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Episode 12 – “Grab Bag” Super Special


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Episode 12 is a grab-bag super special! Topics covered include:

  • Thyroid glandulars
  • Raw milk vs. colostrum
  • Testosterone and other hormone replacement
  • Magnesium & potassium for constipation
  • Hair thinning and decreased libido in men
  • Iodine, thyroid meds and hypothyroidism
  • Protein shakes. Good or bad?

Full Text Transcript: 

DANNY RODDY: Hello everyone and welcome to the Healthy Skeptic podcast. My name is Danny Roddy and with me is Chris Kresser, health detective and creator of thehealthyskeptic.org, a blog challenging mainstream myths about nutrition and health. Chris, we’re on round two how are you doin buddy?

CHRIS KRESSER: Forty five minutes of the best material ever and it’s gone. You’ll never ever hear it you’ll just hear Danny’s side of it nodding his head, so hopefully my voice doesn’t completely go out since this is gonna end up being a very long period of me just blabbing away.

DANNY RODDY: We have a random grab bag episode but before we start how is your lady and how is the forthcoming child?

CHRIS KRESSER: She’s great and baby is great. I haven’t had the chance to really verify that but it seems good. The first time around we’re doin a birth unplugged we haven’t had an ultrasound, have not interacted with the medical establishment at all. We have a midwife, we’re having a home birth so all we know is that we’re having a baby some point in the next several weeks. Don’t know who that baby is, boy, girl, which is pretty cool I think people miss out when they find out what it is in advance because one of the things that’s been really interesting is I’ve had no opportunity to project a whole identity onto this child. I’m not imagining playing catch, all the things that I would do with a boy or all the things I would do with a girl, it’s just this big mystery right now and I’m enjoying it a lot because I feel like I’m really open to whoever is gonna come out of there.

DANNY RODDY: That’s so cool yeah, so you haven’t purchased the catcher’s mit yet?

CHRIS KRESSER: No catcher’s mit no blue nursery walls or pink nursery walls we have this hodge-podge of clothes, I have six nieces and nephews so my brothers and sisters in law have been setting us up as well as all of our friends so we’ve got a little androgynous wardrobe going. Our baby will be a cross-dresser one way or the other.


CHRIS KRESSER: How’s it going for you?

DANNY RODDY: Good, can’t complain waiting for school to start. I’ve purchased some new sweet soft star Vibram fivefinger-like shoes and I’m wearing them around town.

CHRIS KRESSER: The paper bags on your feet.

DANNY RODDY: Yeah the running joke at my work is that I’m wearing static bags, which is always a good laugh.

CHRIS KRESSER: Sweet, alright so shall we dive into the grab bag-o-rama?

DANNY RODDY: Grab bag super special.

CHRIS KRESSER: Right, sorry.

Thyroid Glandulars

DANNY RODDY: Okay the first question is from my buddy who lives super close to here Bill Milan, Chris what are your thoughts on thyroid glandulars? Can you comment on the quality, consistency compared to Armour, Westhyroid, and Naturethroid? And then also thoughts on raw milk vs. colostrum? Is colostrum more or less tolerated and what are your thoughts on colostrum for leaky gut?

CHRIS KRESSER: Okay I do use thyroid glandulars but I tend to use them in more mild thyroid hypo-function cases where it doesn’t seems as important to control the consistency, like you would have more control with Armour, or Westhyroid, or Naturethroid. That is an issue, Armour is a very specific ratio of T4 to T3 its 4.22 to 1 I think, I could be slightly off on that but I think it’s pretty close. Whereas the thyroid glandulars you’re just taking glandular extracts, so you’re taking actual thyroid gland from usually a bovine source. So that can be helpful but there’s just less control of the dosing. Something I’ve mentioned in my thyroid series on the blog, on the healthyskeptic, is that the key, and this is true for treating any condition but it’s certainly true with thyroid is figuring out the nature of the problem. The exact nature of the disharmony or the problem and addressing it at that level because if you don’t then the results are gonna be limited. Te perfect example of that is I see a lot of mostly women but sometimes men in my practice who have quote hypothyroidism and their doctors put them on levothyroxine because that’s just what they do, it’s the popular one to use and it’s what a lot of doctors use. In a lot of cases these people have never even had their T3 tested they’ve just had their TSH and their T4, their total T4. And when I run my labs and test their total T3 we see that their T4 is actually fairly normal, that it’s been brought up from the levothyroxine but their T3 is still in the toilet. Many people who listen to this will probably know that T4 is the inactive form of thyroid hormone and it needs to be converted into T3 which is the active form in order to have its physiologic effect on the tissues and the cells. So you could have fairly normal TSH, normal T4, but low T3 and you would still experience all the signs and symptoms of hypothyroidism. And if you give that person T4 then the outcome is gonna be not that great because their problem is that they’re over-converting T4 into reverse T3 or put another way they’re under-converting T4 into active T3. So this is really common I’d say probably 70% of my thyroid patients have this T4-T3 conversion problem and it’s because inflammation causes it and almost everyone who comes to see me has some level of inflammation. So again it’s important to figure out what the mechanism is and then address that cause and in most cases with Hashimoto’s which is the number one cause of thyroid disease I think it’s probably necessary to be on thyroid hormone replacement. If iodine deficiency is an issue than that needs to be addressed as well. Sometimes just repleting iodine levels can be enough and make it so that thyroid hormone replacement isn’t necessary.

Raw milk vs. colostrum

So the raw milk and colostrum question, truthfully I haven’t had a lot of success with colostrum both personally and in my practice, I’ve tried it on and off for years with patients and I’ve tried it myself several times and I just haven’t seen much benefit from it. I know the theories about why it should work and I know that it’s crucial and important for newborns and that’s one of the reasons breastfeeding right after birth is so important  because it’s mostly colostrum that they’re getting, but I just haven’t seen a lot of benefit.

DANNY RODDY: Agreed I tried raw milk and colostrum both and I never could tell a difference between either one.

CHRIS KRESSER: Raw milk of course there’s whole other issues about what people might react to in raw milk, we’ve talked about that a lot so we won’t beat a dead horse we can move on to the next one. Especially since we just talked about it about twenty minutes ago.

Testosterone and other hormone replacement therapy

DANNY RODDY: This one is from Brandon Freese, what do you recommend for low hormone levels of thyroid and testosterone? What are your thoughts on HRT (hormone replacement therapy)?

