Podcast – Should you be gluten free?

In this episode of Dr. Ruscio Radio, the doc asks the question, “Should you be gluten-free?” There has been a lot of talk lately that gluten-free is a fad and gluten sensitivity doesn’t exist. The doc has you covered with the science as usual! Dr. Ruscio starts by defining what Non-Celiac Gluten Sensitivity actually is. Podcast - Should you be gluten free? - podcast artwork newHe then delves into what the research says about gluten sensitivity, strategies if you are gluten sensitive, lab tests available for NCGS and what to do after being exposed to gluten.

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Topics:
Non-structured time …..1:01
What is non-celiac gluten sensitivity (NCGS)? …..3:16
Symptoms associated with NCGS …..5:03
What the research shows about NCGS …..7:04
Celiac light …..9:48
Strategies if you fall on the gluten sensitivity spectrum…..11:24
What if you don’t respond to a gluten-free diet? ….13:31
Lab testing for NCGS …..16:49
Don’t become a gluten-free crusader …..25:43
What to do after being exposed to gluten …..30:42

Gluten show Graphic one

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Gluten show Graphic 2

Links:

  1. (1:29) The One Who is Not Busy
  2. (7:04) 4 Randomized clinical trials (RCTs):
    1. http://www.ncbi.nlm.nih.gov/pubmed/21224837 Trusted SourcePubMedGo to source
    2. http://www.ncbi.nlm.nih.gov/pubmed/22825366 Trusted SourcePubMedGo to source
    3. http://www.ncbi.nlm.nih.gov/pubmed/25701700 Trusted SourcePubMedGo to source
    4. http://www.ncbi.nlm.nih.gov/pubmed/23648697 Trusted SourcePubMedGo to source
  3. (8:11) Link coming for 3/2015 systemic review
  4. (13:01) Recommended supplements:
    1. Digestzymes
    2. Therbiotic Complete
  5. (13:31) There are also other factors that could be damaging your gut and therefore causing your symptoms:
    1. http://www.ncbi.nlm.nih.gov/pubmed/25753138 Trusted SourcePubMedGo to source
    2. http://www.ncbi.nlm.nih.gov/pubmed/23715643 Trusted SourcePubMedGo to source
  6. (21:29) Diagnostic steps to determine if NCGS http://www.ncbi.nlm.nih.gov/pubmed/25753138 Trusted SourcePubMedGo to source
  7. (23:24) One well-performed clinical trial also found no changes in any laboratory marker in those who noticeably worse eating gluten. http://www.ncbi.nlm.nih.gov/pubmed/21224837 Trusted SourcePubMedGo to source
  8. (26:44) Some grains are not a problem http://www.ncbi.nlm.nih.gov/pubmed/23706063 Trusted SourcePubMedGo to source

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Should you be gluten free?

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio: Hey everyone, this is Dr. Ruscio. Welcome to Dr. Ruscio radio. I am here with the lovely Susan McCully. Hey Susan, what’s going on?

Susan McCully: Hey, not much… just, you know… one foot in front of the other. Trying to get things done and having fun.

DR: Sure, sure. With a… Something I wanted to mention: I’ve recently been reminded of the importance of non-structured time… and I’m sure some people listening here to the show work, maybe, too much, and they feel like they are trying to stave off… you know… burn-off or over work syndrome. And non-structured time just means having time where you don’t have a plan. And I’ve been reading this book called… what’s it called… jeez… “The One Who Is Not Busy”.

SM: Ahh… sounds very interesting.

DR: Yeah, it’s a great book. And what I really like about it is it’s short and it’s to the point. It’s a… I think it’s 126 pages. But, it’s got really good, practical, information about how to be able to work… work a lot… but also not burn out. And so if people are listening to this and kind of struggling with that workaholic-type syndrome of, you know, flirting with the boundary of burn out, than that might be a really nice book to pick up.

SM: Yeah, I’ll have to check that out. I know a lot of us “Type A” personalities… we like to have structure and we like to follow it and we don’t want anybody getting in the way.

(Laughter)

DR: Right, and I include myself in that. Absolutely.

SM: And, for me, I just…you know, I do meditate. And that really helps me to be able to just focus on one thing at a time… instead of getting… you know… I have the moments where I get overwhelmed and I think everything is gonna fall apart, but then I just say ‘Look at the next thing.’ Just put one foot in front of the other. So.

DR: Sure. Sure.

SM: I’ll have to check out the book!

DR: Yeah, it’s well worth it.

