disease, type 1 diabetes, the list goes on, with ligo, rheumatic fever, pernicious anemia, all the colitis.

Yeah.

Yeah. So, you know, and, you know, the cost to us, you know, personally is huge for the individual, but also to society. You know, the National Institute of Allergy and Infectious Disease estimates that the cost of treating autoimmune disease in the US is more than $100 billion annually. and we think that that's probably actually a vast understatement, you know, because estimates around just seven of these 100 plus known autoimmune diseases, you know, estimates of cost annually ranges from 50 to 70 billion dollars.

Whoa.

Well, that's a lot of money.

And I think, I think the, the costs are so staggering for the drugs that we're using. They're immunosuppressant drugs. They increase risk of cancer and infection, and they do help a lot of people. I'm not going to say they don't. but the average cost is about 50 grand for a year per patient. And I know I've seen so many people be able to get off these compounds when they actually are changing the underlying causes. And you mentioned all the different things, toxins, allergens, the gut, diet, infection, stress, and so forth, sleep. These aren't often one thing that's causing it in a single person, but it may be multiple things. And so you have to kind of deal with all the factors. So as traditional doctors, what was our sort of a basic approach? What is sort of the basic approach we sort of touched on a little bit, but I think it's worth sort of talking about it. And then the disconnect between like that and how we deal with functional medicine.

Yeah, so you mentioned these very, very expensive drugs, the monoclonal antibodies of which the pharmaceutical companies have a lot of incentive to develop because they make a lot of money. of money, right? And your point is good, which is they can help people. But really it comes down to this central divide of what is conventional medicine trying to do? And I don't wanna make it seem like doctors are bad people. I have incredible respect. There's just some incredibly smart people, and most doctors are so, so dedicated to taking care of their patients and trying to find them help. But it's really just from the top down of how are we trained and this idea This conventional approach to autoimmune really is kind of like this codifying of a lot of how Western medicine works, which is suppress, which is, you know, make it stop, control the immune response, turn these inflammatory pathways off. And the problem is that it's not asking why. It's not asking why is the inflammation there in the first place? Why is the immune system being triggered in the first place? Right? so the main things that doctors reach for are steroids, you know, corticosteroids like prednisone, methylprednisolone, dexamethasone, you know, these work quickly and they work well. They turn off the inflammation, they shut down the immune system, you know, but huge side effects, really, really staggering side effects, you know, increased type 2 diabetes risk, weight gain, infections, osteoporosis, Etc. Other medications, other immune suppressants are used like methotrexate. also shut down the body's immune response, but a lot of toxicity, liver toxicity, increased risk of infections, cancers, leukemia, etc. And then we've talked about these monoclonal antibodies, some of the biological response modifiers. Again, they can be helpful in the short term, but they're really just targeting one pathway. They're not taking care of why that pathway is inflamed in the first place. And so it makes sense that they might help in the beginning, but a lot of times there's this escape phenomenon that happens where they stop working. And so it's really like a short-term, kind of very myopic approach, which if we stack in all these other lifestyle factors that we know about how to intervene within functional medicine, the potential for true healing is much, much greater.

Yeah, it's pretty quite, quite amazing. It's one of the most satisfying things for me as a functional medicine doctor to treat because, you know, I can just tell you patient after patient with all kinds of weird autoimmune diseases, some which I've never even seen before. If you follow the basic principles, it works. And, you know, we say functional medicine is more about creating health than it is treating disease. And so when you create the conditions for health and you take away the impediments for health, it's quite amazing. So let's, let's talk about a case and let's talk about sort of how, how we diagnostically approach these patients and what we do therapeutically that makes the most difference. So maybe share a case. If I can think of one, I'll share one too, but I'd love to hear a case from you about how someone presented, what you did to them, what you tested for, what you found, how you treated them, and what the outcomes were and what the sort of objective results were that you got.

