The Root Cause Medicine Podcast · Rupa Health

Hard Case? Start Here. Functional Immunology for Complex Cases with Dr. Sam Yanuck

·1 hr 5 min·4 clips

Sue Swedo’s NIH work connected strep to abrupt behavior changes and dopamine receptor antibodies in the brain.

Dr. Kate Kresge introduces the episode as part of a quiet shift in how the immune system is being understood. She frames immune dysfunction as something broader than autoimmunity or infection. Dr. Sam Yannick joins to unpack that idea. The conversation treats functional immunology as a practical lens for making complex cases easier to read. The discussion then moves into specific immune patterns. Th1 and Th2 balance come up early. Inflammasome activation follows. Impaired autophagy enters the picture as another hidden contributor. The show keeps returning to the idea that patients can look normal on paper and still have meaningful immune dysfunction. Kresge and Yannick connect that dysfunction to migraines, neuropathy, heart disease, and psychiatric symptoms. They also discuss PANS, PANDAS, and autoimmune encephalitis. Those conditions are presented as examples of immune reactions that can surface as dramatic changes in behavior and cognition. Heart disease and gout are also tied to surprising immunological roots. The episode then turns toward testing. Yannick describes the role of detailed histories and targeted labs in building a usable clinical inventory. He notes that functional medicine clinicians often look at inflammation, oxidative stress, CBC values, metabolic panels, iron, and glutathione. He also emphasizes that not everything important is directly testable. Sleep quality is one of the most important non-lab inputs. The discussion cites Michael Erwin’s work on sleep and inflammation. Disrupted sleep is described as pro-inflammatory and Th2-promoting. Deep sleep is framed as anti-inflammatory and supportive of a stronger Th1 response. The episode then becomes more practical. Kresge and Yannick talk about tools like wearable sleep tracking. They also discuss sleep apnea and the challenge of improving sleep when a patient does not want to use CPAP. The show keeps the focus on case-based reasoning rather than abstract theory. A skilled clinician, the episode argues, knows where to zoom in and what to unpack first. The host repeatedly brings the discussion back to what the immune findings mean for a real person. The episode closes by reinforcing the value of a broad, structured inventory and by pointing listeners back to the show’s educational purpose.

As heard by us

A dense but useful map of how immune dysfunction can hide inside chronic illness.

The episode treats functional immunology as a practical way to read chronic illness, tying immune dysfunction to migraines, neuropathy, heart disease, and psychiatric symptoms. Dr. Kate Kresge and Dr.

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Why you'd press play

When chronic symptoms stop making sense, you want a better immune map.

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