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All About Kidney Stones, Liver Detoxification, and Calcium


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Note: The Paleologix supplements discussed in this post are no longer available, and we’ve launched a new supplement store. Please click here for more information.

We’re back with another Q&A episode.

In this episode, we cover:

1:00 The cause of kidney stones – and what to do about them
16:37 Bioaccumulation of toxins in the body
21:48 Do we need to supplement with calcium?
28:22 Is there a link between dairy consumption and osteoporosis?
36:30 What Chris ate for breakfast (almost forgot!)

Links We Discuss

Full Text Transcript:

Steve Wright:  Hey, everyone.  Welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com.  I’m your host, Steve Wright.  My website is SCDLifestyle.com.  But with me is integrative medical practitioner and healthy skeptic, Chris Kresser, the man of the hour.  How are you doing, man?

Chris Kresser:  I’m pretty good, Steve.  How are you?

Steve Wright:  I’m pretty jacked up.  I’ve been having a good week.

Chris Kresser:  All right, cool.  Let’s dive in.  It’s a Q&A episode.

The Cause of Kidney Stones – and What to Do about Them

Steve Wright:  Q&A.  This first question comes from Mike, and it’s a little bit long, listeners, so bear with me.  I might need to take a few breaths and a drink of water or something, but it’s all important.  Mike asks:  “I’ve been gluten free and casein free for eight years and paleo for about the last five.  I’ve tried to keep my fat intake high in order to avoid eating too much protein.  I do eat a lot of meat, one to two pounds of beef per day.  My carb intake was very low at the beginning, but in the past year I’ve introduced potatoes, almond meal, tapioca flour, and a little maple syrup.  In May, I got a kidney stone.  It was 40% calcium oxalate and 60% calcium phosphate.  At the time, I was consuming a good deal of baked goods using almond meal, and my consumption of green vegetables, including spinach, was higher than it’s been.  I was also taking 10 to 20 International Units of vitamin D per day and intermittent fasting, rarely drinking any fluids during the day.  Around the same time, I started increasing my carbs.  I stopped taking HCl supplements and included bitters in most of my mealtime beverages.”

“I just visited a urologist, and he gave me a list of personal diet recommendations, which he told me was developed from following the research for the past 10 years.  I was glad to hear that my doctor was keeping up with the research, but some of his recommendations were confusing for me regarding the paleo context.  First, he recommended decreasing animal protein.  I’m a bit confused why he said animal protein since his rationale was that high protein in general increases excretion of calcium oxalate and uric acid.  Second, he recommended sodium restriction, citing studies that show a 50% reduction in stone episodes.  What are these studies?  I have long been a skeptic about salt restriction, and I’ve always used unrefined sea salt both in cooking and at the table.  If I have to restrict salt, I will be really disappointed.  He did not make any strong statements about calcium or oxalate intake, which was encouraging except for the fact that those are the things I would find the easiest to restrict.  Also he specifically called out the Atkins diet, which I did early on before discovering paleo, because he says it has been shown to increase the risk of kidney stones.  What is he referring to here?”

“I haven’t found much paleo information about kidney stones.  Maybe it’s rare among paleo and Weston A. Price dieters.  That would be really nice, but I’d really like to hear your perspective on preventing kidney stones and maybe some ideas about why my stone had so much phosphate.  Can bacon lead to phosphate kidney stones?  I gave it up for a few years, but I eat it two to three times a week now.  My personal approach after getting the stone was to do the following:  stop taking the vitamin D and make sure to get outside as much as possible; drink more fluids, including diluted pure cranberry juice; start taking the HCl again, which has improved my digestion; avoid almond meal and eat less potatoes, also no more spinach; don’t forget to eat some liver.  Does this seem like a reasonable response?”

Chris Kresser:  Lots of good questions there and definitely an interesting topic.  I think I’ve talked a little bit about kidney stones in the past, I’m not sure, but let’s give it a thorough treatment here because I know that is of interest to a lot of people.