Yeah, so as I was getting ready for our talk today, you know, looked through our work and cases, and this one case came to my mind. And so a 43 year old woman who we'll call Sarah, and when we first met Sarah, she was experiencing some joint pain, mild to moderate joint pain, brain fog, trouble thinking clearly, she's having some mood swings, intermittent anxiety, and a lot of fatigue, and she's also having some gut symptoms, some bloating and gas, occasionally some loose stools, disrupted sleep, especially in the week leading up to her period, so some hormonal fluctuations happening there. Usually would fall asleep okay, but would wake up in the middle of the night, some trouble falling back asleep, you know, and like many of us, she was successful. She was very busy. She was working as a pharmacist with long shifts, you know, three kids, very involved in their activities, and, you know, historically always able to manage her busy schedule. But she's kind of feeling like she's having more and more difficulty keeping up, more fatigue, degrees, resilience, not waking up, feeling rested, Etc. You know, and interestingly, when we talked about our family history, there was definitely a a strong family history of hypothyroidism. So that was kind of cluing us in the beginning. And she was also on track with that. She was wondering about that. So she had been tested a bunch of times, but always only with the TSH, the thyroid stimulating hormone, which is kind of like the go-to test for, you know, a lot of the primary doctors and internal medicine doctors. And it always had been normal. It was in the normal range, but her TSH had been trending up, right? So, Remembering that TSH is inversely associated with thyroid function. So a lower TSH is higher thyroid function and a higher TSH means lower thyroid function. Her numbers were 1.2, then 2.3, then 3.6. But she was always told that this was normal, right? And so her backstory during childhood did have some frequent ear infections. needed antibiotics, you know, not infrequently, seven or eight times. So some, I was concerned about some, some early gut disruption there. She also had a history of some stomach ache episodes, but never diagnosed with a problem. You know, was traveling abroad at one point, got food poisoning, some increased gut symptoms after that, Etc. You know, really, it was just trying to watch her diet. And I said, I drink a lot of kombucha. I try to eat a healthy, balanced diet, you know, but, you know, there was some, some disruption there, too, because of how busy she was. She would skip breakfast. she would frequently get home late from work and not have time for dinner until 8 or 9 o'clock and maybe just have a bowl of cereal, etc. So in her words, she came in and she was trying to improve her energy. She wanted to be able to exercise without being sore for days afterwards. She wanted to feel like an athlete again. She wanted to improve her moods and lessen her brain fog so that she could work more efficiently. so we started off at the start gate with our patients, we tend to do a pretty deep dive. We cast this really wide net and I know that you guys do this too.

Yeah, so what would you look for? Like when you think about these patients, what are the kinds of things that come up for you is I gotta find out what the root cause is. How do you start to think about those?

Yeah, so we did a comprehensive blood panel, you know, looking at the thyroid again, but also adding on the free hormones, free T3, free T4, We looked at reverse T3, we looked at thyroid antibodies. We looked at markers of inflammation, markers of blood sugar dysregulation and insulin. We also tested her for celiac, for celiac genetics and a celiac panel given the history of abdominal pain and the strong family history of low thyroid. We did gut testing, we did a stool test, a comprehensive stool test as well as a SIBO breath test, a small intestinal bacterial overgrowth test. you know, and this was kind of correlated with that history of food poisoning, of the GI complaints, and also the cognitive, the brain, right? The gut-brain axis is so, so critical to consider and to look at. And then we also did a deeper dive on the hormone, looking at her adrenal function, looking at, you know, her sex hormones, et cetera. You know, we know that a lot of times, you know, high functioning people, high achievers tend to maybe have higher cortisol. They're pushing that envelope early on in their lives, but then that can drop and they can then have low cortisol, which can manifest with increased susceptibility to illnesses, fatigue, brain fog, trouble getting out of bed in the morning, et cetera. So, you take a good look at.

