Healing Autoimmune Disease Using A Functional Medicine Approach with Dr. Sunjya Schweig

Mark Hyman, MD

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Narrator: Coming up on this episode of the Doctor's Pharmacy. Dr. Sunjya Schweig: The food and drink that we take in by our mouth is by far the biggest factor of information that is hitting that immune system in the gut. Dr. Mark Hyman: Hey everybody, it's Dr. Mark Hyman. Welcome to a special episode of the Doctor's Pharmacy that I call House Call. And in this series, I sit down with colleagues in the field of functional medicine talking about topics that I think are going to interest you all, which is how do you deal with all this chronic stuff we're dealing with as a society that is not getting better using traditional care approaches. And today I'm joined by Sunjya Schweig, who's a friend of mine who went to the same residency program I did in family practice in Santa Rosa, California many years ago. We're going to talk about how we as functional medicine doctors tackle specific conditions that we see every day. Dr. Schweig is a family doctor. He is a leader in this field of functional medicine, and he's done really great work in establishing, with Chris Kresser, this California Center for Functional Medicine, which he now heads up. The website is ccfmed.com. You can learn more about what they're doing there. He's also developed the Functional Medicine Research and Technology Center, which is fxmedresearch.org, to help prevent and reverse chronic illness through research and education, innovation. I'm glad to have you on this House Call podcast. Dr. Sunjya Schweig: Mark, it's great to see you again. Yeah, thanks so much for having me. It's a pleasure to be here. Dr. Mark Hyman: That's great. Well, today we're going to talk about a topic which is probably one of the most important causes of suffering and disability and dysfunction today, and it's something which we really are very poor at dealing with, and it's probably the number one condition facing us other than probably obesity and metabolic syndrome, which is autoimmune disease. Collectively, autoimmune disease represents more people than heart disease, cancer and diabetes combined. That's all comers, right? Hashimoto's, thyroid, MS, rheumatoid arthritis, colitis, all the autoimmune diseases, which are all divided up into specialties, and each specialty takes care of their own autoimmune disease. And unfortunately, that's really not a very good way of thinking about it. Because as we're going to discuss today on the podcast, there are specific causes of autoimmune disease that if you deal with, you can deal with all these various different autoimmune diseases rather than having to slice the body up in all these organs and parts and specialties. Welcome to the podcast. Dr. Sunjya Schweig: Yeah. Thanks again, and it's great to be here. I love having this conversation. Autoimmune disease is just such an incredibly important topic, and as you know and as many of us functional medicine doctors know, it's really one of the most rewarding areas that we work in because of the opportunity that we have to really dig deep and to look at so many different factors that affect the triggering, the onset, the propagation of inflammation and autoimmune. It's really a favorite of mine. Dr. Mark Hyman: Yeah, it is too for me, and it's one of those really satisfying areas of functional medicine where we see real results and real transformations. I remember a number of patients have come to me, for example, about to take their colon out for colitis, and then these people get completely better very quickly. I had one young woman, she was 30 years old, and she was sent by her uncle who was a fairly prominent guy, and she didn't really believe in what I was doing. She lived in New Orleans, in Louisiana. She said she tried because they were about to take her colon out. She was 30 years old and was on all these medications, nothing was working. She came back and I talked to her six weeks later, she says, "Well, I'm completely cured. I didn't believe this was going to work, but I'm completely cured and I feel fine, and I'm not taking any medication." We see that level of change, which you just don't think about as possible, particularly in our traditional medical approach, which is focused on just suppressing inflammation. Tell us about the root causes. Because rather than saying, "How are we going to shut off and inhibit and block or tamp down inflammation?" the question really should be, "What's causing the inflammation in the first place?" So from a functional medicine perspective, what are the causes of autoimmune disease, and why is it so much on the rise these days? Because it really wasn't as prevalent decades ago. It's now increasing dramatically over time. Dr. Sunjya Schweig: Not as prevalent decades ago, and still not as prevalent in societies that still adhere to more traditional lifestyle, balances and diet, sleep, nutrition, stress, exposure to light, exposure to screens, all these factors that are throwing our bodies out of balance. And that's really, I think, the key thing. Why are autoimmune diseases on the rise? I think it really has to deal a lot with the fact that we're increasingly living out of balance and we're not respecting how our bodies have evolved over millions and millions of years. And so we think about when we're looking at functional medicine approach to autoimmune, the key areas to consider are really all of those lifestyle factors: the health of our gut, what are we eating, how are we eating, when are we eating. Super important concept that we'll dig into today of intestinal permeability or leaky gut. The lay term of leaky gut. I prefer the more scientific term of intestinal permeability. Huge key topic. If you go to PubMed where all of our research articles are, and you type in intestinal permeability, more than 14,000 articles show up. And if you type in