Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with gluten?

Transcript

What's the deal with gluten? · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:00
  Speaker 1: Perry.
• 0:02
  Speaker 2: Preparing for this week's episode, I was thinking about the
• 0:05
  Speaker 2: kinds of foods that I love, and I wanted to
• 0:10
  Speaker 2: ask you.
• 0:11
  Speaker 1: A specific question about food.
• 0:13
  Speaker 2: If there was one food you would be sad to lose,
• 0:18
  Speaker 2: like and not alcohol or coffee, like not a not
• 0:21
  Speaker 2: a like fun food, but like a real regular food.
• 0:24
  Speaker 2: What is like the one thing that you would cry
• 0:28
  Speaker 2: if you lost?
• 0:30
  Speaker 3: Pez are cherry flavored pests?
• 0:32
  Speaker 1: Do you eat aboutez frequently?
• 0:36
  Speaker 3: Sorry? That is a deep cut. That is one of
• 0:40
  Speaker 3: my favorite quotes from stand by Me from the.
• 0:43
  Speaker 2: Star Trek about the like replication, Okay, what do you got?
• 0:47
  Speaker 3: I'm here for you. No, my my real like a
• 0:50
  Speaker 3: food that if it was like, no, you can't eat
• 0:52
  Speaker 3: this anymore, this will now kill you. Probably like I
• 0:57
  Speaker 3: don't know, like pasta bolognes that probably like pasta with
• 1:01
  Speaker 3: meat sauces my happy place.
• 1:04
  Speaker 2: So I was thinking about this because mine is definitely bagels,
• 1:07
  Speaker 2: but then like my second one is bread and my
• 1:10
  Speaker 2: third one is pastave. Like I every single thing on
• 1:13
  Speaker 2: my list has gluten.
• 1:15
  Speaker 1: Everyone.
• 1:16
  Speaker 3: Yeah, if if you had Celiac disease, I.
• 1:19
  Speaker 2: Would be so sad. I would be I would just
• 1:21
  Speaker 2: be eating rice all the time. And I think that
• 1:24
  Speaker 2: would make me sad. So I'm I'm glad I am
• 1:27
  Speaker 2: not sensitive to gluten.
• 1:29
  Speaker 3: Well, there are a lot of people out there unfortunately
• 1:32
  Speaker 3: who are. There are a lot of people out there
• 1:35
  Speaker 3: maybe who think they are and might not be, which
• 1:38
  Speaker 3: we're going to dig into a lot in today's episode
• 1:41
  Speaker 3: on one of our favorite proteins, which is gluten.
• 1:45
  Speaker 1: We love it, Let's do it.
• 1:49
  Speaker 2: I'm Emily Astro, I'm an economist and a data expert.
• 1:52
  Speaker 3: And I'm Perry Wilson, I'm a medical doctor.
• 1:55
  Speaker 2: It's Thursday, August sixth, twenty twenty six, and this is wellness.
• 1:59
  Speaker 3: Actually, because you're getting a staggering amount of health and
• 2:02
  Speaker 3: wellness information nowadays from every source imaginable, and some of
• 2:06
  Speaker 3: it is awesome and some.
• 2:08
  Speaker 1: Of it is well actually bullshit.
• 2:12
  Speaker 2: Fortunately, we are both people who know how to read studies,
• 2:15
  Speaker 2: how to parse the data, and can tell you what's
• 2:18
  Speaker 2: worth thinking about and what you can safely ignore.
• 2:21
  Speaker 3: But before we dig in, a note that this podcast
• 2:23
  Speaker 3: is for educational purposes and should not be construed as
• 2:26
  Speaker 3: medical advice. We don't know your unique situation, so talk
• 2:29
  Speaker 3: to your doctor for personal health decisions.
• 2:32
  Speaker 1: This week, we're asking what's the deal with gluten?
• 2:35
  Speaker 2: Harry and I will give the official smasher pass, and
• 2:38
  Speaker 2: then we'll get to your question of the week.
• 2:39
  Speaker 1: But first let's do the health news round us after.
• 2:42
  Speaker 3: The break and we're back with our health news of
• 2:57
  Speaker 3: the week. Emily, I want to start with the great
• 3:02
  Speaker 3: protein backlash. If listeners go back to or What's deal
• 3:06
  Speaker 3: with Protein? Episode, we talked a lot about protein having
• 3:09
  Speaker 3: a moment. This was the macronutrient that everyone was into.
• 3:12
  Speaker 3: Entire aisles at Costco dedicated to protein containing foods. And
• 3:17
  Speaker 3: now we start to see some articles that are saying, hey, wait,
• 3:20
  Speaker 3: if you eat a lot of protein, you're actually gonna
• 3:23
  Speaker 3: die sooner? Is it over? Is the protein party over?
• 3:27
  Speaker 2: I don't think the protein party's over, because let's just
• 3:30
  Speaker 2: emphasize if you donate any protein.
• 3:32
  Speaker 1: You will actually die.
• 3:33
  Speaker 3: That this is true a.
• 3:35
  Speaker 2: Reason you will die. But I find this. I'm going
• 3:37
  Speaker 2: to tell you about the science, but I also think
• 3:40
  Speaker 2: there's something just so interesting about the psychology of how
• 3:43
  Speaker 2: the news works here that this gets covered, because it's surprising.
• 3:49
  Speaker 2: If people don't think protein is great, then you're really
• 3:52
  Speaker 2: interested in publishing articles that say, oh, protein is great,
• 3:54
  Speaker 2: Protein is great surprise.
• 3:55
  Speaker 1: Protein is great.
• 3:56
  Speaker 2: Now everyone's like, I gotta have protein popcorn at Costco.
• 3:59
  Speaker 2: It's not interesting to publish an article that says protein
• 4:02
  Speaker 2: is great, and so now the thing the media wants
• 4:04
  Speaker 2: to cover is like, maybe protein isn't that great?
• 4:06
  Speaker 1: Do you think of that?
• 4:07
  Speaker 3: It's the engaging contrarianism of engaging science communication.
• 4:12
  Speaker 1: Totally okay.
• 4:12
  Speaker 2: But this is the reporting that I saw on this
• 4:15
  Speaker 2: week is based on a study. It's like a review
• 4:19
  Speaker 2: study about data primarily on yeast although they do have
• 4:24
  Speaker 2: some mouse data, there's very little if no data on
• 4:30
  Speaker 2: humans here, and they have an argument about protein restriction.
• 4:34
  Speaker 2: This is actually a set of people who are very
• 4:36
  Speaker 2: interested in calorie restriction for lifespan extension, which is an
• 4:40
  Speaker 2: interesting space where most of the evidence is also in mice.
• 4:46
  Speaker 1: And I want to read you just.
• 4:47
  Speaker 2: One sentence because for me this sort of summarizes like
• 4:51
  Speaker 2: why I think you shouldn't probably learn much from this,
• 4:54
  Speaker 2: which is a quote from the paper like calorie restriction,
• 4:58
  Speaker 2: protein restriction improved health span and increases the lifespan of
• 5:02
  Speaker 2: yeast flies and rodents. It does not mention people, and
• 5:08
  Speaker 2: I think we should not port this to people just yet.
• 5:13
  Speaker 3: Mice aren't people. Although you know, I want nothing but
• 5:15
  Speaker 3: the best for at least yeast who you know, for
• 5:20
  Speaker 3: the gluten episode in particular, where you know we need
• 5:22
  Speaker 3: our good friend Sarkam seravc for many of our yeasty
• 5:27
  Speaker 3: bread products. Yeah, it's true that severe calorie restriction does
• 5:34
  Speaker 3: extend the lifespan of a variety of animals, ranging from
• 5:37
  Speaker 3: single celled organisms up through mice. And we don't know
• 5:40
  Speaker 3: if it happens in people, because you really need people
• 5:43
  Speaker 3: live a long time anyway, and so you need and
• 5:47
  Speaker 3: we're talking calorie restriction on the order for like the
• 5:50
  Speaker 3: equivalent of like twelve hundred calories a day forever. I mean,
• 5:52
  Speaker 3: it's really you're in a starvation state. And my thought
• 5:57
  Speaker 3: about these kind of studies is like, even if true,
• 6:01
  Speaker 3: this is not a life worth living. So, you know,
• 6:05
  Speaker 3: if we can find the mechanisms downstream of the calorie restriction,
• 6:07
  Speaker 3: like if it oh, it upregulates some hormone that like,
• 6:10
  Speaker 3: and we can just give the hormone, great, do that research.
• 6:13
  Speaker 3: But you know I'm not I don't I if eating
• 6:16
  Speaker 3: twelve hundred callies a day gets me to be one
• 6:18
  Speaker 3: hundred and twenty, I don't want to be one hundred.
• 6:19
  Speaker 1: And twenty right totally. I could not agree more. Okay,
• 6:25
  Speaker 1: next up, can we talk about Ebola.
