22. Micah Yu, MD: Integrative Rheumatology, Triggers of an "Invisible Disease"

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. As a medical professional, you should be focused on fixing people's lives. But as a key decision maker in your practice, you have to figure out how to grow your patient volume, keep up with reviews, and how to stay connected on social. You don't have time for that. You went to med school, not marketing school. Good news. Your team and advice media did. Their pyramid of success was created for professionals just like you. The pyramid has six stages that when combined creates the ideal, digital presence. Give them just 30 minutes to consult with you. We would bet that you are doing some things really well, and there might be areas where you can improve. Just for spending the time, they'll give you a $60 Amazon gift card. Don't delay your booking now. Go to Drpodcastnetwork.com for a slash advice media. That's Drpodcastnetwork.com for a slash advice media. This week's guest is Dr. Micahew, a board certified rheumatologist and lifestyle medicine doctor out of Newport Beach, California. Dr.ew is also training to become board certified integrative medicine and certified in functional medicine. Soon enough, he will have the trifecta. In this episode, we dive right into all things integrative rheumatology. Now, a lot of us know that rheumatology involves the immune system, and along with that comes a plethora of medications. But in this episode, we discuss what might be driving what Dr.ew calls this invisible disease. It's a fascinating episode, especially with so much information coming out at this time with COVID and autoimmunity. All right, guys. Welcome back to another episode. Today, we have Dr. Micahew, Dr. Yor, Micah, I should say. How you doing, man? Good. How are you doing? I'm good. I'm good. Excited to have this conversation. I know we've been following you on social media for a while. You're putting out some great content, and I definitely want to pick your brain a little bit. I know we're limited on time, so we're going to get right to it. For those of our listeners who don't know what you're all about, maybe even what your specialty is because I feel like it's not one of the ones that's talked about so much, not one of the quote unquote sexy ones. Tell us a little bit about your journey, who you are, and what brought you into wellness and medicine. Yeah. So I'm a Dr. Micahew. I'm a rheumatologist. So basically, that's a field that specializes in autoimmune disease or the connective tissue and also arthritis. My journey to this specialty really started back in high school. I got diagnosed with a doubt at the young early age of 17. And then that disease pretty much transformed over the years to multi-joint arthritis, and it was unexplained by different rheumatologists, no one could really figure out what I was going on. I saw different rheumatologists, different doctors, had pained in my TMJs, wrists, fingers, toes, knees everywhere. And this happened during medical school. I mean, there were peers where I kind of really eat kind of over my TMJs. So finally, during residency, I saw the rheumatologist at my program, and they finally diagnosed me with Spondyl Arthritis, which is an autoimmune arthritis. So if you guys have heard of Enclosing Spondylitis, I pretty much have that disease without the back pain. So I prefer Spondyl Arthritis. And what got me down this integrative route is really, I went plant-based at the end of my residency. I was so sick and tired of the pain. I didn't take any medications yet. I was recommended to take meds to just methyl treksate by refuse. And within three months of flying plant-based, my joint pain's pretty much went away. My ESR, which is an inflammatory marker, went negative after 10 years of being positive. And my most recent lab work, my CRP, is actually negative now, actually after being positive for over 10 years. So I actually know, my CRP went down first, and then my ESR funding went down. So it's been quite a journey. I still get pain very, very rarely. If I get super stressed, if I eat too much processed food, the pain does come back. But like one out of 10 pain, it goes away in the end of the day. So nothing major. So I don't take any consistent supplements. I don't take any medications for this. I just try to eat clean, stay healthy. But that's where I'm at. I'm doing my second fellowship now in Integrated Medicine, University of Arizona. I'm also learning about functional medicines. So I'm really trying to find all these fields with rheumatology and also certifying lifestyle medicine as well. So just be a pioneer in this space, try and be a voice for all these patients with autoimmune disease out there. I love that. Yeah, I mean, I usually find that most of us who are so passionate and so driven to kind of be a voice. You know, we are always connected, right? And that's, I think, so important because it really gives us that compassion, right? We always talk about this concept of empathy, which again, it can be acquired over time. And there's multiple ways to, you know, and it usually comes easier to those who've had some personal struggle. I find and you've obviously described that for greater than a decade. Two quick questions for you on, you know, just your journey. You said that every now and then you still get some aches and pains. So what kind of like where in the joints will you get it? Is it will be knees, ankles and, you know, what kind of functional limitations do you have with that? If any. And then the other question, you mentioned plant-based, like, what does that mean exactly? Yeah. So going off the first question, the pain sometimes would be just the fingers or the wrists or the foot. But it's nothing doesn't really limit me functionally. So I mean, it goes away. And then the day, sometimes it's