What to do When Autoimmune Patients Fail Standard Elimination Diets

Functional medicine providers are well versed in addressing the myriad manifestations of autoimmune disease, but while our success rates are remarkably high, we still aren’t always able to help everyone using current toolsets (labs, sophisticated elimination diets, gut protocols, and so on). Enter Mymee, a digital app and coaching platform that helps plug that gap – this sophisticated tool helps identify elusive trigger foods and lifestyle factors that may still be contributing to an individual’s disease process. Mymee’s work with COVID long-haul patients and the Mount Sinai post-COVID treatment center (long-COVID is highly autoimmune-related) is impressive and especially relevant for clinicians and patients alike. Some fascinating patterns are emerging from their long-COVID patient data that feed directly back into how to approach these cases differently. I am sure you will find this as interesting and useful a conversation as I did! Please review New Frontiers wherever you hear my voice and let us know what you think! ~DrKF

What to do When Autoimmune Patients Fail Standard Elimination Diets

Autoimmune diseases have been on an alarming growth trajectory for the past few decades, but even that increase doesn’t compare with the dramatic jump in identified autoimmune activity in the last few years related to SARS-CoV-2 and COVID-19. Total incidence of autoimmune conditions in the United States is now rubbing shoulders with that of prediabetes.

Yet many patients still spend a decade or more getting diagnosed and trying (and often failing) medications to control their disease activity. And many patients with long COVID continue to struggle. Functional medicine helps many individuals with autoimmune disease and long COVID, but even then, the disease triggers for some patients can remain undetected. This despite applying best practices in testing, elimination diets, and gut/immune rebalancing work. Mymee is working to bridge that gap and help even more people achieve symptom reduction and remission.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Nikki, talk to me about the scope of the autoimmunity problem.

Dr. Nicole Bundy: Sure. And this is so important to start with, because the burden of autoimmunity is already tremendous, and it’s growing. There are millions of people in the US and across the world struggling to live their lives with very formidable obstacles that autoimmunity presents. First, let’s just talk about numbers. Estimates from several years ago put the number of Americans struggling with one or often more autoimmune diseases at over 23 million. So, globally we’re talking about almost 5% of the world’s population living with autoimmunity.

And as you know, these diseases can be very debilitating. They don’t have cures. They’re often lifelong afflictions which require lifelong management. Now, add to this an estimated 25 to 31 million Americans who are struggling with long COVID, which as you know is a poorly understood condition, but it does appear to have autoimmune origins. So, we’re looking at potentially a doubling or more in the number of people in this country alone with an autoimmune disease just since SARS-CoV-2 hit the scene.

Dr. Kara Fitzgerald: Yeah, that’s just absolutely, absolutely extraordinary.

Dr. Nicole Bundy: Yeah. And as I said, even prior to COVID, the number of people with autoimmune disease was growing at a very alarming rate. There is research from the NIH (National Institutes of Health) that came out saying that the prevalence of ANA (anti-nuclear antibody) positivity increased by almost 45 percent from the late 80s into the 2011, 2012 range. And that can’t be explained by genetic change alone.

Dr. Kara Fitzgerald: Right. And before we hit record, we were talking a little bit about ANA as sort of a harbinger of autoimmunity to come, and there is a rising incidence in it. And I mentioned to you that two of my family members, a preteen and one of my siblings, have new ANA positivity. And there’s no incidence otherwise of autoimmunity in my family. And then Mette, you said something really, I’d love to just capture it on the recording, regarding what you’re seeing with ANA and its connection to COVID.

Mette Dyhrberg: You know what, I think-

Dr. Kara Fitzgerald: And actually, just define ANA, because we didn’t do that yet. So, just define that first.

Dr. Nicole Bundy: Sure. I can do that. So, ANA stands for anti-nuclear antibody. These are antibodies that instead of being targeted against foreign invaders, viruses, bacteria, maybe parasites, they actually target self-tissue. It’s named ANA, anti-nuclear, because the proteins or protein complexes that are typically recognized by these antibodies are in the nucleus, or at least they’ve come from the nucleus and are complexed with DNA. And as you say, Kara, they are markers of an autoimmune propensity in some people, and in other people when it comes about they already have a frank disease.

Dr. Kara Fitzgerald: And Mette, you threw out some pretty astonishing findings recently in New York.

Mette Dyhrberg: Yeah. I think what we are seeing is that hospitals who have had a tendency, as Nikki mentioned, around ANA measurements have recently stopped doing them. Because they saw that more than half were actually testing positive. And the healthcare systems don’t have the funds to go on with all the testing that’s necessary upon that discovery. And so, what is a requirement now is that you have all of the physical manifestations of any of these autoimmune diseases in order for the doctor to actually test ANA.

And so, from our point of view, what that means is that we’re actually masquerading the problem. We’ve seen a rise in ANA over the years, but as we’ve embarked on this COVID journey, if we stop measuring it, then it’s actually not going to go away, it’s just going to sort of be this sort of sleeping animal that will be awakened. And that, I’m actually quite terrified about.

Dr. Kara Fitzgerald: So, this 50% rise in ANA is all a post COVID phenomena?

Mette Dyhrberg: So, we’ve seen the rise even before COVID. And it’s been significant to rise year by year over the last decade. But, with COVID it has completely sort of elevated the positivity around ANA.

Dr. Nicole Bundy: Yeah, the really abrupt, dramatic rise that we’re seeing is COVID related.

Dr. Kara Fitzgerald: You know, as a functional provider, we order ANA as a first-line inquiry in all our patients as often as we’re ordering a CBC or a chemistry screen. But, it just adds a layer of urgency to that. We absolutely have to be looking for and keeping our eyes open. As you suggested, Mette, rather than shutting our eyes waiting for the disaster-

Mette Dyhrberg: For something to go away.

Dr. Kara Fitzgerald: Yeah.

Mette Dyhrberg: Exactly.

Dr. Kara Fitzgerald: Right. Right, right.

Mette Dyhrberg: Yeah. Well, and I think that’s the whole point of Mymee, is that we are seeing… and I’m saying women, but it’s women and men, but it’s over 80% women that are struggling with autoimmune disease, spending an average five to seven years to get diagnosed. Once they’re diagnosed, first line intervention is methotrexate. And these are women who’s often not had children yet. So, it’s at an enormous expense. And only if they fail this chemo drug will they be offered immunosuppressant or specialty pharma medication, and that fails three out of four. So, now you’ve had women whove been on a 10 year journey, and they’ve not had any relief of symptoms. And that is simply just not okay.

Dr. Kara Fitzgerald: Well, you know what, you need to talk about your own journey. I’ve heard your story before. It’s one of the most incredible. And I’ve heard a lot of very powerful stories and functional medicine. But, yours is extraordinary. And Nikki, I look forward to hearing yours as well. And it’s really what prompted you to unite and create the extraordinary entity that is Mymee. So, share with me, both of you, a little bit around your story, and the creation of Mymee, and what Mymee does.

