RHR: Overcoming Low Stomach Acid, Asthma, and Night Time Depression

Note: The Paleologix supplements discussed in this post are no longer available. Please click here to view the products recommended as substitutes.

Another Q&A episode!

In this episode, we cover:

1:46 What Chris ate for breakfast…
6:20 Are colonoscopies necessary?
9:40 What to do about long-term chronic constipation
15:02 Is hydroquinone dangerous for scars?
20:14 Long-term solutions for low stomach acid
25:45 How to convince friends and family Paleo will help
36:30 Overcoming dry eyes, saliva, and mucus
41:33 Dealing with chronic night time depression

Links We Discuss:

• Harsch Crock
• Paleo Diet Challenges and Solutions
• Final Amended Safety Assessment of Hydroquinone as Used in Cosmetics

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Full Text Transcript:

Steve Wright:  Hey everyone, welcome to another episode of the Revolution Health Radio Show brought to you by ChrisKresser.com.  I’m your host, Steve Wright, from SCDLifestyle.com, and with me is integrative medical practitioner, licensed acupuncturist, and healthy skeptic, Chris Kresser.  Chris, how’s it going

Chris Kresser:  It’s going pretty well, Steve.  How are you?

Steve Wright:  Man, I barely got through that.  I woke up this morning feeling awful, and so I’ve been drinking Echinacea tincture and ginger tea and elderberry and all kinds of crazy junk.  I just went to the health food store and just loaded up, just trying to beat this cold/flu

Chris Kresser:  Guess you should have gotten your flu shot, Steve.

Steve Wright:  Aww, man.

Chris Kresser:  Haha.  For those of you who are just joining us on the show, go back and listen to a couple episodes ago, and you’ll see I was joking about that.  But yeah, it is a brutal flu season this year.  At least I’m seeing that in my practice and seeing patients who normally never get sick and who are getting sick this year, so there definitely does seem to be something going on in terms of this flu season.

Steve Wright:  Yeah, I thought I was doing good, but I definitely ran my body down a little bit over the past few weeks, and I think that caught up to me.

Chris Kresser:  Yeah, that’ll do it for sure.  Well, I hope you get well, and I hope you can make it through the show without too much discomfort

What Chris Ate for Breakfast…

Steve Wright:  Yeah.  I’ll be putting the mute button on to blow my nose and get my stuff done over here.  But we haven’t done this in a while.  What did you have for breakfast?

Chris Kresser:  Right.  I forgot.  It crossed my mind last time.  We should have asked Dan and Stephan, but next time we get them on the show we will.  I did another kind of intermittent fast day.  Actually, lately I’ve been doing this thing where I’ll wake up and I have my coffee drink that I described a while back, which is coffee-flavored cream essentially, mostly decaf, water-pressed stuff.  And then I’ve been having a big meal at around 10:30 and then another big meal for dinner.  And I’ve just been really focused on writing my book and really busy with work, and just my body hasn’t really felt like I needed more food than that, and I’ve been kind of enjoying the feeling of taking in a little bit less food, just like an increased mental clarity and sharpness.  It’s working for me, so I’m doing it.  So, my bigger meal at about 10:30 this morning was leftover really nice beef stew that my wife Elanne made with kabocha squash and a lot of bone broth and tomatoes and spices, and then I had some sautéed purple kale in a little bit of this 50/50 ghee/coconut oil blend from Green Pasture that I really like to cook with, and I flavored it with a little bit of bacon grease.  And then some homemade sauerkraut that we just finished that turned out really well and I’m excited about, and a few leftover yucca fries from last night that were roasted in duck fat, and a glass of kefir.  So, a pretty good-size meal for me, and yeah, I’m feeling good now.

Steve Wright:  Good deal.  Do you have one of those German crocks to make your sauerkraut in or do you have a special way that you do it?

Chris Kresser: We do.  We have a Harsch Crock, which I really recommend for anyone who wants to make sauerkraut at home.  They’re excellent.  I mean, it’s not necessary, of course.  There are other ways of doing it, but we’ve just found that it turned out a lot better and a lot more consistent, and it’s big.  It’s like a 5-gallon crock, so when we make sauerkraut, we have it for a while afterwards, which is great.

Steve Wright:  Yeah, that has to be like six or ten heads of cabbage.

