The Silent Killer: Inflammation And Chronic Disease - Transcript

Introduction: Coming up on this episode of The Doctor's Farmacy.

Dr. Shilpa Ravella: If you go into your doctor's office, your typical Western physician's office, you're unlikely to be offered a test for inflammation. So the question is, how exactly do you know that you're inflamed?

Dr. Mark Hyman: Welcome to Doctor's Farmacy, I'm Dr. Mark Hyman. That's farmacy with an F, a place for conversations that matter. And today, we're going to talk about a very important topic, which is inflammation, at the root of almost all modern diseases. And it's something that been much neglected by traditional medicine, except if you're a rheumatologist and you give heavy duty immune suppressing drugs. But it is at the root of most of the things that are causing us to suffer today, from heart disease to diabetes, to cancer, to Alzheimer's, even depression and mental health issues, all driven by inflammation.
And today we have, as our guest, a renowned physician, Dr. Shilpa Ravella, who's a gastroenterologist and assistant professor of medicine at Columbia University. She's the author of a book called A Silent Fire, the Story of Inflammation, Diet and Disease, which investigates inflammation. Which is the hidden force at the heart of most of our modern diseases. And her writing has appeared all over, in The Atlantic, New York Magazine, Time Magazine, The Wall Street Journal, Slight, Discover, USA Today and other publications. And I'm so glad she's getting the word out because I've been beating this drum for three decades now. And thank God people in traditional medicine are finally getting it. So welcome, Shilpa.

Dr. Shilpa Ravella: Thank you so much for having me here, Mark. It's such a pleasure to be here.

Dr. Mark Hyman: Yeah. Now most people kind of get inflammation. "Oh, I have a sore throat." Okay, that's inflammation. Or, "I have an autoimmune disease. Or I have allergies. Or I have asthma." And people sort of get that's inflammation. But most people don't really know that other diseases that I mentioned, like heart disease, cancer, obesity, diabetes, aging itself, depression, autism, are all either caused by, or somehow affected by, inflammation in our body. So can you kind of break it down for us? What is inflammation and why are we suffering from this epidemic of inflammation today?

Dr. Shilpa Ravella: Sure.

Dr. Mark Hyman: And by the way, just to say everybody, the reason why Americans were only 4% of the population but suffered 16% of the cases in deaths from COVID, was not because we have a bad healthcare system, it's because we were all pre-inflamed, because we were living and eating and doing things in a way that make us pre-inflamed. So when COVID hits us, it starts a wildfire. It's like dropping a match in a dry forest. So it creates a wildfire. And that's exactly what COVID was, it was a wildfire in our bodies that killed so many of us. So kind of take us through, why are we having so much inflammation? And what is it? How do we kind of identify it?

Dr. Shilpa Ravella: Sure. Well, just going back to the basics, inflammation is actually an ancestral force that evolved to protect us from things like pathogens and poisons and traumas, all of these ancient killers. So it's actually a good thing in our bodies, to have inflammation when we need it. But the problem is that because we've evolved these strong, robust immune responses, we also tend to pay a price for it. And this is called the biological price of having strong immune system. And we can see that with autoimmune diseases, for example, like rheumatoid arthritis or inflammatory bowel disease.
But now, what we're seeing is that we've also transformed our modern environments, from the food we eat to the air we breathe, to how we move, how we interact with others in terms of social connections. So our immune systems are constantly triggered at a low level, and this leads to chronic, silent inflammation in the bodies. And we know today, that this type of inflammation can actually be an independent cause of disease, and it is tied to a variety of modern, chronic diseases. The majority of our top killers. It's tied to heart disease, cancer, diabetes, neurodegenerative disorders, some psychiatric issues, obesity. So what we're seeing today is that the majority of us in the modern world are inflamed.

Dr. Mark Hyman: Yeah. Most people don't walk around going, "Oh, I'm inflamed." If you got a rash or you have a sore throat, you know, "I'm inflamed." If you have arthritis in your knee and it's swollen up, you go, "I got a problem." But most people who are overweight or have heart disease, or high blood pressure, diabetes or depression, they're not walking around thinking, "Oh, I'm inflamed. I better deal with that." Right?

Dr. Shilpa Ravella: Absolutely.

Dr. Mark Hyman: So explain how inflammation plays a role there. Because we think of inflammation typically, as being something that is there to fight infection, or our immune system, that gets activated to fight cancer. And then can get dysregulated with autoimmunity and allergy. But we don't think of it in terms of this general state of being kind of low grade inflammation, which we're all suffering.

Dr. Shilpa Ravella: Right. And I think that's a great point, is that we don't tend to think of inflammation as being so broad. For example, when we think of inflammation, we think of autoimmune disorders, typical autoimmune disorders, or as you said, when we have a cold or a flu. But now, what we're seeing is that low level inflammation can actually cause some of these disorders or it is tied to nearly all of these modern, chronic disorders. And you're right that if you go into your doctor's office, your typical Western physician's office, you're unlikely to be offered a test for inflammation. So the question is, how exactly do you know that you're inflamed? And I think there are a lot of things that are coming up these days. For example, in cardiology clinics, doctors might test you for something called C-reactive protein, high sensitivity. C-reactive protein. And that's a marker of inflammation in the body.
It's made in the liver in response to areas of inflammation. And there are a variety of other markers as well. But some of the problems with these tests is that they may not be that specific. So if you have elevated C-reactive protein, you may have that elevation from the cold you have, and you cannot be sure where it's coming from in your body, how long it's been there for. But there are new markers being developed. There are inflammatory signatures. For example, there was a Stanford study a couple of years ago on aging and an inflammatory signature comprised of several markers that can help to predict healthy aging. And there are so many different things that are in the works I think, from tests like CAT scans and MRIs that can pick up inflammation around blood vessels, for example, and predict which plaques are most likely to rupture. So those are some of the things.
And one of the proxies for being inflamed, that we can all look at when we go to our primary care physician's office, is just things like high blood sugar or diabetes. If you have pre-diabetes or diabetes, you are most likely to have some amount of inflammation in the body because high blood sugar does tend to create inflammation. And if you have that belly fat for example, then you also know that you most likely have some level of inflammation in the body because we know that the belly fat is a marker for the fat that wraps around your internal, abdominal organs.

