Dr. Peter Osborne – No grain, no pain! – Podcast #88
Dr. Justin Marchegiani interviews Dr. Peter Osborne in today podcast episode where they talk about being true gluten-free and what the gluten-free diet is all about. If you aren’t having the results you are looking for after trying the gluten-free diet, here’s everything you need to know.
Dr. Osborne has a book out right now called No Grain, No Pain. Listen to this podcast and learn how diet becomes a potential cause for autoimmune disease. Discover two common nightshades that most people tend to forget or don’t know about and the need to stay away from these if they are having chronic pain. Find out what highly specialized testings are available that you can take to check if your body tolerates gluten or not.
In this episode, topics include:
01:45 The history of gluten
9:47 Gluten-free diet vs true gluten-free
13:54 Pain and nightshades
16:20 Mechanism of gluten causing pain
25:00 Prescription pain trap
Gluten Free Society: http://justinhealth.com/gluten-free-society
No Pain No Grain Book: http://justinhealth.com/no-grain-no-pain
Gluten Free DNA Testing: http://justinhealth.com/gluten-testing
Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin Marchegiani. Welcome back to the show. Today I have an awesome guest, a friend and mentor, Dr. Peter Osborne. Peter’s got a book out right now called No Grain, No Pain, all about reducing chronic pain by making simple dietary changes. And I first heard of Peter about 5 or 6 years ago because I was one of these conventional gluten-free diets and I wasn’t quite having the results I was looking for. I still had some skin issues, some rosacea, some inflammation and he was the first person that put the concept out there that really resonated with me called being true gluten-free and the phenomenon of gluten-free whiplash. So it stuck with me 5 or 6 years ago and Peter’s out there helping thousands of people. He’s reaching out to hundreds of thousands of people via his weekly emails and this new great book that we wanna talk about and get some more information out to all the listeners today. So Peter, welcome to the podcast.
Dr. Peter Osborne: Hey, Justin! Thanks for having me, it’s great to be here.
Dr. Justin Marchegiani: It’s great for you to be here. Before we start, what did you have for breakfast this morning?
Dr. Peter Osborne: Right out of the gate, well, I had a couple of scrambled eggs and coconut oil with a cabbage salad. I had some purple and green cabbage with some shredded carrots on top, some pecans and some sliced red bell peppers. That was—that was breakfast for—for me this morning.
Dr. Justin Marchegiani: That’s great. I was hoping you weren’t say a gluten-free bagel.
Dr. Peter Osborne: No, I stay away from anything gluten-free. At least labeled gluten-free, right?
Dr. Justin Marchegiani: Yeah, absolutely. Now one of the podcasts I first heard of you on a few years back, you kinda talked about the history of gluten. I think it was Dr. Willem Dicke, he was physician over in Holland and how he came about connecting the dots, I think with World War II rationings that grains, especially wheat, barley and rye, and as you put out there in your research, it’s much deeper than that. But can you just go over, just a brief overview of the history of gluten, and how we know it to be, you know, what it is today from a clinic perspective, cutting it out actually helps with a lot of these issues?
Dr. Peter Osborne: Yeah, this is a really unique story. So, you know the physician was—was treating kids in—in a pediatric ward during World War II and what happened was grain was rationed and so no grain was available as food source for the hospitals, so the kids all went into spontaneous remission. Now this was at a time in our history where we—we knew of celiac dis—disease, we just didn’t know what caused it. So here—here all of a sudden, grain’s no longer available, all these kids are healing because celiac disease is—basically it’s a disease, you know, pediatric disease where you vomit and—and diarrhea and until you dehydrate and die. So—so he wrote a paper. It was published in 1952 and the same year, a group of researchers at the University of Alabama Burming—Burmingham did a study on 10 patients with celiac disease. Now here’s the sad part. This study was done on 10 patients. This is the study that isolated the protein that we—we commonly refer to as gluten. This protein is named alpha gliadin.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Peter Osborne: And they said, “Look, no further, we’ve discovered the cause of celiac disease. It’s alpha gliadin, therefore, all these other things are fine. All we really need to worry about is anything that contains alpha gliadin, and this is where wheat, barley and rye comes from.” Because when we’re referring to gluten in the FDA and the—and the definition in the grocery stores referring only to alpha gliadin, it’s not referring to this family of proteins which gluten is technically, it’s—it’s a family of proteins found within all grains—all grains, meaning corn, meaning rice, and sorghum, and millets. So not just wheat, barley and rye. But again, this study isolated alpha gliadin and it was again, only on 10 patients, but this was kind of a platform moving forward. And another group of—of physicians did a study and wrote a book on it. It’s called If You’ve—If You’ve Heard Or Read, it’s one of these books—I’m actually pulling it off my library shelf right now, by Sidney Valentine Haas.
Dr. Justin Marchegiani: Mmm.
Dr. Peter Osborne: It’s called the Management of Celiac Disease and they did this—this study on 600 patients. So again, a comparative, 10 patients versus 600 patients. And what they found is they found that really grain-free was—was actually what led to a remission, and they had a remission in 600 patients. So 100%—100% remission rate versus today, if you look at the standard gluten-free diet, what is the remission rate if we measure—if we measure the components of celiac disease, which are antibodies, persistent inflammation as well as villous atrophy on biopsy. If we look at how many of the patients with celiac disease actually are cured with a wheat, barley, rye-free diet? It’s in essence, it’s less than 9%. So it’s about 8%–
Dr. Justin Marchegiani: Yeah.
Dr. Peter Osborne: Could actually experience a curative rate. So—so this was my first kind of techy endeavor into or scientific endeavor into this because for me it was—I was eating all these gluten products just like you—gluten-free products. I was drinking the gluten-free beers. I was eating the gluten-free breads and for me, what—what was happening was I felt worse. I—I could go eat a loaf of wheat bread and feel better than if I ate this gluten—this—this gluten-free rice bread or corn bread, etc. So it—it really started to get me asking different questions and so I started reading about the history of—of grain in and of itself, and TJ Osborne who discovered prolamins. He’s actually the—the—who we call the father of plant biochemistry. He discovered prolamins and classified prolamins, which—prolamins are a form of gluten, and—and so we have gluten being this family of proteins found within grains. Grains are the seeds of grass. Within the seeds of these grass, we have proteins that are storage proteins that are designed to feed the—the embryo of the grains so that it can grow and sprout and to form a new grass, right? So, but also designed to protect the embryo so that predators don’t eat all the seeds, and basically eradicate the species of grass. So these glutens are not only storage proteins but they’re defense mechanism proteins found within grains and the—and—and interesting that the guy who discovered this and classified it shares the same last name with me.
Dr. Justin Marchegiani: Small world, right?
Dr. Peter Osborne: Right, right. I was blown away by it, I mean it certainly I don’t take credit for it, but I—I love that he did that work and—and has that available for us to read and—and to think and ponder on, but so we’ve got these—we’ve got these gluten proteins and there are over—in 2010, there was a study done in Australia by Bob Anderson and his group. They discovered 400 new forms of gluten, and they found that 10% of these forms of gluten were worse than alpha gliadin in terms of celiac patient cells. So they found that 10% of these new discovered gluten proteins actually interacted and caused an inflammatory response in celiac cell lines greater than—than alpha gliadin. So we know there’s more to this story and I think—I think it’s important to say, Justin, that, you know, I wrote No Grain, No Pain to shed light on this information so that people could think clearly and people could get real scientific information and—and make good smart decisions, and—and right now, with, you know, if people go to the celiac sites and to the—the general GI doctors, what they’re gonna get is they’re gonna get, “Hey, if you have celiac disease, go wheat, barley, rye-free. Don’t worry about oats. Don’t worry about corn. Don’t worry about rice.” And the vast majority of them are not gonna heal, the vast majority of them are gonna go on to develop multiple autoimmune disease as in have a life span that’s 26 years shorter. So I felt like getting that information out there to the world was an extremely important part of my mission.
