We discuss in this interview:
- Dr. Micah Yu shares his own personal story with inflammatory arthritis
- How a wrong diet can trigger inflammation
- Changing lifestyle, changing disease symptoms
- How inflammation drastically dropped after two months of plant-based diet
- ESR and CRP values and their significance
- Dr Yu’s Doctor Lifestyle clinic and his lifestyle medicine method
- The importance of a personalized approach
- The role of medications
- Biologic drugs
- Join the live Q&A with Dr. Micah Yu and our other special guests – join Rheumatoid Solutions
Clint – Welcome back to www.RheumatoidSolutions.com. Today, we have a very special guest who I’m really excited to present to you, and I was thinking, how can I introduce him appropriately? This is what I thought, imagine if you were trying to put together the perfect rheumatologist, what would you want? You would want someone who understood all of the science around the lifestyle impact on your condition. That includes the microbiome and everything to do with exercise and sleep and so on. And also, you’d want someone who was available in these covid or postcode times through telehealth, someone you could call and say, look, I’m going through a tough time. I’d like to connect with you about these issues and so you can do it all from home. Thirdly, you’d want someone who is really empathetic. We’ve all had some experiences with doctors are just sort of disconnected with us, and we want someone who can really connect with the emotional and the social impact that having this disease has on us. This person has all three. I bring to you today a plant-based doctor who is an integrated rheumatologist. Who also just happens to have rheumatoid arthritis himself, so the empathy is through the roof. Dr. Micah, thank you for joining us today.
Dr. Micah – Thank you so much, Clint. I’m honored to be on your show and thank you so much for everything you’re doing for the community.
Clint – It’s going to be fun to begin this relationship together and work with you. It’s like finally some planets have aligned and we’ve met. I heard originally of your work via our community who sent me email saying, hey, have you heard of this rheumatologist? At the time when Forks Over Knives, published an article about you. To kick this off, we all love a good story, first of all your personal story with your health and how did your health deteriorate end up with the condition?
Dr. Micah’s Previous Health Condition
Dr. Micah – Yeah, I love telling my story because it’s one that really got me to where I am today. It all started back in high school when I was about 16 or 17 years old. I was an American football player, a benchwarmer. I was rather overweight and unhealthy at that time. I want to get stronger, I want to lose weight, so back then, the Atkins diet was very, very popular. So I went to Atkins diet for over I would say 6 months. I was eating almost 200 grams of protein a day, I weighed about 150 to 160 pounds or more, and I caught up to me. I didn’t know the risk of going on an Atkins diet, which now has transplanted more of Akito diet with that’s what they call it these days. After six months or so all of a sudden, boom, my big toe flared, pain on the big toe. It felt like someone got a piece of wood and slammed it overnight. I woke up immediately. My father, who is a Medicine Doctor said, you have gout. He drew my uric acid, it was off the charts 13, 14 at the time. Usually, in patients with gout, we want the uric acid to be 6 or below, so mine was 14 and I was limping. Of course, they had some dietary recommendations back then. Don’t drink alcohol, eat less protein, less meat, so I stopped doing the Atkins diet. But I went off to college, and I lived the college lifestyle, I didn’t go vegan, vegetarian, I still ate meat. I drank alcohol every now and then like a normal 20-year-old. I had a flare almost every month with gout it was not fun. I’ll be lucky if I went out with three months without gout flares.
Dr. Micah – But after college, I would still experience flares and the disease actually took on a different twist. I started getting joint pains in my TMJ’s, my wrists, my ankles, my knees. I want to be able to eat food for weeks on end, because it’s inflammation I would literally be able to feel my TMJ swollen. I would be eating yogurt because I couldn’t eat soft food for weeks in a row. I would miss school for a couple of weeks at a time, I actually had to drop my chemistry class because I couldn’t get out of bed and my feet were so swollen at one point. This was carried on to medical school. During medical school, I didn’t really learn much about nutrition, and so I kept eating the way I was, eating frozen food, salty fast food, you name it. I was a busy med student, so it didn’t really take care of myself. Unfortunately, no, I did get taught about this, no doctors during medical school taught me anything about nutrition. I saw different Rheumatologists, 2 different ones, one at a university, one in a community setting. My inflammatory markers are high, I was on Gout medications at the time, my uric acid was well controlled. So they are is saying you have something else going on, you just don’t have gout, I suspected the same thing. All my autoimmune antibody levels are all negative, so it was very, very confusing what was going on.
Dr. Micah – Fast forward, I go to residency and then I met the rheumatologist at my residency. That’s why I also did my rheumatology fellowship at Loma Linda University.
Clint – Loma Linda University? One of the blue zones.
Dr. Micah – Yeah, the blue zones. Exactly.
Clint – Wow. Was that deliberate or was that just fortuitous?
Dr. Micah – I grew up in Southern California, and my wife is also a doctor. We both wanted to come back home to Southern California. Loma Linda is one of the few universities that offer residencies, so that’s how we ended up at Loma Linda University. It’s a coincidence that it’s in one of the blue zones as well. But at Loma Linda University, they have lifestyle medicine there that promote plant based eating. But during residencies and doctor training, we don’t get top at all. So all the departments are very much siloed. During residency, I had a flare going on, so I had them actually scanned my tendons and they noticed that it was inflamed. They said (inaudible), this is the point where your tendons attached your bones, it’s a very, very small area and when (inaudible) so that was inflamed. At that point they said, it looks like you got Spondyloarthritis, which is a cousin of rheumatoid arthritis. So if you’ve heard of ankylosing spondylitis, I have a variation of that. I don’t have low back pain, but I do have pain in my TMJ, my arms, and my legs. There is a variation of it, psoriatic arthritis is in the same family as well.
