Ask Mark Q&A #5: Celiac Disease, Mold Exposure, Gut Issues, And More

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

Just because it's gluten-free doesn't mean it's healthy, right? It's still cake and cookies even if it's gluten-free. Hey, everybody, it's Dr. Mark Hyman. How you guys doing? I'm doing this brand new live Q&A show for my entire community. I'm really excited about it because people have so many questions and I just love answering the questions. People are so confused out there about what to about eat, about lifestyle issues, about all sorts of things. And we're gonna dive right into it today. If you wanna ask a question, you can do it, but this episode is called Ask Mark. And it's basically where I take questions from my text community and I invite those people to join me live and ask their question. We've got a bunch of live guests coming up. If you wanna get your question in the future, all you have to do is text me at 413-225-8995. and use the hashtag AskMark and my team might pick your question for the future. So I want to remind you that I can't give medical advice, but I can give big picture advice about how I would think about your health challenges. And before we jump in, I want to give a little shout out to a new project that I've been working on and it's called the Pegan Shake. No surprise because, you know, I love all things Pegan because I created that term to kind of blow up the diet wars and get back to common sense and good science. You know, people always ask me, what's my favorite protein powder? And what's my favorite shake mix? Well, I always have a hard time because most of them are full of sugar and flavorings and sugar alcohols and carbs and all kinds of junk that I don't really like. And I like simple. I like real food, and I like real ingredients. And I've created my own, and it's a very powerful shake that is full of protein, fat, and fiber designed to balance your blood sugar, boost your metabolism, supercharge your mitochondria, feed your microbiome, reduce inflammation, and lots, lots more. So, if you wanna learn more about it, go to getpharmacy.com/pegan. That's G-E-T-F-A-R-M-A-C-Y forward slash dot com slash Pegan. And, here's the exciting news. I'm giving everyone who asks a question today on the show, A Free Pegan Shake. All right, so let's jump in to our first guest. And our first guest is Izzy. And Izzy has a question. So Izzy, how are you? What's going on? And tell me where you are.

Sure.

Yeah.

Hi, I'm Izzy and I'm from the Bay Area in California.

Oh.

And I'm a huge fan of the Dark Horse Pharmacy. Thanks so much for having me on. My question for you is that my mom just got diagnosed with celiac disease and I was curious what your advice is for transitioning to a gluten-free diet.

Great question. So that's interesting. You said your mom got diagnosed with celiac disease. Now celiac disease is genetic and your mom's, I'm sure, maybe in her 40s or 50s, right? And so how does something that's genetic start when you're 50. And I just want to sort of give a little background on this question because it's a really important question and it's really two parts. Like how do you get celiac disease? What is it? And what do you do when you get it? And how do you change your diet so you're fully healthy again? And how do you, how do you do that? That's essentially what you're asking. And, you know, 30 or 35% of the population has the gene for celiac disease, but only 1% or so get celiac. There's a whole new category that's been established and recognized by traditional medicine called non-celiac gluten sensitivity. So there are some level of antibodies, but it doesn't rise to the level of full-blown celiac, which is defined as certain blood tests that are above a certain level. And also, more importantly, an abnormal biopsy in your intestine where the lining is flattened and you're not absorbing things and you're not digesting things and you have all these digestive issues. But the truth is that many, many people who have celiac disease or gluten issues don't have an abnormal biopsy unless you really look on a certain, certain types of imaging. And they also, they also may not even have digestive symptoms. So they might be showing up with an autoimmune disease or schizophrenia or depression or joint pain or headaches or migraines. I mean, they may not be actually a real classic presentation like we thought of when I trained in medical school, which was really diagnosed in little children who had distended bellys who were malabsorbing their food, who were bloated and had skin issues and all sorts of, you know, malnutrition issues because they couldn't digest their food. That's just one extreme. And it's actually not how most celiac disease shows up and often shows up later. So the question is, you know, why does it show up? Well, I think a couple of reasons. One is we have done so much damage to our diet and our gut through our gut busting way of eating and our gut busting medications and our gut busting lifestyle. So what do I mean by that? Well, the increase differences in processed food and sugar and starch, the lack of fiber, and all the additives in food have dramatically changed our gut health and our microbiome and has led to the growth of bad bugs that create inflammation and great leaky gut that then makes you more likely to get trouble with gluten if you have a susceptibility. The second thing is all these gut-busting drugs, antibiotics, steroids, hormones. Advil, acid blockers, among the worst. These are things that people take for heartburn, but it actually causes downstream problems in the gut. So you've got all these gut-busting drugs. Then you have our lifestyle, chronic stress, lack of sleep, too much sugar, caffeine, alcohol, environmental toxins, all these things make us more likely to have gut issues and leaky gut, which is what essentially happens. So that's how he got here. And, you know, for you, you probably might have the gene for this. You probably have one copy of a gene or you might have gotten it, and you, you probably don't have any symptoms right now, but you could if you started to go down this path of not taking care of your gut and your microbiome. So it's really important whether you have it or you don't, that you really take care of your gut. And I really focus on that a lot in functional medicine. It's really a center of our, our healing. So with your mom, you know, what I see often with Celiac patients, and I, did she just present with symptoms.

