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The Afternoon Sugar Crash, Green Smoothies, and Liver Detoxification


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A 100% Q&A episode. Keep your questions coming!

In this episode, we cover:

2:35 What to do about sugar cravings and “the afternoon crash”
23:05 How to change your diet for an essential tremor
35:25 The truth about green smoothies and oxalates
42:10 Are there natural ways to shrink ovarian cysts?
47:40 The best method for liver detoxification

Links We Discuss:

Full Text Transcript:

Steve Wright:  Hey everyone, and welcome to another episode of the Revolution Health Radio Show.  I’m Steve Wright from SCDlifestyle.com, and with me is Chris Kresser, health detective and creator of ChrisKresser.com.  Chris, what’s going on?

Chris Kresser:  Not too much, Steve.  How are you?

Steve Wright:  I’m doing well.  Thanks for asking.  I’m just trying to enjoy my summer.

Chris Kresser:  Good.  We’re all pretty excited around here at Revolution Health Radio.  Our producer, Jordan, just landed a very… I’m really excited about this guest.  His name is Dr. Alessio Fasano, and he has probably contributed more to my understanding of gluten intolerance and celiac disease and autoimmune disease than anybody else.  I’ve read all of his papers, looked at several of his presentations, and I’m just really, really thrilled that he’s gonna be coming on the show in late July, and that episode will probably go live in August.

Steve Wright:  Yeah, it’s an awesome opportunity.  Jordan did a lot of hard work on this, and I can’t wait for you two to discuss all of his work, because he’s amazing.

Chris Kresser:  Yeah.  He’s definitely one of my research heroes, so it’ll be great to have him on the show.

Steve Wright:  For sure.  So today we’re doing a lot of Q&A, right?

Chris Kresser:  Yeah, we’re gonna answer your questions and that’s it.

Steve Wright:  All right.  Well, we’ll keep the chit chat to a minimum.  Chris, if you want to get a drink of water, I’d like to tell the listeners that if they’re new to this radio show, they’re new to your website, or if they’re just learning about the paleo diet, they’re probably gonna be interested in Beyond Paleo.  Now, Beyond Paleo is an email series that over 10,000 people have already signed up for, and it’s 13 parts delivered right into your inbox, and it’s Chris’s best ideas, tips, and tricks for burning fat, boosting energy, and preventing and reversing disease without drugs.  Now, if this sounds like something you’d like, head on over to ChrisKresser.com and look for the big red box.

OK, Chris.  We’ve got a lot of questions in the queue.  Are you ready for the first one?

Chris Kresser:  Yeah.  Let’s begin, and we’ll get to as many as we can.

What to do about sugar cravings and “the afternoon crash”

Steve Wright:  OK, perfect.  This first one comes from Melanie, and she asks:  “Is there anything I can eat to give me energy.  I have sugar cravings very bad and also gut damage.  The afternoons are very hard for me.”

Chris Kresser:  OK, yeah, this is a pretty common question that I get a lot.  Unfortunately it’s not so easy to answer without more information, but when I think of energy problems or cravings, they’re fairly nonspecific symptoms, which means they can be caused by a number of different things, but three main possibilities come to mind.  And those would be blood sugar dysregulation, problems with blood sugar control; cortisol issues, number 2; and problems oxidizing or burning fat or glucose.  So, first of all, I’m gonna assume that she’s on a paleo/primal/nutrient-dense type of diet and not eating a lot of processed and refined food, and if she’s not, that would obviously be the first recommendation, but I think probably most people listening to the show are doing some version of that diet, so let’s think about what might be going on if she’s already on that diet and still having these issues.

So, the first thing I would do would be to check blood sugar, and there’s a few different ways to do this, of course.  There are three primary methods.  One is fasting glucose, so just measuring your blood sugar in the morning after a 12 or 14-hour fast.  And then the second would be hemoglobin A1c, which is an indirect way of measuring your average blood sugar over the previous three months with a little bit more of an emphasis on the most recent six weeks.  And then measuring your blood sugar after meals, so one hour after, two hours, and three hours after a meal.  And you can do at least fasting glucose and post-meal blood sugar at home with a device called a glucometer, and I’ve written about this on my website.  We’ll post a link to that article in the show notes.  But you can get a glucometer for about 40 or 50 bucks, maybe even cheaper, and some test strips.  And basically you just prick your finger, and you can test your own blood sugar at home.

And this turns out to be really useful because post-meal blood sugar, in particular, is more predictive of any future blood sugar complications or current blood sugar problems in most cases than fasting glucose and A1c, which are good markers but can be affected by a lot of different variables, and in the case of fasting glucose, it changes a lot from day to day.  And in the case of hemoglobin A1c, it’s not a particularly reliable marker in individuals because it’s based on a variable that changes a lot from person to person.  So, testing blood sugar is a good start, and if you notice that your blood sugar is consistently high after meals, which would be above 140 at one hour after a meal or above 120 at two hours after a meal or consistently high in the mornings, then you probably are gonna want to reduce your carbohydrate intake until you get your blood sugar under those targets.

