The Dr. Hyman Show - Why You Should Ditch Bread & Go Gluten-Free

Episode Date: September 16, 2024

Is going gluten-free just a trend, or is it a legitimate step toward better health? In this episode, I’m joined by Dr. Alessio Fasano and Maggie Ward to explore the science behind gluten sensitivity and why modern bread could be at the root of many gut issues. We dive into the debate over gluten-free diets, discussing whether they’re necessary for everyone or only for those with celiac disease. We also examine how environmental factors like pesticides and hybridized wheat are disrupting the gut microbiome, leading to issues like leaky gut syndrome. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: Is Gluten-Free A Fad Or Is Gluten A Real Threat To Our Health? Should We All Avoid Gluten? What Would Happen If You Stopped Eating Bread For 30 Days? This episode is brought to you by Momentous, AG1, and Happy Egg. Head over to LiveMomentous.com/Mark for 20% off creatine, collagen, and all of their best-in-class products. Get your daily serving of vitamins, minerals, adaptogens, and more with AG1. Head to DrinkAG1.com/Hyman and get a year's worth of D3 and five Travel Packs for FREE with your first order. Shopping for better eggs shouldn’t be confusing. Look for the yellow carton at your local grocery store or visit HappyEgg.com/Farmacy to find Happy Egg near you to get 50% off.

Coming up on this episode of The Doctor's Pharmacy. So that's part of this epidemic of what we're seeing of gluten sensitivity. Is it, you know, they hybridized it way back in the 50s and added more gluten. Many of our breads, they put more gluten in it. Gluten is what makes bread spongy. So you put it in there and you get these nice big loaves of bread and, you know, more is better in this country. Hey everyone, Dr. Mark here.

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that complements my healthy diet. I trust their research and how they're validating the product working in the body. Try AG1 and get a free one-year supply of vitamin D3, K2, and 5 AG1 travel packs with your first purchase at drinkag1.com slash hymen. That's D-R-I-N-K-A-G-1, the number one,.com slash hyman. Check it out today. Before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well,

you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy.

Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in.

There is a gluten sensitivity spectrum out there, and many of us fall somewhere on the spectrum. Most of the folks that come to see us, I think, fall on the end of the spectrum where, you know, it may not be celiac. We can't really determine that based off the testing we've done, but they have to pretty much treat themselves as if. So that's, I think, where it's- It's not an on or off phenomenon.

Right. You either have it or you don't. Because traditional medicine, you go to the doctor, they go, well, if you have an abnormal biopsy of your intestine, you have celiac. Otherwise, you don't. So don't worry about it. Right. Right.

So there's a whole other area of gluten sensitivity. And for many people, it's making them really sick, even if it's not celiac. I also think there's something going on with the quality of gluten. You know, I saw it years ago, and I had so many folks telling me when they came back, like, oh, you know, I was eating pasta in Italy. I was eating bread in France and I was fine. And I come back here and I get so sick. So that's part of this epidemic of what we're seeing of gluten sensitivity is it, you know, they hybridized it way back in the 50s and added more gluten. Many of our breads, they put more gluten in it.

Gluten is what makes bread spongy. So you put it in there and you get these nice big loaves of bread and, you know, more is better in this country. So I think that's a part of it. We spray it with glyphosate and various pesticides and there's a good chance people are reacting to that. And that destroys the microbiome. Exactly.

So once you muck up with the gut microbiome, you're gonna have a lot of digestive and other issues. So that I definitely think is, I can't tell you how many people tell me I eat it abroad and I'm fine. Not our celiac folks, but many other folks that are really sensitive. So the spectrum is what is being missed, I think, in conventional medicine. And you know, we, I don't always... I just wanna underscore what you just said.

