RHR: Poor Sleep Patterns, Low Ferritin Levels, and Juice Fasting

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Another Q&A episode, which we tried recording in a closet!  The clothes apparently absorb the sound, so I want to hear from you if you notice a difference in the audio quality.  Please leave a comment and let me know how it sounds to you.

Sorry it’s a little late. We got off of our normal schedule because of some commitments I had; we’ll be back to normal starting with the next show.

In this episode, we cover:

1:44 What Chris ate for breakfast
4:03 What supplements should kids take?
7:48 What to eat for lifelong constipation
18:05 How to support adrenals after having a baby
27:08 What to do about low ferritin levels
31:50 Tips for teething babies
34:50 Dealing with disrupted sleep patterns
42:14 How do you explain someone that feels better on a juice fast?

Links We Discuss:

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Full Text Transcript:

Steve Wright:  Hey everyone, welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com.  I’m your host for the show, Steve Wright from SCDLifestyle.com, and with me is integrative medical practitioner and healthy skeptic Chris Kresser.  So Chris, how’s the closet?

Chris Kresser:  Haha, so we’ve had a suggestion from one of our more audiophilic listeners who has mentioned that there’s sometimes an echo in the background, and that’s probably because I record in my home office, which has high ceilings and it’s acoustically not the best space.  So somebody recommended that we try recording in a closet!

Steve Wright:  Haha, the lengths to which we go for our listeners, Chris!

Chris Kresser:  That’s right.  I’m in a closet.  The clothes apparently absorb the sound, and I will say it’s not the most aesthetically pleasing recording space, so I want to hear from you if you notice a difference in the audio quality, and I’m not yet committing to doing this every time even if you do notice a difference, because so far I’m not a huge fan of the closet recording.  But we’ll give it a shot.  We’ll see how it goes.

Steve Wright:  OK.  All right, well, you’ve been posting pictures all week of traveling and eating, so we have to talk about what you had for breakfast this morning.

What Chris ate for breakfast

Chris Kresser:  Well, let’s see.  Breakfast I skipped.  I had some coffee and cream, and then I had a leftover stew for lunch, which was made with chuck roast from the beef we get from our local farmer, Freestone Ranch, and potatoes, carrots, peas, homemade chicken broth, I think some onions, and some seasonings.  And then I had some homemade raw sauerkraut with ginger, beets, carrots, and cabbage to go along with that.

Steve Wright:  Sounds pretty delish.

Chris Kresser:  Yeah, it was good.

Steve Wright:  Let me know when I can come over and clean up your leftovers.

Chris Kresser:  Haha, all right.  How are you doing, Steve?

Steve Wright:  Well, as of the time of this recording, it’s late in the week, and I’m ready to respect my body and get a long night’s rest.

Chris Kresser:  TGIF, huh?

Steve Wright:  Yeah.  Thank goodness it’s Friday, and I’m looking forward to maybe, like, 10 or 12 hours’ worth of sleep here.

Chris Kresser:  Nice.

Steve Wright:  I’m going to do my best.

Chris Kresser:  Sounds good.

Steve Wright:  OK, well, I think we have a Q&A episode that’s going to be pretty fun today, Chris, and I know that you’re going to be doing most of the talking, so why don’t you get a glass of water or search through the clothes and see what needs to be folded in there, and I’m going to go ahead and tell everybody about Beyond Paleo.  So if you’re new to this podcast, it’s going to be really fun, you should keep listening, but you should also check out Beyond Paleo.  If you’re new to the paleo diet or you’re just interested in optimizing your health, you’re going to want to check out what over 30,000 other people have signed up for.  It’s this mysterious Beyond Paleo that I keep talking about here, and it’s a free 13-part email series on burning fat, boosting energy, and preventing and reversing disease without drugs.  Head over to ChrisKresser.com, and look for the big red box where you can sign up, and Chris will start sending you the first email very shortly.

Chris, how are the clothes?

Chris Kresser:  Everything’s pretty much the same way I left it before.

Steve Wright:  Haha, perfect.

Chris Kresser:  All is well.

What supplements should kids take?

Steve Wright:  Well, everyone loves to hear about Sylvie, so let’s start off with the first question from Brenda, which is, “Does your daughter receive any supplements, and if so, what?”

Chris Kresser:  She only receives one, and it’s debatable that it’s a supplement at all because it’s a whole food, but it’s fermented cod liver oil.  I do kind of think of it as a supplement because most people just don’t eat it as part of their normal diet.  She’s been getting that since she was about 6 months old, 7 months, when we first started her on food.  And the amount has been gradually increasing.  And I think I’ve mentioned this on the show before, but amazingly she just takes it straight in the mouth, no flavor.  Flavors actually aren’t a good idea for really young kids.  She’s getting close to 2 now, so it wouldn’t be that big of a deal for her, but you wouldn’t want to use strong flavors for infants.  But from the beginning she’s liked it, and it got to the point where she’d ask for it after meals, and we’d just shoot it right into her mouth with the little plastic syringe that they give you.  Lately something interesting has happened:  She has been refusing it.  But I don’t think it has anything to do with the taste.  She’s just in this phase where she’s refusing things!  And the more that she senses that we want her to do something, even though we’re really kind of, at least on the surface, laid back about it, we don’t push it at all, but she senses that we want her to have it, and so lately she’s been saying, “No.  No!”

Steve Wright:  Haha, you’re going to have to just leave it on the counter and go into the other room?

