Should We All Avoid Gluten? with Dr. Alessio Fasano
Welcome to the doctors, pharmacy. I'm Dr Mark Hyman and that's doctors, pharmacy f. a. r. m. c. y. place for conversations that matter in today's guest is an extraordinary scientists and leader in the field of gluten Dr SEO Fasano who I've known for number of years, and it's been a huge contribute to our world of functional medicine, helping us bridge the gap between where we eat our microbiome and chronic disease. So he's extrordinary physician. He's been at the forefront of the field of seal EAC in gluten research. He's now at Harvard. He's the head of the division of pediatric urology, nutrition, it Mass General and professor pediatrics at Harvard Medical School, and he's basically leading huge team looking at how do we understand Celia can gluten issues. He's leading a group called him. You coastal -nology biology research center, which is over forty, five scientists, looking at how do we translate the information about what we eat gluten. Our gut, our leaky gut. The microbiome and chronic disease is pretty exciting work, and he's written extraordinary book gluten freedom which had have you all check out all the proceeds for the book sales go to support research and it's available in seven languages, which is great. So the topic's he's doing now are pretty exciting. One of them we're gonna talk about which is new research study looking at how our genes, our environment, our microbiome and our metabolism, all interact to create risk for disease. So welcome Dr. Fasano thank you Mark for him. 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 are got and chronic disease, particularly autumn you disease. And you know, I started practicing medicine twenty years ago. Nobody even heard a gluten. I was talking about. Gluten free diets are like, what are you talking about? People have to eat the worst food and now it seems like millions of people's spire to be gluten free. It's like an aspirational diet. Gluten free is kind of kind of a badge of honor and now restaurants have free menus, and and the question is really seems to be a lot of noise about it, but where's the signal here? And we've seen a real increase in seal. Celia can in the last fifty years and we're gonna 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 some air, but he's also component of question about that. So it is an interesting journey that I wouldn't Verstand as you were saying twenty years ago, you know, people. No, no. How to spell gluten. So much. So defying the gluten free this gluten free many. And again, you know, the field really went far in the best when years. Thankfully, I have to say because the improve the quality of life of people that have to leave for Madigan assess ity and doing these journey. Also, we learned many lessons. We moved from the concept that the only people that belong blue free Dieter people, we see disease to the concept of the people out of than silly x. debt needs to go for medical necessity. This none Celia gluten what you've really helped pioneer, the discovery of sensitive definitely as the last kid in the block, and then we'd allergy and so on and so forth. So really the field expanded and tremendously. And would that our knowledge what Gruden dust 'twas, of course that went, you know, more than the stepped American assessing when people start to think that in threes, good for everybody because Goulden can be. Foxing for everybody and so on and so forth. So again, I think that there are some element was more than we thought, but not as much as some people phase. So you know. Noise. So the single is, yeah, the two major groups, you know, some people they need to go for Madigan assess ity either because outta meal, responsible disease, lurching response like we dodge or they f- another form amuse response that we still don't know completely don't see the sensitivity. And then the other problem logic group of people that invasive guides for lifestyle the freedom to do so. But definitely have you know the American assess the first script? Well, I've been doing this for twenty years and I would say one of the most powerful tools mytalk kit. My tricks and my trick bag is putting people on a gluten free diet. If they have any chronic inflammatory disease, even neurologic or psychiatric issues, sort of an interesting thing. And sometimes they do have antibodies sometimes they don't, but it's sort of always a one-two-three my list for trying something to see for makes a difference and it's external. How many people respond. Positively when they get off gluten. Yeah. Mark the the major confusion when you go is such a heated debate of believers versus not believers is that if you have the right primis you you clearly fuel a debate 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 besides CDs, the chronic inflammatory conditions that can benefit to going gluten free diets. What is the caveat here is the no believers. They make the assumption that you know, that is a premise that has been based on the part of the see this, meaning that everybody going glue three Shufi a better because that's the culprit of the Ottoman process seated disease. What is the misunderstanding here? In my opinion, for both camps, I have to say is that while the expedition is one hundred percent of people, we see disease, they have to diet because we know that this is a fact there is the misunderstanding that the same applied to all the other chronic inflammatory diseases, my personal opinion that can be wrong, be proved wrong. As many times is that you know. I am an amino of this kind of, you know, to a streams in a sense that I really do believe that they are subgroups of individuals without a chronic inflammatory diseases, including out immune diseases, including chronic fatigue, you name it. I, yes, that may have gluten as the culprit, but not all. Yeah. So you know, ideally, and what I see this going to be the future ally in terms of best-case scenario in terms of best critic practice is to identify volume by markers that will identify this group of individuals in this chronic conditions that have gluten as the instigator and place them on free diets. Yeah. So I give you an example of while ago, collaboration with some colleagues university moments, we found out there is a subgroup of schizophrenic individual to golden. We end up to quantify, but it's still an approach. Mission that probably about fifteen twenty percent. Now those people often will have