- Full Text Transcript
- Why weight loss often plateaus or even reverses on low- or zero-carb diets, and why increasing carbohydrate intake can often jump-start weight loss again
- Whether ketones or glucose are a better source of fuel in particular circumstances
- Whether it’s important to eat glycine-rich foods like bone broths as well as methionine-rich foods like muscle meats and eggs — and what the consequences may be of too little glycine and too much methionine
- How to increase testosterone and libido without testosterone creams
- Whether elevated LDL after adopting a paleo diet is caused by micronutrient deficiencies
- The complete lack of evidence supporting “metabolic typing”
- The potential causes of excessive bloating
- The myth that a paleo diet is bad for the kidneys
- What a paleo diet can — and can’t — do for type 2 diabetes
Bring on the Paleo-Nerd-A-Thon! In this week’s episode paleo nerds Robb Wolf and Mat LaLonde (a.k.a. “The Kraken”) join me to discuss some of the finer points of the paleo/primal approach to nutrition. We answer cover the following topics:
- Why weight loss often plateaus or even reverses on low- or zero-carb diets, and why increasing carbohydrate intake can often jump-start weight loss again
- Whether ketones or glucose are a better source of fuel in particular circumstances
- Whether it’s important to eat glycine-rich foods like bone broths as well as methionine rich foods like muscle meats and eggs – and what the consequences may be of too little glycine and too much methionine
- How to increase testosterone and libido without testosterone creams
- Whether elevated LDL after adopting a paleo diet is caused by micronutrient deficiencies
- The complete lack of evidence supporting “metabolic typing”
- The potential causes of excessive bloating
- The myth that a paleo diet is bad for the kidneys
- What a paleo diet can – and can’t – do for type 2 diabetes
Since we’re all nerds that like to talk, the episode is longer than usual – 90 minutes. But we had a great time and we’re thinking of making it a quarterly event. Let us know what you think!
P.S. You’ll notice the theme song is different this week. We pulled it from Release the Kraken.
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, how are you doing, man?
Chris Kresser: I’m great, Danny. How about you?
Danny Roddy: I’m stoked for the show. That’s all.
Chris Kresser: Me too. We’re gonna skip the smalltalk this time because we’ve had some technical difficulties this morning. We’re gonna dive right in because we have two fantastic guests on the show today. We’re super excited about it. We’ve got Robb Wolf and Mat LaLonde, and I’m just gonna actually have each of them introduce themselves. I’m sure you know who they are already, but for the few listeners who don’t, Robb, tell us a little bit about yourself and how you came to all this stuff.
Robb Wolf: Oh, shoot. A former research biochemist, was a state champion powerlifter, went vegan, got super sick, almost died, ha-ha, downed the Paleo Diet concept, got well, started talking about this stuff. I have a fairly popular blog, podcast, and wrote a book that a few people have read. And despite the fact that I make all this stuff up and it’s complete pseudoscience [unclear].
Chris Kresser: That could be the best 15-second introduction I’ve ever heard!
Robb Wolf: Currently I’m bringing down property values because I’m definitely the least talented person on this call.
Chris Kresser: I beg to differ.
Danny Roddy: Definitely not true.
Chris Kresser: All right, Mat, your turn.
Mat LaLonde: Organic chemist, PhD from Harvard University, still an employee in the Department of Chemistry and Chemical Biology. I’ve always been interested in nutrition as it relates to health and performance. In November 2008, I met a long-winded, skinny geek that talked about this diet that our ancestors were eating, and I was very skeptical of it, and I started looking into the science of it and started lecturing people on it, and I’m here today.
Chris Kresser: Awesome. We’re happy to have you here. Mat and Robb could pretty much run circles around me in terms of biochemistry, and some of the questions, you know, some of the readers and listeners we all have are pretty smart, too, you’ll notice in these questions. So, we’re definitely excited to have Robb and Mat here and get their input on this stuff, and if we have time at the end, Robb and Mat and I are gonna talk a little bit about just our own current research interests and the stuff that we’re thinking about and looking into. So, let’s get into it.
Robb Wolf: Chris, just so you know, if it came down to either needling or an appendectomy, I would also side with Mat doing that stuff.
Chris Kresser: Ha-ha, OK.
Robb Wolf: So, just as an aside. [laughter]
Mat LaLonde: You know, before we start, I promised that I would humiliate Danny publicly for making us wait, so [laughter] I’m really psyched for being on the podcast, for being here for two reasons: (1) You know, we’re heading to Chicago this weekend to do, like, a two-day nutrition gig with James Fitzgerald at Windy City CrossFit. And (2), I listened to the previous podcasts, and I was thinking: Wow, Robb and I really need to get on here and inject some liveliness into this gig. I mean, you guys sound — It’s just my opinion, but I think that people would be more likely to listen to your nutritional advice and not fall asleep if you didn’t sound like an out-of-tune, flat guitar being played by Kurt Cobain.
Chris Kresser: Ha-ha. It’s funny actually that you bring that up. One of my patients, he listened to my podcast or my interview with Jimmy Moore that aired yesterday, and he said: Yeah, you sounded like you were actually not sleeping [laughter] and much more personable. I was like: Oh, thanks. That’s good to know that. Maybe I should start drinking coffee before the podcast or something.
Mat LaLonde: I would put it this way: You guys make Stephen Hawking sound like Hannah Montana.
Chris Kresser: I think it’s this whole, like, laid-back, Southern California, everything-is-cool kind of thing.
Danny Roddy: We’re just two somber dudes doing a podcast talking about nutrition. That’s it.
Chris Kresser: Yeah.
Mat LaLonde: [mimicking Chris] And you can tell that this issue about Synthroid and Armour makes me really irritated by the sound of my voice.
Chris Kresser: All right, I’ll try to be as chipper and lively as possible today.
Robb Wolf: Well, we just, you know, we’re not from the super passive-aggressive Bay Area, so we, you know, The Kraken and I can just kind of let loose a little bit and not feel like we’re gonna step on somebody’s toes or hurt some feelings or something like that, so.
Chris Kresser: Oh, I see. You think I’m too touchy-feely.
Robb Wolf: Oh, totally! Totally.
Danny Roddy: If you guys saw as many lifted trucks each day as I did, you guys would also down-regulate your attitudes. Ha-ha!
Chris Kresser: That’s right, and I’m surrounded by Priuses, so what can I say?
Robb Wolf: Is that Prii?
Chris Kresser: That’s a good question. Maybe ask the guys on South Park. Did you ever see that episode?
Robb Wolf: Ha-ha, yeah!
Chris Kresser: Anyway, as I said we’d skip the smalltalk, but of course we haven’t.
Robb Wolf: But we dragged you down. I told you I was bringing down property values.
Chris Kresser: Right. Danny, give us the first question.
Danny Roddy: Cool. OK, this question is from Hillary McClure: “I like the autoimmune protocol that Mat laid out a little while back on Robb’s podcast, but it is rather extreme for someone not already tuned into the Paleo concept. Mat said that every autoimmune condition that has been looked at closely from the right point of view has been found to have a dietary molecular mimicry involvement. The standard medical claim is that PMR is purely genetic, but I haven’t been able to find anything about identical twins or a high concordance rate that specifically had to do with PMR, and I have come across another possible way for molecular mimicry to occur that doesn’t have to do with a diet or leaky gut: A virus or another pathogen could bring in foreign proteins. Further question: Even if the cause isn’t diet-related molecular mimicry, would Mat’s protocol reduce symptoms, and why?”
Chris Kresser: I think, Mat, before you answer that, why don’t you just tell, you know, say a couple words about what that protocol is for people who aren’t aware of it.
Mat LaLonde: Yeah, so, well, what’s interesting is that she knows that the protocol is extreme, and I was being conservative when I was on Robb’s podcast. The protocol that I actually typically use when people contact me directly is the same that you use, and that is all protein and animal fat from animals that are grass-fed and are wild-caught and are pastured whenever relevant. And on Robb’s podcast, it was, you know, so your typical eat meat, vegetables have to be cooked, maybe some tubers, try to go low-carb if you can, absolutely no grains, absolutely no legumes, absolutely no dairy, and then there are a bunch of other things that you need to play with, like nightshades, which are your tomatoes, your eggplant, your potatoes, and your hot peppers. You know, no oral contraceptives, no NSAIDs. You know, be aware of FODMAPs, eggs, seeds and nuts of any kind. You know, it essentially is just like meat and vegetables, that’s what you get, you know, and actually initially I would just do maybe the animal protein and fat. So, I’m sorry if that sounds extreme. That’s what I’ve seen work in the past, and you know, it all depends on how badly do you want this to work. I mean, it’s fairly simple, it’s not going to kill you, and it might help you, so you don’t have a whole lot to lose to give it a shot. Now, as far as what I said on Robb’s podcast, I actually did not talk about molecular mimicry. Here is what I said: I said whenever autoimmune diseases are tested for the presence of intestinal permeability, intestinal permeability is found, but only a third of all autoimmune diseases, known autoimmune diseases, have been tested for intestinal permeability. That is what I said. As far as the mechanism, yes, if you look at the causes of autoimmune diseases, one of the triggers can be an Epstein-Barr virus, maybe even cholera, any virus that’s going to increase intestinal permeability. There are various viruses that have the capability to do that. That’s definitely one thing. As far as the molecular mimicry is concerned, that’s more of a hypothesis than anything else, and what’s coming out right now, it seems like the bacteria, specifically gram-negative bacteria and the lipopolysaccharides that are found in their membrane, are more problematic, but it’s still possible that molecular mimicry is what’s going on. Whether or not that is the case, if you look at — PMR, by the way, is polymyalgia rheumatica, an autoimmune disease that looks like the white blood cells are attacking the muscles in the body. If you look at that, I would say, yeah, sure, this is definitely worth a shot, and even if it’s not autoimmune in nature, would this help? Well, yeah. You know, improving food quality, removing the grains and legumes is definitely going to improve the working of your immune system, for one, especially if you go low-carb for a while, you know, because it’s been shown that sugar binges have a detrimental effect on the immune system, although that’s controversial to a certain extent, so, you know, my answer is yeah, you know, just get them to give this a shot for 30 days and see what happens. Do is strictly. It’s not gonna kill them. Actually, if they go really, you know, if they go for the GAPS-type diet protocol of just animal meat and fat, whether or not it’s bone broth, then you might want to do that for just a week or two and then slowly reintroduce some cooked vegetables into the mix. I’m not sure what you personally recommend, Chris.
