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Episode 68
The Doctor's Farmacy: House Call

A Functional Medicine Approach To Curing Crohn’s And Colitis

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Inflammatory bowel disease (IBD) is an umbrella term for a variety of symptoms and diagnoses, including ulcerative colitis and Crohn’s disease. Approximately 3 million Americans are impacted by this inflammatory condition that affects the digestive tract and can greatly impact quality of life, disrupt daily routines, and carry very real emotional burdens. Symptoms of IBD include bloating, constipation, diarrhea, urgency, painful cramping, rectal bleeding, and more.

In this episode, Dr. Hyman talks to his UltraWellness Center colleague Dr. George Papanicolaou about the Functional Medicine approach to treating inflammatory bowel disease. They identify root causes and discuss why the health of your microbiome is vital when it comes to treating IBD. IBD is autoimmune in nature and may be helped by following autoimmune protocols also covered in this episode.

George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health, a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017.

This episode is sponsored by Thrive Market and Primal Kitchen.

Thrive Market is offering all Doctor’s Farmacy listeners an extra 25% off your first purchase and a free gift when you sign up for Thrive Market. Just head over to thrivemarket.com/Hyman.

Right now, Primal Kitchen is offering my community 20% off. Just go to primalkitchen.com and use the code DRHYMAN20 at checkout.

In this conversation, Dr. Hyman and Dr. Papanicolaou discuss:

  • How highly-processed foods affect the gut
  • Causes of IBD, including a disordered microbiome, stress, and lack of exercise
  • Why toxins contribute to dis-ease in the body
  • What to investigate when treating inflammatory bowel disease
  • The importance of akkermansia in your gut microbiome
  • The use of the Autoimmune Protocol (AIP) diet to treat Crohn’s and colitis
  • Tools to modulate the immune system

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. George Papanicolaou

Dr. Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital, Abington, Pennsylvania. He is also an Institute for Functional Medicine Certified Practitioner. Dr. Papnicolaou established his own practice: Cornerstone Personal Health dedicated to the Functional Medicine Model. Dr. Hyman invited him to bring his expertise and twenty years of experience to the UltraWellness team. He specializes in treating the root causes of many conditions including Neurodegenerative disorders, ADHD, PANDAS/PANS, gut and hormone health.

Show Notes

  1. Integrating Functional Medicine into Cleveland Clinic’s Inflammatory Bowel Program
  2. A Functional Medicine Approach to Treating Crohn’s and Colitis with Nishtha Patel
  3. A Collaborative Approach to Heal Inflammatory Bowel Disease
  4. What Really Causes AutoImmune Disease with Dr. Todd LePine

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. George Papanicolaou:
And if a person has a genetic predisposition to ulcerative colitis, or Crohn’s, inflammatory bowel disease in general, then they’re going to be at high risk for triggering that gene and developing that disease they have a predisposition for. It’s our diet, it’s our environment, it’s the stress. All of those can trigger your genetic predisposition.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s Farmacy with an F, a place for conversations that matter. And if your digestive system has ever been a problem, especially if you’ve had some type of inflammatory bowel disease like Crohn’s or colitis, this podcast is for you, because we’re going to discuss a functional medicine approach to inflammatory bowel disease with my friend, my colleague at The UltraWellness Center, Dr. George Papanicolaou, who’s been with us for years, and is just one of the brightest and most amazing docs I know. And I’m so happy to have him here to talk about this terrible problem, which affects so many people, which I have suffered from, and which is amazingly fixable using functional medicine. Welcome, George.

Dr. George Papanicolaou:
Mark, it’s always a pleasure. It’s always great to talk about functional medicine and what we do with functional medicine at The UltraWellness Center to help people get better and reach their optimal health.

Dr. Mark Hyman:
Well, thanks, George. Well, listen, we’re going to get right into it. So inflammatory bowel disease, how common is it? What is it? What symptoms do people get? And tell us about what we know about the disease in terms of a traditional approach from traditional, conventional medicine. What’s the approach to this? Because it just seems like a vexing problem, and we just seem to have made some advances, but still, it’s not great.