intestinal autoimmune, you get also a ton of other articles. So the gut chronic infections in our bodies in the gut, but also systemic persistent chronic infections, we'll talk about that some today. Exposure to environmental toxins and stressors, stress on our brain, stress on our body, trauma, these all trigger inflammation and dysregulated hormonal pathways and propagate autoimmune diseases. Inadequate or poor quality sleep, really, really important. And so, we'll go through any and all of these in more detail as we dig into our discussion. Dr. Mark Hyman: Yeah. You touched upon the gut and permeability, but the diet is a big part of that. Our modern diet has really driven our microbiome into disarray, and that's caused a whole host of downstream consequences to our health. Not just autoimmune disease, but cardiovascular disease, obesity, mental health issues, and lots more. So this is a big deal, and I think diet plays such a big role. And in fact, I had patients often go to the rheumatologists who were working with me. They go, "Oh, diet has nothing to do with your rheumatoid arthritis or your lupus, or whatever [inaudible 00:06:51]-" Dr. Sunjya Schweig: I know. It hurts me. Dr. Mark Hyman: I'm like, "What?" Although it's changing. I had a rheumatologist who I talked to at UCLA, at Cedar Sinai who was like, "Oh, thank God you called. I'm really excited about this. I can tell you my work has gotten so much better with my patients since I've started incorporating diet. Their outcomes are so much better." I'm like, "Yeah, it makes a big difference." What actually is autoimmune disease, and what are the most prevalent autoimmune problems people are facing? Dr. Sunjya Schweig: Autoimmune disease is really this idea of... I think of it as the immune system gone haywire. You mentioned the word inflammation. Inflammation is really one of the core concepts. And so, we think about several main factors. Genetics of course are important, but really that's a minority. We think genetics and the contribution that they have to autoimmune disease is maybe only a third of really what's going on. And the other factors are, again, diet, lifestyle, environmental triggers, infections. The genetic factors, again, can create a predisposition, almost like this fuel, but then that spark and also more fuel can get stacked on there from the environment, from chronic infection, from these lifestyle factors to then activate these processes and make the autoimmune disease more clinically apparent. There's probably over 100 different autoimmune diseases. 10 most common, you mentioned some of them, but rheumatoid arthritis, Hashimoto's, autoimmune thyroiditis, celiac disease, Graves' disease, Type 1 diabetes. The list goes on. Vitiligo, rheumatic, fever, pernicious anemia. Dr. Mark Hyman: Oh, but colitis is... Yeah. Dr. Sunjya Schweig: The cost to us personally is huge for the individual, but also to society. The National Institute of Allergy and Infectious Disease estimates that the cost of treating autoimmune disease in the US is more than $100 billion annually. We think that that's probably actually a vast understatement because estimates around just seven of these 100 plus known autoimmune diseases, estimates of cost annually ranges from $50 to 70 billion. Dr. Mark Hyman: Whoa. Wow. That's a lot of money. I think the costs are so staggering for the drugs that we're using. They're immunosuppressant drugs. Increased risk of cancer and infection. They do help a lot of people, I'm not going to say they don't. But the average cost is about 50 grand for a year per patient. And I know, I've seen so many people be able to get off these compounds when they actually are changing their underlying causes. You mentioned all the different things: toxins, allergens, the gut, diet, infection, stress and so forth, sleep. These aren't often one thing that's causing it in a single person, but it may be multiple things. And so, you have to deal with all the factors. As traditional doctors, what was our basic approach, and what is the basic approach? We touched on it a little bit, but I think it's worth talking about it and then the disconnect between that and how we deal with it with functional medicine. Dr. Sunjya Schweig: Yeah. You mentioned these very, very expensive drugs, the monoclonal antibodies, of which the pharmaceutical companies have a lot of incentives to develop because they make a lot of money, on drugs. Your point is good, which is they can help people. But really, it comes down to this central divide of what is conventional medicine trying to do. I don't want to make it seem like doctors are bad people. I have incredible respect. There's just some incredibly smart people, and most doctors are so dedicated to taking care of their patients and trying to find them help. But it's really just from the top down of how we trained and this idea, this conventional approach to autoimmune really is like this codifying of a lot of how western medicine works, which is suppress, which is make it stop, control the immune response, turn these inflammatory pathways off. The problem is that it's not asking why. It's not asking why is the inflammation there in the first place, why is the immune system being triggered in the first place. So the main things that doctors reach for are steroids: corticosteroids like prednisone, methyl prednisolone, dexamethasone. These work quickly and they work well. They turn off the inflammation, they shut down the immune system, but huge side effects, really, really staggering side effects: increased Type 2 diabetes risk, weight gain, infections, osteoporosis, et cetera. Other medications, other immune suppressants are used, like methotrexate also shut down the immune response. A lot of toxicity, liver toxicity, increased risk of infections, cancers, leukemia, et cetera. And then we've talked about these monoclonal antibodies, some of the biological response modifiers. Again, they can be