Explaining Autoimmunity and How to Reduce Risk

In this episode I had the pleasure of speaking with an old pal of mine Robyn Puglia who is a recognised Functional Medicine expert in Autoimmunity. 

Robyn does an incredible job of simplifying the subject of autoimmunity so that we can better understand it. What is most valuable with Robyn's advice is that as a practicing clinician, she not only has a vast knowledge of autoimmunity, she has had many years of applying this knowledge with her patients. 

Autoimmunity is more prevalent amongst female than males and Robyn gives us an understanding of why and also gives many practical clinical pearls for us all to reduce our risk.  

Thanks for listening to our podcast and please feel free to get in touch:

• Tweet us at @fmedassociates
• Follow us on Instagram or Facebook @petewilliams_fma
• Email us on info@fm.associates
• For more information about our services please visit our website www.functional-medicine.associates

We would love to hear from you!

Transcript

Peter Williams  0:00  
okay

welcome everyone. Welcome to this new podcast Functional Medcine bitesize of course. So really important topic that we're going to start with we've got we're hopefully I'm, I've got Robyn Puglia on today. Hi Robin, how you doing?

Robyn Puglia  0:17  
I'm good. Thanks Pete. How are you?

Peter Williams  0:19  
I'm okay. So me and been Robyn have known each other for quite a long time now. I'm not going to say similar backgrounds, but similar pathways. We've all done the IFM education. And I think, Robyn, hopefully she will do a few more for us is that she is the go to expert for autoimmunity. So, in our sort of group, we sort of all rely on Robyn to come up with all the autoimmune stuff and then we just follow so. So Robyn, look, you're definitely considered certainly an expert in the field of autoimmunity. But can we have your background of how you got into it because I think your backgrounds really interesting. And then sort of talk about some of the stuff that you're doing now, particularly, you know, you're involved with quite a lot of the sort of large US organisations that sort of some of their labs that are associated with autoimmunity, because because obviously, this is your expertise. So you've got a really brilliant story. So why don't you introduce that and then we can we can jump on and talk about autoimmunity? Sure.

Robyn Puglia  1:22  
Okay. So my story goes like this celiac disease changed my life twice. So the first time it changed my life was when I was diagnosed, because I was diagnosed after 19 years of having symptoms. But my symptoms were not classic symptoms. I never had GI symptoms, and in fact, so I didn't have any gut symptoms at all. And it was the joke in my family that I was the one with the Cast Iron Stomach. I didn't get carsick. I didn't get gut stuff that was going around. But I had horrific eczema, head to toe eczema from the time I was four. That was my first symptom. I had migraines, classical migraines that started when I was about seven, and I got them about once a month, and it would be 24 to 48 hours of lying in a dark room, vomiting, not able to cope with light, you know, from that's an early age seven to be dealing with that. And then chronic constant infections always had a chest infection always had a sinus infection. You know, when I was in my late teens, it was urinary tract infections. It was just whatever was going around, I would pick it up and I was told at one point that I had just carried a low grade sinus infection all the time and then when it would flare up, I would have to take antibiotics. I was constantly on antibiotics. I got glandular fever when I was 15. And then that took me out for six months and this sort of constant infection and then I started getting anaemic, so I had iron deficient anaemia that didn't respond to oral iron. So then I was every month had to go to the GP and have iron injections because the anaemia was so bad, I was very underweight. And then I started getting fatigued when I was about 22. So I was diagnosed at 24. And I got diagnosed because I thought I was dying. Like I was so sick at that point that I basically saved up and went to this very specific Women's Health Centre. This was in Perth in Australia,I had to wait weeks and weeks and weeks to get in there. And so I got myself really organised and made this whole long list of my symptoms and my history. And I just like landed on the doctor and I was like, I'm there's something seriously wrong with me and you have to find out what it is and here's everything that's ever happened to me and I am not leaving here until I've got an answer. And she said she sort of just joined some dots, you know, you're underweight, you think things get better if you cut out wheat, a lady, a lady who was waxing my legs had noticed that eczema because it was very bad on my legs and she said Why don't you try giving up wheat, this really worked for like my cousin Susan or whatever. So, so I gave that a try. It helped a little bit. So she tested me for celiac disease, the bloods came back positive, I had an endoscopy that was positive. And that was at the time that I was moving to the UK. So I literally got the endoscopy results two weeks before my flights. I'd gotten a job and I was managing this clinic in London and I was making medical aesthetics at that time, which is ironically skin health. And so I ate as much gluten as I possibly could for that two weeks and I booked myself a gluten free meal for the flight and I made that flight from Australia to the UK. The delineating point between my old life with gluten and my new gluten free life so my first introduction to gluten free life was the plane food which just meant like fruit and rice cakes for the 18 hours a flight and then but within two weeks of being gluten free, like absolute miracle migraines I've never had a migraine since unless I've been glutened. After that was coming up to like 15 years of monthly migraines, they completely stopped the eczema completely cleared up the infections, the fatigue, like somebody had waved a magic wand. So then so then I didn't think that much about it after that. I just kind of went on with my life but gluten free and healthy for the first time. Then I started studying nutrition so I discovered the Institute for optimum nutrition in the UK and I read Patrick Holford's book because I was researching cosmetic chemistry and I wanted to know about vitamin C and the production of collagen. So I found an article that he wrote then I read his book at the end of the book is a link to ION. So then within a year of landing in the UK, I was studying ION and this entire world of immunology opened up to me and I discovered that I super double love immunology, and that immune cells are very, very visual for me, I can see the dendritic cells, I can see the different, they've all got little personalities. And I just completely fell in love with, with the body, with the immune system with the brain with how it all connects together. But then, I was in my final year of study, and I got sick again. And I had gotten glutened really badly at work, I was the practice manager of a medical practice by that point. And they had they had a candy bowl in that, you know, a bowl of mints in the reception. And every time I went into the reception, I'd kind of dip into the bowl, which is naughty nutritionists behaviour there you are, and they had changed the brand. But because they opened the bag and put them in the bowl, I didn't notice so for several weeks, I was eating these things with barley in every day not realising. And I got so I got glutened really bad, it was a big exposure. And I also had a mould exposure at the same time, but I didn't realise that. And I was bed bound for six months. And I realised in that moment that I didn't really understand celiac disease, but also not just me, nobody that I was looking for it. You know, my my GP, the functional medicine doctor that I saw at that time, the other nutritionists who I was trying to see, I was so fatigued, the eczema came back, I couldn't get out of bed. And nobody really understood about the extra intestinal like what was going on in my body because of the celiac disease, the whole topic of celiac disease was just focused on the gut. So then I discovered Functional Medicine. So that was when I started looking for answers. And I started looking to IFM, the Institute for Functional Medicine in the US. And then I you know, there were some conversations that were happening at that time in the US that weren't happening in the UK. So I started travelling to the US to study at IFM. And so that was 2010. And, and then that completely changed my life. Because once I that was the second time that celiac disease changed my life because when I started to understand it better, and I understood what was going on in the body and how celiac disease affects the brain and how celiac disease and gluten can affect any and every tissue in the body. Then I started you know, being on the Facebook groups and the sort of online groups and realised that there was this whole world of other people who were in the same situation as me who had celiac disease and were still sick after their diagnosis. So then I started working with and also this also group of people who didn't have celiac disease, but were gluten reactive. So I started really communicating with and and reaching out to help that group of people. And then that expanded into general autoimmune disease and how gluten was affecting autoimmunity. And does everybody with an autoimmune disease need to be gluten free? Yes or no and, and I just, you know, it was a completely natural progression from then on, I completed my study with IFM. And then I started working with Cyrex, who is the functional immunology lab in 2013. So it's been 10 years. And I just couldn't basically couldn't stop talking about it, couldn't stop thinking about autoimmunity, and haven't really stopped talking about autoimmunity sense. It's completely fascinating to me. It's a it is a field that evolves pretty quickly. You know, what we know this year is really different than what we knew two years ago. And the numbers are also rising. Right. So the most recent paper from the Lancet, which is one of the premier global science research journals now puts the number at one in 10 people that was a UK study so people have autoimmune disease. And it used to be like the last time that statistic was researched. It was one in 25. Right? So the numbers are growing. And that research was done pre pandemic. So that doesn't include people who have got infected, you know, pandemic infection by COVID. Actually realising I'm not on Instagram, I'm not going to be not going to be penalised for saying the word COVID. That doesn't include COVID induced auto immunity and lond COVID

