Bioidentical Hormones, Acne Scars, and Heavy Metal Toxins

Another Q&A! In this episode I answer your questions on bioidentical hormones, acne scars, heavy metal toxicity and more. In fact, I think we broke a record for the number of questions I’ve ever answered in a single episode.

My producer Jordan told me this morning that Revolution Health Radio just surpassed 1 million total downloads. Thank you for listening and being a part of this community!

In this episode, we cover:

1:49 New Segment: what did Chris eat for breakfast?
6:30 The latest news from Chris on “HPAD”
14:37 Can “lectin lock” help protect us from diet slips during the holidays?
21:30 The truth about bioidentical hormones
26:28 How to erase lingering acne scars
31:10 Is it OK for kids to occasionally eat gluten?
36:50 Heavy metals, chelation, and detox
41:10 Clearing up the confusion about over-prescribing vitamin D
48:53 What to do – and not do – about cirrhosis of the liver

Links We Discuss:

• Adaptocrine
• Adrenotone
• N-acetyl Cysteine
• BCM-95 curcumin
• GlutenFlam
• Phytosphingosine

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Full Text Transcript:

Steve Wright:  Hi, and 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 from SCDLifestyle.com, and with me is integrative medical practitioner, licensed acupuncturist, and healthy skeptic, Chris Kresser.  How is your week going, man?

Chris Kresser:  It’s good.  We’re going up to Sebastopol, which is about an hour, an hour and 15 minutes north of here, for the weekend just to chill out and relax a little bit, poke around, go out to the beach, get some rest, so I’m looking forward to it.

Steve Wright:  Yeah, that sounds nice.

Chris Kresser:  How are you doing?

Steve Wright:  I’m doing well.  I’m all wired up right now, and by that I mean I just got this new grounding mat, and I got it all plugged in.

Chris Kresser:  You’re grounded.

Steve Wright:  Yeah, I’m grounded.

Chris Kresser:  All right.  What’s your experience been with that like so far?

Steve Wright:  I literally got it in the mail last night.  So just setting it up, I was impressed with the packaging and the little testers to make sure everything was set up correctly.

Chris Kresser:  Yeah.

Steve Wright:  It’s smaller than what I expected, but I can’t report any benefits yet.

Chris Kresser:  All right.  Well, keep us posted.  I’ve heard a lot about those things.  I don’t know much about them myself, or I should say I haven’t used them or talked to many people that have used them, so I’ll be curious to hear.

Steve Wright:  Yeah, hopefully in another week or two I can give you an update.

New Segment: what did Chris eat for breakfast?

Chris Kresser:  Cool.  So before we get into the show, I guess we’re gonna add a new segment to the show by popular demand called…

Steve Wright:  Dun, dun, dun…

Chris Kresser:  The “What did Chris eat for breakfast?” segment, haha.  So let’s see.  This morning I had leftovers, which I will often do if I’m pressed for time.  And last night I made this ground beef dish with some chili powder seasoning from Spice Hound, and you should definitely check out Spice Hound if you haven’t already.  It’s a really cool place to get all kinds of great spices, spice blends and stuff like that.  I learned about it from Nom Nom Paleo.  So it was some chili powder and some tomatoes and some homemade chicken broth simmered for a while, and so I had a little bit of that leftover, so I had that.  And then we had some yuca fries that I had made in duck fat the other day and actually a few taro chips that were left over from last night as well that were cooked in lard.  So taro chips, yuca fries, this leftover kind of Mexican chili spiced ground beef and then some sauerkraut.  Sauerkraut was nothing special today.  It was just the Bubbies brand that we had some from a trip that we took the other day.  Bubbies is all right.  I don’t love it, but it’s one of the few raw sauerkrauts that you can get in a lot of stores that don’t necessarily have the fancier brands, and we had run out of the stuff that we made.  So that was it, and I had a little bit of kefir afterwards.  Today, on Fridays when we do the podcast I often will only have two meals.  I’ll have kind of like a late breakfast before we record the show, and then I don’t eat again until dinner, so it’s my little intermittent fast day.

Steve Wright:  Cool.  Now, do you get your duck fat local, or do you order that online as well?

Chris Kresser:  We get it locally.  There’s an amazing charcuterie at the farmer’s market that I think I mentioned last time.  It’s called The Fifth Quarter.  The guy is local in Oakland here.  He’s my hero!  He has the best sausages and salamis and ciccioli and lamb sugo and all kinds of different prepared meats, and then he has lard.  We render our own lard because we get a half a pig every now and then from a farmer, but occasionally when we haven’t done that or when we run out, we’ll get lard from him.  And he has duck fat as well, so we’re pretty fortunate to be able to buy that at the farmer’s market, but duck fat is actually really easy to make.  You just get a duck and you roast it, and then you pour the fat through the strainer, and that’s pretty much it.  There’s your duck fat!  If you don’t have access to duck fat and you do have access to duck, you can make it pretty easily.

Steve Wright:  Something on my list that I’ve gotta try before the year’s out.

