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Post Birth Control Syndrome, Night Shift Work, and Chronic Constipation


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We forgot to do the “What did Chris and Sylvie eat for breakfast?” segment this time, so here it is. I had lamb kefta, plantains fried in a combination of ghee and coconut oil, and collard greens cooked in bacon grease. Sylvie had blueberries, lamb kefta and sauerkraut. This is another Q&A episode, and our last show for 2012. Happy Holidays and see you in 2013!

In this episode, we cover:

0:42 Chris unveils his new treadmill desk
8:03 The latest news on the Global Burden of Disease Study
12:20 How to treat post birth control syndrome
20:44 What really causes canker sores?
25:35 Tips for night shift workers
32:33 What to do about chronic constipation
40:22 Correcting female hormone imbalance
45:52 Diet recommendations for cataracts
50:08 Does Cod Liver Oil cause acid reflux?

Links We Discuss:

Full Text Transcript:

Steve Wright:  Hey everyone, welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com, and I’m your host, Steve Wright.  My website is SCDLifestyle.com, but the star of this show is Chris Kresser.  He’s an integrative medical practitioner, licensed acupuncturist, and a healthy skeptic.  Chris, how are you doing today?

Chris Kresser:  I’m feeling pretty good, Steve.  How are you?

Steve Wright:  I’m doing well, as well.

Chris unveils his new treadmill desk

Chris Kresser:  Yeah?  I’ve got some interesting news — or at least good news for me!  I think we’ve talked before about using a standing desk, that I’d started that about, I don’t know, eight or nine months ago because I spend a fair amount of time on the computer writing and doing everything else that I do.  And especially with the book coming up, I just didn’t like the idea of sitting on my butt, haha, that much, so I got a standing desk for my office.  And I still have a sitting desk, so I alternate between the two, but I spend a fair amount of time at the standing desk.  But even that still didn’t quite feel like enough to me, and I’ve been aware of treadmill desks for a while, and I’ve just been kind of thinking about it in the back of my mind.  And I’ve kind of had maybe an unfair bias against treadmills and Stairmasters and indoor exercise machines like that because I’d much prefer to get exercise outdoors, but I mean, I have to do work, the work I do, so if I’m gonna be doing that work and I’m gonna be inside doing it, then I might as well be moving while I’m doing it.  That was my thinking.

So, I did some research, and I found — You know, there’s a whole bunch of different options out there.  There are some treadmills and desks that are sold together, but I already had a standing desk, so I just looked for the treadmill, the tread itself, and found one that would fit under my desk.  And so, I got it earlier this week, and on Wednesday I set it up.  Yesterday was my first day, and I logged about seven miles in the midst of writing a little bit on my book and doing a shift with patients, doing some phone consulting yesterday.  I don’t think anybody heard it.  It’s very quiet.  I called up Dan Pardi before and said:  Can you hear this thing?  And he couldn’t, and nobody mentioned it.  And it went pretty well.  I felt great.  It was really exciting to be at the end of a workday and feel like I was out walking for six miles, which is just fantastic, so I’m really excited about that.

Steve Wright:  Yeah, that’s interesting.  Did you notice your energy levels stay higher?  Or did you notice anything in regards to thinking?

Chris Kresser:  Yeah, well, definitely my energy was higher.  I think better when I’m moving, too, to a certain extent.  I think there are certain times when if I really have to focus on something and concentrate really hard, I might still want to use the sitting desk for that.  I don’t know.  It’s still kind of in the experimentation process.  And I was messing around with the speed, too.  Like, one mile an hour seems to be about the right speed for being able to type and work efficiently.  If I increase the speed much beyond that, it starts to be a little hard to do, and I was actually starting to feel almost like a little bit carsick.  If I read in the car, I don’t feel well.  You know, the kind of bouncing up and down and reading doesn’t work for me, so the faster speed on the treadmill was similar to that, and it was just harder to manage the typing.  But one mile an hour was pretty good.  And at that pace, I think I used it — I can’t remember exactly how many hours, but probably three to four hours total.  Or I guess it was more like six if it was six miles and I was doing one mile an hour.  I had some periods where I was going faster when I wasn’t typing and I was just talking on the phone.

Steve Wright:  That’s really cool.

Chris Kresser:  I’ll keep reporting back.

Steve Wright:  Yeah, we’re gonna press you for an update — Or I’ll press you for an update.  I was speaking from the listeners’ point of view.

Chris Kresser:  Yeah, and if people are interested, they can leave some comments, and I’ll post a little bit about the research I did and which ones are available and which are quiet and stuff like that.

Steve Wright:  Yeah, I don’t mean to totally derail the podcast, but do you have one of the pneumatic desks that lifts up so that you’re able to adjust it pretty easily?

Chris Kresser:  No, I don’t.  I just have a fixed standing desk, because as I said, I have another sitting desk, so I didn’t really feel it was necessary to have an adjustable standing desk, because I’m not going back and forth from sitting to standing at the same desk.  I did not have to get a keyboard tray that would extend out from underneath the desk, because a lot of the standing desks only have one surface, and that’s not correct ergonomically.  The monitor should be at eye level, but the keyboard should be at elbow level, so there needs to be a keyboard tray underneath the top of the desk, or if it doesn’t come with one, you can buy one and attach it to the underside of the desk.  Maybe I’ll write an article or we can actually do a longer episode about this if there’s interest.  We’ll see.

Steve Wright:  Yeah, we’ll get you to divulge your brands and the ones you chose.

Chris Kresser:  I’ll take a picture of my setup.

Steve Wright:  Uh-oh.  Haha, going inside the Kresser crib!

Chris Kresser:  Yeah.

Steve Wright:  OK, well, we’re doing a Q&A episode, right?

Chris Kresser:  That’s right.

Steve Wright:  OK, well, let’s go ahead and give you a quick break to review the questions we’re gonna cover.  I’m gonna tell everyone about Beyond Paleo.  Now, if you’re new to this podcast, you’re new to the paleo diet, or you’re just interested in optimizing your health — being as it’s December, a lot of people are gonna be into that — you’re gonna want to check out Beyond PaleoBeyond Paleo is a free 13-part email series that Chris has put together that includes all of his best tips and tricks on burning fat, boosting energy, and preventing and reversing disease without drugs.  So, if you want this, which you should at this point because it’s pretty awesome and I’m making a pretty compelling offer right now, go over to ChrisKresser.com, look for the red box, go ahead and put your name and email in there, and Chris is gonna start sending you free emails.  So, great information.  I highly recommend you check it out.