Peter Williams  10:16  
So I think what you've just done there is a brilliant introduction, and if it's okay with you and as we go forward, I would love to do a podcast purely around celiac and non celiac gluten sensitivity. With pleasure. Yeah. But I think, isn't it interesting, and I think this is where we just want to start defining what is auto immunity. And I think as you as you just alluded to, the numbers are really going up. And I think we should probably chat about the potential mechanisms that have left a lot of long COVID patients, because I know you deal with long COVID patients, we deal with them. They're a real, it's a real difficult patient population to just try and get some rhyme or reason about stepping them forward. It's been really difficult. Some, you have brilliant successes with some, you're still really sort of it's a long slog for a lot of them. And so it'll be really good if we can just sort of maybe expand that today. Because there is no doubt that the the autoimmune prevalence is really jumping up. So can we start just very simple terms? What is auto immunity?

Robyn Puglia  11:26  
Yeah, so So auto immunity is a disease, or autoimmunity is a mechanism. Autoimmune disease is a disease that happens when the immune system starts to attack our own tissue, the own tissue in our body, so it attacks your joints, or it attacks your skin or your brain, or your platelets. And the conversation around autoimmune disease, especially again, in the research is that this is a mistake, that your immune system makes a mistake, and it accidentally attacks your tissues, or it's an aberrant response of the immune system. And I really disagree with that language. It's not your immune system making a mistake, it is your immune system doing exactly what it is supposed to do. So what is your immune system supposed to do? It's supposed to do two things defend and repair mostly. Right. So an autoimmune disease happens when your body no longer recognises your own tissue as being self. So you Autoimmune disease can be classified as failure of self tolerance? What does that mean? Right? So tolerance is a function of the immune system. And it's actually an algorithm. So it goes like this. Your immune system is roving around inside your body, you've got lots of different cells of the immune system. And this is like the defence force of your country. So a defence force of the country has got the Army, the Navy, the Air Force. And each of those Defence Forces has got different you know, you've got soldiers and sailors and they all have different training, and different weapons that they use, you can't use a helicopter if you need a submarine and vice versa. But the overview is the same, right, defend and protect. So you've got these soldiers and you know, naval officers and stuff roaming around the body, looking for trouble, right, trying to understand if there's anything that requires defence or repair. And anytime it comes across a protein, where there's a question mark, the algorithm goes, Is this me? Yes or no? Is this self tissue? Yes or no? Right? So if it is me, if this is thyroid tissue, if this is joint tissue, the immune system, if it's me, then I should tolerate it. I definitely shouldn't be attacking my own body. So but if the answer is no, this is not me, right? This is actually a bacteria, let's say or this is food. Then the algorithm goes, Is this a friendly stranger? Or is this a dangerous stranger? So if it's a friendly stranger, because we have a tonne of bacteria that lives in the body that lives in the gut, that lives in the lungs, in the sinuses, right, we definitely shouldn't be reacting to that we shouldn't be reacting to the clothes that we're wearing or pollen, right. None of those things are going to kill us. So we have to have a mechanism for not reacting to things that are not self, but are not dangerous, but we also and that's called tolerance. But healthy tolerance also includes attacking when it's appropriate. So if you come across the chickenpox virus, you need to attack that, that's a dangerous stranger. So we initiate the stranger danger response, which is a massive inflammatory immune response. And that's appropriate. So healthy tolerance includes tolerating and being able to recognise self tissue Being able to tolerate friendly strangers, so bacteria, food, etc, and being able to attack when there's stranger danger. So with auto immunity, that first step in the algorithm is broken because we're attacking ourself. And the reason for that is because that doesn't happen by accident. The only reason that that can happen is if that tissue is damaged. Because it's because it's infected by a virus, for example, or because you've had surgery or because there's an injury, right? It's damaged, or because of something called oxidative stress, which we'll probably talk about at a later date, but if it's damaged, or it's not recognisable as self anymore. And then the other mechanism is because it looks exactly like a dangerous stranger, right? That's called molecular mimicry, where the protein looks like an infection to the immune system. And so, so the immune system is not making a mistake. In fact, the immune system is doing exactly what it's supposed to be doing, which is attacking something that has activated the stranger danger response. And when it's our own tissue, it's because the tissue has been damaged, because it's not recognisable itself anymore, or because it looks like an infection, and that the immune system has already recognised that that infection is problematic. So when we're talking about why does somebody get in, like how does that happen in the first place? How do we develop autoimmunity, we talk about the three legs of the stool, right, you have to have some kind of genetic predisposition you need to have some kind of immune system activation already. So the immune system is already. For example, if it looks like the, you know, if we're talking about cross reactivity, where the tissue looks like the infection, let's say it looks like the chickenpox infection, you have to already have got immune surveillance for that infection, it doesn't just happen for no reason. Or, and then we talk about, so you have to have immune system immune system dysfunction, and then you have to have an environmental trigger of some kind. So the environmental triggers are infections, toxins, foods, and stress and trauma. And so there's always this, there's always this Venn diagram of those three, so genetics, immune system dysregulation, and environmental trigger. And when they overlap perfectly, when those three things overlap perfectly, you are susceptible to autoimmunity. But auto immunity also develops over a period of time. So it's like you've pressed the first domino. And then the dominoes will continue to fall as you have this development over time until you get to diagnoseable level. So that's helpful to understand because the earlier you can identify that there are problems with the immune system, the better your ability to turn it around in the body.

