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The Microbiome Connection to Hashimoto’s: an Illustrated Guide Guest: Dr. David Perlmutter The purpose of this presentation is to convey information. It is not intended to diagnose, treat, or cure your condition or to be a substitute for advice from your physician or other healthcare professional. Fabienne: Welcome to HA Summit, everybody,

Healing Hashimoto’s. Today we have with us, Dr. David Perlmutter, who is a world-renowned doctor, whose work is evidence-based and cutting edge of innovative medicine that looks at lifestyle influences on health and illness. Pearl: Dr. Perlmutter is a board-certified neurologist and fellow of the American College of Nutrition, who received his MD degree from the University of Miami, School of Medicine, where he was awarded the Leonard G. Rowntree Research Award. Dr. Perlmutter has been interviewed on many nationally syndicated shows like Dr. OZ, Oprah, CNN, Larry King Live, you name it, all over the place. He is the recipient of the Linus Pauling Award for his innovated approaches to neurological disorders and in addition, was awarded the Denham Harman Award for his pioneering work in the application of free radical science to clinical medicine. Fabienne: His new book, Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain For life, is also a New York Times bestseller, and is now available nationwide. Dr. Perlmutter, it is such a privilege to have you with us and share about all the new innovative approaches to healing autoimmunity, in particular Hashimoto’s, today.


Dr. Perlmutter: Well, let me say that I’m delighted to be here. And, right off the bat, how strange it is that you’re interviewing a neurologist because of thyroid disease. And I think that it really speaks to the new changes in understanding health and physiology. How everything is related to everything else. So, I think that will certainly be some of the theme that we develop today. Pearl: Yes. And it’s so interesting being able to talk about the importance of healing, not only the brain but as well as the gut. And really, what we’re going to be getting into, everyone, is about this newfound organ called the microbiome. And Dr. Perlmutter is really going to go into depth about the importance of healing that and what are the strategies of treatment in terms of that as well. So, Dr. Perlmutter, tell us a little bit about the microbiome, how it develops from birth and then evolves based on lifestyle choices people make. Dr. Perlmutter: Well, I’m glad you started off with that question, especially the part about how it develops from birth. Because actually, we now understand that this process of birth is a fundamental player in the development of the human microbiome. How we choose to deliver our children is really critical. At the time of birth, when that baby passes through the birth canal, that child is inoculated with bacteria that live in the birth canal, and frankly that come from another canal that’s nearby, if the truth be known. And these bacteria set the stage for that child’s microbiome. They are the seeds from which that microbiome then develops. When we understand that the microbiome plays such a pivotal role in immunity, and in inflammation, and in regulating brain activity, then the method of birth becomes a lot more important in terms of trying to develop strategies to have the healthiest microbiome for our children. So, when a child is born by cesarean section, he or she bypasses that event, that critical event in establishing a healthy microbiome. When a child is born by C-section, he or she is inoculated with bacteria that happen to be in the


operating room or on the surgeon’s gown or gloves, and those are the bacteria that are then forming the seeds for that future microbiome. So, it’s a very profound event. And it’s so important that parents to be understand that the current level of peer-reviewed literature indicates that there are significant risks associated with being born by C-section, aside from the ones that you may have already heard, in terms of complications from the procedure. There are risks to the infant which include doubling the risk of autism, tripling the risk of ADHD, increasing the risk of becoming obese as an adult by about 50%, increasing the risk of type 1 diabetes by about 70%, and increasing the risk of celiac disease, an autoimmune condition which happens to be associated with increased risk of Hashimoto’s disease, by about 80%. So, I want to be very clear, and that is that a C-section is a lifesaving procedure. It saves mothers’ lives, it saves lives of babies when they're in distress. But here in America, one third of all births are delivered by C-section. The World Health Organization has recently told us that about 10-15% of births are complicated and might require C-section. So, the answer is that indeed C-sections are being performed for other reasons other than medical necessity. And I think, in moving forward, when we recognize that how we deliver our children plays such a crucial role in setting up their microbiome, we will look upon C-section versus vaginal delivery in a whole new way. Then, we have to look at the critical role of breast feeding. It’s quite evident that when a child is breastfed, that he or she receives bacteria from the skin of mother and in addition to those bacteria, is receiving what are called galacto-saccharides. And these are complex carbohydrates that act as, what we call prebiotic. They nurture good gut bacteria. They allow the bacteria in the gut of that newborn, and infant, and toddler, to replicate. So, the act of breastfeeding is something very important from that perspective. So, we really want to


