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Low Cholesterol Is Associated with Higher Risk of Death in Women


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In this episode we discuss the following topics:

  • A recent study demonstrating that low cholesterol is associated with higher risk of death in women
  • What truly normal blood sugar levels during pregnancy are, and cut-offs for pre-diabetic and diabetic women during pregnancy
  • Whether there’s any science behind breaking weight loss plateaus by adding carbs back in the diet
  • Best practices for people with Hashimoto’s
  • Why there has been such an explosion in food sensitivities, celiac disease and leaky gut
  • The connection between diet and body odor
  • Recommendations for moderate to severe ulcerative colitis

Please note that in the next few weeks, the name of the show will be changing. It will be called “Revolution Health Radio”, with Chris Kresser. There’s nothing you need to do. You’ll just notice that the graphic and show name are different at some point.

Full Text Transcript

Danny Roddy: Hello, everyone, and welcome to the Healthy Skeptic podcast. My name is Danny Roddy of dannyroddy.com and with me is Chris Kresser, health detective and creator of chriskresser.com. Chris, how are you doing, buddy?

Chris Kresser: Good, Danny, how are you?

Danny: I’m doing great, man.

Chris: Yeah, I’m a little…actually; Sylvie’s been sleeping pretty well. It’s kind of she’s, let’s see, she’s 11 weeks tomorrow which is kind of unbelievable.

Danny: Amazing.

Chris: Yeah, it goes so fast. I already missed like some of the earlier weeks, you know? She’s getting so big so fast but she sleeps well. it’s just that you know, like when Elanne is nursing her or wakes up to nurse her, I’m kind of a light sleeper so I’m somewhat aware of that so I’m not sleeping that well but, you know, big surprise, right?

Danny: (Laughs). Well I can imagine having that factor on my sleep like just with work and everything else it seems like I hardly get like a good night’s sleep and then have a child factoring in, it’s pretty difficult.

Chris: Yeah, I’ve only got one. I mean, I’m trying to figure out how people have five kids, you know? My older brother has got four kids under the age of eight and you know, a start-up company and it’s just crazy, I don’t how he does it.

Danny: So she’s some kind of amphetamine or something?

Chris: Yeah, I guess so. So what’s new in your world?

Danny: Nothing much. Just researching, we’ll talk about this more at the end but just entrenched in books and sticky notes for my book though.

Chris: Oh!

Danny: It’s literally has been consuming all of my time.

Chris: Yeah. I know the feeling.

Danny: Yeah, exactly. I’m sure it’s about a tenth of as much work as the Healthy Baby Code because the amount of content in there is crazy.

Chris: Well, I’m looking forward to seeing it. Let’s talk about it a little bit in the end.

Danny: Definitely. Do you want to talk about the cholesterol studies?

Low cholesterol is associated with higher risk of death in women

Chris: Yeah. So, this show, we’re always kind of playing around with format but I just kind of do what I feel like doing. Hopefully, that works for all of you listeners. We’re going to talk about a couple of studies I came across this week that I think will be of interest to a lot of people and I’m going to kind of contextualize the first one with a mini case study, so to speak. A family friend of mine called me up this week. She’s in her mid 60s and her daughter is actually a patient of mine. You know, I put her daughter on the Paleo diet and she already was kind of on it but her mom and dad went on it too which is pretty cool because they grew up in the town that I grew up in and I don’t think there are a lot of people on the Paleo diet in this town but apparently, there’s like a Paleo revolution going on down there especially in my parents’ age group. So these are friends of my parents and she called me up, she’s in her mid 60s, recently adopted a Paleo diet and her total cholesterol and LDL cholesterol have gone up.

Danny: Oh yeah.

Chris: So this sounds familiar, right? There has been a lot of discussion about this in the blogosphere recently. And of course, she went to her doctor and she feels great, I mean, she absolutely loves the Paleo diet. She feels really good on it. A lot of her symptoms have improved I think and doesn’t feel ill in any way at all. She went to the doctor and the doctor noticed that the cholesterol went up and guess what he wants to do?

Danny: I have no idea.

Chris: He didn’t tell her to eat more saturated fat. So he wants to put her on a statin and she called me up because she was, you know, reluctant to do that and yet was still, you know, a little bit concerned about the increase in total and LDL cholesterol. So she had the full cardiovascular workup. She had scans, you know, for atherosclerosis and all of the tests were completely clear. You know, the doctors were like, according to all this, you’re completely free of heart disease but we still think you should take a statin. So ironically, in a serendipitous piece of timing, there was a study published, the day, the morning that I was going to talk to her, this study came out. It’s called, “Is The Use Of Cholesterol In Mortality Risk Algorithms In Clinical Guidelines Valid?” Ten years…

Danny: Catchy title.

Chris: Yeah, all these studies, I mean, they need a marketing department, right? Ten years of prospective data from the Norwegian HUNT2 study and it was published in the Journal of Evaluation in Clinical Practice which I don’t know that much about, but basically, what they were looking at, they were analyzing data from a 10-year prospective trial that took place in Norway and they looked at over 52,000 men and women, so a big study, aged 20 to 74 years old so a big wide age group over a period of 10 years so it was a pretty long study period. And that’s over 510,000 person years in total so pretty significant sample size. I want to read a few quotes from the study and we’re going to talk about the data and the conclusions and, you know, we’ll bring it back to the, you know, the case study. So, the first quote is, “we have shown that according to authoritative cardiovascular disease guidelines, 75% of the adult Norwegian population would be deemed at risk for cardiovascular disease and in need of clinical attention.” And what do you suppose that clinical attention would be, Danny?

Danny: Again, I have no idea.

Chris: So basically, what they are saying that according to the current guidelines for heart disease, over 75% of the adult Norwegian population would be recommended to take a statin.

Danny: Unbelievable.

Chris: Yeah.

Danny: It’s definitely something like, if I inquire on like people what they’re taking, statins are definitely the most popular besides like diabetic medication.

Chris: Well, they are I think the most popular drug category right now. They were at one point; they’re right up there with antidepressants, yeah. So that’s crazy, right? Three-quarters of adults should be on statins and that’s no coincidence, right? Every year, the drug companies keep lowering, you know, trying to lower the recommended total cholesterol and LDL cholesterol because they’re running out of patients and the only way that they can get more patients is to lower the targets so that basically at some point, everybody would be advised to be on a statin which of course is ridiculous.