Chris Kresser: Yeah, I mean, it’s interesting first of all just to think about what’s extreme and what’s not because, you know, for 77 thousand generations, two and a half million years, the diet that you described is basically the diet that humans ate. And now we’ve got Cheez Doodles and Twinkies and Big Gulps. From a different perspective, you could say that’s extreme. So, an autoimmune disease, as anyone who suffers from it knows, is pretty brutal, and the treatments are often worse than the diseases in a lot of cases, especially with, you know, steroids like prednisone.
Robb Wolf: Methotrexate.
Chris Kresser: Yeah, which are often the only choice for a lot of these conditions. You know, especially if you’re a young person, the risk/reward ratio is pretty heavily weighted in favor of finding another option than a drug that’s gonna crumble your bones, you know, by the time you’re 45. So, I totally agree with you, Mat. I think in cases of autoimmunity, I usually do put people on the GAPS Diet or a kind of autoimmune-Paleo variant like you just described. The reason I like the GAPS Diet is it does tend to be higher in glycine-rich foods, like with the bone broth, which seems to help with healing the gut and restoring intestinal permeability, or, excuse me, restoring the integrity of the intestinal barrier. But I’ve found actually that a lot of patients — I did the GAPS Diet myself for nine months, and I don’t have any problem with starch. Even though the GAPS Diet typically removes starch, I find that a lot of people, you know, after a few weeks or maybe a few months on the GAPS Diet can safely add starches back in and that starches are a really healthy part of the diet over the long term.
Mat LaLonde: Now, you said that was rich in glycine. You sure it’s glycine and not glutamine?
Chris Kresser: Which part?
Mat LaLonde: You said the GAPS Diet.
Chris Kresser: My understanding is that bone broths would be rich in glycine. Is that not the case?
Mat LaLonde: I don’t know. I was just double-checking. I am familiar with the fact that enterocytes heavily employ glutamine as a source of fuel, so that’s why I was asking.
Chris Kresser: Yeah, well, I think collagen is 35% glycine, right?
Robb Wolf: Yeah.
Chris Kresser: Thirty-five to forty percent. It’s the highest, you know, collagen is the most glycine-rich protein.
Robb Wolf: Things like Knox gelatin, like, it’s super high in glycine. It’s low in branched-chain amino acids, low in tryptophan, so you know, there’s definitely some camps out there that feel like we need a little bit more balance in that regard versus just kind of like the muscle meat kind of orientation. I’ve always eaten a lot of, like, the articular parts on, say, like, chicken. I always boil down the whole chicken carcass. I save all my bones, and this hasn’t been anything other than actually using it mainly for flavor but also looking at more from the fatty acid content.
Chris Kresser: Sure.
Robb Wolf: Like, getting the essential fatty acids out of there, but it always is this really gelatinous, you know, essentially stock, and I’ve always used that. So, I’ve been playing around with the introduction of more gelatin and stuff like that into the mix for me, and I haven’t really noticed that big of a deal, but I think I’ve always been eating more organ meats in general and maybe a little more collagen-rich material than maybe what most folks are doing.
Chris Kresser: The people that seem to notice the biggest difference are people dealing with mental/behavioral issues, it seems like, because, you know, glycine doesn’t compete with tryptophan for transport across the blood-brain barrier.
Mat LaLonde: I was just at an autism conference on April 1, where Alessio Fasano presented and Martha Herbert from Harvard, and you know, they are familiar with that diet, and some people give it a shot and they see some good results, but they unfortunately don’t implement it the way that we implement it. They immediately start with the vegetables and tubers and whatever they can.
Chris Kresser: Uh-huh.
Mat LaLonde: Yeah, so, I had to talk to a lot of parents and be like: Yeah, actually if you’re gonna do this, you want to do it this way first and then introduce this stuff later.
Chris Kresser: Right. So, for those of you familiar with the GAPS Diet, we’re talking about the Intro GAPS part where you’re just doing the bone broths and the meats, and then after a period of time, then you start introducing the vegetables and the other food you can tolerate. So, shall we go on to Summer’s question, Danny?
Danny Roddy: Yeah, I wanted to add in: Is gelatin a rich source of glutamine to heal the gut? I thought that’s something I read from you, Chris.
Chris Kresser: Oh, I don’t remember anything I say. [laughter]
Robb Wolf: Glutamic acid, but not glutamine specifically. It’s actually pretty high proline, pretty high glycine, and then glutamic acid versus glutamine.
Chris Kresser: Yeah. See, you ask the biochemist.
Why weight loss often plateaus or even reverses on low- or zero-carb diets, and why increasing carbohydrate intake can often jump-start weight loss again
Danny Roddy: Ha-ha. Thank you for clearing that up for me, Robb. I knew it was a gluta-something amino acid. Let’s get to our next question. This question is from Summer: “When you (referring to Chris) were on Robb’s podcast, you mentioned that you had success helping people who were previously low- or zero-carb lose body fat by adding in some safe starches and increasing their overall carb load. This is obviously counter-intuitive to what we know when it comes to fat loss. What are the mechanisms that are causing this to work in your situation? Is it simply when these people are in a hypocaloric state and require additional calories, or is there something deeper at a hormonal level? Robb/Mat, have you ever seen the similar success with any of your clients? Discuss.”
Chris Kresser: Well, I’ll just say a little more about what I said on Robb’s podcast. So, I do get a subset of patients, actually quite a few, who come to me on zero carb or very low carb, you know, less than 50 g of carbohydrate diets, and they lost usually a boatload of weight to begin with, but then they stalled, and they’re either not losing any more weight or they actually start gaining weight. And oftentimes these folks have been intermittent fasting too, so they’re compressing all of their food intake into, like, an 8-hour window between, you know, noon and 8 p.m., which I think for some people is really beneficial, clearly, and there’s some evolutionary basis for that, of course. But when I have these people stop intermittent fasting and start eating breakfast and then add some carbohydrate back into their diet, maybe up to, like, 100 g a day, some but not all of them start to lose weight again. And in terms of the mechanisms, I’m not sure. I think one issue might be cortisol dysregulation.
Robb Wolf: Yeah, absolutely. That’s gotta be one of them.
Chris Kresser: Yeah, so the very low-carb, zero-carb diet plus the intermittent fasting. I mean, we know that fasting can cause cortisol problems, both overall output and disruptions in the rhythm, and then, you know, cortisol accumulation can cause fat gain, especially in the visceral abdominal area, so I think that’s probably the biggest one. What do you guys think, Robb? Mat?
Robb Wolf: Yeah, I mean, I can’t add too much to that. I think that — I forget if it was either Mat or Chris that I was talking to about this, or probably both you guys at some point, but you know, when we’re trying to play reconstruct-the-caveman-living-scenario, it’s helpful up to a point, but then it can absolutely bite us in the ass at some points too because we don’t go to bed when the sun goes down. We don’t get up when the sun gets up. A number of the people that we’re all dealing with are trying to maintain an athletic performance protocol, you know, whether it’s CrossFit or something kind of CrossFit-esque, which is very glycogen demanding, and although this stuff is definitely healthy, it doesn’t represent an ancestral activity pattern at all. Like, people did a hard day. Then they did a really easy day, like, they sat on their ass and did nothing. And nobody does that, whether we’re talking about work or family problems and challenges and all that sort of stuff. We’ve got lack of sleep, lack of vitamin D, way too much stress, not enough downtime, and then if you throw too low of carb and too low of carb plus intermittent fasting into that mix, especially on the backbone of a glycolytically demanding exercise protocol, you have a hell of a mess brewing. And that’s where, you know, I wrote on intermittent fasting in a big kind of venue for the first time in 2005, and I had about a 50/50 breakdown on responses. Some people loved it and they got great results, and about 50% of people, they gained fat from it and it seemed to be ergolytic instead of ergogenic. They had performance declination instead of improvement, and I was, like, dude, that’s horrible numbers. I mean, it’s worse than placebo practically, so we thought that wasn’t a good gig, and then as time has gone on we’ve just kind of understood that there are certain situations in which all of those protocols are totally appropriate, and then there are absolutely situations where they’re not appropriate at all. And what will reverse metabolic arrangement may be quite different than what gets you down to a really good level of body fat. You may need some carbs thrown back in the mix to get, you know, if you’re male to get below that 10% body fat level and be really lean and actually see better performance.
Mat LaLonde: And to add to that a little bit, there are studies that have been done on endurance athletes. They’ve given them enough time to adapt to a high-fat diet — let’s say, they cut their carbohydrate from 60% to 30% — and what they see is cortisol increase. They’re doing the same amount of training, both groups, but cortisol increased because it’s trying to turn the glucogenic amino acids into glucose. Glycolysis is limited, or you reach the limit of glycolysis at some point, so cortisol goes up, but then at some point cortisol levels off and testosterone drops, and these people now have a really high cortisol-to-testosterone ratio. The ratio is really bad, and if a doctor were to take that ratio that you are overtrained. You know, this is one of the ratios that they use to determine whether or not people are overtrained. I don’t think it’s the only thing that should be used, but that’s one of the markers, which is bad, really bad obviously. To get back to the whole intermittent fasting thing, I used to do that. I stopped, and I started having breakfast. It’s a really small breakfast. I just have a can of coconut milk from Trader Joe’s, light coconut milk, that I drink in the morning just to stop the hunger. And the reason I started doing that is because I found that, you know, if I really thought about it, the intermittent fasting made me a little bit neurotic, and when I ate I tended to overeat, like, way beyond what I should be eating, just because I was stressed, I was nervous, my body thought that it was not going to get food for a while, and I was doing this every day. So, now it turns out that what I used to have for lunch is what I have throughout my entire day, as opposed to eating a huge lunch and then even eating dinner after that, and I’m fine, and I find that I’m more productive and, you know, everything is better that way. The reason I chose just the coconut milk is that fat is satiating, for one, but it also has very little to no protein, so I still keep the protein fast going, in that the only high-protein meal that I have is lunch. I only have carbohydrate, actually, and a little bit of fat for dinner, which is my post-workout meal. So, I keep the protein fast going, still get some of the benefits of intermittent fasting, still get the autophagy to turn on without necessarily starving and stressing the system too much.
