Should We All Avoid Gluten? with Dr. Alessio Fasano

[Music] welcome to the doctors pharmacy I'm dr. Mark Hyman and that's doctors Pharmacy FA RM Acy a place for conversations that matter and today's guest is an extraordinary scientist and leader in the field of gluten dr. Alessio Fasano who I've known for a number of years and has been a huge contributor to our world of functional medicine helping us bridge the gap between well we eat our microbiome and chronic disease so he's a extraordinary physician he's been at the forefront of the field of celiac and gluten research he's now at Harvard he's the head of the division of pediatric astronaut gene nutrition at Mass General and professor of pediatrics at Harvard Medical School and he's basically leading a huge team looking at how do we understand celiac and gluten issues he's leading a group called the mucosal immunology and biology Research Center which is over 45 scientists looking at how do we translate the information about what we eat gluten our gut our leaky gut the microbiome and chronic disease it's pretty exciting work and he's written an extraordinary book called gluten freedom which I have you all check out all the proceeds for the book sales go to support celiac research and it's available in seven languages which is great so the topics he's doing now are pretty exciting one of them we're going to talk about which is this new research study looking at how our genes our environment our microbiome and our metabolites act to create a risk for disease so welcome dr. Fasano thank you Mark for having me now you're at the forefront of one of the most exciting areas in medicine which is this connection between what we eat the microbes in our gut and chronic disease particularly autoimmune disease and you know I started practicing functional medicine 20 years ago nobody even heard of gluten I was talking about gluten-free diets they're like what are you talking about people have to eat the worst food and now it seems like millions of people's aspire to be gluten free it's like an aspirational diet I'm gluten free it's kind of like kind of a badge of honor and now restaurants have gluten-free menus and and and the question is really there seems to be a lot of noise about it but where is the signal here and and we've seen a real increase in celiac and in the last 50 years and we're going to dig into your work a little bit in a minute but is the world overreacting to this gluten issue is it a fad or is there something there well definitely there is something there but it's also a fat component no question about that so it is an interesting journey that I witnessed first and as you were saying 20 years ago you know people didn't know how to spell gluten and so much so to find the gluten free you know this is good and free you know many him and again you know the the field really went far in the past 20 years thankfully I have to say because they didn't improve the quality of life for people that have to leave and flee from medical necessity and during this journey also we learn many lessons you know we moved from the concept that the only people that belong on a gluten-free diet are people we see a disease to the concept there are people other than celiacs death need to go gluten-free for medical necessity it's none celiac gluten said that's journey which you really helped pioneer the discovery of yeah no gluten sensitivity definitely is the last kid in the block and then with allergy and so on and so forth so really the field expanded and and and tremendously and with that our knowledge what Gruden does to us of course you know that went you know more than you know the step new medical necessity when people they start to think that gluten-free is good for everybody because golden can be talking for everybody and so on and so forth so again i think that there are some elements was more than we thought but not as much as some people face exactly so you know that that's the noise so the single is yeah there are two major groups you know some people they they need to go gluten-free for medical necessity either because they'd have an autoimmune response to Gruden like see the disease an allergic response like you know with allergy or they have another form of meal response that we still don't know completely non-celiac gluten sensitivity and then the other probably larger group of people that in basically free guide first lifestyle they have the freedom to do so but definitely they they may have you know that medical necessity like the first group well I you know I've been doing function medicine for twenty years and I would say one of the most powerful tools in my tool kit my tricks in my trick bag is people on a gluten-free diet if they have any chronic inflammatory disease even neurologic or psychiatric issues it's sort of an interesting thing and sometimes they do have antibodies sometimes they don't but it's sort of always a 1 to 3 on my list for trying something to see if it makes a difference and it's extraordinary how many people respond positively when they get off gluten yeah mark the the major confusion when you you go in such a heated debate believers versus not believers is that you know if you don't have the right premise you you clearly fuel a debate that should not be there to be honest with you so you know believers like you see the light at the end of the tunnel and realize that besides see the disease the other chronic inflammation that can benefit to going gluten-free diets what is the caveat here is the carrot is the knob believers they make the assumption that you know that is a premise that has to be based on the paradigm of cedar disease meaning that everybody going gluten-free should feel better because that's the culprit of the atom across the city disease what is the misunderstanding here in my humble opinion for both camps I have to say is that while the expectation is 100 percent of people we see the disease they have to respond to the gluten-free diets because we know that this is a fact there is the misunderstanding that the same apply to all the other chronic inflammatory sees my personal opinion that can be wrong have many people wrong as many times is that you know I am in a middle of this kind of you know two extremes in a sense that I really do believe that they are subgroups of individuals with other chronic inflammatory diseases including at immune diseases including chronic fatigue you name it I yes there may have gluten as the culprit but not all yeah so you know ideally and that's what I see this is gonna be the future will lie in terms of best case scenario in terms of best clinical practice is to identify very odd my markers that will identify this group of individuals in these chronic conditions that have gluten as the instigator and place them on a gluten-free diet yeah so I'll give you an example a while ago collaboration with some colleagues University