Alessio Fasano - Spectrum of Gluten-Related Disorders: People Shall Not Live by Bread Alone

thank you thank you so much for the kind introduction he took half of my time actually happy Holidays to all huh coming from a place where we are now at eighth inch of snow I don't know how you celebrate holidays with no shoveling and I don't know it's really weird but anyhow I've been told that you celebrate on the beach that's bless your heart um today I have a packed packed you know agenda to share with you I'm assuming that most of you here because you know either yourself or some or your relatives friends are acquainted with this gluten business there is a lot of fun this is very few facts and and you know again I want to give you the perspective of our Center they leave first and the history of the evolution of this gluten we still really sorted for the past 70 years you know even if this probable gluten and specificity disease was described a long time ago 2,000 years ago there are reports from a Greek physicians that describe something that really relates to Syria disease the real story that link city disease to its instigator I gluten it's very very recent and really can be dated you know 60 or 70 years ago thanks to this fellow here this is a Dutch pediatrician they made an unbelievable observation and before that the destiny of the people we see the disease at that time were mainly kids was not a great destiny one-third that these kids will not make it that was the right of mortality before the dis individual will make you know this observation that the destined these kids was pretty you know um you know how to say not really great so in other words if we pediatrician will make the diagnosis these kids will be brought at the hospital the hospital doctor said yeah there is a chance that these kids will have seen the disease leave him or her here come back in three six months and if he or she is still alive you can bring that back home and during these three six months this kids will be fed only and exclusively bananas that's reason why they're called banana babies after which they will be reintroduced gradually the normal food and so on and so forth nevertheless to say who made it will hate whatever was yellow for the rest of their lives because that was not a walk in the park what was the tremendous observation that this guy made was that again your World War two where in Europe you know flour made with wheat was really not available but typically they had potato starch we being flour mortality went to zero and resurfaced at the end of the war when wheat was again available to get back 3035 percent so he's suppose it made the proposition that was gluten or wheat whatever components was in there there was the culprit of City disease to prove that he did a study that now will be unconceivable he did a study with six one two three four five six kids okay n equals six and he recruit these kids put them on a gluten-free diet showed that the symptoms went away then reintroduce gluten and the symptoms came back and that's how he made the link and now seventy years later is still hold true that this is the heart and soul how we treat severe disease remarkable the fact that this was done on on a study that now will be laughable now fast forward the two thousand thirteen what we know about City disease is not anymore a food allergy or food intolerance as we believed before it's truly an atom unisys is not a premises of kids people all ages can be affected it is not true that you have to be fair skinned blond and been first greedy relatives of Santa Claus to have you know see the disease and live in north Europe the bottom line and this is a condition that can affect any age any sex any race and you know what is mum blowing that we didn't know and you're going to see you know during the lecture can affect people really at any age can start at any age but what has been a tremendous tremendous you know improvement our understanding of this condition really was when this was moved from again in a specific you know food intolerance to truly an immune disease and ever since became a sort of paradigm about immunity as such you have to have some ingredients to develop the recipe of immunity and but what makes celiac disease is really one of a kind that the recipe is unique we know about CDC stuff that we don't know about multiple sclerosis rheumatoid arthritis or diabetes even if you know the recipe is exactly the same where are the peculiarities as any other are immune disease there are at least two ingredients genes many that you're born with you're going to see in a moment and piccoli re the number one them some genes there are you know presents almost the totality of people will see the disease particularly these actually genes you know this DQ to DQ 8 98 99 percent of people the see the disease as either of both meaning if you don't have that you cannot develop see the disease no other immune disease has such a huge peniston's of genes and the second peg reality we know the target this strange protein is called transglutaminase OT TG that we use you know in clinical setting because antibodies against this enzyme are the strongest red flag that give high level of suspicion that this individual may have seen the disease but what really sets in the disease apart for any other immune disease is that it's the only one for which we know the instigator thanks to the observation that a pediatrician at all before we don't know what make people sick with diabetes MS we know undisputably that is gluten the culprit and so much so that if you go on a GU the free Dada that's the landmark treatment of City disease you prevent this interplay between the genes and the environment and you completely reverse the autoimmune process because these people will have no symptoms anymore the antibodies that you use for and the diagnosis will go back to normal and the damage of intestine that is the unmarked of the atom you need salt is God so imagine the revolution in the world the science where you know the prediction was once you got in the path about immunity there is no way a return sealer disease is teaching us otherwise you will see in a moment what kind of repercussion that they have