Heal Your Rheumatoid Arthritis by Healing Your Gums · Heal Your Your Gums Speaker: The information provided in this presentation is for educational and informational purposes only

Heal Your Your GumsSpeaker: The information provided in this presentation is for educational and

informational purposes only. It is not a substitute for

professional medical and/or dental advice to diagnosis or treatment any

condition. Always seek the advice

health care professional for any questions you may have regarding a medical

or dental condition.

Scott: Hello, everyone! Welcome back to the Functional Oral Health Summit. I am Dr.

Scott Saunders, Presidentbe speaking with Dr. Susan Blum, functional medicine physician and founder of the Blum Center for Health in Rye Brook, New York. We are going to be talking about arthritis, periodontal disease and a who

Welcome, Susan. Susan: Thank you so much for having me, Scott. I'm

topic. I'm excited to speak about it and share the information with all your listeners.

Scott: Yes, we're happy to have

explore, because I can't think of a better benchmark to spotlight your oral systemic connection nor the many oral systemic connections than from an autoimmune angle and your specialty of coursecontext, you are of course an expert on autoimmunity. Can you share with us a

functional medicine understanding of how autoimmune diseases begin? Susan: Absolutely. I think that's a really good place to start because arthriti

specifically, rheumatoid arthritisthe connection between the oral microbiome and the jointsarthritis is in rheumatoid discussion by talking about autoimmunity in general and the connection between

the general microbiome and the bodyautoimmunity is a great place to start.

In general, autoimmune diseases are an epidemic right nowcentury, arthritis is autoimmune diseases have become increasingly prevalentunderstanding is that there's this interaction between someone whose

genetically susceptible

Heal Your Rheumatoid Arthritis by Healing Your Gums Speaker: Susan Blum, MD, MPH

The information provided in this presentation is for educational and

informational purposes only. It is not a substitute for – nor does it provide


condition. Always seek the advice of your physician, dentist or other qualified


or dental condition.

Hello, everyone! Welcome back to the Functional Oral Health Summit. I am Dr.

Scott Saunders, President of Healthy Mouth Media. Today, it is my privilege to be speaking with Dr. Susan Blum, functional medicine physician and founder of the Blum Center for Health in Rye Brook, New York. We are going to be talking

periodontal disease and a whole world of topics in between.

Thank you so much for having me, Scott. I'm really, really passionate about this

topic. I'm excited to speak about it and share the information with all your

Yes, we're happy to have you with us. This is really a critical link that we want to

because I can't think of a better benchmark to spotlight your oral systemic connection nor the many oral systemic connections than from an autoimmune angle and your specialty of course−arthritis. Just in the general

, you are of course an expert on autoimmunity. Can you share with us a

functional medicine understanding of how autoimmune diseases begin?

that's a really good place to start because arthriti

specifically, rheumatoid arthritis, which has the most research and evidence on the connection between the oral microbiome and the joints; and inflammatory arthritis is in rheumatoid arthritis. I always like to set the stage for that

lking about autoimmunity in general and the connection between

the general microbiome and the body and the gut and the oral microbiomeautoimmunity is a great place to start.

In general, autoimmune diseases are an epidemic right now. In the rthritis is one of the leading causes of disability in the world, but

autoimmune diseases have become increasingly prevalent. What we're understanding is that there's this interaction between someone whose

ally susceptible−so there's always this genetic, underlying perhaps

Arthritis by Healing

The information provided in this presentation is for educational and

nor does it provide -


of your physician, dentist or other qualified


Hello, everyone! Welcome back to the Functional Oral Health Summit. I am Dr.

of Healthy Mouth Media. Today, it is my privilege to be speaking with Dr. Susan Blum, functional medicine physician and founder of the Blum Center for Health in Rye Brook, New York. We are going to be talking

le world of topics in between.

passionate about this

topic. I'm excited to speak about it and share the information with all your

you with us. This is really a critical link that we want to

because I can't think of a better benchmark to spotlight your oral systemic connection nor the many oral systemic connections than from an

. Just in the general , you are of course an expert on autoimmunity. Can you share with us a

functional medicine understanding of how autoimmune diseases begin?

that's a really good place to start because arthritis and

research and evidence on and inflammatory

always like to set the stage for that lking about autoimmunity in general and the connection between

the gut and the oral microbiome. So

. In the 21st of disability in the world, but

hat we're understanding is that there's this interaction between someone whose

underlying perhaps,

©2017 Healthy Mouth Media for the Functional Oral Health Summit

component−and the environment. Sometimes, people think of the environment as only toxins or something that feels very much outside of us, but it turns out

that the environment really just includes anything that's in your life that might influence your genes and your genetic expression. So it includes things like the food you're eating, stress you're experiencing and bringing, the stress response and how your body manages stress. Your microbiome is considered an

environmental influence. If you think about it, the two that starts in our mouth and goes all the way through our gut into our anus is the outside world. It's where we bring the outside world in everyday and the environment comes in that way. So there's this whole microenvironment there that feeds into the body

and has the power to really increase inflammation in the body or keep us having low levels of inflammation.

Of course, environment includes everything from toxins. I know on the Summit, there's a lot of discussion always about Mercury, heavy metals and toxin, but there are also toxins like Roundup which is glyphosate and pesticides, organophosphates, toxin load and plastics. There's so much that we're exposed

to now, as well as the viruses. There are all sorts of triggers that we look for in functional medicine to explain what's come in from the environment that is interacting with our genes and causing a dysfunction in the immune system. I

think it's really important from an autoimmune perspective, for people listening that might not be familiar with autoimmunity, an example of an autoimmune disease is certainly rheumatoid arthritis like we're going to really dig into today, but even things that are common like Hashimoto's thyroiditis. It just means that

the immune system is not working properly, and it's somehow damaging your own tissue where it should be just fighting foreigners. Instead, some collateral damage is happening to your organs and depending on what organ is damaged by your immune system, that's what determines the disease name that you get.

Actually, it also determines where you go. For example, somebody with Hashimoto's thyroiditis goes to an endocrinologist. Somebody with multiple

sclerosis goes to a neurologist. Somebody with rheumatoid arthritis ends up at a rheumatologist. The problem is this kind of reductionist thinking−and this is going to bring us back to the whole view of the body and it all being connected− is that when you treat rheumatoid arthritis, you can't just treat the joints. It's a

systemic condition. The inflammation that's in the joint is everywhere and you might just be showing up with symptoms in your joints which brings you to your rheumatologist, but it's a systemic illness. We've really missed the boat in the

conventional-- I'm conventionally medically trained. I'm a physician. I went to medical school and trained in internal medicine. But the bottom line is that conventional approach is a very much of a disease model, and we're just looking at how do we find the disease someone has. So if had joint, you have a joint

disease. It's really hampered our ability to look at autoimmunity as an immune issue and to do the research and really dig into foundational causes for all autoimmune diseases. Wherever it shows up is that's the name that you have but everybody, it turns out has common underlying triggers that are triggering

that problem that's causing the immune system to go "haywire", for a simple terms. So it's really important and that's what functional medicine does then.

