Chronic pain, depression, and sleep issues with Dr. Gary Kaplan

This week on The Less Stressed Life Podcast, I am joined by Dr. Gary Kaplan who is a doctor of osteopathic medicine (DO). Dr. Kaplan is dual trained in osteopathic and allopathic medicine, as well as acupuncture. In this episode, Dr. Kaplan talks about inflammation from the standpoint of the cause of pain and depression and how the immune system can drive the inflammatory responses. We deep dive into everything from depression to fibromyalgia, give you insight into how these chronic problems manifest, and how to potentially heal them. 

KEY TAKEAWAYS:

• Causes of pain and depression
• What drives the inflammatory process?
• Innate immune system - body's first line of defense against germs & foreign substances
• Microglia - the resident immune cell of the brain
• What is neuroinflammation?
• What products can you use for pain, depression, & sleep?
• What are strategies for down-regulating microglial activation?
• Unhealthy gut equals unhealthy brain
• What is long COVID?
• Surprising facts of social isolation
• Why it's important to look at adverse events during childhood
• Sleep + its effect on the brain

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ABOUT GUEST:
Gary Kaplan, DO a clinical associate professor at Georgetown University School of Medicine, founder and medical director of the Kaplan Center for Integrative Medicine and author of Why You Are Still Sick: How Infections Can Break Your Immune System and How You Can Recover. A pioneer and leader in the field of integrative medicine, Dr. Kaplan is one of only 19 physicians in the country to be board-certified in both Family Medicine and Pain Medicine. In November, Dr Kaplan will co-chair an international conference on New Developments in Understanding Chronic Illness: The Role of the Immune Dysfunction and Infections. 

WHERE TO FIND:
Website: https://kaplanclinic.com/
Instagram: https://www.instagram.com/kaplan_clinic/
Facebook: https://www.facebook.com/KaplanCenterforIntegrativeMedicine
YouTube: https://www.youtube.com/channel/UCjBaguhq1VYTBHMYlvKCMIw

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/links

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TRANSCRIPT:

[00:00:00] Dr. Gary Kaplan: Fix that because failure to fix sleep apnea will take 10 years off your life. Increased risk for hypertension, increased risk for diabetes, increased risk for depression, increased risk for obesity. So sleep apnea is low hanging fruit that we want to make sure we fix.

[00:00:14] Christa Biegler: Stress is the inflammation that robs us of life, energy, and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down. We're over medicated and underserved. At The Less Stressed Life, we're a community of health savvy women exploring solutions outside of our traditional Western medicine toolbox and training to raise the bar and change our stories.

[00:00:41] Christa Biegler: Each week, our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home.

[00:00:58] Christa Biegler: Today on the last stress life, I have Dr. Gary Kaplan, who's a clinical associate professor at Georgetown university school of medicine, founder and medical director of the Kaplan center for integrative medicine. And the author of why you are still sick, how infections can break your immune system and how you can recover, which I love that title, by the way, a pioneer and leader in the field of integrative medicine.

[00:01:20] Christa Biegler: Dr. Kaplan is one of only 19 physicians in the country to be board certified in both family medicine. And pain medicine being so important, which we're going to talk about today. Welcome to the show. Dr. Kaplan. 

[00:01:32] Dr. Gary Kaplan: So, thank you for having me on the show and I'm delighted to be here. 

[00:01:35] Christa Biegler: And we were just discussing offline about all the things we're going to talk about.

[00:01:38] Christa Biegler: It's going to be so much fun. First story time. Love to hear about your story and now you're a DO, our stereotypes of DOs is that maybe, I don't know if this is a correct stereotype, this is the stereotype I grew up with. DOs are more open minded to different things. And I know the things that you treat.

[00:01:55] Christa Biegler: And these are things that not everyone recognizes as even problems. So tell me a little bit about the background and how you ended up in integrated medicine. 

[00:02:03] Dr. Gary Kaplan: So, well, DO is basically the difference between the MDs who are better looking.

[00:02:08] Dr. Gary Kaplan: unfortunately, the osteopathic profession had the opportunity to evolve into the premier integrated preventive medicine field and did not do so. Their motto, unfortunately, was we're as good as you are. And what happens when you have that as your mantra, you end up becoming them.

[00:02:25] Dr. Gary Kaplan: The, being the allopathic profession. So we lost a lot of potential as a result of that. Only about 20 percent of osteopaths do any manual therapy as part of their practice, though it's part of all of our training. And it's a shame because manual therapy is an extremely important tool. I'll tell you a lot of my, you know, the naturopaths pretty much took over that.

[00:02:44] Dr. Gary Kaplan: the position in terms of properly integrating the... Integrative medicine with conventional medicine and done a beautiful job in terms of doing that piece of things. But my training is informed certainly by my osteopathic background, by my allopathic background, because I'm dual trained, I'm boarded in my boards are all allopathic boards.

[00:03:06] Dr. Gary Kaplan: My residency training was an allopathic training at Georgetown. And, but I'm also trained as an acupuncturist. I trained UCLA. The acupuncture training program for physicians that I've taught in that program and I was one of the physicians who helped integrate acupuncture into mainstream medicine through the consensus process at NIH.

[00:03:25] Dr. Gary Kaplan: So I've served on a couple of consensus committees at NIH. I have served as an advisor at NIH and I've served as an advisor at health and human services for specifically chronic fatigue syndrome. And so, I come from a real varied background, but I'll tell you acupuncture has one of the strongest influences on me because acupuncture is about root causes and allopathic medicine tends to be about symptoms.

[00:03:51] Dr. Gary Kaplan: So as we started to look into this I'm a pain specialist, I'm a family medicine specialist. And back in the nineties the American Academy of Pain Medicine thought it would be a spiffy idea to start treating chronic pain issues with opioids. And that turned out to be somewhat of a profoundly bad idea.

[00:04:07] Dr. Gary Kaplan: And we're reaping the consequences of that. What happened for myself was I started treating patients in that manner and found that they were pivoting between depression and pain, and I got very curious as to what that was about. And so I pulled together a bunch of colleagues from NIH and from Georgetown and Said, okay, guys, let's meet once a month, talk about this and explain this to me because there's no making any sense to this.

[00:04:35] Dr. Gary Kaplan: This is back in the mid late 2000s. So, we started that. And what we found is we're working on this was what became the neuroinflammatory model of chronic pain and depression. And I wrote my first book about that called Recovery we looked at

[00:04:54] Dr. Gary Kaplan: inflammation from the standpoint of the cause of pain and the cause of depression. And that was just at the beginnings of thinking about that. And that has proven multifold over to be correct. 

[00:05:06] Christa Biegler: I lit up so much when you said this, because everyone with fibromyalgia has depression. And I'm like, Why?

[00:05:13] Christa Biegler: Why does everyone with fibromyalgia also have depression? So you were way ahead of me on that. Thank you. 

[00:05:19] Dr. Gary Kaplan: So what they have, well, thank you. It was a lot of work with some very smart people. And, but what we found and what we were looking at is, so the immune system is two great big places.

