Childhood Developmental Disorders, Brain Imbalances & Neuroimmune Health with Dr. Peter Scire

In this in-depth episode, Dr. Zimmerman and Dr. Scire go beyond conventional thinking about childhood developmental disorders—unpacking how issues like dyslexia, ADHD, autism, and learning disabilities often stem from deeper, unresolved neurological and immunological imbalances that extend well into adulthood.

🔑 Key Takeaways:

• Developmental Disorders Are Often Misunderstood & Undiagnosed: Learning disabilities, not autism, are the most common childhood developmental issues—yet many kids never receive a proper neurological evaluation. Instead, they're often pushed into compensatory therapies without addressing the root cause in brain function.
• Brain Development Has a Blueprint: The brain develops in a predictable right-to-left hemispheric pattern, and interruptions to this process—often identified through retained primitive reflexes, oculomotor issues, and vestibular dysfunction—can result in cognitive, emotional, and behavioral challenges well into adulthood.
• Functional Neurology Offers a Different Lens: Unlike traditional models that separate neurological and psychiatric care, functional neurology integrates sensory-motor function, primitive reflex testing, and brain hemisphere imbalances to uncover why the brain is underperforming—and how to restore its potential.
• Neuroimmune Interactions Are a Game-Changer: Immune system dysregulation—often starting in the womb due to maternal inflammation—can alter brain development and trigger lifelong neuropsychiatric issues. Inflammatory immune responses can lead to mood disorders, cognitive delay, and even autoimmune issues without ever being properly linked to brain health.
• Treating the Root, Not the Label: Dr. Scire emphasizes that symptom-chasing—whether through meds, supplements, or labs—isn’t enough. Instead, a framework-based approach must consider neurological exam findings, metabolic markers like blood sugar or anemia, and prioritize which systems need regulation first—brain, immune, or both.

To learn more about Dr. Scire you may follow him on Instagram: https://www.instagram.com/drpeterscire/

Transcript

Dr. Scire, great to have you here. Great to be here. Thanks for the invite. Yeah, you're welcome. So I'm excited to talk about childhood developmental disorders and really almost kind of leaving the childhood side behind and talking about, is that really the end of treatment and growth potential that they have? Or is there more that can truly be done for their brain health? So excited to talk about this with you. Absolutely. So first, when we really look at these developmental disorders, you know, I think if we mentioned developmental disorders, most people instantly just go to autism, right? What, you know, are some examples of developmental disorders that kids have, you know, not only things that maybe people recognize, but other things that maybe are there, but people just, you know, it's not talked about as much. So people don't even understand it truly exists. Yeah, well, obviously we're coming off the heels of autism in April, right? The autism month and got so much press and everything that's going on, even with the Maha movement in this country and everything. But honestly, autism is only not even three percent of the population of school age children. The number one childhood development disorder is actually learning disabilities and dyslexia. But because of the diagnostic or lack of good diagnostic workup on those children, those children are often, you know, even at the elementary school, maybe at the middle school level. And if they are, it's a very poor workup. Then we get into learning, you know, get into ADHD, and ADHD probably being about maybe ten percent of the population, maybe upwards of fifteen. And then, like I said, autism and the spectrum of autism, and then we get into the differentiation of, what we've described in the past as high-functioning autism versus moderate autism to profound autism being the non-speaking. Then you have the comorbidities that exist in there. You have the children that have tics or Tourette-like symptoms. Then you also see children being diagnosed with obsessive and compulsive disorders, social anxiety. For many years, they used a non-pragmatic approach um learning disability non-verbal learning disability um at one point we're obviously using asperger's as a diagnosis um so you have this this wide consortium but um and then you have mood disorders you actually have true mood disorders and even behavioral disorders like oppositional defiance and so you know coming from my background and where I've lived for the last twenty years of my career you know we're looking at this um from the through the lens of Dr. Malil's work in hemispheric patterns of left brain. I think for many of the students that I'm seeing these days is I'm working with a population of kids probably from, let's say, seventeen to thirty years old. And when they come in my office now, they truly have bona fide neuropsychiatric disorders. like those profound mood disorders or insomnia or anxiety disorders. Some of them have been treated medically with medication. Some of them have been self-treated themselves with marijuana and even just recreational medications and stuff. But it's really predicated on that brain imbalance that started early on and was probably never identified correctly or obviously never treated correctly. Yeah. And I want to go to learning disabilities really quick, because you mentioned that, you know, it's over twenty percent. You know, how significant is this on these kids lives as they become teenagers and then adults? Because you write, we get people all the time who we both see who are like, oh, yeah, I dyslexia, you know, I, you know, I mix up some stuff. But it almost sounds like when people say dyslexia, it's just crazy. It just gets really minimized as if it's like, oh, it's there, but it doesn't really matter. Now, I think that's a great point. And so, you know, first of all, dyslexia is not just the actual switching of letters or even numbers. It's actually what we call phenomic awareness, the inability to actually identify your phenomes. You know, for example, the differentiation between shuh and chuh. I mean, myself, my own story was that I was actually – a child with a learning disability and really probably an underlying central auditory processing disorders. That's something that's there. We can see visual processing disorders. I think that they do get minimized to the extent of, okay, well, it's just this thing where they switch numbers or they may write their letters backwards or something but you know for us and how we would diagnostically look at it it's a much greater problem and it really stems from this delay in their visual system especially the visual system primarily to the left side of the brain combining that with the auditory pathways of the left side of the brain and then a lot of instances we can actually see you know quite a bit of problems in um muscle tone um as well I mean we know we see that in the in the autism population in the adhd population um but what's fascinating about about a lot of these um learning disability cases and I've worked with loads of them over my career and I actually have several of them currently in my office and um You know, they have some very almost like gifted motor skills in the