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Nutrition & Healing, Obstacles to Optimal Health, Macronutrient Ratios and More


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In this “Grab Bag Q&A” episode of the podcast, I discuss the role of nutrition in healing, obstacles to optimal health, macronutrient ratios and more.

Questions include:

  • Do you feel with the right nutrition the body is capable of healing itself?
  • In your practice, what do you find to be the biggest barrier stopping people from reaching their optimal health?
  • Should I eat low-carb, low-fat, or do macronutrient ratios not matter?

As part of the recent re-branding of the site from The Healthy Skeptic toward Chris Kresser, I will also be changing the name of the podcast soon. I haven’t settled on a name yet, but keep an eye out for the change.

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 owner of ChrisKresser.com, a blog challenging mainstream myths about nutrition and health.  Chris, I’m extremely embarrassed, but yesterday was the first time I’ve ever given blood.

Chris Kresser:  Congratulations!  How’s your glucose tolerance and insulin sensitivity?

Danny Roddy:  I don’t know.  After a few more times, we’ll see how it goes.  I didn’t have extremely high ferritin ever, but your conversation with Colpo was enough to get me in there to plan a few more blood draws.

Chris Kresser:  So, yeah, for those of you who didn’t follow that on the web, I’ve been doing a lot of research lately on iron overload because strangely I seem to have attracted all of the patients in the world that have this condition!  I mean, it’s crazy.  I would say just — and you know, I haven’t actually calculated, but I’d say conservatively 30% of the people that I see — and you know, everybody that I see, everyone who comes through the door I do a comprehensive blood panel on, so it’s pretty good for collecting data — I’d say 30% of people have iron overload, and this means they’re storing excess amounts of iron.  They either have elevated ferritin alone or elevated ferritin with increased serum iron, increased iron saturation, and then decreased total iron-binding capacity or unsaturated iron-binding capacity.  And it’s true that ferritin is an acute phase reactant, like C-reactive protein, so it’s a protein that’s involved in the acute phase response, the inflammatory response, so sometimes elevated ferritin can be caused by inflammation, not iron overload, and it’s really important to distinguish between the two.

But anyways, I’ve got all these patients with iron overload, so I started to really do a lot of research, and what I noticed, too, in my practice was that most of these folks were really glucose intolerant.  They really can’t tolerate much carbohydrate in their diet at all, and as soon as they start to increase their carbohydrate tolerance, they start gaining weight or they start feeling tired, have all the symptoms of insulin resistance and hyperglycemia.

So then I came across, randomly — I don’t even remember how — an article written by Anthony Colpo about how he reduced his ferritin levels because he was having glucose tolerance issues, and that completely reversed that problem.  So I corresponded with him a bit, and we traded papers back and forth, and then I dove into the literature, and it was just fascinating what I learned.  There are all kinds of papers suggesting that even with people with relatively “normal” ferritin levels, meaning in the lab reference range, you know, levels of like 150 to 200, in these studies, what they did is through phlebotomy, which is the removal of blood, they would reduce the ferritin levels into the 25 to 50 range, which is the level of a premenopausal female.  And these folks who were insulin resistant and had pretty significant glucose intolerance before that, that disappeared in the vast majority of the people when they could get their ferritin levels down that low.

Danny Roddy:  Is the mechanism just oxidative stress, or how is it causing the glucose intolerance?

Chris Kresser:  Yeah, iron is a pro-oxidant, so it does cause oxidative damage and inflammation, and it damages tissue and cells and organs and namely the pancreas and the pancreatic beta cells.  So when you have too much iron, the iron damages the beta cells of the pancreas, it compromises insulin secretion, which would in turn decrease your carbohydrate tolerance.

And there are a bunch of other mechanisms, too.  Iron overload is associated with — It’s one of those things like when you read the list of symptoms that can be caused by iron overload, it’s like, OK, well, maybe you should just make a list of symptoms that aren’t caused by iron overload.  It’d be a lot easier!  But some of the major ones and the ones that I’ve seen in my practice are hypogonadism, particularly in males, so it’s another hidden cause of low testosterone and issues with male hormone production because iron damages the pituitary and the whole hypothalamic-pituitary-adrenal axis.  And then the pituitary can’t produce FSH and LH, and then that can’t stimulate the Sertoli cells and the Leydig cells to produce sperm and testosterone, so you get male infertility.  It’s a huge cardiovascular disease risk, iron overload.  It gets deposited in the liver, so it can cause impaired liver function and even lead to hepatitis or cirrhosis.  It has pretty serious effects on brain and cognitive function and mood.  It’s significantly associated with depression, muscle and joint pain.  I mean, every tissue of the body is affected, so yeah, it’s a really big problem.

And interestingly enough, a lot of these papers that I was reading, these researchers are convinced that the difference between the heart disease risk between men and premenopausal women has nothing to do with hormone levels, and it’s actually related to iron status.  And a little background on that is that, as I’m sure a lot of you know, it used to be thought that premenopausal women had such a lower risk for heart disease there was some protective effect of estrogen.  And then we know that postmenopausal women have a more similar risk of heart disease to men, and it was thought that that’s because that protective effect of estrogen was no longer happening after menopause.  And I’m sure a lot of you remember they tested this theory out — I think it was back in the ‘90s — with the hormone-replacement therapy trials, the HRT debacle.  And the reason why it was a debacle is because they gave these menopausal women estrogen and they had to stop the trial because they were having twice the number of heart attacks instead of fewer.

So these researchers in these papers — And these are published in major peer-reviewed journals.  It’s kind of amazing that I had never heard about it before. — These researchers believed that the difference is largely due to iron status because women, of course, menstruate every month, and they lose iron.  Because the only two ways to get rid of iron when you have it in your body is through bleeding, so that could be menstruation or phlebotomy, which is the therapeutic removal of blood or donating blood like you did, Danny, or chelation, which is taking chemicals and, in some cases, some natural substances that bind to iron and remove it from the body.  So premenopausal women are menstruating every month.  They’re losing iron.  Their ferritin levels tend to stay low, and their risk of heart disease is low, whereas men, of course, don’t lose blood like that unless they’re maybe mixed martial arts fighters or something like that!

