Non celiac gluten sensitivity and what you can do about it – Podcast #105

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Dr. Justin Marchegiani and Evan Brand talk about addressing some gluten issues in this podcast episode. Get some great info regarding gluten sensitivity testing and whether you really need to take it or not. Find out the truth about gluten when you listen to this discussion.

gluten sensitivityDiscover the different reactions that people get when they consume gluten. Learn why grains in the modern world is quite different from the ancient grains. Get great advice on options and what you can eat when you're out at restaurants as well as how you can avoid exposure to gluten.

In this episode, topics include:

00:57   The effects of gluten

08:21   Gluten reactions

13:30   Alternatives to eating gluten

20:40   Gluten sensitivity testing

22:22   FODMAPs






Dr. Justin Marchegiani:  Evan Brand, it’s Dr. J! What’s going on, man?

Evan Brand:  How you doin’?

Dr. Justin Marchegiani:  Doing great! Doing great! It’s been a little while since we chatted. I was out of town in the Boston area. I’m back in Austin here. It’s Labor Day weekend right now so it’s probably won’t come out for another month but that’s where we’re at on the schedule and excited for our fall to be here soon enough.

Evan Brand:  Back in action.

Dr. Justin Marchegiani:  That’s it man. How about you?

Evan Brand:  I’m doing great. We’ve had perfect weather for like the past week. I’ve been outside as much as possible soaking up the sun rays because in the next 4-6 weeks, we’ll probably see some trees starting to turn colors here, so then we’ll be freezing and complaining before you know it.

Dr. Justin Marchegiani:  I know right? Well, we talked about in the pre-show a little bit that we wanted to address some gluten issues. When we talked about gluten we got a whole bunch of content on gluten, but we’re gonna try to look at it from a nuance position here today.

Evan Brand:  Sure.

Dr. Justin Marchegiani:  Well, off the bat, people know gluten is the main protein primarily found in wheat, barley, and rye. Anyone who wants a little more intel, they can go look at my interview with Dr. Peter Osborne on that topic, but gluten, primary protein, wheat, barley, rye and why does it matter? Because of the fact that there can be some inflammatory reactions that can occur in the body via the immune system and then also one of the big catastrophic side effects is leaky gut and when you have leaky gut, that can really exacerbate the immune system to start tagging and attacking proteins that were in the gut that now got into the bloodstream and then immune system can basically have a case of mistaken identity, right? The APB goes out for the guy driving the black—the black Honda Civic so to speak, and then you’re driving that Civic because it’s a similar car, right? And you get pulled over. In other words, what’s happening in your body is it’s tagging this certain protein marker, whatever that tag is—X, Y, Z, A, B, C and then it looks similar to the proteins—surface proteins on your thyroid and then your thyroid gets attacked or your brain or your nervous tissue, your myelin, your—your ganglioside tissue, your intrinsic factor. So then what happens is your body can start to mistakenly attack various things. So the key issue is we wanna cut some of these things out. One because they’re inflammatory. One, they’re nutrient-poor and the second done would be they are toxic, meaning there’s a high amount of pesticides and chemicals, GMOs and Roundup that are used on it so people that are using it especially if not from organic sources, they’re gonna have a high amount of toxicity.

Evan Brand:  Yup, yup. Now people in the health space, sometimes they’ll have a little bit of a relaxed approach with gluten. I think what Dr. Rodney Ford, I think he said it best when he came on my show. He likes to call it instead of a gluten-free diet that he recommends for his patients, he calls it a gluten-zero diet, which honestly, I think sounds better because gluten-free just kinda sounds like, “Ehh.” Gluten-zero is like, it’s very blunt and—and concise. Zero gluten is the amount that’s best for you even if you’re not someone that is a celiac. You don’t have to be a celiac. I’m not celiac. I feel like I would know if I was celiac by now. I’m not, but I still do no consume it as much as possible, close to 100% zero.

Dr. Justin Marchegiani:  Yeah, in my clinic, I refer to it as a grain-free diet, because it’s not just popcorn or this or that. It’s gonna be grain-free, 100%, no grains at all. Now if I cheat—in my life, I cheat a little bit—it’s gonna be with high quality organic corn or it’s gonna be with high quality, you know, organic rice. Things like that. But it’s gon—it’s gonna be few and far between and the better I feel though, the more I wanna keep my diet dialed in because I’m just addicted to performing at a certain level.

Evan Brand:  I agree.

