In this week’s show we interview the illustrious Kurt Harris, M.D. from PaNu.
Topics discussed include:
- Meditation practice
- Whether anyone should care about their lipid measurements
- Are their hormetic benefits from fructose, wheat and seed oils?
- A lot more…
We had a great time recording it, and I think you’ll enjoy it.
Full Text Transcript
Danny Roddy: Welcome to the Healthy Skeptic Podcast. My name is Danny Roddy, and with me is Chris Kresser, health detective and creator of TheHealthySkeptic.org, a blog challenging mainstream myths about nutrition and health. Chris, how are you doing, buddy?
Chris Kresser: I’m doing great, Danny. How are you doing?
Danny Roddy: I’m doing awesome.
Chris Kresser: I’m really, really excited that we have Dr. Kurt Harris from the PaNu weblog here. Kurt, how’s it going?
Kurt Harris: It’s going great! Thanks for having me on your show.
Chris Kresser: We’re excited about it.
Danny Roddy: Super excited.
Kurt Harris: Me, too!
Chris Kresser: OK, well let’s just dive in. The plan is I think we’re gonna try to spend the first half hour or so just chatting about some topics of interest, at least to me, with Dr. Harris, and then we’ll spend the last half hour answering some reader questions that we collected from the blog. So, let’s dive in and talk a little bit about orthorexia. You mentioned this in a recent blog post, Kurt, and why don’t you just tell people what it is, first of all for people who don’t know, and some of your thoughts on it.
Kurt Harris: Well, I guess I first heard the term pop up only maybe a few months ago, and I can’t say I’ve made this a great interest, you know, reading articles on orthorexia, and I don’t even necessarily ascribe to it being a legitimate medical diagnosis. I think that when you include things like anorexia, you know, things that are actually in the DSM-III, and certainly it is, but in the context of Paleo and dieting, I would buy the definition that orthorexia is an unhealthy obsession with eating to the point that it limits your function. I guess I define it similar to an anxiety disorder. Everybody has anxiety, but it’s only an anxiety disorder if it interferes with your activities of daily living. And my experience with that — you know, we chatted a little earlier — I think my perspective might be a little different than some because I stumbled on the whole diet realm late in life, and although certainly being a physician in radiology you have to have some OCD traits to even function in that field, but I haven’t spent, you know, 50 years of my life searching for the perfect diet. So, I have a perspective there that I believe that you can spend some time learning about some of these concepts and then kind of do your best, and that’s the best that you can do.
Chris Kresser: Right. I feel the same way, and I think part of what concerns me is I see people, as you said, obsessing so much over food to the point where I think they’re actually increasing their stress level significantly, and of course, we know that stress can produce a lot of the same negative effects that poor diet can.
Kurt Harris: Sure, and to relate that, bring that back personally, a lot of your listeners might be familiar with the thread over at Richard Nikoley’s about John Sarno and working with mind-body connection. You and I have talked some about meditation and are both familiar with that. I think it’s fair to say that if anything, I went from a view thinking that diet didn’t have anything to do with anything, but that there are a lot of psychosomatic illnesses out there and that you could maybe, you know, meditate or relax your way to health! I kinda came into this world where almost nobody really talks about anything other than diet, and it actually at first puzzled me that so many people would actually say on my blog and elsewhere: Gee, I don’t understand this. I all of a sudden have diarrhea or I’m constipated or I have allergies or whatever, and you know, I’ve been eating perfectly for years now, and what am I doing wrong with my diet? — the assumption being that the only way one could be sick or have anything wrong would be if you’re doing something wrong with what you’re eating.
Chris Kresser: Right. Yeah, I’m right with you on that, and in fact, my kinda pet topic recently in the scientific literature has been the brain-gut axis, and I’m getting ready to write a series about that because I think it’s something, as you said, that’s really, really missed in the healthcare world.
Kurt Harris: Chris, do you plan to talk about irritable bowel syndrome?
Chris Kresser: Absolutely. That’s gonna be a big part of it.
Kurt Harris: Well, let me spend two seconds on that because I dealt with that like about a quarter of the population if you actually have them take the test for the symptoms, you know, as irritable bowel syndrome.
Chris Kresser: Yeah, the Rome criteria.
Kurt Harris: Yeah. And I couldn’t even tick off what those criteria are, but you know, it’s basically: Do you ever have diarrhea or constipation or excess gas?
Chris Kresser: You know it when you got it!
Kurt Harris: You know it when you got it. It’s like the bad kind of pornography. Yeah, and I struggled with that on and off, and I’d noticed early on, even before I did any meditation or read several hundred books on psychology, which I have, by the way. I was into psychology long before I was interested in diet, and in fact, the Psychology Today thing is kinda funny because the people that invited me to do that had no knowledge of that, that actually I have quite an interest in that and in mind-body medicine. So, I was long aware that my own symptoms related not totally, but 80% of the time were due to stress, unacknowledged emotions that I was feeling, meaning something really was bothering me, but I wasn’t consciously aware of it. You know, that’s a well-known phenomenon, and a lot of times it would be just overt, you know, pretest anxiety. In medical school, I had colleagues that would go barf before every exam.
Chris Kresser: Right!
Kurt Harris: Or sit on the toilet. I mean, I actually didn’t get that nervous for that, but I have my own triggers. And so, then I come into the diet area and I see people talking about, well, irritable bowel syndrome, how to take care of that. And interestingly, I could manage IBS somewhat with meditation or just awareness, but it did improve a lot not going Paleo but just going to a low-carb diet. And I think that’s because when you go to, you know, 50 grams a day of carbohydrates, you’re eliminating about 80% of the wheat. I think it’s mostly the wheat.
Chris Kresser: Right.
Kurt Harris: But then lately I got into this FODMAPs issue, the fermentable substrates that are fermented in the proximal part of the colon, and that literature seems to suggest that you can improve IBS with that. The way I would synthesize all that is to say necessary but not sufficient. That is, I’ve found that — Actually if I had to pick one, I would say that I can get away with eating just about anything is my mental state is good.
Chris Kresser: Yeah.
Kurt Harris: On the other hand, if things are bothering me, I kinda do to have to watch the onions and so forth, and that actually fits with the research that the guy in Australia — I can’t remember his name.
