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06/05/2017 09:52 AM
All About Wine, Part 2: The Health Benefits and Risks

Polyphenols fight disease

Almost every positive health benefit from consuming wine is attributed to polyphenols, a class of more than 8,000 compounds produced by plants. During winemaking, fermentation, oxygen exposure, and oak barrel aging change the phenolic content of grapes, resulting in a more complex product. (1) Polyphenols are divided into flavonoids and non-flavonoids, based mostly on chemical structure. Flavonoids include compounds such as catechins, epicatechins, proanthocyanidins, condensed tannins, anthocyanins, and quercetin. The most talked about non-flavonoid is resveratrol, but this category also includes phenolic alcohols and ellagitannins. Polyphenols are good for our health for several reasons. First, as antioxidants, they reduce the burden of oxidative stress, which is at the root of many diseases. (2) Second, they neutralize free radicals, which are very unstable and damage body tissues through volatile chain reactions. (3) Furthermore, polyphenols help our guts by increasing beneficial bacterial strains such as Lactobacillus and Bifidobacteria.
Is wine healthy, or a health hazard?

Health benefits of wine consumption

Red wine contains more polyphenols than white wine (200 mg per glass vs. 30 mg per glass), as red winemaking also includes the skin of grapes. Although many health benefits have been shown for both types of wine, red wine has consistently been proven more beneficial than other types of alcohol. Antioxidant/anti-inflammatory effects. Antioxidant and anti-inflammatory effects of wine consumption, not just of individual polyphenols, are probably at the root of red wine’s health benefits. Red wine consumption significantly increased total plasma antioxidant status in both younger and older people in a two-week crossover study. (4) Two glasses of red wine every day for a week improved participants’ antioxidant enzyme expression and activity in blood. (5) In healthy women, red wine decreased the levels of several inflammatory markers and cellular adhesion molecules in another crossover study. (6) Cardiovascular disease. Red wine was hypothesized as one reason for the “French Paradox,” (7) the supposed “contradiction” of lower cardiovascular disease in France despite higher saturated fat intake. (Read more about the diet–heart myth here). But it seems that drinking red wine does have heart benefits. Red wine has been shown to both raise HDL “good” cholesterol (8, 9) and reduce oxidized LDL “bad” cholesterol. (10, 11, 12) In addition, moderate red wine drinkers had lower blood pressure, although other studies have reported the opposite. (13) After consuming Sicilian red wine for four weeks, inflammatory biomarkers of atherosclerosis were lowered. (14) In a large prospective study, red wine drinkers had significantly lower mortality from coronary heart disease than non-wine drinkers. (15) Cognitive/brain. The brain consumes 15 to 20 percent of the body’s oxygen, despite its relatively small size, which makes it highly susceptible to oxidative stress. (16) Several studies have shown that moderate wine consumption, with its antioxidant properties, can have positive effects on brain health. In a seven-year follow-up study, moderate wine drinkers performed better than people who consumed other types of alcohol on cognitive tests. (17) In women, alcohol abstainers actually scored lower on the tests than wine consumers! Brain function declined more quickly in nondrinkers than in moderate drinkers, from a review of studies spanning 19 countries. (18) Prospective studies demonstrate lower risks of dementia, Alzheimer’s, and Parkinson’s disease in those who drink red wine regularly. (19, 20, 21, 22, 23) Gut/microbiome. I have written before about the prebiotic effects of polyphenols, which extend to wine. Two glasses of red wine per day increased levels of beneficial bacteria such as Bifidobacterium and Enterococcus, compared to gin consumption, which showed no benefits. (24) Bacteroides, another beneficial gut bacteria, were positively associated with red wine consumption. (25) Natural wines that aren’t aggressively filtered or fermented with commercial yeast strains contain their own probiotics similar to what you find in fermented vegetables and dairy products. Cancer. Individually, polyphenols found in wine like resveratrol and anthocyanin demonstrate anticancer activity by inhibiting cancer cell proliferation and inducing cancer cell death. (26, 27, 28) Polyphenol-rich wine may offer similar anticancer benefits. Compared to non-wine drinkers, those who regularly consumed moderate amounts of wine had lower overall cancer mortality. (29) In contrast to beer and liquor drinkers, wine consumers had a 40 percent lower risk for both esophageal and gastric cancers, hinting again that there is something special about wine among alcoholic beverages. (30) Mortality rate. Wine consumption is linked to overall lower mortality. A large study of nearly 25,000 people from 20 to 98 years old found that those who consumed moderate amounts of wine had lower all-cause mortality compared to non-drinkers. (31) The Copenhagen City Heart Study from Denmark followed more than 13,000 adults for 11 years and found that those who drank three to five glasses of wine per day had a lower risk of dying than both spirit drinkers and alcohol abstainers. (32) Massive numbers of prospective studies and even some clinical trials demonstrate that moderate wine consumption, especially red wine, has many health benefits, which extend even beyond this list. Wine consumption has also been linked to lower stroke risk, (33) lower risk of type 2 diabetes, (34) and lower incidence of bone fracture in the elderly. (35)

Health risks of wine consumption

Now for the bad news. Red wine isn’t all rainbows and sunshine. Ethanol is a poison and poses some serious health risks. Glutathione depletion. If you have been following my work for some time, you will know that glutathione is crucial for the detoxification of many harmful substances. Because it is required for detoxing ethanol, alcohol consumption can deplete glutathione, making our bodies more susceptible to toxic substances and disease. (36, 37) Liver damage. When the liver detoxes ethanol, it is first broken down into acetaldehyde, an even more harmful poison that can stick around if your detox capacity is impaired. If you drink too much, your liver (and other body organs) will suffer. Fatty liver disease, hepatitis, and, after long-term heavy drinking, cirrhosis are all downstream effects of chronic alcohol use. (38) Addiction. Not everyone who drinks will develop a bad habit, but alcohol can be very addictive. Although less addicting that nicotine and crystal meth, alcohol is more addicting than heroin, amphetamine, cocaine, and caffeine. Depression. Moderate drinking is linked to lower incidence of depression, but heavy drinking increases the risk. (39, 40) Substance abuse in general is correlated with mental health problems. (41) Gut disruption. Ethanol can further the symptoms of leaky gut. Alcohol damages the gut and causes changes in the gut microbiome, increasing the absorption of pro-inflammatory endotoxins. (42) The polyphenols in red wine may help to offset some of the pro-inflammatory effects imparted by alcohol. Residual sugar (which fortunately is found only in very, very low doses in biodynamic, natural wines) is detrimental to gut health. Sugar can feed unhealthy microbes and other pathogens, leading to gut dysbiosis. (43) Breast cancer. Earlier I laid out the evidence for lower cancer incidence in those who drank red wine regularly. However, even at low levels of consumption, alcohol consumption may increase the risk of breast cancer in a dose-dependent manner. (44) Myriad other health risks are attributed to or related to alcohol consumption. For example, although drinking alcohol can increase HDL, the so-called “good cholesterol,” it simultaneously increases triglyceride levels, which is a risk factor for cardiovascular disease. (45)

Who should avoid alcohol

Now let’s return to the question from the beginning of the article. Is wine healthy, or a health hazard? The answer, I believe, is highly individual and depends on a variety of factors. Alcohol in general, including red wine, may not be a good choice for some people. Genetics can play a huge role. Alcoholism is a serious illness with a strong genetic component. (46) If there is a history of alcohol abuse in your family, avoiding alcohol altogether is probably the most prudent choice. Those with certain genetic polymorphisms in alcohol and aldehyde dehydrogenases, common in people with East Asian ancestry, may also want to avoid alcohol. These variants put them at higher risks of cancer, liver damage, and more because of their inability to detox aldehyde proficiently. (47) Sulfur-sensitive people, who are estimated to include 1 percent of the population, (48) shouldn’t drink wine due to the sulfites contained either naturally or added. One thing to keep in mind is that dried fruits often have much higher levels of sulfites than wine. So, if you tolerate dried fruit well but have trouble after drinking wine, it might not be due to the sulfites. Those who take any medications, prescription or not, should be cautious about any potential interactions with alcohol. Some medications can enhance the effects of alcohol, some can cause extreme drowsiness when combined with alcohol, and others can interfere with or change a medication’s effectiveness. This might be a no-brainer, but alcohol should be avoided when trying to conceive or while pregnant. Some evidence shows that alcohol can negatively impact fertility, especially for males. (49) The CDC states that no safe level of alcohol exists for pregnant women. Although traditionally, French women still drink lightly during pregnancy, and some research has suggested that light drinking may not be problematic for the fetus, (50) I would play it safe here. A baby’s body metabolizes alcohol much more slowly than does an adult’s. If you suffer from asthma, have a blood disorder, or have liver or detoxification issues, avoiding all alcohol is probably the best choice.

How to maximize the benefits and minimize the risks

If you aren’t a wine drinker, I see no real reason to start. Instead, eat a variety of rich-colored fruits and vegetables to get a wide mixture of polyphenols. Try to include other fermented foods, like sauerkraut and kefir, into your diet. Cooking with red wine is also an option. The alcohol will evaporate, but beneficial polyphenols will remain to an extent. If you are a wine drinker, try taking it out of your diet for 30 days. Then, add back in natural, organic wine, at moderate levels to see how you feel. If your sleep and mood are unaffected, then moderate wine consumption is probably doing you more good than harm, in terms of health benefits and enjoyment. Now I’d like to hear from you. Do you think red wine has legitimate health benefits? Will you change the way you enjoy wine after this article? Let us know in the comments!
06/01/2017 07:43 PM
RHR: Will I Have to Follow This Diet Forever?

revolution health radio

In this episode we discuss:
  • Treating autoimmunity in two steps
  • Foods that prove difficult to reintroduce
  • Dietary changes alone are often not enough
  • Regulating and balancing the immune system
  • Reintroducing foods successfully
  • How do we define health?
  • The ability to live your dreams
  • The downsides of lengthy dietary restriction
[smart_track_player url="" title="RHR: Will I Have to Follow This Diet Forever?" artist="Chris Kresser" ] Chris Kresser: Hey, everybody welcome to another episode of Revolution Health Radio. This week, we have a question from Mikaela, so let's give it a listen. Mikaela: Hi, Chris. This is Mikaela. I have a question for you about the autoimmune protocol. Well, and actually, really, in the elimination diet. I have been following the autoimmune protocol for Crohn's disease to control my symptoms since 2012. And I have had success, but I'm not 100 percent better. And I've had very limited success in reintroducing foods. So my question is, when you're following an elimination diet, if you are unable to reintroduce foods, does that mean that you're not healing? Or do you think that some foods are just off the table for good? I'd love to be able to sit down and have some salsa or maybe scrambled eggs. And I'm wondering if that's just something I'm going to have to live without. Thanks for an awesome podcast and looking forward to hearing your response. Chris: Thanks so much for sending in your question, Mikaela. It's a great one. We receive some kind of variant of this question pretty regularly, and in some ways it's the million dollar question because there are so many people out there who are doing elimination diets like autoimmune Paleo (AIP) or low FODMAP or even just a 30-Day Paleo reset or a Whole30, and they are wondering the same thing, “Will I have to be on this diet forever?” or “Will some healing take place that allows me to recover my function and be able to eat some of these foods that I've taken out of my diet?” Now of course, if you're removing things like Twinkies, Cheez Doodles and Super Big Gulps, unfortunately, you're never going to (at least that's as far as we know) acquire any magical properties that will enable you to better tolerate those foods because they're just nutrient poor and calorie-dense, and we have really no business eating them in the first place. But certainly there are other foods that are healthy otherwise, and they're well tolerated that are removed from things like the autoimmune Paleo protocol—nightshades, eggs, nuts, and even full-fat or fermented dairy. I would argue they're perfectly healthy. A lot of research supports their benefits but may not work for some people because of certain conditions. I am generally a believer that our diet should be as broad and diverse within that Paleo template—or “Paleo-plus” kind of template that might include some full-fat and fermented dairy and even properly prepared legumes and some grains or pseudo-grains if they're tolerated in moderation—because the broader and more diverse we can make our diets, the greater the nutrient density and the wider variety of nutrients it will get. I'm always by default an advocate for eating the broadest diet that we can tolerate, but there are obviously conditions in which we may have to restrict our diet, in some cases pretty significantly, at least to begin with, while we're in the healing process.
Two steps to healing that can help you eat your favorite foods again
As is often the case with these types of questions, the answer is, “it depends.” I don't think there really is a single answer to Mikaela's question, but I can share my experience working with thousands of patients at this point. And what I would say is that diet is an absolutely crucial factor and sometimes the most significant factor in the healing process, but it's certainly not a panacea. Sometimes dietary changes will be enough on their own to get somebody back to where they want to be, but often additional steps are necessary above and beyond diet.

Treating autoimmunity in two steps

Since Mikaela's talking about Crohn's disease, that's an inflammatory bowel disease, which is autoimmune in nature, let's discuss an overall functional approach to autoimmunity as it relates to Mikaela’s question. For me at least, this consists roughly of two steps. Step one would be removing triggers that provoke or exacerbate a dysregulated immune response, and then step two would be taking specific actions to regulate the immune system if removing the triggers wasn't sufficient to bring it back into line. The AIP falls into the first category of removing triggers, and more specifically it would fall into the category of removing dietary triggers. If for a particular patient the primary trigger for them was dietary in origin, things that they were eating that were provoking an inflammatory response and really wreaking havoc on the immune system, then removing that trigger for that person could settle their inflammation and lead to long-lasting healing. That healing could itself lead to being able to tolerate that same dietary trigger, those same dietary triggers that originally caused the problem. If you think of it like—let’s think of an analogy here. If you have an injury, for example, or let's say you were playing soccer and you got injured. While you're injured, playing soccer is probably going to be painful and difficult and possibly even make the injury worse, but there's no reason that once you heal the injury, you can't go back to playing soccer. That's kind of a similar idea here. If food triggers originally provoked a response, in some cases but not all—I’ll come back to that—removing the trigger may allow the body to heal sufficiently such that you can actually even return to eating that food trigger that initially caused the problem without any difficulty.

Foods that prove difficult to reintroduce

However, there are a lot of exceptions and caveats to what I just said. Probably the biggest one is gluten. In many cases, no matter how much healing happens, a patient who is significantly gluten intolerant will never recover the ability to eat gluten without problems. There are always exceptions to the rule and I've actually seen that happen in some cases, but at least in my experience, it is the exception and not the rule. There are also some other dietary antigens like eggs and dairy that seem to have more of a persistent effect over time even after gut healing takes place, less so in kids. I think kids can tend to outgrow these things and move on from them more so than adults. But with adults I don't see as many people fully recovering their ability to tolerate eggs and dairy if they haven't been able to tolerate them at all, although there are some shades of gray there. For example, if somebody is lactose intolerant rather than intolerant to the proteins and dairy, there are some studies that suggest that consuming fermented dairy can actually restore lactose tolerance, and I've seen that with some patients. I'm qualifying everything I say, which can be irritating, but that's really how it is in clinical practice and working with patients. Everybody is different and everybody responds in a different way, and so it's really hard to make general statements about this stuff without providing those qualifications.

