Nutrition for Managing Autoimmune Disease with Dr. Marc Kesselman

Understanding Autoimmune Disease: Nutrition, Hormones, and Healing Strategies

Have questions about autoimmune disease and the Fast Metabolism approach? Join the Fast Metabolism community and get personalized guidance from Haylie and her team at hayliepomroy.com/member.

Autoimmune disease affects an estimated 50 million Americans — yet for many, the path to diagnosis, understanding, and effective management remains frustratingly unclear. In this episode of the Fast Metabolism Matters podcast, host Haylie Pomroy sits down with Dr. Marc Kesselman, rheumatologist, chair and associate professor at the Department of Internal Medicine at Dr. Kiran C. Patel College of Osteopathic Medicine, and chief of the Division of Rheumatology at Nova Southeastern University — for one of the most comprehensive conversations on autoimmunity, nutrition, and healing available today.

Whether you've been living with an autoimmune condition for years or are just beginning to understand what's happening in your body, this episode is packed with clinical insight, practical guidance, and real hope.

What Is Autoimmune Disease? A Plain-Language Definition

At its core, autoimmune disease occurs when the body's immune system — designed to protect you from foreign invaders like bacteria and viruses — mistakenly begins attacking its own healthy tissue. Instead of recognizing the body's own cells as "self," the immune system treats them as threats and launches an inflammatory response against them.

There are more than 100 recognized autoimmune conditions, including:

  • Rheumatoid arthritis — the immune system attacks the joints
  • Lupus (SLE) — affects multiple organ systems including the skin, kidneys, and heart
  • Hashimoto's thyroiditis — the immune system attacks the thyroid gland
  • Multiple sclerosis — the immune system damages the protective covering of nerve fibers
  • Celiac disease — an immune reaction to gluten that damages the small intestine
  • Psoriasis — an immune-driven skin condition
  • Type 1 diabetes — the immune system destroys insulin-producing cells in the pancreas

Understanding your specific diagnosis is the first step — but understanding why your immune system became dysregulated in the first place is where real healing begins.

Why Do Autoimmune Diseases Disproportionately Affect Women?

One of the most striking facts about autoimmune disease is its gender disparity: approximately 80% of autoimmune disease patients are women. Dr. Kesselman discusses this imbalance in depth, and it's a critical conversation for anyone managing or researching these conditions.

Several factors contribute to this disparity:

Hormonal influences: Estrogen has a direct stimulating effect on the immune system, which may increase immune reactivity in women. This helps explain why many autoimmune conditions flare during hormonal shifts — puberty, pregnancy, postpartum, perimenopause, and menopause.

Chromosomal factors: Women carry two X chromosomes, and the X chromosome contains a high concentration of immune-related genes. Having two copies may increase the likelihood of immune dysregulation.

Microbiome differences: Emerging research suggests that the gut microbiome — which plays a central role in immune regulation — differs between men and women in ways that may influence autoimmune risk.

For women managing autoimmune conditions, tracking symptoms in relation to hormonal cycles can be an important tool in identifying triggers and anticipating flares.

The Genetic Component of Autoimmune Disease

Autoimmune disease runs in families — but genetics is only part of the picture. Dr. Kesselman explains that while certain genetic markers increase susceptibility to autoimmune conditions, genes alone don't determine your fate.

This is where epigenetics becomes critical. Epigenetics refers to changes in gene expression caused by environmental and lifestyle factors — without changing the underlying DNA sequence. In practical terms, this means:

  • You may carry a genetic predisposition for an autoimmune condition
  • But environmental triggers — including diet, stress, toxin exposure, infections, and sleep disruption — can "switch on" that predisposition
  • And lifestyle interventions, including targeted nutrition, can influence whether those genes are expressed

This is an area where Haylie Pomroy's "Food is Medicine" philosophy intersects powerfully with clinical rheumatology. What you eat doesn't just fuel your body — it communicates directly with your immune system and your genes.

Autoimmunity and Post-Infectious Illness: The Connection You Need to Know

One of the most timely topics in this episode is the relationship between autoimmunity and post-infectious illness — including post-COVID conditions.

Dr. Kesselman explains that infections can act as triggers for autoimmune disease in genetically susceptible individuals through a process called molecular mimicry: the immune system, while fighting off a pathogen, creates antibodies that accidentally cross-react with the body's own tissue. When the infection clears, the immune attack can continue.

This mechanism has been observed in:

  • Post-streptococcal conditions (including rheumatic fever)
  • Lyme disease-associated autoimmunity
  • Post-COVID syndrome, where ongoing immune dysregulation, fatigue, joint pain, and neurological symptoms persist long after the initial infection

If you or someone you love has been experiencing new or worsening symptoms following an infection, discussing autoimmune screening with a qualified rheumatologist is an important step.

The Role of Nutrition in Managing Autoimmune Disease

This is where Haylie Pomroy brings her signature depth of knowledge — and why this conversation is so valuable for the Fast Metabolism community.

Nutrition is not a cure for autoimmune disease. But it is one of the most powerful tools for managing inflammation, supporting immune regulation, and reducing the frequency and severity of flares.

Key nutritional principles for autoimmune management include:

1. Anti-inflammatory eating patterns A diet rich in whole foods, colorful vegetables, healthy fats (like omega-3 fatty acids from wild-caught fish, walnuts, and flaxseed), and lean proteins supports a regulated immune response. Reducing processed foods, refined sugars, and industrial seed oils can significantly lower systemic inflammation.

2. Gut health and the gut-immune connection Approximately 70–80% of the immune system resides in the gut. A healthy, diverse gut microbiome is essential for immune tolerance — the ability of the immune system to distinguish between self and non-self. Prioritizing fiber-rich foods, fermented foods, and prebiotic-rich vegetables supports the gut environment that keeps immune responses calibrated.

3. Identifying food sensitivities and triggers For many people with autoimmune conditions, specific foods can act as inflammatory triggers — even foods that are otherwise considered healthy. Common culprits include gluten, dairy, nightshades, eggs, and high-lectin foods. Working with a knowledgeable practitioner to identify your personal triggers through an elimination protocol can be transformative.

4. Nutrient sufficiency Autoimmune conditions are frequently associated with specific nutrient deficiencies that directly impact immune function, including:

  • Vitamin D — a key regulator of immune response; deficiency is strongly associated with autoimmune risk
  • Magnesium — supports hundreds of enzymatic processes including those involved in inflammation regulation
  • Zinc — essential for immune cell development and function
  • B vitamins — critical for methylation and cellular energy, both of which affect immune health
  • Omega-3 fatty acids — directly suppress inflammatory cytokine production

Alcohol, Exercise, and Autoimmune Flares: What the Research Says

Dr. Kesselman offers clinical guidance on two lifestyle factors that come up constantly in the autoimmune community: alcohol consumption and exercise.

