How To Know If Gluten Is An Issue For You

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

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Hi, this is Lauren Phin, one of the producers of the Doctor's Pharmacy podcast. Leaky gut or dysbiosis is often the root cause of many illnesses that affect the brain, the nervous system, hormones, joints, and more. Gluten is a common driver of leaky gut due to its impact on the protein zonulin, which opens tight junctions in the gut causing leaky gut. Gluten affects many people in this way, not just people with celiac disease. In today's episode, we feature three conversations from the doctor's pharmacy on how gluten can create an unhealthy gut and lead to a variety of chronic health conditions. Dr. Hyman speaks with Maggie Ward on gluten and autoimmune diseases such as Hashimoto's disease. With Dr. Alicia Fasano on the role of gluten and inflammation in leaky gut, and with Dr. George Pappas Nicolau on how gluten and leaky gut can be.

A root cause for high blood pressure. Let's jump in. I can't tell you how many symptoms I've seen get better, you know, not across the board, but just I've had brain fog, get better taking gluten out. I've had joint pain get better. I've had skin get better. So, you know, people joke around like, do you take everyone off of gluten?

I'm like, if you saw how many people got better off of gluten, you'd take it all, you know, to take it off the market. We see people who come to see us who are ill. Yeah, right.

Right.

And so we have a select, we call selection bias. But I would say, you know, when people walk in the door with any kind of chronic illness, for me checking gluten antibodies and what we call a Cyrex 3 test, which we'll get into, which looks at way more proteins around gluten, is like checking their blood pressure or their temperature. It's a vital sign for me because it's so common. It's such a big deal. And, you know, I just saw this guy the other day who had all this severe lymphedema and inflammation in his body. and he had one of the worst gluten tests I've ever seen. And he didn't know it and he's like 50 years old. So anytime anybody comes in with a chronic issue that's not getting better, especially anything that's inflammatory or digestive in any way or neurologic, it's the first thing I look at.

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

Yeah, when I was really sick with mercury poisoning and when I was really sick and had gut issues, I couldn't eat any gluten. And now, I mean, I don't eat a lot, but now I don't really bother me and I don't really have any body because I fixed my gut. Right. And I think we see a lot of these patients who, you know, may not have any symptoms for years and years, like you said. And then they're 50, they get an autoimmune disease or they get something, and you check and they have celiac. They actually have celiac or they have really severe gluten sensitivity. And I, I think, you know, you say it's genetic about 30 plus percent of the population has the gene for celiac.

Right.

Only 1% get it. And I think it's all the things you're saying, it's all these insults. Right. That are from the environment, our diet.

Antibiotics, et cetera, that make us susceptible. But your genes are never going to say you're going to get that disease. It's usually your environment that that needs to turn those genes on. So, yeah, it's true. And even though you have the genetics, yeah, it doesn't mean that it's not.

A way to diagnose for it, but it's good to know your genetics. And it's a spectrum, you know, like you look at the antibody test and there's a normal level, right? Like there's you know, 0 to 20 or whatever on the antibody test on your blood level. But when you think about it, there is no normal level of antibodies to gluten in your blood, right? And you talked to Dr. Alessio Fasano, who's been on the podcast, who's the world's expert in gluten at Harvard and brilliant guy. And he said, you know, look, if you have any antibodies, it means three things. One, you've been eating wheat or gluten. Two, you have a leaky gut. And three, your immune system doesn't like it.

Right.

So if the level is five, it's not as bad as 20, but it's not as good as zero.

Right, and you don't want to go to 20.

Right, so why don't you go to five? Right, so a lot of people say, oh, my tests are fine, but it's a spectrum. It's a continuum. It's not on or off. Right. And it's always worth doing an elimination diet because the cost is low, the benefits high, there's really no downside to getting off it for six weeks, let's say, or even two weeks and seeing what you'd feel like. And if your symptoms get better and.

Then you eat it again and you feel worse, There's your answer. Right, right. I think it's a little tricky too though with gluten, 'cause typically with elimination diet, you know, you use two to three weeks off of that food, you should feel better. We've had a lot of people where it's up to three months.

Three months.

