The Dr. Hyman Show - Are Your Gut Issues, Headaches, Heart Palpitations, And Other Symptoms Due To Histamine Intolerance?​​

Episode Date: October 30, 2023

This episode is brought to you by Rupa Health, Mitopure, and Cozy Earth.  Histamine is a common term when discussing allergies, but there is really so much more to it. Histamine is both made by the body and found in food. It has a key function in digestion and also acts as a neurotransmitter. People who have more histamine in their bodies than they can break down may experience a variety of symptoms including hives, heart palpitations, migraines, fluid retention, runny nose, and more. Often, histamine intolerance can be traced back to gut dysbiosis and mast cell activation syndrome. In today’s episode, I talk with Dr. Todd LePine, Dr. Leo Galland, and Lisa Dreher about how histamine plays a role in sleep, digestion, allergies, skin conditions, and so much more. Dr. Todd LePine graduated from Dartmouth Medical School and is board certified in internal medicine, specializing in integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. Leo Galland is a board-certified internist, an international bestselling author, and one of the founders of Functional Medicine. Since the onset of the pandemic, he has devoted most of his time to research on Covid-19 and to the education of other health practitioners in understanding the biology of the disease. His latest publication, Long Covid: Prevention and Treatment, is available on his website. Lisa Dreher is a registered dietitian who got her undergraduate nutrition degree at the Rochester Institute of Technology and completed a dietetic internship through Cornell University. Lisa first worked in the acute care hospital setting and became a clinical nutrition specialist working in pediatric gastroenterology at the University of Rochester Medical Center. At the same time, she pursued her master’s degree in nutrition and integrative health from the Maryland University of Integrative Health and started practicing integrative and functional nutrition in private practice before joining The UltraWellness Center in 2015. This episode is brought to you by Rupa Health, Mitopure, and Cozy Earth. Access more than 3,000 specialty lab tests with Rupa Health. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com today. Support the growth of new, healthy mitochondria and get 10% off Mitopure. Head to timelinenutrition.com/drhyman and use code DRHYMAN10 at checkout. Get 40% off your Cozy Earth sheets. Just head over to cozyearth.com and use code DRHYMAN. Full-length episodes of these interviews can be found here: Dr. Todd LePine (histamine intolerance) Dr. Leo Galland Dr. Todd LePine (ending migraines) Lisa Dreher

Coming up on this episode of The Doctor's Pharmacy. People can come in with all sorts of weird symptoms. They have migraines, facial congestion, brain fog, digestive problems, menstrual cycle problems. If you're suffering from any of these issues, it could be a histamine issue. Hey everyone, it's Dr. Mark. Now, I know a lot of you out there are healthcare practitioners like me, helping patients heal using real food and functional medicine as the framework for getting the root cause of the issues. Now, in my practice, this often means looking at lots of internal variables to find the most effective path to optimize health and reverse disease.

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And use the code DrHyman10, just D-R-Hyman10, number 10. Hi, this is Lauren Feehan, one of the producers of the Doctors Pharmacy Podcast. If you suffer from a slew of symptoms that you just can't shake, such as migraines, fatigue, puffiness, runny nose, anxiety, or heart palpitations, it's possible you may be experiencing histamine sensitivity. Histamine sensitivity as well as mast cell activation syndrome are becoming more understood by doctors and often have a root cause in compromised gut health. In today's episode, we feature four conversations from the doctor's pharmacy about histamine sensitivity, how mast cells are related, and how gut health

issues may be driving your symptoms. Dr. Hyman speaks with Dr. Todd Lapine about his experience treating patients with histamine sensitivity and the connection to migraine headaches, with Dr. Leo Galland about COVID triggering a histamine response, and with Lisa Dreyer about how to use the elimination diet to identify irritating foods and heal the gut. Let's dive in. What the heck is histamine? Why should we care? And tell us why it's so important and why it contributes to so many people's unnecessary suffering. So histamine is found naturally in the body. The body makes histamine. We also consume histamine. And the interesting thing about histamine is it is also part, it's released by mast cells as part of our first response to offending organisms like viruses. So mast cells are like a white blood cell?

Type of, exactly, yes. Type of white blood cell. Type of white blood cells, yeah. And the also interesting thing is that histamine actually works as a neurotransmitter. And when you think about this, this is really an interesting thing is that histamine actually works as a neurotransmitter. And when you think about this, this is really an interesting thing. And as I was preparing for this, I sort of stumbled upon some things which I thought was really quite fascinating. Is that when you take antihistamine, what happens to you? You get drowsy.

Exactly. So histamine, when it's at high enough levels, it stimulates the brain. Histamine is actually involved in the sleep-wake cycle. And- Well, I mean, you know, Tylenol PM or Advil PM, it's Tylenol, Advil, plus Benadryl, which is an antihistamine. Right, so it's a balance.

Like, you know, too much histamine is bad, too little histamine is also bad. So when you actually totally block histamine, you actually get sleepy. It'll actually involve with the sleep-wake cycle. And modafinil, which is the drug that people take, that actually works on histamine. It's part of-

Pro-vigil. Pro-vigil, exactly. Actually part of that works on the histamine. So it keeps the histamine levels higher, so it keeps your brain sort of awake, if you will. Incredible. So most people are familiar with certain histamine conditions, right?

If you get hives, if you have a peanut allergy, if you have this condition we call dermatographia, which sounds weird, but essentially it's if you scratch your fingernail on your skin, it'll create a red welt. Yes, yes. You can literally write your name on your back and it'll kind of have raised letters. And that's actually a poor man's way.

I oftentimes will use that with patients to determine how much histamine they're having in the connective tissue because the mast cells are the type of white blood cells that are in the connective tissue of the body. And when they have excess amounts of histamine in them or they release histamine too easily, you will get this thing called dermatographism where you can take your finger and stroke on the skin

and you will form a red line and it'll stay there. And sometimes it'll get really welty and raised. And that will tell you that there is a problem with excess amounts of histamine in the body. Yeah, and it's something that we've all experienced. And when you get a bee sting or something like that, you'll see this raised welt. But what happens for some people,

they don't necessarily get the hives and they don't get these raised welts on their skin, but they do suffer a whole range of symptoms. So when someone walks in your office, what are the clues that alert you to the fact that they might have a histamine problem? Because by the way, most traditional doctors don't even know anything about this syndrome.

Yeah, if you have allergies, take an histamine, but that's about it. But there's a whole host of problems that people suffer from that are mostly misdiagnosed poorly treated and create so much suffering which is unnecessary yeah and there's a there's a term out now which um when i was in medical school we didn't even have it it was called it's now called mcas mass cell activation syndrome like it's a syndrome. Like it's a real medical diagnosis. It's a real medical diagnosis. I mean, we're seeing a lot of it now.