Dietary changes alone are often not enough

Okay, so let's get back to this framework we're looking at here where we're talking about step one of removing triggers, and we're talking about dietary triggers, and that in some cases, removing these dietary triggers can be enough to heal and even lead to being able to eat some of those same foods that were removed in order to heal in the first place. That may happen in some cases, but in many cases I found that diet, although it's really important, isn't enough on its own to resolve a problem. We have to start looking at other things that could trigger and exacerbate an immune response, and these include:
  • Gut issues like SIBO, dysbiosis, intestinal permeability, disruptive gut microbiome
  • Stress, which I think is absolutely huge with autoimmune disease. I think it's the elephant in the room that’s often not addressed despite the fact that there are many, many studies showing that stress is a common trigger across every single autoimmune disease that we know about, and I've just seen that be such a huge factor in all of my patients with autoimmune disease.
  • Sleep and physical activity—not enough or too much
  • Lack of social support
  • I think another really key factor in autoimmune disease, the role of environmental toxins like heavy metals, mold, etc., infections like latent viral infections or tick-borne illnesses like Lyme or Babesia, Bartonella, intracellular infections
  • Methylation issues, mitochondrial issues, etc.
All of these things can trigger or exacerbate immune dysfunction, and some of these things can be explored and regulated without any testing, such as the sleep and stress management, physical activity, social support, but others will require some testing, particularly the gut issues, screening for environmental toxins and infections, methylation and mitochondrial issues. This, as you can gather, there's quite a bit of work that goes into this, and in some cases it will probably need to be done with someone, a functional medicine specialist who knows how to do this kind of testing, and it can take months or even longer. This is why our conventional medical model, which is really geared towards single patient, single disease, single treatment and you're done, it doesn't really work that well in this world of complex chronic illness that we live in. This exploration will often take some time and often requires some testing, and in some cases, if you just remove all of the triggers and you address all these things that can exacerbate immune dysfunction, that will be enough to restore normal immune function.

Regulating and balancing the immune system

But in other cases, you have to go onto step two, which is taking specific actions to regulate and balance the immune system. This includes relatively simple things like optimizing vitamin D levels, optimizing glutathione status, optimizing short-chain fatty acid production, particularly butyrate, which has an immunoregulatory anti-inflammatory role, considering more advanced nutritional interventions like therapeutic fasting, which has been shown to have an immunoregulatory effect, and some really interesting recent studies by Dr. Walter Longo out of USC, using botanicals or nutraceuticals that play an immunoregulatory role, and even low doses of medication like low-dose naltrexone, which I have spoken about before for immune tolerance and regulation. These things can play a really vital role in helping to get the immune system back into that range of tolerance from where it's easier to maintain itself in that range.

Reintroducing foods successfully

What I can tell you is that when a more comprehensive two-step approach is used like that, removing the triggers and then taking specific actions to regulate the immune system, many people are eventually able to reintroduce foods successfully in their diet. But that said, some sensitivities in some foods often persist. Let's take someone who is on AIP, and they have to be very strict, the most typical response that I see is after a comprehensive functional medicine protocol where we explore all of these triggers and we do things to regulate the immune system, maybe they're able to start eating some dairy products and nightshades, but eggs just continue to be off the table, or maybe they're able to tolerate eggs and nightshades but they just never recover their ability to eat dairy. Or let's take someone who's been on a low-fat diet to prevent recurrence of SIBO. Once we address the SIBO and then perhaps we find that they've got an underlying mercury toxicity that is probably was causing their SIBO to recur over and over again and we address the mercury toxicity and their SIBO kind of resolves once and for all, that person might typically be able to start eating FODMAPs in fruits. Maybe they're fine with the higher fructose. Maybe they're fine with sugar alcohols. Maybe they're fine with most classes of FODMAPs, but they just never really recover an ability to eat a lot of onions and garlic, particularly raw onions, and those just still trigger them despite feeling better in every other way and having addressed all of the issues that have been identified. That's just the lingering effect for that person. That is probably the most typical response.

How do we define health?

If we take a step back and think about this a little bit further, it leads us to interesting questions, which are: What is the goal of treatment? What is health? What are we actually hoping to achieve? In some cases, I see patients who quite understandably have a memory of what it was like to feel really really good, the last time they felt just perfect and had no complaints, and maybe this was in their early 20s or something like that and they really have it in their minds that they want to get back to that particular feeling and now they're 35 or 40. The reality is, in many cases, it may not be possible to return to that exact feeling that somebody had 15 years ago or 20 years ago, the last time they remember feeling perfectly well because the body changes over time and there are some changes that we have considerable control over, and there are some changes that we have less control over, particularly if there was an infection or an accident or something that had a profound impact on the body. We know that many autoimmune diseases are triggered by viral infections or other infections, for example, and once that process of autoimmunity gets going, it can be managed very effectively without drugs, with diet and changes and this whole process that we're talking about. But in many, if not most, cases, that doesn't mean that the condition will be completely cured. That person may always produce some antibodies to whatever tissue they started producing them to, and if we remove the triggers and take specific steps to regulate the immune system, that person may be able to live symptom free or mostly symptom free, but they may never return to that feeling that they had prior to the infection and the autoimmune disease. They may never be able to eat some of the foods that they were able to eat prior to that infection or autoimmune disease, and they may reach a new level, a new place of balance in equilibrium and homeostasis that's possible, given circumstances and the state of their body at that particular point in time rather than going back to some idea of our memory of the way things were 15 or 20 years ago. For me, this is a really interesting question. I've written about it before and talked about it before. What is health really? How do we define it? Do we define it as the absence of symptoms? That can be problematic as a definition, of course, because it’s the absence of symptoms when and in what circumstances. Is there an absence of symptoms when we eat whatever we want? Or does it mean an absence of symptoms when we eat a specific diet? Or does it mean an absence of symptoms when we mostly follow a specific diet but sometimes go off the reservation a little bit somewhere in between? It gets tricky if you use the absence of symptoms as a definition.

The ability to live your dreams

I have long argued for a more inclusive definition of health that comes from Moshe Feldenkrais, who is the creator of the Feldenkrais Method that you might be familiar with. It's a pretty amazing method of reprogramming the nervous system, body-based intervention, and his definition of health is the ability to live your dreams. I find that to be at the very least provocative and a great topic for discussion because it doesn't refer to anything at all in terms of symptoms, energy levels, pain or anything like that, a lot of the things that most people would use to define health. It simply refers to the ability to live your dreams. When you think about it that way, someone that has perfect physical health, if that exists, it's hard to even quantify what that would be, but if we think about it as a spectrum where on the left is perfect and on the right is death, maybe they're closer to the perfect health side. But let's say that person is miserable, they have terrible relationships, they are in a working a job that they hate and they're just really unhappy in their life. Is that person healthy? Versus perhaps somebody who has an autoimmune disease maybe they have Hashimoto's or rheumatoid arthritis and maybe they are on a fairly restricted diet, but they take really good care of themselves. They have really positive relationships. They are doing work that's meaningful to them. Perhaps they're helping other people with a similar condition to recover. They wake up feeling excited and happy to face the day, and sure, maybe there are times during the day where they don't feel like they have quite as much energy as they would like to have, or they have some pain that flares up occasionally, especially if they're exposed to foods they don’t typically eat, but overall they're living a meaningful, rewarding, and fulfilling life. Who is healthy? Is that first person with that perfect physical health but everything else falling apart healthy? Or is that second person who has some physical challenges but still really living their dreams healthy? I think you know what my answer would be, but I encourage you to think of your own answer because the answer to the question “What is health?” really provides an important context and framework through which we interpret our experience. I think that is really important and something that's often overlooked for anybody that's dealing with chronic illness. How we hold ourselves in that place when we have chronic illness, whether we see ourselves as somebody that is fundamentally healthy but dealing with some physical challenges or whether we see ourselves as someone that is broken, sick, ill, and it is a person that has a chronic disease can really make all the difference in the world in terms of how we relate to ourselves and the world around us. I think it's a very, very important thing to consider and look at for anybody that's dealing with ongoing symptoms. Okay, so in summary here, I think elimination diets are often an important part of the treatment, but they're often not the only important thing to look at. In my practice with patients, we go beyond and look at that two-step framework of removing triggers that provoke or exacerbate immune response and then taking specific steps to regulate the immune system if necessary after that.

The downsides of lengthy dietary restriction

The other thing I want to mention before we finish is that I am definitely wary of too much dietary restriction for too long, and there are a few reasons for that. One big one concerns about nutrient deficiency. As I mentioned in the beginning of the show, I advocate eating the broadest diet within the Paleo type of template as possible because that will expose us to the widest range of nutrients and that's very important, of course, for health. But there are also other issues that can happen with diet that’s really super-restricted, like social isolation, not having enough fun or play, not being able to go out and enjoy dinner or meals with friends. And as I mentioned earlier, that kind of stress and social isolation, I think, is a major factor in autoimmune disease and also just with chronic disease in general. I have many, many stories of patients with whom I have gone through the entire process, the functional medicine process, doing all the labs, doing the diet restriction, identifying and addressing triggers, regulating immune system. And ultimately, the thing that made the biggest difference for those patients was not any of what I just described but actually turning their attention to their social environment, actually loosening some of the restriction on their diet, making sure they're spending more time with friends and getting support that they need, making sure they have more fun and pleasure in their lives, getting a regular massage, taking a hot bath walking on the beach, spending time in nature, developing some deeper friendships of people where they can share what's going on in their life. A lot of times these things can seem less tangible. They can seem less important. We all kind of pay lip service and tend to think that more tangible things like taking supplements or medications or making dietary changes will have a bigger impact. But the reality is, when you look at the research, a lot of these less tangible things actually can have a greater impact on quality of life and even symptoms in people who are dealing with autoimmune disease, and I have definitely found that to be true in my work with patients, and this is a growing focus. I hope that was helpful, Mikaela, lots of information there. I hope you can make sense of that and it helps you and others who are listening in some way, and please do keep sending in your questions to Even though I'm not able to answer all of them, they help me understand what you're thinking and what you want to know about and they inform my ideas for blog posts in addition to podcasts and other content that we're developing, so please do keep sending in your questions. Enjoy your weekend and I'll talk to you soon. Take care.
05/22/2017 06:05 PM
All About Wine, Part 1: The Evolution of Winemaking

Is wine Paleo?

Although some speculate that our Paleolithic ancestors did consume “wine” in the form of fermented fruits, the earliest evidence of wine purposefully made from grapes is from the Neolithic period. A drinking vessel with tartaric acid, which only occurs in large amounts naturally in grapes, was found in an ancient village in Iran, dating from 7,000 years ago. (1) From the southern Caucasus region (which includes modern-day Iran), winemaking traveled to Palestine, Syria, Egypt, Mesopotamia, and then the Mediterranean. (2) When Rome conquered Greece more than 2,000 years ago, winemaking was one aspect of Greek culture adopted by the Romans. (3) Southern Europe, which contains regions once in the former Roman empire, still consumes plenty of wine, usually with a meal. In the 18th century, winemaking expanded to South Africa, Australia, and New Zealand. (4) Europeans brought wine to the Americas, first to Mexico and South America. In comparison to this extensive history, the United States’ large-scale vineyards are practically infants, only appearing around 200 years ago.
Do you know what’s in the wine you’re drinking?

What is in a bottle of wine?

Aside from water, a bottle of wine contains hundreds of substances, most of which fall into the categories below.
  • Sugar. Glucose and fructose are the principal sugars found in grapes, which are fermented into ethanol during winemaking. What isn’t fermented is called residual sugar.
  • Wine yeasts. Naturally found on grapes, yeast is what ferments the grape sugars. Most wines today, however, use added commercial yeast instead.
  • Ethanol. Yeasts ferment the sugars into ethanol, generally resulting in an alcohol content of 10 to 13 percent, (2) but this number can be modified by temperature, certain added yeast strains, and added sugar.
  • Phenols/polyphenols. Polyphenols affect the appearance, taste, mouth feel, and fragrance of wine. Found in fruits, vegetables, coffee, and tea, polyphenols are most likely responsible for the positive health outcomes associated with moderate wine consumption. They are present in the seeds, skin, and flesh of grapes but are also increased through fermentation and oak aging.
  • Methanol. Methanol, a toxic substance, is found in wine in very low levels (0.1–0.2 g/L), (2) but it also occurs naturally in other fruits, vegetables, and their juices.
  • Other alcohols, aldehydes, acids. Grape sugars are also metabolized into higher alcohols, esters, and aldehydes, contributing to the overall complex nature of wine.

The stages of winemaking 

To understand how wine has evolved over the millennia, an appreciation for the winemaking process is a good place to start. The general steps involved in winemaking are (5):
  • Harvesting the grapes
  • Stemming and crushing the grapes
  • Maceration – Time is given for phenolic components of grapes to be leached from the skin, seeds, and stems into what is called the “must”
  • Fermentation – Yeast converts sugar into carbon dioxide and ethanol
  • Draining – “Must” is drained without being pressed into barrels
  • Thermovinification – Wine may be heated at 50–80°C to improve red wine color
  • Clarification and stabilization – This may involve filtration, centrifugation, flotation, refrigeration, and/or pasteurization
  • Aging – Wine is transferred to a wooden barrel or metal container
  • Bottling – A dose of sulfite is usually added commercially to help preserve the wine

Commercialization changed wine

Everyone’s heard of wine’s supposed health benefits, but not all wine is created equal. Traditionally, wine was made with mashed grapes left to ferment for an extended period of time, resulting in a polyphenol-rich, relatively low-alcohol-containing beverage. Few additional ingredients were added and intervention was minimal. Today, picturing chemists in lab coats is a more accurate portrayal of winemaking than a casually dressed vineyard owner with an oak barrel. Modern processes have changed wine production. Growing grapes closer together increases vine yields, but this overproduction delays fruit maturity, retains excessive acidity, and is associated with reduced wine quality. (2) To grow grapes in such close proximity, irrigation is almost always required. While this can double fruit yield and increase fruit size, over-irrigation can result in lower sugar and increased grape acidity. (2) Traditionally, a “mild water stress” following grape ripening actually improves grape quality. Unfortunately, many of these traditional methods are lost in today’s wine production.

