Going Gluten-Free Without Going Crazy – Simple Tips and Tricks with Jennifer Fugo

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Going Gluten-Free Without Going Crazy – Simple Tips and Tricks with Jennifer Fugo

Episode Intro

Dr. Michael Ruscio: Hey, everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with Jennifer Fugo, who, this is actually the second time she’s been on the podcast, but the first time you’re going to hear it because we did a great recording last week and my computer shut off literally during like the last minute, and I lost the entire file. So graciously, she has agreed to come back on despite my meandering for technology. So we’re going to talk about gluten today. Jen, thanks for coming the second time and having this chat.

Jennifer Fugo: Yes, thanks for having me back. I’m glad we can figure it out with both of our busy schedules.

DrMR: Yeah, it actually worked out pretty good to be able to reschedule a week afterwards. Usually, it’s a few months, I feel like, but it worked out pretty good.

JF: It did, it did. And I really appreciate it. We’ve learned a lot about technology. We both had hiccups, but we’re back. And this is actually for your audience who may not quite remember, you were on my podcast, like I think we said it was like two years ago, talking about—it was one of my favorite podcasts. You talked about how to bring down the cost of the functional testing and how you can help people save money so that it’s not this super exorbitant experience that consumes all of their money in the bank. And I really loved and appreciated that, because I know that not all of this stuff is covered by insurance and you want to make it accessible to as many people as possible. Obviously, your mission is to really get out there and help people. So it’s a great podcast.

DrMR: Thank you. And it was a lot of fun. And to the point of making healthcare affordable, you have to really nail the fundamentals, because what you want to try to guard against is someone going on to testing and treatment and hopefully not even going all the way to more experimental or exotic testing treatments if they’ve missed one of the fundamentals, one of the foundational pieces. And of course, diet is a huge piece of that. And removing gluten from the diet is a huge piece of that.

And so this is what leads us to our discussion today, which is a gluten-free diet and how to, I guess for lack of a better term, flawlessly execute that. And you shared some interesting things in our last conversation on this. But before we jump into that, can you tell people a little bit about your background? Because you have an impressive background and involvement in the field, so tell people a little bit about you, your background and then we’ll launch in.

JF: Yeah. So I worked for my dad who is a medical doctor and a surgeon for about 10 years in his office. So I got the sense very well of what conventional medicine was like. And during that period, I ended up—now, I’m Italian, so I used to love pasta, bread, pizza, etcetera, and I ended up getting really sick. I couldn’t wake up after sleeping even 11 hours. I felt drunk. I had a lot of digestive problems. I’d put on like 20 pounds. I felt like old. I was 27 years old at the time and I felt really old. I mean, I couldn’t even ride my bike. I was an avid road cyclist and couldn’t ride my bike anymore because we’d get 10 minutes from the house and I was like, oh my gosh, when can we get to the bathroom? Because I had such terrible diarrhea that I couldn’t control it, I didn’t know when it will come on, and it will come on of course at the most inopportune times.

And so I went through the process of discovering that gluten was a huge problem, along with other food sensitivities. And I also ended up, unfortunately, going the route of the standard gluten-free diet that led me down the path of ending up with adrenal fatigue and Candida and such. So I’ve seen the ups and downs, personally, with having to do this alone. And I became a wellness coach. I started coaching people in 2009. And then I felt like, for my community, I’d start a gluten-free school at some point because I wanted everyone to have the resources and tools that I did not have when I was advised to go gluten-free. I decided that I needed more education in order to really serve the people, like myself, who were not getting served, and to really be able to understand what doctors, like yourself, or other functional practitioners, were saying and recommending. And so I went back for a master’s in Clinical Nutrition at the University of Bridgeport and completed that program. And so I ran a gluten-free school and had a private practice myself and, yeah, that’s what I do.

DrMR: All right. So like many of us here—when I say here, I mean in the functional and integrative space—you’ve had your own health experience, which I think is always a great teacher to give you that additional depth of understanding of what it’s like and sifting through research and just being able to have kind of a practical boots on the ground perspective with this stuff, which is fantastic.

Avoiding an Irrational Fear of Food

Now, one of the things that we talked about last time we spoke, last week, was how do we balance this spectrum of being careful about avoiding gluten in your diet on the one hand and on the other hand not falling into this pseudo-orthorexia, fear of food, not going out, not doing anything. And you had some good thoughts on that. So how do you balance these two seemingly opposing extremes?

JF: Well, I think the first piece of it is that we need to take a step back from very inflammatory information that is readily found on the internet, because if anyone has ever done Google research as I have for myself, it’s easy to find websites that will tell you that gluten is toxic, that it’s poisonous, that it’s the devil, that, oh, by the way, you also need to avoid all these other food sensitivities, because I’ve seen stats of 50% of people with celiac disease should also avoid dairy because they may be sensitive to that; and oh, by the way, maybe eggs are bad too; and oh, maybe you should take out soy and maybe you should get rid of corn and maybe you should get rid of rice and oh all grains are bad; and then you start to going to cross-reactivity. And you can go on and on endlessly down a rabbit hole to the point where you’re afraid of drinking even something like tea because tea could contain pesticides and all sorts of things and they’re GMOs and they could wreck your gut.

And I get emails from people weekly that are terrified to consume anything at this point. And their diets, I had clients that come to me and I’ll review—there are seven days of a diet journal. And I’m looking at this like, is this all you eat? Like your diet is so limited and I don’t fully understand why or how they even got here. It wasn’t directed by a doctor or a nutritionist or a dietitian. They’ve just been reading things online. They’ve seen someone tell their story and assume because their symptoms were the same, that because it worked for that person, it’s going to work for me. It’s guaranteed.

DrMR: Yup.