So the next quote, “in particular, we challenge the widespread assumption of a linear relationship between total cholesterol levels and disease development, expressed as mortality in our analysis.” So they’re saying that in this idea that the higher your cholesterol is, the higher your risk of death from heart disease and from cardiovascular disease and from any cause, they’re challenging that which is such a relief to see in a big study.

So next quote, “in the past decades, a number of studies have found a strong and graded association between serum cholesterol and mortality from heart disease. Regarding total mortality, however, that association has not been clear. Some studies have found no association and then others have even suggested an inverse relationship.” So another translation is they’re saying, there have been a lot of studies that have found an association, not a causal relationship but a correlation between cholesterol and death from heart disease but the relationship between cholesterol and death from all causes or even death from cardiovascular disease and I’ll define the difference in a second, has not been clear and even in some cases, studies have suggested that higher cholesterol actually, you know, confers a lower risk of death from all causes.

So just in the context of what we’re going to be talking about, the difference between heart disease and cardiovascular diseases, you know. Heart disease just refers to exactly that, heart disease whereas cardiovascular disease is a broader category that includes heart disease but also includes stroke.

Okay, so let’s talk about what they actually found in this study. What they found was that for women there was an inverse linear relationship between cholesterol and all causes of death. So they used women with cholesterol of 195 mg/dL or lower as a reference point and then they looked at three different groups, women with cholesterol between 195 and 230, between 230 and 270 and between 270 and above. So, you know, any cholesterol above 200 in this country, you’re basically going to be advised to take a statin.

Danny: Danger zone.

Chris: Danger zone, yeah. 200 is the lab range, I see this, you know. I work with people all over the country so I see lab ranges from all over the country. They’re all consistent, if it’s anything above 200, you should take a statin.

Okay, so what they’ve found is that, I mean conventional wisdom would say that in each of those groups, the risk of death from heart disease and all other causes should go up, right? In a linear fashion, that’s the general idea. But guess what? In every single group, including the women who had cholesterol levels over 270, they had a lower risk of death from heart disease, from cardiovascular disease and from all other causes. So I mean this is, big bells should be going off somewhere, you know. This is huge. And of course, it will probably just be brushed under the table and you know, you won’t see a lot of news reports about it in the media. I haven’t seen any mainstream media stories about it yet. But if you look at the hazard ratios in the actual table on the study, they’re lower in every single category for women across the board.

So this is pretty big news and of course, I shared this with my family friend who I was talking to whose doctor wanted to, you know, put her on a statin and you know I sent the study for her so she could print it out and take it in and say, “why do you want to kill me, doctor?”

So, you know, if we put this in another way, women with cholesterol under 195 mg have a higher risk of death from all causes than women with cholesterol above 195 mg/dL and this was adjusted for age and smoking and blood pressure.

In men, it was similar, actually but a little more complicated. So there was an inverse linear relationship between cholesterol and death from all causes in cardiovascular disease so in other words in the same way with women, men with cholesterol under 195 mg/dL had a high risk of death from cardiovascular disease and all causes than men with cholesterol between 195 and 270 and up.

But for men with heart disease, the curve was not linear; it was U-shaped which means that men with cholesterol below 195 and above 230 had a high risk of heart disease than men with cholesterol between 195 and 230. So it appears just purely from an association, you know, correlation standpoint, that having cholesterol between 195 and 230 as a man is kind of the sweet spot for mortality only from heart disease but I don’t know about you, I’m more concerned with mortality from all causes.

Danny: Totally.

Chris: Because if I am less likely to die from heart disease but more likely to die from cancer, that doesn’t really help me out. And unfortunately, you know, a lot of these studies don’t even look at total mortality. So this was great that they did and that they reported on it. And even with the heart disease mortality, we have to keep in mind that it’s an association, it’s not a causal link. So one could assume that a guy with cholesterol of 270 following a Paleo diet and exercising regularly and managing his stress is going to have a very different heart disease risk than a sedentary person with cholesterol of 270 who is not managing stress and not taking care of himself.

Danny: It doesn’t sound like it poses, where the researchers’ proposing mechanisms or why the higher cholesterol is corrected like the antioxidant effect or anything like that?

Chris: They didn’t go into mechanisms at all but that is a good point, you know, we should talk a little bit about that. cholesterol, is I’m sure, a lot of people who are listening in this podcast already know is not just an evil nutrient which was put into our body so that it would kill us and we need to take, you know, to support the statin industry which is kind of what it, you know, what it comes off as in the mainstream views sometimes but it’s a crucial substance that plays so many important roles in the body. As you mentioned, it’s an antioxidant. It protects against oxidative damage which is actually according to the most recent research, oxidative damage and inflammation are really the primary causes of heart disease.

And then in terms of, you know, protecting us from death from other causes, cholesterol is a precursor to all of the hormones in the body and hormones are really ruling the show, as you know, Danny.

Danny: Totally.

Chris: Cholesterol is really an important nutrient in the brain. It’s needed for production of myelin sheath which is the insulation that surrounds the nerves in the brain. If you think of the brain as a big tangle of wires, the myelin sheath is the insulation that surrounds those wires and it’s responsible for conducting nerve impulses. It’s a precursor to neurotransmitters. There are so many things that cholesterol does that’s important and that could protect us from disease. It’s also, as Paul Jaminet has pointed out, plays an important role in immune function.

So when you lower cholesterol especially below this target in the study 195 and I’ve seen other studies, you know, with where mortality risk doubles when your cholesterol drops below 160 or 150. Those are some of the potential mechanisms and this is especially true as men and women age. Because as we age, there is more oxidative damage, more of a risk of oxidative damage and more of a need to prevent neurodegeneration and protect our brain health.

So you know, it’s a big deal. It’s something that a lot of people are still, even in the Paleo community are worried about bringing their cholesterol down. I’ve talked a lot about this so we won’t spend too much time on it but high cholesterol can be a marker for other problems like poor thyroid function. You know, Chris Masterjohn and I talked about that a lot in our podcast so if you missed those, make sure to check them out. But the point here is that high cholesterol alone is not a risk factor for death from all causes for men and women and in some cases, it’s actually protective meaning lower cholesterol would increase your risk of death.