Alcohol and autoimmunity: Alcohol has a complex relationship with the immune system. While light consumption may have some anti-inflammatory effects in healthy individuals, in people with autoimmune conditions, alcohol can:

  • Disrupt the gut lining, increasing intestinal permeability ("leaky gut") and allowing inflammatory compounds into the bloodstream
  • Interfere with medications commonly used to manage autoimmune conditions
  • Disrupt sleep architecture, which is a key driver of immune regulation
  • Trigger or worsen flares in conditions like lupus, psoriasis, and rheumatoid arthritis

Exercise and autoimmunity: Movement is medicine — but the type, intensity, and timing of exercise matters enormously for people managing autoimmune disease. Dr. Kesselman discusses how:

  • Moderate, consistent exercise — like walking, swimming, and yoga — can reduce systemic inflammation and improve immune regulation
  • Overtraining or high-intensity exercise during a flare can actually increase inflammation and worsen symptoms
  • Rest is a legitimate and necessary part of an autoimmune exercise protocol, not a sign of weakness

For anyone using the Fast Metabolism Diet or Haylie's programs alongside an autoimmune diagnosis, this guidance is especially relevant — the goal is to support the body's healing capacity, not push through inflammation.

Strategies to Help Prevent Autoimmune Disease Progression

For those already diagnosed, the conversation around prevention shifts from avoiding the condition to slowing progression, reducing flares, and preserving function and quality of life. Dr. Kesselman outlines several evidence-supported strategies:

Early and accurate diagnosis: The sooner autoimmune activity is identified, the more options are available to manage it before significant tissue damage occurs. Don't dismiss persistent fatigue, joint pain, skin changes, or unexplained symptoms.

Stress management: Chronic psychological stress is one of the most well-documented triggers for autoimmune flares. Practices like meditation, breathwork, adequate sleep, and nervous system regulation are not optional add-ons — they are core components of an autoimmune management protocol.

Environmental toxin reduction: As discussed in previous episodes with Dr. Irina Rozenfeld, toxin exposure can act as a trigger for autoimmune activation. Reducing exposure to heavy metals, mold, pesticides, plasticizers, and air pollutants is a meaningful protective strategy.

Consistent follow-up with a rheumatologist: Autoimmune conditions are dynamic — they change over time. Regular monitoring allows for early detection of changes in disease activity and timely adjustment of treatment plans.

Medication adherence when prescribed: For many autoimmune conditions, disease-modifying medications are essential tools. Understanding why a medication has been prescribed and working collaboratively with your physician is key to long-term outcomes.

About Dr. Marc Kesselman

Dr. Marc Kesselman, DO, FACOI, FACC, FACR is the chair and associate professor at the Department of Internal Medicine at Dr. Kiran C. Patel College of Osteopathic Medicine and the chief of the Division of Rheumatology at Nova Southeastern University. He received his medical degree from Des Moines University College of Osteopathic Medicine and has been in practice for more than 20 years, bringing deep clinical expertise in rheumatology, autoimmune disease management, and internal medicine.

Connect with Dr. Kesselman on LinkedIn: linkedin.com/in/marc-m-kesselman-d-o-facoi-facc-facr-6491479

About Haylie Pomroy

Haylie Pomroy is the founder and CEO of The Haylie Pomroy Group and a leading health strategist specializing in metabolism, weight loss, and integrative wellness. With over 25 years of experience working alongside top medical institutions and high-profile clients, Haylie has developed targeted programs and supplements rooted in her "Food is Medicine" philosophy.

Inspired by her own autoimmune journey, she combines deep expertise in nutrition, biochemistry, and patient advocacy to help others reclaim their health. She is the New York Times bestselling author of The Fast Metabolism Diet.

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Listen to the Full Episode

Tune in to the full conversation with Dr. Marc Kesselman on the Fast Metabolism Matters podcast for a deep dive into autoimmune disease, the clinical perspective on nutrition and healing, and practical strategies you can begin implementing today.

Have questions about autoimmune disease and the Fast Metabolism approach? Join the Fast Metabolism community and get personalized guidance from Haylie and her team at hayliepomroy.com/member.



Transcript

Haylie Pomroy

Hi, I'm Haylie Pomroy, your host of Fast Metabolism Matters, and today we're going to take on a topic that's very near and very dear to my heart, which is autoimmunity. I'm bringing in Dr. Marc Kesselman. He's a rheumatologist at the Kiran C. Patel College of Osteopathic Medicine.

We've worked together on cases, and at the Institute of Neuroimmune Medicine, we collaborate a lot on what's going on with this big surge in autoimmunity. He covered things like estrogen dominance in women, why the X chromosome — the second X chromosome that we carry — makes us more susceptible, things that we can do to prevent it, labs to run, how we can make our body more resilient or tolerant if we've been diagnosed with an autoimmune disorder.

This was a great episode, you guys, and as always, you asked some incredible questions. So hold on, let's get ready. Let's have Dr. Kesselman come talk to us about autoimmunity.

Today, I have Dr. Marc Kesselman back with us. Dr. Kesselman, your episode that we did had so many views, and what I noticed was there were so many people that had so many questions. And so thank you so much for coming back, because I would like to just kind of run through and see if we can help people get anchored a little bit about autoimmunity — what it is, what it means to our bodies.

But thank you so much for being here with us. I know you're crazy busy.

Marc Kesselman

Well, thank you. Thank you, Haylie, and your team. I certainly appreciate the opportunity to speak with you and your audience.

Again, autoimmunity is a complex issue. It's probably one of the hardest courses in medical school for medical students. So it's not unusual for it to be a topic of great interest.

So it's my pleasure to be here and discuss and explain whatever I can.

Haylie Pomroy

Yeah. And you mentioned medical school — it's evolving so much.

I mean, we were at the International Conference for Autoimmunity, and I could not believe how many new ideas were coming into play. And I think long COVID is bringing that up too. We've kind of had this quick trajectory into, oh no, what do we do with the immune system?

The immune system — I mean, talking about the immune system has been really exciting. I wanted to ask: why are we seeing — there are some statistics going around, some people say it's 80% women — but why are we seeing a disproportionate amount of autoimmunity in women?

Marc Kesselman

That's a good question. I think there are a lot of reasons for that. Traditionally, autoimmune diseases have been more common in women, and it's mainly because of estrogen.

Estrogen is a modulator. It's a hormone that modulates immune function, and it enhances immune reactivity, which means that it can be an accelerator of immune activity. So hormonal fluctuations, which occur during different diseases and also natural situations like puberty, pregnancy, and menopause, can influence the onset and also the severity.

