Latest / Becker’s Healthcare Podcast / Understanding Inflammation and Chronic Disease with Dr. Tom O'Bryan

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Understanding Inflammation and Chronic Disease with Dr. Tom O'Bryan · Becker’s Healthcare Podcast

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This is Scott Becker with the Beckers HealthCare
0:41
podcast.
0:42
We're thrilled today to be joined by doctor
0:44
Thomas O'Brien.
0:45
And doctor O'Brien's gonna talk about where he
0:47
specializes, what he focuses on, what he's most
0:50
excited about, and a lot more.
0:53
Tom, doctor O'Brien, can you take a moment
0:55
to introduce yourself and and tell us a
0:57
bit about what you do?
0:58
Hi, Scott. Sure. Thanks for the opportunity here.
1:02
Let's see. I guess I'd start in my
1:04
internship
1:05
forty five years ago,
1:07
and my wife and I, my ex and
1:09
I, were unable to get pregnant.
1:12
And I called the 7 most famous
1:15
holistic oriented doctors I had heard of at
1:18
the time and said, what do you do?
1:20
And I was able to reach all of
1:22
them, and I put a protocol together. And
1:24
we were pregnant in six weeks.
1:27
Our neighbors in married housing, we lived on
1:30
campus.
1:31
They had gone through artificial insemination, and nothing
1:34
had worked for them.
1:35
And they asked if I'd work with them,
1:37
and I said, well, I don't really know
1:39
what I'm doing, but I don't think it'll
1:41
harm you. Sure. They were pregnant in three
1:44
months.
1:45
So we're now four months pregnant, just hard
1:47
to trot and tell the world. And,
1:51
we were in school in Chicago, and our
1:53
friends would tell their sister in Wisconsin
1:57
of what we were doing, and she had
1:59
had two miscarriages.
2:01
Could she come down and talk to us
2:03
because no one was giving her any answers?
2:06
And I just I just I I don't
2:07
really sure. Okay.
2:09
And so when we opened our practice, we
2:12
had a general practice and with a strong
2:15
emphasis on lifestyle factors, and this was in
2:19
1980.
2:21
And so we came out of the box,
2:24
and
2:25
there was
2:26
one thing that seemed to be common
2:28
with every couple that was having some type
2:30
of fertility issue.
2:32
And one of the common factors was that
2:35
they were eating foods that they had no
2:38
idea
2:39
were a problem for them because the food
2:41
didn't give them stomach pains or abdominal distress.
2:46
So they thought the foods were fine.
2:48
But when you check the immune system and
2:51
you see that your immune system is fighting
2:53
dairy
2:54
or your immune system is fighting wheat or
2:57
gluten,
2:58
and understanding
2:59
that an activated immune system is what creates
3:02
inflammation,
3:04
and NIH tells us that 14 of the
3:07
15 top causes of death are chronic
3:10
inflammatory
3:11
diseases, it's always inflammation,
3:14
then it makes sense that if you're eating
3:16
a food that's triggering more inflammation,
3:19
you might wanna reduce your exposure to that
3:21
food.
3:22
And we found that to be a paradigm
3:25
that just consistently
3:27
was at the base
3:29
of helping people with all types of problems.
3:32
And,
3:33
I joined the Institute for Functional Medicine
3:35
about fifteen years ago, and my area of
3:38
expertise
3:39
is talking about the gut, the microbiome in
3:42
the gut.
3:43
And,
3:44
so we've talked to thousands of practitioners
3:47
over the years of the importance
3:49
of including
3:51
an evaluation
3:52
of gut function
3:53
with any chronic condition that they're dealing with.
3:57
And that pretty much brings us up to
3:58
today.
3:59
Thank you. And when you look at today,
4:02
how important is gut function and what people
4:04
eat to keep their inflammation under control
4:07
and then that inflammation has such an impact
4:09
on everything they do, doesn't it? It does.
4:11
It does. You know, if if we take
4:13
a step back and no one emphasized this
4:16
in our education,
4:17
not one professor
4:19
emphasized the critical nature that 14 of the
4:21
15 top causes of death are chronic inflammatory
4:25
diseases.
4:26
No one emphasized that.