Chris Kresser:  Yeah, it’s big.  It’s a lot.  And we tend to make it kind of a blend with some grated carrot and some beets along with the sauerkraut, and it comes out really nice.  And Sylvie just absolutely loves it.  In fact, the only foods that she will just kind of a seemingly endless amount of are sauerkraut and right now lately berries, like blueberries and raspberries she just loves.  But I actually have to limit her sauerkraut intake a little bit because it is potentially goitrogenic, and I think if a baby her age is eating huge amounts of it that that could actually pose a problem for the thyroid.  I mean, she gets iodine.  She eats salmon several times a week, and I think she’s fine there, but sauerkraut — It’s kind of weird to be concerned about overconsumption of sauerkraut!  I mean, most parents have different battles, right, with food?

Steve Wright:  Yeah.

Chris Kresser:  Eating too many cookies or whatever, but it is worth considering, I think, at least.

Steve Wright:  Gotcha.  OK, well, even though I need to get more tea, I’m going to let you go get some tea, and I’m going to tell everybody about Beyond Paleo.  Beyond Paleo is Chris’ free 13-part email series that he has put together.  It’s for you if you’re interesting in optimizing your health, if you’re just new to this podcast or new to the paleo diet.  It’s really going to help you burn fat, boost energy, and prevent and reverse disease without drugs.  To sign up, go over to ChrisKresser.com and look for the big red box.

OK, Chris, so we’re doing Q&A today, right?

Chris Kresser:  That’s right.  Let’s do it

Are Colonoscopies Necessary?

Steve Wright:  OK, this first question comes from Susan.  “Hey guys, I would like to know your thoughts on colonoscopies.  Are they necessary after a certain age?  What are some reasons why you would or wouldn’t recommend them?  And do you have any guidelines for deciding if a person should have one?  It’s the last thing I want to do, but am I being negligent in my self-care by not having one done at age 46?”

Chris Kresser:  I’ve received this question a lot, and frankly I’m not entirely sure where I stand on it.  The main reason for doing these at this age is the potential for colorectal cancer, which usually is associated with symptoms but not always, so taking a look inside of the colon to make sure there are no cancerous polyps or growths might be a sensible precaution.  The downside of colonoscopies is that the full bowel washout that you do beforehand, it really has a negative or adverse effect on the gut flora, I think, and I have definitely heard stories of people who have experienced a significant decline in gut function after having a colonoscopy that didn’t really reverse within a couple of days after.  And that’s not the norm.  I mean, most people recover pretty quickly from it, but I think people who are sensitive, have sensitive guts, have dysbiosis, inflammatory bowel disease, and things like that, it’s a pretty invasive procedure and shouldn’t be done unless it’s really necessary.  In general, I’m usually of the mind that a lot of invasive screening procedures are probably not a good idea for people that are otherwise healthy, but on the other hand, like I said, there are some cases where cancer in the rectum or the colon can be asymptomatic and catching it early on is important to improving the chances that it can be successfully treated.

So, this is something I would have to look into a little bit further.  My inclination would be to say every five years or something like that might be sufficient if you’re in good health and you’re not dealing with any other obvious issues, but let me kind of take a rain check on that one and come back to it once I’ve had a chance to look into it a little more.  I mostly want to find out what the research says about the screening procedure and how much disease that prevents because I know we talked before about other kinds of screenings, like particularly with female health, that don’t necessarily improve treatment outcomes and actually lead to a lot of unnecessary treatment that can cause harm, and I just don’t know if there’s a similar phenomenon that’s happening with this.  So, let’s put this on another show, Steve, and we’ll circle back to it.

What to Do about Long-Term Chronic Constipation

Steve Wright:  Sounds good.  OK, we’ll move on to Jay’s question.  “I’m a 40-year-old male who started eating paleo a couple years ago.  I lost 50 pounds, brought all my labs within normal limits, and got in great shape.  However, I’m dealing with what I always believed were prostate issues:  urgency, frequent urination, dribbling, etc., since my early 20s.  I finally saw a urologist within the last month, and he surprisingly reported that my prostate is fine and the problem is with my bladder, which has underdeveloped muscle tone/reflexes from chronic constipation.  This made sense to me since I’ve had severe constipation issues in grade school and just adapted to it over the years and didn’t consider it an issue.  Now I’m concerned that I’m destroying or already have destroyed my colon and bladder.  Switching to a paleo diet has had no impact on my bowel habits.  I respect your opinions and would appreciate any thoughts or suggestions you might have.”