sense that they have an interest in playing sports. But when you actually look at some of their midline ability of their spine and their cerebellum, um they have quite a bit of midline disruptions and oftentimes they actually have tremendous underlying vestibular problems um that may contribute to the oculomotor deficiencies that we may see that we may see these obviously old problem of of eye muscles um in terms of gaze and smooth movements of eyes or rapid eye movements is that obviously in our functional neurology group that we we're trained to look for um and then you also see a tremendous amount of retained primitive reflexes in these patients population yeah and I want to you know because there's going to be people who this the first time listening this podcast and probably even their first time hearing the term functional neurology um Can you briefly explain, you know, what the functional neurology like concept is? Because it's definitely very different than traditional neurology when people hear the term neurology. Yeah. I mean, well, I mean, it's a, it's a field that emerged practically basically almost forty was the originator of it and we're all descendants of that and we're multiple layers of descendants from practitioners from that. But the ideal aspect is that functional neurology to look at the functional capacity of the nervous system, we're going to go through, we're taught how to do a neurological exam and I think even more extensively at a bedside level than probably even a primary neurologist would do. would do, but we're actually looking at the function of the different parts of the nervous system. So we may look at, for example, talking about the inner ear and talking about the vestibular system, and we may put patients through a variety of different balance testing and head movement positions and look at the functionality of that particular area. So I think from a standpoint of how we go about it, We're going to be looking for the capacity of the nervous system and how it's functioning. We're going to also look, obviously, for frank neurological pathology. But most of the time when we're actually treating these patients, they actually have, obviously, just disturbances in different parts of their nervous system. And we know that from a developmental standpoint that the lower parts of the brain are feeding into the upper parts of the brain. And a lot of people that may have problems in cognition or problems in your relationship to moods or they may see you know again changes in their memory they may actually have problems in the lower parts of their brain so I think for us we're always looking at this relationship of how does the pathway function and and we've just been trained at a very high level to go in and measure these at different levels of what we've always referred to as these longitudinal levels of the nervous system. So we take this step from looking at the muscles of the extremities and then working forward and working backwards towards the spine and then upwards into our brainstem and so on. So I think that's how we go about doing it. Yeah. And whenever we look at, you know, developmental neurology, because once again, you know, We're going to be talking a lot about neurology. What are some of the things that we should be considering? Because I hear you talking about vestibular function, talking about oculomotor function, because Most of these kids who get diagnosed with learning disabilities, dyslexia, visual processing, auditory processing disorders, just overall sensory processing disorder, autism, any of those, they're usually not getting neurological evals. Usually it's like maybe they see a pediatric neurologist, but normally they get shifted to more of psychiatry and then to OT and PT for I'm almost you know, I'm not even gonna say rehabilitative treatment more of here's how you deal with what you have treatment. Right? So yeah, you know, how does that tie in when we look at developmental neurology in the vestibular and oculomotor systems? Well, the concept of developmental neurology is the idea that it is a developmental blueprint. There is a developmental blueprint of the central nervous system. It starts obviously in the womb, and there's certain neurological circuitry that's starting to emerge within several early weeks of gestation, okay, and through the process of gestation. And one of those primary functions is what we look at in terms of these primitive reflexes. So primitive reflexes are these automatic reflexes that respond to environmental stimuli in the womb as well as as soon as the child is born. And they're automatic, they're stereotypical, and that all humans have them. And we go through these different steps through development of these primitive reflexes, the first, you know, twelve months of our life, they, when we're born, you know, the upper regions of our brain are really not developed because, you know, as a human brain, we have to have a very small cranium for an infant to be able to be born okay it's not like a horse or you know some other mammal that can be born and then all of a sudden walk so you know we have you know human brains have to be tiny and then you know as they you know engage with the new sensory input upon birth the parts of the brain that are more metabolically active at the time are living in our brainstem and they're really governed by these primitive reflexes. And we go through these very specific steps of how these primitive reflexes, when they appear, when they should turn off and then allow for other reflexes to mature. And so there's a trajectory of development. We have very odd Reflexive eye movements early on at birth, and then we develop more, you know, what we call volunteer eye movements that we actually have complete control of. And so when we talk about a developmental relationship, there's a developmental relationship of how the brain is going through its early development. And this actually leads into the development of what we call brain laterality, okay? That there is a, our two hemispheres, there is actually a blueprint on how they're developing. And so from birth to the first three years of life, the primary hemisphere that is developing is the right hemisphere. And then around about two, two and a half years old, the left hemisphere becomes more developed turning on and developing. And that's where we begin to see much more language development from a child. And what happens is that there's this developmental sequence of this right to left development that happens all into late stages of teenagers and into early twenties. And now we may think that this development goes on way into our mid twenties. And so there's this neurological loop. And So from a developmental perspective, what we're doing and what Robert and I are teaching practitioners to do is to be able to go in and examine for where the developmental blueprint goes sideways and where we have problems in that. And the easiest way to do that initially, especially in an early child or even in an adult, is look for retained primitive reflexes because they, again, should not be there after about twelve, fifteen months of life. And if they're retained, they're literally actually slowing down that maturation development of the hemispheres. Yeah. And so, you know, so with, you know, evaluating primitive reflexes, we've talked about balance, vestibular system. Why, you know, for those