WEBVTT - What's the deal with gluten? 0:00:00.920 --> 0:00:01.240 Perry. 0:00:02.240 --> 0:00:05.840 Preparing for this week's episode, I was thinking about the 0:00:05.920 --> 0:00:10.320 kinds of foods that I love, and I wanted to 0:00:10.360 --> 0:00:10.920 ask you. 0:00:11.560 --> 0:00:13.039 A specific question about food. 0:00:13.800 --> 0:00:18.560 If there was one food you would be sad to lose, 0:00:18.800 --> 0:00:21.360 like and not alcohol or coffee, like not a not 0:00:21.440 --> 0:00:23.960 a like fun food, but like a real regular food. 0:00:24.280 --> 0:00:28.600 What is like the one thing that you would cry 0:00:28.880 --> 0:00:29.600 if you lost? 0:00:30.880 --> 0:00:32.800 Pez are cherry flavored pests? 0:00:32.800 --> 0:00:34.839 Do you eat aboutez frequently? 0:00:36.800 --> 0:00:40.080 Sorry? That is a deep cut. That is one of 0:00:40.159 --> 0:00:43.280 my favorite quotes from stand by Me from the. 0:00:43.280 --> 0:00:46.480 Star Trek about the like replication, Okay, what do you got? 0:00:47.040 --> 0:00:50.120 I'm here for you. No, my my real like a 0:00:50.159 --> 0:00:52.400 food that if it was like, no, you can't eat 0:00:52.400 --> 0:00:57.560 this anymore, this will now kill you. Probably like I 0:00:57.600 --> 0:01:01.160 don't know, like pasta bolognes that probably like pasta with 0:01:01.200 --> 0:01:03.920 meat sauces my happy place. 0:01:04.480 --> 0:01:07.120 So I was thinking about this because mine is definitely bagels, 0:01:07.920 --> 0:01:10.800 but then like my second one is bread and my 0:01:10.920 --> 0:01:13.920 third one is pastave. Like I every single thing on 0:01:13.959 --> 0:01:15.000 my list has gluten. 0:01:15.720 --> 0:01:16.200 Everyone. 0:01:16.760 --> 0:01:19.240 Yeah, if if you had Celiac disease, I. 0:01:19.200 --> 0:01:21.000 Would be so sad. I would be I would just 0:01:21.000 --> 0:01:24.440 be eating rice all the time. And I think that 0:01:24.480 --> 0:01:27.880 would make me sad. So I'm I'm glad I am 0:01:27.920 --> 0:01:29.080 not sensitive to gluten. 0:01:29.440 --> 0:01:32.680 Well, there are a lot of people out there unfortunately 0:01:32.800 --> 0:01:35.600 who are. There are a lot of people out there 0:01:35.680 --> 0:01:38.240 maybe who think they are and might not be, which 0:01:38.240 --> 0:01:41.760 we're going to dig into a lot in today's episode 0:01:41.920 --> 0:01:45.520 on one of our favorite proteins, which is gluten. 0:01:45.600 --> 0:01:46.880 We love it, Let's do it. 0:01:49.600 --> 0:01:52.680 I'm Emily Astro, I'm an economist and a data expert. 0:01:52.760 --> 0:01:54.840 And I'm Perry Wilson, I'm a medical doctor. 0:01:55.120 --> 0:01:59.720 It's Thursday, August sixth, twenty twenty six, and this is wellness. 0:01:59.200 --> 0:02:02.840 Actually, because you're getting a staggering amount of health and 0:02:02.880 --> 0:02:06.880 wellness information nowadays from every source imaginable, and some of 0:02:06.920 --> 0:02:08.840 it is awesome and some. 0:02:08.720 --> 0:02:11.800 Of it is well actually bullshit. 0:02:12.600 --> 0:02:15.639 Fortunately, we are both people who know how to read studies, 0:02:15.919 --> 0:02:18.200 how to parse the data, and can tell you what's 0:02:18.240 --> 0:02:21.080 worth thinking about and what you can safely ignore. 0:02:21.400 --> 0:02:23.680 But before we dig in, a note that this podcast 0:02:23.760 --> 0:02:26.320 is for educational purposes and should not be construed as 0:02:26.360 --> 0:02:29.560 medical advice. We don't know your unique situation, so talk 0:02:29.600 --> 0:02:31.440 to your doctor for personal health decisions. 0:02:32.880 --> 0:02:35.359 This week, we're asking what's the deal with gluten? 0:02:35.680 --> 0:02:37.960 Harry and I will give the official smasher pass, and 0:02:38.000 --> 0:02:39.440 then we'll get to your question of the week. 0:02:39.760 --> 0:02:42.440 But first let's do the health news round us after. 