CHRIS KRESSER: I went into a whole long thing about man-o-pause which was so fun we’ll have to do it again, we’ll do a whole show on it I promise because it’s a big issue and although no man likes to admit that they are in man-o-pause, cause it’s not very manly, it’s a pretty common phenomenon I think and it’s happening prematurely more and more and it’s a big issue so I definitely wanna talk about it at some point. I’ll answer the question more directly here, we just talked about thyroid and it’s kind of impossible to say what you should do for low levels of thyroid hormone because the answer to that question depends on why thyroid hormone levels are low. Are they low because T4 is not being converted into T3? Are they low because the person has hashimoto’s and there’s this uncontrolled autoimmune destruction of the thyroid gland? Are they low because a person’s iodine deficient? Are they low because the person has inflammation and the inflammatory cytokines are depressing pituitary function and then the pituitary can’t secrete enough TSH to stimulate T4 and T3 production? You get the picture, so I can’t answer a question of what to do with low thyroid hormones because it completely depends on why thyroid hormone is low and I’ve covered that on the blog in detail, if you haven’t seen it go to healthyskeptic.org/thyroid there’s probably 12 articles on it in a lot of detail so check that out if you haven’t.

Testosterone I haven’t talked about much and as I said I’m planning to do a series on it maybe some time after I get out of the intensive diaper changing phase. So it probably won’t be in the near future but it’s an important thing for men’s health because men should be naturally androgen dominant just like women should be naturally estrogen dominant. For a male testosterone has a protective effect, it protects against cardiovascular disease, cancer, diabetes, really all of the top 10 causes of death for men you can argue that testosterone plays a role in each of them. For example alzheimer’s I think is the number 10 cause of death for men and it’s growing every year, and low testosterone has been linked with alzheimer’s and cognitive decline and memory loss. It’s also been linked with depression and anxiety, I think suicide and depression I think is number 7 on the list of top 10 causes of death for men. And that’s probably via inflammation which we’re gonna talk a little bit more about in a second because low testosterone is associated with increased LH levels, luteinizing hormone, and luteinizing hormone has been shown to promote degeneration of the hippocampus which is the part of the brain that degenerates in alzheimer’s and dementia. So getting back to the importance of addressing the underlying cause, just like I can’t say what do you do for low thyroid hormone, I can’t say what do you do for low testosterone without knowing what the causes are. There are some basic patterns for man-o-pause that we’ll talk about when we do an episode on this in the future but in general I can kind of break it down into two things. That the main causes of low testosterone and increased estrogen levels and inflammation. Once again inflammation rears its ugly head. Show me a disease and I’ll show you inflammation. Just to give you an idea of how this works, like most processes in the body it’s cyclical and it’s a chicken and egg downward spiral type of thing where you get elevation of inflammatory cytokines and insulin resistance. Both promote each other so inflammation promotes insulin resistance and insulin resistance promotes inflammation. Both of those both cause and are caused by leaky gut, systemic inflammation in the body, which both cause and are caused by obesity and neurodegeneration which both are caused and caused by vascular degeneration like cardiovascular disease, and if you draw this out in a schematic with all of those factors I just mentioned you see just a bunch of arrows with double ends pointing to each other. It just becomes a tangle of causality and everything just promoting everything, it’s ugly when you see it actually diagrammed out and so that’s the viscous cycle that we can get into that becomes a downward spiral. As inflammatory cytokine surges happen and insulin resistance happens then that increases body fat, and as body fat increases that causes more inflammation and more insulin resistance, and all of that together upregulates an enzyme called aromatase which converts testosterone into estrogen, and  that’s when you get things like man boobs. And the accumulation of fat around the middle. When you see someone who’s got that going that is usually excess estrogen and probably also excess cortisol. This aromatization is kind of the core of the problem in a lot of cases. You don’t want that as a man, in addition to the undesirable appearance of man boobs that’s a sign that you are not androgen dominant or you have too much estradiol and of course that can predispose you to heart disease and strokes and alzheimer’s and diabetes and all kinds of other fun stuff.

Now let’s get to the second part of the question which I think was what do you think about hormone replacement therapy, right? Okay so in order to fully explain what I think about this I need to give you some basic physiology in terms of how hormone regulation works in the body. It works on a negative feedback system, and the pituitary gland sits up in the brain and you can think of it as a control tower for hormones. It monitors levels of hormones in the bloodstream and when hormone levels are low, the pituitary will send a message to the particular gland that produces that hormone to increase production. And that message is in the form of stimulating hormone so you have thyroid stimulating hormone, you have follicle stimulating hormone or FSH, you have luteinizing hormone which is LH. Those are the relevant ones in testosterone production it’s luteinizing hormone that acts on the leydig cells in the testes. Okay the way this would work is if testosterone levels are low, the pituitary notices that and then will produce more luteinizing hormone so that that luteinizing hormone will stimulate the leydig cells to produce more testosterone. Does that make sense? Okay so likewise if testosterone levels are high, then you would expect the pituitary to produce less LH so that less stimulation of the leydig cells happens and less testosterone gets produced. So that’s a negative feedback system and it’s amazingly complex. We know a lot about it we’ve learned a lot but there’s still aspects of it that we don’t fully understand. For example all of the hormones that are produced in the body are produced bound to a protein. This is because hormones are fat soluble and they can’t be transported throughout the bloodstream unless they’re bound to a protein. So in the case of thyroid hormone it’s secreted attached to thyroid binding globulin, which is the protein, and in the case of sex hormones like testosterone they’re secreted attached to sex hormone binding globulin. And those protein bound hormones are inactive, so they can’t have any effect on the tissues or cells, and in order for them to have an effect they have to be cleaved from that protein carrier and we don’t understand how the body knows when to do that, or how exactly that that happens. So there’s a lot that we don’t understand about the body and as much as we like to think we do, there’s a lot that we don’t. And so here’s how this all comes into play with hormone replacement therapy.

