The Hidden Drivers of Autoimmune Disease
What is actually driving the rise in autoimmune disease?
In today's episode, Haylie Pomroy is joined by Dr. Marc Kesselman, Chair of Internal Medicine and Chief of Rheumatology at Nova Southeastern University, to dig into the hidden drivers of autoimmune disease and what patients can actually do about them.
Dr. Kesselman breaks down how COVID-19, vaccine adjuvants, environmental toxins, gut microbiome imbalance, and Epstein-Barr virus all contribute to the rising wave of autoimmune conditions. He explains why non-celiac gluten sensitivity is real even when tests come back negative, how food rotation and plant diversity help protect the microbiome, and why autoantibodies can appear in the bloodstream 15 to 20 years before a single symptom shows up.
He also covers a piece of the autoimmune conversation that most patients never hear: why chronic inflammation significantly raises cardiovascular risk even when cholesterol looks normal, and which tests can catch it before it becomes a crisis.
If you have been told your labs are fine but something still feels wrong, this episode is for you. Tune in to Fast Metabolism Matters.
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Dr. Marc Kesselman is the chair and associate professor at the Department of Internal Medicine at Dr. Kiran C. Patel College of Osteopathic Medicine. He is also the chief of the Division of Rheumatology at Nova Southeastern University. Dr. Kesselman received his medical degree from Des Moines University College of Osteopathic Medicine and has been in practice for more than 20 years.
LinkedIn: https://www.linkedin.com/in/marc-m-kesselman-d-o-facoi-facc-facr-6491479/
Haylie Pomroy, Founder and CEO of The Haylie Pomroy Group, is a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience, she has worked with top medical institutions and high-profile clients, developing targeted programs and supplements rooted in the "Food is Medicine" philosophy. Inspired by her own autoimmune journey, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is a New York Times bestselling author of The Fast Metabolism Diet.
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Transcript:
Dr. Marc Kesselman: What we find in patients that have autoimmune disease, whether it's rheumatoid arthritis, whether it's lupus, is that there's a lack of diversity in the collection of bacteria when we look at bacterial identity. And that causes the autoimmune disease to start flourishing.
There are pathological bacteria that are more dominant. And when these dominant species exist in our system, they can trigger cells that start triggering the inflammatory cascade.
Haylie Pomroy: Welcome to the Hope & Help podcast, where we talk about science and science-based tools for fatigue and chronic illness. I'm your host, Haylie Pomroy, #1 New York Times bestselling author of The Fast Metabolism Diet. And that's right, you guys, I am back in school again, finishing my PhD in neuroimmunology. As always, I'm a fierce advocate for those in need of a little bit of help and a whole lot of hope.
Today, I'm bringing you a very special guest. We are going to talk about autoimmune disorders. And I would not do this without the help of Dr. Kesselman.
Dr. Kesselman is the chair of the Department of Internal Medicine here at KPCOM at our medical school. And he is also the chief of the Division of Rheumatology. Dr. Kesselman, thank you so much for being here.
Dr. Marc Kesselman: Thank you. It's a pleasure. And I appreciate the opportunity to talk about autoimmunity, which is near and dear to me.
Haylie Pomroy: Me too. As I shared with you before we jumped on camera, I was diagnosed with an autoimmune disorder when I was 19. And I did the route of very strong prednisone, lots of immunosuppressants. I was fortunate that I was able to turn towards integrative medicine and nutrition to change my health. But back then, and even 10 or 15 years ago, I felt like I was kind of alone. Like in a social setting, it would be like myself and maybe one other person. But now it's everywhere. And why? What is happening?
I'm not just more aware of it because I've had it for a long time. It just seems like it's more prevalent. Are you noticing that?
Dr. Marc Kesselman: Absolutely. In my practice, especially, we're seeing a lot more autoimmune disorders. Recently, we had a COVID epidemic. And the COVID epidemic alone is responsible for the production of what we call autoantibodies and causing more autoimmune disorders, more fatigue disorders. And in fact, there's a disorder of prolonged fatigue, long COVID-type syndromes, which mimic myalgic encephalomyelitis, chronic fatigue disorders, which is very prevalent as well. We're seeing a lot more environmental toxins. We're seeing a lot more genetic abnormalities that are occurring. Even though autoimmune disorders are small percentage-wise worldwide, we're seeing a lot more evidence of that coming about.
Haylie Pomroy: It seems like it's everywhere. We're looking at triggers. And you just hit a few really hot topics there. COVID was a trigger for a lot of people that maybe had the propensity towards it? Was it just the final straw or what is going on in the body there?
Dr. Marc Kesselman: Absolutely. When COVID first came about, not all people had a memory to that virus. We recommended vaccine administration to try to stimulate antibody production. Now we have 98% of the population has been exposed to COVID, so they're producing antibodies. The need for vaccines is questionable at this point going forward.
But what COVID has done, the virus itself and maybe even vaccines, it has changed and morphed our body into producing more autoantibodies. And these autoantibodies are now causing some degree of autoimmunity. In fact, going forward, the large amount of antibodies that have been produced because of the virus have given us pause to think, are these conditions going to evolve into more progressive autoimmune syndromes? And that's something we don't know. We'll have to follow that closely.
Haylie Pomroy: And I was just at an event in Oxford. And then we went on to Cambridge. And I was with Dr. Rozenfeld and some of Dr. Klimas, a lot of our colleagues. And it was phenomenal what they were showing about if a person had maybe a propensity, and it wasn't even maybe the vaccine, but could have been the adjuvant also in that, which is meant to stimulate the immune system. Correct?
Dr. Marc Kesselman: Absolutely. And the adjuvant is actually meant to have the immune system accept the vaccine a little bit more easily. But we found, again, as you pointed out, with the COVID virus itself, because it morphs into different forms over the course of a year, and every year it gets different, but also the vaccine as well has stimulated patients that may not have expressed autoimmune disorders into expressing autoimmune levels of antibodies. And that's the thing that we don't know yet. We don't know whether these levels of antibodies are going to cause full-blown autoimmune disorders or whether we just have to continue to surveil these patients over time.
Haylie Pomroy: Kind of like a simmer.
Dr. Marc Kesselman: A simmer. Exactly.
Haylie Pomroy: And is that why we're also seeing individuals that maybe had one, like celiac or lupus or myself with ITP, suddenly having multiple positive antibodies?
Dr. Marc Kesselman: Absolutely. And the patients that have celiac disease, we know, have an autoimmune disorder. And it's very common when we see one autoimmune disorder to see a second or a third autoimmune disorder.
In fact, in patients that do have one autoimmune disease, we're likely very on the watch to look for other autoimmune disorders.
Haylie Pomroy: And can things develop as they age? Or is it once you have an antibody, can you start with one and develop another? Or is it just that we haven't detected the second, the third, or the fourth?
Dr. Marc Kesselman: That's a very good question. And I think that the answer to that is complex.
Patients, as we age, and our telomere length is variable. Aging itself can cause certain degrees of laxity in our genetic system. And what happens is we have a higher vulnerability to develop autoimmune disease. Then you put that into play with a virus or an infection or an altered microbiome, or the nutritional status of a patient becomes poor over time. They become ill, and they go into a nursing home, and they end up having a decreased ability to eat or things like that. You put all these together, and that causes a higher propensity of developing autoimmune disorders as we grow older.
Haylie Pomroy: You brought a really good point, which is that we're kind of this biodynamic body, and we have a whole host of defense mechanisms to prevent ourselves from manifesting any disease.
And all of that stress, environmental toxins, all of the things, it's like a big complex word problem, not an addition. This plus this equals this. It's just a big if and/or with complex word problem is the way I look at it.
And so when our defenses come down, it makes us more vulnerable.
Dr. Marc Kesselman: Absolutely. And that's really one of the issues.
We talked earlier about nutrition, how nutritional support as we get older, how important good nutrition is, especially for patients with autoimmune diseases with everybody. But for patients with hypertension, for patients, especially with diabetes, but especially in patients with autoimmune disease, having appropriate good nutrition as a support to the immune system is very—
Haylie Pomroy: I learned early on, and I shared with you, I did Mepron and CellCept and a lot of prednisone. And that got me into a world of trouble with a health perspective. I ended up with the right kidney infection and lost significant function in my right kidney. And that's when I said, OK. But I will tell you, I didn't focus on nutrition and supplementation, and I didn't focus on stress reduction. And my world kind of came crashing down. And so I took a leave of absence from school, and I shifted in and focused on it. And it's like not something I'm interested in. It's completely given me my life back.
I love what you just said, because in patients that are struggling or have been recently diagnosed, like on a scale of one to 10, how important would you say for them to take a beat, take a moment, and assess their nutritional perspective, their nutritional plane, their nutritional support is?
Dr. Marc Kesselman: In the top five, I would say it's number one. Lifestyle changes, support of their nutrition, physical exercise, spirituality. All of that is important on top of all the pharmacological support that we give to patients. And unfortunately, sometimes the pharmacological support, the medicines that you mentioned, the CellCept or even prednisone, which a lot of patients are on, is good and bad. It has good things that it does to the body, and it does, unfortunately, there are some bad effects as well.