0:02:42.240 --> 0:02:57.280 The break and we're back with our health news of 0:02:57.280 --> 0:03:01.760 the week. Emily, I want to start with the great 0:03:02.120 --> 0:03:06.799 protein backlash. If listeners go back to or What's deal 0:03:06.840 --> 0:03:09.560 with Protein? Episode, we talked a lot about protein having 0:03:09.600 --> 0:03:12.480 a moment. This was the macronutrient that everyone was into. 0:03:12.760 --> 0:03:17.200 Entire aisles at Costco dedicated to protein containing foods. And 0:03:17.240 --> 0:03:19.760 now we start to see some articles that are saying, hey, wait, 0:03:20.320 --> 0:03:23.480 if you eat a lot of protein, you're actually gonna 0:03:23.480 --> 0:03:27.239 die sooner? Is it over? Is the protein party over? 0:03:27.880 --> 0:03:30.360 I don't think the protein party's over, because let's just 0:03:30.360 --> 0:03:32.799 emphasize if you donate any protein. 0:03:32.400 --> 0:03:33.519 You will actually die. 0:03:33.560 --> 0:03:35.040 That this is true a. 0:03:35.000 --> 0:03:37.920 Reason you will die. But I find this. I'm going 0:03:37.960 --> 0:03:40.200 to tell you about the science, but I also think 0:03:40.200 --> 0:03:43.480 there's something just so interesting about the psychology of how 0:03:43.520 --> 0:03:48.560 the news works here that this gets covered, because it's surprising. 0:03:49.160 --> 0:03:52.080 If people don't think protein is great, then you're really 0:03:52.120 --> 0:03:54.560 interested in publishing articles that say, oh, protein is great, 0:03:54.560 --> 0:03:55.560 Protein is great surprise. 0:03:55.600 --> 0:03:56.360 Protein is great. 0:03:56.560 --> 0:03:59.400 Now everyone's like, I gotta have protein popcorn at Costco. 0:03:59.600 --> 0:04:02.040 It's not interesting to publish an article that says protein 0:04:02.120 --> 0:04:04.400 is great, and so now the thing the media wants 0:04:04.400 --> 0:04:06.200 to cover is like, maybe protein isn't that great? 0:04:06.320 --> 0:04:06.920 Do you think of that? 0:04:07.120 --> 0:04:11.320 It's the engaging contrarianism of engaging science communication. 0:04:12.000 --> 0:04:12.880 Totally okay. 0:04:12.960 --> 0:04:15.720 But this is the reporting that I saw on this 0:04:15.760 --> 0:04:19.240 week is based on a study. It's like a review 0:04:19.440 --> 0:04:24.320 study about data primarily on yeast although they do have 0:04:24.400 --> 0:04:29.640 some mouse data, there's very little if no data on 0:04:30.000 --> 0:04:34.479 humans here, and they have an argument about protein restriction. 0:04:34.520 --> 0:04:36.640 This is actually a set of people who are very 0:04:36.640 --> 0:04:40.480 interested in calorie restriction for lifespan extension, which is an 0:04:40.520 --> 0:04:45.159 interesting space where most of the evidence is also in mice. 0:04:46.000 --> 0:04:47.800 And I want to read you just. 0:04:47.800 --> 0:04:50.800 One sentence because for me this sort of summarizes like 0:04:51.680 --> 0:04:53.760 why I think you shouldn't probably learn much from this, 0:04:54.200 --> 0:04:58.040 which is a quote from the paper like calorie restriction, 0:04:58.440 --> 0:05:02.080 protein restriction improved health span and increases the lifespan of 0:05:02.240 --> 0:05:08.640 yeast flies and rodents. It does not mention people, and 0:05:08.720 --> 0:05:12.120 I think we should not port this to people just yet. 0:05:13.040 --> 0:05:15.920 Mice aren't people. Although you know, I want nothing but 0:05:15.960 --> 0:05:20.279 the best for at least yeast who you know, for 0:05:20.320 --> 0:05:22.560 the gluten episode in particular, where you know we need 0:05:22.640 --> 0:05:27.080 our good friend Sarkam seravc for many of our yeasty 0:05:27.520 --> 0:05:34.200 bread products. Yeah, it's true that severe calorie restriction does 0:05:34.240 --> 0:05:37.120 extend the lifespan of a variety of animals, ranging from 0:05:37.160 --> 0:05:40.480 single celled organisms up through mice. And we don't know 0:05:40.520 --> 0:05:43.600 if it happens in people, because you