How to Fix Leaky Gut & Reverse Chronic Inflammation with Dr. Tom O'Bryan

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Healthy. Dr. Tom O' Brien's goal for you is making it easy to do the right thing. As an internationally recognized, admired and compassionate speaker. Focuses on food sensitivities, environmental toxins, and development of autoimmune diseases, Dr. Tom's audiences discover that it is through a clear understanding of how you got to where you are that you and your doctor can figure out what will take you to get well. Thank you for joining the show today, Dr. Tom O'. Brien. So I have a special guest, Dr. Tom O', Brien. And we've had long chats about this, but we thought we'd go a direction today and really discuss how disease begins. And we were just discussing how all diseases begin in the gut. And I'll let Dr. Tom kind of take it from there so we can hit the core concepts for everybody.

Okay, well, thanks, Dr. Whitfield. Nice to be with you. Yeah. One of my teachers who I follow and have for many years is named Alessio Fasano, and he's a professor of medicine at Harvard Medical School, a professor of nutrition, Harvard School of Public Health, the chief of pediatric gastroenterology at Mass General, Harvard, the director of the Celiac Research center at Harvard, and the director of mucosal immunology at Harvard. This guy's got five titles. Any one title is a lifelong dream for someone at the top of their game. He's got five.

Right.

And we think he's going to win the Nobel Prize. We truly do, because it was him and his team that identified the mechanism of this thing that's now known as leaky gut. And they identified it back in 1997, and the physiology of how it happens and why it happens. And he's always so careful about what he says, you know, so he's not misquoted, but. And you know, he's got over 300 papers. You know, there'll be six authors on the paper. And the last name, Alessio Fasano. The boss. Right. The stamp of approval. This paper is ready to go. Well, this paper he wrote himself, which gives you a sense of how important he thinks it is to make sure the message comes across.

Right.

And the title. The title says it all. All disease begins in the, quote, leaky gut. The role of the protein zonulin in the development of chronic inflammatory diseases. And he talks about. In that paper, he talks about what he refers to as the perfect storm, where disease comes from. Now, first, let me backtrack for a moment and say that the center for Disease control tells us 14 of the 15 top causes of death are chronic inflammatory diseases. It's always inflammation, always, except for unintentional injuries, everything else.

Let's pause for a second and say, like what, what we mean by that. So everybody's brain, you can have something like Alzheimer's, a chronic inflammatory process, right? Have in your lungs pulmonary fibrosis or emphysema, an inflammatory process. When we talk about kidneys in end stage renal disease requiring dialysis, so that may be glomerular, glomerular nephritis, or somebody's problem with that. And then obviously hepatitis, end stage liver disease requiring not just hemodialysis, but a liver transplant. Right.

And diabetes, cognitive decline, Parkinson's, rheumatoid arthritis, Ms. It doesn't matter. They're all inflammatory diseases.

And we're all saying they start all in the gut.

That's what Fasano was telling us. And I'm going to go through the perfect storm that he refers to. But before we do that, I want to make sure everyone understands that this relates to everybody, right? And it doesn't matter what disease you've been diagnosed with this concept. You know, some doctors talk about the root cause of disease and they'll do a genetic test or something. And I'll say there is no root cause. There are many causes for disease, but there's. There's one root mechanism. It's always inflammation, right?

Always.

And the visual that I give is that if you pull at a chain, the chain always breaks. At the weakest link is at one end, the middle, the other end. It's your heart, your brain, your liver, your skin, your joints. Wherever the weak link is. And the weak link is determined by two things. First, your genetics. That's the deck of cards you were dealt in life. Can't do anything about that. And your antecedents, which is a geek word that means how you live your life. You know, if you eat tuna fish twice a week, you likely have mercury toxicity because the tuna's high in mercury. That's an antecedent, right? Or if you live in a moldy house and you're breathing mold spores all the time and you can't tell, but you're breathing mold spores. That's an antecedent. And if the weak link in your chain is cognitive decline, the inflammation in the brain is going to just make that vulnerability show quicker because the pull on the chain is always inflammation. And if the weak link is your brain, that's the symptoms you're going to get. If the weak links, your kidneys, that's the symptoms you're going to get wherever your weak link is determined by genetics and antecedents. But the mechanism, the root mechanism is the same. Inflammation is pulling on the chain. Inflammation is taxing your body.