elevated any light any Bob. Alright. Yup. Yup, absolutely. And that's how we in defied them and they have other out onto this that invalidated -ly on like the tissue transplant. I'm knees six people a biomarker near inflammation. But the bottom line I'm trying to say is if we have taken the bold statement that all schizophrenic individuals benefit gluten-free died and do a trial, which congress gets a frantic and put all the free diet and only those twenty one hundred will respond. Right, right. Because, you know, you know the efficiency of twenty percent Africa. See, I told you so doesn't work. If on the other hand us threatened by the population, find the subgroup in this. The heart of functional medicine has always personalized, and you say, well, those have by Marcus the anti Glenn onto the six, this, whatever this, that tells me that chance there will respond to the for that put all to twenty you have onto percent. Exactly. Now, I don't think that is. It's really a thing considered. We're talking about a devastating disease, hopefully, very often do not respond to cut on legal intervention. You give the life back to people and you made job are dis that possibility. If you know again, you don't approach this way. So this is a long way to say, I'm not in the camp of the people. They are skeptical that say, has to be only are. Wise goons not business. You should be interesting, but the hand, I have to give a word of caution to vilify treatment. They can be extremely powerful and effective by placing everybody on the free diet and hope for the best. Yeah, I think that's really important. I want on pack that from it because there's a couple of pearls and there one is that gluten can cause brain inflammation across a spectrum of different conditions from schizophrenia. Autism also see and large portion, twenty percent almost who have anybody's to gluten depression, anxiety, ADD. I mean, all these have been linked to gluten in the right person. One of the things that you published in two thousand three was seminal article in New England Journal, which I found extremely helpful because it mapped out the fact that gluten and CLA disease can be linked to over fifty different diseases. So it can be linked to schizophrenia, but it doesn't mean that all schizophrenia is gluten problem or that all collide is gluten problem. And I think. Probably gonna medicines. We think these conditions are uniform, but they're not. There's no such thing as schizophrenia, schizophrenia, and I think this is an important concept that that you kind of lose stating with this personalized approach, dentists who sensitive and the biomarker issue I think is important too, because we typically in medicine or trained that enlist you have a positive biopsy of your small tests and the shows you have Celia act, then it's not an issue and I still see this going on, and then there's the antibody studies and it's very elevated. I think people will agree that that's pretty good marker for its TGI or any glide anybody's. But if they're slightly elevated, what's normal, what's optimal? Is there any normal? We've had this conversation before. If you have any anybody's, it means you have a leaky, got it means you've been exposed to gluten enemies. Your immune system's pissed off. That's right. So. Navigate that world is again raise on. If if we take the. Again, the strong position of debate with right was wrong, and we keep, you know, in the raider screen, what should be our focus. So what is the best thing that we can do for our patients? So improve the quality of life commonsense would suggest you that this is all know. For example, if you look at the best drug on the market, the best of all in terms of efficacy. Bets. Are you talking about forty, five, fifty, percents efficacy. These doesn't work on half the people have to pay, and this is the best drug that we have in the market. So we know ready that this are non genus, publish the design. Those are about thirty percents. That's right. So that's the background noise. So if you if you honestly keep this in mind, less learn number one, where on the only qual number two, we conventionally talk about diseases as of this nation that can be common. So you're Crohn's disease can be similar to microns east about how we got there can be very different. So imagine results the same, but the causes and imagine that you then on that premise that our believe is not disputable because everybody will agree on that. Then you go to the next step assay and I have a bullet magic magic bullet to that can fix them. All that doesn't commute. So. So that's what drug development is approaching the problem and that sense. So if you sect that these are fun of this nation and you can get there and different way you also as a Colonel Larry to that statement after, except that eventually treatments needs to be diversifying. Right. Which is a radical concept what you're saying that all diseases in a category or not the same. So everybody with rheumatoid arthritis or colitis, or it's free air, not the same, and each one is different treatment, even though the looks the same at the end of the day, and that's functional medicine. Fundamental again, I don't want to be philosophical romantic here, but you know you're in your. Just because I'm all physicians in healers of two thousand years ago. They were focused on individual trying to balance by different approach, philosophical wages, little bit of science, and then we start to really be programmatic and systematic and then look at, you know, conditions as diseases always shift the focus from the individual to the seas and conventionally we, you know, went to that path to try to be evidence based find the target to find the solutions on and so forth. Recently am not just functional medicine that probably seal this before then. Evidence made imagine, but even the, you know, the classical train physician like me, start to really appreciate that we should shift back to the individual because that's the way that I've actually you can have the best efficacy possible. William alter said, right, the father exactly. We should treat the person who has a disease, not disease at the person has. And if you got in that kind of premise, the debate is over and there is no discussion that you know, sure. We have to have conventional approaches of. We have to be system attic. We have to be evidence based, but we also need to accept with Miltie and an approach that the magic bullet is