RHR: The Highly Effective (But Little Known) Treatment For Chronic Sinusitis

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Well, folks, I blew it with the audio this time.  My recording settings weren’t set properly, so we had to use the Skype back-up.  Sorry!

Pork has been getting a bad rap in the blogosphere lately.  In this episode we explore whether pork deserves the harsh treatment, or whether it’s merely a victim of misunderstanding.  We also discuss a novel treatment for chronic sinusitis, which by some measurements is the most common chronic disease in the U.S., as well as a few other great questions.  Enjoy!

In this episode, we cover:

4:38  Is pork a “dirty meat” that causes liver disease?
17:20  What do you recommend for chronic sinus infections?
27:58  Does high intra-abdominal pressure always cause GERD?
35:11  Are “properly prepared” grains OK to eat?
45:45  Is postnasal drip a sign of a bigger problem?
47:35  Should pregnant moms supplement with folic acid?

Links We Discuss:

http://www.ncbi.nlm.nih.gov/pubmed/21739098
http://www.ncbi.nlm.nih.gov/pubmed/21814734
http://www.ncbi.nlm.nih.gov/pubmed/22144052
http://www.ncbi.nlm.nih.gov/pubmed/21865700
http://www.ncbi.nlm.nih.gov/pubmed/22088282
http://www.ncbi.nlm.nih.gov/pubmed/22182736
http://www.ncbi.nlm.nih.gov/pubmed/22241786
http://www.ncbi.nlm.nih.gov/pubmed/22287462

Play

Full Text Transcript:

Steve Wright:  Hi everyone, and welcome to the Revolution Health Radio Show.  I’m Steve Wright from SCDlifestyle.com, and with me is Chris Kresser, health detective and creator of ChrisKresser.com.  How’s it going today, Chris?

Chris Kresser:  It’s going pretty well, Steve.  How are you?

Steve Wright:  I’m doing great, man.  I got my sling off yesterday, so I’m finally back to two arms.

Chris Kresser:  Glad to hear it.  I bet that’s liberating.

Steve Wright:  It is, it is; however, I have a bunch of new pains now, and I’m gonna have to learn how to sleep again.  So.

Chris Kresser:  Right.  Ah, well, it’s all part of the fun, huh?

Steve Wright:  Yeah.  Only like four more months, right?  So.

Chris Kresser:  Ha-ha.  You’ll hardly remember it in a few years.

Steve Wright:  Exactly!

Chris Kresser:  Cool.  So, we have some good questions.  We’re gonna do a 100% Q&A episode today, which is a little unusual, but lots going on for me right now, and didn’t have time to prepare anything for the show, and I actually like doing these Q&A episodes every now and then.  Before we do that, though, I want to tell everyone — I’m sure most of you have already heard of this, but in case you haven’t, I want to tell you about a really cool event that’s coming up starting on February 26 and running through March 4.  It’s put on by my good buddy, Sean Croxton, over at Underground Wellness, and it’s called The Paleo Summit.  So, this is an online conference with tons of great speakers in the Paleo/Primal niche, a lot of familiar names:  Mark Sisson, Jack Kruse, Erwin Le Corre from MovNat, Paul Jaminet, Diane Sanfillipo, myself, Sarah Fragoso, Mat Lalonde, Amy Kubal, Denise Minger.  So, it’s a great group of speakers.  And then even Matt Stone is gonna be there for the anti-Paleo perspective, so Sean is really interested in hearing from a number of different voices.  I think that’s great.  I enjoy that.  And it’s really cool because it’s free.  Free is good.  It’s gonna be accessible to everybody, and all you have to do is go there and register and you get a couple of bonus videos:  an interview with Mark Sisson and Sean and another with Sean interviewing Gary Taubes.  So, definitely check it out.  It kicks off on Sunday, February 26, and go to CKPaleoSummit.com to register.  So that’s CKPaleoSummit.com.  And I hope you enjoy it.  It’s a great opportunity to get exposed to some cool stuff, and unlike the Ancestral Health Symposium and PaleoFX, which are awesome events too that I’m speaking at this year, this one’s totally free, and you can participate from the comfort of your own home.

Steve Wright:  Yeah, I’m pretty jacked about this.  I’m all signed up, and I think it’s gonna be great.  I think the speaker lineup is just amazing.  There are 24 people, right?

Chris Kresser:  Yeah, 24 people.  I think eight days and three people on each day, and then there’s gonna be full transcripts and PDFs and videos and a whole package.  That part is not free, but if you want to have the whole thing so you can refer back to it afterwards, you’ll be able to do that.  So, it’s a cool format.  I think Sean is doing a great thing, and I’m looking forward to being a part of it.  My talk actually is gonna be — it’s called An Update on Cholesterol, so I take a lot of the information that we discussed in the three-part series with Chris Masterjohn, and I distill it down into a really practical framework of what to do — if anything — if you have high cholesterol, when is it a problem, when is it not a problem, and what do you do about it from a natural perspective.  So, yeah, check it out.  It’s pretty exciting.

Steve Wright:  All right, so should we roll on to the first question?

Chris Kresser:  Yeah, let’s do it.

Is pork a “dirty meat” that causes liver disease?

Steve Wright:  OK, so here’s question number one from Marianne:  “I would love to hear what you think about pork consumption and liver disease, as referenced from an article this week from the Perfect Health Diet website.”

Chris Kresser:  Yeah, this has caused a little bit of a stir.  So, for those of you that didn’t see it, Paul wrote an article quoting a 2009 study by Bridges showing a stronger correlation between liver cirrhosis and pork than liver cirrhosis and alcohol.  And Paul’s argument was, therefore, that eating pork may cause liver cirrhosis.  But, of course, correlation is not causation.  We talk about this a lot.  That’s research 101.  Two things occurring together does not necessarily mean that one thing causes the other.  So, it’s really crucial and important to understand that basic principle.  And Ned Kock, who has a blog called Health Correlator, which is pretty technical — he’s a statistician and sometimes it’s over my head.  I’m not a statistician.  I get basic statistics, but when it gets really advanced, my eyes start to glaze over.  But this article is pretty easy to follow, and you should check it out if you are concerned about pork consumption after reading Paul’s article.  Ned did a more sophisticated multivariate analysis on the same study, and he found that the total effect of alcohol consumption on cirrhosis was actually 94% stronger than the total effect of pork consumption on cirrhosis.  He also pointed out that another factor that’s associated with liver cirrhosis is obesity, so in countries where pork is a staple, you might think it’s reasonable to assume that pork consumption may be correlated with obesity, but people who consume a lot of junk food also consume a lot of saturated fat, and they show up in the disease stats, but this is exactly the kind of confusion that led to the mistaken idea that saturated fat causes heart disease, right?  So, that idea rose out of epidemiological studies that saw:  Oh, these people are eating a lot of saturated fat and they have heart disease.  But what they didn’t control for was the fact that those people were also eating tons of other processed junk food that could very well have been contributing to heart disease, and it had nothing to do with the saturated fat, because later when they looked at studies that isolated those variables and they just compared saturated fat with other types of fat, they found that saturated fat did not increase the risk of heart disease.  So, we don’t want to make that same mistake here with pork and liver cirrhosis, and that’s why we can’t look at epidemiological data like this and draw causal relationships from it.  So, Ned went on to — just for the other side of the coin — to look at evidence that pork might be good for you.  And he took some data from NationMaster.com on pork and alcohol consumption and life expectancy, and it was a much larger list of countries than was used in the Bridges study, so it included Australia, Brazil, Canada, China, Denmark, France, Germany, Hong Kong, Hungary, Japan, Mexico, Poland, Russia, Singapore, Spain, Sweden, the UK, and the US — so a broad representative sample from all different parts of the world.  And in that study, the link between pork consumption and life expectancy is actually positive, with a 0.36 correlation.  So, according to this data set, the more pork is consumed in a country, the longer people live.  And in fact, the data suggested that each additional gram of pork consumed per person per day adds an extra 13 days to their life expectancy.  Now before everyone runs off and goes on a 100% pork diet, you have to realize that this is merely a correlation too, so we can’t draw conclusions about causal relationships from this data either, but we can say that the data don’t prove that pork consumption causes liver cirrhosis unless, perhaps, you become obese from eating it.  Now there was a second part to that question, which was:  What about the idea that pork is a “dirty meat”, which is somewhat prevalent in the mainstream?  Conventionally raised pigs or pigs raised in confinement feeding operations are given a lot of antibiotics because of the conditions of their confinement, and the problem with this is that just like in humans, if you give animals a lot of antibiotics, they’ll develop antibiotic-resistant super strains of bacteria.  So, Canadian researchers have found antibiotic-resistant staph bacteria in conventionally raised pork products, and that could, indeed, be a problem.  Also improperly cooked and prepared pork may harbor parasites that can cause disease in humans, and there are two helminths or worms that we have in common.  Both humans and pigs can be affected by them, and they cause the same diseases in pigs and in us.  One is the nematode Trichinella spiralis, which causes trichinosis.  That’s the disease most people have heard of associated with pork.  And then a tapeworm, Taenia solium.  And both of these diseases were known to ancient cultures, including the Egyptian and Greek cultures, and then later on Jews and Muslims, which is probably why both Judaism and Islam proscribe the eating of pork.  But today, I mean, if you completely cook pork, if you cook it thoroughly, that should effectively kill the parasites if they’re present, and that’s probably why trichinosis has become pretty rare in the US, because cooking pork thoroughly has become a widespread practice.  And traditionally pork was marinated or cured, i.e. bacon, before cooking because the marinating and curing helped kill the pathogens, as well.  So, if you’re concerned about the potential of pathogens in pork, (1) don’t eat conventionally raised pork.  Get grass-fed, pasture-raised pork from a local farmer or a farmers’ market or a store that sells that.  And that will reduce the risk of super strains of antibiotic-resistant staph that you would find in conventionally raised pork.  (2)  You can marinate or cure pork before eating it.  One way to do that without using nitrates or nitrite salts is just to use a little bit of salt and a natural sweetener, like maple sugar, to treat the meat, to marinate it for a period of time, maybe 18 hours, 24 hours, and some spices with flavor, and then just make sure to cook it all the way through, and it shouldn’t be an issue.  So, you know, based on the evidence that I’ve seen, I don’t think that you can make an argument that pork is unhealthy or is associated with disease.  I think you can make an argument that undercooked pork or improperly prepared pork that’s raised in confinement feeding operations can contribute to that, but I think we need to be a little more specific, you know, when we make these kinds of statements.