[00:05:30] Dr. Gary Kaplan: All right. On one side is the innate immune system. Those are our first responders. Those are the white cells that everybody knows about in the brain. It's a particular cell called the microglia. And a lot of my research and work was on microglia. And so if you can help modulate the microglia, then that helps to slow down the inflammatory process.

[00:05:50] Dr. Gary Kaplan: You don't want to turn it off because you don't want the inflammation we need for healing, but too much inflammation can kill us. So, you always have to figure out what is driving the inflammatory process. And in this case, we're first looking at microglia and easy way to treat the microglia was by modulating with a medication called low dose naltrexone.

[00:06:12] Dr. Gary Kaplan: Now, Traxone in high doses is used for treating opioid overdoses, but at very low doses, it actually quiets the hyperactivity of the microglia, which can help with sleep and depression and chronic pain issues. So, little tiny dose four and a half milligrams once a day, period. You don't want to go higher than that because then you're getting into full pharmaceutical doses of it.

[00:06:33] Dr. Gary Kaplan: But you can also use CBD to quiet down the microglia as well, because there's a CBD receptor on the microglia. So the CBD can be another thing. THC can be other things that help downregulate the microglia, which is why in fact, we're seeing that C B, D and t h C marijuana has been in fact helpful in certain ratios to modulate pain.

[00:06:54] Christa Biegler: I love this story. Can I ask you a 

[00:06:56] Christa Biegler: question about the cd. 

[00:06:57] Dr. Gary Kaplan: Yeah, absolutely. 

[00:06:57] Christa Biegler: Okay. When I initially learned. When I was originally wanting to bring CBD into practice, it was still a little taboo as far as who could get it, who couldn't get it. But what I learned at that time is what I'm still applying if I'm using it now, which is start at maybe 15, 30 milligrams, and then go up by 15 milligrams until you find the dose that's actually giving you some efficacy.

[00:07:20] Christa Biegler: Because you've got to fill these cannabidoid receptors, and I can't tell you the exact dose. So just kind of titrate up to see what you need. Would you change that? 

[00:07:29] Christa Biegler: All right. Cool. 

[00:07:30] Dr. Gary Kaplan: I do lean more toward the away from CBD because I find that it's not quite as effective. I need a little bit of THC mixed in there.

[00:07:37] Christa Biegler: And how's that working for the taboo issues with 

[00:07:41] Dr. Gary Kaplan: we're legally licensed to we have dispensaries in Virginia for marijuana, the same in DC and same in Maryland. So it's not been an issue. So there's a lot of states that now license it and thus give us access to it. The challenge is Which product to give, and there's no friggin standardization across and you can have 200 different products.

[00:08:02] Dr. Gary Kaplan: And so generally I turned to the pharmacist who's managing the formularies and go, okay what makes sense for this person? Because what's available in Virginia is different than what's available in Maryland is different. What's available in DC. These products do work, but you do have to play a little bit in terms of figuring out and you're not getting high on these products.

[00:08:20] Dr. Gary Kaplan: By the way, what you're doing is it's helping with sleep. It's helping with pain. It's helping with depression. 

[00:08:26] Christa Biegler: Okay. I want to overarch what you're saying because I want to make sure it sinks in because so often here, and even this morning I had a different but comparable conversation about very different things.

[00:08:35] Christa Biegler: And we were talking about immune system buckets and what contributes to it. So I'm excited. We're talking about it from a different way. So immune system, two big buckets, there's the innate immune system. I feel like a lot of that lives in the gut. And then, and you can correct me and in the brain, it's microglia.

[00:08:50] Christa Biegler: And so the microglia for sure are driving inflammatory responses in these big chronic pain things with mood stuff. And so you are using either LDN or CBD and, or THC to calm microglia. And are there any other strategies for down regulating or tamping down microglial activation that you want to make sure we cover?

[00:09:13] Dr. Gary Kaplan: So the simple things, exercise. Exercise is a lovely anti inflammatory of the central nervous system. So exercise is very important. How much? At least three to four times a week. But you don't have to be running. You don't have to be jogging. You may do it with just walking, but anything that gets your heart rate up and get your steps and can be highly effective.

[00:09:33] Dr. Gary Kaplan: Now for people who have chronic fatigue syndrome, not so easy. Everything has to be about pacing, not pushing. So we have to be respectful of where the given individual is and what they can tolerate, what they can't tolerate. But the biggest thing sleep, we've got to fix your sleep and a lot of these people are not sleeping or getting really screwed up sleep.

[00:09:54] Dr. Gary Kaplan: And the thing about sleep is it's not a thing. It's not on off. It's a whole bunch of stages. So in stages two, three, four and REM three, four, we actually grouped together and now call slow wave sleep. REM is classically associated with dream sleep, but, and there runs to about a 90 minute cycle. So we want to make sure that your sleep is not highly fractured during the night.

[00:10:15] Dr. Gary Kaplan: I have people whose brains are so inflamed that they'll sleep four or five hours, every three to four days, whether or not they need to. So we have to do a lot of work to quiet and think of it as being inflammation in the central nervous system. That's the reason that you're not sleeping. . Okay.

[00:10:30] Dr. Gary Kaplan: And so what do we need to do in order to manage that? But sleep is something that's crucial. About 5% of people struggle with a thing called sleep apnea. 85 percent of those people don't know they have it. The symptoms are snoring. You're never rested. When you wake up in the morning, you may fall asleep during the day.

[00:10:48] Dr. Gary Kaplan: There is a very simple test you can take called the Epworth, E P W O R T H. Look it up online. Google it. It'll take you two minutes to answer the questions. If you score a nine or above on that test, you need to talk to your doctor about possibly having sleep apnea. 

[00:11:03] Christa Biegler: Why is sleep apnea out of control? I mean, it's not extremely common. 

[00:11:10] Dr. Gary Kaplan: Well, 5 percent of the population would rate it as very common. I think obesity is certainly one factor that contributes to it. A lack of exercise contributes to it because we get relaxity of the muscles in our throat and that collapses medications can certainly contribute to it. So there's a lot of medications, opioids in particular, that can cause sleep apnea, what causes central apnea as opposed to obstructive.

[00:11:33] Dr. Gary Kaplan: So, and there are some antidepressant meds can do the same thing. So, it's a combination of things but we're also better at diagnosing it. So, it was sitting there. We were just missing it. 

[00:11:44] Christa Biegler: I just wanted to pause on that because I am intrigued by breathwork, oxygen, breathing dysfunction, huge problem, right?

[00:11:54] Christa Biegler: And I've got a breathwork colleague who says he works on sleep apnea and improves it. And it would make sense that they improve airway function, maybe muscle function, et cetera, that area and potentially improve it. I'm guessing. So just think about how to 

[00:12:08] Christa Biegler: make things better. 

[00:12:09] Dr. Gary Kaplan: All of that stuff can be highly effective.