Chris Kresser:  And if you have not had roasted vegetables in duck fat or if you haven’t had, like, potatoes roasted in duck fat, you haven’t had potatoes or vegetables yet.  That’s what I’m saying.

Steve Wright:  Well, I’m gonna get out of my cave, and I’m gonna find me some duck fat.

Chris Kresser:  That was the way that French fries were originally made.  In duck fat.  At least, that’s what I’m told.  Somebody might protest who is actually French.

Steve Wright:  Haha.

Chris Kresser:  Yeah, it’s amazing.  That’s my number one favorite vegetable and potato and yuca and starch-roasting fat, would be duck fat.  And number two would be lard.  Lard’s really good too, but I prefer duck fat if I have a choice.  And you know, I can’t even remember the last time I ever roasted anything in olive oil.  It’s not even on the list.

Steve Wright:  Interesting.  Yeah, I don’t have access to it at our farmer’s market around me, and I’ve seen it online, so I might just roll the dice with somebody online and see what it tastes like.

Chris Kresser:  Yeah.

The latest news from Chris on “HPAD”

Steve Wright:  So are we having a new segment in the show as well, “Chris’s follow-up appointment with Chris?”

Chris Kresser:  Haha, yeah, we’ve got all kinds of great ideas, huh, Steve?

Steve Wright:  Yeah, the comments were awesome.  Thank you, everyone, for commenting on the show.  We do read them, and Chris responds to a lot of them.  So based upon popular commenting, I think we need an update, Chris.  What’s going on with your adrenals?

Chris Kresser:  They’re slowly but surely making a recovery.  As I often tell my patients when you’re dealing with HPAD, as one of the commenters suggested we call it, which would stand for hypothalamic-pituitary-adrenal dysfunction.

Steve Wright:  Wait, wait, hippa-d is way cooler.

Chris Kresser:  Hippa-d is definitely cooler.  There’s no doubt about that.  The cool factor is pretty strong with hippa-d, but I think HPAD sounds maybe a little bit more legit?  I don’t know.

Steve Wright:  OK, OK.

Chris Kresser:  So yeah, I always tell my patients it’s a long process.  It takes a while to get there, you know, to get to the point where you’re in a later stage of that, and then it can take a while to get out, so patience is actually one of the most important qualities to cultivate when you’re dealing with this kind of thing.  And along those same lines, something I’ve been focused on lately the last week or couple weeks is I think I’ve mentioned on the show that I’ve had a long-term meditation practice.  I actually started when I was 17 years old.  My dad introduced me to it, and my dad has taught me a lot and introduced me to a lot of amazing things in my life, but if you knew my dad, you’d probably be surprised that he introduced me to meditation because when you meet him, he doesn’t strike you as a meditator.  He’s not immersed in that subculture at all, and it’s not his shtick at all.  But when he was in his early 30s or mid 30s, he was dealing with some serious stress in his life.  He was a business owner and there was a lot going on, and some colleague or someone introduced him to meditation or told him about it, and he actually got pretty into it.  So when I was about 17, he introduced me to it, and I fell in love with it right away.

And so I’d been meditating pretty steadily, steady sitting practice every morning or at least every day for about 20 years until Sylvie was born.  And then when Sylvie was born, my life was turned upside down, of course, in all of the best ways.  But one of the consequences of that was that for the first time in 20 years I found it difficult to be consistent with my meditation practice.  And part of the issue was it was difficult to find the time to do it because I’m the morning person with Sylvie, and that’s the time where I used to really consistently sit, because as the day got going, it was hard for me to find the time in the midst of everything else that was going on.  But what I realized, and it’s kind of one of those take-your-own-advice things because I’m always telling my patients this, but I realized that rather than just not sitting, if I didn’t have 30 minutes to sit, it would probably be a lot better to just sit for 5 minutes if I had 5 minutes, or 3 minutes if I had 3 minutes.  So just before we did the show, I sat for about 10 minutes, 8 minutes or something.  I had about that much time before the show started.  And in the last couple of weeks I’ve been sitting for 5 minutes here or 7 minutes there or even a couple minutes.  And it might seem like that doesn’t make a big difference because it’s such a short period of time, but just making that commitment and sticking to it and being in the rhythm of having at least a few minutes a day of quiet time makes a really big difference actually for me, and I know it does for a lot of other people too because of the feedback that I get when I share this stuff with patients and talk to them about it.

So I’ve found it helpful to set little reminders.  I have a little timer on my computer.  When I’m working, I’ll set it for every 20 or 25 minutes just as a reminder to get up and do maybe a little bit of exercise, like some mountain-climbers or running in place or I’ll go outside and jump up and down, haha, on the steps or jump rope or do some push-ups or pull-ups or whatever I’m doing that day.  But then I’ll also have a timer set to just step away from all of that and sit for 5 minutes or something periodically throughout the day, and I’ve found that that has made a really big difference.  It’s a good way of kind of checking myself and hitting the reset button periodically.

Steve Wright:  Well, that’s a really cool insight into your life right now.  Do you have a special breathing practice that you use when you even have 3 minutes or 5 minutes?  Or is it mostly just about staying still and clearing the mind?