And the question is, is why are we seeing so much mass cell activation? And I've been puzzling on this myself. Yeah, I never took that class in med school. I know, right, exactly. But it's true, it's a big thing now. We're seeing a lot of it. And it's not like there's one cause

for mass cell activation there are multiple causes and and i actually even in i deep dived into the literature one of the things that i stumbled upon was the effects of emf on mass cells emf emf is electromagnetic frequencies so like your cell phone background cell towers wi-fi absolutely absolutely and there's some uh there's some work by a woman, Johansson, out of, I think it's Sweden, who's done some work on the effects of EMFs on mast cell degranulation. And there's some good studies showing that EMFs are one of the things in susceptible individuals that cause their mast cells to release more histamine that drives this allergic

inflammatory response. So that's fascinating. And so what, when, one of the sort of symptoms that you see people coming in with? Well, they oftentimes will react to every food. They're sort of the people who they can't, they have a more and more restricted diet because the more foods that they eat, it'll trigger because lots of foods contain histamine or will get broken down. Histidine is an amino acid. And when you consume foods that are high in histidine, things like meats have a lot of

histidine, your body will actually break it down into histamine. And normally the body can process that. But when you have problems with either too much ingestion or too much production of histamine or not enough breakdown of the histamine, then you'll have problems with histamine intolerance. And these are typically a lot of people who have food allergies. And Mark, I think you've done this yourself. This is really interesting is the old way of treating food allergies was what? Chromalalin sodium, right? Remember using that? And it's actually a pretty good treatment for people who are really, really reactive to foods and the way that chromalin sodium,

because chromalin is actually used for patients with asthma. Yeah, you inhale, it's an inhaler. It's an inhaler, exactly. And it's a very effective drug. For really bad cases, chromalin sodium can be very, very helpful for patients who have a severe of

Histamine responses to foods and it's true and people can come in with all sorts of weird symptoms that just are mistaken of they have headaches They get migraines. Yes, well congestion sinus issues fatigue brain fog brain fog digestive problems menstrual cycle problems Yeah, nausea vomiting and if it's really, you can get really bad cramping, you can get edema, tons of fluid retention, palpitations, anxiety, your temperature regulation is off, dizziness. So a lot of people come in with all these weird symptoms. I don't know what's wrong. I'm taking an antidepressant. But there is a way to diagnose this. And so if you're suffering from any of these issues, there may be that there may be a chance that it could be a histamine issue. Yeah.

And when you have someone who comes in with all these symptoms, and by the way, a lot of people have edema and fluid retention. You can just stick your finger in their body and their tissue. You can feel it's puffy and swollen. You can get edema in the legs. You can see just people carrying a lot of extra weight and fluid. There's often some type of histamine activation there. Well, sure, because, well, the mast cells,

which are the cells that contain histamine, they're actually found in the spaces, the interstitial spaces in the connective tissue of the body. So that's why they get puffy, because those are where those cells that are high in histamine reside. And it can really be something that leads to chronic fatigue syndrome, this mast cell activation issue. It's a big deal. And most of the time, it's just completely missed. Yeah.

I mean, if you ask the average doctor, say, Doc, I think I have mast cell activation syndrome. Can you please get me the test and diagnose me? They're going to go, I don't know. Yeah. You know, let me check your histamine levels. So when you have a patient with this, how do you begin to think about diagnosing this? Because, you know, it can be a big deal for people. And I want to share a case later. You're going to share some cases of some patients who suffered for decades, decades, and finally get better when we treat them. Yeah.

Well, again, we talked on the last podcast about the role of leaky gut in the microbiome. Interestingly, when you have dysbiosis, some of the bacteria will actually cause more of your body to produce excess amounts of histamine. So that's another thing where when the histamine is in excess in the digestive tract, that can be related to food consumption, which are high foods in the histamine, or the bacteria are actually causing the breakdown of histidine as an amino acid to go into histamine. So dysbiosis is one of the things

that can trigger excess amounts of histamine. That old nasty gut thing again. We're just talking about the gut here on the Doctors Pharmacy podcast and especially on our house call episodes because it's such a fundamental thing and it's such a fundamental thing and it's connected to everything.

And the microbiome is so critical in so many aspects of our health. And I remember when we started doing this, Todd, decades ago, and we'd say, oh, people have a leaky gut or there's problems with their gut flora, they have dysbiosis, they would just laugh at us. Literally, doctors would just laugh at us and think we were completely crazy.

And yet it is now one of the most important areas of research in medicine is the microbiome and understanding leaky gut. And you see all kinds of papers in scientific literature using the term leaky gut. And I'm like, wow. I literally remember sitting, it was in 1997 and I was at Canyon Ranch

and I was having dinner with some guests and there was some doctors in the crowd and we were having nice dinner and I was talking Canyon Ranch and I was having dinner with some guests and there was some doctors in the crowd and we were having nice dinner and we were I was talking about leaky gut and the woman this woman was an allergist so her specialty was allergy and things like this to me and she looked at me and she's you're just completely nuts there's no such thing as leaky gut you know this is just a bunch of you know what and and I just was like looked at her like oh boy you know and it's now you know 25 years later yeah and medicines really, looked at her, I'm like, oh boy. And it's now 25 years later, and medicine's really come along. It takes a long time, but people are still struggling.

And I think the obvious, the worst sort of case scenario of a histamine reaction is obviously anaphylaxis, right? But it doesn't have to be that. So talk about how we begin to diagnose it. We look at what tests besides a SIBO test? Well, you can measure histamine in the blood. You can also measure tryptase, which is another marker for mast cell activation. You can also measure, there's another test, which in my preparation for this, I've not measured, I haven't found the lab that does it, but it can be measured as N-methyl histamine, which is a breakdown product of histamine. That is another one that can be done. And then, again, I think one of the tests for me is dermatographism.

I find that a very helpful clinical test to determine if a person's mast cells in interstitial spaces are overly reactive and releasing lots of histamine. Yeah. And we also do a test for DAO deficiency. Yes. Yeah. So talk about what that is. DAO is an enzyme, right? Yes. So DAO is a diamine oxidase. So this is an enzyme that our body has, and it helps to break down histamine. So histamine has to be consumed, it's used, and then it has to be detoxified. And if this enzyme is lacking in a person, for whatever reasons, the enzyme may be turned off, you will have problems with detoxifying histamine, especially in the gut.

So, and there are enzyme products that you can use, DAO enzymes that you can use, that patients respond very, very well to this. Yeah, we do that here at the Thelta Wellness Center. We give people hist-DAO and enzyme support. And it's interesting, there's a lot of things we do every day that block DAO production. Absolutely, yeah. Alcohol, black tea, green tea, which is a good thing,

mate, energy drinks, these all block DAO production, so it's gonna increase your histamine intolerance. Yeah, exactly, yeah. And then you can use antihistamines. And the other thing, we had another podcast earlier on migraines. And I found this also very interesting is one of the things that is a histamine blocker is Butterbur. And Butterbur is used in migraines. And the reason why Butterbur works in migraines is it actually is working on an antihistamine level. Because you can get an allergic brain, if you will.