meaning that if is any way to impede this interplay between genes and environment in this case by subtracting the environment you can stop and reverse that immunity that's the impact that see the disease really is having on the general world of immune-mediated diseases in general specific another immune diseases what was the outcome what is the outcome when these two ingredients they come together well again in tux classical textbooks this is the picture of a typical celiac and that's what we have in mind for many many many years classical manifestation mainly a few weeks a few months after that the environmental instigator I gluten comes into the picture so a few months after the gluten is introducing the diet with symptoms they are typical of what is described in the classical textbooks look very carefully this picture these kids we see the disease is a picture of kids in the late 30s from London this kids they look exactly like the malnourished kids that we see nowadays in third-world countries they are absolutely the same the difference is that the kids with malnutrition now they look like this because they don't have food to eat seal the disease look like this they have food at the wazoo but cannot make use of it because we just go through them that was the picture that we had in mind and that's the classical the big belly the subcutaneous fat that's gone fairly to drive stomach ache vomiting the irritability by the way this was a common denominator when I was in training my boss used to say forget about the blood tests could forget even you know the clinical exam you see the parents stress out with the air up in the air and the background of the eyes the kids is pissed off that see the disease are let's prove out was pissed off right there okay for many years we look in this direction and that's reason the premises the the general wisdom was because we don't see this in United States silly disease does not exist here that was the premises and then we learned that this was not what silly disease is really all about this problem was like this in the 70s but now they see the disease is what we call a systemic disease there is no organ or tissue of our body that is spared by the attack that is instigated by the introduction of gluten if you're genetically predisposed true the intestine is the battlefield where this war between our immune system and this enemy igoogle occurs but guys and this is something that I keep telling my students over and over again the gut is not like Las Vegas what happen the gut does not stay in the gut so once this instigator got there and this immune cells the sort of soldiers that see the enemy and start to fight and generate collateral damage and this inflammation sometimes these soldiers the light they leave the battlefield IED intestine and spread out any place in your body go to the skin and you develop that skin manifestation is dermatitis of pretty formas goes to your teeth and then you have this discoloration there is an a problem and inflammation the bones associated with the vitamin D and calcium deficit and you develop osteoporosis and I can go on and on and on matter of fact contrary to the general wisdom the most frequent way the disease percentage say it's itself nowadays is not diarrhea and 30 pounds weight loss the most frequent way that disease present today is anemia and with that chronic fatigue some people they are diagnosed with fibromyalgia or chronic fatigue syndrome they this is the most frequent way that this is percent yourself don't be surprised that this can happen because iron is absorbed in a very inches to the very early part of the intestine if that is gone there is no back up there is no other way to bring iron and if you don't bring iron you develop anemia so you can have only these few inches damaged the rest is spared the capability of the intestine to digest absorb foodstuff is untouched by you develop this other since symptoms so that's not should be surprising bottom line the reason why we overlooked for many years because this is truly a clinical kamala if you don't know all the permutation that this disease you know materialize and can present itself chance exists that you would not make the diagnosis that for many years the lag period between the onset of the symptoms and somebody diagnosed we see the disease was measuring the matter of 10 12 years 10 12 years now we're much better six or seven years while we're talking about years not months imagine if we will make that kind of slow journey for people there you're affected by diabetes or MS these people would die because of you know the fact that the diagnosis miss for such long periods are so what are the milestones that really change the landscape in the past you know a decade and a half starting from 1997 we realize that this recipe of cedar disease really called for and three ingredients and not two as we believed before sure you have to have these three elements the Holy Trinity to come together in order to develop cedar disease and then we realize that this applies to any other odd immune disease with tremendous repercussion in terms of what we can do in terms of science to open the possible hope of a treatment for our immune diseases thanks to see the disease that is leading us hold it by hands the Lord our knowledge of science to make that kind of you know improvement and let's take a look at these three ingredients genes again these are many genes involved these are multifactorial diseases there are several genes involved right now we reach roughly 40 45 genes that we know that are necessary to develop City disease but probably would talking the hundreds the more we learn the more we see that genes are involved there one that I told you must be there is actually the key to this you ate almost the totality of people will see the disease they have either dick you to and or dq8 now this is absolutely necessary but not sufficient you have to have all these other pieces of the puzzle and matter of fact you know one-third of the general population they have this actually gene said they would never develop see the disease so that's it's extremely complex matter that is you know objects of a great level of interest in terms of science