Dr. Justin Marchegiani: Love that. And I had a patient just maybe a month or two ago came in with severe RA, had multiple surgeries on her spine and hands because of the actual disfigurement and she had been on gluten-free diets, but then we kind of upped it one notch with a true gluten-free diet or an autoimmune diet following a lot of the same tenets in your book and her pain, 30-year pain, literally vanished in little less than a month. I couldn’t believe it, so this stuff is real. So a lot of the things that you’re talking about should be a first line defense with anyone with chronic pain or joint issues and it’s too bad the rheumatologists out there aren’t holding this book up and giving it to all their patients.
Dr. Peter Osborne: Yeah, I would love to see it become a primer in—in rheumatology internships and rotations in hospitals across the country, and—and maybe one day we’ll get that to happen. I—I actually, you know, what’s ironic is? I—I started this whole thing started for me in Rheumatology. I—I was fortunate enough to do a rotation in the VA Hospital here in Houston, Texas in the Rheumatology Department. So what I got to see first-hand was patient after patient on methotrexate, on steroids, on immune-suppressing drugs. None of them really ever got better.
Dr. Justin Marchegiani: It’s terrible.
Dr. Peter Osborne: It—it was a horrible environment for these people, and then the surgeons would come in on—on one day a week and they would do these surgical consults and it was kind of like a mill. So, you know, the patients would get drugged with immune-suppressants. They really didn’t get better. Their joints continued to deteriorate and then they got surgical consults and got surgical joint replacements and then they were back 10 years later with a—with—with a need for a secondary joint replacement because there other one wore out. And so I got to see kind of all these kinds of patients going through that rotation through the VA Hospital. It was very eye-opening and enlightening for me and it’s actually what led me down the path or even investigating diet as a potential cause for autoimmune disease.
Dr. Justin Marchegiani: Yeah and a lot of people talk about gluten-free being kind of like a fad, and I think people need to kind of realize if you study the Paleo diet, gluten-free from a true gluten-free perspective that you echo really cutting out the grains in general is not a fad, it’s actually has history of 10-plus thousand years, it being in our, you know, in part of our diet and lifestyle, but really what it is the fad is the gluten-free substitutes that are being added in. I mean, you don’t ever have to put a label on broccoli being gluten-free, but you have to put a label on maybe rice flour or potato flour being gluten-free. So can you just talk briefly about the—the misnomer of gluten-free being a fad and then compare it to the true gluten-free aspects?
Dr. Peter Osborne: Yeah, so I mean, in—in any diet trend and we’ve seen this with Atkins and—and South Beach and we’ve seen this with—even with Paleo and ketogenic diets and probably the—the most famous of all is the gluten-free diet, right? Because what happens is big business, big companies take advantage of ignorance and—and that’s—they take advantage of ignorance through marketing. So gluten-free is a perfect example of this. We’ve got, you know, tons of companies that are out there. I think—I think some of them really started with good intention, Justin. I think, you know—you know, not really understanding what gluten truly was, they were just trying to create options for people with celiac disease, you know, rice breads, corn breads, and pastas, etc. But I mean, the reality is we have the science and we have the knowledge and—and now that they’re continuing to do that, to me now there’s an ethical and moral obligation for them to reevaluate their business models and to come back and say hey, we need to look at this in a different way. But if you look at what they’re doing, you know, first of all, we’re taking people who are very sick—autoimmune disease, right? Years, decades of damage, and we’re saying, “Hey, cut out gluten but eat crap.” I mean, that’s literally what these marketers are saying is cut out gluten, but here it’s still okay. Coke is gluten-free. Snickers candy bars are gluten-free, and hey, by the way, there’s genetically modified corn that we just shaped into the form of pasta spirals so that you can still eat macaroni and cheese. We want you to go ahead and buy a ton of that for 10 times what you pay for regular macaroni and cheese, it’s not healthy for you but we’re gonna—we’re gonna label it gluten-free and we’re gonna—we’re gonna kind of put the trend out there that gluten-free is healthier, and that’s what marketers have done. That’s what companies have done, is they’ve created this kind of trend in the market that says, “Hey, gluten-free is better for you.” But the—the problem is that the vast majority of—of people out there are ignorant to the fact of what gluten actually is. So they’re just going out buying gluten-free products, right? They’re eating them and they’re still feeling like crap, and then they’re saying, “Hey, why do I still feel like crap on this gluten-free diet?” It’s because they’re—one, they’re not really on a gluten-free diet. Two, they’re eating food that isn’t good for them, right? And the cardinal rule in nutrition, you can’t get healthy or stay healthy eating food that isn’t healthy regardless of gluten-free status. There are, you know, sugars gluten-free but it isn’t good for you, and so if you’re diet is 60% sugar, you’re still gonna feel bad and you’re still not gonna heal and recover from years of chronic autoimmune damage. So it’s important to understand perspective and perspective for the person who needs this diet is that, “Look, you’ve been sick and you’ve been accumulating damage, inflammatory damage in an—in an overactive immune system for decades.” That requires a degree of stoicism in the diet. That requires a degree of—of discipline. It requires a degree of willpower and change and desire to change if your desire to get healthy is greater than your pain, then you will make these right decisions. If your desire to get healthy is not your priority, then you’ll continue to buy these processed foods, and you’ll continue to—to buy into these marketing hype and you’ll be one of those statistics where—or you’ll be one of those people out there that say, “Yeah, I tried that gluten-free diet thing, it didn’t work for me.” And it’s not that it doesn’t work, it’s that it didn’t work for you because you didn’t apply it correctly.
Dr. Justin Marchegiani: Exactly. That makes so much sense. And I have so many patients that we even go grain-free but there’s one element because you talk about the pain in your—in your book, all about pain. I find some patients have to really cut out some of the nightshades, the tomatoes, the potatoes, the eggplants, peppers, and we know there’s a high amount of alpha-solanine and glycoalkaloids that can be very irritating to the joints and cause pain. Can you touch more upon the nightshade piece and pain?
Dr. Peter Osborne: Yeah, so—I mean, nightshades, in and of themselves, especially for rheumatic-arthritic conditions, we see these more. So like a person with a thyroid condition, we might not see nightshades be as much of a problem, but if somebody is really suffering with joint pain, these compounds in nightshades really have a great tendency. If there’s an intestinal leakage or a leaky gut or a permeability, they have a tendency to travel to the joints and really create a lot of the irritation and breakdown. So this is one food group that really needs to be looked at with aggression at removing and—and I see it in—very chronically and a lot of patients have to remove it indefinitely meaning that it’s not like a, you know, remove it for the next six months and then bring it back in. It’s a remove it because for you, as a unique person, as a unique genetic biochemical individual, this group and this compound of foods it—it irritates your joints. It’s actually we could—we could actually look at nightshades with rheumatic pain and say they’re probably just as much of a problem as grains are and that we really wanna get them out of the diet. Potatoes, peppers, one of the nightshades that people tend to forget about is a goji berry.
Dr. Justin Marchegiani: Ahh.
Dr. Peter Osborne: I mean, we—you buy the goji berries in these, you know, you can buy, you go to Whole Foods or like Trader Joe’s and buy the bags and berries frozen to make smoothies and stuff like that, and a lot of times, goji berries are in these mixes. You gotta remember goji berry is a nightshade. Now one of the other nightshades that—that people tend to forget about because you don’t eat it is tobacco because you smoke it.
Dr. Justin Marchegiani: Oh.
Dr. Peter Osborne: And so let’s say that you live—and I just had a patient. She’s living in a home, her father smokes, she’s getting exposure to second-hand smoke, she’s got chronic rheumatic pain and what ends up having to happen is we gotta get this girl out of this place and into her own place, so that—and she was an adult, so we—we were able to make that recommendation. She was able to get out of there and basically was able to recover a little bit better. Now you will see a higher tendency of people who are smokers developing rheumatic-arthritic and that’s one of the reasons why. It’s that tobacco is a nightshade.
Dr. Justin Marchegiani: Well, I just learned two new things. Goji berries and tobacco. That’s great. Good clinical call on that one. And what’s the mechanism of gluten actually driving the joint pain. We know we have the underlying leaky gut which can cause all these proteins, undigested proteins to kind of get into the bloodstream. We know the immune system and then maybe the potential molecular mimicry that’s happening where the immune response is calling out an APB for this type of protein and then other tissues kinda get in the way because they look similar. What else is happening just beyond that molecular mimicry mechanism?
