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How can Lifestyle and Integrative Medicine Help People with Rheumatic Diseases? Dr. Yu’s unique perspective as both patient and provider.

Episode  Dr Yu

On Episode 27 of the Arthritis Life podcast, Dr. Micah Yu shares his journey with gout and spondyloarthritis, and explains how lifestyle changes (such as diet) and integrative medicine can help people with rheumatic diseases.

This episode includes in depth discussions about the benefits of a plant-based diet, ways to reduce fatigue, the importance of collaboration between patients and providers, and how  Dr. Yu helps determine the best path for his patients (medicines and/or natural alternatives). 

Speaker biographies: 

Dr. Micah Yu is double board-certified in internal medicine and lifestyle medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He has been accepted with a full scholarship to the Andrew Weil Integrative Medicine Fellowship at the University of Arizona.   Dr. Yu has a very unique perspective on autoimmune disease and arthritis as he is both a patient with arthritis and a physician. 

Cheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources. 

Medical disclaimer:

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode  Dr Yu

Links to things discussed in the episode:

Here’s the show breakdown:

  •  01:15 – Rheumatologist Dr. Yu’s journey first with gout, then diffuse joint pain while in medical school, then a diagnosis of spondyloarthritis during his fellowship.
  •  4:30 – What made Dr. Yu want to pursue Rheumatology.
  •  6:00 – Dr. Yu pursues Integrative Medicine and the 6 pillars of Lifestyle Medicine with the help of his wife, also a physician. He adopts a whole food, plant based vegan diet and experiences huge improvements shown in lab work, pain levels and overall weight within 2-3 months.  
  • 8:28 – Dr. Yu explains what “Integrative Medicine” is and explains the process he’s going through to get board certified in it, including learning about Chinese medicine, ayurveda, herbal medicine and more.
  • 9:51 – Dr. Yu explains what the newer field of “Lifestyle Medicine” is, and the overlap between the two.
  • 10:30 – How can an appointment with an integrative medicine Rheumatologist differ from an appointment with a typical Rheumatologist? Discussions of nutrition, sleep, stress and whether medications are necessary. 
  • 12:00 – Cheryl and Dr. Yu discuss the importance of each patient’s treatment plan being individualized and customized to them, and how it can be a source of confusion for newly diagnosed patients when they see that someone else with their “same” diagnosis has a different treatment plan. For example, one person with severe disease who is afraid of medication might be confused why another patient (with more mild disease) was told they could avoid meds.
  • 15:08 – Dr. Yu answers some of the most frequently asked questions about diet and rheumatic disease (vegan diet, plant based, Mediterranean, Paleo and more). Explanation of the influence of the gut microbiome on autoimmune disease
  • 18:50 – Dr. Yu explains which supplements can help with rheumatic diseases and inflammation.
  • 20:15- Dr. Yu shares tips for fatigue. 
  • 21:30- Definition of “Functional Medicine” and his recommendations on finding a provider with valid credentials. 
  • 23:35 – Cheryl and Dr. Yu discuss the importance of sleep, ruling out a sleep disorder and how poor sleep contributes to fatigue and inflammation.
  • 24:45 – Dr. Yu discusses evidence for THC and CBD for it’s anti-inflammatory and pain relief properties. 
  • 26:00 – Is it hard being a patient and provider in Rheumatology? How Dr. Yu’s passion pushes him through the long hours!
  • 28:45 – If Dr. Yu could change anything about Medical School, what would he do?
  • 30:00 – Reflections on how the gray areas in between Integrative / Natural medicine and Western Medicine can be difficult for patients who have anxiety about their condition. How Dr. Yu finds a middle ground with his patients – combining medicines and natural alternatives. 
  • 31:30 – Dr. Yu’s message to patients who are afraid of medications.
  • 33:25 – How do you find a Rheumatologist who also has an Integrative Medicine board certification? 
  • 34:45 – Where can people find Dr. Yu online?

Full Episode Transcript:

Interview between Speaker 1 (Cheryl) and Speaker 2 (Dr. Micah Yu)

[Introductory music]

Hi! My name is Cheryl Crow, and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen life hacks, and how to respond when people say, “You don’t look sick”, stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness — no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started. 

Cheryl:    Welcome to the Arthritis Life podcast, Dr. Micah! We’re so, so happy to have you here today.