helpful in the short term, but they're really just targeting one pathway. They're not taking care of why that pathway is inflamed in the first place. And so, it makes sense that they might help in the beginning, but a lot of times this escape phenomenon happens where they stop working. And so, it's really a short-term, very myopic approach, which if we stack in all these other lifestyle factors that we know about how to intervene within functional medicine, the potential for true healing is much, much greater. Dr. Mark Hyman: Yeah. It's quite amazing. It's one of the most satisfying things for me as a functional medicine doctor to treat, because I can just tell you patient after patient with all kinds of weird autoimmune diseases, some of which I've never even seen before, if you follow the basic principles, it works. You always say functional medicine is more about creating health than it is treating disease. And so when you create the conditions for health and you take away the impediments for health, it's quite amazing. Let's talk about a case and then let's talk about how we diagnostically approach these patients and what we do therapeutically that makes the most difference. So maybe share a case. If I can think of one, I'll share one too. But I'd love to hear a case from you about how someone presented, what you did to them, what you tested for, what you found, how you treated them, and what the outcomes were and what the objective results were that you got. Dr. Sunjya Schweig: Yeah. So as I was getting ready for our talk today, looked through our work and cases, and this one case came to my mind. A 43-year-old woman who we'll call Sarah. When we first met Sarah, she was experiencing some joint pain, mild to moderate joint pain, brain fog, trouble thinking clearly, she's having some mood swings, intermittent anxiety and a lot of fatigue. She's also having some gut symptoms, some bloating and gas occasionally, some loose stools, disrupted sleep, especially in the week leading up to her period. So some hormonal fluctuations happening there. Usually would fall asleep okay but would wake up in the middle of the night, some trouble falling back asleep. Like many of us, she was successful. She was very busy. She was working as a pharmacist with long shifts. Three kids. Very involved in their activities. And historically always able to manage her busy schedule, but she's feeling like she's having more and more difficulty keeping up, more fatigue, decreased resilience, not waking up feeling rested, et cetera. And interestingly, when we talked about her family history though, it was definitely a strong family history of hypothyroidism, so that was clueing us in the beginning. She was also on track with that. She was wondering about that so she had been tested a bunch of times, but always only with the TSH, the thyroid stimulating hormone, which is the go-to test for a lot of the primary doctors and internal medicine doctors. It always had been normal and it was in the normal range, but her TSH had been trending up. Remembering that TSH is inversely associated with thyroid function. So a lower TSH is higher thyroid function, and a higher TSH means lower thyroid function. Her numbers were 1.2 then 2.3 then 3.6, but she was always told that this was quite normal. And so, her backstory during childhood, did have some frequent ear infections, needed antibiotics. Not infrequently. Seven or eight times. So I was concerned about some early gut disruption there. She also had a history of some stomach ache episodes, but never diagnosed with a problem. Was traveling abroad at one point, got food poisoning, some increased gut symptoms after that, et cetera. Really was just trying to watch her diet. She said, "I drink a lot of kombucha. I tried to eat a healthy, balanced diet." But there was some disruption there too because of how busy she was. She would skip breakfast. She would frequently get home late from work and not have time for dinner until eight or nine o'clock and maybe just have a bowl of cereal, et cetera. So in her words, she came in and she was trying to improve her energy. She wanted to be able to exercise without being sore for days afterwards. She wanted to feel like an athlete again. She wanted to improve her moods and lessen her brain fog so that she could work more efficiently. We started off at the [inaudible 00:16:18] with our patients, we tend to do a pretty deep dive. We cast this really wide net, and I know that you guys do this too. Dr. Mark Hyman: Yeah. What would you look for? When you think about these patients. What are the kinds of things that come up for you as, "I got to find out what the root cause is."? How do you start to think about those? Dr. Sunjya Schweig: Yeah. We did a comprehensive blood panel looking at the thyroid again, but also adding on the free hormones, free T3, free T4. We looked at reverse T3, we looked at thyroid antibodies, we looked at markers of inflammation, markers of blood sugar dysregulation and insulin. We also tested her for celiac, for celiac genetics and a celiac panel given the history of abdominal pain and the strong family history of low thyroid. We did gut testing. We did a stool test, a comprehensive stool test, as well as a SIBO breath test, a small intestinal bacterial overgrowth test. This was correlated with that history of food poisoning, of the GI complaints and also the cognitive, the brain. The gut-brain axis is so critical to consider and to look at. And then we also did a deeper dive on the hormones, looking at her adrenal function, looking at her sex hormones, et cetera. We know that a lot of times high functioning people, high achievers, tend to maybe have higher cortisol. They're pushing that envelope early on in their lives, but then that can drop and they can then have low cortisol, which can manifest with increased susceptibility to illnesses, fatigue, brain fog, trouble getting out of bed in the morning, et