Chris Kresser:  Yeah, I mean, I’ve done a lot of different forms of meditation over my life, but the last 10 years, zen has been my practice.  And with sitting in zen, the zazen technique doesn’t involve any particular breathing.  It’s more about sitting still and just observing what arises in that still space.  I mean, the traditional zazen technique is sitting against a white wall with your eyes open, so it’s a little bit different than other meditation techniques where your eyes are closed and you might, like in Vipassana where you might be kind of sweeping your awareness around different parts of your body.  Zazen traditionally, if you went to a zen monastery in Japan, you’d see a bunch of monks sitting, facing the wall with their eyes open.  I don’t think it really matters, you know, for someone getting into meditation.  I certainly don’t get into arguments about what meditation technique is best.  I think what’s best is what appeals to you, and whichever one it is that you’re doing is the best one to do!  Certainly there’s a larger discussion to have about that some other time, but I don’t think it matters too much.

Steve Wright:  Awesome.  Well, if they comment, if people want it, then we’ll talk about more meditation.

Chris Kresser:  All right.  Sounds good.

Steve Wright:  OK, well, do you need to go sit for 30 seconds?  Because if you do, I think this is a perfect opportunity for us to talk to our listeners.  Well, I’m gonna assume that you’re already sitting, and I’m gonna tell everyone about Beyond Paleo.  Beyond Paleo is a free 13-part email series that Chris has put together, and it’s designed for someone who might be new to the paleo diet, someone who might be dealing with a chronic problem, a chronic illness, or someone who is just learning or wondering how to optimize their health.  It’s, like I said, a free 13-part email series, and in each email you’ll be getting Chris’s best tips and tricks on different types of topics like burning fat, boosting energy, and preventing and reversing disease without drugs.  Now, if you want to get this free email series, go over to ChrisKresser.com, look for the giant red box in the middle of the page, and go ahead and put your name and email in that box, and Chris will start sending you those emails.
OK, Chris, you ready?
Chris Kresser:  All right, I’m back.

Steve Wright:  All right, good, good.  It’s my job to keep you rested, man.  We got a lot of questions today.

Chris Kresser:  All right, let’s do it.  We’re gonna try to answer more than two this time, haha.  I won’t just bladder on endlessly about each one.  So let’s do it.

Can “lectin lock” help protect us from diet slips during the holidays?

Steve Wright:  Cool.  Well, this first one comes from Rafael.  His question is on rescue agents.  Recently he saw a product called Lectin Lock.  “Do you have any thoughts on this, Chris?  It’s from a company, VRP.  I am not associated in any way with the company, but I’m wondering if this would be good for slips, especially during the social eating season.  Dave Asprey has also mentioned things like charcoal if you might come in contact with these slips or, you know, in the social eating season.”

Chris Kresser:  Yeah.  I don’t know how necessary that is.  You know, we had Mat Lalonde on the show a while back, and we talked about some of the myths and truths about the paleo diet.  And one of the ones we discussed was the idea that lectins are toxic and harmful for humans.  And for those of you who remember this discussion, you might recall that lectins certainly are toxic in their raw form, but they are very sensitive to heat and they are destroyed by heat, so most of the common lectins like wheat germ agglutinin in wheat and phytohemagglutinin in legumes are not likely to be a problem in human health because they’re destroyed in cooking and/or inactivated in the digestive process.  So eating raw wheat or raw legumes would be a really, really, really bad idea, but that’s, of course, virtually impossible, so I’m not convinced that getting exposed to lectins occasionally is really that big of a problem where you would need to take steps like a product like Lectin Lock or even activated charcoal to deal with it because I think it’s probably unnecessary.  Now, there are some lectins that aren’t deactivated by heat that Mat and I talked about and do survive digestion, and those are probably pretty allergenic, and one of those is peanut lectin.  So you know, that may be an issue for people who are allergic to peanuts or people who have a strong sensitivity to it, but for the most part, in other cases with lectins I don’t think it’s really necessary.

Now, with something like gluten, that’s a different story.  I mean, if someone’s gluten intolerant and they have an exposure to gluten, then a product like GlutenFlam, which has particular enzymes that are helpful, brush border enzymes that are helpful with breaking down gluten, that might be helpful.  Apex makes that product called GlutenFlam.  I sometimes will recommend that to people that are extremely gluten sensitive, like so gluten sensitive that… like, a former housemate of mine from a while back, she was so sensitive that if she went to a barbecue and they were cooking hamburgers on the grill, if there was a bun on the grill at any time during that barbecue, even an hour later if she had a hamburger that came off that grill, she would be in distress for days afterwards.  So people who have that level of sensitivity, I’ll sometimes recommend that they travel with something like GlutenFlam, but otherwise I just don’t think it’s necessary in most cases.

Steve Wright:  So is charcoal or bentonite clay, are any of those kind of a general thing that you might recommend for a protect-all?