Dr. Mark Hyman: Yeah. I mean by the way, that fat is a source of a lot of inflammation because the belly fat is not just holding up your pants, it's actually a very active, immune, hormonal organ that's spewing out all kinds of inflammatory signals, if you get this excess belly fat. And I think most people don't realize that. If you have a big belly, you've got a smoldering fire inside of you. And that is really important to understand. And the reason we get the big belly is because of what we're eating. So let's talk about... Some of the things we were talking about, like how do we know? So we can do a CRP, but it's not very specific. It doesn't tell us why. There are other markers, we mentioned Stanford research. I think that was David Ferman's work on the Thousand Immunos Project, where he looked at cytokines or inflammatory markers in a thousand people, from little kids to old people.
And he found there were things that we probably never heard about in medical school, these cytokines that we don't test for in a normal lab result, but that actually are probably more predictive and more correlated with various age-related diseases than other markers that we actually do measure. So we're sort of learning about how to test for this. And you mentioned high resolution scans, imaging tests. Now for example with Alzheimer's, we know that Alzheimer's is an inflammation in the brain. We can see through the various MRI and high technology scans, we can see inflammation in the brain. We can see, for example, a new AI driven heart scans. We can see inflamed plaque, rather than just looking at an angiogram or even calcium score, which gives you a rough idea of the calcified plaque, it doesn't tell you how inflamed your plaque is. So we're getting more and more sophisticated. But are there tests that we should all be doing to check for inflammation? And are there tests that help us figure out the why? What is the why behind why we're so inflamed?

Dr. Shilpa Ravella: I think that's certainly a tough question for sure. And I think it's also very specialty dependent. For example, in my own practice, I tend to see inflammation all throughout the intestinal tract. And so, depending on what sorts of symptoms a patients come in with, I may do endoscopic testing, I may do an upper endoscopy and a colonoscopy, and I may catch microscopic inflammation in the intestines as well, through that way. And there are also stool tests that we do in our practice, to measure inflammation, like lactoferrin, which is one of the stool tests. And these are very situation dependent. And again, if you go to your physician, in general, you're unlikely to be told, "Hey, let's just check you for inflammation and then let's try to treat it." And we're not quite there yet. But I think we're getting there. And I think one of the interesting things too with testing, is that perhaps we should be measuring inflammatory responses to challenges rather than just a baseline snapshot of inflammation.
I think that's something that could be very interesting as well. Because we want to know that the immune system is doing its job when it should be and not overreacting as well. So I think there are a lot of great things that will come up in the future, regarding testing, and hopefully we'll see more and more specific markers and we'll see more trials in this space. But I think when we go to our physician's office in the modern age, we have some proxies that can tell us if we're inflamed and we have specialty specific diagnostic tools that we can use as well.

Dr. Mark Hyman: Interesting. So you mentioned the challenging in the immune system. Can you talk more about that? Because we know that for example, if you want to check for diabetes, you do a glucose tolerance test where you give people a bunch of sugar and see what happens to their blood sugar. Or if you want to check someone's heart, you don't just check an EKG, you put them on a stress test or do a stress echo to stress their system. So tell us what you're talking about. I think this is a really interesting concept of, how do we test our immune system's function? Are we overreacting or under-reacting?

Dr. Shilpa Ravella: Yeah. I think it can be as simple as injecting a molecule like a lipopolysaccharieds, and trying to figure out what the immune system's response is. Is the immune system, one, responding appropriately? And two, is it overreacting? Are we having too much inflammation to a stressor? And I think that could tell us more than perhaps just a snapshot of the blood markers that we have currently. And this is something that I think maybe that we will see in the future.

Dr. Mark Hyman: Yeah. Now we've all heard about this cytokine storm from COVID, and cytokines are basically the messenger molecules of your immune system. And a lot of the work by David Furman, things we're measuring, like CRP, [inaudible 00:11:49], IL6, cytokines, they're just the symptoms of inflammation. They're not the cause, they're the body's response to something that's irritating it. Right? So my question is, why is the immune system pissed off in the first place? Right? It's easy to measure it, you can look at scans, you can look at a colonoscopy, you can look at CRP, you can look at all these other biomarkers, but it's not going to tell you the why.
And so, my joke always is that a functional medicine doctor is really an inflamologist, like I'm an inflamologist. I made it my life's work to understand inflammation, to understand what causes it, how to actually remove the causes, and how did they get the body's own immune system to calm down and to reduce the inflammation naturally. So can you talk a little bit about, from your perspective, what do you see as the main drivers of this epidemic of inflammation and inflammaging, which we talk a lot about?

Dr. Shilpa Ravella: I think first of all, that this idea that all of these disorders share a deep biological link, from heart disease and cancer, to some cases of depression and neurodegenerative disorders, that link being inflammation, it forces us to look at all of these things and really try to figure out what these root causes are. And it forces us also to look at patients and to treat patients not only from specialty perspectives, but also holistically in some ways as well. And a lot of what is causing this low level, chronic, silent inflammation today is our environment, our dietary habits, our lifestyle. And we know that chronic inflammatory disorders... And when I talk about chronic inflammatory disorders, I'm talking not just about rheumatoid arthritis and inflammatory bowel disease, but all of these different modern diseases because these are inflammatory disorders. And so, we know that our lifestyle factors play a very, very important part.

Dr. Mark Hyman: So talk more about specifically, what is it about our diet that's driving the inflammation? And then I want to get into potentially exploring other causes that may not be immediately obvious to people, that are driving inflammation.

Dr. Shilpa Ravella: Sure. I think-

Dr. Mark Hyman: Because your book is really... A Silent Fire, talks about diet as a big driver of inflammation.

Dr. Shilpa Ravella: Exactly.

Dr. Mark Hyman: Exactly what are we talking about here?

Dr. Shilpa Ravella: There are so many different factors, and I think one of the biggest ones is the western diet. And this type of diet is loaded with an excess amount of sugar or salt, inappropriate fats, processed foods, processed meats, refined carbohydrates. And the problem with this western diet is that our immune system actually tends to respond to it as it would a germ. Your immune system tries and tries to fix things in your body and it realizing that keeps getting these hits, maybe three times a day or six times a day, however many times a day you'll have a meal. And when we are eating this western type of diet, we are also starving our gut microbes of their most beneficial nutrient, which is fiber. And fiber can manipulate all arms of the immune system, from the innate immune system to the adaptive immune system. And it's an incredibly powerful, powerful nutrient that we need to be eating more of.
But 95% of Americans today do not meet the recommended daily allowances of fiber. It's 28 grams for females and 38 I think for males. So we are really starving that microbiome. Then the microbes change their behaviors, causing inflammation. They'll inch closer to the mucosa, they will create more inflammatory molecules, like lipopolysaccharieds. Those molecules will go out into the bloodstream, causing body-wide inflammation. So it's changing who the microbes are, the species in your gut, and also what their behaviors are. So the western diet, one of the biggest losses is also the fact that we are depriving our bodies and our guts, and our gut microbes, of their most essential nutrient. So diet is certainly a very big component of creating this low grade inflammation. And I would also say that the other main problem-

Dr. Mark Hyman: Not just the lack of fiber though, right? It's probably other things in our diet.

