Immune System Testing with Dr. Aristo Vojdani: Rational Wellness Podcast 244

Dr. Aristo Vojdani speaks about Immune System Testing with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on January 27, 2022.

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Podcast Highlights

9:49   Dr. Aristo Vojdani published a review paper along with Dr. Elroy Vojdani in the journal Pathophysiology, The Role of Exposomes in the Pathophysiology of Autoimmune Diseases I: Toxic Chemicals and Food. Pathophysiology 202128 (4), 513-543; https://doi.org/10.3390/pathophysiology28040034  While genes play a role, environmental factors, the exposome, are responsible for two thirds of the cases of autoimmune diseases.  These environmental factors that trigger autoimmunity include food sensitivities, infections, toxic chemicals, and the gut microbiome.  Environmental factors affect the immune system and the Lymphocyte Map test is a sensitive biomarker for these immune changes.  A number of environmental factors affect the immune system and affect our barriers and can result in autoimmunity, including silica, trichloroethylene, smoking, mercury, pesticides, pristane, and many other toxic chemicals, inducing reactive oxygen species and lipid peroxidation.

12:45  Reactive Oxygen Species can inhibit good genes and enhance bad genes, such as DNA damage. Lipid peroxidation can cause neo-antigen formation, which means they can bind to our tissues and result in auto-antibody production and over activation of Th1 and Th17, which are the autoreactive lymphocytes.  We end up with dysregulation between our T reg cells and our Th1 and Th17 T cells, which communicate with our B cells, which produce autoantibodies and autoimmune disease.

15:13  The exposomes include the external environment, which include stress, lifestyle, indoor air pollution, outdoor air pollution, diet, additives, salt intake, vitamin D, medications, infections, and xenobiotics. There are also internal environmental factors like protein modification.  More than 600 different proteins get modified internally for many reasons that we don’t even understand. Our microbiome also plays a role in inflammation and autoimmunity.

17:50  Any miscommunication between the immune system, the nervous system, and the GI system may result in autoimmunity. 

18:18  The immune system has two parts: the Mucosal Immune system (aka, the Innate Immune system) and the Humoral Immune system (aka, the Adaptive Immune system)The Mucosal Immune system is our Homeland Security and includes our mucous membranes and secretory IgA.  The SARS-Cov2 virus breaks down our mucous membranes before getting into the lungs and then secretory IgA antibodies start protecting us. Three important cells–dendritic cells, mast cells, and macrophages–start by attacking the foreign pathogens like the virus.  In the case of the coronavirus, the macrophages take it up and internalize it. But because it is such a huge molecule, they break it down into a smaller size, which we call antigens and includes the nucleoprotein and the spike protein. These antigens, like the spike protein, then get taken up by antigen presenting cells and present it to T helper cells. The adaptive immune response will then release either Th1, cytokines such as interferon gamma and IL2 and activate some T cells to become cytotoxic lymphocytes, that go after the corona virus or cells infected with coronavirus.  When cytotoxic lymphocytes finish the job, they leave behind memory T cells and memory cytotoxic T cells.  T cells then collaborate with B cells, that become plasma cells, which have the capacity to produce IgG, IgA, IgM, and IgE antibodies that will recognize the coronavirus in the future.  These antibodies will last months or a few years but after that there will be memory B cells that last many years and continue to recognize that virus and can make antibodies again within a day or two to fight off a future coronavirus infection.  Memory B cells continue to provide protection against the virus for many years, unlike what we may have heard in the media.

28:17  The immune system is as diverse in different people as their appearance.  Cyrex’s lymphocyte immunotyping is different and this is why we need personalized care for each person and why different people may respond differently to the same medication.  B cells in the presence of different environmental factors (exposomes) will become Th1, Th2, T-reg cells, Th9, Th17, Th22, combination of Th2 and Th22, and Follicular Th9.  Each of these T cell subsets have different functions.  Th1 is involved in pathogenic inflammation and autoimmunity. Th2 is involved with allergies and hypersensitivities. T-reg cells provide protection against pathogenic inflammation and autoimmunity. Th9 is involved with allergic response. Th17 both protects us against extracellular pathogens and when they are overactivated they will participate in inflammation and autoimmunity.  The most pathogenic lymphocyte is the hybrid between Th1 and Th17, which participates in both inflammation and autoimmunity. Th22 is involved in skin dermatitis and psoriasis. Th2/Th22 are related to allergies and hypersensitivities. The combo of Follicular (TFh) and Th9 has a high affinity for autoantibody production.

31:13  Some Labs/Researchers/Doctors in the past have claimed that we can classify patients as having Th1/Th2 imbalances based on the cytokines that they produce and this is not an accurate way to do this because the same cytokine may be produced by different lymphocytes. For example, Interferon gamma can be produced by Th1, but also by Th9.  IL-17 is produced by Th17, but it is also produced by natural killer cells. The best way to determine Th1 and Th2 balance and other lymphocyte imbalances is by staining and counting each of these cells directly, which is what Cyrex Labs is doing with their Lymphocyte Map test.  Also, both red blood cells and platelets also produce cytokines.

34:10  Our immune system is essential to protect us against infection and cancer and abnormalities of the immune system can lead to autoimmune disorders, allergic diseases, immune deficiencies, including Alzheimer’s disease, Parkinson’s disease, cardiovascular disease, etc.  Advancements in immunology have now made it possible to do complete lymphocyte immunophenotyping.

37:30  When investigators looked at hundreds of patients with COVID-19 they found one group that had hypoactivation of their immune system, low white blood cells, low lymphocytes, low CD-4, low CD-8, etc., another group that had hyperactivation of the immune system, and a third group that had an immune system that was more balanced, but yet all of these patients were treated with the same cocktail of medications.  It should be no surprise that they did not all respond well to the same protocol. If you give dexamethasone to a patient with a depressed immune system, this will suppress their immune system even more.

52:37  Measuring cytokines became obsolete after this new method of directly separating and staining lymphocyte cells.

52:52  If we look at a patient with Systemic Lupus Erythematosus, we often see Th2 low and Th17 high.  Vitamin D can help to lower Th17 by increasing the number of T reg cells. If you find a patient is Th17 dominant and you don’t do anything about it, they have an increased risk of having lupus or some other autoimmune  disease.

55:38  The next case is a patient with Lyme Disease, multiple chemical sensitivities, and repeated concussions. This patient has elevated 21 hyroxylase, meaning adrenal insufficiency, elevated paraben antibodies, and reactions to 70 out of 180 foods measured by Cyrex.  This patients has an elevated CD4:CD8 ratio and has elevated Th1 and Th17. This patient is classified as Th1 plus Th17 dominant and while this patient does not currently have autoimmune disease, they will likely develop full blown autoimmune disease if not treated for Lyme and toxins and food sensitivities.

1:00:39  This is a case of patient with low IgG subclass 2, Epstein Barr Virus early antigens, meaning that EBV became reactivated. This patient also had exposure to mold and mycotoxins.  This patient had low IgG and EBV early antigen, which means that EBV became reactivated and the B cells became activated to produce more antibodies. This patient has Th17 dominance and elevation of natural killer cells, which were probably elevated to fight the EBV virus and perhaps for the mold. 

1:02:03  The clinical Importance of lymphocyte immunotyping.  In the case of Grave’s thyroid autoimmunity, most of the patients were Th1 dominant, and when they were treated with antithyroid drugs, the Th1 went down and the Th2 went up, creating more balance.