fast or I just try to avoid all that processed junk. That's the main thing. And I work overnight, I work one night and we get an alternate. So sometimes that would go straight into my rheumatology practice. I work outside one day, we get a counting hospital too. So I work 20 hours straight. So sometimes that would hurt a little bit, but sometimes I forget that I have this disease. So that's how minimal it comes back. And then as far as plant-based is concerned. So I eat a lot of greens, a lot of fruits and vegetables. I try to avoid as many animal products as I can. I haven't eaten any animal meat within the past, I don't know, three years since I started. So lots of fruits and vegetables, spices. I try to go as vegan as much as I can, of course, sometimes you eat dairy, sometimes you can't avoid it, but I try to limit that. Fish once in the blue balloon, but other than that, it's pretty much the night I've seen vegan animals eating animal products at home. Yeah, and the other quick thing worth noting is, you know, when most of us in medical school learn about AS, right, it's kind of the spine, right, that's the buzzword, that's what's on our board examinations. What, how is it rare or is it common to have a more manifestation in peripheral joints versus spine? You're clearly in the minority there, right? And if so, what percentage of the population will have those types of symptoms peripheral joint and not have any issues with the spine? Oh, yeah, great question. I don't have a number of percent. I don't know if that data is out there, but I mean, in my practice, I've seen AS in the back width, the peripheral, you usually see it with the, you know, infecitis, you guys learn that. So for those of you that are listening, the infecitis is what it is, it's pretty much, you have a DCs which are your connection between your tendons and your bones, that little connection there that can get inflamed, even the sports tennis elbow, golfers elbow, that's sometimes it's called infecitis, but you can have an autoimmune component to that, which you get with ankle dyspondylitis and the spinal arthritis family. So I do see patients without, with the joint pain in the extremities along with the back pain. That can be pretty frequent as well. Usually it does manifest solely in the back, but sometimes it spreads to everywhere else. Gotcha. Yeah, so I would say my own disease is more rare. That's why it took me a while to get diagnosed because usually you see with back pain, right? There are several types of spinal arthritis, ankle losing spondylitis, which you guys know already. There is peripheral spondyl arthritis, which is pretty much in the extremities without the back pain. And then you have a differentiated spondyl arthritis as well. So they're very, very minute details, but the treatment is pretty interesting. Yeah. Yeah, it's quick, I don't know if you're comfortable actually answering this question, but how old were you when you got diagnosed? As a galos 17 with spinal arthritis, I mean, I was suffering with that for quite a long time. I think it goes around 20, 29, what I've got diagnosed. Okay. Cool. Yeah. Yeah. So Micah, one of the things I noticed on your Instagram page is that you write that the impact you want to make is by giving a voice to invisible diseases. What does that exactly mean by when you say invisible diseases? Yeah. Great question. So, you know, a lot of these, you can't really see it, usually unless it's on the skin. And there's a lot of patients out there that are suffering. They look right on the outside, but inside they're hurting. So I mean, with joint pain, you can get a swollen joints, but if you're not a doctor, you probably won't notice that someone's having swollen joints that day or their pain. These can have, like for example, lupus can attack any organ of the body. You can have lupus nephritis of the kidneys, you can have lupus of the lungs. You can have even autoimmune disease attacking the lungs, interstitial lung disease as well. You can't see those things. You can't see someone's that short of breath. You can't see someone that is having a kidney attack that's having brain fog, thyroid disease. You don't see patients that are having hypothyroidism, having issues that they being tired and asleep, having more stiffness. These are things that these patients look and talk like they're normal, just like everybody else in the population that's healthy with no, nothing going on, but really they're hurting inside. They can't function. They're losing jobs. They're gone disability. I'm just trying to give a voice to these diseases so that these patients can be heard. Because what I'm doing is I'm trying to bring an integrated medicine and the fact that there's so many ways to heal these diseases, not just during medications that we are tissue trained in, and patients are looking for something like this. I was a patient that was looking for something like this, that's why I'm passionate about it. Absolutely. I think in the last decade or so, autoimmunity has been this pretty hot topic, that people are looking more for getting away from these pretty hard medications on the body, looking for a more natural approach, which is why again, you just mentioned that you're going down this integrated functional lifestyle pathway. Is it that autoimmune diseases have been on the rise, or is it that the prevalence has always been there, it's just that the fact that we're now unmasking those symptoms and we're better aware at what autoimmune disease looks like? Yeah. Technology has definitely gone better over the past several decades, so yeah, we're better at detecting diseases. Because there was a paper I'm always quoting of the International Journal of, I think, Celia Disease. They were talking about how there's a rise of autoimmune diseases and across all spectrums neurologic, endocrine, GI, rheumatology. There