Episode 55

Autoimmune Diseases and Charlatans

Published on: 11th September, 2024

The Cyclical Nature of Autoimmune Diseases: A Huckster's Playground

Autoimmune diseases are notoriously difficult to manage because they don’t follow a linear progression. Patients often experience periods of remission, where symptoms lessen or disappear, followed by flare-ups, where symptoms return, sometimes worse than before. This cyclical nature gives the illusion that certain "treatments" or lifestyle changes are working when, in reality, the disease is simply following its natural course.

Hucksters exploit this ebb and flow, offering unproven solutions and claiming credit for any improvements that coincide with the natural remission phase. When symptoms return during a flare-up, they may shift the blame to the patient, suggesting they didn’t follow the regimen properly or need to try an even more restrictive approach.

In many cases, these alternative therapies center around the idea that gut issues cause autoimmune diseases, particularly leaky gut syndrome. The pitch is simple: repair the gut, and the immune system will stop attacking the body. Unfortunately, the science doesn’t back this up.

Why the Gut Isn’t the Root Cause of Autoimmune Disease

It's true that there is a connection between the gut and the immune system. In fact, about 70% of the immune system resides in the gut, and gut bacteria (the microbiome) play a role in regulating immune responses. However, autoimmune diseases are far more complex than just a gut issue.

Genetic predispositions primarily drive Autoimmune diseases, environmental triggers, and immune system dysregulation. While diet and gut health can influence immune responses, there’s no evidence that simply "healing" the gut will reverse the course of autoimmune diseases. The immune system in these conditions has gone awry in ways that are not fully understood, and current medical treatments focus on suppressing overactive immune responses and managing symptoms—not on gut health alone.

 

Myasthenia Gravis (MG) is an autoimmune disease where medical treatment significantly outperforms dietary interventions.

MG is characterized by autoantibodies targeting the neuromuscular junction, leading to fluctuating muscle weakness and fatigability. The primary treatment modalities for MG involve immunosuppressive therapies and precision medicine approaches.

Current treatment guidelines, as discussed by Cavalcante et al., highlight the use of immunosuppressive therapies such as corticosteroids, azathioprine, and mycophenolate mofetil to control symptoms and improve muscle strength. (reference here)

Additionally, novel biological drugs targeting B cell activation, antibody recycling, and complement system-mediated neuromuscular junction damage have shown efficacy and safety in clinical trials. These precision medicine approaches are tailored to the patient's specific immunopathogenic mechanisms, offering a more targeted and effective treatment strategy.

In contrast, dietary interventions have not demonstrated significant efficacy in managing MG. While general nutritional support is important for overall health, there is no specific diet that can modulate the autoimmune mechanisms underlying MG to the same extent as pharmacological treatments.

In summary, medicine does better than diet in managing Myasthenia Gravis, with immunosuppressive therapies and precision medicine approaches being the cornerstone of treatment.[1]

Here’s why relying on gut health as the sole solution is like using a garden hose to fight a forest fire:

 

A. The Complexity of Autoimmune Dysregulation

Autoimmune diseases involve dysregulation at multiple levels of the immune system. In diseases like lupus or multiple sclerosis, immune cells are mistaking the body's own tissues for foreign invaders. This misidentification isn’t simply the result of a leaky gut; it’s a deeper issue with how the body’s T-cells, B-cells, and other immune components are functioning.

Medical treatments for autoimmune conditions, such as biologics and immunosuppressants, target these complex pathways to reduce inflammation and prevent further tissue damage. These therapies are carefully designed to modulate specific immune processes—something that diet and gut health alone can’t achieve.

B. Gut Health Cannot Reverse Severe Immune Attacks

Imagine trying to put out a raging forest fire with a garden hose—that’s what focusing solely on gut health is like when trying to manage autoimmune flare-ups. Autoimmune diseases can cause severe damage to the organs, such as the joints, kidneys, or central nervous system, depending on the condition. These diseases are often life-altering and, in severe cases, life-threatening.

Even if the gut plays some role in immune regulation, "fixing" the gut doesn’t address the immune attacks happening in vital organs throughout the body. Managing an autoimmune condition requires powerful treatments that target these immune responses at the source, not superficial changes to the digestive system.

C. Gut-Focused Diets Can Be Restrictive and Harmful

Another major issue with the gut-healing approach is that it often involves restrictive diets that cut out whole food groups in the name of reducing inflammation or healing the gut lining. These diets, such as the autoimmune protocol (AIP) or extreme versions of the paleo diet, are promoted as cures but lack strong scientific backing.

For many patients, these diets can lead to nutrient deficiencies, unnecessary food anxiety, and added stress—none of which is helpful when managing a chronic condition. Worse, some people may forego or delay important medical treatments, opting instead for these restrictive, gut-healing diets in hopes of a cure. This can lead to uncontrolled disease progression and irreversible damage to organs.

What We Do Know: The Gut’s Role in Autoimmune Disease Management

This isn’t to say the gut has no role in autoimmune disease—far from it. Gut health can influence overall health, including the immune system, and managing autoimmune diseases often includes dietary adjustments to improve symptom management. But diet should be seen as one tool in a larger toolbox, not the magic bullet.