Wine additives and contaminants

Since wine went commercial, it has evolved into something so different from what it used to be that our bodies no longer handle it well. Today, more than 70 additives are approved in winemaking to increase production, ensure repeatable outcomes, and keep costs low. If you have ever experienced headaches, asthma symptoms, or even diarrhea after enjoying a glass or two of wine, it might actually be due to all that is added to wine rather than the wine itself. Unlike everything else we eat and drink, nutrition labels and ingredients lists are not required for wine in the United States. Instead of being regulated by the FDA, wine falls under the jurisdiction of the Alcohol and Tobacco Tax and Trade Bureau. As commercial winemakers strive to increase production and lower costs, some questionable and harmful substances have found their way into wine: Oak chips and sawdust. Those “oak notes” discussed during wine tastings may not actually be the result of oak-aged wine. Commercially, oak chips or sawdust might be used instead to give that oak flavor without the added time of real oak barrel aging. Fining agents. To remove unwanted substances in wine before bottling, a variety of agents can be used. Many animal-based ones, including egg white, fish bladder, and casein, might surprise many wine-consuming vegans. Bentonite clay is the most common non-animal-based fining agent. Mega purple. Natural red wine isn’t really supposed to darkly stain your teeth, gums, and clothing. Mega purple, a super concentrated grape juice additive, is to blame. Ten thousand gallons of this sugary concoction are added to 25 million bottles of wine per year. Mega purple, along with another dye, ultra red, are used to produce wine of consistent color. Sulfur dioxide. Although low levels of sulfites occur naturally in wine as a byproduct of yeast metabolism, commercial winemakers often add sulfite in the form of sulfur dioxide as a preservative and stabilizer. Because a small portion of the population is allergic to sulfites, a wine label must disclose if the sulfite content is more than 10 parts per million (ppm). White wines typically have more sulfites than red wines. Conventional wines can contain up to 350 ppm in the United States, while organic winemakers limit sulfites to 100 ppm. In addition to allergic reactions, sulfites are linked to asthma induction, dermatitis, hives, abdominal pain, diarrhea, and hypotension. (6, 7, 8) Histamines. Histamines are found naturally in many foods, including cheese, wine, seafood, processed meats, fermented foods, and eggs. I have talked about histamine intolerance in a previous post and how it is better understood as a component of mast cell activation syndrome. Histamines are produced by immune cells and are responsible for the swelling and redness you see if you get a bee sting. However, some people produce too much histamine and/or are not able to break it down properly. Histamine overload results in sneezing, headache, diarrhea, skin itchiness, and shortness of breath. The histamine content of wine varies widely, depending on grapes used, ethanol content, sulfite content, and more. (9, 10, 11) The commercialization of wine may have increased histamine content. Fertilizing grape vines increases the histamine content of wines, (12) and organic wines have lower levels of histamine. (13) Commercial yeasts. Before 1974, all wines were fermented with their naturally occurring yeasts, but most today in the United States are not. Winemakers instead opt for commercial yeasts to better control the fermentation process for a more reproducible product. Many of these added yeasts are genetically modified. Histamine-sensitive individuals may experience headaches after wine fermented with commercial yeasts, as some bacterial cultures produce more histamine than others. (14) Sugar. In winemaking, yeasts ferment the sugar found naturally in grapes. Wine is “dry” when the yeasts fully ferment all the sugar into alcohol. Winemakers sometimes will add additional sugar before fermentation to increase the alcohol content or flavor. Residual sugars in wine can be masked by tannins and acidity, so you can’t always tell by the taste of wine how much sugar is present. Pesticides/herbicides/fungicides. Just as in produce, organic wine exposes you to fewer pesticides, herbicides, and fungicides. In a study of French wines, only 10 percent were free of pesticide and fungicide traces. Vineyards are only 20 percent of produce volume in France but use 80 percent of the nation’s fungicide. In the United States, Monsanto’s Roundup is the most commonly used herbicide in vineyards. Some of these compounds are linked to cancer and can disrupt hormone function, which I have covered in depth in articles on organic produce and environmental toxins. Arsenic. Looks like rice may not be the only food with arsenic concerns. The Environmental Protection Agency’s water standard for arsenic is less than 10 parts per billion (ppb). A few years ago, a class action lawsuit was filed against several winemakers for having up to five times the arsenic level acceptable for water in their wines. Included wines were varieties of Trader Joe’s infamous Two-Buck Chuck and some types of Franzia. Although the lawsuit was dropped for a couple of reasons, I would still steer clear of cheaply made wine. Phthalates. Phthalates are endocrine disruptors linked to cancer and fertility issues. (15, 16) They are common in cosmetics and plastics, but a study of French wines found dibutyl phthalate in almost two-thirds of the wines tested. (17) Only 17 percent of the samples didn’t contain one of the three phthalates tested. Mycotoxins. Mycotoxins are toxic substances produced by fungi and are linked to diabetes, obesity, and kidney disease. (18) Unfortunately, mycotoxins are widespread in wine and in other processed foods like grains. One study found a certain mycotoxin called fumonisin B(2) in 23 percent of wines tested from 13 countries. (19) That’s quite an intimidating list! Can the health-boosting polyphenols in wine outweigh these dangerous additives? In the second article of this series, I will go through the health benefits and risks of wine consumption to determine if drinking wine can actually be good for you. Now I’d like to hear from you. Do you suffer ill effects after enjoying a glass or two of wine? Were you aware of the additives and contaminants often found in table wine? Let us know in the comments!
05/19/2017 12:44 PM
RHR: Why B12 Deficiency Is Significantly Underdiagnosed

revolution health radio

In this episode we discuss:
  • The problem with conventional B12 serum testing
  • The prevalence of B12 deficiency
  • Why even omnivores may be deficient
  • The serious consequences of B12 deficiency going undiagnosed
  • Lab results: what to look for
  • Nutrients rich in vitamin B12
Show notes: [smart_track_player url="" title="RHR: Why B12 Deficiency Is Significantly Underdiagnosed " artist="Chris Kresser" ] Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, we have a question from Kristin. Let's give it a listen. Kristin: Hey, Chris, my name is Kristin. I have a question for you in regards to vitamin B12 and deficiency in it. I was doing some research on vitamin B12 a while back because I have severe anxiety and panic attacks, and I noticed that sometimes people that have symptoms like that have B12 deficiency. But I also came across some articles in regards to our fingernails and how the half moons will be gone if we have vitamin B12 deficiency. I don't know if that's something that is common in functional medicine to look at, is the fingernails, or stuff like that. But that's really been interesting to me lately and I would just really love to know your opinion on that. Thanks. Chris: That's a great question. I often get questions like this related to the fingernails as markers of nutritional deficiency, and there is some limited data on nutritional deficiency showing up in the fingernails. It can be one of the many diagnostic criteria for nutritional deficiencies, but in some cases, the data is stronger than they are in other cases, and I wouldn't use fingernails as the sole way of diagnosing a nutritional deficiency. I would think about it as one sign that could point us toward doing further diagnostic workup for nutritional deficiencies that would include lab testing, blood testing in most cases, sometimes urine testing. But I would never make a definitive diagnosis of a nutritional deficiency just based on the fingernails alone.
Why you should have your vitamin B12 tested—and the right way to test it
Let's talk a little bit more about B12 and diagnosing the B12 deficiency because it's really, really important. B12 deficiency turns out to be much more common than statistics indicate, and it can have really devastating consequences. B12 deficiency has been associated with or can actually cause premature aging or logical disorders that are similar in presentation to MS or even Parkinson's, brain fog, memory problems, cognitive decline; stroke, heart disease, and other vascular problems, primarily due to elevated homocysteine levels—B12 is required to convert homocysteine back into methionine; developmental or learning disabilities in children; impaired immune function, autoimmune disease, and cancer; male and female infertility; and numerous other symptoms because B12 plays a very, very important role in the body. As you can see, when you don't have enough B12, it can affect virtually every system and tissue in the body.

The problem with conventional B12 serum testing

Now, one of the biggest issues with diagnosing B12 deficiency is that the conventional serum B12 test that most doctors use only picks up a small fraction of people who are actually B12 deficient. I mean, that's a big enough problem on its own. I suppose we could say an even bigger problem is that very few doctors even use that conventional serum B12 test. I've had so many patients that I have diagnosed with B12 deficiency in their 40s, 50s, even 60s or older who have never once in their entire life been tested for B12, which is just crazy to me given how important it is, given how easy it is to test for B12 and how cheap that serum B12 test is. That's a big problem. A lot of doctors aren't including serum B12 in their workup. But as I just said, even if they are including it, chances are they're missing a lot of people with B12 deficiency because the serum B12 test measures a total amount of B12 in the blood, but it doesn't rule out functional B12 deficiency. There are more sensitive markers for B12 deficiency that are now available including methylmalonic acid (MMA), which can be measured both in the serum or the urine. And not so much in the US but in Europe and other parts of the world, there's another marker called holotranscobalamin II, or holoTC. That's in fact the most sensitive marker for B12 deficiency. It is capable of detecting B12 deficiency at the earliest stage, stage one. These markers are much more sensitive to B12 deficiency than serum B12, which means they'll go out of range at an earlier stage of B12 deficiency. Then we also have homocysteine, which is a marker of B12 deficiency, although it's not exclusively related to B12. Homocysteine can be high in cases of folate deficiency or even B6 deficiency as well. Homocysteine is more sensitive than serum B12, but it doesn't only reflect B12 deficiency. If you see it high, that tells you that either B12, folate, or B6 is low, and you need to do some additional testing with these other markers to determine whether the cause of the elevated homocysteine is related to B12 or if it's related to folate or B6. Those are the additional markers you can use. Serum B12 is still a useful test and can still detect deficiency in some patients, but those people are people that are in stage three or four of 12 deficiency. There are four stages: One, two, three, and four—and serum B12 doesn't typically go out of range until stage three or four, so you're missing people in stage one or two if that's the only marker that's used. Homocysteine and methylmalonic acid can detect people in stage two deficiency. Holotranscobalamin or holoTC is the only marker, unfortunately, that they can detect people in stage one deficiency. It's a mystery to me why it's not available in the US. It is in a few teaching hospitals—I think Mayo Clinic, maybe Cleveland Clinic and a few other places around the country offer it—but you can't get it drawn at your typical lab. I've been hoping that that will change for years, but unfortunately, it hasn't yet.

The prevalence of B12 deficiency

We talked a little bit about the important roles of B12 and why you should get tested, but I want to mention a little bit more about the prevalence of B12 deficiency because there is an incorrect notion in the medical world that B12 deficiency is rare and it only really affects people on a plant-based diet like vegans and vegetarians. There is even a bigger myth in the vegan and vegetarian world that B12 deficiency is not common in those worlds. The problem is, those ideas are based in using only serum B12 as a marker for B12 deficiency. If you use serum B12 as the only marker for B12 deficiency rather than some of these newer tests, the statistics suggest that only 7 percent of vegetarians are B12 deficient. Interestingly enough, they still show that 52 percent of vegans are deficient. Even using a relatively insensitive marker like serum B12, you still see over 50 percent of vegans deficient in it, 7 percent of vegetarians. But in a more recent study, using the more sensitive markers that I just talked about that are capable of detecting B12 deficiency at an earlier stage, a whopping 83 percent of vegans were B12 deficient and 68 percent of vegetarians were B12 deficient. Now remember, only 7 percent were deficient using serum B12, but 68 percent were deficient using these more accurate and sensitive markers.

Why even omnivores may be deficient

Now in terms of omnivores, only 5 percent were deficient. But I can tell you having worked with patients for a very long time—most of whom are on a Paleo type of diet or a nutrient-dense diet where they're consuming animal products—I see B2 deficiency fairly regularly. One of the reasons for that is that deficiency of a certain nutrient doesn't just come down to how much of that nutrient you're getting from your diet. It comes down to how well you are absorbing that nutrient in the gut and also what the demand for that nutrient is because of certain physiological processes in the body. It also comes down to whether you have genetic polymorphisms that affect your utilization of that nutrient. Let's use folate as an example—well, let’s use B12 as an example since that’s what we're talking about here. There are some polymorphisms that affect B12 metabolism and the use of B12 in the body. MTRR and MTR are both genes that are connected to B12 metabolism. If you have single nucleotide polymorphisms or SNPs in those genes, MTRR and MTR, that can be measured with a test like 23andMe, those can impact B12 metabolism and they may indicate a greater need for B12 than you would have if you didn't have polymorphisms in those genes. And then there are conditions like SIBO, bacterial overgrowth in the small intestine, that have been shown to decrease absorption of B vitamins like B12 in the small intestine because the bacteria in the small intestine can actually utilize B vitamins as well. They'll take them for themselves and you will get less of them. Hypochlorhydria, or low stomach acid, which, as I've written and spoken about elsewhere, I think is a major cause of reflux in people and a very common condition that can also decrease the absorption of B12. Even if someone is consuming enough B12, if they have low stomach acid, they have SIBO or they have genetic polymorphisms that affect their ability to absorb and then utilize B12, then these people can also be deficient even though they're not vegetarian or vegan and so that's really important to understand.

The serious consequences of B12 deficiency going undiagnosed

Another crucial concept to get is that B12 depletion can take years to become clinically evident. I mentioned that there are four stages of B12 deficiency. In stage one and two, there will be no observable ... usually no signs or symptoms of B12 deficiency. In other words, it's not measurable using any other markers. It doesn't start to cause anemia at that level and it's not going to show up in other markers and it may even be completely asymptomatic. In fact, B12 deficiency doesn't cause macrocytic anemia until stage 4, so that's in the very last stage of B12 deficiency. Unfortunately, some of the more serious effects of B12 deficiency such as nerve damage are irreversible. We have this really tricky situation where B12 deficiency is underdiagnosed because it's not being adequately tested for. The symptoms and clinical signs can take years to become evident, but some of the more serious effects of B12 deficiency can actually be irreversible if the B12 deficiency has progressed to an advanced stage and has gone on for long enough. I think it's a major issue. This is why I've written two really detailed articles about the important effects of B12 and the problems with diagnosis and how to accurately diagnose it. We’ll definitely include a link to those articles in the show notes for the show. There are actually books that have been written about B12 deficiency. Sally Pacholok and Jeffrey Stuart have a book, Could It Be B12?: An Epidemic of Misdiagnoses, that covers this topic in great detail and goes into even some of the history and all of the conditions that can be caused by B12 deficiency and more background on what we've been talking about in this podcast.