There are some key reasons why we're seeing this increase. So one, it's the change in the kind of wheat we're eating, right? They've hybridized it. The dwarf wheat has way more gluten proteins and the way more inflammatory gluten proteins than heirloom wheat. You spray with glyphosate, which not all wheat is full of glyphosate, but a lot of it is. And that causes damage to your gut, which causes more leaky gut and more gluten reactions. Reactivity, yep. It also is sprayed in the preservative when it's put in the bread called calcium propionate, which is actually a toxin that causes problems

with behavior and attention and focus. So it can cause a lot of brain issues for people. And then on top of that, we've created a background level of dysfunction in our gut over the last decades by our poor quality diets, starched sugar, low fiber, processed food, which damage our microbiome, makes it more likely we have a leaky gut.

We've taken antibiotics, we take acid blocking drugs, we take steroids, we take hormones, all of which mess up our gut. We have increased rates of C-section, increased rates of bottle feeding. All these things make your gut more likely to become gluten sensitive. Right, it sets you up to become more sensitive. So that's why we're seeing this sort of escalation of gluten sensitivity over the last 50 years, and it's real. Right. And you know, not many of us are eating these like whole wheat berries. I mean, we're eating in the form of flour. So even if you get organic, you know, bread or whole grain bread, I mean, it's still refined carbohydrates and you're selectively feeding things in your gut. You probably don't want to be feeding too much and throwing off your blood sugar. So when people go gluten free, I do think part of the reason they

feel better, as long as they don't start eating a lot of gluten-free junk, is they transition over to more whole carbohydrates, whole foods. Yeah. And they feel a lot better for that reason, too. So for that reason, you know. Gluten-free junk food is still junk food. It's still. If it's gluten-free, it's still cake and cookies. Right.

Exactly. So I really wanted to bring attention to that because we see, 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 of 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? Yeah, 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, is like checking their blood pressure. Yeah.

Or their temperature. Right. It's a vital sign for me because it's so common. It's such a big deal. And, you know, 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. Yeah.

And he didn't know it. And he's like 50 years old. Yeah. 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 questions. 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 antibodies, so I fix my gut. And I think we see a lot of these patients

who may not have any symptoms for years and years, like you said, and when they're 50, they get an autoimmune disease or they get something. And you check and they have celiac. They actually have celiac or 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 all the things you're saying, it's all these insults that are from the environment, our diet, antibiotics, et cetera, that make us susceptible. Right, your genes are never gonna say you're gonna 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, though, too. 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 tests 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 I mean, it's a spectrum. It's a continuum. It's not on or off. 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 I mean, 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, 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 stradipatient 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, you know, it sneaks in in a lot of places, which we'll talk about. But, you know, most folks who are fairly sensitive

have to be 100 plus percent off of it, or they will still be reactive. 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. Like you can't even cheat a little bit if you wanna, because your body then creates an immune response.

And I remember a patient who had rheumatoid arthritis and she was very, you know, good. But, you know, 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 her 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. Yeah. And I was like, wow. And I think I saw her like three months later or six months later, and she had completely changed. She lost 40 pounds. Her arthritis was gone.

She felt great. Right, right. I think one of the things I just want to emphasize is that whatever condition you have, almost anything really in medicine, it should be on your list of things to think about. Right, 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 Cyrex-3 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 but 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 you know 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 you, not everyone in the house is gluten-free and they're sharing space and food. So this is where you have, 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. When it comes to eggs, quality matters. and that's why I choose Happy Egg.

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That's H-A-P-P-Y-E-G-G dot com slash pharmacy, F-A-R-M-A-C-Y, to get 50% off your next dozen. That's H-A-P-P-Y-E-G-G.com slash pharmacy, F-A-R-M-A-C-Y. You get 50% off your next dozen eggs. Gluten can cause brain inflammation across a spectrum of different conditions, from schizophrenia, autism, also see a large portion, 20% almost, who have antibodies to gluten, depression, anxiety, ADD. I mean, all these have been linked to gluten in the right

person. I know one of the things that you published in 2003 was a seminal article in New England Journal, which I found extremely helpful because it mapped out the fact that gluten and celiac disease can be linked to over 50 different diseases. So it can be linked to schizophrenia, but it doesn't mean that all schizophrenia is a gluten problem or that all colitis is a gluten problem. And I think that's the problem we get into medicine is we think these conditions are uniform, but they're not. There's no such thing as schizophrenia. They're schizophrenia's. And I think this is an important concept that you kind of elucidating with this personalized approach to identifying who's sensitive. And the biomarker issue, I think, is important too,

because we typically, in medicine, are trained that unless you have a positive biopsy of your small intestine that shows you have celiac, then it's not an issue. And I still see this going on. And then there's the antibody studies. And if it's very elevated, I think people will agree that that's a pretty good marker if it's TTG or any gliding antibodies. But if they're slightly elevated, if what's normal, what's optimal, is there any normal?