Let’s start with the kind of broader issue, which is this idea that high protein diets have an adverse effect on kidney function.  You see this repeated a lot in the mainstream media and particularly in the kind of vegetarian/alternative health communities, but comprehensive reviews in the scientific literature suggest that it’s not true.  It’s another one of these kind of urban myths like the acid-alkaline theory that I recently debunked in a couple of articles on my blog.  There’s a good study, which we’ll provide a link to in the show notes, from the Journal of Nutrition and Metabolism in 2005.  They found no evidence that high protein diets increase glomerular pressure or hyperfiltration or contribute to kidney disease in any other way in health people.  There is some evidence that reducing protein in people that have pre-existing renal disease may have some benefit, and perhaps that’s how some of the confusion got started.  You’ll often see this happen, where some intervention works in a disease state and then people assume that that intervention will prevent that given disease state, but it doesn’t always work like that.  In many cases, the thing that you might remove in order to treat a particular condition doesn’t have anything to do with the onset of the condition in the first place, and one example of that might be fat and gallbladder disease.  Some people without a gallbladder might need to reduce their fat intake a little bit, but that doesn’t mean that eating a high fat diet leads to gallbladder disease.

As far as kidney stones, the epidemiological research is pretty inconsistent.  There was one study with 45,000 men where researchers found a direct correlation between animal protein and the risk of stone formation, but other studies have shown an inverse relationship.  Excess protein intake does increase excretion of substances that could potentially increase kidney stones, like calcium and uric acid, and one study did find that high protein diets are associated with increased uric acid and calcium output in the urine, but in that study, none of the subjects actually developed kidney stones.  So even though in theory they were excreting substances that could contribute to kidney stone formation, they didn’t actually develop any kidney stones.  What’s more, the people in that study were on a ketogenic diet, and it’s fairly well established that ketogenic diets can contribute to kidney stones via other mechanisms.  They do increase uric acid production, and low carb dieters, as Paul Jaminet has pointed out in his series on the dangers of zero-carb diets, typically can be inefficient at recycling vitamin C from its oxidized form.  And if the oxidized form of vitamin C is degraded rather than recycled, it ends up as oxalate.  Oxalate is a waste material that needs to be excreted by the kidneys, and since most kidney stones affecting the general public are calcium oxalate, vitamin C degradation may be one of the main causes there.  And why would somebody have problems recycling the oxidized form of vitamin C?  It’s usually because of some type of oxidative damage or chronic infection, both of which, of course, are very common.

Forty percent of Mike’s stone was calcium oxalate, and he was on, it sounds like, a very low carb diet, possibly even ketogenic, so that perhaps might have contributed directly to at least the calcium oxalate portion of that stone.  The other 60%, though, in his case, was calcium phosphate, and calcium phosphate precipitates in urine that has an alkaline pH, which is a pH, in this case, above 6.3.  Some patients with calcium phosphate stones have a defect in kidney function, either renal acidification or tubal acidosis, so it might be a good idea – I don’t think this was mentioned in the question – for Mike to get his urinary pH tested to see whether it’s basic or acidic because that would affect the treatment plan.

All of this raises an important point, and I know that was a lot of relatively complex information, but let me just kind of boil it down.  The most convincing studies on this topic of kidney stones suggest that the stones themselves are not caused by a high protein intake alone but by an underlying metabolic abnormality.  To use an analogy here, it would be like the powder keg and a tender box theory of stone formation.  Dietary excess, like a high protein diet, might be a tender box, but the metabolic abnormality is the powder keg, and you only get an explosion, or a stone, in this case, when you put the two together.  So a high protein diet without an underlying metabolic abnormality doesn’t contribute to kidney stones or other kidney disease, whereas a high protein diet with a pre-existing metabolic abnormality might.

Getting back to Mike, it’s a little bit harder to treat a 60/40 stone, 60% phosphate and 40% oxalate, because they typically require somewhat opposite treatment approaches.  And this is why, I think, in Mike’s case and in many cases it makes sense to take a more moderate or balanced approach.  What Mike didn’t mention is why he is on such a low carb diet.  Some people when they first start paleo, their exposure to it is via someone who really recommends an extreme low carb intake, and that’s really the only reason they’re doing it.  Other people have a specific reason, like weight loss or maybe they’re trying to deal with a neurological issue or a brain-related issue.  I don’t know what the case is with Mike, but I would certainly say that if there’s no compelling reason to be on a ketogenic or a very low carb diet, I would absolutely recommend balancing the diet macronutrient intake more, bringing some more carbohydrates back in, some fruit, some safe starches, sweet potatoes… well, maybe not sweet potatoes because of the oxalate, but plantains and yuca and taro and then fruit and getting more carbohydrate, eating a little bit less fat, a little bit less protein so that the diet isn’t ketogenic because it’s probably ketones that in part were contributing at least to the oxalate portion of the stone.  Then reducing oxalates, like in spinach as Mike mentioned, sweet potatoes, and some other oxalate-containing foods, is probably a good idea at least in the short term.  Potassium citrate can inhibit oxalate.  You might want to avoid supplemental vitamin C because if it’s being degraded, it could worsen the stones.  Vitamin B6 has been shown to reduce urinary oxalate excretion.  And then treatment of the phosphate stones usually involves acidifying the urine with things like cranberry extract.  The problem is that’s kind of contraindicated with oxalate stones, so it’s difficult to make a recommendation there because it’s so close; 60/40 is pretty close to being half and half, which is why I’m recommending a return to a more moderately balanced diet as the main solution here.