encourage that. Early in life, and even up through age 10 years, here in America, and in other western cultures, we are bombarding our children with antibiotics. A kid pulls on his ear, a kid has a little sniffle, or complains of a sore throat, the next thing you know, they’re at the pediatrician’s getting some antibiotics that are aggressive and broad-spectrum, for really oftentimes the wrong reasons. We now understand that antibiotics are devastating to the microbiome. We overuse antibiotics so aggressively in western cultures, the World Health Organization has characterized over-usage of antibiotics representing one of the top 3 health threats of this decade. So, I don’t think there's any good medical journal out there that hasn’t written about our over-usage of antibiotics. From the perspective of creating superbugs, but also from the perspective of changing the microbiome, now that we know that the microbiome is so fundamental in terms of regulating immunity, and regulating inflammation. Now, beyond that, we’ve got to talk about nutrition. We’ve got to talk about diet, because this may well be the most important variable or factor controlling the destiny of our gut bacteria. We understand that the shape and complexion of our microbiome has very little to do with our own genes and very much has to do with these early life experiences like I’ve just described, but also diet. And foods that are threating to the microbiome are foods that are high in sugar, low in fiber, that don’t deliver good fat. These are foods that change the array of bacteria in the gut. Foods that have, for example, artificial sweeteners impart a dramatic change on the microbiome that changes all kinds of important metabolic parameters and paves the way for autoimmunity. Interestingly, if I can just go back to the child example for a moment, a study that came out last week, published in the journal archives of pediatrics, put


out by the American Medical Association, looked at the risk of autoimmune diabetes, type 1 diabetes in children who received a probiotic for their first 6 months versus kids who did not, they received a placebo. And there was a dramatic decrease in autoimmune disease, type 1 diabetes, in children who had received the probiotic. So, now that we understand this critical and fundamental role of the gut bacteria in terms of autoimmune conditions, like lupus, like type 1 diabetes, celiac disease, and Hashimoto’s thyroiditis, we’re really beginning to understand what we’re doing to change those bacteria and pave the way for these illnesses. Fabienne: How does the diet affect a person with Hashimoto’s thyroiditis, for example? Dr. Perlmutter: Isn't that an amazingly wonderful question, that we are having this discussion right now about diet affecting a person’s risk for an autoimmune condition. Five years ago, we probably wouldn’t have had this discussion. But with all the work, 90% of all the peer-reviewed scientific publications on the microbiome have only come out in the past 5 years. And we now absolutely have connected the dots between diet, the gut bacteria, and autoimmunity as it related to perhaps the most common autoimmune disease on the planet, which is Hashimoto’s disease. So, diet affects the gut bacteria. And, when the gut bacteria are disturbed, when we have a situation, what is called dysbiosis, where the bacteria have been deranged, it threatens the lining of the gut. And later on in our discussion, I’m going to walk through that a little bit with some slides. But, when the gut lining is altered, it becomes more permeable, then various factors, various proteins that would normally reside within the gut, make their way to challenge our immune cells, and that leads to things like autoimmunity. When the immune system is a little bit deranged, and doesn’t really know what to do, that sets the stage for autoimmunity.


And again, this paradigm of a disturbance of the gut bacteria, the human microbiome goes well beyond the idea of Hashimoto’s. But I will say that interestingly enough, the research that relates changes in the lining of the gut to Hashimoto’s disease, was published 11 years ago. So, this isn’t news. It was published in 2004. And researchers did, what's in the journal, Gut, they actually did what's called microscopic structural analysis of the gut, comparing individuals with Hashimoto’s disease versus those who did not have Hashimoto’s. And found profound structural differences in the lining of the gut in those with Hashimoto’s. Now, just the idea that they would even be looking at the gut is really outstanding. And these are the same researchers who had previously published work looking at autoimmune diabetes, type 1 diabetes. So, we’ve come a long way since that time when we recognize those microscopic changes in the gut wall are taking place because of disturbances in the gut bacteria. And more important, that our dietary choices are affecting the gut bacteria, that absolutely connects the dots between diet and Hashimoto’s disease. Pearl: So, you talk a lot about Hashimoto’s and the gut, and how you can see the difference between someone without Hashimoto’s, looking at their guts. So, what is the connection between having Hashimoto’s and celiac, like they seem to go hand-in-hand a lot of the times. And is it true that if you get the Hashimoto’s under control, you can prevent the celiac from coming on, if you get it early enough? Dr. Perlmutter: Well, they are a lot of interesting questions. And they are very thought provoking. Well, when you're treating Hashimoto’s, let’s start there. Generally, the mainstream approach treating Hashimoto’s disease is regulating thyroid function, right? And perhaps paying some attention to the autoimmune aspect of that disease. But, by and large, it’s regulating the thyroid. And that needs to be done.