Steve Wright:  I’m glad you cleared that up, because I was really sweating about my bacon.

Chris Kresser:  Ha-ha, I know!  A lot of people out there were freaking out.  Don’t mess with their bacon.

Steve Wright:  Do you eat pork on a regular basis at all?

Chris Kresser:  I do eat pork.  I like pork, and we get it from a local farm, and we do marinate it and prepare it that way, and we often, you know, we cook it for — we’ll usually slow cook pork, like, if we get a pork shoulder roast or something like that, and we’ll turn it into carnitas, and we’ll roast it for a long period of time at a low temperature, and that will kill any potential pathogens in there.  I do eat bacon.  I’m not, you know, I don’t eat it every day, but I have it probably two or three times a week.  And I love pork chops, actually.  That’s one of my favorite kinds of meat.  So, I think, like I said, as long as you prepare it well and as long as you cook it thoroughly, it shouldn’t be a problem.  Now the other issue with pork is the omega-6 content, and this has less to do with how the pork is raised, although certainly pork that’s raised in confinement feeding operations is likely to have more omega-6 because of the food that they’re given, but even pasture-raised pork will have more omega-6 than beef or lamb or any other kind of wild game meat, of course.  But it has less omega-6 than chicken, than dark-meat chicken, so I don’t think the omega 6 issue is a reason to completely avoid pork.  I just think it’s probably a reason not to make it your staple meat that you eat every day, twice a day, but I don’t think it’s a reason to avoid it completely.

Steve Wright:  I’m glad you brought that up, because I think most people hold chicken to be like the super-safe meat, but little do they know that it might not be so safe.

Chris Kresser:  Yeah, I mean, it’s all in moderation.  Like, we have the ability to deal with some amount of omega-6, and eating dark-meat chicken, you know, once or twice a week, I don’t think it’s gonna cause any serious health problems for anybody.  I think that the risk in doing what I do and making people aware of these things is it’s sometimes difficult to convey the — What am I trying to say?  It’s easy, I think, sometimes for it to come across too literally, and I’d like to find a way of communicating it where that’s less likely to happen.  But, you know, if I write an article that says omega-6 is proinflammatory in excess and contributes to various disease states, then sometimes that gets interpreted like I shouldn’t eat any omega-6; you know, like even half of an avocado is gonna make me keel over and die of a heart attack.  And I just don’t think that’s the case.  I don’t see evidence really to support that, and I don’t see it clinically in my practice.  I think it’s wise to reduce our omega-6 consumption significantly, as I’ve pointed out several times, but that doesn’t mean we can’t have dark-meat chicken or avocados or walnuts or things like that occasionally as part of an overall healthy diet.  And so, I think the same is true with pork, provided you follow the guidelines that I just mentioned.

Steve Wright:  Yeah, I’m glad you brought that up.  I didn’t mean to demonize chicken in favor of pork or anything, because I think you’re right.  It’s hard for us as we read what you write and as we all do our own research, we’re always looking for a black-and-white answer.  And I think I’ve learned as you get deeper and deeper, you start to become more appreciative of the body we have and its systems, and you start to realize that everything is kind of on a continuum.

Chris Kresser:  Um-hum.

Steve Wright:  And there’s usually never a supremely right or supremely wrong way to eat some things.

Chris Kresser:  Um-hum.  Very well said.

Steve Wright:  Or natural foods, that is.

Chris Kresser:  Um-hum.  Yeah, and it depends on a lot of factors too, like how healthy you are now, what your goals are, you know, where you’re coming from, and I think there’s a question later where we’ll get into more detail about this, but it’s just good to point out in the context of the whole pork thing.

What do you recommend for chronic sinus infections?

Steve Wright:  Cool.  Well, let’s roll on for the next question from David.  He asks, “What do you recommend for chronic sinus infections?  This is, according to some reports, the most common chronic disease in the United States.  Research by Mayo Clinic in 1999 found that virtually all (96%) cases of chronic sinusitis are caused not by bacteria but by fungus.  So, what is your approach to this?”

Chris Kresser:  Yeah, this is a big topic, and maybe we’ll do an entire show on it, and we’ll have Kurt Harris come and help us out.  He is somewhat of an expert on this topic, and I’ve consulted him about it a few times.  And, yeah, I’ve read that Mayo Clinic thing, and it turns out to be a little bit of a red herring.  The consensus that I respect on fungus is that except for true fungal rhinosinusitis — which is what the technical term is for chronic sinus infections, chronic rhinosinusitis or CRS — true fungal CRS is easily diagnosable by the presence of eosinophilic mucin, but that’s actually pretty rare, and fungus in the nose is commensal, meaning it’s just part of the body’s natural terrain, and most cases of CRS have nothing to do with fungus being present, and furthermore, there is no good evidence that antifungal agents help in the treatment for fungal rhinosinusitis, which is relatively rare.  So, I don’t actually buy the fungus hypothesis for that reason, and my view on it is that it’s probably more like chronic, recalcitrant, difficult-to-treat sinus infections are more related to biofilm than fungus, and particularly in those who have had surgery and those who have poor immune function.  And there’s a bunch of studies that I’ve looked at connecting CRS to biofilm — and we can put those studies in the show notes for anybody that’s interested — but there are some pretty interesting emerging treatments for chronic sinusitis that relate to this biofilm hypothesis, and one of them is nasal irrigation with Johnson’s baby shampoo solution.

Steve Wright:  What?!

Chris Kresser:  Ha-ha, yeah, no joke.  This is in the scientific literature.  You’ll find studies in PubMed about this.  So, it’s a 1% Johnson’s baby shampoo solution, so you do kind of like a Neti or a nasal irrigation with the 1% baby shampoo.  And in the study, 60% of patients noted a significant improvement in symptoms, you know, reduction of thickened mucus and postnasal drainage.

Steve Wright:  Is this biofilm, is this in the gut or is this in the nose or the cavities?

Chris Kresser:  Biofilm is everywhere.  Biofilm is an extracellular matrix that bacteria reside in, and most pathogens actually we think now.  One really good example of biofilm is plaque, you know, the thin film that covers our teeth.  And this extracellular matrix allows the bacteria to share nutrients and also even DNA, and it protects them from our own innate immune defenses and also from any external antimicrobials that we might take.  So, it’s kind of like a protective community, strength in numbers, and as long as the bacteria are in the biofilm, a lot of the antibacterial agents that we use don’t really work.  So, that explains why some people take antibiotic after antibiotic after antibiotic with sinus infections and they just don’t recover.  So, one therapeutic approach is to disrupt the biofilm, and there are ways to do that topically, and there are ways to do that systemically.  So topically, one way is this Johnson’s baby shampoo irrigation, and the way it works is that Johnson’s baby shampoo has chemical surfactants in there, and you can think of them as like a therapeutic detergent to break up and assist in the eradication of biofilms, and that’s been known for a while.  That’s been used in the orthopedic literature, this use of chemical surfactants to break up biofilm.  But in chronic sinusitis, it probably has two benefits:  One is as a mucoactive agent, and mucoactive agents work either to increase the ability to expectorate sputum or to decrease mucus hypersecretion.  Or, number two, it has potential bactericidal activity; in other words, antibiotic activity.  So, that’s one.  Another solution that’s maybe a little bit more accessible to people and a little bit easier to get your head around are xylitol nasal drops.  Now xylitol is a sugar alcohol, but it has activity against biofilm, and this is one of the reasons why xylitol chewing gum has become popular amongst dentists.  As I just mentioned, plaque is a biofilm, so if you chew xylitol gum, that can actually help break up plaque.  So, these xylitol nasal drops, or there’s actually a nasal spray that’s called — I’m not sure how to pronounce it.  It’s a very bad name.  Anyways, Xlear nasal spray.  And I’ve read a couple studies that use a similar solution and some accounts from doctors who are working with this stuff, and the consensus seems to be that it needs to be used pretty frequently, like up to three to four times a day, for it to work.  But unlike steroid sprays, which are often used in nasal sprays, xylitol doesn’t dry out the nasal passages, and it doesn’t inhibit the immune defense of the body.  Instead, it acts more as a lubricant, which makes it easier for natural mucus secretions to occur that kind of eliminate the pathogens.  I mean, the way it should work is that the mucus forms, and then you blow your nose and it carries the pathogens out of the nasal passage, and xylitol helps that to happen by lubricating them and acting as a surfactant that allows the nasal passages to clear.  So, another potential avenue, although I haven’t seen any research on this, is using a systemic biofilm disruptor, which would be something like InterFase Plus, and that’s a product that has EDTA and some enzymes that chelate — Well, EDTA chelates some of the minerals that are needed to produce biofilm, that biofilm formation depends on.  And then there are some systemic enzymes that have been shown to break up biofilm.  So, that needs to be taken on an empty stomach, because if you take it with food, the enzymes in there will help digest the food, which is nice but it’s not really, you know, what you’re taking it for.  So, InterFase Plus needs to be taken on an empty stomach a couple hours after a meal or a half hour before a meal.  And, like I said, I haven’t seen any studies on systemic biofilm agents like this in chronic rhinosinusitis, but I do use InterFase for other kinds of infections, and I’ve found it to be extremely effective in most cases.  In fact, it seems to cause more of a Herxheimer or die-off reaction in treating infections than a lot of the botanical antimicrobials, which is indicative that it’s working.

