Are Your Gut Issues, Headaches, Heart Palpitations, And Other Symptoms Due To Histamine Intolerance?​​

Coming up on this episode of the Doctor's Pharmacy.

People can come in with all sorts of weird symptoms. They can have migraines, nasal congestion, brain fog, digestive problems, menstrual cycle problems. If you're suffering from any of these issues, it could be a histamine issue. Hey everyone, it's Dr. Mark. Now, I know a lot of you out there are healthcare practitioners like me, helping patients heal using real food and functional medicine as the framework for getting to the root cause of the issues. Now, in my practice, this often means looking at lots of internal variables to find the most effective path to optimize health and reverse disease. But up until now, that meant we were usually ordering tests for one patient from multiple labs. Now, I'm sure many of you can relate to how time consuming and complicated lab ordering can be for functional medicine practitioners like me and our patients. That's why I love using Rupa Health. With just a few clicks, I can order from 30 plus lab companies. That's over 3,000 tests for free in one single portal. That means one invoice for all labs paid online upfront. Plus, patients get practitioner pricing and receive full patient support through easier personalized collection instructions, automated follow follow-up super bills and answers to testing questions and so much more. Just go to rupahealth.com that's rupahealth.com to sign up for your free account today. In my over three decades of practicing functional medicine, I've learned a few things. Take old age for example. Aging has long been considered a normal process. We used to think disease, frailty, gradual decline were just inevitable parts of life. But it turns out they're not. The negative health effects of aging are actually treatable if you understand the root causes. Mitochondrial dysfunction is one of those root causes of rapid aging that leads to all sorts of long-term health issues. By treating your mitochondria well, you can live a longer, healthier, more active life. And that is why, my friends, I'm super excited about Mitopure. Mitopure is the first and only clinically tested pure form of a natural gut metabolite called Urolithin A that clears damaged mitochondria away from our cells and supports the growth of new healthy mitochondria. New science is showing that healthy mitochondria also improves immune function too. I've been using it for over a year now and at 63, I feel stronger and more energized than ever. Right now, Timeline Nutrition is offering my community 10% off MitoPure, which you can get in a capsule, powder or protein blend at timelinenuetrition.com/DrHyman. That's T-I-M-E-L-I-N-E.com/DrHyman. D-R-H-Y-M-A-N, and use the code Dr. Hyman.

10, just D-R-H-Y-M-A-N 10, number 10. Hi, this is Lauren Fein, one of the producers of the Doctors Pharmacy podcast. If you suffer from a slew of symptoms that you just can't shake, such as migraines, fatigue, puffiness, runny nose, anxiety, or heart palpitations, it's possible you may be experiencing histamine sensitivity. Histamine sensitivity, as well as mast cell activation syndrome, are becoming more understood by doctors and often have a root cause in compromised gut health. In today's episode, we feature four conversations from the Doctor's Pharmacy about histamine sensitivity, how mast cells are related, and how gut health issues may be driving your symptoms. Dr. Hyman speaks with Dr. Todd LePine about his experience treating patients with histamine sensitivity and the connection to migraine headaches, with Dr. Leo Galland about COVID triggering a histamine response, and with Lisa Dier about how to use the elimination diet to identify irritating foods and heal the gut. Let's dive in.

What the heck is histamine? Why should we care? And tell us why it's so important and why it contributes to so many people's unnecessary suffering.

So histamine is found naturally in the body. The body makes histamine. We also consume histamine. And the interesting thing about histamine is it is also part, it's released by mast cells as part of our first response to offending organisms like- so mast cells are like a white blood cell. Exactly, yes. Type of white blood cells. Type of white blood cells, yeah. And the also interesting thing is that histamine actually works as a neurotransmitter. And when you think about this, this is really an interesting thing. And as I was preparing for this, I sort of stumbled upon some things which I thought was really quite fascinating, is that when you take antihistamine, what happens to you? You get drowsy. Exactly. So histamine, when it's at high enough levels, it stimulates the brain. Histamine is actually involved in the sleep-wake cycle.

Well, I mean, Tylenol PM or Advil PM, it's Tylenol, Advil plus Benadryl, which is an antihistamine.

Right, so it's a balance. Too much histamine is bad, too little histamine is also bad. So when you actually totally block histamine, you actually get sleepy. It'll actually involve with the sleep-wake cycle. And, Modafinil, which is the drug that people take, that actually works on histamine.

Pro-vigil.

Pro-vigil, exactly. Actually part of that works on the histamine. So it keeps the histamine levels higher.

So it keeps your brain sort of awake, if you will. Incredible. So most people are familiar with certain histamine conditions, right? If you get hives, if you have a peanut allergy, if you have this condition we call dermatographia, which sounds weird, but essentially it's if you scratch your fingernail on your skin, it'll create a red welt. Yes, yes. You literally write your name on your back and it'll kind of have raised.

And that's actually a poor man's way. I oftentimes will use that with patients to determine how much histamine they're having in the connective tissue because the mast cells are the type of white blood cells that are in the connective tissue of the body. And when they have excess amounts of histamine in them or they release histamine too easily, you will get this thing called dermatographism where you can take your finger and stroke on the skin and you will form a red line and it'll stay there. And sometimes it'll get really welty and raised. And that will tell you that there is a problem with excess amounts of.

Histamine in the body. Yeah, and it's something that we've all experienced. When you get a bee sting or something like that, you'll see this raised welt. But what happens for some people, they don't necessarily get the hives and they don't get these raised welts on their skin, but they do suffer a whole range of symptoms. So, when someone walks in your office, what are the clues that alert you to the fact that they might have a histamine problem? Because by the way, most traditional doctors don't even know anything about this syndrome. Yeah, if you have allergies taken in histamine, but that's about it. But there's a whole host of problems that people suffer from that are mostly misdiagnosed, poorly treated, and create so much suffering, which is unnecessary.

Yeah, and there's a term out now, which when I was in medical school, we didn't even have it. It's now called MCAS, Mast Cell Activation Syndrome.

Like it's a real medical diagnosis.

It's a real medical diagnosis. I mean, we're seeing a lot of it now, and the question is, is why are we seeing so much mast cell activation. It's a really, and I've been puzzling on this myself.

Yeah, I never took that class in med school.

I never, right, exactly.

But it's true, it's a big thing now. We're seeing a lot of it and it's not like there's one cause for mast cell activation. There are multiple causes and I actually even, and I deep dived into the literature, one of the things that I stumbled upon was the effects of EMF on mast cells. EMF is. EMF is electromagnetic frequency. Like your cell phone, background, cell towers, Wi-Fi. Absolutely, absolutely, and there's some work by a woman, Johansson out of, I think it's Sweden, who's done some work on the effects of EMFs on mast cell degranulation. And there's some good studies showing that EMFs are one of the things in susceptible individuals that cause their mast cells to release more histamine that drives this allergic inflammatory response.

