The Immune System Recovery Plan: Interview with Susan Blum, MD, MPH

Posted by: Laura Blum on Thursday, January 2, 2014
Dr. Susan Blum

"Let food be thy medicine and medicine be thy food," advised Hippocrates in 400 BC. Several millennia later, The Father of Medicine's prescription is a keystone of functional medicine around the world. At the Blum Center for Health in Rye Brook, founder Dr. Susan Blum advances "Using Food as Medicine" as the first step in her pioneering wellness program to treat and prevent autoimmune disease -- a condition that affects nearly 23.5 million Americans.

On January 29, JCC Greenwich has an appointment with Dr. Blum to probe the roles of food, stress management, healing the gut and optimizing liver function, as outlined in her new book The Immune System Recovery Plan. For those of you who can't join us -- and even for those who can -- the preventive medicine and chronic disease specialist generously shared her groundbreaking insights with 

Q: What is autoimmune disease?

SB: An autoimmune disease is a condition where your immune system makes a mistake and attacks your own tissue. Think of the immune system as an army of cells that defends your body from foreigners. That includes infectious agents 

like bacteria, virus and yeast, but also toxins, chemicals and heavy metals that it thinks are harmful. The immune system's other job is to clear out dead cells in your body. To do this there's an army of cells living in incubator bases, including the lymph nodes, intestinal lining and spleen. These are the home bases where the immune cells lie in wait to be activated to mobilize the army to attack the bad guy or to take care of your body in whatever it needs to do. Normally the immune system does a very good job of distinguishing between what's foreign and harmful -- and attacking that -- as well as of recognizing your own cells. In certain circumstances the immune system can begin to make mistakes and become dysfunctional, and these cells can attack healthy tissue.

Q: What are some examples of autoimmune diseases?

SB: You can have an autoimmune disease to any tissue in your body. If it's happening in the brain, it's called Multiple Sclerosis, where the myelin in the brain or spinal cord is damaged. If it's happening in the thyroid, it's called Hashimoto's thyroiditis. If it's happening in the stomach you can get perncious anemia where you can't absorb B-12. If it happens throughout the body, for example with lupus, the immune cells are attacking the blood vessels, so you can end up with a systemic autoimmune disease. 

Q: How does functional medicine differ from conventional medicine in its approach to autoimmune disease?

SB: The problem is that these diseases have all been chopped up into many pieces. The rheumatologist sees you for rheumatoid arthritis and the neurologist sees you for MS and the endocrinolist sees you for the thyroid. You end up with different specialists seeing different autoimmune diseases, whereas it's really an immune disease and there's commonality to all of them in that the immune system is not working right. I wrote the book to help people understand that it's what they have in common that's more important than what's separating them.

Q: You begin your four-step program with "Using Food as Medicine." How does food trigger autoimmune disease?

SB: I created the four steps because of what we know that can trigger the immune system to get sick. I like to use a tree analogy. Think of it as all the leaves have fallen off the tree. In order to get the leaves to grow again you have to work from the roots. You can't just glue the leaves back on, which is what conventional medicine tries to do with drugs. Step number one is to help readers understand that food can trigger an inflammatory response. When the immune system doesn't recognize a food and sees it as foreign, it responds against that food and releases inflammatory molecules that zip around the body and cause irritation on the inside. On the outside you see redness, swelling, heat and pain; and you may feel tired or puffy or as if you have brain fog. If the inflammatory molecules run around your body for too long, they can cause the immune cells to not function properly. Trigger number one for autoimmune disease is gluten.

Q: Why is gluten such a troublemaker?

SB: The immune cells respond to gluten in a way that's different from a routine food sensivitity. The proteins in gluten are thought to look like some of the tissues in our bodies. So when the immune cells respond and shoot bullets against gluten, those same cells cross over and damage our own tissue.

Q: People have been eating wheat for thousands of years. Why is it so problematic these days, and are people who don't have Celiac disease also susceptible, as William Davis argues in his book Wheat Belly?