SM: So I am super duper—when you texted me the topic today—I was super duper excited. A non-celiac gluten sensitivity. And the reason why I was super excited is because when a study came out late last year, about gluten and that they had given the people gluten—not food with gluten in it, but actual just gluten, and they didn’t react—that somehow all of this gluten sensitivity was all in our minds. And I have non-celiac gluten sensitivity and I know it’s not in my mind.

DR: Sure.

SM: So I can’t wait to dig in.

DR: Well… well absolutely, and I’m happy you’re happy. I’m excited. You’re excited. And yeah, there’s been quite a bit of hysteria, I think, around this issue. I think, for the people like yourself, who clearly notice that you’re better without gluten, they hear some of these study results being, you know, spun, I guess you could say, and they get a little bit defensive or irritated, because they say “Well, no, I know I have a problem with this, so, you know, what do you mean?” And so, there’s a context here, like, I think there is with all things. And, you know, there’s polar opposites… where there’s some people that think that gluten-free is a fad and there are other people who want to convert people to gluten-free like it’s a religion. And I think the ideal approach, maybe, lies somewhere in the middle of that. So, yeah, let’s jump into this conversation. And if you’re not super familiar with why this might be important: if you are celiac that means you have a full-blown clinical allergy to gluten. And it can cause a myriad of health problems. Everything from Anemia… through neurological conditions… to autoimmune conditions…. to being underweight, uh, and you certainly need to be on a gluten-free diet. No ‘if’, ‘and’s’ or ‘but’s’, questions asked. It’s been really well established. But, where the controversy lies is… what if you’re not celiac? But you still notice you feel better when you avoid foods containing gluten. And this is where there’s some newons. Now, again, why might you want to consider taking gluten out of your diet if you’re not celiac? And, kind of like I foreshadowed a moment ago, there are a lot of potential symptoms and conditions that may be aided by going on a gluten-free diet. And this has been published with regards to non-celiac gluten sensitivity. So, some of the symptoms that we see associated are things like autoimmune conditions…. gastrointestinal symptoms, like gas or bloating or constipation/diarrhea… kind of your concourse, you know, symptoms that are associated with IBS. There are also some neurological conditions. Even things like skin conditions… and even things like canker sores that can clear. So, there’s certainly a wide depth of symptoms that can ultimately be… being caused by a problem in the gut. And I think if people are somewhat familiar with the functional mess and paradigm, definitely with my kind of philosophy, in this regard, the gut is one of the most important facets of health and if you have symptoms that seem paradoxical, or you’re not sure what’s causing them, it’s usually a good bet, a great bet even, to look into your gut health, because that can cause a lot of these symptoms. So that’s kind of why this is important. Now, in terms of what does some of the science say? In terms of studies looking at this issue, I think it’s really important to mention that there are all different kinds of studies. You will see some studies that are… what I would consider… the least… they carry the least weight, and this would be something where we were looking at like a cell line culture, where we took an intestinal cell, we put it in a petri dish we exposed it to gluten and we noted the response. So animal studies, cell studies, not that they’re not important, but, to me, they carry the least weight. Now, at the end of the spectrum: the things that carry the most weight are what we would call a randomized clinical trial… where people are either given the treatment, in this case it would be a gluten free diet, or they’re given a placebo. And then the results are noted. And this is the most important to me because this is really “real world”. Here’s a group of people. We give them this treatment or we withhold this treatment, what happens? So, to me, that’s the closet you can get to what would happen in the real world. So. Today, there have been four randomized clinical trials that have looked at non-celiac gluten sensitivity. Three of the four have found gluten and/or wheat to be an issue. While one has found that fodmaps may be the culprit. And, I think, it’s the fodmaps studies that raised a lot of controversy. And I think it’s… not necessarily something that disproves that gluten is an issue, but it tells us that there may be layers to why people react to certain foods. So, again, if we zoom out for a minute, starting off with, kind of, the “30,000 foot view” of the randomized control trials—Three have found gluten to clearly be an issue. One did not necessarily find gluten to be an issue, but it found it might be the fodmap content in foods.

SM: Now, all four of these studies: were they looking at gastrointestinal symptoms, or were they looking at all different kinds of symptoms?