So that's fascinating. And so one of the sort of symptoms that you see people coming in with?

Well, they oftentimes will react to every food. They're sort of the people who they can't, they have a more and more restricted diet because the more foods that they eat, it'll trigger because lots of foods contain histamine or will get broken down. Histidine is an amino acid and that when you consume foods that are high in histidine, things like meats have a lot of histidine, your body will actually break it down into histamine. And normally the body can process that, but when you have problems with either too much ingestion or too much production of histamine or not enough breakdown of the histamine, then you'll have problems with histamine intolerance. And these are, you know, typically a lot of people who have food allergies. And Mark, I think you've done this yourself. This is really interesting is the old, old way of treating food allergies was what? Chromal and sodium.

Yeah. Right.

Remember using that? And that it's actually quite, it's actually a pretty good treatment for people who are really, really reactive to foods and the way that chromal and sodium because cromolyn is actually used for patients with asthma. Yeah, you inhale. It's an inhaler. It's an inhaler, exactly. And it's a very effective drug. For really bad cases, cromolyn sodium can be very, very helpful for patients who have severe histamine responses to foods.

And it's true. And people can come in with all sorts of weird symptoms that just are misdiagnosed. They have headaches, they can have migraines, nasal congestion, sinus issues, fatigue, brain fog, digestive problems, menstrual cycle problems. nausea, vomiting, and if it's really severe, you can get really bad cramping, you can get edema, tons of fluid retention, palpitations, anxiety, your temperature regulation off, dizziness. So a lot of people come in with all these weird symptoms. I don't know what's wrong. Take an antidepressant. Yeah, exactly. So, but there is a way to diagnose this. And so if you're suffering from any of these issues, it may be that there may be a chance that it could be a histamine issue. Yeah. and, and, you know, when you have someone who comes in with all these symptoms, and, and by the way, a lot of people have edema and fluid retention. You can just stick your finger in their body and their tissue. You feel it's puffy and swollen. You can get edema in the legs. You can see just people carrying a lot of extra weight and fluid. Yep. Is often some type of histamine activation there.

Well, sure, because, well, the mast cells, which are the one, the cells that contain histamine, they're actually found in the spaces, the interstitial spaces and the connective tissue of the body.

So that's why they get puffy, because.

That, those are where those cells that are high in histamine reside.

And it can really be something that leads to chronic fatigue syndrome, this mast cell activation issue. It's a big deal and most of the time it's just completely missed. I mean, if you ask the average doctor, say, Doc, I think I have mast cell activation syndrome. Can you please get me the test and diagnose me? They're gonna go, I don't know. Let me check your histamine levels. So when you have a patient with this, how do you begin to think about diagnosing this because it can be a big deal for people. And I wanna share a case later. You're gonna share some cases of some patients who suffered for decades, decades, and finally get better when we treat them.

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

We'Re talking about the gut here on the Doctors Pharmacy podcast and especially on our House Call episodes, because it's such a fundamental thing. and it's connected to everything. And the microbiome is so critical in so many aspects of our health. And I remember when we started doing this, Todd, decades ago, and we'd say, oh, people have a leaky gut or there's problems with their gut floor or they have dysbiosis. They would just laugh at us. They literally would just, doctors would just laugh at us and think we were completely crazy. Insane. And yet it is now one of the most important areas of research in medicine is the microbiome and understanding leaky gut. And you see all kinds of papers and scientific literature using the term leaky gut. Wow.

Yeah.

I remember sitting, it was in 1997 and I was at Canyon Ranch and I was having dinner with some guests and there were some doctors in the crowd and we were having nice dinner and we were, I was talking about leaky gut and the woman, this woman was an allergist. So her specialty was allergy and things like histamine. And she looked at me and she says, you,'re just completely nuts. There's no such thing as leaky gut. You know, this is just a bunch of, you know what? And I just was like, looked at her like, oh boy, you know, and it's now, you know, 25 years later. and medicines really come along. It takes a long time, but people are still struggling, you know. And I think the obvious, you know, the obvious, the worst sort of case scenario of a histamine reaction is obviously anaphylaxis. But that doesn't have to be that. So talk about how we begin to diagnose it.

We look at what tests besides a SIBO test. Well, you can measure histamine in the blood. You can also measure tryptase, which is another marker for mast cell activation. you can also measure, there's another test which in my preparation for this, I've not measured, I haven't found the lab that does it, but it can be measured as n-methylhistamine, which is a breakdown product of histamine. That is another one that can be done. And then again, I think one of the tests for me is dermatographism. I find that a very helpful clinical test to determine if a person's mast cells in interstitial spaces are overly reactive. and releasing lots of histamine.

Yeah. And we also do a test for DAO deficiency.

Yes.

Yeah. So talk about what that is. DAO is an enzyme, right?

Yes. So DAO is a diamine oxidase. So this is an enzyme that our body has and it helps to break down histamine. So histamine has to be, you know, consumed, it's used, and then it has to be detoxified. And if this enzyme is lacking in a person, for whatever reason, the enzyme may be turned off, you will have problems with detoxifying histamine, that's actually in the gut. So, and there are enzyme products that you can use, DAO enzymes that you can use that patients respond very, very well to.

Yeah, we do that here at the Ulcer Wellness Center. We give people hist DAO and enzyme support. And it's interesting, there's a lot of.

Things we do every day that block DAO production.

Absolutely. Alcohol, black tea, green tea, which is a good thing, mate, energy drinks, these all block DAO production.

So it's going to increase your, your, your histamine intolerance. Yeah, exactly.

Yeah.

And then, you know, you can, you can use his antihistamines. the other thing, we had another podcast earlier on migraines. And this is, I found this also very interesting is one of the things that is a histamine blocker is butterbur. And butterbur is used in migraines. And the reason why butterbur works in migraines is it actually is working on an anti-histamine level because you can get a, an allergic brain, if you will. You know, we know, we know about that where you get fuzzy in the head and you get, you can get headaches and things like that. So excess amounts of histamine has an impact on the right.

Yeah. And, and, and, you know, there, and so when you see these patients, you can do some of the genetic testing, look for these dio deficiency issues. You can look at histamine levels, you can look at some of these byproducts, you can do tests for dio deficiency. You can look at some of the other factors that might be causing it, like leaky gut, food sensitivities, all that is really part of what we do here at the Ultra Wellness Center when we check these patients history and we look at their lab tests. And then, you know, sort of when they come in and you sort you have this sort of suspicion because sometimes it's hard to diagnose. You have a suspicion. It's pretty easy to sort of test and try different approaches that allow people to see if it's an issue. So, what are the dietary things that we'd start with? Because a lot of histamine triggers are in the diet. And so, we can have a low histamine diet. So, what's a low histamine diet? Well, foods which- Or what actually are- put it this way. What are the foods that have the highest histamine that we should be avoiding?