I always say to our patients, it's like you can't pick your parents and you can't outrun a bad diet.

That's right.

Because it doesn't matter how much you exercise or how many other things you do well, ultimately what goes in your body, the air you breathe, the fluid you drink, the food you eat, what you apply to your body, your skin, that leads to what you're going to discuss about all the inflammatory things that then happen to us because, you know, you got four minutes without oxygen, you have a period of time without fluid, and you can actually go quite a while without food. But ultimately there's a lot of prices that get, get paid for that process.

That's exactly right. Exactly right. So Fasano talks about the five factors in the Perfect Storm. The first one is genetics, the deck of cards that you were dealt this time around and you can't do anything about your genetics. Now some doctors say, well, we're going to turn those genes off. Or you can't turn genes off. Genes don't operate that way. Genes operate on dimmer switches, not on off switches. And you certainly can dim down genes or increase their expression. You know, I learned back in the early 90s, one cup of blueberries a day for three years. One cup a day. And your brain's working as well as it was 13 years earlier.

Because glyphosates.

Say it again. That's right, that's right. Because blueberries have these, these ingredients that make them blue that actually turn on the genes in your brain for anti inflammation to put the fire out. You know that. So you, you can operate the dimmer switches on your genes, but you just can't turn them on and off. Right. So that's, number one, is your genes. Number two of the perfect storm are the environmental triggers like blueberries. If you eat blueberries, you calm down inflammation, or if you eat Ding Dongs or french fries, you ramp up inflammation. You know, it just, it just depends. Or if you're breathing the air and it's toxic air, you turn on genes of inflammation. So the environment, where we live, what we put inside our bodies, what we eat and drink, those are the environmental triggers that will activate the genes one way or another. That's number two. And we've got lots of choice, lots of control over our environmental triggers. Some things we don't, but the vast majority of things we do. It's our decision as to what. What's on the end of your fork. That's our decision. Now, number three, especially because of the great American diet that most of us grew up on, is that we've got too many bad guys in our gut and not enough good guys. The bacteria in our gut is called dysbiosis, and just. It's a fancy word. It means too many bad guys, not enough good guys.

Right.

When you have dysbiosis, it creates this environment inside the gut of inflammation because there's too many bad guys. And it causes number four, which is the leaky gut, intestinal permeability. Now, I want to give. You know, I didn't think of this until just now. Can you allow me to share screen? I'm, I'm going to show people what intestinal permeability is so that they'll never wonder after this, what is this thing called leaky gut?

So, yeah, let me bring that up. I'll talk about how we used to do it in surgery. So we'd have that, what they called it, spontaneous bacterial contamination, you know, be a translocation. And this was such a, you know, it seems kind of out there. When you're in training, you're like, what does this mean? And they would explain it as, you know, especially what happened in premature babies, because from a development issue, obviously they weren't developed. They were in a, you know, a NICU environment. They were getting, you know, nutrition either, you know, we knew if you could feed them orally or intrally, you know, through the gut, they would do better, obviously. And if you had to feed them iv, that was always fraught with more problems because ultimately, as you're going to explain the mucosal linings and the barrier is ultimately what fails us in this situation. And I'll, I'll let you. Now that you have it up.

Yep. Let's see here. Share screen. And here it is. Let's bring it up. Okay, can you see my screen now?

Yes.

Okay, so what is a leaky gut? So, Mrs. Patient, your digestive system is a tube. It goes from the mouth to the other end. It's about 20, 25ft long, winds around in the center there. It's one big long tube. And if you think of it like a donut. If you stretch a donut out, that's your digestive tract. So when you, when you swallow food, it's not in your body, it's in the tube.

Right.

