RHR: Integrating Functional and Ayurvedic Medicine to Treat and Heal Your Autoimmunity, with Dr. Akil Palanisamy

In this episode, we discuss:

• Toxins that have been linked to increased risk of autoimmune disease, and how you can minimize your exposure to them
• The microbiome, the mycobiome, the virome, and their connection with autoimmunity
• The five most important keystone bacteria in the microbiome for immune health and autoimmunity
• The two-phase diet that Dr. Palanisamy designed for those with autoimmunity issues
• Why stress reduction is a fundamental part of immune health
• The oral microbiome and its implications in autoimmunity
• The richest food sources for polyphenols and phytonutrients
• Experimental therapies promising for autoimmune diseases

Show notes:

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Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. The latest statistics suggest that up to 50 million Americans are living with an autoimmune disease today, at a cost of almost $90 billion a year. New autoimmune diseases are being discovered every year. I think the list has over 80 distinct conditions now, and they are very poorly served by the conventional medical establishment. I’ve seen this firsthand as a Functional Medicine clinician with almost 15 years of experience treating patients with autoimmune disease. The typical treatments are drugs that just suppress the symptoms like steroids, and although these can be necessary and even life-saving in some situations, it’s clear that they are not addressing the root cause of autoimmunity, which is really what we need to be doing if we want to get a handle on [the] alarming growth of this condition.

So I’m really excited to welcome Dr. Akil Palanisamy as my guest. He’s been a guest on Revolution Health Radio before. He’s a Harvard-trained physician who practices integrative and Functional Medicine, blending his conventional medical expertise with holistic approaches, including Functional Medicine and Ayurveda. Akil and I see eye-to-eye on a lot of things, and I especially like his approach to autoimmunity. I think it’s balanced, it’s evidence-based, and it’s really geared toward helping people address the root causes of their condition so that they can recover their health and live a full and vibrant life. In this show, we’re going to talk about his new book called The TIGER Protocol, which is an integrative five-step program for treating and healing autoimmune disease. TIGER, as you probably gathered, is an acronym, so we’ll talk about what those letters stand for, what some of his most important recommendations are from his decades of experience treating patients with autoimmune conditions, and some simple and practical strategies that you can use at home for improving your quality of life if you are someone who is dealing with an autoimmune disease. I really enjoyed the conversation, [and] I think you will, as well. Let’s dive in.

Chris Kresser:  Dr. Akil, it’s such a pleasure to have you on the show.

Akil Palanisamy:  Thank you so much, Chris, for inviting me back.

Chris Kresser:  So, I want to talk about your new book, The TIGER Protocol: An Integrative 5-Step Program to Treat and Heal Your Autoimmunity, out on May 9th. I’ve always had great respect for your work, and autoimmunity is a problem that is unfortunately not going away. In fact, the number of people that are diagnosed with autoimmune disease seems to rise every year. The number of autoimmune diseases themselves seems to increase every year. My perspective, and I’m sure you agree, is that it is one of the health conditions that is most poorly treated by the conventional medicine establishment. If anything is ripe for a Functional Medicine approach, it’s autoimmunity. So I’m really excited to dive into this with you. Maybe you could start by telling everyone what led you to write this book in the first place.

Akil Palanisamy:  Yeah, exactly. You’re totally right, Chris. In medicine, we’re not very skilled at treating quality-of-life issues or treating root causes. In autoimmune disease, we have wonderful medications [like] drugs that suppress the immune system [and] steroids that can be life-saving. But beyond that, there’s not much that’s offered. Patients are really hungry, as you know, for integrative solutions [and] for diet and lifestyle recommendations. So in my practice, it just organically evolved that I started seeing more and more autoimmune patients. And over the past 20 years [as] I’ve been practicing, I’ve created and fine-tuned this protocol. I saw good results in terms of improving immune function, reducing inflammation, [and] helping quality of life, and, therefore, I wanted to put it all together in the book so more people could learn about it.