The gut, you look at kind of hormones. I often think about looking at other things that are sleepers, like heavy metals or environmental toxins, food sensitivities, gluten, obviously you did mention that, but that's a huge one. I check for anybody who's got any autoimmune diseases. I check for gluten antibodies and it doesn't have to be full celiac, you can have just low level elevations of these antibodies that can cause significant problems without actually being true celiac. And I think this is often a problem with traditional medicine is this on or off. You either have it or you don't. You have diabetes or you don't. It's not a gradient, it's not a continuum. So in truth, the body is just a continuum of function or dysfunction. And hence the term functional medicine. And so it's kind of arbitrary to set a number like diabetes is 126. What about if it's 124? Are you okay? No. Right. so the same thing with everything in terms of all the numbers we look at. And I think the, the, the, the, the ability to kind of find these things are quite impressive. So what did you find when you started to dig in and you looked at the gut and you looked at the hormones, you looked at what else was going on nutritionally with her and how those play a role?

Yeah. So this is kind of my, my, one of my favorite parts of, of the work that we do when, when you have these folks who have been struggling. They've been to a bunch of doctors and they, you know, have been kind of told that everything's normal and maybe they've absorbed that. And they've said, okay, you know, I guess it's just, I'm getting older or, you know, you know, maybe I'm a little bit depressed, you know? And so, but, you know, we got all the labs back and we dug in with Sarah, and there was a lot of things that we found that were, you know, levers. I think of these as levers, potential levers that we can pull to to help her get better. So, you know, her TSH was 3.8, which on the lab test shows as normal, but you and I and, you know, most functional medicine doctors know that that is not optimal from our functional range. We like to see that at around two or less. So I was definitely concerned around low thyroid function. And in fact, her free T3, the most active thyroid hormone, was in the low normal range. Her reverse T3 was elevated, you know, signaling inflammation and immune activation. And then she did have elevated antibodies. So her TPO antibodies to her thyroid were high and the thyroglobulin antibodies were also a little bit high. And importantly, she had antibody against gluten. She had a positive anti-deaminated gliadin peptide, you know, mildly elevated, but certainly way, you know, very, very significant in my opinion. And the US, that's not necessarily diagnostic of celiac, but in Europe it is. And so, you know, there's a little bit of a difference of opinions on sort of how we interpret these, but for me, that's a highly significant marker. For those of you out there who might want to look at testing this on yourself, LabCorp can do this. So can Quest, but the LabCorp test code for the comprehensive Celiac panel, I'll just throw it out there for folks, is 165126. So look that up. If you want to get tested for, you know, just through your insurance, through LabCorp, that's a great test to look at. She also had low vitamin D, low vitamin B12, and low ferritin, which is the storage form of iron. So all three of those together are telling us that she's not absorbing very well, right? She's having trouble on the level of the gut and that there's inflammation there. And in addition to just needing to get those levels up, it's sort of a proxy marker, right, for this bigger problem going on. her stool test showed dysbiosis and balanced bacteria. There was some dropout of the good bacteria. We call that an insufficiency dysbiosis. She had positive H. pylori. Helicobacter pylori. Yeah. And so H. pylori is super, super interesting bug. It's one of the, it's sort of a model for persistence and for chronic inflammation. And it has been linked in the research literature to autoimmune thyroid. you know, so right there, I got really excited. I was like, okay, cool. Like, here is something which we can treat, we can eradicate. It could explain your local gut symptoms, but it could also explain some of the bigger picture autoimmune activation that we're seeing in your body.

Incredible.

So.

So with her, you know, how would you go about starting to treat her? There's so many different things. She's got nutritional deficiencies. She's got gut issues, bacterial overgrowth, gluten issues. I mean, we didn't.

You didn't really check for heavy metals or other things that could be. No, I didn't do that. Yeah.

Yeah.

Because there are, like, no down the road for me. I love just kind of jumping with all these things and see if we get the traction. But yeah, you're right. It's a very important factor. Yeah.

And, you know, she had all these different things. So where do you normally start with these patients?