JF: And I think that’s why it’s really important to take everything, everybody’s story that you read online, everybody’s Instagram account that you follow online with a real grain of salt because it’s really easy to post a picture on Instagram and say, “Oh, yeah, this is what I ate today,” when that’s not what you ate at all. It’s really easy to make your story seem a lot more convenient and fluid and straightforward than it really was.

People don’t want to hear—there’s a phrase like nobody wants to know how the sausage is made. And the truth is, people don’t. They just want to eat the sausage. They don’t want to know the disgusting way that it ended up getting on their table. And the reality of it is, we oftentimes don’t want to know the nitty gritty gross details of how someone got from being really sick to a lot healthier. And we also confuse, it’s very easy to confuse symptoms that just because they have the same symptoms, that that must be my way.

And so that’s why I say, we have to be very careful in reading anything. Everybody that you follow online, I always take everything with a grain of salt. I even tell my clients and anybody that maybe there’s something else out there that will start conversation or help us all to grow as a community. And if we just blindly follow every single thing that somebody says, we end up becoming so afraid of food or even just afraid of gluten. I have clients that are afraid to go out to eat because, well, this fork likely touched something that had gluten on it, so how can it possibly be gluten-free? And I think that there’s that whole side of this that we, unfortunately, and I do think that our community of experts has played a really serious role in contributing to this confusion.

DrMR: I agree.

JF: We have to take responsibility for that.

A Timeline for Elimination Diets

But another piece of it is that we have pushed on people these excessive elimination diets and we give them no guidelines. No really clear-cut guidelines, for the most part, of how long those elimination diets should go on. And so I had asked, I did a podcast with Mickey Trescott. And she always talks about the Autoimmune Paleo Protocol. And she’s like it’s a protocol; it’s not a diet. If you really don’t dramatically feel better after 30, maybe 60 days at most, you have to get help. And she was really the first person ever, ever—I have like almost a hundred interviews on my podcast—she’s the first person to ever say that. And that podcast was about a year ago.

So I think it’s a shame that people think that they have to be on these protocols for excessive periods of time and they become miserable. Their family resents them because they don’t want to eat things. I’ve heard “I hate how I feel. I feel like a food Nazi. My family hates me. They don’t want to hear what I have to say.” And we don’t realize that oftentimes we develop these irrational fears because it’s easy to control food. And I personally believe, and I don’t know how you feel and I think it’s valid for you to also share your feelings, but if you really don’t feel better after 30 to 60 days, like on an elimination-type diet, you likely should ask for help. That’s my personal opinion.

DrMR: I agree with you. First of all, with everything you said, I think that’s very well said. I agree with you wholeheartedly. And I also agree on the timing. And in the book that I just finished writing, I walked people through trying different diets but giving them, in some cases, as short as a two-week trial. Because I want to move people through the dietary trial piece quickly and then move them either firstly, hopefully, they’ll discover a solution there; or if not, secondly, then move them to other interventions.

So like you said, getting help. Because, yes, telling someone that they have to just stay on the diet even when they’re feeling poorly on it because there are some esoteric layer of healing that’s happening and you’re going to feel a lot worse before you feel a lot better. There may be an occasional time and place for that. But outside of maybe a short-term withdrawal, you’re coming off of sugar, you’re coming off of caffeine, and you feel a little yucky for a couple days, maybe a week.

Feeling yucky well beyond that, in my opinion, is almost always because you’re doing something wrong, not doing something right. And because of that, if you’re not feeling any better or you’re feeling worse after a short period of time, anywhere from a couple of weeks to a month or so, then, yeah, I completely agree with you. It’s time to move on and start thinking about other things, absolutely.

And something that we’ve talked about on the podcast before, which is don’t try to force a nutritional solution to a non-nutritional problem.

JF: Exactly. Because as much as I love to say, yes, food is a medicine, it does not resolve everything.

DrMR: Right. Yes, it’s a foundation of a pyramid.

JF: Yeah.

DrMR: I always picture a pyramid in my mind whenever I’m working with a patient or helping to craft recommendations. And the foundation is always diet and lifestyle. And then you come up the rungs of the pyramid. But you can’t discount that. But also it’s not going to be everything to everyone all the time, absolutely.

Celiac vs. Gluten-Sensitive

So Jen, tell me, what are you seeing in terms of—and I know you have a population of people that you’re working with that are very interested in gluten and have probably noticed a level of reactivity to gluten. So I think you have a certain sample and I like you to speak to that as part of your answer also. But what are you seeing in terms of how many people have to be incredibly strict about avoidance? How many people have a little bit of leeway? How many people maybe don’t have any problem at all? What are you seeing in that regard?

JF: I personally don’t sit in the camp that gluten is the devil. So I didn’t even cover that. I don’t need to go over why. But that said, there is research that shows that while gluten does create an issue, gut permeability wise, for everyone, not everybody is in this boat that they’re going to end up sick from gluten. I personally cannot—I mean, I’ve been gluten-free for nearly 10 years. And when I eat things that I find out later that were contaminated, I will end up with a rash across my face. I’ll end up with digestive problems, all sorts of issues. So whether my issue truly is celiac or not, and I don’t know because my nutritionist at the time never advised me to get tested. And I didn’t know what celiac was for a long enough period of time that at this point—

DrMR: Were you celiac or are you kind of more…?

JF: So, I don’t know. I actually don’t know.

DrMR: You don’t know because you’ve already been off of it, got you.

JF: I had gluten sensitivity testing—well, food sensitivity testing done. When I pulled gluten initially out of my diet, I felt incredibly better. But I am sensitive to other things like eggs and dairy, etcetera. So that said, and this is an important point, the sensitivities to the other items have changed and has improved. So I can tolerate some levels of dairy. I can tolerate smaller levels of eggs like mixed in things. I can’t do Paleo breads and stuff where it’s like 10 eggs in a loaf. But I can do like two eggs in a whole batch of something and I’m okay.

