Another Q&A, folks! I hope you enjoyed Thanksgiving and had a restful long weekend.
In this episode, we cover:
2:13 What Chris ate for breakfast (including his coffee ritual)
10:10 Avoiding holiday weight gain
17:56 What to do about sugar cravings after meals
23:00 Demystifying Lyme Disease
34:39 Addressing Diverticulitis
39:46 Chris reveals a HUGE book update (breaking news)
42:11 Underweight with Hashimoto’s
46:54 Can tests really measure how healthy we are?
Links We Discuss:
- 3 tips for preventing holiday weight gain (and why it’s so important)
- Stephan Guyenet’s Weight Gain Article
- Healing Lyme Book: Stephen Harrod Buhner
- AeroPress Coffee and Espresso Maker
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 from SCDLifestyle.com, and with me is integrative medical practitioner, licensed acupuncturist, and healthy skeptic, Chris Kresser. How is it going today, Chris?
Chris Kresser: It’s going pretty well. How are you, Steve?
Steve Wright: I’m doing very well as well.
Chris Kresser: Good. A little bit of rain here in Northern California.
Steve Wright: I’m feeling pretty good about our situation in Michigan. We got about 50 degrees and a bright sunny day, so I was thinking about taking my shirt off, but it was a little too cold.
Chris Kresser: Haha, nice. So we’re gonna do another Q&A episode today and hopefully get through a bunch of questions that we have in the backlog.
Steve Wright: Yeah. Thanks, everyone, for sending in your questions. We still have them. We’re doing our best to get through them, and hopefully we’ll knock out a few today. Before we get started, Chris, I know that we need to abide by your adrenals and make sure they’re well rested, so please take a moment, a couple deep breaths. I’m gonna tell everybody about Beyond Paleo. If you’re wondering what Beyond Paleo is, it is a 13-part email series that Chris has put together, and it’s all of Chris’s best thoughts when it comes to burning fat, boosting energy, and preventing and reversing disease without drugs. This might be a good email series if you’re someone who is just starting the paleo diet, if you’re interested in optimizing your health, or if you’re dealing with a chronic illness. So with over 10,000 other people who have downloaded it, it’s an awesome email series, and I highly encourage you to check it out. If you’re interested, head over to ChrisKresser.com and look for the big red box in the middle of the page. Just go ahead and enter your name and email into that box, and you’ll be all set and Chris will be sending you those emails soon.
Chris, you doing OK?
Chris Kresser: I’m back. Here I am.
What Chris ate for breakfast (including his coffee ritual)
Steve Wright: OK, well, before we get started, this is the new obligatory question of the show. What did you have for breakfast
Chris Kresser: This will be easy today. I didn’t have any breakfast. Occasionally if I wake up and I’m just not feeling super hungry, it’ll become an intermittent fast day. I don’t ever plan it. I just base it on how I’m feeling and what’s going on in the morning. I had a bunch of stuff to do. I had to get a blog post out, and I knew we were going to be recording this program. And I just couldn’t pull it together to eat breakfast, wasn’t super hungry, and so I figured intermittent fast day. I did actually have some mostly decaf coffee, so I can explain that, and with a substantial amount of cream, so maybe that counts for breakfast. But I have an AeroPress. Some listeners might know what that is. It’s a fancy coffee-making device. Not all that fancy, actually. So what I usually do is I have whole coffee beans and I have a hand-operated burr grinder, which is a type of grinder that some coffee aficionados like to use because the way that it works, it kinda pulverizes the coffee bean and exposes more of the volatile aromatic oils, which in theory increases the body and flavor of the coffee. So I put that on a scale. I’m very exact about this because I’m really caffeine sensitive and now, as everyone knows, I’m dealing with some adrenal issues, so caffeine and adrenal issues don’t tend to mix very well. So what I do is I put 18 grams of coffee beans in the burr grinder. That’s what I use to make a cup. And I’ll measure out, like, most days it’s just 100% decaf, but on today, occasionally I’ll give myself a little, almost homeopathic dose of caffeine. So today I put, I think, 14 or 15 grams or decaf in and 3 grams of regular. So, haha, you know, you hear people talk about half caff. You know, it’s more like one-fifth caff. And I grind it all up, and then I put it in the AeroPress. And I boil the water and then I let it cool to 205 degrees, and then I pour it over the coffee. And you know, most people recommend letting it steep for three minutes, maybe a little longer, but I actually let it steep for less time, so that’s another way of reducing the caffeine content. And then I add some cream that’s been warmed up a little bit so it’s not cold. So it tastes pretty good, and that was my breakfast.
Steve Wright: Coffee-favored cream.
Chris Kresser: Pretty much.
Steve Wright: Very exactly measured coffee.
Chris Kresser: Yeah, that’s pretty much what it is. It’s almost like half cream, half coffee.
Steve Wright: And for the record, Chris, you sound like a coffee aficionado.
