Low-Dose Immunotherapy, Allergies, & the Gut with Dr. Ty Vincent
Many gut interventions focus on the health of the microbiota, like diet, probiotics, and antimicrobials. But fewer treatments address the immune system directly. Influences can go both ways between the immune system and the microbiota. In this episode, Dr. Ty Vincent, MD shares his insights on working with a therapy called low-dose immunotherapy. It uses very low dilutions of antigens to calm specific intolerances, allergies, and sensitivities. He’s seen that sometimes healing an intolerance like yeast can restore a gut to balance. If you’ve tried many gut therapies and are still not feeling well, this intervention may be worth considering.
Dr. Michael Ruscio, DC: Hi everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I’m here with Dr. Ty Vincent, and we’re going to be talking about immunotherapy. Why I think this has so much potential benefit comes back to something we discussed on the podcast before. Which is, we do all these interventions to improve the health of one’s gut microbiota. The paleo diet, elimination diet, a low FODMAP diet, probiotics, antimicrobials, elemental diets, stress reduction, lifestyle, all these things. And in many cases, we’re able to get all the symptoms alleviated. Great.
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Dr. R’s Fast Facts Summary
- Typical allergy shots are 10,000:1 to 10:1, but LDI is often dilutions of 100,000,000:1 or weaker
- Body can develop sensitivity to anything, from food to types of gut flora
- LDI dilutions contain mixtures for many common intolerances
Symptoms That Suggest Need for Immune Therapy
- Tend to come and go, have good days and bad days
- Stimulated by changes in environment, stress, other immune stimulus
- SIBO patients may have yeast sensitivity causing overgrowth, and benefit from yeast LDI
- Important to find correct antigen and optimal dose, neither too weak nor too strong
- Gradually build up to dose that causes improvement, repeat treatment
- Average one dose per week, may test 6-7 doses or more to find one that works
- Over time fewer treatments required
When Should You Consider?
- If other therapies haven’t worked
But then there are some cases where it seems—even though we’re doing everything we can do and we’ve gotten the microbiota as good as it can get—the immune system seems to still be agitated by and attacking the microbiota. This is where we’ve discussed that there may be another avenue of therapeutic potential, where we focus on the immune system rather than the microbiota itself. And Allison Siebecker, the queen of SIBO, was very impressed with Dr. Vincent’s work in this field. He’s here today to expand upon this for us.
So, Ty, welcome to the show.
Dr. Ty Vincent, MD: Thank you. It’s good to be here.
DrMR: Can you tell people a little bit about your background as we get started and how you got into immunotherapy specifically?
DrTV: Yeah. I’ll try to make that brief. I went to medical school in Seattle, University of Washington. I had a strong interest in alternative and integrative types of medicine even before medical school, and then was not super impressed with the limited knowledge I got as an MD. I went to a family medicine residency program in Alaska, where I’m from, and learned everything conventional medicine had to offer. I delivered babies. I did colonoscopies. I managed my own intensive care unit patients. Pretty much everything you can think of in conventional medicine. Did surgical assisting.
I leaned gradually towards chronic illness problems, specifically because I didn’t know what to do about them. And I wasn’t taught anything in conventional medicine that I thought really had the answers for people with chronic illness issues (which is the bulk of medical problems we deal with today, it seems like). I learned acupuncture and Chinese herbal medicine. I went on and learned bioidentical hormone therapy. I learned chelation therapy and other methods of detoxification. I became a Reiki master. I picked up some homeopathy knowledge. Then I started learning about immunotherapy techniques through the Environmental Medicine Academy.
I learned sublingual immunotherapy, provocation neutralization, those sorts of techniques. As I picked up all these different toolkits, I found that manipulating people’s hormones had huge power in fixing a lot of chronic illness issues. And I started actually teaching bioidentical hormone workshops.
Then I discovered that immunological problems were another huge missing piece of the puzzle for a lot of these chronically ill patients. And I got more into immunological therapies, starting with allergy therapy, something called low dose allergy therapy that was taught through the Environmental Medicine Academy. I had a lot of patients with allergies, so I worked with allergies extensively in people. And LDA as a technique was incredibly elegant, simple, and useful for broad types of allergies people would have.
As I started to work with that, I began to notice that there were similarities in how patients’ illnesses behaved, for lack of a better term, when they had immunological problems. So I started to have a new appreciation for some of my chronically ill people having an immunological mechanism underlying their condition. I would notice that their symptoms weren’t static. They would have good days and bad days, both in terms of severity and also in what kinds of symptoms they had. They had symptoms that would come and go. They had symptoms that would be influenced by stress or by other immune-stimulating phenomena, like viral infection, a course of antibiotics, or different things I just started to notice about a lot of our chronically ill people that influenced their general health and their specific symptoms, that seemed very similar to what I witnessed in patients with allergies.