Yeah. So the place that we start with everybody is the lifestyle piece, right? We actually try to get the inflammation in the gut calmed down first. You know, that is the gut is really the center of the universe when it comes to the immune system. and if we can heal that intestinal permeability, the diet piece is really the first step. And we frequently embark with that with patients before we're even finished any testing. I think you guys do this too. Basically, the onboarding sequence to our clinic, there's intake visit, we do a bunch of labs, and immediately they see the nutritionist, they see the health coach, they start on these lifestyle changes. So we had Sarah, start an anti-inflammatory whole 30 paleo reset diet. And in particular, you know, really focus with her on, you know, you have to get rid of gluten 100% for at least 30 days. I like to do it for longer, but sometimes I break it up into bite sized pieces for folks. We wanted her to minimize sugar. We wanted to avoid dairy, limit alcohol, you know, and just with that one change within a couple of weeks, she reported that her energy was better. by about 40 or 50%. Her brain was better by about 40% and her joint pain is better by about 60%. And yes, this is one of the things I love about that is just not only like, okay, she's feeling better, but this is really, really good reinforcement for her that she has control over her health and that she can make changes and put things into place that are going to positively affect her. You know, we're going to stack in some supplements, we're going to stack in some prescriptions potentially. But she immediately has this sense that her health is in her own hands and she can be an active participant, which is what we love.

That's so great. And so, let's talk about the diets and autoimmune disease because I think there's so much controversy on what should eat, should you be lectin free, should you be gluten free, should you be paleo, should you be vegan? What are we learning about in terms of food and autoimmune disease? What are the biggest drivers in our diet of autoimmune disease from the dietary perspective? What can people do therapeutically? like how do we sort of stack up against choosing what to do for which person?

Yeah, so there is no one size fits all approach, but I think there are some basic tenets that we can really factor in. And I think this idea of, you know, we talk about the exposome, right? So there's the genetics, there's the epigenetics, you know, genetics are hardwired, the epigenetics is how are your genetics read out, and that can be turned on and off based on environmental factors. And there's this idea of the exposome. These words sound complicated, but they're not.

The exposome is basically, I call it.

The exposome because it sounds better. Yeah, exposome. Everything that you've ever been exposed to from the time you were in your mom's belly until now. And actually, if you want to go deep, it goes back before you were in your mom's belly. Right. So, sort of this, you know, methylation and, and, and way to epigenetics affect Um, offspring, but really, you know, for simplicity, everything that you've ever been exposed to from the time you were in your mom's belly until now. And we can modify that, right? We can take charge. And so the diet is, if you think about the amount of information that your immune system is being exposed to on a daily, monthly, yearly basis, the food and drink that we take in by our mouth is by far the biggest factor of information that is hitting that immune system in the gut. the next would be air and skin. But again, the biggest lever that we have to pull that can affect how our body is receiving information from the outside world is through the diet. So you want to take out all of the things that are going to be triggering aberrant inflammatory activation. And so the biggest culprits are the processed foods, the sugar, grains are frequently a trigger for people. And then eating organic grass-fed is really critical because otherwise you're getting chemicals, you're getting pesticides, you're getting hormones, you're getting antibiotics, all of these are gut disruptors. And so the really easiest way to start with an anti-inflammatory diet or a whole 30 or a paleo reset is just to take out all of the junk and eat real food. You'll eat real clean, nutrient-dense food and do that a period of time. You're downstream from that, we sometimes have to specialize. We have to go into more like what's called an autoimmune paleo diet or a low lectin diet or something like the walls protocol. These are all variations. We don't usually go there first with people, you know, but it's kind of like base is very individualized and what, you know, based on the response that somebody has.

Amazing. So, talk about some of the things that are like controversial, like lectins. Is that something people should focus on or is that just kind of a marginal thing?

