Tom O'Bryan, DC - Gut Healing (2017 Conference) (LDN, low dose naltrexone)

Tom O'Bryan, DC - Gut Healing (2017 Conference) (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Autoimmune diseases are the third leading cause of getting sick and dying in the industrialized world surpassed only by cancer and heart disease. Three things in the development of autoimmune diseases: having the gene for that disease, the environmental trigger that that sets it off, and the loss of intestinal barrier function. How you live your life determines whether or not you get that condition. You can arrest the development of the autoimmune disease.

Dr Tom O'Bryan: Well. Hello everyone. This is Dr Tom O'Bryan, and it's a pleasure to be with you. And this is for the Low Dose Naltrexone Conference, September 21 through the 24th of this year (2017) in Portland, Oregon. And it's with a great deal of gratitude that I am presenting there.

I'm very grateful for the work that Linda Elsegood and the entire team is doing to bring out information about low dose naltrexone to the world and how remarkable a tool it is, to use with many, many different health conditions. And in our presentations in the past in 2016 at the LDN conference, which I believe that presentation is accessible to you if you go to the LDN conference website, we talked a great deal about how LDN is a benefit with autoimmune conditions. I referenced that. And how if a person has a sensitivity to wheat, whether they know it or not, it can diminish the effectiveness of LDN. And, uh, just as a segue last year in 2016, I presented at the Fourth International Oncology Conference in Abu Dhabi and showed the studies that if a person has a sensitivity to wheat, a number of different approaches of chemotherapy will not work the way they're supposed to and is for a similar mechanism. And that is that wheat will bind down to receptor sites that LDN also binds onto and that chemotherapy can bind onto. So this whole thing about wheat is worth exploring in more detail, and you can learn more about that by reviewing the presentation from the 2016 conference.

And that's just a little of who I am. I like to start with this slide. This is a display in the museum of science in Florence, Italy. This is Galileo's finger. And Galileo bequeaths in his will that all of his inventions could be on display for all of the posterity as long as they also displayed his finger.

And I like to put that up because you're going to hear her so much marvelous information in this conference. And when I've sat as an attendee in conferences like this, I take pages and pages of notes, and I'll write down, check this for this patient, or read this article or look more into this topic.

And I have pages of notes, and then I go back home and Monday morning back to work, and I don't have time to do any of it. That there is so much good information that we get. It's hard to implement. So I came up with the principle that if there's one thing, just one thing, that I walk away from a conference, a weekend conference with that goes into my lifestyle or my practice for the rest of my career, that weekend was worthwhile.

The thousands of dollars to travel and stay in hotels and pay the registration and be out of my practice. It's worthwhile, if I can just pick up one thing, I wish I could pick up ten things, but if, if I can pick up one, then it is a value. And so that's how I feel about this presentation, that if we all understand the concept of autoimmune disease and the message that I want to give you here today, this will stay with you the rest of your life. And it will not only help you in making more informed choices in your health care but also your children, your spouse, your family.

The first part of this autoimmune disease concept is that there are four circles to consider when thinking about autoimmune diseases. Genetics, and this is not a talk about genetics today, but let me just say with genetics, if you have a gene for a particular disease, that does not mean you're going to get the disease. It means that you're vulnerable to getting that disease. So the way I say it to patients is, Mrs patient if you pull it a chain, the chain breaks at the weakest link. It's at one end, the middle, the other end. It's your heart, your brain, your liver, your kidney, wherever your weak genetic link is, that's where the chain's going to break if you pull too hard.

So the goal in life is don't pull so hard on the chain because if your weak link is your brain, that's where the disease will manifest. If you pull too hard, if the weak link in your chain is your skin, you may get psoriasis. If the weak link in your chain is your joints, you may get rheumatoid arthritis, but it's the pull on the chain that allows the gene to express itself with the vulnerability that you have.

So genetics is important, but they are not a sentence that you're doomed to get a particular condition. It's how you live your life. That determines whether or not you get that condition. Notice that the genetics in yellow there is not covering everything. That it's only the part of the genetics that merges with the infections, the toxic chemicals, the dietary components.

Those are the triggers that will pull on the chain. And then if the link breaks, the gene gets activated and here come your kidney infections. If that's your weak genetic link, or here comes your Parkinson's if that's your weak genetic link. So the goal here is to learn how to not pull on the chain so hard.

To find out what it is in your life, in your body, with your genetics, where the weak link in the chain is. So the classical paradigm of an autoimmune development, the pathogenesis of autoimmune disease involving a specific genetic trigger and exposure to genetic makeup and exposure to environmental triggers has been challenged by the addition of a third element. There are three things in the development of autoimmune diseases. You've got the gene for that particular disease, whether it's Alzheimer's or Parkinson's or rheumatoid or ms or diabetes. You've got the gene, the environmental trigger that that sets it off, the straw that breaks the camel's back, when you're pulling on that chain too hard. And there's a third element, and that is the loss of intestinal barrier function. The technical term is pathogenic intestinal permeability. The slang term is leaky gut, and we're going to talk about that in detail, so you have a clear understanding of what the scientists are talking about when they're referring to the loss of intestinal barrier function.

So in this article in autoimmune disease, in the journal, autoimmune diseases, they talked about the environmental triggers, whether it's food or something in the air or something like in your clothing. If you get dry cleaning and you're inhaling those chemicals, those minute amount of chemicals, all the time, you can't tell, but you are inhaling them.

So the trigger. Causes a breakdown in oral tolerance. That means that you no longer can tolerate this food changes your gut microbiota. The technical term is dysbiosis, which enhances gut permeability. You get this thing called pathogenic intestinal permeability or the leaky gut, which causes large macromolecules to get into the bloodstream that isn't supposed to get into the bloodstream, which your immune system reacts to, to protect you, which then can trigger autoimmunity.

And in this article, it was neuro autoimmunity. So I'm going to go through these concepts in more detail so that they're crystal clear for you. Increased intestinal permeability is, and I underlined this, is an early biological change that often preceded the onset of autoimmune diseases. The intestinal permeability comes first.

By the way, the way that I do my presentations is that this is the front page of the article I read, and in the upper right side, you see the name of the medical journal, the issue, the volume number, the date, sometimes the pages. And then in the yellow box are exact quotes from the authors, exact quotes. I haven't changed a word.

If I've added anything, it's in parentheses, but these are exact quotes. This becomes your reference library, this presentation on this topic because these are the exact quotes. Such increased permeability could be due to environmental factors such as infections and toxic molecules and allergenic foods that possibly initiate the autoimmune disease.

Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier with its intercellular tight junctions controls the balance between tolerance and immunity to non-self antigens. Non-self antigens mean, uh, environmental molecules you're exposed to, whether it's food or air or water.

It's not part of you, but it's inside of you. And when you lose tolerance to that thing and your immune system gets activated, now you have a non-self antigen. And this suggests the autoimmune process can be arrested if the interplay between genes and the environment is prevented by re-establishing intestinal barrier function.

This is the take-home point that you can arrest the development of rheumatoid psoriasis, multiple sclerosis, Parkinson's, or Alzheimer's, dermatomyositis. It doesn't matter—the autoimmune disease. Practically every autoimmune disease that we've ever looked at, we see this trilogy, which is a genetic vulnerability and the environmental trigger and intestinal permeability, and if intestinal permeability is the gateway into the development of the autoimmune disease when you take care of the intestinal permeability, you close the gates.

And when you close the gates, your immune system calms down. And I'm going to go through this in detail for you in this presentation. So if we take a look at autoimmunity, the National Institute of Health tells us the autoimmune disease coordinating committee that while many individual autoimmune diseases are rare, collectively, they are thought to affect about 8% of our population, about 24 million people. To provide a context for this, the impact of the impact on autoimmune diseases, cancer affects 9 million people. Heart disease, about 22 million people, but autoimmune disease, 24 million people. And Dr Jeffrey Bland went around the country, around the world, actually talking about autoimmune diseases, and he said, collectively, the autoimmune disease has been identified in about 24 million people in the US, but only one out of three are diagnosed.

That means there are about 72 million people out there with an autoimmune disease, and it's not looked for. Doctors don't look for it. Our system waits until the signs and symptoms are severe enough. With organ failure and organ can't function correctly anymore, and there's irreversible damage, and now you have symptoms, then we start to look for it.

Seventy-two million people, autoimmune diseases are the third leading cause of morbidity. That means getting sick and mortality. That means dying in the industrialized world surpassed only by cancer and heart disease. So this is what we're up against. Many times when you start looking at this world of autoimmune diseases, autoimmune diseases can affect any part of the body.

There's no part of your body that can not have an autoimmune mechanism going on. And it takes an inordinate amount of time and perseverance by the patient. Look at how many years it took on average for diagnosis of autoimmune diseases. In the last, uh, almost 20 years here now, 20, 21 years since 1996.

How many years did it take? How many doctors did the person have to see, and how many were told it's just in their head, and they're just a complainer—the years to diagnosis for different autoimmune diseases. The number of doctors seems to get a diagnosis for different autoimmune diseases. The per cent that was told, their diagnosis imagined, or that they were overly concerned that it was just in their head.

Half the people are told it's just in your head, and they've got a devastating disease that's killing off their tissue. These are not exceptions. These are the averages. Why so long and difficult is to correct, to get a correct diagnosis. Physician education was identified as a contributing factor.

The American Autoimmune and Related Diseases Association did a study of family practitioners, family doctors, and this is what they found when asked in medical school, how much training in autoimmune diseases did you receive? Look at the numbers here. 18.5% one lecture, 27.8% two lectures, 18.5% three to five lectures.

That means more than half the people. Half the doctors had some less than five lectures. Now, that's not courses. That's a lecture. This is just unacceptable. Would you agree that you received enough training to diagnose and treat autoimmune diseases? Look how many doctors feel they don't agree with that statement, that they did not get enough training.

What is the level of comfort in diagnosing autoimmune diseases? Half of the physicians interviewed were uncomfortable. Half of them because they just didn't get the training. They don't know how to identify this until it's so obvious that it's just staring you right in the face. So before I go onto this first premise, I just want to say it's not our doctor's fault that patients have to see so many doctors to get the right diagnosis.

They just weren't trained. They weren't trained in this. Now it is their fault. When they tell somebody, it's all in your head. Rather, an appropriate thing would be to say, you know, I just don't know what's going on here. I'm going to have to send you to somebody else cause I just don't know. I take issue with telling people it's in their head. Okay, let's move on.

Premise number one. Just how prevalent is the development of autoimmune diseases? Well, I'm going to introduce a new concept here about the true prevalence of autoimmunity. Autoimmune diseases are the third leading cause of getting sick and dying in the industrialized world surpassed only by cancer and heart disease.

However, if we think a little more closely about this, immune driven inflammation is key to the development of cardiovascular disease. We think the number one cause of getting sick and dying in the world is cardiovascular disease, but it is immune driven. Atherosclerosis is increasingly considered an immune system-mediated process of the vascular system.

Autoimmunity plays a major role in the development of dyslipidemia and atherosclerotic plaque formation. Atherogenesis the development of atherosclerosis has been proposed to be considered an autoimmune disease. Now, this is the World Journal of Cardiology talking to us. Thus, if the cardiovascular disease has an initiating autoimmune component, arguably what becomes the number one mechanism in the progression of getting sick and dying in the world today. If we think about it, and if cardiovascular disease is autoimmune in its initiating phases, then autoimmunity becomes the number one mechanism for getting sick and dying in the world, your immune system attacking your own tissue, and I'm going to show you why this happens, but whether it's number one or number three, it doesn't really matter. The point is it's in your practice every day. It's in your family every single day.

Premise number two, how can we identify people at risk for the development of autoimmune diseases? The National Institute of Health tells us that there are six potential mechanisms by which biomarkers can really help with identifying autoimmune diseases. They enable a diagnosis before the onset of symptoms. I'm going to explain this. They predict specific organ involvement. They predict disease flares.They identify clinically meaningful disease subsets, and they predict and monitor response to therapy and describe organ or tissue damage. So once again, if autoimmunity plays a major role in the development of dyslipidemia, atherosclerotic plaque, the next sentence in this article, what they said was the mechanisms underlying these changes include the interplay of inflammation and autoantibody formation. So the mechanisms underlying these changes include the interplay of inflammation and autoantibody formation. So we can predict organ involvement. We can enable diagnosis before the onset of symptoms. We can predict and monitor response to therapy. We can identify clinical, clinically meaningful disease subsets.

And here's what I'm going to show you how. This articles by Arbuckle and her team and came out in the New England Journal of Medicine in 2003, and she went to the Department of Veterans Affairs hospital system,and looked for people with the autoimmune disease - lupus, systemic lupus erythematosus -and she found 130 people in this one VA centre with lupus. Now, if they're in the VA system, they're veterans. If they're veterans, they were in the armed forces. If they were in the armed forces, they had their blood drawn many times over the years when they were in the armed forces when they were healthy in the Army, the Air Force, the Navy. What most people don't know is that the US government has saved all of that blood since 1978. They've got tens of millions of samples of our service people's blood.