Chris Kresser: Haha, I’m not like some. I mean, some people go much further. But it is a ritual. I believe in ritual and the importance of ritual. And you know, whether that’s making tea. I sometimes will go to fairly elaborate lengths making loose-leaf tea, not as much lately. That coffee has kind of replaced that, this ritual. So it’s enjoyable. I actually notice a big difference in the way it tastes and the way I feel when I do it this way. And of course, the coffee beans are essential. I use Blue Bottle Coffee. People who live in the Bay Area will be familiar with that. It’s excellent quality, all fresh, local roasted, and the decaf is water-pressed, so it doesn’t have that kind of chemical feeling to it that a lot of decaf coffee has. I can tell you, however, what Sylvie had for breakfast because that’s usually my domain, is feeding her in the morning because I tend to wake up early with her and be on duty for the first part of the day. So she had some leftover shepherd’s pie, which had ground lamb with a little bit of beef liver mixed in together, some pork trotter broth, some carrots, and a topping of mashed potatoes with a little bit of cheese in there. And then she had some sauerkraut, which has, I think, surpassed cod liver oil as her favorite food lately! No, she’s probably not a normal kid in that respect, but she just gobbles down sauerkraut like there’s no tomorrow. And then I had some frozen blueberries and I thawed them out for her, and she hasn’t eaten blueberries a lot, but she loved them this morning. She knows the sign for more, and every time she’d finish, she’d just put her fingers together, “More, more, more!”
Steve Wright: Haha.
Chris Kresser: So that was her breakfast.
Steve Wright: Very cool. Well, it sounds like she’s following in your footsteps and she knows exactly what she needs to be eating to build her health.
Chris Kresser: Yeah. It’s amazing to watch. Like, when you provide good, nutrient-dense food for kids, they love it. I have some family members and friends who are always complaining. They say things to me like, “Oh, you’re so lucky that Sylvie eats those foods.” And I’m like it has nothing to do with luck. We’ve never given her other option, haha! If she’s hungry, that’s what she gets to eat. And if she hasn’t been exposed to a lot of processed and refined carbohydrates that screw with your brain chemistry and make you want to eat more of them, I think humans naturally do crave nutrient-dense, satiating foods like that. Of course, within that, everyone has different tastes and things, but it’s really about what you make available. And where I’m fortunate, for sure, is that I knew this at the beginning. It’s a lot harder when you have a kid who has been using refined, processed food and then you at some point later decide it’s time to start a nutrient-dense diet. That can be difficult to make that transition. But even then, I’m kind of more an advocate of a tougher lover approach where you just say, “This is what’s available to eat now, and when you get hungry enough, you’ll eat it.”
Steve Wright: Well, it’s too bad we don’t have Jordan on the line because he did that transition with his kids and his family, and I heard the story, anyways, was that the first 12 to 16 hours weren’t that pleasant, but after that, both of his kids just loved it and they’ve been non-stop like a train after that switch to full paleo.
Chris Kresser: Yeah. So speaking of Jordan, he gave me some pretty interesting news about the show, which I want to share with everyone. I think we’ve recently surpassed one million total downloads, which was pretty cool. I didn’t know we were even approaching that, but I’m really honored and thankful for everyone for listening. It feels like a big milestone, and I think we’re over 100,000 downloads a month as well. And I’m also grateful to you, Steve and Jordan, for making this all possible because I don’t know what I’d do without you guys.
Steve Wright: Well, thank you, Chris, and I, too, want to extend a big thanks to our listeners, to people who send in the questions, download the podcast. It keeps us going, and it keeps us fresh, and that’s why we love doing this.
Avoiding holiday weight gain
Chris Kresser: Absolutely. So we have a few questions. I know I said this would be a Q&A episode. We will get to them, but you know me; I have to ramble on a little bit for a while. I just want to at least talk briefly about an article that I published this morning. This is November 16. You guys won’t be listening to this until after Thanksgiving, so it’ll be a little dated, but still in time for Christmas and Hanukkah and other holiday celebrations. The article is called 3 tips for preventing holiday weight gain (and why it’s so important), and it was inspired by an article I read by Stephan Guyenet, who I’ve had on the show twice and who is a colleague and a friend. And he mentioned in this article — It wasn’t the main subject of the article, but it really popped out to me, and I was fascinated by it, so I decided to share the study and talk a little bit about it. In the study, researchers found that half of annual weight gain that occurs in the US happens over the holiday period. That’s obviously a sobering statistic in itself, but what makes it even more significant is that most of this weight is retained indefinitely. People will lose a little bit of what they gain in the holiday period in January, but the rest of it sticks around for the most part. And this is important because modest increases like that can add up over time. Studies show that the average American gains between 0.5 pound and 1.75 pounds a year and that among 25 to 44-year-olds the body weight measured at 10-year intervals increases by about 3.5% in men and a little over 5% in women. So what might seem kind of like an innocuous thing, like putting on a few pounds over the holidays, can really add up over time to significant weight gain.
