PANS/PANDAS is a neuropsychiatric syndrome that has increased dramatically over the past 15 years. Although the name implies it is neuro and psychiatric, the origins of the syndrome very rarely begin in either place. In this presentation, we will show how PANS/PANDAS is not typically just an infection in the brain that leads to the myriads of symptoms including OCD, motor tics, anxiety, amongst many other symptoms. PANS/PANDAS starts with the immune system losing its ability to regulate what is friend vs foe through a process of molecular mimicry. This immune dysregulation is also not by chance, increased intestinal permeability or "leaky gut" increases the amount of foreign material getting through the intestinal barrier. This increases exponentially the amount of material the immune system has to process, which increases the demand and lack of nutrients getting in reduces the energy it has to do it correctly. We will then discuss strategies to improve improve intestinal permeability and retrain the immune response for better regulation and less inflammation.  This will then improve all the downstream symptoms associated with PANS/PANDAS.