not there. So there is the lesson to be learned here that again. There is the 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 the possibility. Our challenge now is to find this people how to identify those people and talking about, you know, glued in the brain has you were into this for a long time, and this is also not Batabano even people the most sceptical people will know because they do know that seeded disease is associated. So the ones that everybody except it with near logical symptoms, MBA symptoms that I'm the pin, the possibility near inflammation. We know that you can have in on sided depression, mood swings, right? Because new information and to the point that I was telling you there Marcus in information, the most classical example in you not spew the existence. This end term. Therm walking around as inflammation battle uric when this affected because of that the same by the same token novel would dispute that city. This can give peripheral neuropathy. So inflammation peripheral of the nerve never Simpson. And 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 all pretty from new up the Nazi the disease? Is that a possibility? Because now, again, everybody seems to accept that you can have probably grew outside CB disease by transition, need to accept the possibility than your inflammation. Sexual pervert can affect people other than individuals disease. So I don't see too much of the Konomi, but there's there's an interesting tension here with the non seal EAC sensitivity. There's there's a mechanism they wrote about which is our ancient immune system. Call the anatomy in system that can react glued and there's no antibody measurement to. They're just measures just general inflammation and sort of very primitive sense part of your means. And then there's the antibody part of your mean system where the adaptive part, and that is where we get silly anybody's. But the question is, is there way to measure this silly since Nazi? Like since he just looking at ranges of antibodies that aren't quote, abnormal, let's say you're ranges up to twenty. What if it's fifteen or sixteen ten is at a significant factor to look at my own Assan series. I don't know. And the reason why, because again, we're still learning the pathogenesis Seila gluten sensitivity. I lied. I'm convinced because the cool events in the league pitcher that we're dealing with an immune response involves all the native mean system. As you said, this is an saucer away that we developed to fight enemies. You know, it's when we deploy our army without thinking who are fighting because I. I can't think about who are you customize weapons against you on the since I just need to deploy and get rid of carpet bombing smart bomb. Exactly. And again, in that sense, you will not find by Marcus little tither high there that will link inflammatory process to the disease. And fact they are several groups including ours. They're looking for by Marcus sensitive. My sense is going to be a multitude. You were looting to the first generation onto onto antibodies, their positive and fifty percent of people with not see sensitive, but that's not the biomarker of reaction to the nice we typically intend for Sita disease work, give out onto ball this. This is after the fact. So the immune response is is, is been activated. You're fighting inflammation and not what you sees a biomarker. The consequences. This War I as you were saying the individual eating, the intestine got leaks leaked Gruden. Fragments comes in and immune system, does his job is under back and some of that is not supposed to be there and be done about this against it. So. I think that's going to be a combination of civil biomarkers. It has to do with many of the functions that will lead to the inflammation process. I wanna walk back historic little bit because you know hundreds of years ago, we were eating gluten where eating we'd and we didn't see that levels of autumn unity. We didn't see the levels of of Ceac disease that we do now and you're here at the annual conference, tremendous. And you gave it a brilliant talk, looking at how we got here. One of the factors that changed that actually driving this level of gluten reaction. And my wife now is in Danny. 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 an Italy now and she doesn't. I know they don't allow GMO's in Italy other, we'd is not GMO although they spray are we'd here 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. The gluten always been there is the gluten different in the we have is on the else change in our guts and environment. Like what is this driving force? You know, again, first of all, some people believe that this was just an increase awareness, but we know that it's real and they're plenty of evidence that disclu religious orders are in on a rice, and it's not an isolate phenomenon. Every chronic diseases are on a rice, allergic disease out immune disease, nudity Jaren disease, like everybody's inflamed. That's right. Cancer, heart disease high signed, an epidemiologist head, you know, hand on the fire say, we believe that that's the case and the supreme strong. So. This to say, we're not really looking at a weird isolate. The phenomenon relates Guten. It's more in the context of this epidemic row, inflammatory diseases. So. Why there is this epidemics what's going on here? First of all, the time line is is materializing is telling us that is not genetic mutation humankind. That makes us more susceptible because that takes much much longer x. generation. It's not thirty forty years has we've seen in terms of time line. So most likely were changing the environment way too fast for us to adapt and the example you were mentioning about your wife and actually I hear this mom anytime here it. I hear this all say, how come that I go to Europe about? I'm fine. Looks that I can tolerate stuff at cannot even look at when I'm in the United States. Definitely. I don't think the GMO's is the issue because you know, of course, Europe in general, a very strict regulation GMO's more much strengthen us. When you talk about grains like wheat, there is no such thing right now. He's not such a thing, but you know, there are different ways that you can explain why the load of toxic. Baptize may be higher here than Europe because of the dwarf we use here, these different. No, no, not even debt because the cultivars the same. But the way that we manipulate grains can be different. Give you an example