Chris Kresser:  Yeah.  Totally pretend that we don’t want her to have it.  But I also heard some of my patients have tried — you might have seen this, Steve — Green Pasture just came out with this new product.  It’s a coconut oil base, but they infuse it with butter oil, fermented cod liver oil, and fermented skate liver oil, which is a different type of fermented fish liver oil, and it has complementary nutritional properties to fermented cod liver oil.  Apparently some of my patients who just couldn’t stomach any of the cod liver oils, even the cinnamon flavor, which I think barely even tastes like cod liver oil, but some of my patients who couldn’t take any of them are able to take the coconut oil based, and I think that would probably be a good one for kids, too.  So if anyone’s having trouble giving their young child cod liver oil, you might want to give that one a shot.

Steve Wright:  Interesting.  I haven’t seen that one yet, but I typically stick to the cinnamon.

Chris Kresser:  Yeah.  To me, the cinnamon is… literally I can barely taste the cod liver oil.  Maybe it’s just that I’m accustomed to it, but the cinnamon is so strong that it’s pretty overwhelming.

Steve Wright:  I would agree.

Chris Kresser:  So that’s it.  We occasionally, every now and then have given her, like if we’ve traveled, a little bit of infant probiotic from Klaire Labs, but that’s pretty sporadic, and she doesn’t really get anything regularly other than that.

Steve Wright:  But she is fond of eating a whole plate of sauerkraut, so you don’t have to worry too much about the probiotics, right?

Chris Kresser:  Haha, absolutely.  We have to keep her away from it.

What to eat for lifelong constipation

Steve Wright:  Haha.  Well, let’s talk about where some more sauerkraut might be needed.  This question comes from Lucy, and she wants to know, Chris:  “What is the best diet for lifelong constipation?”

Chris Kresser:  Hmmm.  That’s actually a hard question to answer because I think it depends on a lot of factors.  I’ll give a general response, and then I’ll mention some extenuating circumstances.  I think, in general, the best diet for lifelong constipation is one that nourishes the gut and doesn’t irritate the gut.  And that’s really general, so let’s go into a little more detail there.

Steve Wright:  Break it down.

Chris Kresser:  Yeah, so foods that nourish the gut would include fermentable fibers, I think.  So we’re talking about water-soluble fiber in fruits and vegetables, starchy tubers.  Resistant starch is in some tubers, and that’s actually insoluble fiber, but it is fermentable.  And a lot of studies have shown that the fermentation of soluble fiber produces short-chain fatty acids like butyrate, in particular.  And these short-chain fatty acids have a number of beneficial effects on digestive health, but not only digestive health, also heart health and even brain health.  They play an important role in the differentiation of colonic enterocytes, which are the cells that make up the lining of the gut.  And so the production of these short-chain fatty acids is probably responsible for a significant portion of the benefits that are seen in observational studies that look at fiber intake and health outcomes.  And you know, we can never draw causal relationships, of course, from these studies, but the observational studies consistently do show that soluble fiber intake, at least, is associated with better health outcomes.  So there are a lot of reasons to use fruits and vegetables and starchy tubers.  One of them is gut health, and constipation is usually caused by a lack of beneficial gut flora, particularly bifidobacteria in the colon.  And one of the best ways to stimulate the growth of that flora in the colon is eating these fermentable fibers in the context of a whole foods diet, like fruits and vegetables and tubers.

Now, the other part of that was avoiding foods that irritate the gut, so these are the food toxins that we often talk about:  refined flour, refined sugar.  Both refined flour and refined sugar can cause unhealthy changes in the gut flora that could predispose toward constipation.  Grains and grain fiber tend to be high in insoluble fiber, which has a mechanically rough action on the gut.  It’s kind of like rubbing a wire brush against an open wound, so that can be really irritating to the gut, especially if the gut is already inflamed.  Industrial seed oils, you know, corn oil, soybean oil, all of these “Franken-oils” have been shown to cause undesirable changes in the gut.  And then gluten and various different compounds in wheat can be aggravating.  I mean, they can be extremely aggravating to the gut if you have celiac disease, of course, but even non-celiac gluten sensitivity.  And some studies suggest… There have been extremely limited, I think just one or two, studies that have shown that gluten might even be inflammatory in people who don’t have any obvious gluten sensitivity or celiac disease, but that’s definitely not a solid finding.  But non-celiac gluten sensitivity is a lot more common than most people believe.  Some statistics range between… I’ve seen some numbers as high as 1 in 12, and then 1 in 20 is another estimate that often gets thrown around.  And celiac disease is actually more common than was previously believed, as we discussed with Dr. Fasano.  A lot of people have some level of gut inflammation, and I think it’s probably best for most people to avoid gluten for that reason, regardless of where they fall on the spectrum of gluten intolerance.

Let’s see.  Regarding fiber supplements, it’s another one of these things that’s kind of accepted without question:  the idea that fiber and fiber supplements benefit constipation.  And it’s true that fiber in the context of the diet appears to be beneficial for regularity, but fiber supplements, when they’ve been tested, have often not been shown to be beneficial for constipation and can actually have the opposite effect.  So you want to be careful with fiber supplements, just as a side note there.

