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In this episode, you will learn about the numerous contributors to conditions associated with brain inflammation.

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About My Guest

My guest for this episode is Dr. Kenneth Bock.  As a leader in integrative medicine, Kenneth Bock, MD has accumulated over 35 years of experience diagnosing the root cause of chronic illnesses and restoring balance to his patients’ immune systems.  He founded Bock Integrative Medicine in response to the increasing need for board-certified medical providers who take a unique “whole body” approach to diagnosing and treating chronic illness.  Dr. Bock is a well-respected integrative medicine doctor and autism expert who focuses on the treatment of autism and co-occurring conditions, PANS/PANDAS, Infection-Triggered Autoimmune Brain Inflammation, tick-borne illnesses, and adult conditions such as Chronic Fatigue Syndrome, Fibromyalgia, and heart disease.  He integrates alternative modalities with conventional medicine into a comprehensive integrative medicine practice.  His natural curiosity and expertise in working with medical problems that have been difficult to diagnose and treat make him sought after by patients throughout the world as an expert at tackling complex medical problems.

Key Takeaways

  • How often do psychiatric conditions find themselves rooted in underlying biological factors such as infections and environmental toxicants?
  • What is Infection-Triggered Autoimmune Brain Inflammation (ITABI)?
  • What is Mood Dysregulation Spectrum and the symptoms that may present?
  • What are some of the common nutrient deficiencies observed?
  • How can immune tolerance be improved?
  • Is it the bug or the host response that makes the disease?
  • What are the common infections seen in ITABI?
  • What tools can be helpful in quenching the fire of inflammation?
  • What role do Th1, Th2, Th17, and Treg cells play?
  • How can intestinal barrier function be improved?
  • What role does the vagus nerve play in healing?
  • How are the underlying triggers for PANS or ITABI identified?
  • Can CBD be helpful for neuroinflammation?
  • Is IVIG a helpful tool in children with ITABI?
  • Which Lyme-associated microbe is the hardest to treat?
  • Does mold exposure in water-damaged building play a role?
  • What is the role of evaluating and supporting mitochondrial function in ITABI recovery?

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Interview Date

September 29, 2021


Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections. 

[00:00:01.20] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

[00:00:13.23] The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:34.08] Scott: Hello everyone, and welcome to episode number 153 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Kenneth Bock, and the topic of the show is Brain Inflamed.

As a leader in integrative medicine, Dr. Kenneth Bock has accumulated over 35 years of experience diagnosing the root cause of chronic illnesses and restoring balance to his patients' immune systems.

He founded Bock Integrative Medicine in response to the increasing need for board-certified medical providers who take a unique whole-body approach to diagnosing and treating chronic illness.

Dr. Bock is a well-respected integrated medicine doctor and autism expert who focuses on the treatment of autism and co-occurring conditions, PANS/PANDAS, Infection-Triggered Autoimmune Brain Inflammation, tick-borne illnesses, and adult conditions such as Chronic Fatigue Syndrome, Fibromyalgia, and heart disease.

He integrates alternative modalities with conventional medicine into a comprehensive integrative medicine practice. His natural curiosity and expertise in working with medical problems that have been difficult to diagnose and treat make him sought after by patients throughout the world as an expert at tackling complex medical problems.

And now, my interview with Dr. Kenneth Bock.

I met Dr. Bock over a decade ago at several medical conferences, very excited to have him on the podcast today to talk about his latest book; “Brain Inflamed: Uncovering the Hidden Causes of Anxiety, Depression, and Other Mood Disorders in Adolescents and Teens”. Thanks for being here, Dr. Bock. 

[00:02:15.07] Dr. Bock: My pleasure.

[00:02:16.08] Scott: So many children today are labeled as having a psychiatric condition, given numerous psychotropic medications.

Do you think that most of these conditions are rooted in the mental, emotional realm? Or are there often underlying biological factors like infections, environmental toxicants that maybe are driving inflammation, which then presents with psychiatric symptoms?

[00:02:42.10] Dr. Bock: Yes. I would say I think it's much more than recognized. We're seeing it a lot more. I mean, there are a lot of psychosocial factors that are really pressuring kids, and I think causing anxiety/depression the way that the environments we live in, the drive for perfection, the New York City.

I love New York City; I live upstate New York. But the whole thing of people, almost before conception, but certainly when kids are infants and toddlers, and before they go getting interviewed for pre-school, getting tutored for pre-schools, I mean everything. I mean, the concept of getting tested and interviewed and tooted for pre-school blows my mind.

And it just goes to show you the kind of things that kids are going through; everything is structured. When I was a kid, we used to just hang out, and come home from school, and get your homework done quick.

And play ball, and hang out with your friends and play a ring, now everything is teams, travel teams, everything is a lesson, everything is moving, trying to move you forward. And I think kids need to screw off a bit quite frankly and just be kids.

And I think we are taking some of the childhood away. And then, as you get older, of course, with the internet and the texting and the FOMO, and the and the bullying, I do think it's a different world. So there's a lot of psychosocial stuff, and of course COVID, the pandemic, induced isolation and anxiety, and depression.

But on the other hand, the environment is changing too, and the environment is much more toxic. With the pesticides and plasticizers and all the chemicals, that I think there is a reality about environmental factors coupled with genetic predispositions. So that I do think all the tick-borne infections that don't get appreciated, a lot of the Mycoplasma, even Strep that can have influences on neuropsych symptoms, I'm sure we'll talk more about that either directly or indirectly via the like kind of a reactivated immune system or an activated immune system.

So the key that I wanted to get across in Brain Inflamed was not that there are not psychosocial causes. In other words, sometimes anxiety and sometimes a panic disorder is just that anxiety and a panic disorder. Teenager loses a boyfriend or girlfriend; a parent dies, that's going to throw people over.

I mean, inflammation may be involved, don't get me wrong, because stress, acute intense stress, and chronic stress does create inflammation. So the whole idea of inflammation is real. But in terms of the other underlying things, I think we don't want to lose sight of that.

Because a lot of these kids with mood dysregulation, with the rages, and the aggression that can be things like Lyme or Bartonella or even part of the whole PANS/PANDAS, we'll talk about all these things. And the biggest point if you miss them, and just say they're psychosocial and treat them with psych meds and therapy, they'll never really get well, and you may relegate them to a life of meds and therapy and institutions, and what have you, so that's the key.

So I never want anybody to say I'm a big believer in not; anything is one thing. In other words, so like this whole thing of protocols that people told me. I don't have a protocol for treating this out of that; I treat it each person individual work them up figure it out.

And it's the same thing; not everything is going to be inflammation, not everything is going to be Lyme disease or Bartonella. But there are some people get caught up in that.

And so I want I always like to make sure that people understand that these things are very important, and there are clues as you probably if you read I talked about in the book clues, that may make you think that there is some pathophysiological underpinning. But I do not want to have anybody ever say that there's not just sometimes depression related to what have you. Is that clear?

[00:07:20.27] Scott: Yes, absolutely, that's perfect. In the book, you talk about some of these connections that are possible; you talk about OCD and tics potentially being associated with Strep, depression with thyroid dysfunction, anxiety and fatigue with adrenal issues, agitation possibly related to pinworms, ODD or Oppositional Defiant Disorder or panic attacks or rage related to as you pointed out Borrelia and Bartonella.

Many of these psychiatric presentations that can be related to even allergies or gluten sensitivity, and several other connections that you really make in the book that many practitioners probably don't explore very deeply and can very easily miss.

I've had other guests talk about PANS and PANDAS; you've termed ITABI or Infection-Triggered Autoimmune Brain Inflammation that can explain a lot of these symptoms, mood disorders, OCD, tics, impaired writing ability interestingly, incontinence, eating disorders, meltdowns, a long list of potential symptoms. So talk to us about ITABI, how is ITABI different from PANS or PANDAS, or even autoimmune encephalitis.

[00:08:33.14] Dr. Bock: It's really not. It's really just a name that I coined because I think it really explains it. And I also wanted to take it out of the realm of sometimes the controversial.

For some reason, PANS and PANDAS elicit some controversy in some medical circles, which is unfortunate because there's so much literature and increasing literature supporting both of those entities.

Autoimmune encephalitis is an accepted entity in medicine for sure; although thought to be pretty rare, I think it's probably getting to be more common with this whole idea of brain inflammation. So ITABI, as I say, ITABI, that's really like autoimmune encephalitis, because autoimmune brain inflammation is really brain inflammation is encephalitis, that's what whenever in medicine we put itis after a name, dermatitis, inflammation of the skin.