Dr. Micah – A couple of months later, I actually had a swollen foot and they drained my foot and I got the diagnosis of pseudogout. I had calcium deposits in my foot and that can be from inflammation, from chronic inflammation as well. So here I am, I have 3 diagnoses gout, pseudogout, and spondyloarthritis. Very fun right? At the same time, I’m working 80 hours per week during residency, so during my first-year residency ICU rotation, I literally could not get to work without limping for the first 2 weeks of the rotation. ICU rotation is one of the most stressful rotations in medicine, and I had to literally lift my leg up because my hip was swollen and would not move. It felt like something was keeping the tendon down, so I would literally lift it up and down, and during the rotation they actually told me to sit because I was visibly limping but I didn’t want to skip work. That was the way it was, that was one of the worst times during my residency. I would flare every now and then, but that was one of the worst flares I ever had.
Dr. Micah – My wife started to learn what lifestyle medicine was at Loma Linda University. That was our family’s first exposure to lifestyle medicine and plant-based nutrition. During Thanksgiving, she cooked a plant-based meal and I thought it was disgusting to be honest. I was like, what is this? I’m so used to eating fast food. I thought I was eating healthy, I didn’t eat that much fast food anymore, but I would eat out. I would still have some frozen food, processed frozen food.
Clint – It would sound to me like you were eating quickly. Like you were so busy, 80 hours a week in that environment, those situations, it’s microwave stuff, it’s on the go, it’s takeaway, I haven’t got time to cook I just got to eat because I’m going to get back to work.
Dr. Micah – Exactly, and the worst it’ll be 80 hours or plus, and the good ones will be 45, 60 hours. In the morning I grab a bar, a processed bar to go to work. That’s very typical eat cereal, dairy. No one really teaches you these things, right? Thanksgiving comes around, we had. plant-based meal and I didn’t get used to it, so months go on my first exposure to a plant-based meal was November of 2017. This is my last year’s residency, so towards the end of the residency, which is about spring of 2018, I end up going to Guam for rotation. It’s an SDA community (inaudible) so those doctors and nurses, they’re SDA’s, so they were getting plant-based they’re eating a vegetarian diet. So I started learning more about (inaudible) eating there, I grabbed Dr. Greger’s How Not to Die book, I read t during that month, Read the potential transformations that the (inaudible) can have. I said, OK, let’s give this a shot, so when I came back to the United States in May of 2018 I watched forks over knives. I was like, all right, let’s do this, let’s give us a couple of months and let’s see what happens. So I went to a plant-based diet for a couple of months and within two months my pain drastically went away. I was even questioning whether I had the disease anymore. Then within three months I had another blood draw, My C reactive protein went negative after ten years of being positive, and C reactive protein is an inflammatory marker. My ESR was still positive but it cut down by half, so still I was very impressed.
Dr. Micah – So I was in remission for two years, so these days I do eat some processed food, I eat no meat. I work overnight sometimes, so there is stress. I’m working seven days a week, I’m trying to build up my social media and working all the time. So when there’s some stress there, there’s some aches and pains there but it’s like a 1 out of 10 (inaudible) pain, nothing like it was before where I’m limping, I can’t eat, I don’t experience it anymore. I’ve never taken medications for spondyloarthritis. I noticed that there was food correlation before I even discovered plant-based nutrition, I just didn’t know what it was. Even though I am a Doctor, I know that there’s potential side effects and I didn’t want to have those side effects even though the rheumatologist I was working with was pushing me to take it. My thing was if I saw my x-ray and there are damages in my joints, then it’s time to take meds. But luckily, I never got to that point. I recently had my last blood drawn back in January and my ESR was finally negative after 13 years of being positive, so everything’s negative now.
Clint – It’s amazing. When you say negative, just to clarify, does that mean like less than 20 mm/hour? Or do you mean like down to like 3-4 mm/hour?
Dr. Micah – Yeah, so every lab has different numbers that are normal, I think it was like 3 or 4.
Clint – Yeah. There’s a natural separation due to gravity that’s going on, you cannot defy gravity. You can’t have an ESR of zero, right?
Dr. Micah – Yeah. It’s normal to have an ESR.
Clint – Exactly.
Dr. Micah – It’s not very accurate too. I have patients who have normal ESR and CRP.
Clint – It’s true, and one of my rheumatologists told me that it’s also that’s one of the very few labs that is still done by I. There is a there’s a Parallax era as well when it comes to taking that measurement, because it’s done with a human intervention, which is not as reliable. It’s really fascinating a couple of things came up before we get into the content of what I wanted to go across with you. I love that you brought up this concept of tendonitis that you had the symptoms of, and the connective point between the bone and the tendon. It’s so common not just in spondyloarthritis, but more for rheumatoid arthritis for that to happen as well. I’ve found that engagement of the muscles so that that connective tendon, it gets blood flow and gets strengthened, it reduces that sensitivity. Have you found that through exercise as well?
