Mark Sisson's Blog, page 314

Why Personalizing Your Diet and Lifestyle Is the Key to Success

This is a guest post from Chris Kresser of ChrisKresser.com and author of the new book Your Personal Paleo Code. Join me, Chris and numerous other presenters and Primal enthusiasts from around the world at the 5th annual PrimalCon Oxnard in 2014.

Every week it seems there’s a new bestselling diet book promising the “secret” to losing weight, building muscle, or even curing chronic disease. Over the last few decades we’ve seen books that make a wide range of claims:

Fat is the enemy, and we should all eat a low-fat diet
Carbs make us fat and sick, and we should all eat a low-carb diet
Protein is the key to weight loss and health, and we should all eat a high-protein diet
We should all eat 40 percent of calories from carbohydrate, 30 percent from fat, and 30 percent from protein
Animal products are to blame, and we should all follow a vegetarian or vegan diet
Cooked food is the source of our ills, and we should all eat a raw food diet
We can eat whatever we want and still lose weight—as long as we don’t eat anything at all two days out of each week

It’s enough to make your head spin, isn’t it? And if you’re like most of my patients and readers, you’ve probably tried several of these approaches. Maybe some of them even helped—at least for a little while. But eventually you gained that extra weight back, or you developed some new symptoms, or perhaps you never experienced much improvement in the first place.

Why do we continue to see one diet after another make a splash on the bestseller lists, only to fade from the popular consciousness a few years later? Do these approaches really offer the “secrets” to success they claim to? If so, why don’t they last?

One reason is that these dietary approaches aren’t consistent with what evolutionary biology has taught us about optimal human nutrition. Studies of the fossil record as well as contemporary hunter-gatherers following their traditional ways have revealed the following facts:

Human beings evolved on a diet of meat, fish, vegetables, fruits, nuts and seeds, and starchy tubers.
Humans can tolerate (and even thrive on) a wide variety of macronutrient ratios.
Animal products made up a significant percentage of our ancestors’ diet, and we know of no traditional hunter-gatherer cultures that followed a vegetarian or vegan diet.

This is, of course, why a Paleo diet makes so much sense. But I’ve come to understand that while Paleo is a great starting place, it’s just that—a starting place. This brings us to the second reason that most bestselling diets—including Paleo in some cases—fail in the long run: they aren’t personalized to meet your unique needs as an individual.

We share a lot in common as human beings, but we also have important differences. We have different genes, gene expression, lifestyles, activity levels, health status, and goals. Each of these factors will determine what is optimal for a given individual. What’s more, they can change over time, which means that what’s optimal for you now may not be in a year or a decade.

Let’s take a closer look at how each of these factors might affect individual differences in diet:

Constitution (genetics, physiology, biology). Modern studies have shown that some people have genes that predispose them to problems metabolizing glucose (sugar), while others have genes that make it more likely they will have problems burning fat. There is still much we don’t understand about the contribution of genetics to diet and the relationship between genes and environmental factors.
Season. During the summer, your body will naturally crave different foods than it does during the winter. It’s true that our ancestors had access to certain foods only at certain times of the year. If they lived in Northern Europe, they weren’t eating mangoes from Thailand in the winter.
Geography/climate. If you’ve been to the tropics, you probably found yourself craving lighter foods with higher water content, like fruits and vegetables, more than you did at home. Likewise, in cold climates, you probably gravitate toward eating more protein and fat-rich foods, like meat stews. There’s a reason for this.
Health status. Have you ever noticed that you crave different foods when you’re coming down with a cold or the flu? The body has different needs in different physiological states. Women often crave more carbohydrates during pregnancy because the developing fetus has a need for glucose, and women naturally become somewhat insulin resistant as a result. People with thyroid problems may suffer on very low-carb diets, because insulin is required for proper thyroid-hormone conversion. As people age and become less active, they often find that they need less food, or perhaps less of a particular macronutrient, than they did when they were younger.
Activity level. A construction worker doing manual labor for eight hours a day or a high-level athlete in training will have different dietary and macronutrient needs than someone who works at a desk. This should go without saying, but amazingly, it is often ignored in the discussion about macronutrients.
Goals. If you’re training for the next Mr. Olympia competition, you will very likely eat different foods than an obese person trying to lose weight.

Within a basic “template” of Paleo or Primal foods, all of the factors above will influence what specific ways each person should tweak their approach in order to achieve the best results. I’d like to share two case studies from my clinical practice to show you how this works.

The first case was a patient I’ll call Samantha. She was 42, and came to see me after she was diagnosed with Metabolic Syndrome. She was 40 pounds overweight and had several markers of poor metabolic function, including insulin resistance, abdominal obesity, high triglycerides and low HDL, and high blood sugar. Her doctor had prescribed a cocktail of medications, which Samantha was advised she’d have to take for the rest of her life. Samantha came to see me for a second opinion.

I put her on a low-carb (15 percent of calories), high protein (25 percent of calories) Paleo diet to promote fat loss, stabilize her blood sugar and normalize her metabolic and cardiovascular function. I also suggested that she eat all of her meals between 11am and 7pm each day. This strategy, called “intermittent fasting”, has been shown to improve metabolic function and accelerate weight loss in some patients. I also counseled her to reduce her sedentary time, add high-intensity interval and strength training to her exercise routine, sleep for at least eight hours a night, consume fermentable fibers and probiotic foods to improve her gut health, and practice regular stress management. Within three months Samantha had lost 36 pounds, and her metabolic and lipid markers were back in a normal range.

The second case was a patient I’ll call Marissa. She was 43 and came to see me complaining of persistent fatigue. She was a mother of two young children (the youngest was two years old), and she worked full-time outside of the house. Prior to having children she was energetic, enthusiastic, and an early riser—she woke up looking forward to the day. By the time her youngest was two, she could barely get out of bed in the morning and felt exhausted throughout the day. She also had cold hands and feet, hair loss, constipation, and severe brain fog. After running some tests, I determined that Marissa was suffering from Adrenal Fatigue Syndrome and hypothyroidism.

Marissa had been following a very low-carb diet (less than 10 percent of calories from carbohydrate) prior to coming to see me. She started this after her first child was born to lose the weight she gained during pregnancy. This did help with weight loss, but I’ve found that most patients with hypothyroidism and Adrenal Fatigue Syndrome don’t do well with very low-carb diets. If I had suggested the same approach for Marissa that I used with Samantha—a low-carb diet with intermittent fasting—she almost certainly would have continued to get worse. Instead, I recommended a moderate carbohydrate intake (approximately 20–25 percent of calories from carbohydrate) primarily from fruit and starchy plants like sweet potatoes, plantains, taro, and yuca. I suggested that she eat every two to three hours, and start the day with a high-protein (e.g. 40–50 grams) breakfast. Both of these strategies help to stabilize blood sugar and adrenals. I also suggested that she stop or cut back on her intense CrossFit workouts, and instead favor lower-intensity activity like walking, cycling, swimming and yoga. Finally, I made several recommendations for sleep and stress management, and I prescribed supplements for her adrenals and thyroid. Because Marissa’s condition was so advanced, it took about six weeks for her to notice significant changes, and about six months to fully recover and feel like herself again.