Dr. Shilpa Ravella: Right. Plenty of other things. And the other thing too I would say, is that we tend to think of foods as dampening or creating inflammation, but there's also a reversal going on. This whole process by which inflammation tends to die down in the body, is not a passive process, it's an active process. And immune cells, like macrophages and neutrophils, will secrete new mediators, and we need to feed that process. And so, we need to eat healthy fats, like omega-3s. And I think that's something that we don't do enough of, nearly enough of. So that potential to resolve inflammation in our bodies, we need to really be able to create those molecules. And that also comes from diet, because of precursors of these lipid, signaling molecules are actually omega-3s, which we find in a variety of foods.

Dr. Mark Hyman: Yeah. I mean these are called the eicosanoids. This is what we learned in medical school. These pathways of regulating cytokines, inflammation. And they're highly regulated by the fats in our body, particularly the omega-3s fats. I want to loop back to what you earlier talked about because I think it's really important, I don't want to skip over it, which is the role of the microbiome. And as a gastroenterologist, I think this is your area. Which is the microbiome plays a huge role in regulating our immune system.
And most people don't know that 70% of our immune system, or 60% of any you're talking to, is in our gut. And it's because it's the first place where we interact with the outside world. We put all these pounds of foreign stuff in our mouth every day and it goes down there, and it has to be sorted through. And then you've got all this bacteria and bugs and poop in there, and you have to land in the right stuff, but keep out all the bad stuff. And when we get a problem with the microbiome, we tend to get damage to the gut and more inflammation. So can you walk us through that whole story of what we're doing to damage our microbiome, besides just not eating fiber? And what changes happen in our microbiome, and how that starts to upramp the inflammation cycle in our body?

Dr. Shilpa Ravella: Right. So when you look at the microbiome, when you see for example, a mouse who grows in a sterile bubble with no microbiome, no germs on that mouse whatsoever, you find that this mouse actually tends to develop all kinds of abnormalities, like a deformed heart and lungs, and a shrunken brain. So microbes actually train our immune system, they help our immune systems to develop. Our microbes are having conversations with our immune cells at all hours of the day. And this is a process that begins even before we're born, and once we're born of course, and all throughout life. So we need to be having those essential conversations. And how do we foster those conversations? And again, it comes down to lifestyle. What kinds of foods are we eating? I had mentioned fiber, but there's so many other foods that are great for the gut microbiome. Because we know also, that a lot of the fats that we eat can make their way...
Some of them can make their way down into the colon. And we have that proportion of fats for example, being metabolized. And we know that there are spices and herbs, and all of these wonderful foods with polyphenols, which are amazing compounds for the gut microbiome. Because again, some of those make their way down and are metabolized by the microbiome. So it's not just about the fiber, but all of these amazing nutrients that we find in foods. And what we know today too, is that a dysbiotic microbiome or a microbiome that is an imbalance, is very often an inflammatory one. So when you have microbial dysbiosis, when you're eating a poor diet and not exercising, stressed out, and not getting enough sleep or social connections, and you have a dysbiotic microbiome, we do know that you most likely have low level, chronic inflammation coursing through the body in those states. So our microbiome is incredibly important for the inflammation picture as a whole.
And our immune system shapes the microbiome as well. We know that microbes do so much in the body, from digesting nutrients we cannot digest, to changing gene expression, to modulating the inflammatory response.

Dr. Mark Hyman: Yeah, your specialty has definitely got a new renaissance in the microbiome revolution. I mean, I remember speaking to gastroenterologists... I don't know, 20 plus years ago, and they were like, "Really? You think food has an impact on what's happening in the gut?" And I'm like, "Yeah." I mean, what a concept. And I think now it's finally... I mean it just amazes the doctor say, "Well, what you eat has nothing to do with your health, just your autoimmune disease, your colitis or whatever it is. It's like, it's not connected." And it's just kind of absurd. But food is the biggest signal transducer we are interacting with every day, and it's either driving up inflammation or calming down inflammation. And what we eat every day shapes our microbiome for better or worse. And so, when you can have an inflammatory microbiome or an anti-inflammatory microbiome, and it regulates everything from autoimmune diseases to heart disease, to obesity, to cancer, to Alzheimer's, to autism. I mean the list goes on and on and on.
So maybe it's probably one of the central things, when I'm actually treating patients for any problem, I mean that it remotely could be inflammatory. And in pretty much every chronic disease we have, I always start with thinking about the gut. I always like, "Well, how is their gut? Do they have any symptoms? What's their microbiome like?" You mentioned lactoferrin, that's one test you can measure, but you can also look at the immune system in the gut. You got the bacteria in there, you can look at calprotectin, eosinophil, protein X, all kinds of biomarkers that can tell you there's stuff cooking and causing trouble. And it might not be a full-blown, autoimmune disease in the gut, but actually is something you need to pay attention to. So I think that's really important. The microbiome, I think is one of the key factors driving inflammation, and the challenges of the microbiome. What are some of the other things you've found, that might be driving inflammation? Not things that people typically think about.

Dr. Shilpa Ravella: Well, I think one big thing also, is just the stress in our lives. And when we look at stress, we typically think of a bad boss at work or a bereavement, and things like that. One big stressor since the pandemic though has been just loneliness or lack of social connections. And I think this has been a huge and increasing stressor. Being lonely can be very detrimental to the health. And loneliness is tied to all different kinds of diseases, from heart disease and cancer, to obesity. And it's a stress on the body. And inflammation can be one mechanism by which stressors like loneliness, can cause illness. And what happens is, it's not the acute stress. I mean, if you're faced with a saber tooth tiger, as in ancestral times, you want to kill that tiger and go away. And it's not the acute fleeting stress, but it's these chronic, slow-going stressors that occur day after day.
And for a lonely individual, their bodies are going to react to that stress as they would to a germ. And it's kind of paradoxical because when you look at these hormones going through a body, it's an acute stress like cortisol and norepinephrine and epinephrine, you actually have a dampening of the immune response initially. But chronically, you actually have increased inflammation and you have increased cells, immune cells being made in your bone marrow. You have an expansion of white blood cells in the body. So this is what chronic stressors like loneliness do. And I think also, it's a systematic problem. It's a societal problem. It's not necessarily just an individual problem, and a problem that needs systemic solutions.