Dr. Micah – I haven’t noticed a correlation or I haven’t been looking to it. I’m pretty sure there is since exercise anti-inflammatory. I encourage all my patients to exercise, it’s one of the best things you can do for autoimmune disease.
Clint – Yeah. Okay, great. Well, we’ll get into that in a minute, and the other question I had for you was, what do you think was the trigger for this inflammation? I think we’ve covered that really well. You mentioned how you’re eating that Atkins diet, you basically went into this massive, high fat, low fibre environment, which is going to stir everyone up, right? You’ve covered that in detail. So you’ve started your own clinic, you’ve got this dream like clinic for people in our community who look towards integrative approaches from their doctors, and you’ve started with your wife. Tell us about your clinic before we talk about how you interact with patients. Tell us what you’ve set up.
How Dr. Micah Interacts With His Patients
Dr. Micah – Yeah, so it’s the clinic is called Doctor Lifestyle. The reason why it’s called Doctor Lifestyle is because in life we when we discovered lifestyle medicine and plant-based nutrition we decided to go public with it and just talk about it on our social media account. Our Handle at the time was called Doctor Lifestyle 101, teaching about lifestyle. But we have since separated by social media accounts because she’s primary care and I’m a rheumatology autoimmune disease, so I want to focus on what we want to talk about. That’s where our clinic name has come from, Dr. Lifestyle. She does primary care, lifestyle medicine and also does psychiatry, and I share the same office with her I do integrative rheumatology. That’s what we offer, and I can definitely go into how we practice and everything like that.
Clint – Yeah, let’s do that next. Let’s say just because of our audience who are listening or watching this, who might have inflammatory arthritis. What is their experience like? Say you’ve got a new patient who comes in. What’s typical the typical experience for that person? Also cover whether or not that person is mostly coming to you because of your integrative approach or whether or not you’re just the local rheumatologist, who’s the first one on Google. What’s your mix and what do you do with that (inaudible)?
Dr. Micah – At my clinic, I have a mix of them. There are people that find me on Google, I have good reviews on there. They don’t even know that integrative, but they’re the people that do see me internationally and throughout the country. In the United States, they are finding me through social media because I am an integrated rheumatologist. Patients first come to me it’s an hour visit, and I don’t take insurance in my clinic typically because I spend so much time with patients going through everything. I go through their regular symptoms, just to make sure there’s no missed diagnosis with their disease. Because misdiagnosis is very common in rheumatology autoimmune disease, a lot of these symptoms overlap with each other. Also a lot of rheumatologists, different rheumatologists get different experiences during the training. So there are some diseases that I saw a lot in my training that other rheumatologists don’t see that much. So I go with symptoms, I go medications, your typical visit, medications, symptoms, do you drink, do you do drugs, all these different things. So really clinched on that diagnosis, but then again, the last is the medicine aspect. I really dig into the nutrition, sleep, exercise, stress levels, trauma, and environmental toxins as well. Not only am I approaching from a lifestyle aspect, but I’m also getting training in my second fellowship now in integrative medicine at University of Arizona. It’s a 2 year fellowship through the (inaudible) program, I don’t know if you know who he is. He’s that bald guy with the long beard. It’s his program, and it’s two years long and I try to incorporate that. I’m learning about Ayurveda Chinese Medicine, I’m learning about aromatherapy with essential oils, supplements, herbs. Also learning about functional medicine right now as well, so I’m learning about environmental toxins, how to detox all these different aspects of food as well that can impact autoimmune disease. So I’m really trying to grab all these different complementary medicines to combine rheumatology, because I
Don’t think that there’s one complete answer for auto-immune diseases it is such a wide spectrum that every person is different. During the consultation, I really dig into the realm of toxins, heavy metals, if there’s any exposure to that. Then I put that all together with the patient and I really try to see what the patient’s goal is. Do they want to go plant-based? Are they ready for that yet? But do they want to take it step by step? Because in my experience It’s a wide spectrum, there are some patients that just (inaudible) dairy and they get a lot better. But there are some patients that have to go all the way, Tofu, plant-based, no salt, no sugar, no oil to feel really good. Since everyone’s different what I do is I have to figure out what the patient’s threshold is because I don’t want them to go(inaudible) plant-based S.O.S without sugar and oil, then revert back to a complete omnivore process, I’ve seen that before. I’m learning from my experiences back when I was a trainee because I was trying to put everyone to a whole food plant-based diet, but some people just flipped within a week. Everyone’s different, so it really depends on what your goals are, whether you want to be on medications completely or you want to be off of completely. What’s your goal? My goal is to get patients off of medications but in a very safe way. That’s how I approach my patients. With regards to medications, if the patient has a mild disease, then I do more diet and I wait a little bit longer before I prescribe to biologics or other medications. But if they’re flaring very hard, I have a very low threshold of putting them on medications right away because my goal is to control the inflammation. I’ve seen patients die from rheumatoid arthritis, from lupus and all these different diseases, so I know when things can get serious.
Dr. Micah – I had a patient who I’m seeing in another state who has new-onset lupus with lupus of the kidneys. I didn’t mess around with that, I’ve seen patients die from that. I immediately put them on steroids and high-dose medications and put them on a plant-based diet at the same time so that I can get them off medication sooner than if they were not doing that. So that’s how I approach all my disease and arthritis patients.