These two cases illustrate the importance of a personalized approach to a Paleo diet and lifestyle. They aren’t unique; in fact, I use a similar approach with every single patient that walks through my door. My experience—both personally, and as a clinician—has taught me that personalizing your Paleo/Primal program to meet your unique needs is the single most important factor in determining your long-term success.

While this does require a little bit more time and effort up front, it pays off in spades. You won’t feel confused anymore by the conflicting advice you read on the internet. You won’t have to rely on strangers on forums or even experts to tell you what you should eat. Instead, you’ll know exactly what works for you based on your own experience. Even better, you’ll be able to change your approach on the fly as your circumstances and needs change.

For more information on how to personalize a Paleo diet to meet your specific needs, check out my new book Your Personal Paleo Code.

Final 24 Hours of Death By Food Pyramid Special Offer

This is just a quick reminder that today is the final day of the special offer period for the newly released book Death by Food Pyramid by Denise Minger.

If you’ve been meaning to pick up a copy, but just haven’t gotten around to it yet, this is your last chance to grab a copy and get the free gifts, including: a collection of gift certificates and coupons from popular Primal/Paleo retailers, a personal invite to a private Live Webcast Q&A Session on January 8 with author Denise Minger, your name entered for a chance to win Primal prizes worth $1800 in total.

You can learn all the details here.

Many thanks to everyone that has already purchased a copy. I hope you’re finding it as eye-opening and riveting as I did.

If you already have the book in hand, Denise, myself, and our entire team would be incredibly grateful if you would publish a review of the book on Amazon.com. Thank you in advance for your support. Grok on!

Dear Mark: WiFi Effects on Health, Creatine and AGEs, and Introducing Solids

For today’s edition of Dear Mark, we’ve got a two-parter followed by a question for Carrie. First, I discuss the effects of WiFi on health. Or, rather, I explore whether the potential effects of WiFi on health are worth fretting over or whether we should focus on more actionable factors that affect health. Second, I answer a three-part question about creatine and advanced glycation end products. Is there an interaction between supplementary creatine and AGE formation? Are the two contraindicated? Finally, my dear wife Carrie answers a question about introducing solids to a breastfed infant.

Let’s go:

Dear Mark,

I read an unsettling article explaining how our WiFi routers emit harmful radiation throughout the whole house. Is this a cause of concern do you think? Is it significant enough damage to affect my and my family members’ health?

Thanks.

Joe

You know, this is a tough one. I think there is evidence that WiFi signals have physiological effects. Epidemiology suggests a link between proximity to mobile phone base stations and increases in cancer and adverse neurobehavioral effects, even when exposure dosages were under the generally-recognized-as-safe limit. I’ve discussed the potential effect of laptops and cell phones on sperm health and motility before. There might be something there.

There’s also evidence that WiFi can improve health, though. A mouse model of Alzheimer’s disease experienced improved memory when exposed to 2.4 GHz WiFi. And there’s also lots of evidence that it has no effect, particularly on prenatal health and development.

My advice? Don’t worry too much. Worrying about the health effects of WiFi signals can actually increase the health effects of WiFi signals, even if it’s a sham signal!

WiFi is here to stay. Even now, you’re probably bathed in the stuff. If anything, its reach will only grow. You’ll be able to get full coverage while backpacking through the remotest jungles where you’ll stumble upon some untouched Amazonian tribe and upload your photos to Facebook. Heck, they might even already have Facebook accounts. “Remote” will probably cease being a useful descriptor altogether. Short of encasing your body in aluminum foil or moving to the wilderness, it will be impossible to escape WiFi entirely. The best thing we can do is optimize the aspects of life over which we do have control, like our exercise, our eating, our social relationships, our love life, our work life, and our sleep.

That said, getting away from it all (while you still can!) is definitely a good move from time to time, and for other reasons. Disconnect. Go out into nature where the signals are muted, if not absent altogether. These occasional (or more frequent) sojourns into natural solitude can be rejuvenating for the mind and body. Is it because you’re avoiding WiFi signals? Maybe, but I doubt it. Doesn’t really matter either way, though, if it works.

I did some research on creatine after reading your link love yesterday, and have some questions I hope you (as an athlete) can answer.

1. I’ve been giving us both L-carnosine because it breaks the bonds of AGEing. In wanting to prevent sugar from bonding to protein (muscle), thereby aging us, have I made a mistake?

2. Should I be using creatine instead, and not worry about AGE bonds?

3. How do I strike a balance between controlling AGE bonds and using muscles as a sugar-sink, or do I need to?

W.

First, readers, recall that AGEs are advanced glycation end products. AGEs have been associated with inflammation, oxidative stress and aging.

1. Carnosine is a fairly effective inhibitor of AGE (advanced glycation endproducts) formation, especially those mediated by methylglyoxal. Although methylglyoxal’s wholly negative reputation might be unfounded (it does more than just glycate, actually plays an important physiological role, and may have chemotherapeutic effects), excessive AGE formation has been implicated in the negative effects of aging and many degenerative diseases. Luckily, simply by eating ample amounts of animal flesh - the only real dietary source of carnosine – you will obtain carnosine. In fact, vegetarians tend to have lower levels of carnosine (aging also lowers carnosine levels, which could be why many studies show that seniors benefit from significantly increasing protein intake over recommended levels). That’s not to say supplementation won’t help, just that you probably needn’t fret too much since you’re getting more from your diet than most and there’s still a lot about AGEs that we don’t quite know.

2. Creatine is fine. If anything, it will help against AGE formation! An in vitro study found that creatine actually inhibits glycation (PDF). That’s in addition to the beneficial effects on glucose control you already know about. Another study even found that creatine monohydrate (the most basic supplemental form) can improve recovery from nerve damage to muscles. Don’t expect a miracle cure, though.

3. I don’t think increased muscle glycogen levels and lower AGE formation are mutually exclusive. In a recent study of diabetic rats, using a cumin seed extract to improve blood glucose control also increased muscle and liver glycogen content while lowering AGE levels. Besides, stronger people (with bigger muscles and more glycogen) tend to live longer, and exercise (which necessitates glycogen repletion and increases glycogen storage capacity) is positively associated with longevity. There’s also an inverse relationship between muscle strength and AGE levels in the skin of adult men – the stronger you are, the fewer AGEs your skin has. All the evidence points toward muscle glycogen repletion being a good thing.