Mette Dyhrberg: Yeah. So, Mymee came about really as a personal problem. I had had my own journey with autoimmunity for over a couple of decades. I spent half of my 20s going from doctor to doctor. And then the second half of my 20s I accumulated six autoimmune diagnoses, and was giving myself injections, and struggling with just everyday life. And so, I was really set out to be a chronic patient for life, when in my mid 30s one of my many specialty doctors told me they had great news. And upon arriving at the hospital, they proceeded to tell me I wasn’t going to die in the, quote unquote, immediate future. And this didn’t really live up to my expectation of great news.

Dr. Kara Fitzgerald: Yeah.

Mette Dyhrberg: And so, my first question was, what are we going to do about my process? And I was told they were happy with my numbers. And to this day I’m so thankful that that was the sort of emphasis that they talked about. Because as an economist, I went from being a disempowered patient to an empowered human being when I took matters into my own hands. I knew very little about healthcare, so I literally just applied process optimization to my own body, as it was closer to a computer system. And I started out with the good old food journaling.

Dr. Kara Fitzgerald: But, you dove into your numbers. It was that. So, they said the magic word.

Mette Dyhrberg: Yeah, yeah.

Dr. Kara Fitzgerald: Numbers, boom. That you can do.

Mette Dyhrberg: Yeah, exactly. That was where I felt comfortable. So, I basically translated my life into numbers. I had my blood work drawn every three to four weeks, I had every possible metric I could get my hands on. And I basically started journaling, realized probably within a week or two that there was no rhyme or reason in how I was looking at the data. So, as an economist you have the Excel spreadsheet, and it became my best friend. I translated everything into Excel spreadsheets, and realized that I needed sort of the metadata. I needed the timestamps, I needed the locations.

And in a brief four and a half months I was able to prove out that I wasn’t a cardiac patient. And I had done weekly EKGs, blood thinners, cholesterol lowerers since I was 24. And so, I thought, “If I can get rid of this diagnosis, I can probably get rid of all of it.” And I literally AB tested my way, I built some algorithms to look at the causality between what I was doing and how it was affecting my symptoms. And under the thesis of doing a little more of what was good and a little less of what was bad, I was hoping to sort of land myself in remission.

What instead happened was, I discovered that I was severely triggered by one thing. That discovery really changed my whole view actually on autoimmune disease, and how our bodies are misunderstood. And so, when I had sort of normalized my blood work, reversed my symptoms, and gotten out on the other side, it got stuck in my head that there was another way of viewing this. And of course I, like anyone who’s gone through a transformation and had their sort of come to Jesus moment, I went back to my doctors with my laptop and all the data, and it was just too overwhelming. None of them had the time, or even the desire to really take a look at it.

And so, I had just started my last company at the time, and was really sort of getting obsessed with this problem. And so, I started having friends of friends, or friends of friends’ a grandmother’s son’s dog’s neighbor come to me and say, “Hey, we heard about what you did. Could you help us?” And I was able to, over a period of four years, do the same for 70 other people with different autoimmune diagnoses. And then, we came together and started Mymee, really in the foundation that we are not a replacement of the physician. We are a tool to help people identify what is it that’s triggering them and their immune systems to overreact and attack itself? And how do we essentially alleviate the physicians by being a tool in their toolbelt when it comes to triggers and precision nutrition?

Dr. Kara Fitzgerald: It’s such an extraordinary, and powerful, and important, and impactful story. I’m so glad to know you, and so glad you’re here, and you’re on our side in doing this work. It’s amazing. Tell me what the one thing is. What turned out to be your trigger after four months of data capturing?

Mette Dyhrberg: Chicken.

Dr. Kara Fitzgerald: Chicken. Isn’t that astonishing? Chicken. Wow.

Mette Dyhrberg: The funny thing is that when I first… Obviously I got it wrong a lot before I got it right, because I had no idea what I was doing.

Dr. Kara Fitzgerald: Sure.

Mette Dyhrberg: But, when I realized that it was chicken, and I started working with others and seeing that their triggers were really in many cases quite random, I realized that we have a system where the standardized healthcare system is very based on something working for the majority. And even with celiac disease, where we have a straight-line causality with gluten, you are in a position where I think it’s four out of five is undiagnosed, despite the fact that there is a diagnosis, and there is blood work. And there’s quite severe side effects of not adhering to the no gluten when you’re celiac.

And so I thought, “Wow, with billions of people in the world, who’s to say that there’s not a lot of other people that have similar reactions, whether it’s to enzymes or proteins, whatever it is, but we just don’t even have the label and the test yet?” And so, that was really the explorative work that we started with Mymee, and have successfully now taken thousands of people through to figure out that some people can be out of wheelchairs by eliminating oxalates, or other things that really would never have come up as the thing that could change a life.

Dr. Kara Fitzgerald: Extraordinary. That’s just such an extraordinary story. And so, of course they’ve taken this lens, folks, and they’ve applied it to long COVID, and of course then there’s a strong long COVID autoimmunity connection. We’re going to circle back and talk about what this lens has landed on, what are some of the patterns they’ve seen with this long COVID phenomenon. But, we’re going to go through a few other questions first. Nikki, I want to hear your story as well, and what brought you to Mymee.

Dr. Nicole Bundy: Sure, sure. So really, my journey to get me here where I am today with Mymee was driven by both some professional things going on, and then personally. I was very traditionally trained in medicine, and practicing in an academic setting, general rheumatology. And I had this growing uneasiness about the traditional autoimmune disease treatment model. I loved that I had a growing number of effective drugs to help my patients.

But, I saw that these drugs, they certainly were not a panacea. I had non-responders, even to two, three, four drugs. And I had those who did achieve low disease activity, so like Mette said, the numbers looked good, but they were still really suffering with a host of symptoms that weren’t responding like their numbers did.

And I thought, you know, the world of diabetes and cardiovascular disease care, they had already firmly incorporated diet and lifestyle management into their standard of care. And I had countless patients asking me what they could do on their own to help themselves. And I really had no answers. There was nothing in my traditional training that gave me the tools I needed to answer these questions with any kind of authority.

So, in the face of this unease, I got sick. So, among other symptoms I developed Raynaud’s phenomenon, I had a crushing fatigue that no amount of sleep would fix. So, I did what I hate doing, and I went to the doctor, and ultimately I was found to have a positive ANA, a positive RNP, anti-RNP antibody, I had a low white count of two, my platelets were around 100. And I had low complement, C3 and C4. So, I had a diagnosis of basically a lupus-like disorder versus an undifferentiated connective tissue disease. And I started Plaquenil. That’s what I would’ve done for a patient.

Dr. Kara Fitzgerald: Sure.

Dr. Nicole Bundy: After about six or eight months, I felt no better, my labs hadn’t budged. And that’s when, through a series of events, I ended up seeing a fabulous doctor at Cleveland Clinics division of functional medicine. His name is Nate Bergman. And he really opened my eyes to a world of research going on about how food, and activities, stress, sleep  affect health, particularly immune related disorders.

