Solutions for Snoring, Overactive Bladder, and Balancing Goitrogens in Your Diet

Another Q&A episode. Enjoy!

Note: The Prescript-Assist supplements discussed in this article are no longer available. Please click here to learn more about a substitute, the Daily Synbiotic from Seed.

In this episode, we cover:

1:57 What did Chris eat for breakfast?
4:00 The latest private practice update
12:40 How to balance goitrogens in your diet
22:18 What to do about an overactive bladder (especially at night)
26:36 Solutions for snoring
40:16 Are microwaves safe?
44:05 Are some probiotics bad for you?

Links We Discuss

• Additional Reading: Nutrition and Physical Degeneration
• Whole Health Source Series on Malocclusion
• WAPF Article: “Is it Mental or is it Dental?”
• Custom Probiotics D-Lactate Free Probiotic

Podcast: Play in new window | Download

Subscribe: RSS

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 from SCDLifestyle.com.  With me is integrative medical practitioner and healthy skeptic Chris Kresser.  Chris, how’s it going?

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

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

Chris Kresser:  Good.  So we have a Q&A episode today.  I’m not going to talk about any studies to begin with.  We’re just going to dive right into questions, but before we do that, I’m very happy to announce that just this morning I finished the last sentence of the rough draft of my book, which feels really good.

Steve Wright:  Congratulations.

Chris Kresser:  Thank you.

Steve Wright:  Did you end with a period or an exclamation point?

Chris Kresser:  It was a period, Steve.

Steve Wright:  Oh, OK.

Chris Kresser:  This is just the rough draft.  There’s a whole round of edits, but we’ve already actually started some of the edits.  I think it will go pretty fast, so I’m pretty excited.  It’s been a lot of fun writing the book, but it’s also, of course, been a lot of work, so I’m glad to be coming to the end of that chapter, so to speak.

Steve Wright:  Yeah, so this is June when we’re recording this, and you started the manuscript back in, what, November?

Chris Kresser:  Yeah, I guess November or December, but I didn’t really start writing in earnest until probably March or April, so it was a pretty fast turnaround.

Steve Wright:  Cool.  Well, congratulations.  Good luck on the next part.

Chris Kresser:  Thank you.

What Did Chris Eat for Breakfast?

Steve Wright:  So before we get going into Q&A, what did you have for breakfast?

Chris Kresser:  Let’s see, what did I have?  We had these lamb Merguez sausages, which were really good.  And we made some potato hash browns.  We just peeled a russet potato, grated it on a box grater, and then cooked it in some bacon grease.  And we have one of these… not a grill.  What do you call these things, Steve?  You know, they’re for making pancakes?

Steve Wright:  A griddle?

Chris Kresser:  A griddle.  That’s right.

Steve Wright:  Very close to a grill.

Chris Kresser:  See?  All my brain power has just been dumped into the book.  Yeah, so it’s electric.  You put it on the counter and plug it in, and it has a little temperature gauge, and we used that to make hash browns.  Not a lot of pancakes happening around here these days, but it’s really good for hash browns.  And then I made some steamed broccolini that we got from the farmers’ market with a little bit of olive oil and salt, just pretty simple.  And then some sea kraut, like a sauerkraut with cabbage and some sea vegetables.

Steve Wright:  Sounds pretty delish.

Chris Kresser:  It was good.

Steve Wright:  Cool.  Well, before we roll into the Q&A, let me tell everyone about Beyond Paleo.  If you’re new to this podcast or if you’re new to the paleo diet, maybe you haven’t been to ChrisKresser.com yet.  If so, you need to go over there right now, and when you get over there, you’re going to see this big red box, and what Chris has done is he’s put together a free 13-part email series called Beyond Paleo.  Now, this series is all of Chris’ best tips and tricks and ideas surrounding how to burn fat, boost energy, and prevent and reverse disease without drugs.  So when you see that big red box, go ahead and put your name and email in that box, and Chris will send over the first email very soon.

The Latest Private Practice Update

Chris Kresser:  All right, so I do want to talk just for a moment or two about my private practice situation before we jump into the questions.  As many of you know, my private practice has been closed to new patients for a little over a year, I think.  I don’t remember the exact date.  I only see patients two days a week so I can have time to continue to do research and develop new treatment protocols and speak publicly and write the blog and do the radio show and develop new educational products and write a book and do all the other things that I do that make me who I am and inform my work.  And the downside of that is that I can’t see as many new patients as I would otherwise like to.  And then the way I work with patients is pretty intensive.  I start with a really detailed case review process where I spend time reviewing their case even before we meet, and so it’s very time consuming for me to see new patients as much as I enjoy doing it.

So the long and the short of it is I can only see, when I am taking new patients, about four to six new patients a week, and so I reopened on Monday on a waitlist basis.  We had finally made it through the previous waitlist that we had, and within a couple hours of sending the email there were over 200 people on the waitlist, and by the end of the week there were 600.  So we had to close the waitlist down and figure out what to do about this situation.  It’s difficult because, of course, I want to make myself available and help as many people as possible, and the blog and all the articles on the blog and the radio show and the digital programs and everything that I do for free, I get great feedback from people and I know a lot of folks have been helped by that, but of course, there are people who even though they’ve read everything that I’ve written and listened to all the podcasts and have done a lot of the digital programs, are still experiencing problems and need additional help.  It can be really frustrating when you feel like you’re doing everything you can and you’re still not getting the results that you want, and unfortunately there just aren’t that many practitioners out there yet that approach things in this way that we talk about on the blog and the podcast.  There certainly aren’t enough to meet the demand.  There’s a really huge demand.  A lot of people are really dissatisfied with the kind of care they get in the conventional model and even the kind of care they get from some alternative practitioners.