the second element that we don't know until the recent past that's beside the genes and beside an instigator the intestine has to lose one of its key function has been overlooked for many years I the functional barrier the function to divide ourselves from the environment to avoid this promiscuous entrance of bad guys that can really harm us and we didn't know about this until the recent past now some of you guys have been hearing the leaky gut theory or whatever it is you know it the bottom line is that again among the most important function of the intestine is to regulate the trafficking of these guys from outside and then make choices the good guys eye nutrients that can come in the bad guys eye bacteria that can kill us needs to stay out that's pretty much you know a simplicity way to look at the much more complex story but what are the facts of this leaky gut syndrome we know very little we know for example that in the past all the physiologists and we're talking about passive meaning 15 20 years ago the gut was conceptualized as Isis or the floor in which each tile was one of these single cells that cover the entire twenty feet of the intestine length and in between the tiles everything was sealed by a certain grout cement so whatever communication was happened with through the you know environment had to happen through the cell because in between cells nothing will come through because everything was sealed now how big of an interface we're talking about this twenty feet if you stretch on the floor will cover a double tennis court huge so you can imagine why nature put all this stuff in in this little you know little space here and there is a tremendous philosophical message that the biology sending us we want to interact with the environment and the port of entry when we interact with the environment the most important one is not the skin that is one tenth of this not the lung there is one fifth of this but this one here because it's huge 15 it 18 years ago a Japanese group came up with in a revolutionary finding they said there is no grout there is no cement in between cells their doors they are typically closed but because their doors we can open them I will and to allow under tidally control you know a you know a mechanism passage of stuff from the environment into our body and over the years we understood the complexity these doors and one you know information that was missing was what is the key that open and closed this door until by serendipity we stumbled upon this molecule that some of you guys may have heard called zhanlin that that's exactly what it does for living that open and close these doors and if this doors are stuck open has you know happen many out immune diseases as you see in a moment so in other words if you have a leaky gut it's because this zone is produced too much at the wrong time so rather than do this nice job all over and close make this nobody to stay open for a long time long enough that you cannot discriminate anymore friendly folks but everybody will come in by the way let me check am I going to you with the science or you got you know what I'm talking about now because if you don't got it I start the Lord again from very beginning we're going to finish a nine ten you do wonderful because again otherwise this is going to going to be the price when we found this zhanlin and finally we understood what kind of molecule was we were able to identify the gene and where this gene sit in our you know you know chromosomes the chromosome being this this piece of genetic material that really dictate who we are with the color our highs and our heights and our metabolism and so on and so forth so the gene that encodes for dominant sits on this chromosome that is called chromosome 16 very small chromosome account for roughly 3% of the old jeans that we have but very important because many genes related specific disease have been located in this chromosome specifically three major you know a classes out immune disease so genes for example for type 1 diabetes lupus inflamable disease like Crohn's remedied arthritis I've been sitting here many genes for cancer for example breast cancer lymphoma Malad leukemia process the cancer genes are sitting over here and inter singing of genes of the nervous system like Lou Gehrig disease liver dystrophy multiple sclerosis autism genes are sitting on this chromosome the gene for zhanlin was discovered and sequence in 2010 so three years ago in three years the scientific community was able to try to you know define where this genes and therefore zone and therefore leaky gut is linked to in terms of diseases that sure enough the same kind of categories came up so there are out immune diseases like cedar disease Crohn's disease rheumatoid arthritis lupus diabetes cancer interesting brain cancer particularly almas there are a lot of studies now working on that breast cancer lung adenocarcinoma ovarian cancer pancreatic cancer all related to slid got deuter's online and finally some diseases of the nervous system like MSS schizophrenia I'm going to touch upon briefly on these conditions toward the end of the chat so you see how important is really to Title II regulate how we interface with the environment and what are the consequences when this is not done right and we learn those all thanks to our discoveries in Silla disease the third element between the genes that this barrier function is the environmental trigger interest single enough our species was not meant to eat gluten that's reality of the story for the 2.5 million years of evolution the human kind that's been gluten-free for 99.99 percent of the time gluten came into the picture only in the very last second of human evolution 10,000 years ago when our ancestors dramatically changed their lifestyle from a nomadic so in other words moving around with the seasons of the crops and the migration of the animal to settlers in which they start to domesticate food and crops so that food procurement was not the main activity humankind but was predictable and so they can spend you know their time in much more creative stuff like you know to build you know the pyramids and the Colosseum and so on and so forth the the grains that contain gluten