And the food has to go through the walls of the tube to get into the bloodstream, right? Okay, now that's my hand with a piece of cheesecloth over it. Now, the inside lining of the tube is lined with cheesecloth so that if you take a bite of a hamburger, that meat can't get into your bloodstream. If it did, it might kill you. I mean, it can't. It's got to be broken down really small. Think of protein like a pearl necklace. You know, you chew a few times, and then the acid in your stomach undoes the clasp of the pearl necklace. Now you have a string of pearls, and our enzymes act as scissors to cut that pearl necklace smaller and smaller and smaller. Snip, snip, snip, snip, snip, until you're down to each pearl of the pearl necklace called an amino acid. And those are the building blocks to make new cells, right? So when you take a bite of a hamburger, it's got to be broken down really small. So it's like, you know, if you think of a raspberry, every part of the raspberry looks the same, but it's got to be broken down into each part of the raspberry. Your proteins have to be broken down into each individual amino acid. And in the upper part of your digestive system, that raspberry can't get through the cheesecloth into the bloodstream. It's too big. It's got to go further down the digestive tract. It's got to be broken down smaller and smaller and smaller and smaller and smaller until it's small enough. Now it goes right through the cheesecloth into the bloodstream. That's called absorption. So that's digestion and absorption. And the bigger molecules, they can't get through. It's not possible. They've got to go further down the digestive tract and be snipped smaller by our digestive enzymes. And so it looks like this. The small molecules go right through, through the tube into the bloodstream, but the big molecules cannot. They can't. They've got to go further down. But when you've got tears in the cheesecloth, this represents tears in the cheesecloth, which is number four in Fasano's Perfect Storm. Leaky gut. You get tears in the cheesecloth. Now, the smaller molecules still get through into the bloodstream, but now the bigger molecules get through into the bloodstream, and they're called macromolecules. Big molecules, macro. They're way too big. They're not supposed to be in the bloodstream, but they get in there, they get into the bloodstream and what that looks like is, oh, that big molecule, that's a chicken molecule. Don't go up. Now you're going to be allergic to chicken because your immune system is going to fight the chicken or it's going to fight the bananas, it's going to fight the tomatoes. It doesn't matter what the food is. If it got into the bloodstream as a macromolecule, your immune system trying to protect you is going to fight that food. Okay. And that's the person. So your immune system is your armed forces. It's just there to protect you. And, you know, and. And then I go on in this presentation, more about the immune system. But that's the leaky gut. It's tears in the cheesecloth. And it happens to all of us, unfortunately, in today's world, because of the foods that we've eaten, the toxins in the water that cause this, too many bad guys, not enough good guys in the gut, creates this inflammation in your gut that tears the cheesecloth. That's number four, the leaky gut. And then the immune system trying to protect you creates antibodies to fight that food, to fight whatever that is. That's number five. That's the perfect storm. Now you have this inflammation in your bloodstream because of the leaky gut, and whatever got in through the leaky gut, and now the bloodstream goes everywhere. So now you've got these inflammatory molecules and trying to protect you from this macromolecules of chicken or beef or eggs or whatever it is, just trying to protect you. But now those inflammation molecules, when they get to be too abundant, they're pulling on the chain. They're just pulling on your chain. And wherever the weak link is in your chain, that's where you're eventually going to see the symptoms. Thanks.

Well, I was going to say thank you for the explanation. It makes me think of patients who, you know, constantly from a travel. I'll just use travel as the inciting event that leads to. Or your antecedent, which is what you're. You're describing. Because people seem very, very confused by what you just said in that they're like, oh, I eat normally and da, da, da, da, da. But every time someone comes to me with a chronic inflammatory situation and I'm listening to them describe, you know, what I would consider limited genetic detoxification, which is very common.

Yep.

I just asked them, like, where did you grow up? Where do you live? Where did you travel to? And invariably, it's it's poorly understood that what we said in the beginning, the water, or we'll just say the fluid that you take into the body, like the easiest way around the world to get sick is drinking water. 100 hasn't changed in the course of time. It will continue to be the same. Intamoe histolytica or some other parasite will always probably be the number one, you know, thing in terms of travelers. Diarrhea or, you know, gut inflammation. In fact, Dr. O', Brien, I had a lady last week said she had diarrhea for six months, and I was like, and who thought that was okay. And she lives on a lake. I mean, this is not rocket science.

Right, Right.

If you just check the lady, she's got giardia and you just treat giardia.

Yeah.

And that will get better. And, you know, now you have someone in your setting who's got an infective component contributing to leaky gut. Yeah. And now that person, and certainly I'm sure, whether it's the paper, you or me, the first thing I thought about is, like, they're just chronically going to be micronutrient and. Or macronutrient deficient now because you can't absorb anything in your cheesecloth if it's got huge holes like you could drive a Toyota through.