Dr. Mark Hyman: Yeah, for sure. I mean the social issues are huge. And I think in the blue zones, they live so long partly because they have such a deep connected community and that helps calm down inflammation. I think that's really actually, biologically, really plausible.

Dr. Shilpa Ravella: Yeah.

Dr. Mark Hyman: I also want to ask you about things that people don't necessarily think about connected to inflammation. For example, environmental toxins. What have you found around the role of environmental toxins and inflammation? Because it's something we can't really control as well as our diet or exercise, or stress levels, even our social relationships. But it just seems like we're in a sea of toxic chemicals, and what role are they playing in our immune system?

Dr. Shilpa Ravella: I've been seeing more and more data, just studies coming out on some of these chemicals just in daily household goods, from everything we use, from our cleaning products to the clothes we wear, and connections to inflammation in the body through those things as well. And then also just pollution in the air. And pollution, we know is very detrimental to health, linked to a variety of disorders. And inflammation could be one mechanistic pathway by which pollution also causes disease. But I certainly think that environmental toxins are a big part of the picture as well. It's the food we eat, that's a very, very big part. But it's also the air we breathe, how we live, and our household goods and our habits in that sense. So some of these chemicals in plastics for example, or even in your exercise clothes... I think there was a new study that just came out on chemicals in polyester clothes that folks wear for exercise.
And so, I really do think there is utility to really thinking about everything that you're bringing into your house and trying to stick to natural clothing materials, like maybe cotton and linen, over this kind of cheap and fast fashion for example, which has other issues associated with it as well. And I'm not saying someone has to be a hundred percent in avoiding every single chemical they've ever heard about, but I do think that it's prudent to really think about what you're bringing into your home. And this also allows us to live a more sustainable and environmentally friendly lifestyle in a lot of ways.

Dr. Mark Hyman: Yeah, it's true. I mean, I'm on the board of the environmental working group and there's all sorts of wonderful guides there,, for how to reduce your exposure from household products, from skincare products, from food, from pesticides, all the things that are really causing potential harm. And even autoimmune disease, there's now links to, for example, environmental toxins and autoimmune disease through a mechanism they call autogens. Rather than antigens, we call them autogens. Or obesity, or cancer. So all of these inflammatory problems can be triggered as well.
Also, from the diet perspective, what's your take on the increasing rise of true food allergies, as well as sort of food sensitivities? And why we're seeing this and is there merit to it? And as a gastroenterologist, you deal a lot with celiac disease. What's your perspective on the sort of increasing rates of gluten sensitivity? I mean, there was a 400% increase in true celiac disease, based on a large study of 10,000 pool of blood samples, from 50, 60 years ago, to those now, showing a real, true increase. So can you kind of talk about that whole realm? Because I think people really are confused about it and people maybe get a little crazy about food sensitivities. But I think it's an important thing to think about.

Dr. Shilpa Ravella: Yeah. I think there has been an increase in incidence of autoimmune disorders across the board, including celiac disease. And even in the last few decades, we're seeing a steep rise in all of these disorders. And we know that many of these disorders have a genetic component, some more than others. But we also know that we've transformed our environment. So it's not just the genes, and it's largely environmental factors that's also driving this increase, not just in autoimmunity, but also allergies as well, and food sensitivities. Part of the problem is that when we are born, and as we go through childhood, as we go through our lives, and the pandemic is a great example of this, we are not exposed to the microbes that we need to be exposed to. What we need to do is to be finding these microbes that evolved alongside humans in ancient times.
These microbes that are found in the air and mud, and the ocean. Those are the microbes that we need to be keeping in contact with, all throughout our lives. And there is a critical window during the first few years of life, when we especially need all of these microbes to help to train our immune system not to overreact against harmless particles, like dust and dander, but to actually accept what it should accept and to react against infectious, deadly germs. So we need an immune system that's balanced. And I think to have that balance in the immune system, we do need to be exposed to germs much, much more than we have been. And that means that we have to go outside, we have to be outside much more than we are. And it also means not being too, too clean in the house, it means trying to bring nature into the house as well. Maybe trying to have a garden-

Dr. Mark Hyman: So if you drop food on the floor, you should eat it?

Dr. Shilpa Ravella: Well, I say-

Dr. Mark Hyman: Should you not wash your vegetables?

Dr. Shilpa Ravella: Well... And this is the hard part, right? Because there's a balance. And it's tough, because during the pandemic, we were so clean and we were washing our hands a million times a day. And I think it's a fine balance, but one that can be struck. Because if you're going hiking in a place that you're very accustomed to, then maybe you don't have your kid do a complete hand wash after that. It's not essential. But if you're in a perfectly manicured lawn, then you sort of know that there's other things in there that you may not want your kids to have on their hands before dinnertime. So it's really a balance. And of course, if we're living through a pandemic, then it's important to keep all those measures intact and to wash our hands, and to be very cautious. But at the same time, when we go outside, interact with those microbes in the forest and parks and hikes, we are actually boosting our immunity as well. So we do need that interaction, even through pandemics and such. So I think it's a fine balance.

Dr. Mark Hyman: But you think there's a real truth to the increase in these food sensitivities and gluten sensitivity, they're not just in people's head?

Dr. Shilpa Ravella: I do, because if you look at this rise, it's been in the past few decades, and if you look at how much these chronic disorders have risen, the incidences of cancer, heart disease and autoimmune disorders, diabetes, I mean across the board, you see a huge rise in all of these disorders. And our genes cannot transform so quickly. And our environments meanwhile, are continuing to transform. And just with the advent of processed foods even. If you look at the 1950s, a dinner plate in the 1950s, you would not find the amount of processed foods that you find today. And these foods are...
They're kind of like Franken foods. They have so many additives that we do not understand. And it's tough also, in healthcare and in medicine, to try to prescribe lifestyle medicine. And lots of folks are working on that, and that's the goal of all health and wellness practitioners. But the system is set up so that it is just harder and more time-consuming to implement these things. So that's a process, an ongoing process as well. But I absolutely think that we do have a rise in all of these disorders, including autoimmunity, because of our lifestyle in part.

