The Truth about Legumes, Saturated Fats, and Vegetarian Diets

This week we cover two controversial topics: the legume-Paleo debate and my latest article on vegetarian and vegan diets.

In this episode, we cover:

1:30 What Chris ate for breakfast
4:02 Behind the Dr. Oz controversey
15:00 Are legumes Paleo?
25:57 Why you should think twice about vegetarian and vegan diets
30:22 Is there any evidence saturated fat is bad?
31:50 Fermented foods and FODMAP intolerance
33:57 What to do for an infant on antibiotics
37:35 Controlling the symptoms of rosacea
38:55 The biggest cause of muscle cramps and twitching at night

Links We Discuss

• Chris’ Dr. Oz Segment on “Your Personal Paleo Code: The Diet to Lose Weight and Get Healthy for Life”
• Why You Should Think Twice About Vegetarian and Vegan Diets

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Full Text Transcript:

Steve Wright:  Hi, everyone.  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 from SCDlifestyle.com, and with me is medical practitioner, New York Times bestseller, and healthy skeptic Chris Kresser.  Chris, how are you feeling today?

Chris Kresser:  I’m great, Steve.  How are you?

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

Chris Kresser:  Good.  Yeah, it’s a beautiful day here in California, probably like 65 degrees, little hints of spring, although we’re still in mid-February.  That’s California for you, right?

Steve Wright:  Yeah, I don’t know.  I’ve never lived there, Chris, but from what you tell me on this podcast, it seems like a nice place to live.

Chris Kresser:  Well, it’s a dry place to live right now.  We’re in the worst drought on record, I think, ever, since they started keeping records, which is not good.  So, we could actually use some rain, but I won’t lie.  While the state is perishing, I’m at least enjoying the weather.

What Chris Ate for Breakfast

Steve Wright:  Well, that’s good for your health.  We know that.  So –

Chris Kresser:  What did I have for breakfast?

Steve Wright:  Yeah, I know you kind of saw that coming.

Chris Kresser:  It’s funny.  When I was on the book tour doing book signings, at almost every place, someone would come up to the table and ask me what I had for breakfast.  It was awesome!  Let’s see.  I had some pork adobo and some plantains fried in expeller-pressed coconut oil, some kimchi, and some leftover kale that was cooked in chicken broth last night.  That’s what Sylvie and I both had for breakfast.

Steve Wright:  Delicious as always.  I would never turn down an invite to breakfast at your place.

Chris Kresser:  Yeah, well, maybe someday the Ancestral Health Symposium will be at UC Berkeley, and that will be your chance.

Steve Wright:  I’m going to buy a tent and I’m going to sleep in your yard.

Chris Kresser:  Well, that’s very paleo of you, Steve.

Steve Wright:  I try, man.  I try.

Chris Kresser:  Yeah.

Steve Wright:  So, we have a lot of things to cover today, and we’re going to do some Q&A.  You’ve been all over the media.  We need to talk about that.  And before we get to all that stuff, I think it’s a really good thing to let everybody know that as of today, anyway – I just looked on your website – over 74,489 people now have signed up for a free membership at ChrisKresser.com.  Now, I know, Chris, when you’ve been getting ready for this book tour, you and your staff had put a ton of work into creating this free membership.  So, if you’re a listener of this show and you’re not a free member at ChrisKresser.com, you are missing out on a lot of things, including PDF eBooks on gut health, thyroid health, weight loss, things that have never been shared anywhere else except for inside of this membership.  There’s a forum in there.  There are audios with a lot of experts, like Dr. Siebecker, Dr. Galland, and there’s a 30-part email series that gives you a bunch of tips on how to personalize paleo and lots of other things for your health, including recipes and meal plans.  I’m out of breath, and if you’re not signed up for this, you need to make an account at ChrisKresser.com because Chris has really tried to figure out a way to give all the info that he’s been working on for the past five to ten years in one place.  Go there, sign up for it, support Chris, get better health… get back to the show.  Chris, you were on Dr. Oz.  What happened, man?  How did it go?