Regarding salt, the excretion of oxalate consumes electrolytes like salt and water, and as a result of salt and water loss, dehydration typically occurs, and this is common in very low carb diets.  Most people have experienced this.  If you’re dehydrated, what happens to your urine?  It gets a lot darker.  And that darker color reflects an increase in excretion of dissolved compounds like oxalate and phosphorus.  So eating, actually, a decent amount of sea salt and drinking more water, more fluids, can help in this situation.  I’m not aware of the studies that Mike’s doctor referenced about sodium and stones, and I’m skeptical, given the series that I just wrote about salt restriction and the lack of necessity for salt restriction in the vast majority of cases, but I’d have to look into that specifically a little more.  And I don’t know even if the salt issue and drinking more fluids would be particularly relevant if you ate more fruit and more carbohydrates and just balanced your diet overall.  Those are things you might need to do to mitigate the potentially harmful or adverse effects of a ketogenic diet, but I’m suggesting not being on that diet in the first place, again, unless there’s a really compelling reason to do it.

The last thing you may want to consider is vitamin K2, which plays a beneficial role in bone metabolism and keeps calcium in the bones where it belongs and out of the soft tissues, so that might be something to consider as well.

Steve Wright:  Chris, you had talked about earlier in the explanation that the metabolic derangement might be part of it at a deeper level.  How might someone know if they have some sort of metabolic derangement?  Would that be insulin resistance or some sort of glucose test or something that they might be able to dig further for?

Chris Kresser:  I wasn’t specifically referring to metabolic derangement in that sense, but more of an underlying kidney issue, although it could be metabolic dysfunction in the way that you mentioned.  But what that research was referring to is that people who experienced difficulty with high protein diets, they had some pre-existing kidney issue that may or may not be related to diabetes or insulin resistance.

Steve Wright:  OK, gotcha.  Well, I have to say that I just went through this process with my dad, and he is definitely not 100% paleo, although he might be paleo about five days a week.  And when I jumped down the rabbit hole of kidney stones, I came away with some interesting tidbits.  The B6 one that you talked about was definitely one that I got him started on, and then there were a few kind of older studies that were talking about magnesium oxide as well as B6 –

Chris Kresser:  Mm-hmm.

Steve Wright:  – and I kind of thought that was interesting with all the people that get these stones and how there’s lots of research that might indicate that most people are magnesium deficient.

Chris Kresser:  Yeah, potassium, magnesium citrate, I mentioned earlier that that can decrease oxalate excretion, so you could add magnesium in there as well.  And in terms of stone formation, there are mixed ideas about this, but in some cases the median time for a stone to form is three or four months, so if someone was on a really low carb, ketogenic type of diet and they formed a stone… You want to be looking at what your diet was like two to three months leading up to the formation of the stone, not what it’s like right now or right when the stone was formed, and I just mention that because I know that Mike said he was on a really low carb diet up until recently and then he recently made some changes.

Steve Wright:  Interesting.  OK.  Well, I think that’s going to be helpful for a lot of listeners.  I know that a lot of people do suffer with that issue.

Bioaccumulation of Toxins in the Body

This next question comes from Jeremy.  He says:  “I’ve followed your blog on and off for a really long time now, and I really, really appreciate how much you cite.  As a researcher myself, it is extremely important to me to find discussions where people cite rather than just talk and not cite.  However, there is one area that I wish you might touch on more and haven’t for a long time.  The last article you had on detoxification was back in 2010.  I’ve tried to find lots of information regarding the topic but have failed to find anything conclusive.  Many people discuss how toxins are ‘stored’ or ‘encompassed’ by fat cells, though I have found no evidence from actual research which supports this conclusion.”  He says the closest discussion, and he linked to a book.  And he wants to know, Chris, could you do an article on the subject?  Or maybe we can handle it on the podcast here.