1:03:04  Patients with rheumatoid arthritis often have Th17 dominance and studies show that methotrexate lowers the levels of Th17. 1:03:16  Patients with Multiple Sclerosis often have Th1 and Th17 dominance, since under inflammatory conditions, these cells can break down the blood brain barriers and get into the brain and cause brain inflammation, resulting in neuronal cells death resulting in either rheumatoid arthritis or Alzheimer’s or Parkinson’s and when they get treated with medications, they can bring down the levels of Th1 and Th17 cells.

1:05:12  In relation to COVID, patients who had low lymphocytes and T cell subsets were less likely to survive.

1:05:46  25% of the tests that come into Cyrex show low lymphocytes and exercise and good nutrition are the most important factors that improve this. Exercise increases the production of growth factors that enhance production of lymphocytes.  Other factors that can help include the following: 1. Green jackfruit flour, 2. shitake mushrooms, 3. ganoderma mushrooms, 4. Turkey tail mushrooms, 5. Oyster mushrooms, 6. Glutathione, 7. Curcumin, 8. Resveratrol, 9. Berberine, 10 Lactobacillus ramnosus GG.   To promote the production of B cells we have 1. Probiotics, including lactobacillus casei, 2. Fish oil, 3. Curcumin, and 4. Beta glucan from oyster mushrooms. 

1:07:22  To stimulate the production of CD4 T Helper cells, we have 1. IVIG, 2. vit D, 3. Fish oil, 4. Oyster mushrooms, 5. Ganoderma, 6. Whey protein, 7. Soy protein. 

1:07:32  To promote the production of CD8 cells we have 1. BCG vaccination, 2. vit D, 3. DHEA, and 4. peanut agglutinen.

1:08:09  To bring down the activity of Th1 cells, we have a lot of research and among the molecules that have been shown to help include 1. Corticosteroids like dexamethasone, 2. monoclonal antibodies, 3. Chloroquine, 4. Metformin, 5. IVIG, 6. Dimethyl fumarate, which is a new class of medications called nrf2 activators, 7. vit D, 8. fish oil, 9. resolvins, 10. probiotics, 11. zinc, 12. green tea, 13. vit E, 14. probiotics, 15. curcumin, 16. bromelain, 17. polyphenols, and 18. naringenin.

1:08:45  To lower Th2 activity we have 1. probiotics, 2. vitamin E, 3. fish oil, 4. resolvins, 5. zinc, 6. L-citrulline, 7. L-arginine, 8. L-tyrosine, 9. H. pylori(?).

1:09:12  To promote Treg cells we have 1. IVIG, 2. Azithromycin, 3. Rapamycin, 4. Chloroquine, 5. Dexamethasone, 6. Indole-3-carbinol, 7. Vitamins A and D, 8. zinc, 9. Short chain fatty acids, 10. fish oil, 11. L-arginine, 12. Testosterone, 13. Astragalus, 14. Berberine, 15. Quercetin, 16. Genistein, 17. Curcumin, 18. Lactoferrin, 19.

1:15:20  Natural Killer Cells.  The following substances can promote Natural Killer Cells: 1. Vitamins A, B, C, D, and E, 2. Resveratrol, 3. Probiotics, 4. Short chain fatty acids, 5. Blueberry, 6. Ginseng, 7. Garlic, 8. Ashwaganda, 9. Oyster, 10. Medicinal mushrooms, 11. Astragalus. 

1:19:07  The following conditions are associated with an abnormal Lymphocyte Map: 1. Multiple Chemical Sensitivities, 2. Chronic Fatigue, Fibromyalgia, 3. Certain forms of cancer, 4. Asthma, 5. Allergies, 6. Lupus, 7. Rheumatoid arthritis, 8. Multiple sclerosis, 9. Chronic inflammatory demyelinating  polyradiculoneuropathy, 10. Thyroid disorders, 11. Systemic sclerosis, 12. Autoimmune disease of the Liver, 13. Phospholipid syndrome, 14. Psoriasis, 15. Diabetes, 16. Multiple system atrophy, 17. Uveitis, 18. Heart disease, 19. Alzheimer’s disease, 20. Parkinson’s, 21. Schizophrenia, 22. Recurrent pregnancy loss, 23. Chronic obstructive pulmonary disorder, 24. COVID-19 and other infections.




Dr. Aristo Vojdani is the Father of Functional Immunology and he has dedicated his life’s research to helping us figure out what are the triggers for autoimmune diseases and many of the tests he has developed for Cyrex Labs are focused on this.  Dr. Vojdani has a PhD in microbiology and immunology and he has authored over 200 scientific papers published in peer reviewed journals. Dr. Vojdani is the co-owner of Immunosciences Lab in Los Angeles, which offers testing for various types of infections, including Lyme Disease. He is the Chief Science advisor for Cyrex Labs, whom he has developed all of the testing for, including his new Lymphocyte Map test, which is the subject for this talk. He is also a professor in the Department of Preventative Medicine at Loma Linda University.  

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.


Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out my drweitz.com. Thanks for joining me. And let’s jump into the podcast.

Welcome everyone to the functional medicine discussion group meeting tonight. And we’re very happy to be joined by one of our favorite speakers, esteemed Integrative Immunologist, Dr. Aristo Vojdani, who will be telling us how to identify immune system imbalances that are common in autoimmune diseases, and hopefully give us some suggestions about how to address them. I’m Dr. Ben Weitz, and I’ll start by making some introductory remarks before introducing our sponsor for this evening, which is integrative therapeutics. And then, I’ll introduce our speaker for this evening.

I encourage each of you to participate and ask questions by typing in your question in the chat box. And then, I’ll either call on you or simply ask Dr. Vojdani your question when it’s appropriate. And so, I hope that you’ll consider joining some of our future functional medicine discussion group monthly meetings. We usually meet on the fourth Thursday of the month at 6:30 Pacific Standard Time. And I guess, we’ll continue meeting through Zoom for the foreseeable future. Hopefully, will have in-person meetings at some time soon. Some of our upcoming meetings are February 24th, we have Dr. Howard Elkin and he’ll be speaking on integrative cardiology. March 24th, Dr. Julie Greenberg will be speaking about integrative dermatology. April 28th, Dr. Paul Anderson will be speaking about an integrative approach to treating cancer and May 26th, we have functional maternity with Dr. Sarah Thompson, and if you’re not aware, we have a closed Facebook page, Functional Medicine Discussion Group of Santa Monica that you should join, so we can continue the conversation when this evening is over. And I’m also recording this event and I will include it in my weekly Rational Wellness podcast, which you can subscribe to on Apple Podcasts, Spotify or YouTube. And if you enjoy listening to my Rational Wellness podcast, I would appreciate it if you could go to Apple Podcasts and give me a five star ratings and review. We have many excellent interviews with many of the top doctors in the functional medicine world.

Now, I’d like to invite Steve Snyder from Integrative Therapeutics, our sponsor for this evening to give us a little information about some of the integrative therapeutic products, which is one of the few professional brands of products that we carry in our office, Steve.