Dr. George Papanicolaou:
Yeah. So, it’s very common. About three million people have it per year in the United States of America. That is actually up from two million in 2000. So there’s a very steep increase over the last several decades, and the projections are it’s going to increase at an even more rapid rate over the next 20 years. So ulcerative colitis, Crohn’s disease, which both are the two major inflammatory bowel diseases, are frequent and common, and are very, very disruptive to the people that have it. It can really just completely upend their lives. Depending on how quickly you want to get into this, I can get right into it, I’m just thinking of all my patients and their suffering. I can tell you that when it’s uncontrolled, there is a lot of pain, there’s a lot of diarrhea, there’s an inability to eat, there’s fatigue and weakness that keeps people from being able to [crosstalk 00:02:48].

Dr. Mark Hyman:
And weight loss.

Dr. George Papanicolaou:
Weight loss, all of those symptoms, malnutrition can be included in there. So there’s a lot of people that have it, it’s a growing problem, and when you have it, it’s very disruptive, and even when you are well, you have to work hard at staying well.

Dr. Mark Hyman:
Yeah, it’s a huge problem, and it’s basically an autoimmune disease of the gut. What’s amazing to me is in traditional gastroenterology, I’ve talked to gastroenterologists and they’re like, “Oh, what you eat doesn’t really impact it.” I’m like, “Wait a minute. You’re putting pounds of some foreign substance in your mouth every day that’s going through your gut. How could that not affect it?” Right? It’s just so striking to me that there’s just this complete, almost ignoring of the role of nutrition and food, in what’s going on with gut disorders. That’s just kind of a meta comment because it’s such a big-

Dr. George Papanicolaou:
But to make a-

Dr. Mark Hyman:
… obvious “duh” to me.

Dr. George Papanicolaou:
Yeah, but to retort with another meta comment, I would say that in our food, yes, but in that food are toxins, and in our environment are toxins, and we have medications, and we have endocrine disrupting hormones, all of which end up in our gut, in our gut microbiome, and are very disruptive, and if a person has a genetic predisposition to ulcerative colitis, or Crohn’s, inflammatory bowel disease in general, then they’re going to be at high risk for triggering that gene and developing that disease they have a predisposition for. It’s our diet, it’s our environment, it’s the stress. All of those can trigger your genetic predisposition.

Dr. Mark Hyman:
Absolutely, absolutely.

Dr. George Papanicolaou:
Because you have to ask yourself the question, why have we had such a rapid increase over the last several-

Dr. Mark Hyman:
Yeah, what’s going on?

Dr. George Papanicolaou:
… [inaudible 00:04:38], and this is your area that you just, you are the leading edge of the medical voice and understanding agriculture and food production in our country and how it is toxic, and why it’s toxic. We don’t have healthy soil, and that’s where it begins, because if we don’t have healthy soil, we’re not going to get the nutrients in our gut soil to grow good bacteria and have a healthy microbiome, so that our intestines can stay healthy and do their job for us.

Dr. Mark Hyman:
Yeah, it’s such a big deal, and from a conventional perspective, the treatments are really to shut down your immune system, right?

Dr. George Papanicolaou:
Yeah.

Dr. Mark Hyman:
Prednisone, steroids, chemo drugs, TNF alpha blockers, things that increase your risk of cancer and infection. They’re pretty extreme drugs, and they can be very helpful, and they can be life-saving, and they can work for people, but the question is, is there an alternative?

Dr. George Papanicolaou:
Yeah, well-

Dr. Mark Hyman:
And do we have to deal with this the same old way we’ve been doing it? And then of course, for a lot of patients who have it, sometimes they need surgery, they have a total colectomy for ulcerative colitis, where they remove your entire colon, or resect whole sections of your bowel with Crohn’s disease, which doesn’t really cure the problem. It’s just a rough, rough disease.

