RHR: The Saturated Fat – Heart Disease Myth, Colonoscopy Health Risks, and Intermittent Fasting

In this episode we talk about a really interesting study that came across my desk on the saturated fat – heart disease myth. I also revisit the colonoscopy question we had in a previous episode and take questions from Facebook.

In this episode, we cover:

3:55 New Study: is the saturated fat – heart disease myth finally dead?
18:18 The health risks associated with colonoscopies
29:12 Managing histamine intolerance
34:40 Chris answers: “What is health?”
44:00 Does intermittent fasting harm the adrenals?
51:30 Chris Answers: “What is your workout routine?”

Links We Discuss:

• Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis
• The Roar of the Wolverine Blog

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Full Text Transcript:

Steve Wright:  Hi and welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com.  I’m your host, Steve Wright, and you can find my work at SCDLifestyle.com, but we’re both here to learn from integrative medical practitioner and healthy skeptic Chris Kresser, so Chris, how’s your day going?

Chris Kresser:  My day is going great.  It’s a sunny, clear, beautiful day here in February in California.  Can’t complain.  How are you?

Steve Wright:  My day is good as well.  You know what?  We actually have a clear, sunny day in Michigan as well!

Chris Kresser:  Fabulous.  Well, I’m excited.  I posted a little request for questions on Facebook yesterday and was surprised to get 194 of them in less than 12 hours, so we better hurry up if we’re going to get to all those questions today, Steve.

Steve Wright:  Yeah, I was trying to take some classes on speed-reading and speed-talking, but I don’t know if we’re going to do it, Chris.

Chris Kresser:  Haha.  But we have enough for a couple years now on the show, so that’s good news.  There were some great questions, actually.  It was hard to pick some, and of course, we have a backlog of some from the podcast submission form as well.  So, I think we’re good for a little while.

Steve Wright:  Yeah, we’re definitely good until at least 2014, but we would still appreciate more questions.

Chris Kresser:  Yeah.  It’s fun to get fresh questions.  That’s why I like posting to Facebook to see what people are thinking about right now, and the other cool thing about Facebook is other people will like questions that they have as well, so then we can kind of get a sense of which questions are most relevant to people that are listening to the show.  So, go social media!

Steve Wright:  Yes, go social media!  And if you want to follow Chris and where all this action took place, head over to Facebook.com/ChrisKresserLAc.  And we didn’t solicit Twitter that I know of, but if you want to follow Chris on Twitter, it’s Twitter.com/ChrisKresser.

Chris Kresser:  Yeah, well, maybe next time we’ll just do Twitter and get the Twitter crowd.

Steve Wright:  Yeah, we could do a tweet-a-thon question thingamabob.

Chris Kresser:  Haha, all right.  So, are you ready to dive in Steve?  Shall we do it?

Steve Wright:  I am but most importantly I need you to make sure you’re fresh because 194 questions — you better have your voice with you, so get some water, some tea, some coffee, all of those things above, and I want to tell everyone about Beyond Paleo.  So, if you’re new to listening to the Revolution Health Radio Show, if you’re new to the paleo diet, or you’re just interested in optimizing your health, you’re going to want to check out what over 10,000 other people already have signed up for.  It’s a free 13-part email series that Chris has put together called Beyond Paleo, and like I said, it’s 13 emails that Chris has put together on tips and tricks for burning fat, boosting energy, and preventing and reversing disease without drugs.  Now, if this is something you’re interested in, head over to ChrisKresser.com, look for the giant red box in the middle of the page, and go ahead and put your name and email in there and get on the list.

OK, Chris, how’s the voice?

New Study: Is the Saturated Fat – Heart Disease Myth Finally Dead?

Chris Kresser:  It’s pretty good, pretty good.  So, I’m going to talk about a really interesting study that just came across my desk today, so to speak, and I want to revisit the colonoscopy question that we had.  I said I would come back to that after doing a little more research.  This isn’t going to be the conclusive answer on the subject, and I don’t know that there is one actually, but I’ll talk a little bit more about that, and then we’ll get into some questions.

Steve Wright:  OK, perfect!  So, what is the study?

Chris Kresser:  This was a study about omega-6 and saturated fat and their respective relationships to heart disease.  More specifically actually, what the researchers did — This was Christopher Ramsden, his group.  He has done a lot of the studies on linoleic acid, omega-6 polyunsaturated fat, and heart disease.  And what they did is they went back and resurrected some data from the Sydney Diet Heart Study, which was done in the 1960s, and reanalyzed it using modern statistical methods.  Some of the data from that study wasn’t published in the original reporting of that study, and so they went back and looked at the raw data and then reanalyzed it.

