Boost Your Immunity with These Simple Steps | Dr. Elroy Vojdani

Mark Hyman, MD

Full Transcript

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Dr. Elroy Vojdani
Think about it from the immune system's perspective if if its job is to defend us from threat and we are constantly pouring threat into ourselves, I think it was only a matter of time until we saw what we are seeing now.

Dr. Mark Hyman
Welcome, Elroy, to The Doctor's Farmacy. Great to have you. I've been looking forward to this for a long time.

Dr. Elroy Vojdani
This is a thrill. Thank you for having me.

Dr. Mark Hyman
You know, you're you're, somebody I've I've known over a bit of time, but not well, but I know your father really well because your father, Risdavazhani, Iranian Jew escaped Iran during the, the the fall of the shah, and the rise of the sort of current Regine and Ayatollahas. And, you know, made his way to America and was instrumental in my education as a young functional medicine doctor trying to figure out what to do with complex cases, people who are suffering from chronic fatigue, immune issues, mold toxicity, Lyme disease, and I used to use his lab all the time. Immuno sciences. And and, you know, I I I I think probably then you were a little boy, But now you're a doctor in MD. You have a thriving practice in LA, a little too thriving, unfortunately, because there's not that many of us out there who can really deal with these complex chronic cases and and are willing to dig and find out what's going on.

And and you do that really well. And your father was was someone who just wanted to know what was going on in the human body, and and and really took over the immunology space in functional medicine and was a key part of a lot of our curricula and education and I remember, patient I had very well who came in with chronic fatigue syndrome. And it was early on, and she had, told me a story about her house having some mold in it. And so we had the mold checked, and that was right in her bedroom, and her daughter put in another bedroom and had juvenile room to arthritis. And the two of them were pretty sick.

And they each had their molds identified in the house by mold inspectors who were able to go in and identify the exact species and strain of the mold that was in their room that was, like, behind their their walls in the bedroom. And we did the the testing through, you know, sizes through your dad's lab and the exact mold that were in their bodies with the with the antibodies were the ones that were found in the room, and they were different than their rooms and end up getting a $1,000,000 in settlement to clean the house and fix the mold problem. But then, unfortunately, the, the insurance companies didn't like that. Because, it, it, they have to pay for this mold and no people don't wanna cover mold mold issues. I went through that in my own house, and the insurance wouldn't cover it.

And, and, eventually, the lab kinda had to shut down that line of testing, but they still around in doing great stuff. And, you know, your work is really also kind of ventured in the world of immunology, and we're chatting a bit before we started the podcast about this concept that is is I think it's really important to talk about, which is, the decline of our immune resilience is how you phrased it. And and we're seeing this sort of explosion of autoimmune diseases, allergic diseases, asthma, post COVID syndrome, chronic fatigue syndrome, and and, and long COVID has really been a huge thing after the acute bio infection, people stay sick and have very significant symptoms and consequences that it goes way past the original infection. And so you spent a lot of time thinking about this concept of declining immune resilience and what to do about it. Maybe you can start up by defining what is immune resilience, why are we seeing this massive decline in our immunity and our immune function, or not even decline, but dysregulation, you know, because, you know, your your some parts are underactive and some parts are overactive.

Right? And so we're seeing increasing cancers and and increasing autoimmune disease. Right? So those are both not enough and too much sometimes.

Dr. Elroy Vojdani
Yeah. So it it's something that I think about all the time because in in clinical practice, we're seeing this dramatic increased rate of chronic inflammatory autoimmune diseases. So it's always, you know, kind of sitting back there, like, what is going on? What is happening? The world, yes, it's changing.

It's definitely changing, but there seems like there, there's a dramatic difference in the way that we interact with the world. And that's accelerating at a pace that's very, very difficult to understand because, I mean, if you look at the rates of autoimmune disease, You know, we're increasing at an 8 to 10% rate per year.

Dr. Mark Hyman
That's crazy.

Dr. Elroy Vojdani
It's crazy. I mean, if you if if you look at, let's say, 25 years ago, so 1999, 2000, about 3% of the US population had a known diagnosed autoimmune disease. Today, we sit solidly in the 10 to 11% range of a known diagnosed autoimmune disease. And, you know, you might say

Dr. Mark Hyman
more when you, like, out of all the different diseases, and then and it's, like, 50, 60,000,000 Americans

Dr. Elroy Vojdani
are more.

Dr. Elroy Vojdani
It's a

Dr. Elroy Vojdani
it's a very conservative estimate. Right? It's, you know, autoimmune diseases have also in, in their nature a bit of a, a lag time between the onset of the

Dr. Elroy Vojdani
immunological injury and the autoimmune process and then the actual diagnosis of the full blown clinical disease. Right? So

Dr. Elroy Vojdani
let's say it's 5 to 8 years there. So we're, we're talking about, you know, if you kind of count those people, likely 15, 20% of Americans. It's a, it's a humongous number, and the rate, unfortunately, is continuing to increase. You know, thinking about what's at the root of that, it's, it's Again, a lack of the immune system doing what it's supposed to do. If you wanna think of that as immune resilience, it's essentially a loss of the balance and function of the immune system.

So we're we're losing our capacity to do what the immune system is intended to do, which is

Dr. Elroy Vojdani
to defend us from all of the threats in the environment. It's

Dr. Elroy Vojdani
no longer capable of doing that. And in that inability, it's turning against our own bodies by mistake.

Dr. Mark Hyman
So not only did we see, like, this massive rate of

Dr. Elroy Vojdani
death and and hospitalization from COVID in America where we're 4% of the world's population, but we were 16% of the cases

Dr. Mark Hyman
of and deaths and hospitalizations, which is like literally four times what it should have been or even probably more considering we have the quote, best health care system in the world. So one on one hand, we weren't able to fight this infection. And on the other hand, post infection, we're seeing the opposite, the reactivation of the immune system, but not attacking the virus attacking us. And we're seeing this whole phenomenon of long COVID, which is estimated to be anywhere from 10 to 30% of the people who've had COVID. Yeah.

And and there's a lot of humans.

Dr. Elroy Vojdani
It's a lot of humans.

Dr. Mark Hyman
That's a lot. It's like millions and millions and tens of millions of humans who're walking around with their lives affected in some smaller, large way from symptoms that or directly related to the dysregulation of the immune system by this virus. And going back to immune resilience, can you talk about what what are the things that help us have immune resilience? And what are the things that have changed our environment or our life or lifestyle that have actually made our immune systems be dysregulated.

Dr. Elroy Vojdani
Yeah. The the most important cell in the immune system is something called a T regulatory cell. And the dominant population of T regulatory cells in an adult lives in the lining of the gut. So the gut is the center of immune resilience. Those regulatory cells are responsible for, you know, kind of balancing all the different sides, making sure that, you know, in an inflammatory attack against something that we should be attacking.

We don't end up in that mistake of attacking ourselves. So the gut is absolutely the center of the immune system and immune resilience.

Dr. Mark Hyman
So the gut the gut is a big problem, and we've messed up our gut. Right? The increasing rates of C sections, lack of breastfeeding, early use of antibiotics, all the gut busting drugs we use, like acid blockers and anti inflammatories and steroids and hormones, and the depletion of, our microbiome by the glyphosate that we're all exposed to 80% of Americans have glyphosate in their urine, which is a natural antibiotic that kills well, not natural. It's a synthetic body that kills your microbiome. And on top of that, you know, we our diets change dramatically.

We've produced our fiber. We've increased ultra processed food. We take emulsifiers that damage our gut lining costly key gut. So we have a whole cascade of things that have happened in our environment, we call the exposome, that have really caused massive damage to our gut, which is where 60% of the immune system is. And then that's led to, yeah, I think a lot of the rise in chronic illness in general because it gets down linked to everything of psychiatric disease to cardiac disease to diabetes, metabolic health, cancer, and, obviously, autoimmune disease and allergic disorders and asthma, not to mention just the gut issues that people have, like, IBS and all that stuff.

So this is a massive problem. It's causing huge amounts of disability and and and disease. And it's not something that traditional medicine does a very good job of thinking about diagnosing or treating. And I and I've been involved with, you know, academic centers with these long COVID clinics, and it's kinda embarrassing, honestly, alright, to see how little they know and how little they're doing, and yet there's so much that's known that we can actually do something about. And I mean, I just, we're just chatting a little earlier about, like, these different lab tests, for example, in Germany that they're looking at that are common in post COVID's patients, which are auto antibodies against your autonomic nervous system that affects your ability to regulate your blood pressure and gives you dizziness when you stand up or pots, you know, possible orthostatic hypotension syndrome.

And and we're seeing other other auto antibodies against different tissues, and it's kinda scary. And and, there there's techniques to actually fix it. Heal it. We we talked a little bit about positive freezes, which they're looking at in Europe, which basically filters out all the bad stuff in your blood, clean your blood. It's used for a lot of immune diseases.

So so talk about, if we had this problem with immune resilience, you know, you know, what what are we seeing with that? What is what is we're seeing the rise in autoimmune disease and and and and can you kinda kinda help us connect the dots between the the the decline in our immune resilience, the rise in our immunity, and then what's happened with this long COVID phenomena?

Dr. Elroy Vojdani
Yeah. Absolutely. So, you know, 25 years of research now kind of starting to look at what is really happening here from a physiologic perspective, right, you know, intestinal permeability leaky gut. You know, you've covered that many times on the podcast and in your books, but, you know, it, it's hard to understate how important that process is in, chronic inflammatory disease, autoimmune disease, neurodegenerative disease. You know, the more and more and more we look at it, the more we're finding that it is centered to all of these.

So that we do keep talking about it, it's rightfully an incredibly important topic of conversation. So, you know, you listed all of the things in the environment that we are consciously or unconsciously exposed to on a regular basis as a population. Think about it from the immune system's perspective if

Dr. Elroy Vojdani
if its job is to defend us from threat, and we are constantly pouring threat into ourselves

Dr. Elroy Vojdani
Again, knowingly or unknowingly, I think it was only a matter of time until we saw what we are seeing now, you know, massive explosions. Viruses that, you know, I think 5 or 6 years ago didn't pose such a tremendous threat to Yeah. Us as an adult population. We talked about, you know, RSV, this last cold and flu season was horrendous. You know, adenoviruses and rhinoviruses, things that typically cause like 3, 4, 5 days of regular cold causing 2 or 3 weeks of pro, you know, prolonged congestion, you know, lots of secondary infections, you know, just you're just seeing the immune system just completely failing.

So it's because I think of what we're continuously exposing ourselves to, what that does to the center of the immune system. And then we see all the ramifications of it, you know, now 15, 20, 25 years down the road, and a population that's dramatically suffering. And, you know, the current medical infrastructure has zero answer for this. You know, it's it's what other biologic medications can we come up with to try to, you know, kind of suppress the symptoms. Right?

And and now we're getting to the point where, you know, we have patients with 3, 4, 5 autoimmune diseases and and every biologic under the the sun can't control what's going on with them. So it it's a huge problem. It's progressive. And the only way that we're gonna get out of it is to acknowledge that and to start making conscious choices that limit those continuous exposures to our gut.

Dr. Mark Hyman
So so healing the gut is a big part of of healing from autoimmune disease, for sure. And that's been, you know, something I've done in my practice in functional medicine for 30 years in the ultra wellness center, and you do that in your practice as a core strategy to help reset people's immune system because it does start in the gut. But there's other phenomena happening. You know, like, like, when you look at people having COVID, they did a a study of over a 1,500,000 people and it was published in nature. Out of that, you know, 1 and a half million people that they studied in this study that was published in nature, They found a 46% higher chance of getting an autoimmune disease, which is astounding after

Dr. Elroy Vojdani
having COVID. Absolutely. So why why is that happening? That's happening again because I think of the the dramatic loss of immune resilience that we

Dr. Elroy Vojdani
a population. So, you know, to, again, to go over those numbers, that was a huge, very well done

Dr. Elroy Vojdani
retrospective analysis. A million and a half people, 2 different studies combined, showing a very large increase

Dr. Elroy Vojdani
in autoimmunity, and that was in a 6 a 12 month window after the infection. More and more studies are coming out showing that everything from rheumatoid arthritis, lupus, type 1 diabetes, you know, virtually every autoimmune disease under the sun can be triggered by COVID. So again, why is that? It's because our immune systems have

Dr. Elroy Vojdani
lost their fundamental ability to be able to appropriately defend us

Dr. Elroy Vojdani
against viruses in the short term and then also in the long term, you know, to be able to resilience is an ability to defend yourself and then return to normal. Return to balance to say the threat is gone. Everything is okay. We've handled this. Let's go back to the balance that we're supposed to be in.

And that part is completely gone as well too. People stay in very prolonged chronic inflammatory states. I mean, the average long COVID patient has dramatic symptoms for 12 to

Dr. Elroy Vojdani
24 months or more, you know, and and part of that is because I think, you

Dr. Elroy Vojdani
know, the infrastructure isn't addressing things appropriately, but part of that just speaks to how much from a population perspective, immune systems are broken and immune resilience is completely gone.

Dr. Mark Hyman
Yeah. Well, it's so true. And the symptoms for long COVID are just astounding. Like, there's over 200 symptoms described. New ones every day.

I'm hearing stories for my patients about all sorts of different neurologic

Dr. Elroy Vojdani
issues and gut issues, autoimmune issues, cognitive issues, you know, brain fog,

Dr. Mark Hyman
autonomic dysfunction. And this

Dr. Elroy Vojdani
I don't know what you've seen recently, but, you know, I think the early batch of long COVID was, was predictable, whether those who were gonna get really severe or hospitalized forms of COVID, you know, they were gonna have really big struggles afterwards. Now, you know, it's like forty five year old dad walks into the clinic, metabolically healthy, not smoking, you know, not a heavy drink. Very mild COVID. All of a sudden horrendous, long COVID afterwards. Right?

That again speaks to how broken the immune system of the population.

Dr. Mark Hyman
So as long COVID and autoimmune disease in and of itself, it just, one of the aspects of it?

Dr. Elroy Vojdani
Well, in the, in the research that my dad and I have done on lung COVID so far, we've sent, we found specific autoimmunity in a large percentage of them, but it's certainly not everybody. You know, whether it's, you know, cardio life and autoimmunity, neurological medical autoimmunity, you know, a lot of joint related autoimmunity sometimes thyroid as well. You, you, that's certainly, I think, one of the signatures, along with something called viral reactivation, which, you know, in the chronic fatigue space we've known about for a very long time.

Dr. Mark Hyman
I mean, that's an important thing I want you to unpack that because what we're seeing with long COVID is that dormant infections kinda rise up from the dead Mhmm. And tend to get reactivated causing problems. And whether it's Epstein Barr or cytomegalovirus or CMV, it seems to be part of the picture.

Dr. Elroy Vojdani
Absolutely. So there are a large group of viruses that we as adults, you know, by the time we're adults, we've been exposed to. We've been infected with HH V Six, you know, which is Rosiola, something that we typically get by the time we're three years old. Not a big deal. If you are symptomatic, you've got a fever for a couple of days.

You have rashes. Epstein bi virus, the majority of adults are asymptomatic from the infection, same with CMV as well too. These viruses, are are genius in their long term evolution against us. They they have figured out how to evade complete immune eradication Yeah. By hiding in tissue after the acute infection.

Yeah. But with a normal immune system, they stay in dormancy. They wouldn't dare step out, you know, into the wild and get eradicated by the immune system. But, what we're finding is that the

Dr. Mark Hyman
if you have a herpes cold sore. Exactly. It only comes out when you're under stress.

Dr. Elroy Vojdani
Exactly.

Dr. Mark Hyman
It's not there all the time, but the virus is there. Correct. Just sleeping. It wakes up when there's some kind of insult.

Dr. Elroy Vojdani
Correct. Right. It's not it's not rolling around in the bloodstream active all day long. But a very, very large percentage of long COVID cases long COVID patients have viral reactivation as a core of, of their clinical symptom

Dr. Elroy Vojdani
set in, in clinical disease. So again, that, that poses the question: What in the

Dr. Elroy Vojdani
world is happening when the immune system in the short and long term following a COVID viral infection. It's not meeting the demands in the short term and then not balancing itself in the long term as well, which provides a beautiful open window for these reactivated virus

Dr. Mark Hyman
And and are there are there good diagnostics, immunologically, to help map out what's going on with these patients? Because, you know, long COVID is a bucket.

Dr. Elroy Vojdani
Mhmm.

Dr. Elroy Vojdani
But

Dr. Mark Hyman
it's truly probably many, many, many different kinds of problems, and each individual responds to the install with different manifestations and the many different kinds of treatments.

Dr. Elroy Vojdani
But let's go over the buckets if you don't mind.

Dr. Mark Hyman
Yeah. Yeah.

Dr. Elroy Vojdani
Please. So currently, with what we understand right now, I break it into 5 buckets. So there's viral persistence which is essentially, somebody

Dr. Elroy Vojdani
never fully clears the initial COVID infection.