really need people 0:05:43.680 --> 0:05:47.120 live a long time anyway, and so you need and 0:05:47.240 --> 0:05:50.039 we're talking calorie restriction on the order for like the 0:05:50.080 --> 0:05:52.880 equivalent of like twelve hundred calories a day forever. I mean, 0:05:52.920 --> 0:05:57.200 it's really you're in a starvation state. And my thought 0:05:57.240 --> 0:06:00.800 about these kind of studies is like, even if true, 0:06:01.520 --> 0:06:04.880 this is not a life worth living. So, you know, 0:06:05.000 --> 0:06:07.799 if we can find the mechanisms downstream of the calorie restriction, 0:06:07.960 --> 0:06:10.440 like if it oh, it upregulates some hormone that like, 0:06:10.480 --> 0:06:12.960 and we can just give the hormone, great, do that research. 0:06:13.040 --> 0:06:16.400 But you know I'm not I don't I if eating 0:06:16.440 --> 0:06:18.279 twelve hundred callies a day gets me to be one 0:06:18.320 --> 0:06:19.840 hundred and twenty, I don't want to be one hundred. 0:06:19.640 --> 0:06:23.760 And twenty right totally. I could not agree more. Okay, 0:06:25.240 --> 0:06:27.840 next up, can we talk about Ebola. 0:06:28.040 --> 0:06:31.200 Unfortunately, the Ebola outbreak in the Democratic Republic of the 0:06:31.240 --> 0:06:32.680 Congo has gotten worse. 0:06:32.720 --> 0:06:34.479 It's not the worst ever. 0:06:34.920 --> 0:06:38.799 What is going on and is this something people should 0:06:38.880 --> 0:06:41.679 be worried about outside the DRC. 0:06:42.560 --> 0:06:45.560 Yeah, I'm glad that you brought this up. You know, 0:06:45.600 --> 0:06:48.719 we talked about the Bola outbreak a few times when 0:06:48.760 --> 0:06:51.200 it was first emerging, and then these things do have 0:06:51.240 --> 0:06:52.920 a way of falling out of the news and you 0:06:53.040 --> 0:06:56.120 might think, like, oh, I guess that's not an issue anymore, 0:06:56.960 --> 0:06:59.200 but it very much is. As of the thirtieth of July, 0:06:59.360 --> 0:07:02.920 there were three thy six hundred and five confirmed cases, 0:07:03.320 --> 0:07:06.040 including one thy five hundred and eighty seven deaths. That's 0:07:06.040 --> 0:07:09.360 a case fatality rate of forty four percent. That's obviously 0:07:09.640 --> 0:07:14.160 very bad, and the WHO says the outbreak is actually intensifying. 0:07:14.240 --> 0:07:17.760 They've documented sustain chains of transmission across multiple parts of 0:07:17.800 --> 0:07:20.600 the Democratic Republic of Congo as well as in cross 0:07:20.600 --> 0:07:25.480 border movement. There were cases in Uganda, which has done 0:07:25.480 --> 0:07:28.160 a little bit better with containment than the DRC. There 0:07:28.160 --> 0:07:30.760 were a couple of cases that were treated in France 0:07:31.200 --> 0:07:35.960 didn't get acquired in France. One of the really concerning 0:07:36.080 --> 0:07:39.240 things I found was a recent study which showed that 0:07:39.400 --> 0:07:43.360 maternal mortality was increasing in the DRC, not directly because 0:07:43.400 --> 0:07:46.520 of a bola, but because pregnant women are avoiding hospitals 0:07:46.600 --> 0:07:49.880 when they're giving birth and so because of the risk 0:07:49.920 --> 0:07:52.760 of a bola, and so you see young mothers dying. 0:07:53.520 --> 0:07:57.520 You know, this is concerning on a humanitarian level, because 0:07:57.520 --> 0:08:02.480 it's a humanitarian crisis, and it's a place where the 0:08:02.920 --> 0:08:06.000 proper provisioning of some standard public health measures could do 0:08:06.040 --> 0:08:09.080 a lot of good. Is it concerning in terms of 0:08:09.440 --> 0:08:13.200 if you live in Connecticut or Rhode Island. No, You know, 0:08:13.400 --> 0:08:19.480 ebola is certainly transmissible by body fluids, but we haven't 0:08:19.480 --> 0:08:22.920 seen really sustained transmission out of the DRC, and there's 0:08:22.920 --> 0:08:25.760 a lot of monitoring and whatnot. So I'm not worried 0:08:25.760 --> 0:08:27.880 about