[00:12:11] Dr. Gary Kaplan: Dental appliances can be effective that pull the jaw out and take the the tongue off the back of the throat. But honestly, the thing that's most effective is CPAP, but you really have to demonstrate that you fix the apnea and you do that with a sleep study. We can now do that at home. There's a little device called a watch pad that you have to get by prescription, but you can measure at home and it's a disposable vice and it's FDA approved.

[00:12:33] Dr. Gary Kaplan: And it does a beautiful job of determining whether or not you have sleep apnea. If that's there, man, first, second, and third, fix that because failure to fix sleep apnea will take 10 years off your life. Increased risk for hypertension, increased risk for diabetes, increased risk for depression, increased risk for obesity.

[00:12:51] Dr. Gary Kaplan: So sleep apnea is low hanging fruit that we want to make sure we fix. 

[00:12:55] Christa Biegler: And if you're struggling, change your mask, maybe like talk to your provider about like, if you're still waking up.

[00:12:59] Dr. Gary Kaplan: Oh, you've got to work and make sure that even though you're on sleep apnea, you need to make sure you fixed it.

[00:13:04] Dr. Gary Kaplan: Right. So, and it takes a while to work with this stuff and you've got to work closely with your practitioner to get the support you deserve. The other thing that you started to bring up was the gut. And the gut's an interesting challenge. For one thing, linosyltraxone is been used for and highly effective for ulcerative colitis and for Crohn's disease.

[00:13:23] Dr. Gary Kaplan: So it's one of the things that can help modulate and improve the functioning of the gut. You know, the gut, the brain chat, you know this well and basically unhealthy gut, unhealthy brain, unhealthy gut. Now. That's a big challenge, though, because we want to do everything we can to heal the gut, and there's a lot involved in potentially doing that.

[00:13:44] Dr. Gary Kaplan: You start off with the basics, all right? I'll have all of my patients start on what's called a hypoallergenic diet around here. Rice, fish, chicken, fresh fruits, vegetables, and discussion. That's what you're eating. You do that for a month. The challenges I have in the first week, everybody's complaining to me about, well, what do I eat?

[00:14:00] Dr. Gary Kaplan: We work with them on that. And in the last week, they're complaining to me, well, I'm better, now what? So we have to pay attention that food is medicine and we need to be attentive to what's appropriate for ourselves, which is different from individual to individual. I will tell you celiac disease, about 1 percent of the population, the average age of diagnosis of celiac disease.

[00:14:24] Dr. Gary Kaplan: So this is an autoimmune reaction to gluten, okay. Bread products. Wheat. So, the average age of diagnosis now is between ages 40 to 60. We used to think that this was a disease you either saw in childhood or didn't, and it wasn't there. The reality of the matter is, we're now seeing it much later. Why? I believe it's epigenetics, meaning that environmental factors are challenging our immune system, and then something trips off the expression of that gene.

[00:14:53] Dr. Gary Kaplan: Because 35 percent of the population is at genetic risk for developing celiac disease. But only 3 percent of them will ever have celiac disease. So the overwhelming majority of people don't get celiac, even though they get the genes tendency toward. And the thing about genes is they're not our destiny.

[00:15:08] Dr. Gary Kaplan: Genes are a suggestion of what might be. Some cases they'll express more firmly than others, such as eye color, but in other cases. It really is about what the interaction between us and the environment toxins and what the food's reading whether they're in specific poisons and things like child abuse can have a very significant impact on our long term health.

[00:15:33] Dr. Gary Kaplan: If you look at, adverse events of childhood, which is the clinical name for child abuse. Child neglect. We see in these individuals, a 15 percent increased risk over the population of developing autoimmune disease, a 25 percent increased risk of developing heart disease, a 25 percent increased risk of developing diabetes, psychological Stressors have very severe long term impacts on us, and we need to be attentive to those as part of a whole healing process of what we're doing.

[00:16:03] Dr. Gary Kaplan: Stepping back to the gut. If the gut's leaky, the blood brain barrier around the brain is going to be leaky, which keeps things out. And so. We want to make sure that we're doing everything we can to get good healing on the gut. There's a number of tests that we do, but there's that gut's a whole big topic.

[00:16:19] Dr. Gary Kaplan: We'd all show. And you probably have on just a gut microbiome and the health of that, right? But an extremely important part of what we're doing now. There's an interesting thing. We have documented changes in the gut microbiome with a whole array of different diseases, Parkinson's disease, Alzheimer's disease, chronic fatigue syndrome, fibromyalgia But diabetes, all of these are inflammatory diseases, by the way.

[00:16:42] Dr. Gary Kaplan: But what we've found is that there's not a fingerprint pattern, meaning a specific set of bacteria that say, ah, this correlates, you do this, you get Parkinson's, you do this, you get Alzheimer's, whatever. So that doesn't happen. What we see is a tendency to what's called an inflammatory gut microbiome. And the consistency is a imbalance of phemicoidities and bacteroidetes in the gut, which are specific bacterial families.

[00:17:08] Dr. Gary Kaplan: If you were to sterilize the gut and put in a new gut microbiome by doing a fecal transplant, it'll hold for about a week, maybe a month, and then everything reverts back. Because if the primary process is not in the gut, but is in the brain, It doesn't matter. It's going to force it back into its prior gut microbiome pattern.

[00:17:31] Dr. Gary Kaplan: So you've got to go back to the source of what the problem is. If the source is in fact the gut, we have taken people who have had Crohn's disease. We've sterilized their guts. We've given them fecal transplant sterilization. The gut's not an easy thing to do. Typically takes about two years. There's a doc I've worked with in Australia who believes that.

[00:17:49] Dr. Gary Kaplan: The Crohn's is specifically secondary to a mycoplasma avium infection. Killing that, it's a slow growing bug. It can take two years of antibiotics. Ain't a fun process, but we've also then transplanted gut microbiomes from fecal transplants into these individuals, and they're in remission. So I am not a specialist in Crohn's disease.

[00:18:10] Dr. Gary Kaplan: That's not what I do. I'm a neuroinflammatory guy. And I want to back up also and talk about. Celiac for one second, because Celiac doesn't necessarily present as gut problems. 

[00:18:21] Christa Biegler: Yeah anxiety, mood, 

[00:18:24] Dr. Gary Kaplan: Yeah, 5 percent is going to present only as neurologic issues. Okay.

[00:18:29] Dr. Gary Kaplan: So I had a kid who was 17 years old, severely depressed, non responsive to treatment, tried to hang himself. And They sent him to me because I'm a neuroinflammatory guy. And I worked him up and diagnosed him with celiac disease. He had no gastrointestinal complaints, none. He had celiac disease. We got him off all gluten.

[00:18:48] Dr. Gary Kaplan: We healed the gut within a year's time, he's off all antidepressants. The depression is gone. I've followed him now for six years or so. He's been a hundred percent. 

[00:18:57] Christa Biegler: I have a simple question, so there's some Discussion around best ways to test for this, right? The gold standard is colonoscopy, apparently, right?