And that's why supporting the system with good nutrition, with getting some fresh air, exercise is very, very important. And what happens a lot of times is we falter on one of those. Either we don't exercise as much, and we become more restricted in our motion. We don't eat as well, and then our nutritional system declines, and we don't have the amount of proteins to support taking in all the medications.
To your point, nutrition is very, very important.
Haylie Pomroy: I appreciate you saying that. I completely agree, obviously. You mentioned and you touched on environmental toxins. We're bombarded, and our food is bombarded from a nutritional perspective. At the Institute, we do environmental toxin testing, and I know that we collaborate. And when we bring to you a patient, or we're talking or collaborating on a patient that has a lot of mycotoxin or mold, or heavy metal, do you see that taking that burden off of the body helps them be more resilient in dealing with their autoimmune disorder?
Dr. Marc Kesselman: Absolutely. And working with Dr. Roosevelt and Dr. Klimas in the Institute, I have seen positive effects, especially in the testing that is done, the various blood and stool testing, looking at the microbiome, removing the actual environmental toxins, the outgassing of things that I was educated on.
All of that helps take the burden away from the body. It doesn't remove it completely. We sometimes need medications to try to help. Sometimes we need better nutritional support. But all of that is very, very important in helping fight that autoimmune disease.
Haylie Pomroy: A lot of us that have autoimmune disorders, we always talk about fear of the flare. And I've been really symptom-free for many, many years. But something will happen if I have ITP. And so it's a blood disorder. I know you know exactly what it is. But even if I'll get completely hit myself across the table running into something and I get a bruise, I just get nervous because that was one of the main symptoms. I'd wake up, and I'd have kind of bruising from head…
And so there's just that constant fear of the flare. And in our community, I have an online community, and we talk a lot about when we've missed sleep, when we've had a lot of stress, when we've been poor on our nutrition, that that fear of the flare gets greater.
How do you counsel your patients to balance their lives with all the peripheral stress? I know you do so much good communication to your patients about encouraging them about the importance. We're so compliant sometimes with swallowing a pill or taking a medication. But one of the things that our institute, when we talk about you when you're not there, is you have such compliance with your patients for taking care of themselves, part of nutrition, environmental exposures.
How are you so good at that? Like, what is your key to success there?
Dr. Marc Kesselman: Well, thank you. I also feel the same about the Neuroimmune Center and taking care of their patients. To me, communication with patients. I think that's vital. I believe that when patients don't feel well, they need to communicate with me immediately. And even a lot of patients with autoimmune disease will have this type of aura or a sensation that I'm going to develop a flare.
It's almost like when the weather changes and you start feeling like aches and pains in your bones. Now, everybody out there who has some autoimmune disease or some arthritis will tell you that they can tell you when the weather changes. So, with patients with autoimmune disease, and you speak about this flare, which is really vital, to communicate with me the earliest possibility for me to intervene and give them medications to try to suppress that flare or deal with it, the better.
Once the flare gets going, it's harder to deal with. We can deal with it, but it's harder to deal with. But I think my key is being able to communicate with my patients, trying to, for example, I'll come into the office and I'll just have a feeling that I need to call people.
And I've said this several times, that I call them and go, oh, my goodness, I can't believe you called because I was just feeling badly. Now, why I thought of that patient, I don't know, but certainly there's threads with our patient that we have. But I think communication is really the key.
Haylie Pomroy: I just have to stop for a second and say, you gave permission to everybody out there to have two things. One is to not be gaslit. I'll use that term not loosely, but pretty strongly from what we hear from our community, into a situation where they feel like they can't express how they're feeling.
I think sometimes patients get discounted for saying things like you just said. I mean, I can tell you when it's going to storm, and everybody laughs and calls me the rainmaker. Like, oh, you can do a rain dance. I said, no, my body can tell you. My immune system's talking to me. But to kind of express that to a doctor sometimes, they're like, well, maybe we should consider some psychotic medication. But that feeling when a person, I think because there's a war within in autoimmunity, that when something happens, you're more primed to be sensitive to it. Ine, you gave us permission to have communication, which I love. And the other is to have open dialogue with their doctors. And a lot of people out there don't. It's why we obviously synergistically work together as an institute. But I know that a lot of people there aren't having their experience. And so I just want to take a minute and tell everybody that if you're struggling out there and you don't have that kind of relationship with your physician, keep looking because it's possible, and it gets people better care. And like I said, we talk about with you all the time, you'll check in with your patients and be like, oh, so how is your stress? And are you eating well? And did you get your exercise? And they're like, no, Dr. Kesselman, I didn't.
And you're like, well, that's why you're calling me. That's why you don't feel good. I think I just want to pause and really tell people.
And I think coming from you, that's really important. And I don't know. I know that your patient population it's really hard to get into. And I understand that. But I think telling people that that's the kind of relationship they need with their doctor if they have an autoimmune disorder. Absolutely.
Dr. Marc Kesselman: Sharing an autoimmune disorder with a doctor, it has to be a close relationship. The doctor has to be able to listen, which is very important. It is so important. Not being time-limited, which is unfortunate in daily practice that patients don't have a certain amount of time and only a certain amount of time to tell their problems. I think that that's really important, opening up to the doctor and telling me. I spend a lot of time in my patients' rooms listening to their whole life, understanding where they are from when they wake up in the morning until they go to sleep at night, which is very, very important, understanding how they feel in a flare, what they're experiencing.
Because it gives me a better idea on how to treat them and to focus on things, focus on nutrition, focus on all aspects.
Haylie Pomroy: Even from a pharmacological perspective, like there's so many different medications that can be applied, and they're nuanced, and how they work in the immune system is so nuanced. And I don't understand how to prescribe without understanding the patient.
Hi, it's Haylie Pomroy, your host. I've written six New York Times bestselling books on metabolic pathways. And my latest book, Toxic Overload, tells you exactly what to do when your body's overburdened. If you go to hayliepomroy.com/book for a limited time, you can download a digital copy of this book completely free. That's hayliepomroy.com/book. Grab your free copy while supplies last. Now back to our show.
Dr. Marc Kesselman: Absolutely. And a lot of the medications are difficult to consume. Some of them are injections. Some of them are large pills. It's not easy for patients.
Not even mentioning the preauthorization processes that we go through and that patients go through, and getting medicines from pharmacies. But it's difficult, and it's a struggle every day for patients. It is. And that's very important for us as healthcare providers to understand that.
Haylie Pomroy: Well, I appreciate the compassion because I think at least a lot of women in our community, even to get to run a panel has been a fight. And they're like, but something's not right, and something's wrong.
And then we either send them to a different doctor, or we get them into our institute or we call a doc and say, please run this on them. And they'll run, and they've got Hashimoto's and Celiac. And it's like, no wonder why you're feeling so awful.
And they're saying, well, maybe just eat less and exercise more or have less stress. I don't know.
You've done some phenomenal research on gluten specifically. Can you share a little bit of that with me?
Dr. Marc Kesselman: Sure. We know that gluten sensitivity is tied into rheumatoid arthritis. But we also know that there are patients that don't test positive for gluten sensitivity but still are sensitive to gluten. And a lot of times, patients are dismissed, and they get tested in the office, and the doctor will say, you test negative for gluten. You're not gluten sensitive. And that's not entirely true. There's a whole field of medicine that we looked into called non-wheat gluten sensitivity that patients will test negative serology-wise in the office for gluten or gluten sensitivity or Celiac, but feel extremely sensitive if they eat one piece of food that has gluten.
And we know that that can stimulate significant autoimmune disease because it's associated with a significant flare of rheumatoid arthritis. We look into that a lot in our practice. And even if patients test negative, sometimes being on a gluten-restricted diet can be very helpful for patients, especially also in fibromyalgia, which we see a lot of.
Haylie Pomroy: It's like lighter fluid, I feel like, for an autoimmune disorder. I feel like whatever you have going on, at least what we see clinically, is it seems to intensify or amplify it. In our community, I always tell people it's just not like for me, it's just not an option. And when I do, I don't have positive rheumatoid titers, but I genuinely feel like I aged overnight. It's the best way I can describe it.
I just feel like everything, nothing fits, everything's tight, and that's inflammation.
Dr. Marc Kesselman: Absolutely. And I go over diet with my patients in the exam room, and I hear multiple times, whether it's gluten or whether it's MSG or whether it's some preservative or different types of food, I always tell my patients, see how you feel in the morning.
If you feel good, write down what you had the day before. If you don't feel good, write down what you had the day before and try to see what part of that diet may have caused that type of situation, and do some type of elimination of those objects. And usually that works.
Haylie Pomroy: It makes a huge impact in just the reduction of the inflammatory process, which helps with blood sugar and insulin resistance. I mean, there's just this whole host of things that benefit.
Diversity of food. You mentioned gut microbiome. How does the gut microbiome, there's so much talk about the gut-brain connection, about type 3 diabetes and insulin resistance, and sugar. I know it from a practical perspective, but talk to me about some of the science with the gut microbiome and autoimmunity.
Dr. Marc Kesselman: That's a great question. The microbiome is a collection of all the bacteria that reside within our intestinal system, starting from our mouth down to below, as well as surface bacteria. And all of these bacteria in the body, there are about 100 trillion cells of microbes in the body.
