Chris Kresser – Let's take back your health - Starting Now.
Blog by a health detective specializing in investigative medicine, blogger, podcaster, teacher and a Paleo diet and lifestyle enthusiast - Chris Kresser. He studied about Chinese and integrative medicine and has been studying, practicing, and teaching alternative medicine for more than fifteen years.
Green smoothies: Not necessarily a “health food”
In the health community, the green smoothie has become the poster child for healthy eating. If you are a green smoothie fan, your typical recipe probably looks something like this:
1 apple, peeled, cored, and chopped
8 ounces unsweetened almond milk
2 cups stemmed and chopped spinach or kale
1 cup broccoli
This green smoothie is full of veggies—spinach, kale, and broccoli—so it must be healthy, right? Well, not necessarily. While cruciferous vegetables and leafy greens certainly have health benefits, consuming large amounts of them in green smoothies may not be healthy in the long run, for several significant reasons.
Cruciferous vegetables, such as kale, broccoli, cauliflower, and cabbage, have been found to contain high levels of a toxic heavy metal, thallium.
Cruciferous vegetables contain goitrogens, which are naturally occurring plant chemicals that inhibit the uptake of iodine by the thyroid gland and reduce the production of thyroid hormone, thus lowering thyroid function.
Many leafy greens, such as spinach and collard greens, are high in oxalates. Oxalates are plant-based compounds that may promote kidney stone formation and inflammation when consumed in large amounts.
As you can see, it may be time to reconsider whether regularly drinking green smoothies is a wise choice for our health.
Cruciferous veggies and leafy greens undoubtedly have many health benefits, but consuming large amounts of them in green smoothies may not be healthy in the long run
Are there heavy metals in your kale?
The soil in which vegetables grow has a significant impact on their micronutrient content. However, just as beneficial minerals are transferred from soil into plants, so too are toxic metals. Unfortunately, research shows that the toxic heavy metal thallium, which occurs in soil as a byproduct of smelting and coal-burning, preferentially accumulates in cruciferous vegetables such as kale, broccoli, cauliflower, cabbage, brussels sprouts, and bok choy. (1) This means that people who eat a lot of cruciferous vegetables, as green smoothie aficionados are wont to do, may be exposing themselves to high levels of thallium. In fact, an astute molecular biologist and alternative health practitioner named Ernie Hubbard found this to be just the case among his health-conscious clients, who were experiencing many bizarre symptoms that did not fit any standard disease pattern. After much investigation, he was eventually able to trace their symptoms back to thallium toxicity resulting from their cruciferous vegetable-heavy green smoothie habits. (2)
Unfortunately, when it comes to thallium, even low-level exposures can cause symptoms such as nausea, diarrhea, stomach pain, hair loss, and peripheral neuropathy. (3) While some medical authorities have argued that toxic metals are present throughout our environment and that we shouldn’t worry about trace levels in otherwise-healthy vegetables, the problem remains that heavy metal exposures are additive and synergistic. Many heavy metals have similar adverse effects on the body, so continuous consumption of thallium in vegetables, plus daily exposure to other heavy metal sources, exponentially increases the body’s toxic burden. Based on this evidence, if you are regularly drinking green smoothies and experiencing any unusual health problems, it may be time to investigate your thallium level and reconsider your green smoothie habit. If you aren’t ready to get rid of your green smoothie just yet, at least consider using only organic cruciferous vegetables in your drink. Soils that are rich in carbon-based matter, such as soil on organic farms, have been found to impede the transfer of thallium into plants; this effect is less likely to occur in the carbon-depleted soils used on conventional farms. This means that organic produce may contain lower levels of heavy metals, such as thallium, compared to conventionally raised produce, potentially resulting in a healthier green smoothie. (4, 5, 6)
Green smoothies and the thyroid gland
Concerningly, green smoothies may also have adverse effects on the thyroid gland. The thyroid gland requires the mineral iodine to produce thyroid hormones. Cruciferous vegetables—common ingredients in green smoothies—contain compounds called glucosinolates, which inhibit iodine uptake by the thyroid. This may result in a reduced ability of the thyroid gland to produce hormones, leading to reduced thyroid function. (7) Furthermore, the risk of high cruciferous vegetable intake impairing thyroid function is greater in people with iodine deficiency. Iodine deficiency is not uncommon in folks on a Paleo or otherwise “healthy” diet, since the main dietary sources of iodine available are sea vegetables, iodized salt, dairy, and fortified foods, which are often excluded on a Paleo or unprocessed diet.
While large quantities of raw cruciferous vegetables pose a problem to the thyroid gland, cooked cruciferous vegetables appear to be much safer. Cooking cruciferous vegetables stimulates the production of an enzyme called myrosinase that helps to deactivate goitrogenic glucosinolates. (8)
Opting to eat cruciferous vegetables in their whole-food form is another way to reap the health benefits of these vegetables without getting a heavy hit of goitrogens; it is much harder to overeat vegetables when they are in their whole form versus juiced or blended in a green smoothie.
Oxalates in green smoothiesAnother significant problem with green smoothies is that they are often high in oxalate, a type of naturally occurring plant compound that promotes kidney stone formation and inflammation in certain people when eaten in excess. (9) Oxalate occurs in high amounts in spinach, chard, dandelion greens, beets, collard greens, berries, broccoli, cabbage, and carrots. In some people, oxalates accumulate in body tissues and provoke inflammation. In fact, oxalate accumulation has been associated with chronic pain, nephrolithiasis (aka kidney stones), neurological symptoms, vulvar pain, and fibromyalgia pain.
Currently, a high oxalate intake is defined as the consumption of 250 mg oxalate per day. For reference, one cup of raw spinach contains around 656 mg oxalate. (10) As you can see, it would be quite easy to overdo it on oxalates if you are regularly drinking green smoothies, which often contain a cup or more of spinach! Research has confirmed that green juices made using common vegetables contain high levels of soluble oxalates and that the consumption of these drinks may precipitate oxalate kidney stone formation. (11, 12) Some green smoothie proponents advocate “rotating” greens to include low-oxalate options such as mustard greens, watercress, and lettuce; this may help prevent green smoothie-induced oxalate overload.
Certain genetic variants, such as the SLC26A1 variant, and pre-existing gut issues, such as Crohn’s disease and dysbiosis, may increase an individual’s susceptibility to the harmful effects of dietary oxalates. For these individuals, reducing dietary oxalate intake may significantly relieve symptoms. (13, 14) Replenishing the gut with beneficial bacteria from probiotics and fermented foods may also assist in the degradation of oxalate, since several probiotic species, including Lactobacillus rhamnosus, Bifidobacterium animalis subsp. lactis BI07, and Oxalobacter formigenes, have been found to degrade dietary oxalate. (15, 16, 17)
Final thoughts on green smoothies
Unfortunately, green smoothies are not quite as healthy as we have been led to believe, due to their thallium, goitrogen, and oxalate content. Rather than relying on green smoothies as a primary source of vegetables, I recommend eating veggies in their whole-food form and cooking cruciferous vegetables to lower their goitrogen content. If you are not ready to forgo green smoothies entirely, choose organic vegetables, which may be lower in heavy metals; rotate your greens so that you are regularly including low-oxalate options such as mustard greens and watercress; and consider supplementing with oxalate-degrading probiotics such as Lactobacilli and Bifidobacteria.
Now I want to hear from you. Are you a fan of green smoothies? Have you noticed any adverse health effects as the result of your green smoothie habit? Let me know in the comments below.
Sleep is an absolute necessity for optimal health. I’ve written before about the risks of sleep deprivation in adults and why maximizing sleep quality is essential to achieving optimal health. However, children and adolescents are arguably even more at risk, since sleep is so crucial for proper growth and development.
In this article, I’ll discuss the health impacts of too little sleep, how much sleep kids and teens really need vs. how much sleep kids in the United States are actually getting, and my tips to help your kids get better-quality sleep.
The health costs of too little sleep
In children and adolescents, insufficient sleep is associated with increased risk for:
Obesity: a 2015 meta-analysis of longitudinal studies found that children and adolescents with shorter sleep duration had more than twice the risk of becoming overweight or obese (1).
Diabetes: sleep deprivation adversely impacts blood glucose regulation. A 2012 study found that short sleep duration is associated with increased insulin resistance in adolescents (2).
Hypertension: youth with short sleep duration have a 2.5-fold increased risk of having elevated blood pressure (3).
Depression: while the connection between depression and poor sleep may be a vicious cycle, with depression leading to sleeplessness, several studies suggest that poor-quality sleep itself is a risk factor for depression (4, 5).
Attention and behavior problems: more than a dozen studies have linked attention and behavior issues in children to poor sleep quality and short sleep duration (6, 7, 8, 9).
Poor academic performance: sleep is unequivocally related to academic performance. Sleep loss is frequently associated with poor learning capacity and neurocognitive performance (10), while earlier bedtimes and wake times are associated with better grades (11).
How much sleep do your kids really need? It might be more than you think!
In teens, short sleep duration is also associated with increased risky behaviors (12):
Abuse of drugs and alcohol: in a nationwide study of U.S. adolescents, getting seven or fewer hours of sleep was associated with increased use of drugs and alcohol (13).
Motor vehicle crashes: one study found that later school start times were associated with increased sleep and fewer car crashes among teens (14).
Suicide attempts: sleeping fewer than eight hours a night is associated with a threefold increased risk of suicidal attempts (15).
How much sleep do kids and teens really need?
To determine how much sleep children and teens need to promote optimal health and avoid all of these potential health issues, a panel of 13 experts at the American Academy of Sleep Medicine reviewed more than 864 articles in 2016 on sleep and health in children and adolescents. They came to a consensus that for every 24 hours, children ages six to 12 years old should sleep nine to 12 hours, and teens ages 13 to 18 years old should sleep eight to 10 hours (16). Therefore, fewer than nine hours in children or eight hours in teens is considered inadequate.
Too many kids getting inadequate shut-eye
Despite the fact that short sleep duration in kids has been a national health concern for a decade, the percentage of students who get sufficient sleep has substantially decreased since 2009. A recent analysis performed by the CDC attempted to determine the prevalence of short sleep duration (fewer than nine hours for middle schoolers and fewer than eight hours for high schoolers) on weekdays. They found that 73 percent of youth got inadequate hours of sleep (17). Here’s the full breakdown:
For middle schoolers:
6 percent got four hours or less
6 percent got five hours
11 percent got six hours
20 percent got seven hours
30 percent got eight hours
27 percent got nine hours or more (adequate sleep)
For high schoolers:
7 percent got four hours or less
13 percent got five hours
23 percent got six hours
30 percent got seven hours
27 percent got eight hours or more (adequate sleep)
Put another way, a whopping 23 percent of middle schoolers and 43 percent of high schoolers get six or fewer hours of sleep per night. And this doesn’t even tell us whether the little sleep they are getting is quality sleep. When we consider these data, is it really any wonder that we have epidemics of childhood obesity, diabetes, and ADHD?
How to support healthy sleep habits
Now that we know just how crucial sleep is, let’s talk about solutions. The conventional approach to sleep difficulties is all too often pharmaceutical intervention. A 2007 study found that 81 percent of visits to the pediatrician for sleep difficulties resulted in a prescription for a sleep medication (18), many of which are not even approved or tested for use in children.
In contrast, the functional approach seeks to determine the causes of poor sleep in the first place. While some kids may have more complex causes of underlying sleep abnormalities, in my experience, most sleep difficulties in children can be addressed by making a few simple lifestyle changes. Try these tips in your home to improve your kids’ sleep:
Get kids outside during the day: Like adults, kids need exposure to bright blue light during the day to help entrain their circadian rhythms. If they attend school during the day, make sure they are getting exposure to sunlight before or after school, or ideally at lunchtime, when the sun is highest.
Reduce bright light in your house in the evening: Even if you can’t convince your kids to wear the hip blue-blocking glasses, you can reduce the amount of blue light they are exposed to in the evening hours. Try lighting some red-bulb lamps or beeswax candles at night instead of harsh white lights.
Eat dinner earlier in the evening: Kids may find it difficult to fall asleep with a stomach full of food after a late dinner. Try to eat dinner earlier if possible to allow time to digest, and discourage large late-night snacks.
Set bedtimes for your kids: Parent-set bedtimes have been associated with improved sleep duration and better daytime functioning in teens (19). If your child isn’t sleepy, encourage him to at least get in bed and read or journal by red or orange light. Children thrive on routines, so having a pattern of low-key activities that repeat every night can help them relax and start to feel sleepy.
Make the bedroom a device-free sleep sanctuary: Make a house rule that there are no devices allowed in the bedroom at nighttime and set a “media curfew” elsewhere in the house (i.e., no devices after a certain time). Evening technology use is associated with poor-quality sleep and shorter sleep duration among youth (20). If teens must use devices to complete homework in the evenings, be sure that they have blue-blocking applications like F.lux set up on their computers and/or that they wear blue-blocking glasses. Make the bedroom a dark, cool, and quiet place.
Limit caffeine: The abuse of caffeine in teens is highly concerning. Children and adolescents are one of the fastest-growing populations of caffeine users, with an estimated 70 percent increase in the number of teens using caffeine in the past 30 years (21). There is no evidence for a benefit of caffeine in children and adolescents, and at least one animal study suggests that it could interfere with sleep and brain maturation (22).
Explain why: Helping kids to understand why healthy sleep practices are important and the association between sleep and their health can reduce their resistance to new practices. It also makes them more likely to continue these practices into adulthood, when they become independent.
Model good behavior: All of these principles for healthy sleep in kids also apply to adults. If you’re staying up until 12:30 a.m. on your iPad, your kids are much more likely to take after your bad habits. This is a great opportunity for you to check in with your own sleep habits, too!