I think it's been helpful for a lot of people, but I don't think it's everybody. And so what we do is we kind of go step by step down the list. If people are doing a Paleo or a Whole30 and they're just feeling great, I don't necessarily feel the need to go down into the next steps. If they're not feeling well, we go into an autoimmune Paleo. But it's also the case, the foundational intervention of anti-inflammatory diet in naturopathic medicine, in functional medicine, is get rid of things that might be triggering you and then add them back in one at a time in a systemic way and see what your body tells us. The food sensitivity testing that you mentioned, that's helpful. I definitely use that and we like it, but it's imperfect for a lot of reasons. But what does your body tell you? What is your body reading out to you in terms of symptoms and reactions? You can't argue with that, right? And so, yes, some people do need to avoid lectins, but I really don't find it's the majority of people. What's your finding with that?

Yeah, I think it's got a lot of sexy play, but I think I've really helped so many people not having to focus on just that. I do recommend initially doing a a more strict elimination diet. I call it the 10 day detox diet, but essentially it's more or less the autoimmune paleo diet or paleo diet. The more advanced versions where you take out nuts and seeds and eggs and night shades and other, it's a more sort of aggressive form, which some people might benefit from, but I think often it's not necessarily needed. If you can fix the gut and get off the bigger triggers of gluten and the dairy, it's key. So I actually find that different, you know, decades. I've been using the 10-day detox diet.

It really works very well. Yeah. I think we also have to be cautious about overwhelm for people and, and, you know, these dietary interventions causing more stress and, and also the social isolation and what that can do for people's, you know, ability to be out with friends and, and, you know, so it's always a balance. And what we always tell people is that these aren't permanent interventions. You know, we're going to try these for a period of time. It's like a, it's like a therapeutic you know, trial, and hopefully it's time bounded. Some people have more severe issues and they need to be on these diets for longer. But we're always working as a care team. We're working with our nutritionist and our health coach and the provider trying to find what's the right balance and what's the right timing and really individualize these diets. You know, food is medicine, right? And so these are medical interventions in our world.

It's so true. And I'm just so interested when rheumatology is going to start to wake up to this because I think more and more rheumatologists are figuring this out and we have more and more in functional medicine. But I think, you know, for me, it, you know, when I look at autoimmune disease, it's sort of emblematic of what's sort of wrong with our society, the, the processed food, the, the sort of industrialized food system, the food additives, the environmental toxins, the the gut-busting ways we live, the added stresses in our lives. These are all things that are driving this autoimmune epidemic. And yet, it's something that people really don't have to suffer from, which is quite amazing.

Yeah, from the provider side, I think that it's not even that there's a huge resistance on the provider side to looking at this. I think it's just a knowledge gap. I think they don't know about the importance. and I think that there's a huge time crunch factor. They just don't have the time to go into these histories, to ask the patients these questions. I think a lot of doctors are, like, afraid of talking diet with folks because, you know, it gets into a lot of discussion, a lot of nuance. And so I think there's actually a really big opportunity there for the health system, you know, to leverage a care team approach and to bring in mid-level practitioners, to bring in coaches and nutritionists and to to offload that work to these folks, but have it still be part of the entire plan. I think that the doctor doesn't necessarily need to be doing that all the time, and it might not be their passion, but they could easily leverage that expertise in their practice. And really, if the health system woke up and saw what you and I know, what all of us know in functional medicine, they would be jumping at this because the opportunity for cost savings is staggering, right?

It's true. that's true. That's really true. It's quite, it is quite staggering. I mean, I think, you know, we, we have to really sort of reframe what we're doing in autoimmune disease. I think the, the concept of this lifelong chronic illness that you have, that you have to suffer with and you have to manage, you have to take medications for, it's sort of accepted. And I, I actually, I've had pretty much everything. That's what I learned functional medicine. I've talked about on the podcast. before, but a number of years ago, five years ago, I developed ulcerative colitis, and it was horrible. I was having, you know, 20 bloody bowels a day. I lost 25 pounds from my skinny self. I ended up, you know, was vomiting all the time. I was in bed, in and out of the hospital, and, you know, nothing was working. And even all my normal functional medicine tricks. So sometimes I have to go out of the box. And turned out that I, you know, I had mold toxicity, but my system had just gotten in a cycle. and I ended up using ozone therapy to help reset my whole immune system. And I used exosomes and other kind of stuff that's kind of on the edge. But just, I'm just bringing that up because I think that, you know, we're constantly learning more about how to regulate the immune system, how to regulate our body's own healing mechanisms. So I had to activate my healing mechanisms using some pretty extraordinary therapies because the normal stuff wasn't working. I wonder from your perspective, what are some of the other great cases you've seen that kind of get you excited about functional medicine and autoimmuness?