Lab results: what to look for

I would encourage everybody to, at the very least, have their serum B12 measured. But as I have mentioned, that’s in many cases inadequate to detect stage one and stage two deficiency. Homocysteine is a marker that you shouldn't have any trouble getting your primary care practitioner to order. It's well known. It’s recognized as a marker for cardiovascular disease, and it's pretty cheap. They should at least be familiar with that, and if you request a serum homocysteine, that's probably a good starting place. Remember though, if it comes back high, it doesn't guarantee you a B12 deficiency. It could also be folate or B6, but that might be enough ammunition to then get your clinician to order some of the more advanced tests for detecting B12 deficiency like serum or urine methylmalonic acid. I personally have found that urine methylmalonic acid is superior to serum, possibly because it's more concentrated in urine than in the blood. I've just seen it be more sensitive and more consistent with the other markers of B12 deficiency then than serum methylmalonic acid. If you live in Europe or outside of the United States, you also might be able to get a holotranscobalamin, or a holoTC, which is again, the most sensitive marker for B12 deficiency. If you can't get your doctor to order those tests, you can order some of these tests perhaps through companies like, although there is quite a bit of nuance to interpreting these tests. It's really helpful to have somebody who is experienced in interpreting these tests. Another thing I want to say about these labs, if you've been listening to my work for any length of time, you may be aware that the conventional lab ranges that are used for these markers and many other lab markers are often not accurate. Conventional ranges are typically designed to detect frank disease rather than an optimal level, and serum B12 and even homocysteine are no exception. Most labs define B12 deficiency at less than 200 pg/mL, but it is well documented in the scientific literature that many people experience signs and symptoms of B12 deficiency at levels between 200 and 350. In Japan and Europe, I believe the lower end of the range is 400 and up or even 500 and up in either Japan or Europe. I can't recall. And so, if you get the B12 tests back and the level is 300, it's going to be marked as normal, but at that level there's a really good chance that you are in the earlier stages of B12 deficiency, and then if you were to measure homocysteine or MMA, that those would be out of range as well. With homocysteine, the range typically goes up to 13, 14, or even 15 in some labs, but I've seen lots of research suggesting that with B12 or folate deficiency, that can show up on homocysteine levels, start getting higher than eight. Homocysteine level above eight doesn't necessarily reflect B12 deficiency, but it would be cause in my mind for doing further testing. Keep in mind that homocysteine is an inverse marker, which means when it's high, that suggests B12 is low, and both serum and urine methylmalonic acid are also inverse markers, so when they're high, that suggests that B12 is low. Be aware that high serum B12 does not necessarily rule out functional B12 deficiency. This is what I was referring to when I said there's some nuance on how to interpret these markers. In fact, I have come to view a high serum B12 when the patient is not supplementing or not eating really extreme amounts of B12 foods like liver as a potential red flag for active B12 deficiency.

Nutrients rich in vitamin B12

If you do actually have B12 deficiency, then there is much bigger discussion about how to address that. Eating B12-rich foods in my opinion is the best way. If you do eat animal products, B12 is richest in liver, clams, oysters, organ meats, and shellfish—once again, top of the list in terms of the most nutrient-dense foods. If you just ate a serving of liver and a serving of clams, oysters, or mussels each once a week, you would probably be able to meet your needs for B12 for the entire week. Other seafood like fish eggs, octopus, crab, and lobster are good sources for B12. Beef, lamb, even cheese and eggs are good sources of B12 as well, but they pale in comparison to the organ meats and shellfish in terms of the amount of B12 per serving. A common myth amongst vegetarians and vegans is that it's possible to get B12 from plant sources like seaweed, fermented soy, spirulina, brewer’s yeast, etc., but many of those plant foods actually contain B12 analogues called cobamides that block the intake of and increase the need for true B12. My intention here is not to bash vegetarian and vegan diets. As many of you know, I was a macrobiotic vegan myself at one point, but just helping to educate people about how to make wise choices. If you are on a vegetarian or vegan diet, you should be definitely getting your B12 levels measured with the more sensitive markers that I have mentioned, and then if your levels are low, you should be supplementing with B12, which is really quite easy to do. We won't go into a lot of detail on supplementation because I've written about that before, and I will just provide a link to the articles, which have some recommendations there. Okay. Thanks again, Kristen, for sending in your question, and please do continue to send in your questions, everybody, to Thanks for listening. Talk to you next time.
05/16/2017 09:40 PM
Environmental Toxins: Steps for Decreasing Exposure and Increasing Detoxification

environmental toxins

Earlier this year, I wrote an article about the hundreds of environmental toxins found in our bodies—in our blood and urine and in the umbilical cords of newborns. I covered how low doses of toxins can be harmful over time, how sometimes low doses can act differently in the body than high doses, and how we all have varying responses to toxins depending on genetics, gut health, detox capacity, and more. In the near future, hopefully we will be able to run a battery of tests that quickly determine individual susceptibility to mercury and other toxins. Based on those results, we could make customized diet and lifestyle recommendations. But in the meantime, we can all take four key steps to protect ourselves. This article will provide resources to guide you through decreasing your exposure to toxins and increasing your detoxification capacity.
4 steps to help protect yourself from environmental toxins

Step 1: Reduce exposure to toxins

You have a lot of control over what you are exposed to in the home, from cleaning products and personal care products to food storage. If you are using popular conventional products, the idea of changing them all according to recommendations below can be very overwhelming at first. I recommend starting with either what you believe will make the biggest difference or with what is the easiest change to make and then taking small steps from there. Cosmetic and personal care products What is applied to the skin may be more important than what we ingest. The gut is pretty good at blocking toxin absorption when it’s working properly. Through the skin, however, toxins can readily reach the bloodstream. Many common products we use daily are linked to allergies, endocrine disruption, and cancer, yet they continue to be sold and used by millions. Being cautious and particular about what products we buy and use is especially important for children, pregnant women, the elderly, and those with compromised immune systems. The Environmental Working Group provides a fantastic resource called Skin Deep, which critically evaluates specific products and brands and rates them on a safety concern scale from 1–10. Below are some examples of harmful ingredients that should be avoided:
  • Triclocarban and triclosan in soaps and toothpaste
  • Aluminum in deodorants/antiperspirants—I recommend Native Deodorant. It’s aluminium-free and contains only natural ingredients. This is what my wife and I both use now, and we love it.
  • Phthalates, parabens, and retinoids in moisturizers
  • Boric acid and BHA in diaper cream
  • PEGs, heavy metals, formaldehyde, and siloxanes in makeup/cosmetics
  • Formaldehyde, toluene, and dibutyl phthalate (DBP) in nail polish
  • Oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate in chemical-based sunscreens
If you are adventurous, Wellness Mama provides some great recipes for homemade foaming hand soap, body wash, deodorant, lotion, and even makeup. Essential oils are often suggested for homemade products, but they can be powerful and should be used with high discretion. Home cleaning products We think cleaning our homes contributes to good health, but many conventional home cleaning products contain carcinogens, irritate the respiratory system, and contribute to allergies. This large category includes air fresheners, bathroom cleaners, laundry products, dish soap, dishwasher detergent, floor care, furniture cleaner, and all-purpose cleaning products. According to an EWG assessment of more than 2,000 products, half didn’t adequately disclose ingredients, 75 percent contained ingredients that have worrisome respiratory health effects, and 25 percent scored moderate to high concern because ingredients or impurities in the products were linked to cancer. The EWG published a free guide to healthy cleaning products, using a rating system of A through F. Another option to consider is making your own home products. Most are easy to make and can often end up being cheaper than store-bought options. Mark Sisson provides a great guide to homemade natural cleaners, and Wellness Mama has several helpful posts on how to make your own or purchase safe products. Toxins in food Toxins are in our food, too—whether purposely added or contaminated through processing and packaging. The biggest offenders are discussed below. Pesticides. For avoiding pesticides and herbicides, organic, locally grown produce is the safest bet. The EWG publishes lists for the vegetables and fruits that have the highest pesticide levels, called the “Dirty Dozen,” and for those with the lowest levels, called the “Clean Fifteen.” Antibiotics. Organic meat and grass-fed red meat trump conventional meats nutrition-wise, and they are free from antibiotics and growth hormones. Heavy metals. While I believe concerns about mercury in fish are mostly misguided, I do recommend avoiding varieties such as shark, swordfish, tilefish, and king mackerel because they can contain far more mercury than selenium. Arsenic in rice (and products made with rice flour) is also a concern. I advise that adults limit rice intake to a few servings a week and that pregnant women and children under the age of two avoid rice altogether. Food additives. The EWG published a guide on the Dirty Dozen food additives and how to avoid them. The number one best way to stay clear of food additives is to avoid processed food completely. BPA and other endocrine-disrupting chemicals You would almost have to be living under a rock to not be aware of the dangers of bisphenol A, or BPA. I have written about the toxic effects of BPA here, here, and here. But BPA isn’t the only endocrine disruptor lurking in everyday plastics. The EWG provides a list of the twelve worst endocrine disruptors. Even BPA-free plastics can contain other bisphenols that may be just as hazardous (1). Below are ten tips for avoiding BPA and other endocrine disruptors:
  • Use stainless steel, glass, or aluminum for water bottles and food storage
  • Use parchment paper, beeswax, or recycled aluminum foil instead of plastic wrap
  • Avoid canned food products, as they are often lined with BPA or its relatives
  • Brew coffee in a glass French press instead of a percolator
  • Eat at home with fresh food ingredients, as studies show that people who do have lower levels of BPA (2)
  • Keep plastic out of the dishwasher, freezer, and microwaves, because hot and cold temperatures can release more phthalates
  • Do not drink canned soda or seltzer, because aluminum cans are often lined with BPA
  • Skip the receipt, which often contains BPA
  • Choose wood or cloth toys over plastic toys for kids
  • Talk to your dentist about sealants and composites, which often contain BPA
Drinking water The United States does have one of the safest drinking water systems in the world, but contamination still does occur. The EWG has identified 316 contaminants in the public water supply, 202 of which are unregulated. Infants, young people, pregnant women, the elderly, and people whose immune systems are compromised are disproportionately affected by contaminated water. Some of the toxins of concern include:
  • Pathogens (bacteria, parasites, viruses)
  • Heavy metals (copper and lead)
  • Nitrate (from chemical fertilizers and smoke)
  • Radon (radioactive gas)
Ensuring access to clean water is one of the most important steps you can take to reduce your toxin exposure. Both the EWG and NSF have guides for choosing a water filter. Water filter types vary, from containers that sit on the counter to tanks under the sink to whole-house filtration systems. Indoor air A major source of indoor air pollution stems from water damage. The Federal Facilities Council estimated that 43 percent of current homes have water damage, while up to 85 percent have had past water damage (3). Once water damage occurs, mold can grow in 24 to 48 hours. Bacteria, actinomycetes, endotoxins, and microbial volatile organic compounds are also of concern. Air filters and air purifiers/sanitizers are two ways to improve the quality of indoor air. I shared some of my recommendations on choosing these systems in a previous post. A HEPA or charcoal filter will remove ultrafine particles like  , dust, and viruses from the air, while an air sanitizer will remove allergens, odors, and germs, as well as mold.

Step 2: Eat a nutrient-dense diet

The rise of processed, refined food paired with unprecedented toxin exposure is taking a toll on our bodies. In the first article of my series “9 Steps to Perfect Health,” I discussed the dangers of four toxins humans are now ingesting as food, sometimes as the bulk of their diets. These four “foods” can disrupt the gut, disturb endocrine function, increase inflammation, and ultimately lead to a laundry list of chronic diseases:
  • Cereal grains (especially refined flours)
  • Omega-6 industrial seed oils (corn, cottonseed, safflower, soybean, etc.)
  • Refined sugar (especially high-fructose corn syrup)
  • Processed soy (soy milk, soy protein, soy flour, etc.)
In contrast, a Paleo diet will naturally support detoxification and health. Instead of focusing on macronutrients, put the focus on real, nutrient-dense whole foods. A Paleo diet is anti-inflammatory, reduces stress on the body, and provides important micronutrients that are required for detoxification, including but not limited to:
  • B vitamins – B6, B12, folate, niacin, riboflavin, biotin (dark leafy greens, fish)
  • Zinc (seafood, beef)
  • Magnesium (dark leafy greens, nuts, seeds)
  • Choline (liver, eggs)
  • Glycine (bone broth, cartilage)
  • Plant polyphenols (fruits and vegetables)

Step 3: Improve your gut health

As I mentioned earlier, the gut is terrific at removing ingested toxins (4, 5, 6), but only if it is working properly. Antibiotics, birth control, diets high in refined carbohydrates and industrial seed oils, chronic stress, and chronic infections all directly contribute to unhealthy gut flora. I have written extensively about the gut’s connection to the skin, heart, thyroid, brain, and more. Healing and maintaining your gut microbiome is vital to overall health. Including the following in your diet will help promote gut health:
  • Probiotics or fermented foods. Sauerkraut, beet kvass, and kimchi are a few examples. Probiotic supplements are also available, but they will not have the same diversity as eating a variety of naturally fermented foods will.
  • Prebiotics are even better than probiotics at promoting the growth of beneficial bacteria (7). Fruits and vegetables high in soluble fiber like sweet potatoes, Brussels sprouts, and avocados are prebiotic. Prebiogen is my preferred prebiotic supplement.
  • Resistant starch. Cooked and cooled potatoes, if you tolerate them, provide resistant starch. More concentrated doses can be obtained from potato starch.
Avoiding antibiotics unless absolutely necessary will keep your gut microbiome robust, but if you must treat with antibiotics, read my guide on how to mitigate the damage.

