108: Understanding Autoimmune Disease & Inflammation | Dr. Micah Yu

Dr. Micah Yu  00:00

So in summary, autoimmune disease is a very, very complicated topic. I think we're just scratching the surface here in regards to research, with lifestyle, medicine and epigenetics. It's part genetics and part environment nutrition does play a huge role that gut microbiome is tied to the immune system. Fasting can help decrease inflammation. But, again, it's a bandage. It's not the cure all to cure. There is no cure for autoimmune diseases, but you can put it to remission. Okay, once you have autoimmune disease, you'll always have autoimmune disease, but doesn't mean that you have to have symptoms of it. And it's important to get a plant predominant diet for anti inflammatory diet and a whole food plant based diet is an excellent option.

Maya Acosta  00:41

Welcome to the Plant Based DFW Podcast weekly show with Dr. Riz and Maya, a show broadcasted from the Dallas Fort Worth area that focuses on lifestyle medicine. This is the use of evidence based lifestyle therapeutic approaches, such as a whole food plant based diet, regular physical exercise, adequate sleep, and stress management to treat, prevent and oftentimes reverse lifestyle related chronic diseases that are all too prevalent. Every week they feature a guest who speaks on one of these lifestyle medicine pillars. This show is for you, the person who is seeking to improve your overall wellness and quality of life. So whether you are driving, walking, or relaxing at home, we hope this show will provide you one more tool for your wellness toolbox. Let's meet today's podcast guest.

Maya Acosta  01:33

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is double board certified in internal medicine and lifestyle medicine. He obtained his MD from Chicago medical school and holds a master's in healthcare administration and biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He's also in the Andrew Weil, integrative medicine fellowship at the University of Arizona. He's currently working at the Doctor Lifestyle Clinic that is in Newport Beach, California. Dr. Yu has a very unique perspective on autoimmune disease and arthritis. As he is both a patient with arthritis and a physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He has been able to significantly improve his arthritis through plant based nutrition, he's able to understand his patients medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease but also is aligned with his patients goals. His primary focus is on autoimmune disease and arthritis. Rheumatologists tree conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus srojen, gout, fibromyalgia, myositis, vasculitis and other inflammatory conditions. As a fellow he has published multiple papers on osteoporosis and spearheaded a double blind randomized control trial on curcumin supplementation in systemic lupus. He has also had multiple presentations at the American College of Rheumatology national conferences. He has been featured in multiple articles and webinars including Forbes magazine, Spondyloarthritis Association of America, lupus, LA and creaky joints. His social media handle is @myautoimmunemd on Facebook, Instagram, and Twitter. And the first half of the episode Dr. Yu will provide a presentation with his story and will also explain the various autoimmune diseases that he treats. If you're interested in seeing the video version of the presentation. I will include the link in the show notes, make sure to listen to the entire episode as we will ask him a handful of questions. Dr. Micah Yu will also be part of a massive summit coming your way it's packed with awesome insights, tips and tools to get you thriving in life. Join us along with these incredible health and wellness experts in the thrive 5 formula virtual summit this May 5th . As you sign up, you will enjoy lifetime access to workshops and talks with over 45 speakers and you can register at tinyurl.com/MAYA50off. That means that right now through April 14, you can get this wonderful summit for 50% off Dr. Micah Yu is licensed in 17 states and that includes Texas. Hope you enjoy this episode as well. So welcome Dr. Micah Yu,

Dr. Micah Yu  04:38

Thank you so much for having us show Dr. Riz and Maya, I really appreciate you bringing me on. And I'm so excited to chat with you about autoimmune disease and my story today. 

Dr. Rizwan Bukhari  04:48

Yeah, we're excited to have you I mean, it's been we've had you on our minds for ever since we met you guys, you know, couple years back.

Maya Acosta  04:54

I was really shocked to hear how you know how specialized this field is, but also how he people enter the field.

Dr. Micah Yu  05:01

Yeah, yeah, we'll get right to it. Yeah, there's not many of us. About only 200 of us get out of training every year. so fascinating field.

Dr. Rizwan Bukhari  05:10

Yeah, that's about four per state. Right. So that's not too many. When you break it down that way,

Dr. Micah Yu  05:14

Mostly of California, there's 20 of us. Some states have 00.

Dr. Rizwan Bukhari  05:18

My goodness,

Maya Acosta  05:19

Wow. Well, we'll also learn you are now licensed in 17 states to practice telemedicine, which I think is awesome, because we're always hearing of people that are looking for specialists like yourself.

