I’m happy to say we finally managed to do a Q&A episode! In this episode we cover how to know when it’s time to ditch GAPS or very low carb (VLC) diets, what causes night-time leg cramps and what to do about them, how to treat migraines naturally, vaccinations, red meat/protein and kidney disease and CoQ10. Enjoy!
In this episode, we cover:
2:41 What to do – and not do – if you get worse on Paleo, GAPS, or other Low-carb diets
13:41 Simple supplements for night-time leg cramps, even if Natural Calm isn’t working
21:31 Remove these 3 foods to naturally treat chronic migraines
32:36 What is your opinion on vaccinations for early infants?
45:18 The myth that you should avoid red meat if you have kidney disease
50:04 Is it necessary to supplement with CoQ10, even on a Paleo Diet?
Links We Discuss:
- Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children
- Vaccinations: A Thoughtful Parent’s Guide: How to Make Safe, Sensible Decisions about the Risks, Benefits, and Alternatives
- Jarrow Formulas Q-Absorb Co-Q10, 100mg, 120 Softgels
- Doctor’s Best High Absorption Chelated Magnesium (200 Mg Elemental), 240-Count
- Proferrin ES Iron Supplement – 90 tablets
Full Text Transcript:
Steve Wright: Hey everyone, and welcome to the Revolution Health Radio Show. I’m Steve Wright from SCDlifestyle.com, and with me is Chris Kresser, health detective and creator of ChrisKresser.com. How are you doing today, Chris?
Chris Kresser: I’m pretty good, Steve. Just getting ready to start a little bit of time off, which I’m looking forward to.
Steve Wright: How long are you gonna be off?
Chris Kresser: Close to two weeks total from seeing patients. It’s been a while since I’ve taken that much time, and I’m looking forward to getting a chance to spend even more time with Sylvie and Elanne and just having some time to rest.
Steve Wright: Well, good for you, man. It’s well deserved and well earned, I’m sure.
Chris Kresser: How are you doing?
Steve Wright: Doing well, doing well. We got some new, exciting developments over at SCD Lifestyle. We just came out with a new stress product, and we’re working hard on some other new products, so it’s a busy time of the year for us.
Chris Kresser: Cool. So you’re gonna teach people how to get stressed out?
Steve Wright: We’re gonna try to remove the stress from stress management programs, because I have a stack of them that I’ve fallen off the wagon with, and it just seems like every program that we’ve bought, Jordan and I, we never stick with it, and so we wanted to try to strip them down and recombine them into a new product that sorta removes that, and we’re looking for people to commit 2 minutes a day, just 2 minutes, and if you can do that, we can guarantee that we’ll lower your overall stress.
Chris Kresser: Sounds like a good plan.
Steve Wright: Yeah, we hope so. OK, well, before we get started, I want to let you know that this radio show is brought to you by Beyond Paleo, and if you’re new to the paleo diet or you’re just interested in optimizing your health, then you’re gonna want to check it out. It’s a free 13-part email series on burning fat, boosting energy, and preventing and reversing disease without drugs. To sign up, go over to ChrisKresser.com and look for the big red box.
OK, Chris, so we’re finally gonna get around to the Q&A today, right?
Chris Kresser: We’re gonna do it! I’m excited.
What to do – and not do – if you get worse on Paleo, GAPS, or other Low-carb diets
Steve Wright: All right, well, let’s dive right in so we can get as many in as possible. The first one — and I apologize ahead of time, but I’m gonna do my best with this name — is from Aglaée, and she asks: “For someone with SIBO, which is small intestinal bacterial overgrowth, who is following a GAPS/Paleo/low-carb, grain-free, sugar-free, and dairy-free, and nightshade-free, and fruit-free, and nut-free” –
Chris Kresser: Holy moly. What are they eating?
Steve Wright: She says she’s eating bone broth, some probiotics, and some cod liver oil, but she’s not eating a lot of things, a lot of things that you’ve said in the past could make a gut hurt. She wants to know how long it’s gonna take to heal on something like this because she feels that her tolerances have worsened on this plan as of seven months ago. She used to be able to tolerate butter and can’t anymore and has to resort to ghee now.
Chris Kresser: Yeah. This is an interesting question from a lot of different perspectives. Well, let’s see. Let’s break it down into a few parts. So, the first question: How long does it take to heal a gut? Unfortunately, there’s no way I can answer that generally. Some people tend to respond very quickly to gut-healing protocols. I’ve had patients who have gone from pretty intractable gut symptoms to almost no gut symptoms at all within the space of a one-month dietary regimen similar to what she has described here, and then I have other patients for whom it takes years for their gut to fully recover. And the difference, I think, depends on what the initial cause of the gut problem is, whether it’s just dietary, you know, diet related or whether it’s related to a gut-brain axis issue or a pathogen or dysbiosis and SIBO or an autoimmune inflammatory condition like Crohn’s disease or ulcerative colitis or some combination of all of the above. It also seems to have something to do with how long somebody has had a gut issue. With nervous systems problems in the gut obviously being part of that, when we get into a certain groove or a pattern, the longer that pattern has become entrenched, the longer it can take to set a new pattern. So, it’s a really broad range, and it just varies from person to person.
