The Dr. Hyman Show - How To Know If Gluten Is An Issue For You

Episode Date: October 17, 2022

This episode is brought to you by Rupa Health, Paleovalley, and HigherDOSE.   Gluten is one ingredient we all love in bread or our favorite pizza dough, but it’s often the cause of inflammation and leaky gut, which is implicated in so many health conditions such as IBS, skin problems, Hashimoto’s, high blood pressure, and more. And it is not just people with celiac disease who are affected.   In today’s episode, I talk with Maggie Ward, Dr. Alessio Fasano, and Dr. George Papanicolaou about how gluten affects the gut and how to know if it's a problem for you.   Maggie Ward, MS, RD, LDN, is the Nutrition Director at The UltraWellness Center. Maggie holds a master’s degree in Nutrition from Bastyr University, which focuses on using whole foods for holistic nutrition therapy. She completed her requirements to become a registered dietitian at Westchester Medical Center in New York. Prior to joining The UltraWellness Center team in 2008, Maggie worked at the Brooklyn Hospital Center in New York.   Advancing innovation in research, clinical care, and education, Alessio Fasano, MD, has dedicated his life to improving the quality of life for people with celiac disease and other gluten-related disorders. He founded the Center for Celiac Research at the University of Maryland School of Medicine in 1996. In 2013, he moved the center to Massachusetts General Hospital and renamed it the Center for Celiac Research and Treatment. He is chief of the Division of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital for Children and a professor of pediatrics at Harvard Medical School.   Dr. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is board certified in family medicine from Abington Memorial Hospital. Upon graduation from his residency, he joined the Indian Health Service. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He began training in Functional Medicine through the Institute for Functional Medicine. In 2015, he established Cornerstone Personal Health—a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017.   This episode is brought to you by Rupa Health, Paleovalley, and HigherDOSE.   Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs. Check out a free, live demo with a Q&A or create an account at RupaHealth.com.   Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal.   Right now, get your own Infrared Sauna Blanket or Infrared PEMF Mat at HigherDOSE.com and use my exclusive promo code FARMACY15 at checkout to save 15% off.   Full-length episodes of these interviews can be found here: Maggie Ward Dr. Alessio Fasano Dr. George Papanicolaou

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listeners 15% off their entire first order. Just go to paleovalley.com slash hymen to check out all their clean paleo products and take advantage of this deal. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Leaky gut or dysbiosis is often the root cause of many illnesses that affect the brain, the nervous system, hormones, joints, and more. Gluten is a common driver of leaky gut due to its impact on the protein zonulin, which opens tight junctions in the gut, causing leaky gut. Gluten affects many people in this way, not just people with celiac disease. In today's episode, we feature three conversations from the

doctor's pharmacy on how gluten can create an unhealthy gut and lead to a variety of chronic health conditions. Dr. Hyman speaks with Maggie Ward on gluten and autoimmune diseases, such as Hashimoto's disease, with Dr. Alicia Fasano on the role of gluten and inflammation in leaky gut, and with Dr. George Papanikolaou on how gluten and leaky gut can be a root cause for high blood pressure. Let's jump in. I can't tell you how many symptoms I've seen get better, you know, not across the board, but just I've had brain fog get better taking gluten out. I've had joint pain get better. I've had skin get better. So, you know, people joke around, like, do you take everyone off a gluten? I'm like, if you saw how many people got better off of gluten, you'd take it, you know, take another

diet too. We see people who come to see us who are ill, right? And so we have a select, we call it selection bias. But I would say, you know, when people walk in the door with any kind of chronic illness, for me, checking gluten antibodies and what we call a Cyrix 3 test, which we'll get into, which looks at way more proteins around gluten, it's like checking their blood pressure or their temperature. It's a vital sign for me because it's so common. It's such a big deal. And I just saw this guy the other day who had all this severe lymphedema

and inflammation in his body, and he had one of the worst gluten tests I've ever seen. And he didn't know it, and he's like 50 years old. So anytime anybody comes in with a chronic issue that's not getting better, especially anything that's inflammatory or digestive in any way or neurologic, it's the first thing I look at. Yeah. And I think the question I get a lot too is like, well, why was I okay eating gluten through

my younger years? And why is it an issue now? And I'm like, well, even with celiac, right? That's a genetic condition. You're technically born with it, but when it develops can really vary. So you need to have like the genetic predisposition, gluten in your diet, and some type of trigger. So an infection, you know, a really stressful event, you know, toxins again, something has compromised your gut lining and now you're reacting to these proteins. So for some people, it might not even be a life sentence. I mean, if they have celiac or something similar,

