Preventing Autoimmune Disease with Dr. Shelly Sethi: Rational Wellness Podcast 97
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Dr. Shelly Sethi discusses Preventing Autoimmune Disease with Dr. Ben Weitz.
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4:37 In the Functional Medicine world instead of just treating the overactive or dysregulated immune system that we see in autoimmune diseases, we search for some of the underlying triggers, such as leaky gut, food sensitivities, toxins, infections, nutritional deficiencies. Dr. Sethi said that the first place we should look for potential triggers for autoimmune diseases is the gut. We now have discovered that there are certain specific bacteria and viruses and parasites that are associated with specific autoimmune diseases.
6:55 Dr. Sethi said that food sensitivities can play an important role as triggers for autoimmune diseases, so she will often start her patients with an elimination diet that eliminates all grains, esp. gluten, dairy, soy and sometimes eggs and nuts, for at least 30 days and then she will test each food back for three days. Sometimes she will get a patient who has had a food sensitivity test run that shows that they have a lot of different sensitivities, then she will focus on healing the leaky gut. She will often then look at the gut and do a GI Map stool test from Diagnostic Solutions and an organic acids test from either Great Plains or Genova Labs to look for evidence of bacterial or fungal overgrowth. Dr. Sethi will also look at the secretory IgA on the stool test as an indication of the status of the gut immune system. If the secretory IgA is low, she will support the gut with things like vitamin A, vitamin C, Saccharomyces, and she will sometimes use amla. She may use colostrum or a dairy free colostrum product. If the secretory IgA is high and she also sees organisms like Citrobacter or Klebsiella, which are highly associated with autoimmune conditions, she may refer to a gastroenterologist to get scoped to look for Inflammatory Bowel Disease. Once the immune system is supported, if they have a parasite, she will use a product that contains Mimosa pudica. If there is bacterial overgrowth, she may use an antimicrobial product that contains berberine. She may use mucilaginous herbs like diglycerized licorice (DGL) and marshmallow to soothe the gut. Zinc carnosine can also be helpful. She will often used a product with a blend of these. She will often follow an antimicrobial protocol with some liver support such as milk thistle. She may add some binders like activated charcoal or zeolite clay or fulvic acid for two to three months. She also will use spore based probiotics.
20:22 Exposure to toxins like heavy metals, plastics, phthalates, BPA can negatively affect the gut microbiome and lead to leaky gut or dysbiosis or SIBO. Also, if the gut membrane isn’t healthy, then you can become nutrient deficient. This is why Dr. Sethi will include an organic acids test with her initial testing.
22:10 I asked Dr. Sethi to go through a few case studies, starting with a case of Hashimoto’s autoimmune thyroiditis. She said that often she will get a patient with Hashimoto’s and they have been given Synthroid by their conventional doctor as their only option. Either nobody has even measured their thyroid antibodies or they only measured after the TSH is elevated. Dr. Sethi mentioned that she has some kids in her practice now who are 10, 11, 12 years old who’s parents or relatives have Hashimoto’s and she finds that their TPO antibodies are already elevated. She will then look at their lifestyle for triggers like food, stress, toxins, or bacteria or parasites in the gut. Dr. Sethi has a 12 year swimmer who’s in chlorinated water every day of the year, which could be triggering her thyroid problems, since chlorine competes with iodine. Dr. Sethi talked to her patient’s endocrinologist, who disagreed that chlorine could be a problem, but the girl took a break from swimming in the summer and they also got inflammatory foods out of her diet, got her sleeping better, and had her introduce a meditation practice every day. By the end of the summer, the rash that she had had on her skin, which looks to be some sort of scleroderma-type thing, had actually shrunk to half the size. Her dermatologist was shocked. Dr. Sethi talked about the importance with patients with hypothyroid of replenishing selenium and zinc and magnesium. Also we are starting to see more iodine deficiencies, esp. in vegetarians unless they are eating seaweed. Also people are no longer eating iodized salt and are buying sea salt or Himalayan pink salt in bulk and iodine evaporates when it’s exposed to air. Salt should be kept in a darkened container and you should go through it quickly. Also much of the public water has both chlorine and flouride added, both of which compete with iodine. And then there’s the gluten thing, since if your immune system reacts to gluten, it can cross-react and attack the thyroid tissue.