Danny Roddy:  Haha!

Chris Kresser:  But their ferritin levels just gradually tend to increase with age because they just accumulate iron, and then they end up with higher ferritin levels, and higher ferritin levels are associated with increased risk for diabetes and cardiovascular disease.  So I’m gonna write a series on it.  It’s a fascinating topic.  I will say that one thing I don’t fully understand at this point is — You know, I always try to look at things from an evolutionary perspective, and I’m pretty sure that Grok wasn’t going down to donate blood every couple of months to keep his heart healthy and avoid diabetes.  So I’m not sure why iron accumulation would be more of a problem now than it was then, especially considering the fact that, I mean, we can imagine that at least some of our ancestors were eating even more iron-rich foods like organ meats than we’re eating today.  One possibility is that there is a genetic condition called hemochromatosis, where there’s a mutation of the HFE gene, and that causes overly aggressive iron storage.  People who are homozygous for that mutation have really, really high levels of ferritin, like over 1000, and iron saturation of, like, 95%.

Danny Roddy:  And they’re feeling really good.

Chris Kresser:  Haha, yeah.  I have a few patients in my practice with hemochromatosis actually, and one of them didn’t have a typical presentation.  His ferritin levels, I think, were only 300 or 400, and that’s still actually in the lab range, so this is another example of where the lab ranges fail us, right?  Because doctors saw that, told him it was no big deal.  I saw it, thought it was a big deal!

Danny Roddy:  Haha.

Chris Kresser:  You know, we gave him the gene test, and he did, in fact, have hemochromatosis, and that’s a potentially life-threatening condition, so it’s really important to pay attention to this kind of stuff.  But anyways, this genetic condition causes iron storage.  Homozygous carriers usually become aware that they have it if they’re getting any kind of regular testing, but there are heterozygous carriers and then less common mutations of the gene that also probably cause increased iron storage but not to the degree that full-on hemochromatosis, you know, homozygous carriers have.  I’m not familiar with the genetic history of this disease.  In other words, I don’t know when hemochromatosis became a more common mutation.  I do know that now it’s one of the most common genetic conditions in the Western world.  In fact, I think it’s the most common.  Between 1 in 200 and 1 in 300 people have it, so that’s not super common, but it’s not rare either.

Danny Roddy:  I think we can blame Stop the Thyroid Madness for a ton of misinformation on this subject.  I don’t know if you remember, but that website suggested that anybody exhibiting thyroid symptoms should try to get their ferritin, like, as high as possible.

Chris Kresser:  Really?

Danny Roddy:  I remember tons of people on that forum just trying to drive up their ferritin.

Chris Kresser:  I never read that.

Danny Roddy:  And I think one of the symptoms for iron overload is hypothyroidism.

Chris Kresser:  You’ve got that right!  Because like I said, if it affects the pituitary and the hypothalamus, which it does, then it’s gonna tank the thyroid because obviously the hypothalamus and the pituitary are the upstream regulatory glands that determine, you know, send the message to the thyroid gland of how much thyroid hormone to produce.  So yeah, there’s a lot of misinformation out there on the Internet.  It’s my nemesis in a way because, you know, a lot of patients come to me with all kinds of crazy ideas, and a lot of my work is sort of trying to re-educate them.  And a lot of patients, on the other hand, are really smart and know a lot and have learned a ton from the Internet, and so it’s a mixed bag because it’s awesome that people can go and learn so much and educate themselves.  And of course, that’s how I learned a lot of what I learned, so I’m talking out of both sides of my mouth here!  But there is a danger in, you know, like you said, you read something on the Internet and you see a lot of other people doing it or following along, and you think it must be true because there are a lot of people following along, but unfortunately that’s not really a sufficient criterion to determine something’s validity.

Danny Roddy:  You mean that’s not a logical fallacy?

Chris Kresser:  I think Anatole France — I think that was his name — One of my favorite quotes is even if 50 million people say a stupid thing, it’s still a stupid thing.

Danny Roddy:  Haha!

Chris Kresser:  Words to live by!

Danny Roddy:  On that note, do you want to get to our first question, Chris?

Chris Kresser:  Yeah, let me just finish by saying before everyone runs out and starts donating blood every few weeks, it’s important to get a sense of whether your elevated ferritin is due to iron overload or because of inflammation, and also it’s important not to give blood more than every 55 or 60 days, especially if you’re active.  Do not plan a high-altitude hike on the day that you’re giving blood because you’re gonna lose a fifth — They take a pint of blood, which is a lot, so it’s a fifth of your total blood volume.  And if you’re sedentary, you might not notice it, but if you’re training or you’re active, I mean, they’re taking hemoglobin and red blood cells out.  Hemoglobin delivers oxygen to the tissues.  You need oxygen to produce ATP, which is the fundamental energy unit, energy currency of the body, so take it easy the day or two after you donate blood if you’re gonna do it.  And I really recommend working under the supervision of a qualified practitioner with this because there are a lot of moving pieces, and if it is an inflammatory condition and you’re just removing blood month after month, hoping that the ferritin is gonna go down, that’s not gonna help.

Danny Roddy:  Good advice.  Real quick, Chris, do you want to touch on your article that you published today?

Chris Kresser:  Oh, yeah, so I wrote an article today called Another reason you shouldn’t go nuts on nuts.

Danny Roddy:  Haha!

Chris Kresser:  And this is something I’ve been wanting to talk about for a while.  I think we actually have talked about it in the past.  So, one of the main principles of the paleo diet is that we avoid food toxins.  We avoid eating grains and legumes because of the food toxins they contain, and one of the primary food toxins is phytic acid, and phytic acid binds to minerals in the body and chelates them.  And we were talking before of chelation in the iron example.  Phytic acid, as it turns out, is a pretty effective iron chelator, but it also chelates other minerals like calcium.  In fact, you can see in the research that people who eat diets high in phytic acid, like grain-based cultures, have significantly increased risk of Rickets and osteoporosis.  So we know a lot about phytic acid.  We know that it removes minerals from the body, and of course, that’s why on a paleo diet we try to stay away from grains that haven’t been properly prepared, especially, and legumes.  But one of the things that’s often not talked about in the paleo world and I’ve rarely seen discussed is the fact that nuts and seeds often have as much or even more phytic acid than grains.  And you know, a lot of people when they first adopt a paleo diet are just chowing down on nuts like they’re going out of style.

