Episode #153: Brain Inflamed with Dr. Kenneth Bock, MD

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Hello everyone and welcome to episode number.

153 of the Better Health Guy Blogcast series. Today's guest is Dr. Kenneth Bach and the topic of the show is Brain Inflamed. As a leader in integrative medicine, Dr. Kenneth Bach has accumulated over 35 years of experience diagnosing the root cause of chronic illnesses and restoring balance to his patients immune systems. He founded Bach Integrated Medicine in response to the increasing need for board certified medical providers who take a unique whole body approach to diagnosing and treating chronic illness. Dr. Bak is a well respected integrative medicine doctor and autism expert who focuses on the treatment of autism and co occurring conditions, pans pandas infection triggered autoimmune brain inflammation, tick borne illnesses and adult conditions such as chronic fatigue syndrome, fibromyalgia and heart disease. He integrates alternative modalities with conventional medicine into a comprehensive integrative medicine practice. His natural curiosity and expertise in working with medical problems that have been difficult to diagnose and treat make him sought after by patients throughout the world as an expert at tackling complex medical problems.

And now my interview with Dr. Kenneth Bach. I met Dr. Bach over a decade ago at several medical conferences. Very excited to have him on the.

Podcast today to talk about his latest.

Book Brain Uncovering the Hidden Causes of Anxiety, Depression and Other Mood disorders in Adolescents and Teens. Thanks for being here Dr. Bach.

My pleasure.

So many children today are labeled as having a psychiatric condition given numerous psychotropic medications. Do you think that most of these conditions are rooted in the mental emotional realm or are there often underlying biological factors like infections, environmental toxicants that maybe are driving inflammation which then presents with psychiatric symptoms?

Yeah, I would say I think it's much more than recognized. We're seeing it a lot more. I mean there are a lot of psychosocial factors that are really pressuring kids and I think causing anxiety, depression, you know, the way that the environments we live in, the drive for perfection, you know, the New York City. I use New York City. I love New York City and I live upstate New York. But you know, the whole thing of people, you know, almost before conception, but certainly, you know, when kids are infants and toddlers and before they go and getting interviewed for preschool, getting tutored for preschools, I mean everything, I mean the concept of getting tested and interviewed and tutored for preschool blows my mind. And it just goes to show you the kind of things, you know, that kids are going through. Everything is structured. You know, when I was a kid we used to just hang out and come home from school and get your homework done quick and play ball and hang out with your friends and ring a levio. Now everything is teams, travel teams, everything is a lesson, everything is moving, trying to move you forward. And I think kids need to screw off a bit, quite frankly and just be kids. And I think we are taking some of the childhood away. And then as you get older, of course with the Internet and, and the texting and the FOMO and the bullying, I do think it's a different world. So there's a lot of psychosocial stuff and of course Covid and the pandemic induced isolation and anxiety and depression. But on the other hand, the environment is changing too and the environment is much more toxic with the pesticides and plasticizers and all the chemicals that I think there is a reality about environmental factors coupled with genetic predispositions. So that I do think all the tick borne infections that don't get appreciated, a lot of the mycoplasma, even strep that can have influences on neuropsych symptoms. I'm sure we'll talk more about that either directly or indirectly via the kind of a reactivated immune system or an activated immune system. The key that I wanted to get across and brain inflamed was not that there's not psychosocial causes. In other words, sometimes anxiety and sometimes a panic disorder is just that, anxiety and a panic disorder. Teenager loses a boyfriend or girlfriend, you know, a parent dies, that's going to throw people over. We don't need, I mean it may be involved and inflammation may be involved, don't get me wrong, because stress, acute intense stress and chronic stress does create inflammation. So the whole idea of inflammation is real. But in terms of the other underlying things, I think we don't want to lose sight of that because a lot of these kids with mood dysregulation, with the rages and the aggression that can be things like Lyme or Bartonella or even part of the whole pans Pandas, we'll talk about all these things. And the biggest point is if you miss them and just say they're psychosocial and treat them with psych meds and therapy, they'll never really get well. And you may relegate them to a life of meds and therapy and institutions and what have you. So that's the key. So I don't want to, I never want anybody to say I'm a big believer in not anything is one thing, you know, in other words, so like this whole thing of protocols that people talk about, I don't have a protocol for treating this, that or that I treat each person, individual, work them up, figure it out, and it's the same thing. Not everything is going to be inflammation, not everything is going to be Lyme disease or bartonella. But there are some people who get caught up in that, you know. And so I want, I always like to make sure that people understand that these things are very important. And there are clues, as you probably, if you've read, I talk about in the book, clues that may make you think that there is some pathophysiological underpinning. But I do not want to have anybody ever say that there's not just sometimes depression related to, you know, what have you. Does that make it clear?

Yeah, absolutely. That's perfect. In the book, you talk about some of these connections that are possible. You talk about OCD and tics potentially being associated with strep, depression with thyroid dysfunction, anxiety and fatigue with adrenal issues, agitation possibly related to pinworms, ODD or oppositional defiant disorder or panic attacks or rage related to, as you pointed out, borrelia and bartonella. Many of these psychiatric presentations that can be related to even allergies or gluten sensitivity and other connections that you really make in the book that many practitioners probably don't explore very deeply and can very easily miss. I've had other guests talk about pans and pandas you've termed itabi or infection triggered autoimmune brain inflammation that can explain a lot of these symptoms. Mood disorders, ocd, tics, impaired writing ability, interestingly, incontinence, eating disorders, meltdowns, a long list of potential symptoms.

So talk to us about itavi.

How is itabi different from pans or pandas or even autoimmune encephalitis?

It's really not. It's really just a name that I coined because I think it really explains it. And I also wanted to take it out of the realm of sometimes the controversial. For some reason, pans and pandas elicit some controversy in some medical circles, which is unfortunate because there's so much literature and increasing literature supporting both of those entities. Autoimmune encephalitis is an accepted entity in medicine for sure. Although thought to be pretty rare. I think it's probably getting to be more common with this whole idea of brain inflammation. So itavi or itavi as I say itavi. It's really, that's really like autoimmune encephalitis because autoimmune brain inflammation is really. Brain inflammation is encephalitis. That's what in every medicine we put itis after a name. Dermatitis, inflammation of the skin. So encephalitis, inflammation of the brain, colitis, inflammation of the colon. So I for, for laypeople in the book, I didn't want to say encephalitis. I wanted to make it more understandable. And infection triggered is really what it is most of the time. I mean can there be other things that can trigger it? Yes, but most frequently what I was referring to as infection triggered. And pans and pandas doesn't really have that. It has an associated with strep. Pans doesn't have that. And so I like, I mean both of them are fine. But I felt like I wanted to describe it as what I really felt it was and take it away from the quote. Controversial. Unfortunately it shouldn't be controversial, but that's why I did it just to. To have is self explanatory.

What is different about our world today that is leading to so many children struggling with these conditions that share an overlap of brain inflammation and autoimmunity. Why are we seeing so much more of this now?

I think it's really environmental. I think partly it may not have been recognized prior, but as much. I mean pandas was Described first really 1998 by Sue Sweeto and colleagues. But I really think our immune systems are getting skewed by toxicants. Skew the immune system. Hey, let's go back right to the beginning. C section skew the immune system. I talk about in the book as, you know, maternal stress. Just my last patient before I got on this thing was a mother who gave birth. One of the kid that John G. Brought in is dealing with anxiety, ocd, et cetera. And during her pregnancy there's a lot of marital discord, eventually resulting in divorce. And there's a lot of, there's a lot of maternal stress. Maternal stress can have implications far just from during gestation into the future. And then C section of course one of the things that's very important is for an infant to go through the mother's birth canal, hopefully get populated with good intestinal bacteria from the vagina. So good vaginal bacteria which is related to the intestine, hopefully that's healthy bacteria. It's not always healthy, unfortunately, but hopefully it is. That bacteria very quickly starts educating the immune system in the proper way. That's what's supposed to happen in terms of developing a healthy immune system. Well, if you get a C section, what's the first bacteria that this infant or neonate sees? It's bacteria in the or it's bacteria on the skin of one of the people at the C section, etc. Etc. All of a sudden, right from the start, you get an altered flora that can alter the trajectory in the course of wellness illness for years and years. So I'm big, listen, C sections are important at certain times, no question. However, I do think our C section rate is higher than many and I think it's not good. And I am a believer that kids right from the get go need to be populated with bacteria. So what they're starting to do, I have to say, which I like, is they're starting to take a swab of the mother's vaginal secretions and put it in the child's mouth. So trying to get some good bacteria or hopefully healthy microbiome right away. Hopefully the mother didn't have antibiotics right away for group B strep, which can alter things for the mother and the kid. And then I believe in giving infant and toddler probiotics. So I, for kids with C section, I think they should start on healthy probiotics and prebiotics right away. So that's the microbiome. I mean, I spent a whole chapter on the micro. It's so important to health, it's so important to the maturation and development of the brain and the brain's immune system, the microglia, where they're very closely connected. So the microbiome needs to be attended to. And like I said, a C section puts you at a disadvantage. You can't imagine how many kids have been C sectioned. When I asked their mothers how they were delivered and, and I do think it tends to skew the immune system to a more allergic type, a more hyperreactive type immune system. Yes.