So encephalitis inflammation of the brain, colitis information of the colon. So for laypeople in the book, I didn't want to say encephalitis; I wanted to make it more understandable. And infection triggered is really what it is most of the time. I mean can be other things that can trigger it, yes. But most frequently, what I was referring to is infection triggered, and PANS and PANDAS doesn't really have that; it has been associated with Strep.

PANS doesn't have that. And so I mean, both of them are fine, but I felt like I wanted to describe it as what I really felt it was and take it away from the quote controversial. Unfortunately, it shouldn't be controversial. But that's why I did it, just to try to have a self-explanatory.

[00:10:15.24] Scott: What is different about our world today that is leading to so many children struggling with these conditions that share an overlap of brain inflammation and autoimmunity? Why are we seeing so much more of this now?

[00:10:29.00] Dr. Bock: I think it's really environmental. I think partly it may not have been recognized prior as much. I mean, pandas was described first really 1998 by Sue Swedo and colleagues. But I really think our immune systems are getting skewed by toxicants skew the immune system. Hey, let's go back right to the beginning; C-sections skew the immune system, and I talk about it in the book, as you know.

So maternal stress, just my last patient before I got on this thing, was a mother who gave birth one that the kid…dealing with anxiety, OCD, etc. And during her pregnancy, there's a lot of marital discord, eventually resulting in divorce.

And there's a lot of maternal stress; maternal stress can have implications far from just from during gestation into the future. And then C-section, of course, one of the things that's very important is for an infant to go through the mother's birth canal, hopefully, get populated with good intestinal bacteria from the vagina.

So good vaginal bacteria, which is related to the intestine. And hopefully, that's healthy bacteria. It's not always healthy, unfortunately, but hopefully, it is. And so that bacteria very quickly start educating the immune system in the proper way. And that's what's supposed to happen in terms of developing a healthy immune system.

Well, if you get a C-section, what's the first bacteria that this infant or neonate sees? It's bacteria in the OR; it's bacteria on the skin of one of the people at the C-section etc. And so, all of a sudden, right from the start, you get an altered flora. And that can alter the trajectory in the course of wellness, illness for years and years.

So I'm big - listen C-sections are important and certain times no question. However, I do think our C-section rate is higher than many, and I think it's not good, and I am a believer that kids right from the get-go need to be populated with bacteria.

So what they're starting to do, I have to say which I like is they're starting to take a swab of the mother's vaginal secretions, and put it in the child's mouth, so trying to get some good bacteria or hopefully, healthy microbiome right away. Hopefully, the mother didn't have antibiotics right away for Group B Strep, which can alter things for the mother and the kid.

And then, I believe in giving infant and toddler probiotics. So for kids with C-sections, I think they should start on healthy probiotics and prebiotics right away. So that's the microbiome. I mean, I spend a whole chapter in the microbiome; it's so important to health, it's so important to the maturation and development of the brain, and the brain's immune system, the microglia, they're very closely connected.

So the microbiome needs to be attended to. And like I said, a C-section puts you at a disadvantage. You can't imagine how many kids have been C-section when I asked their mothers how they were delivered. And I do think it tends to skew the immune system to a more allergic-type, a more hyper-reactive type of immune system, yes.

[00:14:03.10] Scott: In the book, you talk about the mood dysregulation spectrum. And so, I'm wondering if you can talk about some of the symptoms that a child on the lesser impaired end of this spectrum might present with, contrasting that with a more impaired child.

And how do these then overlap with someone that might have Lyme disease or brain inflammation from molecular mimicry to strep or other microbes? Is there an overlap between those?

[00:14:28.15] Dr. Bock: First of all, they can look the same; that's what gets complicated. And that's why you have to do the appropriate workups and use clinical judgment. I always tell parents who bring someone in, who are doing very intelligent, they're very determined, they're doing a lot of research.

But I frequently say to a mother or father, and frequently it's the mothers that are driving this, the fathers I think are out there working trying to support, because it does take funds to try to do some of these investigations and treatments.

Whichever parent it is, I'll say you guys have an N of one, the N of one being their one child. So they can do all this research and try to apply it to their child. I say I might say I have an N of thousands, and what that does is helps me, gives me perspective, helps give me a sense of clinically when I do an in-depth history, I spend an hour and a half, maybe even more with a new patient, that's especially the complicated ones.

So gives me a sense of okay; where do they fit? Where may I be, what directions may I be going in? And then, of course, what directions are avenues to take in evaluations and treatment based on their specific history, and also a knowledge of, good knowledge base of thousands of kids.

So there is a lot of overlap, so some of the symptoms, and I made that mood dysregulation spectrum that is also a term I coined, I happen to. Because I started seeing autistic kids, probably. I saw a few in the mid-90s, but after 1998 was when really I gave a lecture at a conference, I wasn't known in the autism community, I'll never forget this, I was put on the schedule five o'clock the last speaker for half an hour.

So I think, oh, they didn't know me, I said I figured there they'd heard of my work with the immune system, I was researching transfer factors and autism as they heard the work. And so I figured most people would be either leaving or to the bar or whatever it didn't turn out that way, there's still a lot of people in the audience.

And I give a very scientific lecture, and they were the organizations of the conference, and the attendees were very impressed, and all of a sudden, because of my integrative medicine approach, they started bringing the kids to me.

And because I had results probably more than most were getting because of the approach, the word got around, and they started just basically swarming my office from all over the country. And of course, eventually all over the world. And so, there are thousands of kids in the spectrum.

But as I saw those thousands of kids over the course of a decade or a little more, the parents also started asking me about the other siblings. And the other siblings not being autistic but being neurotypical with mood disorders. Either with anxiety, depression, mood swings, mood instability, rages, what have you.

And so I started to take care of them, or lo and behold, I saw the same approaches really were effective. And that's when I realized I'm dealing with here a mood dysregulation spectrum. It's not the same; it is as autism spectrum.

But of course, the autism spectrum does, is there's very low functioning and very high functioning autism spectrum, used to call high functioning Asperger's. Where they had language, but they had social issues, they were quirky, same thing with mood dysregulation spectrum.

There's the moodiness and irrITABIlity that can be part of what we call teenage items, just being a teenager. And there's also, it can progress then anxiety, depression, OCD, panic attacks. And of course, then entering into the more serious realms of really severe mood swings, with rages, aggression, sometimes they can be homicidal, sometimes self-injury or suicidal and even psychosis, even psychotics. So these intrusive thoughts with OCD, you can have visual hallucinations, auditory hallucinations.

So when I try to graph it and one of the things I tried to do is we made the BrainInflamed.com website, so people can get a template of the mood dysregulation spectrum. And actually kind of almost draw it in themselves, try to compare it to some templates of the disorders I've drawn.

They're not exact; they're not the same. It just gives an idea like there may be, like let's say thyroid disorders, that may not be frankly hypothyroid, but may be functionally hypothyroid. In other words, it may be much more depression, maybe a little anxiety, but much more depression.

Wherewith the whole ITABI, PANS, PANDAS you can have mild to moderate where it's going to be more anxiety, OCD, in addition to tic disorders which are not on the spectrum, because it's neurologic. And panic attacks, perhaps.

To the more severe ITABI, where you have these intense mood swings with rages and aggression and even psychosis. And there are, of course, overlaps, same thing with Lyme and Bartonella. So they can look the same, some of it's to the degree, some of it's like with adrenal dysfunction that you mentioned in low blood sugar, it's probably made a lot more anxiety and panic attacks than it's going to be the rages and the psychosis.

So you can get a sense of it, and the moodiness and irrITABIlity may be higher in the low blood sugar. So I think it's just to give people a sense of where they may fit and what avenues they may want to pursue. It's not by far not exact because it can really vary.

But I think it's been helpful, and then you can graph your kids as you go through a month, two months, three months and see if the curves are getting smaller; that means that they're getting better, which is hopefully what we see with the various treatment modalities that we use.

[00:20:44.22] Scott: We know that the number of children with autism is about 1 in 54; some predict 1 in 2 by the year 2032. What percentage of children today fall onto this spectrum of conditions associated with brain inflammation?

[00:21:00.05] Dr. Bock: You know I can't give you percentages because I'm not good at that. I do think that I could say it's a lot, and it's increasing, because there are so many kids, I mean millions of kids affected by anxiety and depression. I have a slide; anxiety is the most prevalent, and then there's depression; autism spectrum disorders are obviously less than that.

But worldwide, they're millions; I don't have enough in my head; I think it was 250 some million. I mean, it's very high. One-third of all adolescents will be affected by anxiety over some course of their life. So that's very high. So although I can't give you a percentage, I can tell you that it's, and it seems to be increasing, there's no question about that.

[00:21:54.10] Scott: You talk about many factors in the book that impact our immune systems; those could be genetics or nutrition, allergies, hormones like adrenals and thyroid, environmental toxicants, infections, and those psychosocial factors that we talked about earlier.