of Maryland we found out there is a subgroup of schizophrenic individually yeah we end up to quantify a but is still an approximation the problem were talk about fifteen twenty percent now I mean those people often will have elevated any glide named absolute absolutely and that's how we identify them and they they have other out antibodies that then being validated later on like the anti tissue transglutaminase 6 there is a biomarker inflammation perennial the bottom line is I'm trying to say is if we have taken the you know bold statements that all schizophrenic individual will benefit the Gulen free diet and do a trial in which you take on dress schizophrenic and put all on a gluten-free diet and only do is twenty out of hundreds will respond will go to work right because you know you know the efficiency of 20% efficacy you say I told you so it doesn't work if on the other hand you stratify the population find the subgroup and this is the heart of functional medicine I guess so in other words personalized medicine and you say well those have by mark is the anticline aren't about this the T 2 G 6 antibodies whatever this there tells me that there is a chance they will respond to the very light they put all the toys twos 20 you have a hundred percent F is exactly now I don't think that this is trivial thing consider we're talking about a devastating disease hopefully very often do not respond to intervention you give the life back to people and you may jeopardize you know that possibility if you know again you don't approach this in the correct way so this is a long way to say I'm not in the camp of the people they're skeptical that say it has to be only celiac otherwise gluten-free guys is not a business you should be interested but on the other hand I have to give a word of caution to not vilify treatment that can be extremely powerful and effective by placing everybody on a gluten-free diet and hope for the best yeah I think that's really important I want to unpack that for a minute because there's a couple of pearls in there one is that gluten can cause brain inflammation across a spectrum of different conditions from schizophrenia autism also see in a large portion 20% almost uh who have antibodies to gluten depression anxiety a DD I mean all these have been linked to gluten in the right person and one of the things that you published in 2003 was a seminal article in New England Journal which which I found extremely helpful because it mapped out the fact that gluten and celiac disease can be linked to over 50 different diseases so it can be linked to schizophrenia but it doesn't mean that all schizophrenia is a gluten problem or that all colitis is a gluten problem and I think that's the problem again in medicine is we think these conditions are uniform but they're not there's no such thing as schizophrenia there's schizophrenias yes and I think this is an important concept that you kind of elucidating with this personalized approach to identifying who's sensitive and the biomarker issue I think is important too because we typically in medicine they were trained that unless you have a positive biopsy of your small intestine that shows you have celiac then it's not an issue it's and I still see this going on and then there's the antibody studies and you know if it's very elevated I think people will agree that that's a pretty good marker for its ttg or any gliding any bites but if they're slightly elevated if what's normal what's optimal is there any normal you know we've had this conversation before but you said well if you have any antibodies it means you have a leaky gut it means you've been exposed to gluten it means your immune system is pissed off that's right so how sort of navigate that world is well again Ray's own if if we take the again the strong position of debate with right was wrong and we keep you know in the radar screen which should be our focus so what is the best thing that we can do for our patients so you know to improve the quality of life common sense would suggest you that this is all known for example if you look at the best drug on markets the best of all in terms of efficacy yeah bets Kison are you talk about 45 50 percent efficacy doesn't work on half the people that should have the paper so do and this is the best drug that we have on the market so we know already that this are not homogeneous population but these are those are about 30% and that's right so that's the background noise so if you if you honestly keep this in mind let's learn our number one we're not made it all equal mm-hmm number two we conventionally talk about diseases as final destination that can be common so your Crohn's disease can be similar to my Crohn's disease about how we got there can be very different so imagine the end result looks the same but the causes are absolutely and imagine that you then on that premise that I believe is not disputable because everybody will agree on that then you go to the next step and say and I have a bullet you know magic magic bullet II that can fix them all that doesn't compute so that's what you know drug development now is you know approaching the problem in that sense so if you accept that these are fara destination and you can get there in different way you also as a corollary to that statement have to accept that eventually treatment needs to be diversified right which is a radical concept what you're saying is that all diseases in a category are not the same so everybody with rheumatoid arthritis or colitis or schizophrenia are not the same and each one is a different treatment even though that looks the same at the end of the day and that's a functional medicine fundamental again I don't want to be philosophical or romantic here but you know you're just because I mean to say that you know the old physicians in other words the healers of 2,000 years ago they were focused on individual trying to put balanced by different approach philosophical religious a little bit of science and then we start to really be programmatic and systematic and then look at you know conditions as diseases so we shift before from the individual to the disease and conventionally we you know went to that path to try to be evidence-based to find the target to find the solution and so on and so forth recently and not just functional medicine that probably see this before then you know evidence made medicine but even you know the classical trained physician like me start to really appreciate that we should shift back to the individual yeah because that's the way that eventually you can have the best efficacy possible that's what William Ulster said right the father but exactly we should treat the person who has a disease not the disease that the person has absolutely and if you got in that kind of premise the debate is over you know there is no discussion that you know sure we have to have conventional you know approaches