Step 4: Improve your detox capacity

Detoxification happens mostly in the liver, through three phases (8, 9). Phase 1 begins to process the toxin, often creating free radicals and other more harmful substances. In Phase 2, products are further broken down into water-soluble compounds. Phase 3 moves remaining products out of the cells to be excreted. The three detox phases involve a complicated network of biochemical reactions, which are assisted by dozens of cofactors, enzymes, and more. Although an intricate process, there are several ways to improve and support your detoxification capacity. Support methylation Methylation is one of the conjugation reactions in Phase 2. Methylation requires B vitamins, zinc, magnesium, choline, glycine, betaine, and methionine to function properly, along with methylation adaptogens found in certain fruits and vegetables. As I mentioned in a previous section, those on a Paleo diet who eat a wide variety of foods are probably getting adequate levels of these nutrients, but not always. If you have heavy metal toxicity or chronic infections, impaired methylation might be an underlying cause. To test for methylation status, the Methylation Pathways Panel from Health Diagnostics and Research Institute or the Methylation Panel from Doctor’s Data are both viable options to get an idea of where methylation might need support. You might have heard of methylation in the context of MTHFR gene mutations. The MTHFR gene codes for an enzyme that adds a methyl group to folic acid, converting it to the more usable form, folate. A current trend is for people to identify their MTHFR gene mutations through a DNA kit from 23andme and then supplement based on the results. Although a surprisingly high percentage of people do have a MTHFR gene mutation, supplementation based on this alone isn’t the way to go. Some with mutations will have very good methylation status, while others might not. Furthermore, MTHFR isn’t the only enzyme involved in methylation. Therefore, I highly recommend working with a functional medicine practitioner to get the whole picture through methylation panels and more before supplementing. Many health problems are associated with overmethylation, including cancer, autoimmune disease, and allergies (10, 11, 12). Methylation is also required to produce glutathione, which is a major molecule in the detoxification cycle and an important antioxidant (13). Many nutrient-dense foods provide glutathione precursors, but in particular, whey from raw dairy or whey protein is a good source. Those with autoimmune diseases likely have glutathione deficiency. One way to test for this would be a urine organic acids panel from Genova or Metametrix, which identifies the levels of byproducts of reactions involved in glutathione regulation. Supplement To support overall liver function, the supplement I most often suggest is Pure Encapsulations DIM Detox. This supplement contains:
  • DIM, or diindolylmethane, which promotes healthy estrogen metabolism and cell cycle activity
  • Calcium D-glucarate, which promotes healthy hormone detox
  • Milk thistle extract, which supports phase 2 detox and helps metabolize estrogen (14)
  • Alpha-lipoic acid and N-acetylcysteine, which support phase 2 detox
  • Taurine, glycine, and methionine, which are amino acids that support phase 2 detox and healthy cell metabolism
Sweat Toxins that the liver and kidneys cannot properly detox can sometimes be expelled through sweating. This is a bit of a controversial topic, but there is evidence of heavy metals, BPA, and flame retardants found in sweat (15, 16, 17). Work up a sweat during regular exercise, or frequent a sauna. Mark Sisson has laid out the many benefits of saunas beyond boosting detox. Proper hydration is especially important for exercise or sauna use, but it is vital for everyone, since we release toxins through urine. I don’t like to provide a specific number of ounces of water per day. Don’t force water, but listen to your body and look for markers of dehydration, like dark-colored or infrequent urination. Manage stress Stress management is a core aspect of a Paleo lifestyle and is something I have written about many times. Chronic stress raises cortisol levels with dire health consequences, including a weakened immune system, hormonal imbalances, mood disorders, and decreased detox capacity. In our ever-increasingly busy world, it’s still important to find time to wind down and relax, even if it means cutting back and saying “no” sometimes. Incorporating regular stress management practices like meditation, yoga, tai chi, or progressive relaxation can provide many benefits. Get enough sleep Almost one-third of Americans are getting six or fewer hours of sleep per night (18). Sleep deprivation increases inflammation (19) and impairs the immune system, which negatively impacts the body’s ability to detox. Research indicates that during sleep, neurotoxic waste products are eliminated from the brain, pointing to a direct role for sleep in detoxification (20). Our circadian rhythms also can help regulate liver detoxification (21). Here are some of my best tips for getting enough sleep:
  • Avoid artificial light from screens at least an hour before bed
  • Minimize all artificial light exposure in the late evening hours
  • Sleep in a dark, relatively cool room (68–70F)
  • Take a hot bath before bed
  • Keep electronics out of the bedroom
I hope these four steps will help jump start your journey toward minimizing your exposure to toxins and maximizing your detox capacity. Now I want to hear from you. Which step will be most challenging for you? What changes have you already made? Let us know in the comments!  
05/09/2017 12:46 PM
Does Skipping Breakfast Help with Weight Loss?

Skipping breakfast and weight loss

While intermittent fasting has been lauded for its health benefits, including promoting cellular maintenance and protecting against aging and neurodegenerative diseases, popular wisdom maintains that skipping breakfast is bad for you. Often labeled as the most important meal of the day, breakfast is said to “boost metabolism” and reduce hunger. But is this really true? Mounting evidence suggests that eating three meals a day may not be important for weight loss. David Allison, director of the UAB Nutrition Obesity Research Center and senior investigator on a recent long-term study, commented:
“The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested. This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered.” (1)
In this article, we’ll explore the evidence for and against eating breakfast with all its nuances, including an ancestral approach, the problems with association studies, a review of the biochemistry of intermittent fasting, and relevant results from randomized controlled trials.

Did our ancestors eat breakfast?

For those of you who have been following my blog for a while, you know that I like to look at health questions through an ancestral or evolutionary lens in addition to looking at the latest scientific research. So, did early human anthropoids eat breakfast? The truth is, it’s hard to know for sure, but it’s thought that most hunter–gatherers ate intermittently depending upon food availability. (2, 3) Loren Cordain, founder of the Paleo diet, writes:
“The most consistent daily eating pattern that is beginning to emerge from the ethnographic literature in hunter–gatherers is that of a large single meal which was consumed in the late afternoon or evening. A midday meal or lunch was rarely or never consumed and a small breakfast (consisting of the remainders of the previous evening meal) was sometimes eaten. Some snacking may have occurred during daily gathering, however the bulk of the daily calories were taken in the late afternoon or evening.” (4)
It appears that the three-meals-a-day paradigm was not adopted until the Agricultural Revolution around 10,000 years ago. Frankly, the fact that we eat three times a day is somewhat arbitrary and seems to be based on when it was most convenient to eat during farm work and harvest. (5)

The trouble with association studies

Most studies regarding breakfast consumption and obesity are association studies. And while there is undeniably an association between a lean body type and breakfast consumption, correlation does not imply causation, and many of these association studies have been inappropriately used to shape recommendations for weight loss. I have talked before about the healthy user bias on my blog in the context of red meat. Because “eat breakfast” is such popular health advice, people who are committed to their health are more likely to eat breakfast. They are also likely to avoid smoking, manage stress, and eat more fruits and vegetables, all things associated with a healthier weight. Breakfast eaters tend to be leaner, but this doesn’t mean that they are lean because they eat breakfast.
Can you lose weight faster if you skip breakfast?
While the healthy user bias is difficult to avoid when designing a research study, there are also more intentional breaches of good science mixed up in this question. A recent meta-analysis looked at the proposed effect of breakfast on obesity (PEBO) and found that the PEBO was subject to two common practices used to distort scientific evidence. (6) The first was biased research reporting. Authors of breakfast studies were guilty of biased interpretation of their own results, misleadingly citing others’ results, and improper use of causal language. This is similar to confirmation bias or the “a priori” effect. When you presume something to be true, like “eating breakfast causes weight loss,” all of your research and interpretation flow from that belief. The second was what they called “research lacking probative value” (RLPV). This is where experiments either continue to be performed about questions that have already been sufficiently answered or are designed in such a way that they simply cannot advance scientific knowledge about the question. As the authors put it:
“… at some point, additional similar observational analyses will only trivially add to our knowledge regarding the PEBO. […] The association, but not the causal relation, between breakfast and obesity has been more than sufficiently established.” (6)
Other scientific reviews came to similar conclusions: it’s abundantly clear that there is an association between leanness and breakfast intake. But to really determine if the breakfast–weight connection is causative, we need long-term, randomized trials. (7, 8, 9)

Breakfast vs. no breakfast: evidence from RCTs

Luckily, in the last few years, several research groups have sought to use randomized controlled trials (RCTs) to answer the question “does eating breakfast cause weight loss?” Let’s take a closer look at the studies and what they found. In one of the first RCTs in 1992, researchers separated 52 moderately obese adult women  based on their normal breakfast habit (whether they ate or skipped breakfast regularly) and then randomly assigned half of each category to a breakfast group and half to a no-breakfast group. In their results, they reported a trend suggesting that women who had to make the most substantial changes to their initial eating habits achieved more weight loss. Essentially, habitual breakfast skippers tended to do a bit better when they had to eat breakfast, and habitual breakfast eaters tended to do better when they had to skip breakfast. (10) Unfortunately, when this result was cited by other studies and the media, it was widely misconstrued. First, the researchers only observed a trend for this interaction effect, meaning that it did not reach the level of statistical significance (p < 0.06, for those familiar with statistics). Second, the study was widely reported in the scientific literature as having shown that eating breakfast led to weight loss, even though the authors never concluded anything of the sort. Unfortunately, poor reporting of this study shaped scientific and popular opinion for several decades. The belief that breakfast is important for weight loss prevailed, despite a few smaller studies that found that skipping breakfast had no effect or even a potential beneficial effect on weight loss. In 2013, Cornell researchers performed a randomized crossover study in 24 undergraduate students and found that skipping a meal did not result in energy compensation at later meals and that it might even be an effective means to reduce energy intake in some people. (11) In 2015, researchers in the UK performed a similar study with a week-long intervention in 37 participants and concluded that “there is little evidence from this study for a metabolic-based mechanism to explain lower BMIs in breakfast eaters.” (12) However, these studies were both relatively short-term compared to the 1992 study and didn’t receive as much attention. In 2014, as part of the Bath Breakfast Project in the UK, 33 obese adults were randomly assigned to a breakfast group or no-breakfast group for six weeks. (13) The breakfast group ate slightly more calories but was also a bit more physically active. The no-breakfast group ate fewer calories over the entire day but was also slightly less active and had slightly more variable glucose levels in the afternoon and evening at the end of the trial. Body mass and fat mass did not differ between the two treatments, and neither did indexes of cardiovascular health. Contrary to the popular notion that breakfast “boosts metabolism,” resting metabolic rate did not differ between the groups. Breakfast also did not provide any significant suppression of energy intake later in the day. It seemed like the evidence was mounting against popular belief. Finally, in the largest long-term, multisite clinical trial to date, researchers attempted to settle the debate once and for all. They randomized 309 obese adult participants to a breakfast group or no-breakfast group for 16 weeks. They reported in the American Journal of Clinical Nutrition:
“A recommendation to eat or skip breakfast for weight loss was effective at changing self-reported breakfast eating habits, but contrary to widely espoused views this had no discernable effect on weight loss in free-living adults who were attempting to lose weight.” (14)
Over 92 percent of subjects complied with the recommendation they were given, but it had no impact on weight loss. They also separated individuals based on their baseline breakfast habit and found no interaction between initial breakfast habit and success of the intervention. This is directly contrary to the near-significant interaction found by Schlundt and colleagues in 1992 and was a much larger study.

What type of breakfast were they eating?

But wait, does a bowl of cereal and toast with jam have the same effect as an egg omelette, greens, and a sweet potato? Food quality matters more than food quantity, right? Yep. When “breakfast” is lumped into one big category, there’s not conclusive evidence for or against it, (15) as we saw in the previous section. But researchers have looked at different types of breakfast and weight loss as well, with some intriguing results. In 2015, a study in China found that obese teenagers ate less at lunchtime if they had an egg breakfast compared to a bread breakfast. The egg breakfast was reported to increase levels of satiety hormones, keeping them full for longer. The egg breakfast group also had significantly more weight loss. (16) Sounds pretty good to me! Unfortunately, there wasn’t a “no-breakfast” group in this study, so it’s hard to know how the egg breakfast would have compared to intermittent fasting. Researchers in Missouri performed a randomized trial in 2015 with three different groups. They randomly assigned 57 breakfast-skipping teens to a cereal-based breakfast (13g protein), an “egg-and-beef rich” breakfast (35g protein), or to continue skipping breakfast. They found that the egg-and-beef breakfast led to voluntary reductions in daily food intake and reduced reported daily hunger. It also prevented fat mass gains over the 12-week study. (17) The truth is, most of the studies above (that found no effect of breakfast) were likely based on a typical high-carbohydrate breakfast, a la the Standard American Diet. It would be very interesting to see the metabolic response to breakfast omission in a group of healthy individuals eating a nutrient-dense, evolutionarily appropriate diet.

Skipping breakfast and exercise

What about fasting in relation to exercise for weight loss? In the fed and fasted states, we preferentially oxidize (“burn”) different substrates to produce energy. Could exercising in one state or the other provide benefits for weight loss? In 2012, researchers in London performed a crossover study, monitoring food intake and energy expenditure in 49 participants during one week with breakfast and one week skipping breakfast. They found that total energy intake, energy expenditure, and activity levels did not differ between conditions. (18) A study in Japan in 2014 used a randomized crossover design with eight male subjects, all of whom were habitual breakfast eaters. The subjects were instructed to eat or skip breakfast, and the researchers measured their energy expenditure during the day. Interestingly, they found that breakfast skipping did not affect energy expenditure, fat oxidation, or the thermic effect of food if you looked at the entire 24-hour period (similar to the previous study), but it did change the rhythm over the course of the day. When people skipped breakfast, energy expenditure was lower during the morning but higher during the evening and sleep than those who ate breakfast. Breakfast skipping increased fat oxidation and reduced carbohydrate oxidation in the morning relative to breakfast eating and increased carbohydrate oxidation during the evening. (19) Following up on this study, a crossover study in Korea in 2015 tracked 10 obese male college students. For one week, they ate before their morning workout. The second week, they ate breakfast after their morning workout. Their results? The fasted workout caused the men to burn more body fat, but it also increased levels of the stress hormone cortisol after exercise relative to the fed workout. (20) While burning body fat is beneficial to weight loss, large rises in cortisol are not. It should be noted that these participants were not adapted to fasted exercise and that “fat-adapted” people might have a smaller cortisol response to fasting. I’ll explore this idea more in the next section, when we dive into the biochemistry. What do these studies tell us? Well first, the thermic effect of food in the morning, a common argument for why we should eat breakfast and “boost our metabolism,” is a myth. Over the total course of a day, total energy expenditure does not change. They also suggest that morning fasting might be a great time for a fat-burning workout, as long as it’s not too stressful on your body.

