#267 – How trauma can contribute to autoimmune disorders, and what you can do | Dr. Sara (Gottfried) Szal and Mike Haney

Trauma causes physiological changes to the nervous system. Over time, these impacts may place someone on a trajectory from health to a pre-disease state to a disease state, leading to autoimmunity or autoimmune disorders. Dr. Sara (Gottfried) Szal and Mike Haney discuss Szal’s new book “The Autoimmune Cure,” trauma and how it can contribute to autoimmunity, how personalized precision medicine may help individuals reverse autoimmunity and return to a state of health, and how psychedelic therapies can help with addressing trauma.

Helpful links:

The Autoimmune Cure: Healing the Trauma and Other Triggers That Have Turned Your Body Against You: https://www.saragottfriedmd.com/the-autoimmune-cure/

The Hormone Cure: Reclaim Balance, Sleep and Sex Drive; Lose Weight; Feel Focused, Vital, and Energized Naturally with the Gottfried Protocol: https://www.amazon.com/Hormone-Cure-Energized-Naturally-Gottfried/dp/1451666950/

Sara (Gottfried) Szal, MD, Director of Precision Medicine at the Marcus Institute of Integrative Health at Thomas Jefferson University, and multiple New York Times bestselling author: https://www.saragottfriedmd.com

What’s your ACE score? https://www.saragottfriedmd.com/discover-your-ace-score/

Free guide: https://www.saragottfriedmd.com/ace

Sara (Gottfried) Szal, MD, on Twitter/X: https://x.com/DrGottfried

Sara (Gottfried) Szal, MD, on Instagram: https://www.instagram.com/saragottfriedmd/

Sara (Gottfried) Szal, MD, on YouTube: https://www.youtube.com/user/DrGottfried

Sara (Gottfried) Szal, MD, on TikTok: https://www.tiktok.com/@saragottfriedmd

Sara (Gottfried) Szal, MD, on Facebook: https://www.facebook.com/DrGottfried

04:55 — What is precision medicine?

Precision medicine focuses on what will work for an individual, rather than focusing on what works for the average person.

In my case, I’m often using lifestyle interventions. And then you remove the intervention and you see what happens in terms of how the person feels, subjective awareness, objective data, such as the data from a continuous glucose monitor or autoimmune antibodies. That then allows you to know what’s going to work for that individual. So personalized medicine as a heading is really about leveraging all the data that you can collect. So that’s genetic data, biomarkers, wearables, digital biomarkers, and understanding based on that person’s goals. How do we get that person in the direction that they want to go? So it’s the medicine that I love to practice. I take care of mostly professional athletes and executives and perimenopausal women. And in those populations, I would say medicine for the average doesn’t work so well.

10:23 — How tools that give you a “window” into your physiology can help

Data from a continuous glucose monitor (CGM) and other metrics empower individuals to make lifestyle behavioral changes.

When you have that transparency, when you have this window into what’s happening with your physiology, it creates behavior change more effectively than anything I’ve seen in my 30 years of practice. So I think that transparency is really important, but we also need to make it easier and trustworthy for individuals. So when I get up in the morning, I have sort of a few things that I check. I wish I had a single dashboard that had all of my data flows, but instead I go to the Levels app and I see what’s going on with my glucose. Did my travel yesterday kind of tip me back into a prediabetic state? In fact, it did. So my fasting glucose this morning was in the 105 to 110 range. So that is the kind of insight that I need to tighten up the ship today in terms of my food and my exercise and glucose intake and disposal. And then I also look at my sleep data. And then throughout the day, I look at my daytime stress and these allow for N of one experiments and small iterations that I really feel are the hinges that swing big doors.

14:28 — Why catching autoimmunity in a pre-disease state is important

Well before an autoimmune disease blatantly shows up, people transition from a healthy state to a pre-disease state. The goal should be to catch that transition and start interventions to revert to a healthy state. However, conventional medicine often misses the pre-disease state.