Chris Kresser: Yeah, he’s written most of the papers. I can’t either.
Kurt Harris: Yeah, he’s written some papers. If you just PubMed FODMAPs, you get those papers. But anyway, what he said is that if you measure gas, you know, hydrogen production in the breath, or even look at volume of flatus, you can’t really tell the IBS people from the regular people eating the same diet.
Chris Kresser: That’s right.
Kurt Harris: And that makes perfect sense. What’s happening there is IBS basically is a mind-body disease, where you are abnormally sensitive to what’s going on in your gut. It’s not really a disease of too much gas.
Chris Kresser: Right. It’s a hypersensitivity reaction.
Kurt Harris: Exactly! So, you can make it better by decreasing how much gas production there is, but that doesn’t mean that IBS is caused by that.
Chris Kresser: Yeah, I couldn’t agree more.
Kurt Harris: I probably talked too long about that, but that’s a perfect example of how things can be, yes, diet and also mind-body medicine or your state of mind, and they can be both at the same time. It’s both. It’s not either-or.
Chris Kresser: Yeah, I agree, and I’m making it my mission, I think, in the next year to really try to emphasize that as much as I can. I was just reading a study. It was fascinating. It was on mice, but they induced brain lesions, traumatic brain injury, and they found that that produced leaky gut within 6 hours.
Kurt Harris: Wow.
Chris Kresser: So, it’s not only a causal connection. It’s immediate, pretty much. Within a few hours any kind of decreased output into the polyvagal system will actually cause intestinal permeability. So, it’s pretty fascinating stuff. I have a little personal story about that, too, this whole idea of the mind-body connection and orthorexia, in particular. Back around 2000, I was interning for a holistic doctor down in San Diego, and this was before I got into Paleo or anything, and I was, I think, a vegan macrobiotic, for crying out loud, at that point! So, we had a patient who was just really, really sick, and he was just getting sicker and sicker. He weighed about 90 pounds. I think he was about 6 feet tall. And the doctor had him on a restricted diet, you know, one of those food allergy type of diets where all you’re eating is, like, broccoli, venison, and quinoa.
Kurt Harris: The Specific Carbohydrate Diet?
Chris Kresser: No, no, just like a really, you know, they do the IgG food testing, which is kinda bunk anyways.
Kurt Harris: Yeah, that’s pretty bunk.
Chris Kresser: And then they find out you can only eat strawberries, broccoli, quinoa, and ostrich! You know? And so, he was doing that, and he kept removing foods until he was literally down to, like, broccoli and steamed whitefish or something. That was all he was eating. And he just kept getting sicker and sicker. So, he disappears for about six months, comes back a completely different person. He’s back up to 160 or 170, which was his normal weight, you know, completely normal complexion. Literally, we didn’t even recognize him, and the doctor was saying: What happened? Was it diet? And the guy was like: Yep, it was diet. And he said: Was it the candida diet? Was it the Specific Carbohydrate? What was it? And he said: It was the beer and pizza diet! [laughter] And this guy literally, I mean, the guy got to this point where he was like: OK, if this is my life, I’m fine with just flaring out. You know, this isn’t worth it. And if I’m gonna go out, I’m gonna have fun. And so, he started going out. You know, he wasn’t ever hanging out with his friends anymore because he was on such a restricted diet, he had no social life, so he just said: Forget it. I’m gonna drink beer and eat pizza at least three times a week, and then the other times I’m gonna do whatever I want. And that completely restored his health. So, go figure. I mean, if that’s not an example of going from orthorexia to, and the effect of stress on our gut and on our overall health, I don’t know what is!
Kurt Harris: Yeah. I should call my blog The Bubble-Bursting Blog or something, because my most popular posts, I think, are these kinds of posts, but they’re also probably why I shut off comments.
Chris Kresser: Right.
Kurt Harris: It’s like, you know, maybe running a marathon five times a year is not good for you. Maybe if you have an allergic reaction to butter that consists of, I don’t know, anything that happens as soon as you put butter in your mouth, maybe that’s all in your head. I mean, there are people claiming reactions that there’s no physiologic way that there could be that reaction other than a psychosomatic reaction. And then let’s stop there. What does psychosomatic mean? Does that mean it’s all in your head? No. It means it’s created by a real organ, which is your brain. And you know, you just suggested that leaky gut can actually be caused by a lesion in the brain. I have no doubt — And I’m a physician, OK? Some things are obvious to me. I’ve had patients that have urticaria, which is big, red welts that happens in response to stress. I’ve seen patients have asthma that puts them in the hospital because they have a crappy homelife. I’ve seen this. This is not controversial to me. Why is it so hard to believe that somebody could convince themselves that they’re allergic to everything except oatmeal and chicken breasts? Now, why did I pick that as an example? I had a patient — Actually she’s not a patient anymore because my practice closed, but this is a woman that I’ve known that was in my practice for five years. She was healthier than you might think, but she ate nothing but oatmeal and chicken breasts.
Chris Kresser: Wow.
Kurt Harris: And she claimed she was allergic to everything else. I should say parenthetically the problem with this IgG testing and any kind of antibody testing is that when you have — I also have a problem with the term “leaky gut” because people mean different things by it, but when you have actual leakage of tight junctions and things going into your bloodstream, you can have an immune response mounted to almost any of those molecules going through there. The correlation of the immune level response or finding the antibodies with the clinical effect is poor to nonexistent, meaning if they tested me, they might find some level of detectable antibodies to lamb and beef because I live on lamb and beef, but that wouldn’t mean that I’m having any particular symptom due to that. So, that’s how some people get in a bind. Not only are they convincing themselves they’re having problems, but then they get testing done, which is bogus, that reinforces that they really are allergic to everything, and actually maybe they do have leaky gut, but the problem is the leaky gut, not the particular things that are leaking.
Chris Kresser: Exactly. Or maybe they had leaky gut and those larger molecules slipped through, created an immune response six months ago, and those IgG antibodies are still there because they last for three to six months, but the body already repaired that damage long before.
Kurt Harris: Sure.
Chris Kresser: I’ve also heard — I don’t know if you’ve heard stories like this, but I had a colleague who drew his own blood on the same day, marked the vials with two different bogus names, and sent them into the same lab. He got back completely different results. One was, like, if you eat peanuts you’re gonna die, and then the other one was, like, go ahead and eat peanuts, no problem.