31:34 If a patient wants to prevent autoimmune diseases but does not currently have any symptoms, Dr. Sethi says that autoimmune diseases are really all related and tend to have similar triggers. We should start by looking at the microbiota with GI testing with the pcr stool test and the organic acids urine test. She will look at inflammatory foods that might be in their diet and either eliminate them for a month or do food sensitivity testing. She recommends making sure you are having your drinking water filtered with reverse osmosis or at least a Berkey filter. Make sure that you are not getting exposure to mold. Consider a HEPA filter in your bedroom. Look at nutritional deficiencies. Everybody should at least be taking a high quality multivitamin. Dr. Sethi cautioned to be careful about doing some of the autoantibody testing, esp. on kids, since there can be some false positives.
Dr. Shelly Sethi is an integrative, Osteopathic Physician who is board certified in integrative medicine. She has written a best-selling book, Built To Thrive. Dr. Sethi’s website is Dr.ShellySethi.com and you can make an appointment to see her by calling 512-215-9984.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting-edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube, and sign up for my free e-book on my website by doing to drweitz.com. Let’s get started on your road to better health. Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes. Give us a ratings and review. That way, more people can find out about the Rational Wellness podcast.
Our topic for today is the natural treatment for autoimmune diseases, and we’ll be speaking with Dr. Shelly Sethi. There’s been a significant increase in autoimmune diseases in the last several decades. We also have come to realize that a number of diseases that we didn’t understand the autoimmune origin, that now we’re starting to understand. Now there are approximately 100 different autoimmune diseases. For some reason, 75% of these occur in women. Having two X chromosomes seems to create a lower risk of infection in women, but a higher risk of autoimmune diseases. According to the American Autoimmune Related Diseases Association, there are approximately 50 million Americans suffering with autoimmune diseases. Some of the more common autoimmune diseases include Alzheimer’s disease, Parkinson’s, asthma, hypothyroid, rheumatoid arthritis, lupus, psoriasis, celiac disease, irritable bowel syndrome, Crohn’s disease, multiple sclerosis, and type 1 diabetes.
Our immune system is designed to protect us from pathogens, like bacteria, viruses, and parasites, as well as to help us repair our tissues when they’re damaged. But what happens in autoimmune diseases is that our immune system mistakenly attacks our own cells and organs. The conventional medical approach is to treat autoimmune diseases either by controlling the symptoms, such as by providing thyroid medication in the case of Hashimoto’s thyroiditis, or by using medications that suppress the immune system, such as corticosteroids steroids or chemotherapy agents or the newer immune-blocking drugs, like HUMIRA and REMICADE. These drugs simply block part of our immune system, which is a problem because you do need a properly functioning immune system, and they have potential side effects, like infections and cancer. But functional medicine treats autoimmune diseases by looking at some of the underlying factors that lead to the immune system getting dysregulated, such as leaky gut, food sensitivities, toxins, infections, nutritional deficiencies. This is all very important.
If I have a patient with hypothyroid, and it’s autoimmune in origin, and all this patient is treated with is thyroid medication, it doesn’t do anything for these smoldering fire of the autoimmune disease underlying it. This will continue to attack the thyroid gland. Chances are, it will continue, and the patient will need higher dosages of thyroid medication. Or, they may end up with another autoimmune disease because, statistically, they have a much higher risk of that. So, from a Functional Medicine perspective, not just regulating the thyroid, but also putting out that smoldering fire of autoimmunity is crucial for this patient’s long-term health. Dr. Shelly Sethi is a board-certified family physician with an emphasis on integrative and functional medicine. She studied integrative medicine with Dr. Andrew Weil and was also certified by the Institute of Functional Medicine. She also practices yoga and meditation and has written a number-one best-selling book, Built to Thrive. Dr. Sethi, thank you so much for joining me today.
Dr. Sethi: Thank you for having me.
Dr. Weitz: What do you think are some of the most important triggers for autoimmune diseases?
Dr. Sethi: Yeah. That’s such a good question and, I think, really under-addressed in the conventional community as you let us know. I feel like one of the first things that we should be looking at, really, is the gut because we know that many of the triggers that are coming to light for a number of these autoimmune diseases really do stem from what our microbiome or microbiota look like. In the advances in research in this field, we’ve really found that there are a number of various bacteria as well as viruses and parasites that have been associated with very specific autoimmune diseases. So, I think we’re really coming to a new era in the diagnosis and treatment and prevention of autoimmune disease.
Dr. Weitz: Cool. How do we diagnose autoimmune diseases?
