I’m so excited for tonight’s guest, Dr. Tom O’Bryan. He is absolutely brilliant, and I know you’re just going to be blown away by some of the information he’s going to share about gluten sensitivity and its relation to women’s health.
Dr. Thomas O’Bryan is an internationally recognized speaker and a workshop leader specializing in gluten sensitivity & celiac disease. He’s a Sherlock Holmes for chronic disease and metabolic disorders. He’s a clinician par excellence in treating chronic disease and metabolic disorders from a functional medicine perspective. He holds teaching faculty positions with the Institute for Functional Medicine and the National University of Life Sciences. Dr. O’Bryan is always one of the most respected, highly appreciated speakers. Dr. O’Bryan’s passion is in teaching the many manifestations of gluten sensitivity and celiac disease as they occur inside and outside of the intestines. His website is www.thedr.com.
Dr. O’Bryan, welcome to the show!
Dr. O’Bryan: Thank you! It’s a pleasure to be with you.
Evelyne: Awesome. So first of all, how did you become the gluten – or rather, the gluten-free doctor?
Dr. O’Bryan: [Laughs] Well, there are a number of factors that came into play I guess. Bottom line is… this is kind of an unusual way to start the show, but this is what killed my godmother, father, and mother. They had different diagnoses. My godmother’s was hepatocellular carcinoma liver cancer. It turned out to be secondary to celiac disease. My father had acute MI – that’s a fatal heart attack. That turned out to be secondary to elevated homocysteine levels from a folic acid deficiency because of malabsorption from celiac disease. And my mother had toxic metabolic encephalopathy, which is when the brain just stops working very well because it’s toxic, which was secondary to celiac disease. None of them were diagnosed in a timely way until there was so much tissue damage, and that’s what eventually caused their deaths.
Dr. O’Bryan: I didn’t plan on saying any of that, but that’s how it began for me. And I am on a mission to make sure that everyone that I can have an impact on will just consider if they’re not feeling like a million bucks or if they have some condition, and it’s not being taken care of to their ideals with natural care – I mean sometimes pharmaceuticals are necessary, but you don’t heal when you’re on long-term pharmaceuticals in general. So anyone who has a condition that they’re not happy or satisfied with the outcome, that they just consider maybe a common food that I’m eating every day could be contributing to this problem I have. Because gluten sensitivity and celiac disease can manifest in any tissue of the body. It just depends on where your weak link is. You know, you pull at a chain, it breaks at the weak link. It’s at one end, the middle and the other end; it’s your heart, your liver, your ovaries, your reproductive system, your brain. Wherever your genetic weak link is, when you pull on the chain, that’s where the chain is going to break. And so, there are over 19,000 studies in the medical literature that identify or talk about gluten sensitivity and celiac disease and how they manifest in any tissue of the body.
Dr. O’Bryan: So that’s a bit of a long answer but that’s how I got into this [Laughs].
Evelyne: Yeah so first, what is gluten? Let’s go over that.
Dr. O’Bryan: Sure. Gluten is a family of proteins. What we have to remember is that gluten is not bad for you. Bad gluten is bad for you. There’s gluten in corn, there’s gluten in rice, there’s gluten in most grains. But there’s a toxic family of glutens that are in wheat, rye, and barley. That family of gluten proteins is toxic to humans. So gluten’s not bad; bad gluten is bad.
Evelyne: And so you said there are over 19,000 studies in the literature? A lot of people think that this gluten free is trendy right now. Can you touch on that?
Dr. O’Bryan: Sure, you bet. That’s because there’s so much demand. There was an article last year that identified in the US over 25% of the population eats gluten-free food annually. That doesn’t mean they only eat gluten-free food, but they include gluten-free food in their meals. 25% of the population! And it’s estimated to be a 3.5 billion dollar industry by the end of this year. So there’s a lot of interest in this. This is not going to go away. This is just going to be more common and more prevalent as people just consider “Could I have a sensitivity?” And then they do the right kind of test, and realize, “Oh my gosh, look at this. I do!” And then they go on a gluten-free diet and they feel better. They function better.
So there are doctors who say a gluten-free diet is dangerous for you, but there is no evidence of a gluten-free diet being dangerous. The problem for some people with a gluten-free diet is if they rationalize poor behavior on a gluten-free diet.
I’ll give you an example. Maybe you would go to Starbucks or Pete’s Coffee or somewhere and get a coffee and maybe a blueberry muffin. And you get a muffin once a week or a couple of times a week. And now you go there and you’re trying to eat gluten-free and you think, “Oh, look they’ve got gluten-free muffins. They’re healthy for me! I can have one! As a matter of fact, I can have two!” And you have them every day! But no, they’re not healthy for you; they’re just not bad for you. There’s a difference between being healthy and bad.
So what happens is that people start indulging in fast foods that are gluten-free because they mistakenly think they’re healthy for them. There’s a difference between being healthy for you and being bad for you. That’s the first concept.