• 6:28
  Speaker 2: Unfortunately, the Ebola outbreak in the Democratic Republic of the
• 6:31
  Speaker 2: Congo has gotten worse.
• 6:32
  Speaker 1: It's not the worst ever.
• 6:34
  Speaker 2: What is going on and is this something people should
• 6:38
  Speaker 2: be worried about outside the DRC.
• 6:42
  Speaker 3: Yeah, I'm glad that you brought this up. You know,
• 6:45
  Speaker 3: we talked about the Bola outbreak a few times when
• 6:48
  Speaker 3: it was first emerging, and then these things do have
• 6:51
  Speaker 3: a way of falling out of the news and you
• 6:53
  Speaker 3: might think, like, oh, I guess that's not an issue anymore,
• 6:56
  Speaker 3: but it very much is. As of the thirtieth of July,
• 6:59
  Speaker 3: there were three thy six hundred and five confirmed cases,
• 7:03
  Speaker 3: including one thy five hundred and eighty seven deaths. That's
• 7:06
  Speaker 3: a case fatality rate of forty four percent. That's obviously
• 7:09
  Speaker 3: very bad, and the WHO says the outbreak is actually intensifying.
• 7:14
  Speaker 3: They've documented sustain chains of transmission across multiple parts of
• 7:17
  Speaker 3: the Democratic Republic of Congo as well as in cross
• 7:20
  Speaker 3: border movement. There were cases in Uganda, which has done
• 7:25
  Speaker 3: a little bit better with containment than the DRC. There
• 7:28
  Speaker 3: were a couple of cases that were treated in France
• 7:31
  Speaker 3: didn't get acquired in France. One of the really concerning
• 7:36
  Speaker 3: things I found was a recent study which showed that
• 7:39
  Speaker 3: maternal mortality was increasing in the DRC, not directly because
• 7:43
  Speaker 3: of a bola, but because pregnant women are avoiding hospitals
• 7:46
  Speaker 3: when they're giving birth and so because of the risk
• 7:49
  Speaker 3: of a bola, and so you see young mothers dying.
• 7:53
  Speaker 3: You know, this is concerning on a humanitarian level, because
• 7:57
  Speaker 3: it's a humanitarian crisis, and it's a place where the
• 8:02
  Speaker 3: proper provisioning of some standard public health measures could do
• 8:06
  Speaker 3: a lot of good. Is it concerning in terms of
• 8:09
  Speaker 3: if you live in Connecticut or Rhode Island. No, You know,
• 8:13
  Speaker 3: ebola is certainly transmissible by body fluids, but we haven't
• 8:19
  Speaker 3: seen really sustained transmission out of the DRC, and there's
• 8:22
  Speaker 3: a lot of monitoring and whatnot. So I'm not worried
• 8:25
  Speaker 3: about that. There are some vaccines in the pipeline which
• 8:27
  Speaker 3: might make a dent. But most important just to remind
• 8:30
  Speaker 3: people like this is still happening, and happening more than
• 8:33
  Speaker 3: it was before. Actually, even though you're not hearing about
• 8:35
  Speaker 3: it too much.
• 8:36
  Speaker 2: Absolutely, Okay, in better news, it seems like viagra might
• 8:43
  Speaker 2: help prevent cancer in addition to being super super fun.
• 8:48
  Speaker 2: So the result in at least in this article, is
• 8:52
  Speaker 2: it mean taking viagara before their cancer diagnosis had an
• 8:56
  Speaker 2: overall can't hire cancer survival. And I think there are
• 9:01
  Speaker 2: some you know, like always in these articles, or some
• 9:04
  Speaker 2: made up suggested mechanism which could or could I mean
• 9:07
  Speaker 2: a little bit of a just so story. You know,
• 9:10
  Speaker 2: this is not a randomized study. What do we think
• 9:12
  Speaker 2: is driving the results here?
• 9:15
  Speaker 3: This is one of those things where you have one
• 9:17
  Speaker 3: paper this is uh. This came out in cancer, the
• 9:20
  Speaker 3: journal Cancer Research, and they were looking actually most of
• 9:26
  Speaker 3: the papers in cell culture and stuff looking at the
• 9:28
  Speaker 3: effect of viagra and statins, so cholesterol luring medications on
• 9:33
  Speaker 3: cancer cells. And you know what sometimes we'll do in
• 9:37
  Speaker 3: science when we have a very sort of wet lab
• 9:41
  Speaker 3: technical paper, like we did some cell work and blah
• 9:44
  Speaker 3: blah blah, and you sort of are looking at the
• 9:46
  Speaker 3: resulting like, Okay, this is interesting to us in our
• 9:48
  Speaker 3: little field, but maybe it's not super compelling to the
• 9:51
  Speaker 3: rest of the world. So what we're gonna do is
• 9:52
  Speaker 3: we're going to tack on some kind of epidemiology study,
• 9:56
  Speaker 3: and so they have all this kind of rather elegant
• 9:58
  Speaker 3: work in cell culture looking at class straw synthesis, which
• 10:01
  Speaker 3: if that's what you're interested in, please check it out.
• 10:03
  Speaker 3: And then they're like, and by the way, we looked
• 10:05
  Speaker 3: in this huge data set, and men who take viagra
• 10:08
  Speaker 3: before they got cancer had a better overall survival. And
• 10:11
  Speaker 3: that's that's literally it like, it's really a paper about
• 10:15
  Speaker 3: cell culture. But of course that is what's generating dozens
• 10:18
  Speaker 3: and dozens of news articles. Their proposed mechanism is that
• 10:23
  Speaker 3: viagra has some effect of limiting cancer cells access to cholesterol,
• 10:27
  Speaker 3: and cells need cholesterol to do a lot of work,
• 10:29
  Speaker 3: and if they don't get the cholesterol, maybe they don't
• 10:32
  Speaker 3: live as long. You're right, this is a adjust so story.
• 10:35
  Speaker 3: There are plenty of reasons to think that men who
• 10:38
  Speaker 3: have access to viagra might have better contact with the
• 10:41
  Speaker 3: healthcare system, maybe even more health literacy, might be in
• 10:44
  Speaker 3: different socioeconomic status, all sorts of things that might improve
• 10:47
  Speaker 3: outcomes after a cancer diagnosis.
• 10:49
  Speaker 1: Might have better social support.
• 10:51
  Speaker 2: I mean, if maybe the case that their access to
• 10:53
  Speaker 2: viagra is so they can use it to have sex
• 10:56
  Speaker 2: with a partner and that having a partner to support
• 10:59
  Speaker 2: you in a cancer diagnosis may improve your survival.
• 11:03
  Speaker 3: Another excellent point, but just to underscore how headlines can
• 11:07
  Speaker 3: be misleading. I actually read the article, you know, which
• 11:11
  Speaker 3: is like I sometimes wonder if the science reporters actually
• 11:15
  Speaker 3: look at it, and it actually only shows a significant
• 11:20
  Speaker 3: effect among men taking statins. So they looked both at
• 11:24
  Speaker 3: as I said, Statin's and viagrant, and the significant effect
• 11:27
  Speaker 3: was in men who take statins prior to their cancer
• 11:30
  Speaker 3: diagnosis live longer. And then they looked at men who
• 11:33
  Speaker 3: take statins and viagra and saw a similar benefit, but
• 11:38
  Speaker 3: like the statins were still there, and then when they
• 11:39
  Speaker 3: looked at viagra alone, there was no significant benefit. So
• 11:44
  Speaker 3: I'm like, all right, so it's the statins conclusion.
• 11:48
  Speaker 1: Together something.
• 11:49
  Speaker 3: Yeah, I don't know anyway, Viagra's a great and useful
• 11:53
  Speaker 3: drug for many things. I'm not sure that it's it's
• 11:57
  Speaker 3: carrying cancer though, Sorryfizer.
• 11:59
  Speaker 2: Yeah, sorry, folks. Great cell work, poor rapidy theology. All right,
• 12:05
  Speaker 2: that's it for the help news of the week. Now,
• 12:08
  Speaker 2: what's the deal with gluten?
• 12:10
  Speaker 3: All right, Emily, there's as soon as this episode was
• 12:13
  Speaker 3: added to our list of upcoming episodes, I knew exactly
• 12:17
  Speaker 3: what clip I wanted to play for you, so please
• 12:22
  Speaker 3: listen to this. Look, man, if you stopped eating gluten,
• 12:24
  Speaker 3: you'd feel way better all day. Whenever you feel that's
• 12:28
  Speaker 3: because of gluten. That's not true. Who told you not
• 12:31
  Speaker 3: to eat gluten? It's just true. You don't even know
• 12:33
  Speaker 3: what gluten is. You have no ideal. Gluten's a vague term.