In a perfect world, I’d be able to see every single patient that wanted to see me, but in the real world, that’s simply not going to be possible, unfortunately.  And I think it’s likely to only get worse when the book comes out.  This all happened pretty fast, and I’m doing the best that I can to figure out an equitable solution.  In the long term, my plan is to create a clinician training program to train others in my approach, and then that, of course, can evolve into a referral network where I can refer patients to people that have gone through the program or other likeminded practitioners that I feel confident in referring patients to.  I want to create some more advanced-level patient trainings, like a health mastery program, for example, that just takes people through maybe a six-month course with all of my best thoughts and tips on nutrition and lifestyle and supplements with a little more detail and support and handholding than is available just by reading a book or following my blog.  And then I want to create modules for particular health conditions, like hypothyroidism and weight loss and autoimmune disease and skin disorders and things like that.  I’m going to be talking about all this stuff in my book, but because of length concerns, I was only able to really do about 7 to 10 pages for each condition, which obviously isn’t enough to do them full justice.  I mean, it’s going to be a great help for people, especially people who haven’t seen all this stuff in one place, but what I’m talking about here are much more in-depth modules on those conditions, similar to The High Cholesterol Action Plan and The Healthy Baby Code.

So that’s the good news.  The bad news is all of that stuff will take time to develop, and between continuing my private practice and seeing the patients that I have and writing the book and doing everything else, it could be a few years before all that stuff is available.  So in the meantime, we decided to do a lottery system to generate a random sequence of numbers and then use that to determine what the order of the waitlist will be.  I really thought a lot about this.  I talked to friends, and I talked to colleagues.  I turned it around over and over in my head a lot, and there were a lot of different ideas proposed.  And in the end, a lottery seemed like the best solution.  It’s certainly not perfect.  It’s all based on chance, and it means that some people who really need to see me might end up being very low on the waitlist, and perhaps other people whose need isn’t as great might be higher on the waitlist, but there’s really, I think, no way easy way to qualify that or determine that without just going over the top in terms of staffing and resource needs.  So I hope everyone understands, and I’m really sorry, especially if you end up getting a low number on the list.  I wish there was more that I could do about this, but I think this is the best it can be for right now, and down the line, if we train some more practitioners and get some more programs out there, I hope that we can meet your needs that way.

Steve Wright:  Yeah, it’s pretty obvious that you’ve put a lot of thought into this, Chris, and I think that it’s a good and bad problem to have, but I’m glad that you took the time to explain it to people because I think just hearing the deliberation and how it happened will help people really understand it when words can only say so much.  You can’t really get the full emotion of the gravity of not only health but how much you can do in a day.

Chris Kresser:  Yeah.  And I just want to say I’ve been on the other side.  I think a lot of people know my story.  I was chronically and seriously ill for many, many years, and I know what it’s like to be in that place.  I know what it’s like to feel the desperation of having tried everything and not getting well, and to feel the hope of finding a practitioner that you think might be able to help and then not being able to see that person for any number of reasons.  That happened to me on numerous occasions as I was navigating my own health journey.  And I just want to say that in each case, for me, although those experiences were disappointing, in the end I did find my own path and the way that worked for me, and I’m confident that even though it may not seem that way right now and if someone’s not able to see me, there are a lot of skilled practitioners out there, and where there’s a will, there’s a way.  So I just encourage you to keep trying and keep looking, keep your mind and your ears open, and hopefully the right solution will present itself.

Steve Wright:  Yeah, that’s such a good point.  You have to keep the state of abundance.  I had similar experiences as well for a number of reasons, and just keep that thought of abundance even when all your health problems are stacking up against you.  As long as you keep fighting, you’re going to keep gaining ground.

Chris Kresser:  Yeah.  Acceptance and also perseverance at the same time, it’s that kind of walking the razor’s edge.  So we have some good questions.  Let’s get to it.

How to Balance Goitrogens in Your Diet

Steve Wright:  All right.  This first question comes from Nina.  “Dear Chris, I’ve heard some of your podcasts on managing hypothyroid/Hashimoto’s, and I have a question about balancing goitrogens in the diet with iodine and selenium.  I can’t find this addressed anywhere online, just blanket admonitions to avoid iodine or avoid goitrogens, so if could you give me some more nuanced information, that would be great.  Thanks.”

Chris Kresser:  Sure.  The connection between goiter and goitrogenic foods has been known for about 80 years.  Back in 1929, researchers produced a goiter in rabbits by feeding them cabbage.  Goiter, which is a swelling of the thyroid gland, is most frequently caused by either iodine deficiency or exposure to chemicals or drugs that somehow block the uptake of iodine or interfere with its utilization.  Now, there are some foods that have been shown to be goitrogenic when they’re eaten in excess or if they’re eaten even in moderation but background intakes of iodine are low, and this is what the questioner is referring to with goitrogenic foods, and we have talked a little bit about this before.  These include cassava, which is also manioc or yuca, soy products, millet, sweet potatoes, cruciferous vegetables like cabbage, broccoli, Brussels sprouts, cauliflower, bok choy, kale, and collard greens.