Chris Kresser:  Yeah, well, the podcast isn’t necessarily the best place to get into a discussion where a lot of citations and references are flying around, but the question has been on our list for a while, and I just haven’t had a chance to write about it, given how busy I’ve been with the book and stuff, so I figured I’d at least point you in the right direction.

What you want to look for is the subject of bioaccumulation.  If you do some searching around that, you’ll probably find plenty of references.  And you may also want to study, more specifically, the phases of liver detoxification.  Bioaccumulation refers to the accumulation of substances like pesticides or other organic chemicals in an organism.  It happens when a toxic substance is absorbed at a rate faster than it can be detoxified by the detox system of whatever organism we’re talking about.  And many of these toxins are lipid soluble or fat soluble, which means they accumulate in lipid tissues, particularly the brain.  Mercury is a great example of this.  There’s a phrase I’m sure everyone has heard of:  Mad as a hatter.  And this refers to the process historically for stiffening hats, which used to involve mercury.  Mercury can form methylmercury, which accumulates in the brain, and the brain is mostly fat, actually.  Sixty percent of the dry weight of the brain is lipids.  There are other lipid-soluble toxins, like certain lead compounds and DDT, for example, that are stored in the body’s fat tissue.  And when the fatty tissues are used for energy, the compounds are released and they can cause poisoning or toxicity.

Naturally produced toxins, though, can also bioaccumulate.  For example, marine algal blooms, like red tides, can result in toxicity in filter-feeding shellfish, like mussels and oysters.  I’m sure most people who live by the ocean have heard that you shouldn’t eat mussels and oysters during a red tide, and that’s exactly why.  And then natural substances like hormones are lipid soluble and can accumulate in fat tissue if they’re not eliminated properly.  I talked about that a bit in my series on paleo diet challenges and solutions, and when we released the Paleologix supplement line [The Paleologix supplements discussed in this post are no longer available, and we’ve launched a new supplement store. Please click here for more information], there was some discussion there about this issue of hormones accumulating particularly in women who have been on birth control for a long period of time or they’ve been taking bioidentical or other kinds of hormones, like hormone creams and things.  You can see really significant accumulation of hormones in women like that, and they have a lot of symptoms related to that.  Some of the compounds that help with phase one detoxification can be useful in that situation because they involve converting lipid-soluble toxins to water-soluble compounds which then can be eliminated through the urine and feces and sweat.  Hopefully that will point you in the right direction to do a little bit more research, and I’ll definitely put this on my list to write more about in the future.

Steve Wright:  Hey, Chris, were you saying that, in general, the fat in the brain tends to accumulate the toxins more than, say, fat distributed around the body?  Or did I mishear that?

Chris Kresser:  I don’t know the answer to that across the board, but certainly with mercury and some of the metals the brain seems to be more preferentially affected.

Steve Wright:  Huh.  That’s interesting.  I always wondered about, like, for instance, I once was fat and then lost a bunch of weight, and just curious about the belly fat, how much of that stores toxins as well.  Interesting.

Chris Kresser:  Mm-hmm.

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Do We Need to Supplement with Calcium?

Steve Wright:  OK, enough about my previous fat kid life!  Let’s move on to the next question from Heidi.  This question says:  “I’m in the unfortunate position where I became so ill with ulcerative colitis that I had to go on prednisone.  Now that it’s happened, my doctor wants me to supplement with calcium to minimize my risk of bone problems.  My understanding is that vitamin D and vitamin K2 are more important to building bone for a healthy person, but are there situations where one should supplement with calcium?  I do consume bone broth at least three times a week and so eat some cheese and yogurt.”