cetera. Dr. Mark Hyman: You take a good look at the gut, you look at kind of hormones. I often think about looking at other things that are sleepers, like heavy metals or environmental toxins, food sensitivities, gluten. Obviously, you did mention that, but that's a huge one. I check for anybody who's got any autoimmune disease. I check for gluten antibodies. It doesn't have to be full celiac. You can have just low level elevations of these antibodies that can cause significant problems without actually being true celiac. I think this is often on a problem with traditional medicine. There's on or off. You either have it or you don't. You have diabetes or you don't. It's not a gradient. It's not a continuum. In truth, the body is just a continuum of function or dysfunction, and hence the dysfunctional medicine. And so, it's arbitrary to set a number, like diabetes 126, [inaudible 00:18:36] was 124. Are you okay? No. The same thing with everything in terms of all the numbers we look at. I think the ability to find these things are quite impressive. So what did you find when you started to dig in and you looked at the gut and you looked at the hormones, you looked at what else was going on nutritionally with her and how those play a role? Dr. Sunjya Schweig: Yeah. This is one of my favorite parts of the work that we do when you have these folks who have been struggling, they've been to a bunch of doctors and they have been told that everything's normal. And maybe they've absorbed that and they've said, "Okay. I guess I'm just getting old, or maybe a little bit depressed." We got all the labs back and we dug in with Sarah, and there was a lot of things that we found that were levers. I think of these as levers, potential levers that we can pull to help her get better. Her TSH was 3.8, which on the lab test shows as normal, but you and I and most functional medicine doctors know that that is not optimal. From our functional range, we like to see that at around 2 or less. So I was definitely concerned around low thyroid function. And in fact, her free T3, the most active thyroid hormone, was in the low-normal range. Her reverse T3 was elevated, signaling inflammation and immune activation. And then she did have elevated antibodies. Her TPO antibodies to her thyroid were high and the thyroglobulin antibodies were also a little bit high. And importantly, she had antibody against gluten. She had a positive anti-deamidated gliadin peptides. Mildly elevated, but certainly very, very significant, in my opinion. In the US, that's not necessarily diagnostic of celiac, but in Europe it is. And so, there's a little bit of a difference of opinions on how we interpret these. But for me, that's a highly significant marker. For those of you out there who might want to look at testing this on yourself, Labcorp can do this. So can Quest, but the Labcorp test code for the comprehensive celiac panel, I'll just throw it out there for folks, is 165126. Look that up. If you want to get tested just through your insurance, through LabCorp, that's a great test to look at. She also had low vitamin D, low vitamin B12 and low ferritin, which is this storage form of iron. So all three of those together are telling us that she's not absorbing very well. She's having trouble on the level of the gut and that there's inflammation there, in addition to just needing to get those levels up is a proxy marker for this bigger problem going on. Her stool test showed dysbiosis, imbalanced bacteria. There was some dropout of the good bacteria. We call it an insufficiency dysbiosis. She had positive H. pylori, helicobacter pylori. And so, H. pylori is super, super interesting bug. It's a model for persistence and for chronic inflammation, and it has been linked in the research literature to autoimmune thyroid. So right there, I got really excited. I was like, "Okay, cool. Here is something which we can treat, we can eradicate. It could explain your local gut symptoms, but it could also explain some of the bigger picture autoimmune activation that we're seeing in your body." Dr. Mark Hyman: Incredible. With her, how would you go about starting to treat her? Because there's so many different things. She's got nutritional deficiencies, she's got gut issues, bacterial growth, gluten issues. I mean, you didn't really check for heavy metals or other things she's going to be treated. Dr. Sunjya Schweig: No, I didn't do that. Yeah, yeah. Because it's a little bit down the road for me. I'd love to just jump in with all these things and see if we get the traction. But yeah, you're right. It's a very important factor. Dr. Mark Hyman: Yeah. She had all these different things. So where do you normally start with these patients? Dr. Sunjya Schweig: Yeah. The place that we start with everybody is the lifestyle piece. We actually try to get the inflammation in the gut calm down first. The gut is really the center of the universe when it comes to the immune system. And if we can heal that intestinal permeability, the diet piece is really the first step. We frequently embark with that with patients before we even finish any testing, and I think you guys do this too. Basically, the onboarding sequence to our clinic: there's intake visit, we do a bunch of labs, then immediately they see the nutritionist, they see the health coach, they start on these lifestyle changes. We had Sarah start an anti-inflammatory whole 30 paleo reset diet, and in particular really focused with her on... "You have to get rid of gluten 100% for at least 30 days." I'd like to do it for longer, but sometimes I'd break it up into bite size pieces for folks. We wanted her to minimize sugar, we wanted her to avoid dairy, limit alcohol. And just with that one change within a couple of weeks, she reported that her energy was better by about 40 or 50%. Her brain was better by about 40%, and her joint pain is better by about 60%. This is one of the things I love about that, is