And, you know, we've had this conversation before. We said, well, if you have any antibodies, it means you have a leaky gut. It means you've been exposed to gluten and it means your immune system is pissed off. That's right. So how do you sort of navigate that world of this well again if if if we take the um again the strong position of debate with right was wrong and we keep you know in the radar screen what should be our focus so what is the best thing that we can do for our patients so you know to improve the quality of life common sense would suggest you that this is all known. For example, if you look at the best drug on the market, the best of all in terms of efficacy, best case scenario, you talk about 45%, 50% efficacy.

That means it doesn't work on half the people and it works on half the people. And this is the best drug that we have on the market. So we know already that these are non-homogeneous populations. The placebo's are about 30%. That's right. And that's background noise. So if you honestly keep this in mind, lesson learned are, number one,

we're not made all equal. Number two, we conventionally talk about um as final destination that can be common so your crohn's disease can be similar to my crohn's disease but how we got there can be very different so imagine at the end result looks the same but the causes are absolutely and imagine that you then on that premise that i believe is not disputable because everybody will agree on that then you go to the next step and say, and I have a bullet, you know, magic bullet that can fix them all. That doesn't compute.

So that's what, you know, drug development now is, you know, approaching the problem in that sense. So if you accept that these are final destination and you can get there in different way, you you also as a corollary to that statement have to accept that eventually treatments needs to be diversified right which is a radical concept what you're saying is that all diseases in a category are not the same so everybody with rheumatoid arthritis or colitis or schizophrenia are not the same and each one needs a different treatment even though it looks the same at the end of the day.

And that's a functional medicine fundamental principle. Mark, again, I don't want to be philosophical or romantic here, but, you know. You're Italian, you're alive. Well, just because I'm Italian, I have to say that, you know, the old physicians, in other words, the healers of 2,000 years ago, they were focused on individual, trying to put the individual back in balance by different approach, philosophical, religious, a little bit of science. And then we start to really be programmatic and systematic and then look at conditions as diseases. So we shift the focus from the individual to the disease. And conventionally, we went to that path to try to be evidence-based, to find the target,

to find the solution, and so on and so forth. Recently, and not just functional medicine, that probably sealed this before then evidence-based medicine, but even the classical trained physician like me start to really appreciate that we should shift back to the individual because that's the way that eventually you can have the best efficacy possible. Well, that's what William Ulster said, right? The father of moderation. Exactly. We should treat the person who has the disease, not the disease that the person has.

Absolutely. And if you got in that kind of premise, the debate is over. There is no discussion that, sure, we have to have conventional approaches. We have to be systematic. We have to be evidence-based, but we also need to accept with humility and an humble approach that the magic bullet is not there. So there is the lesson to be learned here that again, there is a possibility of a subgroup of individual in any given category of chronic inflammation

that can be treated with a gluten-free diet, because maybe there is this possibility. Our challenge now is to find these people, how to identify those people. Yeah. And talking about gluten in the brain, as you were alluding to, we knew this for a long time. And this is also not debatable. Even the people, the most skeptical people will know, because they do know that CD disease is associated, so the ones that everybody accepted, with neurological symptoms and behavioral symptoms that underpin the possibility of neuroinflammation we know that you can have you know anxiety depression

mood swings your brain chronic headache right um you know because neuroinflammation and to the point that i was telling you there are markers in your information the the most classical example is gluten ataxia nobody will dispute the existence of this entity that means you can't walk and you're out of balance there is inflammation of the cerebellum and your equilibrium is affected because of that the same by the same token nobody would dispute that celiac disease can give peripheral neuropathy so inflammation of the peripheral of the peripheral nervous system. And again, by the same token, I think that if now you go back and say, what about people with depression but not Citi disease, or anxiety without any Citi disease, or peripheral neuropathy

