Chronic Inflammation: The Hidden Driver Behind Autoimmune Disease, Fatigue, and Gut Health | Daniel Cardenas

[00:00:00] People who have autoimmune disease and they have to be checking their vitamin D at least every six months. 

Where is conventional medicine still missing the mark when it comes to chronic inflammatory conditions? 

We tend, as physicians, see things separately. Inflammatory diseases is everywhere in chronic disease.

In chronic states, it starts to alter other systems in the body. 

From Red Cross paramedic to physician, neurosciences trainee, and functional medicine expert, Dr. Daniel Cardenas brings a powerful perspective on the mind-body connection, chronic pain, and what real healing can look like. 

When someone's in the early antibody stage, and they're starting to have symptoms, what are some of the things that you recommend they start doing so that they don't end up in that full tissue damage side?

There are people who think it's inevitable. If you have antibodies, it is gonna progress, no matter what. 

It has the opposite effect of helping your body 

We have both [00:01:00] seen how often women are told their symptoms are normal when they are clearly not. From your perspective, where is conventional medicine still missing the mark when it comes to chronic inflammatory conditions?

Okay, that's a very nice question. We tend, as a physicians, like see things separately. Like, uh, systems with like endocrinology and then cardiometabolic and things that are like different. But at the end of the day, when you start looking at all the chronic, um, illness, you realize there's always an inflammatory compound, no matter what, where it comes.

Like, it always something that is, uh, the inflammation, like getting worse or creating the, the symptoms that the patient- Mm ... is having. So when you start to looking at like, um, with a, with a view, like a integral view of the disease, you start realizing that inflammatory diseases is everywhere in chronic disease.

Mm-hmm. 

Like, no matter, no matter what system. So that's, that is it. 

And I appreciate you saying that [00:02:00] because it can be really frustrating for patients when, you know, they have something like a surgery to treat a condition or they take one step that their doctor says this is the solution, but yet the inflammation persists.

So when we're talking about inflammation, what are we talking about specifically, and how can a patient know when inflammation is a bad thing? Because it's not always a bad thing, but sometimes it's a very bad thing. 

Yeah. First of all, we have to understand that inflammation, i- it's good. It's, it's a system that our body has to defend itself.

It's not something bad. The problem, it's when it's chronic inflammation. Like for example, when you have a, a fever or something like that, like an infection, your body reacts with inflammation, with... It also helps the processes to your body helping to get, uh, healthier, to get through the disease. But when you have it like, uh, in chronic states, it starts to alter other systems in the body, and it has the opposite effect of helping your body.

It has the effect [00:03:00] of, uh, slowing, uh, healing. It has the effect also in some, uh, parts of the mental state because when you're talking about inflammation, you're not just talking about like the gut or something. When you have a flu, how is your mood? You are like, "Ugh," like, or you don't want to do anything.

Uh, so inflammation we have to see like- In all the systems in the body, and I think that's the, the main thing. 

Mm-hmm. 

Yeah. 

If someone's listening to this right now, how can they know they have chronic inflammation? What are some of the common symptoms? 

The mood is one of the things that you can see because I, I saw a lot of patients, uh, and in my clinical experience they say like, "I have a heavy character.

I'm very... I, I don't have, like, tolerance for anything." But then you see their habits. Uh, they're, they're eating, uh, processed food. They're not working, uh, and they have something. Okay? So the mood is very important to, to realize that you have, like, the inflammation. Also, uh, when you [00:04:00] are, uh, in an inf- inflammated body the immune system is not regulated So imagine that like an army.

Like in inflammation, the army, it's like, uh, here, here, and they're, like, not in a very well, uh, formation, so they're very vulnerable to viruses, to catch a flu 

Yeah. I would imagine fatigue too is a big one. Fatigue, yes. Yeah And fatigue can sometimes feel like mental fatigue. It can also masquerade as depression.

I wanna talk about leaky gut. This term gets thrown around a lot, but we know that gut dysfunction can be a major source of inflammation. 

Yes. 

So often you'll hear conventional doctors say there's no such thing as leaky gut. Yeah, 

I've heard that. Yeah 

Yet we do have a lot of research. It's, it's funny 'cause they'll say the same thing, "There's no such thing as HPA axis dysregulation.

There's only Cushing's or Addison's disease." Addison's And I'm like, okay, but we've got, like, a chronic disease epidemic, and you're [00:05:00] telling me the only states where cortisol will be off is in extreme disease states? Yes. And we wonder why people feel like they're not getting help. But going back to intestinal hyperpermeability, for maybe people who have heard this only for the first time right now, how would you describe that to them?

When you have intestinal permeability, uh, inflammation, for example, is made for you, as we were talking at the beginning, is made for your body to have, uh, a better response to illness. So, uh, it creates spaces. When you are in an inflammatory state, uh, for example, in a vascular fight when you have a heat or something, uh, your body reacts, uh, in a vascular level to open up and allow, like, your defenses to go there and fight for you.

So when you have, uh, chronic states of inflammatory gut, it happens the same. The, the cells in the, in the intestine, because of the continuous state of inflammation, they start to, to have a little bit of [00:06:00] gaps between them. So those gaps are not meant to be there. So when you eat something, like, um, whatever thing you, you have, uh, it has to pass through the cells, not between the cells.

But you have the, that inflammation, you have that gap, they, there start to pass some things, uh, in that, those kind of gap that don't, doesn't have to be there. Mm. So your body doesn't know anything about, like, it's good or it's bad. It just takes something that doesn't have to be there, and they create defenses against that specific thing So there's a lot of things that when, when they start to pass, of course, uh, the body doesn't know, so they react as inflammation.

So, uh, that inflammation also is gonna continue, continue, continue because every time you eat, it's gonna pass something through that gap, and your body's gonna response. And if that kind of things are similar to other tissue in your body, or you start eating like something like a very common thing, [00:07:00] and it's...

and your body's gonna recognize it, it's gonna make defenses against it, and imagine that that thing is, has a little bit, uh, s- uh, similar to other tissue in your body- Mm-hmm ... your body's not gonna know, and they're gonna attack. So it's leaky gut and, uh, molecular mimicry. I al- always make the, the comparison with, uh, rheumatic fever.

Like for example, when you have, uh, rheumatic fever because of a bacteria, uh, the body creates, um, defenses against that bacteria, specific ones. And in a molecular way that we call, like, uh, molecular mimicry, uh, they are pretty, pretty much the same of one part of the heart. So the body creates like an army against the bacteria, but then, uh, they confuse themself because it's very similar, like the, this part of the heart, so they start to attack this part of the heart.

So that is molecular mimicry. 

So if someone's like, "I suspect I have chronic [00:08:00] inflammation," what labs should practitioners be running to evaluate that? 

Uh, well, y- you can diff- differentiate, like, in the, the basic ones, or you can do, like, other labs are more, um, uh, how can I say? Like, specialized- Mm-hmm ... like labs.

Like for example, when you, uh, test fatty acids in the blood and things like that. But going to the basic ones, PSG, like the, the... I, I don't recall the... how, how can... is, is the, um, translation. Uh, sedimental globular velocity. Uh, PS- 

Oh, so like an ESR. 

ESR. Yeah. Yes. Yeah, so that one is, it's very, very simple to test in a lab.

Mm-hmm. And you can, you can use it, and it's, it's very good. Um, other, other labs that, that are pretty interesting also, it's, uh, for example, homocysteine, homocysteine levels. Mm-hmm. Uh, it also talks about, like, inflammation, and there's some levels that, that, laboratory, sorry, that are a little bit indirect, indirect.

Uh, when you can measure, [00:09:00] uh, for example, cortisol. When cortisol is elevated but you have to test it, like, in saliva, and maybe four points of, of the cortisol test in saliva, uh, you can see, like, uh, the patient is in a inflammatory state also. 

Mm-hmm. 

Yeah. Mm-hmm. 

What are you looking for specifically in that cortisol panel?

Um, you're looking for, for the response of the HPA axis, uh, of the patient. 

Mm-hmm. 

So first we have to identify, like, there are three stages of HP axis dysfunction. Uh, the first one is, uh, not very evident, and you have to match up the cortisol levels with DHEA, uh, sulfate. It's, it's better. So then, uh, you can see how the body is reacting to stress.

Mm-hmm. Um, and then you can say, okay, this phase, in the phase one, it's when the body is just beginning with the state of stress. Uh, then there's another phase, uh, when it's a little bit more regulated. The body's always trying to have [00:10:00] homeostatis, homeostasis, sorry. And the latest stage is when it's like, uh, already fatigue, and the cortisol may be lower.

