The Root Cause Of Autoimmune Disease & How To Prevent It For Longevity | Dr. Sara Gottfried

In a group of people from San Diego who were members of Kaiser Permanente, they found that when they take these people age 40 to 65 and they ask them about adverse childhood experiences using this questionnaire, a score of zero was no trauma, but a score of one or higher was associated with a greater risk of chronic disease.

So Sarah, welcome back to the Dr. Strauss and Company podcast. It's so great to have you here.

Hey Mark, so happy to be here.

Now you've been on quite a journey, my friend. We've known each other a long time and we had dinner last night and we talked about a lot of stuff, a lot of personal stuff about our lives and the transformations that happen throughout our life cycle and some of the big insights we've had about healing and medicine and how we deal with the issues around autoimmune disease and trauma and use of psychedelics and functional medicine. We had this wide ranging conversation Talking about things that are causing so much suffering for so many people. There's so many people who have autoimmune disease, who suffer from trauma, who struggle with all the consequences of our toxic food environment, environmental toxins, and challenges of chronic stress. And living in 21st century and 2024 is not a simple experience for most humans. We're meant to be out there in caves hunting and gathering, and we're just inundated with all sorts of inputs that have dysregulated our nervous system, our hormones, our brain chemistry, our moods. And so we're seeing sort of this global epidemic of chronic disease. And one of the most disturbing things, and this is something I've seen in my practice, is the explosion of autoimmune diseases. Yes. You know, you had your health challenges and you had a high level of something called an ACE score. Yes. And so did I, by the way.

Oh, what was your ACE score?

I forgot. It wasn't like horrible, but you know, it wasn't fun when I was a kid and you know, divorced and there was abuse and incest and lots of things that were very problematic, let's say, that trigger some type of cellular memory that gets registered in your biology. Carolyn May says your biography becomes your biology, meaning what happens to you in your life gets transmuted into biological changes that can create health or disease.

And so, and maybe your mission.

Yeah. Yeah.

Maybe my mission. Yeah, for sure.

Yeah.

So I think, I think in, in the book, the autoimmune cure, you talk a lot about trauma and, and, and maybe a little about your own trauma and what happened to you and in your childhood and how that affected you and how you didn't really figure it out until your 50s and you didn't even know you had this sort of trauma signature, you call it. And I think that We're gonna get into the role of trauma and autoimmunity a little bit deeper right now. And I think it's something we don't really talk about. We talk about leaky gut, we talk about nutritional factors and elimination diets and toxins and heavy metals, but the sort of psycho-emotional spiritual aspect of our lives that drive disease kind of gets short shrift a little bit. But they actually may be front and center and maybe some of the most important things. So what kind of was your story? that led to your autoimmunity. Let's talk about that. And tell us a little bit about the ACE score and how you've uncovered all that and what you've done about it and what you learned in that process.

I can tell you, Mark, from taking care of patients for the past 30 years that I was typical in that I would tell someone, if they were taking a medical history, that my childhood was quite happy.

Mm-.

But when you look under the hood, when you actually use a validated questionnaire, like the Adverse Childhood Experiences or ACE questionnaire.

Yeah, which is online. We'll link to it in the show notes.

You can go take it right now. And I really, you know, if you learn nothing else today, I hope you.

Go take the ACE. Not while you're driving, if you're listening to this driving, but just go home.

And get on your computer and take the ACE score. You're gonna be enlightened.

Yeah. Yeah.

So this is one of those tests that you don't want a high score on. You really want a zero. That means that you are not exposed to significant childhood trauma. So the ACE questionnaire is a 10-point questionnaire, at least the one that was originally studied by the Centers for Disease Control and Kaiser Permanente. So on this questionnaire, they're asking about things like you mentioned, divorce, physical abuse, sexual abuse, having a parent who was in an addictive process, having a parent who went to jail. So there's not everything is covered in terms of childhood adverse experiences. It could be mild stuff like did.

Your parents swear at you, did they yell at you, did they insult you, did they put you down?

Neglect, maltreatment.

Neglect, so it may not even be like sexual abuse or anything like that, but it can be like, you know, my stepfather was a rageaholic and it was like terrifying, so that registered in my nervous system.

It does, and you know what was striking about this original study that was done in 1998, is that they found in a group of people from San Diego who were members of Kaiser Permanente, so mostly middle class folks, they found that when they take these people age 40 to 65 and they ask them about adverse childhood experiences using this questionnaire, a score of zero was no trauma, but a score of one or higher was associated with a greater risk of chronic disease. So not just what you might imagine, like depression, post-traumatic stress disorder, anxiety. But actually the chronic diseases that kill us, more than 45 of them. So coronary heart disease, cancer, autoimmune disease for sure.

Obesity.

Alcohol use disorder. Obesity.

Diabetes.

Diabetes. So many different conditions. And that was really the first time that we were connecting the dots between Childhood trauma and the risk of chronic disease later.

Yeah. Yeah.

And it's so important. So what was your particular story in this way? Do you want to share it?

Yeah, sure. So the punchline is my ACE score is six, so it's pretty high. And I've got an increased risk of pretty much all of those chronic diseases, all 45 of them. And the way that I came into this work was that I had a falling out with a family member. Someone that I adore and love. And we had a disagreement and we became estranged for about a year. And this was about five years ago, and it was right around the time that we started to see some of the data coming out on MDMA assisted therapy. And we were starting to see that some of these novel treatments for trauma are about double as effective as the gold standard or more. And so that really got my attention as a scientist, and I applied it to my own situation. I thought, you know, if there are things in my history that are driving my behavior and relationships, and I have the opportunity to heal them, I'm gonna do it. So yes, I wanna reduce my risk of these 45 chronic diseases, especially autoimmune disease, But I also want to heal this relationship. And I want to do everything on my side of the street to show up as the best possible person who's not driven by behaviors that I learned as a child.

Which pretty much is how we all operate. We think we're grown-ups, but there's actually that little kid inside of us that wasn't loved enough, that wasn't seen, that wasn't acknowledged, that was maybe beaten or worse. And that's the human that we tend to be as we get older, even though we get gray hair, we get wrinkles, we basically still are that little kid and are responding from that adapted process. And I developed some very successful adaptive strategies as a child to stay safe.

Right?

But can we talk about that? Because this, I think, I'm going to get a little quieter here because it's vulnerable, it's really tender, but there are so many ways that People like you and me get exposed to trauma. And the way that we get attention, the way that we get love as children, is... -To Harvard and Cornell. -Well, certainly is to achieve. And also to start to sacrifice authenticity, to remain connected and attached.

-To not tell the truth.

-To not tell the truth and to become hyper independent. self-reliant a lot of different behaviors that may be lauded by our culture.

Yeah.

And lead to a lot of, you know, educational success. But they may not really work in terms of your biology.

No, no, no. And you and I both been sick, and we both had to deal with it. And, and I want to get into what happened to you. I just, you just reminded me of a, a story about my my childhood, I was, you know, someone who had to just be completely self-reliant my mother was depressed, my father was absent, my stepfather was a rageaholic. So I literally had to take care of myself physically and emotionally. And- At what age? Like starting at five. Yes.

Incredibly young.