So, I embarked on healing myself. And it took well over a year, with all the difficulties of a traditional elimination diet, lots of blindfolded trial and error. But, I found my triggers, and I’m happy to say that my labs have normalized, I’m off Plaquenil now for years. And even better, I have my vitality back. And once I got in that place, I was introduced to Mette, and I knew that Mymee was where I belonged.

Dr. Kara Fitzgerald: That’s  also a great, inspiring story. And yes, I’m glad that you were able to connect with Nate. He’s a really good doctor.

Dr. Nicole Bundy: Isn’t he fabulous? Yeah.

Dr. Kara Fitzgerald: Let me just ask you, I want to just ask you about… Both of you have normalized labs. By the way, before I say that, let me say, there’s an individual with IBD in our practice who’s trigger was also chicken. But, I can’t say that I’ve encountered it much. It tends to be something we think of as being more hypoallergenic. But yeah, it was a big player in her IBD. Normalized labs, both of you-

Mette Dyhrberg: It’s also, it’s actually quite interesting. Because my brother’s kid at the age of three got juvenile arthritis, and was wheelchair-bound. And of course, as a family, we all sort of went all in on figuring out what was going on. And after doing Mymee it was clear that his biggest triggers were eggs. And so, we are also now sort of wondering, is there some sort of genetic positioning to this? Being that we don’t understand why chicken and eggs are actually the triggers, we have no idea. But, I think what Mymee does is it makes an observation, it’s able to replicate the process, and figure it out. But, we don’t have all the answers to why.

Dr. Kara Fitzgerald: Yeah.

Mette Dyhrberg: And so, it might be a decade or two before we have all those answers. But, we need to at least start peeling this onion to get somewhere in terms of understanding, why is it that we still describe this disease with the use of the word confusion in it?

Dr. Kara Fitzgerald: Yes. Yes. So, both of you have normalized your labs. And I see that in practice, I don’t see it in all the cases. What do you say about that? Is it reasonable for somebody with autoimmune positive labs to expect to drop or clear them?

Dr. Nicole Bundy: So, I think what… The answer to that really brings up in my mind the concept of stages of autoimmune disease. We’re very comfortable in the medical world talking about stages of cancer, but we don’t typically talk about stages of autoimmune disease. And I think that is actually at the expense of patients. And I know Mette shares this. So, I think that the answer to your question, Kara, is it depends on what stage somebody starts to intervene in their life. There’s so much literature now about patients going into remission on biologics.

Dr. Kara Fitzgerald: Yes.

Dr. Nicole Bundy: But, now that we’ve had enough time on biologics that people are actually being able to come off of them and be in remission, but we see that they often flare up again. So, what my hope is, is that if we combine this lifestyle medicine with these really powerful medications, that’s when we’ll be able to achieve really sustained remission.

Dr. Kara Fitzgerald: Amazing.

Mette Dyhrberg: I think it’s really important to say that there is no cure for autoimmune disease. That is really, unfortunately, the culprit of all of this, that there is… Even though I normalize my blood work, I’ve been symptom-free for a decade, I promise you I could eat my way into a flare very easily. My body still has the susceptibility. And while I agree with Nikki on the staging, we also see people who have what we…

So, internally we use staging quite a lot in our work. The patient with stage IV who has organ involvement, we see sometimes if the triggers are clear, that they can get full remission and normalization of blood work as well. And that’s when there is organ involvement, and people have reduced kidney function and stuff they can also reclaim.

In those cases though, it really depends on… I remember Terry Wahls once said, with an MS patient, it’s almost like are they still on their way up the mountain, or have they crossed over and now they’re sort of free pedaling down fast? How far along are people in order for them to be peeled back up?

Dr. Kara Fitzgerald: Yes.

Mette Dyhrberg: And I think that’s really the key here, is let’s not have people walk around five to seven years undiagnosed, ignoring how people feel just because we don’t have a system that understands how to measure it.

Dr. Kara Fitzgerald: Absolutely. Yes. Absolutely. I’m just thinking about some of the late stage RA patients, rheumatoid arthritis patients that we see, and how heartbreaking that is.

Dr. Nicole Bundy: Yeah. Because there is joint destruction, and yeah, I know. I think that a lot of that is avoidable. Again, and certainly the medications are life-changing for so many people. But, it’s incomplete.

Dr. Kara Fitzgerald: Yeah. Yeah. All right, so you’ve talked about a number of the medications out there as a piece of the picture, perhaps not the whole result of the whole intervention. Well, not the whole intervention actually, from a functional lens. And they may not always make patients symptom-free. But, let’s pivot over to long COVID, whether you’re seeing any of these medications work with long COVID. What kind of symptoms are you seeing in your autoimmune population that overlap with those with long COVID? So, I guess let’s talk about long COVID and what you’re seeing, medications, and perhaps other interventions.

Mette Dyhrberg: So, I’ll leave the medication part to the doctor in the room. But, from my perspective what’s fascinating is if you take the top 20 autoimmune symptoms across our population, there’s an overlap in 17 of 20.

Dr. Kara Fitzgerald: Wow.

Mette Dyhrberg: So, the place where we have a difference is really in the dysautonomia, and then in the breathing, the lungs. But, when you look beyond that, the main complaints are still fatigue, brain fog, a lot of the similarities. Where they differ is that when you look at the profile of an autoimmune patient, they have sort of simmered. They typically have been on their journey, they’ve slowly been accumulating symptoms, and they’ve been getting used to, quote unquote, their new circumstance.

With the COVID long haulers, they got the same symptomology overnight. So, if you look at the questionnaires, they really have extremely poor management of their own health. They have a lot of places where if you just look at the numbers and we admit to the first couple of months in the spring of 2020 being sort of terrified at what we were seeing in the data, because the COVID long haulers looked like they were much, much, much sicker than the autoimmune population. And what we found was that it was almost like the scenario where you boil a frog in cold water, versus throwing it in hot water. It was simply the perception of how their situation was that was very different because it was an immediate change.

What our belief system was from the beginning was that this is an acceleration of pre-autoimmunity, and we saw in the early cohorts from Mount Sinai, where we are the preferred partner of their long COVID work, that it was very clearly autoimmune. And so, that was really why it was easy for us to start working on how to get to the root cause of these issues from the beginning. Because there was such an enormous overlap in symptomology, and the way that it was being displayed.

While that’s been under the microscope, what really happened next was fascinating. Because it didn’t look at all like what we had seen in autoimmunity. Because we saw things like the vegans and vegetarians, for example, they tanked. They were just much worse off. And instead of saying, “Oh, they weren’t managing their dietary style correctly,” we said, “Well, let’s look at the whole population.” And so instead we said, “What is the grams of protein that people are having on intake in a general basis?” And we found that it didn’t matter whether you were a carnivore or a vegan, what matters was grams of protein on a daily basis.