Chris Kresser: Right. I think that’s a great compromise, and I definitely recommend that for pretty much anybody who’s intermittent fasting. I mean, I don’t see any downside to getting those benefits and, you know, keeping yourself from going into, like, you know, a continued catabolic state.
Mat LaLonde: Well, it’s been shown that there isn’t necessarily catabolic state, actually. There’s a growth hormone release if you do this, like, over a period of a day that prevents the excess degradation of muscle mass.
Chris Kresser: Right, but if people are, if they’re like what Robb was saying, if they’re not sleeping, if they’re overtraining, they’re doing all of these things that ultimately can be catabolic, and then they’re throwing intermittent fasting on top of that, then —
Mat LaLonde: Like the endurance athletes in the study that I talked about. They’re getting in a catabolic state. I mean, that’s one of the reasons why endurance athletes are so skinny and weak. It’s because they’re eating away their muscle mass with cortisol.
Chris Kresser: Right.
Robb Wolf: And depending on how you look at it, it’s actually a favorable adaptation for endurance athletics because you’re literally trying to whittle down every bit of nonessential body mass, and you actually see a decrease in brain stem mass. Like, the ability to learn new motor patterns decreases in high-level endurance athletes because, I mean, it’s literally the backpacker that is drilling holes in their toothbrush handle and stuff like that to save weight.
Chris Kresser: Right.
Robb Wolf: That’s what’s going on inside your body. You know, so bone demineralization, whittling away every scrap of bone and muscle that is completely nonessential, digestive organs — it’s all gotta go. It’s a fire sale, folks! You know, and again people get mad about this stuff, but this is just kind of the basic physiology of what’s going on with that. Just one thing that I want to throw in there: For me, with the intermittent fasting, what it did for me if nothing else, having come from a fairly neurotic, probably body dysmorphia from bodybuilding and powerlifting background, intermittent fasting allowed me to just non-neurotically say: I don’t need to eat every 2 hours. And so, it was really good for me in that regard, in that I still run lean, I still have good performance, I carry some muscle mass, but I don’t have to eat every 2 hours in order to do that. And in fact, I seem to get better results with a little bit of punctuation and kind of breaking that stuff up, but you know, I think again as we live and learn, we go about our research. I think what Mat has been tinkering with, with this essentially a protein fast but not necessarily an overall caloric fast throughout the whole day, there’s probably some serious benefit to that, not the least of which is just improved quality of life while you’re doing this stuff.
Chris Kresser: Yeah, I’m pretty much the same. I do intermittent fast maybe twice a week, but it’s intermittent, ha-ha. I don’t have a schedule around it, and I also have some fat in the morning. Sometimes I’ll have cream, you know, like, full-fat cream in some coffee if I have a little decaf coffee or something like that. And then sometimes I’ll just skip lunch. Like you, Robb, the biggest benefit for me is just not having my days revolve around food. Like, if I get interested in something or I’m busy, I don’t have to just stop it and go make lunch because it’s 12:00.
Robb Wolf: Right.
Chris Kresser: And that’s liberating, definitely.
Danny Roddy: So, to sum it up, more carbs, less adrenal hormones, kind of more fat loss. Is that a good summation?
Robb Wolf: That’s where the fat loss would probably be blocked, and we’d probably start getting a — If there is any continued weight loss, it’s probably muscular and not adipose tissue loss, and so that’s where the reintroduction of some carbs and then some really good attention to these lifestyle features — sleep, stress level, intelligent exercise intensity and volume — can bring people down to lower levels of body fat. Art De Vany wrote about this stuff very intelligently, like, a long time ago, which was that if you want to run at relatively low body fat levels, you’ve got to not send a stress signal to the body. If the body gets into a stress situation, it’s gonna start hoarding calories, and you know, it’ll do that via cortisol, and it does it via insulin resistance. So, if you want to be healthy, you want to run lean, you need to have intermittent stressors that are acute in nature and then, you know, long periods of kind of happy time for your body.
Chris Kresser: Yeah, unfortunately, I mean, we’ve all, I think, been talking about this lately, but it seems to be one of the hardest things for people to change. It’s a lot easier to, you know, tweak your carbohydrate ratio or, you know, change your supplement regime than it is to totally, you know, to turn off the computer a couple hours earlier at night or sleep in a couple hours later or whatever it is. It seems to be a lot harder for people to make those changes.
Robb Wolf: I had to cut myself off of Angry Birds. [indiscernible] you, Angry Birds! [laughter]
Chris Kresser: All right, so, next question from Tyler, Danny?
Whether ketones or glucose are a better source of fuel in particular circumstances
Danny Roddy: This question is from Tyler Simmons: “Is there a health or performance advantage to supplying the body’s base glucose needs, about 600 calories a day, through dietary carbohydrate from starch, glucose, not fructose, rather than through ketones or gluconeogenesis? Or does it just depend on the individual metabolic state, goals, and activity level? Is it best to some or both approaches?” What do you guys think?
Mat LaLonde: I mean, we more or less covered this at this point, I guess. Right? You know, the more high intensity exercise you do, the more carbohydrate you should be getting from, like, roots and tubers and starchy vegetables in order to prevent the cortisol levels from going sky high. It is true that, you know, the ketones that are created from the liver can replace glucose in a lot of pathways, but it still requires the ramp-up of cortisol, and that stuff is being made from either fatty acids or from proteins, depending on which pathway you’re looking at. So, I would say, you know, yeah, it does depend on your activity level. It does depend on your goals.
Danny Roddy: Is gluconeogenesis inherently stressful?
Mat LaLonde: Not necessarily.
Robb Wolf: It’s really an intensity thing. Like, you look at some of the stuff Mike Eades has talked about. You know, a long-term ketogenic or quasi-ketogenic state with, I would say, an activity level of, like, lifting some weights and walking, you could probably be fine on that, I think, you know, from here to the end of time basically. But, again, as soon as you start tapping into that glycolytic pathway, as soon as you start doing anything that’s normally lactate producing, then you are gonna flip on every alarm signal in your body, because that type of intensity is sending a signal that, you know, you need to do something serious, whether it’s trying to catch food or run away from being food or, you know, you’re in a fight for your life kind of gig, and so the body takes that really seriously. So, again, it’s very context oriented whether or not it’s gonna be an OK or a not OK scenario.
Chris Kresser: Yeah, I agree with that, and the only thing I’d add: I don’t know if Tyler was asking about these particular populations, but certainly there are populations, like people who are dealing with cognitive deficit, Alzheimer’s, Parkinson’s, or even major depressive disorder, and there’s been some pretty interesting research that Emily Deans has been blogging about lately that shows that a ketogenic diet can benefit those conditions when there’s some kind of glutamate toxicity or dysregulated glucose metabolism in the brain that a ketogenic diet can be helpful. But even then, I don’t think that those people would be protected from all of the effects that you just described, Robb, if they’re doing crazy kind of training.
Robb Wolf: Yeah. There’s some interesting stuff out there. Like, one of my favorite papers is this piece, Secrets of the Lac Operon, and it talks about glucose hysteresis and basically this idea that poor cellular aging tends to push us away from the ability to metabolize fatty acids as a primary fuel source and we shift more and more towards a glycolysis-based energy source, which starts looking really more and more like a lot of cancers. So, it’s just kind of interesting in that regard. And so this, when I read it initially, and there were some other insights into that, which still kind of leans me towards, like, the high-dose fish oil for a short period of time when people are very sick, overweight, inflamed, and Chris and I have talked about that, and we have kind of different views on that, but you know, it’s still, like, some pretty good homology overall. The interesting thing for me on this is when I first read that paper, my interpretation of it was: OK, don’t eat any carbs because, you know, if you don’t eat any carbs then you encourage the body to be as fat efficient as you possibly can be, but then there’s always that secondary effect, you know, the law of unintended consequences, and so if you’re very, very low carbohydrate and you’re doing any degree of intense activity, then we start getting some cortisol issues, and by hook or by crook, you will introduce carbohydrate back into the system, but when you do it via carbohydrate doing gluconeogenesis breaking down your proteins, that sucks. That’s almost worse than eating a Twinkie in some ways, you know, all the gut irritation stuff aside. And so, some other interesting stuff, Frits Muskiet and Professor Staffan Lindeberg, you know, all the Kitava study stuff. The Kitavans eat a pretty high carbohydrate diet, but then the bulk of the carbohydrate actually gets converted into palmitic acid, and what they are metabolizing moment to moment is actually a high-fat diet.
Chris Kresser: Right.
Robb Wolf: It’s palmitic acid that’s being metabolized, a very stable saturated fat, which doesn’t cause any type of reactive oxygen species, it plugs into the mitochondria very nicely, it doesn’t cause any type of collateral damage, and so again it’s this kind of wacky, Alice in Wonderland-like kind of nonlinear kind of world where these folks are eating a significant amount of carbohydrates, that carbohydrate is getting converted into palmitic acid and subsequently burned as a fat source essentially. This stuff is at the mitochondrial level not registering as an oxidized carbohydrate, and so it all works within this kind of, you know, mitochondrial hormesis scenario where you’re both getting a carbohydrate load but also still maintaining the metabolic headroom that you want to burn fats as a fuel source. And what is happening is that these people are getting plenty of vitamin D, they’re getting, you know, non-significant amounts of gut irritants via grains and legumes, you know, good exercise level, blah, blah, you know, good group interaction and all that sort of stuff, all the kind of intangibles, but it was kind of interesting that you can arrive at this hormetically sound — And hormesis, just for folks that aren’t familiar with that, an exposure to one type of an irritant today would make you more resistant to that irritant later. Most of the adaptations to exercise are via hormetic effects, low-carbohydrate diets kind of have some hormetic effects, brief transient radiation exposure tends to increase the survivability to radiation down the road, not that you should go run naked through a nuclear reactor or anything, but it’s just kind of some interesting adaptation stuff.