You know, one of the cornerstones of the advice given for heart disease, at least in the mainstream paradigm, is to replace saturated fat with polyunsaturated oils, so soybean oil and corn oil and safflower and sunflower oil.  I think that’s changing a little bit now.  In fact, I think the most current guidelines don’t suggest those oils.  They talk more about the monounsaturated oils, like olive oil and stuff like that, but still there are a lot of people out there who were listening for those 20 or 30 years that the mainstream health organizations were telling people not to eat saturated fat and to eat margarine and corn oil instead.  And when this advice originated back in the ’60s, polyunsaturated fat and omega-6 were used interchangeably as terms because at that time, they only really knew about linoleic acid.  They didn’t know about the omega-3 fats yet.  And so, a lot of the early studies that suggested that polyunsaturated fat or omega-6 were beneficial also included omega-3’s because they didn’t know enough to separate them out.  Of course, we now know that omega-3’s have really different properties than omega-6, and when you actually look at studies that separate linoleic acid, which is the main short-chain, plant-based form of omega-6 fat, from the omega-3’s, there’s really no evidence that replacing saturated fat with linoleic acid lowers heart disease risk, and there’s some evidence that it might even increase it, which this study contributes to.

So, as I mentioned, this paper resurrected data from the Sydney Diet Heart Study.  It was a randomized, single-blind trial from 1966 to 1973, and it’s a pretty unusual opportunity to study the effects of linoleic acid because they used safflower oil, which is 75% linoleic acid by weight, so if you have 100 g of safflower oil, 75 g of that is going to be linoleic acid.  And there are no other polyunsaturated fats in safflower oil, so you don’t run into the problems that we have in other studies where you have multiple polyunsaturated fats and you can’t tell which one is having which effect.  So, the participants were men between 30 and 59 years old who had recently had a heart attack or an acute episode of angina, and there were 221 men in the intervention group and 237 in the control group, and the intervention group was told to increase their linoleic acid or total polyunsaturated fat intake to 15% and to decrease saturated fat and cholesterol to below 10% per day.

And a really important point about this study is that some people in the control group went ahead and decreased their saturated fat intake and increased their linoleic acid anyhow after their heart attack on their own.  They weren’t told to do that by the study investigators, but they had heard enough maybe through the media or whatever and they had recently had a heart attack and they thought maybe it was the butter or something, and so they did that on their own.  So, this study was not a perfect — as observational studies rarely are — it wasn’t a perfect separation between people who were following these guidelines and people who weren’t, and what that means is that the difference that was observed between the two groups could have been even greater if the control group was strictly just eating animal fats rather than vegetable oil or a combination of vegetable oil and animal fats.

So, what the researchers did is they provided the participants in the trial with safflower oil and safflower oil margarine — mmm, yum — and then they also gave them safflower oil to take in capsules as a supplement.

Steve Wright:  Oh, wow.

Chris Kresser:  Yeah.  So, it was a little different than just a completely free-living study where they gave instructions and then just left it up to the participants to do whatever they were going to do.  They actually provided the safflower oil and the margarine for them to use as fats to put on their toast and use in salad dressing and things like that, and then they also gave them safflower oil in capsules, so definitely not like a metabolic ward study where people were living in the hospital while they were doing this, but it was a little bit better than a typical free-living study.  And then the food frequency questionnaires were every seven days, which is really much more frequent than they typically are in these longer-term studies.  You still have some of the problems of people not being able to remember what they ate, but those should be a little bit less with seven-day questionnaires rather than people being asked to remember what they ate six months or a year ago.

In this study, because of the way it was designed and using safflower oil, which is pretty much mostly linoleic acid with no other PUFA, they were able to selectively increase linoleic acid levels without also increasing omega-3 levels.  So, what were the results?  The intervention group, the people who had the safflower oil and decreased saturated fat, had an increased risk of death from all causes, 17.6% versus 11.8% in the control group; they had an increase in death from cardiovascular disease, 17.2% versus 11%; and then an increase in deaths from heart disease, 16.3% versus 10.1%.  And the researchers calculated that an increase of 5% of calories from linoleic acid predicted a 35% increase in deaths from cardiovascular disease and a 29% increase in deaths from all causes.

Another important thing about this study is that the intervention group that had a statistically significantly higher risk of death had lower cholesterol levels than the control group.  So, linoleic acid did indeed reduce their cholesterol levels, but they were more likely to die, and that’s really important to get because some of the studies that suggest that omega-6 linoleic acid improves heart disease risk didn’t even have mortality as an endpoint.  All they did was look at people’s cholesterol levels, and if the cholesterol levels went down, in the conclusion of the study they’d say:  Oh, it reduces the risk of heart disease because everybody knows that when your cholesterol levels go down, your risk of heart disease goes down as well.  Of course, we know that there are studies that actually show the opposite and that the concentration of cholesterol inside of the lipoprotein is not the main driving risk factor for heart disease, but there’s this whole group-think thing that happens, and in the studies they don’t even bother sometimes to cite a reference for that when they make that claim.  It’s just so deeply ingrained that they figure they don’t even need to cite a reference for it.  So, yeah, the cholesterol levels went down, but people still died more frequently in the group that was eating more linoleic acid.