For example:

Probiotics and prebiotics may support gut health and help modulate immune responses in some cases, though the evidence is still emerging.

However, if these patients are not appropriately followed, they can develop kidney involvement leading to loss of function or severe joint destruction for RA type, or even severe vasculitis, and none of these conditions are treated by or recognized by chiropractors

Transcript
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>> Dr. Terry Simpson: Hey, welcome back to Fork U Fork University, where

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we make sense of the badness, bust a few myths and show

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you how food may not be medicine, but it is

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important. I am your chief medical

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explanationist and host, doctor Terry Simpson.

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Today we're going to tackle the topic that is both timely

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and critical. We're going to talk about why

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chiropractors and other functional medicine practitioners

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take stool samples and recommend rather

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restrictive diets for autoimmune disease like Hashimoto's

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thyroiditis, rheumatoid arthritis and

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others. Let's start with the simple truth.

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Autoimmune diseases are complex,

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chronic conditions that require careful

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management. Conditions like Hashimoto's

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thyroiditis, where the immune system attacks the thyroid

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gland leading to hypothyroidism, are

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not easily fixed by dietary changes

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or gut health gimmicks. Yet there are people

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out there, often without a medical degree,

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claiming they can diagnose and treat these

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serious conditions by analyzing your

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stool or putting you on a restrictive

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diet. Let me be clear, these

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folks are quacks.

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Now don't get me wrong. Diet does

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play a role in your health, and there's growing

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evidence that our gut microbiome is important to

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overall well being. But when it comes to autoimmune

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disease, the science is far more

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nuanced than what these so called experts would have

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you believe. Let's break it down.

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First, let's talk about the chiropractors and other

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alternative health practitioners who claim they

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can diagnose autoimmune diseases

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and their treatments by analyzing stool

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samples. The idea here is by looking at the

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bacteria in your gut, they can identify

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imbalances or what we call

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dysbiosis, which claims to be the root

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cause of your autoimmune disease.

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They will tell you by adjusting your gut bacteria,

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usually with expensive probiotics, supplements

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and restrictive diets, you can cure or

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manage your disease. Heres the problem.

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While its true that our gut microbiome influences

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many aspects of our health, the science

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of specific gut bacteria to

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autoimmune disease is in its

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infancy. We do not yet have a

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clear understanding of how to manipulate the gut

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microbiome and treat autoimmune

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diseases effectively. The studies

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that do exist are often preliminary,

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done with mice or rats, or based

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on small sample sizes of human beings,

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and to extrapolate that limited amount of

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data into broad claims that gut health

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can cure or significantly

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change autoimmune disease is just

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not only premature, it's

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irresponsible. I'll give you an example.

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A study published in Nature Reviews Immunology in

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2015, highlighted the complexity

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of gut immune interaction and noted

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that the gut microbiome likely plays a role

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in the development of autoimmune disease, but we are far

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from understanding how to target it for treatment.

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More recent research, such as that from the Journal of

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Autoimmunology in 2021

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supports that view, acknowledging that

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while gut dysbiosis is associated with

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autoimmune conditions, there is no one size fits

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all pattern, no one solution to fixing it

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through diets or gut probiotics.

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Furthermore, recent

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studies show that stool samples

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may not be helpful in termining the

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gut microbiome, especially in the context of

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determining autoimmune disease. A study by Lew

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et al found that fecal bacteria

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significantly different from the swab and tissue

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microbiota in patients with irritable bowel

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syndrome versus if we lavage the

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gut with like a colonoscopy so we can get

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truer to where anatomically

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the gut microbiome is. Let's be clear,

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the chiris factors will have you take a stool sample.

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However, the microbacteria which are in your

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gut that might be affecting it are going to be

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completely different if you go up further into the colon,

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as if you use a colonoscopy.

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Leviathan et al demonstrated stool samples

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are a poor proxy for what we call

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the inner colonic microbiome, or the bacteria of your

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gut. Their study showed that those samples that were

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taken very carefully significantly

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differ from those in a stool sample.

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It's just not the same

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thing. So in summary, stool samples may not be

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helpful for determining gut microbiome, as if gut

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microbiome could actually fix autoimmune

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diseases. So when someone takes

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your stool sample and say they can cure your

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hashimoto's or your lupus or your rheumatoid

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arthritis by tweaking your diet and selling you rather

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expensive stuff, theyre selling you

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snake oil. The truth is, managing

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autoimmune diseases requires a

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multifaceted approach and typically involves

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medications such as synthetic thyroid hormone. In the case of

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Hashimoto's and close monitoring by

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healthcare professionals, this is something that these

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people have no clinical idea about. They weren't

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trained clinically. Let's be clear, a

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chiropractor doesn't have the extensive

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clinical training that

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a physician does. Consider this. Your average medical

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student not only spends two years studying basic clinical

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medicine in a textbook, they then go on to the wards

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of hospitals where they see the most complex

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patients on the planet treated by the most

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well known physicians on the wards, then they

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go out and do a three year internal

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medicine internship in some of the brightest

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hospitals in the nation, taught by some of the best scientists.

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Then they go on to do a fellowship in rheumatology.