So circling back to the functional medicine approach is really about finding-- I'm a medical detective so I'm looking. We call ourselves medical detectives and I'm using detective work. This isn't just theory. This is evidence-based. This is research proven. Then we're going to talk about studies for rheumatoid arthritis


and the oral health. This is research proven connections for what the triggers are for autoimmunity, including arthritis. If it turns out that with that understanding,

if we use our medical chops and approach and functional medicine is a new kind of operating system to do this, to look at the body, to bring a treatment approach to treating the root causes, people get better. You go upstream, and you're treating inflammation where it begins.

Scott: I like that term that you applied− an operating system. I think that's going to

resonate with a lot of our audience members. Now, we're speaking of an interaction of the genes and the environment. A lot of people are still stuck in

the model of our wealth. My father died of a heart attack at 43, so you know I guess my days are numbered. My DNA is my destiny, to borrow from the title of another book. Is this really the case? It sounds like from what we're talking

about, the environment has an effect on our genome and that has been described as an epigenetic influence.

Susan: Epigenetics. Exactly. Scott: That is what we're talking about here.

Susan: Yes. Scott: Go ahead.

Susan: No, I was going to say I could them just a simple explanation of what that term

means.

Scott: Sure. Yes, please. Susan: Let's see. So we have our genes and genes are just your book of life. So when

somebody thinks of your genetics, it's in every cell of your body. You have a complete book of life in you genome, and every gene is in every cell. What happens is it's actually the way our cells develop and work. In each cell, for example like the liver cell, is expressing one chapter in the book of life that helps

make it a liver cell. In your ovaries, if you're a woman, the cells that developed in your ovaries when they came from germ cells, those genes got read. That chapter in your book of life was opened, and it was read. This is the way Jeffrey

Bland explains it. I have to give a shout out to him. I love the book of life analogy and the reading of the chapters.

Scott: He is amazing.

Susan: Isn't he amazing? Scott: Yes.

Susan: He is the father of functional medicine, and so love him. This whole idea of a

chapter being read in each cell and that helps determine how that cell functions.

It not only helps determine what that cell becomes like what it's personality ends up and what kind of cell it becomes in your body, but then once it becomes your liver cell, for example, there are still genes in there that are helping it work. At any given moment, what turns on and off those genes? Jeffrey Bland calls them


like paper clips that go into your genome and open up a chapter and have it read. These are things that you people that are listening, you might have heard

of like methylation: B12 and folate. Methylation is actually one of the very powerful ways that we open and close different genes. They get read or not read, and it changes the expression and the functioning of the genes. Phytonutrients from food. Food has a very strong powerful way like Resveratrol,

for example. It goes in and opens a chapter of anti-inflammatory and anti-aging genes. So this is called epigenetics, that there's this paper clip that goes into the gene into the nucleus of your cell based upon something from the environment that you're doing. So you're eating those B vitamins. You're taking your B12 or

you're eating enough foods that have those B vitamins in them. You're eating enough colors, vegetables and food. I have to stay out of the gate that the number one most powerful way that we influence the expression of our genes is

the way we live. So there's food and stress. We'll talk more about all those things.

Epigenetics is the way we live and these chemical messengers that come into

our cell can help the cell function, either in a pro-inflammatory way if we bring it back to arthritis or in an anti-inflammatory way. So genetics is definitely not destiny. When it comes to cardiovascular prevention, I do preventive cardiology

everyday in my practice and there are a lot of these risk factors. So it's really helpful to understand what your risks are, because genetics does matter. It is a predisposition. But you take your genetics and you could modify every part of that and the outcome based upon choices that you make and how you live.

Scott: So the human genome is malleable after all. We do have control. We are not

stuck with the genes that we're borne with. To me, that seems like a very basic message but I think that there are a lot of healthcare consumers that are still

trying to get their mind around that and to appreciate that diet and exercise does matter.

Susan: It does. If I can just add one more thing since we're on the genetic topic. Scott: Sure.

Susan: There are a lot of direct consumer labs like 23andMe. I read those of my patients all the time, and I just want to point out that one of the things that's happened with the availability of all the genetic testing is that we've gotten

drawn into this reductionist way of thinking about it, like "Oh, I have this MTHFR gene which is the difficulty metabolizing folate −gene methylene tetrahydrofolate reductase. This gene codes for the enzyme, and everybody in the population has some version of it. Certain versions of MTHFR, you could be a

slow methylator of folate. So maybe you need to take methylated folate. I don't want to get stuck into what the end result is but with the point is-- Sorry.

Scott: No. Go ahead.

Susan: I want to keep this simple is that there are about 15 methylation genes. So

people will come in and say, "I have this one gene. This is why I feel this way.

This is why I have this symptoms and health condition." I always say, listen not only is that one gene, maybe it's expressing and maybe it's not and that's the epigenetic part. You have the gene but we don't know how active it is, first of all or how well it's expressing itself. But second of all, all your genes talk to each


other. It's a big communication loop and there are many methylation genes. You cannot determine anything about your health based upon one gene. We are

learning the patterns and are able to look at the whole series of patterns that you can try to bring that to the table in the discussion, that we're now able to do looking at patterns, but one gene does not equal one disease.

Scott: So maybe, something that our listeners or audience members wanted to be aware of is to guard against falling into a reductionist paradigm of their own. I like that word; you used that a couple of times. I picture that as almost a tunnel vision that can result in the mind fixating on "Oh, I have this one gene. I have

this one pre-disposition" without looking at it in a broader scientific context and a broader all-encompassing functional medicine, body systems working in an integrative fashion approach. It's possible to get into a mindset that might get

you into an additional epigenetic influence that might take you in a direction that you don't need to go in, but is perhaps magnified outside of the extent that it should be and that you might focus on the control that you have in view of what a broad variable that you control like nutrition. The effect of that might have on

the total interaction of your total genome, I mean a lot of which we have not really undertaken to map yet.

Susan: Yes. I think we're in its infancy. I do want to clarify one thing. There are some genes that are a disease like Toy-Sachs disease. I'm talking about the general things you're getting from 23andMe which are just general genetic snips. There is so much influence that lifestyle has, which just popped into my mind actually.