that can be one of the many that I can give you to make breads. You Kice you take water. You take the flower. You make your dull. We as human beings. We do not have enzymes to completely dismantled gluten in its basic elements acids. What we do is a partial digestion and what is left or this under just fragments that can get inflammation. We know that most of us can Endel that will not be deal unless you go to the streams or if you eat a slice of two pizzas, it's fine. But you've three, I will be sick no matter where you are, and this applies to anything in life. Of course, even Durkee that is good for you. If you too. Much. You fell asleep and you know why. So. This process of relations. When you make the bread dough a use east east Appleton's arms, they can completely dismantle the stocks elements. In Europe. Breath is still made the old-fashioned is an overnight process. So you have ten twelve hours designs can dismantle the load of this fragments. Not hear the process takes two hours because now exhilarated officially. So you give only two hours the enzymes to. The lower so risk. The grain is the same culture. You don't know, but, but again, the way that you prepare pasta is there are processes that you have to go through the caissons drying the past and so on. It's a fourth 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 looking to pesticides, we use specifies here down that allowed in Europe. And you know, again, that changed completely landscape is now into not a variable that can affect now aid that we in terms of our immune system can react where any given product and to be grain, but it can be any other product can give you the same kind of reaction. So. And I can go on with many other elements. You know the water the way that straighted environment the pollution in the I mean, there is so much. And then of course, the great unknowns that we see. Understand because even the in United States is not on a genius. So you are pockets of places in which this phenomenon seems to be much stronger than other pockets. So gotta be some environmental situation that we still control. Yes. So going back to that, you know, the environmental factors changed, and I think in your lecture, you mentioned a lot of changes that have happened that altered a different thing besides the food. So there's the quality of food how we produced 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. You're originally came into this through an cholera. That's your sort of coming back to it. Looking at wait a minute. Why are people so sensitive? It's not your sensitive to gluten. Let's get. Why is this happening? And and house are changing our environment, toxins, stress, diet antibiotic, c. sections. How's that? Led to this increase in autumn unity, increase in seal EAC disease, and allergic. Inflammatory disorders. So if you really want to look systematically the environmental factors that eventually fuelling this epidemics now that again, we agree that this where we have to focus our tension and not the human beings genetically speaking. Because again, we didn't mutate such a short period time. You start to really question what up in the best fifty sixty years. It was different from the previous generation where we didn't have this epidemics and of course you're losing some of the factors. So. You know our lifestyle, you mostly were leaving your rural out of style, you know wanted to generations ago. So living vicinity, animals. A lot more Migros. That's right. Have Reidy but you name it parasites viruses bacteria, but there was a full exchange and again, we make again, this other convention that we are is elated Zeila in terms of environment, we are in a continuous sequel life, so soil animal Uman back to soil and the waters. We conventionally analyze them separately, but a unified ecosystem. And you know, again, if you believe that and you just human beings, make the statement we didn't change much through, but what about our soil? What about our water? What? What our animals you know? What about, you know, leaving in a crowded environment versus. Sparse environment, you know how this changed the dynamic of what's going on. And again, you know, now that we have to that we didn't have before we can understand, this continues ecosystem what we exchange. So the most important thing that which are microbes and microbes are integral part of where we are now. We know that only one percent human right most. Genetic speaking, that's that's definitely the case and you. We are whatever we are because we quibble with microbes is not that we talk him ways. Right. That's right from Mars. And then all of been exposed some than ever seen before we look an act and are shaped the way that we are because we have all with this ecosystem. Now, again, that s- you know, when when when we ask ourself, what kind of changes we mate. The stuff that's visible. So the heiress polluted and other is fog or the water looks dirty lawing in fruit but problem not the driving force. Is this parallel universe that since through mental for our health that changed medically microbiome nocco Buyum. So in other words, you know, this community that is supposed to come in orderly since we're in one and stay with us until would die. That has been completely. We've Lucien is in its composition and function that mesmerize are that we are not make even more dramatic changes with seen. So that means there is some terms of ability, but I can't emphasize enough that change in lifestyle from rural to urban introducing antibiotics for treatment, infectious diseases into. Reduce new practice like the c set showers one third of all births now. Well, it depends because I just was in Mexico for a meeting and I learned an Mexican section is sixty percent of the population that sixty ninety two percent in Brazil. So it's staggering ninety two propsal and again, I welcome with option checkup ABC no, Mark. The reality of the story is in a lot of hundreds of thousands of women's died because of her true. Exactly. So see section has been tremendously important events in medicine when I medical indicates. But when the OBGYN will prescribe a c section, so he or she can plan vacations or cash more money in or. The woman decides to go see section for our own needs, but not because. Necessity. I will suggest to think very carefully because again, the plan of in grafting and growing the proper friendly, Marco bio is being planned for two million years to be done to