we have to be systematic we have to be have it in space but we also need to accept with humility and an humble approach that the magic bullet is not there so there is the lesson to be learned here that again there is a possibility of a subgroup of individual in any given category of chronic inflammation that can be treated with a gluten-free diet because maybe there is a possibility our challenge now is to find these people how to identify those people yeah and you know talking about you know gluten in the brain as you were alluding to we knew this for a long time and this is all those are not debatable even the people the most skeptical people will know because they do know that cedar disease is associated so the ones that everybody accepted with neurological symptoms and behavioral symptoms that underpin the possibility or near inflammation we know that you can have you know anxiety depression mood swings right you know because newer information and to the point and I was telling you there are blood markers in your information there that the most classical example is gluten ataxia nobody will dispute the existence walking around yeah there is inflammation cerebellum and your equilibrium is factor because of that the same by the same token nobody would dispute that silly disease can give peripheral neuropathy so inflammation of the peripheral of the nerve never seems and you know again by the same token I think that if now you go back and say what about people with depression but not silly disease or anxiety without necessarily disease or peripheral neuropathy not see the disease it is such a possibility because now again everybody seems to accept that you can have probably gluten outside see the disease yeah bye transition you need to accept the possibility then your inflammation Central Perk can affect people other than individual disease so I don't see you know too much of a dichotomy you know but there's there's an interesting distinction here with the non-celiac gluten sensitivity there's there's a mechanism he wrote about which is our ancient immune system called the innate immune system that can react to gluten and there's no antibody measurement - they're just measures just general inflammation instead of a very primitive sense part of your immune system and then there's the antibody part of your immune system or the adaptive part and and that is where we get celiac antibodies but the question is is there a way to measure this non-gluten celiac since that's like gluten sensitivity just looking at ranges of antibodies that aren't quote abnormal let's say your ranges up to 20 what if it's 15 or 16 or 10 is that a significant factor to look at mark my honest answer is I don't know and the reason why is because again we're still learning the pathogenesis and unsealer to the sensitivity I read I'm convinced because the cumulative evidence in the literature that we are dealing with an immune response that involves only the innate immune system and as you said this is the ancestral way that we developed to fight enemies you know it's when we deploy our army without thinking who I'm fighting because I don't know so I can't think about who are you customized weapons against you guys are antibodies and I just need to deploy it and get rid of carpet-bombing instead of smart bomb exactly and and again in that sense you will not find biomarkers low titer or height either that will link you know this inflammatory process to the disease and matter of fact there are several groups including ours they are looking for biomarkers and my sense is there is gonna be a multitude you were alluding to the first generation anti-gliadin antibodies they are present in 50% of people would not see the sensitivity but that's not a biomarker of you know reaction to gluten as we typically intend for celiac disease where you have out on the bodies this is after the fact so the innate immune responses go it's been activated you're fighting you have the inflammation and now what you see is a biomarker the consequence of this war I as you were saying the individual is eating the intestine got leaks leaked you know gluten fragments comes in an immune system does its job is under attack and something that is not supposed to be there and we learn about this against it so I think that's going to be a combination of several biomarkers it has to do with many of the functions that will lead to you know the inflammatory process yeah all right so I want to walk back historic a little bit because you know hundreds of years ago we were eating gluten we're eating wheat and we didn't see the levels of autoimmunity we didn't see the levels of celiac disease that we do now and you're here at the annual conference of emotional medicine you gave it a brilliant talk looking at how we kind of got here one of the factors have changed that actually are driving this level of gluten reaction and you know my wife now is in Sardinia I wish I was there with her and she and she has trouble eating pasta in America because she always gets a stomach ache but she said she's in Italy now and she does and I know they don't allow GMOs and all the other wheat is not Jimoh although they spray our wheat here with glyphosate at harvest which may have an effect on the microbiome but how do you sort of explain why we all of a sudden got this way what are the changes that happened that make people more susceptible because the gluten has always been there is the gluten different in the wheat we have is something else changed in our guts an environment like what this driving force you know again you know first of all some people believe that this was just an increase of awareness but we know that it's real and you know now there are plenty of evidence that you know this glutton religious orders are in on a rise and it's not an isolated you know phenomenon and every chronic flower diseases are on the rise you know allergic disease autoimmune disease disease like everybody's inflamed that's joint cancer heart disease you know adding an epidemiologist put their head you know hands on the fire say this we believe that that's the case and and the evidence are pretty strong so you know this is to say we're not really looking at an a weird isolated phenomenon that really it's good it's more in the contest of this epidemic sacral inflammatory diseases so why there is this epidemics what's going on here first of all the timeline that this epidemic is materializing is telling us that is not genetic mutation humankind that makes us more susceptible because that takes much much longer text generation it's not thirty forty years as we've seen in terms of timeline so most likely we're changing the environment way too fast for us to adapt and the example unit were you know mentioning about your wife and actually I hear this many time here in a lot yeah I hear this all the time say how come that I go to Europa benefind looks