DR: Mostly gastrointestinal symptoms are what has been studied… and that actually is a good reminder of me to mention something, which is: there was recently a systemic review published, in 2015, actually, this month, March 2015. And, again, systemic review looks at many other studies and this systemic review reviewed three of the four randomized control trials that I mentioned. And they found the prevalence of non-celiac gluten sensitivity ranged from .5% of the population to 13% of the population… Of those who were no celiac. Now, what’s interesting here, they only tracked gastrointestinal symptoms. Although, the authors did admit that non-celiac gluten sensitivity has been linked to extra intestinal symptoms, right? So things that would be like… headaches, depression, problems with your skin, canker sores… so the authors do admit and they cite data showing that those that are non-celiac gluten sensitive have been documented to have manifestations of symptoms, or of reactivity, outside of the gut. But in this review they only tracked gut-based symptoms.

SM: Ok.

DR: So, that .5-13% may actually be higher once we factored in the extra-intestinal… so…

SM: All the other… all the other symptoms. Ok.

DR: Exactly. Exactly. So, when we read this systemic review, they propose a… or they discuss a new, I guess, term, or new entity, called “Celiac Lite”.

SM: Oh.

DR: Now…

SM: I like that term.

DR: Yeah, “I’ll have a Celiac Lite, please.”

SM: Yeah!

(Laughter)

DR: In fact, I’m going to write an article on this, and I’m thinking about entitling it that, but I’m not sure if that will drive some people away thinking that it’s a beer article.

SM: It will probably get you a lot of clicks.

DR: Yeah.

(Laughter)

DR: But, yeah, I kind of like that term from that perspective, it’s kind of fun play on words. But, the authors discussed this in their review: they find some evidence of the celiac lite, and there’s two other studies that have discussed this, and essentially what they found, and what’s being found, is some people that think that they’re non-celiac gluten sensitive. When further testing is done, they actually find low level evidence of celiac disease and they’re now terming this celiac lite. So…

SM: Ok.

DR: We could… so these people don’t fit into the normal box of routine celiac screening, but when, again, further, more detailed, follow up testing is done they find some markers that are associated with celiac and so they’re calling that celiac lite. So I created a little image I call the gluten sensitivity spectrum, and going from most severe to least severe: we would have celiac, celiac lite, then non-celiac gluten sensitive, and then finally someone we would call “normal”, meaning they have no reactivity or no problem at all. So, I guess this can come down to now, ok, who….

(Laughter)

DR: Maybe you’re saying “Who really cares? Am I celiac lite, am I non-celiac gluten sensitivity? I just want to know, you know, what can I do to feel better?” Alright, kind of bring this back to practicality…

SM: Or, what do I have to take out of my diet, too? What restrictions do I have to live with?

DR: Exactly, yeah. So, this is where I’d like this conversation—cause I think it’s a little bit more “real world” and a little bit more “big picture”. The first thing that I’d recommend one do is try one of the few diets that are available. Now, autoimmune paleo is usually where I like to start someone. And if you’re not familiar with that diets there’s plenty of stuff on the internet, if you just search that term. I would give the autoimmune paleo diet a 30-day try. If that doesn’t work it’s possible that you could fall into this niche of fodmap intolerant. Right? And so, if the autoimmune paleo diet doesn’t work for you, you could try the low fodmap diet or the low fodmap with SCD restrictions. And, Dr. Allison Sidbecker… she has made a nice PDF chart that combines low fodmap with SCD. And these are just restricting certain foods that may cause intestinal irritation and may feed bacteria in the gut. So, I would start with autoimmune paleo, if autoimmune paleo doesn’t solve the problem try the low fodmap with SCD and then along with that I would try an enzyme and acid formula—I like a compound known as digest-zymes, and I’ll put a link to it in the show notes—and also a probiotic. And my favorite probiotic is a probiotic known as Ther-Biotic. Or Ther-Biotic Complete which is a powder. And that will help a lot of people sort this out because you’ll be removing gluten, you’ll also be removing, if you go to the low fodmap SCD diet, fodmaps. And also be giving yourself some probiotic and some acid and enzymes. And interestingly there has been a few trials published, essentially trying to answer the question, “What do you do if you take gluten out of your diet, but you still have all these gastrointestinal symptoms?” Or even these extra intestinal symptoms like… neurological symptoms… like brain fog or depression, or feeling tired, or having a skin issue, or having a non-responsive autoimmune condition… and interestingly these studies have shown there’s a couple things that can prevent you from responding to a gluten free diet. And some of these are H. Pylori infection, small intestinal bacterial overgrowth, the use of non steroidal anti-inflammatory (things like Advil), other food allergies… and the other food allergies would be pretty well faired out by trying the autoimmune paleo diet or by trying the low fodmap SCD diet. And then, also, poor secretion of acids and enzymes. And I’ll link to the studies that have suggested this. But, you have the potential of these problems being caused by foods and then you also have these potential of these problems being caused by different infections in the gut… should you not respond to a gluten free diet. So again, zoom way out, the first thing I would do would be to try one of these diets: Autoimmune paleo or low fodmap with SCD, and add in there a probiotic and a digestive enzyme. That’s a great level one, step one. If that doesn’t then work I would not go chasing down “Am I celiac? Am I non-celiac gluten sensitive?”. I would go right into looking into “Do I have an H. Pylori infection? Do I have small intestinal bacterial overgrowth? Or maybe some other sort of imbalance or infection in the gut that are causing these problems?” And this is, in agreement with, again, the… some of the published studies showing what do we do when someone is non-responsive gluten free diet but were expecting that they should be responding. So does that… does that kind of make sense Susan?