Mm-hmm. 

Uh, it's not... That's why it's not very good just to have, like, the serum cortisol of one test because it doesn't says you, like, uh, much about how your patient is reacting- Mm-hmm ... to, to stress. Yeah. 

Yeah. And for people listening, we use saliva and we use urine to eval- evaluate the cortisol levels because four points of either spitting or urinating is much easier than four blood draws during the day.

I would never subject somebody to that. And, you know, going back to the lab testing, the other thing I think is interesting for women to understand is that ferritin- Mm-hmm ... can be a marker of inflammation. Mm. And so sometimes women are actually iron deficient, but their ferritin is elevated, and they think, "Well, oh, I have a great ferritin," but it's because it's actually attributed to inflammation.

Yes, that's very good. 

Yeah. 

Mm-hmm. 

What do you see are some of the biggest [00:11:00] offenders for creating that intestinal hyperpermeability in individuals? 

It's habits, like chronic stress, it alters a lot of things. Alcohol, and I also in my practice saw a lot of patients that after a surgery they have, uh, the chronic inflammation.

So, um, we have to look at things that makes us feel bloated, for example, and it has to be, uh, there are some people, for example, when they, uh, gluten, when they eat gluten, they have this kind of reaction. There are people that not. But, uh, I think all the things that you feel that, uh, overwhelmed your, your gut- 

Mm-hmm

is gonna happen, is gonna be, uh, a possible, uh, way for, uh, having leaky gut. 

Yeah. Mm-hmm. And we also know there's a lot of common medications. Mm-hmm. So a lot of over-the-counter medications like an- um, anti-inflammatories, like NSAIDs. Hormonal birth control has been- Yes ... implicated in driving intestinal [00:12:00] hyperpermeability- Yeah

which is specifically the oral contraceptive pill, which I find very troubling because so many of these women are on that for decades. Yes. We're gonna talk about things you can do to support your gut health, but I, I, before we go there, I wanna go a little bit deeper on this molecular mimicry. You had mentioned gluten.

Mm-hmm. And there's this really interesting phenomenon where people tend to have gluten issues in the United States, and yet you'll see people in other countries don't have the rate of non-celiac gluten sensitivity. You practice in Mexico, so I'm curious, do you see people have, you know, a heightened sensitivity to gluten, or what's been your clinical experience?

Well, my clinical experience is, uh, it's something very interesting because, uh- I receive a lot of, of patients that they have all the tests, uh, because in, um, physician's mind, when you talk about gluten, uh, you always think about celiac. 

Mm-hmm. 

And they, they come patients and they told me, "I don't have celiac disease.

I don't know what [00:13:00] happens. I don't have allergy. I can eat a bread and I don't feel nothing, but now I have, uh, thyroid problems like Hashimoto. I have burnout. I have a lot of things." So, um, I always start with, um, trying with some patients because, and explaining to them that is not an allergy. That is not that you're celiac.

It's a sensitivity. 

Mm-hmm. 

And that kind of sensitivity is not always, like, uh, obvious. I think, uh, we have a very, uh, useful tool in functional medicine, uh, which is the elimination diet. So sometimes it's a little bit hard for the patient because you get rid of some, uh, foods like for example, uh, gluten, like, uh, dairy, uh, eggs.

But for them are like, it's very, very hard for some people to get rid of them. Corn also. Imagine in Mexico- ... like getting rid of corn, like it's- Like 

sacrilegious. 

Yeah. You can't do that. Like, you just can't do that. But in my clinical practice what I saw, it's, [00:14:00] uh, when I take off wheat, I, I, I realize like a lot of patients, like maybe, I don't know, not everybody because this is not for everybody, but 80% of the patients with a autoimmune disease, starting from Hashimoto, uh, they get better.

And I can see it in the labs. 

Mm-hmm. 

Uh, the antibodies, uh, go lower. Uh, and that's, that's the clinical approach that I have. Like, I say like it's not for everybody, but it's always, uh, good to try it. You don't lose anything. 

Yeah. Mm-hmm. You mentioned elimination diets, and there will be people who are like, "I just need to do an elimination diet and my gut will heal," and then it doesn't.

What is going on there? What should people know? 

Uh, well, the elimination diet is, is, um, a self-knowledge exercise, and it's not gonna, uh, fix like everything. It's just for you to realize which, um, food is not good for you. So after that you have to make [00:15:00] some changes, and there is not easy changes because the food that we're talking about is something that it's everywhere.

It's not like, uh, some specific things because, uh, gluten, it's everywhere. Dairy, it's everywhere. Egg is everywhere. So, uh, I, I told them like it has to be like step to step. After that you realize that- You realize like, um, this food is not getting very good for me because you let the time for you to get to realize that.

Because sometimes if you just like stop eating, for example, bread for five days, it's not gonna be enough for you to realize what's going on with you. And this is also very funny because it happens the same with alcohol. 

Mm-hmm. 

Like a lot of people, uh, doesn't realize how much alcohol it's, uh, affecting their body and also their mind.

So going back to elimination diet, um, it's very interesting because it's a, it's, um, a practice of self-knowledge and then you have to go step by step. [00:16:00] It's a very personal journey- Mm-hmm ... that you have to adjust for what your body really needs. 

And there are ... If you have leaky gut a- and you've had it long enough, you, um

I've seen this when people will do food sensitivity panels and it's like 96 well food sensitivity and they're sensitive to 94 foods, and they're like, "I can't eat all these foods." Wow. I'm like, "No, no, no." If you have leaky gut, then your immune system is showing us what you're eating every day Yes And that doesn't mean that everything is a trigger.

And it also doesn't mean that these foods have to go away forever, and I think that's always the sign of a good clinician is when they're like, "We're gonna have a goal of reintroducing and trying to bring things back in." 

Yes. 

But often we'll see on the internet people are saying, "Autoimmune protocol needs to be for life.

Low FODMAP needs to be for life." Not in my view. Not for life I'm like, no. RIP my life. I love food too much. I would never do it. As someone who's had small intestinal bacterial overgrowth, I'm like, I would not be compliant with that for life. Even, like, anti-candida [00:17:00] diet. Yes. And I think the understanding people need to have is that all of these are therapeutic.

They are temporary, because therapies are temporary- Yeah ... only for the time you need them. And what you just described is the program of, oh, you know, basically it's gonna have to be tailored for each person, but how you actually heal the gut so you can get back to eating those foods, but also calm the inflammation.

I wanna ask you, though, how often do you see that nervous system dysregulation is actually involved in perpetuating inflammation and leaky gut? 

Wow. Wow. Now, what a nice question. And I think all the time. All the time. Um- 

You're like, "100%" 

Yeah, 100%. Yeah, for sure. Uh, because we live in a sympathetic state. We always are running.

We always rushing. And the parasympathetic state, it's, uh, where digestion happens. So if we are always like, uh... And I think everybody have fallen that, like, eating faster because you have to do this, and then you have to do another things. So it, [00:18:00] it really, uh... It has two things, because you are in a, in a sym- uh, sympathetic state.

You're not gonna absorb well the, the nutrients, and also you're not gonna chew well. So those, those big pieces of, of food- 

Mm-hmm ... 

they're not very well absorbed, and they also create inflammation. So, uh, that's in, like, the physical pa- part. But in the mental part also, let's just remember that, um, our mind and our body's connected.

So if, if we're having a rush always, when we have... We're always, like, not having the time, for example, to touch the food. Uh, I remember my, uh, one of my niece, uh, we were cutting a strawberries, and I remember she said, like, "Oh, this is beautiful how it feels to cut the strawberry." 

Yeah. 

So that connection with food, it's, um, it's a healing part.

It's also a nutrition part. It's not just like, like swallowing the food. 

Mm-hmm. 

So when you relax, when you have time, or you give yourself the time to reconnect with [00:19:00] the, with the food, um, magic happens, but you have to be relaxed. 

Yeah. 

Mm-hmm. 

I appreciate you talking about touching your food. So digestion begins before food ever- Mm

enters our mouth. There are a lot of parents, my husband's one of them- ... who will tell my toddler Don't eat with your hands. Don't touch your food. Mm-hmm. And what most people don't realize is that it's necessary- Yes ... often for children to touch the food- Yes ... starting the digestive process, but it also tells their brain this is what to expect.