Peter Williams  18:15  
So question on that, then, as far as my understanding is, is that for many, you can start seeing antibodies appear 10 to 12 years before you're diagnosed with an autoimmune disorder. I suppose the question on that, though, is that it's unlikely? Well, I mean, maybe you would know better, unless you're with the right person, you wouldn't be getting the right message that maybe there's something that we would probably want to at least monitor here. Go on Robin,

Robyn Puglia  18:45  
sorry. Yeah. So, so 10 to 12 years, up to 20 years beforehand, you know, they've done studies in lupus that have found, you know, 17 to 20 years, the antibodies are there before the lupus is diagnoseable. And something that I see a lot is people who have got something called ANA positive anti nuclear antibodies, right? This is the very, very standard conventional test for autoimmunity (cheap to do) Yeah, it's cheap to do. And it is often raised in things like, you know, in the more common systemic auto immunities, but so ama will be positive and then they're told are but you're, you know, we can't see anything, there's no joint damage, there's no, and so it's probably nothing, instead of saying this is the beginning of something. People are told by their GP by their medical team, the rheumatologist whoever's run that panel, but it doesn't you're not diagnoseable so there's not really anything we're going to do about this. And for me, that's like seeing the check engine light. Come on, on the dashboard, but because the engine hasn't fallen out of the car, we're just going to watch and wait until the engine falls out once the engine falls out, then we can get the duct tape out and strap it back in and, you know, keep on going. But

Peter Williams  20:10  
so just on that, is there, is there a level? Obviously, we measure this in the sort of the dilution of the titre that they do is that is there cuz I know, you know, up to a certain level, whether that's one in 80, that, you know, you're going to have 25%, maybe a little bit more of the population who have that going on. And it's not clinically relevant or is it? And if you are, if you are looking at ANA numbers, is there, is there a sort of? How would you follow that over time? Let's assume you are that you had a positive ANA it's I know one in 80, what would you say to a patient who's asymptomatic? Yeah,

Robyn Puglia  20:52  
so it's your check engine light. So it doesn't necessarily mean you're going to go on to develop autoimmune disease. But ANA is anti nuclear antibodies, it is antibodies against the DNA of your cell, the nucleic acids of the DNA of your cell, there is no scenario except repair, where you should be making antibodies to your own DNA. So there has something that has gone wrong enough for the immune system to get involved. So either the immune system is doing the damage it's attacking, or the immune system is cleaning it up. So that means something else is doing the damage. So that's serious enough for me that even if it doesn't go on to autoimmunity, we still have to see if we can find out what is causing that damage. Now with anti nuclear antibodies with ANA specifically, the research tells us that the vast majority of ANA happens to oxidised DNA, that that doesn't actually happen to healthy DNA. So if we talk about what is oxidised DNA, so oxidised means that it has been susceptible to something called oxidative stress. So there are two, if I'm going to really simplify things, there are two types of inflammation in the body there is the inflammation that we call inflammation, which is like fire. And then there is oxidative stress, which is like rust. So, and in fact, Rust is oxidative stress of metal. So when we're talking about oxidised DNA, what we're talking about is you've got rusty DNA. And because it's rusty, it's not recognisable as self to the body anymore. So if you if you visualise what a bicycle looks like, and it's blue, and it's shiny, and it's got writing on it, but then if you visualise what a completely rusted out, bicycle looks like it's not blue anymore. It's not shiny anymore. It's kind of pitted and red, that looks so different to the immune system, your immune system is expecting something shiny and blue. And instead it's got something rusted and red. And so it's not recognisable as self anymore, because self would be shiny and blue, and now it's red and pitted. So that becomes the reason that you're making antibodies in the first place. But what we really need to know is why is it rusty? Because that's not good. So and then the other. The other thing we're looking for is infection in that specific, you know what, what has caused this damage in the first place? There's got to be something there that has caused this and even if it doesn't go on to develop auto immunity. It's, a positive ANA for me is enough of a warning that I want to take it seriously. Yeah, I think I think it's serious. I don't think that we should be making antibodies to our own DNA. That's a problem.

Peter Williams  23:54  
Okay, so So here's a question for you. Autoimmunity seems to be much more prevalent in women than men. So why is that? Okay,

Robyn Puglia  24:04  
so that's a great question. So in that most recent study, they found that it's about two thirds to 1/3 over the most popular 19 autoimmune diseases so for every so of the that's a lot Yeah, it's a lot but that also is an aggregate so there are some autoimmune diseases so lupus, the numbers are seven women to one man diagnosed and sjogrens, it's nine, right? So it from from disease to diseases, there's an even bigger gap between how many women are being diagnosed and how many men so the obvious answer to that is, do hormones have something to do with it? And the answer to that is yes. So all of, all of your immune cells have got hormone receptors on on and we know that oestrogen has a proliferative effect. So whereas androgens the male hormones, and progesterone as well actually are more calming to the immune system. But we also know that 50 years ago, there was always been this, we call this the gender bias, right? Where there's more women than men affected. That's called gender bias. So that gender bias has always existed. But 50 years ago, actually, you know, in the 50s, that's now 75 years ago. The numbers were different, you know, there was still the gender bias, but it was much smaller than it is now. So we know that hormones are not really the if it was only hormones, the numbers would have stayed about the same. So hormones definitely play a role. And also,

Peter Williams  25:43  
question on that then. Does that change the numbers, perimenopause, or menopause, Is there a big shift?

Robyn Puglia  25:51  
I was just gonna say the big risk times because one of the big risk factors for autoimmunity in women is when you have big shifts in hormones. So puberty, pregnancy, postpartum, perimenopause, and menopause, are very big risk times for women where your hormones undergo a rapid rise or a rapid fall. That is when we're at most risk for developing an autoimmune disease in the first place, or developing a second or third if you already have an autoimmune disease. So yes, that's a definite. And then there are other things like the contraceptive pill and contraceptive replacement. So understanding because for some people, the contraceptive pill for some women, for some girls, a contraceptive pill reduces risk because it reduces the amount of oestrogen in the system and for other women, it will actually increase risk. So there's not a there's not a hard and fast statement that we can make where, you know, this is a risk factor or this is a protective factor, because it depends on the individual. For some, it is protective. And for some it is actually massive, encrypted massively increases the risk. And then the second thing is that women are exposed to much more chemicals than men actually women are. You know, the studies have shown that women are exposing themselves to between 100 and 120 chemicals per day from cosmetics, skincare, body care, deodorant, perfume 100 to 120, before we've had our morning coffee, you know,

Peter Williams  27:32  
so that's unbelievable, because the reality of that is that that really does hit the message from the point of view, you've got to be careful what you put on your, on your skin or while you're washing or I mean, that's, that's pretty significant. And obviously the literature really supports that.