that. There are some vaccines in the pipeline which 0:08:27.960 --> 0:08:30.760 might make a dent. But most important just to remind 0:08:30.800 --> 0:08:33.480 people like this is still happening, and happening more than 0:08:33.520 --> 0:08:35.840 it was before. Actually, even though you're not hearing about 0:08:35.880 --> 0:08:36.320 it too much. 0:08:36.760 --> 0:08:43.000 Absolutely, Okay, in better news, it seems like viagra might 0:08:43.080 --> 0:08:46.760 help prevent cancer in addition to being super super fun. 0:08:48.520 --> 0:08:52.559 So the result in at least in this article, is 0:08:52.559 --> 0:08:56.199 it mean taking viagara before their cancer diagnosis had an 0:08:56.280 --> 0:09:01.199 overall can't hire cancer survival. And I think there are 0:09:01.480 --> 0:09:04.720 some you know, like always in these articles, or some 0:09:04.760 --> 0:09:07.520 made up suggested mechanism which could or could I mean 0:09:07.679 --> 0:09:10.320 a little bit of a just so story. You know, 0:09:10.400 --> 0:09:12.760 this is not a randomized study. What do we think 0:09:12.840 --> 0:09:14.800 is driving the results here? 0:09:15.679 --> 0:09:17.199 This is one of those things where you have one 0:09:17.240 --> 0:09:20.679 paper this is uh. This came out in cancer, the 0:09:20.760 --> 0:09:26.199 journal Cancer Research, and they were looking actually most of 0:09:26.200 --> 0:09:28.480 the papers in cell culture and stuff looking at the 0:09:28.520 --> 0:09:33.720 effect of viagra and statins, so cholesterol luring medications on 0:09:33.760 --> 0:09:37.760 cancer cells. And you know what sometimes we'll do in 0:09:37.800 --> 0:09:41.360 science when we have a very sort of wet lab 0:09:41.640 --> 0:09:44.120 technical paper, like we did some cell work and blah 0:09:44.160 --> 0:09:46.160 blah blah, and you sort of are looking at the 0:09:46.200 --> 0:09:48.720 resulting like, Okay, this is interesting to us in our 0:09:48.720 --> 0:09:51.120 little field, but maybe it's not super compelling to the 0:09:51.200 --> 0:09:52.599 rest of the world. So what we're gonna do is 0:09:52.600 --> 0:09:55.959 we're going to tack on some kind of epidemiology study, 0:09:56.000 --> 0:09:58.439 and so they have all this kind of rather elegant 0:09:58.480 --> 0:10:01.120 work in cell culture looking at class straw synthesis, which 0:10:01.160 --> 0:10:03.120 if that's what you're interested in, please check it out. 0:10:03.720 --> 0:10:05.360 And then they're like, and by the way, we looked 0:10:05.360 --> 0:10:08.240 in this huge data set, and men who take viagra 0:10:08.520 --> 0:10:11.760 before they got cancer had a better overall survival. And 0:10:11.800 --> 0:10:15.000 that's that's literally it like, it's really a paper about 0:10:15.000 --> 0:10:18.760 cell culture. But of course that is what's generating dozens 0:10:18.800 --> 0:10:22.920 and dozens of news articles. Their proposed mechanism is that 0:10:23.400 --> 0:10:27.559 viagra has some effect of limiting cancer cells access to cholesterol, 0:10:27.600 --> 0:10:29.839 and cells need cholesterol to do a lot of work, 0:10:29.880 --> 0:10:32.040 and if they don't get the cholesterol, maybe they don't 0:10:32.080 --> 0:10:35.400 live as long. You're right, this is a adjust so story. 0:10:35.840 --> 0:10:38.400 There are plenty of reasons to think that men who 0:10:38.480 --> 0:10:41.880 have access to viagra might have better contact with the 0:10:41.920 --> 0:10:44.760 healthcare system, maybe even more health literacy, might be in 0:10:44.760 --> 0:10:47.840 different socioeconomic status, all sorts of things that might improve 0:10:47.880 --> 0:10:50.120 outcomes after a cancer diagnosis. 0:10:49.640 --> 0:10:50.959 Might have better social support. 0:10:51.080 --> 0:10:53.599 I mean, if maybe the case that their access to 0:10:53.679 --> 0:10:56.360 viagra is so they can use it to have sex 0:10:56.400 --> 0:10:59.840 with a partner and that having a partner to support 0:10:59.880 --> 0:11:02.360 you in a cancer diagnosis may improve your survival. 