So Dr Arbuckle went to the VA and asked for permission to look at the blood of these people currently diagnosed with lupus from when they were healthy in the Navy or in the Marines, and she received permission to do it. And what did she find? She found that antibodies are typically present many years before the diagnosis of lupus.

That the appearance of these antibodies follows a predictable course with a progressive accumulation of the antibodies, you keep producing more and more and more before the onset of lupus, before the, while those patients are still asymptomatic, they have no symptoms. So this graph from her research article shows that with the antibodies in general, they were 50% above the limit of normal six years before the patient ever had symptoms, six years, and the average was six months after the start of symptoms before they got the diagnosis of lupus in this particular study. And these are the seven different antibodies of lupus. There are seven, and you can see every single one of them. Zero is normal. So if going from left to right, the zero lines are normal and every one of those antibodies was elevated years before there ever were symptoms and referred to as the first manifestation of SLE, systemic lupus erythematosus.

Years beforehand, the antibodies were elevated, and you can see how they kept climbing up every year, going up, going up, going up until they start to plateau. After you get symptoms, you've pretty much killed off enough tissue where you're getting symptoms now. So let's just back up. Let me just tell you something here.

Why is it normal to have antibodies to your own tissue? To your thyroid or to your brain or to your muscles or to your skin. Why is it normal? Because for most patients, we have an entirely new body every seven years. Entire new body. Some cells reproduce very quickly, like the inside lining of your guts—every three to five days.

Other cells are very slow, like bone cells are very slow. So every seven years you have an entirely new body. Right? So when cells get old or damaged, they get bruised from oxidation, bad foods, radiation when you fly in it in an aeroplane. There are many reasons why our cells get damaged. When that happens, the body has to make antibodies to get rid of the old and damaged cells, to make room for new cells.

That's how we create new cells. You've got to get rid of the old ones to make room for the new ones. So there's a normal reference range of antibodies. To your thyroid, to the myelin that wraps around your nerves, to the cerebellum in your brain, to the hypothalamus, in your brain, to your skin, to your joints.

We have a normal reference range of those antibodies, but when you have elevated antibodies, like in this slide here, you see all seven antibodies to lupus are elevated years beforehand, you're killing off more cells than you're making. And if the mechanism that's causing the elevation of the antibodies - remember environmental trigger genetics and intestinal permeability - if the mechanism continues, you keep making more antibodies, more antibodies, killing off more tissue, killing off more tissue, killing off more tissue until eventually, you've killed off so much tissue now that organ can't work right now, you start getting symptoms. Then it takes years to get the right diagnosis.

As you saw in the slides from earlier, it takes years to get the right diagnosis while you're still killing off tissue. So Dr Arbuckle refers to it as the prodromal period—that period before you have symptoms when you're killing off tissue. And the entire goal here is to identify the prodromal period for people before they've killed off so many tissues the brain can't work right anymore, or the heart can't work right anymore, and they get diagnosed with cardiomyopathy, or they get diagnosed with Alzheimer's or they get diagnosed with Parkinson's. So the goal here is to understand this prodromal period, and I'm going to talk to you about the testing to identify if people are in this prodromal period killing off cells.

So Dr Arbuckle drew this graph. You have normal immunity, a normal amount of a normal immune system. You get some benign auto-immunity. You're killing off a few cells to make room for new cells. Now you get pathogenic autoimmunity where you're killing off more cells than you're making, killing off your tissue, destroying your tissue, destroying your tissue until eventually, you get the clinical illness.

Now back in 2003, Dr Arbuckle did not know about the intestinal permeability part of this. So she's got two of the three, she's got the genetics on top and the environmental factors underneath. But the third one, the gateway that caused that allows all of this to happen is intestinal permeability. So immunologists all over the world said, well, that's brilliant what Dr Arbuckle did. Let's go back to the blood banks and look and see about other diseases. And there are many, many papers now published on the world of predictive autoimmunity. So look at this graph. If you have any antibodies to lupus, any of these seven antibodies elevated - the PPV stands for positive predictive value - you have a 94 to 100% positive predictive value. You're going to get lupus within 7to 10 years. For scleroderma, if either of these antibodies is elevated, 100% you're getting scleroderma within 11 years. Rheumatoid is 52 to 97% depending on the antibodies, within 14 years, you're getting rheumatoid Sjogren's; primary antiphospholipid syndrome is 100%. Now in this one, the bottom one, beta-2 glycoprotein 1, this is the antibody that's elevated for many women with unexplained miscarriages. It's an autoimmune mechanism causing a clot, blocking the blood flow into the uterus, into the placenta, and the woman miscarries.

So every woman, of childbearing age, in my opinion, that has a family history of miscarriages, should do this test to see if they have elevated antibodies to beta-2 glycoprotein 1 because it's such a very common trigger for the loss of a pregnancy, unexplained loss of a pregnancy, especially in the second trimester, but not exclusively in the second trimester.

If you have TPO antibodies elevated, especially postpartum, it's 92% you're getting Hashimoto's within 7 to 10 years. Primary billiary cirrhosis, 95% 25 years; type one diabetes, Addison's. 70% of Crohn's disease. Look at this. If you have sacharomyces or BCA antibodies elevated, that's ASCA antibodies. ASEA it's 100% you're getting Crohn's within three years.

The science has done on this. I mean, predictive autoimmunity is where we all want to go. We all want to include. What's cooking inside of me right now? What is it that I might be able to nip in the bud before it progresses by killing off enough cells that finally I'm now I'm diagnosed with dementia or Parkinson's or schizophrenia.

So this is a test that's available that looks at 24 different tissue antibodies in one blood draw. The top four, the grey ones are to the gut. The next two are to the thyroid, the adrenals, four for the heart, the reproductive system, three for the muscles and ligaments. Then the bones, a couple for the liver and the pancreas, and the bottom six are for the brain. You do this blood test, this single blood draw.

When I did this, I had three of the ones on the bottom elevated. I had myelin, basic protein, AGL, gangliosides and cerebellar antibodies elevated. I was 45 years old. I was at the peak of my triathlon career scoring in the top 10% of the 30 to 35-year-old. So I thought I was really healthy physically, but my immune system was killing off my brain, and I never knew. All outward appearances were that I was healthy.