Chris Kresser:  Fantastic. We’re just going to jump right into some of the potential root causes of autoimmunity that I think some folks are not even aware of because, again, the conventional treatment is usually just suppressing the symptoms with drugs. And as you pointed out, there is a case for that. There are situations, for example, where someone who is having a very severe Crohn’s disease flare might need medication to quell that flare and get them back to a point where they can address these longer-term issues. Another example that comes to mind is someone who has Graves’ disease and is in a thyroid storm. That can be fatal, right? So drugs can be very necessary in that situation. But generally, there’s very little exploration or discussion about what these root causes are. In your book, you talk about environmental toxins. There’s growing literature linking a whole range of toxins to immune disruption and autoimmunity. Can you talk about that a little bit?

The Link Between Toxins and Autoimmunity

Akil Palanisamy:  Yeah, absolutely. So, the TIGER Protocol is the acronym. “T” is for toxins. And I’m putting that first because I feel like it’s the hidden biggest driver that a lot of people don’t think about. So in the book, I review 20 different categories of toxins that have been associated with increased risk of autoimmunity—heavy metals, endocrine-disrupting chemicals, pesticides, [bisphenol A] (BPA), waterborne toxins, air pollution, [perfluorinated compounds] (PFCs), [polychlorinated biphenyls] (PCBs). Each of them individually conveys an increased risk of autoimmunity. When you start combining them, [and] the studies have shown that most people have between 100 [and] 200 levels of significant toxins, then they have synergistic effects. We’re starting to see some research about that because we need to know how all of these factors are working together. Because that’s the reality. We’re all exposed to chronic, low-level accumulation of multiple, probably hundreds of, toxins. And that is really a huge factor in driving oxidative stress, driving inflammation, and driving autoimmunity.

Chris Kresser:  Absolutely. As you said, we’re really just scratching the surface of understanding the synergistic effects of these compounds. Up until relatively recently, the study of toxicology was mostly concerned with extreme, acute toxicity. We didn’t even really understand what the impacts of low-level chronic exposure were, nor did we understand that those impacts are often quite different [from] the impacts of acute toxicity. I think toxicologists just assume that with lower exposure, you just get sort of junior versions of the impacts that you get at higher exposure. But it turns out that’s not true. They can be totally different and even opposite, in some cases. To me, this is a major problem that, unfortunately, is difficult to avoid if we’re living in the industrial world, which almost everyone listening to this podcast is. It’s not something that we can just avoid.

Akil Palanisamy:  Yes, you’re totally right. I think the perfect example of that is glyphosate because the acute toxicity studies have been done. And that’s why there’s controversy, because those scientists are saying the acute toxicity has to be a very high dose. But with autoimmune disease, there are two mechanisms that are not being well studied. One is that glyphosate inhibits your Cytochrome P450 liver enzymes, which are critical for detox. It impairs the clearance of all the environmental toxins. And then secondly, glyphosate came to market as an antibiotic many years ago. It causes a decline in beneficial bacteria [and] predisposes [you] to dysbiosis. So I think these kinds of things need more study in terms of the long-term effects of that. And I agree with you, that’s a direction we need to pursue.

Chris Kresser:  So even though we can’t completely eliminate our exposure to these toxins in most cases, what are some of the recommendations you suggest in terms of mitigating or minimizing exposure?

Ways to Minimize Exposure to Toxins and Mitigate Their Effects

Akil Palanisamy:  Oh yeah, absolutely. I think it’s, try to do both. Try to reduce your exposure to toxins, and then try to enhance detoxification. The first thing to remember is mindset because I don’t want people to be depressed or overwhelmed. That’s not my goal. Because it’s easy to get overwhelmed [by] the mountain of research. But we all have our own detox capacities. In terms of reducing exposures, I think purifying your drinking water, like getting a really good filter, is beneficial, [and] purifying your air with a home filter, which I know you’ve talked about extensively. There was an interesting study about shoes. Removing your shoes upon entering the house is beneficial because, on the bottoms of your shoes, studies have found lead, pesticides, [and] harmful bacteria. So if you’re leaving them at the door, then they’re not going to be tracked into your house. That’s something a little bit less well-known. I think some other strategies are reducing your exposure to heavy metals, especially mercury and lead, and using healthy cooking vessels. You have to also look at your personal care products. The Environmental Working Group has a lot of guidelines there. And finally, the household chemicals that we’re all exposed to, cleaning materials at home, and also indoor air is very important.