Chris, are you ready?

Chris Kresser:  Yeah, I’m ready, and I’m not walking right now, haha, in case anyone’s wondering.  I was trying to figure out a way to do it with the podcast if it wasn’t gonna mess up the audio quality, but I need some kind of arm to attach to the desk and the microphone to kind of swivel it out to where the treadmill is.  So, I’m working on it, but I have to just be plain, old standing up for this one.

Steve Wright:  Well, if you do that, then we’re gonna have to do a video podcast because I want to see this!

The latest news on the Global Burden of Disease Study

Chris Kresser:  Haha, yeah.  It may be the only podcast — probably not.  There are so many people doing this stuff.  I bet there is someone who’s doing it on a treadmill.  But who knows?  We’ll see.

So, before we do Q&A, I want to talk just very briefly about an interesting study that was published in The Lancet today.  I just heard about it like 20 minutes before we started recording this, so I didn’t have a chance to go over it in detail, but there was a collaboration of 486 scientists from 302 institutions in 50 countries around the world, so pretty comprehensive.  It’s called the Global Burden of Disease Study from 2010, and the idea is just to get a sense of what the global burden of disease is and how it’s changed over the years.  And the conclusion, very roughly, was that the life expectancy for both men and women is increasing pretty much everywhere around the world, but the burden of chronic disease and disability is increasing.  So, mental health disorders, substance use, musculoskeletal disease, diabetes, chronic respiratory disease, autoimmune disease, etc., are all increasing.  So, we’re living longer, but we’re getting more sick as we live longer.  This is, of course, a discussion that comes up a lot when we talk about ancestral health and lifespan in ancestral communities, and it’s true that our lifespan today is longer than it’s ever been, but I think there’s been a significant tradeoff.  You know, we have a lot of pretty miraculous modern medical interventions that have been able to extend our life both early on during childhood and infancy and then later during the end of life.  But it’s pretty clear that our modern lifestyle has made our lives worse in between.  So, we’re living longer, but arguably the quality of life and the quality of our health while we’re alive is worse than it was certainly for thousands of years until the introduction of the modern industrial lifestyle.  So, I just thought it was interesting.  I’m gonna review it, and maybe we’ll talk about it a little bit later, but since it was fresh, I wanted to at least mention it.

Steve Wright:  Yeah, I think I saw those same headlines, and it’s gonna be interesting.  They were saying something — I think the quote that I read on CNN about it that they’d pulled out of the study, which of course, is journalism now and marketing, but they basically said the obesity/overweight problem is now worse than the hunger problem.

Chris Kresser:  Yeah, here are a couple stats:  One in four deaths was from heart disease or stroke.  That’s just amazing, you know?  The fact that the INTERHEART Study a while back suggested that 90% of heart disease is preventable by modifying diet and lifestyle, and yet still today after all of the focus on heart disease over decades, it’s still the major cause of death.  Diabetes deaths are increasing, and of course, obesity is a big part of that.  And actually the biggest global risk factor for disease — You want to take a guess that it is?

Steve Wright:  Obesity.

Chris Kresser:  Blood pressure, hypertension.  That’s the number one risk factor for global disease.  I was surprised, too.

Steve Wright:  Interesting.

Chris Kresser:  Yeah.  So, yeah, we’ll come back to this, but I just wanted to throw it out there.  I think it highlights some of the issues that the modern lifestyle presents and some of the tradeoffs that we’ve had to face through our adoption of the modern lifestyle.  We’ve definitely gotten a lot of benefit from it, of course, through modern medical care, but it’s hasn’t come without a cost.

Steve Wright:  So true.  OK, well, we will move on so we do get through some questions on this podcast, but I think we should definitely spend some time on that study a little bit later.

Chris Kresser:  All right.

How to treat post birth control syndrome

Steve Wright:  OK, this first question comes from Jennifer, and she says:  “Hi, Chris.  I have a question regarding regulating hormones after getting off birth control pills.  For the last two years, I’ve immersed myself in healthy living, following a paleo diet, supplementing, and using natural skin care, and I’ve never felt better.  The last step for me was to get off the pill, which I had been on for seven years.  I’ve been off the pill now for almost two months, and my skin is going insane.  I’m breaking out horribly, and I’ve tried numerous efforts to get it under control, including maca powder, detoxifying the liver with milk thistle phytosome and detox tincture from the herbalist.  Is this something I will have to just wait out for my body to get back to normal?  What else can I do?”  Wow, that was tough to get out of my mouth!

Chris Kresser:  Haha!  Yeah, so this is common.  There’s actually a condition known as post birth control syndrome, and it’s a label for hormonal imbalance that frequently occurs after a woman gets off birth control pills, especially if she’s been on them for quite a long time.  So, one answer is, yes, it may resolve over time on its own, but there are other things that can be done that could probably help that process along.  Proper hormone balance, there are some basic contributing factors that should be addressed as a beginning step.  It sounds like a lot of them probably already have been addressed in this case, but that would be proper blood sugar regulation.  Blood sugar has a profound influence on hormones.  When female sex hormones go out of balance, there’s almost always an adrenal hormone imbalance underneath that because pregnenolone and DHEA, two of the main adrenal hormones, are precursors to all of the sex hormones, so if there are adrenal issues, if the pregnenolone steal is going on where pregnenolone is being diverted into cortisol production at the expense of DHEA and estrogen and progesterone, that can cause issues.  Liver and gallbladder detoxification is crucial, as she seems to be aware, because one of the liver’s jobs is to clear out excess hormones that have built up in the system, which is something that would happen over time after using birth control.  So, she may need more intensive liver support than she’s getting right now.  Fatty acid balance is also really crucial for hormone regulation, making sure that she’s getting enough long-chain omega-3 fats and not too much linoleic acid, the omega-6 fat.  Gut health is, of course, another major player in hormone regulation.  So, these are all basic foundational things that can be addressed to try to improve hormone health.