The other thing that’s really interesting about it to me is Stephan’s speculation in his article that weight gain itself might be something that dysregulates the body fat set-point. We’ve talked about the set-point before on the show, and I’ve written about it several times. This is an evolutionary mechanism that is designed to protect our survival in a natural environment by maintaining an ideal weight. From an evolutionary perspective, if we have too much fat, we’re not gonna be able to hunt and gather food and evade predators and survive, but if we have too little fat, we couldn’t survive periods of food scarcity or extremes in climate changes, and we would starve. So the body has a really exquisite and sophisticated way of regulating body fat, and that mechanism is the body fat set-point, and that’s what makes it possible for normal-weight people to maintain virtually the same weight throughout their entire life without ever counting calories coming in or going out. It’s really amazing when you think about it. But we know now that in overweight and obesity what happens is this body fat set-point starts to creep up, and the weight that the body is defending gets higher and higher. And it’s not a weight that is optimal from an evolutionary fitness standpoint, but the body thinks it is, and the body defends that weight, which means that it becomes very difficult to lose weight because when you drop below that weight that the body is defending, a whole bunch of mechanisms kick in to bring your weight back up, because from your body’s perspective, it’s trying to help you survive. And you’re then fighting against hardwired survival mechanisms that have evolved over millions of years. And I’m sure, as a lot of people who’ve tried to lose weight can attest to, it really feels like you’re fighting against something hardwired like that.
There are a lot of potential things that can affect the set-point. It’s complex and multifactorial, but Stephan’s speculation, especially after thinking about this study, is that weight gain itself could potentially increase the body fat set-point. So just a seemingly innocent 2 or 3 pounds of weight gain over the holidays can increase the set-point so that not only is it hard to lose the weight that you’ve just gained over the holidays, that will then become the weight that your body defends. So the set-point creeps up, and if that happens repeatedly over time, then after 10 or 15 years you find yourself being 10 or 20 pounds heavier than you were before, and you find it really difficult to lose that weight.
It’s not a new study. It was actually published in 2000, but I only just became aware of it, and I’m not sure when Stephan learned about it, but I know it has affected his thinking about this, and I think then what this means is that preventing holiday weight gain is really crucial, especially if you’re already overweight or obese, because studies have shown that people that are already overweight or obese tend to gain more weight over the holidays than people that are normal weight, so they’re even more susceptible to that effect, which makes sense if you believe that weight gain is caused at least in part by a dysregulation in the neurobiological mechanisms that regulate weight. In the article, I just talked about a few different tips to keep the weight off during the holidays, and you can go to the website and check those out, but I just thought I’d mention it now in case some people missed that article.
Steve Wright: Here’s an interesting idea: What about the stress spike that happens in these next four to six weeks that also accompanies the amount of food that’s available and everything? Do you think that’s also gonna play into this whole problem?
Chris Kresser: I do. I didn’t focus on that in the article because frankly I was running out of time and the podcast was coming up, but I think stress plays a big role in that. We know that lack of sleep, which tends to be common during the holidays for various reasons, can contribute to increased appetite and increased calorie intake and increased weight gain as a result. Stress can definitely contribute to weight gain in several different ways. People tend to exercise less during the holidays because they’re busy getting everything ready and together, and at least in the US, holidays tend to be a time of increased TV watching, especially for sports fans who are sitting on their butts and watching games all day. So there are a number of factors that probably contribute. I think a lot of people spend holidays with their families and that can be stressful in itself. There’s a lot of kind of nervous and emotional overeating that happens, so I do think that meditation, stress management, spending time outdoors, taking a break from it all is a really important part of keeping weight off during the holiday time. I didn’t specifically address that in the article. I was focusing more on nutritional strategies.
Steve Wright: OK, awesome. Something I’m gonna be attacking this year for sure is the stress piece.
Chris Kresser: Yeah, good idea. So let’s jump into the questions.
What to do about sugar cravings after meals
Steve Wright: All right. Well, we have a few long ones, so listeners and Chris, bear with me on this one, but I think it really is gonna help tie into what we just talked about with the holidays coming around. This question comes from Erin, and she says: “Thanks so much for taking my question and for all the wonderful info you provide for your listeners. I’m wondering what might be the basis for the timing of my sweet cravings. I have been working toward reducing the number of sweet carbs I ingest, having completely removed refined sugars, narrowing it down to raw honey, maple syrup and fruit, dried fruit, and a little bit of dark chocolate. I regularly have intense sweet cravings just as a finish up a meal, no matter how large or small. For example, today at lunch I had a sweet potato with two to three tablespoons of coconut oil, ghee, a whole avocado, and four ounces of New York steak.” She says she is a lean, 5’5″ female with Hashimoto’s, and just as she takes the last couple bites, all she can think about is “the sweet thing that I can eat to feel satiated. Typically some chocolate or dried fruit will do the trick. What would cause these types of cravings? Could it be simply blood sugar dysregulation?”