Dr. Yu:    Oh, thank you so much, Cheryl. It’s a pleasure and honor to be on your podcast.

Cheryl:  Yeah, so, for those who maybe haven’t seen your amazing TikTok and Instagram before, can you introduce yourself a little to the audience? Say where you live, and what do you do, and what’s your relationship to arthritis.

Dr. Yu:  Yeah, so, my name is Dr. Micah Yu, and I’m a rheumatologist, and I’m also a patient as well. So, my story started all the way back in high school, I got diagnosed with gout. And then throughout the years, my arthritis really transformed. I’m going to pack in about 15 years into 5 minutes, so, diagnosed with gout in high school because from a high protein diet — I was on the Atkins diet at that time — I wanted to lose weight and get stronger, which I did, at the expense of my health. So, after that, I still didn’t pay attention to my diet. I mean, I stopped eating that much protein, but still I was eating junk food, and sugar, and all the regular stuff that people usually eat, and my arthritis actually transformed throughout the years where I started getting pain in multiple joints that was not typical of gout. So, I went to see different rheumatologists in medical school, they couldn’t really figure me out. They said that I had gout and something else. My inflammation markers were high, but all my antibodies were negative, so I finally got diagnosed when I was in residency. Oh, spondyloarthritis. The rheumatologist — which ended up being my bosses because I went there for fellowship at Loma Linda University — they ultrasounded my tendons, and they said they found some inflammation there, it’s called tendonitis, and that’s putting the picture together; ended up being diagnosed with spondyloarthritis.

Cheryl:  And because there’s a little bit of confusion in the community sometimes about like spondyloarthropathy versus ankylosing spondylitis. 

Dr. Yu:  Yeah, so spondyloarthritis comprises of many different diseases. So, we can have Ankylosing Spondylitis, that’s a spondyloarthritis; psoriatic arthritis is also spondyloarthritis. It’s like an overarching name. I have what’s called peripheral spondyloarthritis where I don’t have the lower back pain, but I have the pain in my arms and legs. 

Cheryl:  I didn’t realize you got diagnosed in medical school. That must have been so fascinating itself, but then how did that change your trajectory of what you were interested in as a physician?

Dr. Yu:  Yeah, so, I didn’t really know there was a field of rheumatology and so like in medical school, even though I had gout, I wasn’t really aware what they really did. And during medical school, immunology was one of the hardest topics for me, all that rheumatology diseases. I didn’t really understand it, but I’m always up for a challenge, that’s why I wanted to pursue rheumatology. And my pain really frustrated me during med school, and even throughout the previous years. I would get pain in my TMJ, my wrist, my ankles, my knees, and Cheryl, you have arthritis so you perfectly understand. It was so frustrating. Morning stiffness, I wouldn’t be able to eat for weeks, because my TMJ was so inflamed, I would only be able to eat something soft like yogurt, and I couldn’t really find a pattern with food or anything like that. It was part of the hardest times of my life, even during residency. It was really tough. 

And yeah, that the fact that I have these diseases made me want to go down the path of Rheumatology to figure out why I got this disease, what else can I do, and I refused medications. The rheumatologist in Loma Linda University offered medications to me, I refused it. I was like, “I’m a doctor, I can monitor this. If I start seeing changes on X-ray, that’s my green light that I need to start taking medications, but until then I’m trying to try to figure this out, see if there’s any dietary pattern,” because I noticed that sometimes there’s certain foods that would make things worse, I just didn’t know what, and I wasn’t eating a particular diet. I was just eating the standard American diet at the time. Yeah, in medical school, they don’t teach you much about nutrition. I got diagnosed after medical school. I graduate medical school 2015, so this is just 2016 or 2017. It’s interesting because I went into the same residency fellowship program afterwards. So, everyone knew me pretty well.

Cheryl:  Oh, my God. Was that weird, being colleagues with the same people that were treating you? 

Dr. Yu:  Um, no, because we — some of them I knew beforehand, so it’s like, it’s yes and no. It’s like they’re still your friends, at the same time they’re — because you see them so much, you do rotations with them, so they know who you are. And we got along well. So, but it’s interesting because they were always saying, “Oh, you should be on meds,” and I’m like, “I don’t want to. I really want to figure this out,” which really led me down the road of Integrative Medicine. So, I learned about the field of Integrative Medicine during my fourth year of medical school, but what got me into this whole dietary thing was my wife. So, there’s a new field now called Lifestyle Medicine, is by the American College of Lifestyle Medicine, and there’s six pillars that they go by, or five. 