Beyond that, this is one situation where bioidentical hormones, particularly progesterone in a cyclical augmentation protocol, can be really useful.  And what I mean by that is progesterone — women don’t produce it in the same amount throughout the entire month.  It’s produced in a cycle, right?  Just like estrogen.  The levels will be fairly low during the first half of the cycle, peak in the mid cycle, and then stay elevated throughout the second half of the cycle, dropping down fairly precipitously just before menstruation.  That’s the typical monthly cycle for hormone production.  And what often happens in post birth control syndrome is there can be a problem with the distribution of progesterone throughout the second half of the cycle, so maybe progesterone is dropping too quickly — That’s the most common problem — Or it’s not peaking in the right spot.  There can be a problem with the overall production of progesterone or estrogen throughout the whole cycle, and there can be a problem with the timing of ovulation.  It’s maybe happening too soon or too late or not at all, or even in some more rare cases, twice, which I’ve seen a few times on hormone panels.

So, working with a practitioner who understands hormone regulation is probably a good idea.  It can really expedite the process of recovering from post birth control syndrome.  Getting a good monthly hormone test is really important.  As I just said, hormones are produced in different amounts at different points in the cycle, so getting a single hormone test on one day of the month, it tells you something.  You know, it tells you what the hormones were doing on that day, and if you do it on a certain day of the month, like midway through the luteal phase, you can kind of extrapolate some information from that.  But really, for a woman who’s still cycling, the best test to get is a complete monthly hormone profile where you take samples all the way through the month of progesterone and estrogen, and then you chart the cycle out so you can see where the problem is.  You look at the cycle that’s on the chart, and you compare that to what we know the cycle should actually look like, and then you use a protocol that is customized for that particular presentation.  So, you give more progesterone when progesterone is needed and less or none at all when it’s not needed.

So, those are all steps to take.  If the basic stuff has already been tried and it’s not working, then I think the next step would be to find a practitioner that does this kind of testing and treatment.  Reed Davis’s group, Functional Diagnostic Nutrition, I think it is, FDN — That might be a good resource.  We’ll put a URL to his website where you can find people who are trained in this kind of testing and treatment.  The Institute of Functional Medicine and maybe the Paleo Physicians Network; those are all potential places to look.

Steve Wright:  Yeah, and anybody that’s been through Kalish’s functional training will have covered this in depth.

Chris Kresser:  Absolutely.  Thanks for mentioning that.  Do you know?  I don’t know if there is a directory of those folks.  Is there on his website?

Steve Wright:  There is not, and that’s on my prodding list of things to get him to do.

Chris Kresser:  Right.  Yeah, it seems like that would be useful.

Steve Wright:  Yeah.  He’s been training them for over seven years now, so there are at least a couple hundred of them out there somewhere.

Chris Kresser:  Yeah.

Steve Wright:  One thing I want to throw out there, Chris, and maybe it’s not that big of a deal, but she’s talking about taking milk thistle here, and as far as I understand, that’s more of a phase one style detox enhancer, and that she might want to focus, if she’s going to continue to use that in the meantime before she finds another practitioner, to also incorporate a phase two, something like NAC or something?

Chris Kresser:  Yeah.  I like Amino-D-Tox from Designs For Health for phase two support.  And just to clarify everybody, there are two or three phases of liver detox.  It depends on what kind of classification you’re using.  We’ve talked about this before on a previous episode, which we can link to for a much more complete discussion.  But what often happens in people is their phase two detox is impaired, and then they end up taking “liver detox” products that upregulate phase one, and then there’s a bottleneck because the phase two isn’t happening right, so you get this production of free radicals that happens in phase one, and then the body cannot clear those out in phase two, and so it actually can sometimes make the situation worse than it was to begin with, so it’s really important to pay attention to both of those phases of liver detox when you’re doing a protocol like this.

What really causes canker sores?

Steve Wright:  Awesome.  OK, well, let’s move on to the next question.  This question comes from Tasha, and she says:  “Hi, Chris.  I recently discovered your podcast and blog, and I love it.  My question is in regards to canker sores.  If they are not caused by injury such as biting your cheek, why are they popping up?  Do you have any suggestions on how to decrease or eliminate the frequency of canker sores and to shorten the healing time?  Mine usually take about two weeks to heal, and I’ve been using SLS-free toothpaste for years with no improvement.  I haven’t been able to correlate them with any food allergy or intolerance.  A friend told me that she heard that it could be autoimmune related.  Another suggestion was B12 deficiency.  I’m rather new to the paleo and Weston Price diets, so I’m just starting to incorporate more saturated animal fats, pasture-raised meats and sprouted grains from seeds.”

Chris Kresser:  Yeah, so canker sores, there are a lot of different theories on what causes them.  They’re not very well understood, actually.  And we want to distinguish here between canker sores and cold sores.  Cold sores are caused by the herpes simplex 1 virus, and canker sores may actually be viral.  Some people think they are viral or bacterial, but the more conventional view is that they’re caused by stress, an impaired immune system, nutritional deficiencies like B12, as she mentioned, or zinc or folate or iron deficiency, although there’s not a lot of evidence to support that.  There’s also a correlation between canker sores and gut disorders like inflammatory bowel disease, so Crohn’s and ulcerative colitis, and celiac disease, so there’s a correlation between gluten intolerance and canker sores.  Tasha mentioned that she’s doing the Weston A. Price approach, and she mentioned sprouted grains.  I would definitely try removing gluten entirely from the diet if you haven’t done that already because there can be a connection there.

As far as helping with the healing process once you already have the canker sore, there are a few ideas.  One, you can do a goldenseal mouth rinse.  Goldenseal is an antimicrobial botanical that’s used in both Western and Chinese medicine.  So, you could dissolve some goldenseal, like one capsule of goldenseal powder, in one cup of warm water, and then add a quarter teaspoon of sea salt to that and swish that around in the mouth.  So, that’s one thing.  Manuka honey has pretty powerful wound-healing properties, so if you get a 200+ or a 400+ potency of manuka honey and apply that directly to the canker sore, that can help a lot.  DGL, deglycyrrhizinated licorice, also has mucosal healing properties, so you can make a paste with the powder and just with your saliva.  So, you put some of the saliva in the powder, make a paste with it, and then apply that paste to the canker sore.  And you can actually add some slippery elm powder to that, too.  That’s another botanical with mucosal healing properties.  And then you could try an internal antimicrobial like monolaurin extract.  Lauricidin is the brand that I use in my practice.  That has antiviral properties and has some activity against gram-negative bacteria and some gram-positive bacteria as well.