and not Citi disease? Is it actually a possibility? Because now, again, everybody seems to accept that you can have probably gluten outside celiac disease yeah by transition you need to accept the possibility that your inflammation central peripheric can affect people other than individual celiac disease so i don't see you know too much of a dichotomy here no but there's there's an interesting distinction here with the non-celiac gluten sensitivity there's's a mechanism he wrote about, which is our ancient immune system called the innate immune system that can react to gluten.

And there's no antibody measurement to there. It just measures just general inflammation. It's sort of a very primitive sense part of your immune system. And then there's the antibody part of your immune system or the adaptive part. And that is where we get celiac antibodies. But the question is, is there a way to measure this non-celiac gluten sensitivity just looking at ranges of antibodies that aren't, quote, abnormal? Let's say your range is up to 20. What if it's 15 or 16 or 10? Is that a significant factor to look at? Mark, my honest answer is I don't know.

And the reason why is because again, we're still learning the pathogenesis and on celiac gluten sensitivity. I really am convinced because the cumulative evidence in the literature that we're dealing with an immune response that involves only the innate immune system. As you said, this is the ancestral way that we developed to fight enemies. It's when we deploy our army without thinking who I'm fighting because I need to fight right away. So I can't think about who are you, customize weapons against you, or antibodies,

since I just need to deploy and get rid of you. It's like carpet bombing instead of smart bombing. Exactly. And again, in that sense, you will not find biomarkers, low titer or high titer, that will link this inflammatory process to the disease. As a matter of fact, there are several groups, including ours, that are looking for biomarkers for non-celiac gluten sensitivity.

My sense is there is going to be a multitude. You were alluding to the first generation anti-glide antibodies. They are positive in 50% of people with non-celiac gluten sensitivity, but that's not a biomarker of reaction to gluten as we typically intend for celiac disease where you have autoantibodies. This is after the fact. So the innate immune response has been activated. You're fighting. You have the inflammation. And now what you see is a biomarker of the consequence of this war, i.e., as you were saying, the individual is eating, the intestine got

leaked, gluten fragments comes in, and immune system does its job. It's under attack and something that is not supposed to be there and build antibodies against it. So I think that's going to be a combination of several biomarkers. It has to do with many of the functions that will lead to the inflammatory process. All right, so I want to walk back historically a little bit because hundreds of years ago we were eating gluten, we were eating wheat, and we didn't see the levels of autoimmunity, we didn't see the levels of celiac disease that we do now.

And you're here at the Annual Conference of Emotional Medicine, you gave a brilliant talk looking at how we kind of got here. What are the factors that changed that actually are driving this level of gluten reaction? And my wife now is in Sardinia, I wish I was there with her. Good for her. And she has trouble eating pasta in America because she always gets a stomachache. But she said she's in Italy now and she doesn't. I know they don't allow GMOs in Italy, although wheat is not GMO, although they spray our wheat here with glyphosate at harvest, which may have an effect on the microbiome. But how do you sort of explain why we all of a sudden got this way?

What are the changes that happen that make people more susceptible? Because the gluten has always been there. Is the gluten different in the wheat we have? Is something else changed in our guts and environment? Like, what is this driving force? You know, again, you know, first of all, some people believe that this was just an increased awareness, but we know that it's real.