Danny Roddy:  Who wouldn’t?

Chris Kresser:  They’re eating handfuls left and right because they’re a quick snack, they’re convenient, they taste good, and a lot of the things that people used to eat for travel, snacks, in that sort of capacity are now not available on the paleo diet, and so nuts become a staple food.  And I think this is especially true for people who aren’t really that motivated to cook or they’re not that familiar with food preparation.  And anyone can go to the store and get a big bag of nuts, right?  And just come home and eat them.  And they’re also small, they’re finger food.  It’s kinda easy to just sit there and eat a lot of them unconsciously, and it’s one reason why some people recommend only eating shelled nuts because you actually have to work at getting at them!

Danny Roddy:  Haha.

Chris Kresser:  So the nuts thing, I think, is a problem in the paleo community.  And I’m not suggesting that people shouldn’t eat any nuts at all because humans can tolerate some amount of phytic acid, you know, I think somewhere in the range of 150 mg to 300 or 400 mg a day in the context of a diet that is overall low in phytic acid and high in micronutrients that phytic acid tends to carry out of the body.

And there are ways that you can prepare nuts so that the phytic acid content is reduced.  And in fact, traditional cultures have been doing this for a long time.  Native Americans and Native Californians who ate acorns and acorn meal would only do it after a long period of soaking and rinsing and then pounding and cooking the acorns and leaving them out in the sun to dry.  Other Native American populations who used hickory nuts would parch the nuts until they cracked and then pound them until they were really fine and then put the nuts into boiling water and boil them for an hour or longer and then cook them down into kind of a soup.  So there was really extensive preparation going on, and they just knew that intuitively, and it’s an amazing thing about traditional cultures and traditional wisdom because just through trial and error and a lot of experimentation over thousands of generations they figured this stuff out, and now with modern science we’ve confirmed that it’s true.  It turns out that if you soak nuts for 18 hours and then you dehydrate them or dry them in a warm oven, like, as low as the temperature can go, around 150 or 170, and then you roast them, probably most of the phytic acid will be removed.  But that’s a lot of work, and I’m guessing — maybe you can back me up on this, Danny — that about probably 99.9% of people are not preparing their nuts that way.

Danny Roddy:  Haha, I would agree with you.  I think that’s a safe

Chris Kresser:  So, Elanne and I have been doing that for the last few years, like, since we discovered the Weston A. Price Foundation and got into all of this a long time ago.  And I notice a huge difference.  I used to feel kind of heavy when I ate a lot of nuts or even a moderate amount of nuts, and now that we prepare them this way, I digest them really well and don’t notice that.

So how many nuts is it safe to eat?  I would say it depends a lot on your health status and your micronutrient status.  It depends on how much omega-6 you’re eating, because that’s another issue when it comes to nuts.  It depends on your total intake of phytic acid from other foods, and it depends whether you’re soaking or dehydrating or roasting nuts before you consume them.  So in general, what I’d recommend is that for people who are healthy, a handful of soaked, dehydrated nuts, you know, a significant-size handful of soaked, dehydrated nuts a day is probably fine.  But for people who are more vulnerable populations, we could say, like people suffering from tooth decay or bone loss or mineral deficiencies, pregnant women, children who are under 6 years of age, or people with digestive issues or serious illnesses, it’s probably best to consume as little phytic acid as possible and if you do nuts, to limit them fairly significantly and make absolutely sure you’re soaking and dehydrating and roasting them before you eat them.

And then the last thing I’ll say about this is one of the issues I’ve had with the GAPS Diet, which I do use with my patients and I think is a great therapeutic approach, I have my own little caveats and tweaks to it, and one of them is that I really discourage the liberal use of nut flour, which is really emphasized in both the GAPS and the Specific Carbohydrate Diet.  You know, there are all kinds of recipes for nut flour pancakes and baked goods, and I think it’s because a lot of people who adopt these diets coming from a standard American diet find it pretty hard to live without grains and legumes and starch or any baked type of foods when they’re accustomed to eating them, and so they just go crazy with the nut flour products.  And nut flour, of course, is not soaked or prepared that way, so it would be high in phytic acid, and it’s really easy to eat a lot of nut flour, even easier than eating whole nuts.  People can take down several nut flour muffins without a second thought!  And that’s a lot of phytic acid.  Just to give you an idea, 100 grams of almonds has up to 1400 or 1500 mg of phytic acid, and I mentioned earlier the safe range is, like, 150 to 400.  And 100 grams, for Americans who are more familiar with ounces, that’s about 3-1/2 ounces.  That’s a moderate to large-size handful.  So if you’re eating several nut flour muffins or pancakes or baked goods during the day, you’re probably far exceeding the safe amount of phytic acid.  You can soak the flours for 18 hours to try to deactivate some of the phytates, but the changes the texture significantly, and a lot of people find that undesirable.

Danny Roddy:  Make it like gruel.

Chris Kresser:  Yeah, pretty much!  It’s not your gourmet baked product, that’s for sure.  And then the last thing I’ll say, the sad news is that coconut flour, which is all the rage in the paleo/GAPS community right now, also has phytic acid.  Not quite as much as almond flour, but it’s something that you’d want to use judiciously, you know, as a treat, not make it a staple part of your diet.  So there.

Danny Roddy:  Everything you ever wanted to know about nuts.

Chris Kresser:  All right.  Shall we answer some questions?

Danny Roddy:  Yeah, let’s get to a very simple, simplistic question from Dawn.

Chris Kresser:  I like those.

Do you feel with the right nutrition the body is capable of healing itself?

Danny Roddy:  She asks:  “Do you feel with the right nutrition the body is capable of healing itself?”  What do you think?  What have you seen in your practice?

