Clinical Use of Immune Testing with Dr. Elroy Vojdani: Rational Wellness Podcast 249

Dr. Elroy Vojdani discusses the Clinical Uses of Immune System Testing with Dr. Ben Weitz.  You might consider this a follow up podcast to the presentation by Dr. Aristo Vojdani in episode 244 where he explained the new immune system test that he developed for Cyrex Labs called the Lymphocyte Map test.  

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 


Podcast Highlights

3:15   The Lymphocyte Map test is a technological leap in the ability to understand the current state of the immune system.  Prior to this test, the only way to measure immune system imbalance is through measuring cytokines, which are the chemical messengers that these immune cells release. But the Lymphocyte Map test directly measures the different type of lymphocytes, including the amount of Th1, Th2, Th17, natural killer cells, etc.

5:09  Two of the best times to use this test is for patients with autoimmune and inflammatory conditions and also when there is immune dysfunction and mitochondrial dysfunction associated with aging.  As an example, Dr. Vojdani may have a patient come to see him with some vague symptoms like joint pain, brain fog, gut issues, etc. and he may discover that they have some sort of autoimmune disease, like rheumatoid arthritis or lupus or ankylosing spondylitis and then the challenge is how to make this patient feel better and to arrest the disease process. You start working on discovering and modifying the root causes and then the Lymphocyte Map will give you a different picture that is complementary to the root work. It lets you understand exactly what sort of immune imbalance is occurring and provides some clues for interventions to modify things while the longer term root work is occurring.  It gives you an opportunity to improve patients in a shorter time frame.

7:40  With the Lymphocyte Map test we can identify the particular proinflammatory subtype of immune imbalance, which has typically been there for a long period of time prior to the onset of the autoimmune disease.  You can see how much of a Th1 or a Th17 or a natural killer cell problem do we have. You can also get a sense of whether this condition will be amenable to diet, lifestyle, and nutraceuticals, or will medications be required?  If someone has a Th1 or Th17 that is beyond the detectable levels, there’s not a lot that diet and supplements can do.  On the other hand if they are 20% or even 40% elevated, as long as you choose the right targeted nutraceuticals and improve diet and lifestyle, you definitely improve them.

10:47  The two main branches of T cells are CD4 and CD8 suppressor and helper cells.  The three main branches of CD4 include Th1, which are responsible for killing different pathogens and play a role in autoimmune disease, Th2, which are responsible for allergies, and Th17, which is responsible for specific intracellular pathogens, like stealth infections.

13:02  If you are treating a patient who has an autoimmune disease, such as rheumatoid arthritis, and who is on an immune modulating drug, such as methotrexate or hydroxychloroquine or Humira, the Lymphocyte Map test can provide some very useful information that the rheumatologist didn’t know it was possible to get.  You can find out if that dosage of that drug is actually doing what was intended to modulate the immune system without over suppressing it.  Humira is the number one drug in the US and it is a monoclonal antibody against TNF alpha, which is a very broad proinflammatory cytokine.  Rheumatologists are typically prescribing the amount they expect will help and then raise it if needed to control symptoms, but they don’t really know if it is the correct amount, other than symptoms.  They are flying relatively blind.  Now, with this Lymphocyte Map test we can see if they are not taking enough or if they are taking too high a dosage and the patient is in danger of being immunocompromised.  If you take someone with a massive amount of T cells and they go to zero T cells, then they are vulnerable to a virus or cancer, so this is not in anyone’s interest.

20:02  Long COVID.  Figuring out exactly what long COVID is is a work in progress and probably will be for the next 5 or 10 years. Long COVID is probably many things and each individual appears to have their own version of it, but there is without doubt an autoimmune version and an inflammatory version. The inflammatory version may have dramatic imbalances of Th1, Th2, and Th17 that don’t resolve the way a virus normally would. We don’t yet know if this is because there is a stealth component with some lingering amount of SARS-CoV-2 virus still in the body. But we can identify that there is a proinflammatory T cell imbalance and then try to push them in the right direction and see clinical resolution of their symptoms.  A T cell imbalance such as a proinflammatory Th1 and Th17 dominance is also often an indicator of a mitochondrial imbalance, since the mitochondria communicate directly with the T cells and there are really no direct reliable markers of mitochondrial status.  And we know that there is often a mitochondrial component of long COVID with symptoms like fatigue being very common.

