The Natural Evolution Podcast

Season 2

Episode 23

S2E23 – Combining Direct Rheumatology with Integrative and Lifestyle Medicine with Dr. Micah Yu

Being a triple board-certified Rheumatologist combining integrative and functional medicine, we have long awaited this conversation with Dr. Micah Yu. Not only does he bring a wide view of rheumatology to the table, he is also a patient himself.

For years he suffered in silence, his diagnosis bringing no treatment options despite going to medical school, completing a residency, and seeking out numerous rheumatologists. It wasn’t until he made the decision to utilize a tool he had overlooked in the past – food and plant based eating – that he started seeing improvements in his condition. From then on, Dr. Yu knew he could reinvent the wheel by bringing a whole-body approach to rheumatology.

Dr. Yu shares his journey as a patient and physician, explains how nutrition relates to autoimmune disease and the underlying root causes of autoimmunity, and talks about what happens to patients when they can not find the right treatment for them. 

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Listen to Episode #23

Dr. Micah Yu shares his journey as a patient and physician, explains how nutrition relates to autoimmune disease and the underlying root causes of autoimmunity, and talks about what happens to patients when they can not find the right treatment for them.
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About our Guest

Dr. Micah Yu, MD is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is triple board-certified in Rheumatology, Internal Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences.

Dr. Yu has a very unique perspective on autoimmune disease and arthritis as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis. This enables him to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine, and he works with his patients to come up with a treatment plan that not only fights the disease but also is aligned with his patient’s goals.

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Podcast Transcript

Michael Roesslein: All right. We are live for another episode today of the podcast. I am joined by Dr. Micah Yu. Micah, thank you for being here.

Dr. Micah Yu:

Thank you so much, Michael.

Michael Roesslein:

This is going to be a fun conversation. We’ve had a lot of people in our audience express over the years that they want to hear from people in your shoes, which you are a board certified rheumatologist who’s got a private practice in Newport Beach, California, but you see patients from all over the US, licensed in 16 states, which I just found out on the pre-taping here. And seen patients in every continent except Antarctica. And Dr. Yu combines integrative and functional medicine with rheumatology to help patients with autoimmune disease. And so, what I meant is that by… We’ve been waiting [inaudible 00:00:51]… They voiced that they want to hear from people in your shoes is that you are a rheumatologist, a board certified rheumatologist, MD, trained in conventional medicine.

Dr. Micah Yu:

Yes.

Michael Roesslein:

Who has found yourself over in the integrative functional side. And I always get really excited when I get introduced to or find somebody that is kind of bridging those gaps. And so, I guess first, I’d love to just share with the audience a little bit about your own journey, your own story from… Did you always have an inkling towards more natural or integrative or alternative types of things or was this discovered after medical school or how did it come about?

Dr. Micah Yu:

Yeah, that’s a great question. I mean, so growing up, my dad was a traditional family medicine MD, and my uncle is a pharmacist turned acupuncturist Chinese medicine. So, growing up, I saw both fields. So, I had respect for both fields, but I never knew about this field of integrated medicine until the end of medical school. I didn’t really know it existed. I mean, I went to school in Chicago. Medical school, four years, but it wasn’t until I met some people on the interview trail when I was applying for residency that I found out that the field, integrated medicine, even existed. And I always wanted to learn about diet and nutrition, but in medical school, I didn’t really learn much of it. And I didn’t know where I could learn about it. And the nutrition that I got in medical school was very little. It was on stuff that we don’t really see like scurvy, like vitamin C deficiency. Things that we don’t see like protein deficiency. Things that’s not very practical. So, that was frustrating.

And I had my own disease journey as well. I was diagnosed with gout in high school from a very high protein diet. Woke up with excruciating pain in my senior year of high school and then I was given medication. I mean, it did help, but my disease actually transformed over the years. In my early 20s, I started gaining pain, not just in one joint, but in multiple joints. There was a point where I couldn’t even go to school for two weeks during college because the pain was so severe. I had fevers. Yeah, it was controlled with medication over time. With a gout medication, with ibuprofen and stuff. But with a transformation of the disease, I couldn’t really understand what was going on. It wasn’t very consistent with gout. Even during medical school, I couldn’t figure myself out. And I went to different rheumatologists in the Chicago area and they couldn’t understand my disease either. I had joint pain that would random occur. I would-

Michael Roesslein:

Isn’t gout usually just in the feet?

Dr. Micah Yu:

I mean, typically, it can be in the big toe.

Michael Roesslein:

Is that where it starts or [inaudible 00:03:54].

Dr. Micah Yu:

Yeah. Yeah, if you look in Wikipedia, it shows a rat, I think, eating the big toe because it’s very painful. That’s where the classic spot is. It’s called podagra in rheumatology, but it can attack any joint of the body. I’ve seen it in the fingers and the elbows and it can attack multiple joints too, which is uncommon, but we see all the different stuff in rheumatology. But yes, I had the classic symptom. Big toe pain in the middle of the night. Feels like someone use a piece of wood and slammed against your toe. Red hot. So, I had that, but over the years I started getting pain in my jaw where I couldn’t eat. It was stiff, it was hot. I would wake up with stiffness in my fingers. And like I said, the rheumatologist couldn’t figure me out. I had elevated inflammatory markers, but all my rheumatology antibodies were negative. So, that was frustrating. Seeing a couple of rheumatologists that couldn’t really diagnose me. So, I mean, the years went on, I kept getting pain. My diet was very poor still. Ate frozen food out of a box. I got take out all the time, ate fast food. It was a very stressful time.