Right, before. I saw it clinically for a while and now that we're testing for it more, you see these antibodies to gluten stay around for a long time after someone's been off of it, right? You're no longer getting exposure, those antibodies should come down, the inflammation should come down. So that's something to keep in mind for listeners because I've had a lot of people say, you know, I went gluten free for three weeks and I didn't feel all that much different. And then I'm like, I think you got to give it longer. It's around that three-month mark that a lot of people are like, you know, my joints finally started feeling better around that point. So that's something to keep in mind.

Dr. A steroid patient when she was off for 10 weeks before she started.

To feel better with psoriatic arthritis. Right. Yeah. And, you know, usually it's a combination of a few other things that need to be sorted out, but you really want to give yourself a good time period. So if you've never done up to three months, you should. And, you know, it sneaks in in a lot of places, which we'll talk about. you know, most folks who are fairly sensitive have to be 100 plus percent off of it or they will still be reacting.

And it's 150%. I mean, if people have Dr. Fasano said to me once is if you have a thumb full, a thumbnail full of gluten in three months, you're back to zero. Yeah, like you can't even cheat a little bit if you want to do it because your body then creates an immune response. And I remember a patient who had rheumatoid arthritis and she was very, you know, good, but, you know, she was trying all the functional medicine stuff, which would get a little bit better. She was wasn't, it wasn't cutting it. And I said, look, you think you're gluten free? And I went through a diet and she was getting some and maybe she had some soy milk with barley malt and this and that. So I said, why don't we put you on just a 10 day ultra clear plus shake, which is what we were using back then, which is basically a rice protein, low allergenic, just no other food, just this shake for 10 days, see what happens. Everything went away. And I was like, wow, you know, and I think I saw her like three months later or six months later and she'd completely changed. She lost 40 pounds or arthritis was gone. She felt great. Right. And I think one of the things I just want to emphasize is that whatever condition you have, almost anything really in medicine, it should be on your list of things to think about.

Right, right.

Because when you look, for example, the New England Journal of Medicine had an article years ago which listed over 55 different diseases that were really caused by celiac and gluten, but were masquerading as something else. Osteoporosis, iron deficiency, schizophrenia, autism, cancers.

You.

Name it, autoimmune diseases, migraines, I mean, just disease after disease. And if you really look at that list, and that's just, I think, a short list compared to things I've seen over the last 30 years, you're gonna think that pretty much anybody who has a serious chronic illness or has chronic symptoms or is just not feeling great should check for it and also should try an elimination diet.

Right, right. And this is where too testing can be helpful because there's some people that think they're 100% off of it. You know, I've had several folks come in already knowing they have celiac or very sensitive and they're off of gluten, we still test them. And the antibodies that we're looking for, this is through the Cyrex 3 panel that we do. There's about 32 different immune markers that they're looking at at various parts of the gluten protein and wheat and other proteins within wheat. But so it's a very sensitive test and these antibodies shouldn't be in your system if you have not been eating gluten and they come back positive and that's like, okay, you're getting some hidden sources. When you eat out, are you doing all the precautions you need to do? Have you checked your body care products? Is your house gluten-free? There's so much contamination that happens in the house of, not everyone in the house is gluten-free and they're sharing space and food. So this is where you have, the testing can be really helpful to kind of dig in. And again, traces can make a difference even if you don't have celiac for.

Someone that's really sensitive. So tell us about like some of.

The common things we see. One of the cases you had was a thyroid. Yeah, so I wanted to kind of focus on autoimmunity 'cause that's a lot. anytime I see someone with autoimmune condition, if they're not gluten free, I'm like, that's, you gotta start there just to make sure that's not triggering it.

Because again, even if you don't have celiac, I would emphasize what you said. Anybody who has an autoimmune disease, gluten should be on your list.