We know about that where you get fuzzy in the head and you can get headaches and things like that. So excess amounts of histamine has an impact on the brain. Yeah. And so when you see these patients, you can do some of the genetic testing, look for these DAO deficiency issues. You can look at histamine levels. You can look at some of these byproducts. You can do tests for DAO deficiency. You can look at some of the other factors that might be causing it, like leaky gut,

food sensitivities. All that is really part of what we do here at the Alta Juana Center when we check these patients' history and we look at their lab tests. And then when they come in, you sort of, you have this suspicion, because sometimes it's hard to diagnose, you have a suspicion, like, it's pretty easy to sort of test and try different approaches

that allow people to see if it's an issue. So what are the dietary things that we'd start with? Because a lot of histamine triggers are in the diet. Right, and so we can have a low histamine diet. So what's a low histamine diet? Well, foods would- Or what actually are, put it this way, what are the foods that have the highest histamine that we should be avoiding? Yeah. So basically the way to think about it is bacteria produce histamine. So if you have

food that's old, if you have food that's sitting in the refrigerator for a couple of days, guess what happens? The bacteria actually break down histidine, the amino acid, into histamine. So no leftovers for these people. Leftovers, exactly. Leftovers, exactly. Oh boy, I live on leftovers. Or maybe just like the next day. And then fermented foods. Fermented foods are fermented by bacteria. So anytime we have food that's old or fermented, things like Parmesan cheese, aged meats, et cetera, cured meats, et cetera. They have high histamine, and that's part of the fermentation process.

And yet we talk about fermented foods being so good for you, like sauerkraut and kimchi and natto and miso. Exactly. And this is where these really good foods in someone who has histamine intolerance is like putting gasoline on a fire. And they'll say, well, I'm getting worse. It's like, well, no, you should be getting worse. These are good foods for you. No, you have histamine problems. What I was saying was good for the gooses and good for the gander, right? I think this is so critical what we're talking about here, Todd, because functional medicine is personalized medicine. It's precision medicine. And it's not only medicine, it's precision nutrition.

So it's really important to understand that even though this way of eating may be great for some people with fermented foods and eating avocados and having delicious shellfish. Bone broth. Bone broth. That's another one. Right. We think, oh, these are great foods, but you might be killing yourself. Of course, alcohol and beer and all that is a problem.

Wine. But we're really here focused on what is right for you. And I think dietary dogma really interrupts personalization and approach to nutrition. Some people do great on vegan diets. Some people do terribly. Some people do great on keto and some people do terribly. So there's no one size fits all approach.

And what really frustrates me, Todd, and probably I imagine you too, is that there's all these people out there on the web and internet and promoting this and that approach and this and that diet, and they're not seeing patients. Yeah.

And the thing about seeing patients is it's incredibly humbling. If you've seen tens of thousands of patients, you can't be dogmatic. Absolutely. You can't say, this is the way. You have to be vegan or you have to eat meat or you have to eat fermented foods.

It's like, you go, wait a minute, everybody's different. Yeah. And what works for one may not work for another. Yeah, one man's food is another man's poison. That's right. And even good, quote, good foods. You know, we're talking about good foods. Yeah. And so I think this is a really important point, particularly when people have histamine

issues, which is a lot of people at some level or another, they should consider trying a histamine free diet. And also other foods that we think are also great, maybe triggering histamine like papayas and chocolate. Oh my God, chocolate, which I love, would be terrible to get this condition. Dried fruit, certain nuts, food dyes, additives, you know, white germ. White germ is supposed to be health food, right? Tomatoes, bananas, all these things may really cause increased histamine production.

And sadly, you know, in order to get this under control, sometimes you need to be restricting some of these foods for a while to allow your body to heal. It's not forever. That's the thing is, I think you're absolutely absolutely right like an elimination diet is not something that you do forever and a low histamine diet is also something that you don't necessarily have to do forever and i i think that the key thing is really working with a really good well-trained experienced functional medicine nutritionist who can help you navigate all of the nuances of what to eat

what to avoid uh what what what to take in terms of supplements can be very, very helpful. Absolutely. And the things that we want to focus on, if you have histamine intolerance or foods that are low in histamine, like fresh, really fresh food is the key, right? Not old food, like you said. Fresh meat, freshly caught fish. Not fish that's been sitting around for a while or canned fish is not necessarily good. Fruit that's not citrus fruits. Eggs are great. Not gluten grains. Get away from the gluten. But quinoa and black rice. Not dairy. Avoid dairy, but you can have coconut milk or almond milk. Lots of veggies, but no tomatoes, avocados, spinach, or eggplant, right? So you've got to be smart about this. And it's a little

complicated and often you need help with the nutritionist. All the good oils and fats that we like, those are all great. So, you know, it's pretty much how I eat. I mean, I do eat avocados and certain things, but I really pretty much eat protein and vegetables and it works so well for these patients. Hey everybody, it's Dr. Mark. Getting quality sleep is incredibly important to me. Sleep is really one of the pillars of good health. So you can imagine my frustration when I used to lie down at night, but couldn't fall asleep because I was just too hot. But those sleepless nights are behind me now thanks to Cozy Earth. The bed sheets are made from temperature-regulating fabric

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go to CozyEarth.com and use the code Dr. Hyman. That's D-R-H-Y-M-A-N. And now let's get back to this week's episode of The Doctor's Pharmacy. And there's a condition called the mast cell activation syndrome. It's been getting increasing attention, certainly in functional medicine over the past several years. Mast cells are these large kind of primitive cells that don't circulate in the blood. They're in the tissues. And they release a couple of hundred different chemicals, including histamine. Now, the role of histamine in long COVID has gotten some attention because the use of histamine blockers, drugs like Pepsod, have been used to treat it.

And low histamine diets have sometimes been used. If you look online and you go into chat rooms, people will talk about the benefits of low histamine diets. There's this phenomenon of mast cell activation that occurs, and it's very much tied in with POTS and with some of the neurologic dysfunction that occurs. So mast cells we think of as typically in allergies, right? When you have allergies, your mast cells increase histamine, which then creates this sort of hives and allergic symptoms.

That's what you're saying happens as part of post-COVID for people? Yes, except that this can happen without hives. Mast cells in the skin, for example, are very different from mass cells around blood vessels. The mass cells around blood vessels or in the GI tract, they react to blood platelets and to blood clotting, whereas the skin mass cells don't. So this whole blood vessel inflammation, blood clot phenomena, that can impact your gut, or it can impact your organs, internal organs, with no effect on your skin. You might have redness, but you're not necessarily going to get hives or the more obvious symptoms of mast cell activation. In my experience, I would say that the people who do not respond in a smooth way to the program that I use or who are the most disabled almost always have mast cell activation as what is taken over. And so you have

to address that directly. You mean with antihistamines? Well, okay. So there's a whole series of things that are done. And what conventional specialists in mast cell activation will do is they'll start you with an antihistamine, you know, any of the ones that are used, Claritin, Zyrtec, Allegra. And sometimes those are helpful. Sometimes they're not. One of the rules of mast cell activation is that there are no rules. You can, anything that may help you can make you worse. Yeah, interesting.

And because the mast cells kind of become like loose cannons in this situation, and you never know what exactly how they're going to respond and what they're going to do. So you have to go very slowly, very methodically. So how would someone know if the mast cells are going on and activated in their post-COVID phenomena? There are some blood tests that can be helpful and some urine tests, but they're not very sensitive. So you can have, certainly we'll look at plasmahistamine. We'll look at an enzyme called tryptase that's produced by mast cells. But as I said, there are 200 different chemicals that are produced.