Steve:                                   Hello, everyone. I actually had a couple slides too, but I’ll just not do it because I don’t want to complicate stuff, but Dr. Waserman was asking about some immune stuff for COVID and that’s kind of what I was going to show you guys. We have a few just pretty unique things for immune function that are super popular for us. And the biggest one is called V-Clear. It used to be called ViraClear. We’re not allowed to say virus anymore. So, that sort of gives you an idea of what it’s about. It is an extract of pelargonium sidoides that’s grown and produced by our parent company in Germany. And because it’s marketed as a supplement in Germany, it requires a lot of clinical research to actually launch it.  So, we have about 25 clinical studies on this product, over 10,000 patients, over 3000 kids in all kinds of upper respiratory tract infections, including coronavirus before the pandemic.  There’s actually a study going on right now with the original coronavirus from the pandemic. It’s not done yet, but it looks pretty good.  And basically the bottom line of all of these studies is shorter duration of episode and reduced severity of symptoms. The way it’s marketed is to be taken at the first sign of symptoms.  So, Dr. Waserman, if you want some, I can send you some to try, but we should do it fast, but the reality is, it can be taken preventatively, it works really well for that.  It’s just not super practical, the way that it’s packaged, but in full disclosure, I’ve been taking it for about two years.  It has multi-mechanisms.  It inhibits viral implantation on the cell wall.  It improves ciliary activity. It has virucidal action of its own. There’s actually a study showing better efficacy than amoxicillin in sinusitis. So, it’s the real deal. It’s something that we literally can’t make enough of.  So, if anybody [who is a practitioner] has any questions about it or would like to try it, my email is steve.snyder@integrativepro.com.

The other one I really wanted to mention real fast is our sort of the integrative version of quercitrin. It’s called Alpha-glycosyl isoquercitrin. It’s about 18 times more bioavailable than regular quercitrin. So, one of our 33 milligram capsules is equivalent to about 500 milligrams of the other brands on the market. It’s been a huge, like literally can’t make it fast enough. Everybody wants that and zinc because the course of it helps get zinc into the cells and zinc is, there was a point where you couldn’t get zinc anywhere.  The AGI we call it, because it’s hard to say, is another thing that’s been super popular for us over the last two years. Typically, people think of it as part of an allergy regimen or anti-allergy regimen and we sell it for that. But over the last two and a half years, the immune aspect of it has become a major point. And then, we have a zinc, standalone zinc chelate. It’s 30 milligram capsules, a hundred capsules in a bottle and it’s nine bucks retail. So, there’s nothing as inexpensive as that out there. And so, that’s pretty much it for right now. So again, if you have any questions, email me and we’ll set you up.

Dr. Weitz:                            Great. Thanks, Steve. And somebody asked if you could type your email into the chat box.

Steve:                                  I can try.

Dr. Weitz:                            Okay. Thank you. So, let me introduce our speaker for tonight is Dr. Aristo Vojdani, the Father of Functional Immunology, and he’s dedicated his life to helping us to better understand some of the root causes of autoimmune diseases as well as how to treat them. And many of the tests he has developed for Cyrex Labs are focused on this, including his newest test, the Lymphocyte Map Test. Since we are speaking about autoimmune diseases, I just wanted to mention the shocking news report from a new paper that was just published today in a British medical journal. I know this will come as a surprise to all of you, but they are reporting that vitamin D and fish oil reduce the risk of autoimmune disease.

Dr. Vojdani has a PhD in microbiology and immunology, and he’s authored over 200 scientific papers published in peer review journals. Dr. Vojdani is the co-owner of Immunosciences Lab in Los Angeles, which offers testing for various types of infections, including Lyme disease. He’s the chief science officer for Cyrex Labs, for whom he’s developed all their tests. He’s also a professor in the department of preventative medicine at Loma Linda University. Dr. Aristo Vojdani, my friend, Ari, thank you so much for honoring us with your presence tonight.

Dr. Vojdani:                        Thank you so much, Dr. Weitz. And thank you all the participants. Tonight, I’m going to speak about a very, very important test, which from the bottom of my heart, I believe that every one of us should have this test once a year as part of our annual checkup. So, I hope by end of the presentation, Dr. Weitz, at least I will convince you hopefully that you’ll decide to do this test on your own blood.

Dr. Weitz:                           Oh, absolutely. I just got the test kits in yesterday.

Dr. Vojdani:                        Okay. Thank you.

Dr. Weitz:                           I can’t wait to do it.

Dr. Vojdani:                        Thank you. So, recently, very recently, about a month ago, I published this article in the journal called Pathophysiology about the role of exposomes in autoimmune diseases. And this figure is taken from there. So, what are exposomes, you’ll see a little bit later on, but they are in general infections, dietary components, toxic chemicals, gut microbiome and effect on the immune system, which may result in autoimmune disease. For genes plus exposomes are responsible for many, many autoimmune diseases, but gene or genetics is only one third. The exposome or the environmental factors are the other two third. So, we have to pay attention more to the environmental factors when we talk about inflammatory and autoimmune disorders. I like very much this article and look at the title of this article, which was published in Frontiers in Immunology about a year ago, environmental exposure and autoimmune diseases contribution of gut microbiome.

That’s exactly what was in those in earlier slide. So, they talk about this dysbiosis of gut microbiome is another important environmental factor, which can alter our immune system, our barriers, our mucosal immune system, that can result in autoimmunity. But you’ll see, I emphasize this sentence in blue and that is the most challenging aspects of autoimmunity is to identify the early events that trigger immune dysregulation and autoimmunity.  So, environmental factors affect the immune system and the more sensitive biomarker based on my opinion is lymphocyte mapping.  And that’s what we are going to talk about tonight.  In the same article, you see that they talk about environmental factors, silica, trichloroethylene, smoking, mercury, pesticides, pristane, and many other toxic chemicals, inducing reactive oxygen species, lipid peroxidation.  ROS can affect, inhibit good gene, enhances bad genes, for example, DNA damage.  And all of that will have a significant effect on the immune system because lipid peroxidation results in neo-antigen formation, what is neo-antigen formation meaning?  Some of these chemicals such as mercury bind to body components, albumin, hemoglobin, smooth muscle, IgG, then results in auto-antibody production, for example, rheumatoid factor is IgM produced against our own IgG.  Furthermore, you see that these neo-antigens affect the T-cell. Tonight, we’ll talk a lot about the balance between Treg versus TH1 and TH17. Tregs are the good guys regulating the immune system and TH1 and TH17 are the autoreactive lymphocytes, when become overactivated by releasing all these inflammatory cytokines can have significant effect on body composition in general. So, these regulation in T-cell, low Treg, high TH1 and TH17 causing cell mediated immune overreaction, and then communication between the T-cell with the B cells results in activation of the B cell, which the B cell then produces auto-antibodies such as anti-nuclear antibodies, rheumatoid factor already mentioned, double stranded DNA, smooth muscle antibody, mitochondrial antibody. And the final result is going to be autoimmune disease. I really love this article, which was published in Frontiers in Immunology, actually summarizing probably my work of 25 years.

So, what are the exposomes?  You can see in here, there are two parts associated with exposome, the external environment, which I talked about, but we have to include stress, lifestyle, indoor air pollution, outdoor air pollution, diet, and additives. Please do not forget salt. This is an opportunity. Too much salt is activating T helper 17 and vitamin D downregulating TH17.  So, when you talk about, we have to take our vitamin D, please also think about reducing the amount of salt that you take.  Medications, infections, xenobiotics.  So, those are external environmental factors.  Now, we have internal environmental factors, protein modification. We have more than 600 different proteins get modified internally for many, many reasons that we don’t know about. Our gut flora plays a significant role in inflammation and autoimmunity and on this side you have proteins adducts and many other factors. So, we have to pay attention to the exposome factors.