They have nutrition, exercise, sleep, stress, healthy relationships, and avoiding risky substances. And the nutrition part, they really emphasize whole food, plant-based nutrition. So, my wife is a doctor as well, she’s studied medicine, and she found out about this field during the last year of her residency, which is also my last year of my residency. And so, she’s introduced me to whole food, plant-based nutrition, and she cooked like a total vegan meal during Thanksgiving, so not used to it. I thought it was disgusting. It took me about six months later to really start giving this a try. I read — I don’t know if you know Dr. Michael Greger — he wrote the book ‘How Not to Die’, and I watched the documentary ‘Forks Over Knives’. So, I really gave this whole food, plant-based diet a shot. Within three months of going on it, my C-reactive protein, which was an inflammatory marker, went negative after 10 years of being positive. I was pain-free within two to three months. So, it was really amazing. My ESR went down by half. So, I was actually pain free for over about one or two years, and then my pain started coming back recently because I’ve been eating more processed food. Not as strict of a diet, and I do overnights now, so sometimes that stresses me out a little bit. But overall when my paint comes back, it’s like one or two out of 10 pain, and it rarely comes back. I don’t take medications at all for my arthritis, except for my gout meds. 

Cheryl:  Was it hard to adjust mentally to such a drastic diet? 

Dr. Yu:  Yeah, it was because I was a typical omnivore back then, I also eat fast food every now and then. So, it was nice, it gave me more energy. I lost almost 30 — I’ve lost 30 pounds, or 25, 30 pounds since I started. And it’s just natural. I didn’t want to lose weight, but because you’re eating so much fiber, and so much vegetables and fruits, and a couple of carbohydrates that naturally you can lose weight on it. Yeah, I mean, I’m used to the way of eating now, but the first couple weeks is definitely hard ’cause you have to cook for yourself. 

Cheryl:  But back to the word ‘integrative’ because that’s a word that not all patients understand either. We know it means something like holistic, you know, but how do you define being an integrative rheumatologist? 

Dr. Yu: Yeah, so, Integrative Medicine is an actual field, you can actually get boarded in it. They have it at different universities, I’m going to the one through University of Arizona. It’s a two-year fellowship, but they have it, I think at Duke, at UCSF, and different big name universities, and it’s — at least here at the University of Arizona — I’m learning about Chinese medicine, acupuncture, Environmental Medicine, aromatherapy, mind-body medicine, Ayurveda, supplements and herbs, and how herbs interact with drugs, and what you should look for, also with supplements as well. The term ‘integrative’ is very thrown around very loosely. A lot of doctors, sometimes they’ll put that into their name as a marketing tool when they’ve never had formal training in Integrative Medicine. They’ll maybe know a little bit about nutrition and the concepts, but I don’t really consider that integrative. 

Cheryl:  I see. So, you can get — if I understand this right — you can get a board certification in either Lifestyle Medicine, or Integrative Medicine, or both. Is that right?

Dr. Yu:  Yeah, so, Lifestyle Medicine is through the American College of Lifestyle Medicine. It’s a new field, it was formed in 2014. Yeah, but Integrative Medicine is actually much longer. So, before the actual term Lifestyle Medicine came out, Integrative Medicine was emphasizing lifestyle medicine already because they’d talk about sleep and all these different things. I don’t know if you know the gentleman Andrew Weil, Dr. Andrew Weil, he’s a doctor. 

Cheryl:  Yeah, yeah.

Dr. Yu:  He’s the bald guy, as you all know. That’s his program that I’m going to. 

Cheryl:  Oh, that’s great. Yeah and I think, you know, I’m sure so many patients are just wondering what are some of the things — like, if a patient was to come to an integrative rheumatologist or rheumatologist with that additional lens of Integrative Medicine and Lifestyle Medicine, how might that be different than your typical appointment with a non-integrative rheumatologist? 