Fat-adapted vs. carb-adapted: fasting biochemistry

When you eat, the hormone insulin is released from your pancreas to the bloodstream and shuttles glucose (carbohydrate) into muscles and other tissues, where it is used for energy production. Excess glucose is converted to fat and stored in the adipose tissue. When you fast, the hormones glucagon and cortisol stimulate the release of these fatty acids from adipose tissue into the bloodstream. The fatty acids are taken up by the muscles and other tissues and broken down (oxidized) to produce cellular energy. In this concerted manner, the body switches from utilizing carbohydrates to fats as its primary fuel and ensures a constant source of energy to the body. This is all good and rosy, as long as the body can actually make this metabolic switch. In the scientific literature, this is called “metabolic flexibility,” (21) though you may be familiar with it as “fat-adapted.” People who are “fat-adapted” are more accurately “metabolically flexible,” meaning that they can easily switch from oxidizing carbohydrates in the fed state to oxidizing fat in the fasted state, and vice versa. On the other hand, people who are said to be “carb-adapted” are “metabolically inflexible,” meaning that they are constantly burning carbohydrates and have trouble switching to fat oxidation. These people still release fatty acids from adipose tissue to the bloodstream but have lost the capacity to oxidize fatty acids in the muscle and other tissues. The accumulation of lipids due to reduced fatty acid oxidation has been hypothesized to cause insulin resistance, (21) and a low ratio of fat to carbohydrate oxidation has been identified to be a good predictor of weight gain. (22) The phenomenon of metabolic inflexibility may explain some of the results of breakfast studies. Most of the participants in these studies were individuals eating an evolutionarily inappropriate Standard American Diet with large amounts of refined carbohydrates three times a day. If, all of a sudden, you instruct these “carb-adapted” people to skip breakfast, you’re asking for a blood glucose crash and insatiable hunger by lunchtime. In reality, most people who want to try intermittent fasting transition do so gradually by slowly increasing the time between meals, allowing the body to adapt and restore metabolic flexibility. This may explain why prior breakfast habits have an effect in some studies. Researchers at the University of Colorado studying 18 overweight women found that the adverse effects of skipping breakfast were restricted to habitual breakfast eaters. While habitual breakfast eaters who skipped breakfast had increased blood lipids, insulin, and free fatty acid responses at lunchtime, habitual breakfast skippers who skipped breakfast had none of these effects. The authors concluded that meal skipping may have enhanced effects in habitual breakfast eaters due to entrainment of metabolic regulatory systems. (23) So, skipping breakfast might not cause weight loss in the short term, but if over the long term it allows your body to “reset” and restore metabolic flexibility and insulin sensitivity, you may ultimately see some weight loss benefit. This is especially true if you’re also improving the overall quality of your diet. A low-fat diet reduces your body’s ability to release fatty acids from adipose tissue and oxidize them in the muscle, (24) while a high-fat diet increases the ability to use fat for energy in muscle and thus improves metabolic flexibility. (25, 26)

Summing it up: should you fast, or break-fast?

If you’re overwhelmed by this quantity of research, you’re not alone. Researchers have been struggling to find consensus on this topic for decades. If you glazed over some of it, here are the major takeaways from this article:
  1. Hunter–gatherers probably only ate one large meal later in the day.
  2. You cannot trust association studies. Correlation does not equal causation!
  3. When all breakfast is lumped together, skipping or eating breakfast has no apparent effect on weight loss.
  4. If you separate out different types of breakfasts, a protein-rich, fiber-rich breakfast seems to confer the most benefits.
  5. Eat before or after exercising depending on your health status and goals. Skipping breakfast will optimize fat metabolism during your morning workout, but it may also spike your cortisol levels.
  6. Most of the individuals in these studies were “carb-adapted” individuals eating a Standard American Diet. It would be interesting to see how the results might differ in “fat-adapted,” metabolically flexible individuals eating a nutrient-dense Paleo diet.
And that’s it! If anything is clear from this consortium of research, it is the need for individualized nutrition. I’ve written several articles and spoken on my podcast previously about why intermittent fasting (IF) may not work for everyone. If IF works for some people (they lose weight) and is detrimental to others (they gain weight), and these people are all lumped together, we’ll see a net zero change in weight. So how do you know if intermittent fasting is right for you? Try an n=1 experiment: eat or skip breakfast for a period of time, and notice how it affects your weight, mood, productivity, gut function, and other factors. Transition slowly if necessary, by eating your first meal of the day later and later each morning. There are some predictors of success with fasting, but only you can really know if IF works well for you. Are you a breakfast-eater, or a breakfast-skipper?  Has IF helped you to lose weight or improve your health? Share your experience in the comments!
05/04/2017 08:53 PM
RHR: What Nutrients Do Kids Need to Thrive?

revolution health radio

In this episode, we cover:
  • Do kids need different food from adults?
  • The nutrients kids need most
  • Ways to monitor your child’s nutrition
[smart_track_player url="" title="RHR: What Nutrients Do Kids Need to Thrive?" artist="Chris Kresser" ] Chris Kresser: Hey, everybody. It’s Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, we have a question from Terra. Let's give it a listen. Terra: Hello, Chris. My name is Terra and I've been following your work for several years now. Our family has pursued a functional medicine-type lifestyle for the last couple of years and we've overcome a great number of health issues as well as escaped a toxic mold situation that was wrecking our health. I do have a question for you specifically regarding children. We've had our kids on mostly the same dietary plan as we've had for the last couple of years. We are all gluten-free and most of the kids are also dairy-free except for the few that tolerate it in small portions. With that being said, our kids are on the very small side. All of them except for one are under the first percentile for height and they are very small in weight as well. I will say that my husband is Asian and he is five foot three, and I am only five foot six. So we're not the largest people on the planet. With that said, I will say that they are also smaller than most all of their peers. I'm just curious if I should be doing anything different in regards to their nutritional needs on a daily basis as children. I know people often will tell me that they need milk or that they need grains or that they need all these things to help them with their growth. But I also know the downfalls of those different things. So I'm just curious what your thoughts are regarding children specifically and any additional nutritional needs that they may need. Thank you so much for your time. We really appreciate it. Chris: Thanks so much for sending that question in, Terra. This is one of the most important topics for me as a father myself, and I just am so passionate about the health of future generations and making sure our kids are getting the nutrition they need and also just avoiding things in the environment that could worsen their health. It's a hugely important issue. I can't think of many topics in the whole health world that are more important than this. Thanks again for bringing this up.

Do kids need different food from adults?

Chris: Before we talk more specifically about your question, Terra, I want to step back and discuss this issue a little bit more generally first. I think one of the most ridiculous aspects of the Standard American Diet and our overall approach to food in this country is this idea of kids’ food being different from adult food. For example, if you go out to a restaurant with a kid, one of the first things they're going to do is bring you a kids’ menu. If you look at the kids’ menu, generally, it's some combination of pizza, like cheese pizza; macaroni and cheese, or some other kind of super-simple pasta dish with butter or maybe cheese on it; burgers and fries; grilled cheese sandwiches; this sort of thing. Then of course we have the mega-industry that is kids’ breakfast cereals like Trix and Cap'n Crunch, and I don't even know what they are anymore, I'm just thinking back to the ones that we had in my childhood. Super Sugar Crisp, cereals that are just absolutely full of sugar and other crap, totally processed and refined. We've got a whole range of packaged lunch products like Lunchables, juice boxes, things that you squeeze out of a tube and a whole bunch of other processed and refined foods that we're supposed to give our kids and have them take to school. It's pretty typical now for families to prepare an entirely different meal for their kids, whether we're talking about breakfast, lunch, or dinner, than what the adults in that family are eating. I think that's a direct result of this food culture that we've developed in this country with this idea of kids’ food being separate, which, by the way, is a notion that was predominantly created by Big Food to sell more stuff. I mean, if you don't have the notion of “kids’ food,” then you're just feeding your kids the same kind of foods that you're eating, and you're going to end up spending a lot less money on all of these so-called “kids’ food products” that we're led to believe that we should be giving our kids, so this is a big commercial opportunity for Big Food, and they spent a lot of money on marketing and advertising to make people think that somehow they're depriving their kids if they don't feed them this kind of food.
Is a Paleo diet OK for children?
If we think about this from an evolutionary perspective, of course it's absurd. There was no such thing as kids’ food. There was just food in hunter–gatherer cultures and even up until very recently in this country. You don't have to go back to the Paleolithic era and you don't even have to go back to the early agricultural period; you can just go back, in many cases, even just 50 years, certainly 100 years in this country, and you would find that kids were eating the same things that their parents were eating and their grandparents were eating, and when they sat down to have a meal at the table, they were all eating the same foods. Now, certainly very young kids, for example, the kids who don't have teeth yet or kids that aren’t able to chew certain foods, they may have needed some modifications like meat being cut off the bone and cut into smaller chunks so that they are able to chew it well, but they can largely eat the same food as adults. This is exactly what happened in our home. We have a daughter, Sylvie, who's almost six years old, and she's eaten the same food that we've eaten from the beginning. If we're having dinner and we have salmon, kale, and sweet potatoes, that's what Sylvie has. If we’re having breakfast and we have eggs, some greens, some bacon or plantains, that's what she has. If we go out to dinner, the only thing she does with the kids’ menu is color on it with crayons, which I think is an appropriate use of the kids menu. That's the only appropriate use of the kids menu. We will almost always order for her off of the adult menu, and it's pretty fun to see the look on the waiter's face sometimes when we order a medium rare New York steak with broccoli and red potatoes for her, and then the look on their faces when she finishes a good part of it is always interesting as well. In general, I think we need to get away from this notion that there is separate kids’ food from adult food. That's one of the biggest problems overall with nutrition for children. Now, of course that's not Terra’s question. Terra, it sounds like, is feeding her child a Paleo-friendly, gluten-free and mostly dairy-free diet (except for the kids that tolerate it in small portions), and that's fantastic. What I just said there doesn't apply to Terra particularly, but it's something that comes up a lot in discussions with parents, and just my observation about the food system overall and the role of nutrition for kids in that system, so I wanted to mention it.

The nutrients kids need most

But getting back to Terra’s question specifically, “Do kids need any special nutrients above and beyond what adults need?” The answer to that is no, they need the same nutrients. However, it's even more important, arguably, that they get adequate amounts of those nutrients because those nutrients are so crucial to the developmental process overall, and we now know that there are really important windows for development that if the child is not adequately nourished during those windows, that can unfortunately lead to lifelong consequences. I guess I would say the stakes are higher for making sure those nutrients are adequately represented in the diet. As you know, kids are still growing, they're still developing in so many different ways, and so those nutrients that we talk about as being important for adults are arguably even more important for kids, so let’s talk about what some of those are. Fat-soluble vitamins You’ve got fat-soluble vitamins—A, D, and K2, in particular, but also E. And the foods that will be richest in fat-soluble vitamins would be organ meats for vitamins A and K2, cold-water fatty fish for vitamin D. Cod liver oil is a great source of vitamins D and B. Fermented foods are a good source of vitamin K2. Dairy—particularly hard cheese can be a good source of K2 if it’s tolerated. Pasture-raised egg yolks can be a decent source of K2. Natto—the fermented Japanese soy product—is the highest source of K2, but I have to admit, I have a really hard time with natto. I don’t like it myself. I wouldn’t expect Sylvie, our daughter, to like it. If you can get your kid to eat natto, that’s great, but there are other sources of K2 that are probably more reasonable for most kids. Choline and glycine Choline and glycine—pasture-raised egg yolks are a fantastic source of choline, and one of the best sources is organ meats, as well, and then bone broth, of course, is a really great source of glycine. Glycine is really important to balance the effects of methionine, which is the amino acid that’s found in muscle meats. Part of the issue in the US, and the industrialized world in general, now, we tend to eat a lot of muscle meats, which are high in methionine, but we don’t eat as much of the fattier cuts of meat or the collagen-dense cuts of meats, the gelatinous cuts like oxtail, brisket, or shanks, which are really high on glycine. Traditionally, our ancestors ate from nose to tail, so all of the different parts, and what we now know is that it’s this balance of glycine that you get from the more gelatinous cuts and then the nutrients you get from eating the organ meats like choline, and all of the B vitamins and the fat-soluble vitamins that balance the effects of methionine. If you eat too much methionine with not enough of the glycine and the other nutrients that are found in organ meats, then there is some evidence, actually, that suggests that that can increase the risk of cancer. We know once you already have cancer, there's benefit in restricting the intake of methionine and leucine. And so, there's an argument to be made for not just eating very high amounts of methionine without also eating enough glycine and some of the fat-soluble vitamins, choline, and B vitamins that would be found in organ meats. Iodine Then we have iodine. That's an important nutrient, and that is found primarily in the sea vegetables and dairy products, if they're tolerated. A good way to get sea vegetables into the diet would be things like adding some kombu into any soups or stews. It adds a really nice umami flavor and it's very rich in iodine. Nori sheets that are made with olive oil—sea snacks—these are pretty popular with kids. Sylvie loves them. The downside is that nori is lower in iodine than just about any other sea vegetable, but it's still a pretty decent source and they can be really good snacks. Another way to get the sea vegetables into the diet is to use kelp flakes in addition to sea salt as a seasoning or a salty flavor. We might put kelp flakes on Sylvie’s scrambled eggs, for example. That's a good way to get them into the diet. And then, I mentioned dairy products are probably the highest source of iodine in most people's diet, and it's not because iodine is in the milk itself. Iodophor is a cleanser that's used to sterilize the tanks that hold the milk, so the iodine from that cleanser actually gets into the milk and we ingest it that way. Those are some options for iodine. EPA and DHA Then of course we have EPA and particularly DHA, which has been shown to be a crucial nutrient for brain development, very, very important for kids, and cold-water fatty fish and shellfish, preferably low-mercury species. That's the best way to increase or get enough of those nutrients. Zinc, iron, and copper We have zinc, iron, and copper—a very wide range of benefits, and organ meats and shellfish are by far the most nutrient-dense sources for those particular nutrients, and certainly they are also found in a variety of other animal products and then copper in some other plant products. But it's important to know that with all three of those particular—zinc, iron and copper—the absorption of those nutrients from plant foods is much lower, typically, than the absorption from animal foods. It doesn't mean the plant foods that contain them don't have a lot of other benefits and that you might not get some of those nutrients from the plant foods, but you're not going to absorb nearly as much as you would from shellfish, organ meats, muscle meats, or other animal products. Calcium Then we have calcium, obviously important for skeletal development and bone. If you're completely dairy free, then one of the best options is consuming bone-in fish, so Vital Choice, which I've spoken about before, it’s one of our favorites. At, we order canned salmon with bones still in it, and there are also anchovies, sardines, and other fish that still have the bones in. Once they're canned, the bones get really soft, so you can just eat the fish with the bones, and that's a fantastic source of calcium. It's also a great way to get EPA and DHA and highly absorbable protein and selenium, so you're killing a number of birds with one stone with that. And then, dark, leafy greens can be a great source of calcium. Of course, dairy products are a fantastic source of calcium. I've written and spoken about this a lot before. I believe that full-fat and fermented dairy can be a healthy addition to the diet if the child tolerates it well. That's the big question mark. But if there are no signs of any kind of reactions to dairy, no skin breakouts, no digestive issues, no sinus congestion, then full-fat and fermented dairy—the research has been overwhelmingly positive. It helps prevent cardiovascular disease, diabetes, obesity, and a number of other conditions. And note that, that is not true for low-fat or non-fat dairy because it appears that many of the beneficial compounds in dairy are found in the fat itself. That can be a really useful addition to a diet if they tolerate it well. Phytonutrients And then of course, all of the phytonutrients that are present in fresh fruits and vegetables are very important, and the fiber that's present in those foods is really crucial to feeding their beneficial gut bacteria, which we know is one of the most important things that we need to focus on for ourselves and our children. Protein And then finally protein, making sure that kids are getting enough protein for the development of their muscles, tissues, and enzyme scaffolding. If you think of protein, that it's kind of like the scaffolding of the body, it's what is necessary to build that scaffolding and all of those support systems.