Now, the extenuating circumstances here are that it often depends what the cause of the lifelong constipation is.  As I said, it’s often insufficient amounts of beneficial bacteria in the gut, particularly bifidobacteria in the colon, and the reason for that is 70% to 80% of the dry weight of stool is bacteria.  So if you don’t have enough good bacteria, the stool won’t have enough bulk, and that will reduce motility.  However, if someone has small intestine bacterial overgrowth, that means they have too much bacteria growing in the upper part of their small intestine.  Those bacteria can feed on fermentable fibers and carbohydrates too, so in those situations, things like starch and foods that are rich in fermentable fibers might actually exacerbate the problem.  So in that scenario, you would probably need to treat the small bowel bacterial overgrowth first — and that can be a common cause of long-term constipation — with a low-carb diet and some antimicrobial nutrients.  And then after that’s treated, it’s probably beneficial to gradually reincorporate some fermentable fibers over time.  And the GAPS diet is a good example of this.  I often see patients in my practice who have been on GAPS or SCD — and Steve, you probably have some thoughts about this — but it worked really well for them for a time, and when they were on the intro GAPS or intro SCD, they were kind of starving out the overgrowth in bacteria.  But then after a long period of being on an almost zero-fiber diet, it also starved the good bacteria in their gut, and then they either went from having diarrhea to having constipation, or maybe they just got more constipated over a period of time.  So at that point, if that starts to happen on one of those diets, it’s probably the right time to start adding back in some starchy tubers or other fermentable fibers.

Steve Wright:  Yeah, I think from what we’ve seen… The message Jordan and I are always trying to get out is that everyone has a custom diet that also is changing with your health.  So as Chris is talking about, as you change your foods, the easiest output to measure is going to be your stool, and as that changes over time and you get healthier, it’s likely a good idea to continue to broaden your horizons.  So like, on our site we like to start with the SCD, get your symptoms under control, and then begin to branch back out to, like Chris was talking about, the starchy tubers, things like that, but with the caveat that Chris already mentioned, which is that constipation is almost like acne.  There’s not a really easy way to explain why it’s happening to you.  There could be a lot of different causes that are at the root of the issue.  Diet is a huge part of it, but if you have SIBO, not everyone can just change their diet to GAPS or SCD and get rid of SIBO.

Chris Kresser:  Right, and there could be other pathogens, like H. pylori, or parasites.  A lot of people think of diarrhea when they think of parasites, but chronic parasite infections can and do lead to constipation.  If a patient were to come see me in the clinic with this complaint of lifelong constipation, the very first thing I would do would be to run some tests for gut pathogens and SIBO because you have to at least rule that stuff out before even proceeding, and the chances are really high that someone has those things, because constipation is not only a result of those problems, it actually increases the risk of those problems, because proper elimination, as you can imagine, is helpful to keep a healthy intestinal environment.  And if you’re not eliminating properly, then you’re going to be at a lot higher risk for getting infections even if you didn’t already have one and that wasn’t the original cause of the constipation.

Steve Wright:  Yeah, I think that’s the huge takeaway right there.  Get some really good, advanced testing because I think that’s going to be the root at which you’ll be able to figure this out.

Chris Kresser:  Yeah.

How to support adrenals after having a baby

Steve Wright:  Cool.  Well, let’s roll on.  This next question comes from Jenny, Chris, and she wants to know about supporting adrenals after eight months of poor sleep due to nursing an infant.  She wants to know about safe supplements.

Chris Kresser:  Yeah, that’s a great question, and it’s frankly not an easy one to answer, again.  I think the hardest part for me as a clinician in treating pregnant women or women who are nursing is that there aren’t really any studies on safety of nutritional supplements during pregnancy and nursing, for obvious reasons, right?  I mean, it’s unethical to do that kind of study where you give pregnant women something of unknown safety and then just watch what happens.  No one is going to sign up for that study, and they shouldn’t because it’s completely unethical and dangerous.  So we’re left kind of wondering about a lot of natural supplements and even drugs, for that matter.  There are some wisdom traditions, like ayurvedic medicine and Chinese medicine, where there’s a history of apparently safe use with certain botanicals over a long period of time.  And if you talk to herbalists, they might tell you that something is safe, but then you go and search on the Internet and it says don’t take this during nursing and pregnancy, and it’s confusing because maybe someone just told you it was safe, but then you research it yourself and it says it’s not safe.  Well, generally if you ever look anything up on the Internet, it’s going to say it’s not safe because there are no studies proving that it’s safe, and due to obvious liability concerns, websites and healthcare practitioners and people in general don’t want to say that something is safe on the Internet when it’s not absolutely known to be safe because if something does happen, then that would be a terrible thing.

So the first thing, the primary thing with adrenal support during pregnancy and nursing would be actually non-nutritional interventions.  So things like Mindfulness-Based Stress Reduction, which is a clinically proven program, and the Rest Assured program, which I’ve talked about before at SounderSleep.com, these two things regulate the nervous system and induce a parasympathetic response, which can definitely help with adrenal fatigue syndrome type of problems.

Acupuncture, I think, can be helpful in this type of situation.  It’s safe to do during both pregnancy and nursing.  There aren’t really any side effects other than feeling better for most people.  The research on whether it works for adrenal fatigue syndrome is a little unclear because in the conventional world, adrenal fatigue syndrome doesn’t really exist, so there haven’t been studies done on that, per se, but there have been studies on acupuncture and anxiety, and acupuncture and depression, and acupuncture and insomnia, and the research is somewhat mixed, but part of the reason for that is that it’s really difficult to study acupuncture in a randomized controlled trial because there’s no obvious way to do a placebo control arm.  I mean, they do this shallow needling or dummy needling at non-acupuncture points.  There are a lot of different ways they’ve tried to do a placebo arm, but what they’ve found is that even some of the placebo needling can actually have physiological effects, so it’s not a true control.  So the acupuncture research is really confounded and not easy to draw conclusions from, but I can just tell you from my own experience doing acupuncture and receiving acupuncture and seeing a lot of people receive acupuncture that it can be very effective for adrenal-fatigue-related problems, and it’s certainly worth a try because it’s safe and it’s one of few things that is safe during pregnancy and nursing.