• 12:39
  Speaker 3: It's it's it's something that's used to categorize things that
• 12:41
  Speaker 3: are bad. You know, calories, that's a gluten fat. That's
• 12:44
  Speaker 3: a gluten gluten me badge. Man, And I'm not needing it. HM,
• 12:53
  Speaker 3: all right. That's seth Rogen and Jay Barroschel from Great movie.
• 12:58
  Speaker 3: This is the end And for those of you, they're
• 13:01
  Speaker 3: driving in a car in California and at the end
• 13:04
  Speaker 3: they end up at a Carls Junior and are eating
• 13:06
  Speaker 3: like delicious looking cheeseburgers, obviously with bread containing gluten. I
• 13:12
  Speaker 3: just thought this was the most emblematic thing we could
• 13:15
  Speaker 3: start the episode with.
• 13:16
  Speaker 2: I love it, and I think I particularly love it
• 13:18
  Speaker 2: because this is how many people talk about gluten as
• 13:24
  Speaker 2: sort of this like nefarious, like, well, you're bloating diarrhea
• 13:30
  Speaker 2: too much. Poop, not enough poop, not feeling good, tiredness.
• 13:34
  Speaker 2: It must be gluten. It's I guess like gluten. It
• 13:37
  Speaker 2: just means feeling badness. But gluten is actually a specific thing.
• 13:43
  Speaker 3: Yeah, and so we need to talk about what is gluten,
• 13:47
  Speaker 3: So let's start there. Gluten is a protein. In fact,
• 13:52
  Speaker 3: it's two proteins, gleiodin and glutenin, and it's the primary
• 13:57
  Speaker 3: protein in wheat. It's also fa in barley and rye.
• 14:01
  Speaker 3: And it is the sticky stuff that polymerizes when you
• 14:05
  Speaker 3: make dough that makes your dough all stretchy and amazing.
• 14:09
  Speaker 3: You know, when you are rolling out pizza dough and
• 14:11
  Speaker 3: it springs back, that's a gluten. When you are baking
• 14:16
  Speaker 3: your bread and those air bubbles get trapped, the air
• 14:19
  Speaker 3: bubbles or the carbon dioxide bubbles that the yeast are
• 14:21
  Speaker 3: generating get trapped in the sticky bread dough, that's a gluten.
• 14:27
  Speaker 3: There really is no other grains that have that, and
• 14:32
  Speaker 3: because of that, it's really hard to make chewy, stretchy
• 14:37
  Speaker 3: delicious does out of things like rice flour unless you
• 14:40
  Speaker 3: put in an additive like wargum or xantheon gum or
• 14:43
  Speaker 3: some other binder. But Gluten is a natural binder in wheat,
• 14:46
  Speaker 3: and without it, life would be a little bit more sad.
• 14:50
  Speaker 2: Yeah, and the higher stretchier like kind of more stretchy
• 14:56
  Speaker 2: bread flour. When people say the high protein flower, it
• 14:59
  Speaker 2: is because it has more gluten.
• 15:00
  Speaker 1: That is the protein that we are discussing.
• 15:02
  Speaker 3: Oh, that's right. And yeah, if you're if you're not
• 15:04
  Speaker 3: baking your bread with bread flour, switch right away. It's
• 15:08
  Speaker 3: it's more unctuous.
• 15:09
  Speaker 1: Okay, cooking with Perry, that's our next episode. That's our
• 15:14
  Speaker 1: new podcast.
• 15:15
  Speaker 3: I make a lot of bread, I too.
• 15:16
  Speaker 1: Perry makes up that's could you have a sour dough
• 15:18
  Speaker 1: starter person?
• 15:20
  Speaker 3: Okay, we're going to talk. Can we table sour dough?
• 15:22
  Speaker 3: I have thoughts. I have many thoughts on side. We
• 15:24
  Speaker 3: will get to sour dough folks. We'll get there.
• 15:26
  Speaker 2: But some other things before that, let's say, before we
• 15:30
  Speaker 2: get into this, some other things do have gluten in them,
• 15:33
  Speaker 2: soy sauce, often salad dressings, malt, vinegar, so actually a
• 15:38
  Speaker 2: lot of if you are a person who is gluten sensitive,
• 15:41
  Speaker 2: there are many things that have gluten. Although bread and
• 15:45
  Speaker 2: bread products are the primary, the primary ones.
• 15:49
  Speaker 1: So when we are thinking about this episode, The setup.
• 15:52
  Speaker 2: For me here is there is a real set of
• 15:57
  Speaker 2: issues associated with how people process gluten. Like many food sensitivities,
• 16:03
  Speaker 2: this is something that some people have a sensitivity to,
• 16:05
  Speaker 2: and I want to start talking about that. But in
• 16:09
  Speaker 2: the influencer wellness space, there is a much.
• 16:14
  Speaker 1: Wider discussion about gluten sensitivity.
• 16:17
  Speaker 2: And if you look at some numbers, you know, the
• 16:21
  Speaker 2: Enhynes says there's like two percent of people who you
• 16:26
  Speaker 2: know don't eat gluten at all, But in other surveys,
• 16:29
  Speaker 2: like thirty percent of the people in the USA they
• 16:31
  Speaker 2: limit their gluten intake, and about ten percent of people
• 16:34
  Speaker 2: worldwide identify as gluten sensitive, but something like fifteen to
• 16:38
  Speaker 2: thirty percent of those have symptoms that are triggered. So
• 16:41
  Speaker 2: there's a disconnect here, I think between how people talk
• 16:45
  Speaker 2: about gluten and the sort of scientific diseases that are
• 16:52
  Speaker 2: actually gluten sensitive. And I think that's that's like the
• 16:54
  Speaker 2: interesting thing to unpack is what is real? And then
• 16:58
  Speaker 2: how much do you want to extend the existence of
• 17:00
  Speaker 2: Celiac disease into everybody should stop eating so much bread?
• 17:06
  Speaker 3: Right? An analogy might be, you know, there are people
• 17:08
  Speaker 3: with peanut allergy. They truly could die if they get
• 17:13
  Speaker 3: any peanut product. And then if we had people who
• 17:15
  Speaker 3: are like, oh, I don't have a full blown penat allergy,
• 17:18
  Speaker 3: but I'm peanuts sensitive. You know, peanuts make me feel bad.
• 17:21
  Speaker 3: And we need to explore that aspect because that's actually
• 17:24
  Speaker 3: what the vast majority of people who are avoiding gluten
• 17:27
  Speaker 3: are avoiding gluten for. And we can start by, like
• 17:30
  Speaker 3: we can kind of buzz through the easy diagnose not easy,
• 17:34
  Speaker 3: but like the confirmed gluten diseases, and I think obviously
• 17:38
  Speaker 3: we have to start with Celiac disease.
• 17:40
  Speaker 2: Celiac disease broadly is a disease that in which people
• 17:45
  Speaker 2: cannot tolerate gluten.
• 17:46
  Speaker 1: Tell me how we know about it?
• 17:48
  Speaker 3: Uh, fascinating. We've known about it for centuries. The oldest
• 17:51
  Speaker 3: reference I found was three hundred a d. And what
• 17:56
  Speaker 3: coeliac disease presents as is a chronic disease of the bowels.
• 18:01
  Speaker 3: Celiac literally means belly in like ancient Greek or something,
• 18:05
  Speaker 3: so Celiac disease just like belly disease. Not very descriptive,
• 18:09
  Speaker 3: but it's not just that. You know, in kids, it
• 18:12
  Speaker 3: typically presents as GI symptoms malnutrition, failure to thrive, like
• 18:17
  Speaker 3: so growth limitation and stuff, And for a long time
• 18:20
  Speaker 3: it was really thought to be a disease of children.
• 18:22
  Speaker 3: We now recognize that Celiac disease can present in later
• 18:25
  Speaker 3: life and it's actually quite easy to diagnose, but you
• 18:29
  Speaker 3: have to think of it first. And Celiac is one
• 18:31
  Speaker 3: of those great imitator diseases. So you know, yes, it
• 18:35
  Speaker 3: gives you gi upset, diarrhea, you know, excessive gas and
• 18:40
  Speaker 3: things like that, but so do a lot of things right.
• 18:44
  Speaker 3: It can also cause joint pain. It has a very
• 18:48
  Speaker 3: characteristic rash called dermatitis her petiformis sort of a sicular
• 18:52
  Speaker 3: intensely itchy rash on the extensor service surfaces of the
• 18:56
  Speaker 3: arms and legs and stuff. A lot of fatigue, anemia, osteoporosis,
• 19:01
  Speaker 3: and so these are.
• 19:02
  Speaker 2: Like, so, I mean this isn't there's an issue with
• 19:05
  Speaker 2: a disease like this where these are such generic symptoms.
• 19:08
  Speaker 1: People come in they say, I'm not feeling good.
• 19:09
  Speaker 2: I've got floating in diarrhea, i have a weird rash,
• 19:13
  Speaker 2: I've got some monemia totally.