So, I do think that there is room for improvement no matter where most people are. That said, most of the people that are in my community tend to have celiac disease or pretty severe reactions that don’t necessarily allow them the ability to be flexible. I do know people like friends of mine that were like kind of moderately to mildly sensitive to gluten went to like, say, Italy and ate regular food and said they felt fine. I went to Italy in April and did not do that. I ate gluten-free. But I will tell you this, I didn’t actually watch any of my other food sensitivities, the dairy or eggs and I didn’t get sick at all. My husband was like, ‘How are you eating things that have eggs and all this dairy like multiple times a day in them and you’re not getting sick?’ And I can’t tell you, like nothing, did not get sick at all. And he is the first person to notice.

So I do think that there’s something to be said about the quality of our food supply and such. But most of the people in my audience actually get quite sick. And where they do have some leeway are in the other sensitivities that pop up oftentimes and things that tend to be on the mild end will dissipate and sometimes even the moderate ones will as well. But the concern for me mostly is helping people who really do truly need to figure out how to do this lifestyle, because it is integral to their body’s ability to literally heal and for them to function on a daily basis for them to become more compliant. And the rate of compliance is really not good. I think, as a whole, we should be pretty concerned because people tend to take more liberties than they likely should.

I surveyed my list and we’re looking at like 36,000 plus individuals. And I’ve done it on a number of occasions. And it’s interesting that like after a year, about 70% of people who are supposed to be gluten-free are not compliant, 70% after a year. You look at two years, the rate drops to 54%. Beyond the two-year mark, you’re looking at 42%. So we’re still looking at a large number of people that never really got to compliance and still don’t feel well, like they’re still not well. And it’s a little challenging when they’re trying to see a doctor, the doctor’s recommending them do this, and they just are not being compliant. So I think that that’s a big piece to this that oftentimes gets overlooked, because you don’t have a ton of time to teach somebody all the ins and outs to do this. It’s a lot.

Sponsored Resources

DrMR: Hey, everyone. I wanted to thank the two companies that help to make this podcast possible. Firstly, Kettle & Fire, which has a great line of bone broth products. They are, of course, organic and devoid of fillers, preservatives. But in spite of that, they also have a very stable and long shelf life, which is great for me, because one of the things that happens is I sometimes end up wasting bone broth. So having a serving that is shelf-stable and lasts a while is definitely helpful. So I would definitely check out Kettle & Fire. They taste good, they’re clean, they’re convenient, and they have a long shelf life. So, definitely something that can be very helpful and has help made consuming bone broth easier for me.

Also want to thank Equip Foods and Perfect Keto, two companies that are owned and operated by Anthony Gustin. And as you probably heard on the podcast before, he went to great lengths to make sure that his line of protein powders, of pre- and post-workout powders of exogenous ketones, and medium-chain triglyceride powders were devoid of excipients and fillers. And I have to say, I feel the best, namely the least bloated, when I use these products out of any of the products that I’ve ever tried. So I highly recommend also checking out Equip Foods and Perfect Keto for some of those powdered products. Okay, back to the show.

How to Make Testing More Accessible

One of the things that’s been nice with a lot of the patients that I see in the clinic is they’ve already educated themselves on diet. So I don’t necessarily have to give them a lot of coaching. That’s been very helpful for me. Now, as our clinic is starting to attract I guess less health enthusiastic people, I’m starting to see people who need more support there. And so it’s an interesting dynamic. Because as I focus on trying to bring the cost down, I am noticing, or able to reach more just kind of general folks, not the people in the Paleo community, who are awesome. Don’t get me wrong there. They come in. They’re super well-educated. They’re very compliant. They’re a delight to work with.

But it’s also nice to be able to reach people who haven’t had that ‘aha’ yet and had that epiphany about their healthcare. And I’ve been able to reach more of them as we’ve made the lab bill less encroaching. But why that’s relevant is because now that I’m seeing more of those people needing more resources to the right people too, because you’re right, I am challenged in terms of having as much time as I’d like to have to be able to go over the dietary fundamentals with them. So I absolutely agree, people need resources in order to be compliant.

Tolerating Troublesome Foods

And I wanted to touch on one thing you said a moment ago and just kind of piggyback on that, which is you’re able to eat more some of the other reactive foods that you were not really able to eat previously. And I think it’s just important or worthwhile to reiterate that—remember that as the intestines heals, and this is remember for the audience I mean, as the intestines heal, you’re able to secrete more enzymes that can help you with breaking down of food like dairy enzymes, which are made from the brush border, also histamine-degrading enzymes.

And even on a little FODMAP diet, research is showing that you can have an increase in serotonin cells, which can help with motility and also with pain signaling or, hopefully, reducing pain signaling. So the intestines definitely can heal. And certainly, we see plenty of evidence showing that as your intestines heal, your gut health improves. You should be able to tolerate more of these foods.

I just make that qualification because unfortunately—and this drives me nuts when I see this—every once in a while, you have a self-proclaimed guru on the internet who says, “I can now eat dairy, and I wasn’t able to eat dairy six months ago because of x, y, or z magic pill that I have.” And what bothers me is it’s claiming that this product is magical when it’s just really trying to identify and remove the things that are irritating the gut is really where the magic comes from.

JF: There are no magic pills.

DrMR: There are not, yeah. I absolutely agree that there are not. So I just wanted to piggyback on that.