I'll give you another example, a 44-year-old guy comes in to see me. His father died of a massive coronary at 44; his two older brothers died in their early forties of massive coronaries. He was 28 when his last brother died, and so he went to a cardiologist who put them on a statin right away, preventively. Now he comes to me 16 years later. He's been on a statin for 16 years, but he's the picture of health, really smart guy ,and learned the potential complications of statins. So he was taking a lot of nutrition to protect himself, including coincide Akutan. His diet was squeaky clean. He never ate junk, only good food, good healthy food. His body fat was 16%/ He had an excellent job. He was an executive. Happy family life. Everything looked great to doctors every year he got his physicals,. They said you're as healthy as a horse. When he came to me and said I want to do your tests, he wanted to do this test because he had heard about it. So we did this blood draw on him.

It came back: all four antibodies to his heart were sky-high, all four of them. He said, why is that really worrisome? And I said I don't know. Let's find out. It turns out that he was allergic to wheat and to dairy. When we did the right tests for him, he was allergic to wheat and dairy. I talked about those tests in last year's presentation at the LDN conference, on testing accurately for sensitivity to wheat. So he's allergic to wheat and dairy, and we put a wheat-free dairy-free. I didn't do anything else. He was already taking a bunch of good vitamins. All of his other markers were as healthy as could be. Six months later, he comes back, and then we retest—his heart antibodies are down to normal. The autoimmune mechanism killing off his heart had stopped. It was a reaction to the environmental triggers of some of the food that he was eating. And he said you saved my life. And I said, well, I don't know. You know, the doctors that did this work, they did all the research on this. That's really what we need to be grateful for. But this test is an introductory test to identify where is the pathology in your body right now. You know, no one gets Alzheimer's in their sixties or seventies. You get Alzheimer's in your twenties and thirties. It just takes decades of killing off brain cells before the damage is so extensive that it becomes obvious, and as you kill off more brain cells, the rate of the increase goes up, so you kill off faster as you go forward, as the antibodies keep going up and up and up and up.

Premise number three, what's the trigger to the production of antibodies to yourself? And the extremely important function of the GI tract is its ability to regulate the trafficking of macromolecules between the environment and the host through a barrier mechanism. What they mean here, Mrs Patient, if you could take a doughnut and just stretch a doughnut out, and if you look down that stretched out doughnut, looked down the hole, that's your GI tract from your mouth to the other end. It's one long tube. It's 20 to 25 feet long. Winds around inside your abdomen there, but it's one big long tube. So when you swallow food, it's really not in your body yet. It's in the tube. And it's gotta be broken down to go through the walls of the doughnut into the bloodstream.

We have to digest that food, break it down. Think of proteins like a pearl necklace. Hydrochloric acid made in your stomach undoes the clasp of the pearl necklace. Now you have a string of pearls. And the digestive enzymes that we make in the pancreas, in the gallbladder or in the microbiota., these digestive enzymes act as scissors to cut the pearl necklace into smaller clumps of the pearl necklace, and it keeps snipping them, snipping them, snipping them until you snip it into each little pearl of the pearl necklace.That's digestion.

Now you've got this long tube, the inside of the tube, it's got Shea carpeting, but the surface of it is lined with cheesecloth. The cheesecloth only lets really small molecules get through. If you remember your grandmother pouring gravy into the cheesecloth, only the liquid comes through the other side and all the clumps, they stay on the outside. They can't get into the gravy pouring dish. That's the way our system is. The inside of the tube is lined with cheesecloth, so only each little pearl of the pearl necklace can get through the cheesecloth and get in the bloodstream. Then your body uses these acids that are called amino acids to make new bone cells and brain cells and heart cells. That's the raw material you make your new cells from. But it's got to be in the form of the amino acids. As you're snipping down the pearl necklace, that 33 pearl clump, that 17 pearl clump, that 19 pearl club, they're not supposed to get through into the bloodstream. They can't get through unless you have intestinal permeability.

If you get tears in the cheesecloth, then larger clumps of the pearl necklace get through the tears in the cheesecloth. They're called macromolecules. They get through the tears in the cheesecloth into the bloodstream before they're supposed to be able to get through into the bloodstream. They're supposed to go further down the digestive tract. That's one reason why your intestines are 20 to 25 feet long, because prime rib takes a whole lot longer to break down than bananas. So you've got to snip, snip, snip, snip, snip. But if you've got tears in the cheesecloth, that's intestinal permeability.

If you've got tears in the cheesecloth clumps of the prime rib, clumps of that food molecule get through before they're supposed to. They're called macromolecules, big molecules. They're not supposed to get through, but they do. And when they get through your immune system says, Whoa, what's this? This is not something I can use to make new bone cells or brain cells. I better fight this. And your immune system makes antibodies to protect you from that food.

What we see here is what's called the healthy gut. And you can see the lining of the gut here. These are the shags in the tube, in the intestines, and the shags are all lined with cheesecloth. Now, and here's what it looks like. Those big molecules can't get through into the bloodstream. They can not get through. Only the little molecules get through, and doctors notice that the absorption of the small molecules is both between the cells, paracellular, and through the cells. That's really important when we talk more about high-fat diets later on. But this is normal. This is what a healthy gut is supposed to do. Only the small molecules get through, not the big molecules. Now when you have a gut that's been damaged, and you've got the tears in the cheesecloth, if you will, now you see the big molecules get through that big green mile. You'll know don't tell this chicken out. You're going to be allergic to chicken. Oh no, not beef. You're going to be allergic to cantaloupe. Any macromolecules that get through the tears in the cheesecloth into the bloodstream, your immune system then in an effort to protect you from  the macromolecule is going to make antibodies to that molecule.

Now you become sensitive to that food - and the people who do 90 food panels, IgG panels, look at 90 different foods - and it comes back they're sensitive to 25 different foods. They say, Oh my God, that's everything I eat. What am I going to eat? Well, of course, it's everything you eat. It's because your immune system's trying to protect you.

When you heal the gut, which we'll talk about how to do when you heal the gut, you wait six months and go back and check again. Now you're sensitive to maybe three foods. This is so critically important to understand because it's these macromolecules that get into the bloodstream. Your body fights these macromolecules, the immune system trying to protect you, fights it, and then there's this whole world of molecular mimicry, the antibodies against the food start attacking your own tissue.

So a common initial autoimmune pathway and therapeutic target to the degenerative disease include the immune response to intestinal antigen presentation. That means, when these macromolecules get into your bloodstream, your immune system responds trying to protect you, which triggers intestinal inflammation from that antigen getting in, which triggers activating the tight junction proteins, which triggers antibody production to the barrier proteins, which triggers leaky or leaky gut, leaky brain, leaky bladder. Which triggers pathogenic intestinal permeability antigen and macromolecule translocation into the bloodstream and immune response to the antibody production, molecular mimicry, and other pathways that occur and the development of the autoimmune mechanism.