And now, let’s hear from Carrie on the topic of introducing solids:

Dear Mark (and Carrie),

I have a three-month-old, and since he’s starting to teeth and becoming a little bit interested in food (though he’s still far from trying to grab it from my fork or plate), I have been trying to find out what the best foods to start him with might be. All of my online research came back with “iron-fortified rice cereal”, or other similar results, and when I searched for an answer on your site, I came across an article that discusses feeding babies. However, mostly it talks about the benefits of breastfeeding, and what not to feed baby (with a brief “try more healthy brands, or make your own”), with only a very short few lines talking about what *to* start feeding baby. And so my question is: what would you suggest for good first foods, and what, if anything, should be avoided during those first couple of months of solid foods?

Respectfully yours,

Erin

First, I’ll speak from experience. I exclusively breastfed my kids until they were six months old. After that, I introduced solids while maintaining the breastfeeding, starting with cooked peas, carrots, and sweet potatoes. I wasn’t into processed foods, neither for myself nor our kids, so I made all their food instead of buying it. But I was still in the low-fat paradigm (lots of whole grains, fruits, veggies and low-fat dairy). It never crossed my mind to offer things like egg yolks or liver! They did great and have grown up to be healthy, happy (young) adults, but if I knew then what I knew now I probably would have introduced a few other foods as well.

Egg yolks are great. They’ve been shown to be a great way to increase iron stores in babies (PDF), who after the six month mark really start dipping into the iron reserves and require an outside source of it. Bonus points if you use DHA-enriched or pastured eggs, which are higher in nutrients and can increase the serum DHA levels of babies. Soft boil the eggs and either spoon the yolk direct into mouth, or mash with something like banana or sweet potato.

Liver’s another food I would have liked to have given my kids very early. It’s super high in folate, iron, and vitamin A, which are nutrients they need. Some people recommend giving it raw after being frozen for 14 days to eliminate pathogens, but I don’t know about that to be quite honest. I think lightly pan cooking it in some butter, coconut oil, or olive oil is just fine.

But mostly just let him decide based on what he’s drawn to on your plate. I think babies’ instincts should be respected. If you’re reading this blog, you’re probably eating a generally healthy diet, so I wouldn’t worry about just letting him eat what you’re eating. There aren’t too many restrictions. It’s generally accepted that you can feed babies food. Stay away from overly spicy stuff, but they don’t necessarily need bland, flavorless, boring food. Just start with little bites, little dabs of whatever food you’re offering, and see how they react. Babies tend to be super expressive with their faces. They’ll let you know when they don’t like something!

When you do offer starchy foods or fruits like sweet potatoes and bananas, consider pre-chewing them. Babies don’t make a ton of pancreatic amylase right off the bat, nor are they big chewers. Your saliva however does contain salivary amylase that can start the digestive process, survive passage into their guts, and make starch digestion easier for your baby. If you don’t want to chew the foods, be sure they are thoroughly cooked. Babies do make significant amounts of salivary amylase before pancreatic, too, so they’re not totally helpless as long as they gum the food (which they do!).

Regarding grains, there is some evidence that introducing too early (before 3 months) or “too late” (after around 7-8 months) can increase the risk of allergies or celiac in genetically susceptible kids. So if either of the baby’s parents have a history of celiac, gluten sensitivity, or other food intolerances, some people are recommending that he be introduced to cereal grains at around the six month mark. Other evidence suggests that waiting until 12 months is better. Could be that waiting even longer works even better. There’s not much evidence to say definitively either way. What’s my take on it? I’m not sure. The evidence is pretty interesting, if conflicting and unclear, despite our general anti-grain stance. I can conceivably see some benefit to giving a tiny bit of grain to an infant to prime them for later exposure. After all, it probably isn’t realistic to keep all grains and gluten from a kid for the rest of their lives. What happens when they go to a birthday party? A pizza joint with friends? Their lives are theirs, and they may choose to eat grains. If you do decide to introduce grains, make sure you’re still breastfeeding, which keeps the gut healthy and stocked full of beneficial, protective Bifidobacteria. A healthy gut appears to be key in preventing food intolerances from arising and promoting a healthy immune response to any food you may eat, and I think this is the most important factor (more so than when you introduce foods).

Well, that’s it for today, folks. Thanks for reading!

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Weekend Link Love

Pretty much anyone who’s ever tried the tired old “calories in, calories out, eat less, move more” way to lose weight can tell you that doesn’t really work, especially not for the long haul. Jonathan Bailor’s fantastic new book, The Calorie Myth, explains exactly why the old paradigm doesn’t work and shows you how you can lose weight by emphasizing the quality of what you eat and how you move – even if you eat more and move less than before. Enter to win a copy, or just buy the book outright (and get some awesome bonuses exclusive to MDA readers!). I highly recommend it.

There are still a couple days to take advantage of the special offer we’re running for Denise Minger’s Death by Food Pyramid. It ends December 31.

Even though her book is done, Denise Minger remains busy as ever, having recently appeared on three podcasts to talk about her new book: Live to 110, Smash the Fat, and The Smarter Science of Slim.

Research of the Week

Psyching yourself up when stricken with performance anxiety is better than trying to calm yourself down (which, let’s face it, never works).

When it comes to partial meniscal tears, sham knee surgery might work just as well as actual knee surgery.

Interesting Blog Posts

How to go without your phone for a month in a major city (and not go crazy and totally disrupt your professional life).

Turns out coffee won’t stunt kids’ growth. Cool, but I think there remain valid reasons not to dose your toddlers with caffeine.

Media, Schmedia

After ten years of losses, McDonald’s has finally closed up shop in Bolivia. The people there just like actual food too much.

Paleo (or Caveman Diet) was the most searched-for diet term on Google this year. It’s the world’s oldest fad diet.

Satire or Serious?

Who’s ready to welcome the Medium-Chain Sugar Amphiphiles, a new “family of healthy vegetable oil structuring agents,” into our lives?

Everything Else

America’s citizenry are in the unenviable position of suffering an expansion of morbidity even as they experience a compression of life expectancy.

McDonald’s isn’t all bad, though (if entirely bereft of – or, come to think of it, filthy with – self-awareness): in their employee resource handbook, they recommend that McDonald’s employees limit fast food.

Grizzly bears may not be as easy to manipulate as lab rats, but they serve as better models of human metabolism.

Are allergic reactions an evolved defense against toxins and venoms?

Recipe Corner

Montana bison picadillo pie with grass-fed beef liver is quite a mouthful. In a good way.
Everyone loves finger food, especially people at a New Year’s eve party. Here are 29 recipes from PaleOMG.

Time Capsule

One year ago (Dec 29 – Jan 4)

A Different Kind of Fitness Resolution – Instead of resolving to lift more, run faster, and log more miles, a better resolution might actually be to slow things down.
Are You Eating These Important Supplemental Foods? – It’s usually preferable to get your nutrients through foods rather than supplements. But what if you treat certain foods like supplements?

Comment of the Week

OK boss I need 30 days off. I think I might be allergic to work and we best reintroduce it slowly 

- Nice idea! I might even humor it if a Worker Bee tried it on me.