Chris Kresser: Yeah, definitely, and blood sugar dysregulation isn’t always simple. It’s actually a fairly complex process that often involves several other influences like hypothalamic-pituitary-adrenal axis status, ovarian-adrenal-thyroid axis status, female hormones like progesterone and estrogen, and then thyroid.
I guess the first thing I would say, stepping back a little bit, is that it sounds like Erin is in a transition period where she’s moving from a less nutrient-dense diet to a more nutrient-dense diet, probably from a higher carbohydrate diet to a lower carbohydrate diet. And what I can say about that is that that transition often just takes some time. I remember when I first started a more nutrient-diet. I mean, I’ve always eaten pretty well. I was never on a standard American diet or anything even remotely close to that, but way back in the day when I was doing my more kind of vegetarian/vegan type of thing and then after that maybe just a diet that was a little bit higher in carbohydrates even after I started to eat meat, and then I switched to a paleo/primal kind of diet and I started really focusing on nutrient density including the skin, bones, plenty of glycine-rich foods like Chris Masterjohn talked about at the Weston A. Price conference, and organ meats and all of that stuff, that’s when things really changed for me, because I used to be the type of person that always had to have something sweet after a meal. That was one of my main sort of downfalls, and it didn’t have to be a lot. Like Erin, it could be some chocolate or something relatively small, not that I think it’s a bad thing to have some dark chocolate after a meal, but it’s different when you do it because you enjoy it and want to or to do it because you absolutely have to because you have this really strong craving. So for me, it just took time. After a while of being on the newer diet, I stopped having that craving at all. And now I really don’t. I could finish a meal and have no sweet craving. Sometimes, often after dinner I will have a little bit of dark chocolate, but I can take it or leave it for the most part. So that’s the first thing I would say. Just give it some time and see if it goes away.
If this has been present for weeks or months and you’ve already made these changes for a long time and I’m misinterpreting this, then I would investigate. First of all, I would try testing your blood sugar, although often with things like this, you don’t actually see any spikes in blood sugar after meals or drops in blood sugar between meals. It’s more like a subclinical problem where it doesn’t really show in the numbers. I would have adrenals tested, like a saliva hormone profile, because that can really contribute to blood sugar dysregulation, and in women, fluctuations in estrogen and progesterone can really contribute, especially if there are other symptoms present that tend to cycle with the menstrual cycle throughout the month. So those are a few ideas, and let us know how it goes, and we’ll chip in with a few more if those don’t work.
Steve Wright: Yeah, and definitely remember to try to get your recommended number of hours of sleep because I know for me, especially, if I’m low in sleep and trying to run through the day, the cravings are 10 times higher.
Chris Kresser: Yeah. There was a question about Lyme disease. I think it got stuck up there at the top. Maybe you missed it. You want to throw that in there? I have a few things to say about it. We won’t be able to cover it in detail, but I’d like to talk a little about it.
Demystifying Lyme Disease
Steve Wright: Yeah, OK. This comes from several listeners who have written in with very detailed explanations of what’s going on with their Lyme disease, and I also know a few friends that have it too, so I’m sticking this at the top of the list. Chris, what are your recommendations for those who find out that they have Lyme disease?
Chris Kresser: Yeah, wow. There are few conditions in medicine that are more controversial. It’s a real Pandora’s box, and anyone who either had Lyme themselves or suspects they may have Lyme or has friends with Lyme or has just taken a moment to read a little bit about Lyme, I’m sure, is aware of what I’m talking about. I mean, there are violent, literally, disagreements in the medical world, people coming to blows. There are doctors that have been prosecuted for malpractice in their efforts to treat Lyme. There are huge, heated debates taking place, books being written on both sides. It’s a really, really crazy situation. And unfortunately, the patients and people who have Lyme or suspect they may have Lyme are the ones that are caught in the crossfire because there’s a lot of sensationalism on both sides, and it can be really difficult for patients to kind of parse through it and figure out what is credible and trustworthy.
There are really kind of two ends of the spectrum to polarize the issue. On the one end, you have doctors who say that there’s no such thing as chronic Lyme disease, that Lyme is an acute disease. It’s associated with a bulls-eye rash. It has X, Y, Z characteristics, and it’s treatable with antibiotics and that’s the end of the story, period. That’s one end of the spectrum. Then the other end, I would say these are typically more people in the alternative medicine camp saying that everything is caused by Lyme and everybody has Lyme. And if you go in to see one of these Lyme specialists, pretty much whatever symptoms you say that you have are going to be attributed to Lyme, even if all of your blood tests are negative for Lyme, because the claim is that these tests are not reliable and so we basically have to make a diagnosis by symptoms. The problem with that, of course, is that if you look at a list of symptoms that can be associated with Lyme that are provided by some of these practitioners, it’s basically every symptom that anybody could experience!