26:44  Dr. Vojdani discussed a patient with long COVID, who got sick during the big winter wave of COVID in Los Angeles in 2021 before vaccines were available and he was experiencing chronic digestive issues, almost like a post-infectious IBS, as well as significant fatigue, esp. morning fatigue, and brain fog. The leaky gut workup was negative as was the blood brain barrier testing. Adrenal testing was also normal.  A Lymphocyte Map test, however, showed massive elevations of Th1 and Th17. He gave the patient a blend of anti-viral supplements and he tried to counter the Th1 dominance by pushing the TReg cells, which included serum bovine immunoglobulins, short-chain fatty acids, large amounts of probiotics, including spores.  On the antiviral arm, he had a low natural killer cell count, so he used andrographis, L-lysine, vitamin C, Monolaurin, and olive leaf extract.  He also gave him a peptide, BPC-157 for healing the gut.

31:18  The Lympocyte Map test can be helpful for managing patients with autoimmune diseases. Dr. Vojdani has a patient who had a long history of joint disease who was seen by a number of doctors and given different diagnoses because most of her tests were negative.  When Dr. Vojdani worked her up she had intestinal permeability, she had strong antibody response to multiple mold species, and her Lympocyte Map test showed extreme elevations of Th1, Th2, and Th17, indicating extreme aggressive T cell activation. While Dr. Vojdani worked with her on lifestyle factors, to clear mycotoxins, heal her gut, but he also called her rheumatologist, who prescribed Humira, which after three months balanced her T cells.  Her T cells were so highly activated that no natural approaches would have worked and Humira makes more sense.



Dr. Elroy Vojdani is the founder of Regenera Medical, a boutique Functional Medicine practice in Los Angeles, California. Dr. Vojdani began his medical career as an Interventional Radiologist, diagnosing and treating complex, late-stage cancers and other extremely debilitating diseases but wanted to prevent these chronic conditions, so he embraced Functional Medicine and went into private practice. Dr. Vojdani has coauthored over 40 articles in the Scientific literature and he continues to play an integral role in research related to Autoimmune, Neurodegenerative, and Autoinflammatory conditions. Elroy has just published his first book, When Food Bites Back and his website is RegeneraMedical.com.

Dr. Ben Weitz is available for Functional 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. To learn more, check out my website, drweitz.com. Thanks for joining me. Let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Today I’m excited to be speaking with Dr. Elroy Vojdani about a new test called the Lymphocyte Map test. The Lymphocyte Map test is a new test by Dr. Vojdani and his father, Dr. Aristo Vojdani, to determine specific immune system imbalances. Dr. Aristo Vojdani spoke to our functional medicine discussion group in January and informed us about this exciting new test.  This is Rational Wellness episode number 244, if you want to go listen to that. If you want to see the presentation, you can go to my YouTube page, Weitz Chiro. We’ve known that patients with autoimmune diseases often have immune system imbalances, but it wasn’t so easy to find out exactly what these imbalances were. Now we have one test that can help us to really understand this.  This Lymphocyte Map test helps us understand what specific lymphocytes are elevated or depressed. Then we can take specific diet, lifestyle, and nutritional supplements to change them, hopefully in a positive direction.

While Dr. Aristo Vojdani gave us a lot of detail of what this test is, since he’s a researcher, not a clinician, this is why I wanted to speak with Dr. Elroy Vojdani to help us with some clinical insights for how functional medicine practitioners like myself might utilize this new test offered by Cyrex in clinical practice.  Dr. Elroy Vojdani is the founder of Regenera Medical, a boutique functional medicine practice in West Los Angeles, California. Dr. Vojdani began his medical career as a interventional radiologist diagnosing and treating complex late-stage cancers and other extremely debilitating diseases, but he wanted to prevent these chronic conditions so he embraced functional medicine and went into private practice.  Dr. Vojdani has co-authored over 40 articles in the scientific literature, probably more than that. He continues to play an integral role in research related to autoimmune, neurodegenerative and autoinflammatory conditions. He just released a new book, When Food Bites Back. Elroy, thank you so much for joining us.

Dr. Vojdani:                        It’s my pleasure to be here, Ben.