I know there are a lot of other things that we want to make sure we cover and talk about, but when you talk about the whole Paleo movements and this whole idea that we're at, why are all these diseases so prevalent right now? What's going on? I guess when I meant Paleo, I meant that we have these ancestral

genes that are used to us eating and living a certain way. It manages life. Our genes have been very well able to keep up with and take care of us in the old way we live 1000 years ago.

But in the past 100 years, our lives have completely changed. The exposures and the way we're eating and living, the things we're breathing, the plastics and the stress, our genes have not had a chance to adapt to all of that. So in some

ways, the diseases of the 21st Century are thought to be a disconnect between our genes and the new way of living. If we kept eating and living this way in a thousand years, our genes would adapt and everyone wouldn't be so sick with

inflammatory diseases. But right now, there's a mismatch. Scott: Yes.

Susan: Does that make sense? Scott: It does. I would hate to think of the disease burden from here to 1000 years

from now if we don't do anything to adopt more of a functional medicine

approach. Basically, what this Summit is trying to do is to empower the healthcare consumer to be a better advocate, be more in control of what happens to his or her genome, body and health, and to empower. That is our

goal. Susan: Right. From an empowerment perspective, when those of you listening to the

Summit, this is the kind of information you need because your genetics is not


destiny and you absolutely can cure reverse inflammatory disease. My first book, The Immune System Recovery Plan, that's a four-step program for treating and

repairing your immune system, which is reducing inflammation and reversing autoimmune disease. It's looking at food, stress, gut health, toxins, infections, all those triggers and how to treat them.

I smile whenever I think about this, because I wrote the book in 2013, and I still get emails every week. I get at least an email or two thanking me for writing the book. I just put down on paper and in a book form what we've been doing in functional medicine to get it out there and getting the word out that there is

hope and there's so much that you can do. I'm an eternal optimist; I get that from my mother. I believe everything. Nothing's inevitable. I live that way, I teach that way, and I treat people that way. I really believe, for those of you

listening, if you have any kind of inflammatory health condition, especially arthritis, autoimmunity or really any inflammatory condition by working with your food, changing what you're eating, working with stress, healing your gut and improving the microbes in your mouth and your gut and making sure your

toxin load is low and having a strong, really good balanced immune system, you can reverse these inflammatory diseases.

Scott: So once again, the healthcare consumer, the patient, the average person eating the diet, taking the supplement or not is for better or for worse in control of these triggers of inflammation from these very basic, yet very powerful standpoints could stress your various microbiomes, toxins, infections and other

environmental causative factors. Any other comments on inflammation before we move out of our general context and move in to arthritis specifically?

Susan: Oh, well I think we can probably just talk about it in the context of arthritis. At

some point, we can certainly talk about how food causes inflammation and how stress-- There's all the "how-tos." So how does food cause inflammation? I think that it's really important to understand the concept of an anti-inflammatory diet

and what that means. When you think about food triggering information, you're always thinking about "Are there foods that need to be removed, that are pro-inflammatory, apro-triggering of autoimmunity? Are there foods that need to be brought in that are really important and supportive of health?"

For me, I always start with what I call "leaky gut diet" at the very beginning when I'm working with somebody, which we'll talk about what a leaky gut is,

and dysbiosis. A leaky mouth, I think is also a part of that whole concept. We're talking about a leaky gut, leaky brain barrier and permeability in the mouth and all this permeability that allows the microbes to basically get into your body and trigger an immune reaction. So I don't know if you want to talk more about food

or you want to just jump into that. I do want to say a few things about food. Scott: Sure. The whole food is a medicine concept, borrowing from Mark Hyman's work.

Susan: Yes, from Mark Hyman's work, and it's not just Mark Hyman. Food as medicine, the idea is fundamental to how we work in functional medicine. It's called nutritional medicine. We've been doing it from the beginning for 20 years or

even longer. I always think that as functional medicine folks are naturopath wannabes. We're sort of an outgrowth. It's naturopathic medicine that's bridged over into the medical world, and we really just took it in and it kept growing in an additional way. Mark is a really good friend and colleague. His books were the


first books, I think that really reached the public and shared this information in a really easy way to access which was amazing.

Here's a simple way of thinking about food. From an autoimmune perspective, there's a lot of research on gluten and grasses that have a lot of gluten and gliadins in them. Historically, man was never meant to eat those things. We

found that they damage the gut. There's this whole way and process by which gluten, we know that there are mechanisms by which it can trigger autoimmunity. So if you have an autoimmune condition, we always take gluten out. So looking for the foods that are triggering inflammation in your body.

Gluten's always one of them.

The way that we approach this in general is this thing called an elimination diet.

All of us functional medicine folks will always start you off if you're going to get embarked on a program through my book or any book or with a functional medicine specialists, you're always going to start with an elimination diet because we want to find out if you have any food sensitivities. So step one is

always "Do you have any food sensitivities?" How are we going to find out? So you remove a whole list of food that's usually gluten, dairy, soy, corn and eggs. With arthritis and autoimmunity, I usually take out nightshade vegetables which

are tomato, potatoes, eggplants and peppers, and always sugar. The sugar piece is important which is processed in flours and all the processed foods in boxes are sort of end up going. You're really looking for a whole foods plant-based diet.

Animal food's okay but you really want to choose the quality of your animals− how are they being fed. The moral of the story on that is what Michael Pollan says which is:"You're eating what your animal ate. You're eating what your plants ate." So you have to be very mindful of the food quality. You have to be

mindful of how much pesticide you're getting. You have to be mindful of the quality of the fat. Saturated animal fat can be very inflammatory, especially if the cows were fed corn and feed lots. These are all the kinds of things. You

really start working on cleaning up the diet, making sure they're getting the sugar out, the fat is healthy fats, the animals are from good quality animals and then really, really important is bringing in what you want to bring it.

Because we're going to talk about the gut and the health of the gut microbes (and I know that the oral microbes also the number one influence is the food you're eating, right), you want to bring in the foods that are going to increase

diversity of your microbes, to keep the good bacteria flourishing and suppress the growth of the bad bacteria. So food is the number one influence. You want to eat a lot of phytonutrients, polyphenols and the colors. You actually go in and change the genetic expression of the bugs. So colorful foods, phytonutrients,

polyphenols and flavonoids actually have a really positive profound effect on the diversity of your gut flora.