Dr. Yu:  Yeah, great question. So, when you go to your typical rheumatologist, they’ll talk to you about your symptoms. They’ll probably ask you how you’re doing if you’re lucky, and then they’ll give you your medications and ask you if you have any side effects, and then off you go. And that’s usually like a 15-minute visit, 20-minute visit sometimes if you’re lucky. Sometimes, I’ve heard of less two from patients. So, if you go to integrated rheumatologists, I mean, there’s no one way to practice Integrative Medicine, but typically they’ll go over your nutrition, they’ll talk about your sleep, your exercise. And they’ll also talk about your stress levels and give you ways to fight your disease in addition to medications, if you need it. 

But the way I practice is I really find out what my patient goals are. So, if they want less medication or they want to avoid it completely if they’re not that sick, then we’re going to try to do everything we can to avoid medications. But if they’re very sick, I put them right away on all the rheumatology medications that are necessary and then emphasize everything on the side that’s lifestyle, that’s integrative, to get to wean them off of medications. 

Cheryl:  Okay, yeah, what you just said is, I think, one of the most important things for patients, but that is often not looked at in the early days when people are just kind of like in shock. Like, you know, when I was 21, I got diagnosed. My life was going in one direction, all of a sudden, you get this bomb thrown, you know, like, “You have this autoimmune disease.” So, I have seen a lot of patients online, especially on social media groups be like, “Well, my doctor told me this. Well, my doctor told me this. Well, my doctor told me this,” and it’s very good to share information and, you know, support, but what you said about severity is one of the things I think a lot of patients — because I’m an occupational therapist, by the way, I think you know that, but in case anyone else is listening — so, I have some medical training notes. I have a master’s in occupational therapy which is pretty much Lifestyle Medicine. 

We do everything that’s not — and we’re not doctors, obviously — but we really look at habits, roles, routines, work-arounds, compensatory strategies, life hacks. But anyway, the back to the point is, when patients get — they’re looking for what’s the solution. Like, what am I supposed to do now after my diagnosis? And if you don’t understand the difference, the fact that your doctor is going to customize the recommendation to your severity and your past history, then it’s confusing to patients because they go online and be like, well, why — like, I was put really aggressively, in 2004 when I was diagnosed, I was put immediately on [13:25 sulfasalazine first, and then I was put on methotrexate], and I went into immediate remission, because I had really, really big numbers. Mine was very, very severe and aggressive, you know, RA versus somebody, like you’re saying, with more mild symptoms. I was going to turn that into a question but it just turned into a little rant. But do you find it, that that can be hard for patients sometimes or to have that sense of ‘What’s the right path for me’

Dr. Yu:  Yes. Patients, some of them, they come to me because they don’t want to take meds. But, you know, if they’re very sick, I put them on meds right away and I don’t mess around, because I know as a rheumatologist, I’ve seen patients die from these diseases. I do hospital consults on them. But I’ve seen very mild cases as well. So, I see the whole spectrum, so I’m able to use my judgment to figure out when this patient needs to go on meds and when can we just try a more integrative approach. I mean, I have patients that are doing well off medications. They’re in remission. Just diet and lifestyle alone, and it’s possible. But everyone’s different, there’s no one size fits all. Some patients may never be off medications just because their autoimmune disease is so strong. It takes genetics and their environment to cause — nature and nurture — to cause autoimmune disease. My own path, my own disease has really inspired me to really find out why patients are getting autoimmune diseases and what can we do to minimize the use of medications. Because I’m sure that’s every patient’s goal, is to be off medications.

Cheryl:  Right, yeah, that completely makes logical sense. And what are some of the most — let’s cover some of the most frequently asked questions you get. I’m sure the diet is one of them. I saw you posted recently about vegan versus Mediterranean, or plant-based versus Mediterranean. Because those are the two that I see come up the most often. There are certainly some people that are doing well on a keto diet, but that has other health risks. So, do you care to speak to some of these conundrums, like which one should I try? 

Dr. Yu:  Yeah, so I’m plant-based, so not necessarily — so, there’s a confusion sometimes between vegan and plant-based, so. 

Cheryl:  Oh, yes, thank you, I totally put us together. Yeah.

