Podcast Episode #36: Surgery Recovery, Problems Despite “Paleo,” Low Cholesterol?

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Topics: 
1:  Sunscreen [11:39] 2 : Recovery from Surgery [20:24] 3:  Ongoing physical problems despite “Paleo” diet [27:22] 4: New to “Paleo” – sports-specific goals/reducing inflammation [36:24] 5: Cholesterol & Triglycerides – too low? Cholesterol & Cortisol [43:16]

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LIZ WOLFE: Wow, are we live?

DIANE SANFILIPPO:We're totally live.

LIZ WOLFE: Holy crap.

DIANE SANFILIPPO:It's like [laughs]

LIZ WOLFE: [laughs]

DIANE SANFILIPPO:Almost 20 seconds of dead air. Oops.

LIZ WOLFE: That was an awesome start. That was awesome.

DIANE SANFILIPPO:[sighs]

LIZ WOLFE: Wow, isn't that just the way life goes?

DIANE SANFILIPPO:That was a mistake. Yeah. That was my fault.

LIZ WOLFE: I was totally in the kitchen, and I'm so depressed because I poached a couple of duck eggs, and you know you like turn the heat off, remove them from heat, and let them sit for a little bit?

DIANE SANFILIPPO:Oh Jesus, I'm dropping things all over the place. No, I've never poached eggs before. Surprised?

LIZ WOLFE: Oh my gosh, it is so good. These big yolks, and I totally over poached these duck eggs, and it's literally just the worst thing ever happened to me.

DIANE SANFILIPPO:[sigh] Well, I'm not that high tech. I boiled a bunch of eggs this morning, so maybe we should do a standard intro because some people seem to get a little upset about our casual nature. I'm just kidding. I really-they can…[laughs] They can tune out if they don't love that we're casual. What episode is this? Thirty-six?

LIZ WOLFE: Yeah, I'll do…let's do the whole deal. All right. hey, let's start over. Let's start over. [sounding overly upbeat and perky] Hey everyone, I'm Liz Wolfe, here with Diane Sanfilippo of Balanced Bites. Welcome to Episode 36 of the Balanced Bites podcast. Remember our CYA statement: that the materials and content contained in this podcast are for general information only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. We are however excellent alternatives to Kardashian-related television. You know, that's debatable, actually.

DIANE SANFILIPPO:I haven't seen any of that stuff in a long time. Oh my gosh. The television in the office I work in, I almost never turn it on, but when I do, the little cable box, I mean, my family is not like super high tech. We don't have, like I don't know, like FIOS, like these crazy cable things. We don't have anything crazy going on, so to even just have cable working in the house is like huge, so if I turn it on, it's stuck on the Food Network. [laughs] I can't possibly change it, like the little cable box thing doesn't work, so I'll put it on mid-day here or there while I'm eating lunch, and it's like Paula Deen or who knows what, and I can't even change the channel, so I haven't seen any Kardashians in a long time. [laughs]

LIZ WOLFE: Oh my God. So I'm, you know, super lame and you know, at the beginning of our marriage, my husband and I, you know, would go out with our friends. We'd go out and have fun. And now we're like, never before in my life have I watched Saturday Night Live, except for some of those old classic episodes, but all of a sudden, we find ourselves watching it, like on many a Saturday night, except for those obviously where we're out and whatever doing workshops. But there's a skit where they made fun of Paula Deen…

DIANE SANFILIPPO:[laughs] Sure.

LIZ WOLFE: [extreme Southern drawl} Like oh my God, y'all. Y'all.

DIANE SANFILIPPO:[laughs]

LIZ WOLFE: Chicken wing, y'all.

DIANE SANFILIPPO:All. She says all. I actually watched the show the other day. She doesn't say oil, she says all. [laughs]

LIZ WOLFE: All. Butter and all. [laughs]

DIANE SANFILIPPO:All. Yeah, it's really funny. Oh man.

LIZ WOLFE: Yup. [laughs] Upcoming workshops!

DIANE SANFILIPPO:Upcoming workshops. So this weekend, today's Thursday, we're actually recording this live, so there might be a few sneaky people who figured out how to find the podcast when it's being recorded, but today's Thursday, May 3, and yeah, we'll be in Houston this weekend. So if anyone's listening, you know, today, tomorrow, and wants to come on over to the event in Houston, you're welcome to. You can register right through BalancedBites.com. There's a link on the sidebar and also underneath on Schedule Page. Then I will be away on the Low-Carb Cruise for a week between that event and then the next event, we have CrossFit Oregon City May 19th, so that's in the Portland area, right? That's 20 minutes from Portland?

LIZ WOLFE: I believe so.

DIANE SANFILIPPO:And then we have a couple weeks of, I don't even want to call it downtime because it's not actually downtime for me. It's book crunch time for me. My book will probably get sent off to print probably, you know, the beginning of June. So we've got June 2nd and 3rd, we'll be in North Carolina; we'll be in Winston-Salem at CrossFit Amplitude on Saturday, the 2nd and on Sunday, June 3rd, Charlotte, North Carolina at CrossFit Voltage. And I'm really excited about that because I've got some friends down there that we're going to hang out with a little bit, so I'm pretty excited about all these events actually.

LIZ WOLFE: Yeah.

DIANE SANFILIPPO:And yeah. That's kind of what's coming up.

LIZ WOLFE: So here's what's going on with me. Back to me. I've decided and I've wrote about this on my blog CaveGirlEats.com. I am going to do your 21 Day Sugar Detox, Diane. I'm kind of excited.