But, understand that the issues with thyroid function are merely a symptom of the underlying disease. They are not the cause. And unfortunately, so much is dedicated to looking at the symptom at ignoring the cause, meaning, treating the smoke and ignoring the fire. The fire is in the gut. The fire in celiac disease is squarely in the gut. Now, on the other hand, the treatment for celiac disease is a gluten-free diet, a strict gluten-free diet. And that is exactly what we want to recommend for individuals with all other autoimmune conditions, including Hashimoto’s, and rheumatoid arthritis, and lupus, and multiple sclerosis, to name a few. Because, consuming foods that have gluten in them increases the damage to the gut lining, the actual, exact area that I’m referring to. The separation between things inside the gut and things outside the gut is only one cell thick. And that’s not very much. The cells are kept together by some cement, we call it a tight junction, we’re going to look at that in just a moment. But, anything that can threaten the integrity of the lining of the gut, whether it’s antibiotics, because they change the gut bacteria, or gluten, because the effect of a part of gluten called gliadin, on disrupting these cement junctions between the cells, toxins in the environment, like glyphosate, which is the active ingredient in the herbicide Roundup, which is why we have genetically modified foods, other toxins in the environment, chlorine in our drinking water, and even some of the very commonly used over-the-counter medications like NSAIDs, which are used for aches and pains, and even the acid blocking drugs that are over-the-counter, you see them advertised on the evening news, powerfully disrupt the gut bacteria. And it is our healthy gut bacteria that maintain the gut lining. Again, it all centers on keeping the integrity of the gut lining intact. When it is violated, we put into play the mechanisms that underlie our autoimmune conditions, celiac, type 1 diabetes, Hashimoto’s. And that’s why, while it’s really important to regulate the thyroid function, it’s not treating the underlying Hashimoto’s disease. That is oddly enough, a gut related problem.


Fabienne: Yes. So, you talked a little bit about the antibiotic effects, but what really happens? Let’s say a person with Hashimoto’s comes and takes antibiotics, what happens inside, can you explain? Dr. Perlmutter: Well, antibiotics represent a weapon of mass microbial destruction in the gut. And I want to be super-clear for all of the viewers of this presentation that, antibiotics are really important. They save lives. But, when the World Health Organization characterizes antibiotic overuse as one of the top 3 threats to human health on the planet this decade, we have to take notice. And again, we’re dramatically overusing antibiotics. But, here is America, more than 70% of the antibiotics that are used, actually aren’t consumed by humans, they go into the livestock, the food, the meat, the creation of the meat and poultry that we then consume. So, we’re getting lots of antibiotics whether we know it or not. Glyphosate, that I mentioned a moment ago, the Roundup herbicide, is actually an antibiotic as well. The company that manufactures glyphosate, has a patent whereby glyphosate is determined to be an antibiotic. They hold the patent on that. All of these things threaten the gut bacteria, and change the array, change the complexion, the diversity of the gut bacteria. And it is this change that allows us to understand the current literature that relates for example, antibiotics exposure with risk for obesity, that relates the consumption of artificial sweeteners with risk of diabetes, and risk of obesity. It all gets back to the changes in the microbiome. And that’s kind of an interesting topic because people think, well, I shouldn’t drink sugar sweetened beverages because they're going to make me fat and give me diabetes. It turns out that the risk of type 2 diabetes is twice what it is when you drink sugar sweetened beverages, when you drink an artificially sweetened beverage, twice as bad. And it comes from, according to studies that were published from Israel, it comes from the changes of these artificial sweeteners that they have in terms of the gut bacteria.


