This week on the podcast, we are going deep into immune health with Dr. Elroy Vojdani. The Vojdani family, Elroy and his father Aristo have been very helpful for James in sense-making over the last year and a half in the most important topic on the planet, immunology. On this episode, we talked about some of the things that practitioners tend to get wrong about inflammation, about autoimmune disease. We talked about the connection between SARS-CoV-2 and a human tissue and how that’s affecting clinical practice. Enjoy!
- Dr. Vojdani’s recent research looking at the reaction between SARS-CoV-2 proteins and tissue antigens
- How people can navigate through long term and short-term effects from COVID-19
- Tips to look at a patient who suffers from an acute viral infection turning into a chronic immunological problem, and how you must see what happened in that person’s past
- And so much more!
James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
Hello and welcome to the podcast. This week, we are going deep into immune health with Dr. Elroy Vojdani. The Vojdani family, Elroy and his father Aristo have been very helpful for me in my sense-making over the last year and a half in the most important topic on the planet, immunology. In this episode, we talked about some of the things that practitioners tend to get wrong about inflammation, about autoimmune disease. We talked about the connection between SARS-CoV-2 and a human-tissues and how that’s affecting clinical practice. Lots of great stuff in here enjoy.
So, a warm welcome back to the podcast, Dr. Elroy Vojdani. Welcome, doc.
Elroy Vojdani: Glad to be here, James. Good to see you again. Thanks for having me.
James Maskell: Yeah. Thanks so much for being on! The last time when you were speaking, I just realized you are the guy to go to when we were talking about the immune system and, you know, obviously it’s a time of year where people are very aware of their immune system and, people were sort of moving into fall. It’s the change in the seasons. And it’s kind of a time where immune health is front and center for people and therefore the practitioners in our community. Over the last year, we’ve learned a lot about immunity and everyone’s an expert on immunity seemingly, but I really, I guess I wanted to just really dive into the science of the immune system from someone who’s really in it, because I think these terms like boosting your immune system or otherwise are being pushed to one side because they don’t really reflect what is happening. So, I just wanted to start right at the beginning with you and just say, look, what is immune health and what do practitioners need to know about the new science of immunity?
Elroy Vojdani: I think one of the biggest takeaways from this last year, as you mentioned, is we’re finally starting to look and pay a tremendous amount of attention at immune function and immune health, but, if you pay attention to the terminology that we use, the metrics that we use, the data sets that we use to assess immune health, it’s very clear that there’s a very big disconnect between what we would like to know and what we actually know. And I’m hoping that this is a leap board for us going forward to close the gap between those. We use terms like inflammation or immune dysfunction, autoimmunity. We don’t really have very good clinical grasp about what that means in real time for the person in front of us as a patient. And I hope to shed some light on that and provide people with new tools to be able to understand that a bit further.
James Maskell: Beautiful. Well, let’s get into that because my feeling is that this functional medicine community needs to be the leaders in this new understanding of immunity, autoimmunity and so forth because we’re already well set up to understand systems biology. It seems like the emerging science is pointing towards a functional immunology approach being the new standard. And so I really want to up level all of the ways that practitioners in our community understand. So, why don’t we just start with those two terms? I mean, you mentioned inflammation, autoimmunity. What do those mean in the context of the immune system and what do practitioners have to know in order to really understand the physiology and how to make the best inputs?
Elroy Vojdani: I think the first part is, inflammation essentially just means activation of the immune system, right? And that can happen at numerous levels, one level. So you really have to start understanding the different levels of immune function and then get some sense of how you can quantify what an individual’s function and level of production is at each level and then boost where they’re deficient or imbalanced. So it all begins with the mucosal immune system. That’s the barriers, our nose, our mouth, our esophagus, our first line of defense against what is outside and inside. We have a very robust immune system surveying that space. Next levels we go into the systemic immune system. So our blood, and we’ve got two very big, important branches there, the innate immune system, which is our primal, non-specific immune defense, and then we’ve got our adaptive immune system, which is our programmable, you know, I kind of think about it as like we’ve got this deep learning software, AI an immune part of us, which is the adaptive immune system, which can meet any new challenge and reprogram itself to face that.