Dr. Yu:  Yeah, yeah, yeah, so, I was confused at first, at the very beginning. When you’re vegan, you don’t touch any dairy products, any meat, any fish. For me, I would say I’m more plant-based. I was complete vegan for almost a year, a year and a half, but, you know, when you have parties sometimes, there’s cake there, so like, I’ll grab a cake, but at home I don’t eat any animal products. But when I’m out sometimes — I don’t eat any meat, I haven’t touched meat in over… Since I started this. Fish, maybe once in a blue moon, because my parents eat seafood, and sometimes I see them, it’s on the table, but otherwise I avoid it. I can’t say I’m like 100% vegan, but I would say 99%. So, when you’re plant-based, you’re more — you eat as many plants as you can, more whole foods, but you’re not necessarily ethical vegan. What was the other question? So, there’s the Mediterranean  —

Cheryl:  Oh, Mediterranean, because I think there’s evidence for that one, so I think people get a little confused. 

Dr. Yu:  Yeah, a lot of literature they look at Mediterranean diets and that can be very helpful too. So, Mediterranean diets they emphasize on extra virgin olive oil, fishes with omega threes. They also eat meat, but not that much. They minimize red meat and chicken. A lot of fish, plants; a lot of plants are involved. So, which is why it makes it so useful, anti-inflammatory. 

Cheryl:  Yeah, so, if you’re adopting a Mediterranean diet, it’s like one of one step closer to a vegan diet, if you’re comparing it — if your starting point is the standard American diet. That totally makes sense. 

Dr. Yu:  Oh, yeah, there’s also the Paleo diet which is very popular as well. The Paleo diet cuts out grains. They emphasize — they still eat meat, beef, chicken, but they cut out grains and I think they cut out dairy as well. That’s not the diet I advise my patients to go on. It’s very popular because a lot of people probably have issues with gluten, with the wheats, just because of the way it’s processed in the United States, but I don’t advise people to go on that because, grains, if you look at the data, people that eat whole grains live very healthy, overall. So, that’s why I don’t advise people to cut out grains, unless they have issues with them that they know of.

Cheryl:  I see, okay. That’s good news for me because I like grains. I did notice at the 2020 Rheumatology Conference, a lot of people were really interested in one of the presentations about the gut microbiome, and there was like a Stanford and Harvard and something else study what they showed — like, they altered the microbiome based on like the Mediterranean — did you see that one? 

Dr. Yu:  I would say almost all autoimmune diseases have an altered gut microbiome which is called gut dysbiosis, which is part of my foundation of what I do, because you can alter your immune system through the gut, from the food, and that’s through the gut microbiome, because 60% percent of your immune system is located at the gut. So, if you eat anti-inflammatory foods, it’s gonna send anti-inflammatory signals in the gut, and that circulates throughout the whole body. 

Cheryl:  That’s amazing. Great. So, that kind of covers a little bit of nutrition. What about kind of adjacent to nutrition, supplements? Like, I know a lot of us are told to try fish oil or, you know, vitamin D, or B12, but what are some of the common ones that you recommend?

Dr. Yu:  Oh, vitamin D, definitely. Studies have shown that lupus patients flare more when they’re vitamin D deficient, I think RA also, as well, which makes sense because vitamin D is part of the immune system naturally. It’s located at the gut, there’s receptors at the gut, auto-immune cells. So, it makes perfect sense. I would say it’s one of the most anti-inflammatory vitamins out there, and it’s also a hormone as well. It’s very important for your bones, so I always make sure I test vitamin D and make sure my patients vitamin D levels are normal. It’s hard to over-supplement, on vitamin D, but it can be done. I actually saw somewhere, someone was taking this very high dose of vitamin D for a long time. Their level was off the charts and they end up getting vitamin D toxicity, but I personally have not seen that because it’s very hard to do that if you’re following the right doctor’s direction. 

Yeah, and then there’s fish oil. Fish oil has been shown to be anti-inflammatory as well because of omega threes. You always want to emphasize your omega threes over your omega six. Omega six are found in processed foods, refined sugar, some cooking oils and meat as well, so you want to decrease that amount. Just inflammatory omegas.

Cheryl:  And then actually, speaking of fatigue, that’s something else a lot of patients aren’t given a lot of guidance on. I have had my disease for six years before I even knew that the fatigue I was experiencing was related to rheumatoid arthritis, because I thought that was just in my joints, you know. So, what are some other things that you recommend, or that people should consider as interventions for fatigue?