0:11:03.000 --> 0:11:07.240 Another excellent point, but just to underscore how headlines can 0:11:07.280 --> 0:11:11.360 be misleading. I actually read the article, you know, which 0:11:11.440 --> 0:11:15.560 is like I sometimes wonder if the science reporters actually 0:11:15.559 --> 0:11:20.439 look at it, and it actually only shows a significant 0:11:20.480 --> 0:11:24.520 effect among men taking statins. So they looked both at 0:11:24.559 --> 0:11:27.920 as I said, Statin's and viagrant, and the significant effect 0:11:27.960 --> 0:11:30.040 was in men who take statins prior to their cancer 0:11:30.080 --> 0:11:33.439 diagnosis live longer. And then they looked at men who 0:11:33.480 --> 0:11:38.160 take statins and viagra and saw a similar benefit, but 0:11:38.280 --> 0:11:39.720 like the statins were still there, and then when they 0:11:39.720 --> 0:11:43.840 looked at viagra alone, there was no significant benefit. So 0:11:44.320 --> 0:11:47.400 I'm like, all right, so it's the statins conclusion. 0:11:48.400 --> 0:11:49.480 Together something. 0:11:49.559 --> 0:11:53.440 Yeah, I don't know anyway, Viagra's a great and useful 0:11:53.480 --> 0:11:57.680 drug for many things. I'm not sure that it's it's 0:11:57.720 --> 0:11:59.920 carrying cancer though, Sorryfizer. 0:11:59.440 --> 0:12:05.280 Yeah, sorry, folks. Great cell work, poor rapidy theology. All right, 0:12:05.320 --> 0:12:07.600 that's it for the help news of the week. Now, 0:12:08.000 --> 0:12:09.520 what's the deal with gluten? 0:12:10.040 --> 0:12:13.240 All right, Emily, there's as soon as this episode was 0:12:13.280 --> 0:12:17.640 added to our list of upcoming episodes, I knew exactly 0:12:17.640 --> 0:12:21.880 what clip I wanted to play for you, so please 0:12:22.040 --> 0:12:24.800 listen to this. Look, man, if you stopped eating gluten, 0:12:24.880 --> 0:12:28.240 you'd feel way better all day. Whenever you feel that's 0:12:28.240 --> 0:12:31.120 because of gluten. That's not true. Who told you not 0:12:31.160 --> 0:12:33.240 to eat gluten? It's just true. You don't even know 0:12:33.280 --> 0:12:38.920 what gluten is. You have no ideal. Gluten's a vague term. 0:12:39.000 --> 0:12:41.240 It's it's it's something that's used to categorize things that 0:12:41.280 --> 0:12:44.880 are bad. You know, calories, that's a gluten fat. That's 0:12:44.920 --> 0:12:49.280 a gluten gluten me badge. Man, And I'm not needing it. HM, 0:12:53.120 --> 0:12:58.839 all right. That's seth Rogen and Jay Barroschel from Great movie. 0:12:58.880 --> 0:13:01.880 This is the end And for those of you, they're 0:13:01.960 --> 0:13:04.240 driving in a car in California and at the end 0:13:04.720 --> 0:13:06.640 they end up at a Carls Junior and are eating 0:13:06.720 --> 0:13:12.079 like delicious looking cheeseburgers, obviously with bread containing gluten. I 0:13:12.160 --> 0:13:15.280 just thought this was the most emblematic thing we could 0:13:15.320 --> 0:13:16.120 start the episode with. 0:13:16.480 --> 0:13:18.720 I love it, and I think I particularly love it 0:13:18.800 --> 0:13:23.840 because this is how many people talk about gluten as 0:13:24.000 --> 0:13:30.160 sort of this like nefarious, like, well, you're bloating diarrhea 0:13:30.400 --> 0:13:34.199 too much. Poop, not enough poop, not feeling good, tiredness. 0:13:34.240 --> 0:13:37.520 It must be gluten. It's I guess like gluten. It 0:13:37.600 --> 0:13:42.840 just means feeling badness. But gluten is actually a specific thing. 0:13:43.559 --> 0:13:47.520 Yeah, and so we need to talk about what is gluten, 0:13:47.960 --> 0:13:52.240 So let's start there. Gluten is a protein. In fact, 0:13:52.280 --> 0:13:57.640 it's two proteins, gleiodin and glutenin, and it's the primary 0:13:57.640 --> 0:14:01.559 protein in wheat. It's also fa in barley and rye. 0:14:01.840 --> 0:14:05.240 And it is the sticky stuff that polymerizes when you 0:14:05.240 --> 0:14:09.400 make dough that makes your dough all stretchy and amazing. 