Yeah, so basically the way to think about it is bacteria produce histamine. So if you have food that's old, if you have food that's sitting in the refrigerator for a couple of days, guess what happens? The bacteria actually break down histidine, the amino acid, into histamine.

So no leftovers for you?

Leftovers, exactly. Leftovers, exactly.

I love leftovers. Maybe just like the next day.

And then fermented foods, fermented foods are fermented by bacteria. So anytime we have food that's old or fermented, things like Parmesan cheese, aged cheese, aged meats, et cetera. Cured meats, et cetera. They have high histamine and that's part.

Of the fermentation process. So, yeah, we talk about fermented foods being so good for you, like sauerkraut.

And kimchi and natto and miso. Exactly. And this is where these really good foods in someone who has histamine intolerance is like putting gasoline on a fire. And they'll be like, well, I'm getting worse. It's like, well, no, you should be getting worse.

These are good foods for you. No, you have histamine problems. What is that saying was good for the gooses and good for the gander, right?

I think this is so critical what.

We'Re talking about here, Todd, Functional medicine is personalized medicine. Absolutely, yeah. It's precision medicine. And it's not only medicine, it's precision nutrition. So it's really important to understand that even though this way of eating may be great for some people with fermented foods and eating avocados and having delicious shellfish.

Bone broth. Bone broth.

That's another one. Right, we think all these are great foods, but you might be killing yourself. And of course, alcohol and beer and all that is a problem. but we're really here focused on what is right for you. And I think dietary dogma really interrupts personalization and approach to nutrition. Some people do great on vegan diets, some people do terribly. Some people do great on keto and some people do terribly. So there's no one size fits all approach. And what really frustrates me, Todd, and probably I'm imagining you too, is that you know, there's all these people out there on the web and internet and promoting this and that approach and this and that diet, and they're not seeing patients.

Yeah.

And, and, and the thing about seeing patients is it's incredibly humbling. If you've seen tens of thousands of patients, you know, you, you can't be dogmatic. You can't say, this is the way. You have to be vegan or you have to eat meat or you have to eat fermented foods or. Yeah, it's like you go, wait a minute, everybody's different. and what works for one may not work for another. Yeah, one man's food is another man's poison.

That's right.

And even good, quote, good foods, you know, we're talking about good foods. And so I think this is a really important point, particularly people who have histamine issues, which is a lot of people at some level or another, they should consider trying a histamine free diet and also other foods that we think are also great, maybe triggering histamine like papayas and chocolate, oh my God, chocolate, which I love, would be terrible to get this condition. Dried fruit, certain nuts, food dyes, additives, you know, wheat germ, weight gain, supposed to be health food, right? Tomatoes, bananas, all these things may really cause increased histamine production. And sadly, in order to get this under control, sometimes you need to be restricting some of these foods for a while for your body to heal.

It's not forever. That's the thing is I think you're absolutely right. An elimination diet is not something that you do forever. And a low histamine diet is also something that you don't necessarily have to do forever. And I think that the key thing is really working with a really good, well-trained, experienced functional medicine nutritionist who can help you navigate all of the nuances of what to eat, what to avoid, what to take in terms of supplements can be very, very helpful.

Absolutely. And the things that we want to focus on if you have histamine intolerance are foods that are low in histamine. Really fresh food is the key, right? Not old food, like you said. Fresh meat, freshly caught fish, not fish that's been sitting around for a while or canned fish is not as very good. Fruit that's not citrus fruits, eggs are great. not gluten grains, get away from the gluten, but quinoa and black rice, not dairy, avoid dairy, but you can have coconut milk or almond milk, lots of veggies, but no tomatoes, avocado, spinach, or eggplant, right? So you've got to be smart about this and it's a little complicated and often you need help with the nutritionist. All the good oils and fats that we like, those are all great. So you know, it's pretty much how I eat. I mean, I do eat avocados and.

Certain things, but I really pretty much.

Eat protein and vegetables and it works so well for these patients. Hey everybody, it's Dr. Mark. getting quality sleep is incredibly important to me. Sleep is really one of the pillars of good health. So you can imagine my frustration when I used to lie down at night but couldn't fall asleep because I was just too hot. But those sleepless nights are behind me now thanks to Cozy Earth. The bed sheets are made from temperature regulating fabric that keeps you comfortable all night long. I naturally run hot but with Cozy Earth's breathable sheets, I cool off and get right to sleep and stay asleep much faster. Cozy Earth offers a variety of luxury pillows, sheets, blankets, and more, and their durable weave fabric won't pill for 10 years, guaranteed. heat. Plus, they pride themselves on the ethical production of all their products so you can feel good about your purchase knowing you're supporting a truly responsible company. And right now, Cozy Earth is providing an exclusive offer for my listeners. You can get 40 off site-wide when you use the code Dr. Hyman. Just go to cozyearth.com and use the code Dr. Hyman.

That's D-R-H-Y-M-A-N. And now let's get back to this week's episode of the Doctor's Pharmacy. And there's a condition called the mast cell activation syndrome. It's been getting increasing attention, certainly in functional medicine over the past several years. Mast cells are these large kind of primitive cells that don't circulate in the blood. They're in the tissues. And they release a couple of hundred different chemicals, including histamine. Now, the role of histamine in long COVID has gotten some attention because the use of histamine blockers, drugs like Pepcid, have been used to treat it. And low histamine diets have sometimes been used. If you look online and you go into chat rooms, people will talk about the benefits of low histamine diets. There's this phenomenon of mast cell activation that occurs and it's very much tied in with POTS and with some of the neurologic dysfunction that occurs. So, mast cells we think of as.

Typically in allergies, right? And, when you have allergies, your mast cells increase. They increase histamine, which then creates this sort of hives and allergic symptoms. That's what you're saying happens as part of post-COVID for people Yes, except that.

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

You mean with antihistamines?

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

Yeah, interesting.

Because the mast cells kind of become like loose cannons in this situation and you never know exactly how they're going to respond and what they're going to do. You have to go very slowly, very methodically.

So how does someone know if the mast cells are going on and activated in their post-COVID phenomena?

There are some blood tests that can be helpful and some urine tests, but they're not very sensitive. So you can have, it certainly will look at plasma histamine, we'll look at an enzyme called tryptase that's produced by mast cells. But as I said, there are 200 different chemicals. that are produced. And unless the timing is right, you may miss the peak of those chemicals. So ultimately it is a clinical diagnosis based upon the nature of the symptoms, the pattern, the response to treatment.