that I can tolerate stuff that cannot even look at when I'm the United States yeah definitely I don't think the GMOs is an issue because you know of course Europe in general a very strict regulation GMOs more much stricter than us yeah when you talk about grains like wheat there is no such right there's not such a thing but you know there are different ways that you can explain why the load of toxic you know peptides may be higher here than in Europe may be because of the dwarf wheat we use here they use difference no no no not even there because the cultivars are the same but you know the way that we manipulate grains can be different I'll give you an example that can be one of the many that I can give you to make bread you take hysts you take water you take the flour and you make your dough we as human beings we do not have enzymes to completely dismantle gluten in its basic elements amino acids what we do we is a partial digestion and what is left over this and adjustable fragments that can instigate inflammation we know that most of us can handle that no big deal unless you go to the extreme so if you eat a slice of 2 or pizzas it's fine but you've three pizzas it will be sick no matter who you are and this applies to anything in life of course even turkey that is good for you if you have too much you fell asleep and you know why so this process of unification so when you make the bread and dough I use East East F those enzymes they can completely dismantle these toxic elements in Europe bread is still made the old-fashioned this is an overnight process so you have 1012 hours that these enzymes can dismantle the load of this you know fragments not here the process takes two hours because now it's accelerating artificially yeah so you give only two hours to these enzymes to Gracie the lower so the grain is the same the culture what I'm saying you know no but but again the way that you prepare pasta is there are processes that you have to go through the education the drying of the past and so on and so forth yet again give less time if you speed up the process to make this right that's one the other is you know as you were alluding to pesticides we use pesticides here they are not allowed in Europe yeah and you know again that changed completely landscaping is now you can choose not a variable that can affect the way that we in terms of our immune system can react yeah or any given product and then it happened to be grain but it can any other product that can give you the same kind of reaction so and and you know I can go on with many other elements you know the water the way they're restricted so that make you know the environment the pollution in the air I mean there is so much and then of course the great unknowns we still don't understand because even here in the United States is not I'm a genius so you have pockets of places in which this phenomenon seems to be much stronger than out of pocket some ways so gotta be some environments of situation that we still poorly control yeah so sort of going back to that you know the the environmental factors have changed and I think you know you and your lecture you mentioned a lot of change that have happened that altered a different thing besides the food so there's the quality of the food how we produce the food all those things in terms of traditional methods it may affect people's sensitivity but you also talk about the changes in the gut microbiome and you know you you originally came into this through studying in cholera that's right now you're sort of coming back to it looking at wait a minute why are people so sensitive it's not oh you're sensitive to gluten let's get Jeff glued it's like why is this happening and and how is our change in our environment toxins stress diet antibiotics c-sections how has that led to this increase in autoimmunity increase in celiac disease and allergic and inflammatory disorders so if you really want to look systematically the environmental factors that eventually fuel in this you know epidemics now that you know again we agreed that this is where we have to focus our attention and not the human beings genetically speaking because again we didn't mutate in such a short period of time you you start to really question what happened in the past 50 60 years it was different from the previous generation where we didn't even have this epidemics and of course you alluded some of the factors so you know our lifestyle you know mostly we're living a rural lifestyle you know one or two generations ago so living you know vicinity animals cause a lot more microbes that's right a variety of but you name it parasites viruses you know but bacteria but there was a full exchange and then again we make again these are the convention that we are isolated Zyliss in terms of environment we are in a continuous sequel of life so soil animal human back to soil and and the waters you know we conventionally analyze them separately but there are a unit a co system yes and you know again if you believe that and you look just the human beings and make this statement we didn't change that much true but what about our soil what about our water what about our animals you know what about you know living in a crowded environment versus it you know a sparse environment you know how this changed the dynamic of what's going on and again you know now that we have tools that we didn't have before we can understand this continuous ecosystem what we exchange so the most important innovations are microbes yeah and microbes are interview part of what we are now we know that we're only one percent human right most yeah you know up genetically speaking that's that's definitely the case and you we are whatever we are because we evolved with microbes it's not that we talk him away sterile right that's right from Mars and then all of a sudden we've been exposed something never seen before we look and act and and and you know are shaped the way that we are because we co-evolved with this ecosystem now again that's you know when when when we ask ourself what kind of changes we made the stuff that's visible so the air is polluted now there is fog or the water looks dirty it's the low hanging fruit but problem not the driving force is this parallel universe that is instrumental for our health that changed dramatically microbiome so in other words you know this community that is supposed to come in orderly since we aren't want and stay with us until we die that has been completely revolutionized in its composition and function that you know I'm mesmerized how come that we are not making even more dramatic changes that we've seen so that means that there is some terms of adaptability but I can't emphasize enough that change in lifestyle from rural to urban introducing antibiotics you know for treatment infectious diseases introduce a new practice like the c-section which is almost 1/3 of all births now right well