SM: Yeah, look at your diet first and then we look to the gut. Because, those are just two things… the diet is probably gonna clear, probably, 80% of things we do and then, after that, then let’s get to the testing. Let’s look for H. Pylori, SIBO, those kinds of things. Total sense.

DR: Exactly. And I know that the testing can seem tempting. I especially think, when someone’s not feeling well, you’re just thinking, “Ugh, I just need an answer. I need a test. I need to be told what it is.” And I know… I know how that feels. Where you almost feel like you’re desperate. You’re just like “Ugh, I just need something, give me something.” And I totally get that. I totally respect that. I’ve been there. But, being on the other side of the, you know, the table, now, for a number of years, I’ve been able to see that a lot of this testing is really wasteful. And something I’m really passionate about is trying to save people from buying tests that aren’t really going to help them get better. Right? Now… so… with regards to gluten, and kind of coming back to, you know, do you want to figure out if you’re non-celiac gluten sensitive or not, you maybe want to do some lab testing. I think this is going to be really challenging for people because there are other components outside of just the gluten or the gliadin in wheat that may cause reactions. And, not all of these reactions are going to be your classic celiac mechanism. Because that’s what would separate, in my opinion here, celiac from non-celiac gluten sensitivity. Right? The people that have celiac have a certain immune reaction in the gut that causes destruction and damage of their intestinal lining.

SM: Right, they have a certain set of symptoms that can be diagnostically tested through… what is it… is it an endoscopy? Where they can put the camera down and actually look at the intestines and see if there’s damage?

DR: Yes, and there’s also blood antibodies that can be tested too.

SM: Right.

DR: Yeah, so… that’s one mechanism of reactivity. But what we’re seeing with the non-celiac gluten sensitivity is there are people that don’t have that classical celiac mechanism that are still having some of the same symptoms. And this is probably because there are other mechanisms of reactivity to wheat… gluten… that we’re not testing for. And, this systematic review that I mentioned a moment ago, they say the number of other compounds—and I’ll put one of the diagrams from the study in here—but there are things like amylase and trypsin inhibitors… there’s gliadin… there’s other proteins… there are fructans… there are certain toxins that can be… that we can actually feed in the gut. There’s also the production of opioid-like, or exorphins, and endorphins, that can be produced. So, there’s a number of different things that could happen in reaction to gluten. Not to mention there was recently a study done, and actually caught wind of this from Dr. Thomas O’Brian, that showed that cooked foods, compared to raw foods, showed different results on food allergy testing. And, I guess, SIOREX has now made a cooked in addition to a raw, food allergy panel. And, in my opinion that’s really not a good use of money, because you’re looking at just under a thousand dollars to figure all this out.

SM: I was going to say… a lot of those are very expensive.

DR: Yeah, and really you can cut foods out and you can bring them back in, and know your response. And I really think there’s a lot of wisdom in that approach because we’re only able to test for the mechanisms that we’ve identified. There may be someone, last year, that did a food allergy test to… kale, I’ll use kale because I actually have a personal example with that one. And they say “Geez, my food allergy test says I do not have any reactivity to kale… but I always make this kale sautéed and I always feel a little bit worse after I eat it.” Well, now we know that raw kale is what is usually done, or performed, in the food allergy testing. But, you may have an allergy to cooked kale.

SM: Ahhhh. I’ve never heard that before, that’s really super interesting.

DR: I actually have noticed that myself, where I can eat raw kale and steamed kale… but for some reason if I eat too much sautéed kale, you know sautéed almost has a little bit of browning to that point, I will get… I will feel a little bit foggy, mentally. And it took me a few times to figure that out, but I’ve now kind of narrowed down that association to be as clear as day. I don’t know exactly why or what compound is released, or what have you, but that’s why I think the approach that I advocate—which is just notice how you feel when you eat certain foods. Take foods out. Bring them back in—I think that’s really going to get you there much more quickly than through testing because we’re still limited to testing the mechanisms that we’ve identified.