Another thing would be all of the stuff we’ve talked about in terms of limiting artificial light exposure at night, so turning down the room lights, getting the orange goggles that block out the blue light that suppresses melatonin, reducing your use of electronic media at night, making sure on the flipside that you get out during the day and get some sun or bright light exposure on your eyeballs.  It doesn’t even have to be sun, just bright light, just getting outside in the morning and during the day.  That actually helps regulate the cortisol/melatonin circadian rhythm.  If it’s dark where you live a lot during the day or you’re not able to go outside because of your job or something, a light machine used in the morning can be helpful to reset the circadian rhythm, the type that they use for seasonal affective disorder and depression.

And then there are some medicinals that are generally recognized to be safe.  Now, again, the caveat here is you should talk to your doctor about this, and you should do your own research too and make sure that you feel comfortable, but most herbalists and even most conventional sources and physicians would say that herbs like chamomile and lemon balm are very safe during pregnancy and nursing.  And the Chinese skullcap — not American skullcap.  There are two different versions of skullcap, but Chinese skullcap is an anxiolytic — which means it’s antianxiety — can have a pretty calming effect.  So those are some botanicals that can be used.

From a dietary perspective, you want to make sure that you’re getting plenty of protein, not too low carb, not skipping meals.  For some people, eating every 2 to 3 hours would be really helpful with adrenal fatigue type of symptoms.  And hopefully something in all of that that we just talked about can make an impact, or some combination of all of those things.  I think if you did all of that stuff, it’s pretty likely that you’d start to see some improvement.

Steve Wright:  Yeah, I would think so.  That one about not skipping meals, I think, is a big one for a lot of people I see suffering from adrenal issues.

Chris Kresser:  Yeah.  There was one more thing, which has always been kind of interesting to me.  If you look up 5-HTP, which is an intermediary between tryptophan and serotonin — so tryptophan gets converted into 5-HTP, and 5-HTP into serotonin, and serotonin has a really strong regulatory effect on the nervous system.  It’s kind of responsible for well-being.  It helps with sleep, and it can be really helpful in adrenal fatigue scenarios where the sleep pattern is really disrupted.  And if you look up 5-HTP, it says contraindicated during pregnancy, but what’s interesting to me is that a lot of doctors don’t hesitate to prescribe SSRIs, which have a much more potent effect on serotonin metabolism than 5-HTP does.  That’s maybe something to discuss with your doctor.  If you’re really kind of on the edge and none of the other stuff that I’ve talked about is helping, that might be worth exploring with your doctor as well.

What to do about low ferritin levels

Steve Wright:  All right, let’s roll on.  This next question comes from Krista, and she wants to know the best way to increase ferritin levels, because she’s been taking an iron supplement for about a year and she hasn’t had any change.

Chris Kresser:  Well, I noticed in the question that her ferritin levels were 80, and in my opinion, there’s no need to increase ferritin above 80.  In fact, in women, the upper end of ferritin, the safe range, is about 140 or 150.  If you see ferritin above that in a woman, it means iron overload.  So I’m just not totally clear on why Krista wants to get her ferritin levels above 80.  I don’t think that that’s necessary or even desirable, and maybe her body is self-regulating in some way, although I’m not sure how the body would do that because the only ways to get rid of excess iron are bleeding and chelation, and that’s one of the problems with iron and it’s one of the problems with iron supplements.  So I would say just be happy with your ferritin level of 80.  That’s a good level.

Steve Wright:  What’s the lower end, Chris, for women?

Chris Kresser:  It depends whether they’re premenopausal or postmenopausal.  And it depends sometimes on what point they’re at in their cycle and how heavy the menstruation is and what’s normal for them.  But the lab range for premenopausal women goes down to 13 or 15, but I think that’s too low.  I don’t like to see premenopausal women — or postmenopausal women, for that matter — below about 30.  And when they are below 30, it can be really hard to get them above 30.  There’s kind of this threshold that if you’re below the threshold, it often can take fairly large amounts of supplementation and sometimes even shots to get you above the threshold, but then once you’re above the threshold, it’s easier to stay above it just with eating iron-rich foods like organ meats and things like that, or even just red meat.

I think in premenopausal women, iron deficiency is a bigger problem.  In postmenopausal women, iron overload is actually often a bigger problem because menstruation is one of the primary ways that women lose iron, and when that stops they start accumulating iron just like men do.  So the risk generally kind of shifts as women go into menopause to iron overload, and in fact, some of you might remember the whole HRT debacle, which was the idea that there was an observation that premenopausal women had much lower rates of heart disease than postmenopausal women, and the first theory about why that was was related to estrogen levels.  Postmenopausal women have lower estrogen levels than premenopausal women, so they did a trial and they gave postmenopausal women estrogen, thinking that that would reduce their risk of heart disease, and in fact, they had to stop the trial early because it was dramatically increasing the risk of heart disease in postmenopausal women.  The latest theory now about why that difference exists is iron.  Premenopausal women have lower iron saturation and ferritin levels than both postmenopausal women and men, and when women go into menopause they start to match men in terms of their iron saturation and ferritin levels.  I mean, they’re still on average lower, but they start to accumulate more iron.  So that’s just something to be aware of.  Like most nutrients, there’s a sweet spot for iron.  You don’t want too little, and you don’t want too much.  And what that is depends on your gender and also on the stage of life you’re in if you’re a woman.

Tips for teething babies

Steve Wright:  OK, awesome.  Well, let’s move on to the next question, and this question comes from Tom.  He has a 14-month-old son whose molars are coming in, and Chris, he wants to know, do you have any recommendations for treating teething?

