The Main Causes Of Autoimmune Disease And How To Reverse It - Transcript

Speaker 1: Coming up on this episode of The Doctor's Farmacy. Dr. Mark Hyman: This is the single biggest threat facing Americans today. And I say Americans, because in other parts of the world where indigenous cultures are, or the developing world, they don't have as much autoimmune disease because they don't have the same environment that we do. Dr. Mark Hyman: Hey everyone. It's Dr. Mark Hyman. Welcome to a new series on The Doctor's Farmacy called Masterclass, where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, sleep, and lots more. Today I'm joined by my guest host, my good friend and my business partner and host of the Dhru Purohit Podcast, Dhru Purohit. We're going to be talking about the main causes of autoimmune disease and how to prevent and even reverse the course of these devastating illnesses. Welcome Dhru. Dhru Purohit: Mark, great to be here. This is a topic that a lot of people are interested in. So let's jump right in. Dr. Mark Hyman: Okay. Dhru Purohit: Let's start at the basics. What are five of the top things, top things that people are doing that you can think of that contribute to the root factors that drive autoimmune disease? Dr. Mark Hyman: So from a functional medicine perspective, we're always thinking about the cause. And there are basically five causes of autoimmune disease, pretty much all disease, but particularly autoimmune disease. And most traditional medicine just ignores those causes and gives medications that shut off the immune system. So when I'm thinking about someone with inflammation, I'm thinking about what's causing their immune system to be pissed off. And it's a short list. It's toxins, and that can be heavy metals, pesticides, mycotoxins, any kind of toxin, either internal toxin or external toxin. Allergens, and that can be food sensitivities. It can be gluten, it can be dairy. So foods and environmental triggers. And microbes. So that would be everything from your microbiome, which we're going to talk about, to things like tick infections and viral infections, all can trigger autoimmune disease. Dr. Mark Hyman: Poor diet, which is basically our SAD diet, our standard American diet, which is highly inflammatory. And stress. And that can be psychological stress or physical stresses. All those trigger inflammation and autoimmune disease. So my job as a doctor is to hunt down the rabbit holes at each of those areas and find out what that particular person has. Because everybody's different. You can have 10 people with exactly the same autoimmune disease and might have 10 different factors causing it, and you need to treat them all differently. Dhru Purohit: Now, out of the ones that you mentioned, are there a few that you're seeing in this time that we're in, that are the primary contributors? If you had to take a few of those, because they all can play part, but which ones are the biggest driver for 80% of the people that are out there that you see? Dr. Mark Hyman: Well, number one, two and three in my mind is gluten. If someone's got an autoimmune disease, that's, until proven otherwise, a factor because it drives not only systemic inflammation, but it causes leaky gut. And the second thing is dysbiosis, which is imbalances in the gut flora that cause leaky gut, it could be gluten or other things. That drives inflammation. And the third thing I think is probably the hidden infections that are affecting so many people, particularly tick infections. And then of course there's all the of secondary things that I mentioned, whether it's mold or whether it's heavy metals or environmental toxins, all of those drive inflammation. Dhru Purohit: So give us a sense of how big is this. I can think about five, 10 years ago, you were just starting to hear a lot more about autoimmune conditions. And I think that anybody who's watching this podcast on YouTube or listening on audio, they may not get how big this classification of diseases are. So what do you know from the stats that are out there? Dr. Mark Hyman: The problem with looking at autoimmune disease is that it's so siloed. So the neurologist takes care of multiple sclerosis. The gastroenterologist takes care of inflammatory bowel disease. The endocrinologist takes care of how Hashimoto's, and the rheumatologist takes care of rheumatoid arthritis or psoriatic arthritis. So everybody's looking at their little autoimmune disease and their specialty and not understanding the scope of the problem. When you zoom out and you look at autoimmune disease is probably 80 million people. Dr. Mark Hyman: Which is almost as many people as have diabetes, heart disease and cancer combined. So now you got to take that in. This is the single biggest threat facing Americans today. And I say Americans, because in other parts of the world where indigenous cultures are or the developing world, they don't have as much autoimmune disease because they don't have the same environment that we do. They are more in the dirt, they have more exposure to parasites. They have more exposure to stuff that makes their immune system smarter. When we hyper-hygienized ourself and our food's purified and we're not playing in farms and dirts, when we're exposed to all the horrible diet we have in America, all these factors drive this about pandemic of autoimmune disease in America. Dhru Purohit: Which is why we're probably also seeing it grow in other parts of the