4:28
And with our patients, the way I say
4:30
to missus patient, your immune system is the
4:33
armed forces in your body. It's there to
4:35
protect you. There's an army, a navy, an
4:38
air force, a marines. We call them IGA,
4:40
IGG, IGE,
4:42
IGM, cytokines.
4:44
They're just there to protect you.
4:46
So when they get activated and they're creating
4:49
inflammation,
4:50
the million dollar question is, what are they
4:53
trying to protect you from?
4:55
And that's a base
4:57
one zero one concept that we recommend every
5:00
clinician
5:01
includes
5:02
in their evaluations.
5:04
Is this patient fighting mold?
5:06
Do they have high inflammatory
5:08
markers because of bold exposure?
5:10
Or is it gluten? I mean, you see
5:12
miracles sometimes
5:14
when people go gluten free. Not every time,
5:17
but sometimes.
5:18
So the question is, what is your immune
5:21
system trying to protect you from?
5:24
Rarely is it an immune system that's gone
5:26
crazy.
5:28
Rather,
5:28
it's highly activated trying to protect you from
5:31
the amount of accumulated chemicals
5:34
that we're getting now. You know, we run
5:36
a
5:37
a test now on every new patient that
5:39
wants to work with me.
5:41
I represent myself as a Sherlock Holmes, you
5:44
know, trying to identify what are the underlying
5:46
mechanisms
5:47
for people who have been everywhere and done
5:49
everything.
5:50
And,
5:51
I won't talk to them unless they do
5:53
a few tests. And one of the tests
5:55
is just a cutting edge test. It looks
5:57
at
5:58
18 heavy metals,
6:00
28
6:01
mycotoxins,
6:02
which is the exhaust from mold,
6:05
and 34
6:07
pesticides
6:08
and insecticides,
6:09
organophosphates.
6:11
And when you do that simple urine test,
6:13
which is highly sensitive and highly specific,
6:17
people are shocked
6:18
to see what's accumulated in their body over
6:21
the years.
6:23
And so we do that test first to
6:25
show them even if they're eating an organic
6:28
healthy lifestyle,
6:30
what's maybe in their body from the last
6:33
twenty, thirty years of accumulation,
6:35
minute amounts. You know, for
6:38
let me give you one example. Chicago, 02/1946
6:43
pregnant women in the eighth month of pregnancy.
6:46
They did urine analysis on them, and they
6:48
measured five phthalates. Phthalates are chemicals used to
6:52
mold plastic, and there are many different phthalates,
6:55
but they looked at five of them,
6:58
including bisphenol
6:59
a, BPA.
7:01
And they divided the results into quartiles.
7:04
The lowest, the next, the third, and the
7:06
highest.
7:07
They then followed the offspring of those pregnancies.
7:10
And when the children turned seven years old,
7:13
the researchers reached out and said, hi. It's
7:15
time to run the,
7:18
Wechsler IQ test, the official IQ test. So
7:21
they ran these tests on all these kids,
7:24
and the results were shocking. Every child
7:27
whose mother was in the highest quartile of
7:30
phthalates and urine in pregnancy
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compared to the children whose mothers were in
7:35
the lowest quartile,
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every child
7:39
in the highest quartile,
7:42
their IQ was seven points lower.
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The average was 6.7
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to 7.4
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points
7:49
lower. Every one of them.
7:51
Now, you you say, wait, what? What?
7:54
What?
7:56
And now, the the science is coming out
7:58
that,
8:00
of the fetal programming in utero that occurs
8:03
when mom is high in phthalates
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and how it impacts on neurodevelopment.
8:08
There are multiple studies that have come out
8:11
in the last four or five years
8:12
on this topic.
8:14
Now let's take it to day to day
8:16
life.
8:17
Two years ago, a paper came out where
8:19
they looked at three most common bottled waters
8:23
on the market in Europe. This was a
8:25
European paper.
8:26
And they bought a liter of each of
8:29
the three most common waters, and they measured
8:32
not just how many microplastics
8:35
were in the water, but nano plastics.
8:38
They have laser technology to identify nano plastics.
8:42
And the average between the three major brands
8:45
was 240,000
8:49
nano particles
8:50
per liter of water.