it depends because you know just was in Mexico for a meeting and I learned in a Mexican c-section is 60% of the population at 60 92 percent in Brazil so it's staggering absolutely and again welcome option checkup ABC well no you know Marc the reality the story is again you know a lot of hundreds of thousands of women's die because our birth you know exactly so c-section has been a tremendously important events in medicine when I symmetrical indicated but when the ob/gyn will prescribe the c-section so he or she can plan vacations or cash more money and or you know that you know the woman decides to go c-section for our own you know needs but not because a medical necessity I will suggest you know to think and think very carefully because you know again the plan of in grafting and growing the proper friendly microbiome has been planned for two million years to be done through vaginal delivery yeah well the baby absorbs through its mouth all the vegetables pollen eyes and and that is a flora that has been highly selective my mom to be genetically compatible with her and therefore with her baby the skin microbiome is not selected there are all comers so the operator in the in the operating room or the nurse or the anesthesiologist their microbiome come in there and may not be that friendly for the new baby there so and then of course you see more allergic to season asthma absolutely if you think about it three natal factors mums lifestyle mom's environment or perinatal like the c-section or antibiotic exposure or the way their you feed the baby breastfeeding reading or bottle feeding or postnatal all these name pinch on the composition and and function of the microbiome why I'm so obsessed at this first because as you said that's where I start you know my science from the very beginning was totally focused on understand how microbes they cross talk with us at the beginning my focus was on a single pathogen to understand how they can make us sick and then that knowledge you know move to the community and now the ecosystem that now we called microbiome but again we were studying this 20 years ago with tools that were ridiculous yeah compared to the ones that we have right now that now clarified the complexity of the matter yeah and we're just really at the infancy of this system most definitely but again it's giving us the opportunity even more to appreciate how singularly we are how different we are from each other how eventually you know losing tolerance develop an inflammatory process can be so different from one individual matter even if again we end up with the same disease you know it's interesting I treat a lot of patients with gluten issues and celiac disease and often I find they don't get completely better when you remove the gluten and then when I put them on a gut restoration program you know really getting rid of the bad bugs and putting in good bugs just simple function medicine principles which are you know not really that well established scientifically but we've been using for decades to just help normalize gut function then they get better have you seen that so we and others to publish that even if you are strictly gluten-free 20% of kids up to 40% of the dots they still have inflamed gut not because they cheats but because you know again there is no repair I don't know why most the design is because in averse and exposure to cross contamination other times because again there are situation which the immune system is hyperbola gent so if I have to say you know clearly I understand what's going on the answer no but again I would be dismissive if I will not consider this I / belligerent in this individual that are not able to repair them from the process to be totally unrelated to microbiome congestion function well it's also interesting you know the way I think about it is that the sort of the gluten is sort of the gatekeeper 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 because it's hard 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 one that discovered the molecular mechanism by which gluten can really make your intestine leak through the releases on this molecule that it's been manually that's right a link to a variety of the Nobel Prize for this guy you know people are still very skeptical so but any other bottom line is that you you know and you put together say well if if gluten is capable through some of these antigens but peptides to engage in a specific receptor that instigate the cells to release its own line and make the intestine leak then you know this is can be detrimental and harmful to everybody the answer is it depends actually the vast majority 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 antigen so 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 Gunda you eat you are genetically predisposed 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 really disorders so all this to say I would not cut our guys gluten as the villain in 21st century necessarily after all if you and I were here rather than jump from one tree 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 by the same token you know to dismiss completely the fact that gluten can be an issue for you know a variety of individual outside City disease that will be also to not see wood it's become more and more obvious yeah it's pretty it's pretty extraordinary see how this whole field is opening up and and you know one of the things we often were made fun of for decades is this idea of a leaky gut that you know basically the belief was that if you had a leaky gut you'd have you know sepsis and you died basically which means I'm overwhelming infection but you know this is sort of intermediate zone of sort 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 it's sort of it's like almost as a unifying theory of how we get inflammation so I'm fascinated how historical memory is lost during generations for example you know yeah I've called that amnesia whatever but you know when you know at the beginning the 90s we were convinced a silly disease was a big deal in United States the establishment really came after us big time you know you you you really miss the boat here we look for see the disease that we didn't find it so you know you you are not you know in the right direction and this to put that very model because the criticism were I'm much more harsh than that and again and their premise was on state of mind that was fixed on what was at that time the definition cedar disease young kids would be belly yeah area yeah and that's true and we don't see that we don't see that we see other stuff and you don't have to have any digestive systems zero you can be obese but that was not clear at that time and that's why we were highly criticized now in 2018 if you ask anybody nobody would question that silly disease is as frequent in the United States and in Europe but if you ask has been always like this the answer was like yeah