So I took the underlying concepts of low-dose allergy therapy and started to develop a lot of my own new antigen mixtures, mostly comprised of microorganisms. The first thing I put together was yeast, a group of candida species combined with baker’s yeast and brewer’s yeast, and I would desensitize people immunologically with that. I found that that had very broad applicability in the areas of a lot of chronic illnesses that we treat, that have interesting names and labels that don’t mean anything, like irritable bowel syndrome. SIBO is another one. I’ll just give away part of the ending of the story, that desensitizing people to yeast is often the answer for patients that are diagnosed with SIBO.
But also systemic inflammatory symptoms people would have that get labeled as fibromyalgia, or chronic fatigue patients, people with migraines, lots of different digestive problems that you could think of, rashes that don’t make any sense, burning mouth syndrome, different things I would find responded to yeast. Then over time I developed dozens of other antigen mixtures with different microbes, from Lyme disease, herpes simplex, Epstein-Barr virus, mycoplasma, parasites, all sorts of things we now treat with low-dose immunotherapy with a very high degree of success. Even autism spectrum disorder, one of my favorite things to work with, because a lot of those kids have immune mechanisms underlying their autistic symptoms.
A lot of people with gut issues end up having immune system problems as one of the primary causes.
What Is Low-Dose Immunotherapy?
DrMR: Let’s talk about what immunotherapy is, just so the audience is clear. I’ll state it here simply. It’s essentially, as I understand it, repeat exposures to a small dose of what could be a noxious agent and gradually increasing that exposure so as to train the immune system to tolerate that stimulus. Can you give that a better or more elegant definition for people who haven’t heard of it before?
DrTV: Right. Well, the way you just described that is how conventional allergy shots work. For conventional allergy shots—if somebody has hay fever, they’re allergic to cats, pollens, things like that—they will do skin testing to figure out exactly which things you’re sensitive to. If they’re doing this in a more significant way, in a more targeted way, they will do serial endpoint titration with a series of different injections in the skin to see where the initial reaction point is. Then they start your dilution there, and they gradually make it stronger, sort of how you described. There’s an escalating exposure to antigen.
That’s actually not at all how LDI works. It’s very different. There are systems of immunotherapy that are vastly different from one another. The way conventional allergy shots work is, there’s a physical interaction between the antigen molecule, the immune system cells, and antibodies. So there’s something physical, molecular, and cellular going on with the interaction. The way low-dose immunotherapy interfaces with the person is more like homeopathy. There is an energy vibrational signature that is received by the body somehow, that then translates into immunological change.
DrMR: So the doses you’re using are far less than conventional immune therapy?
DrTV: Right. A typical patient getting allergy shots for hay fever might be getting shots that are 10,000 to one concentration to start with. That’s usually about the weakest point they’re at. Then they’ll escalate all the way up to, like, 100 to one, or in some cases just straight concentrate, which is 10 to one. A typical LDI dilution for yeast is incredibly broad, but about the strongest I end up using is about 10 to the eighth, which is about 100 million or so to one. That’s about the strongest concentration.
Then we have people diluted all the way out to—homeopathically, I would label it as 30C—a dilution of 60 zeros. So the typical dilutions range anywhere from eight zeros to 60 zeros of dilution, which is ridiculous.
DrMR: Now, it’s a very small dose. I’m imagining one of the good things here is, I’m hoping anyway, that the incidence of reactions is fairly low if you’re having such a diluted dose.
DrTV: You’d like to think so.
DrMR: No? Huh, okay.
DrTV: What’s interesting with this is—and again, I can’t explain why it works the way it does—if somebody’s ideal response dose is going to be 15C, which is a dilution of 30 zeros, there’s nothing there physically. Theoretically, you get past 12C, which is 24 zeroes dilution, theoretically there’s no more stuff, no more physical molecules present in the dilution. This is kind of the idea of homeopathy. You’re out past Avogadro’s number, 6.023 x 10 to the negative 23rd particles in a mole. So you’re out past that, because you’re at 10 to the 24th. Theoretically, everything you’re exposing the patient to that matters is just the vibrational frequency.
But for some reason, the rules of engagement, the way people respond to doses, seems to be exactly the same everywhere from eight zeros, like I said, to 60 zeros or beyond. There can be molecules in the dose, and then it could be doses that don’t have molecules, and it really doesn’t seem to matter. It seems to be the vibration anyway.
DrMR: I’m sorry. When you say it doesn’t matter, in terms of the effectiveness or someone’s potential reaction, or both?
DrTV: Both. The dilution only seems to matter in terms of the energy’s signature that’s being delivered, and not how many molecules.
DrTV: Which is very different from the way we think about things in Western mentality, right? This is a homeopathic sort of concept. The way they talk about things in the schools of homeopathy, traditional homeopathy, is also different from what I’ve observed with LDI. But, see, there will be a right dose. I guess the take-home thing for people to understand is that there’s a correct dilution for you, for your symptom, for that antigen. If we think about it in terms of allergy, it’s a little easier to grasp. Let’s say you’re allergic to peanuts. That’s a common thing. If we give you a dilution of peanut antigen, there will be a dose that will make your peanut allergy go away. You can eat peanuts all day long and nothing happens to you.