And so, at that point you have an intervention, right? Medical protein shakes were immediately put in as an intervention to make sure that people got the protein levels up. So, a lot of the things that we saw that differed is that in, obviously, long COVID patients are similar to autoimmune patients N of ones… you don’t have a one size fits all. But, what we did see is trends. Histamine hugely risen among a large part of the population.

So, we saw more that there was sort of trending factors, which of course in the early days made our strives towards helping people a lot easier. What we are seeing today though is that the COVID long haulers that we see are extremely complicated cases. They typically have organ involvement across a whole array of organs. They have debilitating fatigue, brain fog, and so on.

And so, they’re not necessarily easy patients to unravel, and figure out how to work with. And there’s some we can’t work with at all. We’ll work with them, but we can’t necessarily help them. But in general, we see that identifying triggers and understanding what goes into producing the symptomology is quite similar.

Dr. Kara Fitzgerald: So, it’s like they moved to… overnight they have a late-stage autoimmune condition, or multiple conditions?

Mette Dyhrberg: Literally imagine waking up with lupus overnight.

Dr. Kara Fitzgerald: That’s just mind blowing. I’m just so sorry to hear that. What is the incidence of long COVID? Do you have any numbers?

Dr. Nicole Bundy: It’s so widely variable.

Mette Dyhrberg: 25 million in the US.

Dr. Nicole Bundy: Yeah. I mean, it’s so widely variable. The estimates are between 25 and 31 million Americans.

Dr. Kara Fitzgerald: Right.

Dr. Nicole Bundy: But I’ve seen numbers that 50% of people, 5% of people after COVID. A lot of that depends on, we haven’t really come to a case definition yet. Some places say that if you have persistent symptoms after 12 weeks, for some it’s 28 weeks, it’s six months. So, I think these numbers are going to be widely variable. But, suffice it to say that this is not a small minority.

Dr. Kara Fitzgerald: Right, right. And you did give us those numbers earlier, so my apologies for asking that question again.

Mette Dyhrberg: But I also think that when we actually start stacking these numbers, if we look at one in five Americans have an autoimmune disease, the latest ANA numbers is from 2012, and at that point it was 41.6 million Americans. And then you put, if we take the lowest official number, 25 million long haulers on top, you start stacking that up, and it looks an awful lot like the prediabetes numbers. And that’s a third of the population.

And so, we’re sitting, unfortunately, on a problem here that is completely overlooked. The only upside, and this is going to sound horrible, because there’s so many people struggling from long COVID, the only upside for autoimmunity is that long COVID put high beams on this disease, and there’s more research going into this field in the last 24 months than in the last 24 years.

Dr. Kara Fitzgerald: Right. Right. Do you see… What kind of labs do you see high in long COVID?

Dr. Nicole Bundy: You know, and we can get more into this, Kara, but we don’t see a ton of labs, because to work with folks, we don’t always need them. In fact, we very rarely need them. And we can talk about our process a little bit more. But, so we’re not really collecting a bunch of labs. What I would say is, I want to go back to something that we talked about before.

Mette, you mentioned that there are people that we can’t help. And I think that that stems from the fact that, consistent with everything we’ve been saying, we don’t really know enough about long COVID to say what’s underlying the pathogenesis in every case. And so, for those people who either have viral persistence, or they have had micro thrombus, then we’re talking about a different set of people than those who have had autoimmunity triggered by this virus, whether it’s molecular mimicry, or bystander effect, right?

Dr. Kara Fitzgerald: Right.

Dr. Nicole Bundy: So, and that goes back into the what kind of labs we’re going to be seeing. We’ve already talked about the huge number of ANAs. And it’s not just ANA. People with COVID have been found to have a host of different autoantibodies. Both in the acute phase, and then also when they’ve looked at these patients weeks and weeks out, there’s development of new autoantibodies, and persistence of some of the ones that they saw earlier.

Dr. Kara Fitzgerald: And when you mentioned, Mette, earlier that you see that there is a strong histamine component, is this a clinical diagnosis, or are you actually measuring histamine, or some other biomarker?

Mette Dyhrberg: So, there’s a duplex here. Because there’s both us seeing people overreacting to histamine inducing foods. But also, with the COVID long haulers, a lot of time people bring an enormous amount of labs as they enter the program. I think where it becomes interesting is also when we’re talk… And I’m fully aware that I’m the economist in the room right now.

But, when we initially started up working with Mount Sinai, one of the things that we observed was that over 72% of the long COVID population was suffering from thrush. And as you know, it’s sort of been a thing of the age of HIV, but not really since. And all of a sudden we’ve seen these numbers in this.

The question really was, can we prove it, is all of the Doctor’s notes actually giving  this diagnosis? And I thought to myself at the time, I thought, “Wow, think about how we view the world and these patients, when we’re always thinking about the proof point.” Because I don’t think any normal person walking around don’t even know what thrush is. It hadn’t been described in the media yet, it wasn’t something that people came in and mentioned. It was something that doctors either identified and put in the journals, or because we were seeing such high numbers, we had them tested for it.

And I really found that we are sort of on this journey of trying to find the truth and statistical significance. But, a lot of times we sort of missed the point of body signaling, and where people really are on their journeys.

Dr. Kara Fitzgerald: Yeah. Yeah. So, Nikki, I just want to talk a little bit about what you’re… Earlier, you brought up the fact that there’s some patients… Or Mette said, some folks you’re not able to help as much as you want to. Are medications that you’re seeing effective in long COVID, or other ways? Oh, and I also want to ask you about vaccines, and whether they seem to be protective against long COVID, as has been proposed.

Dr. Nicole Bundy: Sure. As part of our program, we don’t prescribe. But, we have had patients coming in who have either already been on the host of different things that have been tried out there, so on steroids, received monoclonal antibodies. And then more recently, we’ve seen people on the JAK inhibitor, baricitinib. We’ve seen people on the IL-6 inhibitors, and they are… These are people who were obviously pretty seriously ill, and they survived. So, there’s not a ton to say yet about what is it strictly because of these medications.

But, we’ll learn a lot more in the next, I believe, several months as we are able to look at all this data. So, from our perspective, in addition to the information that Mette shared about finding these triggers, we’re also finding… Because as she also mentioned, we’re seeing a lot of autonomic dysfunction. So, we’re seeing that the techniques that we use to stimulate the vagus nerve, and stimulate the parasympathetic system, those things that are familiar to you, Kara, the humming and the singing, the breathing exercises that get that parasympathetic tone up, those have been very, very helpful.

We focus a lot on the slow return to activity. That’s very eye-opening for us, how exercise intolerant these folks are. So, that’s been a real big part of our intervention. Again, along with finding these triggering factors.

Dr. Kara Fitzgerald: Wow.