Steve Wright:  Interesting.  So, let’s back up to the very beginning of the question just to clarify this for everyone.  Chronic rhinosinusitis, you said, was kind of rare, so what’s –

Chris Kresser:  No, chronic rhinosinusitis is actually pretty common.  It might be one of the most common diseases there is, but the fungal chronic rhinosinusitis or fungal RS, as it is called, which is caused by a fungus, that’s rare.

Steve Wright:  OK.

Chris Kresser:  And that is easily diagnosed by looking for eosinophilic mucin, and there’s been an idea that — I don’t know if it started with that Mayo Clinic article, but it’s been bounced around a lot in the blogosphere that all sinus infections are fungal in origin, and what I’m saying is I don’t think the evidence really supports that.

Steve Wright:  All right, I gotcha.

Chris Kresser:  Yeah, it’s more about biofilm than it is about fungus.

Steve Wright:  OK.  That makes much more sense now.

Chris Kresser:  Yeah, so I mean, of course, all of the other things apply, like all of the other things that you would do to regulate your immune system and not eating food toxins and making sure you have the micronutrients that support immunity, like vitamin C and iodine and selenium and, you know, exercise, all the basics apply here.  But I am assuming a lot of people are already doing that who are listening to this show, and they’re already eating a Paleo/Primal type of diet, and if they’re still having sinusitis, then you might want to investigate this biofilm angle.  I think the easiest way to do that is the Xlear — or however you say that — nasal spray and then possibly a systemic biofilm agent like InterFase Plus.

Steve Wright:  OK, and don’t forget to check your vitamin D if this is a problem for you, as well.

Chris Kresser:  Absolutely.

Does high intra-abdominal pressure always cause GERD?

Steve Wright:  All right.  So, let’s move on to the next one.  This comes from Brendan:  “I’ve got one regarding your position on GERD.  In my medical nutrition therapy class at school my professor taught us that increased pressure from the other side of the lower esophageal sphincter actually helps to keep the sphincter closed and that a lack of pressure allows it to relax and allows the reflux to occur.  This seems to conflict with your idea that bacterial overgrowth leads to increased intra-abdominal pressure and causes reflux.  I tend to trust your information more, but I wanted to get your opinion on this.”

Chris Kresser:  A real tongue-twister, huh?

Steve Wright:  Man!  Got me all messed up.

Chris Kresser:  Ha-ha.  So, I think the first thing I want to say is I don’t believe that all GERD is caused by one thing.  GERD is a pretty vast landscape of varying conditions, and a lot of what is referred to as GERD, gastroesophageal reflux disease, is actually NERD, which is non-erosive reflux disease.  There are lots of different presentations, lots of ways that it shows up and manifests, and I don’t think they’re all caused by the same thing.  In fact, some people do produce excess stomach acid, and that is the cause of their problem.  That’s a minority.  According to the scientific literature, it’s a small number of people, but it doesn’t mean that, you know, the fact that I wrote that series suggesting that GERD is caused by low stomach acid primarily and bacterial overgrowth doesn’t mean that that’s true in 100% of cases.  So, just wanted to clarify that.  The main pathology involved in GERD or NERD is transient lower esophageal sphincter relaxations or TLESRs, as they are referred to in the literature.  And so, just a little anatomy/physiology here:  The esophagus is separated from the stomach by the lower esophageal sphincter, and that sphincter should most of the time be closed, and it opens, of course, when we eat and when we burp and things like that.  One of things, I mean, the main thing that happens with GERD or NERD is that you get these transient relaxations of that sphincter at inappropriate times, so the sphincter will open or relax when it should be closed, and then you get a reflux of acid or bile into the esophagus, and that causes the symptoms associated with reflux.  So, studies have shown that gastric distension increases the number of TLESRs, the number of these transient relaxation events.  And, of course, gas can increase gastric distension and thus can increase the number of transient relaxations and reflux.  So, I think you can make an argument — I understand where the question is coming from, and it’s true that pressure could, in theory, keep the sphincter closed, but it turns out that, according to the studies, that this gas and gastric distension actually increases the number of relaxations that happen.  And if you do a search on PubMed for gastric distension and TLESRs, you’ll see the study come up, and you can take it in and show it to your professor.  Also, I think it’s important to look at actual clinical results.  I’ve talked about this three-legged framework I use for determining whether something is valid or for testing a hypothesis.  And one of those legs is modern scientific research; that’s important.  Another leg is traditional wisdom, evolutionary medicine, which is also important.  You know, does it check out according to what we know about ancestral health?  And then the third leg, which I think is also very important, is clinical experience.  And, so, for something to really check out for me, it has to pass all three of those tests.  And if you look at the comments on some of those GERD articles, particularly the three steps to curing GERD article, you’ll see literally hundreds of people that have tried this protocol and that were suffering tremendously and had been on PPIs in some cases for as much as 20 years or acid-suppressing drugs for 20 years and were able, using this protocol, which is geared, you know, towards reducing the bacterial overgrowth in the small intestine and improving, increasing stomach acid production via HCl, have been able to stop for the first time in their lives their acid-suppressing drugs and have been able to eat food without reflux for the first time in their lives.  So, I think that’s highly significant and shouldn’t be ignored as part of this whole picture of figuring out reflux and GERD.  I will say that there are some people that that protocol doesn’t work for, and they very well may be the people that do produce excess stomach acid for other reasons, and in those cases something like melatonin and methylation precursors, serotonin precursors might be a better option because melatonin has been shown to regulate the contractility of the lower esophageal sphincter, and that’s probably why it works in a couple studies as well as PPIs, a combination of melatonin and serotonergic nutrients like 5-HTP and methyl donors like B6 and B12 and folate.  So, I think that’s it.  That’s how I’m tying together the gastric distension and gas and the transient lower esophageal relaxations.

Steve Wright:  You know, the one thing I’ve never really understood, Chris, is with the lower esophageal sphincter, is that like a flap, like a trapdoor flap, or is it more like an opening and closing of, like, a hole?  How does it actually work?

Chris Kresser:  It’s more like a flap, I think.

Steve Wright:  OK.

Chris Kresser:  I’m not totally sure, actually.  It would be interesting to see a picture.

Steve Wright:  Yeah, I’ve never seen one, and I was just curious because with some of these, you know, low pressure / high pressure kind of is determinant upon how it actually mechanically works.

Chris Kresser:  Yeah, I’m pretty sure it’s a flap.

Are “properly prepared” grains OK to eat?

Steve Wright:  Interesting.  OK.  Let’s more on to the next one.  This comes from Monica, and she would like to know your thoughts regarding several real food bloggers who are recently posting about wheat, grains, and even gluten and the fact that they are not inherently bad and if properly prepared after having undergone a gut-healing protocol, can be consumed without ill effects.

Chris Kresser:  I bet she’s talking about Matt Stone.

Steve Wright:  Yeah, I’ve seen some from, I think, Cheeseslave, as well.