Dr. Micah Yu  05:31

Yeah, we'll get right to it. Yeah, we can talk afterwards. Let me just share my screen presentation for you all. So this presentation is called Fighting Autoimmune Disease with an Integrative Rheumatologists. I am located in Newport Beach, California, and you see patients all throughout the US and internationally as well. And if you follow me on Instagram, Facebook and Twitter, and if you're interested in seeing me in clinic, that's Dr. Lifestyle .org. So a little bit about me. My background is I got my bachelor's in Science in Business at UC Riverside. Then I went to Chicago for medical school. And then I did my residency internal medicine fellowship in Rheumatology at Loma Linda University, and double board certified in internal medicine, lifestyle medicine, and I'm currently in my Integrative Medicine Fellowship at the University of Arizona. So brief background on how I came to be very passionate about lifestyle medicine, and rheumatology, we have to go back to my childhood. That's where it all began. I was overweight, I was eating standard American diet. Getting takeout fast food, frozen food, whatever, you can name it, I ate it. Okay, it's even Asian food, even though can be very healthy. I was really eating the very standardized American Asian food. So fast forward to high school, still overweight. I was playing football, I wanted to lose weight and I wanted to get stronger. So I eventually found the Atkins diet, the infamous Atkins diet full of protein, meats, dairy, so I ate about 200 grams of protein a day while weighing about 150 pounds, way over than what's suggested. So you've actually got caught up to me. And I ended up getting something called gout. First of all, I did lose weight, and I did get stronger. I lost about 30 pounds on this diet. However, overnight, I got an acute arthritic attack on my big toe. That's not my foot, but that is what it looked like. So overnight at 4 am I woke up, I felt someone use the piece of wood and slammed against my toe. That's how it felt. It used to be known as the disease of Kings because kings ate a lot of rich foods like a lot of seafood, a lot of heavy meats, organ meats. I think Nostradamus had it Benjamin Franklin, King Henry also had an as well, so many different famous people had gout. However, my pain had transformed over the years to unexplained symptoms because gout usually, maybe one or two joints are involved. It can be more of course. But that's not common. So my pain went to the TMJ on the wrists, the hands, the toes or knees. Is my foot during medical school, it was a swollen, I went you to see couple rheumatologists, they couldn't really explain why I had, a couple of labs positive for inflammation, a CRP ESR. But the rest of my antibodies were negative for autoimmune disease. But luckily, at my residency, I went to see the rheumatology program there. And the doctors that eventually became my bosses, and they diagnosed with spondyloarthritis. So if you've heard the diagnosis, ankylosing spondylitis, that's an autoimmune disease attack, mainly of the lower back and sacral iliac joint area. And I have a variation of that I have peripheral spondyloarthritis. So I don't have the back pain. I do have the pains everywhere else on the hands and legs. So it is autoimmune. I was never really counsel on diet and lifestyle. I was that they had some diet counseling on gout, both never whole food plant based diet was made to avoid meats and beans and all these type of foods which are now a little bit outdated. This is about almost 15 years ago at that time about these guidelines. So I eventually got diagnosed with this I do have gout as well. And I noticed that there was an association with food and my arthritis. I didn't know what it was. I didn't take any meds I refused it. I was basically self managing it I told myself if I get extra damage, then I will start taking medications. Luckily I didn't have to get the extra damage to start my medications. I found a whole food plant based diet Through through How Not To Die. That's the first book I read from Michael Greger and then watch Forks Over Knives. This is me 10 years apart in 2009 at for medical school or maybe just being in medical school, I went on a trip to Europe, grossly overweight, 160 pounds, this is me unchosen 2019,  130 pounds, just from being plants, I did not expect that much weight loss, it's very natural. And in three months of going to whole food plant based diet, my joint pain from it went away, and my CRP went negative after three months. And actually, my labs I got I drew labs recently about a month ago and my ESR finally went to negative. ESR is another inflammatory market and went to negative for the first time ever in my life since I've been diagnosed. So my ESR, CRP is now negative, and you get some joint pains here and there every now and then I was pretty much I was in remission total remission for about almost two years. And I started doing some little bit more processed food. I work overnight sometimes, and I get a little bit stressed. So the stress does catch up to me sometimes, but the pain is nowhere near where it was before as like one to two out of 10 pain compared to what it was in the past. So now I use my social media to really empower followers, to really get the word out there that someone like me does exist. There's someone that has been in the patient's shoes and is a doctor of rheumatic diseases as well. So I have been able to use whole food plant based diet in lifestyle medicine to patients to remission without medications. Of course, not every person or patient is able to do this, but it is possible. So I'm here to give hope to a lot of my followers. You can find me on Instagram and other social media through my handle My Autoimmune MD, and my website is coming out very very soon. And me and my wife, created our Dr. Lifestyle Clinic, where she uses lifestyle medicine, primary care and mental health treatments to help her patients where I use autoimmune disease, where I treat autoimmune disease and use lifestyle medicine to help with that.

Dr. Micah Yu  12:07

So what is the field of Rheumatology? Rheumatology is not a field that treat all autoimmune diseases, but we are known as disease specialists, specifically for the muscle skeletal system and connective tissue diseases. We're also known as the immunologist of medicine. So I treat these diseases. These are just some of them. Gout is not an autoimmune disease, osteoarthritis, not autoimmune disease, we do treat arthritis that is not autoimmune. We do treat osteoporosis and Fibromyalgia are not autoimmune as well. This is just a sample we treat many other conditions also. So we usually we are treating patients sometimes where they see 10 other specialists and no one has an answer. So we're mainly the detectives. So we're sort of like Doctor House of medicine. So this is an example of a disease actually rheumatoid arthritis. This is end stage rheumatoid arthritis, where patients are pretty much not treated for a very long time. pains, you get inflammatory pain in the hands and feet. And these are just some examples of signs that we look for. Lupus and other autoimmune diseases is very classic butterfly rash. Lupus can affect any organ in the body, including your blood cells. And these are some signs that we look for as well. Gout is something that I have is end stage gout. Gout, and when you don't treat it properly, is untreated, you get something called tau phi, which are chalky substances full of uric acid that builds up in your body and joints. And I've seen this in my clinic. These patients don't want to get treated. They refuse treatment. They don't see the doctors and this is what happens. Ankylosing spondylitis something I talked about earlier. Fusion this company called bamboo spine is in stage ankylosing spondylitis, inflammation, of the back and hip area you get buttock pain as well. This can happen your 20s and 30s typically, and these patients they have low back pain, untreated, they go from doctor to doctor. No one thinks about ankylosing spondylitis, they think it's a matress of issues because they think it's a mechanical issue, but really, they have an autoimmune disease going on. And usually, if they're lucky, they end up with a rheumatologist sooner rather than later. Myositis is an another autoimmune disease of the muscles, they can affect the lungs as well. All our autoimmune disease can affect the lungs. But these patients usually can't lift the hand can't lift the shoulders can't lift their legs, they can't walk up the stairs. And that's very, very classic. This is another example of an autoimmune disease can be very very debilitating, as well. Psoriatic arthritis, is another autoimmune disease and other arthritis, typically coupled with psoriasis as well, which is autoimmune disease, attack of the skin. Sjogrens is an autoimmune disease that attacks the lacrimal glands and the mucosal glands and can also give you arthritis, brain fog, lung issues can increase your risk of cancer as well specifically lymphoma. Very, very classic rheumatology disease. So classically you're thinking of dry eyes and dry mouth. Vasculitis is another autoimmune disease that we treat as well. You can translate into inflammation of the vessels. So you can get pretty much any symptom under the sun, you can get autoimmune hearing loss from this you, can get chronic sinus issues, joint pain, anything you could think of, you can get it from vasculitis, so very typically is treated by rheumatologist. And hopefully you can get in sooner rather than later. I've seen patients die from these diseases, it can be very, very dangerous. So one in five Americans do you have an autoimmune disease, and that's spread across all different medical systems. And this is something from the double A R D A so Autoimmune Disease Association. And basically, I think that there is an increase in these diseases, but it's likely due to environmental factors, not genes, because our genes haven't really changed in the past 100 years or so. So rheumatoid arthritis and smaller arthritis even though it's rare. It is, when you couple that to the amount of people in the nation is quite a lot. There's about 1 million Americans with rheumatoid arthritis. And these are just some of the other numbers of patients affected as well. So like I said earlier, there is a rise in autoimmune diseases about 5% to 7%, a year across all different spectrums between neurologic, gastrointestinal and endocrinologic. So why I'm so passionate about lifestyle medicine, and nutrition, and integrative medicine and functional medicine as well, because I'm, my goal is to treat the root cause of disease, because if I don't, then I'm giving biologics, my medications all day, which can be an average of $20,000 a year, not cheap to treat these diseases. And autoimmune disease is a combination of genetics and environment. So you can't have autoimmune disease without a genetic component. So why am I doing integrative medicine? integrative medicine is so important because we're looking at genetics, diet, sleep, stress, exercise, substance abuse, environmental toxins, infections, and trauma, childhood trauma specifically. And lifestyle medicine is a part of integrative medicine, and lifestyle medicine is a part of functional medicine as well. Before lifestyle medicine became popular and famous. The field of integrative medicine leaded the way. Integrative medicine was the forefront talking about all these different things. Now, integrative medicine and functional medicine, lifestyle medicine all something very, very common. They talk about these different things, especially your lifestyle, but they also emphasize plants as well. Each of them have a different philosophy, but it's grounded in predominant plants as the diet. So this is why lifestyle medicine is importhant because we talk about all these important factors underlying diseases. 