Chris Kresser:  Yeah, a lot to consider. Both Akil and I have articles about this and [how] to chip away at it. I think start with the biggest offenders [like] the personal care products because our skin is one of the barrier systems in our body. What a lot of people don’t realize is [that] the gut is actually a much less permeable barrier than the skin. Because from an evolutionary perspective, we were at risk of dying from eating something that was toxic, so the gut evolved mechanisms to keep toxins out. There weren’t really any examples of skin creams that were [used] hundreds of thousands of years ago. Our ancestors weren’t putting things on their skin, so the skin never evolved that kind of discernment, you could say. Whatever we put on our skin has, I think, a much greater potential for causing toxicity. And a lot of personal care products with chemicals fall into that category.

Akil Palanisamy:  Yeah, that’s a great point.

The Relationship Between Infections and Autoimmunity

Chris Kresser:  I want to talk a little bit about the next [piece], which is the “I” in TIGER. This is healing infections. I think most recently, the way this has been on people’s radar is with COVID[-19] and SARS-CoV-2, and the discussion around how infection with SARS-CoV-2 can perhaps predispose people to autoimmunity. In fact, this shouldn’t have been a surprise, right? We have a long history of literature linking [autoimmunity to] all kinds of different infections, not just SARS-CoV-2, but all kinds of other viruses and bacteria and fungi, etc. So, talk a little bit about that.

Akil Palanisamy:  Yeah, absolutely. I think infections are a really big factor. And in terms of the overall approach, I try to focus on the terrain of the body, the internal environment. Making your body inhospitable to infections, rather than focusing excessively on the germ or the microbe. So we do include antimicrobial herbs and spices in the protocol, but I think focusing on the terrain is really the emphasis. And you’re exactly right; many different categories of organisms have been associated with increased risk of autoimmunity. Bacteria, of course, in the microbiome. Dysbiosis, which is the decline in beneficial keystone species and overgrowth of potential pathogens. There’s also the virome, which is the community of viruses. [There] is very interesting new research, early research about the connection with autoimmunity. And then there’s the mycobiome, which is all the fungi. Candida is the most well-known one. There is pretty good research [showing] that can play a role in certain people. Then we have parasites and archaea, as well. So I think there’s this broad range of different microbes, and the focus is [to] make your body inhospitable, make your gut inhospitable, and then try to include some of these natural antimicrobial compounds like spices and herbs to support that process.

Chris Kresser:  Yeah, you and I have agreed on this for a long time, I think. The pendulum, I think, went too far in the other direction with germ theory. The discovery that germs cause disease was perhaps one of the most important breakthroughs in the history of science and medicine. We’re not disputing that, of course. But the idea that all microbes are harmful and we need to create as sterile an environment as possible, whether we’re talking about inside of our bodies, or in our external environment, we now know that’s not a good approach either. Through the hygiene hypothesis or the old friends hypothesis and the idea that these microbes actually play beneficial roles, we could even consider ourselves more of an ecosystem than an individual, in that sense.

Akil Palanisamy:  Right, exactly.

Chris Kresser:  It’s so important that we preserve the health of that ecological community. And I love what you just said, doing that with a combination of diet and probiotics and prebiotics and spices and herbs and things that essentially, if you use, keep the garden healthy. Because then, in that garden, the weeds and other pathogens will be less likely to take over.

Akil Palanisamy:  Right, exactly.

Gut Health and Autoimmunity

Chris Kresser:  That’s a good segue into “G,” which is gut health. Because gut health, as we just discussed, is important for protecting us against infections. It’s also important for helping us detoxify toxins, which [is] “T.” So it seems to me that it’s funny, because “G” is the center of this word TIGER, but it’s also playing a central role in this entire approach, isn’t it?