Dr. Elroy Vojdani
They've they've got this very

Dr. Elroy Vojdani
low level infection that

Dr. Elroy Vojdani
just keeps ongoing and going and going and going. There's something called super antigen activation. Which is parts of COVID have an

Dr. Elroy Vojdani
ability to just dramatically, I'll just say piss off the immune system. There's the mitochondrial dysfunction and loss of autophagy that happens there. There's the

Dr. Elroy Vojdani
microbiome and gut permeability dysfunction, and then there's the auto immunity component. So if you're going to talk about diagnostics to be able to accurately pick up what's happening with long COVID, you basically have to say, okay. Which one of these five buckets the person living in. Everyone is gonna have some unique spectrum of those 5, though, the most will the majority will have, let's say, 3 or 4 of them. So we, we don't have diagnostics for the mitochondrial part you know, maybe on the research side.

Dr. Mark Hyman
There are some things, but they're they're hard to get.

Dr. Elroy Vojdani
They're very hard to get. Germany and Yeah. Like the Seahorse analysis.

Dr. Mark Hyman
Yeah. It's a IGL lab in Germany that does a detailed mitochondrial assessment. It's miter swab. It looks at mitochondrial, you know, it's up, but it's organic acids, but it's it's definitely hard.

Dr. Elroy Vojdani
You and I know that stuff. Right? Yeah. Yeah. But not, not every physician out there in the United States.

Right? And then Yeah.

Dr. Mark Hyman
These are sort of more functional medicine diagnostics that are not used in traditional medicine, but they're real.

Dr. Elroy Vojdani
They're real for sure. The viral reactivation stuff, I think, you know, rather straightforward antibodies, IgM, IgG antibodies to different targets of FCBAR virus, HHV6, CMV. There's no diagnostics for COVID persistence. If that is in case what's going on. I mean, you can look at, you know, whether there's very high levels of COVID antibody production for long periods of time, and you can infer that there's COVID persistence there.

The autoimmune part of it, you, you brought up the lab in Germany that doing an autoimmune panel, specifically for long COVID, in our studies as well, neurological targets like myelin basic protein, myelop oligodendrocyte glycoprotein, the blood brain barrier is a very common target that was demonstrated in mouse literature.

Dr. Mark Hyman
So you're basically seeing auto antibodies, based on your own immune system attacking aspects of your brain and brain tissue.

Dr. Elroy Vojdani
You're you're you're the most important defense of your brain, which is the blood brain barrier, you know, disrupted in football players, poxers, Alzheimer's, Parkinson's. So, you know, that, that same kind of core defense layer of the brain gets damaged by COVID. You can look at those markers in the blood. And then the specific neurological proteins like myelin basic protein, which is traditionally damaged in something like multiple sclerosis.

Dr. Mark Hyman
And and so these these are lab tests that you can do to help sort of sort things out. And tell which type of the sort of 5 buckets people go in?

Dr. Elroy Vojdani
Yeah. I I, you know, make an attempt to to try to, you know, on on this kind of early leading edge side of things, identify how much of each one of them they're dealing with.

Dr. Mark Hyman
Mean, you've published a lot on this. You published in Nature, which is a major journal and other journals looking at autoimmunity and the exposome and COVID. And I think, you know, it might be helpful for us to sort of, dig into sort of how how do the, sort of, this persistence of long COVID symptoms. You know, what's the underlying biology that's happening here? Is it is it an over activation of cytokines?

Is it is it autoantibodies? Is it damage to the gut? Is it, you know, endothelial problem, which is all the blood vessel linings, which affects everything, which is why maybe you have symptoms everywhere because it affects everything. Yep. You know, how does how does it all sort of fit together for me?

Dr. Elroy Vojdani
It's tough because it's it's multiple pieces, but if I was gonna break it down to what I think the core of it is, you know, the the acquired mitochondrial damage and the associated lack of autophagy to me is really core there. So mitochondria are, you know, the, the powerhouse of the body. We know that for energy production, but I think it's under appreciated how much a damaged mitochondria will lead to a pro inflammatory dysfunctional immune phenotype, meaning somebody who has a dysfunctional immune system just as the result of the damaged mitochondria And then from there, there are neurological immune cells called glial cells. They will enter something called glial, activation and end up with a pro inflammatory immune subset in the brain. So you can see

Dr. Mark Hyman
on on fire.

Dr. Elroy Vojdani
Brain on fire. Exactly. So tired, dysfunctional immune system, brain on fire, strictly from the mitochondrial damage that comes from the viral infection.

Dr. Elroy Vojdani
And, you know, of course, in the United

Dr. Elroy Vojdani
States, with all the metabolic dysfunction that exists. Right? Massive mitochondrial issues to begin with. Right? So that's that's why we're seeing a bigger problem with it here, both in the short term and the long term.

Dr. Mark Hyman
So some pack a little bit. Mitochondi for a minute. Those are those little organelles. There's thousands of them in every cell that take food and oxygen turn into energy and form ATP that our body uses to fuel everything. So when you basically think about that, it it's your engine.

And if you run-in a gas, you're in trouble. And so everything doesn't work in the body when you run a gas. And so what you're saying is the the COVID virus somehow affects the mitochondria in ways that make them less functional and less able to produce energy and then has this huge downstream effect that even affects the immune system. Absolutely. Because not not a lot of people talk about the connection between the immune system and the mitochondria.

What do we know about that?

Dr. Elroy Vojdani
It it it's clear. So if mitochondria can run either on something called oxidative phosphorylation, sorry for the fancy words, but, you know, to to

Dr. Mark Hyman
It's burning carbs. Yeah. Right. B burning oxygen and carbs, but

Dr. Elroy Vojdani
that's that's an efficient form of, you know, converting food into energy.

Dr. Mark Hyman
It's kinda like a diesel

Dr. Elroy Vojdani
truck. Yeah. Right? Let let's fuel more miles. Yeah.

Dr. Mark Hyman
Right? And the more miles you get out of the amount of

Dr. Elroy Vojdani
fuel

Dr. Elroy Vojdani
the less antioxidants or less oxidative injury is

Dr. Elroy Vojdani
produced by the mitochondria. In metabolic dysfunction like insulin resistance, the mitochondria are not running on diesel. They're running

Dr. Elroy Vojdani
on the least efficient fuel on the planet. So one gallon will get them a mile. And in doing so, they burn through all of their antioxidant reservoir because the the mitochondrial production relies on this continuous balance between producing things that require us to produce antioxidants to neutralize.

Dr. Elroy Vojdani
Otherwise, the mitochondric damages itself. Right? So you imagine somebody with insulin resistance running

Dr. Elroy Vojdani
on that very inefficient fuel system they're teetering on the edge, you know, barely making it with the antioxidants. All of a sudden, the huge oxidative injury like COVID comes along. Tipping point. Now the mitochondria cannot, function anymore because you don't have enough antioxidants to meet what it's producing. And, essentially, what happens is it structurally becomes damaged, and it will release its own unique DNA into the cytoplasm, which signals to the immune system I'm in trouble.

What does the immune system do when you're in trouble? So it's okay. We've got something we need to fight. It puts itself into fighting mode, which is a pro inflammatory mode. The nervous system, the glial cells know when macrophages, which are, a kind of primal defense cell, are in this white blood cell or in this, like, fight, and they will convert themselves into glial activation and put themselves into this neuro inflammatory fight response, all from the powerhouse of the cell.

But that makes perfect sense.

Dr. Mark Hyman
It's a domino effect.

Dr. Elroy Vojdani
Yeah. But it's the most important part of you. Yeah. Of course, that's gonna happen. If it gets damage to the point that it can't function anymore, You need to fight whatever's doing.

Dr. Mark Hyman
I mean, you know, most people had the flu or bad cold or some virus, and they're achy, they're tired, they have brain fog, they have no energy, and it's in part because of how the virus affecting the mitochondria.

Dr. Elroy Vojdani
Yep. Right. Absolutely.

Dr. Mark Hyman
And so so with COVID, it just persists. It doesn't get better. Like, if you get a cold, it gets better. You feel fine the next week. With COVID, it seems to kind of persist.

And I I I actually had a a experience after COVID where I where I got a pretty bad case of COVID, and I was coughing a lot for a couple of weeks and that kinda got better. And then I developed arthritis. Yep. Like, my hand swelled up. I got joint pain, and it was kinda scary.

And and, you know, I I aggressively did a bunch of things that helped fix it like plasmapheresis and ozone.

Dr. Elroy Vojdani
Mhmm.

Dr. Mark Hyman
Literally, then one plasmapheresis session, which is basically where you filter your blood and take out all the bad inky stuff in the plasma and throw it out and give yourself a new albumin and put your blood cells back in. Literally within hours, it was better. Yeah. And the next day, I was like, all better and had plenty of energy.

Dr. Elroy Vojdani
And I was like, woah. Did you do it in Europe or in the US?

Dr. Mark Hyman
No. I did it in the US.

Dr. Elroy Vojdani
Yeah. Because it's actually pretty common practice in Europe. Right? Switzerland, in particular, like, they're they're very big on that.

Dr. Mark Hyman
Around low COVID, you mean?

Dr. Elroy Vojdani
Yes.

Dr. Mark Hyman
In

Dr. Elroy Vojdani
in in general and specifically for long COVID. And and it makes total logical sense. Right? Like, you're filtering out a lot of the inflammatory cells. You're filtering out a lot of the antibodies that are being produced against your own tissue.

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
And you're giving your immune system a breather, basically. Right? And in that breather, you're allowing all of these, like, antioxidant balances to restore themselves, and then you can go back to the way things were supposed to be.

Dr. Mark Hyman
So so let's just sort of just pretend I'm a a long COVID patient. I'm, you know, pretty healthy guy, but I got COVID. And then I'm suffering. Like, I have headaches, brain fog. I have no stomach

Dr. Elroy Vojdani
is not right. Muscle aches, have no energy. And, my joints are a little sore.

Dr. Mark Hyman
You know, where do you start with someone like that? What what are you gonna do diagnostically? What are the kinds of steps you're gonna take to help me get better?

Dr. Elroy Vojdani
Even even before the diagnostics, you know, I'm I'm starting with a very, very strong gut centric approach. So I'm looking very carefully at what they're eating. Obviously, you know, many times they're not eating what, you know, you and I know to be a healthy diet, a whole foods diet, rich with vital nutrients, you know, pulling the grains, you know, sometimes in certain situations, pulling the the the dairy out of their diet as well too. Shoring things up with specific probiotics. And, and then, you know, depending on what the response is in a very short period of time, then I'll start adding the diagnostics.

So, you know, I wanna know again, is there a microbiome biome dysfunction do they have intestinal permeability leaky gut is the viral reactivation part of it there. And and in my experience, when they have that real, you know, acute chronic fatigue picture, like they cannot get out of bed. They try their best to take a walk around the block. It crashes them. The viral reactivation will be there usually in those cases.

Like, Epstein BAR or CMB or? FC BAR virus HHV Six in a in a recent study that we just did, 90 patients, long COVID, 90 normal controls, we found actually that HHV 6, IGM was one of the most predictive, markers for long COVID, because such a high percentage of people will have HHV 6 reactions activation, which has been very classically described in viral induced chronic chronic fatigue. So again, not a surprise. Just something that we're learning is specifically applicable to long COVID.

Dr. Elroy Vojdani
So

Dr. Mark Hyman
you look at the gut, you look reactivation of viruses. What else you're looking at?

Dr. Elroy Vojdani
And then it's, you know, blood brain barrier neurological antibodies. Again, in that recent, study, we found that blood brain barrier protein and myelin basic protein IgM antibodies, which are more of an acute antibody were very good predictors of long COVID.

Dr. Mark Hyman
So you can get these tests through, like, specialty labs, like, immunosciences, like your dad's lab or Cyrics, some somewhat.

Dr. Elroy Vojdani
Yeah. Immuno sciences has a specific long COVID panel, which includes COVID antibodies, HHV6, and EBV.

Dr. Mark Hyman
And and and and yet, that's not really easily accessible to most people. Right?

Dr. Elroy Vojdani
No. Yeah. No. I mean,

Dr. Mark Hyman
questionable doctors won't typically do these tests.

Dr. Elroy Vojdani
There's access to it. Right. You know, Quest And Labcor, they all run EBV HV Six. You know, we could make an argument about whether it's not the best version of it in the world, but at least you're getting some sense. Right?

And insurance will typically pay for them because these doctors need to know that EBV and HHV 6 reactivation are very common in long COVID and you have to look for them. And then also they need to know what to do about it.

Dr. Mark Hyman
Exactly. Well, that's the hard part.

Dr. Elroy Vojdani
Or you don't look for anything that you don't know what to do about. Right?

Dr. Mark Hyman
Exactly.

Dr. Elroy Vojdani
So what do we

Dr. Elroy Vojdani
do about it in that situation if you do find the viral reactivation? In our clinic, we're doing a lot of high dose IV vitamin c to get them kick started. Oftentimes IV, l l I c to pair with it as well.

Dr. Mark Hyman
Which is sort of an amino acid that has an antiviral component.

Dr. Elroy Vojdani
Exactly. And then, you know, just pairing that with a lot of antiviral supplements, monomeran, loracitan, you know, all of leaf extract, you know, quercetin, NAX, zinc, you know, just making sure that they have as much of an antiviral fighting capacity on a daily basis as they possibly can have. Hyperbarics are

Dr. Elroy Vojdani
showing a lot of promise in lung COVID. So recommending patients go get

Dr. Elroy Vojdani
hyperbaric treatment and is a very good study out of Tel Aviv. Yeah. You know, you had to know that that study, they use 2.4 atmospheres.

Dr. Mark Hyman
This is a hard chamber,

Dr. Elroy Vojdani
not a soft chamber. Hard chamber. So they need to go to hard chamber facilities. And, I think it was 40 out of 80 days.

Dr. Elroy Vojdani
Yeah. So it's it's

Dr. Elroy Vojdani
an investment, obviously, a time

Dr. Mark Hyman
Time and money. Yeah.

Dr. Elroy Vojdani
And money, but it works. Yeah.

Dr. Mark Hyman
Right. But let me get getting your life back is worth it.

Dr. Elroy Vojdani
Absolutely. Right? You know, and and you're investing in your short term and long term you know, the if you're having long COVID symptoms, something is dramatically wrong with your immune system. Resking you yourself from that is not just resting yourself from long COVID. It's doing something for yourself in the future.

Dr. Elroy Vojdani
Yeah. I mean, because otherwise people sort

Dr. Mark Hyman
of tend to have this forever.

Dr. Elroy Vojdani
Sure.

Dr. Mark Hyman
Right? I, I mean, I personally had chronic fatigue syndrome, and I know what it's like. And it's the worst feeling in the world. You feel like you, you know, you you haven't slept for 3 days, even if you just slept and you walk in through a fog and every step is an effort and you can't really function and you have to fake it

Dr. Elroy Vojdani
Yeah.

Dr. Mark Hyman
If you can get out of bed. Yeah. And it's, it's something that it it's unfortunate that traditional medicine just has very poor treatments for and also very poor understanding of, you know, and the multi kind of factorial cause of these conditions is important to understand because it's not just one thing. Like with autoimmunity, it can be a lot of things. Right?

So long COVID can be one piece, but it's this lack of immune immune resilience that's causing the problem, really, because if we were basically healthy, we would be able to handle a lot of this.

Dr. Elroy Vojdani
I think it's the most important part of us. I'm biased in that, right? But with a healthy immune system, you're really protecting yourself from everything.

Dr. Mark Hyman
Yeah. And the and the the immunity stuff is significant because, you

Dr. Elroy Vojdani
know, everything that's happening across the board now with almost all disease in America is the upregulation of our

Dr. Mark Hyman
immune system and inflammation, whether it's heart disease or cancer or dementia or diabetes or obviously autoimmune diseases, they're all inflammatory problems, sir. And and we're kind of a nation on fire and increasingly a global population on fire. And that it's something that we're really not great at at diagnosing or treating with traditional medicine. So if I'm that patient who comes to you, you're fixing my gut. You're fixing my diet.

You wrote, and you wrote a book called, when food bikes back, you know, how to treat autoimmune disease using food, which is great. Really get a copy, but the the the there's a lot of steps that we know how to do in functional medicine to help people recover from autoimmune disease and from long COVID. So can you kind of talk about how you would start to sort of you know, take care of me in addition to the basic things you mentioned?

Dr. Elroy Vojdani
Yeah. So that book was really

Dr. Elroy Vojdani
written as a, as a primer for creating, you know, immune resilience in the gut and then also providing people

Dr. Elroy Vojdani
a map for What specific foods do you need to pay attention to for specific autoimmune diseases? And the reason I wrote it was because as you and I were chatting about before we, we started recording, you know, when you're on the physician side of this, Sometimes it just feels like the people that need your help is a never ending just, you know,

Dr. Mark Hyman
sea of sick people out there.