Chris Kresser:  I was going to ask Tom for some recommendations, actually!  Haha.  Sylvie’s getting her two-year molars right now, and actually it’s a little better lately.  It was pretty rough there for a while.  She was in obvious discomfort and rubbing her cheeks, and it was kind of sad.  You know, we’ve done a few things, and I have to be honest, I don’t really understand homeopathy from an allopathic, scientific perspective.  It doesn’t really make sense to me.  But I certainly don’t think it can cause any harm.  There are a couple of homeopathic ointments that a lot of parents swear by, and we’ve tried them.  Like I said, why not?  It couldn’t hurt.  And it’s hard to say.  It’s really hard to say when you’re in just kind of real life whether something clearly is working or not working.  It seems to help her, but I could be just imagining that.

Steve Wright:  You didn’t do any scientific trials?

Chris Kresser:  Haha, no.  And then there are also analgesics with not-so-nice ingredients in them, but I think if teething gets so bad to the point where sleep is seriously disrupted that using those over-the-counter analgesics can be helpful, because as we’ve discussed many times, there’s really nothing worse than chronic sleep deprivation for your health and for a baby’s health.  So unfortunately, I don’t really have a lot of insight to offer on teething.  The homeopathic stuff sometimes can help.  Giving the baby something to chew on, like frozen fruit.  Sometimes we give Sylvie a frozen strawberry, and she kind of gnaws on that a little bit.  They make, of course, various frozen teething toys.  But maybe some other parents who have had more success than we have could chime in in the comments section and help Tom out.

Steve Wright:  So no whiskey, then?

Chris Kresser:  Haha.  Well, there’s something maybe…

Steve Wright:  Grandma knows best, right?

Chris Kresser:  Believe me, there were a few nights we definitely were thinking along those lines, haha, let me tell you!  We didn’t resort to it because we didn’t actually happen to have any whiskey in the house, which was probably a good thing.

Steve Wright:   Haha, OK.  Well, thanks for the question, Tom, and hopefully our listeners will give everyone some ideas.

Dealing with disrupted sleep patterns

Let’s move on to the next question.  This comes from Joss and it’s a little bit long, so bear with me here.  He has a question regarding his sleep pattern, and it starts off with him falling asleep most days between 9:30 and 10:30 p.m.  Then he sleeps for about 4 to 5 hours pretty deep, undisturbed.  He wakes up around 3 a.m. to go to the bathroom and urinate.  After that, he says:  “I turn and I go in and out of sleep, kind of doze, and I either generally get frustrated or I get rested, but not any real deep sleep.”  Sometimes during this frustrated time of sleep he will read, and it doesn’t matter what happens, it all seems to happen before 6 a.m. when he gets up.  So after that, during the day he feels the urge to nap between 30 minutes to an hour around 3 p.m., and when he does nap, it feels very restorative for his focus and concentration.  In general, he goes on to say that he is following a good diet, he has very good overall health, has a pretty good workout regimen, and has a little bit of coffee but not too much and never past 9 a.m.  So, Chris, his question is, “Should I worry about my sleep pattern?  Is there anything I should do to change and get more complete nights?  Alternatively, should I just embrace it and get up at 3 a.m. and read for an hour?”

Chris Kresser:  Yeah, it’s a good question.  I wouldn’t worry about it, per se, but I think it’s something to address because it’s not normal to wake up at 3 a.m. and be restless and toss and turn for the rest of the time.  And it sounds like he’s holding up pretty well so far, but maybe after a longer period of time with that kind of sleep pattern it’s going to catch up.  That’s the thing about sleep deprivation:  it’s cumulative.  A lot of people are able to deal with some sleep loss for a significant period of time without really obvious effects or symptoms, but over time, it just deepens and becomes harder and harder to get out of, so I think it is important to address.

Some of you might have read about biphasic sleep recently, this idea that for humans the natural sleep pattern was to fall asleep, sleep for maybe 4 hours, then wake up and either just lie awake for an hour or two or actually even get up and do something and then go back to sleep for another 4 hours.  And that may be true, and there are actually references in medieval texts about that kind of sleep pattern.  They called it first sleep and second sleep, and some traditional cultures that have been studied do have that kind of sleep pattern, but here’s the thing:  That works fine if you’re in bed for 12 hours or you’re allocating 12 to 14 hours for rest.  If you go to bed at 8 p.m., and then you sleep until midnight, and then you’re kind of awake until 2 a.m., and then you sleep again from 2 a.m. to 6 a.m., that’s still 8 hours of good-quality sleep, and that’s what’s recommended, 7 to 8 hours.  A biphasic sleep pattern when you’re getting in bed at 10 o’clock and getting up at 6 a.m. isn’t going to work because if you sleep for 3 hours or 4 hours, and then you’re awake for an hour or two, and then you sleep again for a little while, that’s not enough sleep put together.

The first thing I would do in this situation is get an adrenal test, look at cortisol and DHEA levels.  That waking at 3 a.m., even if it’s just to urinate… I mean, if you wake at 3 a.m. and go right back to sleep, that’s not that big of a problem for most people.  Ideally you wouldn’t be waking to urinate.  Maybe drink a little less water, start drinking less water earlier in the day.  If someone just wakes up and goes pee and then goes right back to sleep and sleeps deeply, I’m not really concerned about that.  But if you’re waking up at 3 a.m. and then just not getting any restful sleep after that, to me, chances are really high that there’s an adrenal issue, a cortisol issue there.  Cortisol levels are too high too early, and that’s what’s waking you up or preventing you from getting back to sleep.

Some of the same things that I recommended earlier for Jenny, who was asking about adrenal support during nursing, would apply here.  But since Joss is not nursing, I’m assuming, we have, of course, many other things to consider there.  So depending on what the specific pattern of cortisol dysregulation is, adaptogenic herbs, licorice root extract if cortisol is low, Seriphos or phosphatidylserine if the cortisol is high, pantethine or pantothenic acid, adrenal glandulars, and in some more extreme cases maybe sublingual DHEA and pregnenolone, although those need to be used with caution.  And then, of course, all the same other artificial light and light modification stuff that we talked about would apply here, too.