In the book you talk about the mood dysregulation spectrum and so I'm wondering if you can talk about some of the symptoms that a child on the lesser impaired end of this spectrum might present with contrasting that with a more impaired child. And how do these then overlap with someone that might have Lyme disease or brain inflammation from molecular mimicry to strep or other microbes, Is there an overlap between those?

First of all, they can look the same. That's where it gets complicated. And that's why you have to do the appropriate workups and use clinical judgment. I always tell parents who bring someone in who are doing very intelligent, they're very determined, they're doing a lot of research. But I frequently say to a mother or father, and frequently it's the mothers that are driving this. The fathers, I think are out there working, trying to support, because it does take funds to try to do some of these investigations and treatments. But whichever parent it is, I'll say, you know, you guys have N of 1. N of 1 being bare one child. So they can do all this research and try to apply it to the child. I say I must. I have an N of thousands. And what that does is, helps me, gives me perspective, helps give me a sense of, of clinically. When I do an in depth history, I spend an hour and a half, maybe even more with a new patient, especially the complicated ones. So it gives me a sense of where do they fit, what directions may I be going in and then of course, what directions or avenues to take in evaluations and treatment based on their specific history. And also a knowledge of, good knowledge base of thousands of kids. So there is a lot of overlap. So some of the symptoms and I made that mood dysregulation spectrum. That is also a term I coined. I happened to, because I've spent, you know, I spent a good. I started seeing autistic kids, probably I saw a few in the, in the, in the mid-90s. But you know, after 1998 was when really I gave a lecture at a conference. I wasn't known in the autism community. I'll never forget this. I was put on the schedule, five o', clock, the last speaker for half an hour. I figured they didn't know me. I said, I figured they'd heard of my work with the immune system. I was researching transfer factors and autism. They heard of the work. I figured most people will be either leaving to the bar or whatever. It didn't turn out that way. There's still a lot of people in the audience. I give a very scientific lecture and the organization of the conference attendees were very impressed. And all of a sudden, because of my integrative medicine approach, they started bringing the kids to me. And because I had results, probably more than most were getting because of the approach, the Word got around and they started just basically swarming my office from all over the country and of course eventually all over the world. And so there's thousands of kids in the spectrum. But as I saw those thousands of kids over the course of a decade or a little more, the parents also started asking me about the other siblings and the other siblings not being autistic, but being neurotypical with mood disorders either with anxiety, depression, mood swings, mood instability, rages, what have you. And so I started to take care of them more and more. Lo and behold, I saw the same approaches really were effective. And that's when I realized I'm dealing with here a mood dysregulation spectrum. It's not the same. It is as autism spectrum. But of course the autism spectrum does is there's very low functioning and very high functioning autism spectrum. We used to call the high functioning Asperger's where they had language but they had social issues, they were quirky. Same thing with mood dysregulation spectrum. You know, there's the moodiness and irritability that can be part of what we call teenageitis just being a teenager. And there's also, it can progress anxiety, depression, ocd, panic attacks, and of course then entering into the more serious realms of really severe mood swings with rages, aggression, sometimes they can be homicidal, sometimes self injurious, suicidal and even psychosis, even psychotics, these intrusive thoughts. With OCD you can have visual hallucinations, auditory hallucinations when I try to graph it. And one of the things I tried to do is we made the brain inflamed.com website so people can get a template of the mood dysregulation spectrum and actually almost draw it in themselves. Try to compare it to some templates of the disorders I've drawn. They're not exact, they're not the same. It just gives an idea like there may be, let's say thyroid disorders that may not be frankly hypothyroid, but may be functionally hypothyroid. In other words, maybe much more depression, maybe a little anxiety, but much more depression. Where with the whole itabi pans pandas, you can have mild to moderate, where it's going to be more anxiety, OCD in addition to tic disorders which are not on the spectrum because it's neurologic and panic attacks perhaps to the more severe atabi where you have these intense mood swings with rages and aggression and even psychosis. And there's of course overlaps, same thing with Lyme and Bartonella so they can look the same. Some of it's to the degree, some of it's like, you know, with adrenal dysfunction that you mentioned in low blood sugar, it's probably a lot more anxiety and panic attacks than it's going to be. The, you know, the rages and the psychosis. So you can get a sense of it and the moodiness and irritability may be higher in the, in the low blood sugar. But so I think it's just to give people a sense of where they may fit and what avenues they may want to pursue. It's not by far, not exact because it can really vary, but I think it's been helpful. And then you can graph your kids as you go through month, two months, three months, and see if the curves are getting smaller. That means that they're getting better, which is hopefully what we see with the various treatment modalities that we use.

We know that the number of children with autism is about 1 in 54. Some predict 1 in 2 by the year 2032. What percentage of children today fall onto this spectrum of conditions associated with brain inflammation?

You know, I can't give you percentages. I'm not good at that. You know, I do think that I could say it's a lot and it's increasing because there are so many kids, I mean, millions of kids affected by anxiety and depression. I have a slide. Anxiety is the most prevalent. Then there's depression. Autism spectrum disorders are obviously less than that, but worldwide there are millions. I don't have it off the top of my head. I think it was 250, some odd million. It's very, very high. One third of all adolescents will be affected by anxiety over some course of their life. That's very high. So though I can't give you a percentage, I can tell you that it's. And it seems to be increasing. There's no question about that.

You talk about many factors in the book that impact our immune systems. Those could be genetics or nutrition, allergies, hormones like adrenals and thyroid, environmental toxicants, infections, and those psychosocial factors that we talked about earlier. How much of a role do genetics seem to play in these conditions as compared to the epigenetic influencers? In other words, can we blame it all on genetics?

Well, obviously we can't, because as we say, you know, genetics load the gun and environment pulls the trigger. There's no such thing as genetic epidemics. And, you know, certainly what's as infectious disorders is an epidemic. You Know, over the last several decades, to go from, you know, at one point, you know, in the 60s, 70s, maybe, you know, 1 in 5000, 1 in 2500, and then it kept on going. I mean, I have slides of that to show, you know, it was one in 500, and then one in 167. And then one, you know, kept on going up to now where it's people say 1 in 54, 1 in 46, whatever, like 2, you know, almost 2.2% or something. It's. That's crazy. That's an epidemic. It just doesn't happen with genetics. So. But I do think genetic predisposition is important. That's why I put it at the base of that immune kettle. And sometimes when that genetic predisposition is really playing a role, it actually occupies a larger place in the immune kettle. But I think it's the overriding other levels in that kettle that are what throws a lot of kids over. I mean, you know, obviously you can have a genetic syndrome, and part of that genetic syndrome could be autism, but that's just a very small percentage. And I think people have. Have been very involved with genetics. And I think, you know, it's good to know. But most of the kids we see, I mean, I just saw a kid with genetics that, you know, I tell them if there's a genetic. Significant genetic defect, then that's probably going to lower our ceiling of where we can get to, you know, I mean, because genetics are real. But most of the time, what we do in my field is nutritional modulation of genetic expression. So because we can modulate the expression of genetics and especially the epigenetic factors. So you're right. Those are probably, to me, the most important with all these things. And what are those factors? You know, you just. What you said, you're talking about toxicants, you're talking about infections, you're talking about allergies, sensitivities, nutritional deficiencies and imbalances and insufficiencies and hormonal imbalances and of course, immunological imbalances, which are really key, which are related to a lot of the other things. So I would have to. I emphasize those because those are number one things I can do something about and really help people. You can't do that with, you know, it can't affect the genetics. You can affect genetic expression, you can affect epigenetic factors. And obviously, for me, I like to focus on the things that I can help.