is a rise of about 7 to 10 percent a year in these diseases, and that really doesn't surprise me. Our food is getting more processed, there's more pollution, so I think, yeah, our detection rate is getting better because of technology by the same time, it's not all because of technology. It is also because of the way we live, the food, the environment, everything is playing a role in this rising rates. Yeah, absolutely. And you know, I really want to delve into your kind of integrative experience, your functional medicine experience, and you just said one thing with food being more processed. How much of a role are diets playing? We know that there's so much food having pesticide on it, even organic, right? We'll have like trace amounts of pesticide on it. How much of that's actually playing a role in terms of these flare-ups or having people start up with autoimmune disease? Yeah, I don't have a number for that, there's any studies out there that can say there's a number on this. But definitely, I think food is definitely a role before we get to the pesticide part. I think just the fact that patients are eating, people are eating processed food in general, this is so bad. You got your fast food, you got chips, you got cookies, and all these different things, the way we're raising animals doesn't really help either, we're feeding the animals. So all these things are pretty much throwing inflammation at the body, left and right. So if you have the right genetic factors, you're going to spark, you're going to flare up with some autoimmune disease. And with the pesticides, I mean, there are studies out there that just being around pesticides, having a spread around your home or living on a farm, even the worst part is working on with pesticides directly does contribute to higher incidence of lupus and rheumatoid thrice. They are in prominent journals that we've talked about, but of course, we don't tab on an academic medicine because, you know, what we're going to do with it, right? There's no medication throw again, pesticides. Yeah, no, I mean, I think that that's a really important point, though. I guess, you know, I'm always interested, I think from an academic standpoint, this is a really interesting discussion, right? But I always want to know, and the people closest to me in my inner circles always want to ask me questions, but what do I do with this information, right? Because that's what really matters at the end of the day, and you've spoken about how you're an advocate, and we're trying to make an impact, right? So the question for you is, when you see these types of patients and clinic, what's your approach, right? I mean, I think that for me, personally, if we're talking about the pesticides, I can see the role and how they can have an adverse effect when it comes to these diseases. However, I also look at it from, like, how significant is that, right? First of all, we're talking about eating cheetos all day every day, right? So it's, to me, it just becomes, are we majoring in the miners there, right? Right, right. So the question for you is, like, when you're seeing these patients and they have a clear diagnosis, right? We've gone through that. We've got all the thing. There's no doubt in your mind. What's your approach to kind of helping overhaul the diet or make adjustments to the diet? How wherever you do it? So for the diet, I go over the most obvious inflammatory foods, which are red and processed meat. You're fast food, you're chips, all these things, highly processed. Those are the main things I try to cut out, high salt diets, refined sugar. These are the main components that I focus on. And then we talk about organic food, right? So main thing is getting the fruits and vegetables, whether it's organic or non-organic, like, you got to get it in. I would rather have you eat a non-organic pesticide, filled with pesticide, apple, rather than go to McDonald's down the street, right? So I think that's the main thing here. That's the main message to get those fruits and vegetables. I don't care how you get it in, whether it's organic enough. If you get a far organic rate, if you can't, then it's no big deal. That's in my contribute to the disease, but overall, you got to get the foundation, right? Because if you don't get the foundation, you need all the organic, all you want, but you're still going to be flaring. Right. So having something off the dirty dozen is okay versus having an organic twinkie. Is that what I'm hearing from you? Exactly. I'm very practical in my approach. So how do you do that? Is that something that you're kind of taken on your plate, or do you have a team, do you have a nutritionist, dietician in your practice? No, it's me. Gotcha. One minute show. So my model of health care is very different. That's why I want to practice. That's why I didn't stay with any organization or going to academic medicine. Because if you do that, you're seeing patients every 15 minutes, right? Every 20 minutes, and you're doing medicine, and are you doing this during medications that patients without really giving them counsel on what a proper lifestyle is? So I spend one hour on new visits, half an hour on follow-ups, and I got all the insurance model so that I can do this kind of health care, where I spend whole hour counseling patients. First of all, I go over the symptoms, diagnosis, medications, and then I go over all these other components that are very important. It's all about education. Your patients are not educated properly. There's so much mission information on the internet. You got people that are not even qualified to give advice on the internet that are giving the wrong advice. So it's, the internet is a very, very scary place if you're looking on the wrong places. Exactly. As a rheumatologist, I mean, I've had the training already, and I'm