If we give you a dose that is more diluted than that… (and I use the term weaker, if it’s more diluted, like in chemistry class. But the homeopaths would call that stronger. So anybody out there has homeopathy training, you’re going to have to go with my lingo and not yours. It bothers those people, when I talk like that. They have to get over it.) If it’s a weaker dilution, if it’s more diluted than that, nothing will happen. It will not improve your peanut allergy reaction. It’ll do nothing at all.
Importance of Dosage in LDI
We give people progressively stronger dilutions, so we find that sweet spot where, “Oh, they can eat peanuts now, with no reaction.” If you give them a stronger dilution than that, a more concentrated dose, their peanut reaction will get worse, instead of better. There is the potential to make people worse.
And when we’re talking about SIBO, it’s exactly the same thing, the same phenomenon, the same behavior of dose and response occurs with anything we’re using. So if somebody with SIBO actually has a yeast allergy that’s causing their SIBO (and that is the most common circumstance I encounter with SIBO), then if we give them dilutions of yeast that are weaker than where they need, nothing gets better. They have no improvement in their symptoms, but also it doesn’t get any worse. Nothing happens. It’s the same crap, different day.
We move along, gradually stronger, until we get to a dilution where they say, “You know what? My symptoms were better for some period of time.” Sometimes it’s a partial improvement, as we approach that perfect dose for the patient, and then we make finer adjustments to it. And we get to a dose eventually where they say, “My symptoms basically go away for a month or longer after I take this dose.” Then we keep repeating that dose for them every seven weeks, and you get better and longer lasting results.
But if you overshoot the mark, if the patient needs a 15C dilution and you go to 14.5—which is 10 times stronger, one zero more concentrated—they get worse instead of better. That’s a true phenomenon with this technique, no matter what antigen we’re talking about, no matter what disease we’re treating. It’s the Goldilocks phenomenon. This one’s too hard, this one’s too soft, this one’s just right. So we’re looking for baby bear’s dose every time.
DrMR: Roughly how long will it take you to find that Goldilocks dose for someone?
DrTV: That has a lot to do with luck, and it has a lot to do with the level of fear and anxiety that the patient has. So I explain this to everybody at the outset: “Look, there’s a right dose. We don’t know where it is. I can give you my best educated guess on that, and I’m wrong way more often than I’m right.”
Again, we’ll talk about yeast. The typical SIBO patient who reacts to yeast will respond somewhere between 12C and 18C, most of them. Then there are outliers in both directions, of course. If you’re going from 18C to 12C, you might have to go through six or seven different doses to try along the way until you find one that works. We can go through generally about one dose per week.
People have to check in with me every time and tell me if it had any effect before I tell them to go ahead and try the next dose. It might take two months to go through that dosing spectrum and go, “Hey, we found it. This is where it works for you.”
Then we just keep making fine adjustments until it works really well for them. In a good scenario, it takes six weeks to two months often to try to find the right dose for people. And that’s if we have the right antigen to start with. Sometimes people are reacting to foods, or they’re reacting to parasites, or they’re reacting to some other thing and it’s not yeast.
If it’s not even the yeast dose that we need, I have to go all the way to 4C before we decide to give up on it. If we start it at 18, we might have to go through 15 different doses. And it’s 10 days per dose, so you’re looking at five months just to prove the yeast was not even the right antigen.
Yeast Intolerance & SIBO
DrMR: I’m assuming having the right initial suspicion is going to be highly impactful. Are there any ways, certain presentation types or symptoms, that help clue you in on where to start?
DrTV: Yes. That is a matter of experience and skill, just like anything else we learn in medicine. Here’s a typical SIBO patient scenario. A lot of the people listening out there, this will resonate…
DrMR: I’m sorry, Ty, one clarifying question. When you say SIBO, are you referring SIBO more as a catch-all for IBS, or patients that have had documented breath-test-positive SIBO?
DrTV: No. When I say SIBO I’m using the conventional medical diagnostic term for SIBO. From my standpoint, there’s an important distinction to be made between primary SIBO, I guess “real SIBO”, and secondary SIBO, which is actually a symptomatic condition that is caused by something else. So, the primary SIBO people generally have to have had something occur that reduced their stomach acid drastically. They’re on proton pump inhibitors for a while, or they had a vagotomy for chronic stomach ulcers, or they had a surgery that removed half of their stomach. Those people are going to have persistent bacterial overgrowth because they’re not producing enough acid to keep the population down, and they probably need antibiotics, and do well with antibiotics.
The people that you generally see though are secondary SIBO, my categorization for them, where the reason they have overgrowth of intestinal bacteria is because their immune system is no longer tolerating some other organism in their normal flora. As a result, yeast, again, is the most common. If you have a sensitivity or an immune intolerance to yeast, your body won’t allow the normal yeast population to exist in your bowel. What happens is you end up with this available real-estate ecological mix that then gets occupied secondarily by fermenting bacteria.