However, there’s another part of this question that’s interesting and that tends to come up a lot, which is what happens when you go on a restrictive diet and foods that you weren’t previously sensitive to you are now more sensitive to? The example that she used was that she used to be able to tolerate butter, but she can’t anymore, and now she can only tolerate ghee, which has really no detectable casein or lactose in it. And I’ve heard variations of this question, like they remove gluten from their diet and whereas they didn’t really notice a strong reaction to gluten, after they’ve eliminated it for 30 to 90 days and they add it back in, all of a sudden they feel horribly ill when they eat it or any number of other foods that people can be sensitive to. So, to be honest, I’m not entirely sure what’s happening here, and I’m not sure it’s the same thing in every case because I have witnessed this in my patient population, and I’ve heard from enough people out in the blogosphere to know it’s real. My first thought and my first response to it is that sometimes when you’re having a number of reactions simultaneously, it’s difficult to know what you’re reacting to with any clarity. And then when you do one of these elimination diets and then add something back in and you have a very clear, strong reaction, it’s just more obvious than it was when you were in kind of a permanent state of reaction. That may be the case with some people, but I don’t think it accounts for all of the phenomena that we’re talking about. It’s also true that the body is pretty adaptable, and it’s probably the case that if you eat something that you react to, you can build up a little bit of a tolerance to it. That doesn’t mean it’s optimal food for you or that it’s a good idea to go on doing it, but it may have some kind of hormetic effect or the body may have some mechanism for protecting itself against the damage that that does, and so the reaction isn’t quite as severe. This isn’t really the case with allergies, like a true food allergy. That rarely happens, but maybe with an intolerance it’s possible.
The other thing is that with an extremely low-carb diet like the GAPS diet, it really starves the gut flora, and that’s a good thing when you’re trying to deal with SIBO, but over a longer period of time, I think it can also starve some of the good gut flora, and I have seen people worsen over the long term with the GAPS or SCD type of approach that’s very low-carb, and I think in certain cases that may be what’s happening, is the good gut flora is getting starved and their digestion actually worsens over time rather than improves. The truth is I don’t think we fully understand the whys and the hows to the extent that we’d like to with all of this stuff, and that’s why I do pay a lot of attention to people’s symptoms and I try not to be too dogmatic about any one particular approach. I know if you go on the GAPS forum and you say you’ve been on the diet for nine months and you’re getting worse, the responses that you’ll get are usually you’re not doing it right or you need to do it more, better, harder, faster, you know, whatever…longer! Because understandably a lot of the people on that forum have had their lives transformed by the diet, they really believe in it, and they kind of assume that it should work that way for everybody else, but the truth is it doesn’t always, and that’s why I sometimes will recommend when someone’s been on a really restrictive approach like this for a long time and they feel like they’re getting worse, Occam’s razor would suggest that the simplest explanation might be that that’s not the right program for you and that you might consider adding some foods back in that you had eliminated, particularly starch, and see what happens.
As a matter of fact, I just got an email yesterday from one of my patients who had a very similar story to the questioner here, and she had been on a GAPS diet for a longer period of time, probably 18 months, and just felt like she was spinning her wheels and getting worse, and her energy was extremely low, her digestion was really bad. She was gassy and bloated and constipated and was just having tons of trouble, and so I suggested that she not consider herself on the GAPS diet anymore, that she add some starch back in, and that she actually pretty dramatically reduce her intake of insoluble fiber and plant foods, because when you have a really inflamed gut, a lot of insoluble fiber-containing vegetables and fruits like winter greens and broccoli and cauliflower and things like that she was eating a lot of and that most people eat a lot of when they’re on a low-carb, GAPS type of diet can be really irritating to the gut. So, I talked to her, I don’t know, maybe two weeks ago or something, and I got this email from her yesterday that said that she was just doing so much better, that her energy levels had improved dramatically, that her digestion had improved dramatically. She had liberated herself from the idea that she had to eats tons of vegetables every day. I suggested that that wasn’t necessary because of the nutrient density of all of the other foods she’s eating, like bone broth and meat and liver and things like that. You don’t really need to rely on getting all of your micronutrients from plant food. So, now her meals were much more simple. They were just consisting of a portion of protein, a portion of starch, and maybe one vegetable that’s cooked well and that’s not particularly high in insoluble fiber, like carrots or squash. Or if she was going to eat winter greens, she would remove the stems and cook them very well, and that has really made a huge difference for her. So, it’s just one example, but I’m kind of a fan of people not beating their head up against the wall for too long. If they’re trying an approach and it’s not working, it might be worth trying something different. Now, having said that, of course, that’s not to say that someone should do something for a week and then skip to the next thing. I see that a lot, too, and that’s not an effective way of approaching things. But if you’ve given it a fair trial, and in my mind, you know, six to nine months is a pretty fair trial on something like the GAPS diet, and if you’re just worsening that entire time and not really experiencing much improvement, then I think it’s probably not a bad idea to try something different.
Steve Wright: Yeah, I think it’s important to definitely look to change especially if you’ve been on something for, like you said, six months. At SCD Lifestyle, this is kind of a plan that we basically try to start everybody on, something this small, and so we do get some of these emails every week, and so I’d like to share just kind of a tip that I’ve found to be in common for a lot of these people, and it’s usually, like you said, it could definitely be that this is just not the way for them to heal, and a lot of other times it’s that there’s an underlying problem. And you’ve talked about this many times, like there could be a parasite problem that they really need more testing. And a lot of other times it’s actually a defective digestive problem, like stomach acid, they might have a problem there, and so it doesn’t matter how stripped-down you strip your diet. If you’re not producing the right amount of stomach acid, you’re really not gonna digest anything very well. And so that might be something for her to look into.
Chris Kresser: Definitely.
Simple supplements for night-time leg cramps, even if Natural Calm isn’t working
Steve Wright: OK, let’s move on to the next question, Chris. This one comes from Cecilia, and she would like to know what to do about nighttime leg cramps. “Ever since going paleo, I get cramps at night similar to the ones I would get when pregnant in my third trimester. I’ve been supplementing with magnesium (Natural Calm at night) and this hasn’t made a difference. Any suggestions?”