they have to be really careful. But other people, sometimes if you get the gut sorted out and healed, they can tolerate some of these proteins. Yeah, when I was really sick with mercury poisoning and when I was really sick and had gut issues, I couldn't eat any gluten. And now, I mean, I don't eat a lot, but now it doesn't really bother me and I don't really have any body, so I fix my gut. And I think we see a lot of these patients who, you know, may not have any symptoms for years and years, like you said, and then when they're 50, they get an autoimmune disease or they get something. And you check and they have celiac. They actually have celiac where they have really severe gluten sensitivity. And I think, you know, you say it's genetic, about 30 plus percent of

the population has the gene for celiac. Only 1% get it. And I think it's know, you say it's genetic, about 30 plus percent of the population has the gene for celiac. Right. Only 1% get it. And I think it's all the things you're saying. It's all these insults. Right. That are from the environment, our diet, antibiotics, et cetera, that make us susceptible.

Right. Your genes are never going to say you're going to get that disease. It's usually your environment that needs to turn those genes on. So yeah, it's true. And even though you have the genetics, yeah, it doesn't mean that it's not a way to diagnose for it, but it's good to know your genetics. And it's a spectrum, you know, like you look at the antibody test and there's a normal level, right? Like there's, you know, zero to 20 or whatever on the antibody test on your blood level. But when you think about it, there is no normal level of antibodies to gluten

in your blood, right? And you talked to Dr. Leslie Fasano who's been on the podcast, who's the world's expert in gluten at Harvard and brilliant guy. And he said, you know, look, if you have any antibodies, it means three things. One, you've been eating wheat or gluten. Two, you have a leaky gut. And three, your immune system doesn't like it, right? So if the level is five, it's not as bad as 20, but it's not as good as zero. Right.

And you don't want to go to 20. Right. So be careful now. Right. So a lot of people say, oh, my tests are fine. But they may, it's a spectrum. It's a continuum. It's not on or off.

Right. And it's always worth doing an elimination diet because the cost is low, the benefit's high. There's really no downside to getting off it for six weeks, let's say, or even two weeks and seeing what you'd feel like. And if your symptoms get better and then you eat it again and you feel worse, there's your answer. Right, right.

I think it's a little tricky too, though, with gluten because typically with elimination diet, you know, use two to three weeks off of that food, you should feel better. We've had a lot of people where it's up to three months, right? Three months, yes. Three months. I saw it clinically for a while and now that we're testing for it more, you see these antibodies to gluten stay around for a long time after someone's been off of it, right? You're no longer getting exposure, those antibodies should come down, the inflammation should come down. So that's something

to keep in mind for listeners because I've had a lot of people say, you know, I went gluten-free for three weeks and I didn't feel all that much different. And then I'm like, I think you got to give it longer. It's around that three-month mark that a lot of people like, you know, my joints finally started feeling better around that point. So, that's something to keep in mind. A strata patient when she was off for 10 weeks before she started to feel better with psoriatic arthritis. Right. Yeah. And, you know, usually it's a combination of a few other things that need to be sorted out, but you really want to give yourself a good time period. So if you've never done up to three months, you should. And it sneaks in,

in a lot of places, which we'll talk about, but most folks who are fairly sensitive have to be 100 plus percent off of it, or they will still be reacting. And it's 150%. I mean, if people have, Dr. Fasano said to me once, is if you have a thumb fall, a thumbnail fall of gluten in three months, you're back to zero. You can't even cheat a little bit if you want to do it because your body then creates an immune response. And I remember a patient who had rheumatoid arthritis and she was very good, but she was trying all the functional medicine stuff. She would get a little bit better. It wasn't cutting it. And I said, look, you think you're gluten-free?

And I went through a diet and she was getting some and maybe she had some soy milk with barley malt and this and that. So I said, why don't we put you on just a 10-day ultra clear plus shake, which is what we were using back then, which is basically a rice protein, low allergenic, just no other food, just this shake for 10 days, see what happens. Everything went away. And I was like, wow. And I think I saw her like three months later six months later and she had completely changed she lost 40 pounds her arthritis was gone she felt great right and i think you know one of the things i just want to but emphasize is that

whatever condition you have um almost anything really in medicine it should be on your list of things to think about right because when you look, for example, the New England Journal of Medicine had an article years ago, which listed over 55 different diseases that were really caused by celiac and gluten, but were masquerading as something else. Osteoporosis, iron deficiency, schizophrenia, autism, cancers, you name it, autoimmune diseases, migraines, I mean, just disease after disease. And if you really look at that list, and that's just, I think, a short list compared to things I've seen over the last 30 years, you're going to think that pretty much anybody who has a serious chronic illness or has chronic symptoms or is just not feeling great should check for it and also should try an

elimination diet. Right, right. And this is where too testing can be helpful because there's some people that think they're 100% off of it. You know, I've had several folks come in already knowing they have celiac or very sensitive and they're off of gluten. We still test them. And the antibodies that we're looking for, this is through the Cyrex3 panel that we do. There's about 32 different immune markers that they're looking at. It varies parts of the gluten protein and wheat and other proteins within wheat. So it's a very sensitive test. And these antibodies shouldn't be in your system if you have not been eating gluten and they come back positive. And that's like, okay, you're getting some hidden sources. When you eat out, are you doing all the precautions you need to do? Have you checked your body care products?

