Gluten Sensitivity and Celiac Disease - with Dr. Tom O'Bryan | The Empowering Neurologist EP. 61

[Music] hello everyone dr. David Perlmutter here welcome again to the empowering neurologists you know one of the great parts of my job is that I get a lot of books every day I get another book or a manuscript and it really allows me to stay up on the cutting edge of where we're going at least in terms of science along with reading journals this new book the autoimmune fix by my good friend dr. Tom O'Brien is really very very important because autoimmune conditions like type 1 diabetes celiac disease rheumatoid arthritis lupus etc are becoming more and more prevalent let me tell you a little bit about dr. Tom O'Brien the author of the book he's internationally recognized as a speaker and workshop leader specializing in the impact of both celiac disease and non-celiac gluten sensitivity he talks about celiac disease as an autoimmune condition and also now is talking about non-celiac gluten sensitivity as perhaps paving the way for autoimmune conditions in general he is the founder of the very popular website the dr. calm and he recently hosted the very impactful paradigm shifting online summit called the gluten summit a grain of truth they were 29 of us available on that gluten summit and I think it really helped push the needle in terms of raising public awareness as to gluten related issues dr. O'Brien is really what we call a Sherlock Holmes as it relates to understanding what's going on with chronic diseases metabolic disorders he is a clinician who has been trained quite in-depth in terms of the functional medicine perspective he holds teaching faculty positions within the Institute for functional medicine as well as the National University of Health Sciences and he is always a very well respected speaker at the various venues where I have seen him delivered terrific and for so we're gonna be talking again today about the autoimmune fix let's jump right in well welcome dr. O'Brien great to have you here thank you dr. Perlmutter it's always a pleasure to hang out with you and any venue well we're going to talk today about your new book the autoimmune fix and but I can't help but say that we're going to need to backtrack a little bit because you've done quite a bit of work not just on autoimmunity but also as it relates to gluten and gluten issues and I think there's some really nice segue there as I'm sure you will pave the way for you talk about in your title how awesome unity may be related to why people generally feel sick why they gained weight why they feel tired and let's first just do paint the broad strokes about what autoimmunity is and then we'll take it from there in terms of its prevalence and what then we'll explore what may be causing it and ultimately what we can do about it you bet you bet so autoimmunity is when your immune system is attacking our own tissue and historically it's been considered to be an immune system that's gone crazy like girls gone wild this is an immune system that's gone crazy it turns out that's not the case that mrs. patients your immune system is the Armed Forces in your body it's there to protect you there's an army and Air Force and Marines a Coast Guard a navy we call those IgA IgG IgE IgM there are many different branches of the armed forces to protect you what happens when your immune system gets activated the vast majority of the time it's trying to protect you from something and the question is what is it trying to protect you from and why is it attacking our own tissue and in the book we go through this in detail the common mechanism is called molecular mimicry and what that means is that if we get if you eat some raspberries that have a little white fuzz on them and you don't really notice the white fuzz but if you've taken some bacteria that's a little more than our gut can handle and some of that bacteria gets into your immune system to the bloodstream your immune system gets activated to fight that bacteria to protect you it happens hundreds of times a day every day so the way that works is that the immune system targets what that bacteria looks like it has a signature like a protein signature and the immune system has this army of soldiers going everywhere in the bloodstream looking for that signature let's say it's a vest that's got a red stripe on the best and it's a protein signature well anywhere it sees a red stripe on the best it's going to fire its chemical bullets anywhere it sees that protein signature turns out that so much of the protein signatures of bacteria and viruses and molds and fungus some of the components of that protein signature are identical to the protein signature of our own tissue that's why if you go to a dentist often will recommend antibiotics before they begin because when they work on your gums bacteria can go right through the damaged gums into the bloodstream and a very common one is called streptococcus streptococcus has a protein signature that looks a whole light a whole lot like part of our heart and so to protect people from heart problems or complications after having dental work done you take antibiotics to kill any bacteria that gets in there because the streptococcus has a red line on the best that looks just like the heart tissue so that's the concept there is no peer-reviewed evidence that taking prophylactic antibiotics at the dentist is effective at all and reducing risk of bacterial