Absolutely. What to check and what to eliminate. It is easy to do and you can have profound results. Absolutely. Yeah, because even if you don't have the celiac, what we so often find is that when you take gluten out, these other like antibodies to the thyroid, other conditions of autoimmune, conditions, they get better, the numbers start getting better. So we've seen that clinically and now we're, you know, we test for it so much more. So even on celiac, we do find it can trigger a lot of other autoimmune like conditions. So that's, I was kind of wanting to focus on two cases around autoimmunity. The first one is a 38 year old woman with Hashimoto's, which is the autoimmune condition you can get with your thyroid. Very common and a lot of reasons to have it. But she was interesting. She was a really intense triathlete, so very competitive, high exercise person. She came with severe fatigue just in for nutrition because I think she, you know, want to focus on nutrition and weight loss, which is not typically what you see with low thyroid function. But her thyroid antibodies were extremely high, some of the highest I've ever seen. And she also had a liver enzyme that was elevated, too. So I was, you know, wondering if there maybe was a toxicity component to that. And I do think she was a bit malnourished, given the high level of, um, exercise that she does her. Some of her nutrition labs, like even her cholesterol was coming back low, which could indicate that she wasn't getting all the nutrition or maybe not absorbing all the nutrition she needs. So, you know, like I always do with autoimmune, I'm like, let's take all the gluten out. She kind of did her own research and went full-on paleo, which takes out all the grains and all the legumes, which sometimes really can make a difference for folks that are gluten sensitive. And I really focused again on getting enough good fats and protein, good quality carbohydrates in her diet. With the exercise piece, I was thinking there could be an adrenal component to that and your adrenals are very closely linked to your thyroid. So she worked on some other lifestyle things and did some yoga and restorative stuff that I think was important.

But you see how she motos, which is very common, right? One in five women have low thyroid. A lot of that is autoimmune thyroid conditions, probably the most common autoimmune disease in the country. It is not all related to gluten, but probably I would say a third. of my patients who have Hashimoto's when.

I check their gluten antibodies are elevated.

Right.

It's a piece of the puzzle, right? When they get off gluten, they get better.

Right.

Exactly. It's so often a piece of the puzzle. It's usually not the only thing, but it's definitely a big component for a lot of folks. And, you know, again, being a high-level triathlete, your digestive system takes a hit to that, you know? And I think she got a little bit of leaky gut where before the gluten may not have been an issue. And she'd also had a daughter soon before. And, you know, sometimes just the process of going through a pregnancy can switch what goes on with the immune system as well. And on her blood test she found elevated IgG. Yeah, so I had her, you know, she didn't do any specialty testing with us. I just had her, she had a good local doctor who did more integrative stuff. I said, have them do a celiac panel and not just check tissue transglutaminase, which is what the kind of the gold standard, so to say, right, for blood work is for celiac. You can check for antibodies to gliadin, which is part of the gluten protein. You could check for deaminated gliadin. so I wrote out what to ask her doctor for and they ran it and she did not have the tissue transglutaminase, which right mostly is what they're going to look for for celiac. But she did have anti-gliadin antibodies. And I was like, you should not have those, you know, so you may not have celiac, but you could have something similar.

So yeah, so that's a good point because a lot of doctors will check the basic test and they say you're fine and they only check like one antibody called TTG, right? But they don't check the anti-gliadin antibodies, which are less specific but actually more sensitive. So they'll show up often when the other one doesn't. And they do indicate a level of leaky gut, a level of food sensitivity, and they are definitely contributing to all sorts of issues for people.

Right. And we did some other nutritional stuff. She was low in iodine and we did some sea vegetables and things, which is important for thyroid. So again, there's other things that are going on. But that, you know, when I had a two-year follow-up with her, obviously we had a few follow-ups in between, She said her digestion was great, her energy was great. Her thyroid antibodies, you know, what I think we hear in conventional medicine is like, you got autoimmunity, you have it. You know, why check antibodies? It doesn't go away. So her thyroid peroxidase, which is one of the ones they check, came down to lesson zero, whatever the normal is. And her thyroglobulin antibody, which is the.

Other one, is slightly elevated but came down significantly. So that's remarkable. So she had one of the highest levels of autoimmune antibodies you'd ever seen. and after getting her gut sorted and getting the gluten out of her diet and optimizing your nutritional status, doing stress reduction, she actually had a complete normalization on one of them and almost normal the other one, which, quote, doesn't happen in traditional medicine.

And she's on armor. She's on some thyroid support. She does feel better with it. And I think there's, you know, often a need for it. But, you know, she pretty much reversed her autoimmunity by going paleo. That's amazing. So it, that was Pretty remarkable. It's nice to see when things, you.

Know, kind of quickly turn around for some people.

What about this other case you had? So this other one was a bit more complicated. She's a young woman, 27 years old, but she has mixed connective tissue disease, which, you know, is kind of a combination of similar lupus or scleroderma. It's kind of a mix of where.

Autoimmunity can affect many different tissues. So it's a bad autoimmune.