So let me read another quote from the conclusion of the study, “many individuals who would otherwise call themselves healthy struggle conscientiously to push their cholesterol under the presumed danger limit i.e. the recommended cutoff point of 195, you know, 200 mg/dL coached by health personnel, personal trainers and caring family members. Massive commercial interests are linked to drugs and other remedies marketed for this purpose. It is therefore of immediate and wide interest to find out whether our results are generalizable to other populations.”

Danny: Wow.

Chris: Pretty cool, huh?

Danny: That’s, I mean, I don’t read as many studies as you do in detail but that’s pretty like indicting or…

Chris: It’s pretty forceful.

Danny: Yeah.

Chris: Researchers tend to be, you know, they don’t make really powerful statements like that very often. They tend to be a lot more circumspect and cautious in their appraisal but that was, you know, that’s pretty clear.

So just one other thing, before we go on. Even if high cholesterol were a risk factor for women which this study clearly suggests that it’s not, you know, is taking a statin a good idea? That’s another question to ask. I’m frankly surprised that doctors are still recommending this to some extent, I guess because there have been a lot of studies and a lot of even mainstream press showing that statins don’t really benefit women. In fact, there was a really, you know, a big article on TIME magazine not too long ago that covered this.

And I think around, the last statistics I saw were around 15 million women are routinely prescribes statins which, as most of you know, carry a pretty serious risk of side effects and complications and yet there is almost no evidence. There is no evidence that I’m aware of that they reduced the risk of total mortality and there are a lot of evidence that suggest that women are even more likely than men to suffer side effects from statins.

So there are some studies that suggest statins may reduce deaths from heart disease but they don’t reduce overall mortality and as we just talked about, disease substitution is not really an acceptable outcome. If your risk of heart disease goes down but your risk of dying from cancer or some other terrible disease goes up, that’s not acceptable for most people.

So any women out there who’s listening to this show who knows, you know, other women, your mom, sister, friends, colleagues, whatever who are taking statins, you know, go use the Google machine to search for TIME magazine’s statins and women and I think that article will pop up and you can send it to them because there is really absolutely no reason for any woman to be on a statin at all in light of what we’ve just talked about.

What truly normal blood sugar levels during pregnancy are

Let’s talk a little about this other study. Like that, I was, you know, dorking out this week. This one was about normal blood sugars during pregnancy so it’s relevant you know for anyone who’s pregnant or thinking about getting pregnant who has blood sugar issues or suspect they might have blood sugar issues.

So this is a new study and they looked at the current recommendations for blood sugar targets, you know, what women should keep their blood sugar under who are diabetic or prediabetic during pregnancy. And what they found is that the targets that they had recommended were higher than they should be and the way that I figured this out is they looked at a bunch of studies, I think 12 or 13 studies that used 24-hour glucose monitoring of nondiabetic pregnant women to figure out what normal blood sugar during pregnancy is and they found that normal blood sugar in pregnancy is lower than was previously thought. And so that the targets for diabetic women should be the same, you know, they should be lower. They’re trying to get their blood sugar down to that normal level because the issue is that high blood sugar during pregnancy can cause macrosomia which is excessive birth weight and that in turn changes gene expression that negatively impacts blood sugar regulation and metabolism for the rest of the baby’s life.

So I think we talked about this before when we did the podcast on the fetal origins theory where changes that happen in the womb don’t only affect the baby right at birth but they actually can cause epigenetic changes that, you know, alter gene expression and metabolic function for the rest of the baby’s life so it’s pretty important to pay attention to.

Danny: But what were the normal ranges for like the, in actual values?

Chris: Yeah, I’m going to tell you, good question. So the actual, the normal ranges for nondiabetic women were probably lower than you would expect and one reason is that blood sugar is lower in pregnant women because they have a higher blood volume. So you know blood sugar naturally should be lower in pregnant women than non pregnant women. But anyways, the normal markers or the normal values were for fasting blood sugar, 71 mg/dL +/- 8 mg/dL so anywhere from 63 to 79 which is pretty low, right?

Danny: Yeah.

Chris: I mean, it’s lower than the normal target. One hour post meal number was 109 mg/dL +/- 13 so that would be 96 to 122 one after a meal and then 99 +/- 10 for two-hour post meal so that’s 89 to 109 two hours post meal. And for people who unaware with what post meal blood sugars are, there are several different ways of measuring blood sugar. One is fasting blood sugar that pretty much just tells you what your blood sugar was that morning. It can be affected by a lot of different things like what you ate, you know, the day before, the night before even how you slept and whether you exercised before the test or not.

Then there’s hemoglobin A1c which is essentially an average of your, a measure of your average blood sugar over the last three months. That is not very accurate because it can be affected by a lot of things most particularly red blood cell turnover rate.

And then the most accurate way of determining your risk of blood sugar complications is measuring post meal blood sugar. So they measure your blood sugar right before you eat and then an hour after you eat, two hours after you eat. You can do this at home with a glucometer which is a device that diabetics, you know, use to measure the blood sugar where you prick your finger and put a little drop of blood on there.

But they usually do it, you know, in a clinical setting, it’s the oral glucose tolerance test where you fast and then you consume like a 50 to 75 mg bolus of pure glucose and then they measure your blood sugar one hour and two hours after that and that’s how a lot of women end up getting diagnosed with gestational diabetes.

So in light of those targets for normal nondiabetic women during pregnancy, the researchers in this study suggested that pregnant women with diabetes or prediabetes should be no more than one standard deviation above the mean for those targets which means that for fasting that would be 79 mg/dL is the upper end of the limit. For one hour post meal would 122 mg/dL, two hour post meal would be 110 mg/dL.

So again, these limits are lower than what were previously issued. Previously, it was thought 140 mg/dL at one hour and 120 at two hours and those are still the limits that are recommended for non pregnant women.

So if you have blood sugar issues, you’re diabetic and you’re going into pregnancy or you’re pregnant, what you can do is use a low-carb diet to try to keep your blood sugar under those targets and you can use a glucometer and measure yourself, keeping in mind that glucometers are not 100% accurate. There’s usually a little bit of a sort of plus or minus margin of error of either 5 or 10 points in either range so, you know, I don’t usually recommend oral glucose tolerance test but it might be a good idea to do once to get a really accurate reading on what’s happening. But the glucometer I think you can use just to establish trends and if you’re staying well below these targets, you’ll be fine. The challenge though is not to go too low with blood sugar because that can also cause problems.

