Written by Julie Kelly
July 31, 2014
[0:00:00]
Julie: Hello and welcome to the Nourish Balance Thrive podcast. I'm Julie.
Chris: And I'm Chris.
Julie: And today, we're joined by former PhD medical researcher and autoimmunity expert, Sarah Ballantyne. Sarah is an author, blogger, and consultant at ThePaleoMom.com.
Hi, Sarah! Thank you for joining us.
Sarah: Well, thank you so much for having me.
Julie: Of course! We're really excited to have you because your work has had a hugely profound impact on our lives. I wouldn't mind if you would tell our listeners a little bit about how you came to be the champion of the AIP diet.
Sarah: Well, really it comes from my own personal experience, my own personal struggles with health. I was a medical researcher. I started in critical care medicine, so I was actually studying inflammation, but it was very clinical and pharmaceutical based.
What I was actually studying was sort of pre-clinical work, trying to understand the differences between one patient who would have a major injury and recover, and then the next patient who would suffer the same or very similar major injury and their immune systems would go crazy and they would get this body-wide, non-specific inflammation that would cause tons of damage to their entire bodies and they would start to have organ failure. Basically, the wheels would fall off the bus and they would end up in the critical care ward.
It never was research that had direct relevance to me even though I was morbidly obese, even though I had asthma and allergies and irritable bowel syndrome. I had psoriasis, eczema and autoimmune disease called lichen planus. I was diagnosed with early arthritis. I had really terrible acne, really low energy, chronic joint pain, repetitive strain injuries, carpal tunnel syndrome. The list went on and on and on.
It never really occurred to me at that point in my life even though I was studying inflammation -- and inflammation was sort of the uniting pathogenesis of all of my complaints -- it never occurred to me that my medical background was knowledge that I could apply to my own health until fast forward years and years later. I ended up -- when my oldest daughter was born -- deciding to be a stay-at-home mom in large part because I was really -- well, I was really ambitious and a perfectionist, and quite very poised to be at the beginning of a very high profile research career, but I was struggling so much with my health that I knew that I wouldn't be able to do that high profile research career and be this really great, engaged mom that I wanted to be.
And so, I really in one of the best decisions I've ever made in my entire life decided to take turns, so I would take time off being a researcher and be a mom for a while, and then I get to take eight years off. The National Institutes of Health has this program for women to take time off to have kids or whatever other reasons actually. They don't put a limitation on why women take time off. They pay your salary for three years and some research expense support for you to get back into research, so I could take up to eight years off.
So I decided to take advantage of this program and really I was taking advantage of this program because I just wasn't physically healthy enough to find balance, and I'm a perfectionist and I'm very ambitious. There was that thing, too. The great thing was that they gave me space to first of all get more sleep and reduce my stress, but they gave me the space to start to work on my own health, and it really took years.
The first year after my daughter was born, I had gestational diabetes when I was pregnant, so I was forced into a blood sugar regulation diet and I was amazing. I think I had one high blood sugar reading after a meal the entire time between diagnosis at 16 weeks pregnancy and when she was born. I was so highly motivated to keep my blood sugars regulated so that my baby would be healthy, and that was just huge for me.
I did a great job, but then she was born and the consequences for her were not so overt, so I really slipped back into some pretty bad eating habits. I'm actually still in the hospital. The thing that I asked for people to bring me was a Cinnabon and I end up eating I think 13 or 14 Cinnabons over the next week. Apparently, that was the thing I really felt like I was missing out on, which is horrible because it's like the junkiest junk food.
[0:05:10]
So it took me a while to -- actually, I had this scare when my daughter was one and I started to realize that I wasn't feeling well and in part because my eating was not in any semblance of control whatsoever. I tested my blood sugar one day like albeit after binging on Oreo cookies, but I tested my blood sugar and it was 200, which is borderline between pre-diabetic and Type 2 diabetes, and that scared me.
I cried. I was embarrassed. I never actually told the doctor. I was so embarrassed and I knew enough science at that point to know that it was the sugars that I was eating, to know it was my blood sugar regulation, to know that the solution to that was a low carbohydrate diet. And so, I ended up right that minute finding the strength because low carbohydrate diet, especially initially, requires a lot of willpower to go on a low carbohydrate.
I lost 100 pounds. I got my blood sugar really well regulated. I got pregnant again. I didn't have gestational diabetes with my second pregnancy. I had a much healthier second pregnancy. I had this trick. I had this low carb diet trick, which was working really well for losing weight, so I lost the weight after my second daughter was born. I didn't get healthy and that for me was a shock.
I finally got down to a pretty good weight. I was fitting into normal size clothes. I was relatively active and I still had most of my health conditions. My blood pressure was normal. My blood sugars were okay, but everything else, I was still having problems with asthma, frequent infections. I got colds and flu all the time. I got everything that was going around. I had strep throat several times a year. I would get pneumonia, just infection after infection, all of the skin conditions, the joint pain, the low energy, sleeping 9, 10, 11 hours a day and still not having energy when I woke up.
I had this moment of realization that being thin and being healthy was not the same thing. That started me researching and then also applying my scientific knowledge to my research. Okay, so what do I have to do to be healthy? That's actually what started me on the road to the Paleo diet. When I started the Paleo diet, it worked tremendously for most of my health conditions, so much so that I became this crazy zealot who couldn't stop talking about it.