Behind the Dr. Oz Controversy

Chris Kresser:  Well, it was an amazing experience.  I was originally asked to go on to do a segment on Your Personal Paleo Code (published as The Paleo Cure in paperback), which was fantastic, and then it evolved a little bit over time.  The way that these shows work is they have a huge team of people working on them.  They have a booking producer who books the guest on the show with the original idea, and then it goes to the segment producer who puts together a script and an outline of the whole segment and how they want it to go, and they’re the person that’s really in touch the most with the Dr. Oz audience.  They’ve been working on the show for a long time.  They know what their viewers are looking for and how to present the information in a way that’s friendly to the viewer.  And then they have a clear idea of the shows that they’ve recently done and the shows that they’re doing in the future, and so they have to design the show in a way that fits all of those various criteria, which is not an easy thing to do.  And there are the senior producers, and then there’s, of course, Dr. Oz, so as you can imagine, with a big daytime TV show like that, there are a lot of people involved in producing these segments.

So, they contacted me and let me know that I was going to be sharing the segment with Nell Stephenson who’s known as the Paleoista, and that was something I had no control over.  I don’t know Nell very well, but our approaches are quite different, and that’s part of what they wanted to contrast.  They did a show on paleo that some people may have seen with Loren Cordain and Nell Stephenson.  I think it was last year sometime.  And the diet that was presented there was Loren Cordain’s version of paleo, which is lean meats and non-starchy vegetables and fruits and nuts and seeds, and that was the plates of food that they showed, basically a serving of lean meat, a lot of non-starchy vegetables, maybe a few nuts, and a few little pieces of fruit.  People were excited about that show, it got good ratings, but the feedback the Dr. Oz crew got was that it was too restrictive for most people.  And then they heard about my book and that I was talking about an approach that was based on the paleo diet but not as restrictive and more flexible and sustainable over the long term, and that’s what they really wanted me to come on and talk about.  So, there was a big controversy about this yesterday and the day before in the Internet world that you may have seen, Steve, and people saying that I confused people by talking about legumes and dairy and those aren’t paleo and I shouldn’t have been on there talking about paleo because I’m not paleo and a bunch of comments like that.

Steve Wright:  How dare you?!

Chris Kresser:  Yeah.  I can understand that.  I understand there are people who are really passionate about the paleo diet and care about it and want to be portrayed in a certain way that is consistent with the paleo diet that they understand and have had success with.  But it’s important to remember that I have never been a representative of The Paleo Diet – end quote or TM – which Dr. Cordain has advocated.  I have a lot of respect for his work, I’ve read a lot of his papers, I think he’s made an incredible contribution to the community, and as I’ve explained clearly in the past, I don’t agree with him on a number of issues, which is fine.  I have no problem with that.  I think mature adults should be able to disagree and still maintain a professional relationship.  It’s not personal for me.  I just don’t agree.  We’ve looked at some of the same research on dairy and legumes and we’ve come to different conclusions, and that’s fine with me.  And I’ve been clear about that from day one.  I’ve always recommended what I call a paleo template or in my book, a Personal Paleo Code, and the whole idea of that, of course, is using paleo as a starting place from which you then can expand your diet based on your individual tolerances and your individual needs.