So let’s say somebody has low testosterone, because they have low levels of luteinizing hormone which is as I just said what stimulates testosterone production. And the reason they have low levels of luteinizing hormone might be because they’ve got inflammation that is suppressing pituitary function. What happens if that person takes testosterone? Well a few things are gonna happen, number one it’s not gonna address the underlying cause of low testosterone which in this case is inflammation. It’s just like putting a band-aid over the problem it doesn’t address the underlying cause. The second thing that’s gonna happen is that it’s gonna completely bypass the body’s natural regulatory feedback mechanism which I just described. And that’s not good because we don’t know how to operate that system like the body knows how to do it. When you take testosterone what’s gonna happen is the pituitary gland’s gonna go, oh great we;ve got plenty of testosterone. And it’s gonna reduce further the production of LH and of course that’s gonna mean that even less internal testosterone will be produced, which means the person taking testosterone will have to increase their dose, and guess what happens when they increase their dose? It further suppresses LH, which further reduces the amount of testosterone that the body produces. Now it’s kinda funny when we think about it and talk about it but it’s also kind of sad because I see a lot of patients in my practice, both women and men, who’ve been on supplemental hormones for a long time and the ones that are especially a problem are the creams, because the cream is usually in the free fraction state. So they are absorbed directly through the skin into the bloodstream in the free state so they’re available immediately to act on the tissues. The difference there if you take oral hormones are usually in their protein bound state and so the body still has some control, as I described it can still describe when it cleaves those protein bound hormones and makes them free and available to the tissues, but that’s not true with hormone creams. I’ve seen men who’ve been on testosterone creams, they get on the cream they feel fantastic for the first week, they’re just like oh I’m a new person, new personal records in the gym, I’m just gettin the chicks… they’re like way into it, but then a couple weeks later they start feeling bad again. Their libido’s decreased, plateaued at the gym, they just feel terrible and so what happens, they increase their dose and then they feel good again they’re back on the ball, everything’s working and then usually in less time this time around they feel bad and then they increase the dose again. At some point they’ve really screwed up their system because what happens is the body, in its wisdom in spite of our often stupidity, and that’s not directed at anyone that’s taking hormone replacement it’s just a general comment about human ‘monkey-mindness’ I guess I would call it, where we’re always trying to mess around  with things that we don’t understand and getting ourself in trouble in the process.

So what happens is the body is smart, and the body will do everything it can to protect itself from this excess testosterone exposure. One of the way it does that is by a), downregulating receptor site sensitivity, so that the receptors for thyroid hormone on the cells will become less sensitive to testosterone just in insulin resistance. And number two the body will actually downregulate the number of receptor sites on the cell for testosterone. And that’s its smart, intelligent way of protecting itself from too much free testosterone hanging around in the blood. So it’s doing everything it can to stay well in spite of us, while we’re taking the excess hormone. Over time that just becomes more and pronounced and so the big problem is that when we stop the hormone, we’re kind of in a bad way because (let’s use testosterone  as an example) not only is LH completely suppressed because of the external supplementation, which means that there will be very little internal production of testosterone, the cells have not only few receptors but the receptors they do are insensitive to testosterone. So you take somebody off testosterone hormone that’s been on it for a long time like that it’s literally like pulling the rug out from under them and there’s gonna be a period of weeks where they are very unhappy. Because it’s gonna take a while for the receptor site function to upregulate and for the cells to express more receptors and for the LH production to increase. And that’s assuming that the underlying cause is being addressed, which often would be inflammation and/or insulin resistance.

DANNY RODDY: Been there, done that.

CHRIS KRESSER: Right, so this is where you the people like the bodybuilder folks, I know you used to hang out in some of those forums where they just dig their selves deep into a hole and  it gets worse and worse.

DANNY RODDY: The deepest holes it was never ending. Do you know who you can write a letter to to thank for all this trans-dermal hormone usage, Chris?

CHRIS KRESSER: About 500 practitioners on the web that have an entire practice based on hormone replacement creams? Who are you thinking about?

DANNY RODDY: Suzanne Somers.

CHRIS KRESSER: Oh right, the sugar blues and the hormone replacement. She got one part of that right.

DANNY RODDY: Awesome, I could not agree any more with what you just said.

CHRIS KRESSER: I feel bad now, I feel like I might have been a little harsh on people taking hormone creams, it’s actually more directed at people who are prescribing the hormone creams and even then I think most people are doing their best and trying to help other people and that’s what they believe will help. I’m just kind of frustrated at the lack of education around this issue and why more people don’t understand this phenomenon that I just described. Because if you understand the physiology it’s perfectly clear how that would be a bad idea but I guess the other thing is it’s a lot easier to prescribe and take a hormone cream then it is to make the necessary diet and lifestyle changes that would be required to address the underlying mechanisms.

DANNY RODDY: Chris real quickly, man-o-pause, what age range do you think that is? Is there any different protocol for a younger gentlemen?

CHRIS KRESSER: I think man-o-pause is man-o-pause, but you can enter in to it prematurely any time if you start getting really inflamed and insulin resistant. So I don’t really necessarily treat them differently other than there may be effects like neurodegeneration that are more common later on in simply life because there’s been more of a chance for that to happen. It’s fairly rare to see severe neurodegeneration for a 21 year old male but it can happen if there’s enough inflammation, gut problems, and blood sugar irregularities.

DANNY RODDY: In a world of Four Loko I could see neurodegeneration happening, quite rapidly.

CHRIS KRESSER: Right, some people might argue there’s a lot of neurodegenerating in young men out there but that’s maybe a different cause, a different story.

Magnesium & potassium for constipation

DANNY RODDY: This next question, a completely different question, this is from Kara De Leon, my question is regarding magnesium and potassium for those who suffer with constipation. How much of both of these supplements should one take to help the situation? I already eat paleo and I’m currently pulling nightshades and eggs out of my diet. What do you think Chris?

CHRIS KRESSER: It depends? No it’s a good question and of course the answer is not the same for everybody, it depends. I test people’s magnesium levels and even though that’s not a super accurate test, if someone comes back below 2.0, in 99% of cases they’re gonna really benefit from magnesium supplementation.

DANNY RODDY: Do you just do serum magnesium?