The question is, how do you know what’s going on in each one of these levels and how do you boost function where appropriate and what tools do we have to be able to boost those things? In today’s world, when we try to have a discussion about an imbalanced systemic immune system, that’s prone to auto-immunity, we have this like focus on T-cells and specifically we talk about Th1 versus Th2. Sometimes, we have a discussion about Th17 and what we’re specifically talking about there is the most important subgroup of cells in that adaptive immune system. The other is incredibly important. And we have new generational tools to be able to actually accurately identify when someone is in Th1 or Th2 or Th17, but it’s also important to understand innate immune function and also mucosal immune function, if possible as well. Ultimately, supporting or boosting all three of those levels will be the most successful preventative treatment tool for encouraging normal immune function, normal health and preventing auto-immune disease.
James Maskell: Is it possible now to predict your immune status or your immune readiness on those different levels?
Elroy Vojdani: Yeah, yeah, you know, for those who don’t know, my dad Aristo Vojdani is the Chief Scientific Officer for Cyrex. He’s a brilliant mind in the world of immunology and creates many clinical laboratory tests. In his newest invention, a brainchild of his for the last four or five years is a next-generation immuno type test. So, essentially what he’s doing with this test is quantifying all of the different cells in different layers of the immune system by tagging them specifically and then providing an output saying, “this is how much of this type of cell is present.” “This is how much of that type of cell is present.” “This is what the ratios are between them.” So you get a sense of overall level of function and then also whether there are imbalances that will lead someone to some potential decline in function, or autoimmunity down the road. That test is called an immuno type test or Cyrex calls it the Advanced Lymphocyte Map. And that’s available actually now for clinicians to start using.
James Maskell: Interesting. So, once you get that information back and you start to see that, what are the range of tools that you use in your practice to then mediate those levels, either upward, downward, or any other way?
Elroy Vojdani: I think more than anything, it just gives you another very specific tool to use the things that we have in our tool belt already. We know about things like N-acetylcysteine, quercetin, zinc, vitamin D, vitamin C, probiotics, immunoglobulins, low-dose naltrexone. We have all these things in our tool belt, but I really think what’s lacking is actually specifically knowing when to use each one of the tools for the right person that’s in front of them. And it’s because we really haven’t had the ability to specifically personally identify those immune subtypes before. So, you find somebody that has barrier dysfunction, low IGA production, their mucosal immune system is really heavily hit, and they’re also Th1 dominant and developing auto-immunity. I’m kind of taking you through the line from the beginning all the way to the end.
You boost their mucosal immune function with traditional tools like probiotics, N-acetylcysteine, immunoglobulins, vitamin-D, and you try to identify the trigger as, we always talk about. But specifically when you know someone’s in a Th1 dominant immune subtype, you really start laser focusing on pathogens. So, that’s the kind of thing that you can start developing. So, you know when to use the tools, you know how to identify where the tools will be helpful, you have a baseline tracking point that you can use forward to make sure your protocol is successful. And I think it gives you another magnifying glass or where to look for the trigger.
James Maskell: Has the pandemic brought a sort of new interest from the blue ocean of what would you call it like conventional doctors into some of these ideas?
Elroy Vojdani: There’s certainly curiosity. And I think that COVID has propelled the curiosity that existed before, prior to COVID. I was lucky enough to collaborate and work with several traditional Western referring docs here in the LA area. I’ll give a shout out to one of the bigger groups out there that I think has been functional leaning. It’s the Attune Health Rheumatology Group associated with Cedars here in LA. So there’s been that interest and I think that COVID has certainly propelled that interest, but the education and ability, maybe opportunity to execute this kind of more complex, deep level stuff still hasn’t fully happened though. I’m seeing positive signs of that happening.
James Maskell: That’s really exciting. What inspired your recent research to look at the reaction between SARS-CoV-2 proteins and tissue antigens?
