What Happens in the Gut Does Not Stay in the Gut — FMU Blog for January 2014

 

“The gut is not like Las Vegas. What happens in the gut does not stay in the gut.”

The audience—about 1000 healthcare practitioners—erupted in laughter when Dr. Alessio Fasano made this statement last May at the Institute for Functional Medicine’s Annual International Conference. Social media devotees reached for their smart phones of course, and within minutes, the quip made its way from a crowded hotel ballroom in Dallas out into the blogosphere and beyond. What happened in Dallas didn’t stay in Dallas, and that’s a very good thing.

Alessio Fasano, MD, has traveled an intellectual journey farther than most. Born and educated in Italy, he came to the United States as a young physician in the 1980s on a temporary visa—to Baltimore, and the Center for Vaccine Studies, to be exact—to study bacterial pathogenesis, and more specifically, cholera. After two years, he returned to Italy to continue his work. But—as is often the case with adventure stories—a single phone call changed everything. In the early 1990s, knowing only basic English and little about the rules of medical practice in the US, Dr. Fasano was asked by the Chair of the Department of Pediatrics at the University of Maryland to make a permanent move and become the Division Chief of that well-respected institution. “And the rest is history,” he says, invoking a phrase familiar to everyone who loves a good story.

Today, Dr. Fasano is Director of the Center for Celiac Research and Chief of the Division of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital for Children in Boston. As his research interests in diarrheal diseases and pathology evolved, the scope of Dr. Fasano’s focus on intestinal health and disease expanded, and he is now considered to be one of the world’s leading experts on celiac disease and non-celiac gluten sensitivity. Dr. Fasano and his collaborators have published more than 200 scientific articles, and he is credited with identifying the protein zonulin, which plays a major role in intestinal permeability.

The intestinal flora—or the microbiome, as it is now commonly referred to—is a very important component in establishing the integrity of the mucosal barrier in the intestinal tract. It contributes to immune function and epithelial growth and differentiation, which is obviously a key factor in conditions such as celiac disease. When intestinal barrier function is lost, the intestines can’t keep out the “enemies,” the cell antigens that will trigger the immune system and lead to autoimmunity. The term “leaky gut” was coined many years ago to describe the concept of compromised intestinal mucosa. However, until only recently, to speak about leaky gut among traditionally trained medical practitioners could earn a person stern looks and dismissive gestures. But paradigms are shifting, and they are shifting because of the work of professionals like Dr. Fasano. He explains his philosophy in an interview we recorded for the January 2014 issue of Functional Medicine Update:

“Many colleagues say, ‘Now you are embracing the leaky gut theory that is bogus, it’s not true, and so on and so forth.’ Again, in all these examples, you can just express your opinion based on your honest, humble observation, because what a scientist does is not invent anything, or score anything; you just listen to nature, because the stuff is already written. Either you are a good listener or not. If you are a good listener, therefore rather than to try to force on nature your concept, you are just are there to serve what is already out there.”

When you are a truth-seeker—and I believe Dr. Fasano is, as are so many of the great scientists, both past and present—you have the unique ability to remain composed when confronted with criticism, and express your own perspective with balance and grace. Such has been the case with Dr. Fasano’s research into potential connections between intestinal health and autism, a line of study that has existed under a dark cloud of controversy since the work of Dr. Andrew Wakefield—a gastroenterologist whose data came into question, ultimately resulting in the retraction of his publications—in the late 1990s and early 2000s. Pointedly, I asked Dr. Fasano for his comments. Eloquently, he gave them:

“This was an unfortunate situation in which it doesn’t matter which part of the fence you are on. It created tremendous confusion in the field—distrust on the topic—and who ultimately paid the price have been the patients. We saw a deceleration of science that really put the entire field on hold. What are the facts? The fact that I don’t see anybody dispute is that there is an axis that puts in touch and cross talks gut with the brain. That’s pretty much a concept that everybody now accepts; there is a brain/gut axis. This applies not just to autism, but to schizophrenia, it applies to multiple sclerosis, and so on and so forth. The basic science to explain the mechanisms that are engaged in a situation in which you have an inflammation of the gut that eventually will affect the behavior of individuals, and now specifically there is concern about the autistic kids… I had the opportunity, in a very unbiased way, to take a look at the situation and I find it is fascinating. Everybody agrees that autism is a situation that you can develop via different links. In other words, metabolic disorders, genetic problems, you can have metal exposure, I believe that vaccination can be involved, definitely food intolerance, and so on and so forth. So everybody agrees there are different paths that can bring you to your final destination, yet everybody was looking for a single magic bullet that will fix them all. That, to me, is counterintuitive. There are different theories, not mutually exclusive, why people eventually develop autism through a GI-initiated process.”

blandfasanoLet’s return now to Dallas, last May. That crowded ballroom. That engaged audience. That tweet about Las Vegas that is no doubt still being shared throughout the living, breathing entity that is the Internet. Dr. Fasano was in Dallas that night to receive an award, one that is particularly meaningful to me: The Linus Pauling Functional Medicine Award. I was honored to be on stage to welcome Dr. Fasano into the small community of recipients to whom this award has been presented. It is an award for seekers, for innovators, for the fearlessly committed. It is an award made for a clinician and scientist like Dr. Alessio Fasano.

 

My interview with Dr. Alessio Fasano  is available through an all-access Functional Medicine Update subscription. He is the latest in a long line of clinicians and researchers I have had the good fortune to talk with. Learn more about subscribing to FMU here. All revenue from Functional Medicine Update is donated to support the Personalized Lifestyle Medicine Institute, a nonprofit organization.

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