Julie: Like most people do.
Sarah: Yeah. It's kind of a common experience for us. I actually went off six prescription medications in two weeks.
Julie: That's a big deal.
Sarah: It was a huge deal. I eventually had to then figure out how to modify it because I think the irony was the health condition that got me researching online what can I change to deal with this health condition was my primary autoimmune disease, which is a skin condition called lichen planus and it started flaring when my second daughter night weaned.
So I went through that hormone shift and it's actually a common experience for women with autoimmune diseases that when you go through a hormone shift when your baby is born or when they wean or when they dramatically decrease the number of times per day that they're nursing, or all three of those things, you can experience a flare.
And so, it was this painful and relatively disfiguring disease that started me on this road to figuring things out. And while Paleo basically helped every other health condition I suffered from, it didn't help that one. In fact, it continued to get worse throughout my first four months on a Paleo diet.
That for me was the beginning of understanding the intersection between diet and eventually lifestyle, although at the beginning, I was really only focused on diet and the immune system, and really starting to get into the details of how the choices that I was making both in terms of food and activity, what time I was going to bed, what I did throughout my day, how those things were impacting my immune system because it was a dysfunctional immune system that was the cause of my disease.
That was where I started really understanding the details of how food interacts with the human body and became really passionate about not just understanding it from my own application, but writing about it on my blog even though my blog started as really not ever thinking that my science background would come into it, which is weird.
[0:10:08]
I don't know how I didn't think I would ever let people know that I was a scientist person because I'm a scientist by training, but I'm so a scientist by nature. I'm just like a natural geek and I don't know how I thought that wouldn't ever come out on the blog, but it did.
It became an outlet for me and an outlet for my geekiness, but also a megaphone for me to share my experiences, share what I was learning, help others. It became this wonderful center for all of my interests, so it became a combination of my science background and then also my personal health triumph, and then also my personal struggles and my struggles getting my family to come join me in the Paleo universe, and then my passion for cooking because I love cooking; I always have.
I get to draw, so I get to draw my own little sketches for this blog, which eventually became like my own technical illustrations for my first book. I got to learn how to do photography, something I've always wanted to do. And so, it just got to be this great place for all of my passions meet, so that was a really long story for what could've been a really short answer of my own personal health battles with autoimmune disease that brought me here.
But really, it was this combination of wanting to be a good role model for my kids and to be alive and healthy and be able to watch them grow up. I was really scared that what I was doing was going to dramatically shorten my life and dramatically reduce my ability to enjoy having young kids.
When my oldest first started running, I couldn't run after her and that was a huge wakeup call for me. It was something that I really wanted to be able to do, was swing on the monkey bars. I still can't swing on the monkey bars, but I can hang on them now. I can do that, but I just wanted to be able to really play, play like a kid at play.
Chris: I also want to thank you -- before you go any further -- for putting all that information on the web because if you've not done that, then I probably would have still been floundering, wondering why I wasn't really making any improvement. It was frustrating. I think my story is probably similar to a certain extent in that the Paleo diet fixed some of my problems, but there's still some stuff that lingered that I couldn't quite figure out, and I definitely saw a huge improvement once I switched to your version of the Paleo diet.
Tell me, how did you figure this stuff out in the beginning? Was it just like from what Robb Wolf had written with the Autoimmune Caveat? Was that your starting point?
Sarah: That was my starting point. My starting point was Robb Wolf's Autoimmune Caveat, which if anyone is familiar with the Paleo Solution, the Autoimmune Caveat is a half page text box somewhere in the middle of the book that basically says if you have an autoimmune disease, you should also avoid -- I think it says nuts, seeds, tomatoes, eggplants, peppers, and alcohol.
It's even actually fairly an incomplete list, but there were a couple of blog posts on thepaleodiet.com, Loren Cordain's site, because clearly they had some conversations about this while Rob was writing the book. Certainly, that was my impression as I was reading some of the various things that were available on the internet at the time.
Interestingly enough, Loren Cordain at the time anyways was very, very passionately anti-nightshade, especially tomatoes, but he really I think was pretty leery about whether or not nightshade should be included in the Paleo diet in the first place. I think he kind of begrudgingly included them with lots of warnings of "If you have any kind of inflammation, nightshades could be the problem."
At the same time, he did really see why anyone should avoid nuts or seeds, but he had a great article on his site about lysozyme and egg whites. And so, that kind of got me started in this understanding, so understanding where Rob came up with this list, what should be on this list that isn't, is there anything on this list that might be okay, and it became something that I was really interested in understanding for myself.
[0:15:04]
So when I first started living the autoimmune protocol, there was so little information out there that it took me about four months to even just figure out what the autoimmune protocol was. It took me about that long even to know that paprika was a nightshade because people would say no nightshades, and there was no list of what nightshades were, or they say tomatoes, peppers, eggplant. Meanwhile, the list of nightshades is actually substantially longer and much more difficult to avoid.
Chris: I've had several people say to me, "Which list do you mean?" There's no standardization in terms of the autoimmune protocol, so I always point people at your website. There's that one blog post in particular and I tell them to buy your book, but what do you think about standardization? Do you think that's something that should happen or do you think everyone is an individual and you just have to figure it out for yourself?