And the researchers went on to speculate a little bit about the mechanisms.  The theory is that omega-6 fats are — and this isn’t so much a theory.  This is pretty well established that they’re very fragile and vulnerable to oxidative damage.  And studies have shown that oxidized metabolites of linoleic acid, which are referred to as OXLAMs, are the most abundant oxidized fats in oxidized LDL particles.  So in other words, when LDL oxidizes, it’s usually the linoleic acid in the LDL particle that oxidizes, and this is important because oxidized LDL is potentially much more atherogenic than normal or native unoxidized LDL because it stimulates collagen formation, which forms the fibrous plaque.  It weakens plaque stability, which makes plaque more likely to rupture, and that’s the precipitating event for a heart attack.  Oxidized LDL is smaller and denser than native LDL, which makes it more likely to penetrate the fragile lining of the artery, and that’s what initiates the process of plaque formation.  So, when you put all those together, it might explain why some recent trials have shown that if you look at omega-6 individually in studies where they isolated the effects of linoleic acid from other polyunsaturated fats that it increases the amount of these OXLAMs, these oxidized metabolites of linoleic acid, and possibly increases the risk of heart disease because of that.

And then there was another study recently that showed that lowering linoleic acid in the diet reduced levels of OXLAMs and their precursors and then increased levels of EPA and DHA.  So, it’s just another study to add to the pile of research that we already have that suggests that we should base our diet on traditional fats that human beings have been eating for a very, very long time that we get naturally from eating animal products, long-chain saturated fats, medium-chain triglycerides, and omega-3 long-chain fats DHA and EPA from eating cold-water fatty fish are particularly important.  And then a low to moderate amount of omega-6 linoleic acid as it naturally occurs in things like nuts and avocados and poultry is fine, but this idea that we should be dramatically reducing our saturated fat intake and increasing our intake of vegetable oils to protect against heart disease really just has no support for it in the scientific literature.

Steve Wright:  Well, I can’t say that I’m surprised, Chris.

Chris Kresser:  No.

Steve Wright:  But I will try to add to the conversation.  I think something that is still kind of confusing to some people in the health sphere that we work in is this idea that some of the higher-level fats can actually convert into EPA and DHA.  Can any of the linoleic acid actually convert into EPA or DHA?

Chris Kresser:  No, those are different pathways.  You have conversion and retroconversion in both pathways.  For example, some of the longest-chain omega-3’s can retroconvert to EPA, which is a long chain but it’s not the longest, so you can go backwards in the conversion process in some circumstances.   And the main conversion process that happens is from the short-chain fats to the longest-chains.  So, alpha-linolenic acid is the short-chain omega-3, and that has to go through several steps to get to EPA, and then further down the line is DHA.  And I think I mentioned this before, but less than half a percent of alpha-linolenic acid, the plant-based omega-3 that’s found in flax and walnut, gets converted into DHA, which is probably the most beneficial long-chain omega-3 fat.  Something like 5% gets converted into EPA.  But that’s in healthy people, and the enzymes that are required to make those conversions are dependent on B6 and zinc and other micronutrients that a lot of people are deficient in, especially vegetarians and vegans who need that conversion to be more efficient because they’re only eating the shorter-chain fats, so there’s kind of a cruel irony there, where they’re more likely to be deficient in the nutrients that are needed to make those conversions, and the conversion is already so poor, even in people who have sufficient amounts of those nutrients.  And then the other thing where the relationship is, is that omega-6 can compete for some of the conversion enzymes, and so if you have an excess of omega-6 in your diet, that’s going to impair your conversion of short-chain omega-3 to the EPA and DHA.  That can be mitigated to some extent by just eating EPA and DHA, so you don’t need to worry about the conversion as much, but particularly for people who aren’t eating those longer-chain fats, it’s really problematic if they have a diet that’s high in omega-6.

Steve Wright:  And that’s why you recommend eating fish several times a week, correct?

Chris Kresser:  That’s right.

The Health Risks Associated with Colonoscopies

Steve Wright:  All right.  So, shall we move on to the dirty subject of colonoscopies?

Chris Kresser:  Yeah, let’s do that.  One of my listeners, Tucker, forwarded me an article about this subject, I think after he had heard us talk about this on the last podcast, and it was an article on a blog called the Roar of Wolverine, which is a pretty cool name for a blog if you ask me!  I don’t know the person who writes this blog.  He has a really fascinating story that’s relevant to the topic we’re discussing here, which I’ll get into in a second, but in this article about colonoscopy, he linked to study suggesting that colonoscopies may cause more deaths than they prevent, and this is something I touched on when we were talking about this originally.  In a lot of these screening procedures, that’s part of the issue is if the procedure itself is dangerous and it causes more deaths than it prevents, that’s obviously not very smart.  But sometimes even when the procedure itself is not dangerous, it can lead to overtreatment and the treatment can be dangerous, and then that can end up causing more harm than the thing that the screening procedure is designed to prevent in the first place.

This study suggested that the perforation rate — This is one of the main risks of a colonoscopy is you’re inserting a scope, a solid object, into the colon, which is a soft tissue, and one of the dangers of doing that is poking a hole in the intestine.  And the perforation rate apparently is 1 in 1000 procedures, which might not sound like a lot, but when you compare it to the rates of colorectal cancer, it’s fairly significant.  And then there are serious complications in 5 out of every 1000 colonoscopies.