Pearl: So, wow, yeah, sugar is obviously a no-no. Dr. Perlmutter: Well, sugar is a no-no, but artificial sweeteners… Fabienne: Even more Pearl: Are even worse. So, that’s about the diet and how those triggers will start to affect the microbiome. So, how does family history though really affect a person’s risk of how the microbiome forms? Like, how a person with Hashimoto’s…explain a little bit about that. Dr. Perlmutter: Well, there's no question that there are some families who are more predisposed to autoimmune conditions in general than others. We see it certainly in neurological autoimmune conditions, and in systemic autoimmune conditions, as well. But, I think that we’re now just beginning to understand that that may represent not necessarily a direct genetic issue in terms of our 23,000 gene genome, but rather because of similarities in environment, similarities in food choices, and similarities in the microbiome, which mediate, or help to mediate the set point of immunity and inflammation. But we do inherit risks for certain diseases, and that risk can then be amplified or played upon by our choices, our lifestyle choices, related to our food choices, do we take medications, do we exercise, what do we drink in terms of water for example. Does it have chlorine in it? So, many factors come in to play. But, as we move forward and we recognize the effects of these various parameters, these various variables on the microbiome, we’re looking at these things now through a very new lens. The microbiome, the gut bacteria represent a profound repository of information. We never really think about that. First of all from a genetic perspective, 99% of the DNA in your body isn’t the DNA that you got from mom and dad, the 23,000 genes, 99% is bacterial


DNA. So, even from that perspective, that’s a lot of information. What I thought I’d do is, why don’t we look at some slides now. And begin to graphically explain what we’re talking about? Pearl: Great. Yes. Dr. Perlmutter: Okay. So, in this first slide, what we’re seeing is a teaspoon. And the reason I’m going to use this teaspoon is, because I’m going to show you in purple that one-fifth of fecal material, where the microbiome lives, contains about 100 million terabytes of information. That’s an awful lot of information. Most people these days have computers that have maybe half a terabyte of storage capacity. So this is a huge amount of information in just a fifth of a teaspoon, or one gram of fecal material. Now, when you consider those numbers, if you were to examine the data, the information that’s contained in 2 tablespoons of fecal material, which is again where the microbiome lives, that would represent an amount of information, just from the data perspective, of all the computer storage capacity on the planet. Think about that, in just 2 tablespoons of fecal material, is more information than could be stored in all of the computers on the Earth. Now, if you were to store that information on a CD, and stack those CDs up. It would span from the Earth to the Moon. That’s the amount of data contained in this small amount of fecal material. Now, this next slide demonstrates the number of cells in the human body that are mammalian cells or cells of us, in comparison to the microbial cells. And you’ll see that really, we are 90% microbial cells and only 10% of the cells of who we think we are. In the next slide we see, when we look at the DNA, we are only 1% mammalian DNA, that microbial DNA represents 99% of the genetic information in the human body. Now, in this next slide, this is a cover from Time Magazine, from several years ago. It says, why your DNA isn’t your destiny. And I’ve used this picture over the years because it came out at a time when we began to realize that our


DNA, our genetic code wasn’t fixed. It wasn’t locked in. That, many of our lifestyle choices could change the expression of our genome, of parts of our genes that we inherited from mother and father. But, when you understand that 99% of the DNA in our bodies is bacterial DNA, and that the expression of those genes is, to some degree, under our control, it really gives us a new sense of how we can leverage this information for better health. Now, I’d like to take you to a study that was performed, looking at the bacteria in the stool of children living in sub-Saharan Africa and compared that bacteria to the children of same age, living in Western Europe. So, the only real variable here is their diet. And first, this next slide shows you where the sub-Saharan African live. They lived in a country called Burkina Faso. And Burkina Faso is a fairly, I would think you’d agree when you look at this slide of the village of Boulpon, in Burkina Faso, it’s fairly rural. And here is, in this next picture, what one of the dwelling looks like. And I think you’d agree that this is not a very cosmopolitan area. This is preparing food. And I think, when we look at the next slide, at this porridge called To, which is made out on a dirt wall, that basically they’re preparing their food in a very unhygienic way, full of bacteria, maybe even some parasites. It turns out, when we look at their bacteria in the stool, when I simplify this picture, and only look at only two major groups, the firmicutes and the bacteroidetes, you see huge differences between the European kids and the kids living in Africa. That, their gut bacteria, because of the foods that they eat, are dramatically different. The European kids have huge overgrowth of the firmicutes group. And that’s the group of bacteria that are associated with autoimmunity, that are associated with diabetes types 2, that are associated with obesity. So, we see that things like obesity are related to the changes in the bacteria that are diet induced. In this next slide, you see two laboratory mice. They’re the same type of laboratory mouse. They're eating the same exact food. But the mouse on the left of your screen is hugely overweight, and the mouse on the right is normal.