So you mentioned like four, so that's one of them. What are the other? Right.

Well then they're a group of Yeah, they're a group of white blood cells called monocytes.

Which.

Have a tissue component that is the monocyte circle. In the tissues, they're called macrophages, which means a large eater. And these are cells that gobble up bacteria and viruses and damaged cells. And they they have important regulatory functions that are definitely imbalanced. I call it the phenomenon monocyte polarization, but they're imbalanced in long COVID. And I think we can trace a lot of that imbalance directly to the ACE2 deficiency and to some extent to the mitochondrial dysfunction. So it's not as the mast cells need to be treated on their own, the monocyte macro macrophage polarization, that will usually respond if you deal with the other factors. Then there's the production of autoantibodies. So that involves a type of cell called a B lymphocyte. B lymphocytes produce antibodies. Antibodies are proteins. that your body makes to protect itself basically from foreign invaders. I would say I view antibodies like the artillery. You know, they get the cells themselves are not involved in the combat. The cells produce these antibodies that fly like cannonballs to be involved in the combat.

And.

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

So the antibodies, you're giving antibodies with IVIG. So how does that work? Because you're giving immunoglobulins and you're trying to fight the autoantibodies.

What they do is they tie up the autoantibodies basically.

They kind of bind them up.

Yeah, they bind them up. See, there's a complex phenomenon called immune networks in which antibodies recognize proteins called antigens and they bind to them. But in doing that, they can damage your tissues. There can be fallout from that. the antibodies can lead, can themselves act as antigens and stimulate other antibodies against them. And you get this kind of feed forward cycle of antibodies to antibodies and then antibodies to the antibodies to antibodies. And sometimes that actually helps to control inflammation and damps it down. But sometimes it aggravates the inflammation. It all depends on the specifics of the individual case. So that's a very complex area which no one can navigate on their own. We don't have the tools for self-care there.

However... And you can measure these different antibodies though, right?

Yes.

What are the common antibodies that we see?

Well, the one that I've seen in terms of what you can measure through a standard lab, the ones that are most common are the antiphospholipid antibodies. And those are significant because they may be contributing, there's this phenomenon called antiphospholipid syndrome in which you get blood clots. So they may be aggravating the blood clots. But there are other antibodies that are only identified in research labs.

Or in.

Highly specialized clinical labs. You know, there's like one lab in the US and one lab in Germany that are that will measure these. And, and some of these are.

Specific to COVID-19, but they they're autoantibody.

The ones that may be specific to COVID-19 are antibodies directed against ACE2. This was research done at the University of Arkansas.

And.

They, and these were functional, that is they were interfering with ACE2 function and they developed in people who had been hospitalized in almost 80% of people, but in people who had relatively mild infection and were not hospitalized, about 5% of people. So they may play a role. However, most of these antibodies are only active if there's cell damage and inflammation. So if you can calm down the cell damage and inflammation, the autoantibodies don't make a difference.

Interesting.

And that's one of the goals. And then the fourth type of cell are the T cells, T lymphocytes. So T lymphocytes are kind of the generals of the immune system. They are the most evolved cells. They have the most complex sets of functions and there are many different types of T lymphocytes and one type can morph into another. And it is very clear that there's dysfunction of T lymphocytes in COVID-19, but it isn't clear exactly what but it may not be the same in everybody. And maybe the most intriguing study that I saw was a study from Northwestern University where they took people with what they call neurologic neuropasc. Pasc stands for post-acute sequelae of COVID It's another word for long COVID. And they took people with neurologic symptoms, which included chronic fatigue. chronic fatigue is often a neurologic symptom. So it took people with fatigue, with POTS, with other complications, and they found that there was a major impairment of a group of T lymphocytes that are called TEMs, T effector memory cells. These are cells that are really important for antiviral immunity. They remember what you've been infected with and they go after the cells that harbor them. And T effector memory cells are the cells that keep viruses in check. Epstein-Barr virus, for example.

Yeah.

Okay. Everybody in the world gets infected with Epstein-Barr virus during the course of their life. It never leaves your body. it stays in a dormant state, actually living in B lymphocytes. And what keeps it normal is the activity of these T effector memory cells. When those cells take a hit, Epstein-Barr virus gets more active. That's why antibody levels go up. And I think there's a widespread misinterpretation of the significance of increasing antibodies to EBV in people who have had COVID. So I've seen it even in people who are asymptomatic. It's a sign that the effector memory cells, the T effector memory cells, took a hit. Yeah, and so the B cell memory kicks in to keep the virus under control. It's a sign that you need to activate, that you need to support T effector memory cells. They happen, by the way, they happen to love fat. They love on fat. They run on fat, fatty acid oxidation. They don't like sugar, those cells. So you need to support them with an adequate amount of fat in your diet, inflammation like sugar and cancer cells like sugar and that metabolic pathway that is activated when the immune cells are multiplying fast and, you know, yeah, that runs on sugar. It's a complex kind of phenomenon. But when you want to calm it down, you really, you know, you need the fat.

I've had people who've had, you know, chronic daily migraines or, you know, 20 days a month. And it's just so awful for people.

Especially in women. Women are tend to have a little more, I think, I think in general, women, I'd probably see more women with migraines than as opposed to men. And then women also get menstrual migraines, which is another sort of flavor of migraines, which is another, probably related to estrogen detoxification. So it really is. It's, it's, and it's actually, it's, it's, it's, it really keeps me on my toes in functional medicine when I see a migraine patient, because it's not like, oh, here's your problem, you know, just do this. And it's fine. I've got to, like, play detective. I've got to figure out what are the factors that are driving that person's unique presentation of their migraines.

That's absolutely right because what we do in traditional medicine is okay, you have this type of headache and I ask these questions and it meets these criteria for what a migraine headache is according to the neurological society criteria. But once you make the diagnosis, there's no more thinking involved. It's like, okay, here's the cocktail of drugs I get to pick from. Start with these, try this. That doesn't work, we'll try this. and it's just like it's kind of a merry-go-round of drugs and it often is so difficult for people to get better because they're not asking the right questions. So in functional medicine, we don't just name and blame, which is what our mentor, Sydney Baker talks. We name it, blame it and tame it. You name the disease. Say, oh, you have a migraine. That's why your head hurts. No, that's not why your head hurts. That's just the name of why your head hurts. And then we try to tame it with a drug. instead of actually figuring out the cause. So let's talk a little bit from a functional medicine perspective about what the causes are and let's get into some cases because I think we've both seen so many cases. It's one of the most satisfying things for me as a doctor to actually treat because it's so easy usually and people do so, so well with simple approaches that deal with the root causes.

Yeah, absolutely.

So tell me what what are the things that you think of when you're coming to see these patients that could be driving the migraines?