Dr. Justin Marchegiani:  So that’s kinda—that’s kinda my goal regarding that. Now the cross-reactivity is also there where other sister or cousin grains, whether it’s oats or whether it’s rye or whether it’s other type of gluten-free types of grains even rice, can potentially cross-react so you’re immune system can see those other proteins, and think, “Well, hey, you know, your cousin kinda looks like you or your brother kinda looks like you,” and it may mistake it as being gluten. So that can be an immune stressor on the body. So keeping all the grains out can be a really good starting point. Now here’s the problem. There are a lot of clinicians and people out there that say, “Well, you know what? If you don’t feel bad when you have gluten, then you may be okay.” That’s kind of the adage or the thinking out there with a lot of people that may not react to it. And the problem with that is, it’s like telling a diabetic, “Well, if you don’t get diabetes after having a little bit of sugar one time, it’s probably okay.” Now we know those kind of an effect where having maybe a small amount of sugar once may not be a big a deal but over time, your blood sugar would start to spiral out of control and go higher and higher and higher as insulin resistance sets in. Now looking at gluten issues, so when we have celiac, that’s like the pathological form of gluten sensitivity, and then we have the NC, the non-celiac gluten sensitivity, and CGS, that’s the “Hey, you’re not quite celiac, it’s not quite pathological, but we know you’re sensitive to it.” That’s where to person may have it and they may not have an instantaneous response. It may not happen right away and it may take a while and it may not even be connected to the gut, meaning you may not have the bloating, the diarrhea, the gas, the cramping. You may just have a little bit of brain fog or maybe a little bit of joint pain and never even connect the dots.

Evan Brand:  Exactly. Now a lot of people they have spent money and a lot of practitioners out there are recommending people to get tested, food sensitivity testing to look for wheat or gluten sensitivity, a waste of money. You and I have covered this on several, several podcasts. Don’t go and pay $400, $500, $600 to get told that you shouldn’t eat gluten. Just cut it out for 60 days. Cut out all of your grains for 60 days and see what changes. See what happens and then if you’re willing to add some back in, like you mentioned Justin, the organic rice or the organic corn and see if things change, like for you, you got on me about corn. You’re like, “Look, man. You need to get rid of all grains. Don’t just go gluten-free,” and my skin got better, as soon as pulled the corn, as soon as I pulled out–

Dr. Justin Marchegiani:  Yes.

Evan Brand:  The rice. So for me, I have to be a little bit more strict. I’m trying to make sure that we give people take-aways and we’re not just saying a bunch of stuff. The point is clear here. Don’t waste money on food sensitivity testing. The best test is yourself, using patients, and journal and if you react to blueberries, well, there you go. If you react to avocados, there you go. If you react to rice or potato, there you go. But wouldn’t you agree that there could be some false positives where someone may test reactive to something but they’re not? They’re immune system is just hyperstimulated from their previous historical diet. Is that possible?

Dr. Justin Marchegiani:  Yeah, I mean, my issue is more with the false negatives. Meaning they test for something, gluten whether it’s like a—a gliadin test.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And they test negative and they think, “Oh, now I got this false sense of security that I can go–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Eat gluten.” That’s really the issue. The false positive’s gonna be harder because your immune system’s gonna be hyperresponsive, so if those antibodies are higher, it’s gonna be easier to see. My issue is maybe the immune system isn’t at that responding level and it really is but it’s just not at that time, and then you—you basically take snapshot when it’s negative, but it’s really an issue because then typically people that are positive, they’re gonna go and do what? Cut the foods out.

Evan Brand:  Right, yeah.

Dr. Justin Marchegiani:  So I’m not worried about someone cutting it out that may be able to handle it. I’m worried about someone adding it in because they think they can handle it based on a lab test.

Evan Brand:  Because they got the green light, for sure.

Dr. Justin Marchegiani:  They get—they get the green light. Exactly.

Evan Brand:  Right.

Dr. Justin Marchegiani:  I’d rather have someone stop at that stop sign even though they may not have to.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Than think it’s a green light and go through it and get T-boned, right?

Evan Brand:  Ex—yeah, that’s well said.

Dr. Justin Marchegiani:  Yeah, so that’s kinda my mindset on that. Now the big picture on top of that is there can be delayed reaction. So when we add foods back in in our patient’s diet, we do it every 3-4 days. So it’s kind of a very slow type of add in and we do a small amount in the beginning and then we max out to about 3 or 4 days and we look for any type of reaction, any kind of small reaction whether it could be brain fog, joint pain; it could even be just skin issues. So it could be poor sleep. So we really wanna look at the nuance symptoms that may not even be a gut-based symptom, and also, I got patients—one patient said, “Screw it! I’m adding gluten back in.” It took 2 weeks and they just felt absolutely terrible, like it just came reeling in where he was literally incapacitated for days.