[00:19:06] Dr. Gary Kaplan: endoscopy, 

[00:19:07] Christa Biegler: if they've been on gluten any thoughts on blood testing, screening tools? What do you do first before you do such a invasive procedure, so to speak? 

[00:19:15] Dr. Gary Kaplan: I think the blood testing is perfectly adequate. I think the Europeans demonstrated this demonstrating transglutaminase levels.

[00:19:23] Dr. Gary Kaplan: There's, I don't see any reason to do anything past that. Now, as the 

[00:19:27] Dr. Gary Kaplan: caveat, yeah, 

[00:19:28] Christa Biegler: what if they've been off gluten? 

[00:19:30] Dr. Gary Kaplan: There's the caveat. Caveat is if you've been off gluten for three months, basically things should have healed. So now what we would look at an endoscopy, we would see changes in the villa, these little outpouchings in the gut that help absorb things.

[00:19:44] Dr. Gary Kaplan: So we would see loss of the blunting of the villa, and we would see an abundance of inflammatory cells. Three months later, all that should repair, and the antibody should clear. So if you've been off gluten for three months, and the test comes back negative, it doesn't mean necessarily that you don't have celiac disease.

[00:20:00] Dr. Gary Kaplan: And so that could be a caveat. And sometimes what we'll do is we'll challenge for two weeks with gluten and then test and that can work now that's about 1 percent of the population, about 16 percent of the population has gluten sensitivity. 

[00:20:16] Christa Biegler: Yeah.

[00:20:17] Dr. Gary Kaplan: So it's not a true autoimmune disease, but really what it is, and what I believe it is a toxicity to glyphosates, herbicides.

[00:20:25] Dr. Gary Kaplan: So we use these things called GMOs, and these are seeds which are manufactured to be resistant to the herbicides, they're genetically modified. So then we pour all of this glyphosates onto the plants in order to increase the yield. The plant then takes up. The herbicide stores it, but it doesn't affect it because the plants have been genetically engineered to not be impacted by it.

[00:20:50] Dr. Gary Kaplan: Except that herbicide moves from the plant through processing into your Cheerios and you get to then eat them. 

[00:21:00] Christa Biegler: I want to talk to you about this because this topic bothers me a lot because 

[00:21:04] Dr. Gary Kaplan: it should bother all of us. 

[00:21:06] Christa Biegler: Well, it bothers me because it's not good. And that's not a good enough explanation to me because we're putting glyphosate on all kinds of things.

[00:21:13] Christa Biegler: And so actually there's not Roundup Ready Wheat. There's generally Engineered wheat, but there's not roundup ready wheat. So the only reason that they should be putting roundup on wheat is if it's not drying down for harvest, then they would be spraying it on to kill it, which I live in the middle of wheat country.

[00:21:28] Christa Biegler: So that's why it bugs me. Cause I'm like, well, that theory isn't good enough because they're actually not really ever doing that. That would be really uncommon depending on weather patterns. It might be more common in other areas that grow wheat. Here in this whole area, it's not common at all because it dries down 

[00:21:44] Christa Biegler: so I agree. Like, I think there's for sure a toxicity thing. I'm just like, there must be more as well. And there must be also processing as well, because we have genetically modified fruits, right? For the same purposes. And we are corn and soybeans are probably the most heavily doused in glyphosate.

[00:22:00] Christa Biegler: So why is it wheat? Right. So actually this is like a long, we weren't probably not going to answer this question. 

[00:22:06] Dr. Gary Kaplan: It's an extremely important question, but what I will note is that I have patients who cannot tolerate gluten in any way, shape, or form unless they go to Europe. 

[00:22:15] Christa Biegler: Oh, I see this all the time.

[00:22:17] Dr. Gary Kaplan: Right. 

[00:22:17] Christa Biegler: I've been turning this over. As to why this is for a long time, I mean, I'm like, I feel like the only answer is for me to go shadow some wheat farmers in Europe for a while and try to understand. I think there is varieties probably. I just am like, why aren't we sensitive to more than just wheat if it's glyphosate?

[00:22:34] Christa Biegler: Cause glyphosate wouldn't be enough of an answer for me on this particular topic, just because I'm intimately familiar with the industry. So it's a weird, I understand it's a very commonly discussed thing in functional and integrative medicine. It's just not good enough for me yet. And so I'm like, Oh, probably better to 

[00:22:48] Dr. Gary Kaplan: dig deeper.

[00:22:49] Christa Biegler: Yeah, exactly. And I totally respect it. It's like, yeah, what else is, there's gotta be more that's like massively affecting the neuroinflammatory, a more applicable question. Also that I want to ask you is you mentioned 16 percent is gluten sensitive. People ask me all the time, you know, I'm pretty like, I am a rational person who likes birthday cake.

[00:23:10] Christa Biegler: And so some people are all like no gluten for anybody. And then some people are like, I am, but depends on if you react to it. Right. And what the problems are. Right. Like not everything is, we don't have to, if it causes more stress for you to avoid it and you're not having symptoms, I don't really see the point of this.

[00:23:27] Christa Biegler: So I'm just curious about your opinion. Cause I think as people hear this, they're like, maybe I should just avoid gluten altogether. Well, does it cause a problem for you? That would be my perspective. I'd love to hear your perspective. 

[00:23:36] Dr. Gary Kaplan: So pretty much the same as yours. I mean, basically what we do is we take people off this stuff.

[00:23:42] Dr. Gary Kaplan: Rice, fish, chicken, fresh fruits and vegetables. No soy, no corn, no gluten. All right. One month, then we start adding foods back in, assuming you've noticed any difference, we started adding foods back in one group at a time and we give it a week or two and we see if you react to it. Because what happens is when you're allergic to things or sensitive to things, you keep eating them.

[00:24:05] Dr. Gary Kaplan: You're kind of in the soup and you get this low grade muck. 

[00:24:07] Christa Biegler: Yeah. 

[00:24:08] Dr. Gary Kaplan: So when you step out of that and then it's about as we identify things that don't cause you to feel good, bloating, gas, a little more fatigue, a little less focus. Now you can attend to these things because we've cleaned things up and then we can add this stuff back in and then you need to make your choices.

[00:24:28] Dr. Gary Kaplan: You need to figure out what makes sense for you. Celiac is a true autoimmune disease. No discussion. You have to be off gluten because you're killing yourself. 

[00:24:36] Christa Biegler: Yep. 

[00:24:37] Dr. Gary Kaplan: Gluten sensitivity. You'll aggravate yourself. And how much of that do you want to do? And You know, we want people to be responsible for themselves.

[00:24:45] Dr. Gary Kaplan: So yeah, you judge what you're doing to your point though, about your white, about the wheat, that what we do is we don't typically spray it on the crop, but we spray it on it after harvest for, 

[00:24:57] Christa Biegler: To dry it out, 

[00:24:58] Dr. Gary Kaplan: but it still takes it up and it still carries it through 

[00:25:02] Dr. Gary Kaplan: the process. 

[00:25:02] Christa Biegler: It's just not a common practice.