Or what, what was the digestive issues or autoimmune? What happened? Yeah, she was having some digestive symptoms like. pretty excessive like gas and bloating, and she wasn't really sure what the cause was. Yeah.

So that's not an uncommon set of symptoms. People have irritable bowel or they have inflammatory bowel or they have, you know, other things that show up, but it's not always gut. So people don't have to have gut symptoms to have celiac. Just remember that. But what happens is, you know, your mom has caused damage to her gut. If she got full-blown celiac disease, she's really caused a lot of damage and having a malabsorption. What I find is that doctors will say, okay, go on a gluten-free diet. but then they don't address how to heal the gut because what's happened is the whole gut lining has separated and all these bacterial toxins and food particles leak in. You often get additional food sensitivities, often dairy or other foods. Grains can often be an issue, very hard to digest for people, beans, for people who have a lot of gut issues and problems with that. And I find that what people need is a whole gut repair and rebuilding program. So on the dietary strategies, I would really be careful with the gluten-free food. I mean, an apple is gluten-free right. But gluten-free bread, gluten-free cake, gluten-free cookies, gluten-free ice cream, gluten-free potato chips. It's all junk, right? Just because it's, you know, gluten-free doesn't mean it's healthy, right? It's still cake and cookies, even if it's gluten-free so I think people often will go, oh, I mean, you know, this gluten-free pasta and gluten-free this and gluten-free that. And it's, it's probably bad news. Egg is gluten-free and avocados gluten-free almonds are gluten-free chicken's gluten-free I stick with with actual real food. I mean, you can have alternatives sometimes. You can have gluten-free pizza crust if you want to make that sometimes. That's fine, but it shouldn't be like the staple of your diet is gluten-free junk food. That's really important. And you just stick to whole real unprocessed foods. In the repair phase, I often put people on what I call the 10-day reset, which people can learn about by going to getpharmacy.com that's G-E-T-F-A-R-M-A-C-Y.com and essentially it's a in addition and in an elimination diet. I think it's also not only about what you exclude, but what you include in your diet. And for her, I'd really recommend trying this because it helps to remove all the potential triggers, gluten, dairy, often other grains and beans can be difficult in the early phase of gut healing and give yourself three months to really repair your gut. And then there's also other things that you can do, like probiotics and extra fiber. and prebiotic foods, those things that just help her gut stay healthy. So that's really important because you can't just sort of go on this gluten-free junk food and think you're going to be okay, or even go on a regular diet because it's often not enough. So you got to repair and the gut needs also zinc and glutamine and certain fatty acids like omega-3. So we need to take the right supplements, we need to take the right probiotics and prebiotics. We need to make sure the diet is right and give the gut time.

To heal and she will feel so much better afterwards. Great, that's so helpful. Thank you so much.

Was that helpful? Okay, great. All right. Thank you. And the next question is, I think, coming from maybe Lisa or... Oh, Christine. Okay, great. Hi, Christine. How are you?