that are listening, why should they be considering like, hey, maybe this is something I should have my sixteen year old kid, you know, we should be talking about their development or why should a twenty five year old who maybe had a prior diagnosis of dyslexia or visual processing, why is it important that they communicate with their provider or find the right provider to really talk about their developmental history and they don't focus just on what's going on at that moment in time? Because that's what a lot of people tend to do is say, here's what I've got, right? Let's focus on what's most recent in our history versus looking at the spectrum. Yeah, well, I mean, it really starts from the idea that motor function drives cognition, okay? And we can look at the work that Jeremy Shumaman from, I think he's at a, It's not MIT, it might be MIT, but he's been one of the people that for thirty plus years has been looking at the role of the cerebellum, the back portion of our brain that we used to think was the main function for muscle tone and balance and posture and gait. But as brain imaging emerged, the late eighties you know we realized that the cerebellum actually had all these contributions to different parts of the brain when you look at movement this is one of the primary functions of the early development of the child I mean what comes first does movement or speaking come first so we know that movement and complex movement and especially bipedalism um emerges first before When the motor circuits are not functioning ideally, we're not going to see the normal match of these more advanced cognitive functions. And that may then show up in how the two hemispheres are actually developing from a standpoint of their asymmetry. And we may then see where we have these cognitive deficits from right to left side of the brain, or we may have in our social development. And so that's a real big thing is that what we're looking and what we're diagnosing is we're diagnosing the deficits and we're naming it, but we're not actually saying, okay, what's the primary reason for why this happened? And it actually really happened because along the way there has been all these apparent motor milestones or motor sensory motor milestones that actually have been missed and now that's led to the immaturity in these more advanced cognitive skills and executive functions and so on yeah yeah exactly you know it's just like if you have a team and you're trying to train him to do stuff you know You always have the foundations that everything's built upon. And if the foundation's not done right, you then start getting some issues. You start getting mistakes and stuff that really shouldn't be occurring. And same thing with this. You go back and say, what's the foundational stuff that should have been addressed? And you've got to take care of it for the other things to really develop and grow in the way you want them to. Yes. yeah and it's very essential and so and I think that that's what's been missed for I mean again I've been doing this work for twenty years and and I I think I've seen the gamut of how these kids are worked up diagnostically in the traditional model like you said even from the occupational therapy model or physical therapy or speech language pathology um you know mostly looking at you know maybe one area, whether it's just, oh, child doesn't speak properly, we're going to work on some training of some muscles of speech and everything, but not realizing the contributions that other parts of the brain may play a role in that functionality. And again, teaching this for almost fifteen years now and knowing what's the education of those disciplines, it's always shocking when you get speech pathologists or OTs or even PTs that come in and go out like, We were never taught to look at this developmentally. We were just taught to look at this in a very linear way and maybe look for some muscle imbalances and stuff. Or again, the activity of daily lives that they may not be able to do, and we may work towards that. But not to go and say, OK, what is the blueprint of the brain, and how do we work by repairing this blueprint? Yep. And it's, you know, it's definitely a different framework than most people are used to because like you were saying, right, people are used to going, oh, I've got cognitive issues. I've got speech issues. I'm going to see a speech language pathologist. You definitely see a lot more kids and teens and even adults with neurodevelopmental disorders than I do. But even with those I treat and the amount of concussions, they're always like, wait, what? You mean doing vestibular and oculomotor based therapies is going to improve my cognition and my ability to find words and improve my memory? I thought I needed speech for this. And that leads, unfortunately, to a lot of people not getting the proper care because it's still something conceptually. it's not really talked about in the world of really brain health in general, whether it's neurodevelopmental acquired injuries, you know, it's just like, oh, well, you know, you've got this, you go for that. It's like, well, it's not actually the best way we're going about it. No, I think you're right. And I think there are phases to that. And I know we live in this world together as well. And, and, crossover of functional medicine and I think that's even a calamity itself because now everybody gets into oh it's it's mold or it's histamine intolerance and it's all these these things that are are driving um these problems on the brain and they're still not understanding functional connectivity there they don't understand the fact that there is these aberrancies and in the trajectory of a developmental blueprint It changes the way these hemispheres are communicating to one another, which is then going to change downstream relationships of how the individual hemispheres are dictating the function of the immune system or the cardiovascular system or the endocrine system. And so everybody that's looking at those systems from a functional medicine piece is really missing functional neurology and especially developmental neurology. And I'll see families that have gone to really talented functional medicine practitioners over the years but they come into my office and you know they've run thousands of dollars of labs and and they're they're on twenty thirty forty supplements and you know get a whole spreadsheet of of supplements and you know is your child any better and I'm like no because again you know you're not you're not addressing you know the primary source which really you know for the for the vast majority of these kids is this imbalance in their in their two hemispheres and that one side of the brain is has been thrown into a more growth development and the other side of the brain is lagging behind. And one of the potentials for that is are we seeing where we're getting generationally gifted children, especially in the autism population and the ADHD population, where there are traits that are being passed down from parents to grandparents. And that's a common theme I see in my office where we get a child with an autism diagnosis or an ADHD diagnosis, and you can look no further to probably the father or even the grandfather, and see these very dominant left hemisphere traits. And Simon Baron Cohen and others about this for, you know, almost twenty years now called like the geek syndrome. OK, so