Clint – Yeah, it’s beautiful. It’s kind of what I have come to understand is also completely appropriate with regards to trying to heal the gut and reverse the issues in the stomach. You can’t do it when you’re highly inflamed. I’ve seen this time and time again, I experienced it myself and I witnessed it with a lot of really hopeful people who just say, hey, I just want to change my diet, I don’t want to take the meds, my CRP is 50, I just want to do it, I can do it. Look, the intention is beautiful, but this disease is brutal, this is like the giant enemy of all enemies. I’ve read studies about the coexistence of gut inflammation with joint inflammation. It’s just so difficult to win the arm wrestle against the inflammation when it’s really high, because that triggers oxidative stress, which creates more inflammation, and you’re in this vicious cycle. The way you have described so eloquently is is the ideal approach, which is if you really inflamed, let’s get the inflammation under control, because my view is it’s easier to eventually taper and in some cases get off drugs after a while, than what it is to beat the inflammation when it’s high without any drugs.
Dr. Micah – Exactly. You hit it on the spot. Also with rheumatoid arthritis, it’s not just the joints you’re hurting, OK? You can get something called uveitis, which I’m sure you’re very aware of.
Clint – Yes.
Dr. Micah – With the eye inflammation, I’ve seen that time and time again, the sclerosis of the eye can get strokes, you can get heart attacks, you can get heart disease from rheumatoid arthritis, you can get rheumatoid arthritis to attack the lungs I’ve seen that as well. If you’re going to try to do diet alone and you’re flaring very, very hard and you decide to go on the diet and you’re still flaring, and you haven’t found the right one as months go by and you’re (inaudible) on medications. You’re asking for trouble so I’d be very, very careful.
Clint – Yeah, most definitely. Do you get some patients who have that expectation that here we go, I’ve finally got an appointment to see Dr. Yu, I’m going to get off all my meds. I know it’s case by case, along the lines of what we’ve been talking about, do you set some expectations here and sort of just say, well, you know, let’s look at maybe a year from now and I mean, can you talk through that that expectation setting?
Dr. Micah – Yeah. So it all comes down to how the (inaudible) of patient first right? So I decide whether they’re a mild case or a serious case. I tell them it’s possible that if you go on an anti-inflammatory diet a plant-based diet, that within a couple of months your disease can get a lot better. But there’s also a chance that you might not be in a resolution, you might still have some disease there.
Dr. Micah – I tell my story just because I got a lot better and my pain went away doesn’t mean that yours will everybody’s different. I tell them there’s so much to auto-immune disease that’s still undiscovered and they’re still at the beginning of research. You have your environmental toxins, you have heavy metals, you have the pollution associated with just pollution and rheumatoid arthritis. This was in the Journal of Arthritis and Rheumatology. There’s some things that you just can’t control, stress levels can cause disease flares as well. You have all of these things going on so you have to go on a plant based diet or another anti-inflammatory diet, it doesn’t mean that you’re going to be in complete resolution. But I presented the best case scenario, but also the worst case scenario is that you probably will get better, but you will still need meds.
Clint – You mentioned prednisone as one of the options to get inflammation under control quickly, and again, it’s very case by case. But with all of the contra-indications or I call it counterproductive effects of prednisone on the gut, it causes leaky guts, especially when used with nonsteroidal anti-inflammatories. Do you make the patient aware that prednisone and these painkillers should be only for short term, and that we really if you got a good amount of inflammation going on, we need a disease modifying or biologic drug?
Clint – Exactly. Yeah. So I tell the patients when I do put them on prednisone, I tell them I have a love-hate relationship with this drug. My love for this drug is that it works very fast, my hate for this drug is that it gives you so many side effects. Not only that you get that you talk about, but osteoporosis, it gives you diabetes, insomnia, mood swings, there are so many different things. This is the sentiment amongst all rheumatologists but unfortunately in medicine, we’re not at that point where we have something that can act very quickly within like a day or two. So I tell patients, you know what, the steroids te prednisone is a temporary measure, but I have to put in a second agent. The whole purpose of the second agent is to get you off of the steroids faster, this stuff is a very, very temporary.
Clint – I love it. It’s like we have overlapped sentences coming out of our mouths all the time. The concept of the bridge of the steroid bridge to wait for the methotrexate or Plaquenil whatever it might be, do you employ that strategy in most instances? My feeling with that is sometimes the prednisone can sort of mask the patients or my client’s experience with whether or not the DMARD is actually beginning to work and then they get stuck on prednisone and then six months go by, they’re still on the steroid. That’s been then detrimental for their gut.
Dr. Micah – Yeah, that’s why it requires frequent follow up to the rheumatologist. In my clinic, I try not to give steroids. I’m really pushing hard on an anti-inflammatory diet and lifestyle. I tell them if you eat this like this with a plant based diet, I mean, you’ll get off the steroids faster, even have to give it. But we can tell whether patients are responding to the DMARD like the methotrexate or not, because when the patient is steroids, we usually don’t just keep them on for a long time, we taper it. Tapering. As they taper it, and they’re still flaring, that means that the DMARD is not working right? I tell them that the DMARD is not working so I might have to put another medication, another DMARD or another biologic. My determination whether They are going biologic or not, is how serious is the disease, and sometimes I feel like the biologics are better than methotrexate. Because methotrexate I feel like it’s a dirty drug, it’s so many side effects, a lot of GI upset, diarrhea, nausea, vomiting and.