And now there are plenty of evidence that these gluten-related disorders are on the rise. And it's not an isolated phenomenon. Every chronic inflammatory diseases are on the rise. Allergic disease, autoimmune disease, neurodegenerative disease like Alzheimer's. Dr. Everybody's inflamed. Dr. That's right. Dr. Even cancer, heart disease, obesity, and diabetes are all inflammatory. And again, epidemiologists will put their hand on the fire and say,

we believe that that's the case, and the evidence is pretty strong. So this is to say we're not really looking at a weird, isolated phenomenon that relates to gluten. It's more in the context of these epidemics that cause inflammatory diseases. So why there is these epidemics? What's going on here? First of all, the timeline that this epidemic is materializing is telling us that it's not genetic mutation in humankind that makes us more susceptible,

because that takes much, much longer. It takes generations, not 30, 40 years, as we've seen in terms of timeline. So most likely we're changing the environment way too fast for us to adapt. And the example you were mentioning about your wife, and actually, I hear this many times from people. Oh, you hear it a lot, right? Oh, yeah. I hear this all the. You hear it a lot, right? I hear this all the time with my patients. The patients, they say, how come that I go to Europe and it looks that I can tolerate stuff

that I cannot even look at when I am in the United States. Definitely, I don't think the GMOs is the issue because, you know, of course, Europe in general, a very strict regulation, GMOs, much stricter than us. When you talk about grains like wheat, there is no such a thing. There is no such a thing. But there are different ways that you can explain why the load of toxic peptides may be higher here than in Europe. Meaning because of the dwarf wheat we use here?

They use a different strain of wheat? No, no, not even that because the cultivars are the same, but the way that we manipulate grains can be different. I'll give you an example that can be one of the many that I can give you. To make bread, you take yeast, you take water, you take the flour, and you make your dough. We, as human beings, we do not have enzymes to completely dismantle gluten in its basic elements amino acids. What we do is a partial digestion, and what is left over are these indigestible fragments that can instigate inflammation. We know that. Most of us can handle that with no big deal unless you go to the extreme. So if you eat a slice or two of pizzas, it's fine, but if you eat three pizzas, you will be sick no matter who you are. And this applies to anything in life, of course, even turkey that is good for you. If you eat too much, you fell asleep and you know why.

So this process of panification, so when you make the bread and dough, you use yeast. Yeast has those enzymes that can completely dismantle these toxic elements. In Europe, bread is still made the old-fashioned. This is an overnight process. So you have 10, 12 hours that these enzymes can dismantle the load of these fragments. Not here. The process takes two hours because now it's accelerated artificially. hours that these enzymes can dismantle the load of this, you know, fragments. Not here. The process takes two hours because now it's accelerated artificially.

Yeah. So you give only two hours to these enzymes to reduce the load. So the grain is the same. The culture is the same. Uh, same story. No, but, but again, the way that you prepare pasta is there are processes that you have to go through, the essiccations, the drying of the pasta, and so on and so forth. And again, give less time if you speed up the process to make this right. That's one.

The other is, you know, as you were alluding to pesticides, we use pesticides here. They are not allowed in Europe. And again, that changed completely the landscape because now you introduce another variable that can affect the way that we, in terms of our immune system, can react to any given product. And it will happen to be grain, but it can be any other product that can give you the same kind of reaction. And I can go on with many other elements, the water, the way that it's treated- So that may explain-

The environment, the pollution in the air. I mean, there is so much. And then of course, the great unknowns that we still don't understand, because even here in the United States, it's not homogeneous. So you have pockets of places in which this phenomenon seems to be much stronger than other pockets of the place. So there's got to be some environmental situation that we still poorly control. Yeah. So sort of going back to that, the environmental factors have changed. And I think in your lecture, you mentioned a lot of changes that have happened that altered a

different thing besides the food. So there's the quality of the food, how we produce the food, all those things in terms of traditional methods that may affect people's sensitivity. But you also talk about the changes in the gut microbiome. And you know, you originally came into this through your study on cholera. And now you're sort of coming back to it, looking at, wait a minute, why are people so sensitive? It's not, oh, you're sensitive to gluten. Let's get you off gluten it's like why is this happening and and how is our change in our environment toxins stress diet antibiotics c-sections how has that led to this increase in autoimmunity increase in celiac disease and allergic and inflammatory disorders so if you really want to look systematically the environmental factors that eventually are

fueling this, you know, epidemics. Now that, you know, again, we agree that this is where we have to focus our attention and not the human beings, genetically speaking, because again, we didn't mutate in such a short period of time. You start to really question what happened in the past 50, 60 years that was different from the previous generation where we didn't even have these epidemics. And of course, you alluded some of the factors. So our lifestyle, mostly we're living a rural lifestyle one or two generations ago. So living in vicinity of animals. Or exposed to a lot more microbes.