And unless the timing is right, you may miss the peak of those chemicals so ultimately it is a clinical diagnosis based upon uh the nature of the symptoms the pattern the response to treatment so you mentioned like four so that's one of them what monocyte circle. In the tissues, they're called macrophages, which means a large eater. And these are cells that gobble up bacteria and viruses and damage cells. And they have important regulatory functions that are definitely imbalanced. I call it the phenomenon monocyte polarization, but they're imbalanced in long COVID. And I think we can trace a lot of that imbalance directly to the ACE2 deficiency and to some extent to the mitochondrial dysfunction. So it's not as if the mass cells need to be treated on their own. The monocyte macrophage polarization, that will usually respond if you deal with the other factors.

Then there's the production of autoantibodies. So that involves a type of cell called a B lymphocyte. B lymphocytes produce antibodies. Antibodies are proteins that your body makes to protect itself basically from foreign invaders. I would say I view antibodies like the artillery. You know, they get the cells themselves are not involved in the combat. The cells produce these antibodies that fly like cannonballs to be involved in the combat. And one of the phenomena that occurs in COVID-19 is the production of autoantibodies, antibodies that recognize your own cells and components of your own cells. There are many reasons why this happens and part of it is that there are proteins in your body that are similar to the proteins that are in the virus and so there's this confusion the

in the immune system and as many as 20% of people with COVID-19 may be making these autoantibodies. There's a lot of debate as to how significant they are. There's some people, because often the autoantibodies kind of need inflammation to be activated. They're just, most of the time, if the inflammation calms down, they're just there. They're not doing anything. But there are some people for whom they really become part of the problem. That is, aside from calming inflammation, that's very hard to treat on your own. You need a, you know, You'll need a medical professional to treat that. And probably the most effective treatment that I've seen so far has been intravenous gamma globulin, IVIG, which ties up these antibodies.

So the antibodies, you're giving antibodies with IVIGs. So how does that work? Because you're giving antibodies with IVIGs. So how does that work? Because you're giving immunoglobulins and you're trying to fight the autoantibodies. What they do is they tie up the autoantibodies, basically. They kind of bind them up. Yeah, they bind them up. See, there's a complex phenomenon called immune networks in which antibodies recognize proteins called antigens, and they bind to them. But in doing that, they can damage your tissues.

There can be fallout from that. Also, the antibodies can themselves act as antigens and stimulate other antibodies against them. And you get this kind of feed forward cycle of antibodies to antibodies and then antibodies to the antibodies to antibodies. And sometimes that actually helps to control inflammation and damps it down. But sometimes it aggravates the inflammation. It all depends on the specifics of the individual case. So that's a very complex area which no one can navigate on their own. We don't have the tools for self-care there. However...

And you can measure these different antibodies though, right? Yes. What are the common antibodies that we see? Well, the one that I've seen in terms of what you can measure through a standard lab, the ones that are most common are the antiphospholipid antibodies. And those are significant because they may be contributing. There's this phenomenon called antiphospholipid syndrome in which you get blood clots. So they may be aggravating the blood clots. But there are other antibodies that are only identified in research labs or in highly specialized clinical labs.

You know, there's like one lab in the U.S. and one lab in Germany that will measure these. And some of these are antibodies directed against. They're not specific to COVID-19, but they're autoantibodies. Some of them are. The ones that may be specific to COVID-19 are antibodies directed against ACE2. This was research done at the University of Arkansas. And these were functional,

that is, they were interfering with ACE2 function, and they developed in people who had been hospitalized in almost 80% of people, but in people who had relatively mild infection and were not hospitalized, about 5% of people. So they may play a role. However, most of these antibodies are only active if there's cell damage and inflammation. So if you can calm down the cell damage and inflammation, the autoantibodies don't make a difference. And that's one of the goals. And then the fourth type of cell are the T cells, T lymphocytes. So T lymphocytes are kind of the generals of the immune system. They are the most evolved cells. They have the most complex sets of functions, and there are many different types of T lymphocytes, and one type can morph into another. And it is very clear that there's dysfunction

of T lymphocytes in COVID-19, but it isn't clear exactly what, it may not be the same in everybody. And maybe the most intriguing study that I saw was a study from Northwestern University where they took people with what they call neurologic, neuropask. Pask stands for post-acute sequelae of COVID. It's another word for long COVID. And they took people with neurologic symptoms, which included chronic fatigue. I mean, the chronic fatigue is often a neurologic symptom. So they took people with fatigue, with POTS, with other complications, and they found that there was a major impairment of a group of T lymphocytes that are called TEMs, T-effector

memory cells. These are cells that are really important for antiviral immunity. They remember what you've been infected with, and they go after the cells that harbor them. And they are T-effector memory cells are the cells that keep viruses in check. Epstein-Barr virus, for example. Yeah. Okay. Everybody in the world gets infected with Epstein-Barr virus during the course of their life. It never leaves your body.

It stays in a dormant state, actually living in B lymphocytes. And what keeps it normal is the activity of these T effector memory cells. When those cells take a hit, Epstein-Barr virus gets more active. That's why antibody levels go up. And I think there's a widespread misinterpretation of the significance of increasing antibodies to EBV in people who have had COVID. So I've seen it even in people who are asymptomatic. It's a sign that the effector memory cells, the T effector memory cells, took a hit. Yeah. And so the B cell memory kicks in to keep the virus under control.

It's a sign that you need to activate, that you need to support T effector memory cells. They happen, by the way, they happen to love fat. They love on fat. They run on fat, fatty acid oxidation. They don't like sugar, those cells. So you need to support them with an adequate amount of fat in your diet. Inflammation likes sugar and cancer cells like sugar and that metabolic pathway that is activated when the immune cells are multiplying fast and, you know, yeah, that runs on sugar. It's a complex kind of phenomenon. But when you want to calm it down, you really, you know,

you need the fat. I've had people who had, you know, chronic daily migraines or, you know, 20 days a month. And it's just so awful for people especially especially in women women are tend to have a little more i think in general women uh i probably see more women with migraines than as opposed to men and then women also get menstrual migraines which is another sort of flavor of migraines which is another i probably relate to estrogen detoxification um so it really is it's it's and it's actually it's it's it's it really keeps me on my toes in functional medicine when I see a migraine patient because it's not like, oh, here's your problem, just do this and it's fine. I've got to play detective. I've got to figure out what are the factors that are driving that person's unique presentation of their migraines. That's absolutely right. Because what, what we do in traditional medicines, okay, you have this type of headache and I ask these questions and it meets this criteria for what a migraine headache is according to the neurological society criteria. But once you make the diagnosis, there's no more thinking involved. It's like, okay,

here's the cocktail of drugs I get to pick from. Yeah. Start with these, try this, that doesn't work, we'll try this. And it's just like, it's kind of a merry-go-round of drugs i get to pick from yeah start with these try this that doesn't work we'll try this and it's just like it's kind of a yeah a merry-go-round of drugs and and it often is is so difficult for people to get better oh yeah because they're not asking the right questions so in functional medicine we don't just name and blame which is what our mentor sydney baker talks we name it blame it and tame it you name the disease and say oh you have a migraine that's you have a migraine. That's why your head hurts. No, that's not why your head hurts. That's just the name of why your head hurts. And then we try to tame it with a drug instead of actually figuring out the cause. So, let's talk a little bit from a functional medicine perspective about what the causes are and let's get into some cases because I think we've both seen so many cases.