Elroy Vojdani: It was simple. I think in March, April, May of last year, at the beginning of the pandemic, I certainly felt like I was treating patients in a knowledge black hole. People were experiencing all kinds of symptoms from obviously the infection, but, more specifically the long-term consequences of the infection, and didn’t really have much understanding or much in the database. So, we were just throwing everything at them. As I was thinking about potential mechanisms in which people were experiencing, let’s say myocarditis or chronic fatigue, knowing how immunogenic some of the antigens were of SARS-CoV-2, I just had a thought that there had to be numerous mechanisms at play. And one of the big ones had to be cross-reactive antibody production.
So, I pulled my dad aside, I think in May or June of last year and said, we have to do this study. You know, we need to figure out what spike can cross-react with in our own body and what nucleocapsid can within our own body. It took us many months to do that study because we had to get the monoclonal human antibodies and react them to human tissues. But the results were, I think in many ways, not surprising based on clinical experience, but very illuminating.
James Maskell: Do you want to just give our audience the bullet point overview of what you found and what the implications are for practitioners who are treating either healthy-ish patients, people with COVID or people with auto-immune disease?
Elroy Vojdani: The antibodies to numerous antigens in SARS-CoV-2 cross-react with several human tissues, very strongly. And I guess this is not a surprise given clinical symptoms, but, the strongest subset was to mitochondrial antigens. So both spike and nucleocapsid, the antibodies will bind to our mitochondrial tissue and cause damage there. But, they’ll buy into myocardial tissue, they’ll bind to thyroid tissue, they’ll bind to neurological tissue, they’ll bind to pancreatic tissue. So, many things. So, when you look at this kind of wide spectrum of how people experience the infection, and also those who experience the unfortunate long-term consequences, this looks like a very viable mechanism for why some of those patients experience what they do.
James Maskell: One of the conversations that has been hot in the last year is this idea of an immuno type and Dr. Bland has spoken about it a fair amount. As you go through in your clinical practice and also in those studies, did you identify certain immune types? And what’s the implications for that kind of conversation?
Elroy Vojdani: We don’t know the entirety of the map of those who are more inclined to have either short-term or long-term consequences. It certainly seems at least with preliminary experience and data that those who are T1 dominant are going to have more long-term consequences following the SARS-CoV-2 infection. And certainly those who are in their later phases of immune production, likely as the consequence of chronic inflammation, a concept known as inflammaging or immunosenescence are certainly much more predisposed to the short-term consequences, being either hospitalization or death, and then also in the long run, they seem to be more predisposed to chronic fatigue as a consequence, probably because of the mitochondrial dysfunction that happens to both people who are in inflammaging, immunosenescence, there’s, pre-existing mitochondrial dysfunction for them. That’s the biggest group that’s hit hard. The people who have the weakest mucosal immune system, first line of defense, and also have inflammaging, immunosenescence waiting right after that.
James Maskell: That’s super interesting. How do those two types end up sort of being effected by long COVID and how do you help the people who are experiencing sort of long-term effects of a short-term infection understand what’s going on and plot their path back to health?
Elroy Vojdani: Well, I will ideally immunotype them. So, I’ll get the data to kind of show me, oh, you know, natural killer cell activity is low, there’s low salivary IGA production. You know, they’ve got Th1 or Th2 dominance, or maybe even their T cell and B cell counts are completely wiped out, which is a more late stage of immunosenescence. And then I will bolster the production at the appropriate levels. And I think also a lot of these people will suffer from some low-level uncleared chronic viral load, so I will also give them some antiviral support on top of it. And then once you feel like you’re starting to make headway with the clearance of the chronic viral load and boosting immune function, you’ve got to hit their mitochondria with every support element that you can think of. These are things that are heavy in acetyl-l-carnitine, green tea extract, N-acetylcysteine, methylated B-vitamins. You’ve got to pick those mitochondria up because they’ve been hit over the head by a hammer for far too long.
James Maskell: That’s really interesting. Are there other clinical tools that you have in your repertoire that you think that most functional medicine people maybe haven’t come to yet, or don’t understand that you think give you a sort of an advantage in bringing clarity and resolution to these kinds of conditions?