Steve Wright:  Now, Chris, isn’t it the Chinese realm that says if you wake up at 3 a.m. it’s a liver issue?  Do you put any stock in that?

Chris Kresser:  Not really.  Maybe my former Chinese medicine colleagues will be upset to hear that, but it’s not my orientation right now.  I’m not saying there’s nothing to it.  It’s just not the lens that I look through at this point.

Steve Wright:  OK.

Chris Kresser:  Yeah.  I will say, though, that the liver system in Chinese medicine would be closely related to the kinds of personality types and symptoms and signs that you would expect to see in someone that’s waking up at 3 in the morning.  And it can often be stress related, although it doesn’t seem to be really the case with Joss.  The lifestyle he describes seems pretty grounded and pretty low stress.  But there may be something to that connection.  That’s all I’m saying.

Steve Wright:  OK.  All right.  Well, let’s do one more question, Chris.  You up for it?

Chris Kresser:  Yeah.

How do you explain someone that feels better on a juice fast?

Steve Wright:  OK.  So this question comes from Jeremy.  He says:  “I searched the blog the best I could, and I couldn’t find anything specifically related to this.  Recently I watched Fat, Sick, and Nearly Dead.  I understand that with super-greens your feeling is that unless a person is also eating fats, those micronutrients are not going to absorb well.  My question is, how does one explain the amazing recovery and improvement to health those individuals have after doing a juice fast for 10, 15, or even 60 days?  And second, could someone combine these two diet approaches, where they juice for one meal or more daily and then consume a paleo-based diet for the other meal or two?  And if so, would you add something like olive oil or macadamia nut oil or something of that sort to help the absorbability of some of the micronutrients?”

Chris Kresser:  To answer the first question, how do you explain how someone feels better on a juice fast — or we could ask the same question about a raw food diet, vegan diet, whatever — you always have to consider where people are coming from.  If someone is coming from a Standard American Diet or a diet low in nutrient density and high in a lot of food toxins and they switch to a vegan diet, a raw food diet, juice fast, whatever it is, of course they’re going to feel better.  I mean, they went from eating crap to eating real foods.  And yes, I think the science is pretty clear that if they persist and follow a juice fast type of thing or a raw vegan diet for an extended period of time, a high percentage of people are going to develop nutrient deficiencies, but in the short term it can make you feel really good.  Generally, people are eating fewer calories so that they’re getting the benefits of caloric restriction and fasting.  Autophagy kicks in, like all of the stuff we’ve talked about with intermittent fasting and just eating fewer calories.  So it’s not a surprise at all to me that someone would feel better in the short term doing that.  The question is, is that a sustainable approach over the long term, number one?  Number two, is that appropriate for everybody?  Like, I don’t recommend that for people who have severe adrenal fatigue, for example.  It can actually often take them in the worse direction.  And is it appropriate in the context of a more nutrient-dense, whole foods approach?  If you tolerate carbohydrates well, I don’t see a problem with doing fresh vegetable juices and fruit juices even, too, although you probably want to be moderate with the fruit juice because of the amount of sugar and the lack of fiber.  I know some people are really crazy about this thing called the NutriBullet.  Have you heard about that, Steve?

Steve Wright:  I have.  I have had some people I know go and take the dive.Chris Kresser:  NutriBullet fanatics?

Steve Wright:  Yes.

Chris Kresser:  Yeah, so the NutriBullet is basically like… I don’t have one myself, but what I gather, it’s like an ultra, super-duper-powered blender that you put vegetables and fruits in there, and it turns it into liquid.  And it’s different than juicing because when you juice, it’s removing all of the fiber and pulp, and the NutriBullet, it’s all still in there.  So to me, that’s actually probably better than juicing because the fiber slows down the absorption of the sugars and it also provides some beneficial stuff for the gut bacteria.  But I don’t see a problem with doing, haha, some NutriBulleting.

Steve Wright:  Some extracting?!  That’s what they call it, the Extractor.

Chris Kresser:  Some extracting or some juicing within the context of a paleo type of diet, especially during the summer months when seasonally that feels better and seems more appropriate for the body.  I think that’s fine.

Steve Wright:  Yeah, anecdotally I’ve never done whole lot of experimenting with juicing, but it does seem to be that a lot of people when they do start they do report some sort of increased well-being or energy of some type.

Chris Kresser:  Um-hum.

Steve Wright:  But I’ve never done a whole lot of experimenting myself.

Chris Kresser:  You know, the GAPS diet is pretty big on juicing.  And when I was doing the GAPS intro and then going through the phases way back in the day, I did a fair amount of juicing, and I liked it.  I did almost exclusively vegetable juices because I just felt better with that, but there was a time in my life where that felt good.  I really don’t do it at all anymore.  I don’t feel the need to do it at this point.  And to be honest, cleaning out the juicer is just such a pain in the butt!

Steve Wright:  Haha!

Chris Kresser:  I can’t be bothered to do it!  I guess that’s why people like that NutriBullet, too, because you don’t have to deal with that.  It’s a lot easier to clean out.

Steve Wright:  Yeah, if they made a self-cleaner, man, you could make a million bucks easy.

Chris Kresser:  Yeah, exactly.  So yeah, in summary, I don’t think a 60-day juice fast… I think that absolutely requires supervision.  I think it’s way too extreme for most people.  I wouldn’t recommend it.  But short periods of juice fasting and juicing or NutriBulleting, extracting, whatever you want to call it, within the context of a nutrient-dense diet?  Sure.  Why not?