Kurt Harris: Yeah!
Chris Kresser: But kinda tying this back all together, what we’ve been talking about, it is curious to me, and you alluded to this before, that I think everybody has had the experience of the gut-brain connection. Everyone has had that experience of maybe having to speak publicly or being nervous and they have diarrhea or they just feel — And yet, like you said, there’s such a reluctance to accept that stress or if we want to refer to this or any kind of psychological, emotional condition could be the primary factor in illness. And I think part of that issue is we need some new language, because even the idea of a mind-body connection suggests that the mind is separate to be connected to the body, that it’s separate, you know? It’s a problem, I think, that we’re just kinda conditioned. The dominant paradigm in allopathy is insufficient in this regard.
Kurt Harris: Yeah, for sure, and we’re not even getting into the really controversial territory of, you know, what is the mind? What is the brain? I’m basically a pure materialist. I mean, I meditate but I don’t buy any of the metaphysics. I mean, I kinda buy some of it in a metaphoric sense. You know, when they talk about if you meditate and you have that feeling of oneness, I believe that feeling of oneness is real, like you’re one with the whole universe. I also believe it’s mediated by brain chemicals.
Chris Kresser: Right.
Kurt Harris: And that when you die, there isn’t anything left other than what you wrote or what people remember about you. A lot of people that meditate or are into Buddhism buy the reincarnation and so forth. To me, I not only don’t believe it, I don’t think that’s really the critical part of it. To me, the critical part of it is what it does for you. To me, the mind is a function of the brain, and that doesn’t in any way diminish the mind. To me, what it does –
UPS Driver: Anybody home?
Kurt Harris: Hang on one second, please.
Chris Kresser: Sure.
Kurt Harris: I’m on the telephone. Can I do something for you? Who are you?
Chris Kresser: UPS!
Kurt Harris: I’m on a conference call.
Chris Kresser: Perfect timing. He interrupted your meditation on meditation!
Kurt Harris: Exactly! Well, anyhow, I didn’t mean to go off on a philosophical tangent. What I was going to say is it’s kind of a parallel to what Dawkins often says, or what I take him to say, is he says that if you know enough about science and nature, it doesn’t diminish God. It elevates how cool science and nature is to think that there is no God. To see that what we have in front of us is all there is, and wow, that’s pretty amazing! To me, that’s all I need, and I think of the mind-body connection as something not at all mystical. When I talk about the Sarno technique as being control of your mind over what’s happening in your body, I don’t look at that as there’s something out there in the ether or there’s some noncorporeal thing happening. To me, I look at that as you’re having one part of your brain, probably the orbital frontal cortex, control other parts of your brain, more the limbic system, and that’s something that you can control consciously. That doesn’t mean it’s anything mystical. And to me, I take all that — this is my sort of materialism — as just look at how powerful the brain is, mediating all of these effects in the gut and elsewhere. And like your friend that went on beer and pizza and now is thriving — I don’t doubt that story at all. And this is why on my blog and in my writings, my claims for what this will do are actually pretty modest. I read Good Calories, Bad Calories and then went further into the literature, and to me, my goal is can we come up with a diet that if not eliminates, at least reduces the possibility that we might die of certain things? Not everything, but certain things, diseases of civilization. If we could have a lifespan like a Northern Plains Lakota Sioux, say probably the same length of lifespan, but have access to modern medicine if we get into accidents, and just not die of complications of diabetes or Alzheimer’s, to me, that may seem like a modest goal, but when you’ve been a physician and seen people die of that stuff for 25 years, that seems like a pretty dramatic thing if we can do that. I don’t think we have any need, nor is it realistic to think that we’re all gonna live to be 150 or even that we’re all gonna be perfectly happy or all perfectly wealthy or that we’ll never have anything bad happen to us, or even that our health will be perfect in every way. I think that’s totally unrealistic, and maybe somebody listening will say: Well, Dr. Harris, there’s obviously something wrong with your diet if you’re not happy all the time. Well, OK, maybe there is.
Chris Kresser: You need a few more percent of this and a few less percent of that.
Kurt Harris: Yeah.
Chris Kresser: I know we talked about this earlier, Kurt, but that last idea you mentioned, it really boils down to the idea that we have complete control over our lives, whether that’s using diet or meditation or anything else, and that is an assumption that’s worth questioning, in my opinion!
Kurt Harris: For sure.
Chris Kresser: And in my personal experience, the value of meditation practice has been all about learning to live the life that we have and be present to the circumstances of our life without being totally dominated by them. And I saw, I think, that you had Uchiyama’s book, Opening the Hand of Thought, listed on that post you did a while back of your influences.
Kurt Harris: Yeah.
Chris Kresser: That’s one of my favorite books about, you know, sitting practice and meditation, mostly because he makes it out to be so ordinary. It’s not a mystical thing, it’s not about getting enlightened, it’s not about getting to the point where you’re an automaton and you don’t feel any human emotion and you’re completely detached and disconnected from your life, but it’s a practice like anything else, you know, how to just be fully present in your life. And one of the things I love, I don’t know if you remember this, but he calls thoughts mental secretions! Just like the pancreas secretes digestive enzymes and the stomach secretes hydrochloric acid and we have feces coming out of our intestines, the mind secretes thoughts. And the mistake that we make, of course, is attaching all kinds of value to this thought and not that thought and getting all caught up in –
Kurt Harris: Yeah, you know, identifying with the thoughts. Thinking that thought is me, my anger is me, what I’m feeling is me, the urge to do whatever is me. If there’s one thing that you can get out of it, and you know, I joked earlier. I should probably say for the benefit of those that think I’m the Clint Eastwood of nutrition, before I used to meditate, I was maybe the Charles Manson of whatever. I mean, I say that in jest. I think that it’s made positive changes on me and how I handle things, but good Lord, I still obviously become very upset if I read negative comments about me or people send me nasty emails or whatever. When I read people that say they are not bothered by that, I think they are either the Dalai Lama or they’re lying.
Chris Kresser: Yeah.