Chris Kresser: Yeah. Leg cramps are tricky because they’re kind of a nonspecific symptom, which means they can be caused by a number of different problems, and they don’t point to any one particular problem without doing more investigation. But in my clinical experience, I can say that the most common perpetrators are either iron deficiency or excess iron, magnesium deficiency, potassium deficiency or imbalance, sometimes B12 deficiency, and then sodium imbalance or dehydration. Low blood sugar, hypoglycemia, or elevated blood sugar can also cause leg cramps. So, those are kinda the basic things to think about. Potassium, in particular, it’s one of the minerals that regulates muscle contraction, so potassium imbalance can definitely trigger leg cramps. It would be unusual for someone to experience that after going on a paleo diet. Usually people’s potassium levels increase when they go on a paleo diet because a lot of the most potassium-rich foods are fruits and vegetables that people tend to eat more of when they go on a paleo diet, especially like sweet potatoes and yams, pumpkin, spinach, avocados, bananas, oranges. Some of the melons are pretty potassium-rich, as are mushrooms. But it’s a pretty same thing to do to try and increase your intake of those potassium-rich foods and also supplement. You can consider supplementing with 100 mg of potassium a day.
In terms of magnesium, Natural Calm, I’m not a big fan of that product. A lot of my patients come to me, people when I first start working with them, they’re taking it, and I test their magnesium, red blood cell magnesium levels, and they’re low. They still have a lot of signs and symptoms of magnesium deficiency, and they’ve been taking Natural Calm. So, it does seem to help with sleep for some people and with constipation for some people, but I don’t know that it’s particularly well absorbed, and I usually recommend a chelated form of magnesium, like magnesium glycinate or magnesium maleate, and those especially at slightly higher doses, like 400 mg to 600 mg, even up to 800 mg a day, tend to be really effective for leg cramps if they’re caused by magnesium deficiency. You can also take epsom salt baths. That’s another thing that might help, like especially before bed if it’s happening at night during sleep. So, just soak in some epsom salts and given that a shot.
Check your iron levels using an iron panel and ferritin, so that would be serum iron, total iron binding capacity, unsaturated iron binding capacity, and iron saturation or transferrin saturation plus ferritin. And if all of those suggest that you’re iron deficient, then you’d want to eat more iron-rich foods. Organ meats like liver, and shellfish like oysters and mussels, and lamb are the highest dietary sources of iron. And you could also consider supplementing with iron. I prefer using the heme form of iron as a supplement, which is the form that you find in animal products. It’s much more readily absorbed than the plant or ferrous forms of iron. Unfortunately, there aren’t a lot of choices for heme iron supplements, but the one that I know of that’s most accessible is called Proferrin ES. Unfortunately, it’s got some somewhat unsavory ingredients in the capsule, but I think for short-term use, probably the benefit is gonna outweigh any harm that some of the additives that they put in the capsule might do. There are also iron chelates, like iron bisglycinate, that you could try. And that has been shown to be better absorbed than some of the more typical forms of iron that you find in supplements. Iron is tricky to supplement with because a lot of the plant-based forms of iron that are used cause pretty intense GI symptoms. Like, constipation is one of the classic symptoms or just gut pain or gas or bloating. So, Ferrochel is a popular brand of iron bisglycinate. You could try that. And acupuncture actually can be quite helpful for this kind of thing, for musculoskeletal stuff. It’s one of the things that I refer people to acupuncture for. So, if you have access to a good acupuncture clinic, you might give that a shot as well.
Steve Wright: You’re doing a big series right now on salt. Is salt sometimes a problem with leg cramps for paleo people?
Chris Kresser: Right. Yeah, I did mention that before with sodium imbalance and dehydration, so thanks for reminding me. I think it is an issue. I’m not sure that it’s a big problem, but certainly if someone is switched to a paleo diet and they’re only using sea salt or they’re not using sea salt, I mean, a lot of people switch to a paleo diet and they don’t salt their food at all, so getting one to two teaspoons, even up to three teaspoons of sea salt a day might be something to try as well.
Steve Wright: OK, so start with some potassium-rich foods and probably some sea salt and then get the rest of that tested. Does that sound like a plan?
Chris Kresser: Yeah. I will say that magnesium is really hard to test for. Serum magnesium is not an accurate marker. Red blood cell magnesium is a little bit more accurate. It measures the amount of intracellular magnesium in the red blood cell. But frankly the best way to determine if you have a magnesium imbalance is to take a high quality chelated form of magnesium like maleate or glycinate and see how you respond.
Steve Wright: With those chelated forms, I’ve heard a lot of people with the Natural Calm will be in, like, the 800 mg, 1200 mg a day. Do you suggest a lower amount and then sort of building up?
Chris Kresser: Yeah, I think a starting dose if you’re experiencing constipation or cramps or something like this would be two 100 mg capsules twice a day, so in the morning and with dinner, and that usually does the trick for most people. I think it’s safe to go up to 800 mg or even 1000 mg for short-term purposes, but yes, they usually will need less because it’s better absorbed than citrate or oxide or some of the other forms that are typically used.
Remove these 3 foods to naturally treat chronic migraines
Steve Wright: Awesome. Thanks, that’s great knowledge. OK, great. Let’s move on to the next question from Ellyn. She asks: “Any thoughts on naturals treatments for chronic migraine in a teenage girl? It’s been suggested that a ketogenic diet (a la the Perfect Health Diet) could be helpful along with magnesium supplements. Any thoughts?”