world, even though it's in lower numbers, because we're exporting this American lifestyle out there, which is very sad and we got to do something about it, which is what this podcast is all about. Dr. Mark Hyman: Absolutely. Dhru Purohit: So how do you even begin? All the things that you shared earlier can feel quite overwhelming, even I'm sure for other physicians, which there are some physicians that watch this podcast. How do you even begin to uncover the root causes of autoimmune diseases? You have a patient that's coming in, maybe they have a diagnosis, maybe they don't. How do you even get started from step one? Dr. Mark Hyman: Well, after doing functional medicine for 30 years, I do the same thing I've done every day for 30 years, which is you use the matrix, which is a map of how the body works from a functional medicine perspective. So I look at all the predisposing factors, those five things and I dig deep into those. I look at their lifestyle, I look at their mind, body stress, and I come up with what are their issues? So it's a detailed history. I just gave a case example from yesterday, I had a young girl, 26 years old, inflammatory arthritis. She's also got terrible bacterial overgrowth in her gut and IBS, or irritable bowel syndrome, migraines, fatigue, all kinds of symptoms. And she was actually sent to me by rheumatologist at Cleveland Clinic because they're like, "Hey, maybe you can help her because this is pretty complex." Dr. Mark Hyman: And for her, we looked at mold, we looked at toxins, we looked at her gut, we looked at infections. We looked at all these things through diagnostic testing and we found a lot of stuff. She didn't really have mold, but she had the highest lead level I've ever seen. And it may have been coming from the environment she lived in, maybe in London. She also had four infections, Lyme disease, ehrlichia, which is another tick infection, CMV, which is cytomegalovirus and Epstein bar virus. They were hot. So she had toxins, she had infections and she also had bacterial overgrowth in her gut of a methane producing bacteria that causes leaky gut, inflammation and the whole dysbiosis that drives inflammation. So for her, fixing her is getting rid of her infections, getting rid of her metals and fixing her gut. Now for somebody else, it might have been mold or it might've been organotoxins and not heavy metals, or it might have been gluten that was a factor. For her, it wasn't. Dr. Mark Hyman: So we really have to look at each person individually and then we can map it out. So it's really through a detailed history, looking at tox and exposure, tick infections, mold exposure, nutritional status, dietary history, various triggers, insults. Sometimes people were traveling in Thailand, they got a bug in their gut and it caused some disruption that led to long term inflammatory issues. So we basically do a medical detective approach, like Sherlock Holmes, and dig down into these areas based on their medical history. And then based on the history, we'll do deep dives into diagnostics, around toxins, allergies, infections, diet, and so forth. Dhru Purohit: Now you talked about this a little bit, but how does conventional medicine typically approach an autoimmune patient? Somebody who has autoimmune, how do they think about that? And you've already shared a little about functional medicine, but it'd be nice to just tease that out a little bit more in conventional medicine. And what are some basic core distinctions that are well intentioned in conventional medicine, but completely misguided when it comes to the fundamental basics of autoimmune? Dr. Mark Hyman: Yeah. I think the real mental difference is in traditional conventional care, the approach is to diagnose based on symptoms. Where is the symptom and what is the symptom? If you have, for example, joint pain, you go to rheumatologist. You have a stomach inflammatory bowel disease, you go to the gastroenterologist. No one's asking why, they're asking what. What disease do you have? What category do you fit in? And the joke, if you actually even ask a rheumatologist, they go, "Well, most people don't fit into these narrow categories of these diagnostic criteria that we've developed that we used to study these illnesses. They're actually more mushy." And I think they're not asking how this disease arose, they're simply saying, "Oh, you have this disease." And then our job then is to shut off the inflammation. I'm more interested in getting to the cause of the inflammation and getting rid of it. Dr. Mark Hyman: And functional medicine, we've talk about the Tacks rules. This is from Sidney Baker. He said, when you're standing on a tack, it takes a lot of aspirin to make it feel better. And if you're standing on two tacks, you have take both of them out because taking one of them out won't make you 50% better. So there may be multiple causes. If you have a broken ankle, I can give you morphine and you can walk around the room and go hike a mountain, but probably not a good idea. So traditional care is essentially saying, "How do we shut off inflammation?" And they have a number of tools. Prednisone is the most crude tool, sort of a general anti-inflammatory with terrible side effects. And it was the mainstay of rheumatology treatment for decades. And then we started using chemotherapy drugs like methotrexate or cyclosporin or others that are used for transplant rejection. Very intense drugs that shut off your