Chris Kresser:  Well, this is a really good example of where the paleo diet isn’t necessarily magic where it solves all problems, although it sure sounds like it solved most of Jay’s problems.  But I just finished writing a series called Paleo Diet Challenges and Solutions.  It’s a five-part series, and you should definitely check it out if you’re interested and you haven’t seen it already.  And one of the articles was about digestive issues that persist even after you’ve been on a paleo diet for a while.  And I think a lot of that is probably relevant here, so definitely check that out, Jay, if you haven’t yet.  But the things I would be looking for if you came to see me as a patient in the clinic would be any gut conditions that could contribute to constipation that aren’t necessarily directly related to diet.  So, I’m thinking of a potential parasite; small bowel bacterial overgrowth; overgrowth of opportunistic bacteria in the gut; leaky gut or intestinal permeability, which is usually related to some of the things that I just mentioned; inflammatory bowel disease, you know, like an autoimmune problem; dysbiosis and overgrowth of unhealthy bacteria and not enough good bacteria.  And in fact, long-term chronic constipation is almost always related to some kind of dysbiosis and usually related specifically to a lack of bifidobacter, which is a species of bacteria in the colon.  Seventy to eighty percent of the dry weight of stool is bacteria, and so if you don’t have a sufficient amount of good bacteria in your gut, the stool won’t have sufficient bulk, and constipation will be the result.

However, it sounds like there may be some nerve issues here, maybe like a gut-brain axis issue and a motility issue above and beyond or along with any dysbiosis that might be present.  So, I think the best recommendation I can make would be to find a practitioner to work with that knows gut health really well and that can give you the best tests for these gut pathogens that I mentioned and small intestine bacterial overgrowth.  We’ve talked about some of these tests before, like the Metametrix Organix Dysbiosis Profile, which is a urine test that looks for SIBO and fungal overgrowth and dysbiosis, and then either the Metametrix #2105 for gut ecology or the BioHealth #401, which is a really good stool microscopy test for gut pathogens, and really focus on that end of the spectrum.  It sounds like you’ve got the diet pretty dialed in, but you want to rule out any underlying problems that could be contributing to the constipation.

And then I’m not sure if you’ve done this or not, Jay, because you didn’t mention it in your question, but I’m assuming or hoping that you are eating some fermented foods, sauerkraut or water kefir or dairy kefir if you tolerate dairy, kimchi, beet kvass.  Those kinds of things can have a really beneficial impact on constipation.  And prebiotics are kind of a mixed bag because they are a FODMAP, and a lot of people with gut issues are sensitive to FODMAPs, but I’ve actually found in my experience that prebiotics, even for people that are FODMAP sensitive, if you start with a low enough dose and you build up slowly enough, they tend to be more effective for constipation over the long term — and even in the short term — than probiotics in a lot of cases, although they do work synergistically together.

So, those are a few ideas.  The probiotics and prebiotics, of course, you can try on your own, but I would recommend getting some testing done just to rule out any other problems since you’ve been dealing with this for so long.

Steve Wright:  The only thing I’d add there is if you’re going to spend the money to get the #401 from BioHealth, you might want to throw in the H, which is for H. pylori.

Chris Kresser:  Yeah, that’s the test I usually order, #401H.  Thanks for reminding me.

Is Hydroquinone Dangerous for Scars?

Steve Wright:  OK, great.  This next question comes from Kevin.  “I recently saw a dermatologist that was treating me for a scar on my face caused by impetigo.  She prescribed me hydroquinone as a skin bleaching agent and asked me to use the product twice daily.  However, I uncovered tons of information on the Internet regarding how dangerous hydroquinone is for the skin.  I’ve used natural products like castor oil and honey before seeing my dermatologist, but nothing seems to help fade away the scar.  My question is, do you think I’m causing more harm than good by regularly using hydroquinone for my hyperpigmentation?”

Chris Kresser:  All right, so we’re talking here about hydroquinone.  And yes, good question, and I’m glad you asked because hydroquinone definitely is potentially dangerous.  If you go into PubMed.org, the database of published research, and you search for hydroquinone, you’ll very quickly see a number of studies that raise some issues about its toxicity and safety.  I’m going to quote from one of them called Final Amended Safety Assessment of Hydroquinone as Used in Cosmetics, and it says in the abstract:  “Hydroquinone is associated with altered immune function in vitro and in vivo in animals and an increased incidence of renal tubule cell tumors and leukemia, but the relevance to humans is uncertain.”  And they go on to say hydroquinone may be “safe at concentrations of ≤ 1% in hair dyes and is safe for use in nail adhesives.  Hydroquinone should not be used in other leave-on cosmetics.”

