Season 2, Episode 9: Advancements in Treating Autoimmune Diseases with Functional Medicine with Dr. Michael Jurgelewicz

Evelyne: Today we’re talking about autoimmune disease and treatment with a focus on Hashimoto’s autoimmune diseases encompass more than a hundred different health disorders, which affect more than 24 million people in the U.S. Some statistics say up to 50 million people and an estimated one in 10 people worldwide. That was from a study in the Lancet last year, and 75% of people affected are women. It’s also the third most common cause of chronic illness. So I really believe that integrative and functional medicine can help so much here. So I’m really excited for this conversation today. Dr. Mike Jurgelewicz is involved in the research coordination and execution of new product development and product reformulation as well as clinical and technical support for Designs for Health.

He has been studying nutrition and wellness for the past 17 years and is an adjunct clinical instructor for the Master of Science and Human Nutrition Program at the University of Bridgeport. He is a board certified in nutrition by the American Clinical Board of Nutrition, a diplomat of the Chiropractic Board of Clinical Nutrition, a certified nutrition specialist and a doctor of chiropractic. He’s also a member of the American Clinical Board of Nutrition’s Item Writers Committee and is the author and contributor to several professional publications. So, Mike, tell us more about your story. How did you get into this and into nutrition then specifically focusing on autoimmune diseases?

Michael Jurgelewicz: Sure. So I got introduced to, I would say, the functional medicine back when I was finishing up chiropractic school because we do get exposed to clinical nutrition in the program, but there was a couple professors that I had that were doing some functional medicine and I started to go to some of their clinics and see what they were doing. But when I got out of chiropractic, I should say, when I first got out of undergrad, I found out that I had positive antibodies for hypothyroidism and that just stuck in the back of my head, but I didn’t have hypothyroidism. So when I was learning a little bit about functional medicine, I really started as many people that get into the integrative functional medicine space is they start to go down their own health journey and as they discover their own underlying issues and they correct those, then maybe they have other family members of the same issue and they help resolve that and then they start to attract a lot of those individuals into their clinical practice.

And so ultimately I treat or help support those with most of the more chronic conditions. I don’t have really a specific niche, but I tend to attract a lot more with autoimmunity, for the most part NGI, just because that tends to fall through the cracks of traditional medicine. And I think the big thing is these individuals that have the autoimmune issue, regardless of their label, they’re not really being told by their practitioner that they can change the trajectory of their health issue with lifestyle changes, dietary interventions, and nutritional therapeutics. So that’s how I got into it. And as far as designs for health goes, I’ve always had a passion for nutritional therapeutics and I got exposed to the brand when I was in chiropractic school using them on myself. And then obviously later down the road getting more involved in product development and clinical support, et cetera.

Evelyne: Awesome. Well, we’re happy to have you on our team. So what are some of the most common autoimmune diseases that you see in practice? And would you say that people come to you when they’ve already been diagnosed elsewhere with an autoimmune disease or they’re coming to you for different issues and then maybe you suspect some things, you’re going to test antibodies and then they may not have an autoimmune disease yet, they may just have the antibodies. Can you talk a little bit about that as well?

Michael Jurgelewicz: Yeah, I would say it is all over the place, but for the most part, those who have the Hashimoto’s is definitely one of the most prevalent just because 90% of those that have hypothyroidism in the US is typically an autoimmune origin. And those individuals, for the most part, I’m probably not picking up on that immune dysfunction. Many of them probably have had some hypothyroidism for some time, maybe they’re on medication. And then just because the functional medicine model is becoming more prevalent now and there’s a larger awareness, these individuals are having some of their antibodies checked and they’re like, “Oh, I really had Hashimoto’s.” And the thing is they’re still taking medication, they’re still following the standard of care, but they’re still symptomatic. And our goal is to obviously figure out let’s correct the underlying immune dysfunction, but the other types of issues tend to be inflammatory bowel diseases is pretty common as well as rheumatoid arthritis.

And then you have the whole, a lot of just the mixed connective tissue type issues because whether that’s Sjogren’s, lupus, et cetera, just because some of these individuals, what happens is they don’t really have a label at this point and they have an ANA that’s positive, which could be due to inflammation or some autoimmune issues, but they don’t typically meet the criteria for any one label. So they’re often told, well, we don’t really have an answer for you. You can try some of these chemotherapeutics or other immune modulators and see how you respond to it.

And a lot of these individuals, because they don’t really know what’s going on, they’re not really comfortable with any medical management at that point. And they start to do some research. And then from our goal is not necessarily to really treat a label or a condition, it’s more of, okay, we’re not here to replace your primary care specialist, but what we’re going to do is we’re going to look at some snapshots of your health to see where your physiology is not functioning optimally, and then we’re just going to support that, whether that’s with diet, lifestyle and therapeutics.

Evelyne: And you mentioned ANA antibodies, remind me again what that stands for.

Michael Jurgelewicz: Yeah, the anti-antinuclear antibodies. So again, it’s not really specific to one autoimmune issue, but then obviously, if it’s positive, there’ll be a reflex to a certain type of pattern as well as a whole array of the other types of lupus or Sjogren’s, et cetera. And many times these individuals just have that elevated and they may have joint pain or some other things. And so the whole goal is in the traditional model, if you have a positive antibody, it’s looked at, okay, well, that’s going to be positive. Whatever issue you have going on, it’s just going to get progressively worse and you can’t really become empowered and take control of it.