CHRIS KRESSER: I do serum, red blood cell magnesium is more accurate, and there’s one lab in the country that does intra-cellular magnesium and claims that that’s more accurate than red blood cell magnesium. Those tests are pretty expensive, they’re more expensive, and I’ve just found that magnesium is one of the nutrients that I think many people should be supplementing with because it’s hard to find in the diet, even a healthy diet. Nuts are the biggest source, and dark chocolate I think is a pretty good source but nuts and chocolate have phytates and in the case of nuts a significant amounts of omega 6. So I don’t necessarily like to see people gobble down a huge amount of nuts to get their magnesium and I definitely wouldn’t want to see someone gobbling huge huge amounts of chocolate for that reason either. Although they might enjoy that. So typically if somebody is magnesium deficient I’ll put them on 600-800 mg of magnesium glycinate. The form is important. Most supplements have magnesium citrate or magnesium oxide and those are not really well absorbed. They have some effect for constipation but they tend to bring a lot of water into the bowel and cause loose stools or what I sometimes call contsorrhea, which I’m sure you can figure out for yourself what that is. The chelated forms of magnesium, magnesium glycinate and malate tend to be much better absorbed and I have a lot more success with them so I would say 600-800 mg of magnesium glycinate. Potassium I don’t use as much for constipation, there is a product  called ageless Hydro-C, which I sometimes give to my patients. It’s got a blend of a highly absorbable form of vitamin C, calcium, magnesium, and potassium. The amount of potassium is pretty small, it’s 40 mg which is like 1% of the RDA, and then the vitamin C can also have an effect on bowel regularity so you can take a gram or 2 grams or up to 3 grams of vitamin C per day, really up to bowel tolerance but if you take too much vitamin C that will also create often diarrhea or loose stools so you gotta be careful there.

DANNY RODDY: Do you think the constipation is a result of a magnesium deficiency or is this another thing that you kind of have to do some investigative work on finding the root cause of the constipation?

CHRIS KRESSER: Ding ding ding…Yeah. Well certainly a magnesium deficiency can cause constipation, and magnesium can help even if there’s another cause. But, you’re right, you definitely have to look and see what the underlying cause is and in my experience, constipation is 99% of the time due to gut dysbiosis. Because something like 70-80% of the dry weight of stool is dead bacteria, and so if you’re not producing a lot of good healthy gut flora you’re gonna have problems forming bulky stool and you’re gonna have problems with intestinal motility. So the long term solution to constipation is almost always addressing the gut flora, but magnesium can be really helpful in the short term, especially if there’s a deficiency.

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Hair thinning and decreased libido in men

DANNY RODDY: Awesome. Okay bear with me this one’s kinda long. This one’s from Robbie Garfinkle, I’ve been doing paleo, low fat moderate protein, carbs range from 20-50g/day of citrus, buckwheat, yams, and green veggies since January. So far I went from 164 to 152lbs. I’m a male, 41 years old and my hair seems to be thinning since I’m 19 but so far I’m not completely bald. About 3 months into paleo I noticed some thinning and dismissed it but now it’s definitely obvious. My hair seems to thin quite rapidly even after only a few weeks, I will soon be completely bald up top if this keeps up. Is this a coincidence? Or something to do with my diet and current state of health? More information, I’ve had borderline high blood pressure for a few years recently this has gone from the 140s to 160s, my libido has suddenly gone downhill as well. I know the liver is involved in a lot I was a moderate-heavy social drinker for about 10 years, I’ve cut down drastically when I started paleo. He says his liver enzymes show up just fine. He also says that stress is fairly high and he’s worried about money, job, and he has sleep apnea as well.

CHRIS KRESSER: Okay, one of the first thoughts I have is he’s on a very low carb diet, 20-50 g is extremely low in my opinion, and I know that can be helpful in weight loss for some people, it certainly seems like it’s worked for Robbie, however there is some at least anecdotal evidence I don’t know about actual studies that show this but that low carb diets, I certainly see it in my practice I know other practitioners have reported it, Chris Masterjohn talks about it, that low carb diets can have an adverse effect on thyroid function. One of the primary symptoms of hypothyroidism or low thyroid function is hair loss. So that’s one thought, that this low carb diet is adversely affecting Robbie’s thyroid function and that is causing some of the hair loss and could even be contributing to the low libido as well, and another thought is that there’s some kind of inflammatory process  going on that could be stress related and cortisol related. Like cortisol disregulation from all of the stress that he’s been through recently and that is causing some kind of inflammation that is in turn promoting hair loss. Danny, you are the hair loss expert so I would love to hear your opinion on this question.

DANNY RODDY: Hardly, I’m gonna align right with you I think his very low carbing, that might be a major stressor, so the thing that comes to mind is telogen effluvium, which is the medical name for rapid hair loss if you’re in the state of malnutrition or you’re dieting really badly. He doesn’t say that he’s restricting calories but I wouldn’t be surprised if he was.

CHRIS KRESSER: Yeah that tends to happen spontaneously on a diet that low in carbs.

DANNY RODDY: Exactly, because male pattern baldness isn’t a rapid thing that happens all in a couple months, it happens over a long period of time so anytime it’s happening very fast it’s probably a major stressor like you said. And the only other thing I would throw in that I’m glad he mentioned was he had high blood pressure, so Chris I’m gonna need your help on this but I know aldosterone is part of the renin-angiotensin system, and aldosterone is, in all my research correlated with premature hair loss. So if he was willing to go to the doctor, and you can help me on this again, is there a test to measure aldosterone?

CHRIS KRESSER: Well the question still would be what’s causing the elevation in the aldosterone and the elevated blood pressure, but if it’s always been high, or no what did he say for a few years?

DANNY RODDY: I had borderline high blood pressure for a few years.

CHRIS KRESSER: I’m thinking that stress is probably the major player here in addition to the low carb diet because the stress can raise the blood pressure, it can cause inflammation, it can promote the hair loss. And the cortisol disregulation is also associated with sleep apnea.

DANNY RODDY: Totally, that’s exactly where I was going I was just gonna throw in, I have an article on my site and I remember digging up some research on pubmed suggesting that aldosterone can be reduced oddly enough with salt. I know that a salt-restricted diet can increase synthesis of aldosterone.

CHRIS KRESSER: Yeah, which a lot of paleo people are doing either intentionally or unintentionally. The original version of the paleo diet suggested salt restriction, right?

DANNY RODDY: Exactly, and then another thing to look into, vitamin D deficiency can also increase the renin-angiotensin system, increasing aldosterone. But like you said he’d have to find the root cause of the stress which can be so many thing it will make your head spin.

CHRIS KRESSER: Yeah, and to manage it, which we talked about this before but I didn’t say eliminate because most of us can’t do that but there are a lot of things we can do to manage stress and mitigate the impact that it has on us. I’ve written about some of those things in the 9 steps to perfect health series on my blog. I can’t remember what step it was maybe 7 or 8 or something but go check that out and there’s some recommendations there for how you can improve your stress tolerance. That’s probably the best way of saying it.