Yeah, so another big area of interest of mine is this intersection around chronic infections and how those can drive autoimmune disease. This is actually, I have it here to show you, it's one of my favorite books, Infections and Autoimmunity. This is a huge textbook. It's like a $250 textbook. But this idea that we could have pathogens inside of our bodies that are persisting and that are driving this sort of ongoing low-level chronic inflammation because it's so treatable, right? And so we see this especially with, you know, I mentioned H. pylori, that's a good one, but with the tick-borne pathogens, with Lyme disease, we see a lot of folks with Lyme disease with co-infections. with chronic viral infections, you know, and so, you know, these are really gratifying on the one hand because, you know, if you look at them the right way, if you look at them deeply, if you really engage and find ways to treat them, you know, Lyme disease or Borrelia burgdorferi, pretty controversial, but, you know, we know that there is a persistent pathogen there and we know that there is autoimmune activation. There's both. and so you kind of have the worst of both worlds. And when we diagnose that and we treat it aggressively and effectively, we can turn off that autoimmune signaling, right? We've seen that again and again in folks with these chronic tick-borne cases. And, you know, it's really gratifying on the one hand because there are a lot, there's a lot of work being done in these areas on, you know, Monica Embers at Tulane has done some incredible primate research looking at persistence of the Lyme spirochete and the chronic inflammation that it causes. Organizations like the Bay Area Lyme Foundation are really pushing the research agenda along with the Steven and Alexandra Cohen Foundation. But we see those patients who have these chronic persistent infections and you identify it and you treat it and they get better and those autoimmune markers go away. I mean it's kind of like with this patient Sarah with cases like that, It's just so incredibly gratifying because you know, and we know that if that person, you know, didn't get onto that treatment course, they basically would be set up for a life descending into worse and worse chronic illness. And the, the, you know, the mainstream doctors, the, you know, immunologist and the rheumatologist would just be kind of, you know, scratching their head and tossing the next drug, the next drug, the next drug, and, and basically saying, gosh, you know, there's not a lot of options left, you know, and so so we have the opportunity to turn that around and to help these people recover their health, which is really just amazing in my world. Yeah, the chronic infections are a real phenomena.

I think, you know, it's something we really have marginalized in traditional medicine. You know, you either have Lyme disease or you don't. You get three weeks of doxycycline and that's it. I mean, it's sort of not accepted that there's even this sort of long-term chronic Lyme. And we know we talk about post-COVID syndrome, which is this post-viral Lyme syndrome, which can cause all kinds of symptoms, including, I think, potentially inflammatory autoimmune stuff. And I know personally I've had Lyme, I've had Babesia, I've pretty much had everything, mercury poisoning, I get the works. And, I've seen so many patients with these chronic infections that do show up as autoimmune disease and often are neglected by traditional rheumatologists and they can be viral, they can be tick-borne infections, but there are ways to treat them. And often our conventional approaches aren't that great. And, you know, we've used different combinations of herbs and antibiotics, but I, you know, I found some of the more kind of wacky, what may sound like wacky or marginal therapies like ozone or hyperthermia tend to work really well for these really treatment resistant conditions. Some people do respond to sort of a normal approach, but a lot of people don't. And, and, and that's really where the sort of failure of our system is to try look at some of these novel therapies that whether it's hyperbaric oxygen or ozone therapy or transfer plasma exchange or hyperthermia, which they're using in Europe and in Mexico to treat some of these kind of chronic persistent infections.