That's right. A variety of, but you, you name it, parasites, viruses, you know, but bacteria, but there was a full exchange. And then again, we make, again, this other convention that we are. Isolated Xylus in terms of environment. We are in a continuous, circular life. So soil, animal, human, back to soil. And the waters, we conventionally analyze them separately, but we are a unified ecosystem.

And again, if you believe that, and you look just at the human beings and make the statement, we didn't change that much. True, but what about our soil? What about our water? What about our animals? What about living in a crowded environment versus a sparse environment?

How this changed the dynamic of what's going on. And again, you know, now that we have tools that we didn't have before, we can understand this continuous ecosystem, what we exchange. So the most important thing that we change are microbes. And microbes are an integral part of what we are. And now we know that, again... We're only 1% human, right? Yeah, I mean, again, you know, genetically speaking, that's definitely the case. we are and now we know that again we're only one percent human right most of us yeah i mean again you know genetically speaking that's that's definitely the case and you we are whatever

we are because we co-evolve with microbes it's not that we it's not just a waste that's right from mars and then all of a sudden we've been exposed something never seen before we look and act and and you know are shaped the way that we are because we co-evolve with this ecosystem. Now, again, when we ask ourselves what kind of changes we made, the stuff that's visible, so the air is polluted, now there is fog or the water looks dirty it's the low-hanging fruit but probably not the driving force it's this parallel universe that is instrumental for our health that changed dramatically the microbiome so in other words you know this community that is supposed to come in orderly since we are in the

wounds and stay with us until we die, that has been completely revolutionized in its composition and function. Um, that, you know, I'm mesmerized how come that we are not making even more dramatic changes that we're seeing. And so that means that there is some terms of adaptability. But I can't emphasize enough that changing lifestyle from rural to urban, introducing antibiotics for treatment of infectious diseases, introducing new practice like the C-section. Yeah, which is almost one-third of all births now, right?

Well, it depends because I just was in Mexico for a meeting, and I learned that in Mexico, C-section is 60% of the population. 60? 92% in Brazil. So it's staggering. 92%. Absolutely. And again, I would welcome with C-section.

It's a birth option, check off ABC. Well, no, you know, Mark, the reality of the story is, again, you know, a lot of hundreds of thousands of women died because of you know exactly so c-section has been a tremendously important advance in medicine when it's medically indicated but when the ob-gyn will prescribe the a c-section so he or she can plan vacations or cash more money in, or that the woman decides to go C-section for her own needs, but not because of medical necessity. I will suggest to think and think very carefully because, again, the plan of engrafting and growing the proper friendly

microbiome has been planned for 2 million years to be done through vaginal delivery. Yeah. When the baby absorbs through its mouth, all the vaginal flora, which colonizes its gut. Absolutely. Yeah. And, and that is a, a flora that has been highly selective from my mom to be genetically compatible with her and therefore with her baby.

The skin microbiome is not selected, they are all comers. So the operator in the operating room or the nurse or the anesthesiologist, their microbiome come in there and may not be that friendly for the new baby there. So, and then of course- And that's why you see more allergic to seizes asthma. Absolutely.

And autism. Because no matter, no matter if you talk about prenatal factors, mom's lifestyle, mom's environment, or perinatal, like the C-section or antibiotic exposure, or the way that you feed the baby breastfeeding, feeding or bottle feeding or postnatal. All these things hinge on the composition and function of the microbiome. Why I'm so obsessed with this? First because, as you said, that's where I start.

My science from the very beginning was totally focused on understanding how microbes, they cross-talk with us. At the beginning, my focus was on a single pathogen to understand how they can make us sick. And then that knowledge moved to the community and now the ecosystem that now we call microbiome. But again, we were studying this 20 years ago with tools that were ridiculous compared to the ones that we have right now that now clarify the complexity of the matter. And we're just really at the infancy of this discovery.