I don't think it's something that, you know, we're talking out of turn. I think it is truly there that you can get these traits. And so, you know, even though people are going, oh, there's all these environmental stuff going on and and all these things and problems in our foods and know the whole vaccine discussion and everything but the reality of it is that you can actually look back and see these these dominant atmospheric traits that are that are that are appearing in a lot of families that could be influencing way these hemispheres are beginning to develop or changing the way that pattern happens and then that's going to have a consequence on those other systems and so you have to go back to the central system being the central nervous system to have a better long-term effect on those other systems and if not you're just you're even in the functional medicine world you're just symptom chasing this Correct. You know, and there's a lot of symptom chasing in that arena. And, you know, whenever I talk to patients like, well, what's different? Like, well, I look at both brain health and body health. You know, it's not one or the other because we've been knowing what we do. right? There are those in the neurology space, functional neurology who only look at the brain, but they ignore outside influences. And then there's, you know, functional medicine that often ignores the influence of the brain and they try to treat everything neurologically through any mechanism other than the brain. Now that doesn't mean it's, you know not going to work for some individuals and and this kind of brings us to what we're going to talk about next it's we both have a love of immunology and the immune system right because we know it's not all that neurology lives on its own we know that there's an influence of the immune system as well so you know Kind of let's walk through that. You know, how does the immune system play a role in neurodevelopmental disorders that not only impact kids initially, but how it can keep impacting them as they grow into teenagers, young adults, and they enter adulthood? Yeah. So it's a great conversation here and it's a little, you might get a little intense for our listeners, but you know, one, it comes down to starting out with the two elements of the immune system, the innate immune system, the adaptive immune system. And you know, we know obviously the innate immune system is going to respond very rapidly to the different pathogens and and get stimulated by these pathogens and try to recognize them and mount a rapid response. And if they can't map a response, they're going to take a piece of that pathogen and then present it to our adaptive immune system and engage our T and our B cells. But when we're looking at these children with these developmental disorders, one of the things that we're seeing right now is that if a mother is in an inflammatory state in terms of maybe they're having um maybe they're obese you know during the pregnancy or they develop an underlying metabolic disorder like maybe they have diabetes during their pregnancy or you know they have a history of autoimmune disorders themselves they may actually change the way the immune system is functioning in the development during the gestational periods where they actually start pushing the adaptive immune system too aggressively in early development. And so it drives this brain to get into a more in what we call a really pro-inflammatory state. So we start activating very specific branches of our T cell positions and one of them being what we call our TH-seventeen system. And so there's this term called maternal immune activation called MIA. So MIA is where it is very dominant inflammatory response and does this inflammatory response then alter um the contributions of our immune cells during normal neuronal development that um you know probably in only the last thirty years neuroscience and neuroimmunology specifically figured out that we have obviously these immune cells in our brain called our mic and our micro astrocytes and others play roles in actually kind of like the scaffolding of the brain and then in the building of our our individual neurons and the maintenance of those neurons and as well as the connections of those neurons and and so do we get maybe an excessive uh inflammatory response early on in to we may get an altered of how we build those early connections in the brain, as well as postnatally, you know, then, you know, is the child into more of an inflammatory state themselves? And does the immune system begin to create more of a memory to that state? So now when they are... with particular responses to their environment, whether it's a food that might create an inflammatory response, maybe a chemical aspect, or even when the immune system turns on to kill a pathogen, whether it's bacteria or virus or fungus, that we may get a very aggressive immune response. And so what does that do? Well, that might actually prime these microglia more aggressively, and now we get this thing called neuroinflammation, and we get this inflammatory storm at the brain. And at that level, what does it simply do? It really basically slows down the connection speed of the brain. So yeah, there's definitely this immunological relationship. And then taking it one step further and saying that each hemisphere has a role in the immune response. And for the most part, the laterality research has shown that The left brain tends to have more of an inflammatory response telling the immune system to turn on and go, and that the right brain through more high inflammatory mechanism, primarily through vagus and through the autonomic network has an anti-inflammatory response. So what it should tell the immune system to do is to come to our level of resolution. But what's happening is that if the brain is immature, that when the immune system turns on and does its job, it may not turn down. So now we get this constant promotion of the inflammatory response that then causes gene expression. And we may end up developing autoimmune expression to our body. Yep. And it's, you know, it's really important for everyone to know, you know, whenever we're talking about like left hemisphere being more inflammatory, it doesn't mean if oh, well, I'm a little bit more left brain. You're going to be in massive inflammation because really these should be shifting back and forth. So, you know, we don't always need to consider inflammation is bad. It's anything that's sustained is what's bad. So even someone that's stuck in an anti-inflammatory state, which as we know, it's not even necessarily truly anti-inflammatory. It's just which side of the immune system is being biased. You know, any shift from really a balanced state. I kind of tell people it's like a seesaw. You know, you want to go back and forth depending on what's happening. But it's when it gets permanently in a place or persistently stays there, that's where we get issues. And the more I learn, I've really just kind of broken everything down. I'm like, you know, most things I see in my office are neural and immune issues. Like I'm like, you know, under the immune system, I'm like, sure, yes, there's gut, there's all of that, right? That impacts immunology. But I'm like, most everything I see now is neuroimmunology. And going into that arena, I know we've talked about it briefly, but I want to dive in a bit more now. It's mood