SM: Yeah, I… we don’t have, like we said, they’re just now realizing that cooked food VS raw food is different, what else is different? You know? Steamed… like you said, steamed…microwaved…all the different ways you can do food, we don’t have all the answers yet. So keep a food log and notice your symptoms and, you know, kind of put the pieces of the puzzle together.

DR: Exactly, yeah. Otherwise, it can be a very expensive and probably inaccurate endeavor. And I totally get the piece about wanting to test and wanting to be objective, but I don’t think this is in the area where the testing is really very good. So, now I’ll put a link to the proposed, kind of, diagnostic steps that’s recommended to go through to determine if you’re non-celiac gluten sensitive. But, it’s a pretty robust algorithm of steps. And you’re going to be subjected to a little bit… a fair amount… of poking and prodding and intestinal biopsies to figure this out…so…. you know, again, as much as I think testing is a very valuable piece, I also think that, you know, he who is the best can do the most with the least. And, in this case, I don’t think we need to go crazy with the tests to figure this out, where as you can cut gluten out, bring it back in, and see how you respond. And if you’re not tolerating gluten or you notice you have some sort of regression when you bring gluten back in, then, to me, that’s evidence enough. Unless you want to, you know, again, be poked and prodded and sampled and biopsied… several different times. I should also, maybe, reiterate that: if you’ve gone gluten free and you’re just not feeling well, then you’ll probably want to try one of the diets that I recommended. That will do more than just restrict gluten and also maybe the acid enzyme combination with the probiotic, and if that level one is, I kind of termed it with, either the AAP diet, the low fodmap SCD diet enzyme probiotic… if that doesn’t address your issues, then, you probably want to get yourself to a skilled clinician—functional medicine clinician that’s very well versed in the gut—to go through good gut workup, because the answer to your symptoms is probably going to be contained in figuring out what’s going on with your gut. Not in every case, but definitely in the next step.

SM: Oh so many.

DR: Yeah, definitely the next step.

SM: Yeah so many cases.

DR: Yeah. Absolutely. I should also mention, just to kind of really babble on here for a while, there was one clinical trial that found no change in any of the several laboratory markers they assessed—after giving people who are non-celiac gluten sensitive, gluten. So, they tracked leaky gut, they tracked lactoferrin, they tracked a number of markers in these non-celiac gluten sensitive people, so, just, you know… Here’s Samantha. Samantha says she has a problem with gluten cause she notices whenever she eats it she feels bad. So we’re going to give her gluten and we’re going to run all these laboratory tests before and after and see if these laboratory tests change. And they found no change in any of the laboratory markers that they had tested.

SM: Now did they get… was this the refined gluten? Or did they just give her foods that contain gluten?

DR: I don’t recall this… what they gave in this one… off the top of my head.

SM: Ok.

DR: But, you bring up a good question, which is: “Is it just the gluten?     Or is it potentially other compounds in the gluten?” And there’s been one clinical trial that gave just gluten isolate and they did find a reaction from the gluten isolate.

SM: Ok yeah, like you said, there’s so many layers in the wheat and then there’s also the other compounding factors: wheat in the United States grown… and different types of wheat grown in different places in the world and the difference between the two. Because I know, personally, when I went to Europe this summer, I had gluten in Switzerland and didn’t have a reaction—because I had to have a croissant—and then I did some research, and the Swiss grow 98% of their own wheat. And I did not have a reaction. And then I came home, and just a couple weeks ago I ate at Chipotle and got gluten, of all places, and I had a severe reaction. So it’s just crazy… like it just really depends on where you live and what type of wheat you’re eating, I think.

DR: Exactly. And I just plugged that… a link to that study about giving just gluten isolate… into the show notes, so we have it. And also to your point I think… I think you make a fantastic point because another thing I wanted to mention is depending on the type of grain that you have there could be a different amount of reactivity, and so kind of two things I would put under the umbrella: don’t become a gluten free crusader, cause that might not be fully necessary. And one is, not everyone has a problem with gluten.

SM: Exactly!

DR: And that’s just… not everyone has a problem with gluten, and that’s just the facts. I mean I have patients come in and some people are exquisitely sensitive. They’re exposed to a small amount of gluten and, for days to weeks, they don’t feel right. I have other people who come in and we’ve gone through our work and they’re feeling really well and during a routine follow-up they come in and I check in and “How’s the diet going?” Yadda yadda yadda… “Oh, good, you know, I had some pizza the other day… and… you know a few weeks ago I had some beer… and there was a Christmas party and so…” And… “How’d you feel?”  “You know, I didn’t really notice much of a difference.”