Chris Kresser:  Yeah.  Just getting a little sip of water here.  Let’s get back to what you and I were talking about at the end of the first question on pork.  Health is a continuum, so if you have on the one hand death, which is the end of health, and on the other hand you have perfect health, then there’s a huge, huge spectrum of what you can experience in between those two extremes.  And I just assume that most people who are listening to the show and who are reading my website are interested in optimizing their health, and so that’s the audience that I’m speaking to.  I’m also, because I’m a health care practitioner, I’m speaking in particular to an audience that’s dealing with chronic health issues and disease, so you know, above and beyond just people who want to optimize their health, I’m really more focused on people who have health problems, and I’m trying to help them recover.  So, a lot of what I speak and write about is geared towards that audience, and that’s important to understand because that audience is more likely to experience difficulties with foods that may not be problematic for people that are otherwise healthy, and I think grains and wheat and even gluten fall into this category, where — Well, let’s break them down separately.  So, gluten, I think, is an inflammatory protein on its own, and so I don’t actually recommend that even healthy people eat it for that reason, but does that mean if someone who is very healthy, has a really healthy gut and no real health issues to speak of is gonna keel over and die if they eat a piece of bread a few times a week?  I don’t think so.  Probably not.  And, you know, we can handle some amount of inflammation.  We can handle some amount of toxicity, of toxins.  You know, there’s a concept called hormesis where a small amount of toxin actually sensitizes our immune system and our ability to cope with larger amounts of toxins.  So, I think that you really have to consider who is asking the question, where are they coming from, again, what are their goals, are they trying to optimize their health to the greatest possible degree and feel as good as they possibly can?  Most people in that situation do better without wheat and gluten, in my experience.  That doesn’t mean there aren’t people that are exceptions.  It doesn’t mean that you can’t eat some wheat and gluten if you’re healthy and still feel fine.  But if you’re interested in absolutely optimizing your health, I think you’re better off without it.  Now, with grains — and there is a distinction here between grains that are not properly prepared and grains that are properly prepared.  Grains that are not properly prepared have a number of food toxins in them that are part of the plant’s natural defense system, and of course, people who are following a Paleo and Primal type of diet are well aware of all of this.  But again, you know, for someone who is basically healthy, some small amount of grain may not be that big of a deal.  And even for people who are not that healthy, if you properly prepare the grains and break them down, break down the phytic acid, break down some of the food toxins by soaking or fermenting or sprouting, then grains may not present any problem at all, even for someone who is not at the top of their health.  But I’ll say in my experience as a clinician that most people who are sick or who are dealing with gut issues or immune dysregulation or any number of other conditions generally feel better without grains, as a general rule.  But these are all general guidelines, and they’re all subject to all of the variables that I’ve mentioned.  You know, what’s the current health status, what’s the constitutional health, what are the goals?  So, I think that’s why I get a little bit irritated about all of the debating because it’s kind of nonsensical unless you know what the context is.

Steve Wright:  That makes sense, and I think you brought up something really important there, which is the toxic load.  You know, if you’re pretty healthy and you recovered your health, if you keep the toxic load pretty low and you eat a non-prepared grain every once in a while, it’s likely that you probably wouldn’t see a problem because your body is designed to handle that load.

Chris Kresser:  That’s right.  Exactly.  And then let’s take it a step further:  I’ve said this in the Beyond Paleo, previously the 9 Steps series, but there’s more to health than food.  You know, there is!  There’s a lot more to health than food.  There’s movement and exercise.  There’s sleep.  There’s stress management.  There’s cultivating pleasure.  There’s having a purpose and feeling like your life is meaningful and you’re serving others or some higher purpose that goes above and beyond just, you know, getting what you want.  I think that’s actually a really crucial element that contributes to health.  There’s relationships, how you relate to your partner, your kids, your colleagues at work.  There’s connection with nature, and you know, this whole earthing movement that’s kind of taken on steam lately in the Paleosphere; there’s concern with that.  So, there are so many things that contribute to whether we feel healthy on a daily basis and whether we prevent disease or recover from disease, and food is a huge part of that equation, of course.  I think it’s pretty clear that I believe that from what I write.  But it’s not the only variable, and when obsession with food happens at the expense of all of those other things that contribute to health, then actually even eating really healthy food can become problematic.  I think we talked about this on a previous episode, my beer and pizza story.

Steve Wright:  Yeah, I’m not sure I remember that, but sounds like a fun diet, maybe?  I don’t know.  Ha-ha!

Chris Kresser:  Ha-ha!  OK, I’ll tell it again.  It’s not my beer and pizza story, but I’ll tell it briefly again for people who are new to the show.  So, I was in San Diego way back when I was in school, and I was interning with a holistic doctor, and he specialized in, you know, treating people who were dealing with chronic mysterious kind of diseases.  And we had a young guy, I think he was like in his early 20s, and he came to us and he was really emaciated, really sick, and just couldn’t eat anything.  And, so, the doctor further restricted his diet, and I mean, he got down to the point where he was eating like boneless, skinless chicken breasts, broccoli, and quinoa, I think were the only three foods he was eating.  And each time he came back to the office, he was just literally wasting away in front of our eyes.  He looked like death.  You know, he looked so sick.  And he was this young guy, you know, like totally in the prime of his life.  So, he disappeared, stopped coming.  We didn’t see him for, like, six to seven months, and then he came back to the office and he was literally — We didn’t even recognize him.  He looked like a different person.  He had gained like 40 pounds, no dark circles under his eyes, really good complexion, you know, looking extremely healthy.  And the doctor and I were both like, “Whoa!  What happened here?  What was it?  Was it diet?”  And he’s like, “Yeah, it was diet.”  And we said, “Well, what was it?  The anti-candida diet or the macrobiotic diet?  Which one was it?”  And he said, “It was the beer and pizza diet!”  Ha-ha, and we were like, “What?”  And he said, “Yeah.  I just got to the point where I thought if I’m gonna die,” which he though he might, “I’m gonna just forget about all these dietary restrictions and have some fun before I check out.”  And so, he decided that at three days a week he would go out with his friends and have beer and pizza and the rest of the time he would eat whatever he wanted.  And after, you know, several months of doing that, he was completely transformed and completely well.  And, you know, there are a lot of caveats to the story, but in his case, I think, a lot of what was happening was social isolation and he had broken up with his girlfriend because she just, you know, couldn’t handle being with him, and there was a lot going on behind the scenes there, and I’m not suggesting that it’s as simple as just, you know, having fun and eating whatever you want.  That’s ridiculous.  It doesn’t work that way for everybody.  But I am suggesting that that’s how powerful the mind and the heart can be in the healing process and that sometimes eating the wrong food with the right attitude is a better choice than eating the right food with the wrong attitude.

Steve Wright:  Hmm.  Good advice.  OK, well I know we don’t have that much more time here, so let’s ask at least one more question.

Chris Kresser:  All right.

Is postnasal drip a sign of a bigger problem?

Steve Wright:  This one comes from Warren, and he’s wondering — and it kind of might relate to a previous question — he’s wondering about postnasal drip.  Is it a sign of a larger problem, and could it be helped by just eliminating dairy?

Chris Kresser:  Uh, yes, it is a sign of a larger problem.  That’s not a normal physiological process.  And eliminating dairy is certainly a good step.  I think if you’re not already eliminating wheat and grains, that’s important too.  Wheat tends to have a really strong connection with sinus problems, in my experience.  And, so, a Paleo type of diet as a starting place, maybe a 30-day challenge where you eliminate dairy and — I don’t really know necessarily that an autoimmune version is necessary, but if you wanted to be really thorough, you could do that and eliminate eggs and nightshades and all dairy for 30 days and then start adding those things back in sequentially.  And if you’re still having the postnasal drip at that point, it’s possible that there’s a histamine issue there.  You could try a low histamine and tyramine diet, which we’ve talked about before on the show when we talked about skin problems, the gut-skin issues.  And then if you’re still, after that, having issues, it’s probably time to seek out some help and see what’s happening with the immune system.

Steve Wright:  So, if you’re already on a Paleo diet and you don’t think you have a histamine problem, it’s indicative of an immune system dysregulation?

Chris Kresser:  Yeah, immune dysregulation, some inflammation there in the sinuses.  Yeah, definitely.

Steve Wright:  OK.

Chris Kresser:  We can do one more.  I see that the next one is pretty short, too.

Should pregnant moms supplement with folic acid?

Steve Wright:  All right.  This one comes from Sally, and she would like some advice on the whole folic acid issue.  Is there any prenatal vitamin you do recommend?  And if so, which?

Chris Kresser:  Yeah, so, folic acid is a synthetic form of the active methyltetrahydrofolate, or there are different versions of active folates other than that.  But folic acid — the important thing to realize is it’s a synthetic chemical that’s not found in nature in the body, and it has to be converted via several steps into the active forms of folates, which are what the body needs and can utilize.  So, the problem is that most multivitamins, including prenatal vitamins, use folic acid, and what happens in a lot of people is that that conversion is poor from folic acid to active folates, and you get a buildup of unmetabolized folic acid.  And unmetabolized folic acid has been linked with cancer and other health problems, and this can happen at doses as low as 400 mcg a day.  It certainly is more likely to happen at higher doses of 800 mcg per day, which is often what’s in pregnancy multis.  So, you want to make sure if you’re taking supplemental folate that it’s an active form of folate.  So, sometimes it’s abbreviated as L-5-MTHF, which is 5-methyltetrahydrofolate.  There’s a brand name called Metafolin.  It is used in Thorne products and Pure Encapsulations and some other products.  You just want to make sure on the bottle that it says “folates” on there and not “folic acid.”  But in terms of a prenatal that I do recommend, there aren’t that many because most multivitamins, in my opinion, have too much of the wrong thing and not enough of the right thing.  But the one I would recommend is Nutrient 950 with Vitamin K, and that’s by Pure Encapsulations, and you can find it online.  It’s more expensive than other choices, but it’s definitely worth it.  There’s not much that’s more important than nourishing your body with the right nutrients if you’re trying to conceive.  That said, I think prenatals are not strictly necessary if you’re getting all of the nutrients that you need from food.  Additional folate is one of the few things that I think is crucial even if you’re eating a Primal/Paleo type of diet because it’s so important for the development of the fetus and the prevention of neural tube defects that I think it just makes sense to take some extra folate during prenatal period and during pregnancy.