Dr. Weitz:                           To begin with, for those who perhaps have haven’t listened to the other podcast, can you explain what the Lymphocyte Map test is and why you and your dad developed this test?

Dr. Vojdani:                        Yeah. Lymphocyte Map testing represents a technological leap in the ability to understand the current state of the immune system. Essentially what we’re doing with this test is tagging and quantifying all the different branches of the adaptive immune system. We’re getting information about B cells, T cells and more specifically their subtypes and also natural killer cells.  Not only are you seeing quantification, but you’re also seeing balance and ratios, and the immune system really thrives on relationships between different populations of cells. This is really the first time that you get a hands-on objectively quantifiable look at the immune system.  Prior to this, getting a sense of where immune system balance came from was all done by looking at cytokines, so chemical messengers. The problem with chemical messengers is that they go up and down quite a bit over time, and they’re not specific to any particular branch. As we’ll get into, there was a lot of discussion in the past about Th1 and Th2, Th17 subtypes of CD4 T cells, which are incredibly important T cells.  We never really had a way to say, “Well, how much Th1 is there? How much Th2 is there? How much Th17 is there?” You would only be able to look at the intermediary chemical signals, which were not specific to that branch. Now we get to go to a specific direct quantification, and with that specificity we have a lot more power.

Dr. Weitz:                            Okay. Great. When would we use this type of test in a functional medicine practice? Considering that most functional medicine testing is out of pocket and trying to be judicious as possible with our patient’s out-of-pocket costs, is this a test that we would use for routine screening for patients? Is this a test that we’re going to use more specifically with patients who already have existing autoimmune disease? When’s the most judicious use of this test?

Dr. Vojdani:                        I break up that into two big buckets. Bucket number one is the autoimmune inflammatory bucket, which is a big part of what comes to us in the functional medicine world. Then let’s talk about Lymphocyte Map testing in another very popular bucket, which is immune dysfunction associated with aging, or maybe even mitochondrial dysfunction. Those are the two main areas where I find this very useful.  I’m not using this as a screening tool. I think this is meant as when you’ve done the work, you know what’s going on with the patient, or you have some suspicion as to what their underlying issues are. You now go to that next step of quantifying specifically where the immune function is so that you know specifically where can you can rebalance things.

A very good example for patients that typically come into my practice, they’ve got these vague symptoms, joint pain, brain fog, insomnia, gut issues, some of the usual things that we find. Sometimes as you’re working that patient up, you’ll discover that they have a known … or they have a direct autoimmune disease. They’re planting their flag in the ground.  They have lupus, or they have rheumatoid arthritis, or they have ankylosing spondylitis. Okay. Well, you’re making a disease diagnosis there and that doesn’t really stop you from doing the work that you really were intended to do. Now, you need to say, “Well, what am I going to do to make this person feel better? How am I going to balance their immune system?”  Of course, in functional medicine, we’re looking quite a bit at the root which is incredibly important. To me, the Lymphocyte Map gives you a different picture. It gives you the picture of today. It complements that root work and gives you an opportunity or a window to clinically improve them in a shorter timeframe while the root is taking its time to do the work.

Dr. Weitz:                            Okay. Let’s say we have a patient with some sort of inflammatory or autoimmune condition, let’s say we see a significant imbalance on a Lymphocyte Map test, do we know if that is a result of their inflammatory or autoinflammatory condition, or is that one of the causes?

Dr. Vojdani:                        I think you’re asking is the proinflammatory immune subtype the thing that leads to the autoimmune disease, or does the autoimmune disease lead to the proinflammatory subtype?

Dr. Weitz:                           Correct.

Dr. Vojdani:                        Right. The proinflammatory subtype typically leads to the autoimmune disease. You can imagine if let’s say their Th1, Th17 elevated, they’ve been that way for five or 10 years. Yeah. I think that’s the really important thing about autoimmune, is it requires that proinflammatory subtype for a very long period of time.

Dr. Weitz:                            Yes. Then, do we know if we take some of the interventions that might be effective at modulating the immune imbalance, let’s say we’re lowering Th17 and maybe increasing Treg cells using certain nutritional supplements, diet, exercise, do we know if that will affect the autoimmune condition?