Sarah: I think both. I put a lot of effort into creating guidelines based on science and based on what I could understand from the scientific literature would be probable culprits for people with autoimmune disease. And so, what I really did was create a list of the most likely candidates for causing you problems if you're having an autoimmune flare.
It really comes from looking at thousands of thousands of scientific papers. And so, I really feel that that as a standardized starting point should be where most people start. From there, you can play around with it in an infinite number of ways and I think that the exact triggers are going to be different for different people, and I think they might even be moving targets.
I know for myself that my ability to tolerate through suboptimal foods like egg whites and nuts and seeds decreases when I'm stressed or I'm tired. If I'm getting enough sleep and my stress is really well managed, I can actually enjoy a cup of coffee every day. As soon as I'm not getting enough sleep when I really want the coffee, that's when I notice inflammation if I have that coffee.
I think that what becomes a maintenance diet for people after doing an elimination and reintroduction approach is going to be very individualized, but I didn't just make up this list of food that people should eliminate or this list of food that people should be focusing on eating more of. It really comes from the accumulated knowledge that I have from reading so many papers.
I do have to say that one of the things that I think -- I think my book plays such a detailed case for each tenant of the autoimmune protocol that I think there's less room for people to debate or -- I mean, there's always room for debate and I'm always willing to change my mind as new science comes in, if that's the case. But what I've seen -- and it was more so before my book came out -- in other people's presentation of the autoimmune protocol was it was really based on what have worked for them personally.
And for them personally, they found that for example, seed-based spices were not a problem, so they don't include that in their recommendations, but when you look at the autoimmune population as a whole, seed-based spices are trigger food, especially pepper. I can't tell you how many people I've encountered that discovered how problematic pepper was for them.
Chris: Just ordinary black pepper?
Sarah: Just ordinary black pepper and I'm not entirely sure why. I think black pepper is extraordinarily high in phytoestrogens, so I think that might be why, but of course, it's a berry but it's basically a seed. It's a dried out seed with almost no flesh around it, so it really is almost all seed and it's clearly a problem for a lot of people.
I feel like if you're going to cut these many things out of your diet, there's nothing more frustrating than depriving yourself of foods that you would rather be eating and accidentally -- or because you didn't have the right recommendations, leaving something in your diet that is completely undermining your ability to see improvements.
So you're going through all of this self-deprivation, all of this work preparing your own food. You're missing out on these foods you don't like to be missing and you're not seeing results, and it's because somebody forgot to tell you that black pepper might be a problem and you should try cooking without black pepper for a month.
[0:20:05]
Chris: That's an interesting question. Do you think it's possible to do the autoimmune protocol without supervision? So by supervision, I mean someone that's seeing all of the foods that you're eating. We've had some success -- Julie being a food scientist and also being an AIP cook for nearly two years, she's got pretty good knowledge now of what's included and what's not.
And so, one of the things we've been doing is giving people just a simple Google doc spreadsheet like a live document and they'll enter in their food for the day. It doesn't count calories or do anything sophisticated like that, but at least you can see. And then sometimes you'll find people that just didn't know the eggs weren't on the AIP diet. If that's a very obvious example, then you just come up with a more subtle one there. Do you think it's possible to be successful on the diet then without supervision?
Sarah: Yes, I do think it's possible. I don't think it's possible for everybody. I think some people really do need support. That support, I think for some people, it's really having that exactly what you described, having somebody really evaluate what they're doing to pinpoint any problem areas right from the beginning. For some people, the support is the medical professional who's going to help you troubleshoot, who's going to track your progress.
Sometimes the support is a friend or a family member who's going to come over and help you cook all these weird, new foods so that you're not spending 20 hours in your kitchen every week when you also need to do things like have naps and go out and be active, go to bed early and all of those other things.
I think some people do really well. They get the information and they go, "Aha! That's what I need to do." They jump in and they see success, which then motivates them to keep going and they do great on their own, but I think it's just the case for any health journey whether you're trying to deal with autoimmune disease or if it's something a little bit more straightforward like -- I don't want to call it straightforward -- losing weight or something that maybe it doesn't have the complex immune system problems that autoimmune disease have, or you have high cholesterol, so you're just looking to lower your risk of cardiovascular disease.
I think no matter what type of health journey you're talking about, some people do great on their own with the right information and some people just need help making the positive changes, and that's fine. I think there's nothing wrong with being a person who needs help.
Julie: No, not at all.
Sarah: The only problem is if you're a person who needs help and you don't get it or you don't ask for it or you refuse to accept it. That's where you're obviously going to hinder your ability to see success.
Julie: Yeah. That's one of the reasons why we really do recommend people to get your book specifically because I think it covers so much, but it's also just a great reference. The people that I'm working with, I can point them to a specific page or a chapter, and that's hugely fabulous.
How has the feedback been for The Paleo Approach? From everything that I've seen, it's been fabulous and I know that so many people are just chomping at the bit to get the cookbook as well.
Sarah: They are excited about the cookbook.
Julie: I'm definitely one of those people, so can you tell us a little bit about the cookbook?
Sarah: I can. Just to answer the first part of the question first, the feedback has been overwhelming. It is humbling and I don't even know if I can put into words how it feels when I go to do a book signing and people are showing me how they can walk. Three months ago when they got my book, they were bedridden and they couldn't get out of their own bed.