Mette Dyhrberg: And the triggering factors are only actually this impactful, because for many it’s an acceleration of pre-autoimmunity. So, when we have a long COVID patient land at Mymee, and we reverse their disease symptoms, often times the next question is, “Well actually, I’ve had these lingering joint pain for a couple of years, or I’ve had this…” And so, it becomes very clear that these patients were already on a journey. It was just accelerated. And I think we’ve always known that viruses and infections were the main trigger for autoimmune disease. But, it used to be Lyme’s disease and Epstein-Barr, and all of a sudden we’ve had 100 million Americans infected by COVID, and we’re unfortunately seeing this rise in autoimmunity, as Nikki mentioned earlier. But unfortunately, I think it’s going to be the next 24 months that we are going to see this rise continue.

 

Dr. Kara Fitzgerald: Well, it’s just really beneficial that you’re in the trenches looking at this through a prism of so many different vantage points, and crunching your data, and being able to observe trends, and hopefully really help us all.  Diet and lifestyle in… I want to move back to talking about autoimmunity. Although, the broader topic of autoimmunity. But, anything that you can pin to long COVID that would be beneficial. What kind of evidence is there in the literature to support diet and lifestyle in general, but specifically your work? And I know you’ve conducted some of your own research.

Dr. Nicole Bundy: We have, we have. So, I’ll speak about some of the general literature out there that I find really compelling, and then we can talk about a couple of things that we’ve published. There are tons of people working on this now. I really liked a study that came out of UCSD, Dr. Guma was the lead on this. What she did was she took 22 patients with RA and she put them on what she called an “itis” diet. So, an anti-inflammatory diet.

But really, it was very tailored. It wasn’t kind of run-of-the-mill. She thought it out very carefully. And they continued to take their meds unchanged. About half of the patients experienced a 50 percent improvement in the joint pain and swelling, as well as subjective measures, including fatigue, sometimes really just in a few days on the diet. Some people even went into complete remission. Now, that leaves 50% who didn’t improve. And that speaks, again, to what we do at Mymee.

So, I have no doubt that there are some general dietary recommendations out there that would be helpful for the large majority of people with autoimmunity. However, what that doesn’t take into account are these individual sensitivities. Who would ever take chicken out of a healthy diet?

Dr. Kara Fitzgerald: When I was in school, chicken you would use for a very, very austere anti-inflammatory, very short-term elimination diet. Chicken and rice, I think, was what we would prescribe. Yeah, so we… Of course, and so-

Dr. Nicole Bundy: It’s also why I’ve failed every elimination diet I’ve ever done.

Dr. Kara Fitzgerald: Yeah, of course.

Dr. Nicole Bundy:  Yeah. Yeah. Yeah. And so, there was another study, also in RA patients, so much of this work has been done in RA, and they put people on what they call a primitive diet. And so, that excluded meat, gluten, all dairy products. Versus the controls in that study who ate a balanced diet, that included those foods. And they looked at pain on a visual analog scale, and the SF 36 for quality of life. And in the primitive diet group, things did improve. Although, they also measured DAS-28, which is, it was just a measure of disease activity in RA. That didn’t really move.

But again, the patient reported outcomes improved. But, it’s hard to know without a much deeper dive, well, what is it about that diet that helped people? Was it excluding meat? Was it excluding gluten? And from our work, what we’d argue is it was different things from different people.

Dr. Nicole Bundy: Yes. Right, right, right. Well, going back to your point earlier, there are some things that you would omit from a diet that would help a large swath of those with an autoimmune process happening.

Mette Dyhrberg: I think one thing that we’ve heard over and over again, it’s hugely promoted, is that autoimmune patients should stop gluten and dairy. And we generally get those patients who got sicker when they were given this advice. I think we just had a client, I think it was Lupus LA, but one of these podcasts who shared that prior to Mymee she had been by her doctors given this diet, and as she was changing her diet, she was just getting sicker and sicker. And going through Mymee, she found out that her two triggers were potatoes, so starch, which is in a lot of the products you eat when you replace gluten with gluten-free products.

Dr. Kara Fitzgerald: Yes.

Mette Dyhrberg: And fructose. And so, she had actually on that diet been eating a lot of sugars, she was a baker, instead of the baked goods. So, she’d been replacing refined sugar with fructose, and she’d been replacing the gluten with potato starch. And so, she tanked. Today, she’s back to baking. Because gluten and sugar are not her issues. She has dietary issues, but not those.

And so, I think that’s where it becomes fascinating. Because we have had for generations this idea that there’s good diets and bad diets, and then the avocado is in, and then it’s out. It’s sort of these trends. But what we’re seeing is that those trends do not apply to our more complex rheumatic and neuro autoimmune disease people.

Dr. Kara Fitzgerald: Fascinating. Yeah, in the Institute for functional medicine, I teach in the immune module, and we introduce elimination diets. We actually do a pretty good job at running through a variety of intolerances and so forth beyond the standard elimination. But, when we’re advising clinicians transitioning into this model where to start, it’s do a simple gluten and dairy elimination. And we do. Obviously, we all have plenty of cases where we can-

Mette Dyhrberg: It works, right?

Dr. Nicole Bundy: Right. If you’re going to pick up people, we could go on forever and talk about the science behind the gluten, but that approach is still going to leave a lot of people eating their triggers, and maybe even as Mette said, actually eating more of their triggers.

Dr. Kara Fitzgerald: Yes. It’s extraordinary. So, you guys are doing this data crunching to identify these triggers. Are you aware of any labs that might capture them? There are labs looking at IgG, and complement.

Dr. Nicole Bundy: Complement, yeah.

Dr. Kara Fitzgerald: Or IgG4, or IgE, etc. There’s labs looking at flow cytometry, white blood cell size changes after exposure to different foods. Are any of these tools in your experience, or observation, useful? Or do they all have their limits?

Dr. Nicole Bundy: Yeah. Kara, I think that’s it, they have their limits. And this is coming from several N’s of one, some anecdotes, and I have had a fairly good sized handful of people come through that have had these, as you say, IgG, complement level food sensitivity tests. And I think that where they have value is, if they come back with strong positivity on one or two foods, I think it’s certainly worth taking those foods out, eliminating and seeing how it does.

And then, the other case where I think it’s helpful is where, and that was in my case, I reacted to everything. I mean, it was ridiculous. If I had followed the number of things that I should eliminate because I had reactions to, I would be eating three things. And so, what that says to me is, my gut was in a bad place, I had leaky gut. And my immune system was just so revved up from these antigens crossing the epithelial border and getting into the lamina propria, where all those immune cells are living.

So, yes, I think those tests can be helpful. But, I don’t think that they’re always telling you with the kind of precision that we’d like that, “Yes, this food in particular is something you are going to need to eliminate.” Certainly not for the long term. Because I think, again, in the cases where you are reacting to so much, they can heal their gut. They can heal their gut, and you guys, as functional docs, have great gut healing protocols. And they can tolerate some of those foods again.