[00:25:04] Christa Biegler: So it's you.

[00:25:08] Dr. Gary Kaplan: The GMOs also have a higher concentration of gluten in them. 

[00:25:11] Christa Biegler: Right. 

[00:25:11] Dr. Gary Kaplan: Than the non-GMOs. 

[00:25:13] Christa Biegler: That's true. 'cause they make more money when the protein is higher when they sell it. So, and it might not just be, you know, there's other proteins as well, but Yes, absolutely. That one, 

[00:25:22] Dr. Gary Kaplan: we'll build antibody reactions to proteins.

[00:25:24] Christa Biegler: Yes, exactly. So like this could be three or four episodes. So I'm going to keep us scooching along simply because I want to get to all of the good Gary Kaplan material. So you treat a ton of people with hard stuff. I'm actually kind of curious why you got into pain in the first place.

[00:25:38] Christa Biegler: And when I first read your stuff and you're Doing chronic fatigue syndrome, chronic pain, post Lyme chronic, non responsive depression. I was like, man, this guy is a glutton for punishment, or he just loves to achieve. And they just started sending Tim. So I'm curious about that. And then let's get into, you mentioned this up line.

[00:25:54] Christa Biegler: These are not separate conditions. So maybe if you want to talk a little bit about how you ended up getting all these people, but let's talk about why these are not separate conditions. 

[00:26:01] Dr. Gary Kaplan: So they're not separate conditions because it turns out they're all neuroinflammatory conditions. They have different ways of presenting in different people because our genes are different, because our backgrounds and experiences are different.

[00:26:12] Dr. Gary Kaplan: But the reality of the matter is they're all inflammation of the brain. Now we've talked about the innate side of things. The other thing we have to talk about is the acquired, and that's been the area that I've been most focused on in the last several years, because the acquired is you get an immunization and you develop antibodies, right?

[00:26:30] Dr. Gary Kaplan: So you get an immunization against flu, you develop antibodies to the flu so that when the flu bug shows up, your immune system's ready to roll and take it on and hopefully fight it off before you can get sick, or at least cause a much less severe reaction to the bug. That's their antibodies. Well, it turns out that things get a bit fouled up sometimes.

[00:26:52] Dr. Gary Kaplan: So in things like Lyme disease, and Lyme disease is the whole tick borne disease stuff, right? So it's not just Lyme, it's Bartonella, it's Anaplasma, Ehrlichia Babesia, there's a whole bunch of different bugs that takes care of Rocky Mountain spotted fever. But what happens in those infections in about 20 percent of people, so 80 percent of people get the bug, get treated, get better, they're done.

[00:27:17] Dr. Gary Kaplan: Which is the same thing that we see in COVID, which is the same thing that we see in strep. So this is not unique to one set of diseases per se. It's in fact, almost most viruses and bacteria can create this problem. And so what that happens is the immune system ramps up and goes after the bug. That's what it's supposed to do.

[00:27:40] Dr. Gary Kaplan: It makes antibodies to go kill that specific bug. And antibodies are specific. They are specific for flu. The antibodies you make to flu will not kill Lyme disease. They will not kill strep. So you need different sets of antibodies in order to respond to this stuff. But if the reaction is screwed up because the immune system's weakened for some reason, or it has been damaged, or the response is Excessive.

[00:28:06] Dr. Gary Kaplan: What happens is the immune system looks around and goes, you know what? The protein on that bug looks really similar to your brain. And then it starts attacking your brain and now your brain is inflamed. So now what happens? Focus, concentration issues, difficulty falling asleep, depression, anxiety disorders, chronic pain generalized pain in particular all of these.

[00:28:31] Dr. Gary Kaplan: Our result of the brain becoming inflamed, but where's the trigger in the case of an infection, you had an overreaction of the acquired immune system, which is now building antibodies to the brain itself. So treatment requires killing the bug, but it also requires treating the immune system on the acquired side, as well as the innate side in order to get that quieted down.

[00:28:56] Dr. Gary Kaplan: Treating the acquired side of the immune system is a bit more complicated and that's something you can really do on your own.

[00:29:02] Christa Biegler: Okay. I want to make sure we understand. So we talked about innate, we talked about it being in the gut, we talked about microglial activation, now we're talking about this acquired immune system.

[00:29:10] Christa Biegler: I want to hear, you so far mentioned that vaccinations inform the acquired immune system and I would assume environment. What's informing the acquired immune system before we talk about treating? 

[00:29:21] Dr. Gary Kaplan: Well, the acquired means that you get a bug, you get an infection. Okay. So body has an initial response to it, but then it wants to keep a memory of this stuff.

[00:29:30] Dr. Gary Kaplan: And it wants to know, in case this shows up again I can 

[00:29:33] Dr. Gary Kaplan: find a

[00:29:33] Christa Biegler: smart brain. 

[00:29:34] Dr. Gary Kaplan: Yeah. Yeah. So that's what the antibodies do. You make the antibodies. Now the antibodies don't last forever. As we talked about in celiac disease, after three months, they clear in the case of flu, you have to get a flu shot every year because the antibodies only last about six months and then they clear some are longterm measles, mumps, rubella will stay with us pretty much throughout life.

[00:29:54] Christa Biegler: Why is that? 

[00:29:55] Dr. Gary Kaplan: I don't know. 

[00:29:58] Christa Biegler: It's kind of bizarre, right? Why would measles stay with us?

[00:30:01] Dr. Gary Kaplan: It I would have to talk with my immunology friends to get a better explanation of that. But I haven't heard a good explanation, even though I've asked that question a few times. But there are some just maintain the memory, others do not.

[00:30:12] Dr. Gary Kaplan: And so COVID. You know, the reason we've gotten all these immunizations is because the immunizations don't last. I mean, the immunizations are good for about three to six months, Max and thus, we have to keep coming up and the virus itself is evolving. We have to keep coming up with new formulas in order to treat it.

[00:30:31] Dr. Gary Kaplan: But COVID in particular is a nasty bug because about 25 percent of people who get COVID develop long COVID. That's 

[00:30:38] Dr. Gary Kaplan: a serious problem. 

[00:30:39] Christa Biegler: Yeah. Let's talk about what is long COVID. First of all, 

[00:30:43] Dr. Gary Kaplan: long COVID is you stay, you get sick and you stay sick and long COVID can look like a lot of different things.

[00:30:48] Dr. Gary Kaplan: So chronic fatigue can certainly be one of the presentations in this most common presentation, but chronic headaches, digestive issues. Heart issues. COVID does affect the heart in a high percentage of people. And so you can end up with congestive heart failure, cardiomyopathy, which is an inflammation of the heart muscle.

[00:31:05] Dr. Gary Kaplan: You can end up with asthma. And you also end up with a thing, a very interesting shortness of breath where the lungs themselves test out fine, but you get short of breath. And I had the distinct Unpleasure of of having that happen to me after I had an episode of COVID for about a month fortunately it went away.