I’ve read quite a bit about Lyme. I do not consider myself to be an expert by any stretch. This is another one of those things that’s like a lifetime practice. There are people who are devoting their entire careers to this and who have been at it for 30 years, and they stay very current with the literature on Lyme, although that’s fairly sparse in terms of the conventional peer-reviewed literature, and their whole entire practice and professional life is centered around Lyme, and that’s not me at all. However, I have read a fair amount about it. I have actually some colleagues in the Bay Area who are specialists and that I communicate with occasionally, so I feel like I’m relatively well informed about it. And as usual with polarized issues like this, I tend to come down somewhere in the middle. I think chronic Lyme does exist. I think there is ample evidence for that. There is plenty of evidence that shows that many people who contract Lyme do not have the typical bulls-eye rash presentation, and I think there’s abundant evidence that antibiotics don’t work for many people, especially if they are taken well after the initial tick bite. The efficacy of antibiotics decreases significantly the further away from the initial tick bite that you get.
The organism that causes Lyme is extremely sophisticated in its ability to evade the immune system. It can exist in several different forms in the body, depending on what’s happening, and if a patient is taking antibiotics, it can shift and morph into a different form that may not be susceptible to the effect of that particular class of antibiotics. It’s really actually if you don’t have Lyme — and even if you do, perhaps — a quite fascinating organism to study in terms of what it teaches us about evolution and the evolution of organisms like that and their ability to survive in a host. If you begin to look into this issue, you will come away — if you’re anything like me, at least — feeling kind of awestruck by just how sophisticated some of these mechanisms can be in relatively simple organisms. And after all of the reading I did, I came away with a great appreciation for the complexity and difficulty of diagnosing and treating Lyme. Diagnosis is problematic because if an organism is really expert at evading the immune system, then it’s also going to be expert at evading a lot of the tests that we know how to do.
There are conventional tests for Lyme that mostly include antibody testing. There are some specialized labs like IGeneX that do DNA and PCR analysis and more specific kinds of antibody testing. There’s a new test that just became available by, I think it’s called Advanced Laboratories. I could be getting that wrong. But that’s a Lyme culture test. Up until recently, we haven’t had the ability to culture the Lyme organism in the blood, and now this is possible. It’s a very expensive test. I think it’s about $600, and it takes about 8 to 10 weeks, but some of the Lyme specialists are now using it. And unlike a lot of the other tests that can be equivocal — Like, even if you have a positive result on some of these other tests, it doesn’t necessary indicate that you have a current Lyme infection, you know, if you test positive to antibodies. And some of the tests, like the blot test, are subject to interpretation. It’s not like a black or white thing; it’s like lots of shades of gray. The blot is kind of equivocally positive or not. But the culture test, as far as I understand it, if it’s positive, it’s positive. If it’s negative, it doesn’t necessarily mean that you don’t have Lyme, because perhaps it wasn’t present in that sample. But if it’s positive, it seems pretty unequivocally positive. I imagine the conventional folks on the other end of the spectrum — I’m not sure what their opinion of the Lyme culture test is. Just from what I know about how heated and controversial this all can be, I imagine they don’t believe in it, because if they don’t believe in chronic Lyme, then what’s the use of that test?
In terms of treatment, all I can do is really summarize here. Maybe someday we’ll do an entire show on Lyme, but as I said, it’s extremely difficult to treat Lyme, and there are some herbal protocols that some patients have found to be effective, like the Buhner protocol, Stephen Harrod Buhner, an herbalist who has focused a lot on Lyme. There’s a book that’s very well known in the Lyme community that he wrote with a lot of options for treating Lyme herbally. Of course, the more conventional, or I should say the allopathic treatment in the alternative Lyme community that’s used by a lot of Lyme MDs involves high-dose use of antibiotics for an extended period of time, and that can be either oral antibiotics or IV antibiotics, and that will often be combined with herbs and all of the other alternative treatments as well.
The difficulty for me with all of this is that when the testing is so equivocal and uncertain, it’s one thing if you — like when people, I suspect they have a gut infection or SIBO but the tests are equivocal for that, I’ll go ahead and do a therapeutic protocol partly as a way of diagnosing, but that is fairly gentle and mild. It might include some botanical antimicrobials and something like a biofilm disruptor and then maybe Lauricidin or something like that and some probiotics. If they don’t have a gut infection, that kind of protocol is not generally gonna really set them back, for the most part. But if someone suspects they have Lyme but doesn’t have Lyme and then takes extremely high-dose antibiotics for a long period of time with a bunch of other really intense antimicrobial botanicals and alternative treatments, that’s not a zero-risk thing at all. In fact, I know of many people who have done really intense Lyme treatments and become much more sick, and some people might argue that that’s the Herxheimer reaction and a die-off, and it certainly could be, but another possibility is that they never had Lyme in the first place and they just basically wiped out their gut flora, which we know doesn’t really fully recover after big doses of antibiotics like that, and they’re actually experiencing the fallout from the treatment, not from Lyme and the treatment’s effect on Lyme.