Dr. Elroy Vojdani
See of

Dr. Elroy Vojdani
sick people out there. And if I worked 24 hours a day 7 days a week, I wouldn't put a dent in it. So I thought I just owed it to everybody to put my hat into this knowledge and just, you know, say, hey, this is what I've seen and done

Dr. Elroy Vojdani
so far. So, in the

Dr. Elroy Vojdani
book, we talk about the restoration of oral tolerance. Which is a gut centered approach. That's essentially what we mean by immune resilience. To, to be able to convince the

Dr. Elroy Vojdani
immune system that attacking your own tissue or being in a continuous pro inflammatory state

Dr. Elroy Vojdani
is not the way that we wanna be. So all the supplements that have very good data behind them that you can use to restore oral tolerance and mean resilience are in the book. Everything from vitamin A, vitamin D, short chain fatty acids, specific probiotics, fish oil, everything is in the book. Yeah. And, you know, also all the tests that I like to use.

And the idea behind that was, you know, although functional medicine is growing dramatically, thanks to pioneering efforts from physicians like yourself, pioneers like my dad, Jeff Bland, all these other people who have really, like you put yourselves out there at a very early time. I benefit from that. So thank you. You know,

Dr. Elroy Vojdani
sometimes you're gonna live in a neighborhood or, you know, where there is no functional medicine doctor or

Dr. Elroy Vojdani
they're just not available. And if you have a physician who's empathetic and caring and wants to go to bat for you. You can always go to them and say, hey. Listen. Like, these are the tests that were recommended.

Why don't we do them? We can learn together. Let's see what we get out

Dr. Elroy Vojdani
of this.

Dr. Mark Hyman
You want a doctor who's a willing to be a partner?

Dr. Elroy Vojdani
Yeah. Yeah.

Dr. Elroy Vojdani
Right? And a good doctor. I believe we'll be very willing to engage because we're supposed to be continuous learners.

Dr. Mark Hyman
That's right. That's right. Absolutely. And I think, sadly, it's not the case most of the time because we get, like, stuck in a paradigm and we don't learn much about autoimmune disease in the sense of what's really the root cause of it or how to deal with it other than just using immunosuppressive medications, which are often very expensive and have significant side effects. You know, I I wanna kinda look back on what you talked about around oral tolerance because this is such an important issue.

And and I wanna sort of sort of kind of lean into it through this lens of food sensitivities because, you know, when you eat something, that is, from your diet. It your body shouldn't be pissed off about it. It should be thankful and it should absorb it and get rid of the stuff that doesn't want, but keep the stuff that it needs. Right? And what's what's happened is that there's been a disruption in the normal way in which our immune system starts to build tolerance for all these foreign molecules that we eat pounds a day.

Like, it's the most amount of foreign stuff that we're exposed to every day. Is what we stick in our mouth. Right? And and our body has to determine if it's friend or foe. And when we don't have a proper functioning gut immune system, what it should be a friend Turns into a foe.

Yep. Like, I I remember I had a patient way back when she had, like, intractable migraines for, like, 30 years. It was in bed, you know, multiple days every week, and we did a food sensitivity testing. And she had super high score of eggs. I was like, well, why don't you try to stop eggs?

She did and her migraines in a way.

Dr. Elroy Vojdani
Yeah.

Dr. Mark Hyman
And and and and so a lot of people are doing food allergy or food sensitivity testing. And people are kind of confused about it. And I'd love to sort of unpack this because it's it's sort of helps us to kind of understand, 1, why why we're seeing this increase in food reactions and, 2, what we can do about it. And and I just wanna sort of put my stake in the ground by saying, a lot of people do these food sensory testing, and I think, oh, I'm I can never eat this. I'm allergic to this.

Instead of going, oh, I have all these reactions to foods. I have a leaky gut. How do I not become so sensitive? Why am I so sensitive and how do I reset my immune system? So I'm not so sensitive.

Yeah. So that that's what I love you to talk about because oral tolerance is a really important concept that allows us to be in the world without getting sick from it.

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
So I'm gonna I'm gonna back up real quickly and just make the distinction between food allergy and food immune reaction or food sensitivities. Yes.

Dr. Mark Hyman
Because it is a it's a it's a it's it's, yeah, it's very confusing.

Dr. Elroy Vojdani
So food allergy is, IgE mediated just traditional allergic response to food. I always say just think about a kid with a peanut allergy. Exactly. It happens in minutes. Right?

And the symptoms are, you know, extremeness. Yes. Extreme life threatening. Yeah. Right.

A food immune reaction or food sensitivity revolves around different antibodies. IGA and IgG antibodies, which are part of a different branch of the immune system. Symptoms from food, immune reactivity

Dr. Elroy Vojdani
or food sensitivity are basically the symptoms that we talk about with leaky

Dr. Elroy Vojdani
gut because they're the result of a chronically leaky gut. Essentially, the intestinal

Dr. Elroy Vojdani
barrier, which has this incredibly difficult task that we talked about of friend, friend, foe, friend, foe,

Dr. Elroy Vojdani
because of it, it breaks down structurally doesn't have that ability to make that

Dr. Elroy Vojdani
distinction anymore because the breakdown basically convinces you that you're in some continuous threat.

Dr. Elroy Vojdani
So you just start attacking everything. Right? So food immune reactivity testing, more than anything thematically just tells you what's happening with the immune system, right? Getting a food sensitivity test and seeing everything in red removing it That's not the point.

Dr. Mark Hyman
Yeah. Which most people honestly think it is the point. And and I it gets me kind of a little upside down because I'm like, no. No. No.

This does not mean you have to avoid these foods for life. It means that something else is going on. We need a fit.

Dr. Elroy Vojdani
Right?

Dr. Elroy Vojdani
You and I both get up in arms about that. For sure we share that in common. It is it's a state of a particular part of the immune system. It's saying your intestinal immune system is pissed off. Yep.

It doesn't know whether food is something it should attack or not. That's a huge problem, right? Then in food, immune activity, there are very traditional trigger foods where the actual presence of the reactivity

Dr. Elroy Vojdani
is continuing the process of the permeability. And it's very important to understand. Right. It's a self perpetuating cycle. Exactly.

So there are select ones.

Dr. Elroy Vojdani
That if you remove in the right case, the the healing of the gut back to normal is gonna happen much more quickly. Yeah. And that's why we talk about gluten so much. Yeah. Because it's number 1, 2, 3, 4, and 5 on that list.

Dr. Mark Hyman
It certainly is. Yeah.

Dr. Elroy Vojdani
Right? Dairy, corn, soy, eggs. Those are other common, you know, culprits. Eggs, as you mentioned in that case, is a pretty common one. Yeah.

But the rest of them, you know, it's like, I understand if you sensitivity to cucumber, and all my problems are gonna be solved by eliminating cucumber. No. No. No. You're not solving anything there.

Dr. Mark Hyman
And I and the gluten thing's important because it's kind of the gateway

Dr. Elroy Vojdani
drug because because what it does, and then we've had Alessio Fasan on the podcast, is it is it increases the

Dr. Mark Hyman
production of a compound called Xyulin. Yes. Which is a really important molecule

Dr. Elroy Vojdani
that is increased in certain diseases like cholera, but it seems to also be increased with exposure to gluten. Yes. And what that protein does is it breaks down the

Dr. Mark Hyman
the stickiness that the cells have together, we call it tight junctions, basically like legos are stuck together. And so the cells sort of come apart. Literally, the lining of your gut gets like a like a sieve. And and it's like a coffee filter with holes in it, let's say. And so then all these food and bacterial toxins and proteins leak in creating all this inflammatory.

So gluten

Dr. Elroy Vojdani
often, if you get rid of gluten, it will help the gut start to heal. Yeah. Gluten vitamin a, vitamin d probiotics, short

Dr. Mark Hyman
chain fatty acids, fish oil. Take all the,

Dr. Elroy Vojdani
leaky gut offending crap out of your life, and it's a pretty good formula for restoring your immune resilience.

Dr. Mark Hyman
And that doesn't mean that everybody's gluten sensitive and everybody should be gluten free. It just means that in people who are sick, it's, like you said, number 1 to 5 things to think about. If you have an inflammatory or autoimmune problem. Yeah.

Dr. Elroy Vojdani
It's just really common. It's not gonna be the case for everyone, but if you're playing the odds, yeah, it's a pretty good card to play.

Dr. Mark Hyman
So then so then, you know, when when we're seeing these sort of decrease in oral tolerance because of all the factors we talked about earlier, the destroyer got microbiome. We see this sort of increasing in reactions to foods. And and it's something we test for. But the tests are are are confusing for people because they get all these lists of things that they think they're allergic to, but it's not really an allergy. And so so what what do you do then in in terms of repairing the gut?

You talked about some of the basic stuff removing the foods like dairy, gluten, maybe soy eggs, and then giving certain compounds like fish oil or glutamine or short chain fatty acids or course of 10, the things that kinda we know help repair the gut. But is there more to it than that? Is there a way to kinda really, you know, look even deeper at what you call in in some of your papers, the exposure? Because because maybe there's something going on with a virus or a toxin or something else. It's I know that happened with me.

For example, I had terrible leaky gut, reacted to everything, and it was a mercury. It was destroying my ability to maintain my gut integrity and poisoned all the enzymes in my gut and I got a leaky gut.

Dr. Elroy Vojdani
Yep.

Dr. Mark Hyman
And I would eat, like, almost anything and I would get a rash or sore on my tongue or my eyes would swell up or or would have, like, not classic IgE reactions, but weird things happening. Right?

Dr. Elroy Vojdani
Yeah. And anything in the environment can be something that triggers intestinal permeability leaky gut, right? And so the exposome is a very big thing. Food is the most common thing, I think, in the exposome that we're exposed to. You know, we're we're literally taking something from the outside environment and internalizing it by eating it.

But pathogens, bacteria,

Dr. Elroy Vojdani
fungus, viruses, other unusual organisms. They're very common triggers of autoimmunity

Dr. Elroy Vojdani
as we discuss with COVID. But, let's say the bacteria from food poisoning can be very common triggers.

Dr. Elroy Vojdani
And then environmental chemicals are a huge contributor. And unfortunately, I think probably the grow

Dr. Elroy Vojdani
the the largest growing group of contribution to autoimmunity. And chemicals, create autoimmunity in a very unusual way in certain people. They create something called a neoantigen. So if you just kinda like think about this, it's horrifying what chemicals do to human beings. A neoantigen

Dr. Elroy Vojdani
is when something comes along from the environment binds to your own tissue and modifies the structure of the tissue to the point that your

Dr. Elroy Vojdani
own immune system doesn't recognize your tissue as yours anymore. And attacks it. And that's a very traditional way in which chemicals cause autoimmunity. Yeah. They're called autogens.

Right?

Dr. Elroy Vojdani
Yes.

Dr. Mark Hyman
Like auto auto and autoimmune inducing toxins that can be heavy metals like mercury, and I had autoimmunity from that. It can be the plastics and petrochemicals we see it can be viruses. It could be foods. And so there's so many things that that disrupt our immune system. And and the problem in our modern size is many of us have many of them.

Right? We have latent viruses. We have exposure to environmental toxins. We eat all these crap and nerve diet that causes leaky gut. We have you know, modern wheat, which has way more gliding antibodies that drives more a week he got.

So you've got this whole cascade effect.

Dr. Elroy Vojdani
Yep.

Dr. Mark Hyman
But the good news is, I realize that is it with functional medicine, we actually can help people dig out of this

Dr. Elroy Vojdani
hole.

Dr. Mark Hyman
Because from traditional medicine, it's like, oh, shit. You know, like, I don't know what to do with this patient. Let's create a clinic called the lung COVID clinic, and we'll figure out to give them symptomatic treatment for their drugs, but they're not doing any of the stuff we're talking about. And and so tell us sort of some cases of patients you've had come in with with long COVID who you've sort of identified some of these findings and and what you've done for them and and what their outcomes have been. Because I think I think people need to hear some helpful stories because it's bad out there.

And and a lot of the and by the way, a lot of the stuff that we do you know, you can do on your own and get better without actually having to do a lot of expensive stuff.

Dr. Elroy Vojdani
That's the goal.

Dr. Elroy Vojdani
Yeah. Right.

Dr. Mark Hyman
I mean, and and and and and, you know, I I think it's such a big issue that I I wrote up a whole guide, a solution guide on COVID and long COVID for for people because I was getting a question like every day for people. It's like

Dr. Elroy Vojdani
and the spirit of functional medicine is empowerment of the people on the other side. Right? It's about giving people the ability to step back into the driver seat and drive their health in the direction that they want. Right? So so whether you're doing it with a practitioner or you're doing it from the knowledge that we're all spreading, that's all the same.

So, a recent case of long COVID was a, forty eight year old gentleman, 3 kids, extremely metabolically healthy, exercise fanatic.

Dr. Elroy Vojdani
It was his 3rd COVID infection. Extremely mild. We're talking about the sniffles for 3 days

Dr. Elroy Vojdani
The only reason he knew it was COVID was because everybody else in the house, including the kids were testing positive for COVID. Yeah. 2 weeks on the dot after the infection, bedbound. Just could not get up couldn't eat Wow. Wasn't exercising.

Just, like, was a completely different person. I saw him in clinic because he came in and said, I need your help. And it just looked like like hell. Like, sunken eyes. I was just shocked because he was so healthy before.

Ran all of the usual tests found out he had a really significant case of BBV reactivation. And, Epstein bar. Epstein bar

Dr. Elroy Vojdani
of iron.

Dr. Mark Hyman
And you can just check that by seeing antibody levels and increase in certain patterns. Right?

Dr. Elroy Vojdani
Quest and Labcorp will run it if that's what you need to do. And we gave him a few rounds of IV vitamin c, and some antiviral supplements. And I think it was 3 months later, he was back to himself a 100%. Wow. But what I tell them afterwards is, great.

We got you out of this long COVID state. Now let's ask the question why the hell this happened to you. Because on paper, it never should have. Right? He had been a patient for a very long time, had really significant intestinal permeability, use, you know, identified that gluten was a very big problem for him, did the whole restoration thing.

He had dropped out of the the continuous care in the clinic during COVID for a while. And what went back to his normal eating? Yeah. You know, didn't have any of the usual symptoms that we started all that for, but he, you know, he was eating gluten and dairy regularly, you know, wasn't being mindful, I think. And ran an intestinal permeability panel on him because as, you know, my curiosity says, I need to know why this happened to you.

Dr. Mark Hyman
Right.

Dr. Elroy Vojdani
And it was, you know, a 10 out of 10. It was, you know, both the zonuline issue and then you mentioned the bacterial toxins really, really severe endotoxinemia.

Dr. Mark Hyman
Are you talking about the CIREX 2 panel?

Dr. Elroy Vojdani
Yeah. CIREX array 2.

Dr. Mark Hyman
Yeah. And this is CIREX is a lab that does a lot of immunological testing and antibodies and your dad's been involved with that lab and helping them develop a lot of their I I use it a lot clinically in our practice at the ultra wellness center. It's true. You can see when people have a lot of these auto antibodies against zonulin, which is the gluten protein or against lipopolysaccharides, which are the toxins from bacteria, you can tell that all this crap literally is getting into their immune system and their bodies reacting to it.

Dr. Elroy Vojdani
Yeah. So, you know, so this this is this is your story. You know, you we clean things up. You did great. Understandably, I think human beings fall off the wagon sometimes.

You fell off the wagon. Something relatively innocuous was a huge problem. And it led to further immunological problems. So we take care of the first layer and then we take care of the intestinal permeability and then we make sure this never happens.

Dr. Mark Hyman
Do again. And and and and so this was this seems like a pretty straightforward case where he he just was sort of hit pretty hard with fatigue, and he had leaky gut, and he had some sort of reactivated viruses. Are there patients that, you know, coming with full blown autoimmune disease that you see? Absolutely. And and what what are what are those stories like?

Dr. Elroy Vojdani
They're longer cases. They're more complicated.

Dr. Mark Hyman
Yeah. Oh, we got a few minutes.

Dr. Elroy Vojdani
A thirty five year old that comes to mind, this gentleman had seen many practitioners across the country, suffering from long COVID for 12 months by the time I saw him. So it'd been a really long time. His, his, his case was quite unique. A lot of neurological symptoms.

Dr. Elroy Vojdani
It's

Dr. Elroy Vojdani
so much so that neurologists were constantly working him up for MS. Yeah. You know, spinal taps and MRI is coming back negative, thankfully, but he had really dominant visual and motor neurological symptoms, a lot of numbness, tingling, and a lot of visual disturbances, along with the fatigue, the brain fog, the muscle pain. So, you know, I I went, you know, deep dive. Those people have been to 10 people before they come to see you.

You really need to figure, I think, all the pieces out in that situation, as you know. Like the detective. Yeah. Yes. So he had extremely elevated COVID antibodies that stayed elevated no matter what, over, let's say, a 6 month time frame, they were continuously high.