How to Begin Addressing Gut Issues

And then as you transition into some of the tips for avoiding gluten, I just want to paint for the audience something that I see in my mind, which is kind of this divergent path, if you will, or we can maybe even paint into the pyramid-like hierarchy. But what I see is this, if you’ve gone gluten-free and you haven’t fully responded—and I should mention, if you’ve gone on elimination diet, because if you have an unhealthy diet and you just start avoiding gluten that certainly—that may be helpful, yes. But I wouldn’t say that’s a great diet. I think starting with something like a Paleo diet or a similar-type diet that eliminates common problematic foods is a great place to start.

If you’ve done that and you haven’t seen optimum results, I think there are two other things to consider. First would be being a bit more diligent or compliant with a gluten-free aspect as Jen is going to outline for us in a moment. The other would be getting help, also like you said before Jen. And this will be in my mind starting with a good gut evaluation looking for things like SIBO, other infections.

And again, last time when we recorded this last week, I mentioned that there was one study in particular. And I forget if it was in celiac or if it was a non-celiac gluten sensitive. I’m fairly certain that this study wasn’t celiac patients who were recalcitrant to a gluten-free diet, meaning they hadn’t seen a full response with a gluten-free diet. And they did a workup and they found in the majority of these patients there was small intestinal bacterial overgrowth. They also found Blastocystis hominis infection in a couple others. And essentially, they treated these patients with various antibiotics and they saw a resolution of the non-responsive symptoms.

So that’s definitely one avenue that can help you. But again, we also want to make sure that you’re being fully compliant. And as you mentioned before, Jen, sometimes people aren’t getting a good set of guidelines to help with that. And I know you have a number of things that we discussed last time that were, I think, important for people to know.

Staying Compliant on a Gluten-Free Diet

So what would you say to people? What would be some of the most salient tips for making sure that they’re on a compliant gluten-free diet?

JF: Yeah. So the first thing I want to talk about, which we didn’t talk about the last time, but you mentioned magic pills. So let’s talk about magic pills. I think that this is actually a really good topic, because it’s often brought up in a lot of the gluten groups that are online like, “Oh, I’m using these gluten enzymes, and I can go and eat what I want.”

Now, first of all, if you have celiac disease, they do not work for you. And I would argue that I don’t think that those pills actually work as often as most people think they do.

Gluten Digestive Aids

I had done a bunch of research and I don’t know if you’ve looked into them, Dr. Ruscio, but I had done a bunch of research because I was a bit alarmed at the rate by which companies are coming out with their own like gluten product. They’re like, “Oh, buy my gluten enzyme. It’s $50 a bottle. And you should take it before every meal, just to ensure that every piece of gluten is broken down and it doesn’t get to your intestines,” as if this is some surefire way to avoid learning the ins and outs of how to live gluten-free, how to dine out gluten-free, how to ask the right questions, do the right research. “Oh, you should just take a pill.”

And what I found was most alarming is that I’ve tried to contact a lot of the big companies like Gluten Cutter, for one, is one that I think is available in a lot of different stores. They never got back to me to provide me any research whatsoever. And in fact, you can’t really find any research on their website. They sort of cite things, but then don’t point you to the actual research that proves anything.

Other companies got back to me with research that was really shoddy, like it was basically looking at people who were normal. They were healthy individuals who didn’t have any problems with gluten. I don’t really know what the point of studying those people are because they’re not looking at what’s happening to the proteins and the digestive process. They’re just looking at their symptoms, that’s it. And to me, that’s really not enough to say whether a product like that works.

Now, one problem that I have with the product and I had actually voiced with a biochemical engineer that works for Jarrow, was that if a lot of people with digestive and autoimmune issues have problems with low stomach acid, well, if you don’t have an acidic enough environment in the stomach, how can you be certain that these enzymes may be properly activated or any number of things? And he’s like, well, you can’t. That’s one of the big drawbacks is we can’t guarantee that the enzymes will actually ever be activated.

So they’ve predominantly done test tube studies. But you can’t correlate test tube studies to what’s going to happen in the human digestive environment, because there’s far too many factors involved in that. And one product in particular that I looked at, I had to search and search online because I requested the study repeatedly, and I was kind of given the run-around, which really annoyed me and angered me. Because, really, if you’re going to cite that as your main support piece saying that this is why this works, we have definitive proof, then you should have no problem providing me a link or a copy of the PDF to review.

Well, it turned out that it was this terrible study and I actually had a biostatician look at it because I was kind of curious to see what somebody who really can look at this kind of data could tell me. And she actually bought, at the time, the product and was horrified that with the claims that were being made based off this terrible study. Again, it was just based off a very small cohort of people that were healthy so they weren’t even the right population. And they were just looking at symptoms, that’s it. They didn’t actually do any other testing to make sure that the product was actually working. And she said she would no longer purchase that product and was horrified that the company and the individual, the expert in our community was claiming that this product was amazing and selling it for like $50 a bottle.

So I just advise people to, fine, if you feel like you really need a backup, I guess, go ahead and try. Again, there is some research out there that some of these enzymes and test tube environments do work. But they haven’t done a whole lot of really good human clinical trials that show that these products actually do anything. And they should not be an excuse for cutting corners or not doing research or asking the right questions or learning the rules of how to essentially play this game. You have to learn.

DrMR: Yup. You’re 1000% right. We could do a whole podcast just on this, I feel like.

How to Find Reliable Studies

So one of the things I think that leads or gives many of these companies marketing fodder is citing mechanism. This is why I’m such a big critic of not using mechanism to justify a product, a test, or a clinical intervention, because you can find a mechanism to say or to reinforce almost anything that you want.

And you’re right. A lot of these studies, the purported studies that are used to support a given product, are merely mechanism studies oftentimes in test tubes or sometimes in animals or even mechanisms in humans. But we need to have more than just mechanism. We need outcome.