How much of a role do genetics seem to play in these conditions, as compared to the epigenetic influencers? In other words, can we blame it all on genetics?

[00:22:22.00] Dr. Bock: Well, obviously we can't, because as we say, genetics load the gun, and environment pulls the trigger.

There's no such thing as genetic epidemics, and certainly autism spectrum disorders is an epidemic over the last several decades, to go from one point in in the 60s, 70s maybe, 1 in 5000, 1 in 2500, and then it kept on going.

And I have slides of that to show, it's 1 in 500 and 1 in 167 and kept on going up to now where people say 1 in 54, 1 in 46 whatever, like two, almost 2.2 percent or something that's crazy, that's an epidemic. It just doesn't happen with genetics.

But I do think genetic predisposition is important; that's why I put it at the base of that immune kettle. And sometimes, when that genetic predisposition is really playing a role, it actually occupies a larger place in the immune kettle.

But I think it's the overriding other levels in that kettle that are what throws a lot of kids over. I mean, obviously, you can have a genetic syndrome, and part of that genetic syndrome could be autism. But that's just a very small percentage, and I think people have been very involved with genetics, and I think it's good to know. But most of the kids we see, and I just saw a kid with genetics, that I tell them, if there's a genetic, significant genetic defect, then that's probably going to lower our ceiling of where we can get to.

You know what I mean? Because genetics are real. But most of the time, what we do in my field is nutritional modulation of genetic expression because we can modulate the expression of genetics and especially the epigenetic factors.

So you're right, those are probably to me the most important with all these things. And what are those factors? You're just what you said; you're talking about toxicants, you're talking about infections, you're talking about allergy sensitivities, nutritional deficiencies, and imbalances and insufficiencies and hormonal imbalances, and of course, immunological imbalances, which are really key, which are related to a lot of the other things.

So I would have to emphasize those because those are number one things I can do something about and really help people. You can't do that, you can't affect the genetics, you can affect genetic expression, you can affect epigenetic factors, and obviously, for me, I like to focus on the things that I can help kids.

[00:25:10.24] Scott: So let's talk then a little bit more about nutrition and diet. Is it more that we are deficient, and that results in not having a nutrient-dense diet? Or is it more that the foods that are being consumed are triggering inflammation?

Or is it a combination of both triggering inflammation and not having enough nutrient density? And then what are some of the more common nutritional deficiencies that you see in your patients?

[00:25:36.03] Dr. Bock: So, the questions you ask actually are, like I particularly want to say both or all of the above. I mean, it is the fact that a lot of the typical American diet is called SAD for a reason, the standard American diet.

It's definitely not nutrient-dense; it's nutrient insufficient or deficient. So that's the ones loaded with sugar, and sugar has implications for behavior as well as the immune system. And also, things have over the years, like I was talking with a GI doctor the other day, and we both agree.

Like our systems were not made actually to digest any gluten. You go back years and years and years; we were hunter and gatherers. That's eating berries and fruits and vegetables and meats, let's say, right? Or fish. And it's only relatively new that we started having the production of all these grains, and I think that was to try to probably enhance storage of energy for larger, maybe forays into the woods or whatever.

It was as you got, for more carbohydrates for energy. But the truth is I don't think in a lot of ways we were really equipped to deal with it. And especially the gluten that's been changed over the years. Like I do think there's a difference between flour in Europe and flour here.

Because there's a lot of people who say it, I know even myself; I mean, I'm gluten-free. And I love Italy, I travel in Europe, and I am gluten-free. But if I would somehow mistakenly get a little gluten, it wouldn't affect me like it would here.

And I think the flour's are different. I think maybe all the pesticides here and things like that, maybe GMOs or what have you. But the point being is I think all that, for example, and if you have a diet of kids, it was basically all flour and dairy, and very little greens.

So very little nutrients, not eating vegetables and salads, and maybe eating maybe some high sugar fruits and certainly a lot of cereals with colorings and additives. All that stuff plays a role in what's happening to these kids. And so, I think nutrition is always the backbone of a foundation in terms of moving forward, in terms of treatment modalities.

[00:28:11.17] Scott: And are there certain nutritional deficiencies that you commonly see as a pattern in the children that you work with? 

[00:28:17.29] Dr. Bock: Yes, there are some, they vary obviously because it's not everybody's the same. But I would have to say frequently magnesium, frequently zinc, and then various of the B vitamins that depends.

We test for that; I like to do some organic, urine organic acid testing. I don't like to do static nutritional levels because those are usually be “okay”. But I like to look at the more functional consequences of a nutrient deficiency or insufficiency.

I say insufficiency because they're not always frankly deficient, but there are people who have greater needs for certain nutrients based on the genetics, maybe based on their exposures, and so you can be not frankly deficient, and so, therefore, you're told by another practitioner or somebody nutritionist or your physician that you're fine, when you're at the bottom of the normal because you're still in the normal range. But the reality is for that person, that may be nutritionally insufficient.

And by getting a more functional test, like a urine organic acids test. We can look at various metabolic processes based on various enzymes, and those enzymes have cofactors that are nutrients. They can be vitamins such as vitamin B12, B6, vitamin B2.

They can be minerals like zinc, magnesium, selenium. And I would say when I look at all those, it's very frequently you see magnesium issues, zinc issues, iodine, a lot of people are low in iodine, and iodine, of course, is important for the thyroid.

So there's a lot of low thyroid out there that is under-recognized, and then the vitamins as well. And so we do a lot with methyl B12 with kids, and methylfolate, because we look at things that look at functional needs for them, as well as autoimmunity.

We look at anti-cerebral folate receptors. So we look at these more functional indicators, and a lot of times, you'll see them, so it can help me target my nutrients. And I like to do it in a scientifically based way. I mean, a lot of times, I do it clinically as well, because vitamin D, I don't want to forget, I said all the others.

Vitamin D is low in so many of the kids, or very low normal, which we call insufficient. So the normal range is 30 to 100, you'll see a lot in the 20s, some in the teens, I just saw somebody that was eight, and then maybe 34-32, which would said to be normal. But I like the kids to be 50-60 higher. Vitamin D is very important, not only for calcium status but for immune regulation and inflammation. 

[00:31:05.22] Scott: When we look at allergies and sensitivities, why is there such an issue today with these? Is it that we've lost our immune tolerance? You touched on this a little bit earlier.

And then is it this hyper-vigilant immune response, is that a major contributor to the inflammation that's driving a lot of the symptoms, a lot of these conditions. And then, what are some of the tools that you find helpful for increasing immune tolerance?

[00:31:30.14] Dr. Bock: So yes, I think hyper-vigilance is a very good word, immune hyperreactivity, loss of immune tolerance, that is a biggie. I mean, people probably never think about this, and if they do want to learn more, I mean, I do write a bunch.

But there's a whole chapter in the immune system in Brain Inflamed that I try to break it down as simple as I can. And many people have said it's helped them because I tried to simplify it.

But immune tolerance, just think about this. I mean, basically, we shovel all kinds of stuff in our gullets, in our mouth every day; I mean all kinds of junk, right? It goes down the esophagus, go through the pharynx, the esophagus into the stomach and then the intestines, and then eventually the colon.

Now we have to figure out; we want to digest this, we want to break it down, we want to assimilate it and absorb it assimilate it in the body. Well, our immune system 75% of which, around 75%, 70-75% lies right under that thin layer of epithelium of our guts, right?

And so you might say, well, why does so much of the immune system reside there? And we've got all these other parts of our body. It's because it's so crucial for us to figure out what's coming in, is it friend? Is it foe? Is it just benign, and we can ignore it? Because that is, and it's going on like constantly, and it's going on like in not seconds, but fractions, like it's so fast.

I mean, it blows my mind that it works so well, really. You've got to be making these decisions. You have secretary IgA, which basically is kind of one of the immune globulins that secreted that kind of coach the mucosa, that tries to keep it safe, so to speak.

But you have to be able to bring these tiny particles into contact with the immune system and have them say recognize that oh, this is okay, this is not. And it's a very fine and precise process. Like I said, it's amazing how it works so well.

There are lots of immune messenger molecules, so there's a lot of conversation between the immune cells as well as between immune cells and the hormonal system, and the nervous system. But the fact of immune tolerance is allowing us to tolerate that which we should tolerate; we should be able to tolerate an egg.

We literally should also be able to tolerate wheat or dairy; it would be nice. The problem is it's easier to understand maybe intolerance of grass, so somehow grass, somebody cuts the grass, and you get all congested, and your eyes are water. And we should be tolerant of that as well, but okay, that's a more classic allergy.