Right, Right. Because there's so much inflammation in there at the same time, and it just becomes so dysfunctional. It's what killed my father. He had a massive coronary, is 64 years old, with no advanced warnings ever. And Monday morning, like most men that die of coronaries, it's Monday morning after a weekend of summer weekend, you know, big pot roast or lots of meats at barbecue or something. And. And he had an elevated homocysteine level that had never been checked before. And it's a byproduct of eating protein. And that's because in the first part of his intestine, he wasn't absorbing B vitamins. So he developed this homocysteine problem that nobody knew about, no one diagnosed. And the first part of the intestines is where Fasano's talking. All disease begins in the leaky gut. That's where it begins.

And I'm glad you brought that up because, you know, you. We kind of. We didn't gloss over genetics. And I always say you can't pick your parents. But in our patient population where there's. I clearly have people that don't detox well. And then if you look at Eric Topol's script study that he did on the welderly population, he found these folks who lived into their 70s and 80s and 90s with no evidence of chronic inflammation. So no Alzheimer's, no cardiac disease, no diabetes, no rheumatoid or they just didn't develop these things. And so they did whole genome sequencing and they didn't find anything amazing in terms of genetics. Right, but doesn't that just answer the question? If you live that long, you don't have amazing genetics. You have, you can detoxify and then you haven't put in all the things that I would say highlight someone who can't.

Well, you know, it's interesting. There was a study that came out four years ago, I think it was. They looked at 79 centenarians, people over a hundred years old, that had no diagnosed diseases. They were fully functional, and they compared them to 178 people under the age of 40 who had had a heart attack and survived, and 178 people under the age of 40who were healthy. So 79 centenarians and 148 people previous heart attack and 148 healthy people, all under the age of 40. They found two things that were common with every centenarian. One, they had much lower levels of zonulin, that's the protein that causes leaky gut. And they had much lower levels of LPS lipopolysaccharide, which is toxin from bad bacteria in your gut that gets through the leaky gut into the bloodstream.

Right. So everybody listening. LPS is basically endotoxin. It's from gram negative bacteria. And those are sources of, think of like E. Coli. That's a very common gram negative.

Right, right. And so those were the two things that were common with every centenarian compared to these two groups of 178 people under the age of 40.

So a really more of a, a tube that's intact versus one that's starting to separate or have holes in the, in the cheesecloth as, as you described, which is a great analogy, great way to think about terms of breaking it down, making it easy to understand. So if we have those problems, then take us through. All right, you have increased levels of zonulin, you have leaky gut, like what is going to go off? We'll say, you know, the top five things you may encounter in that situation.

Most common is cognitive decline. Most common, and that's because, you know, the papers have been coming out for the last four to six years. I think maybe a little sooner than that, but at least the last four to six years that the number one disease that most everyone is concerned about is dementia and Alzheimer's.

Right.

With everyone I talk to. And what they, we now know is that beta amyloid, the plaque that develops in the brain, the hallmark of Alzheimer's, is actually an immune system response to try to wall off and hide the LPS that got into the brain. The researchers at Harvard, they call them Lego peptides. You know, I've got a five year old and he plays with Legos. And so when I heard that, I said, oh, these geek guys, they're like, oh look, it looks like a Lego. You know, they're trying to, you know, they're, they're enjoying their work, talking about something that's very serious. But they call them Lego peptides because they all look different. That the beta amyloid that goes after and to wall off a bacteria like Klebsiella that gets in the brain looks very different. The configuration is different than the beta amyloid that goes after Proteus in the brain. You know, so depending on what bacteria, what LPS gets into your bloodstream and if you have a leaky gut, you often get a leaky brain. So now this bacteria gets into your brain and beta amyloid goes in there to wall it off. So that's consistent with the study on the centenarians. Once again, it's lps. But the most common symptom that I see in the studies around all of this is fatigue, either mental fatigue or physical fatigue. Second most common symptom is, and depending on the age group, you know, because I see more people that are in their mid-40s and above is some cognitive decline, some memory that's just starting. Oh, I'm getting old, doc. I don't remember the way I used to. Haha. Well, how old are you? I'm 46. No, that's not supposed to happen.

Right, right. So you said beta amyloid and then certainly we're hearing more and more about P Tau and measuring P Tau and how it's maybe even a. Because the, the, the, the drugs trialed for beta amyloid lowering didn't work. Or they haven't.