Dr. Mark Hyman: Yeah, that's true. I think there's some things that are out there now, that I think are driving inflammation and create a lot of chronic sort of issues. And I think we've seen this with COVID for example. We saw this sort of wave of COVID, but now that's calmed down, there's a whole aftermath of what we call post COVID syndrome or long COVID, or long haul COVID. And that is an inflammatory condition that's real, and it's making people feel like crap. Brain fog, fatigue, muscle aches, all sorts of symptoms. And so, the other thing that I think is driving inflammation for people are some of these low grade, chronic infections. And it could be things like Lyme disease or other tick-borne illnesses, certain viruses that get activated if your immune system's not regulated well. COVID is a great example of something that kind of persists. So what's your take on how we think about looking for those root causes of inflammation?

Dr. Shilpa Ravella: Well, I think especially as we age, it becomes harder for our immune system to fend off pathogens. And it's more likely that we may have some of these low level, infectious issues. So I certainly recommend going to your physician and going to your specialist, and getting a full workup for whatever it is that you do need. Just being mindful of signs and symptoms at home, clinical signs and symptoms as well. And I think that's one of the best things that you can do.

Dr. Mark Hyman: Yeah. In terms of another sort of take on this, the inflammation that we're getting is an issue, right? We've talked about diet, we've talked about stress, we've talked about toxins, we talked about allergens, we talked about the microbiome, we've talked about infections, all things that are triggering inflammation. So as a physician, you have to be really good at being a detective about all these things. How do you analyze diet, exercise, stress, sleep, obviously lifestyle factors? But also, how do you look for hidden infections? How do you look for hidden toxins? How do you look for what's going on in the microbiome? How do you measure what may be the root causes? But we also have an opportunity, once you've done that, to live an antiinflammatory lifestyle, to reduce inflammation.
So how, as a physician, do you think about addressing this? Because it's not like, take aspirin or Advil, or take an immunosuppressive drug. I mean, I read one study for depression where they were using basically these TNF alpha blockers, these powerful, biological immune suppressants to treat depression because they thought it was inflammation in the brain. I'm like, "That is the worst idea I've ever heard about." So can you talk about how we can start to think about reducing inflammation in the body? What are the tools we have to treat it? And how do we start on that process?

Dr. Shilpa Ravella: I think for one, if I see a patient coming into my clinic, the first thing I want to establish is their baseline. What source of comorbidities do they have? And then also, what kinds of GI comorbidities? If you have, for example, intestinal bacterial overgrowth, you may have sensitivities to certain foods, that may resolve entirely after that overgrowth is treated. If you have things like microscopic inflammation of the colon, you may need to treat that first. If you are very, very stressed out and have had major stressors in your life, then that could play a part in the types of foods you tolerate and your general health as well. So I think just looking at the baseline health of an individual is kind of my first step. And then from there, I do prescribe empiric lifestyle therapies. So I empirically prescribe dietary and lifestyle therapies for patients, that can actually help them to live a more anti-inflammatory life.
I think everyone is different. And I have patients, I had a huge population of patients at one point, who were missing most of their intestines. So instead of having a 20 feet of small bowel, they had 20 centimeters. And of course, dietary recommendations have to be tailored. But looking at all of these different food sensitivities and allergies and food intolerances, you really have to tailor the diet in those situations, to each individuals. And when you're looking at a global sort of a diet, a population-wide diet... Because these are population-wide problems, when we're talking about these chronic inflammatory disorders, like heart disease and obesity, and cancer. And I prescribe diets like the Mediterranean diet or the Okinawan diet. I think there's no single size fits all type of answer sometimes, but the dietary patterns that we have today that are rooted in tradition, are absolutely wonderful, and that's something I use to personalize a diet for each patient. Because I think in so many of these cultures, the ancient traditions do really support a diet that is very anti-inflammatory.

Dr. Mark Hyman: It's true. And a lot of the diet that's the most inflammatory is the amount of sugar in the diet. And I think sugar and starch are probably the most inflammatory foods, and they drive that belly fat, which is a very different kind of fat, that we talked about earlier. And I think that's the fat that's driving so much of the inflammation and is a problem. One of the most powerful things, as a functional medicine doctor, that I've done, and I think if I had one tool as a doctor, if I only had one prescription to give people for everything, it would be an anti-inflammatory diet, but a particular kind of one. We call it an elimination diet. And typically, this has been sort of dismissed by most of traditional medicine, but I'd love your perspective on the idea of removing all the inflammatory foods and adding in all the anti-inflammatory foods, as a strategy for treating a wide host of chronic diseases.

Dr. Shilpa Ravella: I think certainly in certain conditions, for example, with chronic food allergies and such, where it's some immediate reaction, there are food elimination diets that you can do. And in my population, I have patients with irritable bowel syndrome, and those patients have a certain elimination diets as well. So I do think that elimination diets do play a role in several conditions. When I see a patient in my clinic and I want to prescribe a broad anti-inflammatory diet, yes, of course I take out all those western foods, those processed foods, and I start slowly adding in some of these other foods that are higher in fiber. And I think one thing also to keep in mind is that it's a process. It doesn't happen overnight. Your gut can alter its secretions and its contractions over time, to better process fiber. And that's something that for most people, if they start from a low fiber diet to a hundred percent fiber diet, then they kind of get discouraged initially.
And so, that's one thing that I tell people to be mindful of. But certainly I do use some elimination diets in my practice, and for a variety of disorders. And I think it can be useful to keep a food journal, to really try to figure out which of these foods are causing issues for you. So for eosinophilic esophagitis, which is an inflammation of the esophagus, we know that there is a type of elimination diet that can actually help that condition. And you can eliminate six foods at once or a single food at a time. So I try to go with a single food at a time, and then reintroduce it back in a couple of weeks to see if that food is actually causing problems. And I think patients can benefit from that, as opposed to just starting steroids or starting a medication immediately, after such diagnoses.