I have heard literally thousands of those stories now. It's overwhelming. It makes me feel great that I'm making a difference in people's lives. It also is kind of high pressure at the same time because I really don't want to be wrong, but the feedback has been overwhelmingly positive and it's just been amazing. The cookbook, originally the book was supposed to be -- the cookbook and the guidebook were supposed to be one book.
[0:25:02]
My original vision was like practical Paleo for autoimmune disease, but I'm going to go deeper into the science. And then when I started going deeper into the science, I had no idea -- I've never written a book before. I've written a PhD thesis, but that's hardly the same thing.
I had no idea that it would just take me that many pages to explain that the science that I want to explain in a way that most people would be able to understand it. So we realized about nine months into the project that between the science and the recipes that I had even at that point that I was looking at about an 850 to 900-page book.
The most that we would be able to bind was about 400 to 430 pages, so I had the option of either cutting it down dramatically, basically cutting out half the recipes and cutting out half of the science, or dividing it into two books. I could kind of get my head around cutting out a bunch of recipes because I felt like as long as I've got the major ones, that'll get somebody started in the kitchen. They'll still be useful, but I couldn't wrap my head around the idea of cutting out any of the science. I said, "No, people have to understand the science."
So I ended up basically -- we decided to divide it into two books, which was hugely controversial and there were many people who were disappointed. I mean, they were disappointed until they actually saw the book and then they think they got it. I stopped working on the cookbook and focused on finishing The Paleo Approach.
I had a complete health crash after The Paleo Approach. And so, my original intent was basically get The Paleo Approach off to the printers, start finishing the cookbook, have the cookbook done by the time I'm marketing The Paleo Approach, and it'll be released right on the heels. I had such a severe health crash after the prolonged stress of finishing The Paleo Approach that I just was incapable of working on the cookbook for months.
So it became something where I would post something like, "Oh, I'm working on this new recipe for the cookbook," and there would be dozens of comments of, "Hurry up and finish that book. I can't wait to see that book," and I'd be like, "I'm trying. I'm doing the best I can. I really am promising," and they're hurrying up on this.
It became such a weight on my shoulders, so it was something that -- I finished the manuscript. I turned it in. All the photography was done. Edits came back really quickly because we learnt some really important lessons from The Paleo Approach, the main one being I don't write short books. So we learned that we have to have more different teams of people working on different parts of the book simultaneously rather than the more serial progression of editing and designing a book that'd be typical for other books.
So I didn't get very much for a break and I jumped right into editing. Editing, I enjoy because I enjoy seeing my words get polished, but it's quite an arduous or time-consuming task. There was this moment a couple of months ago now where I was looking at my book and it was really coming together. All of the recipes were in. All the photos were put into the book and there are 100 pages before you even get to the recipes of information.
All of the stuff that I'd wanted to really summarize and include for the people who -- either they don't want to know the detailed science or they just aren't interested in that part, but they still need to know what to do, so I try to really summarize the rules rather than going into the why's behind them. I had this moment where I looked at the book and I liked it. It really turned on. All of a sudden, I really liked the cookbook, so that's a pretty good feeling.
Julie: On top of it.
Sarah: Yeah, and by the time it was done, it just became something that I feel so proud of. I'm in that in-between phase, so it will be in reviewer's hand in I think two, two and a half weeks, and then it will be in everybody's hand in five weeks -- no, six weeks, I guess -- no, five weeks. Oh my gosh! Oh my gosh, really that fast.
So I'm at that moment where I've created the thing. I'm super proud of it and I love it, and now I just have to wait to see what the world thinks of it, which is kind of nerve-wrecking.
[0:30:03]
Chris: I'm sure it'd be great. I know there's been lots of anticipation from the people I've spoken to. It's all very well saying to someone, "You should eat from this diet." The first question they ask is, "What can I eat?" Mickey Trescott's book has been great, but clearly when you've only got one cookbook, there's more than --
Sarah: And one other thing that I think the autoimmune disease community is going to love -- because I love Mickey Trescott's cookbook as well -- is that we actually -- Mickey and I did a couple of joint book signings on the West Coast, the Pacific Northwest last month. I sat and I flipped through her book in her living room and counted up the number of recipes that were very, very similar to recipes in my book. There was about ten.
So between the 120 or 130 recipes in her book and over 200 recipes in my book, there's very, very little overlap, so people are going to have just that many more recipe in order to have that much more variety in their lives, which I think is one of the things that as soon as you do any diet restrictions, no matter what your goal is, as soon as you start eliminating foods, variety becomes the big challenge and changing up the flavors that you're eating night after night becomes the big challenge.
It can be really emotionally taxing to feel like you're not getting enjoyment out of the foods that you're eating. So yeah, I'm really excited about my book. I'm really relieved that it's different from Mickey's. That way, I can also say if people are looking for autoimmune cookbooks, that both books complement each other really well. But yeah, I think it's going to be a really amazing resource for people because it's actually going to help them in the kitchen.
I've made the book with the novice cook in mind, with the idea of many people who are challenged with chronic illness are not used to spending very much time in the kitchen.
Chris: Which is part of the reason why they're chronically ill in some cases, right?
Sarah: In some cases, absolutely. It's because the majority of their diet comes from pre-packaged foods and takeout and that's certainly not the case across the board, but it can be one of the biggest roadblocks to somebody taking control of their health, is not feeling comfortable in the kitchen.