This is a cover of one of my books that you see the immune system right here, the GI, and the nervous system, and direct communication between these three systems. And of course, if you ask the neurologist will say, this one is the most important one, the nervous system. Ask the GI, they will say, yes, the gastrointestinal is more important. I am as immunologist, I’m going to fight with them and saying the immune system is more important because it’s communicating both with GI and with nervous system. So, any abnormality anyway, in result of miscommunication between immune system, nervous system, and GI system may result in autoimmunity, which should be in the middle. So, this is gut brain immune access.

So, that will take us since I believe that the immune system is the most important one. Let’s classify the immune system in a simple manner. The mucosal immune system, which our first line of defense, our Homeland Security. Mucous membrane, secretory IgA. SARS-CoV-2 should break down the mucous membrane before getting into the lungs. And secretory IgA is the most protective against SARS-CoV-2. The next humoral immunity, which is the antibodies, IgG, IgA, IgM. And of course also in the case of allergies, we produce IgE. So, remember game, IgG, IgA, IgM, and IgE. Those are the antibodies, but tonight, I’m going to talk mainly about cell-mediated immunity.

T-cells, B cells, NK cells, cytokines, I’m not going to talk about, but indirectly, yes, I will talk about. So in each one of these, these components of the immune system, we have both innate and adaptive. So in the case of innate immune response, three very important cells, dendritic cells, mass cells, and macrophages by taking up the foreign materials can protect the body against these pathogens. The adaptive immune response, also dendritic cells play a role, but by communicating with not even T-cells, which are not being differentiated, they become TH1, TH2, TH3 which is Treg, T17, some natural killer cells and together protecting the body against all the enemies. So, that was a little bit introduction about innate and adaptive immune response. So, let’s put together the picture because unfortunately in the media or the media misled people about the immune system and how the immune system works.

That’s why I put the neuron in here, and you’ll see why I put the neuron in here. So, when we get exposed to a virus such as Corona, the first line of defense, as part of the innate immunity, the macrophages will take that up, internalizing it. And since the virus is very huge molecule, they have to break it down to smaller size called antigens, like nucleoprotein, spike protein. Then, the nucleoprotein or spike protein and other proteins taken up by antigen presenting cells presenting it to T helper cells. So up to here, we are talking about innate immune system, but here, these are components of adaptive immune response that will release either TH1, cytokines, such as interferon gamma, and IL2, activate some T-cells to become cytotoxic lymphocytes. And the job of cytotoxic lymphocyte is to go after the corona virus or cells infected with coronavirus in order to protect the body against that infectious material. When cytotoxic lymphocytes finish the job, they are going to leave behind memory T-cell and memory cytotoxic T-cells.   So if the vaccine did not protect us, which we know that is a reality now, and we get for the second time, or for the second time the same virus get into our body, this memory, cytotoxic memory cells and memory T-cells immediately will go after the virus and try to stop the virus to infect even the macrophages. And that’s how the body become victorious against different pathogens. This part of cytotoxic lymphocyte is also part of innate immune system, because unconditionally will go after pathogens and try to stop them from infecting our body.

Now, in the presence of Th2 cytokines, such as IL-4, IL-13, and others, becomes T helper cell, either Th1, or Th2, and then collaboration with B cells becomes plasma cells, and plasma cells have the capacity to produce antibody IgG, IgI, IgM, and IgE antibodies, and in this particular case, the antibodies will recognize the coronavirus. However, after finishing the job of producing antibody, in majority of the cases, this antibody may stay in the body for a year or two, six months, depends on the antigenicity or structure of the antigen, but that will leave behind short term and long term memory B-cell.  So when the next time the body will have some encounter with the same virus, these B-cells on the normal condition take 14 days to be in place. But this time within a day or two, they will become activated, especially the long term memory cells will start making antibodies and antibodies will go after coronavirus. So altogether the cytotoxic lymphocytes, T-cell, memory T-cell, memory cytotoxic T-cells, and memory B-cell protect the body, not only against the viruses today, but against the viruses tomorrow and even next year, and probably even in next 20 years. So please, based on this principle of the immune system, do not accept what they told us in the media, that the memory lymphocyte will stay in the body only for one year or two. No, the memory lymphocytes are comparable to memory neurons.  If I will see Ben on the street, because I have seen him before, right away, I can recognize you, right? That’s thanks to my memory cells in my brain. The same thing, our memory B-cells, our memory T cells are going to recognize the virus if we had an encounter with that virus six months ago, five years ago, 20 years ago.

Dr. Weitz:                            Now, what’s the difference between the memory B-cells and the memory T-cells?

Dr. Vojdani:                        Okay. Each one of them have different function. The memory T-cells, as you could see in here that mainly they are memory cytotoxic lymphocytes. Their lineage is they have different receptor on their surface. Their job is different.  The memory B-cells job is when the antigen is in the body, they will become plasma cells, and will double produce antibodies. So T-cells do not produce antibodies, the B-cells are going to produce antibodies. So together, the T-cell response plus B-cell response in the form of antibody is going to protect the body against the pathogens. So this was the most important slide. That was the main reason I spent so much time on this. So let’s move on.

So the immune system in people is as diverse as height, beauty, intelligence, and other human features. Our genome, lifestyles, and exposomes affects our immunotypes. Immunotypes, meaning the pattern of lymphocytes. And so therefore, we cannot treat every individual with specific disease with the same medication. So this is the message of lifestyle medicine and personalized medicine. So now, if B cells in the presence of different exposomes, they become Th1, T helper one, T helper two, T-Reg cell, Th9, Th17, the combination of Th1 and Th17, Th22, combination of Th2 with Th22, and the last one is follicular T helper 9.  As you can see, each one of these T-cell subsets have different function. For example, Th1 is involved in pathogenic inflammation and auto immunity, Th2 involved with allergies and hyper sensitivities. T-Reg cell, protection against pathogenic inflammation and autoimmunity, keeping the balance. Th9 is involved with allergic response, T helper 17, although is protecting us against extra cellular pathogens, but when become overactivated participate in inflammation and autoimmunity. And of course, when we have the hybrid cell, hybrid between Th1 and Th17, this is the most pathogenic lymphocyte. So because it does participate in pathogenic inflammation autoimmunity, Th22 in skin dermatitis, psoriasis, Th2 Th22 allergies hyper sensitivities, and Th9 high affinity auto-antibody production.

But there is a point I would like to make in here. Each one of these cells, as you can see, produced different cocktail of cytokines. In the past, I’m saying in the past, many individuals were classifying Th1 and Th2 based on the cytokine they produced.  In fact, there are some practitioners still, they measure Th1 and Th2 cytokines, and they tell you the patient is having Th1 imbalance, or Th2 imbalance. And tonight, I’m going to tell you that’s wrong. Why? Because let’s look at interferon gamma. You’re seen here, it’s produced by Th1, right? Look at interferon gamma here, it’s produced by Th9. So when you measure interferon gamma as a measure of Th1, how do you know it’s produced by Th1 and not by Th9? IL-17 is produced by Th17, but IL-17 also is produced by natural killer cells, NKT cells. So when you measure that as a measure of Th-17, how do you know that IL-17 is not produced by NKT? So in summary, I would like to tell you the best way is to stain and count each one of these cells directly, and not to go after indirect bio-markers. And that’s what exactly we do at Cyrex.

