Transcript of Most Replayed Moment: Are You Really Gluten Intolerant? It Could Be This Instead!

On this point about bloating, discomfort, irregular digestion, if I have one of those things, does that theoretically mean that something is not right?

Everyone gets bloated once in a while. So I think, I think it would be unfair to make it sound like you should never have any adverse symptoms at all.

But if it's prolonged.

But if it's prolonged, if it's a chronic health issue, if you're the type of person who you wake up in the morning and you say, I hope today's gonna be a good day. I hope I don't have to deal with that specific issue. You are, you have a problem. Like we already know. And then we have to work on that to address that issue. And how we go about that, I think needs to be on some level personalized. But the tools that are at our disposal remain the same. So it's just a matter of like, let's put it on the table. Here are your choices. You pick which ones are most applicable to you. Where are the opportunities for you? And I, I can't tell you that without knowing more about you.

What about this issue of people getting gassy, like farting a lot?

Yeah.

Is that typically associated with one particular gut issue, or is that— again, could that be a plethora of issues?

So it could be a plethora of issues. This is a common problem. If I have to, like, start with what is my number one thing, it's constipation. For sure. 100%. There are so many people who are listening right now that are constipated and they don't even know it. Because they poop every day and they think that how often they poop is the definition. And that's not true. So constipation is what happens when you're not adequately emptying your bowels. And that could be a frequency problem, but it could also be that it's a partial poop.

Oh, OK, 'cause I thought constipation was if you just haven't been— you go to the toilet and nothing comes out.

Look, don't get me wrong, if you, if you don't poop for a week, I know you're constipated. I don't need to ask any more questions if you go a week. But if it's— there are people who they poop every other day, that's their normal, they feel fine, they don't have any gut symptoms, they don't have a constipation problem, we're okay, right?

So frequency is not the be-all and end-all.

It's part of the— it's part of the equation, right? But there's also people who they poop, and I want to sort of paint the picture and Forgive me, Ike, I feel very comfortable talking about poop. This is what I've done for a living. But they, they go to the bathroom in the morning, they struggle. It's not satisfying. They had to work really hard to get a little nugget to come out. And then they feel like they still have to go. And maybe 45 minutes later, they poop again. Okay, that's not a new poop. You're doing partial poops. You're probably doing a 20 or 25% poop. So you could poop 3, 4 times during the day. You might not still be fully emptying your bowels, right? And so that's an example of a person who can actually be struggling with bloating and constipation and not think because they're like, "Doc, I'm pooping 3 times a day." Where is the gas coming from in that?

Why do people, you eat something and then you fart a lot, what's going on?

So gas travels with poop. You may, I don't mean you specifically, Steve, people listening may notice this, that you wake up in the morning and you're farting like crazy, and that farting continues until you actually have your morning bowel movement. And then once you have your good, healthy morning bowel movement, you feel solid and you're not farting anymore, right? The gas travels with the poop. So, and the reason why this happens is because first of all, your poop is not just the leftover remains of your food. Actually, your poop is predominantly your microbiome. 60% of the weight of your stool is microbial.

Really?

Yes.

When you say microbial, you mean like the bacteria? The bacteria. 60% of it.

Let me give you an example. If I took your drink and I added some soluble fiber, which is prebiotic, into your drink.

Yeah.

There's no grit. There's no roughage. You don't even know it's there. And you're going to have a bigger, healthier bowel movement tomorrow as a result of what I just did.

Why?

Because I fed your microbes., and they grow stronger, and then they multiply. And because they multiplied, you have a bigger bowel movement, right? That's the way that that works. Now don't get me wrong, you eat, you know, a salad, you're going to end up with a bigger bowel movement as well. But a big part of that is the fiber within that salad that's feeding these microbes. They multiply, they grow, and you have a big bowel movement.

So if that was my— if that was my stool, my poop, I'm holding a chocolate bar here. 60% of that would be the microbes?