Dr. Sethi: Yeah. In conventional care, the typical way to diagnose is to run a series of blood tests. Typically, what you’re looking at are a number of things like antibodies that are related to various types of proteins that are produced in the blood. For example, looking at an anti-nuclear antibody, an ANA, would be a screening test, an initial test that’s typically run for somebody who might be presenting with things like fatigue and joint pain or inflammation, something to really trigger the doctor to think that maybe there’s something going on that’s autoimmune-related. Then, from there, that is … Standard conventional care, that’s kind of the screening test. We also typically had been taught in medical school that if somebody presents with symptoms of rheumatoid arthritis that you would also run the RA panel, which also will look at antibodies. Then, from there, typically a patient would be referred to a rheumatologist who would then run a series of additional tests, which are highly specific to certain autoimmune conditions, and there’s a number of those different antibodies.
Dr. Weitz: Cool. What’s the role of diet and food sensitivities in autoimmune diseases?
Dr. Sethi: From my training in integrative medicine and Functional Medicine, I can tell you it’s huge. I will also say that what’s happening now, at least in my practice, is that I’m getting a number of referrals from the conventional rheumatologist into my practice because they are starting to recognize that food and diet and lifestyle have a significant impact. But unfortunately, the training isn’t there. Right? They’re just not taught in medical school, and I know because I was there myself, what to do about it. What they’ve been telling their patients is, “You need to change your diet, maybe even anti-inflammatory diet, and maybe reduce stress a little bit,” which isn’t enough information for patients. What I’ve found is that over that last couple years, the number of referrals to me in from rheumatologists into my practice has really increased, which is really exciting-
Dr. Weitz: That’s great.
Dr. Sethi: … because we’re able to then really get into it, look specifically at food sensitivities, look at whether or not they’ve been tested for celiac, which, of course, is more specific to gluten sensitivity or gluten allergy. Then, of course, the lifestyle component is huge, and we do a lot of that in my practice. I find that the combination of being able to really work with food sensitivities, dietary changes, lifestyle, medicine, along with what the rheumatologists are doing to help their patients once they’re so far along into the disease process I think is really effective.
Dr. Weitz: How do you screen for food sensitivities? Do you just tell them to avoid some of the most common food sensitivities, like wheat, dairy, soy? Do you do an elimination diet? Do you do food sensitivity testing?
Dr. Sethi: I do all of the above. I sort of have an order to that, and it’s because what I’ve found is that, oftentimes patients will come to me because they’ve had a food sensitivity test done by another practitioner or a nutritionist or somebody who is running this panel, and suddenly, they’re allergic to … 50 things show up on their panel, and they’re really stressed because they don’t know what to eat. They’ve lost some weight. They feel really nervous and fearful of eating different foods, and part of my job is to say, “Let’s really look at this from a standpoint of what makes sense.” I don’t really believe that the body would come to a place where it would be allergic to 100 different food items. I think that in that situation, when you’re seeing that sort of thing turn up on a food sensitivity test, what you’re really looking at is leaky gut. When you begin with the gut-healing process, and you fix leaky gut, and you repeat that food sensitivity test, oftentimes, you find that it just might be a couple of items. That being said, the gold-standard still is elimination. Right? A full-elimination diet, eliminating each of those foods for at least 30 days and then replacing them one by one over the course of three days is really the only way to truly understand whether or not somebody has a true sensitivity to a food, at least that’s what I’ve found in my practice.
Dr. Weitz: So, how do you do … Let’s say you do have a patient. They come in. They have this food sensitivity panel, and they have 50 different positives. How do you do an elimination diet? You’re not going to eliminate all of those. What are you going to eliminate in your elimination diet? How many foods are you going to include?
Dr. Sethi: Yeah. To start with, I would actually probably put that aside for now and begin treatment of leaky gut. Right? I would first say, “Well, let’s fix the gut.” Now, in part of that fixing of the leaky gut, we are going to remove from the diet kind of our top five things that seem to be quite inflammatory regardless, right, so of course, gluten. I typically eliminate dairy, soy, grains from somebody’s diet for at least a time period. I think that if we’re really thinking there’s an egg allergy, nuts, we can do those as well, but I try not to give them a lot of things to do at once. What I find is patients get really overwhelmed. We want to try to meet them where they’re at but also really be kind of strict about the fact that we need to get some of these top items out of their diet, so that’s what I found-
Dr. Weitz: So, you said gluten, dairy, soy. What else?
Dr. Sethi: Grains, initially.
Dr. Weitz: All grains. Okay.
Dr. Sethi: All grain initially is typically what I do for 30 days.
Dr. Weitz: Okay.