that belongs to this tribe of grass family they're called already so with rye and barley they came up with the agriculture so they did not exist so in other words we did not evolve to deal with gluten it just was something that we did not plan what are the consequence of this is that gluten is toxic for everybody but not listen carefully because I know there's somebody else you know there is a lot of confusion here it sucks for everybody but not everybody it's gluten we got sick that's the bottom line and I will tell you in a moment why so that's where I could culture started you know in Turkey and then moved east west and south north at the rate of one kilometer per year and then spread everywhere and this was a very popular crop in the inch of Egyptians and and and Romans the wealth was based on the availability discs and the grains changed over time so in other words the old grains the ones that the Romans used to do it was this grain here okay the hill was very low then the middle aged this grain came by and roughly four hundred years ago this motor grain the one that we still eat came about four hundred years ago and for as far as we know based on agronomists from their genetically this grain never changed are the same for the last 400 years that's what we understand but they became extremely popular you know making bread in Egypt was a great deal unfortunately the first beverage that was really developed was not wine as I want to believe why was beer you know I think the who drinks beer is an unsophisticated drinker but you know Egyptians they drink beer and what's developed before that the Romans really perfected you know the production of wine and and and the wealth was not measured by stocks and bonds oh uh you know because at that time there was not such a thing but by how much grain and how much oil you own because they were not perishable and you can do so many things with that okay so that's reason why grains containing gluten became so popular now this is a painting of the 1500 look very careful this is a wheat field look at this gentleman here you know see how tall was wheat at that time compared to human beings sure you know the average height at that time was not what we have today but that was pretty much you know that's what's the typical height of grains at that time the the seeds were only the 5% on the top so the yield was not great and the artisan was once a year and that's when the you know agricultural revolution and people that start to play with grains made you know this is much more efficient and increased yield and this became shorter and 30% of the plant now are the seeds and the 70% is waste but but again this is one this happened a long time ago not fifty years ago what is so special about guna why is such a unique protein first of all why we talk about gluten without commissioner prudence gluten gluten in and lightens both toxic people will see the disease the other Google related disorders what is so special is that you know this protein is extremely elastic and created you know when you mix water and East creates a sort of chambers in which air can be entrapped so when you mix you know this ingredients flour with weeds water and beasts this puffs and you have this beautiful cross on the crashing breath I mean forget it but you got abort you try to do this with rice it's not going to happen but the beauty comes with a beast because that is the reason why gluten is so toxic being so elastic and so unique as a protein cannot be digested so again I don't want to go on technicalities but imagine a protein as a salt or pearl necklace each of this pearl is a basic component that we call amino acids any protein that we put in our mouth in order to make use of it we need to break the necklace first cut in pieces and then peel one um in us at the time so that we can bring it in we can do this for each protein that we put in our mouth with the exception of this one here due to strange composition the best that we can do is to break it and make pieces but we cannot completely dismantle you know Google in a single amino acid when I say we I mean human species all of us we don't have in other words the seizures that technically are called you know enzymes digestive enzymes produced by the pancreas or by the intestine to do this job we don't now it also important to understand that you know instigation of an immune response in other words one immune system see the anenome start to really fight create this collateral damage' we call inflammation it's mainly instigated by proteins or pizza proteins so the fact that gluten cannot be completely digested and will have the capability to drive through these two pieces here in blue to make the intestinal liquor it's a great instigator of inflammation that's what it is and and again it will be seen by this immune system as an invader that can create danger and the immune system goes all-in to get rid of it now disclaimer this happen in everybody a matter of fact everybody that eat gluten will have a leaky gut so you glue them a gluten is digested you know in completely we release the smaller dominant that will open this gate in between cells and glue that will come underneath here now here the destined is different depending who you are the vast majority of people will go after gluten we clean it up we will not know that happened a very - percentage of individuals will lose this battle and we develop symptoms and will make these people to develop what one of the gluten related disorders that we're going to discuss the last part of this chat the other thing that is cool that we learned in studying all this process is that by mistake of evolution gluten is interpreted by the immune system as a bacterium so in other words an invader that can really kill us now we are surrounded by bacteria and we fight against bacteria all the time very few of us will lose the Bob and would develop infection and fever and whatever comes with this same story with gluten we all are eating gluten no matter who you are they live in a north pole or you live you know the equity are the same that we all exposed to gluten we all will engage in this fight but very few would develop problem with that so this is an apparent