DIANE SANFILIPPO:I'm sorry.

LIZ WOLFE: A little bit…I had a little bit of dried mango overload, which, you know, really like…I don't have a problem with a little bit of dried fruit here and there, but you want…one knows when one is using dried fruit as a replacement for candy, sugar, frosting, and you know, all manner of other Neolithic foods that I used to enjoy. I think a lot of it is stress. Some of it is just kind of I don't know, laziness, I guess, but I'm going to go ahead and detox from a little of that sugar and do a 21 day sugar detox. So if anyone is doing that as well, hop over to my blog and leave me a comment of support because [laughs]

DIANE SANFILIPPO:Yeah, there's a lot of people doing it this month. We kicked off a group starting May 1st, just a couple of days ago, and there's a whole like Facebook support page. It's at Facebook.com/21daysugardetox, like the numbers 21, and I think this is probably the biggest group since the New Year's group. Like I mean, tons of people, probably, I don't know, hundreds if not thousands who are doing it right now or who at least, you know, have kind of downloaded the guide and come on to the page and want to see what it's about and maybe they'll start even, you know, with the next one if they're not kind of ready yet, but we usually kick it off pretty much the first Monday of every month, so that there's a new, you know, fresh group, fresh influx of people on the Facebook who are all going through the same thing at the same time. And you know, you can kind of hop over there and see pretty much, you know, you go through similar things at similar times or stages, and in this three weeks, so it's kind of a cool thing to see each group go through and kind of address the same issues and then see what new things pop up and new answers, new, you know, support, all of that. So I think also I have 4 moderators now on that Facebook page and we'll continue to develop more and more ways to support people through the program. We've got a lot of plans for expanding the program and developing it a little bit more into the summer when some other huge projects are kind of my plate and probably, you know, clear some time. But we've got 4 moderators. I think I announced two of them on the 21 Day Sugar Detox website and on the Facebook page, so under Team…if you go to the website under the Team, there's a page called Moderators. We've got Rebecca Reddy and Ellen Goffin. Those are two, and then there's 2 more that I'll be adding to that page so people can kind of see who are the ones who are, you know, a little bit more of the experienced kind of resources to ask questions of or when they're responding on the page, you know, so you can kind of know they're…they've got kind of my stamp of you know, approval on their level of authority on the whole program. So I'm excited about that because I can't possibly as one person answer five thousand people's questions, you know, 24/7, so I love having people that I have seen go through the program who, you know, they've proven that they answer questions, you know, out of the program and they know what they're talking about and some of them are actually practitioners as well. Like I'm pretty sure, I know Rebecca went through part of the same program that I did at Bauman College, so she's a certified nutrition educator, so kind of nice that we've also got a little bit more of a you know, nutrition certification on those people, too. So that's the help we have for everyone.

LIZ WOLFE: Cool!

DIANE SANFILIPPO:Liz is like, where's my mango? I think it's really funny that you're trying to give up dried mango because like to the average person, they're like completely perplexed by the fact that we would say that we like ate dried mango and that was any sort of problem at all.

LIZ WOLFE: Yeah. ‘

DIANE SANFILIPPO:Like besides the fact that it does sound slightly crazy, like I don't think people understand that you know, that might mean eating an entire bag of it in one sitting, which is like, I don't know, 3 mangoes at once. Who would really ever do that as a fresh mango, I don't know. But for me, like I think it's funny because it's been a good step to replace things like sour gummy worms with dried mango, and that was like [laughs] I'm not kidding. I mean, gummy candy was one of the last things that…I mean, I haven't had it in a really long time, but it was one of those little like kind of emotional, one of the kinds of candy that I just, you know, it was a very non-Paleo thing. It was like, I was still having that every now and then, like probably not even once a month, but every now and then and like now dried mango is like my sour gummy worms. I know, it's crazy.

LIZ WOLFE: I mean, you know what? I love fruit, but the sad reality is it has selectively bred for sweetness at the expense of nutrient content. You know? And I know when my digestion's not working properly and I know why, you know, so…

DIANE SANFILIPPO:Yup. We're going to talk about a bunch of stuff like related to digesting some of that, and dried mango is definitely one that causes some problems for people, so maybe we can…do you have any other announcements? Any other information you'd like to share with people?

LIZ WOLFE: The only thing I want to throw out there…

DIANE SANFILIPPO:[laughs]

LIZ WOLFE: is I've gotten a lot of…what? What happened?

DIANE SANFILIPPO:I'm trying to provoke you to share information that you don't want to share. [laughs]

LIZ WOLFE: I'm not going to do it.

DIANE SANFILIPPO:What?

LIZ WOLFE: Another day.

DIANE SANFILIPPO:Ugh.

LIZ WOLFE: It's not going to happen. Sorry everyone. Inside joke. [laughs]

DIANE SANFILIPPO:Liz has secrets. [laughs]

LIZ WOLFE: I have secrets. Okay, there's a little bit of a hint at it in my latest blog post at CaveGirlEats.com. You can check that out. It's-that's all you get for now. The one thing I did want to throw out there that we've gotten some questions about lately, just via my Facebook page and yours and just kind of floating around there is appropriate sunscreen for…as we are getting into summer. I know you're going on the Low-Carb Cruise and we're kind of looking at your options there. I did want to say the most ideal thing is to conscientiously control your sun exposure based on, you know, people with darker skin can handle a little bit more sun. It takes a little bit more sun to get that vitamin D production going than people with lighter skin can be in the sun for a shorter amount of time and have a little bit more vitamin D production. The gold standard is clothing and umbrellas, in my opinion. I love the sun.