As a parent, ensuring that your child gets adequate sleep is one of the most important things you can do to set them up for success and health in the future.
That’s all for now! Now I’d like to hear from you. Do your kids get enough sleep? Will you incorporate some of these tips? Share your thoughts in the comments below.
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RHR What the Heck Should We Eat With Mark Hyman - YouTube
Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week I’m very excited to welcome back Dr. Mark Hyman to the show. Dr. Hyman is a practicing family physician, a 10-time #1 New York Times best-selling author, and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He’s the Pritzker Foundation Chair in Functional Medicine at the Cleveland Clinic Lerner College of Medicine and the Director of the Cleveland Clinic Center for Functional Medicine. He’s also founder and director of the UltraWellness Center, chairman of the Institute for Functional Medicine, medical editor of HuffPost, and a regular medical contributor in the media for CBS This Morning, Good Morning America, CNN, The Dr. Oz Show, and more.
I met Mark personally a few years ago; of course, I’ve known about his work for many years. There is really no one else who has done as much to advance Functional Medicine as Dr. Hyman, and over the last couple of years I have gotten to know him personally and really enjoy his balanced, nuanced approach and everything he does as an advocate for Functional Medicine and nutrition in the field. So, I’m really excited to welcome Mark back to talk about his most recent book: Food: What the Heck Should I Eat? It's a great title, and I think a lot of people actually have that question at this point. We’re so overwhelmed with so much conflicting, contradictory information, and I think a lot of people have just thrown up their hands and really don’t know what to eat, so that's what we’re going to talk about in this episode. I hope you enjoy it as much as I did. Let's dive in.
Chris Kresser: Mark, it’s such a pleasure to have you back. Thanks for joining us again.
Mark Hyman: Of course. It’s always so great to talk to you, Chris.
Chris: Before we jump in and start talking about food, which is what we're going to be mostly talking about today, I just want to kind of get some updates from you. It's been a while since we've chatted, and especially with you, there’s never a dull moment. So what's been going on in your world and how are things going at Cleveland Clinic Center for Functional Medicine and what's new in your world?
Mark: So many things. I got married.
Chris: Congratulations again.
Mark: Thank you. I was super sick and had to use the magic of Functional Medicine to fix myself and learn new things and launch A Broken Brain documentary online, and it's a lot of stuff going on. We’re excited about my new book, Food: What the Heck Should I Eat? which is, I guess, what we're talking about today, and it's really been a labor of love, and it's one of my favorite books that I've written out of 14. I think this is my favorite because it just gives people what they need, and it's so difficult for people knowing how to sort through all the confusing, often conflicting, advice about what is healthy nutrition.
Wondering what the heck you should eat and why there are so many conflicting opinions? Dr. Mark Hyman shares his answers in his new book
Why are people so confused about what to eat?
Chris: Yes. Most people on the street now, I think, are feeling pretty overwhelmed at this point, and they don't really know who to trust or what to believe. For many years it was like eggs—I think there are some jokes about this, like “eggs are good, eggs are bad, eggs are good, eggs are bad,” back and forth, and I think with enough of that it's kind of, people do start to tune out and they don't really believe anything, and it is left to their own devices. So what's the deal? What's your take on why this has been so confusing and conflicted?
Mark: Well, it's a sort of a whole conspiracy of actions from a whole different set of sectors. It makes the consumer wonder what the heck they should eat and why there are so many conflicting opinions. One is science and nutrition are challenging because it's hard to study what people eat. In a typical research, you give someone a drug and another group you would not give the drug and you follow them along for a year and you see what happens and you control everything else. That's impossible with food unless you only feed them certain foods and another group you only feed other foods and you do that for 10, 20, or 30 years. Then you're going to get useful information, but no one’s going to do that. So you have to sort of try to understand what studies show and what they don't show. A study can prove cause and effect and one study can't—
Chris: And people are notoriously inaccurate when they report their food intake. That’s another problem.
Mark: There's also the bias. I mean, we'll talk about it, but meat is a great example. Meat was deemed to be bad because it contains saturated fat. Saturated fat was thought to be bad. Saturated fat in your diet was bad, so hence meat was bad, but there is no evidence that meat was bad. There were no studies showing it was bad. It was built by association based on some pretty bad studies, and so people are confused about it. During the time that the study showed that meat was bad, it was because the people who were eating meat didn't care about their health because everybody said meat was bad, so if you ate meat, you really weren't concerned about your health, and you ate more calories, you weighed more, you smoked more, you drank more, you didn’t eat any fruits and vegetables, you didn't exercise. The people who didn't eat meat in those studies exercised, ate healthy food, fruits and vegetables, didn't smoke, didn't drink too much, took their vitamins. They were healthy. It wasn't because they didn't eat meat that they were healthier. It was because they had all these other healthy habits, and I think the reason people who ate meat got sick was because they had all these unhealthy habits. So you have to look at the context of the study.
Nutrition research is notoriously bad and there’s money in the whole problem, which is science is funded by different vehicles, one is industry and one is the government, and there's philanthropy. Philanthropy hasn't done a whole lot in the field of nutrition research, although that's changing. The government funds only certain kinds of studies, which aren’t that helpful, and the food industry is funding studies that prove their products are healthy. If you look at the data, for example, on artificial sweeteners, almost 100 percent of the studies done by the food industry on their products find out they're safe, whereas almost 100 percent of studies done by independent researchers find that they're harmful. So you have to look at where the money is coming from, and then the third reason is the government is not producing guidelines that match the science.
If you look recently, the Congress mandated the National Academy of Sciences, which is the nation's highest independent science group, to look at how we come up with their dietary guidelines, and they published a massive report in November, I think, October 2017, where they outlined how corrupt the process was and how unduly influenced it was by industry and how the people and the Guidelines Committee worked for the Dairy Council and other industry trade groups, and there are huge amounts of data, for example, or unsaturated fat, which really has exonerated saturated fat, but still the government recommends to not eat saturated fat. So yes, it made some progress, it said we don't have to worry about fat anymore, yes it said we don’t have to worry about cholesterol or eggs anymore. But there's still a lot of corruption in the guidelines, which inform all of our policies and recommendations. Then of course there are the public health and professional associations like the American Heart Association, the Academy of Nutrition and Dietetics and their funding in large part comes from the pharma and the food industries. Forty percent of the Academy of Nutrition and Dietetics funding comes from junk food industry companies.
Chris: Yes. I'll never forget a registered dietitian that we work with told me what was served at those conferences. It was all vastly sugar. Basically, the entire table was sugar, and it was low-fat, so-called “healthy” because it's low fat, but it's all processed and refined sugar, basically.
Mark: Exactly. I mean I also read a big meeting in California of The Nutrition Society. There was a mandatory lunch, and the lunch was provided by McDonald's.
Chris: Oh my God. That's just crazy. So we’ve got these three problems—
Mark: And then there's one more, which is the media.
[Crosstalk]Mark: —headlines and does a disservice to the consumer by latching onto various means that actually are incorrect, like the recent coconut oil. You can see where the American Heart Association said that that coconut oil was bad, and by the way, there's not a single study that shows that. It was again built by association, which is it's got saturated fats, saturated fats are bad, so don’t eat it. And the USA Today headline “Coconut Oil Is Not Healthy, Never Was Healthy,” and so everybody just went into a tizzy and got so confused. I know you wrote about it. I certainly wrote about it. I mean, people are confused. I did a Facebook, like there were over a million views because people are just so desperate to know what to think. All these reasons lead to a confused eater.
Chris: Yes, and that's a big deal because food—one of the fundamental tenets of Functional Medicine is that food is medicine, and that's how it's different than conventional medicine, which is you go in, you have a chronic condition, generally you're going to walk out with a prescription for a drug, maybe some vague advice about eating healthier. But in Functional Medicine, of course, we approach it differently, so I imagine that was a big impetus behind you writing this book at this time too.
Food is medicine
Mark: Absolutely. Food is medicine, and I was so heartened to hear that one of my friends and colleagues and you know well, Dr. Dariush Mozaffarian, who is the dean of the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, recently was in Washington holding a hearing on food as medicine and how we need to influence policy, or this new understanding of the role of food and health and chronic disease, so I think that's moving forward. In the meantime, people are wondering, what the heck should I eat? And then of course there are other issues besides whether it's healthy or not. How is it affecting the environment? How is it affecting our soils, water, air, and climate change? And how do we treat animals? And all these issues are so confusing for people. So should you eat GMO or should you not? Does it matter if you eat organic or not? What about food additives? Are they very safe? Are they bad? What about processed foods? Are there any ones that you can eat? These are very confusing to people. So I've taken my 30 years of—well, actually probably, God it’s embarrassing to say now, 40 years of studying nutrition, oh my God, I'm old—
Mark: I started in Cornell in 1979 or ’78, and it’s almost 2019, holy cow. All right. Anyway, moving on, I've been studying nutrition that long, and the first book I read was Nutrition Against Disease, by Roger Williams, of how food can be used to actually heal chronic illness. In that time I really swung back and forth from being vegetarian and vegan to being low fat to being high fat to being Paleo, all the way in between, experimenting, and I've done that with my patients. I've probably read, like you, probably over 10,000 papers on nutrition and I've treated over 10,000 patients over 30 years, and I've seen the results of people doing different diets in real life looking at all their biochemistry and hormonal regulation, their metabolism, their other health conditions, and so this isn't just a theoretical book. This isn't just based on some scanning of literature and trying to put something into something that makes sense. This is a combination of my own experimentation, my work with patients, reviewing literature, studying nutrition for 40 years and coming up with just common sense, not extreme, in a way to eat that actually follows the guidelines of most of the sort of trends out there. In other words, you’ve got vegan, you’ve got Paleo, you got raw food, you got keto, you got high fat, low fat, high carb, low carb, it's pretty crazy for a consumer, what should they do. So I've taken all that and tried to synthesize it in really practical ways. It's not about individual nutrients, and you and I both write about those things. What about omega-6 fats? What about zinc?
But at the end of the day, people eat food. They eat meat, they eat vegetables, they eat chicken, really, and so in my book I go through each major food category, meat, poultry and eggs, dairy, nuts, seeds, beans, grains, vegetables, fruit, drinks, beverages, sweeteners, and come up with what do we know, what do we don't know, and combined with sort of common sense and evolutionary biology, which is what you call ancestral nutrition, what makes sense. So that's really where I sort of came up with this idea of the book is, how do we sift through all that and give people a guide? It's sort of like a user's guide to eating.Chris: Yes, absolutely. It's so needed and it's something that shouldn't be that complicated, but as you've pointed out, has gotten really complicated. It has, I think, also taken people away from their own intuitive sense of what's right for them, which is a whole other topic. But I want to talk a little bit more about meat because that's obviously, if we were to think of one thing that maybe causes more conflict and sometimes even violent conflicts from people who think we should eat it versus we shouldn't eat it. I know this is an area where you've now changed, as you said, you've shifted. Both of us have been vegan in the past. I was a macrobiotic vegan at one point and then a vegetarian, and both of us now eat meat. What led you to make that transition yourself, and then what should we be looking at from your perspective now in terms of meat consumption?
Transitioning from vegetarian to meat-eater
Mark: It is the big rallying point for controversy, and I want live to be 120. I have a young wife, maybe 140 if I can get there, and I don't want to do anything that's going to jeopardize that. Just a human being, I want to know, and a scientist and doctor, I have the ability to figure that out, and I lock myself in a room with a stack of the best papers on meat and research on meat that were about three feet high for a week in a hotel room so I wouldn’t be distracted, and I just read it all. Then I synthesized it and I realized there are really three main issues around meat.
One is moral, and I have patients who are Buddhist monks, and if they don't want to eat animals, that's okay. We can work around that part. Then there's more around how we treat our animals, and that's a fair concern around how we humanely can raise animals, and I want to talk about that. Then there's the environmental issue, which is very real, and our CAFO system of agriculture, confined feeding operations, these are factory farms using a lot of industrial inputs from oil through fossil fuels, through fertilizers, pesticides, herbicides to grow the food; enormous amounts of water through irrigation that depletes our aquifers; the runoff from the fertilizers damages the waterways, it causes dead zones and kills all the marine life; to the effect of climate change from the methane in the way we produce and grow food; and the depletion of our soils, which leads to the inability of the soils to sequester carbon; to our depletion of our aquifers from irrigation for the water, which leads to droughts, which is why we have this whole problem. So those are all real issues, and yet it's not about meat or no meat, it’s how we raise the meat.
There’s a movement of regenerative agriculture, which is fascinating, which is using animals to help build soil, which then sequesters carbon, retains water, and raises animals that have much higher-quality meat and don't contribute to climate change and actually help reverse climate change. They're humanely raised and actually are a part of the natural agricultural cycle. Even organic agriculture, feeding a ton of plants that are grown with conventional tilling, organic agriculture, you're doing a little bit better avoiding pesticides, but you're not actually helping the soil, and you're contributing to climate change, and by the way, most plants are not vegetarians. Most plants are carnivores because organic food is fertilized with bone meal and where else would that come from?
“It’s not the cow, it’s the how” and studies that don’t prove cause and effect
Chris: And a lot of animals are killed in that style of agriculture too. They are smaller animals, but then you start getting into the question of, is the life a rodent any worth less than a life of an herbivore? There’s a film that I'm supporting, a friend and colleague of mine is making, called Kale vs. Cow: The Case for Better Meat. She sent me a t-shirt that I love with the tagline, “It's not the cow, it's the how.”
Mark: That’s right, that’s right. That’s exactly what I'm talking about.