I've seen bar virus reactivation classic with, something called an early antigen antibody, which is the the classic antibody that tells you that that's the situation. And very high neurological antibodies, myelin basic protein, synapsin, and tubulin, I think, were the 3. And These are autoimmune antibodies against your brain, basically. Exactly. So he he's he's got what looks like COVID persistence, Epstein BioVirus reactivation, and now he's attacking his own neurological tissue as a consequence of the initial viral infection.

Dr. Elroy Vojdani
Which

Dr. Mark Hyman
is showing up almost like an autoimmune MS condition.

Dr. Elroy Vojdani
Exactly. Exactly. So not diagnostic for MS at this point, but, you know, certainly looks like he's in that spectrum. So he did also have

Dr. Elroy Vojdani
intestinal permeability, gluten, and dairy sensitive. Dairy is

Dr. Elroy Vojdani
very cross reactive with neurological tissue as is gluten. So what that means is if you do have leaky gut and permeability and you're eating those foods, you might actually be contributing to the neurological autoimmunity. So by removing them, you can, you can kind of lower the fire a little bit. So remove those foods, started on the oral tolerance protocol, started on the IV vitamin c for the Epstein BAR virus, kinda hitting as many of these things as we possibly can. Things get better, for sure, in a very quick time.

I'd say 12 weeks later, he was going from he would call himself 2 out of 10 functional to 7 out of 10 functional. And then, what you mentioned. Plasmapheresis. Yeah. He started contacting on on his own different clinics and actually brought to me the idea of doing plasmapheresis and and, you know, you and I know a lot of people in the country, but, I think one in particular that does this in in Tennessee, And, yeah, it's sent up to David.

Dr. Elroy Vojdani
And,

Dr. Elroy Vojdani
after plasma freezes did remarkably well. And, you know, I think that that took a while for sure to kind of get in motion. And he suffered for a really long time, but it was a case where if you identify every piece appropriately, you make dramatic progress when progress isn't being made. Yeah.

Dr. Mark Hyman
So I think it's really important. I mean, I think there's a whole spectrum of severity of long COVID. Right? And and I think a lot of the basic things can work to get people better, like fixing your gut, cleaning up your diet, you

Dr. Elroy Vojdani
know, a few extra supplements, maybe a few nutritional IVs, which which are affordable for most

Dr. Mark Hyman
people. But then there's no cases which are more serious, and you need to kinda go a little bit further diagnostically and therapeutically. And there's been a lot of work out of Europe around, diagnosing a lot of these autoantibodies against the autonomic nervous system and other other things that happen in the body. And they use platinum freezes there, and it found it very effective in actually reducing some of these neurological and also kind of long COVID symptoms. So I think we have a lot of things in our toolkit that aren't part of traditional medicine.

Whether it's, you know, diet, lifestyle interventions, supplements, intravenous nutrition, things like

Dr. Elroy Vojdani
plasmapheresis, ozone therapy, hyperbaric oxygen therapy. You know, there's a whole tool at peptides Mhmm.

Dr. Mark Hyman
Can be used. And and so when you're suffering out there, I want you to know there is hope and there is there is a pathway. Now sometimes it's not a straight line. Sometimes you have to go find the right practitioner, but I I think it's really important to understand that there's a there's an array of understanding that's pretty deep about this. And, you know, you know, you've written some great papers.

We're gonna link to the papers with in the show notes, your dad, and you've written others in in major journals. And and they're really quite in-depth discussing how the mechanisms work and what to do about it. And I think that, you know, there's no lack of literature now on this. There's just a lack of of cohesive approach to systematically figure out what's going on with each individual patient and treating them uniquely because like you said, there's no or like I said, I'm not gonna do too long COVID patients that are the same. Yeah.

And so it's really about personalized medicine. It's really about understanding each person's unique biology and then customizing the treatment to match what their particular issues are.

Dr. Elroy Vojdani
Yep.

Dr. Mark Hyman
The sort of comment you brought up a little bit earlier was this

Dr. Elroy Vojdani
sort of you you kinda didn't say the words, but there's a phenomenon that happens where our immune system gets confused whether it's an environmental toxin or a virus

Dr. Mark Hyman
or a food or something that we react to

Dr. Elroy Vojdani
that we probably should react to because it's foreign. Right. But then it's like kind of a mass mass shooting, you know, like, instead of, like, just targeting that thing. Yeah. It's like

Dr. Mark Hyman
the bullets spray everywhere and start targeting your own tissue. So that's when you sort of get auto antibodies and attacking your own tissues, which is which is a whole, phenomena that happens in autoimmune disease. And we call this molecular mimicry where So can you kinda unpack that a little bit and how how that happens? Because it's like, well, wait a minute. He's talking about the gut.

Oh, wait a minute. He's talking

Dr. Elroy Vojdani
about a virus. Oh, wait a minute.

Dr. Mark Hyman
He's talking about, like, toxin.

Dr. Elroy Vojdani
Oh, wait a minute.

Dr. Mark Hyman
It's a little confusing. Right? And you call this the exposome, right, which is the the sum total of all the things that our biology is exposed to over a lifetime and what washes over us and determines our phenotype, which is the expression of who we are in any moment.

Dr. Elroy Vojdani
I I think probably the most important thing to understand first is it's very, very difficult for autoimmune

Dr. Elroy Vojdani
disease to occur if you just think about all the safety measures that are built into our own immune systems for this not to happen. Yeah. The immune system has

Dr. Elroy Vojdani
to be essentially tricked

Dr. Elroy Vojdani
into attacking your own tissue. The basis of that trickery is something called molecular mimicry. That means that a

Dr. Elroy Vojdani
protein or peptide sequence that exists in the environment gets attacked by your own immune system. And it looks similar enough to your own tissue that your immune system can, after that attack, no longer distinguish between the 2 of them. So Let's say again, I mentioned dairy and myelin basic protein or

Dr. Elroy Vojdani
myeloma oligodendrocyte glycoprotein neurological protein targets, right, like dairy case in protein, which is what the immune system always reacts to a protein. Yeah.

Dr. Elroy Vojdani
Looks similar to neurological tissue.

Dr. Mark Hyman
So, basically, your your your cow protein looks similar to your own Your own brain tissue. Your own brain tissue.

Dr. Elroy Vojdani
So if you attack the cow protein, the attack is not specific enough to be able to say when it comes across your brain protein, hey.

Dr. Elroy Vojdani
That's brain protein, not cow protein, and it attacks it by accident. That's that's the fundamental basis of autoimmunity. So everything in the environment where there's an amino acid sequence that looks close enough to your own tissue has that potential. And the work of my dad has been actually trying to map that crossover. The the proteins and amino acids in the exposome and the amino acids in our own body where do they match so that we have a real legend or map as a practitioner or as people to be able to get specific and say, this is the autoimmune disease I have.

These are what we call the cross reactive epitopes or the proteins

Dr. Elroy Vojdani
in the environment that look similar. Those are the places I need to look.

Dr. Elroy Vojdani
Because otherwise, the environment is a humongous Right. Humongous category. Right? You're you're you're gonna be fishing forever if you're just going through the list at Nauseam.

Dr. Mark Hyman
Yeah. Yeah. I mean, I I I I think, you know, getting that specific is amazing. And if we can do that, that's great because it helps diagnostically, but, you know, when I see enough patient with autoimmune disease, I'm thinking, okay. Leaky got what foods do they react to?

Gluten's top of my list. Do they have exposure to petrochemicals, other environmental toxins, heavy metals? What about tick infections? What about mold exposure? What about viruses?

So this is sort of the list we go down in a functional medicine model to think about root causes because you cannot treat someone with an autoimmune disease unless you address the root cause, which is something that we don't do in traditional medicine. And that and I think

Dr. Elroy Vojdani
that's

Dr. Mark Hyman
you know, there's a there's a, you know, of all the things that we do in functional medicine, immunity is one of the most satisfying because it's it's one of those things that actually can get better, which is something we don't think about in traditional medicine. Once you've got an autoimmune disease, you got it for life. Like, rheumatoid arthritis, lupus, MS. Like, there's it's a one way street.

Dr. Elroy Vojdani
Yeah. You're gonna cycle through medications. That's basically what your future looks like. You're gonna be on Humira for 3 to 5 years and then cycle on to the new one and then the new one and the new one, and that's That's all that's really offered to you. I

Dr. Elroy Vojdani
mean, I had

Dr. Mark Hyman
a horrible autoimmune disease. I mean, I got autoimmune when I had chronic fatigue, which was sort of positive NA and low grade thing was not specific, but then I got full blown ulcerative. After a c

Dr. Elroy Vojdani
diff, infection and mold exposure. And it it was awful. I mean, I have to tell you, it was awful and, I tried everything that I had in my toolkit that I knew of from

Dr. Mark Hyman
functional medicine, it didn't work. And I tried traditional medicine. I took

Dr. Elroy Vojdani
60 milligrams of prednisone for 6 weeks. Did touch it. They were monitoring for me on biologics.

Dr. Mark Hyman
I did not wanna go on biologics. And I finally, like, I said, alright. I gotta do something crazy. And that's when I I really, double down and

Dr. Elroy Vojdani
said, what could I do that would be a reset for my immune system and to kill anything

Dr. Mark Hyman
that's in there? And I did, intravenous ozone therapy and I did high dose IB vitamin c and glutathione and minerals vitamins, and I did hyperbaric oxygen. And that that combo of those three things all at once kinda kicked me out of that cycle. And it was quite amazing to see. And I was like, that's amazing.

And now I'm like, perfect. I don't have an autoimmune disease, but typically people with croaties or colitis, it's an on and off thing, you know, they're never really better.

Dr. Elroy Vojdani
And But

Dr. Elroy Vojdani
and like a traditional doc will tell them, like, what you eat makes zero difference in the disease.

Dr. Mark Hyman
Oh, yeah. Especially you have a digestive disorder, but you mean it makes no difference. No difference. It's just safety. What a god's echo.

I guess, like, the one organ, you're putting pounds of stuff in every day. And I'm gonna But I think what's changing, you know, I think that New England Journal just had a a a launched a series called nutrition medicine, which I'm extremely excited about, and they talked about the food and the microbiome and, I mean, I'm thinking, wow, this is like you'd never would have seen that 10 years ago. So I think things are changing. I think all the work we're doing is really making things move forward. I I think the the sort of, kind of last thing I want you to really dive into is is you know, where if I if I was like a, basically, more or less average American, and I and I came to see you and I said, look, I've been hearing about this rising immunity.

I've been hearing about the reduced, immune resilience. I'm scared about you know, COVID or the next pandemic, and I I wanna fix my immune system. What do I do? Because if you go to a regular doctor, they're gonna go, I'm, wait till you're sick, and then I'll give you a drug. Right?

But what what what can you do for people? What can we do as functional medicine community to educate people about how

Dr. Elroy Vojdani
they can build this immune resilience? Well, there there's a lot of options there.

Dr. Mark Hyman
You know, I think you you have written a bunch of really wonderful functional medicine,

Dr. Elroy Vojdani
in general does a really good job about just teaching the concept of nourishing the gut and the microbiome being an incredibly influential way to create that immune resilience. So don't don't discard just how often that will work for the average person out there.

Dr. Mark Hyman
Fixing your gut.

Dr. Elroy Vojdani
Fixing your gut. Just getting to the fundamentals. Let's say your diet, you know, your exercise, your sleep, your socialization. Right? The look.

Incredibly effective really across the board. There are certain cases where you need to go a little bit beyond that, and you need to start using objective data. And, you know, that's where we have a lot of newer things, like immunophenotype testing where you get to look at the

Dr. Elroy Vojdani
entire spectrum of your immune system and say, you know what? Yes. There's intestinal permeability,

Dr. Elroy Vojdani
but the specific dysfunction of the immune system is this for this person. You know, in in other words, like, you're starting to practice that highly personalized end of 1.

Dr. Mark Hyman
Different things for different things you'd find on the

Dr. Elroy Vojdani
Absolutely. Right? Like, if somebody's in th1 or or th2 dominance, which are particular types of immune states, they get completely different, interventions.

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
Right? Like, the supplement list for the 2 of them is completely different. The foods are gonna be different in that situation. If it's th17, Mark, for example, we see th17 abnormalities.

Dr. Mark Hyman
TB's T cells, which are white blood cells, or there's, like, a lot of different kinds of T cells. Like, like, different divisions in the military, you know, Exactly. Teach 1, teach 2, teach 17.

Dr. Elroy Vojdani
And th17 is a part of the military that is typically involved with unusual organisms like fungal organisms. So if I see when I

Dr. Elroy Vojdani
phenotype somebody, a massive TH17 abnormality. I'm going very deep into the questionnaire about what type of living environment are you in? What office do you work in?

Dr. Elroy Vojdani
What exactly? What were your prior homes? And then we're we're

Dr. Elroy Vojdani
really looking for where that that mycotoxin or mold exposure came from.

Dr. Mark Hyman
And when was the last time you checked your HVAC system?

Dr. Elroy Vojdani
And you'll find it. Yeah. Right? You know? So in in if you're using this the tools today, there there is a really highly personalized ability to practice this just for you version of medicine, which is all the power in the world.

Dr. Mark Hyman
But I but I think I think fundamentally what you said at the beginning was key. We don't really think about how we take care of our inner garden. And our

Dr. Elroy Vojdani
microbiome just relates to everything. So whether it's mental health or auto community or obesity or whatever, it's it's literally the root

Dr. Mark Hyman
root root root for so many. And and the other things from the outside, they can affect it like toxins or certain infections and so forth. But a lot of times just a dysregulation of the ecosystem in our gut.

Dr. Elroy Vojdani
And so when functional medicine, we have a really coherent methodology for

Dr. Mark Hyman
addressing it called the 5 r program. And we'll put that in the show notes. I've had podcasts about it and solo podcasts. You can go back and listen to it, but we'll link to those as well. But I think that the reality is that that, you know, traditional medicine has no idea how to reset your gut, but functional medicine really has a clear path, which is to remove the bad stuff food sensitivities, food reactions, gluten, bad bugs in there, overgrowth of bacteria, yeast, parasites, whatever, and then kind of replace missing things like enzymes and prebiotics.

And, phytochemicals, and I think a lot of phytochemicals are really prebiotics that we we haven't really realized before.

Dr. Elroy Vojdani
Mhmm.

Dr. Mark Hyman
Reinoculate with healthy bacteria repair with some of the things you mentioned, like, you know, stretching fatty acids and glutamine and zinc, vitamin a, and fish oil, and then kind of restore the nervous system because the gut in the nervous system are connected through kind of dealing with the psycho emotional pieces of your life to reduce stress. And so so it works pretty well, and it doesn't require a doctor most of the time, and you can kind of follow along. As soon as you do need to go, check a stool test, you need to do different things, but it's it's, it it's one of those most rewarding things because you fix the gut and often let other stuff gets better. And and it's sort of like kind of shocking when you see when you see how central it is, and yet it's it's just kinda absent from medicine. It's the it's the easiest place in medicine to practice, not not because of

Dr. Elroy Vojdani
the lack of challenge, right? You you you are you constantly have to just embrace that there's something new that you have to learn every day, but the results that you get in medical practice are on, unbelievably and the gratitude that you get just from knowing that you're making those improvements is enough to propel

Dr. Elroy Vojdani
you forward, through whatever difficulty you're going through. It's, it's an incredibly rewarding experience. Contrast that to my prior medical

Dr. Elroy Vojdani
practice, which was being a full time interventional radiologist in the hospital Wow. Dealing with the complete opposite end of the spectrum Yeah. Chronic disease in the hospital

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
Renal failure, dementia, you name it, you know, where no matter what I did, or what fancy tool I was using, I didn't make a dent,

Dr. Elroy Vojdani
right, versus the other side, you know, you feel like you can completely change someone's trajectory and life. Yeah. So amazing.

Dr. Elroy Vojdani
Yeah.

Dr. Mark Hyman
Amazing. Well, this is very helpful. And I think those listening out there with autoimmune disease or long COVID, just know there are answers and that I know we've had a number of podcasts on this with doctor Lev Gallant and others and, now with you. And I think I think it's it's one of the most important things we can think about is how do we create immunore rejuvenation, immunore resilience. Jeff plan talks about a lot about strategies of immunore rejuvenation, which is something we should be thinking about.

And it's kind of an exciting moment, but it's it's also a a fraught moment because so many people are now suffering. And, you know, we were talking earlier, but, like, my practice is is is with me is pretty full. I have plenty of physicians at the ultra wellness center that can see your practice is pretty full. So so, you know, the educational stuff you put out like your book, when food bites back, taking control about immunities, certainly should get that. Everybody should get a copy and and check it out because it does provide a road map of how to think about this differently.

And, we're entering a new era. So so don't lose hope there's a way out and, or I thank you for what you've done and and kinda continue to work at your father in immunology. I've learned so much from both of you and everybody check out the papers if you wanna learn more. And and, we'll see you next time at the doctor's pharmacy.