The Dr. Oz segment producer read my book, and the three things that she really wanted to talk about and that stood out to her and that she thought would be of interest to the Dr. Oz audience in this particular segment that had designed were the fact that I had talked about losing weight without counting calories in the book, and of course, that is something I’ve discussed a lot, and they were quite interested in my stance on legumes, which I’m going to reiterate in a little more detail than I was able to on the Dr. Oz show in a second here, and they were quite interested in my stance on dairy.  And they designed this segment – which may or may not have been clear, depending on how carefully you were watching – for what they call the “high volume eater.”  This is a term they’ve used apparently on the show before, and it’s someone who doesn’t want to count calories and who wants to have a more varied and broad diet.  And so, they invited me to speak to that person because they knew that my approach permitted moderate amounts of foods that aren’t typically considered to be paleo if they’re well tolerated, and they also knew that I didn’t advocate counting calories, so of course, I was the perfect person to come on and discuss that.  I think what confused some people is that throughout the entire segment they were referring to the Personal Paleo Code, which is the term that I came up with and the title of my book, but Nell Stephenson was doing her segment within that context, and I think that threw people off because she isn’t a believer in the Personal Paleo Code, per se.  She’s an advocate of the paleo diet, the strict paleo diet, and although she was talking about having a few cheat meals, she recommends that the other meals be very kind of strict standard, what we could call paleo 1.0, and so I think some people got thrown off and thought that the segment itself was about the paleo diet overall and that I was misrepresenting it, but the segment was actually about Your Personal Paleo Code (The Paleo Cure in paperback) and the idea of personalizing the paleo diet or a diet based on the paleo diet to meet your own unique needs.

So, that’s the backstory, and as far as the experience itself, it was fun.  I flew back to New York, I had a day to adjust to the time zone and get ready.  We were still working on the segment.  Basically emails were going back and forth right up until the day before, and then I just rested, worked out, had some great food, met some friends.  Then they sent a car to pick me up in the morning bright and early on the morning of the taping, and I went to the show, met the segment producer and the crew.  Everyone was really friendly, really professional, and really easy to talk to and get along with.  Then we had a rehearsal before the show, and I met Dr. Oz during the rehearsal, and we walked through everything.  We didn’t actually go through what we were going to say on the show, but just kind of blocked everything out, like stand here and then you stand over here, and they practiced the demos and everything like that.  Then the live studio audience came in, and we did the taping in one go, and then I was out of there.  The whole thing only took about 4 hours from start to finish, and I had a blast.  It was really fun – for me, at least – and I think overall it’s going to have a really positive effect.  The whole point of these shows is not to educate in a really detailed way.  It’s to get people interested enough to learn more.  That’s all you can really do in a 7 or 8-minute segment.  And a thing like a book or even a website or a blog like mine is where you can do a lot more education.  Yeah.  That’s pretty much how it went.

Steve Wright:  Well, I was flying back from London yesterday, so I wasn’t able to sit on the Interwebs all day and just monitor the Facebook chatter for the past two days, but yeah, I find it hilarious, people’s reactions to what happened there.  I think a lot of people – not everyone, obviously – but I think there were some people who lost sight of really what might have happened with, again, just being on a show like Dr. Oz, whose audience is much different than most people who have already heard about paleo, and so just getting the foot in the door and getting people like yourself and Nell on there again a second time, I think this is just progress, and I think hopefully people can see that we should keep the babies in the bath water and don’t heat the water up too bad, and just everybody play with your rubber duckies and it’s going to be OK.

Chris Kresser:  Yeah.  I mean, I get it.  I see both sides of what’s happening here, and I think what most people miss is the segment was primarily about Personal Paleo Code.  It was not about THE Paleo Diet.  It never was supposed to be about that.  And people got a little confused by Nell’s presence, and that’s understandable because I was a little confused by that, but that’s what it is.  We do the best we can with what we’ve got, and again, I think it’s going to do a lot more good than harm.  I don’t actually have a problem with people being a little bit confused.  I’m a big advocate of people asking questions and thinking about things and learning more and finding out what works for them.  That’s, of course, the whole premise of my book, is not just telling them to follow a really rigid, standard prescription that everyone follows.  I don’t believe in that, and so I want people to be asking these questions, and I think good will come out of it.

Let’s talk just a little bit about legumes and dairy.  I’ve talked a lot about dairy, so I’m not going to beat that dead horse again.  And all the information is there in my book.

Steve Wright:  We should call it a dead cow.

Are Legumes Paleo?