Steve Wright:  And would there be any reason to throw an ounce or two of some oil into that?

Chris Kresser:  Right, that was the original question!

Steve Wright:  Like a Slurpee?

Chris Kresser:  Yeah, I think adding some coconut oil or some olive oil does absolutely help with nutrient absorption.  I wrote an article called “Eat some vegetables with your butter,” haha, or “Have some butter with your veggies!”  I can’t remember.  Something like that.  And I presented some data in that article showing that the absorption of carotenoids and various other vitamins in green vegetables increases dramatically when you add fat.  So yeah, to really improve the results that you’re going to get from something like that, absolutely.  Add some fat.

Steve Wright:  All right, Chris.  Well, that was a great answer, and I guess if people are extracting nutrients out there, please leave a comment and tell us about your experience with the NutriBullet.  Are you ready to get out of the closet yet, Chris?

Chris Kresser:  I’m really ready to get out of the closet.  It’s a beautiful day here in Berkeley, and I want to go take a walk in the woods near my house.

Steve Wright:  All right, well, with that, thank you for listening.  If you want to get more of Chris in between the shows, please head over to Facebook.com/ChrisKresserLAc, or head over to Twitter.com/ChrisKresser.  Thanks for listening to the show today.  Please keep sending us your questions at ChrisKresser.com using the podcast submission link.  If you enjoyed listening to the show, head over to iTunes and leave us a review.  It helps to get the message out and spread this information to more people.

Chris Kresser:  Thanks, everyone, for listening, and we’ll see you next time!

Note: I earn a small commission if you use the links in this article to purchase the products I mentioned. I only recommend products I would use myself or that I use with patients in my practice. Your purchase helps support this site and my ongoing research.

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Comments Join the Conversation

  1. Blair says

    Hi Chris,
    Do you do parasite testing on pregnant mamas who have struggled with lifelong constipation? What specific tests do you run? Is it safe to treat parasites during pregnancy?
    Thanks,
    Blair

  2. Sara says

    Thanks very much for another informative podcast. In addition to eating iron-rich foods what type of supplementation would you recommend for a premenopausal woman with a low ferritin level of 16?

  3. Mark says

    What about optimal serum ferritin level for MEN? For thyroid function and energy, I have heard it needs to be in the 150-200 range.

  4. willis says

    Sound definitely more clear and without echo.
    An more pleasant alternative to a closet is using Sound absorbing panels like what is used by telemarketing agents. They are aesthetically far superior to the closet. I used to have small portable cubicles for operators to sit at.
    Thanks for working on the sound quality .
    regards

  5. David says

    Hi Joss, I can very much relate to your situation with waking at 3am and then struggling to get back to sleep. The onset of this problem for me occurred when I developed microscopic colitis. The bizarre thing was that after my colitis healed with a paleo diet, the sleep problem remained. Waking hot and a bit sweaty, sometimes anxious, needing to pee and HUNGRY after about 4 hours of good sleep. This problem persisted for 7 years. Followed all of Chris’ and Robb Wolf’s recommendations about sleep, which helped overall but not with this specific problem. A small dose of valium would help me go back to sleep, but this is obviously not a good option. The main factor that I could identify that made the situation worse was having an “upset stomach” from having eaten too much fibre (keeping in mind that I never eat gluten, lactose, caffeine etc). I then developed overt symptoms of SIBO in January 2013. A specialised stool test revealed that I had a lactobacillus overgrowth and no bifidobacteria. I discontinued the broad spectrum probiotic I had been taking for years and years, and now take bifidobacteria only. The SIBO was gone within a few days, and miracle of miracles my sleep improved by 95%.

    • Diana says

      Wow. I have the same issue of waking in the night and also have been diagnosed with macrocytic colotis. Stool test found 2 bad bacteria which I treated unfortunately with antibiotics. Ill have to retook at the other bacterial

  6. Sheila says

    In my experience, I wanted to lose a little weight after going through menopause. I was already exercising with a trainer and decided to try juicing. Drank all kinds of different green juices with fruit and thought I was doing something good. About six months into this new regime, I started waking up with severe headaches and started feeling lightheaded all the time. Long story short – I was eventually diagnosed with hypothyroidism and adrenal fatigue. I could never seem to recover from exercise like in the past. I feel drinking large amounts of greens like mustard greens, turnip greens, etc. irritated my thyroid and I think I started experiencing hypoglycemia because of erratic blood sugar issues. I was not taking in enough calories for the amount of exercise, etc. I think it’s OK once in awhile to drink a green drink but I think we were meant to eat our food in smaller amounts — that’s probably why many greens have lectins and goitrogens, etc. to protect them from being overeaten. A good solid, natural diet with appropriate amounts of protein and fat is the way to go. Oh, did I also mention that I was diagnosed with osteoporosis at the age of 49 (I was vegan for three years before the juice fasting). I have to feel it is related to my past diet and I hope people will use caution before trying anything extreme.

  7. Allison says

    What a bummer the ferritin question wasn’t actually answered! There are many women whose ferritin levels are too low and hard to increase, even if Krista’s levels are good! I’m in that boat but I can’t eat organ meats due to the high copper content.