DIANE SANFILIPPO:Mm-hmm.

LIZ WOLFE: I'm not a huge fan of chemical sunscreen. I think there's some valid talk that those can be somewhat toxic. I'm also not convinced that broad spectrum sunscreens, the ones that claim to block both UVA and UVB rays. I'm not convinced that those actually block UVA rays. UVA rays do not generally cause burn the way UVB rays do, and so for the most part, when people are out in the sun all day long, not burning, it's not necessarily because they're completely protected based on their sunscreen. It's simply because they've filtered out the UVB rays and not necessarily the UVA rays. And from what I've read, UVA rays, the quote unquote non-burning rays are actually more highly implicated in like malignant melanomas. So I'm really just talking off the top of my head here, not-I don't have a whole lot of resources to throw out, but I think that's really important. I think if you're willing to put on, you know, some kind of lightweight clothing to block the sun a little bit, get under an umbrella after awhile, I think that's a really good idea. Otherwise, choose what's called physical sunscreens. You want something like, I believe, zinc oxide, something like that. A lot of those sunscreens, the old school sunscreens that actually appear white on the skin don't necessarily absorb. You'll see the word non-nano floating, non-nano just basically means that the particles are not so small that you need to worry about supposedly them being absorbed and taken into your bloodstream.
Wellness Mama, a website I really like, also had a little shpiel on homemade sunscreen and the sun protective steps that you can take. I do take astaxanthin every day. That can help you build up a little bit of sun type protection. Other than that, what do you have to say, Diane?

DIANE SANFILIPPO:Should I be taking that? Well, I'm about to head on this cruise and I know, you know, I was asking my skin care expert, Liz Wolfe, what should I get? You know, like I was one of those people who's like I don't normally wear sunscreen. I pretty much have given up all of that when it comes to any kind of like regular use, and generally opt for coconut oil as a semi-protective layer, just on a daily basis and that's my moisturizer, whatever. I don't really have any issues with being out in the sun very regularly. I definitely found after living in California for you know, 7 years, my sun exposure was much more regular and consistent than it was when I'm here on the East Coast. You know, having months of nothing. San Francisco, it's like winter, you'll get weeks of sun, so I don't think my skin…I think my skin has been slightly tanned for like the last 7 years, you know, compared to what I used to…the color I used to have. What?

LIZ WOLFE: Jersey…

DIANE SANFILIPPO:Jersey. No! That was being in California though. So there's this news story circulating about this woman who is like completely tanorexic. Like she like tans way too much and supposedly brought her daughter to a tanning salon. Everyone was kind of like a little uproar about that, but anyway. I digress. So no, the thing about sunscreen is that like I definitely don't support it, believe in it, recommend it for people on a regular everyday basis, but my question was that, the same one about, okay, l, well I'm going on vacation. It's going to be a tropical setting, and I'm not a dark-skinned person, so what is the best choice? And of course, you told me the same things about clothing and covering up, and I'm huge on hats, like I'll probably wear a hat most of the time I'm in the sun. I can't possibly consider burning my face. I've done that before [laughs]. But yeah, I bought some of the non-nano sunscreen. I couldn't believe I found it in my regular drugstore, you know, drugstore.

LIZ WOLFE: Yeah.

DIANE SANFILIPPO:Yeah, it wasn't even at Whole Foods. It was not on the top, you know, eye level shelf. I had to kind of had to kind of search around for it. But I got…the one that I got was Badger brand, I think, and it's a pretty small container so I bought two, just in case, but now I'm picturing the fact that it's not going to absorb and I'll be laying on the beach looking like I'm completely like ghosted out, covered in zinc oxide. Is that's what going to happen? [laughs]

LIZ WOLFE: Yeah, totally. Nobody's going to play with you, Diane.

DIANE SANFILIPPO:[laughs] That's actually perfect because I really am on being a total shut-in, just lay down, nobody talk to me, my brain is fried from working on a book and just like sleeping somewhere for most of the week. People are going to ask how was the trip, and I'm going to be like, great, I had sleep for the whole time. No, I'm kidding. I'll be social. Anyway, well, I think that's really good information and maybe we can…what do you think about, I know, like Environmental Working Group might have some information on like the cosmetics and sunscreen thing. Are there some other websites that you know of that's a really good resource for that? Or was that the one?

LIZ WOLFE: I like that. I think, as much as, you know, Dr. Mercola rankles me a little bit with his alarmist type, you know…

DIANE SANFILIPPO:Yeah.

LIZ WOLFE: writing, he does have some good information on there. Wellness Mama-we'll dig up that post by Wellness Mama because she pretty much covers things really, really well.

DIANE SANFILIPPO:Yeah.

LIZ WOLFE: Biggest thing to remember is that burning is kind of a sign. It's a sign that you can take very seriously, but when you're covered up and your skin can't, you know, create that natural signal that maybe it's kind of time to move out of the sun, you can very easily get over-exposed…

DIANE SANFILIPPO:Yeah.