So let's talk then a little bit more about nutrition and diet. Is it More that we are deficient and that results in not having a nutrient dense diet? Or is it more that the foods that are being consumed are triggering inflammation, or is it a combination of both triggering inflammation and not having enough nutrient density? And then what are some of the more common nutritional deficiencies that you see in your patients?

So, you know, the questions you ask actually are like, I quickly want to say both or all of the above. I mean, you know, it is the fact that, you know, a lot of the typical American diet is called sad for a reason. The standard American diet, it's definitely not nutrient dense, it's nutrient insufficient or deficient. So that's the ones loaded with sugar. And sugar has implications for behavior as well as the immune system. And also things have, over the years, gluten. Like, I just was talking with a GI doctor the other day, and we both agree our systems were not made actually to digest any gluten. And you know, you know, you go back years and years and years. We were hunter gatherers. That's, you know, you know, eating berries and fruits and vegetables and meats, let's say, right? Or fish. And it's only. It's relatively new that we started having the production of all these grains. And I think that was to try to probably enhance storage of energy for larger, maybe forays into the woods or whatever it was, as you got, you know, to, for. For more carbohydrates for energy. But the truth is, I don't think, you know, in a lot of ways we were, we were really equipped to deal with it. And especially the gluten that's been changed over the years. Like, I do think there's a difference between flour in Europe and flour here, because there's a lot of people who say it. And I know even myself, I mean, I'm gluten free and I was, you know, I love Italy, I travel in Europe and, and I am gluten free. But if I would somehow mistakenly get a little gluten, it wouldn't affect me like it would here. And I think the flowers are different. I think, you know, maybe all the pesticides here and things like that, you know, maybe GMOs or what have you. But the point being is I think all that plays a role. And if you have a diet of kids who is basically all flour and dairy and very little greens, very little nutrients, not eating vegetables and salads and maybe some high sugar fruits and certainly a lot of cereals with colorings and additives, all that stuff plays a role in what's happening to these kids. I think nutrition is always the backbone of a foundation in terms of moving forward, in terms of treatment modalities.

Are there certain nutritional deficiencies that you commonly see as a pattern in the children that you work with?

Yeah, yeah, there are some. They vary, obviously, because it's not everybody's the same. But I would have to say frequently magnesium, frequently zinc, and then various of the B vitamins. That depends. We test for that. I like to do some organic urine, organic acid testing. I don't like to do static nutritional levels because those are usually the okay quote. But I like to look at the more functional consequences of a nutrient deficiency or insufficiency. I say insufficiency because they're not always frankly deficient. But there are people who have greater needs for certain nutrients based on their genetics, maybe based on their exposures. And so you can be not frankly deficient. And so therefore you're told by another practitioner or somebody, a nutritionist or your physician, that you're fine when you're at the bottom of the normal because you're still in the normal range. But the reality is for that person, that may be nutritionally insufficient. And by getting a more functional test, like a urine organic acids test, we can look at various metabolic processes based on various enzymes. And those enzymes have cofactors that are nutrients. They can be vitamins, such as vitamin B12, B6, vitamin B2. They can be minerals like zinc, magnesium, selenium. So, and I would say when I look at all those, it's very frequently you see magnesium issues, zinc issues, iodine. A lot of people are low in iodine. And iodine, of course, is important for the thyroid. There's a lot of low thyroid out there that is under recognized then the vitamins as well. We do a lot with methyl B12 with kids and methylfolate because we look at things that look at functional needs for them as well as autoimmunity. We look at antiserebral folic receptors. So we look at these more functional indicators. And a lot of times you'll see them. So it can help me target my nutrients. And I like to do it in a scientifically based way. I mean, a lot of times I do it clinically as well, because vitamin D, I don't want to forget I said all the others. Vitamin D is low in so many of the kids, or very low normal, which we call insufficient. So the normal range is 30 to 100. You'll see a lot in the 20s, some in the teens. I just saw somebody that was 8 and then maybe 34, 32, which would set to be normal, but I like the kids to be 50, 60. Higher. Vitamin D is very, very important not only for calcium status, but for immune regulation and. And inflammation.

When we look at allergies and sensitivities, why is there such an issue today with these. Is it that we've lost our immune tolerance? You touched on this a little bit earlier. And then is it this hypervigilant immune response? Is that a major contributor to the inflammation that's driving a lot of the symptoms, a lot of these conditions? And then what are some of the tools that you find helpful for increasing immune tolerance?

So, yes, I think hyper vigilance is a very good word. Immune hyperreactivity, loss of immune tolerance. That is a biggie. I mean, people probably never think about this. And if they do want to learn more, I mean, I do write a bunch of. But there's a whole chapter on the immune system in Brain Inflamed. And I try to break it down as simple as I can. And many people have said it's helped them because I tried to simplify it. But immune tolerance, just think about this. I mean, basically, we shovel all kinds of stuff in our gullets, in our mouth every day. I mean, all kinds of junk, right, goes down the esophagus, through the pharynx, the esophagus, into the stomach, and then the intestines, and then eventually the colon. Now we have to figure out. We want to digest this, we want to break it down, we want to assimilate it, absorb it, assimilate it in the body. Well, our immune system, 75% of which. Around. 75%, 70. 75, lies right under that thin layer of epithelium of our guts, right? And so you might say, well, why does so much of the immune system reside there? And we got all these other parts of our body? It's because it's so crucial for us to figure out what's coming in. Is it friend, is it foe, Is it just benign? And we can ignore it because that is. And it's going on, like, constantly, and it's going on, like in not seconds, but fractions, like now. You know, it's so fast. It's. I mean, it blows my mind that it works so well. Really, you've got to be making these decisions. You gotta. You have secretary iga, which basically is kind of one of the immune globulins that secreted that kind of coach the mucosa that tries to keep it safe, so to speak. But you have to be able to bring these tiny particles into contact with the immune system and have them say, recognize that. Oh, this is. Okay, this is not. And it's a very fine and precise process. Like I said, it's amazing how it works so well. There's lots of immune messenger molecules. So there's a lot of conversation between the immune cells as well as between immune cells in the hormonal system and the nervous system. But the fact of immune tolerance is allowing us to tolerate that which we should tolerate. We should be able to tolerate an egg. We literally should also be able to tolerate wheat or dairy. Be nice. The problem is, it's easier to understand, maybe intolerance of grass. So somehow grass. Somebody cuts the grass and you get all congested in your eyes water. But. And we should be tolerant of that as well. But okay, that's a more classic allergy. But we need to have this immune tolerance to so many of the things we encounter. And when we lose that immune tolerance to something like, let's say, an egg, all of a sudden we eat an egg. And that egg can not only cause eczema or congestion or asthma, but it can cause hyperactivity. I mean, I remember Doris Rapp, analogist, many years ago, had this great video of a kid eating an egg. Eggs are healthy. Eggs have been maligned. And for me, I think eggs are healthiest. When you don't break the yolk and scramble it or make it an omelet. When you keep the yolk intact, it's the healthiest. But be that as it may, eggs themselves are a nice, inexpensive source of good protein. And yet, if you're intolerant of an egg. I saw this video way back when I was younger, and this kid went really ballistic. Hyperactive. And somebody said, how could that be from an egg? Well, foods can be very powerful. I've had people where I've diagnosed a corn allergy. Now, corn is basically in everything. This was another kid who had mood dysregulation with kind of rages and hyperactivity. We diagnosed a corn allergy in the office because we do some skin testing in the office as well as IG rash, blood testing, and sure enough, took person off the corn and the hyperactivity. And that mood dysregulation rages improves so much just by getting rid of corn. Now, that's not easy because it's in everything. I'm not just talking about corn and the cob, but I think the point that I want to get across Is it's the nutrients in the food that are very important because those nutrients support a healthy immune system. Things like vitamin D are so essential, but it's also promoting this immune tolerance. And we can get into more about Tregs. Tregs are the key to that.