60% of that would be the microbes, yes. So for that person, when the poop is in gridlock and it's not moving through, then those microbes are basically sitting there with unlimited time to ferment and produce gas.

Okay.

So anything they come into contact with, they're just gonna start working on it. So it's— and it's not just like a fiber thing. Anything they come into contact with, it could be protein, they will ferment it, they will produce gas. So this is a big part of the reason why constipation is so strongly associated with gas and bloating.

When people eat dairy and things like that, and I think some people that have gluten, they, they often tend to get a little bit gassy. Yeah. Is that constipation?

Gas and bloating is not just a constipation issue. I would argue that constipation is the number one cause of that particular issue, but there's many potential causes. Number one could be motility. That's constipation.

What's motility?

Motility is the way in which your intestines move. So if the intestines move too fast and out of rhythm, you get diarrhea. If the intestines slow down too much, sluggish, you get constipation. We want the intestines in a rhythm because when they're in a rhythm, just like your heart, that's when they perform their best. So, and a rhythm basically means predictable, consistent, daily bowel movements. That's ultimately where we would love to be, right? And that, in a way, taps into like an entire circadian conversation that we can have later. This is a part of your circadian rhythm— is a fantastic morning bowel movement. Motility is just one of the causes of gas and bloating. The second is the microbiome. If you have a microbiome that's damaged and struggling, it's not going to be able to do its job the way it's supposed to. And part of its job is processing and breaking down fiber because the fiber in our diet, we don't have the enzymes to digest it. So it works its way through the intestines, comes into contact with the microbes, and the microbes, they have literally 60,000 enzymes that we don't have as humans.

They go to work as teams. Fiber stops being fiber, produces short-chain fatty acids. This is the way that it's supposed to work. When your gut is not happy, they're weak, the microbes are weak, and you're asking them to do work and they can't handle that, and you end up with sloppy digestion, and that's gas and bloating. The third thing can be your diet. So you just mentioned dairy, which contains lactose. Lactose can be easily fermented to produce gas. You mentioned gluten. Gluten itself is a protein. So can gluten technically be fermented? Yes, it could be technically fermented, but that's not really the— that's not really what's going on. What's happening is that gluten-containing foods, which are wheat, barley, and rye, also contain these carbohydrates called fructans. And fructans are actually really good for our microbes. They're prebiotic. But if you consume a very large amount of them and you're not used to eating these foods, it can cause gas and bloating.

These days, when I was younger, if I had, uh, if I had pasta, I was fine. If I have pasta these days, I'm gonna feel it for the next like 2 days.

Really?

Yeah. I don't know, and I don't even know what's going on. But then other people can eat pasta as much as they want, it seems.

Out of curiosity, can you go to Italy and eat pasta and be okay, or no? Same thing.

I haven't really, not really tried. Okay. Anecdotally, I think when I remove, when I have like non-gluten bread or non-gluten pasta, I think I feel much better. But I'm well aware from speaking to people like yourself that such a small percentage of the population is actually gluten intolerant. But we all kind of think we are to some degree. I think it's, what's the numbers? Is it like 20% of people think they are or something?

So like here in Los Angeles, it's, like probably 80% of people think that. Well, like almost everyone's gluten-free.

Yeah.

Right. Which they don't need to be. And actually it can cause problems. It can cause problems to be gluten-free unless you know what adaptations to make.

So what are you, when you ask that question about Italy, what are you getting at?

There's a processing issue in the United States involving wheat, which is that they allow the wheat to be sprayed with glyphosate, which is Roundup. It's a weed killer. And you— they do that to basically dry it out as quickly as possible. So imagine for a moment that you're a farmer and you have this, this field of wheat. You harvest it. Okay, here are your choices, Steve. You can wait a couple weeks and let it dry out naturally in the air and store it somewhere, or you can spray it with this chemical and it will be dry by tomorrow, and then you can ship it out. Yeah, right. And the problem is that glyphosate is not on the label. You would never know whether it's sprayed or not sprayed unless you're buying organic. If you buy organic, then by definition they're not allowed to spray it. You would never know if it's there. The, the, the thing about glyphosate is that it's been approved to exist in our food system under the assumption of safety. Because what it does is it shuts down this thing called the shikimaa pathway, and that kills weeds or it kills plants.