The studies, I know on the gut. I don't know all the studies on the oral microbes

but my biologic dentist and colleagues have told me that there a lot of studies on that too. So you can share with me if there's a specific studies on that, but I have my book on arthritis then. My next book which is healing arthritis, I did a

thorough review on food, what food and what diets we know improve and treat arthritis and support gut health.

Hands down, it's all about the fiber and phytonutrients and taking away


processed foods, acidic, too much animal, too much processed foods really does not favor an abundant and diverse gut microbiome. It turns out, it's actually

interesting and maybe this will be the simple way to leave this is that at a good old Mediterranean diet has shown really positive effects on improving arthritis symptoms in humans, as well as vegan and vegetarian diets as well. But it turns out that I love the Mediterranean diet because it's very balanced. It's healthy.

It's a lot of colorful fruits and vegetables. It's some grains, not overdoing it. It's a little dairy maybe, but not over doing that. It's limited red beet, not overdoing that. It's fish, eggs, olive oil and a little wine is okay. It's like this balance which is really nice, but it's filled with healthy fats, nuts, seeds and legumes and it's

filled with color and all that good gut healthy stuff. So a gut healthy diet is the long-term, I think, plan.

Scott: So that's the future that you envision for your patients who get on a healthy diet. Let's back up for a minute and take a look at what they're coming to you with.

Susan: Yes. Scott: Now, we hear the term dysbiosis a great deal, and it's been mentioned by a

number of our speakers here on the Functional Oral Health Summit. Can you give our audience members a little crash course just on the whole phenomenon of dysbiosis and the side syndromes that go along with it?

Susan: Absolutely. It's actually a very important foundational concept that I think everybody needs to understand. So let's start at the basics. You've got about let's say 100 trillion bacteria in your gut. We're all pretty much in agreement that's around what the number is but there's 100 trillion bacteria and that's just

in the gut and then we had the oral microbes to that as well. We have a lot of bacteria in there. Everybody's different. The way that your gut microbiome develops is influenced by many, many things like "Did you have a C-section?

Were you borne from C-section? What did you eat? What were you fed as a child? Did you have any trauma or stress or big stressors in your life? How much antibiotics you've had, what kind of medication you're on. There are all sorts of ways things that influence the microbes.

But food and the food your family was eating and the kind of food you were raised on will have a very big influence as well. These bacteria have a very

important function. I always like to help people understand what they're doing for us. We like them. They like us. These friendly flora, what they do, not only help us digest and absorb our nutrients and they metabolize and ferment our foods, and make their own nutrients. They're called short-chain fatty acids which

are very, very important for our immune function and for the barrier function of our intestines, which we'll come back to in a second. We'll stick with the bacteria for second.

One of the really, really important functions of your gut microbes which is very, very important for system-wide inflammation as well as autoimmune disease is the bacteria help tone your immune system as it's developing. About 70% of

your immune system lies just inside the intestinal lining in clusters. It's called the gastrointestinal lymphoid tissue. The lymphoid tissue is filled with these lymphocytes. They're just members of your immune army and they're lying in wait really to protect you from when you bring the outside world in. But the


good microbes in your gut send signals to your immune system and there, it helps tone the development of something called the T regulator cells, which are

in those clusters and your T-regulator cells do exactly what the name says. They regulate. They're like the switching of the on and the off. Just think of on and off. The T regulators help turn off the switch once it's turned on. So it keeps the train from rolling away without stopping down the track and prevents

autoimmunity.

So your microbes have a very, very important role in keeping your immune system balanced. The other thing that your microbes do that are very, very

important is they keep your gut lining strong and intact. There's something called an increased intestinal permeability which is when actually I should go like this. These are all the cells and the lining of your intestine, and there are these -

think of it like glue between the cells- but we call them tight junctions or gates. What happens is the good bacteria that are there, they keep the gates really healthy and working well. This is called a good, healthy intestinal lining. You want to have a healthy intestinal lining because it prevents what's inside, the

intestinal lumen from getting inside the body.

If you have this thing that we call leaky gut, which is when there's damage to

the tight junctions and there are openings in the intestinal lining, this is how system-wide inflammation happens because particles inside the gut and it could be pieces of the bacteria, food or toxins that are in the gut that you ate, just drift into the body and then the immune system that's over here on the

other side of the wall starts seeing all of these far looking things and starts reacting to everything. You start getting food sensitivities and reactions to food and really amped up reactions to the bacteria you can get to the bacterial cell walls. That's really important for arthritis and I'm going to come back to that in a

second because I want to come back and finish my definition of dysbiosis. Scott: Sure.

Susan: So now that we know what a healthy gut would look like: robust and good

amount, it's good diversity of all different strains of the gut bacteria. They're keeping your wall really solid, your immune system working good. They're

helping digest and absorb your food. What happens is and we can think of this as weeds in a garden. I think it's a simple analogy but it works. People will say, "Where did those bad bacteria come from?" Well, if you think about your garden,

you didn't plant the weeds there. There are always weeds in the soil but under certain conditions, they'll flourish.

Normally, there are all your good bacteria which we consider beneficial. There are always

other kinds of bacteria that can grow in abundant amounts. We always have a little bits of them there but if they over grow in large amounts, we call that dysbiosis because you have an overgrowth of potentially harmful bacteria. When it comes to arthritis, we know now there's a certain whole category of bacteria

that have been well studied that when they over grow, they tend to trigger system-wide inflammation. This is specifically the whole group of bacteria called Enterobacteria GA, which are like enterobacter but it's Klebsiella, Citrobacter,

Pseudomonas, Yersinia. These bacteria are always there in a little bit but if they gain traction and over grow, their cell wall has something in them that's very annoying to the immune system. We've actually found bacterial cell wall proteins from those bacteria in the joints. They trigger big inflammation.


So if those bacteria are there in large amounts, those bacteria dysbiosis triggers

the damage to the tight junctions and they do that by increasing zonulin which is one of the things that modulates the tight junctions. But they damage the tight junctions, which open the gates and then those bacteria themselves, and it's actually called the lipopolysaccharide component. Yes, all of those bacterial cell

walls get into the body and trigger inflammation and you're off to the races. That was a lot at once but--

Scott: No. That's a really good summation and you come full circle in defining dysbiosis

as having basically not enough good guys in proportion to the bad guys that overgrow. It's okay if they are there in small numbers and that is part of the natural balance. But like in the mouth, I can't help but envision a periodontal

pocket to say the parallel thing going on there if in response to pro-inflammatory triggers, these bed bugs mainly what we're talking about, the gram-negative bugs which are the ones that were associated with the toxic lipopolysaccharide cell wall component when they get out of control and things start breaking down

and then your gut starts to leak. Susan: They leak into the body. There are really good arthritis studies looking at the

connection between that and rheumatoid arthritis, as well as just inflammatory arthritis in general.