SM: Yeah…

DR: “Ok..” And… I don’t… you know we haven’t been running super elaborate laboratory saves for these people to see what was going on underneath the surface but I really don’t think everyone in the world…every person, 100% of the people, have a problem with gluten. I think that’s just a little bit over zealous. And then to your point Susan, there was this study with a different… an ancient grain, as it’s termed, called ‘Tri’— um.

SM: Triticum.

DR: Triticum Monococcum… I believe is how it’s pronounced. I’m attempting to pronounce it, anyway. And they administered this grain, gluten containing grain, to those with celiac and did not find… they found a very very low level of reactivity. Even less than that of rice. So, there are definitely some grains out there depending on the type and the harvesting and the processing that won’t be a problem. So, again, we could try to test these thousand and one mechanisms, but I really think the best way to figure it out is to just experiment a little bit. Tinker, as Rob Wolf would call it, and see if you can figure out what works for you and what doesn’t work for you.

SM: Yeah, I’ve also heard that try another gluten containing grain that’s not a fodmap as well… so what are the… rye is not a fodmap but it has gluten, correct? So, try some rye, and if you have the symptoms, then maybe it is fodmaps, and it is, yanno, not gluten. We don’t know. If you don’t have the symptoms, figure it out.

DR: Yeah, and I think that is an unbelievably good recommendation. And again, because it’s… even the fodmaps I’ve found to be individual. When… when…

SM: Oh, totally!

DR: Um… and I treat a lot of people in the clinic with SIBO. A lot of people in the clinic with SIBO. And we always revert to.. in the preventative phase, after we’ve cleared the SIBO, we usually refer to either a low fodmap or low fodmap with SCD restriction and we eventually after someone’s been stable for a few months, have them bring these foods back in. And we have them bring back in the fodmaps retaining foods first, and it’s individual on terms of what people notice it can and cannot tolerate. And so the same thing to what you’re saying, Susan, which is a great point, try a low fodmap grain but then there are different fodmaps that are problems for different people. So, bringing it back to practicality go through the elimination-reintroduction, play around with it, and with a little bit of time and observation, you’ll probably figure out what you’re ideal, kind of, diet is gonna look like.

SM: Yeah, and make sure to take notes, because then you can always go back and refer to those. And it’s like ‘Ooo, my belly hurts, what did I have?” And you can go look and see, yanno. Write down what you ate. And be your own detective. Be your own health detective.

DR: Yes, in this case, I really think that being your own health detective is going to be more accurate and it’s going to be much much cheaper than trying to test for these food allergies and intolerances. And again if you’re really not feeling well then your first step would be to try either the autoimmune paleo diet or the low fodmap SCD diet with an enzyme acid formula and a probiotic. That’s going to wipe out most of the food allergies on the table. And then if you’re still not feeling well from there, I wouldn’t… you know, as great as journaling is, that’s probably the point and time where you want to bring in a skilled clinician, because there might be something else going on. And that’s exactly what happened to me.

SM: Trust the gut.

DR: Yeah, I had an infection. I had an ameba infection. And, I was journaling and I was driving myself nuts. I just couldn’t make heads or tails of it. I was eating a really good diet, I was having, you know, a reaction to this sometimes, but not other times. And sometimes this and not to that. And I just wanted to pull my hair out. I said, “What the heck is causing–!” I had no clue! For me, it was very hard to figure out because there was a pathogen on the table. So if you run through level one and it doesn’t get you there then I would definitely say get a good gut evaluation because that could be the confounding variable throwing a monkey wrench into the system.

SM: So, here’s another question for you. Say that you have non-celiac gluten sensitivity, or celiac lite, I just love that.

(Laughter)

SM: Um, and you do get exposed to gluten… what can you do afterwards to heal as quick as possible? And return back to normal?

DR: Hm. That’s a great question. And, you know what, it’s not something that… I don’t… it’s not something that I really advise on in the clinic where… yeah… it’s not something I typically do. I think that people are eating a healthy diet and they’re minding…there…lifestyle well. I really think that’s a very good way to recover quickly.

SM: Mmmhm. Just go back to what you were doing?

DR: Yeah. I mean, that’s really what my preference is.

SM: Yeah.