Again, just to kind of put this in perspective, 999 people will get a colonoscopy and not have a perforation, and 995 people will have a colonoscopy and not have a serious complication, so overwhelmingly the odds are in favor of nothing serious happening if you have a colonoscopy.  I just want to point that out.  But there are a few reasons to believe that the numbers might even be higher.  For one — and this is the case in a lot of different situations, like with side effects of statin drugs — in any adverse effects, they tend to be underreported because the reporting system just isn’t that robust and it’s dependent on the doctor actually making the report and the patient and/or the doctor realizing that the problem is related to the procedure and just having time to fill out the paperwork and all that stuff, so it generally means reactions and complications tend to be underreported rather than overreported.

And then there are some other risks associated with colonoscopies, including infection.  It has recently been revealed that it’s impossible to completely sterilize an endoscope — there was actually an article in the LA Times about this awhile back — because the endoscopes have these cavities that are inaccessible to being cleaned completely by hand.  And then another problem is that one of the common sterilizers they use for colonoscopies, which is called glutaraldehyde, has actually been shown to cause colitis itself.  This might explain why some people actually develop colitis after having a colonoscopy.

We talked last time about the washout procedure that you have to do before the colonoscopy that removes a lot of the beneficial bacteria in the gut, which could definitely be problematic.  And then there are more rare reactions that can happen, like to general anesthesia.  A colonoscopy, I think, is the only cancer screening test that requires you to go under general to have it, and general anesthesia definitely can cause some problems for some people — deep vein thrombosis, pulmonary embolism, kidney damage, electrolyte imbalance, and a few other not-so-nice things.  Those are very rare, but since we’re talking about the risk, it’s worth pointing out.

There was another study in the Annals of Internal Medicine that showed that 70,000 or 0.5% of people who get colonoscopies are either injured or killed by complications related to the procedure.  And that figure is 22% higher than annual deaths from colorectal cancer.  So again, when you think about it, if the procedure is causing more injuries and deaths than what it’s screening against, you really want to think twice about whether you’re going to do it.  And that’s on a population-wide scale.  Part of the problem when talk about these studies is that studies are looking at populations, but when we’re talking about whether to get a test or do a treatment, we’re really talking about individuals, and individuals have medical histories and different risk tolerances and different circumstances and situations that need to be taken into account.  So, if someone is at very high risk for colorectal cancer, for example, it runs in their family and they have a number of other lifestyle risk factors, then it very well may make sense for that person to get a colonoscopy in spite of these statistics.  The statistics are just averages, but we don’t treat averages in a clinic, we treat people, so you just have to keep that in mind when we’re talking about things like this.

Another thing is the average age for the onset for colorectal cancer is, I think, 71, and typically the mainstream recommendation is to start screening at 50 years old and 45 for African Americans.  So, the first couple of decades there, based on these statistics, it would seem that getting a colonoscopy might be more risky than it’s worth, depending on your personal situation.  But perhaps as time passes, those odds start to even out a little bit.  It’s still a little unclear to me.

There was a study — just to present the other side of the argument — also in the Annals of Internal Medicine that looked at 10,300 patients who had died of colorectal cancer, and then they looked at five matched controls for each patient who died, so over 50,000 controls.  Seven percent of patients who died had not had a colonoscopy in the previous time leading up to study versus 9.8% of controls, so not a huge difference, but it was statistically significant.  And interestingly, the difference was only valid for cancer of the right colon, not the left.

So, this guy’s story who writes that blog is pretty interesting.  At 48, he developed colitis, and he went in to have a colonoscopy, and he suffered a perforation during the colonoscopy and developed a really serious infection and went through hell, it looks like.  His story is on his blog; you can check it out.  But he eventually had emergency surgery where they discovered his intestines were necrotic, so the tissue had died.  They removed all by 3 feet of his small intestine, and then after more surgeries, he ended up with just 10 inches of small intestine left, which is barely enough to live on.  And then he finally ended up receiving a full intestinal transplant, which is a really rare procedure.  And after he had that transplant, he had to receive regular colonoscopies to check up, and after one of them, he contracted an infection with a gram-negative bacteria pseudomonas species, which can be really, really serious in immunocompromised patients like him, and that almost finished him.  His blood pressured dropped to 35/28, and he was given a really small chance of surviving and basically told to say goodbye to his wife.  This is obviously a really extreme story on the spectrum.  Most people, as I said, get colonoscopies and don’t experience anything like this, but it is important to at least understand the risks when you’re considering a procedure like this so you can determine whether it makes sense for you to do it.

Steve Wright:  Yeah, it sure is one of those kind of catch-22 scenarios because it definitely seems to do some good, but the risks are definitely there.  I mean, we hear about them on our site quite often with people who have some sort of inflammatory bowel disease and they’re in basically what they believe to be is remission. — Remission is kind of an interesting term.  It’s kind of like ‘cure.’  You don’t really know what that is. — But for people who are feeling great, they’re not symptomatic, and then their doctor just insists that they get a colonoscopy every two years or every three years, and we routinely get emails from these people who after they’ve gone back in, even though they’re asymptomatic, that just sends them back into a whole symptomatic flare.