It is a bad autoimmune. It affects like all the tissues and organs and skin and liver and kidneys and muscles and so on. And then she came in with all those symptoms, you know, a ton of joint pain. She had a lot of digestive stuff, which she said that she kind of always had her whole life fatigue. She was depressed. She had weight gain, probably because she was so inflamed. She wanted to lose about 20 pounds or so. And her symptoms did start in her teens with some, you know, exercise stuff. And then by the time she came to see us, again, only just in her twenties, she was getting arthritis in her in her hands. So she was on autoimmune suppressant medications. She was on cellcept, but she had been on a lot of things over the years, a meprazole for her reflux. 'cause she had a lot of the digestion issues. She was on a low gluten diet. Yeah, yeah, yeah. It doesn't count.

That's what I was talking to be.

What is it like? It's like being a little bit pregnant. What is low gluten? I was like, you have all these conditions. You have to take gluten out. And she had done testing, I think some specialty tests that did show she was reactive to gluten and soy before, and that's why she was low. But I told her, you know, you got to be 100%. And she said, you know, I do feel like my headaches are worse and my stomach's worse when I have gluten. so we got our strict gluten-free, you know, I kind of low grain, I try to get it low allergen overall. I told her to come off the coffee, no alcohol, anything else that could be inflammatory to her gut.

And you also did this test, which was not the normal test. So you mentioned a little bit earlier. So when you go to the traditional doctor, they'll do a celiac panel, they'll do the TTG, they'll do sometimes gliding antibodies. But we at Ultra Wellness Center do a different test from the lab called Cyrex, which, looks at not just a few proteins in the wheat, but all sorts of different like dozens of different- Dr.

Right. The gliadins, glutens, or different parts of the gluten proteins. So they're breaking them down to these smaller units so you can really get a closer, you know, look at what the immune system's reacting to. And there's a section there of transglutaminase. So it's not the same thing as tissue transglutaminase. You can't diagnose celiac with it. But what Cyrex says is that folks that have these other transglutaminase reactions, are more likely to have an autoimmune condition related to gluten. So this is where it's like, okay, it may not be celiac, but you probably have something very similar. So out of 32 markers, 30 of them came back positive on a low gluten diet. I mean, she wasn't eating a standard American diet at all. She did have a celiac panel. Her tissue transglutaminase, again, that gold standard, was borderline high, which should not really be showing anything. And her deaminated gliadin was high. She did have the genetics. She had, it's called HLA-DQ2 and DQ8. The DQ2 is positive, which brings your risk up pretty high for celiac. We also did a Cyrex 4, which is known as kind of their autoimmune profile as well. So they're looking at dairy. Dairy we know is big allergen in and of itself, but a lot of people that react to gluten seem to react to dairy. And they've, you know, with paleo, a lot of folks take out all grains and sometimes that is helpful. According to Cyrex research, oats and oats have been identified a long time ago, even when they're gluten-free, when they're not contaminated with gluten, there is a protein in there very close in structure to gluten.

So many people do react to it. I see that a lot. I mean, I see, oh, I run the gluten-free oats and I'm like, no. Yeah, usually.

If you are still having any symptoms, then you should just get rid of all the oats. Yeah, so I tend to throw oats in the gluten category. And then they also suspect rice, which I've always thought of as a low allergen grain, but we do have a lot of folks that seem reactive to rice. corn and millet. So those are the ones I kind of focus on. They also check corn, soy, some of these other common allergens.

Yeah, and so what happens is, you know, the way I think about it is gluten is sort of the gatekeeper, right? When you eat gluten, you become sensitive to it, it opens up the channels in the gut creating what we call leaky gut. And then other foods get in and you get these cross reactions. So you get other grains, you get dairy, you get soy, but it's really the gluten that's sort of started the whole thing. And if you fix the gluten and you heal the gut and you get rid of all those other foods for a short time, maybe three months, six months, maybe a year, you can heal the leaky gut and then become able to tolerate a much wider diet.

Absolutely. So I think that's a fear of so many people when they start reacting to so many things. I'm like, you know, a lot of these foods are not at fault.

You know, there's something else compromising your gut.

Bacterial bysander. What's that? Like the innocent bystander.

Yeah.

And I'm like, once that gut gets.