Dr. Sethi: If that’s really difficult, then we will focus on the non-gluten grains for them. Then, depending on … Sometimes I also really get a food history and say, “Well, what do you eat a lot of?” If there are a lot of eggs in their diet, like if they’re eating three eggs a day, and they’re presenting with skin rashes, then we might also say, “Let’s eliminate that for 30 days as well and see what happens.” Oftentimes, that gives us a really good idea of what really might be happening in the gut.
Dr. Weitz: Then, do you test for leaky gut? Or you just figure they must have leaky gut because of the way they present?
Dr. Sethi: Yeah, I’ve gone back and forth on that. I have used Zonulin. I haven’t found it to be as helpful, in all honesty, as I wanted it to be. I think we get a lot of information. I typically actually run the PCR stool tests, so I’m usually looking-
Dr. Weitz: You use a GI Map?
Dr. Sethi: I use a GI Map. That’s one of the very first things that I do with my patients. I also combine that with an organic acids test so that we can look at small intestine and look to see if there’s bacterial overgrowth or fungal overgrowth, and those two tests together-
Dr. Weitz: Is that through Great Plains or Genova?
Dr. Sethi: I use both. It just depends on insurance and cost for the patient, so I’m familiar with both of those and offer either one of those tests, depending.
Dr. Weitz: Okay.
Dr. Sethi: Yeah, so we’ll start with that typically. Then, that gives me enough information to get started. Usually, we’re looking at a number of different organisms that either are imbalanced or an overgrowth. Or, oftentimes, we’re picking up parasites or C. diff or H. pylori, all of which we know now have been associated with very specific autoimmune conditions, like ankylosing spondylitis, and MS, rheumatoid arthritis. So, I feel like that’s the best place to start for most patients. We get enough information to move forward. Then, once we’ve really fixed up the leaky gut situation, then we’ll run a food allergy panel, especially if they’re not getting the results that I would expect. But if they are getting the results that I expect, I don’t always run those panels. I still really urge my patients to be gluten-free and dairy-free because I do think that, no matter what, those are two foods that I feel are quite inflammatory in most of our diets these days.
Dr. Weitz: Let’s say you run those two initial panels. You do the GI Map, and you do the organic acids testing. Say, the organic acid testing has maybe some indication that there might be a little fungal overgrowth and the GI Map shows some bacteria that are overgrown or maybe a protozoan or something like that. What sorts of treatments will you then do?
Dr. Sethi: Yeah. Usually, I’m also looking at what their immune status looks like in the gut as well. Right? Secretory IgA is a really good marker for that. If they look like they need a little help there … First, we’ll work on supporting the gut with things like Saccharomyces, vitamin A, vitamin C. I like to use amla in some of those patients.
Dr. Weitz: In other words, if their secretory IgA is low, that might indicate that their immune system in their gut is not functioning properly to help them get rid of these pathogens, so then you’re going to try to support the immune system?
Dr. Sethi: Yes, absolutely. If the secretory IgA is high, it actually gives me another indication that their immune system is really turned on, and it’s trying to fight something. So, it’s a nice marker. I also look at the calprotectin and other inflammatory markers in the gut. I’ve actually diagnosed a number of patients with inflammatory bowel disease just from that GI Map and got them over to the GI and
Dr. Weitz: Just because they had a elevated calprotectin?
Dr. Sethi: Mm-hmm (affirmative), elevated calprotectin. Sometimes, there’s blood in the stool and a particular sort of look to what their dysbiosis looks like as well, so-
Dr. Weitz: Oh, really? What sort of things do you see in the dysbiosis factor?
Dr. Sethi: Well, with IBD, oftentimes, I’ve seen organisms like Citrobacter or Klebsiella, which are highly associated with autoimmune conditions. That tends to come up quite a lot, actually, just in my experience working here with patients. At that point, I say, “Let’s just go a little further and get a colonoscopy and figure out what’s going on.” Supporting that secretory IgA, the immune system, it really doesn’t take very much. A lot of it is-
Dr. Weitz: Do you use-
Dr. Sethi: … natural foods, like-
Dr. Weitz: Do you use colostrum as part of that protocol?
Dr. Sethi: I do if we’re not very concerned about a dairy allergy. I know there’s kind of mixed evidence on whether or not it should be avoided with a dairy allergy or not. I’ve found most people-
Dr. Weitz: And then use a non-dairy colostrum product as well out there.
Dr. Sethi: Yes, and so sometimes we’ll use that as well. But I also think Saccharomyces boulardii is one of the best ways to increase and help the immune system of the gut as well.
