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Bill Klaproth: Welcome to Oasis Rheumatainment, a podcast with Dr. George Munoz. On this episode, we'll be talking about functional medicine and how it plays a role in arthritis therapy. And we'll discuss how an anti-inflammatory lifestyle can help you manage arthritis and live a more pain-free life. And alongside Dr. Munoz, we want to introduce, Isabella Leoni.

Isabella Leoni is a licensed nutritionist. She holds a Master's in Nutrition for Health and Human Performance from the University of Miami and a Bachelor's Degree in Exercise Physiology. Isabella began her journey in the field of integrative nutrition while working as an intern at the Arthritis Osteoporosis Treatment and Research Center, the AOTRC, and the Oasis Institute Center with Dr. Munoz. She then went on to continue her studies in functional and integrative nutrition with the Institute of Functional Medicine, the IFNA, and practiced as a clinical nutritionist in Miami, Florida.

Today, Isabella works alongside Dr. Munoz and his team at the AOTRC, which is part of the largest rheumatology group nationally known as the American Arthritis and Rheumatology Associates or the AARA in Aventura, Florida. She combines functional and integrative nutrition with mind, body wellness to provide the most comprehensive treatment for the patient along with weaving other advanced conventional therapies for inflammatory autoimmune conditions with the supervision of Dr. George Munoz, Medical Director.

Isabella and Dr. Munoz, welcome to the podcast. Isabella, no rest for you. We're going to jump right in and welcome. So what is functional medicine and how does it play a role in arthritis therapy?

Isabella Leoni: The difference between functional medicine and conventional medicine is that we look at the individual, not the disease in general. So in functional medicine, we focus on finding the underlying cause of the disease while taking into account the person's genetics, also the environment they're in, and their lifestyle factors. So in that, we include things like stress, sleep exercise, and of course, nutrition.

In other words, we treat the individual as a whole. Specifically for arthritis in conventional medicine, we can take a look at the labs, we can use a medication. But when it comes to functional medicine, we can use medications, but we also try to look at what's the cause, why is this happening? Why did their arthritis develop? Why is the body out of balance? Why is the body attacking itself? Because that's what's happening.

So we try to look at the underlying causes and we treat those causes. These can be anything that ranges from heavy metal toxicity; dysbiosis, which basically just means an imbalance of the bacteria in your gut; toxins in the environment and toxins in the environment can come anywhere from food to even the products you put on your skin or even the water you're drinking.

Some of the other causes could be things like viruses, food sensitivities like gluten, dairy or nightshade consumption. And of course, stress is a big component there and nutritional deficiencies. So we're looking at all of these aspects in trying to treat from the root.

Bill Klaproth: Isabella, I love what you said there, focusing on the individual because everybody is different. And then getting to that root cause, the underlying reasons. So as you said that, I was thinking to myself, "That makes a lot of sense." Just because we get older, it doesn't mean we're destined to have arthritis, right? "Oh, I'm getting older. Oh, my gosh. My thumb hurts. I'm just getting old." So what you're saying is, by focusing on the individual and understanding what potential underlying cause is, you can potentially help manage that arthritis pain better. Is that right?

Isabella Leoni: That's exactly what we're saying. It's funny, some patients come in and they say, "Well, I'm old that's why I have hypertension," or "that's why my blood sugar is high," but it's really taking a look at why is the blood sugar elevated? The great thing about functional medicine is that we work as a team. So we have Dr. Munoz working with the patient, chiming in in the nutrition aspect and then I go deep into what it is the patient eating or how are they managing their stress? So, I love what you said.

Bill Klaproth: Yeah, that's really, really good. All right. So let me ask you this. I hear about this all the time. It's called the microbiome. And for a layman out there, a goof like me, it's like, "What are they talking about? What's this microbiome thing?" So tell me what is the microbiome and how does it relate to functional medicine as we're talking about it today and the approaches to health in arthritis?

Isabella Leoni: So we briefly touched on it when we were talking about the root causes of arthritis and disease in general. Microbiome is basically the bacteria, that combination of bacteria, fungus, parasites, and viruses that live in our body. These viruses, these bacteria, all these microbiome, they actually have a role in our body.

They can actually simulate our immune system. In fact, 70% of our immune system lies around our gut. They can also help break down food. They can synthesize vitamins, amino acids, even neurotransmitters, that dopamine, serotonin, which makes you feel good. These microbes in general, they're supposed to be in balance, right? But again, due to the consumption of highly processed foods, all those sugars, those packaged foods, fast foods, due to the toxins in our environment, due to the overuse of antibiotics and medications and again, that emotional stress, these microbes, they become imbalanced. And that's what we call dysbiosis.

So what we see is that we get more of the bad guys, to put it that way, more of those bad bacteria. We see an overgrowth of fungi, such as like candida and an overgrowth of parasites. We're starting to have all these symptoms.