Chris Kresser:  I tend to use charcoal more when I’m doing an antimicrobial treatment, especially an antifungal treatment, because it binds to the fungal cell wall components that would be killed in an antifungal protocol, and then it carries them out of the body.  It binds to a lot of toxins and carries them out of the body, so it’s helpful in detox protocols, but I just don’t know that I would use it if I ate something I wouldn’t normally eat, and so I’m taking this to deal with that.  I just don’t think of it that way.  And for me, as I’m sure most people know, I’m sort of an 80/20, 90/10 guy anyway in the sense that I don’t consider myself to be on a strict diet.  You know, I will occasionally eat things that I don’t think are optimal because I like to eat them and I get pleasure from eating them, and I don’t then feel like I need to take anything afterwards to cleanse myself of that.  It’s just not how I think about it.  I think humans, if we’re healthy — even if we’re not 100% healthy — I think we have a certain resilience and tolerance for a certain level of nonoptimal foods.  And I’m not accusing at all the person who asked this question or Dave Asprey of this mentality, but I’m just saying that I think there is a mentality out there that’s like “We have to be 100% clean,” and taken to the extreme, this goes to people who get colonics four times a week or something and they’re obsessed with this idea of being pure or clean.  And I think we should be resilient enough to be able to tolerate a little bit of nonoptimal food and not worry about it.  That’s kinda what I’m saying.

Steve Wright:  Cool.  And if you do, maybe you should do some meditation afterwards.

Chris Kresser:  I mean, I just want to be clear.  I’m not talking about someone with known severe gluten intolerance.  Obviously the 80/20, 90/10 rule does not apply to them in terms of gluten.  They have to be 100% zero gluten because the consequences of eating it in those cases are just so severe and so long lasting that it’s not worth it.  But that’s not what the question was about, so I’m addressing kind of the broader population.

Steve Wright:  Right.  So if you’re dealing with an autoimmune condition or if you’re currently executing a specific protocol that you and your practitioner have put you on, just figure out a why to not partake in the social eating.  Otherwise, you know, it doesn’t have to be militant, strict.

Chris Kresser:  That’s definitely my perspective.

The truth about bioidentical hormones

Steve Wright:  Cool.  Well, let’s move on to the next question from Alex.  “Hey, Chris, what’s the deal with bioidentical hormones?  Do you use them in your practice or do you go with a different approach?  Thanks.”

Chris Kresser:  I do use them in my practice sometimes.  It depends on what the problem is, and it’s rarely, if ever, the first place that I start.  So in the case of, haha, hippa-d or HPAD or adrenal fatigue, whatever you want to call it, I’ll usually start with botanical adaptogens like eleutherococcus, ashwagandha, rhodiola, and micronutrients like vitamin C and pantothenic acid and possibly phosphatidylserine or phosphorylated serine like Seriphos if the cortisol is high, and then lifestyle changes and dietary changes, etc., and try to regulate it that way.  And that’s usually pretty effective for the early stages of that process.  But if it has progressed to a later stage, I might try something like IsoCort, which is a cortisol analog derived from plants.  And then from there I might go to, or I might go directly in some cases, to a low dose of sublingual bioidentical pregnenolone and/or DHEA.  And the reason I use sublingual bioidentical is that you can take bioidentical hormones in capsule form, but then you have to worry about the digestive process.  And a lot of people with adrenal issues also have digestive problems, so you wonder how well they’re gonna absorb what they’re taking, so you can’t be exact with the dosing because the first-pass liver detox will take a swipe at and reduce the level of bioactive hormones that are available there.  And then if you take hormones that aren’t bioidentical, then the body has to convert them into the form that is bioidentical that works in the human body, and that can be an energy-intensive process, and that conversion process might be impaired, especially in people that are not doing well.

So I think bioidentical hormones have a place if they’re used wisely, and the concern always with hormones is the risk of disrupting the natural regulatory and feedback mechanisms.  We’ve talked about this a lot in other contexts, but if you take high doses of sublingual hormones for a long period of time, then the concern is that your body will say, “Oh, OK, there’s plenty of pregnenolone and DHEA in the system, so we don’t need to produce them ourselves,” and it will shut down CRH and ACTH secretion, which act on the adrenals to produce cortisol and DHEA, and then when you stop the hormones, then you have a problem because you’re not producing them internally.  And that’s rarely irreversible, but it can be a difficult process to get back.  So I guess what I would say is I use them.  I try to use them judiciously and cautiously and temporarily because of the potential for problems over the long term.

And that’s actually one of the main reasons that I don’t use creams, hormone creams, because that is even more likely to cause feedback problems, because the creams, number one, they tend to accumulate in the fat tissue, so I’ll often see people who have been on creams for a long time and their progesterone levels will just be sky-high, you know, way, way high.  And they’ve been on the cream for a long time, and the hormone has just accumulated over a long period of time.  The other reason is that the hormones in the creams are often in the free-fraction form, meaning they’re not bound in any way, so the body has no way of regulating those levels.  So that’s another issue.  And then a third issue, which is kind of interesting, that recently has come to light is that sometimes, like if a woman is taking creams and then she is having physical contact with her partner, husband, whatever, then the other people can actually be affected by the cream and the hormones can get into the other person.  So there are a lot of potential issues with creams, and I definitely prefer using the sublinguals for that and several other reasons.