Dr. Vojdani:                        Yeah. I think this is where the personalization of this immune workup really comes into play and really where it shines the most. Let’s say you’re working somebody up, you discover that they have an autoimmune disease, or they had an autoimmune disease prior to coming into you, you want to be able to have some discussion about what you can do to help them with their symptoms set.  Then the first thing that the Lymphocyte Map or immunophenotyping test is going to do is tell you what areas should you be looking into. Then, because you’re getting a quantification, you’re not just getting a qualitative output, you’re seeing on the scale how much of a Th1 problem do I have? How much of a Th17, how much of a Th2, how much of a natural killer cell problem do I have?  You can get some sense of how much of this is within my grasp and how much of this is not? I think those are very important distinctions. You can kind of give yourself a window into the three or six-month future that person and guide them very much as to what they can expect.  If you have somebody who is beyond the upper limits of detection limit for Th1 and Th17, as much as we think that we can make dramatic improvements, there’s not a lot that diet and supplements are going to do. On the other hand, if they’re 20 or 30 or 40% elevated, as long as you use the right targeted nutraceuticals, while also working on lifestyle, you can absolutely make that style of change.

Dr. Weitz:                            You mentioned Th1 and Th17, for those who aren’t aware is those are particular lymphocytes that tend to be associated with proinflammatory conditions.

Dr. Vojdani:                        That’s correct. These are all subtypes of CD4 T cells. Let’s break up T cells into their two most important branches. We’ve got CD4 and CD8 suppressor and helper cells. The CD4s have three big branches, Th1, Th2 Th17. Th1 is responsible for killing of different organisms and as well autoimmune disease. Th2 is the allergic part of the T cells. Then Th17 is responsible for a specific intracellular type of pathogen, a difficult to find, or maybe a stealth pathogen.

Dr. Weitz:                           Interesting.


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Dr. Weitz:                            Now, a typical Functional Medicine practitioner, say like myself, I may have a patient come in, say with rheumatoid arthritis, who’s being co-managed by a rheumatologist and let’s say, they’re on methotrexate, or they’re on some other immune-modulating drugs. I heard your dad say that methotrexate will help to change the Lymphocyte Map.  Then I run a Lymphocyte Map, how do I interpret that in a patient and who has autoimmune disease, but who is also taking immune-modulating drugs?

Dr. Vojdani:                        All right. This is, to me, a huge golden opportunity to make an intervention on that patient that they otherwise would never have and an opportunity to give the rheumatologist data that they didn’t know was possible to get.

Dr. Weitz:                            Both.

Dr. Vojdani:                        Both the patient and the rheumatologist will thank you for this. All right? What you’re really looking for, for somebody who’s on methotrexate or hydroxychloroquine, or whatever first-line immune-modulator is how successful has it been? Right? Is it creating balance between Th1, Th2, Th17 or on the flip side, is it may be overcorrecting and creating imbalance on the other end?  What you need to remember is that when we, as physicians, rheumatologists, whoever, are prescribing this medication, oftentimes it’s relatively blind. You’ve got a diagnosis of the autoimmune disease. You’ve got the clinical features. Maybe you have some basic blood work, but you don’t have these specific Lymphocyte Maps done.  You’re saying, “Well, for the majority of people with this clinical condition, methotrexate at this dose works, and if it works at this dose, let’s go up a little bit until we get to wherever.” Right?

Dr. Weitz:                            See an improvement of symptoms.

Dr. Vojdani:                        Exactly. You don’t know if that means immunological balance, homeostasis. You can look at the Lymphocyte Map and say, “Well, no, we still have quite a bit to go, or the methotrexate isn’t really touching this or you know what? We’ve actually created a bigger imbalance than we started with on the flip side.”

Dr. Weitz:                            Right. Meaning you’re now putting the patient in an immunocompromised situation, in which case, if they happen to come into contact with some virus-

Dr. Vojdani:                        Exactly.

Dr. Weitz:                            … or some other pathogen they’re particularly vulnerable.

