Dr. Akil Palanisamy

And so if you're getting blood work, screening for some of those autoantibodies can be a clue because that could be one of the signs that you might benefit from this program. But some of the common symptoms I see, fatigue, of course is super common, but that can be caused by this. Joint pains, like different kinds of aches and pains.

And so if you're getting blood work, screening for some of those autoantibodies can be a clue because that could be one of the signs that you might benefit from this program. But some of the common symptoms I see, fatigue, of course is super common, but that can be caused by this. Joint pains, like different kinds of aches and pains.

And then cognitive issues like brain fog or mood issues, those are probably the three most common symptoms I see.

And then cognitive issues like brain fog or mood issues, those are probably the three most common symptoms I see.

Well, Cyrex Labs. Cyrex Labs.

Well, Cyrex Labs. Cyrex Labs.

You got to have a practitioner. Yeah. I don't think there's a direct to consumer. I think there's a great opportunity for that, but I don't think it's been done.

You got to have a practitioner. Yeah. I don't think there's a direct to consumer. I think there's a great opportunity for that, but I don't think it's been done.

Yes, exactly. So yeah, and anyone, you know, even in that early autoimmune subclinical phase could benefit from it. And anyone who wants to reduce inflammation, I think would benefit from this approach because it's highly anti inflammatory.

Yes, exactly. So yeah, and anyone, you know, even in that early autoimmune subclinical phase could benefit from it. And anyone who wants to reduce inflammation, I think would benefit from this approach because it's highly anti inflammatory.

you know, from the diet perspective, from the spices we're incorporating, from just detoxing that lowers your inflammation, from some of the supplements I'm recommending. And we know inflammation is kind of the root cause for all our modern chronic diseases, right? So we know like for almost all of us working to bring our inflammation down and keep it low is really vital for long-term health.

you know, from the diet perspective, from the spices we're incorporating, from just detoxing that lowers your inflammation, from some of the supplements I'm recommending. And we know inflammation is kind of the root cause for all our modern chronic diseases, right? So we know like for almost all of us working to bring our inflammation down and keep it low is really vital for long-term health.

Yeah, absolutely. So with diet, I like to separate it out. So I have like a phase one diet, which is more of an elimination diet, which is more restrictive, more focused on gut healing. And then there's the phase two diet where you're kind of reintroducing foods, you're expanding the prebiotic foods, you're rebuilding the microbiome.

Yeah, absolutely. So with diet, I like to separate it out. So I have like a phase one diet, which is more of an elimination diet, which is more restrictive, more focused on gut healing. And then there's the phase two diet where you're kind of reintroducing foods, you're expanding the prebiotic foods, you're rebuilding the microbiome.

Yeah, absolutely. So that's very important because during that phase one of elimination, you want to really add in these things so that you get the most benefit from that phase one diet. So I am a big fan of bone broth. I think that even though it's a bit of a fad, there is research on all the benefits for gut healing from the gelatin, the glycine, the amino acids.

Yeah, absolutely. So that's very important because during that phase one of elimination, you want to really add in these things so that you get the most benefit from that phase one diet. So I am a big fan of bone broth. I think that even though it's a bit of a fad, there is research on all the benefits for gut healing from the gelatin, the glycine, the amino acids.

Yes. It's actually a medicine in Ayurveda. For thousands of years, it's been used in Ayurveda. Wow, I didn't know that. Yeah, so if people do not want to eat, have bone broth, then doing collagen powder is a good substitute. You can find like grass fed collagen powder, and that's pretty easy to mix into like smoothies or water. So that's an alternative. So either bone broth or collagen powder.

Yes. It's actually a medicine in Ayurveda. For thousands of years, it's been used in Ayurveda. Wow, I didn't know that. Yeah, so if people do not want to eat, have bone broth, then doing collagen powder is a good substitute. You can find like grass fed collagen powder, and that's pretty easy to mix into like smoothies or water. So that's an alternative. So either bone broth or collagen powder.

And then second, I really like glutamine. for its gut healing effects. And the best food source is actually the cabbage juice. So if you just, you have a juicer and can juice some cabbage, or you can make it in a blender. Cabbage is that one of the richest food sources of glutamine. So if you're willing to drink that, that's an option. Or if not, you can find it easily as a supplement.