Now, there’s a little bit of a nuance to the whole goitrogenic story.  At relatively low concentrations, they decrease the uptake of iodine in the thyroid gland from other foods that we eat.  So for example, if you’re eating goitrogens and you’re also eating some seaweeds and other foods that contain iodine, you’ll still get iodine from those foods, but you’ll get a little less than you would if you were eating no goitrogens at all.  But that’s not a problem if you’re eating an adequate amount of iodine-rich food, likes seaweeds and sea vegetables, for example, or if you’re supplementing with iodine at maybe 800 mcg or more per day.  If you’re getting that amount of iodine in your diet, a moderate intake of the foods that I just listed is not likely to interfere with iodine… well, it’ll interfere, but it won’t interfere enough to prevent you from getting the iodine that you need.  But at high concentrations, goitrogens actually interfere with the incorporation of iodine into thyroid hormone itself, and this means that even if there’s enough iodine in the diet or through supplements going into the gland, it can’t be properly utilized, and therefore, no amount of supplemental iodine or high amounts of iodine-containing foods, like seaweed, would be able to overcome a really high intake of goitrogenic foods.

Another thing to be aware of is it’s commonly believed that cooking or fermenting reduces the goitrogenic effect, but again, it’s a little more nuanced when you look at the details.  Fermenting cabbage into sauerkraut actually increases the goitrogens that it contains, but it reduces the amount of nitriles, which is another type of chemical that’s present in some foods like cabbage that has a toxic effect on the thyroid, and in fact, it’s even a more harmful effect that goitrogens.  And unlike goitrogens, the effects of nitriles can’t be offset by iodine intake or iodine supplementation.  So with fermentation, you do have an increase in goitrogens, but you have the nitriles, which are even more harmful and not offset by iodine, cut in half.  So we might say that the net effect of the fermentation of cabbage and probably other goitrogenic foods is either neutral or even positive because of the reduction of nitriles.

Most forms of cooking do reduce goitrogens, but they don’t eliminate them entirely, and it depends on the cooking methods.  For example, steaming cruciferous veggies until they’re fully cooked reduces goitrogens by about 35%.  Boiling vegetables for 30 minutes, although I don’t know when you would do that except if you were making soup because they’re going to turn to mush, that destroys 90% of the goitrogens if the water is discarded, so you would drain the water.  Of course, you would boil yuca, and it’s very important to boil yuca for 30 minutes before you have it, actually, which is again also cassava and manioc, because it’s goitrogenic and it also has some other potentially toxic chemicals.  It’s also worth pointing out that cooking greatly reduces the formation of nitriles in most cases, which we just talked about as being even potentially more harmful than goitrogens.

So to put all this together in kind of practical terms, even if you have a thyroid condition, if you have sauerkraut as a condiment, like one or two tablespoons with meals, and maybe three to six servings of steamed or parboiled cruciferous veggies a week, you’ll be fine, especially if your background iodine intake is sufficient, which I think it absolutely should be if you have a thyroid condition.

One of the things I’ve been meaning to do but just haven’t had time to do is update my article on iodine and hypothyroidism that I wrote, I think, four years ago now.  In that article, I argued that iodine can trigger or exacerbate autoimmune thyroid disease, and that is true, but it appears to be only true or mostly true when background intake of selenium is insufficient because selenium can protect against the potentially toxic effects of iodine in people that are susceptible to autoimmune thyroid disease.  So in most of my patients with thyroid issues, as long as they are taking enough selenium or getting enough selenium in the diet, iodine doesn’t tend to cause any problems or exacerbate their autoimmune condition, especially if they follow the guidelines I’ve laid out for starting with a really low dose, a few hundred or couple hundred micrograms maybe, and then building up really slowly over time.  There are a few patients, however, that do react even to a very small dose even when their selenium intake is adequate.  And in those cases, they might want to exercise a little bit more caution with goitrogenic foods because they may not be able to increase their iodine intake to the point where it’s sufficient to protect against the potentially iodine-limiting effects or goitrogenic effects of these foods.

So like always, the answer is depends on your individual circumstances, but I can tell you that in most cases, especially provided that you’re able to tolerate either sea vegetables, like kelp and hijiki and kombu and dulse, those are all relatively high in iodine.  Kelp, in particular, is very high.  Nori is not so high, incidentally, but if you’re able to eat seaweeds like that regularly and/or you’re taking iodine supplements, then I think the guidelines I just laid out are absolutely fine, and you may even be able to eat more than that without any negative effect.

It’s also important to point out that a lot of the potentially goitrogenic foods are really healthy foods that have a lot of other beneficial properties.  The cruciferous vegetables, for example, have some compounds that some researchers believe are cancer fighting or cancer preventing, and all the leafy greens, like kale and collard greens, are really nutrient dense, so it’s probably unwise to remove these foods from your diet altogether.

The last thing that I wanted to point out is that pregnant women may also want to be particularly careful with goitrogens just because iodine’s a crucial nutrient for pregnancy and the development of the growing baby.  So maybe making sure you get a little extra iodine and maybe dialing back the amount of these foods a little bit would be a wise precaution during pregnancy.