Chris: That sums it up. It’s not the cow, it’s the how,Mark: There’s a book coming out, it just came out, called Kiss the Ground, and a movie, a documentary, coming out as well, which talks about this whole movement of regenerative agriculture. So the whole issue of environmental issues can be addressed. We have 60 million bison that were in this continent that we're raising and they built literally tens of feet of topsoil over a millennia, who knows how long they were here, and we have 60 million. It’s not the fact that we have so many cows, it's how they were raised and what they do. The bison actually were contributing to climate change because of the way that they were roaming and grazing and restoring soils. So that's a whole issue, so I think environmental issues are right. I don’t think anybody should eat CAFO meat, both for their health and for the environment.
So then the third issue other than moral, environmental, is health. And then the question becomes what does the data show about the effect of meat on our health? And when I began to look at that, it was all over the place. There were large studies that showed it was harmful, studies have shown it’s helpful. If we look at the studies that showed the population studies, these are what we call observation or population studies. They don't prove cause and effect, what they do is they give people a food questionnaire every year and they ask them what they ate and see who died from what, and then they correlate these things, but correlation isn’t causation. I wake up every morning and the sun comes up. I had nothing to do with the sun coming up, right?
Chris: Don’t be modest.
Mark: I could do a study of women over 55 who have sex and I would conclude 100 percent of the time that sex never leads to pregnancy. It's wrong but it's right as far as the study goes, so I think we have to understand that. Now when you look at the data that, you find that, gosh, the meat eaters in those studies, which were done in a time when meat was evil, didn't give a crap about their health. Like I said, they ate more calories per day, they smoked more, they drank more, they didn’t exercise, they didn’t eat fruits and vegetables, so their results are confounded and the people who didn't eat meat were trying to be healthy. It wasn't that the meat was the problem, and of course they're eating CAFO meat. And then there are studies that look at vegetarians and meat eaters who shop at health food stores who would presumably have a healthy diet, so eating meat in the context of a healthy diet is a very good thing. For example, today I had a big salad with arugula, pumpkin seeds, avocados, fennel, and cherry tomatoes, and I had a few slices of grass-fed beef with it. That's what I call a “Pegan” diet, which is kind of a joke between Paleo and vegan, but it's essentially eating meat in the context of an otherwise healthy diet. The risk was reduced at half for both of those groups. And then you look at interventional studies, which is a more reliable type of study, where you actually give people, let’s say, a Paleo diet. I just saw an article published today about women who eat Paleo who are overweight have much more weight reduction and health benefits than those who don't, and so you have to look at the..
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RHR: How to Make Paleo Cooking Fun, Easy and Filled with Umami—with Michelle Tam - YouTube
Chris: Michelle, it's so fantastic to have you here. I cannot believe I've never had you on the show yet. What's up with that?
Michelle: I don't know, I feel like I've been on your show because I listen to it all the time.
Chris: I feel like you've been on it too. I'm really excited about this. It's going to be a nice break from all the sciencey, medicine stuff I'm usually talking about.
Michelle: That's probably why you don't have me on [laughter] because I don't deal with the sciencey, medicine stuff.
Chris: You retired from that a while ago.
Michelle: I did. I pretended it didn't exist. [chuckle]
Chris: Yeah. Well, you know what? I think it's interesting because these days, especially as we get ready to launch the Health Coach Training Program a little bit later this year, I'm just really tuned in to how important ... I mean, I've always been tuned in to this, but I'm even more focused now on the importance of not just food from the perspective of "Why ... What we should eat?" but actually how to do it. Because it's one thing to tell people what to eat, and it's another thing to actually make it possible, to give them that support. And I think you've always focused on that so much in your work and your first book and now your new book, Ready or Not! 150+ Make-Ahead, Make-Over, and Make-Now Recipes by Nom Nom Paleo, is really all about that, isn't it? Just giving people ... making it more accessible for people.
Michelle’s new book: Ready or Not! 150+ Make-Ahead, Make-Over, and Make-Now Recipes by Nom Nom Paleo
Michelle: Definitely. I think I leave all of the science heavy lifting to you and a bunch of other people who are way smarter and way geekier and love to dive in to all of the journal articles, whereas I just focus on the food. Because number one, I'm, like, I've been a foodie my whole life, but I didn't really start cooking until I went Paleo. And I only started cooking because I realized I couldn't really eat out or get delivery if I was eating Paleo. And because I'm so picky, I was like, "Shoot, I gotta get good at this." And how ... what do I do till I get better at cooking?” And I think everybody ... I think cooking is a practice, and it's something that you have to work on every day and you get better with practice, but I think people forget that. And so, with our blog and our book and our app, we really try to make it as simple and easy as possible. We have a picture for every single step, we have cartoons, we have funny jokes in there so it's just not intimidating.
Chris: Right. Yeah. And I so appreciate that about your work. Kids love your books. They love to flip through 'em and it makes it really fun and accessible, like I said.
Michelle: Yeah, that was the secret mission of our books, is to get kids excited about cooking. People are like, "When are you gonna make a kids’ book?" I'm like, "Well, these secretly are kind of kids’ books." Because we kind of ... and especially with our new book, we tried to make it even more of a comic book format. But it's really funny because I got an email this morning from someone who was like, "I'm a long-time reader, and I noticed you had a poop emoji in your book, and I was not super happy about that." I'm like, "I'm sorry, but I actually ... we did that on purpose because our kids, our two sons, love it, and every kid who has seen that page just thinks it's the funniest and most taboo thing. And we're gonna keep that."
Chris: Well, yeah, there's the book Everybody Poops, which is a must-have on every kid's bookshelf, right?
Michelle: Totally. It's the best. It's the best book.
Chris: You gotta just get over that, whoever wrote that, with all due respect.
Michelle: Right. No, I understand where she's coming from, I think she's like, "To be respectable." I'm like, "No. I'm not looking for respect."
Chris: You gave that up with the whole pharmacy thing, huh?
Chris: But of course, now ... I want to talk, actually, a little bit more about kids, but let's leave that for a second because I think kids and Paleo is something you also have to focus on. You have two kids yourself, and unlike me, when Sylvie was ... our daughter was born, she was born into Paleo. So, we didn't have the difficulty ...
Michelle: You were lucky and smart.
Chris: Lucky is pretty much what it comes down to. [chuckle] And so we didn't have to go through that whole transition thing. So I wanna come back to that because I know that's really challenging for parents and that you have some ... you have an interesting experience because I think for one of your kids it was easier than the other, so I'd love to chat about that. But first, let's just maybe talk a little bit about some of the most important things you've discovered in your work: helping people to learn to cook for themselves and cook healthy and nutrient-dense Paleo type of food. Because you've been doing this for a while now, as you said, a couple different books and an app, and you're out and about talking to people a lot. What are some of the biggest factors that you've determined make a difference for people when they're taking this on? Especially if they're coming from a background, like many Americans now, where they just ... they don't even know how to cook an egg. They've never cooked, and it's terrifying for them to step into the kitchen and try to do this.
Tips and tricks to encourage people to start cooking
Michelle: Totally, and it's so funny because people say, like ... food television is the most popular it's ever been, but people actually cooking, it's probably at the lowest it's ever been.Chris: That's so interesting.
Michelle: Yeah. So I think ...
Chris: It's like a voyeuristic thing, huh?
Michelle: Right. And I think people love food, and it brings back all these memories, but actually doing it is a totally different thing. I totally understand because I love food porn, and watching all these awesome food documentaries and stuff, and I love going out to eat. And so I think for most people it has to be really visual and really easy, and I think the recipes have to be super well-tested, so that all of their time and energy and money that has gone into cooking actually results in something delicious, at least delicious enough so that they'll do it again. Because I know myself. I will buy ... I mean, I have tons and tons of cookbooks, and I will pick a recipe and I'll buy all these expensive ingredients, and it'll take forever and then the end result won't be delicious, and I'm like, "Forget it, I'm never gonna cook again," like that was such a waste of all of my resources.
Chris: We're the same way. It's a bummer to spend all that time and energy for it to not come out well. I'm likely to just not go back to that. And sometimes even to that cookbook author. I like to give people a chance, but I totally know what you mean.
Michelle: And so I think that's what we have always tried to do. Henry, my husband, is ... he's the guy behind all of the visuals and the cartoons and the photos and the layout. My whole concentration is I want it to taste really, really good. And to make it really, almost foolproof for people to get through the recipe. And I think having a blog and having instant feedback really forces me to do that. I think that's just what we've done, I think as we've kind of been ... We just did our second cookbook, but with the second cookbook we were really ... we really did want to make sure that every single step had a picture and that it's fun and it's not crazy and intimidating, and it doesn't have to be perfect, and I tell people you should totally use shortcuts when you can, and I try to tell people which ingredients have umami because that'll naturally make your food taste better, and it's as simple as ...
Chris: Well, let's just stop right there because I think there are probably a few people listening to this who don't ... who've never heard that word or who've maybe heard it and don't know what that means.
What is umami?
Michelle: Umami is the fifth taste besides sweet, salty, bitter, and did I already …? I think I did all four.
Michelle: Sour. Yes! [chuckle] So it's that other taste. That indescribable deliciousness or savoriness ...Chris: Savory ...
Michelle: Sometimes it's called meatiness. But it's basically, what ... it's the ingredients that make your food taste delicious. Tomato paste has a ton of umami, bacon has tons of umami, most meats have lots of umami ...
Michelle: Yes. Dried mushrooms especially have a lot of umami, fish sauce. And so these are things that I stock in my kitchen because you just add a little bit and it will just make everything taste better. They have this institute in Japan where they study umami, and they've discovered that if you combine ingredients with the umami, it exponentially increases the deliciousness. I use that to my advantage. In most of my recipes there is always fish sauce, and I'll throw in some tomato paste or something extra, just because it adds so much flavor. And I think if people just knew these shortcuts, things ... And as they practice more, and they feel more comfortable cooking, that they'll just kind of ... it'll become second nature. It's not like I love cooking, people will assume I love cooking and people reach out to me and are like, "Hey, would you like to do this, like, pop-up?" and I'm like, "No." [chuckle]
Chris: Absolutely not.
Michelle: No, I love to eat and if you wanna do a pop-up I will show up.
Michelle: But I cook to kind of feed my family, but it's not like this passion, [chuckle] it's out of necessity.
Chris: Yeah. And if you're going to do it, you do it well. I mean, that's the thing, it's like, you love to eat, as you said before, so that's why you needed to learn to cook, because no one was cooking the food that you then understood that you needed to eat, and that's a really good reason to learn to cook, is just to be able to nourish yourself and feed your family and do it in a way that's enjoyable. I love that about your book because I think you hit on a really important point which is, I think about it in a similar way to like, if someone's trying to lose weight, we know that if you rely on willpower alone, it's not going to be very successful. What you really have to do is change your environment. For example, you shouldn't have a bunch of junk food in the house because at the end of the day when you're tired and you've been at work all day and been making a lot of decisions and you have ... you're experiencing what we call decision fatigue, and you get home and there is a big bag of potato chips there or a pint of ice cream in the freezer, [chuckle] chances are you're gonna eat it.
Michelle: Yeah. I've been in that position.
Setting up your cooking environment for success
Chris: We all have. I think with cooking it's like what you just said is so true, it's a lot about setting up your environment for success. If you have the umami flavorings nearby, and you have some of the right kitchen tools that make things easier, which I want to come back to, and you have the right ingredients on hand, you can put something together in a relatively short period of time with not very much effort and it will still taste good. But if you haven't done that preparation and you haven't created that environment, then it's going to be hard.
Michelle: Yeah. I think that's also something we try to address in our new book. It is called "Ready or Not!" because we wanted it so that no matter what state of readiness you're in, you should be able to find something that you can cook. Obviously, the best position would be where you're kind of ready, where you've set aside a day where you've made a bunch of sauces or you've made some proteins that you can remake in a bunch of different ways throughout the week. But there are tons of days when you're not ready and so we have a whole section in our book where everything can be made in about, I would say, 30 minutes, but realistically, it's probably 45 minutes from start to finish, without any pre-made ingredients. Just so there are no excuses. We try to say our cookbook is the no-excuse cookbook because even if you don't know how to cook, there are step-by-step pictures for every single recipe. If you have no time, we have recipes for that. If you are a meal planner, we have meal plans for you. So there is ... [laughter] there should be no excuse.
Chris: Yeah. Yeah, and I love ... I'm looking at the section now, which is ... it's basically a recipe for your kitchen, like what do you need to have in there, plants, animals, healthy fats, fermented stuff, flavor boosters, a lot of which are the umami ingredients that we talked about before, and then some of the tools that make things a lot easier. We have talked a little bit about the Instant Pot, which I think has now just blown up beyond ... I think it just went nuts, in large part because of you. Have they hired you as an ambassador, given you some equity in their company, or what?
Pressure cookers and other essential kitchen tools
Michelle: No. People think that I'm their spokesperson. No. They've sent me Instant Pots before, and then I'll reach out to them and say, "Hey, I'm doing this giveaway. Can you send one to these people because I don't wanna send stuff myself." [chuckle] But I think I just get really excited about things, and then I want to tell people about it, and that's what happened with the Instant Pot. I had a traditional stove top. People think the Instant Pot is some magical thing, but really it is just an electric pressure cooker. It does other things, but I only use it as an electric pressure cooker, and that's all I recommend people use it as because I think you can ... There are better slow cookers out there, but if you can slow-cook something, you might as well do it under pressure because it's faster and it'll taste better. I used to have a stove-top pressure cooker, and I was telling my sister who's an actual chef, I was like, "This is amazing. You can make oxtails and all these cheaper braising cuts faster and tastier." But it's a pain because I have to babysit it on the stove. She's like, "Oh, you should get an electric pressure cooker." I'm like, "What?"