This is the mechanism that's responsible for so much of the autoimmune disease that we are suffering from today. Arguably, number one or two or three cause of morbidity and mortality in the industrialized world. This is the mechanism. When you understand this, and you start addressing this mechanism, you will find so many of your patients not only get dramatic results in a few months, but they're so grateful, and you extend the quality of their life and most likely the length of their life, but certainly, the quality causes you to calm down this inflammatory cascade.

The autoimmune process, once again, can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function, you can arrest the development of the autoimmune disease by healing the gut. Most critical is healing the gut. Well, what? How do you heal the gut? Well, first you have to stop throwing gasoline on the fire. You have to find out what the person is sensitive to and reacting to, and then you heal the gut. We'll talk about that in a little bit.

Premise number four, can foods trigger pathogenic intestinal permeability. This is a great study that came out of Harvard a couple of years ago using confocal endomicroscopy. They took patients, I don't remember how many patients, 36; they took 36 patients at Harvard diagnosed with irritable bowel syndrome, IBS, who were complete failures to every protocol they had tried for a year. The minimum was a year of no results. Still suffering dramatically, and this is Harvard.

So they took these people - confocal endomicroscopy is taking pictures of the inside of the gut - when, they looked at the inside of the gut, they found that the microvilli were closely attached to each other without space between. This is what it looks like. That's confocal endomicroscopy on the left, and that's a scanning electron microscope picture on the right. With confocal endomicroscopy, you get much clearer pictures of what's going on. So they exposed these 36 patients to cows milk, wheat, yeast, soy, and sterile water to see was there any reaction in the gut when they were exposed to these common antigen foods, antigenic foods. Lots of people are sensitive to these foods, so they said, well, let's, let's try it on these failure patients and see what happens. Within five minutes of exposure to food antigens, intraepithelial lymphocytes increase, epithelial leaks and gaps form between the cells and the intervillous spaces widened. This is what it looks like. It shows that the villi are close together. They injected a white dye, and I think they injected it into the femoral vein. I'm not sure. I think that's where they did so that the dye would be flowing through the blood vessels in the intestines. And then when they expose the intestines of these people to these different foods, they look to see if they got intestinal permeability. Did the dye leak out of the blood vessels out into the lumen of the intestines? So it's kind of a reverse permeability, you know? But are there gaps? And this dye is leaking out and look at B, multiple eruptions represent breaks in the wall, and they put white arrows where these eruptions are. See, the white dye is out into the lumen of the intestines, now. This all occurred within five minutes, people. Within five minutes.

Now this one is really cool. This is a five-minute video, and if you scroll over the video, you'll see the arrow comes up, and if you click on it now the videos starts, and you'll see it looks the same for a moment. But notice that the white starts showing itself more on the surface here. Remember the dye's inside. Now you can see the gaps forming. See that gap on the right side there, and it's white. Watch what happens. This is intestinal permeability as it's occurring. Look at all the white that's coming in up. The gaps between the cells that are not supposed to be there. This is how macromolecules get into the bloodstream that isn't supposed to be there.

Aren't the video's cool? To see this. This is at Harvard, within five minutes of being exposed to these foods that the clinicians thought these people might be sensitive to. After food challenge, 22 of the 36 patients showed an immediate and dramatic mucosal response to these antigens. Increased permeability is an early biological change that often precedes the onset of autoimmune disease.

Now I've shown you a video of what permeability looks like. And that foods can trigger it. There are many things that can trigger it. We'll do another session on that. I've got a full day course that I'll be doing this year at the LDN conference, going into great detail on all of this. There's just not enough time to go into all the detail now.

Premise number five the more lipopolysaccharide or weed peptides that pass through a permeable intestine, the stronger the inflammatory response. So there's a correlation between the degree of systemic inflammation and the increase in intestinal permeability. The more permeability you have, the more systemic inflammation you have; the more systemic inflammation you have, you're pulling on the chain; the more wherever the weak link is and the chain develops.

I have a gift for all of you, and the gift is I'm giving you all 43 studies that I'm using in they're all available to you. Now, 31 of those studies were free. I got them for free, so I'm giving them to you. For the others, I'm giving you the link to the abstract so that you can read the abstract. So many of these studies that you want to learn more about and read the study here they are. All you have to do is go to my website, https://thedr.com/LDN17, and all of the studies are there for you. It's my gift to you because I want you guys to really get this. You really need to know this because it's a foundational platform of healthcare. This is so common in your practice. Every day you will find six, seven out of 10 people, when you check them, they've got elevated antibodies to their own tissue. They have an autoimmune mechanism going on. Obviously, if it's the platform for most of the degenerative diseases, including atherosclerosis and cardiovascular disease, it's got to be going on in most people. So you'll have the studies here. This is what your handout will look like, the scientific references from this talk.

Premise number six. So how do you arrest pathogenic intestinal permeability? How do you arrest this process? You have to put the fire out. If, if every degenerative disease, as far as I know, every degenerative disease at the cellular level is a disease of inflammation, you have to stop the inflammation, so you have to stop throwing gasoline on the fire and then put the fire out. So how do you do that?

The first concept is a pleiotropic concept. It's a good Scrabble word. Pleiotropic it means all roads lead to Rome. You know, there are many, many ways to heal intestinal permeability and put the inflammation out in your body. There are many ways, and because certain products like glutamine, it's a great product to heal the gut. Glutamine turns on certain genes, but vitamin D turns on genes in the gut that glutamine does not. Curcumin turns on genes in the gut that vitamin D does not. And so there are many different paths to get a comprehensive treatment protocol that's going to work in the vast majority of your patients. Here's an example for curcumin. These are all the inflammatory and anti-inflammatory pathways that are impacted by taking curcumin, and I'll talk more about that in a minute. So all roads lead to Rome. A pleiotropic approach to addressing pathogenic intestinal permeability.