How to erase lingering acne scars

Steve Wright:  OK, very cool.  OK, this next question comes from Rhea.  “After starting a paleo diet a few months ago, my acne has calmed down, which I’m very happy about.  Unfortunately, my skin does not heal quickly, so I have a lot of discoloration from the acne with red marks all over my face.  These marks look like I have acne even though there hasn’t been a pimple in the spot for months.  Is there anything I can do to speed up the healing process?  I’d love to be able to not only have acne-free skin but clear, normally colored skin.”  Chris, what are your thoughts?

Chris Kresser:  Yeah, so two things.  One thing is just a general comment on the healing process, which is one of the analogies I will often use in the case of gut infections or anything that involves a more acute phase and then a more chronic phase is the analogy of getting stabbed.  So if you get stabbed, taking out the knife, you know, pulling the knife out is the first step in the healing process.  You’re not gonna do very well as long as the knife stays in there.  But obviously, once you take the knife out, there’s still a fair amount that needs to happen for you to get back to normal.  And it’s kinda similar with a gut infection where you treat the infection.  Let’s say it’s a parasite.  You get rid of the parasite, but 9 times out of 10, the patient won’t feel 100% right after that.  There’s a rebuilding process that needs to happen both because of the damage that the parasite itself did and, in some cases, the damage that the treatment for the parasite does.  So with acne it may be similar.  At least, that’s what I’ve observed to some extent, where the clearing of the lesions, the inflammatory lesions, is the first step, and there’s often some discoloration and usually temporary kind of scarring that’s there after the inflammatory lesions are resolved.  And so it may just be a question of time in this case.

In terms of things you could do to speed things along, if you’re not already taking fermented cod liver oil, it has a large amount of food-based retinol, which can be really helpful in skin conditions, and it also has long-chain omega-3 fats, which are helpful in skin conditions, and some vitamin E isomers.  So I would consider doing a more therapeutic dose of fermented cod liver oil, like maybe 5 mL a day or 5 to 10 mL a day, and see if that helps.  I would also consider both internal probiotics for the gut-skin connection, which I just wrote about not too long ago.  There’s a really strong connection between the gut and the skin, and I’m gonna be speaking on that topic at the Weston A. Price conference next weekend.  So internal probiotics and then there are also some topical probiotics.  They’re like creams that you can put on your face that have probiotics in them.  I think, was it Dr. Ohhira?  If you consult Dr. Google, there are actually a few good skin products with probiotics in them, creams that you can apply like moisturizer to your face.

And then phytosphingosine is another compound that might be helpful in this sort of situation.  It’s been shown to have antimicrobial activity against the bacteria that causes acne and then also direct antiinflammatory activity.  And it’s found in significant concentrations in healthy skin in the stratum corneum, which is the outermost layer, but in people with acne it’s been shown to be low.  And then there are also studies showing that when that’s applied as a topical agent, it tends to benefit acne, so those are a few ideas to explore.

Steve Wright:  Great.  So we’ll put some links probably in the notes to those because I can’t even re-pronounce that name.

Chris Kresser:  Yeah, phytosphingo… now you’ve got me all twisted up, Steve!

Steve Wright:  Haha!  All right, well, we’ll end that question.  We’ll move on.  There’ll be plenty of links.

Chris Kresser:  That’s one of my favorite words, phytosphingosine.

Steve Wright:  Sounds like a fruit.

Chris Kresser:  We’ll put it in the show notes, for sure.

Is it OK for kids to occasionally eat gluten?

Steve Wright:  OK.  All right, this one’s a bit of a long one, so bear with me.  This one comes in from Celeste.  “What is your perspective on children and gluten when there are no obvious indicators of digestive problems or food sensitivities?  We follow a mostly paleo/Weston Price diet in our house, informed by your work as well as Paul Jaminet and other shining lights in the nutrition blogosphere.  I have Hashimoto’s myself and have been gluten-free for about a year.  I homeschool my four kids and make most all the meals they eat, so their diet is basically gluten-free.  However, knowing the dangers that gluten can pose over time, I’m wondering about whether to encourage them to avoid gluten altogether.  I currently follow the 80/20 approach to foods offered outside the home, which helps minimize social awkwardness but leaves me concerned about their health and feeling somewhat of a hypocrite when I allow them to indulge in certain foods.  Does gluten pose a serious enough threat to the integrity of the digestive tract and the proper functioning of the immune system to warrant a more consistently gluten-free diet for today’s children?”

Chris Kresser:  It’s a great question, and it’s something I’m thinking a lot about as a parent now.  And as Sylvie gets old enough to eat a wider range of foods… You know, we were in the store the other day, and I ran into a neighbor, and the neighbor has two kids, one who’s a little less than a year older than Sylvie and a 5-year-old, and they were there, and they were eating some… I don’t even know, you know, cheese puffs or Pirate’s Booty or whatever it is!

Steve Wright:  Yes!