Clint – Fatigue right? A tremendous amount of fatigue, I used to feel like I was a walking zombie. This is not to hate ff course, we’re not hating on drugs. We’re just saying the reality is for a lot of people that the med can make you feel not yourself. I just felt like I just had to have a nap every afternoon on methotrexate, so yeah you’re right.
Dr. Micah – Yeah.
Clint – Let’s talk about the biologic drugs. What’s become evident to me in the last few years is that, this is my 15th year or something since I was diagnosed and when I was first diagnosed, the biologic drugs was sort of yes, I think Enbrel was on the table and so forth. But it was considered like you got to be like that was like end of life scenario before you go on a biologic drug, look out like you’re on this chemical thing. But now it seems like it’s become the treatment of choice, and if your insurance company in the US covers it, you could actually go straight onto that. Is that correct?
Dr. Micah – Oh, yeah. If you have good insurance, that is. Some insurances, even though I want to put patients right away on a biologic, they won’t let me. They will require that methotrexate first. Sometimes message if it does work, it’s the cheapest one out there. According to the guidelines, methotrexate and some of these DMARDS are the first line. These biologics can work wonders, you have injectables now, you also have infusions, and you also have oral medications. It really depends on the patient’s preference and the insurance companies which one they would want patients on. I mean, again, I like these medications, I think modern medicine has done wonders for our rheumatoid arthritis community and just with auto-immune in general. But it’s a Russian Roulette with these biologics. Most of them have a black box warning of cancer risk. I’ve seen rashes with these biologics, I’ve seen different side effects. To me it’s always a Russian roulette whether you’re going to get, you just take your chances of getting a side effect or not. I’ve see patients that have been on these for 15 years and getting no side effects whatsoever, they’re living the best days of life. I’ve seen some of them where they take 1 or 2 doses and they get reaction to it, full body rash. Some get cancer within five years, even though the chances are very minimal less than 1%, there’s a whole spectrum there. I see patients who develop antibodies against the biologics which is very common. You have to keep rotating the different ones. So I tell my patients, you can go on a plant based diet or another anti-inflammatory diet of your choosing. But if you keep living, you don’t change your lifestyle. You’re pretty much fighting against the medications I’m giving you and they won’t work as well.
Clint – I just put on my podcast recently and shared a study that just came out, I think it was last month, February 2021, that the amount of methotrexate in the study that was metabolized by your gut bacteria influenced how well the methotrexate worked. And they could predict using a computer algorithm based on your microbiome, whether or not methotrexate was going to work for you.
Dr. Micah – Wow, that’s amazing. I don’t know when that will come out, though.
Clint – But what this tells us is what we know intuitively is that we know that the microbiome is one of the variables as to whether or not a drug will work. OK, so it’s just been the first drug that for which that has been proven. But I’m sure common sense would prevail that all of the drugs influenced by the gut microbiome in their efficacy. Doing what you’re recommending, which is to get the diet right, your drugs will work better as well.
Dr. Micah – Yeah, I’m going to (inaudible) off of that because I’m so excited that you brought that up because there have been studies recently also on methotrexate and different drugs, that the gut microbiome diversity also helps the treatment process as well. Whether your methotrexate can work also, and we know that I’ve got (inaudible) diversity is based around, how many plants, how much fiber you’re eating as well, so it all ties back down to a plant-based diet.
Clint – It’s beautiful, isn’t it? It’s beautiful. So we’ve talked a lot about clinic patient interaction, drugs, it’s been awesome. Let’s just tap in as a reminder as to why should we eat more plants? Would you like to go there and just talk about the benefits of eating more plants for, say leaky gut or the microbiome? Just as a quick refresher?
The Benefits of a Plant-Based Diet
Dr. Micah – Our gut microbiome is comprised of over 10, 100 trillions of bacteria and gut microbiome is basically where your intestines are and you have your good gut bacteria, bad gut bacteria. In all um diseases across all spectrum, including rheumatoid arthritis. We call it gut dysbiosis so that’s pretty much your bad gut bacteria is overwhelming your good gut bacteria, and when this happens and we call it gut dysbiosis. You have something called leaky gut. The looming of your gut where the food passes through and the immune system and the gut is only divided by one cell line and that one cell line is very tight, it’s connected by tight junctions. So no bacteria (inaudible) through, so when you have gut dysbiosis, you have leaky gut. Your tight junctions open up a little bit so each cell there is a little passageway for the cell to communicate with the immune system. This can have an inflammatory process when you eat food that are very inflammatory, which can contribute to gut dysbiosis. That can stimulate a cascade of an inflammatory process that will eventually lead to the joints where like rheumatoid arthritis.
Dr. Micah – Just getting lots of science here, so you have 2 types the T cells, there are lots of types of T cells. But the meantime we’ll talk about (inaudible) and there are T helper 17 cells. Those (inaudible) cells are the anti-inflammatory T cells, and your T helper 17 cells are inflammatory T cells and these are also located at the gut. When you eat fiber, when you eat Fido nutrients from fruits and vegetables, when you eat herbs. They help build up the t regulatory cells, which are anti-inflammatory T cells. This is from your short-change fatty acids breaking down. (inaudible) fatty acids from fiber and shortening fatty acids, then translate signals to your immune system, which helped build up your T (inaudible) cells, which, again are anti-inflammatory T cells. This in turn will circulate throughout your body and your immune system and will give an anti-inflammatory effect on your body. But when you eat processed food, fast food, this will increase your T helper 17 cells and then this will send a cascade of sending an inflammatory process throughout your body. Not only is this done through the macroscopic aspect of things, but also affects the epigenetics as well. There’s not too many studies on this, but what we do know is that epigenetics are affected so you have a gene. Auto-immune disease is genes and environment, so you cannot get an autoimmune disease without both things, even though you have very, very light genes that might give you rheumatoid arthritis they’re still there.