immune system, chemo drugs. Dr. Mark Hyman: And then we started using biologics, which are a great advance and they do help a lot of people, but they also suppress your immune system. So things like Humira, Enbrel these various drugs are super expensive. They're called TNF alpha blockers. They cost about $50,000 a year. And what they do is they suppress the inflammatory response in the body. So even though you have this trigger, it's shutting it off. For example, even though you have a broken ankle, you'd have pain unless you took that morphine or heroin to shut it off, right? So they can control the symptoms, but don't address the root cause. And these drugs can suppress your immune system and lead to cancer and lead to overwhelming infection and death. They're not benign drugs. So from a functional medicine perspective, we look at why is there inflammation? Dr. Mark Hyman: Now I just hear another story of a young girl came to see me, Isabelle, who was 10 years old. And she had something called mixed connective tissue disorder, meaning everything was on fire. Her muscles were on fire, her arteries and veins were on fire. Her joints were on fire. Her skin was on fire. Everything was on fire. She a whole host of antibodies, autoimmune antibodies. She had high CRP, her liver was affected, her blood cells were affected. It was just a systemic inflammation disease. And they were giving her methotrexate, which is a chemo drug. And they were giving her high doses of intravenous steroids called Solu-Medrol every three weeks, IV, just so she could get to school. She wasn't better, but she was just managing it. And instead of asking what other drugs should I give her? I'm like, well, what's causing this? So I just went down the rabbit hole and looked at her story. Dr. Mark Hyman: And she ate junk food her whole life, tons of sugar. She was 10, but she loved raw fish and she ate tons of sushi and tuna, tons of sugar, had lots of antibiotics. And so I figured she's probably got a lot of heavy metals. She's probably got yeast issues because of all the sugar and antibiotics. She's probably got dysbiosis. So when we dug under the hood, we found she had gluten antibodies. She had high levels of mercury and she had significant nutritional deficiencies like vitamin D, which is important for regulating autoimmunity. And she had terrible dysbiosis and imbalances in her gut and inflammation in her gut, which she didn't have gut symptoms. But when we looked at the tests, we could see that she was in this pre-inflammatory bowel state. So her gut was a mess. Dr. Mark Hyman: So we fixed her gut. We got her off gluten and dairy. We got her off the sugar and processed foods. We get to her metals and we gave her some nutritional support, basically fish oil, vitamin D. Two months later, she comes back and she's completely symptom free and getting off her medications. And by the way, she was on a lot of medications. She was on medications to support her blood vessels from being irritated, called nifedipine, which is a calcium channel blocker that's used for blood pressure. But it was just so she could actually not have Raynaud's. She was on drugs for her stomach and reflux. She was on drugs for blood thinners like aspirin. She was on a whole host of drugs at 10 years old, just to manage the effects of this disease. And in two months, she was off of all that. In a year she was off everything and had no symptoms. And all of her autoantibodies went to normal. Dr. Mark Hyman: Now rheumatologists will say, "Do not bother to check antibodies after you first diagnose the patient, because they never go away." That is not true. If you know what to do, they go away. And I've seen this over and over, over decades. And it's because we don't get rid of the cause that they don't go away. When you get rid of the cause they'll go away. And so after a year, all her massively abnormal lab tests went back to normal except for one minor autoantibody. And I talked to her, it was about 10 years later, I called her up like, "How you doing? I was curious. Like, "I'm great. I'm in university. I'm doing great and no symptoms." So that's the potential of using this model. Dhru Purohit: Now, on the topic of the body and the body being on fire, you started off this masterclass with the five top things that you felt are the primary drivers or the root causes for autoimmune, but they all have a common link, and that link is inflammation. Really help us drive home that connection between inflammation and autoimmune diseases. Dr. Mark Hyman: We're all familiar with inflammation. You cut your finger, it gets a little infected. It gets red, swollen, hot, painful. Those are the signs of inflammation. And so that red hot, swollen, painful happens not just on your skin, but it happens inside, and that's inflammation and that's what drives autoimmune disease. So it's a final common pathway for so many diseases across the age spectrum, but it's a particular kind of inflammation. So heart disease is inflammatory, diabetes is inflammatory, autism is inflammatory, Alzheimer's is inflammatory, depression is inflammatory. Those are not typically autoimmune diseases. So inflammation can be of many types. The particular type that you get with autoimmune disease is where you create autoantibodies. Literally you are attacking yourself. Dr. Mark Hyman: It's not something outside of you that's attacking you, it's you create an antibody response to your own tissues. So