Is your house gluten-free? There's so much contamination that happens in the house of not everyone in the house is gluten-free and they're sharing space and food. So this is where the testing can be really helpful to kind of dig in. And again, traces can make a difference, even if you don't have celiac, for someone that's really sensitive. So tell us about some of the common things we see. One of the cases you had was a thyroid issue. Yeah, so I wanted to kind of focus on autoimmunity,

because that's a lot. Anytime I see someone with an autoimmune condition, if they're not gluten-free, I'm like, you gotta start there, just to make sure that's not triggering it. Because again, even if you don't have celiac. I want to emphasize what you just said. Anybody who has an autoimmune disease, gluten should be on your list of what to check and

what to eliminate. It is easy to do and you can have profound results. Absolutely. Yeah, because even if you don't have the celiac, what we so often find is that when you take gluten out, these other antibodies to the thyroid, other conditions of autoimmune conditions, they get better, the numbers start getting better. So we've seen that clinically. And now we're, you know, we test for it so much more. So even even on celiac, we do find it can trigger a lot of other

autoimmune like conditions. So that's I was kind of wanting to focus on two cases around autoimmunity. The first one is a 38 year old woman with Hashimoto's, which is the autoimmune condition you can get with your thyroid very common and a lot of reasons to have it. But she was interesting. She was a really intense triathlete, so very competitive, high exercise person. She came with severe fatigue just in for nutrition because I think she, you know, wanted to focus on nutrition and weight loss, which is not typically what you see with low thyroid function. But her thyroid antibodies were extremely high, some of the highest I've ever seen. And she also had a liver enzyme that was elevated too. So I was, you know, wondering if there maybe was a toxicity component to that. And I do think she was a bit malnourished given the high level

of exercise that she does. Some of her nutrition labs, like even her cholesterol was coming back low, which could indicate that she wasn't getting all the nutrition or maybe not absorbing all the nutrition she needs um so i you know like i always do with on immune i'm like let's let's take all the gluten out um she kind of did her own research and went full-on paleo which uh takes out all the grains and all the legumes which sometimes really can make a difference for folks that are gluten sensitive um and i really focused again getting enough good fats and protein good quality all the legumes, which sometimes really can make a difference for folks that are gluten sensitive. And I really focused, again, getting enough good fats and protein, good quality carbohydrates in her diet. With the exercise piece, you know, I was thinking there could be an adrenal component to that. And your adrenals are very closely linked to your thyroid. So she, you know,

worked on some other lifestyle things and did some yoga and restorative stuff that I think was important. But she, but you know, when you see Hashimoto's, which is very common, one in five women have low thyroid. A lot of that is autoimmune thyroid conditions, probably the most common autoimmune disease in the country. It's not all related to gluten, but probably I would say a third of my patients who have Hashimoto's, when I check their gluten antibodies, are elevated. It's a piece of the puzzle.

And when they get off gluten, they get better. Right, exactly. It's so often a piece of the puzzle. right? And when they get off gluten, they get better. Right. Exactly. It's so often a piece of the puzzle. It's usually not the only thing, but it's definitely a big component for a lot of folks. And, you know, again, being a high level triathlete, your digestive system takes a hit to that, you know, and I think she got a little bit of leaky gut where before the gluten may not have been an issue.

And she'd also had a daughter soon before. And, you know, sometimes just the process of going through a pregnancy can switch what goes on with the immune system as well. And on her blood test, she found elevated. Yeah. So I had her, you know, she didn't do any specialty testing with us. I just had her, she had a good local doctor who did more integrative stuff. And I said, have them do a celiac panel and not just check tissue transglutaminase, which is what the kind of the gold standard, so to say, right, for blood work is for celiac. You can check for antibodies to gliadin, which is part of the gluten protein. You could check for deaminated gliadin.