I'm well, and you? Great to see you.

Yeah, I'm very good. I just went for a beautiful walk. Unfortunately, I'm in Northern California right now, and it's like nuclear winter just hit. When we're recording this podcast, the entire sky is orange and you have to have your lights on in the daytime. It's like the nuclear apocalypse from the wildfires.

No, it's terrible. That's terrible. I was on a Zoom and we had people from all over the country and one person is showing us outside their window, 11 inches of snow. The other person is showing the fires.

And.

Insane, but Zoom is an interesting Yeah. Anyway, I wanted to thank you for having me. I wanted to ask you your thoughts on the best methods to address mold exposure and how to detox from, say, when you've been tested positive for the penicillin or the, I think it's called oxo-ochra toxins.

Yes. Yeah. Great question. So unfortunately, I am an expert in mold. And I say unfortunately because I almost died from mold exposure about three years ago and I struggled it for a long time and finally sort of got myself better. I've been treating patients for years with it, but I was dumb enough to not figure out that my house had mold in it because it didn't really smell, so I didn't know. And I finally figured it out. And it's a really big problem, 50%. buildings are water damaged in some way, and which means they are at risk for mold. And some is bad, some is very bad. And, and there's a lot of genetic susceptibility variation in who responds badly to mold. So you're gonna have two people walk into a moldy or musty house or room. One person immediately feels sick, and then the person's like, I don't know what you're talking about. I feel fine. So you're gonna have people, two people living in the same house, and one person's sick, and the other person's fine, and, like, they think you're crazy, and it's, it's unfortunate. And mold symptoms are, are really bizarre and often weird. You can fatigue and brain fog and muscle pain, joint eggs and autoimmune issues. And you get this chronic inflammatory state. You hear about the cytokine storm with COVID similar to that, but not as aggressive, but similar to that, often called chronic inflammatory response syndrome. And so it's really important if you suspect you have any weird or vague symptoms, and if you are living in a house that you suspect might have water damage, air conditioning, that you really have it properly evaluated. Because until you know what you're dealing with, you can't really fix it. So that means having a mold expert come in and do an assessment where they can do air samples and other cultures and various things to actually measure the amount of mold, what molds, and where they are in your home. And this has been so, so helpful to people who've actually found there's a problem. So I really first, first you have to make sure you know what you're dealing with. Second is you have to get rid of it because if you are sick, and from mold and you're still living in the house, you're not going to get better no matter what you do.

Right.

So you have to identify the problem. You have to find the mold. You have to have a remediation expert come in and you have to clean it up. And sometimes insurance will pay, sometimes they won't. It's a very difficult, expensive process. I went through it in my own house. I had to literally gut everything, clear it out and, and start over. So that's the first thing. The second thing is identify if you have a problem with mold. And there are a number of tests that we use. They're all imperfect. They look at There you go. The mycotoxin testing, right? Mycotoxin testing, urine mycotoxin. So we can look at one, your body's response to potential inflammatory triggers. And there's also it's a blood test we use like C4A, TGF beta 1, MSH, and so on, MMP9. These are just medical tests that we do to identify the level of inflammation related to some insults. It could be many things, but it's often mold. Second is you look at mold antibodies in your blood, both IgE and IgG, and see if you've been exposed and how your immune system is reacting. And third, and often the most helpful, is urine mycotoxin testing, which is looking at these low molecular weight toxins that are produced by the molds that we inhale, absorb, and that get in our bodies and just recirculate all day long. And you can't really excrete them very well. And these, these, not the mold itself, but the mycotoxins actually may be a problem long after you've even removed yourself from a mold exposed environment. so it's really important to remove yourself from the environment. But second is to identify your levels of toxins and which toxins you have. And then you can design a strategy to remove those toxins from your body. And you often need what we call binders, because what happens is they get excreted through your liver, they get down into your poop and your bile, but then you just reabsorb them and they go round, around, around. So by taking things that bind it up like a sponge in the gut, then it actually helps you poop it out so you don't recirculate and get sick. And so you mentioned ochratoxin, that's one of the common toxins comes from Aspergillus and others. I had very, very high levels of this myself. And so we use various binders like clay and chlorella and charcoal. We often will use things like cholestyramine, which is a drug or Welocoll, another drug, which are cholesterol drugs that bind up bile, which is how you excrete your toxins and helps you poop it out. There are other treatments we'll often use intravenously that I've used in the past and on my patients at the Ultra Wellness Center, glutathione, phosphatidylcholine, even things like intravenous ozone can be extremely helpful in helping your body detoxify, reduce the inflammation, and that really, really helped me get better. So I think there's a lot of various options out there depending on what's going on, level of sickness, but you need to design a strategy to support your detox systems to reduce the inflammation, to make sure you're really strategically getting rid of the the toxins from your body over time and it can take time, but it, you can get better and I'm better and I'm better than ever. So I think as long as you understand how to work with someone who's an expert, how to identify these issues, people, people can get better from mold. There's a lot of great mold Summits online. There's a mold documentaries. I think it's called Moldy by Dave Asprey. I think I was in it. There's a lot, there's a lot of things that you can do to learn more about this problem, but it is a big problem. It's widespread, it's underdiagnosed, and often if you're feeling like crap and you don't know why and you can't figure it out, it's something that's usually high on the list to check for.