So let's continue then, the immunotolerance conversation, talking about microbes. So we know that we talked already about strep and Borrelia and Bartonella and how they can play a role in many of these conditions. Are the infections themselves the problem or is it the host response, the loss of immune tolerance, the lack of integration within our microbiome? Is that what is creating the problems that many people are currently facing? And what are some of the more common infections that you see in children that are driving these conditions?

Well, the microbiome is important for maintaining immune balance and immune tolerance. Very important because also the microbiome helps to maintain the integrity of the intestinal lining, the epithelium. So we talk about sometimes a leaky gut or hyper intestinal hyperpermeability. You don't want that. You want the intestine as your first barrier. Even before the immune system, the epithelium is a barrier. And just like your skin is a barrier, you want to keep things out. That is another way, in some way of keeping foreign invaders or things that can cause mischief out. The microbiome is very important. It's interplay with the intestinal epithelium and the immune system below it to maintaining immune balance and the integrity of the lining. Yes, microbiome is really at the root of so much. And it starts early. The microbiome's effect on the immune system and the brain starts in gestation, goes through infancy. It's very important for the maturation of the microglia and the maintenance of the microglia. Microglia are the brain's immune cells that work along with the neurons and the astrocytes in the brain. So oh yeah, there are studies, articles that discuss this and it's very, very important. So the microbiome is like, you know, is a foundational piece and the microbiome is disrupted with a C section and the microbiome is disrupted with early antibiotics, especially early antibiotics when the woman's got group B strep, so she gets antibiotics right away, or she has sinusitis or whatever infections, and was given antibiotics during pregnancy. And then the child maybe has a little bit of a fever or tachypnea, rapid breathing, so they're put in the NICU and maybe they get a sepsis. Workup. And what happens then? They check blood cultures and maybe sometimes a spinal tap, but also give them prophylactic antibiotics for a few days. So right away, we are affecting the microbiome of those kids. And that has implications for immune tolerance and immune balance years later, unfortunately.

So am I understanding correctly that in some cases where we're dealing maybe with strep or bartonella or borrelia, that it's not always that the symptoms are from the bug itself, that in some people, the symptoms are also that host interplay or the interaction of the immune system with those bugs? Coming back to that hypervigilance, thinking about autoimmunity, is that often the driver of some of the symptoms rather than just the bug itself?

Yes. So that you have to be aware of that, because that is very true in some patients. Sometimes it just is Lyme or Bartonella. I mean, they treat the infection, they get better. Now, of course, Lyme early on, can even suppress the immune system. So it's very complicated because sometimes later on it drives immune hyperactivity, but early on it may suppress the immune system, in which case the immune system can't get rid of it. That's a complicated variable. But yeah. So I think the key is, and that's why this is so complicated and I try to simplify it, is that infections can cause symptoms, but infections can activate the immune system. And sometimes by activating the immune system, it causes a misdirected immune response. This is something that Susan Sweetos, I loved, called it with a strep. Basically, she called the immune response to the strep, and then getting to the brain, responding to the brain and causing inflammation in the basal ganglia and misdirected immune response. Yes, that's molecular mimicry, where your immune system will take the strep. But the same thing can be for Lyme and Barb. Let's take the strep, which is the most classic. Your immune system sees the strep sees a tiny piece of the strep. It's called an epitope. So it's not even a whole protein. It's epitope is like a little tiny peptide. Right. It mounts a response to that in the strep. Well, unfortunately, there's a piece of the basal ganglia that looks just like that epitope of the strep. The immune system sees that. It believes it's going after the strep. It's not. It's going after the basal ganglia. Basal ganglia in the brain is in the lower part of the brain and it's involved with emotions and movement, that is Tics, ocd, anxiety. Right. And so you have their immune dysregulation is what I would call it, immune dysregulation. And the same thing can happen Lyme and Bart. Okay, but we don't really know. We don't always know where the symptoms from the infections end in. The autoimmunity begins in the beginning stages. It's probably just all infection. And you treat with antibiotics, hopefully long enough and the right ones and you can get rid of it. But later on, I call it the conundrum. You don't know if it's one or the other and probably frequently it's both. And what further complicates the issue is that when you kill the Lyme or Bartonella, you can kill them. But if the immune system doesn't do a yeaman's job in terms of clearing them, you can still have pieces of them which may be antigenic, which means they can elicit immune responses even if they're not alive. Even though somebody said, oh you got the infection, you treated them long enough, potentially there's still antigenic material there that is driving an immune response. That's where things like detox can come in and immune modulators, you modulate the immune system to quiet that overreactive immune response. And you hopefully try to do some detox to try to help the system clear itself of these remnants. And so this is where the science can be and not this like you know, sometimes unfortunately there are conventional doctors look at detox and like think of it as voodoo. Well there is, you know, we in the later stages of Lyman, Bart and other illnesses. I mean detox is very important.

Let's talk a little bit more about the connection between psychiatric symptoms and neuro inflammation. Is it true that anti inflammatories for some people can work better than anti anxiety medications or antidepressants? Then what are some of the tools that we can use to quench the fire of inflammation?

Yes, very good question. And sometimes anti inflammatories can be excellent on their own, but frequently they're adjunctive. In other words. So if there's an infection you need the anti inflammatory microbials, whether they be, you know, antibiotics or herbal antimicrobials or antifungals or antivirals, depending on what the infection is. And likewise, even with depression, anxiety, I'll take depression. The kids that we see with this infection triggered autoimmune brain inflammation frequently don't respond great to SSRIs, you know, the Prozacs, the Zolofts, the Celexis, Alexa, some of them do, or some of them just a little bit, but not fully. I mean classically in these things even you know, cbt, which is cognitive behavioral therapy and other types of therapies. In the meds you may get some response but it's not full, it's not adequate. Sometimes you don't get any. But so I use Celebrex. Celecoxib, you can use ibuprofen. Except ibuprofen is in every 8 hour drug or every 6 hours. But we usually use it every 8 hours whereas to Celebrex is a every 12 hours or twice a day, much easier to do. And it's also a selective Cox 2. So it's a little safer for the stomach and because any of them can have side effects. But it can really help sometimes by itself. But frequently with potentially if they were on an ssri, maybe they it'll make it work better and the same thing with antibiotics. So it's not either or. And sometimes it's a huge, doesn't always work or we can give you a little bit, but sometimes it is really, really huge. And there are studies clearly that say it can really augment the response to an ssri. Just like methylfolate. Methylfolate, we use the pure methylfolate. There are prescription drugs out there that are higher dose methyl folate. We like to use it in the purifol form. But you know, you're not talking about, you know, one milligram, you're talking about seven and a half or 15 milligrams. The study is saying that methylfolate probably because of genetic predispositions that the mthfr, let's say polymorphisms, mutations where methylfolate can also augment the response of an antidepressant. So I think it's important to recognize it's not either or, but so that's pharmaceutical anti inflammatories like Celebrex or Ibuprofen or Naprosyn. There are nutraceutical anti inflammatories that we use a lot that are very, very helpful and I much rather give them if we can. So you can avoid the non steroidal anti inflammatories because they can have effects on the stomach. In older people they can affect the kidneys, but if somebody's well hydrated and they're young, they usually don't have any problem with the kidneys. So it's more, it's more the stomach that we worry about. So things like curcumin, which is the extract from the spice turmeric, it's that nice beautiful yellow that's one of the best natural anti inflammatories there are. It really inhibits. I have a slide that shows inhibiting four different inflammatory pathways, including the NF Kappa beta. It decreases the TH17, which is an inflammatory autoimmune type T helper cell and it enhances Tregs. Tregs are those. The T helper cells are divided into four different types. T helper 1, T helper 2 Tregs and TH17 or T helper 17. And without getting too deep into the weeds about it, TH2 is more involved with allergies and potentially more extracellular infections, but more allergies. TH1 is involved with viral infections, yeast infections, cancer. TH17 is involved with inflammation and autoimmunity. And when I say inflammation, there is a healthy inflammation early on. If you cut yourself, that initial inflammation is fighting infection, fighting to heal. It's only when it doesn't work and it's chronic inflammation or it's way too much inflammation. We have problems, but there is, you know, there's that balance between, you know, inflammation by itself is not bad. It's when inflammation becomes pathogenic, when it's too intense, too overwhelming or too prolonged. And the Tregs are those T helper cells that help bring the immune reaction that is stimulated by these other T helper cells into balance. It helps balance TH1, TH2, it helps balance TH17. Tregs are crucial and Tregs are affected by chemicals, BPA and various other chemicals. So that's the influence of the environment on Tregs, which are so important. Tregs will help keep the microglia, you know, regulated, you know, whereas TH17 can be inflammatory and produce all these inflammatory messenger molecules. TH17 can disrupt the blood brain barrier and let the inflammatory mediators in. So Tregs have a crucial role in bringing whenever there's an infection and the immune system gets upregulated or activated, it's the role of Tregs, once it's under control to bring it back into balance. Same thing with viral infections, infections, hepatitis, Epstein Barr. If you don't have an adequate response to balance the initial response, you can get into more chronic types of immune dysregulation, chronic Epstein Barr reactivation, etc. So I would say curcumin, resveratrol, vitamin D. These are all anti omega 3 essential fatty acids. All of these are anti inflammatory and good anti Inflammatories so as nutrients and then taking away the things that may be inflammatory, things like gluten and dairy in some individuals will be inflammatory. So it's almost like, you know, it's like if you look at your, your net income, you get a certain income and you have certain expenses and well, obviously if you increase your income, you increase your, you most likely increase your net income, but if you decrease your expenses, you can also increase your net income without even increasing your income by decreasing this. The same thing here is in the immune system. If we can somehow decrease the inflammation in there as well as. Even if, you know, we want to obviously increase what's coming in, but if we can decrease the inflammation coming in from infections, what have you, but if we can enhance our anti inflammatory mechanisms, we can be almost on that expense that we can actually do it. So it's important to recognize that even if you didn't know the cause at first, you can start to do some things to quiet inflammation. Obviously our goal is always to find the, the root causes of the inflammation as much as we can and then remediate them.