disorders, you know, as a truly neurodevelopmental and a neuroimmunology issue versus the way most people are used to them being treated. Most are just used to being treated with here's your Alexa pro here's your Prozac. Here's your Cymbalta, right? Well, Buterin, oh, you got a lot of anxiety. Here's your Xanax and kind of that whole side. And, and we routinely see, you know, the research is pretty clear on this too, that the meds, they leave a lot to be desired and And the research really isn't even showing that it's necessarily truly a psychiatric issue. It's it's more neuroimmune. So let's talk about that for a little bit. Yeah. I think again, you bring up a great point that, you know, when you're looking at those type of medications, you're, you're talking about changing. receptor site sensitivity to that, or you're trying to turn off an SSRI. And so, but we know even going back to probably the mid-nineties that there's been this relationship of neuroinflammatory mechanisms that happen that, you know, let's say we have a stress response, we have an external stress response, do we start stimulating the production of hormones coming from our pituitary gland that then signal to our brain and to our body, to our macrophages and, and other cells to pump out inflammatory cytokines, these inflammatory signals. Okay. And then make that, and then that's going to loop up and then do the same in the brain. And then what does it do? It impacts it down, regulates transmitter. down-radiates our ability to make our brain-derived neurotropic factors that actually maintain plasticity. So we get these looping effects. We can also coax cells. And so we know the brain is filled with mast cells. So now that we get this dumping of other pro-inflammatory compounds, I mean, a leukotribe to glandins that creating this neuroinflammatory storm. And then we know anatomically in the brain that there's different receptor sites that are more found in certain areas of the brain. And so now do we get a docking of these, pro-inflammatory cytokines that dock onto the cells and then cause a gene expression inside the cell. It creates an inflammatory event. That definitely happens. I've seen it clinically for years and years and years. And it can be a variety of different things. It could be stress chemistry. It can be, again, reactions to certain food proteins. And you like the glutens of the world and the dairy of the world. And even some of the cross-reactive foods, they may have a similar protein sequence. And they may, you know, you may develop a reactivity to dairy or gluten, but then you eat corn and now you're cross-reactive. because of the similar protein reactions or even, you know, work that the teeth carotene and the Arivajani have done and looking at even like, you know, stuff like spinach, okay, and looking at certain types of reactivity there. So there's so much of that's happening. And I think that's superimposed on the brain asymmetry. I think that, you know, the brain asymmetry is definitely there. And the more that we're beginning to understand about the concept, constitution of the right hemisphere's relationship to sickness and in the right hand side of the brain and especially the insular cortex's role and trying to control that inflammatory response and say okay hey like you said we need inflammatory responses okay we need our T cells and the branches of our T cells to go and fight intracellularly and fight pathogens that get inside the cells like viruses. and they're gonna create an inflammatory response, but how good are we at turning that down? We need the part of our T-cell system that's going to fight extracellularly and fight bacteria that's in a tissue or in our blood. But again, how good is our immune system at turning it down? And if we don't turn it down, Then are we getting, you know, tissue destruction? Are we, what we're calling damps, you know, damage associated molecular patterns? And now are we, then is that creating another problem for us because now our immune system is tagging that tissue and saying, okay, hey, I want to, you know, break down that tissue further. And that's what can obviously lead into greater, you know, autoimmune expression. Yep. Yeah, and I know that was a lot for a lot of people. I just want you to know this is very nuanced, right? We're not here to be like, oh, well, you know, there was some research that said fish oils could help with autism or fish oils, right? I know there's supplement companies that are like, look, here's the fish oil blend we got for ADHD. This is what's going to do it. Realistically, it's not that simple. I always tell people to avoid places that try to reduce everything down to here's the one thing you do and it takes care of it. But as you went through, right, there's a lot of different things from foods that people are eating to chronic infections to gut health to stress chemistry and everything else. And these all interact, but also at the same time, know and and this where we're gonna go next is we also don't necessarily try to address all of those at once right there may be times we do but there's other times like no where's our greatest leverage points um because I assume you're probably not practicing the same way now that you were when you first graduated from school and and kind of started doing this about twenty years ago Yeah, absolutely. And I think that a couple of things, you know, obviously we've been talking about the neuroimmunology and, you know, kind of, you know, when you and I probably got into this, there was only a beginning understanding of the T cells and the different branches of the T cells. And now we know that there's, you know, just under T helper cell system, there's about seven or eight or even maybe potentially more lineatures of what that, and they're, they're doing different things. And so, like you said, you hear a lot of people you know talking you know you always you know on you log on to instagram Everybody's talking about NAC, N-acetylcysteine. And you and I both know that you better measure a certain marker before you go, specifically this marker called TGF beta, before we go and just start blankingly giving NAC. Because you actually could, if that TGF beta is way elevated and you give somebody too much NAC, you can actually push them into a very aggressive situation. inflammatory immune response. And so I think that's the big thing that I've tried to explain to patients is that, you know, we are trying to be really in about this idea of immunotherapy, very specific with how a certain compound is going to drive an immune response and whether it's going to upregulate that immune response. response or downregulate that immune response. And so that's something that's dramatically changed, especially for me over the last five to seven years in my practice. And then the other thing from a neurological perspective is that early in my career, when I started doing this work and started working with Dr. Malone, we started developing this model to identify the brain imbalance and then treating the brain imbalance. A lot of it was based on the fact that we were trying to activate the brain and bring up the low side, okay? And for instance, in children that had more like ADHD or autism or Asperger's, it would be the right side of the brain and we would do all these different modalities simultaneously to activate that one side. But in some of these very