If your carb intake is already low and you’re still having high blood sugar post meals or high blood sugar in the morning, then a couple other things to consider would be stress or cortisol dysregulation as a possible mechanism.  When our cortisol levels go up or if we have cortisol surges throughout the day, that can either increase our blood sugar or dysregulate our blood sugar and make it go up and down, fluctuate, and that can cause some of the fatigue symptoms that she’s experiencing.  So the way to test for this is to get a saliva cortisol panel where you measure your cortisol at four different times throughout the day.  And you can get it from a lab like BioHealth Diagnostics or Diagnos-Techs up in Washington, and if the cortisol rhythm is off or your DHEA, another adrenal hormone is low or high, that’s indicative of a stress response.

So, in that case, you’d want to take steps to manage stress, many of which we’ve discussed on the show.  Things like mindfulness-based stress reduction or the Rest Assured program are a pretty good place to start, but you can also use adaptogenic herbs like rhodiola or ashwagandha, eleutherococcus, which is Siberian ginseng, and B vitamins like pantothenic acid to give yourself a little bit of adrenal support.  And then you can use either phosphatidylserine or phosphorylated serine, which is Seriphos, which acts on the hippocampus, which is the region of the brain that controls the cortisol rhythm.  So, the adrenals govern the output of cortisol and other adrenal hormones, but the hippocampus in the brain actually controls the rhythm at which cortisol is secreted throughout the day, so you have to focus on both in order to treat that problem properly.

So if your blood sugar is low, though, on the other hand, you still want to check your cortisol levels because what can happen is that there’s a really close connection between cortisol and blood sugar, so if blood sugar drops too low, cortisol will be secreted to bring it back up, because that’s one of the main roles of cortisol.  Low blood sugar is a much bigger threat to the body from an evolutionary perspective than high blood sugar.  We can die from low blood sugar quite quickly, but it takes years or even decades to die from the complications of high blood sugar, so the body has multiple redundant systems for making sure the blood sugar doesn’t drop too low, several different hormones that play a role in that process, and cortisol is one of them.  But if that happens repeatedly over time, blood sugar dropping, cortisol being secreted, then the cortisol levels can drop, and then that can also cause fatigue, difficulty waking up in the morning, or those afternoon crashes.

So, if your blood sugar is low, you would still follow some of the same tweaks that we talked about for adrenals just now.  But in addition to those, you want to make some dietary tweaks as well.  One of them would be to eat every two to three hours, and that’s one way to keep your blood sugar from dropping in between meals.  If you’re having symptoms like feeling jittery or agitated or anxious or lightheaded or brain fog or a feeling that you have to eat or you’re gonna die in between meals, those are really classic signs of low blood sugar, and just having a small snack, a little bit of food, at least 150 calories in between meals can be helpful in preventing that from happening.  Another recommendation along the same lines would be to eat within 30 minutes of waking up, preferably a protein meal.  And a lot of people find that to be difficult if they don’t wake up feeling very hungry, but in most cases, if you do it for five or six days and just kind of force yourself to do it, you’ll start waking up hungry and it won’t be uncomfortable anymore.

And then the last one would be to eat a little snack just before bed, and that can help your blood sugar levels from dropping too low and cortisol surges from happening during the night, which is actually a common cause of sleep maintenance insomnia, which is the pattern where people have no trouble falling asleep, but once they fall asleep, they wake up frequently throughout the night or they’re restless.  One of the potential causes of that is when blood sugar is dropping through the night and then cortisol gets produced.  There’s a cortisol surge, and that sort of wakes you up because cortisol is a get-up-and-go hormone.  For people who have cortisol depletion, it can be even worse, because instead of cortisol getting produced, epinephrine or norepinephrine, which are much more potent hormones in a way, in terms of their effect on our nervous system, will be made, and those the hormones that are released in the fight-or-flight stress response.  So, if you can imagine you’re sleeping and your blood sugar drops and all of a sudden you have a surge of adrenaline, that’s definitely gonna wake you up.  And one of the kind of main symptoms of this pattern is waking up with a really rapid heart beat or a pounding heart beat, feeling like you were just kind of plugged into a socket.  That’s a fairly frequent complaint amongst some of my patients who have this hypothalamic-pituitary axis dysregulation.

So you can also take some nutrients and herbs that help regulate blood sugar, and those include things like chromium, magnesium, or gymnema, which has been used in East Asia for a long time.  It’s kind of an interesting herb.  If you take it straight or in liquid form or in powder form, it will actually numb your tongue, and it really has a pretty dramatic effect on reducing sugar cravings.  But taken in capsule form, it doesn’t have that effect on your tongue, but it still does reduce sugar cravings.  And green tea extract is another one that has been shown to help regulate blood sugar.