So if we talk a little bit more about th1, th2 in the kids that you work with, would you say that it's common to see a TH2 dominance and then other than curcumin, are there other tools that can help to increase T regulatory cells?

So yes, frequently I think when I wrote the book preceding this Healing the New childhood epidemics, autism, ADHD, asthma and allergies, I talked a lot about a TH2 skewing which is promoted by C sections, which is promoted by chemicals and also a lack of Tregs. So basically, yes, There is a TH2 skewing. It pushes allergies, eczema, asthma, that relates to that TH2 skewing. So you want to balance it out with TH1 but also really with Tregs to balance out that TH2 skewing. And you can do that again with diet by getting away from some of the things that may inflame it. Like let's say if you can figure out food allergies, figure out inflammatory foods frequently gluten and dairy, not only. And other things and nutrients like vitamin D, glutathione in the early stages has been shown to help there probiotics, very, very important. So really good probiotics. Here's why I know and this may be too much, but I always like people to know that the two things, nutrients that I think are the most important to get the highest grade. I mean, I Think you should always get high grade. But if we had to break it down, because I know the higher grade ones are more expensive. Probiotics and fish oils are really key to get them at the highest grade. So don't try to save money on fish oils and probiotics. Get the good ones. Because probiotics are not always what they seem to be. They may be said to be something when they went in the box, but when you take them out they may be very different. So we use actually these probiotics that are nitrogen packed and foil wrapped. Each one, they don't even have to be refrigerated so that you know when you open it, it's what went into it. And the same thing with fish oils. They should be refrigerated and they should be from companies that you know of that are high grade, no pesticides, no mercury, etc. So that's where I just, I don't want to belabor that point, but I think it's an important one for your listeners to know. I think there are, there are a number of good labs out there that make probiotics. I just would say, and we usually, most of ours are not milk based because obviously a lot of the kids have dairy sensitivities. I just would emphasize without getting into names that they really should look at them, research them and be prepared to pay a few more bucks.

And are you in the camp that in many of these kids it's best to avoid probiotics that have strep strains?

That's a very good question and it's not a simple one. I, I think theoretically, I understand my parents are very uptight about giving them a strep strain. Usually the strep in a probiotic is strep thermophilus. It's not beta hemolytic groups, group A strep. So it's very different. So most of our probiotics don't have them for that reason. One or two of them do have the strep thermophilus. I haven't really seen a problem with that, but I know parents are very sensitive to it. So I usually use ones without it. But they're all just so, you know, there's also a strep salivarius, which is, we have it and it, it's put at night in the back of the throat. It's not meant to be swallowed, it's meant to be dissolved in the back of the throat and populate the throat with the strep salivaris, which there were a Number of studies from Italy showing this would keep out the bad group a beta hemolytic strep. So it was protective and it was a strep. So I think parents, I understand their fear, I acknowledge it and I don't want to push strep on them but I think sometimes it's not as bad as they're worried about, but I understand it.

We know that leaky gut can play a role in terms of being another contributor to leaky brain to brain inflammation. So what are some of the tools that you like for improving intestinal barrier function? Obviously it also means eliminating those foods and things that might be triggering to the lining of the gastrointestinal tract. But what are some of the other tools that can help improve the barrier?

Firstly, it's besides that which is key, the microbiome. So restoring and maintaining the microbiome with probiotics and prebiotics that feed the good bacteria. And then of course there are numbers of nutrients that help the intestinal lining and its integrity. And it would be glutamine, we use aloe, it's zinc and for especially even for the stomach we use it, we use a gastroprotect, it's a zinc carnosine and your anti inflammatory nutrients, I mean we will use certainly vitamin D and we use some of the anti inflammatory I just mentioned But I think the ones we really generally think of for the gut lining are glutamine and some of them might have marshmallow aloe in there. DGL for the upper. And the microbiome being really key.

Can strategies that support the vagus nerve and calm the nervous system bring benefit to these brain inflamed kids? And then what can we do to get out of this sympathetic overdrive and into more of a parasympathetic response that really supports rest, digest, detoxify and heal?

Well yes, it's funny because Munsha said that I was going to say for sure the vagus nerve is probably it's a connection between the GI tract and the brain. It's the most direct. So I talked to you about the microbiome and the metabolites that produces and then it eventually gets up to the brain and affects the microglia. Well, the vagus nerve is the instantaneous connection between the gut and the brain. And that's why you know, you get a gut feeling. That gut feeling is probably related to activation of the vagus nerve. It's so sudden, it's so quick and obviously there are a lot of other mediators there. You Know, I mean, I think it's 90, 95% of the serotonin is produced in the gut. You know, so the hormones, that nerve and the microbiome and the metabolites it produces, and then of course the immune cells and their cytokines, all of them have an influence. But the vagus nerve. Yes, the sympathetic overdrive is what I was going to say. As we see in a lot of these kids, they have pupillary dilation, many of them can be intense, associated with episodic regressions or episodic behaviors. Doing things to enhance the parasympathetic system and decrease the sympathetic overdrive can be very helpful. Now, obviously in older kids you can do meditation, yoga, exercise you talked about, even with the Tregs. Exercise. Tai chi can help enhance Tregs. I meant to say even vitamin D and probiotics can enhance Treg. Those I wanted to make sure I mentioned. But for this whole thing about the parasympathetic, you want to increase the cholinergic tone versus the sympathetic tone. And you know, nutrients could be phosphatidylcholine. We actually give. Phosphatidylcholine can be very helpful. So yoga, meditation, walking, a good walking, relaxation exercise, social interaction with loved ones, all of that can enhance parasympathetic and decreased sympathetic tone. I think it's really a very important question.

Excellent. I've had my tablespoon of phosphatidylcholine this morning, so I'm good to go.

Take it. Pills, tablespoons, probably better because it takes three large caps to equal a tablespoon, but you have to put up with that taste.

It's not bad in my smoothie in the morning. It's pretty good. Many know that pandas can be triggered by molecular mimicry to strep, as we discussed in pans. For example, if you have an abnormal Cunningham panel or a neural zoomer and it's not necessarily strep, how do you then determine what that underlying trigger that is creating that abnormal immune or autoimmune response might be?