They are both eating the same food, but they’ve been inoculated with different bacteria. The mouse on the left has higher levels of firmicutes, whereas the mouse on the right, eating the same food, is of normal body weight, and has lower levels of firmicutes. That’s how important this really is. When we look at this next image, we see something very fundamental, that there are incredible differences in what are called the short chain fatty acids. These are the products of the bacteria in the gut, when we compare the African kids versus the European kids. And I would call everyone’s attention to the far right side of the screen, where you see that the African children had higher levels of butyrate compared to the European kids, based upon their diet. Why this important is because the butyric acid or butyrate plays a critical role in keeping the gut from being permeable or leaky. And that is a fundamental concept as it relates to autoimmune diseases. This next slide is actually a quote from the study. And it really basically states that diet plays the fundamental role in shaping the gut bacteria. Now, this next slide looks at what is called next generation sequencing, and that’s a fancy way of describing how research scientists are actually able to look at the fossilized dental calculus that we all have in our teeth. This is actually a way of encapsulating the bacteria that live in the mouth. This is the plaque that the dentist removes. It’s the reason we go to the dentist. But, in fossilized human specimens we see that we still can visualize this plaque. And incredibly, this plaque encapsulates the microbiome of that individual living thousands and thousands of years ago. So, through this technology, we’re able to understand what the microbiome was like of our ancestors. And as these researchers have stated in this next slide, in their quote that common medical interventions such as antibiotic therapy have dramatically reduced infectious diseases worldwide. But, rather than being targeted strikes


against harmful bacteria alone, these therapies act as weapons of mass microbial disruption. So, it means that our over-usage of antibiotics is changing the microbiome. And this next slide is a child receiving antibiotics, which happens day in and day out, to the extent that parents oftentimes keep the antibiotics in the refrigerator in case their daughter or son gets sick again, why, we’ll just give them more antibiotics. But these, as the authors describe, represent weapons of mass microbial disruption. So, many factors build a healthy microbiome, like we’ve talked about. Being born naturally as opposed to being born by C-section. Breastfeeding, as we mentioned. Exposure to antibiotics. And when we are careful about these factors, we create symbiosis, a good gut bacteria. We resolve inflammation. We heal the gut lining. We reduce autoimmunity. But when we overuse antibiotics, when our diet is bad, then we create a situation not of symbiosis but a dysbiosis. This is the cornerstone of autoimmunity. This is the cornerstone of Hashimoto’s thyroiditis. Those factors, on the lower left of the screen, are powerfully contributing to the explosive incidence, increasing incidence of Hashimoto’s disease, meaning antibiotic use, our obsession with hygiene, the western diet that’s so high in carbohydrate and low in fiber, and even stress, because it increases cortisol. So, these are actually very important factors that lead us to our discussion of what are the issues then, as you see in this next slide, that compromise the gut lining. Antibiotics, how we’re delivered, various medications, how our water is treated, immunization, the diet that we think is appropriate, hormone therapy, and even the genetic modification of our foods. Why is GMO such an issue? GMO, in and of itself, there is science that talks about the actual GMO modification of our seeds. But please understand that the main reason that GMO is such a threat to our health, such a threat to our


microbiome, is that by and large foods, their seeds are genetically modified to make them resistant to this herbicide called Roundup. And as you’ll notice on this next slide, number one on the list, in terms of the damaging effects of glyphosate are the changes in the human microbiome. Therefore, increased gut permeability and increased leakiness of the gut that leads to autoimmunity. Now, you might ask, as this next slide does, how does glyphosate work? And glyphosate, as I mentioned, is an antibiotic. It changes our gut bacteria, just like changing the gut bacteria happens when you take an oral antibiotic. And just to be very clear, this is the original patent for glyphosate, the active ingredient in Roundup, whereby it was patented as an antibiotic. I think that’s a critically important message for everyone to understand. Now, this next graphic is what we had talked about earlier, how our lining cells of our intestine are glued together in this tight junction. We absorb things through the cells, into our bodies, in what's called the transcellular pathway. And in addition, we absorb things between the cells, in what is called the paracellular pathway. When we are exposed to various things, stress, infection, various drugs, poisons like glyphosate, gliadin, these things tend to destabilize or breakdown the gut lining, and we get a leaky gut. When the gut is permeable, or leaky, then various things, like for example, something called LPS, which is on the covering of many of the bacteria in the gut, make their way into the systemic circulation, challenge our immune cells. This is the cornerstone of autoimmunity. So this very well then connects the notion of food, the notion of our antibiotics, of being exposed to glyphosate that’s sprayed on the very food that we eat, with changing our gut bacteria, leading to increased permeability. And that paves the way for conditions like Hashimoto’s disease, like MS, rheumatoid, lupus, all of the autoimmune condition. And in addition, turns on inflammation. And that’s important when you get your arms around the