For some people, it's time and then you have to have the discussion about, "Well, do you really need to work 75 hours a week? What are your priorities?" It's just comfort in the kitchen because -- I grew up cooking. I always help my mom in the kitchen by the time I could stand, but not everybody does that, I think especially now.
And so, being able to say, "Here's what these words mean. Here's what these techniques mean. Here's just some basic cooking knowledge and here's how to build on that," I've really tried to make it a cookbook that keeps the novice cook in mind, but gives you so many ways that you can build on your knowledge as you go that ideally, eventually you're creating great food on your own and you don't actually need my cookbook, but by then you've fallen in love with it so much you can't see it leave.
Chris: Yeah. I think that's the right way to go actually because --
Sarah: But there are also some sophisticated recipes for people who are really looking for that as well.
Chris: Well, I think that the more sophisticated people, they will use your book as more of a source of inspiration and they'll be creative by themselves and they won't need so much handholding --
Sarah: That's how I cook. That's really what I do with other people's cookbooks generally, unless I'm writing a book with you and then I try to --
Chris: Personally, I'll just buy Julie a copy. That's how it's worked so far. I wanted to talk to you about cortisol because that's been a really important piece for me personally. I think it's been a really important piece for all the other people that we've been working with, too.
I'll tell you what happened to me. After I had amazing results with AIP, I started wondering what else was possible, like really start the wheels turning. And apart from anything else, I was feeling so much better. I was much more motivated and I was thinking more clearly, too, which is an important piece.
And then I heard a podcast by Dr. Dan Kalish and he was talking about adrenal complex hormones like cortisol. Some of what he said really resonated with me and I went away and started doing his tests. One of the tests was the saliva cortisol, four-point cortisol panel.
My result came back exactly the same as every other person as I've ever seen, and we've seen over a hundred of these now that is low cortisol, low DHEA, low testosterone, low everything.
[0:35:12]
It seems like there's something going on here in the chronically ill, I guess, so just ending up in a situation where all of these hormones are low. So I was wondering what your experience has been like with the cortisol and whether maybe -- with The Paleo Approach, I only see two types of dysfunction listed and that's high cortisol, which I never see, and then dysregulation where the circadian rhythm is broken, which I occasionally see, but usually it's just low cortisol across the board.
Sarah: Yeah. When my body crashed after The Paleo Approach and I was having such a hard time basically regaining health even though I was doing everything right -- I was more active. I was getting more sleep. My diet was super, super clean -- it was just such a hard road back.
First, I ended up getting an email from you suggesting I do this cortisol panel because maybe my cortisol was too low, and I was completely prepared to do that. And then I ended up getting in touch with a local functional medicine doctor. He was actually an emergency medicine doctor for 20 years before deciding that he really wanted to do integrative and functional medicine. He quit running an ER and opened an anti-aging practice.
It was such a great connection. One of his nurses is the mom of a kid who's in my daughter's class last year, so it just became this local family for me. So I went in and he suggested the same panel and I was like, "Whoa! I have a friend, Chris, who thinks I should do this, too."
Sure enough, my cortisol was low. It's actually following a normal rhythm, but just low at all points of the day. My DHA was low and my testosterone was low and my progesterone was low. That was something that I wasn't expecting. I was expecting it to be low in the morning and high in the afternoon because I was used to getting these second winds in the afternoon and evening, and I knew that there was something wrong with my cortisol.
What Dr. Flowers explained to me, which really furthered my understanding of adrenal gland dysfunction more than adrenal gland function, was that it's a very, very typical pattern for people after prolonged periods of high stress.
For example, writing up an encyclopedic book. It's basically sort of the stereotypical thing that he sees when the adrenal glands have just been going on high gear for so long that they're just burnt out and they can no longer keep up. We started adrenal support program and hormone balancing program along with -- clearly I already put a lot of attention into my diet.
I actually credit all of that for the fact that my health stayed together throughout finishing a second book, but yeah, this whole experience has actually really expanded my understanding of not just cortisol regulation and dysregulation, but also hormones. I already had a fairly good understanding of where those two things intersect and where they intersect with the immune system, but really coming up to this realization that this can be very, very difficult things to address with just diet and lifestyle.
It's one of the reasons why I didn't go into much more detail especially about sex hormones in the book was because already I was at a point where I was like, "Well, if people are experiencing sex hormone dysregulation, that's not something that's likely to change dramatically." It does for some people, but it's not likely to change dramatically with lifestyle changes, so it's not something that I can really focus on in this giant dome and I need to focus on the things that people can change.
For me, it's been understanding I think some of the more intricate details of exactly how things can go wrong while also understanding how to fix it.
[0:40:00]
So what's really interesting to me about fixing adrenal issues and fixing sex hormone issues is that they're difficult to fix on their own with diet and lifestyle, but the therapies don't work if you don't have the diet and lifestyle dialed in.
Chris: Yeah, absolutely. You can definitely disrupt the whole thing. And then sometimes we see with people that they take some supplements and they start feeling better, and then they start doing more of what it was that probably got them into that situation in the first place.
Sarah: I actually did that initially.
Chris: Oh really?
Sarah: Yes. I completely fully admit to taking adrenal supplement and being on this ridiculous high for about two weeks and two weeks until I figured out doses and timing better, and ended up basically taking advantage of being on this great high and getting a lot of work done even in the evenings when I should've been winding down and getting ready for bed.