Very low carb diets are ketogenic and ketogenic diets are not a problem in non pregnant women but in pregnant women, they’re not a good idea because they say now to the baby that the baby is being born to an environment of scarcity and this actually causes epigenetic changes that predispose the baby to store excess calories once they’re born, you know, in order to protect against starvation.

So it’s an evolutionary mechanism where the baby thinks it’s being born into an environment where it’s not going to be fed so the genes get changed so that the baby stores whatever calories it does receive. But unfortunately, once those genes are switched on, the metabolic changes are lifelong.

So you don’t want to be on a ketogenic diet during pregnancy for that reason. And another issue with ketogenic diet that I’m sure you’ll appreciate, Danny, is that they tend to down regulate T4 to T3 conversion so that they may negatively impact the thyroid function of the baby.

So it is best to find the middle ground, you know, where you keep carbohydrate intake within the range of about 50 to 100 grams to avoid ketosis and you can test to make sure you’re avoiding ketosis with the keto sticks. You can usually get them in the drug store. And then if you can’t lower your blood sugar eating that amount of carbohydrate, you know, to the point where you’re not on ketosis, it’s probably a good idea to find a practitioner whose familiar with this kind of stuff to, you know, use either natural or conventional options to lower your blood sugar.

So insulin would be one of the options on the conventional side and it’s safe during pregnancy when it’s used correctly and a lot of gynecologists use actually, know how to use insulin better than some endocrinologists that are treating diabetes because they have to really pay close attention, you know, during pregnancy to how it’s used.

And then on the natural side, you have things like Gymnema and L-carnitine and acetylcysteine. There’s an herb, a Chinese herb called fu ling or poria cocos which is a fungus that’s been shown to restore insulin sensitivity and glucose tolerance. Green tea extract and things like but definitely find some help, you know. Don’t just go out and buy all that stuff and start taking it because obviously there are some herbs that are not safe to take during pregnancy. Most herbs are not safe to take during pregnancy and a lot of nutrients and supplements aren’t either. So definitely find someone who has experience working with pregnant women.

Last thing I’ll say about that is abnormal blood sugars during pregnancy are often a sign that blood sugar was abnormal before pregnancy but it was just missed because a lot of women wonder why do I all of a sudden have diabetes now that I’m pregnant and often, it’s just the first time they’ve received that kind of testing.

So I think that’s it for that study.

Danny: Awesome.

Chris: Go on to the questions now, if we have any time for them because I’ve been going on and on.

Danny: Do you want me to skip to any of these specifically or just go down the list?

Chris: Let’s see…let’s just go down the list. We might be able to answer all of them.

Breaking weight loss plateaus by adding carbs back in the diet

Danny: This first question’s from Erin, this is a Facebook question, “is there any science behind breaking weight loss plateaus on the low-carb diets by temporarily increasing carb intake?”

Chris: I haven’t seen any studies that specifically look at that, have you?

Danny: No. I’ve seen the metabolic rate like stabilized with increasing carb intake but nothing; actually, there was one overfeeding study on carbohydrates that increases like T3 so I don’t if that would count.

Chris: Yeah, well, I’ve seen a lot of studies, well, not a lot but I’ve seen studies on, you know, metabolic function and weight loss so we can presume mechanisms like we know that a very low carb diet can reduce conversion of T4 to T3 like we just, you know, talked about in the context of the pregnancy study and then, you know, we know there are studies certainly that show that poor thyroid function contributes to weight gain or inability to lose weight.

So if we kind of piece things together, we can assume that, we can make an argument for a mechanism by which increasing carbohydrate intake could, you know, kick start the weight loss again if that person’s inability to lose weight was due to poor thyroid function in the first place.

Danny: Totally.

Chris: So that’s what I would say. I haven’t seen any studies like specifically taking people who are on a low-carb diet and then adding carbs back in and then showing that that causes weight loss, you know, I think that was the question. I haven’t seen any specific studies like that but we can make an argument for a mechanism based on that.

And I can say from my clinical practice that it’s mixed. You know, some people on a low-carb diet and they plateau and stop losing weight, I have them start adding carbs back in. They actually gain weight. But other people, when I do that, they start losing weight again and they feel better. So I think, again, this is very individual. It’s tempting to try to, you know, make a one size fits all approach but it just doesn’t work like that.

Danny: I do know after like my two years of zero carb, I switched to a pretty high-starch diet and I gained, it took me months before I actually went down a lot in weight but I was pretty tubby for a while.

Chris: Yeah and it may be that these patients that would happen if they kept going for long enough but in most cases, they weren’t, you know, willing to do that experiment so…

Best practices for people with Hashimoto’s

Danny: Cool. Good stuff. Okay, let’s get to the next question, also a Facebook question, this one’s from Winnie, “there’s so much information out there. Could you simplify it and give some simple best practices for people with Hashimoto disease.”

Chris: Okay, so Hashimoto’s for people who don’t know is an autoimmune disease that affects the thyroid and basically the body attacks the thyroid gland as if it were a foreign tissue instead of self tissue. It’s the number one cause of thyroid problems in the developed world whereas iodine deficiency is the number cause in the developing world and those two can actually go together.

The most important thing to understand with Hashimoto’s and I talk about this a lot with my patients because I have a lot of patients who have Hashimoto’s is that the root of the problem is not the thyroid. The root of the problem is the immune system gone out of whack. So it follows then that the key to successfully treating it over the long term is to balance and regulate the immune system and that’s the reason that conventional treatment often fails because they don’t address the immune dysregulation. All they do is give thyroid hormone which I think is actually appropriate in the case of Hashimoto’s but it’s only addressing the symptom, it’s not addressing the underlying cause.

And so what happens is women will get on thyroid hormone at a certain dose and over time, they’ll have to generally increase the dose or even switch to a different medication or add a medication because the immune attack is just continuing to go on and it’s destroying more and more thyroid tissue and as that thyroid tissue is destroyed, the capacity of the thyroid gland to produce hormones is destroyed.

So you get on this kind of treadmill and it just gets worse and worse over time and the body just kind of falls apart.

