Autoimmune Disease in Menopause and Changing Treatment Status Quo

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25mg of CBD and 25mg CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. Beyond aches and pains, today we're talking about autoimmune disease, and we'll define it first of all. So you may think that you know what autoimmune disease, or if you have one, if you happen to have arthritis or you happen to have Hashimoto's, it's immediately where your brain goes. But we're gonna classify a much bigger and broader spectrum, and it's not just for you. So all ages are impacted. Genetics do play a part. And so this is an episode to tune into, not just for yourself, but for the whole family. I'm Debra Atkinson, and you're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness and menopause and beyond before you know to ask them. The goal: to help accelerate your results with the science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman. It's not just you, but it's the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert and international speaker, to founder of the first and the only exclusively made-for-menopause-and-beyond fitness membership in the world. Every week, I interview experts behind the science of optimal hormone-balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy you want, need, and deserve. Why is autoimmune disease in menopause becoming more prevalent? And why are college-age patients a growing autoimmune demographic? And why women need to be more concerned than men? And why at 67, when the rest of the world is thinking about retirement, would you ever consider being a founder of a new business instead of spending days on the golf course or traveling? Answers to all these and more in this special episode. I think you may find both alarming and fascinating, and both a shot of reality and hope. No matter whether you have an autoimmune disease or not, tune into this episode because you are one of the most powerful health influencers in the world, my friend. My guest in this episode, Dr. Bonnie Feldman, is 69. She's co-founder and chief patient officer of Remission. She's an entrepreneur, health practitioner, researcher, financial analyst, digital health advisor, and autoimmune patient and advocate. Since 2010, Dr. Feldman's mission has been to integrate digital tech virtual-first care and lifestyle interventions with conventional care to improve outcomes for autoimmune patients. She's spent the past decade raising awareness of the largely underserved and growing immune or autoimmune market opportunity for private investment. Her decades of experience as an autoimmune patient, in addition to her 10 grandchildren at high genetic risk for autoimmune disease, have fueled Bonnie's passion for prevention, early diagnosis, and improved care for all autoimmune patients. Prior to founding Remission in April 2023 at the age of 67, Bonnie built and managed two dental practices, served as an executive with early-stage biotech startups. She also boasts a rich financial background as a Wall Street equity research analyst, strategic advisor, and investment consultant. She's a woman you want on your team. Can't wait for you to hear this episode. Dr. Bonnie Feldman, welcome to Flipping 50.

Delighted to be here.

So excited. Okay. There's so many things that we want to uncover. So many of our community members struggle with an autoimmune issue or challenges that each of them pose. But first, we want to dive into this. So we like the dirt here. Tell me about you, because why become a startup at, you know, 67 when a lot of people are looking at retirement, not rewirement? What, what was the impetus behind this for you?

Great question. I started as a practicing clinical dentist, and I would still be a dentist had I not broken my hand. So that was sort of my first— actually, it was a huge career change. I was very shaken because I had spent a long time preparing for what I thought was my ideal career. And believe it or not, I loved my patients and I loved working on their smile and their cosmetics. And so I went to a career counselor who said, well, you're good at people and numbers. I think I could have figured that out before. But I got an MBA in finance from the Anderson School, which was not an easy feat because at that time I had 4 children. But more importantly, I was a disabled student who couldn't use their right arm.

Hmm.

So it turns out they have a whole program of voice technology which dates back many decades. And I was a star student and I got to work on Wall Street as a sell-side equity research analyst and a buy-side long-short hedge fund analyst and all sorts of other things. So, the resilience that I learned in my first career change carried forward to starting a startup, Remission, at the age of 67. Fast forward, I have now 3 autoimmune diseases. I'm not bragging. I have a family with multiple autoimmune diseases. I have 2 son-in-laws with autoimmune disease and 10 grandchildren, some of which have a double dose of these genes. So at 67, I kept waiting for someone else to fix this problem, and then I just decided it was going to be me.

So it's very personal.

It's extremely personal.

And you said 10 grandchildren, if I got that right?

I do have 10 grandchildren. They come in all shapes and sizes. Remission, the rheumatology, the virtual-first rheumatology startup that I started at 67, is my legacy to them. To leave a record or an improvement in autoimmune care, specifically a better care team model that focuses on a larger public health issue of prevention of disease earlier.