So I wrote out what to ask her doctor for and they ran it. And she did not have the tissue transglutaminase, which, right, mostly is what they're going to look for for celiac. But she did have anti-gliadin antibodies. And I was like, you should not have those. So you may not have celiac, but you could have something similar. So yeah, so that's a good point because a lot of doctors will check the basic test and they'll say you're fine. And they only check like one antibody called TTG. But they don't check the anti-gliding antibodies, which are less specific, but actually more sensitive. So they'll

show up often when the other one doesn't. And they do indicate a level of leaky gut, a level of wound sensitivity, and they are definitely contributing to all sorts of issues for people. Right. And we did some other nutritional stuff. She was low in iodine, and we did some sea vegetables and things, which is important for thyroid. So again, there's other things that are going on. But that, you you know when i had a two-year follow-up with her obviously we had a few follow-ups in between but she said her digestion was great her energy was great um her thyroid antibodies and you know what i think we hear in conventional medicines like you got on immunity you have it you know why check antibodies it doesn't go away so her thyroid proxidase which is one of the ones they check came down to less than zero whatever the

normal is and her thyroid globulin antibody which is the other one is slightly elevated but came down significantly that's remarkable so you had one of the highest levels of autoimmune antibodies you'd ever seen and after getting her gut sorted and getting the gluten out of her diet and optimizing her nutritional status doing stress reduction she actually had a complete normalization one of them and almost normal the other one right which quote doesn't happen in traditional medicine and she's on armor she's on some thyroid support she does feel better with it and i think there's you know often a need for it but you know she pretty much reversed her autoimmunity by going paleo.

That's amazing. So that was pretty remarkable. It's nice to see when things kind of quickly turn around for some of us. What about this other case you had? So this other one was a bit more complicated. She's a young woman, 27 years old, but she has mixed connective tissue disease, which is kind of a combination of similar lupus or scleroderma. It's kind of a mix of where autoimmunity can affect many different tissues. Yeah, so it's a bad autoimmunity disease.

It is a bad one. It affects like all the tissues and organs and skin and liver and kidneys and muscles. And then she came in with all those symptoms, you know, a ton of joint pain, a lot of digestive stuff, which she said she kind of always had her whole life, fatigue. She was depressed. She had weight gain, probably because she was so inflamed. She wanted to lose about 20 pounds or so. And her symptoms did start in her teens with some exercise stuff. And then by the time she came to see us, again, only just in her 20s, she was getting

arthritis in her hands. So she was on autoimmune suppressant medications. She was on Celsep, but she had been on a lot of things over the years. Omeprazole for her reflux because she had a lot of the digestion issues. She was on a low gluten diet. Yeah, yeah. That doesn't count. That's what I always talk to people. What is low?

It's like being a little bit pregnant. What is low gluten? I was like, you have all these conditions. You have to take gluten out. And she had done testing. I think some specialty tests that did show she was reactive to gluten and soy before and that's why she was low um but i told her you know you got to be 100 and she said you know i do feel like my headaches are worse and my stomach's worse when i have

gluten so um so we got our strict gluten-free and i kind of low grain i try to get it low allergen overall um i told her to come off the coffee, no alcohol, anything else that could be inflammatory to her gut. And you also did this test, which was not the normal test. So you mentioned a little bit earlier. So when you go to the traditional doctor, they'll do a celiac panel, they'll do the TTG, they'll do sometimes gliadin antibodies. But we at the Ultra Wellness Center do a different test from the lab called Cyrex, which looks at not just a few proteins in the wheat, but all sorts of different, like dozens of different. Right, the gliadins, glutenins, there are different parts of the gluten proteins. So they're breaking them down to these smaller units so you can really get a closer, you

know, look at what the immune system's reacting to. And there's a section there of transglutaminase. So it's not the same thing as tissue transglutaminase. You can't diagnose celiac with it. But what Cyrex says is that folks that have these tissue transglutaminase you can't diagnose celiac with it but what cyrex says is that folks that have these other transglutaminase reactions are more likely to have an autoimmune condition related to gluten so this is where it's like okay it may not be celiac but you probably have something very similar so out of 32 markers 30 of them came back positive on a low gluten diet i mean she wasn't eating a standard American diet at all.

She did have a celiac panel. Her tissue transglutaminase, again, that gold standard, was borderline high, which should not really be showing anything. And her deaminated gliadin was high. She did have the genetics. It's called HLA-DQ2 and DQ8. The DQ2 is positive, which brings your risk up pretty high for celiac. We also did a Cyrex-4, which is known as kind of their autoimmune profile as well. So they're looking at dairy. Dairy we know is big allergen in and of itself, but a lot of people that react to gluten seem to react to dairy. And with paleo, a lot of folks take out all grains and sometimes that is helpful. According to Cyrex research, oats oats and oats have been identified a long time ago even when they're gluten-free when they're not contaminated with gluten there is a protein in there very close

in structure to gluten so many people do react to it i see that a lot i mean i run the gluten-free oats and i'm like no yeah usually if you are still having any symptoms, then you should just get rid of all the oats. Yeah, so I tend to throw oats in the gluten category. And then they also suspect rice, which I've always thought of as a low allergen grain, but we do have a lot of folks that seem reactive to rice, corn, and millet. So those are the ones I kind of focus on. They also check corn, soy, some of these other common allergens. Yeah, and so what happens is, you is, the way I think about it is gluten