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Your 15% off today. And now, let's get back to this week's episode of the Doctor's Pharmacy. The way I think about it is that the gluten is sort of the gatekeeper. It sort of opens the gate and creates this leaky gut and then all these other food antigens can leak in and start to aggravate the immune systems. The body begins to start to react to other things and I've seen this over and over over the decades. Is this something you're noticing?

Yeah, I mean again, I'm quoted all the time about this because you know our group was the one that discovered the molecular mechanism by which which gluten can really make your intestine leak through the released zonulin. There's this molecule that has been now- that's right. Linked to a variety of- you- get.

The Nobel Prize for discovering that.

You know, people are still very skeptical. But anyhow, the bottom line is that you, you know, and you put two and two together and say, well, if gluten is capable through some of these undigestible peptides to engage in a specific receptor that instigate the cells to release zonulin, and make the intestine leak, then this can be detrimental and harmful to everybody. The answer is it depends. Actually, the vast majority of people would not have consequences if you have a balanced diet. And can even be useful to help what we call antigen sampling to bring very small amount of antigens so that the immune system will be more robust, more robust trained in case that the storm will come, the real deal will come. the problem arises when you exceed the amount of gluten, for example, so that this continues all the time. Or even if you have, you know, not a huge amount of gluten that you eat, you are genetically predisposed that when you increase the gut permeability on the other side of the fence, you find an immune system that is ready to fight against gluten. And these are the people, they have a gluten-related disorders. So all this to say, I would.

Not.

Cuddle of guys, gluten as the villain in 21st century necessarily. After all, if you and I were here, rather than jump from one tree to another, we have to thank agriculture that predicted the amount of food that we can have and free up our time to do more creative stuff. But the same token, you know, to dismiss completely the fact that gluten can be an issue for, you know, a variety of individual outside celiac disease, that will be also to not see what has become more and more obvious.

Yeah, it's pretty extraordinary to see how this whole field is opening up. And one of the things we often were made fun of for decades is this idea of a leaky gut. Basically, the belief was that if you had a leaky gut, you'd have sepsis and you'd die basically, which means you have overwhelming infection. But this sort of intermediate zone of slightly leaky gut leading to inflammatory diseases is seemingly connected to everything from obesity and type 2 diabetes to heart disease, to autoimmune diseases, neurologic diseases, autism. I mean, it's sort of, it's like almost this unifying theory of how we get inflammation.

So, I'm fascinated how historical memory is lost during generations. For example, you know, amnesia. Yeah, I've called that amnesia, whatever. But, you know, when, you know, at the beginning in the 90s, we were convinced that cerebral disease was a big deal in the United States. The establishment really came after us big time. You know, you really missed the boat here. We looked for cerebral disease and we didn't find it. So, you know, you are not, you know, in the right direction. And this to put that very mildly because the criticism were very much more harsh than that. and again, and their premise was on a state of mind that was fixed on what was at that time the definition of the disease, young kids with a big belly, diarrhea, and that's true. We don't see that, we don't see that, we see other stuff.

And you don't have to have any digestive system.

Well, zero, you can be obese, but that was not clear at that time and that's the reason why we were highly criticized. Now in 2018, if you ask anybody, nobody will question that celiac disease is as frequent in the United States than in Europe. But if you ask, it's been always like this, the answer most likely is, yeah, of course we always thought so. Even the ones that were hypercritical, same phenomenon with this leaky gut story. Again, it's not that I was like a functional medicine doctor always tuning in to this. I came to this by you know, chance by again doing this color vaccine and learning the color can make your gut leak and then try to understand how that does and see that there is a very sophisticated machinery to loosen up the, to increase the permeability of tight junction in intestine.

And then- and the little connections that-.

Yeah, these are the little gates in between cells that we thought that were cemented so that no things can come.

Through and then we- Through the cells, not between cells.

That's right. Everything that we negotiate with the environment, we thought that has to come through the cell. And then we learn, no, actually there is a space in between cells that can be modulated in its permeability. And, you know, when we studied the mechanism of this toxin and we saw this very complicated machinery, the reasoning that I made there, I said it can't be that we evolved to this machinery there just to get sick with this toxin from Vibrio cholerae. Vibrio probably learned physiology from us and exploited that possibility for its own return. And that's how we end up to, you know, this core zonulin. And I have to say, you know, with the story of the leaky gut are now half away compared to the story of city disease is over. It goes to the discussion over, I say half away because even the establishment now of evidence-based medicine, the hypercritical to our work that has been coming right here, the journal vein, when we discuss.