Dr. Yu:  Yeah, fatigue is very tricky because you can get it in fibromyalgia, you can get it by itself, you can get it from thyroid disease. I would say, first of all, see a doctor. Find out, get labs done, and see if it’s due to underlying issue. Even if you have a rheumatic disease, you can always have an underlying thyroid issue, your vitamin D can be low, you’re deficient in some vitamins; B12, folate if you’re vegan. So, really, first of all, just get labs, and then second of all, if you’re not getting the answers you’re looking for, then maybe it’s time to look for an integrative doctor. There’s Integrative Medicine — we haven’t been touching on Functional Medicine because that’s — I’m also studying that too on the side as well.

Cheryl:  Okay, let’s make sure we’ll cover that too. 

Dr. Yu:  Yeah, so, Functional Medicine is a field that you don’t have to be an MD to get. You can be a naturopath, you can be a chiropractor, but you can also be a D.O. or M.D. to obtain your certificate in Functional Medicine. I’m taking the one through Institute of Functional Medicine. It’s not that hard to get — six weekend courses, just to be honest with you — to get a certificate, and you take a test at the end. And some of it is evidence-based, some of it is not. But I think it’s very useful because they’re trying to find out — the field of Functional Medicine is trying to find out what’s causing all these issues. They look a lot at bile chemistry, they talk a lot about environmental toxins as well, which I appreciate, which is why I got into this. They have a module just on immunology. So, I think they’re the one the first ones that talked about leaky gut before anyone really emphasized it. 

And what I appreciate is that they talk about gluten and all these things, dietary questions that people always have; lectins, dairy, the gut microbiome. They talk about that, so I appreciate that. And it’s important that when you find a Functional Medicine doctor that you really look at the credentials, make sure they’re doing things more evidence-based, if you find one. These tests can run a lot of money, so you don’t want someone that just runs a lot of tests and throws a lot of supplements at you, but I would say that’s a good place to maybe start; a Functional Medicine or Integrative Medicine doctor to look for the root cause of your fatigue. There just can be so many issues. 

[Intermission begins]

Hi, everyone! I’m interrupting really quickly to remind you that this podcast is brought to you by The Rheumatoid Arthritis Roadmap. It’s a comprehensive online education and support program that I created from scratch to help people learn how to live a full life despite rheumatoid arthritis. In the course, you get to learn how to manage everything from physical symptoms like pain and fatigue, to social and emotional aspects of living with rheumatoid arthritis. I even cover the logistics of things like how to track symptoms and how to advocate for yourself in medical appointments. To learn more, go to myarthritislife.net. 

[Intermission ends]

Cheryl:  One of the things I also learned when I went to the American College of Rheumatology Conference was how frequent it is for people with rheumatoid arthritis to also have a sleep disorder, even if they have no other underlying risk factor for sleep disorders. So, you know, because I thought, “Oh, I don’t have sleep apnea because I don’t have — I’m not overweight or like I didn’t have any other risk factors, and  I don’t snore,” but they actually recommended that if anyone’s feeling really fatigued, to get a sleep study just to rule it out.

Dr. Yu:  That sleep, you know, insomnia, is a big issue, too. It’s related to that, I think, inflammation also. There’s a gut-brain connection out there, and a lot of patients, they do have trouble sleeping. Either they’re overweight or they have OSA. Something is causing it, or is inflammation as well; their medications can cause insomnia also. There’s so many causes, or they’re just staying up late because they’re on the computer. So, there’s so many ways to tackle it. Meditation helps a lot, a lot of mind-body medicine is effective. Some herbs help, melatonin can help. 

Cheryl:  Yeah, another hot topic is CBD. I don’t know if you’re — we didn’t discuss talking about this beforehand, but do a lot of your patients ask about CBD, do you have — and towards THC?

Dr. Yu:  Yeah, yeah. So, I think, 25% of my patients are on CBD, I would say. It’s something that we don’t learn in traditional medicine but I’m actually been studying it, I took some lectures actually recently. So, there’s your THC component and your CBD component. Your THC component is the psychoactive component and your CBD is what you want because there’s less psychoactivity there. And research has come to show that there is some anti-inflammatory properties of CBD, so you can take it through tinctures through drops in the mouth, you can do creams, there’s so many different forms you can take, and it can be useful instead of taking an ibuprofen or NSAID. You can reach for CBD, if it relieves the pain instead. And you don’t have the toxicity. 