8:53
So we're drinking bottled water thinking we're safer,
8:56
but it's loaded
8:57
with phthalates,
8:58
which
8:59
the exposure you get from a bottle of
9:01
water is there's no evidence it's harmful in
9:04
any way whatsoever.
9:06
But it can accumulate in the body as
9:09
evidence with the women in the eighth month
9:11
of pregnancy and what happened to their baby's
9:14
brain development
9:15
in utero that manifested seven years later when
9:19
they did the IQ test on them.
9:21
So it's our environment now that is a
9:25
major concern
9:27
in the development of chronic inflammatory diseases.
9:30
It's it's, it's not an unknown. You know?
9:33
There are so many studies now on this.
9:37
And, to your question specifically,
9:41
we have to go back to Hippocrates,
9:42
and,
9:44
he told us way back a few thousand
9:46
years ago, all diseases begin in the gut.
9:49
Now let's move forward to Alessio Fasano at
9:53
Harvard.
9:54
Professor of medicine, Harvard Medical School, professor of
9:57
nutrition, Harvard School of Public Health, the chief
10:00
of pediatric gastroenterology,
10:03
Mass General, Harvard,
10:04
the director of the Celiac Research Center at
10:07
Harvard,
10:08
the director of mucosal immunology
10:10
at Harvard.
10:11
Five titles.
10:14
Any one title is a lifelong dream for
10:17
someone at the top of their game. This
10:18
guy's got five. He really is one of
10:20
the greats.
10:22
And his papers are always so
10:24
engaging
10:25
to read.
10:26
And, you know, he's got over 350
10:30
or so publications now, and
10:32
and you'll see eight authors on a paper.
10:35
And the last one, Alessio Fasano, the boss.
10:38
You know, he puts a stamp of approval
10:40
on it.
10:41
Well, this paper he wrote himself,
10:44
which gives you a sense of how important
10:47
he considers it is. And I think every
10:49
physician needs to read this paper. It's a
10:51
mandate,
10:53
for every physician. The title, oh, by by
10:55
the way, Fasano,
10:57
it was, 1978.
11:00
He wrote the first paper on the mechanism
11:02
that causes this thing that we call leaky
11:05
gut, and that's the protein zonulin. He identified
11:08
the protein zonulin
11:10
and how it gets increased, which creates this,
11:13
excessive intestinal permeability.
11:16
And he's been writing about it now for
11:18
over twenty five years.
11:19
And we think he's gonna win a Nobel
11:21
Prize because of the impact of this thing
11:24
called leaky gut,
11:26
on so many chronic diseases.
11:29
Now this paper, he wrote himself,
11:32
single author, which gives you a sense of
11:35
the importance of the paper.
11:37
Now and the title of the paper,
11:40
all disease
11:41
begins in the parenthesis,
11:43
leaky and parenthesis, gut. All disease begins in
11:46
the leaky gut. The role of zonulin in
11:49
the development of chronic inflammatory diseases.
11:52
And they outline
11:54
excessive intestinal permeability
11:57
as a primary mechanism
11:59
in the development of the chronic inflammation.
12:03
14 of the 15 top causes of death
12:05
are chronic inflammatory
12:07
diseases.
12:07
And he goes through all of the science
12:10
of how it occurs.
12:11
Every physician needs to read this paper. All
12:14
disease begins in the leaky gut.
12:16
Yeah. And when they do, you know, you
12:18
have to read it like two or three
12:19
times to really get the big picture of
12:21
what he's talking about. But when you do
12:24
and you listen, my god, this just makes
12:26
sense.
12:27
Okay. So this microbiome
12:29
thing and this thing about the gut, it's
12:32
very important
12:33
in every chronic inflammatory
12:36
disease.
12:38
And so doctor O'Brien, what does somebody do
12:40
about this? As an individual, as a doctor,
12:44
how do you start to think about this?
12:46
Supplements, how do you what's the first thing
12:47
that someone should do when they look at
12:49
this stuff? Well, you know, I've got a
12:51
good friend, doctor Andrew Campbell. He runs,
12:55
my Michael lab. I think the same of
12:58
his lab. He he has a lab that
12:59
tests just for mycotoxins
13:02
from mold.