Chris Kresser: Yeah, that certainly could be helpful, and I have used that in my practice. But actually there’s something that I try first before I do that, and I think that a paleo/primal/Perfect Health type of diet is a great starting place. So, if you’re not already doing that, I would recommend doing that. Sometimes that’s all people need, but a lot of people often need more than that. So, what I do is a low tyramine, histamine, arginine diet, and I’ll go into a little more detail about why and where you find those in food in a second here, but as a general rule, total elimination of all of these foods is rarely necessary, and restricting or limiting them is usually all that you need to do, but I do recommend eliminating them to the extent that’s possible for 30 to 60 days just to see if this is gonna work for you, and then you can try gradually adding them back in in small amounts, class by class, to see which one has had the greatest impact, because some people, for example, tend to be particularly sensitive to tyramines but not as much to histamines or maybe the other way around or they don’t have any issue at all with arginine. So, just like any other elimination protocol, you really have to experiment and find what works for you.
So, tyramines are derivatives of the amino acid tyrosine, and they are present in some foods and some medications. Normally they’re inactivated by an enzyme called monoamine oxidase, or MAO, in the liver and the intestines, and it’s possible, some research suggests that MAO function might be compromised in migraine sufferers, which then leads to excess levels of tyramines in the blood, and excess tyramine in the blood can cause a temporary rise in blood pressure, sweating, nausea, migraine headaches, and a lot of the symptoms that are associated with migraines. So, tyramines are found primarily in fermented foods like smelly and strong cheeses, like blue cheese, for example; high-yeast alcohol like beer and wine containing sulfates; broad beans; brewer’s yeast; fermented foods, so like all the dairy ferments and sauerkraut and kimchi; sulfur-dried fruits; grapes; preserved meats and fish; and then in some OTC cough and cold medications. Some of these foods, of course, aren’t really typically considered to be on a paleo diet, but a lot of them are, and some of them are even very beneficial at least for people who don’t have this issue, like fermented foods, so it’s not necessarily something that would be done over the long term, and you can meet your need for probiotic organisms by taking a commercial, like an encapsulated probiotic while you’re doing this diet, but for anyone who has experienced migraines and the suffering that that can cause, it’s definitely worth giving this a shot for a period of time.
So, histamines, they occur in food as a result of microbial enzymes converting the amino acid histidine, which is found in all proteins, into histamine. And pretty much all foods that are subject to that kind of microbial fermentation as they’re made contain histamine, so this would include all cheeses, fermented soy products and all other fermented foods, like kimchi and sauerkraut, as well as alcoholic beverages and vinegars. There’s some overlap, as you probably noticed, between histamine and tyramine foods, so in addition to the list of tyramines that I just mentioned, you’d also want to restrict or eliminate for a period of time things like cinnamon, cloves, cocoa, certain vegetables like tomatoes, spinach, eggplant, and avocado, fruits like strawberries, banana, papaya, some tropical fruits like pineapple and mango, and then tangerines and grapefruit. And you can find lists of all of these foods online, by the way, if you just Google high-tyramine foods or high-histamine foods. We’re also talking about balsamic vinegar, peanuts and cashews and walnuts, and mustard and ketchup. So, what’s happening here with histamines is that people with histamine intolerance — and a lot of migraine sufferers seem to have that — have low levels of either or both of two enzymes: diamine oxidase, DAO, and histamine N-methyltransferase, and that’s sometimes abbreviated HNMT. These enzymes bind to and metabolize histamine, so if you have inadequate levels of these enzymes, you’re gonna have excess levels of histamine in your body. So, in addition to lowering your intake of histamines in the diet, another thing that you can do is take an enzyme, take DAO, diamine oxidase, which is one of the enzymes I just mentioned that metabolizes histamine. You can actually take it as a supplement, and that can improve histamine tolerance and reduce your symptoms. It doesn’t mean you should eat a whole bunch of histamine foods and just gobble a lot of DAO capsules, because that’s not gonna work very well, but those capsules in conjunction with a lower-histamine diet can make it more effective, and for some people, they can slightly increase histamine tolerance so that you can eat some of the foods that tend to have higher histamine levels in them without suffering. So, there’s one product called DAOSin. I think Swanson has one. It’s one of those things like Metafolin. It’s kind of a patented product that a number of different manufacturers use. It’s diamine oxidase from pork kidneys, porcine kidney, and that can help in conjunction with everything we’re talking about here.
And then lastly, arginine increases the amount of nitric oxide in the blood, which acts as a vasodilator. And migraine pain is thought to be caused by vasodilation in the cranial blood vessels, which is an expansion of the blood vessels, while headache pain, in contrast, is thought to be caused by vasoconstriction or a narrowing of the blood vessels, and this isn’t still very well understood, but this is one theory of how it works. So, avoiding foods that are rich in arginine can help prevent that vasodilation that’s thought to lead to migraine headache pain. And the paleo diet excludes most of the foods that are highest in arginine, but there are two foods that are permitted on a paleo diet that do contain high amounts of arginine, and those are nuts and chocolate, unfortunately! Those are usually the hardest ones to give up for people that are doing this antimigraine diet. So, that’s where I would start for migraines, and it’s a pretty successful approach. I would say probably 70% to 85% of my patients with migraines experience significant relief. I have some patients who have had intractable migraines for 20-plus years who have been on all of the medications and, you know, are just at their wits’ end, and they’ve tried this dietary approach in conjunction with an herbal formula that I make for them that has some foods that help prevent the histamine response and that are anti-inflammatory and have beneficial effects on the vascular system. So, the diet alone or the diet in combination with the herbal formula and the DAOSin, the DAO enzyme product, in some cases has completely stopped migraines after 20-plus years of just really debilitating episodes. So, it’s very effective. I think it’s absolutely worth a try, especially when you consider the alternatives. You know, some of the drugs that are used for migraines are not very effective and have a lot of side effects, so I think it’s worth a shot, for sure.