bringing the wellness space to patients as well with a scientific evidence here, and I think that's important to bring the science to it, because some people, they just make up stuff on the internet, and it's dangerous when they do that. Right. There's no internet police out there, right? This is what's good about what people don't understand is, I mean, we can kind of spend a whole couple of hours talking about even the errors in evidence-based medicine and issues with different types of journals and whatnot, but at least most journal articles and publications that you're going to find in PubMed, there is somebody out there, editors that are reviewing the work, right? The credibility of some journals, again, that's a different discussion and it's an heritage, but anybody going on just blogs and this and kind of that kind of information can put anything. Nobody's out there editing and policing that type of stuff, so which is why every time somebody comes to me and says, you know, well, what do you think about this? And I have to ask, why? Like, why does that matter? Like, why is that important to you or why is that a question that you're even asking? I even have to ask that, you know, and they're like, oh, well, I read this and I did my research here and I was like, well, what does that mean? Like, what kind of research? You know, what's your reference? And we talk about that. But I want to kind of, we took a zoomed-out approach of, you know, okay, how do we address that kind of stuff in your diet? And that's probably nothing new for anybody who's listened to our last couple of episodes. We've kind of spoken at length about why that's important. So I'd like to zoom in a little bit more now, right? Specifically, let's just take rheumatoid arthritis. I think that for us, we're both physiatrist, something we see is highly prevalent now as out of the osteoarthritis, right? It's more of a degenerative condition. And like, if you live long enough and you put enough mileage on your body, 100% of people are going to get that. There's just no getting away from that. Rheumatoid arthritis is a little bit different though. So maybe you could kind of explain how that differs from osteoarthritis, like what's just more of considered aware and tear. And then specifically, how might, in terms of mechanistically, a plant-based diet help at a systemic level with that disease, just so people have some perspective? Yeah. So rheumatoid arthritis is an autoimmune disease that attacks the joints, it's different from osteoarthritis. So osteoarthritis is more aware and tear. There is inflammation at the level of joint, but not systemic inflammation. osteoarthritis will not give you eye inflammation and all these different things. Rheumatoid arthritis, people think it's this joint, but it's also eye. You can get blind from it. You get eye inflammation. You get it's so lung disease, you can get heart attacks from rheumatoid arthritis. There's so many things that you can get vasculitis from rheumatoid arthritis as well. It attacks, it's similar to rubis where it attacks a lot of different organs. This is a different manifestation of it. So I've seen patients die from rheumatoid arthritis before. That's why we work with so many different specialists on rheumatoid arthritis. In rheumatoid arthritis, a happy stack can help because there is gut dysbiosis. So I'm sure you've had many podcasts and episodes time of gut health already. Gut health is tied directly in with the immune system. Sixty-seven percent of the immune system is located at the gut in the pyres patches. That's something that we tend to forget after a medical school. And so every time you eat food, it touches the immune system in some shape or form. And so there are two types of T cells that are very, very important out there. There's T-rectory cells which are anti-inflammatory and your T-helper-70 cells are pro-inflammatory. So with many autoimmune diseases, your T-rectory cells will be depleted or very low. T-rectory cells are their main function. One of the main functions is to basically, if you remember from medical school, is to pretty much if you're finding an infection, when you're done finding the infection of the virus of bacteria, you want it to stop fighting, right? Or else you're over-fighting or stimulating your immune system too much. So that's what T-rects do, T-rectory cells. With autoimmune diseases and immune system, what it does is it helps your body tolerate immune system, so it helps with immune tolerance. So with autoimmune disease, you lose immune tolerance. So pretty much your immune system is socially recognized its own cells, so it doesn't attack itself, right? And that's what T-rectory cells do. It helps it recognize itself. So it helps attacking its own body. But when it's down and low, your body will keep attacking itself. And when you eat a plant based diet full of fiber and vital nutrients, it actually up-regulates T-rectory cells at the level of the gut. And it actually down-regulates T-helper-17 cells. It's a seesaw effect. And also, this effect at the level of the gut will go through the circulation system, the live-voice system, and it will pass the signals on eventually to the level of the joint, which is the gut joint axis. And this is generated through short-chain fatty acids, which I'm sure you've heard of time-time again on your podcast, short-chain fatty acids, butatory propionane acetate, are generated from fiber, from the gut, from the gut bacteria. So when you generate short-chain fatty acids, that will up-regulate T-rectory cells, which then up-regulate the anti-inflammatory cytokines out there. And we eat inflammatory foods that will increase T-helper-17 cells, which will then up-regulate pro-inflammatory cytokine into looking 17 and various other inflammatory cytokines. This is why food is so important. It's not the