Really, there's a small percentage of human cells. We're actually symbiotes with our microbiome as we go forward. The microbiome has all different types of bacteria, and a healthy microbiome has a diverse selection of bacteria. What we find in patients that have autoimmune disease, whether it's rheumatoid arthritis, whether it's lupus, is that there is a lack of diversity in the collection of bacteria when we look at bacterial identity. And that causes the autoimmune disease to start flourishing.
There are pathological bacteria that are more dominant. And when these dominant species exist in our system, they can trigger cells that start triggering the inflammatory cascade. It all has to do with the diversity of our microbiome.
Haylie Pomroy: And I know Dr. Rey talks a lot about this in all of my books. This is the prescription from a food prescription. We do food rotation, and we do diversity of food, lots of fiber, diversity of food, food rotation, elimination of toxic-based foods or foods that have mycotoxins or chemical-based toxins, and things of that nature. But the diversity is so important, I feel like, in an autoimmune perspective. And sometimes when people don't feel good, they have a tendency to eat the same thing over and over again because of ease. And so I'm always educating on how we can maybe eat and freeze and save that for three days later, or eat and freeze and maybe use that the next week later, rotate even just the snacks, like apple, orange, grapefruit, pear, as opposed to apple, apple, apple, apple, that kind of diversity. And it speaks right to that microbiome piece.
Dr. Marc Kesselman: No, absolutely. And making sure that you eat a healthy array. I believe in the Mediterranean diet, olive oil, and omega-3, so I think that that's super important. It is. It would be great if we could say to everybody, eat yogurt, and that'll provide all of your probiotics and prebiotics and everything.
But that's not the case. We've never discovered that that's really the answer yet.
Haylie Pomroy: We've tried it for decades, haven't we? We've tried.
Dr. Marc Kesselman: It doesn't work. It doesn't work. But providing a selection of healthy foods, of green vegetables, and maybe more as we progress as a society, we need to be more plant-based as we go forward.
And I think that that is a big plus in patients that have autoimmune disease, leaving the red meat behind as much. Maybe if you're doing it two, three times a week, go back to once a week. I think that's important. And more in the pesco-vegetarian type of selection of foods.
Haylie Pomroy: And I always, when I'm counseling clients on nutrition, I'm always saying, talk to me about your veggie intake. Not that I want it necessarily to be a replacement always for me, but I want them to double down on it.
Because if they are eating a higher-protein diet, it takes those vegetables and complements to break those down and not create an inflammatory response. I love that. And you mentioned earlier we talked about COVID. I want to loop another virus in here. Epstein-Barr virus, EBV. I was a CMV girl, a cytomegalovirus girl, when we went and looked at some of the triggers for my autoimmune disorder.
And actually, I had a toxicologist and an environmental specialist do tissue and blood isolation. And it was so weird because I showed really high levels of malathion, like crazy high levels. And we were reviewing it. And I said, oh, I know exactly where that is. I got that. And they said, what? I was living in Southern California when I was 17.
We got dumped on. They were spraying malathion for medflies. You were supposed to be in with curfew. Of course, we had snuck out. Never was great at following the rules. But we got saturated, dumped on by the planes that came over with malathion. Now, I didn't get diagnosed till I was 19. I hemorrhaged with a routine tonsillectomy. That's how I got diagnosed. But it was so odd to be later in my life trying to understand and unravel. And I tested for all of those chemicals. And I did therapies to kind of help extract that from the body.
But then the cytomegalovirus was so fascinating to me. And in our clinic, we see a lot of Epstein-Barr virus. What's the connection there with autoimmunity?
Dr. Marc Kesselman: Epstein-Barr, another great question. Epstein-Barr virus, we've known about it for a long time. We've been thinking that that's one of the triggers of chronic fatigue syndrome. Now, research out of many institutions, especially Stanford, has shown that Epstein-Barr has been very associated with the development of rheumatoid arthritis, also multiple sclerosis. MS also, yes. Multiple sclerosis, MS. We're seeing now that patients have had a higher exposure to Epstein-Barr. It's all around the world. And if everybody tests for it, probably everybody has had some exposure to it. But not everybody that tests positive for it will go on to develop that autoimmunity.
But it's certainly something that we should be more aware of, especially if patients start having some symptoms of autoimmunity, some symptoms of rheumatoid arthritis. Testing for that may be a valuable tool because we may be able to understand exactly what the etiology of that autoimmunity is.
Haylie Pomroy: Absolutely. And in our institute, we talk a lot about Epstein-Barr virus coming from mono, right, that most of the U.S. population has had that exposure. And what is it that either the body can't fully clear the virus or put it to rest, I guess I would say, in the body, or the immune system has reset the immune system so it's in a constant trying to fight, whether it's an actual virus, a part of the virus, or a phantom virus. And in the patients, it seems to be different. But the immune trigger seems to be what we have to kind of settle down or reset.
Dr. Marc Kesselman: Absolutely. Interestingly, if a patient tests positive for Epstein-Barr, it takes a milieu of types of situations to try to move that Epstein-Barr virus into causing the autoimmune condition. Whether there's a genetic predisposition, whether there's a microbiome or an environmental or some nutritional trigger, but something lightning-wise attacks that Epstein-Barr that causes it to become an accelerator of the autoimmune condition.
And I think that what we see is some patients are positive for Epstein-Barr and may develop chronic fatigue. Some patients are positive for Epstein-Barr and may develop MS. Some patients with Epstein-Barr may go on to develop rheumatoid arthritis. We don't know what lane they're going to go in until we watch them closely. But we do know that that's certainly a trigger.
Haylie Pomroy: You said something about watch them closely. In our community, again, and I just love this crowdsourcing feedback that we have, a lot of people talk about once they get diagnosed with something like lupus or rheumatoid arthritis, or even myself, that sometimes their doctors will say, I'll see you every other year or once a year. Call me if I need to up your medication type stuff. You monitor your patients. And even so much that we send you people when we're looking at preconditions, which is you're not going to probably say it's new, Hayley, but in the world out there, not in our world here where we do exceptional medicine, in the world out there, the concept of pre-autoimmunity detection is so foreign. But you do this. Talk to me a little bit about that. Educate us about that.
Dr. Marc Kesselman: Pre-autoimmunity is really a wonderful area. I'm going to say it's kind of new, but it's kind of old. We've known about conditions where patients have the presence of autoantibodies. For example, and I'll just give an example, a family, a mom and a dad that may have rheumatoid arthritis or may have lupus has a child, and they call up, and they say, I want my child to be tested. And the child comes in and gets tested and has several autoantibodies but is asymptomatic. What do we do with that situation? What do we do with that child? What do we do with that adult?
We kind of had this area called either early RA, early lupus, pre-RA, pre-autoimmunity, where we have identified patients that are at risk. They may have a series of autoantibodies. They may have a family history.
They may have some evidence or maybe minimal symptoms, but nothing significant where we're able to watch them. We put them on surveillance. And now there's plenty of studies going on, especially at the University of Colorado under Kevin Dean and Mike Hollers, that are looking at treating patients that may have these early conditions with medications, whether or not that medication will eventually prevent the actual autoimmune condition from being expressed down the road or whether it may make the symptoms milder down the road. But right now the studies are still pending, and we'll probably know a little bit more within the next four to five years.
Haylie Pomroy: Always coming at it from a preventative perspective and a nutritional perspective, in looking at some of that stuff that's happening, I wish that everybody would look at their nutrition as a number five in the top five things to do. But looking at some of the pre-work, I love that that can help a younger population understand that it's really important to focus on their nutrition now.
And my daughter actually had an extensive amount of testing because she ended up with a viral infection and very, very sick. And they were going what does your mom have? Because they were looking at her, both the genetic expression, they were looking at her viral expression. And then both of my children's MPVs are huge. Their platelet volumes are huge. They say, well why and how and what? And so we did some extensive stuff with her. And her doc, she's of the age where she's getting married and thinking about having children.
And when I was diagnosed, they said I couldn't carry pregnancy because of my particular ITP. I carried two beautiful children, which I'm so grateful for. But with her, they were looking at that.
Being in her 20s, it was just an eye-opener for her to not be afraid, but to really focus on nutrition. And I think it gave her, really empowered her.
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Dr. Marc Kesselman: I think that's very important. And that's a good way to start. If we identify patients that are at risk and they're in this pre-autoimmunity, pre-RA, pre-lupus, starting out with good nutrition and getting younger people on healthier regimens, having them exercise more.
Haylie Pomroy: Not drinking Red Bull and staying up all night. Absolutely. Totally changed her diet.
Dr. Marc Kesselman: Staying away from smoking and cigarette smoking and vaping and all of that. Decreasing those triggers, we may be able to have an impact down the road. Now, there was an interesting study done early on, probably in the early 90s and early 2000s, showing that patients that may have autoimmunity start out with positive autoantibodies 15 to 20 years before they may manifest symptom one. We need to identify this population. And if we can focus on nutrition and good healthy habits, it may help us down the road with these symptoms.
Haylie Pomroy: And we might not even have the test yet for it. When I was in Ljubljana, I was at the International Congress of Autoimmunity last year in Ljubljana. And the doctor that discovered the lupus autoantibody spoke to us, and I got a chance to spend a little bit of time with him. And he was saying Haylie, we didn't, before we had this test, we saw positive ANAs, but we didn't know what it was. It could be also that there's many more autoantibody tests yet to be discovered too.