Chris Kresser:  This is a difficult one because in general, as I’m sure many of you know, I don’t recommend supplementing with calcium, and in fact, I wrote an article awhile back about how taking more than 1000 mg of a calcium a day is associated with increased risk of heart disease and kidney stones and other conditions, especially in the context of underlying vitamin K2 deficiency because K2, as I mentioned earlier, regulates calcium metabolism and keeps calcium in the bones and teeth where it belongs and out of the soft tissues.  When you absorb calcium from food, it’s generally in smaller quantities and spread out more over time and the body can more easily regulate where that ends up, but if you take it in a huge bolus, like a supplement, it can cause spikes in serum calcium that the body doesn’t really know what to do with.  That’s the downside of calcium supplementation and why I think it’s really unnecessary and potentially harmful for most people.  But one of the main known side effects of prednisone, especially for people who are on it for a long time, is that it can really have a really adverse impact on bone density, and it’s a strong risk factor for osteopenia and osteoporosis, especially if you start taking it when you’re younger and continue to take it later in life.  So you could maybe make an argument for a conservative calcium supplement regimen, maybe 300 to 500 mg per day instead of 1000 mg, but actually what I would suggest in this situation is trying to find an alternative to prednisone.

I know inflammatory bowel disease can be rough.  I have a lot of patients with it.  But I’ve had great success with things like the GAPS diet or SCD, and I know you, Steve and Jordan, have as well.  Of course, some probiotics.  Low-dose naltrexone, which is an immune-regulator that can be extremely helpful.  There are some very encouraging studies on LDN, which is low-dose naltrexone, and Crohn’s disease which show a nearly 70% remission rate with no adverse effects at all, which is just remarkable when you compare it to things like prednisone.  Up-regulating glutathione status, making sure vitamin D levels are adequate, making sure stress management and sleep are dialed in, testing for any latent gut infections by parasites or pathogenic, opportunistic bacteria, dealing with SIBO if it exists – there is so much that can be done for inflammatory bowel disease.  And in the vast majority of cases, in fact, I can’t think of a single patient that I have worked with that hasn’t been able to get off of prednisone or other immunosuppressive drugs.  Now, there’s no guarantee that that would happen, but I think it might be a really good idea if you can to find a practitioner who’s really experienced with inflammatory bowel disease and addressing it from a more holistic perspective because ultimately bone loss is not, of course, the only potential side effect of prednisone, as I’m sure you know.  There are many other side effects.  It can be problematic over the long term, so I would say in the short term you could consider a little bit of calcium supplementation.  You could also get more calcium from the diet.  One good nondairy source of calcium is bones in fish.  If you buy canned salmon from somewhere like Vital Choice, get it with the bones in it, and the bones are very soft and you can eat them.  That’s a fantastic source of calcium.  They also sell, I think, sardines and mackerel with bones in them.  And if you eat several servings of that a week in addition to bone broth and dark, leafy greens and maybe some dairy, you may not even need to supplement at all, and then you could work on focusing more on your IBD with a view towards getting off prednisone.

Steve Wright:  Yeah, I couldn’t agree more with all the recommendations you just said, Chris.  And I just want to throw in a small nugget for Heidi and anybody else listening with IBD, that Jordan and I have seen over a hundred clients with IBD, and they never seem to be making enough cortisol, and I think that’s really why prednisone, a glucocorticoid that really helps reduce the inflammation in the gut, seems to work so well for this population.  So definitely there’s so much to be done on the hormone front to really help these people.

Chris Kresser:  Absolutely.  For those of you who aren’t familiar with cortisol, that’s just another way of saying adrenal fatigue.  When you have a chronic serious illness like IBD, it’s a significant stressor on your body, and over time, that really just taxes your adrenals and reduces your cortisol production in most cases.  That’s where stress management and sleep as a starting place come in, but then doing some specific support for the adrenals is a good idea.  I know it’s not always easy when I say things like, “Find a practitioner who’s experienced in working with this stuff,” and it’s something that’s really high on my list, trying to make that easier, a clinician training program and networking with other practitioners, but Paleo Physicians Network might be a good place to start.  Primal Docs is another.  Networking and online forums and on Facebook and social media, that sort of thing, asking around, asking in the comments section of my blog, maybe.  In a couple months, actually, I’m going to be launching a free forum, which I’m really excited about, and this would be a perfect venue for discussing topics like this and getting help from other people who are following a similar approach.

Is There a Link between Dairy Consumption and Osteoporosis?