But from our perspective it’s more of like, okay, this is a state of your immune dysfunction at this moment in time, and not that you ever really are curing something, but the whole idea is thinking like a dimmer switch in your house. If you can go down that rabbit hole a little bit, identify those handful of things that are abnormal in that person’s uniqueness bioidentical or biochemical issues, then you can essentially plug up those areas and then turn that dimmer switch so much so that you’re turning that progression off or temporarily putting something into remission. And as long as people are identifying or addressing those underlying issues, then ultimately they can change the course of that.

Evelyne: Yeah. So when you have a patient in front of you who has positive ANA antibodies, are you going to be testing for other antibodies? And then along with that question, what are the lab tests that you’re automatically going to run on most people who come to you with positive antibodies?

Michael Jurgelewicz: I would think historically when I first got into functional medicine, I was probably doing a lot of testing and a lot of specialty lab stuff all at once. And things have evolved over the last probably 14 years or so in the sense that what I try to do is bridge the gap from the traditional labs. And I try to identify… Because most people as we know, are always going to have some lab work done, but it’s typically limited. And many times the stuff that’s not tested, they’re not really diagnostic for disease, they’re biomarkers of dysfunction, whether they’re investigational markers around nutrient status or oxidative stress markers, inflammatory markers, and they’re obviously not tested, then I’ll usually try to pair it with one type of specialty lab, whether that’s looking at maybe some GI dysfunction, which could be in the stool or maybe it’s different types of food antibody responses in the blood with different intestinal permeability type screens.

But to answer your question about the antibody screens, it depends on what’s going on. I mean, if they already have a label a little bit and the antibodies are positive, I may not expand on more antibody testing. But a lot of times if they have, just to your point, just the ANA positive for example, I’ll often run some antibody profile, usually bundled maybe with some food antibody tests where you at least get 17 markers where you can look at those as more predictors of future disease because we know those antibodies show up years before there’s a clinical presentation, and instead of having an antibody that’s positive and just letting the destruction continue to happen until you meet a certain criteria to now have the label, that’s where I think the functional medicine model works the best because they’re in that dysfunctional state where we can change that.

And then as far as the traditional labs go, and none of it’s anything that’s very unique, essentially it’s essentially looking at a high-sensitivity, CRP, maybe homocysteine levels, vitamin D levels and a mega-check for the fatty acid profile. I’ll still look at fasting insulin and A1C levels just because they’re not commonly tested unless someone’s already has some metabolic disease. And those few things, believe it or not, I mean, I can’t tell you how many times you have the individual that’s still taking a handful of supplements that they found online and they think they’re doing a good job for their overall health, but maybe their dose isn’t high enough or they’re not taking one of those things, I test it. And here you have a situation where their CRP levels are elevated, their omega-check is low, their vitamin D is low.

And I think from a foundational perspective, those are things that sure, you can just take those things therapeutically without testing, but I do think it helps dial it in because I’ve seen too many times I see those things as the list in the intake form and then when you test it, they’re not near optimal. And so that’s where I start with it. But then as far as the specialty lab testing goes, I mean, I’m trying to still look at what their… From a review of system standpoint, do they also have GI symptoms and other stuff that would make me think that I need to look at some of those things. So I have a lot of questions in my intake form that’s about 25 pages where they can give me all that information. And I think our advantage is most people that do this type of work spend a lot of time with their patients or clients and they collect a lot of information. And the history is so important in really trying to drive what type of testing to do.

And even though I may do that and have some good successful clinical outcomes, I mean you can do some other specialty lab tests and other biomarkers and identify some areas where things aren’t functioning optimally and address it a little bit differently and have a successful clinical outcomes. So I think a lot of practitioners when they’re getting into this type of space, it’s a little bit hard for them because they’re so used to the traditional model where you follow this algorithm, but really in functional medicine it’s just we have our own experiences and then there’s all these different types of snapshots we can take and there’s not one set way to go about it to have the end result up.

Evelyne: Yeah, I love that you said that, and I want to dive into that a little bit later on. I have more questions about the omega-3 index that you mentioned and vitamin D levels in general. So with the omega-3 index, we want it to be above eight, right? Is it eight?

Michael Jurgelewicz: Yeah. Well, I mean, I try to shoot for around 8% and some of the literature really supports that. If you’re looking at some of the lab cutoff ranges, they’ll list it optimal at greater than 5.5%. But I mean, like I said, you’ll probably see more stuff in the literature at like 8% and higher. What I’ve seen at least is in the majority of people that I test anywhere from 2.6% to 3.5% is often what I see. And that’s essentially telling you what your blood concentration is of those essential fatty acids. And I think when you look at some of these other biomarkers combined on a test, it’s not that someone has three or four separate problems, it’s more of like, okay, well, if you have inflammation that’s high essential fatty acid insufficiency or deficiency and then a vitamin D deficiency or insufficiency and you just optimize maybe those two things and get them on some anti-inflammatory type diet, that’s going to knock down the inflammation, that’s going to optimize their nutrient status and it’s going to change some of that regulatory balances or modulations of the immune system as well.