So because of different fluctuations in estrogen, and also testosterone in men, there are different situations that are aggravated and can become more severe. The other part is that we know that women genetically have two X chromosomes, and many of the immune-related genes are located on the X chromosome. There's a kind of a genetic tendency as well.

Now, there are some autoimmune conditions that have a little bit of male dominance, like ankylosing spondylitis. But the majority — the rest of the autoimmune diseases — are more estrogen-based. Women generally mount a stronger immune response than males, which helps fight infection, but also increases the risk of autoimmunity.

So it's certainly complex.

Haylie Pomroy

And so when women go through menopause, and some of their E2s drop, and the E1 elevates — that's even more inflammatory than E2. It doesn't modulate as easily.

Marc Kesselman

Absolutely. And that's a great point. And one of the things we also see is when menopause starts hitting at that stage, a woman's risk of other diseases becomes equal to a man's risk.

So for example, at menopause, as estrogen starts falling, the risk of coronary disease starts increasing. The risk of osteoporosis and bone diseases starts increasing. So at that vital age — in the 50s, or whenever menopause starts hitting — it's really important to be aware, as a physician, when talking to a female patient, that the woman's risks of certain diseases can start increasing or becoming equal to a man's at the same age.

They don't have that hormonal protection that they did when they were younger.

Haylie Pomroy

I love that you use the term "hormonal protection." We have so many people — in our community, we talk a lot about hormone replacement therapy. We talk about autoimmune diseases.

And one of the things that I just really, really try to stress in our community is, when you start having your annual checkup, to add autoimmune screening in there. Because there is so much — and we'll talk about that — there's so much that you can do from a nutrition perspective, from a stress reduction perspective, from looking at your overall health and wellness. But if you don't know that it's there, then you don't maybe feel as compelled to make those positive lifestyle modifications.

What labs would we add in if we were going to start suggesting — and so I suggest in my community — that we add that as part of your annual physical? Is it just an ANA, or what do you like to see when you're screening for autoimmunity?

Marc Kesselman

It's a good question, and I'll just jump in on hormonal replacement. I think that hormonal replacement is a whole other issue. And I think we as a medical community may have gotten it wrong — we stopped the use of hormonal replacement and it was stopped for such a long period of time because of risks of cardiac disease and cancers.

And now when we look at it, we know that there's a tremendous benefit in continuing hormone therapy after a woman reaches menopause because of its positive effects on bone health and on general health itself. But there's certainly another issue that we can talk about at some point.

Haylie Pomroy

I love that you brought that up because so many times when an individual is doing hormone replacement therapy, I'm like, let's make sure we do an autoimmune screen, because they are so cohesive in how they impact the body, and vice versa. I always tell people that have been diagnosed with an autoimmune disorder, let's make sure we're looking at a complete sex hormone profile. Let's make sure we're looking at sex hormone binding globulin.

Let's make sure that we're balancing the body so that it can be less reactive and less pro-inflammatory. I love that you brought that to the forefront. What labs do you love to see?

I'm going to prepare a patient for coming into you. What would be your dream, that I had already run for you?

Marc Kesselman

So in screening labs to look at autoimmunity, there is a lab test called an anti-nuclear antibody. It's basically a broad screening test for connective tissue disease. So for example, if we wanted to test the entire population of the world on whether there was any evidence of autoimmunity, we would want a sensitive test that would give us some idea of the degree of autoimmunity in the total population.

That's an anti-nuclear antibody. If we knew the percentage of patients that have some degree of autoimmunity and we wanted to drill down further, then we could go to extensive testing specifically to look for the degree of lupus or the degree of Sjögren's or other connective tissue diseases. But as a general screening test, an ANA is an excellent general screening test to see if there is some degree of autoimmunity.

Haylie Pomroy

Is there a difference between the ANA titer and the sedimentation rate, or the sed rate?

Marc Kesselman

Yes. Yes. So there's a difference.

The ANA will give you a titer. And generally it goes from a low titer of something called one to 40. That's the lowest that is recorded.

It can go lower in certain sensitive testing that's done in certain places in the country. But a titer of one to 40 is the lowest titer that it could be. And then it doubles from there to one to 80, one to 160, one to 320, and so forth.

The higher the titer, the more significant that titer and that test is. So somebody that has a rather low titer — maybe one to 40, one to 80 — may have early evidence of some autoimmunity, or may be on the threshold, or may just be in the general population of patients that has a positive test without any evidence. But as that titer doubles and triples and quadruples, and if we get a titer of one to 640 for example, the strength of that is that the statistics show there's a higher chance of some degree of autoimmunity, and it's something we can pinpoint at that higher level.

So the higher the titer, the more significant that titer is. That is separate from the sedimentation rate, which is really a marker of inflammation. So the sed rate, or ESR — erythrocyte sedimentation rate — is basically in a red blood cell.

And the C-reactive protein — they're both liver markers — those are markers of inflammation only. So those don't tell us about whether there's autoimmunity, but they tell us, is there inflammation going on in the body?

Haylie Pomroy

So the body can have an inflammatory response but not be in an autoimmune state. Can I take it back and ask you to explain to us — what does it actually mean to be positive for an autoimmune disorder? What's happening in the body?

Marc Kesselman

That's a great question. So the very important part of this is, what are autoimmune reactions and what is autoimmunity? Autoimmunity means literally the body fighting itself.

So what happens is — the term that we use in immunology or in rheumatology is what's called "loss of tolerance." Think of it as a pool table, and on the pool table are all just red pool balls. All of a sudden, one of those balls turns blue.

Out of a hundred balls on a pool table, one turns blue. And all the other red balls say, hey, how are you? Everything's great.

We're glad to have you here. You look different than us, but we're okay. Everything's great.

Well, now all of a sudden, that blue ball starts getting very antsy and it starts bumping into all the other balls. And now it's causing a problem. He or she or they are causing a problem.

Now there's a loss of tolerance. All the other red balls say, hey, you're different. We have to react differently.

So there's a loss of tolerance. It's a loss of tolerance of change or difference from the other cells. And that's what happens as a result of autoimmunity.

One of the cells changes in the body and it changes to the point that the other cells don't accept it as one of their own anymore. And when that happens, the immune system gets activated and starts saying, hey, there's some type of loss of tolerance here. Is this a bad actor?

And if they sense that it is, it starts creating antibodies or defenders to try to defend the other cells and the body against this bad actor. And one of the antibodies that they create is this ANA — anti-nuclear antibody. So it's actually a defender to defend itself from other bad actors.

And that can occur. For example, COVID came to us and we didn't have any memory of it. And we didn't have any antibodies.

And that's why we recommended widespread vaccinations. But COVID is a virus. And when a virus comes to us, we do the same type of evaluation.