Mm. This is, like, why it's better that you let a baby feed themselves, not like not like an infant infant, but like you let a child feed themselves rather than you giving them spoonfuls- Yes ... so that they're making that neuronal connection. They're touching the food, and the brain is getting the signal what to expect before- Yes

it ever enters their mouth. Yeah. And so, and also shout out to every culture that uses their hands to eat food. I see people all the time on social media being like, "Everyone needs to use silverware," and like- That's right ... "Why are you touching food with your hands?" And I'm like, it's [00:20:00] actually a really good thing- Yeah, very good

to touch your food- Really good ... and, and to have all of your senses involved. How many times are you telling patients they should be chewing each bite? 

Um, I try- It is hard because it depends on the food, no? Yeah. It depends. You, you can have like some, uh, uh, like a gold standard, like you have to... But let's say I say a range of 15 times.

Yeah. 

Like, that's the range that I told them. But of course I tell them if it's, uh, something that is, uh, softer, you can be a little bit less. But if, but always, um, I think consciousness when you're eating, it's, uh... gives you, like, the, the right times, amount of time that you have to do it. Because, uh, almo- almost all of the time we don't have the, our consciousness when we are eating.

Mm-hmm. 

I don't know if you have tried sometimes just to, uh... I went to, it was like some, some restaurant made this dynamic. You get in with your closed eyes. 

Oh, yeah, the blindfolded meal. Have you tr- yeah. Yes. 

Have you tried it? Have you tried it? 

I have not [00:21:00] tried it. Mm-hmm. There was... When I lived in Portland, Oregon, there was a place that was doing it, that because, um, at the time I was gluten, dairy- Mm

and soy free, I was like, it was, like, off the table 'cause they're like, "We don't do food sensitivities." Yeah. So I'm like, "All right." Okay. Like... 

Yeah, yeah. But it, it's something amazing, Jolene. Really for me, it was, uh, like I have never done that. It was, like, two years ago, and I, I realized how disconnect we are when we eat, really.

Uh, it has to be like a conscious exercise of, okay, I'm, I'm getting the tastes, I'm getting the textures of the food. Mm-hmm. Even though it helps you for your digestion, it also, it's a, it's a very cool experience to, to have that. 

Yeah. 

And I think sometimes we put a lot of, of health and brain about eating, and say, okay, for example, this, this example, this mood is, is beautiful because, uh, you say, "Okay, I have to eat this one, this one.

They have these vitamins, they have these minerals," so you have everything set up, but you [00:22:00] forget the process of, uh, tasting it. 

Mm-hmm. 

Of really, uh, enjoying the food. 

Yeah. 

And I think that part, if you miss that part, it may be, uh, at the end, uh, physically the same. You get those nutrients inside you. But if, if you miss that part, I think you lose, uh, a lot of things.

Because we were talking about, like, the nervous system regulation, and I think that's what the nervous system regulation helps you to really absorb all your food. 

I always joke that people who say, "Food is just fuel," I'm like, "Those are not my people." 

No, not at all. 

Doctors say food is not medicine. Yes, hot dogs and hamburgers are not medicine.

Not medicine. But if you look at other cultures, it absolutely is medicine. And I will say in my book that's coming out later this year- Yes ... I, I even put in there, like, tacos is the cure for ADHD. Just to, just to kinda push back on that. But I'm like- Yes ... it makes me really sad when a culture doesn't have that appreciation [00:23:00] for food as community, food as, um, you know, joy and passion, and they only view food as just a way to fuel their body, and I think they're missing out on this full experience.

But I also think it is a huge reason why we see so many food sensitivities, so many dysregulated nervous systems, is that the act of eating has become a chore, just something that's necessary to do, and- You know, w- we're, I've talked about tacos, but even if you look at the French- Yeah ... they're like, you sh- like, you eat your dessert, right?

You, you- Mm-hmm ... eat these things because y- life is not just about going through it every single day. It's about slowing down, enjoying it- Wow ... having the passion- Amazing ... and having the joy in it. 

Amazing. Amazing that you said that. And, and it, it, I gonna connect it with, um, I'm from the state of Michoacan- 

Mm-hmm

in Mexico, so, uh, we have a very arranged, uh, food culture. So Mexican food, it's a human patrimony, [00:24:00] but it comes from, from the food from Michoacan because, uh, we have- You're 

like, "I'm the original." 

Yeah, we are the original. Yep, and we have a lot of, a lot of foods, but the interesting part of, of, of the food from where I come from, it's, uh, as you said, like, it's from festivity.

You don't always eat the same. You have a specific, uh, choice of food, uh, if you're, uh, having this kind of festivity, if you're in a fun- funeral, if you're in a, in a birthday, and that's when you connect the food, the kinds of food- Mm-hmm ... with the, the time that you're living as a human. So it's beautiful if you, if you make that connection.

Mm-hmm. I think it, it brings you back to life, and you start looking food in a different way. 

So I wanna ask you- Mm-hmm ... you know, we've been talking about immune system dysregulation. When someone's in the early antibody stage, and they're starting to have symptoms, what are some of the things that you recommend they start doing so that [00:25:00] they don't end up in that full tissue damage, uh, side?

That's very, very good question, and I always start with vitamin D. It's a immune modulator- Mm-hmm ... that, uh, ev- everybody should have, like, le- good levels of vitamin D, but more patients, uh, as we talked before about people who have, like, autoimmune disease in their family, they have to be checking their vitamin D at least, uh, every six months.

So that's the first one because it's a, it's a vitamin, but it works like a hormone. You know? Mm-hmm. It, it, it's everywhere, and one of the things, it's like modulate your immune system, so it's key. It's key for, for, for this thing. The other ones is omega-3 fatty acids also to help you, uh, lower inflammation, and, um, in these kind of patients that we're talking about, the elimination diet and things like that, I think, uh, uh, patient have, uh, have to be very aware of the foods that they are eating because, um, there's not something like [00:26:00] E- everybody reacts difference to foods.

Mm-hmm. So, uh, as I talk with patients, uh, with chronic, uh, illness, uh, I know sometimes, um, it, it's very hard to have a, a chronic illness because it's something that you sleep and you're gonna know the next day you're gonna have it, and it's something, uh, really it's a burden in your mind. 

Mm-hmm. 

Uh, but when you start shifting this, uh, chronic inflammation and this disease on...

And I said with very empathic thing, uh, not that, "Wah- why it happened to me?" And you start to seeing, like, more as a path of self-discovery, a journey of self-discovery. It really change the way you see things, is not... You're not in the a- of course, you're gonna be angry because it's not easy to have it, but then you have a, a thing.

You, you're looking for something. You're looking for, "Okay, I'm getting to know myself." So going back to the question, I think the key point if you have a chronic condition is to get to know [00:27:00] yourself. 

Mm. 

Um, yes, of course, as I told you, like, vitamin D, of course, like, the omega-3. There's a lot of things you can also use like curcumin, like, turmeric, sorry, and a lot, a lot of things.

But also, like, this, uh, process of self-discovery I think is very, very important- Mm-hmm ... um, when you're trying to avoid, uh, the progression of a autoimmune disease. Mm-hmm. 

There are people who think it's inevitable. Like, if you have antibodies, it is gonna progress no matter what. I'm curious what you see are some of the causes that, uh, you know, drive the escalation of an autoimmune disease, and if you believe it is inevitable that you will have full autoimmunity tissue destruction in every case.

Okay. In my practice, what I, what I saw, it's that you can modulate it. Maybe you just can't get rid of it like, uh, genes, like, throwing away and I don't have anything, no. But, um, I think it could be, like, modulate. And the things that I saw that impacts more in [00:28:00] creating more inflammation in the patient, it's, uh, um, not managing well the stress and, uh, sleep.

I think s- sleeping right, it's one of the, also the, the key stones of, of a ver- a good A good approach for somebody to, doesn't want to, the autoimmune disease to prove to get bigger. Mm-hmm. I think those two things are very, very important also. Yeah. 

Yeah. I definitely agree. I mean, sleep is where we repair, and yet there is this cultural mindset of like, we'll sleep when we're dead.

Whenever people are s- say that to me, I'm like, "Well, then you're going to die sooner." Mm-hmm, mm-hmm. That's what will happen. Mm-hmm, mm-hmm. That is unfortunate reality. 

That's true. 

I'm curious how often you see environmental factors playing a role in this discussion of leaky gut, of autoimmune disease. 

When I was, uh, in the hospital, like, uh, finishing my practices as a, as a, as a doctor, as a physician, of course you don't, you don't, you don't sleep well.

Uh, you have, like, the night shifts. And I [00:29:00] see my health, uh, not just my, my physical health, my, also my mental health, like, deteriorating, like, lower to lower. So yes, it depends a lot on where you work Um, it also of, of course it impacts in the, in, in your inflammation and your habits. 