Evan Brand:  Oh, I’ve seen months in some cases.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Nobody that have experienced month, I’ve—I’ve had people say about a month that their wrist pain came back but I’ve read sometimes 3, 4, 5, 6 months for somebody that’s just like, “Ah, I’m gonna go off the rail, screw it, I’m sick of this. I’m not really getting any better with keeping gluten—gluten out. I’ve maximized my potential.” But then they don’t realize, they really haven’t maximized their potential. They were at a good baseline and then they backtracked.

Dr. Justin Marchegiani:  Exactly.

Evan Brand:  So don’t suffer. Don’t suffer. Now people think, well, where does this nutrition advice come from anyway? I mean a lot of the stuff that you and I talk about is inspired by some of the work from Weston A. Price and what he’s done. And he traveled the world looking at tribal societies and maybe some of these ancient tribal were doing grains, but if they were it was gonna be either a fermented or a soaked or a sprouted or a properly prepared grain and yes, they could. So if you see people arguing on the internet about, “Oh, grains are good for you. Here’s why ancestors did eat them.” Well, the grains are still relatively new. Now they probably are some ancient wild rices. There’s the einkorn, the original ancient grain.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Stuff like that.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  But at the same time, the world is a different place, meaning that there’s more toxins and there’s more things that people have to react to. So yeah, maybe a thousand years ago you could have tolerated something like some wheat and some grains. But now, if your toxic load is already so high, if you’ve had a history of a low fat diet and your gallbladder is likely stagnant or not optimally functioning or you have a lot of chronic stress, so your hydrochloric acid levels and your enzyme production is lower, you’re not in the same world that those people were in that were eating those type of grains. So your response is gonna be different. Just because somebody else did something before doesn’t necessarily mean that it’s good for you. We have to really look at the new variables, and so that’s kinda what I think you and I do is we’d look at, “Okay, what is the modern world presenting with this person.” You know, what are your biggest areas of stress? Oh, you’re an executive in a high rise in LA. Okay, well, that level of stress is significantly more than what a hunter or gatherer would have—would have had. So really need to make sure that it’s a low toxin, nutrient dense, anti-inflammatory diet that is based around your goods fats, your good proteins, your veggies. Maybe they can do rice but maybe it’s once a week and it’s a treat and then they’re done and they’re done and they’re okay with it, and they don’t flare up.

Dr. Justin Marchegiani:  Exactly and now looking at it from my perspective, number one we have to realize that negative effects may not happen overnight.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  It’s nice to have that. It’s nice to have like, you know, the so-called canary and the coal mine. Anyone that doesn’t understand that analogy, it’s basically old miners used to not be sensitive to carbon monoxide as fast until they were asleep which means they were dead. But the canaries would literally be sensitive to it. So they would literally bring a canary in the coal mine and the canary would literally drop dead, meaning we’d better get the heck out of this mine because–

Evan Brand:  Ugh.

Dr. Justin Marchegiani:  The carbon monoxide’s really high. So that’s the canary and the coal mine, is you get the instant feedback before it’s too late. Now some people it’s delayed and it comes in ways they don’t ever connect the dots to and that where it’s were—that’s where it gets really hairy. Now I hear a lot of doctors out there, “Well, pull gluten out for a bit,” which I think is great, almost—almost all of my patients go on an autoimmune diet to start with, because I can’t tell you how many times something like nuts or eggs can cause a problem, and because they’re such a common staple in a Paleo diet, anyone that has gut issues or severe neurological stuff or mood stuff or hormone stuff, an autoimmune diet with the potential of something like a—an SCD or GAPS or a low FODMAP may even be added on, kinda like a filter. You kinda add an additional filter on that camera or a different lens on that camera to make it more superior, more intense based on what the patient needs, but I can’t tell you how many times we found things that we would never even have thought to begin with. So we start there and then we add things back in slowly. Now it’s my belief that things like grains should not be a staple just because of their nutrient density, alright? And I shouldn’t even say it’s belief, it’s actually a fact. Grains are pretty nutrient-poor if you look at their nutrient levels and then when you take into account that they have mineral blockers and protein disruptors like chymotrypsin, trypsin inhibitors, oxalates, phytates. Remember these plants don’t wanna be eaten. They want to pass on their DNA just like human beings do.