So, essentially there are a lot of studies that suggest that hydroquinone can cause cancer in animals.  The studies in humans are less clear, but I personally wouldn’t want to be a guinea pig for that, and one of the issues with cancer studies in humans is cancer takes a long time to develop in humans and animals have shorter lifespans.  When they study it in rats, it develops more quickly, so they’re able to identify cancer as it arises more quickly, whereas in humans it can take up to 20 or 25 years to develop, so if there’s any option to use something else, which I think there is, then I wouldn’t do it personally.  I don’t think it’s worth it.  You know, the risk/benefit analysis isn’t worth it.  I mean, if you have a treatment that could save your life on the one hand and then might cause cancer on the other hand, that’s a little bit different question because maybe it saves your life in the short term and then you end up getting cancer 20 years later, you know, a lot of people might be willing to make that tradeoff, but if it’s a question of helping to remove a scar, as troubling and difficult as that can be when it’s on your face, I don’t think the potential for cancer is a really good tradeoff in that situation.

In terms of alternatives, he mentioned that he’s tried honey.  I’m wondering if he’s tried manuka honey, which is a particular form of honey that’s demonstrated to have really good effects in wound healing.  There’s published research behind that.  Coconut oil can be helpful for wound healing, and emu oil actually is pretty interesting.  A lot of dermatologists of the more kind of holistic, progressive mindset are using it, and I don’t think there’s a real consensus on exactly why it works so well, but the certain fatty acids that it contains seem to have a beneficial effect on wound healing and scars.  I know a lot of plastic surgeons are using it to help with healing, and if you do a little research, you’ll find that there’s a fair amount of excitement about that.  I discovered it actually for burns.  Several years ago, I had a pretty bad burn and someone told me about it, and I used it regularly and I was just blown away at how quickly the burn healed.  It was by far the fastest healing burn that I had ever had, so I’ve been using it since then, and I think it’s pretty amazing.

Steve Wright:  OK, anything else that might support his skin healing?

Chris Kresser:  Well, I’m assuming nutrition is solid.  I don’t know why I always assume that!  I just tend to think a lot of people who are listening to the show are already doing the stuff we talk about, but that’s important.  There are a lot of nutrients that are crucial for skin health, and actually the best way to learn about that is to go to my blog and on the right hand in the sidebar scroll down and there’s a series on skin health where I covered all of the nutrients that are beneficial for skin health.  So, the good news is that you’ll get most of those nutrients in the context of a paleo type diet, but you might want to focus even a little more on some of the nutrients that I mention in that series.

Long-Term Solutions for Low Stomach Acid

Steve Wright:  Awesome.  Thanks, Kevin, for the question.  Let’s move on to Karen’s question.  “My question is about HCl supplementation.  I was on Prilosec a while back for over two years and realized this past summer that low stomach acid could be at the root of my digestive woes since going paleo.  I tried the HCl challenge and got up to 10 pills and felt none of the warmth people have described.  As 10 pills a meal isn’t a sustainable dose for my pocketbook, I started using apple cider vinegar to help my stomach acid, but I have read concerns about it possibly harming the esophagus, tooth enamel, and contributing to weak bones.  Do you think ACV is a healthy long-term way to help someone with low stomach acid?  Also, can I get same benefits from taking four to five HCl pills with each meal and how will I know when I can stop supplementing?”

Chris Kresser:  Another good question.  Steve, you might want to address this, too, because I think you have some personal experience with this, but generally I advise people if they go all the way up to 10 and they don’t notice any of the warmth that we describe in the protocol, just to drop down to a more comfortable number of capsules, like maybe 4 to 5 or something like that for a period of time and see if there are any changes in digestion.  That’s the one thing that’s missing here that I am really wondering about is, does she get any change at all with the increase with the HCl supplementation?  I’m seeing that Karen’s not feeling any of the warmth, but what I’m not sure of is if she is experiencing any benefits from it, you know, any changes in digestion with the HCl.  If she is, then my next question would be does she notice any difference in her digestive process between 4 to 5 HCl pills and 10 HCl pills, and if she doesn’t, then I would stick with the lower dose.  And in terms of when to know if she can stop supplementing, I would base that on her symptoms.  If her digestive symptoms are improving significantly, then she can start to try to decrease that dose over time, and as long as she doesn’t experience any decline in function as she decreases the dose, then she can gradually wean herself completely off of them.

If she is not experiencing any change one way or the other with that many pills, it’s possible that she requires more, but it’s kind of unlikely in my experience.  Steve, you might speak to this, but I would be considering other potential causes of GERD other than low stomach acid.  I mean, that is a common cause, but it’s not always the cause.  There are other things to consider, and there are other interventions that might be considered, too.  For example, I think I talked before on another podcast or I wrote an article about it — I can’t remember which — about strategies for boosting melatonin levels as a way of treating GERD.  There’s 400 or 500 times more melatonin in the gut than there is in the brain, and it plays an important role in gastric emptying and a number of other GI functions, and so taking some melatonin precursors could be helpful.  So, I need a little more information to hone in here, but in general, I guess I would say if you don’t notice a difference between 10 and 4 in terms of digestive function, then I would go with the lower dose, and then I would just titrate off based on your symptoms.