Dr. Micah – Epigenetics means your genes are fixed, but your gene expression can change based on how you live your life and the food you eat, whether you smoke, whether you exercise, and also is affected by your mom how did how does she live when you were a fetus as well? We know that these things get passed on from generation to generation. Your Fido nutrients and your fiber from your fruits and vegetables affect epigenetics as well, and this can affect that new system also. So it gets very, very deep here, but that’s a little bit of how food is medicine and how it can help close up the leaky gut if you can say in layman’s terms.
Clint – Yeah, yeah, absolutely. No, thank you. That’s a great explanation, and I hadn’t heard anyone split out the T rig in the T 17 so neatly like that. Thanks, that’s great.
Clint – Let’s see, I did watch a spondyloarthritis presentation that you gave online and I noticed something that hasn’t come up in any of our discussions in over 160 podcast episodes, no one has ever talked about salt. But you’ve addressed the inflammatory impact of salt. I loved it. Could you just touch on that before we then wrap up and I send people to your website and so on?
The Impact Of Salt
Dr. Micah – Sure, yeah. What’s very popular these days amongst the Palm Beach community is that no salt, no oil, no sugar diet, which not everyone can do. It takes a lot of discipline to do that. But salts, I would say, in high excess can be very, very inflammatory. This isn’t just something that’s in very, very small journals, this was actually talked about in the New England Journal of Medicine, and it’s been talked about different autoimmune disease journals as well. Salt has been studied in different diseases, rheumatoid arthritis, lupus as well, and I think some in human models as well, healthy humans. But just going back, it all ties back to the T (inaudible) cells in the T helper 17 cells. So your T (inaudible) cells just to break it down for you, are very important to your body. When you’re fighting a virus and a bacteria, when you’re killing off the bacteria or virus, your throwing inflammation, you want inflammation in your body because you want to kill off that foreign object. However, you want that inflammation to calm down once that fighting is over. And what calms that information down is the T regulatory cells okay, T regulatory cells do that. But what’s nice about T regulatory cells is that it helps your body from fighting itself. In autoimmune diseases, what we have found is that your T regulatory cells are depleted, they’re low. Your body is fighting itself and T regulatory cells are having a hard time preventing your body’s attacking itself because they’re low. What Salt does is that it also depletes our T regulatory cells and it increases your T helper 17 cells. What’s interesting is that some of these pathways that these biologics are acting on are also stimulated by your high salt intake. So your biologic such as Humaira, Stelara if you have spondyloarthritis, Actemra, some of these pathways (inaudible). These can be stimulated by high salt intake and that’s through the cells. So your T helper 17 is stimulated inside the cell, and then that increases another inflammatory side of (inaudible) 17. (inaudible) 17 can increase other inflammatory cytokines, but it can also put up receptors onto the cells where the inflammatory cytokines can also attach to. So some of these medications I’m giving these biologics that you are all on for everyone that’s listening, salt can trigger these same pathways.
Dr. Micah – If you’re eating a high salt diet, you’re pretty much going against what your biologics are doing. I would not say cut off salt completely if you like some, but I would say always have salt to taste.
Clint – Yeah, great, fantastic, which is what my recommendations are. If we rewind a little bit and you mentioned that whole food plant-based and they’ll love the SOS, that’s the Paddison program. I tell everyone, like just basically say do the most challenging version, because that’s going to give you the most impactful results in the shortest amount of time, which is really motivating. Then you’ll say, OK, look, this wow, this is having an impact and then you can slowly reintroduce foods and become more diverse and live more of a social life. You can eat at some approved places once you’ve asked the chef, oh, sort of stop right now. What I say is to stay on that is hard, and so we can allow ourselves a little bit of salt, as you say, to taste. We obviously get rid of the table salt, but a little bit of Himalayan or Celtic sea salt just so that you don’t give up, basically. It’s hard. Will you say that that’s fair?
Dr. Micah – Yeah, that’s completely fair. We all have a social life and not all our friends are plant based, and you don’t want to isolate yourself either. I mean, I tell my patients to be realistic here, if you’re going out, just ell the chef, don’t put salt on my food, don’t add oil, or minimize it. I would say if 80 to 90% of the time you’re eating a whole food plant-based diet at home you’re doing pretty good because the 10% you’ve got to have a social life with other people as well. I have some patients that don’t want to go whole food plant-based, but they’ve listened to me they’ve cut down their alcohol intake. They have just increased their fruits and vegetable intake, and sometimes that’s just part of the battle that will really help with their disease.