Cheryl:  Right, right. Yeah, and the stomach side effects and stuff like that, yeah. I think it’s pretty interesting area, and I know that the Arthritis Foundation recently did a podcast episode about CBD as well. So, there are some good resources out there for patients. I had a question from one of the audience members on Instagram. She wanted to know, “Is it hard to have your — do you ever get overwhelmed with your personal life and your work being about the same thing?” Meaning like, I think meaning being a patient and a provider in rheumatology. Has that been hard balance, or no?

Dr. Yu:  It’s been hard balance because I’m working so much, and I’m trying to — I really have a mission here. So, that’s what keeps me going. It’s to really find out what’s causing all this. Because as a rheumatologist, you don’t talk about the root causes of autoimmune disease, really. I mean, you do sometimes, there’s obvious things out there, but we don’t really talk about diet, you know, we always talk about biologics, medications, we talk about studies of this medication versus that medication, but you don’t really talk about the environment. We don’t learn about this stuff. Maybe the few obvious things that are very pronounced in the literature, but there’s a lot of things I’ve learned about Integrative Medicine like pollution, I’m learning about things in your water, things in your carpet. All these things are in your beauty products, in your canned foods, BPA. All these things can potentially play a role. And I think we’re at the beginning of research on this. So, I am not overwhelmed by what I’m doing because I’m so passionate about it, and I really want to find out what’s causing all this. It is a juggle, because I’m doing an Integrative Medicine fellowship, I’m taking Functional Medicine courses, I have to do to posts on social media to keep up with that, after I run my business, see patients there — I’m working at a county hospital and overnight as a hospitalist.

Cheryl:  You also started an academic role, right? You’re teaching?

Dr. Yu:  Yeah, so, I’m an assistant professor. I work at county hospitals and they’re associated with the university. 

Cheryl:  Oh, I see. 

Dr. Yu:  Yes, I’m about to give grand rounds to a local university to a rheumatology department. So, currently I’m talking to the Lupus Foundation in May. So, I’m just — I’m trying to keep one foot in the academic world and more of the allopathic world, I keep one foot in integrative world as well, and it’s a new language when you go into the integrated world. 

Cheryl:  Yeah, and that’s where I can see like, you know, you’re kind of bridging these two very disparate worlds. Hopefully, the next 5 to 10 years will show that there’s kind of like a meeting of the minds, right. We have of course the important medications, but we also have this emerging evidence about the brain-gut immune, you know, axis relationship. So, yeah, that’s really exciting. 

Dr. Yu:  Yeah, that’s enough things we talk about doctors unless you are passionate about it, and you read the literature itself. 

Cheryl:  So, if you could like wave a magic wand and change how medical school is structured, or how the medical training is structured, what would you do?

Dr. Yu:  Nutrition is the first thing, and I really would appreciate if they would incorporate some Integrative Medicine to it, even if you’re not going to use supplements and herbs or these things, at least be aware of it because your patients are going to use it. And when you go to your regular doctor, and they don’t know anything about it, like the herbs and stuff. And it’s important when your patients take it, to know how it interacts with the actual medications that you’re taking. A lot of doctors will not have the competency to advise you on that role. 

Cheryl:  There sometimes can be this idea of like, “Oh, that’s all not evidence-based,” like, anything other than Western medicine is, there’s no evidence. But there’s actually like this big gray area, and there’s also actual evidence. Like, I remember when I got SIBO, small intestinal bacterial overgrowth, my naturopath was like, “You know, I know this is gonna sound weird,” because she has autoimmune disease too, but she’s like, “You can either take an antibiotic for two weeks, or these herbs for four weeks,” and she’s like, “The evidence is actually stronger for the herbs.” And I looked at the research papers — again, I’m not doctor — but like, I looked to see. And she’s like, you can look at them and see that the herbs actually work better. So, you know, it’s again — but I think something I’ve talked about before is like, if you have anxiety about your condition, about your health, it can be gray areas are hard, right. Your mind just wants to cling to black and white, so that you don’t have to deal with uncertainty. So, I can see how — it seems like some patients go 100% only quote-unquote ‘natural’, no medication, and then others are like ‘only medication, no natural’ and it’s like,  we need kind of a voice like you to be like, there’s a middle ground, you know.