Kurt Harris: There’s no way you cannot — It would be like saying: My wife ran over my foot with the SUV, and I didn’t feel any pain.
Chris Kresser: And we might even question is that a desirable goal?
Kurt Harris: Exactly! Yeah, exactly. If somebody sent you an email saying: I know who you are. Your picture’s on the Internet. I know your address. I’m gonna come to your house and kill you. If you said you were not upset by that, I would think that you were irrational, as irrational as if your heart rate didn’t increase if somebody pointed a gun at you. So, I don’t want to make this about the blog comments thing, but you know, it’s a nice segue because my decision to do that was all about me. It was completely selfish. And what I learned is that I have sat for years. I don’t do it as often as I should, but I’ve learned that one thing that some people do that have problems with anger, sometimes they have the problem with anger because they put themselves in situations that make them angry or they’re used to be angry or they look for things to be angry about. So, one of the ways I manage that best, rather than saying: Hey, bring it on, insult me and let’s see if I can take it, I think one of the ways you can do that is to, just like you might not want to go to dinner with a friend who insults you, you might manage your life in a way that you’re not exposed to things that make you mad. Is there anything wrong with that? I can’t think of anything wrong with it.
Chris Kresser: I can’t either, and I actually recommended that exact strategy in the Manage Your Stress step in my 9 Steps series was, yeah, there’s a certain amount of stress in our life that we can’t eliminate, so why not eliminate every bit that we can?
Kurt Harris: You bet! And let’s say, even doing something like this podcast. This is only my third podcast. When I did my first one with Jimmy Moore, I had a brain fart in the beginning of that podcast. I blanked. He said: Hi, Kurt! You know, he did this big –
Chris Kresser: Yeah, the big intro.
Kurt Harris: Hey! Da-da-da-da. And I was so shocked, I was like [indiscernible] seconds. And I felt like a complete idiot, and I was nervous, and you know, this is my third one, and did I get nervous before it? Of course. Absolutely. You would be a fool if you said to yourself: Yeah, I’m about to go do something that hundreds of people, if not more, may listen to this –
Chris Kresser: Thousands actually, Kurt.
Kurt Harris: What’s that?
Chris Kresser: Thousands!
Kurt Harris: Thousands!
Chris Kresser: Right.
Kurt Harris: All right. Well, I was trying to be modest, but you know, if thousands of people are going to listen to this, I’m absolutely unconcerned with how I sound. If I told you that, if I told my friend, Emily, that, she’d say: Well, you know, you need to be more aware of your environment!
Chris Kresser: That’s right! She’d wonder if you were a sociopath.
Kurt Harris: Yeah, you’re a sociopath. If you literally don’t care what people think, you’re a sociopath. Sure.
Chris Kresser: Yeah. Well, this is a lot of fun. We could just go on like this, but there are a couple good questions that I think we’d have fun talking about too, so maybe we can move on to those, Danny. What do you think?
Danny Roddy: Cool. I just want to throw in that, Kurt, immediately when Jimmy started his introduction, I played in front of thousands of people with my old band, and I’ve never been more nervous in my whole life than when I was talking to Jimmy!
Kurt Harris: Yeah, there’s something about it. It’s funny. I’ve heard celebrities say that nothing makes them more nervous than when they go on talk shows.
Chris Kresser: Right.
Kurt Harris: And for a while, I was puzzled by that, but now I really understand it completely. If they’re film actors, they don’t feel like that’s a crowd. You know, they know the producer and director, and they’re there, and whoever they are, that’s their gig, that’s what they do. And you put them on a talk show and it’s live and, you know, it’s –
Chris Kresser: No script!
Kurt Harris: No script. Yeah. It’s just like that. No script.
Chris Kresser: Yeah!
Danny Roddy: Awesome. So, let’s get into some reader questions. The first reader question is from John: “Everyone is afraid of being stricken down by a heart attack. You flat out dismiss the relationship between lipid numbers and heart disease. We’re all in search of guidance. I know that you often advise us to simply eat well and worry less, but how about some guidance for those who want to monitor the extent of our risk of cardiac disease?” What do you think, Kurt?
Kurt Harris: Well, I think it’s an outstanding question, and I understand where it’s coming from. I’d sorta like to start by correcting the premise, which is that it sorta makes it sound like I’m not concerned about heart attacks or I think if you eat my way you won’t have a heart attack. Not at all! As I said before, my goals with the things I talk about with diet are pretty modest in the goal sense, but I do think there’s a good chance you can reduce your risk of a heart attack by eating a good diet. The question is not do I think that eliminates your risk. No, I don’t think it does. I think somebody my age that has bad genes in that regard still is probably at risk of a heart attack even if they eat the perfect diet. Just like somebody with familial hypercholesterolemia. They are still at high risk even if they eat what I think is an appropriate diet. I’m not saying you won’t have a heart attack. I’m not saying there’s no such thing as heart attacks! I’m not saying that it’s nothing to worry about or it’s trivial. What I’m saying is I have not found anything other than the things I talk about that I think are worth doing to prevent heart attacks. And that’s a really, really, really important distinction. If you think about things like, you know, when I talk about traditional lipids, things about measuring your cholesterol, measuring your LDL, measuring whether you have big particles or small particles, measuring your lipoprotein(a), looking at your C-reactive protein. Every one of these things is something that has been statistically associated on a population basis with being at risk. We don’t have the hours to go into all of those and what I think about them, but if I had seen anything that convinced me that changing those numbers, in other words, the changing of the number itself, is the thing that makes you not have a heart attack, you will see it on my blog. I’ve not found it. OK? I’m not saying C-reactive protein can’t predict on a population basis the risk of heart attack. I’m saying I’ve never seen a single thing that you could do to lower your CRP and say: Oh! My CRP was this and now it’s that, and my risk is lower. Or my lipoprotein(a). It was this and now it’s this. My risk is lower. If your risk is lower, it’s probably because of the diet, and the other thing may be just a marker. But saying: Here’s a drug, which does this to this number. We have lots of evidence that that not only doesn’t work, but it could kill you. And I’ve got a post I’m planning to do pretty soon, and I’ll probably actually post it first on Psychology Today, about anacetrapib. Anacetrapib is a cholesteryl ester transfer protein inhibitor similar to torcetrapib. Well, with torcetrapib, what happened was you had the world’s best elevation of the so-called “good cholesterol,” HDL. I mean, you could take somebody and take their HDL from 30 to 60 of 70 and take their LDL levels down to Dr. Davis range, like 50 or 60.