Michael Roesslein:

In your defense, medical school and that type of stuff is not exactly very forgiving when it comes to free time for cooking and shopping and making meals and…

Dr. Micah Yu:

Exactly

Michael Roesslein:

Neither are the first few years of out of medical school. I’ve heard some pretty wild stories about hours and schedules and days [inaudible 00:05:34].

Dr. Micah Yu:

Exactly. Medical school isn’t very forgiving in time and having free time outside of books and studying. So, I had a poor diet. I mean, it got me through medical school, but it definitely worsened my disease. And I did not… I mean, I noticed there was some associated with food, but I didn’t know what it was, so I just kept eating the same food over and over again. I mean, time went on in medical school. Kept getting pain and it wasn’t until residency or actually got diagnosed finally. It was my second disease. It was called spondyloarthritis. So, if you know ankylosing spondylitis… I’m sure maybe you’ve talked about it on your show, but it’s an inflammatory condition in rheumatology that affects mainly the lower back, but affect many different joints as well, including the neck also. So, I got diagnosed with a variation of it. My diagnosis is peripheral spondyloarthritis.

So, meaning, I have inflammatory joint pain in my hands, my feet, my knees, but not my lower back. So, I got a variation of ankylosing spondylitis. So, I got diagnosed there. I got offered traditional medications. Methotrexate, Plaquenil, but I refused it. I was very stubborn. I thought food… One day I could figure out the food part and maybe it could fix me, but I had no knowledge of that at the time. Of course, residency and medical school didn’t teach me anything about anti-inflammatory diet. And I noticed that my pain would [inaudible 00:07:08]. So, I would maybe flare once every month, once every couple months. And being a doctor, I said, “I’m going to monitor myself with x-rays. And if I noticed that I start getting holes in my bone or some changes on the x-rays then maybe that was a signal for me to start going on medications.”

Yeah. I mean, during residency, I would still flare. I remember the worst time I was on my ICU rotation for a month and I was limping for the first two weeks to work. I had to physically take two arms… I mean, two hands and lift my left leg up because my hip was not working. I mean there was countless stories I can give you like that, but I didn’t really take a day off. And luckily towards the end of my residency, I found a plant-based diet and it actually helped me. My wife is a doctor who was in prior practice with me in Newport Beach. And she discovered plant-based nutrition first because I went to Loma Linda University for residency. And if you know anything about Loma Linda University, it’s in Southern California. It’s a Seventh Day Adventist hospital system. And Seventh Day Adventists are vegetarians, but also the American College of Lifestyle Medicine was sort of started here in Loma Linda. It’s not an official field yet, but it’s a growing field in medicine and the American College of Lifestyle Medicine does support a whole food plant-based diet.

So, I gave that a shot and within three months of going a whole food plant-based diet, all my joint pains pretty much went away. And my C-reactive protein, which is an inflammatory marker, went negative as well for the first time in like 10 years. So that was very inspiring and surprising. So, given the fact that I never [inaudible 00:09:05] meds and a diet helped me, that’s what really got me into this whole integrative functional realm because I’m like, “If that helped me and all I’ve been taught is medications, what else am I not learning about or knowing about that is out there that my mentors and my teachers and my attendings aren’t teaching me? Yeah, I know all about drugs, but there’s so many other things that can potentially help patients that if I’m missing that part of my practice, I’m really limiting the options for my patients.”

And that’s what I do in my practice. I give my patients options. I still use medications because there’s a role for it, but there should be options available for patients that don’t want to go on medications. So I started my rheumatology fellowship giving nutritional advice and reading the studies. So that’s how my journey into the integrative functional realm started. So now I’m in the Andrew Weil Integrative Medicine and fellowship at University of Arizona and I’m taking functional medicine courses as well. Combining all the fields. So, working a lot. So that’s where I am now on this podcast.

Michael Roesslein:

That’s great. I mean, it sucks you had to go through that to come find your way to what you’re doing, but I mean it’s the first… This is the second season of the podcast. We’re kind of doing education. The first season we did just people’s healing journeys and stories basically. And a lot of practitioners from the functional medicine world, whether they be MDs or natural paths or other practitioners and they all had their own version of that, and that’s kind of what led them to do what they’re doing now because it’s like, “If I learn all this to help myself, what am I going to do with all this knowledge? I’m not just going to sit on it.”

And especially when your career already was in the helping people that have autoimmune conditions and other chronic diseases. And sometimes we get the little nudges that we need to move in the directions we need to go. And I’m familiar with that center in Arizona. Andrew Weil has been someone I’ve read his stuff for… I don’t know. As long as I’ve been interested in these things. And I know several friends of mine who have been through the training there. I think a couple of them actually teach. Deanna Minich might teach there and Nasha Winters maybe. I’m not sure, but I think I have a couple friends who either teach there or have been through the trainings there and speak pretty highly of it. Nasha works with cancer.