Dr. Vojdani:                        Exactly. Let me take that and run with it a little bit because these are specific experiences that I’ve actually had with patients in interacting with rheumatologists. Humira is the number one drug in the United States, has been for quite a period of time. For those who don’t know what Humira, it’s a biologic. It’s essentially a monoclonal antibody against TNF alpha, a very, very broad proinflammatory cytokine.  Starting with rheumatoid arthritis or ankylosing spondylitis, or going down the chain, it gets used in more and more and more autoimmune diseases as time goes on because it’s incredibly effective because it’s working on this very, very central proinflammatory cytokine. The theory behind makes a lot of sense because typically people with these dramatic autoimmune conditions have humongous amounts of Th1, Th2, Th17.   The only way that you’re going to get them under control is by using something that blocks the chemical signal. But no one is doing follow-up afterwards to make sure that you haven’t bottomed out the immune system in its entirety. If you take somebody with this massive, massive amount of T cells, and then they go to zero T cells, they’re going to have a problem down the road, right?

Dr. Weitz:                            Right.

Dr. Vojdani:                        T cells are responsible for viral clearance, as you mentioned, they’re also essential for cancer clearance.

Dr. Weitz:                            If you’re trying to develop antibodies to protect you against a virus, it’s going to significantly impact the likelihood of that occurring.

Dr. Vojdani:                        Exactly. If you want to know, is this person really immunosuppressed on Humira? The only way to look is to do a Lymphocyte Map and find out Th1, Th2 Th17. You have done again, everyone a service, including the rheumatologist who is theoretically prescribing the Humira there. Maybe they can make dose adjustments.  Maybe they could figure out another solution, but clearly it’s in no one’s interest to be T cell depleted. That’s not the goal. Until this test, you could never look. You had no idea.

Dr. Weitz:                            Cool. Let’s say you had a patient, let’s pick an autoimmune condition. Maybe you can tell us about a case and maybe a case of rheumatoid arthritis or whatever, pick an autoimmune condition. Then let’s say you work them up. Would you run this test at the beginning?  In a functional medicine approach, let’s say the patient’s already diagnosed by a rheumatologist with a particular autoimmune condition. Let’s say rheumatoid arthritis. They came in to see me. I would start looking for what might be some of the underlying inflammatory triggers. Based on her history and any other testing she’s had done, we’d want to consider, does she have food sensitivities?  Does she have some issue with toxins? Are there underlying chronic infections? What’s her gut health like? I might run a stool test. I might run panels to look for possibilities for food sensitivities or toxins or infections. Where would the Lymphocyte Map test fit in? Would this be done as part of the initial screen or maybe second line or after we’ve worked on some of the root causes?  Where in a package of investigation would you think it would make the most sense in that type of a scenario? Maybe you can tell us about a case that you’ve had.

Dr. Vojdani:                        Yeah. I think for probably the majority of cases that come through the doors, it’s going to be used as a troubleshooting tool when you’ve worked on or looked at the basics or worked through what you expected you needed to work through and then maybe you find yourself up against the wall. You need some specific information to get you through to the next step. That’s probably, to me, the primary use for using a Lymphocyte Map, right?

Dr. Weitz:                            Okay.

Dr. Vojdani:                        I’ll give you examples of where I’ve used Lymphocyte Map in those situations. Actually long COVID tends to be one of the areas where I look at this the most.

Dr. Weitz:                            Oh, great. I’d love to talk about long COVID because a lot of people realize that there’s often … I don’t know, always, but at least often an autoimmune component. Then how do we work that up?

Dr. Vojdani:                        Yeah. Long COVID still, although we should say for everybody is a work in progress. There’s probably for the next five or 10 years endless amounts of work that are going to be done to try to really figure out what long COVID is. I think in reality long COVID is probably many, many, many different things and each individual’s going to have their own version of it. There is an autoimmune version of long COVID without doubt.  I mean, there are papers that have come out, out of Cedars. Then my dad and I have a paper coming out very shortly, hopefully in a very big journal that we just submitted to looking at the autoimmune propagation that occurs after COVID, but that’s not true for everybody who has long COVID. There also is this-

Dr. Weitz:                            What do you think about some of the other causes besides autoimmune?