So my focus is to try to short circuit that process by you know, putting the brakes on the immune attack against the thyroid gland and the way to do that is there are some fundamental factors that need to be considered and then there are some more specific things.

Fundamentally, the things that contribute to proper immune function are blood sugar regulation, oxygen deliverability so that the capacity of hemoglobin to deliver oxygen to the tissues and cells, proper gut functions so treating any gut infections, restoring gut barrier integrity, proper adrenal functions about regulating the cortisol, melatonin, circadian rhythm, making sure the adrenals are producing enough cortisol or not too much cortisol. Fatty acid balance so this is the omega 6, omega 3 balance we talk about so much because when that’s out of balance, that can cause a lot of inflammation which can exacerbate the Hashimoto’s. And then liver and gallbladder function since those are the primary organs of detoxification.

So the first thing I do is focus on all of those kinds of fundamental mechanisms and make sure that they’re working well, they’re operating, they’re functioning well. And then we would move on to more specific focus which is balancing the two different sides of the immune system that tend to go out of balance in autoimmunity. I mean that’s the TH1 and TH2 side and let’s see, I don’t think I want to go on a lot of detail in this because we can get off on a big tangent.

Danny: That is a gigantic principle.

Chris: So basically, the way to think about it is your immune, this is an oversimplification but you have two sides of the immune system and one side is responsible for that first line of defense like when you get exposed to a virus or a pathogen, these cells attack it without really even knowing what it is, they just know that it shouldn’t be there.

And then the other side is responsible for antibody-mediated immune response which means like you get exposed to chicken pox when you’re young, you produce antibodies to it so that when you get exposed to it in the future, you don’t get it.

So those are the two different sides and ideally, they should be in a balance. So if you think like of a teeter totter that, you know, it should be off the ground and both sides should be balanced but what we know is that in autoimmune disease, one of those sides get depressed and the other becomes dominant. So one side of that teeter totter is sticking up in the air and the other is stuck to the ground.

Hashimoto’s in 70% of the cases is TH1 dominant and 30% of the cases is TH2 dominant. So the key is to figure which side is dominant or just to balance the TH3 cells which are the T regulatory cells that bring the TH1 and TH2 sides of the immune system back into balance. And there are a number of things to do that which we will talk about in a second. So there’s a kind of a general approach and then a more specific approach.

Now breaking that down into, you know, what people can do, I think a Paleo type of diet that’s free of food toxins which could potentially aggravate an overactive immune system is really important. I think addressing those underlying mechanisms that we talked about, the blood sugar, oxygen deliverability, gut, adrenals, fatty acid balance and liver and gallbladder is really important.

And then in terms of the specific focus, boosting T regulatory cell function that would mean optimizing vitamin D status, that would mean optimizing glutathione status because glutathione is one of the key regulators of the TH1 and TH2 sides. And then acupuncture has actually been shown to regulate the TH1 and TH2 sides of the immune system. But the single most effective thing that I know of for regulating TH1 and TH2 is low-dose naltrexone which we’ve talked about a little bit in the past. I won’t go into a lot of detail on it either because we could get off on a big tangent but essentially, low-dose naltrexone works by balancing the TH1 and TH2 sides of the immune system. That’s why it’s so effective for so many different kinds of autoimmune disease because that’s a common underlying mechanism.

And then the last thing is that you’d want to check for iodine deficiency or bromide toxicity because bromide is a toxic collagen that can bind to the iodine receptors and block the uptake and utilization of iodine. So if either of those are present that would definitely adversely affect thyroid function. And I’ve learned, you know, I wrote an article a while back about how iodine supplementation with Hashimoto’s can be really dangerous and it’s true, it can be. But I’ve since learned through further research and talking with some other people that that’s only the case when selenium is deficient.

So if you don’t have enough selenium in your diet and you have Hashimoto’s and you take iodine, it can flare up or trigger the autoimmune condition but if you have enough selenium, you know, which is the recommended amount is about 200 mcg a day from food or supplements then iodine supplementation should be safe and actually can even be beneficial especially if iodine deficiency is one of the underlying causes of the Hashimoto’s in the first place.

Danny: Are we talking like Brownstein size doses or something?

Chris: I usually don’t find those to be necessary but one thing that’s really important with iodine is you have to start at a small dose like 400 or 500 mcg and build up very slowly over time because even with adequate selenium, if you go too fast with iodine supplementation, you can, you know, either trigger like a hyperthyroid kind of symptom or you can trigger immune dysregulation.

So you can it’s good to do very slowly and I mean, I’m realizing that that may not have been a big simplification that the person who asked the question was looking for but that’s because treating autoimmune disease is not simple and that’s certainly true for Hashimoto’s. There are a lot of factors to consider. It’s, yeah, it’s not simple at all.

Danny: If Winnie is looking to get into this, she should check out your articles and then, do you remember the title of that…

Chris: Yeah, you go to chriskresser.com/thyroid and it’s all there.

Danny: And print that in there. And then Dr. Kharrazian’s book, Why Do I Still Have Thyroid Symptoms? Is really great.

Chris: That’s right. It’s a very good book. And I’ve studied with him. I’ve taken his mastering thyroid course and learned a lot through that and then I’ve just learned a lot with my patients. I mean like, I think probably 20% to 30% of my practice is Hashimoto’s patients so it’s, I just don’t know why that is but it’s just, you know, it’s something I have a lot of experience with because my wife has Hashimoto’s/Graves so I have a personal interest in it as well as a professional interest.

Why there has been such an explosion in food sensitivities, celiac disease and leaky gut

Danny: That leads perfectly into our next question. This one’s from Katie and she asks, why is there such an explosion in food sensitivity/leaky gut/celiac?

Chris: The modern lifestyle. Next question. No just kidding. Honestly, I think that’s my belief. I don’t really know why for sure and then a lot of people might have different answers but my belief is that we’re not living in a way that we’re adapted to live. And, you hear Sylvie in the background there? So basically, we are far, far away from the genetic template that we evolved with. You know, the foods that are natural for us to eat, the amount of activity that’s natural for us, our connection with the land, spending a lot of time outdoors, fresh air, fresh water, lack of exposure to significant amount of environmental toxins. I mean there’s incredible, I think, increase in stress levels. There are medications both over-the-counter and prescription and I think all of that put together has had a profound effect on the gut.