They all failed. They all failed.

Yeah, they've been whatever gabillion dollars in production and have done absolutely nothing. But P Tau now certainly can be measured in, in both CSF and in the plasma. And that's probably, you know, a, a better indicator. And then, you know, how can we maybe avoid. Because we're talking about amyloid and gram negatives and lps, but as it relates to pta. What can we do?

Well, there are five tests that I recommend. Everyone gets, you know, the rule is in God we trust. All others require data. You have to know what you're dealing with. And so there are five tests. I won't see a patient, I won't talk to a patient until they've done these tests because we find consistently that they're indicators of what's been going on in this person's life for quite a while.

Okay.

And the first test is called the Neural Zoomer Plus. And it looks at 55 markers of inflammation in the brain. 55, 55. It's just tremendous. It's a tremendous test. And we. I've never gotten a negative back on a first test that we all have inflammation in our brain because of the air we're breathing. You know, you really think those chemtrails don't have effects on us? You know, we're breathing that stuff. So that's the first test. The second test is the oxidative stress profile. Here's how to think about. And oxidative stress is a measure of how much damage is going on right now. And my friend and mentor introduced this concept back in the 1980s, Jeff Bland. And he figured out that it takes 976,000 mouse traps laid out on a football field side by side. It's 976,000 cock each Mousetrap and put a ping pong ball on each mousetrap. Now you have 976,000 mousetraps cocked with a ping pong ball on them. So the football field looks white. It looks like just all white. And if you look closely, they're all ping pong balls. Walk along the sideline with one ping pong ball, just one little ping pong ball, Throw it out onto this big football field. It hits one mouse trap. Pop. Now there are two ping pong balls in the air. They hit two mouse traps. Pop, pop. Now there's four ping pong balls there. Pop, pop, pop, pop. Eight, 16. And you've got what's called a cascade reaction. That's what oxidative stress is. And, you know, for example, when you fly, I fly a lot. And depending on the solar cycle, the, the radiation from flying being at 35,000ft goes in 11 year cycles. And at the peak of the 11 year cycle, you fly from New York to L. A, you're getting the radiation exposure of seven chest X rays. And at the bottom of that 11 year cycle, it's about two to three chest X rays. Then it Goes back up to about 11 again. And it's the radiation. But what's the radiation doing? It's causing oxidative damage in our body. Pop. Which eventually causes the diseases like cancer or whatever the weak link in our chain is. But it's oxidative stress that's causing the damage. And the oxidative stress profile will not only look at 25 genes that say these are your vulnerable genes that you don't handle pop, pop, pop very well, it also looks at 18 different markers. Is that oxidative stress going on right now? So you can measure how much damage is occurring on a daily basis. That is pulling on the chain eventually will manifest with the symptoms of whatever your disease vulnerability is.

Right, Right.

So that's the oxidative stress profile. That's number two. Number three is the total tox burden. It looks at 18 heavy metals, 28 mycotoxins for mold exposure, and 34 or 36 chemicals like organophosphates and glyphosate, things like that. And that's just a simple urine test. The first couple are blood tests. Number four is the Wheat Zoomer. It's called, because you zoom in on the problem, and not only does it identify if your immune system is fighting wheat, it's also the best test I've ever seen to identify the leaky gut. And that's all in one test called the Wheat Zoomer. And number five is a stool analysis called the Gut Zoomer, which looks at a tremendous number of markers of how healthy or unhealthy is your gut. So from those five tests, you now have an idea, a clear picture of what's going on in my body right now. What's going on. And then you. You can develop the game plan to start to put the fire out. Stop pulling on the chain so hard, right? Reduce the oxidative stress. And then six months later, you go back and do the oxidative stress test again. And it should be coming down, if not to normal yet, it should be down quite a bit. Or the doctor missed something, because those aren't permanent. That's just lifestyle. That's the nutrition or the foods or the air or the beverages we're drinking that cause that oxidative stress.