Dr. Vojdani:                        I think they could strictly be proinflammatory as we’re talking about Th1, Th2, Th17 imbalances, but very dramatic versions of those imbalances and very dramatic versions of those imbalances that don’t self-resolve as a virus normally would.  The question I think is, is that because there’s a stealth component to some lingering amount of SARS-CoV-2 in the person’s body? Or, is that just because they had a bunch of inflammatory issues prior to their infection and now their inflammatory cytokine storm or response is just propagating on its own? Those things we don’t really know, but to me there’s an autoimmune bucket and then there’s this proinflammatory T cells imbalance bucket.  The only way you’re going to know essentially which one of those you’re dealing with is to test. In today’s world with so few tools for long COVID, doing something that’s very detailed, but basic, as far as an immune system is concerned, like doing a Lymphocyte Map, gives you that information hands on like, “Hey, what is happening to this person’s T cells, they’re three months, six months out from the infection, they should have rebalanced, but all of a sudden this is up or this is down.”  You can put your hands on those imbalances and try to push them in the right direction and see clinical resolution of the symptoms along the way.

Dr. Weitz:                            A number of patients have either clotting or cardiovascular aspects to this, would that fit into one of those two buckets, or would that be a third bucket?

Dr. Vojdani:                        That fits into the proinflammatory side?

Dr. Weitz:                            Okay.

Dr. Vojdani:                        I think that the clotting, endothelial activation, that’s all a proinflammatory portion of this, I think.

Dr. Weitz:                            Would the Lymphocyte Map be beneficial in those proinflammatory conditions?

Dr. Vojdani:                        That’s I think where you’ll find that if you do a bunch of testing before that comes out negative, let’s say you’re doing an ANA and you’re doing all of these antibody tests to try to find out if there’s an autoimmune component, comes back negative. All of a sudden you see a very positive Lymphocyte Map, you say, “Oh, aha, that’s the problem.” You know?

Dr. Weitz:                            I see.

Dr. Vojdani:                        Let’s not forget that there is a very large mitochondrial component with long COVID. The interplay between mitochondria and T cells is very intimate. Kind of going back to one of the first things we talked about, what are the two buckets where I use Lymphocyte Map? The second standard non-COVID bucket where I use it is in the overlap between aging and mitochondrial dysfunction.  That’s because the mitochondria themselves communicate directly with T cells. When there is mitochondrial damage, the T cells will actually transform themselves into a proinflammatory state. We don’t have, in my opinion, very good testing for the state of the mitochondria.  I mean, there are some labs that dabble in this and try to do it, but I mean, in reality, really reliable mitochondrial status markers are not available. If you go to the part of the body that communicates directly with the mitochondria, which are T cells and see the imbalance there, you can make inference that the mitochondria themselves are damaged too.

Dr. Weitz:                            How do you identify these patients as potentially having mitochondrial issues? Is it based on the fact that they have unexplained fatigue or?

Dr. Vojdani:                        Yeah. I have a long clinical screening process with them to try to quantify the extent of the fatigue. I think you also probably have to rule out other common contributors to fatigue, difficulty sleeping, adrenal fatigue, whatever you want to go through. Essentially if they have the T cell makeup of somebody with mitochondrial issues, which is by the way, Th1, Th17 dominance, proinflammatory response and there are clinical symptoms that matches that, then you know that the mitochondrial issues are there.


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Dr. Weitz:                            Tell us about a case of a patient you had with long COVID. What did you find and what did you do for them?

Dr. Vojdani:                        This was a case that came very early on, I think when Lymphocyte Map was first available. I think we’re talking probably around summer of last year, that would be July or August of 2021 for those that are watching the podcast later. Individual had had COVID during the big LA wave of winter. We had our own Alpha LA variant here. We had a very big winter surge. Lots of people were infected.  Nothing like Omicron, but definitely a very big winter surge at the time and vaccines weren’t available yet. There were a lot of COVID injuries that happened at the time. He was experiencing chronic digestive issues, so almost having like a post-infectious IBS picture, but this time related to a viral infection, very significant fatigue, predominantly morning fatigue, so feeling like they could never really get out of bed no matter how much they slept.