I hope I haven’t just thoroughly confused everybody, but on the other hand, if you’re not confused when it comes to Lyme, I think you’re not being honest with yourself or someone’s not being honest with you, because it is a very confusing, uncertain, and controversial issue. I really feel for people who have Lyme and who are struggling with it. It’s a really a thorny issue, and like I said, maybe in the future, we can talk a little bit more about it.
Steve Wright: Awesome. Well, thank you for that overview. I think that’s gonna help a lot of people, and if you write in and there’s demand for the full show, we will dig into it.
OK, well, let’s go to the next question, and this actually is like a double question. Both Donna and Resolute sent this question in. It says: “Very excited for your upcoming digestion book. Here’s my observation question: Whether it’s various podcasts, blogs, books and so on, when discussing this issue from causation standpoint, healing protocol and so on, I’ve not seen anything discussed about diverticulosis. Now, I do understand the cascade effect, and I take to heart all you know about gut health, but what about diverticulosis specifically? The only information I’ve been able to glean is from mainstream medicine and that’s not much, and it is confusing. For example, some say not to eat nuts and seeds. Others say it’s OK. There is little known about its causes per mainstream medicine, and I’m wondering if the gut infections you mention go beyond leaky gut to impact diverticulosis. Any insights on diverticulosis or diverticulitis would be great. Thank you.”
Chris Kresser: Yeah, that’s a good question. A couple of things here: One is that I don’t know a lot specifically about diverticulosis and diverticulitis, partly because I don’t think that there is a lot known about those conditions. I mean, generally they’re thought to be caused by increased pressure in the intestine, and there are pretty strong associations with constipation and diverticulosis and diverticulitis, but a lot of the early things that were believed about it have turned out to be false upon more rigorous investigation. One of those ideas is that diverticulosis is caused by a low-fiber diet. The most recent well-designed, better-controlled study actually found that a high-fiber diet increased diverticulosis, and I wrote an article about that a while back. The article was about fiber and gut health and the myth that insoluble fiber, at least the kind of grain fiber that is often promoted as being healthy, prevents diverticulosis. It actually contributes to it. Soluble fiber, the type that you find in starchy tubers and other resistant starches, is probably beneficial. When you separate them out, the studies mostly show that soluble fiber is beneficial mostly because it feeds the beneficial gut flora in the colon, and as I reviewed in my presentation at the Weston A. Price conference, we know that low levels of beneficial gut bacteria is one of the primary causes of constipation. So I think taking care of your gut flora is paramount with diverticulosis because that will keep the bowels regular, and keeping the bowels regular is important in avoiding it in the first place and preventing any recurrences.
Early studies did suggest that things like popcorn and nuts would make diverticulosis worse, but later trials suggested that that’s not true, so that’s somewhat equivocal. It stands to reason to me that if you have an inflamed gut, which people do, especially in diverticulitis, which is inflammation of the diverticula, which are little pouches that extrude from the intestines, then eating foods that are high in insoluble fiber, like popcorn would be and some nuts are, might be problematic. I think people just have to really use their own individual judgment and do some self-experimentation to see what works there.
But in a more general sense, I’ve always said this about gut conditions: I think there’s too much focus in conventional medicine on the name of particular gut conditions and specific diagnoses like irritable bowel syndrome or diverticulosis or inflammatory bowel disease or what have you. From my perspective, what’s most important is not the particular expression of the disease, but what the underlying causes are that contribute to these problems. And from that perspective, I think that addressing all of those underlying causes is what we should be focusing on and that even if we don’t know a lot about a specific condition like diverticulosis and diverticulitis, I think it makes sense that addressing all of the known possible underlying causes of other gut problems would probably be beneficial in this case as well. So we’re talking about ensuring adequate stomach acid production and pancreatic enzyme secretion, ensuring the health of the gut flora, treating any gut infections that are present, attending to the gut-brain axis, dealing with any small intestine bacterial overgrowth, and restoring intestinal barrier integrity. I think all of those things that we do for any other gut condition will be useful for diverticulosis.
Chris reveals a HUGE book update (breaking news)
This is also probably as good a time as any to say that I’m actually not going to be writing a book on digestive health as I originally planned to, but instead after thinking about it further and talking to some people, I’ve decided to write a more general book describing my overall approach, you know, the Beyond Paleo/Personal Paleo Code type of approach, which embraces the idea of personalization and acknowledges that we have had significant epigenetic changes since the Paleolithic Era that have changed at least in part our ability to process certain foods and looks at paleo as more of a starting place than a destination. And then later after that initial book, I would spin off some more condition-specific books on gut health, for example, skin health, cholesterol and heart disease, maybe fertility and pregnancy, breastfeeding, nutrition, thyroid, etc. It just strategically makes more sense to do that than to start with one of the condition-specific books. I know some folks will be disappointed. Rest assured that there will be a substantial section in this book on gut health. Hopefully that will solve a lot of problems for people. There will also be sections on many of the other common conditions that I would later write more detailed books about. That’s the update.
