Datis Kharrazian, dhsc, dc, ms, mneurosci, cns: Finding Hope for Neurological Autoimmune Disease

Datis Kharrazian, dhsc, dc, ms, mneurosci, cns, is an associate clinical professor for the Department of Preventive Medicine at Loma Linda University School of Medicine and is an adjunct professor at National University of Health Sciences and Bastyr University. He is a fellow of the American College of Nutrition and the author of 2 best-selling books, Why Do I Still Have Thyroid Symptoms When My Lab Test Are Normal and Why Isn’t My Brain Working? Dr Kharrazian is currently in a postdoctorate clinical research scholar program at Harvard Medical School and publishes scientific papers in the literature in the fields of nutrition, autoimmunity, and toxicology.

Integrative Medicine: A Clinician’s Journal (IMCJ): Would you describe your educational path once you first started looking at health as a career?

Dr Kharrazian: I was injured in high school with a severe back injury. I ended up not being able to participate in sports or academically. I had to start taking pain medication and I remember all my grades started to drop. I could not do anything. A friend of the family took me to a chiropractor and I got an adjustment—started a treatment—and I immediately felt better. It was an “I want to do that right away” moment in my life.

Once I got my undergraduate in chiropractic, I went on to chiropractic school. Then in chiropractic school, I quickly learned the importance of nutrition. While I was in school, my mom was really ill. I met a person who was doing laboratory analysis and blood work. We ran a blood profile on her and figured out the things she needed nutritionally, and that made a big impact on her health. So, as soon as I finished chiropractic school, I went into earning a master’s degree in nutrition. I realized shortly after that, that there is a point where I need to understand research, so I followed that up with a doctor of health science research degree. After that, I realized I really needed to learn even more about statistics and research methodology, so I enrolled in a 1-year postdoctorate program at Harvard Medical School called the Clinical Scholar Research Training Program. For the next 2 years, I am going back to Harvard Medical School. I’ll be working on a master of medical science research degree.

IMCJ: How does your neurology degree fit into that framework?

Dr Kharrazian: As a master of neurological sciences, in the chiropractic profession we have specialties. This is a 3-year specialty. Just like radiology or internal medicine, the chiropractic profession has a neurology specialty, and I went through that program. We also had a master of clinical neuroscience portion of that. Right now, we are actually developing a master of clinical neuroscience program for the National University of Health Sciences so we can teach people how to use neurology in a rehabilitative aspect and learn how to apply things like rehabilitation and nutrition to recovering brain or preventative brain disease models.

IMCJ: How has this foundation led you into toxicology and immunology?

Dr Kharrazian: I met a person a few years ago who had a dramatic influence in my life. His name was Aristo Vojdani, phd. I heard Dr Vojdani speak at a conference. I was so blown away by his knowledge of autoimmune disease. At that time in my practice, I was seeing so many patients with autoimmune diseases that I basically did everything I could to be around him—whether it was trying to have lunch with him or call him up or call him on his phone asking about laboratory analyses I was getting back from his laboratory, which was Immunosciences Lab, Inc. Over the years, we have become good friends and he has really become a good mentor. We began publishing research together and I have been working in his laboratory doing a lot of research with toxicology as it relates to autoimmune diseases, and even neurological autoimmune disease.

IMCJ: How do you see nutrition impacting autoimmune disease and, in particular, neurological autoimmune disease?

Dr Kharrazian: For the most part, when people have neurological autoimmune disease, or autoimmune disease in general, they have it years before destruction of their tissue accumulates to the point where they will be diagnosed. So, for example, most people who have neurological autoimmune disease will start to have some deficits in certain aspects of the brain function, whether it is memory, cognition, coordination, or balance. They are not really sure where the symptoms are coming from. They go see a neurologist and the neurological exam findings are usually somewhat normal. They do not have any MRI findings. It won’t be until years later, when they really have started to progress, that they will be diagnosed, but that point is a little bit too late.

We know that with laboratory analysis, we can use antibodies against brain tissue, like myelin basic tissue protein or neurofilament antibodies, and be able to almost predict the progression of their disease process. We know these are early markers, so we’re learning to identify subtleties in the examination findings that are early stages of the symptoms and correlate that with laboratory analysis and then apply a preventative disease model using nutrition, diet, and lifestyle medicine to dramatically impact the laboratory markers.

We know we can also do that with people who are already progressed, but the outcomes are much better when we can catch the disease process early. When you look at autoimmune disease or neurological autoimmune disease, there really is nothing for medicine to offer these individuals who are suffering. The only mainline treatment would be steroids, and steroids have their own list of side effects that are almost as bad as the autoimmune disease for some people. Nutrition, diet, and lifestyle can have profound impacts—not curing the autoimmune disease, but dampening it and helping put the autoimmune disease in remission.