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Compare that to a chiropractor who has two years

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of neck cracking. Let's move on.

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Let's talk about the restrictive diets that are pushed by these

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practitioners. You've probably heard of the autoimmune protocol,

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or the AIP diet, which eliminates a wide

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range of foods, from grains and legumes to

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nightshades, dairy, eggs, nuts and seeds.

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The idea is that these foods could trigger some

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immune response, and by eliminating them, you can reduce

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inflammation and manage your autoimmune disease. Sounds

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promising, right? The problem is that the AIP

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diet is based on very, very weak

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science. While some people report

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feeling better on these diets, we have to ask,

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why? Is it limited by their eliminating

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food groups? Or is it simply

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that their disease comes and

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goes, relapses, returns,

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goes into remission, which is the nature of

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autoimmune disease. Let's look at a study published

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in nutrients in 2017. They looked at the

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AIP diet in the context of inflammatory bowel

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disease, another autoimmune disease, and found that while

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some patients experienced symptomatic

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relief, the study was small, lacked the control.

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Group, couldn't possibly say it was the AIP diethouse,

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etcetera. There are other

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diets that are used for this. Typically what they will do is, let's

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eliminate dairy. I can tell you, based on

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what we have seen and has been told to us, that

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their formula comes down to this. Besides selling you the

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really expensive supplements, the really expensive

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probiotics for which there is zero, and I

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mean zero evidence, they will tell you to

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eliminate dairy, eliminate gluten, and

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go on one of these highly restrictive diets, like, oh,

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the whole 30 diet or the AIP diet, and

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then they'll say, look, you're cured.

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Let's be very clear.

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When you have a relapsing disease like

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rheumatoid arthritis, you are going to

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have times when it's going to relapse for unknown reasons. It's not your

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gut microbiome. it will just does it over

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time. And if you have rheumatoid arthritis aren't

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getting appropriate clinical medicine,

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you will end up with more joint destruction and more

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problems. And let's put it this way, once the

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chiropractors have you out of their office, they're not going to

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be able to follow your inflammation. They're not going to be able to

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follow your joint destruction. They

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don't care. They just want to sell you

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their exceedingly expensive tests, which cost up to

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dollar 500 for a stool sample, and their supplements,

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which are like $90 a point at each.

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So what's the bottom line? When it comes to

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autoimmune diseases? Beware of anyone who promises a

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cure or significant management from

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diet and supplements alone. The science

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simply doesn't support these claims.

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Instead, focus on working with a

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qualified healthcare provider. If you have a

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rheumatologic disease, see a board certified

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rheumatologist. If you have a problem with your

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thyroid, see a board certified

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endocrinologist. Because these non qualified

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nurses, dentists and chiropractors who get their

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little functional medicine degree, which by the way, they focus

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on thyroid disease and they focus poorly on

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it, they simply don't lack the clinical

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experience, the comprehensive literature knowledge,

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and they end up keeping people from

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having support, the support you need

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for an exceedingly complex medical

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problem. Alright,

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managing autoimmune diseases is a

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marathon. It's not a sprint. It

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requires thoughtful, multifaceted

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approach, not a quick fix. Don't let

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those quacks steer you off courses with

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promises far too good to be

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true. I hope today's episode has shed a

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little light on the dangers of these so called miracle cures with

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miracle diets and the quackery. That

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sounds too good. This reminds me of one thing

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else. Do you remember when chiropractors

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used to say the cure of all their diseases is in

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sublaxations of the spine, which they could never

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see, could never demonstrate, and spent years telling you to come back

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every week? Now they're going to the gut. They can't

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see it. They have sort of a science y test, and they are trying to

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convince you they alone have the answer to the root cause

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of disease, as opposed to all of the

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people who seriously study this and follow their

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patients intently and publish in the

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literature, the only root cause of

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disease that these functional medicine practitioners have

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found is your wallet. I would be

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careful of them. See board certified people to make

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sure thanks for joining me on this episode of

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fork you where we try to make sense of the madness.

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I'm your host, doctor Terry Simpson. This has been written and

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researched by me and you can find references for

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this to for those of you who like it on the blog

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associated with this, which is called

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yourdoctorsorders.com or four

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q.com dot. I want to thank the people who are

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distributing this, our friends at Simpler media, the pod God, Mister

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Evotera. And of course, I couldn't

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produce this without my favorite producer in the world,

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from producer girl Productions. Thanks for listening. We'll

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see you later.

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Hey, Ivo, did you ever find some sort of

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thing that we could use to, cure everything in that herb garden of

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yours?

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>> Emily: Ivo is on vacation in Portugal. Terry, this is

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Emily filling in for him on the podcasting front, but he

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didn't mention anything about watering his plants.

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About the Podcast

Fork U with Dr. Terry Simpson
Learn more about what you put in your mouth.
Fork U(niversity)
Not everything you put in your mouth is good for you.

There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner.

On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way.

The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist.

Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.

About your host

Profile picture for Terry Simpson

Terry Simpson

Dr. Terry Simpson received his undergraduate, graduate, and medical degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. Until he found he liked people more than petri dishes. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2018 and 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.”