Dr. Marc Kesselman: Absolutely. And I think that we're kind of on the verge of looking at more autoantibodies.
Haylie Pomroy: I wish we didn't. I wish this was an orphan disease as a whole, autoimmunity. I really do wish it wasn't on the rise, that we weren't seeing it. I'm so surprised. And I've been doing this for 31 years now. In that time, what we've seen in the progression of research and in medicine since COVID has been both shocking and exciting to me. It's exciting because it's been accelerated. It's shocking because of how it got accelerated. But if we can learn from this and we can watch the patients in this process and they can have compassionate and thoughtful doctors like yourself, we've got to turn this around.
Dr. Marc Kesselman: Well, thank you. I agree. I think we've seen an overwhelming amount of autoimmunity over the last several years. And unfortunately, I think that we're not at the last stages of that. We're at the beginning of it. We're going to see more viruses, more environmental toxins. And I think we need to be aware. Doctors need to be aware that autoimmunity exists. We need to listen to our patients more. We need to focus more on healthy habits and nutrition. That's going to be very important as the groundwork before we start medications, getting people on healthy habits.
Haylie Pomroy: Absolutely. Because if we can prevent it, or even like in our community, even if we can reduce the amount of medications that a patient needs because they address this multifactor approach, because they're a dimensional body. I mean, they're a multidimensional body. They're a biodynamic body. And you really can't out-medicate, on any level, a poor gut microbiome, nutrient deficiencies, and crushing stress.
I mean, I wish that we could completely out. I would have just kept taking the medication that I was on and not worried about the rest of this if that were the case, even with the patients that absolutely need that medical or pharmacological intervention. I don't want to say they're not going to get away with. They're not going to realize the best health that they can possibly have without supporting their whole body.
Dr. Marc Kesselman: Absolutely. And stress reduction. I think that we have to focus on stress reduction. It's very hard these days with what we see in the news and on television and all of that. It just has caused an overwhelming amount of stress. And we never realized that stress was causing actual positive effects on producing more inflammatory markers. Now we realize the data is there that stress causes an increase in SED rate, increase in CRP, which are inflammatory markers that are negative indicators of disease.
Haylie Pomroy: So, Dr. Kesselman, we've talked a lot about inflammation and joint pain. But when a person's either in a flare or they just have an autoimmune diagnosis, why does there seem to be such an increase in cardiovascular risk?
Dr. Marc Kesselman: Excellent question. When there's a flare, there is systemic inflammation. That inflammation not only is visible in the joints.
A lot of patients will have joint swelling. They'll feel poorly. Maybe their white blood cell count will be decreased. They'll just feel lack of energy. But that inflammation is directly affecting the coronary arteries and causing an increased amount of plaque being deposited in the coronary arteries. We see a lot of cardiac disease and coronary artery disease in our autoimmune population. And we see it at an earlier age than they would normally develop it.
Normally, coronary artery disease is a disease as we get older. But in our autoimmune population, because of the high degree of inflammation, we're seeing cardiac issues at a very young age.
Haylie Pomroy: I think that's such good data for our community because we do this thing called a request for care, which is prepping people for their doctor visit. And I believe women, for sure, men probably for sure too, in their annual visit, they should do an autoimmune panel. We put it in every time, and a cardiovascular panel.
Sometimes, some of their doctors don't feel that they are justified in running an autoimmune panel. But if I can help them communicate that their family has cardiovascular risk and that they're looking at this from a preventative perspective to lessen their cardiovascular risk, I think that would be a really good valid point.
Dr. Marc Kesselman: Very important. And when we look at cardiac risk, we're thinking of risk factors. Does a patient have hypertension? Is a patient a smoker? Is a patient overweight? Do they have diabetes? Do they have high cholesterol? But the interesting part in autoimmune patients is that cholesterol levels may be low, and the risk is still high. Even though you may get a panel that shows your cholesterol levels to be, quote, within normal limits, that still doesn't mean that you have good risk. It means that your risk still could be very high because of your autoimmune disease.
I recommend a lot of times in looking at patients in my autoimmune population doing what we call CT calcium scoring, sending patients in for calcium scoring to be able to look at the deposition of calcium within the coronary arteries, which is one of the earliest signs of atherosclerotic disease.
Haylie Pomroy: And we put that in there also. It's so important to run that. And I think you just said something that also made me think about a better way or an easier way for someone to communicate this, which is sometimes the lipid levels can be stable in these patients. And I remember back in the day begging, and the cost was through the roof to run a HS-CRP, a CRP, a sensitive CRP. It used to be thousands of dollars. Now it's under, it's like 20 bucks or something to run it. But looking at inflammation over the lipid level, I think the tide is changing there, that we're not just looking at total cholesterol, that we're looking at inflammatory response.
But to your point, a CRP, but also a SED rate would be really, really important.
Dr. Marc Kesselman: Absolutely. And an HS-CRP has been a marker of cardiovascular risk for a long time. And we're realizing now that that's super important to run on patients because it does give us an idea, is there underlying cardiac risk? And we know that patients that have autoimmune disease will have cardiac risk. Patients with psoriatic arthritis, patients with rheumatoid arthritis, even my young women patients with lupus have significant cardiac risk. And now we're also seeing the burgeoning field of cardio-inflammatory diseases.
Haylie Pomroy: Yes, the endothelial cell wall, and a lot with our long COVID patients.
Dr. Marc Kesselman: With the long COVID patients as well. We're seeing a lot of cardiac inflammation, and now that inflammation is being treated with anti-inflammatories, even in the post-heart attack period.
Haylie Pomroy: I love that you're involved in a medical school, because if we don't teach our future doctors all of this data, right, we're not going to have adequate physicians, period. But I also love that people are talking about this publicly. With the invent of social media and podcasts, it is something that's come out of it really from a positive perspective. Maybe not the gossip aspect of it, but the empowerment of people to gain medical data and access I think, is really profound.
Dr. Marc Kesselman: Very profound. And I think that patients need to understand what their risks are. Whether they see their primary doctor, their rheumatologist, their immunologist, understanding cardiac risk is very important, and making sure that your blood pressure is good, making sure that your sugar is controlled, making sure that your cholesterol levels are addressed.
Haylie Pomroy: And that you're keeping data. That's why we do that request for care is to get people prepped for their doctor visit. You mentioned earlier that sometimes a physician doesn't have enough time with their patient. I always tell our community we do this. We call it, like I said, a request for care. But the reason why we do this is so that a patient comes in and says this is me from a biomarker perspective maybe or a symptom profile perspective or family history perspective.
There's also, like my mom's blood pressure goes up 50 points when she goes to the doctor's office. And she's a physician, by the way. She has white coat syndrome so bad, which we find as a family very funny. But I always tell her, let's like check your blood pressure five days in a row before you go in so that they're not going, oh my gosh, you're 180 over 90 and freak out.
There's that emotionality of coming in to see your doctor. I think we all are worried about a diagnosis. If you've got an autoimmune disorder, you're worried about it causing some sort of tissue or organ destruction. Sometimes we go online, and we read about it and we hear… I got asked at UCLA to come talk about ITP, my particular autoimmune disorder. And I go out, and I speak all over the world about all kinds of things. My own particular autoimmune disorder, it's really hard for me to give a talk on. And I think it's because I have to dig into the fact that I actually have it. But sometimes going in that doctor's visit can give you that same level of kind of anxiety around it.
Dr. Marc Kesselman: No, absolutely. And wearing a white coat sometimes can cause what we call white coat hypertension or white coat anxiety. It's tough.
I always encourage my patients to write down lists of questions, write down lists of things that they want to talk about so they don't forget. I always also try to give patients lists when they leave the visit of everything that we discussed, what medications that they need to be on, what tests I'm ordering. It's an anxiety-filled visit. I wish it was less anxiety.
Haylie Pomroy: You make it very good for your patients. We get tons of feedback on that. But it's not that way for everybody.
Dr. Marc Kesselman: Unfortunately, not. But hopefully it will be in the future.
Haylie Pomroy: Dr. Kesselman, I know our community is going to have so many questions after we watch this. And I know they're going to want to have access and ask you those questions.
Can I get you to promise me that you will please come back?
Dr. Marc Kesselman: My pleasure. Absolutely. It's been very enjoyable. I enjoy speaking about autoimmunity. And it would be my pleasure to answer any questions that your audience may have.
Haylie Pomroy: Well, any patient that is yours is such a lucky patient. And now our community is lucky for having you as one of their advocates giving them permission to seek the help and seek the medical relationship and to integrate all of the aspects of who they really are, what they eat, what they see, what they think, what they feel, and realize it as a real and actual experience that they're having and find a partner that can help them get the care they deserve.
Dr. Marc Kesselman: Thank you. Very, very, very much.
Haylie Pomroy: Thank you so much. Thank you.
What is actually driving the rise in autoimmune disease?
In today's episode, Haylie Pomroy is joined by Dr. Marc Kesselman, Chair of Internal Medicine and Chief of Rheumatology at Nova Southeastern University, to dig into the hidden drivers of autoimmune disease and what patients can actually do about them.