Dr. Yu:  Yeah, there is a middle ground and it really is up to the patient’s disease, what works and what doesn’t. And it’s so important that, I would say, to find someone that’s integrated, because it can really help minimize medication use. And it’s kind of scary sometimes too, when you go to naturopaths — so, sometimes, naturopaths, they say, “Don’t take medications!” I believe on what naturopaths do, I’m not saying that, but I had a patient who went to one and said don’t take medications at all. But then, you can’t say that because sometimes patients do need medications. And I think the naturopath way can be very helpful, but there has to be some middle ground where, you know, sometimes you do need medications, and you do need a rheumatologist. Even very, very traditional to at least be in the picture, so that they can give you an opinion.

Cheryl:  Yes. Yeah, I totally — I’m glad you clarified that, because yeah, I would never go to only a naturopath for my rheumatoid arthritis, for my disease, because it’s too severe for that. And even my naturopath said like, “No, you need to stay on these meds,” and she’s on Western meds for her autoimmune disease, ulcerative colitis, too. So, yeah, no. But you’re right. There can be a quality control issue especially if people kind of prey on people’s fear, you know, of medication.

Dr. Yu:  Yeah. But then you have the other side of the coin, where you have the traditional M.D. who says there’s no evidence for these supplements, or any of these things, or diet, and so like, you’re missing out as a patient. 

Cheryl:  Yeah, yeah. That’s why I’m such a fan of what you’re doing because you’re trying — you’re, again, you’re giving the middle ground, the evidence for both sides you know, quote-unquote ‘sides’. Earlier you mentioned all the different projects you’re doing, so I want to be respectful of your time. You have so much going on. Oh, my gosh, I’m so grateful. But yeah, is there anything else you wanted to speak to that we haven’t touched on yet?

Dr. Yu:  No, I just want to say that if you’re on medications, it’s okay. A lot of us are on medications. I mean, the bad side of medications is their side effects, right. And not everyone’s gonna get side effects. I have patients that have been on biologics for 10, 15 years, no side effects whatsoever. Yeah. But then you have patients that go on these biologics, get a allergic reaction right away, or get cancer, like in a couple years, and that may be related to the biologic. So, it’s really the patient’s genes, and how you react to these medications. But overall, there is a way out, possibly, but it depends on your genetics and everything around that your environment, as well. So, you can minimize medications but you just have to find the right doctor, someone to guide you.

Cheryl:  That’s so helpful for people I’m sure. And just a logistic question because, you know, a lot of patients are just overwhelmed. Like, literally, how do you find a rheumatologist that is integrative? Do you just look up that integrative, like — will they have like an ‘I.M.’ after their name, or no? 

Dr. Yu:  No, no. So, integrative rheumatology is not an actual — there’s no official Field of Integrative Rheumatology. Well, I just call myself an integrator rheumatologist because I’m doing Integrative Medicine and I’m doing rheumatology. But there are a small group of us, are integrated rheumatologists that are out there. You just have to find us on social media, that’s pretty much it. There’s no — American College of Rheumatology will not have a list of integrative rheumatologists for you. 

Cheryl:  Okay, that makes a lot of sense. So, you got to go through the grapevine. I had an interviewee early on I think in the first five episodes of the podcast, and she actually goes to — she said he calls himself an integrative rheumatologist in New York. So, I know that there are people who call themselves that that are out there, but like you said, there’s not an official location or whatnot. 

Dr. Yu:  There’s a very small handful of us. Yeah, because not everyone believes in what we’re doing either. A lot of doctors, they are very traditional, and they’ll say, “Oh, there’s no evidence for that,” but, you know, just because you haven’t looked doesn’t mean there’s no evidence. 

Cheryl:  Right, right, or that the evidence in the past wasn’t that strong, doesn’t mean that things change in medicine. Oh, and so you mentioned looking people up. So, where can — I’m gonna put everything in the show notes, like all your accounts, so people can follow you — but in case they want to just hear, where can they follow you?

Dr. Yu:  Yeah, they can follow me. My handle’s @myautoimmunemd on Instagram, Tiktok, Twitter, Facebook, and my website is coming out soon, myautoimmunemd.com. That should be out in about two weeks from now, latest. Yeah, I have a blog, I’ll be blogging about both Traditional Medicine and Integrative Medicine, so I really want that to be a home for autoimmune disease patients of all types, especially rheumatic diseases. I’ll be talking about environmental medicine, I’ll be talking about your medications that you’re using, biologics, the newest studies in both the holistic realm and the traditional realm as well. 

Cheryl:  Well, thank you. 

Dr. Yu:  Oh, thank you for having me. I really appreciate you inviting me to your show.