Iodine, thyroid medication, and hypothyroidism

DANNY RODDY: Awesome, okay our next question is from Barbara, she hails from Boston… I am hypothyroid, on armour, and a small dose of synthroid with pretty good results. I took ioderol for a few months and initially felt fabulous. Good energy, better aerobic capacity when cycling, and all over good effects. It did not make my TSH level go up nor make me hyperthyroid however it did give me a runny nose to the point of causing a weeping rash at the bottom of my nose. Does it seem that I am allergic? I took it for a few months and started it again at a very small dose but the same thing happened. Any ideas?

CHRIS KRESSER: Yes I do have an idea actually. Some people with iodine deficiency, which it sounds like she has based on her response to it, also have bromide toxicity. Bromide is a halide which is capable of binding the iodine receptor and blocking uptake of iodine. It’s found naturally in seaweed and seafood in saltwater, in low to moderate amounts. I suppose you could induce bromide toxicity I think I’ve seen some studies of Japanese coastal people who have bromide toxicity from eating tons and tons of seaweed and seafood. But the main exposure to it in our part of the world is that it’s used in a lot of plastic products including computers, and it’s also a flame retardant, it’s found in carpet and clothing, mattresses and a lot of other consumer goods. Also bromide is now added to baked goods, I’m assuming that Barbara is not eating a lot of baked goods but if she did some point in her life that could be part of the exposure. It used to be that iodine is added to baked goods but now they use bromide. And guess what one of the main effects of bromide toxicity is, it’s actually called bromaderma. Which is an acne like papular raised eruption of the face and hands, but it can also cause the more macular non raised rash, particularly on the face. So my guess is that this is, and the way that you detox bromide is by taking iodine. So iodine will help clear excess bromide from the body and so what I suspect is happening is she takes iodine and that starts detoxing the bromide and then she gets this rash, so my suggestion would be to take less iodine and go really slowly, and just try to see if you can manage it in such a way that you don’t get the rash or that if you get it it’s mild and you can work through it. With iodine you really need to move slowly when you’re taking it, I think probably starting off at a small dose a milligram or even less maybe for people who are sensitive and doubling it every 10 days to 2 weeks. So it could take months to build up to a higher dose like 12.5 mg or more, which some people recommend more. And then make sure you’re taking enough selenium when you’re taking iodine because particularly if you have hashimoto’s if you take iodine and you’re selenium deficient that can trigger or flare an autoimmune response. I have learned a lot recently in the last six months from my patients and also looking at the scientific literature and then a guy called Mario who left some comments on my blog a while back when I wrote the thyroid series and just wrote a two article series on the perfect health diet about using iodine in people with hashimoto’s and what the literature seems to suggest, and some of my patients experience, is that iodine only causes problems in hashimoto’s in the presence of selenium deficiency which is quite common unfortunately and so that’s why you see a lot of reactions to iodine in people with hashimoto’s. But it appears that if you take enough selenium or if you’re selenium sufficient then iodine can actually benefit people with hashimoto’s especially those with concurrent iodine deficiency. So that’s what I’d recommend for Barbara, I’m not sure that’s what’s happening but it seems it’s the most likely scenario.

DANNY RODDY: Yeah is there any given time for how long it would take one to detoxify from bromide?  Is there any literature on that?

CHRIS KRESSER: I don’t think there’s any literature but there are guys like Dr. Brownstein and Dr. Abraham who’ve been treating patients with iodine for a really long time and from what I’ve read of their materials in some cases it can take six months or over a year in the more sever cases so it’s unfortunately something you really have to be patient with and go slowly with, just listen to you body and see what kind of response you’re having. It just requires a lot of patience.

Are protein shakes good or bad?

DANNY RODDY: Just keeping your nose clean. Okay let’s go to Blake Smith’s question. I have a question about protein shakes. I supplement them for the protein and the calories, specifically BSN syntha 6, muscle milk cookies and cream, optimum nutrition casein protein, these are all the same ones that you take Chris, which is amazing. Are there any on the market that you’d recommend or would you suggest making your own? Have any recipes? ‘m at the gym 3-4x/week weightlifting to build muscle. He’s not a huge runner, regular diet is pretty clean, besides the occasional indulgence in ice cream and restaurants. What do you think Chris?

CHRIS KRESSER: I’m not a fan of protein shakes or bars, as most of you probably know by now. They’re extremely processed in most cases, they contain a lot of isolated synthetic nutrients. I generally don’t think people need to be on a high protein diet. Our need for protein, like 15% of calories is generally enough, it doesn’t sound like he’s doing tons of bodybuilding but even if he was he could bump that up to 20 or even 25% which is pretty high in my opinion and I think that would provide all of the protein that’s necessary for building muscle without any powders. The powders are like I said highly processed and I don’t see a need for them in the context of a healthy paleo plus raw dairy, whatever you wanna call it real food kind of diet. Fat is the structural part of all cells it’s the preferred storage form of energy for the body and I think a higher fat, moderate protein, moderate carbohydrate diet is a better choice and I don’t really see any need for protein powders.

DANNY RODDY: If he wanted to get jacked would you be opposed to the old school methods of raw eggs and raw milk or something like that? We’re not really bodybuilders though.

CHRIS KRESSER: No, so I’m probably not the best person to ask about that, but yeah the Rocky Balboa crack a few raw eggs but he did it wrong though because you can’t eat raw egg whites, well you can but it’s not a good idea because they contain trypsin inhibitors that contain avidin which inhibits the digestion of trypsin and if you cook egg whites that avidin gets at least partially destroyed but not so in the raw egg whites. You can eat raw egg yolks especially if you get them from pasture raised chickens and the yolks contain most of the protein nutrients anyways or most of the good nutrients so certainly raw egg yolks and raw milk or if you don’t tolerate raw milk, kefir for example make a shake with kefir and several raw egg yolks and some melted coconut oil and that’s like the best shake you could have. And gnaw on some liver while you’re at it and that’s the real superfood shake. If you can take it. Probably won’t taste as good as muscle milk cookies and cream though. With the liver in it, it would without the liver. So anyways I’m not a fan of the powders, they seem overly processed and I don’t think they’re necessary. But I’m not a bodybuilder so there’s a caveat.