Steve Wright:  Well, thanks for laying that out.  I think goitrogens, at least from my perspective and kind of taking maybe somebody who doesn’t have a Hashimoto’s/hypothyroid issue, it seems like goitrogens kind of fall into that class of compounds in foods where you can really get lost in the weeds when you look at foods from a whole, but I think you laid it out pretty simple there.

Chris Kresser:  All right.  Let’s go on to the next one.

What to Do about an Overactive Bladder (Especially at Night)

Steve Wright:  OK.  This next question comes from Tom.  “I’ve been struggling with what seems to be an overactive bladder for some time now.  It is mainly a problem when I’m trying to sleep.  Before I can fall asleep, I have to get up several times to try and empty my bladder because of the constant sensation that it is full.  Then I will wake up multiple times during the night to urinate.  Sometimes it prevents me from falling asleep at all for many hours while I make several trips back and forth to the bathroom.  I’m 30 years old and have no known health issues.  I’m wondering if you know of any causes or possible solutions for this problem.”

Chris Kresser:  Well, I hate to point out the obvious here, but actually in some cases with my patients this has been the solution, is to if you’re drinking a lot of liquid late in the day to not do that, so I’ll just throw that out there in case that’s part of the issue here.

Steve Wright:  It could be.

Chris Kresser:  It sounds to me like it’s only happening at night, and that’s the most obvious possibility, that you’re just taking in too much liquid at night.  For a lot of years, there was a big emphasis on drinking at least 8 glasses and maybe 12 glasses of water per day, and there’s no research to back that up, and for a lot of people I think that’s actually even a bad idea.  And in some cases I had patients that had been following that recommendation for years, not because they were thirsty for that much water but just because they thought it was a good idea, and then when they cut back significantly, that solved the problem.  So I’m assuming that that’s not the case, but I just wanted to put that out there.

One of the most common causes of frequent urination is chronic urinary tract infection, and of course, this is more common in women, but it’s still possible in men, and I’ve seen it in some men.  And sometimes urinary frequency and urgency are really the only symptoms, and they can linger for quite a long time, so getting a urinalysis is probably a good step to take, if anything, just to rule that out.

He’s a little young for this, but it can happen.  Benign prostate hyperplasia, or BPH, is another really common cause of frequent urination, and symptoms do tend to get worse at night.  So if you haven’t been checked for that, I would recommend doing that.

He didn’t mention sleep being an issue, but one of the kind of hidden causes of frequent urination that a lot of people don’t know about is sleep apnea, and it’s a pretty common problem, actually.  Quite a few people suffer from it.  So getting checked for sleep apnea is another possibility.

And then finally, cystitis or interstitial cystitis, so either a bladder infection or interstitial cystitis being an autoimmune disorder where the immune system attacks the bladder and the bladder becomes irritated, that can cause this kind of symptom profile with few other symptoms, actually, too, so it can be a little bit difficult to identify and diagnose.  So seeing perhaps a urologist and looking at that condition, seeing if other symptoms match your experience, that could be a potential cause.  And if it is, of course, all of the things we’ve talked about in the past to deal with autoimmune conditions from a nutritional perspective, like perhaps trying the autoimmune version of the paleo diet and boosting glutathione levels with either whey protein powder or glutathione precursors or S-acetyl glutathione, which we talked about on a previous show, or liposomal glutathione, optimizing vitamin D levels, low-dose naltrexone, getting enough sunlight, stress management – all of those things are, of course, things we’ve discussed in the past in the context of treating autoimmunity.

So those are some ideas.  Check that out and let us know what you find out.

Solutions for Snoring

Steve Wright:  All right.  Let’s roll on to the next one.  This one comes from Nathan.  It’s kind of a sleep theme so far here.  He’d like to hear your thoughts on possible causes and solutions for snoring.  He’s not at all overweight, eating a clean paleo diet, and has no real medical issues that he’s aware of.  He’s claiming that he’s a pretty regular snorer, however, but not at all every night, definitely consistently enough to annoy his partner.  “Is there anything that I can do nutritionally to outright prevent this?”

Chris Kresser:  Snoring is interesting.  It’s one of those conditions that’s, I think, multifactorial.  It has a lot of potential causes.  Sometimes those are difficult to pin down.  There are a lot of nonspecific symptoms associated with it.  We just talked about sleep apnea, and I think that’s one of the first obvious things to try to rule out because snoring can be part of the whole sleep apnea presentation.  However, sleep apnea often has other symptoms such as choking or gasping during sleep, memory loss, high blood pressure, chest pain, depression, headaches, reduced libido – all the kinds of things that you’d expect when someone’s not getting enough oxygen.  And he didn’t mention any of those, and his partner would probably notice some of them, especially if she’s noticing his snoring, so it’s doubtful that that’s the problem for him, but it may be worth checking out.

The causes of snoring, as I mentioned, are numerous.  From a convention perspective, it could be an issue with mouth anatomy, like having a large tongue or a narrow airway due to a thick soft palate or an elongated uvula.  It could be an issue with nasal anatomy, like a deviated septum, or throat anatomy, like poor muscle tone in the throat, which can be due to aging or other causes.  And then chronic nasal congestion due to things like allergies and sinus infection is another possibility.  Again, he didn’t mention any of these things, but in the event that some of those ring a bell, it’s worth considering.