Evan Brand:  Well–

Dr. Justin Marchegiani:  So they secrete to make it so if the person that eats it may not want to do so long-term. So because of that we wanna be choosing foods that we can digest and eat and still have the nutrient density. So my say on the patients is pretty simple. Sub your grains for greens. Sub your grains for greens. Meaning anytime you would eaten a whole bunch of grains in your diet, eat greens instead and if we want to have a little bit more carbs because you need more carbs because it fits you better metabolically, then we can add some yucca or we can add some sweet potato or we could add some plantains or we can add some pumpkin or some squash. That’s a good starting point and if you want something that gives you the pasta feel, you can do like a miracle noodle or a zucchini noodle or a sweet potato noodle, so you still have that mouth feel and you don’t feel like you’re missing out.

Evan Brand:  Yup, yup. That’s well said. Yeah, I did some white rice the other day. I didn’t feel good with it. So I’m back on plantain cake and I’m feeling amazing with it.

Dr. Justin Marchegiani:  Yeah, I actually went and had sushi last night. I love sushi. I primarily do sashimi and I actually show up there with my own MCT oil and coconut aminos and I just—I mix that up. That’s kinda my, you know, my so-called soy sauce. You know, they have tamari there which is a gluten-free soy sauce, but tamari still got a whole bunch of soy and which is a phytoestrogen, so I’m not a big fan of that, so we chose—my wife and I did the MCT and the coconut aminos—now I did do a nice roll. I did like 2 nice rolls and again, imitation crab or imitation lobster is commonly loaded with gluten. Be mindful of that. And a lot of times they coat gluten and stuff on there. So anytime you go to restaurant—this is advice I’ve used over the last decade—you tell them you have celiac disease. You say, “I’m celiac. I have a severe allergy to gluten.” You let them know and they come back and they—they really kinda comb over everything for you. If you just tell them, “Hey, please avoid gluten” or “Hey, I’m gluten sensitive,” people don’t quite know what that means. So “Hey, I have celiac disease. I have a severe gluten allergy.” Because what does that mean to the waitress or the restaurant owner? It means if I feed this person this food, they’re gonna start choking and that’s bad for business. They’re gonna start, you know, grabbing their throat. They’re gonna need an Epi-Pen. They’re gonna get shipped off to the ER. We’re gonna have an ambulance pull up to the restaurant. So you wanna insinuate that by letting them know severe allergy. Now they go back and they’re very careful at what they give you.

Evan Brand:  Yup. I’ve heard–

Dr. Justin Marchegiani:  Like last–

Evan Brand:  I’ve heard–

Dr. Justin Marchegiani:  Go ahead, yeah.

Evan Brand:  Multiple people say that. So what do you do logistically? You just—you bring the bottles in your wife’s purse, of your aminos?’

Dr. Justin Marchegiani:  Yeah, I just literally brought them. I just—I had a nice little baggy and I just brought it in there, in my wife’s pur—purse, It’s actually just like that.

Evan Brand:  It—it’s really not that hard. We bring—I bring Himalayan salt packets in, too,

Dr. Justin Marchegiani:  Yeah. It was easy. I just brought it in and it was great and I feel good afterwards. I get really good fats in my body which is excellent, and I just feel a lot better.

Evan Brand:  Now how do you know—how do you know if you’re getting imitation meat at those places? Do you ask them? How does that work?

Dr. Justin Marchegiani:  Yeah, you ask. You ask and this place I went to–

Evan Brand:  Is this imitation crab?

Dr. Justin Marchegiani:  Yeah, I asked and say, “Is this imitation crab or imitation lobster?” Now on the menu, it said imitation crab, imitation lobster, so I knew off the bat–

Evan Brand:  What is that?

Dr. Justin Marchegiani:  It’s typically like gluten. It’s gluten combined with some other types of things. Because think about it–

Evan Brand:  Eww.

Dr. Justin Marchegiani:  Gluten is glue, so they can like stick gluten to other types of proteins.

Evan Brand:  Is it fish? I mean, what in the world do they use?

Dr. Justin Marchegiani:  It may be fish. It may be like a pea or a legume kind of thing, and they combined it in it to make it feel like crab or feel like lobster.

Evan Brand:  That’s so gross.

Dr. Justin Marchegiani:  Yeah, I’ll pull it up here and I’ll—I’ll let you know exactly what they bind it to. But again, what does it mean? It just means there’s gluten in it.

Evan Brand:  Yeah, a lot of people ask me that. I think it’s a common question. I know we’re kind of just freestyling this episode here. People ask about, “Well, if I’m trying to do AIP, can I ever go out to restaurants again?” And I would say, the answer is yes. But it’s just–

Dr. Justin Marchegiani:  Of course.

Evan Brand:  You just have to choose carefully where you go.