Steve Wright:  Yeah, and she might have read some of my posts because I have a series kind of low stomach acid and supplementing with betaine HCl.  A couple things:  It’s not really clear from her question if she was using an HCl with pepsin, and I’ve found that people who don’t use with pepsin always don’t get the results they’re looking for, so I think that’s something to look at.  And I just pulled up a reference here from Dr. Jonathan Wright’s book Why Stomach Acid is Good for You, and he quotes in that book saying that his typical range of the patients in his practice take in 3200 mg to 4500 mg of HCl per meal.  So, that’s just kind of like a reference range I like to tell people.  My personal experience is I was kind of like this as well, where I could take up to 11, 12, and around 13 I would start to get some warmth, and for a while I stayed up there, and I too felt the pain in my pocketbook, but what I learned is what Chris was really talking about, was that I could go down, and I kind of sit now around 6 or 7, and I seem to get really good digestion at 6 or 7, and I don’t get any warmth, but the digestion is good, and if I go up to 10, there’s no change in digestion.  It doesn’t get any better or anything like that.  And then it turns out that I have an H. pylori infection, so it kind of makes sense.  So, as Chris was saying, I think the clients that Jordan and I have worked with who have this low stomach acid and the ability to take in massive amounts of HCl, they’re typically dealing with a couple root causes from GI infections to the inability to make hormones as Chris alluded to from an HPA problem.

Chris Kresser:  Well said.

How to Convince Friends and Family Paleo Will Help

Steve Wright:  OK.  Let’s get rolling here.  The next question comes from Bethany.  “My mother suffers terribly from asthma and environmental allergies that she developed as an adult around the age of 45.  She hasn’t really bought into the paleo approach, although she has made some changes through my influence.  She has reached a point where she is so desperate from the never-ending steroids, antibiotics, and inhalers that she’s willing to try alternative treatments, even talking about driving two hours each way for acupuncture.  I think the first place she should start is diet, but I am not sure how to convince her of this.  Is there a resource I can point her to that will address how diet will specifically help with asthma and allergies?”

Chris Kresser:  Yeah, so there are a lot of things here.  There’s kind of some general question about how to convince someone that you know and love and care about that making dietary changes will help, which is kind of a meta question.  And then there is there research that suggests that diet has an effect on allergies?  And then there’s maybe another more specific question about is there research that suggests that a paleo diet can specifically help asthma and allergies?

As for the first question, you know, that’s a tricky one because I spend obviously a lot of time writing and speaking about the health benefits of a nutrient-dense diet and all of the conditions that it can help resolve and even reverse, and I’ve essentially dedicated my life to this work, so I care deeply about it, obviously, but some people are often surprised to see how kind of hands-off I am with people.  You know, if I’m at a grocery store and I hear someone talking about the health benefits of soy, I’m not going to run over there and interrupt them and say, “Well, wait a second.  Did you know…”  You know, it’s just not my personality, and I’m not in the habit of offering unsolicited advice in general, and I’ve found that at a different time in my life when I was more aggressive about things like that, that it often had the opposite effect to what I wanted it to have.  I’ve generally found that offering people unsolicited advice is a really good way of turning them off to whatever it is that you’re talking about!  So, really I just try to trust that when they’re ready, the best way is to just kind of lead by example and be a good example of health and wellness and of how diet can contribute to that, and then to trust that when they’re ready for my opinion and if they want it, they’ll ask for it.  And that’s been a lot less stressful for me and a lot more productive, actually, and in the end, I think it’s more effective as a strategy.  And I deal with this in my own life with my own family and friends, and it’s just the way that works for me.  I mean, I’m not saying it’s the right way, and other people might feel more comfortable with a more aggressive approach, but that’s just a kind of meta comment that I have about approaching people in your life that you want to help make changes.

The second question:  There’s a huge, huge body of evidence about the relationship between diet and asthma and allergies.  I don’t even really know where to start there.  I’m not sure really how to specifically answer that on a podcast, but all I can say is that there’s tons — I mean, even just kind of some basic Internet searching will turn up a lot of information about how diet is related to allergies and asthma.  At the simplest level, you can think about it like this:  If you’re having environmental allergies or asthma, there is an immune system activation happening there, so you’re having an IgE response, or maybe it’s not mediated that way but there’s an inflammatory histamine response happening and there’s an aggravation.  So, then if you eat foods that are known to be immunogenic or allergenic in certain people, that will on top of the existing immune activation just worsen what’s already happening and exacerbate it or lengthen it or whatever.  So, if you already have a predisposition to environmental allergies, you want to do everything that you can to minimize the immune activation, and that should just make good sense from a logical perspective even to someone who doesn’t know anything about the research literature.  But there are a lot of studies there.