Yeah, starting at five. And I think it just, and, and I realized, you know, I just always took care of everybody else. Yes. And, managed everybody else and didn't really have anybody watch out for me or take care of me. And after my one of my divorces, I was sitting on vacation with a bunch of friends in Nantucket and we were sitting in the kitchen and there's a friend of mine who had since college and his wife I've known since college and you know, these very good friends and we're sitting at the kitchen counter and it was like lunchtime. She says, Hey Mark, do you want me to make you a sandwich? And I burst into tears. I literally burst into tears because no one had ever asked to make me a sandwich.

Oh, Mark Hyman, I want to make you a sandwich.

Don't worry, I got a buffet. I've got a 10-course tasting meal going on in my life now. I'm good.

Yes, you do.

I'm good. But it was such a shock to kind of recognize that that was my internal architecture and how I needed to really shift that and to look at that and heal that and see what that was about. that was sort of a beginning of a real journey for me over the last 10 years to sort of unpack all this. And, you know, I had chronic fatigue syndrome, I had mold toxicity, I developed autoimmune disease, I had ulcerative colitis, I had positive ANAs, I had the whole kit and caboodle. And don't worry, guys, I'm fine. I'm like good as new, better than average, and certainly better than I was.

For the last three years.

I'm healthier and stronger and happier than ever. I guess I've ever seen you. Yeah, I'm good. And I've seen also when you look at the data from a hundred years ago, and you look at the data from now around the prevalence of diseases, then it was mostly infectious diseases, tuberculosis, and people died from all sorts of measles, and all the, we have now vaccine preventable diseases. And at the same time as those diseases have gone down, we've seen this incredible explosion, almost exponential growth of autoimmune disease, allergic disorders, inflammatory diseases, and that is, you know, kind of a puzzle for modern medicine. And one of the things that we haven't really answered is why. So, you know, as doctors and the healthcare system, we're like a bunch of janitors mopping up the floor while the sink's overflowing. And nobody's thinking, well, why is this happening? And how do we turn this faucet off so the floor doesn't keep getting wet? And I don't think mopping up the floor with powerful drugs and medications and interventions and surgeries and so you and I both have, you know, had conventional training. I went to Cornell undergraduate, you went to, I don't know, Harvard or something like that, some third rate school in Boston. And, you know, you, you know, we've both come to understand that our current medical Paradigm is deeply flawed and that it doesn't address the root cause of disease and it doesn't create health for patients. It just mitigates symptoms in ways that often, you know, don't really relieve a lot of the suffering. They may help ameliorate some of the symptoms from here and there, but they don't really deal with the problem. And so you and I both kind of landed up in this universe of systems biology, systems medicine, functional medicine, rethinking the operating system of healthcare and medicine and biology and understanding the laws of nature when it comes to biology. We're talking last night about the nature of nature and the mind of God and how we finally have insight into the way our biology works, just like we had this transformation in physics at the turn of the last century with Einstein and Bohr and Heisenberg changing our whole conception of space and time. We are now at that moment in medicine, and nobody's really kind of aware of it. It's like a secret.

Well, you and I, you and I.

A few of us weirdos out there are doing this and talking about it. And what we've seen by applying this model is, nothing short of miraculous. And, and it, you know, we're going to share some stories and some cases of our, of our practical clinical experience as a way of illustrating that there is a way out of this. Like, we're not doomed to suffer from chronic disease. We're not doomed to suffer from the ravages of autoimmune disease. And, and there's a way out. So we're going to get deep into this today. I know I'm going in a little bit of monologue, but I'll let you talk in a minute.

I love it.

And And I know one of the things that sort of we don't recognize in medicine is that disease doesn't just start like that. It's not like one day you're fine and the next day you have rheumatoid arthritis, or one day you're fine and the next day you have MS, or one day you're fine and the next day you have ulcerative colitis or lupus or whatever autoimmune disease you have. There's this gradual shift in your biology towards dysregulation, inflammation, and there's a continuum from wellness to disease. and along that continuum, we can intervene earlier.

Yes.

And I co-founded a company called Function Health, and we've now collected over 3 million data points on 20, almost 30,000 patients. And, you know, it's something people can access themselves. They go to functionhealth.com/mark. You can get in past the waiting list. It's 150,000 people on the waiting list and get your labs done. And what we're finding is that 30% of the people have positive ANA.

Yes.

30% have positive marker for autoimmune disease.

Huge increase in the last two decades. Yes.

And 46% have high elevations in C-reactive protein, which is a cytokine marker for inflammation. So I'm like, whoa, this is bad. And this is not necessarily an even an average sample of the American population, which is a lot sicker than this cohort. This is a health forward group who's interested in their health, who wants to be proactive, who probably has more or less a healthy lifestyle. Not everybody, obviously, but, you know, we're talking about 30, 000 people who don't necessarily represent the sickest of the sick. And they're early adopters. Yeah. And that group, we're seeing 30 have some level of autoimmunity. We call it pre-autoimmune disease, or maybe some have more. 13 have Hashimoto's, which is an autoimmune thyroid condition, and they don't know it. Yes. And, and this inflammation levels are out of control. So, Sarah, why don't you tell us why do you think we're seeing this incredible explosion? This condition, autoimmune disease, and it's grouped together. It's probably when you add in all of them because they're all in different specialties, so we don't really think of them as a group. When you add them all together, the number of people suffering with autoimmunity is greater than the number of people with cancer, heart disease, and diabetes combined, right?

I would say that if we go back to first principles with functional medicine and we look at root causes and we invoke Alessio Fasano.

Yeah.

And what he has found with autoimmune disease, he talks about a three-legged stool that's required to develop autoimmune disease. He's a, he's a, just for those.

As people don't know who he is, he's been on the podcast. We'll link to the show notes of his podcast, but he's a, he's the.

World'S expert on celiac disease and he's at Harvard. He's just a brilliant Italian scientist. Yes, pediatric gastroenterologist. And so he talks about how you have to have genetic predisposition combined with increased intestinal permeability, so-called leaky gut, and then a trigger. And I would say those latter two are the two that I get interested in because that's where the empowerment comes in, because you can do something about it. So leaky gut, we've got lots of treatments that we can use to deal with that. But the triggers are where things get more interesting, because for some people that could be an infection, like we just made it through the pandemic, it could be infection with COVID it could be a hormonal change, such as pregnancy, postpartum, perimenopause, those are really common triggers and lead to a fair amount of dysregulation in people. It could also be toxic stress and trauma, which is what I was seeing in my practice.

Yeah, right. You know, as a functional medicine doctor, you know, we have a different set of questions we ask. We don't ask what disease you have. We ask why do you have that disease? And why, rather than asking the question of, okay, you've got an inflammation that's out of control and your body's attacking itself, let's give you a drug to shut off your inflammation, like a steroid or a cancer drug that we use like methotrexate or worse, Humira, which is, an immune modulator that can potentially lead to unrelenting infections and death and cancer growth. So there's no free ride here and there are $50,000 a year to take these drugs. Rather than saying that, we say why is this happening and why is my immune system so pissed off? And you listed a whole bunch of reasons. Our diet, which changed our microbiome, that changes in our food supply, like the changes in wheat that's caused all sorts of damage to our gut through increased gluten molecules and leaky gut. We have toxins that are all around us. There's more toxic exposures than we've ever had in history of humanity. We're trying to deal with that. And those are immunotoxins and they can cause autoimmunity. We have infections like you mentioned COVID. So post-infectious autoimmunity is very common. We're seeing a lot of that with COVID and we can actually measure those antibodies. we have other things like lime or mold cause autoimmunity. So it's not like there's one thing, but it's many things, right? And stress and trauma, we're going to talk about that. So you add all that in, it's this incredible soup that creates a perfect storm for all this autoimmunity. But the good news, as you said, is it's actually treatable. It's we can actually do something about these things. And that we're just victimized. And that's one of the things that drives me crazy with traditional rotology is they're like, oh, you've got this autoimmune disease, you're going to have it for life.