Thank you. Yeah, the documentary is what led me to you, so thank you.

Good, okay. All right, thank you. Thank you so much, Christine. Great to talk to you. I think the next question might be from Elaine.

Yes, Mark.

Hi. Hi. How do you say your name?

Yes, so it's actually a line. I'm actually speaking the French first name, but it's a line.

Yeah, great. Great. Well, good. Well, hopefully we're aligned. What's your question, Alain?

Well, I'm a conventional medicine provider here in Central Florida. I'm a neurologist by trade for 20 years. And the problem I'm having here locally is finding a good functional medicine provider to complement conventional medicine patients in my practice. So I've been finding that poor socioeconomic status in my practice population precludes the evaluation by a functional medicine provider. so I'm trying to figure out how I may help my poor disabled patients who cannot afford a lot of the testing and supplements desired by functional medicine. It's a big problem trying to help these folks to help themselves.

That's a great question. So, you know, we know that 80 of health is not determined in the clinic. It's determined where people live, work, eat, play, pray, right? It's, it's, it's in all the social determinants of health that we call. And, and unfortunately, these things are not often solved easily in the doctor's office. But I really, really, really do think that functional medicine can play a significant role in addressing health disparities, addressing the chronic disease burden in these underserved populations, and do it not in the traditional way we do it with high intensity testing or supplementation. Those are really secondary. And I think so much, so much of the functional medicine paradigm is really based on what we call the foundation of the matrix, right? So the matrix is essentially the map of how your body works. And there's genetics and predisposing factors. There's the fundamental modifiable lifestyle factors, which are the central things that drive most of health. And then of course, there's all the biological systems like your detox system and your hormones and your gut and so forth. The truth is a lot of the systems can be managed through these modifiable lifestyle factors, which is diet, exercise, sleep, stress reduction, relationships, connection, community. These are all things that people can do that don't cost a lot of money that are not difficult. The problem is they don't know what to do, they don't know how to do it, and they don't have any support to do it. So what we've created at Cleveland Clinic, and it really grew out of my work at Saddleback Church, where we worked with an entire church to help them get healthy, and 15,000 people signed up for a program called the Daniel Plan, which is a faith-based wellness program. designed to empower people in small groups to help each other get well. And it was using the functional medicine intel inside to drive the biology change and the small group model to drive the behavior change, which allowed people to support each other. Sort of like a support group like AA or any of those other things that people like. And so we've modeled that in a way that was modeled after the community support health workers that Paul Farmer used in Haiti to help TB and AIDS deal with infectious disease. But for chronic disease, it works equally as well. And so created a program at Cleveland Clinic called Functioning for Life, which is a shared medical appointment. It's billable through insurance if they have fee for service, if they're in a capitated or or a basically a value-based model, which means that they're, you