Michelle: And so, she told me about hers and she actually didn't have an Instant Pot. She had another brand and I'm someone that really likes to do my research on the best-rated for the best price, because I was raised by thrifty Chinese immigrants. So I went to a site that I really like because I was pressure cooking, called . She had ... I think she's always reviewing different pressure cookers, and she reviewed the Instant Pot. I was like, "Wow, this looks pretty cool." And I looked on Amazon and the reviews were good. It had a stainless steel insert, which was something that was different from other electric pressure cookers. I'm like, "This sounds pretty cool. It's well-rated. The price is right." And so, I bought one and then I was like, "Wow, this is amazing. But the interface is terrible." So I think I had to show people how to use this thing. But I just thought it was such a life-changing device. I also used to love sous vide, and I know you were one of the original sous-viders too.
Chris: I was until I blew that for everybody with the ... [chuckle]
Michelle: No, I know, with your “plastic might not be so good.” I'm like, "Oh, shoot." [laughter] I don't think I can use this as much as I would like to. So then the Instant Pot, because I think everyone loves slow cookers and the whole idea that you can throw stuff in, set it, and forget it. And with an electric pressure cooker, you can do the same thing but it cooks faster and even if you're not around, it'll keep it warm but it doesn't overcook it like a slow cooker does.
Chris: Yeah. That's the big difference. I've used slow cookers for years. When I first heard about the Instant Pot, I think, from you and also Stephan Guyenet was an early adopter. I was like, "Big deal. It's a pressure cooker." [chuckle] And then, when I got it, I mean we use that thing every day and it's ... for everything from cooking vegetables like kale, it makes it really tender.
Michelle: Yes, and fast.
Chris: Fast, yeah. You just set it and forget it too. Like carnitas. I saw you just published an Instant Pot Carnitas recipe and so, we've done that as well. It's just one of those game-changing devices.
Michelle: Like soup, we have soup all the time just because it's so fast. I can dump in a bunch of vegetables. I can have something cooking while we're sleeping, when I run out. I think it's just great. [chuckle]
Chris: Absolutely. And that makes a huge difference. That's the difference between you having a hot finished meal when you get home and not. [chuckle] And then calling for take-out that you probably don't really wanna eat or shouldn't eat because there's nothing ready.
Michelle: And you can save money. People are always like, "Oh, it's so expensive to be Paleo." But now, you can buy the cheaper, braising cuts and they will turn out amazing.Chris: So delicious. They're more flavorful in many cases than the lean cuts, of course.
Michelle: Right. And then, there's all that collagen, so you don't have to buy all that powder.
Chris: Win, win, win, win, for sure. So what other kitchen essentials would you put high on the list, like if you were on a desert island, what would you take ... What would you take with you along with your Instant Pot?
Michelle: So the Instant Pot could do many things. [chuckle] Obviously, I like my cast iron skillet. So I actually tried with this new book to not put any crazy stuff, because there's tons of amazing stuff that's coming out all the time, but I think rimmed baking sheets, I love, just because you can roast vegetables and you can roast meats. But I think the game changer to combine with the rimmed baking sheet is to have a stainless steel wire rack, because it will elevate stuff, it doesn't get soggy. Even if you don't have a convection oven that has a fan that circulates all of the hot air, by just elevating the food, I think it makes it taste better. And it's funny, they didn't have stainless steel wire racks until pretty recently because I think I first found one only at a specialty store. I'm like, "This is amazing, now I can scrub them and throw them in the dishwasher, and it won't flake off like the chrome or nonstick ones." But now you can totally find stainless steel [chuckle] for your racks everywhere, which is amazing.
Chris: We have a bunch of those too. I think you do this as well, but it's a great way to cook bacon.
Chris: The roast ... So the bacon's not just getting super soggy in the bacon grease, it actually falls down under the rack, and then I know you have the recipe for Mok Mok Wings where you use that, where you use the racks and the dish, so that's super. We use those a lot too and I agree that that's really ... That's gotta be really high on the list. So we got the Instant Pot, we've got the rimmed baking sheets and the racks.
Michelle: I think a good knife.
Chris: Good knife has gotta be up there.
Michelle: And then people always say, "Which knife?" I'm like, "That's one where you need to go and go to a store and pick one up." Because one might be really well-rated, but people's..
I’ve written enough articles on thyroid health to fill an entire e-book: all about low T3 syndrome, five thyroid patterns that won’t show up on standard lab tests, the little-known cause of hypothyroidism, and the gut–thyroid connection.
Thyroid hormone regulates a great deal of metabolism, and virtually every cell in the body has a receptor for thyroid hormone. In a recent podcast, I mentioned poor thyroid function as one of the six underlying causes of high cholesterol. In this article, I’ll discuss exactly how your thyroid impacts lipid metabolism, cholesterol levels, and other risk factors for cardiovascular disease. First, though, a quick review of the major hormones involved.
A quick review of thyroid physiology and lab panels
The thyroid is a small butterfly-shaped gland that sits at the front of the neck. It receives a hormone signal from the pituitary and secretes other hormones into the bloodstream. You might be familiar with these hormones, which are included in a full thyroid panel:
Thyroid-stimulating hormone (TSH): This hormone is released by the pituitary gland and reflects the body’s need for thyroid hormone. This means that when TSH is high, not enough thyroid hormone is being produced (hypothyroidism). When TSH is low, there is more than enough thyroid hormone in the body (hyperthyroidism).
Do you have heart disease or high cholesterol? You might want to get your thyroid checked
Thyroxine (T4): The thyroid gland releases large amounts of this largely inactive form of thyroid hormone, which must be converted into the more active T3 by deiodinase enzymes. Low amounts of T4 may indicate hypothyroidism; high amounts may indicate hyperthyroidism.
Triiodothyronine (T3): This is the active form of thyroid hormone, secreted in small amounts by the thyroid gland and formed from the conversion of T4 to T3. T3 is the primary thyroid hormone that will act on cells all over the body to regulate metabolism. Low amounts of T3 may indicate hypothyroidism or low T3 syndrome; high amounts indicate hyperthyroidism.
If thyroid medication is given for hypothyroidism, it is usually in the form of T4, T3, or a combination of the two.
The association between thyroid hormone levels and cholesterol
The association between thyroid function and cholesterol has been known for quite some time. As early as 1934, it was recognized that “the concentration of blood cholesterol is usually raised in hypothyroidism, and lowered slightly in hyperthyroidism” (1). Today, a PubMed search for thyroid and cholesterol yields more than 3,000 articles—yet few people, and even few doctors, are aware of how various thyroid conditions can impact cholesterol levels.
Let’s review the four major types and how they impact basic cholesterol measurements:
Hypothyroidism: People with an underactive thyroid, or hypothyroidism, often have increased levels of total cholesterol and LDL cholesterol (2) and may have elevated triglyceride levels as well (3). Thyroid medication can significantly improve lipid profiles. A study in newly diagnosed hypothyroid patients found that total cholesterol and LDL cholesterol levels decreased after T4 treatment. Those with higher TSH levels (indicating a greater need for thyroid hormone and a greater degree of hypothyroidism) at baseline saw a more dramatic reduction in cholesterol levels with T4 therapy (4).
Subclinical hypothyroidism: Subclinical hypothyroidism (SH) is characterized by elevated serum TSH with normal levels of free T4 and free T3. SH is far more common than overt hypothyroidism and may affect up to 9 percent of the population (5). Studies are mixed on the effect of SH on lipid profiles, but even within the normal range of values, increasing TSH is associated with an increase in total cholesterol and LDL cholesterol (6, 7). One systematic review found that T4 substitution therapy on average resulted in an eight mg/dL decrease in total cholesterol and a 10 mg/dL decrease in LDL cholesterol in people with SH (8).
Thyroid autoimmunity: Autoimmunity is a major cause of hypothyroidism. An estimated 90 percent of people with underactive thyroid have autoimmune thyroiditis, also known as Hashimoto’s disease. People with high-normal TSH levels that have positive anti-thyroid antibodies are even more likely to have abnormal cholesterol levels. On the bright side, their cholesterol levels are more likely to respond to thyroid medication (9).
Hyperthyroidism: While not as common, hyperthyroidism is associated with low levels of total cholesterol, HDL cholesterol, and LDL cholesterol (10, 11). While this may seem like a good thing, low blood cholesterol has been associated with altered cell membrane function, depression, anxiety, memory loss, and increased mortality (12, 13, 14).
How the thyroid regulates lipid metabolism
Fair warning, this section contains the nitty gritty details of lipid metabolism. If you’re not in the mood for a physiology lesson, you can skip on to the next section!
Thyroid hormones regulate cholesterol synthesis
You may have heard that dietary cholesterol doesn’t have much impact on blood levels of cholesterol. This is because cholesterol is also synthesized by the liver. This process is tightly regulated by several hormones, including thyroid hormones. TSH increases the expression and activity of an enzyme called HMG CoA reductase, which controls the rate of cholesterol synthesis (15). This means that hypothyroidism increases the amount of cholesterol produced in the liver. This cholesterol is then packaged with triglycerides into VLDL particles, which are shipped out to the bloodstream.
Thyroid hormones affect lipoprotein lipase (LPL)
VLDL particles travel through the bloodstream until they reach the small blood vessel beds, where they encounter an enzyme called lipoprotein lipase (LPL). This enzyme breaks down the triglycerides in the VLDL particle into fatty acids, which are taken up by adipose, heart, and muscle cells. T3 stimulates LPL to increase this breakdown of triglyceride-rich VLDL (16). Eventually, the cholesterol content of the lipoprotein becomes higher than the triglyceride content, and these particles become LDL.
Thyroid hormones increase LDL particle uptake
LDL particles circulate around in the blood until they bind to LDL receptors. This binding triggers the capturing of LDL particles into the cell. There, the LDL particles are degraded and the contents used for cell membrane structure or converted to other steroid hormones. Through several mechanisms, T3 increases the expression of LDL receptors (17, 18). This reduces the amount of time that LDL particles spend circulating in the blood and the total number of LDL particles in the blood.
Thyroid hormones affect LDL particle oxidation
Excess LDL particles in the blood can cause some particles to “crash” into the blood vessel wall and be taken into the inner lining of the blood vessel. Once there, the LDL particles can become oxidized, which triggers inflammation and is thought to be the major event initiating the formation of arterial plaque. T3 acts as a free radical scavenger and may protect LDL from oxidation (19). However, high free T4 can also enhance LDL oxidation (20). Thus, both hypo- and hyperthyroidism can lead to LDL oxidation.
The dangers of statins in people with thyroid dysfunction
If you’ve been following my work for a while, you probably know my opinion of statin drugs. Here are just a few of the articles I’ve written on statins:
But it turns out that statin use is particularly concerning when the cause of high cholesterol is poor thyroid function. This is due to the effects of statins on creatine kinase levels.
Creatine kinase (CK) is an enzyme expressed in many different tissues throughout the body, though it’s probably most well-known for its action in muscle cells. CK is responsible for adding a phosphate to creatine to form phosphocreatine, which serves as an energy reservoir and allows for the quick release of energy in times of need.
Both statins and hypothyroidism result in CK release into the blood, and the cumulative effect is severe CK elevation (21, 22). This can potentially amplify the adverse side effects of statins. Statins can cause a variety of skeletal muscle problems, including damage and inflammation to the muscle. Based on several case reports, researchers have speculated that the use of lipid-lowering agents in hypothyroid patients may severely increase the risk of myopathy and rhabdomyolysis (23, 24).
Yet, in reviewing the relevant medical records of 77 patients treated receiving statins in a hospital, a team of medical researchers discovered that only 23 percent of patients had received a thyroid panel before beginning statin treatment. Worse yet, 12 percent of patients with overt hypothyroidism received statins without receiving a thyroid panel or hypothyroid diagnosis (21).
The authors commented on their findings, emphasizing the need for routine thyroid screening in patients with lipid abnormalities:
“We must not begin and continue to use these drugs without checking the possibility of hypothyroidism.” (21).
Statin drug information in Japan and the UK now includes warnings that emphasize the need for careful use in patients with hypothyroidism. The same cannot be said for the United States or in other countries. Thus, it’s very important to exclude other diseases that cause high cholesterol, such as hypothyroidism, diabetes, and kidney dysfunction, before even considering taking a statin.
Better markers of cardiovascular risk
Wait, but I thought cholesterol tests were out—aren’t lipoprotein particle numbers what we really care about?
Yep. I’ve discussed in several articles and on my podcast why lipoprotein particle numbers are much better predictors of cardiovascular risk than cholesterol levels. However, there are few studies that have assessed the effects of thyroid hormones on lipoprotein particle number, compared to the number of studies that have assessed standard cholesterol measurements. Still, we see similar effects:
LDL particle number (LDL-P): SH has been associated with higher levels of ApoB-100, a surrogate marker for LDL particle number. T4 treatment significantly reduced ApoB-100 levels (25).
Oxidized LDL: Decreased thyroid function increases the number of LDL particles and promotes LDL “oxidizability” (26).
Thyroid health also impacts other cardiovascular risk factors:
Blood pressure: Underactive thyroid is strongly associated with hypertension. This is due to both sympathetic and adrenal activation (27). One study of 30 patients with both hypothyroidism and hypertension found that hypertension was reversed in 50 percent of patients after thyroid medication therapy (28).
C-reactive protein (CRP): CRP, a marker of inflammation, has been shown to be negatively correlated with levels of free T4 (29). Patients with SH have also been found to have increased CRP (30).