I think all of those together would probably have a pretty good effect on healing, and Lauricidin, to some extent, could be used for prevention, but I think just optimizing the nutrient density of the diet as you’re starting to do with a paleo or Weston A. Price-type of approach, avoiding gluten, and then taking other steps to boost your immune system, which we talked about on the last podcast, and then on a previous podcast we’ve talked about that in the context of dealing with viral infections.  So, listen to those or read the transcripts for some additional tips on immune regulation.

Steve Wright:  Yeah, it seems like all the diseases that you mentioned that were correlated with canker sores are kind of diseases that revolve around an underlying condition of high inflammation, so she might also look into really analyzing her stress and her sleep, too.

Chris Kresser:  Absolutely, yes.  I mean, stress is very strongly correlated, and a lot of people who have canker sores report that they tend to get breakouts when they’re under a lot of stress.  So, that’s important.

Tips for night shift workers

Steve Wright:  Awesome.  Let’s keep on rolling.  OK, this question comes from Ben, and he says:  “In light of the recent Dan’s Plan post on vitamin D toxicity, any tips for night shift workers and getting vitamin D?  I work from 6:30 p.m. to 7 a.m. three or four days a week.  We rotate days and nights every three months.  Should I just supplement or adjust my sleep schedule on days I’m off in order to get some sunlight?  Any other suggestions for us shift workers?”

Chris Kresser:  Well, I’m gonna sound like a broken record here, but my thing with vitamin D and with many conditions and nutrients is to test, not guess.  It’s relatively simple to determine how much vitamin D to take.  It takes time, but it’s simple.  You test your levels, and I think still the bulk of the evidence suggests that being somewhere between 35 and 55 or 60 is a safe and beneficial level for most people.  There are some caveats to that, and there are some recent studies that have come out that suggest lower levels might be better for certain people.  Chris Masterjohn and Stephan Guyenet and Mat Lalonde and I have been corresponding about this quite a bit lately.  It appears that there are some genetic mutations that affect vitamin D metabolism and regulation, and so that may explain these differences in studies where some populations seem to do better with lower levels of vitamin D, whereas other populations seem to do better with higher.  So, I think it’s a lot more complicated than we’ve been led to believe by, like, the Vitamin D Council who is telling everyone to get their levels up to 70 or 80.  I’ve long been not a fan of that, as I’ve said many times.

But the way to figure out your optimal dose of vitamin D is to first get tested.  And let’s say you come back and your levels are low.  Let’s say they’re 25.  Then you might start taking 4000 IU to 6000 IU per day and then get retested in another two months.  If you’re then up in the normal range of, let’s say, 40, then you would reduce the dose to 2000 IU per day or 4000 IU every other day or something like that.  If it’s the wintertime, that’s probably a good maintenance dose to maintain your level.  If it’s the summertime, you may not need to do it at all.  If you’re getting at least 20 to 30 minutes of sun exposure in midday without any sunblock, that might be sufficient to maintain your levels and you don’t need to take any.  It’s really just a process of trial and error, because as it turns out, there’s a large variation in how people convert sunlight to vitamin D.  Inflammation and overweight can reduce the conversion of sunlight to vitamin D, so if you have someone dealing with obesity or any kind of inflammatory process and you put them in the sun for the same amount of time as someone who doesn’t have those conditions, they’re probably not gonna make as much vitamin D from that given exposure to sunlight.

And then in terms of orally consumed vitamin D either from food or supplements, there’s a pretty wide variation of how people absorb it, because anything that we take as a supplement or eat as a food, we have to absorb it before it gets to where it gets to.  And in my practice, I’ve seen a huge, huge range.  I mean, some people take 10,000 IU of oral vitamin D per day and barely are able to maintain their level doing that.  Other people with just 2000 IU per day, they get up into the 60s and 70s really quickly, and they actually have to stop supplementing.  So, there’s a really wide range, and unfortunately that doesn’t get talked about much in the media, and there’s just kind of this advice to take vitamin D, and none of these nuances really get discussed.

Another thing along those same lines is if you’re not absorbing oral vitamin D in capsule form very well or in the food-based form, then you could try a sublingual emulsified or micellized form.  Those are better absorbed than the capsule forms for people who have issues.  Biotics makes an emulsified vitamin D that’s pretty good, and Klaire Labs makes a micellized form of vitamin D, which is even more absorbable.  These are sublingual products you put under the tongue.

But really the gist of this is you’ve got to get tested, you’ve got to do trial-and-error supplementation between the tests, and you really need to get tested at least at a couple different times a year, because what’s gonna work for you in the summer is gonna be different than what works for you in the winter.  The good news is once you do that testing and once you figure it out, it’s generally not gonna change very much unless you’re dealing with some underlying health issues that you then address and improve.  Then your dose might go down because you’ll be absorbing it better from sunlight and from food.  But if you do this a few times, you’ll figure out your dose, and then just aim for keeping yourself in a range of 35 to 60.  And especially if you’re towards the higher end of that range, but even if you’re not, you want to always make sure to get enough vitamin A and vitamin K2 because all of the fat-soluble vitamins work synergistically.  Vitamin A protects against vitamin D toxicity.  Vitamin D and K2 protect against vitamin toxicity, and a lot of these potential problems with the toxicity of fat-soluble vitamins in high doses could be mitigated or completely avoided by just ensuring an adequate intake of all of them together.

Steve Wright:  That’s a great update on vitamin D.  When it comes back to the question from Ben when he’s talking about having a shift schedule, it sounds like what you might suggest to him then would be something like, you know, when he can before he goes into work, just get a little vitamin D from the sun and not worry too much about supplementing until he gets his levels tested?

Chris Kresser:  Yeah, get the levels tested first of all.  I mean, that’s relatively easy.  Any doctor will do it.  It should be covered by insurance.  You can even order them yourself from DirectLabs.com or PrivateMDLabs.com or AccesaLabs.com.  I mean, it’s very easy and it’s fairly cheap, so there’s no reason not to do it.  And once you have the baseline level, then you can determine whether you need any supplementation to be in the 35 to 55 or 60 range.