Steve Wright:  Awesome.  Well, let’s move on to the next question from John.  John asks, Chris:  “What do you think about the link between dairy consumption and osteoporosis?  My impression is that the countries who consume more conventional dairy products have a higher risk of osteoporosis.  If this is true, then do you think there is the same risk among those who consume raw milk from heritage breed cows that are raised on pasture?  Do you think that the high quality raw milk is generally good for the bones or bad?  Can you imagine any case where raw milk could be a contributing factor to osteoporosis?”

Chris Kresser:  Well, as many know, I’m generally a fan of raw milk, provided people understand the risks, and I wrote a whole series about that.  I think the risks are low, but ultimately everyone has to make their own decision regarding their risk tolerance.  However, I don’t buy the claim that even conventional pasteurized dairy is associated with osteoporosis.  You see that claim made a lot in the alternative health media.  The idea is that the phosphate in milk and dairy make them acid-producing foods and this causes our bodies to become “acidified” – I’m using air quotes there – which then promotes osteoporosis.  Well, as many of you know, I recently wrote a two-part series debunking this whole acid-alkaline myth.  Diet has no effect on serum pH.  If it did, we’d all be in a lot of trouble!  The acidity or alkalinity of our blood – the pH, that is – has to be regulated in a very, very tight range, and if it deviates from that range, we can die quickly.  From an evolutionary perspective, it doesn’t make any sense that we would be able to throw that pH number way out of that optimal range just by what we eat.  If we did, we wouldn’t have survived this long.  And it’s important to point out that urine pH is not the same as serum pH, so if you buy these test kits that are advertised to alkalinize your body and make your body more alkaline and less acidic and you see that your urine is acidic, that doesn’t mean that your blood is acidic.  That doesn’t mean there’s any correlation between the two.

There was a great study in 2011 that specifically took aim at this acid claim for dairy products, and it’s called “Milk and acid-base balance:  proposed hypothesis versus scientific evidence,” and we’ll put a link in the show notes.  It makes it clear that there’s no scientific evidence supporting these ideas.  Milk and dairy neither produce acid, nor cause metabolic acidosis, and the researchers reiterate what I just pointed out, that diet does not affect systemic pH, and measurement of pH in the urine does not reflect serum pH.  In fact, in another separate meta-analysis of the whole acid-alkaline theory, researchers in that study found that most studies not only don’t support that theory, they directly contradict it.  Higher phosphate intakes were actually associated with decreased urine calcium and increased calcium retention.  And then on top of all that, there’s tons of evidence that correlates dairy consumption with reduced risk of osteoporosis rather than increased risk, and these studies aren’t distinguishing between raw and pasteurized, and since most people in most places consume pasteurized dairy, we can assume that that’s the kind of dairy products that were consumed in these studies.  In Korea, increased intake of dairy products in Korean menopausal women reduced osteoporosis.  In the US, there was a study that showed that those with the lowest quartile of dairy intake among US postmenopausal women had the highest risk of osteoporosis, and people in the higher quartiles had lower risk.  And then there was a study involving Polish women that were in menopause that found that consumption of dairy products during childhood and adolescence reduced the risk of women developing osteoporosis later in life, particularly when they’re in menopause.

So, I don’t think there’s any evidence to support the idea that dairy products increase the risk of osteoporosis.  If anything, the weight of the evidence suggests the opposite, that they protect against it.  And there’s certainly no evidence to support the claim that dairy products are harmful because they’re acid forming.  That’s just another one of these alternative health myths that gets repeated over and over again.

Steve Wright:  Yeah, can we just kill that cow?  Like, bury it?

Chris Kresser:  I don’t know.  It keeps coming back, so we’re going to keep talking about it, I guess.

Steve Wright:  I saw some zombie movies, and you know, when they come back from the dead, they multiply fast.

Chris Kresser:  Yeah, I guess so.  We’ll also post a link to the acid-alkaline articles that I wrote in case folks missed those.  You definitely want to check that out.  The question of whether dairy products are beneficial, as I’ve always maintained, is highly individual.  Some people have the ability to break down lactose.  Other people don’t.  But even if you don’t have the ability to break down lactose, you can still consume dairy products that are low in lactose, like butter and ghee and homemade fermented kefir where you ferment it for at least, generally, 24 hours or so.  It’s going to have virtually no lactose at all, the same with yogurt that you make at home.  Cream has about 3% lactose, and that’s kind of up in the air.  Some people with lactose intolerance don’t tolerate it and others do, and I think it depends on the degree of lactose intolerance.  And then soft cheeses have around that amount, so they’re kind of questionable for lactose intolerance.  Hard cheeses that have been aged for a while, they have virtually no lactose either.  So even if you’re lactose intolerant, you can still get some of the health benefits of dairy products if you’d like by following those guidelines.