your body starts attacking your joints or your nerves in MS, or your stomach in inflammatory bowel disease, or your thyroid in Hashimoto's, which by the way is super common, it affects one in five women, one in 10 men. Half of them are not diagnosed and probably another three quarters are poorly treated. So that's a huge problem. Dr. Mark Hyman: But the ability for the body to recover from this is really important to understand because most people, when they get diagnosed with autoimmune disease, they're told, "This is a lifelong problem. You will always have this. We will have to manage it with immune suppressing medication and hopefully you'll be all right." It's basically how it's done. And the reality is that we can not only improve the symptoms, not only stop it, but we can literally reverse it and get people to lose the diagnosis of autoimmune disease. And you can say it's in remission, it'll come back, sure. If you're eating gluten and you cut out gluten and your autoimmune disease goes away, and you eat the gluten, it's going to come back, right? Dr. Mark Hyman: So you have to be aware of what are your triggers and we're all a little bit different and need to pay attention to what our unique differences are about what we need to avoid or what we need to do to manage the autoimmunity. But the truth is that once you heal things, the body is so resilient and robust. And so there's so much that we now understand about how autoimmune disease works, but it's not necessarily incorporated into traditional care yet. And what's really heartening to me is I see rheumatologists start to get into this. I was talking to one from UCLA, Cedar Sinai, and I was asked to speak to him because one of my patients also was seeing him. And I thought, it's going to be a challenging conversation. He's going to question everything I'm doing. He's going to blah, blah, blah, blah. Dr. Mark Hyman: I get on the phone. He's like, "Dr. Hyman. I'm so glad to talk to you. I've been using your approach. I'm using anti-inflammatory diets with the traditional treatments and we're getting such better results, way better than we ever got." So I see the crack in the edifice of our modern medical care system, around immune disease. It's just not fast enough for me, because I see so many people suffer needlessly. And we do understand in depth inflammation. And so by using the model of functional medicine, we can help people to remove the cause of inflammation and then put in the things into body that help regulate the immune system, whether it's vitamin D or fish oil, probiotics, there's a whole of bunch of stuff that's on the positive end that we have to add in. Just like we have to take out the stuff that's causing problems, we have to add in the things that help the immune system work better. Dhru Purohit: Now you give us a great sense of hope because the landscape is changing, but it's also changing slowly. And there are great functional medicine practitioners out there. But a lot of them, especially in the last year, they're not taking on new patients, they're overloaded. You're not taking on new patients. It's very challenging and people are trying to get help and trying to navigate. So for the person that doesn't have access and is trying to figure out the steps that they can take, can they still have hope that there's progress that they can make and stuff that they can do on their own with the course of support of their doctor that they have currently? Dr. Mark Hyman: Oh my God, yes. Most of the causes of immunity can be managed without the help of a doctor. Dhru Purohit: So let's start off with the first one, which is diet. Dr. Mark Hyman: Yes. So the reason that I write the books that I write is to give people access to the science of functional medicine, without having to see a functional medicine practitioner. And I can't tell you Dhru how many times people have come up to me and said, "Dr. Hyman, you saved my life." Last night, I was going to dinner in LA and someone stopped me. He said, "My dad read all your books. He had all these issues and autoimmune, and he's cured everything, and thank you." So it's not that you have to necessarily see a functional medicine practitioner to get better. Sometimes you do, but for the most part, if you with food, because that's the biggest trigger I would say for autoimmunity, and do what I have written as the 10 day detox diet or what we now call the 10 Day Reset. Dr. Mark Hyman: The book I wrote was designed to help people remove the inflammatory foods from their diet and add in the anti-inflammatory foods and to help fix their gut, help boost detoxification and help the microbiome get back to normal. That alone can work for so many, many, many people. So essentially what I would say is and there's a whole bunch of science looking at these kinds of approaches around diet. One of them is about inflammatory bowel disease. They call it the autoimmune paleo diet, which is very similar to the 10 detox diet, which essentially gets rid of grains, beans, dairy, sugar, processed food. And then it also gets sort of eggs, nightshades and nuts, which can be triggers for some people. I don't remove eggs, nightseed, nuts for most people, because it's not that common. But if you really want to go extreme, you can do that. And then you add things back. Dr. Mark Hyman: And one guy can came up to me at a lecture at Cleveland Clinic. He said, "Dr. Hyman, I have rheumatoid arthritis and I did