Dr. Kesselman breaks down how COVID-19, vaccine adjuvants, environmental toxins, gut microbiome imbalance, and Epstein-Barr virus all contribute to the rising wave of autoimmune conditions. He explains why non-celiac gluten sensitivity is real even when tests come back negative, how food rotation and plant diversity help protect the microbiome, and why autoantibodies can appear in the bloodstream 15 to 20 years before a single symptom shows up.
He also covers a piece of the autoimmune conversation that most patients never hear: why chronic inflammation significantly raises cardiovascular risk even when cholesterol looks normal, and which tests can catch it before it becomes a crisis.
If you have been told your labs are fine but something still feels wrong, this episode is for you. Tune in to Fast Metabolism Matters.
If your body feels like it's running on empty, overburdened, or just not responding the way it used to, Haylie's latest book, Toxic Overload, tells you exactly what to do. Download your free digital copy today and start understanding what your body is trying to tell you.
Free Download: Get Your Copy of Toxic Overload 👉 https://hayliepomroy.com/pages/toxic-overload
You don't have to figure this out alone. Inside Haylie's private membership community, you get personalized guidance and support, member discounts on supplements and shakes, and the ability to ask questions directly to podcast guests like Dr. Systrom. Join free for 30 days and take the next step on your health journey.
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Dr. Marc Kesselman is the chair and associate professor at the Department of Internal Medicine at Dr. Kiran C. Patel College of Osteopathic Medicine. He is also the chief of the Division of Rheumatology at Nova Southeastern University. Dr. Kesselman received his medical degree from Des Moines University College of Osteopathic Medicine and has been in practice for more than 20 years.
LinkedIn: https://www.linkedin.com/in/marc-m-kesselman-d-o-facoi-facc-facr-6491479/
Haylie Pomroy, Founder and CEO of The Haylie Pomroy Group, is a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience, she has worked with top medical institutions and high-profile clients, developing targeted programs and supplements rooted in the "Food is Medicine" philosophy. Inspired by her own autoimmune journey, she combines expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is a New York Times bestselling author of The Fast Metabolism Diet.
Learn more about Haylie Pomroy's approach to wellness through her website: https://hayliepomroy.com
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Transcript:
Dr. Marc Kesselman: What we find in patients that have autoimmune disease, whether it's rheumatoid arthritis, whether it's lupus, is that there's a lack of diversity in the collection of bacteria when we look at bacterial identity. And that causes the autoimmune disease to start flourishing.
There are pathological bacteria that are more dominant. And when these dominant species exist in our system, they can trigger cells that start triggering the inflammatory cascade.
Haylie Pomroy: Welcome to the Hope & Help podcast, where we talk about science and science-based tools for fatigue and chronic illness. I'm your host, Haylie Pomroy, #1 New York Times bestselling author of The Fast Metabolism Diet. And that's right, you guys, I am back in school again, finishing my PhD in neuroimmunology. As always, I'm a fierce advocate for those in need of a little bit of help and a whole lot of hope.
Today, I'm bringing you a very special guest. We are going to talk about autoimmune disorders. And I would not do this without the help of Dr. Kesselman.
Dr. Kesselman is the chair of the Department of Internal Medicine here at KPCOM at our medical school. And he is also the chief of the Division of Rheumatology. Dr. Kesselman, thank you so much for being here.
Dr. Marc Kesselman: Thank you. It's a pleasure. And I appreciate the opportunity to talk about autoimmunity, which is near and dear to me.
Haylie Pomroy: Me too. As I shared with you before we jumped on camera, I was diagnosed with an autoimmune disorder when I was 19. And I did the route of very strong prednisone, lots of immunosuppressants. I was fortunate that I was able to turn towards integrative medicine and nutrition to change my health. But back then, and even 10 or 15 years ago, I felt like I was kind of alone. Like in a social setting, it would be like myself and maybe one other person. But now it's everywhere. And why? What is happening?
I'm not just more aware of it because I've had it for a long time. It just seems like it's more prevalent. Are you noticing that?
Dr. Marc Kesselman: Absolutely. In my practice, especially, we're seeing a lot more autoimmune disorders. Recently, we had a COVID epidemic. And the COVID epidemic alone is responsible for the production of what we call autoantibodies and causing more autoimmune disorders, more fatigue disorders. And in fact, there's a disorder of prolonged fatigue, long COVID-type syndromes, which mimic myalgic encephalomyelitis, chronic fatigue disorders, which is very prevalent as well. We're seeing a lot more environmental toxins. We're seeing a lot more genetic abnormalities that are occurring. Even though autoimmune disorders are small percentage-wise worldwide, we're seeing a lot more evidence of that coming about.
Haylie Pomroy: It seems like it's everywhere. We're looking at triggers. And you just hit a few really hot topics there. COVID was a trigger for a lot of people that maybe had the propensity towards it? Was it just the final straw or what is going on in the body there?
Dr. Marc Kesselman: Absolutely. When COVID first came about, not all people had a memory to that virus. We recommended vaccine administration to try to stimulate antibody production. Now we have 98% of the population has been exposed to COVID, so they're producing antibodies. The need for vaccines is questionable at this point going forward.
But what COVID has done, the virus itself and maybe even vaccines, it has changed and morphed our body into producing more autoantibodies. And these autoantibodies are now causing some degree of autoimmunity. In fact, going forward, the large amount of antibodies that have been produced because of the virus have given us pause to think, are these conditions going to evolve into more progressive autoimmune syndromes? And that's something we don't know. We'll have to follow that closely.
Haylie Pomroy: And I was just at an event in Oxford. And then we went on to Cambridge. And I was with Dr. Rozenfeld and some of Dr. Klimas, a lot of our colleagues. And it was phenomenal what they were showing about if a person had maybe a propensity, and it wasn't even maybe the vaccine, but could have been the adjuvant also in that, which is meant to stimulate the immune system. Correct?
Dr. Marc Kesselman: Absolutely. And the adjuvant is actually meant to have the immune system accept the vaccine a little bit more easily. But we found, again, as you pointed out, with the COVID virus itself, because it morphs into different forms over the course of a year, and every year it gets different, but also the vaccine as well has stimulated patients that may not have expressed autoimmune disorders into expressing autoimmune levels of antibodies. And that's the thing that we don't know yet. We don't know whether these levels of antibodies are going to cause full-blown autoimmune disorders or whether we just have to continue to surveil these patients over time.
Haylie Pomroy: Kind of like a simmer.
Dr. Marc Kesselman: A simmer. Exactly.
Haylie Pomroy: And is that why we're also seeing individuals that maybe had one, like celiac or lupus or myself with ITP, suddenly having multiple positive antibodies?
Dr. Marc Kesselman: Absolutely. And the patients that have celiac disease, we know, have an autoimmune disorder. And it's very common when we see one autoimmune disorder to see a second or a third autoimmune disorder.
In fact, in patients that do have one autoimmune disease, we're likely very on the watch to look for other autoimmune disorders.
Haylie Pomroy: And can things develop as they age? Or is it once you have an antibody, can you start with one and develop another? Or is it just that we haven't detected the second, the third, or the fourth?
Dr. Marc Kesselman: That's a very good question. And I think that the answer to that is complex.
Patients, as we age, and our telomere length is variable. Aging itself can cause certain degrees of laxity in our genetic system. And what happens is we have a higher vulnerability to develop autoimmune disease. Then you put that into play with a virus or an infection or an altered microbiome, or the nutritional status of a patient becomes poor over time. They become ill, and they go into a nursing home, and they end up having a decreased ability to eat or things like that. You put all these together, and that causes a higher propensity of developing autoimmune disorders as we grow older.
Haylie Pomroy: You brought a really good point, which is that we're kind of this biodynamic body, and we have a whole host of defense mechanisms to prevent ourselves from manifesting any disease.
And all of that stress, environmental toxins, all of the things, it's like a big complex word problem, not an addition. This plus this equals this. It's just a big if and/or with complex word problem is the way I look at it.
And so when our defenses come down, it makes us more vulnerable.
Dr. Marc Kesselman: Absolutely. And that's really one of the issues.
We talked earlier about nutrition, how nutritional support as we get older, how important good nutrition is, especially for patients with autoimmune diseases with everybody. But for patients with hypertension, for patients, especially with diabetes, but especially in patients with autoimmune disease, having appropriate good nutrition as a support to the immune system is very—
Haylie Pomroy: I learned early on, and I shared with you, I did Mepron and CellCept and a lot of prednisone. And that got me into a world of trouble with a health perspective. I ended up with the right kidney infection and lost significant function in my right kidney. And that's when I said, OK. But I will tell you, I didn't focus on nutrition and supplementation, and I didn't focus on stress reduction. And my world kind of came crashing down. And so I took a leave of absence from school, and I shifted in and focused on it. And it's like not something I'm interested in. It's completely given me my life back.
I love what you just said, because in patients that are struggling or have been recently diagnosed, like on a scale of one to 10, how important would you say for them to take a beat, take a moment, and assess their nutritional perspective, their nutritional plane, their nutritional support is?