notion, the science that demonstrates that inflammation as a mechanism, is a cornerstone player in Alzheimer’s, Parkinson’s, autism, diabetes, coronary artery disease, and even cancer. So, I’ve thrown a very, very wide net, haven’t I, that really reins in the idea of the fundamental importance of the gut bacteria in terms of regulating so many parameters that deal with health and resistance to disease. Fabienne: It’s incredible. It’s really opening up a whole brand new way of looking at it for me today, that something is really shifting for me with bacteria. Dr. Perlmutter: I’m glad you didn’t say a can of worms, because I don’t like that. Everybody always say, “Oh, you’ve opened up a can of worms.” And what’s that supposed to mean? Now, [inaudible] enough, I don’t know if there's a segue here, but worms in the gut tend to reduce autoimmunity. Pearl: They tend to reduce it? Explain a little bit about how that works. Dr. Perlmutter: Well, we’ve known this for a long time that the immune system is brought under control when certain types of helminths are present in the gut. And in fact, there are various treatment protocols now that are actually looking at inoculating people with the eggs of whipworms in order to treat various autoimmune conditions. It’s pretty exciting because it tends to reduce autoimmunity. One report that was published actually just about 2 weeks ago, indicates that the way the worms are able to do this is by changing the expression of the gut bacteria. So, there is a beautiful relationship then, between worms changing the gut bacteria, the microbiome, and then reducing the parameters of autoimmunity. So, we’re actually seeing researchers treat people by giving them the eggs of whipworms to treat autoimmune conditions. Who knew?


Pearl: Wow. Based on your research, Dr. Perlmutter, you have 6 specific steps to improving gut ecology. Can you share a little bit about those steps and why and how you’ve come up with those? Dr. Perlmutter: How I came up with them is really spending the hours reading the studies, working with patients, seeing what works. And at the end of the day, applying some good old common sense and connecting seemingly disparate dots. After all, I’m a neuroscientist, I’m a brain specialist. And here we are, talking about gut bacteria and gut permeability. Those are dots that used to be very, very far away. Like the thyroid gland, and the lining of the gut, those are far away dots. So, my mission in life is to look at the science and then connect these dots. So, a lot of what goes into the program are in fact factors that we’ve already discussed. Number one, remove. Remove those issues that may threaten your gut ecology, those issues include the foods that we eat, the high-sugar, high-carbohydrate, low-fiber, low-fat diet that is so prevalent amongst western cultures and now spreading throughout the world. Remove excessive usage of things like antibiotics and other pharmaceuticals that threaten the gut bacteria. And these include the NSAIDs, and non-steroid anti-inflammatories that are so commonly used. These include the proton pump inhibitors which are the common antacids that we see advertised in every common magazine that you might read. We’ve got to stop blocking stomach acid. Our gut bacteria need that environment to be healthy. We have to remove chlorine from our drinking water. Chlorine is put there to kill bacteria. We have to do our very best to remove stress from our lives. Why? Because when we are under stress, our brain sends a signal to our adrenal glands to make cortisol. And cortisol actually changes the gut bacteria and increases the leakiness. Then we have to replete. We have to put back into the gut, those factors that


are so fundamental for building a good microbiome. And this includes giving our good gut bacteria the foods that they need in order to flourish. We call these foods prebiotics. Prebiotics nurture the probiotics, the good bacteria. Probiotic - for life. Yes, they are for our lives as well. So the prebiotic fiber rich foods are the foods like the Mexican yam or jicama, dandelion greens, Jerusalem artichoke, artichoke itself, radicchio, garlic, onions, leeks. Dandelion greens being one of my favorites, certainly very versatile foods as a group. These are foods that are rich in what we call prebiotic fiber. Allows the good bacteria to make butyrate. I showed you that slide earlier, how the children, their metabolic profiles, living in sub-Saharan Africa, make a lot of butyrate because of their microbiomes. And the reason that’s important is because butyrate, this short chain fatty acid, heals the gut lining. And I might add, it also heals what is called the blood-brain barrier. If you think it’s bad to have a leaky gut, let me tell you, leaky brain is not a party. So, the other thing to consider is actually adding back good bacteria to you system. And that means eating foods for example that are fermented. Fermented foods have been a part of the human experience for thousands of years. In other words, actively fermenting foods, making things like kimchi, cultured yoghurt, fermented vegetables, sauerkraut, these are foods that naturally are full of good gut healing, inflammation reducing, immune balancing bacteria. Now, humans have eaten fermented foods for a lot longer than we’ve been making fermented foods, because truthfully, a food source that’s out in nature, that’s decomposing, is actually undergoing fermentation. And when we were hunter-gatherers, we didn’t necessarily kill everything we ate. Sometimes we found things that were already on the ground, having fallen from the tree or something that died. And we would eat that. And when you eat foods in that condition, and it may sound distasteful, but when you do so,