There just aren’t that many studies on the paleo diet, period.  There are a lot of studies on various aspects of the paleo diet, for example, studies on how industrial seed oils can cause harm.  There’s a lot of new research on that, actually, which is pretty interesting.  Studies on how excess sugar is a problem, on how certain immunogenic and allergenic proteins in cereal grains and, to a lesser extent, legumes can be a problem.  There are studies on micronutrient deficiency and how that can cause problems, particularly with the immune system, and one of the biggest selling points, if you will, of a paleo diet is its nutrient density, and we live in a culture that is extremely well fed but also extremely undernourished.  I was just looking at some statistics that show that about half of Americans are deficient in several different micronutrients, including zinc, calcium, magnesium, vitamin A, B6, I think, and vitamin E; and one-third are deficient in riboflavin (B2), thiamine (B1), folate, vitamin C, and iron, and in a lot of cases, they’re not mild nutrient deficiencies.  Up to half of Americans eat less than half the recommended daily allowance for several of those micronutrients, so they’re pretty significant deficiencies, and all of the 40 micronutrients that contribute to proper function are known to play a role in immune health, so maximizing nutrient density is crucial for the immune system, and a paleo, nutrient-dense type of diet is really a great way to do that.  There are other approaches, like Weston A. Price, which are also nutrient dense.

So, there are a lot of lines of evidence that can be pulled together that point to paleo being a great choice for things like allergies and asthma and then autoimmune conditions.  And then, of course, there’s the considerable clinical/anecdotal kind of evidence of practitioners like me who treat people who see that they had severe asthma and allergies, they start a paleo diet, and after two or three months, they don’t have any allergies or asthma anymore.  And that’s pretty compelling when you witness it firsthand, and it’s compelling when you see it multiple times with people from all different walks of life and different histories and backgrounds, and then when you talk with colleagues like Robb Wolf who has put thousands and thousands of people through these paleo challenges and seen similar things.  you know, personal experience and clinical experience like that, it’s not gold-standard, double-blind, placebo-controlled evidence, but it’s a different kind of evidence that I think shouldn’t be discounted.  So, no, there’s no double-blind, placebo-controlled, gold-standard clinical trial that compares the paleo diet with a different diet for allergies and asthma that I can point to, but there are tons and tons of studies showing how food and these various aspects of diet contribute to asthma and allergies and autoimmunity, and unfortunately, it’s just impossible to neatly summarize all of them in a really short time.

Steve Wright:  I think if I can just add, you know, starting with what you talked about, Chris, at the beginning where you’re trying to help someone close to you, I think in my experience it’s always been better to just refer them to the best practitioner that you know practices the guidelines, such as the paleo diet or something, because then, like Chris was talking about, you’re not the one coming up with the ideas and they’re hearing it from a different voice.  And I would say that with somebody with asthma and environmental allergies, there’s obviously immune dysregulation, so you also want to refer them to probably a functional medicine oriented practitioner because there could be hidden problems.  If she just developed this at age 45, she could have picked up some sort of parasite or something else that, you know, she’s going to need to make a diet change, but there also could be underlying things that are driving her new-found problems.

Chris Kresser:  Yeah, that’s a great point, absolutely.  And I agree with Bethany that the starting place should be diet, and really while seeing a functional medicine practitioner is a great idea for something like this, if someone can just try the diet for 30 days, in some cases, that completely resolves the issues and there’s not even a need to go see the functional medicine specialist.  But if seeing a functional medicine specialist can help convince her to do that, then that’s another reason to do it, right?  Sometimes just having a third-party perspective that’s not a family member can be helpful in making the leap.

Steve Wright:  Good points.

Chris Kresser:  What is it?  Jesus isn’t a prophet in his own town?  Something like that?

Steve Wright:  I don’t know.

Chris Kresser:  Have you heard that?

Steve Wright:  I haven’t heard that.

Chris Kresser:  I’m not making it up.  I’m probably really butchering it.

Steve Wright:  But this is your show, so it’s OK.

Chris Kresser:  Haha, but it’s the idea that you can acquire a ton of knowledge and even be recognized for that elsewhere, but if you go back to your family or your friends and try to position yourself as an authority, good luck with that.