Dr. Micah Yu  17:56

So today, we're going to talk about some objectives. I know what I'm what I'm a briefly glance over some anti inflammatory foods. I know you talked about a lot this on your podcast. So now we're not going to dig into too much. And then we're going to talk a little about gut microbiome, intermittent fasting. So nutrition, eat the rainbow. This is heavily emphasized in all fields of alternative medicine and complementary medicine. And there's so many diets out there for autoimmune disease, army proper diet, which is a paleo diet, the carnivore diet, keto diet, vegan diet, mainstream diets, whole food plant based, pescetarian. vegetarian, so really, there's so many variations of this out there that there's a lot of misinformation. So what should we really be eating with as a patient with autoimmune diseases, and Dr. Riz and Maya, you'll find some commonalities with autoimmune disease, because you guys are very, very passionate about cardiovascular disease. And it's basically the same principles, the same message plant predominant diet, whole food plant based diet. 

Dr. Micah Yu  18:57

So tumeric is another plant that can be very, very powerful for anti inflammation tumeric they write books on it, they use it in lattes nowadays, they even sell it for dogs on Amazon, and they've been studying in lupus as well. Very few studies have been done outside in the world. But there are studies done and it's been shown to have an anti inflammatory effect through modulation of T cells, it does decrease the inflammatory cytokines, tumor necrosis factor, interleukin six and interleukin one, which we do you have medications to fight these inflammatory cytokines in Rheumatology. So cytokines are cell to cell communicators. These are commission signals that tell it by to kick up inflammation. So these are used when you have whereby you're fighting bacterial infections or viruses, but you don't want them to be chronic, or else they can send too much inflammation the body possibly inciting autoimmune diseases. And these are all the types of different diseases that curcumin hasn't studied in. 

Dr. Micah Yu  19:58

Resveratrol is found grapes and other phytonutrients that is anti inflammatory. And it's being studied potential mechanism to help us fight joint disease. Fiber is so important for fighting inflammation, we don't eat enough fiber in a day only 5% of Americans reached a minimal dietary recommendation for fiber. So usually it's around 25 grams for woman and 38 grams for men. Fiber is anti inflammatory, it's being studied and multiple studies and the enhanced data, the more fiber you're eating, the less inflammatory markers are high. So the more fiber you eat the lower inflammation, as measured by C reactive protein, the lower chance of obesity and metabolic syndrome. Fiber has also been studied in knee pain, specific osteoarthritis. So this study showed that the higher the dietary fiber was obtained, the lower the amount of knee pain was felt.

Dr. Micah Yu  20:56

And omega and omega three and omega six fatty acids are very, very important. omega three fatty acids are anti inflammatory and omega six fatty acids are inflammatory. So your omega six fatty acids are mainly obtained from Russian diets or process of red meat, process oil, processed foods, your junk food, all that is omega six fatty acids is always fighting against your anti inflammatory omega six fatty acids. So your flaxseed and chia seeds have omega three fatty acids, your fish, heavier omega three fatty acids, and pretty much all. Almost a lot of Rheumatology journals fish is anti inflammatory. But the reason why I don't permit more fish that much is because you have to think about their environment. Even though this can be anti inflammatory. Fish does have PCBs and other environmental toxins from the ocean that can get into it. So I don't recommend fish as a main way to get omega three fatty acids if you don't have to, because of the environmental toxins, which fish do get omega three fatty acids from the ocean from algae. So if you're vegan, I recommend get it from algae supplement if you need your omega three fatty acids on the flax seeds and chia seeds are not as bioavailable, they don't break down to the DHA and EPA as well as just getting it from a algae source. I think it's a 10 to 15% transformation from ALA to EPA and DHA. And you need omega three fatty acids. The reason why it's anti inflammatory is because of  resolvement or protectants. When you have inflammation and you need to resolve the inflammation, your resolve, it's and protections are there to resolve the inflammation. Okay, that's when you start getting better. It's because these are in play. So if you're not eating enough omega three fatty acids, then the omega six fatty acids are overwhelming the system. So it's a seesaw effect. So I'll briefly touch on proinflammatory foods, we all know this already a lot of junk food out there. very classic standard American diet. Well, what's not as well known is that salts in high excess is pro inflammatory, it is promoting your inflammatory T cells, and downgrading or anti inflammatory T cells. So, T retro cells are anti inflammatory T cells. Those are psychologists in your immune system. achiever actually, cells are telling your body to stop fighting inflammation when you're done fighting a virus or bacteria. But it also is used to tell your body that your own cells are belong to you and it's not a foreign substance. So, almost in all autoimmune diseases territory cells are downregulated. So your body's fighting itself. And this is from england journal medicine, a very prominent medical journal. So if you look at 1623, tumor necrosis factor and interleukin 17 are upregulated from excess salt. And these are all inflammatory cytokines, these kickout inflammation Okay. Let's try not to get bogged down in details. But as a rheumatologist, I love these details. So we use these medications and it cannot tell us to lose a map. We said can you map out a little bit Mab, s secukinumab. These are biologics in Rheumatology that we use to fight these different signals. So if you're eating a lot of salts, then you're fighting against these medications and their use of it. So even though I have patients on medications, they do flare. So that's why I always talk about diet and see what they're eating because sometimes the reason why the medications not using is maybe because they're eating too much inflam inflammatory foods such as too much salt. And the high style has been studying lupus. So this is lupus nephritis and they found that as patients ate too, too much of a salty substance lupus did get exacerbated. So this is just an example. Advanced glycation end products are basically your proteins and your fats being attached to sugars. So A G E can be inflammatory when it's in excess, and it's associated with inflammation and diabetes, cardiovascular disease and chronic kidney disease. This is from the American Journal Lifestyle Medicine. So he is associated with food and this from the general American Dietetic Association, so he does go up with higher temperature and just go down with more moisture. So trying to cook with more water. And it's the highest and annual price so stay away from a bacon, okay, that's the highest one. And fruits and vegetables are the lowest in ag E. So that's what he wants. Stick with that. And try not to cook with oil because if you do, you're going to increase even Korean french fries and that has higher agvs and processed foods and fats are high in ag nice. Okay, so butter as the most in this little group here.