Chris Kresser:  Right.  But legumes, I mention in my book.  If you haven’t read it, here’s my stance on legumes in a nutshell.  I didn’t get to go into as much detail as I would have liked on The Dr. Oz Show.  The main reason not to eat legumes is because they’re not very nutrient dense, and if you eat a lot of legumes and they replace more nutrient-dense foods, you’re not going to be maximizing nutrient density, which is one of the fundamental principles of the Personal Paleo Code.  The more nutrient-dense foods we eat, the more nutrients we get in our body, the better our body functions, period.  The original paleo argument is that legumes are harmful because of compounds called lectins that they contain, which cause leaky gut and inflammation and then all kinds of other problems, and these claims are based on animal studies where they feed animals tremendous amounts of raw legumes or other foods that contain lectins that are raw, and they watch what happens.  And sure enough, these animals get extremely sick with leaky gut, inflammation, and a whole bunch of other problems, including cancer.  But here’s the deal:  Research suggests that the vast majority of lectins are destroyed by heat and cooking.  So, when you cook the beans, the lectins are almost completely gone by the time you cook them.  And lectins are also disabled and prevented from entering our bloodstream because they bind to sugar.  All beans have carbohydrate and sugar in them, so if there’s any residual lectin left over, it’s probably going to bind to the sugars in the beans and it’s not going to be absorbed in the bloodstream.  So, that kind of throws that whole argument out the window because most people are not eating raw beans.  It’s pretty hard to do that, and I wouldn’t recommend it.

Peanut lectin is an exception because that’s a legume and a lot of people do eat peanuts and peanut butter raw, and I think there is a basis for caution there because of some of the research on raw lectins and how they can harm us, although there’s still not a lot of research in humans about that, and most of the research comes from animals.  But if you’re cooking beans in a normal way and especially if you soak them in advance, which I recommend if you’re ever going to consume legumes, the soaking also deactivates lectins, and then you rinse the soaking water, you cook them, any residual lectins bind to some of the sugars, then the beans aren’t going to be toxic and kill you, as some paleo experts have argued.

Then we’re left with, well, why don’t you eat beans all the time, in that case?  And the answer is, as I already mentioned, they’re not as nutrient dense as other paleo protein sources like organ meats and meat and shellfish and fish.  That’s number one.  Number two, beans and legumes do have other substances that can be problematic for some people.  For example, they’re FODMAPs, which means they have a type of carbohydrate in them that can cause digestive distress in people with fructose intolerance or small intestinal bacterial overgrowth, and that is a relatively large number of people these days.  There was one comment from someone on Twitter that I kind of chuckled when I read because I said:  Where is the evidence that legumes are harmful for humans and cause inflammation and leaky gut?  And his response was:  Well, Dr. Cordain said so and I see it in my clients.  And I thought, well, if you see a client who eats legumes and they feel bad, how do you know that it’s the lectins?  I mean, there are so many compounds in legumes.  How can you possibly know it’s the lectins that are causing that problem?  It’s far, far more likely to be FODMAPs because a number of people are FODMAP intolerant.  In that case, you wouldn’t want to eat legumes, and that’s why I said on the show to only do this if they’re well tolerated and limit them to maybe two or three times a week and small servings, like on top of a salad or in a soup or as a side dish so that they don’t replace, again, more nutrient-dense protein sources.

That’s the deal with legumes, and that may be kind of a change for people who have been told that legumes are toxic and harmful.  I just think that it’s really important that we always continue to question our beliefs and hold them up against scientific evidence, and if there’s not a match there, if the evidence changes, then we have to change our beliefs.  That’s scientific progress and that’s required of us if we want to be honest about what we’re talking about here.

Steve Wright:  It reminds me of a poem I once heard, Chris.

Chris Kresser:  Uh-oh.

Steve Wright:  Beans, beans, the musical fruit –

Chris Kresser:  Right.

Steve Wright:  – the more you eat, the more you toot.  The more you toot, the better you feel, so eat beans at every meal.

Chris Kresser:  Wow.