Dr. George Papanicolaou:
It is rough, and I think you and I can bring people some really good news today, that using functional medicine and what we understand about the gut microbiome, what we understand about food as medicine, you can get better and stay better, without having to use the kind of drugs that you just mentioned, that can lead to cancers down the road. People on immunosuppressive drugs followed for 20 years, they’re already at very high risk, they’re already at an increased risk with inflammatory bowel disease for colon cancer. And then if you put them on an immunosuppressive drug and follow them for 20 years, they have an increased rate of skin cancers by about 40%. And so, and during that period of time, they have increased rates of infection, they have side effects to the medications, they have to come on and off them, they have to try new medications, and by and large, they’re moderately effective, and sometimes it’s not effective at all for some people.

Dr. Mark Hyman:
For sure, and I think that people suffer a lot from this and they can manage the disease, but it often doesn’t go away or it’s not curable, but from a functional medicine perspective, it can be really curable. And I can tell you so many patients that I’ve had, I mean, I just… Actually, how I got the job, and partly how I got the job at Cleveland Clinic, was because I met someone through the CEO whose niece had severe colitis, tried all the medications, wasn’t working, was about to have her total entire colon removed at 32 years old. And I said, “Look, just have her come to me. No promises, but no it’s worth trying before she rips out her entire colon, which is irreversible.”

Dr. Mark Hyman:
And I think she was skeptical. She was from New Orleans, and probably wasn’t the healthiest lifestyle down there, and she agreed to do what I told her to do, but she was quite skeptical, but I changed her diet, I reset her gut microbiome, did simple things, simple things. And in six weeks I talked to her, she said, “I’m perfect. I’m fine. I’m on no medication.” And I’m like, “What?” Literally, six weeks, and they were going to take her colon out, and she’s symptom-free and off her medication. And I can tell you story after story like that. Another young kid was 25 years old, same thing about taking his colon out, just some simple dietary lifestyle changes and getting the gut microbiome straight, and resetting the gut with the functional medicine for our 5R Program was so key. So I think, it’s-

Dr. George Papanicolaou:
Well, we had talked earlier as we were preparing for this, and one of the first things that happened, and you can correct me if I’m wrong, but you met with Dr. Regueiro, who’s a GI doc through the clinic, and you guys [inaudible 00:08:51] to work with functional medicine and traditional and conventional forms to treat ulcerative colitis and inflammatory bowel diseases, and that sounds like a phenomenal partnership.

Dr. Mark Hyman:
Absolutely, it really is, and I think there’s a real openness to understanding there’s really room for this, including with everything. It’s not either or, it’s, “How do we create the best conditions for a patient to get to health?” And I think, I just, in terms of causes, let’s sort of dive into that, because from a functional medicine perspective, we really look at root causes. And today, I was going through my medical research that I do every day and just sort of looking at what’s new, and I was sort of shocked to see this, well, not really shocked actually, I kind of expected it, but I was shocked to see it sort of published so prominently in a medical journal, really discussing the way in which food additives and ultra-processed food will drive changes in people’s guts.

Dr. Mark Hyman:
So when you look at this data, it was quite interesting. They looked at mice and people, and they basically showed that a high sugar, processed food diet affects the gut, and in a harmful way. We also know that there’s a lot of emulsifiers and additives in food, like thickeners, even things like microbial transglutaminase, which is like a gluten product that’s put on purpose in food to make it stick together, because gluten makes it glue, it makes it stick together. And so, we have to sort of think about when we take care of these patients, what their causes are. So from your experience, George, what are the top things you think about when you’re seeing a patient with inflammatory bowel disease?

Dr. George Papanicolaou:
Well, the first thing I think of is disordered microbiome, and then I think of all of the components that go into that from their diet, specifically, their lack of foods that are prebiotic and probiotic. I think about the types of foods they eat that would be disruptive to the gut microbiome, like grains that have glyphosate sprayed on them, if you’re not eating organically. That’s where I really begin to dig down deep. I look at stress. I will tell you that whenever one of my ulcerative colitis patients or Crohn’s patients call suddenly with a exacerbation has come on, and they’re in a panic and they want help, eight times out of 10, stress is triggered, and the role of stress in triggering this disease and in driving it, and causing exacerbations and making it even more difficult to get under control.