Dr. Micah Yu  26:00

So that's my little tidbit on A G E  just another source of inflammation. So AGE has been studied in Rheumatology. But of course there's no medication to fight AGEs, they tried to do this for and they have been done doing it successfully. There's always side effects of medications. So this doesn't exist either example, the higher he has been associated with more lupus disease activity and more adult onset disease activity another autoimmune disease. So let's talk a little about obesity. So obesity is not just benign, okay, excess fat, does produce hormones is it does affect the immune system. It's called adipokines adipokines are signals are prior your hormones and immune system, it does affect all the different immune cells. It just doesn't sit there. Obesity does affect the autoimmune diseases, it does create inflammation. So it does. So studies are now showing that obesity is correlated. It does correlate with more psoriatic arthritis and more psoriasis. So sometimes if you lose weight and might take that away. And let's talk about the gut microbiome. gut microbiome is so important for nutrient metabolism, drug metabolism, immunomodulation and antimicrobial protection, but today we're going to talk about low nutrient metabolism, and immunomodulation. So why is the gut microbiome important to 67% of the immune system is located the gut. I cannot talk about immunology without talking about the gut microbiome. What's interesting is that right now, the gut microbiome is very popular, but not 20 years ago. In our conferences, we do talk about the gut microbiome gut dysbiosis, but not 20 years ago. So there's something that's emerging. But no one really talks about how to modulate this, we always talk about how, how it can affect medications. And I think we're we're not talking about the root issue here, which is food. So pregnancy, diet, gender, genetics, previous infection, stress age, the age can affect the gut microbiome. And this in turn affects autoimmune disease. So how you're born, what medications are taking, all these things are very, very important. Gut dysbiosis is when your bad gut bacteria is overwhelming your good gut bacteria. This is known as gut dysbiosis. And it's prevalent and it's present in lupus and ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, sjogrens and vasculitis. along with many other autoimmune disease as well, even though this disease don't touch, you don't really get GI symptoms from it, you have a gut dysbiosis. So short chain fatty acids are so important in our immune system. So fiber, we eat it, it breaks down to short chain fatty acids. And these are fatty acids that do affect the immune system. And the effect IGA production, which is one of your, in your goblins in your body, which are very important. promotes to actually cells revert to charge cells during anti inflammatory T cells, short chain fatty acids, promote them and inhibits inflammation. So has many, many good effects on inflammation at the level of the gut and short chain fatty acids, including acetate, propionate, and butyrate affects all different organs of the body. This is what is from the journal itself. Very, very prestigious journal, from nature abuse, so it so this is showing how if you eat a poor diet, it does affect the gut microbiome, and it blocks your anti inflammatory T cells and the level of the gut and it promotes t helper 17 cells, which are your inflammatory T cells, which then in turn promotes interleukin 17, which are inflammatory cytokines, which promotes autoimmune disease. So that's how the cascade happens. I have medications that stop interleukin 17. So when you have gut dysbiosis, it causes an increased intestinal permeability, also known as a leaky gut. When this happens, you have increased foods, viruses, bacteria that can leak through that then in turn communicates with your T cells, your immune system, in a very detrimental way promotes inflammation. And that was a level of the guts. So now we're looking at the very, very wider view. So your this shows you just how medications, your your sex, your food can affect your gut microbiome, and affects your pires patches, which is the area that's housing the immune system at the level of the guts. When that gets affected, the signals do then go to your lymph nodes, and then from the lymph nodes and travels to the systemic circulation to the gut system. So it can touch your joints, your brain, your lungs, whatever organ, you name it, your gut, toxic, every single one of these places. So that's how your the immune system at the gut talks to everything else. That's why the gut microbiome is so important. And what's interesting is that in our western medicine, allopathic medicine, we don't really talk about how food affects the gut that much but in ancient practices, that an alternative alternative medicine, the gut is central to everything. We're talking about Chinese medicine ayuverda. Functional Medicine, integrative medicine, is so important. So it is a very unfortunate that we don't focus on this as essential cause of our issues. Luckily, we do have lifestyle medicine that's talking about it now. So the oral microbiome is also very important for rheumatoid arthritis. So smoking can cause rheumatoid won't say can't cause but its associated a high risk factor for rheumatoid arthritis. The reason why is because when you're smoking we know that it can give you lung cancer, but also it up regulates something called the P A  D enzyme the pad enzyme does increase p ginger can increase P ginger ballasts also. And when this happens, it increases your risk of getting rheumatoid arthritis because it increases the antibody known as CCP antibody. And that's a marker we look for in Rheumatology for rheumatoid arthritis. And also, when you have periodontitis, which is gum infection, it also increases your pH and debellis, which is a bacteria which then regulates pad enzyme, which then increases your anti CCP antibodies as well, which can lead to rheumatoid arthritis also. So I always ask patients about how their teeth are doing, because that's something I'm very, very wary of. 