Mat LaLonde: Did you just say “nucular?” [laughter]
Robb Wolf: I probably did.
Chris Kresser: Awesome.
Mat LaLonde: To add to that, one of the reasons why the palmitic acid is not a problem in the Kitavans is because they don’t have insulin resistance, as is a problem in Western societies because it presents with insulin resistance in hyperinsulinemia specifically, which if you’ve got hyperinsulinemia you can’t burn that fat for fuel. It’s just being shoved into cells and stored and staying in the bloodstream and causing a variety of problems.
Chris Kresser: Right, and there’s another question about that later, so we’ll come back to that. Next question, possibly from one of the best handles ever, from Stabby Raccoon. [laughter] I’m not even sure where to go with that.
Whether it’s important to eat glycine-rich foods like bone broths as well as methionine-rich foods like muscle meats and eggs — and what the consequences may be of too little glycine and too much methionine
Danny Roddy: That is a pretty solid handle. Let’s go ahead and get to their question: “Generally the high-protein camp advocates consuming at least 30% of calories from protein, generally in the form of muscle meat, organs, fish, seafood, and eggs. While I have no doubt that a higher protein intake has its benefits, it has also been observed that there are benefits to a decreased intake of various amino acids such as cysteine, methionine, and tryptophan. Reported problems with this diet higher in methionine and tryptophan include increased oxidative stress, cellular replication, increased homocysteine, impaired thyroid function, accelerated brain aging, etc. Guys like Dr. Ray Peat advocate balancing muscle meat with gelatinous parts of an animal, which do not have very much methionine and no tryptophan, thus providing protein for repairs for the tissues without the deleterious effects of excess amino acids like the aforementioned. I simply do not see a lot of emphasis on gelatin, and I’m wondering why not. So in summary: Are we deficient in chicken feet? Do you want to eat my face? Would that be a good compliment to a shoulder-chop? Is Paleo jello for breakfast the path to longevity?” What do you guys think?
Robb Wolf: Ah, man, jello is misspelled.
Chris Kresser: Jello-o!
Mat LaLonde: I think he was trying to say “J Lo,” and I would have her for breakfast definitely. [laughter]
Chris Kresser: I think we kinda covered this already. Do we want to talk more about it?
Mat LaLonde: We talked about protein fasting, but what I want to say is that this whole thing about methionine and cysteine increasing cellular oxidative stress and other problems, they’re mistaking the cause and the effect. So, if you have metabolic syndrome, there’s a bunch of metabolic pathways that are producing hydrogen peroxide, that are producing superoxide, and your antioxidant stores, specifically glutathione and whatnot, are in the toilet. So, that stuff — You have an oxidative environment, and now if you had these sulfur-containing amino acids like cysteine and methionine, they get oxidized to sulfur-containing organic acids. And you know, yes, that’s true, but that increased oxidative stress in the presence of those amino acids and what impairs you from processing those amino acids properly, that’s the metabolic syndrome. It’s not that these things are causing it. They’re just there.
Robb Wolf: It’s like the net acid load that comes out of the —
Mat LaLonde: Don’t get me started.
Robb Wolf: That comes out of the metabolic arrangement, not necessarily from dietary factors.
Chris Kresser: Right.
Mat LaLonde: I mean, the mistake that they made there is that they saw that, you know, you have increased acid production in these people that are demineralizing bone, and it turns out again that that’s because of the metabolic syndrome and the effects that I just described. And then there’s this other guy that showed that there’s this phenomenon related to food that depending on what food you ate, it changed the acidity of your urine, and then someone somewhere made the leap that the acidity of your urine and these foods were related to the acidity of the blood, which is absolutely not the case, and there are a couple papers. I could find them and cite them here if you want. There was a recent review in 2010 that came out, and they showed that that is absolutely not the case. It’s just like if I go on a low-carb diet and I start losing water, does that mean I’m dehydrated? No. If I go, like, on a high acid load diet and I start losing magnesium or I start losing calcium, does that mean that my bones are demineralizing, not necessarily.
Chris Kresser: Yeah, I mean, the body very tightly regulates the acid/alkaline balance in the blood, so the idea that you can measure that in the urine is pretty ridiculous. It’s kind of similar to the idea that you can measure neurotransmitter levels in the brain by measuring them in the urine, which a lot of alternative practitioners — I get a lot of patients coming to me with those tests. And you know, there are all kinds of things that can affect neurotransmitter clearance that would affect their levels in the urine that don’t tell us anything about what levels are in the brain. Not to get sidetracked here, but just, yeah, the urine tests sometimes are not indicative of what’s happening in the blood.
Robb Wolf: Even when I was a student of Professor Cordain’s when we talked about the net renal acid load, I always asked: Well, why are we not tracking bicarbonate shift? You know, basically carbon dioxide is another huge factor in the total acid/base buffering within the system, and you can see either respiratory shifts or renal shifts, you know, depending on what type of acid load is being introduced into the body, and it seemed really odd to focus on simply the renal element of that when you can literally have pounds of acid or base load shifted per day in or out of your system, based on carbohydrate and bicarbonate dissolution within the blood. So, it’s a wacky kind of scenario.
Danny Roddy: So, I know Ray Peat’s big deal is that tryptophan and methionine and cysteine somehow down-regulate the metabolism and block the thyroid. What do you guys think about that?
Robb Wolf: I would have to look at the study, and that would really be news to me, and all of these things taken as a singular item, I’d really want to step back and look at the whole picture. And it’s just kind of wacky also that — Yeah, I don’t know. That’s all I want to say on that. I don’t want to go down that rabbit track I was thinking of. I’d really want to look at that and see. I’d be a little incredulous on that.
Chris Kresser: Never heard of it.
Mat LaLonde: You know, this reminds me of there’s a lot of people that use endocrinological studies improperly. The one that comes to mind is this researcher, [41:16] Gapon, that looked at the effect of eating fat about 3 hours before a workout, and he showed that the growth hormone release was lower, and so he suggested it’s bad. And here I am looking at this thing; it’s like: (1) They didn’t notice how big the growth hormone shift was relative to baseline. (2) They did not notice, you know, what was the purpose of the growth hormone release anyways, and it turns out that when you’re working out the purpose of that growth hormone release is to —
Robb Wolf: Release fats!
Mat LaLonde: Yeah! [laughter] Into the blood stream so your body can metabolize it for energy. So, if it’s already there, then the growth hormone doesn’t get released. And (3), like, all of this focus on these hormones, it’s not like they’re changing permanently. It’s not like your baseline level of growth hormone goes up. These things are trivial. And so, I look at that. I’m like, well, maybe it’s true, maybe it’s not. I haven’t read the study, but if it’s true, does it necessarily mean that it’s bad? Or is there a reason for it? Is there a mechanism, and what is the mechanism? So, I don’t know. I mean, I would have to read the study.
Chris Kresser: Yeah, it sounds doubtful.
How to increase testosterone and libido without testosterone creams
Danny Roddy: This next question is from Henry. Chris, this was a popular question on your blog when you posted the Nerd-A-Thon, but: “How do I increase testosterone and libido?” Henry asks. And I’m assuming he’s talking about diet-wise.
Chris Kresser: Well, I mean, there are a few things we’ve already talked about, correcting the cortisol/testosterone ratio, so doing things to bring cortisol back down to normal levels and to make sure the cortisol rhythm is where it should be, because cortisol should be higher in the morning and it should taper off and be lower at night. So, you have the overall output of cortisol to consider, but also the rhythm. Then the other obvious thing is that if you’ve got any kind of insulin resistance going on, you’re up-regulating aromatase and you’re converting testosterone into estrogen, and that’s not gonna do wonders for your testosterone levels and your libido. I think those are the most basic approaches.
Robb Wolf: Good vitamin D status, you know, some resistance training. I have seen some pretty good bump out of things like nettle root, which can modify sex hormone-binding globulin and its affinity for testosterone, so you can get a little bump in free testosterone relative to bound testosterone. And then I still don’t really know if it’s more of a luteinizing hormone effect, like a dopaminergic effect, but tribulus seems to definitely help with libido, and I seem to recover from training and have a little more focus and chutzpah and all that when I’m using some tribulus [indiscernible]
Mat LaLonde: I recommend increasing fat intake. I can provide a reference that shows that increasing fat intake, especially saturated fat intake, is going to lower levels of sex hormone-binding globulin, which is going to increase the levels of free testosterone, and I personally had some very good success with that, doing a low-carb diet and only lifting for about a month or two put on some muscle mass, and that worked really well. I did look into the research into nettle root, and I think there are some questions that remain to be answered there in order to determine whether or not that is useful. So, it turns out that there is a compound in nettle root that can bind to receptors, very similar receptors to which testosterone can bind. So, it’s true that if you consume it, then your free testosterone goes up, but if this stuff is occupying the receptors, then the free testosterone is useless because it can’t bind to the receptors anywhere.
Chris Kresser: Right.
Robb Wolf: Competitive inhibition, yeah.
Mat LaLonde: Yeah, so it’s not clear to me whether or not that is really helping even though it’s increasing free testosterone.
Chris Kresser: And that’s just another point I want to make about using testosterone creams and any kind of hormone creams, which I see a lot of patients come to me in my practice, and they’ve been using these creams, and their testosterone levels are very, very high, or if they’re a female, their progesterone levels might be very high, and yet they display symptoms of testosterone or progesterone deficiency, which is probably because the receptor sites are shutting down because the levels are so high and they’re completely bypassing the normal negative feedback regulatory mechanism. So, one thing I would suggest not doing is using these testosterone creams.