Well, the first thing I do is put in my. I put on my medical detective cap, right. And what do I do? I take a thorough history to try to figure out what I think may be going on. Because let's say tick borne, which you have to, you know, there are questions I can ask about which tick borne infections it may be. Are they having a lot of burning, neurologic pains, neuralgias, this esthesias, which may be more like bartonella, also lying, or are they Having numbness and tingling, that kind of stuff. Do they have a lot of neuropsychiatric, which we probably do since we're talking about this, that can be prominent. All of them, especially Lyme and of course rages. You know, we know Bartonella rage is known, but I'll ask, do they have recurrent fever, chills, sweats, which can be seen with Babesia, which is a co infection parasite in the tick. Do they have air hunger? Chest pains also can be indicative of Babesia. So you have to ask the right question, questions in terms of those infections, but I'm going to check. We do a full tick borne. If I think I was. You have to ask for endometriosis. Are they in endemic areas? Do they hike, do they camp? Do they travel to the Hamptons? They go to Cape Cod. A patient before me, you know, grandparents have a place in Cape Cod. They're there frequently pulled off multi, multiple. They pulled off multiple ticks from their son, but never treated. Right. So even though there's not maybe a, a known tick bite or an em, you know, erythema, migraines, bullseye, rash, you ask these questions and are there dogs? Yes, the dog, I have a dog gets a lot of ticks. This is going to lead you more to believe that there may be a tick borne illness. So you have to look at ticks and not just Lyme. You have to look at the co infections. The basic ones are lichiana, plasma, Babesia and Bartonella, but there are also many others. So we do a complete tick borne evaluation. All right. And then you. I'm going to look at allergies. Are there the foods that they're eating that may be a problem. I want to be be aware of that. But in terms of the infections which you asked about, it's more. You look at mycoplasma, chlamydia. In addition, mycoplasma is very common and can really cause this. As well as viruses. There are papers that show herpes virus can do it, Coxsackie virus. So we look at all those things and you know, in my first book, 1997. So what are we talking about? 24 years ago, one of the things I said, it was called the Road to immunity, how to thrive and survive in a toxic world. Right. Which I think is still quite relevant to the times. And I said, if you don't look, you won't see. And if you don't listen, you won't hear. And so the key is you'll ask. You know, I've had People ask doctors, well you know, what about my zinc or something? Oh, you eat, you eat a normal American diet. You're not zinc deficient. Well, I pick up a lot of zinc deficiency and vitamin D deficiency and magnesium etc etc, and why? Because I look for it, because I suspect it more so than others depending on the dietary history I get. But if you don't look, you won't see. So you don't know. I don't know what somebody's zinc level is. I can have a sense based on some of their, you know, whether it be short stature or lack of healing or skin issues, you know, so there are things, or you know, recurrent infections because it's for immunity. But you know, I can't tell you what your vitamin D is. I would suspect it's low, I could say, but you know, could I know it's going to be an 8, you know, as opposed to a 32 because that dictates also what I'm going to treat with and then I'm going to get a follow up to make sure I'm in the right zone, that I don't overshoot. Vitamin D can be toxic, so you don't want to overshoot. So you have to make sure if you give a adequate dose of vitamin D that you're in the better range and you're not toxic. And this is why I think people need to do it with practitioners and physicians other than themselves because there are side effects. I mean methyl B12 can make maybe 10% of kids hyper and irritable and maybe agitated. Vitamin B6 can do that as well. So you have to be aware that there are side effects even of nutrients and therefore they need to be monitored and the dose needs to be adjusted and those kind of things.

Briefly, I wanted to touch on CBD and whether or not you see that as a helpful treatment in children with atabi. Do you find it consistently helpful? Does it need to have THC to be effective?

Firstly, it does not need to have thc. In fact, I don't like to use THC in the kids. So there's another caveat. I use pharmaceutical grade CBD and I, and I, and I think that, you know, there's a lot of CBD out there and some of which is not great I don't think because people have come to me on it and then they respond to the CBD I use because it's more of a pharmaceutical grade. It does, it's, it's certified certificates of analysis. It doesn't have the pesticides size of heavy. You know, it's really, it's much purer and it's also, it is what it is. That's the key you want it to. And so there are some CVD's with THC. If it's from hemp, which is what I use, then it's going to be 0.3% or less, which is legal. You know, cannabis can have up to 35, up 35%, it would be a whopping THC. But, but so, so I rather not have any THC for the kids. I think most parents feel better about that, as do I. And it's very dose related. It's very, very helpful. I feel like CBD has helped many of my patients both with the mood dysregulation spectrum, with the tabby in the autism spectrum, with anxiety, with calming, with sleep, but also something other than just neuropsychiatric. It's anti inflammatory. I just gave a lecture and I have another one coming up in two weeks to an autism organization of probably several thousand parents. And part of what I put in there is about CBD because they need to understand. So I put a bunch of slides of what CBD does between the various CB1 and CB2 receptors which are all over the body, CB1 more in the brain, CB2 more peripheral. But that's why CBD can have all these effects that sometimes people say, oh yeah, that's garbage. How can it have so many effects? Well, there are receptors all over the body in numerous organs, but one of the keys is that it's dose related. So we start slow and we build up slowly, increasing probably every week. So it may take weeks to get there. But the doses that are out there in a lot of the over the counter products, our miniscule and they got all kinds of other junk in them. And so you get a pure. And it's not just pure cbd. This is a broad spectrum, full spectrum CBD might have the thc, the tiny bit if it's hemp, which is okay, but I'd rather not. And the broad spectrum doesn't have the thc, but it has terpenes, flavonoids and it may have cbg, cbn, which are other cannabinoids rather than just the cbd. And so they have what we call an entourage effect. Okay. And the entourage effect means that they, it's like, you know this, the, the effect is greater than just the sum of the parts. It's an entourage effect. They make it, they make it better. So we don't use pure cbd although we, you know, it's obviously the most prominent component. It's the second most common of the cannabidiols, cannabinoids, except for THC in the, in the cannabis, but in the hemp, of course, it's, it's, it's, it's the most common. So I like one that's broad spectrum, I like one that's pure, I like that it's assayed. I want to make sure it's acid and I want to make sure the dose is adequate.

In these children, how often do you find IVIG as necessary and are there other tools that maybe you try first to provide that immune support and also quench any autoimmune process that might be underway?

So IVG is extremely effective. We do it every week here and sometimes multiple times in a week. It's very intense. It's two days because it's not the low dose IVIG that you give for immune deficiency, it's a high dose one. So you have to give it over two days for adults. Sometimes it's given over four or five days because you spread it over like for adults with Ms. But for autoimmunity you need the higher dose, 2 grams per kilogram given over two days. So they could be six to eight hour days because you have to do fluids. Because one of the things is immunoglobulins are large molecules, they can be a stress on the kidneys. So we do a lot of hydration before, during and after and we don't see those problems. It's very expensive. That's the one problem. We try to get insurance to cover it and we're successful a number of times. Sometimes you can, and I don't want parents mortgaging a home for it. But some of the patients we see from around the world can afford it. I feel like it should be covered for the things we use it for because it clearly works not in everybody, but in a high percentage it can be effective. One's not magic. So they frequently need three to six, sometimes even a little more, and usually give it every month or two. Sometimes you get away with just one. And it really does help. And that's what they need. It can quiet the inflammation and it can help stop the autoimmunity. So it's really, there's a lot of other more complex biochemical effects, but that in essence what it's doing, it's quelling the inflammation and autoimmunity.

In cases where IVIG is just not financially accessible to people, are there some Other tools that you might try that have a similar therapeutic intent.