Academy because you read out there google or books and so on and so forth that we will be a sting that a species with we don't eliminate gluten from our diets and this is based on our you know discoveries the gluten is structure for everybody however again very few will lose this battle and very few will eventually got in trouble if we consume gluten for long period of time and other milestones that really change dramatically the landscape is the diagnosis of seeded disease now we have unbelievable tools this blood test that they really are red flags they give great level of confidence if you have a problem their sensitivity I to identify celiacs no question or specificity to identify only celiacs and not been falsely positive people they have other problems other than see the disease is almost unparalleled in biology it are formidable formidable tools and and this is a great arm you know you know a tool that we have in our toolbox really to make the diagnosis see the disease as a screening what we are going from here where is the next step well these are the next step that we are looking for diagnosis algorithms to make sure that you are absolutely adamantly sure that you're dealing with silly disease without doing procedures that X quite invasive there is the endoscopy in custom biopsy this was a dream not long ago now is the reality I'm going to talk a little bit about this that is the most mind-blowing I still can't get you know my arms are out this concept I to predict who's going to develop see the disease and now we have the way to do that and then we're going to touch a little bit about this awesome test and microbiome interaction I'm not going to talk about this because I don't even know how to pronounce it so forget about that a lot of milestones that we reach in 2005 was amazingly uh conceptualizing alternative or integrative treatment to the gluten free diet this was unconceivable until 2005 I don't have to explain this this pretty simple here I just want to you need to love what I just said because this is not simple because I don't understand myself this but you look at these yellow dots here one to ten these are all steps that we didn't know until 10 years ago that are the chain of events there leads from the introduction of gluten to destroy the intestine characterized City disease and each of these yellow dots is a possible point that you can stop this chain of events so that you don't lead Suseela disease what we do right now we use step number one I do not eat gluten that's the only thing that we know how to do it but all the others are pure theoretical steps one that I want to really focus and is step number two in other words to stop the permeability of the gut by stopping this capability at zomling to open these gates and make the gluten to lick from outside here and cause all this because if you can close this doors everything downstream is becoming material because it's not going to happen so that's pretty much we've been working on for the past five years and this is again because now we have the understanding both through the genetic zone and also to clinical studies that this leaky gut is a big deal it's involved in many conditions and again this is by far not a complete list of conditions for which it's been clearly demonstrated that intestinal barrier function is jeopardize it doesn't work anymore so a master schizophrenia asthma copd and you go down to the least tumors metastatic disease you name it okay so now we have a way to measure zhanlin in the blood of people and interesting enough both and people with see the disease and type 1 diabetes the amount of zonin is much higher than normal people there's down here ok so that means that definitely there's something wrong in the production of zonin that is exaggerated in people who had immunity so back to the recipe with three ingredients if it is true that each of them it's absolutely necessary meaning genes environment and this impairment that in mucosal barrier it is also true that if you take any of the three out of the question you should prevent out immunity take the genes out is is a theoretical proposition because there are too many if they are still around they must be imported we don't know them all so that's not the proposition eliminate the environment the trigger is a proposition that it supplies only for cedar disease because we don't know where are the triggers for the other immune diseases what about if we correct this impairment music mucosal barrier in other words if we fix the leaky gut and leave everything beyond can we treat our immune in that way and once again silly disease came to rescue because we develop a a blocker inhibitor of Donnellan let's say going back to the peril of the key let's say that zonin is the key we develop a sort of wax that goes in the hole where the key needs to go so because you can't engage in this all this food ores cannot be commanded to be open so you prevent your dominant to really make this intestinal leak and we use these molecules and now is in clinical trials in people we see the disease so these are people that eventually been diagnosed with C the disease and blindly are given gluten only making them sick or gluten plus this zoning blocker and the question is can you prevent the symptoms to come if you rather to put these people on gluten-free diets you let them eat gluten but make gluten not coming through because you block the zhanlin are you guys still with me you met better than my students what the heck all right so this is the sum of almost 800 people 800 people that got this blocker in yellow are the people that got gluten only in blue are the column people that got gluten plus this zoning blocker and these are different symptoms of different trials many GI symptoms the message here in other words they refute and gluten by itself as a specter you are in trouble in deep doo-doo if you are got gluten plus this inhibitor most of the symptoms are you know highly reduce or totally ameliorated so proving that indeed if rather than take google out you fix the leaky gut you achieve the same goal now I can't conceptualize enough but importance the outcome of what we're doing here my cell number five this by far is the most