Dr. Peter Osborne: So, okay, you’ve got—you’ve got leaky gut, which like you just said, it allows all these things into the bloodstream that, you know, can travel to the joint, can travel to the muscles and that’s where the inflammation process is occurring. The immune response is occurring and so we’re getting secondary or collateral damage, right? Collateral damage to the tissue as a result of the immune system mounting a response. But one of the other things is just the direct inflammation, so gluten has been shown to cause a number of different pathways in the immune system. It’s been shown to activate a number of different ones. We generally tend when we’re measuring, clinically when we’re measuring to analyze to see where the person’s making antibodies, we measure antibodies to something called an antiendomysial antibodies. We will measure antigliadin antibodies. We’ll measure anti-tissue transglutaminase antibodies. But when we’re doing these measurements, we’re typically only measuring IgG which is one type of antibody or IgA. Now we make also IgM, okay? Which is an antibody that very rarely gets measured. So you’ve got also IgE which is an acute allergic response, and then you’ve T-cell responses and immune complex responses that are also potential pathways where people are reacting to gluten but then you have this whole other pathway that isn’t measurable at this point in time. We don’t have a commercial lab that measures this and this is the innate immune response. So antibody responses are called humoral immunity, it’s—it’s ada—what we call adaptive immunity where people get exposure and they create antibodies to what they’re getting exposure to to protect themselves, so that, you know, the example would be like a virus. You get—get exposed to a virus, your body responds by making these antibodies to protect you. But in the case of a virus, the virus comes, your body attacks it, and the virus goes away. It’s not like gluten where you—gluten comes, your body creates antibodies against it and gluten goes away, because if you keep eating the gluten, you continue to make the antibodies, you continue to battle it. You continue to create inflammation and collateral damage. But, so that’s humoral immunity. Then we have innate immunity. And innate immunity is the immune system you’re born with. Humoral immunity is the immune system you adapt with. So your body gets smart and basically takes the feedback from the environment and makes decisions. Whereas innate immunity is what you’re born with. And so there are specialized immune cells that look—they look at things and they just don’t like them and they’re gonna attack them. And so there’s not a way that we can clinically measure innate immune response specific to gluten or specific to grain. It doesn’t exist. There’s no technology out there at this point in time. Maybe they’ll happen in the next 10 years but as of right now, it doesn’t exist. And so that’s one of the other mechanisms of inflammation damage is an innate immune response. And so what we’ll see is we’ll see people with high levels of interferon gamma or tumor necrosis factor alpha, you know, these are other markers in the blood. You can measure that they’re high. They’re markers of inflammation but again, you—you can’t measure that they’re high because of gluten but—but you can—you can measure them and you can see that their high and then you can take gluten out of the diet and then you can measure them again and see that they come down. So—so does that make sense? So you have these generalized markers of inflammation that you can measure. You can get a baseline and then you can do a follow-up and you can say, “Okay, yeah, we changed your diet and these markers have come down.” But there’s not a test that says your—your markers are high because of gluten. Because those markers can be high for other reasons, too, Justin. They can be high because you have a bacterial infection or a viral infection. They can be high over trauma, over an ankle sprain, or over liver damage. So there are other reasons why these—these inflammatory markers can be high. So it’s up to the clinician to kind of piece that together when he’s working with a patient. So–
Dr. Justin Marchegiani: Yeah, totally agree with that.
Dr. Peter Osborne: The other mechanism of damage that we see in—in rheumatic athritity, so in autoimmune arthritis is infection. So when that gut is leaky, we get bacteria that now get access and so some of the bacteria that are notorious for contributing to arthritic pains, Klebsiella and pseudomonas are two different species of bacteria. Another one is Lyme. Lyme is a very, very common cause and mimicker or rheumatoid arthritic symptoms. So you’ve got multiple forms of bacteria, so the other thing that’s important to rule out is infection. So you’ve got food that can cause leaky gut, then the bacteria leaks in, and it can get in—it can get in to the joints and start creating damage, so now you’ve got, you know, food started the problem but bacteria is finishing the problem, so if you just treat the bacteria but you don’t treat the leaky gut, then you still don’t win the war. So all of these things have to be looked at, because it—it’s the old scenario, which came first, the chicken or the egg?
Dr. Justin Marchegiani: Uh-hmm.
Dr. Peter Osborne: It doesn’t matter. We can’t answer the question but we have to address the chicken and the egg if we’re gonna get the patient better.
Dr. Justin Marchegiani: Also I think mycoplasma pneumonia is a—a big infection, too, for some of the joint stuff, do you see that, too?
Dr. Peter Osborne: Yup, yup. It’s another one, Absolutely.
Dr. Justin Marchegiani: And I also notice where there’s smoke, there’s fire. Could we have this systemic inflammation thing happening and pain may be the first indicator for people that have that genetic predisposition, but we also see autoimmune issues, maybe even type I diabetes or MS, so how many other—they call it PGAS or polyglandular autoimmune syndrome and they say, I think 78% of people that have one autoimmune condition, maybe it’s RA or some type of fibromyalgia pain, probably have another one, how much of the people—patients that you’re seeing individually in your office are having more than just the pain? There’s something else right next to it or beside it that’s happening.
Dr. Peter Osborne: Well, pretty much all of them.
Dr. Justin Marchegiani: Yeah.
Dr. Peter Osborne: It’s very rare to see a—a singular autoimmune disease that just presents in solo fashion if you look. Now you know a lot of times, the patient’s symptoms, whatever predominating symptoms they have, those are the ones they bring to the doctor and then the doctor gives them a singular diagnosis. But I find if you’re thorough and ask enough questions, you find that these patients don’t have singular autoimmune conditions, and these can actually be measured, too. You can—there are a number of autoimmune tests that can be run if a person has—if a person doesn’t have a severe immune compromi—compromization, you can run tests that measure different autoimmune responses to different tissues, and you can actually find in many of these patients, 4, 5, 6 different autoimmune reactions going on in multiple tissues. It explains a lot of their other mysterious symptoms. It’s just a lot of times, doctors don’t dive in any deeper than just kind of, patient’s got joint pain, they go to the rheumatologist. They run rheumatoid factor and any nuclear antibodies as tests, and if those come back positive, they give them a diagnosis of lupus or RA or reactive arthritis, and that’s where it ends. You know? And then patient, you know, then they stay putting them on drugs and then you know, maybe that patient’s tired, too. Maybe that patient has other symptoms like chronic brain fog and fatigue, but they never get that piece put together, they never get—they never get tested for brain antibodies or neurological antibodies, so they never even know that that piece is part of their—is part of their underlying autoimmune complex problem. It just ends with the rheumatologist.
Dr. Justin Marchegiani: Exactly. And then you just kinda talked about the—the dangerous medications that they’re putting a lot of the patients on. What really bothers me a ton is that the first line of therapy that they’re using actually perpetuates the problem even more because you have the NSAIDs which then are gonna create more of a leaky gut. It’s gonna lower glutathione levels, make it harder to detoxify the inflammation to begin with. Typically there’s gonna be gastrointestinal symptoms so they’re gonna be put on a proton pump inhibitor which will then decrease stomach acid which will make it harder to ionize minerals like selenium, calcium, magnesium, iron. They’ll get anemic. They’ll have low B12. That’s gonna create more fatigue, more leaky gut, more brain and mood issues because of the LPS that you mentioned, that lipopolysaccharide. So then now a couple years in, they’re on an antidepressant. They probably have low libido. They’re on a—a proton pump inhibitor. And then they’re on all these dangerous pain medications creating more, more issues decreasing detox. So it’s like conventional medicine is setting these people up for a world of hurt. Can you talk about the conventional approach that I outlined briefly and then your approach to get into the root?