Steve Wright:  And you couldn’t really get that from food or you’d have to eat too much greens or anything probably?

Chris Kresser:  Yeah, I mean, you can get some folate from foods, but folate is highest in chicken liver, lentils, and leafy greens.  You’d have to eat a lot of, you know, like, six to eight cups of dark leafy greens a day to get the recommended folate amount.  You’d only have to eat 3 ounces or so of chicken liver, but I don’t know that many people that are eating 3 ounces of chicken liver.  And then grains and legumes are other sources of folate, and those are not happening on the Paleo and Primal type of diet, so I think supplemental folate is a good idea.

Steve Wright:  OK, awesome.  Good to know.  I think that will help a lot of people.

Chris Kresser:  Yeah, and if, you know, folks need more guidance on this specifically, you can check out The Healthy Baby Code, HealthyBabyCode.com.  That’s my whole program with a lot of detailed information about fertility and pregnancy nutrition.

Steve Wright:  If someone is thinking about getting pregnant, how soon should they begin supplementing?  Is it a couple months or a year?

Chris Kresser:  Well, yeah, probably.  I mean, honestly, in some ways the sooner the better.  I mean, to an extent.  There’s no need to start 10 years in advance, but if you started a year in advance, you would just improve your chances of conceiving easily probably.  And, you know, there’s no reason not to do that maybe other than expense because folate at the kind of dose I’m recommending is well tolerated and is not gonna cause any problems.  So, you know, six months to a year before, I think, starting the special fertility stuff is a good idea.

Steve Wright:  You definitely want to pick up The Healthy Baby Code so you get all the info about what you should be doing.

Chris Kresser:  All right.  I think that’s it.

Steve Wright:  Yeah, I think that’s what we got for questions this time.

Chris Kresser:  Let’s call it a wrap.

Steve Wright:  All right.  It’s been a good show.  If you’re new to the Paleo Diet or you’re just interested in optimizing your health, check out Beyond Paleo.  It’s a free 13-part email series on burning fat, boosting energy, and preventing and reversing disease without drugs.  To sign up, go to ChrisKresser.com and look for the big red box.  Chris and I want to thank you for listening today, and please keep sending us your questions at ChrisKresser.com using the podcast submission link.  If you enjoyed listening to the show today, head over to iTunes and leave us a review.

 Full disclosure: I make a small commission if you use the links in this article to purchase the supplements, books or other products I’ve mentioned.

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Comments Join the Conversation

  1. Hugh says

    I just learned yesterday that xylitol is promoted by dentists as a great way to improve oral hygiene, and as I was looking up some gums on Amazon I noticed one reviewer mentioned they had cleared up all of their sinus issues using xylitol. At the time I was also wondering to myself if the “health-o-sphere” had anything negative to say about xylitol, but if Chris Kresser is okay with it then all systems go.

    Good to hear about pork, too. ;)

  2. Mario Iwakura says

    Hi Chris,

    Regarding GERD, specially for those who doesn’t do well on your protocol, I would like to add some other disease that cause it: hypothyroidism. Hypothyroidism is know for altering digestion time and gastric acid content, but it can, also, lead to a disfunction of the muscle of the esophageal sphincter:

    http://www.ncbi.nlm.nih.gov/pubmed/7119407

  3. says

    Hi Chris,

    I have oft and on been reading and listening to your info and thank you for it! It’s all very interesting. The reason I am commenting is because I have have chronic sinusitis for about two and half years. Took the antibiotics–two or three times–then gave up on the doctors knowledge about it and have been working with various alternative methods. I have it under control through diet. When I eat something that triggers the sinus headaches I know right away–I can feel it inflame. If I avoid grains and sugars I don’t get the headaches. Anyway, I do think it has something to do with the candida fungus—rather a imbalance in that the enzymes that break down the sugars are lacking and the fungus (which I guess is always there) proliferates. The reason I think this is because I was wondering why the headaches happen so fast after I eat something that triggers them. Then I looked into it and the enzyme amylase begins the digestion in the mouth. Anyway the bottom line is I think it has something to do with enzymes and a balance of the candida fungus. There is an excellent book “The Enzyme Factor” by Hiromi Shinya that I read.

    Also, my big problems began after I was prescribed flonase for a couple of months and there has been some linkage to fungus problems and using it—-I was diagnosed with rhinitis when I was prescribed it.

    I also find that if I eat raw garlic and raw honey it helps a lot.

    Thank you again,

    Belinda Chlouber

  4. Heidie Lish says

    My husband is contantly blowing his nose and feels like his air passage is partially blocked often. We think that it might be related to inflamed nasal turbinates. Do think it could have anything to do with the biofilm?

    Thanks for your input,
    Heidie

  5. says

    Re folic acid/folate, there is a somewhat uncommon genetic defect called MTHFR – one of these is called C667T and is estimated that 10% of the population are homozygous for this defect (I am one of those lucky 10%) and 50% are heterozygous. Those that are homozygous have no way of forming the 5MTH so they must take 5MTH in supplement form (I use either Thorne or AOR though AOR’s labelling is now very confusing even though they insist it is 5MTH). Those that are heterozygous have partial ability to convert. This has major implications for the methylation cycle which happens in the body constantly and is involved with good function. Another well known defect is MTHFR A1298C which has implications for ammonia processing in the body (some with this have problems eating protein). These types of polymorphisms are not rare and can have major health implications – being linked to cardiovascular disease, chronic fatigue syndrome and autism amongst others.

    More info can be found on this website which has quite a few research articles: http://mthfr.net/

    The good news is that the testing is affordable and the treatment involves careful use of supplements under the guidance of a practitioner savvy with nutrigenomics.

    • says

      Just wanted to add that everyone regardless of being pregnant or not should be taking 5MTH not folic acid to be on the safe side, a lot of people can’t afford the testing so in that case they should get a multi with 5MTH and avoid folic acid like the plague!

    • Chris Kresser says

      Thanks for raising this issue, Allison. I see a lot of people with methylation defects and MTHFR deficiency, and I treat that pretty regularly in my practice. One good test for active B12 and folate deficiency is a urine organic acids panel, from a lab like Metametrix (Organix). It includes methylmalonic acid (MMA) and formiminoglutamic acid (figlu). MMA will be out of range when active B12 is deficient, and figlu will be out of range when 5MTH is deficient. Spectracell has a MTHFR test. I also use the Vitamin Diagnostics methylation panel for more detail on methylation status.

    • Caitlin says

      Allison,
      Thanks for posting this! I just found out I am homozygous for MTHFR and was surprised to read your post. I’m glad word is getting out. I take the Thorne Methyl Guard.

  6. Roswitha says

    Regarding Johnson’s baby Shampoo. Is there another product you could recommend. Reason is: The Campaign for Safe Cosmetics has unsuccessfully been urging the world’s largest health care company for 2 1/2 years to remove the trace amounts of potentially cancer-causing chemicals — dioxane and a substance called quaternium-15 that releases formaldehyde — from Johnson’s Baby Shampoo, one of its signature products.
    http://articles.nydailynews.com/2011-11-01/news/30347901_1_baby-products-johnson-s-baby-shampoo-johnson-johnson

    Thanks for really informative articles. Am learning much from you.

    • Dana says

      I’m guessing that once the biofilm has been broken up and assuming no relapse, you wouldn’t be using the baby shampoo more than two or three times at most. In fact if I were going to try this I would look for a travel-sized bottle, otherwise it will sit in your bathroom cabinet for years. I would not, however, pass it on to a family with kids. “No more tears” sounds great but the shampoo’s still damaging your child’s eyes–he or she just can’t feel it.

    • says

      That baby shampoo is gooey and difficult to completely removed. I suggest J&J Baby Wash instead. (I was told to use baby shampoo for a chronic eyelid condition and used the baby wash instead, finding it quite effective.)

  7. Ellen Ussery says

    Another data point with regard to GERD

    After eating low carb for years, Fast 5 version of IF and also consuming 2 3 T of coconut oil on a regular basis, I tried the PHD version of the ketogenic diet, which was low carb, with IF and 6 T coconut oil..

    I suddenly started having serious, burning GERD at random times through the day. Never had a hint of it before. It was not specific to post meal time. Since I did have other evidence of fungal infection (toenail and foot fungus of longstanding and facial rash that I did not realize must be of fungal origin ) Paul Jaminet thought that the high level of ketones was exacerbating and existing systemic fungal infection and that was what was causing my GERD. (and by inference the long years of doing milder ketone producing diets helped this infection grow somewhat silently to that point) Cutting back the CO to < 2 T stopped the GERD.

    But also that experience led me to understand that I needed to address the fungal infection. Which I am working on.

    But my point is that in some cases GERD might be evidence of a fungal infection. And that keotgenic diets can have a downside in certain cases.