I don't jump to IVIG first because of its expense and the fact that there are side effects. I mean it's a blood production. So I've been reassured by researchers that when they changed how it was developed in 1991, there's no way anything could survive. And it's tested for everything under the sun, but who knows if there's something we don't know. It's theoretical, but I have no problem with it. I would do with my own kid in a second. It is a solute load, so you have to hydrate them and so watch the kidney. We don't have any problem with that. You got to make sure in a certain older population that it wouldn't cause like any kind of thrombosis. Again, you don't see that in the kids. So the most common side effects are headaches, vomiting, like a flu, like symptoms that can come a day or two after and that we have, we've worked out a way to prevent that with certain prophylactic drugs and the fluids and stuff. So I just wanted to finish that up. But I do that in kids that are really not well, that are missing school for months or years, that are homicidal, psychotic, so depressed and just non functional, etc. Can't be around their siblings or family. I have stories that would blow your mind. I'm not going to get into them here, but I do do all these other things. First I try to figure out what's triggering and it may be more than one trigger. And that looks at all the different layers of the immune kettle, some more than others based on that person's history and what I think is going on. So I want to find out what's driving it. And then I would do a lot of the anti inflammatory treatments. We might do a modified ketogenic type diet, gluten free, dairy free, get them off grains, sugars, artificial colors, that kind of flavors to get them on more of protein, vegetables and good fats, that's one thing. The second thing would be a number of, you know, nourishment and replenish the microbiome with probiotics, prebiotics. And they'd be usually bacterial, but they could sometimes be saccharomyces, which is a probiotic yeast, especially if we have to give them antibiotics. And then a lot of the anti inflammatory nutrients, certainly the fish oils and vitamin D I call it. This was a friend of mine who once called the holy Trinity probiotics, vitamin D and fish oil and I like to call it that our holy trinity. Right. I think that's. And they're all anti inflammatory. Probiotics are anti inflammatory. They enhance Tregs and then and they also all those things fish oils inhibit inflammatory cytokines, the immune messenger molecules that are inflammatory. Then you go to the next things, you know for the blood brain barrier if there's a leaky gut when it should try to support that maybe with it like we have something we call glutamine plus which is glutamine plus some other things like health aloe and marshmallow, various things you can use igg, you can use immunoglobulins that don't really get absorbed but they're helpful for the gut as well. So we use those and then nutrients like zinc and then the anti inflammators like talked about like curcumin, resveratrol, very good for restoring the integrity of the blood brain barrier resveratrol and sometimes you use quercetin if there's allergies. Quercetin is another flavonoid. So there are many things that we can use and frequently I'll give things on it. And of course cbd. CBD is very helpful not only because of the anxiolytic and the calming and the sleep but also for its anti.

Inflammatory effects of Borrelia, Bartonella and Babesia in the vector borne illness and lime arena. Do you find that one of these is more commonly the trigger for a tabby than others? And then when you're approaching treatment of Lyme and co infections do you generally use antibiotics or do you use herbs and homeopathy or a combination of all of those potentially?

Well, firstly I'm integrated so I use a combination of all. I use antibiotics. I know there are a lot of natural practitioners out there that they either can't or they don't use antibiotics. Antibiotics are very helpful. So we use herbs with them or certainly after them. We transition and we frequently may end with homeopathics because homeopathics don't kill the organisms but they help the body to get rid of them and part of it as a homeopathic detox. And I do do a homeopathic detox earlier on, even before I do this we have some series of homeopathics for specific infections. It's a prolonged course, it's like several months. You do it either every three days or eventually every week. But and detox is very important when you use antibiotics because you want to help clear you Know, like you go to war, you have to unfortunately clear the debris, the weapons, the bodies. You got to do that in this because in essence you are going to war to try to fight these things. We like to protect. If we use antibiotics, you know, obviously the microbiome and the liver, so there are nutrients we use for that and you know which ones. And I will treat, yeah, I'll treat all of them, but I may not treat them all at once. I may start, you know, slower because I don't like to pile on a ton of antibiotics. I may start. A lot of times you need combination antibiotics, more than one. Sometimes you pulse them. If that seems to be a way. I don't usually start that way. There are certain medicines in Lyme disease like lineometronidazole for the cyst forms around bodies that we do pulse. You know, there are a lot of times together, so there's more frequently multiple CO infections. I can't quote you the percentages. I have them in a slide. But the amount of one CO infection, two and three, you'd be surprised how many times there are two or three CO infections. It's really increasing and they're difficult to get better if you don't address the CO infections. Although it doesn't hurt to get rid of one or decrease the load of one and then go to the other. And I do them together. But sometimes a matter of tolerance of antibiotics and anti parasitics like for the, for Babesia, Bartonella is, I would say is the most difficult. Bartonella can be really difficult, most severe symptoms, really hard to get rid of. Babesi and Bartonella do this dance together sometimes where you treat one and the other comes out, you got to treat that. So. And sometimes, you know, they're there. I mean clinically, you know, I mean, you think they're there. I don't want to be presumptuous and say if you have negative labs, you know, but there are times, you know, listen, I'm a clinician. I was, I was raised in University of Rochester with the foremost guy, George Angle, in biomedical psychosocial medicine. And he taught us how to really be clinicians and not just rely on labs. And I'm thankful for him all the time. I write about him in the latest book and he's, you know, he was amazing, right? And so that's what I learned and that's why I take a very detailed history and basically I. If I think somebody has all the symptoms of Babesia and they're testing negative and of course there's not Just Babesia Microti, there's Babesia Duncani and there are some other tests you can get other than antibody tests. But I will, I'll treat. And like I say, sometimes you go for one more, the other, the other comes out. Sometimes you'll do, a lot of times you'll do them together. Don't get me wrong, a lot of times I'm doing combination antibiotics to get all of them. But sometimes, you know, I don't want to throw on five antibiotics. There's some practitioners I know, so you always think of the patient, what they can tolerate, what's best for them. How do we go about this where some herbs may be real helpful so we can do a few antibiotics and then move to the next whatever. So this is all the, the art of treating tick borne, not just the science. There are many times I make clinical decisions with the patient. I tell them, listen, there's no right or wrong. 99% of the doctors or 90% would have stopped an antibiotic after a month. Well, we don't do that because we feel like we have to get rid of it. But exactly when you stop the antibiotic or when you add this or that, people do it differently. You got to get it. I would advise your listeners to get a practitioner they trust that's knowledgeable and then hopefully they feel like they have a partnership with rather than somebody just throwing everything at them.

I've heard that dance between Babesia and Bartonella referred to as the Babanella dance. I think it's a common thing. As we get down to our last couple of questions here for today, I wanted to touch on water damaged buildings. And so in the children you work with, how often is sick building syndrome or exposure to mold and other toxicants, this soup of toxins in water damaged buildings, how much does that contribute to the inflammation that can be involved in Etabi? And what are some of your favorite ways for dealing with exposure to water damaged buildings?

It can be very significant. No question. It can be very significant. I just had it today because I just saw a couple of patients, both of whom have been in water damage base buildings, both of who had a suspicion of mold, but they're getting it checked and who I'm checking for mycotoxins. So they are real. And so the first thing obviously is to either get away from it or remediate it. Sometimes I have to have people move out. If it's really bad, sometimes it's really bad. I mean I've had, I have stories that, you know, shake you up A bit, but sometimes it's not terrible, but it happens to be in the bedroom of the kid or right in their bathroom. So they're getting exposed to it every day or the family room where they're down there playing on their computers and their video games or tv. So you got to get it tested, you got to get it by very good testers, mold evaluators. There are companies and you probably want to get you, you want to get a company that tests and then another company that remediates. They shouldn't be the same company. I don't think they can anymore. I think that maybe has been legislated and it's a big project and it's expensive, but you can do all the binders that we do, you know, and we treat antifungals like nystatin or you know, potentially iflucan or itraconazole. We treat binders, pharmaceuticals like cholestyramine or GI detox like charcoal, folic acid and other kinds of binders. So you do have various kinds pectorisol and other ones. We do binders. You can do far infrared saunas to try to help eliminate, you know, some of the toxins. And you know you will, and you want to, you want to replete the immune system, to have the immune system be more helpful. We use homeopathic detox for that as well. Homeopathic detox I think is really helpful for helping clear the system of some of the toxins. So it's a multifactorial approach. It's not easy, it takes a while, but it can be done. But first and foremost you have to get away from the exposure and you have to remediate it before you go back, if possible.

The mitochondrial topic is gaining more and more interest with newer options like NAD precursors, urolithin A and other tools that are emerging. How common is mitochondrial dysfunction in your patients? Is there a way to test for it? And what are some of the ways that you like to support the mitochondria and the production of ATP?