your 10 day detox diet. And all my symptoms went away. Is that possible?" And I'm like, "Yes, if it was something you're eating." Now, if you have mercury poisoning or if you have a tick infection or you have mold exposure, you're not going to necessarily get all the way better. But you will improve and you still have to do the gut repair just really kind of easy to do on your own. Dr. Mark Hyman: Basically for most people, if you just do the 10 day detox diet for 10 days, you'll see whether or not what you're eating is driving inflammation. And for most people it is. That's the first step. And then there are ways to navigate these other aspects around heavy metals, toxins, gut, and you sometimes may see a functional medicine doctor. But what I'm finding is now there are solutions that are coming up online. There's a lot of things that are affordable and accessible. You don't actually necessarily have to go see a physician. Sometimes you will, but for most people it's worth a try to start just with diet and lifestyle. Exercise, stress reduction, sleep. Some basic supplements are really helpful. So getting people on probiotics, getting them on omega-3 fats, getting them on vitamin D. Simple things can make a big difference for people by just resetting their biology. Dhru Purohit: Now, most physicians, again well intentioned and sometimes maybe not well intentioned, but most physicians well intentioned, they see a lot of those recommendations, interventions as sort of soft recommendations. Right? Nothing wrong with it, but it's not going to do anything for you. Why is that? With all the education, with all the background, with everything that's there, why is it that still those are seen as soft when it comes to diet, sleep and exercise and some of these other things that you just mentioned? Dr. Mark Hyman: It's astounding to me how much data there is. Right? And physicians often hide behind the veil, what we call evidence based medicine. And that is often a sort of deflection from having to do the hard work of looking at the data. Because if you go on PubMed and the National Library of Medicine and you search for diet and autoimmunity, exercise and autoimmunity, sleep and autoimmunity, stress and autoimmunity, various vitamins, omega-3, vitamin E, you'll see there's plenty of data. But no one's put all the dots together and that's what functional medicine does. So for people who are skeptical, I would say, look, just do your homework. Go look at the data. We need more obviously, but there's a huge start. Dr. Mark Hyman: And we did a preliminary analysis that was done by the rheumatology department at Cleveland Clinic. We didn't actually look at the data. So it was sort of an arms length. And we had a fellow from the rheumatology department look at our patients at the Center for Functional Medicine and then their patients. And Cleveland Clinic is I think the number two in the world in rheumatology. So they're not a third rate rheumatology center. These are the best docs in the world. And our docs at the center did better with those rheumatoid arthritis and psoriatic arthritis patients across a number of metrics that are standardized validated metrics from the rheumatology. They got better in terms of pain, inflammation, symptoms, and so forth. So there's a there, there, and I think there's a real awareness that there's a need to incorporate some of these things. And I think when I hear these stories of other rheumatologists starting to come on board and other people thinking about how to actually use diet and lifestyle and how effective it is, it's important. Dr. Mark Hyman: And I think the reason we've had this soft idea about it is because nutrition's been the stepchild of medicine. It's like well, okay, if you don't use much and you won't maybe get overweight and blah, blah, blah. But there really is, in a sense, that it's that powerful. And when you look at the science around food is medicine, it works better than a drug. Listen Dhru, I don't care what the therapy is. If I thought a biologic was going to be the best therapy for this patient, I'd recommend it. I'm agnostic. I'm not pro or anti-drug, I'm pro finding out the root cause and addressing that. I'm pro creating health and seeing what happens. And when you do that, these problems just tend to go away and we don't have to go in that rabbit hole of medication. Dr. Mark Hyman: So I think we're kind of in this threshold old moment where there's a real understanding that the microbiome is involved in so much autoimmune disease. And yet, when you go to the rheumatologist and the neurologist or the GI doctor, they're not actually looking at your diet. And it's just stunning to me that they're not, or they're not looking at your microbiome. For rheumatoid arthritis you go to the rheumatologist and like, "Let me look at your poop," or when you go to the neurologist with you have MS, they're like, "Let me look at your poop." And I remember, God, it probably was 25 years ago, I had an MS patient at Canyon Ranch when I was working there. And she said to me, "Dr. Hyman, whenever my stomach and irritable bowel gets worse, my MS gets worse." I'm like, "Oh, noted." Dr. Mark Hyman: So you begin to go into these rabbit holes of listening to patients and listening to their stories. And the problem often with medicine is we come up with preconceived ideas about what's going on instead of actually listening to our patients. And most of what I've learned, I