SB: The problem with wheat is that it has become more dense with gluten as the plant has been hybridized in the past 50 years. Why now? We eat more wheat than ever before; we live on wheat as a society. And, as William Davis argues, the gluten is different because the new genes that have been spliced into the wheat plant have a different profile of protein than ever before in history.

Q: Besides genetic modification of our foods, what are some other reasons for today's spike in autoimmune disease?

SB: The second reason why autoimmune disease is on the rise is about healing the gut. Our digestive systems are being exposed to antibiotics and other medications and to stress. Leaky gut syndrome has become a very common affliction.

Q: How does someone end up with a leaky gut?

SB: Your gut is supposed to provide a really good barrier between you and the outside world and have strong power to digest the gluten well. Our guts aren't working like they used to. People take antacids, such as Prevacid and Pepcid AC, which has caused us to have impaired digestion and damaged intestinal lining so that partially digested food gets into our blood stream. Seventy percent of the immune system lies right below the surface of the gut. If the barrier is damaged, which is what happens over time when you take all these medications, you become much more susceptible to being sensitive to food.

Q: What role do intestinal bacteria play?

SB: We have 70 to 100 trillion bacteria in our gut. One of the many functions of the good flora is to send out signals to keep the immune system healthy in the gut. It's also to secrete substances that keep the lining healthy. Healthy flora keep the barrier function working right.

Q: Does everyone with autoimmune disease have a leaky gut?

SB: That's what the research suggests. So one of the foundations for healing leaky gut is to make sure the gut flora is really healthy. In my experience, about 90 percent of the people with autoimmune disease have some overgrowth of bad bacteria or harmful yeast or maybe parasites. So removing the altered gut flora, ordysbiosis, and replanting the good bacteria are very important foundations of the program.

Q: Do you have a preferred brand of probiotic?

SB: Klaire Labs makes a very good one that requires refrigeration.

Q: Do people with a leaky gut necessarily have food sensitivities?

SB: It's especially likely that food is a trigger if you have leaky gut. So step one is looking for foods that trigger inflammation and removing them.

Q: What's the process?

SB: I take people through an elimination diet, which is removing all gluten, dairy, soy, corn and eggs for three weeks, and reintroducing these foods one at a time to see if they produce symptoms. While we're working on the gut you have to remove those foods to help calm down the system, and then, after the gut's all fixed in six months or a year, these foods might come back into your diet in a way that might be fine. The second part is eating an anti-inflammatory diet. This means right kinds of fats: nuts, seeds, fish, grass-fed beef, not too-much animal and no dairy, low sugar and gluten-free grains. And all vegetables except corn unless you're not sensitive to it.

Q: We skipped over step number two, which is manageing stress. What's the connection between stress and the immune system?

SB: Step number two is understanding that stress affects the immune system in a big way. There are two main stress systems in the body: one is the nervous system, which is the sympathetic fight-or-flight, and that's adrenaline that gets activated when you're stressed. And then there's the adrenal glands and cortisol. When your body is stressed it pumps out a lot of cortisol. We all have stress; stress gets us ready for a talk or a for test. But after the stress is over you're supposed to breathe and relax and it's all supposed to shut off. Yet we humans get stuck worrying about the future and thinking about what just happened, and we'll often stay in that "on" switch in a way that can impair the immune system.

Q: How do you help people to manage stress?

SB: As part of healing the immune system, you have to make sure that the stress system is back to working right and that people learn tools to managing their stress better. If your foot is always on the gas driving the immune system to be overactive, that can push it towards making mistakes. You have to take the foot off that gas so the immune system can relax and stop being driven that way. People need to learn tools to balance and heal their stress system -- including healing their adrenals if they have adrenal fatigue -- but also to learn tools so that they don't keep driving those high-stress hormones to push the immune system in that direction.

Q: Meditation is a favorite stress management tool, but what if someone can't seem to hack it?