deliver. Yeah. What absorbs through its mouth all the vaginal colonize? Scott solely. And that is a Florida that is been highly selective, my mum to be genetically compatible with her and therefore her baby, the skin microbiome. It's not selective. They are all comers. So the operator in the operating room or the nurse, or the honest microbiome coming there and may not be friendly for the new baby. So, and of course, you see more allergic to seize as MMA. Absolutely. Because no matter with you about three NATO factors mums lifestyle mums environment or the like the C-section or about exposure or the way that you feed the baby breastfeeding three thing about offending or postnatal all this named binge on the composition and function of the microbiome. Why? I'm so obsessive this first because as you said, that's where I start. You know, my science from the very beginning was totally focus on understand how microbes stay crosstalk with us at the beginning focus on a single package into understand how they make us sick, then that knowledge moved to the community. And now the ecosystem that now we call microbial but the game, we're studying this twenty years ago with tools ridiculous compared to the ones that we have right now. That now clarified the complexity of the matter. And we're just really at the infancy of this gun most definitely. But again is giving us the paternity even more to appreciate how singly we are, how different we are from each other, how eventually, you know, loosen tolerance, develop an inflammatory process can be so different from one individual or even if again, we end up within the c.'s. Interesting. I treat a lot of patients with flute issues and seal Z's 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, really getting rid of the bad bugs and putting good bugs, just simple function as principles which are not really that well established scientifically, but we've been using for decades. There's help normalize function, then they get better. Have you seen that? So we and others published that even if you're reclusion free twenty. Percent of kids up to forty percent of the dolls still have inflamed gut, not because they cheat, but because again, there is no repair. I don't know why most design is because in averts in exposure to cross contamination outta times because again, there are situation which the misison is either belligerent. So if I say, you know, clearly I understand what's going on the answer, no. But again, I would be this missive if I were not consider this either belligerent in this individual that are not able to repair inflammatory process to be totally unrelated to micro biomass function. Well, it's also interesting. The way I think about it is that the gluten is sort of the gatekeeper sort of opens the gate in creates this leaky gut, and then all these other food antigens can leak in and start to aggravate the immune systems. Begin starter react to other things, and I seen this over and over the decades this something you noticed? Yeah. I mean, again, I'm quoted all the time about this because you know, our group was one that scored the molecular mechanism by which gluten can really make curtain tests and leak through the release, a zone. This molecule that is been Netanya Netanyahu. That's right. Linked to a variety on prize for. People are still very skeptical, so. But any the bottom line is that you know. You know and you, you put two together saying, well, if Gooden is capable through some of these under just peptides to engage on a specific receptor, instigate the cells to release zone land and make this leak than this be that mental armful to everybody. The answer is the band's actual. The vast majority of people will not have consequences if you have a balanced diet and can even be useful to help. We call antigen sampling to to, to bring very small amount. And so immune system will be more robust more a bust trained in case the storm will come. The real deal will come. The problem arises when you exceed the amount of gluten, for example, so that contains all the time or even if you're not a huge amount of you're genetically predisposed when you increase per mobility. On the other side of the fence, you find an immune system that is ready to fight against gluten. And this other. People have been really disorders. So all this to say, I will not cut guys. Gluten has the villain at twenty first century necessarily. After all, if you and I were here running, jumped from one three and other, we have to 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 to dismiss completely the fact that Glynn can be an issue for a variety of individual outside CD disease that will be also to not see would become more and more obvious. Yeah, it's pretty. It's pretty strenuously how this whole field opening up and one of the things we are were made fun of for decades idea of leaky. Gut that basically the belief was that if you had elite gut, you have sepsis and you die basically which means you have roaming infection. But this sort of intermediate zone of sort of slightly leaky God leading inflammatory diseases seemingly connected to. Everything from obesity and type two diabetes, heart disease to autumn indices is neurologic diseases autism. I mean, it's sort of it's like almost as unifying theory of how we get inflammation. So I'm fascinated how Stargell memory is lost doing generation. So for example. The of called a measure, whatever. But you know, when you know at the beginning, the nineties, we were convinced that was a big deal in. I states the the subli- -ment really came after us be time. You know you, you really miss the boat. Here we look for, we didn't find it. So you know, you're you are not, you know, in the right direction and this very much because the criticism were very much more harsh than that. And again, and their premise was on state of mind that was fixed on what was that time. The definition disease young kids with be belly I rea- through and we don't see that we don't see that we see other stuff and you don't have to have any Justice systems zero. You can be Abe's, but that was not clear that time. And that's why we were highly criticized. Now in two thousand eighteen. If you ask anybody mutt nutty. What question that disease is frequent and the United States and in Europe. But if you ask is been always like this, the answer most? Yeah, of course. We always thugs even the ones that were hypercritical same phenomenon. Would this leaky gut