Dr. Micah Yu  32:48

Epigenetics is also something that we look for in the gut microbiome as well. So your genes are not fixed, they can be turned on and off through epigenetics. So how does your brain cells know that should be a brain cell? That's through epigenetics because it knows to turn some part of your genes off the other parts are turned on to become a brain cell. So and epigenetics are inflammation can be turned on and off through through modulation as well. So through histone deacetylase, so, histone deacetylase, when it goes down, it's inhibited, it does bring down inflammation, and then promotes t rotary cells, as you remember t rotary cells are your po or your anti inflammatory T cells, and then it has the opposite effect in autoimmune disease. So when you have autoimmune disease, it up regulates histone deacetylase and it up regulates inflammation, which then up regulates t helper cells and T cells, which are inflammatory T cells. So very, very interesting, how everything is connected, and why am I talking about histone deacetylase epigenetics because of course, it's been looked at in Rheumatology, of course, there's no medication that can really block it. As of now, if they did find something, there was a side effect where it wasn't feasible to use it in the general population. However, food does inhibit histone deacetylase and all these are your plants, your herbs, your fruits and vegetables, which can affect your epigenetics. So it's all tied together, there is no reason why I'm bringing such topics up if it doesn't affect if it's not affected by food. So look here, your curcumin, your cursitine, you're resveratrol, grapes, genestein and soy so all your fruits and vegetable whole food plant based diet has tremendous benefits when it comes to your autoimmune diseases and your overall health in general. So intermittent fasting, I think can be very, very helpful as well. Of course not everyone can tolerate intermittent fasting. But it can be very, very helpful and sometimes you don't want to eat Because you're fasting, but beer is not part of fasting as such as what this child is doing. So in the internal medicine just came out the article two years ago on intermittent fasting and its benefits on health and inflammation, it does play a role. And what fasting does increases something called beta hydroxy butyrate. Beta hydroxy butyrate is a ketone. So when we talk about ketogenic diet, or fasting in general, it does increase beta hydroxy butyrate. When you start fasting when the time period we're not eating for a long time, and are testing centers out there that fast for days, if you do this, you do have to be watched by a practitioner that's experienced with fasting. Not everyone should be fasting type one diabetics should not be fasting because they can go to the ICU and kill diabetic ketoacidosis. But when you do increase beta hydroxy butyrate, it does down regulate the end Tor pathway. And I'll talk I'll explain more in the next couple of slides. But this pathway is so important. Dr. Valter Longo is a prominent researcher with a PhD that has talked about fasting and its benefits in our health. Mtorr is upregulated, by food by glucose by email assets of proteins and carbohydrates does upregulate upregulate mTOR. But mTOR is needed because you needed to build the building blocks of your body, but you don't always want it to be turned on because it can sometimes induce inflammation. So it's all tied down to inflammation remember t reg T cells and your T helper 17 cells. This is a seesaw effect your anti inflammatory and proinflammatory T cells. So when you do eat your sometimes your sugars and your proteins and you do turn on mtorr, it does have upgrade inflammatory T cells. It's not bad to in upgraded these inflammatory T cells, you need it in your body, but you don't want in an excess. So when you're fasting, you're blocking your mtorr. So you're you're not inducing inflammation. So that's why sometimes when people fasted to feel better, I don't recommend your ketogenic diet because you're eating heavy fats and heavy meats, which are pro inflammatory. But when you eat it with with a whole food plant based diet, with fasting that's controlled. They're like your 12 hour on 12 hour off, which is very easy to eat by 7pm. And then you wake up and eat after 7am. That's a form of fasting as well. Some people do it for eight hours and fast for 16 hours, that's another form of fasting. But everyone should be very careful of if and when they should fast because not everyone can tolerate it. But it can help with some individuals. The fasting has been looked at in psoriatic arthritis and Ramadan, it did improve disease activity when patients fasted. It's also been looked at in rheumatoid arthritis. This is a journal there are a couple fasting studies and rheumatoid arthritis actually dating back to the late 80s, early 90s. And they so there was one study. So this study looked at fasting with the vegetarian diet and patients with rheumatoid arthritis did do better. Also, there was a study back in the 90s, where patients were put on fasting for I think, 10 days. And then they did split them into two cohorts, one went to omnivore diet and the other went to a vegetarian vegan diet for a year, the cohort that did go through a vegetarian or vegan diet that do much better than the cohort that went to an omnivore diet. And both groups did do better during the fasting period of seven to 10 days. So in summary, autoimmune disease is a very, very complicated topic. I think we're just scratching the surface here in regards to research, with lifestyle, medicine and epigenetics. It's part genetics and part environment, nutrition does play a huge role that gut microbiome is tightened in the system. Fasting can help decrease inflammation. But again, it's a bandage. It's not the cure all to cure. There is no cure for autoimmune diseases, but you can put your remission Okay, once you have autoimmune disease, you'll always have autoimmune disease, but it doesn't mean that you have to have symptoms of it. And it is important to get a plant predominant diet for anti inflammatory diet and a whole food plant based diet is an excellent option. So there's so much I didn't go over I mean their sleep, the stress, exercise, environmental toxins. I think we're the scratching the surface with environmental toxins here. Pollution has been talked to has been associated with rheumatoid arthritis and different autoimmune diseases even multiple sclerosis. I don't have time to talk about today but it's very, very fascinating field. Even infection with viruses and bacterial infections can trigger autoimmune diseases, trauma, childhood trauma, any type of abuse and bullying has been sorted autoimmune diseases, there's so many things you can do besides a whole food, plant based diet, nutrition, just acupuncture, Tai Chi, original Chinese medicine. Tai Chi is part of the osteoarthritis guidelines, Reiki, aroma therapy, deep breathing, Mind, Body medicine, Ayurveda, these things can be so helpful, as with more tools in fighting autoimmune diseases. And I'm so excited that to study integrative medicine, because I use these as my toolbox for my patients. And if you want to get to know me better, you always follow me on social media or wants to see me as a patient, please go to our website. And I have seen pages all through the US. And I do see clients internationally as well, because I don't need medications to treat my patients. 

Maya Acosta  40:44

Awesome. Thank you so much. Lots and lots of information 

Dr. Rizwan Bukhari  40:47

Dr. Yu. Yeah, that was wonderful. You know, yes, you're right. There's so much to cover, but, and you couldn't cover it all. But what you did share with us were very valuable information. Thank you very much.