gifted cases of like let's say high functioning Asperger's or even some of these cases where there was a lot of obsessive compulsion type of manifestations, just bringing up the right side may not be enough to impose an inhibition to the strong side. So this was something that we knew, we recognized it fairly early, but we didn't have the technology at the time to do that. Now, fast forward over the last four or five years, we've now been able to utilize different technology whether it's transcranial stimulation. I mean, I know you've looked at transmagnetic stimulation as well, utilizing the use of low-level laser, and even now maybe even developing some different neurofeedback protocols that while we're actually trying to upregulate the weaker side, we're trying to slow down the overactivation or the overconnectivity in different areas of the brain, what we refer to Brodmann areas of the brain on the stronger side. So just like in immunology, where I think a lot of people in the functional medicine world just take this blanket statement and go, hey, immune support, immune support. Let's just throw everybody on these basic immune protocols. You and I both know that's not how it works. There's very discreet ways to assess the immune system now or had through mainstream labs like LabCorp or Quest, but even some of the obviously specialized labs in functional medicine. And so the same thing goes with the brain is that we have to now just say maybe ten years ago we would have said, okay, hey, only stimulate the right brain and we can make a difference. And we made a difference in a lot, a lot of students at the time. But there was also students that we could have done a better job. Well, now we understand how we could have done a better job And that's probably the two biggest things that have changed in my practice is understanding excitation and inhibition. And from a rehab standpoint, and then even from an immunological standpoint, is that, you know, I'm trying to bring a somewhat, like you said, the balance to the system. But how do I go, how do I, and I may at times have to slow down an overactive immune system before I'm trying to bring up a system. Correct. Yeah. And I just want to make two points. One of the things you said was trying to do a better job. And I think that's super important that when people are trying to find a provider, it's okay to have one that's evolving. And you're like, wow, you're doing things a little bit differently than you were two years ago. It's like, yeah, that's actually a good thing. In the world of immunology and neurology, if you're seeing someone who's still doing stuff they did five, ten years ago, it doesn't mean they can't be doing parts of it. but if they're doing that as their entire thing and there's no evolution, it's, you know, that's kind of a red flag. It's just like, you're clearly not staying up on any of the research. And then the other part is, you know, with balancing things, right. We can either excite or we can inhibit, we can, we can kind of do both. And it's even the same thing with the immune system, right. We can turn up one side, but we may also have to turn down. And, that's also important right because some of you have been told oh well my immune system is over activated you know I I know you probably run in this a lot too and I'm just like it's not that simple it's which side of your immune system like there's different layers it's not so black and white now where we can just say something's overactive it's like well I mean is it overactive like Like you've got eczema, like you get sick all the time. Like which side, which side is biased? Like we don't know. Yeah, exactly. Like, I mean, you and I both know that back to this T helper cell position and years ago when we first probably got exposed to this, we got taught that there was a Th one and there's a Th two, but we now know that Th two has a nastier version called Th nine. And so people can have a more TH nine expression of that, not maybe that mast cell component, but may now push them into more of a respiratory problem and a EOPV type of problem and stuff. And so, you know, how do we address that differently than we would address an asthma? So I think for us, you know, I do agree with you that I think that the patients out there that are going to be listening to this, try to count providers that are constantly taking their continued ed hours. You know, I think the general amount of hours that most of us have to maintain per year for our licenses, no more than twenty. I mean, I know I've been taking classes upwards over one hundred to fifty classes a year in continued ed for twenty years, not counting what I actually teach in continued ed hours and stuff. And so I think that, And then reading journals and reading articles and getting with colleagues that are in that same mental space of, you know, hey, I want to hang out with so-and-so and find out what they're into and everything like that. So I think that's important is that I always tell patients that, you know, you said that is your practitioner evolving or, you know, still holding on mostly the philosophy, you know, more than anything and not, you know, actually looking at the emerging science that's out there. And we also know we've been around this long enough to know that there's a big gap between, you know, research and in clinical application. I think we're fortunate that we hang around some, you know, very bright instructors that are close that gap for the rank and file clinicians. that want to get that education, but you got to want to go get it and learn it and stuff and then apply it. And so I think that's a big thing. And I think that's why it makes it sometimes it makes it challenging for guys like us and gals like us that that are on the frontiers because we sound like the weirdos because we're actually so in front of everybody, you know. And so, I mean, I look now and, you know, twenty years into this and I turn on Instagram and I see all these people talking about primitive reflex and everything. And I'm like, where were you, you know, fifteen years ago when I'd go do a lecture at a small group for ADHD and maybe have three moms show up and we're like, what are these primitive reflexes about? And so, yeah, so I'm glad, you know, the evolution of it, it's happening. But I still think that there is a lot of practitioners that are somewhat, you know, practicing in the dark ages. Correct, yeah. I mean, there's plenty of people who are staying behind and because the fact is it takes sacrifice right mean you are on calls tuesday night on our own free will like like we choose to and run it more often than not because we're wanting to learn because the fact is you know if we have to go and do everything on our own it takes longer and so it's like people are like who's my I'm like they're like who's your mentor I'm like for which aspect right like exactly there's not one person Yeah. And, you know, again, you know, you and I have been on those calls for years together. And even when we're on those calls, there's probably no more than twenty five people on those calls. And and then, you know, I know who some of your mentors are and you know who my mentors are. And, you know, we go to their conferences and maybe there's forty, fifty people in the room out of tens of thousands of practitioners that could be there. And for whatever reason, they're choosing not to