Dr. Peter Osborne: Yeah, so I actually I call this the protru—the prescription pain trap, because what ultimately happens with chronic pain is you get patients that are put on—they’re—they’re put initially some form of pain reduction medication, typically a nonsteroidal anti-inflammatory like an ibuprofen or a—or a Celebrex or a Mobic. You know, one of these—one of these classes of—of nonsteroidal anti-inflammatories that will—will erode the mucosal lining of the GI tract and induce a permeability within the gut itself and also induce ulceration within the GI tract. So it starts to affect their nutrition. Now once you start affecting nutrition and you start reducing their ability to absorb and digest, now it’s—it’s even harder for them to heal. So you’ve—you’ve kinda established this—this is why it’s called a trap, because you start with the medication and the medication does reduce the pain. It is effective at that, but it’s effective at keeping the person trapped in a state of always needing the medication and never being able to truly fully heal because of the damage to the GI tract. You’ll also induce vitamin and mineral deficiencies in this way—vitamin C and folate, and as you mentioned, glutathione. These are nutrients that get depleted and that’s just nonsteroidal anti-inflammatory drugs. But then we look at some of the other drugs that are used in these patients. The—the steroids, so the steroids themselves which inhibit calcium and magnesium and vitamin D. Vitamin D deficiency all by itself can cause an autoimmune condition. So for being put on a drug that causes a deficiency of vitamin D long-term and we’re being treated with an autoimmune condition. We’re just allowing again—we’re allowing vitamin D deficiency to never kind of recoup, and so one of vitamin D’s function is—is it regulates immune response. It regulates how strong immune cells respond to a threat. That’s why vitamin D deficiency can cause a hyperreactive immune system, and so again these steroid medications cause these nutrient deficiencies. They also cause bone loss and water retention and bloating and weight gain. So now you take this person who’s got pain and you’ve just given them a drug that causes them to gain weight and increase their chance of diabetes, and now they’ve got joint pain already, so you’ve increased the physical pressure on their joints because now they weigh more. So now that joint gets eroded and damaged, just having to carry more weight and so that extra weight now causes more erosion. You see where it’s kind of a bleak scenario, isn’t it?
Dr. Justin Marchegiani: Yeah.
Dr. Peter Osborne: And the now we look at other drugs that sometimes get brought in and these drugs are basically severe immune-suppressants like Humira or Enbrel, and these things shut down immune system so now you—you start these medications and you’re on them 5-10 years, now you’re looking at a huge risk, increased risk for cancer and other kinds of infection. Well, we said earlier that infections play a big role, and the by-products of infection is lipopolysaccharides, play a big role in perpetual joint pain. So it’s—it’s a futile effort in modern rheumatology. It is a futile effort to go that route and expect to get resolution. All you will do is—is fall into that trap. Now how do you get out of that trap? Because a lot of people will say “Well, I can’t get off my methotrexate, or I can’t get off my–”
Dr. Justin Marchegiani: Mmm.
Dr. Peter Osborne: “My steroid because it hurts so much.” Yes, you can. But it has to be done. It has to be done with scrutiny. It has to be done with intelligence and purpose. The first step is you gotta change your diet. Diet change, first and foremost, has to be implemented because a lot of the inflammation is stemming from the poor diet in the first place. The second step is part of changing the diet is increasing your Omega 3:Omega 6 ratio. You want—for somebody with chronic pain, you want a 2:1 at least Omega 3:Omega 6 ratio of fat–
Dr. Justin Marchegiani: Mmm.
Dr. Peter Osborne: In your diet. Now that’s really hard to achieve in modern diets today. Most people don’t live on the coast where they have access to fresh coldwater fish–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Peter Osborne: Where they can get that quantity of Omega 3. So we’re gonna use concentrated EPA and DHA, you know, fish oils, so that we can drive that factor up. And I see working really, really well anywhere from 4 to 8 grams. So a lot of people stop shy of about 2 grams and they never really achieve a therapeutic dose of Omega 3 to switch that—that balance. So we’re looking at 4-6 grams potentially there. Other things that can be done naturally is the use of turmeric. It’s very, very–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Peter Osborne: Effective at pain control and—and it can be—you can use turmeric to cook with, and so if you—if, you know, a lot of Indian recipes, this is where turmeric hails, a lot of our knowledge from turmeric actually comes from that culture but it’s being—been studied more and more and more. We know it has extremely powerful and potent anti-inflammatory and pain reductive properties so the use of turmeric and I recommend 3-4 grams of turmeric, concentrated turmeric, meaning it should be at least 90% or more concentrated curcurminoid. So it needs to be standardized to contain that, otherwise, you gotta use so much turmeric in your cooking, it’s really, really hard to achieve that level for pain reduction. So if we’re trying to get pharmacological pain reduction, we really gotta go high doses, we can’t go small doses.
Dr. Justin Marchegiani: And only 15% of that’s absorb, too. I’ve—I’ve seen.
Dr. Peter Osborne: Right, so you can use things like pepper, black pepper, or BioPerine to enhance absorption then there are also lipophilic forms of curcuminoids, meaning they’re—they’re fat-soluble forms, it get absorbed better than your traditional powder. So those are all things that if you’ve got a good functional medicine doctor to guide you, that—that ultimately is a—is a really smart thing to have. You know one other thing that works extremely well for kind of pain reduction in—in these people, who there’s a couple—I’ll talk about a couple more. One is a proteolytic enzyme. Proteolytic enzymes work extremely well at modulating pain and there are a number of good clinical brands that are out there. I actually have my own formulation called Matrizyme, but they—they work really, really well at pain reduction and inflammation control. You’ve got to get the dose high enough and then the other thing that I find that is very, very helpful is something called an SPM. It’s—SPM stands for specialized pro-resolving mediators and these are by-products of fish oil. So what these are is ultra-concentrated resolvents that are derived from EPA and DHA that have a tendency to shut off the inflammatory cascade when it’s overreactive and so this is—again this is one of those things it can be used, it’s—it’s clinical so you can use it clinically in high doses for several months as you’re trying to get a patient to wean off some of their pain medications and get them moving back in the right direction. So again, if we summarize: the diet’s gotta change, inflammatory foods have to go away, grains gotta come out, nightshades gotta come out, I recommend that dairy comes out, I recommend high levels of—of Omega 3 fatty foods as well as high levels 4-8 grams a day of Omega 3 fatty acids concentrated EPA and DHA, I recommend high levels of turmeric anywhere form 4—3 to 4 grams a day, concentrated curcuminoids at least 90%, I recommend proteolytic enzymes, and I recommend SPMs, specialized pro-resolving mediators, to help with all of these different things to wean that person out of that prescription pain trap.
Dr. Justin Marchegiani: And you also use Gluten Shield as well, I think, you formulated that. It’s very high in dipeptidyl peptidase-4 to help with any cross-reactive gluten and you also use a lot of anti-inflammatory herbal blends. I think you use like your GI Soothe or your GI Restore, is that true, too?
Dr. Peter Osborne: I do, yeah. We try to seal the gut, and—and so the difference is, Justin, as you know, when we’re doing a podcast together, we’re trying to give a general—general quantity of information to people. Ultimately what I recommend if somebody has an autoimmune arthritis or an autoimmune condition, really to work with a doctor like yourself or myself or another functional medicine expert who has these things at their disposal and discretion but also the ability to run highly specialized types of tests, because the testing and you know the—we’re do—we’re giving general advice and it’s good advice but highly specialized testing allows us to take the guesswork out, because for some patients—for some patients, it’s not a bacteria at all. It’s a yeast overgrowth and for some it’s not bacteria or yeast. For some patients, it’s that their reac—I had one young child terminal allergic to blueberries, right? And every morning, blueberry smoothie was breakfast, so—so this is the kind of specialization, you can do all these right general things and still be struggling to find an answer, and that’s why taking the guesswork out, you know, sometimes it’s the best thing that you could possibly do.
Dr. Justin Marchegiani: That’s great. So in summary, get the food dialed in. Go get a good functional medicine doctor in your corner to get the—the right supplements, whether it’s getting rid of the infections, adding in digestive support whether it’s specific enzymes and hydrochloric acid, anti-inflammatory herbs to help reduce inflammation, anti-inflammatory fats and then healing-repairing nutrients. Is that a good summary to start?