know, you're just paid for keeping people well. It is very effective and it can be done at low cost, at scale, it can be done virtually. And it's really a beautiful way to get people together. And we've done this in our underserved communities in Cleveland. We've done this in and underserved churches and underserved community centers with minority populations and have been extremely effective by helping them understand, you know, how to take care of each other and themselves through these fundamental lifestyle factors. And it's extremely effective and it works even better than one-on-one visits. And it's essential model, I think, that's going to be needed to change healthcare in America and can be done at scale. And the beautiful thing is that it's available to to anybody pretty easily. If people like you, for example, want to do this, there's ways to get access and to be able to use some of these approaches. So I think this is a really fundamental idea is kind of decentralizing and democratizing healthcare. I mean, for example, in the churches, you know, we have something called the Daniel Plan, which is a functional medicine-based lifestyle program that's basically online, pretty, it's almost free. It's like very cheap for the kit, and you can use it in your church. and you can put as many groups through it as you want and you don't even need a doctor or provider. So a lot of these things don't even need high level providers, but these shared medical appointments are really a wonderful way to train people in these changes and can have tremendous impact and save a lot of money, be more cost effective and more effective. Thank you. Of course. And then of course, you know, supplements, you know, a lot of the testing can be done through regular labs and insurance, a lot of nutrient testing, hormone testing, even gut testing. So there's a lot of things, heavy metals, there's a lot of things you you can look at just through conventional labs that will be covered. And second, a lot of a very good history and assessment can tell you really where to go and what's going on with the patient. And then in terms of supplementation, there are a lot of supplements that are prescription. You can get fish oil, a prescription, vitamin D by prescription, B vitamins by prescription. So there's a lot of things that you can actually do for these patients that will be covered by their insurance. So I encourage to sort of explore that and sort of build a repertoire.

Of tests and supplements that you can use.

That are covered by their insurance.

Great.

Thank you so much, Mark.

Hopefully that was helpful.

You're welcome. Thank you.

All right, next question. We have Gianna. How are you?

Hi, I'm doing well. How are you?

Good. Where are you? It looks so nice.

I have the beautiful downtown skyline right behind me on the rooftop of my apartment.

Where?

Pittsburgh.

Oh, Pittsburgh. Nice. Great. Oh, great. It's beautiful. Well, there's no clear sky here in California today. The sunny California skies are just gray.

Well, yeah, we don't get this too often, so I'm taking advantage.

Enjoy. So, what's your question, Jana?

Yes.

So, my question is related to digestion. I wanted to know your best holistic remedies for bloating and indigestion. I have been tested for food sensitivities and nothing came back positive. I am not allergic to any specific foods like gluten, dairy. I've experimented with it all. So I was just wondering what kind of suggestions you have. I've tried gluten free, dairy free, food combining, and I haven't quite figured out vegetarian, vegan. I haven't quite figured out what was the issue. and how to do it.