you're actually taking into your system, lots of good bacteria. You can also take probiotics. You can go to the health food store, and buy a good probiotic supplement that has good types of bacteria in it, like, Lactobacillus plantarum, Bifidobacterium longum, Lactobacillus brevis. These are good bacteria that tend to heal the gut lining as well. So, in these days when our food choices are so inappropriate, if I might say so, it’s good to have on board, a good probiotic supplement, available in health food stores online around the country, if not around the world. Fabienne: Would you recommend a vegan probiotic versus animal probiotic? Dr. Perlmutter: I believe that the animal based probiotics, basically the reason that we’re not able to characterize probiotics as being vegan per se is because they are derived from milk products, certain of them are derived from the products and cultured in milk based sort of environment. That said, it doesn’t necessarily detract from the fact that these are, for all intents and purposes, not actual animal based products themselves. The other thing to consider though is, sometimes the capsule in which these probiotics are contained, may be of a vegetable variety or it may be an animal based capsule, the material from which the capsule is made. And I hardly think that matters from a physiologic perspective, but it may matter to somebody who has chosen to be a vegan or a vegetarian for other reasons that are not necessarily based in biology, that are for perhaps spiritual reasons or other reasons that they decide to be vegan or vegetarian. So, you have to look not just at the product itself but at the capsule. And if you're strictly vegetarian, there are certain capsules that would be off the list for you because they come from animal derived products. But I think in terms of the activation of your microbiome, and the role that probiotics play in terms of nurturing the microbiome, it doesn’t matter whether the capsule is vegetarian derived or animal derived.


Pearl: So, we’ve talked about the diet, we’ve talked about environmental triggers that could come into play, how healing the gut, the leaky brain, even you are speaking of. A lot of people who have autoimmune, Hashimoto’s, they want a quick fix. They want to get the information as fast as they can, and then try something and see if it works. But then, what happens is, maybe it doesn’t work for them. Share with the audience and viewers, these types of processes, it’s individual, right? It’s something unique. How can we share with them that it does not just happen overnight? Dr. Perlmutter: Well, you ask several questions. How can we indicate to them that it is not necessarily, or maybe it is a specific unique program that they, as individuals, need to follow? Clearly at the end of the day, everybody is unique. We are each unique from our genetic perspective, in terms of our inheritance from mom and dad, but we’re also very, very unique in terms of our microbiomes. But that said, we do understand now the broad strokes as they relate to the microbiome in terms of the changes that tend to favor our autoimmunity, we’re beginning to see that data appear. We do know that, for example, lack of certain type of clostridial organism called Faecalibacterium prausnitzii, has been correlated with certain autoimmune conditions, including for example multiple sclerosis, and even bowel related autoimmune conditions. So, we’re beginning to gain some broad stroke understandings about the complexion of the gut bacteria that may be related to autoimmune conditions. A lot of very high-powered computing data is being looked at, at the University of California, San Diego, looking at those broad strokes and recognizing, as you take a step back, those changes in the array of bacteria that relate to autoimmune conditions, specifically inflammatory bowel conditions. Therefore, we can make broad stroke recommendations that is, what are the general things you should be thinking about. I’ve covered those now, in terms of diet and lifestyle that relate to building in general, a healthier microbiome. You mention people are looking for the quick fix. It is not a quick fix. It’s a