Robb Wolf: You know, there’s an important feature of it. If you start getting into the anabolic drugs literature a little bit, you see a lot of this stuff. If you have elevated testosterone levels with, say, like a luteinizing hormone knockout kind of model, you don’t get really much of any of the desired effects out of the testosterone.
Chris Kresser: Right.
Robb Wolf: And particularly on, like, the strength increase, you get some anabolic effect, but not as much the neurological effect, the dopaminergic effect. So, again, this stuff tends to work in synchrony, and to a degree that you can, I think, trying to coax and nudge as much out of your huevos as you can for as long as you can is probably a smart way to go.
Chris Kresser: Right. So, it’s about improving your HPA, you know, hypogonadal axis rather than, you know, using every supplement, cream, and exogenous method that you can think of. What about Tim Ferriss? Do you go down to Uruguay of wherever he went and eat a pound of red meat three times a day? Did you read The 4-Hour Body?
Robb Wolf: Yeah, Nicaragua? I did that in Nicaragua, and I tend to do it at home. [laughter]
Danny Roddy: Mat, I know you’re a huge fan of Tim Ferriss and The 4-Hour Body. Is that true?
Mat LaLonde: No. No, that book is the biggest piece of shit I’ve ever purchased. [laughter]
Robb Wolf: Poking the bear, guys. Poking the bear.
Mat LaLonde: No. And especially, I mean, oh, man, the mechanisms that he — Yeah. I mean, I talked about it on Robb’s. I mean, he should have consulted some real scientists before. But, I mean, yeah. He’s just selling books to poor suckers. I mean, a lot of the stuff in there might be useful to pure beginners, but anyone listening to Robb’s podcast or this podcast know any better and they have better information and it was delivered for free.
Danny Roddy: It’s funny. It’s really taken my workplace by storm. All the guys that don’t care about nutrition are so into it. It’s like he really has a hold on them.
Mat LaLonde: Of course! He’s telling them you can have your cake and eat it too.
Chris Kresser: Yeah. Well, he made a good book trailer. I mean, he’s a freaking genius when it comes to marketing, and that’s really what it’s all about.
Mat LaLonde: [indiscernible] the song that’s playing in the background. [laughter]
Robb Wolf: And at the end of the day, I mean, to the degree that let’s say 20 million Americans ended up picking that thing up and started eating a slow-carb diet, even if it’s got legumes in it, they’re probably gonna end up being a lot better off than where they’re at now.
Chris Kresser: Sure, absolutely.
Robb Wolf: He is in many ways also the skinny end of the wedge. He’s very kind of pro-Paleo and this whole concept, so it’s definitely the skinny end of the wedge of getting some idea about these concepts of insulin regulation and dysbiosis and all the rest of that and getting it out in front of a massive number of eyeballs.
Chris Kresser: Yeah. Can’t be bad.
Mat LaLonde: I could say that same about Barry Sears’ Zone book. [laughter]
Robb Wolf: Yeah.
Chris Kresser: Yeah, it’s a whole other can!
Whether elevated LDL after adopting a paleo diet is caused by micronutrient deficiencies
Danny Roddy: OK, guys, let’s get to Todd33’s question: “Could you put your collective giganto brains together and discuss Paul Jaminet’s relatively recent blog post and discussion in which he suggests that the most likely cause of elevated LDL in the low-carb and Paleo community is vascular damage caused by micronutrient deficiencies such as copper? What do you guys think? Anything to this?”
Robb Wolf: You want me to jump in on it?
Mat LaLonde: You can jump in on it first if you want.
Robb Wolf: I found this interesting, but it was fascinating to me that we would go, and I’ve had a couple of people, probably the same person, throw this on my blog, and I think I answered it on the last podcast, which was I don’t really get the mechanism here if you go from a generally nutrient-deficient, gut-irritated Standard American Diet, eat a Paleo Diet — what’s the mechanism of causation that, you know, we suddenly become even more nutrient deficient? Like, I’m even more zinc and copper and selenium deficient eating, you know, even if it’s conventional meat and conventional fruit and veggies and all that? Like, that part of it just flat did not make any sense to me at all, and so I looked at it, and it was kind of interesting. I think that there are probably some nutrient deficiencies floating around out there, even with standard kind of Paleo-type stuff. I think iodine is hard to track down. I think that adequate selenium is probably hard to track down because of the way that we irrigate our agricultural crops, it just kind of washes stuff away, but it seems odd to me. It doesn’t really compute. I think they have kind of a supplement line kind of backing this thing up, and you can pretty clearly get in and look at, you know, different saturated fat intakes and see mechanistically out of the liver where we can get some changes in LDL cholesterol production, but it doesn’t really mean all that much. If it goes up, it doesn’t really matter. So, I’ll let The Kraken jump in from there.
Mat LaLonde: Yeah, so, from the post, I mean, I looked at it and I saw, I guess this guy was doing physics at Harvard and he’s now doing some economics. His wife is at the med school at Harvard. He was at the Gary Taubes seminar wearing some flimsy, weird-looking boots and gave Gary his book. Just this interesting guy. So, I really don’t care. He can come find me in my office. I can break him in half. [laughter] You know, I was reading the post. I’m sort of kidding. It would be interesting to talk to him. I was reading the post, and it seems to me like there were just some logical fallacies that just abound. So, he’s taking, like, a specific scenario and then applying it out of context. So, the thing being, like, are there gray clouds in the sky when it rains? Yes. Does it rain every time that there are gray clouds in the sky? No! So, just because LDL cholesterol is increased doesn’t mean that there is vascular injury, although it is true that cholesterol production is increased in response to injury and in response to infection, as Robb and I know, in sepsis. And then depletion of VLDL to IDL to LDL and small, dense LDL is not necessarily detrimental and may even be normal. So, if you’re increasing your fat intake, first that’s going to get to your cells via a chylomicron. That chylomicron is going to get depleted via lipoprotein lipase expression on various cells. Then the remnant is going to go to the liver, and it’s all gonna be repackaged as VLDL. Then the VLDL is gonna come out; it’s gonna be depleted. It’ll become IDL, deplete again, LDL. It may become small, dense if it’s depleted again, but what’s interesting is that the higher the fat content of your diet, the less likely it is to become small, dense because the lipoprotein particle is packed with more fat. And that’s something we don’t have here: Was that cholesterol mostly pattern A, large, buoyant, and non-atherogenic, or was it mostly pattern B, small, dense, and atherogenic? We don’t know. And then he sort of states that cholesterol and LDL particles are part of the vascular wound repair process. True. That’s absolutely true. And immune cells indeed have LDL receptors to guide to site of injuries. That’s true. And then he says very high LDL levels are a marker of widespread vascular injury. Not necessarily the case! I mean, biology right now is moving towards what they call systems biology, where instead of looking at the effect of one variable on a pathway, they’re looking at all of the variables because the human body is a multivariate problem. They’re looking at all the variables and how that is affecting it. So, I mean, I looked at the numbers, and you know, for someone who is doing a low-carb diet — Now, another problem is that we don’t know how this guy is implementing his low-carb diet.
Chris Kresser: Right.
Mat LaLonde: I don’t know what kind of foods he was eating. And his copper levels were also never measured, and it turns out those are problematic to measure because most people don’t measure copper levels in the liver where it’s stored, and I don’t think there is a method for doing that. They’ll look at blood levels of copper, and those vary depending on whether or not you’ve got an infection, stress, and whatnot, so they’re not very reliable. So, there is, like, a correlation between copper deficiency and dyslipidemia, but if you do read the post by Stephan Guyenet that is linked in there, it’s not 100% clear whether or not it’s cause and effect. And then, you know, he goes off and recommends a bunch of supplements, one of which is choline, but then at the end it’s, like, yeah, look, his numbers improved, so it must have been the vascular injury. And I’m looking at the numbers, and yeah, his HDL is a little low for a high-fat diet. His LDL is a little high for a high-fat diet, and his triglycerides were a little high for a high-fat diet. What I think actually helped here was the choline.
Robb Wolf: The choline.
Chris Kresser: Right. The whole fatty liver connection.
Mat LaLonde: Exactly! I think what was corrected here was a case of fatty liver disease, and that can happen if you’re eating a high-fat diet where a lot of the fat is coming from isolated sources as opposed to the whole food sources because you’re not gonna get a lot of the choline with the food; whereas, if you eat liver — and he recommended eating liver and eggs; those are rich sources of choline — then you’re going to get the choline. So, you know, to me, that’s what happened there. Like Robb said, I do not see the mechanism for increased vascular injury when you switch to a Paleo Diet. I just don’t see it. You should have lower inflammation. So, there’s some stuff in there that’s right, but it’s just not being applied properly, and I don’t think that the vascular injury was the cause. I think that the choline deficiency was the cause because the guy wasn’t eating enough whole foods probably or not eating enough organ meats and eggs, and that’s what was causing the shift in the numbers.
Chris Kresser: So, I’ll throw in a few things here too, and whether or not I agree with Paul on this post, I have a lot of respect for him and his work and generally do agree with most of what he writes. But in this case, I think the choline deficiency is probably the main thing, and Chris Masterjohn has written a lot about this recently. You know, Mat, you probably could explain the mechanism better than me, but my understanding —
Mat LaLonde: Actually, I have the whole mechanism, organic molecules included, drawn on one of my slides.
Chris Kresser: Ha-ha, there you go!
Robb Wolf: And he sticks it under his pillow at night.
Chris Kresser: So, fatty liver is there, and then without choline the liver can’t export triglycerides into VLDL and then LDL? Is that right?
Mat LaLonde: That’s right, because phosphatidylcholine is required to synthesize VLDL.