Well, one of the things that I think is missed by a lot of mainstream doctors, even neurologists, is to understand the role that mitochondria play in migraines. So, interestingly, mitochondria, which are the powerhouses of the cell, they basically is where our body consumes food, we produce energy from that food in the form of ATP. and mitochondria are not really tested by mainstream medicine. They are not well understood, something that you learn about in medical school and then you forget about it. And the interesting thing is that people who have migraines also have a higher incidence of seizures. And that's why to some degree, anti-seizure medications can actually have efficacy in some patients who have migraines. So there's a real important to realize that connection between mitochondrial dysfunction mitochondria make.

Energy in your cells.

Make energy in your cells. In fact, I've actually seen some patients, interestingly, who, and I don't see, I don't treat children, but I've seen some adults. When I go into their history, they had a history of what is called cyclic vomiting syndrome. And so that's where a young kid is vomiting for no particular reason. And turns out, cyclic vomiting syndrome is actually a mitochondrial problem. And as a person gets older, they sort of grow outgrow that vomiting. episodes, but they actually then present with migraines. And interestingly, the gut is connected to the brain. So a lot of people can have what we call abdominal migraines. Yes, exactly.

Right, right. Yeah. This reminds me, Todd, I had a patient who struggled with headaches and migraines, and she had terrible SIBO, which is overgrowth of bad bugs in your small intestine that was causing all this fermentation and creates these toxic byproducts that were clearly creating inflammation in the brain.

And we treated her gut with antibiotics to cure migraine. But who would. Who.

Thought of that as a neurologist, right?

Exactly. And it's also the other interesting, and we're going to talk about that in one of the upcoming episodes, is on histamine, the role of histamine. And that's actually a very interesting thing when you look at histamine because people who have SIBO, they actually have bacteria that are producing toxins like you're talking about. And one of the problems is excess amounts of histamine. So normally our bacteria will degrade histamine and we have enzymes that do that and there's all different, these different pathways. And when you look at some people who have migraine headaches, there are certain foods which can trigger a migraine. So is it the food that's doing it or is it something in the food or it's how the food is actually being metabolized? So that's a really a key important feature is that the connection between the gut, our food and the brain.

Yeah. I mean, it is such a big problem, Tony. you know, the amount of people with migraines, over 10 million people have migraines. It costs about $17 billion a year to society in healthcare costs, just direct healthcare costs, that's medications, emergency room visits, hospitalizations, doctor visits, testing, and then even managing the side effects. And then the loss of productivity to employers because like you're saying, is $15 billion, about half that's a huge due to absenteeism and the other half is due to just people being on the job but not, being at the job but not on the job. They're just sort of there but not functioning. And so over the years of functional medicine, I've seen so many patients and like you said before, there's so many different flavors. Tell us about some of the other flavors because we went through the mitochondria and let's just go to code down the list of what are the most common things because there could be 29 things but there's a few that are really common. Stress.

Stress.

Stress, okay.

Tell us about stress in mitochondria. so stress by itself does not cause any diseases, but stress can turn the volume up on all different kinds of conditions. We see that in autoimmune conditions. So how our bodies respond to stress, and some people have, I would call it a genetic predisposition, to be more stress resilient. And some people don't. And some people are more prone to the effects of stress. And time after time, you see these people who they'll go through a very stressful period and all of a sudden they get a full-blown migraine. Well, what is that? what's going on there. And I think it is how that person perceives the world and how they detoxify their stress. Absolutely. And that's why, you know, beta blockers, which block adrenaline, which you get high levels of stress, makes a big difference.

So things like yoga, meditation.

Exactly. And then also sometimes when you have patients who have migraines and you measure their cortisol levels, they've got higher levels of cortisol. So that's telling you they're having more chronic stress. And there's, you know, they sometimes will be type A, where they're sort of very, very driven. those kinds of things.

So you mentioned gut issues a little bit earlier and I think that's another big one and not just SIBO, but there are a lot of symptoms that people get that could be related to leaky gut and food sensitivities, which seem to be a huge factor with migraines that are really undiagnosed. We know traditionally that people say scientists and doctors say stay away from tyramine foods, other things cheeses, foods that contain certain chemicals like MSG or aspartame. So there are some recommendations, chocolate, Fe, and there are doctors who do say some of these things and that can be helpful for some patients, but it goes much deeper than that. There's like food sensitivities and gluten. So tell us about, you know, how that, how that works.

Yeah, well, I think that, you know, the connection between the gut and the brain is huge and the, the leaky gut component you oftentimes will see leaky gut in patients who have increased risk for, for migraine. migraines. There's definitely a two-way communication that's going on there. And again, you know, sleep is another thing that plays a huge role. So lack of sleep is huge in migraines. So when you look at, when somebody comes to see me, you know, I ask them, how's your stress level? How are you sleeping? And what are you eating? And who are you feeding? Which is, you know, what's going on with the gut bugs?

Yeah.

You have patients who will tell you that when they eat certain types of foods, like sugar, They'll trigger a migraine. It's huge. And, I suspect that some of those foods are actually affecting the gut microbiome in a very rapid fashion that's causing migraines.

Yeah.

One of the biggest things I've seen.

I'm sure you probably noticed this too, is that gluten tops the list when it comes to migraines. If anybody has a migraine, the simplest thing to do is an elimination diet. Absolutely. And get rid of the most common allergens like gluten. gluten, dairy, eggs, and I've seen so many people. I had one woman, she was married to a mafia don, and she had headaches for 40 years. It was incapacitated in bed very often. And it turned out that it was eggs. Now, we found this on a food sensitivity test, and that's not to say everybody's migraine is caused by eggs, but hers seemed to be triggered by eggs. She stopped the eggs and her migraines in a way. So, I think everybody's different, like you said, we have to treat the person, not the disease.

Absolutely.

I think Thomas, I mean, what is it? William Ulcer said that, you know, we should treat the person who has the disease, not the disease that the person has. And I think that's the mistake we make in medicine. So doing elimination diet, getting food sensitivity testing, checking for gluten, that's all important. The chemical triggers, you know, we talked a little bit about that. Talk more a little bit about some of these chemical triggers that we notice with migraines.

I mean, like exogenous chemicals.

Things like aspartame, artificial. Food additives, sulfites, for example.

I would say that, you know, those are basically excitotoxins. There are certain types of foods which can cause excess activity, like monosodium glutamate. You get, you know, excess glutamine in the brain because glutamine gets converted into glutamate, which is an excitotoxin. So, yeah, definitely there are, you know, those types of foods. And even if you actually, if you give somebody glutamine, which we use a lot to help with patients, I've had these patients who they'll metabolize their glutamine directly into glutamate and you'll get taking glutamine, it'll be just like taking MSG. They'll get very agitated and get a headache.