significant dedication to lifestyle changes, the benefits of which will extend far beyond your current situation with Hashimoto’s thyroiditis. It will extend to overall weight reduction, balancing of the immune system. When we see a publication like the journal of the American Medical Association back in 2004, publishing a report indicating a direct correlation between risk for breast cancer, and women’s consumption of antibiotics, and then in their discussion talked about the microbiome being related, it tends to open our eyes. Now, that study demonstrated not that the antibiotics caused breast cancer, but showed a strong correlation between taking antibiotics and the risk of breast cancer. Correlation doesn’t mean causation. But it doesn’t mean it couldn’t have. And I think that for people to think about what they can do to actually treat their autoimmune condition, in this case, their thyroiditis, I think they need to understand again that what they’re getting in large part from mainstream practitioners, is only treating the thyroid dysfunction, the problems with the thyroid hormone, the T3 and T4, mostly just getting T4. Understand that when you're treating hypothyroidism, it’s often very reasonable to add T3 to the mix because a lot of people don’t convert T4, which is the standard thyroid medicine, into T3. And therefore they’re not getting active thyroid hormone. But oftentimes, that’s as far as it goes in treating their thyroid situation. You’ve got to get to the source. And the source is the gut. And the source is the permeability of the gut, the leakiness of the gut that challenges the regulation of the immune system. And please understand that the biggest factor that keeps the gut from being leaky is the wonderful array of organisms that we call the microbiome. When they are given what they want to be given, in terms of being healthy. Fabienne: Thank you. Dr. Perlmutter, would you say that GMO is an issue in autoimmune disease?


Dr. Perlmutter: Well, categorically I would. And I’m not going to directly connect GMO foods at this moment with autoimmune conditions although we could have that discussion. But by and large, as I demonstrated in the slide presentation, the reason that we have genetic modification of our food seeds, is to create foods that are resistant to glyphosate. Glyphosate damages the gut bacteria and therefore threatens the integrity of the gut lining, leads to increased permeability, the cornerstone of autoimmune conditions. And that is the real threat of GMO. When people talk about GMO, well, should we label our foods or not, why do people need to know, GMO doesn’t really matter. It matters a whole heck of a lot because GMO really paves the way for this poison, glyphosate, to get into our foods that we’re eating. It’s used around the globe, estimated that by 2017, 1.3 million metric tons of glyphosate are going to be applied to our food every year. It is a huge threat to our health. It is a huge threat as it relates to autoimmunity. When you look at the work of Dr. Stephanie Seneff, who published on this topic, she correlates the rise in the usage of glyphosate, with certain autoimmune conditions like celiac disease for example. Now again, this is a correlation that she has drawn. She is not necessarily saying that glyphosate caused these problems, celiac disease, autism. But, when we recognize a mechanism now exists, because glyphosate changes our gut bacteria, it makes connecting these dots a lot more meaningful and really a lot easier. Fabienne: Yes. That’s another subject and passion, but it’s another summit. Dr. Perlmutter: That’s for sure. Fabienne: Yes. We’re not going to go into that today. But, do you want to ask something? Pearl: Yeah. So, we are coming to an end to this amazing educational


experience for us all. Dr. Perlmutter, can you just share 3 actions that you could leave our listeners with, for them to do on a daily basis, to prevent or reverse their autoimmune disorder? Dr. Perlmutter: Just 3, boy, you're making it tough. Maybe I can have part one and subparts a, b, and c. I think that first and foremost you have to rebuild your microbiome. And maybe that’s not so easy. But if you want to get rid of your condition, have a good shot at making that happen, that is first and foremost on the list. Number two, I think exercise is critically important as it relates to the microbiome, as it relates to reducing cortisol, and therefore strengthening the gut, and changing the gut bacteria for the better. And that includes the ideas of stress reduction and adequate sleep, all play into that cortisol pathway. And gee, have I done it in 2 major steps? Maybe I have. I don’t know. I think in rebuilding the gut bacteria, that embodies the notion of excluding those things that are so threatening, adding back the prebiotic fiber rich foods, and the fermented probiotics foods, taking good probiotic. And I would say one other thing that I think I’d give consideration to, and that would be making sure that your vitamin D status is adequate. We’re learning more and more about vitamin D every single day. And we’re really learning that vitamin D has some powerful immune-regulatory activity. So think having your blood tested and not just making sure you're squeaking by, in terms of a vitamin D level in the normal range, but having an optimal vitamin D level by using a supplement. I think that would be very important. Pearl: That’s great. Thank you so much for your time. And for educating everyone here with what's happening in the innovative medicine. It’s profound. And we’re so excited to have you this time. Fabienne: It was a privilege to be with you. Dr. Perlmutter: My pleasure.


Pearl: And we will see you next time. Dr. Perlmutter: Okay. Thanks for having me. Pearl: Thank you. Dr. Perlmutter: Bye, bye. Pearl: Bye.

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