So what I noticed right before the pandemic was this rise of autoimmunity. So I mentioned working for a health tech company and seeing so many employees who had autoimmunity, and this is not autoimmune disease. I think it might be important to separate those. So I think of this transition that I mentioned before between health, pre disease, and disease. I think about that with pretty much every condition, whether it’s from health to diabetes or from health to autoimmune disease, and there’s this really broad middle part of that spectrum where you’ve got pre-disease, and unless you’re specifically looking for it, you may not know that you have it. And that is certainly true when it comes to autoimmunity. So we think that people have pre-autoimmune disease for somewhere around seven to 14 years. And so as I started testing more of my patients—this is around seven years ago—with a functional medicine panel that includes looking for certain antibodies, like anti-nuclear antibodies, rheumatoid factor, the antibodies associated with celiac. What I found was that—wow—about one in three have positive antibodies, and so I get excited as bioengineer when I see a pre-disease state, because I know, based on the signaling properties, that it’s easier to reverse the sooner that we find it.

31:33 — A person’s life history, especially their trauma, matters for their overall health

Trauma can cause dysfunction with the autonomic nervous system, preventing people from fully tapping into their parasympathetic nervous system.

So I think this again circles back to personalized medicine and knowing where are your vulnerabilities? And your question about, “OK, how does the trauma signature show up physically?” This is where we’re still in the earliest stages. So for instance, we know that when it comes to the nervous system, if you look at the autonomic nervous system and the sympathetic nervous system in balance with the parasympathetic nervous system, the sympathetic nervous system being fight-flight as originally described by Walter Cannon in the 1930s, I would actually extend that to include some of the more female responses. So fight, flight, freeze, fawn, sometimes faint, and how that is in dynamic balance with the parasympathetic nervous system, which some people think of as feed and breed or rest and digest or stay and play. What we know, in a trauma state, some people have parasympathetic dysfunction.

35:28 — The three components that lead to autoimmunity

Three factors together contribute to autoimmunity: genetics, intestinal permeability, and a trigger.

So those three components are from Alessio Fasano, MD. He was a pediatric gastroenterologist at Massachusetts General Hospital. So he first started with looking at celiac, mostly in children. And he found that to develop celiac, you had to have these three components: genetics, increased intestinal permeability (so called leaky gut), and then a trigger. So he then looked at other autoimmune diseases and found that the same triad held; you have to have each part of that three-legged stool to develop an autoimmune disease. So that’s where it comes from. And what we’re talking about here is the parts that you can do something about. So you can’t change your genetics; you can change the way that your genes are expressed. So you’ve got some ability to modulate epigenetic change, but you can do something about the increased intestinal permeability, and you can certainly do something about triggers. So triggers really vary in the book. I’m talking about trauma as a trigger. But not everyone with autoimmune disease has trauma as a trigger. Although we think the correlation is somewhere around 70% to 80%. But there are other triggers. There are things like big hormonal shifts, postpartum pregnancy, perimenopause, menopause. There’s infection, the way that some people responded to the COVID virus is different than the way others responded to it. And we even think that long COVID is a form of autoimmunity. So that triad is required to develop autoimmune disease.

39:55 — More people are living in fight-or-flight mode all the time

Trauma has existed throughout history, but in today’s always-on society, we are exposed to triggers regularly, preventing us from getting back to our baseline calmer state.

We’ve been exposed to trauma for millennia. And maybe some stand out more than others. The isolation and the sheltering in place, I think stands out with the pandemic in terms of the effect on physiology. But I also think that—if I put my research hat on—it’s very hard to measure these things. Like, how do you measure trauma? Right. You know, the best we have is adverse childhood experiences. There are some lifetime stress scores that you can use. Is that the best way to do it—to take a questionnaire and then map it to physiological variables like fasting insulin, postprandial insulin, fasting glucose? Is that the right way to do it? Or should we be measuring physiology and nervous system dysregulation? And I think the other thing that’s happened . . . is that it used to be that trauma—I really believe the body was designed to experience threat or trauma occasionally, maybe like once a quarter. And then you go back to kind of your normal default physiological state. And what I see now is that people are in survival mode continuously. They never really get out of that heightened hypervigilance. And what’s the reason for that? Well, it’s the usual suspects, like having smartphones and using social media and getting activated with triggers on your phone, having this accessibility, having emails kind of penetrate your existence at all hours of the day. So there are ways that our stress response system never had to deal with the volume of potential triggers and inputs that we have right now.