Evelyne: My follow-up question to that is I know that having an omega-3 index of higher than 8% has positive outcomes on mortality. Is there research showing that in autoimmune diseases having it at 8% or higher it leads to positive outcomes? And same with vitamin D, like in functional medicine, depending on who you’re talking to, some people say 50 to 80 nanograms per milliliter. And I’m curious, based on the research and also based on what you’ve seen in practice, where do you like people to be?

Michael Jurgelewicz: Well, there was the vital study that was in January of 2022, which was pretty cool because it had around 25,000 participants, and they essentially looked at vitamin D supplementation as well as omega-3 fatty acid supplementation. And when you looked at what the risk factor was and the prevalence of autoimmunity and the risk of developing autoimmunity, like the vitamin D optimizing it, or I should say they gave therapeutic doses, not what I would give a little bit less to what you alluded to, maybe like a gram or so. And it lowered that index or that lowered that percent by 15 or 20%, and then if you optimize the vitamin D, it was around 15%. So when you took them both collectively combined, it was essentially like a 30% reduction in that risk of autoimmunity. And so I think those are just the most simplistic things that a practitioner can do.

But what you alluded to is you’d always see these studies where they gave a 1,000 IUFD or 800 IUFD, maybe there was a one-off that was 2,000, and you’re talking about levels. Most of the time the research is showing, well, here’s the lab range of 30 to a hundred nanograms per ml, and if you’re 30.1, you’re optimal in traditional medicine. And then even with some of the literature we’ll say, well, that’s normal, but to your point is if you look at some of the research on the vitamin D council, they’ll say 50 to 60 nanograms per ml. There was a study in the Journal of Immunology back in 2012 that showed the maximum anti-inflammatory effect in immune modulatory effect occurred at 50 nanograms per ml. So I just shoot to 50, I just want it over 50 and based upon that originally. And then you also have to look at, there was a study done in 2022, which I liked because it showed the benefit of getting it over 30, but then it said, but even better, between 40 and 60.

So it was one of the first ones I’ve seen where they actually, besides the vitamin D council, showing that this range of the 40 to 60 is more optimal. But what we do know is if you live near the equator, farmers that live near the equator essentially can get from the sun exposure alone, they can reach up to a hundred nanograms per ml just from that. And so we know from that, from a physiology standpoint, that it’s not harmful up to that level. Then I guess the big thing is I can’t tell you how many times we’ve moved someone’s level from a 20 to 70 or 80 and then their traditional doctor sees that level and then they start freaking out and tell them it has to come down. It’s just one of those things that we have to explain to individuals that why we’re doing it.

A lot of times we’ll show the research to support why we’re doing it. And then the other thing too is when people get freaked out about vitamin D, toxicity is, even though the reference range is 30 to a hundred, if you Google vitamin D toxicity and the symptoms that are associated with that, in order to actually get those symptoms, you really need to get your vitamin D up to 250 to 400 in a blood level to actually have those types of severe issues. So even if someone overshot their level a little bit, you just stop taking it for a few weeks and then start back on at a lower dose.

Evelyne: Out of curiosity, when you’re working with patients who have low vitamin D levels, are you a fan of using higher dosing for a shorter amount of time or how do you usually strategize around that?

Michael Jurgelewicz: So, I mean, there’s a couple ways mean sometimes if they had a low level with their traditional doctor, some of these individuals may have been prescribed that higher dose prescription. It was like 50,000 IU once a week and they’re told to take it for eight weeks, so then they just top taking it after that and then their level just goes back to where it was. But a lot of the research shows that daily dosing is better than the weekly dosing from a maintenance perspective, plus there’s different interrelationships with other nutrients that influence vitamin D levels and the immune system. So with that being said, I always dose either 5,000 or 10,000 IU, and that’s usually going to be just in general context for the most part is if someone has a level less than probably 30, I’m going to go 10,000, and if they’re in that 30 to 45 range, I’ll just put them on 5,000.

Even when you’re looking at some of the recommendations from the vitamin D council, they’ll say You can give 5,000 IU a day to an adult without testing, without the concern of toxicity with it. But I think one of the important things about supplementation is it’s important to have other co-factors like vitamin K along with it because that’s what helps prevent arterial calcification. And a lot of people probably for the last decade have been… Because vitamin D’s become so popular and it’s traditionally sold over the counter as a standalone, people are just taking boatloads of vitamin D all the time, and even when I used to do a lot of the science updates and blogs over the years and looking at the research a lot, essential fatty acid or omega-3 levels actually influence vitamin D level to some degree.

I mean, it’s not going to just normalize it, but then magnesium can do that, plays a role as well. And so a lot of times by optimizing both of them therapeutically, there’s just some of those strong interrelationships and there are things that from a practitioner standpoint, I think it’s important to pay attention to and utilize because it’s going to essentially help with other things as well.

Evelyne: Yeah, thank you. I definitely want to go into diet and lifestyle as well, but since we’re already talking about supplementation, I’m curious about some of the other nutrients that you use in your practice, a lot around autoimmune diseases. And I feel like some of the controversy with these is that some are thought to be immune stimulators versus immune modulators. Can you talk about that concept?