And then second, I really like glutamine. for its gut healing effects. And the best food source is actually the cabbage juice. So if you just, you have a juicer and can juice some cabbage, or you can make it in a blender. Cabbage is that one of the richest food sources of glutamine. So if you're willing to drink that, that's an option. Or if not, you can find it easily as a supplement.

It's a white powder, easy to use.

It's a white powder, easy to use.

Yeah, I always give people the option for food because there are some that just only want to do foods. And I love working with food as medicine because it's so powerful. But yeah, glutamine has good research to show it heals intestinal permeability, helps with the leaky gut. It helps with the dysbiosis, the imbalance of bacteria. And it's usually like very well tolerated.

Yeah, I always give people the option for food because there are some that just only want to do foods. And I love working with food as medicine because it's so powerful. But yeah, glutamine has good research to show it heals intestinal permeability, helps with the leaky gut. It helps with the dysbiosis, the imbalance of bacteria. And it's usually like very well tolerated.

So I think that's another integral part of the gut healing.

So I think that's another integral part of the gut healing.

Yeah. There are two other categories of foods that I think are very important. One is prebiotic foods. A prebiotic is basically something that has food for your gut bacteria. That's different from a probiotic, which is like the actual gut bacteria.

Yeah. There are two other categories of foods that I think are very important. One is prebiotic foods. A prebiotic is basically something that has food for your gut bacteria. That's different from a probiotic, which is like the actual gut bacteria.

And I feel like that's something that's missing, you know, because oftentimes I see patients you know, they're on like the autoimmune paleo diet, which is a very common diet, or the whole 30. And they, you know, felt significantly better.

And I feel like that's something that's missing, you know, because oftentimes I see patients you know, they're on like the autoimmune paleo diet, which is a very common diet, or the whole 30. And they, you know, felt significantly better.

So prebiotic foods, I think, should be introduced really upfront in the phase one diet even because there are certain prebiotic foods that most people can tolerate that don't really cause issues. And those are the polyphenol rich foods. So I think prebiotic foods are really key.

So prebiotic foods, I think, should be introduced really upfront in the phase one diet even because there are certain prebiotic foods that most people can tolerate that don't really cause issues. And those are the polyphenol rich foods. So I think prebiotic foods are really key.

That's an even bigger part of the phase two diet because prebiotic foods are how you build the diversity of the microbiome. So then I go through some of the main categories like polyphenols and what are the best fruits and vegetables, what are the the best like nuts and seeds. So there's a lot of literature about the polyphenol content of foods.

That's an even bigger part of the phase two diet because prebiotic foods are how you build the diversity of the microbiome. So then I go through some of the main categories like polyphenols and what are the best fruits and vegetables, what are the the best like nuts and seeds. So there's a lot of literature about the polyphenol content of foods.

So just to take a step back with prebiotic foods, like for example, legumes and beans are a really good source. People with certain conditions like SIBO, small intestinal bacterial overgrowth, they may not do well on prebiotic foods upfront. So they typically do well on polyphenols, which are the food that's tolerated.

So just to take a step back with prebiotic foods, like for example, legumes and beans are a really good source. People with certain conditions like SIBO, small intestinal bacterial overgrowth, they may not do well on prebiotic foods upfront. So they typically do well on polyphenols, which are the food that's tolerated.

um but then i i really recommend getting resistant starch so there's like three types of resistant starch we can talk about those foods later and then i emphasize inulin so inulin rich foods there's about a dozen inulin rich foods that are really excellent inulin is one of those prebiotics that has a really good research for

um but then i i really recommend getting resistant starch so there's like three types of resistant starch we can talk about those foods later and then i emphasize inulin so inulin rich foods there's about a dozen inulin rich foods that are really excellent inulin is one of those prebiotics that has a really good research for

Not just gut health, but helping your blood sugar, helping brain health, helping inflammation. So getting inulin-rich foods. And then there are other categories like mushrooms are actually very powerful for healing the gut, powerful prebiotics. So yeah, prebiotic foods is a really huge topic. But then the second big category is fermented foods.

Not just gut health, but helping your blood sugar, helping brain health, helping inflammation. So getting inulin-rich foods. And then there are other categories like mushrooms are actually very powerful for healing the gut, powerful prebiotics. So yeah, prebiotic foods is a really huge topic. But then the second big category is fermented foods.