Chris Kresser: Right. So, then if someone starts eating more egg yolks and choline-rich organ meats, which they weren’t eating probably before they switched to the Paleo Diet, and their liver becomes liberated of those triglycerides, their LDL goes up. That, to me, is the most likely explanation. But there’s another interesting thing here, which is timing, because Stephan Guyenet a while back wrote a post where he reviewed all the literature and showed that when you increase saturated fat, you do get a temporary increase in LDL, but over the long term, there’s actually a negligible increase in LDL with a high saturated fat diet. So you really have to ask is this elevation of LDL after switching to low-carb Paleo, you know, are we talking about a month later? Three months later? Six months later? And then, of course, the final thing, which you’ve already mentioned, is who cares? Does it matter? Are we talking about large, buoyant LDL, because we know from Krauss’s work that when you eat saturated fat three things happen: Small, dense LDL goes down; HDL goes up; and large, buoyant LDL goes up. And triglycerides go down too, so it’s four things.
Mat LaLonde: It’s interesting that you mention Stephan Guyenet because most of the stuff that is in the Perfect Health Diet was directly lifted from his blog. And they reference that liberally, which I was like OK. I’m sure Stephan signed off on it, but I was, like, wow, that’s interesting. But the whole choline thing, it’s been shown that irrespective of choline, as long as you have enough protein in your diet, you can avoid fatty liver disease, and that’s because methionine gets methylated by — it gets turned into s-adenosylmethionine, which is a good methylating agent, and that’s what turns the phosphatidylethanolamine into phosphatidylcholine. So, ethanolamine is first hooked up to the phosphatidyl portion, and then it is methylated to be turned into choline. And a little bit of betaine can help there too. If you have a deficiency in folic acid, that can also hurt the conversion of methionine to s-adenosylmethionine, so there are a lot of things that are playing into that.
Robb Wolf: And this is some of the stuff where there are a lot of different recharge mechanisms, whether we’re talking antioxidants or the, you know, different phosphatidyl derivatives or whether it’s choline or ethanolamine or whatever, is that there are typically redundancies in this system, and so people will get super spazzed out about, like: You’ve gotta eat organ meats! And it’s like: I like organ meats! They’re really good. They’re good stuff. But at the end of the day, if we’re getting people off of grains, legumes, and generally dairy; if we’re getting their vitamin D levels up; if they’re generally sleeping; I’m just not seeing horrific problems in these folks. And those seem to be the biggies, and so even, like Mat said, when we’re talking about choline, and the main sources of choline would be, you know, like, organ meats, specifically liver, or eggs or something like that, that stuff is all great, definitely go for it, but if those overall ducks are in a row, I’m just not seeing these horrific consequences that some folks like Ray Peat are talking about.
Chris Kresser: And they’re probably talking about, like, the last 10%, you know, or 5% of tweaking their diet.
Robb Wolf: Yeah.
Chris Kresser: And the choline issue is probably only an issue for people who have fatty liver in the first place, you know.
Robb Wolf: Exactly. Yeah, that’s where it’s probably beneficial and nutraceutical to maybe even do some isolated phosphatides or some, God forbid, soy lecithin or something like that because of the density, even if it’s heavy in omega-6’s, you’re probably finishing off better in the long run with that.
Chris Kresser: Yeah.
Mat LaLonde: You know, to that I can add for [indiscernible] pound of homemade beef liver pate, and my urine has been a beautiful concentrated fluorescent yellow since. [laughter] And as I was washing the dish last night, my roommate was like, “Dude, it smells like vomit.” And I’m like, “Well, hey, you know what? There’s bile that’s produced by the liver. That’s why it smells like vomit.” And my roommate was completely unimpressed. So, I just need to find myself a roommate that can appreciate the fact that —
Robb Wolf: That would be a great craigslist deal: Harvard PhD searching for roommate that appreciates the eau de vomit.
Chris Kresser: That’s right. Got another good one for Mat here from Tim T.
The complete lack of evidence supporting “metabolic typing”
Danny Roddy: You’re gonna love this one: “What do you guys think about metabolic typing?”
Mat LaLonde: So, I have access to this program called SciFinder through Harvard, and it searches every scientific article that has ever existed. It’s a very powerful database. And I tried to find scientific articles on metabolic typing, and the only thing that it spit back was one patent that has absolutely no scientific references in it. And I started reading that thing, and it was a complete waste of my time. If you want to completely waste your time, this patent is called Method for Determining Metabolic Type, and the patent number is W02007/050940 A2. And it’s really stupid. So, it describes the whole thing about, you know, the autonomic nervous system and the oxidative system, and some people tend to be favored toward one or favored toward the other, and the method they’re using to determine the “metabolic type” is that they’re challenging people with a glucose tolerance test, you know, a very typical glucose tolerance test. They’re testing the blood pH before the test, and then they’re testing the blood pH after the test. And depending on where your pH was before and how the test affected the blood pH, you get put into one of these four categories, and I cannot find any scientific evidence to support this whole — And I know a lot of metabolism, OK? I cannot find any scientific evidence to support this. What was really interesting is — let’s see if I can find it — they say that their method is better — this is really interesting. Let me see. They say their method is better but that you can use a variety of other things to test aside from sugar, and then they name the stuff, and I was just appalled by what they suggested you could use to test for this. Let’s see. Now, why did I lose this? That was priceless. Ah, man.
Chris Kresser: Did it have to do with astrological divination?
Robb Wolf: Ha-ha. Oh, did you find it?
Mat LaLonde: Yeah. “Although glucose is preferable to use as a challenge because it tends to be absorbed into the bloodstream fairly rapidly and consistently for most people, other pure substances such as dextrose…” Last time I checked, that was glucose.
Chris Kresser: Right, ha-ha!
Mat LaLonde: “…vitamins, minerals, chemicals, pharmaceuticals, etc., may be used as well and might be better suited for certain types of people such as diabetics.”
Chris Kresser: Well, at least that’s specific!
Mat LaLonde: So, they’re just proposing challenging the body with any kind of substance and looking at how this affects the blood pH and that’s what determines your metabolic type. And this patent had nothing to say about, well, if your metabolic type is this, you need to eat this way. So, I started looking on the Web, and all I found were surveys, and to take most of the surveys, you had to pay. So, this looks like a total money-making scheme. I highly recommend that you go on Wikipedia and look up “metabolic type” to see what you’ll find. A lot of schemes there. So, I eventually wound up on a few of the websites, and their survey is like: What did you eat for breakfast, and how does that make you feel? And if you had to eat something for breakfast, what would it be? And then they repeat the same thing for lunch and for dinner, and then they tell you: Oh, you’re like a veggie type. Or a mixed type. Or a protein type. And then they give you a meal plan, but there is absolutely no mechanism, no biochemistry. It’s not like someone actually determined where you were at, your levels of lipase, for example, or amylase, and say: Oh, right now you can probably digest this stuff really well. So, there’s no scientific basis to it that I can find anywhere. Some of the foods that are prescribed, you know, will sometimes be grains, pseudocereals, and whatnot, which I wouldn’t recommend anyone eat. The only reasonable thing I found was on Dr. Mercola’s site, but that’s because he’s already on board with the gluten-free deal. So, if you go through what he calls his “nutritional typing,” he’s gonna give you something that’s a little bit more reasonable. He’s still gonna have quinoa and crap like that, you know, junk food like that in there. Yeah, I called quinoa junk food. [laughter] But it seems a little bit more reasonable. So, it seems to me like it’s just a bunch of organizations trying to make money off of poor people, there’s no legitimate science supporting this, and I simply — you know, if the food quality is not there, I simply cannot support it. You know, the gig that we do is typically food quality first, macronutrient ratios will vary depending on your goals and your activity levels, and the thing that really irked me with the whole metabolic typing deal is that it seems to suggest that you could not adapt to a different kind of diet, which is not the case. Like, yeah, sure, even if you were going to run a battery of tests on me right now, you could tell me my amylase levels are this, my lipase levels are this, right now you are primed to digesting this type of diet. That doesn’t mean I can’t change.
Robb Wolf: It’s largely reflective of what you’ve been eating because your body adapts more to the fuel you put into it.
Chris Kresser: Right. Well, clearly you guys haven’t been reading the Jolly Fats Weekawken Journal of Metabolic Typing. [laughter] There’s plenty of articles in there about it.
Mat LaLonde: There’s seriously a journal?
Chris Kresser: No, no, just kidding.
Mat LaLonde: OK, because I can’t find any reference —
Chris Kresser: I’m totally kidding. I’m so suspicious of these kinds of things. I did half of a podcast about the blood type diet a while ago.
Mat LaLonde: Another crock.
Chris Kresser: Yeah, exactly.
Robb Wolf: It’s so sad, though, that book, Eat Right 4 Your Type, has been on the top 200 on Amazon for, like, 15 years.
Chris Kresser: It’s crazy.
Robb Wolf: It is insane.
Chris Kresser: Everybody has heard of it and does it. I mean, the thing is most people are type O’s in North America, and you know, they switch to the Type O Diet and they go: It works! Guess what that is?
Mat LaLonde: It’s a Paleo Diet.
Chris Kresser: Exactly! Anyway, we’ve already been there, done that. So, let’s look at Neil’s question, Danny.
The potential causes of excessive bloating
Danny Roddy: OK. “I’m 6’1” and 145 pounds. Don’t laugh. Despite my weedy frame, I have a gut that protrudes over my pants in a bloated state for most of the day, causing me to look pregnant. I don’t feel overly full or sick as much, but obviously something is wrong here. Could this be an intolerance to gluten, or are there any other causes of excessive bloating?” What do you guys think about that one?
Robb Wolf: Possibly he might be pregnant is my only other test, ha-ha.
Chris Kresser: I would say a urine test, pregnancy. Yeah, there are a lot of possible causes of excessive bloating. I mean, any kind of gut infection would be one obvious cause. Parasitosis can cause bloating, and it’s not limited to people who travel in the third world. You can definitely get parasites — you know, I’m not sure where Neil lives, but it’s not an entirely uncommon issue. Certainly, an intolerance to gluten could cause that problem. It’s one of the main symptoms of gluten intolerance. And then he goes on to say he has postnasal drip and allergies to pollen and grass, which are all other signs of immune dysregulation, and then he asks whether these things would be helped after switching to a Paleo Diet, and I would say absolutely. I mean, there are clearly signs of gut inflammation and immune dysregulation here, and the Paleo Diet, as we’ve talked about, is the best nutritional approach to resolving that.