Akil Palanisamy:  Yeah, absolutely. You and I have been speaking for a long time about how the gut is foundational and affects every organ system. Many people have heard about the microbiome, but in the book, I really wanted to do a deep dive. So I cover five of the keystone species that are very important and make up a huge percentage of the microbiome. For example, Bacteroides can be up to 25 percent of all species in a healthy microbiome. It’s a pathobiont, which means that it’s highly dependent on an environment, highly pH dependent in the intestine, and can be either beneficial or very harmful depending on the environment. Also Faecalibacterium prausnitzii, which is another keystone species, [can be] up to 15 percent of all species in a healthy microbiome, [and] very important in COVID[-19]. That’s kind of helped make it more well-known. It seems to play a role in the immune system and inflammation. And then, of course, there’s Bifidobacterium and Lactobacillus, which most people have heard about, but I think that they do play a role in immune health. And then finally, there’s Akkermansia muciniphila, [which] is now well known for its role in metabolism and blood sugar and healthy weight.

There is some controversy about the role of Akkermansia in autoimmunity because [in] certain conditions, specifically multiple sclerosis, there [are] three studies that showed increased presence of Akkermansia. But there are researchers who argue that [it] is more a result of a disrupted gut microbiome and not a cause of it, which is my view. Akkermansia, in most studies, because of the remodeling it triggers for the gut mucus and gut lining, leads to an increase in gut mucus thickness. I think it’s beneficial bacteria to try to raise up through foods. So, yeah, I just wanted to teach people more about what the individual organisms [are] and how to support each of them with certain foods.

Chris Kresser:  Great. Yeah, that’s not uncommon. Some people would make the argument that cholesterol has a similar function as a repair substance. I think there is some merit to that. But when you see something elevated, it doesn’t mean that thing, that’s confusion of correlation and causation, right? Which is a fundamental thing that we hopefully learn when we’re studying research methodology. But it is difficult to tease out sometimes, that chain of causality. So yeah, these [bacteria], even just in the time you and I have been doing this work, Akil, we’ve learned a lot more [about]. Particularly about the anaerobic species, which we didn’t initially have insight into because they couldn’t easily be cultured. All of the new methodologies for testing make that a lot easier. And we found that these are actually, in many cases, the major players that we didn’t even know about before.

Akil Palanisamy:  Right. Exactly.

Food as Medicine and Approaching Diet as Someone with Autoimmune Disease

Chris Kresser:  So the “E” is learn to eat right. This is something that people will probably be most familiar with when it comes to general health and well-being. But [for] people with autoimmune disease, eating right for them might be somewhat different than eating right for people without autoimmunity. So how are you approaching this? Because there’s obviously so many different ways of looking at the right diet for someone with autoimmune disease.

Akil Palanisamy:  Yes, absolutely. So this is my favorite topic. I really believe in food as medicine, and the book has tons of recipes from my kitchen that I use. The way I approach[ed] it [was] I broke it up into two diets. One is the phase one diet, which is more of an elimination diet [and] more restrictive. Then there’s the phase two diet, which is designed to boost your microbiome diversity. It’s more of a long-term diet. I know this is something you and I have seen in our practice—sometimes patients end up staying on a very restrictive diet for too long, like the [autoimmune protocol] (AIP) diet, and then losing some of that beneficial diversity in the microbiome, which is harmful in the long run. You do need to start with an elimination diet. I talk about some of the differences between food sensitivity versus food intolerance versus food allergy. The main way that my elimination diet, the phase one, differs from, for example, the AIP, is that I include mung beans because mung beans are unique among all legumes in Ayurveda, the system of medicine from India, because they’re considered to be the most easily digestible. They’re part of a dish called khichuri, which is a medicinal dish in Ayurveda. Then I also allow gluten-free grains. If people tolerate rice or quinoa or other gluten-free grains, then I don’t often see that is inflammatory for people.