So studies show that fermented foods also reduce inflammation and improve immune markers. So they do improve some of these like cytokines, which are the immune system like messengers. So incorporating both of those is very good for gut healing.

So studies show that fermented foods also reduce inflammation and improve immune markers. So they do improve some of these like cytokines, which are the immune system like messengers. So incorporating both of those is very good for gut healing.

And then I've been on it for 10 years, you know, but it was never intended for that, because you don't want to be on a very restrictive diet long term, you want to be on a

And then I've been on it for 10 years, you know, but it was never intended for that, because you don't want to be on a very restrictive diet long term, you want to be on a

Yeah, I think that's an important principle, which is start low and go slow with the dosage, because even low dosages of prebiotic foods and fermented foods have benefit. I've had patients, when they're trying to introduce fermented foods like sauerkraut, they could only start with the sauerkraut juice. They could not have the actual vegetable.

Yeah, I think that's an important principle, which is start low and go slow with the dosage, because even low dosages of prebiotic foods and fermented foods have benefit. I've had patients, when they're trying to introduce fermented foods like sauerkraut, they could only start with the sauerkraut juice. They could not have the actual vegetable.

So then they start with like a teaspoon of sauerkraut juice per day. And it feels like laughably small, but I say, no, that's good. You're getting your gut used to this change. And then you work up to a tablespoon. Then you start adding a little bit of actual sauerkraut, the cabbage. And so that way, over many days or weeks, you're building up slowly.

So then they start with like a teaspoon of sauerkraut juice per day. And it feels like laughably small, but I say, no, that's good. You're getting your gut used to this change. And then you work up to a tablespoon. Then you start adding a little bit of actual sauerkraut, the cabbage. And so that way, over many days or weeks, you're building up slowly.

And that's a much better strategy to get your gut to tolerate these foods.

And that's a much better strategy to get your gut to tolerate these foods.

restrictive diet for a certain amount of time, do some gut healing, do some detox, and then start expanding your diet so you can build up the diversity of your bacteria, which is one of the key barometers of the microbiome and keys to longevity. So that's a mistake I often see in diet when I have patients come to me saying, yeah, I've been on this very restrictive diet.

restrictive diet for a certain amount of time, do some gut healing, do some detox, and then start expanding your diet so you can build up the diversity of your bacteria, which is one of the key barometers of the microbiome and keys to longevity. So that's a mistake I often see in diet when I have patients come to me saying, yeah, I've been on this very restrictive diet.

Although in our case, we take insurance.

Although in our case, we take insurance.

Yeah. We're part of a group called Sutter Health, which is throughout California. And we're trying to be the integrative medicine branch within Sutter Health.

Yeah. We're part of a group called Sutter Health, which is throughout California. And we're trying to be the integrative medicine branch within Sutter Health.

Yeah. For that reason. Yeah. For that reason. We have five clinics in the Bay Area, but yeah, massive waiting lists. But that's why I'm looking at more innovative models. I'm doing a lot of group visits these days. And then I've also created some online courses on autoimmune disease and so

Yeah. For that reason. Yeah. For that reason. We have five clinics in the Bay Area, but yeah, massive waiting lists. But that's why I'm looking at more innovative models. I'm doing a lot of group visits these days. And then I've also created some online courses on autoimmune disease and so

Yes, absolutely. And that was my goal for writing the book was to try to keep it simple, try to keep it practical and not overwhelm people and include steps that because I think the average person may not have access to a practitioner to guide them. So I wanted to really put enough information in here that would allow a person to do this on their own.

Yes, absolutely. And that was my goal for writing the book was to try to keep it simple, try to keep it practical and not overwhelm people and include steps that because I think the average person may not have access to a practitioner to guide them. So I wanted to really put enough information in here that would allow a person to do this on their own.

There's a lot of guidance about the reintroductions, like how you expand your diet after the initial elimination diet. That is trial and error. So every person has to do that on their own. But I walk people through how to do that. And I think incorporating a lot of these practices like the exercise or the sauna or meditation, those are

There's a lot of guidance about the reintroductions, like how you expand your diet after the initial elimination diet. That is trial and error. So every person has to do that on their own. But I walk people through how to do that. And I think incorporating a lot of these practices like the exercise or the sauna or meditation, those are

um with some support like with apps or coaches or trainers you know you can reach out to whoever you have but i my goal was to make it accessible and possible to do on one's own

um with some support like with apps or coaches or trainers you know you can reach out to whoever you have but i my goal was to make it accessible and possible to do on one's own

And then over time, it becomes very hard to follow because it's so restrictive. And so what I focused on with her, for example, was three kind of big things, which were cutting back on gluten, dairy, and sugar.