story? You know, again, I, you know, I his not that I was like a functional medicine doctor always tune in. I came to this by chance by again doing this cholera vaccine and learning. The color can make your leak. And then try to understand how does and see a very sophisticated machinery to loosen up the increase in permeability of digestion in intestine and then the little connections. Yeah. These gates in between cells that we thought that were cemented so that no, no things can come through cells, not betray. That's right. Has everything that we negotiate. With environment without has to come through the cell, and then we'll learn no, actually space in between cells can be modulated in its permeability, and we started the stocks and we saw this very complex machinery reasoning that I made. There said it can't be that we evolved to this machinery there just to get sick with this toxin from the cholera libra probably learned physiology from us and exploited that possibility for its own return. And that's how end up to the scored zonalin. And I have to say, you know. With the story of the league are now half a way compared to the stores diseases over the discussion. I say away because even establishment now of evidence based medicine, the hypercritical our work that has been coming right here to. Vein, when we discussed right track when you're. Again, Mark, I again, I'm a an individual that not only I'm open minded, but I, the individual, you know, I have met that science is a constellation of failures were very few successes a, you leave for those, but also the sciences perfect path. Most of the time you're wrong, and there is nothing worse as a scientist to not omit what you're wrong. You know you do is you know hatch, their ideology. What is to today will be garbage in two years. We know that that that dynamic. So as a good sign, this you formulate an parts you design and experiment challenge diapers, and you perform the experiments, and then you've violate the outcome that nine out of ten times is different where you disobeyed with your formula that I, this, this brings to kind of science incremental science. I want to go from point eight to be to see to to to my final destination. I know where I am. I see my sites where I'm going. That's the one in which you're Pierce will follow. You will understand what you're doing and eventual, except, you know the approach that you're taking because everything is clear. Sometimes you want to go from point eight to point be a you end up to point z. so in a place where number he's been before, most of the time is dead ends. So it's it's something that leads to nothing. Very few times. You got more, we call transformation of science. It's not something that you intend, but by and up to be in something that completely depowered. I'm away of unintended consequences of your, and that's what it's on. The score was all about when you got there to understand if you're dead hand or you do something transformation. The only thing that you need to do is to seek and see if you're Pierce, can validate every produce what you've done or this was not reproducible. The zome story now is highly produced. A matter of fact, I don't, you know, auditor the vast majority of what is the signs on. Now days. We can't view the meniscus component of the. Hundreds of papers out there all this to say that not only zone story, but the story of the motivation, GOP him ability with the identify of genes modulate Taichung since the indication that lost Barry function is the core, many, chronic inflammatory diseases. People are coming around and it's so powerful yet as a. Sort of. Disciplined medicine is not really thought about how do we 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 why mechanism deletes to that because this is a very complex machinery with very sophisticated functions. And that was mentioned during the lecture that the structure, this type junctions is still imile done. That means it's a function. It's a dear to us because we're redundancy means that you know, you have back a lot of backups, Sebastian. I can tell you grit level confidence that the two key elements that makes you tested leak is one Gruden as we said because release zone through this mechanism and am balanced mccrone where we call this bios. That can be either because the function and composition is imbalanced or because the microfilm is establishing the place where it's not supposed to be small intestine, but your growth CBO is one of the most way over to release zone and make into this all the time. I call the food baby bloating. After ended in that often means there's bacteria and they are producing gas, and that's right. So I think that you know is going to 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 hearts of soul of immunologist vision knowledge will never come around us that will never come around to the idea that out immune diseases can be treated as are believed that they can't. Because if you start this thing got, of course, you know, which is not. We do it in functional medicine, not even knowing what we're doing. This conditions, including in this is our based on five pillars, the genetics. So who you are your environment, including you eat in increased gap ability and immune system that becomes eyebrow Durance and a macro by home that is not doing what is supposed to because epi genetically will make your genes to be either spread or repress. So they switch from genetic disposition to kindergarten. Eighty and when I running inflammation anything, yeah, you know, cardiological issues. Arthritis fry might go by on any anything. Anytime, knitting, any of this five pillars are fair targets to try to meteoroid inflammation again, genetic editing. I don't think that's a possibility because the complex is way too much. It's too many genes involved in that is going to happen mobility environment that something that we should really deal with all those pillars in medicine. We just try to find the one drug to fix the one. No, it's not gonna work that way. So if you will continue to have an environment that is really conducive, OMB inflammation, foods, pollution chemicals, you can fix whatever you want in terms of Munis, oppressors or change the micro, everything will go there. But if if you start to think. More, I would not say Listrik comprehensive, say, let's start with so lifestyle really is a common sense. Of course, we can go back and leaving a cave that's not feasible, but can