Steve Wright: OK, that was breaking news from Chris Kresser himself!
Chris Kresser: Haha.
Steve Wright: Not necessarily poking fun at this, but I admire what you’re doing there, Chris. I think what the questions we just got and what you said is so true about almost all of the issues that many of us who are getting our health back or got our health back were dealing with, and that’s “-itis,” inflammation, so laying the groundwork with a foundational book on reducing the “-itis,” the inflammation, and then going on to figuring out the specific things is something that I think a lot of people sometimes lose sight of, and so I’m excited to still read your new book.
Chris Kresser: Great. Let’s see. I’m just looking down at the list of questions here. We’ve got room for a couple more, so let’s see. How about the Hashimoto’s question there?
Underweight with Hashimoto’s
Steve Wright: OK. This question comes from Joel. He says: “Hi. I’m a 21-year-old male with Hashimoto’s. Despite having Hashimoto’s, I am very underweight and have to eat a lot of food to maintain my current weight. While many people have problems being overweight with Hashimoto’s, I actually have problems with being underweight. What’s the difference between people who are overweight with Hashimoto’s and people who are underweight?” And he also says that he has been completely paleo-type diet plus raw, fermented dairy for six months.
Chris Kresser: Well, I don’t know that there is a difference that is applicable in all cases. The most obvious is that people who are overweight with Hashimoto’s may be truly hypothyroid, meaning their T4 and T3 are low and their metabolism has slowed down and they’ve gained weight as a result. Not everyone with Hashimoto’s actually progresses to hypothyroidism. A large percentage of people who produce antibodies to the thyroid do eventually progress to hypothyroidism, but some people who produce antibodies never actually do go on to develop hypothyroidism, and I’m not sure where Joel is on that spectrum, but it’s possible that he hasn’t developed hypothyroidism and his metabolism is still fairly functional and he’s not gaining weight as a result. It’s also possible that some people with hypothyroidism don’t gain weight even though their T4 and T3 are low and their metabolism would theoretically be impaired. I have patients like that.
From a nutritional perspective, there isn’t much difference in the quality of food that you should be eating. I mean, paleo plus raw dairy, a paleo template type of diet is great, but of course, if you’re trying to maintain weight, you might consider increasing your intake of starch, for example, which can help some people to gain weight. If you’re exercising and working out, you might consider doing some post-workout carbohydrate loading, not working out in a fasted state, just kind of doing the opposite of things that people do when they’re trying to lean out on a diet like this. That’s all from a nutritional perspective that I would say about that, and then from a clinical perspective, you would still want to investigate all of the things that you want to investigate when someone is overweight with Hashimoto’s, like blood sugar regulation and hypothalamic-pituitary-adrenal axis, potential problems there, and in the case of a man who’s trying to gain weight and not able to may be looking at testosterone levels as well.
Steve Wright: Is it also maybe worthwhile checking into something with the gut? Because I have known some people who maybe haven’t had Hashimoto’s but who are underweight and they’re men trying to gain weight and they don’t seem to absorb the calories that they eat. Is there anything that someone might check into there, too?
Chris Kresser: Yeah, that’s absolutely important, especially if there are gut symptoms, but if you don’t have gut symptoms, that doesn’t mean you don’t have a gut issue. I talked about this in my presentation last weekend, but about 30% or 40% of people, for example, with intestinal permeability, leaky gut, don’t actually have gut symptoms. They have extra-intestinal manifestations like skin problems. So good point. Even if there aren’t gut symptoms, I will almost always check the gut in people with autoimmune disease because as Dr. Fasano said when he was on the program, it may not even be possible to develop autoimmune disease unless you have intestinal permeability.
Steve Wright: OK, good stuff. Do you have time for one more, Chris?
Chris Kresser: Yeah. Let’s go down to — I’m not sure how to pronounce his name, Bijarte? The Norwegian management consultant. See that one?
Steve Wright: Yep.
Chris Kresser: This one’s been around for a while, so maybe we should do it.
Can tests really measure how healthy we are?
Steve Wright: Our apologies, Bijarte, for your name and hanging onto your question. So over to his question: He’s trying to get the best people out there to provide their opinion on — and this is his idea or what he would like your opinion on, Chris: “Life and health is my main interest, and I strongly believe in the importance of identifying key drivers and how to measure these. One of the life and health topics I have studied is how to measure health from the perspective of answering the question, how healthy am I currently, and what are my disease risk levels? Unfortunately, I’ve been frustrated in my quest for identifying such key health markers. Having spoken to dozens of doctors, nutritionists, paleo and low-carb, high-fat experts and the blood work guys, my conclusion is that no one knows what the key health markers are, say, the top 10 to 15 most important ones. Chris, do you have any ideas about these?”