So, it’s an interesting track you’re on and I’m excited to see how much further it goes. And I’m sure having the seed planted a little bit, [inaudible 00:11:52] said your uncle was a Chinese medicine in acupuncture. That’s kind of was my seed planted to even… I have a master’s degree in exercise physiology, which is definitely very different than an MD, but it’s on the conventional side. What I was taught in the master’s program was very conventional even when it came to things around diet or anything else. It was like, “Don’t eat any fat and don’t do this and don’t…” It was kind of like an older paradigm of diet nutrition, but what opened my eyes was I had to write a report on some “alternative healing modality” is what they called it.

And I chose Chinese medicine. I didn’t realize it’s the most complex, in depth thing literally ever. So I was like, “Sure. I’ll write a five page paper on this or seven page paper. No problem.” I went to the library, got a few books, and they were all about this big and I’m like, “What did I just do? How do I summarize something with 1,700 pages?” But I got really fascinated with it, and I got interested. Then I saw a doctor in Chicago, actually, who’s an MD and a doctorate of traditional Chinese medicine. And she, after talking to me for 90 minutes, told me things about myself and how things in my life connect with anger and liver issues and this and that it exploded my mind, so then I just ran with that and that’s kind of how I ended up here. So Chinese medicine was… It’s fascinating stuff.

So, you got better. You decided to study these things and now you’re incorporating more integrative approach into your… And I like the way you say. You like to give your patients options where it’s not just, “Here, this is what’s wrong with you. This is the drug that matches this disease.” And it could be, “Here’s the pharmaceutical options. Here’s the medications. Here’s also the research when it comes to diet and lifestyle.” And you mentioned diet and I’ve had some people that we’ve had on and that I know, and I used to do coaching and I worked with a couple doctors and did health coaching for them to help their patients implement practices. And I saw some people do really well almost immediately on plant-based diets. I’ve seen people do really well on a more autoimmune, anti-inflammatory diet that does involve animal foods. 100% of the time I’ve seen people do really well when they remove the processed foods and the fried foods and the fast foods and that kind of thing and the sugary drinks, but what have you seen… How long ago was this? You look pretty young. So how long ago was that flip for you and how long have you been in practice using a more integrative approach first?

Dr. Micah Yu:

Yeah. I started the plant-based diet in May of 2018.

Michael Roesslein:

Oh, okay. So you’ve going on four years.

Dr. Micah Yu:

Yeah, because that’s when I finished residency and I went into fellowship for rheumatology was just two years. So I graduated from rheumatology fellowship summer of 2020.

Michael Roesslein:

Okay.

Dr. Micah Yu:

So it’s been…

Michael Roesslein:

About two years.

Dr. Micah Yu:

Yeah. It’s two years in prior practice. Going on two years. Yeah. We officially opened our doors November of 2020 or… Yeah, November, 2020. Yeah. November, 2020. So it’s been-

Michael Roesslein:

Opening during the plague.

Dr. Micah Yu:

Yeah. Opening during the plague, but I didn’t see myself working full time for somebody else because there’s no way I could do what I want to do.

Michael Roesslein:

Yeah. That’s a whole nother conversation I’d love to have some time because I’ve talked to many MDs who have made the leap into functional medicine and they all said, “I didn’t realize I was also going to have to learn how to be an entrepreneur and run my own business and do marketing and do these kind of things. And they don’t teach that in medical school.” And so, that’s something that actually prevents a lot of doctors, I think, from making a shift to a more functional integrative approach because your option then is a private practice.

So, seeing that there are multiple paths towards dietary anti-inflammatory effects, what have you seen in the last couple years working with people with this type of approach? When you give these options, do a lot of patients interested in dietary lifestyle things or do more of them opt for the medication or what are you seeing?

Dr. Micah Yu:

Yeah. So, I get a mix of patients. Some patients, they come to me. They don’t care about diet. They just want the med and they just want to get off their life, but some people, I mean, they find me on social media and stuff and they do know I work with that field. So, they’re coming to me for more integrative approaches. They’re okay with it. So, I mean, there’s a whole spectrum of patients. There’s patients who don’t care about anything else. They just want the meds and you have the patients on the other side, they don’t want to do take any meds and they want to do everything alternative to help with them. So, I’m more in the middle. I can do both things, but being a specialist, I’ve seen patients be very sick from disease in the hospital and even die from them. So I know when the serious complications from the disease is happening. So just not when patients. I don’t mess around. I put them on these medications right away, and then I implement the dietary part, the integrative part, to kind of work backwards. Some patients they’re more mild, so I-

Michael Roesslein:

Like damage control. Like putting out the fire-

Dr. Micah Yu:

Exactly.

Michael Roesslein:

… before trying to do anything else.

Dr. Micah Yu:

Exactly. Exactly. And then there’s patients who I will work with them to try to get them better without medications. So, throughout the years, I mean, I’ve seen patients who I’ve tried supplemental stuff and they were able to prevent medications; diet, supplements. So I’ve seen that. I’ve seen recently… I saw a patient with oral lichen planus which is like a… It’s like a plaque in the mouth. It’s just not really a rheumatology field, but sometimes it does come… The patient just end up coming to me because they saw that I do this sort of stuff. And then I put them on… I recommend a more plant-based diet, but she didn’t go plant-based. She still has some animal products in her diet, but she cut a lot of the sugars in her diet. That was the main thing. The processed sugars and the fake sugars. And within a week, she got better and…

Michael Roesslein:

Wow.