It's one of the most satisfying things for me as a doctor to actually treat because it's so easy usually and people do so so well with simple approaches that deal with the root causes yeah absolutely yeah so what tell me what what are the things that you think of when you're coming to see these patients that could be driving the the uh the migraines well one of the things that I think is missed by a lot of mainstream doctors, even neurologists, is to understand the role that mitochondria play in migraines. So interestingly, mitochondria, which are the powerhouses of the cell,

they basically is where when our body consumes food, we produce energy from that food in the form of ATP. And mitochondria are not really tested by mainstream medicine. They are not well understood. It's something that you learn about in medical school and then you forget about it. And the interesting thing is that people who have migraines also have a higher incidence of seizures. And that's why to some degrees anti-seizure medications can actually have efficacy in some patients who have migraines. have a higher incidence of seizures. And that's why, to some degrees, anti-seizure medications can actually have efficacy

in some patients who have migraines. So there's a real important to realize that connection between mitochondrial dysfunction and migraines. Mitochondria make energy in your cells. Make energy in your cells. In fact, I've actually seen some patients, interestingly, who, and I don't see, I don't treat children, but've actually seen some patients, interestingly, who, and I don't see, I don't treat children, but I've seen some adults, when I go into their history, they had a history

of what is called cyclic vomiting syndrome. And so that's where a young kid is vomiting for no particular reason. And it turns out cyclic vomiting syndrome is actually a mitochondrial problem. And as a person gets older, they sort of outgrow that vomiting episodes, but they actually then present with migraines. And interestingly, the gut is connected to the brain. So a lot of people can have what we call abdominal migraines. Yes. Exactly.

Right. Yeah, this reminds me, Todd. I had a patient who struggled with headaches and migraines, and she had terrible SIBO, which is overgrowth of bad bugs in your small intestine that was causing all this fermentation and creates these toxic byproducts that were clearly creating inflammation in the brain. And we treated her gut with antibiotics to cure migraine. But who would have thought of that as a neurologist, right? Exactly.

Yeah. And it's also the other interesting, we're going to talk about that in one of the upcoming episodes is on histamine, the role of histamine. And that's actually a very interesting thing when you look at histamine, because people who have SIBO, they actually have bacteria that are producing toxins, like you're talking about. And one of the problems is excess amounts of histamine. So normally our bacteria will degrade histamine, and we have enzymes that do that. And there's all these different pathways. And when you look at some people who have migraine headaches, there are certain foods which can trigger a migraine.

So is it the food that's doing it or is it something in the food or it's how the food is actually being metabolized? So that's a really key important feature is that the connection between the gut, our food and the brain. Yeah. I mean, it's such a big problem, Todd. You know, the amount of people with migraines, over 10 million people have migraines. It costs about $17 billion a year to society in healthcare costs, just direct healthcare costs. That's medications, emergency room visits, hospitalizations, doctor visits, testing, and then even managing the side effects.

And then the loss of productivity to employers because like you were saying, it's $15 billion, about half that's due to absenteeism, and the other half is due to just people being on the job but not, being at the job but not on the job. You know, they're just sort of there but not functioning absolutely and so you know over the years of functional medicine i i've seen so many patients and and like you said before there's so many different flavors uh tell us about some of the other flavors because we went through the mitochondria and let's just go to go down the list of what are the the most common things because you know like there could be 29 things but there's a few that are really common stress stress stress okay tell us about stress and so so so so stress by itself does not cause

any diseases but stress can turn the volume up on on all different kinds of conditions we see that in autoimmune conditions so how our bodies respond to stress and some people have um i would call it a genetic predisposition to be more stress resilient. And some people don't. And some people are more prone to the effects of stress. And time after time, you know, you see these people who they'll go through a very stressful period. All of a sudden, they get a full-blown migraine. Well, what is that?

What's going on there? And I think it is how that person perceives the world and how they detoxify their stress. Absolutely. And that's why, you know, beta blockers, which block adrenaline, which you get high levels of stress makes a big difference. So things like yoga, meditation. Exactly. And then also sometimes when you have patients who have migraines and you

measure their cortisol levels, they've got higher levels of cortisol. So that's telling you they're having some more chronic stress. And there's, you know, they sometimes will be type A where they're sort of very, very driven, those kinds of things. So you mentioned gut issues a little bit earlier. And I think that's another big one and not just SIBO. But, you know, there are a lot of symptoms that people get that could be related to leaky gut and food sensitivities,

which seem to be a huge factor with migraines that are really undiagnosed. We know traditionally that all people say, scientists and doctors say stay away from tyramine foods, those are the things, cheeses, foods that contain certain chemicals like MSG or aspartame. So there are some recommendations, chocolate, caffeine. There are doctors who do say some of these things

and that can be helpful for some patients, but it goes much deeper than that. There's like food sensitivities and gluten. So tell us about, you know, how that, how that works. Yeah. Well, I think that, you know, the connection between the gut and the brain is huge and the leaky gut component, you oftentimes will see leaky gut in patients who have increased risk for migraines. There's definitely a two-way communication that's going on there. And again, you know, sleep is another thing that plays a huge role. So lack of sleep is huge in migraines. So when you look at, when somebody comes to see me, you know, I ask them,

how's your stress level? How are you sleeping? And what are you eating? And who are you feeding? Which is what's going on with the gut bugs. You have patients who will tell you that when they eat certain types of foods, like sugar, they'll trigger a migraine. It's huge. And I suspect that some of those foods are actually affecting the gut microbiome in a

very rapid fashion that's causing migraines. Yeah. One of the biggest things I've seen, I'm sure you probably noticed this too, is that gluten tops the list when it comes to migraines. If anybody has a migraine, the simplest thing to do is an elimination diet. Absolutely. And get rid of the most common allergens, gluten, dairy, eggs.

And I've seen so many people i had one woman she was married to a mafia don and she had headaches for 40 years and was incapacitated in bed very often and it turned out that it was eggs yeah now we found this on a food sensitivity test and uh that's not to say everybody's migraine is caused by eggs but hers seem to be triggered by eggs she stopped the eggs and her migraines in a way yeah so i think you know everybody's different like you said we have to treat the person not the disease absolutely i think thomas uh i mean uh what is it um uh william ulcer said that you know we should treat the the person who has the disease not the disease that the person has. And I think

that's the mistake we make in medicine. So doing elimination diet, getting food sensitivity testing, checking for gluten, that's all important. The chemical triggers, you know, we talked a little bit about that. Talk more a little bit about some of these chemical triggers that we notice with migraines. You mean like exogenous chemicals? Things like aspartame, artificial sweeteners, food additives, sulfites, for example.

I would say that, you know, the, the, the, those are basically excitotoxins. There's, there are certain types of foods which can cause excess activity,

like monosodium glutamate. You get, you know, excess glutamine in the, in the brain. Cause glutamine gets converted into glutamate, which is an excitotoxin. So definitely there are,

you know, those, those types of foods. And even if you you actually if you give somebody glutamine which we use a lot to help with the patient i've had these patients who they'll they'll they'll metabolize their glutamine directly into glutamate and you'll get taking glutamine it'll be just like taking msg they'll get very you know agitated and get a headache aspartame is bad i've seen so many patients who oh aspartame yesig back those diet sodas and they get- We have somebody in the White House who does about, I think about 10 a day.