Chris Kresser:  Sometimes.  Yeah, so I know people are probably getting annoyed with me for saying things like “sometimes” and “it depends” all the time.  That’s, like, my stock answer to questions.  But it’s not a cop-out.  It’s actually true.  In some cases, just shifting the diet is enough to allow the body to heal itself and to promote optimal health.  In other cases, it’s a great start and it plays a significant role in recovering health, but it’s not enough.  I think an easy way to understand this or to talk about it is using a different kind of physical problem as an example.  So let’s say you get in a car accident and you shatter your leg in several places, you know, just really, really damage it.  And you’re in physical therapy, and you get pins put in it, and thanks to the miracles of modern surgical techniques, you’re able to walk again.  But you probably wouldn’t expect to be, you know, running any marathons or breaking any records in the 100 meter dash, right?  After that kind of experience, you might expect that you’d recover some function, but you may never recover the full function that you had prior to the accident.

And I think that there’s a similar phenomenon in more functional illnesses.  When I say “functional”, I’m talking about stuff that doesn’t necessarily have a structural component, you know, like auto… Well, autoimmune disease does have a structural component, but let’s say something that’s not musculoskeletal.  So somebody, has an autoimmune disease, which is usually some combination of genetic predisposition and epigenetic environmental factor, and that gets triggered, and then they have Crohn’s disease or rheumatoid arthritis or something like that.  Absolutely, nutrition is gonna play a huge role in managing and in some cases partially reversing and maybe in some cases completely reversing that condition.  However, I think there is some damage that’s done to the body in that autoimmune attack that may not be reversible only through nutrition and, in fact, may not be reversible completely at all.

So in my practice with people dealing with those conditions, my goal, you know, we start with nutrition always, and then we see how far we get, and then we start to address the remaining issues that nutrition hasn’t been able to deal with, with things like botanical medicine or nutritional supplements with a particular therapeutic aim or lifestyle modification, which would include, you know, particular stress management techniques or particular recommendations for exercise that are appropriate for that person’s physical condition and health status.

And then I also work with people on how to shift their relationship with themselves and enjoy their lives and their bodies wherever they are in that process, because the truth is some people will never regain 100% of their health, and our relationships to ourselves and to our health are just as important, I think, in many ways as our health itself.  And this can be illustrated by the difference between people who — I mean, this is interesting.  So I have some patients who come in.  They fill out my paperwork, which has a bunch of questionnaires, like, rate how often do you experience this symptom?  Zero never, 3 being always.  And they’re all zeros on the questionnaire, and I’m looking at it, going:  Whoa.  Why is this person even coming to see me?  They’re healthier than I am!  But then I get to talking to them and I start asking them questions, and I have learned this over time.  And I say:  So, how’s your digestion?  Fine.  OK, well, do you have any gas and bloating?  Well, yeah.

Danny Roddy:  Haha!

Chris Kresser:  Is it kind of just occasional or after every time you eat?  Well, it’s kind of, you know, a little bit every time I eat.  Are you constipated?  Well, I don’t know if I’m “constipated.”  OK, well, how many bowel movements do you have a week?  Uh, usually about three.

Danny Roddy:  Haha.

Chris Kresser:  You know?  I mean, it goes like that, honestly.  And usually they’re men.  Men tend to be a little more tightfisted when talking about their health.  But actually they’re not suffering in relation to their health the way — In other words, they’re at some level of peace with their health.  And there are good things about that, and there are not-so-good things about that.

And then there’s another subtype that when I open up their paperwork, it’s all 3’s going down.  Every single category, every question is a 3.  I’m like:  Oh, my gosh!  This person is gonna die tomorrow!

Danny Roddy:  Dying in front of you.

Chris Kresser:  Yeah, and then I talk to them, and they’re actually healthier than the previous person that I was just talking about.  On an objective level, they have very few symptoms, but the symptoms they have just totally bother them.  So I think this is where how we relate to ourselves and how we relate to our bodies and the condition of our bodies is an important thing to pay attention to.

Danny Roddy:  This is interesting just because it kinda connects to the iron overload, but would you say that if somebody had the perfect nutrition and the perfect diet but they still had extreme amounts of iron, they could possibly “never” heal themselves?

Chris Kresser:  Yeah, that’s possible because, like I said earlier, the body can’t get rid of iron unless you bleed or do chelation.  So if you’ve stored up that iron for whatever reason, if it’s genetic or some other reason that we don’t fully understand yet, then absolutely because iron gets deposited in the tissues and organs and then it compromises the function of those organs, and then no matter what dietary thing you’re doing, diet alone won’t be able to deal with that.

Danny Roddy:  Totally, so working with somebody or getting blood tests or working with a competent physician if you’re dealing with some serious issues is probably a pretty good idea.

Chris Kresser:  Yeah, I think it’s pretty key.  I mean, there’s a lot that you can do on your own too, of course, but I think, getting back to that first question, a lot of people have the idea that nutrition is capable of doing everything and like it’s kind of magic.  And I’ll be the first to say that I think adequate nutrition can be magic.  I mean, probably everyone listening to this show — I know you, Danny, and I have experienced that — it’s incredible the effect that nutrition can have on healing the body, but it’s not omnipotent, you know?  It’s not all-powerful in the sense that it can deal with any problem that the world can throw at us in terms of physical health.  So it’s an excellent starting place.  In some cases, it can do everything that we need it to do.  But in other cases, other types of interventions are needed.  So that’s the summary.

In your practice, what do you find to be the biggest barrier stopping people from reaching their optimal health?

Danny Roddy:  Cool.  This question is completely related.  This one’s from Laura, and she asks:  “In your practice, what do you find to be the biggest barrier stopping people from reaching their optimal health?”

Chris Kresser:  Well, I just tweeted out an old post that I wrote called The biggest obstacle to perfect health is your mind, so that’s still my answer.  And, yeah, we referred to that in a previous question.  In my experience as a practitioner and also in my personal experience and my long journey recovering my health, what I’ve noticed is that most of us have areas in our life overall, of course, but specifically in our approach to our health, where we go blind basically.  These are areas, I think I called them “weak links in the chain” in that article.  I sometimes refer to them as “power shortages,” but they’re areas where we lack awareness, where we can’t see things clearly, where we just don’t relate to them as being an important part of health.  So an example of that would be there are tons of people out there on the Internet in the paleo world who are spending hours and hours a day on PaleoHacks and Robb Wolf’s forums and leaving comments on my site and stuff like that, and they can tell you their exact macronutrient ratio down to the percentage, you know, 38% carbohydrate, 25% protein, you know, X% fat.  They can tell you, you know, they’re like a walking NutritionData.com encyclopedia in their head.