Wow. Talk about the rest of us who are thinking about leaving a legacy of demonstrating how to exercise better, take better care of ourselves. You've taken that to the next level, girlfriend. So definitely raising the bar.

So that's actually very interesting because I have a TED Talk that I did many years ago on that very subject. My parents were both obese, had horrible eating habits, and never exercised.

Wow.

So even before remission was born, the idea of preventive lifestyle medicine is what it's called now, or integrative or functional, depending upon how you think about it. Longevity medicine. There's a lot of words around this. Yeah, that light bulb went on in my head because I can still remember 'til the day my father died. And he was obese. He had to get an extra large casket. He said, "I'm going to enjoy the pleasure around my food." I said, "What about food as medicine?" And he would say, "That's never for me." Wow.

Okay. We do have a lot in common. So I'm sure this is gonna unfold more. I wanna start at the very beginning for listeners. For anybody who's not certain that they could answer this question or turn around and tell somebody else what it is, can we just go back and say what is classified as an autoimmune disease?

That's actually a complicated question. So I'll try to give you some easy answers. The old definition of an autoimmune disease was when the immune system attacks itself. And there's actually 100 different kinds of autoimmune diseases. The ones that are better known are multiple sclerosis or rheumatoid arthritis or psoriatic arthritis, ulcerative colitis, and maybe Crohn's. There's others that are better recognized. With COVID which was a virus, general people, lay people began to recognize the importance of the immune system. And it kind of helped for general people to understand about the power of the immune system and what an immune cascade from a virus could do, which was basically shut down many other systems. That has led along with Alzheimer's and longevity research and other research to a new expanded definition of autoimmune disease that could include many more things along this inflammatory spectrum. For example, there's studies showing that the oral microbiome, a subject close to my heart as a dentist, is related to rheumatoid arthritis and even Alzheimer's. There's other studies that show that the autism spectrum could have components of this inflammatory process. So the definition of autoimmune is expanding into autoinflammatory and includes many of diseases than we used to think were classic autoimmune.

And I'm gonna ask a question. We talked a little bit about this before we even turned on record, but a lot of my clients— and when I look at just collectively the people that I've worked with one-on-one, you know, because I had more experience potentially than some, because I had a little bit more education than some, you know, I would get often tougher clients. So can you address, and where do we put fibromyalgia on that spectrum? I know it wasn't classified for a long time.

It was like, no, exactly. Yeah. And I have unfortunately 3 decades of experience as a fibromyalgia patient. In the early days when I would show up at various different doctors' offices saying, you know, one day it hurts here and the next day it's my feet feet, and then it's my hands, and it's my knees, and it's my back, and it travels all over the place. They thought I was absolutely crazy. Then they looked at the classic definition of fibromyalgia. If you have 12 different trigger points, so if they touch you here, there, and everywhere, and if that hurts, then maybe you have fibromyalgia. Um, in the olden days, again, they only classified PT as post-surgical rehab. But candidly, I have been a patient 2 or 3 times a week in physical therapy for 3 decades because my view of physical therapy or movement therapy or any movement is a reduction in fibromyalgia pain. Fibromyalgia most recently is somewhat, by some people, classified as an autoimmune disease, mostly around this inflammatory spectrum, although They think it has to do with changes in your brain and your pain perception, but no one's really sure.

Thank you for addressing that. And, and a shout out to anybody listening who's in that category or who has been misunderstood for too long. Can you talk to all of us, whether, whether you were addressing physicians or you're addressing a layperson who's dealing with this, what is it that we still don't understand about autoimmune disease. And, and we all know it's been around for so long. I, um, my personal experience— well, twofold. My grandmother had terrible rheumatoid arthritis, and so I grew up watching, you know, what happened, not knowing that wasn't every older person because she was just— she was my older person. Later, my brother actually had, from being exposed and having rheumatoid arthritis as a 2-year-old, you know, he's now diagnosed with a very rare autoimmune disease. And so I've learned it from a different side of things. But there is, in both cases, a complete lack of understanding, even in the medical world. What is it that we don't know or understand yet?