Steve Wright:  Maybe we didn’t know about FODMAPs a hundred years ago, but I think even back then they knew a little bit about beans.

Chris Kresser:  Yeah, people definitely had experienced that, and that’s where the individual tolerance comes in.  Dairy is much the same.  I’ve talked about that a lot already, so I’m not going to belabor the point, but the evidence on dairy, as I said in the show, shows that the people who eat the most full-fat dairy have the lowest rates of obesity, metabolic disease, and cardiovascular disease.  I don’t find any arguments that dairy causes metabolic problems because it promotes insulin spikes, etc., very convincing because when you look in studies of actual human beings rather than mechanistic studies or test tube studies or animal studies, you see that real human beings who consume full-fat dairy but not low-fat or non-fat actually have lower rates of all of these conditions that we’re told dairy is supposed to give us.  So, that kind of shoots that argument in the foot.  And why is that the case?  Again, as I mentioned on the show, dairy fat contains compounds that reduce oxidative stress and inflammation.  These are the short-chain fatty acids, like butyrate, and also phytanic acid, trans-palmitoleic acid.  The research on conjugated linolenic acid is not quite as convincing, I think, but there are some studies that suggest that might be beneficial as well.  Pretty much all modern diseases involve oxidative stress and inflammation, so if dairy fat is reducing those things, then it’s a very good thing.  Like with legumes, dairy is a FODMAP, at least lactose-containing dairy products are, and that means you need to check your own individual tolerance to see if you can handle these foods.  But if you can, there’s no reason to avoid them from a health perspective or according to scientific evidence.

Steve Wright:  Yeah, and I think something that maybe you haven’t specifically said that I’ll specifically say for you – and feel free to disagree if I’m getting this wrong – every legume, each kind, so lentils versus black beans versus peanuts, should be tested for individual tolerance, as the profile of each food is completely different, as well as when it comes to dairy, fermented of some kind of dairy versus raw of some kind of dairy.  It’s been my experience in my own health as well as clients and thousands of people that I’ve talked to that it can vary inside of these categories of foods very differently.  And the other thing to know is that – and I see this a lot in the Interwebs – people who test the food and then they immediately react to it and then they’re just expressing their frustration across the web, and when I drill down with these people, I find out that they ate, like, one and a half cups or a whole half bag of broccoli or something.  I just want people to know that you have to introduce these foods slowly over time to get tolerance.  You can’t just eat a whole plate of black beans one night and be like:  Oh, my gosh!  I’m dying with gas pain, so I can’t eat black beans!  You have to give your body, your enzymes, everything a little bit of a chance to catch up to testing these foods.

Chris Kresser:  Absolutely.  That’s a great point.  Lentils, for example, in my experience, seem to be the best tolerated of all the different beans, and some people who can’t eat any other beans at all can eat lentils.  And they actually happen to be one of the most nutritious legumes, too, because they’re high in folate and some other compounds that are difficult to get from most other plant foods.  Are they mandatory?  Do you need to eat legumes to be healthy?  Of course not.  You can get the nutrients that are in legumes in many other foods.  So, why bother eating them at all?  Well, some people like them and they like to have that flexibility and they like to have that variety in their diet.  And so, my point is if you are one of those people and you follow the guidelines that I’ve outlined here, there’s no evidence that including them in moderation, especially when they’re properly prepared to maximize nutrient bioavailability, and they’re eaten occasionally in the context of an overall diet that’s very nutrient dense, there’s no evidence to support the idea that they’re harmful.

Steve Wright:  Not to mention that if you work out your FODMAP intolerance, they become a very beneficial food for the gut flora.

Chris Kresser:  Absolutely.  It’s a hugely important topic which we’ve covered many times and will be continuing to cover.

All right, so I think we put that one to bed.

Steve Wright:  I doubt it.

Chris Kresser:  That’s true.

Steve Wright:  But you’re right.  We should move on, Chris.  The listeners need more from this podcast.  So, it’s time for – drumroll, please – Q&A time.