Steve Wright: Yeah, that sounds like a great natural, alternative way to see if you can get some help without referring to some drugs. Now, you mentioned that some people can kind of, like, eliminate them for some time and then slowly add these foods back in. Is that just because the body needs a little bit of time to clear out these byproducts?
Chris Kresser: I think that’s part of what it is. It’s like if you think of it like a cup and you pour water into a cup, and if the level of water is all the way right at the top, then any amount of new water you add to it will make it overflow. But if the water level drops in the cup, then you can add some more in without it overflowing. It’s kind of a rough analogy with what might be happening in this situation. But I think the other thing that happens with the elimination diet is when people eliminate all of these foods because they don’t really know which ones are the most problematic, and then they start adding things back in and trying them class by class, like histamine, tyramine, arginine, but then also even within a class, like within the histamine class, maybe the cinnamon and cloves and spices like that aren’t really a problem for them, but certain nuts and vinegar are really problematic. So, there’s a range of tolerance even within a particular category, and that’s the sort of thing that people can figure out through experimentation, which means that ultimately the diet isn’t as restrictive, you know, over time as it was for that first 30 or 60-day period.
What is your opinion on vaccinations for early infants?
Steve Wright: OK, awesome. Let’s move on to the next question from Judah. “What is your opinion on vaccinations and early infants?”
Chris Kresser: I’m just chuckling a little because it’s a little bit like walking into a room and saying: What’s your opinion on abortion? You know, and then just closing the door and seeing all hell break loose.
Steve Wright: Putting the ball on the tee, man!
Chris Kresser: Yeah, talk about a hot button issue in the world of health and medicine! I mean, I can’t really think of a more contentious topic, and unfortunately there’s a lot of hype and propaganda on both sides, and the people that end up suffering are people like this who just generally want to know what the science says about it so they make the most informed decision as parents. So, I do intend to cover this in more detail at some point, but I’ve frankly delayed doing it, partly because of how contentious it is and it’s a monumental undertaking. I mean, you can spend a whole lifetime researching this stuff and still not really feel like you’re completely on top of it, and it’s just something I haven’t really had the time to put together in a series yet. I hope to do it at some point but haven’t been able to. Of course, it is something I’ve researched extensively and thought a lot about, especially as a new parent, and as Elanne was pregnant with Sylvie, I did a lot more research on it, and we came to a decision that we felt comfortable with, but I think the way I’m gonna answer this question for now is by sharing a little bit about our process in deciding and then just kind of a general recommendation that I have for people in terms of making this decision.
So, the first thing I’ll say in that regard is that I don’t think this is a decision that can be made based on the data alone. The data are conflicting. There’s a lot that we don’t fully understand about how vaccination affects the body. There’s a lot that we probably will never fully understand or that it will be difficult to fully understand, and this is similar to what we talked about in either the last episode or the episode before that about the difficulty doing randomized clinical trials with certain kinds of conditions because with vaccination, for example, it’s very difficult to say, let’s say if you vaccinate a group of children and you want to find out if vaccinations contribute to immune dysregulation and autoimmunity and, you know, allergies and asthma and things like that. So, let’s say you take a group of children and one group of children is not vaccinated and another group of children is vaccinated, and you follow them 15 years later and the group of children that’s vaccinated has higher incidence of autoimmune disease. Well, that doesn’t prove anything. You can’t say for sure, as we talked about in the red meat study, that it was the vaccinations that caused that higher incidence of autoimmune disease, because there could be a lot of potential confounding factors. Maybe parents who are more likely to vaccinate are more likely to follow mainstream dietary advice, for example, and parents who are less likely to vaccinate are more “health conscious” and they’re considering, you know, maybe they have their kids on healthier diets, and there are any number of other intervening factors. So, to really find out whether vaccinations contribute, you’d have to do very long randomized, controlled trials that would be extremely expensive, and it’s unlikely that the pharmaceutical company’s gonna pay for that trial, right? Because they’re the ones manufacturing the vaccines, and they’re not really interested in proving that vaccines cause immune dysregulation.
So, I think that the most important sort of meta-comment I can make here is that, yes, we can look at the data here and then we can also look at known and understood physiological mechanisms, ways by which vaccines could potentially cause immune dysregulation, and that’s part of the Hill criteria that I alluded to in designing better epidemiological research, is when you have an epidemiological connection or a correlation between two things, if there is also a mechanism, a plausible mechanism that can explain that correlation, it strengthens the correlation. It makes it more obvious, which is why the red meat and cancer connection isn’t as strong because nobody’s ever explained what the plausible mechanism is there. So, when people ask me this, in the most basic sense I tell them you can’t make a decision on whether to vaccinate your children only based on the data, because the data are insufficient to lead to a really conclusive recommendation. So that’s number one. Number two is that I emphasize to people that there is a risk in vaccinating, and there is a risk in not vaccinating. And anyone who tells you differently is not acquainted with the research literature, and that’s why I said there’s a lot of hype and propaganda on both sides, because you have some anti-vaccine proponents saying that’s completely safe not to vaccinate. And then you have pro-vaccine people saying it’s completely safe to vaccinate, and of course, we can easily find examples that disprove both of those statements. There is a risk when you don’t vaccinate. There’s a risk of your child contracting an acute illness that could even potentially be fatal, and anyone who chooses not to vaccinate has to understand that, because it’s a real risk. Now, how big of a risk that is, that’s, of course, a whole other question, and it’s something that I’ll be talking about in detail when I finally get around to discussing vaccines. And on the other hand, there’s clearly a risk with vaccination, and there are studies that have shown vaccine injuries and particularly vaccines that contain mercury in them, and then there’s a lot of, like I said, correlations and plausible mechanisms and other data that point to the distinct possibility that vaccines cause immune dysregulation and can increase the risk of autoimmunity as kids get older.