  8. Ellen Ussery says

    AAck!! I wrote a comment about GERD and fungus which got lost in the ether. Will try again:

    GERD might , in some cases, be evidence of a systemic fungal infection. It was for me, it seems. It came on suddenly after greatly upping my coconut oil intake to conform to the Ketogenic diet as PHD sees it. But it was random throughout the day, not in any specific relation to meals so it didn’t seem that it digesting the CO itself that was my problem.

    The fact that I already had a longstanding toenail and foot fungus as well as a mysterious (to me) facial rash that would come and go over the years, suggested to Paul Jaminet that my GERD came from the plethora of ketones which exacerbated an existing systemic fungal infection. And that somehow the fungus was the cause of the GERD.

    Going back to < T Coconut oil immediately stopped the GERD. And now I am working on dealing with the systemic fungal infection, with Chris' help…( and so far, things are looking up )

  9. says

    I’m very interested in trying the 1% Shampoo in my Neti Pot. How much shampoo does one add to the pot? A quick search on questionable websites pulled up 1/2 teaspoon or “5 drops”. Does that sound like a good recipe? Thanks!

    • speno says

      Get out your scale and measure 1 gram of the shampoo and mix it into 100 grams of water. Adjust amounts as required to match the accuracy of your scale. :-)

    • David says

      If you’re wanting to use a 1% solution like they used in the study, convert the amount of water you’re using to ml and divide by 100 to get the amount of shampoo you would need. For example, 8 oz of water is about 236 ml. 1% (1/100) of 236 is 2.36, so you would need 2.36 ml of shampoo. 2.36 ml is roughly 1/2 tsp (0.4788 teaspoon, to be precise).

      In the full text of the study, they said they used the 1% solution 2x per day.

    • Sara says

      By volume, a 1% solution is approximately 1 tsp in 2 cups of water, so that’s what I did. And holy heck did it hurt! (So I stopped right away.) I read some of the papers where they use it, and it looks like they *may* have added it to an isotonic saline solution (one paper mentions it, the other doesn’t) so I added a heaping quarter tsp to one cup of the 1% Johnson’s baby wash solution, and it was tolerable, but still not pleasant. So if you’re going to do this, make sure to add the baby wash to your normal saline solution.

      Also, I rinsed with another pot of normal, saline-only wash, to wash the bubbles out.

      I think my problem with the Johnson’s baby wash was that they too heavily perfume it. If I do it again, I’ll do something without added perfumes.

      • David says

        A tip for making a good homemade salt nasal solution that won’t burn: According to an “insider” with a neti pot company, I’ve learned that the ideal ratio of salt to sodium bicarbonate is 39:1. So I mixed 1.6 Tablespoons (just 1 TBS + a slightly rounded 1/2 TBS) of sea salt with 1/8 teaspoon of baking soda — a rough 39:1 ratio.

        I ground up the mixture as fine and as thoroughly as I could with a mortar and pestle (I wonder if a coffee grinder would work?), and added a 1/2 teaspoon of the final product to the neti squeeze bottle. It was TERRIFIC. No burning. Just smooth watery comfort. My eyes didn’t even tear up. I also tried 1/4 tsp. This worked, too, but maybe not quite as nice as the 1/2 tsp. I wonder if using a base like this would improve the comfort of the baby shampoo solution?

        • Sara says

          My usual saline solution doesn’t burn and is quite comfortable. It was the baby wash without saline that burned. The papers aren’t explicit about adding the baby wash to a saline solution, but I think they must have done, given the big difference in comfort between the baby wash without saline and the baby wash with saline.

  10. Tara says

    Hi Chris, Awesome show as usual! Looking forward to the Paleo Summit this weekend! I was curious about what you said about Folic Acid. I picked up the Pure Encapsulations PreNatal Nutrients from my Chiropractor/Wellness Coach here before I heard your recommendations today. Would you promote these as well, since I have already invested in them? I see on the label is lists Folic Acid and not folate or L5MTF :( Why can’t life just be simple!

    • Chris Kresser says

      It does appear to have folic acid in it, although I know in some cases the labeling has lagged behind the ingredients. In other words, it may actually contain folate but the label still says folic acid. You might want to call Pure Encapsulations and find out. If it actually is 1 mg of folic acid, you wouldn’t want to take that.

        • Tara says

          Here was the response. :(

          Pure Encapsulations uses almost all 5-MTHF only in all it’s products. The one exception is the PreNatal Nutrients. PreNatal Nutrients contains regular folic acid. All of our other products contain 5-MTF, which is labeled on our website, in the catalog and in the product catalog as folate (as Metafolin 5-MTHF).

          • Chris Kresser says

            Thanks for reporting back. That’s too bad. I wonder why they haven’t switched it in that product, since it’s the most important one not to use folic acid in of all of the products they sell!

  11. Lynn says

    I had my first cold in 6 years recently. I’ve managed to avoid cold and flu by taking Vit C (ascorbic acid or sodium ascorbate – both in powder form, dissolved in water, and taken to bowel tolerance) The trick seems to be taking a big dose at the first sign of a cold; most of us know what that sign is. For me, it’s always a feeling in my throat. It really works when one takes enough Vit C, and uses the powder form (no excipients too) Having never developed a cold or flu by doing the above, it didn’t work this time, but I realized in the past, I used a double dose of my “healthy” saturation limit, which is 4g/day, so I took 8g and went to bed. I woke up with a horrible throat for the first time in 6 years of successful “pre-dosing, so what did I do wrong? My problem was not knowing what to do with the Vit C if I DID get sick! Turns out I needed to re-discover my bowel tolerance for the Vit C once sick, I should have know this, and even though I increased my daily dose, it turned out this was a 20 gram daily cold. Once I began taking 20g/day, I got almost immediate relief of my sore throat. (the cold never went up into my sinuses or down to my chest; it pretty much remained in my throat; all others with this got sinus issues so I think my “too little” dosing of the C actually kept this in my throat) Because I figured my throat was being irritated by mucus, I got out my Neti pot (unused for 6 years) and used a combo of warm water, a pinch of salt & I added 2g of sodium ascorbate powder. It worked like a charm! (Years ago, I only got temporary relief with the Neti pot with just salted warm water) I only had to to this once.
    After reading your article on bacterial mucus causing chronic sinusitis, I wonder whether Vit C added to a Neti pot would help break up the mucus. The benefit of this is direct contact with the offending bacteria by the C, which is, among other benefits, a natural antibiotic & anti-viral. I think this should be studied. I hope I don’t need to try this again, but I would in a heartbeat and I recommend others to try it! You need to find your daily bowel tolerance to Vit C when you are healthy first. Once you know what that is, you use that as your baseline when and if you ever feel sick or when you are exposed to something. You need to take more than your daily “well” dose at those times. I’m never sure what that amount is, and I’ve had success these past 6 years by simply taking a double dose immediately upon feeling something in my throat, or if I was exposed. When I woke up the next morning with that bad throat, I began to take hourly doses of 4 grams (4000 mg) of ascorbic acid, and I reached bowel tolerance at 20g by 3 pm. Where I went wrong was stopping at bowel tolerance! I’d never been sick so I didn’t know that I needed to continue to dose, but cut back on the amount, as you need a continual dose in the body for the C to work. I felt great all day, but woke up the next day with the sore throat again. At that point, I divided the 20g by 4, and took 4 doses spread out throughout the day. It’s also imperative to continue to dose with Vit C after you feel well – for up to a week, but the dose will decrease daily. It’s a tricky thing to figure this all out but it beats taking an antibiotic (I believe I had strep). but it works. I never felt unwell, other than throat discomfort the first 2 days (but I hadn’t taken enough C at first; once I did, the throat was fine). The other thing I learned was that if you do wake up with cold symptoms, another way to dose with C is to take 1000 mg every 10 minutes until your symptom is gone, or you reach bowel tolerance (look B.T. up online if new to you) . Keep track of how much you took when that symptom went away & that’s your daily dose for that illness! There is a ton of info on using Vit C online and in books. I suggest anyone with interest to read about it. I believe the “fathers” of this kind of dosing with C were Drs. Klenner and Cathcart. Good health to all!

    • prioris says

      most colds are caused by rhinovirus. zinc stops the reproduction of this virus. first sign of cold or sore throat, i just take zinc. haven’t had a cold in years.

  12. says

    Great podcast!! This is a VERY common problem. (I love the transcription form as well.)

    Have you also considered use of Nasally applied Argentyn? I love Argentyn (micro silver) though it costs as much as liquid GOLD. *hahha aah* Like xylitol it has antibacterial and antifungal properties. Dave Asprey at Bulletproof was telling us at dinner how he cleared his chronic sinusitis with nasal Argentyn + Xylitol.

    Strong work!!!

  13. Julia says

    FYI
    Regarding the LES and sphincters. You may want to remember that sphincters are by definition circular and muscle driven – vs a flap like the epiglottis

    • Sonya says

      Julia I was going to point this out as well. I’m a Physician Assistant in Gastroenterology and have seen many, many endoscopies and the Lower Esophageal Sphincter is in fact a circular muscle which opens when enough air is forced into the stomach and entering the jejunum and duodenum. This is clearly seen on upper endoscopy. I’m sure there’s video of it online.

  14. Ellen Ussery says

    With regard to Xylitol, do you think the bloating and other discomfort some people have when using Xylitol as a sweetener could be due to the disruption of biofilms? Would that side effect be a helpful diagnostic? If so, then what would you suggest for that person?