DANNY RODDY: That’s gonna bring us to the end of this week’s episode. You can find all of Chris’ work at thehealthyskeptic.org. You can find me at Dannyroddy.com. Keep sending us your questions at thehealthyskeptic.org using the podcast submission link. If you enjoy listening to this podcast head over to itunes and leave us a review. Thank you for listening and thank you for your support.

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Join the conversation

  1. Question regarding about selenium. Do I supplement selenium or do I eat the food that contains a lot of selenium?

    • Either way. But it’s hard to get enough unless you’re eating fish regularly and/or 2-3 brazil nuts every day.

      • Unfortunatly, most selenium you get from fish is sequestred by mercury, as a recent study done in Tokyo residents (pubmed 21671085) has show:

        “However, as ocean fish provide a significant percentage of the Se in the Japanese
        diet, much of the Se in these foods is present in the form of complexes with mercury (Hg),
        causing the hair Se values of the present subjects to be directly and significantly correlated
        with those of Hg, with P<0.0001. The mean hair Hg level of 3.891±0.415 μg/g of the men
        was higher than that of the women of 2.905±0.294 μg/g. From the observed Hg/Se slope of
        the least squares fitted line of 2,105 in the males, it is estimated that 82% hair Se is bound
        to Hg. In the females, the corresponding percentage was estimated to 45%, suggesting that
        the women obtained more of their dietary Se from food sources with lower mercury
        contents than the men."

  2. Just to confirm I heard you correctly – you said the yolk contains most of the protein and nutrients. Is this correct? Yes it contains most of the nutrients but I was under the impression that the whites contained most of the protein.

  3. Hi Chris,

    I think that’s awesome you are avoiding the traditional medical system with the birth of your child. Do you plan on getting him or her vaccinated? If it’s a boy would you get him circumcised?

    • No circumcision and no vaccination (100% certain on the former and 99% certain on the latter).

      • Hi, Chris.

        Do you think you might ever go into your reasons for not vaccinating? It’s hard to wade through all the different viewpoints, and I think your readers would be much obliged to hear your take on it. As someone who wants kids soon, I know I would.


        • Someday I will. It will be the most difficult, time-consuming, polarizing and controversial series I’ll ever write – which is probably why it hasn’t been written yet. Here’s the other thing: I don’t believe it’s possible to reach a place of “certainty”, or anything near it, by reading the literature. Thus the decision whether to vaccinate or not, or which vaccinations to use, is highly personal and subjective and dependent on factors well outside of scientific evidence. For us, the crucial question is this: would we rather take the exceedingly small chance of our child dying from an acute infection, or the much larger chance of permanently impairing our child’s immune system and predisposing him/her to autoimmune disease? Since both my wife and I have autoimmune diseases and can track their onset to soon after we received vaccinations as adults (for third-world travel in my case, for emigration to the U.S. in Elanne’s case), we’re admittedly biased toward the former.

  4. Chris…
    A good dear friend of mine has been struggling with Low T.. He was tested, retested and tested again and consistlenty scored low on all T levels and very little to no LH production.. I think he said his androgen scores were 261..

    So he has been on a low does TRT program now for 7 weeks and has never felt better.. He is sleeping and recoverying better, has a better attitude and says he has never looked better….

    He has actually told me that since starting the TRT he has been able to handle more carbs than in the past..

    He has had a very stressful job – SWAT – has 4 kids, a business on the side etc..

    Whenever I hear stuff like you are discussing here I start worrying about him and wonder if this is something for him that just could not be avoided? It sounds like he was on his way to producing no T whatsoever.

    So my questions is.. in this case, is there no other solution than a proper TRT program? and if no what options does he have? and Two Is it proven that Carb intolerance causes low T or are folks carb intolerant because of low T?

    Thanks Chris! Love listening to your podcasts! You and Robb make my work days go by so much faster!!

  5. I’d just tell you that this was an awesome podcast. I really like the q/a-style and your willingness to go in depth in answering.

    And it was a very good clarification on the hashimotos/iodine/selenium-connection.

  6. Hi Chris,

    Again, all I couild find in store is Magnesium Bis-Glycinate. I suffer from constipation on a cyclical basis and I am in that cycle now. I regularly take natural calm, vi ct , fish oil, lots of fat and drink 2-3L of water daily. However, my stools are still very dry, small, and difficult to pass. I have no idea what to do. I get extremely bloated during this time as well and this makes me incredibly moody.Any other suggestions? I am on HMF powder, sauerkraut, experimented with what seems like everything.

    • Ali: I also suffered with stools that were dry and hard to pass. At the end of Chris’ answer, he talks about gut flora and integrity. I read at article by Dr. Art Ayers at Cooling Inflammation, and shortly thereafter listened to a Jimmy Moore podcast with Dr. Ayers where Dr. Ayers points out the importance of healthy gut flora, and as Chris said, that fecal matter is a high percentage of bacteria. I began taking probiotics (3 different brands that had different bacteria strains), consuming raw milk yogurt and kefir, and increasing my consumption of sauerkraut and kimche. Within 3 days, my stools went from hard and dry to soft and fully formed.

      I see that you take Natural Calm as a magnesium supplement. I am a subscriber to Consumerlab which does independent testing of vitamin and mineral supplements. They have found high levels of lead in NC and put the brand on its unapproved list. I have provided a link below, but if you are unable to get to it, let me know and I will post the text in a reply. Best of luck.




      • Hey Ron,

        Thanks for the response, good links. However, I am currently taking in quite a bit of probiotic. HMF powder is a probiotic, stored in the fridge, powder form which I mix with room temp water in the morning and at night on an empty stomach. I also eat about 1-1.5c of sauerkraut a day. Seems like that should do the trick but no urge or anything.

        Cut the NC out as I saw the flavour I have has stevia. NC has worked in the past but not anymore. Switched to mag bis-glycinate, all I could find in the store here and was desperate. Still nothing. I also react negatively to dairy. Thanks for your suggestions, but I am thinking it may be low bile production? I am currently taking herbatox but after 2 weeks, doesnt seem to be working.

        • I don’t know if there is one close to you but The Vitamin Shoppe caries pure Magnesium Glycinate in the store from the KAL brand. It is likely that other stores who carry the KAL brand will have it or can order it.

  7. Chris,

    What do you think of pure glucose (commercially available from baking specialty shops, I believe), as a replacement for sucrose, in exceptional desserts and sweets (i.e., in the context of a reasonably low sugar diet), or in one cup of coffee a day?