Dr. Justin Marchegiani:  So basically what it is it’s the—the fake crab or the fake lobster—they just take other kinds of fish and they kind of mush it together they use gluten to hold it together. It’s kinda like a–

Evan Brand:  Ahh.

Dr. Justin Marchegiani:  A binder of you will.

Evan Brand:  Ahh.

Dr. Justin Marchegiani:  No, you totally can. People tell me this all the time and I’m like, “It’s nonsense. I’m sorry. It’s absolutely nonsense.” I went out to eat last night. All I would have had to have done which was not have the rolls and the rolls just had a little bit of white rice in it. But everything else was super clean. It had like eel or I had tuna or I had salmon and I had like avocado and like some carrot and some lettuce. The only thing was a little bit of white rice, but worse off, I would just go and get the sashimi.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  I would just do sashimi. I would just do a seaweed salad or regular salad and make sure the dressing is clean. I’ll just typically use the coconut aminos and the MCT for the dressing. So I’ll just say, “Please no dressing.” And I’ll do–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  MCT, coconut aminos, a little bit of sea salt on there and then you’re good to go. If you go on to a streak restaurant, really simple.  Order a nice clean steak and just say, “Hey, I have severe gluten allergy. I wanna make sure the spices that are on the steak are just sea salt or just you know, spices that contain no filler, no MSG, and any nice restaurant’s gonna have that.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Even The Outback had that, too. They have like really good like spices that are certified gluten-free. So worse off, you just say, “Hey, just sea salt.” That’s it and you’re good.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And then you can always do your vegetables and if they don’t—if you don’t like butter, you can’t do butter, you can always bring a little thing with you or if you don’t wanna do that because it’s too high maintenance, just do olive oil. Have them put some high quality olive oil. Have them just steam it and have them just bring the olive oil to the table and you dress it. Same thing–

Evan Brand:  Or you could bring that, too, if you want it.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You could bring some olive oil.

Dr. Justin Marchegiani:  Yeah, and most restaurants will have it though so you don’t have to.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And then worst off, for like dressing, you can always just ask for a lime or a lemon and then some olive oil and then just squeeze that lemon on there and then just pour some olive oil, add a little sea salt and you’re good to go.

Evan Brand:  I’m on an avocado oil cake lately.

Dr. Justin Marchegiani:  It’s great. It’s a little expensive but it’s great.

Evan Brand:  It is expensive.

Dr. Justin Marchegiani:  Yeah, I’m a huge fan, like I do all my dressings either with avocado or olive oil and I’ll just do a little olive oil. I try to stay away from balsamic because it’s a little higher in sugar and mycotoxins–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Which is like the fungus and I’ll mix that with some olive oil and I’ll do a tablespoon of high quality, organic German mustard and I blend it up in my Vitamix and it’s good to go.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  That’s my salad dressing.

Evan Brand:  So you don’t—it—it doesn’t have to feel so sacrificing. I think it’s a mindset thing.

Dr. Justin Marchegiani:  Totally is.

Evan Brand:  You just have to hack it a little bit.

Dr. Justin Marchegiani:  Totally is.

Evan Brand:  You gotta be a food hacker.

Dr. Justin Marchegiani:  Meat, right? Steak, great, awesome. You can go to a place that has salad. Get a really good Cobb salad. There’s a restaurant across me called Maudie’s where I live in Austin and then we’ll just go and I’ll get the fajita and green salad in which I’ll ask for extra meat. I’ll say no fajitas chips on it, and I’ll say 100% certified gluten-free so they know not use different tongs or use the same grill that may have had something that had gluten on it before, and they keep it really clean and then it just got vegetables and it’s got a whole bunch of meat and some salad in it and that’s it. It’s good to go.

Evan Brand:  That’s excellent.

Dr. Justin Marchegiani:  Yeah, so there’s a lot of good options that you can do. Just speak up and remember like, you’re the customer. You know what you want. You wanna feel good afterwards. That’s the goal. It’s not that you wanna be a pain in the butt, you wanna feel good.

Evan Brand:  Right.

Dr. Justin Marchegiani:  And you just gotta know what makes you feel good. That’s it. If you know what your kryptonite is, Superman is not gonna choose to be around kryptonite just because it makes you feel better. You wanna choose to be around and say screw it. I’m gonna—I’m gonna do what makes me feel the best.

Evan Brand:  Yup. Yup.

Dr. Justin Marchegiani:  So outside of that, we talked about some the testing stuff. Now like Cyrex Labs has some testing that you can do as well.

Evan Brand:  It’s pricey.