So, I will tell you what Elanne and I have decided to do. I actually hesitate to do it because my concern is that somebody will just follow what we did because that’s what I said that I do, because sometimes people are busy and it’s natural to find someone that you trust and just follow their recommendation, but I actually strongly urge you not to do that in this case. It’s something that you really, really need to investigate. And I’ll recommend a couple of books that we can put in the show notes that you can read, but I just really stress that this is a personal decision. It’s something that has to fit with your philosophy and worldview with your risk tolerance. Like, for example, do you consider the, I think, very, very small chance of your child contracting a serious and potentially fatal acute illness to be the greater risk? Or do you consider the much larger chance, in my opinion, my interpretation of the data, of your child experiencing chronic immune dysregulation as a result of being vaccinated a bigger risk? And that’s not a rhetorical question. You know, some people, I’m sure, who are listening to this might think: Well, you know what? I could not deal with the possibility of my child getting really sick or dying from an illness that they could have been vaccinated against. Now, having said that, keep in mind that a lot of children die from those illnesses who are vaccinated against those illnesses, so getting vaccinated is not a guarantee by any stretch of the imagination. It’s not 100% protection against serious illness or death, and in a lot of cases, the kids who are getting sick and dying are vaccinated. But you have to ask yourself what are you most comfortable with, and that decision is gonna be really different based on someone’s worldview and philosophy and approach to health and wellness. And I don’t have any judgement about that. You know, I have my own opinions and ideas, and I know where I stand on that spectrum, but we all have to kind of meet this wherever we are and where we’re coming from. So, at the moment, and Elanne and I continue to talk about it, so it’s something that could change, but at the moment, we’ve decided we haven’t given Sylvie any vaccinations at all. She’s 9 months old now, which is amazing. It goes so fast! But she’s 9 months old, she hasn’t been vaccinated, and the only vaccination that we’re considering at this point is tetanus, partly because it’s one of the vaccines that seems to have the fewest adverse effects, and tetanus is a very, very serious illness. So, that’s our current thinking on it. Again, who knows? We may change our mind, but that’s where we’re at right now.
So to summarize, I think, number one, the decision can’t be made on the data alone. You really have to consider your own philosophy and worldview and risk tolerance. And number two, please don’t make this decision based on what I do or somebody else that you know does. Do your own research, and speak to people that you know and you trust, and really give it the thought that it deserves.
Steve Wright: Well, I want to thank you as a listener of the show for sharing that, because I know it puts you out on a ledge to stand there and tell us about your personal life and the decision that you’re currently making with your little daughter, so I want to thank you, Chris, and I just want to add on to the doing the research that, you know, Chris is going to raise and feed and all of the reasons why a drug trial cannot really prove vaccinations one way or the other way is another reason why it’s really important to do your own research and come to your own conclusion because all the different factors that happen throughout life as you raise your child will be different.
Chris Kresser: Absolutely. Yeah, and I hope this was helpful. I imagine some people might be frustrated and wished that I have gone further into the data, and I understand that, and like I said, I’ll do my best to get to it at some point, but it’s a really big, big topic, as I’m sure most of you know. And I’ll give you a couple of book recommendations, like I said, that can get you started.
- Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children
- Vaccinations: A Thoughtful Parent’s Guide: How to Make Safe, Sensible Decisions about the Risks, Benefits, and Alternatives
The myth that you should avoid red meat if you have kidney disease
Steve Wright: OK, great. Well, let’s move on to a simpler question from Rachel. First, she loves the podcasts. Thank you, Rachel. And second, of the info that you gave people who may need to minimize their red meat intake on one of our past shows, we mentioned hemochromatosis and not individuals with kidney disease. Do you not feel that limiting protein is necessary among this population?
Chris Kresser: Well, actually, thanks for pointing that out, Rachel. I do think that in some cases that might be necessary, and there are probably other populations that I didn’t mention there as well. I was just, I think, trying to hit the major ones. In the scientific literature, we could say that a high-protein diet is often defined as a daily consumption of more than 0.7 grams per pound per day or 1.5 grams per kilogram per day. So, when we say a high-protein diet, just so everyone understands, that’s what we’re referring to. So, it’s not red meat, per se, that’s problematic for people with kidney issues if you’re eating a moderate amount of protein. I mean, that’s a pretty high protein intake of 0.7 grams per pound per day. So, you could eat red meat in a moderate amount, even with kidney disease, and as long as you’re not exceeding that amount, then you’re not really eating a high-protein diet and you wouldn’t be at any additional risk for kidney problems, so I think that’s the first thing that I would say. The second thing I would say is that there is some evidence that suggests that people with kidney disease should not eat a high-protein diet. There’s a big, big trial called the Modification of Diet in Renal Disease Study, MDRD. It’s the largest randomized multicenter controlled trial that’s been done to evaluate how dietary protein restriction affects the progression of renal disease. And they found that patients with kidney disease that were following a low-protein diet had slightly lower, not hugely, but slightly lower decline in glomerular filtration rate, which is a measure of kidney function, compared with patients that were eating the higher-protein diet. And then they did some further data analysis that showed that patients with lower total protein intake would have a longer time to reaching late-stage kidney disease or renal failure and suggested that a lower protein intake would postpone the progression into those later stages of kidney disease, because chronic kidney disease is classified in five stages, stage one being the mildest and stage five being the most serious with kidney failure. And then there have been meta-analyses of studies on protein restriction in diabetics and nondiabetics with kidney disease that found that the progression of renal disease in both of those populations could be effectively delayed with restriction of dietary protein.