In my experience, snoring can also be caused by food intolerances.  Snoring mostly involves a narrowing of the airway, and if you have kind of chronic low-grade inflammatory responses caused by gluten or milk protein intolerance or any other food intolerance, that could certainly contribute, so if you haven’t done this already, doing a 30-day reset with no dairy and possibly even the autoimmune modifications if you want to take the extra step might be a good thing to do.  And if it improves during that, then you know that it has something to do with something that you’re eating, and then you can start to add foods back in and try to figure out what’s causing it.  Some people report that avoiding caffeine and/or alcohol, especially later in the day for caffeine and at night for alcohol, can make a difference.

But there is a whole other approach to consider here, assuming you do all that stuff or you’ve already done all that stuff and it hasn’t worked.  There’s a device called the Silent Nite SL, and it’s something you put in your mouth.  It’s prescribed by a dentist.  It’s made of, I think, a high-grade BPA-free type of plastic, and it pushes the lower jaw forward using S-shaped connectors that are attached to lower and upper trays.  And you can also work with a dentist that specializes in what they call dental orthopedics or functional orthopedics, and they will make a similar device, but they do it in a more sophisticated way that’s really kind of customized for your mouth.

So why would they do this, and why would this help?  Well, we’ve talked before and I’ve written a lot about Weston Price, the dentist back in the 1930s that became interested in why in the modern world people’s teeth were so messed up and their facial structure was really different.  He just didn’t feel like that made sense from an evolutionary perspective.  Why would we evolve to just have our teeth decay and start falling out and be totally crowded in our mouth?  He didn’t think that was a normal circumstance even though it was completely normal in the industrialized world and in the US where he was practicing medicine.  So he took off to travel around the world to make contact with cultures who’d had very little Western contact and were still living their traditional diet and lifestyle and find out, first of all, whether these dental problems that were so epidemic in the industrialized world were an issue in those places and, second of all, if they weren’t, what were the common threads in all of those different places that he visited that could explain why their teeth and their facial structure was so good and why ours was so bad.  And he published his findings in a book called Nutrition and Physical Degeneration.  It’s a fantastic book.  I highly recommend it for people who are interested in medicine and anthropology and just this topic in general.

He indeed did find that people in traditional cultures around that world that he studied had beautiful wide faces with often perfectly spaced teeth that meet tip to tip when the mouth is closed, and this is contrasted with the modern face, so to speak, that’s characterized by underdeveloped cranial structure and maxilla, the jaw, really narrow faces with weak chins and crowded, overlapping teeth with an overbite, which is known as malocclusion in the scientific literature.  And he studied, then, the nutrition of the people in all of these places, and I’m sure many of you are familiar with the Weston A. Price dietary approach.  It’s very similar to what I advocate with a few differences, but it’s a nutrient-dense diet with no processed and refined foods.  And he also was able to observe that people in those traditional cultures, when they adopted a Western diet they very quickly, even within one generation, would develop all kinds of dental problems, and the shape of the faces of the offspring would change even just within a generation or two generations.  Their children would be born and you could see side by side if you look at the pictures in the book the very wide faces and wide dental arches of the traditional people versus the really narrow faces of the modern industrialized folks.

So how does this all relate to snoring?  Well, one of the consequences of the underdevelopment of the maxilla is that it narrows the airway and can cause things like mouth breathing and snoring and sleep apnea.  And a device like the Silent Nite SL or one that you get working individually with a functional orthopedic dentist corrects this malocclusion and can have a profound effect on facial physiology, anatomy, and in fact, almost every system in the body.  It’s not difficult to understand that, really, when you consider that the hypothalamus and the pituitary and these master hormone control glands are all in your head!  If you have a really different facial structure and anatomy, it could certainly affect the function of those organs and glands, so correcting that can, in turn, correct some of those functional problems.

These orthopedic dentists, as they call themselves, or functional dentists, there are quite a few of them in the Bay Area, and anecdotally I know quite a few people who have worked with them and have seen incredible resolution of problems that you would not at all associate typically unless you’re familiar with this kind of work with dental issues or malocclusion.  My wife actually is one of them, and she had some, maybe not life-long, but 20- or 30-year neck pain that just would not resolve no matter what she did.  She’s a Feldenkrais practitioner herself, so she’s incredibly aware of her own body and how posture and the way she moves and holds her body affects her physiology.  She has a number of skilled colleagues that she’s worked with.  She’s done just about everything you can imagine, and yet in her meditation practice, which she’s had for many, many years, she basically would never have a single sitting period where she wasn’t in considerable pain in her neck.  And literally within days of getting fitted for this dental appliance – and she’s working with a local dentist – that pain that she’d had for decades completely disappeared.  It was really remarkable to witness, actually.  I’ll admit that prior to that I was… I wouldn’t say was I skeptical because it certainly made a lot of sense that that was just another evolutionary mismatch, so to speak, and all the physiology made sense to me, but I was having a harder time just understanding how profound the effect could be with multiple different body systems that were seemingly unrelated.  And I’m definitely a believer now, having witnessed what she went through, and I know, again, a lot of other people who have done it and had pretty significant changes in everything from snoring or sleep apnea on the sort of – and I don’t mean to diminish the potential seriousness of sleep apnea, which can actually be fatal – but a relatively mild problem like snoring, and certainly it has worked well for that, but I’m talking about seeing really big shifts in people with serious autoimmune diseases and in some cases some life-threatening conditions.