So, furthermore, did you know that in addition to lymphocyte that release cytokines, red blood cells produce cytokines, or release cytokines, or absorbs cytokines, and then release them. Platelet release cytokines. So again, when you measure Th1 or Th2 cytokines, how do you know they’re not produced by red blood cells, platelets, or other type of cells? So that’s the question I’m putting in here? How are you sure the cytokine that is measured is produced by Th1, Th2, Th17, or T-Rex? We are not sure. So that’s why we have to measure immunity by counting different lymphocytes directly, which we call this lymphocyte map or lymphocyte mapping.

So why we have to measure immunity with lymphocyte map, because immune system is essential to protect our body against infection, I already mentioned that. Cancer and other environmental factors. The exposome factors, intrinsic and extrinsic factor have a significant effect on the immune system years before disease development, and sometimes 20 years, that’s the beauty of lymphocyte mapping. So these are some of the factors associated with effect on the immune system. And abnormalities of the immune system can lead to autoimmune disorders, allergic diseases, immune deficiency, and many more that I’ll show you, even Parkinson’s and Alzheimer’s, cardiovascular disease, and more. So quantitative and qualitative changes in the composition of lymphocytes subsets provide an opportunity for not only for early detection, but for prevention of many immune disorders that affect one out of three Americans.

So here, the list of cells that I started measuring in 1989, the time which AIDS was discovered. And so therefore we were doing lots of close cytometry, including T cell, B cell, CD-4, CD-8, and natural killer cell, that’s all. But with advancement in the field of immunology and availability of monoclonal antibodies specifically made against different cluster differentiations, now we can stain additional cells directly, such as Th1, Th2, T-Rex cells, Th17 and other type of natural killer cell. So we used to call this partial immunophenotyping, which was very limited.

And today, this is what we are measuring. The upper part, what we used to do all the way up to 2010, and this is the addition including Th1, Th2, the ratios, T-Reg cell, Th17, and the ratios that we are doing today, which is the major breakthrough. And by the way, this is done in many research laboratories, but Cyrex is the only clinical laboratory doing the lymphocyte immunophenotyping, including all of these, which we call it comprehensive immunophenotyping, or the lymphocyte map. So let’s go back to COVID profiling, deep immune profiling of COVID patients, and talking about distinct immuno type with therapeutic implications. And Dr. Weitz, if I need to stop for 30 seconds after this message, you are more than welcome to interject something in here.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        Because the message is extremely important because what they found that when they looked at several hundred of patients with COVID during hospitalization, they found one subgroup, they had hypo activation of the immune system, low white blood cell count, low lymphocyte, low CD-4, low CD-8, low Th17, low Th1, low Th… Everything was low.  Second group, hyperactivation of the immune system. Everything was elevated. And you’ll see some examples. And the third group were comparable… They had COVID, but they were comparable to healthy people. Their immune system was comparable to healthy people. So the question I’m putting in here, and I had COVID, I was hospitalized for four days. So how come, even until today, all patients with COVID are treated with the same cocktail of medication.

Dr. Weitz:                            Well, when all you have is a hammer and we use the hammer for every job you have.

Dr. Vojdani:                        Yeah. So we realize, or we know we appreciate that personalized treatment. And if you read this sentence right here, these immunotypes may have implication for design of therapeutics and vaccines for COVID 19. This was published more than a year ago.

Dr. Weitz:                            Now, what about we hear all the time, the real risk of severe COVID has to do with this cytokine storm that happens in the lungs, and so that’s the reason, I think, for using the dexamethasone is that everybody with severe COVID has this cytokine storm is extreme inflammatory process that we’re trying to intervene in.

Dr. Vojdani:                        I will have an answer for you. First of all, there are lots of articles, and you’ll see in my continuation of my presentation, that the one with low white blood cell counts, low lymphocyte, low CD-4, low CD-8, it makes sense. When you don’t have enough soldiers to fight for you, then the body’s not going to survive. The cytokines storm and other… Whatever factors produced by these few lymphocytes in our body. So the one who did not survive in the hospitals were the one who were suffering from hypoactivation of the immune system, not hyperactivation of immune system, relatively. Okay. So let’s continue. So here example, this article, I think published very, very recently.

Dr. Weitz:                            But by the way, you’re saying that patients had low white blood cells prior to getting COVID, not that their white blood cells got low after getting COVID.

Dr. Vojdani:                        They say at the time of hospitalization. So obviously they had probably low white blood cell counts and low lymphocytes before.

Dr. Weitz:                            Right.

Dr. Vojdani:                        I believe so. Yes. So here example, and in this article, they found that the threshold for T-cell was 400, CD-200, and again, we used to say individual with less than 400 CD-4 cell, they may have AIDS. Now they reduce that to 200. So this is the extreme, CD-8 less than 100, B-cell, less than one to 20. And I believe that also is less than 100. So conclusion, the results of this study suggest that evaluation of peripheral blood lymphocyte in COVID 19 patients could be valuable in the study of the immune responses to the disease and the prognostication and of the outcome. So if you have a picture like this, the probability of surviving the virus is very low. But in individual with hyper activation of the immune system, even you have cytokines store, the probability of surviving the disease is much, because you have so many soldiers that are fighting for you.

Okay. So let’s look at some examples. So this is my own blood. Okay. So what are we looking at? This is before COVID. White blood count, very nice, total lymphocyte, beautiful, and B and T-cell ratio 5.6, CD-4 CD-8 ratio 2.7, and you’ll see the normal ranges, Th1, Th2, 3.9, right in the middle, Th-17, T-Rex 1.5 again, in the middle, and NK cytotoxic, NK normal, I had few extra NKT cell, which I don’t think in here cause any problem in my body.

So these are the seven components that we use for interpretation of the test results. That’s why I call them the magnificent seven to look at these for interpretation of results. So please remember this is before COVID. Now, when I was in the hospital and few, when I released from the hospital, this is what I did. Look what happened. This is hyperactivation of the immune system. The T-cell were increased by 20, 30%, helper cells were increased, Th1, Th2, T-Rex cells went down, and NK T-cell also went up significantly. So this is five months after, because the test was not available. Okay. Then I repeated the test three months after that, look what happened.  So almost everything, almost went back to normal. So this is the beauty of lymphocyte immunophenotyping and classification to hyperactivation and hyperactivation of the immune system. So yes, Dr. Weitz, I had cytokine storm, hyperactivation of the immune system, but I did survive the disease, because my soldiers knew how to fight, because of my lifestyle, my normal lifestyle.

Dr. Weitz:                            And, and somebody who had low white blood cell count, if you give them dexamethasone, that’s going to suppress their immune system even more, and that could be why those patients who don’t respond don’t do well with that treatment.

Dr. Vojdani:                        That’s the exact point I made and I agree with you that imagine the person is having only 600 lymphocytes instead of having couple thousands. You put them on dexamethasone. So even if those cells could produce some beneficial cytokines, they’re not going to produce them anymore. You inhibit them. So that’s why, unfortunately, those who died in hospitals, they were suffering from low number of soldiers. Okay. Let’s continue now.

Dr. Weitz:                            And what percentage of our population probably has low white blood cells, especially considering, since the topic is autoimmunity, how common these drugs that suppressed part of the immune system are that are often used to treat autoimmunity.

Dr. Vojdani:                        We have a round table discussion every other week, by Cyrex. Another meaning you order your own lymphocyte map. Then two weeks later, you can participate in this round table discussion and I’ll put your test result, without of course, revealing your name. We’ll discuss your patient’s test results. Only based on what we got at Cyrex I can attest that about 20 to 25% of those orders came through Cyrex had very low lymphocyte count, T cell and B cells helpers, suppressor, and so forth. Okay. So now let’s go to methodology.