There are three categories to consider. First, avoid inflammatory triggers. Stop throwing gasoline on the fire. Critically important. So the question about is gluten sensitivity really limited to just celiacs or is there's this thing called non-gluten sensitivity? This is about the world of non-celiac gluten sensitivity. So in this study, this is a study that Hollon and his team at Harvard did. They took celiac patients recently diagnosed, so they had villous atrophy and lots of inflammation. They took celiac patients who were in remission at least a year on a gluten-free diet, so their microvilli had healed, and the inflammation was greatly reduced. They took people who had a problem with wheat but didn't have celiac. They refer to them as non-celiac patients with gluten sensitivity. And then they took people that didn't have a problem with wheat at all, all four groups, and they exposed them to wheat. The peptide, the clump of the pearl necklace of poorly digested wheat called gliadin, alpha-gliadin. Their conclusion: increased intestinal permeability after gliadin exposure occurs in all individuals. And one part in there, they said in all humans, so any of you that is human, every time you eat wheat, this is what happens to you irrespective of how you feel when you eat it. This is what the science tells us. Well, I don't feel bad when I wheat. It doesn't matter if you feel bad. The lucky ones are the ones that feel bad. Then if they continue to eat wheat, that's their problem to deal with. But the unlucky ones are the ones that don't feel bad when they eat wheat, because you can't feel when you tear the cheesecloth. But remember, Mrs Patient, the fastest-growing cells in the body are the inside lining of the intestines; every three to five days, you have all new lining of your gut. So you eat toast for breakfast. You tear the lining of your gut, but it heals. You eat a sandwich for lunch. You tear the lining of your gut, but it heals. You have pasta for dinner. You tear the lining of your gut, but it heals. Croutons on your salad. Tear the lining of the gut, but it heals. A cookie tears the lining of the gut. But it heals. Day in, day out, day in, day out until one day. And that can be when you're two years old, 22 years old or 92 years old. One day you cross that line. You lose oral tolerance. You don't heal anymore.  Now you get tears in the cheesecloth that don't heal. That's called pathogenic intestinal permeability. You don't feel that now the macromolecules get into the bloodstream; that now your immune system produces antibodies against those macromolecules; that now because of molecular mimicry you produce antibodies against the weak link in your chain, your thyroid, your brain, your liver, your kidney. Now you're on the autoimmune spectrum. That's how it happens.

It's so cool when you look at this science, and you realize, wow, this is so very common. This is an underlying mechanism that we can identify years in advance. And that gives you a heads up to do something different. Well, what do you do differently? Well, first stop throwing gasoline on the fire and then heal the gut. So this is the book that came out in September of last year. This is 35 years of my, professional life. But it's all about this mechanism in great, great detail. And I think everyone should read this book, not because I wrote it, but because this gives you the clear, precise, step-by-step mechanisms and what causes the primary mechanism in getting sick and dying in the world.

The immune system is attacking your own tissue. The autoimmune mechanism. Alzheimer's is autoimmune, cardiovascular diseases autoimmune, cancers are autoimmune, and all the studies are in the book with explanations on how to explain it to patients. And when you see this, you go, my God, that's profound. I make $2.10 or something on a book, so this isn't going to pay for my grandchildren's college funds. I'm not saying buy the book because of some personal benefit. I'm saying buy the book because you're really going to learn so much. Or you can take my old day course at the LDN pre-conference in September. You learn so much about this, you'll really understand it, and you can apply it in your practices.

In the book, I recommend a three-week protocol for people to give up wheat, dairy, and sugar for three weeks. And we give lots of examples of breakfast, breakfast for your kids, breakfast for the family, lunches, dinners, snacks for three weeks. And just see how you feel. Just see what happens. Cause most people can't afford or don't have access to the tests. So just do this, and you say, Oh my gosh, my headaches are gone. Oh my gosh, I'm waking up, and I've got more energy. Oh my gosh, I'm sleeping better. Oh my gosh, my child's doing better in school. They're sitting still in school. You just see a condition after condition after condition that's better after doing or during this three-week protocol. So that's a recommendation that I give to people who can't have access to the tests for one reason or another.

The second category in the pleiotropic approach to pathogenic intestinal permeability is included foods that heal intestinal permeability. The first one, of course, vegetables, and one of the benefits of the vegetables is, as you know, the microbiota work on the fibres in vegetables, insoluble fibres, to produce short-chain fatty acids like butyric acid or butyrate. Mrs Patient, the past is growing cells in the body are the inside lining of the gut. Every three to five days, you have a whole new lining to your gut. The fuel for those cells to reproduce is called butyric acid or butyrate. That is why butyric acid is so critically important. If you don't have enough butyric acid, you make your house out of straw instead of brick. And you find so many studies, just go to Google and type in butyric acid and colon cancer. And when you have low butyric acid, you're at a much higher risk of developing colon cancer because you made your house out of straw instead of brick. So you need butyric acid . How do you get butyric acid? it's the good bacteria in your gut working on the vegetable fibres that produce butyric acid.

My good friend Terry Walls, who is a brain neurophysiologist, a professor of medicine, and she developed MS, and being a brain neurophysiologist, she knew all the cutting edge techniques of how to deal with MS and they didn't work. Within seven years, she was in a wheelchair, and her brain wasn't working very well anymore, and a friend said, wake up. What you're doing isn't working. Do something else. It's not working. And she did. She went back to the basic literature, and she found studies on animals that they had induced MS-like symptoms, and they changed their diet, and the animals got better. So she changed her diet to mimic what they did for the animals. She started feeling better. So then she went to functional medicine courses, and she learned about this, and she completely reversed her MS, and she has what she's called The Walls protocol. It's a great book on how to reverse MS. And Terry, applies these principles at the VA Medical Center in Iowa, where she's associated; and she's taking these veterans who are completely disabled. They'd lost a limb, or they've got PTSD, and they can't function in life. She's taken these bedrooms, and she's completely reversing them, getting their brains working normally again, getting rid of their chronic pains.And there are a couple of things that she's doing that I'll talk about here.

The first one, they have to eat 12 cups of vegetables a day before they eat any starches, like pasta and bread and stuff. What does that mean? It's kind of hard. There's no room for pasta after 12 cups of vegetables a day. Right? But that's how she gets them to do it. You eat 12 cups of vegetables a day, five different colours, then you can have some pasta or some toast or something.

Prebiotics, originally defined as nondigestible food ingredients, had beneficially affected the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon. That's what these vegetables are. Some of these vegetables are prebiotics. Here's a study demonstrated the apple derived pectin could modulate gut back microbiota. Here's a study that shows that apple pectin treatment attenuated the level of lipopolysaccharides and reduced intestinal permeability. So what they did here on the left, you see high-fat diets, how it changes the gut microbiota, and it causes more inflammation. And the change in the gut microbiota is to microbiota that induces weight gain. So you get more of the formicilis's family (as I understand the family of G. formicilic (Geriger)) of microbiota that hoard calories, survival, survival, hoard calories. So you store more calories, thus you gain weight. Plus you get the inflammation. Then when they did the same high fat diet, but they added pectin from apples, you see the benefits that occurred from that suppressing weight gain and healing tight junctions of intestinal permeability.