haven't learned in a textbook. I've learned from being on the street, working with thousands and thousands of patients doing thousands and thousands, maybe millions of tests and seeing all the patterns in there. Dr. Mark Hyman: And I remember one guy who had severe ulcerative colitis early on and I was like, we're doing the four hour program, at the time, now it's a five hour program, to rebuild the gut and put them in elimination diet. And all the things I thought should work, give him fish oil and this and that. He just didn't get better. He was losing weight. He was having bloody diarrhea. It was just miserable. And I said, "Well, let me go back and look at what the causes are." So let's look at heavy metals. Let's look at all the potential immunotoxic things that are out there. And his mercury was off the chart. And I just detoxed him from mercury and his ulcerative colitis went away. Dhru Purohit: Wow, powerful. Now you talked about diet. You mentioned a little bit about testing, again. A lot of that testing is going to have to happen with participation from a doctor, an integrative doctor, a functional medicine doctor. Not all these doctors are trained in these tests. What about supplements? Where can supplements be a part of the picture, and in some instances where may they not be helping when it comes to autoimmune? Dr. Mark Hyman: So I think they're part of the therapy package. But the same rule applies. If you're standing on a tack, it takes a lot of aspirin to make it feel better. If you've got Lyme disease and that's causing your autoimmunity, take a lot of vitamin D to make you feel better, or fish oil or whatever. So when I think of autoimmunity, I'm thinking, how do I one, help the body's own immune system do what it's supposed to do? And there are basic fundamental ingredients for regulating inflammation in the body. The biggest is the omega-3 fatty acid that come from mostly wild things, right? Wild fish, wild plants, wild animals. We don't eat that much anymore except wild fish. And that's primarily our source of omega-3 fats. And yet many people don't eat enough fish or they eat fish and it's got heavy metals in it. So it's problematic. So omega-3 deficiency probably affects 90 plus percent, maybe 98% of Americans. Dr. Mark Hyman: The second category would be vitamin D, which regulates hundreds of genes that control inflammation. So having adequate vitamin D is very important and it's been linked to, for example, MS. We know that people who have low vitamin D have more MS. It's more common in Northern climates where there's low sunlight. So we know vitamin D plays a role in autoimmunity and inflammation. Probiotics are also extremely helpful because they help to normalize the gut. Now, if you have a bad overgrowth of bacteria, you can get into if you take probiotics. But it can be very helpful in normalizing the gut. And there's all sorts of anti-inflammatory probiotics. And that's a big rabbit hole. We can go down another conversation. Dr. Mark Hyman: Think about precision probiotics. It's not just like, "Oh, take lactobacillus and that's it." There's really different probiotics that do different things for different conditions. And then there's a class of compounds that are more kind of immune regulatory that are phytochemical. So there's a whole class of polyphenols that are plant compounds that regulate inflammation. For example, curcumin or turmeric. We've heard a lot about that. So that's probably the most potent one. But there's many, all the proanthocyanidins from colorful fruits and vegetables, all the purple and blues and yellows and oranges and greens, they all have anti-inflammatory effects. And so I make sure I include a lot of those in my diet and spices are great to use for that. So we start to begin to take those. Dr. Mark Hyman: And I also look at ways to sort of regulate my gut health and keep my inner garden healthy. We're coming out with a product called Gut Food, which is designed to rebuild your gut. How do we feed our inner garden? How do we take care of that? And that's what the purpose of this new product is. How do we reestablish a healthy microbiome? And I am excited to how people are going to do on that because it's one of those areas that is a little messy and there's not a lot of great, simple solutions. So we really have the potential, at any time, to rebuild our gut. And that's another part of the supplementation is how do we create a healthy gut? And that includes vitamin A and fish oil and vitamin D and various nutrients like quercetin and even things like amino acids, like glutamine. So we put together a cocktail of things to help rebuild the gut. Dhru Purohit: Now you mentioned sleep earlier, and sleep is one of those things that doesn't get as much attention as it deserves. Now, you've done a whole free sleep masterclass, like completely free, people can sign up. We'll put the link to that in the show notes, it's But give us a couple high level components for sleep and its direct connection with recovering from autoimmune. Dr. Mark Hyman: So sleep is one of those things that when I was in surgery in medical school rotations, they would say, "Real surgeons don't need sleep." And I've used up all my sleep credits in life and it definitely drives inflammation. You can feel it. If you don't sleep, I remember working in the emergency room all night or delivering babies and I would be so sore and achy and stiff. I felt like my whole body