Are you bad or good? If it's bad, we start saying, okay, we need to create a defender and we try to create antibodies against this outside influence. In autoimmunity, we're creating antibodies against an internal, self-generated threat.

Haylie Pomroy

When we were in Cambridge this year, there were a variety of different international scientists presenting. And a couple of them were talking — and I love that you brought up COVID — they were talking that possibly we're looking at long COVID having an autoimmune character. I'll use that.

What are they saying in the rheumatology world? Are they embracing that theory? Are we pondering it?

Do we feel like we've got some data around it?

Marc Kesselman

Also an excellent question. So the answer to that is, from the rheumatology community, we're very much aware that COVID — this virus — and in some instances the vaccination as well, may have caused the body to start creating these autoantibodies. And we have seen in patients that have had COVID one time, two times, three times, also vaccinations, that there are a lot of new antibodies that have been created.

So there's definitely a risk that these antibodies may generate some degree of autoimmunity. We don't know yet, because we need the longevity studies and longitudinal studies to kind of see where these go. In a lot of patients, the autoantibodies are just sitting there.

They're not reactive yet. The red pool balls are not reacting to the blue one — not yet. But there's always that potential.

And the only way we know is to put these patients on surveillance. So yes, I think we're very much aware that this is a potential. We don't know where it's going yet.

Haylie Pomroy

Right. And it's been — I hate to say fascinating, but it's been fascinating to watch — because I think it's really made us all think about what is causing such a surge in autoimmunity. You mentioned that sometimes a virus can trigger it, like we've seen a lot of Epstein-Barr virus.

Are they correlating that with things like MS or other potential autoimmune conditions? What can trigger autoimmunity? What makes the cell change and causes us to attack ourselves?

Marc Kesselman

That's a great question. And I think we're going to continue to ask ourselves that. There are several different potential triggers, and we don't know all of them.

We know that genetics plays a big role. And certainly there are certain genetic attributes and certain genetic markers that show that patients are vulnerable to autoimmune events. We know that in lupus, we know that in rheumatoid arthritis, there are certain genetic profiles that are definitely found in patients that have certain autoimmune diseases.

Haylie Pomroy

So do they have more of a tendency? So it's like an epigenetic perspective — something turns it on?

Marc Kesselman

Yes. So they have that genetic tendency, but they need more than that for that autoimmune reaction to occur. And again, let me just take a step back.

Even if you have autoantibodies, or you have a genetic tendency, or you have an abnormal bacteria or a virus in your system, you need kind of a multiple of reactions to occur and lightning to hit. And then all of a sudden, lightning hits that cell — that one cell — and starts that trigger going. And once that trigger is activated, it starts causing a lot of inflammation going elsewhere and everywhere else in the body.

Up until that point, a patient can have a genetic vulnerability, a patient can have autoantibodies, a patient can have abnormal bacteria, but not go into that autoimmune response until that one situation triggers it to start becoming active and causing inflammation.

Haylie Pomroy

So we did family testing because I have an autoimmune disorder. You and I have talked about it a lot. Every time I get Dr. Kesselman to myself, I'm like, what about this?

So we did do some screening on both my son and my daughter. And that predisposition is definitely evident with both of them. And so, yeah, I'm 31 years in clinical practice of nutrition.

I'm now a research scientist in neuroimmunology, finishing my PhD. All of that is to say that I try to be a stickler with their nutrition, because I think that's one of the most powerful things that we can do to prevent and cool off — on all facets, all aspects of it. And you and I have had a lot of conversations about that.

There are a few triggers that we had a great conversation about, which was gluten in the diet. And I love the way that you have explained that to me. I was hoping that you could talk to our community about that.

I think sometimes they think I'm just the gluten police or a buzzkill, but it's really important when we're talking about autoimmunity and inflammatory perspectives.

Marc Kesselman

Absolutely. Gluten is a major cause of symptoms in patients. There is a disease called celiac disease, which is really a true autoimmune disorder, and it's triggered by gluten.

It occurs in a small percentage of the population, but I see it in a large percentage of my rheumatological population of patients who are gluten sensitive. There is gluten sensitivity that's non-celiac based. So there's what's called non-wheat, non-gluten sensitivity.

And those situations exist as well. So a patient may test negative for celiac disease but still have a gluten-sensitive behavior. Some people feel better on a gluten-reduced diet — without a doubt — whether they test positive or negative.

Sometimes when patients are placed on a gluten-free diet, they just feel better. Even though their blood doesn't show that they have a true gluten sensitivity, they're not celiac positive, but they feel better. And there are patients that don't need to be on gluten-free diets.

I think it's all trial by elimination. Elimination diets and seeing what patients are sensitive to, seeing what diets aggravate disease. And I think I tell all my patients, make a diary.

If you wake up the next morning and you don't feel well, what did you eat the day before? Put that down, and it's not worth getting sick over. There are multiple foods to eat that are delicious.

But don't force yourself, because sometimes when we see people that continue to force themselves to say, I'm going to eat the gluten, they get worse and worse. And then all of a sudden it triggers acute flares of their inflammation. So that's the end result.

Haylie Pomroy

Once a person has — yeah. And we're big on rotating your foods, right? Not eating the same thing every day.

And, you know, I am — from my autoimmune perspective — gluten, soy, wheat, dairy, and corn free. We find in the animal population that those are all what we use for a pro-inflammatory weight gain, is what we say when we are formulating feed. We want to trigger the certain hormones that create adipocytes and things like that.

So for me, from an autoimmune perspective, those are just out. And then the rotating is so important. We're seeing people — and I was one of them — where they've been maybe diagnosed with lupus, or celiac, and then they start stacking the autoimmune receptivities or testing. Do they truly have multiple autoimmune disorders, or is the testing just becoming sensitive because they're in that pro-autoimmune, inflammatory perspective?

I've heard debate on that.

Marc Kesselman

Yeah, sure. That's a really good question. The answer to that is, when you have one autoimmune disease, it makes you more vulnerable to others.

I see patients who generally have — they may have lupus, but they also may have a mixed connective tissue picture as well, where a patient may have two competing autoimmune conditions. And generally one is more dominant than the other and has more symptoms. So we end up treating the more dominant situation, but a patient can have celiac disease.

A patient can have a skin disease called vitiligo — which is another autoimmune skin disease — a thyroid condition, and also have rheumatoid arthritis, or also have lupus or Sjögren's. So it's common to see one autoimmune condition and a secondary autoimmune condition. In fact, the way I was trained is we should always watch out for that second autoimmune condition to develop.

Haylie Pomroy

I had a client that had really low — like a one to 40 ratio — ANA titers, but she had dermatographia, right, where we could write on her arm. And then she got a tick bite and got really sick. But we had checked her for celiac several times because she did have that gluten sensitivity.