Chris Kresser: I think the reason nobody knows is because nobody knows. Haha! And markers are just markers. We really have to remember that lab markers don’t tell us necessarily whether someone’s healthy or not healthy. I see this a lot as a clinician. I will get a patient who comes to me who is very, very ill, and I’ll do my standard case review blood panel, and they’ll be mostly normal in all of the blood markers that I do, and yet they’re more ill than most of my patients. We can’t rely on markers exclusively to tell us whether we’re healthy or not. I think that’s just a really important thing to understand. It’s kinda that idea that the map is not the territory. It is helpful to have maps. I use a lot of markers in my practice, of course, and I think they’re important, but they don’t tell us conclusively whether someone’s healthy or not. And that’s probably in part why there’s so much disagreement about which markers to use. If we knew exactly which markers could accurately tell us how healthy someone is, everyone would be using them. Everyone would be using the same ones. But I can say what I do in my case review blood panel, for example, and then I can talk a little bit about other tests that I think are important.
With my case review blood panel, I had to strike a balance between being as thorough as possible and also being systematic and not doing too much, which can be prohibitively expensive and can also be overwhelming. So I start with a panel that includes several markers for blood sugar regulation like fasting glucose, hemoglobin A1c, fructosamine, lactate dehydrogenase, and then a comprehensive metabolic panel, which includes the aminotransferases, aka, liver enzymes, although some of these are produced elsewhere other than the liver, GGT, some of the minerals, like magnesium, and then vitamin D, a full iron panel with ferritin. I’ve spoken a lot about how important that is. Then a basic lipid panel, which as I’ve talked about before, is not necessarily the best way to predict heart disease risk, but it’s a good starting place. You can discern a lot by the ratio of total cholesterol to HDL and looking at triglycerides and then decide from there whether you’re gonna go on and do more. I’ll test B12 because I think that’s crucial, and I’ll do a CBC, which gives me some important hints on immune function. There could be a couple others I’m forgetting, but that’s the gist of it.
And from the results of that, then I will go on and do more specific testing if necessary, for example — Oh, the thyroid panel, of course. So if the thyroid panel, the basic TSH, T4, T3, T3 uptake, any of those are off, then I’ll go ahead and do more extensive thyroid testing like free T3, free T4, thyroid antibodies, reverse T3, etc. Likewise, if the iron panel is off, I might do more specific testing for iron. If blood sugar is off, I’ll have someone do post-meal blood sugar testing with a glucometer. I used to do that right at the beginning of the case review, but now I do it as a follow-up. And then there are gut tests like the stool pathogen test, the test for SIBO, and then adrenal hormone profile. There are inflammatory markers blood tests, like C-reactive protein, but that turns out to be not very accurate and there’s a lot of intraindividual variation, which means that a given individual has to get more than one test, probably two or three, to get an accurate marker because things as simple as a common cold can elevate it.
Yeah, I just think it’s pretty hard to come up with a set of markers that’s applicable to everyone that would determine health. I completely understand the intention behind that, and it may be that there is some way of doing it, but I don’t know what that is because I think we share a lot in common as humans, but we’re also quite different. And as I said at the beginning of this question, somebody who has a really serious autoimmune disease could test almost completely normal on a blood panel like the one that I just described because those markers may not be affected by the particular autoimmune disease, and in that case, you’d need to do less commonly used markers to determine that person’s health, which wouldn’t be applicable to the general population necessarily.
Steve Wright: And I think the other thing to maybe think about here is we’re kind of in our infancy. All this data is new. We’ve never before been sharing this much data, been testing this much, and people have been talking about this, so in a data-driven culture, I think part of the reason why we don’t yet have this blueprint for what everybody should be testing and tracking long term is because we’re all guinea pigs. We’re the start of it. I think it’ll probably get clearer as we go on, but I think you just illustrated very clearly, Chris, why there are not 10 to 20 tests that everyone should get done every few months or something.
Chris Kresser: Yeah. And I guess also part of what I was getting at was that — and I’m not saying this is true for the questioner, Bijarte — sorry we’re slaughtering your name — but I do see people just in my world that I inhabit, I think, overly focusing too much on tests and labs and things, and that can actually become somewhat of an addiction. And I think in some cases, those people would be better off just spending that energy and attention on living their life and doing things like stress management and increasing their activity level and enjoying life, you know, spending more time outdoors and having more fun and just focusing on enjoying life more. I think there’s something to be said for that.
Steve Wright: Great point, Chris. Well, this has been an awesome podcast. And again, thanks to all the listeners. We just hit a million total downloads, and as Chris said, we’re trending over 100,000 a month now, so we really appreciate you listening to the show.
Chris Kresser: Yes. Thank you for listening, and keep sending us your questions like Steve said so we can make sure that we’re talking about stuff that you want to hear about and it’s relevant to you.
Steve Wright: Yeah, so if you want to send us some questions, please head over to ChrisKresser.com and look for the podcast submission link. And then if you’ve enjoyed listening to this show or any of the past shows, please go over to iTunes and leave us a review. Getting our review stars up just helps us spread the message to other people like yourself who might need to hear this kind of stuff. Thanks for listening, and we’ll talk to you on the next show.