Most definitely. But again, it's giving us the opportunity even more to appreciate how singularly we are, how different we are from each other, how eventually, you know, losing tolerance to develop an inflammatory process can be so different from one individual to another, even if, again, we end up with the same disease. You know, it's interesting. I treat a lot of patients with gluten issues and celiac disease. And often I find they don't get completely better when you remove the gluten.

And then when I put them on a gut restoration program, you know, really getting rid of the bad bugs and putting in good bugs, just simple functional medicine principles, which are, you know, not really that well established scientifically, but we've been using for decades to just help normalize gut function, then they get better. So when you look at modern bread, it's extremely finely milled flour and with a lot of surface area. So when you consume it, it's quickly absorbed, just like sugar. And in fact, I guess it's worse than sugar in terms of its glycemic index. And that causes you to spike insulin levels. After your blood sugar goes up, your insulin spikes. And that insulin spike causes a cascade of phenomena that leads to all the chronic diseases

we see, heart disease, cancer, diabetes, Alzheimer's, and much more and much more infertility i mean i can go on and on acne and that and that phenomena of insulin resistance is driving inflammation in the body it causes you to store fat around the middle it causes you to crave more carbohydrates and food it causes you to eat more overall it slows your metabolism down it really is a hormonal immune catastrophe uh and that's really because of the kind of flour we're eating so we really need to cut that out if we want to stay healthy it doesn't mean we can't have different kinds of bread and there's many kinds of bread and in food what the heck should i cook which is my cookbook there's a couple of great recipes for seed and nut breads there's other breads like wins life which are made from just you know pumpkin seeds chia seeds flax seeds psyllium husks eggs and the llama milk and

and lemon juice and baking soda and it's delicious bread but it's not made from flour it's made from nuts and seeds so i think i think we really can reimagine bread and also we can look at all kinds of other grains that might be helpful and beneficial at how rich in phytochemicals because basically when you're eating modern white flour, it's just completely devoid of any nutrients. And the reason they call it enriched flour is because when they first started making it and people started eating it, they would get massive nutritional deficiencies

because of the lack of the B vitamins that are in the whole grain. So they would get thiamine deficiency, berry, berry, pellagra. You know, and it was a terrible time of vitamin deficiency and it was because of the refining of the flour. That's how we began to actually discover the vitamins because when we started milling the flour so fine, whether it was rice or whether it was other grains or flour, we saw this massive rise in really serious nutritional vitamin deficiencies. So people don't think of, oh, I'm eating a bagel or I'm having a piece of bread with dinner

that I'm actually harming myself. But the truth is we are, we are really harming ourselves when we have white flour. I mean, like I said, we eat 133 pounds of flour per person per year. That's like a little, like a third of a pound a day, basically, or a little more, right? That's a lot of flour.

The second is this this phenomena of increased gliding proteins in gluten and and the number of gluten proteins that are inflammatory and then that combined with all the other stressors in our life that cause leaky gut from environmental toxins to food additives to chronic stress to you know microbiome changes and antibiotic use and other medication, we're in a situation where we're seeing rampant leaky gut. And gluten is one of the biggest drivers of leaky gut because it creates a damage to what we call the tight junctions,

which are the little sort of Lego lock kind of things that put the cells together. And when you consume gluten, this is work by Alessio Fasano from Harvard, who discovered that it increases a compound called zonulin in the body, in the gut. Zonulin is a very important molecule that will cause a weakening of the tight junctions. And it can be helpful, like, you know, if you get certain infections or disease, you want to flush the gut out. But this actually creates this chronic leaky gut and you absorb all the bacterial toxins and food proteins and you can get inflammation in the body and autoimmune disease and allergies and much worse. So I think, you know,

that those two things, both the sugar content and the leaky gut damage from gluten and bread, are the two biggest real threats. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at DrMarkHyman. And we'll see you next time on The Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And we'll help you too.

Again, that's drhyman.com forward slash Mark's Picks. Thank you again, and we'll see you next time on The Doctor's Pharmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only.

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