Robyn Puglia  27:48  
It really supports that that's a very big variable. And there's lots of different mechanisms through which chemicals completely drive autoimmunity, they drive immune system dysregulation, they break your barriers, so chemicals and the chemicals in our skincare and our hair care. And when you're spraying things in the air, you're breathing them in and you're causing leaky gut, leaky lungs, leaky skin, leaky gums, right and once you've got leaky barriers, then you have immune system dysregulation, which is one of the legs of the stool and then you also have the chemical in the body. And you know, I said one of the things that causes autoimmunity is that the body can't recognise its own tissues anymore. So one of the ways that that happens is if the tissue has got a chemical stuck on it, right, it's basically wearing it like a disguise if you can visualise one of those Groucho Marx disguise, party disguises with the glasses and the fake nose and the moustache. And if you've got thyroid tissue that's got BPA stuck to it, that's what it looks like it's wearing a disguise. It's not recognisable to the immune system as thyroid anymore. And then bang, you've got thyroid autoimmunity, because the immune system has a stranger danger response to tissue that has a chemical attached to it.

Peter Williams  29:02  
And just on that it would that also mean that because women generally have more body fat in general than men, that they are more more at risk of storing chemicals as well. That's

Robyn Puglia  29:16  
exactly right. So not only are women exposed to more chemicals, but we store them and we respond to them differently. So we usually have a higher body burden because we have a higher body fat percentage. And because we metabolise and we store fat differently than men so not only are we exposed more but we store more as well Yeah. So

Peter Williams  29:38  
on on that trying to keep your I suppose weight and body fat down is a key player in probably prevent preventing autoimmunity Well, certainly moving down the pathway to help you prevent autoimmunity.

Robyn Puglia  29:53  
It is one of the variables but it's difficult because some chemicals are obesogens

Peter Williams  29:58  
Of course, yeah. So So can you just explain? Can you just explain what you mean by that? Yeah, so

Robyn Puglia  30:04  
there's a class of chemicals that we call obesogens. Because they completely change, once they're in the body, they completely change the messaging around the way that we store fat. And so they promote obesity, right, they promote the storage and not just the storage, but the holding on to fat in the body. They make it very if you've got a tonne of obesogens in your system, and people, you know, the people, some of the people who are at highest risk for this exposure is people that work in hospitals and medical staff.

Peter Williams  30:35  
Bless you, 

Robyn Puglia  30:36  
So doctors, nurses cleaners. Just pause for a sec, because I have to cough for it.

Peter Williams  30:44  
We are going to let you cough, you're all good. I'm gonna show you we're going to show you that you're normal. And I know we're talking about that the Queen of autoimmunity, but she has a she has had a pretty heavy cold, so

Robyn Puglia  30:57  
okay, I've got little kids who are super germy. So, all good.

Peter Williams  31:01  
Well, I'm gonna take a big sniff, and we'll carry on. Okay, let's go.

Robyn Puglia  31:05  
Yeah, so obesogens, and so once you have them on board, not only do they promote weight gain, but they make it very, very difficult to lose that weight, even if you're doing all of the right things.

Peter Williams  31:16  
So let me again, let me ask you a question. Because the key to this is that obviously, we're speaking to an expert here. And you can you can go on to on social media. And to be fair, there's a lot, there's a lot of crap that runs through that. And so here's a question for you then. And you can explain, there really is very significant science to show that we live in a pretty toxic and polluted world. And so do you ever do any testing around that for patients when you're dealing with autoimmunity? If you feel as though it's necessary?

Robyn Puglia  31:48  
I do. So yeah, I very definitely do. So there's there are a couple of tests that I look at one of them is not actually available at the moment, which is annoying, but I'm looking at the release of chemicals in urine, right? So I basically asked people to, to do an exercise before so that that particular test is a urine test that they do first thing in the morning. So the day before, I'm asking people to do a few things that help them to release stores of chemicals from their fat just a little bit. And they so we're going to dump it out in the urine, so I can see what's there. Yeah, and those were looking for lots of different types of chemicals that are found in the environment. And that's looking at how much is in the body? What do you actually have? What do you have in the stores? What's floating around in your blood? But the other tests that I do look at immune reactivity to chemicals. And that one is not about how much do you have? It's about how much is it bothering your immune system, which is very, very relevant for autoimmunity. But in order for it to be measured it has to be attached to the person's protein. So you know, talked about wearing it like a like a disguise. Yeah. So that has to be in place, in order for it to be measured in that immune reactivity test, because you can't measure antibodies to a chemical, it has to be attached to the tissue already. So that one is very specific to auto immunity, because it helps us really join the dots between not just what chemical do you have in your body, but what chemical Do you have bound to your tissue that is bothering your immune system that's very specific to auto immunity. And then I also look at mould and mycotoxins. Which let's do just one podcast episode on that, because it's too big of a topic to do in just one episode.

Peter Williams  33:40  
Yeah, I suppose

Robyn Puglia  33:43  
They're the three that I'm thinking about with autoimmunity in people

Peter Williams  33:46  
so I'm gonna write that down. So I'm definitely going to hold you to that one. Because it's definitely not an area that that I have huge knowledge on. So let's talk let's I mean, it's amazing, isn't it about what might be causing autoimmunity? And, you know, there really is pretty serious research out there to show that, you know, the environment from a point of view, toxins and pollutants really does affect us and I mean and that sort of chemical exposure, which is probably dominated by the bathroom is even more scary, really. So it really does push people.

Robyn Puglia  34:22  
Yeah, and it's an unregulated industry, like the cosmetics industry is unregulated. And, you know, again, I worked in medical aesthetics is literally my background, like my first job was on the Clarins counter. So when I tell you that I understand the ingredients, and I understand the industry, I mean, I know it in a way that's intimate. And I'm horrified by what's in you know, what's in fragrances and what's in candles and air fresheners and, you know, the things that most of us have in our homes without even really thinking about it the things that are easily available. There's just so many of them like it's, it becomes really overwhelming. There are so many Ingredients in in one shampoo, and then we're using shampoo, conditioner, treatment mask, leave in conditioner, heat protecting spray, shining serum. Right. And that's just hair. And then we're using serum, moisturiser, primer, foundation, concealer, blush, bronzer, or contouring stuff, eyeshadow, eyeliner, mascara, eyebrow pencil, eyebrow gel, lip liner, lipstick, like, it's so many, and it's so many products. And each of those products has got so many ingredients. And it's you know, it's an in a 20 minute routine. We're talking about 120 different chemicals. And they're, you know, they you absorb them, and within two minutes, they're in your bloodstream. But so, if but then the other thing I want to make sure that I when we're talking about why women end up with autoimmunity, the other thing that we can't actually ignore. So we've talked about hormones, and we've talked about chemicals, but we also have to talk about the mental and emotional load of women. You know, women are carrying a huge stress burden, that has become more I think, where we are carrying the social and emotional load of our families, you know, it is still it has become better. But women are still doing the majority of care for elderly parents, care for children. The mental load of things that need to happen around the home, as well as working full time a lot of the time. And so there's a there's a level of burnout and of psychological stress and fatigue, that also happens for women. That doesn't happen. There's not parity there with men. Even if you've got a great partner, there's still not parity and it's still not normal. You know, the norm is still that women are holding that burden. And

Peter Williams  37:11  
that can I ask if you could just give a really layman's terms with regards to how stress influences the immune system and then predisposes the immune immune system to become more autoimmune. Yeah.