So if your blood sugar is fine or you’ve taken steps to address it, another potential cause of low energy or cravings would be difficulty burning fat or glucose, which are the simple sugar and carbohydrate.  I see this also quite a bit in my practice.  There’s a test that I will often run on patients with this problem and other metabolic problems.  It’s called a urine organic acids test.  You can get it from Metametrix.  It’s called the Organix Profile.  And I think Geneva has one called OAT, organic acids test.  And organic acids are metabolic intermediaries produced in pathways of central energy production and biotransformation, detoxification, neurotransmitter breakdown, or intestinal microbial activity.  And an accumulation of specific organic acids in the urine signals a metabolic inhibition or blockage somewhere in one of those cycles.  And the abnormality could be caused by a nutrient deficiency, which is probably the most common; an inherited enzyme defect, so a genetic mutation, which is less common; toxic exposure or a drug side effect or adverse effect.

So the citric acid cycle, which some of you might remember from back in high school biology, or the Krebs cycle, as it’s also known, is the primary biochemical pathway for energy production.  Another way to put it is it’s the main way that we convert the food that we eat into usable energy.  So the conversion of fat and carbs, glucose and other sugars, and proteins into acetyl-CoA.  That’s the main substrate that fats, carbohydrate, and proteins go into.  And then acetyl-CoA goes into the citric acid cycle, and it’s ultimately converted into ATP.  And ATP is the fundamental energy currency of the cell.  It’s crucial for muscle and nerve function and for muscle and nerve maintenance and repair.  So the conversion of fat to acetyl-CoA requires an amino acid called l-carnitine, and the conversion of glucose and other sugars to acetyl-CoA requires a bunch of B vitamins like thiamine, riboflavin, niacin, pantothenic acid, and also lipoic acid.  And the same is true for protein.  So if you have deficiencies in any of these nutrients, then you’re gonna have problems producing energy from the food that you eye.  You could be eating a great diet, a paleo/primal type of diet, but if you’re deficient in these nutrients for any of the reasons that I mentioned, like you’re not absorbing them very well or you have an inherited enzyme defect or some toxic exposure or drug side effect, then you’re not gonna thrive on the diet like you otherwise would.

So once acetyl-CoA enters the citric acid cycle, there are some other nutrients that are required for completion of the cycle and production of ATP, and those include manganese, magnesium, some of the same B vitamins that I just mentioned, and some amino acids.  And the organics profile is great because it shows defects in these pathways.  For example, if suberic or adipic are elevated, then that suggests that you have impaired fatty acid oxidation, and that’s usually secondary to carnitine deficiency or maybe riboflavin deficiency.  So in that case, taking something like 250 mg to 500 mg of l-carnitine would be recommended, and maybe some l-lysine, like 500 mg or 1000 mg of l-lysine, which is a precursor to carnitine.  I should point out a potential caveat there is that some studies suggest that fairly high doses of carnitine can suppress the conversion of T4 to T3, so you wouldn’t want to necessarily do this if you have that problem, if you have a thyroid problem.  Some other cofactors in this energy production process include riboflavin, SAM-e, B6, magnesium, and niacin, so you want to be aware of those as well.  Now, if pyruvate or lactate are elevated on the organic acids profile, that suggests a problem burning sugar or glucose for fuel, and that’s usually caused by a deficiency in B vitamins or lipoic acid and possibly CoQ10, which plays a role in that cycle and is also a major antioxidant in the body.

So those are some of the basic causes of low energy and of cravings when you’re on a paleo or primal type of diet and some of the possible remedies, but of course, there are a lot of other potential causes of low energy since it’s such a nonspecific symptom, including infection, autoimmune disease, poor sleep, methylation defects.  I mean, the list just goes on and on.  Just every chronic illness probably has low energy associated with it.  So if the low energy continues after making some of the changes that we’ve talked about, getting some of the testing done, then I would definitely seek out a qualified practitioner to work with to try to dive a little bit deeper and see if you can get some more information about what’s going on.

Steve Wright:  Hey, Chris, when you talk about the deficiencies of those various nutrients, is the best way to test for that an intracellular test?

Chris Kresser:  I like the organic acids test for a lot of those nutrients because there’s a fair amount of controversy about the best way to test for some nutrients.  Like, magnesium is a good example.  Serum magnesium is recognized as being a pretty inaccurate test.  Red blood cell magnesium is a little bit more accurate.  And then there’s another test offered by EXA Test for intracellular magnesium, which actually measures the levels of magnesium inside the cell, which would theoretically be the most accurate.  And that’s not a serum or blood test.  You swab the inside of your mouth to get some cells on the swab and send that in.  So the organic acids profile is a different approach.  It looks at organic acids that are part of these pathways of energy production, neurotransmitter breakdown, detoxification, etc.  And all of those pathways are cyclical, and each step in the cycle requires a certain enzyme or enzymes to complete.  So if you get a buildup of a particular organic acid in the urine, based on what we know about these cycles, we can identify where in the cycle there is a block or an inhibition and what enzyme is defective.  And then we know what nutrients those enzymes require, so we can surmise that if those enzymes aren’t functioning properly, then there’s likely to be a deficiency of one of those nutrients.  So it’s an indirect way, but I think it’s a pretty good way of measuring, at least in the case of the B vitamins.  And then for measuring other minerals that aren’t covered on the organic acids test, the EXA Test intracellular test is probably a good option, but it’s pretty expensive, and that’s a potential downside.  The SpectraCell test, which measures the levels of vitamins and nutrients in the white blood cell… frankly, I’m not sure about the validity of that test.  I’m kind of reserving judgement on that for now until I can do some more research and figure out if it’s really a valid means of testing.