Maya Acosta  40:56

And I like that, that you said that you don't necessarily prescribe medication because what you're you're prescribing are really kind of incorporating more lifestyle enhancement kind of activities and meditation and things like that. That's awesome.

Dr. Micah Yu  41:10

Yeah, that's the beauty of doing lifestyle medicine and integrative medicine is that not everyone fits one box, everyone needs something to some people need medications. Not every year, of course, there's you share stories of people not using medications and going on remission. I'm one, I'm just one other patient that doesn't use medications to treat my autoimmune disease. Well, not everyone can be like me, you have to find the right triggers. Some people do need a little bit of medication, some need more. But it's important to find a specialist that understands these so that and understands lifestyle medicine as well, so that they can combine the best of both worlds.

Dr. Rizwan Bukhari  41:48

Yeah, I'd certainly want to find a physician who can help me get off as many medications as possible. Certainly, if I need them, I need them. But I you know, I'd much rather not be taking them if I don't need to if I can find other ways to not take the medications or or less than what I'm taking. I think those are very valuable. 

Dr. Micah Yu  42:05

Dr. Riz I think you'll you'll find a connection and what I'm about to say. So you're you deal with vascular disease a lot, and a lot of your patients are on statins. Statins can be a pretty it's a very, very used, widely used medication, generally known to be pretty safe. But in my field, it causes necrotizing myositis which is another, I would say autoimmune disease, where patients I've seen patients from statin use who are bed bound, because the muscles break down so much. It's very rare record necrotizing myositis. But I end up having to give off heavy duty biologics and medications for them just to get them better. 

Dr. Rizwan Bukhari  42:51

Yeah, yeah, I hear you. And so yeah, I don't think we should just throw statins at people, if they got a high cholesterol, I My belief is that the first thing should be lifestyle changes to the, to the greatest extent that a person is able to do so. And then, you know, if you still need to put a statin on top of that, then sure, do it. I actually think statins are a very valuable drug. But they shouldn't be overused. You know, and it shouldn't be our first line of defense.

Dr. Micah Yu  43:17

I agree with you completely

Maya Acosta  43:19

Dr. Yu,  I wonder if individuals who may have all sorts of symptoms related to autoimmune diseases and may not even know that they have such a condition. What is the first step that happens? Do they go to their primary physician kind of complaining about aches, pains, rashes? And

Dr. Micah Yu  43:35

Yeah absolutely. Some patients may say, Oh, I have brain fog, fatigue, these are very nonspecific, you can have these symptoms. And it can be from any disease, right? This these are very nice, but they can also be an autoimmune disease. And sometimes presented with joint pain and rashes, but your primary care, autoimmune disease, specifically rheumatic disease, it's such a specialized field. And a lot of doctors actually don't get training in this field that much apart from medical school and like a rotation. So they don't recognize these symptoms, and they'll send them to the wrong specialist, or they'll just stay with the primary care for a long time until things get a lot worse, and which time they'll see me or they'll bounce from specialist to specialist for over five years, six years, and they'll finally see me and they're like, the joints are like breaking down and everything. So it's really important to get a good primary care doctor, I would say, so they can recognize the signs and get the appropriate labs, and then send them to the appropriate specialist.

Dr. Rizwan Bukhari  44:35

I imagine under recognition is a significant issue and delay in getting care because you know, they can be very nonspecific, and it could be a million different things. And so it's really up to the gatekeeper, the primary care physician to recognize and refer Right?

Dr. Micah Yu  44:53

Exactly, yeah. And then even so that even if you see a specialty rheumatologist and you're not getting the right you don't think you're getting the right answer. You're having symptoms always get a second opinion get a second rheumatologist because as a specialist, not every not every rheumatologist has been trained the same, not everyone rheumatologist has seen the same diseases. Some places geographically have a heavy disease of one heavier population one disease than another geographic location, so it's important to get a second opinion also,

Dr. Rizwan Bukhari  45:23

That kind of points to an environmental aspect or to disease. Right, you know if there's heavily if it's different in different geographies, right?

Dr. Micah Yu  45:31

Exactly.

Maya Acosta  45:32

So if there's such a genetic component to this, meaning you can't have an autoimmune disease without the gene, is there testing can people have have a panel or check for it and do some genetic testing to see if they might be suffering from some of these conditions?

Dr. Micah Yu  45:48

Yeah, like like ankylosing spondylitis is a gene that we you get HLA b 27 is one of them. And 80 to 90% of patients with ankylosing spondylitis will have a positive. But I mean, this field is still growing. I feel like we're at the beginning of research in Rheumatology, and we do have negative HLA between seven part negative HLA b 27 patients with ankylosing spondylitis. So there's other markers that still need to be investigated. And we don't really get genetic tests for patients who get more antibody testing for patients to find out whether they have one of these but of course, it can be negative, and still have the autoimmune disease. That's where the field of Rheumatology gets very, very tricky. Because you can have negative antibody test negative inflammatory markers, I still have lupus still have rheumatoid arthritis.

Maya Acosta  46:36

All right. I didn't know that. 

Dr. Rizwan Bukhari  46:38

Yeah, that's why, you know, you gotta you gotta rely on your clinical aspects of diagnosing disease as well.

Dr. Micah Yu  46:44

Yeah, exactly. That's where the years of training come in really handy, because I have seen negative markers, and then you just have to rely on your clinical experience and your, and what the history is, and most of the time, it's the history, that's really important.

Maya Acosta  47:00

Okay, we also, one of the things we been wanting to touch on more and more, especially this year, is kind of the racial disparities that we see in medicine. And I think I heard you talk about when addressing, like, which sort of patients are the ones that are kind of either not diagnosed or not properly treated? They tend to be people that have kind of lower socio economic situations. Can you tell us a little bit about that?