Dr. Peter Osborne: Yeah, it’s great. Perfect summary.
Dr. Justin Marchegiani: Good, and then you touched upon the lab testing. You already talked about we have some of the immune testing, IgA, IgG, which is indirect—it’s not looking at things directly, and we know based on whether your weakened immune system, that may even come back a false-negative. You also talked about the conventional testing, looking at endomysial antibodies, transglutaminase, and then also your typical villous atrophy where we need like an 80% reduction in those microvilli in the small intestine to be even be able to pick up celiac which is one out of hundreds of manifestation of gluten-sensitivity, but your big thing is you’ve really gotten into the genetic testing and you’ve laid out the—the conventional HLA-DQ2 and HLA-DQ8 as being the—the celiac. But then you go deeper into the different subtypes, A1, B1, and then all the different subtypes there. Can you just kinda give us an overview with the HLA-DQ genetic typing? I know you do it on your site over at GlutenFreeSociety. We’ll put some links below the video so if anyone’s on the fence and doesn’t know if they have a sensitivity to gluten, they can get the—the tell-tale sign which is the genetic test. Can you go into that, Peter?
Dr. Peter Osborne: Yeah, so as you—as you mentioned, a lot of these tests they detect late-stage disease. So you’ve gotta have 80% of your villi destroyed before biopsy comes back.
Dr. Justin Marchegiani: Yup.
Dr. Peter Osborne: I actually had a patient, you know, it—it was a 19-year trek for her. She literally had 19 biopsies. The 20th biopsy was positive. The first 19 were negative. And—and so I say it because a lot of people go to the GI doctor, they’re dependent upon this test to give them a definitive answer. And it’s not that you shouldn’t get a biopsy per se, it’s that, look if you get a biopsy and it’s negative and you suspect gluten, you shouldn’t rule gluten out just because the biopsy is negative. You get false-negatives with biopsies very frequently. One of the reason why is the damage has to be severe enough to identify, too. The intestinal tract is 22-foot long and has a surface area of a tennis court. So when you do a biopsy, you take one little tiny cross-section, one little microscopic—it’s like taking a little tiny pebble off the tennis court and saying this pebble represents the entire tennis court and it doesn’t. And so you can’t rely on that information as definitive. You can rely on it if it’s positive. You can’t rely on it if it’s negative.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: What genetic testing does, HLA-DQ2—there are two genes, there’s HLA-DQ2, alpha 1 and HLA-DQ beta 1—these are immune genes and they’re job is—and they’re on Chromosome 6, their job is to produce an antenna that sits on the surface of the white blood cell, and the—the job of this antenna is to identify what is good versus what is bad. So if the body says, “Hey, we don’t like this.” That antenna says bad guy and then it—it captures it, presents it to the immune system and create some kind of inflammatory reaction. Okay? They’re a variety of different types of inflammatory reactions that can occur as a result of that. So there are certain pattern s on the HLA-DQ2 alpha 1 and beta 1 gene that are gluten-sensitive patterns, meaning if a person has these patterns, their body, their genetic receptor is gonna look at gluten as an enemy not as a friend. And so it doesn’t—so gene—what genetic testing tells us is that they’re going to look at gluten as a friend or an enemy. It doesn’t tell us whether they’re currently reacting to gluten, it tells us whether or not they would react to gluten and to me that is far more variable because you can take somebody who’s chronically, chronically sick, and run a genetic test and not worry about a false-negative, because a lot of these chronically sick people have immune suppression over time. Their—their IgA levels plummet and—and they’re malnourished, so they don’t have enough protein to generate enough IgG to generate an IgG-positive response. So if we’re using these traditional labs, we have this high tendency towards false-neg—excuse me—false-negative. Genetic testing doesn’t ever change. You either have the gene pattern for gluten-sensitivity or you don’t. And so again, what it tells us—it doesn’t tell us that it tells that you are reacting to gluten. It tells us that you will or you will not react to gluten. And these genes are activated by gluten exposure, so you know, a lot of people say, “Well, how do you turn these genes on?” Well, you eat gluten and these genes get mad and they activate the immune system and create an inflammatory response. So it allows us to actu—it actually and accurately identify people who should be taking gluten out of their diet and it’s a genetic issue. So gluten—we’ve defined gluten sensitivity as it’s not disease. It’s a state of genetics. If you have the gluten-sensitive gene pattern and you eat gluten, your body’s normal and natural response is gonna be to create inflammation. The more gluten exposure you get over time, the more inflammation you make. The more inflammation you make, the more you perpetuate disease processes and the more sick you become with time. So it’s—it allows us to say, “Look, you could be a little kid who doesn’t have any symptoms, but have gluten-sensitive genes, we can now say, ‘Look, get it out of your diet now, so that in 20 years, you’re not back at my clinic for me to treat your 3 or 4 different autoimmune and disease and 20 or 30 years’ worth of damage.’” We can—we can actually isolate and identify the people who need to get it out of their diet right now regardless of their illness and—and that to me is a much valuable, clinical tool than any other form of blood test because genetics don’t change. Blood tests can vary dramatically.
Dr. Justin Marchegiani: And I know that the conventional celiac genes are 2 and 8, HLA-DQ2 and HLA-DQ8, which supposedly about 35-40% of the population has those, but when you look at the other HLA-DQ1, 2, and 3, and then 1 breaks down into 5 and 6, and the alpha 1 and beta 1, and 3 breaks down to the 7, 8, 9. According to, I think, Kenneth Fine, he says 90-95% of celiacs have a copy—have at least 1 copy of those genes. So we know it went from 35-40 to 90-95 and then we originally thought well, it was at 1 in 133 people were celiacs, so now we’re starting to see it’s getting the infinites is getting greater and greater and greater.
Dr. Peter Osborne: Well, and part of that it has to do with—you know, I—I honestly believe that most people are gonna benefit from a gluten-free diet because most people have a degree of genetic gluten intolerance or gluten sensitivity. Nobody has done enough of broad scale genetic study to confirm that one way or the other, but you know, we’ve got data in our clinic that tends to—tends to go to that direction. But the other factor that you—you have to consider, it’s a—it’s a dose response issue, so the more gluten you eat, the more damage you create. So with some people who don’t eat as much, maybe don’t create as much damage and don’t get quite as sick, but so you’ve got that as an issue, but then you also have certain medications that enhance–
Dr. Justin Marchegiani: Mmm.
Dr. Peter Osborne: The way we would react to gluten, and so these are what would—and Dr. Fasano refers to these as—as the trick. He says what happens is there’s a trick. There’s basically an event that occurs and then your body starts reacting to the gluten more aggressively to the point where you could identify it almost immediately. Those tricks per se are things like chronic non-steroidal anti-inflammatory use, chronic Nexium or Prilosec or Zantac or you know, antacid–
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: Medication use. Chronic antibiotic use, right? Chronic intake of chlorine because you’re drinking chlorinated water which disrupts gut bacteria.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: You know, these are the tricks per se that we now we have an environment—a modern environment that has—we have all these elements that damage our gut and make it more susceptible. So we may already have genetic susceptibility but now you add all these other factors and it accelerates the damage that’s being done to the GI tract so that we’re getting more leaky gut. We’re getting more of these chemicals and bacteria and other things that are leaking through. So we have a modern environment that accelerates the damage that gluten can cause, because that’s one of the big questions I get, what—you know, go—go back in time 50 years ago, why weren’t people quite as reactive? Well, 50 years ago, you didn’t have antibiotics in the major cities’ drinking water on accident, right? Fifty years ago, doctors weren’t just hammering everybody with the antibiotic. You know, you didn’t have ear infections in kids and every other week, the kid’s getting put on a new antibiotics. You didn’t have mother delivering vaginal—or cesarean babies where kids don’t get normal bacterial flora from the vaginal canal when they’re being born. They get nosocomial disease-causing bacteria as the first bacteria that colonize our GI tract. So we have all these other factors that are going on today that enhance gluten sensitivity and make it happen earlier in life, and I think that’s the trend that we’re seeing. But then you also add, Justin, you add to the compo—all that component, you add to the fact that grain is processed with heavy quantities of glyphosate.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: Atrazine is another pesticide that’s used. So these grains are soaked in pesticide. These grains are stored in large bins where they have this tendency to grow heavy quantities of mold which produce mycotoxins.