be there. So I think that, you know, for us, that's It's always been a challenge, but I think it's a fun challenge to be able to educate patients and educate people and say, listen, this is the frontier. And I think that, you know, for me now in my year, you're entering year twenty in my practice, you know, for the most part, I have just purely a referral practice. I don't I don't have to spend an enormous amount of time marketing because most people are just like, hey, that's the guy you want to go see, you know, and, or, or, you know, someone like yourself. I mean, and, and so I think that's the beauty of trying to stay ahead of, of that. And we know that some of our mentors are getting up there in age and we're trying to get as much out of them as we can before, you know, they may decide to like retire or whatever and do something different. And we're that old guard now that is expected to go and, and teach all this stuff and keep, keep these, keep advancing the protocols and so on. Yep. So, I mean, really people just keep looking and honestly, you don't really know till you experience it with the providers kind of how good they are. Cause there's a lot of terms that people are using now. Oh, I do functional medicine or, oh, I do fun. You know, I I'm a neurology centered chiropractor or, or, or whatever it is. There's a lot of things people are doing because it works marketing wise. But it doesn't really tell you how good they are, which unfortunately is adding to a lot of confusion. But where I want to go next is let's just run through a couple pretend cases. We're not necessarily going to talk about how we do treatment because for me, it's, you know, that's nuances and people. Yes, I understand you want to know, oh, but what's the treatment? But I like. the framework right what's the framework that's actually going to provide us with the information we need to to actually make smart decisions versus rushing to something because it sounds good because a lot of people rush the things that sound good on social media and then it doesn't work so let's pretend right we've got a eighteen-year-old female she comes into the clinic She has a history of visual processing disorder and she's also been diagnosed with depression and anxiety and has previously been on meds for that. She may currently still be on them, but it's just not quite doing it. Kind of let's walk through a framework for that. Yeah, well, number one, I mean, it starts with my intake forms, and I'm sure you have very similar intake forms where we're going to get a lot of developmental history from that case, because I want to see, like for me, I'm looking for, you know, are there a presence of these hemispheric imbalance types of symptoms associated I'm looking for red flags in the history that may give me some states of underlying metabolic aspects. You know, obviously wanting to know as much as I possibly can about the woman's menstrual cycle and looking at, you know, in relationship to that, is there any symptoms of autoimmune expressions that you know maybe she does not realize there is some symptoms that become related to that so I think it starts with you know doing a good case history you know first and foremost um and then for there you know we obviously have certain questionnaires that are going to be specific to neurological function um that allows me to then start maybe beginning to get a framework of how I may go in and do a specific exam And, you know, again, do I need to, you know, is it a short exam or is it more, I mean, it's gonna obviously be based on, you know, some of that history that I find in that case. And then you're just walking through that very consistent examination. I mean, going through, again, looking for primitive reflexes, going through, you know, checking their vestibular, checking their balance and their muscle tone and all that we do as a functional neurologist, And then at that point, you know, if in the case history, I would have seen if there was any labs, if there was any recent labs, if there were no labs, then, you know, I'm already beginning a workup of like, okay, what labs do we need to start, you know, running in that case? And, you know, for me, you know, I'm not going to immediately jump to advance, you know, functional medicine labs and run a complete hormone panel and stuff I want to start looking for. Hey, is there an underlying anemia? Is there an underlying blood sugar dysregulation? Is there any, you know, thyroid stuff going on? I can just tell you just out of my own experience of working with that age population of eighteen-year-old girls to twenty-five-year-old girls, I've dealt with a lot of symptoms by just, you know, a lot of problems just by balancing their blood sugar. OK, and looking at their blood sugar adrenal mechanisms that might have or, you know, they have pro-inflammatory mechanisms. And we know there's a ton of research on pro-inflammatory states and PCOS and painful mental menstruation and stuff. So, I mean, these are things that I think that you got to start going through your differential and working, you know, the hierarchy, you know, rather than just saying, hey, I'm going to jump to these fancy labs over here that look shiny and great. for social media and I'm going to run a stool test and do all this stuff, you may end up there eventually, but check the obvious. Go for, you know, is a person have an underlying anemia? they have an underlying anemia that might be being driven by an inflammatory response you know rule out the pathology you know some people may actually have a pathology that you might be the first person to discover that frank pathology and and so that might meet again extensive labs or you may have to order you know some imaging you know because you suspect certain things that may happen I mean I've I've caught you know pituitary tumors and people and stuff that you know, based on their history, you're like, hey, we might want to go and get an image of your brain and stuff. So I think doing that, I mean, never immediately jumping to the flashy labs and never not doing some type of physical exam. And I think that's the other part that's frustrating in the functional medicine space is that people don't, in the functional medicine space, and I know the T. sclerosian talks about this all the time that they don't do functional exams. Correct. Yep. Yeah. There's, there's typically an absence, you know, it's just more of like, okay, we're here talking and everything else. And like you said, it's, it's sad because there's a lot of females who have issues. I mean, like their ferritins don't even get checked. It's just like, and menstrual cycle, it's like, Oh, you know, like it, it should be gory and and horrible it's like wait what like and it's like what happens to your brain when that happens like do you understand how inflammatory that is and then on the other side you know it's it's the teenagers it's the young adults who really get the shaft with anything neurological and mental health because it you know once you mention anxiety like oh well it's just anxiety you know and then everything's really focused around anxiety treatment But one of the things I see, especially in like, not even just visual processing, but I find when people, their eyes do not perform their job appropriately, they are very prone to anxiety in crowds, in groups of people at grocery stores. And it, And I explain it