Death by Food Pyramid, the Highly Anticipated New Book by Denise Minger, is Now Available! Get FREE Gifts When You Order by Dec. 31. Learn All the Details Here.

Oysters Casino

Oysters Casino is a retro dish that should never go out of style. It’s the type of appetizer that’s so good you wish it was a main course, and maybe it could be, with a hefty salad on the side.

To make Oysters Casino, oysters on the half shell are briefly baked in a bath of butter flavored with roasted red pepper, shallots, bacon and a jalapeño pepper garnish. The whole thing goes down the hatch in one delicious bite. If you love raw oysters you’ll probably also love this rich and flavorful recipe. If oysters have never been your thing, then Oysters Casino is a gateway recipe that will turn you into a fan.

Even compared to other shellfish, oysters have an uncommonly dense nutritional profile. These small morsels are packed with minerals (zinc, copper, iodine, selenium, and magnesium), vitamin A, and B-vitamins, plus healthy protein and fat. As far as appetizers go, it’s hard to find anything better than oysters, either slurped raw or dressed up and baked like irresistible Oysters Casino.

Servings: 2 appetizer servings

Time in the Kitchen: 30 minutes, plus shucking the oysters

Ingredients:

1 dozen oysters, shucked on the half shell
2 slices of bacon
2 tablespoon unsalted butter (15 g)
1 tablespoon lemon juice (15 ml)
1 tablespoon finely chopped roasted red pepper (10 g)
1 tablespoon finely chopped shallot (10 g)
1 jalapeño pepper, sliced into thin rounds

Instructions:

Preheat oven to 400 ºF (204 ºC).

In a skillet, heat bacon until cooked but not crisp. Transfer to a cutting board to cool then finely chop the bacon.

In a medium bowl, use a fork to mash together the butter, lemon juice, red pepper and shallot.

Put a dollop of butter into each oyster. Sprinkle bacon over each one. The jalapeño pepper slices can be added before baking (which mellows the jalapeño flavor), or for a crunchy, spicier garnish wait and add the jalapeño after the oysters come out of the oven.

Bake for 12 to 15 minutes, until the oysters are no longer raw and the butter is bubbling.

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The “Paleo Fantasy” That Saved My Life

It’s Friday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Friday as long as they keep coming in. Thank you for reading!

Dear Mark and the Paleo community,

This post has been a long time coming. What motivated me to share this story now is all of the current criticism of the Paleo diet in the mainstream media and from certain scientists. I read through some of their findings and felt the wave of fury and frustration crash down on me. It made me think once again, “Am I doing it all wrong?” But upon reflection I realized this (following a modified Paleo diet) is the only way there is for me. If I chose to take those findings and bloggers at their word I would thus begin my journey back down a tunnel of sickness and most likely a very short life.

One and a half years ago my body felt and looked very different then what it does today. I was 21 years old and my body and mind started to turn on me. My last semester of college was on the horizon and I was set to graduate from the University of Arizona in December. In order to graduate early I enrolled in summer classes to complete needed credits. So the summer of 2011 consisted of summer school, training for my first marathon and boxing 1 or 2 hours per day. Seriously, some days I would wake up at 4am (the only time you can run during an Arizona summer) and run 13 miles and then go to class in the afternoon and go to boxing classes for a couple hours in the evening. To top it all off I had seen “Forks over Knives” multiple times and read excerpts from The China Study and had been a vegan/vegetarian for nearly 2 years. I didn’t eat a lot of junk though (or so I thought). A lot of rice and beans, granola with rice milk, oatmeal with mounds of peanut butter, and tons of salads and fruit. I shopped at co-ops and tried to buy local and organic when my budget would allow. This was my summer, a summer to tackle school and also train to run that first of many many marathons.

The first change I began to notice while I was saturated in this nonstop cycle of mental and physical motion was my weight began to plummet. I am 5 feet 9 inches tall (female) and I stayed around 140 most of the time. That summer I dropped down to 115/120. I noticed all of my clothes and belts did not fit anymore, everything just draped over my withering frame. Of course I thought, “Great! I’m going to be so thin and fit for my marathon!” I was finally developing that emaciated runner physique I had always wanted! As the summer ended and a full school course load began I started to increase my mileage and add some interval training into the mix. It-was-insane. I would wake up most days and lead an interval run with the running club, go to class all day and box in the evenings. I will also still eating a heavy-grain low-fat diet. Is it any surprise my body began to crumble?

Within the first month of school this is what I began to feel everyday: headaches, brain fog, joint pain everywhere, exhaustion, no menstruation (this had been going on for 1.5 years), shooting pains down my legs, hair loss, my toe and fingernails stopped growing, eyes were always bloodshot, depression, constant night sweats, major chest pain, constant pain in the back of my neck, major collarbone and hip pain while running, receding gums with shooting pain along my jaw line, low back pain so terrible I could not sit up straight, I could only sleep 2 hours a night due to discomfort, major pain in my face, my fingers began to look very bony and sickly and the list goes on, but those were the main offenders. I had no idea what was going on, I was terrified. After many calls home that ended with my parents being as confused as I was I set up appointments at Campus Health to evaluate why I was no longer menstruating and also see if I could get some answers about everything else I was feeling at the time.

I had loads of blood work done to test for reasons why I no longer menstruated. According to the doctor, everything they tested was within normal range and in order to begin menstruating again I should stretch daily and meditate to try to calm down; once I adopt those habits my cycle will return. At the same time I was seeing another doctor who told me my neck and facial pain were due to a sinus infection and also from bending my neck over textbooks while studying. I was promptly put on a round of antibiotics and told to adjust how I sat while studying. I took all of their instructions to heart and figured I would be good to go in a week or so. I wish. The antibiotics made me sick, so I went back and he put me on a different type. My poor poor gut flora. I was also offered a prescription for a very strong pain reliever to ease my constant headaches. I was told, “It’s normal for some people to have constant headaches, soon they go away, I can prescribe you something in the meantime to make you more comfortable.” That was the breaking point, I was furious. It had been 4 months (August to November) that I had been feeling this way and this was their solution? I spent so much time and money in campus health that semester. I would say 8 visits total, which is a lot for me. I was 21 and felt like an 85 year old with arthritis and crippling depression preparing my last words.

I stopped the running then and defaulted to the half marathon. I only boxed 3 times a week and focused more on resting. These changes, however, did not ease any of the pain. The last thing I thought I had to focus on was diet so it didn’t even cross my mind to change that. I was a brown rice and beans eating vegan who had all the answers about nutrition, right?

As December came I had spent almost 5 months in more physical and mental pain than I had experienced in all my other months of living combined. I was ready to accept this as the new normal and leave this earth young. On my graduation day I didn’t care at all that I had finished college. I wanted to be flown to the best researchers in the country so they could solve all my problems and make me who I used to be. Instead I walked across the stage with a pounding headache; my graduation robes draped over my boney frame, faked a smile in a few pictures and flew back to Colorado for the holidays with my family.