The next category here, or the next component of category two, is bone broth. And once again, Dr Walls with these vets, she has them drink one quart of bone broth a day, not a cup, a quart of bone broth the day. And how do these guys do it, because they don't have any money, they can't work because they're disabled. They can't afford to buy quarts of bone broth a day. They make their own. So these guys go out hunting. They harvest an animal, they make their own bone broth, and they're very proud to be so active in taking care of their own health in a way that they can relate to. They go hunting, they kill a deer, and they make bone broth.

Now about bone broth. Gelatin Tannet is in bone broth. It's a strong anti-inflammatory. Next fermented vegetables. And focus on diversity. Mrs Patient goes to the local natural foods store and buy five different types of fermented vegetables just to make sure they're not pasteurized because pasteurization kills bacteria. So get sauerkraut, get kimchi, get fermented beets, get kvass, get Italian flavoured fermented vegetables, curry flavoured fermented vegetables. Get five, six different types. Keep in the refrigerator. Every day, walk by, take one fork full of fermented vegetables. And somebody said, well, why can't they take more? They can take more. I'm happy, if they get a fork full, then they can take more. Do it twice a day. Why? Because every family of vegetables that ferment produces different species of probiotic bacteria, the good bacteria, and we now know it's not lactobacillus or bifidobacteria that are the commercial ones we've used for 20 years that change the gut microbiota. They help. But you really want the diversity of hundreds and hundreds of different species of good bacteria in your gut. And how do you inoculate for that? Eat fermented vegetables every day.

So you're changing the microbiota because if you have intestinal permeability, you've changed the microbiota to be more pathogenic. That contributes to more intestinal permeability. You take the nutrition and stuff to heal the gut, but if you still have dysbiotic gut flora, you're going to get more permeability. So you have to change the gut microbiota, and by doing the vegetables, doing the fermented vegetables, 12 cups a day, vegetables, bone broth and the fermented vegetables, you're going to change the microbiome.

Fermented foods and beverages were among the first processed food products consumed by humans. The ingestion of fermented foods potentially increases the numbers of microbes in the diet by up to 10,000 fold in one day. It doesn't take long to do this.Consumption of fermented foods may provide an indirect means of counteracting the hygienic, sanitized, Western diet and lifestyle. Many of these species found in fermented foods are either identical to or share physiological traits with species relevant to promoting GI tract health. You know, docs, so many of you just don't have time to talk about foods with your patients. That's understandable. Every office should bring on board a nutritionist or a registered dietician, or have one of your staff people trained, so that you can just prescribe what needs to be done, and the expert can sit down with the patient and walk them through how to change their lifestyle habits. They don't do it in a day by giving them a handout, you know it's going to take some time, and we talk about that in the full-day course, how to get the right people and how to train them, and all of that.

Next, the third category of the three categories, is nutrient supplementation. You want to do nutrient supply admin supplementation to address the inflammation, rebuild the microbiome and healing of the intestinal epithelial lining.

Vitamin D plays a role in the aetiology of autoimmunity. Vitamin D causes assembly of the adherence junctions. That's part of the control for intestinal permeability. Here is a drawing of the adherence junctions right there, and this is a drawing of two full cells, and on the outsides is the start of a third and fourth cell. Vitamin D plays a critical role in the mucosal barrier homeostasis by preserving the integrity of tight junction complexes and the healing capacity of the colonic epithelium. Vitamin D markedly enhances tight junctions by increasing junction protein expression at the kissing joints, and preserving the structural integrity of the tight junctions. Here's the visual, that's the tight junction strands. Here's the drawing of the whole thing. The upper left one is the one you saw previously. The letter B is a picture of a tight junction. Now when you see they blew up that tight junction in the lower-left corner, you see that it's looped the tight junction where food goes through, vitamins go through, its loot. Think of the Panama Canal. The gates open, the food comes down a little bit in between the cells, the gates close, the immune system checks it out. The next gate's open, the food goes down a little further. The gates close behind it, then another part of the immune system checks it out. The next gates open, the food goes down further, the gates close, the immune system checks it out. That's how we check out foods and things that we're being exposed to through the oral cavity coming down into the gut.

And then you see the drawings of these kissing joints. Now, that extracellular space, that's where the tight junctions are. That's the Panama Canal. You are going through that extracellular space. Now watch how much, and then on the right is the drawing of the kissing joint itself. And so you see the paracellular space, the extracellular space there on the right side of the drawing and the zonulin family of proteins are like shoelaces and the shoelaces, you untied the shoes, they open; you close, or you tie the shoelaces, they close the gates, open the gates, close. Now watch how much of this is controlled by vitamin D. All of those are controlled by Vitamin D. Vitamin D controls the gate opening the gate closing, the shoelaces opening the shoelaces closing, all controlled by Vitamin D.

Here are some recommended protocols that you can review. There are three main mechanisms of how probiotics contribute to human health. They shape the ecosystem by a competition for the resources and the adhesion sites. They decrease the local pH, and they produce specific antibacterial substances.

Probiotic strains can not only affect the intestinal microbiota directly, but also affect other organs by modulating the intestinal inflammation and permeability. Changes in gut microbiota modulator. Endotoxemia. By a mechanism that affects gut barrier function and increases intestinal permeability. Look at the journal diabetes metabolism that this is a critical, critical component of dealing with diabetics, is having a healthy gut and closing the intestinal permeability and rebuilding the microbiota.

Our findings that the human gut microbiome can rapidly switch between herbivores and carnivores. Functional profiles may reflect past selective pressures during human evolution. Consumption of animal foods by our ancestors were probably by little, depending on the season and forging success with readily available plant foods, offering a fallback source.

So that's why you eat meat. You change your microbiome in one day. Not saying it's bad, not saying it's good, just know it changes the microbiome. So you have to see what type of microbiome you have to determine what kind of foods you should be emphasizing more. We found that microbiota changes on the animal-based diet could be linked to altered faecal bile acid profiles and the potential for human enteric disease.

VSL Number 3 is a type of probiotic that you can use. There are some really good studies on SL Number 3, and its multi-species. You always want to go through varied species, not just take one type of probiotic, but the key is diversity.

Here are some recommendations on dosing. Fish oils exert much of their anti-inflammatory benefit by suppressing NF Kappa B, which is the major amplifier of inflammation in the body. The safety of fish oils is high, has been well established in numerous clinical studies. Drug interactions are extremely rare. A dose of up to three grams a day has been determined to be safe for general consumption.