And then over time, it becomes very hard to follow because it's so restrictive. And so what I focused on with her, for example, was three kind of big things, which were cutting back on gluten, dairy, and sugar.

In the first phase. Yeah, exactly.

In the first phase. Yeah, exactly.

Yes.

Yes.

Yes.

Yes.

Yeah. So the research shows that patients with autoimmune disease tend to have much higher levels of food sensitivities. And that's like common ones that they've tested are like dairy products, gluten as well. So we know that they are much more likely to have reactions to foods. And we have to distinguish between food allergy and food sensitivity.

Yeah. So the research shows that patients with autoimmune disease tend to have much higher levels of food sensitivities. And that's like common ones that they've tested are like dairy products, gluten as well. So we know that they are much more likely to have reactions to foods. And we have to distinguish between food allergy and food sensitivity.

So a food allergy is like what people think of usually, like you react to shellfish or peanuts and you can't breathe or your lip swells up. That's an immediate reaction that's a food allergy. But a food sensitivity is actually something quite different. There may be no symptoms. There could be delayed symptoms, like up to two to three days after ingesting the food.

So a food allergy is like what people think of usually, like you react to shellfish or peanuts and you can't breathe or your lip swells up. That's an immediate reaction that's a food allergy. But a food sensitivity is actually something quite different. There may be no symptoms. There could be delayed symptoms, like up to two to three days after ingesting the food.

There could be nonspecific symptoms like brain fog, fatigue, or malaise, headaches, congestion. Or there could just be inflammation triggered in the body without symptoms.

There could be nonspecific symptoms like brain fog, fatigue, or malaise, headaches, congestion. Or there could just be inflammation triggered in the body without symptoms.

um food sensitivities are what we think about and that's the reason for eliminating those foods because those are some of the common sensitivities and you know we can do tests so like sometimes we test patients for food sensitivities and then use that as a guide to what they need to eliminate but statistically yeah gluten dairy are the two biggest food sensitivities

um food sensitivities are what we think about and that's the reason for eliminating those foods because those are some of the common sensitivities and you know we can do tests so like sometimes we test patients for food sensitivities and then use that as a guide to what they need to eliminate but statistically yeah gluten dairy are the two biggest food sensitivities

And those are a problem because they really inflame your immune system. So in the gut, when you are exposed to foods that you have antibodies against, which is what a food sensitivity is, then your immune system goes into hyperdrive. It's like constantly reacting to the foods you're eating every single day. And that just predisposes to autoimmunity and worsens autoimmunity.

And those are a problem because they really inflame your immune system. So in the gut, when you are exposed to foods that you have antibodies against, which is what a food sensitivity is, then your immune system goes into hyperdrive. It's like constantly reacting to the foods you're eating every single day. And that just predisposes to autoimmunity and worsens autoimmunity.

So that's the main reason for that.

So that's the main reason for that.

Yep.

Yep.

Yeah, exactly. My goal is always trying to expand the diet as much as possible, as much as someone will tolerate. I think the elimination phase is the phase one diet, but then the reintroductions are even more important, and that's part of the phase two. There's a lot of subtlety and nuance in that, which I work with my patients on, I talk about in the book.

Yeah, exactly. My goal is always trying to expand the diet as much as possible, as much as someone will tolerate. I think the elimination phase is the phase one diet, but then the reintroductions are even more important, and that's part of the phase two. There's a lot of subtlety and nuance in that, which I work with my patients on, I talk about in the book.

what's the order to reintroduce foods, you should reintroduce the foods that are kind of least allergenic first. So you know, if you've eliminated like nuts and seeds or nightshades, or you know, the maybe those are earlier in the reintroduction, and then you reintroduce more allergenic foods like dairy towards the end and then gluten at the very end, because it's the most allergenic.

what's the order to reintroduce foods, you should reintroduce the foods that are kind of least allergenic first. So you know, if you've eliminated like nuts and seeds or nightshades, or you know, the maybe those are earlier in the reintroduction, and then you reintroduce more allergenic foods like dairy towards the end and then gluten at the very end, because it's the most allergenic.