Dr. Weitz: Cool.
Dr. Sethi: Yeah. Vitamin A, vitamin C, those are two other big ones that we usually start our patients out on and get that immune system working.
Dr. Weitz: Then, once you got the immune system working, what’s the next level of protocol?
Dr. Sethi: Yeah. Then, it would be really getting rid of what’s there. If they have parasites, I actually really like the parasite protocol from BioCore Cell Sciences or Core Cell Sciences. They use a product that has Mimosa pudica in it, which … In the work that I’ve done trying to work with organisms like Dientamoeba and some of those ones that are a little bit more difficult to get rid of from the gut, this is the one product that works immediately, so that’s my go-to for parasites.
Dr. Weitz: Interesting. Mimosa, okay. Cool.
Dr. Sethi: Yeah, it works really well. Then, if they are dealing with a bacterial overgrowth, it really depends if it’s H. Pylori or some of the other ones like Klebsiella or Citrobacter, we’ll start using … Products that contain berberine, that’s a very, very effective antimicrobial. Things that contain mucilaginous-type botanicals as well, like DGL and marshmallow’s one of my favorite- Yeah, all of those. Zinc carnosine is really nice to add in there as well. There’s a number of products, and I typically … In order to reduce the number of supplements that a patient’s taking, I have my mixed blends of products that I like to use to get rid of the overgrowth or the parasites.
Dr. Weitz: So, you’ll use anti-microbial herbs and also supplements to help strengthen the gut at the same time?
Dr. Sethi: I do, yeah. I’ll do typically the support for the immune system. Then, it’ll be followed by an antimicrobial-type protocol along with some liver support. Because a lot of times, as there’s die-off from those organisms, we want to make sure that they’re on some milk thistle and other things to support the gut, sorry, the liver. Then, of course, something to sort of bind to those things as they’re dying off as well, so either an activated charcoal or zeolite clay or fulvic acid or something of that nature. That’s usually going on for about two to three months with most patients.
Dr. Weitz: Okay.
Dr. Sethi: Then, once we kind of get them through that phase, the killing phase, I’ll retest. Usually, I retest at that point and look to see whether or not we’ve really budged with the balance there and gotten that secretory IgA increased. If so, which in most cases, I would say three months is typically enough, we’ve been able to get rid of C. diff or H. pylori or some of those more aggressive organisms or the fungal overgrowth. Then from there, we really go into kind of soothing the gut. There I like to use zinc carnosine, marshmallow, chamomile, all of those sorts of things, antioxidants, quercetin, those sorts of things that really do help the gut kind of restore, and, of course, some of the spore-based probiotics as well at that point.
Dr. Weitz: Cool. L-glutamine as well?
Dr. Sethi: L-glutamine as well, yes. Yes.
Dr. Weitz: Okay. What part does toxic exposure play in the etiology of autoimmune diseases?
Dr. Sethi: Yeah. I think that there’s a lot of different things that we are starting to understand can affect the gut. Right? Heavy metals for one, which can come through the air that we’re breathing. Can also come from exposures through amalgams and things like that. Certainly, plastics, phthalates, BPA, all of those things do affect the microbiome. I think what we’re seeing now is that, as they’re doing more and more research on a lot of these different toxic substances in our environment, we’re really finding that the way in which they actually affect our bodies the most is probably mitigated through the microbiome itself. I always tell my patients, “You’re only going to be as healthy as your gut is.” So, if the gut’s not healthy because of toxic exposures, poor lifestyle, poor sleep, increased stress, poor nutrition, then you’ve already got a situation where you’re set up for leaky gut or dysbiosis, SIBO, SIFO, all of those various things.
Then, on top of it, you’re really going to become nutrient deficient because if the gut membrane isn’t healthy, you’re not going to be able to absorb the nutrients that you should be absorbing just from your food. So, you could have the cleanest diet, and have all this organic food, but not absorbing all those nutrients, which is why I also include that initial organic acids test so I can really understand what their vitamin deficiencies and nutrient deficiencies look like from the outset. In addition to doing a gut treatment, I will replenish them with nutrients that they’re deficient in so that the cells can really begin to heal with all of those nutrients that they need.
Dr. Weitz: Cool. Let’s go through a few case studies. I understand you’re not going to have all the details, but just sort of in general, some of the ways you would approach a few patients.
Dr. Sethi: Sure.