Gluten-Degrading Enzymes: Effectiveness & Red Flags

There are a small number of clinical trials that look at outcome. And I do review these in the book and I break them down by either supplement-grade gluten-degrading enzymes or pharmaceutical-grade gluten-degrading enzymes. And the long story short is you see that there may be a slight benefit for those with celiac when used occasionally. And that’s a maybe to a slight benefit. And that’s the best case scenario.

Other studies have shown essentially no benefit at all. And one of the things, not to get pulled too far on this tangent, but one of the rhetorical questions I’m asked and answer in the book when I address this is, what about my friend who started gluten blaster 5000 enzyme and swears she feels better? It’s important to remember that placebo, the placebo effect that is, in randomized control trials where they’re trying to control and minimize the effect of placebo averages at 45%. So if your friend, Mary Sue, read an article, compelling article with all sorts of cool fancy graphics about how helpful this enzyme could be and took it and feels like she felt better, there is an extraordinarily high possibility that that may be from placebo.

Now, I’m not against that. But if that comes at $100 a month or $200 or $300 a month, depending on how many these enzymes you’re taking with each meal at $50, $60, $70 a bottle, then that’s where I start taking issue with it. So that’s my rant on that whole piece.

JF: Well, and the other problem I have, and these are red flags I think that are good for people to know, is like if the study is in Chinese, so you can’t read it, that’s a red flag. If the study again mentions that it was done in animals or test tubes, that’s a red flag. If you don’t see any research whatsoever, before you go and spend all this money, email them and say, I’d like to see the data that shows some sort of proof that this product actually works. And if they’re not willing to provide it to you, that’s a red flag.

DrMR: Yup. I 100% agree. All right, so the enzyme piece, people, be guarded on that because I think this is one area where a company would love to get you on a product that you feel like you have to take every day or multiple times a day for the rest of your life. It’s very attractive.

And don’t get me wrong. I don’t think these companies are mal-intended or mal-intentioned. But there are different people in these companies and sometimes what you’ll have in these companies is a back and forth between the medical research department and the business department. And the business department may decide to put more marketing into a certain product or really to position the product higher because they think they can get a better return from a given product. So you have to just know that going in and going to the discussion with your eyes open.

Finding Certified Gluten-Free Products

But to get us off of the topic I’d love to talk more about, coming back to you—all right, someone’s maybe doing a gluten-free diet but they’re scratching their heads saying, “Hmm, maybe I’m not doing it as compliant as I could be, what are some things that may be tripping me up that I’m not aware of?” Where would you take us next?

JF: Yeah. So the first thing I would say is make sure that you’re looking for certified gluten-free products, because products that are simply marked gluten-free may or may not be checked on multiple levels for where gluten contamination could occur. So when a product is certified gluten-free, they’re certified by a body, a certifying body, that essentially will look at, for example, are the ingredients, the initial ingredients, gluten-free? Are the ingredients then stored in an area that will prevent any sort of cross-contamination through the airway ducts or just handling, in general? Are the production lines cleaned appropriately and well enough to then produce a product that is gluten-free?

Because a lot of co-packers—that’s what these companies are that make food, they’re called co-packers—a lot of them are not solely gluten-free facilities. I think that’s a real big confusion point. People think that like, oh, it’s a gluten-free product. It’s made in a gluten-free facility. That’s not true. They will typically tell you if it’s made in a gluten-free facility or not.

Otherwise, there’ll be other warnings on the packaging stating that. And these are all, by the way, they’re not required by law to be included, so it’s important to understand labeling. But they will say things like, ‘This facility may include soy and peanuts and wheat’ or ‘This product was produced on a line that also uses wheat, dairy, and eggs’ or something like that. That’s a voluntary warning that they’re allowed to give you just to kind of like cover their butts.

But a certified gluten-free product is not just checking all these different points at which the product could become contaminated, but they’re also checking the finished product. Though it is not to say that certified gluten-free products haven’t been recalled due to contamination problems that exceeded 20 parts per million.

Avoiding Gluten Contamination

Now, to be clear, most certifying bodies are certifying products between three to five parts per million and then up to 10. They don’t usually certify 20, which is the legal limit set by the FDA in the United States as well as most other countries that have a legal limit. With the exception of I believe Australia and New Zealand, which their legal limit I think is really low. It’s like the lowest testable level which currently is three parts per million, not zero parts per million because it’s a threshold. You have to test beneath three parts per million. So you can’t test below zero.

And so understanding gluten-free labeling is really important, because one in five products that are labeled gluten-free, it was found in an article that was written in 2014 in the Journal of Food Protection, found that one in five was actually not gluten-free. And so it’s possible that you could be getting contaminated in that respect. It is also possible for gluten levels to ‘add up’ throughout the day. So if you’re eating a ton of gluten-free products, maybe your diet is gluten-free cereals and gluten-free breakfast bars and then sandwiches and pizza and pasta and all this stuff, just gluten-free products all the time, you can essentially be consuming too much within the amount that you’re allotted every day. So that’s a problem.

You also want to make sure that you understand that you have to look—if you do tolerate oats, for example, you have to look for certified gluten-free oats. Oats, while they don’t contain gluten in and of itself, they tend to be grown in fields next to wheat, processed on the same equipment, and heavily contaminated. Again, that’s been studied and found to be the case that regular oats are not safe to eat.

And even naturally gluten-free grains are a big problem because people go, oh, I’m at Whole Foods, I’m going to the bulk bin aisle and I’m just going to get my brown rice and I’m going to get my millet and my quinoa out of the bulk bins because it’s cheaper. Well, yeah, sure, it’s cheaper. But you don’t know where the spoons were put. You don’t know if those containers were cleaned out recently. You don’t know what has happened. And so bulk bins are not a safe way. Aside from that, it’s been discovered that about one-third of all naturally gluten-free grains are contaminated to a point where they are no longer considered gluten-free. It’s just because there’s so much wheat and gluten-containing ingredients within our food supply that it’s very easy for things to become contaminated.