I don't know if he's getting migraines, but he's giving everybody else a headache. But I think that you're right. I think we have to really look at these things. The nitrates that are in, for example, deli meats, sulfites that are commonly added to salad bars, you know, just keep the vegetables fresh or the dried fruit and wine, tyramine was in chocolate, cheese. These are really significant. So getting rid of all the processed food, all those chemicals, super important.

So the IgE is an immune reaction. Intolerance, a lot of people might think, okay, lactose intolerance, even fructose intolerance or histamine intolerance or intolerance to sugar alcohols. These compounds that are poorly digested and absorbed and can lead to symptoms such as abdominal pain, diarrhea, headaches. Yeah, you eat ice cream and you get gas, your stomach blows up, you feel like bad and you get diarrhea. That's not an allergy. Right. That's not an allergy. It's a little bit different than a sensitivity, which I'll explain. But these are a little bit easier to pick up on. The symptoms usually show up within an hour or so

after eating the food. Like you said, eat milk, drink milk, then you're in the bathroom not too long after. And there are also these things like other reactions that are not even related to intolerance, like for example, MSG or aspartame, which are the excitotoxins. Yes. So these are compounds that, you know, do have reactions to the body that are not really immune related. They're more related to the neurologic effects of the amino acid-like compounds that can alter your brain function and give you headaches or make you hyperactive.

Brain fog, all that. Yes, exactly. Migraines. So there's that whole series. And then I would argue probably the most common, but the hardest to pick up on are the food sensitivities. So going back to the IgE reactions, these food sensitivities are IgG and IgA. So just the different way that the body reacts, in fact, IgGs are the most common antibodies in the body. So-

These are delayed. It's not like- Delayed, exactly. If you eat a peanut, you know, you're going to know within minutes. Yes. If you eat, you know, let's say you have, you're allergic to like, uh, I don't know, like onions. It could be gluten. Or maybe it's, you know, any, you know, eggplant. Right. And you feel sick three days later. You're not going to know that it was from- It's several hours or days. Yeah, it can be hours or days later.

So you're not always going to connect the dots. Right. And unless you're writing down everything you eat. I know if you ask me, what did you eat two days ago? Unless you're eating the same thing every day, it's going to be very hard to- I ate an artichoke. I ate an artichoke with some sauerkraut. So no, it's very hard.

So if you have these, the other thing that makes it difficult too to pick up on this is the symptoms range so broadly. So it's not like, oh, I'm going to have hives and swelling of the lips. It could be anything from brain fog, hyperactivity. It could be depression, anxiety. It could be weight gain. It could be F, anxiety, could be weight gain, could be FLC syndrome, feel like crap, right? And it could be anything else, really. Sleep, depression, mood changes, eczema, acne. It's so much, right? Eczema, yes. So much. So hormonal changes, menstrual issues. Joint pain. Joint pain, aching. And so a lot of people don't associate so many of these symptoms with the food that they've eaten. Sinus issues, allergies. Absolutely. Changes, it could be GI, it could be

changes to the bowels, it could be constipation, diarrhea, abdominal pain, but again, it's not so acute. So it's difficult to recognize which foods are associated with that. And we do check here at the Ultra Wellness Center, we do have testing to check for these IgG, IgA antibodies, but there's no one test that's perfect. There's no one test that checks every way that a food can interact with somebody or cause these symptoms, which is really why the elimination diet continues to be the gold standard. And that's what we do pretty much with all of our patients. Yeah, there's even another response, because what you're talking about is antibody responses that the body creates. And antibodies are sort of like smart bombs. They're specific, right? So you get an antibody to dairy or an

antibody to eggs or an antibody to chicken, right? Corn, whatever. Corn, whatever. But there's another part of your immune system. It's the ancient immune system. It's your primitive immune system, like we call it your innate or cell-mediated immune system. And that creates a sort of a general response. And you can't measure that. And it just creates this just generalized inflammation. And it can be to anything. And also gluten is commonly causing this type of innate immune response, which is really hard to measure. So even if you check for gluten antibodies or celiac, you'll miss it. You may not pick it up. Right. Exactly. No, that's very true. And there are many reasons why we can have these types because we're always thinking in functional medicine, why? Why is this happening? Yeah. So why do people get these weird

sensitivities? Because it seems like odd that we would be reacting to all these foods that we should be eating and they're actually probably even good for us. Like, that we would be reacting to all these foods that we should be eating and they're not actually probably even good for us. Right. Why would you be reacting to an egg? Yes. Or, you know, kidney beans. All these things. Or strawberries, like you said before.

Strawberries. It's like they're good for you, right? Such a wonderful food. Right. Well, there are a number of different reasons. And I would say in relation to sensitivities specifically, number one, you think about what's the variety in our diet? Our diets are becoming less and less varied. Okay, I don't even need to preach to the choir here, but just with subsidies and just all of the foods, it's like you go into the supermarket and they're all made with the same five basic ingredients.

I mean, 90% of our diet is 12 plants and 60% of our diet is three plants, wheat, corn, soy, and rice, depending on where you're from. Exactly. So the lack of variety really, really is a problem. But also if you're eating a high quantity of certain foods, let's say it is eggs, which eggs are a wonderful food, very high in nutrient density, but they're a higher allergenic potential food. So if you're eating multiple eggs every day, and I talk to people who do this because they love it and it's easy and it's quick, but eventually with enough exposure, those proteins can start to become what the body interprets as an invader. So it can begin to develop a sensitivity if there's not enough

variety and rotation in the diet. But then you also have to think about the gut microbiome. How balanced is it? Do we have dysbiosis or lack of balance of gut bacteria? And how can that be influencing the inflammation in our gut, the integrity of the lining of our gut, all the things that can lead to leaky gut or intestinal permeability, herbicides, pesticides, overuse of medications, non-steroidal anti-inflammatories, antibiotics. I mean, the list goes on and we're all bombarded with this all the time. Okay. You just said something really important, Lisa. You said leaky gut. Leaky gut.

So I want to backpedal on that. Yes. What is leaky gut and why should I care? Okay. I love explaining this. It's like you can really get the visual because our gut really there's- It sounds kind of messy, actually. I don't know. I mean, it kind of can be. I don't know if I want the visual on this one.

I'll make it. I won't get too crazy with it. So what we eat- There might be children listening. What we eat and what we drink, we want those things, especially what we eat, to break down to their basic molecules. We want the vitamins, the minerals, the, to break down to their basic molecules. We want the vitamins, the minerals, the amino acids, all these things that our body needs to be absorbed.