Why You Should Think Twice about Vegetarian and Vegan Diets

Chris Kresser:  Actually, wait.  We need to talk about the other highly controversial topic from this week.

Steve Wright:  Oh!

Chris Kresser:  Yeah, my blog post on vegetarian and vegan diets.  If you haven’t seen this, head over and check it out.  It’s called Why You Should Think Twice About Vegetarian and Vegan Diets.  This is something we’ve also discussed a lot on the show, and as I mention in the article, there are a number of reasons why someone might follow a vegetarian or vegan diet ranging from environmental impacts to ethical and religious reasons, and I respect people’s choices along those lines and appreciate anyone who spends a considerable amount of time thinking about the implications of the choices that they make around food.  I have a lot of respect for that process even if I end up in a different place at the end of it.  And those are all very valid considerations when it comes to making dietary choices, and I’ve talked about them as well in the past, but I wanted to do an article that was really solely focused on the nutritional aspects of choosing a vegetarian or vegan diet and what some of the issues are that you might want to be aware of if you’re making that choice only for nutritional reasons.  I didn’t want to get into debating the ethics or morality or even environmental implications in this article.  I really just wanted to address the nutritional reasoning behind this choice and whether it is a good choice from a nutritional perspective.

In the article, I outline some very compelling research indicating a number of nutrients that both vegetarians and vegans are more likely to not get enough of, not only because plant foods are often lower in these nutrients, but because the bioavailability of those nutrients is lower in plant foods.  So, even if on paper they have a similar amount of a certain nutrient to an animal product, the ability of the body to digest and absorb and assimilate that nutrient from animal products is very often significantly higher than in plants.  A great example of that is iron, calcium is another example, and zinc is another example of that.  If you’re just looking at nutrition labels on food and you say:  Oh, this has got a lot of iron, it’s got a lot of calcium, or some calcium or it’s got a fair amount of zinc, that doesn’t mean you’re actually absorbing 100% of that.  You’re not going to absorb 100% from an animal food either, but you’re going to absorb a lot more.  And that’s something that’s often left out in these discussions about comparing the nutrient profiles of vegetarian/vegan diets and omnivorous diets.  People link to studies that show:  Oh, hey, look!  This study said there are plenty of nutrients in a vegetarian diet!  Well, a lot of those studies are not considering bioavailability, and so when I look at them and I follow that link, the first thing I do is check for that, and if it’s not considering that, it’s really not compelling at all because a food could have the most amazing nutrient profile there is, and if we can’t absorb and assimilate those nutrients, it’s worthless to us, so that’s something very important to keep in mind.

Steve Wright:  Well, I think for a week or so here, you are holding onto a lightning rod.  I think it’s good, and I think it helps people grow.  As you said, people are free and I honor all their choices regarding what foods you decide to eat or not eat, whether that’s meat or legumes, but I think having a good grasp and at least being able to see all sides of the argument will help people hopefully choose the best things for their health if that’s their number one value because there are obviously a lot of values out there that you can choose from.

Chris Kresser:  Exactly.  All right, now we’re going to answer a few questions before we finish up, so let’s head over in that direction.

Is There Any Evidence Saturated Fat Is Bad?

Steve Wright:  OK, Chris, you have been doing some online summits lately, and one of the most recent summits you were in was the Future of Nutrition online summit.  Jill writes in, and she has a question for you.  Basically there was speaker after speaker, including vegetarian and vegan speakers who kept saying that saturated fat has been proven to be inflammatory.  They were saying this almost as if this was gospel, and Jill really wants to know, Chris, what evidence would they be using to make this assertion, and how reliable is the research?

Chris Kresser:  Usually it’s animal evidence.  Usually it’s mixed diet, where they feed saturated fats together with refined carbohydrates and other crappy parts of rat chow.  It’s not very compelling evidence, actually.  There’s not compelling evidence that saturated fat outside of a sort of standard American style diet with a lot of refined carbohydrates is problematic.  There is some evidence that it’s problematic in that context, but that’s not what we’re suggesting to people here.