DR: And with people in the clinic, once we’ve gone through the foundational pieces than I just think that the body is going to be able to recover pretty quickly on it’s own. If you’re doing all the other piece parts right. There’s one other thing that I do sometimes recommend, which would be some kind of modified fast…

SM: Ah, I never thought of that!

DR: Yeah… It could be an intermittent fast.

SM: Mmmhm, or broth fast

DR: Yeah, or a broth fast. Or the master’s cleanse version of the fast.

SM: Ahhh…

DR: But not the two weeks the master’s cleanse recommends… just a day or two. Or three. But, yeah… I mean, to me that’s the most practical. I think it works really well and I like that approach rather than saying ‘Well, here, go buy $185 worth of supplements and take those for four days. Cause then, for a lot of people, it’s not a very very prolonged reaction that they have. I’ve usually noticed it’s usually a few days, maybe between one and four days and they’re back to normal. So, by the time someone gets a supplement and starts taking it, they’re almost gonna be halfway out of the woods anyway. And, also, because I think a fast has a very strong evolutionary component to it, yeah, I think at that point in time rather than shoving more stuff down the gut that’s already a little bit pissed off– let’s just give the gut a little bit of a break.

SM: Yeah, cause like I said, I got gluten about three weeks ago and everything else returned to normal within about a week– but it’s just my digestion is just… it just… it’s just being a little finicky right now. It’s like, what else can you do? I mean, I eat a really, yanno, strict… pretty strict… paleo diet and meditate and drink lots of broth– you know all the stuff. But it’s just… curious, is there anything people can do? Cause I know a lot of people– I have a lot of friends, that are really, I have a couple friends with celiac, and they, you know, accidentally… restaurants, it does happen. You do get gluten. And what do you do afterwards?

DR: Sure. And the other thing you could do is try taking, if you have, probiotic on hand, just try really upping your dose of your probiotic for a few days too.

SM: Ah, that’s a good idea too.

DR: I like the more practical things there about not needing to buy something, just because for a lot of people these things are fairly short lived. You know I have a hard time making a recommendation to buy something. But I think if you, you know, if your diet and lifestyle fundamentals are there, on top of some kind of modified fast, and then you really up your dose of probiotic, then I think you’re gonna be in really really good shape. And there’s other things you can consider like herbs that are anti-inflammatory nature… or things like…. okra… or slippery elm…

SM: Ah… yeah.

DR: Some, you know, some of the classical ingredients…

SM: What do they call those? Mutagenic herbs?

DR: Yeah… yeah… but again I’ve really gotten away from those in clinical trials over the past several years because I found that as long as we kind of work through the system of starting with diet and lifestyle, if that lifestyle doesn’t work, moving onto a gut evaluation and figuring out if there’s an infection, and then treating that infection and maybe if there’s inflammatory bowl disease and… managing that properly that there’s not really a huge need for these soothing and reparative compounds because you’ve removed the offenders that cause irritation.

SM: Oh yeah. And then if you do become exposed to gluten… don’t… just… go back to your lifestyle that you had before. Don’t… give yourself permission to go on a gluten bender.

(Laughter)

DR: Right… yeah. And I’ve found that people and this is actually a really good, maybe a point to bring us to close, which is upon going through reintroduction I notice that my patients report back to me…a…compendium of reactivity. Some people can have gluten, maybe once…twice…three times a week… well some people can have gluten and notice nothing at all. Right? So, those would be the most resilient to gluten.

SM: Mmmm…

DR: Other people notice they can have a little bit and get away with it. And then at the other end of the spectrum, some people will have just a small exposure, and they won’t feel well for days to a week.

SM: Mmmhm.

DR: And when you go through your food reintroduction, I found… it’s usually pretty apparent for people. That they usually have a pretty good sense of what their level of reactivity is, given they’ve gone through the steps of, you know, starting with the diet and lifestyle, if that doesn’t address it, clearing out any kind of gut infection, and then you have a healthy gut from what you can perform the reintroduction. Cause, a key point for a successful reintroduction, in my opinion, is you have to have a gut devoid of any kind of pathogen. And once the gut is devoid of the pathogen, then it’s much easier to get a solid gauge on your reintroduction.

SM: And do you think that once you are non-celiac gluten sensitive that you will always be? To the same extent? Or do you think after, you know, a year or two of healing, working on the gut, working on other issues, would you… suggest people maybe, try some gluten and see how it works for them? Or just? You know what, you’re sensitive, you should probably avoid it forever.