cool and unbelievable part of my chat so forget about what I told you so far this is it we were absolutely convinced that you were born with see the disease so in other words you're born with the genes you eat gluten it's destiny there is absolutely nothing you can do about it and we were convinced then when the two come together so when baby food is introduced that's when the outer mean process started now some folks lose this battle right away and develop symptoms like you know being a little kid other people they lose this battle in 20 30 40 years and develop you know see the disease as adult by the way how many you guys have seen the disease alright how many you guys develop see the disease after that you turn twenty three forty I stop there because otherwise never figure out how old are you I by the way I see you know the ladies hands decreasing you know when increasing the age so you're not being honest there but any so we did a study that was kind of interesting study with total different purpose in which we took 3,000 healthy adults and we followed them for 50 years they are healthy we reasoned that since 1 percent of these folks have to have seen the disease that's the problem in general population so 30 them has silly disease and we want to see over time how they will develop symptoms we were mesmerised than in this group of people see the disease double every 15 years one in 500 here one in 250 here 1% here there are people they eat gluten for 56 there are two ladies for 70 years they were eating gluten no problem whatsoever and that's something up with them they lost that capability tolerate gluten and they develop see the disease so yes you need genes yes you need gluten but that not sufficient to lead to our immunity so the question is what are the tricks that these people they are genetically destined at least we thought to develop silly disease they use to really tolerate what is the undisputable trigger outta memory and most importantly what happened to them they caused the loss of capability tolerate gluten and develop our immunity answer this question will be the only Grail of primary prevention of God knows how many diseases so there are the list of the possible causes and again I don't have the time to go through all of them but this here particularly the change of what we call the macro biome the now it's becoming buzzword seems to be extremely important so let me let me try to conceptualize something that's quite difficult we decide because we're at the big dog on a planet Earth that we are the most sophisticated machine around I don't know if you follow about the human genome project that all the genes would that we have been you know resolved and so on and so forth my self-esteem went to the bathroom when I realized that we are you know genetically rudimental we're made by only 25,000 genes that's all a warm in the wine that we detect in elementary school has 90,000 genes the planted gluten under 50,000 genes were only 25,000 genes and 99.5% identical to chimpanzees I love sympathy I work with them can work it could talk about politics or you know the weather here they do not respond so how to explain the complexity humankind the only way is that we have to consider this parallel civilization that comes to us when we're born and will leave us where we die that is this complex community of bacteria the most complicated living in the gods that we complexin called microbiome and in the totality produce a hundred times more genes that we do so for the past three years of being preaching up you know around and being crucified head down this concept we are really made by two genomes the human genomes that were born with that will never change that we got from mom and dad that is as defective genes that would make me a risk for City disease or brain cancer or prostate cancer or Alzheimer when go away but the beauty of this is that the fact that I have this doesn't mean that I will develop it if I do or do not depended on by the second genome that we have there is the microbiome change all the time that if we're lucky we got from our mothers because if this microbiome live in peace with my mother most likely will believe in peace with me as well because I have similar genes as she does so if I'm born by vaginal delivery I have 3 4 3 4 less chances to develop see the disease if compared to c-section because if you're born by c-section your risk is much higher and the reason why is because all-comers bad guys are good guys from the hospital for whatever you know you are will come in from the skin of mom and so on and so forth so I'm going to skip this because it's too complicated we did the study to prove that the microbiome is important by taking a group of infant neonates I reached for cedar disease because some of the members of the family had it and we follow our time and we ask ourselves does the microbiome really has to do with anything that happened these kids I if they develop cedar Denise or not and the answer is yes and what we realize a very complicated concept that I try to make simple is considered human genome as a piano with twenty five thirty thousand notes one for each gene these notes will not give any sound unless somebody sits and play the piano and the piano player is the microbiome so why the piano would never change and if I had 300 notes that if their stroke they will play the acidic music you can't read them that's a very expensive piano but the microbiome the piano player changed all the time and depends you who sits the piano you have different music so if you have Elton John for example they can touch 200 of the 300 notes despite that you have the genes the the song silly disease will not be played but let's say that you have an you undergo two pregnancy you go to surgery you have any stressors in other words any or you take a trip somewhere anything that can change your microbiome now rather than Elton John maybe there Rachel's is sit in the piano he can touch all 300 notes and you play the song see the disease at any age this is what we call epigenetics and how do we notice because we can listen to the music so now we have the capability to listen the music that technol is called metabolome so if I here in pop