Yeah. Mm-hmm. 

Mm-hmm. 

When we're talking about environmental toxins, what kinds of things do you talk to your patients about?

Um, first of all, uh, avoid the toxins. Now, I think it's the first thing. Um, I think in the water there could be like a lot of, of heavy metals and things like that. So, uh, you always, uh, uh... As I talk with, uh, experts on this, like, uh, how to say, osmosis, like inverse osmosis. Yeah, 

reverse osmosis. 

Reverse osmosis.

Mm-hmm. Thank you. I think you have to have, first of all, a filter of that. Also, there's a lot of toxin that is gonna be, i- it's normal for, for we live in that kind of environment. So we have to be aware of it, and we have to... The things that we can, we can, uh, work on, for example, reduce the intake of [00:30:00] alcohol, of sugar, of, uh, fructose to help our liver to clean, to detox.

Mm-hmm. I, I think that's the first thing that we have to do. Also, for example, that's, that's the, the classical things. No? But when you talk a- also about BPA, there's, uh, when all the tickets that you get from the store- 

Oh, yeah, the receipts. 

Yeah. That the thermic paper, the receipts that you get in all- Yeah

the stores is full with BPA. 

Yeah. 

That is a, uh, it's a, it's a bad toxin for you, for your hormones. So I think w- we have to, to get into know what things we can avoid. Of course, uh, smoking is not a good idea because cadmium, you gotta... That is, is not acceptable in any ways. 

Mm-hmm. 

So but I think it's, it's that way.

I think also we, we sometimes have, uh, misunderstand the liver and, and they sell like this detox is gonna help your liver to work fa- harder. I think we have to, I don't know how to say, but to pet our liver. We have, we have [00:31:00] to- Be 

gentle 

with it? Be gentle with it. Okay. Yeah. It's, it's not because he's lazy.

No, no, no. It's the, the liver is not lazy. Uh, that's what they told us because of marketing. Be- because you have to h- take this pill and your liver is gonna work like that. No, we have to be gentle. 

Mm-hmm. 

Um, first of all, is get to know where we're living. What are the toxin that we're getting in touch with?

Like for example, these, uh, tickets with the BPA, uh, avoiding the, the alcohol, the fructose. Um, and then you can Have another things like help like, um, uh, silymarin, I think like milk thistle 

Mm-hmm ... 

it will help. But I think the first approach that you have is to be gentle with your liver, and m- reduce the exposure most of you can.

Yeah. 

When you say fructose, people hear fruit, and- Mm-hmm ... they're gonna wanna know, are you saying avoid fruit? No, no, no, no, no. What are you talking about specifically? 

Yeah, yeah. No, no, fructose is, uh, for example, like a boxed juice, they, they put a lot of fructose. I think it's, it's the main, uh, thing that they use to, to put sweet, no, on, on things.

Yeah, high fructose [00:32:00] corn syrup. Like high fructose corn syrup. And it doesn't... Uh, of course, it, it sounds like, like fruit, but fruit, uh, has something that is very interesting. Yes, it, it has, of course, like, uh, sugar, but it has fiber So it's not the same amount of, uh, you can take the same amount of sugar, but in a fruit, when you have the fiber, it helps you, like, not getting into your bloodstream, like, so fast.

Like for example, if you take it, like, in a, in a drink with a lot of, of sugar. Mm-hmm. With the, with the fiber, it reduce the time that your body's getting into the, the, the sugar into your system. So of course you have, e- if you eat a lot of fruits, it could be over. You have, like, diabetes, something you have to be careful, no?

But it's, it not. And yes, it's a very misun- it's a very common misunderstanding about fructose and fruit. Mm-hmm. Yeah. And it's not, not, not the same. 

You see two ends of the spectrum, uh, when it comes to liver detoxification. There's the influencer that says, like, "The only way to detox is you have to take all of these [00:33:00] supplements."

And then there's the doctor that says, "Your liver just detoxes on its own. There's no reason for you to do anything special." Where does the truth live? 

In the middle. 

So let's talk about that. Yeah. Because, you know, whenever I hear that, that extreme argument of, like, "There's nothing you need to do. Your liver detoxes on its own," I'm like, and so do your kidneys, but they don't do it without water.

Like, there are inputs that are required. There's a reason why we eat. And so let's talk a little bit about how people can nutritionally, lifestyle-wise, set up their liver for successful detoxification. And so we've talked a little bit about, like, you know, avoiding alcohol. Mm-hmm. I think that's, that's definitely number one.

That's number one. Yeah. I mean, when you... It's interesting because when you drink alcohol, if you have it with a meal, your, uh, which is great, so you don't absorb so much, but your body actually prior- it'll prioritize processing the alcohol over actually processing your nutrients that are coming in, and of course that's problematic.

But let's talk a little bit [00:34:00] about how people can support their liver's detox capacity. 

Yeah. So I think first of all, we have to, to understand, like, the liver doesn't have, like, a, an output. Like, it has to go through the kidneys, the kidney, sorry, or through your gut. So, um, first of all, it's not, as we talk at the beginning, it's not isolated.

The liver has connection. It has to be, uh, for example, you can have a very good liver, like, uh, phase one working perfectly. Uh, but if you have constipation, you're not gonna eliminate all the things, and it could be even worse becau- because you have intermediate forms, for example, like estrogens, and it's gonna be there, and it's gonna be even worse.

So I think, uh, first of all, we have, uh, we go back again to the gut. To have a, a, a nice, um, working gut, it will help the, the process of getting rid of the things that you don't need. Mm-hmm. Also, as you told, like in the kidneys. That's the main thing that [00:35:00] sometimes it's not very... Because you just go right to the, to the liver.

I also saw that they were, like, selling some castor oil or something that you put the- Castor oil packs ... like, the packs. Like- I, I personally don't, don't think it, it, it works, like, too much because you get- you have to know, like, the liver is not like that. It, it has a connection with a lot of things. Mm-hmm.

And I think nice gut working and also, like, the, the liver. And going back, uh, specifically to the, to how to help your liver to work, mm, there's a lot of things we already talk about, like avoiding toxins, and then we have to understand how it works, uh, the, the two phases of the how it works, our liver. So the phase one is the CPY.

The- there's some, some, uh, enzymes that work, and the phase two is the conjugation part. In the phase two, I think we can have, uh, more range to work and to help it it. Uh, we can use like, uh, for example, this kind [00:36:00] of milk thistle, uh, SAMe also. Uh, the methionine, it also works very good. But a- as, as I say, we have to be very, mm, it depends on every patient.

Mm-hmm. 

I think that's, that is... Yeah. 

But I think we could agree, cruciferous vegetables. 

Ah, wow, broccoli sprouts, yeah. 

Broccoli sprouts especially- Yes ... 'cause that's going to give you the sulforaphane with the phase two liver- Yeah ... detoxification. Wow, 

yes. 

As we're recording this right now, it is Ostara this weekend, which is the first day of spring, and that's whenever, um, you know, whenever people are like, "Oh, New Year's resolution, I wanna do a detox," I'm like, follow nature's rhythm.

When you see the dandelions, that's nature's sign because- Yeah ... dandelion roots help with liver detoxification, and dandelion leaves help with kid- the kidneys detoxifying. And so you can, um, if you have a yard that's sprayed with glyphosate, do not, do not harvest your dandelions. But if you, you know, I keep a chemical-free yard, I have [00:37:00] dandelions.

I let them grow, and before they flower, I take their leaves. I make a tea out of it. I'll dig up the roots. I'll dry them out, and I'll make teas out of that as well. And it's because so many people wanna focus on the liver because It is an amazing organ, but you're absolutely right. The process of elimination, the bowels and the kidneys, also have to be cared for, and that should be the first step.

Wow, it's amazing what you talk about, like how nature, it's speaking to us. Like, uh, wow, that's a very good, good point that you say about the dandelion. I haven't think about it, but now that you say, like, it's a very, very, very good one. Yeah. 

Yeah. Now we're like, wow, there's kohlrabi and Jerusalem artichoke and- That's true

and kale and chard, and all of these things that you're like, wow. And I think that's fantastic, but I also think it's removed us from that rhythm of nature. And of course, I'm not saying, like, don't eat a banana because you don't live, like, in the tropics. Mm-hmm. But it's more of, like, just paying attention that, like, you're in rhythm with the entire [00:38:00] Earth.

Like, our health is dependent on the Earth's health, and like all animals, we're in rhythm with nature. 