was inflamed and I would have to go manage that by sleeping, or I would go take a hot tub or something. And I think we understand that if you have sleep deprivation, it creates a cascade of dysregulation in the body, hormonal, cognitive, and inflammatory and immune. And so sleep is among the best medicines. Why do you think when you have the flu or when you have a viral infection, you tend to sleep a lot because your body requires that to repair and heal and to activate your immune response. So getting high quality sleep and enough sleep is super important if you have any kind of autoimmune disease, and generally for everybody, by the way. Dhru Purohit: Yeah. Across the board beneficial. But especially if you're dealing with any kind of disease, like an autoimmune disease. Dr. Mark Hyman: Even in your brain, you have an immune system in your brain called the microglia and the glymphatic system, which is like the lymph system of your brain. It only works at night when you're asleep. So to clear out all the waste and the garbage and all the things that affect us, we need sleep. Dhru Purohit: So we have a few questions from our community that have come in and we're going to rapid fire, go through a few of them before we go into the final thoughts on all things autoimmune diseases. So the first question that's here from our community, which is any connections between autoimmune and lots of allergies? Somebody who's suffering from a lot of allergies and has autoimmune. Dr. Mark Hyman: Yes. So just to back up a little bit, in functional medicine, we look at the timeline of someone's illness from before conception, the mother's health to what happened in utero, at birth, in the first year of life, in the early toddler years. We look at that whole timeline. And what's fascinating to me is, and I don't see this described many places, but there's a continuum that happens. And the story always goes something like this. Okay. My mother and the pregnancy was fine, born by C-section, not breasted. My gut was a mess as a kid, a colic, early antibiotics for ear infections, development of allergies, asthma, eczema, irritable bowel syndrome. This is the story, and it's the same freaking story over and over again. And then that goes on, usually in people's early childhood, teens, twenties starts to get a little worse. And then by thirties and forties, that's when autoimmune tends to kick in. Dr. Mark Hyman: And it's part of that continuum. And often when I treat the gut and the autoimmune stuff, the allergy stuff gets better. The sensitivities to foods to environmental allergens get better. Even if someone's got pollen allergy or tree allergies, you think that wouldn't get better. But when you fix the gut, everything gets downregulated. And there's a big connection. There's also an interesting connection with a therapy that sounds really weird, but there's a lot of research on this, and there's a number of books written about it. And one is called the Epidemic of Absence, and it's using worms to actually help reset the immune system in the gut. Because historically, we were all managing all kinds of critters that we lived with in our gut, that we had this balance with. And our immune system was always surveying and looking and managing and keeping everything under control. Dr. Mark Hyman: Well now we've eliminated all the worms and the parasites. We have clean water, we have sanitation, which is all great. I'm not saying we should go back to eating a lot of worms. But there are a number of studies that look at using a worm therapy, which helps to reset the gut to reduce allergies, but also autoimmunity. And I've had some remarkable success. I remember with this one kid who was on the Asperger's autism spectrum who had super high levels of allergies, IgE allergies, which is a true allergy, not like a food sensitivity. And the blood level of 1,000, normal's 100, of IgE, which is the antibody for allergies. And we did the worm therapy and it came down to normal and his allergies went away. I was like, "Wow, okay." And we've seen this in other autoimmune diseases. So it's not my first line of therapy, but it is something that I fall back on if we get stuck. And so regulating the gut and regulating those allergies really helps to control inflammation in general and the whole autoimmunity picture. Dhru Purohit: Great. So my son has celiac and Graves' disease. Any tips on supporting and reversing this process? Well, all the things that we just mentioned above. Dr. Mark Hyman: Absolutely. Often, people have two or three autoimmune diseases and it's stunning to me how traditional medicine doesn't ask, "Why?" Is this just coincidence or is there a reason? Well yeah, celiac will drive Graves' disease. So if you actually heal the gut with celiac, you often can reverse the Graves' disease. The problem is that with celiac, often people just get rid of the wheat or the gluten, but they don't rebuild the gut. And I've seen many, many people struggling, even after getting off gluten because their guts have been so messed up. They need a rehab, they need a remodel in there. And so when you do that, often people will get better. Dhru Purohit: Okay. Next question. How bad is alcohol for autoimmune diseases? Dr. Mark Hyman: Well, it depends on what alcohol, right? There's spirits, beer, and wine, let's say. The more alcohol you drink, the more it disrupts the microbiome, the more it leads to leaky gut, the more it drives inflammation. So