of course we always thought so missed even the ones that were hyper critical same phenomenon with this leaky gut story you know again I'm you know I it's not that I was like a functional medicine doctor always tuning in us I came to this by you know chance by again doing this cholera vaccine and learning the color can make your luck 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 tie junction in intestine and the little connections and yeah these are little gates in between cells that we thought that were cemented so that no no things can come through and never cells not betray that's right it has everything that we negotiate with environment we thought it has to come through the cell and then we learn no actually there is a space in between cells 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 said it can't be that we evolved this machinery there just to get sick with this toxin from the blue cholera Vibrio probably learned physiology from us and exploited that possibility for its own return yeah and that's how I end up to you know discord zhanlin and I have to say you know with the story of the link you got are now half away compared to the story city this is over it goes the discussion over I say after way because even the establishment now of evidence-based medicine the hyper critical to our work that has been coming right here the general vein when we discuss all right track when your well you know again mark I again I am a an individual that not only I'm open-minded but I am the individual that you know I admit that you know science is a constellation of failures were very few successes and you need for those but I also made the science is not perfect you know 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 you know catch their ideology that's right because you know what is true today it will be garbage in three years we know that that's it's that dynamic so as a good scientist you formulate a hypothesis you design an experiment to challenge the hypothesis and you perform the experiments and then you evaluate the outcome then nine out of ten times is different to what you anticipated with your formulated hypothesis this brings to two kinds 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 sites where I'm going yeah that's the one in which your peers will follow you will understand what you're doing and the venture will accept you know the the approach yeah that you're taking because you know 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 mhm most of the time is dead ends so it's it's something that bleeds to not nothing very few times you got in what we call transformational science it is not something that you intend but by you end up to be in something that changed completely paradigm a way of the unintended consequences of your and that's what it's all of the scoring was all about when you got there to understand if you are in that hand or you do something transformation the only thing that you need to do is to seek and see if your peers can validate and reproduce what you've done or this was not reproducible the zone story now is highly reproduced a matter of fact I don't you know order the vast majority of what is the science in Zona nowadays we continue the middle schools component of the hundreds of papers they're out there all this to say that none on the dominant story but the story of the modulation of gap permeability with the identification of genes Takamori tight junctions the identification that you know lost of very function is the core many chronic inflammatory seasons people are coming around it's so powerful yet is a it's 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 the mechanist elites to that because this is a very complex machinery with very sophisticated functions and I was mentioned during the lecture that the structure this tight junctions is a still more redundant that that means it's a function it's a dear to us because where the redundancy means that you know we have back have a lot of backup systems the base in case something goes right I can tell you a great level of confidence that the two key elements that makes you intestine leak is one gluten as we said because release is only through this mechanism and an imbalance microbiome what we call dysbiosis there can be either because the function and the composition is imbalance or because the microbiome is establishing the place where it's not supposed to be small intestine bacterial growth SIBO is one a most powerful way to release its almond and make intestine we see this all the I call it the food baby they get bloating after eating this ended in that yeah often means that there's bacteria and they are producing gas that's right so I I think that you know it's gonna take not a few years for people to accept completely this idea of the importance of intestinal barrier in a variety of chronic inflammatory diseases so the the heart you know soul of immunologists tradition mammalogists will never come around this they will never come around to the idea that our immune diseases can be treated as I believe that they can because if you start this thing that god of course you know which is not we do it in functional medicine even know what we're doing these conditions include the army and this is are based on five pillars the genetics so who you are your environment and including what you eat in an increased gap permeability and immune system that becomes eiper belligerents and a microbiome that is not doing what it's supposed to because epigenetically will make your genes to be you know either express or repress so that you switch from genetic predisposition to clinical quality and when i say chronic inflammation i mean anything yeah you know cardiological issues you need arthritis a tri microbiome any of these five pillars are fair targets to try to ameliorate inflammation again genetic Ida ting I don't think that's a possibility because the complex is way too much and if there are too many genes involved the islands in that s can happen modulate the environment that's something that we should really focus to deal with all those pillars absolutely and in medicine we just try to find the one drug to fix the one no no it's not worried that way yeah so if 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 mineral suppressors or you know change the microbiome everything will go to all very citrus there but if if you start to think you know more I would not say holistic but comprehend they say you know let's start with your 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 come with the price yeah that's agricultural system our food processing and absolutely 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 then use prebiotics post biotics Pro by all these symbiotic whatever it is drop whatever it is and then you know then you know that's good cut also to the point of dysbiosis because again the spiders they all interact