Elroy Vojdani: If you want to look at the person who suffers from an acute viral infection turning into a chronic immunological problem, you also have to see what happened in that person’s past to make them so susceptible to this current issue. And you have to think of the past and the present concurrently if you want to actively fully treat that person. So, one week in their mucosal immune system, what gave them the chronic inflammation, inflammaging, immunosenescence? Many times for these people, it is someone who’s had a chronic viral infection, uncleared, pre-existing or had mold exposure, or had chronic intestinal inflammation. So, it’s not any new tool set to functional medicine. I think it’s the things that practitioners are used to using. It’s when you see someone who’s significantly COVID affected, you’ve got to make sure that you look at all of that and address it while you’re trying to address the post COVID complication as well.
James Maskell: I mean, is there any other way back, apart from a functional medicine approach? What you spoke about there was going deep into the history and understanding the triggers and the root cause. Do you see any other strategy for unwinding that, that doesn’t take that sort of approach?
Elroy Vojdani: I think the interesting observation on my end being kind of still having a foot in the traditional Western world with referrals and colleagues and also very much in a real practice, completely in the functional and personalized approach, is you see a much more open-mindedness on the traditional Western side to try to get people out of this chronic fatigue, brain fog, myocardial dysfunction syndrome that seems to affect a lot of people post-infection. I’m seeing at least people here locally in LA being referred to IV drip locations to go get Myers infusions and glutathione injection, sauna usage, the idea of cold plunges and breath work seem to becoming even more popular as recommendations in the traditional Western world. So people are, at least in my surrounding area, becoming familiar with enough in the supporting area and also understanding that our preexisting traditional medical tool set doesn’t acknowledge or treat any of this stuff. And so they’re providing some more open-minded recommendations for people.
James Maskell: That’s good. And I would say that it’s traveling outside LA too. I think it’s making its way as content and best practices move it goes through like the bio hacking communities and then it sort of ends up becoming a bit more mainstream. I really appreciate you sharing that. The theme of our year here at The Evolution of Medicine is the reinvention of medicine. I want to just zoom out a bit and, you know, think, okay. First of all, what are your ideas on the reinvention of medicine? And to take it almost a step further, if you’re now put in the hot seat to really be setting immunological policy to try and get America out of the hole that it’s dug itself into, where do you see the reinvention of immunology and then, where do you see the things that would really have to shift dramatically for American immunological health to be transformed?
Elroy Vojdani: If I’m creating policy in the future, I think I’m obviously grabbing the idea that preventative, personalized approaches to immunological health are going to be the key. There’s probably only so much that we can do when someone is in a chronic inflammatory state or even worse when we’re seeing them in inflammaging or immunosenescence at the end of that. So, I think everybody needs relatively early surveillance, early counsel, early lifestyle, basic intervention to prevent them from going down that chronic inflammatory rabbit hole that’s going to be the most successful. Maybe some basic early preventative measures, checking total immunoglobulins, checking to see whether people have positive ANAs, what their CRP and ESRs are. Just kind of early stuff of is the person’s immune system functional and happy? And maybe just doing the more traditional, basic lifestyle intervention, but earlier in the time course.
Anti-inflammatory diets, consumption of more healthy phyto-nutrients. And honestly, if I’m in charge of total country policy, I’m also probably providing some basic immune support, vitamins and supplements to everybody in a daily pack. I hope that the world would trust the government and trust the institution that I would be in charge of to take those things. I think ideally everybody should also be taking some daily immune support where we all could use some kind of basic foundational nutritional boosting to our immune function.
James Maskell: Yeah. It’s wild, isn’t it? That, that still hasn’t happened at scale, given all the research that came out about vitamin D and then gut health and all that kind of stuff. So yeah, I think it’s wild. That makes a lot of sense. You know, last year at PLMI, saw you do your presentation with your father. I know there was some other father-son groups there. What’s it like riding out the pandemic? Immunology becomes the hottest topic in the world from nothing almost. And here you are at the cutting edge, obviously following in your father’s footsteps, but obviously like taking this into Western medicine as well with your own career. I’d love to just get your thoughts about what it’s like to be you for the last 18 months and sort of being on the forefront of this pioneering work in functional immunology at a moment where it suddenly became the most important topic in the world?