Wow, Jillian, it's amazing what you're saying. I al- I always had that, that idea, that's like why New Year's Eve, it's on, on January? Wh- why when it's cold? Why when everybody just want to lay down, hibernate?

So that, that exposed, like, how as humanity, we live, like, totally separate from the nature's rhythm. 

Mm-hmm. 

Uh, so that's amazing. 

Yeah. Spring is really the start. 

Yeah. 

It's because we've been- It's the start ... it's the rebirth. Yes. We're start- we're starting anew. Yeah. I wanna shift the conversation into talking more about Hashimoto's, since it is, like, the top autoimmune condition that affects women.

Mm-hmm. We know a huge portion of women hear, "Your TSH is normal, therefore everything's fine." Everything's fine. Why is that not correct? 

Because, um, it's not like that. We have to understand as, as we were talking about before, like everything is connected. So [00:39:00] also the thyroid gland is connected also to your mood, is also connected to how you're eating.

So TSH, it's a good parameter. We, we have to s- we have to, to look at it in our patients, but it's not the, the only one. It's not the only one because, um, the thyroid need, needs, uh, a lot of things to work. It's not just like l- the, the creating of the hormone, of the hormones. It also... We have to understand that we have, uh...

When the thyroid gland release the hormone, it's T4. 

Mm-hmm. 

Uh, so that is not very active in... Bi- biologically it's almost non-active. It has to lose, um, one iodine, uh, so be active. And in order to happen that we need, uh, uh, minerals, we need nutrients like selenium, like zinc. And so if you just look at TSH, it's a good parameter, but it's not, it's not gonna tell you like everything how it's working because you have [00:40:00] to, ooh, as we said, like you have to match the laboratories with your patient.

Mm-hmm. 

So I think one of the, the things that, that we share, Jolene, it's about like not just going, uh, to, to tap the symptom, not to, to avoid, to get rid of the symptom, to you have to take this for a symptom. You have to understand where the symptom is coming And when you understand this patient with the TSH normal, but they say, "I'm tired, I'm losing hair, I have constipation," you have to realize it's not enough just to see TSH.

So you have to s- continue to talk with your patient, habits, how he's sleeping, if they have, like, the, the, the good, uh, supplementation, if they're eating a lot of nuts, also seeds. You- that's why you have to be, uh, like, an integral view of your patient. 

Mm-hmm. 

But of course, it's important, TSH, but it's not the only thing.

Mm-hmm. There are many women who get diagnosed as hypothyroid. Mm. They're [00:41:00] told, "Antibodies don't matter. Take levothyroxine," so synthetic T4, and yet they don't feel better. Mm. What's going on in those cases, and what are doctors missing? 

Um, be- because the, the T4, it needs to, it needs to lose, like, the, the deiodinase enzyme, which works and, and make this T4 active in your body.

So if you just take the T4, you're gonna have, like, good levels, but then you're, you're gonna n- don't have, like, uh, a good systemic impact because your body doesn't have the, the nutrients to make this, uh, this T4 into T3 to be active. Mm-hmm. So that's why you just can't, uh, just give, uh, T4 and stay calm.

You have to give T4, see how patient is eating, see how the patient is feeling, and that's gonna be the proper, uh, way that you can realize if it's working, your therapy, or it's not working. Mm. [00:42:00] You need to do more for, for him. Yeah. 

In the cases of autoimmunity, is it enough just to replace thyroid hormone and do nothing else?

No. No, no, no. It would be, like, very simple. It would be simple and, um, in my clinical practice, for example, my recipes for the patients is, like, two pages, two pages. And when I see of my colleagues', uh, recipes is like, uh, levothyroxine, uh, 20 minutes before breakfast. Yeah. That's it. 

By recipes, you mean prescriptions.

Yeah, 

prescriptions. 

Okay. 

Yeah, sorry. Yeah, got you. Yeah, yeah, 

prescription. I kind of like recipes better, though. Like, here's our recipe- Yeah, yeah ... to a fantastic life. 

Yeah, the prescription. Sorry. So yes, you have, you have to see, like, all of other things, like, in the patient, not just, like, giving the, the medication.

You have to, you have to dig in a little bit more. 

Mm-hmm. Can you take us through your framework for approaching Hashimoto's with a patient? 

Okay. Yeah, first what, what [00:43:00] I want to know is how the patient is feeling. For me, that's the, the right thing where... the first thing that I, that I see in my patient. And after that, y- you have always to, to see not, not just the thyroid gland because some, most of them, the patient with Hashimoto, they have, uh, they are very tired.

Uh, I think that's the, one of the main symptoms that, that they, why they come to me. Of course, then you see have bloating and inflammation. Uh, also see, like, mood swings, and then you start to realize, like, okay, it's a autoimmune disease. It's Hashimoto, but where does it comes? And again, the first thing that you have to look is the gut, that we were talking about the, the molecular mimicry and the inflammation.

So, uh, for me, the first approach is, uh, repair the gut. To avoid, to con- uh, those stressors that make your body, uh, inflammated. So get rid of them. That's the first thing you have to do. Uh, [00:44:00] after that, of course, you can use, uh, levothyroxine, like T4, sorry, and then you have to To see how the patient is feeling, not just like, uh...

Because sometimes in, in medicine, we, we think it's Jeopardy, you know? We, we're playing Jeopardy. Like, Hashimoto, like this medication, like this one and this one. No. You have to, to, to see where the symptom is coming from. So my approach, first heal the gut. Uh, after that, of course, if you need medication, supplementation, you just do it, but always looking how your patient is feeling.

Mm-hmm. How he's feeling, how's their habits, and that's why, uh, you make a kind of a partnership with your patient in functional medicine. Because it's not like, uh, you just go and in one, uh, consultation you're gonna give them, like, the, all the, the answers and... No, no, it's a process. It's a process. As I, as I, I always say it, it's a self-knowledge process.

Yeah. That's the way I approach it. 

How often are you [00:45:00] seeing small intestinal bacterial overgrowth, or SIBO, with your Hashimoto's patients? 

Mm. Uh, SIBO. Well, in my practice, uh, to be honest, um, a lot of patients that I, that I treat, they don't have, like, the resources. So to diagnose SIBO, uh, it's a little bit expensive.

Mm-hmm. 

So sometimes I have that, um... How can I say? Like a- Barrier ... yeah, that barrier- Yeah ... that doesn't allow me to, to go deeper in SIBO. That's- Mm-hmm ... that's the truth. Yeah. 

Yeah. We have to prioritize those things and be realistic of, like, here's our ideal, and then here's what the patient can actually do.

Yes. And that sounds like that's what you're doing. 

Yes. Yeah, that's true. Because, um, you know, s- also with social media, like, it's very easy to, for, for a patient, also for doctors to, "Okay, I read this, and this is the thing that we have to do." But when you see patients, things changes. 

Mm-hmm. 

Like, uh, you have to know the, the status of your patient, the, the economic possibilities.

Uh, also there are some cultural [00:46:00] barriers that you just have to get to be aware that they exist, and you have to, to, how to modulate your clinical practice also for your patients, uh, in each individual pa- case. 

Mm-hmm. 

Mm-hmm. 

Uh, cultural competency is one of the biggest glaring issues I think is just nonexistent in a lot of medical practices.

Yeah. And that people- Agree ... don't recognize you, you will never have someone's trust if you don't respect their culture. I wanna ask about rheumatoid arthritis, 'cause that's another autoimmune condition that you commonly- Yeah ... treat. For people who don't know what that is, I feel like Hashimoto's a lot more common, and we've talked about the thyroid, but what is rheumatoid arthritis, for people listening?

Well, um, it's, um- It's a autoimmune disease, which means your body, uh, attacks itself, and it attacks, like, the, the, your, um, your joints. It start, like, um, by a process of, of molecular mimicry. It get [00:47:00] confused, and it attacks your, your joints, and it's gonna be progressive, uh, degenerative. Uh, so that's why it's a very, very debilitating, um, autoimmune disease.

Uh, what I saw, and it's something that I... it, for me, it's, it's very, very important, this, this thing, that, uh, I saw people with arthritis, uh, with RA. Uh, they, uh, maybe, I don't know h- how can I say, like 70%, when they came in and I see their faces because I... as a, as a, as a doctor, you, you have to see how your patient getting, how it walks, how it, it, it behaves.

I saw with this, uh, specific autoimmune disease, they are people who want to have control in everything. In, in mental part, yeah. Yeah. They, they, they, they try. 

With the A-type personality, I just, I, like- Yeah ... I giggle because literally everybody says this about autoimmunity. Yes. But, but I'm sorry, continue.