Right.

Let's manage your symptoms.

Right.

There's no way back. Like, okay, sorry Charlie, you just got MS or you just got rheumatoid arthritis or you just got lupus or you just got whatever and there's no way to reverse this.

So we're gonna have to just manage it. And that's such a disempowering message. You know, I just really feel for people who are sitting in that rheumatology office and they're being told with their rheumatoid arthritis that Here's your life sentence of taking pharmaceuticals. And no one's talking about an elimination diet. No one's talking about some of these other immune modulators that you could consider. So that frustration is something I really resonate with. And as you described, it's not like a switch that goes off and you go from perfectly healthy and normal to rheumatoid arthritis or one of the other 100 autoimmune diseases. It's this progression. And I'm one of those people, the 30% that you just described, who's got those positive anti-nuclear antibodies. So making antibodies against the nucleus of my cells. And so that's when you want to intervene. You want to intervene as early as possible and do the kind of testing that you and I offer so that you can get a glimpse at what's going on with the immune system and intervene as early as you can.

Yeah, it's true. We don't, we don't know how to get to the answer with our traditional approach. And I was with Eric Topol yesterday, who's one of the Giants in medicine in San Diego, and he, he sort of, you know, talks about AI in medicine and the doctors of the future. And he's sort of a medical futurist, a brilliant scientist at Scripps Translational Research Institute. And, you know, we're talking about how do we, how do we build a system where people can like with function, how do you build a system where we can program into the AI, the future paradigm of medicine, not just how to give better drug or how to match the drug to the person in a more appropriate way, which is important, but how do we actually get to the right answer? So if someone comes in with, let's say, rheumatoid arthritis, the rheumatologist isn't doing heavy metal testing, isn't looking at the microbiome and doing stool testing, isn't looking at food sensitivities, isn't looking at the chronic infections that could be triggering it like Lyme or maybe post-COVID. They're not paying attention to those things. So it's like, okay, you just have an autoimmune disease. You have these antibodies, you have these symptoms. This is what you got. I gave you your condition name. That's what's causing your symptoms. But it's not the cause, it's just a name that we give to people who share a collection of symptoms. And so we have to think differently about this. And that's what functional medicine is, is a different way of thinking or navigating the landscape disease to get to the root cause. So we do a lot of different things and we do a lot of different things that actually helped us to figure out the root cause. So when someone comes in to see you and they've got, let's say, MS or they've got lupus or they've got alopecia areata, which is you'll lose hair everywhere in your body, your eyebrows, your pubic hair, your head hair, everything. What do you do for that patient?

How do you start to approach that patient? Well, first a history. So In functional medicine, we take a particular type of history. We're building out a timeline of what's been the progression to this point. And we're looking at antecedents, what are some of the genetic issues that might be important for this person? What are some of the triggers? And then what are some of the mediators that could be affecting their symptoms, the constellation of symptoms that they have? With triggers, what I'm always listening for, and I was taught this at the Institute for Functional Medicine, I was fine until... Yeah, right. Right, blank, blank, you know, dot dot dot. So that's the moment that I'm really listening for in a history. And then I work in a... I'm the director of precision medicine at the Marcus Institute of Integrative Health. So there I do a lot of testing because I'm mostly seeing executives and professional athletes who also are suffering with autoimmune conditions. And so, I do genetic testing, I do biomarker testing, and that includes stool testing, looking for heavy metals, nutritional testing. You know, the full gamut. Hormones, of course, I'm looking at, I use Dutch Plus for most of my patients, male and female. So that's kind of the panel. And part of the biomarkers, and this has changed for me in the past 20 years, I run an autoimmune panel on every single patient. Because as you described with function, there are so many people who've got pre-autoimmune conditions or pre-autoimmunity and we want to start to address it.

What are you doing for the autoimmune markers that you look at to screen?

Well, I look at inflammation, so inflammatory tone, high C-reactive protein. I'm looking at the neutrophil to lymphocyte ratio and I look at the white blood cells. I'm looking at Sometimes sed rate, ESR, I look at... And that's a marker.

For how basically thick your blood is and how long it takes to settle. And if it's high, it means you've got inflammation in your blood.

Exactly. So I run anti-nuclear antibodies. I look for Hashimoto's because it's so common, especially in women. So thyroid peroxidase antibodies, antithyroglobulin. And then I usually run a rheumatoid factor. depending on whether they've got some joint issues, a few other tests. That's where I start in the blood. And then I'm also looking in the stool for bacteria that are associated with autoimmunity. I'm looking for dysbiosis and imbalance of the good and bad bacteria. I'm looking at gut function.

Yeah, that's exactly what I do. And I think the one thing I do often, in addition to those autoimmune markers, and by the way, ANA and nuclear antibodies that means you're attacking your own nucleus. It's like you're attacking your own body. That's what quite commonly is. You're, you're, you're basically rejecting yourself. There's some level of self-rejection we're going to get into the sort of more sort of psychological, metaphysical framework around that because I think there's something to it and around trauma and our past history and who gets autoimmunity. But I think, you know, we also, we also look at a celiac panel. We look at gluten antibodies. So I on function health panel, all those things are included. celiac you can get as an add-on, but essentially all those things you mentioned are just standard and they're not done by your traditional doctorate, your annual physical. That's right.

Right?

And so it's important to get a sense of what's happening. And like you said, we're, we're looking, we're finding. And I think that just speaks to the level of, of sickness in our population and the need to do something about it. And, and then you start, have started digging, like you said, to the root causes. You know, one of the, one of the, you know, and what do we, we do a lot of different things to help people. We elimination diets, we treat the heavy metals, we fix the gut, we do all this stuff. We'll get into that. But I sort of want to sort of go sideways a little bit and talk about, you know, what's sort of unspoken. And I think, you know, when you mentioned history, and history is so important in a medical evaluation because you want to know a person's story and history, right? His story or her story.

Right.

And so the, that's so critical. You want to know like, what their ancestors were like. Did their parents, were they survivors of, were they children of survivors of Auschwitz, for example, where there's epigenetic changes that program in things to your biology. What was your mother eating during pregnancy? Did you breastfeed? Did you have a C-section? Did you take antibiotics as a kid? Did you have colic? Did you have eczema? These are all clues. Did you have allergies, irritable bowel syndrome? And then we start to see this pattern in these patients, and I'm sure you've seen the same thing, They all kind of have a similar story of like this sort of low, slow breakdown and increasing inflammation where it ends up with an autoimmune disease when they get in their, you know, 20s, 30s, 40s. And it's kind of a striking pattern. And one of the things we often do, and you mentioned this in your book, the Autoimmune Cure, which I think everybody needs to pick up a copy, is available now, get it everywhere. It's a really profound book that explains autoimmune disease in a way that I don't think ever has been explained. in a very comprehensive way that looks at all the things we just talked about and the psycho-emotional states and trauma and how to deal with those things with novel ways and novel treatments that we're gonna get into in a little bit. So if you stay tuned, you'll hear all about that. But tell us your story. Like, what was your story and what happened to you health-wise and how did you connect the dots back to the trauma? You know, maybe it was the ACE questionnaire, maybe it was something else, but I think it was really important to hear, like, what did you go through and how did you navigate it?