Michael Jurgelewicz: Yeah, well, I mean, I think in general when you’re looking at some of the different, and Dr. Schoenfeld, he’s one of the biggest researchers around autoimmunity in Israel. He spoke at IHS back in 2019. Dr. Brady was able to get him over there. Then we had him at CASI a few years ago, but ultimately he wrote, he published a textbook, the Mosaic of Autoimmunity. And when you’re looking at some of these different dietary factors that can play a role, whether it’s supplementation or from a diet perspective, there’s things like coffee can have an influence, salt intake can have an influence, resveratrol, curcumin, essential fatty acids, dark chocolate. But then when we think about some of these different nutrients that we see from a supplementation perspective, for example, like in autoimmune thyroid, there’s the selenium and inositol and inositol is a secondary messenger to insulin as well as thyroid hormone.

And I think the big thing is, and why supplementation is so important, is because these individuals are coming to us in a crisis and they have some dysfunction or chronic disease state or from the immune dysfunction standpoint, they’ve had something chronically stimulating their immune system over a period of time and it’s lost that ability to function and it needs to get reset a little bit. And when you have these chronic issues, you have increased metabolic demands and nutrient requirements than what you can achieve in the diet alone. And so you can get inositol in the diet, but the whole thing is a lot of these people have metabolism issues or they have increased metabolic demands where they’re going to benefit from more of it, which can lower antibody levels and help with that from a thyroid perspective. But then selenium, for example, we think of it as just this micronutrient with maybe thyroid health helps with converting thyroid hormones, but realistically it’s also an antioxidant.

And so when you see it lowering antibody levels, especially when we look at some of the specialty labs, you’ll see oftentimes the nutrient and toxic elements together. So you’ll see selenium, zinc, copper in the upper portion, and then you see the heavy metals at the bottom and they make sense to be paired a little bit together because if you have some of these micronutrient deficiencies, then you’re actually going to put out more receptors on the cell for increased uptake, but they share the same protein transporters as some of the heavy metals. So actually, when you’re in a nutrient-deficient state, you’re going to be having an increased risk of potential heavy metal issues. And so from a therapeutic perspective, things like N-acetylglucosamine, that molecule, I mean that doesn’t really modulate the immune system, but what it does is we have the B cells that make our autoantibodies, which are basically tagging that tissue for future destruction, and then we have the T cells which are responsible for acting upon that.

And so a lot of these therapeutics that we’re giving are either working on the T regulatory cells or they’re decreasing the pathogenic T cell production to have that immune response. And so something like NAG, what it does, it actually blocks the receptors, the T cell receptors, so it can’t have that autoimmune response. And even when you look at some of the intestinal permeability type therapeutics that we use, you see a lot of these mucilaginous sluggish botanicals that are very soothing to the GI mucosa like Slippery Elm Marshmallow, Cat’s Claw, Musin and DGL. And so a lot of times we’ve always historically thought that they’re just really coding that GI lining and soothing it and healing it, which I’m sure it has those properties. But what they do stuff similar to the NAG, they’re blocking up these receptors so people can’t have this autoimmune response. So I think you’re not going to really, you can’t achieve those types of things from the diet.

So you can definitely eliminate some of the inflammation in the diet, but if you don’t address the underlying intestinal permeability, it’s like if someone’s house catches on fire, you can remove the inflammation, but now the house is damaged and it needs contractors to build it up. Well, you need things therapeutically, and it’s not always just glutamine, it’s some of those mucilaginous botanicals, it’s other therapeutics that can help block those receptors. Then you can think of, it’s not a one size fits all, but oftentimes since these individuals have lost immune tolerance for so long, then it does often take more than just two months therapeutically to help correct that dysfunction.

Evelyne: Yeah. I have a couple of follow up questions. You mentioned with the thyroid antibodies and using selenium and inositol, I have recommended that combination as well in people with Hashimoto’s. And do you find that generally antibodies go down all the way to where they’re non-detectable, or do you work people to where maybe they go down by say a few hundred points if they’re very elevated and then maybe symptomatically they’re a lot better? Where are you trying to get levels to?

Michael Jurgelewicz: Yeah, so I think from a practitioner standpoint, it’s important not to really get in the weeds too much with the antibody levels. I mean, I think when you’re testing it and you see it abnormal, that’s definitely going to tell you that they have some autoimmune dysfunction if you just want keep it that simple. But as I alluded to before, you have your one area of the immune system that’s making the antibody production, and then you have your other area that’s responding to it. And when you’re looking at some of the research with the therapeutics, sometimes those levels are not changing for up to six months. So you can’t expect someone just to get on these things therapeutically and six to eight weeks later all of a sudden start seeing all these antibodies drop. Now we also have to look at how long people have had their issue.

So for example, if there’s many times I’ve seen the antibodies go back to being negative or go back to normal, and obviously that’s a good thing because if it’s not normal, there’s nothing being flagged out there to go after. But I think sometimes where there could be some frustrations is, let’s say you have a different individual that you’re doing all of these things therapeutically, you’re seeing all their other labs improve and their antibody levels are still high, or maybe they slightly elevated, but then they feel great and you’re just like, well, the labs aren’t really corresponding with this. And that’s where it’s important to know, even though you have the antibody production still being present, if you’re doing all these things therapeutically from a lifestyle and a diet and from supplementation, you’re still influencing that T cell response. So if you’re modulating that T cell response, even though they have the higher level of the antibodies, they’re not going to be symptomatic and they’re not going to really have the destruction.