Dr. Weitz:                            Hang on one second. Somebody asked a question. Since your immune system was working so well, why did you end up being hospitalized?

Dr. Vojdani:                        First of all, it wasn’t needed to go to the hospital. But always, you have to listen to your wife. Because the doctor told her that, “He has the beginning of pneumonia.”

Dr. Weitz:                            On the basis of what?

Dr. Vojdani:                        Well, was listening to my-

Dr. Weitz:                            Okay.

Dr. Vojdani:                        … Lungs. And, by the way, they put me on a medication, Remdesivir. It is proven that Remdesivir prolongs stay in the hospital, or prolong the patient’s stay in the hospital. So they’re not using it anymore. Was published in several articles.

So let’s move on to methodology. The methodologies is called flow cytometry. What is flow cytometry? The study of cells, as they move in fluid suspension, allowing multiple measurements to be made per cell. Another meaning, we can count more than 20,000 cells in less than one minute. Imagine when I was in graduate school and the professor put me behind the microscope to count 20,000 cells. How long would’ve taken? Probably a week. So now, in a minute with, high reproducibility can report a results.  So what do we do? We take drop of blood, mixing it with mixture of monoclonal antibodies, which each one have different color. And each cell we have different cluster differentiation, CD. Like T cell has cluster differentiation, 23, or three. B cell has cluster differentiation 19, specifically. And the same thing for Th1, Th2, Th17 and Treg cells. Okay? So the antibodies now, if they are red, they will bind only to cluster differentiation specific to that monoclonal antibody.

So now when this mixture of cells go through the sheath fluid, they get separated based on their color, red or green. And then, when it goes into very narrow area, the laser will hit. The red cells will go to one direction and the green cells will go to another direction and will count 20,000 cells and will give us the percentage of T cell, B cell, T helper 1, T helper two, Th17, regulatory T-cell and natural killer cell. So this is the principle of the methodology.  So again, you see that B cell has specific cluster differentiation, CD19, it’s right here. You are not going to find that on CD4, you are not going to find that on CD8. And CD4 cell, okay, there is cluster differentiation at four, you are not going to find that on B cell, you are not going to find that on CD8 cells. And the same thing, CD8, which is covered in this area, is going to be found on cytotoxic lymphocyte and not on other type of cells. Therefore, monoclonal antibodies going to stain specifically CD4, CD8, Th1, Th2, Th17 and more. So in less than one minute, the computer will count 20,000 cells and classify them based on their characteristics or their CD marker on the surface of lymphocytes. So that’s why measuring cytokines became obsolete after this, because we are directly staining the cells and we are counting the cells.

So now let’s look at some examples of patients with autoimmune disease. This is a patient with systemic lupus erythematosus. So please, just be with me, and let’s look at up to CD4-CD8 ratio. What do you see? That was a test I used to do between 1989 to 2010. I would’ve reported everything normal for this patient, correct? But when you do measure, Th2 is low, Th17 is high. Then the ratio Th17-Treg is high. The NK cell is high, but overall, this patient is Th17 dominant. And therefore there are many nutritional factors, medications can decrease the number of Th17 and increase the of regulatory T cell, and return the immune system to complete balance. And that will help patients with lupus erythematosus. And by the way, vitamin D is one of those, can bring down the number of Th17 by increasing the number of regulatory T cell.

Dr. Weitz:                           Now is she Th17 dominant because of lupus? Or is the Th17 dominance part of the causation of lupus?

Dr. Vojdani:                        No one really can answer that question. Based on my opinion, could be both. Okay. Environmental factors can increase the number of Th17 years before systemic lupus erythematosus. But if you don’t do anything about it in individual who is Th17 dominant, most probably that person will end up five years, 10 years, 20 years later, with full blown lupus or other type of autoimmune disease.

Dr. Weitz:                           Sorry, what do you say-

Dr. Vojdani:                        Do we have-

Dr. Weitz:                           What are you saying will bring down the Th17 more directly, other than vitamin D bringing up the Tregs.

Dr. Vojdani:                        Please, please. Wait.

Dr. Weitz:                           Okay.

Dr. Vojdani:                        I have slides specifically for that.

Dr. Weitz:                           Terrific.

Dr. Vojdani:                        Okay. Yeah, let’s go. So the next item is patient with Lyme disease, multiple chemical sensitivity, repeated concussion, and Dr. Mosnik is very familiar with those patients. Elevated 21-hydroxylase, meaning adrenal insufficiency, elevated parabens, toxic chemical exposure, reaction to many foods like out of 180 measured by Cyrex about 70 of them were abnormal. So highly reactive, antinuclear antibody one to 80.  So when we did this, guess what, first of all, you see that number of helper cells are elevated, 1,174. And relatively CD4-CD8 ratio is 3.9. The ideal for me is around two. Then T helper 1 is increased, and T helper 17. So this individual was classified as Th1 plus Th17 dominant. And this is an answer to your question, Dr. Weitz, this individual doesn’t have autoimmune disease, but is having Lyme disease, exposure to chemicals and adrenal insufficiency, chemical antibodies, food immune reaction. So this is a classical patient. If the doctor will not take care of this individual down the road will develop full blown autoimmune disease.

Dr. Weitz:                            Now, if you correct the Lyme disease and some of the toxins and, and food sensitivities, will the immune system go back into better balance?

Dr. Vojdani:                        I have no doubt. I have no doubt. Yes. But as we do more testing, we learn every day. So now, that was relatively high CD4-CD8 ratio. So look at these patients. Multiple chemical sensitivity, they react to everything. Look at the ratio of CD4-CD8, even is less than HIV and AIDS. We used to call this chemical induced immune deficiency syndrome. So, unless you take care of chemical sensitivity, which is not easy, these patients react to everything, perfume, name it, everything. So never CD4-CD8 ratio should be less than one. The best is two. As soon as goes higher than three, it goes towards autoimmunity when it goes below than one that goes towards immunodeficiencies. So we have to take care of that.

Now this is the opposite case. Look at CD4-CD8 ratio of 5.6. This patient is having inflammation and autoimmunity. What kind? I don’t know. That’s what the doctor told us. But again, high CD4, relatively low CD8 resulted in ratio of 5.6. I do see this in patient with rheumatoid arthritis, lupus, thyroiditis, multiple sclerosis, and many other disorders. And then you see the patient also is having very high Th1. So it is also Th1 dominant. So the high number of T helper cells actually, most of them are Th1 and some of them also are Th2. So the patient is mainly Th1 dominant, and therefore they have to take care of the increasing, probably, the number of cytotoxic CD8 cells return the balance between CD4-CD8, and hopefully that will also result in correction in the number of Th1 and Th2 cells.

Go to the next one. This individual, as you can see, had low IgG2. EBV early antigen, this is not IgG antibody elevation. Early antigen, meaning EBV became reactivated and B cells became activated to produce more antibodies, whether mold exposure was part of that, I really don’t know, but here we see combination of two different pathogens, molds and Epstein-Barr. Caused what? Significant elevation in Th17. This individual is classical Th17 dominant, with elevation of natural killer cells, because natural killer cells probably tried to fight the Epstein-Barr virus, and maybe even the mold.

So you see these, abnormalities are found not only in patient with autoimmune disease, patients exposed to environmental triggers. So those were some of the cases. What is the clinical importance of comprehensive lymphocyte immunophenotyping. And as you can see in here, first of all, this is based on articles I read in scientific journals, and this evidence is in different journal articles in relation to different autoimmune diseases. For example, in Thyroid autoimmunity, they found patients, most of them, were Th1 dominant. When they treated them with antithyroid drugs, the number of Th1 went down the number of Th2 went up, and therefore more balance between Th1 and Th2. And that shows that the treatment that the doctor gave to that patient was working for that specific patient.