[00:31:22] Dr. Gary Kaplan: We define lung COVID also as symptoms which persist, depends who you chat with, anywhere from a month past your infection or to three months. And it can be fairly disabling and it varies everywhere from annoying to disabling. And extremely disabled where people are bed bound and really have to leave their jobs and, you know, there's massive consequences to this economically, but there's also massive consequences to this psychologically.

[00:31:48] Dr. Gary Kaplan: Their participation in their families get diminished dramatically. It really is a problem and they become increasingly socially isolated, which social isolation, by the way, turns out to be one of the largest killers in the United States. Social isolation is the equivalent it's work. Health benefits are worse than smoking 16 cigarettes a day or having six drinks a day of alcohol. 

[00:32:12] Christa Biegler: This is literally what my conclusion was after visiting Europe for two and a half weeks was that everyone's like, man, I feel better when I'm in Europe. And I'm like, yes, the food is somewhat different.

[00:32:21] Christa Biegler: We're on a bit of a Mediterranean diet here in Spain, but you guys are not sleeping. You're drinking. All the time. And a lot of you are smoking, but you were so darn social and you just dance your life off and you eat for two hours. So you're definitely digesting your food. That's all I could come up with so far.

[00:32:37] Dr. Gary Kaplan: And the surgeon general issued a report this year talking about the severity of the problem of loneliness and social isolation. So creating these networks and when you get this sick, you end up isolating. You end up not seeing your friends, you end up, you know, the kids I see, okay, definition of a kid.

[00:32:53] Dr. Gary Kaplan: All right. I've been at this for a while. Definition of a kid in my practice is anybody younger than my oldest daughter. My oldest daughter is 39. So increasingly I'm running a pediatric practice. 

[00:33:05] Christa Biegler: Yeah.

[00:33:08] Dr. Gary Kaplan: .But the reality of the matter is this impacts people across all age groups. And it seems to just proportionally impact people teens and twenties and thirties and that's a large portion of my practice. So we do see people certainly in their fifties, sixties and older. So the reality is these are diseases impacting all of us.

[00:33:32] Dr. Gary Kaplan: COVID is something which is going to be with us for the rest of our lives. Probably it's endemic now. So meaning that it is just part of the background viruses that we have to deal with the year in and year out. It looks like the newer viruses may create long COVID less than the earlier viruses did.

[00:33:51] Dr. Gary Kaplan: So Delta hands down was among the worst. But and what we talked about earlier, by the way, in terms of the immune system, people die from COVID, not from the bug itself, but from the immune system's reaction to that bug. Thank you. 

[00:34:03] Christa Biegler: Yeah. So what was the stress on the immune system before they got it?

[00:34:06] Christa Biegler: Would that be correct? Right? 

[00:34:07] Dr. Gary Kaplan: That would be absolutely correct. And so that then backs us up to a conversation you and I started to have about epigenetics and epigenetics are the things that turn on and off our genes and those things are environmental. So we talked about the potential impact of adverse events of childhood, but we also are exposed to toxins.

[00:34:27] Dr. Gary Kaplan: We're exposed to heavy metals where, well, In tuna fish, mercury, and in other fish, mercury, unfortunately. In the dental amalgams that we no longer use those will kick out mercury on a regular basis. 

[00:34:39] Christa Biegler: But we have. People have. 

[00:34:41] Dr. Gary Kaplan: They do have. You got three or more of those, you might want to look into that.

[00:34:46] Dr. Gary Kaplan: If Lead. Lead is unfortunately far too prevalent in our water supply, but it was also prevalent in a lot of paint we used on older buildings. And in fact, a couple of years ago in New Orleans, they were after flood down, hurricane damage. They were power washing and sanding down these old mansions which have been painted with lead paint, and they aerosolized all the lead.

[00:35:08] Dr. Gary Kaplan: So it went into the air, everybody's breathing it, and lo and behold, the number of lead toxicity cases is going way up. We tend to focus on kids with lead toxicity because it does a lot of damage to the brain. But in adults, it can cause hypertension. And, in fact, one of the things that correlated with a decrease in heart disease is switching from leaded to unleaded gasoline.

[00:35:32] Christa Biegler: Interesting. 

[00:35:33] Dr. Gary Kaplan: But environmental pollutions, air pollution, we know definitely has a long term impact. You're in a better place for that than I am, meaning that you have very little of it compared to what I have to deal with. So we need to be attentive to these things. Mold toxins. If you're living in a water damaged building.

[00:35:49] Dr. Gary Kaplan: You probably are getting exposed to mold. Again. Not everybody's going to have a problem with it because genetically you process the toxins, but in a lot of the large percentage of people, again, it comes out about 20%. They don't have the enzymes necessary to process the mold toxins, the accumulate in your body.

[00:36:05] Dr. Gary Kaplan: Where do they accumulate? Well, one of the places is the brain and other places in the wall of the gut because they're all fat soluble can also be in the lungs and create asthma problems. So, if you got a symptom, right, I bang my thumb with a hammer my thumb hurts.

[00:36:19] Dr. Gary Kaplan: Okay. I think I know what happened there. But when you're finding that. Your focus and concentration isn't what it used to be. Your memory, you're missing things. You're having problems with energy. It's just, you're just not as well rested as you used to be. You're having, you can't exercise to the extent that you used to.

[00:36:35] Dr. Gary Kaplan: You're having more aches and pains generalized. Okay. Mood, a little anxious, a little depression. And. Now you've got some more generalized stuff going on, digestion isn't working the way it should. Now you're going to step back and you're going to say, okay this is a picture of somebody who's inflamed.

[00:36:53] Dr. Gary Kaplan: And this is a picture of what we want to do in order to quiet things down. So we start thinking in terms of where's the inflammation. Is it in the gut? Is it in the brain? And then what's causing the inflammation. So we have the things that set you up, all these epigenetic things we just talked about, and those have to be treated.

[00:37:12] Dr. Gary Kaplan: If you're mold toxic, we got to get that out. If you're heavy metal toxic, we got to get that out of you. And in fact, I just saw a patient yesterday dramatically elevated mercury levels. Why? Well, he eats a lot of sushi. And in fact the solution for him is simply take them off the sushi. 

[00:37:30] Christa Biegler: How did you test him for mercury because you could test urine, which is more acute.

[00:37:34] Dr. Gary Kaplan: We do blood testing. 

[00:37:35] Christa Biegler: Blood testing. 

[00:37:36] Dr. Gary Kaplan: We do blood testing for through labs and specialize in doing heavy metals. And hair is also potential, but the trick with hair is there's a lot of environmental pollutions. And yeah, it's long term. You won't. necessarily pick it up as acutely. So, and we use hair products that can, and dyes and all this stuff, which can cloud the whole picture.

[00:37:55] Dr. Gary Kaplan: So the blood testing is what we rely on. So we're looking at what are the things that potentially set up the immune system, and I want to get back to one second, this business about adverse events of childhood. Okay. This is so important and not addressed. We think of, oh, it's a psychiatric problem. Oh, it's a neurologic problem.