There [is], of course, a subset of patients that have to be off all grains, and you have to kind of investigate that. But I don’t think it’s automatic for everyone. That way, you’re getting a little more flexibility, even with the elimination diet. Then the phase two diet is really all about how to reintroduce the prebiotic foods. So, the different categories of prebiotic foods, including polyphenols. Foods that are rich in polyphenols are often the best tolerated, even by patients with [small intestinal bacterial overgrowth] (SIBO) or dysbiosis. Then I go through the top foods that contain inulin, all three types of resistant starch, the arabinogalactans, the various other types of prebiotic foods, and also emphasize fermented foods in the long-term diet. But I really place more emphasis on the prebiotic foods because I feel like fermented foods are recognized and emphasized, but we have a lot of research on the health benefits of getting these prebiotic foods that you can tolerate into your diet.

Chris Kresser:  Excellent. Yeah. And [here’s] a funny anecdote. I did a 30-day meditation retreat in Thailand when I was in my 20s, and the only thing we were allowed to eat during that time was khichuri in the evenings. We had [a] midday meal. We had no food in the evening, [and] then we had a late breakfast. So [the] taste of khichuri is deeply ingrained in my psyche. Even right now, if I think about it, it’s vivid. And I really like it. There was quite a while where I couldn’t eat a bowl of khichuri because I was just so tired of it. But yeah, it was interesting because at that time, I was struggling with my health and my gut health, and I couldn’t really eat any other legumes or beans, but the khichuri didn’t cause any problem for me, which was one of my biggest hesitations of doing that retreat, because I was like, “Oh my gosh. I’m going to be eating legumes every day. This is going to wreak havoc.” But it didn’t. So I find [it] interesting that you allow that, even on the phase one part of the diet.

Akil Palanisamy:  Yeah, fascinating story. [In] many Ayurvedic hospitals in India, the entire diet that people eat for a 21- or 28-day cleanse is khichuri. That’s all they’re eating.

Chris Kresser:  Yeah, it’s the khichuri cleanse.

Akil Palanisamy:  And then plenty of ghee, as well.

Chris Kresser:  Yeah, we did add some ghee. Because [since] all I was eating was khichuri, I did lose quite a bit of weight, as you can imagine. But I think the ghee helped to make that less severe than it would have been otherwise.

Autoimmune disorders affect an estimated 300 million people worldwide. These disorders can be frustrating, as they are difficult to diagnose, painful, and often invisible. With the simple yet powerful five-step plan devised by Dr. Akil Palanisamy, you can learn to treat, tame, and potentially reverse painful autoimmune conditions. #chriskresser #autoimmunity #functionalmedicine #TIGERprotocol

“Rest and Rebalance”: Stress Reduction and Having Fun

Chris Kresser: All right. So the last one, and this is one of great interest to me, is rest and rebalance. There [are] two “R”s there that we are combining into one. I will say from my 15 years of experience working with autoimmune patients that I think this is the most underrated one of the bunch, and one where I have often seen people make great progress when everything else has not yielded results. So I’m curious to hear about your experience with this and what you suggest in this category.

Akil Palanisamy:  Yeah, absolutely. I completely agree. I think it’s absolutely fundamental and a key part of immune health, inflammation, and just longevity overall. When I start talking about stress, usually, my patients’ eyes glaze over, and it’s kind of like, [they] zone out. But I’ve learned to give people options. I’m a big fan of meditation. There is research showing that meditation reduces inflammation and lowers levels of your C-reactive protein and tumor necrosis factor alpha. It helps your gut, [and] it transforms your brain through neuroplasticity, literally grows your brain; your hippocampus gets bigger, frontal cortex gets bigger, [and] white and gray matter both increase in size. If you are okay with meditation, it’s unsurpassed in terms of health-promoting benefits. But it’s not for everyone. And the studies show that there are many different ways to climb the mountain and tackle stress. So, things that are beneficial include psychotherapy, guided imagery, prayer for certain people, gratitude practices, yoga, or tai chi. There’s a lot of different ways to come at it. The main thing I recommend [is that] people find something they can do every day. Something that they enjoy, something they can do, even if it’s for five or 10 minutes, every day. I think it’s really key to continuously be clearing out stress from our body and prevent it from exerting its negative impacts if it builds up to a high level.