Scott: so very important to the context of arthritis or rheumatoid arthritis in particular

to keep the gut microbiome and all microbiomes balanced toward an anti-inflammatory sustaining--

Susan: We want to make sure you don't have a leaky gut. I do want to point out there's

also, in addition to harmful bacteria, you can end up with yeast overgrowth like Candida or the yeast or parasites that you pick up from when you travel. Actually, I say travel but plenty of people in the United States have parasites. So

you do have to be careful. Dysbiosis can be any kind of overgrowth of the bacteria, yeast, parasites. Like you said not enough good bacteria and you do want to repair the microbiome. So there's a whole steps for repairing the gut, and so you want to repair the leaky gut but in order to really ensure that you

have repaired the leaky gut, you have to repair the microbes as well and take steps to improve the balance.

Scott: Sure. The best vehicle for doing that, of course as we discussed is diet. Susan: It's food. But if somebody's very sick I always -- Look, the number one and two

most influential factors toward the gut is food and stress. That's absolutely true.

However, in the beginning I do want to separate out. So when listeners go and you look at the way I approach all of my programs, it's really important to realize that there's the initial jump start which is that first month of starting work on feeling better. There are the kick start programs of what you need to do

at the beginning, which I called like the therapeutic phase. You really have to start with the elimination diet, figure out if you have food sensitivities, be very strict on the new food plan, and work on healing your gut. You're doing all that

stuff and I do use herbal antimicrobial blends, glutamine and other powders for healing the gut lining. So I get very assertive in repairing the gut microbiome at the beginning. Then there's the sort of "finish what you started; how am I going to live my life in balance that's supporting a healthy gut and that's the long-term


plan.

So there's the therapeutic and then there's how you can live your life so that you continue to heal on a deeper level and that you'll continue to facilitate long-term health of your got, because otherwise you'll be right back to where you started it, unless you dress the food eaten it in a way and address the stress and other

factors that might be affecting your gut microbes and we'll push them back at a balance again, right.

Scott: Right. A part of rebalancing the microbiome is the administration or can be the

administration of probiotics. Can you tell us a little bit about your experience with how you help your patients with probiotics?

Susan: Yes, I can. So a couple of things about probiotics. This is such a controversial topic. I've interviewed my colleagues too and talked about probiotics. We probably all have a little bit of a different take on this. But I just want to share what I've read because like I said, my book healing arthritis published in 2017.

I did a thorough review of the studies looking at probiotics. What I want people to understand is that probiotics probably do not take up residence in the gut. You take them and they live. They stay inside maybe for a couple weeks and

then they move through.

Probiotics are immunomodulators. Don't think of probiotics as I'm taking those to change my gut flora, although they do have an effect on your gut flora

definitely. I'll talk about that in a second. Probiotics, it's very, very cool and the studies are really looking at individual strains now. So where are we going with probiotics is the identification of different strains and really understanding what they do. As a general rule, all the probiotics in the different formulas that you

take, the lactobacilli and the bifidus, what they're doing is they're reducing inflammatory cytokines in the body. They increase the functioning of those T regulators. So you get how important that is?

Scott: So this is the bugs and probiotics interacting with the different separate

components or individual components of the human immune system.

Susan: Of the immune system. So they are immunomodulators. You take probiotics and they actually help reduce inflammation and help balance your T regulators. They are treatment. They are part of treating inflammation. They also help repair the

gut lining. I don't know that it's so much about thinking about planting seeds that you think it's going to grow when you think about taking probiotics. Whether or not that's really true and that really work in that way, I think that they create an environment that helps what’s there grow. You have to think of it

as contributing to the ecosystem. That's a word I haven't used yet, but I love that word. You need to think of your whole inner garden including your mouth, gut, skin and lungs. It's like an ecosystem.

There are bacteria everywhere and taking probiotics comes into the ecosystem and has a positive effect, but I don't think it's straight like how we might imagine it like it's a seed you're taking and it's going to grow in your gut. I don't

know that there's that much evidence for that, but it doesn't mean that you shouldn't take it. For example, there are some really good studies. From my book on arthritis, I reviewed the studies looking at treating dysbiosis. So if our theory is in functional medicine that well, if dysbiosis and leaky gut are causing


arthritis, then if we treat dysbiosis and leaky gut, we should be able to reverse the arthritis. I'm doing that every day in my practice. My book is filled with 11

different stories of the treatment plans and everything I did with 11 different people from arthritis. It works.

When you look at the literature, we in functional medicine, our gut healing

programs have been going on for like 20 years. We've had this 5R Gut Program. We know how to do this repair work. The study we've done, I'm just giving people probiotics. That was just their way. "Okay, so let's try to improve the microbes and see whether or not it treats arthritis." You know what? It does.

There are some really good studies on like lactobacillus casei, both improved symptoms and reduced inflammatory cytokines; and lactobacillus rhamnosus and reuteri improved function in the daily function questionnaires.

Probiotics studies have been very positive in people with arthritis. Then the animal studies is actually where they really open the animals up, it's clearly showing an improvement at the surface of the joint capsules. You can see the

animals improving in their symptoms. It's really fascinating. Probiotics definitely have a role to play in the treatment of anyone with inflammatory disease or dysbiosis. Personally, the way that I do it now in my practice is I use probiotics

definitely for therapeutic period− three to six months. As people are getting better, I'm removing into how I said "therapeutic period and then you move into long-term."

I really believe once somebody recovered from their initial inflammatory condition and they're feeling better, I try to move to fermented and cultured foods, the diet and really work with food to improve the microbes− so cultured and fermented foods. I've actually been really fond lately of pickled beets. I

found this great product. It's like organic pickled beets, dulse and-- There are three things in there. Oh, it's so good and it's not as sour as people think. You can just eat it. It's really easy to eat on all your food. Fermented food is actually

really easy to bring into your diet. It doesn't have to be just kimchi and sauerkraut that we all always talk about.

Scott: Oh, I happen to be sauerkraut chummyself. I eat side dishes fairly frequently of

the good locally-produced fermented sauerkraut that I've got here in Pennsylvania, but I realized that not everyone shares my taste for something that might be so robust from the standpoint of a low pH, sour--

Susan: Taste. Scott: Yes, right.