So what happens when all of these bacteria, they become imbalanced, is that we see an increase in intestinal permeability. I want to stop right here. I don't want to make it more complicated. But I think this part is really important because intestinal permeability was seen at the root cause of many diseases. And it's what we call leaky gut. And basically what that means is that the wall of our intestines, which is supposed to only let the good stuff come into your blood so we can use it as nutrients as energy, these wall starts having holes in it, starts becoming permeable. So toxins from the foods that we eat, from medication, and the foods, which are not digested, they start getting into our blood. So as these are getting to our blood, our body doesn't recognize it. And what does it do? It creates inflammation and our immune system becomes dysregulated.

So the immune system can't function as it should. It can’t protect us. It can't protect it from the pathogen, from the viruses, from the toxins. So we have this systemic inflammation and the body starts attacking itself. And that is basically an autoimmune disease like arthritis.

Bill Klaproth: Yeah. So there's a lot to unpack there. Really good stuff, Isabella. So 70% of our immune system revolves around our gut. I did not know that. And when you talk about having an imbalance, this dysbiosis, that's where a leaky gut allows bad things into our system causing inflammation. So if inflammation is the problem, first off, can you explain to us a little bit more in depth what is inflammation? And then how can we lead an anti-inflammatory lifestyle to ultimately lessen the effects of things like inflammation, which causes arthritis and other auto-immune conditions?

Isabella Leoni: Inflammation is a normal response of our body. So whenever you have an injury and infection, inflammation is something that calls upon the immune system so it can come and repair the site of the injury, okay? It can get rid of the infection. The problem is that today we're chronically inflamed due to everything that we mentioned before. When there is a persistent inflammation, it damages our body.

We need to find ways to decrease the inflammation. And one of the ways to do it is start including more anti-inflammatory foods. Anti-inflammatory foods includes things that will nourish my body. Things like fruits; plenty of vegetables, which are rich in phytonutrients; fermented foods. Because fermented foods, what they do is that they increase that microbial diversity. They increase the bacteria and the type of bacteria and the amount of bacteria in your gut. So it's important to include those.

By fermented foods, I mean things like kimchi, sauerkraut. And also I think that is really important to add spices and herbs. It's something so simple to add, but they're very rich in antioxidants. And of course, things like healthy fats and good quality protein, which is going to help repair that leaky gut.

Aside from that, it's also important to take out those inflammatory foods, things that actually depress our immune system. So things like sugar, for example, is number one. So think of anything like chips, cookies, gummies, sodas, definitely juices. Patients always ask me about juices. Juices, they can be packaged juices or actually natural juices that you make at home, but they're very high in sugar and they can also increase the inflammation. And of course, anything with any sort of flour.

Additionally, Bill, I think it's really important to touch up on anti-inflammatory lifestyle, not only anti-inflammatory foods. And that means taking care of your sleep. So good quantity and good quality sleep. Moving, finding a form of exercise, which motivates you. Managing stress, of course, and spending time in nature. Right now, with COVID, we've been spending so much time inside that we forgot that we're connected to nature. And we should be outside being in touch with the sun, being in touch with the water, the ocean or the forest, whatever is near you. But we found that actually being in touch with nature on a daily basis helps improve your immune function. So it actually increases the natural killer cells.

And of course, the last part, but not the least, it's to foster positive and meaningful relationships in your life because we are social beings.

Bill Klaproth: That is so true. You have to keep up on those relationships. So you said start by adding anti-inflammatory foods into your diet and remove the inflammatory foods. And you know what those are. Those are the processed things that come in packages, things that are high in sugar. You know what's bad for you, you got to stay away from those things. And then pay attention to sleep, pay attention to exercise and make sure you lower your stress.

So I want to zero in on stress a little bit more though, because I think that gets overlooked. And Dr. Munoz, let's bring you in on this question as well. Isabella, as I said, I think sometimes people overlook stress, they pay more attention to what they're eating and exercise and those types of things.

So let's talk a little bit more about the importance of emotional and stress management and especially the effect that stress has on auto-immune diseases. Can you explain to us then the impact that stress has on our immune system?

Isabella Leoni: We know that stress, emotional stress, actually impacts directly our immune system by activating this inflammatory cascade, again inflammation. But it also affects or disregulates the HPA axis, that is the hypothalamic-pituitary-adrenal axis. Let's just call it HPA axis to not make it more complicated. But basically this axis, it's made up of the hypothalamus and the pituitary gland, so basically your brain, which sends signals to your adrenal glands that produce hormones, okay?