endocarditis interestingly enough but so how do we get into this situation where our immune system has issues and discerning between friend and foe what are the factors are the genetic are they environmental are they factors over which we have control certainly our genes determine what our threshold is that if you know if you pull on a chain it always breaks at the weakest link you know it's a one in the middle of the other energy or heart your brain your liver your kidneys wherever the weak link is that's where the chains going to break so if you have genes where the weak link is in your brain and what you want to do is don't pull on the chain so hard or else you may have brain symptoms well I learned from you so many years ago the primary full on the chain of the brain is inflammation where's the inflammation coming from is the million-dollar question so if you have genes that make you vulnerable your threshold might be lower in a particular area you don't want to pull that hard on the chain but what is it that triggers the immune system to go after self to go after our own tissue it's the same mechanism as why some people have noticeable problems with wheat and other people don't it's called a loss of oral tolerance wheat and I'm use wheat is the example and we talked about it in the book quite a bit wheat is a minor irritant it's an annoyance to the immune system you know our bodies don't say every time we take a bite of bread or eat a roll our bodies don't say oh my god this poisons coming down we have to address it but it's a minor annoyance so the immune system screens it says oh that's not a big deal let it go it's fine and there is not an immune response however there are so many toxins that were exposed to every single day of our lives that our immune systems have to protect us from it's in the water it's in the food we've said in the air that we're breathing there are just many many many toxins were exposed to every day that our immune systems become hyper-vigilant they become overactive trying to protect us from the chemicals in the black fairies you're eating well blackberries are good for you but if they're not organic they're likely going to have these chemicals that would insecticides and pesticides that your immune system is going to try to protect you from or the rice that you're eating may have arsenic because the water dripping down into the rice fields is full of arsenic so our immune systems are constantly trying to protect us they become trigger-happy and once they're just overwhelmed it's a hyperactive immune system trying to protect you now even the minor annoyances are more than the body's going to take and your immune system says no you're not coming in now you make antibodies to wheat and once you cross that line and you're making antibodies to wheat we know at this point it's a permanent situation but the mechanism in answered your question dr. Perlmutter the mechanism is an overwhelm of so many toxins that our immune system is trying to protect us from we lose and in the example of wheat the loss of oral towers of Tolerance you spend a lot of time in your book talking about the important role of the integrity of the gut lining and how permeability of the gut lining plays a mechanistic role in inflammation but also in autoimmunity can you take us through how a permeable gut how we get there in the first place but how that then relates to lack of tolerance how it increases risk for autoimmunity you bet you'd bet once again I'll use an analogy that I give to our patients and mrs. patients your intestines are a tube it's 20 25 feet long starts at the mouth goes to the other end via and if you think of that tube like a doughnut and if you could just stretch out one big long doughnut and when you look down the hole of the doughnut you swallow food down there too it's in the tube it's not in the body yet it's in the tube the proteins and the fats and the carbohydrates they have to go through the walls of the tube the intestinal lining to get into the bloodstream well the tube is lined with cheesecloth and just like your grandmother when she was making gravy you know she pours the gravy into the cheesecloth and the liquid comes out the other side but all the clumps stay on one side the cheesecloth in the intestines only let really small molecules come through that's the job of the cheesecloth so that no big molecules can get through into the bloodstream when you develop intestinal permeability and slang term is the leaky gut now you get these larger molecules they get through the tears in the cheesecloth they're called macromolecules big molecules and the immune system says what's that in the bloodstream that's not something that I can use to build new bone cells or new brain cells or new nerve hormones neurotransmitters I better fight that and your body makes antibodies to that mackeral molecule to protect you if that ain't the mackerel molecule that got in is for example beef now you make antibodies to beef now you can develop a sensitivity to beat or to mushrooms or to bananas or to any mackerel molecules they get through when a patient does when a doctor orders a 90 food panel to see what foods are you sensitive to and the results come back and the patient says oh my there's 20 or 25 foods and they say oh my god that's everything I eat the answer is well of course it is your immune systems trying to protect you because you've got intestinal permeability right