Steve Wright:  OK, gotcha.  Last thing on this topic, but I think I’ve heard from other people in our natural health world that if you’re having, like, a really bad sugar craving and you’re kinda searching your cabinet for something to do, that you can take, like, 10 grams of l-glutamine and it will help you subside the craving.  And I’ve tried it, and I’ve seen a little success, and I was just curious if you had ever heard of that or if you ever recommend that.

Chris Kresser:  Yeah, I’ve heard of it.  L-glutamine I have mixed feelings about.  Certainly it has some therapeutic effects and it can be beneficial, but for some people it seems to really trigger kind of a state of agitation or anxiety, and there’s some controversy about whether glutamine can end up as glutamate, which is the major excitatory neurotransmitter in the brain, and I just see that some patients have a bad reaction to it, so I would be a little bit cautious with it.  But another option along the same lines is coconut oil.  A lot of people, if they’re feeling that kind of sugar craving and they have, like, a teaspoon or a tablespoon or whatever of coconut oil just straight in the mouth, that will take care of it because coconut oil does not require bile acids for digestion because it’s primarily medium-chain triglyceride, so it gets absorbed very quickly and easily, and it’s a very accessible form of energy, and that’s usually what sugar cravings are about.

Steve Wright:  OK, perfect.

Chris Kresser:  I have some patients who keep a little thing of coconut oil on their desk at work, and if they’re feeling that kind of strong sugar craving, they just whip it out and take a spoonful, and it takes care of it pretty well.

Steve Wright:  Yeah, that would make sense.  I mean, I got a thing of MCT oil.  If it happens again, I’m gonna go that route and see what happens.

Chris Kresser:  All right.

How to change your diet for an essential tremor

Steve Wright:  Cool.  Well, let’s move on to the next question, and this comes from E, and her email asks:  “My brother has been diagnosed with essential tremor by his general practitioner.  He has had this tremor in his hands for many years, over 10, as far as I’m certain.  He also has GERD, which he takes a proton pump inhibitor for.  Is there a nutritional connection to essential tremor?  My brother eats a diet high in grains, and I have hypothyroidism and celiac disease, and I have not eaten gluten in many years.  Following all these severe health issues, are they connected?  My brother is a very science-oriented person, so if you could point me in the direction of any studies or info that he could read, that would be very helpful.  Thank you.”

Chris Kresser:  Well, let me just start off by saying that I’m by no means an expert in neurological disorders like this.  I don’t know that much about essential tremor.  I’ve come across it a few times, and I’ve done a little bit of looking into it, so take anything that I say about it with a grain of salt.  But I do think there are some interesting things to explore, and we can talk a little bit about those.

For those of you who don’t know much about essential tremor, you’re not alone!  Nobody really does, as it turns out, but it’s a tremor usually in the hands, and the etiology is not clear, meaning nobody really knows what causes it or how it happens.  A lot of researchers suspect a genetic mechanism.  Although no genes have been identified, a genetic linkage has been established with several different chromosomal regions, which suggests that it is genetic, but we just haven’t discovered what genes are involved.  But as with most diseases with a genetic predisposition, environmental factors are probably required to trigger it.  And environmental toxins are being considered as the possibility with ET, or essential tremor, and the pathology of the condition is thought to involve the cerebellum and/or the cerebello-thalamocortical circuits in the brain.  Postmortem studies have shown the presence of degenerative changes in the brains of patients with essential tremor, and studies suggest that the disease is degenerative and heterogeneous, which means that it’s probably a family of degenerative diseases rather than just one single disease.  And we’ve talked about this in the context of other conditions like Crohn’s disease, which I think is more than likely a collection of different diseases with different etiologies that share a single label.

There’s one recent study that I saw that showed that 80% of the autopsied brains of people with essential tremor had exhibited changes within the cerebellum, particularly to neurons that produce GABA, which is the major inhibitory neurotransmitter in the brain, which we talked about in a recent show.  And that same study showed elevated levels of two potent neurotoxins, one lead and the other harmane, which is a heterocyclic amine.  And heterocyclic amines are chemicals found in some foods.  For example, harmane has been detected in coffee and then also in cigarettes, but it’s especially prevalent in meats that have been barbecued or exposed to high heat.  We talked about the possible risks of foods cooked with high heat on the last show where we had Mat Lalonde on, and this, in fact, might be one of the risks.  It looks like some of the heterocyclic amines that are in these charred or grilled foods can cause oxidative damage in the central nervous system, particularly in the brain, and this could explain another finding that there’s a strong correlation between essential tremor in males and the amount of meat consumed.  So if the men are eating meat that’s barbecued or grilled, it’s got nothing to do with the meat, per se, but it’s the heterocyclic amines that are produced in the cooking of the meat at high temperatures.  The changes in the cerebellum, some researchers speculate it could also be mediated by alcohol consumption.  There’s a type of cell; I think it’s pronounced Purkinje cells, which are affected in essential tremor that are especially susceptible to ethanol toxicity.