Dr. George Papanicolaou:
So I think about lifestyle, I think about stress, I think about the role of exercise, because exercise does play a role in controlling inflammatory bowel disease. I mean, stress and exercise have been in studies showing controlling stress, getting your exercise, and altering your diet, those are three things that can make a big difference. So I think about those when a person’s coming to me, and it lights up.

Dr. George Papanicolaou:
What the causes are, there’s obviously a genetic predisposition for people, and so we think about that. There’s not a lot I can do to change the genetics at this point in medicine. I think about the, again, I go back to the immune system. We know that there’s an immune [inaudible 00:12:21] that goes on, and we know that the gut and the microbiome very specifically, is the gateway to the immune system. And that’s why I think about it first, because we need a healthy gut microbiome to have a healthy gut lining, or that mucosal lining, because that mucosal lining plays a very important role of providing very concise and precise communication between the gut bacteria and the immune system.

Dr. George Papanicolaou:
Because the gut bacteria and the immune system work very closely together to make sure that we are protected from outside danger, things that aren’t us, and when that gut microbiome, those bacteria aren’t healthy, that mucosal lining breaks down, and now toxins, and bacteria, and viruses, heavy metals can get back into our system and recirculate, increasing our toxic load, further damaging our immune system, further creating inflammation, to trigger or maintain that inflammatory process that we call ulcerative colitis and Crohn’s disease.

Dr. Mark Hyman:
Yeah, what’s great now is that we’re learning so much about the microbiome, and so much about how to work with it, and how to optimize it, and what harms it, and I’ve seen all sorts of cases of Crohn’s and colitis. And I’ll just share another story of a guy who I saw years ago who had severe colitis, was really losing weight, struggling. I tried all the normal functional medicine stuff, reset his gut microbiome, the 5R, elimination diet, tried everything, the right supplements, and he just wasn’t getting better. And so, I went back to the principles, first principles that I learned from Sid Baker, which is, “What could be bugging this person that needs to be gotten rid of? Is there something else that I’m missing and what am I missing? Is there something I’m missing?” So I went back to the drawing board with my medical detective hat on, and found out this guy had really high levels of mercury, and it wasn’t until chelate his mercury that he was able to correct his colitis, and is now symptom-free.

Dr. Mark Hyman:
I personally had a different cause. I was somebody who mostly had a healthy gut most of my life, and then I developed mercury poisoning and that messed up my gut. I didn’t get colitis, but I had really bad irritable bowel and bacterial overgrowth, and all sorts of issues, and I’m cured. But then a few years ago, about five years ago, I got a confluence of events where I ended up having to take an antibiotic for a bad tooth and a root canal, and it was clindamycin, and this antibiotic is known to cause C. difficile, which is a really common intestinal infection that causes death in about 30,000 people a year. And all of a sudden, I started getting not just diarrhea and this and that from it, I started getting really severe pain, nausea, I’m going to the bathroom 20 times a day, bloody bowel movements. It was just, it was miserable. I literally was in bed five months, running back and forth to the bathroom.

Dr. Mark Hyman:
And it turned out I had developed colitis from the C. difficile, and then it continued even after we cured the infection, the colitis continued. And so, I had to really go back to the drawing board and think about, “What do I do?” Because I also had mold exposures, and I had all these imbalances, I had low Akkermansia. So I learned a lot about on a personal level, which I really didn’t want to learn that way, but I learned about what the symptoms are, what it does, and how to actually start to think about fixing it differently. And for me, I did a number of things. I used a cocktail, I call it gut food, which is a cocktail of components that I think have not really been put together too often, including prebiotics, probiotics, polyphenols, and immunoglobulins, and things that really help the body to reset the gut, and I also dealt with the mold that I had in my house, and I also used ozone to help boost my immune system and kill infections. And it was really amazing, within a very short time, I was able to really recover.