So it’s pretty fascinating.  I may end up interviewing Elanne’s dentist on the show to talk more about it because it’s something that I’m interested in.  Stephan Guyenet, by the way, has written a series on his fantastic blog called Whole Health Source on malocclusion, and I would definitely recommend checking that out.  If you just google Whole Health Source and malocclusion, it will come right up, or we’ll put the links in the show notes.  And then there’s a great article on the Weston A. Price Foundation’s website called Is it Mental or is it Dental?, which is a great name for an article!  So you should read that series and that article if you want to learn more about this.  I know it might sound kind of out there for something like snoring, but if you’ve tried everything and nothing else has worked, I think it’s worth looking into.

Steve Wright:  Well, that’s fascinating.  I think I would love to hear some other listeners who are listening to this or readers of your blog hopefully will comment and let us know who else has used this and what sort of problems resolved when they used it.

Chris Kresser:  Yeah, please do that because I’m relatively certain that there are quite a few people in my audience that are doing this or have done it.  Maybe we can get a little thread going on the comments there either in Facebook or on the website about people’s experiences because I think this is fascinating stuff, and I’m not doing it justice because I haven’t yet taken the time to go really deeply into it, but as I said, I think we can come back to it, especially if there’s more interest.

Steve Wright:  Well, I’m interested because I had never heard of it, so let’s do it!

Chris Kresser:  All right, let’s do it!  And I’m actually considering doing it myself.  If you’ve ever met me in person, you’ll know that I’m one of those narrow faces.  A lot of people in the industrialized world are.  I definitely have an overbite and had orthodontics and some dental issues when I was a young kid, and I’m curious to see what might come of it if I do it.

Steve Wright:  We shall see.  Let’s have some fun in 2013 with our teeth.

Chris Kresser:  All right.

Are Microwaves Safe?

Steve Wright:  OK, let’s roll on here.  This one, I’m sure, will touch everyone who’s listening.  This comes from Brianna, and she wants to know very simply, “Microwaves:  yea or nay?”

Chris Kresser:  OK.  That is simple.

Steve Wright:  Very simple.

Chris Kresser:  I might be one of the few freaks in the world now that doesn’t use a microwave, but I can’t say that it’s because of any safety concern or scientific concern.  I think early on they just kind of freaked me out a little bit, the whole concept of it, and this was before I was really doing a lot of my own research.  We’re talking about years and years and years ago.  Here’s what I can tell you:  The studies really suggest that they’re safe.  They do emit some radiation, but it’s well below the established limits, even if you’re using it 24 hours a day in your house, which I’m sure nobody is.  You obviously want to take basic precautions, like making sure you have a relatively new device or a device that’s in good shape, where the seals are tight.  And if you have any doubt, if the seals look frayed and it looks like it’s not closing properly, then, of course, you’d want to replace it, but provided you take those basic precautions, there’s really no evidence that microwaving poses any risk in terms of radiation.

And then there’s the question of how does it affect nutrients in food.  Well, cooking of any kind will change the nutrient profile in food, sometimes for the better and sometimes for the worse, depending on the type of food and the type of nutrient, and microwaving is no different in that regard, but in fact, because cooking happens more quickly in the microwave, it doesn’t tend to have as strong of an effect on depleting nutrients as some other forms of high-heat cooking that go on for longer, like if you do a stir-fry for a long time.  It generally preserves nutrients in vegetables, though in one study they did find that microwaving brassicas led to lower antioxidant content versus other forms of cooking.  But overall, like I said, the balance of studies seem to suggest that microwaving is safe, doesn’t reduce nutrient levels, and may even reduce nutrient levels less than some other forms of cooking, although the studies did seem to suggest that using lower settings on the microwave is probably better for preserving nutrients.

So if you need to use the microwave or you’re at work and you’re going to heat up some food, go ahead.  There’s no reason not to do it.  Personally, I can’t, again, say that this is a completely rational, evidence-based approach, but I’ve never liked the microwave, I’ve never liked what it does to the texture of certain foods, and I just, for whatever reason, have never gotten into it.  But that’s not a reason that you shouldn’t use it or that you should follow my convoluted logic in this case.

Steve Wright:  Well, I have to say that I use the microwave a lot.  And I would agree with you that it is definitely is a different method of cooking.  It definitely ruins the taste and texture of some foods, but the balance of what I have researched as well suggests that it’s not harmful to the food in any one way.  However, based on my research and my background in electrical engineering, I would say don’t stare in the window while it’s moving.  Go in the other room.

Chris Kresser:  So there we have the electrical engineering perspective.  That’s great.

Steve Wright:  It’s not probably not as bad as using your cellphone all day long, but yeah, when the microwave’s on, just go in the other room.

Are Some Probiotics Bad for You?

OK.  This next question comes from Sheila.  Chris, she wants to know your thoughts on some probiotics being not good and/or I guess there seems to be a lot of confusion out there when it comes to probiotics regarding D-lactate and the Specific Carbohydrate Diet including VSL#3 as problematic.  There’s, I guess – and I can definitely comment on this – There are definitely a lot of things out on the web that are saying that bifidobacteria can be a problem when you’re doing some diets like SCD or GAPS.

Chris Kresser:  Well, I’ll be interested to hear about your experience with this, Steve, but I actually haven’t observed that as much.  A lot of people with compromised guts tend to have low bifidobacteria concentrations and really benefit from getting those back up, but oftentimes probiotics with bifidobacteria aren’t the best way to do that.  I think prebiotics actually have been shown in the scientific literature to have a more potent effect on increasing bifidobacteria levels because prebiotics are just providing the food that your own internal bifidobacteria need to multiple, and that seems to be more a more effective approach than taking bifidobacteria itself.  But I want to address the kind of general theme of the question, which is which probiotic should you take when for what condition.