At this point I had accepted what I felt like and just tried to be as normal as possible. I started doing yoga and went skiing with my family and helped cook breakfast and dinner, I assumed this was just my fate. I thought that relaxing and changing my exercise routines would do the trick but my body still felt like it had been drenched in lighter fluid and set aflame.

The moment of change occurred at Christmas Eve mass. I was sitting between my Mom and Dad and the shooting pains in my legs were so strong I couldn’t move. I burst into tears and went running out of the church. My mom followed me out and comforted me in the best way she could. It was impossible for me to explain exactly what I was feeling, that it wasn’t just depression, it was very much a physical reaction too. One week later I was out shopping; while mulling over a tortilla purchase this thought popped into my head, “What if I’m gluten intolerant?” I went with it and bought corn instead of flour tortillas. That day I began to keep a journal of what I ate and how I felt afterward. Through the record keeping I also found that if I ate dairy during the day I would wake up drenched in sweat during the night. So I cut that too. For a while it was just dairy and gluten that I eliminated, and my gosh – I started to come back to life! Two nights after being gluten/dairy free I slept a full 8 hours and 1 week later my cycle returned. I was shocked, I started reading gluten free blogs and stories and felt this sense of power I had not had for a while.

Though so many things began to get better, I still had lingering issues, my headaches still came daily and I was still really underweight. So I decided to keep my food log going to see if I could find any other connections. It was the corn tortillas 2 months into this new diet that did me in. I had some for dinner and they seemed to rip through my digestive track and the next morning my face was broken out with pimples and I had lost 2 pants sizes in one night. It seemed like my whole body has been emptied.

After that I cut out corn and slowly began to realize the only things I could stomach and not react to were meat and vegetables (he vegetables had to be cooked). My vegetarian/vegan habits went out the window and I just ate meat and veggies. As I was explaining this whole experience to a relative they said, “oh! You’re on the Paleo diet!” I was amazed that such a diet existed. With that I began to follow blogs about Paleo and GAPS and have broadened my palate and knowledge by learning from so many who have found the true freedom that comes with this way of eating and living. I am more sensitive than most people who follow a Paleo model and too many nuts, sweet potatoes, nightshades and citrus will cause noticeable inflammation so I typically avoid those. Coffee had to go as well as I have similar reactions to it as when I eat gluten.

What has changed since incorporating this new lifestyle? I have gained 20 pounds! I am back to my normal weight. I no longer run, I walk a lot, do yoga, drop and do 20 pushups and flip large car tires at the nearby park. I sleep like a baby now. I can go for 10 solid hours without moving a muscle; it’s amazing to experience this wild shift. I also have a head of thick hair now and have to keep nail clippers nearby because of how quickly they grow. My moods are more balanced and most importantly I have a normal cycle. My headaches are few and far between. When they happen I can usually pinpoint the food or stressful situation that triggered it.

What has also been a huge help in understanding what I have gone and am still going through is meeting people with shared experience. I am doing a year of service as a volunteer in Portland, Oregon (and anyone who says Paleo is too expensive can talk to me because I manage on a very limited living allowance). The Paleo movement here is strong and I have been to meetups at the Cultured Caveman foodcart, a class on the Paleo diet taught by Jason Seib, author of The Paleo Coach, lectures by Joel Salatin of Polyface farms and Dr. Shannon Weeks, and a Paleo tour of a local grocery store. I have talked to so many people who have found healing and new internal and external strength from the Paleo diet and lifestyle. I’ve learned what works for one person in the Paleo framework does not work for another, but the shared experience of wellness and vitality is something to be continually celebrated and honored. I’m going to keep living my “Paleo Fantasy” because I want to feel well and I want to help others who have been given band aids to their health their whole life. I may have majored in English but nutrition, wellness, and healing are my passion. Thank you to Mark and many other Paleo and GAPS bloggers who have made this journey so much easier!

In peace and healing,

Caroline K.

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How to Recover from Holiday Overindulgence

So, you overdid it…or just ate something that does very bad things to you. Maybe you didn’t binge per se but abandoned the original plan and now feel the pain. You ate…maybe more than you intended, maybe differently than you intended. Non-Primal foods were consumed – perhaps many of them or just a few in larger than planned quantities. Non-Primal/sub-Primal drinks were imbibed beyond the point of intention. And now the consequences are playing out. You’re stuck in a bloated, sloth-like, catatonic state. You’re nursing a major headache with every shade shut and the covers over your head wishing in a rather non-seasonal mindset that your children would take the noise to some distant corner of the neighborhood. Maybe you’ve taken up residence in the water closet. In a less dramatic scenario, perhaps you’re just pushing yourself through the day because you notice your energy is off, your digestion not up to full speed, your mood not quite as equanimous as usual. Whether you feel it was worth it or not, who wouldn’t want to reverse the course of misery itself after the fact?

I’ll admit I don’t really get into cleanses or detoxes. That said, I do think we can help our bodies in their own miraculous processes get back on track – or at least get out of their way while they curse our names. With a little time and care, we can recover and move on from the day’s damage not too much worse for the wear. The healthier we eat and live on a daily basis, the better condition we’re in to weather these upsets. Unfortunately, however, the cleaner we eat the other 364 days of the year, the more we might feel a significant detour in our diet. That heaping plate of mashed potatoes with processed gravy product might have barely registered pre-Primal. Today it can leave you with indigestion and noxious gas for a good 36 hours. (Do I lie?) Think of it this way: with health comes sensitivity to what’s unhealthy. If you’re looking to feel better after a big day (or season) of non-Primal eating, consider these modest proposals for what ails you.

Commit to a morning fast.

Conventional wisdom says eat normally after a holiday binge, but the body says differently. (Guess which one I’m inclined to heed.) Maybe the digestive fallout makes fasting a given, but even if you’re able to eat, give your body a break until early or even mid-afternoon. CW thinks if you go for a few hours without eating you’re sure to throw yourself head on into a major binge. That’s not the case for most Primal folks. Give your body the time it needs to take care of the residuals from the day before.

Drink some tea.

Lay off the food for a while, but go ahead and hydrate. Resist, however, Grandma’s suggestion to down a shot of hard booze. (Hands for how many times folks have heard this from family or friends?) Research has shown alcohol actually slows gastric emptying. One study that compared the effects of tea, wine and schnapps on gastric emptying showed that tea won hands down. Although the tea in the study was simple black tea, consider something without caffeine. (Your body has enough to contend with at the moment.) Chamomile can relax your nerves and your digestive tract, while peppermint can soothe an upset stomach. Opt for something other than mint, however, if heartburn is an issue. Keep in mind you shouldn’t down massive quantities of water (another common recommendation you’ll hear from conventional sources). You don’t want to drink so much that you end up diluting the gastric juices that are trying to do their job.

Try bitters.

There’s not much in terms of research (to be found in English anyway), but this is one age-old home remedy that will likely help. The folk wisdom that recommends schnapps, for example, is generally based on herb/bitter based schnapps formulations. The remedy is in the herb – not the alcohol.