Dr. Marc Kesselman: In the top five, I would say it's number one. Lifestyle changes, support of their nutrition, physical exercise, spirituality. All of that is important on top of all the pharmacological support that we give to patients. And unfortunately, sometimes the pharmacological support, the medicines that you mentioned, the CellCept or even prednisone, which a lot of patients are on, is good and bad. It has good things that it does to the body, and it does, unfortunately, there are some bad effects as well.
And that's why supporting the system with good nutrition, with getting some fresh air, exercise is very, very important. And what happens a lot of times is we falter on one of those. Either we don't exercise as much, and we become more restricted in our motion. We don't eat as well, and then our nutritional system declines, and we don't have the amount of proteins to support taking in all the medications.
To your point, nutrition is very, very important.
Haylie Pomroy: I appreciate you saying that. I completely agree, obviously. You mentioned and you touched on environmental toxins. We're bombarded, and our food is bombarded from a nutritional perspective. At the Institute, we do environmental toxin testing, and I know that we collaborate. And when we bring to you a patient, or we're talking or collaborating on a patient that has a lot of mycotoxin or mold, or heavy metal, do you see that taking that burden off of the body helps them be more resilient in dealing with their autoimmune disorder?
Dr. Marc Kesselman: Absolutely. And working with Dr. Roosevelt and Dr. Klimas in the Institute, I have seen positive effects, especially in the testing that is done, the various blood and stool testing, looking at the microbiome, removing the actual environmental toxins, the outgassing of things that I was educated on.
All of that helps take the burden away from the body. It doesn't remove it completely. We sometimes need medications to try to help. Sometimes we need better nutritional support. But all of that is very, very important in helping fight that autoimmune disease.
Haylie Pomroy: A lot of us that have autoimmune disorders, we always talk about fear of the flare. And I've been really symptom-free for many, many years. But something will happen if I have ITP. And so it's a blood disorder. I know you know exactly what it is. But even if I'll get completely hit myself across the table running into something and I get a bruise, I just get nervous because that was one of the main symptoms. I'd wake up, and I'd have kind of bruising from head…
And so there's just that constant fear of the flare. And in our community, I have an online community, and we talk a lot about when we've missed sleep, when we've had a lot of stress, when we've been poor on our nutrition, that that fear of the flare gets greater.
How do you counsel your patients to balance their lives with all the peripheral stress? I know you do so much good communication to your patients about encouraging them about the importance. We're so compliant sometimes with swallowing a pill or taking a medication. But one of the things that our institute, when we talk about you when you're not there, is you have such compliance with your patients for taking care of themselves, part of nutrition, environmental exposures.
How are you so good at that? Like, what is your key to success there?
Dr. Marc Kesselman: Well, thank you. I also feel the same about the Neuroimmune Center and taking care of their patients. To me, communication with patients. I think that's vital. I believe that when patients don't feel well, they need to communicate with me immediately. And even a lot of patients with autoimmune disease will have this type of aura or a sensation that I'm going to develop a flare.
It's almost like when the weather changes and you start feeling like aches and pains in your bones. Now, everybody out there who has some autoimmune disease or some arthritis will tell you that they can tell you when the weather changes. So, with patients with autoimmune disease, and you speak about this flare, which is really vital, to communicate with me the earliest possibility for me to intervene and give them medications to try to suppress that flare or deal with it, the better.
Once the flare gets going, it's harder to deal with. We can deal with it, but it's harder to deal with. But I think my key is being able to communicate with my patients, trying to, for example, I'll come into the office and I'll just have a feeling that I need to call people.
And I've said this several times, that I call them and go, oh, my goodness, I can't believe you called because I was just feeling badly. Now, why I thought of that patient, I don't know, but certainly there's threads with our patient that we have. But I think communication is really the key.
Haylie Pomroy: I just have to stop for a second and say, you gave permission to everybody out there to have two things. One is to not be gaslit. I'll use that term not loosely, but pretty strongly from what we hear from our community, into a situation where they feel like they can't express how they're feeling.
I think sometimes patients get discounted for saying things like you just said. I mean, I can tell you when it's going to storm, and everybody laughs and calls me the rainmaker. Like, oh, you can do a rain dance. I said, no, my body can tell you. My immune system's talking to me. But to kind of express that to a doctor sometimes, they're like, well, maybe we should consider some psychotic medication. But that feeling when a person, I think because there's a war within in autoimmunity, that when something happens, you're more primed to be sensitive to it. Ine, you gave us permission to have communication, which I love. And the other is to have open dialogue with their doctors. And a lot of people out there don't. It's why we obviously synergistically work together as an institute. But I know that a lot of people there aren't having their experience. And so I just want to take a minute and tell everybody that if you're struggling out there and you don't have that kind of relationship with your physician, keep looking because it's possible, and it gets people better care. And like I said, we talk about with you all the time, you'll check in with your patients and be like, oh, so how is your stress? And are you eating well? And did you get your exercise? And they're like, no, Dr. Kesselman, I didn't.
And you're like, well, that's why you're calling me. That's why you don't feel good. I think I just want to pause and really tell people.
And I think coming from you, that's really important. And I don't know. I know that your patient population it's really hard to get into. And I understand that. But I think telling people that that's the kind of relationship they need with their doctor if they have an autoimmune disorder. Absolutely.
Dr. Marc Kesselman: Sharing an autoimmune disorder with a doctor, it has to be a close relationship. The doctor has to be able to listen, which is very important. It is so important. Not being time-limited, which is unfortunate in daily practice that patients don't have a certain amount of time and only a certain amount of time to tell their problems. I think that that's really important, opening up to the doctor and telling me. I spend a lot of time in my patients' rooms listening to their whole life, understanding where they are from when they wake up in the morning until they go to sleep at night, which is very, very important, understanding how they feel in a flare, what they're experiencing.
Because it gives me a better idea on how to treat them and to focus on things, focus on nutrition, focus on all aspects.
Haylie Pomroy: Even from a pharmacological perspective, like there's so many different medications that can be applied, and they're nuanced, and how they work in the immune system is so nuanced. And I don't understand how to prescribe without understanding the patient.
Hi, it's Haylie Pomroy, your host. I've written six New York Times bestselling books on metabolic pathways. And my latest book, Toxic Overload, tells you exactly what to do when your body's overburdened. If you go to hayliepomroy.com/book for a limited time, you can download a digital copy of this book completely free. That's hayliepomroy.com/book. Grab your free copy while supplies last. Now back to our show.
Dr. Marc Kesselman: Absolutely. And a lot of the medications are difficult to consume. Some of them are injections. Some of them are large pills. It's not easy for patients.
Not even mentioning the preauthorization processes that we go through and that patients go through, and getting medicines from pharmacies. But it's difficult, and it's a struggle every day for patients. It is. And that's very important for us as healthcare providers to understand that.
Haylie Pomroy: Well, I appreciate the compassion because I think at least a lot of women in our community, even to get to run a panel has been a fight. And they're like, but something's not right, and something's wrong.
And then we either send them to a different doctor, or we get them into our institute or we call a doc and say, please run this on them. And they'll run, and they've got Hashimoto's and Celiac. And it's like, no wonder why you're feeling so awful.
And they're saying, well, maybe just eat less and exercise more or have less stress. I don't know.
You've done some phenomenal research on gluten specifically. Can you share a little bit of that with me?
Dr. Marc Kesselman: Sure. We know that gluten sensitivity is tied into rheumatoid arthritis. But we also know that there are patients that don't test positive for gluten sensitivity but still are sensitive to gluten. And a lot of times, patients are dismissed, and they get tested in the office, and the doctor will say, you test negative for gluten. You're not gluten sensitive. And that's not entirely true. There's a whole field of medicine that we looked into called non-wheat gluten sensitivity that patients will test negative serology-wise in the office for gluten or gluten sensitivity or Celiac, but feel extremely sensitive if they eat one piece of food that has gluten.
And we know that that can stimulate significant autoimmune disease because it's associated with a significant flare of rheumatoid arthritis. We look into that a lot in our practice. And even if patients test negative, sometimes being on a gluten-restricted diet can be very helpful for patients, especially also in fibromyalgia, which we see a lot of.
Haylie Pomroy: It's like lighter fluid, I feel like, for an autoimmune disorder. I feel like whatever you have going on, at least what we see clinically, is it seems to intensify or amplify it. In our community, I always tell people it's just not like for me, it's just not an option. And when I do, I don't have positive rheumatoid titers, but I genuinely feel like I aged overnight. It's the best way I can describe it.
I just feel like everything, nothing fits, everything's tight, and that's inflammation.
Dr. Marc Kesselman: Absolutely. And I go over diet with my patients in the exam room, and I hear multiple times, whether it's gluten or whether it's MSG or whether it's some preservative or different types of food, I always tell my patients, see how you feel in the morning.
If you feel good, write down what you had the day before. If you don't feel good, write down what you had the day before and try to see what part of that diet may have caused that type of situation, and do some type of elimination of those objects. And usually that works.
Haylie Pomroy: It makes a huge impact in just the reduction of the inflammatory process, which helps with blood sugar and insulin resistance. I mean, there's just this whole host of things that benefit.
Diversity of food. You mentioned gut microbiome. How does the gut microbiome, there's so much talk about the gut-brain connection, about type 3 diabetes and insulin resistance, and sugar. I know it from a practical perspective, but talk to me about some of the science with the gut microbiome and autoimmunity.