Yeah, I think it's everything combined, right? We do end up kind of throwing the kitchen sink at folks with these complex chronic illnesses. But, the treatments, any treatment, I believe, works better when you've really dialed in all the lifestyle pieces. You have somebody sleeping better, you have them doing stress management, you have their gut cleaned up and nutritionally, and you've dealt with intestinal permeability. Because what you're doing in all of those pathways is really lowering this inflammatory load. And a lot of the pathogens, they thrive in an environment of inflammation. you know, it's, it's, you know, they crank up all the cytokines, they crank up all the chemokines, and they create this incredible dysregulation and confusion in the body. And as you start to turn all that down, now the pathogens have a harder time thriving. And then any other treatments that we end up doing tend to work a little bit better. And, you know, so I agree with you. There's a lot of amazing options out there. It's still very end of one, right? Like what works from one person doesn't work for the rest. necessarily, which is actually a big area of interest of mine in the work that we're doing with our 501, the Functional Medicine Research and Technology Center. It's like how can we get better at figuring out what works for who and how can we use data to show that, right? Because the COVID era, there were some incredible studies that came out showing that if you look at the marriage, the combination of patient reported symptoms along with wearable data, that you can actually have a much more robust physiological signal. In fact, in this case that we talked about today with Sarah, she had an Oura ring on, which is one of my favorite wearable devices because the fidelity of the signal that we get. We were able to show, as she got better, that key parameters for her heart rate variability, her resting heart rate, improved significantly. Now what we're seeing, not only she's saying I feel better, but we're seeing this physiological signal from her body's set point of her nervous system, of her, you know, autonomic and ability to reset down is much improved, right? And so we're really trying to find ways of how do we get smart about this data? How do we create almost like this real-time data dashboard that the care team, the provider, the patient, and the family can all be viewing in order to really, you know, predict and respond to either worsenings or improvements or temporary flares, you know, how do we figure out how all that data marries together? It's a really fun area to be in.

That's so exciting. So, tell us more about your center, the California Center for Functional Medicine. It's not just California, it's all over, right? It's telemedicine. You can access it from anywhere. It's a pretty unique novel kind of practice. I'd love to hear more about it because people want to try to access functional medicine. often finding difficult. They can't find a provider in their area. It can be very expensive. So you've kind of figured out a different model that I think is very interesting in terms of the kind of things you can do given the limitations of a lot of our practice styles.

Yeah, thanks. Yeah, so we do, we are completely telemedicine at this point. You know, we were a hybrid clinic prior to COVID and then flipped the switch and moved into the cloud basically. But we basically are able to provide care anywhere in the US and we have providers in a lot of different states. I myself have licenses in a bunch of different states and as we add new patients, we expand our access to that licensure. And so we have a really amazing team of providers, doctors, nurse practitioners, health coaches, nutritionists, and we all work really in close collaboration with folks. And so, you know, we're really trying to find a way again to bring this care to more people because I know that functional medicine is expensive and, you know, it is a little bit harder to access because of the intricacies and the nuances of what insurance does or doesn't cover. But we really believe both in, you know, geographical distribution and access, and then also trying to find ways to make it more affordable. And, you know, I love listening to tech podcasts. There's a guy named Balaji Srinivasan who talks about this concept of bundling and unbundling, right? And I think of our clinics right now, your clinic, my clinic, we're still in this bundled phenomenon. We have this sort of path that we want everyone to go down. It's kind of like the equivalent of a university degree, right? But I'm really curious about how do we break that up? And how do we give people more bite-sized segments of this information? to let them start to access that. So we're actually currently developing a new offering. We're calling it the Functional Medicine Checkup. And so we're hoping to launch that by the beginning of the year, which will give people the opportunity to kind of do part at least of what Sarah did, right? Get in with a provider, get some basic blood testing, lab tests done, and get a much deeper snapshot of their body, which we think is really going to set them up for better health. And they can then decide, okay, that's enough. I've got what I need. go with this or they're going to go deeper and join the clinic in a more robust manner. But the idea really again is to get that care to more people and to get that knowledge base out there and have them at least understand, wow, there is another option and I have the choice of what I do with my healthcare.