How did you heal?

What was your path?

My story is a bit different from yours and definitely there's a female lens to it. So I would say the way that I started to track my trauma without realizing that I was tracking my trauma was in my 30s. So I had my first baby and I really struggled postpartum. So I had depression, postpartum depression. I had, weight loss resistance. I just couldn't lose the baby fat. I had a lot of belly fat. I had, I just felt way too young to feel so old.

That's a great line. I felt way too young to feel way so old. How many of you out there feel that?

Oh my gosh, well I was 33 and at 33 you don't want to feel like an old lady. And so I didn't sleep for about a year. I remember my mother saying to me and pretty much everyone I talked to, sleep while the baby sleeps. And I just couldn't. My system was just so revved up that I just couldn't. And so I remember going to my doctor with my list of woes and he said, Probably hormones, why don't you go on a birth control pill? And how about you exercise more and eat less? And how about a selective serotonin reuptake inhibitor?

Prozac. How many of you all heard that when you went to the doctor? Take Prozac, take a drug. you know, it's your fault you're overweight because you're not eating the right way and you're not exercising enough.

Right, right. And it's, you know, at the moment.

That'S a victim blaming a little bit.

It's a bit of blaming, but it was also such a turning point for me because I realized after I got over kind of the humiliation, the flush of shame with what he was offering and suggesting to me, I then got angry. the kind of righteous indignation that leads to a change in conceptual model. And so I left his office, I went to the lab, and I ran my first hormone panel on myself. My cortisol was three times what it should have been in my blood.

That's your stress hormone.

My stress hormone was super high. My glucose was about 110, and I was fasting.

That's pre-diabetic.

That's pre-diabetes. My insulin was in the 20s.

Wow.

I had girl. thyroid function that wasn't up to snuff. My TSH was like three. And I was around the time of ovulation. My estrogen was on the high side. My progesterone was nowhere to be seen. It was super low, like 0.1. And so I had this constellation of symptoms that I've written quite a bit about. It was sort of my portal to-.

Yeah, you wrote a book called Hormone Cure and I don't know about mood and food and hormones in women, right?

That's right, but I would say if we look upstream, there was a level of dysregulation that was driving those hormone imbalances. There was a level of nervous system dysregulation, and it turns out, I learned later, immune system dysregulation. So when we think about the vulnerability of the human body, I like to conceptualize it as the pine network, the psycho-immuno-neuro-endocrine, network. So your hormones are part of the story, as I described. But if I also was measuring my heart rate variability at that time, I imagine it would be really low.

Yeah.

And I didn't check my anti-nuclear antibodies at that time, but there was this backstory in my system of this research.

By the way, as doctors, we're trained not to test those things unless someone already has a disease.

That's right. That's right. Yeah, the paradigm is shifting. So that was really my first insight into dysregulation. And I started to look for it in my patients, and I was surprised to find 98% of them had dysregulation of some degree. I focused on hormones. That was kind of my way into this work. But the hormones are just the beginning.

Yeah, just beginning. But, you know, Sarah, it's important when you said that you checked all these different hormones in ways that are not typically checked by your regular doctor. you checked insulin, you checked cortisol, you checked your thyroid function in a different way. You looked at thyroid antibodies. You looked at various markers that are not part of a typical checkup or panel. And it's definitely part of what we do in functional medicine. It's what we offer on the standard panel in functional health. And we're finding stuff like exactly like what you're talking about. And it's disturbing because it means there's a lot of people walking around there suffering who don't need to suffer. that there are simple ways to understand how these things go awry and how to fix them. So in your case, how did you come to understand what to do and what happened when you did those things? And what were those things that helped you get back to health? Because honestly, you look better than I've ever seen you, too. So it's like, we're just both getting older. We've been known each other for, like, over, I don't know, 10, 15 years.

Yeah.

And it's like, I'm like, wow, she looks great.

And we better than ever.

And we feel, yeah, you're vibrant, shiny, happy. I'm like, yeah, your skin looks different. I mean, you just look great. And I'm like, wow, something she's doing is working.

Yeah, well, thank you for that. And same back to you. So I, you know, that kicked off, I turned left from conventional medicine. I'd always sort of had this thread of integrative medicine. I grew up with a great grandmother who took me to yoga class and I was a whole foodist. So I always had a thread of that. I went to Kripalu.

Yeah.

All through medical school just to survive.

I'm glad I didn't see you there.

I know. I was there all the time. So I had a sense that there was another way of being. And, you know, especially I would say out of all of those things, the cortisol and the pre-diabetes worried me the most.

Yeah.

So I was at that time a board-certified gynecologist and so. You know, topping off my progesterone, taking some herbs to do that, like chasberry, that was pretty easy. But this cortisol and insulin issue really got my attention. And I started to research, okay, what are the randomized trials, multiple randomized trials that are concordant that can help me with this cortisol and insulin problem? And I changed the way I ate. So I started, I never found that the Mediterranean diet was a good fit for me. It was just too many grains, too many carbs. And so, I started to modify and personalize the Mediterranean diet, more low carb, more healthy fat. That seemed to make a difference. This is before we were using continuous glucose monitors and non-diabetics. That'll come later. And what I found, which I think is interesting and relevant for our listeners, is that I could improve my cortisol significantly. So I picked up meditation again. I became a certified yoga teacher. I took phosphatidylserine, I got religious about taking fish oil, all the things that have been shown to reduce cortisol. And I would take three steps forward and then I'd have a conflict in my marriage and I'd take two steps back. And I started to notice that these changes that I could make with my hormones, with cortisol and with insulin were not durable. And it was that lack of durability that I noticed in myself and in others.

So many patients, yeah.

That I got to this point where I felt like, we've got to look deeper. What about trauma? Could trauma be the through line that leads to people improving and then backsliding?

Yeah, interesting, interesting, interesting. And you talk about the sort of deep connection in your book, the Autoimmune Cure. Like I said, everybody gets that book because it's not just about autoimmunity, it's really about what's happening in our society with our food, environmental toxins and trauma. functional medicine and as a way of navigating any chronic illness. You could be called the anything cure. And basically, and, and you, you talk about the sort of Discovery, as you just mentioned, between trauma and autoimmunity. And, and we kind of knew that from the literature, but there's mechanisms we now understand. And, and you talk about the, this four primary ways to connect the dots between trauma and autoimmunity through this. thing you just briefly mentioned, the pine thing. You just kind of whiz through it, but psychology, immune system, your nervous system, your endocrine system, and you can even add your microbiome. So it's PIMM, maybe. And all of those things are basically transducers, transmitters of the kind of psychopharmacology of your brain. And that leads to systemic dysregulation. Unless you fix that, software and you can fix it. And by the way, in medicine as a doctor, you know, psychiatry is sort of in the dark ages, and we have really crummy ways for dealing with people with trauma, PTSD, with, you know, not even PTSD degree trauma, but just kind of garden variety trauma, which most of us have to some degree. We, we have, you know, drugs that really don't work that well, that have tons of side effects. And all of a sudden, like we're beginning to understand there are different ways through. So talk about the way trauma actually does biologically impact you through this pine, let's say, I'll call it pinum system.