Chris Kresser:  Something that Sylvie is just not exposed to at all, you know, that she’s never seen in her life.  And one of the little girls walked up to her and said, “Here, try some of this.  It’s great.”  And her mom looked at me and said, “Is that okay?”  And I said, “Well, actually Sylvie has some food sensitivities, so we’re pretty careful with what we feed her.”  And that’s kind of what I do in those situations.  And we don’t know actually.  In all likelihood, Sylvie would’ve been fine if she had some of that.  I mean, it’s not something I want her to be eating often, but she’s really healthy and doesn’t really have a lot of food sensitivities.  At least with the good foods that we’re feeding her, we haven’t really observed that.  But my wife Elanne, I don’t know that she still has Graves’ disease.  She was diagnosed with it at one point, and we’ve used LDN and botanicals and a bunch of other things, and she has no symptoms at all, so she very well could be one of the 30% of people who are diagnosed with Graves’ and it just goes into remission.  But I have a long history of health challenges after the parasite thing in Asia 15 years ago, and some of my symptoms could definitely fall into the category of autoimmunity from that in that follow-up period, so we just choose to be cautious because of both of our health histories and our family.  There’s a history on Elanne’s side of some autoimmunity.  Her mom has Hashimoto’s.

So I think it really depends.  I think it depends on your family health history, how healthy the parents are, what the history of autoimmunity is in the family.  And then it depends on your values and what’s important to you and how much effort you’re willing to make to keep the diet extremely strict if you feel like that’s really important because of your family health history and you’re concerned about exposure for your child and the development of an autoimmune disease.  But I will say that I think for most people who don’t have a strong family history of autoimmunity and whose kids are generally health, as I said at the beginning of this show, I think human beings when they’re healthy are fairly resilient and can tolerate some nonoptimal food.  I do think gluten is probably… You know, there’s some evidence that suggests it causes gastrointestinal inflammation in people even without celiac disease or gluten intolerance.  It could be an inflammatory protein for everybody, and that might be why it’s best to avoid it in general.  But for someone who’s generally healthy and their gut flora is good and they don’t have any observable reaction to gluten, then eating it occasionally is probably not gonna be the end of the world.  It’s probably not gonna cause any significant health problems, and if it’s part of the 80/20 rule, I don’t think it’s an issue.  So it’s really a judgement call based on all of those different factors.  And I think social connection and a feeling of belonging is important for kids, and it can be really hard on kids if there’s no flexibility or leeway there at all, so it’s as much a parenting decision and a decision about how you want your child to grow up and what you want their social milieu and environment to be like than it is a health decision.  You have to consider all of those different factors.

Heavy metals, chelation, and detox

Steve Wright:  Lots of factors to pick from there, so hopefully that helps Celeste out.  OK, let’s roll on to the next question.  We’ve officially surpassed more questions than we’ve answered in the last six months, so keep this rolling.  This one comes from Jennifer.  “My nurse practitioner recently ran a heavy metals tox screen, and I found out that I have high levels of mercury and lead.  She recommends both oral DMSA and IV EDTA chelation.  From my research, I’ve read mixed reviews of each.  What do you think of chelation therapy, and what do you recommend for heavy metals detox?”

Chris Kresser:  So I will start with a caveat that I don’t consider this to be a particular area of expertise for me.  It’s not something that I’ve spent a lot of time researching and learning about.  I do treat metal toxicity in my practice, but I don’t have a ton of patients.  I mean, there are, of course, practitioners who do nothing but treat metal toxicity, and they’ve built an entire practice around it, and they’ve spent 20 or 30 years researching it.  I think of people like Andrew Cutler… I think that’s his name.  But there’s a whole other world there, and I’ll start by saying that I’m not an expert in this area.

Having said that, my feeling about chelation protocols is that I’m not a big fan of the more intense methods of chelation like DMSA because in a lot of cases people who have metal toxicity also have really compromised liver detoxification pathways.  So if you do some really heavy chelation with those patients, taking the metals out of the fat tissue where it’s stored relatively safely — I’m not saying safely in that it doesn’t have an effect when it’s stored there, but I’m saying that relatively it’s safer in the fat tissue.  That’s where the body keeps it in a way to try to insulate itself from the harmful effects of it.  And you pull it out into the blood, and then the liver is totally backed up and sluggish, and the detox capacity is impaired.  Then you’re taking a bad situation and making it worse.  And I’ve certainly seen that happen with patients who have gone through intense chelation protocols and gotten much worse.  So my approach is usually to do a more gentle protocol, and I tend to use modified citrus pectin, which is really effective, but it’s a lot more gentle than other options.  And then a modified alginate complex, which has chlorella and other algaes in it, which are good chelators but tend to be a little bit more gentle as well.  And I will also do things to support the liver, particularly phase 2 liver detoxification, so that could include silmarian and alpha lipoic acid and N-acetyl Cysteine and several other micronutrients that are beneficial for liver detox.

Clearing up the confusion about over-prescribing vitamin D

Steve Wright:  Hopefully Jennifer gets some help there.  The next question comes from Alex.  “Wondering if you’ve heard Dr. Alan Gaby’s opinion that vitamin D is being overprescribed and it may be doing more harm than good.”