Dr. Elroy Vojdani
Thank you, Mark.Dr. Elroy Vojdani
Think about it from the immune system's perspective if if its job is to defend us from threat and we are constantly pouring threat into ourselves, I think it was only a matter of time until we saw what we are seeing now.

Dr. Mark Hyman
Welcome, Elroy, to The Doctor's Farmacy. Great to have you. I've been looking forward to this for a long time.

Dr. Elroy Vojdani
This is a thrill. Thank you for having me.

Dr. Mark Hyman
You know, you're you're, somebody I've I've known over a bit of time, but not well, but I know your father really well because your father, Risdavazhani, Iranian Jew escaped Iran during the, the the fall of the shah, and the rise of the sort of current Regine and Ayatollahas. And, you know, made his way to America and was instrumental in my education as a young functional medicine doctor trying to figure out what to do with complex cases, people who are suffering from chronic fatigue, immune issues, mold toxicity, Lyme disease, and I used to use his lab all the time. Immuno sciences. And and, you know, I I I I think probably then you were a little boy, But now you're a doctor in MD. You have a thriving practice in LA, a little too thriving, unfortunately, because there's not that many of us out there who can really deal with these complex chronic cases and and are willing to dig and find out what's going on.

And and you do that really well. And your father was was someone who just wanted to know what was going on in the human body, and and and really took over the immunology space in functional medicine and was a key part of a lot of our curricula and education and I remember, patient I had very well who came in with chronic fatigue syndrome. And it was early on, and she had, told me a story about her house having some mold in it. And so we had the mold checked, and that was right in her bedroom, and her daughter put in another bedroom and had juvenile room to arthritis. And the two of them were pretty sick.

And they each had their molds identified in the house by mold inspectors who were able to go in and identify the exact species and strain of the mold that was in their room that was, like, behind their their walls in the bedroom. And we did the the testing through, you know, sizes through your dad's lab and the exact mold that were in their bodies with the with the antibodies were the ones that were found in the room, and they were different than their rooms and end up getting a $1,000,000 in settlement to clean the house and fix the mold problem. But then, unfortunately, the, the insurance companies didn't like that. Because, it, it, they have to pay for this mold and no people don't wanna cover mold mold issues. I went through that in my own house, and the insurance wouldn't cover it.

And, and, eventually, the lab kinda had to shut down that line of testing, but they still around in doing great stuff. And, you know, your work is really also kind of ventured in the world of immunology, and we're chatting a bit before we started the podcast about this concept that is is I think it's really important to talk about, which is, the decline of our immune resilience is how you phrased it. And and we're seeing this sort of explosion of autoimmune diseases, allergic diseases, asthma, post COVID syndrome, chronic fatigue syndrome, and and, and long COVID has really been a huge thing after the acute bio infection, people stay sick and have very significant symptoms and consequences that it goes way past the original infection. And so you spent a lot of time thinking about this concept of declining immune resilience and what to do about it. Maybe you can start up by defining what is immune resilience, why are we seeing this massive decline in our immunity and our immune function, or not even decline, but dysregulation, you know, because, you know, your your some parts are underactive and some parts are overactive.

Right? And so we're seeing increasing cancers and and increasing autoimmune disease. Right? So those are both not enough and too much sometimes.

Dr. Elroy Vojdani
Yeah. So it it's something that I think about all the time because in in clinical practice, we're seeing this dramatic increased rate of chronic inflammatory autoimmune diseases. So it's always, you know, kind of sitting back there, like, what is going on? What is happening? The world, yes, it's changing.

It's definitely changing, but there seems like there, there's a dramatic difference in the way that we interact with the world. And that's accelerating at a pace that's very, very difficult to understand because, I mean, if you look at the rates of autoimmune disease, You know, we're increasing at an 8 to 10% rate per year.

Dr. Mark Hyman
That's crazy.

Dr. Elroy Vojdani
It's crazy. I mean, if you if if you look at, let's say, 25 years ago, so 1999, 2000, about 3% of the US population had a known diagnosed autoimmune disease. Today, we sit solidly in the 10 to 11% range of a known diagnosed autoimmune disease. And, you know, you might say

Dr. Mark Hyman
more when you, like, out of all the different diseases, and then and it's, like, 50, 60,000,000 Americans

Dr. Elroy Vojdani
are more.

Dr. Elroy Vojdani
It's a

Dr. Elroy Vojdani
it's a very conservative estimate. Right? It's, you know, autoimmune diseases have also in, in their nature a bit of a, a lag time between the onset of the

Dr. Elroy Vojdani
immunological injury and the autoimmune process and then the actual diagnosis of the full blown clinical disease. Right? So

Dr. Elroy Vojdani
let's say it's 5 to 8 years there. So we're, we're talking about, you know, if you kind of count those people, likely 15, 20% of Americans. It's a, it's a humongous number, and the rate, unfortunately, is continuing to increase. You know, thinking about what's at the root of that, it's, it's Again, a lack of the immune system doing what it's supposed to do. If you wanna think of that as immune resilience, it's essentially a loss of the balance and function of the immune system.

So we're we're losing our capacity to do what the immune system is intended to do, which is

Dr. Elroy Vojdani
to defend us from all of the threats in the environment. It's

Dr. Elroy Vojdani
no longer capable of doing that. And in that inability, it's turning against our own bodies by mistake.

Dr. Mark Hyman
So not only did we see, like, this massive rate of

Dr. Elroy Vojdani
death and and hospitalization from COVID in America where we're 4% of the world's population, but we were 16% of the cases

Dr. Mark Hyman
of and deaths and hospitalizations, which is like literally four times what it should have been or even probably more considering we have the quote, best health care system in the world. So one on one hand, we weren't able to fight this infection. And on the other hand, post infection, we're seeing the opposite, the reactivation of the immune system, but not attacking the virus attacking us. And we're seeing this whole phenomenon of long COVID, which is estimated to be anywhere from 10 to 30% of the people who've had COVID. Yeah.

And and there's a lot of humans.

Dr. Elroy Vojdani
It's a lot of humans.

Dr. Mark Hyman
That's a lot. It's like millions and millions and tens of millions of humans who're walking around with their lives affected in some smaller, large way from symptoms that or directly related to the dysregulation of the immune system by this virus. And going back to immune resilience, can you talk about what what are the things that help us have immune resilience? And what are the things that have changed our environment or our life or lifestyle that have actually made our immune systems be dysregulated.

Dr. Elroy Vojdani
Yeah. The the most important cell in the immune system is something called a T regulatory cell. And the dominant population of T regulatory cells in an adult lives in the lining of the gut. So the gut is the center of immune resilience. Those regulatory cells are responsible for, you know, kind of balancing all the different sides, making sure that, you know, in an inflammatory attack against something that we should be attacking.

We don't end up in that mistake of attacking ourselves. So the gut is absolutely the center of the immune system and immune resilience.

Dr. Mark Hyman
So the gut the gut is a big problem, and we've messed up our gut. Right? The increasing rates of C sections, lack of breastfeeding, early use of antibiotics, all the gut busting drugs we use, like acid blockers and anti inflammatories and steroids and hormones, and the depletion of, our microbiome by the glyphosate that we're all exposed to 80% of Americans have glyphosate in their urine, which is a natural antibiotic that kills well, not natural. It's a synthetic body that kills your microbiome. And on top of that, you know, we our diets change dramatically.

We've produced our fiber. We've increased ultra processed food. We take emulsifiers that damage our gut lining costly key gut. So we have a whole cascade of things that have happened in our environment, we call the exposome, that have really caused massive damage to our gut, which is where 60% of the immune system is. And then that's led to, yeah, I think a lot of the rise in chronic illness in general because it gets down linked to everything of psychiatric disease to cardiac disease to diabetes, metabolic health, cancer, and, obviously, autoimmune disease and allergic disorders and asthma, not to mention just the gut issues that people have, like, IBS and all that stuff.

So this is a massive problem. It's causing huge amounts of disability and and and disease. And it's not something that traditional medicine does a very good job of thinking about diagnosing or treating. And I and I've been involved with, you know, academic centers with these long COVID clinics, and it's kinda embarrassing, honestly, alright, to see how little they know and how little they're doing, and yet there's so much that's known that we can actually do something about. And I mean, I just, we're just chatting a little earlier about, like, these different lab tests, for example, in Germany that they're looking at that are common in post COVID's patients, which are auto antibodies against your autonomic nervous system that affects your ability to regulate your blood pressure and gives you dizziness when you stand up or pots, you know, possible orthostatic hypotension syndrome.

And and we're seeing other other auto antibodies against different tissues, and it's kinda scary. And and, there there's techniques to actually fix it. Heal it. We we talked a little bit about positive freezes, which they're looking at in Europe, which basically filters out all the bad stuff in your blood, clean your blood. It's used for a lot of immune diseases.

So so talk about, if we had this problem with immune resilience, you know, you know, what what are we seeing with that? What is what is we're seeing the rise in autoimmune disease and and and and can you kinda kinda help us connect the dots between the the the decline in our immune resilience, the rise in our immunity, and then what's happened with this long COVID phenomena?

Dr. Elroy Vojdani
Yeah. Absolutely. So, you know, 25 years of research now kind of starting to look at what is really happening here from a physiologic perspective, right, you know, intestinal permeability leaky gut. You know, you've covered that many times on the podcast and in your books, but, you know, it, it's hard to understate how important that process is in, chronic inflammatory disease, autoimmune disease, neurodegenerative disease. You know, the more and more and more we look at it, the more we're finding that it is centered to all of these.

So that we do keep talking about it, it's rightfully an incredibly important topic of conversation. So, you know, you listed all of the things in the environment that we are consciously or unconsciously exposed to on a regular basis as a population. Think about it from the immune system's perspective if

Dr. Elroy Vojdani
if its job is to defend us from threat, and we are constantly pouring threat into ourselves

Dr. Elroy Vojdani
Again, knowingly or unknowingly, I think it was only a matter of time until we saw what we are seeing now, you know, massive explosions. Viruses that, you know, I think 5 or 6 years ago didn't pose such a tremendous threat to Yeah. Us as an adult population. We talked about, you know, RSV, this last cold and flu season was horrendous. You know, adenoviruses and rhinoviruses, things that typically cause like 3, 4, 5 days of regular cold causing 2 or 3 weeks of pro, you know, prolonged congestion, you know, lots of secondary infections, you know, just you're just seeing the immune system just completely failing.

So it's because I think of what we're continuously exposing ourselves to, what that does to the center of the immune system. And then we see all the ramifications of it, you know, now 15, 20, 25 years down the road, and a population that's dramatically suffering. And, you know, the current medical infrastructure has zero answer for this. You know, it's it's what other biologic medications can we come up with to try to, you know, kind of suppress the symptoms. Right?

And and now we're getting to the point where, you know, we have patients with 3, 4, 5 autoimmune diseases and and every biologic under the the sun can't control what's going on with them. So it it's a huge problem. It's progressive. And the only way that we're gonna get out of it is to acknowledge that and to start making conscious choices that limit those continuous exposures to our gut.

Dr. Mark Hyman
So so healing the gut is a big part of of healing from autoimmune disease, for sure. And that's been, you know, something I've done in my practice in functional medicine for 30 years in the ultra wellness center, and you do that in your practice as a core strategy to help reset people's immune system because it does start in the gut. But there's other phenomena happening. You know, like, like, when you look at people having COVID, they did a a study of over a 1,500,000 people and it was published in nature. Out of that, you know, 1 and a half million people that they studied in this study that was published in nature, They found a 46% higher chance of getting an autoimmune disease, which is astounding after

Dr. Elroy Vojdani
having COVID. Absolutely. So why why is that happening? That's happening again because I think of the the dramatic loss of immune resilience that we

Dr. Elroy Vojdani
a population. So, you know, to, again, to go over those numbers, that was a huge, very well done

Dr. Elroy Vojdani
retrospective analysis. A million and a half people, 2 different studies combined, showing a very large increase

Dr. Elroy Vojdani
in autoimmunity, and that was in a 6 a 12 month window after the infection. More and more studies are coming out showing that everything from rheumatoid arthritis, lupus, type 1 diabetes, you know, virtually every autoimmune disease under the sun can be triggered by COVID. So again, why is that? It's because our immune systems have

Dr. Elroy Vojdani
lost their fundamental ability to be able to appropriately defend us

Dr. Elroy Vojdani
against viruses in the short term and then also in the long term, you know, to be able to resilience is an ability to defend yourself and then return to normal. Return to balance to say the threat is gone. Everything is okay. We've handled this. Let's go back to the balance that we're supposed to be in.

And that part is completely gone as well too. People stay in very prolonged chronic inflammatory states. I mean, the average long COVID patient has dramatic symptoms for 12 to

Dr. Elroy Vojdani
24 months or more, you know, and and part of that is because I think, you

Dr. Elroy Vojdani
know, the infrastructure isn't addressing things appropriately, but part of that just speaks to how much from a population perspective, immune systems are broken and immune resilience is completely gone.

Dr. Mark Hyman
Yeah. Well, it's so true. And the symptoms for long COVID are just astounding. Like, there's over 200 symptoms described. New ones every day.

I'm hearing stories for my patients about all sorts of different neurologic

Dr. Elroy Vojdani
issues and gut issues, autoimmune issues, cognitive issues, you know, brain fog,

Dr. Mark Hyman
autonomic dysfunction. And this

Dr. Elroy Vojdani
I don't know what you've seen recently, but, you know, I think the early batch of long COVID was, was predictable, whether those who were gonna get really severe or hospitalized forms of COVID, you know, they were gonna have really big struggles afterwards. Now, you know, it's like forty five year old dad walks into the clinic, metabolically healthy, not smoking, you know, not a heavy drink. Very mild COVID. All of a sudden horrendous, long COVID afterwards. Right?

That again speaks to how broken the immune system of the population.

Dr. Mark Hyman
So as long COVID and autoimmune disease in and of itself, it just, one of the aspects of it?

Dr. Elroy Vojdani
Well, in the, in the research that my dad and I have done on lung COVID so far, we've sent, we found specific autoimmunity in a large percentage of them, but it's certainly not everybody. You know, whether it's, you know, cardio life and autoimmunity, neurological medical autoimmunity, you know, a lot of joint related autoimmunity sometimes thyroid as well. You, you, that's certainly, I think, one of the signatures, along with something called viral reactivation, which, you know, in the chronic fatigue space we've known about for a very long time.

Dr. Mark Hyman
I mean, that's an important thing I want you to unpack that because what we're seeing with long COVID is that dormant infections kinda rise up from the dead Mhmm. And tend to get reactivated causing problems. And whether it's Epstein Barr or cytomegalovirus or CMV, it seems to be part of the picture.

Dr. Elroy Vojdani
Absolutely. So there are a large group of viruses that we as adults, you know, by the time we're adults, we've been exposed to. We've been infected with HH V Six, you know, which is Rosiola, something that we typically get by the time we're three years old. Not a big deal. If you are symptomatic, you've got a fever for a couple of days.

You have rashes. Epstein bi virus, the majority of adults are asymptomatic from the infection, same with CMV as well too. These viruses, are are genius in their long term evolution against us. They they have figured out how to evade complete immune eradication Yeah. By hiding in tissue after the acute infection.

Yeah. But with a normal immune system, they stay in dormancy. They wouldn't dare step out, you know, into the wild and get eradicated by the immune system. But, what we're finding is that the

Dr. Mark Hyman
if you have a herpes cold sore. Exactly. It only comes out when you're under stress.

Dr. Elroy Vojdani
Exactly.

Dr. Mark Hyman
It's not there all the time, but the virus is there. Correct. Just sleeping. It wakes up when there's some kind of insult.

Dr. Elroy Vojdani
Correct. Right. It's not it's not rolling around in the bloodstream active all day long. But a very, very large percentage of long COVID cases long COVID patients have viral reactivation as a core of, of their clinical symptom

Dr. Elroy Vojdani
set in, in clinical disease. So again, that, that poses the question: What in the

Dr. Elroy Vojdani
world is happening when the immune system in the short and long term following a COVID viral infection. It's not meeting the demands in the short term and then not balancing itself in the long term as well, which provides a beautiful open window for these reactivated virus

Dr. Mark Hyman
And and are there are there good diagnostics, immunologically, to help map out what's going on with these patients? Because, you know, long COVID is a bucket.

Dr. Elroy Vojdani
Mhmm.

Dr. Elroy Vojdani
But

Dr. Mark Hyman
it's truly probably many, many, many different kinds of problems, and each individual responds to the install with different manifestations and the many different kinds of treatments.

Dr. Elroy Vojdani
But let's go over the buckets if you don't mind.

Dr. Mark Hyman
Yeah. Yeah.

Dr. Elroy Vojdani
Please. So currently, with what we understand right now, I break it into 5 buckets. So there's viral persistence which is essentially, somebody

Dr. Elroy Vojdani
never fully clears the initial COVID infection.