If you just look at the medical literature—your options when you have an autoimmune disease and what’s effective—and you were not biased, the only reasonable approach you would take, based on the evidence-based medicine model, is to apply diet and nutrition therapies. We see this big void in how autoimmune disease is being managed in the health care mode. So, if we can get people to really connect what is being published in literature to identification of autoimmune individuals, I think we can help practitioners do a better job of helping their patients. Patients will also feel better if we can make these connections happen. The information is already there, but we have two problems: One is, practitioners are not trained well enough to identify autoimmune diseases, and two, there is a shortage of knowing exactly what you can do for an autoimmune disease in both conventional and alternative medicine models.

IMCJ: What is needed to bring the levels of practitioner’s knowledge up so that they can identify these autoimmune diseases early?

Dr Kharrazian: When you look at all the different health care disciplines, whether it is medicine or alternative medicine, first of all, there is no real training in autoimmune diseases. We have the specialty of rheumatology, which is isolated to a few joint-based, degenerative autoimmune diseases. But autoimmune diseases hit all types of medical specialties. They hit gastroenterology, they hit neurology, they impact even cardiology, and all the various specialties. But those specialties do not have any real training or understanding of autoimmunity, so we have this void where no one is getting any treatment. In the medical specialty model, we do not have an autoimmunologist. This does not exist as a specialty. We do not have even an immunologist; we have immunologists who are PhD-level researchers, but it is not a specialty in medicine. Medicine has an infectious disease specialty, and that does not address the autoimmune nature of it.

For the most part, we have this huge deficit in identifying autoimmune disease. This is one of the goals of the American Autoimmune Related Diseases Association, which looks at “What do we do to help autoimmune patients?” Its biggest concern is to actually train the medical community to identify autoimmune diseases early. It has to start with basic coursework in medical school and that has to also involve basic coursework in alternative medicine programs such as naturopathic programs, chiropractic programs, or osteopathic programs. I really hope that would happen soon, but it does not seem like it will. Right now, if we can get into the postgraduate community, more and more, I think at least it will continue to have an impact.

IMCJ: What challenges are involved in bringing the standard of knowledge up?

Dr Kharrazian: Immunology, without question, is very complex. In the field of immunology, we know there are certain immunological reactions, but there is also an exception to every rule. As time goes on, we identify more and more messenger proteins and we identify more types of immune cells and their functions. So it is a very complex topic.

However, in a clinical setting, we know we can identify some biomarkers—markers for inflammation, markers for autoimmunity—and then we can take the literature and apply application—particularly simple things like using high amounts of turmeric, resveratrol, or other supplements like vitamin D, which we know impacts the immune system. We can use strategies such as those that are well published and look at laboratory markers that our patient has, then combine that with diet and nutrition lifestyle strategies. As a result, we can see some of these markers change even though we do not necessarily understand all the mechanisms.

We know, for example, that if you don’t sleep, your immune system dysregulates. So in the clinical scenario, by getting patients who have autoimmune diseases to sleep; getting them just a little bit of exercise, where they do not overtrain; teaching them how to stabilize their blood sugar levels; teaching them how to use antioxidants and anti-inflammatory compounds; and changing their diets so they are not as inflammatory, they can have profound impacts on changing autoimmune disease. These sets of strategies can be employed, to some degree, without us understanding all of the complexities that are involved.

There are some basic things that are just common sense. We know that if we can change people’s lifestyle and support their diet to the point where it’s not so inflammatory or antigenic, meaning we identify food proteins and sugars—whether they are from food or from environment, such as chemical exposure—if we can identify those things and remove them, we can help their immune systems be less inflamed. We can give their immune systems modulators to support their autoimmunity, like vitamin A and vitamin D and different types of botanicals, and we can make a huge impact in a disease where no one is currently offering any options in the health care model.

IMCJ: How do toxins contribute to autoimmunity?

Dr Kharrazian: Toxins are a huge component of autoimmunity, and I think one of the problems we have in alternative medicine is we blame everything on heavy metals. In the conventional model, I do not think we are at the point where there is real recognition of toxins being a contributing factor to autoimmune disease. So we have basically overlooked this whole vector for autoimmune disease. But we are realizing is it is not just heavy metals that have an effect on autoimmune disease. Things like BPA and bisphenol A, in plastic compounds, can trigger an inflammatory response and autoimmune disease. Things like formaldehyde, which is found in glue used in carpet, in wallpaper, and in Scotch tape, and benzene compounds from cigarette smoke or from gas exhaust—these can be triggers in autoimmunity.