Robyn Puglia  37:27  
Well, so. So first of all, if you are in a state if your nervous system is in a state of hyper vigilance, right, if so, if you are a person who jumps easily and startles easily, and you don't like rollercoasters, and you're just that kind of person, then your your nervous system is in a state of hyper vigilance. And you cannot have a calm immune system if you have a hyper vigilant nervous system. If you have a hyper vigilant nervous system, you also have a hyper vigilant immune system, those two things go hand in glove and a hyper vigilant immune system is one that is going to be more pro attack, basically. So you are more likely to have big inflammatory responses to small injuries, and start the ball rolling that will end up with auto immunity. But stress, so there's two types of stress, there is current stress, and then there is historical stress. So historical stress comes from adverse childhood events, and from, you know, traumatic things that are happening in adulthood as well. And that rewires the nervous system to become hyper vigilant, even if you're not aware of feeling stress, but then you also have current stress, right? We all know what current stress feels like. Yeah. But it also feels like being busy, it feels like not being able to switch off. It doesn't necessarily feel like an exam or like a work deadlines, something like that. It can also just be I'm too busy. And I'm busy all the time. And I can't switch off and I lie in bed at night, and I'm worrying about what's happening the next day. And when in both of those situations, if you have current chronic stress, or if you have long term historical stress, then you are constantly constantly constantly secreting adrenaline and cortisol and the other hormones at a low level, right? So we have this constant low level dripping of that tap. And cortisol has a very specific action on the immune system in that it it suppresses defence against infection. So it actively, you know, I talked about the different soldiers, you've got soldiers and you've got illness. So cortisol actually yanks those out of circulation and essentially kills them so that you have less defence against infection which makes you much more susceptible to damage from infection and chronic infection which makes you much more susceptible to autoimmunity or It also stops you from it. It's so long term cortisol, activation in the body equals long term inflammation in the body cortisol short term is anti inflammatory. But cortisol long term is aggressively pro inflammatory. So you're also carrying this low level burden of inflammation, which makes it very difficult to switch off. And it changes the a bit, you know, it changes the algorithm, right? I talked about the tolerance algorithm of Is this me yes or no? Is this a friendly stranger or a dangerous stranger? So cortisol affects the ability of that algorithm to work, so it's more likely to be recognising and activating the stranger danger response. And another interesting well I find this really interesting is that when they've when they have studied autoimmune disease in chickens, chickens can spontaneously get vitiligo. But that only happens. autoimmunity only happens in chickens where there is something wrong with their glucocorticoid system, right. So it's all, for chickens it's always the glucocorticoids that creates spontaneous autoimmunity. And so a lot of the research has been done around how stress affects the immune system. And there's, so your stress response starts in the brain where your brain is reading the environment, it's reading the sounds and the sights and the smells, and that's called your hypothalamus. So and then your hypothalamus read the environment decides you need a stress response indicates your pituitary gland, which activates your hormones in the body. And actually forget where I was going with that.

Peter Williams  41:50  
We talked about how stress spontaneously increases. Yes. Yeah, yeah. Can you explain what vitiligo is because I think many people probably see it quite a lot. Yeah. So. So associated with increased stress levels as well. Yeah, so

Robyn Puglia  42:07  
vitiligo is an autoimmune disease of the skin, where you know, I've talked about where the immune system attacks the tissue, so when the immune system is attacking the skin, it D pigments, the skin, so it affects the melanocyte, which is the cell in the skin that makes melanin and melanin is what makes you tan Or what makes you colour if you have any kind of pigment in your skin. So when you see vitiligo, it is a difference in colour in the skin. So usually white patches, but it can also affect the hair. So it can be like to completely snow white patches of hair in the head, the eyelashes in the eyebrows, or it can be deep pigmented patches on the face on the hands. It's it's visually very specific. There's a very definite look to vitiligo. But so chickens get vitiligo when they have a problem with the glucocorticoid system. But my point we're talking about the hypothalamus and the pituitary. So there is a psycho neuro immunology, axis for auto immunity, where the only trigger of your autoimmunity can be that like the hypothalamic activation that happens in the brain.

Peter Williams  43:23  
So what you're saying. So, again, let me put a scenario, if you have genes that predispose you, if you have early childhood trauma, that rewires your brain and this literally sounds like a lot of our patient groups, doesn't it? You know, they tend, I would say more likely to be women, more likely to have had psychological or sexual trauma, as kids and then they go into adulthood with a brain that's and a nervous system that's rewired again, for I'm not safe, and therefore it becomes hyper vigilant. And they turn up with chronic fatigue. They've got Fibromyalgia they've got, a whole underpinning of autoimmunity. I mean, that must be what you see all the time.

Robyn Puglia  44:11  
All, I would say. So first of all, auto immunity is never always anything. So I say that all the time. It's never nothing is ever always 100% of time, but let me tell you what you've just described as like, 95% of the time, it's as close to always as auto immunity is ever going to get it's such a common scenario. And the reality is, if you've got two adverse childhood events, your chance of developing an autoimmune disease is 400% more than somebody with one or none, you know,

Peter Williams  44:41  
I mean, that's just awesome statistics, isn't it? And you know, that, I suppose, I suppose it's I mean, because we've been doing this for such a long time. It almost becomes, you almost see it straight away, don't you? You know, literally when that patient comes in, you're like, Shit, I know where this is going and I know how this is and then one she'd gone through all that background story. You know, it's like shit. You know, I think that's the nice thing about how you can tell a story back to them about here's probably how you've arrived where you've arrived.

Robyn Puglia  45:13  
But what you said about safety, like don't feel don't women don't feel safe in their body a lot of the time, or they don't feel safe in the environment. Yeah, I actually saw a meme yesterday that said, Something about being a straight woman is wild because you have to date your only natural predator which made me laugh, but in a very wry way. You know, often women don't feel safe in the environment, they maybe don't feel safe in their home, maybe they didn't feel safe in their childhood home, maybe they don't feel safe in their marital home. Maybe they don't feel safe, you know, in their workplace. But you can't, you know, not feeling you can't have a normally functioning immune system if you don't feel safe

Peter Williams  45:58  
You know, as I always say to these patients is that if you live life on the with your with your accelerator, accelerator pedal on the floor all the time, you're gonna end up being pretty tired. Pretty soon.

Robyn Puglia  46:11  
I call it the Sabre toothed Tiger lens, your body is operating 100% of your of the day as if you are in a room with a sabre toothed Tiger. Yeah, right. And every single like, every time the wind changes, your immune system is immediately going was that a sabre toothed Tiger running past, every time a twig snaps your immune system is your nervous system is going was that a sabre toothed Tiger hiding behind a bush stepping on a twig like every single activation of the environment activates your body because you don't feel safe, even if you're unaware of it. Because you feel normal. But your body is acting as if you are about to be eaten all the time, even when you're asleep. Yes, I had I did I saw some stress results this week. Where the first the first reading of the day which which is done on Waking, right? You wake up you do you take the saliva sample, and you read how much stress hormone was the highest part of the day, it's supposed to be low and then jump up 30 minutes later, it was like four times higher than the than the highest point of the reference range. And I was like you're stressing in your sleep. 