Susan: Yes. That's why I was saying like the beets and there's a separate one that I

have also that's just fermented beets. It really almost tastes like just beets that are just a little sour. It's not as intense as some really intense sauerkraut. There

are so many options in fermented vegetables. So I do think that long run, it's really a plant-based diet. That doesn't mean I'm anti-animal. It also doesn't mean that when you're doing a therapeutic program, some people don't tolerate

legumes at the beginning. Some people can tolerate any grains at the beginning. If your gut is really, really damaged, you might have trouble with those foods. My colleagues who believed in Paleo autoimmune plants, they take out everything: legumes, all grains, nuts and seeds, and be really very, very, very


restrictive at the beginning. I don't know that everybody needs to be that restrictive, but for the sickest people, sometimes that is what they need. I do

use probiotics for sure at the beginning.

I do a lot of stool testing. I get a sense of if somebody looks like have something called small intestinal bacterial overgrowth, I won't go very high dose;

otherwise, if I do a stool test and it looks like the good stuff is very low, I'll go up to 100 billion a day. I use mixed strain products that have like 11 or 12 different strains in them. I don't stay high dose for that long (a couple of months maybe) and then we come back down to like 25 billion a day. Eventually, within

six months to that first year, I really might go when it's really always to get people just using food.

Scott: With the stool testing, you're collecting data so you can actually benchmark how a particular patient is doing on a particular diet or the particular probiotic. I can't help but think of the opposite end of the GI tract where there are all these wonderful tests such as MyPerioPath by OralDNA Labs. I'm just taking a wild

guess here that you work pretty closely with some of the biologic dentist in your area?

Susan: Yes. So we spend a lot of time on the gut, but I want to make sure to talk about the oral microbiome for a second before talking about how we work with dentists, which I do.

Scott: Sure. Susan: I also do MyPerioPath in my office as well. So I do that testing which is getting a

culture of the oral microbiome from an oral lab that specializes in that. We were

talking before of bad bacteria and how they can trigger the arthritis from the gut. There's another entirely different mechanism for the connection between the oral microbes and rheumatoid arthritis specifically. So I just want to share

that with people because it's the most fascinating thing that I really learned the details of when I did the research for my book. First of all, one of the other bacteria that's just generally associated with RA is called Prevotella intermedia and that's a bacteria in the mouth that increases. That's the bad guy, right?

Scott: Yes, it is. It sounds very familiar.

Susan: That's associated with periodontal disease. So that's the first thing. One of the bugs in the mouth that's definitely has studies connecting it to rheumatoid arthritis is Prevotella intermedia. But the other one that's very, very specific is called Porphyromonas gingivalis. I'm going to take you through this mechanism

which I think is the most fascinating thing ever.

Porphyromonas gingivalis makes enzymes. There's an enzyme called Gingipain, which is a funny name and the other is called Peptidylarginine deiminases (PAD)

enzyme. The bacteria in your mouth, they're just hanging out and secreting and making these enzymes that then go into your body and get absorbed through your gums. Now keep in mind, we talked about leaky gut in the gastrointestinal

track, but your gums when you have periodontal disease, it's all leaky there. You have openings into your body from your gums.

Scott: Yes, tight junctions there too that can go awry.


Susan: You have tight junctions that can go awry, and these enzymes that these bad

bacteria make dissolve-- I don't know if they dissolve tight junctions but that's what the bacteria in the gut do, so I assume that's what they're doing in the mouth. But these particular enzymes made by Porphyromonas gingivalis, they go into the body and do something called citrullination of the peptides. What

that particular enzyme does is it facilitates this process called citrullination of the tissues. It just damages specific tissues. When it damages these tissues, your body then makes antibodies to it. The specific antibody that's made is called the Cyclic Citrullinated Peptide (CCP).

Now CCP antibodies are much more specific for rheumatoid arthritis than the rheumatoid factor. So if you have RA, you absolutely have to get tested for both

of those antibodies. It's rheumatoid factor and the CCP antibody. You can have a positive rheumatoid factor for other reasons; it's not as specific rheumatoid arthritis. CCP is like 95 percent specific rheumatoid arthritis. If you have a positive CCP antibody, you've got RA. The really interesting thing is that the CCP

antibodies are really correlated with this process of citrullination from these bacteria. The two ways you can get this citrullination that the scientists and researchers have worked out from: (1) the oral microbes, Porphyromonas

gingivalis, and (2) smoking. That's why smoking is so associated with rheumatoid arthritis because you get citrullination of the tissues in the lungs because smoking facilitates the same kind of enzyme activity. If you smoke, that with the Porphyromonas in your mouth is double trouble. It amps up the whole

process. So that's really, really important.

Along those lines, I had this amazing patient. I actually wrote her story in my book. I was working with her. It's a really interesting story. It's a very good oral

story because she came in and said to me, "I have rheumatoid arthritis. I've been in terrible pain. It all started after dental work. I had all my mercury fillings taken out. I don't think she went to a biologic dentist; I'm not sure. Five years

ago, whatever her story was, she went to a dentist. She had all her fillings taken out and her joint pain was ever since then. I of course thought, "Oh, well that makes sense. You just released a lot of mercury. It's all about toxins. I spent all this time working on detox with her. Her CCP antibodies were greater than 250

and her stool test is fine. She tells me she has terrible periodontal disease and has been going to a periodontist because she has pockets and has all this stuff. I didn't know anything about this. This is before I really was enlightened about

this connection and had done the research.

Somewhere between a year or two after working with her-- We worked together for a while working on this until the light bulb went off, and I said, "You know

what? Maybe, it's your gum. Maybe, it's your mouth." I did the PerioPath test. She actually didn't have Porphyromonas but she did have Prevotella. She had terrible PerioPath result. I started working with her on improving her oral microbiome and her joint pain finally started resolving. It's my end of one of

course. I understand but it influenced me so much in really understanding that connection. It was the thing I finally did with this patient was work on her mouth that finally helped improve her arthritis symptoms. It was black and white.

Scott: These individual case reports, these are the things that I like to-- Well, in my

day job in my writing business, I write up an awful lot of case reports and an end of one is better than end of zero, certainly.


Susan: Yes.

Scott: It may officially be the lowest quality of evidence, but in a world where there

isn't a great deal of good research being published in the mainstream medical literature, it is a wonderful place to start. Success stories like the one you just

told are simply amazing. Susan: I'm a medical director in a health center where there are six of us practicing and

seeing patients. There's a whole bunch of us. We have a medical meeting every

week. So we're very much like team-based. We share information and make sure that we're all up-to-date with everything everybody's doing. So now as a team, all of our RA patients-- I was always measuring CCP before but we are

routinely doing thorough questioning and questionnaires of people for what's happening with their mouth. Do they have any periodontal disease that they know of? We're asking them to have their dentist do a thorough evaluation for pockets in their gums.