Chris Kresser:  Yeah, so to me what’s interesting about this is all of the confusion or the, maybe, conflict and debate about how much vitamin D someone should take is really strange to me because it’s a simple answer.  You test for vitamin D levels, you see where they are, and then you supplement accordingly.  You don’t have to worry about should I take this, should I take that?  There is no one dose that everybody should take.  There’s a blood level that we’re trying to aim for, and that’s, in my opinion, somewhere between maybe 35 and 50, maybe a little above 50 for people with autoimmune disease.  But I would agree with that doctor in that vitamin D is often being overprescribed because what you will see is that a lot of doctors, now that they’ve become aware of vitamin D and then they see someone’s vitamin D levels are low, they’ll just prescribe 10,000 IU per day.  And then the patient leaves and they don’t come back, and they just keep taking 10,000 IU per day.  And I’ve seen a few of those patients who have been doing that for two to three years and they have toxic levels of vitamin D, they’re up in the 110 or 120 range.  And then they’re at higher risk for kidney stones and cardiovascular disease because of hypercalcemia, which can be caused by elevated vitamin D levels.

I think we’ve talked a lot about this before, but the simplest thing is you just need to aim for between 35 and maybe 55 ng/mL.  And vitamin D tests are cheap, so you just go and get a test.  You see where you are.  If you’re at maybe between 25 and 35, I would suggest starting with something like 5000 IU a day.  I always suggest that people take a food-based form of vitamin D as well, like fermented cod liver oil because it has all the cofactors and enzymes that help you digest and absorb vitamin D.  But on top of that, I think people who are low will often need additional synthetic vitamin D3, so you could do 4000 to 6000 IU per day, and then you do that for maybe six to eight weeks, and then you retest and you see where you are.  And then if you’re back up into the reference range at that point, you go down to a maintenance dose, which would be probably — and this will depend on the time of year, but if you’re getting at least 15 to 20 minutes of sun exposure in the midday hours between 10:00 and 2:00 in the summer and spring, you probably don’t need any vitamin D, assuming you’re not obese and you don’t have significant systemic inflammation, because both of those things inhibit the conversion of sunlight to vitamin D.  So in the summer you might not need any.  If you’re not gonna get sun exposure, you might need something like 2000 to 4000 IU per day.  In the winter, it might be more like 4000 IU per day as a maintenance dose, especially if you’re getting no sun exposure at all and you live in a northern latitude.  And then maybe you take another vitamin D test in the winter just to monitor and see where you’re at.  And if you do that a few times, then you’ll know what your summer/spring maintenance dose is, what your fall/winter maintenance dose is, and you won’t have to worry about this whole debate about what the optimal dose of vitamin D is because it’s really different in different people.

Steve Wright:  Yep.  Get regular testing if you’re supplementing.

Chris Kresser:  Definitely.  I have patients who can barely maintain a level in the low 30s on 10,000 IU a day every day, so they clearly have absorption problems and/or they’re obese and inflamed and they can’t convert any sunlight to vitamin D so they’re getting virtually no love from the sun!

Steve Wright:  Haha.

Chris Kresser:  And then I have patients on the other hand who are super sensitive to it who even taking 4000 IU a day their levels quickly go up into the 80s.  So it really, really does depend, and that’s the message I want to get across as much as possible with vitamin D.

Steve Wright:  Great.

Chris Kresser:  I want to say one more thing, too, about that.  I posted an article to Facebook a while back that caused some consternation, which was the Institute of Medicine report.

Steve Wright:  Oh, I saw that.

Chris Kresser:  Based on a thousand studies that they reviewed, and they are reducing the lower end of the vitamin D lab range from 30 ng/mL to 20.  And you know, a lot of people commented and said, “That’s crazy!” and, you know, “What idiots!”  And I understand because there’s been a ton of press about the importance of vitamin D and particularly the Vitamin D Council’s really pushing levels up to 60, 70, 80 ng/mL as being the most beneficial.  But I’m not so sure about that.  And actually there was an email exchange.  I sent Chris Masterjohn and Stephan Guyenet and Mat Lalonde that article, and we had a little back-and-forth on it.  And Chris Masterjohn I consider to be one of the most educated people on this subject and especially the interaction between vitamin D and the other fat-soluble vitamins, which he’s made a big contribution in understanding.  And we all pretty much agreed that the more we’ve looked into the evidence on vitamin D, the less impressed we are with the idea that any levels above, you know, 40 to 45 ng/mL are any more beneficial than levels above 30, let’s say.

And there was a study that came out a little while back, a rather large epidemiological study, which of course most of you all know now that we can’t draw conclusions from those studies, but nonetheless, this study showed that there was a U-shaped curve with mortality and vitamin D, meaning too low and mortality would go up, and if your vitamin D level is too high, mortality would go up.  But what was interesting about this study — I mean, that’s nothing new.  Most people know that, but what was interesting is that the lowest mortality rates were observed at vitamin D levels in the low 20s, like 22 to 24 ng/mL, which would currently be considered a deficiency level.  So if we want to be rigorous, we shouldn’t ignore things like that just because they don’t fit our current conception of what’s healthy and normal.  And Chris was explaining in this email exchange there are a lot of genetic — not a lot, but there are some genetic polymorphisms that can really impact vitamin D status.  And what that means is that some people with certain genetic predisposition or certain genes would likely do better with lower vitamin D levels on the scale, and then certain people with other genes would likely do better with higher vitamin D levels on the scale.