    Joss Delage

  8. First, just want to say I love your podcast. I wish you lived in the Maryland area.

    What do you recommend to someone who is trying to increase their estrogen level naturally?
    42 yr old female, 5’2″ 108, eats a Paleo diet (minimal fruit aside from avocados)
    Had been on the pill for 13 years, but has been off for 12 years. Had 2 successful pregnancies thanks to one round of injectible drugs each time to get pregnant. FSH= 8.2. Estradial < 5.0 Not trying to get pregnant, just maintain bone health and overall health.

  9. Chris, thank you for answering my question on hypothyroid and Iodoral. I stopped taking it several months ago due to my response to it.. I thought it was a bromide reaction but really need to get confirmation which you provided along with the refrence to the article on selenium. When I took Iodoral i had amazing positive changes in my heartrate when cycling and since stopping it my max heart rate has gone down again, can you describe why this happens? Better oxyget up take or what?

    I love the blog and podcast and have turned many friends on to your site. Thanks again.

    Barbara in Boston

  10. Regarding the caller who mentioned having apnea: I would JUMP on that: fix the sleep apnea! As someone who’s just now dealing with my apnea of more than a decade – and who’s been dealing with and trying solutions to fatigue, brain fog, leaky gut, and gluten intolerance, I can tell you that fixing the apnea can have HUGE effects. Do not look for underlying problems that might be causing the apnea – you can do that AFTER the apnea is under control. To someone starved for oxygen and for the restorative psychological effects of dreaming, that should be the #1 advice.

    • Tim: Thanks for the response. I’ve been dealing with apnea for about a decade as well. For many years, my primary doctors said I was “too skinny” to have apnea. Finally found a good doc. She doubted it as well, but wrote me the script for a sleep study. What I learned is that weight isn’t always an issue. The guys at the Sleep Center told me their WORST patient was a rail-thin Indonesian guy, and that their heaviest patient (500 pounds!) snored, but had no apnea at all.

      I’ve been sleeping off and on with a CPAP. Somethings the mask is difficult to get comfortable. So, I use it whenever I can.

      Not looking for underlying causes of the apnea. I have an abnormal pharynx that causes narrower airways.

      • I listened to an interview with a sleep dentist and he said his worst apnea patients were all small boned women with underdeveloped upper and lower jaws/dental arches. There is a way to help open up the airways through maxilla development using special functional orthodontic devices that are worn at night and gently widen the palate and correct the airways.
        Homeoblock is one such device and the creator, Br. Theodore Belfor ,has extensive experience with sleep apnea (and the imaging to show the marked improvement in patient’s airways- check out his newsletter archives): http://www.facialdevelopment.com/

        For more info on functional orthodontic appliances, I list a bunch of resources here: http://prettyinprimal.blogspot.com/2011/05/epigenetic-orthodontics-building-better.html

        • Thanks but I have a device and, though it helps, it does about 20% of what CPAP does. And my apnea is weight-related.

  11. Any thoughts on the MegaFoods Thyroid Strength? I saw it in a store the other day and was curious if it might help. I’m currently on the smallest dose of Levo (25mcg) with a slightly elevated TSH, normal T3 and T4 as well as normal freeT3 and freeT4. Been “paleo” for about 6 months and was hoping that might fix things, but latest blood work showed no real change. Thanks for any feedback.

  12. Regarding protein powders, not to mention the artificial colors, flavors, preservatives in these products, plus the cows are likely grain-fed and treated with rBGH.

    • Artifical flavors and colorings is one of the reasons I’m considering switching to natural whey protein powder. There are few on the market, like this Optimum Nutrition one (http://www.amazon.com/Optimum-Nutrition-Standard-Natural-Chocolate/dp/B000GIQT06)

      I understand Chris’ argument for choosing raw, not processed.

      In practice, however, it’s hard to get a necessary amount of protein without substituting with powder. Glass of milk is 8g of protein; egg yolk is ~3g. Even if you do manage to get used to gulping mixture of milk and few egg yolks, it would be pretty hard to get recommended 1-1.5g protein per 1lb body weight a day (when involved in heavy resistance training, and/or trying to gain muscle mass).

      If we’re talking about pre-workout supplementation, you also can’t get the fast absorption effect from milk/eggs/meat that you would get from whey isolate (taken shortly before training session). But you can certainly substitute taking casein powder before bedtime with something more wholesome, like cottage cheese (which is high in casein).

      I think making natural, nutritious food a staple of your diet, while substituting with whey concentrate/isolate around the training sessions (once a day at most, likely) wouldn’t hurt.

      • I found grass-fed whey from all-pro science but it’s a bit sweet:

        Protein factory let’s you concoct your blend, omitting sweeteners and flavors entirely. Consider it may be undrinkable though!

        Robb Wolf insists that whey drinks and liquid calories in general will stop you from leaning, but body builders do it and I think this may be up to individual variation. While there may be an insulin spike, you can get a massive amount of protein down with relTively few calories and post-workout that spike is actually desired…

        • Thanks for the links. Good to see grass-fed option exists.

          I’m not sure why Robb Wolf thinks whey drinks will stop you from leaning. What’s his explanation? Protein shakes are usually a low-calorie liquid, and protein in general has a higher thermic effect (so more calories are burnt during digestion/absorption process).

          Given enough physical activity, I don’t see how whey drinks can stop you from leaning (especially when consumed before/after workout, in which case they stimulate protein synthesis and result in certain hormonal response, which further induces muscle growth, which further results in even more calories burnt :)).

          • I don’t remember Robb actually explaining it in any of the podcasts I’ve heard…. But have heard him say it repeatedly and he definitely does not like liquid calories in any form for leaning out. Post-workout, it seems like a free-for-all anyway, so I’m pretty convinced it doesn’t interfere then. I’m doing a 1/2 shake before and full after, but I’m on a mass gain, not leaning out!

            I double-checked the All-Pro Science label and looks pretty good: all natural, (even the chocolate which is rare!), no artificial anything and the sweetener is Stevia. I don’t know much about that, but it’s gotta be better than aspartame, right?

            • Stevia is awesome. It has a slight licorice aftertaste though. It isn’t a sugar but merely an herb that taste sweet. There was some controversy about it, but I really believe it was made up hysteria. The herb has been safely consumed for thousands of years.