Ways to monitor your child’s nutrition

If their diet is very rich in all of these various micronutrients and macronutrients, then I probably wouldn't worry, especially given your height and the height of your husband. However, if you are concerned, you might consider having some testing done for nutrient status to make sure that they are in the right ranges. If you have access to a functional medicine provider, they could do some serum testing for nutrients. There are also some urine organic acids testing through labs like Genova, for example. The ION Profile or NutrEval can be helpful in identifying deficiencies of certain nutrients. You also want to make sure that the kids are getting enough to eat overall and that their calorie intake is sufficient. Usually kids will eat according to their hunger. If they're hungry, they’ll let you know about it and you feed them and it's relatively simple. But in some cases if there are any issues, you didn't mention any health problems, Terra, but if there are any issues, for example, like SIBO or any gut issues, undiagnosed parasites, or anything like that, those could potentially affect appetite, and perhaps the kids are not eating as much as they normally would otherwise. Depending on what their overall intake is of carbohydrate, sometimes what we've seen with adults is that when people go on, unintentionally, a kind of low-carb Paleo type of diet, their overall calorie intake drops as well. If they're really active they may not be getting enough carbohydrates to fuel their particular activity levels. I think the idea that kids have to eat grains and dairy to be healthy is preposterous because for the vast majority of human history, kids and adults were not eating grains and dairy. That was the natural human diet. It didn’t include those foods. But, there is something to be said for getting enough food and calories overall, and so things like sweet potatoes, plantains, yuca, taro, these starchy tubers can be really important for kids to make sure they're getting enough calories and enough glucose to fuel activity levels, especially if you're not including grains, dairy products, and things like that. If you're not including those foods in their diet, then I would do that because it's possible that if they're not really eating those carbohydrate sources, then they're not getting enough calories overall. Those are my thoughts. I hope that's helpful. It sounds like you guys are doing a great job with their diet and I imagine that they're doing fine, but if you want to have a little bit of extra assurance, you could consider having some of that testing done and make sure their nutrient status is good overall. You could also do some calculations using something like MyFitnessPal or on what their overall calorie intake is, what your estimates are based on what you're feeding them, and then compare that with what the calorie intake should be for a kid of their age and their height and weight. That might be able to help give you an idea of where they are on that spectrum and if you may need to add some higher-calorie foods to their diet. Last thing along those lines is I've talked about things like white rice in the past. As many of you know, I think that white rice, which is just starch, can be a fine addition to the diet as long as it doesn't replace more nutrient-dense foods and as long as it's well tolerated. That can be a way of increasing calorie intake as well, particularly carbohydrate if they're not getting a lot of that elsewhere. Okay, Terra, thanks again for your question. Thanks, everybody, for listening. If you have a question, go to, and I'll talk to you soon.
04/25/2017 04:48 PM
Join Me in the UK and Sweden July 2017

London functional medicine seminar

When I was 20 years old, I spent a couple of months in Sweden. I was visiting a friend that I met while living in Spain that year, and I took several weeks to travel around afterwards. I had such an amazing time in and around Stockholm, Västerås (where my friend lived), and Göteborg. It was summer, and I remember the long days, festive atmosphere, and beautiful places I visited. That’s why I’m so happy to announce that I’m finally returning to Sweden after more than 20 years away. I’ve had a number of requests to come talk about functional medicine and ancestral health, which are both increasingly popular topics in Sweden, and I’ll be teaching seminars for both the general public and healthcare practitioners.
Ancestral health events in London and Stockholm this summer
While I’m over on that side of the world, I’m also going to return to the UK. In October of 2015 I visited London and taught a couple of seminars—organized by Chris and his fantastic team at Re-Find Health—that I really enjoyed. There was so much enthusiasm and passion in the room, and I’m looking forward to doing more events in London this summer. In both Stockholm and London, with the support of Re-Find Health, I’ll be doing seminars for clinicians/healthcare practitioners and the general public, as well as a unique and intimate pop-up dinner. Here’s the schedule: Join Chris Kresser in London, UK July 8th – General Public: Half-day Discussion and Q&A July 8th – Dinner with Chris Kresser by Chef Holly Redman – limited to 40 seats! July 9th – Full Day for Healthcare Professionals and Students LONDON: Learn more and reserve your spot here Join Chris Kresser in Stockholm, Sweden July 14th – General Public: Discussion and Q&A July 14th – Pop-up Dinner with Chris Kresser – limited to 50 seats! July 15th – Full Day for Healthcare Professionals and Students STOCKHOLM: Learn more and reserve your spot here Join me for a lively, interactive conversation about new trends defining the future of medicine, including:
  • The crucial role of the exposome in human health and disease
  • The power of “ancestral” nutrition and living in line with our “evolutionary template”
  • Preventing and reversing disease with functional medicine
  • Creating a career in functional and evolutionary medicine
  • And more!
I’m passionate about educating practitioners and the public on these topics, and I’ve seen a growing interest in them in both Scandinavia and the UK. We’ve had several doctors and other healthcare professionals from both of these areas enroll in my ADAPT clinician training program over the past 18 months, and outside of the United States and Canada, I have more email and social media followers in the UK and Scandinavia than any other parts of the world. I hope to see many of you at these events. Don’t wait to register, as seats will fill up fast—especially for the dinner event. P.S. If you can't make it to the live event, my full-day London seminar for health professionals and students will be recorded and available after the event. If you pre-purchase the video now, you can use the coupon code "prekresser" and get 15% off the post-event pricing.
04/20/2017 07:06 PM
RHR: Could Gluten-Free Diets Be Harmful?

revolution health radio

In this episode, we discuss:
  • Correlation does not equal causation
  • The problem with confounding factors
  • Rice flour lacks fermentable fiber
  • Fiber intake on Paleo-type diets
  • How the media is guilty of oversimplification
  • Why rice flour can also lead to higher arsenic levels
  • Reducing intake of refined flours of any kind is key
[smart_track_player url="" title="RHR: Could Gluten-Free Diets Be Harmful?" artist="Chris Kresser" ] Chris Kresser: Welcome to another episode of Revolution Health Radio. This week we have a question from Pam. Actually, several people sent this question in, but I just chose Pam's version of it and I think it will address everybody's question on this topic. Let's give it a listen. Pam: Hi, Chris. My name is Pam Grover. I'm a functional medicine doctor in Rochester, New York. I'm calling to ask a question that was posed by my patient a few days ago. She was doing some research and found an article written on the University of Wisconsin website that stated patients who followed a gluten-free diet could possibly be causing low good bacteria and putting themselves at risk for nutrient deficiencies. I myself have found that patients who follow gluten-free diets have a lot of benefit from that. And with the right nutritional guidance, they do not get nutritional deficiencies and also they can maintain good levels of lactobacilli. However you have always been a great resource of knowledge for the rest of us and I thought I would pose the question to you so you can shed some more light on the situation. Chris: Okay. Thanks again, Pam, for sending that question in as well as everybody else who sent similar questions. This is really a great example of the inherent problems with nutrition research because the study suffers from many of the problems that we see in this type of research, including confounding factors and healthy user bias. We've talked about “healthy user bias” many times before. For example, if a study finds that people who eat more red meat have higher rates of cancer or heart disease, does that mean that red meat is actually causing that increased risk of cancer or heart disease? If you've been reading my blog or listening to my podcast for any length of time, you know that the answer to that question is no, or at least we can't be sure that the answer to that question is yes. That's a more accurate way of putting it. We would need more information to be able to draw a causal link between those two factors.

Correlation does not equal causation

Unfortunately, when you see media reports of studies like this, the headlines and even the articles themselves tend to suggest that there is a causal relationship between whatever factors are shown to be associated in the study, which is really disappointing because if it's a science reporter writing that article, and even the scientists who have those studies themselves should absolutely know better than that because as you learn in Research Methodology 101 class, correlation does not equal causation. You cannot assume just because two factors are correlated that there's a causal relationship between them.
Avoiding gluten? Simply substituting other flours for wheat flour is not the best option.
Now, it doesn't mean that epidemiological evidence, these kinds of observational studies, aren’t valuable. They are valuable and they can be used to generate hypotheses that can be tested in randomized controlled trials to see if there really is a causal relationship. And also, there are several other factors that can strengthen the likelihood that an associative relationship or two factors that are correlated together do have a causal relationship even without doing a randomized controlled trial. For example, is there a plausible mechanism that could explain a causal relationship? How strong is the association? The stronger it is, the more likely that it might be causal. Is there a linear relationship, meaning that the more one factor goes up, the more the other factor goes up or down? There are these other criteria that can be used to determine the likelihood that there's a causal association, but even with those, we can't be absolutely sure. We always need to keep this in mind when we see media headlines like this and even scientific studies that come out purporting to draw a causal relationship between two factors. In the case of red meat, if a study finds that people who eat more red meat have higher rates of cancer or heart disease, it's at least possible and it's actually very plausible, and it's been shown to be true, and in studies that people who eat red meat, because it's been perceived as unhealthy for so long, also tend to engage in other behaviors that actually are unhealthy, like smoking cigarettes, not exercising, not eating fruits and vegetables, eating a lot of refined flour and sugar, etc. It is more likely, in fact, according to better studies that have done a good job of controlling for all of these factors, that it’s not the red meat that's causing the increased risk of cancer or heart disease, but it's actually all of these other behaviors that are increasing the risk. Good research studies do attempt to control for those confounding factors. And by control for them, I mean remove their influence or limit their influence, but due to the complexity and number of these factors, the truth is, we don’t live in a vacuum. We don't live in a controlled metabolic ward where all of these things can be isolated. We live in a really messy complex world. It's really quite impossible to control for all of these potential confounding factors in a nutritional study, and that's assuming we even know what all the confounding factors are. For example, over the last two decades, we've really come to understand how important the gut microbiome is to health and disease, yet virtually no studies even today control for differences in the gut microbiome between populations when they're being studied. We don't even know what some of the confounding factors are and much less are we able to accurately control for them in every study.

The problem with confounding factors

We were talking about the healthy user bias and that's related to confounding. I want to talk a little bit more about confounding. The definition of “confounding” is that it's a distortion or inaccuracy in the measure of association that occurs when the primary exposure of interest is mixed up with some other factor that's associated with the outcome. I can imagine for many of you that this went in one ear and out the other, but to put it in plain language, a confounding factor in a study is one that may create a false impression that there is a connection between two factors that are not in fact directly related. We’ll make this more clear. Let's go back to the study in question that Pam mentioned. This study found that those who ate a gluten-free diet had lower levels of beneficial bacteria, and the knee-jerk assumption here (which, as we have discussed, is not a safe assumption to make) is that the gluten-free diet caused the low levels of bacteria. But again, correlation does not equal causation, so we can't know that. Well, what we need to do is think about possible mechanisms, so what increases or decreases beneficial bacteria? What is in gluten-containing products that could positively impact beneficial bacteria, and what might people who are on a gluten-free diet be eating more of or less of that would lead to lower levels of beneficial bacteria?

Rice flour lacks fermentable fiber

Let's talk about the first question, which is, “What increases or decreases beneficial bacteria?” Well, the biggest dietary factor by far is fermentable fiber. There are numerous studies now that show that fermentable fiber, which means certain types of fiber that can be consumed by our beneficial bacteria in the large intestine or colon and thus lead to their proliferation, is the single biggest factor that determines the status of our beneficial bacteria from a dietary perspective. Certainly, there are other factors like antibiotics that affect the gut flora, but right now, we're just talking about dietary factors. Someone who is eating a diet that is high in fermentable fiber is likely to have high levels of beneficial bacteria, whereas someone who is eating a diet that is low on fermentable fibers is likely to have lower numbers of beneficial bacteria. Wheat and wheat flour are relatively high in fiber. There are 12 grams of fiber per cup of wheat flour, but if someone is on a gluten-free diet, they're not going to be eating wheat flour. The most common replacement for wheat and wheat flour products on a gluten-free diet, in at least the way that it is typically implemented, is rice and rice flour. Rice flour has 66 percent less fiber per cup, just 4 grams compared to the 12 grams in wheat fiber. That alone could explain the association. If you change nothing else in the diet, the only thing someone did on a gluten-free diet was switch their wheat flour products out for rice flour products, then that person could potentially significantly reduce their fermentable fiber consumption and that could conceivably lead to lower levels of beneficial bacteria. This of course leads to another question, which is, “Is a gluten-free diet necessarily healthier than a diet with gluten?” The answer to that question is, “It depends.” If someone just swaps out all of their wheat flour breads, crackers, and cookies with gluten-free versions of those foods—so, gluten-free bread, flour, crackers, cookies, etc.—then it's really not much better from a nutritional perspective. Now, if that person is gluten intolerant, it certainly may be better from an inflammatory or immune health perspective, but in terms of nutrient content, nutrient density, and fiber content, that gluten-free (we could call it maybe a Standard American Gluten-Free Diet, if you will, which means that it's basically still a lot of processed and refined foods but just gluten-free varieties) would be no better than the version of that with gluten and maybe even worse from a fiber-gut-flora perspective if rice is the main substitute.

Fiber intake on Paleo-type diets

But people who are on a Paleo-type gluten-free diet, which substitutes starchy tubers like sweet potatoes, plantains, yuca, taro, and all of those kinds of plants, and then lots of whole fruits and non-starchy vegetables, nuts, and seeds for all of the refined-flour products like breads, crackers, and cookies, does that mean that that person who is on that really nutrient-dense, whole-foods diet is going to end up with lower levels of beneficial bacteria compared to someone who is eating a Standard American Diet? Of course not, that's preposterous. In fact, the opposite is true because those tubers, fruits, veggies, nuts, and seeds are higher in fiber than wheat flour. How do we know this? Well, first of all, we can just look it up with sites like or My Fitness Pal that show us the fiber content of various foods, and you can create a meal plan for a day with someone who is on a Paleo type of diet eating all those foods versus someone who's on a Standard American Diet, and you can see that the Paleo type of diet comes out way ahead in terms of fiber content. We can also look at studies that have been done that look at the average fiber intake of the Americans following a Standard American Diet and then compare that with the average fiber intake of contemporary hunter–gatherers that are following their traditional diet. Those studies have found that contemporary hunter–gatherers sometimes eat upwards of 100 grams of fiber per day, which is five to six times the amount of fiber found in a typical Standard American Diet containing wheat flour and wheat products, so they're not even in the same ballpark. It's not even really a comparison.