end-all of all diseases, but it's a major foundation to how we attack these autumn disease from the integrative standpoint. Yeah, absolutely. I mean, that was a great recap of the immune system, right? And like I said offline, Michael, we had Dr. B, right? We'll also wish the gut health envy kind of come on to our podcast here and talk about weeky gut, right? Which is kind of essentially what you're talking about here, where food can escape the gut lining, and then our body sees that as a foreign object and says, hey, we need to kind of need to attack this antigen, right? So let's talk about kind of like the therapies of food, right? So we know that, like you said, plant-based can be helpful for some people, right? So we know if it was an important part. What are your thoughts on fasting and gut health? How has that played a role if any in some of your patients? Yeah, so fasting there is, I don't know if you saw the new general medicine article about year or two ago on fasting and overall health. Fasting does have an anti-inflammatory component to it. It's not bogus, quack-rich medicine, like some people think. So fasting, I actually get backgrounds of this. So fasting does have anti-inflammatory component for the immune system. It does down-regulate amtore. Amtore. When you, it does up-regulate, I think, beta hydroxybutyrate, which is up-regulated, DKA, as you remember. So beta hydroxybutyrate is actually anti-inflammatory. So when you fast up-regates that pathway and it does then up-regulate T-ratory cells again, which are anti-inflammatory. So when you eat, it's okay, but when you eat too much, it keeps turning on amtore and that will turn on the T-helper-17 cells. You want to activate amtore because it builds up the cells. You need it to build cells, but you want to be activate all the time. So when you do fast, you give your body a break, and you do give your body an anti-inflammatory T-ratory cells, and that's where the foundation is. They've tried to produce medications for this already on amtore, but nothing has been used yet that we can safely use in rheumatology. So the amtore molecular target of rapamycin, for example. There's some medications out there, but nothing for rheumatology yet. But that's where it's at. I don't know about the gut health details of fasting. I think probably... Actually, I don't have an answer for you. I don't remember the literature on that. Sure. That's completely fine. I know. Yeah, no. That's totally cool. I think for a lot of those individuals who might have read that paper, or if you didn't, I think on in a more simplistic layman's terms, that's what you're talking about is ketosis, right? At a certain point, you're going to be in ketosis, and that's where they're at. Exactly. And ketosis. Yeah, and then that nature review did a great article on this to amtore and metology. So there's a lot of legit papers out there on integrated medicine that people don't see. And that's... I think we're going to get to this point, too. There's so many traditional doctors that attack integrated medicine. And it's because of they don't understand, they haven't seen the science yet behind it. And they... We can get to that point later on. Yeah. When was that... Just curious in nature, when was that paper published? Part of the past three years. Okay. Yeah, I got to check that out for sure. Thank you. You just emailed me. Yeah, yeah, absolutely. So you know, this kind of begs the question over the past year, obviously in this pandemic. Again, I've said it before. I'll say it again in my lifetime, arguably like the craziest thing that we as a society on a global level that we've been through, right? And we've all kind of suffered and struggled through this together, where stress is at all time high. You eloquently described the role of T-helper cell, T-reglatory cells with, you know, the immune response with respect to autoimmune and attacking its own body. COVID, we know that T cells have a pretty influential role when it comes to viruses in our body as well, right? From both innate and acquired immunity type stuff. So one of the things to set off these autoimmune conditions a lot of times, and please correct me if I'm wrong, are like these times of acute stressors, right? Or, you know, subacute dichronic stressors that people, it'll set something, whether it's like just excessive sleep deprivation for a lot of people. It's a medical school, you know, having a new child, that kind of stuff. So again, just COVID going back to being this global stressor, understanding that this might be purely anecdotal in your practice. I'm wondering if you have seen a rise of autoimmune diseases or certain types of diagnoses more so than other over the past year. I don't think I've seen a specific rise in certain diagnoses, but going back to viruses, like you said, COVID can give you a new autoimmune disease. We know in literature that viruses are a root cause of autoimmune disease, EBV, CMV, different viruses, COVID. I've seen you on set rheumatoid arthritis, lupus from getting COVID. And as far as acute stressors, they are a root cause of autoimmune disease as well. There's something called psychonural immunology that no one's, that no one will talk about, that connects the brain, stress, sleep, to autoimmune disease and the immune system. So it's out there. It is a known trigger. And that's something that, like, astringent medicine doctors, we don't really talk about much, but if you go into integrated medicine, functional medicine, they do talk about these type of stressors and viruses out there. Psychonural immunology. That's next level stuff, man. It's out there in the immunology literature. It's quite exciting stuff. But, unfortunately, we don't talk about it enough. Yeah. I mean, we don't have time to talk about nutrition. I'm not really sure where we're going to fit that into the