So I still retest them, but probably every six months. But it’s one of those things that I tell the individual that short, we would like to see it go down, but we can’t look at it purely as disease severity and the exacerbation with it. So I think a lot of people sometimes when they get first into functional medicine, the goal is it’s purely this level means x when the neuroendocrine immune type system is a lot more complex than that, and it shouldn’t discourage someone from thinking they can help people. And obviously the testing helps guide us in the way from addressing deficiencies and optimizing levels and helping with compliance. But at the same standpoint, we don’t want to just treat tests and not have people feel better either. So we ultimately want whatever they came in for, their health concerns, whether it’s fatigue or the GI issues with the autoimmunity or whatever else they’ve had going on, if they’re feeling great and then you have the labs to show with it, then that’s really what we’re trying to achieve with that outcome there.

Evelyne: Yeah, I want to go back to some of the other nutrients that we can use in autoimmunity. Tell me about your experience using things like mushrooms, medicinal mushrooms, andrographis, black cumin seed oil or Nigella sativa. I’m a big fan of that one. Are these also nutrients that you use in your practice?

Michael Jurgelewicz: I’m a little bit more biased, obviously just because of my involvement with product development and being on the raw material side of the business as well. But I tend to use a product that has curcumin in there with the NIG and the andrographis, a lot is like a foundational thing for anyone who has some autoimmune dysfunction because you’re not testing levels of curcumin in someone, you’re not testing those other things. It’s more of you see that stuff in the clinical research, but for bioavailability, but for the most part, we’re doing it because of their balancing either immune responses or they’re blocking those receptors. And so the par actin, I mean, I think the difference is when people think of immune stimulating versus immune modulation, sure, there’s different botanicals that have immune stimulation that we think more for different viral type issues like elderberry or echinacea, et cetera, and giving some of those things therapeutically.

If you have a cold or something for two weeks, that’s fine, but if you had an autoimmune person, if you already have an overactive immune system, you don’t want to keep stimulating it. So something like the andrographis is that’s not something that really is immune stimulating. It’s more it has some anti-inflammatory effects against things like interleukin six and TNF-alpha, and it also has some immune modulatory effects, similar how you would see with vitamin D, but it’s also not just a generic, a clinically studied trademark material that’s actually standardized to 50% of these andrographolides which have those properties. And so they have studies with autoimmune individuals. And so that’s typically why I like to use that. And in general, curcumin, if I wasn’t using that product, curcumin is obviously probably the most common supplement people that use besides vitamin D and omega-3. So they’re probably the three bigger things.

Now, the black cumin seed is another one that, it’s interesting you bring that up because it probably does benefit a lot of people with autoimmunity. I personally haven’t used it just because I’m trying to keep things like a handful of things. And this could be a perfect example where I may use curcumin and you might use black cumin seed and we can have a similar result. And I think a lot of times with black cumin seed is, there’s lots of research on there for many different things, and mainly because it has cardioprotective properties, neuroprotective properties, anti-proliferative properties, it’s an antioxidant, it modulates inflammation as well. So I think because black cumin seed in general is, it’s not a proprietary thing and there’s not really a lot of necessarily trademarks with it, so you don’t see the masses marketing it a lot, but from a raw material perspective and it’s standardization to different thymoquinone’s and things like that, it does have some benefits.

And when I’ve previously looked at things around autoimmunity or even Hashimoto’s and things, I mean there’s not a ton of human clinicals on it, but there’s probably about nine clinicals associated with autoimmunity in that there was one actually published in June of last year that was looking at women. It was more like a cell line study, but it did show some benefits from the autoimmunity. So I think it can be a good candidate for sure. I think the challenge is when a lot of professional brands have 300 plus products in their line, you can probably do a combination of a handful of things that are different with different individuals, and again, they’re still going to work mechanistically on some of the same modulatory effects.

Evelyne: Yeah, thank you for that. And you’ve mentioned gut healing before and using some of those herbs and nutrients for gut healing. Do you find that that’s something that you are treating in all of your autoimmune patients?

Michael Jurgelewicz: I want to say maybe like 80%+ that I noticed there’s some level of GI type issue. And I mean, it’s one of those things that most of the people I feel like that I’ve dealt with, they tend to know that already a little bit because when they’re researching stuff, but I think they just haven’t had any practitioners that are really looking at it. But definitely, we’ll deal with a lot of the therapeutics that way. Sometimes I’m waiting for testing to come back first to determine what I’m going to use. But I do besides the NAG, I mean, I use the immunoline, which is that serum bovine immunoglobulin a lot just because it has a lot of benefits around the intestinal barrier function. It also has a lot of benefits as a selective binder to certain dysbiosis type markers and Gliadin and other types of things that, and just because I have a higher prevalence of people that have IBD, there’s some really good clinicals on that as well.

And obviously let’s say if someone’s doing an intestinal permeability screen and they see antibodies to lipopolysaccharides, I mean, you can definitely look at what the stool looks like to see other dysbiosis markers and things as well, but there’s benefits with the immunoline on lipopolysaccharides. And so that’s one of my main things. Or you can use the gram negative cytol type botanicals that you would see in some of the antimicrobial blends with your uva-ursi, sweet wormwood, black walnut, and the different berberines, et cetera, if you have to be a little bit more aggressive and eradicate something from that perspective.