we avoid some chemicals that can instigate inflammation can we eventually decided to feed our kids food and other junk that we feed so that eventually have the same chance that we had? Can we promote blocker production of produce rather massive production? That of course come with a price that that's, you know, agricultural system, our food processing, and again, you know this, it's an uphill battle because you 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 this bios can then use prebiotics post -biotics pro by all these symbiotic, whatever. It is. Whatever it is and then you know, then. That's got also to the point of this bios because again, the they all interacted very powerful in your talk, which is that the single biggest thing we can do to change microbiome is changed the food we and the quality of the food we eat and get off the processed food and eat more plan, rich foods, and good quality foods, right. If you think about this, five dealers just told you they highly interact. So if you affect foods, you affected the composition microbiome. If you micro back balance where supposed to be based on our Lucien plans, the immune system will defend us rather than be beligerant gas us, and we'll finish inflammation all when I definitely need it. If you were a balanced microbiome, you also will have a gut permeability. They will go back to the way this supposed to be an a good gut permeability will make them you system to be less login. So it's all interconnecting. So you said something to me about a year and a half ago. That has 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 gluten has some change in their permeability even if they have no symptoms. And to me in my simple mindedness, that means that anybody is going to generate some level of chronic inflammation. Did I get that right around? I don't think so. Again, as I was telling you watch the majora people debt, you know, have you know this crisper mobility Fulla by again, a very tightly control inflammation, there is good for us. I mean, you know, I'm Augusta, Allah gist. And if you little bit of a poison is good because it helps. If you look at the gut of anybody, I've been in this business longtime and never seen in a biopsy of a human being gut with no inflammation there. He sold information there all the time and what we defined inflammation in the terms of a scrutiny of mass of immune cells. They are really, they're ready to fight to colitis. It's just a low raise those. It's a low grade signed. You've got your military and they're ready in the front slack that you have athletes their training for the Olympics. Don't train just the day before to deal in this day. They trained for the four years before. So that one is the time they're really invest the best shape possible. So the is in the entire guts and not just a colon isn't a chronic state of tidily control, healthy, low inflammation that is local goes nowhere, but it cleared. That condition which you ever baseline situation that is radio training fight. That's right. So training camp exactly the problems arise when this inflammation goes to the next level spill out the and go somewhere else that's worth the problem. And that is when that tightly control gut permeability. Because again, if you have a gate, this will be open and close all the time. Gruden is one off the many reason why we can open close this gates. It's useful for us to do that if was not useful Madam, nature will put the wall the gates. So the fact that Gruden increase per mobility to everybody. It doesn't mean that everybody will be in trouble. There is a subgroup of individual definitely got in trouble and of that will not. That's reason why I will not them Nuys Gruden necessarily. But at the same token, I would not this miss the possibility that the diseases we've been saying for almost the entire. Casts here, there is the possibility that there are people that don't have the disease. They got in trouble because of gluten that increase the up regulated up, regulates the Zona pathway, create a shortcut for other junk to come through and maybe into get. That's right. One of the things I ran his true is that in the in the effort to increase food production, we hybridize and Brad, we'd to contain more starch and to be shorter and drought resistant and grow better and produce more carbohydrates, which is dwarf wheat. And in the process we combine the genes of different weed strains which led to more gliding proteins in the door fleet. And those land seemed to be more of the ones that trigger inflammation is that part of why we've seen this increase? I'm not an agronomic, so I speak saying on hands for would I learned mainly boy, say a meeting that the National Academy of science. Actually lean in Washington DC a couple years ago to which I was invited. So I had the opportunity here the agronomists. There's been such a shame. No question about that. So Romans and Greeks, the used to eat a very tall. Weeds. We eat is not the we we ate, no, absolutely. But was it told plants only five percent of the top had seats four percent of the dry weight was gluten at that time. And then later on during the renaissance of we increase the, he'll to make more produce a useful wheat by doubling the amount of, you know, granted there. So from four to eight percent, and then the less relation was doing the agricultural revolution that we're this, your. We one third of the plant now is seeds. So the efficiencies much higher and now we're about twelve percent rather than four percent. As we start the thousand years ago. The epidemic that we have seen materialize after this event. So I think that is the Coulter ours that have been pretty much fueled by farmers to he'll that's what is is fueling the epidemic. I really do believe that is more the way that we handled the products. And you know what your wife experience in Sardinia is testimony that it's not that the genetics and the load weeds. Gluten, which is called personnel, like it's more ancient string. Well, of course there's going to be less gluten endear Anchin grains can be beneficial. For example, if people don't see the sensitivity like Lauren, we, that's right to decrease. The load of Goulden will not be beneficial for Silva acts because no matter was four percent of twelve percents, it's way too much fascinating. So one of the things I think people who are listening were wonder about as when when the introduce gluten because there are a lot of women who have