Chris Kresser:  Absolutely, yeah. I’m going to put in a plug here for having fun as an antidote to stress. That’s one of my preferred stress-busting approaches. I mean, I started meditating when I was 17, and I’m 48 now, so it’s been over 30 years. And I’m a huge, huge proponent of meditation. Absolutely. And I agree with you; it’s unsurpassed because it’s such a full and rich practice that can support us in so many ways. [But] I like talking about fun as a stress management modality because you rarely hear that. [It’s] usually, “Oh God, I’ve got to sit down and meditate, or I have to do really slow movements, tai chi or chi gong or deep breathing,” all of which are great and really helpful. But even just doing something you really enjoy, or laughing, playing with your pets or your kids, those release endorphins. And you talk about this, as well, that those endorphins have a regulatory role on the immune system. It’s the whole principle of Patch Adams, [for] people who’ve seen that movie.

Akil Palanisamy:  Yeah, yeah. And I recall, you and I led a retreat on burnout for physicians many years ago before the pandemic. I remember how you spoke about [playing] and having fun. And it was really kind of a shock, I think, to these physicians to hear that. But it was very great, I think, that you opened their eyes to that, because it’s so powerful.

Chris Kresser:  Absolutely. And it’s fun, right?

Akil Palanisamy:  Yes, exactly.

Chris Kresser:  Having fun is fun. It might be easier to convince some of our patients to have more fun than it is to get them to meditate, right?

Akil Palanisamy:  Oh, for sure. Yes, for sure.

The Oral Microbiome’s Impact on Our Immune Function

Chris Kresser:  I want to talk about a few other things from your book that I really appreciated [and] that I think can play a significant role. One is the role of the oral microbiome. This is something that’s definitely gained more attention. I don’t think very many people were talking about this at all even 10 years ago, much less 20. But now there’s quite a bit of research that suggests that the health of our gums and our teeth and what’s happening in our mouth can actually have a major impact on our immune function.

Akil Palanisamy:  Yes, for sure. I think the oral microbiome is now being increasingly connected to heart disease, diabetes, cancer, infections, and autoimmunity. And I was very surprised by how strong the research is. The oral microbiome is our second biggest microbiome, about 6 billion bacteria, whereas the [gastrointestinal] (GI) microbiome is about 40 billion. And we swallow probably, on average, between 800 billion oral bacteria per day on the low end to more than 1 trillion oral bacteria per day, every day. There are no breaks; there are no days off. That’s why it’s so important. What’s the makeup of those microbes?

There is also leaky mouth syndrome. Just like you [can] have leaky gut syndrome [and] you can have increased intestinal permeability, you can have dysbiosis in the oral microbiome, which is [an increase] of pathogens [and] decline of the keystone species. To strengthen the oral microbiome, there [are] many strategies. From Ayurveda, I think oil pulling is a very beneficial practice, and also tongue scraping, where you are cleaning your tongue either with a toothbrush or a tongue cleaner every day. That also reduces quite a bit of the pathogenic bacteria. And then, from the diet point of view, I’m a big fan of green tea, which is a prebiotic that supports both your oral and intestinal microbiome. I just tell people to swish around green tea in their mouth before swallowing, and it gets to those oral bacteria, and then it goes into your gut and has other benefits, too. I’m a big fan of matcha because you get the highest levels of the catechins, which are the antioxidants that are active and a prebiotic.

So I think that’s a good way, with diet and lifestyle practices like those Ayurvedic techniques. Then finally, we do have to talk about root canals. That’s potentially an area that can be a real unrecognized driver for autoimmunity. Not for everybody, but for some people, they can be a hidden nidus of infections [and] contribute to inflammation. There’s a lot better technology now, like the 3D cone beam X-rays to investigate, and working with specialists that can look and see if that’s an issue for you. But there’s so much from the oral microbiome that’s relevant to health.

Chris Kresser:  Absolutely, yeah. It’s something that I think we’re going to learn more and more about as our understanding improves. And I think, unfortunately, in my experience, the understanding of how this contributes is a little bit ahead of people’s ability to access advanced dental and periodontal care that is consistent with this new understanding of principles. But that will change over time. Hopefully, sooner rather than later.