13:03
And, I we,
13:05
had dinner in, Las Vegas.
13:08
I was on stage there in December, and
13:10
Andrew was also, and we had dinner. And
13:13
I and,
13:14
he's an elder man, and I said, Andrew,
13:17
I've got a picture of you on a
13:18
slide in every talk I give. And his
13:21
wife looked at me. And I said, so
13:23
there's a picture of you. And then I
13:25
put up there
13:26
all no. No. How does he say it?
13:30
In god we trust.
13:32
And then the next click on the slide,
13:35
all others require data.
13:37
And he just started laughing. That's a famous
13:39
quote from him. In god we trust, all
13:42
others require data. So the first thing you
13:44
do
13:45
is you learn how to test
13:47
to see is this something that we should
13:50
explore?
13:51
And the key is to do comprehensive testing.
13:55
And so it takes a while to really
13:57
figure out what where the comprehensive tests are.
14:01
But, in the world of functional medicine, there's
14:05
there's just a group of laboratories that have
14:07
been,
14:09
on the cutting edge for many years. And
14:11
and
14:12
so we recommend a series of tests
14:15
for individuals. And,
14:17
the test that I referred to just now
14:19
that looks at, total toxic burden
14:23
is just a simple urine test, but the
14:25
sensitivity and specificity
14:27
is over 90%.
14:29
And so you test You test to identify.
14:32
Is my immune system fighting gluten? Well, I
14:35
feel fine when I eat gluten. What does
14:36
it matter how you feel?
14:38
You know, excuse me, but it doesn't.
14:41
In Italy, they've got 36 centers that are
14:44
designated by the government as gluten related disorder
14:47
centers.
14:48
And if you get a diagnosis
14:50
of a wheat related disorder from one of
14:53
these centers, your food's a tax deduction.
14:56
So local physicians, if they suspect that one
14:59
of their patients
15:00
has some kind of a wheat related problem,
15:03
whether it's celiac or not, they'll send them
15:05
to one of these centers.
15:07
There's 36 of them around the country.
15:10
They looked at 5,000 patients
15:12
who were sent to them,
15:15
referrals from local physicians,
15:18
and they summarized the symptom patterns.
15:21
Just under fifty percent of them had some
15:24
type of gut or GI symptom,
15:27
But the other fifty percent did not. It
15:30
was forty eight had, fifty two percent did
15:33
not have any gut symptoms. They had psoriasis,
15:37
or they had rheumatoid, or they had MS,
15:39
or they had chronic fatigue. They didn't have
15:41
any gut symptoms when they eat wheat.
15:44
But it was wheat that was activating
15:47
this chronic inflammatory
15:49
response
15:51
fueling
15:52
However, missus patient, you pull it a chain,
15:55
it breaks at the weakest link. Always.
15:57
It's at one end, the middle, the other
15:59
end. It's your heart, your brain, your liver,
16:01
your kidneys, wherever your weak link is. Well,
16:04
the pull on the chain is inflammation.
16:07
So when you identify the trigger of the
16:10
inflammation, that's why you hear stories
16:13
all the time. I mean, I've got, I've
16:15
I've got articles in my lectures. I I
16:17
just show the slides from the published articles
16:20
in the medical journals, reversing a conjunctival tumor
16:24
diagnosed as Kaposi's sarcoma
16:26
in a three year old on a gluten
16:28
free diet.
16:30
Reversing severe psoriasis
16:32
from an elder
16:33
who had psoriasis since his mid forties. He
16:36
was now in his seventies.
16:38
Within one month, completely eliminated on a gluten
16:41
free diet. That sometimes
16:43
you see the most
16:44
dramatic results
16:46
when you eliminate
16:48
the trigger
16:49
of the ongoing
16:51
inflammation.
16:52
So to your question, Scott,
16:54
test,
16:55
don't guess,
16:57
don't shotgun.
16:59
We used to teach about the elimination diet
17:02
and get the foods out of your diet
17:03
you suspect may be a problem. When you
17:05
feel better, reintroduce one food at a time
17:08
and see how you feel.