Chris Kresser:  Yeah.  I’ve definitely had a similar experience with my patients and in my own experience too, by the way.  Back when I was still trying to figure out what was going on with my gut, I had a couple of colonoscopies, and they absolutely wrecked me.  I had two, and in both cases it took me weeks to recover, and so I think it definitely depends where — You know, at that time, my gut was really inflamed, and if you go into a procedure like that with an inflamed gut, it’s just going to make it worse.

Steve Wright:  Yeah, it’s kind of scary to think about.

Chris Kresser:  So, let’s go on to a few questions.

Steve Wright:  OK, we only have a 194, Chris, so shall we start with the most voted-on question out of all 194?

Chris Kresser:  All right.  Sounds reasonable.

Managing Histamine Intolerance

Steve Wright:  OK.  With the most likes, this comes from Resolute Michaels:  “Histamine!  Can you discuss the whole histamine intolerance thing?  If the symptoms are ‘manageable,’ is it more of an annoyance issue, or are there greater issues with histamine overload?  If someone is truly intolerant, does this translate to health issues?  As an aside, I’ve been working with this for the last week or so with amazing results, with my sense of smell starting to return, and I’ve had this since a child.  I got sinus congestion, anxiety, and sometimes itchy skin and eyes.  I do not get hives.”

Chris Kresser:  Yeah, this is interesting.  I just wrote about this.  I think we’ve talked about it a few times.  Histamine intolerance is definitely on my radar in a much bigger way than it was a year ago, and I think the consciousness of it is increasing and more and more people are trying it and getting results.  I have a number of patients that have histamine intolerance and are experiencing reversal of symptoms they’ve had for years and even symptoms that didn’t resolve when they went paleo or switched to a real food, nutrient-dense type of diet.  So, it’s an exciting therapeutic tool.

In terms of answering the question, there are a couple things.  One is, is histamine intolerance on the rise?  Is it increasing in prevalence, or is it just that now we’re more aware of it and so more people realize that they have it?  I think it could probably be a little of both, and I’ll tell you why and this will kind of answer the question.  As I mentioned in the article, one of the main causes of histamine intolerance is an increase in histamine-producing bacteria in the gut, so if you through antibiotic use, perhaps, or other things that can shift the balance of bacteria in the gut and lead to more histamine-producing bacteria, it’s not totally clear yet.  We don’t have an extensive list of bacteria that produce histamine and bacteria that degrade histamine, but what I tend to see is the people who generally suffer from histamine intolerance are people with gut issues, and in many cases, the histamine intolerance came on or got worse when they developed gut problems or after they took a course of antibiotics or something like that.  So, I think that histamine intolerance is in many ways pointing to a deeper disharmony in the gut that probably needs to be addressed.  So, that’s one way of answering the question.  If it’s pointing to a gut dysbiosis, then yeah, I think just following a low-histamine diet, that will certainly help, but you’d also want to address any gut dysbiosis that might be present, gut infections, pathogens, leaky gut, etc., because that, number one, would enable you to tolerate some high-histamine foods, many of which can be really healthy otherwise, like fermented foods in particular, and number two, because the gut dysbiosis and other problems I just described can lead to other issues aside from histamine intolerance.

If it’s a genetic problem where you don’t produce enough diamine oxidase, the enzyme required to break down histamine, that might be a different story, but even then, there are some bacteria that we know about, like Lactobacillus rhamnosus and bifidobacteria, particularly B. infantis, that are histamine degrading, and so it’s possible that if you supplement with those specific strains of bacteria that you could increase your ability to break down histamine even if the problem is genetic in origin.

Steve Wright:  In your practice, Chris, has there been anybody that you’ve kind of worked through some GI infections or some gut dysbiosis issues and after this then they’ve been able to introduce histamine foods again?

Chris Kresser:  Oh, definitely.  Yeah.  And usually it’s slow and they have to be careful about going overboard, but for most people, that’s fine.  If they’re able to enjoy a moderate amount of histamine-containing foods, then they’re happy.  And some people have gotten over it almost entirely.  So, the response varies, and that probably is determined by what the original cause is in the first place.  But yeah, people do improve.

Steve Wright:  OK.  Well, I think that’s good for everyone to know that it is kind of manageable.  I think it’s kind of akin to using the Specific Carbohydrate Diet or the GAPS Diet sometimes to get rid of and start to heal some of the gut issues, but if you don’t ever get to the actual root causes on what has maybe started it or still growing in there, then you can never really get back to maybe a full paleo or a full real foods diet.

Chris Kresser:  Yeah.

Chris Answers: “What Is Health?”

Steve Wright:  Awesome.  Well, let’s move on to a little lighter question.  This question comes from John:  “Chris, what is health?”