just not only like, "Okay, she's feeling better," but this is really, really good reinforcement for her that she has control over her health and that she can- Dr. Mark Hyman: That's incredible. Dr. Sunjya Schweig: ... put things into place that are going to possibly affect her. We're going to stack in some supplements. We're going to stack in some prescriptions, potentially. But she immediately has this sense that her health is in her own hands and she could be an active participant, which is what we love. Dr. Mark Hyman: That's so great. Let's talk about the diets and autoimmune disease because I think there's so much controversy on what should eat or should you be lectin-free, should you be gluten-free, should you be paleo, should you be vegan. What are we learning about in terms of food and autoimmune disease? What are the biggest drivers in our diet of autoimmune disease from the dietary perspective? What can people do therapeutically? How do we stack up against choosing what to do for which person? Dr. Sunjya Schweig: There is no one size fits all approach, but I think there are some basic tenets that we can really factor in. I think this idea of... We talk about the exposome. There's the genetics, there's the epigenetics. Genetics are hardwired. The epigenetics is how are your genetics read out, and that can be turned on and off based on environmental factors. And then there's this is the idea of the exposome. These words sound complicated but they're not. The exposome was basically- Dr. Mark Hyman: I call it the exposome because it sounds better. Dr. Sunjya Schweig: Yeah. Exposome. Everything that you've ever been exposed to from the time you were in your mom's belly until now. And actually if you want to go deep, it goes back before you were in your mom's belly. It's this methylation and way that epigenetics affect offspring. But really for simplicity, everything that you've ever been exposed to from the time you were in your mom's belly until now. We can modify that and we can take charge. And so the diet is, you think about the amount of information that your immune system is being exposed to on a daily, monthly, yearly basis, the food and drink that we take in by our mouth is by far the biggest factor of information that is hitting that immune system in the gut. The next would be air and skin. But again, the biggest lever that we have to pull that can affect how our body is receiving information from the outside world is through the diet. So you want to take out all of the things that are going to be triggering aberrant inflammatory activation. And so, the biggest culprits are the processed foods, the sugar. Grains are frequently a trigger for people. And then eating organic grass-fed is really critical because otherwise you're getting chemicals, you're getting pesticides, you're getting hormones, you're getting antibiotics. All of these are gut disruptors. And so, the really easiest way to start with an anti-inflammatory diet or a whole 30 or a paleo reset is just to take out all of the junk and eat real food. You'll eat real, clean, nutrient-dense food and do that for a period of time. Downstream from that, we sometimes have to specialize. We have to go into more of what's called an autoimmune paleo diet or a low lectin diet or something like the Wahls Protocol. These are all variations. We don't usually go there first with people, but it's based... It is very individualized and based on the response that somebody has. Dr. Mark Hyman: Amazing. Talk about some of the things that are controversial, like lectin. Is that something people should focus on or is that just kind of a marginal thing? Dr. Sunjya Schweig: I think it's been helpful for a lot of people, but I don't think it's everybody. And so, what we do is we go step by step down the list. If people are doing a paleo or a whole 30 and they're just feeling great, I don't necessarily feel the need to go down into the next steps. If they're not feeling well, we go into an autoimmune paleo. But it's also the case the foundational intervention of anti-inflammatory diet in naturopathic medicine, in functional medicine is get rid of things that might be triggering you and then add them back in one at a time in a systemic way and see what your body tells us. The food sensitivity testing that you mentioned, that's helpful. I've definitely used that and we like it, but it's imperfect for a lot of reasons. But what does your body tell you? What is your body reading out to you in terms of symptoms and reactions? You can't argue with that. And so yes, some people do need to avoid lectins, but I really don't find it's the majority of people. What's your finding with that? Dr. Mark Hyman: Yeah. I think it's gotten a lot of sexy play, but I think I've really helped so many people not having to focus on just that. I do recommend initially doing a more strict elimination diet. I call it the 10-day detox diet. But essentially, it's more or less the autoimmune paleo diet or paleo diet. The more advanced versions where you take out nuts and seeds and eggs and nightshades and other... It's a more aggressive form, which some people might benefit from, but I think often it's not necessarily needed. If you can fix the gut and get off the bigger triggers of gluten and the dairy, it's key. I actually find that for decades I've been using the 10-day detox diet, it really works very well. Dr. Sunjya Schweig: Yeah. I think we also have to be cautious about overwhelm for people and these dietary interventions causing more stress and also the social isolation and what that can do for people's ability to be out with friends. So it's always a balance. What we always tell people is that these aren't permanent interventions. We're going to try these for a period of time. It's like a therapeutic trial, and hopefully it's time bounded. Some people have more severe issues. They need to be on these diets for longer. But we're always working as a care