I'm glad you put it that way, because I talk to patients about it, and we use many of the same tools you're describing. And then what I try to get them to do right off the bat is understand that you know your sleep patterns, your circadian rhythm, you know, the air you breathe, the fluid you drink the food you eat. Like, I can't do anything about those. You have to do those things. You have to make those changes. And we try to educate first by, you know, as, you know, the hardest thing to do is modify behavior. So trying to get folks to recognize, you know, what they're eating, what they're drinking, you know, the air they're breathing. And then people get super offended when you say anything about their homes or, you know, if you say, hey, could there be mold in your home or could there be a problem in your home? People just immediately get defensive about it. I'm like, I'm not trying to attack your home. I'm trying to ask you, you know, to think about, did you have a water leak or did you see something or, you know, is there? And you, you know this, like, you, you get these folks who are supremely susceptible to mold, like I am, just because they're genetics, their GSST and GSTP1 SNPs, anyway, they're going to have a problem. And if, if you can, you know, get them to, like, cognitively, if you will, come on board with that, like, these are all things that make you susceptible. These are your antecedents. These are the things that lead up to, you know, why you're hanging out in my office, sitting in front of me. It's not because you just decided that day to come get surgery and, you know, you made that, you know, Google entry or j, you know, now it's ChatGPT entry and found me. And you're like, oh, I'm going to go see him today.

It's, it's all, I, I, I. My practice was in Chicago for 25 years and, and then I moved to Southern California and I would talk to patients by Zoom once in a while, but that was it because I was teaching, I was traveling and teaching a lot. And this one senior exec from back east, his staff called and said, hi, we'd like to send our jet out to bring you back because Mr. So and so his brain's not working anymore. He had to take a leave of absence from his job, and he's been to three world famous centers and no one can help, but we've heard about you and you know, can we send the jet? And I said, no, I don't want to go back east. No, no, he can come here if he wants to come here. And so he and his wife decided to come out and they rented an RV and drove the coast from San Francisco down to San Diego, which is where I was Living. So, you know, they had a nice trip, which was great. And I don't have an office. I work from home. So I met him at a coffee shop. Right. And we sit down and, nice to meet you. And we got our coffees and sat down. It took me three minutes. Just three minutes. And we're sitting there. I said, so when did your basement flood? What? What? How did you know my basement flood flooded? And I said, well, you're from the Midwest, right? Yeah. Yeah. Well, when did the basement flood? Just over two years ago. And when did your symptoms start? About a year and a half ago. Do you think that had something to do with it? Right. And so I told him, just go home and have a mold remediator come and take a look at the house. Because they cleaned the carpet in the basement, they dried it out, but the drywall got wet and the backside. And although, you know, the wet stains were gone pretty quickly, the backside of the drywall, it was full of black mold. And the entire family was not feeling well. And it affected him dramatically because, like you, he had some genetic vulnerabilities that didn't handle mold very well at all. Right, right. But, you know, you want to look for the basic things first. It doesn't matter what the symptoms are. Where is the inflammation coming from? Is it gasoline or kerosene? Where is it coming from? That's the million dollar question that most of our practitioners were never guided to think about in their education.

Yeah, it is, it's a, it's a, gosh, I guess going back to school, you know, they're like, you have to be able to take a history. And if you can't, you're, you know, I always say, like, if you just listen, people are going to tell you exactly what's wrong.

Yeah.

They will tell you what happened. If you just keep asking. If you don't get tired of asking the questions and you just listen to them, they will invariably lead you right where you need to go. And just like you spoke with them about the basement. You know, I just, I get obsessed with like, travel history. I just am like, when it sounds like a parasite, I just won't get off of it. And I assume everybody now has been exposed to mycotoxin levels that are too high. And, you know, I'm sure, as you are aware of regionally, you're going to have some weird chemical exposures, especially in southern states, not so much in, you know, where you were talking about California, but you have ag. Anywhere you have ag, you're going to have something. It's just, you just have to sit there and think about it and say, like, all right, where'd you grow up? Where do you live now? Where have you traveled to? Like, invariably they're going to tell you exactly what's wrong. And then you, it's not hard to postulate, you know, genetically what their, you know, problems are, like methylate, well, they have poor antioxidant pathway, they have a poor vitamin D pathway, they have a poor methylation. I mean, it's not rocket science. And then you just, if, obviously, if it's a woman and you're, they have complicated problems with their cycle, then they're typically going to be estrogen toxic. And so the, the whole thing just becomes very like, wrote to me. Like when I listen to them, it's like, okay.