Dr. Mark Hyman:
And I think a lot of us sort of struggle without really knowing what to do, and even sometimes when you do an elimination diet, if you have colitis, you don’t necessarily always get cured, because there may be something else going on, maybe like what I had, maybe there was C. diff, or maybe there was mercury, or maybe there was something else going on, but you can really help these patients so much. Crohn’s is often a little more challenging, but we do a lot of different approaches. So traditional medicine is pretty cut and dried. What are the kinds of diagnostics you’d see us using with these patients to figure out what’s going on with them?

Dr. George Papanicolaou:
Well, traditionally, first you’re going to get [inaudible 00:16:54]. I always like to go back to the basics. We’ve got to remember that doctors are cognitive beings. We are medical detectives, we like to think. So, I think you need to make sure that you’re listening to the patient’s story, hearing all their symptoms, doing a really good examination, and making sure you do that part, because that’s where you find those predispositions, you find those triggers, and you find those mediators that are so important, because those are the categories you think in to solve the mystery.

Dr. George Papanicolaou:
Okay. So once I’ve done that piece and I have a really good idea of what their predispositions are, I have really good idea of what their potential triggers are, because those triggers can give me an idea of how I’m going to help them get better and control it down the road, and some of the mediators or perpetuators, that could be stress or it could be their diet. Once I have those pieces, then I say, “Okay, you know what? I’m pretty sure you have ulcerative colitis.” How do we know for sure? We can check inflammatory markers like something called calprotectin, which will be very elevated in people with inflammatory bowel disease. And then we can also visualize, and it’s the gold standard, is to visualize with a colonoscopy, the intestines, and you’ll probably do both, upper and lower. And you’ll see that with Crohn’s disease, it can involve the entire intestinal track, whereas with colitis, it typically just involves the very end or the distal part of the large intestine, the rectus sigmoid, and the last third of the colon, and we’ll visualize it through colonoscopy.

Dr. George Papanicolaou:
So that’s the conventional way, and then once they land in my lap after being frustrated by just not getting better, or finding that their diet’s really restrictive and they’re constantly having symptoms, and they’re not finding any answers in the places they’re looking in the conventional medical world, then I immediately go into action and I’ll look at the complete diagnostic stool analysis where we will get a full, complete picture of your digestive processes. Are you making enough gastric acid, pancreatic acids? Do you have markers of inflammation? Is your detox system in your gut working correctly? Is your immune system over-responding, under-responding? And it will also tell us very specifically the diversity and abundance of your gut microbiome.

Dr. George Papanicolaou:
And so, it is the first test that I’ll get, but I’ll also look for other things, and we should’ve mentioned this earlier, but I’ll look for SIBO, which is small intestinal bacterial overgrowth. I will look for food sensitivities, particularly to gluten. I’ll look for leaky gut, and I’ll also look for those cross-reactive foods, foods that act like gluten that can create inflammation if you’re sensitive to gluten, and then be a trigger for your ulcerative colitis.

Dr. George Papanicolaou:
So those are some of the tests. I’ll do an ION Profile or a micronutrient, it’s a functional evaluation of all the most important biologic processes that your body does, and it allows us to determine which systems are or aren’t working, and if they’re not, what nutrients are you missing? Particularly when it comes to the mitochondria, do you have compounds or toxins that might be impairing those functions, like with you, you had mercury elevations that probably were impairing your mitochondria, probably impairing your immune system, and on top of the other conditions you had, may have tipped you over and made you more susceptible to the adverse outcome with a antibiotic. So we’re looking at all those things, and those are the tests that I look at. And I may do some… Well, yeah, I usually will stop there in my first tier, and I usually get most of all the information I need with those tests.