Mette Dyhrberg: I was just about to say, I think that’s actually the fascinating part, is once you identify the true trigger in an autoimmune patient, they can oftentimes start reintroducing things that they have been severely allergic to since childhood. A good example is peanut allergies. Grown men and women who’ve had peanut allergies their entire life, once we identify their triggers, they can reintroduce peanuts and other nuts. That’s fascinating, because it does say something about the accumulative load.

Dr. Kara Fitzgerald: That’s such a provocative thing to say. I mean, clearly they’re working with, I’m hoping, their allergist when they try the peanut.

Dr. Nicole Bundy: Right.

Dr. Kara Fitzgerald: That’s huge.

Dr. Nicole Bundy: Right. We would never have people do that without very, very, very close supervision.

Mette Dyhrberg: We always hear about it in hindsight, right?

Dr. Kara Fitzgerald: Yeah, yeah.

Mette Dyhrberg: A few months after the program people are Like, “My doctor said so and so, and here we are,” or whatever. But, it’s fascinating to me to see the journeys, and see how many things we don’t understand yet.

Dr. Kara Fitzgerald: Yes.

Mette Dyhrberg: And I think that’s why COVID was so perfectly aligned with Mymee. Because we’ve built a platform for unraveling unknown causality. And I don’t think there’s anywhere in the medical realm at the moment where there’s more questions than answers than in long COVID. And maybe I should just sort of cover what Mymee really is.

Dr. Kara Fitzgerald: Wait, let me just make…

Mette Dyhrberg: Okay.

Dr. Kara Fitzgerald: Before you go there. Because that actually was my next question. I want to know what you’re doing, and also how we can access it. There’s certainly a lot of clinicians listening to this podcast really feeling probably, I don’t know if inadequate is the right word, but are just excited about the possibility of using this tool that you’ve created.

But before we go there, I just want to underscore this extraordinary point that you’re observing in your data. We’re dealing, again, it’s teaching in the immune module at IFM, I’m thinking about allergies. We have a focus on allergic disease here in this practice, so we’re using some fairly sophisticated interventions, I think. But, what you’re saying, Mette, is that there may be something more root cause.

There may be a triggering exposure that at a glance is not a cross reactive protein, it’s not in the same family, it’s not necessarily intestinal permeability. It could be something that we just wouldn’t even consider clinically, but once that’s removed… or we wouldn’t be able to identify it on lab tests. But, once this trigger, once this underlying… once the big issue is pulled, then their immune system normalizes. Their immune system calms down. Whatever arm of the immune system is turned on, be that IgE TH2, or others.

Dr. Nicole Bundy: Right. And again, these are anecdotes, these are one-offs. But, certainly there’s enough of an issue to be looked at.

Dr. Kara Fitzgerald: Compelling.

Dr. Nicole Bundy: It is very compelling.

Dr. Kara Fitzgerald: Yeah, it’s really compelling. It’s huge. Okay, so with that just out of the way, let’s talk about what it is you’re doing over there at Mymee.

Mette Dyhrberg: Obviously, it’s a clinically validated program. And we’ve proven to reduce autoimmune symptoms in over 90% of the members. But, what the approach really consists of is, cut down to basics, three key elements. It’s an easy to use mobile app that uses the snap to track feature. So, all you need to do is either take a quick photo of what you’re eating, or if you’re logging symptoms for example, let’s say a runny nose or joint pain, it’s tailored to you. So, all you do is tap a button.

And so, the idea is that it maximum takes a couple of minutes a day to give us enough data to make the causality. We basically then take your body’s signaling, and we turn that noise into understanding by pinpointing casualties between what you do and how it affects your symptoms, using our proprietary technology. And as Nikki said earlier, studies show that 80% of the immune system is determined by these lifestyle environmental factors.

But, I think third, and perhaps most importantly, our approach is led by certified coaches that can translate these machine insights into a personalized plan. Everyone on our clinical care team has reversed their own autoimmune disease, like Nikki and I. And through these weekly one-on-one sessions, our team can help people avoid the triggers by guiding them through these small and doable changes over time.

And so, I am a strong believer that the diagnostic part of identifying the trigger, while hugely important and valuable, it’s nothing without behavior change. And so, while Mymee’s technology helps identify triggers in as little as eight weeks, the traditional way of telling someone, let’s say, “You can’t have stone fruits,” well, what does that mean? But, actually going through people’s diet and show them what wines can they have versus what can’t they have, and helping them incorporate it. Because it’s women who has jobs, husbands, kids, they have lots of responsibilities. And oftentimes, we put ourselves at the bottom of that laundry list.

Dr. Kara Fitzgerald: Yeah.

Mette Dyhrberg: And so, we need things that can be done in an easily manageable way. Because at first, when you’ve gone through Mymee, we’ve now told you you have to change something, whether it’s diet, or something more complex like gluten or eggs, or whatever, it can be in everything, we’re actually making your life more complicated, not less complicated. Where we win is because the price is right. If you can all of a sudden pick up your kids, do eight loads of laundry, or get out of that wheelchair that you’ve been bound to because you take out one or two things of your diet, then all of a sudden it becomes worth it. But initially, it’s actually hard to wrap your head around.

Dr. Kara Fitzgerald: Yeah, absolutely. And so, that coaching needs to be exquisite, and very supportive. I’m sure the app is really helpful as well.

Mette Dyhrberg: And so, our app is really built, I call it zero to one. You come in, and it’s almost barely existing, the app. But, the app is evolved around you and your journey. And of course, when you’ve had thousands of individuals, all of those N of ones might be different. But when you line them all up next to each other, all of a sudden patterns emerge, theories emerge, and all of that is leading the way that the next person goes into the program. So, for every client, we get smarter about what it takes, and where those nuances are. And that’s how we actually have been able to over the last 10 years get better and better, and faster and faster at understanding what are the importance?

A good example is, five years ago if you came to Mymee, we would focus on your sleep. Today, we don’t. Not because we don’t think sleep is important, but because we’ve figured out how to stack the problems. And if you wake up between 1:00 and 3:00, then it’s a digestive issue, it’s not a sleep issue. Whereas if you wake up between 4:00 and 5:00, it’s a completely different problem. But, we have the specificity in our data to see what kind of problem is this. And all of a sudden, you can build the stack differently. And that’s what helps us give results fast.

Dr. Kara Fitzgerald: What is the 4:00 to 5:00 problem? I’ve been doing that lately.

Mette Dyhrberg: I think we’ll go there. Because it really is interesting to see how all of these nuances on the sleep side pairs in to how people live their lives, and not least how that impacts everything they do.

Dr. Kara Fitzgerald: It’s just so fascinating. Talk to me, Nikki, about the study you published, and just leaping off of what Mette’s just said.