17:10
Back in the seventies and eighties, you know,
17:13
that was cutting edge and it made sense
17:15
to do that. But now we know so
17:18
many symptoms
17:19
are not related to the gut
17:22
from foods that are activating
17:24
an immune response. It doesn't matter how you
17:26
feel.
17:27
Not really. You know, if you feel bad
17:29
with eating food, that's pretty obvious.
17:31
But for just over half of the people
17:33
that have a sensitivity to wheat,
17:35
as an example,
17:36
they don't get gut symptoms.
17:38
So if they eat it and they feel
17:40
fine, they think it's okay, but they still
17:43
have their seizures.
17:44
Or the here listen to this one.
17:47
Children
17:49
with drug resistant
17:51
epilepsy, meaning they've been on at least three
17:54
medications and nothing has worked.
17:56
Fifty percent of children with drug resistant epilepsy
18:00
go into complete remission
18:02
on a gluten free diet.
18:04
Fifty percent. And that's published in the journal
18:06
gastroenterology.
18:08
Now why don't our neurologists know this? Because
18:11
they don't read gastroenterology.
18:13
They read neurology journals.
18:15
So they don't know that.
18:18
I mean, you see that these studies have
18:20
been coming out for the last thirty years,
18:23
if you look for them.
18:25
And it just validates
18:27
that you want to look.
18:29
Don't be fanatical,
18:30
but just test.
18:32
Don't guess.
18:34
Thank you so much. And and and talk
18:36
for a second about,
18:38
you know, the functional doctor know we well,
18:41
some of the things that you do today,
18:43
and and and what you've grown and done,
18:45
and and then talk about,
18:48
whether Michigan is likely to compete for a
18:50
national championship again in the future or not
18:52
likely.
18:54
Oh, you know I'm from Michigan.
18:57
That's a great question.
18:59
I don't know. I don't know. I'm I'm
19:01
sure they will at some point.
19:03
So a
19:04
in in our training, there is a a
19:07
program we have called applied functional medicine and
19:09
clinical practice.
19:11
And it's a five day program.
19:13
Practitioners come,
19:15
on Sunday afternoon, and we start Monday morning,
19:19
and we go until Friday,
19:21
06:00.
19:22
And,
19:24
the first,
19:26
on Monday morning, they're welcome. We talk about
19:29
what what it's gonna be like for the
19:31
week.
19:32
We're gonna do case studies.
19:34
We're gonna have group discussions.
19:36
Then we break for lunch. And the first
19:38
technical talk they get in the afternoon is
19:41
me.
19:42
The gut. Talking about the gut. And we
19:45
go through this whole concept of why all
19:47
disease begins in the gut.
19:50
And just to consider
19:52
and never forget,
19:54
just consider and evaluate
19:56
how is gut function going. So a functional
19:59
medicine practitioner
20:01
doesn't look
20:02
just at the presenting symptoms.
20:05
You, of course, have to deal with the
20:06
presenting symptoms or the patient doesn't come back.
20:09
But we look at what's the health history.
20:12
What was mom's health like during pregnancy with
20:15
this person?
20:17
We now know that fetal programming
20:19
is just substantially
20:21
altered for neural development when mom is really
20:24
toxic with high loads
20:26
of toxic chemicals in her body. There's too
20:28
many studies now to not recognize that sometimes
20:31
that's a problem.
20:33
So we go back and we look at
20:35
the health history as far back as we
20:37
can go.
20:39
From their
20:41
their mother's pregnancy,
20:43
from their infancy,
20:45
their toddlerhood,
20:46
how many prescriptions for antibiotics have you had
20:48
in your life,
20:49
all the way up to today.
20:52
And we try to put together the storyline
20:55
of what likely has happened to this person
20:58
and where it come from. It takes a
20:59
lot of time.
21:01
And so the recommendation is you start with
21:03
one patient a week, you know, because you
21:05
can't transition
21:06
that quickly usually.
21:08
But you just start with one. You take
21:09
the file home at night, and you think
21:11
about it with all of your notes from
21:13
the five day course and what are the
21:15
questions to ask.
21:16
And and then you just start
21:19
putting yourself
21:20
in the hot seat of thinking,
21:22
asking different questions.