Avoid antacids and acid reducing medication.

Your gastric juices are there to digest your food. If your food is slow to digest and feels like a rock in your stomach, does countering or reducing the natural acids that will break things down and move them along make any logical sense? Steer clear of these “remedies” and let your body do its thing.

Take a good helping of probiotic.

Whatever you ate likely did a number on your bacterial profile. A recent study, in fact, shows it only takes a few days to effect substantial change (about the same duration as most holiday visits to non-Primal relatives). While our guts are amazingly adaptable, that holiday binge might not be doing it any favors. Help replenish your healthy gut environment with a good probiotic supplement.

Relax yourself.

If you’re a bound up bag of aches and nerves, it doesn’t do your digestive process (or mentality) any good. Relax. Take a hot bath or shower. Turn up the heat, put on some relaxing music, and put a hot water bottle on your stomach and heated rice sock around your neck and shoulders.

Get some help from enzymes.

Especially if you ate something that you don’t tolerate well, try a quality enzyme supplement. (If you don’t have one on hand, bribe a family member or friend to visit your local health food/co-op store and search for one.) Avoid anything that contains sugar or artificial colors, fillers, etc. This is not the time for chemical additives.

Move but don’t push it.

You might not be up for your regular weight lifting session, but resist the urge to totally park it on the couch all day. Research shows that slow, low-level moving like walking aids gastric emptying. Those residuals of your holiday meal will move along more quickly if you get it in gear. There’s motivation to get up!

Don’t underestimate the power of fresh air and sun.

Especially if you’re feeling nauseated, fresh air can pull you out of your misery. Add sun, and you might just have a new lease on life. Sure, you may feel just as crappy an hour after you go back inside, but stay outside as long as you can to give yourself some relief. (I know we all don’t live in California.)

Eat a small Primal meal at the end of the day.

Avoid sending your insulin spiking multiple times that day by grazing. Fast as long as it’s productive and comfortable, and then enjoy a modest Primal meal. When you do, choose something that will keep you satisfied for the rest of the night without taking up too much space/energy in an already sensitive stomach. Some vegetable-based fiber and protein should do the trick.

Go to bed early.

You’ve been through the wringer. However lethargic you’ve felt, certain body processes have been on overdrive or have been working harder to compensate for the food related stresses. Give into your body’s intuitive demands, and hit the sack early. Tomorrow is another Primal day.

Have you had any post-indulgence days that left you seeking relief? What’s works for you? Let me know your thoughts, and thanks for reading, everyone.

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Happy Holidays!

Whether you bring a personal faith tradition to this time of year or not, I think there’s something to be valued in the ritual and community of the holidays. It offers us one of those rare occasions in our culture to collectively come together, reflect and relax into the moment. However we choose to observe the day, we hopefully have the chance to do something that enhances our social connectedness, our spiritual good and emotional well-being. If I have one wish for each and every one of my readers, it’s that you claim the day to fill the well somehow – whatever that means for you and your life right now.

Every year I take stock of how grateful I am for the people in my life, the experiences of the year and the work I love doing here among all of you. It’s given me the chance to share the perspective and research that has made such a difference in my life, and it’s a gift to see how it’s made a difference in others’ lives as well.

Enjoy your holiday, everyone. And if you’re so inspired, take a look back at some of the posts that reflect on the Primal significance of (and suggestions for) the holiday experience. Thank you all for sharing the journey….

The Power of Holiday Tradition
Savoring the Holiday
A Primal Take on the Holidays: Surviving or Thriving?
Dear Mark: Family Dinner
Social Wellness, or Why Friendship Should Be a Health Priority
The Benefits of Giving Thanks
The Power of Touch
Primal Play: Dance
10 Active Ways to Celebrate the Holidays
Eat. Rejoice. Repeat.
The Definitive Guide to Sugar
The Psychology of Giving Up Junk Food
The 80/20 Principle: When 20 Inches Toward 40
Choose Your Booze: A Guide to Healthy Drinking
Primal Holiday Desserts
15 Primal Ways to Savor the Holiday Season
The Joy of Receiving
Gateway Foods: The Slippery Slope of “Just a Bite”
10 Healthier Ways to Spend Black Friday




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Dairy Intolerance: What It Is and How to Determine If You Have It

I often say that “dairy is fine and even healthy if you tolerate it.” But what exactly does that mean? How do you know if it’s “not okay”? You could be reacting poorly to the lactose, the casein, the whey, or all of it. You could just ditch all dairy forever more and be perfectly fine – but you shouldn’t eliminate a food group, especially one as delicious, nutrient-dense, and potentially rewarding as dairy, unless you absolutely must. Plus, it’s just good to know what you can and cannot tolerate. You don’t want to tiptoe through life, scared of food because you’ve never taken the time to determine your ability to tolerate it. You want to be empowered with knowledge and venture forth boldly – or carefully, if caution is warranted – through the cheese aisle.

The most common dairy components that people have trouble with are lactose and casein, with intolerance to each presenting differently. Let’s look at both.

Lactose Intolerance

Lactose intolerance occurs when people stop making lactase, the digestive enzyme located along the small intestinal wall that breaks lactose into glucose and galactose for easy digestion. This usually occurs around the age of four or five (lactose intolerance is incredibly rare in infants, for obvious reasons). Without lactase, lactose is instead metabolized by bacteria, which can cause stomach upset, flatulence, diarrhea, bloating, nausea, and a host of familiar but unwelcome gastrointestinal symptoms also seen in FODMAPs intolerance. In fact, the disaccharide lactose is a FODMAP. Lactose intolerance generally isn’t life threatening (unless you’re a baby who depends on a lactose-containing food) but it is annoying and can make life difficult and unpleasant.

Causes: Most lactose intolerance develops because people stop producing lactase after weaning. No more breast milk, no more need to expend the energy necessary to produce lactase. This is usually genetically determined, and people with milk-drinking ancestry are far more likely to possess the gene(s) for lactase persistence (it takes just one copy to keep making lactase into adulthood).

Some lactose intolerance is transient and stems from damage to the epithelial cells lining the intestine, which are responsible for producing lactase in the gut. If something like viral gastroenteritis or food poisoning damages enough gut lining, lactase production and thus lactose digestion may be hampered for the duration of the sickness.

Other lactose intolerance stems from gut dysbiosis. Many gut bacteria, particularly Lactobacillus, produce lactase that help the host (that’s us) break down and absorb lactose. If your gut flora composition is missing the right species or overcrowded with the wrong ones, lactase production may suffer.

Prevalence: About 75% of the world’s population shows decreased lactase production into adulthood, but distribution varies wildly by ethnicity and nation. Looking at this global map is probably a better way to understand the prevalence of lactose intolerance than throwing out a single number. Among Northern Europeans, who have a long history of dairy consumption, prevalence is around 5%. In most of Sub Saharan Africa, where dairy is rarely consumed, lactose intolerance nears or surpasses 90% prevalence.