Aspartame is bad. I've seen so many patients who- oh, aspartame, yes.

Swig back those diet sodas and they-.

We have somebody in the White House who does about, I think about 10 a day. I don't know if he's getting migraines, but he's giving everybody else a headache. But I think you're right. I think we have to really look at these things, the nitrates that in, for example, deli meats, sulfites that are commonly added to salad bars. Just keep the vegetables fresh or the dried fruit and wine, tyramine which is in chocolate, cheese, these are really significant. So getting rid of all the processed food, all those chemicals, super important. So the IGE is an immune reaction.

Intolerance, a lot of people might think, okay, lactose intolerance, even fructose intolerance or histamine intolerance or intolerance to sugar, alcohol, these compounds that are poorly digested and absorbed and can lead to symptoms such as abdominal pain, diarrhea, headaches, and nausea.

Yeah, you eat ice cream and you get gas, your stomach blows up, you.

Feel like bad, you get diarrhea. That's not an allergy. Right, that's not an allergy. It's a little bit different than a sensitivity, which I'll explain, but these are a little bit easier to pick up on. The symptoms usually show up within an hour or so after eating the food.

Like you said, eat milk, drink milk, then you're in the bathroom not too long after.

And there are also these things like.

Other reactions that are not even related to intolerance, like for example MSG or aspartame, which are these excitotoxins. So these are compounds that do have reactions in the body that are not really immune related, they're more related to the neurological effects of the amino acid like compounds that can alter your brain function, your headaches or make you hyperactive.

Yeah, exactly.

Migraines.

So there's that whole series and then I would argue probably the most common but the hardest to pick up on are the food sensitivities. so going back to the IgE reactions, these food sensitivities are IgG and IgA. So just a different way that the body reacts. In fact, IgGs are the most common antibodies in the body.

These are delayed. It's like delayed peanut. You know, you're gonna know in minutes.

Yes.

If you eat, let's say you have, you're allergic to, I don't know, like.

It could be gluten. It could be gluten.

Or maybe it's, you know, any eggplant and you feel sick three days later. It's going to be several hours or days.

Exactly.

It's going to be hours or days later, so you're not always going to connect the dots.

Right, and unless you're writing down everything you eat, I know if you ask me, what did you eat two days ago? Unless you're eating the same thing every day, it's going to be very hard.

To-- I ate an artichoke.

I ate an artichoke with some sauerkraut. So, no, it's very hard. So if you have these, the other thing that makes it difficult too to pick up on this is the symptoms range so broadly. So it's not like, oh, I'm going to have hives and swelling of the lips. It could be anything from brain fog, hyperactivity, it could be depression, anxiety, it could be weight gain, it could be FLC syndrome, feel like crap, right? And it could be anything else. Sleep.

Depression, mood changes.

It's so much, right? Eczema. Yes, so much.

Hormonal changes, menstrual issues, joint pain, aching.

And so a lot of people don't associate so many of these symptoms with the food that they've eaten.

Sinus issues, allergies.

Absolutely. Changes, it could be GI, it could be changes to the bowels, it could be constipation, diarrhea, abdominal pain, but again, it's not so acute. So it's difficult to recognize which foods are associated with that. and we do check here at the Ultra Wellness Center, we do have testing to check for these IgG, IgA antibodies, but there's no one test that's perfect. There's no one test that checks every way that a food can interact with somebody or cause these symptoms, which is really why the elimination diet continues to be the gold standard, and that's what we do pretty much with all of our patients.

Yeah, there's even another response, because what you're talking about is antibody responses that the body creates and antibodies are sort of like smart bombs. They're specific, right? So you can antibody to dairy or an antibody to eggs or an antibody to chicken, corn, whatever. But there's another part of your immune system. It's the ancient immune system. It's your primitive immune system, like we call it your innate or cell-mediated immune system. And that creates a sort of a general response. And you can't measure that. And it just creates this just generalized inflammation. And it can be to anything. And also gluten is commonly certainly causing this type of innate immune response, which is really hard to measure. So even if you check for gluten antibodies or celiac, you'll miss it.

You may not pick it up. Right, exactly. No, that's very true. And there are many reasons why we can have these types, because we're always thinking in functional medicine, why? Why is this happening?

Yeah, so why do people get these weird sensitivities? Because it seems like odd that we would be reacting to all these foods that we should be eating and they're not actually probably even good for us.

Right.

Why would you be reacting to an egg? Or, you know, kidney beans.

Or strawberries, like you said.

Strawberries.

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

The same, like, five basic ingredients. Yeah, 90% of our diet diet is 12 plants and 60% of our diet is three plants: wheat, corn, soy, and rice, depending on where you're from.

Exactly. So the lack of variety really, really is a problem. But also if you're eating a high quantity of certain foods, let's say it is eggs, which eggs are a wonderful food, very high in nutrient density, but they're a higher allergenic potential food. So if you're eating multiple eggs every day and I talk to people who do this, because they love it and it's easy and it's quick, but eventually with enough exposure, those proteins can start to become what the body interprets as an invader. So it can begin to develop a sensitivity if there's not enough variety and rotation in the diet. But then you also have to think about the gut microbiome. How balanced is it? Do we have dysbiosis or lack of balance of gut bacteria? And how can that be influencing the inflammation in our gut, the integrity of the lining of all the things that can lead to leaky gut or intestinal permeability, herbicides, pesticides, overuse of medications, nonsteroidal anti-inflammatories, antibiotics. I mean, the list goes on and we're all bombarded with this all the time.

Okay, you just said something really important, Lisa. You said leaky gut. Leaky gut. So, I want to backpedal on that. What is leaky gut and why should I care?

Okay. I love explaining this. It's like you can really get the visual because our our gut, really there's...

It sounds kind of messy actually. I don't know. I don't know if I want the visual on this one.

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

It was like a big filter.

It's a filter. Exactly. It's a protector, which is why 70 to 80% of our immune system is in the lining of our gut because so much goes through there. So there's one, there's basically one cell thick that helps protect us between whatever is in there, all the toxins.

It's like a sewer.

Yes, it is a sewer, right? And everything else that gets absorbed, there's this one cell lining that we need to be, you know, we want those cells to be tight together unless we give that, unless we're in a place where those foods are completely broken down and then those gaps can open up a little bit, allow some of the amino acids and all the vitamins and minerals to go through, we absorb them and we utilize them in a perfect world. But all these things we're talking about, herbicides, pesticides, medications, all that, and certain foods can actually cause gaps to form in between the cells inappropriately and allow larger protein molecules from our food as well as bacteria, viruses, all the things that are in our gut to start leaking through into our circulatory system, into our blood where it shouldn't be, and then our body sees that as an invader because technically it is. It shouldn't be there. It should be in our gut. And so there's that in and of itself is leaky gut.