Danny Roddy:  Haha.

Chris Kresser:  They’re just, like, they know everything about nutrition and everything about their diet, and they’re constantly making tweaks.  They’re going from this diet to that diet, or this supplement to that supplement, and they’re just wholly focused on nutrition and nutrients.  And there’s something to be said for that, I mean, and some people are just intellectually interested in it.  I know I am, and I know you probably are, Danny.  And so it’s like they just enjoy reading about it and talking about it.  But there’s a point at which, I think, it starts to become a little bit pathological.  And that point is reached when the focus on one part of health happens at the exclusion or the expense of other important aspects of health.

So I wrote this series, The 9 Steps to Perfect Health, and the first four of those nine steps deal with nutrition and nutrients, you know, macronutrients, micronutrients, and food toxins and things like that.  But the last five have really nothing to do with food and nutrients.  They’re things like managing stress, physical activity, making sure you have enough pleasure in your life, attending to your gut health.  And I think those things are, for some people, just as important as nutrition, you know, especially the ones who have already dialed into nutrition, and in other people actually more important than nutrition.  So for example, if somebody comes into my practice and they’re on a pretty good diet.  Let’s say they’re not on a full paleo diet, but they eat a pretty whole-food-based type of diet, but they’re an absolute wreck.  They’re stressed out, they’re not sleeping, they’re not having any fun in their lives.  The first thing I’ll focus on with them is not improving their diet, it’s dealing with their stress and all of the non-dietary factors because, I think, in that case that that’s actually what’s gonna produce the biggest improvement.

So I think one of the best things you can do for your health is to first identify what your power shortages — if you want to call them that — are.  And one of the easiest ways to do that is to just think about the part — If you go through my 9 Steps to Health series, pay attention to which one you just kind of ignore or you think is stupid or doesn’t apply to you or, you know, that you just discount.  Or pay attention to the one that you already know, to some extent, is an issue for you but every time you try to focus on it, some thick wall, you know, blanket surrounds your head and you just can’t focus on it and you forget about it and you move on and go back to counting macronutrient ratios.  And once you identify what that is, then that’s where I think you should really focus your attention.  And there are a lot of techniques and ways for doing that, working with challenges and obstacles.  But in general, I think, starting with really small, achievable goals that aren’t gonna overwhelm you is a good strategy.  So a lot of times people say:  Yeah, I know.  I really need to do some stress management or, you know, try meditation or try tai chi or qigong or some kind of deep breathing or relaxation.  And they go:  OK!  I’m gonna do it!  So this week I’m gonna do an hour and a half of meditation every day.  Haha.  And then they sit down on Monday to do their meditation, and after 5 minutes, they’re like:  This is hard!

Danny Roddy:  Haha!

Chris Kresser:  I can’t do this!  And so then they stop, and then they don’t do it again.  So it’s way better to say:  OK, I’m gonna do 3 minutes of meditation every day this week.  And for the vast majority of people, that’s an attainable goal.  And then they do that 3 minutes, and they notice:  Wow!  Even after 3 minutes, I feel different.  I feel a little bit more relaxed and rested.  And so maybe next week I’ll go up to 5 minutes.  And then they go up to 5 minutes.  And this kind of incremental method, I think, is the best way of making change, especially when there’s some strong, you know, some blind-spot conditioning involved.

Danny Roddy:  Good answer.  I agree.  That is definitely my weak area.

Chris Kresser:  Well, which one?

Danny Roddy:  Not stress management, but for a certain period of time I would listen to relaxation tapes and just kind of calm my mind.  And it helped so much, and I really enjoyed it.  And I think that was actually after listening to the episode with Kurt Harris.  And I don’t know why I stopped doing it, but it was amazing and I really felt great doing it, but definitely something I kind of lost sight on.

Chris Kresser:  Isn’t that weird how that happens?  We do something, it benefits us tremendously, we feel good, and then we just stop doing it.

Danny Roddy:  Haha.  Yeah, I can’t explain it.

Chris Kresser:  Maybe we’ll have a whole show about that sometime, because that’s a very interesting psychological dynamic.  And I think it’s related to pretty deep patterns and conditioning, and I think it would be useful maybe.  It’s totally veering away from the normal topic that we talk about, but I have a background in that kind of thing, and I think it might be helpful for people to discuss more about how to work with really challenging issues.  I know for myself it’s having fun.  I do a pretty good job of stress management.  I’ve been a long-time meditator, although I have to be honest, eight weeks of Sylvie in my life has sort of torpedoed that recently!

Danny Roddy:  Haha!

Chris Kresser:  But, I used to be the kind of person that would just always be doing stuff that was really fun, like going surfing or going out dancing or going on backpacking trips and things like that.  And since I’ve gotten really, really busy, it’s so hard to find time to do that.  And even things like just watching a funny movie and laughing, I think, can be so therapeutic for me, and I’m just struggling to find time to do that lately.  And I know that it’s not good for me and not good for my health, and I’m aware of it, but it’s still a challenge for me, so that’s my main one.

Danny Roddy:  Chris, I can come over and we can watch Operation Dumbo Drop together.

Chris Kresser:  All right!  Sounds good.  Just fly up.  No problem.

Danny Roddy:  Haha.

Chris Kresser:  All right, so let’s go on to the next one.

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Should I eat low-carb, low-fat, or do macronutrient ratios not matter?

Danny Roddy:  All right.  This one’s from Kstar437:  “Opinion question:  Lowish-carb, low-fat, macronutrients don’t matter, or too individualistic?”  Go.

Chris Kresser:  Yeah.  I feel like I’ve talked a lot about this on my blog, and it’s been just discussed ad nauseum on the Internet lately.

Danny Roddy:  Yeah, true.