Dr. Mark Hyman:
Yeah, it’s true. I mean, I do look at food sensitivities, look at the gut, look at heavy metals and those can often be so helpful in figuring out what’s really going on with people, and then you end up being able to sort of customize their treatment based on what you find. And there are some dietary approaches, but if you don’t deal with the root causes and figure out what you’re doing initially, it’s a problem. That’s really what we do at The UltraWellness Center. We map out what’s going on with people at a much deeper level. I mean, we look at things that most traditional physicians just don’t look at, like, who’s measuring Akkermansia levels? Well, we do, because we want to-

Dr. George Papanicolaou:
We do.

Dr. Mark Hyman:
… [inaudible 00:22:03] what this particular bacteria does, we want to know what your nutritional status is, we want to know whether gluten’s an issue, we want to know what’s going on with your gut. Is it leaky? I mean, we do all these things, and then we implement a plan. So what are the kind of things we find that work the best? And talk about from a dietary approach, and then sort of drill down into the other aspects of our treatment for colitis and Crohn’s disease.

Dr. George Papanicolaou:
Right. So neck and neck, it’s diet and gut microbiome, right? So it’s really neck and neck, and I will say with the gut microbiome, it’s very intriguing, because there’s more and more research being done into the differences between a healthy gut microbiome and the gut microbiome of a person that has inflammatory bowel disease, and there are significant differences. And in the person that has inflammatory bowel disease, one of the key bacteria, as you mentioned earlier, is Akkermansia. Akkermansia plays a role in keeping the mucosa, the gut lining of goblet cells, really healthy. It breaks down the mucin, and then when it breaks that down, it turns it into short-chain fatty acids, and we know that short-chain fatty acids, that’s the honey of the colonocyte. It just loves these short-chain fatty acids, and that keeps it really healthy. People who have inflammatory bowel disease tend to have really low levels of Akkermansia, and it’s not uncommon for me to find that they’re not even detected, when I do the complete diagnostic stool analysis on a patient.

Dr. George Papanicolaou:
So replacing Akkermansia has been shown to have an important role in helping the gut mucosa heal. There is a study that I had come across in preparing for this, it was in The European Journal of Inflammation, 2020, and it basically, in this study, they took bifidobacteria, another strain of bacteria that is found to be really low in patients with inflammatory bowel disease. And they took a specific strain of bifidobacterium lactis, and they combined it with xyloglucan, which is a non-digestible fiber source. So they had a prebiotic and a probiotic together in a patient with ulcerative colitis, and they followed all of the patients in the study and control groups, and they found that there was at six weeks, the study group had significantly more healing and resolution of their symptoms, more healing of the gut mucosa, and healing and resolution of their symptoms. And they had no other therapy, this is just a prebiotic and a probiotic that they used.

Dr. George Papanicolaou:
And so, using probiotics to control and to resolve an exacerbation can be really critical, and I think we’re learning more and more about how they work. There are other probiotics, or there are other bacterial species that are missing or in low concentration in patients with inflammatory bowel disease, including lactobacillus GG, Saccharomyces boulardii, and when you replace these, you find huge benefits. So I use probiotics pretty quickly in a patient. I also will use, there’s a probiotic called VSL#3. A lot of people know about that, because it’s frequently used, and it’s really powerful. It has all the strains of lactobacillus and bifidobacterium that are low, and are also very helpful in healing the gut lining, the gut mucosa, and just by using that, I’ve been able to help people start to feel better and see their symptoms resolve.

Dr. George Papanicolaou:
So, as you can tell, the gut microbiome, using probiotics, are really a big part of how I’ll treat my patients, but that has to be balanced about what you can tolerate and where they are in their disease, because the diet then becomes really important. Sometimes I can’t give probiotics right away. Sometimes I’ve got to get this person eating. I’ve got to get them feeling better before they can actually tolerate the addition of the probiotics.