Dr. Mark Hyman: I just recall a patient I had from Cleveland Clinic a number of years ago, who sort of had a terrible autoimmune disease, psoriatic arthritis, and had... Just miserable, with joint pain and inflammation, and terrible skin lesions. But she also had pre-diabetes, she had depression, she had migraines, she had severe reflux, she had severe irritable bowel with bloating. And rather than... And she was seen by the best physicians, getting the best drugs, she was on a $50,000 a year medication for autoimmune disease. She was on reflux medication, she was on antidepressants, she was on metformin. She was a mess. And she came in to see me and she was... These were managed but they weren't better. And I said, "Gee, well, it seems like you have a lot of inflammatory diseases. Depression is inflammation, insulin resistance inflammation, psoriasis inflammation, arthritis is inflammation, your gut stuff is inflammation. Why don't we just try to deal with the root cause based on your symptoms." Which I sort of deduced to be her gut.
And so I gave her... She had really bad bacterial overgrowth or sibo, she had fungal overgrowth from all the steroids and antibiotics she'd been on. And so I gave her an antibiotic and an antifungal. I cleared out the bad bugs in her gut. I repopulated it with healthy bugs. I put her on elimination diet, got rid of gluten, dairy, sugar, processed food, and gave her some probiotics and vitamin D and fish oil. And she came back six weeks later, and I thought... I didn't tell her to stop any of her meds. I just said, "Why don't you try this? See how you do." She came back six weeks later, and she stopped all her medication, she had no more psoriasis, no more arthritis, no more depression, no more irritable bowel, no more reflux, no more migraines. And her weight dropped by 20 points and she reversed her insulin resistance.
And I was like, "Wow. This is powerful." And most doctors would not think about doing that. But it was just basically an elimination diet and a reboot of her gut, that dealt with all these issues. And many of us walk around with things that are not as severe, but that would really respond to a trial of elimination diet. And actually, that's why I wrote a book called The 10-Day Detox Diet. It's basically an elimination diet. And I've used it over and over, and it's remarkable. Like 70% reduction in all symptoms from all diseases, just using that approach. And it's almost like a reboot.
And I find it so powerful. And you can eliminate one thing at a time, but my philosophy is to try to reboot. Like your computer just not working, you can't just shut off one program, you got to kind of restart the whole thing. And it's amazing, the level of inflammation that goes down, the fluid comes out of their body, they feel better, their skin gets better. And it's something that I think most doctors should know about and learn about, but we don't learn anything about it. My daughter's in medical school now and she's not learning anything about nutrition, nothing about what's ideal-

Dr. Shilpa Ravella: That's very common. That's very common.

Dr. Mark Hyman: And not even learning about the microbiome, which is like... It's not exactly alternative medicine anymore and-

Dr. Shilpa Ravella: Well, you can teach her about nutrition.

Dr. Mark Hyman: I try, trust me. I can't get her to read one of my books.

Dr. Shilpa Ravella: Oh, no.

Dr. Mark Hyman: It's okay. She's coming around. I think she'll come around. But she's learning. I mean, it's tough because we're so outdated in our practice, we haven't incorporated a lot of this emerging science. And your work, your book, The Silent Fire, your article in Time Magazine, Wall Street Journal, were really great because they help people to see that we need to really think differently about these problems that we face as a society.

Dr. Shilpa Ravella: Thank you, I appreciate that.

Dr. Mark Hyman: So what are the other suggestions you have for people in terms of how to address inflammation? What are the sort of suggestions you have in your book? What are the kind of guidelines you use to help people think about this?

Dr. Shilpa Ravella: So one of the other things too, that we haven't talked about, is just trying to do some exercise as much as you can every day. And this doesn't have to be going to a gym and doing two hours of exercise a day, and lifting hard weights. I tend to think of it as the blue zones' folks would think of it, where you incorporate exercise naturally into the day. And we know today, that exercise actually can dampen inflammation in the body. We have dozens of clinical trials to back this up. And even in the absence of weight loss, the exercise can decrease the amount of immune cells that are infiltrating your fat tissue. And to me, that's an amazing fact because we're not just looking at the end result, weight loss, we're actually changing our bodies on a biological level, even if we are not able to see it on the outside.
And so just getting out and moving every day, even if you do it in small bursts, that tends to add up. For example, if you take the train, if you take your bike instead of the train. Or if you try to go up the stairs instead of taking the elevator. All of these different things can actually add some exercise in your day, some movement in your day. And when you think about the blue zones' folks, this is how they incorporated some movement into their days. And I think it's a very seamless way to do it. And nothing wrong with going to the gym and exercising, or anything like that, but for most people, it's this difficult thing to begin exercising, when they have not done any of it. Especially some of my patients who come to me saying, "Doc, I don't have time to incorporate exercise into my day."
And this is something I think, that anyone can do, just by making some simple lifestyle changes, and it can actually dampen the inflammation in the body. And another thing too, I think, is to just be mindful of the times at which you're eating. Because fasting has been shown to dampen inflammation in the body, to fortify your body against a variety of diseases. And just something as simple as trying to consume your calories in a 10-hour window. It doesn't have to be anything complicated. And of course if you have comorbidities, then you should speak to your physician and a nutritionist, before attempting a fasting program. But we do know that stressors like exercise and fasting are good stress in our life, because we have to have the good stress and also maintain the bad stress that we don't want. And those things I think, are very important for inflammation.

Dr. Mark Hyman: Yeah, I think that's really important to think about. I think exercise is so key, and I think we don't realize how powerful it is as a trigger for all the beneficial things we want to have happen with aging. And it works for depression, it works for heart disease, for cancer, for diabetes, for Alzheimer's, for every kind of inflammatory disease. It's pretty amazing. And yet, less than 8% of Americans get the recommended amount of exercise. I think maybe 20 something if you take a broader view of what's minimal. But I think most people don't even get close to that. I think... What about the role of supplements or phytochemicals, or other things that we can be taking to help regulate our immune system? Do you have any perspective on that?

Dr. Shilpa Ravella: I mean, I do love to tell patients to get their phytochemicals from the foods first. So I basically have my patients eat lots and lots of colorful vegetables. And we know that polyphenols are incredibly important phytochemicals for inflammation. They're antioxidants, they help to tone inflammation down in the body. They're also metabolized by the gut microbiome in part, and more beneficial compounds were created. So I certainly think that polyphenols have a major role. And when I think about supplements, I think it's more the exception than the rule. So when you look at supplements like curcumin supplements, some of which have been shown to be efficacious in diseases like inflammatory bowel disease, that's a great thing. You can also use curcumin in your cooking, for example. So I think with supplements, as long as you have the data behind them, then that could be something that is potentially beneficial, depending on your disease process as well.