Chris Kresser:  Hmmm, profound question.  I think it’s the shortest question we’ve ever had.  I don’t think you could really get much shorter than three words, but it’s a really fascinating question.  It’s actually one that I’ve thought a lot about, and as someone who suffered from a very longstanding health challenge, it was on my mind and in the front of my mind for many years.  And of course, as someone who works with people who suffer from those challenges now, it’s still pretty front and center.  Probably the best definition of health that I’ve ever heard, the one that I resonate the most with is from Moshé Feldenkrais who created this body of work called the Feldenkrais Method, which is difficult to describe even if you ask a Feldenkrais practitioner what it is!  And I won’t pretend to describe it accurately even though my wife is a Feldenkrais practitioner!  But it’s a way of essentially reeducating yourself, reeducating the body and the nervous system, reprogramming the nervous system, but probably the easiest way to explain it is to tell you what Moshé Feldenkrais’ definition of health was, which was the ability to live your dreams.  And I really like that because if you use a really kind of objective measure of health, like you have these biomarkers, or you have this weight, or you’re able to do this much exercise, if you describe it in terms of function, I think what’s missing there is a much larger, broader perspective on health, which is, in my mind, the most important because there are people, for example, who are extremely and, in my opinion, obsessively focused on their physical health to the exclusion of other aspects of health, like their relationships with other people or their ability to function socially in the world or their ability to enjoy life and to be at peace with their own circumstances and their life in general.

So, for me I think I would even modify that description a little bit and say the ability to enjoy life and to be at peace with oneself and with one’s life, because let’s say someone had a dream of becoming an Olympic runner and then they get hit by a bus and they break their leg and they scatter it and it just becomes clear that they’ll never be able to achieve their dream of being an Olympic runner.  Well, does that mean that that person can’t be healthy?  If you strictly stick to Moshé’s definition, it would, but if you kind of broaden that definition to mean can somebody find joy and happiness in their life and can they live a life that they want to live and can they be at peace with themselves and their circumstances, then to me, that’s probably the broadest and most inclusive definition of health, and it’s one that takes into account that we’re not always in complete control of our circumstances.  We’re not always in complete control of what happens to our bodies.  It recognizes that not all problems are solvable.  There are illnesses so far that are terminal.  There are illnesses that are not completely curable.  And part of being healthy, I think, if you’re in a situation like that, is learning to accept each moment as it comes and continue at the same time to try to find a solution and improve your health but not lose your sanity and happiness and capacity to enjoy life as it is in that process.

And that can be a really tricky negotiation when you’re sick.  It’s something I know about firsthand, and again, as I said, it’s something I thought about a lot as I went through that period because there was a long stretch of time where, despite my best efforts, I was still very sick.  And I realized that I had a choice.  I could either struggle in every single moment against what I was experiencing, or I could accept it as it was.  It doesn’t mean giving up.  Acceptance is very different than submission.  Submission is giving up.  Acceptance is just realizing in each moment that you can’t change that particular moment.  You might be able to change the next one, but you can’t change the moment that you’re living in right then.  So, for me, it was this razor’s edge of continuing to search for the answers and find a solution to my problems but learning to relax around the situation in each moment as it was and enjoy life and reach some level of peace with things even when they weren’t exactly as I wanted them to be.  And so, to me, that’s my definition of health.  That might not be what John had in mind, and I’m sure a lot of other health care practitioners would have a really different way of responding to that question, but any definition of health, in my mind, has to take into account all of those factors that I just mentioned, and that’s the best that I can do at this point.

Steve Wright:  I think what I loved about what you just said was that when somebody probably heard me say that question, they probably thought, like you said, of a lot of physical traits, but really what you just talked about was meshing the physical with the mental — and a lot of the mental — and I think that in my own health fight, like you said, turning to allowance for what is and helping that guide you in your search for maybe a better physical health, I think was one of the biggest tools that I have come to learn over the last few years.  And I think it was really elegant where you went with that because I do think that one of the best books ever, in my opinion, is Man’s Search for Meaning by Viktor Frankl.  For him to be in his own head in a concentration camp and with no physical health basically but to have beautiful mental health that allowed him to go through that time period.  And of course, he had breaks that other people didn’t get breaks of, and there’s always some chance involved, but I think it’s just a great illustration of what having that robust mental health can also do for physical health.

Chris Kresser:  Yeah, that’s a fantastic example, Steve, and there are other examples of people who have become physically incapacitated, who are in a wheelchair and just have an amazing spirit and sense of peace and acceptance and joy, and then there are people who have almost perfect physical health, but they’re entirely miserable.  So, who is healthy in that situation?  What does health mean?  How does health help us to live our lives in a more meaningful and rewarding way?  Because what’s the purpose of health?  That’s another interesting question, and I think that’s what we’re getting at as we’re talking about this is, is health an end?  Is it a means to an end?  Is it both?  And what do we get out of being healthy?  Definitely a fascinating question for me and one that I continue to kind of toss around in my head, you know, not consciously every day, but it’s never far from my consciousness, so thanks for the question, John.  It was a pleasure to get to think about it and talk about it again.

Steve Wright:  And I would encourage all the listeners of this podcast if you’re just in iTunes or you’re on your phone, take the time to come back to the blog, to this post, and post your definition of health because I think it helps everyone broaden what they see the world as, as we learn other people’s definitions.  And the ebook that Jordan and I wrote, before we even talk about any sort of physical diet changes, we ask people to write out what is their health, what does health mean to them, what’s the goal here, because as Chris alluded to, in the end, I think happiness is really kind of tied into this whole thing, and a lot of that isn’t necessarily always physical based.