Lipoprotein(a) (Lp(a)): Lp(a) is a measure of how many lipoprotein particles are carrying apolipoprotein A1. Apolipoprotein A1 has a high affinity for oxidized lipids and is thought to be largely based on genetics. Patients with overt hypothyroidism and SH have increased Lp(a) (31, 32). Some studies of SH patients suggest that thyroid medication can reduce Lp(a) (33), but others found no significant change (34).
Phospholipase A2 (Lp-PLA2): This is an enzyme that travels largely with LDL particles, is highly pro-inflammatory, and is involved in the development of atherosclerosis (35). SH subjects have been shown to have higher Lp-PLA2 (36).
Homocysteine: Hypothyroidism is associated with increased plasma homocysteine levels (37)
Insulin resistance and BMI: Insulin resistance and a high BMI are both positively correlated with low thyroid function (38, 39).
I hope I have convinced you that thyroid function plays a major role in lipid metabolism. I can’t tell you the number of patients I have seen in my clinic with lipid abnormalities that had undiagnosed thyroid conditions. Restoring thyroid health by correcting nutrient deficiencies, rebalancing the immune system, and making simple diet and lifestyle changes can often make a major difference in cholesterol levels and cardiovascular risk markers. In some cases, thyroid support in the form of medication may also be helpful and is much less harmful than statins.
Now I’d like to hear from you. Do you have cardiovascular risk factors? When was the last time you had a full thyroid panel? Did you know about the thyroid–cholesterol connection? Share your thoughts in the comments below.
Schweig and the California Center for Functional Medicine (CCFM)
Shortcomings of the episodic model of care
Changing how care is delivered
The collaborative care model
Technology advancements in collaborative care
Giving clients more resources and access to more professionals
Hiring a health coach and registered nutritionist
Group treatments and reducing the feeling of isolation
The Berkeley Fire Department pilot wellness program
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RHR A New Model of Care for Chronic Disease - with Dr. Sunja Schweig - YouTube
Hey, everyone. Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I'm excited to welcome back Dr. Sunjya Schweig. He is my co-director at the California Center for Functional Medicine. And in this episode, we're going to talk all about a new model of care, specifically for treating chronic disease. Now, in my book, Unconventional Medicine, I mentioned that conventional medicine is fantastic at dealing with acute trauma, emergency care-type of situations but really lousy when it comes to addressing chronic disease. So the obvious question is, what is the best model for treating chronic disease? And I outlined that in my book Unconventional Medicine. But I wanted to ask Dr. Schweig to come on the show to talk a little bit more about how we are implementing that at the California Center for Functional Medicine, so you can get a better idea of what it actually looks like in practice. I'm really excited to have him back on, and I hope you enjoy this episode.
Chris: Sunjya, it's a pleasure to have you back on the show.
Sunjya: Yeah thank you. It’s a pleasure to be here. I’m excited for today’s topic.
Chris: So, you have been on the show before, and I think some people have met you that way, but there are probably several listeners that haven't. So, why don't we start with your background, how you got into medicine, and then how you transitioned to functional medicine.
Dr. Schweig and the California Center for Functional Medicine (CCFM)
Sunjya: Yeah, so I grew up here in Northern California and had a very alternative upbringing. Lots of focus on alternative medicine as our main option for care in the family as well as diet; vegetarian and pluses or minuses on that, but also organic, really conscious thinking in terms of how my parents were putting everything together. And as I made my way up through high school and into college, I pretty much knew in high school that I wanted to go into medicine, and, however, I also knew, especially towards the end of my college years at Berkeley that I didn’t want to practice mainstream medicine.
And I did some work at UC Berkeley learning about medical anthropology and religious studies and was very passionate about trying to understand other people’s explanatory models. Sort of what did they think was happening to them and why and transitioned and did some work abroad in Ecuador expanding on that, but then also starting to interview and work with some of the indigenous people on some of the folk medicine or herbal medicines that they were using. And so I made my way through, up through med school after that at UC Irvine and then my residency at the UCSF Santa Rosa Program, and the same thing.
Basically, I knew that I wanted to do medicine, I love science, I think science is amazing in many regards and I’m passionate about it. And at the same time, I kept plotting my course and making sure, and also hoping, there’s a little bit of risk there, but hoping that I came through the other side and could integrate everything into alternative, functional, complementary medicine practice. And my plan came to fruition. I would do whatever coursework and electives during my studies, but then immediately after I graduated from residency, I started a Functional Medicine practice with a friend and colleague, Brian Bouch, who was always a mentor for me from even before I started. So it was nice to be able to jump in with him.
Chris: And so you were practicing Functional Medicine in that clinic, and I imagine that was going well for the most part, but what led you to transition from that situation?
Sunjya: Yeah, so I think with any career trajectory, there’s different phases and that served me really well for a number of years. I was there for about seven or eight years. And it took a little while for me to get launched and got my feet under me. And then I started working more intensively with patients with chronic infections after my wife was diagnosed.
People don't struggle to change because they don't know what to do; they struggle because they don't know how to do it. Collaborative care can help.
Sunjya: And that’s sort of like a pretty serious training ground for this type of medicine because of how complex the patients are and you really have to use any and all avenues that are available. And so that’s happened, I got more busy, started doing more lecturing and teaching. And it was around that time that I found you. We met and started kind of talking, and we had also moved. So geography was part of it. We had moved from Sonoma County down to the East Bay where my wife and I had met at Berkeley. So came back down here and the idea of commuting back up to Sonoma County for work was not a long-lasting solution. So things evolved from there and that’s kind of the birthplace of CCFM really—the pinnacle conversations that you and I had.
Shortcomings of the episodic model of care
Chris: Right, yeah. So I remember that quite well, because ... And we met down on Fourth Street, in a restaurant there, and we had a kind of similar experience and a shared vision, I think. We had both been practicing Functional Medicine, me on my own and you in a group practice but kind of in a solo fashion, it seemed like, for the most part. And we both had had some successes, we were ... The Functional Medicine model is really powerful and patients were getting better. And at the same time, we both also were aware of some things that were missing. I know that one of the first things that we connected on was the shortcomings of the episodic model of care for people who are suffering from really complex chronic illness. And I know you like to say this, we both do, that many of our patients are not sick enough to be in the hospital, but they're too sick for just seeing a doctor or practitioner once every three months for a half hour. That really didn't cut it for a lot of our patients. And yet that was the model that we were employing and that we were familiar with because I think that's just how it was done. Granted, we had longer appointment times than in the conventional model with eight- to 10-minute visits, we were seeing patients for 30 minutes, 45 minutes, or even an hour in follow-up, so that was very different. But even that, every three months just wasn't enough.
Sunjya: Yeah, yeah, absolutely. Yeah, I mean, the fact is that as a clinic ourselves, and I think Functional Medicine doctors in general tend to acquire and collect the people who really haven’t been served by the system. They were still sick despite seeing 10 or 15 doctors, and our friend and colleague, Mark Hyman, I love his phrase, but he says that the people who see the holistic doctor are the people with the “whole list” of medical problems.Chris: [chuckle] Yeah, exactly.
Sunjya: Right? So, yeah, so, you’re absolutely right, and then that was one of the real key factors that you and I started discussing from the outset, which is that this, even though we think and we hope and we get some feedback to the point that we’re helping people frequently, it’s certainly not an optimal system.
And when we have patients that have this huge long list of symptoms, and I spend the first 15 or 20 minutes of the appointment just saying, “Okay how’s your headache? And how’s your knee pain?”
Chris: Right, right.
Sunjya: “How’s your brain working? And what happened when I gave you that supplement for your GI tract?”
Sunjya: And that’s just not a great use of anybody’s time or resources, especially given where we’re at this point in time with the ability to leverage technology.
Changing how care is delivered
Chris: Yeah, and it's interesting to me because I think that that episodic care model is just like a carry-over from the conventional approach. And we’re kind of in this process of reinventing all different aspects of how care is delivered. Functional Medicine is really a paradigm shift, shifting from suppressing symptoms with drugs to addressing the underlying cause of the problem. But I think along with that, what we realized is, it's not just the medical paradigm that needs to shift, it's how care is delivered. And it felt a little bit to me early on like we had adopted this new paradigm, but the model that we were using for delivering the care was still kind of based in the old way. And there is a disconnect there. Just as an example, if we recognize that diet, lifestyle, and behavior change are really at the core of addressing complex chronic illness, which I know we both agree on, how do you really successfully support patients in making those kinds of changes if you're just seeing them once every six months? That's a total disconnect.
We know that behavior change, it’s not just about information, it's not just about telling people what to do. You can't just hand someone a list of 42 recommendations and expect them to go and be successful with 100 percent of them. There need to be frequent touch points and check-ins and support that are offered over the next several weeks or months that they are going to be implementing those things. When we had lunch that first time and we’re chatting about this, we both ... I was really excited, I remember feeling really excited because I was like, yes! This is right. This is exactly the way it should be and it can ... there is nothing stopping it from being this way.
Sunjya: Yeah, absolutely. I remember that lunch well. I remember other sessions that we had. For example, I remember I parked myself at the, I think the library at UC Berkeley. At one point I was working on a lecture that I was going to give at the Eye Labs conference, and you and I had gotten involved with a Google Doc, just kind of batting ideas back and forth. And it was just an exciting moment. I just felt like it’s the start of this new era. and I remember that document. We were, we’re still in the process of implementing it, but that document largely focused around this idea of building in these extra layers of support.
Sunjya: So we’re doing this exciting thing in Functional Medicine. We’re offering this care to people that we always were striving to get to the root cause of what’s happening. But you’re right that we’re still working within the mainstream system. And sure, we might have longer visits to offer people, but still, and we might catch on more lifestyle pieces, like, hey, I think you should meditate. I think you should focus on this diet and you should be doing this kind of exercise. Or this kind of psychospiritual work. But to tell the patient that okay, that’s a step in the right direction, but to tell them that without giving them the fabric and this sort of community network of support around that work, we’re not in any way approaching the efficacy that we could have.
Chris: Absolutely. As you know, Sunjya, I've been kind of a behavior change geek. And when I was researching for the practitioner training program, and even more now with the upcoming health coach training program, and when you look at the research on behavior change, it's just so clear that, as I said, information is not enough. People don't struggle to change because they don't know what to do, they struggle because they don't know how to do it. [chuckle]
Chris: And I would even extend that and say they don't have the support they need to do it.
The collaborative care model
Chris: It's not because people are lazy or unmotivated or ambivalent, even although those can be factors in some cases, but they're really the minority. It's more just not knowing how to actually change. That's like a huge cornerstone of this collaborative care model, that I wrote about in Unconventional Medicine and that we're really trying to implement it at CCFM. And it hasn't been perfect, but I think we've made some strides. First two years ... The first year really was about, for me, building out the capacity to serve more patients, because I think we both had the same situation when we started, where we had really full practices.
I think my waitlist was like a year or a year and a half at that time, and it was painful not to be able to help people who needed help.
Chris: Because I'd been in that situation myself as a patient, and to have to turn people away and to not even really have many other practitioners to refer them to was painful. So I hired Dr. Amy Nett who was working earlier on in her career as a radiologist at Stanford and had seen the limitations of that model, was tired of doing scans of obese eight-year-olds.
Chris: Tragic with markers for type 2 diabetes at eight years old and just figured, hey, this is probably not the best way that I could help them. If I can get involved earlier and prevent this from happening in the first place, I'm gonna have much bigger impact. And so she joined us ... Gosh, two-and-a-half years ago I think, now.
Sunjya: Yeah, that’s about right.
Chris: And it's been amazing to have her on staff, and she's now treated hundreds if not thousands of patients, just is ... amazing to have her expertise with radiology as well. We sometimes now rely on that with a NeuroQuant, and other things that we've expanded into. And then I think ... Did you hire Ramzi before I hired Tracey? Or is that right around the same time?
Sunjya: Yeah, a little bit before. Ramzi joined us, I first met him in the summer a year and a half ago, then he joined us last fall. Yeah, so Ramzi’s another really interesting case. And we’re seeing this a lot and I love how you approach it in your book Unconventional Medicine you were just talking about, and it’s sort of a truism in Functional Medicine that so frequently doctors within the mainstream system are aware that their hands are tied, but they don’t know what to do about it and they’re becoming increasingly frustrated and burnt out. And Ramzi’s a great case in point.
Here’s this really smart, passionate … he’s just a great, great person working in mainstream infectious disease, and he’s basically realizing that he is joined with these incredibly sick people. He’s frequently recovering them from either death or severe, severe illness using his infectious disease skills, antibiotics, infection control, etc. But he’s not really moving the needle in terms of helping people really get better. And so he on his own had been very passionate about Functional Medicine, was working his way through the Institute for Functional Medicine training programs. And when I met him it was like another one of those ah-ha! moments. We talk about in our clinic that we want to work with the best of the best, and you and I, I think, have really developed our intuition in terms of getting a sense of, is this person an A player? Are they going to be a great addition?
And as soon as I met Ramzi, I was like pinching myself. It was like, oh my goodness, this guy is amazing and just would love for him to join our practice. So that’s been a great transition on our end and again I think we, like Amy with her radiology knowledge, we’re really leaning on Ramzi for his infectious disease knowledge as well. And so many of the patients that we treat with these multi-system illnesses, so much of the time there’s some kind of infection in the background that’s triggering them. So, yeah, he’s been a wonderful addition to the team as well.
Chris: Yeah. And that's been amazing for me, just this team approach to care that we have. If I have a patient with a tick-borne illness or a complex chronic infection, for example, one patient comes to mind who was working in the Peace Corps down in South America and came back with a very mysterious illness and nobody could figure it out. And even though I have my own experience with mysterious illness that I acquired while traveling abroad, that's not my particular area of expertise. But of course, Ramzi used to work for the WHO and has worked in Africa and South America and does have expertise in this area. And so it was amazing to be able to get ideas about what kind of testing to run. He has friends at the CDC that he was able to contact and get advice on a pretty unusual ... I think it ended up being a gallbladder fluke or a liver fluke. And just to have that expertise that I can rely on is amazing.