What to do about chronic constipation

Steve Wright:  Got it.  OK, cool.  Well, let’s move on to the next question from Mike.  He asks:  “In a recent podcast episode, Steve asked you if you had a go-to treatment for helping with constipation, and you said, ‘I often will use magnesium glycinate in fairly high doses.  That’s a chelated form of magnesium that’s easier to absorb and it doesn’t affect the gut in the same way that magnesium citrate and oxide do.’  Is this a DIY kind of treatment that I can try?  If so, what kind of dosage should I start at, and how high should I go?  I’m a 39-year-old male, 5’8″, 150 pounds, with chronic constipation.  Thanks.”

Chris Kresser:  Yes, it’s definitely a DIY treatment.  It’s very safe.  Magnesium is well tolerated, especially magnesium glycinate.  With chronic constipation, I’d probably recommend a starting dose of close to 400 mg.  A lot of the capsules are 120 mg, so three capsules maybe just before dinner.  And then you can increase up to 800 mg safely.

So, that’s definitely worth a try, and I would recommend it if you’re dealing with chronic constipation.  But I will say also that in my experience and from my reading of the scientific literature, chronic constipation is almost always caused by intestinal dysbiosis, so an imbalance of good and bacteria in the gut.  And in particular, it’s often caused by a lack of bifidobacteria in the large intestine.  There’s a strong association between low levels of bifido and constipation.  I talked about that in my gut-brain-skin axis presentation at the Weston A. Price Foundation, the Wise Traditions Conference that I spoke at recently.  So, magnesium glycinate can be helpful in the transition period while you’re healing your gut and even long term, because a lot of people, as I’ve said before, don’t get enough magnesium through the diet even in the context of a healthy diet.  But I wouldn’t only do that.  I would be focusing on gut dysbiosis, and you can get the organic acids Organix Dysbiosis test to see if there’s SIBO or dysbiosis.  I would also do a stool profile to make sure there are no pathogens, like parasites or bacteria or yeast, that can be contributing, because that’s often a player in constipation.

Once you’ve ruled those things out and dealt with them, though, making sure you’re eating plenty of fermented foods, and I’ve found prebiotics to be more effective for constipation than probiotics in most cases.  Now, prebiotics are indigestible starches that selectively stimulate the growth of Bifidobacter and other beneficial bacteria in the colon, but they’re also a FODMAP, so some people may not tolerate them very well.  But I’ve actually found that even for people who are FODMAP intolerant, if they’re dealing with really intractable constipation, a really small amount of prebiotics can be helpful if they start at a really, really low dose and build up really slowly and carefully.  And what this will do is it will dramatically increase the levels of Bifidobacter, and since 70% to 80% of the dry weight of stool is bacteria, when you increase the amount of Bifidobacter, you’re gonna increase the bulk of the stool, and that’s gonna help with chronic constipation in most cases.  That’s the long-term goal, is to fix that gut flora, and that will eventually resolve the chronic constipation, but you really need to have a lot of patience with it because it can take months and, in some cases, even years.  You can’t speed it up very easily because if you take large doses of probiotics or prebiotics in effort to do that, you’re gonna cause yourself a lot of pain and discomfort and probably make the constipation worse rather than better.  So, it usually just needs to happen really slowly.  It requires a lot of patience and a kind of methodical approach, but in almost everyone I’ve worked with, it pays off in the end.

Another thing to consider is a product called Ageless Hydro-C, and I use it when magnesium glycinate doesn’t produce the desired effect even at 800 mg.  And Ageless Hydro-C is a blend of minerals, chelated minerals, not just magnesium, and vitamins also.  It contains vitamin C and potassium and calcium in a good balance.  Probably the only risk of taking a high dose of magnesium like that over the long term is causing a mineral imbalance, you know, with potassium or calcium or other minerals.  So, if someone’s gonna be taking a high dose of magnesium or requires that, I might suggest Ageless Hydro-C over the long term to get some of the other minerals.  And of course, we want to be addressing the gut dysbiosis throughout that period as well.

The last thing I’ll say about chronic constipation, another issue is motility.  In some people, it’s not as much about the gut flora; it’s more about motility, and the natural peristaltic action isn’t happening property.  And that can often be a gut-brain axis problem, which we’ve discussed a few times on the show.  And so, to deal with that, you want to pay attention to stress management, to hypothalamic-pituitary-adrenal axis health, aka adrenal fatigue syndrome.  Serotonin and GABA are two neurotransmitters that are produced in large amounts in the gut, in fact, much larger amounts than in the brain.  Serotonin, in particular, is associated with gut motility.  So, in some cases, 5-HTP, which is a precursor to serotonin, can improve constipation, and it’s pretty safe to take, so like 100 mg in the evening time.  Some practitioners, myself included, will also recommend that if you’re taking 5-HTP in the evening, you want to take some tyrosine in the morning so that you don’t create an imbalance of neurotransmitters.  Tyrosine is a dopamine precursor.

So, those are a few things that you can focus on for chronic constipation, and as I said in the beginning, it’s also a really good idea to rule out small intestine bacterial overgrowth or a fungal infection or a parasitic infection, because a significant percentage of the time with chronic constipation, one of those will be present.

Steve Wright:  That’s an awesome, very distilled overview of chronic constipation, so I appreciate that, Chris, and I’ll only add that, since I see a lot of this on my site, if this guy is already doing the paleo diet or a real food diet, or anybody else that’s out there, and they’ve tried some of these other things, a lot of times what I also find is people are actually not eating enough fat, and so another DIY as you step into getting all the testing done and making sure you’re clear of all the potential pathogens and potential hormonal issues, is try increasing your fat using some supplemental coconut oil or olive oil or MCT oil, and that can also help move things along.

Chris Kresser:  Cool.

Correcting female hormone imbalance

Steve Wright:  All right.  Let’s roll on to the next question here.  This one comes from Allison, and she asks:  “What is the best way to retrain one’s body to produce higher levels of progesterone without using birth control?  Can it be done?  I get intense PMS symptoms, painful cramps in my ovaries and the front of my legs, brain fog, sugar cravings.  I’m very irritable every 23 days, accompanied by heavy flow.  I was able to delay PMS by using a progesterone cream this month, but I understand that this is not a good long-term solution and that PMS can come back as soon as I have my period.”