Chris Kresser:  Um-hum.  All right, well, looks like we have time for a couple more questions.

Does Intermittent Fasting Harm the Adrenals?

Steve Wright:  OK.  This next question comes from Sharon:  “Does intermittent fasting harm the adrenals?  Popular wisdom indicates it does, but IF proponents say it doesn’t.”

Chris Kresser:  Well, I’m going to say my typical answer and say yes, no, maybe.  And I don’t mean to be flippant, but really so many of these questions can be answered — The reason there is conflicting answers is because there are conflicting answers.  Sometimes it does harm the adrenals, and sometimes it doesn’t.  It really depends on a lot of factors.  I do not recommend intermittent fasting for someone who’s really overstressed and overtrained, who has a tendency towards hypoglycemia, and who’s just really kind of frayed around the edges.  For that person, in my opinion and in my experience clinically, intermittent fasting will generally harm the adrenals.  Will it always?  No.  Will it most of the time?  Yes, in my experience.  However, if someone is sleeping pretty well, not dealing with any kind of chronic infection or other catabolic process that’s breaking their body down, not overtraining, eating a good diet, then intermittent fasting can be really well tolerated.

I guess I’m doing a little bit of intermittent fasting now.  I’m kind of having two meals a day recently.  I think I mentioned that on a previous show.  And it just happened really organically and spontaneously.  There was no plan.  I’ve just noticed recently that I would wake up and didn’t feel as hungry as I typically do, and so I delay my first meal until around 11 and then have another bigger meal later in the day, and I seem to be doing really well with that right now.  But if history is any indication of the future, in a week or maybe two weeks or something, I’ll start feeling hungrier in the mornings, I’ll start feeling like I’m not getting enough nourishment, and then I’ll just switch back to my normal routine, which is eating three meals a day.

I think it’s really important to emphasize the individual nature of these questions, to learn to listen to your own body, to learn to kind of tune in to the symptoms that you experience, and I know this can be hard, especially if you don’t have experience with it or any kind of training to know what symptoms to associate with what, but I really do feel that most people have the capacity to do this.  If you start intermittent fasting and after a while you notice that your sleep is getting worse, you have cognitive issues, you’re starting to forget things, you feel kind of shaky and jittery all the time, you’re not recovering from workouts well, your performance is declining in your workouts, then most people are going to notice that, and that’s generally a sign that it’s not working for you.  If that happens for a couple of days during the adjustment period, that’s one thing, but it’s continually happening and it’s getting worse, that’s a sign that it’s not a good idea.  On the other hand, if you do it and you feel good and you feel an increase in mental clarity and you’re losing weight — if that’s one of the reasons you’re doing it — and you’re not extremely hungry in between meals to the point where you’re shaky and feel like you’re going to die if you don’t eat soon, then yeah, it probably will work for you.  And it’s important not to get too attached to either of those outcomes because like I was saying in my own experience, it will work for me for a period of time, and then it won’t work, and if I have this idea that it’s good or it’s not good, then that keeps me from just being present to what’s happening, listening to my body, and then making an appropriate decision.

I don’t talk about my training in Chinese medicine very much, but I think it really does inform my perspective in certain fundamental ways, and one of those ways is that in the Chinese theory on diet, they would never suggest that there’s one appropriate diet for everyone, and they wouldn’t even suggest that there’s one appropriate diet for one person throughout that person’s entire life, because for them and that way of looking at things, what the right diet is is affected by a person’s individual constitution, it’s affected by their current health status.  For example, if you feel like you’re getting a cold, you’re probably going to eat differently than if you’re not.  It’s affected by geography, so if you live in the tropics, you might do better eating more tropical fruit and things that have a higher water content than you would if you’re living in Alaska.  You know, in the winter, it might not be a good idea to be eating a lot of papaya and pineapple and stuff.  It will depend on your goals.  Someone who is trying to lean out for some kind of competitive activity is going to have a different approach than someone who just wants to maintain general health.

Yeah, I’m beating a dead horse here, but it’s really, really crucial to tailor your approach to your own needs and goals.  And of course, that’s the whole idea behind the Personal Paleo Code and why I created that program, because it was just really frustrating for me to see all this continual argument about what the best diet is, you know, should you do low carb, should you do high carb, should you eat dairy, should you not eat dairy?  The answer is always, almost always it depends, with those kinds of things.  I mean, there are some foods I think are just really harmful for everybody and some foods that are generally beneficial for everybody, but I can find an exception with almost every food or nutrient, so the message here is to tailor it for yourself.

Steve Wright:  I think that’s kind of a perfect follow-up to the ‘what is health’ question because I think if anyone has been in this community for a while, they can go out there and they can read stories about yourself and about other leaders like Robb Wolf and Mark who at various times even in their primal or paleo journeys have been doing intermittent fasting or have been higher carb or lower carb or ketosis or not, and I think it’s so much, even in my experience, about what is right about your current situation and what is working for your current situation and then just being open to the change.