And I know that there's more testing now, but she got a tick bite, she got really sick, and then her ANA titers went to one to 640. She developed dermatomyositis. And then, what was crazy was, boom, she popped positive for celiac.

I mean, it was just like — you know — maybe the scenario was, the table was set. What happens in situations like that?

Marc Kesselman

Well, that is a good example of one situation where you have an acute inflammatory response. Dermatomyositis — for your audience — "derm" is the skin and "myo" is muscle. So breaking down the word, it's a skin and muscle inflammatory disease.

It is prevalent in children and prevalent in adults. And it is generally an active systemic cause of inflammation. Once there's systemic inflammation, it breaks down the barriers in the body for opportunistic other infections, and also autoimmune diseases to kind of sneak in there and start setting up shop.

So once a patient has one condition — which is an acute muscle and skin inflammation — other inflammatory and autoimmune conditions can certainly pop up because of the vulnerability that is now created by the primary autoimmune condition.

Haylie Pomroy

I love that. I was so lucky — I was young when I was diagnosed with ITP, the autoimmune disorder that I have. And I have the best hematologist at UCLA who really said to me, control your stress, control your nutrition, and set your environment up to be conducive to you staying out of an inflammatory period.

And then I went and got in a car accident. But I worked so hard. My focus is always, okay, the best thing that I can do is not insult my body with things that can trigger other autoimmune disorders, balance my nutrition, and focus on stress reduction. And for me it's been a wild success.

You know, my platelets are normal. I don't take any medication anymore. I worked really hard.

But he really sat me down and said, don't take this lightly. This is a turning point. I had been accepted into vet school and I took a medical leave of absence.

And I honestly feel like it was because he was honest and candid with me — that this is a turning point in your life and you can either live an incredibly healthy life and get control of this, or you can continue to eat Funyuns and grape soda — and I just dated myself — and it's just a slippery slope and it's not going to a good place. So how do you help clients embrace or feel empowered? Because, to leave that school — you know, maybe people would think that was tragic, but for me it was like this massive shift in empowering myself to have control over my health destiny.

So how — and your patients love you — how do you work with them so that they feel like, look, they've gotten this diagnosis and now, how do I take control and empower myself?

Marc Kesselman

Well, thank you. First of all, I think what you've done in your journey is just absolutely amazing. And I really applaud how you've handled it.

You know, when I talk to patients and I manage patients, making them feel empowered — that they do have a chance on their own to try to help themselves — I think is very important. Cutting out specific environmental triggers, for example, smoking, or being away from high-powered radiation lines, or any type of pollution — cold weather sometimes can be a trigger. I think those are very important.

And, you know, you stressed the nutritional part. I really believe that nutrition plays a big role in helping people deal with their autoimmune diseases. Now, again, my lupus patients are very fragile.

They could do everything right, and then somehow the body just changes even overnight, and they can go from a stable situation today to ending up in the emergency room tomorrow. So a lot of these patients are dancing on a razor's edge as far as stability. But I think that being on a good diet, eating healthy, exercising, being spiritual and getting good relief from that, and stress reduction — I think all of that plays a big role in keeping people at the best that they can be.

And also having good contact with their physician. And again, I think I may have stressed this earlier — if they don't feel well, don't hide it. Don't try to say it's going to get better.

Let somebody know so somebody can evaluate and say, okay, this is okay, you're doing fine, this was just a little blip — or, I need to do something else with you, with your medications or something else, before it turns into something catastrophic.

Haylie Pomroy

And I love what you do where you look at what the immune system is doing when they're having an autoimmune flare, so that you can almost reverse-engineer it to tailor their body specifically. And I encourage everybody — if you're working with a rheumatologist that's not Dr. Kesselman — to really look at, when you do have a flare, go in, get your labs run. Look at your CK, look at homocysteine. We look at TNF alpha, we look at IL-1, we look at a lot of different immune markers, because we want to understand what your body is doing in a flare and how we can possibly support that flame to stay nice and low and not stimulate a reaction.

You said something to me about smoking, radiation lines, pollution, cold weather. Where do you land on alcohol? Every so often — I've never tolerated alcohol well — I've always wondered about wine apparently, but genetically neither of my kids do. They both called me during college and complained about that.

But every once in a while, I'm like, okay, I'll have a glass of wine. And I just — boom — inflammation. And I've tested for every allergy you can think of related to alcohol, because I think if I could wrap my head around that and not blame it on my autoimmunity. But how do you weigh in? What do you see with your patients with that consumption?

Marc Kesselman

Another good question. What I see with my patients is an intolerance to alcohol — a general intolerance to alcohol. And even though, you know, from the American College of Cardiology, for a while we were recommending maybe one or two drinks a week, more of a red wine because of the anthocyanidins and the colorful aspects that are creating antioxidation in the body —

But now we also know, by current literature and current data, that there's a relationship to cancer with alcohol. And one of the other aspects in rheumatology is we use medications that could be directly affected by alcohol. Patients who are on Tylenol — if you take a Tylenol and then combine that with alcohol, that starts causing significant liver dysfunction.

There's a medicine that we use in rheumatology called methotrexate, which is one of the most common medicines we use for treatment of rheumatoid arthritis and other diseases. Combining that with alcohol can cause significant liver dysfunction and elevation of liver tests and hepatic dysfunction. So in general, I think that alcohol is a bad actor and can trigger autoimmune events.

It can trigger — and now we know it triggers cancer. There was this idea that maybe it's beneficial for patients with heart disease because of the French studies that showed they drink lots of alcohol and have lower rates of heart disease, but we know that that has not been proven true. And it certainly has not been proven good for patients with autoimmune diseases as well.

Haylie Pomroy

I appreciate that. And it's so funny because literally every couple of years or so, I'll be like, I think I can have that. The little person sitting right here says, just try it again.

And then I literally can't get my rings off and my body hurts and I just go, okay. We have some great questions from our community. I want to ask one more — more on the psychological and spiritual aspect of it.

We talk a lot about what we call "fear of the flare" in our world, in our community. And with ITP — that I have — I mean, I was moving a ton of furniture and I literally banged and dropped things and ended up with a bruise on my leg, and I had to talk myself off a cliff. I said, it's okay.

And what I do is, I'll run — I've got an open order with my rheumatologist, who has been my rheumatologist for almost 30 years. He just lets me test my platelets and my ANAs and whatever I want, whenever I want, because he says emotionally, it's good for me. Right.

So, you know, big gnarly bruise and I know exactly what I did. But when my ITP was in full flare, I would bruise — I mean, I could count 20 bruises on my leg and 14 on my arm, and my gums would bleed. So after this many years, I ran in and said, let's look at my platelets, look at my liver values, and look at my ANA titers. Everything was pretty good.

But how do you help people that are just waiting for that other shoe to drop? How do you counsel people in that?