LIZ WOLFE: And that's part of the reason in general, like you do not go too gung ho on these, you know, commercial sunscreens. I just think they kind of override a natural protective mechanism. So…

DIANE SANFILIPPO:Yeah, and I think that's where I've gotten some of the information on the whole tanning booth thing from Dr. Mercola, where you know, we've talked about this before, but he just said to reiterate that you know, if that's something that people are going to do for any therapeutic use in terms of like vitamin D production, that you do want essentially what are the cheaper beds or booths because they have more of the UVB rays, correct? Which are the ones that can burn you. And if you're not getting that, then you're not getting that natural signal of when to step out of the booth, and you're also not getting the same vitamin D production. So using something, you know, that does have more of those rays for the short period of time now and then actually can be quite therapeutic. So coincidentally, when I saw that story, people will probably see what I'm talking about, the news story about the woman, you know, bringing her daughter to a tanning salon and it being very controversial, I was like okay, well, this is controversial because this woman is clearly like, she clearly has some issues and addiction to tanning, but the reality is, I actually know some people who I've recommended they bring their kid to a tanning booth because they have some underlying autoimmune conditions where their vitamin D production is not appropriate and that little bit literally like 2, 3 minutes of exposure to some of those rays in a situation where the sun is not available, you know, if it's winter, whatever. It can be therapeutic and helpful. So I want people to understand, you know, the same way like you said, you don't like the alarmist approach of someone like Dr. Mercola, the same thing happens with any news and media we see things about red meat causing cancer. It's like okay, you see a woman taking her kid to the tanning salon and you just go in an uproar, like oh my God, we should never do that. Well, actually there are-there's always another side to the story, so just kind of keeping that stuff in mind. But enough about the sun.

LIZ WOLFE: You do ramble. I freely admit it. So let's just jump..

DIANE SANFILIPPO:Well I think it's an interesting topic, so you know, people are into it.

LIZ WOLFE: Well, I think it's relevant as we get into summer. All right, speaking of relevant topics, we have this first question from Steve, our buddy over at the Paleo Drummer. This is his blog, funny stuff over there. And I got to say, Steve, I'm really, really sorry because this is regarding a surgery you had about 2 months ago. [laughs] So this is less timely than the sunscreen discussion, but hopefully, you know, we can get people some information despite the fact that we're a little late for your situation.
All right, so Steve asks: “Hey Diane and Liz, I love the podcast and figured you two might have some useful nutrition-related advice related to recovery from surgery. I am 49 years old and, on March 26th,” Whoops. Well, I guess that was like a month ago. “I am having arthroscopic surgery on my right elbow to remove huge bone spurs and clean out scar tissue that has built up from 30-some years of playing the drums in bands. I am actually really excited (weird, I know) to get the surgery because I hope to get a big payoff in terms of mobility in that arm that I haven’t had for years.
My question is this: is there some particular tweak to my paleo/primal eating that I should be doing post-surgery to optimize/speed recovery? I am technically a “primal” eater, rather than paleo, since I do incorporate Weston A. Price Foundation-style grass-fed butter and grass-fed raw-milk cheese into my diet, but otherwise I keep things pretty darn close to 100% paleo compliant. But is there either: (1) something I should be particularly focusing on to include in my meals more than usual (e.g., more organ meat, more bone broth, etc), or (2) something that I am eating that is totally paleo or primal but which I should nevertheless knock out for a while because it might inhibit recovery (e.g. dairy, nightshades, whatever). Thanks for all you do.”
So I'll jump in on this real quick, Diane, and you can tell me your thoughts. Obviously we totally Steve out of pre-surgical advice here, so hopefully he did all right. [laughs] I'm actually acquainted with Steve and his awesome wife, Jamie, so I know he's still kicking, which is good news, but still. I think that most often it's actually the pre-operative nutritional environment that needs to be really, really well planned, especially if you were weren't eating as Steve does eat, things like organ meats, really getting that good stuff in along with the cod liver oil/butter oil blend that we love and that good, grass-fed raw dairy. So that's what I'd pretty much tell anybody to do that was approaching surgery. Post-surgery, I think the first big concern is it's really important for us to get enough protein. There is kind of a spectrum in the Paleo/Primal community. Some folks like the CrossFitters will kind of have a tendency to eat fairly high protein. Those more oriented towards the Nora Gegaudas Primal Body/Primal Mind interpretation of what's an appropriate diet might do slightly lower protein with much higher fat. I'm fairly sure that both of these approaches are fine within that real, whole, Paleo/Primal foods spectrum with regards to surgery recovery, but I will say that often even after minor procedures, the taste and the desire for protein is just the first thing to go. I think that's a pretty natural physical response to this kind of stress. So definitely don't allow yourself to skimp on it. Protein is necessary for the creation of anti-bodies and at this point, I feel like every day I read more and more kind of scary stuff about hospital-acquired infections. They're really, really dangerous. So it's important to have built that immunity and to maintain that immunity. Protein's important for what, the formation of appropriate scarring and the rebuilding of tissue. I definitely think that gelatin from bone broth is a great source of amino acids. L-glutamine, even BCAA, fatty fish for your fish oil. Neither Diane nor I really advocate fish oil consumption. Again, we always say this: cod liver oil is entirely different from fish oil because it's not an isolated polyunsaturate and if you attend one of our workshops, you'll learn a little bit more about how we feel about these isolated polyunsaturates.
The other thing is, and Steve asked about this. Nucleotides from organ meats will really help with recovery as well. So if there's any time for people to really jump on that organ meat/bone broth type of train, I think post-surgery is as good a time as any. Diane, what are your thoughts on that?