Dr. Justin Marchegiani: Exactly.
Dr. Peter Osborne: Okay, and then you also have the fact that grain in and of itself, some of the—some of the grains have been hybridized so that genetically they’re more complex and harder to digest. Some of them have been genetically manipulated and so they actually produce their own chemical toxins and so when we eat them, we’re eating a lot of that. So you’ve got all these different factors that play a role in why we’re seeing people respond so well to going grain-free. That’s why that—that’s why the gluten-free diet trend is there. And if you look at historically at how this is all played out, it really started with Dr. Atkins. You know, he—he challenged the original conventional wisdom and said, “Look, quit eating carbohydrate and he—what he was onto is he was on—I think he was on to two very important things. One, he was onto the burden of—of too much excessive sugar in the diet creates a problem, causes sticky blood and—and damaged blood and it—it causes brain damage and brain fog, and it disrupts mitochondrial function and a number of other things, but I think the other piece that he really stumbled on and—and maybe he was aware of it, maybe not—I never—I never had the chance to talk to him, so I can’t say one way or the other. But I couldn’t detect that he—that he was onto this by reading any of his—his books, is that gluten in and of itself was in all these carbohydrates that people were eating as staple foods, and so just eliminating those two factors, eliminating excessive carbohydrates but also eliminating grain and—and glutens, people were dramatically improving their health and so today we have evolutions of that. We’ve got the gluten-free diet. We’ve got ketogenic diets. We’ve got Paleo diets. All kind of evolutionary diets that have moved in—into a—and they all have the same thing in common, right? And that’s grain-free for the most part. Let’s get the grain out of the diet and I think that’s why we see that as all those different reasons that we just talked about again. That’s why I wrote No Grain, No Pain. It’s not another gluten-free diet book. So those of you who are out there listening, it’s like you’re tired of hearing about gluten. It’s not another gluten-free diet book. If you really wanna understand this topic and you really wanna be able to apply it to your life intelligently so that you can restore your health, you gotta understand that this book is so much deeper than just a gluten-free diet.
Dr. Justin Marchegiani: That’s great. So if anyone’s on the fence about whether or not getting grains or out, you know, are a good thing for you? Definitely get it out, but if you need more, the genetic testing’s gonna be great especially the one that Peter’s talking about because it looks at that alpha 1, beta 1 subtype and we’ll put a link in the podcast and the video description below so people can access it. Now in your testing, you also talk about HLA-DQ4 being the only genotype that technically isn’t a gluten sensitivity genotype but even if you have that, you may still have problems with gluten. Can you talk about that for a second?
Dr. Peter Osborne: Well, it would—it wouldn’t necessarily be that you had problems with gluten per se as much as it might—is it might be that you have problems with—with grain because of all the unhealthy other factors.
Dr. Justin Marchegiani: All the things you mentioned.
Dr. Peter Osborne: Right. Well, here’s the—here’s another thing. This has been around for a number of years, but it’s really starting to come to head. There are several new classes of proteins found in grain.
Dr. Justin Marchegiani: Mmm.
Dr. Peter Osborne: That are non-glutens, and one of them is—is called ATI, amylase trypsin inhibitors. These are proteins that shut off your pancreas. So here we’re—we’re saying, we’re shutting off your pancreas, then—then we’re shutting off the digestive function of your pancreas so that when you eat these grains, they’re not being digested because the grain’s goal—it’s a seed, right? It wasn’t to come out. It—it doesn’t wanna be your food. It wants to come out of your butt with poop around it because that’s fertilizer so it can grow.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: So it has developed mechanisms to protect itself from predators and one is to prevent digestion. So this—this family of proteins called ATIs have been shown to shut down pancreatic function. But they’ve also been shown to acti—activate something in the GI tract called the toll-like receptor. And one of the things that happen when you activate this toll-like receptors is you get an anti-inflammatory pathway or an inflammatory cascade going, and so this ATI has not only created a gastrointestinal inflammation but they also created pancreatic shutdown and these have nothing to do with gluten. So if we’re talking just specifically HLA-DQ testing is—is gonna identify gluten sensitivity where-as grain may be unhealthy for other reasons and I just want—I want the—I want the audience to understand that, and ATI is one of those reasons. I actually—I wrote there’s 5 different—part of the book is I wrote, there’s 5 different classes of new proteins that have been discovered in grains. They’re inherent to protect the grain, and—and so part of their job in protecting the grain is to defend it from us and our ability to digest it and our ability to process it. So you wanna understand that those are part of the problem of grains beyond gluten. Pesticides are part of the problem. Molds and mycotoxins are part of the problem. None of these things have anything to do with gluten.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: And that heavy metals like cadmium and arsenic are part of this problem because especially rice, rice contains high quantities of these. And then you have what Atkins and so many others have discovered is that grains are super high sugar producers.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: You know? So we’re gonna get, you know, the amylopectin which is one of the—one of the elements to grain that causes elevations in blood sugar worse than sugar does. So you’re gonna get carbohydrate load that’s going to induce a diabetic state. So you’ve got all these different reasons. We could—we could say, “Look, regardless of your gluten status, maybe you are HLA-DQ4, but do you really want to eat this grain as a primary staple food in your diet because all of these other things are gonna wreck your health, too.”
Dr. Justin Marchegiani: Totally agree. I got a study here form the Journal of Experimental Medicine that says more over ATIs, that’s the trypsin inhibitors you just mentioned, may fuel inflammation and immune reactions in—in other intestinal and non-intestinal immune disorders. So this is right out there in the literature, everyone. So what we’re talking about really is—is deep and hardcore science. It’s just most conventional doctors haven’t really got into it yet.
Dr. Peter Osborne: And that’s the sad part, Justin, is like—look, you know, one of biggest criticisms I take on, you know, and I’m—I’m definitely a leader, a thought leader in this field, I—I know that to be the—the truth, and I don’t say that, I’m not tooting my own horn, but I take on this criticism because I’m a chiropractor, you know, and I’ve got other degrees and diplomas, but my heart is in chiropractic as well, and that because I’m not a medical doctor, so many people say, “Oh, he’s a quack. He doesn’t know what he’s talking about.” But the reality is, I didn’t create any of this information like out of a whim or even out of clinical experience. This information comes directly from the medical literature. The problem is most doctors don’t read their own literature.
Dr. Justin Marchegiani: Nope.
Dr. Peter Osborne: I happen to read an extra 15 to 20 hours a week in my spare time so that I can keep up with this type of information because I feel like it’s my job. If I’m gonna help patients get better, I gotta understand the latest and the greatest and the newest and even the oldest and—and if more doctors took time to take that on and take their jobs more seriously, I think a lot of doctors just get into this, you know, this regular routine of just cranking patients through a mill and not really seeing patients, not really hearing patients, just kinda of—just kind of going through the motions with patients. I think that’s a travesty. That’s—that’s one of the hugest problems we face in the United States is that we’ve got doctors who have lost bedside manner, who’ve lost compassion, who are in it for the wrong reasons and I’m—and I’m not categorizing all doctors here. I know there’s a lot of great doctors, too. But look, I wouldn’t have a clinic with 5-month waiting list if those doctors they were out there, for most of the GI doctors that were out there, most of the specialists that were out there, if they actually look the moments and the time to read the literature and to—to apply the literature with their existing patients, I would be out of job. But the fact of the matter is, I’m not out of a job. I’m busier than I’ve ever been in my life because the experts who are supposed to be being the experts, who are supposed to be being the leaders and leading the field, are dropping the ball. So the chiropractor has to pick up the literature and he’s gotta read it and he’s gotta be able to apply it with his patients and he’s gotta be able to apply functional medicine, you know, and I—and I just say that because that—that is one of the things that makes me the maddest, it—it, you know, it’s frustrating to deal with every patient coming through the door who’s so frustrated because they’ve been to 8 to 9 or 10 different doctors who are supposed to be the leading experts. It’s so—so it’s an uphill battle, Justin, as you know, not only do we have to educate our patients, but we’ve got to overcome all the misinformation. And look, a lot of these doctors—I had a patient come in to see me last week, her child had hives—had had hives for years. They didn’t know why. So they were seeing a pediatrician. They were seeing an allergist. The kid had been taking allergy shots for 2 years and the doctor said, “Well, it’s gonna take about 5 years of allergy shots to really get it to clear up.” Now that’s ridiculous, to take 5 years of allergy shots–
Dr. Justin Marchegiani: Oh, man.