The gut, it’s interesting to think about the fact that the gut is basically one big nervous system tissue. And so in a way it’s like the canary in the coal mine. It’s often the first thing to go out of whack when our lifestyle and our diet is not optimal and it’s you know, there’s, it’s really a second nervous system, some people think of it as a second brain so it’s really likely to be affected by all this stuff and that’s why I think we’ve seen this huge explosion in gut-mediated problems.

And now we know that almost every disease, a lot of diseases are mediated by, you know, inflammatory or leaky gut especially autoimmunity. So I think that’s a key factor. I know we’ve talked about this in another podcast but some researchers actually believed that you can’t develop autoimmunity without a leaky gut which is a pretty big statement.

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The connection between diet and body odor

Danny: Awesome. This one is another Facebook question. This one’s from Hans who is a great guy.

Chris: Hans, yes.

Danny: Yeah. He asks, do you see a connection between bad body smell and certain foods. And he said, is bad body smell a sign of trouble a sign of more trouble under the hood?

Chris: I think so, yeah. I mean, I haven’t seen a lot of research on this so I’ve poked around and _____ 0:46:32.3 a little bit and I actually found a study that was arguing that red meat eaters have worse body odor than non red meat eaters. It was out of, I think, Hungry or something and I read the full text and it was a little hokey about that. I’m not sure I would rely on that but I think what comes out of our body is a reflection of what goes in. That seems like common sense to me and that would be true of sweat, stool, urine and breath.

One of the functions of the sweat glands in the armpits is to excrete toxins from the body and it’s primarily the apocrine glands in the armpits that are responsible for the odor and they excrete waste, mostly protein and lipids and you know the scientific view is the sweat does not smell inherently. It’s when it reaches the skin that the odor is produces because there is native flora and microorganisms like bacteria and fungi that are found in colonies of biofilm on the skin and those flora basically eat the sweat when it’s excreted on to the skin’s surface and as they feed on the sweat, isn’t this fascinating, as they feed on the sweat, those microorganisms produce the body odor which is a byproduct of metabolism. So it stands to reason that the composition of the sweat would affect the odor that the microorganisms produce when they eat the sweat, right? So we have kind of like a microcosm macrocosm here where the microorganisms are affected by you know what they’re eating and we’re affected therefore by what we’re eating in terms of our body odor.

I think one thing to investigate with body odor is stomach acid. I know with people who have low stomach acid and who have trouble digesting proteins especially they can putrefy in the gut and that tends to cause bad breath and body odor so that’s one thing I might investigate.

Danny: You know what, we were laughing at that study but it’s actually, it’s actually could be pretty accurate if, I mean if a lot of people have digestive issues and they’re not secreting enough stomach acid…

Chris: Yeah, I mean don’t doubt that the study itself was hokey just the way it was done but, yeah it’s true. I mean if someone has low stomach acid and they’re eating a lot of meat and they’re not digesting it well and it’s putrefying that could definitely make them stink. I don’t know, maybe we should do an experiment.

Danny: I’m going to write an apology to that statement.

Chris: So let’s see, one more question and I think we can do it.

Recommendations for moderate to severe ulcerative colitis

Danny: Well, this one’s from Janine. This one’s also from Facebook and she asks, what are you recommendations for dealing with a moderate to severe ulcerative colitis?

Chris: Okay. So ulcerative colitis is an autoimmune inflammatory bowel disease for people who don’t know this and it causes ulceration of the colon and sometimes, yeah, it’s usually the colon. Whereas Crohn disease can affect any part of the intestinal tract, you know, from the anus all the way up to the throat although it typically involves the small intestine and the large intestine.

So what I recommend for inflammatory bowel disease in general and also for ulcerative colitis is the GAPS diet. So this is a diet that removes longer chain sugar molecules like polysaccharides and disaccharides because some studies have shown that people with inflammatory bowel disorders have compromised brush border enzymes and note these are used to break down these longer chain carbohydrates and when they can’t be broken down, they stick around in the gut and become food for pathogenic organisms like bacteria or fungi and then that causes an inflammatory condition and even you know ulceration of the gut lining.

So the GAPS diet removes these disaccharides and polysaccharides and this is very similar to the Paleo diet except it goes one step further and removes starch so like starchy tubers would be out because they’re polysaccharides. And then it really emphasizes bone broth, you know, broth made from beef bones, chicken carcass or fish bones because bone broth has a lot of glycine in it and glycine is important in restoring the enterocytes in the gut barrier.

So usually people with inflammatory bowel disease who have a leaky gut and the bone broth, the glycine gelatin rich foods can help restore that gut lining. So that’s usually a good place to start especially if the diarrhea is severe and there’s an intro version of the GAPS diet where you basically just eat meat broth, meat and broth because even vegetables can promote inflammation or can worsen inflammation when the gut’s really inflamed. So you do the intro phase until the diarrhea completely or lessens significantly and then you move on to the next stage. There’s a book. You can I think go to gapsdiet.com or just search for GAPS and there are several books and resources you can take advantage of.

The next thing would be low-dose naltrexone. We talked about this earlier in the show. It’s an excellent choice for any autoimmune condition. My philosophy on medicine is whatever works and causes the least harm, 98 times out of 100 that’s not a drug but in some cases it is and I think low-dose naltrexone is one of those. It’s an extremely low dose of medication that’s very well tolerated. There are almost no known long-term complications or risks and very, very few side effects. The main one that comes up sometimes is transient insomnia when somebody starts; usually when they first start taking it but that tends to wear off over time.

Probiotics are really important for ulcerative colitis. In particular, there’s a probiotic called VSL#3 that’s been clinically studies. It’s very high dose, I think hundreds of billions of CFU and there’s an over-the-counter version and there’s a prescription version and that can be really helpful.

You want to do all of the things that I’ve talked about in the Hashimoto’s, when we talked about Hashimoto’s, optimizing all of those underlying factors like blood sugar regulation, oxygen deliverability, gut, adrenals, fatty acid, liver and gallbladder. And then you want to do the more specific things for optimizing or balancing TH1 and TH2 function like optimizing vitamin D and glutathione status and then the LDN.

And then I think anybody dealing with a gut problem, stress management is absolutely crucial and that’s for the reason that we talked about. Also is that the gut is a big nervous system tissue so stress really torpedoes the gut and that’s particularly true in inflammatory bowel disease.