Chris Kresser: Right.
Kurt Harris: Based on population statistics, you would have zero risk of a heart attack, but when they did this with a drug, people had a 50% greater risk of death not just from heart attack. They stopped the study early. Anybody who’s read that study is familiar with that.
Chris Kresser: Yeah, I am.
Kurt Harris: And now, what’s interesting is they did the phase one trial, which is just to test for safety with anacetrapib, and I literally can’t believe that these people think this is gonna work, because if you go into the biochemistry of how this drug works, and you know what happened in the other trial, you will predict that anacetrapib will kill people. And sure enough, when you look at the phase one trial, the numbers were not “statistically significant,” but the death rate was five times higher with the drug. And you might ask yourself: Well, how can they continue with the trial? Ah, that’s the magic of statistical significance! You know, one of the things wrong with allopathic medicine is that the understanding of statistics is completely retarded. I’ve met maybe a handful of doctors, mostly who are academics, that even understand the proper use of medical statistics, and to say: We did this trial. If we were smart, we would have a plausible mechanism where anacetrapib would kill people just like torcetrapib. Well, I’m gonna say it right now, and thousands of people are gonna hear it: I predict the trial will be stopped just like the first one because it’s killing people, and if not, I believe it’s probably fraud because the death rate was higher, and the number of cardiac events, if you read in the lay press, they said that the number of cardiac events with anacetrapib in the preliminary trial was lower. But guess what? They defined cardiac event as having an angioplasty or an intervention. Well, the thing is that’s not an endpoint. That’s an intervention. A doctor does that to you. Well, what happens if you take a drug that changes your pain threshold or your perception that you’re having a heart attack? You can easily imagine a scenario where the anacetrapib would — Oh! The best way is anacetrapib by improving your cholesterol levels means that when you go to the doctor with chest pain and they look at your cholesterol levels, they are less likely to do a cath on you. All right? This seems totally obvious to me. Right? You’re on a drug that makes your lipid profile better, so if somebody says: Oh, you probably have costochondritis, you probably don’t have coronary artery disease, so we’re not gonna do a cath. So, it’s obviously biased, and I’m not the only one that’s pointed that out, by the way.
Chris Kresser: Yeah. You know, it reminds me of some of the statin studies with a classic case of disease substitution. They say: Guess what? Our drug reduces your risk of heart disease by 20%! But they don’t tell you that it increases your risk of cancer by 50% or something.
Kurt Harris: Yeah, or that cancer has longer lag time than heart disease.
Chris Kresser: Right.
Kurt Harris: And if you think biologically plausible mechanisms, I can’t prove it, but I would guess if you took 100,000 people and put them on statins for 10 years, and I’m talking about the people that have already had a heart attack, you know, you’re probably gonna get as many people more dying of cancer as the lives you actually do save. And statins do save lives, but let’s go back to my example of somebody with familial hypercholesterolemia or — No, that’s a bad example. Let’s go back to somebody that’s already had a heart attack.
Chris Kresser: Right, secondary prevention.
Kurt Harris: A person that’s already had a heart attack has a risk probably six times of what my risk is because they’ve had a heart attack. Right? The best predictor of having a heart attack is already having a heart attack. So, if you give that person a statin, their risk is not six times as high; it’s only five times as high.
Chris Kresser: Right.
Kurt Harris: Does anybody think that’s still not a high risk? Of course it is. And I can’t prove it, but if we think that these heart attacks are really being caused by a bad diet, I don’t think it’s unreasonable to hypothesize that you could get a much bigger reduction in your risk of having a heart attack by eating correctly than merely reducing your risk from, you know, six times my risk to five times. There’s no way to prove it, and that’s why I don’t make that claim.
Chris Kresser: Not to mention that with the diet you’re not risking forgetting who you are and permanent muscle damage, impotence, depression, death from violent or aggressive behavior, suicide, etc.!
Kurt Harris: Yeah. So, to sum up, I don’t minimize the risk of heart attack. I don’t claim that your risk is zero. I don’t claim that your risk becomes zero when you eat this way. I’m not claiming that anybody who eats my 12 steps is not gonna have a heart attack. I expect that they will, without a doubt. I could have a heart attack tomorrow, but when I do have it, I will not entertain any thoughts that I have had it later eating what I was eating before. That’s just not too likely.
Chris Kresser: Yeah. Danny, I’ll throw in a couple things to add to that actually. The one thing I would say — You know, I’m not actually even totally clear on John’s question, but I think he might also be asking, like, does high cholesterol point to any other problems? And if that’s the case, all I would add to what Kurt said is, yeah, if your cholesterol is high and you’re on a diet where you’re surprised that it’s high, it might be worth checking your thyroid, because we know that thyroid hormone activates the LDL receptor, and it might be worth investigating micronutrient deficiencies.
Kurt Harris: But it totally depends on why, and it takes a long time to answer that, but let me give a concrete example. Before I started eating this way, I was still already at an animal product-heavy diet, but probably let’s say 40% carbs, OK? And my total cholesterol was probably 140. And my LDL was probably calculated at around 110 or something like that. I had good trigs and everything like that. When I went VLC, after about six months — and I don’t know what it is now — my LDL went to 192. But my particle count was only 1100, which means I pretty much had the same number of particles, they were just packed, huge, big fluffy particles because of the high sat fat diet.
Chris Kresser: Right.
Kurt Harris: So, all of this stuff is really contextual. I don’t have any doubt — If you’re eating a Kitavan-style diet and your total cholesterol and your LDL are high, there might be something wrong, including thyroid. But your total cholesterol or LDL going up if you go on a high fat diet like Peter eats or like a VLC, PaNu diet, you know, I wouldn’t get too alarmed about that. And I would go so far as to even say I don’t even recommend measuring any cholesterol or lipid numbers because, OK, if you’ve got a spare several thousand dollars in your pocket to get the NMR and be reassured about it that it’s OK, fine. But most of the time, I mean, for instance, total cholesterol is not the best way to detect thyroid dysfunction.