is sort of the gatekeeper, right? When you eat gluten, you become sensitive to it. It opens up the channels in the gut, creating what we call leaky gut. And then other foods get in, and you get these cross reactions. So you get other grains, you get dairy, you get soy. But it's really the gluten

that's sort of started the whole thing. And if you fix the gluten, and you heal the gut, and you get rid of all those other foods for a short time, maybe three months, six months, maybe a year, you can heal the leaky gut and then become able to tolerate a much wider diet. Absolutely. So I think that's a fear of so many people when they start reacting to so many things. I'm like, you know, a lot of these foods are not at fault. You know, there's something else compromising your gut. Maybe gluten. Like the innocent bystander. What's that? Like the innocent bystander. What's that? Like the innocent bystander.

Yeah. And I'm like, once that gut gets healthy, you know, your immune system's not going to be seeing it and reacting as much. Now, you've probably heard me talk about how much I love infrared saunas on the podcast. They've been linked to so many different benefits, like better muscle recovery, calming of the nervous system, improved circulation, even activation of the immune system to support protection and healing. Saunas also promote the release of feel-good endorphins for that blissed out feeling and give your skin a healthy glow. Now, I know not everyone has room or the budget to have their own sauna at home,

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and use my exclusive promo code pharmacy, that's F-A-R-M-A-C-Y 15 at checkout to save 15% off. That's higherdose.com and the code is pharmacy15 or just go to higherdose.com forward slash hymen to get your 15% off today. And now let's get back to this week's episode of The Doctor's Pharmacy. The way I think about it is that the gluten is sort of the gatekeeper. It sort of opens the gate and creates this leaky gut. And then all these other food antigens can leak in and start to aggravate the immune system. So the body begins to start to react to other things. And I've seen this over and over, over the decades. Is this something you're noticing yeah I mean again I'm quoted all the time about this because you know our group was the one that discovered the molecular mechanism by which gluten can really make your intestine

leak through the release of zonulin this molecule that has been now that's right linked to a variety of you should get the Nobel Prize for discovery. I know, but people are still very skeptical. But anyhow, the bottom line is that you put the two together and say, well, if gluten is capable through some of these indigestible peptides to engage in a specific receptor that instigates the cells to release zonulin and make the intestine leak, then this can be detrimental and harmful to everybody. The answer is it depends.

Actually, the vast majority of people would not have consequences if you have a balanced diet and can even be useful to help what we call antigen sampling, to bring very small amount of antigen so that immune system will be- More robust. More robust, trained in case that the storm will come, the real deal will come. The problem arises when you exceed the amount of gluten, for example, so that this continues all the time. Or even if you have, you know, not a huge amount of gluten that you eat, you are genetically predisposed that when you increase

gut permeability on the other side of the fence, you find an immune system that is ready to fight against gluten, and these other people, they have gluten-related disorders. So all this to say, I would not categorize gluten as the villain of the 21st century necessarily. After all, if you and I were here, rather than jump from one tree to another, we have to thank agriculture that predicted the amount of food that we can have and free up our time to do more creative stuff yeah um by the same token you know to dismiss completely the fact that gluten can be an issue for you know a variety of individual outside city disease that will be also

to not see what is becoming more and more obvious. Yeah, it's pretty extraordinary to see how this whole field is opening up. And, you know, one of the things we often were made fun of for decades is this idea of a leaky gut. That, you know, basically the belief was that if you had a leaky gut, you'd have, you know, sepsis and you'd die, basically, which means you have overwhelming infection. But, you know, this sort of intermediate zone of sort of slightly leaky gut leading to inflammatory diseases is seemingly connected to everything from obesity and type 2 diabetes to heart disease to autoimmune diseases neurologic diseases autism i mean it's it's sort of it's like almost this unifying theory

of how we get inflammation so i'm fascinated how historical memory is lost during generations. For example, you know, I've called that amnesia, whatever. But you know, when, you know, at the beginning of the 90s, we were convinced that celiac disease was a big deal in the United States. The establishment really came after us big time and said, you know, you really missed the boat here. We looked for celiac disease and we didn't find it. So, you know, you are not, you know, in the right direction. And this, to put that very mildly,

because the criticisms were much more harsh than that. And again, their premise was on a state of mind that was fixed on what was at that time the definition of serious disease. Young kids with a big belly, diarrhea. And that's true. We don't see that. We don't see that. We see other stuff. And you don't have to have any digestive systems.

Well, zero. You can be obese. But that was not clear at that time. And that's the reason why we were highly criticized. Now in 2018, if you ask anybody, nobody will question that CD disease is as frequent in the United States than in Europe. But if you ask, it's been always like this, the answer most likely is, yeah, of course, we always thought so.