How to determine: The medical profession uses two main tests for determining lactose intolerance. Both involve the test subject consuming a lactose-rich drink. The hydrogen breath test measures the amount of hydrogen in your breath. If you’re unable to digest lactose, any lactose you consume will make it to the colon to be digested by hydrogen-producing bacteria; this hydrogen will show up in your breath. Another option is the blood glucose test. If your glucose doesn’t go up after eating lactose, you’re not cleaving it into digestible monosaccharides and you are probably lactose intolerant.

At home, a simple test is the oral challenge: eat some lactose powder that you’ve mixed into water and see if any of the previously mentioned symptoms arise. Start with 25 grams of lactose, which is the amount found in two big glasses of milk. I would advise against using milk itself, since milk contains both whey and casein, and it might be difficult to parse which component you’re responding to. Even though lactose powder is a processed, isolate, refined component, it doesn’t really matter much since whole food lactose is identical.

Dairy Protein Intolerance

A dairy protein (whey or, more commonly, casein) intolerance is different than a full-blown allergy. In an allergy, consumption of the offending food elicits an immediate, acute, unmistakable immune response. You might get severely plugged sinuses, itchy skin, hives or rashes, hypotension, diarrhea, vomiting, an elevated heart rate, and have difficulty breathing. Tests can confirm it but you’ll probably already know you’re allergic. If a swig of milk causes anaphylaxis, you don’t need a post on MDA telling you to drop it for 30 days and reintroduce it. You’re already in the know.

Intolerances to the proteins in dairy are a bit more confusing. Some of the symptoms are similar to, if milder than those of allergic reactions. For some people, it manifests as constipation. For others, diarrhea. Still others get tingly fingers, joint pain, and a foggy head. Whatever the symptoms of a dairy protein intolerance, they usually take longer to appear, making identification difficult. Plus, little scientific consensus exists on the nature of dairy protein intolerance. There are no universally accepted lab tests and few medical professionals will be able to help. Casein seems to be the most common dairy protein people are sensitive to; it’s far more rare for whey to be an issue.

Prevalence: According to population-based studies, the prevalence of cow’s milk protein allergy ranges from 0.25 to 4.9% of young children. It’s less prevalent among adults and older kids. Official numbers for milk protein intolerance prevalence are unknown because the condition itself is relatively unknown in the medical community.

How to Determine: You can do skin prick tests or shell out the dough for expensive food sensitivity lab results (that may not even tell you anything definitive), but the gold standard remains the food challenge: strict avoidance of the suspected food until symptoms subside followed by an oral challenge.

It seems like the simplest way to perform an oral challenge would be to eat some whey isolate or casein protein powder. After all, that’s just whey or casein, right? That may work, but I don’t think the results would necessarily transfer over to other sources of whey (like milk) or casein (like Greek yogurt). Unfortunately, the way we process dairy seems to change the structure of the proteins and, thus, their potential for reactivity. Fermentation of yogurt alters protein peptides. Heat treatment has been shown to make casein more allergenic and resistant to digestion by infants, while kids with cow milk allergy, for example, can tolerate baked milk fairly well – although that may be a function of quantity since “baked milk” is shorthand for “baked goods containing milk,” which are mostly flour and sugar, not milk protein.

So, given the fluid nature of dairy protein in response to processing, you may have to determine your tolerance of specific types of dairy to get an accurate picture.

The basic idea is to remove all dairy for at least 30 days. This gives your body a reprieve that, according to some, is necessary to re-sensitize your body to potentially problematic proteins. If dairy proteins are inducing a low-level inflammatory state that lasts for days or weeks and muddles the message, you need a solid chunk of time without any for reintroduction to provide accurate information. So skip the cheese, the milk, the cream, even the butter (I’m sorry) for 30 days if you suspect you have a dairy intolerance. Then, introduce dairy foods one by one, giving yourself two or three days to ensure lack of latent response before trying a new one.

Casein-rich foods: most cheeses, Greek yogurt (yogurt with the whey drained), cottage cheese, casein protein powder

Whey-rich foods: ricotta, whey protein powder

Foods with casein and whey: milk, yogurt, kefir, butter

Causes: A major, and in my opinion likely, candidate for the cause of dairy protein intolerance is intestinal permeability, or leaky gut. An overly permeable intestine (all intestines are permeable to a certain degree; it’s excessive permeability that’s the main issue) allows protein fragments from the digestive tract into the bloodstream. When the immune system identifies these errant proteins as invaders, it does what it does in response to any other invading pathogen: mount an attack and fortify the body’s defenses by releasing histamine (which tries to get rid of the “pathogen” by inducing diarrhea, sneezing, runny nose, watery eyes, and all the other symptoms you might get from an allergic or intolerance reaction). In a perfect world, casein may not be inflammatory in and of itself, but its presence in the bloodstream can invite an inflammatory response.

What to Do

Say you’ve figured out you have an intolerance but you still want to eat dairy. What can you do?

If it’s lactose intolerance, you can beat that. Chris Kresser explains how to go about it.

Try different kinds of dairy. Try raw. Try fermented. Try grass-fed. Try organic. Try sheep. Try goat. Try camel, even. Try hard cheese, aged cheese, soft cheese. Try yogurt or kefir. Try ghee. Try A2 dairy. In other words, you may not be intolerant of all forms of dairy.

Fix your gut; make it less permeable. Easier said than done, I know. Here are some things to try or track to tighten up those tight junctions:

Be vitamin D replete. Activation of the vitamin D receptors on the intestinal wall inhibit intestinal permeability. If you lack adequate vitamin D, your gut permeability may increase, leaving you open to dairy intolerance.
Eat fermented foods and/or probiotics. One study (highlighted by a reader last week; hat tip to you) showed that adding a probiotic strain to dairy could inhibit intestinal permeability.
Feed your gut flora with prebiotics. Prebiotics like inulin and resistant starch (which I discussed here) have been shown to increase butyrate production and reduce intestinal permeability.
Get a handle on stress (or change how you approach it). Stress can increase intestinal permeability and disrupt your digestion.
Exercise regularly. This can attenuate the stress-induced permeability.
Watch your omega-6 intake and be sure to get your omega-3s. Omega-6 PUFAs lower occludin in tight junctions, making them not so, how you say, tight. DHA had the opposite effect.

The main message here is: Be methodical so you know what’s really going on. This is where The Primal Blueprint 90-Day Journal will really come in handy.

What do you think, readers? Do you suspect you have a problem with dairy? Think you’ll give it a shot and try to get to the bottom of it?

Thanks for reading, all!

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Dear Mark: Are Supplements Useless?