music despite that I'm genetically at-risk I know that I'm safe because the good microbiome is sitting there but if I all of a sudden I hear Jets music I know that the wrong speed on a player is sitting there this guy will lead me to see their disease is that fantasy no no this is the reality this is again this pure cancer study these kids develop CD disease these other kids develop type 1 diabetes both of them months before that they lost tolerance to gluten that's changing this metabolite they picked and then dropped a few months after they dropped these people their loss tolerance and that develop our immunity this is a handful of kids imagine if we can extrapolate the big numbers what that means that we have the capability to predict who will down the road develop see the disease type 1 diabetes Alzheimer breast cancer you name it and then manipulates the microbiome so that the music will go back to the friendly microbiome that would be played that is what we're trying to do right now it's mind blowing if somebody will have told me three years ago that that's where we're going to do in the blood in the lab nowadays I would say where are you smoking because I want a piece of that as well so the real up and that's that I believe the Philosopher's this Institute I was mind-blowing to learn what these people they do for living the best way to predict the future is indeed to create it I'm going to finish up I have five more minutes or are do or not know I started at 6:10 so I'm taking right but we have guys disclaimer either we go with 10 minutes of question or we go 5 minute question I wrap it up okay five minutes a question okay so bottom line we learn that cedar disease is all the tip of the iceberg this is the trend of the diet in the past ten years this is low-carb fat-free gluten-free less than a hundred million dollars of of market in 2003 2004 from 2008 over this became by far the most popular diet in the United States by 2014 ten point two billion dollars in sales who the heck are these people they go google freak there is a fad factor for sure no question about that it's lady gaga go gluten free because she was losing weight or you know opera wants to cleanse their body there are a lot of people who follow this is this right wrong I don't know for me as a physician I want to make sure that people are feel healthy and if going through the free they feel healthy go to go for it there is no question about this but definitely there is a fat component but cannot explain all this the reality of the story that the gluten-free diet consumers can be divided in people they are gluten free for medical necessity and the one day occasional consumers that you know they feel better when I google the free from the medical necessity they are the celiacs the at immune disease the wheat allergy that is a relatively small number and then this third you know new kids on the block that we didn't know that it's called non-celiac gluten sensitivity or spirit or gluten sensitivity very interesting this is the definition we don't know too much about this it's by exclusion criteria because we do not have tests on this so in other words if you do not see the disease and with allergy and you feel better gluten-free if you feel sick when you drink reduce gluten you are called gluten sensitive as much as we know right now and decide the typical symptoms stomachache eczema headaches foggy mind I love this I try ghulam free my mind's remain foggy so it didn't work for me fatigue diarrhea and so on and so forth so bottom line this is what is the current classification you can have an atom unit reaction to gluten so you have see the disease an allergic reaction weed ology or this a third animal here is called gluten sensitivity we have tests for the first two we do not have tests for a gluten sensitivity are validated yet but people are working on it am I going to finish up with the most controversial question about gluten sensitivity what gluten has to do without is my schizophrenia there is a lot of stuff that's going on there and again I'm not going to tell you about this well you asked me the question I will answer okay and finally you know the major milestone how much gluten is too much in who has been dealing with gluten for a long time know that this has been a milestone in August 2003 13 finally the Food Drug Administration declared that 20 parts per million is the safe threshold for people that consume gluten free products because they have a Google related disorders now I I wrote this book that will come out in May 2014 it's called Gouda freedom what you heard and more will be in there you know if you really are tackled and tickled and curriers about what I just said you're going to find much more in there it took three years to write it and I'm still you know monitoring this but again what I told you in 47 minutes it is 17 years of a constellation of failures and what you heard are all the few successes now I am the ambassador who did all this the real players are the number of individuals have been working for me for many years they are totally dedicated to make your life better and that's the model and that's the the purpose of our Center it was it is and it will be thank you so much questions if we want to make this efficient ma'am a quick question a quick answer so we can really rock and roll if you have a gluten sensitivity can you develop Crohn's disease um there are comorbidities with celiac disease and gluten sensitivity without inflammation like Crohn's disease you can but it's not that it's very strong for example we see comorbidities between celiac disease and diabetes they're much stronger or silly this is a Shimoda the reason why you can develop clones by having gluten sensitivity people believe that you create this studied inflammation in the intestine and if you're genetically predisposed to develop Crohn's as well that chronic inflammation may instigate and bring you over the edge and make you develop groans thank you so much over there what do you think the relationship is between genetically engineered wheat and previous wheat have you done any studies with that I'm not an agronomist so I have to rely what my colleague agronomist and they've done extensive