    • Chris Kresser says

      It’s possible, but more likely because xylitol is a FODMAP. Sugar alcohols are poorly absorbed and can cause fermentation and gas in people with gut issues.

  15. Nicole says

    Hi Chris,

    This question is unrelated to this podcast however I wasnt sure where to submit it.

    What are your thoughts on the situation where a pretty healthy person goes on a paleo diet, after a period of time of being grain free that person eats something with gluten in it and gets immediate stomach pain. However before going paleo this person ate lots of gluten with no symptoms that they knew of. Is this person actually gluten intolerant or is just because the body is no longer adapted to digest it? Is it an inverse to the situation when people get allergy shots so they decrease their body’s reaction to the allergen? If it can stand that the body is just not adapted to digest it anymore, then if someone is pregnant and avoiding gluten, could they be causing the gene expression to be different then someone who is not avoiding it? Are there any studies about the effect of gene expression on mothers that ARE in fact celiac or lactose intolerant and what the avoidance of these foods can mean for the unborn child in terms of their tolerances to these foods for the rest of their life? Otherwise I dont see any downsides to avoiding gluten even if the person is tolerant to it long term.. except maybe possible social issues.

  16. Rebecca says

    Hi
    I was just wondering about biofilm. I have been reading about a biofilm carbohydrate diet rather then SCD which I have been on for the last five months. I was wondering what your views are on this diet and like treating chronic sinusitis should I be using something to break up the biofilm in my small intestines to treat my Crohns. I have been on SCD the last five months and just dont know if I am getting anywhere healing wise. I have had Crohns for eighteen years and realise I will not heal straight away. However I am trying to get pregnant (hence why I stopped taking Imuran and started SCD) and cant gain weight on this diet so feel it would be pointless trying to conceive. My inflammatory markers are normal but I have strictures.
    If you have any advice I would really appreciate it .
    Thank you
    Rebecca

  17. Lisa truitt says

    Fungal infections can exist within a biofilm too. You seem to suggest that sinus problems are mostly biofims rather than fungal, but that ignores that there are fungal biofilms,and that there can be mutiple biofilm creating bugs going on. I would never much believe in tests to prove or disprove what infections people have. I dont much trust doctors or yheir tests whether allopathic or holistic. Scams are rampant in both. I think there is just blind faith in testing and that people dont have the expertise to know if they are really accurate so they just trust what they are told when in reality there is a lot of evidence that they are very often not. Therefore, just take antimicrobials cause they kill all microbes. Many herbs are antimocrobials. Bayberry root is an herb that works great for sinus problems. It is specific for shrinking sinus membranes and clearing out an infection. I take 1/2 tsp of powder three times a day. It is bitter and astringent to some might like capsules 2 or 3 3x day but bulk herb is cheaper. Be sure to get plenty of veggies and fruit and water cause its astringency can constipate if you take too much or dont get enough of the fiber foods.

  18. Lisa truitt says

    You can also really improve you sinuses by improving your diet. I used to get sinus congestion and infection a lot before I cut out cows milk and sugar and processed junk food. I am very sensitive to casein that is in cows milk and start getting stabbing pains in my sinuses within a day or two of consuming, unless the milk is from nonhyrid cows like old jersey or gernsey breeds. Goats milk doesnt bother me.

  19. says

    I’m home for the holidays and I just had this exchange with my mom:

    Mom: “I’ve noticed that you aren’t constantly blowing your nose anymore.”
    Me: “That’s because I’ve been breaking up my biofilms!”

    Heh. Seriously though. I started using Xlear 4 times/day about a month ago after listening to this episode, and it has cleared up my chronic runny nose. Chris, THANK YOU.

  20. Charlie says

    Hi there chris!

    I have wegeners granulomatosis. I have recently decided to cut grains and wheat.

    When i read this, i had to laugh. I clicked on it because i lose my voice alot due to post nasal drip and my husband has GERD . You covered 4 topics that interest me in 1 podcast.

    I have done the shampoo rinse. Everything seems to help me for
    Abit, then loses its affectiveness. I have tracheal and bronchial stenonsis, but its just how dry my nose is with the crusting that is my major problem right now. I humidify in the winter and everything. I have had 3 septorhinoplastys as well. Any suggestions for this nasal crusting? Pretty please!

  21. Claire says

    Regarding xylitol, I heard Dr Natasha Campbell-McBride say to avoid eating it as it is linked to fribromyalgia (she quoted 2 conditions, I think that was one of them).

    Chris, have you heard about negative affects of xylitol?

  22. Kim Murray says

    Just FYI the lower esophageal sphincter is not a “flap” as you describe. It is a opening essentially which size is controlled by contraction / relaxation of the muscular diaphragmatic sling at the gastroesophageal junction. There are plenty of endoscopic pictures available I’m sure if you are looking for visual confirmation.

    Disappointed you would make a statement regarding something you were unsure about, however I do normally appreciate your well informed view points.

    Thanks!

  23. Lauren says

    I purchased Pure Encapsulations Nutrient 950 with Vitamin K. I took it with me to my first prenatal appointment at 11 weeks. The nurse at my midwife practictioner’s office looked at the supplement facts and the only problem she saw was the level of Vitamin A. She said it exceeds safe levels and too much Vitamin A can cause birth defects. I looked up on my own and it appears there are different types of Vitamin A; preformed and provitamin. It seems that she may have overlooked that Pure Encapsulations form is provitamin A (beta carotene). The information I found independently shows birth defects are associated with the preformed variety. Should I still be concerned?

  24. Michael says

    I’ve suffered with chronic sinusitis for years, on and off. Having availed myself to the yoga cleansing practice of Jala Neti (aka Neti pot nasal irrigation), I found this practice to be unpleasant when suffering with sinus trouble, as it would often stir things up and leave me with congestion for an hour or longer after irrigating. It would be difficult to breathe through one or both nostrils, I would often experience additional pressure and/or pain in my head, and my voice would often become pronouncedly nasal-sounding for a lengthy period afterwards. Same experience with the Lavage and/or bulb syringe. It may have helped a little, but it took it’s toll for some time afterwards.

    A colleague recommended a pulsatile nasal irrigation, (Dr. Grossan, M.D. E.N.T.’s HydroMed/HydroPulse or a basic Waterpik with a special cone-shaped nasal adapter). This proved to make a huge difference. The pulsatile irrigation action is reported to be 40x more effective at removing bio-film pathogens than a continuous stream, and the common pulse rate of 8-16 cycles per second reportedly helps rehabilitate impaired nasal cilia (which are responsible for removing foreign material in healthy sinus and nasal passages). Pulsatile irrigation also features a siphoning effect, which is particularly helpful in my case to pull out thick biofilms from the various recesses. There are numerous medical articles on the benefits of pulsatile irrigation in wound therapy and sinus irrigation treatment (check out Grossan, M.D. et al).

    As for irrigation formulas, I’ve tried quite a few. My favorite is a blend of pure Kosher Salt (don’t use table salt as there are commonly additives), Baking Soda and pure Xylitol (2:1:1). I mix 2 tsp of this mixture to warm filtered water in my 600ml waterpik reservoir when I have blocked and congested sinuses. For general therapeutic treatment, I use 1 tsp of the mixture.

    At the onset of a sinus infection, I have also had good luck adding oil of oregano (in gently increasing increments as this is a very hot/spicy experience and requires some getting used to). I credit Jini Patel with this suggestion, as she has been researching and reporting on the gut-sinus connection for quite a few years now.

    A couple questions for Chris:

    1) Like other readers, I also hope you can find some healthy alternatives to Johnson’s Baby Shampoo, which I suspect contains lots of chemical additives (SLS, etc.) that are unhealthy. A sinus pharmacist suggested chelation agent EDTA and polysorbate.

    2) Are there any other topical rinse agents worth considering (enzymes, anti-fungals, astringents, etc.)? I’ve recently experimented with grapefruit seed extract and colloidal silver. Are you aware of any contraindications for these, Chris?

    I’m also looking for additional pure and safe raw ingredients that are worth trying to achieve my own personal mixture for various occasions. Any insights or references from Chris or fellow readers would be welcome. Thanks in advance!

    • Shazid says

      Michael,
      Thanks for sharing your story. I am a chronic sinus sufferer as well. I have had it for one year on-going (some days/weeks are better than others). I have tried many different proposed solutions. Here’s what works best for me when I’m congested:

      - Steam Inhaler (I use http://www.amazon.com/Mabis-40-741-000-92-741-00-Steam-Inhaler/dp/B000AYYK5M)
      - Nasal Irrigation using Sinupulse with sea salt and baking soda solution. I have experimented adding shampoo, eucalyptus oil and apple cider vinegar. For me, shampoo and ACV works best). I will try out your suggestions with oil of oregano and xylitol.
      - As for food, I cut out dairy and wheat completely. This might be helping, not sure. For me, poor digestion always comes with sinus infections.
      - Xylitol or other nasal herbal spray
      - Corticosteroid sprays help also but I don’t want to depend on it long term

      I have also been doing the Sinus Survival program (http://www.sinussurvival.com) which is basically candida diet + supplements and it also covers other factors that could be causing your sinus infection. It might be helping a little.