Yeah.

I think it's short. I think like so your gut lining is a coffee filter, right?

Yeah.

So you want the coffee, you know, it's good stuff to go through the coffee filter, but you don't want the grounds in your coffee. Exactly. So if the holes were holes are too big, then all this coffee grounds end up in your coffee, it's not so great. And the reason the lining is there is to allow the right stuff through and to keep the bad stuff out. And what happens with all the things you're talking about are processed diet, pesticides, glyphosate for example, which destroys our microbiome, and the overuse of medications, stress, all these various things cause damage to the gut. so if you look at the microbiome of some indigenous cultures or people who are living more traditional lives and diets, their microbiomes are incredibly diverse, incredibly healthy, and they don't have allergies, they don't have asthma, they don't have autoimmune disease, they don't have sinus problems, they don't have eczema, they don't have any of these problems because their guts are different and their microbiome is very diverse. It's like a rainforest instead of a monocrop soybean rainfield. And I think that's what we're facing in this country, is a devastation of our microbiome. We're worried about the rainforest. We got a rainforest inside of us.

Exactly.

We should be worried about that. Yes. And how do we restore that? How do we plant the good trees in there? And I think the whole concept of these food sensitivities is being completely neglected in traditional medicine. It's thought as quackery. The tests are challenging. They can be helpful. but they're not like a perfect test, right? So often, for example, I just had a patient yesterday who we did a test on five years ago. She had 26 different foods that she was reacting to. Doesn't mean she's allergic to 20 different foods, but she had a terrible gut. She had giardia, she had terrible bloating, she had irritable bowel, she had all these issues. We fixed her gut and her reactions went down to none. nine. And in fact, not only did they go down nine, but they were very, very low levels of reaction. And so they were all, and they were only into the things that we knew she was really reactive, like gluten. So it was rye, barley, oats, you know, the, you know, those are wheat. Those are the ones that, that she was reacting to. So out of the nine, five of them were like gluten grains, which we knew anyway. So I think, I think the key is you can heal a leaky gut. Yeah. And, you know, if you were allergic to peanuts, you probably want to stay away from peanuts.

Forever.

There may be new treatments and so forth that we can modify that, but you don't want to mess with that. If you're sensitive to a food, it doesn't mean that you need to stay away from it forever. You need to fix the cause. Exactly.

And that's what functional medicine really is focused on. Absolutely. And I think another point of what you're saying is we're trying to increase and improve the resilience of the body. So the goal is to not keep those foods out that we see on these sensitivities or if we're doing some kind of comprehensive elimination diet, we're not trying to keep those out for the next 10 years of your life. We're trying to heal and seal the lining of the gut, help improve the microbiome to the point where you can then be more varied with your diet. Expose yourself to new foods that before perhaps were giving you a problem but won't be as much of an issue down the road. So yes, I think that's a very good point.

It's not just about getting rid of the foods. It's about figuring out why the gut is a mess.

Yes. And what can you add to help heal it?

Add to heal it.

Right.

So it's not just about what you take out. That's why we should call it an addition diet.

Instead of elimination diet.

I know. I really, I don't come with you. It's bad marketing.

I think we should come up with a better name for it. Yes. I don't like the elimination part. That's one thing. There are two things I really like to emphasize with my patients. And one is it's not just about what you can't eat. I know it's easy and it's very natural to see this list of foods, whether it's a short list or a comprehensive elimination diet where we have a ton of foods that we take out like corn, soy, wheat, gluten, dairy, all these things. And then they're left thinking, well, what can I eat? Well, the reality is there's a lot more you can eat than you can't eat in this situation. But it's so easy because food isn't just calories and fat and protein. It's also what connects us. It's part of the community and emotional connection we have. So if you're used to eating these foods all the time, it's a big shock to some people. So then that's all they can see, is what they I can't eat.

Yeah.

But it's really... You're taking away my cheese.

I've got a story about that.

Wait.

Yeah, exactly. But it's also about what you can add in, not only in terms of whole foods that are rich in polyphenols, these things that protect and heal the lining of the gut, but it's like getting more diversity in your diet, learning how to get into the kitchen, you know, cook with all these different flavors and textures, sort of like reconnect...

Spices.

With foods. Exactly, that are actively healing. but you're also enjoying this.

Yeah, I was joking about the artichoke, but that's a great prebiotic food. I eat them every week, multiple times a week. And it's so delicious. I dip them in extra virgin olive oil, balsamic vinegar, which also helps your gut. Exactly. Polyphenols. Right. And so it's really fun.

It is, it can be fun.

And then you get to add stuff back.

Right. Right. So, that's so important. And that's what people don't realize. And a lot of people come come to me and either they've already tried an elimination diet, let's say they've done gluten and dairy free. My first question always is, did you have any help? Did you do this on your own? Did you go online? Did you find something? Or did you have a professional who knows how to guide you through this? First question. Second question is, how do you reintroduce? What do you do? Well, you know, I went and had a pizza. I had a pizza.

Well, that's like, you know, three or.

Four different- all these things. And we're not even talking about good quality gluten, we're talking about white so that and this patient, when she was.

She had rheumatoid arthritis and she was overweight and she really was struggling. And, and she was, you know, tested gluten. She was definitely tested for gluten sensitivity, and she had elevated antibodies. And I said, you really can't be eating any gluten. And she's like, well, I'm not, I'm not, I'm not, I'm not. I'm like, well, let's do an experiment. Let's put you on a, at the point at that time was just a, we call it an ultra clear fast. So for 10 days, all she did was this rice protein shake, which is hyperallergenic, and that was it. All of her symptoms went away. She dropped a ton of weight, and she realized that there was gluten in her diet, and it was hidden. It could be in soy milk that you're having. It could be in all kinds of dressings and stuff. And it's got all these names that you wouldn't even know.

It's like sugar.

And then in processed food, there's something are called microbial transglutaminase. So gluten is what is often used to make things stick together because it's like glue, right?

Right.

If you ever made flour or bread, it's like that sticky thing. And it makes processed food stick together. And so they have bacteria make these actually bacterial versions of gluten essentially that then they put in food and it doesn't have to be on the label. So pretty much if you're eating any package or processed food, you don't know what you're eating. I think, and people are, you know, really, really sensitive, you know, even a flyby, you know, if they're eating out of a grill that somebody cooked something on was breaded. Cross-contamination. You're gonna get it. So I think, you know, I did that. And then I saw her a few months later, and I was like, what happened to you? She lost 40 pounds. She, like, all of her symptoms went away. So I think people have to understand, like, it's, you know, oh, I just had, like, a little bit.