DIANE SANFILIPPO:I think you covered it pretty well. I think, you know, it's interesting that he was asking about things like dairy and nightshades. I mean, if he's never eliminated those things, especially for anything regarding like joint, you know, healing and recovery, the nightshades could be a good idea to just kind of knock out for a little while. They're just known to trigger some kind of like stickiness and pain and stiffness in joints, so you know, that could be a good one. Same thing with the dairy. I mean, a lot of people do really react to it, but again, like I think the grass-fed is probably okay and I'm pretty confident that he's getting really well-sourced forms and I think probably more beneficial constituents to the grass-fed dairy, then possibly harmful, so I think it was funny, too that he kind of, you know, was making the distinction within his question of like, you know, I guess I'm a little more like Primal; I incorporate a lot of Weston A. Price centric approaches. The grass-fed dairy and like, I think at this point, you know, for you and I, and our sort of definition of Paleo does include well-raised, you know, raw grass-fed dairy. Like we don't really, I know you and I don't really consider that to be kind of non-Paleo. It's just more that each individual person really needs to discover their own power into that stuff, so it's just a little side note there, but I know, you know, what he's getting from that from the beneficial side as a fat-soluble vitamins, A, D, K2, possibly some vitamin E probably weigh, outweigh any possible downsides, so, no, I think that sounds good and hopefully he can kind of report back, let us know, you know, what he did end up doing, and yeah, it's just unfortunately we don't always get to questions within like a week or two when they're submitted, so hopefully when people are submitting them, just kind of understanding that. Ask way ahead of time if you're going to have some kind of procedure done, so that we can maybe get you in a timely fashion.

LIZ WOLFE: I feel like Gilly from Saturday Night Live, another Saturday Night Live reference. I feel like Gilly, where I'm like “sorry.” [laughs] Bad story. All right, so next question from No Name. Not sure. “Hello ladies, I love the podcast and I’m seriously considering getting some coaching (you’ll see why shortly…). I have a myriad of issues that I have been continually working on for over 5 years but I’d like to focus in on one or two in this question submittal. I have post nasal drip which requires constant throat clearing and excessive swallowing all day, 24/7 no matter what the weather is like or the time of year or what I eat etc. I’ve been off dairy (with the exception of Kerrygold butter) for at least 6 months and I have not had any relief. I eat a very clean paleo diet otherwise. In case you need some background info, here are all my other problems….
1. Chronic fatigue (probably due to poor sleep quality which is due to sinus congestion)
2. Chronic sinus congestion and post nasal drip (dry and stuffy sinus passage but constant nasal drippage of clear mucus, never had a sinus infection)
3. Restless leg syndrome
4. Cold hands and feet
5. Sleep apnea (I’m not overweight so I believe it’s due to my sinus congestion, however, it’s not technically sleep apnea because I hold my breath upon inhaling rather than exhaling and I either hold my breath or let it out very slowly in a groaning fashion)
6. Depression (more apathy than anxiety which is probably due to feeling tired and crappy all day)
7. Itchy bum….no explanation needed
So, I hope that providing my rap sheet will allow you to make some accurate assessments of what the root cause of my problem actually is. I’m looking forward to getting your take on this, and I think we'll be talking soon.”
I wrote some ideas down, Diane, but do you have any initial thoughts?

DIANE SANFILIPPO:I think sometimes when people kind of have this list of like, you know, just `a huge list of symptoms and issues that are still unresolved, there's something going on with leaky gut. Like whether it's an underlying autoimmune condition, that, you know, I think a lot of people wait for some kind of diagnosis, like you have this condition. Or some kind of, you know, if you have a condition, if you have some kind of down-regulated immune system, if your immune system isn't working properly, you will always have leaky gut to some degree. That's not-it's very hard to heal it completely when your system already has this mechanism that it knows to take of this self-attacking. So when we talk about leaky gut, we've talked about autoimmunity a lot in some previous podcasts, but that's just like my overarching, when somebody has this huge list of issues, it's that there's something going on that your gut lining is not intact, and what's causing that is really hard to get to the root, and it may not just be eating perfectly clean food. It may be really taking it back to something like a GAPS protocol, the Gut and Psychology Syndrome Protocol which does connect sort of the brain-gut issues, like she's talking about a little bit of the depression stuff, so getting down to like bone broth and some very well cooked meats as a starting point. And there's a lot of different things you can do with the food regarding that, so you know, that might be a book that he wants to check out and just kind of see what the approach is and that does probably mean getting even the Kerrygold butter out, which I love it, too, but you know, it may need to go because that dairy protein that is in there can still be triggering some of those problems. And then working on a gut healing protocol and this is something that I'm outlining in my book, like what to do about leaky gut and kind of the steps to take and you know, a bunch of supplementation that might need to happen, and I know sometimes people get a little like weirded out about all the supplements, but the reality is, if you're trying to fix a list of seven problems, you might need some support. You know, obviously, just getting rid of you know, the commonly problematic food isn't enough for him.
So those are kind of the first two things, and you know, the third is really when it comes to this kind of level of really just sounds like a, like I said, you know, an overall kind of leaky gut situation, what's your stress level like? And could there be some kind of systemic stressor going on. So this might be we're getting like stool test, to find out if you've got a gut pathogen. Or maybe you have some kind of bacterial overgrowth, Small Intestinal Bacterial Overgrowth, which I'll talk a little bit more about later. But if you have any kind of infection going on that you don't know about, that infection could be what's causing, you know, high level cortisol output in your body, which you may not necessarily as like a high level of energy, but it can again be promoting leaky gut. Or if you've got an infection, the by-product of these bacteria, they're called gram-negative bacteria, they're kind of an endotoxin that will also promote leaky gut. So this is kind of like you're doing everything right, but there's something else inside that's causing this problem. It's really hard to get to the root of it without a lot of diagnostic testing and it's unfortunate that I can't just be like here, just you can do this on your own because you really can't.
So getting hooked up with some kind of like naturopathic doctor or, you know, maybe if there's an acupuncturist you know that's testing. A lot of chiropractors do stool testing, that kind of thing. Just to get to the root of what's causing it. And it's not cheap to do that. So that's why going through all of the sort of diet and lifestyle stuff first is so critical because when you get to the point where you're like, I've done everything I know to do, you have to be ready, and I'm sorry, but that's just how it is. But you have to ready to spend some money on digging deeper into these issues systemically, and it may mean blood testing, stool testing, urine tests. There's a lot of different things to just kind of find out what's really happening under the hood. And I know this is stuff like what Chris Kresser does with his patients. A ton of diagnostic testing because we don't know what's causing the problem, you know what I mean? Like you come to us with a list like this and you're eating a clean diet, so it's like, okay, well, obviously there's something systemically that we need to uncover. We need those tests to be able to see what's happening because, you know, just from appearances, there's nothing else wrong.
But when you've got this list of here's how I'm feeling, and this is where I think that sometimes this is where we tend to do differentiate from like a standard medical approach. Like I think a lot of doctors will look at blood work alone and say well, you look healthy, so see you later. You know? Like your blood work might be perfect. But when you say I'm not feeling well, you know, then what? What's next? So that's really what I think is kind of the approach for him to take and for anyone who's like, I've been doing this for a year and these are the symptoms I'm having still. That's just kind of my take. More? More thoughts on that, Liz?