Dr. Marc Kesselman: That's a great question. The microbiome is a collection of all the bacteria that reside within our intestinal system, starting from our mouth down to below, as well as surface bacteria. And all of these bacteria in the body, there are about 100 trillion cells of microbes in the body.
Really, there's a small percentage of human cells. We're actually symbiotes with our microbiome as we go forward. The microbiome has all different types of bacteria, and a healthy microbiome has a diverse selection of bacteria. What we find in patients that have autoimmune disease, whether it's rheumatoid arthritis, whether it's lupus, is that there is a lack of diversity in the collection of bacteria when we look at bacterial identity. And that causes the autoimmune disease to start flourishing.
There are pathological bacteria that are more dominant. And when these dominant species exist in our system, they can trigger cells that start triggering the inflammatory cascade. It all has to do with the diversity of our microbiome.
Haylie Pomroy: And I know Dr. Rey talks a lot about this in all of my books. This is the prescription from a food prescription. We do food rotation, and we do diversity of food, lots of fiber, diversity of food, food rotation, elimination of toxic-based foods or foods that have mycotoxins or chemical-based toxins, and things of that nature. But the diversity is so important, I feel like, in an autoimmune perspective. And sometimes when people don't feel good, they have a tendency to eat the same thing over and over again because of ease. And so I'm always educating on how we can maybe eat and freeze and save that for three days later, or eat and freeze and maybe use that the next week later, rotate even just the snacks, like apple, orange, grapefruit, pear, as opposed to apple, apple, apple, apple, that kind of diversity. And it speaks right to that microbiome piece.
Dr. Marc Kesselman: No, absolutely. And making sure that you eat a healthy array. I believe in the Mediterranean diet, olive oil, and omega-3, so I think that that's super important. It is. It would be great if we could say to everybody, eat yogurt, and that'll provide all of your probiotics and prebiotics and everything.
But that's not the case. We've never discovered that that's really the answer yet.
Haylie Pomroy: We've tried it for decades, haven't we? We've tried.
Dr. Marc Kesselman: It doesn't work. It doesn't work. But providing a selection of healthy foods, of green vegetables, and maybe more as we progress as a society, we need to be more plant-based as we go forward.
And I think that that is a big plus in patients that have autoimmune disease, leaving the red meat behind as much. Maybe if you're doing it two, three times a week, go back to once a week. I think that's important. And more in the pesco-vegetarian type of selection of foods.
Haylie Pomroy: And I always, when I'm counseling clients on nutrition, I'm always saying, talk to me about your veggie intake. Not that I want it necessarily to be a replacement always for me, but I want them to double down on it.
Because if they are eating a higher-protein diet, it takes those vegetables and complements to break those down and not create an inflammatory response. I love that. And you mentioned earlier we talked about COVID. I want to loop another virus in here. Epstein-Barr virus, EBV. I was a CMV girl, a cytomegalovirus girl, when we went and looked at some of the triggers for my autoimmune disorder.
And actually, I had a toxicologist and an environmental specialist do tissue and blood isolation. And it was so weird because I showed really high levels of malathion, like crazy high levels. And we were reviewing it. And I said, oh, I know exactly where that is. I got that. And they said, what? I was living in Southern California when I was 17.
We got dumped on. They were spraying malathion for medflies. You were supposed to be in with curfew. Of course, we had snuck out. Never was great at following the rules. But we got saturated, dumped on by the planes that came over with malathion. Now, I didn't get diagnosed till I was 19. I hemorrhaged with a routine tonsillectomy. That's how I got diagnosed. But it was so odd to be later in my life trying to understand and unravel. And I tested for all of those chemicals. And I did therapies to kind of help extract that from the body.
But then the cytomegalovirus was so fascinating to me. And in our clinic, we see a lot of Epstein-Barr virus. What's the connection there with autoimmunity?
Dr. Marc Kesselman: Epstein-Barr, another great question. Epstein-Barr virus, we've known about it for a long time. We've been thinking that that's one of the triggers of chronic fatigue syndrome. Now, research out of many institutions, especially Stanford, has shown that Epstein-Barr has been very associated with the development of rheumatoid arthritis, also multiple sclerosis. MS also, yes. Multiple sclerosis, MS. We're seeing now that patients have had a higher exposure to Epstein-Barr. It's all around the world. And if everybody tests for it, probably everybody has had some exposure to it. But not everybody that tests positive for it will go on to develop that autoimmunity.
But it's certainly something that we should be more aware of, especially if patients start having some symptoms of autoimmunity, some symptoms of rheumatoid arthritis. Testing for that may be a valuable tool because we may be able to understand exactly what the etiology of that autoimmunity is.
Haylie Pomroy: Absolutely. And in our institute, we talk a lot about Epstein-Barr virus coming from mono, right, that most of the U.S. population has had that exposure. And what is it that either the body can't fully clear the virus or put it to rest, I guess I would say, in the body, or the immune system has reset the immune system so it's in a constant trying to fight, whether it's an actual virus, a part of the virus, or a phantom virus. And in the patients, it seems to be different. But the immune trigger seems to be what we have to kind of settle down or reset.
Dr. Marc Kesselman: Absolutely. Interestingly, if a patient tests positive for Epstein-Barr, it takes a milieu of types of situations to try to move that Epstein-Barr virus into causing the autoimmune condition. Whether there's a genetic predisposition, whether there's a microbiome or an environmental or some nutritional trigger, but something lightning-wise attacks that Epstein-Barr that causes it to become an accelerator of the autoimmune condition.
And I think that what we see is some patients are positive for Epstein-Barr and may develop chronic fatigue. Some patients are positive for Epstein-Barr and may develop MS. Some patients with Epstein-Barr may go on to develop rheumatoid arthritis. We don't know what lane they're going to go in until we watch them closely. But we do know that that's certainly a trigger.
Haylie Pomroy: You said something about watch them closely. In our community, again, and I just love this crowdsourcing feedback that we have, a lot of people talk about once they get diagnosed with something like lupus or rheumatoid arthritis, or even myself, that sometimes their doctors will say, I'll see you every other year or once a year. Call me if I need to up your medication type stuff. You monitor your patients. And even so much that we send you people when we're looking at preconditions, which is you're not going to probably say it's new, Hayley, but in the world out there, not in our world here where we do exceptional medicine, in the world out there, the concept of pre-autoimmunity detection is so foreign. But you do this. Talk to me a little bit about that. Educate us about that.
Dr. Marc Kesselman: Pre-autoimmunity is really a wonderful area. I'm going to say it's kind of new, but it's kind of old. We've known about conditions where patients have the presence of autoantibodies. For example, and I'll just give an example, a family, a mom and a dad that may have rheumatoid arthritis or may have lupus has a child, and they call up, and they say, I want my child to be tested. And the child comes in and gets tested and has several autoantibodies but is asymptomatic. What do we do with that situation? What do we do with that child? What do we do with that adult?
We kind of had this area called either early RA, early lupus, pre-RA, pre-autoimmunity, where we have identified patients that are at risk. They may have a series of autoantibodies. They may have a family history.
They may have some evidence or maybe minimal symptoms, but nothing significant where we're able to watch them. We put them on surveillance. And now there's plenty of studies going on, especially at the University of Colorado under Kevin Dean and Mike Hollers, that are looking at treating patients that may have these early conditions with medications, whether or not that medication will eventually prevent the actual autoimmune condition from being expressed down the road or whether it may make the symptoms milder down the road. But right now the studies are still pending, and we'll probably know a little bit more within the next four to five years.
Haylie Pomroy: Always coming at it from a preventative perspective and a nutritional perspective, in looking at some of that stuff that's happening, I wish that everybody would look at their nutrition as a number five in the top five things to do. But looking at some of the pre-work, I love that that can help a younger population understand that it's really important to focus on their nutrition now.
And my daughter actually had an extensive amount of testing because she ended up with a viral infection and very, very sick. And they were going what does your mom have? Because they were looking at her, both the genetic expression, they were looking at her viral expression. And then both of my children's MPVs are huge. Their platelet volumes are huge. They say, well why and how and what? And so we did some extensive stuff with her. And her doc, she's of the age where she's getting married and thinking about having children.
And when I was diagnosed, they said I couldn't carry pregnancy because of my particular ITP. I carried two beautiful children, which I'm so grateful for. But with her, they were looking at that.
Being in her 20s, it was just an eye-opener for her to not be afraid, but to really focus on nutrition. And I think it gave her, really empowered her.
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Dr. Marc Kesselman: I think that's very important. And that's a good way to start. If we identify patients that are at risk and they're in this pre-autoimmunity, pre-RA, pre-lupus, starting out with good nutrition and getting younger people on healthier regimens, having them exercise more.
Haylie Pomroy: Not drinking Red Bull and staying up all night. Absolutely. Totally changed her diet.
Dr. Marc Kesselman: Staying away from smoking and cigarette smoking and vaping and all of that. Decreasing those triggers, we may be able to have an impact down the road. Now, there was an interesting study done early on, probably in the early 90s and early 2000s, showing that patients that may have autoimmunity start out with positive autoantibodies 15 to 20 years before they may manifest symptom one. We need to identify this population. And if we can focus on nutrition and good healthy habits, it may help us down the road with these symptoms.