curriculum. Yeah, maybe in the future. I wanted to shift gears here a little bit because I think this is somewhat of an important topic because, again, in the last decade, a lot of people have been talking about that. And that's pollution, molotoxicity, right? You're from California, pollution's rampant over the right L.A. and things. But also this concept of molotoxicity, I'm seeing a lot of naturopathic doctors, functional medicine doctors as well. Talk about how mold can silently, you know, be quote unquote killing us as well. And I know you've touched about this a little bit on your Instagram post. Can you take us through some of these environmental exposures and maybe, you know, what are those symptoms that humans might feel? But also, what are those red flags that we should be looking for maybe in our environment? Yeah. So environmental toxins is something that's legitimate. A lot of people will, I should show doctors we'll talk bad about environmental toxic things, you know, exist. But they do exist. Actually, there's a prominent general in the prominent paper in nature reviews immunology that talks about environmental toxins and detoxification. Which is another buzz where there are a lot of people on doctors on social media tech. But detoxification actually looks to exist, functional medicine actually talks about it. And it's, so some of these environmental toxins are BPA, plastics, phallates, what else is there? There is PFAS. So water source is a source of environmental toxins. You're a teflon, you're like I said, you're heavy metals also. The environment, arsenic, mercury, these are environmental toxins too. There's so many things out there. Your flame retardants are also a source of environmental toxins. And my integrated message tells you talks about this as well. And you can actually detox these things. Sweating is one form of way in sauna or exercising to get rid of it. There's other ways out there. There's supplements that can help you as well. So some of the things you can manifest, you can definitely, I think it contributes to autoimmune disease. There is a pathway, but I mean, we're in the beginning research here. There's nothing that is conclusive yet. But you can manifest brain fog, fatigue, some joint pain, thyroid disease symptoms. There's so many, it's very not specific how these symptoms can manifest. And I don't think there's enough literature to say that you're going to get these specific diseases. I think everyone's genetics, epidemics are different. So time will tell once research comes out of the next two decades or so. Mike, I want us to be a little bit more clear, just because there might be some people listening. And because I've been a part of this where we're talking and people say, well, I'm doing a detox diet. Again, I can certainly appreciate it. I couldn't agree more in terms of our body does a phenomenal job. And we have organs that are designed just for detoxification purposes, right? And we've got liver that does tremendous job at that, or kidneys do a tremendous job at that. And certainly with sweating, we know, some of the therapeutic benefits are because of what you're talking about. I know Dr. Rhonda Patrick's talked at length about that. And it's been very informative. But what you're not suggesting, just so we're clear, detox diets, is that something that you think has merit? Because I mean, people will market that. Like do this seven day juice detox diet and you will be rid of all these toxins and your life will change. Is that is that what we're talking about? Or yeah, so I don't do any specific detox diet. I think I believe in a detox lifestyle, not so much in detox diet. So so detox diet, I mean, really is just fruits of vegetables and fiber, right? That the basics here that will fight your environmental toxins, there is a scientific pathway to that how we'll fight it. So it's more about your lifestyle that just eating right for seven days, whatever that is, there's no detox juicing, there's no detox diet. I think it's the buzzword for marketing to sell stuff, but their scientific detox does exist. Gotcha. Yeah, absolutely. I think that's a great point that you that you mentioned in a very clear distinction because again, I think a lot of people get caught up in this marketing term saying, Oh, detox, I need to get on that, right? They dish out $500 and nothing's really changed. Maybe they feel great for three days. They're back to where they are. But talk about environmental exposures in your patients. Is there anything that at least prompts you to ask those questions to your patients? Is there anything specific we're saying? Let me ask this now because this might be a reason that's the why. It's actually part of my HMP. It's part of my visit. So I ask it automatically. I have, I'm full of questionnaires. It's in my fall visits too. Gotcha. Okay. All right. There's nothing. Yeah, there's no nothing where prompts you to ask these. I ask it automatically. Okay. Gotcha. And then keeping on this topic of environment, right? I know you're really into grounding or like getting in touch with nature. How does that really help us? Yeah. Yeah. So I haven't looked into literature and grounding, but I'm sure it helps. But I mean, there was a paper. And so, so I think I was out in Japan. I think there are other papers as well where they did. They went to a forest for like a couple days or a week. And it did help with their immune system. I forgot. I haven't looked at that paper for at least six months or years. I don't remember the details. But it is out there. You just have been with the forest bathing. Look at forest bathing. And I'm sure you guys talk about this and your podcast already. No, we haven't. But it's actually it's it's it's quite famous out there. And it's quite talked about them. They call it Shinroon Yoku. It's a concept before bathing to