let's heal the gut let's heal that lining wait six months and check again now they're sensitive to two foods or maybe three and those are the ones that they have to stay away from so it's the tears in the lining that occurs the tears in the cheesecloth that's intestinal permeability or the leaky gut and there are many many things that can trigger that unfortunately the most common one I think that doctors forget about is the actual environment of the gut if patients have been eating the wrong kind of foods for many years and haven't put much attention taking care of their gut the environment of the gut the microbiome is going to be altered it's out of balance and this is the main reason why celiacs when they go in and gluten-free diet they get a little bit better but they don't get healed only 8% of celiacs heal on a gluten-free diet it's because the environment of the microbiota in the gut is a dysfunctional environment and causes intestinal permeability all by itself so you can have a squeaky clean diet as you learn from your doctor what to do but if you don't also begin rebuilding the microbiome for a healthier microbiome what you've got is the residue microbiome of when your diet wasn't as good as it is now well that said you know there's certainly a push that I'm sure you've appreciated for people to be very aggressive in terms of repopulating the gut with a wider diversity of organisms hence the exploration of things like fecal microbial transplant as a an actual intervention or treatment for autoimmune conditions certainly those that relate to the gut but even considering things in other autoimmune situations like type 1 diabetes and celiac disease so how what are your thoughts about that that notion being as aggressive as fecal transplant to target autoimmunity you know in the topic of fecal transplants I'm no expert I but I can tell you I've read some of the studies and they're extremely impressive in the short term results that people do a lot better a large percentage of the people do some studies that I've read 60% 70% of the better have 70 percent of the patients will have noticeable improvements that are substantial and some studies higher than that the discussions that I've read talk about the uncertainty of fecal transplants because of the viruses that are also included that are not screened out and no one knows what happens long term as a result of a fecal transplant terms of viruses that we may be exposing people to that made their home in another person and they found we might say a commensal environment the viruses learned how to live there and not take the hosts down or the hosts learned how to allow the viruses to be there it may be different in a transplant so my personal opinion is that a fecal transplant may be a last resort to enhance function but not a first option mm-hmm now you talk in your book about predictive autoimmunity can you walk us through that meat what that means that term oh that is just such a magic tool to use once we understand it I'll give you the example that was the landmark study that introduced me to it this was in 2003 dr. Melissa Arbuckle an MD PhD she went to the VA and she looked for people with an autoimmune disease systemic lupus erythematosus Lucas she found 132 people with lupus in this one VA Center now if they're in a VA center they're veterans if they're veterans they were in the Armed Forces if they were in the Armed Forces they had their blood drawn many times when they were in the Navy or the Air Force healthy Navy personnel many times over the years before they ever got sick and what most people don't know is that the government's been saving and freezing that blood since 1978 they've got tens of millions of samples of our service people's blood well dr. Arbuckle knew this and so she went to the VA and asked for permission to look at some of the stored blood of the currently diagnosed lupus patients when they were healthy in the Air Force or in the Navy or the Marines she received permission and what she found was that every single lupus patient had the antibodies that were attacking the tissue the antibodies were elevated years and years and years before they ever had a symptom which makes sense because if you have elevated antibodies you're killing off tissue right so if you have a normal amount of antibodies you're in the normal reference range you're okay but when you have elevated levels of antibodies you're killing off more tissue than you're making and so there's a deficit that develops she found that these people had elevated antibodies to lupus there are seven different antibodies all seven them were elevated the average was I think it was seven years most of them it was nine years but the average was seven years before they ever had a symptom they had these antibodies elevated that was in 2003 well immunologists all over the world said that's a brilliant idea let's follow that so they went to blood banks and got blood of patients currently diagnosed with different autoimmune diseases and they looked to see for each of these autoimmune diseases where the antibodies elevated beforehand and they found yes they were so there's so much data on this now that immunologists have developed what's called the positive predictive value the PPV if you have elevated antibodies for example to thyroid TPO antibodies especially postpartum you have a 92% positive predictive value you're getting Hashimoto's thyroid disease within