Robb Wolf: But if he’s pregnant, then the Paleo Diet will not help. Only safe sex can prevent that. [laughter]
Chris Kresser: That’s right.
Mat LaLonde: Yeah, there are a couple things I’d like to add to this. So, what he describes here reminds me of Karen Pendergrass. I’m not sure if you guys are familiar with her. She’s a girl on a mission. She started this deal called Paleo Approved. I think the name is unfortunate because it doesn’t truly reflect what she’s trying to do. She has taught herself all of, like, animal husbandry, nutrition, and whatnot, and is trying to certify farms that produce foods in a truly ideal manner. Only grass-fed cows, chickens that only eat bugs and some grass, pork that only eats very specific foods whether it’s acorns and whatnot, like, really super high food quality. She’s not trying to put stickers on, like, celery and bananas, you know. And she got into that because she has something that’s beyond celiac. I mean, Robb can eat a steak from a grass-fed animal and be OK. She cannot. She absolutely cannot.
Robb Wolf: Grain-fed.
Mat LaLonde: Exactly, I mean from a grain-fed animal.
Chris Kresser: Grain-fed. Oh, wow.
Mat LaLonde: She absolutely cannot. And she’s one of the people where I said: OK, you have to be all meat and fat. And that’s one of the only things that has put her liver enzymes back to normal but also reduce the swelling. Like, at some point she broke down, she went to Whole Foods, she bought a sweet potato and ate it, and she woke up swollen the next morning. Like, her feet are swollen; they can’t fit into her shoes anymore. If she gets exposed to gluten, she looks like she is pregnant. So, it sounds a whole lot like that, so I would say absolutely yes. When it comes to the whole postnasal drip, there’s some interesting stuff here. I started to suffer from that last year, exactly a year from now, last spring, and I just thought that it was allergies. And it turns out that when I was a kid, my front tooth, #9, broke off and it was patched haphazardly. I then had a root canal, and the root canal was not done properly, and it got infected. And I only noticed like a month later once the pustule formed there, and I had to get that tooth removed. And my advice to anybody who has to get that done: If you need to get a root canal done, do not get it done by a regular dentist. Go see a professional, experienced endodontist. If that root canal [indiscernible] removed. Do not get an apicoectomy. It’s just barbaric. Do not do that. I went through two apicoectomies, and my face is still swollen from it. I’m still recovering from that, and it’s a year later. So, anyway, it turns out that if you do a little bit of sleuthing, you’re gonna find this research by Dr. Meinig. Dr. Mercola has interviewed him in the past. And he has dealt with people that had autoimmune diseases like arthritis, removed teeth like that that were dead but still in the body, teeth that had undergone root canals but improper root canals, and showed that it removed the symptoms. And what’s interesting is that those teeth can be places where gram-negative bacteria can thrive and have direct access to your bloodstream. There is a similar mechanism that’s going on when you have an intestinal permeability and overgrowth of gram-negative bacteria in your gut. So, really interesting stuff there.
Danny Roddy: That’s actually extremely fascinating that you brought that up. I visited a dentist in San Diego, and I talked to him about root canals, and he said one of the most common symptoms that his root canal patients experience were autoimmune diseases, so he was telling me how it’s, like, synonymous with Hashimoto’s disease and other autoimmune conditions. I thought that was an overlooked area that’s not really explored too much in the Paleosphere.
Mat LaLonde: Yeah, as soon as that tooth was removed, and it was removed about a month ago, the postnasal drip went away.
Chris Kresser: Wow.
Danny Roddy: I actually wrote a post about this subject, but my front left tooth was root-canalled and I have a retainer in it right now. I’m just saving up the pennies to get the expensive implant, unfortunately.
Mat LaLonde: I still have one in my mouth right now, and I am debating getting it pulled out.
Chris Kresser: Yeah, go for Thomas. I’m doing a little question editing here just because, you know, for time.
Mat LaLonde: I’m actually doing that too because they’re full of mistakes and it’s irritating. [laughter] I’m gonna sound like [indiscernible]
Chris Kresser: Go ahead, Danny.
The myth that a paleo diet is bad for the kidneys
Danny Roddy: OK, this one is from Thomas Drake, which is an awesome name: “Since a Paleo Diet can introduce a high load of uric acid and possibly oxalic acid from specific vegetable sources, is there a potential for greater stress on the kidneys, like kidney stones, compared to a diet with less meats and more Twinkies. 🙂 If so, what in a Paleo-ish diet allows for healthy kidney function?”
Robb Wolf: What? Ha-ha!
Mat LaLonde: I can handle that. I discussed that in my seminar at length. So, it turns out that when you increase your protein intake, there is adaptation by the kidneys. They ramp up. Uric acid excretion increases. So does the excretion of urea and other materials, so this is absolutely not a problem. What is a problem is excess fructose consumption. When you do that, that increases uric acid production, but it does not increase uric acid excretion.
Chris Kresser: Right.
Mat LaLonde: So, in that case, you’re gonna get a buildup of uric acid, but not when you’re increasing protein. It’s just a very common misconception, and there are plenty of good scientific articles to show that it’s just not the case. You are producing more uric acid, but the kidneys adapt. Now, there is a situation, for example, let’s say someone has kidney damage or kidney disease, they recommend that they eat less protein. That’s legit because the kidneys are diseased and probably cannot adapt quite as well as they used to to the extra load. That makes sense, but it doesn’t mean it’s the protein that caused the problem or caused the kidney disease. It’s more like you need to, you know, lay off the protein because your kidneys can’t adapt [indiscernible]
Robb Wolf: Was there an element, like oxalates?
Chris Kresser: Yeah, he said introduce a high load of uric acid and possibly oxalic acid from specific vegetable sources.
Robb Wolf: Yeah, I mean, if you eat — This is where, like, diversifying your toxin load, you know, getting different vegetables that you bring in. You know, if you do a massive head of fairly old collards or chard, the oxalate load can be quite high, and then depending on what else you have going on, you could potentially get some precipitation of oxalate crystals in the kidneys, but this is where you’re eating, like, a pound of it at a time and it’s a specific time of year and all these sorts of things, but you know, it’d be damn hard to get some sort of a metabolic situation that would really make that problematic. But what would really make it problematic is being insulin resistant and doing that. That would absolutely be a problem.
Chris Kresser: Right. Confusing cause and effect a lot here. It seems to be a big theme in today’s podcast and, of course, in the scientific literature in general. All right, how —
Mat LaLonde: I think we skipped a question. There’s one by Isagio, like, the Eat to Live Diet. That’s on my list.
Chris Kresser: Yeah, do you want to take that on? I mean, it’s almost kind of — I feel almost sorry for them.
Mat LaLonde: I’ve never heard of it. What is it?
Chris Kresser: Oh, you know, Joel Fuhrman. It’s vegan.
Mat LaLonde: Oh, wow.
Chris Kresser: Yeah, you know, it’s kinda like, yeah, we could do that. We could get a few laughs. Been there, done that. I don’t know. Do you guys want to do it? Let’s just go on.
Robb Wolf: No, that’s just kicking a downed man.
Chris Kresser: Exactly! So, I’d rather answer some questions and try to actually just help people out.
Mat LaLonde: It’s kicking a downed, emaciated man. [laughter]
Robb Wolf: Yeah, there we go. Better.
Chris Kresser: Ha-ha, right. So, let’s see. Thomas. We just did that. OK, [indiscernible]. I have something to say about that, so go ahead, Danny.
What a paleo diet can — and can’t — do for type 2 diabetes
Danny Roddy: Here we go: “You guys tell us that a diet will easily fix diabetes, and although my A1c is down from 10.3 of three years ago, it’s still too high. I suspect that I may be trapped in an insulin weight loss merry-go-round. I can’t lose weight with high insulin, and I can’t reduce insulin unless I lose weight. I’m assuming that I have high insulin levels. Doc sees no merit in checking. He’s kinda conventional. So, do you feel that taking glucose-lowering meds temporarily might be a quick fix for the weight loss, leading to an elusive cascade of health benefits? Or any other suggestions? I’d love to be able to reclaim some of that feeling of immortality before going down that final dirt nap.” And you guys are gonna have to interpret this one for me, because I don’t get it. [laughter]
Robb Wolf: Wow.
Chris Kresser: Well, OK. So, I don’t know about Robb and Mat. I suspect I could guess, but I’ve never said that the Paleo Diet will easily fix diabetes. That’s a pretty general statement, and it really depends. Blood sugar dysregulation is a whole spectrum. You know, starting from really mild blood sugar imbalance to full-fledged type 2 diabetes with progressive beta cell destruction and really no ability to produce much insulin at all. If somebody is at that stage, a Paleo Diet and a low-carb diet is gonna be certainly very helpful, you know, with glucose control, but it’s not gonna magically grow back beta cells. So, my perspective on this is it really depends where somebody is on that spectrum. And of course, the low-carb Paleo Diet is, you know, just standard with metabolic damage, but whether it’s going to fix it completely, that’s a different question.
Mat LaLonde: That’s something I talk about often, is depending on how damage was done, there are some people that aren’t going to be able to tolerate carbohydrate for maybe the rest of their lives, and they’ll have to stay low-carb. Now, this person does not say what kind of diet they’re on, whether they’re low-carb or high-carb, and it seems to me like you should be low-carb Paleo right now.
Robb Wolf: Yeah, it seems like he or she is fishing for, you know, like, can I just go on meds and fix it? is kind of what I’m getting from this.
Mat LaLonde: The meds are just playing with the numbers. I mean, I’ve looked at the mechanisms and whatnot. What’s interesting about lifestyle drugs is that what you really need to do to cure a disease that’s treated with lifestyle drugs is change the lifestyle, not take a lifestyle drug.