Chris Kresser:  Absolutely.  If there was one message I could get across in my work, that would be probably the most important in terms of diet.  This is a good segue into the next question too, actually, which will be the last one for today.

Chris Answers: “What Is Your Workout Routine?”

Steve Wright:  OK, another simple, but probably elegant question.  Chris, this comes from John:  “What is your exercise regimen?”

Chris Kresser:  Let’s put this in the context that we’ve been talking about.  I right now am dealing with some not serious but significant and noticeable adrenal fatigue syndrome or hypothalamic-pituitary axis dysfunction, if I want to get nerdy and technical about it, and I’m extremely busy.  I’m writing a book, I have several other programs going on — the blog, the podcast, an 18-month-old daughter and wife, blah, blah, blah, etc.  So, my current physical activity regimen is a reflection of all of those factors, and my activity levels and types of activity I engage in, types of exercise that I do really change significantly over time based on how I’m feeling, what my health is like, what’s going on in my life.

Lately the most significant change I’ve made, which I’ve talked about and written about extensively now, is getting a treadmill desk, which has totally changed my life, really.  It’s probably one of the biggest changes in my health I’ve ever noticed from a single intervention, and I’ve done a lot over 15 years, probably more than most people.  I’m actually writing this chapter in my book right now, so it’s really fresh in my mind that a lot of research recently — and I know people who follow the health media have probably seen these stories — suggests that sitting for too long has uniquely harmful effects that are completely independent of exercise.  Someone who exercises, meets the current recommendations for exercise or even exceeds them, so someone who goes to the gym for a half hour five days a week or even someone who’s a marathon runner and running 60 miles a week or more in training, if they spend a large percentage of the rest of their time on their butt, like their drive to work for 45 minutes in both directions, then they’re sitting in a chair working at a computer for 6 or 7 hours, and then they come home and they watch a couple hours of TV, that’s like 8 to 10 hours of sitting in a day.  Even if they’re training hard, that’s going to be problematic.

For me, I was getting plenty of exercise and movement, going on hikes and lifting weights and surfing occasionally when I could and things like that, but I was sitting way more than was healthy because I do a lot of work on the computer and I consult with patients and talk to patients on the phone and stuff, and so I got this treadmill desk, and now I’m averaging between 15,000 and 20,000 steps a day, and I feel so different at the end of the day.  It’s night and day.  My brain is way more clear.  That’s one of the more unexpected effects, but I was having some back pain — that’s completely gone.  I was having some kind of muscle aches that I associated with adrenal fatigue issues, but I think they were actually caused by sitting too much because I don’t have them anymore!

So, my routine now is that I’m walking 15,000 to 20,000 steps a day.  Not all of those are at the treadmill desk.  I go on a long walk in the mornings usually with Sylvie.  We spend a couple hours in the morning together.  She and I both wake up early and we give Elanne a chance to sleep in for a couple hours and we get to hang out.  But I also have shifted from doing specific periods of training, of the higher-intensity stuff like going to the gym and doing 30 minutes of higher-intensity strength training or sprints or things like that.  Instead of doing that, I’ve incorporated those all the way throughout the day.  So, after we get off from recording this show, I might go over and do some weights.  I have some weights at home and a bench, and so I might do some strength training exercises.  Or I have some push-up bars and a weight vest, so I might do some push-ups.  I have a pull-up bar, so I might put the weight vest on and do some pull-ups, and I just do sets throughout the day.  In a given day, I might do anywhere from 4 to 10 to 12 or more sets of weight-bearing exercises, higher-intensity exercises.  Or I might do some sprints.  We have some stairs in front of the house, so I might sprint up and down the stairs.  I might jump rope intensely for periods of time.  So, I’m incorporating the movement all the way through the day, and that’s really great for me right now for a couple of reasons.  Number one, it has just completely freed up some time for me, which is really valuable at the moment.  We live way up in the hills, and so even to drive somewhere specifically to exercise takes an hour or an hour and a half out of my day, and now I have that time back to some extent.  And then it also is just working for my body better right now.  I guess you could say it looks like a combination of hiking, the walking all the way through the day, and then the higher-intensity strength training and sprints throughout the day.  Right now that’s what I’m doing.

Steve Wright:  OK, well, I’m sold.  Treadmill desk is on the 2013 goal list.  I’m writing it down.

Chris Kresser:  Yeah, it’s incredible.  It’s really, really phenomenal.  For me, at least, it’s been life changing.

Steve Wright:  I’ve heard nothing but good, so I’m taking your advice, Chris, and it’s going on the goal sheet.

Chris Kresser:  All right, cool.  OK, well, thanks everyone for listening.  Four questions down and 190 to go!

Steve Wright:  Yeah.  I’m telling you.  We’ll be good in 2014.

Chris Kresser:  All right.

Steve Wright:  Thanks everyone for sending in your questions both to the site, ChrisKresser.com, and also to Facebook, and we will do our best to get through as many as possible.  We just hit on a few today that definitely needed a little extra time.  If you enjoyed listening to the show, please head over to iTunes and leave us a review.  It helps get the message out to more people, and we’ll talk to you on the next episode.