So what you’re measuring is this overabundance of these fermentational bacteria. But the reason they’re there is because the yeast aren’t there, if that makes sense.
DrMR: It does make sense. Just for the audience, I want to tie this to when we had Richard McCallum on the podcast. He was discussing research where he was assessing jejunal sampling against the SIBO breath test. So, actually going into the small intestine, taking a sample and comparing that to a breath test. Essentially what he found was, it doesn’t always seem to be SIBO per se, but rather this dysbiosis or imbalance.
It sounds like that’s essentially what you’re saying, Ty, which is these ecological niches that are getting skewed by the immune system knocking out one niche, which allows other players to overgrow or imbalance. You’re describing this cascade effect where the dysbiosis or the SIBO is really a byproduct of the immune system.
DrTV: Yeah, I think that would make sense. The research you’re describing is what I would expect to see with my theory. I haven’t done the sampling, so I’m basing this on my observation of what ends up working for these people immunologically, and then their gut balance is out. Which is interesting, because when you focus on the SIBO test and the stool analysis that people tend to run on these patients, you get this dysbiosis picture, and you get an increase in methane or hydrogen sulfide or some other gas being produced.
Then often, in the case where the patient is, in fact, sensitive to yeast, you frequently see either low amounts of yeast in their stool test or zero. A lot of them it’s zero, which is interesting. That should catch every doctor’s attention, but it doesn’t usually. It usually escapes notice as being significant.
Many times people will have the theory at the outset, oh, you might have a candida problem. It sounds like you do. You can’t tolerate sugar. You get bloated and gassy. You get these other symptoms. You might get thrush sometimes. You might get rashes or itchy anus or whatever makes you think of yeast. Then they do a stool analysis and the patient has no yeast. Generally, the practitioner then doubts themselves. They second-guess themselves and go, “Oh, well, I guess you don’t have a yeast problem after all.” But what they need to realize is that they absolutely do have a yeast problem, it’s just not the problem they thought.
Instead of a yeast infection or a yeast overgrowth situation, that patient has a yeast allergy. What happens then is the immune system just doesn’t allow the normal amount of yeast to be present in their stool, so it shows up as low normal or zero. If it’s zero yeast, that implies that the patient has an even higher level of sensitivity to yeast than somebody who still tolerates a certain amount.
DrMR: And Ty, this is a great point. One of the things that I often encourage clinicians and patients working with the clinicians to do is not to treat their lab tests overly literally. That’s what I’ve observed in the clinic. This hypothesis you’re putting forth really fills in some of the mechanism that may be underlying that, where what you’re seeing on the lab test may not be the cause of the symptom. It may be a byproduct of immune system imbalance. So I think that’s really insightful.
DrTV: Yeah. I think your position on that, where you got to the same as me, was born from failure, right? We do these tests we’re supposed to do. You give the patient whatever treatment plan makes sense based on the results you see, and if they don’t get better, after a while you start to question the utility of the test you’re running. You start to think, “I need to think about this in a different way,” instead of just the test results. I used to run stool tests on patients a lot that had digestive problems. I rarely got good results for the patient by doing everything correctly based on their stool analysis.
Then I started to realize in the scenario I just described, when it’s an immunological problem—and in many of these patients, that’s a big piece of it—it’s what you do not see in their stool that is the answer. Everything you see in their stool growing with an abundance is irrelevant. And that is not helpful. It’s really frustrating, in fact. You give them all this stuff, and then it doesn’t work, and then you’re left going, “Well, I don’t even understand what’s going on.” In many cases, it’s the thing you don’t see.
The easiest thing to realize is absent happens to be yeast, because it should be there in everybody. Abundantly, right?
DrMR: Right. I should first state, I agree with everything that you’re saying. To make a devil’s advocate remark, just so we don’t put all of the culpability on the immune system, there’s also the possibility that a stool test isn’t showing you something that’s going on in the small intestine.
So the point I’m making is, there are gaps in our knowledge base, which is why a clinician should always keep thinking, “Could the test not have found the culprit? Or could what we think the culprit is be a byproduct of the immune system?”
This is why, again, I harp on clinicians not to be overly literal in their interpretation of lab tests, but to contextualize those with the patient’s history, their response. And keep thinking through these problems.
DrTV: Right. And you also have to realize that you can only see something on a test that people already know exists.
DrMR: Right, exactly. There are definitely things that we know are being looked at in research centers that are not available in routine clinical testing. So, fully agreed.
DrMR: Hey everyone. I’d like to thank Aerodiagnostics, my favorite SIBO lab, for making this podcast possible.
Again, Aerodiagnostics is the SIBO lab I use in my clinic. They have impeccable organization, customer service, test quality, and support. Regarding support, if you’re not highly proficient in reading SIBO labs, Gary definitely offers the best clinical support I’ve ever come across. He goes over labs in detail and offers insight analysis and really goes above and beyond.