Chris Kresser:  So I don’t want to spend too much time on it, but I’ll just give you the basic answer without a lot of elaboration.  Absolutely individualistic.  Macronutrients do matter, but the extent to which they matter depends on who you’re talking about.  I think is someone is leptin sensitive and is generally healthy, macronutrients probably don’t matter that much.  If you look at evolutionary history, we see that humans can tolerate a wide variety of macronutrient ratios.  You have the Tukisenta in Papua New Guinea; 95.5% of their calories from carbohydrate primarily in the form of starchy tubers, 95%!  So people who tell you that carbs make you fat, we would expect the Tukisenta to be morbidly obese, you know, like so fat they couldn’t even move.  But they’re actually really lean and totally free of all modern diseases.  Then you have people like the Inuit, traditional Inuit, who eat 80% to 90% of their calories from fat.  And in the conventional view, they should be dropping dead of heart disease left and right, and they should be obese, but they’re not.  So in that context, I don’t think macronutrients matter very much.  There’s a wide range of cultural variation, and there’s a wide range of individual tolerance and variation.  I have some patients who feel better on a lowish-carb diet.  I have other patients and friends like you, Danny, who feel a lot better on a higher-carb diet.  I myself feel best on a kind of moderate-carb diet, so somewhere like around probably 150 to 200 grams a day is my intake.

But it also then varies.  There are other factors.  Like in Chinese medicine, in school we were taught that not only is there no optimal, exactly similar diet for every different person, that even for one person there’s no optimal diet that would stay the same for their entire life, which I think, is a really smart concept because things like geography, where we live and the climate, seasons, what the temperature and climate is like at any given time of the year, our constitution, meaning our genetics and epigenetic factors, our health status, whether we’re healthy or dealing with a chronic illness, our goals, like are we training to be Mr. Olympia and we want to put on a ton of muscle?  Are we trying to lean out?  Our activity levels, you know, are we mostly sedentary, sitting in a chair all day or are we, you know, an ultramarathon runner?  All of those things influence what a given individual’s macronutrient intake might be at any given point in time.  And that might change over time, and it might even change over the course of a week.  Some days, if I know I’m gonna be really active or it’s a workout day, I might boost my carbohydrate intake.  Other days if I’m feeling like I’m gonna be more sedentary and I just feel like it, I might eat fewer carbohydrates.  So I’ve now totally elaborated when I said I wouldn’t, but it’s one of those questions that — I don’t know — it’s a thorn in my side because I’m really tired of people saying you should eat this exact macronutrient ratio, everybody.  I just don’t see how that makes any sense in light of what we just talked about.

Danny Roddy:  Do you think when people subscribe to a paleo diet, the idea that they have to eat what their ancestors ate, which is usually defined as a low-carb diet, do you think that hinders progress in any way?  Or do you think that they would usually deem it unacceptable to have higher carbohydrate intakes?  Do you think that in any way hinders people from hitting their health goals?

Chris Kresser:  As a totally general rule.  I mean, I don’t have a problem with somebody eating 400 grams of carbs if they’re an athlete preparing for competition, training, and all of those carbs are natural, toxin-free carbohydrates and that’s what makes them feel good and they’re metabolically healthy doing that.  I have no problem with that at all.  All of these things — I think one of the difficulties is, Danny, that when we’re writing books or articles, it’s hard not to give people a place to start from, because a lot of people don’t really have experience with self-observation and it’s just helpful to say:  Hey, this is what works for a lot of people.  Give this a shot.  But I think unfortunately that gets often interpreted as a rigid prescription that everybody has to follow and that if somebody does that and doesn’t feel good, then they just have to continue doing it even though it’s making them worse.

So getting back to your question, actually Dr. Eades tweeted a study a little while back, and we had a little back-and-forth about it because his tweet said:  Study shows that carbohydrate intake of paleo people was lower than modern intake.  And indeed, it did show that on average the intake of carbs by paleo people was lower than it is today.  But what the study also showed was that there was a huge variation in carbohydrate intake, and so I tweeted that because that was interesting to me.  And it’s interesting how, based on our particular perspective, we can use a study to show what we want it to show.  And he was showing it to say that low-carb diets are good for everybody, and I tweeted back and said:  Well, actually the range in the paper was, like, 3% to 50% for carbohydrate intake!  And then there are several quotes in the paper… Let’s see if… Oh, I can’t find it.  I had it right here on my desk.  But the quotes were like:  And by the way, for the people that had that range of carbohydrate intake, they were all equally healthy, you know, in terms of the perimeters that we were studying.  So in other words, that paper showed that macronutrient intake didn’t really matter in terms of health, although it was lower in general than carbohydrate intake today.

That paper didn’t tell us about the influence of the type of carbohydrates that people are eating today.  So we don’t know, for example, that if modern people were eating, you know, 400 grams on average or carbohydrate from sweet potatoes and fruit, would we have the disease epidemic that we have today?  In other words, is it because of the carbs or is it because of the type of carbs and the food toxins in the carbs that people are eating today?  I think it’s the latter, and I think you can make a strong argument based on evolutionary, you know, studying other modern hunter-gatherers and carbohydrate ratios like we just talked about.

I have so many things, series and things I want to write, but I’ve been reading a lot of paleoanthropology lately, and Kurt Harris turned me on to some good books, and I’ve been following Hawks’ blog.  And one of the things that I think is… Let’s see, how should I say this?  I think the understanding of paleoanthropology in the paleo diet movement is somewhat out of date, the idea that 50,000 years ago our genes were basically the same as they are today.  You know, that’s often used as an argument for why we should eat only foods that our paleo ancestors ate, that even though things have changed a lot, our genes are basically the same.  And I used that argument myself in the past, so I’m guilty.  I was wrong, and I’ve learned since a lot more about genetics and paleoanthropology, so my view has changed, because what we know, what paleoanthropologists know, is that our genes have actually changed quite a bit in the last 10,000 years.  You know, it’s true that they haven’t changed to the extent that we can thrive on a completely plant-based diet.  I mean, we didn’t evolve five different new chambers in our stomach and a rumen and enzymes that help us break down cellulose and the other food toxins in cereal grains like herbivores like cows and sheep can do.  But we have had significant genetic change, and a good example of that is lactase persistence.