Dr. Justin Marchegiani:  Yeah, it’s a little pricey, and I only do that kinda testing—I think it’s Array Panel 3.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I’ll do that testing with some patient only if they’re just absolutely, for the most part, not willing to make any diet changes. Now most people that are finding us have already read and already are—heard our content so they’re already very motivated to make these diet changes and most of them have already done it. So we kinda help people already because our content is so ubiquitous. The next, some our stool testing that we do with the DRG and GI Map comes with gliadin antibodies and I see a lot of patients that come back with gliadin antibodies in the stool and they may not even be symptomatic from a digestive perspective. I had one patient on Friday with a whole bunch of mood issues and joint pain, and they have the gliadin in their stool.

Evan Brand:  So what is that telling you? That they are getting exposed to gluten?

Dr. Justin Marchegiani:  They’re getting exposed or they’ve been clean for a few months, but their immune system is so jacked up from that previous exposure that it’s taking that long for it to drop. That’s kinda scary, right?

Evan Brand:  That is.

Dr. Justin Marchegiani:  That can be very–

Evan Brand:  Well, that’s why I’ve heard that I—I think, I can’t remember if that was Dr. Ford or who it was, that told me about that—the 6th month number is stuck in my head. I believe that’s what he said, that was how long his—he’s a pediatric gastro—that’s how long his pediatric patients took, was 6 months away from gluten to get that immune system reset.

Dr. Justin Marchegiani:  There’s a famous study out there that looks at thyroid patient’s thyroid antibodies being elevated up to 6 months after gluten exposure. So that—I think that’s where some of that came from.

Evan Brand:  Oh, okay.

Dr. Justin Marchegiani:  It just came from that piece. And again, there’s claims out there like that gluten sensitivity isn’t’ real and that any reactions that people may be from FODMAPs and FODMAPs are like these fermentable carbohydrates. Fermentable, oligo, fructo-oligo, disaccharide, monosaccaride, and polyols. And these are certain sugars that can be in foods. I mean onions are really high, garlic’s really high, avocado is moderate, sweet potato is moderate. So sometimes people can be reacting to these higher FODMAP foods.

Evan Brand:  And not actually a gluten exposure.

Dr. Justin Marchegiani:  Yeah, and that’s tough, right? It’s really hard to figure that out, so we start with an autoimmune diet and I tell patients to be FODMAP conscious because FODMAP symptoms tend to be more immediate, because it’s the gas that arises from the bacteria in your gut eating the fermentable carbohydrate. So you eat, let’s say some onions, the bacteria in your gut after a certain amount of hours it‘s gonna start producing methane or hydrogen-based gases that will create either bloating or—or flatulence or gas or indigestion and you’ll tend to know more frequently, again the problem is I’ve seen patients cut out gluten, still have other higher FODMAP foods like cruciferous vegetables or broccoli or onion, and their symptoms are gone. Even though they’re still consuming high FODMAP food. So that’s kinda where I call BS on it, is I’ve just seen too many patients that cut it out but still have FODMAPs feel better. And that’s where the clinical experience is really important because we’ve dealt with so many thousands of patients. We just go back to our database, you know, of what makes sense based on our clinical experience and—and that may be the case, or it may not be the case, but we have examples of it on both sides.

Evan Brand:  Yup. Also I’ve seen on the GI Map some of the elevated—what was it—it’s the one near the bottom.

Dr. Justin Marchegiani:  Probably lactoferrin or elastase.

Evan Brand:  Yeah, the elastase, I’ve seen that one.

Dr. Justin Marchegiani:  Yeah, typically we’ll see it low. We’ll see it like, you know, we’ll see it low which means the enzyme level is low, meaning the amount of enzymes the person is putting out is lower, so if you’re not putting out enough enzymes that means the foods you eat, you don’t break them down fully. The better chance of them not being broken down meaning there’s more fermentation and the more gas and bloating and symptoms can arise because of it.

Evan Brand:  Oh, never mind. I was thinking of the secretory IgA, that one being high and then the anti-gliadin secretory IgA, too. Those—those two top ones that are on the bottom. That’s what the one I was thinking about.

Dr. Justin Marchegiani:  Yes, yes.

Evan Brand:  Okay.