Peter Williams  47:24  
I think I want to pick this point up because because this actually think this is really important point. I'm probably not a lot of people understand this. Number one, you know if you can talk to us about the role of cortisol through the day. But what you're talking about there aren't us you're talking about the cortisol awakening response. And why actually, we think it's quite a good indicator of, you know, the ship really is hitting the fan for some of these patients. So so why don't you just give a very simple brief about well, why did why you run that test, I think would be a good thing to chat about.

Robyn Puglia  47:57  
Yeah, because what we've just said is, so when I'm working with somebody with autoimmunity, or chronic fatigue, or long COVID, understanding how their stress response is reacting to the things in their day is make or break. For everything else, it will affect infections, it will affect the way you make energy, it affects blood sugar, it affects the immune system directly. So it becomes almost a proxy reading of the immune system to look at what your cortisol is doing. And there's so the cortisol awakening response is very, very interesting. And this is how it works. Before you wake up, your body starts to gather together your cortisol. And when your eyes are in it, in a natural setting, this would start to happen as the light starts to increase in the room, right. So if you're sleeping without, without curtains on, as the light starts to go up, the light penetrates through your eyelid, and it hits a receptor in the back of the eye, which signals to the brain. So as that light starts to increase, your body starts to gather together a bunch of cortisol. And when you open your eye, ie when you wake up, then that cortisol is dumped into your system, and it's how you get up and start the day basically. So you're supposed to on rising, have a level and then within 30 minutes as that cortisol hits your bloodstream, have it go up by a specific amount. And then it goes down and then it continues to go down in a in a set rhythm throughout the day. So your highest cortisol should be in the morning. And then your lowest cortisol should be at night before bed. It's the opposite. And this is that's called your diurnal rhythm or your circadian rhythm and it is how your body is supposed to be reacting to the to the demands of your day and responding and adjusting to A daytime rythym. And it's opposite to your sleep cycle where your melatonin is highest at night, and then lowest in the morning, your cortisol is the opposite to that. But that cortisol awakening response, which is that peak where it starts at a point, and then it goes up, and then it comes down. That is very indicative of what's going on with your immune system, if you've got a very elevated cortisol awakening response, then we know that you are immediately you, you're immediately foot is on the gas. And that tells us something about your stress responses, and also about your immune system. But the opposite can also happen where instead of peeking up, when you wake up, your cortisol drops. So you wake up at a certain point, and it drops. And we call that a low cortisol awakening response, and that person is very likely to be suppressed, right? So an elevated cortisol awakening response is somebody who is in hyperdrive, their nervous system is in hyperdrive, their immune system is in hyperdrive, the opposite when we see that dropping, and it might not drop down, like in a V shape, but it might be flat, or it might not pick up, you know, you're supposed to have a 60% Peak and only has a 20% Peak, that's still insufficient, right? That is a person who cannot mount an immune response their immune system is going to be suppressed their nervous system is inappropriately reacting to the demands of the day. And that is a person who is much more likely to be burned out and fatigued, low, everything's low, they're much more susceptible to infection. You know, so it's, I use, I use it, because it very much helps me understand the immune system, looking at the stress responses.

Peter Williams  51:44  
And I think it's also a really good test. Because visually, I think it's really good for your patients to get that reinforcement that what you've said is exactly what you've seen on testing. Exactly.

Robyn Puglia  51:54  
And also, it's, you know, functional testing, if we're just going to be honest, can be very, very expensive. Agreed. Whereas the cortisol test, and the cortisol awakening response is is not an expensive one. Yeah, you know, in the grand scheme of things, and it gives us a tonne of information. And it also really helps us to track changes, right. So it's an easy one for us to repeat, we make these changes to diet, we make these changes to lifestyle, and then we can watch how the body responds to that.

Peter Williams  52:23  
Totally agree with you on that. I think I think, you know, I've actually sort of calmed a little bit on this, because I just think, you know, I think in the world that we're in now, with this sort of systems approach, I think there is a risk that people are just so heavily over tested. That I think that's slightly problematic. But I also sort of look at that and think, you know, if you're, if you're a new clinician to this, you're most likely going to over test patients anyway, because you just don't have that experience to set the programme up in an appropriate way. But I do I love it. I think as I say, it's cheap to do, and you'll get a load of bang for your buck from that one. I've got, I mean, this is this is our introductory lecture to autoimmunity. So I know we're going to have you on again. So I've got just one more sort of topic because we could be here all day listening to your words of wisdom. I can remember reading papers 20 years ago, maybe even more than that, that started to show that autoimmunity was also associated with the latitude that you lived at, which I found pretty amazing. Can you can you expand on that for us? Yeah,

Robyn Puglia  53:32  
so that is also very interesting. There's a lot of stuff that I mean, we call that the social determinants of health, where a lot of focus around health in the wellness industry is on diet and supplements and red light devices and cold plunges. And there's all of this sort of stuff, but diet vary especially and, and stress. But in fact, there are a lot of variables that go into determining whether or not somebody gets sick or not, which are out of that person's control. So the social determinants of health so poverty is obviously one of those, gender is one of those, you know, you can't just gonna say you can't change your gender, but that really opens up a whole can of worms. political perspective, we're just going to drop that

Peter Williams  54:23  
there and we'll drop and walk away. Yeah. Okay.

Robyn Puglia  54:27  
But latitude has a big impact. And the research around that is really fascinating. And some of that has to do with exposure to vitamin D, you know, natural exposure to daylight as well. Yeah. And, and the impact that that has on your circadian rhythms. Yeah. So,

Peter Williams  54:47  
can you just briefly explain what circadian rhythms are because we have this sort of side of medicine called circadian rhythm biology, and I think there's some pretty cool stuff on that, but it's So

Robyn Puglia  55:00  
interesting. So your circadian rhythms are, it is the clock that your body uses to decide what it's doing and when. And it is the set of systems that it has in place to keep that entirely regulated. So one of those examples that we've talked about is cortisol, cortisol is supposed to be high in the morning, you have this peak, and then it gradually declines over the day until its lowest at nighttime melatonin is another one. But in fact, we have a whole series of mechanisms and sets of communication that happened in the body that anchor the body, that anchor the function of the body to different points during the day. So we sleep in the dark, we are awake during the day, digestion happens more during the day. Immune activity, interestingly, often often happens more at nighttime. And in order to govern all of that there's a set of communications. So circadian circadian rhythm biology really is just the, the understanding of your body's internal clock, and how it decides what is going to be active when. And, and it's, and one of the primary communicators of circadian rhythms is light and dark, right. So as light increases with the sunrise that exposes that part of the back of the eye, gradually over about a 30 minute period to an increasing amount of light. And then you have exposure to light during the day. And then at sunset, you have a decreasing exposure to light over again, this 30 minute period where you're supposed to go through a visual sunsets. So you have more exposure to blue light in the morning, around the sunset, it's more the reds and oranges. And then you're supposed to be in the dark at nighttime. And so the absence of that light stimulation also impacts the messaging that the brain and the hormones and everything gets in that determines what gets switched on and what gets switched off and what's active and when. So