I think we’re probably just at the very beginning in terms of understanding probiotics and how they work and how to customize them for various health conditions.  I mean, even just several years ago our understanding of probiotics, I think, was a lot more primitive than it is now, and this is something that I’m going to be discussing in my Ancestral Health Symposium presentation this year.  The notion of how probiotics work has really shifted, in the scientific community at least.  Originally, the idea was kind of like a quantitative understanding, so you have a certain number or amount of probiotic bacteria in your gut, and that amount can get depleted over time from antibiotic use and other aspects of the modern lifestyle, and so then you need to replace those probiotics, kind of top them off by taking oral probiotics.  And now the understanding is quite different.  It’s more that probiotic bacteria have been part of our internal environment for as long as we’ve been human and a lot longer before that, and they perform numerous functions and help regulate and modulate our immune system, and the loss of those probiotic bacteria disrupts our immune function because we evolved in concert with those bacteria, and we actually probably even outsource some of our immune function to those bacteria because about 70% to 80% of our immune system exists in the gut-associated lymphoid tissue, which is comprised of those bacteria.  So it’s almost like we need those probiotic bacteria for our immune system to function properly, and so when you take probiotics, what’s happening is you’re priming or tuning the immune system because of the way the immune system reacts to their presence as they move through us, whether they are a transient form or bacteria that doesn’t actually colonize us and they just pass through or whether they’re the type of bacteria that can actually live in our gut.  That was a little bit of a side note, but I think it’s important because it’s going to inform the way that we look at probiotics and even particular species of probiotics.

So with probiotics, it’s not generally a question of whether one species is good or bad because by definition probiotics are good.  That’s part of the way that they’re defined, is that they’re organisms that have a beneficial effect.  It’s more about what you’re trying to do and the condition that you have.  Different species of probiotics can produce different chemicals and compounds and have different effects on gut function and immune regulation and pretty much every system of the body.  To give you an example, which Sheila mentioned in the question, some species of probiotic bacteria produce more D-lactic acid, which is a byproduct of bacterial metabolism.  And D-lactic acid is broken down much more slowly than L-lactic acid, or L-lactate.  A little quick chemistry lesson:  Lactate and lactic acid are synonymous.  They’re just different ways of expressing it.  So if I jump back and forth between those two, I’m talking about the same thing.

So when D-lactate accumulates in the gut, it then can bet absorbed into the bloodstream, and other factors can enhance D-lactate absorption into the bloodstream, like if you have a leaky gut or if you’re under chronic stress or if there’s a lot of lipopolysaccharide, which is an endotoxin that’s produced by some gram-negative bacteria in the gut, hanging around that can increase the rate of D-lactate absorption into your blood.  And there are a lot of studies that actually suggest that too much D-lactate in the blood can be problematic.  For example, there were two species of bacteria that produce D-lactate in higher amounts found in greater concentrations in patients with chronic fatigue syndrome, and in an animal study, animals that had excessive D-lactate in their gut exhibited anxiety, aggression, and impaired memory.  D-lactate can cross the blood-brain barrier, and it interferes with the energy supply of neurons, or brain cells.  These studies involve relatively low grade of D-lactate increases.  They weren’t huge, ridiculous doses of D-lactate that you would never get in real life, and the problem is that conventional medicine doesn’t really test for D-lactate, although it can be tested for with one of the tests I use frequently in my practice, an organic acids urine panel.

Some bells might be ringing for some of you because we’ve talked a lot about the gut-brain axis before and the connection between things like SIBO, small intestine bacterial overgrowth, and mental health problems, like anxiety, depression, insomnia, things like that, and this is one of the mechanisms here.  Overgrowth of lactate-producing bacteria, like acidophilus in the small intestine, the D-lactate gets across the gut barrier because it’s permeable often in people with SIBO and gets into the blood, goes up, crosses the blood-brain barrier, starts interfering with the energy supply of neurons, and then that can cause all kinds of different problems in the brain.  And it’s worth pointing out that this can happen even without any gut symptoms.  Most people with SIBO do have gut symptoms, but some patients, I’ve seen them just come in complaining of primarily mental health problems, perhaps a skin disorder or something like that, and I test them for SIBO and find that they have SIBO and they have an overgrowth specifically of D-lactate-forming species of bacteria, like Lactobacillus acidophilus, which is otherwise a good guy, a good bacteria.  But the problem is when it’s overgrown or there’s too much of it in the wrong place, it can cause these kinds of issues.

So for people who have SIBO, they probably want to avoid probiotics and fermented foods that have high amounts of D-lactate-forming species like Lactobacillus acidophilus.  And there are a couple of options there.  There’s a product made by a company called Custom Probiotics, which I don’t have any affiliation with, but it’s CustomProbiotics.com, I think, and it’s called D-Lactate Free Probiotic, and it only has species that don’t produce much D-lactate.  Another option, which I actually prefer at this point, are soil-based organisms, like Prescript-Assist, and I’m having more success with that even with patients with SIBO than I was with the D-Lactate Free Probiotic.  I think they can both be useful, but the Prescript-Assist is working really well, and I even started selling that in my store on my website because it was kind of difficult to obtain before that, and I want people to be able to access it because I’m having a lot of success with it in a lot of different conditions, not just SIBO.  That’s one example.