Polyphenols and Phytonutrients

Chris Kresser:  Another topic I want to cover is one that I know you have been a big advocate for since your first book and something you’ve often spoken about, especially in the context of herbs and spices, which are a big part of Ayurveda. [It] is polyphenols and the phytonutrients that we get from plant foods like vegetables, fruits, nuts, seeds, and, of course, herbs and spices, which are among the most nutrient-dense foods that we can eat.

Akil Palanisamy:  Yes. I think polyphenols are really central to my phase two diet because of their anti-inflammatory benefits [and] their prebiotic effects. In the literature, there [are] actually published data about hundreds of foods and their polyphenol content. So I put that all together in tables going through every category. For example, in fruits, elderberries [are] the highest in polyphenol, followed by blueberry and black currant. Elderberries [are] something that, of course, has benefits for your immune system, as well. In vegetables, it’s capers, black olives, and green olives that are way above most other vegetables. This is all looking at 100 grams of serving size. Then with herbs and spices, there’s clove powder [and] dried peppermint; those are both [around] three times the amount of polyphenols as the other compounds. Also, ground flax seeds and chestnuts are the most rich polyphenols in terms of nuts, beans, and seeds. So I think that it’s beneficial because many people with SIBO cannot tolerate inulin-rich foods, which are kind of high [fermentable oligosaccharides, disaccharides, monosaccharides, and polyols] (FODMAP) foods. Many people with autoimmune disease don’t tolerate legumes, which are incredibly good sources of prebiotic and resistant starch. But if you can’t tolerate them, you can go to the polyphenols and choose from these lists. Whatever you can tolerate, that will really help boost your microbiome diversity.

Chris Kresser:  Yeah, I’m excited about this. And I’ve appreciated your balanced approach [to] this topic over the years. I think, again, this is something you and I agree on. Because on the one hand, you have plant-based diet advocates who believe that we can get everything we need from plants, and we don’t need animals. And on the other end, more recently, you have the carnivore camp that believes that there’s nothing that we need from plants. And my way of looking at it, which I think you agree with, I don’t want to put words in your mouth, is that the best diet for most people is a combination of both plant and animal foods.

Akil Palanisamy:  Agreed.

Chris Kresser:  One of the reasons for that is these phytonutrients, and not just polyphenols, but lignans and soluble fibers, beta-glucan, all the interesting compounds that science has really [been] shining the light on, in terms of their health benefits. They’re not essential in the sense that vitamins and minerals are, that we literally cannot live without [them or] we’ll develop acute diseases and die, but if you want to live a good life, a healthy life, and a long life, they appear to be very important.

Akil Palanisamy:  Yes, absolutely. [I] couldn’t agree more.

Emerging Therapies in the Treatment of Autoimmunity

Chris Kresser:  The last thing I want to talk about is some of the more experimental therapies, we could say. Things that are being studied now. There may not be as much research on them yet, but they have some interesting mechanisms. There [have] already been some interesting pilot studies or bigger studies, and anecdotally, patients are getting good results with them. I’m thinking about things like vagus nerve stimulation with a [Portable Neuromodulation Stimulator] (PoNS) device and some of the other therapies you mentioned later in your book. So maybe pick a couple that you think are most promising that you’re using with patients that you like, and I’d love to hear about those.