help reduce stress and promote. And it's actually my favorite way to meditate. I know that Darshan I always talking about how do we implement mindfulness in our practice on a daily basis and something that I haven't quite skillfully adapted as much as Darshan is in his daily right. But for me, you know, not not to kind of interject and go off and tangent here. For me to the way to do that is to go on a walk through a forest type stuff. So yeah, it's it's very much so. But I'm pretty sure that I know what you're talking about the article. We'll find it. Is that yeah. Yeah. That's what I did. Oh, wow. Okay. Yeah, you have to get away from the city. Because I think they did two groups. They didn't want to stay in the city. One other one that was actually in the forest. Nothing else, right? No pollution. Nothing. And they they looked at the cortisol level. They looked at other levels as well. And it's also the essential oils from the trees also contribute to that as well. Aromatherapy can be pretty helpful as well. That's part of independent medicine. Essential oils. Very cool. Okay. Yeah. I never knew that. I mean, I love going out in nature, but having that distinction of getting actually out of the city and literally bathing in the forest sounds pretty awesome. Yeah. That's right. Yeah. Yeah. Very cool. Yeah. I literally did a quick search and pop med right now. And there's quite a few articles. I mean, the most recent one. I'm looking at this Shenru Niyoku forest bathing and nature therapy. I stated the art review. This was published in the International Journal of Environmental Public Health in 2017. First author is oh man, I'm going to ruin this name. But anyways, it's there. We'll link in the show. Yeah, it's definitely been talked about quite a bit. And you know, it's I mean, it always goes back to again, we talk about this concept of, you know, literature looking at the masses in terms of what teams to work in. But then also, you know, if there's not a lot of harm to be able to do it, understanding there's an opportunity cost for everything. Just try it and try it and see whether it works or not, right? Yeah. Yeah. Well, yeah. Well, so, you know, I want to ask you a little bit more here. I know we're a little short on time. You mentioned the whole integrative approach and how a lot of quote unquote traditional doctors will seem to dismiss it, right? And, you know, all these things, whether we're talking about toxins, whether we're talking about forest bathing, honestly, really nutrition, although they're less likely to do that. I think that that's just a of more of an ignorance thing. They don't really understand it. And so it's like, ah, you know, we're not going to worry about that. And that's understandable. We don't we don't learn about that. We're not educated on that. But, you know, what inspired you to even kind of go down this path of integrated medicine? You're doing your second fellowship now, right? And as I understand it, rheumatology is two year fellowship. Is that correct? rheumatology is two years. I did, uh, I took my boards and left on medicine during fellowship. So now, yeah, years in integrated medicine. Um, and really it's, it's because of my own disease. Um, I found a way to help myself. Um, and I want to now help people because, you know, going on medications, um, is one of the answers, but it's not the only answer. And there's always side effects with medications, right? Um, people are taking um, stands like it's candy. Um, but there are side effects to it. Um, and I mean, you can get, um, myocytis, um, from democratizing myocytis from stands. It's rare. I spy as a rheumatologist, I see a, um, a couple of times already. And these, it's one of the worst forms of myocytis out there. It's an auto-view disease. Um, so now medications have its role. Um, but it's not the only form of healing and medicine. And unfortunately, I think that, um, because we spent so much time as MDs and DOs, um, learning about medicine that we think that it's the only form and it's the only truth out there, which I don't think that's true. I think there's so many other ways that can be beneficial to helping patients. Um, and that's what I'm trying to explore. I'm trying to have a global view here. Um, I mean, natural paths have their own way of medicine. We also do too. I don't think everything that they're doing is wrong. Um, and, you know, we're always attacking natural paths, natural paths are attacking us. Uh, but I think there is some middle ground here. Um, I think that medications have its role and natural medicine have its role too. I, I want to just blend both fields and give the best, whatever the patient's goal is, and that's what I want to work towards. As my counterpart here said in a recent talk, your, your truth is ever evolving. Is that right, Darsh? Um, yeah, no, I, you know, this is, it's such, such a thing that I struggle with because we always want good, good versus evil. We want bad versus good. We don't want as team natural path, team MD or Dio or team chiropractor versus team osteopath. And it's just like, you know, we could work together. We all have, most of the time, we all have a same goal, right? And, and I imagine you're not anti immunotherapy. Like if somebody's coming in and they're an excruciating pain, um, you're not going to say, well, you know, let's, uh, let's give you an apple, right? Like everything has a rule and to tool in their tool belt, right? Yeah, exactly. It's, it's adding tools to the toolbox. That's exactly what it is. Yeah. So, I mean, that is, uh, I mean, we're all on board with that. That's exactly how we love to practice. And that's what we looked learning about. And so, um, you know, I know you've been doing a lot of great things. We've been following you and it's, it's finally, it's great to, to connect with you. Um, and we'd love to kind