studies and again this factual there is no major change in grains in the past 50 60 years so the epidemics that we're living is more due to a total change of lifestyle we use much more antibiotics I mean we use mild biotics at the wazoo and before there were discovery we did not we traveled real-time from one corner of the world and the other and we are exposed to different bacteria we eat differently I you know when I was a kid that was telling Ken I used to eat strawberries in July and August and they came in to all sides all shape all colors now are the same sides the same color 12 months a year you know you wonder what is doing but to my guts so more than the genetic engineer greens I believe that is the total environment that is driving this epidemic of immunity diseases all the way in the back at gentlemen the earth no you you yep they were saying New York time articles earlier this year by Moises Velasquez and he was talking about out to immunity and glutenin and he make the point that it seemed like the intestinal bacteria seemed to determine if you're going to see gluten as a food or saw or as an enemy and my question is are there any Studies on humans or animals changing the bacteria in the gut to see if that makes a difference in the event of gluten sensitivity up okay so now then we understand a little bit more in the microbiome I can really make you nuts smart thin fat and sensitive to gluten by changing your microbiome if you were a mouse I can do that nobody has done this in humans but all this to say again this you know really support the notion that we are really the component these two genomes okay yes ma'am uh-uh microphone is comic I have a thyroiditis Hashimoto's and my doctor who is sitting here today feels that if I went on a gluten-free diet that I could cure my Hashimoto's and yet I tested negative for celiac disease what is your feeling yeah I mean it's not because he's here she's here but you know it's partially correct you know and I'm respond with an anecdote a colleague of mine from UCLA call me up his daughter has elevated antibodies against the thyroid was in a preclinical stage the kids didn't develop a Shimoda yet and he looked everything in the literature and the destiny was that over time she will have the attack of the toroid and and loose you know the capability tolerate you know a to do have a functional thyroid so he asked for advice it said you know I read that you know gluten can eventually you know instigate an immune response they can't really touch any organ and tissue and I not in Toulouse should I put her on a good and free diet and the reason why was asking because he tests the kids for City disease was negative but she does policy for antibodies against climate and I said you have not introduced and in three months the auto antibodies went away now if you already have a Shimoda so part of the Europe immune I mean cells that make the Ormond are God that's the done deal you know you can't reproduce that cells because while intestine we can in the in the thyroid at least you know now until we find it you know a way to you know work up you know stem cells in the thyroid you can make the thyroid to produce more cells that will make the arrow moans but definitely again this is a long way to answer there is some realities now I want to make another disclaimer you know the gluten-free diet is not the panacea to resolve all the tyroid problems all the chronic fatigue problems all you know the stuff that goes wrong in the world you know these are complex diseases you know those our final destination like autism for example one of the paths then you go there is through the gluten you know problem those are the ones that will benefit the gluten-free diet but would be a mistake that is creating a lot of confusion and skepticism among traditional medicine if you say all of them will be resolved the gluten-free diet you know this is what we call personalized medicine there is a group you need to stratify to find the one stable eventually problem with gluten and those will be targeted by the intervention time for one last question last question all the way in the back this may be covered already in your book so maybe give it something away or taking something away and your assessment which tests do you believe is the best marker it be it blood or be it biopsy for cedar disease or for cedar disease well again um you know in the past the the paradigm to make the no CC disease was to fulfill five criteria you have sinus symptoms of celiac disease you have the antibodies test positive you have to have the actually I the genetic compatible you have to have the damage and it's lessons show the add immune attack and the symptoms they need to go away when you embrace and guru free diet eighty percent of people will CDC will fulfill all five criteria but there are exceptions there are people they have no symptoms and yet they have City disease there are rare ten percent of people they may have silly disease with negative antibodies I still am only more rare 1% but people that can have see the disease without have the Prophet HLA genes 10-15 percent at the time that we do an endoscopy we don't find the damage because either the deletion is patchy or it's too far for the endoscope to reach and we know well that some people on a gluten-free diet for months and months the symptoms will not go away so there are exception and basically that we propose and not be embraced by the scientific community the four out of five criteria will do it so if you have sinus syndrome see the disease strongly passing antibodies compatible HLA you can go on a gluten-free diet without doing an endoscopy if the symptoms will go away and the antibodies will go away on a gluten-free diet that diagnosis is confirmed even if without the endoscopy but you have to fulfill for our five right here gentlemen ladies it's been a great pleasure and have a safe holidays and thank you for coming

Channel: TheIHMC

Views: 107,165

Rating: 4.8660288 out of 5

Keywords: Gluten-free Diet (Diet), grain

Id: VvfTV57iPUY

Length: 57min 7sec (3427 seconds)

Published: Tue Jan 21 2014

Reddit Comments

[u/star_blazar]

Watching it right now. Very informative! Thanks for posting