Dr. Micah Yu:

Yeah. [inaudible 00:18:14].

Michael Roesslein:

[inaudible 00:18:14] some people realize… When people are really new to this stuff, our audience is… That’s no shock to a lot of the people listening to this, but if you pull 10 random people off the street and question them on their nutrition knowledge and experience, I think people are stunned when they first… I know I was when I first started learning what’s actually in the food and how much sugar I actually was consuming. I love those pictures people make when they put the actual sugar that’s in a thing next to it and they’ll show it to you and it’s like a cup.

Dr. Micah Yu:

It’s like this much.

Michael Roesslein:

Oh, yeah. It’s like this much. Because we need that visual with sodas and with breakfast cereals and… A lot of these foods that are really, really common. People don’t realize that you see a breakfast of a donut and a bowl of sugar or cereal with milk and orange juice and how much sugar is in that breakfast is like, “Would you eat seven giant spoons of sugar in the morning?” “No.” Everyone would see that and be like, “That’s not good to do,” yet they don’t realize that’s what they’re consuming. So, I bet that was a wake up call for her, and it’s not tough to keep people on board when they see something like that happen-

Dr. Micah Yu:

Yeah.

Michael Roesslein:

… probably.

Dr. Micah Yu:

Yeah. Exactly. Yeah.

Michael Roesslein:

[inaudible 00:19:35] for me, doc?

Dr. Micah Yu:

Yeah, exactly. Yeah. I mean, luckily, that’s the best when you just implement dietary therapy and then they get better. They don’t have to do anything else. I’ve had patients who I was able to prevent going on medications. Patients with some joint pain, rheumatoid arthritis. Implemented a certain diet and they got better or add some extra supplements onto the regimen, but I’ve had patients who actually have tried a lot of different diets and their disease is just progressing aggressively, and I just have to put on medications biologics right away. And then try to work backwards from there.

Michael Roesslein:

Yeah.

Dr. Micah Yu:

When you see in your x-rays and your patients with something called erosions which are holes on the sides of the bone already, that’s very severe already. And one thing-

Michael Roesslein:

[inaudible 00:20:21] the damage to the joints and the swelling and all those [inaudible 00:20:23].

Dr. Micah Yu:

Oh, yeah, that’s visible. Visible deformities of the hands already.

Michael Roesslein:

Yeah. We were starting to get concerned with my wife with that because hers was going on long enough that we were starting to get concerned. Admittedly, when I first got into functional medicine, talking about all this stuff and working with clients and working with functional doctors and all that, I was pretty anti-medication. I was pretty arrogant. I thought like, “Oh, lifestyle and dietary things can flip anything, and anybody who takes any drugs is a failure. It’s the lazy way out or they didn’t try everything or whatever.” And that was until my wife developed really aggressive autoimmune conditions. And the only thing that got her out of pain was steroids. And I witnessed that firsthand and that changed my mind about some of the medications. And it’s like, use what you need to use to get things under control enough because she couldn’t function. I don’t even want to think about how bad it would’ve gone. She was paralyzed. She couldn’t move any of the joints in her body. She was nine out of 10 pain. Full body. And you don’t realize how many joints you have in your body until they all hurt.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

Joints in the chest and joints up here. All this is joints technically. Yeah. And so, seeing her in such excruciating pain and we threw everything at it. I have every connection known to man in the functional medicine world. We had access to every type of therapy, every modality, every supplement, everything. Diet was perfect. All that stuff, and nothing touched it. And getting it under control with the medication, now we can manage it. We’re managing it with very, very minimal intervention like that. But man, if anybody out there has that hardline stance, I would encourage you to consider another train of thought.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

So, it sounds like you kind of help people understand where they are on that spectrum too because, I mean, if a disease is early in the stages, the symptoms are pretty mild to moderate and they haven’t tried any dietary stuff, any natural stuff, sure. That’s a great candidate for somebody to give that a [inaudible 00:22:31], but if they’re in a hell of a lot of trouble and it’s advanced and it’s severe and it’s aggressively worsening, that’s not the time to… Right.

Dr. Micah Yu:

Right. Yeah, exactly.

Michael Roesslein:

[inaudible 00:22:43].

Dr. Micah Yu:

Yeah. Let’s take, for example, rheumatoid arthritis. People think of only joint pain when it comes to rheumatoid arthritis, but people don’t know that it can affect the eye. It can give you autoimmune attack of the eye called uveitis, scleritis. It can give you heart disease if it’s uncontrolled. It can give you lung issues. I’ve seen patients who’ve come to the ICU when I was in my training who presented with being on a ventilator. And the only thing that came positive was rheumatoid arthritis antibodies. And so, the rheumatoid arthritis affected only the lungs without any joint damage surprisingly.