Last year, Dr Vojdani and I published a paper in the Journal of Applied Toxicology1 where we found that these toxic chemicals, like formaldehyde and fire retardants such as tetrabromobisphenol A and BPA, actually bind to our own proteins. So when we get exposed to these chemicals, we do not have 100% elimination of them through our bodies. When they bind to our protein, they become a new antigen. These antigens have potential to then become triggers for autoimmune disease.

We checked 400 samples to see what degree the healthy population has chemicals bound to proteins, which we then measured with antibodies. This means they are having an immune response to them. We found that these chemicals were in a range of anywhere from between 8% to 15% of the population. What we have been doing since then is correlating whether people have antibodies to their own tissues with specific chemicals.

We have a paper in submission right now where we found that plastic compounds, BPA, bind to human albumin and we found very high correlation with those people having antibodies to nervous system tissue, specifically myelin basic protein. A 1.0 correlation means you have perfect correlation. If one marker goes up, then the other goes up. These are called r values. We found an r value of 0.9 with immune reactions to plastics and neurological autoimmunity, which suggest that those people who are having immune reactions to plastic compounds are also having immune reactions to their own nervous tissue, including their brain and peripheral nervous system. We are now going through checking all the different tissue antibody proteins that we saw in our initial research and correlating those with these specific autoimmune diseases. The correlation is unbelievably high. So we think that plastic compounds and compounds like formaldehyde in commonly overlooked household items can be a trigger for autoimmunity, and it is not just heavy metals, which has really been the focus of alternative medicine when it comes to autoimmune disease.

IMCJ: So you’ve kind of focused on the plastics, the bisphenol A, and the formaldehyde. What about volatile organic compounds?

Dr Kharrazian: Our research has been on chemicals that we encounter every day. We did check with mercury and heavy metals and we can produce antibodies to them when they bind to our own tissue proteins and become haptens. We are also finding research that has correlation between immune reactivity to chemicals bound to your proteins—albumin—and neurological autoimmune reactivity. The interesting thing is that we’re finding these exposures are unavoidable. You are going to get exposed. You can not live in an industrialized nation and not be exposed to plastic compounds or benzene rings or fire retardants. They are everywhere.

So the key issue is a complete shift in paradigm of how we treat these things. It is not just about removal, because they are abundant everywhere and there is constant exposure. It is really about what we call, and what the literature calls, chemical tolerance. Our immune systems have something called tolerance, which means we can be exposed to something that is an antigen or potential immune trigger, but we may or may not react against it. For example, look at food proteins. When people lose their oral tolerance and they start to react to every food protein they eat, then they get multiple food sensitivities and reactions. But the key issue is that they have lost tolerance in their gut immune system.

We can have the same thing happen with chemicals. So, even though we may have one person who has very high levels of a chemical in their bodies—whether it is mercury or bisphenol A in plastics—their level is not necessarily reflective of how much of a problem it is for their autoimmunity. What really matters is their antibody level, not their total load level. You can have someone who has trace levels of mercury, but then very high immune reactivity to mercury, so then they may have very high levels of mercury bound to albumin antibodies. Those are the people we are really concerned about. We know that when people become sick with chemicals from autoimmune disease, it is not just the exposure, even though that is a variable. The other concerns relate to their immune chemical tolerance. So things like intestinal permeability, regulatory T-cell function, dendritic cell activity, T_h1 and T_h2 cell polarization, or their ability to turn on TRAC cells—these are all key factors that then determine how a person may or may not react when they are exposed to chemicals.

In a clinical model, we have looked at people who have autoimmune disease and antibody levels to chemicals that are very, very high. If the chemicals we are concerned about are ones that they are going to get exposed to on a daily basis, then we try to do things to improve their chemical tolerance, like put them on high amounts of antioxidants, try to block their inflammatory pathways with flavonoids, and give them high amounts of vitamin D to get their T_reg cells to work. When we employ these strategies, many times we will see that their chemical antibody reactions dramatically change and their autoimmune reactions dramatically change as well.

IMCJ: At what point in your career were you exposed to functional medicine?

Dr Kharrazian: When I was a student in chiropractic school, I heard Jeff Bland speak. It was one of those moments where I go, “Wow, that’s it, that’s what I need to do.” Since then, I have been involved in that community for the past 15 or 20 years. I think it is the future of health care to some degree.

IMCJ: You have done a lot of work to extend the functional medicine framework into the neurology specialty area. How did you come to decide to pursue that?