Overcoming Dry Eyes, Saliva, and Mucus

Steve Wright:  Yeah, haha.  OK, let’s move on to Beth’s question.  She asks:  “My question is about dryness, for lack of a better word.  I have dry eyes.  I do not produce much saliva.”  Saliva in the eye, hmm.  Chris, you’re going to have to tell me what’s really going on with Beth here.  “Despite chronic mild sinus pressure and nasal clogging, my nose feels dry.  I never experience post sinus drip.  When I blow my nose, the ensuing mucus appears to lack moisture.  Finally, my vagina does not produce much lubrication when I am aroused.  None of these issues interfere much with my life, but I am curious about possible causes and if they’re indicative of something more serious.”

Chris Kresser:  OK, so we can stop there.  There is some important background information that she provided, but I’ll just kind of work it into my answer.  Steve, just for clarification there, I’m pretty sure she wasn’t concerned about her eyes lacking production of saliva, but she was just saying that she has dry eyes AND she doesn’t produce saliva.

Steve Wright:  Dude, my brain is so slow today.  I apologize, Beth.

Chris Kresser:  Haha.  OK, so this is an interesting problem.  I’ve seen a couple patients in my practice that have presented with a similar constellation of symptoms.  In both cases, we found that it was a hormone imbalance and namely, a really low level of progesterone.  And low progesterone is associated with vaginal dryness, and there’s less in the literature about dry eyes and saliva and mucus, but I think that’s at least theoretically possible.  Hormones have a pretty potent effect on several different systems of the body.  What kind of leads me to that, too, is part of what she included in the background information, which was that she was on hormonal birth control.  She isn’t any longer, but there’s a condition called post birth control syndrome where when a woman comes off birth control, she deals with some residual hormone imbalance from being on supplemental estrogen and birth control for a long time.  It doesn’t always have to be a long time, but it often is in women who have been taking it for a long time.

So, one of the things I’d recommend doing here would be to work with a practitioner who is skilled with hormone balancing and testing.  The test that I like is the BioHealth test where you test your progesterone and estrogen levels all the way through the month instead of just doing a single day, and that’s important, as we’ve discussed before, because hormone levels are supposed to change throughout the month for women.  You know, estrogen and progesterone should be fairly low in the first half of the cycle and then peak around mid-cycle, and then progesterone stays high and then drops off just before menstruation.  Estrogen’s curve is a little more complex, but the point is that testing hormones on one day during the cycle, you can try to extrapolate what they would be on other days and whether there’s a problem just by knowing where it should be at that particular time of the month, but it still doesn’t tell you with any accuracy what the levels were at other times during the month that weren’t tested.  So, if you do, like, a cycling hormone profile, that would be really useful to get a sense of whether this theory that I’m working with here is accurate or not.

Another thing that’s important if you’ve been on birth control for any significant length of time and if you’re dealing with some of these issues would be focusing a little bit on liver detoxification because one of the liver’s jobs is to detoxify hormones.  So, doing some basic liver support, things like milk thistle extract and repleting glutathione, broccoli seed extract, etc., can be useful in this situation, and sometimes that alone will solve the problem without any additional progesterone supplementation or anything like that.  Some of you might have noticed that Robb Wolf and I just came out with a new supplement line called Paleologix, and one of the products is called AdaptaClear and was designed somewhat specifically with this kind of problem in mind, issues with liver detoxification, supporting all of the different phases of liver detox.  So, yeah, give that a try probably first, something for the liver, and then if that doesn’t resolve the issue, I would look into the progesterone theory. [Note: The Paleologix supplements discussed in this post are no longer available. I now recommend Liver Nutrients by Seeking Health for those that would have taken AdaptaClear. Please click here to view the products recommended as substitutes.]

Steve Wright:  I think the BioHealth test you’re talking about is the #208.

Chris Kresser:  Yeah, that’s right.

Steve Wright:  All right, great.  Well, Chris, I think this is going to have to be the last question for me.  I probably need to go take a nap.

Chris Kresser:  OK.

Dealing with Chronic Night Time Depression

Steve Wright:  OK, this question comes from Ashley.  “First, I just want to say thanks for all the work you put into getting your information out there and accessible to the general public.  It’s been a big help finding your site and podcast so far.  My question is this:  I’ve had major depression for about 20 years that’s never been successfully treated despite therapy, various psychiatric drugs, and now I’m being treated for thyroid and adrenal issues.  My doctor has me on T3 and low doses of oral hydrocortisone as well as oral progesterone for estrogen dominance.  I thought that this would help my depression, which seems to always cycle daily with the daylight hours.  I’m functional and decent during the days.  As soon as night falls, I feel like a completely different person.  The thyroid and adrenal treatment does seem to be helping my sluggishness during the days but not the depression itself.  I’m currently eating a paleo, grain-free, moderate-carb diet, lift heavy weights, and walk a lot.  I’m also taking extra fish oil supplements and vitamin D.  Do you have any more insight for someone like me with this cyclical, treatment-resistant depression?”