If somebody has anything, then we tell them to go-- I don't send everybody to a biologic dentist and we can talk about that, but I do believe that everybody that

has a positive CCP, I definitely encourage them to either get evaluated by their own dentist or go to see a biologic dentist, because I believe that's really, really important to work on to figure out what's going. I do the PerioPath test. I'm a little bit of a beginner when it comes to really repairing the oral microbiome. I

use some herbal antimicrobial liquid in a Waterpick and I'll try to get people doing better cleaning. I really like to refer them out and engage help with that. I think as a team, we are all very aware of that now. We ask those questions and refer them out as needed for sure.

Scott: So you're practicing a true interdisciplinary approach. I applaud the fact that

you're bringing in the whole biologic functional dentistry−I guess we might want

to start calling it−the functional oral health presence on the healthcare team. Question for you: is the CCP readily available as part of a laboratory testing panel or as a standalone test methodology or is it just one of those esoteric things?

Susan: No. No, no, no, no, no. If you don't get a CCP test from your rheumatologists,

they're not practicing good medicine.

Scott: Really? Susan: CCOP is a standard rheumatology test. It's one of the tests you should

automatically get when you go to your rheumatologist or internist and you're being evaluated for inflammatory arthritis.

Scott: I'm going to play devil's advocate here for a moment.

Susan: I don't know that people understand routinely that it's associated with oral

dysbiosis.

Scott: But if you were to go to your primary care physician, internist, family practice

doctor or whatever and ask, "Doc, I've got some joint pain, and I also have some periodontal disease. I don't know how these things might be related.


Maybe, they're not but I heard that if I suspect rheumatoid arthritis, I should be tested for CCP." What kind of answers do you think that patient is going to get?

Susan: They should get an, "Of course, I'm going to test you for that. I would have

tested you anyway once you told me you're having joint pain and swelling. It's a standard test for rheumatoid arthritis. It's part of the standard workup." But I

have to tell you, listen, it's very easy to point fingers at those of us who are practicing outside the box a little bit, but I don't actually think we're going to be outside the box much longer. I think we're pretty much in the box these days. But sometimes, for those of you listening, because we are the emerging new

medical specialty (I'd like to call us that), I'm up on the literature. I'm writing books and really getting the word out there and I'm reading the science. All medical doctors, just because they're practicing in your local medical clinic

doesn't mean that they've read the most current stuff. I get the American College of Rheumatology Journal updates on my phone. I'm subscribed to it so I read the rheumatology stuff. Not all rheumatologists are reading all the rheumatology stuff. I have had people come in and they'll say, "Yes, I've got

worked up for my arthritis and there's no CCP there." To me, that's bad medicine. That means the doctor has not been reading their own journals from their own specialty.

Scott: Yes. Unfortunately, that was the point of my question and is something that the

healthcare consumer needs to be vigilant about.

Susan: Right. So that's the point. It's not that it's a woo-woo test that they shouldn't be offering. Be mindful that I think in the most ways, we are offering the most current up-to-date research proven ideas, studies and practice standards that are being released most currently in a lot of these specialties. So you just keep

your doctor on their toes. You go in and ask for them. If they won't give it to you, then find a different doctor because that's not alternative in any way.

Scott: That is a very strong message and that is one of the pillars of what we're trying to get across here on the Functional Oral Health Summit is that people should be doing their own research. It's not that they have to go out and read the medical literature, but they need to be mindful and cognizant to know what to ask their

doctor and dentist for. That brings another thing to mind in that the PerioPath testing panels are wonderful. They tests not only for P. gingivalis and Prevotella intermedia but there are several other really nasty "denizens" of the oral

microbiome, for lack of a better term, that MyPerioPath tests for.

I'm thinking this heralds a whole new frontier in medical and dental collaboration, whereby dentists and doctors are both collaborating on ordering

these MyPerioPath tests and actually sharing notes and consulting on these parameters and what they're showing. The doctors were saying, "Yes, you're positive for XYZ and this is significant rheumatoid arthritis problem here; and the dentist is saying, "Yes. This person has got some 5mm to 6mm. pockets and

we're bringing it under control, but until we get the total body inflammation down, what we do in the mouth (scraping the teeth, scaling, root planning and even brushing and flossing) are probably not going to be as effective as that

would be after we have the microbiomes balanced and inflammatory response under control." I see all too often that dental practitioners have kind of a one line bottom line in that, "If you've got periodontal disease and it's not resolving, well you have to brush and floss better. Come back in 6 months and “shape up


or ship out "without recognizing that there is a whole systemically-focused universe that they may not be addressing.

Susan: Yes. It's easy to get stuck in that chicken egg thing. As you're talking, that's

what I'm thinking myself. Well, just like the gut is going to keep triggering system wide inflammation, the mouth will still be doing the same thing. So the

mouth really does have to be addressed if you are going to reduce your inflammation. I just want to mention about CCP, and then I'll come right back to this just to throw it out there.

Scott: Sure. Susan: The studies are very clear actually that CCP is the best way to gauge whether or

not you're in remission. So if your CCP levels are not normal yet, you'll have an increased risk of remission when you go off your medication.

Scott: This is for RA specifically.

Susan: For RA specifically. So that's why I'm saying, it's like a validated measure. It's

one of those things that if you taught, you must follow it. So if your CCP is high,

you have to keep working on your foundations. You have to keep working on your gut microbiome, oral microbiome and periodontal disease to keep going until the CCP is normal, because if it's not normal then you're not out of the woods yet even if you're feeling a little bit better.

So back to periodontal though. I do want to say that I do get stuck. I don't think it's enough to just say, "Oh, just brush and floss." There's treatment. The person really needs a repair of the microbes in the mouth. It's like they need some

reboot and repair of the microbes. I'm experimenting with things like probiotic toothpaste. I know food is a very big influence. Like I said, I'm using some herbal rinses and then the biologic dentist. It's not budging or even if people are

happy to go off, I'm always giving them. I have two biologic dentists in my area, and I give them the cards.

I think it's incumbent upon us to explain the connection, to make the referral

and to keep at it until we know that this part is treated, because the saying in functional medicine goes:"If you're sitting on a tack, the answer is to find the tack and remove it, not just take aspirin to smother the pain." You've heard

that. But if there are three tacks and you only treat two of them, you're still going to have pain. So if one of the tacks is the mouth and we repaired the gut, let's say you're eating okay for now, and your food is good. We repair the gut and the inflammation's down from that but you still have the one tack, which is

the mouth. You're still going to have this brewing low-grade problem in the body that's not going to completely go away. So you really have to find all the tacks and remove them.