Steve Wright:  Yeah, and I would say from reviewing a lot of those saturated fat studies that they’re not holding very many variables in the diet constant when they’re making these conclusions regarding saturated fat.

Chris Kresser:  No, they’re not.

Fermented Foods and FODMAP Intolerance

Steve Wright:  OK, awesome.  Let’s roll on to the next question.  Chris, this question comes from Jen.  She says:  “Hi, Chris!  I have definitely improved from being on the FODMAP elimination diet.  I’d like to improve my gut flora; however, there are many foods that I feel cautionary on because of prior experience, for instance, cabbage and yogurt (being lactose intolerant, both of these give me gas).  How are fermented foods supposed to negate FODMAP intolerance?”

Chris Kresser:  FODMAPs are carbohydrates.  They’re certain types of carbohydrates, and carbohydrates are sugars.  And when you ferment a food, the microorganisms that are involved in the fermentation process are consuming the sugars, and they ferment the sugars.  That’s how they consume them, and that’s how you get the fermentation byproducts there, and that’s how the food becomes fermented in the first place.  If you ferment cabbage or dairy for long enough, there will be virtually no carbohydrates left, no lactose left in the dairy and much fewer carbohydrates, if any, in the cabbage.  The things that made those foods FODMAPs in the first place are gone, so they no longer are FODMAPs.  A lot of people who have intolerance to cabbage because it’s a FODMAP or dairy can consume fermented cabbage, or sauerkraut or kimchi, or fermented dairy, and that’s really why it can work.  You still need to check it out and see how that works for you, but it’s certainly true that it can be that way for people.

Steve Wright:  It’s been my experience that FODMAP intolerance correlates with a significant amount of inflammation and damage in that gut, and as you work on those root causes and heal, which takes time – months, maybe years – those intolerances seem to get less and less and you can reintroduce these types of foods.

What to Do for an Infant on Antibiotics

OK, Chris, so let’s move on to the next question from Duncan.  He asks:  “My 2-month-old son just received antibiotics due to a urinary tract infection.  His doctor advised us to give him acidophilus and lactobacillus up until two weeks after he is finished with his medication.  I’m wondering if that will be sufficient to restore his gut bacteria or if there’s anything else I can or should do to ensure that his development is not hindered in any way.  Thank you for your excellent work.”

Chris Kresser:  Actually for a 2-month-old, I would recommend Ther-Biotic Infant, which is Bifidobacterium infantis, because at that age different probiotic strains are required because the gut flora of an infant is different than the gut flora of an adult.  Unfortunately a lot of clinicians aren’t aware of that.  I actually just finished reading a paper, too, that suggested that you don’t want to go overboard with probiotics for infants because there’s still a lot we don’t know about how the flora develops at that time.  Unfortunately, antibiotics can have a fairly significant impact on the flora for a developing child that can last for quite a while after they’ve stopped taking the antibiotic.  That’s not a reason not to take them when you absolutely have to.  As everybody probably listening to this knows, antibiotics can save lives, and they can be necessary in serious infections.  But it is a reason to exercise a lot of caution and to think very carefully about taking an antibiotic and explore whatever other options might be available instead of taking the antibiotics whenever you can do that because the more we learn about the importance of the gut microbiota, the more caution is warranted in terms of doing anything, and it could semi-permanently alter that microbial community.

So, just a lot of breast milk.  Since it’s a 2-month-old, you’re not going to be feeding any fermentable fibers.  Thankfully breast milk has galactooligosaccharides, which is one of the best prebiotics there is, and that’s why it’s there – Nature, in its wisdom.  So, just continue to breastfeed, and you can use something like Ther-Biotic Infant, which is from Klaire Labs, a specific combination of strains for kids under 2 years old.  Other than that, there’s not really much else to do at this age.  If the child were older, you could use some prebiotics and/or emphasize fermentable fibers, but that’s not really an option, in my opinion, at this phase.