So, ET is considered by most physicians to be incurable, and they use medications just to manage the symptoms, like beta-blockers and antiepileptics like primidone, so as I said before, I’m no expert in neurological conditions, and I think anyone who has this condition should be under the care of a neurologist, probably goes without saying.  That said, if it were me or a family member that had this condition, I would probably be exploring a few different things.  The first would be a ketogenic diet.  Research has shown ketogenic diets to be helpful with a lot of different neurological conditions like epilepsy, seizure, Parkinson’s, which may have some similar features to essential tremor, and dementia and Alzheimer’s disease.  The ketogenic diet was initially developed in the ‘20s in response to the observation that fasting had antiseizure properties.  So during fasting or when we restrict carbs below a certain level, the body metabolizes fat stores by lipolysis, and then the fatty acids undergo beta-oxidation into acetoacetate, beta-hydroxybutyrate, and acetone, and these are all ketone bodies.  Then the cell uses these ketone bodies as precursors to generate ATP, which is again the fundamental energy currency of the cell.  So, the ketogenic diet, which is really high in fat and low in carbohydrates, is thought to simulate the metabolic effects of starvation by forcing the body to use primarily fat as a fuel source.  And it’s believed that ketones can bypass complex I to provide an alternative fuel source for neurons in the brain that are at risk.  It’s also thought that ketone bodies can enhance mitochondrial function and, thus, ATP production, and increased ATP production would protect cells against various potential insults like the neurotoxins that we just talked about.

When it comes to implementing a ketogenic diet, I like Paul Jaminet’s version, which allows 50 grams of carbohydrates per day in the hope of avoiding any potential issues with glucose deficiency that can come with ketogenic diets that typically only permit something like 20 grams of carbohydrates a day.  If you eat 50 grams of carbs per day, you will generally not be in ketosis, but Paul’s approach is to add ketogenic substances like MCT oil, maybe 4 to 6 tablespoons of MCT oil, or coconut oil, which is half medium-chain triglyceride, so you’d need about 8 to 12 tablespoons of coconut oil to have the same effect, and then 5 grams of leucine, which is a ketogenic amino acid.  Some amino acids are glucogenic, they produce glucose; and some amino acids are ketogenic.  So if you do 5 grams of leucine and either 4 to 6 tablespoons of MCT oil or 8 to 12 tablespoons of coconut oil, then you should be able to reach ketosis even while eating 50 grams of carbohydrates a day.  So I have no idea really if a ketogenic diet would help in this condition, but it’s the safe approach, especially when you do it this way with 50 grams of carbs a day.  And I really don’t see much downside in trying, especially when you consider the alternatives, which are drugs.  Beta-blockers have some pretty nasty side effects, and so do the antiepileptics, so I would definitely try it if it were me or one of my friends or family members.  But again, it’s something you should probably discuss with your neurologist or whomever’s supervising the treatment.

Steve Wright:  You would probably look into taking him off the proton pump inhibitor as well?

Chris Kresser:  I’m glad you brought that up, because there was another piece to this that I forgot to mention.  A few days back or maybe a week or two back now — It’s all kind of a blur lately! — Amy Kubal, who is a great paleo RD who works with Robb Wolf, sent an email with some articles attached, some studies attached, exploring the link between Parkinson’s and the gut, and I haven’t had a chance to read the full papers.  I’ve only read the abstracts, but the researchers were hypothesizing that gut dysfunction is actually a contributing factor to Parkinson’s disease.  And this, of course, is interesting in the context of what we’re talking about right now.  If there is some gut dysfunction happening, which it sounds like there is in this person, it’s possible that fixing the gut, which would mean in this case dealing with whatever was causing the GERD that he went on proton pump inhibitors for in the first place, which in my opinion is often low stomach acid, could be H. pylori, a bacterium that causes GERD-like symptoms, or just gut dysbiosis in general, treat that, and I think, again, there’s little downside to treating the gut and bringing the gut back to a state of health.  And I don’t know if that would solve this problem or even improve the symptoms, but I think there’s no reason not to do that, especially in light of those studies linking Parkinson’s to gut issues.

Steve Wright:  Well, I hope that E’s brother listens to this, because you shared a ton of awesome info for them.