Chris Kresser: Sure, not even. Not at all!
Kurt Harris: Talking to people and getting their history and measuring [indiscernible]
Chris Kresser: Yeah, absolutely!
Kurt Harris: So, you know, the best way to avoid the whole issue is don’t get them measured. And Gary Taubes even said that when he was on Oz. He said: I don’t want them measured because they don’t mean anything. And I agree. They don’t.
Chris Kresser: All right, Danny. I think we got time for maybe one or two more. What do you think?
Danny Roddy: Definitely. The interesting thing about the Oz interview is Gary explained why exactly, because if you watch that segment again, it just kind of basically has him saying: No, I don’t want to do it, but he doesn’t really give an explanation, but apparently there was a whole other section on him explaining it that was cut out, unfortunately.
Kurt Harris: Yeah. Funny how that works.
Chris Kresser: Yeah, exactly! That’s what happens when you control the debate.
Kurt Harris: Yeah, and then they had Oz eating pork rinds. What do you think those are fried in? Vegetable oil.
Chris Kresser: Soybean oil.
Danny Roddy: OK, you’ll have to forgive me for this next question because it’s kind of in an email format. But this is from Aravind: “What are your views on the hormetic effects of the consumption of the neolithic agents of disease, i.e. fructose, wheat, and vegetable oils? Related to this, I see a lot of energy in the blogosphere regarding hormesis lately. Is this just scientifically validating the conventional wisdom of everything in moderation? Cocaine in moderation, too?”
Chris Kresser: I like that!
Danny Roddy: Yeah, that’s my favorite part, too! And then there’s a second part that I’m actually interested in: “Any concerns about the oxidized PUFAs (polyunsaturated fatty acids) in the diet, say, from eating lots of scrambled eggs, for example, or as long as total PUFA intake is below 4% no big worries?” What do you think, Kurt and Chris?
Kurt Harris: Let me handle the second question first, because I think I can answer that quickly. The way I look at the whole oxidized PUFAs thing is the oxidized PUFAs you care about are the ones in your bloodstream, right? The way to avoid oxidized PUFAs in your bloodstream is to not eat them. Worrying about whether these nuts have been on the shelf too long or do the eggs contain oxidized PUFAs versus unoxidized PUFAs, that’s tinkering around the edges, all right? What I would do is try to keep your total PUFAs — total, counting your omega-3s — under 4%. For most people, if they can eat some grass-fed butter and beef and lamb now and then, if you do that, you’ll have a 6:3 ratio of around 2:1, which is perfect, and you won’t need to supplement with nasty fish oil pills, which cost money, and you’ll keep your total PUFAs under 4%, which is if not perfect, it’s pretty close to what a hunter-gatherer diet would do. Total PUFAs of 15% like the average American or even — I was actually just reading Cordain’s latest Paleo Diet updated book. He’s got in the very first sample diet in the book has total PUFAs recommended meal of 9%, and it’s almost all due to, like, about a half cup of shaved almonds. You know, almonds taste good. I might put them on some ice cream or something, but going nuts on nuts, I mean, there’s nothing really Paleo — I don’t like the term “Paleo” even anymore. I mean, there’s nothing really healthy about eating a lot of nuts. There just isn’t, you know?
Chris Kresser: Yeah.
Kurt Harris: So, that’s the way to approach that is instead of worrying about are the nuts stale, just don’t eat so many nuts. The first part of the question was about what again?
Danny Roddy: The hormetic effects of the neolithic agents of disease.
Kurt Harris: Yeah, my response is let’s not get carried away. Let’s keep speculating about hormesis to things where we have proven hormetic effects: radiation, polyphenols… I’m struggling to think of a whole lot of other things. Physical exercise. That totally fits into the “cardio causes heart disease” thing.
Chris Kresser: Intermittent fasting is another one.
Kurt Harris: Yeah, intermittent fasting carried to extreme is Dachau, right?
Chris Kresser: Exactly!
Kurt Harris: If you intermittently fast forever, you die. If you run a marathon a week, you will probably cause myocardial fibrosis. But people who struggle with this, again I’m like, well, I don’t eat 50,000 tons of kale or broccoli a week either. My post on polyphenols and hormesis was, you know, riffing off of what Stephan wrote. I’m not saying that Stephan endorses this view. My personal view is sorta somewhere between Stephan and Peter, which is to say there’s a certain level of vegetables that’s better than eating no vegetables, but I do not agree the more vegetables you eat or even that you need to eat them every day. I can’t prove it, but that’s my feeling.
Chris Kresser: Well, you can’t prove that there is a benefit either. A lot of people have tried doing that, and they haven’t been able to yet.
Kurt Harris: Yeah. Or as we were discussing this morning, colleagues and teachers you’ve cared about and that I’ve known about that have been on — you know, zen teachers who are thin, healthy, and fit-looking have been on macrobiotic vegetarian diets and are ridden with cancers and autoimmune diseases. So, certainly I’m not claiming that eating like Bear Stanley is the optimal diet, and I never did. I never did claim that. But I certainly don’t think macrobiotic vegetarian is the way to go. If I had to guess, getting more than half of your calories from animal products is the way to go, because there are things you simply can’t get from plants. What the optimal level is beyond that whether it’s a Big Ass Salad once a day a la Mark Sisson or whether it’s using vegetables as a garnish like Peter does — I don’t know. It’s probably somewhere between them. We’ll probably never know because the study will never been done.
Chris Kresser: Yeah, and there might even be some room for personal preference and individual [indiscernible]
Kurt Harris: Sure, but I don’t think you’re gonna be able to prevent a heart attack by eating certain vegetables or taking certain pills, and I don’t think you’re gonna cause a heart attack by not doing that. But as far as hormetic effects of the other neolithic agents, I’m more open to the idea that a cigarette a day might be more hormetic than wheat. I’m totally serious about that. I’m not 100% gluten-free, but what I know about the mechanism of action of how our bodies respond to gluten and wheat germ and glutenin, I don’t see that as being possibly hormetic. Maybe I’m wrong and there’s a study that shows that it is, but I don’t think so. But cigarette smoking, a little bit of oxidative stress now and then — who knows? It’s possible. What were the others? Yeah, or sugar, fructose. We know that uptake of glucose and storage of it is actually enhanced if you have a little fructose, and although I’ve called fruit a candybar from a tree, I’m really bagging on people going nuts on fruit. I’m not saying don’t ever eat fruit. You know, eat an orange a day or something like that. That’s like 8 grams of fructose. That’s nothing. But fructose itself being a little hormetic — I don’t know. It’s possible.