Yeah. So you get those presentations. It can affect the brain, the skin. And I’ve seen patients who didn’t go on treatments. Who are non-compliant, who ended up having so much deformities and so many organs involved that they end up dying from rheumatoid arthritis. And you’ll see much of that these days because we have so many great medications in rheumatology. So, back in the day, in the ’80s, the ’70s, we didn’t have many options back then. We had [inaudible 00:23:48] as treatment and maybe some methotrexate, some steroids. That was pretty much it. So you see patients come in wheelchairs and canes, but these days patients are walking in through the door because we have so many great biologics now, but of course a drawback of medications are the potential side effects, right? That’s why if we can avoid it and do well, of course, that’s the best thing, but that’s not an option for everybody. And like you said, you thought initially that medications were evil and that natural’s the best. Initially, I thought the same way too. I thought very similarly. I thought I got better in a whole food plant-based diet. That is a solution for everybody. If everyone went that on that diet, then everybody will be fixed, but a little… I mean, throughout time, I learned that that’s not true. That’s not the only diet out there that helps you.

Michael Roesslein:

[inaudible 00:24:39] factors too.

Dr. Micah Yu:

A lot of other factors. That’s one of the diets that can help. That’s a great diet, but there’s a lot of other great diets as well. And that medications sometimes need to be used. And even though you go on the best diet for that particular person, there’s other interventions that still may need to be used to help that person. And that was… This part of my medical training, I saw things left and right. I tried different things on different from people. I noticed that “You know what? That diet didn’t help on that person.” So, I came to realize that whole food plant-based diet, it’s a great diet, but it’s not the solution for every single person out there.

Michael Roesslein:

So we talked a lot about food and diet here. And what other root causes or factors are you seeing when it comes to… And I’m sure people come to you now for more than just rheumatology because when word gets out that there’s an integrative doctor in the neighborhood, they become pretty popular. And people are now starting to search for this. And what other factors have you seen firsthand really play a role in either the development of autoimmune disease or the progression of it or really right in getting things more under control outside of diet?

Dr. Micah Yu:

Right. So, we can talk about trauma and stress. That’s one of them. You probably have talked about on this podcast, but there are studies now that are coming out that adverse childhood events like abuse, divorce in the parents at a young age does lead to a risk of autoimmune disease later on in adulthood. We have many studies in that. Recently… Yeah. I was going to talk about environment, but we’ll talk about that later on. Let’s stick to the stress part.

So, in my patients, stress I’ve noticed after a divorce or a loss of a loved one, patients do flare as well. So, the gut, brain, immune connection is very strong. So, it does affect the gut microbiome, the stress levels and the gut microbiome is connected to the immune system and autoimmune disease. So stress can be managed, not through medicine-

Michael Roesslein:

So, you see direct correlation though between stressful events in the person’s life and then flare ups of their autoimmune conditions.

Dr. Micah Yu:

Yes, definitely. So, when patients have a great diet that’s anti-inflammatory, but the stress is out of control, it will counteract all the benefits of the anti-inflammatory diet. So, patients will out-win it. So, I tell my patient, “You have to work on your mental health. That is key. That’s just as important as diet alone.” So, the vagus nerve… I don’t know if you’ve talked about this on your podcast, but the vagus nerve is very important to help control inflammation. So, there are lots of studies coming out now with the vagus nerve, one of the most important nerves that affects the immune system.

So, the vagus nerve, when it’s stimulated, it can increase heart rate variability and that in turn can decrease inflammation. And there are things you could do to help yourself like meditation, singing, humming. There’s all these studies out there, but another thing is they’re coming up with devices out now that can help stimulate the vagus nerve. They used to do it. They used to implant things in the neck. They still do that for seizures or for depression, anxiety, but there are studies coming out now for lupus, rheumatoid arthritis and autoimmune diseases. And I think there’s devices now that you just clip onto the ear or there’s apps now that can help you stimulate the vagus nerve.

Michael Roesslein:

Yeah. I’ve seen the external ones. I don’t know. I haven’t talked to anybody who… I usually just find the person who knows the most about the thing instead of me having to learn all about the thing, and then I talk to them. I haven’t found those people about those external vagus nerve stimulators yet, but somebody in the marketing world knows that I’m interested in them because I see the ads for them on my Instagram.

Dr. Micah Yu:

Oh, they’re hearing you.

Michael Roesslein:

I’ll have to come find out if they’re stalking my conversations, but you mentioned heart rate variability and HeartMath is an organization that does a lot of research on that and they have devices that are pretty awesome. And I’ve interviewed their head of research, Rollin McCraty, a couple times and they have some mind blowing stuff over there that they talk about regarding heart variability and inflammation and disease states. And it’s not theoretical anymore. It’s one of the more direct all cause mortality and all cause disease markers that you can measure is heart rate variability. So I get excited when I hear that come into a conversation. So, I’ll have to check those out. That’s a nudge to check out those vagus nerve-

Dr. Micah Yu:

Yeah.

Michael Roesslein:

… stimulators.

Dr. Micah Yu:

Yeah. I think my wife recently just came onto those devices. So my wife is a family medicine doctor also in practice with me. She focuses on psychiatry and then she went to an integrated mental health conference and there were a couple of devices that she came upon. So I’m going to start implementing [crosstalk 00:29:47]. Yeah.

Michael Roesslein:

I’m taking a note of that. I founded another platform other than this one that’s focused entirely on that side of things. And we’re looking for doctors who can speak to this type of conversation, but more related to mental health and emotional health.

Dr. Micah Yu:

Perfect.