Dr. Micah Yu  47:25

Yeah. A lot of the studies out there for like rheumatoid arthritis, and lupus, lower socioeconomic status, is has been shown to be a risk factor for these diseases and for layers. I mean, if, and I think the reason one of the reasons why is because maybe if you're a lower socio status, you tend to maybe not to go to the doctor sometimes, or you may not have a, say you don't have a car, you don't have a writing in the bus. And sometimes you might miss appointments, or you're far away from a doctor, or sometimes these places have a long wait times I work at a county hospital one day a week. And these patients, sometimes they you know, they don't they're on Medicaid. And they don't live there and maybe lower socioeconomic level. And sometimes it takes a year to see a specialist because the wait time so long, or maybe they're living in an area, maybe they're in a lower socioeconomic status. The areas don't have specialists, you know, let's say you're in the middle of New Mexico or somewhere or another area of the world where the nation where there's some states some states don't have rheumatologists, some states don't have specialists. So how do you see these doctors, you can't and sometimes just stay at home and and sometimes your your friends or family are sick or something, you got to take care of them, and you don't have a way to see a specialist if you don't have insurance. And it's unfortunate the way that insurance system is set up. There's patients, you know, patients in my clinic who are in the middle, they they don't qualify for Medicaid, but they don't make enough to pay to afford insurance, right? So you're stuck in the middle. So you don't want to pay that insurance because you got to feed your family. So you don't end up not seeing the doctor. I have  patients like these who finally see me cause they finally get on Medicaid, but they can't see their doctor because they don't have insurance and they don't want to pay out of pocket for it. So they spend years in pain. So that's another risk.

Maya Acosta  49:31

We talk about that all the time the limitations of insurance companies and what they've done to medicine you know, just in general the system is very complicated and you know, I when we talk about job security, one of the key things that we want is health care coverage like we want that insurance so that in case we need it but at the same time then we're limited when it comes they don't cover lifestyle components you know modalities Right?

Dr. Micah Yu  49:56

Exactly. That's why I don't take insurance my clinic because I spent so much time with my patients, I spent an hour with my patients. Talking about everything we just talked about, I'm also digging into the root causes of what so when patients come to me, I asked why do you have lupus? Why do you have rheumatoid arthritis? These things just don't come out of blue. There's always some trigger to it.

Dr. Rizwan Bukhari  50:20

So I got some questions. You talked about myositis. And the, you know, we've got a significant proportion of our population who are who have chronic fatigue syndrome. What's the relationship? There is some chronic fatigue syndrome myositis. Is it all myositis? What do you What's your thoughts on all that?

Dr. Micah Yu  50:39

Yeah, chronic fatigue syndrome is a very, very big category. So chronic fatigue syndrome, they actually change the diagnosis of it, they change something, Myo encephalitis, something like that, oh, they change the term recently. 

Dr. Rizwan Bukhari  50:55

It's just it's just easier for me to say chronic fatigue syndrome.

Dr. Micah Yu  51:01

So chronic fatigue, you can get fatigued from autoimmune disease, you can get fatigue from a thyroid issue from diabetes, from Yeah, untreated diabetes, from multiple sclerosis that multiple sclerosis, so it's a very fatigue is a very, very nonspecific symptom. But if you talk about chronic fatigue syndrome, that's very, very difficult to treat. Okay. Some chronic fatigue syndrome, patients do end up in Rheumatology, some end up in endocrinology neurology, but that's one of the hardest syndromes to treat because, frankly, in western medicine, we have no answer for that no good answer. Okay. That's this is one of the syndromes that that motivated me to go into integrative medicine and functional medicine, because I feel like this is where the root cause issues can be explained. So you, so the way I approach it, so you get your third panel, you look for obvious causes, like diabetes, you look for autoimmune disease, you ask all the very detailed history to see what else they have, besides chronic fatigue, and then you dig into psychiatric psychological issues, root causes. My fibromyalgia patients have a lot of chronic fatigue, so they need to figure out what else it can be. And then so there's no good medication for this. So that's when you do specialized testing. Sometimes that's when you have to focus on of course, the diet, nutrition, lifestyle medicine is very important here. And you have to fix that. And then you go into maybe supplements, what supplements do they need to upregulate, some of their anti inflammatory pathways to help them so. And some herbs can help this as well. And maybe acupuncture can help. So just having a lot of tools in my toolbox, and really tailoring my care for the patient can sometimes get them through chronic fatigue.

Dr. Rizwan Bukhari  52:56

That's very interesting. I am curious to know if you've had patients who have come to you with that kind of, and you know, the end of the line, no one's been able to diagnose them yet. They still feel that way. So they get this diagnosis called chronic fatigue. And then when you start to work with them, does whole food plant based nutrition Have you had Have you had a significant number who are willing to try it? And what impact has it had?

Dr. Micah Yu  53:16

Yeah, some patients I mean, that they're, they come to me because I'm integrative, and they're happy that they're working with another like, natural path or functional medicine and more of their specialists. So some of them don't want to do a whole premise because they don't want to go vegan. But I do have patients who do go vegan, and they do a lot better. Of course it's not. Because Because you're hopeful. It doesn't mean it's bulletproof, right? It's not magic. But there are properties that do get a lot better to go to a remission.

Dr. Rizwan Bukhari  53:47

Dp you think that's an inflammation thing?

Dr. Micah Yu  53:49

It's inflammation. Yeah. The root cause of a lot of disease are inflammation, right?

Dr. Rizwan Bukhari  53:54

Especially autoimmune disease. We talked about turmeric and curcumin. Okay. And you had shown that slide about how it affects all these interleukins Okay, and now we got we got a we're in a pandemic. And COVID One of the things that kills COVID patients is an interleukin storm. That happens, you know, around day seven to 10. And do you think that there's a place for just plain old turmeric and the treatment of our hospitalized sick COVID patients?

Dr. Micah Yu  54:22

Yeah, I'm glad you bring that up because as rheumatologists We are the doctors who treat the cytokine storm. So the interleukins cytokine storm or Yeah, that's also known as a cytokine. Storm. And eye diseases and autoimmune disease do trigger cytokine storms. Don't ask us till disease is a very classic disease that does this. So at the hospital, I was training at Loma Linda the rheumatology department. We're the ones that are treating the COVID patients with cytokine storms with our medication stuff. toasted Luiza Mab which they use now for a cytokine storm. Also known as a Tamra is actually Medication we use in Rheumatology and a camera that into local into the locker is another one we use for cytokine storm as well. So when we talk about tumor for the cytokine storm, I think it can be used, but I don't think it'll bring down the cytokine. Storm. The cytokine storm is, let's have a solid case, your body's pretty much your own state ready for the ICU? Okay, yeah. And I don't think any, any amount of tumeric will bring that cytokine storm down, you need heavy duty medications, or else you're going to be intubated, ready to go. I think just eating a whole food plant based diet in the rainbow even before you get COVID, I think is very important. Getting that inflammation down, eat because when you it's not only building the inflammation, but it's also eating the antioxidants, gain the minerals in just building up your body's immune system is very, very important. That doesn't happen overnight, that takes a while to do. So if you get your body, you got to optimize your innate immune system, your adaptive immune system, get them ready to go. Because your immune system is the military of your body. So if you're not eating right, you're, you're you're having a state of chronic inflammation, but you're eating well, you're optimized. And then even when you see COVID and you're Elise, much, you're much better positioned to fight COVID. And yeah, hopefully your decrease the chance of getting cytokine storm.