0:14:09.559 --> 0:14:11.319 You know, when you are rolling out pizza dough and 0:14:11.360 --> 0:14:15.960 it springs back, that's a gluten. When you are baking 0:14:16.000 --> 0:14:19.520 your bread and those air bubbles get trapped, the air 0:14:19.560 --> 0:14:21.800 bubbles or the carbon dioxide bubbles that the yeast are 0:14:21.800 --> 0:14:26.200 generating get trapped in the sticky bread dough, that's a gluten. 0:14:27.120 --> 0:14:32.000 There really is no other grains that have that, and 0:14:32.080 --> 0:14:36.920 because of that, it's really hard to make chewy, stretchy 0:14:37.000 --> 0:14:40.400 delicious does out of things like rice flour unless you 0:14:40.520 --> 0:14:42.960 put in an additive like wargum or xantheon gum or 0:14:43.000 --> 0:14:46.680 some other binder. But Gluten is a natural binder in wheat, 0:14:46.720 --> 0:14:49.680 and without it, life would be a little bit more sad. 0:14:50.320 --> 0:14:56.000 Yeah, and the higher stretchier like kind of more stretchy 0:14:56.200 --> 0:14:59.720 bread flour. When people say the high protein flower, it 0:14:59.760 --> 0:15:00.920 is because it has more gluten. 0:15:00.960 --> 0:15:02.800 That is the protein that we are discussing. 0:15:02.840 --> 0:15:04.480 Oh, that's right. And yeah, if you're if you're not 0:15:04.520 --> 0:15:07.720 baking your bread with bread flour, switch right away. It's 0:15:08.200 --> 0:15:09.440 it's more unctuous. 0:15:09.960 --> 0:15:14.040 Okay, cooking with Perry, that's our next episode. That's our 0:15:14.080 --> 0:15:14.720 new podcast. 0:15:15.080 --> 0:15:16.440 I make a lot of bread, I too. 0:15:16.920 --> 0:15:18.920 Perry makes up that's could you have a sour dough 0:15:18.920 --> 0:15:20.160 starter person? 0:15:20.280 --> 0:15:22.560 Okay, we're going to talk. Can we table sour dough? 0:15:22.680 --> 0:15:24.600 I have thoughts. I have many thoughts on side. We 0:15:24.640 --> 0:15:26.320 will get to sour dough folks. We'll get there. 0:15:26.400 --> 0:15:30.280 But some other things before that, let's say, before we 0:15:30.320 --> 0:15:33.080 get into this, some other things do have gluten in them, 0:15:33.360 --> 0:15:38.000 soy sauce, often salad dressings, malt, vinegar, so actually a 0:15:38.160 --> 0:15:41.840 lot of if you are a person who is gluten sensitive, 0:15:41.880 --> 0:15:44.600 there are many things that have gluten. Although bread and 0:15:45.160 --> 0:15:48.240 bread products are the primary, the primary ones. 0:15:49.040 --> 0:15:52.680 So when we are thinking about this episode, The setup. 0:15:52.320 --> 0:15:57.520 For me here is there is a real set of 0:15:57.600 --> 0:16:03.040 issues associated with how people process gluten. Like many food sensitivities, 0:16:03.240 --> 0:16:05.800 this is something that some people have a sensitivity to, 0:16:05.920 --> 0:16:09.400 and I want to start talking about that. But in 0:16:09.480 --> 0:16:14.400 the influencer wellness space, there is a much. 0:16:14.320 --> 0:16:17.440 Wider discussion about gluten sensitivity. 0:16:17.520 --> 0:16:21.040 And if you look at some numbers, you know, the 0:16:21.200 --> 0:16:26.040 Enhynes says there's like two percent of people who you 0:16:26.080 --> 0:16:28.960 know don't eat gluten at all, But in other surveys, 0:16:29.000 --> 0:16:30.920 like thirty percent of the people in the USA they 0:16:31.000 --> 0:16:34.560 limit their gluten intake, and about ten percent of people 0:16:34.560 --> 0:16:38.400 worldwide identify as gluten sensitive, but something like fifteen to 0:16:38.440 --> 0:16:41.080 thirty percent of those have symptoms that are triggered. So 0:16:41.360 --> 0:16:45.560 there's a disconnect here, I think between how people talk 0:16:45.640 --> 0:16:52.160 about gluten and the sort of scientific diseases that are 0:16:52.200 --> 0:16:54.400 actually gluten sensitive. And I think that's that's like the 0:16:54.440 --> 0:16:57.480 interesting thing to unpack is what is real? And then 0:16:58.240 --> 0:17:00.800 how much do you want to extend the existence of 0:17:00.840 --> 0:17:05.000 Celiac disease into everybody should stop eating so much bread? 