Dr. Justin Marchegiani:  100%. So IgA will get elevated as an immune response because that’s the first line of defense for our immune system. So when we see IgA elevated it’s like the army sending out the infantry to kinda start the attack so to speak. Now most people that when they’re chronically stressed adrenally because of all kinds of diet and lifestyle issues, they’ll—they’re IgA will be lower. So it’s analogous to leaving your front door open and unlocked at night.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Anyone can just walk in. So IgA, having good IgA levels are important. Stress, adrenal issues, and chronic food allergen exposure can really weaken your immune system for sure.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Via the leaky gut.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Just like leaving the light on. If you’re immune system is chronically hyperresponsive. That’s extra energy being allocated towards something that shouldn’t be there. If, you know, you leave some water running in your bathroom, your guest bathroom that you’re never in and then you leave a light on in that bedroom, too, and you’re magically, the next month your electric bill and your water bill are much higher even though you didn’t notice that because you were, you know, that was—that room was all closed off, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  That’s kinda what’s happens with gluten sensitivity, your following the food pyramid, you’re eating your 10-12 servings of grains a day, and you’re thinking you’re doing yourself a good deed, but you’re really turning on the lights and running the water and you don’t even know it.

Evan Brand:  Absolutely. Good analogy.

Dr. Justin Marchegiani:  Yeah. So regarding that piece, don’t fall prey with a lot of people saying that, “Hey, you know, just because you didn’t react to gluten, it may not be an issue.” There are tests out there that you can do. But you can also reintroduce it very carefully and see how you respond, then obviously gluten-free grains first, and those may be okay from time to time. It should never be a staple and I would try to never do gluten unless it’s really a special occasion and you know you can handle it, and, you know, have no un—you have no diagnosed autoimmune conditions.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  That’s kinda my rule of thumbs and just, the big take-home is this. You can ignore reality but you cannot ignore the consequences of reality. Know your body. Know you what you can handle. Make sure you’re really healthy before you—you even get to that level of exposure. I much rather see someone cheat with gluten-free food, like a white rice-based dessert or something versus a whole bunch of wheat.

Evan Brand:  Yup. Definitely.

Dr. Justin Marchegiani:  So any other comments–

Evan Brand:  Less risk.

Dr. Justin Marchegiani:  So far?

Evan Brand:  I don’t think so. I think we’ve—we’ve kinda gone to a couple different places and gotten the point across, I believe, which is be careful. Don’t be paranoid. But be careful, be wise, be questionable, but you don’t have to create a scene. You can still get what you need at restaurants and not be problematic. Like today we went to a local place where I got a bison burger with some greens and it was excellent and I feel so good from it. Avocado on it, oh, man! I’m still feeling good.

Dr. Justin Marchegiani:  Yeah, excellent.

Evan Brand:  So—so it’s possible. You don’t have to—you—it’s not as big as a sacrifice as it may seem I guess. So that would be my last—my last message.

Dr. Justin Marchegiani:  I’m gonna just read one last research study. This came from a Chris Kresser blog. It was really good on gluten sensitivity, but I’ll just kinda reference it here. New study took place over at the Columbia University and what they did was they enrolled 80 subjects who had self-reported non-celiac wheat sensitivity. So they reported that were sensitive to what they ate, that they didn’t feel good. Forty was celiac and then 40 healthy subjects. So 40 were celiac, 40 were just sensitive, and then what they did was they—they excluded certain diagnostic markers. So like they had IgA, they had transglutaminase 2, histology—they took blood samples on all of the patients and even intestinal biopsies. The blood samples were used to look at signaling molecule proteins in the blood which is really interesting. Now what they found was that the non-celiac wheat-sensitive individuals had leaky gut. So they had this gastrointestinal permeability. Now they compared it to the health—the healthy subjects and they did not since—this is not really surprisingly but they found out that the gliadin component of gluten can affect the tight junctions even in the healthy patients as well. So what does that mean? It means the main mechanism of action is the leaky gut. So it’s like just because you leave your front door open for one night and no one comes in your house, doesn’t necessarily mean that you’re compromising your house, your gut, your immune system in this analogy in the long-term. So if you do it every day and you leave that door open every day, your chance of getting robbed goes higher and higher and higher.

Evan Brand:  Yes, so you could feel well eating gluten but you’re still gonna be causing intestinal permeability–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Therefore, allowing toxins and parasites and other things to get into the system that shouldn’t be allowed in free.