Yeah. So, yeah. So, you know, we have a saying in functional medicine. If you're standing on a tack, it takes a lot of aspirin to make it feel better, which means find the cause. Right. If you're standing on two tacks, taking one of them out will make you 50 better. So, for example, if you take out gluten, but gluten is not the issue, or it's only half the issue, you won't feel better. Right. So you have to figure out what's really going on. And, you know, there's a lot of work we've done in functional medicine on the gut. It's really the central foundation of how we help people through all sorts of issues, including obviously gut issues. And in fact, we've done a number of podcasts on the Doctor's Pharmacy with some of our clinical team from the Ultra Wellness Center talking about these gut issues, everything from irritable bowel to SIBO, reflux and so forth. So if you have bloating after you eat, I call it a food baby where you know you're gonna eat something and just get really distended and uncomfortable afterwards. or you have gas or you have loose stools or you have undigested food in your stool or weird smelling stools or regular bowel movements or constipated. It's all a sign that something is rotten in Denmark. You know, there's something awry down there that is causing a lot of challenges to the microbiome. And so what you're describing often is a problem we call small intestinal bacterial overgrowth. And what does that mean? well, you have about 12 feet of large intestine where most of your bacteria are and your poop is. And then there's your small intestine, which is about 22 feet. And it's a tube that goes basically from your stomach all the way to your large intestine. And this. And, and what happens is these bacteria can migrate up into from the large intestine, the small intestine, and they should grow there, and they're not supposed to be there. So when you eat something, particularly starchy foods, if you're eating beans and grains, for example, if you're a vegan or you're trying to eat raw food, whatever, your body can't handle it because there's bacteria in there that then eat that stuff for lunch basically. And that causes fermentation, just like fermentation if you brew beer or if you, for example, leave your apple cider in the fridge too long and ferments and then the container blows up, you've all seen that, right? That's really what's going on in your stomach. so you get this fermentation process and there's even a syndrome that's called auto-brewery syndrome. When it gets really bad, you literally can get drunk from the byproducts of the fermentation in your gut of the starch. You literally create a little brewery in there and that can cause all these symptoms, not just digestive symptoms. So, it's really important to identify what the issues are. So, with gut issues, I often really recommend to what I do called the weeding, seeding and feeding program. And, and I've written a lot about this. You can Google various blogs I've written about irritable bowel syndrome and how to figure it out. But the, the idea is you weed out the bad bugs. So it might be taking herbs, for example. It might be taking herbs that kill off the bad bugs. Or maybe you, maybe you've been on the pill, or maybe you have antibiotics you've taken, or maybe you lost sugar or drink a lot and you get yeast issues. you need to address the yeast, but there can be CIFO and CIBO. CIFO is small intestinal fungal overgrowth and small intestinal bacterial overgrowth. They often go together. So, I've been putting people on a comprehensive plan to get rid of all these bugs through either herbs that can kill them off or even sometimes medication. And, there's a number of medication we use. One of them is called rifaximin or Xifaxan along with any fungal such as nystatin or diflucan. that literally kind of weaves out all these bugs that shouldn't be there. And then you have to find out why you're, you're having this problem. It might be because you don't take enough magnesium or because you're stressed or because whatever is going on. You need to fix the underlying issue for the bacterial overgrowth. But you clear out the bad bugs, and then you, then you seed them with good bugs. So you put in probiotics. But if you take probiotics too early, you'll get worse. Right. And then Prebiotics to help feed the good guys. Now, pre and probiotics you can have as foods. For example, prebiotic foods are asparagus and artichokes and seaweed and Jerusalem artichokes and jicama. There's all kinds of foods you can eat that have plantains that have these wonderful starches that the bacteria love and feed them. And you can take probiotic foods like sauerkraut and kimchi and miso and tempeh and natto and all these wonderful traditional foods that are fermented, but you can also take probiotics, even prebiotic fibers. and then you need to feed the gut, which is to give the gut lining and the things that it needs to heal. So the incredible amount of the, like, healing the gut needs, needs to be supported through things like zinc and glutamine and fish oil and vitamin A and curcumin and all kinds of things that the gut likes to heal. So it's really the weeding, seeding and feeding program. But first you have to find out what's going on. You maybe have a parasite. you know, you might have, for example, a common one called blastocystis that is really not terrible, but causes a lot of irritable bowel and bloating and discomfort. So you might need a special stool test to see a functional medicine doctor. But the first thing, you know, you can do is, is, for example, I've called the, I come, got something online and go look at. It's called the food, a food irritable bowel solution. Or just Google Dr. Hyman irritable bowel solution. I talk about what the herbs and supplements you can take. the dietary things you can do, and really how to reset it. And that works nine times out of 10 without even having to see the doctor. And if you don't get better, you need to go to go see somebody.

Okay.

Thank you. Yeah. I'm really glad you joined me and I want you to come back for the next time. If you want to ask me a question in the future, just text me at 413-225-8995. Use the hashtag AskMark and my team might pick your question for one of our future calls. So thanks so much for joining us today on this special episode. of the Doctor's Pharmacy.

Hi everyone. I hope you enjoyed this episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed.

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