But the important thing to take away from this, as we talked about with the red meat study, is you can’t extrapolate findings from one population to another population, so just because high-protein diets might be harmful in people with kidney disease, that doesn’t mean they are for healthy people. I know I’ve probably used this example before, but if someone who has had their gallbladder removed doesn’t tolerate fat and doesn’t digest it very well, it doesn’t mean that healthy people with an intact gallbladder will have the same experience. And indeed, a lot of different studies have shown that high-protein diets don’t reduce kidney function in healthy people, and they don’t even reduce kidney function in populations that are generally at risk for kidney disease, like people with dyslipidemia or obesity or hypertension. So, yes, if you have chronic kidney disease, particularly later-stage chronic kidney disease, you don’t want to eat a high-protein diet, but that doesn’t mean you need to avoid red meat. It just means you need to avoid eating red meat and other protein in excess of 0.7 grams per pound per day or 1.5 grams per kilogram per day. I think that’s it for this question.
Steve Wright: OK. Well, I think you covered it pretty in depth there. So, do we have time for one more question?
Chris Kresser: Let’s do the CoQ10 question.
Is it necessary to supplement with CoQ10, even on a Paleo Diet?
Steve Wright: OK, so Carrie asks: “If you haven’t already, would you speak about CoQ10 levels with paleo nutrition and your opinion of supplementing with it? I.e. do CoQ10 levels decrease with age the same as the general population? Thanks!”
Chris Kresser: Yeah. It’s a great question. It’s one that I get fairly regularly, actually. CoQ10, it’s found in most cells, primarily in the mitochondria, and it’s a component of the electron transport chain, and it participates in aerobic cellular respiration, which is generating energy in the form of ATP, so I don’t know if you all remember back to your high school biology class and the Krebs cycle, citric acid cycle, and ATP production, ATP being the fundamental energy unit of the cell. This is what we’re talking about here. And 95% of the human body’s energy is actually generated this way, so it’s a very important process. You can think of CoQ10 kinda like the spark plug in a car, and without that initial spark that CoQ10 supplies, the body can’t function properly. CoQ10 deficiency can produce not only subjective signs of low energy and fatigue but all kinds of different — You know, the range of symptoms that it can produce is vast because ATP fuels cellular energy production, and cellular energy production is what makes the body function properly. So, if you’re CoQ10 deficient, a lot can go wrong. Now, CoQ10 can exist in three redox states and be fully oxidized as ubiquinone, it can be semiquinone as ubisemiquinone, and then fully reduced in the ubiquinol form. And this enables it to perform functions both of energy production in the electron transport chain that I mentioned, and also it can function as an antioxidant. And when it does that, CoQ10 inhibits lipid peroxidation, so the oxidation of fats by preventing the production of lipid peroxyl radicals. So, that’s a lot of scientific mumbo jumbo, but basically the thing that most people need to understand about CoQ10 is that it plays a crucial role in energy production, and it plays a crucial role in preventing oxidative damage. So, lately in my patient population, I’ve been doing some urine organic acids testing, and one of the things that shows up on that test is several different markers for CoQ10 deficiency, and I would say probably 80% to 85% of people that I test with the organic acids test are CoQ10 deficient.
Steve Wright: Wow.
Chris Kresser: Yeah, really high. And I think that probably can be explained by the level of oxidative stress that most of us are living with in modern lifestyle. There’s a lot of oxidative stress that we’re subject to, and CoQ10 would be depleted in those conditions.
Steve Wright: Are there any patterns that you see? Is it gender or age?
Chris Kresser: Well, CoQ10 production tends to decline with age, so I’ve seen some statistics that suggest that by the time we’re 50 we have half the amount of CoQ10 that we had than we were 20 years old. So, simply aging can decrease CoQ10 levels, but we experience oxidative stress as we age, so that’s not an underlying mechanism, but it’s just something to be aware of. And then there are genetic factors that can also lead to CoQ10 deficiency, because the biosynthesis of CoQ10 requires at least 12 different genes, and mutations in many of them can cause CoQ10 deficiency. I don’t do a lot of that kind of genetic testing, but I have some colleagues that have done that, and apparently those mutations in those genes are not uncommon. CoQ10, as many people know, shares a biosynthetic pathway with cholesterol, so the synthesis of mevalonate, which is an intermediary precursor of CoQ10 is inhibited by some drugs, like beta-blockers, in particular, and blood-pressure-lowering drugs and, of course, statins. Statins inhibit the production of cholesterol and CoQ10, and that’s why statins have been shown to reduce serum levels of CoQ10 by up to 40%. So, anybody who’s taking a statin should absolutely be taking CoQ10. That’s just a no-brainer. And fortunately, I think the awareness for this is increasing in the general medical community, and I think a lot of doctors even recommend it now, but if anyone knows someone who’s taking a statin or you’re taking one yourself, that’s definitely something you should speak to them about or you should be doing. And if you have CoQ10 deficiency, whether you’re on a statin or not, supplementing is really good idea.