• 19:15
  Speaker 1: A lot of people are anemic, a lot of people
• 19:16
  Speaker 1: are tired.
• 19:17
  Speaker 3: Ra Yeah, yeah, so your doctor actually has to think
• 19:20
  Speaker 3: about it. But the good news if you think about
• 19:22
  Speaker 3: Celiac disease, it's a blood test. There's a screening blood
• 19:25
  Speaker 3: test anti tissue transclutamina's antibody. It's ninety five percent sensitive
• 19:29
  Speaker 3: and specific. That's not perfect. You do need a confirmatory
• 19:32
  Speaker 3: biopsy test which is done by Endosco. People like broadly speaking,
• 19:36
  Speaker 3: if you think about it, you test for it, and
• 19:39
  Speaker 3: you're well on your way. Historically, it's really interesting that
• 19:43
  Speaker 3: although the disease has been known about for two millennia,
• 19:47
  Speaker 3: it was only in World War Two that they figured
• 19:49
  Speaker 3: out what the cause was. So Celiac disease is a
• 19:52
  Speaker 3: classic autoimmune disease that is due to a genetic susceptibility,
• 19:58
  Speaker 3: so it's largely genetically mediated, but it has an environmental trigger.
• 20:03
  Speaker 3: And for all this until World War Two, it wasn't
• 20:06
  Speaker 3: clear what the environmental trigger actually was. And it was
• 20:09
  Speaker 3: a Dutch pediatrician, William Carrol Dickey, who found that his
• 20:17
  Speaker 3: patients his kids with this disease got better during the
• 20:20
  Speaker 3: Dutch hunger winter of nineteen forty four to nineteen forty
• 20:23
  Speaker 3: five when they ran out of bread and then the
• 20:26
  Speaker 3: Allies air dropped bread into Holland, I guess, and the
• 20:29
  Speaker 3: kids developed the symptoms again once they were eating bread again.
• 20:33
  Speaker 3: So it was actually that long before we knew at
• 20:35
  Speaker 3: least that it was a wheat product. I think it
• 20:37
  Speaker 3: took a little longer to figure out exactly that it
• 20:39
  Speaker 3: was the gluten and the wheat what the cause was.
• 20:42
  Speaker 2: So the incidence of this has gone up over timeing
• 20:44
  Speaker 2: this is quite interesting. So if you think of this
• 20:46
  Speaker 2: as a as a genetic disease within an environmental interaction
• 20:50
  Speaker 2: over the past, it's gone of a lot in the
• 20:53
  Speaker 2: past few decades. Some of that's going to be diagnosis
• 20:55
  Speaker 2: and awareness, but some of that is aligned with a
• 20:58
  Speaker 2: general rise in autoimmune diseases. Almost certainly, this is not
• 21:03
  Speaker 2: genetic drift. It's just not enough time for their debe
• 21:06
  Speaker 2: genetic dript So there is something going on in the
• 21:09
  Speaker 2: environment or the food that we are eating that means
• 21:14
  Speaker 2: that more people are having this big moon that we're providing.
• 21:18
  Speaker 2: The foods that we're providing are more likely to trigger
• 21:21
  Speaker 2: this in people.
• 21:22
  Speaker 3: Yeah, and we actually know that it's a true increase
• 21:26
  Speaker 3: again because that blood test is pretty good to detect
• 21:28
  Speaker 3: celiac disease. There's a study in the Journal Gastroentrology in
• 21:32
  Speaker 3: two thousand and nine which looked at banked blood samples
• 21:36
  Speaker 3: from Warren Air Force Base, where like the privates had
• 21:39
  Speaker 3: gotten their blood sampled in nineteen forty eight and nineteen
• 21:42
  Speaker 3: fifty four, and they went back to those old samples
• 21:44
  Speaker 3: and tested them for this anti tissue tense glutaminy sandibody,
• 21:48
  Speaker 3: this diagnostic test for Celiac disease, and some of them
• 21:51
  Speaker 3: had it. You know, they probably weren't even diagnosed at
• 21:53
  Speaker 3: that point in time, but they are based on their
• 21:55
  Speaker 3: blood they had it, and that rate has increased over time,
• 21:58
  Speaker 3: So we do know something's going on. And here's where
• 22:01
  Speaker 3: we should talk about.
• 22:02
  Speaker 1: Sourdough is never a bad time, is it?
• 22:06
  Speaker 3: The lack of sery?
• 22:07
  Speaker 1: Why we should just got sourdough.
• 22:10
  Speaker 3: So some people are hypothesizing that our modern industrial bread
• 22:16
  Speaker 3: making process is a problem here, and the reason is
• 22:19
  Speaker 3: that in the old times when we made bread and
• 22:22
  Speaker 3: sort of with a slow fermentation. So think sourdough where
• 22:25
  Speaker 3: it's like it takes twenty four hour and I've made sourdough,
• 22:29
  Speaker 3: I actually don't love it because it's so labor intensive
• 22:32
  Speaker 3: and I just like getting yased from the store and
• 22:34
  Speaker 3: it's easy, but you know you've got twenty four to
• 22:36
  Speaker 3: thirty six hours. Over that slow fermentation process, the gleodin
• 22:41
  Speaker 3: and glutenin proteins are broken down somewhat more by the yeast,
• 22:45
  Speaker 3: and so they're potentially in a less immunogenic form. Modern
• 22:50
  Speaker 3: industrial bread is made with a process called the Chorleywood process,
• 22:55
  Speaker 3: which is crazy and incredibly fast. You can make one
• 22:58
  Speaker 3: of those whole loafs of bread based start to finish
• 23:00
  Speaker 3: takes about two hours. Now I do that, so I
• 23:05
  Speaker 3: did read about it. They use a lot more yeast,
• 23:09
  Speaker 3: they like mix the dough really fast, and it actually
• 23:15
  Speaker 3: gets hot as they're mixing, and they have to inject
• 23:17
  Speaker 3: like cold water to keep it from getting too hot.
• 23:20
  Speaker 3: I think they inject some maybe some gas or CO
• 23:22
  Speaker 3: two in it themselves. But the bottom line is the
• 23:25
  Speaker 3: yeast don't have much time to like do their breaking
• 23:28
  Speaker 3: down of proteins things. So some people are saying that
• 23:31
  Speaker 3: like it's the old fashioned bread that that might.
• 23:34
  Speaker 2: People say things though like speculative sourdough bread could be
• 23:38
  Speaker 2: something you would enjoy, but.
• 23:40
  Speaker 1: That feels speculative today.
• 23:42
  Speaker 2: So there's a lot of evidence that autoimmune disease, other
• 23:44
  Speaker 2: autoimmune disease, they've gone up over time.
• 23:46
  Speaker 3: This is also true, and we can't blame bread for everything,
• 23:48
  Speaker 3: all right.
• 23:48
  Speaker 2: Worth noting is that people often take quite a long
• 23:51
  Speaker 2: time to be diagnosed, because this is not clear, an
• 23:54
  Speaker 2: average of eleven years between first symptoms and diagnosis. And
• 23:59
  Speaker 2: so you know, if some of what we've described here
• 24:01
  Speaker 2: seems like it's you, there is a test, and a
• 24:04
  Speaker 2: gluten free diet is truly curative, although you have to
• 24:07
  Speaker 2: keep up with it over time.
• 24:10
  Speaker 3: Right, and for real celiac disease, I mean, a tiny
• 24:12
  Speaker 3: amount of gluten will set it off. So this is
• 24:14
  Speaker 3: like the real deal gluten free diet. And one thing
• 24:16
  Speaker 3: we're going to say here is that for all of
• 24:18
  Speaker 3: the conditions we talk about, jumping straight to the gluten
• 24:22
  Speaker 3: free diet is generally not the recommendation because it's hard
• 24:26
  Speaker 3: and not easy. And you know, with Celiac disease, at
• 24:29
  Speaker 3: least we can test and make sure you have celiac
• 24:32
  Speaker 3: disease and then put you on a gluten free diet.
• 24:34
  Speaker 3: But you don't want to do that. You don't want
• 24:35
  Speaker 3: to pull that trigger if you don't have to.
• 24:38
  Speaker 2: Okay, you can also be allergic to wheat to have
• 24:40
  Speaker 2: a just a regular person wheat allergy, just like you
• 24:45
  Speaker 2: can be allergic to other foods. This is separate from
• 24:47
  Speaker 2: a gluten allergy and would present with normal allergy symptoms,
• 24:53
  Speaker 2: difficulty breathing in principle anaphylaxis. So separate gluten celiac disease
• 24:59
  Speaker 2: and wheat allergy.
• 25:00
  Speaker 1: You are not the same thing.
• 25:01
  Speaker 3: Have you heard of wheat dependent allergy? Exercise induced anaphylaxis?