Another example would be histamine intolerance, which we’ve talked about a lot and there’s just kind of a lot of chatter about it on the web right now in various forums and stuff because a lot of people seem to suffer from it at one level or another.  And there are genetic causes of histamine intolerance where there’s a single-nucleotide polymorphism which leads to a decrease in the production of diamine oxidase, which is the primary enzyme that breaks down histamine in the body.  And of course, if the cause is genetic like that, you have fewer options in terms of how to remedy it, but another cause, and I think this is the one that’s more significant, especially lately, and explains why there’s perhaps more maybe… I don’t have any statistics to back this up, but it seems like it could just be that the increase in awareness of histamine intolerance is what is responsible for the increase in the number of people that are suffering from it, but it could also be that a change in people’s gut flora is responsible, because there are some types of bacteria that are histamine producers, and there are other types of bacteria that are histamine degraders, and there are some types of bacteria that seem to have a neutral effect on histamine.  And of the thousand species of intestinal bacteria that we know about, only a few have been characterized, and then there are also the species of bacteria that are found in probiotics and fermented foods, and a lot more of those have been characterized.  I found one study that went over 250 different species.

So in terms of foods or probiotics, the species that are notorious for histamine production are Lactobacillus casei, Lactobacillus reuteri, and Lactobacillus bulgaricus, which is in yogurt and which is one of the reasons why fermented foods are generally off the list with people histamine intolerance.  Neutral species that have been studied include Streptococcus thermophilus, which is also in yogurt, and Lactobacillus rhamnosus.  And then histamine-degrading bacteria stains include Bifidobacterium infantis, which is one of the strains that’s found in breast milk and really important for babies, but it’s also been shown to be really effective in IBS, and I wonder if there isn’t some correlation there between histamine intolerance in some cases and IBS, but it may not have anything to do with that.  I mean, Bifidobacterium infantis has a lot of beneficial effects.  Bifidobacterium longum, which is a more typical kind of bifidobacteria, and then Lactobacillus plantarum.  Soil-based organisms, which we just discussed, appear to either neutral or histamine degrading, depending on the sources that you look at.  In my clinical experience, I think they’re histamine degrading because I see improvement in people that are taking soil-based organisms that have histamine intolerance.

There’s more to this story, it will continue to evolve, but those are two of the best examples of how you’d want to change your probiotic preference based on a couple of different conditions.

Steve Wright:  Yeah, I think you hit the nail on the head in two ways.  Number one is that it seems like every year we make huge leaps forward in both the execution of using probiotics to help people as well as the research as far as what’s actually going on and why they work.  And I think the other thing that I’ve noticed working with a lot of people and just observing my own health and other people’s health over the last four years is that it seems like there’s a spectrum in which… well, there’s obviously a spectrum in which your health is, but there also seems to be spectrums in which, depending on where your health is, certain types of probiotics might be useful and your progression from wherever you are when you’re very sick to all the way being really healthy.  And so I think kind of where they’re coming from as far as bifidobacteria got a bad rap in SCD a long time ago from Elaine Gottschall, and I think what kind of was noticed there is that some people, and I have seen this reaction before, but there are cursory reactions.  You know, anyone can have any reaction to any one thing, but there have been people who are on the very sick end of IBD disorder, and when they do get a bifidobacteria strain they tend to react to it.  So a lot of really more sick people, I’ve seen them have the best success kind of sticking to single-strain Lactobacillus acidophilus.  But as Chris just mentioned, that’s just kind of the beginning stages, and I do think that over time bifidobacteria are obviously very immensely powerfully helpful, and moving on from stages as you heal, I think, is really where I’m at with probiotics and how to use them in my own health and with clients.

Chris Kresser:  Yeah, that’s a really important point.  I know we’ve talked about this before, but one of the things that happens with people on the GAPS diet is I think they get stuck in a particular stage and do it for too long, and then they end up kind of moving back in the other direction.  They had an initial benefit, and then they start to get worse, and I’ve had a lot of patients with that experience, and that might be part of the picture there.  And it’s one of the reasons that working with a practitioner who’s familiar with that kind of thing can be so helpful.  So I think that’s it for this time.  We got through a few questions at least.

Steve Wright:  Yeah, that was a good solid six questions there.

Chris Kresser:  Five.

Steve Wright:  Dang it.  We almost made it to six.

Chris Kresser:  Five down, 1200 to go, right?

Steve Wright:  Well, we shared a lot of good stuff today, and I think everybody’s going to be pretty happy because I know some of these topics were things that affect all of us every day when we make decisions on what we’re going to eat or what we’re going to do with our health.

Chris Kresser:  Yeah, well, thanks again, Steve.  And thanks, everyone, for listening, and we’ll talk to you next time.

Steve Wright:  Yeah, thanks for listening, everyone.  If you enjoyed today’s podcast, please head over to iTunes and leave us a review.  That helps get us a little more exposure and get the name out there for the Revolution Health Radio Show.  Also if you have any questions that you’d like us to address on the podcast, please head over to ChrisKresser.com and submit them using the podcast submission link.  Thanks, and we’ll talk to you on the next show, Chris.

Chris Kresser:  Thanks, Steve.  Take care.