Chris Kresser: Yeah, but you’ll get that just by eating a pretty normal Paleo type of diet.
Kurt Harris: Exactly. The nature of the question sounds to me like: Hey, do you think there are some other things that are inducing hormesis that I should be doing a lot of? Well, the idea of hormesis is you don’t do a lot of it, you just do a little bit of it.
Chris Kresser: So you can go on a wheat bender and say: I’m working on doing my hormesis part of the month right now!
Kurt Harris: Or you could volunteer to throw buckets of water on the reactor in Japan, and that’d be a whole bunch of hormesis in an hour.
Chris Kresser: Just do the Tim Ferriss thing and take really ice-cold baths a lot. That would be even better.
Kurt Harris: Well, you know, that’s a Paleo thing I’ve heard of before, and my brother-in-law likes to do these cold showers, but he lives in San Diego.
Chris Kresser: Right!
Kurt Harris: And I’m like I don’t have to take a freaking cold shower. All I have to do is go out to my car every day in the snow, so I get plenty of cold exposure. No cold shower necessary.
Chris Kresser: It’s all relative. All right, Danny, where are we at?
Danny Roddy: OK, the vitamin D question from Laura in Arizona.
Kurt Harris: Sure.
Danny Roddy: OK, cool. “Chris and Dr. Harris, love both of your blogs and appreciate your time and effort. My question is in regards to vitamin D. Although I’ve jumped on the bandwagon and have been supplementing 5000 units of D3 and do get my levels tested, I’m a little concerned with this approach as practice for a healthy life, and I would like to know what are your current recommendations for vitamin D3 replacement? What is the good vitamin D for overall health? Should we attempt to maintain our levels year round, or should we strive for higher levels in the summer and allow winter levels to fall, thus mimicking our natural ancestral cycle?”
Kurt Harris: All right, what me to take that?
Chris Kresser: Sure. Go for it, and I’ll jump in if I have another thought.
Kurt Harris: If you think I’m totally wrong, just jump in! My current recommendation, which actually is not anywhere on the blog, so this is sort of an exclusive here. From the beginning, I wrote a bunch of posts on vitamin D, and I read all the standard sources and so forth, but from the beginning, I said I thought it was best to get vitamin D from the sun. And I started supplementing. Last winter was the first winter I supplemented with vitamin D, and I got the worst virus I’ve had probably in 20 years. And I started doing a little more reading and thinking about it, and I’ve decided once I’ve learned something about the likely evolution of light skin, I believe that’s probably due to sexual selection, not making us vitamin D receptors. When you read a little bit about the differences between black and white people and how quickly they both max out on vitamin D production in the sun, etc., etc., when you read about what are the real causes of rickets in populations, it probably relates to too much grains and not enough animal food. I got that idea first from Peter. He directed me to some other sources. I have simply not had time to make a whole big blog post about this, but I’ve kinda sprinkled this elsewhere in the blogosphere. I don’t take vitamin D anymore. Just another brief anecdote: My wife continued to take about 2000 units a day over the winter, and she went on a trip and got a terrible cold, brought it home. She was sick in bed for four days and I didn’t even catch it, and I don’t supplement. So, here’s my current recommendation: If you’re in a prison in solitary confinement or in an nursing home, get your D level measured and take enough supplement to keep it over 30 ng/mL. Not 50, 30. I think 30 is plenty, and I think there’s probably a J-curve or a U-curve where artificially supplementing anything beyond that level is questionable. I don’t think it’s definitely dangerous. I just think it’s unproven, and I don’t really trust it. I think the best way to get vitamin D is to get sunlight on enough skin to get some vitamin D for as much of the year as you can and then let your levels fall during the winter, and I can’t prove that, but I have theoretical reasons to believe that works. It’s actually worked for me for most of my life. I’ve always been a person that’s gotten plenty of sun. I mean, even when I had a full-time job, I would try to sit out in the sunlight and eat my lunch and try to get a little sun that way.
Chris Kresser: That’s like you, Danny, lying out on your sidewalk, huh?
Danny Roddy: Yeah, it’s all because of — Kurt, I know you’ve interfaced with him, but Lex Rooker, I told him I was taking vitamin D, and he was like: Danny, you’ll never learn. It’s always real hot at the moment, and then there’s always, like, a U-shaped curve. And, man, he told me that, like, two years ago, and now I’ve finally listened to him.
Kurt Harris: Lex is a pretty smart guy on the leading edge in many things, I think. But I agree with that. Chris, what are your recommendations these days?
Chris Kresser: Yeah, I have a couple different thoughts on it. The one thing about sun exposure and vitamin D that I’ve found in my research is there are two factors that can really reduce the synthesis of vitamin D from UV light. One of those is obesity, and the other is inflammation. So, I would just add to what you said, if you’re obese, you are inflamed; and if you’re inflamed, you might be obese. Or if you have any kind of chronic autoimmune condition, which is low-grade inflammation, you might want to consider supplementing with D in addition to getting D from sunlight. And I’ve seen people come into my — You know, I pretty much measure D on everyone that I see in my practice, because I treat so many people with autoimmune disease, and vitamin D plays a major role in supporting T regulatory cell function.
Kurt Harris: Sure.
Chris Kresser: So, it addresses that Th1/Th2 imbalance that’s typical in autoimmune condition. And so, I’ll see people come in who say they get plenty of sun, and their vitamin D levels are, like, 12. And they can’t believe it because they’re out in the sun and they’re not wearing sunblock, but there’s some mechanism maybe even beyond inflammation and obesity that we don’t fully understand yet that is inhibiting the production of D from UV light.
Kurt Harris: Are those people that are eating your diet?
Chris Kresser: Yeah, they are. It’s kind of amazing.
Kurt Harris: That’s amazing, yeah.