Dr. Elroy Vojdani
They've they've got this very

Dr. Elroy Vojdani
low level infection that

Dr. Elroy Vojdani
just keeps ongoing and going and going and going. There's something called super antigen activation. Which is parts of COVID have an

Dr. Elroy Vojdani
ability to just dramatically, I'll just say piss off the immune system. There's the mitochondrial dysfunction and loss of autophagy that happens there. There's the

Dr. Elroy Vojdani
microbiome and gut permeability dysfunction, and then there's the auto immunity component. So if you're going to talk about diagnostics to be able to accurately pick up what's happening with long COVID, you basically have to say, okay. Which one of these five buckets the person living in. Everyone is gonna have some unique spectrum of those 5, though, the most will the majority will have, let's say, 3 or 4 of them. So we, we don't have diagnostics for the mitochondrial part you know, maybe on the research side.

Dr. Mark Hyman
There are some things, but they're they're hard to get.

Dr. Elroy Vojdani
They're very hard to get. Germany and Yeah. Like the Seahorse analysis.

Dr. Mark Hyman
Yeah. It's a IGL lab in Germany that does a detailed mitochondrial assessment. It's miter swab. It looks at mitochondrial, you know, it's up, but it's organic acids, but it's it's definitely hard.

Dr. Elroy Vojdani
You and I know that stuff. Right? Yeah. Yeah. But not, not every physician out there in the United States.

Right? And then Yeah.

Dr. Mark Hyman
These are sort of more functional medicine diagnostics that are not used in traditional medicine, but they're real.

Dr. Elroy Vojdani
They're real for sure. The viral reactivation stuff, I think, you know, rather straightforward antibodies, IgM, IgG antibodies to different targets of FCBAR virus, HHV6, CMV. There's no diagnostics for COVID persistence. If that is in case what's going on. I mean, you can look at, you know, whether there's very high levels of COVID antibody production for long periods of time, and you can infer that there's COVID persistence there.

The autoimmune part of it, you, you brought up the lab in Germany that doing an autoimmune panel, specifically for long COVID, in our studies as well, neurological targets like myelin basic protein, myelop oligodendrocyte glycoprotein, the blood brain barrier is a very common target that was demonstrated in mouse literature.

Dr. Mark Hyman
So you're basically seeing auto antibodies, based on your own immune system attacking aspects of your brain and brain tissue.

Dr. Elroy Vojdani
You're you're you're the most important defense of your brain, which is the blood brain barrier, you know, disrupted in football players, poxers, Alzheimer's, Parkinson's. So, you know, that, that same kind of core defense layer of the brain gets damaged by COVID. You can look at those markers in the blood. And then the specific neurological proteins like myelin basic protein, which is traditionally damaged in something like multiple sclerosis.

Dr. Mark Hyman
And and so these these are lab tests that you can do to help sort of sort things out. And tell which type of the sort of 5 buckets people go in?

Dr. Elroy Vojdani
Yeah. I I, you know, make an attempt to to try to, you know, on on this kind of early leading edge side of things, identify how much of each one of them they're dealing with.

Dr. Mark Hyman
Mean, you've published a lot on this. You published in Nature, which is a major journal and other journals looking at autoimmunity and the exposome and COVID. And I think, you know, it might be helpful for us to sort of, dig into sort of how how do the, sort of, this persistence of long COVID symptoms. You know, what's the underlying biology that's happening here? Is it is it an over activation of cytokines?

Is it is it autoantibodies? Is it damage to the gut? Is it, you know, endothelial problem, which is all the blood vessel linings, which affects everything, which is why maybe you have symptoms everywhere because it affects everything. Yep. You know, how does how does it all sort of fit together for me?

Dr. Elroy Vojdani
It's tough because it's it's multiple pieces, but if I was gonna break it down to what I think the core of it is, you know, the the acquired mitochondrial damage and the associated lack of autophagy to me is really core there. So mitochondria are, you know, the, the powerhouse of the body. We know that for energy production, but I think it's under appreciated how much a damaged mitochondria will lead to a pro inflammatory dysfunctional immune phenotype, meaning somebody who has a dysfunctional immune system just as the result of the damaged mitochondria And then from there, there are neurological immune cells called glial cells. They will enter something called glial, activation and end up with a pro inflammatory immune subset in the brain. So you can see

Dr. Mark Hyman
on on fire.

Dr. Elroy Vojdani
Brain on fire. Exactly. So tired, dysfunctional immune system, brain on fire, strictly from the mitochondrial damage that comes from the viral infection.

Dr. Elroy Vojdani
And, you know, of course, in the United

Dr. Elroy Vojdani
States, with all the metabolic dysfunction that exists. Right? Massive mitochondrial issues to begin with. Right? So that's that's why we're seeing a bigger problem with it here, both in the short term and the long term.

Dr. Mark Hyman
So some pack a little bit. Mitochondi for a minute. Those are those little organelles. There's thousands of them in every cell that take food and oxygen turn into energy and form ATP that our body uses to fuel everything. So when you basically think about that, it it's your engine.

And if you run-in a gas, you're in trouble. And so everything doesn't work in the body when you run a gas. And so what you're saying is the the COVID virus somehow affects the mitochondria in ways that make them less functional and less able to produce energy and then has this huge downstream effect that even affects the immune system. Absolutely. Because not not a lot of people talk about the connection between the immune system and the mitochondria.

What do we know about that?

Dr. Elroy Vojdani
It it it's clear. So if mitochondria can run either on something called oxidative phosphorylation, sorry for the fancy words, but, you know, to to

Dr. Mark Hyman
It's burning carbs. Yeah. Right. B burning oxygen and carbs, but

Dr. Elroy Vojdani
that's that's an efficient form of, you know, converting food into energy.

Dr. Mark Hyman
It's kinda like a diesel

Dr. Elroy Vojdani
truck. Yeah. Right? Let let's fuel more miles. Yeah.

Dr. Mark Hyman
Right? And the more miles you get out of the amount of

Dr. Elroy Vojdani
fuel

Dr. Elroy Vojdani
the less antioxidants or less oxidative injury is

Dr. Elroy Vojdani
produced by the mitochondria. In metabolic dysfunction like insulin resistance, the mitochondria are not running on diesel. They're running

Dr. Elroy Vojdani
on the least efficient fuel on the planet. So one gallon will get them a mile. And in doing so, they burn through all of their antioxidant reservoir because the the mitochondrial production relies on this continuous balance between producing things that require us to produce antioxidants to neutralize.

Dr. Elroy Vojdani
Otherwise, the mitochondric damages itself. Right? So you imagine somebody with insulin resistance running

Dr. Elroy Vojdani
on that very inefficient fuel system they're teetering on the edge, you know, barely making it with the antioxidants. All of a sudden, the huge oxidative injury like COVID comes along. Tipping point. Now the mitochondria cannot, function anymore because you don't have enough antioxidants to meet what it's producing. And, essentially, what happens is it structurally becomes damaged, and it will release its own unique DNA into the cytoplasm, which signals to the immune system I'm in trouble.

What does the immune system do when you're in trouble? So it's okay. We've got something we need to fight. It puts itself into fighting mode, which is a pro inflammatory mode. The nervous system, the glial cells know when macrophages, which are, a kind of primal defense cell, are in this white blood cell or in this, like, fight, and they will convert themselves into glial activation and put themselves into this neuro inflammatory fight response, all from the powerhouse of the cell.

But that makes perfect sense.

Dr. Mark Hyman
It's a domino effect.

Dr. Elroy Vojdani
Yeah. But it's the most important part of you. Yeah. Of course, that's gonna happen. If it gets damage to the point that it can't function anymore, You need to fight whatever's doing.

Dr. Mark Hyman
I mean, you know, most people had the flu or bad cold or some virus, and they're achy, they're tired, they have brain fog, they have no energy, and it's in part because of how the virus affecting the mitochondria.

Dr. Elroy Vojdani
Yep. Right. Absolutely.

Dr. Mark Hyman
And so so with COVID, it just persists. It doesn't get better. Like, if you get a cold, it gets better. You feel fine the next week. With COVID, it seems to kind of persist.

And I I I actually had a a experience after COVID where I where I got a pretty bad case of COVID, and I was coughing a lot for a couple of weeks and that kinda got better. And then I developed arthritis. Yep. Like, my hand swelled up. I got joint pain, and it was kinda scary.

And and, you know, I I aggressively did a bunch of things that helped fix it like plasmapheresis and ozone.

Dr. Elroy Vojdani
Mhmm.

Dr. Mark Hyman
Literally, then one plasmapheresis session, which is basically where you filter your blood and take out all the bad inky stuff in the plasma and throw it out and give yourself a new albumin and put your blood cells back in. Literally within hours, it was better. Yeah. And the next day, I was like, all better and had plenty of energy.

Dr. Elroy Vojdani
And I was like, woah. Did you do it in Europe or in the US?

Dr. Mark Hyman
No. I did it in the US.

Dr. Elroy Vojdani
Yeah. Because it's actually pretty common practice in Europe. Right? Switzerland, in particular, like, they're they're very big on that.

Dr. Mark Hyman
Around low COVID, you mean?

Dr. Elroy Vojdani
Yes.

Dr. Mark Hyman
In

Dr. Elroy Vojdani
in in general and specifically for long COVID. And and it makes total logical sense. Right? Like, you're filtering out a lot of the inflammatory cells. You're filtering out a lot of the antibodies that are being produced against your own tissue.

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
And you're giving your immune system a breather, basically. Right? And in that breather, you're allowing all of these, like, antioxidant balances to restore themselves, and then you can go back to the way things were supposed to be.

Dr. Mark Hyman
So so let's just sort of just pretend I'm a a long COVID patient. I'm, you know, pretty healthy guy, but I got COVID. And then I'm suffering. Like, I have headaches, brain fog. I have no stomach

Dr. Elroy Vojdani
is not right. Muscle aches, have no energy. And, my joints are a little sore.

Dr. Mark Hyman
You know, where do you start with someone like that? What what are you gonna do diagnostically? What are the kinds of steps you're gonna take to help me get better?

Dr. Elroy Vojdani
Even even before the diagnostics, you know, I'm I'm starting with a very, very strong gut centric approach. So I'm looking very carefully at what they're eating. Obviously, you know, many times they're not eating what, you know, you and I know to be a healthy diet, a whole foods diet, rich with vital nutrients, you know, pulling the grains, you know, sometimes in certain situations, pulling the the the dairy out of their diet as well too. Shoring things up with specific probiotics. And, and then, you know, depending on what the response is in a very short period of time, then I'll start adding the diagnostics.

So, you know, I wanna know again, is there a microbiome biome dysfunction do they have intestinal permeability leaky gut is the viral reactivation part of it there. And and in my experience, when they have that real, you know, acute chronic fatigue picture, like they cannot get out of bed. They try their best to take a walk around the block. It crashes them. The viral reactivation will be there usually in those cases.

Like, Epstein BAR or CMB or? FC BAR virus HHV Six in a in a recent study that we just did, 90 patients, long COVID, 90 normal controls, we found actually that HHV 6, IGM was one of the most predictive, markers for long COVID, because such a high percentage of people will have HHV 6 reactions activation, which has been very classically described in viral induced chronic chronic fatigue. So again, not a surprise. Just something that we're learning is specifically applicable to long COVID.

Dr. Elroy Vojdani
So

Dr. Mark Hyman
you look at the gut, you look reactivation of viruses. What else you're looking at?

Dr. Elroy Vojdani
And then it's, you know, blood brain barrier neurological antibodies. Again, in that recent, study, we found that blood brain barrier protein and myelin basic protein IgM antibodies, which are more of an acute antibody were very good predictors of long COVID.

Dr. Mark Hyman
So you can get these tests through, like, specialty labs, like, immunosciences, like your dad's lab or Cyrics, some somewhat.

Dr. Elroy Vojdani
Yeah. Immuno sciences has a specific long COVID panel, which includes COVID antibodies, HHV6, and EBV.

Dr. Mark Hyman
And and and and yet, that's not really easily accessible to most people. Right?

Dr. Elroy Vojdani
No. Yeah. No. I mean,

Dr. Mark Hyman
questionable doctors won't typically do these tests.

Dr. Elroy Vojdani
There's access to it. Right. You know, Quest And Labcor, they all run EBV HV Six. You know, we could make an argument about whether it's not the best version of it in the world, but at least you're getting some sense. Right?

And insurance will typically pay for them because these doctors need to know that EBV and HHV 6 reactivation are very common in long COVID and you have to look for them. And then also they need to know what to do about it.

Dr. Mark Hyman
Exactly. Well, that's the hard part.

Dr. Elroy Vojdani
Or you don't look for anything that you don't know what to do about. Right?

Dr. Mark Hyman
Exactly.

Dr. Elroy Vojdani
So what do we

Dr. Elroy Vojdani
do about it in that situation if you do find the viral reactivation? In our clinic, we're doing a lot of high dose IV vitamin c to get them kick started. Oftentimes IV, l l I c to pair with it as well.

Dr. Mark Hyman
Which is sort of an amino acid that has an antiviral component.

Dr. Elroy Vojdani
Exactly. And then, you know, just pairing that with a lot of antiviral supplements, monomeran, loracitan, you know, all of leaf extract, you know, quercetin, NAX, zinc, you know, just making sure that they have as much of an antiviral fighting capacity on a daily basis as they possibly can have. Hyperbarics are

Dr. Elroy Vojdani
showing a lot of promise in lung COVID. So recommending patients go get

Dr. Elroy Vojdani
hyperbaric treatment and is a very good study out of Tel Aviv. Yeah. You know, you had to know that that study, they use 2.4 atmospheres.

Dr. Mark Hyman
This is a hard chamber,

Dr. Elroy Vojdani
not a soft chamber. Hard chamber. So they need to go to hard chamber facilities. And, I think it was 40 out of 80 days.

Dr. Elroy Vojdani
Yeah. So it's it's

Dr. Elroy Vojdani
an investment, obviously, a time

Dr. Mark Hyman
Time and money. Yeah.

Dr. Elroy Vojdani
And money, but it works. Yeah.

Dr. Mark Hyman
Right. But let me get getting your life back is worth it.

Dr. Elroy Vojdani
Absolutely. Right? You know, and and you're investing in your short term and long term you know, the if you're having long COVID symptoms, something is dramatically wrong with your immune system. Resking you yourself from that is not just resting yourself from long COVID. It's doing something for yourself in the future.

Dr. Elroy Vojdani
Yeah. I mean, because otherwise people sort

Dr. Mark Hyman
of tend to have this forever.

Dr. Elroy Vojdani
Sure.

Dr. Mark Hyman
Right? I, I mean, I personally had chronic fatigue syndrome, and I know what it's like. And it's the worst feeling in the world. You feel like you, you know, you you haven't slept for 3 days, even if you just slept and you walk in through a fog and every step is an effort and you can't really function and you have to fake it

Dr. Elroy Vojdani
Yeah.

Dr. Mark Hyman
If you can get out of bed. Yeah. And it's, it's something that it it's unfortunate that traditional medicine just has very poor treatments for and also very poor understanding of, you know, and the multi kind of factorial cause of these conditions is important to understand because it's not just one thing. Like with autoimmunity, it can be a lot of things. Right?

So long COVID can be one piece, but it's this lack of immune immune resilience that's causing the problem, really, because if we were basically healthy, we would be able to handle a lot of this.

Dr. Elroy Vojdani
I think it's the most important part of us. I'm biased in that, right? But with a healthy immune system, you're really protecting yourself from everything.

Dr. Mark Hyman
Yeah. And the and the the immunity stuff is significant because, you

Dr. Elroy Vojdani
know, everything that's happening across the board now with almost all disease in America is the upregulation of our

Dr. Mark Hyman
immune system and inflammation, whether it's heart disease or cancer or dementia or diabetes or obviously autoimmune diseases, they're all inflammatory problems, sir. And and we're kind of a nation on fire and increasingly a global population on fire. And that it's something that we're really not great at at diagnosing or treating with traditional medicine. So if I'm that patient who comes to you, you're fixing my gut. You're fixing my diet.

You wrote, and you wrote a book called, when food bikes back, you know, how to treat autoimmune disease using food, which is great. Really get a copy, but the the the there's a lot of steps that we know how to do in functional medicine to help people recover from autoimmune disease and from long COVID. So can you kind of talk about how you would start to sort of you know, take care of me in addition to the basic things you mentioned?

Dr. Elroy Vojdani
Yeah. So that book was really

Dr. Elroy Vojdani
written as a, as a primer for creating, you know, immune resilience in the gut and then also providing people

Dr. Elroy Vojdani
a map for What specific foods do you need to pay attention to for specific autoimmune diseases? And the reason I wrote it was because as you and I were chatting about before we, we started recording, you know, when you're on the physician side of this, Sometimes it just feels like the people that need your help is a never ending just, you know,

Dr. Mark Hyman
sea of sick people out there.