LIZ WOLFE: No. [laughs]

DIANE SANFILIPPO:It was a lot.

LIZ WOLFE: I crossed out everything that I wrote as you were talking because it made so much more sense. Thank God you spoke first.

DIANE SANFILIPPO:It's just really common that we see the same kind of question where someone's like, I'm dealing with the following ten problems and that's not to diminish the validity of it, but it's like, the same thing. I say the same thing when someone says, Oh, I got a food allergy test back and I'm allergic to 50 foods. I'm like, you're not allergic to 50 foods, you have a leaky gut, which means that proteins are not being broken down completely that you're eating or getting into your bloodstream and causing an inflammatory responses throughout your body, which is what's happening with Jonathan. He's having inflammatory responses all over the body and healing the gut first is really what has to happen because that…your gut lining is your barrier between, you know, pathogens that, well, they become pathogens from when you're eating, your body sees these proteins that aren't broken down as invaders, and so your entire immune system is basically just put on red alert. So you can't deal with what's happening is that you can't actually deal with other problems, so normally, any of these, you know, list of problems that he has going on, you know, your immune system would normally be just like be putting out mini-fires all over the place, kind of without you knowing. But when you have a lowered immune response because your immune system is very hyped up at your gut lining. If you've got 70-80% of your immune system focused on irritation at your gut lining, it can't focus on healing all these other little things that, you know, just whatever's happening. He's got like the infections, the fatigue, the restless legs, cold hands and feet. These are all like different autoimmune types of responses, so that's…it's going to be a lot to try and figure out, but that's what you really have to do to unwind it all.

LIZ WOLFE: Agreed. Agreed agreed. All right, next question. “Hey!” Hey, Caleb. “I have a few questions regarding food I eat and other things regarding my body. I play tennis at least 2 hours a day and I go to integrated 3 times a week.” I assume that's some kind of exercise training modality. “I also play tournaments on weekends. I have been looking into the Paleo diet, especially because Novak Djokovic last year switched his diet to follow the Paleo system. I was wondering if you had any tips on what specific foods are great for recovery daily. Recently I feel tired on the court and lack energy; also I am constantly aching and a lot of my joints/muscles are inflamed (tendonitis in my knee) etc… Is there anything I can eat, drink or natural supplement I can take to help with that?
Daily I just eat what is at home. I eat frozen foods (chicken, French fries, pizzas, veggies, turkey burgers) I eat lunch at home, I am home schooled and have time to make good food. I love potatoes I don’t drink milk but I do use rice milk with my cereal, I eat cheeses and breads.”
So if I could just hop in here real quick. This is clearly, obviously Caleb is new to kind of this idea. I think first thing Caleb needs to do is hop over to our websites, especially the Balanced Bites website. You'll benefit immensely from Diane's guides. We have several Paleo 101 podcasts. My website, CaveGirlEats.com, I've got Start Here area, what is Paleo/Primal, for a little bit kind of more of our perspectives on why this stuff is important and what it can kind of do for you. A lot of what you'll do as someone on a Paleo style diet will be naturally anti-inflammatory. I see a lot of foods in there, pizza, specifically, burgers, I'm referring to the bun, that are inherently kind of inflammatory foods. There's no reason to have those in the rotation, especially as an athlete. That's pretty much what I have to say on this. For now. I mean, once he's more kind of well-versed in kind of what he's doing, he can get into the real, you know, fun stuff. The cod liver oil and all that goofy stuff we recommend, but at this point, I think it's about getting rid of the inflammatory foods and focusing on meat, vegetables, healthy fats, and checking out the websites.