Haylie Pomroy: And we might not even have the test yet for it. When I was in Ljubljana, I was at the International Congress of Autoimmunity last year in Ljubljana. And the doctor that discovered the lupus autoantibody spoke to us, and I got a chance to spend a little bit of time with him. And he was saying Haylie, we didn't, before we had this test, we saw positive ANAs, but we didn't know what it was. It could be also that there's many more autoantibody tests yet to be discovered too.
Dr. Marc Kesselman: Absolutely. And I think that we're kind of on the verge of looking at more autoantibodies.
Haylie Pomroy: I wish we didn't. I wish this was an orphan disease as a whole, autoimmunity. I really do wish it wasn't on the rise, that we weren't seeing it. I'm so surprised. And I've been doing this for 31 years now. In that time, what we've seen in the progression of research and in medicine since COVID has been both shocking and exciting to me. It's exciting because it's been accelerated. It's shocking because of how it got accelerated. But if we can learn from this and we can watch the patients in this process and they can have compassionate and thoughtful doctors like yourself, we've got to turn this around.
Dr. Marc Kesselman: Well, thank you. I agree. I think we've seen an overwhelming amount of autoimmunity over the last several years. And unfortunately, I think that we're not at the last stages of that. We're at the beginning of it. We're going to see more viruses, more environmental toxins. And I think we need to be aware. Doctors need to be aware that autoimmunity exists. We need to listen to our patients more. We need to focus more on healthy habits and nutrition. That's going to be very important as the groundwork before we start medications, getting people on healthy habits.
Haylie Pomroy: Absolutely. Because if we can prevent it, or even like in our community, even if we can reduce the amount of medications that a patient needs because they address this multifactor approach, because they're a dimensional body. I mean, they're a multidimensional body. They're a biodynamic body. And you really can't out-medicate, on any level, a poor gut microbiome, nutrient deficiencies, and crushing stress.
I mean, I wish that we could completely out. I would have just kept taking the medication that I was on and not worried about the rest of this if that were the case, even with the patients that absolutely need that medical or pharmacological intervention. I don't want to say they're not going to get away with. They're not going to realize the best health that they can possibly have without supporting their whole body.
Dr. Marc Kesselman: Absolutely. And stress reduction. I think that we have to focus on stress reduction. It's very hard these days with what we see in the news and on television and all of that. It just has caused an overwhelming amount of stress. And we never realized that stress was causing actual positive effects on producing more inflammatory markers. Now we realize the data is there that stress causes an increase in SED rate, increase in CRP, which are inflammatory markers that are negative indicators of disease.
Haylie Pomroy: So, Dr. Kesselman, we've talked a lot about inflammation and joint pain. But when a person's either in a flare or they just have an autoimmune diagnosis, why does there seem to be such an increase in cardiovascular risk?
Dr. Marc Kesselman: Excellent question. When there's a flare, there is systemic inflammation. That inflammation not only is visible in the joints.
A lot of patients will have joint swelling. They'll feel poorly. Maybe their white blood cell count will be decreased. They'll just feel lack of energy. But that inflammation is directly affecting the coronary arteries and causing an increased amount of plaque being deposited in the coronary arteries. We see a lot of cardiac disease and coronary artery disease in our autoimmune population. And we see it at an earlier age than they would normally develop it.
Normally, coronary artery disease is a disease as we get older. But in our autoimmune population, because of the high degree of inflammation, we're seeing cardiac issues at a very young age.
Haylie Pomroy: I think that's such good data for our community because we do this thing called a request for care, which is prepping people for their doctor visit. And I believe women, for sure, men probably for sure too, in their annual visit, they should do an autoimmune panel. We put it in every time, and a cardiovascular panel.
Sometimes, some of their doctors don't feel that they are justified in running an autoimmune panel. But if I can help them communicate that their family has cardiovascular risk and that they're looking at this from a preventative perspective to lessen their cardiovascular risk, I think that would be a really good valid point.
Dr. Marc Kesselman: Very important. And when we look at cardiac risk, we're thinking of risk factors. Does a patient have hypertension? Is a patient a smoker? Is a patient overweight? Do they have diabetes? Do they have high cholesterol? But the interesting part in autoimmune patients is that cholesterol levels may be low, and the risk is still high. Even though you may get a panel that shows your cholesterol levels to be, quote, within normal limits, that still doesn't mean that you have good risk. It means that your risk still could be very high because of your autoimmune disease.
I recommend a lot of times in looking at patients in my autoimmune population doing what we call CT calcium scoring, sending patients in for calcium scoring to be able to look at the deposition of calcium within the coronary arteries, which is one of the earliest signs of atherosclerotic disease.
Haylie Pomroy: And we put that in there also. It's so important to run that. And I think you just said something that also made me think about a better way or an easier way for someone to communicate this, which is sometimes the lipid levels can be stable in these patients. And I remember back in the day begging, and the cost was through the roof to run a HS-CRP, a CRP, a sensitive CRP. It used to be thousands of dollars. Now it's under, it's like 20 bucks or something to run it. But looking at inflammation over the lipid level, I think the tide is changing there, that we're not just looking at total cholesterol, that we're looking at inflammatory response.
But to your point, a CRP, but also a SED rate would be really, really important.
Dr. Marc Kesselman: Absolutely. And an HS-CRP has been a marker of cardiovascular risk for a long time. And we're realizing now that that's super important to run on patients because it does give us an idea, is there underlying cardiac risk? And we know that patients that have autoimmune disease will have cardiac risk. Patients with psoriatic arthritis, patients with rheumatoid arthritis, even my young women patients with lupus have significant cardiac risk. And now we're also seeing the burgeoning field of cardio-inflammatory diseases.
Haylie Pomroy: Yes, the endothelial cell wall, and a lot with our long COVID patients.
Dr. Marc Kesselman: With the long COVID patients as well. We're seeing a lot of cardiac inflammation, and now that inflammation is being treated with anti-inflammatories, even in the post-heart attack period.
Haylie Pomroy: I love that you're involved in a medical school, because if we don't teach our future doctors all of this data, right, we're not going to have adequate physicians, period. But I also love that people are talking about this publicly. With the invent of social media and podcasts, it is something that's come out of it really from a positive perspective. Maybe not the gossip aspect of it, but the empowerment of people to gain medical data and access I think, is really profound.
Dr. Marc Kesselman: Very profound. And I think that patients need to understand what their risks are. Whether they see their primary doctor, their rheumatologist, their immunologist, understanding cardiac risk is very important, and making sure that your blood pressure is good, making sure that your sugar is controlled, making sure that your cholesterol levels are addressed.
Haylie Pomroy: And that you're keeping data. That's why we do that request for care is to get people prepped for their doctor visit. You mentioned earlier that sometimes a physician doesn't have enough time with their patient. I always tell our community we do this. We call it, like I said, a request for care. But the reason why we do this is so that a patient comes in and says this is me from a biomarker perspective maybe or a symptom profile perspective or family history perspective.
There's also, like my mom's blood pressure goes up 50 points when she goes to the doctor's office. And she's a physician, by the way. She has white coat syndrome so bad, which we find as a family very funny. But I always tell her, let's like check your blood pressure five days in a row before you go in so that they're not going, oh my gosh, you're 180 over 90 and freak out.
There's that emotionality of coming in to see your doctor. I think we all are worried about a diagnosis. If you've got an autoimmune disorder, you're worried about it causing some sort of tissue or organ destruction. Sometimes we go online, and we read about it and we hear… I got asked at UCLA to come talk about ITP, my particular autoimmune disorder. And I go out, and I speak all over the world about all kinds of things. My own particular autoimmune disorder, it's really hard for me to give a talk on. And I think it's because I have to dig into the fact that I actually have it. But sometimes going in that doctor's visit can give you that same level of kind of anxiety around it.
Dr. Marc Kesselman: No, absolutely. And wearing a white coat sometimes can cause what we call white coat hypertension or white coat anxiety. It's tough.
I always encourage my patients to write down lists of questions, write down lists of things that they want to talk about so they don't forget. I always also try to give patients lists when they leave the visit of everything that we discussed, what medications that they need to be on, what tests I'm ordering. It's an anxiety-filled visit. I wish it was less anxiety.
Haylie Pomroy: You make it very good for your patients. We get tons of feedback on that. But it's not that way for everybody.
Dr. Marc Kesselman: Unfortunately, not. But hopefully it will be in the future.
Haylie Pomroy: Dr. Kesselman, I know our community is going to have so many questions after we watch this. And I know they're going to want to have access and ask you those questions.
Can I get you to promise me that you will please come back?
Dr. Marc Kesselman: My pleasure. Absolutely. It's been very enjoyable. I enjoy speaking about autoimmunity. And it would be my pleasure to answer any questions that your audience may have.
Haylie Pomroy: Well, any patient that is yours is such a lucky patient. And now our community is lucky for having you as one of their advocates giving them permission to seek the help and seek the medical relationship and to integrate all of the aspects of who they really are, what they eat, what they see, what they think, what they feel, and realize it as a real and actual experience that they're having and find a partner that can help them get the care they deserve.
Dr. Marc Kesselman: Thank you. Very, very, very much.
Haylie Pomroy: Thank you so much. Thank you.