Steve Wright:  Would colostrum be a bad idea, too, at this age?

Chris Kresser:  Yeah, I wouldn’t do that.  I think we need to be careful with things like that when we don’t have that much evidence to support their use.

Steve Wright:  OK.  Yeah, and continuing to breastfeed for a long time seems to be a great idea here.

Chris Kresser:  Yeah, definitely.  I recommend exclusive breastfeeding for the first 5 or 6 months and then complementary breastfeeding, which means along with food, up until probably at least 22 months for most people.  There’s a lot of data to support that.  That’s the WHO recommendation, and there’s a lot of other data to support that.

Controlling the Symptoms of Rosacea

Steve Wright:  OK, cool.  Let’s move on to the next question.  This question comes from Normand.  They want to know about rosacea.  Do you, Chris, have any information about rosacea, and in terms of how do you control the flushing when you go from hot to cold?

Chris Kresser:  Well, rosacea, like everything else, the key to controlling the symptoms is addressing the underlying cause.  With rosacea, there’s a lot of evidence that suggests that the underlying cause is typically small intestinal bacterial overgrowth.  I did a presentation at the Weston A. Price Wise Traditions Conference a couple years ago.  It was on the gut-brain-skin axis, and I presented some data in that talk that suggested that a very high percentage of rosacea sufferers have SIBO and that treating the SIBO led to either a complete resolution or a partial resolution in their symptoms.  When someone comes in to see me and they have rosacea, that is definitely a place that I’m going to start, by looking at their gut for SIBO, low stomach acid, and other gut issues.  More often than not, when we address those problems, their skin improves significantly.

Steve Wright:  Awesome.  Let’s roll on to the next question.  This question comes from Brittany:  “Hi, Chris!  For the past 8 months or so, I’ve been kicking a lot in my sleep.  I don’t wake up, but my boyfriend sometimes has to go to the guest room, it can get so bad.  When I take magnesium at night, it doesn’t help.  There was a period of a couple months where it got better, but now it’s back.  What can I do about this?”

Chris Kresser:  Well, this is a simple symptom, and a lot of people suffer from it, but it’s not easy to figure out because it can have so many different causes.  One of the biggest causes of muscle cramps and twitching at night is actually not getting enough potassium.  A lot of people who are on a paleo type of diet, if they’re low-carbing and they’re not eating nightshades, they’re not going to get much potassium because potassium is in root vegetables like sweet potatoes, yams, white potatoes, plantains, bananas.  There’s some in cooked tomatoes, which, of course, are nightshades, as are potatoes.  If you’re avoiding all of these foods, you may not be getting enough potassium, so the first thing to do would be to add those foods back into your diet.  And you could also consider taking supplemental potassium for just a short period of time to see if that is the cause, and that would be some motivation to increase potassium intake in your diet.  You might try something like 500 mg to 1000 mg of potassium on a nightly basis for a few nights to see if that resolves the symptoms.  Regarding magnesium, not all magnesium is created equal, and the form of magnesium that often works best for muscle cramps is magnesium malate, so you should give that a shot if you haven’t already.  And then there are some other botanicals that can help, at least with the symptoms, like valerian, passion flower, lemon balm, and skullcap, and you can sometimes find some formulas, like Designs for Health MyoSedate that has all of these in them.  Hopefully that helps.  Let us know how that goes.

Thanks, everybody, for listening.  I’m starting to get back into the swing of things after a long absence.  Keep on coming back, we appreciate your support.

Steve Wright:  All right, thanks, everyone, for listening.  You can find more of Chris’ work, including a lot of the debates that have been happening when he goes on shows like The Dr. Oz Show or his articles on Facebook or Twitter.  To go and find him there, go to Facebook.com/ChrisKresserLAc or go to Twitter.com/ChrisKresser.  Keep sending us your questions using the podcast submission link on ChrisKresser.com, and we really appreciate your support on iTunes and the other places where you can leave us feedback.