Michael Roesslein:

I will make a note to reach back out and maybe have a chat with your wife as well.

Dr. Micah Yu:

Very cool. Yeah. [inaudible 00:30:14].

Michael Roesslein:

So, you mentioned stress, trauma, vagus nerve. You started teetering on environmental stuff.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

What kind of environmental stuff have you seen the most or most noticeable or what do you think is the biggest impact there?

Dr. Micah Yu:

Yeah. So, I mean, there are studies on… I mean, with rheumatology, I mean there’s case reports, but in the integrative world we know that it does exist and it does affect the body in various ways. So, heavy metals is one of them. Heavy metals can be one of the root causes of autoimmune disease. Heavy metal toxicity, in particular. When it comes to other environmental toxins like BPA, we know that these things are endocrine disruptors, PFAS, organic phosphates, glyphosate. These are just examples of different environmental toxins that can affect the immune system. We know that it can affect endocrine system, but there are studies coming out now that it can potentially affect the immune system and the smoking. There’s a recent… In rheumatology, we know that smoking has a big… It’s a big risk factor for rheumatoid arthritis because the smoking can help generate anti-CCP antibodies through the lung and through the oral microbiome. We know that already.

Michael Roesslein:

[inaudible 00:31:35] CCP for those out there?

Dr. Micah Yu:

CCP antibodies is also known citrullinated antibodies. It’s one of the biomarkers we use in rheumatology to see whether a patient has rheumatoid arthritis. It’s very specific for it. We knew previously that the previous smokers or active smokers have a big risk, but a recent study came out and one of the rheumatology journals saying that second-hand smoking also plays a role as well. And second-hand smoking, not only when patients are children, but also second-hand smoking when patients are fetuses, are still not born yet. So with a mother smoking or exposed to second-hand smoking, it’ll affect the fetus and then when they grow up, they have a bigger risk of having rheumatoid arthritis.

Michael Roesslein:

Wow.

Dr. Micah Yu:

Yeah. So, that was-

Michael Roesslein:

That’s wild. I’ve seen some studies too recently suggesting in utero links to high amounts of stress in utero and high mother trauma or birth trauma or any of those things. They’re starting to notice lifelong dysregulation of the nervous system, which controls the immune system to some extent. And so, I think it’s going to be really interesting 10 to 20 years coming up in regards to looking at how far back do some of these insults to the system that lead to higher prevalence of different diseases. How far back does it go? It’s not just if you smoked in high school. And did something traumatic happen to your mother when you were two months in utero? And there’s also people learning about what to do about it.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

Because people hear that and they’re like, “Oh my God, are we all doomed? Is there nothing we can do if that happened to me?” And so, in my other area of passion and study and work on the other side of things, I know a lot of people who are doing work with individuals to help regulate nervous system work and do trauma work and things like that. So, that’s a whole nother conversation, but you’re not doomed.

Dr. Micah Yu:

Yeah, you’re not [crosstalk 00:33:52].

Michael Roesslein:

The second-hand smoke. The mother’s exposure to second-hand smoke increases rheumatoid arthritis chances for child.

Dr. Micah Yu:

Yeah. And active smokers too. Active mother smokers. And we not only do we have to look at the mother, but previous generations too. I mean, I remember, there’s a rat study out there where these rats, they did a diet study on them. The rats that didn’t eat much fiber had over time lost their gut microbial diversity. So, over nine generations. So we do have to look at the grandmas and many generations ago because those epigenetics do affect the genes and eventually gets passed down to us. So, there’s so much things that can affect the autoimmune disease we have today or whatever chronic disease we’re dealing with. It’s so complicated, this space. And there’s so much research to be done.

Michael Roesslein:

Yeah. Yeah. I honestly didn’t know much about autoimmune disease until my wife got sick and then I dove into it. I made it my entire focus. I remember first flare I was staying up like all night reading every single thing I could find on what we thought was rheumatoid arthritis, and then that got really scary reading that because I started reading about all the different body systems it can affect. And some of the biologics that are used for that have some pretty nasty side effects or can. And if I read like, “It can cause this,” it’s like immediately, “If my wife takes this pill, that’s going to happen to her.”

Dr. Micah Yu:

Yeah.

Michael Roesslein:

Where the brain goes. So I was terrified in a [inaudible 00:35:41] and just ruling everything I could read. And that was four years ago and many, many interviews with people later and three flares later and several doctors we’ve worked with later and lots of books later, I now probably understand about 2% of it. I don’t think it’s possible to understand 100%. To be able to look at a person and say, “Here’s exactly what’s causing your autoimmune disease. Here’s exactly how to fix your autoimmune disease.” I don’t think that we’re quite there yet because the complexities of even learning about the immune system on a pretty basic level compared to what knowledge exists is confusing.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

And I have a friend who’s a microbiologist who’s pretty fascinated with immunology. And I don’t remember the language he used, but that the complexities are infinite, and our understanding of it is infantile. We’re just starting to understand how it all works and moves, and he was actually encouraged that everything with COVID and how much money and time and effort and energy and research and all of it is important to that. And the effects of long COVID and how they relate to… Not relate to, but seems similar to autoimmune conditions and diseases is actually going to be a blessing when it comes to pushing some of that understanding forward because way more money and time and energy and effort got dumped into it way faster than was happening.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

I don’t know. Do you see long COVID patients? Do they come to you?