So I would also advise people the same goes for beans and nuts. I know there’s like all these jokes and memes about gluten-free water and that’s kind of silly. But I was at a trade show, I go to a lot of these food conferences, and this one company, I think they’re called Rebel. They’re like a smoothie company or something. They make these drinks that are in Whole Foods and they look really fancy and they have all these like adaptogenic herbs.

DrMR: Oh, yeah, I’ve seen them.

JF: But the thing is like some of them contained protein powders. And when I ask them, are these gluten-free? He was like, well, no, what would be the problem with them? And I’m like, well, you’re using all these super protein powders that could be contaminated. Like you can’t say that these are gluten-free. Like don’t tell me that when I ask if it’s gluten-free and you’re like, oh, yeah, it’s fine. It’s not fine. So if you see in your beverages that there’s a protein powder and other herbs, for example, those could be contaminated depending on where they were stored, where they came from.

And so, you just want to be cautious and ask questions. And let companies know too, if you have a favorite product or favorite company and you find that they’re not doing the testing and they’re not checking their ingredients, let them know. Because a lot of companies aren’t going to go through the process and the hassle and the expense of doing it if they don’t think their customers want it.

The Downfalls of a Dietary Dogma

Dr. Ruscio, have you gone gluten-free? I apologize; I don’t actually know.

DrMR: Yeah, I was gluten-free for probably four years, pretty darn strict. And then I started to realize that there are some dogmas in the field, as you alluded to earlier. And I started to experiment a little bit and then I realized like, “Hey, I can be out once in a while and I can essentially have gluten with no discernible reaction.”

Now, I don’t make it a staple but, yeah, I can have it. And what I learned from being gluten-free and not being gluten-free is it is easier, it really is easier to not to have to be gluten-free all the time. And this is why I encourage people to find their own truth. If you have to be gluten-free then that’s great and we can work with that, we can make that happen. We can make it workable. But if you don’t have to be gluten-free, let’s not have you follow the rigors of that, just out of dogma from the field.

JF: Right. And it’s interesting, that’s what I was asking because it can be a real challenge then when it comes to—people are like, oh, it’s really hard to avoid gluten in food. You know what, in this day and age, I was in Costa Rica, in a little tiny village, and I had no problem. I was in Italy, had no problem. So I don’t know how hard it is per se all the time.

Dr. Ruscio’s Resources

DrMR: Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.

For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.

And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show.

The Challenges of Going Gluten-Free

JF: What I do find more challenging is really the social implications that are the result of being gluten-free. So like what do you do when you get a wedding invitation from your cousin, how do you make sure that the caterer…There are 300 people coming to your wedding and you’re the one person that they all of a sudden have to be mindful of your meal. Or a funeral, like how do you handle a luncheon for a funeral? Or dating. That’s where the challenge is. The social implications or the dampers that are put on your life that can really make you be careless. For someone who really does need to be gluten-free, it’s important.

I mean a lot of people too, and I will say this, spend too much time online asking people who don’t actually know the right information. Is this product—I mean, I’m like, I take screenshots. So if anyone’s like no, they don’t. I have screenshots. I can even tell you, I have a whole folder of screenshots of people asking about products that clearly they shouldn’t be eating. But because it doesn’t look like there’s gluten in the product, they’re reading the ingredients, let’s try and like find a needle in a haystack, that we’re not ever going to find, that they end up sick.

And so don’t go online and ask Facebook groups, is this product safe? You call a company and you ask them directly. Ultimately, at the end of the day, like something’s—like I found out Bush’s Beans, for example, I don’t know if they label their cans now but a few years ago, I called them, I was curious if they did double check and they actually did. She said, we haven’t changed our labeling yet. So it is possible that some things that aren’t marked could be. But just don’t rely on strangers. They don’t work for companies.

DrMR: Right.

JF: And just because they don’t react doesn’t mean—like you and I are talking about a spectrum of symptoms. So just because somebody else doesn’t react and you said like, what the friend that uses the gluten blaster 5000 is fine. It could be that they think it’s gluten-free and so they feel fine. And you’ve got that whole placebo effect going on. So you really want to be certain that the information you’re getting is good, that it’s concrete, and it’s coming from a reputable source. And people may all the time and go, is this gluten-free? And I’m like, I honestly don’t know, you need to speak with the company. That’s my first response. And it’s the most responsible response. I know it sucks because you have to make the effort, but so is life.

And truthfully, once I find a product that I can eat, that I really enjoy, I become usually a fan for life, I guess. So to me, my food world has really expanded. I try to be very positive about it. But the social implications can be really challenging.

How to Dine out when Gluten-Free

And I know you had asked me the last time some information about like dining out. And I think that one of the main things I would love to get across to people is that you have to do research before you show up at the restaurant. You don’t have to feel like you have to do research every single time.

One of the apps that I use that is a starting point, not the end-all be-all but a starting point, is called Find Me Gluten-Free. And I’ll go there first. And I’ll look and see what’s available in my area and then I’ll read the comments. And again, I take all the comments with a grain of salt because there are a lot of people who will say, “Oh, my gosh, their fries are gluten-free!” And I’ll ask them. And they’re like, “Oh, no, we fry everything in there.”

DrMR: Right.

JF: And so that’s not the case. Again, this comes down to the fact that people don’t actually know what questions to ask. And it is also entirely possible that a restaurant, their entire staff is not fully trained well enough to be able to handle all of your requests.