But we need to have this immune tolerance to so many of the things we encounter. And when we lose that immune tolerance to something like, let's say, an egg, all of a sudden we eat an egg, and that it can not only cause eczema or congestion or asthma, but it can cause hyperactivity.

I mean, I remember Doris Rapp, an allergist many years ago, had this great video of a kid eating an egg. I like eggs; eggs are healthy, eggs have been maligned. And for me, I think eggs are healthiest when you don't break the yolk and scramble it or make it an omelet.

When you keep the yolk intact, it's the healthiest. But be that as it may, eggs themselves are nice inexpensive source of good protein. And yet, if you're intolerant of an egg, I saw this video way back when I was younger, and this kid went really ballistic hyperactive, and somebody said, how could that be from an egg? Well, foods can be very powerful.

And so I've had people where I've done, I've diagnosed a corn allergy. Now corn is basically in everything. And this was another kid who had mood dysregulation with kind of rages and hyperactivity. We diagnosed the corn allergy in the office because we do some skin testing in the office, as well as IgE RAST blood testing.

And sure enough, took a person off the corn, and the hyperactivity, and that mood dysregulation, rages improved so much, just by getting rid of corn. Now that's not easy, because it's in everything. I'm not just talking about corn on the cob.

But I think the point that I want to get across is it's the nutrients in the food that are very important because those nutrients support a healthy immune system. Things like vitamin D are so essential. But it's also the promoting this immune tolerance; then we can get into more about what Tregs, Tregs are the key to that. 

[00:36:25.05] Scott: So let's continue then the immunotolerance conversation, talking about microbes. So we know that we talked already about strep and Borrelia and Bartonella and how they can play a role in many of these conditions.

Are the infections themselves the problem? Or is it the host response, the loss of immune tolerance, the lack of integration within our microbiome is that what is creating the problems that many people are currently facing? And what are some of the more common infections that you see in children that are driving these conditions?

[00:36:58.27] Dr. Bock: Well, the microbiome is important for maintaining immune balance in the meantime; it's very important. Because also, the microbiome helps to maintain the integrity of the intestinal lining, the epithelium.

So we talk about sometimes a leaky gut or intestinal hyperpermeability; you don't want that. The intestine is your first barrier; even before the immune system, the epithelium is a barrier, and just like your skin is a barrier.

So you want to keep things out; that is another way of in some way of keeping foreign invaders or things that can cause mischief out. And the microbiome is very important. it's interplay with the intestinal epithelium and the immune system below it to maintaining immune balance and the integrity of the lining.

So yes, microbiome is really at the root of so much, and it starts early. The microbiomes effect on the immune system, and the brain starts in gestation, goes through infancy; it's very important for the maturation of the microglia and the maintenance of the microglia.

Microglia, the brain's immune cells, that work along with the neurons and the astrocytes in the brain. So oh yes, there are studies, articles that discuss this, and it's very important. So the microbiome is like, is a foundational piece, and the microbiome is disrupted with the C-section.

And the microbiome is disrupted with early antibiotics, especially early antibiotics when the woman's got group B Strep. So, she gets antibiotics right away, or she has sinusitis or whatever infections and was given antibiotics during pregnancy.

And then the child maybe has a little bit of a fever, or to keep me rapid breathing. So they're put in the NICU, and maybe they get a sepsis workup. And what happens then? They check blood cultures and maybe sometimes a spinal tap.

But also give them prophylactic antibiotics for a few days. So right away, we are affecting the microbiome of those kids, and that has implications for immune tolerance and immune balance years later, unfortunately.

[00:39:08.29] Scott: So am I understanding correctly that in some cases where we're dealing maybe with strep or Bartonella or Borrelia, that it's not always that the symptoms are from the bug itself, that in some people, the symptoms are also that host interplay or the interaction of the immune system with those bugs coming back to that hypervigilance, thinking about autoimmunity. Is that often the driver of some of the symptoms rather than just the bug itself?

[00:39:35.15] Dr. Bock: Yes, so that you have to be aware of that because that is very true in some patients; sometimes it just is Lyme or Bartonella. I mean, you treat the infection, they get better. Now, of course, Lyme early on can even suppress the immune system, so it's very complicated.

Because sometimes, later on, it drives immune hyperactivity, but early on, it may suppress the immune system, in which case the immune system can't get rid of it; that's a complicated variable. But yes, so I think the key is, and that's why this is so complicated, and I try to simplify it, is that infections can cause symptoms.

But infections can activate the immune system, and sometimes by activating the immune system, it causes a misdirected immune response. This is something that Susan Swedo called it with Strep basically, she called the immune response to the Strep and then getting to the brain, responding to the brain and causing inflammation in the basal ganglia, and misdirected immune response, yes that's molecular mimicry.

Where your immune system will take the strep, but the same thing could be for Lyme and Bartonella, let's take the strep, which is the most classic; your immune system sees the strep. Sees a tiny piece of the strep, it's called an epitope, so it's not even a whole protein; it's epitope, it's like a little tiny peptide, right?

So it mounts a response to that in the strep; well, unfortunately, there's a part piece of the basal ganglia that looks just like that epitope of the strep. So the immune system sees that it believes it's going after the strep; it's not; it's going after the basal ganglia.

Basal ganglia in the brain is in the lower part of the brain, and it's involved with emotions and movement, i.e., tics, OCD, anxiety, right? And so you have their immune dysregulation is what I would call it immune dysregulation.

And the same thing can happen Lyme and Bart, okay. But we don't really know; we don't always know where the symptoms from the infections and in the autoimmunity begin. In the beginning stages, it's probably just all infection, and you treat with antibiotics hopefully long enough, and the right ones, and you can get rid of it. But later on, I call it the conundrum. You don't know if it's one or the other, and probably frequently, it's both. And what further complicates the issue is that when you kill the Lyme or Bartonella, you can kill them.

But if the immune system doesn't do a Yaman's job in terms of clearing them, you can still have pieces of them which may be antigenic, which means they can elicit immune responses even if they're not alive. So even though somebody said, oh, you got the infection, you treated them long enough, when potentially there's still antigenic material there that is driving an immune response, and that's where things like detox can come in, and immune modulators.

So you modulate the immune system to quiet that over-reactive immune response, and hopefully try to do some detox to try to help the system clear itself of these remnants. And so this is where the science can be, and not this like, that sometimes, unfortunately, there are conventional doctors look at detox and like think of it as voodoo. Well, there is, in the later stages of Lyme and Barton, other illnesses; I mean, detox is very important.

[00:43:12.17] Scott: Let's talk a little bit more about the connection between psychiatric symptoms and neuroinflammation. Is it true that anti-inflammatories for some people can work better than anti-anxiety medications or antidepressants? And then, what are some of the tools that we can use to quench the fire of inflammation?

[00:43:32.29] Dr. Bock: So yes, very good question. And sometimes, anti-inflammatories can be excellent on their own. But frequently, they're adjunctive. In other words, so if there's an infection, you need the antimicrobials, whether they be antibiotics or herbal antimicrobials or antifungals or antivirals, depending on what the infection is.

And likewise, even with depression, anxiety, I'll take depression; the kids that we see with this Infection Triggered Autoimmune Brain Inflammation frequently don't respond great to SSRIs, the Prozacs, the Zolotfts, the Celexas, the Lexapros. Some of them do, or some of them just a little bit, but not fully.

I mean classically, in these things, even CBT which is cognitive behavioral therapy and other types of therapies in the midst, you may get some response, but it's not full, it's not adequate. Sometimes you don't get any. So I use Celebrex Celecoxib; you can use ibuprofen, except ibuprofen is in every eight-hour drug or every six hours, but we usually use it every eight hours. Whereas Celebrex is a every 12 hours or twice a day, much easier to do, and it's also a selective COX-2. So it's a little safer for the stomach because any of them can have side effects.

But it can really help sometimes by itself, but frequently with, potentially if they were on an SSRI, maybe it'll make it work better and the same thing with antibiotics. So it's not either-or, and sometimes it's a huge, doesn't always work, or you can give you a little bit, but sometimes it is really huge. And there are studies clearly that say it can really augment the response to an SSRI, just like methylfolate.

Methylfolate we use the pure methylfolate; there are prescription drugs out there that are higher dose methylfolate we like to use it in the pure form. But you're not talking about one milligram; you're talking about seven and a half or 15 milligrams.

The study is saying that methylfolate probably because of genetic predispositions, that the MTHFR, let's say polymorphisms mutations where methylfolate can also augment the response of an antidepressant. So I think it's important to recognize it's not either-or. So that's pharmaceutical anti-inflammatories like Celebrex or Ibuprofen or Naprosyn.