And we're constantly going back and forth. I'm asking you questions about the finer points of Lyme, and you're asking me about advanced lipidology and cardiology, and we ask Amy about her opinion on radiology scans. And it's just ... for me as a practitioner, that's certainly a gratifying experience because it keeps me on my toes, I get to continue learning, and I get to offer a much better range of care to my patients.
Technology advancements in collaborative care
Sunjya: Yeah. The patients really appreciate it and the thing that’s so fun for me also is how we’re leveraging the technology for this. And so as some people might know, I’m not sure, I think most of our patients know about the community at large, we are a distributed clinic. And we have our five practitioners spread out across from Palo Alto to Berkeley to Marin to Sacramento. So we’re not face to face with each other all of the time and so we’re using technology like Slack for example––a great communications system. And so we’re basically in there, we all have our Slack channels open, and so if I send out a question to one of you guys, almost always the answer comes back super quickly and we get the information that we need, sort of what we call in medicine like a curb-side, where you ask a question and get an answer from another colleague or a specialist. And then same with our staff, right?
So our staff who are all working from home, we have over 10 people now mostly in California but spread out across the U.S., and we have a channel on Slack called “urgent patient needs.” And so if I’m running late or the patient’s not there in the office, or I need a lab result, I put that in there and usually within one or two minutes one of the staff picks it up, answers the question, pulls the lab in, and calls the patient, whatever needs to happen. And so I remember at my old clinic, I used to have to get up, open the door, walk out to the front desk and say, “Hey, this lab’s not in the chart. Can you please call the lab?” and go back in the room and then maybe hopefully by the end of the visit, we’d get a hold of the lab.
Chris: Oh, right, because they have to open the file drawer and then thumb through all the files to find the file, and then the file is not there [chuckle].
Sunjya: Or call.
Sunjya: The lab. I get this whole …
Chris: And then yeah, and then the lab has to fax it over and you're like, "Wait, are we in 1985 here? What's going on?" [chuckle]
Sunjya: Somebody would be standing by the fax machine pulling the paper off of the fax.
Chris: Yeah, it's so bizarre that medicine in some ways is very far ahead technologically, but in other ways, it's totally in the dark ages.
Chris: Yeah. So I haven't even had a chance to tell you this, but we had... Tracey and I ... We'll talk ... come back to Tracey in a second, but we had a patient last week who came to see us who lives in Dallas, and he's an investor. And he's really interested in investing in Functional Medicine and healthcare in general. He's passionate about this. He sees this as the future of medicine and he wants to ... In his own way, because that's his background in finance. He doesn't wanna become a doctor [chuckle] or enter into it that way, but he wants to use his skill and expertise and resources to support the movement. So he's really interested in investing in Functional Medicine models. And he paid us such an amazing compliment, which he said it was the most incredible experience he's ever had
From the beginning, when he signed up as a new patient to when he was sitting in our office, the best experience he'd had with any company that he'd worked with, not just in medicine or healthcare. And he said he actually saved the emails that we send as part of our new patient onboarding sequence because he wants to figure out a way to kind of rubber-stamp that and roll that out in other ways. So I just wanted to let you know that because I haven't even had a chance to tell you. It's pretty great feedback because that's something that you and I have worked a lot on, and you've been really passionate about how to use technology to create ... to automate things that can be automated, so there's more time for the things that should never be automated, the actual interaction with patients.
Sunjya: Yeah, I mean, that’s the promise of technology and it’s an incredible time right now in healthcare. And especially in the Bay Area. As you know, and you mentioned I’m super passionate about this, and I got to conferences whenever I can. Health 2.0, I was over at JP Morgan week and went to a Google investor meeting, and there’s a ton of movement and it’s so, it’s so exciting right now. And the same discussion is happening in the community at large. Which part of this is relevant? Which part of this adds to the medical patient experience? Which parts can be automated and which parts need to be done by humans? And some people get kind of nervous and negative about a thing.
For example, radiology: there’s going to be a takeover of artificial intelligence and machine learning and the radiologist will be extinct in a number of years. And I don’t see that at all. I see what could happen instead would be that care could improve, ability to diagnose things could improve, the ability to track and visualize data..
Behavioral disorders: A pandemic disabling our children
It is normal for children to be energetic and occasionally distracted, upset, or argumentative. However, when these behaviors become disruptive and cause harm to the child or others, a diagnosis of a behavioral disorder may be made. Recent research indicates that one in six children in the United States is afflicted with developmental and behavioral disorders, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, autism spectrum disorder (ASD), anxiety disorder, learning disorders, and conduct disorders. (1)
According to neurology experts Philippe Grandjean and Philip Landrigan in a 2014 report in The Lancet Neurology, “a silent pandemic of neurodevelopmental toxicity” is disabling children around the world and contributing to the meteoric rise of ADHD, ASD, and other behavioral disorders. (2) What is responsible for the rapidly rising rates of behavioral disorders in children? Research indicates that heavy metal exposure promotes neurodevelopmental toxicity and may be one of the underlying causes of childhood behavioral disorders. Mercury
Childhood exposure to mercury occurs primarily through the consumption of seafood, vaccines containing thimerosal, and dental amalgams. Mercury is a potent neurotoxin that directly passes through the blood–brain barrier and accumulates in brain tissue and the spinal cord, disrupting neurological function. Children are especially susceptible to the harmful effects of mercury, and a growing body of research indicates that mercury exposure is associated with an increased risk of behavioral disorders.
Prenatal mercury exposure, measured through samples of cord blood, is associated with ADHD symptoms in children. (3)
Postnatal mercury exposure from thimerosal in vaccines has been linked to ASD, ADD, ADHD, and tic disorder. (4, 5, 6)
A systematic review of 44 studies concluded that mercury levels were significantly higher in the whole blood, red blood cells, and brains of autistic subjects compared to controls. (7)
Mercury content in ambient air is linked to an increased prevalence of autism in children. (8)
Even low levels of mercury are harmful to the developing brain and have been associated with learning disabilities. (9)
Heavy metals may play a role in your child's behavioral disorder. Learn how to reduce your exposure.
Lead is a pervasive environmental toxin that adversely affects the developing nervous system in children. Children may be exposed to lead through paint chips, dust, and water pipes in homes built prior to 1978, as well as dirt, drinking water, and air pollution. (10)
In animal studies, prenatal exposure to lead has been found to alter synapses in the brain, impairing neurotransmission and learning behaviors. (11)
Children who grew up near the location of a former lead refinery were found to have a higher risk of ADHD. (12)
Even very low levels of lead have adverse effects on the brain and behavior in children. Blood lead levels less than 1.8µg/dL, well below the CDC’s recommended threshold of 5µg of lead per dL of blood, are associated with an increased risk of ADHD. This suggests that there is no safe limit for lead exposure in children. (13)
Manganese is a heavy metal that is required by the body in small amounts to create antioxidant enzymes, for the metabolism of carbohydrates and amino acids, and to promote bone development and wound healing. It can be found in foods such as green leafy vegetables, tea, and legumes. However, manganese toxicity can occur when manganese dust from sources such as chemical manufacturing and welding is inhaled or when high levels of manganese are present in drinking water.
Children exposed to high levels of manganese through drinking water have been found to experience diminished intellectual function and behavioral problems. (15, 16, 17)
Aluminum is a pervasive heavy metal used as an adjuvant in vaccines, as a food additive, and in metal cookware, beverage cans, antacids, and antiperspirants. Research has found high levels of aluminum in the brain tissue of deceased individuals with autism; the aluminum was most concentrated in immune cells of the brain, suggesting that aluminum elicits a neuroimmune response. (18) A significant correlation also exists between the amounts of aluminum adjuvant administered to children in vaccines and the prevalence of autism spectrum disorder, further supporting the theory that aluminum adversely impacts the developing brain. (19)
Arsenic has become a common contaminant in soil and groundwater due to its prevalence as a byproduct of industrial manufacturing processes. Arsenic is also present at high levels in conventionally raised poultry, which is fed arsenic-containing drugs, and in rice from India and areas outside of California. Urine arsenic levels have been associated with decreased IQ in children. (20)
How heavy metals harm the brain
Heavy metals pass through the blood–brain barrier and accumulate in brain tissue. Once in the brain, they harm neurological function through several mechanisms.
Heavy metals displace essential minerals such as zinc and iron that are required for neurotransmitter production. (21)
Heavy metals induce oxidative stress, which reduces neuronal plasticity and impairs learning and behavior. (22)
Aluminum accumulates in immune cells of the brain. This may provoke an inflammatory immune response that ultimately affects neurological function and behavior. (23)
Heavy metal testing
Heavy metal testing is a controversial topic because each of the currently available methods of testing—hair, urine, and blood—has some drawbacks.
Hair testing. Hair testing has become a popular method for assessing heavy metal status. However, using hair testing alone, we cannot know for certain whether a high level of a metal in the hair reflects a significant body burden of that metal or indicates that the patient is efficiently eliminating the metal through the hair and thus has a low level of it in the body.
Urine testing. Urine heavy metal provocation tests, which use a chelating agent such as DMSA to provoke a release of heavy metals into the circulation, present problems similar to those with hair testing; it is possible that a metal may be high in the urine because the body is efficient at excreting it, or it may reflect a high body burden of the metal. Another problem is that reference ranges for provoked urine results have not been developed or validated.
Blood testing. Blood testing is problematic for assessing heavy metal status because heavy metals typically circulate in the blood for only a short time before becoming sequestered in tissues.
While each of these testing methods is faulty when used alone, combining a couple of techniques may be a more accurate way to assess heavy metal toxicity. For example, you could do a provoked and an unprovoked urine test, or a hair test and a provoked urine test. Combining two tests may paint a more accurate picture of the body’s total heavy metal burden.
How to avoid heavy metals
Reducing exposure to heavy metals may lower the risk of childhood developmental disorders. Pregnant women should be conscientious about heavy metal exposure because heavy metals cross the placenta and can affect the brain of the developing fetus. Parents with young children also need to be careful since the brain is especially sensitive to toxic insults during childhood.
There are a handful of steps you can take to reduce exposure to heavy metals:
Don’t use aluminum pans for cooking. Choose stainless steel or enameled cast iron instead.
Choose seafood low in mercury. The Monterey Bay Aquarium’s Seafood Watch program is a helpful tool for learning which types of seafood are highest and lowest in mercury. Wild-caught Alaskan salmon, wild-caught Pacific sardines, and pole-caught albacore tuna are among the lower-mercury choices; Atlantic cod, halibut, shark, and swordfish tend to be much higher in mercury.
Choose thimerosal-free vaccines.
Filter your drinking and bathing water. Invest in a high-quality drinking water filtration system that removes heavy metals.
Choose organic chicken. Conventionally raised chicken is high in arsenic.
Limit intake of brown rice and white rice from India and areas outside of California. Rice from these regions tends to be high in arsenic. White rice from California is lower in arsenic and thus a safer option. See my article “Arsenic in Rice: How Concerned Should You Be?” for more information.
Prevent heavy metal pollution from entering your home. If you have children and work in manufacturing, construction, or another profession that involves heavy metal exposure, bathe and change clothes immediately after work to avoid contaminating your home with heavy metals in dust, dirt, etc.
Strategies for the treatment of heavy metal toxicity in children
Research indicates that detoxification and excretory pathways responsible for detoxifying heavy metals may be impaired in children with behavioral disorders. (24) However, by enhancing detoxification pathways, replenishing essential minerals and vitamins, and supplementing with probiotics, it may be possible to alleviate heavy metal toxicity and reduce symptoms in children with behavioral disorders.
Support the glutathione pathway
The glutathione pathway is a crucial system in the body for detoxifying mercury and other heavy metals. Glutathione, often referred to as the “master antioxidant,” binds to heavy metals and facilitates their removal from the body. Research has found that ASD patients have lower glutathione levels than controls, a problem that may promote the retention of heavy metals in the body. (25) Oral and transdermal glutathione supplementation raises plasma glutathione levels in the blood of autistic children, an effect that may facilitate heavy metal detoxification. (26)
Replenish essential minerals and vitamins
When the body is deficient in essential minerals, heavy metals preferentially bind to sites normally occupied by those minerals. Replenishing the body with essential minerals can, therefore, help prevent heavy metal accumulation and increase metal excretion.
Selenium. Selenium, an essential mineral that serves as a cofactor for the enzyme glutathione peroxidase, may benefit children with autism. (27)
Zinc. Another essential mineral, zinc, alleviates heavy metal toxicity by competing with heavy metals for binding sites on cells and enzymes. Research indicates that zinc replenishment is beneficial for kids with autism and ADHD. (28) To replenish zinc levels, I suggest feeding your children zinc-rich foods, such as oysters, rather than zinc supplements, which may not be safe for children over the long term.
Iron. Iron competes with heavy metals for intestinal absorption, and iron sufficiency downregulates transporters that bring heavy metals into intestinal cells and the systemic circulation. Restoration of iron levels has been found to relieve ADHD symptoms in children. (29) I recommend feeding your kids organ meats and shellfish to ensure optimal iron levels.