Dr Kharrazian: I think one of the things that is really important to understand is that in order for a neuron to function, it has to have connections to other neurons. This is called plasticity. So a neuron has to branch into another neuron, and as they branch into each other, you can have functions for that specific pathway. The interesting thing is that nutrition and functional medicine approaches do nothing to develop plasticity. You cannot develop plasticity from a drug/nutrient/diet model. You just can’t. You can slow down neurodegeneration, you can dampen neuron formation, but you cannot make neurons connect to each other through a diet/nutrition/functional-medicine model. The only way you can make neurons connect is by activating them.

The analogy would be similar to muscle atrophy from wearing a cast. There is no supplement or functional medicine approach they could take to make their muscle develop again. They would actually have to move it. The brain is the same way. You cannot take someone who has degeneration in their brain and just put them on an anti-inflammatory diet, give them mitochondrial support, and give them fasting and expect that their brain’s neurons are going to connect to each other. You are actually going to have to activate the areas of the brain that are involved.

In my practice, I work with a lot of neurological autoimmune disease patients. One of the things we do with them is a complete functional medicine evaluation and try to identify dietary and lifestyle triggers that can impact the promotion of their neurodegeneration. Then we look at strategies to dampen that. We use nutritional strategies to improve their brain function from a neurochemical perspective, but then we find the areas of the brain that are involved and we actually have to have them do rehabilitation. One of the most common areas we see right now, involved in the neurological autoimmune disease model, is cerebellar autoimmune disease. With the explosion of celiac disease and these immune reactions to gluten proteins, we know that gluten has molecular mimicry, which can cross-react with the cerebellum, meaning antibodies made against gluten can attach to the brain’s cerebellum tissue target sites and provide the trigger for the immune system to destroy that tissue.

We see a lot of people who have, for example, cerebellar degeneration, and then they start to get ataxia, and they start to get vertigo, and they start to get nausea. We know getting them off gluten helps with important things like intestinal permeability, and by putting them on an anti-inflammatory diet and lifestyle, it stops the progression. But in a large number of cases, we have to make their cerebellum gain function again. So this is where we do cerebellum rehabilitation exercises. I do things like balance rehabilitation or eye movement. A combination of trying to activate the brain to develop plasticity and employing a functional medicine model to provide the best chemical environment for their brain seems to work well. My interest in going into a functional neurology model, where you really do a very detailed examination of the brain and nervous system and provide exercises for it, merges with the functional medicine model, where we are looking at chemical factors that impact the brain.

IMCJ: So you have initiated clinical incorporation of functional medicine into neurology within your own practice. How is the process for formalizing this happening?

Dr Kharrazian: For the past 8 years, we have had an annual conference and we have an association. It is called the International Association of Functional Neurology and Rehabilitation. It is a multidisciplinary organization. We have almost a thousand members now from all over the world. We get together and we try to merge these concepts together. Some of the people in this group come from a physical therapy background, some come in chiropractic, some come in from natural medicine, and some are more conventional neurologists from medical backgrounds. We are all interested in one thing: How do we make the brain function better than it is? It becomes a combination of toxicology approaches, nutritional approaches, brain rehabilitation approaches, and lifestyle changes. We feel that this is something that is necessary in the population because we have an increase in neurodegenerative diseases taking place like never before in our history. The prevalence of neurodegenerative diseases has increased dramatically and so have neurodevelopmental disorders like ADD, ADHD, autism, and Tourette’s syndrome. We have a void in both conventional and alternative medicine in how to address this.

So the International Association of Function Neurology and Rehabilitation is an attempt to bring all the different fields and specialties together to help find a solution for the problem that we all face.

IMCJ: What kinds of results have been produced?

Dr Kharrazian: We have put together a course that we teach at functional neurology seminars where practitioners learn how to do really detailed examinations of the brain. People throughout the world are now taking it. In addition to the conference, we have a journal, where we try to share case studies and research with each other. We also have clubs in some of the chiropractic schools and some of the naturopathic schools and two of the medical schools. So we have students interested in an integrative functional neurology model. Right now, we are seeing a lot of interest and we are expanding it.

The goal is to train as many people who are interested in it, in addition to trying to get researchers to collaborate and find ways where we can improve brain function. Because at this point, if you have degeneration, you really do not have any medications to help you. Most medications for neurodegenerative disease are only to get rid of symptoms. If your child has autism, you are basically told there is nothing that can be done. If you have a brain injury, besides crossing your fingers hoping you recover, no one is doing serious intervention to make a difference. So we really feel we can fill that void by bringing everyone together and trying to teach people how to do very detailed exams and applications and bringing a multidisciplinary group of specialists together to have a common goal of finding the best approach to treating these types of neurological diseases.