• 25:06
  Speaker 3: Have you heard is you're an exercise person, Emily, I have?
• 25:10
  Speaker 1: I have not, So it's this.
• 25:12
  Speaker 3: Weird phenomenon, which I like to say, like like we
• 25:17
  Speaker 3: don't fully understand, but it might be one of those
• 25:18
  Speaker 3: weird phenomenon that I don't fully understand and other people do,
• 25:21
  Speaker 3: so allergists let me know. But but basically it's people
• 25:24
  Speaker 3: who have a wheat allergy, but it only presents during exercise.
• 25:28
  Speaker 3: And so it's like this weird combination where it they
• 25:31
  Speaker 3: just eat wheat or they just exercise. It's fine, but
• 25:34
  Speaker 3: if they do both in proximity, in time, they develop
• 25:36
  Speaker 3: anaphylaxis like.
• 25:37
  Speaker 1: It did not like while you're running.
• 25:38
  Speaker 2: It's not like if you run and eat a bagel,
• 25:40
  Speaker 2: you're no.
• 25:42
  Speaker 3: I think, I think it can be in your system,
• 25:45
  Speaker 3: but that's sort of a weird one. And then there
• 25:48
  Speaker 3: was a bizarre Japanese facial soap wheat allergy incident that
• 25:54
  Speaker 3: occurred with the cha no Hizuku soap, which was documented
• 25:59
  Speaker 3: in Epidemiology Circles. The short version is this was a
• 26:03
  Speaker 3: soap that contained wheat. I don't know why, I guess whatever.
• 26:06
  Speaker 3: People put a lot of things in wheat, and but
• 26:09
  Speaker 3: for whatever reason, it was wheat in some kind of
• 26:11
  Speaker 3: digestive form that was pretty allergenic, and when people were
• 26:14
  Speaker 3: putting on their faces they were getting it like they
• 26:16
  Speaker 3: were inhaling it and doing stuff like that. There's a
• 26:19
  Speaker 3: lot of evidence in the allergy literature that when you
• 26:22
  Speaker 3: eat something it's protective in terms of allergies, right like
• 26:26
  Speaker 3: giving kids peanut butter when they're extremely young is protective.
• 26:30
  Speaker 3: But when you get it in a different way, like
• 26:32
  Speaker 3: if you inhale it or if it gets like under
• 26:34
  Speaker 3: your skin or something like that, then you can generate allergy.
• 26:37
  Speaker 3: So this happened in a like several thousand women in
• 26:40
  Speaker 3: Japan developed wheat based anaphleaxes based on a soap. Very strange.
• 26:45
  Speaker 2: That's extremely odd, don't buy weird soaps. Don't wash your
• 26:49
  Speaker 2: face of flour. I don't know.
• 26:51
  Speaker 3: I'm sure people do.
• 26:53
  Speaker 1: You probably do.
• 26:54
  Speaker 2: I'm sure there's like a tiktac influencer whose whole thing
• 26:56
  Speaker 2: is like flower face.
• 26:58
  Speaker 1: I feel like, puts flowers on your face, covers it
• 27:00
  Speaker 1: with one of.
• 27:00
  Speaker 2: These masks, and then like stays on the airplane for
• 27:03
  Speaker 2: like nine hours and at the end she's like, look
• 27:04
  Speaker 2: at this and then her face is just like a
• 27:06
  Speaker 2: crumbled mass of dough. Oh.
• 27:10
  Speaker 3: I'm going to try to find this person, and if not,
• 27:12
  Speaker 3: I'll have Ai make it.
• 27:15
  Speaker 1: Yes, Ai needs to make that. Okay, there, do we
• 27:20
  Speaker 1: really need to talk about gluten a taxia.
• 27:22
  Speaker 2: We're just gonna get people freaked out that they're going
• 27:24
  Speaker 2: to have neural loss.
• 27:26
  Speaker 3: Yeah, no, that's okay. There's there's another rare condition that
• 27:30
  Speaker 3: is gluten a taxia, which is another automune condition kind
• 27:34
  Speaker 3: of related to Celiac disease, but it attacks your brain
• 27:36
  Speaker 3: instead of your small intestine and that's not great. But
• 27:40
  Speaker 3: this is this is pretty rare. All of this is
• 27:42
  Speaker 3: just to say that, yes, of course, like like any
• 27:46
  Speaker 3: protein that's out there, including peptides, that you might be
• 27:50
  Speaker 3: getting from China or other places. Anything like that can
• 27:53
  Speaker 3: be a potential allergen. Can you know, your body's a
• 27:56
  Speaker 3: complicated place and can induce strange symptoms and disease states.
• 28:01
  Speaker 3: But the vast majority of people don't have Celiac disease,
• 28:06
  Speaker 3: don't have weed allergy, and certainly don't have gluten a
• 28:09
  Speaker 3: taxia thankfully. What most people have, or are concerned they have,
• 28:14
  Speaker 3: is non celiac gluten sensitivity. And I guess that's what
• 28:19
  Speaker 3: we need to get to after the break.
• 28:26
  Speaker 2: Okay, we're back, and we're going to talk about non
• 28:30
  Speaker 2: celiac gluten sensitivity, which is what many people seem to
• 28:34
  Speaker 2: think that they have.
• 28:36
  Speaker 1: And I will say this conversation a little tricky because
• 28:39
  Speaker 1: there is no defined characteristic of sensitivity.
• 28:43
  Speaker 2: So people often say that they're sensitive to foods, by
• 28:46
  Speaker 2: which they mean some combination of I don't like that food,
• 28:49
  Speaker 2: and you know, I don't feel great after I eat
• 28:51
  Speaker 2: that food. And it can be hard to think about
• 28:54
  Speaker 2: outcomes in this case if what you are saying as
• 28:57
  Speaker 2: the sensitivity, of the outcome of the sensitivity is just
• 28:59
  Speaker 2: like I don't I don't feel great, like I don't
• 29:01
  Speaker 2: eat spicy food, I don't eat spicy food because the
• 29:05
  Speaker 2: next day I feel really bad and I have a
• 29:08
  Speaker 2: lot of problems in the bathroom.
• 29:09
  Speaker 1: We don't need to go into it.
• 29:10
  Speaker 2: But I would say I have a sensitivity, but it's
• 29:12
  Speaker 2: not like a like a documented sensitivity.
• 29:15
  Speaker 1: So I don't know. I think this is what people mean.
• 29:18
  Speaker 2: Here is something different, something fundamentally different than I don't
• 29:22
  Speaker 2: like to eat that food or that food doesn't agree
• 29:24
  Speaker 2: with me.
• 29:25
  Speaker 1: They mean something.
• 29:26
  Speaker 2: Like I am having a version of a Celiac reaction
• 29:29
  Speaker 2: to this food and therefore need to avoid it for.
• 29:34
  Speaker 1: Medical reasons, as opposed to almost preferences. Does that make sense.
• 29:39
  Speaker 1: It's such a hard distinction.
• 29:43
  Speaker 3: Yeah, it's tough. We do not have a diagnostic test
• 29:47
  Speaker 3: or a clear biomarker for non Celiac gluten sensitivity, so
• 29:52
  Speaker 3: in contrast Celiac disease, where it's like yep, blood test,
• 29:54
  Speaker 3: biopsy shows it. You know, these characteristic symptoms people who
• 29:58
  Speaker 3: are like, look, I feel bad, and by the way
• 30:00
  Speaker 3: we say feeling bad generally is in the GI system.
• 30:02
  Speaker 3: People complain of bloating, diarrhea, sometimes constipation, but also brain fog, fatigue, depression,
• 30:12
  Speaker 3: other symptoms that can be hard to pin down. There's
• 30:14
  Speaker 3: no case definition for non celiac gluten sensitivity. And more importantly,
• 30:18
  Speaker 3: there's no blood test. There's no signal of immune activation
• 30:22
  Speaker 3: like we can see in celiac disease, seic disease, you
• 30:24
  Speaker 3: can find the immunoglobulins that are directed against the proteins
• 30:28
  Speaker 3: and things like that. We don't have that in this.
• 30:30
  Speaker 3: This is not to say that this is not a
• 30:33
  Speaker 3: real thing and we can go I think that you know,
• 30:38
  Speaker 3: there are always people who are going to be skeptical
• 30:40
  Speaker 3: of this because it's like, wait, okay, you don't have
• 30:42
  Speaker 3: a blood test. This is just someone kind of complaining
• 30:44
  Speaker 3: that they get gassy sometimes, and we all get gassy sometimes,
• 30:47
  Speaker 3: and who cares whether it's the gluten or not. So
• 30:51
  Speaker 3: the thing I think to take home or an important
• 30:55
  Speaker 3: set of studies that looks at non celiac gluten sensitivity
• 30:58
  Speaker 3: are blinded challenges. So the way this works is you
• 31:02
  Speaker 3: take people who you know believe they have gluten sensitivity
• 31:06
  Speaker 3: for whatever reason, and instead of just saying, okay, go
• 31:10
  Speaker 3: on a gluten free diet and see how you feel,
• 31:12
  Speaker 3: in which case there's going to be a lot of
• 31:13
  Speaker 3: placebo effect there, right, Like you're doing something, you're being proactive,
• 31:16
  Speaker 3: you're eating different foods in general. You give them a
• 31:20
  Speaker 3: blinded challenge where you you know, at random, you give
• 31:24
  Speaker 3: them either food containing gluten or food containing non gluten.