team. We're working, our nutritionist and our health coach and the provider, trying to find what's the right balance and what's the right timing and really individualize these diets. Food is medicine. And so, these are medical interventions in our world. Dr. Mark Hyman: It's so true. I'm just so interested when rheumatology is going to start wake up to this because I think more and more rheumatologists are figuring this out, and we have more and more in functional medicine. But I think for me, when I look at autoimmune disease, it's emblematic of what's wrong with our society: the processed food, the industrialized food system, the food additives, the environmental toxins, the gut-busting ways we live, the added stresses in our lives. These are all things that are driving this autoimmune epidemic, and yet it's something that people really don't have to suffer from, which is quite amazing. Dr. Sunjya Schweig: Yeah. From the provider side, I think that it's not even that there's a huge resistance on the provider's side to looking at this. I think there's just a knowledge gap. I think they don't know about the importance. And I think that there's a huge time crunch factor. They just don't have the time to go into these histories, to ask the patients these questions. And I think a lot of doctors are afraid of talking diet with folks because it gets into a lot of discussion and a lot of nuance. I think there's actually a really big opportunity there for the health system to leverage a care team approach and to bring in mid-level practitioners, to bring in coaches and nutritionists and to offload that work to these folks but have it still be part of the entire plan. I think that the doctor doesn't necessarily need to be doing that all the time. It might not be their passion, but they could easily leverage that expertise in their practice. And really, if the health system woke up and saw what you and I know, all of us know at functional medicine, they would be jumping at this because the opportunity for cost savings is staggering, right? Dr. Mark Hyman: It's true. It's true. That's really true. It is quite staggering. We have to really reframe what we're doing in autoimmune disease. I think the concept of this lifelong chronic illness that you have, that you have to suffer with and you have to manage, have to take medications for is accepted. Actually, I've had pretty much everything. It's why I learned functional medicine. I've talked about on the podcast before. But a number of years ago, five years ago, I developed ulcerative colitis and it was horrible. I was having 20 bloody bowel movements a day. I lost 25 pounds from my skinny self. I ended up vomiting all the time. I was in bed, in and out of the hospital, and nothing was working, even all my normal functional medicine tricks. Sometimes, I have to go out of the box, and turned out that I had mold toxicity, but my system had just gotten in a cycle and I ended up using ozone therapy to help and reset my whole immune system. And I used exosomes and other kinds of stuff that's on the edge. But I'm just bringing that up because I think that we're constantly learning more about how to regulate the immune system, how to regulate our body's own healing mechanisms. So I had to activate my healing mechanisms using some pretty extraordinary therapies because the normal stuff wasn't working. I wonder from perspective, what are some of the other great cases you've seen that get you excited about functional medicine and autoimmune diseases? Dr. Sunjya Schweig: Yeah. Another big area of interest of mine is this intersection around chronic infections and how those can drive autoimmune disease. I have it here to show you. This is one of my favorite books, Infections and Autoimmunity. This is a huge textbook. It's like a $250 textbook. But this idea that we could have pathogens inside of our bodies that are persisting and that are driving this ongoing low-level chronic inflammation because that's... It's so treatable. And so, we see this especially with... I mentioned H. Pylori. That's a good one. But with tickborne pathogens, with Lyme disease, we see a lot of folks with Lyme disease, with co-infections, with chronic viral infections. And so, these are really gratifying on the one hand. Because if you look at them the right way, if you look at them deeply, if you really engage and find ways to treat them, Lyme disease or Borrelia burgdorferi, pretty controversial. But we know that there is a persistent pathogen there and we know that there is autoimmune activation. There's both. And so, you have the worst of both worlds. When we diagnose that and we treat it aggressively and effectively, we can turn off that autoimmune signaling. We've seen that again and again in folks with these chronic tickborne cases. It's really gratifying on the one hand because there's a lot of work being done in these areas, on... Monica Embers at Tulane has done some incredible primate research looking at persistence of the Lyme [inaudible 00:35:08] key and the chronic inflammation that it causes. Organizations like the Bay Area Lyme Foundation are really pushing the research agenda along with the Steven & Alexandra Cohen Foundation. We see those patients who have these chronic persistent infections and you identify it and you treat it and they get better and those autoimmune markers go away. With this patient, Sarah, with cases like that, it's just so incredibly gratifying because we know that if that person didn't get onto that treatment course, they basically would be set up for a life descending into worse and worse chronic illness. The mainstream doctors, the immunologists and the rheumatologists would just be scratching their head and tossing the next drug, the next drug, the next drug, and basically saying, "Gosh, there's not a lot of options left." And so, we have the opportunity to turn that around and to help these people recover their health, which is