Dr. Weitz: If you have a patient who comes in, and they have Hashimoto’s autoimmune thyroid, and as far as we could tell, no other blatant symptoms … Obviously, you’re going to do a careful history and find out if there’s anything else going on. But in general, how would you investigate this patient? What direction would you look at? How would you try to find some of the underlying triggers? What tests would you consider running?
Dr. Sethi: Yeah. That’s a great question. I get a lot of patients with Hashimoto’s because when they see their conventional doctor, they’re typically just given Synthroid. That’s their option. They start to do their own reading. Many of them have been … They’ll come across somebody like Dr. Izabella Wentz’s book or other books out there in the functional medicine community, and they know that there’s more they can do. So, they usually come in with a diagnosis, hopefully fairly early in their diagnosis so we can get them going, and one of the-
Dr. Weitz: Unfortunately, a lot of times, antibodies aren’t even measured. Or, if they are, they don’t really know what to do with them, so they’re just sort of ignored.
Dr. Sethi: Absolutely. I am finding that a lot more of the conventional docs are starting to measure the antibodies, but only at the time of when TSH has been found to be elevated, right, which is a little too late. You really want to be measuring your antibodies for thyroid a decade in advance because you can actually start to see that number rising. I mean, I’ve actually got patients in my practice right now who are 10, 11, 12 years old. Their parents have … The mom has Hashimoto’s. The aunt has Hashimoto’s. The moms are concerned, so they’ve brought them into me for testing, and we’re finding those antibodies already.
Dr. Weitz: Wow.
Dr. Sethi: Yeah, which is shocking to me. Because when I was in medical school, Hashimoto’s was a funny name for a disease we would never see, and it is one of the more common calls that I get these days is help with Hashimoto’s. So-
Dr. Weitz: Interesting. I’ve kind of had a little running debate with another prominent Functional Medicine doctor who says, “Wait until the TPO antibodies get over 500, you shouldn’t really worry about it.”
Dr. Sethi: I disagree with that because I think there’s a lot you can do, so why don’t we talk about that for a minute? Because I think that’s really, really important. What it does for, I think, patients’ family members and just people in general is give them hope, where they don’t … In conventional practice, we wait till we see the disease to give the patient any hope. And it’s not even really hope. It’s really just a pill. But here we can say, “No, this is … Your body has the capacity to heal itself,” and that is my bottom-line premise of my practice is that the body has the capacity to self-heal. It’s one of the very first osteopathic tenets, which I learned in DO school. I abide by that, and I let my patients know there’s a lot that they can do. Just because you have the genetic predisposition for something does not mean that’s your destiny. There have to be triggers, and the triggers typically come from the environment and your exposome, so all the things that your body is exposed to. That might be food. It might be stress. It might be toxins. It might be neuroendocrine disruptors. It might be bacteria, parasites that live and thrive in the gut. It might be a number of things.
When I see these young kids that are already showing signs of elevated antibodies, it’s telling me that something is triggering that process on to where the body is now attacking the thyroid gland. So, what can we do about that? We begin to look at their lifestyle. This 12-year-old girl that I’m treating right now, she’s a swimmer. She’s in chlorinated water every day of the year. We live in Texas, so that’s a lot of the year. I had to have a talk with her that the skin rashes, the antibodies … She’s already to the point where the TSH is elevated, and so her endocrinologist wants to put her on medications already. We really have to consider taking breaks from the chlorine if not considering what it means in terms of giving that up. So-
Dr. Weitz: For those of us who are not aware, chlorine is in the same row in the periodic table as fluorine and iodine. So, potentially, chlorine could interfere with iodine, which is an essential nutrient for thyroid function, correct?
Dr. Sethi: Absolutely. That’s exactly how we think it interferes. I did have her talk to her endocrinologist about it. He was in disagreement with my theory. But I will tell you that, in the summer, I asked her to take a break, and she did. Of course, we did interject a lot of the lifestyle changes. Got inflammatory foods out of her diet. Got her sleeping better. Had her introduce a meditation practice every day. But at the end of the summer, the rash that she had had on her skin, which looks to be some sort of scleroderma-type thing, had actually shrunk to half the size. Her dermatologist was shocked. Now, I can’t tell you this was a large multi-study, multicenter, randomized, controlled trial, but I think we’re past that point of really considering that to be the gold standard in medicine. Patients, they are individuals, and we have to think of them as an N-of-1. To me, this was a study in what happens when we remove chlorine from her life? What happens to her symptoms? Her mom was in agreement that they really did think it had a lot to do with her not having that chlorine exposure for at least three months. So, there’s a lot that can be done earlier for prevention, which is why I really do advocate for testing our girls early, especially if there is a family history.