Evelyne: Yeah. I was actually going to ask you about the immunoglobulins because I feel like they’ve definitely risen in popularity in the last couple of years in the supplement world, and I’m sure you’re never just using serum immunoglobulins, but what are some things you’ve noticed? I know it binds to many different antigens, but specifically in autoimmunity, do you feel like there’s something going on other than the work that they do on the gut? Has that been studied?

Michael Jurgelewicz: Well, I think since you’re also getting that concentrated form of IgG, it’s also going to help people with the food sensitivities and a lot of those people just with the intestinal barrier function, you’re just going to get some more help and regulation with it. I also like Sac-Boulardii a lot. I mean, even though most people think of it was just more like during antibiotic treatment, there’s a lot of good research. There’s some small studies done on Crohn’s disease also. It has different antimicrobial properties. It has some other intestinal barrier type properties that we don’t typically see with some of the facultative anaerobes like lactobacillus and bifido that are beneficial. So oftentimes if there’s not something pathogenic that you have to eradicate, and it might be like a Klebsiella or something else, I might just do the immunoline with the NAG along with something like fluoromyces, but someone else might use the combination antimicrobial with other types of probiotics or oregano, et cetera, and have the same successful outcome.

So it’s just trying to pick what are probably the three to five things that you can do. And from a treatment perspective, I don’t like to give someone more than a handful of supplements at one time because there’s a cost and compliance associated with it. So if I know I have to correct some gut dysfunction or try to do something in that more remove type phase, I might do that therapeutically for the first one or two months and then when I discontinue something, then I’ll start to maybe add something out. So it’s just looking at from a priority perspective, what stuff is insufficient versus deficient and what’s the 80% that’s going to probably help them the most. And then every three months, that plan can change a little bit, but they’re probably not going to be on less than a handful of things.

Evelyne: I actually have some follow up questions for that and maybe we can tie the diet into it too, because it’s part of this treatment plan, but so you just said three months. So is that how long each phase of your treatment plan lasts and about how many supplements are you recommending in each? And then how strict does somebody need to be with their diet? I mean, I’ve definitely seen changes when I’ve recommended going gluten and dairy free. I’ve interviewed Tom O’Brien and he will say no gluten whatsoever when there’s autoimmunity. So I’m curious about your treatment strategy overall.

Michael Jurgelewicz: Yeah, so I wouldn’t say it’s necessarily broken into phases that way, but I often will meet with people every three months. I mean, I’m sure some nutritionists may do an increased frequency, but how I can do things is more at that three month mark because I’m usually continuing to test the abnormal stuff and then trying to dial it in and I have to change the dose and things like that. And so from a dietary perspective, I mean every person that I work with before I would do anything, they receive an intake form that’s about 25 pages, a seven-day food diary, and I won’t even talk to them or schedule anything until it’s completed. So then this way I’m not wasting time. And then I also know that when I get it back and how quick I get it back, it’s how motivated that person is.

Plus I have a readiness assessment at the end of that questionnaire as far as are they willing to make lifestyle changes, dietary changes, take dietary supplements, record what they’re eating? So all of that stuff’s on a different scale level. So I know what the expectation is, but to your point with diet, if someone has an autoimmune issue and I have a pre-screening call for five or 10 minutes and let them know how I do things, if they have an autoimmune issue and they’re not willing to go gluten-free, I’m not going to work with them because then it just tells me that, well, I’m not going to have a successful clinical outcome. And I mean, ultimately you want to help people. And if you have people that if they’re not willing to make the changes themselves, the traditional medicine model is perfect for those individuals because they’re not going to change their environment.

So if they’re not going to do that, we can’t do what we’re going to do because ultimately we’re not fixing these individuals or we’re basically just the teacher and we’re guiding them with a resource. And when they see the changes, it’s like, well, they did a great job to do it because they’re the ones doing those things on a daily basis. So the gluten is a deal breaker for the autoimmune. And then other things on the seven-day food diary is I also have their water intake. What’s their exercise activity that day? When do they go to bed? When do they wake up? And so those other lifestyle things are just as important as the diet. I mean, if someone is not getting adequate sleep, then it’s going to exacerbate any issue they have. And so that’s the big thing. I get real strict with gluten to start. I do think dairy is obviously a common issue with people, and I probably do more food antibody testing to have something a little bit more personalized.

Evelyne: And when you do the food antibody testing, how long does somebody need to eliminate those foods at minimum? And then do you take a phased approach to reintroducing foods or because they have autoimmune issues and they’ve already had the antibodies, do you try to keep them off several of those foods forever? Talk more about that.

Michael Jurgelewicz: If they have any reactivity to the gluten, which every single person with autoimmunity I typically I’ve seen has, and I don’t mean by just colliding antibody. I mean, if you’re looking at the 30 to 35 different wheat and gluten peptides that you see with some of the different immunology labs, I have yet to really see someone with autoimmunity that hasn’t had some reactivity to at least one of those peptides or some of the intestinal permeability screens that are normal. So with that being said, I tell them that the gluten is a long-term thing, and if there’s 10 or 15 foods, those IgG reactions typically stay in the system for three weeks to clear that immune complex. And so in the perfect world, you could probably say three or four weeks, but the reality of the situation is these individuals, we don’t know how long they lost that immune tolerance for, and you could potentially retest that test six months later.