Dr. Elroy Vojdani
See of

Dr. Elroy Vojdani
sick people out there. And if I worked 24 hours a day 7 days a week, I wouldn't put a dent in it. So I thought I just owed it to everybody to put my hat into this knowledge and just, you know, say, hey, this is what I've seen and done

Dr. Elroy Vojdani
so far. So, in the

Dr. Elroy Vojdani
book, we talk about the restoration of oral tolerance. Which is a gut centered approach. That's essentially what we mean by immune resilience. To, to be able to convince the

Dr. Elroy Vojdani
immune system that attacking your own tissue or being in a continuous pro inflammatory state

Dr. Elroy Vojdani
is not the way that we wanna be. So all the supplements that have very good data behind them that you can use to restore oral tolerance and mean resilience are in the book. Everything from vitamin A, vitamin D, short chain fatty acids, specific probiotics, fish oil, everything is in the book. Yeah. And, you know, also all the tests that I like to use.

And the idea behind that was, you know, although functional medicine is growing dramatically, thanks to pioneering efforts from physicians like yourself, pioneers like my dad, Jeff Bland, all these other people who have really, like you put yourselves out there at a very early time. I benefit from that. So thank you. You know,

Dr. Elroy Vojdani
sometimes you're gonna live in a neighborhood or, you know, where there is no functional medicine doctor or

Dr. Elroy Vojdani
they're just not available. And if you have a physician who's empathetic and caring and wants to go to bat for you. You can always go to them and say, hey. Listen. Like, these are the tests that were recommended.

Why don't we do them? We can learn together. Let's see what we get out

Dr. Elroy Vojdani
of this.

Dr. Mark Hyman
You want a doctor who's a willing to be a partner?

Dr. Elroy Vojdani
Yeah. Yeah.

Dr. Elroy Vojdani
Right? And a good doctor. I believe we'll be very willing to engage because we're supposed to be continuous learners.

Dr. Mark Hyman
That's right. That's right. Absolutely. And I think, sadly, it's not the case most of the time because we get, like, stuck in a paradigm and we don't learn much about autoimmune disease in the sense of what's really the root cause of it or how to deal with it other than just using immunosuppressive medications, which are often very expensive and have significant side effects. You know, I I wanna kinda look back on what you talked about around oral tolerance because this is such an important issue.

And and I wanna sort of sort of kind of lean into it through this lens of food sensitivities because, you know, when you eat something, that is, from your diet. It your body shouldn't be pissed off about it. It should be thankful and it should absorb it and get rid of the stuff that doesn't want, but keep the stuff that it needs. Right? And what's what's happened is that there's been a disruption in the normal way in which our immune system starts to build tolerance for all these foreign molecules that we eat pounds a day.

Like, it's the most amount of foreign stuff that we're exposed to every day. Is what we stick in our mouth. Right? And and our body has to determine if it's friend or foe. And when we don't have a proper functioning gut immune system, what it should be a friend Turns into a foe.

Yep. Like, I I remember I had a patient way back when she had, like, intractable migraines for, like, 30 years. It was in bed, you know, multiple days every week, and we did a food sensitivity testing. And she had super high score of eggs. I was like, well, why don't you try to stop eggs?

She did and her migraines in a way.

Dr. Elroy Vojdani
Yeah.

Dr. Mark Hyman
And and and and so a lot of people are doing food allergy or food sensitivity testing. And people are kind of confused about it. And I'd love to sort of unpack this because it's it's sort of helps us to kind of understand, 1, why why we're seeing this increase in food reactions and, 2, what we can do about it. And and I just wanna sort of put my stake in the ground by saying, a lot of people do these food sensory testing, and I think, oh, I'm I can never eat this. I'm allergic to this.

Instead of going, oh, I have all these reactions to foods. I have a leaky gut. How do I not become so sensitive? Why am I so sensitive and how do I reset my immune system? So I'm not so sensitive.

Yeah. So that that's what I love you to talk about because oral tolerance is a really important concept that allows us to be in the world without getting sick from it.

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
So I'm gonna I'm gonna back up real quickly and just make the distinction between food allergy and food immune reaction or food sensitivities. Yes.

Dr. Mark Hyman
Because it is a it's a it's a it's it's, yeah, it's very confusing.

Dr. Elroy Vojdani
So food allergy is, IgE mediated just traditional allergic response to food. I always say just think about a kid with a peanut allergy. Exactly. It happens in minutes. Right?

And the symptoms are, you know, extremeness. Yes. Extreme life threatening. Yeah. Right.

A food immune reaction or food sensitivity revolves around different antibodies. IGA and IgG antibodies, which are part of a different branch of the immune system. Symptoms from food, immune reactivity

Dr. Elroy Vojdani
or food sensitivity are basically the symptoms that we talk about with leaky

Dr. Elroy Vojdani
gut because they're the result of a chronically leaky gut. Essentially, the intestinal

Dr. Elroy Vojdani
barrier, which has this incredibly difficult task that we talked about of friend, friend, foe, friend, foe,

Dr. Elroy Vojdani
because of it, it breaks down structurally doesn't have that ability to make that

Dr. Elroy Vojdani
distinction anymore because the breakdown basically convinces you that you're in some continuous threat.

Dr. Elroy Vojdani
So you just start attacking everything. Right? So food immune reactivity testing, more than anything thematically just tells you what's happening with the immune system, right? Getting a food sensitivity test and seeing everything in red removing it That's not the point.

Dr. Mark Hyman
Yeah. Which most people honestly think it is the point. And and I it gets me kind of a little upside down because I'm like, no. No. No.

This does not mean you have to avoid these foods for life. It means that something else is going on. We need a fit.

Dr. Elroy Vojdani
Right?

Dr. Elroy Vojdani
You and I both get up in arms about that. For sure we share that in common. It is it's a state of a particular part of the immune system. It's saying your intestinal immune system is pissed off. Yep.

It doesn't know whether food is something it should attack or not. That's a huge problem, right? Then in food, immune activity, there are very traditional trigger foods where the actual presence of the reactivity

Dr. Elroy Vojdani
is continuing the process of the permeability. And it's very important to understand. Right. It's a self perpetuating cycle. Exactly.

So there are select ones.

Dr. Elroy Vojdani
That if you remove in the right case, the the healing of the gut back to normal is gonna happen much more quickly. Yeah. And that's why we talk about gluten so much. Yeah. Because it's number 1, 2, 3, 4, and 5 on that list.

Dr. Mark Hyman
It certainly is. Yeah.

Dr. Elroy Vojdani
Right? Dairy, corn, soy, eggs. Those are other common, you know, culprits. Eggs, as you mentioned in that case, is a pretty common one. Yeah.

But the rest of them, you know, it's like, I understand if you sensitivity to cucumber, and all my problems are gonna be solved by eliminating cucumber. No. No. No. You're not solving anything there.

Dr. Mark Hyman
And I and the gluten thing's important because it's kind of the gateway

Dr. Elroy Vojdani
drug because because what it does, and then we've had Alessio Fasan on the podcast, is it is it increases the

Dr. Mark Hyman
production of a compound called Xyulin. Yes. Which is a really important molecule

Dr. Elroy Vojdani
that is increased in certain diseases like cholera, but it seems to also be increased with exposure to gluten. Yes. And what that protein does is it breaks down the

Dr. Mark Hyman
the stickiness that the cells have together, we call it tight junctions, basically like legos are stuck together. And so the cells sort of come apart. Literally, the lining of your gut gets like a like a sieve. And and it's like a coffee filter with holes in it, let's say. And so then all these food and bacterial toxins and proteins leak in creating all this inflammatory.

So gluten

Dr. Elroy Vojdani
often, if you get rid of gluten, it will help the gut start to heal. Yeah. Gluten vitamin a, vitamin d probiotics, short

Dr. Mark Hyman
chain fatty acids, fish oil. Take all the,

Dr. Elroy Vojdani
leaky gut offending crap out of your life, and it's a pretty good formula for restoring your immune resilience.

Dr. Mark Hyman
And that doesn't mean that everybody's gluten sensitive and everybody should be gluten free. It just means that in people who are sick, it's, like you said, number 1 to 5 things to think about. If you have an inflammatory or autoimmune problem. Yeah.

Dr. Elroy Vojdani
It's just really common. It's not gonna be the case for everyone, but if you're playing the odds, yeah, it's a pretty good card to play.

Dr. Mark Hyman
So then so then, you know, when when we're seeing these sort of decrease in oral tolerance because of all the factors we talked about earlier, the destroyer got microbiome. We see this sort of increasing in reactions to foods. And and it's something we test for. But the tests are are are confusing for people because they get all these lists of things that they think they're allergic to, but it's not really an allergy. And so so what what do you do then in in terms of repairing the gut?

You talked about some of the basic stuff removing the foods like dairy, gluten, maybe soy eggs, and then giving certain compounds like fish oil or glutamine or short chain fatty acids or course of 10, the things that kinda we know help repair the gut. But is there more to it than that? Is there a way to kinda really, you know, look even deeper at what you call in in some of your papers, the exposure? Because because maybe there's something going on with a virus or a toxin or something else. It's I know that happened with me.

For example, I had terrible leaky gut, reacted to everything, and it was a mercury. It was destroying my ability to maintain my gut integrity and poisoned all the enzymes in my gut and I got a leaky gut.

Dr. Elroy Vojdani
Yep.

Dr. Mark Hyman
And I would eat, like, almost anything and I would get a rash or sore on my tongue or my eyes would swell up or or would have, like, not classic IgE reactions, but weird things happening. Right?

Dr. Elroy Vojdani
Yeah. And anything in the environment can be something that triggers intestinal permeability leaky gut, right? And so the exposome is a very big thing. Food is the most common thing, I think, in the exposome that we're exposed to. You know, we're we're literally taking something from the outside environment and internalizing it by eating it.

But pathogens, bacteria,

Dr. Elroy Vojdani
fungus, viruses, other unusual organisms. They're very common triggers of autoimmunity

Dr. Elroy Vojdani
as we discuss with COVID. But, let's say the bacteria from food poisoning can be very common triggers.

Dr. Elroy Vojdani
And then environmental chemicals are a huge contributor. And unfortunately, I think probably the grow

Dr. Elroy Vojdani
the the largest growing group of contribution to autoimmunity. And chemicals, create autoimmunity in a very unusual way in certain people. They create something called a neoantigen. So if you just kinda like think about this, it's horrifying what chemicals do to human beings. A neoantigen

Dr. Elroy Vojdani
is when something comes along from the environment binds to your own tissue and modifies the structure of the tissue to the point that your

Dr. Elroy Vojdani
own immune system doesn't recognize your tissue as yours anymore. And attacks it. And that's a very traditional way in which chemicals cause autoimmunity. Yeah. They're called autogens.

Right?

Dr. Elroy Vojdani
Yes.

Dr. Mark Hyman
Like auto auto and autoimmune inducing toxins that can be heavy metals like mercury, and I had autoimmunity from that. It can be the plastics and petrochemicals we see it can be viruses. It could be foods. And so there's so many things that that disrupt our immune system. And and the problem in our modern size is many of us have many of them.

Right? We have latent viruses. We have exposure to environmental toxins. We eat all these crap and nerve diet that causes leaky gut. We have you know, modern wheat, which has way more gliding antibodies that drives more a week he got.

So you've got this whole cascade effect.

Dr. Elroy Vojdani
Yep.

Dr. Mark Hyman
But the good news is, I realize that is it with functional medicine, we actually can help people dig out of this

Dr. Elroy Vojdani
hole.

Dr. Mark Hyman
Because from traditional medicine, it's like, oh, shit. You know, like, I don't know what to do with this patient. Let's create a clinic called the lung COVID clinic, and we'll figure out to give them symptomatic treatment for their drugs, but they're not doing any of the stuff we're talking about. And and so tell us sort of some cases of patients you've had come in with with long COVID who you've sort of identified some of these findings and and what you've done for them and and what their outcomes have been. Because I think I think people need to hear some helpful stories because it's bad out there.

And and a lot of the and by the way, a lot of the stuff that we do you know, you can do on your own and get better without actually having to do a lot of expensive stuff.

Dr. Elroy Vojdani
That's the goal.

Dr. Elroy Vojdani
Yeah. Right.

Dr. Mark Hyman
I mean, and and and and and, you know, I I think it's such a big issue that I I wrote up a whole guide, a solution guide on COVID and long COVID for for people because I was getting a question like every day for people. It's like

Dr. Elroy Vojdani
and the spirit of functional medicine is empowerment of the people on the other side. Right? It's about giving people the ability to step back into the driver seat and drive their health in the direction that they want. Right? So so whether you're doing it with a practitioner or you're doing it from the knowledge that we're all spreading, that's all the same.

So, a recent case of long COVID was a, forty eight year old gentleman, 3 kids, extremely metabolically healthy, exercise fanatic.

Dr. Elroy Vojdani
It was his 3rd COVID infection. Extremely mild. We're talking about the sniffles for 3 days

Dr. Elroy Vojdani
The only reason he knew it was COVID was because everybody else in the house, including the kids were testing positive for COVID. Yeah. 2 weeks on the dot after the infection, bedbound. Just could not get up couldn't eat Wow. Wasn't exercising.

Just, like, was a completely different person. I saw him in clinic because he came in and said, I need your help. And it just looked like like hell. Like, sunken eyes. I was just shocked because he was so healthy before.

Ran all of the usual tests found out he had a really significant case of BBV reactivation. And, Epstein bar. Epstein bar

Dr. Elroy Vojdani
of iron.

Dr. Mark Hyman
And you can just check that by seeing antibody levels and increase in certain patterns. Right?

Dr. Elroy Vojdani
Quest and Labcorp will run it if that's what you need to do. And we gave him a few rounds of IV vitamin c, and some antiviral supplements. And I think it was 3 months later, he was back to himself a 100%. Wow. But what I tell them afterwards is, great.

We got you out of this long COVID state. Now let's ask the question why the hell this happened to you. Because on paper, it never should have. Right? He had been a patient for a very long time, had really significant intestinal permeability, use, you know, identified that gluten was a very big problem for him, did the whole restoration thing.

He had dropped out of the the continuous care in the clinic during COVID for a while. And what went back to his normal eating? Yeah. You know, didn't have any of the usual symptoms that we started all that for, but he, you know, he was eating gluten and dairy regularly, you know, wasn't being mindful, I think. And ran an intestinal permeability panel on him because as, you know, my curiosity says, I need to know why this happened to you.

Dr. Mark Hyman
Right.

Dr. Elroy Vojdani
And it was, you know, a 10 out of 10. It was, you know, both the zonuline issue and then you mentioned the bacterial toxins really, really severe endotoxinemia.

Dr. Mark Hyman
Are you talking about the CIREX 2 panel?

Dr. Elroy Vojdani
Yeah. CIREX array 2.

Dr. Mark Hyman
Yeah. And this is CIREX is a lab that does a lot of immunological testing and antibodies and your dad's been involved with that lab and helping them develop a lot of their I I use it a lot clinically in our practice at the ultra wellness center. It's true. You can see when people have a lot of these auto antibodies against zonulin, which is the gluten protein or against lipopolysaccharides, which are the toxins from bacteria, you can tell that all this crap literally is getting into their immune system and their bodies reacting to it.

Dr. Elroy Vojdani
Yeah. So, you know, so this this is this is your story. You know, you we clean things up. You did great. Understandably, I think human beings fall off the wagon sometimes.

You fell off the wagon. Something relatively innocuous was a huge problem. And it led to further immunological problems. So we take care of the first layer and then we take care of the intestinal permeability and then we make sure this never happens.

Dr. Mark Hyman
Do again. And and and and so this was this seems like a pretty straightforward case where he he just was sort of hit pretty hard with fatigue, and he had leaky gut, and he had some sort of reactivated viruses. Are there patients that, you know, coming with full blown autoimmune disease that you see? Absolutely. And and what what are what are those stories like?

Dr. Elroy Vojdani
They're longer cases. They're more complicated.

Dr. Mark Hyman
Yeah. Oh, we got a few minutes.

Dr. Elroy Vojdani
A thirty five year old that comes to mind, this gentleman had seen many practitioners across the country, suffering from long COVID for 12 months by the time I saw him. So it'd been a really long time. His, his, his case was quite unique. A lot of neurological symptoms.

Dr. Elroy Vojdani
It's

Dr. Elroy Vojdani
so much so that neurologists were constantly working him up for MS. Yeah. You know, spinal taps and MRI is coming back negative, thankfully, but he had really dominant visual and motor neurological symptoms, a lot of numbness, tingling, and a lot of visual disturbances, along with the fatigue, the brain fog, the muscle pain. So, you know, I I went, you know, deep dive. Those people have been to 10 people before they come to see you.

You really need to figure, I think, all the pieces out in that situation, as you know. Like the detective. Yeah. Yes. So he had extremely elevated COVID antibodies that stayed elevated no matter what, over, let's say, a 6 month time frame, they were continuously high.