The second concept is that if people are so nutritionally depleted that they are dependent on adequate amounts of vitamins and minerals from the grains that they eat, when they go off of the standard grain products and they begin eating gluten-free grain products, the gluten-free grain products are not enriched. So enrichment means, with whole wheat for example, you take wheat and you take out 32 nutrients and you put 4 back in, you can market it as “enriched” for you. And some people’s nutrition is so poor that their bodies depend on getting enough of the B vitamins, for example, by the bread that they eat. So if you stop eating that bread and now you begin eating gluten-free bread that is not enriched, it’s conceivable that you could develop a nutrient deficiency. It’s not common but it is conceivable. And what it really means is that the person needs more education on how to eat a balanced diet.
So those are the two ways by which a gluten-free diet may not be good for you. But in general, it’s a very, very healthy diet. It’s the ideal diet! It’s the Mediterranean diet – just exchanging the pasta form from wheat pasta to rice pasta.
Evelyne: You and I were both at the Natural Products Expo a few weeks ago. And I said to people after that, “I don’t think you’ll even be able to buy food with gluten in it in a couple of years.”
Dr. O’Bryan: [Laughs] It was so surprising to see how many vendors were there with new products and how tasty they were and you’re right, it’s a market that’s continuing to improve.
Evelyne: So let’s go back and distinguish first between celiac disease, gluten sensitivity and gluten intolerance. Can you touch on that?
Dr. O’Bryan: Yes, that’s a really good point. There’s been a lot of confusion over the years on that.
The International Celiac Symposium occurs every two years, and it’s where all of the experts from around the world gather and strategize and have meetings. The last one occurred two years ago in Oslo. The next one is coming up this summer in Chicago. It’s all over the world – different places of the world every time. During the last one that occurred in 2011, they finally acknowledged that there is something about gluten sensitivity without celiac disease. It’s been a big argument for many years. They’re finally acknowledging that yes, there is something like that and we’re not quite sure what it is yet. And I’ll get more into that in a minute. But it’s finally been acknowledged.
They came out with a paper a couple of months later saying, “Please, all of the researchers. All of the scientists. All of the clinicians. All of the patients. Can we use the same language please?” They asked that we use this language. The language is at the top of the umbrella. The overlying umbrella term is “gluten-related disorders.” So all people who notice a change in their body function, blood chemistry, or immune system because of gluten have a gluten-related disorder. That’s the big kahuna term. They ask that we all use that.
Underneath that, if you carry the genes and if you have the indicators on endoscopy, you may have celiac disease. That’s on one side underneath that. On the other side, if you don’t have celiac disease, you may have non-celiac gluten sensitivity. And that is as far as they’ve gone in differentiations. They’ve asked “Please, stop using the words ‘gluten intolerance.’” It’s a very confusing term. The result of using a term like that is that some people mistakenly believe it’s like lactose intolerance, where we know that if you don’t make enough of the enzyme that digests lactose, if you take the enzyme lactase you’re then able to eat lactose-containing foods without a problem. That’s not true with gluten. The enzymes do not minimize or diminish or eliminate the problems. So please stop using the word “gluten intolerance.” So that was their message. So “gluten-related disorders” is the umbrella term. And then it’s either celiac disease or non-celiac gluten sensitivity.
Evelyne: Gotcha. How common are both of those in the US?
Dr. O’Bryan: Oh my goodness. Well we know that there are over 3 million people with celiac disease, and only 1 of out of 8 is diagnosed. They find more of this when family members are tested and say, “Yes, you got it, too.” “But I feel fine!” meaning they don’t have any gut problems. That’s because for every celiac patient who has gut symptoms – bloating, constipation, diarrhea, abdominal pains – there are 8 who don’t. But those celiacs will have thyroid symptoms, or they have weight symptoms, or they have migraines or headaches or brain fog. They have some other symptoms outside of the gut. And that’s why so many people are not diagnosed, because our doctors were trained in the past to believe that celiac disease was a disease of the gut. It’s not a disease of the gut. It’s a disease that includes the gut but it may manifest and show symptoms anywhere else.
So we know there’s 3 million or more celiacs out there. But non-celiac gluten sensitivity is much, much more common. And the papers so far have come out and one paper says 6 to 1. There are at least 6 times more non-celiac gluten sensitivities than there are celiacs. Another paper said 10 to 1. When they do studies looking at how many rheumatoid arthritis patients have celiac and how many have the antibodies to gluten, it’s 15 to 1. Gluten sensitivity is much, much more common than the commonly recognized celiac disease.
The test for non-celiac gluten sensitivity came on the market just under three years ago. So it’s still new, and many doctors don’t even know about these tests. But as these tests are being done, more and more people are getting the verification that they’ve got a problem with gluten. It may be celiac and it may not. But the consequences are just as severe in either case.
Evelyne: I want to go back to the tests in just a moment. But someone with gluten sensitivity, would they have different symptoms than someone with celiac?