The stress directly affects this axis. Things like emotional stress, even lack of sleep, irregularities in your blood sugar, so having high blood sugars and the low blood sugars, it directly affects the function of your thyroid and these adrenal glands. When these get out of balance, we see changes in our immune system, so it can function as well. It creates changes in your energy and even in your sleep-wake cycle, which is not beneficial for your body. It is important to manage these chronic stress from lack of sleep, emotional stress, even use of phones, which can have long-lasting effects on your immune function.

Dr. George Munoz: Very well put, Isabella. And yes, so I would add that what happens with stress and it's chronic stress that's the problem as opposed to acute stress, and chronic stress leads to situations where the body is in a fight or flight state chronically. The nervous system that is activated when we are in danger, when our brain tells us, "You must act or else your existence is in jeopardy" is called sympathetic nervous system.

So the release of hormones, adrenaline, epinephrine, norepinephrine, and then the pro-inflammatory hormones from the adrenal gland, which you talked about, which is called cortisol, if these are being released more chronically than just in a fight or flight or emergency situation, then they have bad effects. They're deleterious. That's why we have to balance chronic stress with activities that reduces that fight or flight response. And that would be using the parasympathetic nervous system or the vagus nerve.

And things like breathing, tai chi, yoga, meditation, mindfulness, consistent cardiovascular exercises are all things that can improve vagal tone or that parasympathetic nervous system and reduce chronic cortisol levels that then will help reduce inflammation and its effect through mind-body interventions.

Bill Klaproth: So this stress management, it sounds like it's really in our hands. We can reduce stress if we really want to and try to. And if we apply ourselves, we can manage stress better. Is that right?

Dr. George Munoz: Absolutely. And this is a call to action for all of us individually, as well as our families, our patients, our colleagues. This is something global that's needed.

Bill Klaproth: Yeah. It's like a global pandemic of stress right now. And as you mentioned, there are many different ways to reduce stress, even just sitting quietly for a while or reading a book or even listening to music. You could try some breathing exercises too. Things like that help as well. Is that right?

Dr. George Munoz: Absolutely. And there are different breathing techniques of which my mentor, Dr. Andrew Weil, taught all the integrative fellows in training, which is called the 4-7-8 Breath. And this can be Googled and easily done and really something that you can practice. But there are many types of breathing exercises. This is just one. And I really urge everyone to begin some type of breath work that is comfortable, and that is a calling to one. And you can do it in minutes and it can have profound cardiovascular and neuroendocrine benefits in helping reduce stress so that we don't need to take a Valium and we don't need to take Xanax and we don't need to be in a rageful state when situations occur that could trigger one the other way,

Bill Klaproth: So 4-7-8 breathing technique. We should learn more about that. And that is something, if we do that several times a day, will help us out?

Dr. George Munoz: Absolutely.

Bill Klaproth: Wow. This has really been good. So, all right, we have our marching orders from you and Isabella, Dr. Munoz. We have to cut that stress. We've got to cut out those inflammatory foods. We got to get better sleep, more exercise, spend some time in nature and make sure we foster those really good positive relations. Well, as we wrap up, Isabella, anything you would like to add before we close with Dr. Munoz?

Isabella Leoni: There's one more thing that I would like to add, Bill, and it's that consistency is key here. So even taking five, ten minutes, it doesn't really have to be a very long time to do those deep breathing exercises every day, to do that yoga practice or tapping, whatever you find that helps you the most, you as an individual. So I think that is very, very important. So taking those 10 minutes every day is going to be the key to managing your stress and to feeling a lot better.

Bill Klaproth: Consistency, that's really, really important, and we all need to work on that. And as we wrap up, Dr. Munoz, leave us with some parting thoughts.

Dr. George Munoz: Some parting thoughts are that these are all attainable goals that we have to take care of the whole person through mind-body interventions, through balanced exercise, proper nutrition, anti-inflammatory lifestyle, which isn't one thing. And let's not forget about some key nutrients such as vitamin D, an immune modulator; quercetin, which has antiviral effects; vitamin C, zinc, selenium and omega-3s. These are essential to having an anti-inflammatory setting and are great nutrient and micronutrient and vitamins that, along with a healthy lifestyle and healthy eating, help fill in the gaps. And I recommend that everyone consider taking these types of supplements in their daily routine.

Bill Klaproth: Great information and you both have helped us out immensely today. Isabella and Dr. Munoz, thank you so much for your time. We appreciate it.

Isabella Leoni: Thank you, Bill.

Dr. George Munoz: Bill, awesome to be here. Isabella, thank you so much for joining us on Rheumatainment, our auto-immune and arthritis podcast here every few weeks, looking at different topics. And it was a lot of fun. Thank you both.

Bill Klaproth: And thank you, Dr. Munoz. And this is the Oasis Rheumatainment podcast, featuring Dr. George Munoz and Isabella Leoni. For more information, call (305) 682-8471 or visit the OasisInstitute.com. Thanks for listening.