Marc Kesselman

It is — there's a definite nervousness and anxiety. Once people have finished their flare, will they develop another one? I think trying to give people a sense of confidence — yes, you may develop a flare — and letting people know that there's a good potential that another flare could develop, but we have to have a plan on how to treat it.

Your rheumatologist is saying, go get your labs checked. You'll be able to see your platelets. So you get immediate understanding of that.

And in that situation — for example, in ITP, which is autoimmune thrombocytopenia, where patients are developing antibodies to the platelets or antibodies to the white blood cells — the platelet count drops and the white blood cell count drops, and you start feeling poorly in those situations. The most important thing is to try to understand the flare and the timeline, so that you're able to be aware of kind of the flare aura.

You know, we call it migraine aura — where a lot of patients with migraines, you kind of know they're going to get a migraine. You get this aura that says, oh my goodness, let me go take my medicine, my shot, whatever, to try to prevent that migraine from accelerating and going catastrophic. In autoimmune diseases, there is a slight aura or a slight pre-flare condition that people will notice they start developing.

And if they're aware of that, they may be able to either take medications, contact their healthcare provider, or do something that may prevent it from progressing more than it is at that point. And I think making people more self-aware is really super important.

Haylie Pomroy

And whenever I have fear of the flare, I use the fear as — I have three things. I go, stop, take two minutes. Sometimes I'll go into the bathroom — if we're at the clinic, if we're at the Institute of Neuroimmune Medicine and it's crazy, I'll run into the bathroom.

And I just go, okay, Haylie, these are my three things. How is your sleep? And I sleep like it's a medication. I focus on the priority of sleep as if it's a lifesaving medication, like I equate it to something that would, you know, like an ambulance that would pick me up from a car accident. It's that important for me, to keep me out of a flare.

I say, how's your food? And again, my triggers are corn, wheat, dairy, soy, coffee, and alcohol. And then I say, just assess — where are you around your triggers?

We had people that were staying at our home, and one thing that hits me really hard is any of the peripherals. So, like, Raid or bug spray — which I have none of in my home — but I always just do an assessment. We had a person at the barn who had brought in a different kind of horsefly spray. And I'm like, okay, it's time to clean house. Make sure my environment is conducive to me staying healthy. And so those are kind of my three things.

Are you sleeping? What are you putting in your body and consuming? And what are potential environmental triggers?

And then the fear of the flare — I try to think of it as, it's time to check in. It's just time to check in and say, what's going on? Because all of that data that's coming in, your body peripherally knows like you're not eating right, or you didn't get enough sleep. And so I think it kind of elevates that cortisol a little bit and says, you know, razor, you're on the razor, get off the razor. That's been really helpful for me.

Marc Kesselman

Absolutely. I think recognizing — people who go through flares will recognize when they're in one. They may have certain complaints. For example, if you have an autoimmune blood condition, you're going to feel weak and tired. And there's just a complete general change from your normal behavior.

Some patients will have joint swelling — they'll notice their hands are tight, they can't open and close their hands, or they'll get swelling in elbows or arms. Some people get bruising, like you described — those bruises that will just start popping up. They'll wake up one morning and all of a sudden see five or six bruises and they know they didn't have any traumatic accident that could have caused it.

So I think recognizing where the flare is and then having the plan — do they have medications? Do they have prednisone or a steroid available just in case? Did they take their medicines as they were supposed to? Do they have medicines on board? Are they eating right? Is there something that they may have eaten the day before that they said, oh my goodness, now I know I shouldn't eat that again?

And generally, making sure that they're hemodynamically stable and that they can keep going, or do they feel like, I need to reach out to somebody because I don't want to get worse. I'm concerned that there may be some issue that I may not be able to function appropriately.

So I think making sure that people have that ability to say, look, I need to reach out to somebody, or I need to go to the emergency room myself — that's really, really important.

Haylie Pomroy

Yeah. And it's so interesting that you said that. It was another real pivot point for me. Once I felt like I started getting things under control and it wasn't just this wild, out-of-control feeling — and I spent a big chunk of time in the hospital with different kinds of options that I had to sort through: IV chemotherapeutics, I was on 60 to 80 milligrams of prednisone, and then I lost significant function in my right kidney, which didn't go very well. But I was a surgical tech in the veterinary space, so it was easy to stay on prednisone. It felt good, I felt amazing, but I wasn't testing my body.

And then I started going down, I started feeling better. And I remember Dr. Arzu, my hematologist — he was like, Haylie, we need to check you and monitor you. And I'm like, I'm good, leave me alone, because I just wanted out of it.

But this is the pivot part for me where I said, okay, be empowered. Don't be afraid. I ended up hemorrhaging with an ovarian cyst that ruptured — and ITP. I know. And I got to the hospital, my platelets were 53.

I didn't want a transfusion. But it was at that moment I said, okay, it's one thing to bury your head in the sand. That was when he and I had a big, kind of coming-to-Jesus moment medically, where he said, I understand that you didn't tolerate prednisone well. I understand — I tried it, I was on methotrexate, I tried cell separators, which were really hard on me. I tolerated Imuran better, but it was so hard for me. So I understand that. But we have to create a protocol for progress for you. You can't just be without a plan, and then I get a call that you're hemorrhaging in the hospital.

So that's when we started testing things regularly. In the beginning, fortunately I worked in a clinic, so I was able to test every quarter — four times a year — but we usually recommend twice a year to look at, and everybody's autoimmune markers are different.

Like with my client that had dermatomyositis, her aldolase was a really nice marker. Her aldolase and her CK were really nice markers as we were getting her back into a state of better homeostasis and health. And we did use hormone replacement therapy as part of that collaborative care.

But everybody's markers are different. How often do you like to see your patients, even if they're doing pretty good? Do you see them annually, twice a year? What should people be advocating for?

Marc Kesselman

So I think that patients with active autoimmune disease should be seen every three to four months, and have labs checked. We don't need to always check all the labs at every three to four months, but we need to check inflammatory markers. We need to check liver function.

We need to check blood counts and platelets. Those are things that are standard every three to four months — especially for patients who are on medications like methotrexate, prednisone, hydroxychloroquine, or biologics — making sure that we follow those blood counts on a very regular basis. And if they have a flare, check them then too.

So if there is a flare, it's important to check those inflammatory markers and see where they are, because it could be lower than what we want, and that may require some emergent response from our part.

Checking a marker is very important. As you pointed out, different autoimmune diseases require different markers to be checked. In dermatomyositis, looking at the aldolase and CK — which are muscle enzymes — is very, very important because it's directly related. Remember, skin and muscle. So that's extremely important.

Patients with dermatomyositis also have a higher risk of cancer. So we want to make sure that they get age-appropriate cancer screenings.