Dr. O’Bryan: That’s really a good question. And the answer to that is that we don’t know yet. Because there haven’t been enough papers published about non-celiac gluten sensitivity. There are some. But there are nowhere near as many. There are 19,000 on celiac disease, and there are less than that for non-celiac gluten sensitivity. But there was a textbook that just came out. It’s called Advancing Medicine with Food and Nutrients. It was put out by Johns Hopkins University in December. It is the go-to textbook for holistic healthcare, functional medicine, complementary medicine. There are over 40 authors in there from each specialty that’s talked about.
And regarding the topic of celiac disease and non-celiac gluten sensitivity, they differentiated those conditions that have been shown in the literature to be specific for non-celiac gluten sensitivity. So this is the first publication that’s looked at an overview of that.
And here’s what they identify with non-celiac gluten sensitivity: fatigue, schizophrenia, psychiatric diseases, depression, irritable bowel syndrome, brain atrophy (that means your brain shrinks), peripheral neuropathies (which is numbness and tingling). All of these, by the way, have been associated with celiac disease and there are many papers on that. But these are the papers that identify it with non-celiac gluten sensitivity. So it could be either way. There is also cerebellar ataxia – these are elders who can’t walk and keep their balance very well because their brain has been shrinking on them. There is muscle pains, epilepsy and seizures, kidney diseases, depression, anxiety, paresthesias, bone pains, osteopenia, osteoporosis, cramps in your legs, and of course all the abdominal symptoms, and just general weakness. All of those have been shown in research papers already that they could be associated with non-celiac gluten sensitivity. They could of course be associated with celiac disease, or from something else. But the point is if you have any of those kinds of symptoms, you just want to check! You just want to know. Because if you don’t identify this, everything you do is going to be dancing around in circles on that.
Evelyne: So what are the tests now if you were to go to your general practitioner and say that you want to get tested for gluten sensitivity? And then what is the test that you were talking about that can more accurately identify it?
Dr. O’Bryan: Yes, good. The blood tests that have been done for many years looking for sensitivity to gluten have looked at one of the components of gluten. Let me just back up on that. Consider the protein gluten. Think of it like a brick wall. When we eat a protein, we digest it, and digestion is like getting the mortar off the bricks. So now you have the individual brick – that’s an amino acid. Each individual brick is by itself in your digestive tract and now they’re small enough to go right through and into the bloodstream. That’s the purpose of digestion. It’s to break these foods down into really small little parts that the body can then use to build new muscle, or new nerve, hormones, or more estrogen or testosterone or those types of things.
Dr. Alessio Fasano is a very famous researcher on Celiac Disease. He’s at the University of Maryland and he’s an Italian guy and has got a thick accent. He says it this way: if you could take the acid from your stomach and put it in a vial, and if you could put your finger in that vial, the acid would eat your finger to the bone in less than one minute. That’s the hydrochloric acid that we produce in our stomach. And it can sit there all day long to digest food because the stomach in its healthy state has the protection where the acid doesn’t eat the stomach. So, you put your finger in that vial of acid and it’ll eat the finger to the bone in one minute. But if you put gluten into that vial of acid, it doesn’t digest it at all. Humans are unable to digest the gluten in wheat, rye, and barley as it’s currently on the market today because it’s changed over time by hybridization. It’s a very different product than it was in ancient times.
So for all those people who say “But it’s in the Bible! Wheat is the staff of life.” My direct answer is this. I look them in the eye and say, “With all due respect, no one on the planet is eating the bread that Jesus Christ ate. So stop using that excuse. You cannot use an excuse of the Bible telling you to eat that food. That food is not available. If you could find that food, maybe you could eat it. But what we have now is a completely altered version that the human digestive system cannot digest. Period.” That’s it. And for some people and a vast majority of people, it’s making them sick. And they just didn’t know.
So, back to the digestion now. Digestion is taking the mortar off the bricks, so we have each individual brick. With gluten sensitivity you can’t get the mortar off the bricks. So it’s like someone took a sledgehammer to that wall and broke that wall into a bunch of pieces. There’s a 33-brick piece called alpha gliadin; a 17-brick piece, a 21-brick piece – lots of pieces or clumps of this brick. Now the only lab test that’s been available for many years has looked at a 33-brick piece called alpha gliadin. And 50% of Celiacs will have that. But the other 50% don’t. And so it’s been said that you can’t use a blood test for gluten to tell whether a person has gluten sensitivity or not because many times it doesn’t work, because of the 50% who don’t have a reaction to that one clump of brick.
Now the tests are available that look at 10 different clumps of brick. The top 10. So you don’t get the false negatives anymore. You’ll certainly get it if you have the 33-brick piece. But now you have nine other types of peptides of gluten that can be looked for. So it’s very unusual to get a false negative anymore. And those tests are from a laboratory called Cyrex. So if your listeners go to their doctors and say, “Hey, would you go take a look at Cyrexlabs.com and take a look at these tests? I want to have this test done because this is much more comprehensive.” Then your patients or your listeners can finally identify a missing link.