Yes.

But yeah, talk about that.

Well, there's a number of different ways that it can change the signals of the body. That's kind of how I think of it, that you've got this vast communication process in your body. And when the signals become disrupted or dysregulated, that's when it leads in the future to some of these chronic health conditions. So that could be the insulin signal, it could be the way that your immune system is regulated, it could be the way that your vagus nerve fires. So there's lots of different ways that the signal becomes dysregulated. I think the way I think of it is I'm gonna describe Gabor Mate's way of thinking about trauma. He talks about how it's not so much what happened to you, you know, my A score of six, your A score of whatever it was. It's the way that the adverse experience, this overwhelming experience, lives on in your body.

Yeah.

This trauma signature. And so this is...

He also talks about, it's not the thing that happened to you, it's the meaning you make from what happened to you.

The meaning you make, also the people you were surrounded by, you know, some people have a lot of trauma exposure, but they've got adults who are incredibly helpful at processing that trauma in the moment with them or shortly thereafter. So there's, there's a lot of different factors than just what's your ACE score. But I think it's, it's critical that, and I want to challenge our listeners to have a sense of, do I have dysregulation in my body right now? Is my immune system as healthy and optimized as it's meant to be, is my nervous system functioning correctly. And one of the ways I track it is with my ring. Is my endocrine system, is it the wind at my back? Because that's really what it's meant to be. It's not meant to be this bully, like cortisol that's just wreaking havoc throughout your system.

Yeah, a hormone that's supposed to help you, right? So you have to kind of look at at these sort of mechanisms that our body uses to listen to the thoughts that we have, right? Every cell in your body is listening to your thoughts and it's registering those thoughts and it's changing their function based on those thoughts. So it changes your microbiome. Your thoughts change your immune system. They change your hormones. They change, obviously, your neurotransmitters and your neurologic function. and so, you know, when you, when you realize that, you know, then the question is, how do you tame the monkey in the mind? Because once you have the Insight, oh, okay, you know, I, I've done everything I can for this patient, and they're not getting better, and I don't freaking get why. And I've done all the normal things and everything looks good, but this is just this patient stays in this stuck cycle. And, you know, those patients, we've had those patients. And, and you're like, well, gosh, I, you know, this normally works for people, so why did this work? and, and if you go down the trauma rabbit hole, you usually find something. You start asking the right questions. If you create a safe space to do that, and if you understand that, then, then, you know, you know, what do you do? Because therapy doesn't seem to work. And a lot of people do therapy, and it's like, okay, you need psychoanalysis five days a week for the next 40 years, and then you're gonna be okay. I'm like, well, I don't know about that. Can I do something else? And so, you know, we're seeing, we're seeing a whole new era of thinking about how we deal with the, well, psychological and emotional and spiritual effects of trauma. But, but I would suspect that we're going to see the medicines that we're using for that, which we'll talk about in a minute, also work for other conditions. We had a little brief conversation about that last night. I want to get into that because I'd never heard anybody say that and I want to get into that, but we're talking about is psychedelic medicine. And I want you, before you get in, I want you to talk about why pharmaceuticals and talk therapy kind of may not be enough and that we really need to think differently about our approach to trauma and particularly it's linked to autoimmunity.

When I was in my 20s, I started talk therapy and I've done decades of talk therapy. as well as couples therapy. And what I found was that talking about my relationship with my mother or relationship with father, like it just seemed to reinforce the trauma instead of actually healing it.

You relive all that stuff.

Yeah, you relive it. And that's what's been found in the research, that there's an understanding part of the brain that is different and separate from the healing part of the brain where the trauma resides. And so when you keep that in mind, I looked at the gold standard for post-traumatic stress disorder. I don't take care of a lot of patients with PTSD, but I have a lot of people with partial or sub-threshold PTSD. And the gold standard at the time that I wrote the book was talk therapy, sometimes trauma informed, but mostly talk therapy with or without selective serotonin reuptake inhibitors.

Which talk therapy can actually make it worse sometimes.

Right?

That's right.

Yeah.

So it's, when I looked at the efficacy of these interventions, they were around 30%.

Right.

And I feel like if I was.

Told, by the way, that's about how much you get from a placebo.

Exactly. And if, if people are told, if they're really given informed consent before they start talk therapy, I mean, there's some talk therapy that's incredibly helpful, but if they're told, like, in my 20s, if I was told, you've got a 30% efficacy. You're going to come once a week, you're going to spend thousands and thousands of dollars. It'll take decades and 70% chance it's not going to work. I never would have done it. So that doesn't work. And it sets us up to start to reimagine what might work.

Yeah. So what are we reimagining in 2024 about how to deal with not just the psychological aspects of trauma, but maybe some insights into the biological benefits of these new therapies. Tell us where you're going with your life, what you're doing, and why you've come upon this sort of whole world of psychedelic therapy.

Well, I would broaden it to healing states of consciousness. I think there are ways that you can use breath work, you can use EMDR, there's lots of therapies that can be very effective.

Meditated in a cave for 40 years.

Meditating in a cave for 40 years. And yet, I would say that the most effective, the greatest accelerator that I've seen is psychedelic assisted medicine. So what's happened is that I was a total square. I was telling you at dinner last night, like I never smoked pot, I never took any mushrooms in college, like nothing. I was in the library. I know, it sucks. I got to it at 50.

Oh my God.

I got to it at 50. And maybe that's what I needed. That's my divine timing.

Wow.

So I've become certified in psychedelic assisted treatment. I've gone through probably somewhere around 15 rounds once a quarter of MDMA assisted therapy.

I've got- Wait, did you say 15 rounds once a quarter?

Once a quarter. Yes.

For yourself.

Yes.

That's a lot.

Well, I had some trauma to excavate and to process and, you know, sort of re-pattern in my system. And I felt based on the data that nothing was effective, as effective as MDMA assisted therapy. And I did it with a psychologist. But it's also, you know, I feel like we should Be somewhat circumspect here. There's an above ground way of doing psychedelic assisted treatment and ketamine is the main thing that is above ground and FDA approved, although it's used off label. Yeah, we hope we expect that MDMA is gonna be FDA approved for the treatment of trauma for post-traumatic stress disorder sometime in the next year and then a lot of these other treatments such as Ayahuasca, Psilocybin are for the most part below ground. Yeah, some states are legal. Oregon, Colorado.

Yeah. Amazing. And so these compounds like ketamine is interesting because, you know, it's one of the things that's approved for treatment resistant depression.

Yes.

And you take one dose and it lasts for a long time, which is really fascinating because it's like if you have high blood pressure, you need to take the drug every day.

It's a completely different way of thinking about it.

It doesn't make sense to us, right? It's like how do you take a drug one time or two times and have profound long lasting effects? What's going on with that? And how does it work? And it's sort of interesting to me that these drugs aren't just working on your psychology, they're working on your biology.