I knew at the time, I knew that this is too high. It feels great because I've been so low, but this is too high. And it turns out that what was happening was I started on a DHA supplement as part of my adrenal support supplement and my body ended up converting it into estrogen and I was already estrogen-dominant.
So it started off with this great high in part because I was oversupporting my adrenal glands and I was probably getting too much cortisol production, and then I ended up -- it slowly ebbed away is what happened. And then some new symptoms cropped up that were sort of classic estrogen-dominant symptoms that I hadn't actually had before.
As soon as we took away the DHA supplement because of these estrogen dominance problems and the fact that a good one-in-five, one-in-four women will actually have this reaction to DHA, then suddenly that high just vanished. I think when the high vanished, I felt very frustrated and it felt like I've been trying to seek out what normal is and what normal should feel like ever since, and it's been a real struggle because I've been finishing a book and going through a very similar experience in terms of stress in long days.
I set so much former boundaries in terms of protecting my own health this time and that was really good for me and I'm glad I did that, but it had been an interesting experience because I honestly don't know if I've ever had normal cortisol.
Chris: Yeah. That's the thing actually. That's what I realized, was I'm not sure I understood what a normal level of energy felt like and that's true with a bunch of symptoms. It's only in the retrospective absence do you really notice the symptoms like this. I think there are probably a lot of people today that are walking around and they just don't even know that's not normal.
Sarah: Well, I think in part because chronic low-grade stress is so pervasive in our society and I don't think there are very many people. You have to try really hard to have a low stress life. You have to really make that a priority.
Chris: Yeah. No one's doing that.
Sarah: No.
Julie: It's hard work. Well, I think it's also hard work because it can become stressful in and of itself trying to be not stressed, especially if they're the typical type --
Chris: Especially if someone just handed you a bunch of test results that said you've got low cortisol.
Sarah: That's right.
Chris: Yeah. It's definitely something -- all the people I've talked to and I've spoken to literally hundreds of people on the phone now, the one thing that I can see that's in common with all of them is everybody has too much stress, so everyone's different.
Sometimes you've got a 53-year-old woman that's training for a marathon and also trying to be an accountant and has got three kids and has been through divorce, so just ridiculous amounts of stress and you're completely crazy and you need to stop this immediately. And then there are other people that have less obvious, but still the stress is there and --
Sarah: Yeah, it's a morning commute during rush hour or --
Chris: Or their boss is a dick or an unhealthy relationship. I'm pretty sure that the physiological response to all of these things is exactly the same and all of them will burn you out on the end if it goes on for long enough.
Sarah: Yeah.
Julie: We're talking a lot about the testing and how those things you keep track of and finding out your normal, but for a lot of the people that we work with, while they're waiting for their test results to come in, we dial back and say, "Okay, let's look at all the lowest hanging fruit that we can take care of," and a lot of times, let's dial in your diet and your lifestyle. For some people, that's AIP.
[0:45:02]
Something that I think we don't hear a lot of talk about and I think would be really insightful to hear from you is if you're switching to AIP from a pretty strict Paleo diet already, if you're moving towards a more AIP style diet, how do you track progress? How do you tell that it's working for you?
Sarah: Well, I think there are two different ways that you can go about tracking progress and you can actually combine those two methods. One is to quantify it, so to get testing done. Maybe it's Hashimoto's antibody in your blood or maybe it's a really high C-reactive protein. Not all autoimmune diseases, but for many, there are blood markers even if it's relatively amorphous like C-reactive protein, which is a general indirect measure --
Chris: C-reactive protein is big for me actually. That's something that changed --
Sarah: Yeah. Actually, mine is still a little bit elevated, and that's something that I'm still trying to work on getting down. It's come down dramatically, but it's still a little bit high, so it's a general indirect measure of inflammation and that can be high for a lot of people with autoimmune disease.
Something like that where you've got a number can be a really great way and a very unbiased way to track progress on the autoimmune protocol. Sometimes it's just not possible or sometimes people have doctors who just aren't up to doing anything or just don't want to do those tests or they don't have healthcare coverage that's going to cover those tests and it's forbiddingly expensive.
So when it comes to that, then I really think a journal is the best way to track progress. I really like to combine a symptom journal and a food journal. Symptom journals, that means symptoms of autoimmune disease, but it means so much more. It means how much energy did you have when you woke up this morning. Do you normally wake up with joint pain? How is your joint pain this morning?
What's your energy like in the afternoon? Did you have headache, mood issues? Did you overreact when your child spilt a glass of water all over the floor? How's your skin? How does your skin look today? It can be so many things that we tend to ignore.
Chris: You just never remember. You think, "Well, I'm going to remember how I felt today tomorrow," but you won't. When you think about -- the example the other day is when you've got something in your eye, all you can think about is the fact that you've got something in your eye, but the moment that pain goes away, you forget about it instantly. And this moment, you're not thinking, "Wow! I'm so glad I have nothing in my eye," so you've really got to write that down if you want to track that.
Sarah: One of the interesting changes that people go through when they're really starting to see progress on the autoimmune protocol is changes in mood and general outlook. And so, that's something to include. Not everybody is a journaler. I'm not one. I've tried many times in my life to keep a journal and I have never been successful. I think the best I've ever done is about a year and a half and that was not writing every day.