Aerodiagnostics offers cash pay and insurance billing options, and they do a terrific job of keeping costs low and billing easy. They are for accounts for clinicians and direct-to-consumer testing and Aerodiagnostics, again, is my go-to SIBO lab.
If you’re wondering about how hydrogen sulfide ties into traditional testing of hydrogen and methane, please check out our recent podcast with Gary from Aero. Essentially, we’ve developed a simple questionnaire that will allow you to hone in on hydrogen sulfide SIBO, without needing additional testing or cost. Aerodiagnostics, check them out.
Immune Triggers of Common Gut Symptoms
Ty, to zoom us out for a minute, are there a few important organisms to consider sensitizing someone to for IBS? I’m just going to throw out a few that our audience are probably interested in. I realize that we could probably do an hour on each one of these. But if you have any high-level remarks, IBS, thyroid autoimmunity, joint pain, brain fog? Any notable insights with any of those?
DrTV: Well, in reverse order, brain fog is a nearly useless symptom, because just about everything causes it. I get people who will say that that’s their primary concern. I’m like, “Okay, well, you need to give me more symptoms than that.” Because if I go down the list of antigens that might cause brain fog, it’s just about all of them. When I talk to patients, they will often have what I call their favorite symptom, jokingly. “This is your favorite symptom. Let’s talk about everything else that doesn’t bother you as much.” The more different boxes you can check off on a symptom list, the better chance you have of choosing the right antigen first. It’s the broader picture.
So if somebody has all of those things… Let’s say they have IBS symptoms, bloating, gas, dyspepsia, constipation with occasional diarrhea, whatever, the whole smorgasbord of colonic problems, and they have joint pain that comes and goes—that’s annoying, it’s not maybe the worst thing in the world—and they have brain fog. They have all these things. Then you start to think about certain other things that can cause, not just gut-focused symptoms, but systemic inflammatory symptoms as well. It’s still a broad list, actually. So people that could have all those problems, some of the very common things would include yeast, for sure, as a very, very common immune trigger that can give you literally any symptom in the body from head to toe.
Food allergy is another very, very common one. May people with significant food sensitivities don’t know they have them, and they don’t know what food it is because it’s something that they eat almost every day. It may have a delayed type reaction pattern, so they don’t get sick immediately after eating it, they feel crappy the next day. Since they eat it every day, they just feel bad every day. You can get arthritis from food sensitivity. You can get all kinds of mental suppression, focus, memory problems. You can get mood disorders like depression, anxiety, panic attacks. You can get muscle pain, joint pain, peripheral neurological symptoms, any kind of gastrointestinal symptom you can think of.
Skin conditions from acne to eczema from food sensitivity, so that’s another really common one. And in people that are diagnosed with SIBO or IBS, food is always one of the things I always think about. I try to pin those people down on whether or not they have any food sensitivities at all that they know of, even if they don’t cause gut symptoms. Because they fixate on their gut symptoms. But if you can realize, “Oh, well, when I eat almonds, my mouth itches. When I have eggs, I get a headache,” then you know at least the person has food sensitivities. It’s something you can start with, and you have certain sentinel foods you can use as a gauge for whether or not you got the dose right. And there’s a lot of value to that.
Other things, any kind of gut flora, could be an immunological target. You can develop an immune response to literally anything, whether it lives in your body or it lives outside your body. I have a number of LDI antigens that are standardized on my shelf, that are gut flora. I have H-pylori. I have a collection of parasites that’s two dozen different things, 12 protozoa and 12 worms. I have the yeast mixture, which I actually just recently expanded. It’s now 44 different species of yeasts, 40 candida species, and then four Saccharomyces species.
DrMR: Are you having to test those one at a time as part of this?
DrTV: Oh, God, no.
DrMR: Okay. Good, haha. That would be a very long road…
DrTV: One of the very elegant and utilitarian things about LDA and LDI is that you can give a person this huge broad mixture of antigens, and it doesn’t matter if they don’t need them. It won’t cause any effect at all. Food is a good example. The food mixture I developed has more than 200 different individual foods in it. I actually made extracts myself from all of them. I blended up the actual food items. I drew samples out. I sterilized it, and I put them together in submixtures. So I made this myself by hand.
The yeast mixture, the other microorganisms I have, I purchased from laboratory warehouse sources that are standardized. But let’s say you’re allergic to dairy products, and that’s it. It’s the only food you’re sensitive to. I can give you the whole food mixture that has 200 other things in it you don’t need, and it will only affect you for the ones that you need, which is very, very simplistic. It’s so much easier.
With the candida mixture, you might be specifically sensitive to candida albicans or glabrata or one of these other species, and as long as the right one is in the mixture, all the other ones are irrelevant. It doesn’t matter. I can give them all to you. Because the way LDI works is by promoting tolerance. That’s the key single word that we’re doing. We’re promoting immunological tolerance. To promote tolerance for things you already tolerate is effect-neutral. It doesn’t do anything to you. That’s nice.