How the media is guilty of oversimplification

As usual, the devil here is in the details, and you have to look at these studies and news reports with a very critical eye that should in theory be the job of science reporters, but unfortunately, those seem to be few and far between at this point, and most people who are writing about these studies just seem to pull down their report from the newswire and really not investigate it at all. It's also unfortunate that a lot of researchers aren't more careful about how they present this research, although I know I've spoken to many researchers who complain that their comments are often taken out of context and distorted to make claims that they never made with their research or even with their discussions with reporters because reporters are interested in what gets clicks and attention. The nuance that is often present in research doesn't really translate well to media stories that are trying to generate as much attention as possible. Reporters are often concerned that people will get confused if they tell the story as it really is and so they often will oversimplify it: “Gluten-free diet reduces beneficial bacteria.” That sounds easier to understand and maybe more interesting to click on than, “Study finds that people eating gluten-free diet have lower levels of beneficial bacteria. However …” And then, we go into this whole analysis that we talked about here. That's not going to fly as well as just that oversimplified headline that I mentioned previously. It's unfortunate that we don't have better reporting in this area, but I guess that's what people like me are here for and the many others in my field who are analyzing these articles and writing blog posts about them and getting the information out there. I suppose we're lucky to live in a time where that's even possible, compared to when I was growing up when we had gatekeepers for this kind of information that we had to rely on and it was much more difficult to define independent third-party analyses.

Why rice flour can also lead to higher arsenic levels

As a side note before we finish up, I want to address another recent study that is in some ways similar to what we just talked about because I know I'll get some questions about it. In fact, I already have. This study found that kids consuming a gluten-free diet had higher arsenic levels in their blood, and this was touted as a danger or a risk of a gluten-free diet. Well, again it depends on what you substitute for wheat and gluten. As we talked about before, in most cases, that is rice, and unfortunately, the rice products can in fact be high in arsenic. Now, I wrote about this back in 2012. If you google “Kresser arsenic,” it will be the first result that pops up at the top of the page on Google. The gist of that article was that Consumer Reports did a study and found high levels of arsenic in many rice products, including brown rice and rice milk. I think those were among the highest in terms of arsenic content. The lowest levels, interestingly enough, were found in white rice and in general rice that was grown in California, versus rice that was grown in India or other places. If a kid, or an adult for that matter, does swap out all of their refined wheat and just wheat products in general with rice and rice products, then it is possible that arsenic levels could go up.

Reducing intake of refined flours of any kind is key

This is one of many, many reasons that I've argued for several years that the best option is to simply reduce your consumption of refined flours, processed foods, and grains in general (including rice and other gluten-free varieties) and just eat nutrient-dense whole foods that human beings have eaten for the vast majority of our evolutionary history—like non-starchy vegetables, starchy tubers, fruits, nuts, seeds, and of course some meat and fish. This is the ancestral template for human beings. It's what we know works. It's what we know feeds our beneficial gut bacteria because we evolved with this diet, and the bacteria in our gut co-evolved with us while we are on this diet. This is again where that evolutionary and ancestral lens comes in so handy and can really help us to sift through some of the apparent contradictions and things that are difficult to understand in modern research because we can look back and we can check out what happened from an evolutionary perspective, and then we know since most organisms evolved to survive and thrive in a particular environment that that is the kind of the default for that species, in this case, human beings. Anything that diverges from that default, we have to raise an eyebrow and take a look at. It doesn't mean that automatically something that diverges from that template is not going to be healthy, but it does mean that it's an aberration from a historical perspective and it's something that we need to evaluate with a critical eye. Modern research is very important, but I think looking at it through the evolutionary lens is also important as kind of a check and balance against some of the things that aren't necessarily clear from the modern research. Okay, so I hope that answered the question, and those of you who are on a nutrient-dense, whole-foods, gluten-free diet where you're emphasizing all of those foods that I mentioned, you don't have to worry about low levels of beneficial bacteria as a result of that diet. In fact you can be virtually assured that you're going to have higher levels of beneficial bacteria than someone who is eating pizza, muffins, saltine crackers, and wheat flour-containing foods because the foods that you're eating have much more fiber overall as a group than wheat flour-based foods. Of course that's not even to include the other obvious advantages of that kind of diet, including nutrient density lowering inflammatory factors, less likely to contribute to chronic inflammatory disease, etc., etc. I hope that helps and please do keep sending in your questions to I will talk to you next time.
04/18/2017 01:07 PM
Why Has the American Approach to Heart Disease Failed?

heart disease

Jane Brody wrote an article in The New York Times called “Learning from Our Parents’ Heart Health Mistakes.” She argues that despite decades of advice to change our diet and lifestyle in order to reduce our risk of heart disease, we still depend far too much on drugs and expensive procedures like stents. She says:
Too often, the American approach to heart disease amounts to shutting the barn door after the horse has escaped.
To support this argument, she refers to a recent paper published on the Tsimane, an indigenous population in the Bolivian Amazon. The study found that the rate of coronary atherosclerosis in the Tsimane was one-fifth of that observed in the United States (and the lowest that has ever been measured). Nearly nine in 10 Tsimane had unobstructed coronary arteries and no evidence of heart disease, and the researchers estimated that the average 80-year-old Tsimane has the same vascular age as an American in his mid-50s. I certainly agree with Ms. Brody so far, and her analogy that the American approach to heart disease amounts to shutting the barn door after the horse has escaped is spot on. The problem is what comes next, as she attempts to answer the question of why the Tsimane have so much less heart disease than Americans:
Protein accounts for 14 percent of their calories and comes primarily from animal meats that, unlike American meats, are very low in artery-clogging saturated fat. [emphasis mine]

Does saturated fat “clog” your arteries?

Artery-clogging saturated fat? Are we still using that phrase in 2017? As I’ve written before, on average, long-term studies do not show an association between saturated fat intake and blood cholesterol levels. (1) (I say “on average” because individual response to saturated fat can vary based on genetics and other factors—but this is a subject for another article.) If you’re wondering whether saturated fat may contribute to heart disease in some way that isn’t related to cholesterol, a large meta-analysis of prospective studies involving close to 350,000 participants found no association between saturated fat and heart disease. (2)
Does saturated fat really “clog” your arteries?

Are “clogged arteries” the cause of heart disease?

Moreover, as Peter Attia eloquently and thoroughly described in this article, the notion that atherosclerosis is caused by “clogged arteries” was shown to be false many years ago:
Most people, doctors included, think atherosclerosis is a luminal-narrowing condition—a so-called “pipe narrowing” condition. It’s true that eventually the lumen of a diseased vessel does narrow, but this is sort of like saying the defining feature of a subprime collateralized debt obligation (CDO) is the inevitable default on its underlying assets. By the time that happens, eleven other pathologic things have already happened and you’ve missed the opportunity for the most impactful intervention to prevent the cascade of events from occurring at all. To reiterate: atherosclerosis development begins with plaque accumulation in the vessel wall, which is accompanied by expansion of the outer vessel wall without a change in the size of the lumen. Only in advanced disease, and after significant plaque accumulation, does the lumen narrow.
Michael Rothenberg also published an article on the fallacy of the “clogged pipe” hypothesis of heart disease. He said:
Although the image of coronary arteries as kitchen pipes clogged with fat is simple, familiar, and evocative, it is also wrong.

If heart disease isn’t caused by “clogged arteries,” what does cause it?

The answer to that question is a little more complex. For a condensed version, read my article “The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number.” For a deeper dive, read Dr. Attia’s article. Here’s the 15-second version, courtesy of Dr. Attia:
Atherosclerosis is caused by an inflammatory response to sterols in artery walls. Sterol delivery is lipoprotein-mediated, and therefore much better predicted by the number of lipoprotein particles (LDL-P) than by the cholesterol they carry (LDL-C).
You might think that I’m splitting hairs here over terminology, but that’s not the case. It turns out that this distinction—viewing heart disease as caused by high LDL-P and inflammation, rather than arteries clogged by saturated fat—has crucial implications when it comes to the discussion of how to prevent it. Because while it’s true that a high intake of saturated fat can elevate LDL particle number in some people, this appears to be a minority of the population. The most common cause of high LDL-P in Americans—and elsewhere in the industrial world—is almost certainly insulin resistance and metabolic syndrome. (I explain why in this article.) And what is one of the most effective ways of treating insulin resistance and metabolic syndrome? That’s right: a low-carbohydrate, high-fat diet!

News flash: diets high in saturated fat may actually prevent heart disease

Perhaps this explains why low-carbohydrate, high-fat diets (yes, including saturated fat) have been shown to reduce the risk of heart disease. For example, a meta-analysis of 17 low-carb diet trials covering 1,140 obese patients published in the journal Obesity Reviews found that low-carb diets were associated with significant decreases in body weight, as well as improvements in several CV risk factors, including decreases in triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, and C-reactive protein, as well as an increase in HDL cholesterol. (3) (In case you’re wondering, low-carb diets in these studies had a null effect on LDL cholesterol: they neither increased nor decreased it.)

Saturated fat is a red herring

Instead of focusing so much on saturated fat intake, which is almost certainly a red herring, why not focus on other aspects of the Tsimane’s diet and lifestyle that might contribute to their low risk of heart disease? For example:
  • They are extremely active physically; Tsimane men walk an average of 17,000 steps a day, and Tsimane women walk an average of 15,000 steps a day—and they don’t sit for long periods. Ms. Brody does mention this in her article.
  • They don’t eat processed and refined foods. We have been far too focused on calories and macronutrient ratios and not enough on food quality. We now know that hunter–gatherers and pastoralists around the world have thrived on both high-carbohydrate, low-fat diets (like the Tsimane, who get 72 percent of calories from carbohydrate) and low-carbohydrate, high-fat diets (like the Masai and Inuit). But what all hunter–gatherer diets share in common is their complete absence of processed and refined foods.
Perhaps if we stopped focusing so much on the amount of fat and carbohydrate in our diet and started focusing more on the quality of the food we eat, we’d be better off. And of course we also need to attend to the many other differences between our modern lifestyle (which causes heart disease) and the ancestral lifestyle (which prevents it), including physical activity, sleep, stress, light exposure, play/fun, and social support. The Tsimane study illustrates exactly why an evolutionary perspective on diet, lifestyle, and behavior is so important. It helps us to generate hypotheses on what aspects of our modern way of life may be contributing to chronic diseases like atherosclerosis and gives us ideas about what interventions we need to make to prevent and reverse these diseases. Okay, that’s it for now. Let me know what you think in the comments!
06/08/2017 10:18 AM
Ignite Your Power Chakra
Our core is our center—physically, emotionally and mentally. It’s vital to keep our spine healthy, our abs strong, and cultivate our prana from our navel center. Learn to utilize the wisdom of yoga to become your most confident, decisive, and happy self. Diving into subtle body anatomy, specifically balancing your Manipura or navel Chakra can empower your life. This week, we’ve got four new classes and a previously released class to get you started.
06/07/2017 06:12 PM
Carob Cashew Raw Balls
Today’s recipe was created by culinary master Leslie White from Zeal Food here in Boulder. This decadent sweet treat was the closing morsel of yumminess that completed our cleanse-friendly meal last week, and people have been talking about it since.
06/05/2017 06:31 PM
New Discipline in Yoga
The novelty of yoga has been worn down to almost nothing by a multi-billion dollar industry that cares little for its tenets, like the crumbling shreds of a shoddily made pvc mat from China. But from out of the ashes of craven images and advertising schemes, a new discipline is emerging.
06/05/2017 06:08 PM
Full Moon in Sagittarius (06/09/2017): Discovering Your Personal Myth
A full moon in Sagittarius on June 9, 2017 encourages us to explore the realm of the religious function of our psyche. Often overlooked, or pushed aside in favor of science and certainty, this mystical heart of our being is bereft of attention. Because of a lack of connection to a personal mythology, we suffer from constant overwhelm of life’s circumstances, and an unknowing of how to make sense of them. 
06/01/2017 05:38 PM
5 Reasons People Doing HIIT Should Also Do Yoga
High Intensity Interval Training—often just called HIIT for short—is working its way into fitness enthusiast’s workout schedules everywhere, and not without good reason. In fact, Dr. Axe shares many different benefits of HIIT in addition to better physical fitness, a couple of which include its anti-aging effects and support of healthier levels of hormones like ghrelin (which affects your eating patterns) and leptin (the hormone responsible for making you feel full).
05/30/2017 11:41 PM
Meet Denelle Numis!
Denelle Numis composes an authentic experience on the mat where each student can immediately connect with the rhythm of their body and their breath. With a background in modern dance, Denelle builds her Vinyasa classes through a progression of dynamic sequences to stimulate energy and vitality throughout the body. She infuses her classes with eclectic music and inspiring peak postures. Even though her classes may be challenging, Denelle’s vibrant and gregarious personality motivates her students to stay playful in their practice.
05/30/2017 06:01 PM
A Simple Formula to Practice Forgiveness With Yourself
As humans, we blame ourselves for various perceived shortcomings in life. But some of us really get stuck there. We blame ourselves for not being more disciplined or not being able to do it all. We blame ourselves for not being there for a loved one. There’s an easy tool I use to practice forgiveness, but I’d like to first speak about what happens when we blame ourselves.
05/27/2017 12:13 PM
5 Yogi-Approved Ways to Upgrade Your Summer Vacation
If you’ve been chained to a desk since New Year’s Day, your body’s in need of a liberating vacation, and your mind is ready for a cozy staycation. How do you escape, but stay still at the same time? Well, you could binge watch Netflix or you could try these 5 tips to kick off summer with a sense of adventure and peace.
05/24/2017 08:07 PM
10 Yogic Sayings Explained for Ways to Help (Re)create Balance
It is common for people to go through dry spells or feel burnt out. We all have, at one point of another, felt uninspired, overworked, wanted to check out and just plain exhausted from the humdrum of life and the prevailing idea of not ‘being enough’. We don’t always have time to go to cook healthy meals, go to yoga classes, stick to our budget or just do things ‘right’. One might wonder what it would be like to have more hours in a given day to do the things we want to do to live a more fulfilling and happy life. Yet if your evenings and weekends are spent in the same couch potato or indulgent fashion, it may be time for you to check in and recognise this as a sign that you’ve been making excuses for yourself.
06/06/2017 08:39 PM
5 Ways to tell if your gym is right for you
Working out can be a personal experience for a lot of people. It can take a bit of time to find the right environment. Somewhere you can challenge yourself, feel safe and free to be vulnerable.  I remember while I was away on vacation, there was a gym 5 minutes from where I was staying. It was a familiar… Continue reading 5 Ways to tell if your gym is right for you