It’s December 2013, which means it’s time for another round of popular news articles proclaiming “supplements are useless and maybe even dangerous.” This time they’re based on a recent editorial published in the Annals of Internal Medicine entitled “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements” in which the authors looked at (some of) the research on vitamin and mineral supplementation and prevention of various ailments. Understandably, I got a bunch of emails from people worried that their supplements were useless or might even be hurting them. Let’s look at one of them and see what people are saying:

I thought Mark might want to write a post on this article:

Multivitamin researchers say “case is closed” after studies find no health benefits

Thanks,

Dain

Hear that? The “case is closed.” Or not.

One of the papers the authors examined was pulled from the Physicians’ Health Study II (PHSII), a long-running study of nearly 15,000 US doctors at least 50 years of age or older. Researchers have run a number of studies using this data, mostly examining how taking supplements (either a Centrum Silver multivitamin, vitamin C, vitamin E, beta-carotene, placebo, or some combination thereof) affected various end points like cancer, cardiovascular disease, visual decline, or cognitive decline. The study the authors of the editorial chose to examine looked at the effect of multivitamins on cognitive decline and memory. Turns out multivitamin intake had no effect on cognitive decline or memory when compared to placebo.

Of course, even if multivitamins have no effect on cognitive health it doesn’t say anything about other health conditions. Just last year, a study using the same PHSII data found a beneficial effect on cancer incidence from multivitamin use, with daily multivitamin use predicted a moderate but significant reduction in overall cancer risk, particularly in men with a history of cancer. And although an early PHSII study on cardiovascular disease found no overall effect, multivitamins did reduce the risk of fatal myocardial infarction (your basic heart attack). I’d wager that most people are highly interested in avoiding heart attacks that kill them. Wouldn’t you?

That’s actually pretty impressive when you consider that Centrum Silver is a cheap, relatively low-quality, poorly absorbed multivitamin. That Centrum Silver is a known quantity and inexpensive makes it a good candidate for large trials, but a poor candidate for someone interested in improving their nutrient status when there are so many better options are on the market.

You also have to consider the population studied and how that impacts the effect of a supplement. How do the male doctors included in PHSII differ from other types of people?

According to the latest research (much of it culled from the PHSII), male physicians are a generally healthy bunch. They tend to be wealthier and better-educated than average, which usually results in better health and a greater life expectancy. They rarely smoke, drink, or do (illicit) drugs. They’re thinner than most and rarely suffer from obesity-related diseases like diabetes and cardiovascular disease. They have higher cholesterol than average men, which could actually be a good thing depending on how high it actually is and which lipids are responsible for the elevated readings. High cholesterol could also be a function of access to health care; other Americans may be “free” of high cholesterol simply because they’ve never had it checked. They drink a lot of coffee, which is a great source of antioxidants and has been consistently linked to better health outcomes.

In other words, doctors are starting from a healthier spot than the rest of us. They have less ground to make up. Their diets are less likely to leave them vitamin or mineral deficient, and multivitamins are less likely to have an effect on the vitamin and mineral replete.

You’ll notice that supplement critics usually sneak in an important qualifier that drastically changes the context: “nutrient deficiencies.” As in, “multivitamins may be helpful in combating vitamin or mineral deficiencies, but those are incredibly rare in today’s food environment.” They seem to assume that because so many people are overweight or obese, they couldn’t possibly be missing anything because they’re eating plenty of food to cover their bases. Is it really so rare to have a vitamin or mineral deficiency, though? Are Americans and other people from industrialized nations really eating healthy, nutrient-rich diets? I’m not so sure. Just look around at the way people eat. Obesity doesn’t mean nutrient-replete. An immense macronutrient intake doesn’t ensure a high micronutrient diet if you’re eating modern, industrial foods designed to taste good. Most homeless people I see are sadly overweight, but they overwhelmingly suffer from nutrient deficiencies just the same.

People may not be dying of pellagra or beriberi or getting scurvy or rickets (well, maybe rickets) in industrialized nations, but that doesn’t preclude deficiencies. The true face of modern nutritional deficiency is a subtle one that sneaks up on you and saps at your health over the long term.

Vitamin D deficiency is widespread, which the authors acknowledge. We’re either actively avoiding the sun, using sunscreen at the slightest hint of it, or spending most of our hours indoors. Vitamin D supplementation lowers the risk of falls in susceptible populations (high doses only; lower doses weren’t very effective), reduces body fat, and lowers the risk of fractures (in case you do fall). It and prenatal folic acid were the only supplements given the green light.

Magnesium deficiency is epidemic, too, with a number of factors negatively affecting a person’s serum magnesium levels, including high stress, sweating, alcohol intake, a low selenium intake, and low vitamin D. The biggest factor in magnesium deficiency, though, is inadequate intake, either from poor diets, soft, low-mineral drinking water, or depleted soils.

Should people not obtain more of those nutrients, either through lifestyle modification (diet, sun) or supplementation, if they are deficient? After all, magnesium supplementation has been shown to improve beta cell function in diabetics, insulin sensitivity in non-diabetics and type 2 diabetics, and blood pressure in people with low magnesium status.

And multivitamins themselves have had positive effects. Three recent clinical trials (AREDS, AREDS2, and LAST) found that specifically-formulated multivitamins can help prevent age-related macular degeneration. Multivitamin supplementation can also positively impact fertility, psychological health (mood, perceived stress which is really just stress in the end), and neural efficiency. The problem is that the endpoints that supplementation seems to undoubtedly help aren’t cancer or cardiovascular disease. Improved insulin sensitivity and lower body fat, better vision and lower stress are all well and good, but they aren’t sexy clinical endpoints with the impact of death from cancer or cardiovascular disease. A “lower risk of fractures and falls” doesn’t make headlines.

There are also nutrients that are difficult to obtain from food alone. Take vitamin K2, which can be found in natto (slimy fermented soybeans), goose liver, and gouda, but not in the amounts shown to be protective or restorative in clinical trials. Supplements will help fill in the blanks.

You know, I actually have no beef with the title of the editorial. People absolutely should not be wasting money on mineral and vitamin supplements they don’t need. That’s just common sense. Where we differ is how to define a wasteful supplement. They think all supplements qualify. I don’t. You can find plenty of evidence showing that supplementation of certain nutrients is unhelpful, harmful, or barely helpful in nutrient-replete, healthy populations. You can find plenty of evidence showing that smart supplementation of certain nutrients is extremely helpful or even life-saving in other groups. So-called skeptics love pointing to the former as resounding evidence that supplementation is pointless for everyone. More reasonable folks naturally see the totality of evidence as supportive of a more nuanced position: some supplements are good for some people, some are bad for some people, some are good for most.

Talking about “this study” or “that study” invalidating (or universally validating) the consumption of supplements is ridiculous. Specific supplements work in specific cases. Multivitamins can be helpful for certain conditions, particularly if you eat a poor diet, or they can be mostly useless. Supplement quality matters, too. There’s a lot of research to parse when it comes to evaluating the worthiness of supplements, too much for nice neat headlines – or even two page articles.

What do you think, folks? Be sure to share your thoughts below.

Thanks for reading. Take care and Grok on!

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