Dr. Weitz:                            So this was patient with Grave’s, right?

Dr. Vojdani:                        Yes.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        The same thing, I’m not really going to read this again, in rheumatoid arthritis, Th17 dominant, they claim that methotrexate brought down the number of Th17 and there some publications in scientific journals that I read about, and this is one of them.  I read more multiple sclerosis, Th1 and Th17 dominant. Why? Because these are, remember, the hybrid cells. These cells, under inflammatory condition, have the capacity to break down the blood-brain barriers and get into the brain area, cause inflammation in the brain, resulting in neuronal cell death that result in multiple sclerosis and in some cases, even in Alzheimer’s and Parkinson’s disease. So when they put them on medication, they could bring down the number of Th1 and Th17. And the patient did not have relapse for a long period of time.

The same story about scleroderma and lupus, mainly Th17 and also Th1 and Th2. After treatment, they saw significant improvement in the patient’s condition by doing the lymphocyte immunophenotyping. Psoriasis also, when they were treated with Anti-IL 17, that’s a new medication that they block production of IL17, by so-called Th17, but other cells also producing IL17, they could see significant improvement in inflammatory condition in patients with psoriasis. In relation to COVID, already talked about that those who had low lymphocyte and T cell subsets relatively did not survive the disease. And many of them passed away in the hospital, unfortunately.

So this is the proof of concept that lymphocyte immunophenotyping and treatment, where if works, we can see that by follow up testing with lymphocyte immunophenotyping. So now I’m going to share with you few flowers. Okay. So you see the lymphocyte. I said that 25% that tests that come to Cyrex, they have low lymphocytes. How can we increase that? All of these are in here, but none of them can get close to this and this. Exercise and good nutrition.  At least, three or four articles published in science or nature that showed that exercise increasing production of growth factors that enhancing production of different lymphocytes. And of course, good nutrition. And therefore, I’m not going to read all of this. Okay. Because we don’t have time to go through each one of this.

Next, B cells. We have only few items, but definitely probiotics and specifically Lactobacillus Casei. IgG, this one. So you see lactobacillus, lactobacillus, DHA, fish oil, beta glucan, curcamine. So all these can increase the number of B cells, which is very important.

Next, CD4 cells. IVIG, vitamin D, again fish oil and many others. CD8, so unfortunately we have only few, and BCG vaccination is one of them. And by the way, BCG vaccination also is protective against COVID, because BCG shares homology with SARS-CoV-2. Peanut agglutinen, it’s only one publication. And again, vitamin D. So vitamin D is really the most important molecule. DHEA, five milligram per day.

Look at Th1. Monoclonal antibodies, there are medications, corticosteroids, you have dexamethasone and metformin. The rest are fish oil, zinc, vitamin D, green tea, fish oil again, resolvins, polyphenols, curcumin, bromelain are instrumental in bringing down the activity of Th1.

Th2, you’ll see sometimes the same item may be in both. Why? Because sometimes the issue is immune regulation. They regulate the immune system and therefore, back to balance. So these are, again, you’ll see vitamin E probiotic, zinc, fish oil and many others.

Treg cell is one of the most important one that you should take care of in patients with autoimmunity. So here IVIG, azithromycin. It is enhancing the activity of Treg cells. Chloroquine, if I’m allowed to mention today also increasing the activity of Treg cell. Dexamethasone, and of course, indole-3-carbinol, short-chain fatty acid, L-arginine, DHA, astragulus, Quercetin, berberine, curcumin, lactoferrin, you’ll see that all these factors can regulate the Treg cells and bring down or back to balance Th1 and Th2 imbalance.

Th17 again, chloroquine, IVIG, dexamethasone, metformin and the other factors. But again, remember sodium chloride is increasing, not decreasing the number of Th17 and increasing their activities also to produce more IL17.

So now sub item in the almost was everywhere, correct? So now I would like to share with you the article that I read yesterday in nature immunology, roll of the T-cell vitamin D receptor in severe COVID-19. And they showed that giving vitamin D can bring down the activity of Th1 and increasing the Trx cells, bringing down Th1 and Th17. And so therefore should be recommended for patients with COVID-19. And this is the cover of nature immunology. So bear with me for a few seconds.

So CYP24A1 is a gene that provides instructions for making an enzyme called 21-hydroxylase, the blue. This is the enzyme, this is the vitmain D. Correct? So this enzyme help to convert vitamin D to di-hydroxylated vitamin D. And di-hydroxylated vitamin D get into the nucleus and down regulate Th1 and Th17 and that’s in the next slide. Okay?

So in individual with vitamin insufficiency, T-cell become over activated and they do suffer from inflammation. And if we do not correct that individual may end up with autoimmune disease. Because they produce lots of IL17, because Th17, IL22, interferon gama, they produce less IL6 and IL10, which IL10 is regulatory cytokines. Now we give vitamin D to these patients and they become vitamin D sufficient. So vitamin sufficient, they produce less the cells.

Dr. Weitz:                            Somebody asked is it –

Dr. Vojdani:                        Less IL17, they produce less IL22, they will produce less interferon gama, but will produce more IL6 and IL10. And these cells in the presence of vitamin D can resolve inflammation. This is the message of this article from nature immunology. Did you have any question?

Dr. Weitz:                            Yeah. One of the questions is, it’s common in the functional medicine world that we typically prescribe vitamin D with vitamin K2. In this context, is that also important?

Dr. Vojdani:                        I personally take vitamin D with vitamin K and they do not mention in this article, but other articles discuss the importance of additional vitamin K to vitamin D. Thank you for asking that.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        So that is very well accepted.

Dr. Weitz:                            Also, are you able to share your slides with us and if not, can we get a list of these nutrients that work with these different factors?

Dr. Vojdani:                        Okay. I can provide you with a list of references.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        By the way, for each one of these, I have between two to five, sometimes 10 different articles. For example, resveratrol, I can name 10 different articles that can activate natural killer cells. For example, for some, I have one or two. Some I have five, some I have 10, so I can share with you definitely. The references is better that way.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        Because I’m not promoting any product in here.

Dr. Weitz:                            Right.

Dr. Vojdani:                        But references definitely you can share with audience. Tomorrow morning that will be the first thing I’ll do for you.

Dr. Weitz:                            Great. Thank you.

Dr. Vojdani:                        So natural killer cells. Again, I did work with vitamin C 500 milligram to 1000 is the most ideal, but there are others, including ashwagandha, medicinal mushrooms, astragalus, all of them can increase the activity of natural killer cells.  So now in the last few slides, I really would like to bring your attention to this fascinating article published in Journal of Immunology. It was so important that the editor in chief wrote some review article about all of this. So they emphasizing the importance of microbiome. Remember in my second slide, environmental factors, plus the gut microbiota, the bad microbiome may contribute to all autoimmune disease, but here they emphasize the importance of good microbiota and recommending very strongly to use prebiotic and probiotics. Why? The mechanism is right here. Let’s look at why you have to have one apple a day. So you see the picture of the apple, right?  It has lots of inulin, which makes good microbiome to produce short-chain fatty acids, such as butyrate rate and that butyrate rate activate Trx cell and inhibiting the inflammatory cells. This is one example. Liver, colic acid, gut microbiome can change that to deoxycholic acid. Again, deoxycholic acid activate Trx cell and inhibit. First of all, inhibits macrophages, but improves or enhances gut barrier function, which is the root cause of many autoimmune diseases. That’s why detoxification is so important. And again, the reference is right there. This is in journal of immunology about three months ago.