That's right.

So can you talk about how we can think about using those to address trauma, how people start to think about it, where can they kind of learn more? And what are the kinds of things you're seeing? Maybe you can share a few stories from your practice about what has happened both to you as a result, and then also what's happened to your patients as a result of exploring these therapies, which very soon will be legal. I promise you all that. There's billions of dollars in the space of research. There's many FD applications for new drug applications for these things. lots of people working on this in a massive scale. So even though it sounds like, oh my God, drugs and psychedelics and oh my God, did you take LSD and jump off a building and run in front of a train?

Well, that's not true. Well, they're safer than alcohol. They're safer than horse riding. That's like a David Nutt quote.

Yeah. Oh, damn, I love horse riding. Yeah, I just came back from cow herding in Argentina, which was a lifelong dream on Beautiful horses cowering in the Argentinian ranches. But the safety is quite interesting. There's something called the LD-50 in medicine, which is what is half of the lethal dose? Like what's the dose that kills half the animals getting the drug? And they're like basically is none. It's like they're just safe.

Yes.

Yeah.

So with ketamine, you mentioned these people who take ketamine maybe for depression or some other indication and they've got these benefits. You know, there's a lot of people who do ketamine for six weeks, like a weekly treatment. But what's interesting about ketamine is that we think it increases neuroplasticity. So it's not just a psychological effect. It seems to take, you know, if you think of downhill skiing and the grooves that you create and maybe you just keep going down the same grooves on the mountain, We're getting to fresh powder, and that's super exciting. So to be able to go down the mountain of your life on fresh powder. Do you like to ski? I like to snowboard. And I love powder.

I love powder.

Yeah.

So what have I found? I found that I'll tell you about one patient in particular.

Wait, start with you.

Start with me. Okay. Bring me back here.

What happened when you went through that in terms of your own, not just psychology, and getting free of those old stories and patterns and well-worn grooves. But what happened to your health and biology?

So.

I'm a total nerd, as you know. And I like to track things pretty carefully. And I can tell you that when I take ketamine, when I do ketamine-assisted treatment, my physiology changes. My blood sugar is better. my heart rate variability is improved for the days afterwards, week, weeks afterwards. There's a lightness of being that just feels lovely. With psilocybin, similar results. So really stable blood sugar. I noticed that there's kind of this lift that lasts for a long time, and that's been shown in randomized trials with people who are, who've got a fatal cancer diagnosis and are using psilocybin and trials that are done at NYU. We know it's also helpful for depression. There's a JAMA paper that was published last year on this. MDMA-assisted therapy, what is so striking to me is the way that it changes how trauma drives my behavior. I'm just less reactive. I'm much more in the present moment. And another thing that it did for me that was inspired by a conversation with a friend is that it got me to realize, you know, I knew a lot about secure attachment, avoidant attachment, anxious attachment, and I felt in my body after MDMA as therapy, I want secure attachment.

Yeah.

It's enough already.

Yeah.

I don't want to just have the book learning and the cognitive understanding.

I want to feel the physiologically. Physiologically, yeah.

I want the regulation of that. I want to be in a relationship where we've got that co-regulation.

Yeah.

Like a mother does with the baby, you can have that in a relationship. Yeah, absolutely. So that was a huge paradigm shift for me. Amazing. To realize, okay, I want secure attachment. And so that changed everything really. Yeah. And, you know, my vulnerability is this cortisol insulin issue that I mentioned. I've got the positive anti-nuclear antibodies. and what I've done is test myself, science myself all through this process of using psychedelic assisted treatments. I now have negative anti-nuclear antibodies.

Amazing.

My blood sugar, mean blue glucose is less than 95. The variability is less. I don't spike like I used to. I feel more embodied. You know, I used to spend all my time upstairs and also a little functionally dissociated.

Yeah.

Which frankly we select for in medicine.

Yeah, right.

Like it's really helpful to be functional.

If you kind of ignore your body, it's actually an asset because you have to drive it into the ground to get through medical school. Right.

So I'm not dissociated anymore. I am in my body. I just, I feel everything, which, you know, at times can be difficult because I'm really sensitive. But, you know, the thing about sensitivity and being so present is that you know, we're like orchids, people with this kind of sensitivity. And when an orchid has the right environment, has the right light, is facing North, gets the right amount of water, gets kind of spritzed. They bloom and they bloom and they bloom and they bloom.

Yeah.

And that's what I feel in my body, and that's what I want for my patients or for people who are on this journey.

Yeah.

You know, it's a lot of the doctors who are in this space have had these challenges, right? and they're like, well, gee, everything I learned in medical school isn't quite working, and I don't know what to do, but I'm going to find something else. And sometimes it's a kind of wandering in the dark in the desert for decades. But we get there, and you got there, and you were able to, I mean, reverse a lot of the things that were happening to you and do something that isn't, quote, possible in medicine, which is reverse autoimmune antibodies. And I've seen that over and over. So tell us a patient story where you've seen this. whether it's just the combination. Because it's not just like, oh, you can still have heavy metals and eat tons of gluten if you're sensitive and your gut can be a mess, but if you just do psychedelics, you're gonna be fine. You can't just do that. It's a holistic approach, right? And you talk about that in the book. I want to talk about how you break the vicious cycle of autoimmune disease and reset your system and reset your immune system and restore your health. But I want you to start with maybe a story of of that. And, and by the way, everybody listening, you know, there's been many podcasts I've done with people in the psychedelic space, from Michael Pollin to gabarmate talking about trauma, to Paul Stamets talking about mushrooms, to Tony bosses and, and Rick Doblin, who's talked about MDMA therapy. So there's a lot of content on the Dr. Story podcast if you want to dive deeper into these topics. But, but we're doing this from a medical perspective, which is a little bit different. and I think it's an important conversation because it's not being had in the halls of academia, it's not really being had in doctors' offices around the country, but it is one of the most crucial conversations we need to be having with our patients about how do we deal with this as part of their therapy. So talk about a patient's story and what you found and what kind of made you wake up and go, wow, this really is something.

One of the patients who inspired me the most is a woman named Christina. She's in the book. And she's someone that I met at a yoga studio in Northern California where I live. She was in her early 40s and ran this yoga studio, and she discovered that her husband was having an affair with her best friend. So she had this Profound betrayal, profound toxic stress and trauma as she went through this discovery and confrontation and processing. And so she left the marriage. And within about a year, she started to notice elbow pain and kind of this crackling and discomfort in her elbows. She's a yoga teacher, so this is a big deal. It's really dysfunctional. Right. And so she went to her-.

You.

Can'T do much of anything in yoga, maybe. So she went to her nurse practitioner who ran a few tests. She had a really elevated C-reactive protein. She had rheumatoid factor that was really high. And so the nurse practitioner said, I'm going to send you to a rheumatologist, made the referral. And this woman has private insurance, good insurance, but it was a six month wait before she could see the rheumatologist.

Oh, wow.

And so in the meantime, she did a couple of things. She reached out to me to see if I could help her. And then she also made an ultrasound appointment to take a look at her joints.

Wow.