Dr. Mark Hyman: The things that I tend to sort of recommend people to eat are certain foods which have anti-inflammatory compounds. So what are your top anti-inflammatory foods that people should be focused on?

Dr. Shilpa Ravella: Well, I really love greens. I think kale is one of my favorite greens. It has the immune modulating potential of our ancestors, our ancestral plants, and it's very versatile, very easy to cook. So we want to try to get to foods that are more like those ancestral plants, like scallions instead of onions, for example. Because the ancestral iterations are actually much more powerful from an inflammation damping standpoint. Berries, again, are a wonderful food. You can have frozen berries, for example, just in your freezer and eat them whenever you want.
And they're filled with a variety of phytochemicals, including polyphenols. And when you think about inflammation, you really want to think about the very, very colorful foods, not just the iceberg lettuce and the bananas. And in my pantry, I have a variety of whole grains. And by whole grains, I mean actually whole. So I love quinoa. It's one of my favorite grains. And I think it's something that is very easy to use. And whole intact grains are actually much better for your gut microbiome than processed grains. So that's just something that's a nuance, that can be helpful when it comes to talking about inflammation. And also fermen-

Dr. Mark Hyman: Fermentation?

Dr. Shilpa Ravella: Yeah, fermentation of those grains. So I think that when we are talking about grains in general, or certain foods, we really do need to be looking at the nuances. So if you have a hearty bread that's fermented and baked in the ancient tradition, without any flour say, that's a very different response in terms of your immune response, than a bread that you buy at the supermarket. And so that's something to be very mindful of. And I love beans as well, and lentils. There are dozens of randomized controlled trials showing that beans can help to dampen inflammation and beans have a good amount of soluble fiber. And you probably know all of this already, so I'm just regurgitating what you already know here.

Dr. Mark Hyman: No, great. People need to hear it. People need to hear it.

Dr. Shilpa Ravella: But that soluble fiber is very important-

Dr. Mark Hyman: This podcast isn't for me, it's for everybody listening.

Dr. Shilpa Ravella: Yeah, yeah. So that soluble fiber is very important for the gut germs, and they metabolize that fiber and you salvage calories that way, you make beneficial compounds that go throughout the body and calm the immune system down. And one thing I think that-

Dr. Mark Hyman: So feeding... I don't want you to skip over that.

Dr. Shilpa Ravella: Oh, sure.

Dr. Mark Hyman: Feeding your microbiome is so important, right? And it loves fiber-

Dr. Shilpa Ravella: It's incredibly important, yes.

Dr. Mark Hyman: And also those polyphenols-

Dr. Shilpa Ravella: Yes, polyphenols.

Dr. Mark Hyman: Which is a relatively new discovery. So they're not just eating fiber, but they're eating all the colorful plant compounds that can improve their bacterial content in there.

Dr. Shilpa Ravella: And they're also eating some fat, healthy fats from nuts and seeds. And that's another food that I prescribe for patients. All those healthy, monounsaturated fats and just a handful of nuts a day, is a great thing to add into the diet. And then something I think that people tend to forget about are just spices and herbs. I mean there are so many different spices you can use. And in my family's traditions, the cuisines that my parents and grandparents cook, they're just an array of spices that I can't even... I still have to learn all the names of everything. But spices and herbs are just filled with polyphenols and just very, very beneficial nutrients. You look at something like cumin, which has salicylic acid in it. You're actually getting kind of some anti-inflammatory potential from that, which also helps to resolve inflammation. Because aspirin is one of the few medications that actually not only dampens, but also resolves inflammation. And just thinking of things like seeds-

Dr. Mark Hyman: Yeah. A lot of people were talking during COVID about using black cumin seed oil as a... Black cumin seeds are really different, kind of a cumin. And it's a very powerful immune modulator and anti-inflammatory, potentially antiviral. So these spices and herbs, we sort of neglect. We use a lot of salt, a lot of sugar, a lot of processed refined oils, to make food taste good, and we don't actually use the spices. And then you don't really need that much of those other things when you actually have a yummy, spicy, yummy diet. I mean, I love to cook Indian food at home. I actually make it scratch stuff. So I actually get the actual spices, I grind them, I get the pepper.

Dr. Shilpa Ravella: Oh, that's wonderful.

Dr. Mark Hyman: And it's like... Oh, it's so good. And it's like-

Dr. Shilpa Ravella: It's a lot of hard work. It's a lot of hard work.

Dr. Mark Hyman: Well, I have a little-

Dr. Shilpa Ravella: But good for you.

Dr. Mark Hyman: I have a little, Braun like thing and I just push the button and go... So it's fine. But it's so important to start to include these in your diet on a regular basis.

Dr. Shilpa Ravella: Absolutely. And the one thing I want to mention, the last thing, is also seaweed, because I love seaweed and it's kind of like a super food in some ways. And you can find fibers in seaweed that you don't find in terrestrial plants. And the goal is to-

Dr. Mark Hyman: Yeah. Tell us about that.

Dr. Shilpa Ravella: The goal is just to have a diverse array of some of these plants. And we know that simply by increasing the diversity of plant foods in the diet, that can actually predict lower inflammation. So it's not just about the quantity, but also the diversity. So just thinking about all these different types of foods that you can get, I think can be pretty useful.

Dr. Mark Hyman: I mean, people do eat sushi and they may eat a little seaweed, but tell us about seaweed. Because I think people don't talk enough about it. I'd love to drill down on that a little bit, if you can.

Dr. Shilpa Ravella: Yeah. So if you look at the Okinawan tradition, what you can do is just make a simple miso soup and put some dolls, or other types of seaweed in that. And seaweeds have a variety of fibers that basically you don't find anywhere else. And you can use it as a condiment. You can just sprinkle some seaweed flakes on anything you want really. And it's very, very versatile and easy to use in all kinds of cooking. And it's something I think that I eat probably on a daily basis. And I had not grown up eating it, but it's something I sort of added into my diet after a while. And I find that it's very easy to use overall.