I don’t think dairy is necessary for proper bone health.  That doesn’t make any sense because we obviously lived for millennia without consuming dairy regularly.  But neither do I think that dairy is problematic, and there’s a lot of evidence that supports the idea that dairy is not only potentially beneficial for bone health, but it also has beneficial impacts on cardiovascular health and metabolic health.  And that’s only true for full-fat dairy, by the way.  Stephan Guyenet was a co-author on an interesting paper about that awhile back, the beneficial cardiovascular and metabolic impacts of full-fat dairy products.  If it works for you, there’s no reason to avoid it.  If it doesn’t work for you, you don’t need to worry about avoiding it.  That’s kind of my idea about dairy.

Steve Wright:  Awesome.  Well, this has been a great podcast, Chris.  I just want to let everybody know before we hang up here that if you haven’t gotten Chris’ best tips and tricks, it’s just like what you hear on this podcast except it’s delivered personally in your inbox.  You’re going to want to head over to Chris Kresser’s website and look at the big red box.  Right there, you can sign up for a free 13-part series on burning fat, boosting energy, and preventing and reversing disease without drugs.  It’s called Chris’ Beyond Paleo series.  So head over to ChrisKresser.com and look for the big red box.

Also, if you want to get more of Chris Kresser’s info, you can check him out on Facebook at Facebook.com/ChrisKresserLAc and Twitter.com/ChrisKresser.

What Chris Ate for Breakfast (Almost Forgot!)

Chris Kresser:  Hey, Steve?  A little birdie just whispered in my ear about how we always forget what did I eat for breakfast, right?

Steve Wright:  Oh, it’s true.  What did you have?

Chris Kresser:  We picked up recently another half hog.  We get a half hog a couple times a year from a local farmer, so we picked it up.  And we had some people over, and I roasted a ham the other night.  So I had some leftover ham, and then I had some bok choy cooked in ghee, and I had some sauerkraut that I’ve mentioned a few times made with cabbage, beets, and carrots.  And then I had some mashed potatoes that we had left over also from the other night where we had the ham roast.

Steve Wright:  That sounds pretty delish.

Chris Kresser:  Kind of like a Christmas dinner except for the bok choy and the sauerkraut, I guess!

Steve Wright:  Yeah, where was the sweet potato casserole?

Chris Kresser:  Yeah, not there.

Steve Wright:  Well, I hope the breakfast people listened all the way to the end of this podcast and they didn’t cut out early.

Chris Kresser:  Yeah, don’t feel cheated.

Steve Wright:  Awesome podcast, Chris.  I want to let everybody know you can keep sending us your questions at ChrisKresser.com using the podcast submission link.  And we’d love it, obviously, if you could give back to the show by heading over to iTunes and leaving us a review.

Chris Kresser:  Thanks, everyone.  Talk to you next time.

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  1. Chris, I’m looking for information related to someone living with 1 kidney and a paleo type of diet. A close relative has 1 kidney and no gallbladder. The docs have instructed him to eat no more than 4 ounces of protein per day and to limit potassium and sodium. He is struggling with this dietary protocol. Are there any resources you can point me to that will provide better nutritional guidance for someone in this type of condition?

  2. Hi Chris. Aussie Male, 32, 6’4′ 180 lbs. Training for triathlons and eating mostly around 200g a day of carbs (fruit, oats, vegies) with plenty of canned tuna and other meat. I have recently switched to a Mediterranean type diet with more organic butter and cheeses. I have tried a few processed meats (salami, ham) lately which I havent eaten for a long time. Have noticed foaming in the toilet when I pee, which I have read is a symptom of protein in the urine. Do you suggest trying the above mentioned ketogenic diet (10:10:80) and see if the foaming reduces? (I have tried very low carb diets before)
    Cheers mate.