Peter Williams  57:11  
the further away we are from what we think is optimal natural circadian rhythms, the bigger the risks sort of health wise all over and, of course, within that becomes auto immunity

Robyn Puglia  57:21  
100% And you know, some of the studies are really interesting because of course, there are countries in the north, or in the north, the  Northern Hemisphere, where it's, you know, you have months of the year where there's not really daylight and then months of the year where there's not really darkness. And it's very interesting to look at immunity in those patterns. But also they've done studies where they have deprived people of light and looked at what that has done to their natural circadian rhythm and how much they slept and what happened to their immune system. And it's, it has a surprisingly huge impact, like, just light has a surprisingly huge impact, but also vitamin D, right, how much exposure you have to vitamin D, also has a really big impact.

Peter Williams  58:08  
So can you just obviously, I sort of want to sort of just define this one because it can you define the importance of of having optimal levels of vitamin D with regards to reduction in autoimmunity? Because I know  autoimmunity is, it's got multiple mechanisms in place and with each individual, but, you know, we sort of look at some of the also some of the low hanging fruits that can really help us to try and help our risk factors with regards to that.

Robyn Puglia  58:34  
Yeah, absolutely. So vitamin D is, it's not really a vitamin, it is a form of hormone, for want of a better word, it is made predominantly in the skin from cholesterol, when we're exposed to sun at a particular wavelength. So we make vitamin D, and the more vitamin D you make, let me rephrase that. So we make vitamin D. And all of our immune cells, all of our cells in the body have got vitamin D receptors. So one of the things that we know is that one of the biggest risk factors for a lot of different types of immune dysfunction is vitamin D deficiency. Interesting. Yeah. And so the opposite of that is one of the protective mechanisms is having sufficient or optimal amounts of vitamin D for as much of your life as you can. So from birth all the way through childhood, all the way through adulthood. And, you know, one of the ways that kids do that is that they play outside, they're just wearing a nappy for for a big chunk of their childhood that they're just running outside in the backyard in a nappy, which is not that common anymore, actually. But so the more the longer of your life you spend with optimal amounts of vitamin D, the lower your risk of immune system dysfunction.

Peter Williams  1:00:01  
And so we'd be looking as I say that suppose we could simplify that from a point of view of the more time maybe you spend outside where you can have some exposure, the more likely that so how does the How does vitamin D, what is its role with the immune system. And obviously, what you've just said there is that there's a receptor on every immune cell, which I think tells you how important it is. But it sort of works, it's sort of, it sort of calms it a little bit doesn't, it makes it exactly.

Robyn Puglia  1:00:30  
So it does two things, it is anti inflammatory vitamin D. So it gets used, used up a lot people with an inflammatory condition haven't higher need for vitamin D, because it gets used up in a state of inflammation, but it is also because it's in that hormone family, it's a communicator. So it helps with the communication of the immune system,

Peter Williams  1:00:52  
bless you 

Robyn Puglia  1:00:54  
to have calming and tolerant messages being sent. So again, it really helps with that algorithm, because that algorithm is all about communication. So the immune system and the hormone system are both governed by communication. And so vitamin D helps with the communication of peace in the body, and it helps to resolve inflammation. That's

Peter Williams  1:01:18  
a really good way of putting that question for you, then, are there, is there data suggest to what, What levels of vitamin D that we should be aiming for? If we're thinking about good immunity and auto and auto immunity? Is there sort of is there any evidence on that? 

Robyn Puglia  1:01:40  
Yes, there's so Vitamin D has been researched extensively. And the reality is, there's not really there's, there's not really one consensus on this number. But what I would say for people is that if you have autoimmunity or if you're actually just trying to maintain optimal health, for me, I like for people to be at around 70 nanograms, which is about 120 to 140. nanomoles. Okay, so it's much higher. That's, that's optimal level. Right. So that is much higher than the deficiency insufficiency cut off.

Peter Williams  1:02:19  
Can you explain the difference? Because obviously, you know, people will probably go to the doctors and say, I'm at 50 nanomoles, and actually, you know, I'm not deficient. I'm like, Well, you are for the job that we need you to do. And the other thing about that is that I always insist any of our patients that come in is, is that the minimum requirement we're trying to do beautifully fits into what your numbers and that is the COVID studies on On vit risk of COVID, based against vitamin D levels, and, you know, the minimum requirements 125 nanomoles. So sits beautifully to work to where you're out. And is that because basically, the way probably maybe traditional medicine looks at these numbers and requirements is that they're not thinking about the bigger picture of the bigger role that vitamin D does. It's more sort of, you know, those numbers still defined with regards to bone health. And,

Robyn Puglia  1:03:18  
Exactly, so the RDA for vitamins and minerals, including vitamin D is usually looking at what is the minimum amount that you need to prevent a disease of deficiency? And so, scurvy, you know, the vitamin C recommendations are how much does the population need to get as minimum in order to not get scurvy. And there is a very big difference between not getting a disease and functioning healthily, right. So with vitamins and minerals, we're all like, there's this whole spectrum where we've got deficiency down one end and toxicity up the other end. So it goes deficiency, insufficiency, sufficiency, optimal, excess, toxicity like that. So deficiency, you are at risk of developing a disease. insufficiency is you're not going to get the disease but you don't have enough to do all of the jobs that you need to do. sufficiency is you have enough to do all of the jobs, but not perfectly, optimal is you have enough to meet all of the needs of all of the things that you need to do properly and have a little bit in reserve, but not enough in reserve that you're going to cause problems. Yeah. And then you've got excess where you're not at toxicity yet, but you are bordering and then you've got toxicity and not all, you know, there's not a toxic level of vitamin C. Just for example, I don't know, but vitamin A there is and vitamin D there is although it's very high, it's like greater than 300 000s and even 300,000 is still considered to be safe. .

Peter Williams  1:05:00  
I mean, you've been in, you've been in the game a long time. So you know, we can, again, generally, I like talking to people who are in the trenches and have been in the trenches for a long time because they just have experience of conditions that just most. I mean, I think this is the great thing with regards to even looking at research, when they do the research, sometimes you read it and think there's just no way that they deal with clinicians, because they wouldn't deal with patients because they would they wouldn't be saying, No, exactly, exactly. So. So in your opinion of, you know, being a clinician for a long time.

Robyn Puglia  1:05:37  
You're making me sound old Pete?

Peter Williams  1:05:39  
Well, listen, you're not old. 