Clint – Yeah, absolutely. I am really pleased to have you talk about salt, it’s not something I’ve addressed, and I didn’t know about those studies until I watched your presentation, so I’m really grateful and I’ll include those studies in my work. What I’ve found and I want to know if you’ve had the same experience. I’ve found that the ultimate kryptonite for inflammation is oil, and if someone in this happens to me as well. If you inadvertently or, make a bad decision to have a little oil with your food at a restaurant, I’ve found a study that showed that the industrial style cookies where they reheat the oil over and over again every time that oil is reheated, it like doubles oxidative stress or free radical potential. So it’s not only just bad enough to have some oil, but when you’re having the oil at a restaurant, you’re in for absolute catastrophic outcome if you’re not careful. So your position on oil is what I’m interested in mine, so, you know, is oil is kryptonite. That’s what I’ve observed.
Dr. Micah – Yeah. I’m glad we brought this up. So oil, like you said, I can agree with you when you cook it over over again, it’s very, very inflammatory, especially at the restaurants, it’s also carcinogenic as well. Each oil has a different smoke point so when you cook above that it becomes carcinogenic. I would say some patients I have they can’t eat oil as you said. Some patients can have a little bit about oil and they do fine. I was I would say it’s up to the individual but I would say very minimize oil as much as you can. If you’re going to have some oil, extra olive virgin oil is probably the best one out of all the bunch. I try to minimize oil, but I do eat processed food these days. I minimize it like I eat out at restaurants, sometimes I tell them to minimize oil but they don’t. So sometimes I do get a little pain here and there, but I think it’s up to the individual. Sometimes I eat oil and I don’t feel any pain at all. I guess I’m one of the lucky ones.
Clint – Well, you’ve done the work and there’s a threshold, isn’t there? Because as we know, if there’s an existing fire and you go through kindling on it, it’s going to burn. But if the fire is really low and it’s just a smoldering, you could throw a little dry leaf on there and it might not catch.
Dr. Micah – Exactly, so I would say if you’re eating like doing a very good job 80%, 90% whole food plant-based, no salt, sugar, oil. A little oil when you eat out, I think your gut microbiome has changed, and I think your immune system has gotten stronger to the point where you can withstand a little bit here and there in a social setting. I mean, there needs to be more research on this, I’m just speaking from experience and what I’ve seen so far. But I think we’re just at the beginning of research in immunology and rheumatology in general with regards to food. So it’s a very exciting time.
Clint – Absolutely. Which brings us all the way back to your work and how important what you’re doing is. I saw some commentary somewhere, which I think is accurate, I think you might actually be the only plant based integrative rheumatologist that I’m aware of, correct me if I’m wrong. They used to be a doctor called Charles (inaudible) rheumatologist out of Illinois, who I was I was going to do some work with, but then he retired. You’re at the starting career, he actually came to the end of his career. It’s very exciting to to have you part of the community. Let’s talk about next steps for people, I know people are going to want to contact you. So tell us the best path for them.
Dr. Micah – Yeah. As you said, I think I am the only plant-based rheumatologist out there because I’ve tried to look for another one. I know there’s an integrative rheumatologist out there, but I think I’m the first or not only or maybe a few ones that is going to combine functional lifestyle and integrative medicine together, so I’m really trying to revolutionize this field in a way. Because I think each field of complementary medicine has something to offer that can be very, very beneficial to us autoimmune disease patients.
Dr. Micah – Patients can see me all over the world. I’ve seen patients from the Uk, Panama, from South America, and patients from all over the United States can also see me as well. My website is www.drlifestyle.org, and if you want, you can also see my wife as your primary care doctor as well. I have some patients who I am managing the patients autoimmune disease such as lupus, and my wife is managing the anxiety, and depression from a holistic standpoint. That’s very common to have those diseases together with auto-immune disease. They can go through that website and then they can also just click on the patient registration, and login you put your credit card information. My pricing is on the website. It’s $400 for 1 hour and $250 for follow-up. We can talk about everything your supplements, your herbs, your biologics, your diets, what needs to change? Because there are some nuances here and there. Some patients just can’t tolerate wheat, we can talk about gluten. Life is saying go down this rabbit hole.
Clint – Isn’t it a rabbit hole? You just mentioned Glaucus. I mean, just that alone is like an hour, you know what I mean? Yeah.
Dr. Micah – There’s so much controversy amongst doctors regarding that topic and then your environmental toxins I bring that up (inaudible) in my clinic as well. So it’s very, very easy to see me virtually. I am located in Newport Beach, California, so if you’re local in California, you can just drive on over. It’s a very, very intimate clinic, and I can just fit you in right away in my practice.
Clint – Yeah, great. What I like about this, actually, I like that there’s no insurance involved because there’s been hiccups with trying to do telehealth consultations that I’ve experienced with some other doctors because of the complications of it with insurance. This is just look, here I am, go online, pay the money, let’s talk. And that’s plain and simple, it’s easy and it’s fair. It also enables people not to have to contact an office during an inconvenient, different time zone, trying to get you during business hours or your front desk. And so I want a book. They can just do it at any time online.
Dr. Micah – Exactly. I know it’s there is no front desk, I am the front desk.
Clint – You’ve kind of got like a virtual business, but you also do sort of some face to face.