children and were were fearful that if we just too early look promptly interest too late in my problem, what's the Goldilocks rule here and shoo shoo would be abiding and kids completely. You know, we asked this question when we're trying to understand what is feeling this makes and a matter of fact, we did this by first of all doing a woods Colin introspective. Cochran analysis. So looking all the studies in the literature and try to find out, you know, is there any hand there and the he where maybe the breastfeeding practice degreasing is the culprit or the c. section is the problem or the interaction at large amount tour ily life. And that was the premise that Simpson's jets. These are the kind of wreck shin that we have to look at. It was out of the question and still applies that if introduced gluten way too early before the three months of life, you increase the chance. No question of prima wait for your, but but was not clear for this respective studies is if all the current condition, the Americana pediatrics between four to six months are we really increase the chance of having probably disease. What about if we spawn laissez euro. So we allow the system too much and be able to handle this better. And we did such study. We've perspective full of seven hundred neonates a risk for Assyria disease because someone family had seen a disease for ten years. So it was a longest shitting journey to. There was published a couple years ago, New England in medicine, the lesson that will it was. You know, very hard one. I have to say nothing Pinella to be rights based on the richer, sweat to studies. So you couldn't find a pattern that connected. So if you delay a twelve months of h, you delay the onset of disease, but the final destination. So the frequency was the same incidents was exactly now you can argue that the lane the onset Z's allows, you know, marry important organ like the brain developed develop better and be protected against, you know, this hit of inflammation but is not a preventive approach, c section of difference breastfeeding about a the make defense. Am I saying that these are not important factor? Absolutely not, but teach me and not a module important lesson. You know, again, as we have to deal with. Patients and not diseases. You cannot deal with individual factors, not then has a whole. You have to look at the entire situation and the presentation Communards of some of the data of the next generation starts disease, Gemstar edge. And you know. That is wants that we are doing to try to find out why some people receive the disease keep straight and stay health in some the renter is teaching us that lesson is the combination. The above is not a single one. It can be c section and about, oh, fitting can be -biotics right treatment, and you know, exposure to whatever environment. Factors. But, but again, all this to say that, you know. The single element and change the single practice by say, postponing. He's not. He's not gonna work. We'll solve otter. Intervention should be as important, maybe. So doctor Asano you were appointed king for a day and you could change anything in healthcare science medicine, food. What would you do to make a better place. Well. I, I would take the. The monotony approach when we were Manhattan project that's rights. So when we were doing World War Two at the critical moment. You know of the war, you know, Germans were building nuclear bomb gem was the verge the nuclear bomb and day the leadership of the allies realized that this will have been tilted point. So they established the match project. Take the best of the best luck in the row. Tell them what is the problem and on. Let them out until they come up with this is that we need a Manhattan project here. So President Obama did something like this called hundred people in Washington DC just before wrapping up his presidency. Yep, scientists. You know, leaders in industry nonprofit organization like the Gates Foundation, the Robert Johnson foundation, major thinkers of goernment officials from the food Drug administration, US the the NIH and they he locked us in this building, say, you know, we invest a Yuji amount of money taxpayers money to do the genome project, not human microbiome project, but healthcare is broken. Winnie the solution here. You need to tell us how we can copy the lights all investment 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 DC, push one direction and not as a social service will never solve the problem. So no king can be able to fix anything here because. Fix Lilius convene in my book, the civilization of country is measured by two metrics the way that you educate your population and the way that you take care of it, healthy Weiss, and we do a miserable job here. So I'm afraid south. So I take out the education piece because it's not my expertise. But in terms of healthcare, it will take a Manhattan project. I love that idea convened the best minds in the world to solve the problem of healthcare and food and the food system and change the way we do things. I love that. Absolutely, because the gain, if you would be, if you will be from another planets, if you'll be mashing and you EV zoom, you'll down here. You'll be very powdered. So because you left, you know, the industrial countries spent, you know. Twenty percent of their Gino. Well, today spent forty billion dollars tweet more than they are supposed to and other twenty billion dollars to advertise to eat more. Yes. And now the six million dollars to lose weight going to the gym or slimfast whatever it is. Yeah. Decide the right inside people, they die of survey ship, still they do and said it would take a fraction what you're spending their bought a way. I didn't computer the costs of treating, you know. Diabetes, Arthur sclerosis, heart attack near the generation and so on. It's were dick, a fraction of their price put over there, and everybody will be much better off a Manhattan project should look at the global 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 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 gotta get the money in the egos out of the system and figure out how to solve this humanity. Well, that is a beautiful goal thing. Dr. John, thank you for being on the doctors, pharmacy a place for conversations that matter if you like this podcast, play subscribe to it and leave a comment and share with your friends on Facebook and Twitter, and we'll see next time on the doctors pharmacy.