And we have a workaround, and it has to do with basically amino acids. We have a workaround where we can basically create those amino acids as humans, but the plants can't. So the plants die, we live. But there's a problem. Which is that the microbes that live inside of our large intestine, they don't have the workaround. So that microscopic amount of glyphosate, you would say, well, us big humans, that's so small. Yeah, well, what do you think happens when it comes into contact with them? We know that glyphosate disrupts the microbiome. That it depletes the beneficial bacteria, and the ones that tolerate it the best are the inflammatory ones, the bad bacteria, the bad bacteria. So you're shifting the balance. And this is, this is a small thing, but I hear from people, Steve, that go to Italy, they say, I can't eat wheat in the United States, and then they go to Italy and they're fine.

And you think it's that glyphosate?

Yeah, they don't do that there.

So if I tried— I'll try organic pasta tonight. And maybe that would be better.

Yes. And then like the alternative choice is how do you do with bread? Are you okay?

Uh, not all bread. My, my generally I stay away from bread.

Okay. Do you ever eat sourdough?

Yeah.

Do you do okay with sourdough?

Yeah.

There we go. So here's, here's the second part of this equation. Put the glyphosate, put that to the side for a moment. Let's talk about the fructans that we were talking about a moment ago. When you ferment your, uh, your wheat, when you ferment your dough, you actually reduce the fructan content.

What's fructan?

So these are the, the long-chain carbohydrates that exist in wheat, barley, and rye. So if it contains gluten, it also contains these fructans. Like, gluten is not the only thing in wheat, right? And these fructans, again, they're good for you, they're good for your microbiome. But people who have a slightly damaged gut, they struggle to process and digest them. So this would explain why some people, they eat, you know, wheat-containing, gluten-containing foods and they struggle, but they do okay with sourdough. Because if you ferment the bread, it reduces the fructan content and actually then you can tolerate it.

Oh, okay. So you think it might be the fructan in the bread that I have an issue with and sourdough doesn't have fructan in it.

Yeah, there was, there was a study that was in Gastroenterology a few years ago. Gastroenterology is the top journal in my field where basically they, they send people home with a bunch of breakfast bars. All right, not chocolate, but nonetheless, they send people home with a bunch of breakfast bars, 3 of them. One of them was a placebo bar, so they didn't add anything special. One of them contains a very large concentration of gluten, and then the third one contains the fructans. And the placebo is our standard. We're going to compare to that. When people ate the gluten-containing bar— and these were, by the way, people that, um, they did not have celiac disease, they did have gluten problems according to them, right? So like, this is like the 20% of people that you mentioned a moment ago who think they might have a gluten problem. When they ate the gluten-containing bar, they actually had less symptoms than the placebo. So in other words, the gluten is not the problem. But when they ate the fructan-containing bar, they were triggered. So basically what this said is that we have been taking this concept of gluten intolerance and we've, we've misnamed it.

It's not a gluten intolerance, it's a fructan intolerance. These are people who are tending to struggle with these particular parts of that food.

What foods contain fructane?

So, uh, wheat, barley, and rye.

Okay.

And different— there's, there's many different types of fructans, by the way. So you may not react to all of them, you may react to just some of them. But like garlic and onions are also classic. So you hear people who are like, I can't eat garlic, I feel horrible, right? That's a— that can be a fructan issue. Teff, amaranth, sorghum, um, quinoa. These are, these are whole grains that don't contain gluten, and they also don't contain fructans.