Then brain fog, this kind of cognitive issue that comes from long COVID was still lingering. This was six or seven months following the infection. The issues were still there. At the time I did my usual workup. My dad and I six months earlier had released a paper looking at COVID antibodies, having an issue with zonulin. Did the leaky gut workup, did the blood brain barrier workup on them. Nothing.  Everything looked totally normal, especially with the gut issues. It seemed quite strange to me. Adrenal testing was normal, surprisingly, and then I did a Lymphocyte Map and some massive, massive elevations of Th1 and Th17 for the patient. He’s in his 30s so it was very unusual to find that, especially six months after the infection.  I gave him a blend of different antiviral supplements, and then also looked to try to counter some of the Th1 imbalances by pushing the Treg cells themselves, so I went very gut-heavy. I did serum bovine immunoglobulins, short-chain fatty acids, large amounts of probiotics. I also used spores on him as well too. That to me was the Treg portion to try to push the Th1/Th2 balance back to where it should be.

Then on the antiviral arm of the immune system, he had a low natural killer cell count so I used andrographis, and then I gave a lot of L-lysine, vitamin C, Monolaurin and olive leaf extract. We did that for, I think maybe two or three months. By the end of it, he was clinically back to normal. Repeated the Lymphocyte Map and it was normal afterwards.  That’s an easy case, I think one that was pretty straightforward. There were definitely more complicated versions out there where they require, I think, a lot more calibration on the fly to get them in the right direction. Typically, that’s the way they look.

Dr. Weitz:                           Have you had to use any sort of exotic therapies on patients with long COVID?

Dr. Vojdani:                        Exotic therapies-

Dr. Weitz:                           Any-

Dr. Vojdani:                        … may mean many things in our world, Ben.

Dr. Weitz:                           I know. I’m always hearing about a new thing, you know?

Dr. Vojdani:                        I think I gave him BPC-157 for the gut portion of it. I don’t remember-

Dr. Weitz:                           Okay. Which is a peptide for people who are not familiar.

Dr. Vojdani:                        Yeah. Body protective compound-157 is a peptide. I don’t remember that it had any healing effect on him though. I think that’s probably something that works way better for people with intestinal permeability or some actual physical breakdown of their gut lining, which he didn’t have, surprisingly, despite all the symptoms. No. I don’t think I used anything else fancy for him.

Dr. Weitz:                            Okay. Just clinical pearls, is BPC-157 something you often use for leaky gut patients?

Dr. Vojdani:                        I go through waves. I think when I used it initially when I first learned about it quite a while ago, I was very impressed with it. Then you learn other things along the way, and maybe you need to lean a little bit less on it. I think the problem with it is sourcing it and also cost.  As sourcing got more difficult and costs went up a little bit, I use it in selected cases now where again, I’m up against the wall and I’m not getting gut healing the way that I want to, but I find it a very helpful compound in those situations.

Dr. Weitz:                           Great. Maybe you can give us one more clinical case about specifically how you managed a patient with some autoimmune condition and how the Lymphocyte Map played a role and then what may be some specific treatments that you utilized, if you don’t mind.

Dr. Vojdani:                        I’m going to give you an example of one in which I had interplay with the rheumatologist.

Dr. Weitz:                            Okay. That’d be great.

Dr. Vojdani:                        It wasn’t treatment that really helped this patient at all. It was my relaying of information and utilization of a test that hadn’t been done for this patient before, okay?

Dr. Weitz:                            Okay.

Dr. Vojdani:                        I want everybody to understand that sometimes we can be helpful not by picking the supplement or picking the lifestyle, but by being an advocate for people.

Dr. Weitz:                            Right.

Dr. Vojdani:                        This 50-something-year-old woman, she had a very chronic history of joint disease going all the way back to her teenage years. Some people had called it JRA, juvenile rheumatoid arthritis. Some people had called it adult RA. Some people had called it ankylosing spondylitis. All of her antibody tests were negative.  She was seronegative, HLA-B27 negative as well too so she didn’t fall into any particular bucket, but her clinical symptoms were screaming autoimmune joint disease, but nobody knew what it was. She had seen virtually every rheumatologist in town and everybody was kind of throwing around the idea of a different medication to use just to try it and see if it sticks essentially. That didn’t sit well with her.

I understand why, because she wanted some specifics. I did my workup as far as the usuals, gut health, environmental toxins. She did have intestinal permeability and she had a very strong antibody response to a multiple mold species and ended up having a large mycotoxin issue. I identified those and at the same time I ran Lymphocyte Map on her because she had been suffering for so long.  I mean, like 30 plus years of having debilitating joint disease is horrible. She had extreme elevations of Th1, Th2 and Th17. When I say extreme, they were off the upper limit of detection on all three of them across the board. B cells were normal, natural killer cells were normal. She’s got extreme aggressive T cell activation. I’m looking at that and I’m saying, “Okay. Well, I’m going to work on what I’m going to work on with her.”