Chris Kresser: And so, for those people, I will definitely supplement, but I completely agree with you that somewhere between — My range is like 35 to 50. There’s definitely evidence in the literature that pushing up to 80 or 90 can cause hypercalcemia, which can increase the risk of heart disease and kidney stones and other fun stuff. And even if you gonna go up to 50 or 60, you better make sure that you’re getting enough vitamin A because vitamin A protects against D toxicity and vice versa.
Kurt Harris: Yeah. Well, I think maybe we can synthesize our ideas by saying — And I think this fits because I feel like I’m talking more to the average person walking around. You’re more in the therapeutic realm. The same thing, I think, would be true of thyroid or fish oil or whatever. I’m not denying that there are therapeutic contexts for specific diseases where we can take drugs. Good Lord, you know, if I have a headache, I might take a Tylenol now and then, you know?
Chris Kresser: You better expect a lot of flames for that one! [laughter] Like rice krispies, huh?
Kurt Harris: Yeah, just like the rice krispies. Yeah, 3 grams of sugar in a cup. Sure, in the therapeutic context, I’m not denying that, but I always assume when I’m asked a question like the questioner asked, what about vitamin D, I’m just talking to the average person who isn’t sick, didn’t go to the doctor. They’re just a CrossFitter or whatever and they want to eat Paleo or do some kind of a better diet or maybe just lose a little weight. You know, they don’t have an inflammatory disease. Always when I answer questions like that, if somebody doesn’t preface it by saying: I’m sick, I’m gonna give that answer. But I don’t disagree that it may be appropriate to supplement. The only thing I would caution is that one of my issues with the supplementation is that it’s the peripheral conversion to 1,25. That’s where vitamin D has its action. It’s possible your people with a serum level of 12, that they have enough vitamin D peripherally. It’s possible. You don’t really know. Just like I actually measured my D levels at the end of the summer when I was outside probably an hour a day, but I never really got that — You know, I had a decent California tan, I guess you’d say, for a white person. And at the end of the summer I measured, and I was — I’m sorry. I measured it in October, late October, and it was about 65, and I sort of interpolated that I had probably been up around 90. So, do I think I was at risk of hypercalcemia from a level of 90 from the sun? No, I don’t think that’s possible. I think that the missing thing there, the thing that makes me suspicious is to say: Oh, that serum level, which is the only thing we can conveniently measure, we’re gonna treat based on that when it’s actually the 1,25 level that does the work.
Chris Kresser: Right.
Kurt Harris: So, that’s my hesitance about assuming — You know, I’m not saying it’s bad necessarily, but it’s just what makes me cautious and why I think sun is the best option for most people that aren’t sick anyway.
Chris Kresser: We certainly know that vitamin D metabolism is very complex and affected by a lot of factors, almost too many factors to really completely understand what’s going on.
Kurt Harris: Yeah, and it’s a hormone, and you’re talking nuclear receptors here. This isn’t just like, you know, I took a little extra magnesium, and as long as my kidney’s work, I’m gonna pee it out. Vitamin D is not like that.
Chris Kresser: Yeah, we know there are receptor site polymorphisms in autoimmune disease too that affect activation of 1,25D.
Kurt Harris: Sure.
Chris Kresser: Well, that’s why we make a good team, Kurt! I mean, I work with people like that all day, and so I can’t help having that perspective. Sometimes I need to step back and remember, so it’s been great having you on the show and kind of just kicking it down for the layperson, so to speak.
Kurt Harris: Yeah. I have a lot of fun doing these, and as I said, I’m always a little nervous when it starts, but Jimmy Moore says you can just wind me up and let me go, and it’s always fun once we get started. I like to talk , I guess. Let’s maybe do one just on meditation sometime in the future. That would be fun, I think.
Chris Kresser: Yeah. I think that’d be great. I’m all for it.
Kurt Harris: Cool.
Chris Kresser: Kurt, why don’t you tell all our listeners maybe what you’ve got going on the web these days. Psychology Today, you mentioned. Just before we sign off.
Kurt Harris: Yeah, like I said, I used to always have a stack in my brain of blog posts I was about to do, and I’d always say: Coming up soon! You know, there’s this and then I just drop it for something else, so I don’t really want to mention a lot of specific ones, except I will say I’m gonna do one on anacetrapib, and I’ll probably post that on Psychology Today first. And the Psychology Today thing has worked out well, by the way. I was solicited for that, and I was a little like: Aw, gee. How much am I gonna have to dumb these articles down for, you know, a more general audience? And I thought: Well, if the editor wants me to write there, obviously she doesn’t want them dumbed down, so I didn’t. I took a really long, kinda complex, science-heavy post on running, thought it would be somewhat interesting and controversial, and the last I checked, it’s had like 12,000 hits.
Chris Kresser: That’s amazing. Congratulations!
Kurt Harris: The most-linked and most-viewed article on the whole site with 600 bloggers yesterday.
Chris Kresser: That’s awesome, Kurt.
Kurt Harris: Yeah, I’m very happy about that, and you can look forward to more things. I’m not sure if I’m gonna put up, you know, eight posts a week or anything like that, but I’m gonna try to keep my blog at at least one or two posts a week, and we’ll see how it goes!
Chris Kresser: All right, sounds good.
Danny Roddy: Chris, how can we find more of your work on the Internet this week?
Chris Kresser: Well, let’s see. The 9 Steps series is almost over. I just actually published the eighth step, which was Get More Sleep, and the ninth step is gonna be about having more fun, basically practicing pleasure in your life and the effects of pleasure on the immune system and overall health. So, I’m almost finished with that. It’s been one of the most fun articles to write, actually. And yeah, you know, just keep an eye on the blog. The brain-gut axis series, I think, is the next one that I’m cooking up, but I’ll probably just do some one-off articles before I dive into another series. I feel like I need a little bit of a break from the structure of a series.
Danny Roddy: Cool. You can find me at Twitter.com/DannyRoddy and DannyRoddy.com. Keep sending us your questions at TheHealthySkeptic.org using the podcast submission link. Kurt, Chris, it’s been an absolute pleasure. I’d like to thank all of our listeners, and take care, guys!
Kurt Harris: Thank you!
Chris Kresser: Thanks again! Thank you, Kurt.
Kurt Harris: You bet. Any time!
Chris Kresser: Byebye.
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