Chris Kresser:  This may go without saying, but I would also suggest that he not eat gluten.  Gluten can cause a wide range of symptoms, and a lot of people are aware of the gut-related symptoms of gluten caused by gluten intolerance, you know, gas, bloating, diarrhea, constipation, intestinal permeability, and the immune-mediated symptoms that gluten can contribute to like associations with higher rates of autoimmune disease, etc.  But what some people aren’t aware of is that gluten intolerance can also cause ataxia, which is a pretty severe, almost like a state of paralysis in the nervous system, and so it’s not that big of a stretch to think that gluten intolerance could contribute to something like essential tremors, based on what we know of the full range of symptoms that can be caused by an intolerance to gluten.  So, again, I think it makes really good sense to get off of that.  It may not have an effect, but we don’t have a need for gluten, and because of what we know about the range of symptoms it can cause, I think getting off of it would be a really good idea.

Steve Wright:  Don’t eat gluten for any problem.

Chris Kresser:  Yeah.

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The truth about green smoothies and oxalates

Steve Wright:  OK.  Well, that dead horse is gonna be shot again.  Let’s move on to the next question from Jo.  This is a really interesting one that I think almost everyone that listens to this show will be interested in.  She asks:  “Green smoothies.  Monster or goddess?  We bought a Vitamix, and we’ve been enjoying raw green smoothies made from spinach, chard, and kale.  I’ve been reading about health problems from too much raw greens, from too much alkaloids from a single source of green to problems with oxalate.  What is your take?  Can we safely enjoy our breakfast green smoothie of raw greens, fruits, and amazingness without worry?  Or do we need to take precautions or limit them?”

Chris Kresser:  Yeah, as usual, it’s probably an individual answer.  So, some people may have sensitivities to oxalate.  Oxalates are, for those of you that don’t know, naturally occurring chemicals found in most plants and nuts and seeds, and they’re one of the classes of chemicals that Mat and I were talking about on the show last time.  They protect plants from being preyed upon, in this case by bugs.  The highest food sources of oxalate are okra, sweet potatoes, elderberries, figs, leeks, buckwheat, celery, spinach, and other leafy greens.  There is a rare genetic defect in the enzymes that degrade oxalate, and that can cause a disease called primary hyperoxaluria, but it’s pretty unlikely that you have it because it’s only found in about one to three people in a million.  There are other conditions, though, that can elevate calcium or oxalate in the urine and increase the risk of calcium oxalate kidney stones.  That’s more likely to occur if you’re simultaneously deficient in magnesium.  Oxalic acid is readily oxidized and combines with calcium, iron, sodium, magnesium, and potassium to form less-soluble salts called oxalates.  Intestinal bacteria can usually break down oxalates so that they’re carried out in the feces, but if your gut microbiota has been compromised, if you’ve got a history of antibiotics or you’ve had some gut infections or leaky gut, then these oxalates can enter into your bloodstream, precipitate into crystals, and then get stored in tissues, causing pain and inflammation.

So, to break this down or summarize, I think if you’re generally healthy and you have a pretty healthy gut, I don’t see a problem for most people with oxalates.  However, if you have a gut problem or you have an inflammatory condition or you happen to be one of the one to three people in a million to have this rare genetic defect, then oxalates would be a problem.  So, like with most things, if you suspect that you’re having an issue with this, it always pays to do a little experiment where you remove the foods that are highest in oxalate from your diet for a period of time, say, maybe three weeks, and then you add them back in and you see if you notice a difference.

One other thing I’d say, though, about the green smoothies is that I hope there is some fat being put into those because you’re not gonna absorb very many of the nutrients from them without adding some fat.  I posted an article from Science Daily that was published this week, a study that showed that low-fat and nonfat dressings on salads are a really bad idea, as I’ve always argued, not only because they taste horrible and they’re schwag, but because you won’t absorb very many of the nutrients from the vegetables in the salad if you eat low-fat or nonfat dressings.  Because a lot of the nutrients in those vegetables are fat-soluble, and so eating fat is required to absorb them.

Steve Wright:  I bet you’ll never guess what Jordan’s favorite salad dressing is.

Chris Kresser:  I can’t guess.  What?  Butter?

Steve Wright:  No.  Bacon fat and sea salt mixed together.

Chris Kresser:  That sounds pretty good!  I don’t eat kale or chard and stuff unless it’s cooked in bacon fat.

Steve Wright:  Oh, yeah.  Love it.  Well, here’s a question for you.  There are a lot of gut-healing protocols, specifically the GAPS diet, that tell you to juice these vegetables at the beginning when you have a really compromised gut.  Does juicing remove the oxalate, or is that probably not something —

Chris Kresser:  I don’t think so.  No, I don’t think it does.  I mean, no protocol can… I mean, this is the problem with protocols and why I’m such a big believer in personalization and customization is because even the best protocol can only hope to address some percentage of a group of people, because there are always outliers and people you have sensitivities or genetic mutations or mechanisms that make their needs different than somebody else.  So I think for most people oxalates probably aren’t a problem, even people with gut issues.  I know when I was really struggling with gut stuff, I didn’t have any problem with sweet potatoes.  They were actually a really easy nourishing food for me to eat and digest.  So it’s not even to say that if you have gut problems you necessarily will have trouble with oxalates, but it’s just one potential condition or group of people that could have problems with oxalate.  That part of the GAPS diet, though, to be honest, has always felt like the least necessary to me, the raw juicing.  I think the idea behind that is detoxification, but I don’t think that’s really a crucial or a necessary part of it, in my opinion.