That maximizes the chance of success because the goal is always getting people to expand their diet to the maximum diversity they can tolerate, and then hoping we can heal their gut enough where they get to a point where they can tolerate some amount of gluten, some amount of dairy, fermented dairy, extremely beneficial like yogurt and kefir, and have that 80-20 rule that's our target.

That maximizes the chance of success because the goal is always getting people to expand their diet to the maximum diversity they can tolerate, and then hoping we can heal their gut enough where they get to a point where they can tolerate some amount of gluten, some amount of dairy, fermented dairy, extremely beneficial like yogurt and kefir, and have that 80-20 rule that's our target.

Yeah. So that's one way I differ from the AIP diet is I- Autoimmune paleo. Yeah, autoimmune paleo, which the AIP diet does not allow any grains at all, even the gluten-free grains like rice and quinoa and so forth. But those are allowed in my elimination diet. So people can have oatmeal, they can have...

Yeah. So that's one way I differ from the AIP diet is I- Autoimmune paleo. Yeah, autoimmune paleo, which the AIP diet does not allow any grains at all, even the gluten-free grains like rice and quinoa and so forth. But those are allowed in my elimination diet. So people can have oatmeal, they can have...

rice cereal, they can have quinoa, they can have- As long as they do okay with these, they can have them. Yeah, exactly. As long as they're not having an overt reaction, then those foods I have found very unlikely to cause issues. Some patients do react to all grains, but the majority can tolerate those gluten-free grains. That will open up a lot of options in terms of their diet.

rice cereal, they can have quinoa, they can have- As long as they do okay with these, they can have them. Yeah, exactly. As long as they're not having an overt reaction, then those foods I have found very unlikely to cause issues. Some patients do react to all grains, but the majority can tolerate those gluten-free grains. That will open up a lot of options in terms of their diet.

And then having a good quality protein, whether it could be grass-fed beef or some healthy fish or poultry, I think that's excellent. In terms of legumes, I also allow mung beans in the diet for elimination because- Which are popular in Ayurveda? Yeah, exactly.

And then having a good quality protein, whether it could be grass-fed beef or some healthy fish or poultry, I think that's excellent. In terms of legumes, I also allow mung beans in the diet for elimination because- Which are popular in Ayurveda? Yeah, exactly.

Yeah, mung beans are a very small kind of a yellow bean that is used a lot in Ayurveda because it's super easy to digest. It's the smallest legume. And they're usually sprouted, right? Like often sprouted or pressure cooked. Yes, always pressure cooked. And yeah, so they're very easy to digest. They're excellent source of protein.

Yeah, mung beans are a very small kind of a yellow bean that is used a lot in Ayurveda because it's super easy to digest. It's the smallest legume. And they're usually sprouted, right? Like often sprouted or pressure cooked. Yes, always pressure cooked. And yeah, so they're very easy to digest. They're excellent source of protein.

So for people who are vegetarian, there's an Ayurvedic dish called khichari, which I have a recipe for, which is basically rice and mung beans and some spices. And so that's a very healthy diet. That's a very healthy meal. In Ayurveda, there's some programs where all you eat is kichari for two weeks. People feel great. Yeah, I've seen those. Yeah.

So for people who are vegetarian, there's an Ayurvedic dish called khichari, which I have a recipe for, which is basically rice and mung beans and some spices. And so that's a very healthy diet. That's a very healthy meal. In Ayurveda, there's some programs where all you eat is kichari for two weeks. People feel great. Yeah, I've seen those. Yeah.

And then the foundation of the diet, of course, is fruits and vegetables. Yeah. We all should be eating more fruits and vegetables, but having plenty of those healing foods, the right blend of fruits and vegetables, adding in the prebiotic vegetables. You can add that up front to the foods that start to strengthen the microbiome. So adding in the prebiotic vegetables, incorporating fruits.

And then the foundation of the diet, of course, is fruits and vegetables. Yeah. We all should be eating more fruits and vegetables, but having plenty of those healing foods, the right blend of fruits and vegetables, adding in the prebiotic vegetables. You can add that up front to the foods that start to strengthen the microbiome. So adding in the prebiotic vegetables, incorporating fruits.