Dr. Weitz: You ever test for halides, like chlorine and fluoride?
Dr. Sethi: I haven’t really gone down that path… I did with her, but it’s not something I typically do on a routine basis. It’s something I do want to look more into, but I think that we get a lot of benefit just from doing things like replenishing selenium and zinc and magnesium, which so many of these girls are really low in, all of these things being really, really important for the thyroid. Our vegetarians typically can be iodine deficient. Oftentimes, I’ll test a urine iodine to look for iodine levels because that’s a hugely missed thing now in our society, especially as people have migrated over to using sea salt, which is oftentimes not iodized. There are also vegans, so they’re not eating seaweed. They’re not eating fish. They’re not getting any source of iodine in their diet. Also, people are buying salt in bulk. Iodine evaporates when it’s exposed to the air, so I oftentimes advise people to buy small amounts of salt. Keep it in a darkened container, and go through it quickly. That’s a huge area where we’ve been able to find that we can do something about as well.
Dr. Weitz: Yeah, no. In the natural medicine community, a lot more people are using sea salt, Himalayan pink salt, Redmond Sea Salt, so they’re not getting as much iodine as they used to get. Then, so much of the water has chlorine in it and also fluoride, and they may be brushing their teeth with fluoride toothpaste or using fluoride mouthwash.
Dr. Sethi: Absolutely. Yes, and they do have to look at their city to figure out whether it’s chlorinated or not. We talk about water filters. That’s just another easy way to be able to have a decrease in some of these toxins in the environment. I do think there’s a lot you can do to reduce exposures, which then really do affect whether or not those genes are turned on or not, really.
Dr. Weitz: Right. Then, of course, foods like gluten can cross-react with thyroid tissue. Right?
Dr. Sethi: Yeah. There’s always that debate early on with my patients about gluten, so what I ask them to do is I ask them to do 30 days. I think probably 80% of them come back after 30 days and say they feel significantly different. Then, that’s typically enough for them to stay motivated to really stay as gluten-free as possible. There’s a good 10 to 20% that are like, “I’m going to have my pizza.” At least now we have cauliflower pizza options.
Dr. Weitz: You mentioned a girl whose relatives have hypothyroid. What about somebody who comes to you who’s just concerned about autoimmune diseases because a number of their relatives have had a number of autoimmune diseases? I know that there’s one lab that actually has a multiple autoimmune panel. How would you approach somebody who says, “I don’t know that I have any symptoms of autoimmune disease, but I just want to prevent it. It seems like I have a high family history of it”?
Dr. Sethi: Yeah. I think there’s a number of steps to really consider. Depending on what the autoimmune condition is, and again, the way I describe this to patients is that if you have a family history, then you do probably have some predisposition to a particular kind of … I think of it like a tree. You have the roots, and then how it branches out may look different in you than somebody else, but all autoimmune conditions are really related. It’s just how it presents itself in your body or maybe what your specific triggers were in the environment. So, knowing that they’re all related, I think there’s a lot that can be done early. In a patient like that that would present to me, I would absolutely want to really look at the gut. Right? We want to look at the GI mucosa. We want to look at the microbiota. I think there’s a lot we can do there. I typically recommend getting those tests once a year. I do it on my entire family. I’ve got two young kids, six and eight. We all get our GI tests done once a year so we can keep things going and healthy.
I also usually do look at any inflammatory foods that might be in their diet, and we talk about that. Removing those from the diet early on can really have a long effect on chronic disease processes in the later life. Then, we want to look for potential food sensitivities and eliminate those. So, if it seems as though something’s presenting like a food sensitivity, we’ll do removal or maybe even do a food sensitivity test around that. Some of those are quite easy to tell. They’ll say, “Oh, every time we have nuts, I get a little just itching around my mouth, or I notice stuff when I eat this particular …” I had a guy last week who … He’s been going to an Indian restaurant and eating Saag Paneer every week, and he’s like, “You know, it just occurred to me that every time I eat that, I get this rash.” I was like, “Yeah, I think that’s probably, you probably have a sensitivity to either the dairy or the oil that they’re using, peanut oil or canola or something. Probably want to leave that out of your diet for a month.” He did, and lo and behold, he’s allergic to something. So, some of these are quite easy and obvious when you really kind of focus in on them. Then, of course, we want to really eradicate any toxins in the environment. So, I’m really big on everybody having their water filtered that does an adequate job. I love the Berkey filter as kind of a quick and easy if you’re not going to do a reverse osmosis in your house. Making sure that if you live in an older home that you’re thinking about things like mold. If you’re living near a road where there’s a lot of traffic, considering a HEPA filter in your bedroom. Thinking about where you’re working if you have a lot of exposure there.