So you find places first. You read their comments. You’re like, okay, that kind of looks good. Nobody seemed to have a bad problem with it. And then I make a phone call and I don’t call at lunch or at dinnertime. I call at mid-day when they’re not busy. And I’ll ask them a slew of questions and I will always ask the manager, not the person that answers the phone because the hostess may not have any idea. I was once told that if I was looking for organic food then yes, they had gluten-free food. I was like I don’t even know what that means.

DrMR: Yeah.

JF: So that’s why you don’t talk to the hostesses. No offense to anyone who’s a hostess. But not everybody is well-enough to be trained of what goes on in the kitchen. I will explicitly ask certain things like, do you have a dedicated fryer? And that means that the fryer is only frying foods that are gluten-free. And sometimes they’ll say yes.

But I’ll follow up with a second question because I’ll have looked at their menu already. That’s some of the research that I’ll do ahead of time. I’ll look at the menu and I’ll see are there any fried—like sometimes you and I talked about like do I eat this healthy, super healthy, like clean diet? No, I eat french fries once in a while. Like I’m a normal person. I try to enjoy life. To me that’s more important than like being obsessed with eating clean food all the time.

But if I, say, I want to have french fries, the next question I’m going to say is, well, I see that you have chicken fingers on your menu, do you fry that in the same fryer? I will actually ask them what else do you fry in the fryer. Does anything that goes in the fryer have wheat? Even if they tell me it’s dedicated, because sometimes they don’t fully understand what you mean, and then they’ll say, oh yeah, we do fry that in there and you can’t have it. Just because something’s gluten-free going into the fryer and they fry other things in there, it’s no longer gluten-free because the protein that is gluten is very stable, so stable that it requires a tremendous amount of heat and time exposed to that heat in order to denature or breakdown essentially to a point that it wouldn’t bother you anymore. And it’s like 500 to 600 degrees Fahrenheit, but nobody cooks at that temperature.

So this is why you have to know the right questions to ask, like can they clean the grill? Can they do certain things to ensure that your food is going to be safe? I already know walking into every restaurant that I’m going to go to, what options are safe for me on their menu. So when I sit down, well, yes, I’m going to tell every single person I come in contact with, that my food needs to be gluten-free. I’m very clear about that. And I will tell them that it’s for medical reasons. I’m not going to sit there and have to grill the wait staff and annoy everyone else and get all these like nasty side eyes and stink eyes because people are like move it along. I don’t want to push it.

DrMR: Right.

JF: So it’s important. That’s why you come up with a list of like five to 10 restaurants before you even go out. And when we do, whenever somebody says, ‘Hey, you want to go out to eat?’ Be the first person to suggest a restaurant off of your list and sell it to them in a way that would entice them to go. So don’t talk about being gluten-free. Nobody cares that you have to be gluten-free, just say, oh my gosh, I found this amazing Mexican restaurant and supposedly they have these killer burritos. Maybe the person loves burritos. And let’s go check that place out. I’ll make the reservation, okay? Like kind of don’t even give them the opportunity to like really think about it, just take over, take charge. And most of the time, people won’t even ask you if there’s anything you can eat until you’re sitting down and your food is about to arrive.

DrMR: Right.

JF: So by doing that, you get rid of this whole back and forth of like, can I eat anything? What should I ask? And you make your life a lot easier. Everybody’s happy. And you get to actually enjoy being social and going out and you’ve already done your due diligence before arriving there.

DrMR: Yeah.

JF: You can’t convert a regular restaurant into a gluten-free experience very well, like don’t get mad at restaurants because they can’t do your diet. Like I would never walk into a Chinese restaurant and order a plate of pasta with like marinara sauce. It’s not what they do.

DrMR: Good point, yeah.

JF: I think oftentimes we are really on our high horses and we forget that not everybody’s set up for that. So it’s important to again do your research. And then the other cool thing is, like I said I visited Italy and they actually have an app in Italy, if anyone cares, I believe it’s AiC Mobile. And if it’s something you want to share on your website, Dr. Ruscio, I’m happy to provide you the links in order for people who may be going to Italy or who are interested in going to Italy can download the app. There’s a few steps you have to follow in order to get it to work. And then I would highly advise you just one hiccup with it, double-check on Google all of the addresses of any of the restaurants listed, because you did find that they were not always correct.

However, the database is compiled by the Celiac Association of Italy and Italy is far beyond us as far as awareness of celiac disease and gluten-related issues. Their information is really trustworthy through this app. It was incredibly helpful. And I was able to enjoy like fresh homemade pasta, freshly baked breads, fresh soups, like all these amazing pizza. There’s like gluten-free dedicated bakeries and there’s a chain of them like we found it in Florence and are all over. There’s a dedicated gluten-free gelateria, a chain through Italy. Like there are places that you can go and really truly enjoy food.

And so I want to always encourage people to be positive, to look for what they can enjoy, and never lose sight of the fact that our life is what we make of it. And if you only see, like if you feel like everything sinks, it’s going to sink. But if you keep that open frame of mind and you’re like, hey, if I take a trip, let me find a new place to enjoy, it really does bring a lot of color to your life. And it makes your relationships better and just the feeling of being somewhat spontaneous and being able to go out and just be like a normal human again.

DrMR: It’s a great tip, because I think if you can do your research ahead of time, just like you said, and know where to go, you can make this a very easy experience. If you go into a restaurant and try to convert them on the spot to be gluten-free, you’re going to have an uphill battle. So I think that for our audience will probably be a very helpful tip. I really like that one.

Gluten in Hygiene and Household Products

What about body care? I know last time we spoke you said nothing really significantly important there. I more so ask that question for the audience’s benefit because I do know some people who’ll get so fanatical about avoidance that they don’t even think they can put anything on their skin. And I believe you had said that doesn’t seem to be as prominent or important of an issue, right?