And I'm a really big fan of broccoli sprouts. So because of their sulforaphane, so that's a compound that over 2000 studies have been done looking at sulforaphane and it's clearly lowers inflammation and also supports the immune system. And it's very good for the brain as well. So I think incorporating broccoli sprouts throughout all phases of the diet is what I recommend.

And I'm a really big fan of broccoli sprouts. So because of their sulforaphane, so that's a compound that over 2000 studies have been done looking at sulforaphane and it's clearly lowers inflammation and also supports the immune system. And it's very good for the brain as well. So I think incorporating broccoli sprouts throughout all phases of the diet is what I recommend.

Yes, because with autoimmune disease, there are many people that are kind of in a gray area where they don't meet the criteria for a disease.

Yes, because with autoimmune disease, there are many people that are kind of in a gray area where they don't meet the criteria for a disease.

Yeah, a subclinical, you know. So they're having some symptoms. Yeah, exactly.

Yeah, a subclinical, you know. So they're having some symptoms. Yeah, exactly.

Right. Um, so I think that, um, you know, uh, in terms of blood work, the, these auto antibodies, which are the, um, autoimmune kind of markers made by the immune system, um, often can predate the development of the autoimmune disease by like 10, 20 years.

Right. Um, so I think that, um, you know, uh, in terms of blood work, the, these auto antibodies, which are the, um, autoimmune kind of markers made by the immune system, um, often can predate the development of the autoimmune disease by like 10, 20 years.

And so if you're getting blood work, screening for some of those autoantibodies can be a clue because that could be one of the signs that you might benefit from this program. But some of the common symptoms I see, fatigue, of course is super common, but that can be caused by this. Joint pains, like different kinds of aches and pains.

And then cognitive issues like brain fog or mood issues, those are probably the three most common symptoms I see.

Well, Cyrex Labs. Cyrex Labs.

You got to have a practitioner. Yeah. I don't think there's a direct to consumer. I think there's a great opportunity for that, but I don't think it's been done.

Yes, exactly. So yeah, and anyone, you know, even in that early autoimmune subclinical phase could benefit from it. And anyone who wants to reduce inflammation, I think would benefit from this approach because it's highly anti inflammatory.

you know, from the diet perspective, from the spices we're incorporating, from just detoxing that lowers your inflammation, from some of the supplements I'm recommending. And we know inflammation is kind of the root cause for all our modern chronic diseases, right? So we know like for almost all of us working to bring our inflammation down and keep it low is really vital for long-term health.

Yeah, absolutely. So with diet, I like to separate it out. So I have like a phase one diet, which is more of an elimination diet, which is more restrictive, more focused on gut healing. And then there's the phase two diet where you're kind of reintroducing foods, you're expanding the prebiotic foods, you're rebuilding the microbiome.

Yeah, absolutely. So that's very important because during that phase one of elimination, you want to really add in these things so that you get the most benefit from that phase one diet. So I am a big fan of bone broth. I think that even though it's a bit of a fad, there is research on all the benefits for gut healing from the gelatin, the glycine, the amino acids.

Yes. It's actually a medicine in Ayurveda. For thousands of years, it's been used in Ayurveda. Wow, I didn't know that. Yeah, so if people do not want to eat, have bone broth, then doing collagen powder is a good substitute. You can find like grass fed collagen powder, and that's pretty easy to mix into like smoothies or water. So that's an alternative. So either bone broth or collagen powder.

And then second, I really like glutamine. for its gut healing effects. And the best food source is actually the cabbage juice. So if you just, you have a juicer and can juice some cabbage, or you can make it in a blender. Cabbage is that one of the richest food sources of glutamine. So if you're willing to drink that, that's an option. Or if not, you can find it easily as a supplement.

It's a white powder, easy to use.

Yeah, I always give people the option for food because there are some that just only want to do foods. And I love working with food as medicine because it's so powerful. But yeah, glutamine has good research to show it heals intestinal permeability, helps with the leaky gut. It helps with the dysbiosis, the imbalance of bacteria. And it's usually like very well tolerated.

So I think that's another integral part of the gut healing.

Yeah. There are two other categories of foods that I think are very important. One is prebiotic foods. A prebiotic is basically something that has food for your gut bacteria. That's different from a probiotic, which is like the actual gut bacteria.