      These infections have really affected my life and I want to find a solution.

      If you would like to keep in touch and share your progress, feel free to email me at shazid.rahman22@gmail.com.

      -Shazid

  25. Jessica says

    With regard to the baby shampoo…proceed with caution, people!

    A little background…I’ve had bouts with sinus infections followed by rounds of antibiotics since childhood (I’m now 34). When I started eating paleo-ish (about 6 years ago), I stopped getting the infections, until 2 years ago when my second grade students managed to give me something – a sinus infection turned into an ear infection, and for fear of losing my hearing, I let Augmentin take charge. After that, I was back to ‘normal’, which for me means a persistent runny nose. All day, every day. Needless to say, when I heard about the baby shampoo ‘cure’, I was all aboard.

    I have been using the xylitol spray and saline neti washes for a couple of years now, with no noticeable difference. I began the baby shampoo washes last week and immediately noticed how stuffy I became. A week and about 5 baby shampoo washes later, I’m a mess. Stuffy, ears are itchy and full-feeling, and I’m sneezing like crazy. I should have left ‘well-enough’ alone, I guess.

    Anyone have any advice (aside from stopping the baby shampoo washes) to help repopulate my good sinus bacteria (which I’m thinking I’ve destroyed at this point)? Any input will be much appreciated!

    • Shazid says

      Hey Jessica,
      You can read up on my experience above your post.

      My experimentation with baby shampoo has been bitter sweet. Sometimes, I feel more relieved, sometimes, it’s worst. It’s not a solution for me as I still have sinus congestion, headaches, “clicking” ears etc.

      What has been working better is using Raw Apple Cider Vinegar instead.

      My ENT recently prescribed me antibiotics but didn’t help me.

      Considering surgery at this point.

      If you want to keep in touch and share feedback, feel free to email me at shazid.rahman22@gmail.com

      • Jessica says

        Thank you, Shazid! Honestly, I am really surprised at how quickly the negative effects of the shampoo strategy came on. I’ll keep you posted on my *recovery*. At this point, I’ll probably stick to a simple saline regimen.

        I wonder if it’s possible that there’s soap stuck in my sinuses, or maybe I’m reacting to the fragrance – I was a bit concerned about that before I started because I don’t use synthetic fragrances in any of my products. Silly me for not following my *gut*.

        I hope you find some relief, as well!

      • Jessica says

        Thank you for the information, Michael!

        I am sure that environmental allergens are playing a big part in my sinus problems – I live in a very old house that I have been told has black mold, and I work in a dusty three-bay garage in Upstate New York. Luckily, I’m moving to the Denver area this summer…a much drier climate and hopefully a bit of relief, too!

        Good luck with your progress, and I would love to hear if you have any *breakthroughs* (or missteps, for that matter:)!

  26. Michael says

    Shazid, Jessica, I’m so sorry to hear how you are both suffer chronic sinus illness. Like Jennifer, I am also interested in bringing balance back to the healthy commensal community of microbes that normally lives in the nasal/sinus biofilm. I’m not sure how to do that. I invite and welcome Dr. Kresser’s insights here.

    I would point out that in my case, I believe my chronic illness was precipitated by a lengthy pathogenic exposure in a building with hidden water damage, mold/bacteria, and airborne myco/endotoxins that were verified by mutliple highly qualified professional environmental engineers. I also believe that my lengthy ongoing bouts of chronic fatigue and a range of chronic inflammatory illnesses were precipitated by this ongoing exposure to contaminated indoor air. I’m now barely able to “manage” my chronic sinusitis with frequent pulsatile irrigaiton, but I feel that my recurring illness is likely due to the disruption to biofilms in my gut and nasal passages.

    Again, I welcome any insights Dr. Kresser might have into the emerging treatments focused on the human microbiome, particularly treatments such as MAF-314 and nasal mucosal microbiota transplantation.

    My main insight is that the recent discovery that the non-human microbial cells in the human body that are acquired after birth through environmental contact happen to outnumber our “native” human cells by 10 to 1. And these cells are not just loitering, they are actively performing a wide range of beneficial activities in the human body. So, 90% of our cells by number are microbial, and these cells are almost exclusively playing a symbiotic role in our health…

    Framed in this manner, it appears that the environmental factors that impact our microbiome cannot be ignored. You might want to check your home and workplaces for possible airborne pathogens using an ERMI dust sample (rather than the less revealing and far more expensive air sampling that most industrial hygienists parctice routinely). Dr. Shoemaker’s website has some info on how and why to do this ERMI testing: http://www.survivingmold.com/diagnosis/ermi-testing. Bear in mind that, according to LBL, over half the US residential buildings are contaminated with mold. It’s understandable, since mold and bacteria are ubiquitous and only needs basic food and water to grow and “amplify indoors”. This means that most homes with a history of water intrusion, past plumbing issues, or even just indoor moisture >60% RH (relative humidity) and basic house dust have all that is needed.

    I hope info and perspective is helpful in your efforts to regain your health and vitality.

  27. says

    http://freetheanimal.com

    Might be worth looking at this post by R. Nikoley

    http://freetheanimal.com

    On his recent success with specific probiotics and resistant starch. The effect on his sinuses was a surprising bonus:

    “Best for last: all my life I’ve had sinus problems. Allergies, itchy nose, runny nose, itchy eyes. I once did the subcutaneous injections for a couple of years (French Navy). I once considered buying stock in paper towel manufacturers. Kleenex doesn’t cut it. I need Bounty! I was on prescriptions since college. Paleo helped a lot with that, but I now suspect it was removing those things that most created auto-immune responses (grains, most likely), but not dealing with the underlying cause. Why?* Because after a few years, the problems crept back, such that even a slight indulgence over a burger or a beer would get me sneezing, running of nose, and chronic congestion necessitating habitual squirts of Afrin every night before bed, just so I could get to sleep and not mouth breathe all night. I noticed it immediately, like day 2. About 3 weeks in, I’m 80% plus. Rather than 100 nose blows per day, maybe a few. Don’t need Afrin 90% of the time. Don’t wake up in the middle of the night with desert mouth.”

  28. Gordon Freeman says

    Just regarding xylitol, could it be high in salicylates, as it often comes from birch trees? (Birch tree sap is apparently high in methyl salicylate, which is bad for people sensitive to it). I can’t seem to find an answer to this.

    Also, the other issue is that xylitol can convert to OXALATE, which is another toxin present in loads of foods and which probably causes half of people’s problems on here! Same as gelatin (another ‘miracle’ food promoted on the GAPS diet), that can convert to oxalate too. So if you’re having a lot of almonds, buckwheat flour (or gluten alternatives), spinach and nuts, on TOP of xylitol and gelatin, watch out! (Oxalate crystals can lodge in your body tissues, possibly including chest/sinuses maybe causing breathing issues? My theory anyway). I would be interested to hear Chris’ thoughts on this as it could be an issue for a lot of paleo people.

    Also, regarding sinus problems, what about natural detox remedies like lemon juice, onion juice, honey, herbal teas etc.? What does Mr Kresser think about them? Thanks! :)

  29. says

    The Chronic Sinusitis Cure
    This is a Cure Not a treatment for Chronic Sinusitis.
    http://www.sinusinfectcure.com

    Mayo Clinic found that fungus causes Chronic Sinusitis.
    http://www.princeton.edu/~gpmenos/mold_facts/MayoClinicStudyImplicatesFungusasCauseofChronicSinusi.pdf

    My booklet explains how to kill that fungus by reintroducing selected “Friendly” bacteria directly into the sinuses. These bacteria are normally present in your sinuses, but are killed by antibiotics and/or other means typically used to treat Chronic Sinusitis. Orally consumed bacteria will not reach the sinuses, to eliminate that fungus.
    The “Friendly” Bacteria may also impede the onset of Acute Sinusitis, by negatively impacting “bad” bacteria.

  30. anna says

    are you still recommending nutrient 950 with vitamin k as a prenatal? I see it has no iron, is that not neccessary? and what about vitamin a, I also take fclo, would that be too much?

  31. Kate says

    So I just tried a nasal irrigation 1% solution of Johnson’s Baby Shampoo (1/2 tsp in 250 ml of water) and it was like having boiling lava shoved up my sinuses. Stopped immediately, tears of pain, instant inflammation headache – just waiting for some more boiled water to cool so I can do a usual buffered saline rinse to calm everything down.

    Did I do something wrong?

    • prioris says

      to make nasal solution I used … 1 cup water, 1/4 tsp baking soda, 1 tsp salt, 1 tsp johnson baby shampoo … but this is 2% solution so one can use less than a tsp of shampoo …

      the baking soda and salt is needed … you can use eye dropper or nasal spray bottle to put into nose. i can sniff it in also.

      the baking soda and salt is critical since if you don’t do that, it will hurt

  32. Kate says

    Actually, further to my earlier comment, I didn’t put any saline buffer in – I wonder if that was it?

    • Shazid says

      Baby shampoo wasn’t much helpful to me, infact, it made it worse sometimes.

      Make sure you start off with 1/4 tsp of shampoo and always add baking soda + salt.

      • Kate says

        Thanks – I’m back to the buffered stuff and I’m going to start adding shampoo in a drop at a time and build up!

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