Yeah, so, so that's the first thing, and the [00:48:00] other thing, it's also, like, the, their habits. They're people who never sleep well. They have this problem. You don't know what, what happened first, if they can't sleep and they develop R- RI or it was, like, vice versa. But they're people who their mental state is always like this.

It's always like, like, like they're feeling like they're not safe. So this, I, I think this also accelerates the, the autoimmune disease, not in a direct way, but in a, in a way that they can't sleep. So if you can't sleep, your inflammation's gonna go up. Mm-hmm. And also your disease is gonna get worse. But what I try, I also, as I told you, I don't have, I don't have, like, a protocol to say, "You have this disease, you need this."

I try to, to, to see each patient, but, uh, what I, what I see, they have a lot of relief, and it could sound paradoxically, um, w- they don't move enough. The, because, uh, all the doctors said, "You can't exercise. You have to don't [00:49:00] do anything." And I saw that not moving get, uh, the disease worse. Hmm. And I'm not saying that they have to go and lift, uh, heavy weights.

No, no, but slow, gentle move works, uh, marvels, marvel, sorry, for this kind of, of patients. Also with the foods, with the... also going back to the gut again. I saw when I take off some specific foods- that we already talked before, like, um, breath, uh, dairy, m- those, those two main, um, they get better. They get better, but it's a dance for me to treat a patient because they come with a lot of, of medication, so you have to, to equilibrate them.

Like, okay, I take this food, you're getting better on your inflammation, y- the joints are less swollen, so let's get a little bit down the medication that you're taking. And then you, you have to go, like, step by step. Okay, you start to moving yourself. You start to, [00:50:00] um, going to walk, uh, three times a week.

You're feeling better. Okay, let's go down this other medication. Because, uh, the average of the, of the, uh, patient that I saw with, with this, uh, disease, they have at least Mm, five medications at least. So then you have, for example, uh, they have like the SSRIs, they have like a lot of things, and then you, for example, of course, if you are in pain, it's gonna affect your mood.

So then you have, uh, some options and you say like, okay, uh, 5-HTP to get a little bit l- lower the, lower the SSRI. So it's kind of a dance. It's, it kind of, um... How can I say? Like a move with the patient, like have patience with them and ask them to have patience with themselves. 

Mm-hmm. 

And it works marvels.

Yeah. I'm curious, you know, there's been some compelling evidence showing that oral pathogens and rheumatoid arthritis are connected. [00:51:00] How are you integrating that into your clinical approach? 

Or like the, like oral pa- pathogens, like when... Well, um, I don't have like an, a specific, uh, thing that I do of that.

I, I'm very aware, like the, of, of that things, and also there's the... Because we think for probiotics, I remember right now a case that she also had like a lot of gum, uh, disease. Gingivitis, yeah. Yeah, gingivitis and things like that. So, uh, the approach... Also these patients have als- always a dry mouth also.

Mm-hmm. So, uh, what I- Do you 

think there's a concomitant Sjögren's maybe? 

Yes. I think al- almost in every autoimmune disease there's, there's concomitant Sjögren. And, uh, these patients, it, it, because, you know, also the, the specialists, uh, agree that when you have a, a autoimmune disease, uh, or process, it's not just one.

You have like a, like a little piece of Sjögren, you have a little piece of lupus, you have a [00:52:00] lot of things of psoriasis. So, um, for me, uh, and going back to that question, I use two things, like, uh, the probiotics, there are some, uh, oral probiotics- Mm-hmm ... that works good. But for the people who have the, this dryness, it's, it's, it's, it maybe sounds like it's something like, ah, it doesn't happen anything.

But it, it do because they have a lot, a lot of problems with their teeth. So one of the things that I saw that works marvels is the coconut oil. 

Mm-hmm. 

Uh, a little bit of coconut oil and, uh, passing through your teeth. 

So like oil pulling? 

Yeah. 

Mm-hmm. 

Okay. Mm-hmm. Yeah, like the coconut oil, and it helps you to have, uh, more saliva.

Mm-hmm. 

Um, also, uh, you have... And going back to the, to the nervous system regulation, these, these people, when you, when you have a, a relaxed nervous system, you secrete saliva. And also, as I told you, I saw this, uh, um, character in these kind of [00:53:00] patients that are very, uh, very stressed, uh, very... They try to control everything.

And when they slow down, first they have to recognize it, because you have to be very careful also with these kind of processes. You just can't say like, "Hey, I saw you come and you want control." No, no, no. You have to be very soft with them. Yeah. 

Yeah. I'm like, yeah, tell... That's always like when someone's stressed and then someone says like, "Just stop stressing."

And you're like, "That's, that's not the way." That, that's not the way, 

yes. But when, when you start to like giving them... For example, for me, one of the things that I say to them, "Okay, I'm gonna get you, uh, two things you have to do in your house. When you get a bath, you're gonna feel the hot water on your body.

You're just gonna try to be aware how it soothes you, how it relax you. Um, that's your home- your, your, your homework. And the other one is before going to sleep, uh, you're just gonna have six deep breaths To activate the vagus nerve. And with those [00:54:00] two things, really, uh, there's some patients that told me like, "Uh, doctor, this is mind-blowing.

It doesn't, uh, cure me like that, but right now when I'm in the third s- uh, breathing in the night, I'm already sleep." 

Mm-hmm. 

And it doesn't happen the first time. They have to do it, like, continuously. And after, for example, with the... with being aware of the, of the shower, of the, of the hot shower, they say, "After that, right now I'm more aware when I'm, for example, at the gym," or, "I'm more aware when I'm driving."

So that small things really makes them like, uh, relax the nervous system, and it's also help for the pain and the swelling- 

Mm-hmm ... 

in these patients. Yeah. 

You had mentioned that not exercising actually makes symptoms worse, and I think people automatically will think, "Well, of course movement helps," and, um, you know, moving the lymphatic system.

But I'm curious in terms of insulin resistance and adipokines, [00:55:00] what role you think they're playing in the progression of autoimmunity? 

In the progression? Yeah, because i- if we saw the, the muscle, we c- we have to see it like, uh, as an organ. Like myokines, uh, also reduce inflammation, also help to, to regulate the, the glucose in, in our body.

So but it's not... I- if we don't use the muscles, they're not gonna secrete those substances. So I think that's, uh, the biochemical, uh, explanation of it. But I think in, in your mental part, uh, when you moving, you start feeling, um, that you're alive. Movement, it's very connected with being alive. So if they restrict your movement, they say like, uh, a lot of physicians tell them, "You, you, you don't...

You can't exercise," uh, you get disconnected from life. And when you re- re- restart, uh, moving, it's like an uphill process because they start walking. Then they say, [00:56:00] "Okay, I feel nice walking." Then I go to the water to, to walk maybe in the pool, and then I start to talk with other people, and then it comes another thing that is community.

Mm-hmm. 

That it also w- oof, works marvel for them. But movement for me, it's, uh, basic in these patients. That's, um, it's a key, key thing for, for people with everybody, but more with people without immune disease who can share their experiences, their pain, what works for them, what doesn't work for them. I think that's, um- As you said, that's medicine 

Mm-hmm Mm-hmm.

For me, that's medicine also. Mm-hmm. 

I wanna ask about fibromyalgia because this is something that has a big overlap with autoimmune disease- Yes ... gut dysfunction. So let's talk about what are some of the underlying mechanisms you see with fibromyalgia? 

Fibromyalgia, I think it's one of my favorite, uh, pathologies, and still there's a lot of people, uh, uh, physicians that doesn't think it's real.

[00:57:00] I know it's real And, uh, the thing in fibromyalgia, uh, for me what I have experienced and for, for what I saw in my patients, because we, we try to think, uh, that all the emotions go to our brain, and all the emotions are stored in our brain, but that's not true. All our body, it's, uh, how can I say? Something that is connected.

Uh, and all, all the emotions is not just here in your mind, it's in all your body. So what I saw with people with, with fibromyalgia is that they have a lot of things, a lot of pain, uh, mentally things that they can't express or they don't know how to express it. So the body says it's this accumulative stress of emotions that you don't say, that you keep to yourself, that at the end your body, the only way it has to, to tell you something's wrong is about symptoms.

Mm-hmm. And for me, fibromyalgia is that thing. And of course if you give them like an SSRI, that [00:58:00] is gonna be like the standard treatment for, uh, for this, um, it's not gonna heal. It's just gonna be a block. It works a little bit, but it's not just the, the thing that you have to do. For example, my approach with this kind of patients is, "Okay, I'm gonna give you the SSRI for this time, but you have to do something."