Chris Kresser:  Well, I think the nature of it being cyclical is interesting, and I’m wondering if, Ashley, you’ve tried light therapy, which has been shown to be pretty effective for cyclical, seasonal types of depression.  This seems to travel more in daily cycles since it happens when night falls, and that may be more of a circadian rhythm issue, and so I’m glad that she’s focusing on adrenal issues.  I’m wondering if she has actually had any testing for adrenals.  I’m not a really big fan of taking hydrocortisone.  It’s a downstream hormone, and it’s pretty potent, and it has a pretty high potential for causing resistance or dependency, and I have a lot of patients who’ve been on hydrocortisone for a long time and had a really difficult time coming off of it, so I have a little bit of a concern about that, and then I just haven’t seen it be as effective as some other interventions that address different aspects of adrenal function.  So, like, the BioHealth #201 test that tests for cortisol and DHEA.  I’d also probably add a melatonin to that along with it because of what happens at night after the sun goes down.  That could be an issue with a cortisol and melatonin imbalance, so I would definitely get that test, and I would consider some other adrenal interventions like adaptogenic herbs and nutrients like pantethine and vitamin C, possibly some adrenal glandulars or perhaps some bioidentical pregnenolone and DHEA if the DHEA levels are low.  So, that’s one kind of avenue of exploration with the adrenals.

Another is the gut-brain axis.  I noticed there wasn’t much mentioned about the gut.  I don’t know if that’s problematic from a symptom perspective, but there are a lot of studies that show that people can have intestinal permeability and inflammation in the gut without having gut symptoms, and the symptoms manifest elsewhere, like with mental health conditions, for example.  So, there’s actually something called the inflammatory cytokine model of depression, which is a theory that depression is caused by inflammation that’s produced somewhere in the body, often the gut, and those inflammatory cytokines cross the blood-brain barrier and suppress the activity of the frontal cortex, which causes all of the signs and symptoms of depression.  Since it looks like that might be an avenue that hasn’t been explored yet, I would consider looking into that.

Let’s see, from a dietary perspective, one thing that can be helpful and important is making sure you’re getting plenty of glycine-rich foods, especially if you’re eating methionine.  These are different amino acids, and methionine is high in muscle meats, which people on a paleo type of diet tend to eat a lot of, and glycine is found in the skin, cartilage, and bones of animals, and a lot of people on a paleo diet don’t get enough glycine, and the significance in terms of depression is that methionine competes with tryptophan for absorption and transport across the blood-brain barrier, and tryptophan is a precursor to serotonin, whereas glycine does not compete for absorption with tryptophan across the blood-brain barrier.  So, balancing out that ratio can actually have a pretty significant effect on mental health, and just making that change alone can have a really big impact.  So, what you would do there is you would increase your intake of bone broth.  You might actually consider supplementing with gelatin.  Great Lakes gelatin is a good brand.  Or the collagen hydrosylate, which is a little bit easier to work with.  The gelatin you have to mix with room temperature water.  If you mix it with cold or hot water, it gets really clumpy, but the collagen hydrosylate provides a lot of the same benefits, but it’s easier to mix.  And then you would eat fattier cuts of meat rather than leaner cuts of meat.  So that’s something you can do right away to see if that helps.

But because of the circadian element to this, I think focusing on the adrenals would be a really good first step, and then you could buy a light machine.  I have a recommendation for one on my website if you go to ChrisKresser.com and then you click on the Store link and then Recommended Products and scroll down.  They’re used for seasonal affective disorder, but I’ve also used them for people with adrenal problems.  So, you would wake up and first thing in the morning you would sit in front of that for, you know, 15 or 20 minutes, something like that, and that can really help to reset the circadian rhythm.  Of course, if you can go outside and get exposure to sunlight that way, that’s ideal, but it’s not always possible, especially in the winter and given people’s schedules.  So, those are a few tips, and I hope one of those is helpful.

Steve Wright:  Well, I want to thank the listeners for putting up with my cold today during this podcast.

Chris Kresser:  Thanks for sucking it up and being here with us, Steve.

Steve Wright:  Come hell or high water, we’re getting the Chris Kresser Revolution Health Radio Show out the door!

Chris Kresser:  Haha, that’s why I love you.

Steve Wright:  All right.  Well, thanks everyone for listening.  Please keep sending us your questions at ChrisKresser.com using the podcast submission link.  And if you enjoyed the show, please head over to iTunes and leave us a review.  It helps get the show into more people’s hands and might help them with their health.