to people. Maybe you won't agree, but I tell people we have the concept of anxiety wrong in general. We think anxiety is the brain is processing too fast. We must slow it down. But for a lot of the people I see who have all these visual issues, it's that their brain cannot keep up with the outside world. And so it's like they're watching a movie at two, three X speed. And they're just like, look, I just can't do it. I need to leave and retreat. And then next, you know, like, oh, they're anxious or they're super introverted. And when in reality, that's not it. No, you're, you've hit the nail on the head on that because especially in the learning disability. And I can just tell you my own, my own self experience early on in my own childhood would have, with a pretty profound learning disability. And when I couldn't read and I couldn't spell, the last thing I ever wanted to do was be asked to get up in front of a class and try to spell, okay? Or, I mean, if I knew we had, a potential day where we were going to have a spelling quiz, spelling bee kind of thing. And I'd come up with all kinds of excuses not to go to school or whatever and stuff. And so, yeah, so I think that you're right about that. I think that, again, this idea that we have to get away from Well, we have to educate our patients to stop being cool and just get on, you know, and say, Oh, I got all these symptoms. It must be this. Cause then they have this whole perceived self diagnosis. They've self-diagnosed themselves. And then they went and found some podcast or something or anything. And now basically confirmation bias themselves into that. And then you have to go, no, that's not the mechanism. Here's the true mechanism, the multi mechanisms. And I think that's the big thing, too, is that, you know, I think as we've learned from some of the greats that we've learned from them, Again, patients can have a multitude of mechanisms that you're actually trying to go, okay. And I think that's the other big thing that's probably helped me over my years is to say to a patient that, okay, you know, there's probably about five or six different things going on with you right now. And we have to try to prioritize the number one thing. And so, for example, like with the ferritin, okay, and a woman walks in and, you know, they got low iron saturation, they got low ferritin level. And we've always been taught that obviously neurons need three things, glucose, oxygen, and stimulation. And let's say we got underlying anemia. you know, how good is brain rehab going to be in that case, right? Probably not so great. Probably going to run into some fatigue mechanisms when we try to go rehab that brain. So I think in that instance that you're trying to prioritize the situation. So I think that's, for me, my thing now with my patients and why I do my case reviews the way I do them and my follow-ups and say, hey, on a write-up, here's the order that we're going to do things. And that order is may mean we may spend you know and I think we've all heard our other colleague that's our mentor dr yannick talk about this we may spend six week eight weeks maybe three months or four months on step number one you know and hopefully that's you're okay with that but I think the world that we have to fight against now is that everybody gets on these social media platforms and well I heard this person say this and this that's not reality okay they're just trying to rope you into their program or whatever, they're not working with reality patients. I mean, we've seen, I see some of the toughest patients that I know you do as well. And, you know, sometimes we get beat up, right? Sometimes we're like, holy moly, like what else is going on with this patient? You know, why are they not responding? You know, what am I missing? Okay. And I think that that's okay too, because that's how we learn. Correct. Yep. Anything else you want to share with the listeners? Ah, I think we covered a lot, man. I think that, I think for us, I, and I want patients and. listeners to Jan, like you said, is that things are emerging and more than ever. And I mean, I think obviously probably the biggest profound impact that's happened in our lives, in our practice over the last five or six years is obviously the role COVID has played in patients' health and really understanding the concept now of what we call immunometabolism, understanding the role of how you're energy or your metabolic state and looking at so many of the people that were at abnormal metabolic states like your diabetes, your pre-diabetics, your insulin resistance, all your people that had autoimmune disorders, inflammatory conditions, patients that never took the time to check their vitamin D levels or their vitamin A levels. Those people did not do well if they caught COVID wildly or they got the jab. And now we're seeing a lot of downstream consequences of that. And so I think that's a big thing that patients need to, again, start really addressing with their practitioners is, how do I start getting myself more metabolically stable? And am I getting the best metabolic workup? So if you're going to your primary care provider and you're only going to get your basic CBC and your basic metabolic labs, you know, try to ask more or find a practitioner that's willing to go deeper and do all that for you. And then find somebody that obviously has, you know, tremendous experiencing, you know, managing those type of cases. Correct. Yeah. And whenever we talk about, you know, getting more labs, I know a lot of people will come in and be like, I had a lot of labs done. I'm like, how many vials did you get? They're like a three. I was like, okay, thirty dollars worth of labs. I'm like, I'm kind of a nine to twelve vial guy, depending on what we're doing, because there's just so much more depth that can be had than what most people are getting. But, you know, I hope people got a lot from this and, you know, So you've got a clinic in Georgia outside of Atlanta, but you know, if people want to learn more about you, what you do, you know, some of the education that you're teaching, cause you, you do put a lot of information out there. Where should they go? Yeah. I mean, the best way to find me is really just on my Instagram account, Dr. Peter Skyer or my Facebook account. They can find me there. Then we're always posting about, you know, I'm a co-host with Dr. Robert Millel on a podcast called Millel Method Everything Brain. About one or two podcasts a month. I'm a little behind right now because we haven't been able to catch up with each other because of our busy schedules. And then a lot of times, you know, we're teaching together. Right now, we just did a full year-long program back in twenty twenty-four that is now available. online that practitioners can get if they want to learn a more in-depth level of developmental neuroscience and then also the neuroimmunology. I'm blessed that I get to represent Dr. Yannick and share some of his work to practitioners during those courses. and stuff and introduce a whole new age of practitioners to his work. And so, yeah. And so, and then, you know, I think next year I'm hoping to have some other seminars that people have been wanting me to participate in and teach and just be able to teach more of this neuroimmunology to them. Nice. All right. Well, thank you for being here. This was a really good episode. I appreciate it, man. Thanks a lot.