seven years if you have elevated antibodies to a common yeast in the gut called Aska sacrum Isis or BCA if you have elevated antibodies to ask you have almost a 100 percent positive predictive value you're getting chromes within three years and they've done this for many different autoimmune diseases so the benefit to this if you do a screening blood test for those that consider they may be at risk of developing an autoimmune disease if you do a screening blood test while you still feel fine and find that you have elevated antibodies it gives you a window of opportunity to say whoa why is this happening doctor and your functional medicine doctor or your comprehensive healthcare doctor will say well I don't know but let's find out and that's when you dialed down why is my immune system attacking my own tissue is it food sensitivities is a bacterial exposures is it viral is it toxic chemicals so but you don't know to look and explore if you've crossed the threshold of oral tolerance unless you see you've got elevated antibodies to your brain I did this test on myself back in 1997 when it was research only and I found that I had elevated antibodies to three different tissues in my brain myelin basic protein that's what causes MS as Eleanor contributes to MS is elevated levels of myelin antibodies cerebellar peptides which is why elders can't dance up and down the stairs they can't quite control their balance as well any longer and ganglia sides which causes the entire brain to shrink I had all three of these antibodies elevated no I think I was 4045 a triathlete in what looked like really good shape I was scoring in the top 10% of 30 to 35 year olds in triathlon so I was walking tall and feeling like I was a healthy guy but I've got elevated antibodies to my brain so I called the lab our good friend dr. Virani and I said what's this this is a mistake and he said no it's not I said do it again he said I did we nose you we did it again sorry it's accurate and that's what got me into this entire world of really looking at predictive autoimmunity that I had oh I had a window of opportunity to say something's not right in my body I feel fine but something's not right I'm killing off my brain I'm slowly killing off my brain what the heck is this and that's when I found my sensitivity to gluten was much more severe than I thought and to Dairy I think that was it for me was lutein and dairy those the two main ones now the antibodies to my brain I checked them twice and they're down to normal levels which I'm very grateful but had you not known you wouldn't have made those interventions and you wouldn't have realized this improvement in your laboratory studies and pave the way for better health so you know I think that's really one of the fundamental points of your book and that is that I mean there's one part you talked about doing an assessment by just looking at your face measuring how high your forehead is and being able to predict various things is based upon some morphological issues but I think your point is very well taken that you know we're at a place of not just predictive genomics but using various biomarkers in a predictive way to determine risk for certain things you know it's been over the years academic all right you're at risk for X Y or Z I think we've crossed the threshold now of saying well you are at risk for certain things but here's what you can do to offset that risk so we're getting away from the deterministic model and getting into the you know this is a predisposition that you may not necessarily fulfill so I think it's very well taken let me let me just pursue the glueten part a little bit further if I could because I think a lot of people who know you know you from your work with gluten the gluten summit and your your keen interest in gluten recently as you probably know the BMJ published a report basically concluding that as it was spun and mainstream of current media that going on a gluten-free diet is gonna kill you of heart disease if you're not careful the conclusion was I think extrapolated to a significant degree by the mainstream press I don't think that's what the authors had intended but that is certainly a conclusion I think that many people latched on to after they read these reports so what was that all about and what can you tell our viewers to bring some rationality to this whole idea well that's a very important question thank you so much for asking it and yes I saw that study and there is some validity to the concern but the mainstream press has taken a whale over track I'll give you an example in the largest study ever done on mortality and celiac disease this was published in 2009 in the journal American Medical Association they looked at 39,000 celiacs 39,000 and they found that there is an 86% increased risk of dying in the first year after diagnosis of celiac disease from cardiovascular problems heart attack or stroke 86 percent increased risk after diagnosis in the first year for adults compared to adults of the same age same socioeconomic class that were not diagnosed with celiac disease how is that possible you get a diagnosis of celiac what's different the only thing that's different is that you go on a gluten-free diet there's no drugs that are recommended to people perhaps for some of their symptoms or may have been but but the treatment the known accepted treatment for celiac diagnosis is going to gluten-free diet and in the largest study