And I feel like that's something that's missing, you know, because oftentimes I see patients you know, they're on like the autoimmune paleo diet, which is a very common diet, or the whole 30. And they, you know, felt significantly better.

So prebiotic foods, I think, should be introduced really upfront in the phase one diet even because there are certain prebiotic foods that most people can tolerate that don't really cause issues. And those are the polyphenol rich foods. So I think prebiotic foods are really key.

That's an even bigger part of the phase two diet because prebiotic foods are how you build the diversity of the microbiome. So then I go through some of the main categories like polyphenols and what are the best fruits and vegetables, what are the the best like nuts and seeds. So there's a lot of literature about the polyphenol content of foods.

So just to take a step back with prebiotic foods, like for example, legumes and beans are a really good source. People with certain conditions like SIBO, small intestinal bacterial overgrowth, they may not do well on prebiotic foods upfront. So they typically do well on polyphenols, which are the food that's tolerated.

um but then i i really recommend getting resistant starch so there's like three types of resistant starch we can talk about those foods later and then i emphasize inulin so inulin rich foods there's about a dozen inulin rich foods that are really excellent inulin is one of those prebiotics that has a really good research for

Not just gut health, but helping your blood sugar, helping brain health, helping inflammation. So getting inulin-rich foods. And then there are other categories like mushrooms are actually very powerful for healing the gut, powerful prebiotics. So yeah, prebiotic foods is a really huge topic. But then the second big category is fermented foods.

So studies show that fermented foods also reduce inflammation and improve immune markers. So they do improve some of these like cytokines, which are the immune system like messengers. So incorporating both of those is very good for gut healing.

And then I've been on it for 10 years, you know, but it was never intended for that, because you don't want to be on a very restrictive diet long term, you want to be on a

Yeah, I think that's an important principle, which is start low and go slow with the dosage, because even low dosages of prebiotic foods and fermented foods have benefit. I've had patients, when they're trying to introduce fermented foods like sauerkraut, they could only start with the sauerkraut juice. They could not have the actual vegetable.

So then they start with like a teaspoon of sauerkraut juice per day. And it feels like laughably small, but I say, no, that's good. You're getting your gut used to this change. And then you work up to a tablespoon. Then you start adding a little bit of actual sauerkraut, the cabbage. And so that way, over many days or weeks, you're building up slowly.

And that's a much better strategy to get your gut to tolerate these foods.

restrictive diet for a certain amount of time, do some gut healing, do some detox, and then start expanding your diet so you can build up the diversity of your bacteria, which is one of the key barometers of the microbiome and keys to longevity. So that's a mistake I often see in diet when I have patients come to me saying, yeah, I've been on this very restrictive diet.

Although in our case, we take insurance.

Yeah. We're part of a group called Sutter Health, which is throughout California. And we're trying to be the integrative medicine branch within Sutter Health.

Yeah. For that reason. Yeah. For that reason. We have five clinics in the Bay Area, but yeah, massive waiting lists. But that's why I'm looking at more innovative models. I'm doing a lot of group visits these days. And then I've also created some online courses on autoimmune disease and so

Yes, absolutely. And that was my goal for writing the book was to try to keep it simple, try to keep it practical and not overwhelm people and include steps that because I think the average person may not have access to a practitioner to guide them. So I wanted to really put enough information in here that would allow a person to do this on their own.

There's a lot of guidance about the reintroductions, like how you expand your diet after the initial elimination diet. That is trial and error. So every person has to do that on their own. But I walk people through how to do that. And I think incorporating a lot of these practices like the exercise or the sauna or meditation, those are

um with some support like with apps or coaches or trainers you know you can reach out to whoever you have but i my goal was to make it accessible and possible to do on one's own

And then over time, it becomes very hard to follow because it's so restrictive. And so what I focused on with her, for example, was three kind of big things, which were cutting back on gluten, dairy, and sugar.

In the first phase. Yeah, exactly.

Yes.

Yes.

Yeah. So the research shows that patients with autoimmune disease tend to have much higher levels of food sensitivities. And that's like common ones that they've tested are like dairy products, gluten as well. So we know that they are much more likely to have reactions to foods. And we have to distinguish between food allergy and food sensitivity.