Steve Wright:  Yeah.  I’ve heard of more horror stories than I have happy stories.

Chris Kresser:  Yeah, I mean, especially if someone has diarrhea, and she mentions this in the book, I think.  It’s been a lot time since I looked at the book, but as far as I recall, she makes it clear that if you have diarrhea or loose stool, you should take it easy on the juices because raw foods and raw juices can really promote loose stools or exacerbate loose stools if you already have them.

Steve Wright:  Good stuff.  Put bacon fat in your green smoothies.

Chris Kresser:  Ha-ha, exactly.

Are there natural ways to shrink ovarian cysts?

Steve Wright:  It’ll make them taste better.  OK, well, let’s move on.  Vanessa sent us a great question, and she would like to know:  “I’d love to know if there are any natural methods for shrinking ovarian cysts.  While I’ve never been screened for them, I have plenty of friends who have them and were told by their MDs to get on birth control to shrink them.  Do you recommend a more natural course of treatment to your patients who develop ovarian cysts?  I’d also love to hear your thoughts on using birth control.  Do you ever recommend it?”

Chris Kresser:  I do have a lot of success using botanical medicine for shrinking ovarian cysts, but I’m reluctant… Yeah, I can’t just throw out some herbs to take because, number one, the formula really needs to be personalized based on the individual’s particular characteristics.  That’s a really important part of Chinese medicine and making these formulas.  And number two, the botanicals that are used in these formulas are quite strong and definitely should not be used without supervision and shouldn’t be used for an extended period of time.  So unfortunately, the best I can do is to recommend that someone seek out a qualified herbalist, practitioner of Chinese medicine who is trained in this sort of thing, or a Western herbalist.  These formulas have a long history of successful use for this kind of thing.  You can look in Chinese medicine texts that are over 2000 years old, and they don’t call them ovarian cysts, but they have a different way of talking about them.  And I’ve had patients with multiple large ovarian cysts that have disappeared completely, and that’s been confirmed with ultrasound after use of these formulas.  So they work pretty well.  I think they’re pretty safe when they’re used under supervision, but I think you definitely need to take them with somebody’s supervision.

As for the question of do I ever recommend birth control, I assume that they mean the birth control pill.  The larger question of whether I recommend birth control is… you know, that’s obviously a personal question that depends on your beliefs and worldview and religious beliefs, so I don’t want to get into that, but the birth control pill is definitely problematic from a few different perspectives.  Number one, it has a profoundly negative impact on the gut flora, and that’s a little-known fact about the birth control pill.  Most people know that antibiotics have an adverse effect on the gut flora, but a lot of people don’t know that the birth control pill does, as well.  Number two, supplemental estrogens, like in the birth control pill, can build up.  They can exceed the liver’s capacity to detoxify the excess hormone, and they can build up and cause a condition of estrogen dominance over time, and I have a lot of female patients with post-birth control pill syndrome — there’s actually a name for that — because when they stop taking the birth control pill, they’re hormones are really dysregulated, and it can be a long road to recover from that, especially if they’ve been on the pill for 15 or 20 years.

There are alternative methods of birth control.  One of the ones that I recommend is Toni Weschler’s Fertility Awareness Method, which involves taking your basal temperature and learning your cycle, learning to measure your cervical mucus, and basically knowing when you’re ovulating.  It can be used as a method of increasing your risk of getting pregnant, but it can also be used as a method for decreasing your risk of getting pregnant just by knowing your cycle.  Obviously, that’s not going to be as effective as something like the birth control pill, but it’s completely noninvasive and it has the side effect of you get to know your cycle and your body really well in the process.  I realize that won’t be a viable option for some people, but it’s definitely worth looking into if you haven’t already.  And then there are IUDs and other options.  Maybe we can cover that in more detail on another show.  But the birth control pill itself is… I realize it might be a necessary evil for some people, and for some, it’s been a way to regulate cycle.  You know, some women use it not for actual birth control but just to regulate their cycle, and I would definitely recommend, if that’s the case, trying something different as a means to do that.

Steve Wright:  If they are on the birth control pill for any number of reasons, would they want to be then, you know, supplementing with… I’ve heard B vitamins but also then probiotics or something like that just to protect themselves until they figure out what else they can do?

Chris Kresser:  Yes and yes.  Yeah, some kind of liver detox, which I think we’re gonna talk about in the next question.  Something to support the liver, so Milk Thistle, some of the B vitamins, glycine, glutathione precursors, things like that.  And then definitely a Probiotic and fermented foods and maybe even a prebiotic if you tolerate that well.

Steve Wright:  OK.  Good stuff.  Sounds like we might have to do a whole show on that.

Chris Kresser:  Um-hum.