Vitamin B. Replenishment of vitamin B6 may also alleviate heavy metal toxicity. B6 supplementation reduces the accumulation of lead in body tissues. When combined with magnesium, it has been found to improve symptoms of ADHD. (30, 31) The top dietary sources of vitamin B6 are liver and other organ meats, egg yolks, nuts, bananas, and avocados. (32)
The power of probiotics
Several studies indicate that probiotics alleviate heavy metal toxicity. Research indicates that Lactobacillus rhamnosus and L. plantarum, commonly found in probiotic supplements and fermented foods, protect against heavy metal toxicity. (33, 34) These findings also suggest that a healthy gut microbiome may protect against heavy metal toxicity.
Chelation therapy: Use with caution
Chelation therapy involves the use of synthetic chelating agents such as CaNa2 EDTA and DMSA and may be necessary to remove certain metals like lead. However, there are significant concerns about the safety and efficacy of chelation. Chelation depletes essential minerals and has the potential to redistribute heavy metals within the body. These effects may be especially harmful to children. For this reason, chelation should only be done under the guidance of a qualified healthcare professional. Avoidance of heavy metals and the use of nutritional detoxification strategies such as those mentioned above may be a gentler and safer method for reducing a child's heavy metal burden.
Now I want to hear from you. Do you have a child with a behavioral disorder? Do you think heavy metals might be impacting your child’s health and behavior? What strategies have you tried for treating heavy metal toxicity? Let me know in the comments below.
Each week, around 23 percent of U.S. adults, or 52 million Americans, use a medication containing acetaminophen, according to the Consumer Healthcare Products Association (1). The ubiquitous use of acetaminophen, both by itself and as a component of over-the-counter and prescribed medications, is a major public health issue. Acetaminophen is generally considered safe when taken as recommended, but the margin between a safe dose and a potentially lethal one is incredibly small.
Even when taken as recommended, acetaminophen use can have major side effects. In this article, I’ll discuss the many reasons we should avoid acetaminophen whenever possible and share several safer alternatives for pain relief.
Overdose with acetaminophen is the leading cause for calls to poison control centers in the United States, with more than 100,000 instances per year (2). It’s responsible for more than 56,000 emergency room visits and an estimated 458 deaths every year due to acute liver failure. In fact, over half of all acute liver failure cases in the United States are due to acetaminophen overdose (2). Taken over several days, as little as 25 percent above the maximum dose, or just two additional pills a day, has been reported to cause liver damage. This staggered overdosing may be more dangerous than a single large overdose (3).
Think twice before you reach for Tylenol.
Current guidelines recommend taking no more than 4,000 milligrams of acetaminophen daily (4). Yet according to a 2006 study published in the Journal of the American Medical Association, even this dose, taken for four or more days, frequently causes elevated serum alanine aminotransferase (ALT), a marker of liver injury. Moreover, the elevations in ALT often persisted for several days after the acetaminophen was discontinued (5).
Concerns about liver toxicity were raised as early as 1977, when an FDA advisory panel said it was “obligatory” to add warning labels about liver damage. The FDA dragged its feet until 2011, when it finally issued a statement urging drug manufacturers to limit the strength of each capsule to 325 milligrams of acetaminophen and mandated warning labels about liver toxicity (4).
Acetaminophen toxicity is increased when combined with narcotics like codeine or hydrocodone, when more than the prescribed dose was taken in a 24-hour period, when more than one acetaminophen-containing product is taken at the same time, or when alcohol is consumed while taking acetaminophen (6, 7).
How does it cause liver damage? Acetaminophen depletes levels of glutathione, the body’s master antioxidant. Glutathione helps protect cells from damage by free radicals. Interestingly, prompt administration of N-acetylcysteine (NAC), the precursor to glutathione, can prevent mortality from acetaminophen toxicity (8).
Gut health and microbial drug metabolism
Chronic use of acetaminophen doses greater than 2,000 milligrams has been associated with a 3.7 times increased risk of bleeding in the upper gastrointestinal tract (9). Acetaminophen can also cause intestinal permeability. Overdose with acetaminophen causes massive necrosis of the liver tissue, which releases a protein that results in leakage of bacteria from the gut into the bloodstream (10).
I’ve written before on the Kresser Institute blog about the role of the gut microbiota in drug metabolism. Interestingly, those with higher levels of certain gut bacterial metabolites may be more susceptible to acetaminophen toxicity (11).
Cardiovascular health, kidney disease, and cancer
Several recent studies have also shed light on acetaminophen’s relation to cardiometabolic health. One study, published just this month, found that those taking opiates (some of which contain acetaminophen) were 95 percent more likely to be obese and 63 percent more likely to have hypertension (12). Of course, we can’t separate out the effects of acetaminophen in these combination drugs.
The kidneys are also affected by acetaminophen. Heavy use of acetaminophen is associated with an increased risk for kidney disease. This is especially true when combined with alcohol consumption. One study found that concomitant use of acetaminophen and alcohol resulted in a 2.23 times increased risk for kidney dysfunction (13).
Researchers have also found associations with cancer. A 2013 meta-analysis of epidemiological studies found that acetaminophen was associated with a significantly increased risk of kidney cancer (14). A 2011 study of more than 64,000 older men and women found that acetaminophen use was also associated with several different types of blood cancers, including myeloid neoplasms, non-Hodgkin lymphomas, and plasma cell disorders like multiple myeloma (15).
Blunted emotions and empathy
Researchers at Ohio State University wanted to determine if acetaminophen affected emotional processing. They found that participants who took acetaminophen “evaluated unpleasant stimuli less negatively and pleasant stimuli less positively, compared with participants who took a placebo.” In other words, both negative and positive stimuli were less “emotionally arousing” to people who had taken acetaminophen (16).
In another double-blind, placebo-controlled experiment led by a different research group, participants rated their perceived pain, personal distress, and empathic concern after reading scenarios about another person’s physical or social pain. Participants who had received acetaminophen beforehand showed less empathy towards others’ pain (17).
Together, these studies raise concerns about the broader social side effects of acetaminophen. If a quarter of Americans use this every week, what impact is this having on us as a society?
Autism, ADHD, and brain health
Acetaminophen is currently marketed as safe during pregnancy. However, acetaminophen use may have neurodevelopmental consequences for the fetus. A 2016 study followed more than 2,000 mother–child pairs from the first trimester of pregnancy and performed several tests of behavior when the children were about five years old (18).
Forty percent of the children were exposed to acetaminophen in utero. Exposure to acetaminophen was associated with lower attention function and a greater risk for ADHD-like hyperactivity and impulsivity symptoms. In boys, acetaminophen exposure was also related to a greater number of autism spectrum symptoms, and mothers who used acetaminophen more frequently had an even greater chance of having children with autistic-like behavior. The authors even ran the data again, excluding mothers that had chronic illness, urinary tract infections, or fevers during pregnancy, and found the same results, suggesting that it was not illness itself that contributed to the association.
Some researchers hypothesize that activation of the cannabinoid system by acetaminophen may be affecting neural development (19). A study in rats found that acetaminophen causes toxicity to neurons even at concentrations too low to cause liver failure (20). It caused the neurons to undergo apoptosis, or programmed cell death.
Severe skin reactions and asthma
Acetaminophen has also been linked to rare but very serious skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. These reactions can be fatal. Between 1969 and 2012, there were 107 such cases, of which 67 required hospitalization, and 12 people died. In 2013, the FDA issued a warning and mandated that skin reactions be listed on acetaminophen-containing drug labels as a potential adverse effect (21). Exactly how acetaminophen causes these potentially fatal skin reactions is unknown, but particularly alarming is that they can occur even if you’ve taken acetaminophen in the past without any problems.
Researchers have also found an association between acetaminophen and asthma. A 2009 systematic review and meta-analysis found that in both adults and children, the risk of asthma increased with prior acetaminophen use. Moreover, prenatal exposure to acetaminophen also increased the risk of asthma in child, possibly by increasing oxidative stress during prepregnancy. (22)
Of course, these are only associations, and they don’t prove that acetaminophen is the cause of these problems. Some of these children may have received acetaminophen due to viral respiratory infections that may have also contributed to the development of asthma. Still, the evidence is strong enough that several experts have recommended that acetaminophen use should be avoided in children with asthma or at risk for asthma (23, 24).
Altered reproductive function
Acetaminophen is also an endocrine disruptor. In a 2016 study, rats given acetaminophen had female offspring with fewer eggs, smaller ovaries, and smaller litters when they reached reproductive age. Male offspring had fewer numbers of sperm progenitor cells early in life, but these returned to normal by adulthood. Particularly concerning was the effect it had on the next generation. Granddaughters of the rats given acetaminophen were also found to have smaller ovaries and stunted reproductive function (25).
How did this happen? The researchers speculate that it has to do with acetaminophen’s effect on prostaglandins, hormones that are involved in pain and inflammation but are also important in regulating female menstrual cycles and reproduction.
In humans, acetaminophen use during pregnancy, especially for durations of more than four weeks, is associated with an increased risk of having male children with an undescended testicle at birth (26). Prolonged exposure to acetaminophen also decreases the amount of testosterone produced by human fetal testes (27), which could have major effects on male development.
Alternatives to acetaminophen
Hopefully, I’ve convinced you to think twice about taking acetaminophen. Ultimately, pain is a sign of a deeper problem, and throwing pills at it is only suppressing symptoms. Eating an anti-inflammatory diet, getting adequate sleep, exercising, getting exposure to sunlight, and managing stress are all part of an effective pain-management strategy. For acute relief, there are some alternative painkillers that are far less toxic and, in many cases, just as effective as acetaminophen. Here are a few that I always keep in my “medicine” cabinet:
Curcumin: a potent anti-inflammatory, curcumin is one of the natural compounds found in turmeric. I recommend 1,500 mg up to three times a day of the Meriva-SR form, which is much more bioavailable than other forms of curcumin. (Note: curcumin is contraindicated if you are taking blood thinners.)
Magnesium: three of the most common reasons for taking acetaminophen over the counter are headaches, muscle pain, and menstrual cramps. For many people, magnesium can provide significant relief from these symptoms, often equivalent to or better than Tylenol. I recommend 400 to 600 mg of the magnesium glycinate form.
Boswellia: another anti-inflammatory, the resin of the Boswellia tree has been used medicinally for centuries. It works via a different mechanism than curcumin, so they are complementary when taken together. I recommend 100 mg up to three times a day in the AKBA form.
Clove oil: works like a charm for toothaches. Mix a few drops of therapeutic-grade clove oil with a spoonful of coconut oil and swish it around the mouth.
CBD oil: also known as cannabidiol, this is the non-psychoactive oil of the cannabis plant that has pain-relieving and anti-inflammatory properties. It does not produce the “high” that THC does, and as of now, it is currently sold legally over the counter. I recommend one to two droppersful once or twice a day of the Ojai Energetics Super CBD product.
Acupuncture: can be quite effective at modulating local and systemic pain and reducing inflammation.
Mind-body interventions: emotional-freedom techniques, yoga, and meditation can all provide short-term pain relief.
Now I’d like to hear from you. Did you know the dangers of acetaminophen? What do you use for pain relief? Share your thoughts in the comments below.
RHR - Debunking Paleo Diet Myths—with Sarah Ballantyne - YouTube
Chris Kresser: Hey, everybody. Welcome to another episode of Revolution Health Radio. This week I’m really excited to welcome Dr. Sarah Ballantyne as a guest on the show. She’s the creator of the award-winning online resource ThePaleoMom.com; cohost of the syndicated top-rated The Paleo View podcast; and the New York Times best-selling author of Paleo Principles (her newest book, which I’m excited to talk about today), The Paleo Approach, The Paleo Approach Cookbook, and The Healing Kitchen. Sarah earned her doctorate in medical biophysics at the age of 26 and spent the next four years doing research on critical care medicine, innate immunity, gene therapy, and cell biology, earning a variety of awards for research excellence along the way.
Many of you know Sarah from the Paleo/primal community, and she has long been a voice of reason and also someone who, like myself, shares a passion for research and backing up her writing with evidence, which I think is really important and often in short supply in the health world online. Sarah’s one of those people that I connected with right away, especially in this particular domain, and we both enjoy geeking out on all of the research that supports the ancestral diet and lifestyle. One of the things we’re going to be talking about today is how much research there is that supports these diet and lifestyle choices that we make. You might be surprised to find that there’s much, much more than the mainstream media and critics let on. In fact, that really is the subject of Sarah’s latest book, Paleo Principles. It’s essentially a research bible, looking at all the peer-reviewed research from a biochemical perspective, that supports the ancestral diet and lifestyle. So, Sarah’s very passionate about this subject, she’s extremely knowledgeable, and I’m really looking forward to diving into this podcast with her. So I hope you enjoy it as much as I will. Let’s jump in.
Anyone who’s tried to keep a New Year’s resolution for longer than a week knows how hard it can be to make a change that sticks.
Now, imagine if your life depended on that change. Or the life of someone you love.
Fact is, lifestyle and behavior changes determine whether we succumb to chronic illness or cut it off at the pass. And yet, that doesn’t make change any easier.
The answer to better health isn’t just more doctors trained in Functional Medicine; it’s also more health coaches. Why? Because a skilled coach doesn’t just have more information at her fingertips—she knows what questions to ask, how to link behavior to your goals, and most importantly, how to help you tap your own motivation so that you can make lasting change.
This skill can help reinvent healthcare. It could also be your next career. There’s never been a better time to consider a career in health coaching. The field of health coaching is growing by leaps and bounds. There’s so much demand for this kind of support, which practitioners aren’t always in a position to offer. And it can look lots of different ways, too—whether you’re interested in working on your own as a solo business or in collaboration with practitioners at a range of healthcare facilities.