Even the ones that were hypercritical, Same phenomenon with this leaky gut story. You know, again, you know, it's not that I was like a functional medicine doctor, always tuning in this. I came to this by, you know, chance, by, again, doing this cholera vaccine and learning that cholera can make your gut leak and then try to understand how that does and see that there is a very sophisticated machinery to loosen up, to increase the permeability of disjunction in the intestine. Because of the little connections. Yeah, these are the cellulite gates in between cells that we thought that were cemented so that no things can come through. Everything goes through the cells, not between the cells.

That's right. Everything that we negotiate with the environment, we thought that has to come through the cell. And then we learned, no, actually, there is a space in between cells that can be modulated in its permeability. And, you know, when we started the mechanism of this toxin, and we saw this very complicated machinery, the reasoning that I made there, I said, it can't be that we evolved this machinery there just to get sick with this toxin from Vibrio cholera. Vibrio probably learned physiology from us and exploited that possibility for its own return.

Yeah. And that's how we end up to, you know, this corazonaline. And I have to say, you know, with the story of the leaky gut are now half away compared to the story of celiac disease is over. It goes to the discussion over. I say half away because even the establishment now of evidence-based medicine, the hypercritical to our work

that has been coming right here, the general vein, when we discovered Zona. You're on the right track when you're... Well, you know, again, Mark, again, I am an individual that, not only I'm open-minded, but I am the individual that, you know, I admit that, you know, science is a constellation of failures with very few successes. And you live for those. But I also admit that science is not a perfect path.

Most of the time, you're wrong. And there is nothing worse as a scientist to not admit when you're wrong. What you do is... They're going to attach their ideology. That's right. Because what is true today, it will be garbage in three years. We know that. It's that dynamic. So as a good scientist, you formulate a hypothesis, you design an experiment to challenge the hypothesis, and you perform the experiments. And then you evaluate the outcome.

The nine out of 10 times is different to what you anticipated with your formulated hypothesis. This brings to two kinds of science. The incremental science. I want to go from point A to B to C to D to get to my final destination. I know where I am. I see my sights where I'm going. That's the one in which your peers will follow you, will understand what you're doing,

and eventually will accept the approach that you're taking because everything is clear. Sometimes you want to go from point A to point B and you end up to point Z. So in a place where nobody's been before. Most of the time it's dead end. So it's something that leads to nothing. Very few times you got in what we call

transformational science. That is not something that you intend, but you end up to be in something that changed completely the paradigm of way of thinking. The unintended consequences of your... And that's what the zone and the story was all about. When you got there,

to understand if you're in a dead hand or you do something transformation, the only thing that you need to do is to sit and see if your peers can validate and reproduce what you've done or this was not reproducible. The zone and story now is highly reproduced. As a matter of fact, I don't, you know,

alter the vast majority of what is the science in zonin nowadays. We contribute a minuscule component of the hundreds of papers that are out there. All this to say that not only the zonin story, but the story of the modulation of gut permeability with the identification of genes that can modulate tight junctions, the identification that, you know, loss of barrier function is the core of many chronic inflammatory diseases. People are coming around. And it's so powerful, yet it's sort of a discipline.

Medicine is not really thought about how do we then address that? How do we fix a leaky gut? How do we normalize the function in there? What do we do to fix that problem? Well, we can't because we don't know yet why the mechanism that leads to that, because this is a very complex machinery with very sophisticated functions. And I was mentioned during the lecture that the structure of these tight junctions is extremely redundant. That means it's a function that's dear to us.

Because where the redundancy means that, you know, you have backups. You have a lot of backup systems to make sure you don't get a leak. In case something goes wrong right right i can tell you a great level of confidence that the two key elements that makes your intestine leak is one gluten as we said because it's really zoning through this mechanism and an unbalanced microbiome what we call dysbiosis that can be either because the function and the composition is unbalanced or because the microbiome is established in the place where it's not supposed to be. Small intestine bacterial growth, SIBO, is one of the most powerful ways to release the zone and make the intestine big.

And we see this all the time. I call it the food baby. They get bloating after eating and extended, and that often means that there's bacteria in there producing gas. That's right. So I think that it's going in there producing gas. That's right. So I think that, you know, it's going to take another few years for people to accept completely this idea of the importance of intestinal barrier in a variety of chronic inflammatory diseases. So the hard, you know, soul of immunologists, traditional immunologists will never come around us. They will never come around to the idea that autoimmune diseases can be treated as I believe

that they can. Because if you stop- By fixing the gut. Of course. Which is how we do it in functional medicine, without even knowing what we're doing. These conditions, including autoimmune disease, are based on five pillars. The genetics, so who you are, your environment, including what you eat, an increased gut permeability and immune system that becomes hyper belligerent

and a microbiome that is not doing what it's supposed to, because epigenetically will make your genes to be, you know, either expressed or repressed so that you switch from genetic predisposition to kidney cartruality. And when I say chronic inflammation, I mean anything. Cardiological issues. And in arthritis, microbiome factor in osteoarthritis, which I think is fascinating.