DIANE SANFILIPPO:Yeah. I think it's funny cause he says, you know, daily, just eat what is at home. That's a perfect opportunity to gut your house. Get rid of all of the stuff that you see that's in your freezer that's in boxes, anything that's not, you know, a whole food and, you know, we have a large or a wide variety of listeners, so there are people who are like, probably rolling their eyes, that it's so obvious. But this isn't obvious for everyone. You know, and the same thing happens in our workshops. We've got a pretty wide variety of people, so you know, really just getting rid of the food in the house that is really not food. Anything that's coming in a box with tons of ingredients. If you're pulling it out of the box and microwaving it, that's probably not food. You know, he's talking about, loves potatoes. Okay, I'm cool with you doing some potatoes, generally recommend that you peel them. We'll kind of, you know, what I usually say to people is that everything you know about nutrition is wrong. At least everything that you learned before what's kind of like do this, not that. Previously what people were told to eat the skin on the potatoes, I don't want people to really be eating the skin; any possible irritating glycoalkoloids are what they're called in potato skins, but any possible anti-nutrients that are irritating to our system are found in the skin of potatoes.
So don't drink milk, but he uses rice milk with my cereal. We wouldn't recommend that you eat cereal, so we can get rid of that rice milk and the cereal. Cheeses and breads, definitely inflammatory foods, and this is kind of again, like across the board, this isn't really just about Paleo vs. not Paleo, but it's about what are foods that support optimal health, nutrition, performance, and just overall what a human animal should be eating. And those should be things that you're buying mostly from the perimeter of the grocery store, walking around the outside where, you know, things are kept cold, not necessarily frozen. Now of course, I think, you know, frozen vegetables can be a really good way to get your veggies in. If you are not good at kind of keeping up with what's fresh. If you can't get to the store that often, frozen vegetables are totally fine. They're an easy way to get that in. And just overall, you know, like Liz mentioned, we've got Start here pages. I have a whole page of Useful Guides that are free PDF downloads you can get. There's a list of Paleo foods that you can print that out and take it to the grocery store and like whatever's on that list that appeals to you, go ahead and buy it. See what you can do with it. There's tons of recipe resources out there, if you need help cooking. It doesn't need to be complicated, you know. Lots of, you know, guys I know who are athletes will kind of like cook for the week. They'll grill a bunch of, you know, different types of meats or veggies and kind of get that in the fridge and get things ready and just make it easy for yourself by being prepared. And just keeping a mindset of, you know, is it a whole food or has it been refined? Is this something that, you know, my ancestors would recognize this as food or not? And I think that's just a really good starting point for people.
We, you know, we have a lot of people asking very detailed questions. I've been Paleo for 3 months, 6 months, a year, but…I really love the people who are just like, I just want to learn how to eat better and just understanding that choosing whole, unprocessed, unrefined foods from a farm in nature vs. foods that come from a factory and in a box and packaged for convenience and taste and all of that, that's really just like step one. So I'm really glad he asked that question. I'm glad he's tuning in. And I'm glad that he's kind of recognizing and whatever, you know, whatever the motivation is. I think it's great that you know, this light is now on the fact that food is going to make a difference for him.

LIZ WOLFE: Cool. All right…

DIANE SANFILIPPO:I can tell when you're muted. It's like super silent.

LIZ WOLFE: Am I muted right now? No, I'm not, okay.

DIANE SANFILIPPO:I don't know. You were before.

LIZ WOLFE: No, that's good. Richard? Are we doing Richard? Yeah, let's do…this will be our last one.

DIANE SANFILIPPO:Really? Are we that far? I don't know I want to cover the next group. We can kind of get them all together.

LIZ WOLFE: Oh, shoot we do have a couple more. Okay, cool.

DIANE SANFILIPPO:Yeah, this one's…I think this one's pretty quick.

LIZ WOLFE: Yeah, this will be fast. Richard says: “I've heard that very low cholesterol can be bad, but I haven’t found anything about how to raise it. My total cholesterol used to be in the 80s, back when I was a vegetarian. It raised to 120 after 1 year of eating paleo and 130 after 2 years (60 HDL, 65 LDL, 24 triglycerides). Is that still too low? Are there ways to raise it more other than just eating paleo? What about triglycerides? Can they also get too low?
Also, what is the relationship between low cholesterol and low cortisol? I recently cut way back on exercise due to overtraining and adrenal issues. I did an adrenal salivary test and found out that I have low DHEA and cortisol, both am and pm. I’m currently at about 1/3 of the lower end of the optimal range for all of those. If there is a relationship, is the low cortisol more likely to be a cause or a symptom of the low cholesterol?”
This is all you, Diane.