Elroy Vojdani: It’s, in full transparency, a very split set of emotions. I mean, there’s part of it that is obviously very exciting because there’s a new challenge and a much larger group of people that need help. And I do what I do every day to try to help people. Whether it’s here in the clinic or public or whatever. There’s a reason I switched from my former medical career to this and it is to help spread the word of what I have seen be tremendously effective in improving people’s health. So it’s exciting from that perspective.
And I think there’s an equal amount of frustration and perhaps sadness to see the continued suffering as this pandemic goes on. And we don’t really see a very clear light at the end of the window, that some of the more easy cost-effective, and potentially helpful with little side-effect interventions are not being widely preached or widely spoken in the health community. The things that we, as functional medicine providers, use as our foundation, healthy eating exercise, healthy sleep, the things that we know from robust medical literature result in healthier outcomes, whether we’re talking about COVID or anything else. It’s frustrating to not see that have the platform that it deserves at this point.
James Maskell: I agree with that. I agree with the frustration man, and I feel it as well, but I also feel like, it is continuing to make the case for all of the providers who are in our community, whether you be a functional medicine physician or whether you are practicing as a nutritionist with a doctor or by yourself, or even the health coaches of the world who are helping people make those kinds of choices. Because we know that it makes a big impact. We know that it’s where the needle will get moved and it just continues to help me realize that we’re on the right path in trying to popularize these ways of working, because it does seem that every corner you turn, there’s a need for more robust immune resilience as the really the only long-term solution. I’m excited to hear that, and I’m also sharing your sadness and frustration. What’s new for you? Where can our listeners connect with you or to keep up with what you’re up to and some of the research? Where’s the best place to connect?
Elroy Vojdani: We share everything on social. So Facebook, Regenera Medical Instagram. Regenera Medical actually, shortly after this podcast will be released, I have a new book coming out, which is When Food Bites Back. This is something that I started writing before the pandemic. And I think it has extra importance today. It’s basically discussing the specifics about how food, when the immune system interacts inappropriately with it can lead to specific auto-immune diseases. Kind of taking that theme that I mentioned to you earlier, we talk about food and autoimmunity, but I really wanted to put some real detail to that conversation. So, that’s what the book is about. Of course, there’s a lot in there about immune function, immune balance, and really a global understanding about the immune system as well. That’s coming out September 14th. When Food Bites Back will be on Amazon. Either Regenera Medical on Facebook or Instagram, or a look up When Food Bites Back on Amazon.
James Maskell: Amazing. We’ll definitely have all the links in the show notes to the book and yeah, thank you so much for being here and part of the podcast. I guess I just want to acknowledge all the work that you’ve done in now popularizing some of these concepts. I had the great pleasure of being on two webinars a year apart in April 2020 and then April 2021 with your father and going into the beginning of the pandemic with that level of sense-making around what will cause someone to have a really bad reaction to COVID and what would cause them to fly through it and all the different pieces and understanding that the role of functional medicine and that. Just with that one diagram that he shared, I was able to really take all this information that I was hearing in the media or otherwise, and sort of place it in my mind in a way that helped me understand the biggest picture.
And honestly, I wish everyone actually could have access to that kind of information because it really helped my sense-making, helped me make good decisions for myself and my family. I think that the work that your family and yourself and your father are doing are really important, and I’m hopeful that in the years to come, we’ll see you really starting to come into your own and to have more of a significant influence over the practice of medicine.
Elroy Vojdani: Thank you for the kind of words. I look forward to continuing to contribute and being a part of this wonderful family.
James Maskell: All right. Well, thanks so much for being here. Part of the Evolution of Medicine podcast. Check out the book When Food Bites Back. I’m sure that’d be a great one to have in your clinic to give to patients as you’re putting them through their autoimmune protocol. This has been the Evolution of Medicine podcast. I’m with Dr. Elroy Vojdani. We’ll have all the other details in the show notes. Thanks so much for tuning in, and we’ll see you next time.
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