Here are some dosing recommendations. Glutamine is the most commonly used amino acid in the gut. In a study giving 30 grams a day, every ulcerative colitis patient got better. It didn't matter how bad they were, even the really severe ones, but when they stopped the glutamine, the disease came back. And why is that? Well, it 's because the lifestyle was still throwing gasoline on the fire, and they didn't heal the gut, and they still have the microbiome of the altered lifestyle. You can't just give a pill and expect to heal the gut. We have to change the environment, the ecosystem of the gut. Glutamine is a very clinical, useful, useful tool. But it's also a substrate for lymphocytes and macrophages. So you gotta be careful, Mrs Patient. I give people, I call it the gluten sensitivity packs. There are six pills in a pack. MrsPatient, can you take one pack a day? Yes, they can. And so, okay, now if you have any reaction to the pack, you get a little bloated, you get a little cramping, anything like that, just stop that one pill. And that's the glutamine. Just keep them in a little container. Wait two weeks, take everything else to calm down the inflammation, and then you're going to be fine. Then you can take them again, because glutamine is a precursor for lymphocytes and macrophages.

Here are some recommendations. Tumeric is remarkable in its benefits. Tumeric is anti-amyloid. Orogenic. It's neuroprotective. It enhances cognition. It's a diagnostic marker. It's an antioxidant. It's an anti-inflammatory. Here are the dosings on all of these different studies. Just depending on what you're dealing with and what your target is that you know you, you can be aggressive with a tumour. It's extremely safe. And here, once again, are all the pathways. Inflammatory and anti-inflammatory pathways that are modulating to produce an anti-inflammatory effect. Here are all of the diseases that there are studies showing curcumin is of great benefit for, and how many of them are autoimmune.

Recommended protocols. Colostrum. High intestinal permeability is normal in newborns. Their guts are very permeable. That's one of the main purposes of colostrum. The first three days of mother's milk is not breast milk. It's colostrum, and one of the main purposes immediately is to turn on the genes in the gut. Say okay, baby, let's close these tight junctions now. Come on. Let's get these cells going. Close these tight junctions. Colostrum also says, all right, let's build the receptors for this good bacteria. Let's start colonizing this good bacteria that you just got washed through as you came down the birth canal. Let's start building these receptor sites. So colostrum helps to set up the environment of the gut for a healthy, well-functioning gut. It also promotes recolonization of the bowel by the friendly bacteria. It's the best remedy known for all-around gut help. Restores leaky gut to normal permeability, contains growth factors and hormones to repair damage to the lining and restore gut integrity. It's unmatched as an immune system stimulator and modulator. There are numerous note products lining the shelves of natural food stores that claim to stimulate the immune system. Only colostrum plays the entire symphony. Colostrum.

If there was only one product I was going to use, it would be this, and it would be this colostrum, produced by the author of this book, Andrew Keech. Dr Keech grew up on a dairy farm in New Zealand. He learned really early in life that you have to give these newborn calves colostrum, or they die in a week. They die. And he then learned that the humans, when they were sick, they drank the colostrum, they got better. So he decided he's going to devote his life to colostrum. So he went to Oxford and got a PhD in mechanical engineering, and I said to him, Andrew high five to you, high five Oxford PhD, way to go, man, way to go, but mechanical engineering, what is that? And he said, well, Tom, I knew I was going to make the best colostrum in the world, and no one is doing it. So I was going to have to learn how to build the equipment to do it. So he spent eight years getting a PhD in mechanical engineering to build the equipment to produce the best colostrum in the world—grass-fed antibiotic-free, hormone-free. Every batch is checked when it comes in, every batch, every time. It's the most powerful product that I know of. It's on my website. You'll see it there. My website is TheDr.com. The product is called GI Restore. It's really quite remarkable.

The two key developmental time points of the regulation of gastrointestinal tract help occur postnatally, the first few days after birth, when all the gut digestive functions are launched by first colostrum ingestion; and then the second when weaning, when the digestive system has to modify its function following a switch from mother's milk to solid food. Two critical developmental time points. The first time point is particularly relevant for all mammalian species since it's associated with a complex of dynamic changes in the gastrointestinal tract structure and function, leading to a temporary drop in gut permeability barrier. So when the guts on fire, the body's on fire. This is a protocol that will work for you. Eliminate inflammatory foods. Give prebiotics, give fermented foods, give probiotics, give Vitamin D, give glutamine, give fish oils, curcumin, colostrum; and I want to note there are many other beneficial anti-inflammatories that can be used to heal the gut, reduce inflammation. There are many. I'm not saying these are the best. These are just well referenced in the literature, and it's a safe protocol that everyone can do, and you'll get dramatic results when you do this.

So what did we talk about here in this little over an hour? Just how prevalent is the development of autoimmune disease. If the cardiovascular disease has an autoimmune component, what becomes the number one mechanism? That's how prevalent it is. Premise number two, how can we identify people at risk for the development of autoimmune disease? You do the test, and you find out. Number three, what is the trigger? in the production of antibodies to self. The addition of the third element, the loss of intestinal barrier function. Number four, can foods trigger pathogenic intestinal permeability? Yes, they can. Number five, the more LPs or wheat peptides that pass through a permeable intestine, the stronger the inflammatory response. Number six, how do we address pathogenic intestinal permeability?

Once again, we have a full day course. We'll be doing it as a pre-conference workshop in Portland in September. We guide you on all of the testing, the supplements. How do you diagnosis, how do you think about this? How do you talk to patients about it? You can find out more on the LDN Research Trust website about this. We also offer the online, you can do the course online, but I think it's better in person. You get all of my, visuals and my emphasis when it's live. For those of you that don't know, we did Betrayal, the Autoimmune Disease Solution. It aired in November and we're going to be launching it again in the very near future. I think by the time you're watching this, it will be launched again. You can find it at betrayalseries.com. I interviewed 85 of the world's leaders in autoimmunity, and the scientists, and then clinicians applying the scientist's principles, and then the patients who went through the protocols recommended by the clinicians. For example, Linda, talking about LDN, and it's really quite remarkable. And if you go to betrayalseries.com, you can find out more about that.

So take care of yourselves. Hope you have a wonderful time in Portland. Make sure to tell those important to you how much you love them.

And this is the last slide, a very good book to read about genetics The last paragraph in this book, throughout your life, the most profound influences on your health, vitality, and function are not the doctors you visit or the drugs or the surgery, the therapies you've done. The most profound influences are the cumulative effects of the decisions you make about your diet and lifestyle on the expression of your genes.

And with that, I would say thank you very much for your kind attention.

Linda Elsegood: Thank you for listening to this presentation. All past conference presentations can be found on our website, www.ldnresearchtrust.org.