Scott: To my way of thinking, that requires an increased level of collaboration between

the medical side and the dental side.

Susan: It does. Scott: Can you give us some perspective as to what I like to envision as a functional


medicine future in which dentists, dental specialists, primary docs, family docs, medical specialists, functional medicine, and nutritionally focused specialists,

such a yourself, can work together in more of a systematized interdisciplinary environment?

Susan: First thing that comes to mind is okay, healthcare system and insurance. I

actually think that the whole world of dental and getting dental covered is something nobody talks about which I don't quite understand, because-- Anyway, I'm not going to say anything about dentists. I love my dentist and a dental work is so important, but it's so completely unregulated. There is no

insurance. So I'm not quite sure how that folds-- That's the first thing. I think it has to become part of insurance.

Scott: Yes. You're preaching to the choir, Susan. Susan: The fact that that's outside insurance, I don't understand how you're integrating

it then. That's the first thing. For most people, it has to be considered a medical

field. So once that can happen, I think that's important. I'm thinking of my office. So at Blum Center, I have a family doc, an integrative gynecologist, an internist who loves to do integrative cancer. I do autoimmunity. I do everything

really. I'm a generalists, so to speak but we do lot of information on autoimmunity. I have an integrative allergists and ENT. So I am trying to bring in multidisciplinary, and I'm looking for a physical medicine like osteopath that does the non-surgical orthopedics. A dentist would be perfect, but you guys

need so much equipment. I don't have room to put you under one roof. So I think that the goal is going to be just having relationships with colleagues and with people and connecting, sharing patients and that. I don't think it's going to end up being all under one roof though.

Scott: Yes. You do see a movement toward getting dental procedures covered under

medical insurance. That's quite the buzz in a lot of dental fields. A big empathist

behind that is in the surgical fields such as oral surgery, periodontics, regenerative care and kind of working with the codes to get it covered under medical insurance, because you're right. Dental insurance does not pay for heck of a lot.

Susan: Here's for nothing. You kept that at 15. I know because I did it. I just got dental

insurance as part of my business for everybody. I mean, it's really ridiculous.

Scott: It's great if you don't need any work on. Susan: It's like you might not even get it.

Scott: It's not uncommon if you need some reconstructive regenerative therapy,

implants and crowns. It's not hard for a treatment plan to get into 34--

Susan: Six, seven, eight—Even $30,000, you say? Scott: Well, and even higher. Much higher than that.

Susan: Yes, with no insurance. There's really a big problem with that. I don't know. Is

there anything afoot work on that? I just walk around feeling resentful about that when I go to my dentist, I don't understand it.


Scott: I do too. I try to attenuate that response but I see it as a huge disconnect. I see

a lot of it as being based in the culture of the health insurance industry and the fact that medicine and dentistry have been so separated for so long. What is the answer? I don't know if there is anyone answer. I think medical coding is a step in the right direction. I think the dentists also have to step up to the play and

step up their game and start collaborating, taking the initiative to collaborate with primary docs. Let's face it. A lot of dentists don't want to do that. They're comfortable in their drill, fill and bill scenario.

Susan: Well, yes and people know they're paying out of pocket. So they've got a cash practice without anybody really making a buzz about it. I have a cash practice and people accept it. I'm in the Metro New York area and so I'm a specialist.

Most specialists are out-of-network in this area, but people do have something to say about it a lot of times, and nobody says boo about dentistry because we just all accept that it's a cash business and that we don't have insurance to cover anything.

Scott: Once again, this behooves the Summit listener/the audience member to, I'm

going to say it again folks, do your own research on the medicine and the

dentistry. What is the insurance environment like? What kind of healthcare reform is occurring or not occurring? Educate yourself as to what's happening in the functional medicine movement and the dentists who are on board with that, people like some of our other speakers on the summit: Dr. Gerry Curatola and

Dr. Reid Winick. There are a growing number of biologic dentists such as those doctors who are spearheading and bringing it together in forums such as the Functional Forums started by James Maskell who is bringing in the dental angle, as well as the medical angle. As well as having people likes Jeffrey Bland and all

of the foundational people in functional medicine.

So I'm thinking it's forums like that, but the critical piece is for the healthcare

consumer to become a collaborator and a hands-on participant in that and to foster from his or her standpoint the patient-centered model of healthcare delivery. So it's up to you folks. You need to participate in saving this whole thing or building the functional medicine movement from the ground up rather

than trying to repair the healthcare system from the top down which is-- Susan: Well, we're all going through these changes right now. We're hoping that we

could change our healthcare system, including dental work and dentistry. Putting it on the table as part of the discussion, I think is really important. So as you're all out there speaking up, this is something to add to the plate and add to the discussion.

Scott: Right. That includes, there I said folks, if you're a member of Congress then say

that if there's any magical healthcare bill that's going to come out of the United States Congress, it can't ignore oral health with the Affordable Care Act, the way

that the American Healthcare Act is in whatever direction it's in now is quite likely going to do.

It's up to you folks to help bring that in from the patient's perspective, because you're the one who's going to pay the price for all this, both in health and in financial cost. I'm going to get off my soapbox now. Any concluding remarks? Anything to do with what we've talked about: inflammation, rheumatoid


arthritis, the link with periodontal disease. We've covered that very interestingly and comprehensively. Do you have anything else you want to add, Susan?

Susan: Not really. I think that often, this is just about awareness and even thinking

about it. Remember to think about it, and ask for the test. Also remember that this is a lifelong process. Oral and gut microbiome health is lifestyle. So food

first; that's how we'll end. Scott: That's good. That's it. That's a good way to end. Folks, we've been talking with

Dr. Susan Blum, founder of the Blum Center and author of the brand new book, Healing Arthritis, in addition to her previous books. Susan Blum, thank you so much for joining us here on the Functional Oral Health Summit. It's been a

pleasure speaking with you. Susan: Thank you so much for having me. For those of you who are interested in finding

out more about what we're up to, I'm always doing a million things, but I have a

really robust online program at www.blumhealthmd.com. We have simple programs to help you heal arthritis and treat your gut. So you can find out really everything about me there.

Scott: Excellent! We'll have all that information of course for our Summit listeners and

viewers on the www.functionaloralhealthsummit.com website. Thank you, Susan.

Susan: Thank you.

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Heal Your Rheumatoid Arthritis by Healing Your Gums · Heal Your Your Gums Speaker: The information provided in this presentation is for educational and informational purposes only