Dr. Peter Osborne: To clear up hives. We cleared them up in less than months. Now when this woman took her son back to the allergist, she took all the paper work and all lab testing that we did to this allergist and she said—she said, “Here, I just want you to know what we’re doing because he’s better and, you know, we—it’s not like I—I didn’t give you to get him better. We’ve been doing this for 2 years but I wanted to share this with you because I think that if you understand this, you might be able to help other patients.” And this doctor rolled his eyes at her.
Dr. Justin Marchegiani: Unreal.
Dr. Peter Osborne: It basically laughed at her and said, “Well, you know, if it’s working, keep doing it, but it isn’t really important,” and it’s like, “Shame on that doctor!” I could tell you something right now from patient who brought in information to me. If I had been treating a patient for 2 years and not been able to get them better, and they—and they came back and said, “Look, I visited another doctor and this is what we did.” And it got me better, you can bet your bottom dollar, I’m gonna be on a the phone with that doctor, as soon as that appointment is over, trying to figure out where he’s doing something that I’m not doing, how could I better improve my own skill set so that I could help more people, you know? But—but the attitude with a lot of these doctors is, look, if it’s not mainstream, it’s quackery, which is—which is BS. And—and if—if he’s a chiropractor, he doesn’t know very much and he’s not qualified which is also, as you know, BS. We have our background and education is—is so advanced compared to what people think that it is and anyway that’s—that’s a horse site, we don’t have time to get on but–
Dr. Justin Marchegiani: Yeah.
Dr. Peter Osborne: I just—I just had to say that because, you know, a lot of people that’s—that’s, you know, I would say, “Look, if you—if you doubt the information in this book just because I’m a chiropractor, shame on you.” It’s documented.
Dr. Justin Marchegiani: Right.
Dr. Peter Osborne: There are 33 pages of medical references. I didn’t create this science. I just interpreted, put it out there for the rest of the world in a manner that’s consistently easy to read so they can be applied. So get out there. If you’re struggling with autoimmunity and you’ve gone through convention and it hasn’t worked for you, you know, get your—get off your high horse and read the book and apply it, and watch miracles happen.
Dr. Justin Marchegiani: That’s great. That’s great. And I think a lot of doctors—it—it’s not like this great grand conspiracy but I think a lot of people, a lot of doctors for instance, they are under the impression and most people are, too, that if I didn’t learn it in medical school, it’s not important, and everything in medical school is gonna be all I need to help my patients get better. And that’s I think the grand assumption that most doctors and most people that go the conventional route are under. And you’re really dispelling a lot of that in your book. And—and my last question before we give you a send off, as I heard someone on the podcast just recently talking about, well, you know, get—go gluten-free, cut it out, and then add a little bit back in, and if you don’t have a reaction or a symptom when you add a little bit back in, then you may be able to handle a little bit. So what’s your perspective on just relying off of symptoms and adding a little bit of gluten back in? Is that the best way to do it or should we look deeper?
Dr. Peter Osborne: Symptomatic response, it’s like saying, don’t exercise tomorrow and if you don’t feel diabetic symptoms tomorrow–
Dr. Justin Marchegiani: Beautiful.
Dr. Peter Osborne: That—that, you know what I’m saying? It’s—it’s–
Dr. Justin Marchegiani: Yeah.
Dr. Peter Osborne: It’s a ridiculous statement.
Dr. Justin Marchegiani: It is.
Dr. Justin Marchegiani: I don’t know who said that, but shame on them. Shame on that person. Gluten sensitivity is a very, very serious issue, and if you’re truly gluten-sensitive, you shouldn’t be introducing it back in. So I—I would say, you know, there’s no safe amount of gluten. There’s, you know, not if you’re gluten-sensitive, in fact and as a matter fact, research shows it’s 20 parts per million, which is equivalent to a drop of water to a gallon of water, that—that amount of gluten exposure can create an inflammatory response for up to 2 months.
Dr. Justin Marchegiani: Wow.
Dr. Peter Osborne: So you know, absolutely don’t reintroduce it and try and see if you tolerate it, because what’ll happen is you go gluten-free for 6-8 months, you’re gonna feel dramatically better. Most people do, and when you feel better and your body is now healing, it’s gonna be more adaptive, it’s gonna be more resilient, it’s going to have a greater reserve to combat, you know–
Dr. Justin Marchegiani: Perfect.
Dr. Peter Osborne: Environmental problems. It’s part of what we’re after with wellness, is to have good adaptability to the environment without becoming sick, you know? So—so to say, okay, take the gluten out and then start reintroducing it, it’s like saying, okay, take the sugar out and when the diabetes clears up and the blood sugar normalizes, start eating sugar in again, what’ll happen is eventually you’ll start developing diabetes again, so it’s—it’s a ludicrous statement.
Dr. Justin Marchegiani: Totally agree. And I wanna push everyone to head over to GlutenFreeSociety.org. This is where I got my foundational information about gluten and even being a physician, there’s tons of great info and if even if you’re a layperson just getting into a it, there’s still a ton of great info to kinda get your feet wet and even go beyond that with some of the clinical stuff. So I wanna push everyone to go to GlutenFreeSociety.org. We’ll have some links for the specific lab testing as well. Also head over to DrPeterOsborne.com. Peter’s got his awesome 7 Highly Effective Habits for a Gluten-Free Warrior. Lots of great information there. Anything else Peter that you wanted to kind of leave the listeners with? And then also I’m gonna go purchase my—my copy of your book here, No Grain, No Pain right now and I wanna urge everyone to get their copy as well. Let’s push it on to the New York Times’ List. I know you’re almost right at the 10,000 mark for sales and we’re gonna push it way above it and get you on there so we can get more exposure to people that need access to this information.
Dr. Peter Osborne: I—I would say I’d leave with your audience, you know, if—if you’re suffering and—and you don’t know why and you’ve gone through convention and it hasn’t worked for you, you don’t’ have anything to lose. Try phase 1 and phase 2, it’s a 30-day plan. Try it out. Take it for a test spin. You have nothing to lose. You have everything to gain. I would say to any of your listening audience, if you’re a healthcare practitioners or clinicians, and you really wanna get this dialed in and get this information, because part of my goal is to help people get better and part of that is helping physicians, I’ve created a 10-hour post-Graduate course for physicians. If you go to GlutenFreeSociety, there’s a tab that says GF Doctors, click on that and you can learn more about that. Take the course because the information you’ll learn from it, that knowledge you’ll get from it will allow you to help more people get better.
Dr. Justin Marchegiani: Love it, awesome! Great information and last simple question I ask it to everyone—I almost missed it with you—if you were stuck on a desert island, what supplement or herb would you bring with you or one supplement?
Dr. Peter Osborne: I—you know, what? I think if I were stuck on a desert island, I would probably take my high-quality multivitamin.
Dr. Justin Marchegiani: Mmm.
Dr. Peter Osborne: Simply because I want a diverse amount of vitamins and minerals in me and if I’m gonna be foodless or missing certain foods that are gonna be devoid or certain nutrients, I want as much of a variety to prevent major malnourishment diseases like beriberi, pellagra, or scurvy.
Dr. Justin Marchegiani: Very common sense answer. I appreciate it, Peter. We’re gonna do a video basically summarizing all of the key points with all of the links on the video. Thank you so much, Peter. We really appreciate your time.