So there’s a lot more to this than meets the eye, and that’s one of the reasons I from day one have dissuaded people from getting their vitamin D levels up to 80 and 90, which was kind of recommended and popular for a while, and I’ve long recommended just a sort of what I view as moderate range of 35 to 55, somewhere around there, because I think we still have a lot to learn about vitamin D and, in particular, that there might not be an optimal range of vitamin D for everyone.  There might actually be different ranges for different people, depending on their genes and also on their health status.

Steve Wright:  That’s a very cool vitamin D update.  I appreciate that.  Do we have time for one more?

Chris Kresser:  Yeah, let’s do one more.

What to do – and not do – about cirrhosis of the liver

Steve Wright:  OK.  This comes in from a different Jennifer, and it’s a little bit long, so stay with me here.  “My grandma was recently diagnosed with cirrhosis of the liver and given a year to live.”  We’re very sorry to hear that, Jennifer.  “My family finally agrees with me that we should try some dietary changes.  I have eaten paleo for over two years, and I’m also hounding them about wheat, processed foods, etc.  I’m having an extremely difficult time finding any information on paleo and cirrhosis.  Most of my results are coming from Paul Jaminet and pork.  Our main goal is just to make her more comfortable and reduce inflammation.  Right now she needs fluids removed from her stomach every few days since her kidneys are not the best.  I guess my main concern is how to approach this.  From what I read, she needs to eliminate nuts, seeds, watch her omega-6, sugars, fruits and fructose, corn-fed meats; she says she has some grass-fed cow in the freezer; and also that she needs more saturated fats.  But truthfully, that’s a lot of these recommendations, and I’m just really wondering what to do about the fatty liver disease.”

Chris Kresser:  Yeah, so I’m not sure if she needs to go to those extremes.  I don’t know that eliminating fruit is necessary.  I’ve written and we’ve talked about the fructose issue.  I don’t agree that fructose in any amount is toxic to the liver or is harmful to the liver.  I think liquid fructose certainly in larger amounts, you know, like fruit juice in large amounts or sodas, particularly, she’d want to avoid because that can be hard on the liver.  Obviously I assume she’s not drinking alcohol, but that’s at least worth mentioning.  I don’t necessarily see why nuts would be completely out of the picture.  I think a little bit of omega-6 in whole foods is fine.  You certainly wouldn’t want to make nuts a staple, and you’d want to soak them and dehydrate or roast them first to make them more digestible because I would assume her digestion isn’t functioning that well.  She may not be able to tolerate nuts just because they’re so dense and they would be hard to digest, but from a nutritional perspective, I don’t see any reason to completely remove them from the diet.

You want to do everything you can to reduce the toxic burden, you know, exposure to skin care, hair care products, make them as natural as possible, and make sure she’s not exposed to much processed and refined food with a bunch of ingredients that you can’t pronounce.  And you might also consider some basic liver support stuff, like I mentioned some of it a couple questions back:  alpha lipoic acid, N-acetyl Cysteine, silymarin, milk thistle extract.  All of the major supplement manufacturers like Thorne and Pure Encapsulations, the ones I’ve talked about before, Designs for Health, Apex, they all have pretty good liver support products, so that’s something to consider.  And beyond that, I think a regular, standard old paleo diet is a pretty good choice in terms of antiinflammatory effect.  There are more absorbable forms of curcumin extract like the BCM-95 curcumin, and one commenter on my blog pointed out a newer water-soluble curcumin form called Theracurmin, I think, and the product that I’m aware of that contains it is made by Natural Factors, Natural Factors Theracurmin.  Curcumin is antiinflammatory and could be maybe helpful in keeping her comfortable throughout this process.  So those are a few ideas.  I hope that’s helpful in some ways.  And again, yeah, our condolences for your grandmother and this diagnosis.

Steve Wright:  Yeah, we’re sorry to hear about that.  OK, awesome, Chris.  Well, we banged through a lot of questions there.  I would say that might have been a record for us.

Chris Kresser:  Haha, I think it might have been.  You’re right.  I don’t know what it was.  I think a lot of these, they could be answered in a fairly straightforward way without going into a ton of detail.  Or maybe it was the meditation just before.  Who knows?

Steve Wright:  It could be the grounding mat plus the meditation.

Chris Kresser:  Probably is, huh?

Steve Wright:  Haha, awesome.  Well, we want to thank everyone for listening today.  Please keep sending us your questions at ChrisKresser.com using the podcast submission link.  If you’ve enjoyed listening to this show, please head over to iTunes and leave us a review.  That helps spread this information to others who might enjoy it and might learn from it.  Thanks and we’ll talk to you soon.