You're covering the waterfront today. It is present in many patients. It's not primary mitochondrial disorders. It's mitochondrial dysfunction is very different usually. I remember I was at a conference, one of our autism think tanks and I talked about secondary mitochondrial perturbations. So they're second. It could be toxicants, could be infections, what have you, nutritional deficiencies, etc. So you can test them. You can get an initial lead or confirm a suspicion with an organic acid test because there are krebs Cycle metabolites. If they're abnormal, that certainly pushes you to think there's mitochondrial dysfunction. You can actually get a mitoswab that looks at all the different complexes complex, respiratory complex 1, 2, 3, 4, and they give you percentages. I just had one yesterday. The percentage of respiratory complex 1 was less than 2%. I've never seen that. That's the person. I then ordered a mitochondrial genome to see if that's a genetic thing. But a lot of times you'll see low decrease in respiratory factor 2 and 3 means you need antioxidants. It means you may need to treat the infections. So there are different ways to look at it, but it's very helpful. And yes, there are IVs, certainly we give IV phosphatidylcholine, IV glutathione, IV vitamin C. There are oxidative therapies. And people you can give IV nad to help that as well. Because you know, any NADH is in that respiratory cycle as fadh, you give riboflavin as another nutrient, you know, riboflavin, magnesium. And you got to get rid of the toxic metals because the toxic metals inhibit the enzymes that are involved in the mitochondrial process and the oxidative phosphorylation. So, so mitochondria very important, and there's literature on it. Mitochondria function is very important for the integrity of the blood brain barrier. So that's also what I look at because I'm really this day and age, I'm very interested in the maintaining and restoring, restoring and maintaining the integrity of the blood brain barrier. And we can measure actually an S100B protein, which is comes from the astrocytes, is measured in the peripheral circulation, although there's some, a few little small peripheral sources. If you have an elevated S100B, it's fairly consistent with either some kind of neuronal damage or we usually think of as loss of integrity of the blood brain barrier. Of course, you have to look at the gut as well because an increased intestinal permeability or loss of that intestinal integrity of the barrier can be reflected up to the blood brain barrier as well. So these are all new things because if you can help restore the blood brain barrier integrity, you can potentially make a patient more resistant to tabby pans and pandas because the inflammatory medias can't get in. So that's some newer research and that's very interesting to me and that's a lot of what I've been lecturing about.

So when we talk about Itabi pans and pandas. These are all complex life changing conditions, can be really stressful for families that are dealing with them. What can you say to give listeners hope?

Well, first of all, I like to give listeners, and I do all these lectures and podcasts as well as my patients, realistic hope and realistic expectations. Yes, I have seen stories, I mean some of them written down in the book, but I have others. You know, a child now he's 18, but he turned 18 but at 14, 15 regressed into a whole tabby episode and you know, lost speech, lost, you know, food restriction, lost so many pounds, became so thin, lost the ability to go to school, lost his ability to be with friends. At most his speech was whisper or stuttering. And I stick with these kids and kid number of ivigs as well as all the other treatments we had to treat his infections and do the whole thing with nutrients and immune system balancing, hormone balancing. This kid this year has just restarted school. It's phenomenal. He speaks now like he's 18, he's very far behind. He's in a senior year now. He may have graduated, but he's here because he missed years. He's just picking up with his friends again. He's obviously got some social skills to master, you know, and He's a young 18, obviously it's very encouraging. And this was a kid who I don't know if people, they couldn't do anything for, but so I think if you get in the hands of the right physician, the right practitioner whose knowledge about this and considers all the different aspects and looks at them and then remediates them, there's a good chance that people can improve. Can I say that every kid's going to become totally normal? Will they have some anxiety or this or that? You can't say. But I can say that the majority of the kids I treat, the vast majority, I said the same thing with autism spectrum disorder. The majority of them improve. I won't say the vast majority recover many and recover many of them in college. You never know they're autistic. The same here. I have so many kids now, it may be that it could come back again. They get a bad infection, they're under a lot of couple of things going on. So they may get a recurrence, but we can jump on those recurrences quickly. Knowing how to do it. I would think they should. I would like them to have realistic hope. And that realistic hope starts though with not allowing themselves to be kept down by maybe an opinionated physician that Says this is garden variety anxiety, or this is just this or that and all this other stuff about pans and pandas. We don't believe it because there are places that don't believe it exists. You just have to trust your instincts, you know, hopefully, you know, if they read variously, it doesn't have to be my books, the Brain Inflamed and Healing New Child, that can give them hope, but the numbers of other books out there so that you learn enough to realize that all the stories, these are real stories, these are real kids getting better. And these are. I see some of the most now from all over the world, some of the most affected kids. And I enjoy it. It's very hard work, but I enjoy the medical detective aspect because quite thankfully I'm a bit successful with it, you know, and it's very gratifying, but it is very difficult. There are flares. We have ways of dealing with the flares, ways of dealing with the hoaxes with the, you know, tick borne. So again, I'm being long winded, but I really, I would like to leave people with this whole concept that to have realistic hope.

My last question is the same for every guest and that is, what are some of the key things that you do on a daily basis in support of your own health?

Well, I eat healthy. What I'm going to do now, which I am an hour and a half delayed because I was a little delayed with my patients today. So I have a chopped salad with grilled chicken. That's what I eat almost. I eat probably three times a week or what have you. I didn't eat breakfast today. Sometimes I'll have a shake either at home when I come in. A medical foods protein shake, no sugar, you know, stevia. I, I play tennis and, or golf and I walk the golf course four or five times a week, sometimes two on one day. And I'm still working, so I, you know, so the weather's changing now, but I really try to get out there. I'll be playing tennis indoors, tennis, six and a half hours a week, which is. I meditate. I don't meditate every day like I used to. I do meditate. I think it's important. Try to make sure you see your friends, you know, and have loving relationships with, you know, your family. They're very important. I have a wife, two kids. So I think that social support, I tell the parents of the kids, nourishing yourselves, taking care of yourselves is a key. And they're so committed to getting their kids better. But if you don't take care of yourselves. You can't really help your kids because you won't be in shape to do it. So. And I say the same about, you know, if I'm going to help thousands of patients, I've got to take care of myself. So, you know, and I'm a moderate, doesn't mean you can't have a glass of wine or, you know, a glass of a good, you know, a single malt or a glass of bourbon. You can, I mean, for a lot of the people who have yeast problems, you can't have. You can't have beer, you can't have wine, especially red wine. But, you know, I mean, it's to be a moderate. That's the key. It's not to be an extreme. Sometimes you have to be extreme at the beginning to modify ketogenic diets. And as you get better, maybe you can bring some other things in. But for me, it's, you know, I try to balance. Listen, it hasn't always been easy for me to have balance in my life because I've been so busy, you know, lecturing, traveling, seeing patients from all over the world. So, you know, as I get older, I'm trying to even come into more imbalance. And that probably means playing a little more tennis and golf and maybe unfortunately with COVID not as able to get away as much as I'd like. But the key is to also, for me, I love my work. It's very gratifying to me. So loving. That's a way of nourishing myself as well. So, yeah, my staff will tell you, I mean, my. How I eat and how, you know, not how some of them eat really healthy, but some don't. You know, it's just, you know, I don't impose that on them, but they'll tell you the ones certainly ones who got get my lunch every day of how healthy it is. So. And the same thing with a dinner. You can eat a protein vegetable and a salad every night and have a very healthy dinner without having all, you know, the refined carbs and all that stuff. So that's how I would leave it.

This has been a great conversation. I want to encourage people to go out and get the book brain inflamed. There's so much that we didn't even begin to touch on here, and it is a fantastic resource. I want to thank you, Dr. Bak, for enjoying what you do, for loving what you do, for doing what you do, and for minimizing the suffering of so many children and their families. So thank you for being generous with your time today and for all that you shared with us.

You're very welcome. It's been my pleasure. Thank you.

To learn more about today's guests, visit Brain Inflamed.com or BachIntegrative.com that's Bach B O C K Integrative.com BachIntegrative.com or BachNutritionals.com.

That'S BachNutritionals.com BrainInflame.com BachIntegrative.com Or Bach Nutritional.

Nutritionals.com thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter or Miwi, you can find me there as BetterHealthGuy. To support the show, please visit BetterHealthGuy.com donate To be added to my newsletter, please visit BetterHealthGuy.Com newsletters this and other shows can be found on YouTube, Apple Podcasts, Google Podcasts, Stitcher, and Spotify.

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