Dr. Nicole Bundy: Sure. So, we took a look, this was early on, we took a look at people with lupus, and randomized them to the program, plus their usual care, or usual care alone. It was a pilot study. We ended up with about 50 people that were randomized, and the results were really, really compelling, very encouraging. We looked at something called a lupus QoL. That’s a validated tool looking at several domains related to health related quality of life. And specifically, again, was designed for lupus.

And we saw that across almost all the domains, we had significant changes. And the magnitude of the changes, particularly in fatigue, were incredible. And as you know, fatigue is one of the most common and debilitating symptoms that people with lupus suffer from. So, our results were published in 2020, and that was really our first real hard look at the data that let us know that this is really something that’s impacting people’s lives in a really meaningful way.

Dr. Kara Fitzgerald: By the way, folks, all of the studies that Nikki’s mentioned we’ll corral together onto the show notes. So, you can go and find links to the studies at the show notes. How about comparing to lupus studies looking at different drugs?

Dr. Nicole Bundy: Sure. I can speak to the end. The magnitude of change, again, in fatigue I want to point out in particular, but also in pain severity, pain interference, these outpaced the improvement that you see in many of the drug studies. Some of this, again, is prompted by the fact that the fatigue doesn’t seem to really be touched by the drugs and so many patients.

Dr. Kara Fitzgerald: Yeah.

Dr. Nicole Bundy: So yeah, those were really marked, marked improvements.

Dr. Kara Fitzgerald: So, it’s very exciting. And you’re working with diet and lifestyle.

Mette Dyhrberg: Yeah, that’s awesome. It’s funny, because I think functional medicine has played a huge role in my thinking. And I think a lot of kudos to what Jeffrey Bland, and the team of everyone who’s been lifting in functional medicine has done over the years. Because when you’re coming from the outside coming into healthcare, it’s actually quite hard to wrap your mind around how things are working. And I really think that functional medicine has paved the way for a whole other way of viewing the body. And I don’t think that Mymee and other things would even have a shot in a pre-functional world.

Dr. Kara Fitzgerald: Right. I want to just turn our attention back to long COVID. We started to get into it, and you’re seeing it a lot. Can you just share with me… So, you articulated the fact that, it sounds like you’re able to remove some people fully out of it, and they’re back into their world, and we talked about what it looks like in immediate onset late stage autoimmune condition. But, you’re struggling with others.

Anything you want to talk generally speaking in what you see in your data, what interventions appear to be most broadly useful in this population? There are people, there are clinicians listening to this who are treating folks with long COVID, and it’s probably a huge challenge for some of them. So, I know they’re paying attention to what you’re learning. And, there’s probably individuals with family members, or individuals who are suffering with long COVID themselves listening to this podcast. So, what can you say from your data? How would you guide us?

Dr. Nicole Bundy: I’d say we covered it briefly a little bit before. I would say that one of the biggest things is to pay attention to the dysautonomia. And that is related to the real exercise intolerance for these folks. So, I don’t know if you’re familiar with the Levine protocols for POTS, but we do draw from that pretty heavily, with graded exercise, making sure that the initial exercise is often supine, whether that’s reclined bike or swimming, but not upright. And having people alternate their days between doing their more aerobic work, in which heart rate is very closely followed, and more gentle weight training.

So, I think that that autonomic piece is really important. We do a lot of special breathing exercises. We’ve done a lot of, again, I’ve mentioned before, but the humming and the singing. And we’ve seen that really help a lot of people.

Mette Dyhrberg: But, I do think that those are the more general pieces that go across the long COVID population.

Dr. Nicole Bundy: Right.

Mette Dyhrberg: We are seeing that the same mechanisms that work for an autoimmune population are the mechanisms behind the long COVID patients. And so, it’s varying in terms of how it shows up. But, whether it’s the more usual histamines, or oxalates, or specific triggers is less important. But, we’re seeing the same patterns. And that’s what’s fascinating. Because in a way, it gives us an insight that we’ve never had before.

The data that will be coming out in long COVID is interesting in the sense that, we’ve mentioned earlier that an autoimmune patient has been slow boiling. And when you’ve been getting sick over a long period of time, it’s also harder to determine certain things. But in these cases, it’s fresh cases. All of a sudden you can actually explore everything. There’s a lot of detail that you can capture, that you couldn’t capture over the patient that has spent a decade getting to that moment.

And so, that’s, I think, where the data that would be coming out in long COVID is most interesting, is that it will give us insights into the background of the autoimmune sort of reflection, that we actually didn’t have a chance of even getting close to prior. I guess it’s a very small thing, but I do think that when we started this journey with Mount Sinai, it was based on sort of share despair, in the sense that there was really very little understanding of the population, there was very little understanding of who they were, why they were suffering the way they were, or if there was interventions to be put into play.

And one of the things that has become very clear for us, that is the biggest differentiator, is really the neuro piece. I don’t know if you saw the press release today, but we just acquired a company who was the number one in the MS space. Because it was an expertise that we started to see ourselves lacking as we were going more and more into the long COVID space.

One thing that you also asked was physicians on this call, how to utilize Mymee, how would someone work with us. And anyone who is referring to us today is really using us as a tool in their toolbox. If they’ve gone out and done inflammatory testing, or anything else that didn’t really reap the results that they were hoping, they would refer people to Mymee, and see if we as a team can help people identify things to improve quality of life.

We, of course, send reports back to the physician. But, it’s a small lift for the physician in the sense that we are sort of a tool in their toolbox the same way as a test facility is. We don’t take a lot of time. We will very happily see any lab work and results that is present, but we don’t need it. And so, we can work with the physicians in a very transparent way. And I think because we don’t overlap, we don’t make any advice on drugs, vaccines, any of the physician related areas. That’s not our expertise. We help people drill down and understand their triggers, and we help them make that behavior change.

Dr. Kara Fitzgerald: I just wanted to point out, if anybody missed it, Mymee’s in partnership with Mt Sinai’s post COVID treatment center, and you guys are just working together to tease out what this phenomena of post COVID…

Mette Dyhrberg: Yeah. So, of course we get a lot of our patients referred from Mount Sinai. Especially because they only have the capacity of, I think, 700 people at the New York center. So, that’s a given. But I think more so than anything, I love the relationship we have particularly with Dr. David Putrino. Because it’s really a center who’s been very open and forthright about how many questions are unanswered.

And I think it’s been very imperative, at least for us as an organization, to not go out and pretend we have an easy solution for COVID long haulers. We don’t. We do the hard work with you, and we’ve been able to help people get to better places. But as mentioned, there’s just some people where we still don’t know how to get them over that tipping point.

Dr. Kara Fitzgerald: Well, I appreciate your working on this problem. I just want to… I have a couple more questions. I want to go back to, you’ve brought oxalates and histamine intolerance up a couple times in this conversation, both in autoimmunity, but as well as COVID long haul. Are you seeing, is it a relatively common problem in the Mymee population?