In a few months, I’ll be opening enrollment for my new ADAPT Health Coach Training Program, which is designed to help you tap your talents and sharpen your skills as a health coach so that you can be part of the reinvention of healthcare in this country. If you’re interested in learning more, don’t miss my free webinar, “Health Coaching 101: How to Set Yourself Up for Success,” where I’ll share insights on:
Why coaches are critical
What a health coach does (and doesn’t do)
How to know if this career is a fit for you
The critical skills every health coach needs
How to make a living as a coach
What new opportunities exist for coaches
Plus, I’ll tell you a little more about the upcoming ADAPT Health Coach Training Program so you can keep an eye out for it later this spring. The webinar will happen live on January 17th at 4 p.m. PST. But don’t worry if that time has already passed because you can listen to the recording. Go to chriskresser.com/healthcoachwebinar to register for the webinar or access the recording.
OK, now on to the podcast.
Chris Kresser: Sarah Ballantyne, thanks so much for joining us. Happy to have you here.
Dr. Sarah Ballantyne: Thanks so much for having me.
Chris: So I wanna talk a little bit about Paleo as not evidence-based.
Chris: We hear this all the time. Right? We hear it in the media. It's January 2018, so I don't know if this has already happened, but it's gonna happen soon where the US ...
Sarah: We're gonna get ranked at the bottom of the ...
Chris: That's right. [chuckle]
Sarah: Yeah, every year you ...
Chris: US News & World Report will come out with their diet, and Mediterranean and DASH low-salt diet will be at the top of the list, and Paleo and probably keto will be now at the bottom of the list ...
Sarah: Well you know ...
Chris: Competing for that.
Sarah’s new book and bringing scientific validity to the Paleo movement
Sarah: You have to get used to eating a hamburger without the bun, and that's just too big of an ask for people, right?
Chris: Right, right, absolutely.
Sarah: I believe that was literally in the write-up last year, and I cannot tell you how many times I rolled my eyes. [laughter]
Chris: Yeah. Yeah, and it's really interesting. It's so-called "science journalists," I'm doing air quotes now ...
Empower your food choices with knowledge—Sarah Ballantyne shows us how
Chris: Don't even bother to spend one second looking in the scientific literature to determine if there is actually any support for the Paleo type of diet. Now, fortunately, we have people who have done that, such as yourself, and your new book, Paleo Principles, is a really deep dive into the science that supports nutrient-dense Paleo type of diet. Of course, both of us have written a lot about this over time, but was that your motivation for doing this book? Tell me a little bit more about that.
Sarah: It was 100 percent. So I pitched this book to my publisher, and you've seen it, so I wasn't just pitching, I wanted to write the heaviest Paleo book; that wasn't what I actually set out to do.
Chris: That wasn't a cookbook.
Sarah: I didn't go, "Hey, publisher, I would like to write the heaviest." What I said is, "I wanted to write the book that brings scientific validity to the entire Paleo movement," which is an ambitious statement, but I was so frustrated reading these various critiques of Paleo, some of which have such a distorted understanding of the main tenets of Paleo to begin with, so they're criticizing a diet that doesn't even resemble how most of us eat, so that's frustrating in a different way. But then reading over and over again these articles that equate Paleo to zero-carbohydrate diets, all-meat diets, ketogenic diets, it's not the same thing, and there's some overlap in the approaches, and you can combine approaches, but Paleo, by itself, is not those things. And then you got the ... There's no science to support, there's only a handful of small clinical trials, and you can't put any stock in that, or there's the lack of evidence, the ...
I almost feel like there's more than one group of people that I feel like I'm constantly talking into, like, "Can we just have this conversation about nutrient density and nutrient sufficiency? Number one, can we talk about compounds in foods that are inherently anti-inflammatory versus compounds in foods that are inherently inflammatory?" And I feel like I'm butting up against plant-based diet people, and then this very, very stuck in, “You have to eat foods from all the food groups,” and this ...
Chris: That "We'll die if we don't eat whole grains" argument of nutritionists, dietitians.
Feeling empowered to experiment; a diet shouldn’t be a set of rules
Sarah: And so, I feel like when I'm talking to those groups of people, the only way to break through their very set opinions is to present a really robust scientific argument. And so that's one of the reasons why you and I have gotten along so well [chuckle] for so long because I know you do the same thing. But it's one of the reasons why the articles on my website are always thoroughly researched with citations and always present ... It's really important to me to present the current state of evidence in science, which is different than saying, "This is the way it is." Because we don't actually know everything.
We're still researching various topics. And there's aspects of Paleo for which the evidence is really, really strong, and there's aspects of Paleo where it's a little bit more nuanced, and there's a more detailed conversation to have surrounding those particular foods. And I really feel that it's very important to present that to not just naysayers, but also people who are trying to use Paleo to reach their health goals, because I think that it's really important to empower people with knowledge and to admit the current bounds of human knowledge. Because that's the only way that we can continue to adapt and refine is if we can say, "Now," admit upfront. [chuckle]
Traditionally prepared lentils is kind of a gray area. There might be some real benefits to this food for a lot of people. Maybe we shouldn't demonize it with soy. I think it's really important to have those more detailed conversations upfront so that it allows us to adapt as we learn more but also empower people to experiment with themselves as individuals and really understand their own optimal diet.
Chris: Right. I so agree, 100 percent. And there's so many things came to mind there, I was jotting a couple of them down. [laughter] There's so many directions we could go. One is, I think just expanding the conversation around diet to move away from this idea that there's one diet that is great for everybody. And I think legumes are a perfect example of that because, certainly, you know and I know from my work that for some people, legumes are a really bad idea and are gonna cause a lot of problems. And people that come to mind, there are people with GI issues, FODMAP intolerance, autoimmune issues, in some cases. Whereas for other people, lentils and particularly the fermentable fiber that they contain might be really perfectly fine in the context of an overall nutrient-dense diet. So, I feel like that's something that is changing but needs to continue to change because if you look at even the concept of having the top diet, a list of top diets [chuckle] that US News & World Report publishes, implies that we can just find one diet that's gonna be best for everybody.
Sarah: Well, and that's one of the reasons why I try very much in all of my writing, and I've tried very much in Paleo Principles, was to get away from trying to distill the Paleo diet or any other variation of the Paleo diet into a set of rules. And I really feel like that's one of the things that all of these other [chuckle] diets do. Right? They give you your "Eat this, don't eat this" rules, "measure this, count this" whatever it is. And I feel like that sets us up for two problems: One is that many human beings are sort of inherently rule breakers rather than rule followers, and I like to draw the comparison of speeding limits [chuckle] because I think there's a large percentage of the population that doesn't always drive the speeding limit. And maybe you're only going five miles an hour over, or 10 miles an hour over, and you're staying a belief in that threshold that would get you a ticket if you drove past a speed trap, but you're still pushing that rule, right? You're still trying to figure out your way around it. And I think we approach diet in very much the same way.
When you just say, "This is what I'm supposed to eat and this is what I'm not supposed to eat," it sort of sets us up for rebellion, for trying to find the wiggle room, the cheat meals, whatever it is, and I think that does us a disservice because when you don't really understand the reason behind the rules, it makes it a lot harder to respect those rules. And I think you could make the same argument for a really windy road with a low speed limit, and you say, "Well, look, these corners are so tight that if you take it beyond the speed limit, you can go over the edge of the cliff," and all of a sudden people are driving the speed limit on that road. So, I think that if you can provide a broader education behind the rules and get into, rather than a dogmatic, rule-based approach, start talking about an educational foundation that informs choices and allows people to really understand, "Okay, so if I choose this food instead of this food, this is the impact it's going to have on my body." And that's separate than being perfect. It doesn't mean that we're gonna make the best choice every time, but it empowers our choices with knowledge, so that we have this deeper reasoning for doing something rather than just, "I know I'm supposed to," or "I know I'm not supposed to."
I think that really is key to being able to effect a change in the chronic illness landscape right now because I think so many of us ... If you don't really understand why pizza and ice cream are not supporting your health, but you know they taste really good, you know you're not supposed to eat three meals of pizza and ice cream a day, but why not? Because, hey ... If you don't really understand what that's doing to your body, I think it's a lot easier to make the easy tasty choice as opposed to when you do understand what's going on. And then that translates to exactly what you're talking about, the getting away from one diet because you start to say, "Well, look, here's the main ideas that mean that this food is a better food than this food." It's nutrient density versus presence of compounds that might undermine your health in some way. And the thing is, is not all foods are black and white. There's these awesome foods that have tons of nutrients and nothing problematic in them, and then there's foods that have almost no inherent nutritional value and tons of problematic compounds, but most foods fall somewhere in the spectrum in between.
So, where do you draw the line? And if you have this detailed understanding of what's in that food that is going to hurt you or harm you, then you can figure out where the line is for yourself. And then you can experiment on yourself and figure out, "Well, are the saponins and glutenins that are not completely deactivated by soaking and cooking in lentils, is that enough to be too much of a problem for me personally with my health history, and with my particular health challenges and health goals, compared to the incredible fiber density of lentils, and also the mineral density of lentils?" If I put this on a scale of pros and cons, that scale has to be informed by my personal health, everything. So then I'm gonna be able to decide, "Does this make it into my diet or not?" Because I really understand the decision in this detailed way, and it's one of the reasons why I've tried to really steer clear of even defining Paleo as we eat all these things and not these things.
Learning to listen to your body and how it reacts to certain foods
Chris: Right. That is part of what we're struggling against as practitioners is we live in a culture where that kind of awareness of how things we put into our body impacts us is not cultivated or encouraged, and in some ways is discouraged. So many people don't ... They're not taught that or they're not helped to develop that as a kid, and then when they're adults, that software [chuckle] has not really been installed. And so, sometimes I've found that even if I say something like, "Pay attention to how that affects you," sometimes they get a blank stare like, "What do you mean?" And then I have to actually spell it out like, "Okay, so you're looking for any new symptoms, you're looking for an exacerbation of your current symptoms, you're looking for uncomfortable sensations in your body." It all sounds pretty elementary, but so many of us have not been supported in developing that kind of awareness. So I think that's one obstacle and one reason why people just want to be told what to eat and not to eat.
The other thing is, it's much easier in some ways to just follow a prescription than it is to pay attention and determine what's happening based on what you're eating, and that's not always easy too. You and I both know if you eat something for breakfast and then you feel worse after lunch, was it because of what you ate for lunch or what you ate for breakfast?
Sarah: Or what you ate four days ago. [chuckle]
Chris: So the food journals and stuff can be helpful, but it's not just that most of us haven't been supported to develop this awareness, it's that it's actually quite hard to do. So I think those were some of the obstacles.
Sarah: There's so many ... There's so much signal interference from refined and manufactured foods as well, which I think makes the ... I come from a history of morbid obesity and binge eating disorder, so I'm very familiar [chuckle] with the complete ineffectual aspect of listening to your body. My body says to eat all this ice cream. I don't understand what your body says. [chuckle]
Chris: Right. "What are you talking about?"
Sarah: This is what my body says! And so, part of my personal health journey has been in part getting better in tune with what my body is actually telling me, but it's also been detoxing from those foods that were clouding out the signals from my body. And then in some ways, letting my brain override some of those signals. So, I still ... Even six-and-a-half years into Paleo from ... Binge eating disorder is a mental health problem, and so I will still sometimes have compulsion-to-eat-type sensations, and I have to think my way through it. It's not strong, like it's not ... It's something that in the olden days I wouldn't have been able to resist, when that compulsion to eat would come, that would be a main driver of my behavior.
And now it's something that I can acknowledge and find a healthy something to satisfy that compulsion that's not going to derail me. But it's still something that will hit me from time to time, and I have to use my brain to go, "No, I'm not actually hungry right now." I know I feel like eating, but it's not ... Like this is the brain part, not the rest of my body talking. And that's been a really hard part of my personal health journey because it's required so much consistency in order to get to a place where I have a better relationship with food and a better understanding of my body's signals and what signals are real and which ones can just easily be ignored.
Chris: Yes. This is a subject probably for a whole other podcast. So I'm gonna pause here, and I wanna actually move back a little bit to research, given that it's been such a big focus for both of us. When I was writing my book, my most recent book, Unconventional Medicine, and I was talking about Functional Medicine, one of the biggest critiques of Functional Medicine, just like Paleo, is that it's not evidence-based, or there's no research for it.
Where is all the research for Functional Medicine and the Paleo diet?
Sarah: Again, I'm rolling my eyes.
Chris: Yeah, again, eye roll, of course. But one of the reasons for that is if you go to PubMed and you search, which is, for people who are not familiar, it's a database of studies that have been published. And if you type “functional medicine” into PubMed, you get nothing. You're not gonna see a list of papers all supporting Functional Medicine. Does that mean that there's no research on Functional Medicine? Absolutely not. Functional Medicine is a paradigm. It's a framework. It's a way of looking at things. And so if you use an example like irritable bowel syndrome, a Functional Medicine approach to irritable bowel syndrome involves looking at the underlying causes like SIBO or parasites or disrupted gut microbiome or gut–brain axis dysfunction, things like that, instead of just looking at how effective is using drugs to suppress the symptoms. So if we wanna go into PubMed and search for Functional Medicine evidence for irritable bowel syndrome, you look for a connection between SIBO and IBS, you look for a connection between disrupted gut microbiome and IBS, you look for a connection between nutrient deficiencies and IBS, and every one of those studies that you find, which you will find many of, support Functional Medicine, but none of them are gonna have the term “functional medicine” in them.Sarah: Well, and much of the research that I draw on to support the Paleo diet, it's a very analogous situation ...
Chris: That's what I thought.
Sarah: Because it's not ... These are randomized, controlled [chuckle] cross-over, triple-blinded clinical trials with 10,000 participants of “these people go grain-free and these don't.” I mean, you just can't do that in a blinded fashion, period. But it's more the..
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