really just amazing in my world. Dr. Mark Hyman: The chronic infections are a real phenomena. I think it's something we really have marginalized and traditional medicine. You either have Lyme disease or you don't. You get three weeks of doxycycline and that's it. I mean, it's not accepted that there's even this long-term chronic Lyme. And now we talk about post-COVID syndrome, which is this postviral syndrome, which can cause all kinds of symptoms, including I think potentially inflammatory autoimmune stuff. Personally, I've had Lyme. I've had babesia. I've had pretty much had everything, mercury poisoning, the works. I've seen so many patients with these chronic infections that do show up as autoimmune disease and often are neglected by traditional rheumatologists. They can be viral, they can be tickborne infections, but there are ways to treat them. And often, our conventional approaches aren't that great. We've used different combinations of herbs and antibiotics, but I found some of the more wacky, what may sound like wacky or marginal therapies like ozone or hyperthermia, tend to work really well for these really treatment-resistant conditions. Some people do respond to a normal approach, but a lot of people don't. That's really where this failure of our system is, is to try to look at some of these novel therapies that, whether it's hyperbaric oxygen or ozone therapy or plasma exchange or hyperthermia, which they're using in Europe, in Mexico, to treat some of these kind of chronic persistent infections. Dr. Sunjya Schweig: Yeah. I think it's everything combined. We do end up throwing the kitchen sink at folks with these complex chronic illnesses. But the treatments, any treatment, I believe works better when you've really dialed in all the lifestyle pieces. You have some of these sleeping better, you have them doing stress management, you have their gut cleaned up, and nutritionally, and you've dealt with intestinal permeability. Because what you're doing in all of those pathways is really lowering this inflammatory load. A lot of the pathogens, they thrive in an environment of inflammation. They crank up all the cytokines, they crank up all the chemokines, and they create this incredible dysregulation and confusion in the body. And as you start to turn all that down, now the pathogens have a harder time thriving, and then any other treatments that we end up doing tend to work a little bit better. I agree with you, there's a lot of amazing options out there. It's still very N-of-1, what works from one person doesn't work for the rest necessarily, which is actually a big area of interest of mine and the work that we're doing with our 501(c)(3), the Functional Medicine Research and Technology Center, is how can we get better at figuring out what works for who and how can we use data to show that. Because the COVID era, there was some incredible studies that came out showing that if you look at the marriage, the combination of patient-reported symptoms along with wearable data, that you can actually have a much more robust physiological signal. In fact, in this case that we talked about today with Sarah, she had an Oura Ring on, which is one of my favorite wearable devices because the fidelity of the signal that we get. We were able to show as she got better that key parameters for her, her heart rate variability, her resting heart rate improved significantly. And so now what we're seeing, not only is she saying, I feel better," but we're seeing this physiological signal from her body's set point of her nervous system, of her autonomics and ability to reset down is much improved. And so, we're really trying to find ways of how do we get smart about this data, how do we create almost this realtime data dashboard that the care team, the provider, the patient and their family can all be viewing in order to really predict and respond to either worsenings or improvements or temporary flares. How do we figure out how all that data marries together? It's a really fun area to be in. Dr. Mark Hyman: That's so exciting. Tell more about your center, the California Center for Functional Medicine. Because it's not just California, it's all over, right? It's telemedicine. You can access it from anywhere. Dr. Sunjya Schweig: Yeah. Dr. Mark Hyman: It's a pretty unique novel practice. I'd love to hear more about it. Because people wanting to try to access functional medicine often find a difficult. They can't find a provider in their area, it can be very expensive. You've figured out a different model that I think is very interesting in terms of the things you can do, given the limitations of a lot of our practice styles. Dr. Sunjya Schweig: Yeah, thanks. We are completely telemedicine at this point. We were a hybrid clinic prior to COVID and then flipped the switch and moved into the cloud basically. But we basically are able to provide care anywhere in the US. We have providers in a lot of different states. I myself have licenses in a bunch of different states. And as we add new patients, we expand our access to that licensure. We have a really amazing team of providers, doctors, nurse practitioners, health coach, nutritionists, and we all work really in close collaboration with folks. And so, we're really trying to find a way, again, to bring this care to more people because I know that functional medicine is expensive and it is a little bit harder to access because of the intricacies and the nuances of what insurance does or doesn't cover. But we really believe both in geographical distribution and access, and then also trying to find ways to make it more affordable. I love listening to tech podcasts. There's a guy named Balaji Srinivasan who talks this concept of bundling and unbundling. I think of our clinics right now, your clinic, my clinic, we're still in this bundled phenomena. We have this path that we want everyone to go down. It's the equivalent of the university degree. But I'm