Dr. Mark Hyman:
Absolutely. And what I would say, George, is also diet’s such a key thing for most people, and it’s not only eating an anti-inflammatory diet, it’s not only getting rid of the food additives, the emulsifiers, and the things like the carrageenan and other things that can cause damage to the gut lining, but it’s also thinking about how do we reduce all the potential inflammatory factors in the diet and all the potential food allergens? And there’s been some interesting research done on what we call an autoimmune paleo diet, that’s been shown to be effective for Crohn’s and colitis in trials, and I think it’s really been overlooked for the most part, but can you talk about what is an autoimmune paleo diet, and how does it work for Crohn’s and colitis?

Dr. George Papanicolaou:
Yeah. So, as I said earlier, the microbiome is the gateway to the immune system, and we know that there is a strong immune component to inflammatory bowel disease. The autoimmune paleo diet… I got to put my glasses on so I can see you better. And so, the autoimmune paleo diet basically is going to eliminate foods from your diet that can trigger your immune system to have that autoimmune response, and to create that inflammatory response, and it’s going to allow the gut lining to heal. And so, there are foods that are thought to really be-

Dr. Mark Hyman:
What do they take out? What is an autoimmune paleo diet? What do they take out of the diet?

Dr. George Papanicolaou:
They take out grains, legumes, nuts, seeds, nightshades, eggs, and dairy. All of these have inflammatory components to them.

Dr. Mark Hyman:
Wow.

Dr. George Papanicolaou:
And so, yeah, so that’s the main things and [inaudible 00:28:47]-

Dr. Mark Hyman:
So you’re like, grains, and beans, and nuts, and seeds, and eggs are supposed to be healthy, right? So how does that-

Dr. George Papanicolaou:
They are, but they have inflammatory components to them. Once your system begins to break down, then those foods can tend to trigger the immune system to have that increased autoimmune response, because what happens with some of those foods is that the mucosa breaks down so it can’t do its job. Number one, it can’t break foods down, so you’re not going to get your nutrients that you need. Number two, the mucosa now, this very finally designed gate system is broken, and these foods, when they’re not broken down into the smallest peptides possible, can actually, they don’t have to be, because the gates are broken. So now you have these [inaudible 00:29:37] peptide forms, and these particular foods, their proteins are inflammatory to the immune system when they’re larger and the immune system can’t recognize them, so the immune system then begins to create the autoimmune response and the inflammatory response. So that’s why these particular foods are taken out, and it includes alcohol, coffee. It includes processed oils, corn oil, canola, cottonseed. You want to not have those oils in your diet as well.

Dr. Mark Hyman:
Absolutely. And so, you’re getting rid of all that stuff, and what are the kind of results we’re seeing with those patients?

Dr. George Papanicolaou:
Well, with any IP diet, we see very good results, because a lot of folks, when they’ve come to us, they’ve never been told that you can eat a certain way to improve your symptoms. So when we take these foods away for six, to eight, to 12 weeks, it gives the intestine and the immune system opportunity to rest, and now you can get healing of the gut, because you are still eating very nutritious foods that are healing to the gut. Once the symptoms begin to be vanquished, they’re able to tolerate more foods, we can get more fiber in, we can get more probiotics in, and then the healing process really begins. And by 12 weeks, we’re seeing people with all symptoms are gone, and they feel great.

Dr. Mark Hyman:
That’s amazing.

Dr. George Papanicolaou:
And that’s just eating AIP with probiotics.

Dr. Mark Hyman:
That’s incredible. I mean, really, when you think about the fact that this is such a debilitating disease, that it’s such a difficult challenge for patients, that the drugs are so potentially toxic and harmful, that so many millions of people suffer from this, and that what you’re saying, George, is that in functional medicine, we have a map to figure out why, we have a approach to improve the microbiome, to treat them with an anti-inflammatory diet, and to reset the gut microbiome through a whole host of interventions that we call the 5R Program in functional medicine, we’ve talked about that on the podcast before. And we also tend to look for other things that people don’t look for, like heavy metals, or infections, or other issues. And it’s amazing what you’ll find and what you see, and it’s so gratifying. I mean, out of all-

Dr. George Papanicolaou:
It is.