How long does it take to repair the gut when you have done damage to it? That's a very broad question intentionally, but generally, for the average person who's done— who's sort of irritated their gut, how long does it take to restore and for those microbes to go back?

It really depends. You have to start with, okay, what's your starting point, right? Like, how deep is the damage? How bad is it? Because for the people who have ulcerative colitis or Crohn's disease, those are forms of inflammatory bowel disease. Those people have the deepest dysbiosis. Dysbiosis is the word that we use for a damaged gut.

Is it possible to reverse that?

Um, it's possible to put them into remission so deeply that they don't have a flare.

Is that what the flare looks like on this little model that I have in front of me? Yes.

So, so going back, for the people who are listening and not on YouTube, you can flip over to YouTube if you're interested, but what I'm showing here is the model of the large intestine, and the model includes a little area that it looks raw, ulcerated, it's bleeding. If you, if you were to bump up against it, it's going to start to you'll start to see blood coming out. So it's like a— it's a very vulnerable, sensitive, uh, area. Now, these inflammatory bowel diseases, Steve, I have an interesting study on this topic. They are, to me, the classic gut inflammatory health condition. And what's happening is the immune system is attacking the microbiome. So technically, it's not actually autoimmune. Because autoimmune would be you're attacking your own body. The immune system's not attacking your intestines. The immune system is attacking your microbiome and rejecting it. And because that's happening, your intestines are stuck in the middle.

So this here is the immune system attacking the microbiome.

It's attacking the microbiome, which is in the tube of the large intestine, and the immune system is trying to get at it and kill it.

Why?

And because it's decided that it's the enemy. So the immune system is confused because when we're born, we don't have much of a microbiome at birth. It's the closest that we will get to not really having anything. And then during the first 3 years of life, you build your microbiome through your life experience. And by 3 years of age, you are basically fully adult-sized in terms of your microbiome. During this time, your immune system is learning from and with those microbes. So there's this interplay between the two that is undeniable, where when the microbiome is healthy during childhood, during those first 3 years, it results in a healthier immune system.

So what's going on here?

The immune system is supposed to acknowledge your microbiome as being friendly, and it does not. It decides that your microbiome is the enemy, and so it's taking it out.

So what, what do you think is— for someone that has like irritable bowel syndrome or Crohn's disease, and they, or they, you know, they have one of these big sort of ulcers in their small or large intestine, is it because of their lifestyle typically? So lifestyle change, or, or is it lots of things? What's the number one perpetrator?

Okay, there's clearly a genetic component Okay, so we have to, we have to be upfront about that. Like, these are, these are things that are not necessarily within a person's control entirely, because, I mean, there's no evolutionary reason why this would happen.

Like, there's no evolutionary reason why you'd have severe gut digestion problems.

No, it's not. There's no advantage to it at all. And, and these things that, uh, that occur, they were quite rare years ago. In fact, in third world countries Today there's not much inflammatory bowel disease. There's not a lot of Crohn's disease and ulcerative colitis in third world countries. If you go to Africa, there's very little. And what— then what you see though is as countries industrialize, there's a takeoff and they start ramping up. So within the United States, over the course of 40 years, from 1970 to 2010, ulcerative colitis and Crohn's disease cases were increasing by up to 55%.

And you can get that at any age?

You get that at any age, yeah.

So even if I'm healthy right now, I could do a set of things that would give me this?

Yes. In fact, if you take— so back to our conversation about antibiotics, if you take antibiotics, your risk of developing an inflammatory bowel disease in the next year just doubled.

Oh, gosh.

If you disrupt the gut with antibiotics, which the antibiotics do, there's nothing that will basically like decimate the gut faster. Reducing gut diversity, disrupting the gut barrier by 50% during a course of antibiotics and activating the immune system, it really speaks to that, like, if you take antibiotics, these risks of inflammatory health conditions really start to go up. We see this in both adults and kids.

What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you.