ever done they showed it gives you an 86% increased risk of dying within a year of cardiovascular disease well you don't develop cardiovascular disease in a year you must have been developing your pipes plugging up or whatever the particular issue is for you why does this happen what makes you more vulnerable after a diagnosis of celiac it's that the microbiome of someone who has been sensitive to wheat for years has been so altered people Doc's don't address that that's the first thing and we'll get back to it the second thing is that for 78% of Americans this study was done with Americans and I would say in the Western world it would be accurate or similar 78 percent of the prebiotics in the Western diet come from wheat it's the arabinose islands and we've seventy eight percent comes from wheat so when you take wheat the diet especially if you go to gluten-free products they have no prebiotics in them there are white paste you know there's nothing wrong with having a blueberry gluten-free muffin every once in a while as a treat you know or a piece of pie once every few weeks that's gluten free who cares I mean that's fine but some people are substituting their regular bread or pasta with gluten-free pasta or gluten-free bread every day and so they've just removed 78% of all the prebiotics that we're feeding the good bacteria in their gut the probiotics so one of the critical components for all of our practitioners to recommend and for all of our listeners who are going or are gluten free is to focus on building a healthy microbiome you have to replace the prebiotics that have been taken away by eliminating wheat from your diet that's a critical component and I believe that's probably a contributor to what the authors of this study that you're referencing discovered as a matter of fact it's exactly what the authors concluded it didn't make its way to the mainstream press but the authors actually concluded exactly that that those individuals who go gluten-free generally overall consume less fiber and we know that fiber is well beyond this inert stuff to bulk out the stool it is nurturing the the microbiota so you're exactly right so you've had an interesting quote and I wanted to bring it to our listeners a viewers attention base hits win the ballgame and you know we're we're looking for the homerun general you know what is the magic pill but I think with that statement base hits win the ballgame you really focus on the fact that it is a multitude of small interventions that cumulatively recreate the playing field and allow people to to make to move forward and recover and I think you know it's similar to what doctor bredesen has talked about in his 36 points to reverse Alzheimer's disease in the book the end of Alzheimer's disease so I think you know it what you're saying is it's gonna take a little work and there's no wonderful pill today to get you through your autoimmune condition whether it's celiac disease or type 1 diabetes or rheumatoid or or lupus or or MS for that matter that it's it's a concerted effort but you did a heck of a job in your book really giving people what they need in terms of every step of the way what is the lifestyle like what is the diet like what should you anticipate moving forward so I want to thank you for joining us and I want to thank you for writing such a an amazing book I think our viewers perhaps more than others recognize that autoimmunity has become a big deal so your book is very very timely and certainly well written and very user friendly well thank you very much thank you so much it's a real pleasure to be with you and I think that the concepts of autoimmunity the understanding of autoimmunity is a 101 I demand it as a 101 for every family you know in when when you go to college the introductory courses are 101 understanding autoimmunity is 101 for everyone for you and children you've got to get this concept down so you learn how to protect yourself because the environment around us is becoming more toxic and more inflammatory and it's manifesting with all the numbers of the different diseases so this book is our attempt my attempt to bring everyone up to speed to ask the right questions of your doctors and to stand up with your politicians clean the water clean the air the things that are critically important so thank you very much for the opportunity to speak with you it's been great and in terms of cleaning up I will let our viewers know that you actually had a couple of graphs in your book from the work of dr. Stephanie Senna who talks about how glyphosate or the active ingredient in roundup is threatening to the human microbiota the microbiome and how that might relate to autoimmunity based upon her statistics as well so we were I was pleased to see that make its way to your book and again you know out to the public venue well thank you so much dr. O'Brien we will talk soon and best of luck thank you so much well again the book that dr. O'Brien has just put out is called the autoimmune fix a terrific book and I would encourage you to take a look at it you know especially in these times when autoimmune conditions are becoming more and more prevalent likely because of the mechanisms that dr. O'Brien just discussed with us thank you for joining us on the Empowered neurologist I'm dr. David Perlmutter bye for now [Music] you

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Length: 32min 22sec (1942 seconds)

Published: Sun Feb 04 2018