DIANE SANFILIPPO:Hmm, okay, a lot of questions here. So his first question was, is his, you know, cholesterol at 130 too low? I honestly wouldn't be too concerned about a measure of around 130 for a male. It does seem a little bit low in terms of like modern averages that we see, but I just don't know, you know, without knowing what kind of report you would get, you know. If you're really concerned about it, I would get that tested. Maybe like, I know it sounds a little excessive, but even get it tested once a week for the next 3 weeks, just to see what that measure comes in at, because a lot of what Chris Masterjohn talks about, and he's pretty much who I consider one of the leading experts on low cholesterol and lipids and how all this stuff works in your bloodstream, is that your cholesterol measure can vary by about 30 points from one, literally like one measurement to the next, so you know, you get a reading of 130, tomorrow you could get a reading up to 160 or down to 100. So if you're concerned about it, that's what I would really do. I would do the same thing if you were concerned about having a high cholesterol reading. Get it checked like a little bit more often over you know, the course of like I said, maybe once a week or every two weeks to just get an average, maybe get 2 or 3 more readings, and see what your average really comes out to. So that's kind of like, is it too low? I don't know, but obviously there are more questions after that.
Are there ways to raise it other than eating Paleo? Well, within eating Paleo there are ways to raise or at least work on trying to raise HDL cholesterol and it's a high density hypoprotein is really what HCL is. And the difference between HDL and LDL is just that they do different things in terms of packaging the lipoproteins and the processing of that. So what we know can increase HCL is saturated fats from natural sources, like egg yolks and coconut oil. So I don't know what your intake is like of those two foods particularly, but you can try increasing your intake of those and see what happens. I don't know, you know, if you already eat a good amount of them and this is where your numbers are, I don't know that I would really push it too far.
In terms of triglycerides, I don't know that they can get too low. This is something I've been looking into as well and I just, I have my own bloodwork done for the first time in 20 years, and so I'm like, okay, let's kind of see what's happening here. I can't really think of a reason why triglycerides being very low would be any issue or why it might be problematic, just knowing what they are and what's happening. They're packaging excess, potentially excess carbohydrate as circulating blood fat. I don't know that they could be too low, or that there would be any reason for a low number to be problematic. I just don't know that they serve a beneficial function, If you are not eating high levels of carbohydrate. Now if you said, I eat a very high carb diet and my triglycerides are consistently very low, I might be curious about that, but if you are an athlete, I wouldn't be that curious about it because you're eating a ton of carbohydrates and then you're using them with your athletic expenditure, your energy expenditure, and that would make sense. If you're eating a high carb diet, and you're not an athlete, and your triglycerides are very low, I might question your body's ability to, you know, appropriately package the excess carbohydrate. It's just kind of a question there, but I don't think I would be concerned about that.
It is more interesting when you get down to his question about the relationship between low cortisol and low cholesterol. This can be something that I would be potentially a little bit concerned about. If you don't have enough cholesterol as substrate to make hormones, then your cortisol and DHEA could be low because you don't have enough cholesterol substrate. That being said, I don't know that 130 is low enough to be considered like too low for proper hormone synthesis, but it's possible, so you know, chicken or egg situation a little bit. You know, if you have too much stress going on in your system, typically that raises cholesterol a little bit more. But so I don't really know. Like I don't have a okay, this is exactly what's happening because every person's body is going to be doing this stuff a little bit differently, but just in terms of knowing what we can do to at least help our cholesterol and hormone levels get to a natural, balanced place for us individually. You know, he said he cut way back on exercise, that's like point 1. Getting enough sleep and cutting back on your exercise and seeing how that affects your cholesterol and hormone levels is sort of like numero uno. Just getting that stress level down because you need to be able to let your body use that cholesterol for full hormone synthesis, and if you're driving a stress response too hard, then the DHEA which is the sex hormone precursor is actually going to suffer even more. So you know, is there a relationship? Is the low cortisol mostly likely a cause or a symptom? I don't know. I think it could really be either. I really…yeah. I don't know. I would work on kind of both of those angles, you know. Do the nutritional things you know how to do. Maybe getting in some more of the good saturated fats, and continuing to work on reducing stress. And then I would just test those levels again. Cortisol levels can be pretty different from like month to month, and if you aren't working on a protocol to address it, I would definitely be working on a protocol. I mean, I guess if you got a salivary test, you've got some kind of practitioner you're working with. So I would retest that, you know, possibly in a month or two months, and then I would just get your cholesterol tested again a couple of times and see what's happening and kind of let us know, you know, let us know what happened with that. They definitely can be completely interrelated, but just knowing which is pushing what is hard without testing one part and then the next.
More thoughts?

LIZ WOLFE: I don't think so.

DIANE SANFILIPPO:Do you…you talk a little bit about kind of a this same type of situation in a workshop? It's always kind of one of my favorite parts. It was pretty enlightening.

LIZ WOLFE: Uh…

DIANE SANFILIPPO:Yeah, I think it's interesting for people to see what happens with what cholesterol even is and what it does, and understanding, you know, how stress and being like a stressed out person or living a stressful lifestyle can really just affect the rest of your hormones when, you know. We're so concerned about cholesterol getting lower all the time and it's like, hey wait a minute, we actually need this. The substrate.

LIZ WOLFE: Agreed. I have a question.

DIANE SANFILIPPO:I'm going to link to a-I'm going to link to a diagram for people so people can see what I'm talking about, the one that I really like on cholesterol and hormones since it's a question.

LIZ WOLFE: Yeah. So here's my question for you. And this is a little business that I have to insert in here. I signed us up for a 60 minute podcast. Is it going to cut us off if we go over?

DIANE SANFILIPPO:It might. I might be able to see about…well, I guess we can just cut off.

LIZ WOLFE: Let's…well, I see the next ones are kind of on FODMAPs, so I guess next week or for the next podcast we can get into a lot of this FODMAP stuff because I know a lot of people are curious about it.

DIANE SANFILIPPO:We can do that. We're going to have to bank that one anyway. So we can record that for these soon.

LIZ WOLFE: Okay.

DIANE SANFILIPPO:Because I'm away next week. So yeah, if anyone's going on the cruise, say hello.

LIZ WOLFE: Have so much fun. So I'll see you…

DIANE SANFILIPPO:I'm planning on it.

LIZ WOLFE: tomorrow, so I'll see you tomorrow. Yay! At CrossFit West Houston, the Balanced Bites workshop powered by PaleoKits, of course. Yeah, I think that's all we've got. Stick around, next week's podcast, we'll talk a little bit about FODMAPs, digestive stuff, lots of good stuff. Cool.

DIANE SANFILIPPO:Cool.

LIZ WOLFE: All right, later.

Cheers!
Diane & Liz