The right track when you're- well, you.

Know, again, Mark, I am an individual that not only I'm open-minded, but I am the individual that, you know, I admit that that science is a constellation of failures with very few successes, and you leave for those. But I also admit that science is not a perfect path. Most of the time you're wrong. And there is nothing worse as a scientist to not admit when you're wrong.

What you do is attach their ideology.

That's right. Because what is true today will be garbage in three years. We know that. that's that dynamic. So as a good scientist, you formulate an hypothesis, you design an experiment to challenge the hypothesis, and you perform the experiments, and then you evaluate the outcome. The nine out of ten times is different to what you anticipated with your formulated hypothesis. This brings to two kind of science, the incremental science. I want to go from point A to B, to C, to D, to get to my final destination. I know where I am. I see my sights where I'm going. That's the one in which your peers will follow you, will understand what you're doing, and eventually will accept the approach that you're taking because everything is clear. Sometimes you want to go from point A to point B and you end up to point Z. so in a place where nobody's been before, most of the time is dead end. So it's something that leads to nothing. Very few times you got in what we call transformational science. That is not something that you intend, but you end up to be in something that changed completely the paradigm of way of thinking.

The unintended consequences of your work.

And that's what the zone of discovery was all about. When you got there, to understand if you are in a dead hand or you do something transformation, the only thing that you need to do is to sit and see if your peers can validate and reproduce what you've done or this was not reproducible. The zona story now is highly reproduced. A matter of fact, I don't, you know, alter the vast majority of what is the science and zona nowadays. We contribute the minuscule component of hundreds of papers that are out there. All this to say that not only the Zollner story, but the story of the modulation of gut permeability with the identification of genes that can modulate tight junctions, the identification that, you know, loss of barrier function is the core of many chronic inflammatory diseases. People are coming around.

It is so powerful yet as a it's a if a sort of a discipline, medicine is not really thought about how do we then address that? How do we fix a leaky gut? How do we normalize the function in there? What do we do to fix that problem?

Well, we can't because we don't know yet, you know, why are the mechanism that leads to that? Because this is a very complex machinery with very sophisticated functions. And I was mentioned during the lecture, that the structure of these tight junctions is extremely redundant. That means it's a function, it's a dear to us. Because where the redundancy means that, you.

Know, you have backup.

You have a lot of backup systems to make sure that something goes wrong. In case that something goes wrong. I can tell you with great level of confidence that the two key elements that makes your intestine leak is one, gluten, as we said, because it releases zonulin through this mechanism, and an unbalanced microbiome, what we call dysbiosis. that can be either because the function and the composition is imbalanced or because the microbiome is establishing the place where it's not supposed to be. Small intestine bacterial growth, SIBO, is one of the most powerful way to release its zonin and make intestine.

And we see this all the time. I call it the food baby. They get bloating after eating and it's ended. And that often means that there's bacteria in there producing gas.

That's right. So, I think that that it's going to take another few years for people to accept completely this idea of the importance of the intestinal barrier in a variety of chronic inflammatory diseases. So the heart's soul of immunologists, traditional immunologists, will never come around this. They will never come around to the idea that autoimmune diseases can be treated as I believe that they can.

Because if you stop- By fixing the gut.

Of course, you know.

Which is how we do it in functional medicine. Without even knowing what we're doing.

These conditions, including autoimmune diseases, are based on five pillars. The genetics, so who you are, your environment, including what you eat, and an increased gut permeability, an immune system that becomes hyperbelligerent, and a microbiome that is not doing what it's supposed to because epigenetically will make your genes to be either suppressed or repressed so that you switch from genetic predisposition to chronic gut quality. And when I say chronic inflammation, I mean anything.

Yeah.

You know, cardiological issues, you know, even arthritis, microbiome, anything. Anything.

Arthritis, which I think is fascinating.

So any of these five pillars are fair targets to try to ameliorate inflammation. Again, genetic editing, I don't think that's a possibility because the complex is way too much. If there are too many genes involved, I don't think that is going to happen. Modulate the environment, that's something that we should really focus on.

We have to deal with all those pillars.

Absolutely.

And then in medicine, we just try to find the one drug to fix the one thing.