So I think being in touch with your rheumatologist, with your healthcare provider, is very important. And I'm the first person aware that being in the medical environment, you're vulnerable, and it's not always as conducive as you'd like — you don't get as much time as you like. The billing, the paperwork, and the logistics can sometimes be a nightmare.

But I think with an autoimmune condition, it's really important to find that environment that's going to be good for you. You may need to just go from one person to another until you really feel that healthcare provider-patient relationship.

Haylie Pomroy

I love that you gave us permission to do that, because I think so many times people underestimate that partnership. And for me, I obviously consider you part of my partnership now, and I'm so grateful for that. And I do recognize that I've done a lot of hard work, but I've had a team that has been so supportive of my crazy ideas, science-based ideas, and Hail Mary ideas. And they've helped me navigate through that process.

Hey, this is Haylie Pomroy. And right now we're going to transition into our Q&A portion of the podcast. And you'll notice that we have live viewers asking us questions. They're my Fast Metabolism members, and they get all kinds of amazing benefits like member discounts on my world-class supplements and shakes, every product every day, personalized guidance and support from myself and my team, and even the ability to ask questions of our podcast guests.

If you have questions and want to get them answered, you should absolutely join my membership. And if you go to HayliePomroy.com/member, you can join for free for 30 days. Again, that's HayliePomroy.com/member — join for free for 30 days. I can't wait to see you there.

I have community members that have been listening to our podcast that have some questions for you, Dr. Kesselman, and I'm going to read a couple of them. If you're watching this on delay and you're not here live with us, please go ahead and post comments below. We will get to those for sure, and we'll definitely have Dr. Kesselman back.

But if you're fortunate enough to be watching us live, let me give you a couple of questions. So Dr. Kesselman, one of our listeners asked — they said, is it estrogen-based or is estrogen a catalyst? Does it make an autoimmune condition more impacted in the body? Or how does that work?

Can you revisit that just a little bit?

Marc Kesselman

Sure. Is it a catalyst? Yes. Is it estrogen-based? Yes. So I'm going to say yes to both answers.

And that's why we see so many autoimmune diseases predominantly in women. It acts as a catalyst. We know that sometimes extra estrogen can cause autoimmune reactions in the body.

But we also know that because of the estrogen relationship and the hormonal flux in the body, it can aggravate an underlying condition. It has positive effects — we know that estrogen has positive effects on cardiovascular health and bone health — but it can make a woman more vulnerable to autoimmune dysfunction.

And again, we feel it's probably related to the genetic influence on the X chromosome. I think that's really what we're looking at from a genetic point of view. So the answer is yes, and women have a higher prevalence of autoimmune reactions.

We're seeing more women who have developed more autoimmune reactions. So it's one of those situations where in certain disease states, we see a higher incidence in the female population.

Haylie Pomroy

Yeah. Great. And another great question is, if there were three things that you would suggest a person do today to prevent going into an autoimmune disorder, what three things would you suggest to prevent getting an autoimmune condition?

Marc Kesselman

Wow. That's a great question. So I guess the first one would be eating healthy.

I think changing your diet to a healthy — whether it's Mediterranean, low sugar, low red meat, ideally plant-based — type of diet. That's the most important thing, and eliminating triggers that may have caused dysfunction in your body previously.

Number two would be getting plenty of exercise, based on your age. As we know, 30 minutes at age 25 is good, but 90 minutes at age 50 is kind of the equivalent. So making sure that you get plenty of exercise.

Haylie Pomroy

You're saying we need more exercise as we age?

Marc Kesselman

We do, because our metabolism slows down over time. So the 30 minutes that maintains your weight and your metabolism at age 25 — now at age 50 is probably between 60 to 90 minutes. And as you get even older, 90 minutes is probably necessary to maintain that.

Plus, if you have other anti-metabolism type diseases like thyroid disease or hypothyroid conditions, those can also blunt your exercise responses. Or medications can do it. So we need more exercise to maintain ourselves as we get older.

And I guess the third one I would say is to have a good relationship with your healthcare provider, such that you can talk about disease prevention. And I think that's very, very important. Vaccinations, if that's what's necessary. Staying away from people who are obviously sick. Stop smoking. Being careful about being near any environmental triggers.

And, you know, there's also, I guess, a degree of luck as well. We don't have the full answer, and with full transparency, I wish I could say that all three of those are going to be guarantees, but we don't have the full answer as to what would create an autoimmune condition. Sometimes you can do all of that and still end up with one.

So I don't want anybody to think those are the three holy grails, but those will help.

Haylie Pomroy

Those will help. Yeah. And that's everything we can do, right?

I always tell our community, look, we're all aging, we're all sun-setting. And so if you feel better today than you did yesterday, you've actually made this massive leap in the right direction. So it's the same thing with prevention.

And another community member just asked — if they were recently diagnosed with an autoimmune disorder and it looks like they just had a positive ANA titer — what would be the next thing they should do from a screening perspective?

Marc Kesselman

Okay. So if somebody tests positive for an ANA — and that's generally one of the most common consultations that a rheumatologist would get — when I see a patient referred for a positive ANA, I take an extensive history. And what I do is try to listen to see if there are any aspects of their health or their symptoms that would lead me down one lane or another. Do I hear symptoms of rheumatoid arthritis? Do I hear symptoms of lupus? Do I hear symptoms of Sjögren's or scleroderma?

If I do, then I know which area to pursue. But if I have a patient that says they have a positive ANA but they're relatively healthy, they don't have any obvious symptoms, or some of the symptoms are really not specific, then they could fit into several categories.

Number one, they could fit into a category of patients that have positive ANAs but have no immediate autoimmune component to their disease at this point. Number two, they can fit into a population of patients that may develop autoimmune disease or symptoms 15 years down the road, as we know. Those patients I place in surveillance of potential symptoms that may develop, and recheck the labs on every six-month basis for a couple of cycles.

And number three, those patients with a positive ANA — they may have a relationship to something, whether it's autoimmune disease, whether it's cancer, hopefully not, whether it's thyroid disease or some other cause of the positive ANA. So when a patient has a positive ANA, they need to go through this kind of agenda: Is there any symptom attached to it? Is there anything else that I could say could cause the positive ANA? Do we need to start treatment because I see something, or should I continue surveillance over time?

And I do a couple of cycles of every six months, and then go to every year if I don't see anything develop. Remember, there was a really great article that came out in the late nineties, early 2000s, showing that sometimes patients with a positive ANA may develop symptoms 15 to 20 years later. So those patients I place in surveillance, and we just have to watch and see if they do develop something and whether or not that does develop at all. So I think it fits into one of those categories.

Haylie Pomroy

A couple of community members — I'm going to condense a couple of questions. They were asking about environmental exposures. What are the biggest exposure points that make autoimmunity worse?