Dr. Micah Yu:

Yeah. We do see long haul COVID in our clinic. And long haul COVID is… I think eventually it’s going to be… We can term it like some autoimmune disease because the symptoms are just… They’re so wild, some of those symptoms. And some of them are very similar to rheumatology diseases. So it’s like brain fog, shortness of breath, joint pain, chronic fatigue. Some of these symptoms in long haul, there’s no traditional medications that really help really well. You have to… I think an integrative approach with some, maybe some traditional medications with supplements are one of the best approaches to long haul. So, yeah. We do see long haul in our clinic.

Michael Roesslein:

I have a good friend who’s a doc. She’s a doctor physical therapy. And she works with women with pelvic pain and endometriosis and a couple other generally female conditions. And she’s a long hauler and she’s been sick for 16 months. And she’s going to the clinic at Yale. She’s seeing all these specialists. She’s trying all these different things and she’s gotten to the point where she can walk a mile now.

Dr. Micah Yu:

Wow.

Michael Roesslein:

But she was fit before and all this and she’s tried a million. She’s documenting it all publicly. She’s posting everything on Facebook. She’s sharing everything. She’s learning that she’s going through all of her stuff. Her name’s Jessica Drummond. And we have a podcast episode with her. Anybody listening, you want to check that out. We talked about it a little bit, but it’s super complex. And I think it will be classified as under rheumatology and autoimmune before too long because they’re seeing autoimmune symptoms without being able to find what antibodies are causing what and whatever, but I think that we continue staring at it hard enough like we are, we’re going to figure somethings out.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

So you’re seeing long haulers, you’re seeing traditional rheumatology patients.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

And then some now unrelated people are just finding you because you listed integrated medicine, functional medicine. And I am guessing that will grow because the more study and the more work you do and people are going to be attracted to that and you’re going to start getting more patients coming in that are like, “Hey, I don’t have that, but I have this. What do you think about this?” And is that something you’re interested in? You want to kind of open the doors to everyone and branch out from rheumatology?

Dr. Micah Yu:

I am. So, I recently attended an integrative dermatology conference. I’m about to listen to my wife’s Integrative Mental Health Conference. So I’m really branching out because it really… Integrated medicine, just dealing with rheumatology, you’re missing a lot of different symptoms that patients are coming in and sometimes they don’t have any other avenues, any options. So, I’m really trying to branch out and figure out what else to do with it because mental health is connected to the immune system, but if you’re a traditional rheumatologist, you just need that to a psychiatrist or psychologist. So, if I’m able to sometimes attack the mental health, I’m able to help the rheumatology disease at the same time. And patients with rheumatology diseases like psoriatic arthritis present with psoriasis as well. So sometimes they want integrative approach to psoriasis. So, I’m really… Once you get into this field, you can’t help but learn other fields that’s other systems like functional medicine. When I take those courses, it’s all encompassing like environmental toxins. It just doesn’t affect them. It affects the endocrine system, the brain. So environmental toxins is a huge topic that’s still being explored. All these topics in integrative and functional medicine, we’re just at the beginning of research. And unlike allopathic medicine, there’s no one protocol out there. It’s like everyone sort of has a different protocol-

Michael Roesslein:

So, that’s the frustrating part.

Dr. Micah Yu:

I know.

Michael Roesslein:

Both for the doctors and the patients because the patients want to go to a doctor and they want the doctor to say, “Oh, you have this. Do this. This will work.” And the doctors want to be able to do that. That’d be great. That’d be awesome. If you figure that out, man, you’re going to do just fine. But that’s unfortunately just not how the complex mental, emotional, spiritual, energetic, physical body that this works. There’s all of those things coming, but it’s really cool to hear your excitement with it. And you’ve opened a Pandora’s box now, so you can’t close it because you’re going to hear the next conference and then somebody’s going to talk about this thing and you’re going to go to the next conference then they’re going to talk about [crosstalk 00:42:06].

The fact that your wife does integrative approach to psychiatry, I interviewed… It was for one of our master classes, autoimmune masterclass functional psychiatrist, who talked about how prevalent it is that mental health diagnoses like bipolar and depression and anxiety and all these things. So many people in the mental health field know nothing of integrative medicine or functional medicine or anything else. And they’re just getting diagnosed flat out with these mental health conditions and they never check anything related to that. And what the prevalence is that autoimmune brain and nervous system related autoimmune conditions present with depression, with bipolar, with anxiety, with these things. And the psych meds aren’t going to help that very much. And if it’s not even a psychiatrist, if it’s a psychologist or a therapist, you can’t out-therapy autoimmune neurodegenerative disease. And that there needs to be crosstalk here. And that people with these mental health presentations, they need to get tested for certain types of physical diseases because if that goes undiagnosed and untreated and undealt with, and they don’t address it at all, what is the mental health professional working with? And the other way around. What I’m trying to do personally is just kind of get both sides of those things and mash them together and be like, “Everybody here needs to talk to everybody.”

Dr. Micah Yu:

Yeah. Exactly. I think you hit it right on the spot. The mental health diseases, they sometimes they have another root cause, which is maybe the autoimmune disease, but the autoimmune disease has another root cause which is maybe the toxins diet or something else. And if you fix that, maybe you can fix all of them at the same time over time. With [inaudible 00:44:02].