So there's a lot we don't know or understand, and you really described some of the spectrum. It's a spectrum and it's very individualized. We think autoimmune disease comes from genetic predisposition. Okay, so my own family, my sisters have autoimmune diseases. My parents were actually not diagnosed with autoimmune diseases, but we think that they actually had them. Because one of the things that we're learning and that is a focus of remission is to take what I'm going to call symptom clusters, odd symptoms all over the body. In other words, a rash here, a swollen joint here, a high blood test here that don't make any sense until you put them together and take a systemic look at the body and figure out that they're connected some way in the immune system. So just as our definitions of autoimmune disease are expanding, our understanding of the symptom clusters is getting somewhat better. For example, one of my sisters we thought had mixed connective tissue disease, which is an autoimmune disease. But after seeing specialists all over the country, it's now being called Ehlers-Danlos. Which is a connective tissue disorder. Is that an autoimmune disease? Probably has components, probably not. And then we're also finding a lot of rare diseases, or what used to be called rare diseases, could be autoimmune or immune diseases in disguise. They're not really rare, they just haven't been captured by conventional medicine. And that's why remission is very special. It treats the whole body and soul and mind of a patient with systemic disease under one virtual roof. The problem in conventional medicine is they segment us by body parts and our symptoms are not segmented by body part. Meaning if you have an endocrine problem, you see an endocrinologist. If you have a skin problem, you see a dermatologist. Even within autoimmune disease, if you have a skin problem that's labeled psoriasis, you have a much higher probability of having psoriatic arthritis. But psoriasis is seen in dermatology, psoriatic arthritis is seen in rheumatology, and dermatologists and rheumatologists, believe it or not, do not necessarily talk to each other.

And so the picture you paint from the other side seems as if it would take years to actually get somebody to pull this together and, and to have a quarterback who is integrating all of this information. Am I right?

Sadly, you are very right. And once again, it was the impetus for the start of remission. It takes the average autoimmune patient 4 and a half years, many specialists, and lots of wasted time, money, and effort to get a diagnosis In my own personal journey, I, I was called a quack. I was sent to psychiatrists. I hired and fired lots of doctors until I finally became the CEO of my own health. I put together a team to help me figure this out. Part of the team were specialized exercise people for my initial fibromyalgia. And part of the team, uh, were also, um, cognitive behavioral therapists for the stress and anxiety and all these other things. So yes, shortening, shortening the time to diagnosis, recognizing symptoms earlier is really important.

You say that autoimmune disease is a woman's health crisis. Say more about that.

It is, and I'm kind of excited that the investor world is becoming more interested in this. So autoimmune disease is larger than cancer, heart disease, or diabetes. It affects about 50 million people. 80% of them are women. And, um, that makes about 40 million people. Part of the conventional medical understanding of what causes an autoimmune disease is hormone changes. So puberty, pregnancy, and menopause, premenopause, menopause, postmenopause. We're now seeing late onset autoimmune disease in postmenopausal women, which is kind of a new thing. We're also seeing a large, sadly, growth in the young adult women market of newly diagnosed autoimmune diseases and associated fertility issues. So there's a lot of moving parts. The immune system obviously has a lot of switches in your body, and they are triggered by hormone changes.

Wow. Okay, so talk to me about the interplay of hormones and toxins. I mean, are we, are we seeing a growth in this? And you mentioned, you know, a later-in-life onset. Is that accumulative effect of not only hormone changes but also our exposure to toxins, where, you know, 40 years ago we didn't have the awareness. Maybe we do, but we also maybe didn't have the toxins we do. Do you have a question for a podcast, a question you'd love to ask, or maybe a story you want to tell? Did you know we have a special group just for podcast question roundups and the answers. My community coaches and I provide answers daily inside of this group, but it's also where I go when I occasionally say, okay, open call for podcast questions, or tell your story, would you like to be a guest? So if you're looking for a community of women who are also interested in optimizing their health, strengthening their mindset, and looking forward to every new year Join the Flipping 50 Insiders group. That's Flipping 50 Insiders on Facebook.