Dr. Peter Osborne: Hey, Justin. Thanks for having me and have a great afternoon.
Dr. Justin Marchegiani: You, too. Bye.
Gluten’s Devastating Effects and How To Test For It
By Dr. Justin Marchegiani
Gluten sensitivity is a state of genetics, just like your genes cannot be changed, what we have control over is the expression of our genes. Gluten is one of those food products our genetics have not adapted to well. If you are a person that have genetics that predispose you to gluten sensitivity, the way in which you can control how your genes are being expressed, is to avoid gluten.
Lets review some terminology that is used to describe people who react to gluten and or grains. Many people with gluten sensitivity can be gluten intolerant or have a gluten allergy as well.
The terms “allergy” and “intolerant” have come to mean different things in conventional medicine, so the more excepted terminology in gluten circles like this is the term “sensitivity”.
Sensitivity is referring to the fact that your immune system is hyper responsive to the gluten proteins. The byproduct of these hyper-immune responses is inflammation and if prolonged, autoimmune conditions are a strong possibility.
Refers to your immune system creating an IgE immune response (anaphylactic in nature) to the gluten protein, these allergies are inborn and are usually known at birth. With new cutting testing we know allergies can also be delayed in nature via an IgG or IgA response; this is closer to what we see in gluten sensitivity.
Refers to the inability to break down the gluten proteins in the digestive tract. Just like with lactose intolerance, some individuals have a difficult time breaking down lactose (milk sugar), but with specific enzymes (like lactaid) this is possible. Most people who are gluten sensitive have a difficult time breaking gluten down too, but taking enzymes alone will not be enough to avoid the inflammation and autoimmune destruction from consuming it.
In science today gluten sensitivity has been primarily connected with celiac disease, so the misconception is if you don’t have celiac disease, you don’t have gluten sensitivity.
This couldn’t be further from the truth! The testing used to diagnose and assess celiac disease can miss many people. Essentially you can have all of the telltale signs and symptoms of gluten sensitivity or celiac disease, and still be misdiagnosed.
The typical mainstream diagnosis for celiac disease is a sample of your micro-villi from your small intestine via endoscopy. The micro-villi have to be worn down 80% for you to be considered celiac.
There are a couple problems with this diagnosis criteria:
1. What if we do not collect a sample that was affected by gluten?
2. What if the micro-villi have not been worn down 80%?
This method is analogous to pulling a bucket of water out of the ocean, examining that there is no fish in the bucket and then concluding the ocean must have no fish. This may not be a perfect analogy, but I think you know what I’m getting at.
There are other blood tests that can be used to confirm celiac disease. These blood test includes transglutaminase antibodies, endomyseal antibodies, deamidated gliadin as well as gliadin antibodies. If you come back positive with one of these test markers, you can be confident that you have celiac disease. The problem is, many individuals come back negative with these markers and still may have gluten sensitivity.
This is where genetic testing comes into play, if you have a gene that predisposes you to gluten sensitivity it’s just a matter of time till those gene expresses itself. The more physical, chemical and emotional stress you are under, increases the chance that your gluten sensitive genes will react and start creating symptoms. As you well read below, the symptoms for gluten sensitivity are all over the map!
What are the best tests out there?
I think genetic testing is a good tool to assess if you have the genes for gluten sensitivity. The problem with other testing is it’s very easy to have false negative result (the test comes back negative but in reality you may still have gluten sensitivity). If you come back with a gluten sensitive gene, you can be confident that it’s just a matter of time before that gene expresses itself if you keep eating gluten.
The primary genes that are involved in celiac disease are HLA-DQ2 and HLA-DQ8. There are other HLA-DQ genes involved as well; HLA-DQ 1, HLA-DQ 3 and HLA-DQ 7 are also genes that predispose you to gluten sensitivity.
When you’re looking at genetics such as HLA-DQ testing, you get one HLA-DQ gene from each parent. If you receive two HLA-DQ 2’s or two HLA-DQ 8’s, this increases the risk of celiac disease (the same goes for gluten sensitivity). According to the genetics, the only people that are immune to gluten sensitivity are people with the genetic sub-types HLA-DQ 4 (which are less than 1% of the population). There needs to be more research done validating gluten sensitivity and its connection with the genetics (1).
The percentage estimates surrounding gluten sensitivity regarding the population are a point of contention among experts. Dr. Alessio Fasano at the University of Maryland medical school, who is a pioneer in gluten research, feels that only 6 to 7% of the population are gluten sensitive; while Dr. Ford a pediatrician in New Zealand and the author of the book “The Gluten Syndrome,” believes 30% to 50% of the population are gluten sensitive. According to Dr. Kenneth Fine over 50% of the population is gluten sensitive. Either way you look at it, the new estimates that are coming out surrounding gluten sensitivity are showing a significant increase than the original 1% estimates of celiac disease.
The information that we have now shows the majority of the population are gluten sensitive. The problem with gluten sensitivity, is the majority of symptoms that come from gluten are not necessarily correlated with digestive issues (symptoms that are gastrointestinal in nature like bloating, gas, diarrhea and IBS). With gluten sensitivity you are actually 8X more likely to have extra intestinal symptoms, (symptoms not related to the gastrointestinal tract, like headaches, depression, lupus and thyroid disease). This is the main reason why gluten sensitivity is so easily glossed over today.
Most patients with gluten sensitivity complained of 2 or more symptoms (2).
The symptoms of gluten sensitivity
Celiac disease is a form of gluten sensitivity, so essentially if you have celiac disease you are gluten sensitive. At the same time if you are gluten sensitive, you don’t have to necessarily have celiac disease.
There are many common manifestations of gluten sensitivity, I call this the web of gluten sensitivity:
Various anemia’s, type I diabetes, Hashimotos and other thyroid diseases, fibromyalgia, chronic fatigue syndrome, lupus, there is gut infections, skin issues (psoriasis, eczema, dermatitis herpetiformis), psychological and mood disorders (schizophrenia, depression).
I challenge you to Google scholar or pubmed search gluten or celiac disease with any disease of your choice. You will see many results come up in your search, proving the connection cannot be ignored.
My favorite method to assess for gluten sensitivity!
The problem with many of the tests that are out there, is that similar information can be received through a simple elimination provocation diet (this is where inflammatory foods are cut out for a period of time and then added back in). The only time I conduct testing on patients, is if patients are resistant to changing their diet. Then the lab test be very useful, because they can quantify to the patient in an objective manner that these issues are real. Some people need to see that type of evidence before they cut out some of their most favorite and addicting foods!
I find almost all individuals who are suffering from some type of chronic illness benefit when they cut gluten out of their diet. The foods that contain gluten, which are all grains, tend to be very low in nutrition, have a high glycemic index and create inflammation. It’s always better to eat foods that are nutrient dense, anti-inflammatory and low in toxins.
My recommendations are for all of my patients to start off with some type of anti-inflammatory, autoimmune paleo or bulletproof style of eating. The focus with this type of eating is to be consuming foods that are anti-inflammatory, low in toxins and nutrient dense. This allows us to put our body into a state of healing so we can start recovering from all of the damage created by the gluten exposure. Macro-nutrient ratios including carbohydrate, protein and fat can always be adjusted to meet the needs of the patient. I deal with these macro-nutrient ratios on individual basis per patient.
What Do You Do If you Aren’t Feeling Better After Going Gluten Free?
When dealing with patients that are chronically ill, making the above dietary recommendations may not be enough. The inflammation created from years of stress and gluten consumption, may have caused damage to your adrenals, thyroid and gastrointestinal system. This may have weakened your immune system to the point where chronic infections like parasite, bacterial, fungal and viral infections have gained a foothold. I find removing these infection can be the missing barriers that are preventing people from getting better.
If you’re not getting better from going gluten-free, feel free and schedule a complimentary consultation by clicking here to review what your options are.
1.A. Fasano et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Medicine 2011, 9:23. doi:10.1186/1741-7015-9-23.
2. New understanding of gluten sensitivity, Umberto Volta & Roberto De Giorgio, Nature Reviews Gastroenterology & Hepatology 9, 295-299 (May 2012).