SB: Most people say that. But we're talking here about mind-body medicine. There are different kinds of meditation. There are so many ways to start balancing and healing the stress system. There are things like Tai Chi and Chi Gung, yoga, Pilates, breathing and walking meditation. There's listening to music. There are guided imagery and guided visualizations, which is where I'll often start with people. We have a Learn to Relax kit with a guide and a CD and it has all kinds of exercises. You're just listening to somebody telling you what to do and music. Most people can begin there. And if that's too hard, we begin with movement. We do things like shaking and drumming, and there's a CD of that too. The movement is especially good for people who have suffered trauma. So meditation is not the only way to balance your stress system.

Q: The fourth step is detoxification. What's the link between toxins and autoimmune disease?

SB: We know that toxins cause damage to our immune cells and cause the cells of our tissue to look abnormal, which in turn causes the immune cells to attack them.

Q: What are some of the common environmental toxins we're exposed to?

SB: The Centers for Disease Control and Prevention (CDC) test Americans for toxins, and in 2009 it presented data for 212 chemicals. There's everything from pesticides and xenoestrogens to silica dust and industrial chemicals. In the book I focus a lot on mercury because it's such a well-known autoimmune trigger.

Q: Is there one-stop-shopping detox?

SB: A radiologist colleague once asked me, "How can you do a detox program if you don't know which toxins you're going after?" While I do measure heavy metals in everybody, it is impossible to identify each individual toxin. Therefore the goal is to tune up the liver and it will mobilize all toxins. The good news is that everyone has a liver to do this job of removing toxins. The problem is that we're exposed to so many toxins that the liver can become fatigued, and doing a detox means giving it a tune-up. 

Q: What are some of the factors determining liver function?

SB: How well your liver has done the job of clearing out your exposure to past and current toxins depends on genetics and food. For most people, if they have an autoimmune disease, they're behind; there are too many toxins built up in the body doing something. My goal is to support the liver, tune it up and clear it out. It's like taking a stagnant pond and putting a big filter in the middle of it. It's about clearing out the stagnant water and filtering it so eventually the water is clear. When the liver starts working well, it filters the blood throughout the rest of the body.

Q: During the detox program, which foods do you recommend to boost healthy liver function?

SB: It's about eating anti-inflammatory foods and foods that support the liver -- a healthy diet of greens and antioxidants and colors and protein helps the liver do its job and have the engine running smoothly to remove toxins. We also give supplements that support the enzyme systems of the liver as well as targeted nutrients, supplements and protein shakes that are very specific to amping up the liver.

Q: What differentiates metabolic detoxification from liver cleanses?

SB: Doing those juice cleanses once or twice a year is probably okay but it's just a temporary thing. It doesn't go as deep as the metabolic detoxifical program, which uses supplements for more sustained and improved liver function, and which will have a lasting effect afterwards.

Q: When people participate in their treatment, do they heal faster?

SB: The research shows that there are better outcomes when people are involved in their own healing. The empowering is essential for healing, I believe. 

Dr. Susan Blum is an Assistant Clinical Professor in the Department of Preventive Medicine at the Mount Sinai School of Medicine. A member of the Medical Advisory Board for "The Dr. Oz Show," she has also appeared on "Fox 5 News," "ABC Eyewitness News," and is regularly quoted in Real Simple, Harper’s Bazaar and Redbook

Dr. Blum completed her Internal Medicine training at St-Luke’s Roosevelt Hospital, her residency in Preventive Medicine at The Mount Sinai School of Medicine in New York City, and is Board Certified in Preventive Medicine. She received her Masters in Public Health at Columbia University, and her training in Functional Medicine from The Institute for Functional Medicine, in Gig Harbor, Washington. In addition to her role as Founder of Blum Center for Health, Dr. Blum is on staff at Greenwich Hospital as an Integrative Medicine Specialist in the Medicine Department. She is also a member of the Senior Teaching Faculty at the Center for Mind-Body Medicine in Washington, D.C. and teaches throughout the world in their training programs.


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