Mette Dyhrberg: Particularly in the long COVID more so than in the general autoimmune population. I think the reason that I raised those two is just because I think they’re often missed. I think people think they eat healthy and then they eat a Poke bowl, which basically consists of everything a histamine diet shouldn’t comprise of. I think a lot of times when we talk about dietary triggers, people think of it as the traditional gluten, dairy, something like that. But, what we are seeing is that it’s often these categories that people are completely unaware exist.

Dr. Kara Fitzgerald: Right.

Mette Dyhrberg: So, even people who sort of had ideas that, “Oh, I shouldn’t be doing this, and I shouldn’t be doing that,” but they have no idea why. And so, what we quite clearly, because it’s something we do every day, can see is that, “Hey, if you are having smaller reactions to these two or three things, we can actually help you identify what are all the other things that could be in that bucket, and then how do we then get you back on track and identify?”

Because again, histamines is not often, for an autoimmune population, the main trigger. But, once you have a main trigger, histamine will always be present. So, you sort of need to peel back.

Dr. Kara Fitzgerald: That’s interesting. That’s interesting. And both of those, I think, oxalates, stone formers notwithstanding, both of these are about significant gut disruption, wouldn’t you agree, Nikki?

Dr. Nicole Bundy: 100%.

Mette Dyhrberg: Because autoimmune disease is so related to gut, it’s almost crazy that it’s not better described.

Dr. Kara Fitzgerald: Understood, yeah.

Mette Dyhrberg:  And I also think, to be fair, the way that we’ve looked at the body. When I grew up, people were like, “The appendix, who needs it?” It was almost a nuisance for people to have it. And today I think of it as the pantry of the micro biome. It’s where you go and store a little for winter, or pick up a little if there is imbalance. We are now talking about the importance of the micro biome, and how to balance it. But, the pantry is gone. It’s like having a house in Florida with a thermostat that’s broken, and either it’s hot or cold. And so, I think we’ve sort of missed the point of how brilliant the body is as a regulator of its own processes.

Dr. Kara Fitzgerald: On that note, I just want to… It’s just such a compelling conversation, such important work you’re doing. We’re just going to have to come on when you’re ready to share more. But, Nikki, what do you see as the hope for the future of autoimmune disease, COVID long haul, and the work you’re doing over at Mymee? Why don’t you take us home with your final thoughts?

Dr. Nicole Bundy: Sure, sure. Yeah. Our mission really is to transform the health and well-being of people suffering from autoimmune disorders, including long COVID. And to achieve this, we’re leading efforts aimed at spreading awareness to patients and clinicians about the power of lifestyle medicine for those with autoimmunity. It doesn’t only belong to people with cardiovascular disease and diabetes. We really want the stakeholders to understand that a one-size-fits-all approach will not work in this area. And the painful trial and error process of so many autoimmune patients that they go through needs to be replaced with “self-evidence,” an N of one approach.

So, together with experts like you, Kara, and so many of your colleagues in functional medicine, plus the dedicated researchers who are out there trying to advance the field, we really want to make personalized diet and lifestyle medicine adjunctive standard of care for those with autoimmune disease.

Dr. Kara Fitzgerald: Absolutely. I think that’s entirely reasonable. And we’ll certainly support you in manifesting that. Nikki and Mette, I just want to, again, thank you so much for joining me. Finally. We’ve been talking about this podcast for years. So, it’s really great to have you.

Dr. Nicole Bundy: Thank you, Kara.

Mette Dyhrberg: Thank you so much, Kara.

Dr. Kara Fitzgerald:  As always, thank you for listening to New Frontiers in Functional Medicine, where our sponsors help bring the very best minds in functional medicine, and today is no exception. Not everyone can be a sponsor on my platform, and I so appreciate the good work, relentless research, and generous support from my friends at Biotics, TA Sciences, and Integrative Therapeutics. These are brands I know and trust in my own clinic and can confidently recommend to you. Visit them at BioticsResearch.com, TASciences.com, and IntregrativePro.com, and please, tell them you learned about them on New Frontiers.

If it’s not too much to ask, I would appreciate a thumbs up and a kind review wherever you listen to New Frontiers. Thanks.

Mette is a digital health innovator and the founder of Mymee, a specialized care and support program for people with systemic autoimmune diseases and COVID long haul. An economist turned diagnostician, Mette first entered the functional medicine arena after attempting to tackle her own chronic health issues. Since her first autoimmune diagnosis at 14, Mette battled an evolving set of symptoms and treatments until taking matters into her own hands to hack her health and successfully bring herself into remission. Using an Excel spreadsheet, she began to systematically identify and test potential correlations between her symptoms and various environmental factors to find her disease triggers. Her successful results became the basis for Mymee which uses self-tracking, data analytics and expert health coaching to help people find their own unique triggers, manage disease flares and improve their quality of life. A recognized authority on autoimmune issues, Mette regularly speaks on rethinking healthcare and autoimmunity at industry events, including Stanford Medicine X and Exponential Medicine. Mette holds a Master’s in Economics from Aarhus University/UCLA and is a certified health coach

Dr. Bundy is a licensed, board-certified internist and rheumatologist who is passionate about improving care for autoimmune and other chronic diseases. She has 15+ years of experience as a practicing rheumatologist and clinical researcher, and is focused on developing innovative solutions that leverage the growing understanding of the role that lifestyle and diet play in the development and course of autoimmune disease. Her interest in functional medicine and preventative rheumatology come from her experience working with patients as well as personal struggles with her own health. At Mymee, Dr. Bundy sets clinical and research directions, supervises ongoing clinical studies, serves as a subject matter expert fora number of autoimmune diseases, and builds external collaborations with clinicians, researchers, and other key partners. Dr. Bundy received her MD from Yale University School of Medicine and her MPH from Yale University School of Epidemiology and Public Health. She was a Professor in the Rheumatology division at Ohio State University as well as a Clinical Instructor at Yale University. She is frequently invited as an expert speaker on her research interests which include lupus, arthritis, and Lyme disease.

Digital Therapeutic Platform for Management of Systemic Lupus Erythematosus

Mymee website

Mymee study of individuals with lupus (c. 50 people randomized to program with usual care, or usual care alone. Significant changes seen in almost all Lupus QoL domains (Khan F, Granville N, Malkani R, Chathampally Y.)

Design of an anti-inflammatory diet (ITIS diet) for patients with rheumatoid arthritis (Dr. Guma and team, UCSD)

Privitive diet study in RA vs balanced diet, measures included SF36 and DAS-28 (Guagnano MT, D’Angelo C, Caniglia D, Di Giovanni P, Celletti E, Sabatini E, Speranza L, Bucci M, Cipollone F, Paganelli R.)

Younger You (book by Dr. Kara Fitzgerald)

DrKF Study

Better Broths & Healing Tonics (companion cookbook for Younger You)

• DrKF Clinic: Patient consults with DrKF physicians including Younger You Concierge
• Bio Age Lab Test
• Bio Age Self Assessment Quiz
• Younger You book
• Better Broths and Healing Tonics book