[00:38:14] Dr. Gary Kaplan: Okay. We have to stop thinking like that. All right. I have give you an example of a kid that I saw yesterday. Beautiful young woman. She's currently around 15, 16 years old for the last three years since she got COVID. Anxiety disorders, obsessive compulsive disorders, eating disorder. She has been going into rage attacks.

[00:38:38] Dr. Gary Kaplan: She's had to be taken. They've had to call the police on her multiple times because she's become so violent. They've taken her down for psychiatric admission, and she's been evaluated by one of the leading children's hospitals in the country, and they simply said, Oh, it's all behavioral. Right? This kid was not like this three years ago.

[00:38:57] Dr. Gary Kaplan: All of a sudden she gets COVID and bang, now we've got a kid who's a massive problem and we're throwing lots of psychiatric meds at her and no one's willing to step back and say, wait a minute, is there something else here? She is post COVID. She has pants. Pediatric Acute Onset Neuropsychiatric Syndrome.

[00:39:16] Dr. Gary Kaplan: Horribly named, but nevertheless Swaino did a huge favor to us in the process of creating that classification. And what we're now seeing is a kid that has post COVID, now we have to treat her. We have to look and see Whether she's developed antibodies or she stayed on the innate side. Now there's a huge discussion going on in the field as to whether or not we're looking at a problem on the innate or the acquired side.

[00:39:40] Dr. Gary Kaplan: We think a large portion of these are associated with damage to a particular type of white cell that stays in the system. The spike protein probably did the damage and keeps this thing going. So the important thing is there is no active COVID in your body. Okay. You're not infectious. You are not able to spread the disease, but your immune system has been turned on because a piece of the bug is still there.

[00:40:06] Dr. Gary Kaplan: And so it, you create these kinds of zombie cells, which don't die because cells are supposed to go through a normal life cycle, but keep spewing out lots of inflammatory factors. These cytokines. So we can measure the cytokines and then there are specific things we can do to treat it. This gets back to our earlier discussion about you have to know what's causing the inflammation because that guides you as to what you should be targeting.

[00:40:31] Dr. Gary Kaplan: So low dose naltrexone has been shown to be effective in a number of these people using metformin. Metformin is a drug that we typically use for treating diabetes, but metformin also modulates the functioning of the acquired immune system. And so metformin has been shown to be effective in some studies.

[00:40:49] Dr. Gary Kaplan: And more recently, the suggestion is that we should be giving metformin anytime somebody gets acute COVID because it will prevent the occurrence of long COVID. 

[00:40:59] Christa Biegler: Can I ask a question about this?

[00:41:00] Dr. Gary Kaplan: Sure. 

[00:41:01] Christa Biegler: Okay. So we have. Natural metformin, a nocital somewhat classified as a B vitamin. Do we feel like this could work or we just haven't really tested it yet?

[00:41:11] Dr. Gary Kaplan: Haven't tested it. We don't know. 

[00:41:12] Christa Biegler: Just curious. I'm so on the edge of my seat about this 16 year old girl that's lost her life, honestly, as she knows it post COVID. And so, the treatment pie, I'm listening earnestly to hear how you're going to address this. And so, so far it's like you could do some Lotus LDN, maybe some metformin carry on.

[00:41:35] Dr. Gary Kaplan: So we've got more questions to ask. I need labs back on her now to assess what's going on in the immune system and assess whether or not there's anything else sitting there. Are there more? 

[00:41:42] Christa Biegler: Yeah. 

[00:41:43] Christa Biegler: Did the COVID just activate some other mess that was there? And now, and so there's like multiple pieces to treat because it feels like when we're talking about long COVID, it's like there was already crap going on.

[00:41:56] Christa Biegler: There was already immune junk happening. And so now the buckets just like overflowing. And now we're in desperation. And unfortunately, sometimes when we're in that bad of a place, I think this is where the LDN is probably amazing, right? Because you get immediate change because from my perspective, which that's not in my toolbox.

[00:42:13] Christa Biegler: It's kind of harder once they're already at that point, you've got to, because I've still got to go back and do all the stuff that was a mess probably before. Right. But when they're in this desperation place, they might not even be able to do some of those interventions. So this is where my brain is like on the struggle bus over here.

[00:42:27] Dr. Gary Kaplan: So in fact, she was put on a low dose naltrexone just before I saw her and it dramatically improved her stabilizers long way from cured, but it certainly made a big difference for her. But there are other medications we use called Moravaroc. Moravaroc is a drug that was developed for treatment of HIV AIDS.

[00:42:44] Dr. Gary Kaplan: Moravaroc helps interfere with a specific Type of receptor in the non classical monocytes. I'm getting way into the weeds here. But basically that will help turn off the production of the inflammatory particles coming out of the monocyte, the white cell private statin, which is a statin actually can help reduce the inflammatory process as well.

[00:43:06] Dr. Gary Kaplan: Baby aspirin. It can also help modulate that if the, what's called the SCDL40 is particularly because that's a cytokine that comes out of platelets. So those are the things we can do. NAC and acetyl cysteine can actually be effective in reducing the response and shutting it off. Lumbar kinase nanokinase can also be effective in terms of coupling reducing this.

[00:43:29] Dr. Gary Kaplan: These are things that are available over the counter as can bromelain. So early studies on this stuff suggesting that these may be effective. Cost benefit ratio kind of go try it. Why not? And so these things can all be helpful in terms of doing this, but you're also absolutely correct. We got to back up.

[00:43:45] Dr. Gary Kaplan: Is there mold toxicity? Are there other toxins in this kid's system? What's the gut look like in order to fully comprehend how the system broke and what we need to do to repair it? 

[00:43:56] Christa Biegler: I've been over here thinking that long COVID and people really struggling with post COVID had a lot of mitochondrial dysfunction before they arrived at that area.

[00:44:05] Christa Biegler: And maybe there's just a I think we can just say there's overlap there probably but you're coming at it from a standpoint of, well, the immune system was already weak. Why was the immune system already weak? First of all, we got to put out the fire. I mean, what I'm hearing is there is a hell of a fire going on.

[00:44:19] Christa Biegler: How do we put out the fire so we can actually go figure out the root cause of the fire essentially. 

[00:44:24] Dr. Gary Kaplan: And, in all of these chronic diseases, mitochondria dysfunction is part and parcel of the issue and you have to be addressing that. You can address that with NAD. Probably the most effective way and we do that sometimes with IV, but oral NAD can be effective.

[00:44:36] Dr. Gary Kaplan: And so you've got to be doing mitochondrial repair as part of what you're doing. Again, it's a comprehensive process. There's no here, take this and you're all fixed. When you've been that sick for that long and then in a number of these people, there's a subgroup of people with long COVID who have an autoimmune process.

[00:44:53] Dr. Gary Kaplan: And then what we have to do is identify where that autoimmune process is and treat that. That's more complicated. Then we need to do intravenous immunoglobulins. We may need to do a thing called plasmapheresis, plasma exchange. We're looking into some processes where we can use stem cells. That's all experimental at this point in time.