really curious about how do we break that up and how do we give people more bite-size segments of this information and let them start to access that. So we're actually currently developing a new offering. We're calling it the Functional Medicine Checkup. We're hoping to launch that by the beginning of the year, which will give people the opportunity to do part at least of what Sarah did, get in with a provider, get some basic blood testing lab tests done, and get a much deeper snapshot of their body, which we think is really going to set them up for better health. They can then decide, "Okay, that's enough. I've got what I need. I'm going to go with this," or, "I'm going to go deeper and join the clinic in a more robust manner." But the idea really, again, is to get that care to more people and to get that knowledge base out there and have them at least understand, "Wow, there is another option. Yeah, I have the choice of what I do with my healthcare." Dr. Mark Hyman: Yeah, that's really powerful. You now created something called the Functional Medicine Checkup, which is a very easy on-ramp for people that's affordable, streamlined and allows more people to access care and getting a functional medicine evaluation. Can you tell us about that? Dr. Sunjya Schweig: Absolutely. Yeah. The Functional Medicine Checkup is a streamlined onboarding process that we're looking at. It's going to include two visits with our team where we'll then run a really comprehensive set of labs, probably 75 to 100 different markers that could be run through Labcorp or Quest. The lab side of it should be able to be paid for by their insurance. And then when they follow up with us, we'll dive in similar to how we did with Sarah and really start to isolate a lot of different factors that could be contributing to their health issues or areas that they can optimize in order to improve their health. We're working to find new ways to do this as a care team. My schedule is quite busy. Not everyone ends up seeing me. But as people come in and they see our really incredible team of practitioners, we all work together and I help supervise the cases. We all have case discussions, clinician meetings, et cetera, which is also just a really fun opportunity for us to collaborate and learn together as a team. Dr. Mark Hyman: That's so great. I think it's really allowing us to begin to have more accessibility and more spread. I think it's coming. We are not quite covered by insurance, and I'm working on that through my work with policy stuff in Washington. But I think we really have a moment to start to reimagine healthcare for ourselves and take more opportunity to actually engage in discovering how our bodies work through the lens of functional medicine, through the idea of how we create health rather than just treat symptoms and diseases and how we can get to the root of some of these really gnarly conditions like autoimmune disease, chronic fatigue, post-COVID, all the things that traditional medicine doesn't do great with. And listen, if you need new hip, it's great. If you get in a car accident, it's great. But if you're dealing with these long, chronic, debilitating diseases that we in traditional medicine have really little to offer, functional medicine provides a great doorway for people to start to think about their health differently. Dr. Sunjya Schweig: Yeah, I know. I think you've done some really amazing, amazing work over the years. You've been such a pioneer. The work that you did that, you and Patrick Hanaway did at the Cleveland clinic, getting so many people access to functional medicine, the work that you're doing on the policy side with the White House and The Food Fix Campaign, there's so much. It goes so deep. We're talking a lot about autoimmune today, but if you just clean out people's diet, like you're talking about with Food Fix campaign, and I love that Cory Booker's out there talking about being sugar free. It's so incredible to see. But if you do those basic things, not only do people feel better, but their tendency to then go on and have autoimmune disease, to have cardiovascular disease, to have diabetes, to have cancer. I mean, we're basically just turning that down. That education and that personal experience to get that into the hands and the mouths and the forks and the homes of all these people across the world is really just such an incredible gift. So I just thank you for that, Mark. Dr. Mark Hyman: Yeah. Well, thank you. We all are doing our part in trying to make this basically the standard of care. It takes a minute. We'll get there. Dr. Sunjya Schweig: It does take a minute. Dr. Mark Hyman: I was just talking to Rick Doublin, who is a pioneer in MAPS, which is psychedelic assisted therapy and studies. I've been working this for 40 years. I feel like I'm not quite 40 years yet, but I'm definitely 30 years in. There was a moment where it was invisible and now it's becoming visible and I think people are understanding that there is a different way of thinking about health. So it's great that you're doing this. It's great that you've got the California Center for Functional Medicine. That makes this more accessible. And hopefully, people can find you and hook up with your team and get some help and just optimization health or treating these gnarly conditions that really there's very little else to do for. Dr. Sunjya Schweig: Yeah, yeah. Yeah. Thank you so much. Dr. Mark Hyman: Okay. Thank you, Sunjya. It's great to see you again. And for all of you listening, if you like this podcast, please share it with your friends and family on social media. I'm sure many of you know people with autoimmune disease. Leave a comment. Have you used these kinds of approaches to help you? What are your success stories? We'd love to hear comments from you. Subscribe at every podcast, and we'll see you next week on the Doctor's Pharmacy. Speaker 4: 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.