So this is before the six month appointment with the rheumatologist. So we started a number of different things we ran. you know, the blood testing, the genetic testing, the stool testing, nutritional panels. We found that her cortisol was dysregulated and she was in the early stages of perimenopause and that was something that we addressed. But we changed the way that she was eating. She's a yoga teacher, so she had a pretty healthy diet. But we started to reduce some of those things that are more immunogenic, like certain proteins she was having. a pea protein shake every day.

Yeah.

And it was a little too much for her immune system.

Yeah.

So we went through this process. It took about three months, in her case, of helping her get to a place where she was feeling much better and she was able to teach yoga again. She had the ultrasound, and the ultrasound basically showed that she was relatively normal, a little bit of inflammation, but nothing like what she had.

Yeah.

When she first started to come see me, and then she went to the rheumatologist. She had the appointment. And the rheumatologist said, yeah, your ultrasound doesn't look too bad, but you've got rheumatoid arthritis. Here are your options in terms of drugs. Which one do you want to take? And so she left his office. She never took the medication. And she was never officially diagnosed with rheumatoid arthritis, although she had certainly the constellation of symptoms and signs. And now she is relatively free of this elbow pain that she had. And throughout this process, she was doing a number of psychedelic assisted therapies.

Oh, interesting.

I wasn't delivering them to her, but she did a few different things, bufo and a few others that really helped her with processing.

Bufo is what they call the toad. It's from the Sonoran Desert toad and it's basically called the god molecule.

Yes.

Five by the way, which is releasing your brain at birth and at death. And it's quite a remarkable experience. I don't know if you've tried it.

Sarah, but I haven't tried it yet.

I did. And it was the most profound experience. It lasts just 20 minutes. But, you know, I was wearing my aura ring and my heart variability went up five fold. Yes, five fold.

Exactly. This is the kind of physical change. This is how the pine system is changed by these medicines. It's such an important point. It's not just your psychology. It's also the way that you regulate such as your heart rate variability.

Which is a measure of your stress response and your resilience to stress. And, it's an important biomarker for so many different outcomes in your health. And, it's something you can measure with various devices, even your iPhone. You can use your finger on the camera. There's different apps. You can buy an Oura Ring. a lot of ways to do it, but it's a very important biomarker.

It is. And I would say, you know, as our listeners kind of start to build out a dashboard of the things they want to pay attention to related to their pine network, I would say HRV is critical.

Yeah.

So she used psychedelic medicine to resolve the way that trauma was still living on in her body, and she changed the course of this potential autoimmune disease.

Yeah, that's incredible. That's incredible. So it was a combination of functional medicine interventions and psychedelic assisted therapy and treatments that helped her heal the trauma and rewire some of the brain. And I've seen data, you know, around the psychedelics increasing bdnf and other neurotrophic factors. It increases neuroplasticity and neurogenesis and really restructures your brain. So it changes the structure and the function of your brain. That's right. So it's not just that you have an insight and kind of feel better. It literally changes the, the gray matter, essentially.

Yes.

And, and I'm sure it regulates immune cells and lots of things we haven't even been able to measure. And I think we're just beginning to start to unpeel the onion here around what, what these compounds do biologically. And they've been used for thousands of years by humans across cultures and every, every place. And I think they're, they've used to heal. They've been used to have you know, spiritual awakenings or used as part of cultural rituals to decide on what to do and how to do it. And it's just a very integral part of many, many cultures. And I just visited shamans in Ecuador and deep in the headwaters of the Amazon sort of vanishing tribes, the Ashuar tribe and the Sapara tribes. There's just a few of them left and they're still practicing their traditional medicines in their traditional ways. And I mean, It was a profound experience to sort of witness how connected they are to the earth and how they listen and how they experience things differently and they see things differently and they relate to things differently. And I think they have their struggles for sure, but these medicines have been around for a long, long time. I mean, even animals use them.

That's right. And I think you're making an important point, which is there's this indigenous context in which we've learned about psychedelic medicine. And then there's the more recent medicalization that's happening. And I feel like we need both. The other piece that I, I think is critical is that we're not just talking about, you know, psychedelic medicine for people who've got the disposable income for it. You know, indigenous cultures give psychedelic medicine in group contexts.

Yeah.

And I think groups are a really important way that we're going to change Public Health, and we're going to help resolve trauma, you know, especially among groups that experience trauma. That's my hope that it's not just this one-on-one experience, which is certainly delightful.

Yeah. Yeah.

But that we think more on a population level and on a group level. Yeah. You know, I actually, one of the people I had my podcast was a.

Canadian, Dr. Pam, who's married to Paul Stammets, and she's an MD who does psychedelic assisted therapy and is approved by the government, and they do it in groups, and they see this incredible transformation. So she has a whole curriculum and how to do this and how to actually help people through this journey. And it's sort of average people, not like a bunch of hippies or new age people or firefighters. Silicon billionaires.

That's right.

The average person who really struggles and doesn't have a way out for a lot of these things. So I think it's just an incredible moment to be alive in medicine. We're seeing both an understanding of the deep biology that we are now understanding around systems and networks and functional medicine. And we're also sort of understanding the doorway to the mind and our beliefs and our constructs and the traumas that inform our biology and how to work with those in new ways. So it's this beautiful intersection. And I, you know, in my book Young Forever, I did talk about psychedelic medicine as a therapy for longevity.

Yes.

So it's kind of interesting. So just to kind of wrap up, you know, you have a whole program in your book, the autoimmune and it's really about breaking the vicious cycle. And it's not just one thing. And I think that's the problem with traditional medicine. It's one thing. You have autoimmune disease, take this one drug or these two or three drugs. It's not dealing with the entire spectrum of things you have to do to regulate your biology. And in functional medicine, and this is a lesson from Sydney Baker, one of our mentors, who said, you know, get rid of the stuff that's bugging you and get the stuff that you need to thrive, right? Get rid of the bad stuff, put in the good stuff.

It's so simple.

It's quite simple. It's quite simple. It takes a lot of sometimes investigation and thinking to find out what the bad stuff is. Maybe you have heavy metals, maybe you have some parasite, maybe you have some Lyme disease, maybe there's some mold. You have to dig a little bit and you have to find out what you're missing. You have to look at your nutritional levels, your hormone levels, all the things you mentioned. So, take us through your approach, which is this sort of multimodal, multi-dimensional approach to dealing with people in a deep way to reset their biology and reset their psychology.

It starts with food. So we know, I mean, the data on rheumatoid arthritis and elimination diets goes back decades, and yet I think very few people are offered an elimination diet. So I like to start with an elimination program diet. So it's where you eliminate the things that tend to trigger the immune system, gluten, dairy, nightshades, nuts and seeds. A lot of us don't like that one. Yeah, but it can be really triggering.

Yeah.

And you and I actually share a patient I haven't talked to you about this, who just went on an elimination diet, cut out nuts and seeds, and her gastrointestinal symptoms went away in 24 hours.

Yeah. Right.

So start with food. And then there's the way that you architect your life. often it needs to be redesigned. You need to get adequate sleep. I like two hours of deep sleep every night. That's what works for my system.

Yeah.

Sometimes you got to track these things that you've got objective data about them, and then you've got to get embodied. You've got to come downstairs. If you're someone who tends to be really cognitive in how you face the world, you need to create that integration and not just kind of stop at the neck. Yeah, you need that mind-body connection.