Any of these five pillars are fair targets to try to ameliorate inflammation. Again, genetic editing, I don't think that's a possibility because the complex is way too much. There are too many genes involved. I don't think that that's going to happen. Modulate the environment. That's something that we should really focus on. We have to deal with all those pillars. Absolutely. And then in medicine, we just try to find the one drug to fix the one thing. No, no. It's not going to work that way yeah so if if if you will

continue to have an environment that is really conducive of inflammation foods pollution chemicals you can fix whatever you want in terms of immunosuppressors or you know change the microbiome everything will go back where it's supposed to be right but if if you start to think more, I would not say holistic, but comprehensive. Let's start with lifestyle. What really is a common sense? Of course, we can't go back and live in a cave. That's not feasible. But can we avoid some chemicals that can instigate inflammation? Can we eventually decide to feed our kids food

and not the junk that we feed so that eventually they have the same chance that we had? Can we promote local production of produce, rather than massive production that, of course, comes with the price? That's, you know... It's changing our agricultural system, our food processing and production system.

It's all of that. And again, you know, this is an uphill battle because you go against major interests, of course. But if you do that, then you can tackle how can I fix a leaky gut? What is the problem? Is the dysbiosis? Can I then use prebiotics, postbiotics, probiotics, symbiotics, whatever it is? Fecal transplant. Whatever it is whatever it is and then you know then you know

that's got also to the point of dysbiosis because again these factors they all interacted well you said something very powerful in your talk which is that the single biggest thing we can do to change our microbiome is change the food we eat and the quality of the food we eat and get off the processed food and eat more plant-rich foods and good quality foods, right? Yeah. If you think about these five pillars that I just told you, they highly interact. So if you affect foods, you affect the composition microbiome. If you put the microbiome back in balance where it's supposed to be based on our evolutionary

plans, the immune system will defend us rather than be belligerent against us, and will unleash inflammation only when it's definitely needed. If you have a balanced microbiome, you also will have a gut permeability that will go back the way it's supposed to be. And a good gut permeability will make the immune system

to be less belligerent, so it's all interconnected. There's a connection between the gut and the blood pressure. So tell us about this patient you had who you treated with high blood pressure. Well, I'm glad because it's a perfect segue because he had gut issues. And that sort of is what really was leading to his high blood pressure. So here's the gentleman that came in. Because gut issues leads to inflammation. It leads to inflammation.

And it's not just inflammation in the blood vessels, it's inflammation in the gut lining. So you can get this nonspecific lymphocytic infiltration. It's basically inflammation. That means a lot of white blood cells show up in the gut and makes it inflamed. Exactly. So what happens though is that you get a malabsorption of minerals and nutrients.

That's when you don't absorb vitamin D. That's when you don't absorb potassium. That's when you don't absorb your calcium. That's when you don't absorb your magnesium. Those are the things that can help regulate blood pressure. So with this particular patient that came in, he was a 52-year-old gentleman, and he had been diagnosed with blood pressure high blood pressure about almost a year prior to coming and they tried multiple blood pressure medications and he had different side effects which is one of the issues with blood pressure medicine oh yeah there's that

we forgot to talk about it exactly so you know that's a big problem lots of people have side effects they get dizzy they get tired they get erectile dysfunction they get lower libido they've they've been hair loss associated with their their high blood pressure medicine so he had been put on different medications that resulted in loss of libido fatigue brain fog one of the medications actually caused dehydration that resulted in him being in the emergency room where they found his potassium to be really, really low and had to be replaced. So he was like, I'm coming here because I want a different approach to my blood pressure. So as we were, you know, we go through our new patient packet that's very long, some things that started to stick out were that he was, you know, he did

have fatigue and he also had irritable bowel syndrome and i asked him to explain that to me and when i when i i hear irritable bowel i don't hear this like again we talk about like it's just a syndrome yeah like essential hypertension we essentially don't know what's causing it it's like we say irritable bowel it's like you know what your diarrhea is irritating me i don't want to talk about it right we don't want to get to the bottom line well it's not even that they don't know it's like in other words when we say people have irritable bowel like oh the reason you have bloating and gas and diarrhea and constipation is because you have irritable bowel syndrome right no that's just the name we give to people who have those symptoms it doesn't tell you

about the cause and that is what's unique about functional medicine is we have a methodology right an operating system to navigate to the root cause and we treat that and we don't have to treat the hypertension we treat the cause and the disease goes away as a side effect right so in this particular case we do we do testing for the gut microbiome and we can also do testing that tells us some things about the gut so we can find out if there is inflammation in the endothelial lining and that's basically if you look down a really big stainless steel tube and it's really shiny imagine that shiny layer is basically a very thin membrane that protects the rest of the tube from anything that's going in the tube so that's the endothelial lining that very shiny stainless feel like a one-cell layer between you and the sewer, right?