Research & Practitioners of LDI
DrMR: The other question that I’m sure some of our more skeptical and evidence-based providers are asking themselves is (and rightfully so), is there any kind of research that backs this up, or where is the research here?
DrTV: Well, in terms of how the immune therapy technique works, the only published research dates back to 1960 to 1965, by the person who developed what was called EPD at the time in London. That was Leonard McEwen, and he had all these beliefs back then about beta-glucuronidase enzyme being required for the treatment to work. That was a big crux of his bench research that he published, that you need this dose of beta. I’ve since proven that none of that’s true. So I don’t even point people to that research as being useful.
There is no published research about the use of LDA or LDI, not yet. Maybe somebody else will do it. So those out there who don’t want to use a treatment or technique that doesn’t have published data will probably not want to do this. That’s just a personal choice, I guess.
DrMR: I completely understand that. I think our audience is accustomed to being evidence-based but not evidence-limited, meaning if we don’t have the evidence yet, but a therapy seems to be promising, then it’s something to consider. Is there an association or is there a group of doctors who are putting their heads together here, at least trying to be rigorous in the approach?
DrTV: Not that I know of.
DrMR: You’re a lone pioneer out there?
DrTV: Well, the pioneer, yeah, but I have a whole bunch of other sourdough types following along. That’s an Alaskan term, sourdough. After I started to develop these antigens, I was involved a lot with the Environmental Medicine Academy, and I taught in the LDA workshops there. I let other people know that I had these things. What we’ve developed over the last five years, I guess, since that started, is an LDI practitioner network, so to speak. We have provided the antigen concentrates to well over 200 other practitioners worldwide. They’re in a lot of other countries now. So they have the concentrates of my same antigens that we will provide to those people.
They buy into the network like a cooperative structure, basically, for an annual membership fee. And whenever I develop a new antigen or they run out of one of the concentrates, we send them another one so they have it available. So there are hundreds of other doctors out there using the therapy. And I have a hundred page manual that describes how to use the therapy in great detail. We have training seminars usually about once a year somewhere that they can come in person. They email me when they have questions. So there’s some education available. It’s not incredibly formalized yet.
Your question was more about who’s out there studying this, in a research kind of mentality, and I don’t think anybody is, yet. I’ve had people mention it, that they want to. You can be absolutely certain that I’m not going to, because… two reasons. I don’t have the time for that, and I also don’t have the interest in it, because I’m incredibly cynical about the world of research, just to be honest with you.
Other people might pick that up. I might partner with somebody who wants to do research and just give them suggestions about methods, how to go through a protocol, because that’s one of the things that makes this particular technique very hard to study, in the way that we normally think about medical research. You can’t standardize the treatment to a group of people. You will fail most of them, and then you’ll end up with the idea that the treatment does not work. That’s unfortunate, and I don’t want that to happen.
But the way this has to be applied is entirely individualized. You couldn’t just say, “We’re going to take 50 people with diagnosed SIBO,” and have your criteria for SIBO diagnosis, “and we’re going to give them all yeast 15C dilution.” It’ll work for a couple of them, and it won’t work at all for the others, or it might even make a few people worse. So you have to develop a process of how to find the right dose for those people, in some kind of standardized format that you could follow. And it’s complicated. It’s not like everybody’s going to take VSL-3 probiotics twice a day for a month, and see how many of them get better. That’s the kind of research we’re used to.
DrMR: Right. The research you allude to that’s more personalized, I think we’re going to see a lot of headway being made there. Because this personalized medicine and this personalized application of therapeutics, I think we’re going to see more and more researchers kind of coming out of the woodwork who are finding ways to do that. But you’re right. It is a challenge when looked at next to the traditional RCT methodology, which is understandable.
What’s the name of that network just one more time that you mentioned, so people have it?
DrTV: You know, it’s not a thing you’ll look up on the Internet.
DrMR: Oh, okay.
DrTV: We refer to it as our LDI practitioner network. And there is no way to find it and find a local doctor. Nobody’s put that in place. But if you look up low-dose immunotherapy and Google that and your home state, you might find some practitioners that are listing it on their website as a tool that they offer.
We have not centralized a database that everybody can look at, because a lot of these practitioners don’t want anybody to know. They don’t want to be on a list on the Internet somewhere. A lot of integrative medical practitioners are frankly kind of paranoid that their state medical board might come after them for this or that thing.
This is an experimental therapy at this point, and so some people don’t want it advertised to the world that they’re using this in their clinic.
DrMR: So the best you would offer a patient whose curiosity is piqued is just search low-dose immunotherapy in your state and see what comes up?