The modern paleo argument against drinking milk is that humans don’t produce lactase in adulthood.  We do when we’re babies so we can digest breast milk, but as soon as we’re weaned, we stop producing lactase, and therefore we shouldn’t drink milk.  And that was actually true 10,000 years ago.  Skeletal remains show that no adult humans were lactose tolerant 10,000 years ago.  But then if you look at skeletal remains from about 6000 years ago, you see that about — and this is from people in Northern Europe, I should say — you see that about 25% to 30% of them were lactose tolerant, meaning they continued producing lactase into adulthood, and this is from skeletal remains taken from that same area in Northern Europe.  And now today lactase persistence, or the ability to digest lactose in adulthood, has reached over 95% and up to 100% in some cases in countries in Northern Europe like Norway and Denmark and Sweden and Holland.  And then, of course, the population, there’s been a lot of admixture genetically, so you’ve got people who have mixed genetic descent living all over the world, so the range of lactose tolerance is probably quite broad now, and it’s not accurate to say that just because we didn’t drink milk in paleolithic times that we can’t drink it now.  It’s, again, much more individual than that, and that’s why I’ve always said that about dairy, that it’s good to remove it for 30 days and add it back in and see how you do because there are a number of different factors, including whether you produce lactase, that would determine whether you can digest milk.

So that’s one example, but there are a lot of other examples of genetic mutations that have happened in the past 10,000 years and sometimes even in the past 3000 to 4000 years that are highly significant and affect everything from how we digest and absorb and process food to our personalities even and IQs, which is a — That’s a whole other subject!  But the point being there has been a lot of genetic change in the last 10,000 years, and we don’t have the same exact genes as our paleo ancestors.

Danny Roddy:  Melissa from Hunt.Gather.Love had an amazing presentation on this at the Ancestral Health Symposium, so if our listeners get a chance, they should definitely check that out.

Chris Kresser:  Yeah, I’d like to check it out.  I’m waiting for them to produce transcripts.  I hear that they’re gonna do that, but I just honestly do not have the time to sit there and watch a video.  I can read a transcript in one-twentieth of the time that it takes me to watch the video, so please!  Whoever is dealing with this, get the transcripts out there!

Danny Roddy:  Yeah, it was amazing.  She did an amazing job.

Chris Kresser:  Yeah.  I like her perspective a lot.

Danny Roddy:  Yeah, she’s rad.  Chris, that’s gonna bring us to the end of this week’s episode.  Where can we find more of your work on the Internet this week?

Chris Kresser:  ChrisKresser.com.  Let’s see, I’m writing the series on low T3 syndrome.  I still need to finish up the natural childbirth series.  The last article is gonna be on the risks and complications of C-section.  And let’s see, I mentioned in my last post before the nut one that we’re gonna be renaming the podcast.  And I asked for ideas, and Danny and I had an idea too, and it looks like it’s probably gonna be the Health Detective Podcast or the Health Detective Radio or something like that.  What do you think, Danny?

Danny Roddy:  I like it.

Chris Kresser:  OK, so maybe next time look out for that.  And then just wanted to throw out a quick couple of teases.  I’m working on two projects that I’m really excited about, and it’s too early to say too much, but one of them has to do with weight loss for people who haven’t been able to lose weight, you know, people who have tried the paleo diet, they’ve tried the Atkins diet, low carb, all this other stuff, and they haven’t been able to lose weight.  It’s a huge thing that comes up in my practice all the time.  I’ve been really working hard doing a lot of research to try to figure out a strategy that can work for these people, and I’ve been corresponding, you know, talking a lot with Stephan and with Kurt Harris, and we’ve all been kind of putting our heads together, and we’ve come up with something that I think will be pretty effective, and we’ve gonna be doing not a formal trial, like we proposed with Stephan a few weeks back, but just a more informal trial, I think, mostly with my patients.  And then when I’m confident that it works as well as I think it will, then we’ll bring it out into the public eye.

And then the second is a project — I mean, one of the things I see a lot is confusion about what to eat.  There are so many people that are advocating a paleo diet out there, and everyone has a slightly different take on it, including me, and a lot of my patients come to me just really confused.  They’re like:  My head is spinning.  Paul Jaminet says eat this, and you say eat that, and Robb Wolf says eat that, and I have no idea what to eat.  I’m just paralyzed.  And so I have a particular process that I use in my practice to help patients create their own ideal approach rather than just following a canned prescription, whether it’s mine or Paul’s or Robb’s or anybody else’s.  And I think that it’s been so successful that I want to make it available to a much broader audience, even people that aren’t working with me.  So that’s exciting.  I’m excited about that.  And that’s gonna be ready sometime in the next couple of months, I think.

Danny Roddy:  Please tell me there’s some kind of wheel that you spin.

Chris Kresser:  Absolutely!  You blindfold yourself, and then you throw a dart.

Danny Roddy:  Haha.

Chris Kresser:  And if it hits 50% carbohydrate, that’s what you do.

Danny Roddy:  Cool.  Awesome.  You can find all of my work at DannyRoddy.com.  Keep sending us your questions at ChrisKresser.com using the podcast submission link.  If you enjoy listening to this podcast, head over to iTunes and leave us a review.  Thanks for listening and for your support.  Take care, guys.

Chris Kresser:  Thanks, everybody!

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Join the conversation

  1. Great podcast. I am one of those that have tried every diet. An interesting one that I just found is The Three Hour Diet by Cruise. He says that if you eat more often then your body does not go into starvation mode and you lose fat.

  2. Chris,

    Great podcast… The stuff on iron blew me away. I remember reading an article in the early 90’s on the same but dismissed it at the time. Probably shouldn’t have – iron status could be a “smoking gun” in my case.

    Assuming the proper bloodwork is done to determine ferritin status, could IP6 be used alone or as an adjunct to bloodletting to reduce ferritin levels and/or keep them in the low range?

    Also, two years back my endocrinologist tested for serum iron with the express purpose of looking for iron status as it relates to endocrine function (metabolic syndrome). My test came back mid-low, but I take it this test alone may be almost worthless (figures, this guy wanted to put me on the ADA diet and statins right away too). Can you detail what I should be looking for? I’m a middle-aged male.