You got it. Exactly. Immune system and all poop inside of you. That's a great way to put it. So when that membrane gets inflamed, it cannot function to absorb nutrients the way it should. And that can lead to all of the things I just spoke about earlier in regards to low magnesium, low vitamin D, low calcium. And so we know that people who have irritable bowel, there's a good percentage of them have non-celiac gluten sensitivity. And so that triggered my

thinking. And that's why I ordered that test that will look at whether you have leaky gut whether you have gluten sensitivity and whether you have crossover to other foods like gluten that can create gluten-light impact on the gut and so with this particular gentleman i also did a whole host of metabolic tests that included you know a glucose tolerance test i also looked at his magnesium levels i looked at inflammatory markers omega-3 fat Omega-3 fats that we look at. So I did a comprehensive metabolic evaluation. I looked at a very expansive profile that looks at macronutrients, micronutrients, organic acids, amino acids, that gives us a really good clear picture of what his nutritional status is, whether the very important energy-making systems in his body are actually working the way they

should. Are they getting the nutrients that they need? Are they being blocked from doing their work by toxins? We do this panel that gives us all that information. And this is a very unusual panel in traditional medicine, but we're looking not for disease. We're looking for imbalances or dysfunction that we can correct that will help the body do what it's supposed to do. Exactly. So I gather all that information with the lab test. But the most interesting thing about this gentleman is that he had one gene positive.

It's a gene that would express for celiac disease. But the tests that we do to see if he actually had celiac disease were negative. And what we know about people who have at least one or both of the celiac genes that do not have active celiac disease is they're more likely to be sensitive to gluten. And indeed he was. He had two things going on on that panel that we do to evaluate inflammation and antibody interaction or the immune system creating antibodies against gluten in the body. So he did have leaky gut, meaning that endothelial lining, that one thing saving you from the poop in the center of your intestine from the rest of your body was leaking.

And so the immune system was creating antibodies. So we knew there was inflammation. And the second thing was he had enormous numbers that showed that he was sensitive to gluten. And so that gluten sensitivity... It's not celiac. People understand that there's celiac. And most traditional medicine is like,

you either have celiac or you're fine. But now there's an increasing body of research, particularly by Dr. Alessio Fasano from Harvard, that shows that a lot of people have non-celiac gluten sensitivity, which you can tell through antibody testing a little bit. But it's a milder case, but it still causes leaky gut, inflammation, and many, many problems. And then there's a whole other category, which you can't measure on lab tests called the innate immune system response or cell median response to gluten, which means you can't measure it because it's just a generalized irritation of your immune system. So that can be a case even if these other things are normal. So gluten is often driving leaky gut. And it's

often overlooked. Yeah. Very overlooked. And particularly in a case like this. And the normal doctor will check your levels. And if they're normal, quote normal, like it's 0 to 20. Yeah. Is 19 the same as 1? No. Not at all. Is 5 the same as 0?

No. So I think we have to understand that if there's any level of antibody, it means there's some irritation of your immune system that's causing potential symptoms yeah so in in his particular case um i put him on a gluten-free diet and um i also and and the great thing the and honestly i didn't put him on a gluten-free diet i identified the gluten sensitivity and here at the ultra wellness center we have amazing nutritionists and when i discuss these types of cases then they develop a program for a patient that is going to be customized to what their need are their needs are so in this particular case he was on a mediterranean diet that was gluten-free uh and that that made all the difference and when he tried to reintroduce

gluten back into his diet, his blood pressure went back up. So it was driving the inflammation that was driving his blood pressure. And he was also low in vitamin D, which was impacted by his gluten, because gluten will keep you from absorbing iron and magnesium and calcium, and it can have impacts on lowering vitamin D. And vitamin D regulates inflammation, too. Regulates inflammation.

Interactive dynamic biology where everything is connected, and that's really what we do in functional medicine. Yeah, and there's a lot of observational studies that show that vitamin D in people that have low vitamin D and you replace it, you can lower their blood pressure, particularly in people over 50. So I replaced his vitamin D, put him on a gluten-free diet, and gave him things that we know that work. He wasn't eating a lot of fish, so we gave him omega-3s.

I also added in some CoQ10 and magnesium. And he did phenomenally well. He never went back, well, I shouldn't say never. He's been my patient for about eight months now, but his blood pressure has been normal. 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.

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