Robyn Puglia  1:05:43  
But I hear you, I am an old timer. Now. It's

Peter Williams  1:05:44  
nice that it's good. You've got to be confident you've been in the game for a long time. So there's not there's not? There's not? No,

Robyn Puglia  1:05:53  
I've been in the trenches for a really long time. I've been doing this like, day in day out with people. Yeah, applying with people seeing what happens with people not just looking at what it says in the paper, or what's happening in the petri dish, it's what's going on with the person in front of me. Yeah. And that's honestly, where I've learned the most is

Peter Williams  1:06:11  
agreed. Well, same with me is that, you know, as I say, the reality is you've been in it such a long time, you've seen so many patients that you see a lot of things, and I was gonna ask you this question. I've never ever seen a patient that has had optimal levels of nutrients across the board. I've never seen it. So do you think it exists. I'm not sure it does. I don't

Robyn Puglia  1:06:33  
know that it does. But I also don't I don't know how you would know. Either, because those people are not seeking out, you know, nutrition and health care practitioners. So I never have, but I don't see well, people. Yeah. And even if you're working with people who are well, and I'm using that the air quotes, they're like athletes, right? fit and healthy and not the same thing. And, and even the longevity crew, you know, who are probably more than probably the, I don't know, if I can say that probably like the healthiest group that people like us work with. I'm not even sure if that's true.

Peter Williams  1:07:23  
So this is the interesting thing. And like everything we talked about is that, you know, particularly when you're saying about the environmental aspects to this, and I've never ever seen, I mean, I'd say I do quite a bit of longevity optimal health stuff as well. And I've never ever seen it. And I've just never, ever been so surprised with some of them where you're like, holy cow, you know, you've got everything in the mix for regards to getting this right. And, you know, you know, and I wonder whether that really is the sort of environment sort

of, you're really pushing against it

Robyn Puglia  1:07:54  
Yeah, that's, that is 100%. Like we're not living in an environment that makes optimal health or optimal nutrition, easy. You know, the air is not clean, the water is not clean. Our homes are not clean, like the cost to our body of just going through a 24 hour period is high. Foods are not really that nutrient dense. Everybody is stressed. Even the longevity people are stressed. Yeah. They're stressing about, you know, making sure that they're spending enough time in the hyperbaric oxygen and have they done enough red light therapy today and have they taken their 80 supplements, you know, like they're stressed about their wellness.

Peter Williams  1:08:34  
The Worried Well, I love that? Yes,

Robyn Puglia  1:08:36  
they're tick, you know, ticking things off their list. Have I Okay, have I had my 80 grammes of protein today have I had my four handfuls of kale have I, you know, it's it life is just like that, but do you know? I? Yeah, I you know, it was people weren't healthy before either. The health problems were just different. You know, I learned recently this is, this is really random and you might want to edit this out. But Laura Ingalls Wilder, you know, that prairie girl? Yeah. Right. So,

Peter Williams  1:09:09  
Little House on the Prairie Little House on the Prairie classic. You

Robyn Puglia  1:09:13  
know, her father grew all of their foods. They played in the sunshine, they did have some stress, you know, getting snowed in and all of that kind of stuff. But they you know, from a clean lifestyle perspective, he cut down the trees, there were birds, there was wildlife, the air was still clean. You know, there was no coal railway where they were living. They grew all of their vegetables themselves in soil that was completely untouched by any kind of chemical. They all died of diabetes in their family.

Peter Williams  1:09:46  
And do we know why? That was really random

Robyn Puglia  1:09:50  
There was no investigation of that. But like so Laura's Sister Mary and there was Grace and Carrie they all had diabetes and that's what they died from in their like 60s. use. And they were, they were walking everywhere exercising, they walked three miles to get to school in the morning and three miles to get home. Pa was shooting venison, like, you know, they had a clean lifestyle with clean food and they've got diabetes. So that not understanding that maybe that was some kind of I don't know, no idea. I couldn't even begin to understand why that happened. But you know, we just have modern problems.

Peter Williams  1:10:29  
So let me round this up now in the last question, which you'll, which will be a bit of a quick fire. And of course, if it's good with you, I can also already see two or three podcasts that people are going to just milk up particularly around celiac disease, and particularly around non celiac gluten sensitivity, which I know you're a great expert on, we should definitely do that. If we're talking about just generalised good immunity and reducing the risk of autoimmunity, what would be your top four tips that you would give?

Robyn Puglia  1:11:06  
Learn how to regulate your nervous system. For women learn how to express your anger. Learn how to have boundaries and don't be a people pleaser. If you are already a people pleaser and you are subjugating your needs to make everybody else in your life happy. You're going to have to break out of that learning.

Peter Williams  1:11:25  
Not easy.

Robyn Puglia  1:11:28  
But that's why I'm saying it's my number one.

Peter Williams  1:11:30  
But isn't that really easy? Isn't that really, I just have really fascinate you say that because the amount of times that you see the caregiver, the people pleaser, and they wonder why they're exhausted, you know, their lack of boundaries? And, you know, it's like you're gonna have to you're gonna have to be selfish. Yes. You

Robyn Puglia  1:11:52  
know, exactly. You can't out broccoli, inappropriate boundaries. And we talked about leaky gut in this podcast. I've talked about leaky gut, leaky skin, leaky lungs, but if you don't have boundaries, you have a leaky life. Yeah, totally. As a pro, it's as pro inflammatory as a leaky gut, and you can't take glutamine. Right. So you have to learn how to do that. The second one is sleep. Yeah, we are chronically under slept. And we normalise lack of sleep almost immediately. So you know, within a couple of nights of having an inappropriate amount of sleep, we normalise our function and how that feels. And we normalise the coping mechanisms. So the coffee and the what have you. And so I no longer believe people who say I get five hours of sleep per night and I'm doing great and it's been like that my whole life. No, there are consequences to that in your body. Totally agree. So eight hours of sleep or more, and you have to go to sleep before 11pm. So the type of sleep and the time that you're sleeping is incredibly important. Circadian rhythm plays a huge role in this.

Peter Williams  1:13:00  
Two more.

Robyn Puglia  1:13:01  
Two more, okay, I was going to say where are we up to?

Peter Williams  1:13:03  
There's quite a lot but give me just just I mean these we can always get these on more on other podcasts. Because it's such a big subject. So give me two more.

Robyn Puglia  1:13:12  
So did I say vitamin D? No, but you've said it now optimise you optimise your vitamin D and then eat whole foods. You know lots of colour would actually be my best advice and eat with joy. Enjoy your foods and eat with people who you enjoy.

Peter Williams  1:13:31  
Alright, well I think that's a really good place to finish. Thanks so much. Yeah. So so we're totally have you on again because literally, as I said to you that celiac non non celiac gluten sensitivity is such a big topic and again, gets completely misread I think on a lot of outlets. And so we should have the boss back on to to give us give us the lowdown on on that one. All right. Robyn, thank you so much for your time, and I'll speak to you soon.

Robyn Puglia  1:14:03  
I look forward to it. All right.

Transcribed by https://otter.ai