The best method for liver detoxification

Steve Wright:  OK, well, let’s roll on to the next one about liver detox, and this comes from Jason.  He wants to know your views, Chris, on the best methods for liver detoxification and addressing high estrogen levels.  “The liver/gallbladder flush, is it safe or effective?  Coffee enemas?  Could liver conjugation be the cause of elevated estrogens?  How, Chris, would you treat/approach elevated urinary bile acid sulfates test results?”  So there are a lot of questions there.  Maybe we should just start with the first one.  What’s going on with liver detox and high estrogen levels?

Chris Kresser:  Well, bile acids are a normal component of the blood, and are usually cleared from the blood through the liver.  And the gut-liver circulation regulates bile acid levels, and under normal circumstances, given a healthy liver, a little leaks into the bloodstream and is converted to sulfate and excreted in the urine, but in people with suppressed or diminished blood flow through the liver, you get bile acids built up in the blood, and then they’re cleared through the kidney, and then they become present at higher levels in the urine.  So high levels of urinary bile acid sulfates can be an indication of liver impairment.

So the liver, as we’ve discussed before, is the main organ of detoxification, and most toxins are fat-soluble, so the liver’s job is to convert the fat-soluble toxins into water-soluble toxins so they can be excreted through the urine and the feces.  And the liver is also responsible for clearing out excess hormones that have accumulated.  And there are basically three phases in the liver detox process, and each depends on nutrients like B vitamins, magnesium, vitamin C, and glutathione.  They are all essentially the fuel that runs the detox engine.  Usually the process functions remarkably well.  We couldn’t survive without functioning liver detoxification.  It’s going 24/7, and it’s what enables us to live and survive, so all of us can do it to some degree, but when the toxic burden is high in our lives, either environmental or food toxins, alcohol and medications, tobacco, etc., or when there are other stresses on our liver, all of that detox fuel gets used up, and the liver can’t do its job.

So definitely improving liver function can help normalize hormone levels and clear excess estrogens, and there are a lot of ways to do this.  We’ve talked about some of them, but a couple of over-the-counter products you could try, specifically for this issue of hormone clearance, would be ]Pure Encapsulations DIM Detox or Apex Hepato-Synergy.  The DIM Detox product has glucosinolates from broccoli that support healthy detox function.  It has DIM, which is diindolylmethane, and that promotes healthy estrogen metabolism and cell cycle activity.  It has calcium-d-glucarate, which targets beta-glucuronidase activity — I can never say that word! — enzyme activity, promoting healthy hormone detox through the glucuronidation pathway.  And then silymarin, milk thistle extract; alpha lipoic acid; n-acetylcysteine to support phase II detox, which converts the free radicals that are produced in phase I detox into less harmful substances.  And then there’s taurine, glycine, and methionine, which are amino acids that also promote phase II detox pathways and healthy cell metabolism.  So those of some of the options.  I do use these in my practice.  I do think that focusing on the liver and particularly phase I and phase II detox can help with excess hormones that have built up.  It usually takes two to three months on something like this to have a significant effect.

Steve Wright:  Is the liposomal glutathione another option that you’d use?

Chris Kresser:  I am waiting to find a study… There’s one study, actually, that suggests that liposomal glutathione might be an effective delivery system.  I think we’ve talked about this before.  A lot of the studies suggest that oral glutathione is not effective, it doesn’t raise intracellular levels of glutathione, and that a more effective approach is to take the precursors for glutathione and then take things like milk thistle extract that improve intracellular recycling of glutathione.  Liposomal glutathione, for me, the jury is still out because as far as I know, there’s only one peer-reviewed study, and it was a really small study.  So I’m not saying it doesn’t work, but I’m not sure that it works.

Steve Wright:  OK.  Still a little bit new.  What about the old-school liver flushes and these coffee enemas?  Is that something that we should stay away from?

Chris Kresser:  Well, some people have a lot of success with coffee enemas.  The old-school liver flushes, I think… and some people also have success with those, but I would definitely exercise caution with them.  I’ve seen some people have some pretty bad reactions.  I think people can go overboard and get kind of addicted to them and go them too frequently.  They can be pretty traumatic on the body.  I’m more of a fan of gentler methods, in general, but certainly I know people have really benefitted from them, so I would say I’m sort of ambivalent about them.

Steve Wright:  OK.

Chris Kresser:  All right, Steve.  I think that’s all we’re gonna have time for today.  We got through quite a few, and we’ll just keep plugging away.

Steve Wright:  Yeah, great, Chris.  Well, we do have a bunch more questions listed here in the queue, and we want to thank you for listening today, and keep sending us your questions at ChrisKresser.com using the podcast submission link.  We’ll add them to the list, and we’ll be going through this list and continuing to answer them, so if you’re waiting for yours, it’s probably still in the queue.  Thanks, and if you enjoyed listening to the show, please head over to iTunes and leave us a review.

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  1. Actually, if you use abstinence during the infertile time, methods like FAM and NFP (not the Rhythm Method, btw) are as effective as the Pill. The British Medical Journal, among others, has published this fact.

    To get those efficacy rates, you need instruction and a guide-not just a book or an app. It isn’t rocket science, but it isn’t that simple.