For some people, taking that time can be really challenging, so it can be really point form. It can be that there's a variety of well-being type -- they often use these intake forms for alternative health practitioners. You can download them off the internet or something like that that's going to help you.
Maybe you only fill it out once a month, but I think combining that with not even the quantities of foods, just a list of food that you ate that day because one of the things that can happen is as you're going down this hopefully really great road to better health, having that food journal especially when you start reintroductions -- but especially if you're playing with some of the grey areas right away.
So right away from the beginning, you're like, "Okay, I'm going to do autoimmune protocol, but I'm not going to give up coffee because I can't. I just can't bear it if I give up coffee," fine.
[0:50:00]
If that's what it takes for you to do the autoimmune protocol, then do it, but keep in mind that coffee might be the thing that's holding you back. It might be masking a lot of other symptoms, so --
Chris: Yeah, definitely. It's like a real blocking point for the saliva test as well. I'll have people that will buy or order a test from us and then they'll sit on that saliva test for months on end because they read in the instructions that you're not supposed to drink coffee at the day of the test because it can stimulate the adrenals, and that's a deal breaker for them.
They'll say, "Oh yeah, I'll do it tomorrow," and of course, tomorrow never comes. It makes you wonder what is it about coffee that people really like. Is it the fact that it stimulates the adrenal glands or is tasting good?
Sarah: Or both simultaneously. I gave up coffee entirely for 15 months -- 15 or 16 months, something like that. I was in a pretty good place and I decided I was going to -- no, I wasn't in a pretty good place. I was craving caffeine. So I decided I was going to try and start having one cup every few weeks.
I had my first cup and I got halfway through the cup and I felt high. It was a really eye-opening experience for me because it really felt like I had taken a drug and it was very, very different from an endorphine high that you would have from a really great workout. It was different even when having sex. It was like a drug.
I finished half of the cup and then I left the other half of the cup there. I went and I did my farmer's market shopping feeling really good and then I came home and I reheated the leftover half cup and drank it and went okay, I understand. This is a drug and it's addictive. I don't think it's just the caffeine and the cortisol spike as a result of the stimulation from the caffeine, and I don't think it's just the flavor.
I love the flavor of coffee, but I think that it really is an addiction whether that's via chemical or psychological. I haven't delved into the chemical compounds in coffee that might actually account for a chemical addiction, so maybe it was just psychological for me. It's become something that I then began to overdo it and I started noticing inflammation in my body and then I had to start pulling back and finding that balance again to how often can I have a cup of coffee.
I find what works really well for me is that it's like my one day on the weekend whether it's Saturday or Sunday and it's my weekend treat, and that works really well for me. If I keep it to a weekend treat, I typically continue to feel pretty good. Once I start finding excuses during the week to have it more, that's when I'll start to notice I just won't feel as good.
For me, my ankles will start to hurt a little bit, so it's sort of very general and vague. When you're dealing with these kinds of chronic health conditions, there are a lot of vague symptoms that you have to pay really close attention to and it can be really hard to have that level of body awareness for people especially when they're starting out on their journeys.
Meditation can help or something like a yoga practice can help, just increasing body awareness; doing inventories of your body like I'm just going to sit and then go from my head to my feet, and I'm going to pay attention to each body part and I'm going to try and evaluate how it feels. This is a form of meditation and practicing that on a daily basis can be really helpful.
Chris: Excellent! I wanted to pick your brains a bit about the whole high fat, low carb thing. So nearly everyone that we speak to is doing some form of low carb diet, and that's kind of consistent with your story as well. It's the place where both Julie and I have gravitated through checking blood glucose. I have definitely had some scary moments like you did with the glucose meter and it flew in the face of everything the doctor had said to me about that kind of stuff.
He's like, "Well, you're an athlete. You're doing however many hours on the week on the bike. You're really insulin-sensitive," but clearly the blood glucose meter said otherwise. I started adjusting the amount of carbohydrate that I was eating to get the numbers -- it's actually Dr. Kalish that started talking about what you probably consider quite a low range like this 80 to 90 mg per deciliter range. I started to notice that I felt much more even energy and my sleep quality improved. I felt less hungry on the bike.
[0:55:08]
This started a journey that eventually ended up in ketosis, and I'm doing spectacularly well on that now. So what do you say to people -- because there are a ton of people that think the Paleo diet is a low carb diet for a start, so what do you say to people that come to you that need to do AIP about carbohydrates and controlling blood glucose? What's the best way to do that?
Sarah: Generally, I don't recommend that people start looking at a ketogenic diet. I think that is a macronutrient manipulation that should be left for down the road. Generally, what I recommend is that your blood sugar should not be high and the best way to know is to do either a one-hour to two-hour post-meal blood glucose check and follow the American Diabetic Association Guidelines for what a high blood glucose is, so definitely track fasting glucose and track after each meal, make sure it's not high.
Also, for a lot of people -- and I think it's especially true for women -- going to low carbohydrate can be very strenuous on the thyroid. It can cause insulin-resistance. It can cause leptin-resistance, and both insulin and leptin interact with the immune system, so it can actually end up lowering metabolism. It can have some pretty detrimental effects.
Certainly in the literature, we know that there's an adjustment period and then the metabolism can shift into a metabolism that works better on fats compared to sugars. And if you persevere, you can get over that hump, but women seem to have a harder time getting over that hump than men do, and of course, women are more than two-thirds of autoimmune disease sufferers.