              As far as consuming liquid calories, what about Stephan Guyenet’s food reward series that detailed a liquid diet study where participants lost a profound amount of weight? There are lots of liquid calorie diets where individuals lean out considerably. This is the post op standard in many weight loss surgeries. I’ve personally witnessed a body builder who got to 6 percent body fat employing this method.

              On the other hand liquid calories are probably not good for a lot of reasons. The main one being it is a processed food. And processed foods are obviously not good for long term health and longevity.

          • I bet Robb is just drawing on his experiences with clients. It might be difficult or impossible to pull literature supporting the idea that whey shakes inhibit leanness (especially when it seems to promote insulin sensitivity and lean mass retention), but I feel first-hand experience with real life subjects trumps all that.

            I’ve never found whey to inhibit leaning out, for what it’s worth.

          • Try eWhey (www.evolvedns.com). It comes from organic/pasture-access cows and includes probiotics, colostrum, digestive enzymes, MCTs and is sweetened with low-glycemic coconut sugar. The taste is awesome!

  13. Aside from being overly processed and better sources of protein being available, is there anything inherently dangerous from consuming protein powders? I know we are not rats but what if someone consumed 20 percent of their calories as casein protein? With all the stomach stapling going on and the correspondent liquid diet, I imagine this is actually common. Would whey be better or is this all still part of the same sinking ship?

    • If the product is just whey or just casein with no other ingredients (not likely), then I don’t see anything inherently wrong. It will produce an insulin spike and is a potent growth promoter, so probably not the best thing if you’re trying to lean out.

  14. All I could find was magnesium bis-glycinate. Is that the same as you mentioned in the podcast?

  15. Hi again Chris,

    Thanks for your reply! I also would like to know if grass-fed ground beef from my local coop is fine to purchase. I have heard that ground beef comes from more than one cow, and am not for sure if it is ok to consume. Do they usually contain fillers if it comes a small, sustainable farm?

  16. Hi Chris,

    Great podcast! If I’m not too crazy about grains, are sweet potatoes and yams great staple foods to obtain enough carbs along with fruit and other starchy vegetables?

  17. Chris,

    This podcast only remind’s me why I like you very much! Besides been a very smart guy, you are not afraid to change opinion when faced with evidence (in the case of iodine for hashimoto’s).

    Take care!

    • I always remind myself why what I do is called it a “health care practice“. A practice implies lifelong learning, experimentation and self-inquiry. If I didn’t give myself that permission, my work would be incredibly boring and stale. Thanks for organizing all of the research on selenium and posting it at Paul’s blog.

    • Mario,

      It just occured to me who you were. I loved your artilces on the perfect healt diet on hypothyroidism. The info combined with Chris input gave me the courage to take Iodoral again this time with zinc, selenium and vit C. I am sooooo grateful for the info it was very helpful to me.

      I can tell the difference already in my Vo2 output with cycling after < a week on Iodoral 12.5 /day.

      Thank you …Barbara

  18. I have just recently learned about bromides and their link with thyroid disease, so I enjoyed your nice summary. I know there are brominated vegetable oils in many citrus flavored sodas. I am a FORMER heavy drinker of Diet Mt Dew and am wondering if you have any idea of the relative amount of bromine I might have been exposed to from that vs the environmental exposures in plastics, flame retardants, etc. I tend to confuse this issue with the Bisphenol-A you recently covered, but as long as I know what to minimize my exposure to I am fine with that. Heat sensitive receipt paper is on top of that list thanks to you!

    Keep it coming!

  19. Hey guys,

    Thanks for addressing my question about sudden hair loss while on Paleo.

    A few updates. I did just get labs back last week. Thyroid seems fine. Vitamin D (which was 15.8 in 2008) is now 53.3. I’ve been taking 10,000 IU/day (Carlson’s drops) for about 5 months.

    Carb restriction: Though I was doing low carb, I made sure I was eating 1800-2100 calories per day. Also, I wasn’t restricting salt. Though, I have for some reason been eating lower calories lately; I seem to be satisfied eating two meals a day. However, the sudden hair loss started before that happened.

    It could very well be the stress, as my blood pressure also continues to be an issue. During the same period, I went from borderline to now in the 160s/99 range.


    • UPDATE: Added more carbs. About 80g/day. And making sure I am eating around 2000 calories. Went from 150.1 lbs to 153.7 as of today. Not too happy about that. I need to experiment with carbs vs calories. I know calories supposedly don’t matter (in and out), but it does seem when I eat around 1500/day, I do lose weight.

  20. Hello, I very much enjoy reading your column. However, I need transcripts of your podcasts, as I do not listen to recordings or watch videos. Much too slow, I have to read things instead.



    • You’re welcome to get transcripts made if you want. They usually cost about $75-$100/hr.

      • I have to second the suggestion. Listening podcasts just takes too long, and it can’t be that hard to write out the answers to the questions in a “hodge podge” session like this.

        Your info is excellent, but delivery needs work to match the great quality.

        • Really? Not that hard? You’re welcome to volunteer your time to do it for me if it’s so easy. This podcast is free. Take it or leave it.

          • Easy there Chris, you are hanging out with Robb Wolf too much!

            But seriously people, you don’t have time to listen to a podcast but you think Chris has time to transcribe it for you? Can he get you some tea and massage your feet while you read it?

          • Okay, here’s an example:

            “Q: What is your opinion on testosterone and hormone replacement?

            “A: I think it’s a bad idea because it leads the body to lower its natural hormone levels to reestablish equilibrium. Just like a dopamine releasing drug causes the body to reduce the natural levels of dopamine from regular rewards, so testosterone creams and other HRT cause the body to produce less of its own testosterone. As the result, you’re back to the levels you started with, but now you need to keep taking the drug and increasing the dosage to get the same high.”

            That took me no time at all to write out, and I’m pretty sure I didn’t miss any part of your answer. I’m not trying to be nit-picky or demanding. I simply don’t see the efficiency gains, to either the listener or the talker, from leaving the information in podcast form only.

        • No good deed goes unpunished… it just amazes me the sense of entitlement that some people have.

          • Well said. Chis is taking a lot of time and effort to provide much needed life saving information and people want him to spoon feed it to them. Good grief.

            If one takes a bit of a step back, these big babies are also pretty draim bamaged, I mean for real, since they are so clueless.

    • Why not just appreciate the free service Chris provides? It shouldn’t be about the convenience to you, but that he is generous enough to spend time helping others.