[00:45:10] Dr. Gary Kaplan: But or use T cell regulators. Again, that's more on the experimental end of things. So, There's potentially a lot involved unfortunately, 75 percent of people get better on their own. So we're good. 

[00:45:23] Christa Biegler: Yeah. I have lots of notes here. I feel like a second episode is coming on. One thing that was kind of at the beginning of my notes as I was observing, you're in private practice, but you're also teaching.

[00:45:35] Christa Biegler: So something that's really cool for the rest of us as it sounds like you are teaching what you are learning. Tell me how your practice impacts your teaching. 

[00:45:45] Dr. Gary Kaplan: Oh, I mean, my patients are my greatest teachers. I'm learning from them all the time. There's nothing like clinical practice to keep you humble, right?

[00:45:53] Dr. Gary Kaplan: Every time you think, you know, something, somebody shows up at your door and you asked how I ended up with these really complex patients. It's the curse of being successful, right? So as you're successful with the easy ones, they said, Oh, here, try this one. 

[00:46:07] Christa Biegler: Yeah, exactly. 

[00:46:09] Dr. Gary Kaplan: And the next thing, you know, you're kind of gone.

[00:46:11] Dr. Gary Kaplan: Wow. And that keeps you in the books and that keeps you studying and trying to find better ways to help these individuals. So one of the things we're also doing, so the book is a guideline for people to kind of a do it yourself to inform yourself about all of these different things. It lays out all the testing we do.

[00:46:30] Dr. Gary Kaplan: It's not the be all and end test of testing in the labs that we use, but it's a place to start. You can have a conversation with your doctor on the basis of. Having read this book. Oh, what about this? What about this? And make sure you're getting the right test done because the other challenge is if you don't do the right test, you don't get the right answer.

[00:46:50] Dr. Gary Kaplan: So if I check your blood count and I check for coagulation factors but I don't bother to check your blood sugar and you have diabetes. Well, I missed the diagnosis. 

[00:47:00] Christa Biegler: Yeah. 

[00:47:01] Dr. Gary Kaplan: Okay. So you've got to ask the right tests. And unfortunately, almost all the people I see have quote unquote normal labs and they have normal labs because the right testing was not done.

[00:47:10] Christa Biegler: Right. They did like 6 of testing. 

[00:47:13] Dr. Gary Kaplan: So that has to be changed. The other thing is we've got a conference coming up November 8 9 10. It will be here in D. C. But it can be attended virtually. We want both the public as well as clinicians and researchers attending this program. This is new developments in understanding chronic illness.

[00:47:31] Dr. Gary Kaplan: We have assembled an all star faculty. We have people from NIH and Stanford and Georgetown and Cornell. And so what we want to do is this bring this diverse group of diseases under one roof so that we're talking about the commonalities here and common solutions here, so we're bringing some of our best and brightest, into one room who don't normally talk to each other. We have pediatricians and we have rheumatologists and we have neurologists and family physicians. And so this is a diverse group of docs and researchers who aren't necessarily looking at other people's research across the board. We have specialists in post COVID syndrome testing.

[00:48:13] Dr. Gary Kaplan: We've talked about different testing and treatment modalities. It's the conference is a medical conference. It's got CME for docs and continue medical education for physicians. But I think the public can benefit from hearing this and gaining a lot more knowledge of what's going on. We did this last year.

[00:48:29] Dr. Gary Kaplan: We had over 900 people at the conference. And It's a great way to get educated about what's going on and what's happening for the public. We ask that they just be online because we're having docs live and it changes the room, if you will. I need docs to be able to talk to docs and start creating community and research ideas and opportunities for collaboration.

[00:48:56] Dr. Gary Kaplan: New developments in understanding chronic illness, the role of immune dysfunction and infections. 

[00:49:01] Christa Biegler: Cool. 

[00:49:01] Christa Biegler: Is it on your website? 

[00:49:03] Dr. Gary Kaplan: It is on the foundation website. So foundationfortotalrecovery. org. And so, If you go to that website, it'll show you how you what the foundation is doing. But the foundation is an education and research foundation.

[00:49:15] Dr. Gary Kaplan: It's a 5013 C that I created after my first book for the purposes of doing education and research in this field, this will be our third conference. And we've got we also have speakers from Oxford. It was exceptionally well received last year. We had people from Israel and Brazil and Australia.

[00:49:33] Dr. Gary Kaplan: And so we're excited about this program. We're excited about the opportunity to educate our colleagues and we're excited to be able to educate the public so that they can get better answers. And so this conference, November eight, nine, 10, we'll be here in DC and I hope your listeners will sign up and attend.

[00:49:50] Christa Biegler: We'll get this rearranged. So this comes out before that. I don't know. How do you have enough time in the day for all this, Dr. Kaplan? 

[00:49:56] Dr. Gary Kaplan: Not getting as much sleep as I tell everybody else to. 

[00:50:01] Christa Biegler: Yes, embodiment is the real challenge, isn't it? 

[00:50:03] Dr. Gary Kaplan: And I have an incredibly understanding wife and So the kids are launched.

[00:50:08] Dr. Gary Kaplan: So, that makes my life a little bit easier, but it's my passion. I love what I do. I'm privileged to be able to do it. 

[00:50:14] Christa Biegler: You're making a big difference. I have an opportunity. 

[00:50:16] Dr. Gary Kaplan: Trying. 

[00:50:17] Christa Biegler: Yeah, you're making a big difference. I hope that you'll agree for part two of this, because we didn't get to all the things, and I think there's a lot here either before or after the conference.

[00:50:25] Christa Biegler: Tell us the name of the book again and your other website where people can find you. 

[00:50:29] Dr. Gary Kaplan: So why you are still sick how infections break our immune system. So that's available on Amazon. Easy to get ahold of. The center is the Kaplan Center for Integrative Medicine. Also, KaplanClinic. com K A P L A N, clinic. com. And A lot of information we've put on our website. A lot of lectures that we've done. Our center is three physicians and nurse practitioner, an acupuncturist herbalist, a nutritionist, a psychotherapist. And so we've got a big and physical therapist. So we have a big team to address these, complicated problems.

[00:51:05] Christa Biegler: Yeah, perfect. Well, thank you so much for coming on today. It was a blast. I've got a great list for next time and good luck with this conference. And I'm also checking it out myself. 

[00:51:16] Dr. Gary Kaplan: Krista, thank you. It's a privilege being here and thank you for the work you're doing in terms of getting the word out to educate patients and help them have better lives.

[00:51:23] Christa Biegler: Yeah. Thank you.

[00:51:24] Christa Biegler: Sharing and reviewing this podcast is the best way to help us succeed with our mission to help integrate the best of East and West and empower you to raise the bar on your health story. Just go to review this podcast. com forward slash less stressed life. That's review this podcast. com forward slash less stressed life.

[00:51:46] Christa Biegler: And you'll be taken directly to a page where you can insert your review and hit post.