0:17:06.119 --> 0:17:08.760 Right? An analogy might be, you know, there are people 0:17:08.760 --> 0:17:13.000 with peanut allergy. They truly could die if they get 0:17:13.040 --> 0:17:15.800 any peanut product. And then if we had people who 0:17:15.840 --> 0:17:18.000 are like, oh, I don't have a full blown penat allergy, 0:17:18.000 --> 0:17:20.919 but I'm peanuts sensitive. You know, peanuts make me feel bad. 0:17:21.640 --> 0:17:24.480 And we need to explore that aspect because that's actually 0:17:24.520 --> 0:17:27.359 what the vast majority of people who are avoiding gluten 0:17:27.400 --> 0:17:30.840 are avoiding gluten for. And we can start by, like 0:17:30.880 --> 0:17:34.720 we can kind of buzz through the easy diagnose not easy, 0:17:34.760 --> 0:17:38.679 but like the confirmed gluten diseases, and I think obviously 0:17:38.720 --> 0:17:40.080 we have to start with Celiac disease. 0:17:40.520 --> 0:17:44.800 Celiac disease broadly is a disease that in which people 0:17:45.000 --> 0:17:46.240 cannot tolerate gluten. 0:17:46.840 --> 0:17:47.960 Tell me how we know about it? 0:17:48.760 --> 0:17:51.800 Uh, fascinating. We've known about it for centuries. The oldest 0:17:51.960 --> 0:17:55.560 reference I found was three hundred a d. And what 0:17:56.359 --> 0:18:01.560 coeliac disease presents as is a chronic disease of the bowels. 0:18:01.680 --> 0:18:05.600 Celiac literally means belly in like ancient Greek or something, 0:18:05.640 --> 0:18:09.040 so Celiac disease just like belly disease. Not very descriptive, 0:18:09.640 --> 0:18:12.480 but it's not just that. You know, in kids, it 0:18:12.720 --> 0:18:17.760 typically presents as GI symptoms malnutrition, failure to thrive, like 0:18:17.800 --> 0:18:20.680 so growth limitation and stuff, And for a long time 0:18:20.720 --> 0:18:22.800 it was really thought to be a disease of children. 0:18:22.880 --> 0:18:25.240 We now recognize that Celiac disease can present in later 0:18:25.280 --> 0:18:29.439 life and it's actually quite easy to diagnose, but you 0:18:29.560 --> 0:18:31.959 have to think of it first. And Celiac is one 0:18:31.960 --> 0:18:35.159 of those great imitator diseases. So you know, yes, it 0:18:35.200 --> 0:18:40.520 gives you gi upset, diarrhea, you know, excessive gas and 0:18:40.560 --> 0:18:43.600 things like that, but so do a lot of things right. 0:18:44.119 --> 0:18:48.800 It can also cause joint pain. It has a very 0:18:48.880 --> 0:18:52.280 characteristic rash called dermatitis her petiformis sort of a sicular 0:18:52.840 --> 0:18:56.080 intensely itchy rash on the extensor service surfaces of the 0:18:56.640 --> 0:19:01.720 arms and legs and stuff. A lot of fatigue, anemia, osteoporosis, 0:19:01.760 --> 0:19:02.880 and so these are. 0:19:02.760 --> 0:19:05.000 Like, so, I mean this isn't there's an issue with 0:19:05.040 --> 0:19:08.159 a disease like this where these are such generic symptoms. 0:19:08.200 --> 0:19:09.840 People come in they say, I'm not feeling good. 0:19:09.840 --> 0:19:13.520 I've got floating in diarrhea, i have a weird rash, 0:19:13.760 --> 0:19:15.359 I've got some monemia totally. 0:19:15.359 --> 0:19:16.800 A lot of people are anemic, a lot of people 0:19:16.840 --> 0:19:17.320 are tired. 