I think that looking at the gut, eliminating toxins from the environment, eliminating inflammatory foods or foods that you might be sensitive to from the diet, and just chronically looking at nutrient deficiency. I’m at the point now in my career where I believe everyone should be on a really high-quality multi-vitamin. I didn’t believe that a decade ago. Like many physicians, I thought that you don’t need vitamins. You can get everything from your food. But knowing what I know now and noticing even in myself how everything changed for me when I started supplementing with high-quality vitamins, I think everybody needs to have that as their foundation. Our food sources have changed. We just don’t have enough nutrients in our food. We don’t have healthy guts anymore. Many of us have decreased ability to digest, so sometimes digestive enzymes are necessary. There’s a number of reasons why I think that could be really helpful. That’s how I would approach, really, any patient who is concerned about an autoimmune condition because they have a family history.
Then, as far as … You asked about testing with the autoantibody test. I do think we have to be a little bit careful. I think as a screening, an ANA, an antinuclear antibody, is fine, especially if there’s a family history of autoimmune conditions. I think that doing a rheumatoid arthritis is fine if there’s a family history and maybe some presenting signs or symptoms. Then, of course, the Hashimoto’s antibodies as well. Other than that, when you’re talking about things like the anti-mitochondrial antibodies and the endomysial DNA, I mean, those are really … You have to understand the sensitivity of the test and also the age of the patient. I’ll just give you a case example. On my son, we had a situation with him where he had presented twice with this acute hip pain. It didn’t look like it was an infection. He wasn’t walking, and presented with these high fevers and had this whole pattern going on that really looked like it might have been some sort of autoimmune condition. Well, of course, me being a doctor, I’m like, “Let’s run all these tests,” and so I did. He came back with a very high ANA, and he also came back high with a really high anti-centromere antibody, which, if you look it up, can be really scary. It can mean that there is some sort of a autoimmune condition that affects the brain going on. Of course, I got very nervous and pulled some strings and got him in with the one of two pediatric rheumatologists that work here in Austin very quickly because …
Being a doctor and having this information, I was quite nervous and upset. We went in, and he explained to me and showed me the studies and the percentages of children that have positive ANAs and positive autoantibodies that then grow out of it that may not mean anything at all. Right? They have a different presenting percentage of these antibodies, and so they don’t oftentimes test the same tests in pediatrics as they do in adults because it can mean something very different. Now, being a functional integrative doc, I’m thinking, okay, well, we’re just going to make sure he’s living a clean lifestyle anyway because maybe there’s a potential there, though we don’t have any autoimmunity in our family. But it was really interesting to hear that because I think it does really paint a case for being careful about testing for some of these autoantibody tests and really creating fear in our patients when maybe there doesn’t need to be that situation. So, really focusing on the things that we can do, which there’s a lot we can do preventively and maybe leaving some of those more advanced tests for the people that’ve specialized in that. That’s how I like to approach it.
Dr. Weitz: That sounds great. I think that’s all the questions I have. I think we covered some good information. Any final words you want to leave the viewers? Then, if you could give us your contact information so we can find out about getting ahold of you, and your book, and any of the programs you have to offer.
Dr. Sethi: Absolutely. I mean, the final thing I’d like to say is I think it’s … We’re really in a time of change around some of these chronic illnesses, our understanding of them. So, if you’re listening to this, and you’re in a situation where you’re working with a doctor who is not open to believing that lifestyle can make a big difference and even potentially put you into remission with your disease, then please seek out somebody like Dr. Weitz or myself or any of those other integrative functional docs out there doing this work. Because we’ve all seen it with our own eyes how even just holding hope for this can really make a big difference in our patients’ lives, so really kind of trying to change your mindset around that and finding help where you can get help. Patients can find me at my website, drshellysethi.com. It’s D-R-S-H-E-L-L-Y-S-E-T-H-I dot com. If they go to my site, they can actually download my book, Built to Thrive, for free if they wanted to get a PDF copy of it. I’d love to interact with anybody who has any further questions, but I really appreciate you addressing this and bringing this awareness to your patients and to the public at large.
Dr. Weitz: That’s great. Thank you so much, Dr. Sethi.
Dr. Sethi: Thank you.
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