Chris Kresser:  Yeah, this is difficult to answer on the podcast because it’s potentially very complex, but I’ll do my best in giving a summary of what the potential issues might be.  As I said earlier with an earlier question, with female hormone imbalances, 9 times out of 10 there’s an underlying adrenal hormone imbalance that’s contributing and a dysregulation of the HPA axis, so it’s really important to get a test, like a cortisol/DHEA test, to see what the status of the HPA axis is and address any of those issues that are present, because it’s really hard to work with a progesterone imbalance or female hormone imbalance when you’re not also addressing the adrenal hormones.  And of course, stress management would be a big part of addressing an HPA axis issue if there is one, in addition to supplements.

Bioidentical progesterone in a sublingual form can actually be helpful here.  The reason I’m not a fan of creams — I mean, there are a few reasons, but one of the main reasons is that it’s not usually given in a cyclical fashion because it’s really hard to dose it accurately, and as I was saying earlier, progesterone needs to be taken at different doses at different times of the month because it’s not produced in a linear fashion throughout the month.  So, again, getting a full monthly hormone profile and then tailoring the dose of progesterone according to the results of that profile is what’s gonna give you the best results.  And this isn’t something that you would do forever.  The idea is that you get your body back into the optimal range of progesterone production by using progesterone, and it’s much easier, in general — This is true not just for hormones, but for other conditions. — One of the reasons that using supplements like this works is that it’s a lot easier for the body to maintain production of something in a normal range than it is for it to get it back to the normal range when it’s way outside of it.  Does that make sense?

Steve Wright:  All right, but I’m engineer, haha.

Chris Kresser:  Right, exactly, haha.

Steve Wright:  So, what you’re saying is that if you’re way high or way low on a graph and you’re trying to get into a range, it’s much easier to supplement in order to bring it into the range and then the body can kind of retrain to that range rather than — The body has a really hard time to bring it back to the reference range.

Chris Kresser:  Isn’t there some engineering term like tolerance?  Anyway, whatever.

Steve Wright:  We don’t want to go there.

Chris Kresser:  Haha.  I’m demonstrating my ignorance of engineering.  But yeah, if there’s a normal operating range for hormones, and there is for hormones and pretty much every other substance in the body.  We’ve talked about homeostasis before, which is the body’s state of balance where everything is happening within that normal range.  And when things get outside of that range, of course, we want to address the underlying mechanism, and that’s gonna be the key to long-term healing, but sometimes just bringing things back into that normal range is a way of addressing the mechanism, and that’s why hormone protocols do work when they’re used judiciously and appropriately.  So, I think all of the things that we talked about in the first question would also apply here, but in addition to that, using some progesterone might be a good idea, but using it in the right way rather than a cream that’s applied at the same dose throughout the month.

Steve Wright:  You know, the other negative that I’ve heard about the progesterone creams is that it’s very easy to transfer to another person, so like a kid if you’re holding them or a lover if you’re in bed together.

Chris Kresser:  Right.  And the cream tends to build up in the tissues much more than the sublingual stuff because of the way it’s applied and because it’s free-fraction.  So you know, different practitioners have different approaches and philosophies about this stuff, but I prefer the bioidentical sublingual administration for a number of reasons, but probably the main one is the precision of dosing.

Steve Wright:  Makes complete sense.  All right, are we gonna roll on to the next one?

Chris Kresser:  Yeah, we have time, I think, for one more.

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Diet recommendations for cataracts

Steve Wright:  OK, great.  This next question comes from Jean.  “My optometrist tells me that I’m developing a cataract in one eye.  A nuclear sclerotic is how he put it.  I wonder if there are specific recommendations diet-wise that might either reverse or slow progression or improve/preserve vision in general.  Thanks.”

Chris Kresser:  Yeah, so for those people who aren’t familiar with cataracts, the lens of the eye, which is what allows us to focus, just like the lens of a camera, is filled with a clear protein-containing liquid.  And if the proteins in the liquid denature, they get cloudy, and then that can cause the vision to get cloudy, and that’s what cataracts are.  They can be congenital, which means they’re present at birth.  They can be caused by physical trauma to the eye.  Hypertension and diabetes increase the risk of cataracts, as does living at high altitude.  This is another condition that’s not very well understood, and there are a lot of different theories about why they happen.

Vitamin A, as I’m sure many people know, is a really important vitamin for the health of the eyes, and I think a pretty high dose is required to make progress with cataracts to either stop the progression or, in some cases, improve things, something like 25,000 to 50,000 units a day of retinol, not beta-carotene.  Beta-carotene is a precursor to vitamin A, and although some beta-carotene is converted to retinol, the active form of vitamin A, that conversion is pretty poor in humans.  So, a food-based form, like cod liver oil, is a really good choice, and if you can’t get that much from cod liver oil, you could add some retinol supplementally.  But it’s very important to get the food-based form, and as I said just a couple questions ago, it’s really important to make sure you’re getting enough vitamin D and vitamin K2 if you’re gonna be taking that dose of vitamin A because vitamin A can be toxic at high doses when vitamin D and vitamin K2 are deficient.  This treatment also, I should point out, shouldn’t be used in children, this high dose of vitamin A, or in people with severe liver disease.

Another option is N-acetyl-carnosine eye drops, and there’s one product that is called Can-C, used twice daily.  Another, an herb from both the Western and Chinese pharmacopeia that can be helpful is bilberry, and something like 80 to 120 or 160 mg three times a day would be the dose.  There’s a Chinese herb called Ba-wei-wan, and that really can be helpful in this situation.  There’s a formula called Clinical Nutrients Eye Formula.  It’s by PhytoPharmica.  So, I would do these things and try it for six months or so, and if it doesn’t work and the cataracts are continuing to progress, the surgery is usually pretty effective and pretty safe as surgeries go.  I mean, there’s always a risk with surgery, but it’s not one that’s particularly problematic.

Steve Wright:  Do you have any thoughts on — Does that include LASIK surgery?

Chris Kresser:  Is LASIK effective?

Steve Wright:  Yeah, do you have any thoughts on LASIK as well, since we’re talking about eye surgeries?

Chris Kresser:  I haven’t looked into LASIK in detail, but just anecdotally, from what I’ve heard, it is pretty effective and doesn’t tend to — I have a number of patients that have had LASIK and have been happy with it, but it’s not something I’ve studies much myself.

Steve Wright:  Gotcha.

Chris Kresser:  I think we have time for actually one more.  The next one is pretty short, so I think we can do that.

Does Cod Liver Oil cause acid reflux?