There are nutraceutical anti-inflammatories that we use a lot that are very helpful, and then I much rather give them if we can, so you can avoid the non-steroidal anti-inflammatories because they can have effects on the stomach. In older people, they can affect the kidneys.

But if somebody's well hydrated and they're young, they usually don't have any problem with the kidneys. So it's more of the stomach that we worry about. So things like Curcumin, which is the extract from the spice turmeric, it's that nice beautiful yellow.

That's one of the best natural anti-inflammatories there are. It really inhibits; I have a slide that shows inhibiting four different inflammatory pathways, including the NF kappa beta. It decreases the Th17, which is an inflammatory autoimmune type T helper cell, and it enhances Tregs.  Tregs are those, t-help, T-helper cells are divided into four different types, T helper 1, T helper 2, Tregs and Th-17 and t-helper 17. And without getting too deep into the weeds about it, Th2 is more involved with allergies and potentially more extracellular infections, but more allergies.

Th1 is involved with the viral infections, yeast infections, cancer, Th17 is involved with inflammation and autoimmunity. And when I say inflammation, there is a healthy inflammation early on. If you cut yourself, that initial inflammation is fighting infection, fighting to heal. It's only when it doesn't work, and it's chronic inflammation, or it's way too much inflammation we have problems. But there's that balance between inflammation by itself is not bad; it's when inflammation becomes pathogenic when it's too intense, too overwhelming, or too prolonged.

And the Tregs are those t-helper cells that help bring the immune reaction that is stimulated by these other T helper cells into balance. it helps balance Th1, Th2; it helps balance Th17. So Tregs are crucial, and Tregs are affected by chemicals BPA and various other chemicals, so that's the influence of the environment on Tregs which are so important.

Tregs will help keep the microglia regulated, whereas Th17 can be inflammatory and produce all these inflammatory messenger molecules. Th17 can disrupt the blood-brain barrier and let the inflammatory mediators in. So Tregs have a crucial role in bringing, whenever there's an infection, the immune system gets up-regulated or activated.

It's the role of Tregs once it's under control to bring it back into balance. Same thing with viral infections, Hepatitis, Epstein-Barr. If you don't have an adequate response to balance the initial response, you can get into more chronic types of immune dysregulation, chronic Epstein-Barr reactivation, etc. So I would say curcumin, resveratrol, vitamin D, these are all anti; Omega-3 essential fatty acids. All of these are anti-inflammatory, good anti-inflammatories.

So as nutrients, and then taking away the things that may be inflammatory, things like gluten and dairy in some individuals will be inflammatory. So it's almost like, it's like if you look at your net income, you get a certain income, and you have certain expenses. Well, obviously, if you increase your income, you most likely increase your net income.

But if you decrease your expenses, you can also increase your net income, without even increasing your income by decreasing this. The same thing here is in the immune system if we can somehow decrease the inflammation in there as well.

Even if we want to obviously increase what's coming in, but if we can decrease the inflammation coming in from infections, what have you? But if we can enhance our anti-inflammatory mechanisms, we can be almost on that expense, that we can actually do it. So it's important to recognize that even if you didn't know the cause at first, you can start to do some things to quiet inflammation.

Obviously, our goal is always to find the root causes of the inflammation as much as we can. And then remediate them.

[00:51:09.24] Scott: So if we talk a little bit more about Th1, Th2 in the kids that you work with. Would you say that it's common to see a Th2 dominance? And then other than curcumin, are there other tools that can help to increase T regulatory cells?

[00:51:25.13] Dr. Bock: So yes, frequently I think when I wrote the book preceding this, “Healing the New Childhood Epidemics: Autism, ADHD,  Asthma, and Allergies”, I talked a lot about a Th2 skewing, which is promoted by C-sections, which is promoted by chemicals. And also a lack of Tregs. So basically, yes, there is a Th2 skewing.

It pushes allergies, eczema, asthma that relates to that Th2 skewing. So you want to balance it out with Th1, but also really with Tregs to balance out that Th2 skewing. And you can do that again with diet by getting away from some of the things that may inflame it, like let's say if you can figure out food allergies, figure out inflammatory foods frequently, gluten and dairy and not only and other things, and nutrients like vitamin D.

Glutathione in the early stages has been shown to help there. Probiotics very important, so really good probiotics. Here's where I know, and this may be too much. But I always like people who know that the two things, nutrients that I think are the most important to get the highest grade, I mean I think you should always get high grade.

But if we had to break it down because I know the higher grade ones are more expensive, probiotics and fish oils are really key to get them at the highest grade. So don't try to save money on fish oils and probiotics; get the good ones because probiotics are not always what they seem to be; they may be said to be something when they went in the box. But when you take them out, they may be very different.

So we use actually these probiotics that are nitrogen packed in foil wrap, each one they don't even have to be refrigerated so that you know when you open it, it's what went into it. And the same thing with fish oils, they should be refrigerated, and they should be from companies that you know of that are high grade. No pesticides, no mercury, etc.

So that's where I don't want to belabor that point, but I think it's an important one for your listeners to know. I think there are a number of good labs out there that make probiotics. I just would say don't, and we usually a lot most of our eyes are not milk-based, because obviously a lot of the kids have dairy sensitivities. I just would emphasize without getting into names that they really should look at them, research them and be prepared to pay a few more bucks.

[00:54:03.13] Scott: And are you in the camp that in many of these kids, it's best to avoid probiotics that have Strep strains?

[00:54:09.12] Dr. Bock: That's a very good question, and it's not a simple one. I think theoretically, I understand my parents are very uptight about giving them a Strep strain. Usually, the Strep in a probiotic is Strep thermophilus; it's not beta-hemolytic group strep.

So it's very different. So most of our probiotics don't have them for that reason; one or two of them do have the Strep thermophilus. I haven't really seen a problem with that, but I know parents are very sensitive to it, so I usually use ones without it.

But just so you know, there's also a Strep salivarius, which we have it and it's put at night in the back of the throat. It's not meant to be swallowed. It's meant to be dissolved in the back of the throat and populate the throat with the Strep salivarius.

Which there were a number of studies from Italy shown this would keep out the bad group, a beta hemolytic Strep. So it was protective, and it was a Strep. So I think parents, I understand their fear, I acknowledge it, and I don't want to push Strep on them. But I think sometimes it's not as bad as they're worried about, but I understand it.

[00:55:18.19] Scott: We know that leaky gut can play a role in terms of being another contributor to leaky brain, to brain inflammation. So what are some of the tools that you like for improving intestinal barrier function?

Obviously, it also means eliminating those foods and things that might be triggering to the lining of the gastrointestinal tract. But what are some of the other tools that can help improve the barrier?

[00:55:41.20] Dr. Bock: Firstly, it's besides that which is key, the microbiome. So restoring and maintaining the microbiome with probiotics and prebiotics that feed the good bacteria. And then, of course, there are number of nutrients that help the intestinal lining and its integrity.

And it would be glutamine, we use aloe, zinc for especially even for the stomach, we use a GastroProtec, it's a zinc carnosine. And your anti-inflammatory nutrients. I mean, we will use certainly vitamin D, and we use some of the anti-inflammatory I just mentioned.

But I think the ones we really generally think of for the gut lining or glutamine, and some of them might have marshmallow, aloe in there. DGL for the upper and the microbiome being really key.

[00:56:45.13] Scott: Can strategies that support the vagus nerve and calm the nervous system bring benefit to these brain-inflamed kids? And then what can we do to get out of this sympathetic overdrive? And into more of a parasympathetic response that really supports rest, digest, detoxify and heal?

[00:57:04.10] Dr. Bock: Well yes, it's funny, because much you said that I was going to say for sure. The vagus nerve is probably it's a connection between the GI tract and the brain; it's the most direct. So I talked to you about the microbiome and the metabolites it produces, and then it eventually gets up to the brain and affects the microglia.

Well, the vagus nerve is the instantaneous connection between the gut and the brain, and that's why you get a gut feeling. That gut feeling is probably related to activation of the vagus nerve. It's so sudden; it's so quick. And obviously, there are a lot of other mediators; there are. I mean, I think it's 90; 95% of the serotonin is produced in the gut.

So the hormones, that nerve, and the microbiome and the metabolites it produces and then, of course, the immune cells in their cytokines, all of them have an influence. But the vagus nerve, yes, the sympathetic overdrive is what I was going to say is we've seen a lot of these kids.

They have pupillary dilation; many of them, it can be intense, associated with episodic regressions or episodic behaviors. And so, doing things to enhance the parasympathetic system and decrease the sympathetic overdrive can be very helpful.

Now obviously, in older kids, you can do meditation, yoga, exercise. You talked about even with the Tregs, exercise, Tai chi in older can help enhance Tregs. And I meant to say even vitamin D and probiotics can enhance Tregs.