And let’s say they reacted to 15 things, they might react to seven or eight, but they’re still the seven or eight things they originally reacted to. So I think the bigger point is that most of these individuals also, when they get some results back, they don’t just turn on a switch that day and then just start eliminating all that stuff on the list because it can be very overwhelming. Sometimes they got to put a plan together, and so I get them stripped the gluten first and then anything that’s moderate or highly reactive, we do our best to eliminate for close to two to three months. But as we know, if people have a decent amount of things they have reactivity to, we know they lost that immune tolerance and it’s more of an intestinal permeability issue, and we got to really go hard at healing that.

But for the most part, a lot of these individuals are eating products and not food. And so when they see the antibody testing come back and they eliminate it, I’ve had some really good compliance with it. And for the most part, since those reactions are inflammatory, you typically see maybe some weight loss associated with it, some inflammation that has decreased or they tell you about other stuff that they didn’t tell you about on the intake, even though it was pretty lengthy that maybe my joints aren’t hurting as much or I have more energy or I have less anxiety. And because a lot of those food reactions, I mean they cause generalized vague symptoms, you can’t really put into any label. So it’s like the fatigue, the headache, the joint pain, brain fog. And so I think if anything, it’s a tool that people, it forces them to start eating whole foods and then they’re not eating the stuff that they’re eating every single day because most people don’t eat more than 20 foods anyway.

And so the goal is really just to eliminate that for a few months, have them form some habits, and then depending on how they’re doing, if intestinal permeability screens abnormal, I’ll retest that after say six months. But if they don’t have a ton of reactivity to the other stuff and it’s more like gluten in some of the grains, I just have them continue that. But if they had a bunch of reactivity, I might retest that six to nine months later and get a new set point. But for the most part, most of those people are feeling pretty good. And then you’re doing the other therapeutics, so it doesn’t always warrant or retesting. It’s a clinical judgment. The same thing with stool testing. Some people retested in three months or six months, and if you had something pathogenic you have to eradicate, you clearly want to retest it right after that time. But if everything that you’re doing is improving their symptoms, their other lab markers looking good and they’re feeling good, it doesn’t always necessarily warrant the retest.

Evelyne: Great. Thank you for sharing that, Mike. Since you read a lot of research as part of your work here, what is exciting to you right now in the field of autoimmune?

Michael Jurgelewicz: So I mean, I haven’t really seen a lot of new stuff as far as therapeutically. I mean, you keep seeing a lot of the same therapeutics come up that we’ve talked about already just done again with another autoimmune issue. So it’s nice to see that that stuff keeps getting validated and it’s nice to share with practitioners. It’s also nice to share with the clients and patients. But I think if you’re just looking about that field in general, I think there’s going to be, even though we’ve been aware of it for a long time in our space, I think the traditional type model and the researchers are starting to realize more of the awareness of the environmental factors and not just the genetic part of it. So I think that’s going to continue. As far as biomarkers for susceptibility, I mean up until this point, we have these antibodies that are positive maybe seven to 10 years before a clinical presentation.

And so they’re the predictors of future disease. We talked about screening those, but there is some more research that’s going on to look more at different immune cells, so like the B cells and the T cells that I talked about as different biomarkers. And I think because what we see right now with so much AI going on out there and the machine learning that I think they’re going to be able to look at a lot more of these massive data sets and these actual cells, they’ll be able to potentially test for that may precede abnormality even before some of the antibody production. And we might be able to do more immune monitoring. So a lot of times when I just see antibodies positive, since I’m not going to diagnose someone with an autoimmune issue, I just say, hey, you got immune dysfunction at this point, and we’re going to address that from your physiology.

So I mean, I think there’ll be more opportunities maybe for targeted personalized therapies. But at the end of the day, there’s so much research that has been published the last several decades and it hasn’t turned into clinical practice. I mean, I’ve seen stuff with animal models and other stuff with MS, where the research team would basically say we should start looking at the intestinal barrier function for a therapeutic target in MS. And that was maybe 10 years ago. But I mean, what individual who has that diagnosis goes to neurologist and they talk about doing a stool test. So there’s still going to be that disconnect. And from our standpoint, it’s more taking those snapshots of their health and just not getting hung up on the label.

Evelyne: Yeah, very exciting research. I don’t know if it would be helpful or harmful, but I wish we could go every year or every couple of years and just get all of our antibodies tested, see where we have antibodies to in our bodies, and then hopefully we would do things to reduce our risk of that actually developing into an autoimmune disease, it’d be cool.

Michael Jurgelewicz: For sure.

Evelyne: I have a question for you that, well, we have three questions that we ask every guest on the show. So what are your top three supplements that you personally take?

Michael Jurgelewicz: So what I personally take and what I recommend for immunity is probably a little bit different in the sense that even though I have family history as autoimmunity and I’ve had some autoimmune dysfunction earlier on in my life, I mean, I would still probably say vitamin D is a top one. I make sure it has the K along with it just because I’m in Connecticut. So in the northern latitudes, I mean, we’re not going to be able to get adequate vitamin D production going in the sun, and obviously the importance with that. But as far as other types of therapeutics, I mean, I take curcumin because that’s just so important with so many things, whether you’re looking at autoimmunity, but I’m an active person from a weight training perspective and anything to help with having some anti-inflammatory effect systemically is good.