If we look left, right, and all around our personal environment, what are some things that we can look for to eliminate?

Marc Kesselman

Well, cigarette smoke — I would say that's probably the number one environmental risk factor. It's the number one environmental risk factor for rheumatoid arthritis. It's a bad actor.

We have done a great job by eliminating it from airplanes and from restaurants mostly, but we still walk around and not only do we smell cigarette smoke, but you'll smell marijuana smoke and all of that. So I think the smoke itself — if you can eliminate it or be away from it — is extremely important.

Then we have car exhaust, which has been shown to have even a natural climate effect. So I think air pollution in general is a big factor.

As far as toxins and exposure — some things we can't even control because you want to run on the street, you want to run in the fresh air, and some of that comes with it. Heavy metals, I think, are probably a big component. We know that mercury in the amalgams that dentists used for a long time may have caused a certain amount of disease.

There are plastics — the BPAs and the plastics that we've seen in the microplastics, which are now in everything. I mean, I read cardiology, rheumatology, and general medical articles every morning and I inevitably see microplastics in some food group that I can't believe.

And medications and infections — I think those are probably the last couple.

Haylie Pomroy

So even over-the-counter medications too, right? I mean, when we do our self-assessment questionnaire — and one of the things people think some of the questions are so funny, but because I've been screened for autoimmunity so many times — it's like the dry eyes, the blinking, the mouth. We even do salivary pH testing, where we're just looking at little hints that the body can give us to give us some direction.

But it's always shocking to me how casually over-the-counter medications are taken — by individuals who haven't even been diagnosed with autoimmunity, and by our autoimmune group. The cold, the flu, the allergy medications — they can have such an impact. I get that somebody deemed them as okay, but they're not benign.

Marc Kesselman

No, not at all. Our access to medications has increased over time. And I think that's a direct cause of multiple allergies and symptoms that patients can develop.

And again, every day you see one of these over-the-counter medications in the news — recently eye drops were found to have some abnormal elements in them. And just recently we're seeing that protein powders have lead in them. So you just have to be very careful. You have to be aware of what is out there.

Just because it's over the counter doesn't mean that it's safe or good for you. Even though the FDA said these medications can be over the counter, it doesn't mean that they're good. And it certainly doesn't mean that it's good long-term.

I'll bring one example — proton pump inhibitors, the Protonics and the Nexium and the Prilosec. When they first came out, these medicines — which are great for reflux and esophageal reflux — were only meant for two weeks. And then if it doesn't work in two weeks, you need to contact your GI provider. That was the original intent.

Now we see people that have been on these medicines for years, and how much they have decreased absorption of certain elements in the gut — bone loss, electrolytes, things that are not absorbed well. So just because it's over the counter doesn't mean it's good to take long-term.

Haylie Pomroy

And not to mention — with the histamine blockers, I love that the Treg cells — the Nobel Prize-winning research from the three scientists — because I'm a Treg fanatic. And I'm like, what about these histamine blockers over the counter? I just got all up in arms about that.

And I love that you mentioned the protein powders, because we third-party test everything. And I cannot tell you how many times we find lead, arsenic — it's so prevalent, and it breaks my heart when it's something that you're investing in to stay healthy.

And when I got into more of the research science space, one of the things that I'm almost severely traumatized about is that the majority of the medications that are tested — one of the first exclusion factors in the test population is anybody that has been diagnosed with an autoimmune disorder. So with a lot of medications, if you've been diagnosed with autoimmunity, talk to your rheumatologist — especially if you're on any kind of pharmacological or supplement plan — because some of the stuff that's over the counter, when they study the population to say it's safe, when the FDA says it's safe, one of the exclusion factors is no people that have been diagnosed with an autoimmune disorder.

So it should have a big warning label. I started going through all the cold medications and all those things. They're so contraindicated with somebody that has autoimmunity. But instead of saying it caused people's autoimmune problems, they just don't test it.

I was actually — Dr. Speth brought that up for me when we were in pharmacology ethics class. And I just wanted to shake him and say, do you hear what you just said? Because there are so many people diagnosed with autoimmunity, and they think they can just pop into the store like the rest of the population and take something. And it's really a slippery slope.

So: tight relationship with your doctor, consult a pharmacist, look at the pharmacology of things. Because this whole disease is dysregulation. And so anything that's going to make your body less stable, less sturdy, less hardy, is going to have an impact. Absolutely.

Marc Kesselman

And I'll mention "loss of tolerance" — anything that's going to make your body have a less tolerant view than it did before. And I agree that the reason a lot of medications were approved the way they were is that they wanted to get them approved, so they eliminated a large percentage of the population — which includes autoimmune disease patients.

Also, at an older age, they excluded older-age patients. So we really have no guidance in patients who are over 70 or 75 years old as to what to recommend. That's very important. And always ask — if you have a question, ask your rheumatologist, ask your healthcare provider.

Haylie Pomroy

So, Dr. Kesselman, I can't thank you enough for being here. And one of the reasons why I want to do this live for our community is because our goal is to help them be prepared, not have fear of the flare, to have an empowered feeling, to understand what's going on in their body, and to effectively communicate and understand that a partnership is critical in this situation.

And if you don't feel loved, supported, encouraged, egged on, and cherished by your practitioner, there are phenomenal doctors like Dr. Kesselman that make their patients feel that way. And I love getting to talk to you. But I will tell you, one thing I enjoy more is getting to talk to your patients, because the way they speak of you is with such adoration. There's the academic respect, obviously, but it's adoration for the compassion that you have for your patients.

So I can't thank you enough for doing that on behalf of all of us autoimmune people.

Marc Kesselman

Well, thank you. I feel very humbled and I certainly appreciate the kind comments. And I will tell you that your show and your education of your patients is instrumental in making people healthier and in their ability to accommodate their diseases.

And it's okay to have a flare, okay to be sick, but know how to deal with it and learn how to deal with it. Your show is just amazing at being able to help orient people as to what to do and to be a good soldier in being able to handle their complaints. So I really applaud your efforts. And again, it's my pleasure, and I feel really humbled by your comments.

Haylie Pomroy

Well, thank you. You know, it was a very lonely time when I was going through it, and I promised myself, okay, I'll let vet school go away. But my life's work is going to be to make sure that no one ever feels hopeless and feels alone in this process.

Because it wasn't fun. So I'm trying. I'm trying.

So we will have you back. Our community is good — we're going to have a lot of questions. You guys, I promise we'll get them all answered.

Thank you for being here, everyone. And Dr. Kesselman, again, thank you so much.

Marc Kesselman

Thank you. It's my pleasure. Thank you so much, Haylie, for the opportunity.

Haylie Pomroy

Bye-bye.


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