DrTV: Yeah, if you’re looking for a practitioner. If you want more information about the treatment and how it works, I have a series of about 20 YouTube videos that are just informational. You can watch them all, you learn a lot about it. And that’s a good place to start. There’s no commitment to just watching videos on YouTube, and it’ll tell you a lot about what this is about and what we’re doing. That’s where we send everybody. Other doctors do too. “You want to know about this? Go watch Dr. Vincent’s YouTube videos, and then you know the gist of it.”
You can just go on YouTube and look up “Ty Vincent LDI,” and you’ll see all these videos.
Best Candidates for LDI
DrMR: Gotcha. I want to ask you again for the best place for people on the Internet, in just one second. I do want to ask one final question here, which is—and this is maybe one of the most challenging questions—who do you feel the best candidates are? I ask this in relation to a broader context of whether it’s a provider listening to this or a patient, there are all these different options, right? They could go see a gut specialist like myself. They could go see someone like Annie Hopper or Ashtok Gupta for neural retraining, in case they’re becoming freaked out about reacting and the problems in the brain, rather than it being in the body.
They could do this. Do you have any indicators for when people should make this their next step?
DrTV: Yeah. I’ll tell you who the most common people are that find me, and that we treat. Those are the people that have failed all the other stuff. That’s obvious. The people that are looking for the next thing to try, because they feel like they’re running out of options. Like you mentioned earlier, some people are going to get better with a couple courses of antibiotics. Some people are going to get better with probiotic management. Some people are going to get better with dietary manipulation or supplements that help heal leaky gut. There are a lot of ways to approach what all ends up getting the same diagnostic label.
We use a lot of diagnostic labels, as if they’re all some kind of homogenous population of people, and they’re not. Under the IBS or SIBO mantle, you’re going to find people that get essentially cured or get very successful long-term management with one of those other strategies. And those people don’t call me, it turns out, because they don’t need me. I get the people who have tried antibiotics repeatedly. They’ve tried probiotics from every direction. They’ve tried fecal transplant.
If you’ve already tried other things that were simple and could’ve worked and then they didn’t, then this is a great thing to try next. But also people that have just developed their problems and this is their diagnostic category, “You have something wrong with your gut and we don’t know what it is,” basically that’s where a diagnosis like IBS and SIBO came from is, “I don’t know why your stomach is unruly.” They get scoped. They get stool tested and people don’t know. Those are great candidates right from day one to try this, because you’ve got to try something first.
My attitude about a good therapy to try (because you never know what’s going to work) is something that is not horribly complicated to do, fairly user-friendly—which rules out things like fecal transplant, not super user-friendly—that is cost-effective and reasonably affordable and that has a low chance of hurting you. Antibiotics are a double-edged sword. We all know that antibiotics can potentially cause problems. So if you’re leery about antibiotics in a general way, which is understandable, you might want to try immune manipulation first. You’ve got to start somewhere, and just see what’s going to work. You just never know at the beginning.
This is all I do anymore. I just do LDI. I treat patients all over the planet in 15 different countries. I just sit here at my desk in my room in Kona, looking at the ocean, which is amazing. And I just work with LDI now because I can do this by mail and by Internet. I used to have a big clinic in Alaska I ran for a decade, and I got all kinds of different people in there and I did all kinds of therapies. I had hyperbaric chamber. I did a lot of IV therapies. I did acupuncture in my clinic. I did all kinds of stuff. So I know that all of these other things can work as well.
I would just tell patients, look at all the options you can find and pick the one that resonates with you. Nobody knows what’s going to end up working. So pick something, try it for a reasonable amount of time. If it doesn’t work, try something else. You may eventually end up with LDI, or some other method of immune manipulation, or you might get lucky and the first thing you try fixes your problem.
DrMR: I think that’s great advice. And it’s well-put in terms of, it’s obviously better to start with therapies that are not that expensive, not that complicated, not that invasive.
Costs of Low-Dose Immunotherapy
I’m assuming this also isn’t terribly expensive?
DrTV: Not the way we do it. Like I said, there’s all these other practitioners using therapy. They all charge different amounts. They charge different amounts for their own intake evaluation for the patient and whatever they do in their clinic. We charge $600 for an initial consultation, which gets people’s attention. That’s not a small amount of money, but then we don’t charge people for all of the email communication that ensues for years afterwards. It’s kind of an upfront investment.
I found that people have to be invested in the therapy to take it seriously and to actually put the effort into it that they need for it to work, so there’s that.
DrMR: Let’s say someone sees you maybe once a month or once every other month, is there kind of a ballpark? Just so people have a sense for what this may cost.
DrTV: Yeah. We don’t have follow-up appointments. We have a $600 initial thing. That’s the difference. Other practitioners might say, “Well, you’ve got to come in and see me every six weeks,” or “You have to come and see me every two or three months,” with an expected cost tied to that, even if you have nothing new to talk about. I’ve never really liked that strategy.