And my third is probably the delta and gamma, just because it’s a good antioxidant, mean we typically have, as we get older, we have an increased need for antioxidant type protection with any chronic type issue. But if you just look at it historically, or even in the last eight years or so, there’s human clinicals from things like dyslipidemia to osteoporosis to metabolic health and fatty liver disease and all these different targets that it’s a good foundational nutrient that is important. So not my mainstay for the autoimmune and for an autoimmune person, that third thing would probably be the official. It’s just that I eat a ton of canned wild sockeye salmon every week. So I’m an outlier when it comes to getting my omega threes, but most of most individuals, they either have an aversion towards it and they just don’t eat enough. So that would be my third one if I wasn’t getting adequate in my diet.

Evelyne: Nice. And what are your top health practices for your own personal health and wellbeing?

Michael Jurgelewicz: So I think the biggest thing is the three things that no matter how busy I am with things that can just keep me moving ahead and no matter how much stress I have to get adequate sleep, so I need to get my eight hours of sleep and exercise is important. I mean, you can’t put exercise in a pill. I make sure I get in my four workouts a week that I need. From a weight training perspective, that’s just important to me from a stress standpoint and feeling good and overall health. And then I would just put the diet and supplementation all into one. So from diet perspective, I mean, I’ve gluten-free probably since 2010, so probably the last 14 years.

And I’m very strict about that No matter what, even when I travel, if I eat out and even when I eat out, I’ll still order, but I’ll use some of the digestive enzymes that have the glutalytic and some of those proteases just in case I get some cross-contamination somehow. And then the supplementation, just because again, I know in the perfect world we’d want to get everything from the diet, but the reality of the situation is there’s just certain nutrients we can’t get for optimal health, whether it’s not in the soil these days or from the diet that we eat, we just can’t achieve it. So they’re the main three things.

Evelyne: And what is something that you’ve changed your mind about through all of your years in practice?

Michael Jurgelewicz: Honestly, part of it is I think I’d probably say some of the food antibody testing because I did it early on when I first started, and then I took a hiatus from maybe 2015 to 2018 because I probably had some frustrations that a lot of practitioners had where, I mean, you always hear controversy of is there validity to this? And people may have done different tests at different labs and seen some mixed results. What I will say is over the last probably 15 years, there’s been some really good clinicals on IgG antibody testing. There was actually one published in 2022 showing that IgG elimination was more effective than a low FODMAP diet for IBS than there was studies with migraine obesity. If you had to look at one type of immune response from a testing perspective that has stuff published in peer review, that is one of them.

But what I will say is it seems like a lot labs over the years have the technologies have changed. So I think with some of the newer immunology type labs and things that are out there, I mean, I can just say I’ve had from trying them over the last few years, I’ve had some much better clinical results than I’ve had in the past. And so I can only really speak for that. So that’s probably one of the big things. And individuals like it because they hear about it, and a lot of times I think it gets a bad rap. So many direct to consumer tests, and I’ve seen some crazy stuff on those. And that’s where I think there’s been some of the controversy, but I’ve been doing it more probably the last three or four years.

Evelyne: Great. Thank you for sharing that. And Mike, you actually get a bonus question, since you are on our product formulation team, what has been one of your favorite products you’ve worked on during your years at Designs for Health? It does not need to be related to autoimmunity just in general.

Michael Jurgelewicz: I mean, I guess if I had to pick something, it wouldn’t be one specific product, but it would be more of like a category. And what I mean by that is a lot of brands that are out there, and we do this as well, we buy a lot of trademarked ingredients with the science and everything. But one of the things that I think more from a research perspective and being more hands-on is we always wanted to have our own type of proprietary buy availability technology that we could enhance the delivery of some of those hard-to-absorb nutrients. Things like berberine, curcumin, DIM, quercetin, and even maybe some of those fat soluble vitamins. And so a lot of times in other industry spaces in order to enhance that absorption, they’re using different petrochemicals and polysorbate-AD, some of these things that will enhance the buy availability of these nutrients, but they’re not really natural and they actually can contribute to intestinal permeability or even be irritative to the intestinal barrier.

So I think why I liked working on those is because we’ve done some in-house clinical research with that. So that was fun to participate in with a lot of people. We’ve also worked with other PIs at different universities and published some research on buy availability on those. So it’s always good when you can do something unique and natural, and it gets similar results to what you see with some of the other products out there. And so we’ve used that technology in our Curcum-Evail®, the Berb-Evail, the DIM-Evail™, and then we also use it in some of our fat soluble vitamins with Vitamin D and K. And so as we know, I mean, if someone takes a capsule of any of those with just a powder and have it on an empty stomach, you’re not going to get much absorption unless they really have a meal containing fat. So because there was more involved there and some uniqueness to it, I mean, I’d probably have to go more with that with our e-veils.

Evelyne: Very cool. It must be so fun to be part of the formulation team.

Michael Jurgelewicz: For sure.

Evelyne: Yeah. Well, Mike, thank you so much for this chat today. I learned a lot. Thank you for sharing your clinical expertise with us. And thank you for tuning into Conversations for Health. Check out the show notes from resources from today’s conversation. Please share this podcast with your colleagues follow rate or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht dedicated to engaging discussions with industry experts. Exploring evidence-based, cutting edge research, and practical tips.