I've seen bar virus reactivation classic with, something called an early antigen antibody, which is the the classic antibody that tells you that that's the situation. And very high neurological antibodies, myelin basic protein, synapsin, and tubulin, I think, were the 3. And These are autoimmune antibodies against your brain, basically. Exactly. So he he's he's got what looks like COVID persistence, Epstein BioVirus reactivation, and now he's attacking his own neurological tissue as a consequence of the initial viral infection.

Dr. Elroy Vojdani
Which

Dr. Mark Hyman
is showing up almost like an autoimmune MS condition.

Dr. Elroy Vojdani
Exactly. Exactly. So not diagnostic for MS at this point, but, you know, certainly looks like he's in that spectrum. So he did also have

Dr. Elroy Vojdani
intestinal permeability, gluten, and dairy sensitive. Dairy is

Dr. Elroy Vojdani
very cross reactive with neurological tissue as is gluten. So what that means is if you do have leaky gut and permeability and you're eating those foods, you might actually be contributing to the neurological autoimmunity. So by removing them, you can, you can kind of lower the fire a little bit. So remove those foods, started on the oral tolerance protocol, started on the IV vitamin c for the Epstein BAR virus, kinda hitting as many of these things as we possibly can. Things get better, for sure, in a very quick time.

I'd say 12 weeks later, he was going from he would call himself 2 out of 10 functional to 7 out of 10 functional. And then, what you mentioned. Plasmapheresis. Yeah. He started contacting on on his own different clinics and actually brought to me the idea of doing plasmapheresis and and, you know, you and I know a lot of people in the country, but, I think one in particular that does this in in Tennessee, And, yeah, it's sent up to David.

Dr. Elroy Vojdani
And,

Dr. Elroy Vojdani
after plasma freezes did remarkably well. And, you know, I think that that took a while for sure to kind of get in motion. And he suffered for a really long time, but it was a case where if you identify every piece appropriately, you make dramatic progress when progress isn't being made. Yeah.

Dr. Mark Hyman
So I think it's really important. I mean, I think there's a whole spectrum of severity of long COVID. Right? And and I think a lot of the basic things can work to get people better, like fixing your gut, cleaning up your diet, you

Dr. Elroy Vojdani
know, a few extra supplements, maybe a few nutritional IVs, which which are affordable for most

Dr. Mark Hyman
people. But then there's no cases which are more serious, and you need to kinda go a little bit further diagnostically and therapeutically. And there's been a lot of work out of Europe around, diagnosing a lot of these autoantibodies against the autonomic nervous system and other other things that happen in the body. And they use platinum freezes there, and it found it very effective in actually reducing some of these neurological and also kind of long COVID symptoms. So I think we have a lot of things in our toolkit that aren't part of traditional medicine.

Whether it's, you know, diet, lifestyle interventions, supplements, intravenous nutrition, things like

Dr. Elroy Vojdani
plasmapheresis, ozone therapy, hyperbaric oxygen therapy. You know, there's a whole tool at peptides Mhmm.

Dr. Mark Hyman
Can be used. And and so when you're suffering out there, I want you to know there is hope and there is there is a pathway. Now sometimes it's not a straight line. Sometimes you have to go find the right practitioner, but I I think it's really important to understand that there's a there's an array of understanding that's pretty deep about this. And, you know, you know, you've written some great papers.

We're gonna link to the papers with in the show notes, your dad, and you've written others in in major journals. And and they're really quite in-depth discussing how the mechanisms work and what to do about it. And I think that, you know, there's no lack of literature now on this. There's just a lack of of cohesive approach to systematically figure out what's going on with each individual patient and treating them uniquely because like you said, there's no or like I said, I'm not gonna do too long COVID patients that are the same. Yeah.

And so it's really about personalized medicine. It's really about understanding each person's unique biology and then customizing the treatment to match what their particular issues are.

Dr. Elroy Vojdani
Yep.

Dr. Mark Hyman
The sort of comment you brought up a little bit earlier was this

Dr. Elroy Vojdani
sort of you you kinda didn't say the words, but there's a phenomenon that happens where our immune system gets confused whether it's an environmental toxin or a virus

Dr. Mark Hyman
or a food or something that we react to

Dr. Elroy Vojdani
that we probably should react to because it's foreign. Right. But then it's like kind of a mass mass shooting, you know, like, instead of, like, just targeting that thing. Yeah. It's like

Dr. Mark Hyman
the bullets spray everywhere and start targeting your own tissue. So that's when you sort of get auto antibodies and attacking your own tissues, which is which is a whole, phenomena that happens in autoimmune disease. And we call this molecular mimicry where So can you kinda unpack that a little bit and how how that happens? Because it's like, well, wait a minute. He's talking about the gut.

Oh, wait a minute. He's talking

Dr. Elroy Vojdani
about a virus. Oh, wait a minute.

Dr. Mark Hyman
He's talking about, like, toxin.

Dr. Elroy Vojdani
Oh, wait a minute.

Dr. Mark Hyman
It's a little confusing. Right? And you call this the exposome, right, which is the the sum total of all the things that our biology is exposed to over a lifetime and what washes over us and determines our phenotype, which is the expression of who we are in any moment.

Dr. Elroy Vojdani
I I think probably the most important thing to understand first is it's very, very difficult for autoimmune

Dr. Elroy Vojdani
disease to occur if you just think about all the safety measures that are built into our own immune systems for this not to happen. Yeah. The immune system has

Dr. Elroy Vojdani
to be essentially tricked

Dr. Elroy Vojdani
into attacking your own tissue. The basis of that trickery is something called molecular mimicry. That means that a

Dr. Elroy Vojdani
protein or peptide sequence that exists in the environment gets attacked by your own immune system. And it looks similar enough to your own tissue that your immune system can, after that attack, no longer distinguish between the 2 of them. So Let's say again, I mentioned dairy and myelin basic protein or

Dr. Elroy Vojdani
myeloma oligodendrocyte glycoprotein neurological protein targets, right, like dairy case in protein, which is what the immune system always reacts to a protein. Yeah.

Dr. Elroy Vojdani
Looks similar to neurological tissue.

Dr. Mark Hyman
So, basically, your your your cow protein looks similar to your own Your own brain tissue. Your own brain tissue.

Dr. Elroy Vojdani
So if you attack the cow protein, the attack is not specific enough to be able to say when it comes across your brain protein, hey.

Dr. Elroy Vojdani
That's brain protein, not cow protein, and it attacks it by accident. That's that's the fundamental basis of autoimmunity. So everything in the environment where there's an amino acid sequence that looks close enough to your own tissue has that potential. And the work of my dad has been actually trying to map that crossover. The the proteins and amino acids in the exposome and the amino acids in our own body where do they match so that we have a real legend or map as a practitioner or as people to be able to get specific and say, this is the autoimmune disease I have.

These are what we call the cross reactive epitopes or the proteins

Dr. Elroy Vojdani
in the environment that look similar. Those are the places I need to look.

Dr. Elroy Vojdani
Because otherwise, the environment is a humongous Right. Humongous category. Right? You're you're you're gonna be fishing forever if you're just going through the list at Nauseam.

Dr. Mark Hyman
Yeah. Yeah. I mean, I I I I think, you know, getting that specific is amazing. And if we can do that, that's great because it helps diagnostically, but, you know, when I see enough patient with autoimmune disease, I'm thinking, okay. Leaky got what foods do they react to?

Gluten's top of my list. Do they have exposure to petrochemicals, other environmental toxins, heavy metals? What about tick infections? What about mold exposure? What about viruses?

So this is sort of the list we go down in a functional medicine model to think about root causes because you cannot treat someone with an autoimmune disease unless you address the root cause, which is something that we don't do in traditional medicine. And that and I think

Dr. Elroy Vojdani
that's

Dr. Mark Hyman
you know, there's a there's a, you know, of all the things that we do in functional medicine, immunity is one of the most satisfying because it's it's one of those things that actually can get better, which is something we don't think about in traditional medicine. Once you've got an autoimmune disease, you got it for life. Like, rheumatoid arthritis, lupus, MS. Like, there's it's a one way street.

Dr. Elroy Vojdani
Yeah. You're gonna cycle through medications. That's basically what your future looks like. You're gonna be on Humira for 3 to 5 years and then cycle on to the new one and then the new one and the new one, and that's That's all that's really offered to you. I

Dr. Elroy Vojdani
mean, I had

Dr. Mark Hyman
a horrible autoimmune disease. I mean, I got autoimmune when I had chronic fatigue, which was sort of positive NA and low grade thing was not specific, but then I got full blown ulcerative. After a c

Dr. Elroy Vojdani
diff, infection and mold exposure. And it it was awful. I mean, I have to tell you, it was awful and, I tried everything that I had in my toolkit that I knew of from

Dr. Mark Hyman
functional medicine, it didn't work. And I tried traditional medicine. I took

Dr. Elroy Vojdani
60 milligrams of prednisone for 6 weeks. Did touch it. They were monitoring for me on biologics.

Dr. Mark Hyman
I did not wanna go on biologics. And I finally, like, I said, alright. I gotta do something crazy. And that's when I I really, double down and

Dr. Elroy Vojdani
said, what could I do that would be a reset for my immune system and to kill anything

Dr. Mark Hyman
that's in there? And I did, intravenous ozone therapy and I did high dose IB vitamin c and glutathione and minerals vitamins, and I did hyperbaric oxygen. And that that combo of those three things all at once kinda kicked me out of that cycle. And it was quite amazing to see. And I was like, that's amazing.

And now I'm like, perfect. I don't have an autoimmune disease, but typically people with croaties or colitis, it's an on and off thing, you know, they're never really better.

Dr. Elroy Vojdani
And But

Dr. Elroy Vojdani
and like a traditional doc will tell them, like, what you eat makes zero difference in the disease.

Dr. Mark Hyman
Oh, yeah. Especially you have a digestive disorder, but you mean it makes no difference. No difference. It's just safety. What a god's echo.

I guess, like, the one organ, you're putting pounds of stuff in every day. And I'm gonna But I think what's changing, you know, I think that New England Journal just had a a a launched a series called nutrition medicine, which I'm extremely excited about, and they talked about the food and the microbiome and, I mean, I'm thinking, wow, this is like you'd never would have seen that 10 years ago. So I think things are changing. I think all the work we're doing is really making things move forward. I I think the the sort of, kind of last thing I want you to really dive into is is you know, where if I if I was like a, basically, more or less average American, and I and I came to see you and I said, look, I've been hearing about this rising immunity.

I've been hearing about the reduced, immune resilience. I'm scared about you know, COVID or the next pandemic, and I I wanna fix my immune system. What do I do? Because if you go to a regular doctor, they're gonna go, I'm, wait till you're sick, and then I'll give you a drug. Right?

But what what what can you do for people? What can we do as functional medicine community to educate people about how

Dr. Elroy Vojdani
they can build this immune resilience? Well, there there's a lot of options there.

Dr. Mark Hyman
You know, I think you you have written a bunch of really wonderful functional medicine,

Dr. Elroy Vojdani
in general does a really good job about just teaching the concept of nourishing the gut and the microbiome being an incredibly influential way to create that immune resilience. So don't don't discard just how often that will work for the average person out there.

Dr. Mark Hyman
Fixing your gut.

Dr. Elroy Vojdani
Fixing your gut. Just getting to the fundamentals. Let's say your diet, you know, your exercise, your sleep, your socialization. Right? The look.

Incredibly effective really across the board. There are certain cases where you need to go a little bit beyond that, and you need to start using objective data. And, you know, that's where we have a lot of newer things, like immunophenotype testing where you get to look at the

Dr. Elroy Vojdani
entire spectrum of your immune system and say, you know what? Yes. There's intestinal permeability,

Dr. Elroy Vojdani
but the specific dysfunction of the immune system is this for this person. You know, in in other words, like, you're starting to practice that highly personalized end of 1.

Dr. Mark Hyman
Different things for different things you'd find on the

Dr. Elroy Vojdani
Absolutely. Right? Like, if somebody's in th1 or or th2 dominance, which are particular types of immune states, they get completely different, interventions.

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
Right? Like, the supplement list for the 2 of them is completely different. The foods are gonna be different in that situation. If it's th17, Mark, for example, we see th17 abnormalities.

Dr. Mark Hyman
TB's T cells, which are white blood cells, or there's, like, a lot of different kinds of T cells. Like, like, different divisions in the military, you know, Exactly. Teach 1, teach 2, teach 17.

Dr. Elroy Vojdani
And th17 is a part of the military that is typically involved with unusual organisms like fungal organisms. So if I see when I

Dr. Elroy Vojdani
phenotype somebody, a massive TH17 abnormality. I'm going very deep into the questionnaire about what type of living environment are you in? What office do you work in?

Dr. Elroy Vojdani
What exactly? What were your prior homes? And then we're we're

Dr. Elroy Vojdani
really looking for where that that mycotoxin or mold exposure came from.

Dr. Mark Hyman
And when was the last time you checked your HVAC system?

Dr. Elroy Vojdani
And you'll find it. Yeah. Right? You know? So in in if you're using this the tools today, there there is a really highly personalized ability to practice this just for you version of medicine, which is all the power in the world.

Dr. Mark Hyman
But I but I think I think fundamentally what you said at the beginning was key. We don't really think about how we take care of our inner garden. And our

Dr. Elroy Vojdani
microbiome just relates to everything. So whether it's mental health or auto community or obesity or whatever, it's it's literally the root

Dr. Mark Hyman
root root root for so many. And and the other things from the outside, they can affect it like toxins or certain infections and so forth. But a lot of times just a dysregulation of the ecosystem in our gut.

Dr. Elroy Vojdani
And so when functional medicine, we have a really coherent methodology for

Dr. Mark Hyman
addressing it called the 5 r program. And we'll put that in the show notes. I've had podcasts about it and solo podcasts. You can go back and listen to it, but we'll link to those as well. But I think that the reality is that that, you know, traditional medicine has no idea how to reset your gut, but functional medicine really has a clear path, which is to remove the bad stuff food sensitivities, food reactions, gluten, bad bugs in there, overgrowth of bacteria, yeast, parasites, whatever, and then kind of replace missing things like enzymes and prebiotics.

And, phytochemicals, and I think a lot of phytochemicals are really prebiotics that we we haven't really realized before.

Dr. Elroy Vojdani
Mhmm.

Dr. Mark Hyman
Reinoculate with healthy bacteria repair with some of the things you mentioned, like, you know, stretching fatty acids and glutamine and zinc, vitamin a, and fish oil, and then kind of restore the nervous system because the gut in the nervous system are connected through kind of dealing with the psycho emotional pieces of your life to reduce stress. And so so it works pretty well, and it doesn't require a doctor most of the time, and you can kind of follow along. As soon as you do need to go, check a stool test, you need to do different things, but it's it's, it it's one of those most rewarding things because you fix the gut and often let other stuff gets better. And and it's sort of like kind of shocking when you see when you see how central it is, and yet it's it's just kinda absent from medicine. It's the it's the easiest place in medicine to practice, not not because of

Dr. Elroy Vojdani
the lack of challenge, right? You you you are you constantly have to just embrace that there's something new that you have to learn every day, but the results that you get in medical practice are on, unbelievably and the gratitude that you get just from knowing that you're making those improvements is enough to propel

Dr. Elroy Vojdani
you forward, through whatever difficulty you're going through. It's, it's an incredibly rewarding experience. Contrast that to my prior medical

Dr. Elroy Vojdani
practice, which was being a full time interventional radiologist in the hospital Wow. Dealing with the complete opposite end of the spectrum Yeah. Chronic disease in the hospital

Dr. Elroy Vojdani
Yeah.

Dr. Elroy Vojdani
Renal failure, dementia, you name it, you know, where no matter what I did, or what fancy tool I was using, I didn't make a dent,

Dr. Elroy Vojdani
right, versus the other side, you know, you feel like you can completely change someone's trajectory and life. Yeah. So amazing.

Dr. Elroy Vojdani
Yeah.

Dr. Mark Hyman
Amazing. Well, this is very helpful. And I think those listening out there with autoimmune disease or long COVID, just know there are answers and that I know we've had a number of podcasts on this with doctor Lev Gallant and others and, now with you. And I think I think it's it's one of the most important things we can think about is how do we create immunore rejuvenation, immunore resilience. Jeff plan talks about a lot about strategies of immunore rejuvenation, which is something we should be thinking about.

And it's kind of an exciting moment, but it's it's also a a fraught moment because so many people are now suffering. And, you know, we were talking earlier, but, like, my practice is is is with me is pretty full. I have plenty of physicians at the ultra wellness center that can see your practice is pretty full. So so, you know, the educational stuff you put out like your book, when food bites back, taking control about immunities, certainly should get that. Everybody should get a copy and and check it out because it does provide a road map of how to think about this differently.

And, we're entering a new era. So so don't lose hope there's a way out and, or I thank you for what you've done and and kinda continue to work at your father in immunology. I've learned so much from both of you and everybody check out the papers if you wanna learn more. And and, we'll see you next time at the doctor's pharmacy.

Dr. Elroy Vojdani
Thank you, Mark.