• 31:30
  Speaker 3: And basically, when you do this, you find that, let's see,
• 31:36
  Speaker 3: sixteen to thirty percent of those who believe they have
• 31:40
  Speaker 3: gluten sensitivity get the symptoms reliably reproduced in blinded challenges.
• 31:45
  Speaker 3: Now there's two ways to look at this. One is
• 31:46
  Speaker 3: to be like, oh, that's like glucas, no one has
• 31:50
  Speaker 3: non sea like gluten sensitivity. But that's clearly not true.
• 31:52
  Speaker 3: I mean some people obviously. Do you know up to
• 31:55
  Speaker 3: thirty percent of people who believe they have some noncilia
• 31:58
  Speaker 3: gluten sensitivity can re produce it in a blinded challenge,
• 32:01
  Speaker 3: which means something is happening even if we can't see
• 32:03
  Speaker 3: it in the blood. But it's also really important to
• 32:06
  Speaker 3: realize that there's seventy percent of people out there that
• 32:11
  Speaker 3: don't have a non celiac gluten sensitivity. And I think
• 32:16
  Speaker 3: it's important to realize that there's a heck of a
• 32:18
  Speaker 3: lot more in bread products than just gluten, And it's
• 32:23
  Speaker 3: so critical to determine if you're sensitive to something what
• 32:26
  Speaker 3: you might be sensitive for, because, as we pointed out
• 32:29
  Speaker 3: at the beginning, cutting out gluten means cutting out a
• 32:31
  Speaker 3: lot of really great a lot of really great things.
• 32:35
  Speaker 2: Yeah, let me just double down on this point about
• 32:39
  Speaker 2: how we do these blinded challenges, because there's also some
• 32:42
  Speaker 2: I think very nice, what people would call no sebo evidence.
• 32:47
  Speaker 2: So in these kind of trials, they give people in
• 32:51
  Speaker 2: this case who are potentially gluten sensitive, they either tell
• 32:57
  Speaker 2: them that they're getting gluten or tell them that they are,
• 33:00
  Speaker 2: So there's a difference in your expectations, and then they
• 33:03
  Speaker 2: either give them gluten or not. So the people who so,
• 33:09
  Speaker 2: what they find here is that, you know, there's significantly
• 33:12
  Speaker 2: more gastrointestinal symptoms if you tell someone that they're getting
• 33:16
  Speaker 2: gluten and they get it, then if you tell them
• 33:19
  Speaker 2: they're not getting gluten but they do get it. So
• 33:22
  Speaker 2: there's a sort of like the expectation is driving it.
• 33:25
  Speaker 2: And moreover, the people who think that they're getting the
• 33:28
  Speaker 2: gluten and are not getting it look like the people
• 33:31
  Speaker 2: who think that they're getting it and get it. So
• 33:34
  Speaker 2: in this particular study, the expectations about whether you were
• 33:37
  Speaker 2: going to get gluten were much more important than whether
• 33:40
  Speaker 2: you actually got it in driving the symptoms. Now, again
• 33:43
  Speaker 2: that doesn't mean that there aren't mean this is like
• 33:45
  Speaker 2: one study and there's a variation across people.
• 33:48
  Speaker 1: It doesn't mean that there aren't people for whom.
• 33:51
  Speaker 2: The symptoms deliver based on getting the gluten and not
• 33:54
  Speaker 2: on the expectations. But there is clearly in some of
• 33:57
  Speaker 2: this either some thing about another product that people are
• 34:02
  Speaker 2: consuming or something that is effectively a placebo expectation.
• 34:09
  Speaker 3: Remember that your brain talks to your gut like, this
• 34:13
  Speaker 3: is not just it's all on your head. In fact,
• 34:15
  Speaker 3: your brain can make your small intestine in colon do things.
• 34:19
  Speaker 3: You've actually all experienced this, like when you finally get
• 34:23
  Speaker 3: close to a bathroom that you like and then you
• 34:25
  Speaker 3: have to poop. That is your brain telling you, like, okay,
• 34:29
  Speaker 3: it's like something is going on here. So the fact
• 34:32
  Speaker 3: that expectation can induce gisymptoms is totally reasonable and it's
• 34:37
  Speaker 3: not like a psychology problem. It's how the brain works.
• 34:41
  Speaker 3: But it's really critical to remind people that gluten travels
• 34:47
  Speaker 3: in the company of several other molecules that can give
• 34:51
  Speaker 3: you some gut distress, and I think the big one,
• 34:54
  Speaker 3: and there are a lot but under the sort of
• 34:57
  Speaker 3: it might not be the gluten that you're sensitive to,
• 35:00
  Speaker 3: are the fructo oligosaccharides, or so called fruit tans. These
• 35:05
  Speaker 3: are essentially chains of sugar molecules that you can't digest
• 35:10
  Speaker 3: like you, humans lack the enzymes to digest these things,
• 35:13
  Speaker 3: but the bacteria in your colon are more than happy
• 35:16
  Speaker 3: to digest them. And when they do, they those bacteria
• 35:19
  Speaker 3: produce gas and a feeling of bloating, which you know
• 35:24
  Speaker 3: certainly mimics a lot of the symptoms that people not see,
• 35:26
  Speaker 3: like gluten sensitivity, say they have. And the main source
• 35:29
  Speaker 3: of fruit tans in the Western diet is wheat, So
• 35:33
  Speaker 3: if you cut out gluten, you're biproxy cutting out wheat,
• 35:37
  Speaker 3: and therefore you're biproxy cutting out fruit tans. But so
• 35:41
  Speaker 3: you might feel better, But it actually wasn't the gluten
• 35:44
  Speaker 3: all along, And if you knew that it was the
• 35:47
  Speaker 3: fruit tans, you might do something different than cut out gluten.
• 35:52
  Speaker 3: That is true, that makes sense.
• 35:53
  Speaker 2: What you might try is what's called a fod map diet,
• 35:56
  Speaker 2: which is a specific kind of diet that eliminates these
• 36:00
  Speaker 2: oglio saccharides, but it does.
• 36:03
  Speaker 1: Not require an elimination of all gluten.
• 36:05
  Speaker 3: Yeah, and just to hit on the theme again, like
• 36:08
  Speaker 3: jumping to the conclusion I should stop eating gluten, like
• 36:10
  Speaker 3: seth rogen in the beginning is often incorrect. Like the
• 36:15
  Speaker 3: way you should do this is potentially discussing with your doctor,
• 36:19
  Speaker 3: but more importantly in the situation like this, talking with
• 36:22
  Speaker 3: a dietitian, because there's actually a really defined pathway of
• 36:26
  Speaker 3: trying different foods and recording your symptoms to sort of
• 36:29
  Speaker 3: isolate what the sensitivity is. And that's such an important
• 36:33
  Speaker 3: piece of knowledge if you can actually dial it in.
• 36:36
  Speaker 3: Maybe it's gluten, but if it's something else, it's so
• 36:38
  Speaker 3: important to know that.
• 36:40
  Speaker 1: I think that.
• 36:40
  Speaker 2: I mean, there's a sort of step back on this,
• 36:42
  Speaker 2: which is to say, some of what's going on here
• 36:44
  Speaker 2: almost a lot of what's going on if people are saying,
• 36:46
  Speaker 2: you know, I'm not feeling great.
• 36:48
  Speaker 1: I'm eating food and I'm not feeling great.
• 36:49
  Speaker 2: I feel bloated, I feel nauseous, I feel fatigued, I
• 36:52
  Speaker 2: have a brain fog, And one of the possibilities is
• 36:55
  Speaker 2: that is related to what I'm eating, which in the
• 36:58
  Speaker 2: case of gastrointestinal symptoms, is like a totally reasonable assumption.
• 37:03
  Speaker 1: And then the question should be what is it?
• 37:08
  Speaker 2: And yes, gluten is one of the things that you
• 37:10
  Speaker 2: would put on the list of possibilities, but actually, for
• 37:12
  Speaker 2: most people, there's a lot of other things that you
• 37:15
  Speaker 2: would want to have on that list.
• 37:16
  Speaker 1: Maybe you'd want to have these saccharides, but also.
• 37:19
  Speaker 2: You might want to say, like, maybe you're not having
• 37:21
  Speaker 2: enough fiber, maybe you're not having enough hydration, maybe you're
• 37:24
  Speaker 2: drinking too much, maybe you're not drinking enough like what,
• 37:26
  Speaker 2: There's various other possibilities.