Chris Kresser: Yeah, so we can’t answer that question without knowing more, but I think we’re all agreed that, you know, severe advanced metabolic damage is not always correctable and that your glucose tolerance, you know, you might not be able to eat that sweet potato like other people with normal metabolism can.
Robb Wolf: Right.
Chris Kresser: Next question.
Danny Roddy: This one is from Tyler Backman: “As a practical concern, high omega-6 is so ubiquitous in modern foods that it seems virtually impossible to reduce the natural levels in modern times unless one can afford to eat exclusively grass-fed or wild-caught meats. Do you have any advice for how a psychiatric patient or a limited budget could significantly lower omega-6?”
Chris Kresser: I’m so sorry. I aggressively edited this question because it was really long. So, the background is that he’s dealing with some, you know, mental health issues that he thinks are related to — and he’s probably right — an omega-6/omega-3 imbalance. So, that’s the background there. You know, first of all, there is one pretty popular misconception, which is that grain-fed meat is higher in omega-6 than grass-fed meat. They’re actually about the same in omega-6. The difference is that grass-fed meat is higher in omega-3 and has a better omega-3/6 ratio.
Mat LaLonde: It also has a better vaccenic acid and conjugated linoleic acid level.
Chris Kresser: Right. So, the issue is not probably — Yeah, grass-fed meat is gonna help improve that ratio, but obviously eating more fatty fish like salmon, mackerel, herring, sardines, you know, three times a week at a minimum —
Chris Kresser: Sorry. Someone dropped out there.
Robb Wolf: I’m still here.
Chris Kresser: OK. Maybe it was me. I missed that. And if you limit — a lot of people are unaware of this, but you know, dark-meat poultry with the skin on it particularly is several times higher in omega-6 than either conventional or grass-fed beef or lamb or pork. Pork is lower in omega-6 than the dark-meat poultry with skin. And then, of course, there are the nuts. And we all, you know, in the Paleo world people tend to go a little nuts with the nuts. But macadamias are lower than most in omega-6, so they can be a pretty good choice. I think if you eliminate seed oils; you don’t eat packaged, processed, refined foods; you favor red meat, you know, beef and lamb and pork that are all pasture raised and heritage produced like Mat was talking about earlier; and then you eat three servings of fatty fish per week; you can get pretty close to between a 1:1 to 3:1 ratio.
Robb Wolf: I have nothing to add.
Danny Roddy: Do you guys think it’s hard to avoid excess omega-6?
Robb Wolf: No, I don’t. That’s why I was kinda stumped on it. If you avoid corn and soybean oils, you know, basically the kinda shoddy seed oil type stuff, incorporate coconut and stuff like that, you should be fine. I just don’t see this really being all that big of an issue.
Chris Kresser: Yeah.
Danny Roddy: OK. This one is from Reality: “Are female issues like vaginal dryness, facial hair growth, and hair loss caused by low-fat, high-carb diets? Have you personally witnessed improvements to these issues when your patients go on a Paleo Diet? If so, I think it’s important for it to be talked about because it’s usually focused on weight loss and there are other hormonal issues that relate here that I’d like to know.” Pretty common question. What do you guys think about it?
Robb Wolf: You modify insulin levels. Then you’re gonna modify sex hormone binding protein, aromatase, conversion of estrogen into testosterone, progesterone function — you name it and if there’s any type of, like, hirsutism, abnormal hair growth particularly with a female, then you can fix this, and typically also they have some other under-the-hood issues brewing, like polycystic ovarian syndrome, uterine fibroids, you know, on and on and on, so usually that’s an outward manifestation of some internal stuff brewing.
Chris Kresser: Yeah, I talk about this in my Grow a Healthy Baby presentation. An increase in insulin —
Mat LaLonde: Robb, stop humping your keyboard.
Chris Kresser: Yeah, what’s happening?
Robb Wolf: Oh! Sorry, sorry.
Chris Kresser: High carbohydrate diet, you know, other food toxins, increase in insulin resistance, up-regulation of 17,20-lyase, converts estrogen into testosterone, get androgen dominance, which can cause all those facial hair grown, hair loss, vaginal dryness, and then PCOS, which Robb just mentioned, which is the number one cause of infertility in the US and, you know, probably in other modern industrialized countries as well. So, in my practice, definitely the first thing I do with women dealing with symptoms like this is put them on a high-fat diet, you know, a high-fat, Paleo type of diet, and they see huge changes, usually pretty quickly too.
Mat LaLonde: That’s just a typical hyperinsulinism problem. Everything that needed to be said was said. We did skip a couple questions.
Chris Kresser: Are there any you want to tackle, Mat, that seem interesting?
Mat LaLonde: There’s one here, I guess it’s directed to you, that says: “Can you explain why you recommend Native Forest coconut milk over other brands?”
Chris Kresser: Doesn’t have BPA in the —
Mat LaLonde: In the can?
Chris Kresser: Yeah.
Mat LaLonde: OK. Does it have guar gum in it?
Chris Kresser: Unfortunately it does.
Mat LaLonde: I see.
Chris Kresser: I have not been able to find —
Mat LaLonde: Light coconut milk from Trader Joe’s.
Chris Kresser: Has no guar gum, and also, oh man, what’s the brand? Sorry. There’s another brand that doesn’t have — The only problem — There’s a full-fat coconut oil that has no guar gum. I’m totally spacing on it right now. I’ll think of it before the end of the podcast probably.
Robb Wolf: Is it the [1:28:32] stuff? Like, we have one that doesn’t have guar gum. It’s from Thailand.
Chris Kresser: No.
Danny Roddy: Guar gums are allergens, correct?
Mat LaLonde: They’re derived from legumes.
Danny Roddy: Ah, OK.
Chris Kresser: And they, at least in my experience, they tend to cause huge problems with people with gut issues.
Mat LaLonde: Absolutely.
Chris Kresser: Almost all of my patients —
Mat LaLonde: [indiscernible] 1% to 2%, they will cause problems.
Chris Kresser: Yeah, like, major bloating, gas, you know. I lot of my patients can’t tolerate or think they can’t tolerate coconut milk, but what they actually can’t tolerate is guar gum. So, what I haven’t been able to find yet is a brand that has no BPA in the cans and no guar gum. So, if anyone, ha-ha, anybody out there listening? I mean, there’s the brand that I can’t remember that’s full fat and has no guar gum. I’m looking it up right now. They say that they’re gonna be switching to BPA-free packaging soon. They’ve been saying that the last four months, so I don’t know if that’ll happen, but if it does happen, I will definitely let people know.
Danny Roddy: This is our last question. This is from Virginia: “I have been taking Synthroid for over 30 years. I have never heard of Hashimoto’s until listening to Robb Wolf’s podcast. My question is should one be taking a multivitamin supplement with iodine in it if they have hypothyroidism? If the main cause for hypothyroidism is Hashimoto’s, should I be strictly following Robb’s protocol for autoimmunity?” What do you guys think?
Robb Wolf: Well, does she ever say if she actually does have Hashimoto’s? If you have Hashimoto’s, you should supplement with iodine, but if you don’t have Hashimoto’s, then that’s a pretty good spot to at least start looking, but then there’s, you know, looking at goitrogens, looking at cortisol issues, looking at general gut health. Like, there are definitely some things to tinker with there.
Chris Kresser: Yeah.
Danny Roddy: I know according to Kharrazian, 90% of thyroiditis was Hashimoto’s. I’m not sure where he got that. I think it was a PubMed reference.
Chris Kresser: I have a study. I’ve linked to it in one of my articles. It suggests, I don’t know that it’s 90%. It’s somewhere pretty high. It’s like 8 out of 10 have thyroid antibodies, so in the developed world, Hashimoto’s is the number one cause of hypothyroidism. In the developing world, iodine deficiency is. And you know, I’ve written a whole series on the thyroid, and I did argue that iodine, based on what I’ve seen in the literature, can trigger and flare Hashimoto’s, and I’ve also seen that in my patients. Having said that, there are doctors out there, like Dr. Brownstein, who treat Hashimoto’s patients with high doses of iodine, and some of them improve. So, I don’t know exactly what to make of that. It’s possible that, for whatever reason, some people are sensitive to that effect and other people aren’t. It’s possible that in some people who have Hashimoto’s and are also iodine deficient that the benefits of iodine somehow outweigh, you know, any kind of triggering mechanism that might happen from it.
Mat LaLonde: I think it depends on the antibody, the specific antibody.
Chris Kresser: Whether it’s TPO or TG?
Mat LaLonde: Yeah.
Chris Kresser: Interesting. But as a rule, I usually have people avoid iodine with Hashimoto’s just because in my relatively small sample size, it seems to have caused more problems than it solves in Hashimoto’s patients. However, I totally agree with Robb that for other people it’s one of the most difficult nutrients to obtain even in the context of a healthy Paleo Diet, so supplementation is probably a good idea. By the way, that brand is Natural Value coconut milk. They have no guar gum, a full-fat version. Let’s just wrap it up. I don’t think we’ll have much to contribute in a minute’s time that’s worth talking about. So, I just want to thank you, Robb and Mat, for coming on the show. It was a pleasure to have you. I feel like I always learn a lot when I talk to you guys, and I also really appreciate the email banter and getting a chance to kinda dork-out and talk about all this stuff with you two. It’s great.
Robb Wolf: Totally. I just got to say publicly that Mat and Chris are my dealers for scientific papers. Pretty much I go to one, and I’m like, “C’mon, I just need one little gluten paper,” and Mat’s like, “You’re my bitch.”
Chris Kresser: Mat is definitely the big daddy in the syndicate as we know.
Robb Wolf: Yeah. Chris, you’re a pretty good broker, though. I’m just the toothless crack whore just, you know, selling my body for [indiscernible]
Chris Kresser: I’m the middleman!
Mat LaLonde: I’m the man behind the curtain?
Chris Kresser: Yeah, you are. That’s right. All right, thanks again everybody for listening, and I hope you guys enjoyed the show, and we’ll talk to you in a couple weeks.
Robb Wolf: Thanks, guys.