  3. Thanks Chris, I thoroughly enjoy reading and learning from the podcasts. Several of your suggestions have been very helpful to me. My husband had a kidney stone this year. I had just finished a personal study of coconut water – the liquid inside a young coconut – and had a few boxes of organic coconut water on hand. After a trip to the doctor, to confirm the excrutiating pain was indeed caused by a kidney stone, he started drinking coconut water. About 12 hours later he noticed a fine, white crystalline layer floating atop his ahem, liquid excretions. Pain all gone. The University of Phlippines has done some interesting work on repeat kidney stone formers and the efficacy of coconut water as both preventative and treatment. More on this can be found in Bruce Fifle’s writing in “Coconut Cures.”

  4. Chris, I agree with you about the whole acid/alkaline thing concerning osteoporosis. However, since I have low bone density I have been curious about the cause of osteoporosis. I have done everything over my life time that the “experts” have said to do and theoretically I should have strong bones but I may not.

    Anyway, sometime back I ran across this info. http://www.4.waisays.com/ExcessiveCalcium.htm Maybe the answer is here? What do you and your readers think? The article is long, seems well researched, but easy to read.

    • A VERY interesting article for sure Sharon and I see little in it I would dispute EXCEPT I am not sure the theory of a limited number of cell renewals set at birth hold true…

      • I am not sure about that either. It does seem true that we just wear out, piece by piece. Whether all cells have a life expectancy or not, someone probably knows. We do know that if we abuse our bodies that they generally don’t last as long. It make sense that if we abuse our bones, possibly by over feeding them with calcium, they may give up sooner than they are meant to. The question is, can you give your bones too much calcium to their detriment? I hope someone figures this out someday.

  5. Charlene,
    you may want to take alpha lipoic acid and anti-oxidants that recycle it.
    Also APEX has a dermal cream no one else has.
    It’s a prof product but so much less than injectable G

  6. Chris, you mentioned “up-regulating glutathione status” as a strategy for IBS (and I assume for any inflammatory disease as well). I seem to recall that Chris Masterjohn wrote an article stating that the best food sources for bio-active glutathione are unheated whey (i.e. raw milk whey) and raw egg whites? What are other good sources of glutathione?

  7. I’m not clear what you are saying about magnesium supplements related to oxalate excretion. Do they increase or decrease oxalate excretion? And would taking supplemental magnesium help with oxalate overload in the body?


  8. Hi Chris
    Just read your article/interview on Calcium. SO can’t help but commenting here:
    1- you say “The idea is that the phosphate in milk and dairy make them acid-producing foods and this causes our bodies to become “acidified” ”
    well I agree the cause is not that: the ratio P/Ca in cow’s milk is high thus preventing Ca assimilation is what I have learned.
    This may not be true if you are correct that Ca excretion does not increase w P intake (1 study? what kind of P?).
    Although blood becomes acidic nONLY in severe conditions I still think an acid producing diet does reduce the alkalinity reserves and that may have seriuos consequences (see Bio-electric Vincent testing).
    This by the way will REDUCE stomach HCL production (a brilliant German researcher has speculated that with low alk reserves the body won’t produce excess HCL because that would be deadly below our stomach – which leads to taking baking soda for ex to INCREASE HCL production LATER). What do u think? I have used this myself : 1/2tsp NaHCo3 at 4 pm dinner at 8.

    W regards to a preponderance of studies showing dairy intake protects against osteoporosis, I am VERY surprised by what you claim since The LARGE Harvard Nurses study clearly established that even a low intake of dairy INCREASED the frequency of fractures and fragility of bones. IT WAS VERY CONVINCING!
    Bone density is NOT a good indicator of bone strength!

    I can mail you a link to an article from the Harvard Med school summarizing the question.
    I also have in memory a graph showing osteoporosis in several countries w Denmark, Switzerland at the Top and Africa, China at the bottom/; w the conclusion pointing ONLY to dairy as independent factor…

    I know you do not have time to respond to all mails.
    but hope you will post a reply here

  9. Taro is extremely high in oxolate, the leaves are poisonous and the root is very acidic if undercooked.
    Potassium citrate as Ural or a similar effervescent alkalising salt, and surely plenty of water, seem like sensible measures. Some kidney stones dissolve in acid urine, and whether ascorbic acid increases or decreases the risk may depend on the type of stone. Calcium ascorbate seems like a bad idea on principle. Vitamin C reduces incidence of gout, which has causitive factors in common with kidney stones.
    Here’s the Orthomolecular defense of vitamin C therapy in this regard: http://orthomolecular.org/resources/omns/v09n05.shtml