And I... Specific, um, things that they have to do. And one of the things that I have realized with these patients, uh, it's when I ask them, "What do you like to do? Like, uh, do you like the cinema? Do you like to, uh, I don't know, hiking or something?" Uh, maybe 95% of my patients, they don't know what they, they enjoy doing.

Mm. 

They don't know. So one of the homeworks that I send to them, "You're g- the next time that we're gonna see you, you're gonna take your SSRIs, but you're gonna bring me a list of 10 things that you really enjoy." So I think that, uh, that combination, it works, and it works very, [00:59:00] very good. Then I take off the SSRI, uh, and they have already their things that they enjoy.

They start having moving, and they, they get better and better. 

Mm-hmm. 

Yes. Mm-hmm. 

What is going on with fibromyalgia? And for you, for people who are not familiar with it, what are the signs and symptoms? 

First of all, it's, it's pain. It's pain. It depends on the... We have like the trigger, uh, the, the trigger points- Mm

that as a physician we know, and we touch them. So in a normal person you, you touch, uh, for example, one of them is here. Uh, you touch them in a normal person and nobody's gonna feel pain. You have to do it with your, with your thumbs and, and pressure it until it gets like, uh, a little bit white. Mm-hmm. It's, it's, it's a gentle pressure.

It's not like this. Uh, and they have... You see that the pers- "It, it's, it's hurting me." And so it's this, that hypersensitivity to pain. 

Mm-hmm. 

Um, and when you get, uh, some of those points like, uh, positive- uh, you diagnose [01:00:00] fibro- fibromyalgia because, uh, there's not lab test or, uh, some X-ray or something that can tell you this is, uh, fibromyalgia.

And that's why it's a little bit hard to diagnose, and that's why I understand some physicians don't believe in it. So but, but to, to, uh, resume, like synthesize, like everything, it's, um Hi- hypersensitivity for pain- 

Mm-hmm ... 

to pain. Mm-hmm. 

In your opinion, how much do you think fibromyalgia is central sensitization of the nervous system versus, like, peripheral in- inflammation that's going on?

Or is it both? 

I think it's both, but I think it's more peripheral because we always tend, uh, as we saw in physiology in, in, in, in med school, um, all the pain is right here. The, the brain is what tell you, like... But we, we need to understand that the, the whole body is connected, and the whole body's always speaking to us.

It's not just the brain. We try to, to mentalize, [01:01:00] like, everything. So yes, of course it's a part. Maybe will be, like, some mechanisms in the central nervous system that makes you feel like the pain more, but it's also in the periphery, uh, which means that your body's also telling you something. 

Mm-hmm. Mm-hmm.

What role do you think the mitochondria is playing in this? 

Yeah, I think, I think mitochondria plays, like, almost in every chronic condition They're 

like everything, right? Everything, 

yeah. 

Oh. 

Yeah, for sure. A lot. Yeah. 

Yeah. But, you know, for people listening, you know, as much as they know about the mitochondria, it's probably what they got in sixth grade biology, which is it's the powerhouse of the cell.

Of the cell. It makes energy. What should people know about mitochondrial dysfunction in, in the same conversation that we're having about, uh, systemic inflammation, chronic inflammation, and then pain amplification? 

Well, it's a, it's a very nice question, and it's... I think it's very, uh, extensive what, what mitochondria because it's, uh, as you said, like, it's a powerhouse of, uh, of every cell.

So, um, going back a little bit [01:02:00] with autoimmune disease, you always see, like, of course, there, there's sometimes, uh, pain, but you almost always have, like, uh, no energy. They don't wanna do anything. Mm-hmm. They don't wanna, they don't wanna go out. They don't wanna do anything, so it's a challenge also. It's a challenge because as I told you l- I told them like, "Go and move," but they don't have the energy, so it's a vicious, uh, cycle.

And when you help the mitochondria, that there's, um... Of course, you, you do- can do, like, various, uh, uh, lab tests and to see the mitochondria and whatever. But like, uh, normal things, uh, for example, coenzyme Q10 and things like that, that you know that they're gonna help. Uh, almost, uh, going back a little bit, remember the, the, when I told you, like, vitamin D, also the omega-3 fatty acids in autoimmune disease?

Coenzyme Q10 is gonna, is gonna also work, uh, to start supporting the mitochondria. 

Mm-hmm. 

But then you have a lot of things. You can do, like, sauna. [01:03:00] You can do a lot of things to that. But for starting, I think the- Uh, the easiest way to, to, to help this kind of patient with fatigue, uh, is that Mm-hmm It would be like that, supplementation.

Mm-hmm. 

Yeah. And going back to what you were saying about exercise, we know that exercise is one of the most effective ways to help modulate the immune system, but also to start to build efficient mitochondria- Mm, yes ... and more mitochondria. 

Yes. That's true. Yeah, totally, totally agree. And that's the play that we- that, that's the role we play as a physicians also because we have to encourage our patients, uh, to move.

Because if you just say like, uh, move and, uh, eat vegetables and fruits, uh, it's not gonna work. Mm-hmm. You have to explain them a little bit, uh, about, for example, this mitochondria and this supplement is gonna help you to do that. It's, it makes a world of difference if you just take this, take this, take that.

Mm-hmm. 

It works a lot. Well, I have seen that in, mm-hmm. 

Yeah. I appreciate [01:04:00] what you're saying. SSRIs can be life-changing for some women, and then we can work on the other therapies and bring those up so that we can get them off that medication so they're not on it long term. I always say like, unless the medication's necessary for you to stay alive and avoid chronic disease, like in the case of Hashimoto's, we don't want you developing like heart disease because- Yes

you didn't have enough thyroid hormone. Like, we need to have a plan to not be on that for life- Yes ... because nobody wants to have to take a pill every day. 

No. No. Nobody. Nobody. And yes, I think that's the smartest approach to, to chronic disease. Uh, also for example, going back a little bit with SSRIs, uh, as, um, sometimes p- Uh, there's a time that we thought that they were like, uh, nothing happens.

They just bring you joy, and that's it. That's the way they sell to, to, to us. But, uh, there's not that easy. Uh, everything that changes your, your chemicals in your brain, you have to be a little bit aware of it. So I use, um, the analogy of a cane, no? When, when [01:05:00] you broke your leg, you- 

No, we've both had knee surgeries.

Yeah. So yeah, we've both been on canes. Well, 

we, we both know what it is. Yes. We know what it is. So SSRIs is a cane. When you have, like, this mood, like, going back, you, you need to know it's gonna help you to get better, to get a, uh, to get, um, strong bones, to get back your muscle, and that's what I told to them.

"Okay, I know you feel, uh, with no energy. You're feeling depressed. You're gonna take this SSRI. You're gonna feel the boost, but then you're gonna use it to create a different lifestyle." Mm-hmm. "Because eventually you're gonna get rid of it." 

Yeah. 

Mm-hmm. 

And we know with SSRIs, there's a lot of people that are like the, the research was never great for depression, and I definitely agree.

Before they came out, the research wasn't great. But when now we're understanding that serotonin's actually playing a role in neuroplasticity and changing the brain, and I think it's important for people to understand where they might be like, "Wait, you're telling me SSRI and fibromyalgia, chronic pain?"

Yes, because chronic [01:06:00] pain changes your brain. Yeah. But if we can use something that helps change your brain, like an SSRI, so that you are upregulating neuroplasticity, and then you put the lifestyle factors in place, like, that's a way that we can get your body to adapt and, and, and to adapt out of the dysfunction that it found itself in.

Because as you were saying, it's all about homeostasis, and that's all your body was trying to find, and it became dysfunctional- Yes ... in trying to find that. And so now we have to walk you back out of that. I wanna ask you, why do so many patients with fibromyalgia fail the standard interventions that doctors are providing them?

Mm, because it's center in, in, in medication, and- Mm-hmm ... there's, there's- There's no, for example, like, uh, it's, it's... It would be like saying, like, depression is a Prozac, uh, deficiency. It's, it's not a deficiency of, of something you have to give to the patient. It's something because a patient, uh, we as people, as [01:07:00] humans, we are, uh, complex living things.

Mm-hmm. 

It's, uh, it's not a deficiency of a pill or of a certain thing. Also, with patient with, uh, fibromyalgia, I always, uh, suggest them to, to go to, to a therapist, like a psychological therapy, in order to express the emotions that are trapped in their body. So SSRIs, yes, I use them. I'm not gonna say they're bad because I use them often with these kind of patients.