So that's a very controversial topic in conventional medicine, and I will just give you my opinion based upon my experience and interviewing 500 patients with autoimmune disease. The biggest growth is in young adult women who are college age. So what does that tell us? Is that an environmental toxin? Is that an air pollution? Is that a viral trigger problem? Is that a genetic predisposition? Even outside of autoimmune disease, I come from the generation where we didn't have as many fertility problems than we have today. So I would say, and this is just my opinion, a combination of dirty air, dirty soil, a dirty life that's, that's perpetuated by stress is contributing to the triggers in the immune system that are going off in the body earlier and earlier. Now, that's not a scientific basis. There are pieces of it that are in the conventional medical literature. And there's also the fact that outside of rheumatology, lifestyle medicine has been proven dramatically to improve diabetes, heart disease, and other metabolic diseases.

Wow. Okay. So you alluded to the fact— we've already kind of covered this, but what would you say is fundamentally wrong aside from the 4-point-something years it takes to get a diagnosis. What's fundamentally wrong and needs to change about the way we currently diagnose and treat patients? And I'm scratching my head over— if we still don't know exactly the root cause of an autoimmune disease, how do we go about treating it then?

Here's what we did at Remission, where we now have preliminary great data that shows that this works. It was created by patient physicians and others that are patients themselves. It's got a few elements. Number 1, identify disease earlier. Don't let patients wait 4 years. We see them in 3 days. Give them a care team model. What is a care team model? It's similar to a Mayo Clinic or a Cleveland Clinic that you've seen in cancer. In this case, it has an integrative rheumatologist who is triple-boarded in conventional lifestyle and functional medicine. It has a lifestyle medicine physician, an autoimmune psychologist, an autoimmune dietitian, an exercise program, and a care coordinator. So, it's a team. It's mind, body, and soul under one virtual roof with access to the patient digitally 24/7 if needed. In conventional medicine, the first appointment with a rheumatologist is at most 30 minutes. That's long enough to take a history and give you a prescription for biologics or other drugs. Our first appointment is an hour. So there is more time with the professionals to really understand who you are, where you are in your patient journey, and what you need.

Can you define biologics for all the listeners?

Those TV ads you see with those healthy people running around on Humira, Stelara, and others, those are biologics. For some people, they are miracle drugs. And they give them back the life they had before they were diagnosed with an autoimmune disease. However, for most people, they only work some of the time, and for some people, they don't work at all. So the philosophy of remission is to use lifestyle medicine as the first lever of defense, to fill the patient's toolkit with all sorts of things that they can do change your diet, improve your sleep, reduce your anxiety, depression, find more joy, be hopeful about your disease, learn how to cope with the ups and downs of these autoimmune diseases because they flare, they come, they go, and every day is unpredictable. So there's a lot of that support given in remission that conventional medicine does not have.

Negative side effects of biologics, and it's always a risk-reward ratio whether you're talking about medicine, prescription, lifestyle habit, or, or an exercise for somebody. But what, what are the negative side effects?

So we are not anti-drug. We are only use them in the lowest dose when needed. The side effects are the black box warnings that you hear at the end of those commercials, and they say things like cardiovascular events, early death, and cancer. So they're great when they work for some people, but they definitely can come for some people with severe side effects.

Do you want to chat just a little bit about some of the, you know, lifestyle habits that I'm guessing my audience feels like, okay, I think I could— I think I could target those, but not everyone. I mean, is there, is there a list that you have as a go-to that this would be the first place I'd start with somebody?

Yes, we do have a list that mostly focuses on the 6 pillars of lifestyle medicine, but I'm going to to my own personal favorite, which is movement therapy. And what is movement therapy? So in my 3 decades of fibromyalgia with my PT all the time, I discovered all sorts of movement therapy that people don't actually know about that I would love your audience to learn about. One of them is called Gyrotonic. Do you know what that is?

Yes. So I've heard of it. Yes.

Okay. Gyrotonic. It's hard to explain, but it has been my savior. It's kind of like Pilates and it sort of does core and leg work with these funny looking machines. But of all the things I've ever tried, it reduces my pain the most. So I would encourage your listeners to go on a YouTube video and see what this gyrotonic thing is about. The, the other thing I discovered that maybe other people have too is yoga comes in a lot of flavors, and there's also something called yoga therapy. So yoga teachers can be uptrained in yoga therapy, which is basically accommodating the needs, the special needs of people who have movement disorders. In my case, fibromyalgia. So yoga therapy has been very helpful. Tai Chi and Qigong would also be on that list. But the one that very few people know about is Feldenkrais.