So those I wanted to make sure I mentioned. But for this whole thing about the parasympathetic, you want to increase the cholinergic tone versus the sympathetic tone. And nutrients could be phosphatidylcholine; we actually give phosphatidylcholine; it can be very helpful.

So yoga meditation, walking, a good walking, relaxation, exercise. Social interaction with loved ones, all of that can enhance parasympathetic and decrease sympathetic tone. So I think it's really a very important question.

[00:59:10.19] Scott: Excellent, I've had my tablespoon of phosphatidylcholine this morning, so I'm good to go.

[00:59:16.20] Dr. Bock: Tablespoons probably better because it takes three large caps to equal a tablespoon. But you have to put up with that taste.

[00:59:25.05] Scott: It's not bad in my smoothie in the morning; it's pretty good.

Many know that PANDAS can be triggered by molecular mimicry to strep, as we discussed.

In PANS, for example, if you have an abnormal Cunningham panel or a Neural Zoomer, and it's not necessarily Strep. How do you then determine what that underlying trigger that is creating that abnormal immune or autoimmune response might be?

[00:59:52.21] Dr. Bock: Well, the first thing I do is I put on my medical detective cap, right? And what do I do? I take a thorough history to try to figure out what I think maybe going on because, let's say, tick-borne, which you have to.

There are questions I can ask about which tick-borne infections it may be, are they having a lot of burning pain, neurologic pains, neurologists, dysesthesias which may be more like Bartonella also Lyme? Or they're having numbness and tingling that kind of stuff. Do they have a lot of neuropsychiatric, which we probably do since we're talking about this? That can be prominent all of them, especially Lyme, and of course rages, we know Bartonella rage is known.

But I'll ask do they have recurrent fever chill sweats, which can be seen with Babesia, which is a co-infection parasite in the tick. Do they have air hunger? Chest pains? Also can be indicative of Babesia. So you have to ask the right questions in terms of those infections.

But I'm going to check; we do a full tick-borne. You have to ask for endemics; are they in endemic areas? Did they hike? Do they camp? Do they travel to the Hamptons? They go to Cape Cod a patient before me; grandparents have a place in Cape Cod, they're there frequently. They pulled off multiple ticks from their son but never treated, right?

So even though there's not maybe a known tick bite or an EM, erythema migrans bullseye rash, you ask these questions, and are there dogs? Yes, I have a dog, gets a lot of ticks. This is going to lead you more to believe that there may be a tick-borne illness.

So you have to look at ticks, and not just Lyme; you have to look at the co-infections. The basic ones are Ehrlichia, Anaplasma, Babesia, and Bartonella. But there are also many others, so we do a complete tick-borne evaluation all right. And then I'm going to look at allergies, are there the foods that they're eating that may be a problem? I want to be aware of that.

But in terms of the infections which you asked about, it's more; you look at Mycoplasma, Chlamydia. In addition, Mycoplasma is very common and can really cause this, as well as viruses. There are papers that show herpes virus can do it, Coxsackie virus.

So we look at all those things. And in my first book, 1997, so what are we talking about, 24 years ago. One of the things I said, it was called the “Road to Immunity: How to Thrive and Survive in a Toxic World”, right? Which I think is still quite relevant to the times. And I said if you don't look, you won't see. And if you don't listen, you won't hear.

And so the key is you'll ask, I've had people ask doctors well, what about my zinc? They say, oh, you eat a normal American diet; you're not zinc deficient. Well, I pick up a lot of zinc deficiency and vitamin D deficiency and magnesium, etc. And why? Because I look for it.

Because I suspect it more so than others, depending on the dietary histories I get, but if you don't look, you won't see. So I don't know what somebody's think level, is I can have a sense based on some of their whether it be a short stature or lack of healing or skin issues, so there are things or recurrent infections because it's for immunity. But I can't tell you what your vitamin D is; I would suspect it's low. I could say, but could I know it's going to be an eight as opposed to a 32? Because that dictates also what I'm going to treat with.

And then I'm going to get a follow-up to make sure I'm in the right zone that I don't overshoot; vitamin D can be toxic. So you don't want to overshoot. So you have to make sure if you give an adequate dose of vitamin D, that you're in the better range and you're not toxic.

And this is why I think people need to do it with practitioners and physicians other than themselves because there are side effects. I mean, methyl B12 can make maybe 10% of kids hyper and irritable and maybe agitated. Vitamin B6 can do that as well.

So you have to be aware that there are side effects even of nutrients, and therefore, they need to be monitored, and the dose needs to be adjusted and those kind of things.

[01:04:16.22] Scott: Briefly, I wanted to touch on CBD and whether or not you see that as a helpful treatment in children with a ITABI. Do you find it consistently helpful? Does it need to have THC to be effective?

[01:04:29.17] Dr. Bock: No, firstly, it does not need to have THC. In fact, I don't like to use THC in the kids. So there's another caveat. I use pharmaceutical-grade CBD, and I think that there's a lot of CBD out there, and some of which is not great, I don't think. Because there are people that have come to me on it, and then they respond to the CBD I use because it's more of a pharmaceutical grade.

It's certified, has certificates of analysis, it doesn't have the pesticides, it's really it's much purer, and it's also it is what it is, that's the key. And so, there are some CBDs with THC. If it's from hemp, which is what I use, then it's going to be 0.3 or less, which is legal. Cannabis can have up to 35 up, 35% it would be a whopping THC.

So I rather not have any THC for the kids; I think most parents feel better about that, as do I. And it's very dose-related. It's very helpful; I feel like CBD has helped many of my patients, both with the mood dysregulation spectrum, with the ITABI, with the autism spectrum, with anxiety, with calming, with sleep, but also something other than just neuropsychiatric, it's anti-inflammatory.

So I just gave a lecture, and I have another one coming up within two weeks, to an autism organization of probably several thousand parents. And part of what I put in there is about CBD because they need to understand. So I put a bunch of slides of what CBD does between the various CB1 and CB2 receptors, which are all over the body.

CB1 more in the brain, CB2 more peripheral, but that's why CBD can have all these effects that. Sometimes people say, oh yes, it's garbage; how can it have so many effects? Well, there are receptors all over the body in numerous organs.

And so one of the keys is that it's dose-related. So we start slow, and we build up slowly, increasing probably every week, so it may take weeks to get there. But the doses that are out there in a lot of the over-the-counter products are minuscule, and they got all kinds of other junk in them. And so you get a pure, and it's not just pure CBD; this is a broad spectrum.

The full spectrum CBD might have the THC, but the tiny bit if it's him, which would be okay, but I'd rather not. And the broad spectrum doesn't have the THC. But it has terpenes, flavonoids and it may have CBG, CBN which are other connect cannabinoids rather than just the CBD. And so they have what's we call an entourage effect, okay.

And the entourage effect means that it's like the effect is greater than just the sum of the parts; it's an entourage effect; they make it better. So we don't use pure CBD, although it's obviously the most prominent component.

It's the second most common of the cannabinoids except for THC in the cannabis. But in the hemp, of course, it's common. So I like one that's broad-spectrum, I like one that's pure. I like that it's acid, I want to make sure it's acid, and I want to make sure the dose is adequate.

[01:08:10.14] Scott: In these children, how often do you find IVIG as necessary? And are there other tools that maybe you try first to provide that immune support and also quench any autoimmune process that might be underway?

[01:08:23.04] Dr. Bock: So IVG is extremely effective. We do it every week here and sometimes multiple times in a week. It's very intense; it's two days because it's not the low dose IVIG that you give for immune deficiency, it's a high dose one, so you have to give it over two days.

For adults, sometimes, it's given over four or five days because you spread it over like for adults with MS. But for autoimmunity, you need the higher dose, two grams per kilogram, given over two days.

So they could be six to eight hour days because you have to do fluids because one of the things is immune globulins are large molecules, they can be a stress on the kidneys, so we do a lot of hydration before, during, and after. And we don't see those problems.

And it's very expensive that's the one problem, we try to get insurance to cover it, and we're successful a number of times, sometimes you can't. And I don't want parents mortgaging a home for it, but some of the patients we see from around the world can afford it. I feel like it should be covered for the things we use it for because it clearly works.

Not in everybody, but in a high percentage, it can be effective. One's not magic, so they frequently need three to six, sometimes even one more, and usually give it every month or two. Sometimes you get away with just one, and it really does help, and that's what they need.

It can quiet the inflammation, and it can help stop the autoimmunity. So it's really, it is a lot of other more complex biochemical effects, but that, in essence, what it's doing. It's growing the inflammation in autoimmunity. 

[01:10:03.21] Scott: In cases where IVIG is just not financially accessible to people, are there some other tools that you might try that have a similar therapeutic intent?