No, it's not going to work that way. So if you will continue to have an environment that is really conducive of inflammation, food, pollution, chemicals. You can fix whatever you want in terms of immunosuppressors or, you know, change the microbiome. Everything will go back where it's supposed to be. But if, if you start to think, you know, more, I would not say holistic, but comprehensive, let's say, you know, let's start with a lifestyle. What really is a common sense? Of course, we can't go back and live in a cave. That's not feasible. but can we, you know, avoid some chemicals that can instigate inflammation? Can we eventually, you know, decide to feed our kids food and not the junk that we feed so that eventually they have the same chance that we had? Can we promote local production of produce, rather massive production that of course comes with the price?

Yeah.

That's changing our agricultural system, our processing and absorption system. It's all of that.

And again, you know, I, this, it's an uphill battle because you go against major interests, of course. But if you do that, then you can tackle, how can I fix a leaky gut? What is the problem? Is the dysbiosis? Can I then use prebiotics, postbiotics, probiotics, symbiotics, whatever it is, whatever it is. And then, you know, then, you know, that got also to the point of these bioses because again, this fact, they all interacted.

Well, you said something very powerful in your talk, which is that the single biggest thing we can do to change our microbiome is change the food we eat and the quality of the food we eat and get off the processed food and eat more plant-rich foods and good quality foods, right?

Yeah, if you think about these five pillars that I just told you, they highly interact. if you affect foods, you affect the composition of microbiome. If you put the microbiome back in balance where it's supposed to be based on our evolutionary plans, the immune system will defend us rather than be belligerent against us and will unleash inflammation only when it's definitely needed. If you have a balanced microbiome, you also will have a gut permeability that will go back the way it's supposed to be. And a good gut permeability will make the immune system to be less belligerent. So it's all interconnected.

There's a connection between the gut and the blood pressure.

So tell us about this patient you had who you treated. yeah, well I'm glad because that's a.

Perfect segue because he had gut issues. And that sort of is what really was leading to his high blood pressure. So here's the gentleman that came in.

His gut issues leads to inflammation.

It leads to inflammation. And it's not just inflammation in the blood vessels, it's inflammation in the gut lining. So you can get this non-specific lymphocytic infiltration it's basically inflammation that means a.

Lot of white blood cells show up in the gut and makes it inflamed.

Exactly.

So, and so what happens though is then you get a malabsorption of minerals and nutrients. That's when you don't absorb vitamin D, that's when you don't absorb potassium, that's when you don't absorb your calcium, that's when you don't absorb your magnesium. Those are the things that can help regulate blood pressure. with this particular patient that came in, he was a 52-year-old gentleman and he had been diagnosed with blood pressure, high blood pressure, about almost a year prior to coming. And they had tried multiple blood pressure medications and he had different side effects, which is one of the issues with blood pressure medicine. Oh yeah, there's that. We forgot to talk about it. Yeah, exactly. So, you know, that's a big problem. Lots of people have side effects. They get dizzy, they get tired, they get erectile dysfunction, they get lower libido. They've been hair loss associated with their high blood pressure medicine. So, he had been put on different medications that resulted in loss of libido, fatigue, brain fog. One of the medications actually caused dehydration that resulted in him being in the emergency room where they found his potassium to be really, really low and had to be replaced. So, he was like, I'm coming here because I want a different approach to my blood pressure. So as we were, you know, we go through our new patient packet that's very long, some things that started to stick out were that he was, you know, he did have fatigue and he also had irritable bowel syndrome. And I asked him to explain that to me. And when I hear irritable bowel, I don't hear this, like again, we talk about like, such as a syndrome. Yeah, like essential hypertension. We essentially don't know what's causing it. It's like we say irritable bowel. It's like, you know what?

Your diarrhea is irritating me. I don't want to talk about it. We don't want to get to the bottom line. Well, it's not even that. They don't know. In other words, when we say people have irritable bowel, oh, the reason you have bloating and gas and diarrhea and constipation is because you have irritable bowel syndrome. No. That's just the name we give to people who have those symptoms. It doesn't tell you about the cause. And that what's unique about functional medicine is we have a methodology, an operating system, to navigate to the root cause. And we treat that and we don't have to treat the hypertension. We treat the cause and the disease.

Goes away as a side effect.

Right.