21:25
So functional
21:26
medicine is looking to see where did all
21:28
this come from?
21:30
Why and how is the immune system being
21:33
activated
21:34
to protect you?
21:37
Doctor O'Brien, I I I love what you
21:39
do. Where could people find out more about
21:42
you and learn more about what you do?
21:44
Well, thank you.
21:45
Our website is thedr.com.
21:49
Thedoctor.com.
21:50
Just don't don't spell the word doctor out.
21:52
Thedr.com.
21:55
And to really get an overview of this,
21:58
last year, I traveled to seven countries,
22:01
and I interviewed 64
22:03
of the world leaders
22:04
in immunology
22:06
and functional medicine. I mean, I went to
22:08
Israel and to
22:10
Germany and to London
22:12
and to Rome to interview these people who
22:15
had
22:16
these researchers who have published so many papers
22:18
on these topics
22:20
about chronic inflammation and where it comes from.
22:22
David Furman at the Buck Institute of Aging
22:25
in California.
22:26
Marvelous guy. We we had so much
22:29
fun. But I've interviewed all these people, and
22:31
we put it together in a docuseries
22:34
that really sets the stage of understanding for
22:37
all this. It's free. It's all free. It's
22:39
called the inflammation
22:42
equation.
22:43
And you'll find it on our website, thedr.com.
22:46
You just register for it and then every
22:48
day, we send you one episode
22:50
for nine days. And they're about thirty minutes
22:53
long,
22:54
and you listen to these world experts talking.
22:57
For example,
22:59
Yehuda Schonfeld is the godfather of autoimmunity
23:02
to I mean, there's so many
23:04
accolades. To give you a sense of this
23:06
guy, 26
23:08
at last count that I know of.
23:10
26 of the
23:12
medical doctors who went back to get their
23:14
PhD in immunology
23:16
at Tel Aviv University. There are many, many
23:18
more, but 26 of them chair
23:21
departments of immunology and medical schools and the
23:24
hospitals around the world. They're his students.
23:27
So when I interviewed professor Schonfeld, I said,
23:30
professor, how are you? We've shared the stage
23:32
before. And he looked at me and he
23:36
said, doctor Tom,
23:38
we are born
23:40
99%
23:41
human.
23:43
Meaning, a newborn has a small microbiome, but
23:47
not much.
23:48
We are born 99%
23:50
human,
23:51
and we die
23:53
90%
23:54
microbial.
23:56
And many have heard there is 10 times
23:58
more bacterial cells in our body than human
24:00
cells. And, you know, he just laid that
24:03
out there and then paused. Didn't say anything.
24:05
He wanted to see how I was gonna
24:07
respond.
24:08
And I looked at him for a minute,
24:10
and then I said, well, sir,
24:12
doesn't that mean that this is really the
24:15
dance of life,
24:17
the microbiome?
24:18
And he said,
24:20
precisely.
24:21
Precisely.
24:23
So that's the kind of information you get
24:25
in the inflammation equation where you just wait.
24:28
What?
24:29
What did he say? You You know, when
24:31
you check the science and you see they're
24:34
absolutely accurate in what they're saying, and it
24:37
helps us to think this bigger picture. Alright.
24:39
If the immune system is the armed forces
24:42
trying to protect you,
24:44
and inflammation
24:45
is the result of an activated immune system
24:48
and 14 of the 15 top causes of
24:51
death are chronic inflammatory
24:53
diseases,
24:54
then a critical question you have to include
24:57
is, what is my immune system trying to
25:00
protect me from?
25:02
That is what the inflammation equation is all
25:05
about in everyday language
25:07
interviewing the world greats.
25:09
And it's all free at thedr.com.
25:14
Doctor O'Brien, I I wanna thank you for
25:16
taking the time to join us today, in
25:18
the Becker's Healthcare podcast.
25:20
What a remarkable career.
25:22
Couldn't agree with you more about inflammation being
25:24
the cause of so many troubles, and and
25:26
I love your approach to trying to solve
25:27
it. Thank you for taking the time with
25:29
us today. Just remarkable.
25:31
Thank you, Scott. It's a pleasure.