[01:10:14.12] Dr. Bock: I don't jump to IVIG first because of its expense. And the fact that there are side effects. I mean, it's a blood product, so I've been reassured by researchers that when they changed how it was developed in 1991, there's no way anything could survive.

And it's tested for everything under the sun, but who knows if there's something we don't know. So it's theoretical, but I have no problem with it. I would do with my own kid in a second. It is a solute load, so you have to hydrate them and so watch the kidney.

We don't have any problem with that. You got to make sure in a certain older population then it wouldn't cause like any kind of thrombosis. Again, you don't see that in the kids. So the most common side effects are headaches, vomiting like a flu-like symptoms that can come a day or two after. And we've worked out a way to prevent that with certain prophylactic drugs and the fluids and stuff.

So I just wanted to finish that up. But I do that in kids that are really not well, that are missing school for months or years, that are homicidal, psychotic, so depressed and just non-functional, etc. Can't be around their siblings; I have stories that would kind of blow your mind; I'm not going to get into here.

But I do all these other things. First, I try to figure out what's triggering, and it may be more than one trigger, and that looks at all the different layers of the immune kettle. Some more than others based on that person's history and what I think is going on.

So I want to find out what's driving it. And then I would do a lot of the anti-inflammatory treatments; we might do a modified ketogenic-type diet, gluten-free, dairy-free, get them off grains sugars artificial colors that kind of such flavors.

To get them on more of protein, vegetables, and good fats. That's one thing, the second thing would be a number of nourish and replenish the microbiome with probiotics, prebiotics and they'd be usually a bacterial, but they could sometimes be saccharomyces which is a probiotic yeast, especially if we have to give them antibiotics.

And then a lot of the anti-inflammatory nutrients. Certainly the fish oils in vitamin D, I call it, this was a friend of mine, who once called the holy trinity. Probiotics, vitamin D, and fish oil, and I like to call it that our holy trinity, right? I think that's, and they're all anti-inflammatory.

Probiotics are anti-inflammatory, they enhance Tregs, and they also all those things fish oils inhibit inflammatory cytokines, they mean messenger molecules that are inflammatory. Then you go to the next things for the blood-brain barrier.

If there's a leaky gut, I'm going to try to support that. Maybe with a, like we have something called Glutamine Plus, which is glutamine plus some other things like aloe and marshmallow, various things. You can use IgG; you can use immune globulins that don't really get absorbed. But they're helpful for the gut as well, so we use those.

And then nutrients like zinc, and then the anti-inflammatories like talked about like curcumin resveratrol, very good for restoring the integrity of the blood-brain barrier, resveratrol. And sometimes, you use quercetin if there are allergies; quercetin is another flavonoid. So there are many things that we can use, and frequently I'll give things on it, and of course CBD. CBD is very helpful, not only because of the anxiolytic and the calming, and the sleep. But also for its anti-inflammatory effects.

[01:13:55.18] Scott: Of Borrelia, Bartonella, and Babesia in the vector-borne illness and Lyme arena, do you find that one of these is more commonly the trigger for a ITABI than others?

And then, when you're approaching treatment of Lyme and co-infections, do you generally use antibiotics, or do you use herbs and homeopathy or a combination of all of those potentially?

[01:14:16.14] Dr. Bock: Well, firstly, I'm integrative, so I use a combination of, well, I use antibiotics, right? I know there are a lot of natural practitioners out there that they either can't, or they don't use antibiotics. Antibiotics are very helpful.

So we use herbs with them or certainly after them we transition, and we frequently may end with homeopathics, because homeopathics don't kill the organisms, but they help the body to get rid of them, and part of it as a homeopathic detox. And I do a homeopathic detox earlier on; even before I do this, we have some series of homeopathics for specific infections.

And it's a prolonged course; it's like several months. You do it either every three days or eventually every week. And detox is very important; you use antibiotics because you want to help clear. It's like you go to war; you have to, unfortunately, clear the debris, the weapons, the bodies.

You've got to do that in this because, in essence, you are going to war to try to fight these things. We like to protect if we use antibiotics, obviously the microbiome and the liver, so there are nutrients we use for that. And which ones, and I will treat, yes, I'll treat all of them, but I may not treat them all at once. I may start slower because I don't like to pile on a ton of antibiotics; I may start.

A lot of times, you need combination antibiotics more than one; sometimes, you pulse them if that seems to be a way. I don't usually start that way. There are certain medicines in Lyme disease like Alinia, metronidazole for the cyst forms around bodies that we do pulse.

There are a lot of times together, so it's there's more frequently multiple co-infections. I can't quote you the percentages; I have the in a slide. But the amount of one co-infection, two and three, you'd be surprised how many times there are two or three co-infections it's really increasing. And they're difficult to get better if you don't address the co-infections. Although, it doesn't hurt to get rid of one or decrease the load of one and then go to the other.

And I do them together, but sometimes a matter of tolerance of antibiotics and antiparasitics like for the for Babesia. Bartonella is, I would say is the most difficult; Bartonella can be really difficult, most severe symptoms, really hard to get rid of.

Babesia and Bartonella do this dance together, sometimes where you treat one and the other comes out, you got to treat that. And sometimes you know they're there, I mean clinically, I mean you think they're there, I don't want to be presumptuous and say if you have negative labs.

But there are times, listen, I'm a clinician. I was raised in University of Rochester with the foremost guy George Engel in biomedical, psychosocial medicine, and he taught us how to really be clinicians and not just rely on labs.

And I'm thankful for him all the time. I write about him in the latest book, and he was amazing, right? And so that's what I learned, and that's why I take a very detailed history, and basically if I think somebody has all the symptoms of babesia and they're testing negative.

And of course, there's not just Babesia microti, there are Babesia duncani, and there are some other tests you can get other than antibody tests. But I'll treat, and like I say, sometimes you go for one more the other comes out, a lot of times you'll do them together.

Don't get me wrong, a lot of times, I'm doing combination antibiotics to get all of them. But sometimes, I don't want to throw on five antibiotics; there are some practitioners I know. So I always think of the patient, what they can tolerate, what's best for them, how do we go about this, where some herbs may be real helpful, so we can do a few antibiotics, and then move to the next, whatever.

So this is all the art of treating tick-borne, not just the science. And there are many times I make clinical decisions with the patient; I tell them listen; there's no right or wrong. 99% of the doctors or 90% would have stopped an antibiotic after a month; well, we don't do that because we feel like we have to get rid of it.

But exactly when you stop the antibiotic, or when you had this or that, people do it. Differently, you got to get; I would advise you to get a practitioner they trust, that's knowledgeable. And then hopefully, they feel like they have a partnership with rather than somebody who's just throwing everything at them.

Scott: [01:18:48.15] I've heard that dance between Babesia and Bartonella referred to as the Babonella dance; I think it's a common thing. As we get down to our last couple of questions here for today, I wanted to touch on water-damaged buildings.

And so in the children, you work with, how often is sick building syndrome or exposure to mold and other toxicants this soup of toxins in water-damaged buildings. How much does that contribute to the inflammation that can be involved in ITABI? And what are some of your favorite ways for dealing with exposure to water-damaged buildings?

[01:19:25.03] Dr. Bock: It can be very significant, no question, it can be very significant. I just had it today because I just saw a couple of patients, both of whom have been in water damage-based buildings. Both of whom had a suspicion of mold, but they are getting it checked, and I'm checking for micro toxins. So they are real.

And so the first thing obviously is to either get away from it or remediate it. Sometimes, I have to have people move out if it's really bad, sometimes it's really bad. I mean, I have stories that shake you up a bit. But sometimes, it's not terrible, but it happens to be in the bedroom of the kid or right in their bathroom, so they're getting exposed to it every day.

Or the family room where they're down there playing on their computers and their video games or TV. So you got to get it tested, you got to get it by very good testers, mold evaluators, there are companies. And you probably want to get; you want to get a company that tests and then another company that remediates, they should not be the same company.

I don't think they can anymore; I think that maybe has been legislated. And it's a big project, and it's expensive, but you can do all the binders that we do when we treat where antifungals like Nystatin or potentially Diflucan or Itraconazole.

We treat binders; pharmaceuticals like cholestyramine or GI Detox like charcoal and fulvic acid and other kinds of binders. So you do have various kinds Pectosal and other ones; we do binders, you can do far infrared soreness to try to help eliminate some of the toxins. And you will, and want to repeat the immune system to have the immune system be more helpful.

We use homeopathic detox for that as well; homeopathic detox, I think, is really helpful for helping clear the system of some of the toxins. So it's a multi-factorial approach; it's not easy, it takes a while, but it can be done.