Yeah, that's really powerful. And you now sort of created something called the Functional Medicine Checkup, which is a very sort of easy on-ramp for people that's affordable, streamlined, and allows more people to access care and getting a functional medicine evaluation. Can you tell us about that?

Absolutely, yeah. So the functional medicine checkup is a streamlined onboarding process that we're looking at. It's going to include two visits with our team and where we will then run a really comprehensive set of labs, probably 75 to 100 different markers that could be run through LabCorp or Quest. So basically, this should be able to be paid for the lab side of it should be able to be paid for by their insurance. And then when they follow up with us, we'll dive in similar to how we did with Sarah and really start to isolate a lot of different factors that could be contributing to their health issues or areas that they can optimize in order to improve their health. So we're working to find new ways to do this as a care team. my schedule is quite busy. Not everyone ends up seeing me, but as people come in and they see our really incredible team of practitioners, we all work together and I help supervise the cases, we all have case discussions, clinician meetings, etc. Which is also just a really fun opportunity for us to collaborate and learn together as a team.

So great, and I think it's really allowing us to sort of begin to have more accessibility and more spread. I think it's coming. We're not quite covered by insurance yet. I'm working on that through my work with policy stuff in Washington, but I think we really have a moment to start to sort of reimagine healthcare for ourselves and take more opportunity to actually engage in discovering how our bodies work through the lens of functional medicine, through the idea of how we create health rather than just treat symptoms and diseases and, and how we can get to the root of some of these really kind of gnarly conditions like autoimmune disease, chronic fatigue, post-COVID, all the things that traditional medicine doesn't do great with. I mean, listen, if you need a new hip, it's great, right? If you get a car accident, it's great. But if, if, you know, you're dealing with these long, chronic, debilitating diseases that we in traditional medicine have very little.

To offer, functional medicine provides a great doorway for people to start think about their health differently. Yeah, no, I think you've done some really amazing, amazing work over the years. You've been such a pioneer. You know, the work that you did, that you and Patrick Hanaway did at the Cleveland Clinic, getting so many people access to functional medicine, the work that you're doing on the policy side with the White House and the food fix campaign, you know, there's so much, you know, it goes so deep, right? Because if you We're talking a lot about autoimmune today, but if you just clean out people's diet like you're talking about, which is the Fix Campaign, and I love that Corey Booker is out there talking about being sugar free. It's so incredible to see. But if you do those basic things, not only do people feel better, but their tendency to then go on and have autoimmune disease, to have cardiovascular disease, to have diabetes, to have cancer, I mean, we're basically like just turning that down, right? And that's just, you know, that education and that personal experience to get that into the hands and the mouths and the forks and the homes of all these people across the world is really just such an incredible gift. So I just thank you for that, Mark.

Yeah, well, thank you. It's, you know, we all kind of are doing our part and trying to make this, you know, basically the standard of care. It takes a minute. You know, I was just talking to Rick Doblin, who sort of was a pioneer in maps, which is psychedelic assisted therapy and studies. And, you know, he's been working this for 40 years. You know, I feel like I'm not quite 40 years yet, but I'm definitely 30 years in. And it's, you know, you know, it just, it was, there was a moment where, you know, this, it was kind of invisible, and now it's becoming visible. And I think people are understanding that there a different way of thinking about health. So it's great that you're doing this. It's great that you've got the California Center for Functional Medicine that makes it more accessible and hopefully people can find you and hook up with your team and get some help and just optimization health or treating these gnarly conditions that really there's very little else to do for.

Yeah. Thank you so much.

Okay. Thank you, Sunja. And it's great to see you again. And for all of you listening, if you like podcast, please share with your friends and family, social media. I'm sure many of you know people with autoimmune disease. Leave a comment. Have you used these kinds of approaches to help you? What are your success stories? We'd love to hear comments from you and subscribe to every your podcast. And we'll see you next week on the doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/pix to sign up. That's drhyman.com/pix, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

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.