There are a couple of things I want to point out regarding CoQ10 supplementation. Number one, despite a lot of claims by supplement manufacturers, there’s no solid evidence that ubiquinol is a superior form to supplement with than ubiquinone, which is the cheaper form that’s been used for decades in the research. And I’ve never seen any study that has convinced me that ubiquinol is better to use, so just stick with the ubiquinone. The main factors that determine CoQ10 absorption are, number one, whether you eat it with fat, because CoQ10 is fat-soluble, so whenever you take a CoQ10 supplement, you should always take it with a meal that includes some fat or just a snack that has some fat. And then there are certain forms of CoQ10, certain delivery mechanisms, I guess you could say, that have been shown to be better absorbed than others. There’s one called the Kaneka Q-absorb process that’s a proliposome lipid-soluble delivery system, and that makes sense because CoQ10 is fat-soluble, right? So, that’s been shown in one study to increase CoQ10 levels up to 400% from baseline. The one product that I will often recommend is Jarrow Q-Sorb. That uses this Kaneka Q-absorb delivery mechanism, and it’s pretty affordable. I don’t see any need to buy anything fancier than that. And the dosage can vary a lot, but generally with a mild to moderate deficiency, 60 mg to 120 mg a day is a good starting place.
Steve Wright: This is interesting because I’ve looked into this before. Once you start supplementing with this, do you build the levels back up in the body, or is this something that if you’re under oxidative stress and you’re on a paleo diet that you’re gonna be taking this supplement part of your daily regimen for a while?
Chris Kresser: I think you kind of answered the question to some extent in asking it. It depends on how you’re able to alter the things that led to the CoQ10 deficiency in the first place, right? If you have a genetic mutation, there’s not too much that you’re gonna be able to do about that probably, so some people may need to take CoQ10 indefinitely. They just might feel better on it, more energy, their body might function better. People who are dealing with significant levels of oxidative stress, of course, the recommendation there would be to take steps to reduce oxidative stress, and then if that’s possible, it’s possible in that case to get off the CoQ10. Some people, I think, going back to the analogy we used before with histamine, I think taking CoQ10 for a therapeutic period of time and repleting CoQ10 levels is enough to get things functioning properly again, and then you can discontinue maybe after three to six months or something like that, and that doesn’t rule out the possibility that you might need to start taking it again at some point, but generally I consider three to six months to be kind of a therapeutic window for repleting levels of CoQ10 or any nutrient that’s been depleted. And then, of course, if somebody’s on a statin, for as long as they’re taking a statin or any other drug that’s known to inhibit CoQ10, then they’ll have to continue taking the CoQ10. So, it really depends on the circumstances.
Steve Wright: OK. Thanks for clearing that up. Last question about this: If, say, you don’t have access to some organic acid testing, you’re not taking a statin, you’re just doing paleo and trying to live a healthy life, are any sort of symptoms that might indicate that I’m likely to be CoQ10 deficient?
Chris Kresser: It’s pretty hard to make that determination just with symptoms because a lot of the symptoms are so nonspecific. I would say fatigue is probably one of the biggest ones, particularly, I mean, fatigue on exertion, like getting tired more quickly than you think you should. Muscle fatigue could be another one because CoQ10 is involved in energy production in the muscles, so if your muscles are getting really fatigued even after short periods of activity, that’s another one. And cardiovascular issues because the tissues that have the highest energy needs are the ones that have the highest levels of CoQ10, like the heart. The organic acids test, though, is pretty accessible. It’s not too expensive. It’s like $180 for the basic version. Genova Labs does one. Metametrix does one, which is the one that I use. And I think even now, someone told me the other day that there are some websites now that you can order the test through without having a clinician. I’m not sure what they are. Maybe I should mention which one, but maybe I can find that out for the future. I do, however, recommend working with a clinician, particularly with that test. It’s pretty complicated to interpret, and oftentimes patients are pretty overwhelmed when they see the results, and it takes quite a bit of interpretation and explaining, because even when you see that something is deficient or in excess on that test, it doesn’t tell you why, and that’s where you need some deeper understanding of the mechanisms involved and the connections to be able to figure out why those things are deficient so that you don’t end up just taking a million different pills because the test says you should.
Steve Wright: That is the key: working with somebody who’s seen the patterns.
Chris Kresser: Yeah, I mean, the example, something that tends to come up a lot on that organic acids test is a marker for biotin deficiency, and what is usually the case in that situation is that someone has gut dysbiosis. Why? Because biotin is produced by the intestinal bacteria. And so, if you don’t have enough of the type of intestinal bacteria that produces biotin or you have an imbalance, a gut dysbiosis, that’s probably, in part, what’s contributing to the biotin deficiency rather than a decrease in not eating enough biotin in the diet, although that’s possible, too. So, in that situation, you’d want to address the gut dysbiosis primarily and then secondarily probably supplement with biotin for a particular period, but you really need to get to the underlying cause.
Steve Wright: Wow. You are just a resource of information. That’s awesome.
Chris Kresser: I’m a geek, as you know, Steve. That’s what I spend my time doing.
Steve Wright: But so much more. We don’t even know it. You might have, like, a Batman call, like a light or something out there in California. I’m gonna look more into this. I might travel out there and do some research.
Chris Kresser: Yeah, come on out and say hi. All right, we did it! We did a Q&A episode!
Steve Wright: Yeah! We got all the way through it.
Chris Kresser: Yeah. We’ve got lots of great questions lined up. There were some other ones that we hoped to get to today, but we have them on the list, and we’ll continue to get to them in the future episodes, so thanks for your patience.
Steve Wright: Yeah, thanks everyone for listening. We’re gonna send Chris on his vacation, and I’m hopefully gonna send you over to ChrisKresser.com to use the podcast submission link and send us more questions. And also, if you’ve enjoyed the show today, please head over to iTunes and leave us a review.
Full disclosure: I make a small commission if you use the links in this article to purchase the supplements, books or other products I’ve mentioned.