Okay, we did it.

Danny: Great episode, Chris. Where can we find more of your work on the Internet this week? What are you doing?

Chris: I’m…what am I doing? Let’s see…so the Thyroid Series is still in progress. I’m a little slower with the series these days for probably obvious reasons.

Danny: Get on it, man.

Chris: I know you’re looking forward to it, Danny. I just published an article today which of course will be 10 days ago when this podcast comes out called, There’s More to Health Than Food and There’s More to Life Than Health. So it should fairly obvious what the topic is on that one. Check it out if you haven’t already. But the thing I’m most excited about is at the end of this month, Sylvie willing, I’m hoping to introduce to release a project I’ve been working for a while now and it’s called the Personal Paleo Code and it’s basically a three-step process to help you figure out your own ideal diet.

So many people come to me, so many patients and I see so many comments on blogs and so many emails I get, people are just completely confused about what to eat and there’s so much controversy and contradiction. Even in the Paleo community, you know, one person says this, another person says that and people are just paralyzed, you know in a lot of cases because everything they put in their mouth, there’s like an argument for it and against it, right?

And so there’s a process that I use in my practice with my patients for helping people determine what is ideal for them and this includes you know figuring out the optimal macronutrient ratio for them, you know, how much carbohydrate and fat and protein that works best. Whether dairy is appropriate or not for them, whether things like sourdough buckwheat and white rice work well. Then we get into specific tweaks for weight loss, specific tweaks for conditions like blood sugar problems, like Hashimoto’s and thyroid issues, for athletes, for people with migraines.

So we cover all of these things. It’s kind of like being a patient in my practice without actually being a patient but I’m even, you know I’m particularly excited about some of the tools that are going to be included. One of them is a meal plan generator. So one of the things that’s difficult for people is that you know, like let’s say you’re on a Paleo diet but you include diet but you’re not eating nightshades and you are eating white rice but not you know and you’re eating low carb. So how do you find recipes for that? I mean you basically have to just look in cookbooks and do the adapting and changing of the recipes yourself and that’s you know, that’s fine for people who know how to do and are motivated to do that but a lot of people don’t have the time or know how to do that and so we’re creating this really, it’s a web application.

So you’d go on there and you can choose whatever foods you want to exclude. So you could say exclude all dairy or you can say, you know, you can include butter and ghee but take out milk or yogurt or kefir. You can exclude, excuse me, can I get a little sip of water here? So you can exclude you know, all nightshades or just a couple of nightshades like tomatoes or potatoes or something like that and basically you can configure it however you want and then you hit a button to generate a meal plan either as one recipe or a meal plan for a day or a meal plan for a whole week.

And then a screen comes out with that meal plan and all of the recipes in the grid and then you can click on the recipe and it shows the full recipe with picture and you can print it out. it has a search function so you could go, if you have a certain, you know, you just bought some beef, you can search for beef and it will show all of the recipes that have beef and these recipes are pulled from all of the best, you know Paleo recipe sources like Nom Nom Paleo and Health Bent and Nourishing Kitchen and just some you know, really, really great recipes.

And then there’s an index of recipe by food type ingredient and I’m super excited for it and my wife is to. she’s like, “when is that meal plan generator going to be ready?” because it’s amazing to just be able to go in there and get all of that stuff just in a second to be able to like have a completely customized meal plan.

And then the other tool is a progress tracking app so I think it’s really important for people to be able track their progress when they’re implementing these changes because it can get confusing like you know, if you do an elimination diet and then you start adding things back in, it’s like, how do you keep track of how you feel and determine whether you’re getting better or worse and so we have this tool where you basically fill out a survey each week or every few days and then it graphs your progress on a graph and it tracks things like your energy, your mood, your weight, your…let’s see, what else?

My brain is a little dead this morning from sleep deprivation but you know, you can track a whole, your blood sugar, you know pretty much any symptom that you’re dealing with and then we’ll show you in a chart how you’re doing over time so I’m really excited about it, hoping to get it done by the end of this month and it’ll be in a similar format to the Healthy Baby Code where it’s all available online and yeah, I think that’s it.

Danny: Yeah, that blows my stupid book out of the water.

Chris: No, it’s totally different. I’m not covering hair at all. So why don’t you tell us about your books. I know a lot of my patients are going to be excited about it.

Danny: So I’m not sure if a lot of the listeners know but I actually got into health because of my own personal hair loss. I stopped it a few years ago, when actually I went on zero carb but I didn’t think that going zero carb was the reason that my hair stopped. So all of my attention and my energy have been focused on why or what foods cause hair loss and what hormones and inflammatory markers are involved in the process and I took a full year and I really tried to formulate and gather all my ideas on this subject and I put them into a product that I’ll be releasing called, Hair Like a Fox.

Chris: Love that title, by the way. Awesome title.

Danny: Thank you, Chris. And it should be ready probably at the end of this month maybe a little longer than that. I’m definitely excited to see what happens because in all honesty, this is kind of uncharted territory. I mean, I’ve had a lot of letters and people write when they adopt some of my ideas that positive things happen to their hair and my old book had The Healthy Hair Diet, had really good success and a lot of people that adopted those ideas had a lot of success so I think the new regimen is a lot better so, I’m excited to see what happens.

That brings us to the end of this week’s episode. Please keep sending us your questions to chriskresser.com using the podcast submission link. If you enjoyed this show, please leave us a review on iTunes. Thank you for listening, guys.

Chris: Thanks, everybody.

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Join the conversation

  1. I disagree with what you said about the ketogenic diet and pregnancy. Babies are born in ketosis. There are no healthy risks for being on a keto diet while pregnant. In fact, ketones are the preferred source of fuel for both mom and baby.

  2. Hi Chris,

    Can you help me decode my lab work? I just found out that my bad cholesterol is 61 and my good cholesterol (HDL) is 56, triglycerides are 41. This was after a fasting blood test. My ND left a voice mail stating that I need to raise my cholesterol….what do you think? I’m a 30 year old female, active and eating a low carb high fat paleo + organic dairy diet.