DR: Well I think for a lot of people, it may not be that they’re going to try gluten, but they’re gonna end up in a situation where they almost have to try gluten, right? They’re at a wedding and some…so there’s wedding cake and it would almost be disrespectful not to have a slice, or, you know, they’re visiting someone’s aunt or uncle and they made this famous family recipe and you know you don’t wanna… you know, so I think some people will find themselves in situations where they’re going to have some gluten. And I would just observe how you feel then. You could also be more scientific about it, and say I’m going to wait three months and you know ingest you know two grams of gluten and see how I feel. And yes, I do think that people will notice their reactivity dampens over time. Some people will. I think that the closer you are to celiac the less that may happen.

SM: The less of a chance, yeah…

DR: Yeah. Although I think even with them maybe some increase in tolerability could happen, but I think the people that are more in the camp of non-celiac gluten sensitive as your gut heals and becomes healthier they seem to have less reactivity to gluten and to other foods, which is exactly what I noticed in myself. I used to get set off very easily. Now, I can have a, you know, piece of pizza or some kind of dessert and I don’t feel anything. I’ve never been super gluten sensitive to begin with, but, back when my gut was really messed up, compared to now, my tolerability for bad foods has gone up like hundred fold. So. Yes, I do think people will probably be able to have increased tolerance, as their gut gets healthier.

SM: Well that’s a really good note to end on.

(Laughter)

DR: Yes, a hopeful note!

SM: There’s light at the end of the tunnel.

DR: Yes, yes. And I want that to shine through, because I think this issue is shrouded in fear and I really think that’s not necessary, I think it’s not healthy. And, yeah, hopefully, like you said, this will have a hopeful sort of dialog for people.

SM: Ok. Any events coming up? Any news? Anything else before we get out of here?

DR: Well, I’m working on turning this podcast in a separate article. I mean, the transcript of this podcast will be available, but I’m writing up an article on it. And I’ll be speaking at Paleo Effects coming up… um… on the microbiota, and there’s a lot of interesting research there, so the next couple podcasts will probably be gut focused. And some kind of deep in the gut stuff right now. And…uh, yeah I think that’s pretty much it.

SM: Ok.

DR: Cool, well thank you Susan, and thank you everyone for tuning in.

SM: Take care everyone.

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

Discussion

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4 thoughts on “Podcast – Should you be gluten free?

  1. Hello Dr. Ruscio – great podcast on gluten. I support your approach in terms of patients becoming their own health detective through food elimination/re-introduction protocols and assessing for themselves if gluten is the real problem to their ill health / symptoms.

    There seems to be a push from other functional medicine doctors to move all patients away from gluten (whether they’re sensitive or not) as it’s viewed to be a toxin to all humans, affecting the gut lining by inducing small tears to the gut lining. I see this a lot with fertility protocols – applying this blanket approach when in actual fact it creates a lot of unnecessary stress for the couple which in-turn prevents them from falling pregnant!

    Fertility aside, do you think it’s unhealthy for patients without any known intolerance/allergy to gluten to exclude it from their diet with the view that it’s benefiting the integrity of the gut lining? I also wonder whether over time with those people excluding gluten unnecessarily could they in fact give rise to a sensitivity to gluten due to the lack of gluten exposure..

    1. Chelsea,
      Most likely if someone has a problem with gluten, they will react within 24 hours. A very large study recently found that over 90% of patients react within 24hrs. So avoiding it with no discernible benefit likely will not help. I also doubt if lack of exposure would make someone sensitive.
      Hope this helps!

  2. Hello Dr. Ruscio – great podcast on gluten. I support your approach in terms of patients becoming their own health detective through food elimination/re-introduction protocols and assessing for themselves if gluten is the real problem to their ill health / symptoms.

    There seems to be a push from other functional medicine doctors to move all patients away from gluten (whether they’re sensitive or not) as it’s viewed to be a toxin to all humans, affecting the gut lining by inducing small tears to the gut lining. I see this a lot with fertility protocols – applying this blanket approach when in actual fact it creates a lot of unnecessary stress for the couple which in-turn prevents them from falling pregnant!

    Fertility aside, do you think it’s unhealthy for patients without any known intolerance/allergy to gluten to exclude it from their diet with the view that it’s benefiting the integrity of the gut lining? I also wonder whether over time with those people excluding gluten unnecessarily could they in fact give rise to a sensitivity to gluten due to the lack of gluten exposure..

    1. Chelsea,
      Most likely if someone has a problem with gluten, they will react within 24 hours. A very large study recently found that over 90% of patients react within 24hrs. So avoiding it with no discernible benefit likely will not help. I also doubt if lack of exposure would make someone sensitive.
      Hope this helps!

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