JF: To some degree. Lipstick, anything that goes on, in, or near your mouth, you should make sure that’s gluten-free. So lipstick is a really big red flag for gluten. A lot of makeup companies will put gluten to make the lipstick keep its consistency. Beyond that, I would say hand creams possibly, especially if you’re like handling a lot of food and you’re not going to wash your hands afterwards. I personally have to use gluten-free shampoo because when I was washing my hair, it became, like I started to get a lot of like dandruff but like my scalp was just falling apart every single time I would use shampoo and then I realized some of the names of gluten that show up in body care products under, like hydrolyzed wheat protein is pretty obvious, but hydrolyzed soy protein, hydrolyzed vegetable protein are all red flags for gluten. And so I just have to be careful with that.

But as far as like stuff you’re going to put on your cheeks like rouge and foundation, I don’t really worry about that. It doesn’t bother me. I do know some people that do. So I think, to some degree, once reactivity is personal and its trial and error, I just advise people to be cautious of anything that can end up in your mouth. And anything that you can potentially like inhale, yes, you can get gluten from making cookies. Like I know people that will continue to make regular cookies for their family and that flour becomes airborne and you can inhale it and some people will actually react to that. You also—this is sort of like two sides, you have to be careful what type of—if you’re a gardener, what type of hay that you buy, because sometimes the hay contains wheat in it and some people have reacted to that.

And other people have also found, like I’m really careful with pet food, not that you’re going to eat it but that your animals eat it. They don’t know what they’re doing and they’ll stick their faces in your food or in your glass. My cats are notorious for trying to drink out of my water glass as soon as I turn my back and they just finished eating. You want to be kind of cautious with that, though I cannot say that, for certain, that grain-free pet food is actually gluten-free because there are no labels on it. And as far as I can tell, no one has really tested it. But those are just some FYIs and some heads up, and so like keep an eye on your cats and your dogs.

DrMR: That’s fair enough. Last couple of questions that I’d like to ask you. One, and this is just to display that those of us who do this for a living aren’t necessarily health fanatics. What is the least healthy but most fun thing you’ve done lately?

JF: I had an amazing gluten-free pancake. It was just one because it was really thick in Costa Rica. And I don’t really eat pancakes, but that was pretty cool and they had homemade vegan Nutella. So that was pretty neat. I mean, I occasionally have gluten-free sandwiches. I’ve been jonesing for some gluten-free pizza, though that hasn’t worked out, I’ve been pretty busy lately. I don’t eat it all the time. But I’m Italian. I like to have pasta. I’m not going to give up pasta. I just have to be careful if I make it, how much I eat because I can eat a lot of it, so I have to go watch my portions.

And if I go out, I just have to make the right choices to make sure that they’re not boiling. Some people don’t know this, but there’s a machine in the back of a restaurant that will boil water and keep it boiling all the time. And so they’ll just throw your gluten-free pasta in that water where other regular pasta has cooked. So you have to be very clear with the restaurant and ask, “Are you going to cook my pasta in fresh water?” And it will take them longer, but that’s a good tip.

Episode Wrap-up

DrMR: And speaking of tips, I know you have a book and a program, can you tell people a little bit about that and then where else they can track you down.

JF: Yeah. So I have a book called The Savvy Gluten-Free Shopper: How to Eat Healthy on a Budget. And that book was really helpful because my husband had been laid off and we’re on a really tight budget and we had to figure out how to eat really well because I had adrenal fatigue and Candida at the time. And so I put all the practical tips into that book about how to bring down the cost, because I do think that that is a legitimate challenge for many people out there. And so that’s available on Amazon in both Kindle and softback copy.

And then, I also have a really great webinar called The Three Secrets to an Easy Gluten-Free Diet. So you can eat out, spot hidden gluten, make awesome meals for anyone, and still have a life. And that broadcasts twice a week. So it’s free for anybody to attend and check out. That’s another really cool opportunity for people to learn a ton of tips. I sure have a lot of stuff on there and talk about ways to really make the lifestyle doable.

And then otherwise, they can come on over to GlutenFreeSchool.com and find me there. I’ve got a podcast. I’ve got recipes. I’ve got a lot of like really great practical resources to learn how to do this as well as more in-depth research pieces as well. And so it’s my way of giving back to my community and making sure that they have the tools and the tips that I never had so that they can avoid the pitfalls that I hit every single one. So I hope that I make that journey easier for everybody out there.

 DrMR: Awesome. Well, it’s always just great to talk with someone who is all about educating people on gluten-free but not doing it in a fanatical way. Because, again, just like you said earlier, I think we’ve done a lot of good with the field but also a lot of harm by turning people into food fanatics and making them afraid of food. And I just love the kind of balanced approach you have to this. And I would highly recommend people checking out your book or program or gluten free school to get a balanced, reasonable approach on gluten rather than something that’s really heretical and going to spin you into this fearful existence.

JF: Absolutely. Well, thank you very much for having me. I love talking about all this kind of stuff. And I hope too that you can come back on my podcast one of these days and we can keep having this fun back and forth, because we obviously share a lot of different passions. And ultimately, I think both of us want to see all these people that are really underserved by unfortunately a large portion of conventional medicine, find the answers that they’re not able to get and get back to living. Get back to feeling like a normal person or as close to normal as you can and enjoy your life and your family and your friends and the finer moments of life that we all want to treasure and be there for.

DrMR: Absolutely. I love it, and we’ll definitely get something set up. And I guess until the next time, Jen, thank you again for taking the time and we’ll talk to you soon, hopefully.

JF: Absolutely.

DrMR: All right. Bye-bye.

What do you think? I would like to hear your thoughts or experience with this.

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Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.