Dr. Rizwan Bukhari  56:26

Right and my and I've been involved in a couple of online summits with pcrm, talking about how to fight COVID through nutrition. And but and you said it doesn't happen overnight. But it happens quicker than most people think, you know, like you said, within three months, your symptoms had receded. And I've seen time and time again, when people improve their nutrition and change their diet. Many of their problems go away within weeks to months. It's not it doesn't take it doesn't take years. And so you can you can you can change your health, not overnight, but almost overnight. And I that's what I want people to I want people to understand, you can improve your health rather quickly.

Dr. Micah Yu  57:04

We're sure exactly. 

Maya Acosta  57:06

You've talked about cardiac disease and people that suffer with autoimmune disease have a higher risk for cardiac disease, if the autoimmune condition disease is controlled, does that change the cardiac risk? And then you've also mentioned COVID-19? You know, we know a lot of people are afraid of getting the vaccination. But I've heard you say that a virus can actually bring on or trigger an autoimmune disease 

Dr. Micah Yu  57:32

The first question, so a lot of rheumatic disease patients do have an increased risk of cardiac disease, lupus patients have a 50 times greater risk of a heart attack than the general population. rheumatoid arthritis does have a greater risk of mortality from heart disease, I think heart disease, probably one of the top killers of autoimmune diseases. And for what's interesting is that, so I think getting the inflammation under control, whether through meds or with lifestyle medicine, can decrease the risk of heart disease, from autoimmune disease. But what's interesting is that even if when you have your cholesterol levels controlled, you still have a high risk of cardiac disease and mortality from autoimmune diseases is because inflammation is not the cholesterol levels. So there are states now trying to see which medications and what's hard, you are going to help with the cardiac disease mortality. That's this coming out. So inflammation is an underlying factor for cardiac disease in Rheumatology disease as well. And I think for I think you agree with me a risk is that inflammation is part of the pathogenesis for cardiac disease and heart attack. So if you get that under control, with diet, and lifestyle medicine, it can be very fruitful for all different diseases.

Dr. Rizwan Bukhari  58:55

Absolutely. Yeah, I have a slide in one of my presentations that shows what's happening at the microscopic level, and inflammation is a significant aspect of that with everything. Yeah, at the plaque level, and it you know, it involves our our immune system, you know, and so yeah, and we know that, for example, diabetes doubles the level of inflammation at the microscopic level. And so there are so many things that I'm sure then an autoimmune disease, where you're chronically inflamed, or you know, it will increase the inflammation at that microscopic level as well.

Dr. Micah Yu  59:27

Exactly. And then, just going over to second question, so yes, the viruses can spark our immune diseases EBD CMB, hepatitis, they have all been known to trigger autoimmune diseases, usually in Rheumatology, we don't dig into those. When they come to our clinic, we don't test for EBD and all these different things, because essentially, the treatments are the same. Sometimes patients do come to us with hepatitis C, and then sometimes they end up getting vasculitis or rheumatoid arthritis or some other autoimmune diseases and then but you By this time they have already seen efficiency specialists or another specialty. And they do get some weird symptoms. And that's when we've come along. And then we work with them to figure out what's the best regimen for these patients. But besides viruses, yes, so like some patients I have, I dig into the history of like, what happened 20 years ago, before you end up getting the symptoms, or like, Oh, I got mono, or I got, yeah, mono, I got EBD. So I'm like, okay, that's probably what sparked it. But my, my treatment plan doesn't really change. But it's very interesting to notice. And what's interesting is vaccines can also trigger autoimmune diseases. That's one thing that a lot of people don't know. It's rare, but it's also something that people should know. It's not common. It's but there are case reports out there in literature, you can search in PubMed, that whether it's a flu vaccine, hepatitis vaccine, it has been known to be a potential trigger of autoimmune diseases of different kinds. But the benefits outweigh the risks for vaccines. That's why I do promote vaccines.

Dr. Rizwan Bukhari  1:01:11

So when you say rare, and you're talking about case reports, for our audience to understand, a case report is a one off, it's an anecdote, it's not something that comes out of a study. And when you say rare, it's probably one in millions. So it's not not something that you people can expect it to be like, Okay, I'm going to get when almost everybody gets a fever from their COVID vaccine shot, you know, and, but that's not so. But as far as an autoimmune disorder, that's going to be one in millions,

Dr. Micah Yu  1:01:38

right? Yeah, it's not very, very common. I remember someone case reports where a patient got, I think, a flu vaccine, and then she had autoimmune disease called pomada, medica. And went away with steroids. She got another flu vaccine, and it came back again. So it does happen.

Maya Acosta  1:01:56

So we want to make sure that our listeners know that you're available. you're practicing telehealth telemedicine in 17 states, and I guess they can go to your website to figure out which states those who are. And what's the first thing that they need to do? Do they need to be referred by their primary physician or

Dr. Micah Yu  1:02:13

no, they can just go to the website and literally just register as a patient and then make their own appointment on the website. You don't need referral. I don't take insurance. I only take Medicare. And then I'm licensed in Texas, because I know you're based out of Texas, but I'm licensed in many other states as well, Washington, Oregon now. I'm based in California, but you just go to the website. And if I'm not licensed in your state, I can always get your state license. 

Dr. Rizwan Bukhari  1:02:40

Well, I know I have a lot of people out here locally that will be very interesting speaking to you.

Dr. Micah Yu  1:02:44

Thanks so much for having me. 

Dr. Rizwan Bukhari  1:02:46

Enyoed it. Thank you so much.

Maya Acosta  1:02:47

Great information. Thanks again. Take care. You've been listening to the Plant Based DFW Podcast show. If you like our content, please like, share and leave a review. Our goal is to provide quality episodes to help support the community