Steve Wright:  All right.  This is a good one.  We’ve banged through a lot of questions today.  OK, the last question for today’s podcast comes from Tim.  He says:  “Chris, I recently started taking fermented cod liver oil from Green Pasture after reading a few of your articles where you mention the health benefits.  Unfortunately, the stuff is giving me some pretty bad reflux, and I am taking a very low dose, 0.5 mL.  I’ve tried mixing it with a few different fruit and vegetable smoothies to aid in digestion, and so far, grass-fed milk with banana seems to help the most, but I still get a little bit of reflux.  I don’t want to quit, as I want to get the benefits and the potential nutritional value of FCLO, but the reflux is making it very hard to continue.  Any suggestions on what I can do to help digest the stuff easier?”

Chris Kresser:  Yeah.  If that small of a dose is causing problems, I wonder if he has problems digesting other fats or if it’s just particularly the fermented cod liver oil.  I’ll try to answer it both ways.  So, if it’s trouble also with other fats or fish oils, then something like ox bile could be helpful and cholagogues, like dandelion root, ginger, milk thistle, beetroot powder, in an effort to kind of get the gallbladder functioning better to help with fat digestion.  He could also spread the dose.  It sounds like he’s taking a small dose already, but he could spread it out throughout the day, so instead of taking it once a day, take it three times a day in even smaller doses.

If it’s only a problem with the fermented cod liver oil, then some more investigation would probably be helpful.  Like, do other cod liver oils or fish oils cause the problem, or is it only fermented cod liver oil?  The oil is usually better tolerated than the capsules in terms of this problem of belching, but some people who have the belching with the oil who have tried the capsules actually do better with the capsules, so you might want to try.  They have a fermented cod liver oil/butter oil blend with the capsules, and if you take those with food, if you take the capsules at the beginning of a meal and then eat the meal, because you’re digesting it with the rest of the meal, that can sometimes help.

The AdaptaGest product that Robb Wolf and I created as part of the Paleologix line has a number of cholagogues and other nutrients that are helpful in this situation.  This is kind of one of the scenarios that we were imagining when we designed the Paleologix line — not specifically fermented cod liver oil, but problems with fat digestion in general. [Note: The Paleologix supplements discussed in this post are no longer available. In place of AdaptaGest, I now suggest Super Enzymes by Now and Betaine HCL/Pepsin by Thorne Research.]

So, try some of those things, and get back to us, let us know how you do, and also let us know if you’re having issues with other fat digestion or if it’s just the fermented cod liver oil or cod liver oil in general or fish oil, because that will help determine what you do from there.

Steve Wright:  Great stuff.  Well, we were all over the board today, Chris.  Is there anything else you want to let the listeners know about?

Chris Kresser:  I don’t think so.  I just wish everyone a happy holiday season.  However it is that you spend the time, if you’re with family, I hope you enjoy that, and we’ll be back next year.  We’re gonna be talking with Dan Pardi and Stephan Guyenet about a pretty exciting new weight loss program they’ve put together, so I’m looking forward to that.

Steve Wright:  Good deal.  Yes, everyone have happy holidays of your choice and spend a lot of time with your friends and family and do a lot of laughing.  We appreciate you listening to this podcast.  If you want to get more of Chris, other than ChrisKresser.com, you can also go over to Facebook, and that’s Facebook/ChrisKresserLAc, or you can catch him on Twitter where he sends out a lot of different papers and stuff that he doesn’t necessarily always blog about, and that’s Twitter/ChrisKresser.  So, thanks again for listening.  And if you want to keep sending us your questions — we do our best to get through as many as we can — send those to ChrisKresser.com.  Go over to the podcast submission link, and go ahead and put those in there.  And if you enjoyed listening to the show, head over to iTunes and leave us a review.  It really helps us get more listeners.  As you review us, we get higher rankings and more people get to hear this message, so it helps more people, so we really appreciate it when you do that.  Thanks everyone, and we’ll talk to you on the next episode.

Chris Kresser:  Thanks everybody.  Take care.

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Join the conversation

  1. The BURNING question I have: what about chronic constipation in a young child?

    My daughter’s 4 and healthy. She’s only sick a few times a year with colds and such, which have always been treated at home with natural remedies. However she only has a bowel movement once every two days (sometimes going longer than 48 hours), and her stools are often compacted, cracked lumps that look hard. She doesn’t strain hard or have pain (as she always tells me).

    I have been keeping a diary since January 2013 and she has never been regular. There were periods when she did have a bowel movement everyday *most* (not all) of the time, but looking back I think she has been having this pattern of constipation ever since she started eating more solid food (around 1YO). I did not worry that much then because due to lack of knowledge I thought constipation meant straining hard, having pain going, and/or passing small hard pellets, none of which she ever did.

    About a year ago an IgG food sensitivity test was done on her and she was found to react to over 30 foods (all nutritious foods, NO reaction to soy or any grains, which I suspect is because she hadn’t been eating much/any of those foods). I was in disbelief because she seemed so healthy, no skin or behavioral problems, etc. After reading around I decided to focus on healing her probably leaky gut (I didn’t have the best of diets when pregnant, had a flu shot in the 3rd trimester, took antibiotics after delivery, and she had the Hep B vax at birth and formula the 2nd day of her life) rather than elimination (because she didn’t have any apparent reaction to any of them). I had been giving her probiotics (Klaire Lab’s) since 6MO (then stopped), but I upped her intake of (homemade raw milk) kefir, fermented veggies, and gave her a popular Canadian brand of probiotic.

    She was exclusively breastfed till 6.5MO (with the exception aforementioned plus another 3 oz of formula), 90% breastfed till 1YO, no vax since 6MO, has never had OTC or antibiotics. We have been eating a WAP diet for 1.5 years, with the last 6 months half WAP half Paleo. The Paleo-supportive ND I took her to wanted me to eliminate dairy and potentially eggs too. 🙁 Today’s our day 7 of being dairy-free and nothing’s changed except her stools look even worse. I’ve also been giving her 100mg of Magnesium Bisglycinate and an epsom salt foot bath daily (ND said 50mg). I give her 3 abdominal massages a day.

    I’m worried about her gut health. I don’t know what to do next and would greatly appreciate any insight/info. Can I increase the Mg dosage? What testing to do to know more? How long should I eliminate dairy for (ND said 1 week but I am skeptical)?