Dr. Mark Hyman:
… of these conditions, I love it when I get a patient with Crohn’s or colitis, because it’s such a slam dunk. And for me, I had one of those cases that just was not getting better, and so I always get the cases-

Dr. George Papanicolaou:
Well, you know-

Dr. Mark Hyman:
… [inaudible 00:32:26] or whatever it is, and then I had to figure it out, and I figured it out, and I think there’s other treatments that can be helpful. And I used ozone, I used exosomes, I used a lot of different things, but it’s quite amazing when you see the potential for this.

Dr. George Papanicolaou:
Yeah, and I want people to know that look, you’re really sick. You’re not feeling well, and you’re having bloody mucusy stools, and you’re having them 11 times a day, and you’re having pain and you can’t eat, you’re desperate, and then you’re going to be told, “Well, guess what? We’re going to eliminate all the foods that you like.” Well, you know what? Sometimes, unfortunately, you can’t even start an AIP diet, because people when they come, can be so debilitated that they can’t tolerate food. So to really give their gut a rest, I’ll use something called an elemental diet.

Dr. George Papanicolaou:
Now, an elemental diet is basically medical food that has all the nutrients that you need, but doesn’t require your body, your broken mucosa, to break down the proteins and the complex carbohydrates. And so, we’re able to use the elemental diet to really rest and really get all the symptoms calmed down, then move on to AIP, to then add in our probiotics. And then we have other things that we can do for long-term maintenance of a healthy state, and that is some things that can boost the immune system, we modulate the immune system. I commonly will use things like low dose naltrexone, which modulates the autoimmune response, and I’ll use CBD with THC blends that again, can have a modulatory effect on the immune system, decrease inflammation in the gut, increase appetite.

Dr. George Papanicolaou:
And so, there are a lot of things that we can do in functional medicine, just as you’ve just pointed out, and those are some of them in a little bit more detail. And I agree with you, that’s what we do. There’s not a patient that comes to me, that even if they’re coming for one thing, that we don’t end up talking about their gut. It seems like gut issues are epidemic.

Dr. Mark Hyman:
Huge, huge. It’s huge. I mean-

Dr. George Papanicolaou:
And also colitis and Crohn’s disease I think are at the apex of the severity of what could happen when you have a poor diet, you have a disordered microbiome, and now you have an immune barrier that’s broken, and now your immune system’s now under siege and it can’t respond appropriately.

Dr. Mark Hyman:
Yeah. Well, I’m telling you, George, this is one of the areas in functional medicine that I’ve found over the last 30 years has been such a gratifying area, because people really suffer. The traditional approaches are kind of limited, and the potential to heal the gut through restoring the microbiome, changing diet, and some simple measures, is just huge. It’s huge. And so, I’m excited about having this podcast with you, because I think when we see these interventions in functional medicine working out the way they do, it’s such a life-affirming thing for me as a physician, that I’m helping someone, and I’ve been there. I had all this. I had 20 bloody painful bowel movements a day, I was nauseous and in pain for five months. I was just, I was in bed. All I could do was go bed, bath, bed, bath. It was like, it was terrible. And now I think we have such a clear roadmap to how to fix this, and there’s some other weird things that people are doing, like using worm therapy and other things. I’m not-

Dr. George Papanicolaou:
Helminths, helminths.

Dr. Mark Hyman:
Helminths.

Dr. George Papanicolaou:
[crosstalk 00:36:04].

Dr. Mark Hyman:
I don’t use that that often, but it can be helpful. So there’s a lot of tricks in the functional medicine toolkit, and George, you’ve been really great in helping us understand inflammatory bowel disease. This has been another episode of The House Call with The Doctor’s Farmacy, with Dr. George Papanicolaou. If you loved this podcast, please share with your friends and family on social media. Please leave a comment. How have you dealt with your inflammatory bowel disease? Have you gotten better using a different approach? Subscribe wherever you get your podcasts, and we’ll see you next week on The Doctor’s Farmacy.
Speaker 1:
Hi, everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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