0:19:17.480 --> 0:19:20.960 Ra Yeah, yeah, so your doctor actually has to think 0:19:20.960 --> 0:19:22.600 about it. But the good news if you think about 0:19:22.600 --> 0:19:25.800 Celiac disease, it's a blood test. There's a screening blood 0:19:25.840 --> 0:19:29.960 test anti tissue transclutamina's antibody. It's ninety five percent sensitive 0:19:29.960 --> 0:19:32.399 and specific. That's not perfect. You do need a confirmatory 0:19:32.440 --> 0:19:36.120 biopsy test which is done by Endosco. People like broadly speaking, 0:19:36.680 --> 0:19:39.240 if you think about it, you test for it, and 0:19:39.720 --> 0:19:43.320 you're well on your way. Historically, it's really interesting that 0:19:43.680 --> 0:19:46.520 although the disease has been known about for two millennia, 0:19:47.000 --> 0:19:49.680 it was only in World War Two that they figured 0:19:49.680 --> 0:19:52.600 out what the cause was. So Celiac disease is a 0:19:52.760 --> 0:19:57.919 classic autoimmune disease that is due to a genetic susceptibility, 0:19:58.040 --> 0:20:02.919 so it's largely genetically mediated, but it has an environmental trigger. 0:20:03.520 --> 0:20:06.080 And for all this until World War Two, it wasn't 0:20:06.119 --> 0:20:09.479 clear what the environmental trigger actually was. And it was 0:20:09.720 --> 0:20:16.720 a Dutch pediatrician, William Carrol Dickey, who found that his 0:20:17.280 --> 0:20:20.800 patients his kids with this disease got better during the 0:20:20.920 --> 0:20:23.320 Dutch hunger winter of nineteen forty four to nineteen forty 0:20:23.359 --> 0:20:26.040 five when they ran out of bread and then the 0:20:26.119 --> 0:20:29.879 Allies air dropped bread into Holland, I guess, and the 0:20:29.960 --> 0:20:33.160 kids developed the symptoms again once they were eating bread again. 0:20:33.200 --> 0:20:35.639 So it was actually that long before we knew at 0:20:35.720 --> 0:20:37.639 least that it was a wheat product. I think it 0:20:37.680 --> 0:20:39.240 took a little longer to figure out exactly that it 0:20:39.280 --> 0:20:41.639 was the gluten and the wheat what the cause was. 0:20:42.080 --> 0:20:44.040 So the incidence of this has gone up over timeing 0:20:44.119 --> 0:20:45.960 this is quite interesting. So if you think of this 0:20:46.080 --> 0:20:49.119 as a as a genetic disease within an environmental interaction 0:20:50.160 --> 0:20:53.320 over the past, it's gone of a lot in the 0:20:53.320 --> 0:20:55.840 past few decades. Some of that's going to be diagnosis 0:20:55.920 --> 0:20:58.520 and awareness, but some of that is aligned with a 0:20:58.600 --> 0:21:03.159 general rise in autoimmune diseases. Almost certainly, this is not 0:21:03.240 --> 0:21:05.960 genetic drift. It's just not enough time for their debe 0:21:06.080 --> 0:21:09.679 genetic dript So there is something going on in the 0:21:09.840 --> 0:21:14.879 environment or the food that we are eating that means 0:21:14.880 --> 0:21:18.919 that more people are having this big moon that we're providing. 0:21:18.920 --> 0:21:21.800 The foods that we're providing are more likely to trigger 0:21:21.840 --> 0:21:22.439 this in people. 0:21:22.640 --> 0:21:26.200 Yeah, and we actually know that it's a true increase 0:21:26.280 --> 0:21:28.720 again because that blood test is pretty good to detect 0:21:28.720 --> 0:21:32.000 celiac disease. There's a study in the Journal Gastroentrology in 0:21:32.000 --> 0:21:35.919 two thousand and nine which looked at banked blood samples 0:21:36.200 --> 0:21:39.760 from Warren Air Force Base, where like the privates had 0:21:39.840 --> 0:21:42.159 gotten their blood sampled in nineteen forty eight and nineteen 0:21:42.200 --> 0:21:44.840 fifty four, and they went back to those old samples 0:21:44.880 --> 0:21:48.000 and tested them for this anti tissue tense glutaminy sandibody, 0:21:48.000 --> 0:21:51.360 this diagnostic test for Celiac disease, and some of them 0:21:51.400 --> 0:21:53.399 had it. You know, they probably weren't even diagnosed at 0:21:53.400 --> 0:21:55.320 that point in time, but they are based on their 0:21:55.320 --> 0:21:58.440 blood they had it, and that rate has increased over time, 0:21:58.480 --> 0:22:01.359 So we do know something's going on. And here's where 0:22:01.359 --> 0:22:02.119 we should talk about. 0:22:02.119 --> 0:22:06.399 Sourdough is never a bad time, is it? 0:22:06.440 --> 0:22:07.280 The lack of sery? 0:22:07.560 --> 0:22:09.200