  2. Chris, do you have any guidelines for Lauricidin use and dosing while pregnant and/or breastfeeding? Thanks.

  3. Hi Chris,
    I have a question about Bifidobacteria/Bifidus. I’ve suffered for many years with IBS, mostly with chronic constipation/gas/heartburn (and skin problems). I started paleo about 2 years ago, and was doing a very low carb version for weight loss. Most of my symptoms went away, and the constipation and skin issues improved a bit. I then read that very low carb diets over a prolonged period of time were unhealthy, particularly for women. So, I started adding in lots of carbs in the form of sweet potatoes and other root veggies and winter squashes. My acne was suddenly worse than it’s ever been and I had horrible stabbing gas pains in my upper stomach. I went to an ND and got diagnosed with a pretty bad case of SIBO. She put me on antibiotics, probiotics, and the SCD/GAPS protocol along with strict paleo. The probiotics I’ve been put on are Acidophilus/Bifidobacteria/Fructoogliosaccaride (Metagenics UltraFlora Synergy). For some reason, I can’t tolerate the “allowed” starches on the SCD (squashes and rutabagas and such), and I’ve noticed some of my symptoms getting worse. My skin is clearing up, the constipation and gas are improving, but every once in awhile, I’ll go to a restaurant and order something simple that shouldn’t violate anything, and get horrible stabbing stomach pains and diarrhea. I’d never experienced this kind of severe reaction before starting treatment. I had general problems that had a relatively slow onset, but no “attacks” like this. I’ve been searching the SCD/GAPS websites and forums, and there seems to be a consensus in that community that Bifidobacteria/Bifidus should be completely avoided, because once you kill off the bad bacteria, these particular strains of “good” bacteria are opportunistic and will tend to take over and cause their own host of problems. I notice that you recommend these probiotics for constipation sufferers. What’s your opinion of the SCD aversion to them?

  4. Have you ever heard of The Creighton Method? It is a Natural Family Planning tool at its core, but it involves tracking, charting and interpreting with a practitioner. They were able to identify low progesterone, and direct me to a Creighton OBGYN who would have drawn levels and RXd medications. I am waiting until the new year, with new OOPs and deductibles, etc. But they are strongly in line with taking charge of your own health, and rejecting the status quo if it doesn’t line up with research. I cannot say enough good about this method for a woman struggling with hormone/cycle troubles. Including infertility, PMS/PMDD, and post birth control syndrome.
    I myself had Mirena, and had it removed following elevated blood pressures (preM and now 106/70’s then 150/98ish) weight gain, and an inflammatory mess. Between Creighton and Paleo I feel very lucky to have my life back.

  5. Hi, Chris. Thanks for all the great info! I had a quick question about hormone balance: do you recommend cycling progesterone for a woman in surgical menopause who is replacing estrogen in a continuous steady dose?

  6. Another former canker-sore sufferer here… I would get bouts of sores every 3-4 weeks (roughly correlated with the onset of menstruation, but they were also triggered by the usual suspects – stress, lack of sleep, biting my mouth) and they occasionally grew to the size of peas or larger. I’ve been on a very strict paleo diet (my only “cheats” being some red wine, chocolate and the occasional paleofied baked good) for about four months now and, among the other benefits of eating clean, I haven’t suffered a canker sore since then.

    I transitioned to paleo from a low-fat vegetarian diet, so it’s difficult determine whether the gluten, dairy, lack of healthy fat or complete absence of animal protein was the culprit, but I am happy to say that those nasty little buggers are no longer a problem for me. I would strongly suggest that the caller do a strict month or two without grains and dairy…

  7. Hi Chris,

    The talk about hormone balance reminded me of some questions I was hoping you could answer:

    What’s your preferred brand of DHEA? I’m sure you’ve mentioned before you prefer sublingual administration but I don’t know if you’ve ever mentioned a specific product.

    If you suspect a patient has issues with heavy metal exposure/burden, what’s your preferred test for that?

  8. I was Mr Canker Sore for a decade or two. I got all the “blame the victim” diagnoses like stress, acid foods, mouth biting, etc. The difference was that where most people heal, I would fester and fester and it was horrible. I tried everything and finally hit on two things that really seemed to help.
    1. no sodium lauryl sulfate – I use biotene toothpaste so when I do start to heal, the sore is not chemically scrubbed open
    2. Avoiding gluten. I’ve come to think that canker sores are related to gut health and since going paleo a few years ago, I am completely normal concerning canker sores. I might get a small one every now and then but it heals and doesn’t fester and grow larger every day. Best of all is avoiding the severe pain.
    This ph food idea is like avoiding spice as a cure for gerd. It’s confusing symptom management for the cure.IMHO

  9. I take the Green Pastures FCLO and used to get some icky burps shortly after taking it (I take the encapsulated version). I figured out that if I take it right before a meal I don’t have the issue. Also, if I take it then follow with a spoonful of ghee or coconut oil I don’t get the burps.

  10. Regarding canker sores: I have been told that they are caused by foods with a low pH. Since then (and before I went paleo), I has noticed a lot of outbreaks during the periods when I had consumed lots of yogurt (non-frozen or frozen), so I was kinda buying into the low pH thing. Since then, having learned a lot more of what (possibly) problematic things are in cow’s milk, I have some doubts. Still, it might be worth dropping yogurt and citrus fruit (and any other acidic foods) for a trial period, if one is afflicted with the sores on a regular basis.

  11. Great tips on constipation. Magnesium, bifido and fat are a pretty fool proof combo. I am so sensitive to magnesium in all forms. I have to watch how much I get even through food. Renew Life has a colon care probiotic with all bifido that I’ve had success with.

  12. Fermented Cod Liver Oil totally revoluntionized my periods, in response to Allison’s question… I had all the same issues, are they are 90% gone. All I started taking was FCLO and magnesium glycinate.

  13. I have an Ergo Desktop (the model is the Duel Kangaroo). It’s an adjustable desk so I raise and lower the desktop. It sits right on my regular desk at work, so I didn’t need to change out any furniture. It’s great! I’ve been wondering about getting a treadmill for the floor as well, so I’d love an episode about your research on the quietest brands, etc., soon.

    Keep up the good work!

  14. Hello Chris, excellent show as always. I’d like to know more about your treadmill desk setup. What kind of treadmill did you go with?