So in this particular case, we do testing for the gut microbiome and we can also do testing that tells us some things about the gut. So we can find out if there is inflammation in that endothelial lining and that's basically basically, if you look down a really big stainless steel tube and it's really shiny, imagine that shiny layer is basically a very thin membrane that protects the rest of the tube from anything that's going in the tube. So that's the endothelial lining, that very shiny stainless steel.

It's like a one cell layer between.

You and the sewer, right?

You got it. Exactly.

Your immune system and they'll poop inside of you. That's a great way to put it. so when that membrane gets inflamed, it cannot function to absorb nutrients the way it should, and that can lead to all of the things I just spoke about earlier in regards to low magnesium, low vitamin D, low calcium. And so we know that people who have irritable bowel, there's a good percentage of them have non-celiac gluten sensitivity. and so that triggered my thinking and that's why I ordered that test that will look at whether you have leaky gut, whether you have gluten sensitivity, and whether you have crossover to other foods like gluten that can create gluten-like impact on the gut. And so with this particular gentleman, I also did a whole host of metabolic tests that included, you know, a glucose tolerance test. I also looked at his magnesium levels. I looked at inflammatory markers, Omega-3 fats. Omega-3 fats that we look at. So it did a comprehensive metabolic evaluation. I looked at a very expansive profile that looks at macronutrients, micronutrients, organic acids, amino acids. That gives us a really good clear picture of what his nutritional status is, whether his, the very important energy making systems in his body are actually working the way they should? Are they getting the nutrients that they need? Are they being blocked from doing their work by toxins? We do this panel that gives us all that information.

It is a very unusual panel in traditional medicine, but we're looking not for disease, we're looking for imbalances or dysfunction that we can correct that will help.

The body do what it's supposed to do. Exactly. So, I gather all that information with the lab test, but the most interesting thing about this gentleman is that he had one gene positive. It's a gene that would express for celiac disease. But the tests that we do to see if he actually had celiac disease were negative. And what we know about people who have at least one or both of the celiac genes that do not have active celiac disease is they're more likely to be sensitive to gluten. And indeed he was. he had two things going on on that panel that we do to evaluate inflammation and antibody interaction or the immune system creating antibodies against gluten in the body. So he did have leaky gut, meaning that endothelial lining, that one thing saving you from the poop in the center of your intestine from the rest of your body was leaking. And so the immune system was creating antibodies. So we knew there was inflammation. inflammation. And the second thing was he had enormous numbers that showed that he was sensitive to gluten. And so that gluten sensitivity. It's not celiac because people understand that.

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

So gluten is often driving leaky gut. and it's often overlooked, very overlooked, and particularly in a case like this.

And the normal doctor will check your levels and if they're normal, quote normal, like it's 0 to 20, right? Is 19 the same as 1? No. Is 5 the same as 0? No. So I think we have to understand that if there's any level of anybody, it means there's some irritation of your immune system that's causing potential symptoms.

Yeah.

So in, in his particular case, I put him on a gluten-free diet. And I also, we, and, and the great thing, the, and honestly, I didn't put him on a gluten-free diet. I identified the gluten sensitivity. And here at the Ulmtra Wellness Center, we have amazing nutritionists. And when I discuss these types of cases, then they develop a, a program for a patient that is going to be customized to what their needs are. So in this particular case, he was on a Mediterranean diet that was gluten-free and that made all the difference. And when he tried to re-introduce gluten back into his diet, his blood pressure went back up. So it was driving the inflammation that was driving his blood pressure. And he was also low in vitamin D, which was impacted by his gluten, because gluten will keep you from absorbing iron. magnesium and potassium and calcium and it can have impacts on lowering vitamin D.

And vitamin D regulates inflammation. So, you're in an interactive dynamic biology.

Where everything is connected and that's really what we do in function. And, there's a lot of observational studies that show that vitamin D in people that have low vitamin D and you replace it, you can lower their blood pressure, particularly in people over 50. So, I replaced his vitamin D, put him on a gluten-free diet and gave him things that we know that work. He wasn't eating a lot of fish so we gave him Mega-3s. I also added in some CoQ10 and magnesium. And he did phenomenally well. He never went back, well I shouldn't say never, he's been my patient for about eight months now but his blood pressure has been normal.

I hope you enjoyed today's episode. One of the best ways support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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