And we need everything else to get excreted in the stool, urine, all that. It's like a big filter. It's a filter. Exactly. It's a protector, which is why 70 to 80% of our immune system is in the lining of our gut because so much goes through there. So there's one, there's basically one cell thick that helps protect us between what else, whatever's in there, all the toxins and everything. It's like a sewer. Yes, it is a sewer, right? And everything else that gets absorbed, there's this one cell lining that we need to be, you know,

we want those cells to be tight together. Unless we give that, unless we're in a place where those foods are completely broken down and then those gaps can open up a little bit, allow some of the amino acids and all the vitamins and minerals to go through, we absorb them and we utilize them in a perfect world. But all these things we're talking about, herbicides, pesticides, medications, medications all that and certain foods can actually cause gaps to form in between the cells inappropriately and allow larger protein molecules from our food as well as bacteria viruses all the things that are in our gut to start leaking through into our circulatory system into our blood where it shouldn't be and then our body sees that

as an invader because technically it is it shouldn't be there And then our body sees that as an invader because technically it is. It shouldn't be there. It should be in our gut. And so there's that in and of itself is leaky gut. Yeah. I think like so your gut lining is a coffee filter, right? Yeah. So you want the coffee, you know, it's good stuff to go through the coffee filter, but you don't want the grounds in your coffee. Exactly. So if the holes are too big, then all this coffee grounds end up in your coffee.

It's not so great. And the reason the lining is there is to allow the right stuff through and to keep the bad stuff out. And what happens with all the things you're talking about are processed diet, pesticides, glyphosate, for example, which destroys your microbiome, the overuse of medications, stress, all these various things cause damage to the gut. And so if you look at the microbiome of some indigenous cultures or people who are living more traditional lives and diets, their microbiomes are incredibly diverse, incredibly healthy, and they don't have allergies. They don't have asthma.

They don't have autoimmune disease. They don't have sinus problems. They don't have eczema. They don't have any of these problems because their guts are different and their microbiome is very diverse. It's like a rainforest instead of a monocrop soybean field. And I think that's what we're facing in this country is a devastation of our microbiome. We're worried about the rainforest.

We've got a rainforest inside us. What do you mean we're worried about that? And how do we restore that? Yes. You know, how do we plant the good trees in there? And I think the whole concept of these food sensitivities has been completely neglected in traditional medicine. It's thought as, you know, quackery.

You know, the tests are challenging. They can be helpful, but they're not like a perfect test, right? So often, for example, I just had a patient yesterday who we did a test on five years ago. She had 26 different foods that she was reacting to. Doesn't mean she's allergic to 20 different foods, but she had a terrible gut. She had giardia. She had terrible bloating. She had irritable bowel.

She had all these issues. We fixed her gut and her reactions went down to nine. And in fact, not only did they go down to nine, but they were very, very low levels of reaction. And they were only to the things that we knew she was really reacting to, like gluten. So it was rye, barley, oats, those are the ones that she was reacting to. So out of the nine, five of them were like gluten grains, which we knew anyway. So I think the key is you can heal a leaky gut. Yeah. And, you know, if you're allergic to peanuts, you probably want to stay away from peanuts forever.

Like there may be new treatments and so forth that we can modify that. But you don't want to mess with that. If you're sensitive to a food, it doesn't mean that you need to stay away from it forever. You need to fix the cause. And that's what functional medicine really is focused on. Absolutely. And I think another point of what you're saying is we're trying to increase and improve the resilience of the body. So the goal is to not keep those foods out that we see on these sensitivities. Or if you're doing some kind of comprehensive elimination diet, we're not

trying to keep those foods out for the next 10 years of your life. We're trying to heal and seal the lining of the gut, help improve the microbiome to the point where you can then be more varied with your diet, expose yourself to new foods that before perhaps were giving you a problem, but won't be as much of an issue down the road. So yes, I think that's a very good point. It's not just about getting rid of the foods. Right. It's about figuring out why the gut is a mess. Yes. And what can you add to help heal it? And what can you add to heal it, right? So it's not just about what you take out. It's a huge part of it. We should call it an addition diet instead of elimination diet. I know. I really, I'm with you. It's bad marketing. I think we should come up

with a better name for it. Yes. I don't like the elimination part. That's one thing. There are two things I really like to emphasize with my patients. And one is it's not just about what you can't eat. I know it's easy and it's very natural to see this list of foods, whether it's a short list or a comprehensive elimination diet where we have a ton of foods that we take out like corn, soy, wheat, gluten, dairy, all these things. And then they're left thinking, well, what can I eat?

Well, the reality is there's a lot more you can eat than you can't eat in this situation. But it's so easy because food isn't just calories and fat and protein. It's also what connects us. It's part of the community and emotional connection we have. So if you're used to eating these foods all the time, it's a big shock to some people. So then that's all they can see is what they can't eat. But it's really- You're taking away my cheese. Oh my God. I've got a story about that.

Wait. Yep, exactly. But it's also about what you can add in, not only in terms of whole foods that are rich in polyphenols, these things that protect and heal the lining of the gut. But it's like getting more diversity in your diet, learning how to get into the kitchen, you know, cook with all these different flavors and textures, sort of like reconnect. Spices. With food, exactly, that are actively healing, but you're also enjoying. Yeah, I was joking about the artichoke, but like that's a great prebiotic food. And I eat them like every week, multiple times a week.

Yes. And it's so delicious. I dip them in extra virgin olive oil, balsamic vinegar, which also helps your gut. Exactly. Polyphenols. Right. And so it's really fun and easy. It can be fun.

And then you get to add stuff back, right? Right. And that's so important. And that's what people don't realize. And a lot of people come to me and either they've already tried an elimination diet let's say they've done gluten and dairy free my first question always is did you have any help did you do this on your own did you go online did you find something or or did you have a professional who knows how to guide you through this first question second question is how do you reintroduce like what do you do well do? Well, you know, I went and had a pizza. I had a pizza. Well, that's like, you know,

three or four different. Glutonary, all these things. And we're not even talking about good quality gluten. We're talking about white flour. Right. So that. I had this patient when she was, she had rheumatoid arthritis and she was overweight and she really was struggling. And she was, you know, tested gluten. She was definitely tested for gluten sensitivity and she had elevated antibodies. And I said, you really can't be eating any gluten. And she's like, well, I'm not, I'm not, I'm not, I'm not. I'm like, well, let's do an experiment. Let's put you on a, at the point at that time was just a, we call it an ultra clear fast. So for 10 days, all she did was this rice protein shake,

which is hypoallergenic, and that was it. All of her symptoms went away. She dropped a ton of weight. And she realized that there was gluten in her diet. And it was hidden. Hidden sources. It could be in soy milk that you're having. It could be in all kinds of-

Dressings and all of that. And it's got all these names that you wouldn't even know. It's like sugar. They disguise it. And then in processed food, there's something called microbial transglutaminase. So gluten is what is often used to make things stick together because it's like glue, right? Right. If you ever made flour or bread, it's like that sticky thing.

And it makes processed foods stick together. And so they have bacteria make these actually bacterial versions of gluten, essentially, that then they put in food and it doesn't have to be on the label. So pretty much if you're eating any packaged or processed food, you don't know what you're eating. And so I think, and people are really, really sensitive. Even a flyby, if they're eating out of a grill that somebody cooked something on was breaded.

Cross-contamination. You're going to get it. So I think, you know, I did that. And then I saw her a few months later and I was like, what happened to you? And she lost 40 pounds. She, like all of her symptoms went away. So I think people have to understand like, you know, oh, I just had like a little bit. Right.