Akil Palanisamy:  Yeah, absolutely. I think it is exciting because there are a lot of things coming on the horizon that I think will be very beneficial. You mentioned the PoNS device. So, that’s very interesting. It uses a portable tongue stimulation device that uses neuroplasticity. It sends signals through the tongue back to the brain, and it’s now [United States Food and Drug Administration] (FDA) approved for patients with multiple sclerosis (MS). [It] improves their balance and other things. So for someone with MS, I think that’s already available as an FDA-approved option through their neurologist. I think, in terms of other therapies, I’m excited about stem cells. I think it’s a bit of a Wild West right now in terms of lack of regulation. But there are some promising companies that are researching stem cells. There’s a company from Australia that is working on a stem cell infusion for patients with autoimmune disease. They study [stem cell infusion] in rheumatoid arthritis patients [who] were refractory, meaning they didn’t respond to even the strongest drugs and IV drugs. But a single stem cell infusion was significantly beneficial for 10 months when compared to a placebo. And I think stem cells can help with the repair and regeneration of damaged tissue and inflammation. So that’s some research that I’m following quite closely. Then with the vagus nerve, electrical stimulation, yeah, that’s something that [is] still new, but [there is] very promising research for rheumatoid arthritis and for inflammatory bowel disease that it helps with reducing inflammation. It’s a small implantable device. It’s getting smaller and smaller in the next generation. But [there’s] exciting research about the role of that in a non-drug therapy to help with bringing down inflammation. And, of course, I’m also a big fan of activating your vagus nerve in every other way that you can, like cold showers, exposure to cold, singing, oil pulling, all of those things.

Chris Kresser:  Yeah, a lot of the stress management techniques we talked about earlier can have an effect on the vagus nerve, as well. And there is an interesting device called the Sensate. Have you worked with that at all, Akil?

Akil Palanisamy:  No.

Chris Kresser:  I’ll send you some information on it later. You hang it around your neck while you’re lying down or sitting down, and it rests right on your sternum around above where the vagus nerve would be, and it vibrates. That vibration sends a pulse through the bones that induces a parasympathetic response, and it does it [to] the rhythm [of] pre-programmed music that you listen to in headphones. I find it to be very relaxing. I’ve been testing it out and using it lately. There [are] some really cool new things becoming available, I think, in a non-invasive way and in a way that is pretty relaxing to stimulate the vagus nerve.

Akil Palanisamy:  Yes, yes. Have you heard about the Apollo Neuro device? I notice many of my patients are using that with good success for parasympathetic activation.

Chris Kresser:  Exactly. That’s another good example. And not a lot of people have access to this, but sauna and red light therapy are other interesting pleiotropic modalities that I think have a lot of beneficial effects [on] the immune system.

Akil Palanisamy:  Oh, yeah. No doubt.

Chris Kresser:  And again, [it] feels good, right?

Akil Palanisamy:  Yes, exactly. Yeah.

Chris Kresser:  I’m a big fan of treatments or modalities that are enjoyable to do.

Akil Palanisamy:  Yeah, and they have so many multiple benefits for different conditions, for your longevity, for your mental health.

Chris Kresser:  Yeah, I used that word pleiotropic just now. For people who aren’t familiar with it, in the context of studying drugs or genes, which is where the word came out of, it means benefits other than perhaps the primary or intended benefit. So if statin drugs were thought to work by lowering cholesterol, when they talk about the pleiotropic benefits of statins, they mean other effects that aren’t related to lowering cholesterol. But in the context that we’re talking about, it means pretty much every part of the TIGER Protocol is pleiotropic, right? If you help your gut, it’s going to have multiple benefits not just related to your gut. If you do stress management, relaxation, it’s going to have multiple benefits. If you reduce your exposure to toxins, it’s going to have multiple benefits. If you get in the sauna, it’s going to have multiple benefits. So it’s like an upward spiral, right? Creating that rising tide that lifts all boats, you could say.

Akil Palanisamy:  Yes.

Chris Kresser:  Great. Well, I’ve really enjoyed this conversation, Akil. And I love the book. I think it’s a phenomenal resource for anybody who has autoimmune disease. I highly recommend picking up a copy. Where can people learn more about the book and about your work, in general?

Akil Palanisamy:  Yeah, so it’s sold wherever books are sold. And I’ve partnered with a number of companies to put together more than $1,000 worth of discounts and bonuses and special offers. The best way to access that is through my website, which is DoctorAkil.com. You can preorder and then enter your name to get instant access to those discounts. I know a lot of people have been taking advantage of those and finding benefit already.

Chris Kresser:  Fantastic. Well, thanks, everybody, for listening. Please send your questions to ChrisKresser.com/podcastquestion, and we’ll see you next time.

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