• 37:28
  Speaker 1: And so one of the sort.
• 37:30
  Speaker 2: Of insidious things about this gluten business for me is
• 37:34
  Speaker 2: that I think some people are having these symptoms and
• 37:37
  Speaker 2: just saying, oh, it's probably gluten sensitivity. Let me just
• 37:39
  Speaker 2: cut it all this gluten which is both making their
• 37:41
  Speaker 2: life worse because bread is delicious, but is also actually
• 37:46
  Speaker 2: probably not fixing the problem as much as if they
• 37:48
  Speaker 2: took a more holistic view around the symptom pattern and
• 37:51
  Speaker 2: ask the question, what could I do to improve my symptoms?
• 37:55
  Speaker 2: And this a little bit what happens in this influencer space,
• 37:58
  Speaker 2: which is people see, you know, oh I don't feel good,
• 38:01
  Speaker 2: and then this influencer says, you probably have a gluten allergy.
• 38:05
  Speaker 2: You know, everybody, or you probably have a gluten sensitivity,
• 38:07
  Speaker 2: and you know, make your tortilla out of cottage cheese
• 38:10
  Speaker 2: instead of bread, and everything will get better.
• 38:12
  Speaker 1: And that could be delicious, but it might not fix
• 38:15
  Speaker 1: your problem.
• 38:16
  Speaker 3: Absolutely. And I think you know, there's obviously an entire industry,
• 38:20
  Speaker 3: a gluten free industry out there. You can buy gluten
• 38:23
  Speaker 3: free tortillas and gluten free bread and gluten free pasta
• 38:27
  Speaker 3: and all that stuff. It's worth noting that in general,
• 38:30
  Speaker 3: these gluten free foods are more processed, they're they're more
• 38:33
  Speaker 3: in the ultra processed food spectrum. They tend to be
• 38:35
  Speaker 3: lower in fiber, lower in folate, generally higher in fat
• 38:39
  Speaker 3: and sugar, and two to three times the price. So
• 38:43
  Speaker 3: there is like a cost to be paid for switching
• 38:46
  Speaker 3: into a non gluten framework. There have been some studies
• 38:50
  Speaker 3: in of rice flour. I'm pulling something from the journal
• 38:55
  Speaker 3: Epidemiology from twenty seventeen looking at the unintended consequences of
• 38:59
  Speaker 3: a glut and free diet. And one of the things
• 39:01
  Speaker 3: they found where us higher arsenic and mercury levels in
• 39:04
  Speaker 3: the urine. Because rice flour tends to be slightly more
• 39:08
  Speaker 3: contaminated with arsenic and mercury. So yeah, don't don't jump
• 39:13
  Speaker 3: to conclusions here, you might regret it.
• 39:15
  Speaker 2: And I think also we sort of see one of
• 39:18
  Speaker 2: these people are constantly reporting is that their gluten sensitivities
• 39:21
  Speaker 2: are better when they are in Europe.
• 39:22
  Speaker 3: Oh my gosh, I've had friends say that. Yes, yes, yeah,
• 39:25
  Speaker 3: like in.
• 39:25
  Speaker 2: The flowers different, the croissants are different. Well, French croissants
• 39:30
  Speaker 2: definitely have gluten in them. Now they maybe cooked differently,
• 39:34
  Speaker 2: the wheat is different, but there's no question that they have.
• 39:37
  Speaker 2: Like if you are a person with Celiac disease and
• 39:38
  Speaker 2: you eat a French bisont, you will feel like crap
• 39:40
  Speaker 2: the same way that you will if you are an
• 39:43
  Speaker 2: American American cuissont, Like, no difference. And so this suggests
• 39:48
  Speaker 2: either for some fraction of these people there's something else
• 39:52
  Speaker 2: in the food environment that is different. Maybe there's something
• 39:56
  Speaker 2: about the interactions with stress, maybe there's like, maybe there
• 39:58
  Speaker 2: is something else going on, and maybe there's something that
• 40:01
  Speaker 2: the difference in the way the flower is processed. But
• 40:05
  Speaker 2: my strong.
• 40:05
  Speaker 1: Instinct is it's actually some other things.
• 40:08
  Speaker 3: Yeah, the epidemiology of both Celiac disease and non celiac
• 40:15
  Speaker 3: gluten and gluten sensitivity is the same in Europe and
• 40:18
  Speaker 3: the US, so like there's just as many. It's not like,
• 40:20
  Speaker 3: oh that no one has Celia act disease over there.
• 40:22
  Speaker 3: They do in the same rate as we do. So yes,
• 40:25
  Speaker 3: everything tastes better in France one hundred percent, and we
• 40:28
  Speaker 3: should we all feel better when we're in France. I
• 40:30
  Speaker 3: can speak from personal experience there, but it's probably not
• 40:33
  Speaker 3: anything magic that they're doing with their with their weat.
• 40:36
  Speaker 2: I just feel like if people are not I have
• 40:39
  Speaker 2: a hard time expressing this, but I feel like this
• 40:42
  Speaker 2: has gotten in the way of people improving how they
• 40:44
  Speaker 2: feel because it has given people an easy answer that
• 40:49
  Speaker 2: companies are obviously delighted to take advantage of by saying, oh,
• 40:52
  Speaker 2: you know, you can buy our gluten free crackers, and
• 40:55
  Speaker 2: you know you can buy our gluten free bread and
• 40:56
  Speaker 2: gluten free this, that and the other thing, And that
• 40:59
  Speaker 2: it has gotten people into a space where they're not
• 41:01
  Speaker 2: actually trying to figure out what's wrong. They're just defaulting
• 41:04
  Speaker 2: to something which may or may not really be the solution.
• 41:08
  Speaker 1: And that feels bad to me.
• 41:11
  Speaker 3: Uh yeah, And these symptoms because they're amenable to both
• 41:13
  Speaker 3: the placebo and no cibo effect. You might feel better
• 41:16
  Speaker 3: by switching, even if it has nothing to do with
• 41:18
  Speaker 3: wheat at all, even if your symptoms are due to
• 41:20
  Speaker 3: like you aren't getting enough fiber. The very act of
• 41:23
  Speaker 3: taking initiative and switching all your bread to gluten free
• 41:28
  Speaker 3: bread that has an expectation to it that can have
• 41:31
  Speaker 3: placebo effects as well. They tend to not last forever.
• 41:34
  Speaker 3: And I've had plenty of friends and patients and stuff
• 41:37
  Speaker 3: who have been gluten free for a period of time
• 41:40
  Speaker 3: and then things start creeping back, like symptoms start creeping back,
• 41:43
  Speaker 3: and people start to realize, you know what, like maybe
• 41:45
  Speaker 3: it wasn't the gluten, and at that point in time
• 41:48
  Speaker 3: they actually do what is what's real work is to
• 41:50
  Speaker 3: figure out what you're sensitive to. It's not something that
• 41:53
  Speaker 3: you're going to do overnight. It takes like kind of
• 41:55
  Speaker 3: documentation of symptoms and very specific dietary changes over time.
• 42:00
  Speaker 3: But once people do that work, they're generally happy that
• 42:03
  Speaker 3: they did ye, but it is work. I, as per tradition,
• 42:09
  Speaker 3: tried to find a study that would show that avoiding
• 42:12
  Speaker 3: gluten would improve your athletic performance, so that I could
• 42:14
  Speaker 3: get Emily to be gluten free for the next ten
• 42:17
  Speaker 3: years and I failed. All I found was a study
• 42:22
  Speaker 3: appearing in the journal Medicine and Science in Sports and
• 42:25
  Speaker 3: Exercise in twenty fifteen which took thirteen endurance cyclist and
• 42:29
  Speaker 3: randomized them in a crossover fashion. So they went like
• 42:31
  Speaker 3: a couple of weeks having gluten in a couple of
• 42:33
  Speaker 3: weeks not having gluten, and then did time trials and Nope,
• 42:37
  Speaker 3: they were just as fast and just as endurance as
• 42:42
  Speaker 3: they regardless of what their gluten intake was.
• 42:45
  Speaker 2: I'm actually shocked that this did not go in the
• 42:48
  Speaker 2: other direction. Oh even that, I would think it would
• 42:51
  Speaker 2: be hard to maintain the kind of carbohydrates that you
• 42:54
  Speaker 2: need without gluten containing products.
• 42:58
  Speaker 1: So they guess these guys probably just said a lot
• 42:59
  Speaker 1: of rice.
• 43:01
  Speaker 3: I think they had a dietitian. I think they were
• 43:05
  Speaker 3: calorically equivalent.
• 43:06
  Speaker 2: Yeah, yeah, yeah, I know very few endurance athletes who
• 43:10
  Speaker 2: don't contour who avoid gluten because it's just hard to
• 43:14
  Speaker 2: get enough you know, carbohydrates and sugars.