And for some things that, you know, may not be a big deal. But if you have a little bit of gluten, even a thumbnail full in three months, you're back to square one. It's tough. And in terms of gluten, there's so many people, I'm sure you've had this experience too, where people will go over to Europe and have the gluten there and they won't react as much. And for some people, that is the case. For some people, they just have to keep it out entirely no matter where they are. But I think there are two major reasons why. Number one, in this country, we've hybridized and basically genetically modified wheat to have double the amount of gluten because of exactly what you're saying. That stickiness, we like the texture.

It's just trying to make it more palatable. You don't have those giant croissants and bagels, just the little ones. And then also, we spray wheat with herbicides, pesticides, all these things. And the combination of the excess gluten with all of these chemicals, just it's a perfect storm for our gut and leaky gut and dysbiosis. And then all of the other symptoms that come from that. And that I think of joint pain. I think of headaches. I think of, you know, ADHD.

I think of a lot of things that are associated with that sensitivity specifically. Yeah. I mean, the gluten story is really interesting because, you know, he's watching these movies like, hey, I'm gluten free. It's like, what's that? It's like, I don't know, but everybody's doing it. It must be good. Right? Yep. All those. Yep. I've seen them. Exactly. And it's sort of become this cultural meme. Most people don't even know what gluten is, but it's a protein that's in wheat that can be very inflammatory.

And the modern wheat has much more of these gluten proteins. Right. And tell us why gluten is, of all foods, is so critical in terms of driving this leaky gut and leading not only to gluten sensitivity, but to all these other sensitivities that sort of follow on, that are like hangers-on to the gluten. Exactly. Well, there's one thing that I will say in terms of when you eat gluten, that's one of the major drivers of something called zonulin.

And zonulin was discovered and found to actually drive leaky gut. So to give signals to the lining of the gut to open up and make those gaps so that things fall through. So it actually is one of the major drivers of leaky gut for that reason. And as I said before- So basically, this is a natural molecule in our bodies. It's designed to take care of things. For example, if you get cholera, I mean, sometimes it's good to have a leaky gut.

It can be, right. Sometimes. But gluten tends to trigger this. According to Dr. Alessio Fasano, who's the world's expert in gluten at Harvard, that it triggers some degree of increase in zonulin in everybody, which can trigger some degree of leaky gut in everybody. Regardless, yes.

Now, some people do fine, and they're okay with it, and they're really healthy, and it doesn't matter. But if you're looking to dramatically reduce inflammation, making gluten a staple in your diet is not a great idea, particularly modern wheat. So if you want to eat, you know, ancient spelt or einkorn wheat or kerns of wheat or, you know, rye, like those might be better tolerated. Spelt, especially those that have been sourdough or the traditional way of actually creating and making actually dr frasano said you know here we have these fast rising breads like you know one hour boom two

hours he said in europe it's 12 hours 18 hours 24 hours they make their bread rise so it actually creates a very different process in the wheat that breaks down some of the gluten and creates less reactivity so there's a lot of explanations. Absolutely. So yeah, eventually, no matter who you are, and I think he said this, Dr. Sano said, regardless of your predisposition to gluten sensitivity, celiac disease, if you have gluten in your diet long enough and in large enough quantities, you are going to lose. It's the human that's going to lose. It's the gluten that's going to win.

And basically, if anybody has any chronic disease or any inflammatory problem. Autoimmune condition. Pretty much anything that, you know, it's sort of like, for me, it's like getting someone's blood pressure. You know, checking to see if they're reactive to gluten is like checking their blood pressure. It's the standard here. It is because, you know, partly because we see people who have seen everybody else and done everything else and gone everywhere and have come here because nothing else is working.

But it also is so common and so missed and it's so misdiagnosed. And so we have different diagnostic tests that can help us look at different gluten antibodies, look at zonulin antibodies. We have very sophisticated ways of looking at this. And I think for people who are struggling, it's very helpful. And then you can actually implement a program of a diet to eliminate the foods that are reactive. Very specific to them. So you can do testing or you can just do an elimination diet.

But I'd love you to share some stories of some patients we've had here at the Ultra Wellness Center who've struggled and tell me what was going on with them and how did this approach impact them? Yeah. So one comes to mind I would love to share. So there's a 47 year old woman who came with constipation. She was pooping maybe twice a week. I'm like, we got to get you pooping twice a day, twice a week. So constipation. Oh yeah, that reminds me of

a patient I had. I said, so how are your bowel movements? She goes, oh, they're regular. I said, how often do you go? She goes, once a week. Yep. I said, that's not regular. She goes, it's regular for me. I go every week. Yep. I'm like. Exactly. Just painful. She's Dr. Hyman.

I didn't know it was normal. Like I thought going every day, this is like a whole thing. That's normal to them. That's what they think is normal. But this person had constipation. At least she recognized that it was constipation. She had joint pains. But she had sinus, these recurring sinus

infections that would happen every year, once or twice a year. So when I hear constipation, when I hear sinus congestion and inflammation in general, I think of dairy, dairy products. And when I hear joint pain, I think of gluten. Sure, it could be a lot of other foods, but we thought, okay, let's start off with gluten and dairy-free. Of course, sugar-free and preservative and- Process-free. Gluten, dairy, sugar, and processed food, 90% of the time, that's all you need. Exactly. So at first, she sounded like she was on board. I just kind of gave her the overview. And then it was like a light bulb just went off. So she grabbed- Yeah, told you you had to take away her cheese.

She grabbed, yes. She's like, are you telling me that I have to give up my cheese? So when I told her, I said, well, unfortunately, yes. And I thought it was just going to be like a little back and forth. She started sobbing. Oh no. I mean, sobbing. I had to give her the tissues. And I said, you know what? This is the first time I'm, I'm really seeing in real time the power of food addiction. And I said, I let her finish. Obviously, I didn't interrupt her. But I said, have you ever heard of casomorphins before or gluteomorphins? And these opioid-like peptides that cross the blood-brain barrier and can actually not only influence you neurologically, but cause you to feel addicted to these foods.

Like, you need to have more. She's like, no, I haven't heard of it, but it sounds like me. And I was just kind of nervous. I wasn't sure if she was really going to be on board. Cause she, I, again, I'd never seen something so reactive before. Four weeks later, she comes back. I'm like, how'd she do? Different person, different person entirely. She, even the way she spoke was more clear. She sounded more confident. Like there wasn't something holding her back. She was pooping five times a week. Her joint pain went away.

But she was like, the most remarkable thing about this is not just the fact that I was able to give up cheese, but the fact that I don't have any cravings for it anymore. I don't need it. I don't even want it. Because I can't believe something had such a tight hold over me. Well, you know, you mentioned these caseomorphins and this is a real thing that we actually test for at the Ultra Wellness Center. We use urine testing and we can see both gluten and dairy. They do react with the basically heroin receptors in your brain and the opioid receptors in your brain and they create this pleasure, but they also are

highly addictive. And it's not that it happens in everybody, but it's not that uncommon. It's more common in autistic kids and others. So really very great story because people often don't connect the dots. And when you give people a chance to stop the foods that are problematic and add in the good foods, then their body is going to tell them. They don't need you or me or a doctor or anybody else to tell them what works. They see the difference. Their sinuses clear up. Their headaches go away.

Their skin clears up. They feel better, right? Their digestion improves. So I think that's a great case. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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