So a food allergy is like what people think of usually, like you react to shellfish or peanuts and you can't breathe or your lip swells up. That's an immediate reaction that's a food allergy. But a food sensitivity is actually something quite different. There may be no symptoms. There could be delayed symptoms, like up to two to three days after ingesting the food.

There could be nonspecific symptoms like brain fog, fatigue, or malaise, headaches, congestion. Or there could just be inflammation triggered in the body without symptoms.

um food sensitivities are what we think about and that's the reason for eliminating those foods because those are some of the common sensitivities and you know we can do tests so like sometimes we test patients for food sensitivities and then use that as a guide to what they need to eliminate but statistically yeah gluten dairy are the two biggest food sensitivities

And those are a problem because they really inflame your immune system. So in the gut, when you are exposed to foods that you have antibodies against, which is what a food sensitivity is, then your immune system goes into hyperdrive. It's like constantly reacting to the foods you're eating every single day. And that just predisposes to autoimmunity and worsens autoimmunity.

So that's the main reason for that.

Yep.

Yeah, exactly. My goal is always trying to expand the diet as much as possible, as much as someone will tolerate. I think the elimination phase is the phase one diet, but then the reintroductions are even more important, and that's part of the phase two. There's a lot of subtlety and nuance in that, which I work with my patients on, I talk about in the book.

what's the order to reintroduce foods, you should reintroduce the foods that are kind of least allergenic first. So you know, if you've eliminated like nuts and seeds or nightshades, or you know, the maybe those are earlier in the reintroduction, and then you reintroduce more allergenic foods like dairy towards the end and then gluten at the very end, because it's the most allergenic.

That maximizes the chance of success because the goal is always getting people to expand their diet to the maximum diversity they can tolerate, and then hoping we can heal their gut enough where they get to a point where they can tolerate some amount of gluten, some amount of dairy, fermented dairy, extremely beneficial like yogurt and kefir, and have that 80-20 rule that's our target.

Yeah. So that's one way I differ from the AIP diet is I- Autoimmune paleo. Yeah, autoimmune paleo, which the AIP diet does not allow any grains at all, even the gluten-free grains like rice and quinoa and so forth. But those are allowed in my elimination diet. So people can have oatmeal, they can have...

rice cereal, they can have quinoa, they can have- As long as they do okay with these, they can have them. Yeah, exactly. As long as they're not having an overt reaction, then those foods I have found very unlikely to cause issues. Some patients do react to all grains, but the majority can tolerate those gluten-free grains. That will open up a lot of options in terms of their diet.

And then having a good quality protein, whether it could be grass-fed beef or some healthy fish or poultry, I think that's excellent. In terms of legumes, I also allow mung beans in the diet for elimination because- Which are popular in Ayurveda? Yeah, exactly.

Yeah, mung beans are a very small kind of a yellow bean that is used a lot in Ayurveda because it's super easy to digest. It's the smallest legume. And they're usually sprouted, right? Like often sprouted or pressure cooked. Yes, always pressure cooked. And yeah, so they're very easy to digest. They're excellent source of protein.

So for people who are vegetarian, there's an Ayurvedic dish called khichari, which I have a recipe for, which is basically rice and mung beans and some spices. And so that's a very healthy diet. That's a very healthy meal. In Ayurveda, there's some programs where all you eat is kichari for two weeks. People feel great. Yeah, I've seen those. Yeah.

And then the foundation of the diet, of course, is fruits and vegetables. Yeah. We all should be eating more fruits and vegetables, but having plenty of those healing foods, the right blend of fruits and vegetables, adding in the prebiotic vegetables. You can add that up front to the foods that start to strengthen the microbiome. So adding in the prebiotic vegetables, incorporating fruits.

And I'm a really big fan of broccoli sprouts. So because of their sulforaphane, so that's a compound that over 2000 studies have been done looking at sulforaphane and it's clearly lowers inflammation and also supports the immune system. And it's very good for the brain as well. So I think incorporating broccoli sprouts throughout all phases of the diet is what I recommend.

Yes, because with autoimmune disease, there are many people that are kind of in a gray area where they don't meet the criteria for a disease.

Yeah, a subclinical, you know. So they're having some symptoms. Yeah, exactly.

Right. Um, so I think that, um, you know, uh, in terms of blood work, the, these auto antibodies, which are the, um, autoimmune kind of markers made by the immune system, um, often can predate the development of the autoimmune disease by like 10, 20 years.