it well you see 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 yes if you think about this five pillars that has just told you they highly interact so if you effect foods you affect the composition microbiome if you print the microbiome back imbalance were supposed to be based on our evolution plans the immune system will defend us rather than be belligerent against us and will unleash inflammation only when I Stefan Utley needed if you have a balanced microbiome you also will have it got permeability that will go back to where they're supposed to be and in a good gut permeability will make the immune system to be less bit Legion so it's all interconnected so you said something to me about a year and a half ago that is just resonated in my head and I don't know if I got it right which is that in your work you discovered that anybody eating gluten has some change in their permeable even if they have no symptoms and to me and my set of simple mindedness that means that anybody in gluten is gonna generate some level of chronic inflammation did I get that right or wrong no I don't think so again as I was telling you actually the vast majority will debt you know will have you know this increase permeability followed by again a a very tightly controlled inflammation that is good for us I mean you know I'm a gastroenterologist and if you a little bit of a poison is good because it helps absolutely but if you look at the gut of anybody so I've been in this business long time and never seen in a biopsy of a human being I got with no inflammation he saw information there all the time and you know what we define inflammation in the terms of its critical mass of immune cells they are really they're ready to fight so it's not colitis it's just a little rain it's a low-grade think you've got your military and they're ready in the front it's like that you have athletes they're training for the Olympics they don't train just the day before to the Olympics they train for the four years before the Olympics so that when is the time they're really invest the best shape possible so the the gut is in the entire gut and not just the colon is in a chronic state of tightly control healthy low inflammation that is local goes nowhere but it creates a condition in which you know you have a baseline situation that you know it's draining fight that's right it's a training camp exactly the problem arises when this inflammation goes to the next level and spill out the gut and goes somewhere else that's where is the problem and that is when that tightly control got permeability because again if you have a gate this will be open and closed all the time gluten is one of the many reason why we can open-close this gate it's useful for us to do that if was not useful mother nature will I put a wall and navigate so the fact that gluten increase permeability to everybody it doesn't mean that everybody will be in trouble there is a subgroup of definitely got in trouble another that would not that's reason why I would not demonym necessarily but at the same token I would not dismiss the possibility there are such silly diseases we've been saying for almost the entire podcast yeah there is the possibility that there are people that don't have silly disease they got in trouble because of gluten that increased you know you know up regulates the it's only pathway create a shortcut for other junk to come through yeah and maybe you seem to get that's right one of the things I ran out of it's true is that in the in the effort to increase food production we hybridize and bread wheat to contain more starch and to be shorter and drought resistant and grow better and produce more carbohydrates which is a dwarf wheat and in the process we combine the genes of different weight strains which led to more glidin proteins in the dwarf wheat and that those plant proteins seem to be more of the ones that trigger inflammation is that part of why we've seen this increase I'm not on a grow number so I speak second hands for what I learned mainly there was a meeting that the National Academy of Science actually convene in Washington DC a couple years ago to which i was invited so I had the opportunity to hear the agronomist there's been such a change no question about that so Romans and Greeks we used to eat you know a very tall you know yeah wheat we eat is not the week we ate no no absolutely but you know was a tall plant you know only 5% of the top had seeds 4% of the dry weight was gluten at that time and then you know later on during you know the Renaissance we increase the heel to make you know more you know produce book you know and useful wheat by doubling the amount of you know gluten in there so from four to eight percent and then the last irrigation was doing the Agricultural Revolution that where this dwarf we so one-third of the plant now is seeds so the efficiency is much higher and now we're about 12% rather than 4% as we journey a thousand years ago the epidemics that we have seen materialized after this event so I don't know a thing that is the cultivars that I've been pretty much fueled by Farmer Stinky's heal that's what it is it is fueling the you know the epidemics I really do believe that is more the way that we handle the products and you know what your wife is experienced in Sardinia it's testimonial that it's not that the genetics and the load wheats a lot of gluten in which is the culprits not like they grow more ancient stream no well you know of course there's gonna be less gluten in there and ancient grains can be beneficial for example people who don't see the sensitivity like the corn wheat that's right you know up to decrease the the load of gluten will not be beneficial for celiacs because no matter if it's 4% of 12% it's it's it's great a much yeah yeah fascinating so one of the things I think people who are listening weren't wonder about is when when do you introduce gluten because there are a lot of women who have children and we're fearful that if we just too early look cause a property interest too late it might cause a problem what's the Goldilocks rule here and shoe should be avoiding wheat and kids completely you know we asked our question last question you know when you know we're trying to understand what is fueling these epidemics and a matter of fact we did this by first of all doing a what is called a retrospective Cochrane analysis so look and all the studies in the literature and try to find out you know is there any hint there and the hint where maybe you're the breastfeeding practice are decreasing is the corporate or the c-section is the problem or the introduction gluten at large amount to early in life and that was the premise that seems to suggest these are the kind of reaction that we have to look at it was out of the question and this still applies that if we introduce gluten way too early before the three months of life do you increase the