of have you back in and so we can dive a little bit deeper into all the great things that you're doing and, and pick your brain a little bit. But, you know, what's, what's next for you? What's, what are you excited about in the near future? What's coming for you? What are you planning? Yeah. Yeah. Um, I mean, I'm trying to grow my practice, um, and just finish up. I, I'm been so slow. I go seven days a week. I, either if I'm not working in the hospital or seeing patients, I, I am working on my social media. I'm studying. Um, so medicine is lifelong. Um, so I'm just trying to find, trying to figure out this all out. I mean, there's no mentors for me out here. I am my old mentor. Um, I'm trying to find you the space. I don't think there's any mythologist that has combined functional, integrative and lifestyle medicine all in one and trying to give an answer. Um, and I'm trying to just figure out what's real and what's not. There's, I mean, there's a lot of focus, focus on in the internet too, right? When you learn stuff, um, because I mean, I learned functional medicine, but I'm trying, as an MD, I'm trying to figure out what's real, what's not. I mean, there's some stuff on, um, functional medicine that doesn't have much evidence. Um, and there's stuff stuff that does. Um, and I, I, that's where I'm trying to do here. I'm trying to figure it all out. Um, I'm trying to go into YouTube space. I want to write a book in the future on just figuring this all out for people. Um, I don't think a rheumatologist is going to book like this. Yeah. So, um, there's definitely from other other people, but not the one that has specialized disease. I love it, Micah. That's, that's truly inspirational. And I, I want to say thank you for coming on here, you know, um, and sharing your knowledge. I follow you on Instagram. It's just, it's truly motivational to see someone like you who's gone through their own pathology and now trying to make that impact, as you said, and, and give a voice to people who can have a tough time, you know, with these really terrible and, and struggling diseases. So thank you so much for having to grow with mindset. And I think that's the, you just said it, right? It's about finding the truth. It's about us doing our homework and trying to integrate all three of those fields, lifestyle, functional and, um, integrated medicine and kind of seeing what that balance we can strike is. And again, what does, what helps the patient the most? Um, but before we end here, I also do want to ask you, where can people find you? Yeah. Um, my social media handle is my autoimmune MD. Uh, so you can also go to my army MD.com. And that's where my personal website is. You can find me on Instagram, TikTok, um, Facebook, Twitter, LinkedIn. And if you want to find me as a doctor, go to drlyestyle.org, drlyestyle.org. That's where I'm being my wife practice. Um, my wife is a friend that's a doctor doing the same thing here. I'm just doing the audio inside of so that's where you can find me. It's, um, and if you follow me, I mean, there's a lot of growing and learning on my end. So it's always passed down through my social media. Awesome. Very cool. And last question for you here that we ask all our guests, how do we put the health back in health care? Um, let's see. First, we need to change the model of health care first. We have, uh, uh, put the, we have one minute to answer this question, Micah. No, yeah. Put the, put the power back into the doctors instead of the health care administrators. And, um, that's what it is. I think as, as doctors, we're doing a great job, but we've lost our, our control over medicine and we've lost it to the health care administrators. So we need to take that back so that we can spend the extra time that we need with patients without being pressured from above. If you're working for somebody, but if you're in prep practice, you can do what you want. So that's the way to put the health back in health care. That's the first step, um, because without that, you can learn all the nutrition and stuff you want, but you're never going to be able to implement that into your practice. That's true. That is what's the minute's finest. Well, Micah, thank you so much again for joining us today. Thank you for having me. I hope you all enjoy that episode with Dr. U. I mean, I just can't wait to bring them on for another deeper session, especially when he gets that trifecta of lifestyle medicine, integrative medicine, and then functional medicine. And then with all those three, you know, he's going to have so much knowledge and can really attack rheumatology from any angle on, he's going to have so much knowledge. Um, and that's what I love about Dr. U. He's just on this quest for helping his patients with as much knowledge as he can and really sift through the evidence to see how he can individualize care. And now many of you guys might have questions about COVID and auto immunity. And, you know, by the time we did this episode, a lot more has come out. So I highly recommend checking out his Instagram page, which is at my autoimmune MD. And over there, Dr. U is doing Instagram lives. He's putting out posts and he's sifting through the information for you. So I cannot recommend it more. Uh, and one last thing before we go, remember advice media, don't forget to schedule a console with them to receive a $60 gift card as strategic insight on what your current digital marketing is doing or not doing for you. Contact advice media. Drpodcastnetwork.com for slash advice media. Again, that's Drpodcastnetwork.com for slash advice media. Quick disclaimer, everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No physician patient relationships performed in anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health related issues. And until next time, please rate, review, subscribe, and share. Thank you.