• 43:17
  Speaker 3: Yeah. I also checked because people ask like, is there
• 43:21
  Speaker 3: a difference between organic we and non organic wheat, and
• 43:24
  Speaker 3: the answer is not in terms of gluten. They both
• 43:27
  Speaker 3: have gluten.
• 43:29
  Speaker 2: But it could be something else. And that's like, there
• 43:31
  Speaker 2: could be something else between these things.
• 43:32
  Speaker 1: That are bothering that are bothering you. Yeah, I don't know.
• 43:36
  Speaker 3: Yeah, talk to you a dietitian and work it through.
• 43:39
  Speaker 1: Yeah.
• 43:39
  Speaker 2: If you are having these here's my takeaway here, then
• 43:43
  Speaker 2: we can smash. Our pass is if you are having
• 43:45
  Speaker 2: symptoms like this, you should be tested for celiac. And
• 43:51
  Speaker 2: if you don't have Celiac, you should do something broader
• 43:57
  Speaker 2: to try to figure out what's bothering you, rather than
• 43:59
  Speaker 2: just some Mary's crackers, even though they're it's a very
• 44:02
  Speaker 2: good kind of cracker.
• 44:04
  Speaker 3: Not nad, but send us some Mary's crackers.
• 44:08
  Speaker 2: All right, Perry. Are you a smash or pass on gluten?
• 44:12
  Speaker 3: I'm a smash. I'm a lover of pasta, a lover
• 44:16
  Speaker 3: of bread. I feel for all of you who have
• 44:20
  Speaker 3: any form of gluten intolerance, whether it's Celiac disease or otherwise,
• 44:24
  Speaker 3: and I implore those of you who might just be
• 44:27
  Speaker 3: assuming that they have gluten intolerance to try to figure
• 44:29
  Speaker 3: it out for one certain because a life without gluten
• 44:34
  Speaker 3: is just a smidge less happy than a life with gluten.
• 44:38
  Speaker 3: Emily Smash pass.
• 44:40
  Speaker 2: I'm a smash all my favorite foods contained gluten, and
• 44:43
  Speaker 2: I will dittow you that. I think I love people
• 44:47
  Speaker 2: to just make sure that this is what's going on with.
• 44:49
  Speaker 1: You, and maybe you'll be able to have gluten. All right,
• 44:52
  Speaker 1: that's it for gluten.
• 44:54
  Speaker 2: Mail back question in the week after the break.
• 45:01
  Speaker 1: Hi, Emily and Perry.
• 45:03
  Speaker 4: This is Ellie and Josh and we're calling from Toronto.
• 45:08
  Speaker 4: Our question is is coffee really bad for kids? Does
• 45:12
  Speaker 4: it really stunt kids growth?
• 45:14
  Speaker 3: Like would it hurt if I love it to drink
• 45:17
  Speaker 3: a bit? That's our question, Emily, do your kids drink coffee?
• 45:23
  Speaker 2: My kids don't drink coffee because they tell me that
• 45:27
  Speaker 2: they see how dependent I am on coffee and they
• 45:30
  Speaker 2: don't want that for themselves, which I think shows a
• 45:32
  Speaker 2: level of maturity I have not achieved.
• 45:36
  Speaker 1: What about you.
• 45:37
  Speaker 3: My sixteen year old will occasionally, but but not too often.
• 45:45
  Speaker 1: Coffee does not stunt kids growth. This is a myth.
• 45:49
  Speaker 3: It's I have one hundred percent told my kids this.
• 45:52
  Speaker 3: By the way, on knowing it's not true.
• 45:56
  Speaker 1: Turn this off for your children. It's a myth.
• 46:00
  Speaker 2: I think there are reasons to not give your child coffee,
• 46:05
  Speaker 2: which are that you could develop a tolerance for a
• 46:08
  Speaker 2: caffeine and then you will need it. And that's not
• 46:11
  Speaker 2: a terrible that's not a terrible thing, but it may
• 46:14
  Speaker 2: not be something you want to develop in a child.
• 46:17
  Speaker 1: And particularly since many of.
• 46:19
  Speaker 2: Us use caffeine to address our lack of sleep, I
• 46:23
  Speaker 2: would urge you to make sure your children are sleeping
• 46:26
  Speaker 2: enough so they don't need coffee. And definitely they should
• 46:29
  Speaker 2: not have coffee at the end of the day because
• 46:31
  Speaker 2: it does interfere with sleep, even if it doesn't interfere
• 46:35
  Speaker 2: with growth.
• 46:36
  Speaker 3: So well said one note that teenagers and kids are
• 46:40
  Speaker 3: getting most of their caffeine not from coffee these days.
• 46:43
  Speaker 3: They're getting them from energy drinks and sodas, and those
• 46:48
  Speaker 3: are also not good for kids.
• 46:50
  Speaker 2: And actually those and like the Celsiest energy drink that
• 46:53
  Speaker 2: has a lot of caffeine in it, arguably more than coffee.
• 46:57
  Speaker 2: So people do want to be pretty careful, pretty careful
• 47:00
  Speaker 2: about those.
• 47:01
  Speaker 1: Do you did you?
• 47:02
  Speaker 2: I know you probably this is not going to be
• 47:04
  Speaker 2: for you. Did you watch if you're watch Saved by
• 47:06
  Speaker 2: the Bell?
• 47:06
  Speaker 3: I mean I remember you, sure, I remember Saved by
• 47:08
  Speaker 3: the Bell?
• 47:09
  Speaker 1: And do you remember the episode?
• 47:11
  Speaker 2: Do you remember the Jesse episod where Jesse Spano gets
• 47:13
  Speaker 2: addicted to the caffeine pills.
• 47:14
  Speaker 1: Yeah.
• 47:15
  Speaker 3: Yeah, they were like, we can't do real drugs, but.
• 47:19
  Speaker 2: Burned this image of Jesse Spano like dancing around her
• 47:23
  Speaker 2: room because she's had too many caffeine fills.
• 47:25
  Speaker 1: It's like burned into my mind forever, and I have
• 47:30
  Speaker 1: in high school.
• 47:31
  Speaker 2: Even though I was tempted because I was not sleeping
• 47:33
  Speaker 2: anywhere near enough, I would never have ever taken caffeine
• 47:36
  Speaker 2: pills because of that Saved by the Bell episodes of
• 47:39
  Speaker 2: Drugs Kids.
• 47:39
  Speaker 3: Oh my god, it worked. It worked on a very
• 47:42
  Speaker 3: special episode of Saved by the Bell.
• 47:46
  Speaker 1: Yes, oh my god, that was so great.
• 47:47
  Speaker 2: All right, Well, well Josh, it's probably not a good
• 47:52
  Speaker 2: idea for you to have too much coffee, but it's
• 47:54
  Speaker 2: not going to make you short.
• 47:58
  Speaker 3: All right. That's it for us today. With us next
• 48:00
  Speaker 3: week when we'll ask what's the deal with fluoride? Oh,
• 48:05
  Speaker 3: we're gonna get some emails about that. People get upset about.
• 48:09
  Speaker 2: Flora I Wellness actually is produced in association with iHeartMedia.
• 48:15
  Speaker 1: Our senior producer is Tamar Avishaid.
• 48:18
  Speaker 2: Our executive producer at iHeart is Jennifer Bassett. Our theme
• 48:21
  Speaker 2: music is by Eric Deutsch and Our content is for
• 48:24
  Speaker 2: educational purposes.
• 48:25
  Speaker 3: Owner If you like the show, help other people find us.
• 48:28
  Speaker 3: Leave a rating and review on Apple Podcasts or your
• 48:31
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• 48:33
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• 48:36
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• 48:40
  Speaker 3: Head over to Wellness Actually dot fm and leave us
• 48:43
  Speaker 3: a question for our mailbag or suggest a topic for
• 48:45
  Speaker 3: a future show.
• 48:47
  Speaker 1: We'll let the influencers have the last word. No time,
• 48:50
  Speaker 1: there's never any time. I don't have time to study.
• 48:54
  Speaker 1: I'll never get into Stanford. I'll let everyone down.
• 48:57
  Speaker 2: I'm so confused.
• 48:58
  Speaker 3: Jay, just calm down.
• 49:01
  Speaker 1: It's okay, right, you think will be okay. I just
• 49:05
  Speaker 1: need one of these hills.
• 49:07
  Speaker 3: You mean you really are taking drugs?
• 49:09
  Speaker 1: You need them? Just say, jes See, you can't sing
• 49:14
  Speaker 1: the night you can't. I'm so excited.
• 49:18
  Speaker 3: I'm so excited.
• 49:21
  Speaker 1: I'm so.
• 49:23
  Speaker 3: Scared.
• 49:25
  Speaker 4: Jesse