Yep.

So you want to tell us what Feldenkrais is?

You know, I have not even thought about that for probably a decade and a half. So I might have been, might have been in Boulder at the time I came across it. And I used to allude to the fact that having come from the Midwest in a very conservative, less oriented to exercise and movement, then moving to Boulder, it was a culture shock, and that most people in Boulder wanted yoga, Pilates, and Feldenkrais all rolled into one while they were standing on their head. So Very progressive, but it is a certain kind of bodywork where someone is actually moving and manipulating soft tissue on you into alignment. Now you can correct me.

No, it's kind of like that. You can have someone do it to you. There are classes in it. And I would add from an autoimmune disease perspective, Multiple sclerosis or even Parkinson's, which may or may not be autoimmune, those movement disorders and Feldenkrais can be very helpful for people that are aging who wanna work on their balance and their body awareness. Another thing I had no idea till I found out about it is gait therapy. What is gait therapy?

So we really literally work on your gait. So how do you walk? And most of us don't give a thought to it. Until you're in pain, until your knee hurts, right?

And so I actually went to a walking therapy specialist of all things, and it turns out that the chronic pain in my left hip that's connected to the psoas pariformis SI joint that I cannot get rid of is related to the way that I walk.

Um, so good. And I'm going to mention something here, and this is meant to open a door for anybody listening, not to necessarily sell you on something. But very recently I'd been using a tool called the Protonix G3, and the entire purpose is to look at, you know, if your pelvis is rotated. Oh, that we are not actually utilizing our— generally our hip flexors are over reacting and our hamstrings are underperforming, and that alone could offset the way your knee connects to itself as you're walking in that hinge joint. So this is really the concept of that, is kind of looking at, can we correct your gait by sending a different pattern to your brain to trigger the corrected pattern? And then have you take it off but keep you doing that because we've trained your brain differently.

Exactly. We are kindred spirits. And another thing I want to mention that I just discovered is pelvic floor therapy. Yeah, we think about in older women for incontinence, but actually the pelvic floor is related to the hip, the psoas, and the piriformis, and the gate. And so it's all connected.

I love that. Yeah. And, you know, again, this is probably maybe almost half a dozen times as early as it is in the year we've already mentioned pelvic floor and its importance. And as you said, the first thing you think of is incontinence. I can't jump while I do that exercise. Are you kidding me? Or painful sex, but it is so related to so many things and so related to how you breathe, right, impacts your pelvic floor. It's so— we can't silo anything is really such a message. So, so very grateful knowing that we're talking to women between on average, and there are outliers here, don't go away, I'm not, not missing you if I'm missing you, but between 45 and 70, and they're not, not just influencing themselves but 3 different generations. What have I not asked you? What have we not talked about that really needs to be said as we're discussing autoimmune disease?

A little off topic, but I want to inspire your older listeners that I started remission for myself, my family, my 10 grandchildren at the age of 67. And as I tell my adult daughters and anyone else that will listen, dreams die hard. And there's no reason that older entrepreneurs can't flourish, even ones like me with multiple autoimmune diseases.

So amazing. And where can listeners go and find you and learn more about what it is that you're doing for themselves or their loved ones?

Correct. So the remission is R-H-E-U-M-I-S-S-I-O-N.com. And we're super proud of our website, um, because it was written by autoimmune patients.

So great. And are you on social where people can find you too?

Yes, we are. We are on Instagram. We're on all the social media platforms.

Okay, fantastic. So listeners, you know, if you're walking, you're biking, you're lifting, you're commuting, we've got you covered in all the links to Dr. Bonnie will be in the show notes. Thank you so much for not just the work you're doing— that of course too— and for being such a role model for women. Yes. Okay, thank you so much for listening. To listen and access a decade of episodes and the show notes, visit flipping50.com where you'll be able to to find all of our prior episodes. And I made it easy for you to make the most of your listening time by selecting 5 specific areas most commonly high priorities for our community and giving you top 10 lists if you let me know you'd love them. If you know a midlife woman or a soon-to-be one who wants to optimize her midlife energy and time with the right exercise and lifestyle changes and a mindset shift about just what is possible, share this podcast with her and I thank you. There is no more powerful health influencer in the world than you, midlife woman.