Michael Roesslein:

It requires people to know that. To see that, these people need to be trained in this. A therapist or a psychiatrist or psychologist can only suggest to them what they know.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

And just like you didn’t learn about nutrition and functional medicine or integrated medicine in medical school, psychologists and psychiatrists are not really learning about autoimmune diseases in their trainings or about environmental toxicity. I’m glad to hear there’s lots of conferences. I’m glad to hear people like you are going to them and…

Dr. Micah Yu:

Yeah. It’s a lifelong work. It’s lifelong.

Michael Roesslein:

[inaudible 00:44:36] young. You’ve got plenty of time. So by the time you’re 50, you’ll have it all figured out.

Dr. Micah Yu:

Yeah. Yeah, it’s definitely a complicated journey. And just going back to those psychiatry meds, these meds can help with the mental health, but then they come with their own side effects too. Tingling, numbness, brain fog, feeling like a zombie sometimes when you’re on them and those side effects sometimes you [inaudible 00:45:04] on other meds just to take on those side effects. So, it’s so important to be educated in this integrative world because these integrative supplements or therapies, they can potentially help the patient avoid these medications and maybe just limit to one or two.

Michael Roesslein:

[inaudible 00:45:24]. And I love that you gave those options and I feel like this conversation kind of helps people that might find themselves in that boat with an autoimmune disease kind of feel better about being able to make a decision around like, how severe is this disease? How progressive is it? How dangerous is it? I never understood how fast some autoimmune diseases can go from zero to really severe and really dangerous really fast. For my wife’s first flare, it took about three weeks from when she first had pain to where I was carrying her, crying and screaming into the emergency room at 3:00 in the morning because she couldn’t move. And [inaudible 00:46:08] confused. We had no idea what was going on. That happened in three weeks.

Dr. Micah Yu:

Wow.

Michael Roesslein:

And for those three weeks, we’re like, “Try this supplement. Take this supplement. Do this thing. Try this. Eat this. Don’t do any of that. Do this.” And it just kept getting worse and worse and worse and worse until she literally couldn’t move. And that only took three weeks.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

So, you don’t want that. Nobody wants that. I promise if you’re listening out there, you don’t want that. So, taking appropriate action, whether it be medications or whatever is not a failure. It’s a stop gap for the time being to help you get things under control. So, I love your perspective on that. If people want to find out how to work with you, what states you can work with people in and how to connect with you, where do they go? We’ll have links down below in the show notes, but if people are only listening and they’re not looking right now, where should people go and what should they do when they get there?

Dr. Micah Yu:

Right. So, thank you for asking that. So, I’m on Instagram, YouTube, Facebook, TikTok.

Michael Roesslein:

Wow.

Dr. Micah Yu:

So, my handle is myautoimmunemd.

Michael Roesslein:

You make TikTok videos?

Dr. Micah Yu:

I do.

Michael Roesslein:

That’s impressive.

Dr. Micah Yu:

Not as active, but I am myautoimmunemd. That’s M-Y-autoimmunemd. And my personal website is myautoimmunemd.com. And my clinic website is doctorlifestyle.org. That’s D-R-lifestyle.O-R-G. And if you want to know which states I can see patients in, it’s on that website under the FAQ section. And then I can see patients all the world giving second opinion. I just can’t prescribe in other countries.

Michael Roesslein:

Okay.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

So, We’ll have all the links. That’s a array of social media. Good on you, man. I know the work that it goes into it to do that.

Dr. Micah Yu:

It’s a lot of work.

Michael Roesslein:

But it helps to reach a ton of people that aren’t going to find you otherwise. And TikTok is like killing it with good content. I feel like I’m too old, but I can do it. I have people who have learned… I get sent TikTok videos all the time. People are like, “Do check out this person on TikTok or this person on TikTok,” whether it be medical stuff or nutrition stuff or health stuff, or even the mental health stuff or spiritual things or the emotional things. There’s people killing it on TikTok with really good content. And it’s not just a cheesy dance platform, I promise. If you’re out there and you’re grumbling and groaning when you’re hearing me talk about a new social media, but I’ve heard it’s really beautiful how they let you customize your feed and that it really is the stuff you want to see and only the stuff you want to see, which I think Facebook could learn from.

Dr. Micah Yu:

Yes.

Michael Roesslein:

But all the social medias are down below the website. So, your handles are the same across all the social media?

Dr. Micah Yu:

Yes.

Michael Roesslein:

And what is that one more time?

Dr. Micah Yu:

Myautoimmunemd.

Michael Roesslein:

Okay. That’s easy for people to remember.

Dr. Micah Yu:

Yeah.

Michael Roesslein:

Check that out across the social media web. Both the website links below. You can go there. You can find out information about Dr. Yu and his practice and what states he can practice in and how he might be able to help you out. And thank you for coming on and sharing your story and having a chat about a whole bunch of different things. I’d love to talk again and maybe deep dive into a couple things that we touched on, but I appreciate the time, I appreciate the work you’re doing and go check out his social medias, everyone.

Dr. Micah Yu:

Thank you, Michael, for having me. It’s an honor.