Dr. Justin Marchegiani:  Yes, so the whole moral of the study was just because you didn’t have celiac, and you had this non-celiac, meaning you didn’t have all the diagnostic markers, the villous atrophy, all of the transglutaminase antibodies but you still were sensitive, the reason why was the leaky gut. The more you keep that—that gut open, the bigger chance of inflammation and that’s the thing. It really comes down to immune activation. The more your immune system is activated, the worse and what they also found was that these people in the non-gluten sensitivity group had higher levels of LPS or lipopolysaccharide binding protein. This was elevated and that in itself can increase leaky gut as well and these are sensitive markers for gut bacteria moving in the gut. So basically, you have gut bacteria from the gut moving into the bloodstream. That’s like the vagabonds on the street, the criminals on the street moving into your house. And when they’re in your house, they’re setting up shop, right? They’re not respecting your stuff, they’re creating a whole mess and that’s what these bacteria and these LPS and these bacterial junk are doing in your bloodstream and they’re causing the immune system to activate. So it’s like having someone in your house that’s like the Sheriff and then just start shooting at the people that come in. The problem is there’s gonna be a whole lot of collateral damage and the walls are gonna be shot out and a whole bunch of other things are gonna be shot out, too, and that’s like your immune system attacking the thyroid or attacking other kinds of tissue in the body.

Evan Brand:  Yes, there you go. That was good analogy.

Dr. Justin Marchegiani:  Yeah, anything else you wanna add to that, Evan?

Evan Brand:  I don’t think so. I think we’ve got the point across today.

Dr. Justin Marchegiani:  Cool. And then what would you say the best action points are? I’d say steak restaurants, sashimi, grass-fed burger places just sub the bun and just put the burger on a salad.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Really good things like Epic bars are great. Jerky is great. If you can handle like the nuts and spiced kind bar, if you can handle the nuts, those are great. They’re high protein, lower in carbs. Jerky. I would say smoked salmon at Whole Foods are really good like snacks on the go and really good collagen protein shake is great as well.

Evan Brand:  Yup, I agree. The only thing I would add—I don’t know if I would add anything. No, I thought I had something in mind. I don’t.

Dr. Justin Marchegiani:  So again–

Evan Brand:  I like–

Dr. Justin Marchegiani:  Go ahead.

Evan Brand:  I like butter. I like butter.

Dr. Justin Marchegiani:  I like butter, too, man. I got—that’s why I named my dog, Butter. But moral of the story is this, alright, there are gonna be some people that have already tried this and they’re not getting better. There are gonna be some people that tried it and are feeling a lot better. So my kind of plug is for people that are trying it and aren’t quite getting all the way better, there’s something deeper and there could be some serious digestive distress. You’re not breaking down food. There could be some infections. There could be some serious dysbiosis or SIBO and we may have to have the clinician’s eye really look over it and see what else is going on. There are also may be a lot of malabsorption from this happening for a long period of time, too, that needs to be assessed and looked at.

Evan Brand:  Totally, but here’s the free step. So take the free step first and then reach out, go to Justin’s site, I believe you’re booked out like 2 months now. I’m booked out like a month now. So we’re still available. We still block out a few hours each month for free consults. So if you’re kind of out there thinking, “Well, can I get help? Can I possibly get better?” Generally the answer is yes, as long as you’re motivated to try to–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Make the changes that are necessary.

Dr. Justin Marchegiani:  Yeah and we keep a few after hour consults available. People that need to get in on an emergency basis. So if people need that, you know, they can get to the front of the line. They don’t have to wait the—the one to two months because we know some people really need to get in and people that are, you know, less emergent they can always just get in in 1-2 months.

Evan Brand:  Totally, totally, yeah. So it’s good to have options there because the last thing we want you to do is think that you are going—not necessarily, it’s not that you’re not gonna get help, but we don’t want you to go to the emergency room and say, “Look, my gut’s hurting,” and then you go and you get the endoscopy and then you pick up an antibiotic resistant bacteria but the endoscopy shows nothing because it’s something else. It’s not something that’s pathological enough that’s gonna get detected or diagnosed by them, so–

Dr. Justin Marchegiani:  Yeah, and the worse thing in conventional medicine is once they see you have gluten, they’ll have you come off it and then re-test it and the only problem is if you’re really sensitive, you may feel like crap for weeks or months afterwards. That’s the problem because if you know already, do you really wanna, you know, play around with fire like that?

Evan Brand:  No, it’s scary.

Dr. Justin Marchegiani:  May not be the best. Yeah, it is.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I mean I see patients that are really sensitive where they—if they get exposed to it, they literally can be disabled.

Evan Brand:  Yup, I know.

Dr. Justin Marchegiani:  Not good. So–s

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Well, everyone listening, feel free and click below. Give us a review. We love your feedback. We love the word being spread and if you want, just check out Evan’s site and my site. Get more educated, inform yourself, get wicked smart so you can take your health back and your control.

Evan Brand:  Well said. Take care.

Dr. Justin Marchegiani:  Evan, have an awesome Labor Day weekend, man!

Evan Brand:  You, too. See ya!

Dr. Justin Marchegiani:  Thanks! Bye!

Evan Brand:  Bye!



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