The third one in is the tryptophan that they took it out of the market years ago, unfortunately, but food containing tryptophan is metabolized by the gut microbiome, production of indole and indole derivatives by the gut microbiome and again inhibits, like Th17, but enhancing the gut barrier function. So therefore the importance of probiotics, prebiotics, vitamin D and other nutritional supplements for patient who may have abnormal lymphocyte map. So let’s conclude that what disorders so far based on the articles that I read in scientific journals could be associated with abnormal lymphocyte map, multiple chemical sensitivity, chronic fatigue, fibromyalgia, cancers, asthma, allergy, hypersensitivity, variety of autoimmune diseases, all the way to here psoriasis, phospholipid syndrome, diabetes, multiple system atrophy, uveitis, heart disease, including cardiomyopathy, Alzheimer’s, Parkinson’s, schizophrenia. And also I have read this article about recurrent pregnancy loss, especially when they have too many natural killer cells, especially NKT cells, and then also COPD, and of course COVID and other infections.

So the last two slides in conclusion, I would like to summarize again, why is so important to measure immunity with lymphocyte map? Because the immune system is our homeland security. It is our policeman, our police department. It is our army that is protecting us against many environmental factors. And these are the environmental factors and abnormalities of the immune system. Down the road can lead to immune disorders, auto immunities and immune deficiencies. And quantitative and qualitative changes in the composition of lymphocyte subsets provide an opportunity for the early detection and prevention of many immune disorders that affect one out of three Americans. And finally, I would like to emphasize the importance of personalized immunity for personalized medicine. So it is important to look at lymphocyte map and based on abnormalities in lymphocyte map to provide the patient with personalized medicine.  Hopefully that personalized medicine will take care of abnormalities of their lymphocyte map. And so finally, finally, I would like to emphasize that and go back to that slide from science that individual with hypoactivation of the immune system should be treated differently than the one with hyperactivation of the immune system and with the one even they don’t have any abnormalities of the immune system.  And with that, thank you so much. And I’m ready to answer any question if you have.

Dr. Weitz:                            So that was excellent, Dr. Vojdani. So my first question is, let’s say a patient comes into your office and they already have autoimmune disease. Let’s say they have rheumatoid arthritis or some other autoimmune disease. And we know that we have toxins, food sensitivities and infections that can trigger autoimmunity. And now we know that these immune imbalances can be factors. If we were going to decide what to do first, would it make sense to address food sensitivities, infections, toxins, or would we want to try to balance the immune system first?  What would you think a reasonable clinician should do?

Dr. Vojdani:                        I will answer your question a little bit differently, but I will answer also that specifically. A patient is coming to you for the first time. Where do you start? And that’s the question. Some start with array 2, which they do measure the integrity of gut barriers. Some start with the lymphocyte map, but I will start with lymphocyte map and looking at the barriers. Because the barriers plus lymphocyte map can guide me to the environmental triggers, which causes some of these abnormalities. In one person could be food, in one person could be toxic chemicals, in another person could be pathogen and in some could be all the above. So that’s how I will start.

Dr. Weitz:                            So somebody asked, if we’re treating their immune imbalance based on lymphocyte map, are we treating the root cause? Are we treating a downstream effect of say food sensitivities or toxins?

Dr. Vojdani:                        You are not treating the root cause, unfortunately. You are treating the results. Hopefully after lymphocyte map also you’ll get to the root cause of the problem. Because, let’s take example, your patients is reacting to lectins and agglutinins. They could not or they cannot digest lectins and agglutinins, especially wheat germ agglutinin and phytohemagglutinin, which is produced by beans, kidney beans example. If they don’t digest that and they make antibodies against these agglutinins, those antibodies cross react with thyroid for oxidase and causing thyroid autoimmunity. Unless you remove that food from the diet of the patient until the gut barriers are repaired. Until you provide digestive enzymes to that patient, make sure that undigested molecules in this case, lectins and agglutinins will not get into the blood of the patient.

Dr. Vojdani:                        And patient will not make antibody against that regardless how much the patient’s Th1 and Th17 is abnormal. If you don’t take care of the root cause still six months later, some of these may go back to square one where we started.

Speaker 1:                          Dr. Vojdani, how often do you find that people test positive to antibodies to lectins to more than one lectin?

Dr. Vojdani:                        I would say about 20% of the cases.

Speaker 1:                          Okay. Thank you.

Dr. Vojdani:                        Welcome.

Dr. Weitz:                           Now, Dr. Vojdani, what do you think could be the best marker for, let’s say we’re treating a patient with autoimmune disease. From a functional medicine approach, we’re trying to get to the root cause. Let’s say they get whatever treatment they need maybe for symptoms, but we’re trying to get to the root cause. What is the best marker that we’re treating the underlying auto immunity? Is it, can we expect autoimmune antibodies to go down? Can we expect the lymphocyte map test to improve? What do you think is the best way for us to know show objective progress, not just say on the fact that their TSH is normal, but that we’re getting to the underlying autoimmune process?

Dr. Vojdani:                        I have no doubts that we have to look at both, the antibodies and also the lymphocyte map. Because in many autoimmune diseases, both antibodies and cell-mediated immunity play a significant role. So you have to look at antibodies and you have to look at lymphocyte map in order to find whether or not your treatment made a difference in the life of your patient.

Dr. Weitz:                           So do we have good data that say, for example, antibodies going down correlates with, say less likelihood of destruction of their thyroid on a long term basis?

Dr. Vojdani:                        I think there are lots of articles in the literature and also in relation to lymphocyte map, I will show three or four slides towards the end of my talk.

Dr. Weitz:                           Okay, great. So both those could be measures of -?

Dr. Vojdani:                        Yes.

Dr. Weitz:                           Great. Okay. Any other question? How often should we retest for this patient’s evaluation with a lymphocyte map, say?

Dr. Vojdani:                        You can learn from my test after COVID between three to six months. Because cell-mediated immunity, for example, we have abnormal Th17, is not going to change overnight. The same thing for Th1 and others. They’re not going to change overnight. When you make intervention, wait, please, at least three months, but even I will recommend six months and then repeat the test.

Speaker 1:                          Dr. Vojdani, when you’re talking about cholic acid, we’re basically talking about bile acids, is that correct?

Dr. Vojdani:                        Yes.

Speaker 1:                           So it sounds like it’s important for us to make sure that our patients bodies are producing bile acids adequately.

Dr. Vojdani:                        Yes. Correct. Thank you for mentioning that.

Dr. Weitz:                         Okay.  Okay, great. We’re going to wrap it there unless there’s any final questions. That was a fantastic presentation, Dr. Vojdani. Thank you so much for the information.

Dr. Vojdani:                        My pleasure, and tomorrow I will send the references.

Dr. Weitz:                           That’s great. I can’t wait to take my lymphocyte map test. Okay. Thank you everybody and we’ll see you next month.

Dr. Vojdani:                        Bye-bye.

Dr. Weitz:                          Thank you.



Dr. Weitz:                            Thank you for making it all the way through this episode of the rational wellness podcast. And if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way, more people will be able to find this rational wellness podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few of openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Dr. Ben Weitz. Thank you and see you next week.



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