Dr. Micah – Yeah, it’s interesting. I’ve done steroid injections in my practice, but if they want the injection. It’s interesting how things have developed, because I do work at a hospital clinic 1 day a week, bread and butter, rheumatology cases. I do try to employ lifestyle there as well, but I don’t get the luxury of time and I do in my practice. Over there at the hospital it’s a four-month wait to see a rheumatologist. What you do with insurance is all that stuff. But you see me, it takes like actually within a week, two weeks. It’s a journey, and there’s just so much to offer. I’m in the beginning of my integrative journey as well, I’m in my fellowship, I’m a functional medicine, and there’s new technology and new science coming out all the time. So really there’s a role for integrative medicine, there’s a role for functional medicine and lifestyle medicine. I’m so happy that I can hopefully put a stamp on this space of auto-immune disease, because there’s so much. You have your traditional rheumatologist that don’t think nutrition has anything to do with rheumatoid arthritis or any of these diseases. But then you have your naturopath and your functional medicine doctors say it does but then they say don’t take medication. I’m trying to blend both fields, trying to give the best of both worlds. Using my experience as well as the patient’s goal to feel what’s the best plan for them?
Clint – Oh, I love it, like I love it capital LOVE, uppercase, billboard love. Because what tends to be a little bit blows my mind is just to echo what you’re saying. I mean, it’s quite strange that in this day, in 2021, you can see a specialist in your condition who doesn’t know the wealth of published evidence to show that a change in diet influences the outcome of the disease. I don’t have words to express my disbelief that the person who’s prescribing and managing your condition in some cases hasn’t read that if you eliminate, like we’ve talked about those Efendi foods that you will improve, like, shouldn’t that be sort of the most primary, most crucial piece of the puzzle?
Dr. Micah – Yeah, you bring up a good point. During our fellowship and training, we don’t get anything about nutrition, even where guys do rheumatology. As a trainee, I was the one teaching my bosses, my attendings about this. I gave a grand (inaudible) to a bunch of doctors and rheumatologists regarding lifestyle medicine and rheumatology. In our journals, even, there’s some paper on diet and lifestyle and arthritis and auto-immune disease, we usually glance over it. And because what’s it what excites us right as rheumatologists, the drugs, what’s the latest drug? What’s which drug is better with this drug? So that’s what we talk about at our universities and stuff not diet. How did I get to this point? I didn’t learn it from my training, I had to dig for it myself. I had to literally go in and look at journal articles myself, listen to a podcast. Really dig into this whole thing by myself and find out why did I get better doing what I did? And usually, if you’re not a patient, usually don’t believe that integrative medicine, then nutrition will help you unless you experience it yourself. Like you Clint.
Clint – You’ve just nailed it because you’re also the patient, you’ve got that passion to find the answers. And without that, you just think, well, surely I know everything about this. I’ve spent years studying this, therefore for my cup of knowledge is (inaudible).
Dr. Micah – Exactly. As specialists, you think you have all these years of training and you think you are the master of what you know, and if there’s someone that is not a rheumatologist that comes by and tells you, oh, this diet work or this integrative way, worse, you brush him off because you think you are a know it all as a specialist. As Doctors, we have really big egos, unfortunately. As a patient that’s been on this path, it really humbles me. I thought before as an M.D. that, this is the apex. This is where all the technologies and all these natural things are just bogus. But that’s absolutely not true, being now learning all these complementary medicine fields that there is a place for them. There’s a reason why patients get better on food alone and there is a reason why patients get better supplements, herbs. It’s really humbling and I’m just so happy and grateful that there’s someone like you out there that’s a patient as well that has really put a dent into this community and really giving hope to a lot of patients as well.
Clint – Well, we can share a lot of information, I’ve put together a guide for rheumatologists that I’ve been sharing with my clients for many years, which is a sort of a three page like very, very dense byte basis of evidence that’s reasonably readable, even though it’s so dense with references that follow for about ten pages. But I’ll share that with you, might save you a little bit of time. Also I’m finalizing a book, I’ll actually give you a copy of the draft and you can maybe help me do a little checking on some of my my claims and references there. But I think in that book, you’ll also find, again, just the sharing of the studies, isn’t it? It’s not like, what I’m saying here is not like, hey, I’ve discovered no, I’ve not discovered something. No, what I’ve found is here’s the reference to someone who has discovered something. With a big collection of those and some you may or may not have seen, it can help us share this journey.
Dr. Micah – Oh, yeah, definitely I’m looking forward to it. I think we’re just in the beginning of the research. So much more research is coming every day, I think in the future we’re going to discover that environment plays a bigger role than we think. Insecticides, pesticides, I have the papers for that, if you’re interested.
Clint – Yes, please.
Dr. Micah – So you’re going to know more than rheumatologists. I think you already know more than rheumatologists already and doctors in general with what you’re doing. I’m looking forward to your book, I’m very excited because I want to write a book myself in the future so we can definitely collaborate.
It’s really, really exciting. So we’ve got a couple of things that I want to talk to about about doing stuff together in the future. I’ll save that information for the audience once we confirm and lock that in, but some really exciting stuff, but coming up down the track, so this is only the beginning of our new relationship. So to wrap this up, I’d like everyone to jot down www.drlifestyleorg. Where you can go and get a one-on-one private consultation with Dr. Micah Yu and Micah, and get either a second opinion or begin your journey with him, with your rheumatoid or inflammatory arthritis, whatever it might be. And we will be in touch again Dr. Yu. Thank you so much for coming to the show.
Dr. Micah – Thank you, and if you want to reach us on social media, my handle is myautoimmunemd on Instagram, Facebook, Tick tock if you want to see you dance, and Twitter as well.
Clint – My autoimmune M.D., Fantastic. I’ll see you there. Thanks again.
Dr. Micah – Thank you so much. My pleasure.