    If all of this will be covered in your next series, please let me know if/how I can sign-up for a newsletter or something so I don’t miss it. Otherwise if that series is planned for far off into the future please point me toward some answers so I can check all of this out in the meantime.


  3. CHRIS, great podcast as usual… I would love it if you actually did make an off-the-topic podcast about the strategies to help in fixing your shady areas, the ones we skip over bcs we don’t know how to deal with them…for me its SLEEP:-)

    Also a personal question: do you have any advice on handling Intermittent Hemolytic Anemia? The Docs at UCLA Hematology Department took my bone marrow biopsy, checked for known genetic mutations (both negative) ect but can’t figure out why is my blood going through self-destruction episodes, for now they think its not auto-immune and want to “watch” it… Meanwhile I also have secondary amenorrhea and CFS, chronically elevated cortisol levels, and have recently been given T3 pills bcs my Reverse T3 showed up three times more than the normal range.

    Chris, I would really appreciate if you could give your advice on where should I turn to next…
    Thnx for your time and effort.

  4. Danny’s comment re: stop the thyroid madness website was kind of inaccurate. I know he follows Peat and Peat likes iron and ferritin to be low. However, there are well established links between low/sub optimal iron levels and hypothyroidism. I couldn’t tolerate thyroid when my iron was low, despite my badly needing it. When I got my iron up, I was able to tolerate it.

    STTM does not suggest high ferritin levels; in fact it suggests that levels be between 70-100. Once levels go over this, people are usually told to look at inflammation.

    So who were these people aiming for higher and higher levels? What levels were they aiming for?

  5. Chris – Do plasma donations count for blood letting? Or does it have to be whole blood? If plasma works, can it really be done every few days without health consequences?

    and, while I’m at it:

    What actual BRANDS of dark chocolate bars are suitable for paleo snacking? It appears that ones like 85% Black and Green aren’t really what paleo gurus are recommending. But what is?

  6. Great stuff. I was stupid and thought I needed to supplement with iron once upon a time. Paying for it since, but better since I have started to donate blood. Tomorrow is trip number 3. I love bleeding.

  7. Thank you Chris for another informative podcast. I always appreciate the fact that you delve deeply into research and reevaluate your perspectives based on science not dogma. My questions is about iron overload and vitamin C consumption. When I ingested high doses of vitamin C (1000mg/d +), I would have increased iron levels based on blood tests. I no longer consume supplemental vitamin C and I think that has reduced my iron levels. Have you had this experience in your practice–a proplem with high iron levels and supplemental vitamin C?

      • This really caught my eye. I been supplementing with Vitamin C and HCI recently, and I’ve been having a little join pains and my weight lifting have gone to crap. Probably gonna donate some blood and see if it help, but if it doesn’t I think I gonna need some professional help. Also been paleo for over year probably jack up my iron level with all those red meat.

  8. Chris – this episode really spoke to me in that I think I have been banking on nutrition to fix all my issues. However, eating gluten and free and now full paleo, I am still really struggling with fatigue and weight issues. I keep thinking if I can just find the right combinations of things, the righting timing of nutrients then it will all be better. Looking for that magic pill I guess. 🙂 Still I know I am healthier not eating toxic foods… even if I am sleepy all the time.

  9. Last time I had a full blood count, my ferritin was low even though I’ve had amenorrhea for two years, and the doc gave me iron tablets despite normal haemoglobin. I chucked them in the bin and started eating meat- I should note, he gave me iron tablets despite the fact I came to see him suffering from chronic constipation- doh. I haven’t been retested but as I was only just beyond the low end of the lab range, I’m not very worried.
    I work in blood transfusion and we therapeutically bleed haemochromatosis patients (they’re referred by their general practitioners), as much as once every week (normal donors have to wait 14 weeks between donations in the UK).

  10. Chris, have you read the book “survival of the sickest”? Sharon Moalem discusses the advantage that hemochromatosis offers it’s carriers. I can’t remember the exact mechanism, but it had something to do with offering some protection against the bubonic plague. So with 25% of Europe being wiped out, those with the genetic mutation for hemochromatosis suddenly comprised a larger percentage of the population.

    • Hemochromatosis was advantageous in times or environments where iron-rich foods weren’t easy to come by. In certain type of hemochromatosis iron is sequestered in ferritin (storage form) and serum iron can actually be low, not high, which would be protective against an infection.

      • Wondering if maybe the mutation could have occurred in part because of diets high in phytic acid even if iron-rich foods were consumed?

  11. In the “Perfect Health Diet” the Jaminets say there is an upper limit to the consumption of carbohydrates and protein (but not fat), but this is not what you are saying though, is it?

    • Not from an anthropological perspective. The Kitava, Tukisenta, etc. all did very well on high-carb diets. I think fructose is potentially toxic at high doses (though that’s debatable if it’s primarily eaten as whole fruit, not liquid fructose), but humans do well on glucose from starch. This is highly individual, however, as I said in the podcast.

      • I am a little confused? You did endorse this book and say that you recommended it to your clients.
        Do you still support this book?

  12. How can we tell if our high Ferritin is due to inflammation? If not, what could be causing it?

    • You can test CRP and see if it’s high, but that’s not conclusive. If ferritin doesn’t come down after bloodletting, that’s a clue. But it would have to be considered in the overall clinical context.

  13. Chris, daddy duty can be rough for about the first 6-9 months but after that “fun” happens every day, whether planned or not. I want to share an amazing ritual that I have recently begun with my 1 yo daughter: about 15 minutes before dawn I put her into a carrier (we have a Becco) and go for a 20-25 minute walk. This has brought us closer; I feel like I’ve been promoted from “that guy” to Rock Star Daddy.

  14. Correct me if I’m wrong, but when donating blood they take about 1 pint. This wouldn’t be 1/5 of what we have – there are 5 liters of blood in the body. I think there is about 10.5 pints of blood in the body.

    • Did I say 1/5th? Oops! That’s the problem with podcasts – they can’t be edited!

  15. Really enjoyed this podcast. You give such a balanced and reasoned approach and I always learn something useful. Thanks for all you do.