Sometimes it takes me walking for 15 miles to get there, but. Yeah, yeah.

Me too. And. Yeah, and there are ways that really make a difference there. Things like Hakomi therapy, which is a somatic mindfulness-based form of self-exploration. There's things like EMDR. And at Thomas Jefferson, we study the neuro-emotional technique. There's a lot of ways of working with embodiment and creating some safety around that. Safety is really critical. It's a critical through line through this. And then I would say immune modulators, of which there are many, and we probably don't have time to get into the details of them, but things like vitamin D, curcumin. I use low dose naltrexone a fair amount. I imagine you do as well.

Yeah. And you talk about black cumin. Black cumin.

Which we've got now four randomized trials showing that it's helpful in Hashimoto's thyroiditis. It's where I start.

And COVID.

And COVID, absolutely. I mean, one of the things that's interesting to me because like you, I see a lot of patients in whom I start working, and they may not have a diagnosis of hypothyroidism, but they're starting to make antibodies against their thyroid. And that's a situation where black cumin can be very helpful.

Amazing. Yeah. And like I said earlier on function health in this large cohort of people, we're seeing 13% of people have autoimmune thyroid disease.

13%.

That's a lot.

Yeah, and they're on this on-ramp. toward dysfunction with their thyroid. And the thyroid is critical for really living your life as fully as possible and as fully as expressed as you can be. Yeah, I mean think about it.

If your thyroid's not working, everything's like slowed down. It's like the thermostat's turned way down. Yeah, you're tired, muscle aches, you're fatigued, you can't sleep, you don't have a sex drive, you're depressed, you have memory issues, your hair falls out, you're like, you know, it's like nobody wants that. Your skin's dry, it's like a whole bunch of stuff. Your nails are cracking. so basically this is something that is so common and so missed and so subtle for some people that even if their thyroid levels are in the, quote, normal range according to traditional medicine, they're not really optimal and they're not really good. So.

And.

And doing the things you mentioned are so powerful. The thing you didn't mention was microbiome. That's a big part of fixing the gut is feeling. Because you mentioned earlier at the beginning.

Leaky gut was a big factor. Yes.

Yeah.

So I like to use L-glutamine, aloe vera. There's a lot of different things that can be helpful for increased intestinal permeability. It's something I see so commonly. I used to test for it, and I don't test for it like I used to. Every professional athlete I work with has increased intestinal permeability.

Yeah.

So I treat that. And with microbiome Rehabilitation, that's a more interesting area that I think is still changing we get. sort of ideas that we fall in love with, and then we discover that maybe that's not the whole story. That's what keeps happening in my understanding of the world.

Yeah, for sure we do.

Yeah. But I also, I have a patient who, a guy named Larry Smarr, so he's public about this.

Oh, I know Larry.

He's got 500 stool samples over a period of time, not just when he was healthy, which is less interesting, but he had Crohn's disease. And so we know about how his microbiome shifted with things like having a smoothie with 57 different species of fruits and vegetables every day. So there are ways that you can rehab your microbiome. That can be really important.

Yeah, it was something I didn't realize until recently, when I had ulcerative colitis. It was one of the things that got me better was realizing I had low levels of this molecule, this bacteria called acromania mucinophilia, which is critical to preventing leaky gut. I just didn't have any. Yes. And a lot of the people I see who are sick don't have any. Yeah. And you can't, like, take it. I left the building. I mean, now there's a company that makes it, and you can buy it and take it as a probiotic. But back then there wasn't. Right. So I was, like, researching, researching. I'm like, oh, it loves pomegranate and green tea and cranberries and. Wow. So I'm just gonna, like, Take this concentrate. I'm not eating cranberry juice because that's full sugar, but I'm basically putting that concentrate in a smoothie and a little drink. And it was quite amazing. I took it every day and it really helped heal my gut from autoimmune disease, from resetting my gut. When do you start with the psychedelic.

Therapies in the course of treatment with patients without immunity? Well, I don't start at the first visit.

I am developing a relationship and- Here's.

Your vitamin D and here's your magic mushroom. No, I don't do that. You know, for me, it's about developing a relationship with the person, getting a sense of their values. You know, there are some people for whom psychedelic medicine is not the right fit. They're afraid of it. They've got a negative experience. And so I want to honor that. There are many ways to create a healing state of consciousness. But I would say over time, as we get to know each other, I ask everyone to fill out Nee's questionnaire at the first visit.

Yes.

And then we're talking about it. So every visit we're talking about trauma.

It's a new vital sign. It's a new vital sign. Like your blood pressure, your blood sugar, your heart rate, temperature, your ACE questionnaire.

Yes.

Go, everybody go right now after this podcast's over, go online, Google adverse childhood events or ACE questionnaire and take the quiz.

It's 10 questions. And quickly you'll get a score and.

You'Ll go, oh geez, I better deal with myself. And I have a link to it that we could stick in the show. We'll put the link in the show notes for sure. Yeah, it's easy to get to. So you start this after you've already done the groundwork of helping the biology get better through the principles of functional medicine and building a rapport with the patient, and then you sort of start to open them to the idea that this might be something helpful.

That's right. I like to look at the base case. So what's your baseline in terms of your pine network? What's your baseline in terms of the systems that we study in functional medicine? and once you know where the dysregulation is, that's where you get a sense of whether something like psychedelic assisted medicine is going to be helpful.

Amazing. So, Sarah, last question. What would you have told your 20 or 30 year old self going back and looking back that you wish you had told yourself about how to live your life?

I wish I got that message about secure attachment earlier. I think that would have changed everything. So I can't really say that I would have told my 20 year old self to do psychedelic assisted medicine because I just was too square. But I think healing states of consciousness and the path that that can take you on, that sort of transformation that can occur as a result of that, how it down streams into regulation and biology that can really support you. I wish I knew that in my 20s.

Yeah, that's true. I think that's a really important thing. There's a book called attached, and we'll link to it in the show notes that very short, but it describes what is secure attachment, anxious attachment, what is avoidant attachment, how those influence your life, your relationships, your choices, your business, everything. And it's something that we all should know about because those Styles are not because you're a bad person or you're screwed up or there are things that we learn as adaptive strategies as children that no longer serve us. And we can either carry them on our back like a big weight our whole life or we can learn how to shed them and re-imagine a new way of being in our world, new way of being in a relationship, new way of being in a relationship with ourselves. So it's important and I think in your work it's so beautiful to watch how your work has evolved over the last decades and the things you've come to. the things we're all sort of coming to in this space. And it's very hopeful. It's a very hopeful message. Despite the fact that we're all suffering from chronic disease and have autoimmunity and trauma, there now are really clear pathways for people to get better. And a lot of it has to do with self-care that you can do, and sometimes you need extra help. But your book, the Autoimmune Cure, says it all. Everybody go get a copy. You can follow Sarah on social media at Sarah Gottfried MD. on Instagram at Dr. Gottfried on Facebook, Twitter, and YouTube. So check her work out. She's got lots of other books on hormone regulation and one called the Hormone Cure. And it's just been just a joy to talk to you and have this conversation. And I know we can talk for about three more hours and not even cover what we want to cover. So thanks for being on the podcast again, Zara. Thank you, Mark. If you love that last video, you're gonna love the next one. Check it out here.