having a shot at tequila here and there probably isn't a problem if you're in balance. But if you have an autoimmune disease, alcohol could be a real factor in continuing to trigger the inflammatory response in the body. It is a toxin. The dose makes the poison, obviously. And particularly if you're drinking beer, which is gluten based, if you're drinking a lot of wine, which has sulphites. A lot of sugar can cause dysbiosis and a lot of leaky gut issues and liver problems. So I think depending on where you are in the spectrum of your health, it's good to avoid alcohol, particularly if you have autoimmune disease. Dr. Mark Hyman: Now, the whole purpose of functional medicine is not to make people's life restricted and constrained, and to get off everything and to live in this bubble. The purpose is to create resilience, to create balance, to create redundancy, metabolic flexibility, and make you robust. So you can have a wide variety of things and your body knows what to do. So when I was really sick, I had autoimmune disease, I couldn't eat anything. I had had turkey, brown rice, and broccoli for a year and I couldn't eat anything else. And now I can eat anything, everything. I think if I have traditional dairy, like modern cow dairy, I get stomach issues and I get pimples and congestion. But if I have sheep or goat, that's A2 casein, that's maybe heirloom strains, that's pasteurized, I don't have problems. So really depends on the quality of the food. But I definitely think the purpose is to create a robust system that makes you resilient and not have to be so restricted. Dhru Purohit: All great answers, Mark. Thank you for that. So let's zoom out and do a recap on the topic of autoimmune. If someone is going to start today, first one or two things that they should be thinking about, and next steps. Let's do a recap on some of the stuff that you mentioned. Dr. Mark Hyman: I think the first thing to recognize if you have an autoimmune disease is that there is an approach that's different than what you're going to hear from your traditional rheumatologist. And it's easy to start. And if the beginning things don't work, there's always plan B, which is seeing a functional doctor. But for many people, a dietary change, some fundamental lifestyle changes and a few supplements can make a huge difference. So what diet? Well, I would recommend an elimination diet. Now I used one that I created called the 10 Day Detox Diet. And essentially it's no grains, no beans, no dairy, no sugar, no processed food. And it includes lots of phytochemically rich plant foods, high quality protein, nuts and seeds, some fruit. And it gets rid of all the junk. And that alone can make a huge difference. Even if it doesn't get people all the way better, it can dramatically improve symptoms for people. Dr. Mark Hyman: The second is, make sure you focus on stress and sleep. Those will help your immune system regulate. And the third thing is take a few basic supplements, vitamin D, fish oil, probiotics, curcumin. Those are easy to take. They're safe, they're effective, and they will help your body start to rebuild its natural defenses against inflammation. So I think those are the things that I would say are the top three things. Focus on diet, lifestyle, and a few supplements. If that doesn't work and after two or three weeks, you're still seeing no change, it means you got to dig deeper. It means maybe you have a tick infection. Maybe there's heavy metals, maybe you've been exposed to mold, maybe there's some more serious gut issues going on, like SIBO or SIFO, which is fungal overgrowth. Maybe there's parasite. We have to kind of look deeper. But for most people, that initial approach can make a huge difference. Dhru Purohit: All right, Dr. Hyman, perfect breakdown of autoimmune conditions. And we have our next steps that are out there. And the 10 day detox diet, which we'll link to in the show notes, is a great place for people to get started. Any other couple resources that are out there that you might drive people towards, when it comes to going down the pathway of autoimmune conditions? Any top interviews from your podcast previously that you want to highlight? Dr. Mark Hyman: Oh gosh, yes. All you have to do is Google Dr. Hyman autoimmune, and you'll have more than enough information to start with. Or you can Google MS, or you can Google Hashimoto's, or you can Google anything that pretty much I've written about over the last 30 years. There's an article, there's a podcast, something I've done. So I encourage you to start there and you'll be able to get a lot of insights, a little bit deeper into what to do. Dhru Purohit: Fantastic. Well, I think it's time for your conclusion for this podcast. Dr. Mark Hyman: Well, thank you Dhru for making me look good, asking me the good questions and helping me tell the story of what's really going on. If you've suffered from autoimmune disease, if you have any family members or friends, please share this with them because people need to know what's possible and what the future looks like. If you subscribe to podcasts, subscribe to wherever you get your podcast and leave a comment. Maybe you've cured your autoimmune disease. We'd love to know how you do that. And we'll see you next week on The Doctor's Farmacy. Speaker 1: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed health care practitioner and can help you make changes, especially when it comes to your health.