There’s always a role to be played for lifestyle. It’s always better for her to clear out whatever microtoxin she was exposed to. It can’t be good for her to have those in her body. I’m going to do that part, but for this person to feel as good as they can, they need a bigger weapon, and I’m not the doc to prescribe Humira.  I got her rheumatologist on the phone, talked to him and said, “Hey, listen, I ran this test. We did T cell mapping. This is her Th1 count. This is her Th2 count. This is her Th17 count.” The rheumatologist literally on the phone said, “Oh my God, this person has ankylosing spondylitis. Humira is the right drug for her.” I agreed.  I said, “As much as I would love for supplements to take this person to clinical resolution, it’s not going to happen. They’re too far in that direction. This is the right person for medication.” She started on Humira. She called me a week later after she started it, completely different person, no pain, no fatigue. All the symptoms went away.  Then I said, “Okay. Great. After you’re on Humira for three months, we’re checking your Lymphocyte Map again, because I want to make sure that you’re not going overboard.” Repeat Lymphocyte Map. T cells balanced across the board, not low, not high, just like perfect Th1, Th2 balance. I said, “You rest easy. Your T cells are functional the way that they should. The dose of the medication is correct and it was the right medication for you.”  To me, that’s a huge intervention. I didn’t do anything other than run the test and then relay the information to the doc who should be prescribing it. I think it was life-changing for her.

Dr. Weitz:                            Seems to me another potential benefit of this test is anybody who has autoimmune disease, especially anybody who’s getting treated with one of these drugs who’s maybe … maybe they feel okay, but they’re kind of nervous, “If I get COVID, am I going to potentially have a bad case because of my autoimmune disease, because of my immune status?”  This Lymphocyte Map test would be something that would potentially give us some knowledge to help that person potentially have a more balanced immune system.

Dr. Vojdani:                        For sure. I mean, I think nobody wants to see completely depleted T cells in a dysfunctional adaptive immune system because they’re on a biologic. Then again, as I mentioned, that’s not the intention of the medication. It’s the fact that it’s being used relatively blindly that people end up in that situation. That’s because tools like this didn’t exist before.  They exist. We learn about them. We execute them. Hopefully they start becoming a more regular part of everyone’s care. Everyone’s outcome becomes better when we can put the personalized data to their case. That’s what this represents.

Dr. Weitz:                            Right. That’s what we do in functional medicine, is try to deliver individualized care to the right patient. It’s-

Dr. Vojdani:                        And we try, we do our best.

Dr. Weitz:                            We try. Yeah.

Dr. Vojdani:                        We try.

Dr. Weitz:                            It would be nice if that approach was applied more widely instead of just finding one approach to treat patients with a certain diagnosis and applying that to everybody.

Dr. Vojdani:                        Well, Ben, we’re talking here today. It’s my second time on the podcast. I think in the years, since my first appearance and now doing this now, your podcast has grown in popularity, which it deserves definitely, but that’s also because people are more interested in this. I think more and more clinicians will become more involved in this as time goes on, because it simply means better outcomes for everyone.  It’s certainly more time-consuming, but it’s worth the time consumption because outcomes are better. In the end, that’s what everybody needs.

Dr. Weitz:                            Right. That’s great. Thank you, Elroy. Another great podcast. Can you tell everybody about your practice and about your book and where’s your book available?

Dr. Vojdani:                        Yeah. Absolutely. The practice is Regenera Medical. We’re here on Wilshire and Federal in West LA. It’s me and a nurse practitioner. The book is called When Food Bites Back.  It is meant to be a resource for the public to try to understand first how the environment affects the immune system, and because food is the thing in the environment we are most in contact with, why that’s the most important thing to pay attention to when it comes to the immune system. It’s available on Amazon. Just search When Food Bites Back and you’ll find it there. I hope everybody likes it.

Dr. Weitz:                            That’s great. Thank you so much.



Dr. Weitz:       Thank you for making it all the way through this episode of the Rational Wellness Podcast. 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.  I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. 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. Ben Weitz. Thank you and see you next week.


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