47:14 — A food-based approach is a great place to start for reversing autoimmunity

Diet is a modifiable lifestyle factor that can greatly impact health and potentially help someone revert from a disease or pre-disease state to a healthy state.

I would say food is the best place to start. I don’t think you can eat a poor diet and reverse autoimmunity. I mean, what a lot of people want is they want a pill, right? They want it to be really quick and easy, and it just doesn’t exist. So yes, you can optimize the food plan, do an elimination diet, which helps to reverse leaky gut and also improves dysbiosis and can help the immune system calm down and be less overactivated. But you really need that food-based approach or then an immunomodulator like low-dose naltrexone, curcumin, or vitamin D to help with resetting homeostasis.

48:54 — How do you find someone who practices precision medicine?

Functional medicine doctors are a good place to start when looking for someone who will take a personalized approach to medicine.

Folks who are interested in personalized medicine, and that would include most, but not all, functional medicine clinicians—that’s a good place to start. You know often what I see is that clinicians who’ve struggled personally with autoimmune conditions, they’re often a good place to start because they know what worked for them. They are more steeped in the literature. They’re less likely to have the party line that I got when I went through my medical training, which was, “OK, so you’ve got some positive anti-nuclear antibodies. Big deal. It’s nonspecific. So many people have that.” Yes, so many people have it, and it is not normal and healthy for your immune system to be attacking the nucleus of your cells. So yes, there’s a threshold that is there, becomes more important. But I think in terms of trying to find the right team, those through the ifm.org, find a practitioner—that’s a good place to start. If you go to their website, maybe read about what brought them to functional medicine. If it’s because of Hashimoto’s or some other autoimmune condition, there’s a good chance they’re going to be able to help you. But I think it also, as much as people don’t want to be told that you’ve got to advocate for yourself and you’ve got to learn about this and develop the knowledge, that still applies. You know, this idea that you see a conventional doctor or nurse practitioner for 15 minutes once or twice a year, and they’re going to know you well enough to be able to guide you on this—no, it’s just not going to happen.

1:00:36 — How psychedelic therapies may help with trauma

Psychedelic-assisted therapy can help people view their traumas, without the usual fear triggers, and reprocess them.

We know that for people who go through MDMA-assisted therapy that they have this experience of the amygdala—which is always looking for perceived threat on the horizon—it calms down the amygdala and allows you to go back and revisit some of the traumatic memories that you might have with much more of an objective focus with less of the fear response. So there’s some fear extinction that occurs as a result of taking this medicine.

1:03:49 — The difference between recreational and therapeutic use of psychedelics

Integration, the process of learning and gleaning insights from your psychedelic journey and then making appropriate changes, is key for addressing trauma.

When we look at the structure of a psychedelic-assisted therapeutic encounter, there’s the intake, the preparation, the journey itself, and then integration. And out of all of those, I would say that integration is the most important. What happens with folks who choose to use it recreationally is that usually there’s less prep, there’s less intention setting, and there certainly is less integration. So I really believe that you’ve got to focus on the integration and the journey itself. You know, some people find it pleasant, others less so. Put your money on the integration because that’s where behaviors change. And that’s where you can start to make some of these changes that you very accurately described as somewhat overwhelming. If we look at all the different interventions that you could consider for autoimmunity, this particular process of clearing soul wounds and clearing some of the traumatic signature that might be making you choose a cupcake over steamed broccoli—like that can really help in terms of changing the trajectory you have toward chronic disease.