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

Bagels instead of the little ones.

And then also we spray wheat with herbicides, pesticides, all these things and the combination of the excess gluten with all of these chemicals, just it's a perfect storm for our gut and leaky gut and dysbiosis and then all of the other symptoms that come from that. And that I think of joint pain, I think of headaches, I think of, you know, ADHD. I think of a lot of things that are associated with that sensitivity specifically.

Yeah, I mean, the gluten story is really interesting because, you know, it's like, you watch these movies like, Hey, I'm gluten free. It's like, what's that?

It's like, I don't know, but everybody's doing it.

It must be good. Right? Yep, all those, yep, I've seen them. Exactly. And it's sort of become this cultural meme. And most people don't even know what gluten is, but it's a protein that's in wheat that can be very inflammatory. And the modern wheat has much more of these gluten proteins. And tell us why gluten is, of all foods, is so critical in terms of driving this leaky gut. gut and leading not only to gluten sensitivity but to all these other sensitivities that sort of follow on that are hangers on to the gluten.

Exactly. Well, there's one thing that I will say in terms of when you eat gluten, that's one of the major drivers of something called zonulin. And zonulin was discovered and found to actually drive leaky gut. So, to give signals to the lining of the gut to open up and make those gaps so that things fall through. So it actually is one of the major drivers of leaky gut for that reason. And as I said, so basically, this.

Is a natural molecule in our bodies. It's designed to take care of things, for example, if you get cholera. I mean, sometimes it's good to have a leaky gut.

Right. Sometimes.

But gluten tends to trigger this, according to Dr. Alessio Fasano, who's the world's expert in gluten at Harvard. that it triggers some degree of increase in zonulin in everybody, which can trigger some degree of leaky gut in everybody. Now, some people do fine and they're okay with it and they're really healthy and it doesn't matter. But if you're looking to dramatically reduce inflammation, making gluten a staple in your diet is not a great idea, particularly modern wheat. So, if you want to eat ancient spelt or einkorn or einkorn wheat or Kernza wheat, or, you know, certain rye, like those might be better tolerated.

Belts, especially those that have been sourdough, where the traditional way of actually creating and making bread.

Actually, Dr. Fasano said, you know, here we have these fast rising breads, like, you know, one hour, boom, two hours. He said, in Europe, it's 12 hours, 18 hours, 24 hours, they make their bread rise. So it actually creates a very different process in the wheat that breaks down some of the gluten and creates less reactivity.

So there's a lot of explanations. So, yeah, eventually, no matter who you are, and I think he said this, Dr. Sano said, regardless of your predisposition to gluten sensitivity, celiac disease, if you have gluten in your diet long enough and in large enough quantities, you were going to lose. It's the human that's going to lose. It's the gluten that's going to win.

And basically, if anybody has any chronic disease or any inflammatory problem, pretty much anything that you know, it's sort of like, for me, it's like getting someone's blood pressure, you know, checking to see if they're reactive to gluten is like checking their blood pressure. And that's the standard here. It is because, you know, partly because we see people who have seen everybody else and done everything else and gone everywhere and have come here because nothing else is working. But it also is so common and it's so missed and it's so misdiagnosed. And so we have different diagnostic tests that can help us look at different gluten antibodies. look at zonulin antibodies. We have very sophisticated ways of looking at this. And I think for people who are struggling, it's very helpful. And then you can actually implement a program of a diet to eliminate the foods that are reactive. Yeah, very specific to them. So you can do testing or you can just do an elimination diet. But I'd love you to share some stories of some patients we've had here at the Ultra Wellness Center who struggled and tell me what was going on.

With them and how did this approach impact them. Yeah, so one comes to mind, I would love to share.

There.

So there's a 47 year old woman who came with constipation. She was pooping maybe twice a week. I'm like, we gotta get you pooping twice a day. Twice a week.

So constipation. Oh, yeah. That reminds me of a patient I had. I said, so how are your bowel movements? She says, oh, they're regular. I said, how did you go? She goes, once a week. Yep. I said, that's not regular. She says, it's regular for me.

I go every week.

I'm like, exactly. People want She's Dr. Hyman. I didn't know it was normal. Like I thought going every day was like a whole thing.

That's normal to them. That's what they think is normal. But this person had constipation, at least she recognized that it was constipation. She had joint pains, but she had sinus, recurring sinus infections that would happen every year once or twice a year. So when I hear constipation, when I hear sinus congestion and inflammation in general, I think of dairy. products. And when I hear joint pain, I think of gluten. Sure, it could be a lot of other foods, but we thought, okay, let's start off with gluten and dairy free.

Of course, sugar free and preservative and processed free.

Gluten, dairy, sugar and processed food 90% of the time is all you need. Exactly. So at first she sounded like she was on board. I just kind of gave her the overview. And then it was like a light bulb just went off.

So she grabbed.

Yeah, I told her I had to take away the cheese. She grabbed, yes. She's like, are you telling me that I have to give up my cheese? So when I told her, I said, well, unfortunately, yes. And I thought it was just gonna be like a little back and forth. She started sobbing. I mean sobbing. I had to give her the tissues. And I said, you know what? This is the first time I'm really seeing in real time the power of food addiction. And I said, I let her finish. Obviously, I didn't interrupt her. But I said, have you ever of casomorphins before or gluteomorphins and these opioid-like peptides that cross the blood-brain barrier and can actually not only influence you neurologically but cause you to feel addicted to these foods. Like you need to have more. She's like, no, I haven't heard of it, but it sounds like me. And I was just kind of nervous. I wasn't sure if she was really going to be on board because she, again, I'd never seen something so reactive before. Four weeks later, she comes back back, I'm like, how'd she do? Different person. Different person entirely. Even the way she spoke was more clear. She sounded more confident. There wasn't something holding her back. She was pooping five times a week, her joint pain went away, but she was like, the most remarkable thing about this is not just the fact that I was able to give up cheese, but the fact that I don't have any cravings for it anymore. I don't need it, I don't even want it, because I can't believe something had such a tight hold over me.

Well, you mentioned these casein morphins, and this is a real thing that we actually test for at the Ulchrawana Center. We use urine testing and we can see both gluten and dairy. They do react with the basically heroin receptors in your brain and the opioid receptors in your brain and they create this pleasure, but they also are highly addictive. And it's not that it happens in everybody, but it's not that uncommon. It's more common in autistic kids than others. So really very great story. because people often don't connect the dots. And when you give people a chance to stop the foods that are problematic and add in the good foods, then their body is going to tell them. They don't need you or me or a doctor or anybody else to tell them what works. They see the difference. Their sinuses clear up, their headaches go away, their skin clears up, they feel better, right? Their digestion improves. So I think that's a great case.

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