So we have that initial $600 thing, and then we charge people to send them a set of doses. Let’s say you have somebody with a SIBO diagnosis, because that’s our topic du jour, and I decide that they might respond to yeast. So I might send them five doses of the yeast antigen, 15, 14, 13, 12 and 11C. That might last them six weeks to go through all of them. Or they might have an overdose response to the first one and then the other four are useless, and I’ve got to send them more right away.
That first year where we’re trying to figure out what dose works for them is really variable in terms of cost and how often we have to send them a set of doses. We send a set of doses and charge $150, which is not a lot of money. When you compare with other doctors do, they’ll often charge you $200 for one dose that they give you in their office. You come back two weeks later, and it’s another $200 for another dose. It’s really variable.
For us, if we end up having to send another set of doses every six weeks through that whole first year, it ends up maybe costing $1200 for the first year. That’s a whole year of trying to do this, to put it in perspective. Down the road, the goal is, when we figure out what the right dose is for that person, we send them two of them at a time. And the dose cycle lasts seven weeks before they need the next one. Eventually when we have it dialed in, the long-term cost expectation is that it’ll last two or three months per dose. And we send them two at a time, so odds are it’ll only be $450 to $500 per year to stay totally well, once we get it figured out.
That gets cheaper over time because people will eventually get to where they only need their dose every six months. It’s $150 a year.
DrMR: It certainly sounds reasonable… One of the things I often criticize, and I’ll do it one more time here really quick, is the excessive functional medicine model of $5000 worth of testing just to get started. Juxtapose next to that, this is pennies.
DrTV: Yeah, I don’t do any testing. That intellectually bothers a lot of people. I don’t even want to see their tests, to tell you the truth. “But I spent $10,000 on all these tests.” I go, “Well, I understand that, but if they had the answers you probably wouldn’t be talking to me.”
They usually have to go, “Yeah, okay, I get that. It didn’t fix me.” Yeah, no testing. That’s basically what it costs for us.
If it works, great. It’s low-risk, it’s low-cost, it’s high-yield. And this is what I focus my attention on now, knowing full well that all the other things that we have learned to do in integrative medicine have great utility. And some patients, that’s what’s going to work for them. And, again, those patients don’t usually call me.
View Dr. Ruscio’s Additional Resources
We’ll make sure to put your YouTube page in here. Is there a website you also want to point people to? Then, do you have any closing thoughts you want to leave people with?
DrTV: Our website is www.globalimmunotherapy.com. So the name of our business, as it were, is Global Immunotherapy. That’s our business website. You can find the YouTube page linked from there, Facebook. My wife runs all that stuff.
It’s just my wife and I, which is actually a major advantage. When I had a clinic in Alaska, I had 15 employees, I had medical assistants that were intermediaries for all the communication to and from patients every time, and it was a mess. And I didn’t get nearly the results we do now.
Now I answer all your emails myself. Everything is either my wife or myself, and we get along great. There’s no nonsense, interpersonal BS in the office that I had to deal with before. (We do have nine children, so there’s enough nonsense in the house without business!)
But it’s very direct, and all the communication is very direct and very quick. That’s one of the things I would tell other practitioners who are interested in implementing this and doing a good job with it, is that the communication with patients is critical. And if you have physician extenders in your office, medical assistants or nurses who you expect to manage the go-between, you’re not going to do as well as if you do all the communication yourself directly. There’s just so much that goes into it.
So that’s it. It’s just us. That’s the website. You can find the YouTube channel, I think, by just looking up Ty Vincent LDI. We add new videos periodically to that, a lot of different topics, some on digestive stuff, some in general concepts in LDI, so people can figure out a little more what this is about. Then you’ll probably find that whatever disease you have, if you start looking on the Internet for support groups and whatnot, you may find people talking about LDI among the different groups that are disease-based.
DrMR: Gotcha. Cool. Well, Ty, thank you for the conversation today. It’s been very interesting and I am encouraged at having another option to offer people. I’m thinking there’s probably a subset of people listening to this who have improved some from the various therapies that we’ve discussed in the podcast, or they’ve just tried on their own, but they may be looking for that next layer of improvement. And I’m hopeful that they’ll reach out and try immunotherapy. I’m curious to hear the feedback that we get from it.
DrTV: Yeah, that’s great. The basis of getting better is to keep trying, and if what you’re trying isn’t working, to try something new or something additional. I’m a big fan of hope and positivity. I would tell my own patients, if this doesn’t work for you, if I don’t have the answers for you, that still doesn’t mean the answers aren’t out there. You just go try something else. I usually then add, it just gets weirder from here!
DrMR: Yeah. I think the further toward the end of the line you get, the weirder things do get.
DrTV: This is pretty weird, I will admit. It’s pretty weird, so that means it may be the next best thing.
DrMR: Well, to your earlier point, not very expensive, not invasive, so certainly makes it much easier to justify it.
DrMR: Awesome. Well, Ty, thank you again. Really appreciate it.
DrTV: Thanks for having me.
What do you think? I would like to hear your thoughts or experience with this.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.