But as I told you, like, um, not a prescription, like just take this one and see you in three months. It doesn't work. It doesn't work. It will make, make feel them like a little bit better. But if you encourage your patient and you explain to them what is happening, they feel like your companionship. They feel that they have, uh, trust in yourself.

Mm-hmm. And in their self, uh, things changes, and that's, that's, that... I think that's the beautiful part that we share, uh, about our view, our, uh, clinical approach [01:08:00] of the patient. It's not just like giving the, the pill. It's like something different. 

When you chose to pursue functional medicine, why is it that you j- you decided to go that route?

Well, uh, it was b- because, um, a personal medical condition. Um, my, all my family, my, my father is infectious disease specialist. I have, uh, the aunts that are dermatologists, uh, cousins that are urologists. All my family are like traditional medicines. But then, um, I, I have a, uh, I start to have a lot of, uh, some personal health problems, chronic pain, a lot of surgeries.

And I was desperate to, to something to make me feel better, and I wasn't, uh, getting all the answers from the traditional medicine. So that thing forced me to, to look up on something different. 

Mm-hmm. 

And it starts with homeopathy. And I went with this doctor with homeopathy. He treat me. Um, [01:09:00] before that I thought that homeopathy was just placebo- 

Mm-hmm

uh, to be honest. And I, of course when I was studying I was maybe sometimes I will laugh about homeopathy. That's the truth. But, uh, then I go with this doctor. He treat me. I start feeling better. But, uh, I, I go with him because maybe he was giving me steroids or something that, that is not good for my health.

So I, I ask him to allow me to, to see, uh, his clinical practice and to understand what's homeopathy. And then when, when- So 

you thought maybe he was drugging you and not telling you? 

Yes. Yes. Yeah, yeah, yeah. That he was giving me, like, some medication, like steroids or something that, that is getting me better- Yeah

but is not good. So, mm, I realize and when I start to understanding the philosophy of medicine, for me was like opening my eyes. Like, wow, this is amazing because you take, you take in consideration the [01:10:00] mental things, the emotional things, of course the physical things, and the, the basic thing of homeopathy is that you stimulate your body, work like a vaccine, like stimulates your body to, uh, make him, like with his own processes- 

Mm-hmm

its own process, uh, heal. So then I say, "Okay, I like this." I start practicing. But you have, like, your bibles in, in homeopathy which is a book that is named Organon And the first thing that I told you in homeopathy is you need to know nutrition, and you need to know, uh, your patient habits. Because no matter how good a, a physician you are and you choose the best medicine, if your patient is doing something that is getting him sick, it's not gonna work.

And it sounds right now very logical, no? Like, but in the... But after I graduate from medicine, it's not logical because the, the mind that I have in that time is a [01:11:00] mind that, as I told you, like kind of a jeopardy. Like this medi- this, this, uh, disease, this medicine. This, this. I wasn't able to think the way I was looking at medicine right now.

So I say, "Okay, I need to know about nutrition. I need to know about, uh, sleep, and where do I go? Because I don't know anything about it." In, in faculty, they didn't show me anything, anything. So I say, okay, um, I remember I w- I was in-- I went to Australia to do a, a pass entry in, in neuroscience. So somebody talk about functional medicine.

Somebody. I just re- recall that. And I say, okay. I, I thought it was like, uh, something small. But I, I go to the IFM, I start my certification, and then I realize it was something much, much bigger than I thought. 

Mm-hmm. 

But that was the, the path that I, that I followed to, to get into functional medicine, homeopathy.

But still, I, I re- [01:12:00] very respect the traditional medicine. As we were talking before, we use, uh, medications. They're like very helpful, like tools that we have. And I think you can integrate like different models, and right now it's working for me, it's working for the patients. Uh, of course, you have to be like the M- because you can lose yourself a, a little bit.

You have to be, uh, scientific. You have to, you have to see that the things that you using, uh, is working. Mm-hmm. And also, of course, the safe and the wellbeing of the patient. If you have those two things, you can see different models without, uh, getting lost. 

Mm-hmm. 

Mm-hmm. 

Yeah. It's always interesting to me because it's usually when people have had a homeopathy experience that they're usually like, "Maybe there's something more to this."

And, uh, you know, as I was saying, when I was in Paris and my son had got sick, uh, you go to the pharmacy, and homeo- homeopathy is, like, the first thing they use in France. The pharmacists are like- Mm-hmm ... "This is where we need to start." And there's... I think as a, as [01:13:00] a science, it's very easy to criticize, but it's something that has always been a, a gap for me that I can't explain is, like, why does it work on animals?

Yeah. And this is something that, you know, my dog, I had a dog that was afraid of, uh, fireworks, and I would use homeopathy because what, what else can you give a dog, right? I don't wanna sedate my dog. And it would work- Yes ... every time. And I'm like, "Okay," like, I can see that, like, there is absence of evidence here.

I can hear all the criticisms, but I can't explain this- This ... actual piece or why it works on babies because, yeah, we were like, "Oh, it's just placebo," but a pet doesn't know- Mm ... that I'm gi- and then sometimes I'm like, I'm having to hold her down and put it into her mouth. Like, that's not- Yes ... a, like, positive experience.

Yes. And yet- It 

has to be something. Yeah ... 

it works. Yeah. 

Yeah. They also u- use them with plants. Mm-hmm. Agro, agro homeopathy. 

Oh, really? 

It's a branch of homeopathy. 

Oh, I've never even heard that. 

Y- yes, and it's amazing. One of my cousin is doing that. And yes, of course, I understand [01:14:00] why, why is there resistance of the physicians a- about homeopathy.

I understand it pretty well. But as you said, like, I, I see it, like, every day how it works with the patients. So really I say, "Okay, this is working." 

Mm-hmm. This is 

working. Yeah. Mm-hmm. 

I wanna ask you just as a final question, in what you see happening online in the wellness space, do you feel like there's oversimplification of what patients are dealing with, and that's actually causing harm?

Yes. For sure, for sure. Mm-hmm. And, and we need to understand it, like, in a economic perspective, no? For example, for me, it's very funny to see the, the, uh, in the TV, like the, "You have, uh, back pain? Take the magic pill and everything's gonna solve." But you don't even, uh, change the, the way they sit, the way they move.

So I think it has to ... It's due to, uh, um ... How can I like ... Um, selling strategies. Hmm. I think it's because of [01:15:00] that. And, um, before starting medicine, I was two years in finance, so that's where I understand, uh, it's not that ... Because some, some other people can go to the other side and say like, "Pharma, they're the evil."

Of course not. They have very, very interesting things. Uh, for example, for me, I got a, a, a horrible infection, and if, if there were no pharma, I, I wouldn't be here, like, talking to you. 

Yeah. 

So they have, like, very nice things. But we need to understand, uh, we're immersed in economy, that they want to sell us.

And if they sell you ... Uh, who's gonna sell, for example, like, "Go exercise, eat well"? Nobody, because nobody's gonna win. But if they sell you, like- 

NordicTrack equipment They, they'll do it. They- They do. Yeah, they ... 

Yeah, that's true. That's true. 

Or the Bowflex, right? 

Yeah. But, but, you know, like, they, they simplify things, uh, for you as a consumer- 

Mm-hmm

not as a patient. So I think that's a misconception. [01:16:00] Uh, and we have to be aware that, uh, pharmas and the ... all the companies are to sell. Of course, they have, like, uh, very interesting tools, but the main thing is to sell. Mm-hmm. That's why they, they simplify things, to sell them better. 

Mm-hmm. 

Mm-hmm. 

What would you say to people listening right now to avoid being a consumer of people, of these companies that just wanna sell you, and actually taking actionable steps to heal themselves?

Ah, I, I love that question, and I'm happy that you bring me. I'm not ... And, and I told, for example, to my patients, uh, when they have pain, because they have to take something, uh, before swallowing the pill, just make a little bit of the space to listen, to feel the pain that your body's telling you. Because in that, uh, moment, a very small moment, you're gonna realize a lot of things.

Just take a little bit feel your body and then take the pill. [01:17:00] I think that's the first thing to start making awareness of our body 

Mm-hmm 

And for me, that's the first step. And I, I, I had saw like a lot of people that say, "Doctor, sometimes I was about to take the pill, then I listen to my body, and then I didn't feel the pain, so I left the pill."

Mm. 

So I think that the first step. 

Yeah. 

Yeah. Mm-hmm. 

Well, thank you so much for sitting down with me today. No, it's a pleasure. 

 

I appreciate this conversation. It's a pleasure. It's a pleasure. Thank you