  8. dave says

    I listened to an interview with Joe Cross, the guy from Fat, Sick and nearly Dead, on the Kim Hill (2012 International Radio Personality of the year) Show on New Zealand National Radio a while back. It was ironic that she was interviewing him doing a fairly way out dieting thing (which was also largely a plug for juicing machines) when she recently had Sally Fallon of WAPF lined up for an interview but then didn’t do it because WAPF and raw milk are ‘too controversial.’ If Joe Cross had been raised eating WAPF he would never have got fat sick etc. Obviously there are health benefits to the juicing thing he did but he also said he lost something like 10 kg or more of muscle on his juicing fad, and he keeps having to ‘reboot’ with more juicing regularly as his weight hasn’t stabilized because he doesn’t eat enough animal fat and still eats junk food. Last time I looked muscles use energy and help to keep the basal metabolic rate high, which aids in preventing fat gain. Any diet where you are loosing lots of muscle mass is a bad idea.

  9. Florent Berthet says

    Terry Grossman states that the optimal ferritin range is 12-25 mcg/l (not 20-400). He says one reason why women live longer than men may be because they lose blood regularly by menstruating, which lowers blood iron (which we often have in excess and leads to free radicals).

  10. Whitney says

    Does 5-MTHF or L-5 MTHF help for anemia? In addition, I’ve heard that tea can delete the body of iron. Is this true?

  11. Desh says

    When I suffered from adrenal fatigue while nursing, the accupuncturist gave me a supplement that contained citrus peel. It is safe for a nursing mama to take one teaspoon of dried citrus peel, chunky sea salt as a supplement, maybe 1/4 tsp twice a day, and a b-complex vitamin also supports nursing- with the added bonus that b-6 helps with melatonin production. Getting out in the morning sunlight with exposed skin but without sunglasses also helps.

    Anyone waking at 3 or 4 a.m. should also consider sleep apnea…you can get a portable pulse oximeter rather than going to get sleep study done.

  12. Kirsty says

    You stated towards the end of this podcast that you feel that juicing can be more detrimental than helpful to those suffering severe adrenal fatigue. Can you expand further on that point & explain the physiology of why that would be the case?
    Thanks :-)

  13. Slllade says

    I used to wake up every morning between 2 and 4, having to urinate and feeling hungry. The only way I could get back to sleep was to eat something. Even then, my sleep quality was not good. I felt like a zombie pretty much all of the time, unless I got a good nap in, mid-day. I found that eliminating carbs after about 5:00 PM helps immensely. Instead, I eat a high-fat meal at about 6 or 7, and I sleep very well throughout the night. My favorite evening meal is wild salmon with grass-fed butter. An avocado works like a sleeping pill for me.

  14. Eli Stowe says

    Chris,
    Regarding audio quality, microphone isolation panels such as those made by sE are also a good solution to reduce the capture of reflections/resonances that are inherent within a space. The wrap around the sides and rear of the mic. The front of the capsule can then be positioned towards a non reflective (curtain) or diffusing (bookshelf) surface. Empty, square or rectangular shaped rooms will present the most prominent resonances and reflections, so irregular shaped or filled spaces, (those with lots of dense furniture and variable shaped items such as filled bookshelves) will provide the most intelligible results.
    Hope this helps.
    Cheers,
    Eli

  15. Jenny says

    I recently had my blood work completed and found out I have to go on medication(statin) for high LDL. Is there another alternative? I eat Primarly paleo, take EPA/DHA 5 grams/day and exercise 6 days/week. My dr said my HDL was the highest she had ever seen and my TG were incredibly low. She claims it is just genetics. I am searching for another alternative. Any suggestions would be helpful. I am 31 and the thought of taking a medication everyday for the rest of my life is not appealing.

    • Adrian says

      What was your LDL number? I would think with low triglycerides and a high HDL your doctor would be happy. That is a better heart disease marker than LDL by itself which doesn’t tell you anything. Ask your doc for an LDL particle count instead . Listen to and read the last few articles and podcasts Chris has done on cholesterol and heart disease because they should clear things up. You most likely don’t need a statin .

  16. smgj says

    Sound – sorry, but it IS much better in the closet. But instead of recording from the closet, you may use a room with lot of furnitures, and just cover the most reflective surfaces with some blankets? A little may go a long way.

    Giving babies cod liver oil is the norm (and the official reccomendation from 4 weeks of age) in Norway, and most infants take it straigth, but there are also some tha tare the exceptions – who, literally, can’t stomack it. (If not using cod liver oil, the reccomendation is vitamin d drops.)

  17. troy says

    I really like what you had to say about juicing. I always throw in some avocado when I make smoothies and add coconut oil or MCT oil like eliteNQ Ignite into my fresh juices.

  18. says

    I thought there should have been some mention of the importance of magnesium, or magnesium-rich foods in your answer to the question about constipation. Overall, excellent information!!

  19. Lacy Spangler says

    My number 4 is 10 months and getting her 5th tooth. She responds extremely well to to essential oils. We rub Roman Chamomile along her jaw line and some lavender behind her ears and down the sides of her neck. That seems to help reduce swelling, promote drainage, and help her fall asleep and stay asleep.

  20. Lisa says

    Salt the stop the thyroid madness site run by Janie Bowethorpe there is an article saying that for hypothyroid women ferritin is better on the high side between 90 and 120. This allows thyroid supplementation to work effectively.

    Also there is an interesting study about whether the rda for iron for women is too low in a hematology journal. Google rda for iron for women too low and you should find it. In this study a ferritin of 100 was considered replete, meaning that based on various pieces of evidence they considered this the optimal level so that there would be adequate iron for all metabolic functions and uses in the body. What they found is that none of the menstruating women could maintain that on diet alone. 90 percent could on 48 mg of iron daily. Even a large percent of non menstruating women couldn’t maintain on diet alone. 24 mg kept I think 90 percent of them in iron balance.

    I have a hard time keeping ferritin up. It took months of diet and supps to get to 66. The higher mine went the better I felt. I felt better at 66 but I still don’t think that was optimal yet. I would like to see how I feel at 90 to 100.

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