chance no question no crema wait for your baby that's right but but what was not clear for this retrospective studies is if we follow the current recommendation the America economy of Pediatrics between for six months or we really increase the chance of having probably see the disease what about if we postpone and let's say year or a year so we allow the immune system to mature and be able to handle this better and we did such a study we've prospective full of 700 neonates a risk for a serious disease because some on a family had see the disease for ten years so it was the longest crocheting journey that we took there was published a couple years ago in new england medicine the lesson that we learned was you know a very hard one I have to say nothing pin out to be right based on the retrospective studies so I mean you couldn't find a pattern that connected so if you delete delay at 12 months of age you delay the onset to disease but to find the destination so the frequency was the same the incidence was exactly the same now you can argue that delay in the onset disease allows you know very important organ like the brain to develop develop better and be you know protected against you know you know this heat of the inflammation but it's not a preventative approach c-section of vaginal Eva made no difference breastfeeding or bottle feed make no difference am I saying that these are not important factor absolutely not but it teach me and not a more important lesson you know again as we have to deal with you know patients and not diseases you cannot deal with individual factors not them as a whole you have to look at the entire situation and the presentation dr. neon art of some of the data of the next generation studies the seer disease gem studied and you know that is the ones that we are doing to try to find out why some people are race to see the disease keep straight yeah and stay healthy and some take the wrong turn yeah is teaching us that lesson is the combination they're both it's not the single one it can be c-section and bottle feeding or can be you know antibiotics right treatment and you know exposure to whatever environment yeah you know factors but but again all this to say that you know the single element and change the single practice like say postponing you know it's not it's not gonna work I will solve other intervention that should be as important maybe so doctor Fasano you were appointed king for a day and you could change anything in healthcare science medicine food what would you do to make the world a better place well I I would take the the Manhattan approach when we were you know Manhattan Project that's rights so when we were during World War two at the critical moment you know of the were you know the Germans were building a nuclear bomb German was at the verge of the nuclear bomb and they you know the the leadership of the alleys realized that this will have been the Tilted point so they established the Manhattan Project say take the best of the best lock in the room tell them what is the problem and don't let them out until they come up with a solution I didn't need that we need the Manhattan Project here so President Mahmoud did something like this called a hundred people in Washington DC just before wrapping up his presidency Obama yep scientists you know leaders in industry nonprofit organization like in all the Gates Foundation Johnson Foundation a major thinkers government officials from the Food Drug Administration USDA the NIH and they he locked us in this building and say you know we invest a huge amount of money taxpayers money to do the Human Genome Project now the human microbiome project but the healthcare is broken we need a solution here you need to tell us how we can capitalize all the investments so that we can really improve the quality of people what is needed and again if you continue to approach health care as a business so that lobbyist goes Washington c.push one direction other and not as a social service we will never solve the problem so no king can be able to fix anything here because it takes a village convene in my book the civilization of a country is measured by two metrics the way that you educate your population and the way that you take care of it yeah healthy wise yeah and we do a miserable job here so I take out the education piece because it's not my expertise but in terms of health care it will take him an anthem project I love that idea convene the best minds in the world to solve the problem of health care and food and the food system and change the way we do things I love that absolutely because again if if you will be if you will be from another planet if you'll be imagine and you have exhuming you'll collide it down here you will be very puzzled so because you will see on the left you know the industrialized countries they spend you know 20% of their gene oh wow they spent 40 billion dollars to eat more than they are supposed to another 20 billion dollars to advertise to eat more yes another 16 million dollars to lose weight going to the gym or slimfast or whatever it is yeah on the other side the right hand side you have people they die of starvation is still they do mm-hmm and he said it would take a fraction where you're spending there that by the way I didn't compute the cost of treating you know this is to diabetes Arthur sclerosis heart attack nearly degeneration and so on and support take a fraction that price put over there and everybody will be much better off yeah I'm an item project should look at the global you know aspect of the story that's actually great I mean actually I I'm trying to convene a commission to do just that to look at our entire health and food system and how we got here and how we get out of it and bring all the key stakeholders together because without that I don't know how we're gonna work on this and it's true we got to get the money in the egos out of the system and figure out how to solve this for Humanity well that is a beautiful goal thank you doctor Vasant oh and thank you for being on the doctors pharmacy a place for conversations that matter if you like this podcast please subscribe to it and leave a comment and share with your friends on Facebook and Twitter and we'll see you next time on the doctors pharmacy thank you [Music]

Channel: Mark Hyman, MD

Views: 56,497

Rating: 4.9163985 out of 5

Keywords: Dr. Alessio Fasano, Gluten Intolerance, Gluten Sensitivity, Gluten, Celiac Disease, Wheat, Dr. Mark Hyman, Podcast, The Doctor’s Farmacy, Chronic Disease, Healthcare, Health, Gluten-free, Diet, Nutrition, Leaky Gut, Gut Health, Immune System, Food Allergy, Food Alergies

Id: 0rTAhlJ9PMM

Length: 62min 39sec (3759 seconds)

Published: Wed Sep 26 2018

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The interviewer Hyman at times veers toward woo, but Fasano does not.

Should all AI folx be gluten-free? Fasano's answer will surprise you!