Yes, yes, yeah, exactly. And I, I'm emphasizing all the time on stage, you know, for our doctors to just keep asking the question, what is the immune system trying to protect you from? Because it's, it's always inflammation produced by the immune system, because that's how it kills stuff, is by creating inflammation. So what is it trying to protect you from? That's the million dollar question.

Well, now we have this very interesting response that is being found because, you know, I take out old breast implants with the scar tissue and everything, and there's been this controversy about, oh, should you take the scar tissue out? And it's like, it's not really controversial to me because bacterial biofilms stimulate your immune system and 29% of those devices will have a bacterial biofilm that people are like, well, how does that happen? Like, well, we've been discussing exposures. So if you get a cut on your skin, you get a pneumonia, you get a uti, you get a leaky gut, and you get bacterial translocation. These are all things that get in your bloodstream. And your body has this wonderful surveillance system, as Dr. O' Brien's highlighted, that will protect you, but it only protects self. If it's not recognized as self, it can't protect the self. And the, you know, the only way an organ that's not self is protected is if it came from your genetically identic identical twin. That's it. Dr. Murray won the Nobel Prize for transplanting the first kidney from a monozygotic or a identical twin into another twin because one had gotten glomerulone nephritis. And that twin lived for another year and then passed away. But he showed you could do it. The only way to Navigate circumnavigate your immune system is by having the same genetic identity. Everything else requires a level of immunosuppression and will ultimately lead to, as you know, a response from your immune system. So that's going to create chronic inflammation. So now, because the, and this is very exciting to me because I've been thinking this way for a long period of time, it's more like a rejection rather than a foreign body reaction. And now the papers in the literature are coming out to support the body's reaction with B cells and plasma cells and creating an antibody response. So that's what happens in organ rejection. That's how you reject an organ. So you have a ABO or a blood type match and if you have a HLA negative cross match, you're good. But if it's positive, that means you have preformed antibodies to that cadaver kidney and that will cause a hyper acute rejection episode. Yeah, everything else you basically are trying to make it, as you know, Dr. O', Brien, a chronic rejection process so that person can survive. Because the things that we've been discussing about inflammation lead to end stage renal disease and need kidney transplant or end stage liver disease, need a liver transplant or end stage cardiac disease and need a cardiac transplant. But Dr. Murray then went on to show that you can do it in a non identical twin and they use total body irradiation because that's all they had at the time, which of course, you know, is not something you want to do long term for patients. And then they came up with prednisone and azathioprine and were able to do cadaver transplantation. But so now when we see these scar capsules, it's not the splinter in the finger foreign body reaction that was always taught to us, it's now that a certain group of these patients are actually acting like they're rejecting a cadaveric transplant. Which makes sense because your immune system is so sophisticated and we have the major histocompatibility complex, but in humans, called the human leukocyte antigen complex, and they have all these polymorphisms to recognize and protect us from all these different antigens. So when these antigens are shown to us, as Dr. O' Brien has discussed, our surveillance system takes action. And that's why we get more and more reactivity. You know, whether it's here or in a dental implant or a cardiac implant, every implant you can put in a human is going to get a response and that creates inflammation like he's discussed. And you know, when you Stack the deck too high. Dr. O', Brien, you know what happens? People get ill, and then they come, you know, looking for you or I to understand why they're, they're doing so poorly. And, you know, to your credit, I.

I actually, actually, people don't want to understand why. They just want to feel better. Yes. And my goal is to help them understand why, which then empowers them to change the lifestyle that's creating the problem.

Yeah, I, I, I have the other spectrum. So people have this device placed for whatever reason, cosmetic, reconstructive, and now they're, you know, not doing well. And many of them are kind of at the end of that, that journey. They've saw you, maybe they've seen all the specialists, and there's not really been a, okay, you've done this therapy, this treatment, and, and this has gotten better, but this hasn't. And then that leads them to do something that, you know, they didn't want to come and have undone, which is a surgical procedure, which is a big deal to obviously come and do again. I do. Ever since our first discussion. I like how you think about it. You, like, break it down, and it's very digestible, very understandable. I really enjoy speaking with you, and I, if I ever get over to Italy, and hopefully you can see a race in Milan, I will definitely have a coffee with you.

I'd look forward to that. I very much look forward to that.

All right, thanks so much, Dr. O'.

Brien. Thank you.