  3. “Why there has been such an explosion in food sensitivities, celiac disease and leaky gut” Gooogle “bt corn” It is genetically modified (GMO) to include bt toxin inside the corn. You’ll find a strong correlation there

  4. I follow German New Medicine, and have seen proof of it’s accuracy every single day, but there’s no time to go into that. Regarding cholesterol, the mainstream myth that your body produces cholesterol in an attempt to kill you is preposturous. Nature makes no mistakes. According to GNM, your body produces it in response to inflammation taking place in your body. It heals the ulceration that takes place in your veins and arteries in response to whatever is happening in your life to cause it: Bad diet, severe stress, etc. Your body will take care of itself in the manner in which it sees fit to heal itself. If high cholesterol is what your body needs in order to combat the inflammation, allow it to do it’s job and stop the obsession with lowering it! And if you know what’s causing the inflammation, do everything in your power to change your diet and/or stress to lower it.

  5. If high cholesterol is ideal for lowering risk of death, except for very high cholesterol. What diet would be best to get high cholesterol?

  6. Can you post the link to the study?

    And in the future can you post links to what you discuss so that I can share that with friends and family?

    Thanks so much,


  7. I told my vegan friends that the best way to determine if their high carb diet is causing high blood sugar spikes (they both have had major eye problems) is to test themselves with a glucometer. But I told them not to waste their time if no matter what they find out they refuse to change their diet. I mean just think about it. If you believe in something for 30-40 years and you find out that this info may not be true, I think psychologically it would be too traumatic for certain peoples psyche. A persons world can be turned upside down. I have seen people go into rages from discovering something that they held dear to them for years may be not true. And they will fight others to keep it true. When I found out at an early age that my parents lied about Santa Clause I was fearful, angry and I went screaming to my mother when my brother told me Santa only existed in our parents mind. The next thing I remember was that if I can’t trust my parents and since the whole community was involved in this elaborate story, who could I trust now. I consider that, learning how to ask questions and think for myself instead of going along with conventional beliefs. I swear I see more well educated people turning their life over to their doctor WITHOUT QUESTION.

  8. It’s quite alarming how many medical professionals do not know that total cholesterol is more like shoe size when predicting mortality risk — basically useless. And unfortunately vegan diets are becoming more widely accepted among conventional doctors and nutritionists because supposedly all nutrients can be accounted for on a vegan diet. It’s also upsetting that Whole Foods has basically become a vegetarian bookstore, canola oil food bar, and soy protein fruit smoothie bar. I wonder what percentage of Paleo fooders are former vegetarians who left that way of eating due to health reasons?

    • Jamie, thanks so much for that comment about Whole Foods. I have written to them about 4 times to take that canola crap out of the food bars. They answered back one or two times and the jist of their response was “If you don’t like the food bar, then don’t eat it”. They do cater to the vegan agenda and I guess we just have to work around it.
      Also, their grass fed meats are not always grass finished. It’s important to call the company that supplies their meat to find out if it’s grass finished. For instance, they claim their buffalo is grass fed, but when I called the company, I found that it is GRAIN finished…NOT COOL!

      I have come not to trust any health food store anymore. I have more luck at local farmer’s markets.

  9. Congratulations Lezlee! Getting a glucometer is, in my opinion, a real eye-opener about what foods are “healthy” and what foods aren’t. I went vegetarian at age 12 and vegan at 18, and this way of eating sent me into a state of insulin resistance and pre-diabetes. I’ve been eating Paleo since 2004 and now my 2 hour post-prandial blood glucose levels are typically between 80 – 90. I get about 100 carbs per day from non-starchy vegetables, fermented foods, and occasionally a small amount of nuts or seeds. And since switching to Paleo eight years ago, I got rid of chronic asthma and allergies. 🙂

    • Jamie, Thanks for the thumbs up! I used 3 different glucometers and I used two of them when I was getting my HbA1c tested because I wanted to know which one was most accurate. The Accucheck Aviva was the closest but it read higher. If I continued to use the Beyer Contour my average would of been 80. The accucheck aviva has more contact points on the strips so maybe that is why it was most accurate to lab tests.
      I have also been vegan and I ate like a starved dog. But I kept telling myself that it didn’t matter because I wasn’t eating fat or animals. I didn’t realize that my blood sugar was through the roof. I wasn’t even eating sugar. It was the whole wheat breads, whole wheat pasta, potatoes, rice and beans that were spiking my blood sugar. Back in January I tested a half cup of whole wheat pasta with a little olive oil and my blood sugar went up to 140 in an hour. I was shocked.

        • I would say for about a year, but I had been a vegetarian for years. Even before January of this year I rarely ate meat (only if someone would take me out to eat and they paid for it. LOL) I have two good friends who are strict Vegans who are shocked at what I have done. They still believe that low cholesterol is optimal. When I say low I mean under 135 total. They only read material from PETA and other journals that are against all meat eating. They do not have TV or internet. So most material they read is very old. So my goal back before January was to become a strict Vegan again. Thank goodness my brother came home in december (he’s a skinny type 2 diabetic) and announced to us all how bad carbs are. So of course not believing anything he says I decided to research, read and read and listen to podcasts on low carb, paleo interviews with medical professionals, and I bought my 3 glucomters and started to prove my brother wrong. But he was right. Since I use to work in two different hospitals and a doctors office and saw what I saw, any chance to disassemble conventional beliefs is what I look forward to. Most of my professional medical friends don’t even know what a VAP test is. Most are living back in the old days and still believe that saturated fat is dangerous and everyone needs to get ones cholesterol as low as possible. Some of them take statins.

  10. For Jane and Rebecca….. I got a glucometer and started checking all the food I eat with one and two hour post prandial. I eliminated any food that would test above 120 mg/dl. So I only eat about 30-50 grams of carbs a day. That works for me. I really can’t consider myself a true “Paleo” person as I eat some dairy. Probably more like a low carber. I really avoid foods that spike my blood sugar which in turn cause my insulin to rise. I am 59 years old and there are two family members that have diabetes and I don’t want to go there. I have been an athlete since 1998 and I have never been overweight, but I was becoming insulin resistant and my waist to hip ratio was in the high risk. I’ve been doing low carb since January 13, 2011 and have never looked back. I lost 4 inches around my waist, one inch around my hips and lost 10 lbs. My blood sugar runs between 95-110. I know which foods stimulate my appetite and I stay away from them.
    Did a VAP test 5 months into the low carbing and lipids are fantastic.