But first and foremost, you have to get away from the exposure, and you have to remediate it before you go back if possible.

[01:21:43.20] Scott: The mitochondrial topic is gaining more and more interest with newer options like NAD precursors, Urolithin A, and other tools that are emerging.

How common is mitochondrial dysfunction in your patients? Is there a way to test for it? And what are some of the ways that you like to support the mitochondria and the production of ATP?

[01:22:03.28] Dr. Bock: You're covering the waterfront today. It is present in many patients; it's not primary mitochondrial disorders; its mitochondrial dysfunction is very different. Usually, I remember I was at a conference one of our autism think tanks, and I talked about secondary mitochondrial perturbations. So there's second, it could be toxicants, could be infections what have you, nutritional deficiencies, etc.

So you can test them, you can get an initial lead or confirm a suspicion with an organic acid test because there are Krebs cycle metabolites. So if they're abnormal, that certainly pushes you to think there's mitochondrial function.

And you can actually get a Mitoswab that looks at all the different complexes, complex in a respiratory complex one, two, three, four and see they give you percentages. I just had one yesterday; the percentage of respiratory complex I was less than two percent; I've never seen that.

So that's the person I then ordered a mitochondrial genome to see if that's a genetic thing. But a lot of times, you'll see low, decrease in respiratory factor II and III, means you need antioxidants, it means you may need to treat the infections.

So there are different ways to look at it, but it's very helpful. And yes, there are IVs. Certainly, we give IV phosphatidylcholine, IV glutathione, IV vitamin C, there are oxidative therapies, and people, you can give IV NAD to help that as well. Because NADH is in that the respiratory cycle, as is FADH, you give riboflavin, there's another nutrient, riboflavin, magnesium.

And you got to get rid of the toxic metals because the toxic metals inhibit the enzymes that are involved in the mitochondrial process and the oxidative phosphorylation.

So mitochondria very important, and there's literature on it; mitochondria functions very important for the integrity of the blood-brain barrier, so that's also what I look at because I'm really, in this day and age, I'm very interested in the maintaining and restoring, and maintaining the integrity of the blood-brain barrier.

And we can measure actually an S100B protein, which comes from the astrocytes is measured in the peripheral circulation. Although, there are some a few little small peripheral sources. If you have an elevated S100B, it's fairly consistent with either some kind of neuronal damage, or we usually think of as well as some integrity of the blood-brain barrier.

So, of course, you have to look at the gut as well because an increased intestinal permeability or a loss of bad intestinal integrity of the barrier can be reflected up to the blood-brain barrier as well. So these are all new things because if you can help restore the blood-brain barrier integrity, you can potentially make a patient more resistant to ITABI pans and pandas because the inflammatory media can't get in.

So that's some newer research, and that's very interesting to me, and that's a lot of what I've been lecturing about lately.

[01:25:24.27] Scott: So when we talk about ITABI, PANS, and PANDAS, these are all complex, life-changing conditions can be really stressful for families that are dealing with them. What can you say to give listeners hope?

[01:25:36.16] Dr. Bock: Well, first of all, I like to give listeners, I'm going to do all these lectures and podcasts as well as my patients, realistic hope and realistic expectations. Yes, I mean I have seen stories, I mean some of them written down in the book, but I have others; a child now he's 18 but turned 18, but at 14-15 regressed into a whole ITABI episode.

And lost speech, lost food restriction, lost so many pounds, became so thin. Lost the ability to go to school, lost his ability to be with friends. At most, his speech was whisper or stuttering. And I stick with these kids and get a number of IVIGs as well as all the other treatments we had to treat his infections, and do the whole thing with nutrients and immune system balancing, hormone balancing.

This kid this year has just restarted school; it's phenomenal. He speaks now like; he's 18, he's very far behind, so he's in the senior now. He may have graduated, but he's a year because he missed years. He's just picking up with his friends again; he's obviously got some social skills to master. And he's a young 18.

Obviously, it's very encouraging. And this was a kid who, enough people they couldn't do anything for him. So I think if you get in the hands of the right physician, the right doctor whose knowledge about this, and considers all the different aspects and looks at them and then remediates them, there's a good chance that people can improve.

Can I say that every kid's going to become totally normal? Will they have some anxiety of this or that? You can't say. But I can say that the majority of the kids I treat, the vast majority. They said the same thing with autism spectrum disorder.

The majority of them improve. I won't say that vast majority recover, many recover, many of them in college you never know they're artistic, the same here. I have so many kids. Now it may be that it could come back again, they get a bad infection, they're under a lot, a couple of things going on. So they may get a recurrence, but we can jump on those recurrences quickly, knowing how to do it.

So I would think they should; I would like them to have realistic hope, and that realistic hope starts though with not allowing themselves to be kept down by maybe an opinionated physician that says this is garden variety anxiety, or this is just this or that.

And all this other stuff about PANS and PANDAS, we don't believe it. Because there are places that don't believe it exists. You just have to trust your instincts; hopefully, if they read variously, it doesn't have to be my books to bring inflamed and healing each other that can give them hope.

But the numbers of other books out there, so that you learn enough to realize that all the stories and these are real stories, these are real kids getting better. And I see some of the most now from all over the world, some of the most affected kids. And I enjoy it; it's very hard work.

But I enjoy the medical detective aspect because, quite thankfully, I'm a bit successful with it. And it's very gratifying. But it is very difficult; there are flares, we have ways of dealing with the flares, ways of dealing with the herxes with the tick-borne. So again, I'm being long-winded, but really I would like to leave people with this whole concept that to have realistic hope. 

[01:29:08.17] Scott: My last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health?

[01:29:15.15] Dr. Bock: Well, I eat healthy. You know what I'm going to do now, which I am an hour and a half, I'm delayed because I was a little delayed with my patients today, so I have a chopped salad with grilled chicken, that's what I eat almost all, you probably three times a week or what have you.

I didn't eat breakfast today; sometimes I'll have a shake either at home when I come in a medical foods protein shake, no sugar, stevia. I played tennis and or golf, and I walk the golf course. It was four or five times a week, sometimes two on one day. I mean, I'm still working, so the weather's changing now, but I really try to get out there; I'll be playing tennis indoor standard six and a half hours a week.

I meditate; I don't meditate every day like I used to; I do meditate; I think it's important. Try to make sure you see your friends and have loving relationships with your family and, very important, a wife, two kids. So I think that social support, I tell the parents of the kids, nourishing yourselves, taking care of yourselves is a key, and they're so committed to getting their kids better.

But if you don't take care of yourselves, you can't really help your kids because you won't be in shape to do it. And I say the same about if I'm going to help thousands of patients, I've got to take care of myself.

And I'm a moderate, doesn't mean you can't have a glass of wine or a glass of a good, a single molt or a glass of bourbon, you can. I mean, for a lot of the people who have yeast problems, you can't have beer, you can't have wine, especially red wine.

But I mean, it's to be a moderate, that's the key, it's not to be an extreme. Sometimes, you have to be extreme at the beginning the modified ketogenic diets, and as you get better, maybe you can bring some other things in. But for me, I try to balance.

Listen, it hasn't always been easy for me to have balance in my life because I've been so busy lecturing, traveling, seeing patients from all over the world. So as I get older, I'm trying to even come into mooring balance, and that probably means playing a little more tennis and golf, and maybe, unfortunately, with COVID not as able to get away as much as I'd like.

But the key is to also for me; I love my work; it's very gratifying to me. So that's a way of nourishing myself as well. So yes, my staff will tell you, I mean how I eat and not how, some of them eat really healthy, but some don't. I don't impose that on them.

But they'll tell you the ones that are, certainly ones who go out and get my lunch every day of how healthy it is, and the same thing with a dinner. You can eat a protein, vegetable, and a salad every night and have a very healthy dinner without having all the refined carbs and all that stuff. So that's how I would leave it.

[01:32:08.24] Scott: This has been a great conversation. I want to encourage people to go out and get the book brain inflamed; there's so much that we didn't even begin to touch on here, and it is a fantastic resource.

I want to thank you, Dr. Bock, for enjoying what you do, for loving what you do, for doing what you do, and for minimizing the suffering of so many children and their families. So thank you for being generous with your time today and for all that you shared with us.

[01:32:32.13] Dr. Bock: You're very welcome, it's been my pleasure, thank you. 

[01:32:35.21] Scott: To learn more about today's guest, visit BrainInflamed.com or BockIntegrative.com. That's Bock, B-O-C-K Integrative.com. BockIntegrative.com. Or BockNutritionals.com, that's BockNutritionals.com. BrainInflamed.com, BockIntegrative.com, or BockNutritionals.com.

[01:33:01.24] Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review, as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter, or MeWe, you can find me there as BetterHealthGuy.

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