Dr. Mark Hyman: And it also contains all these polysaccharides and compounds that have anti-cancer properties, immune modulating properties. They also are a great source of minerals and things that you can't get other places. So definitely seaweed, fermented foods, you mentioned a lot of spices. These are all things that are in the plant kingdom that are phytochemicals that regulate our biology, and people don't use enough of. So it's also... It's not just what you don't eat. It's like, get rid of all the starch, sugar, processed foods, so far that we talked about, and low fiber foods. But also, it's increasing all the foods that are anti-inflammatory. And that's a really powerful strategy for people. But I would say that if you have something, like a bad microbiome or you have some low grade infection, or you're exposed to some toxin, or you have some real significant food sensitivity or gluten sensitivity, you kind of have to deal with the cause. Because you can eat all the kale you want, if you've got something going on, you've got to deal with that. And I'm often sort of shocked.
I had one patient with colitis years ago, who was doing everything right. I put him on all the right stuff, an anti-inflammatory diet, elimination diet, probiotics, everything. And he just was getting worse. It wasn't getting better. And I was like, "What's going on?" And it's like, "Well, maybe there's something else." And so I said, "Let's check for heavy metals." And we checked and he had super high levels of mercury. We got the mercury out of his system, we chelated out, and his colitis went away and he was good as new. And I've seen this multiple times. Another one with lead, who was a woman who had Crohn's disease, really bad lead toxicity. And so we don't think of these things, but we have to be really good detectives as physicians, and think about, why is the immune system so pissed off in the first place? Not, "What's the name of your disease? And let me give you the drug for that disease." But actually, "How do I think differently about the root causes of what's causing this?"

Dr. Shilpa Ravella: Yeah, I think it's absolutely true. And we have sort of a break and fix model of medicine often, instead of a preventative model, or even a digging into the root cause type of an evaluation. So I think it's something that's evolving and we'll see more and more tests come out in the future, hopefully to test for inflammation and also for other issues as well, that may be root causes of that inflammation.

Dr. Mark Hyman: What are you most excited about that you're seeing in this field that's coming around the bend, around how we begin to assess and treat inflammation in a different way in medicine?

Dr. Shilpa Ravella: I think I am very excited about the microbiome research. I think just for inflammation to be a mechanistic link. Because when you look at the microbiome and disease studies, a lot of these are associated studies. And to really understand a little bit more about the mechanism and to see the signs behind that, I think would be very interesting. I think the immune system is sort of ripe for investigation in that area. And I would love to see more large scale clinical trials, like Cantos for heart disease, and see if there are treatments potentially for certain conditions. The FDA approved this year, colchicine, which is an anti-inflammatory drug for patients with heart disease. So that's something that potentially could be used.

Dr. Mark Hyman: Wow. That's interesting. I mean, to me, that's a bit backwards because it's like, well, what about getting rid of the cause of the inflammation rather than just taking aspirin?

Dr. Shilpa Ravella: Absolutely. And I do agree with looking for the root cause and addressing those issues first. And I think one of the exciting things for me, is just looking at the fact that modern medicine has so much to offer, from these multiple organ transplants to cancer immunotherapies. So I think we definitely should be focused on the preventative side and also, try to be focused on the anti-inflammatory diet and lifestyle on the therapeutic side as well. Because we know for example, that when you have transplant patients, like kidney transplant patients, who take in the Mediterranean diet, they have a lower risk of graft rejection.
So we know that even when you have some of those conditions, you may have a lot of benefit from managing your lifestyle. And I think as we age in this current environment, many of us are going to have artificial organs, maybe prosthetic organs, and also immunotherapies. And really learning how to manipulate our immune system through diet and lifestyle, which is a type of gene therapy, will be very important. Because we are all turning into these new humans in some ways, and we're facing ecological disasters, like climate change and pandemics, and this type of lifestyle will also be beneficial-

Dr. Mark Hyman: Makes us more resilient.

Dr. Shilpa Ravella: Absolutely.

Dr. Mark Hyman: Yeah. I mean, it's pretty clear that people who died from COVID were the ones who were inflamed when it hit them.

Dr. Shilpa Ravella: Yeah.

Dr. Mark Hyman: I mean if you were healthy, you generally were pretty okay. You might've gotten sick, but you weren't going to die or end up in the hospital. So I mean, it's important for us to think about, as a society, what do we need to do to kind of reset and to learn from this? I mean, I was super frustrated with the NIH director who recently retired, Francis Collins. He's an amazing guy, I love him in so many ways. But I said, "Why don't you use COVID as a teachable moment, to help people understand the role of diet in driving so much of the morbidity and mortality from COVID?" And he's like, "Well, we don't want to blame the victim." I'm like, "Well, this is not their fault. I mean, we live in a toxic food environment that's caused by our food policies and food system, and we need to educate people on how to fight against that."
And so, it was a little disappointing. But I think we really are at this teachable moment where we have this opportunity to really change how we're thinking about things. And I really applaud your work. I'm glad you're doing this in mainstream medicine at Columbia University, and working hard to bring awareness around this. I don't know how you're being received by your colleagues. Are they still talking to you?

Dr. Shilpa Ravella: They are, yes. Honestly, I think there are so many more practitioners today, who are very interested in diet and lifestyle, and there is just a gamut of evidence. It's hard to ignore the evidence of what nutrition science has taught us throughout history, and also all of the new research on the microbiome as well. So I think there are more and more folks, and also students in medical school, who are very interested in lifestyle medicine and inflammation, which we've been talking about for a very long time. Because I remember when I was a medical student, I think I came across your work. And it's a topic that has been talked about for a long time. And I think finally, western medicine is starting to take note as well. And I think it's great that you do work to bring awareness about this topic. And I think it's important for health and wellness professionals to band together, because I think that is how the world is going to be changed. It's not about... If you look at paleo versus vegan, versus vegetarian diets, any of those diet labels tell you nothing about the actual diet.

Dr. Mark Hyman: Right. Right.

Dr. Shilpa Ravella: And you can have a responsibly designed diet in each of those categories, that supports planetary health and that supports microbiome health. And I think that's key, and that's how we're all going to move things forward.

Dr. Mark Hyman: Well, Shilpa, thank you so much. You've been a guiding light in this, and I'm so glad your work is getting out there, and you're getting mainstream media. And I just think it's so important that people start to really take seriously this epidemic of inflammation that's hidden in this, like you call it, a silent fire. So thank you so much.

Dr. Shilpa Ravella: Thank you so much for having me, Mark. It was a pleasure.

Dr. Mark Hyman: Please share this podcast with your friends and family. I think it's very important for them to hear. Leave a comment, how have you dealt with your own inflammation? What have you learned about how your body's regulating your immune system and inflammation? Maybe we can learn some things from you. And subscribe wherever you get your podcasts, and we'll see you next week on the Doctor's Farmacy.

Closing: 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 healthcare practitioner, and can help you make changes, especially when it comes to your health.