The other concern that I have with extremely low carbohydrate diet is my understanding of the immune system. And the nutrients required for the immune system function normally is that there is an incredible importance on vegetable consumption and the tremendous amount of nutrition that we get from vegetables that we cannot get from animal foods, so that includes vegetables that are vitamin-rich, they're mineral-rich, and they're rich in fiber and phytonutrients. They have natural antioxidants.
These things are incredibly important for the immune system to function normally, for the body to repair damaged tissues, for the body to control the production of oxidants, granted the production of oxidants post-meal is lower on a low-carbohydrate diet, but it still happens. We produce oxidants whenever we eat no matter what we east just because we have the benefit of breathing air. My concern with very low carbohydrate and ketogenic diets comes from insufficient vegetable intake.
Julie: Yeah. I think that's one of the things that we're seeing that worries me when I see the food diaries come in and people assuming that because they want to do a low carb diet, they need to go low vegetable, so that's part of the whole reeducation that I've had to deal with almost all of our clients that are trying to do a really low carbohydrate diet.
Even if they're eating no vegetable, what I found -- and maybe you're seeing this, too -- is that getting people to understand what I mean by eating more vegetables is really kind of tricky because for some people, eating a romaine lettuce salad at lunch is a lot of vegetables.
So I think part of the reeducation, I think, that's important is that low carb and even ketosis doesn't mean no veg. In fact, I think it's quite the opposite because one of the ways I get people to eat more fat is by eating more vegetable because vegetable is, as it turns out, a really great vehicle for fat.
Chris: [0:59:24] [Indiscernible] has an extremely high surface area.
Sarah: That's true, and it actually makes -- some of the fats and vitamins in vegetables are more easily absorbed. Otherwise, it's quite hard to get the Vitamin K out of leafy greens, for example.
Chris: Yes. My diet now, I'm still largely eating autoimmune. There are a few things I've introduced like egg yolks. I guess it's technically not AIP, and then butter as well, I suppose. But I would say that by volume, 80% of my diet or Julie's diet -- we're eating the same things -- is vegetable. So if you look at what's on the plate, 80% of it is vegetables.
[1:00:01]
Sarah: Yeah. That's about how I eat. I'm not in ketosis though. There's no way I'm in ketosis.
Chris: Yeah. And then when you look at the energy, 80% of it is fat. So when I put the macronutrients and the micronutrients into chronometer, I'm eating between 70% and 80% fat. And then measuring blood ketones, I'm achieving ketosis even though I'm eating tons and tons of vegetables. Really, this whole idea of net carbs, so you only count --
Sarah: I think depending on where you're getting your information about a ketogenic diet -- also, carbohydrate targets are very, very different. So the classic carbohydrate targets for a ketogenic diet are 30 grams of carbohydrates per day or less, including fiber. When you think about that, that's ridiculous, so the USDA --
Chris: You're just not going to ever poo ever again.
Sarah: No. This is my major concern with 30 grams including fiber or less, is that we are so dependent on healthy diversity and number of bacteria living in our digestive tract for liberating nutrients from our food, for producing nutrients, for controlling the immune system, for regulating the gut barrier.
If we are consuming 30 grams or less of carbohydrates per day, we're not feeding them adequate amounts of food and what can end up happening is having bacterial undergrowth. Everyone talks about, "I have SIBO." "I have yeast overgrowth." I think the health implications of having bacterial overgrowth are much better understood, but there are really intense complications of having bacterial undergrowth including a depressed immune system.
And when you look at diet and these correlative studies, diet factors and risk of chronic disease, the one thing that we can always say, always every single time is that the more vegetables you eat, the lower your risk of any chronic disease. I think that the USDA recommends -- I believe it's 25 grams of fiber per day. When you talk to Jeff Leach from the Human Gut Project, he would say that he personally aims for I believe 50 grams to 150 grams of fiber per day. I know I personally aim for 40 grams to 50 grams of fiber per day.
Some of the hunter/gatherer populations that he's studying are eating 150 grams to 200 grams per day even as toddlers. And so, when you start talking about 30 grams -- and that's all carbohydrates; that's not just fiber, that's all carbohydrates -- to me it's dangerously low.
Chris: I don't know where that came from because it's --
Sarah: It's maybe beneficial for a little while.
Chris: It's not even necessary. I found certainly overeating protein for me would knock me out of ketosis and that's kind of sneaky. I would notice that my blood glucose would be elevated in the morning. You'd overeat protein for dinner and you'd wake up in the morning with an elevated blood glucose. And sure enough, when I reduce my protein intake just a little bit, I'm still eating 90 grams a day, but that would be enough protein and I could still achieve ketosis, but the vegetables have almost no effect at all though, I can see.
Sarah: Which I think is a really interesting story because that's not the guidelines that most people are getting like the ketogenic diet. I think the most liberal guidelines I've seen are in Paul Jaminet's Perfect Human Diet where he recommends supplementing with some amino acids to help with ketone production -- I think lysine, if I remember correctly, but I might be wrong about that -- and then supplementing with MCT oil or coconut oil and then you can handle 50 grams of carbohydrates a day.
Even 50 grams is still pretty low. Even if you're completely sticking with non-starchy vegetables, 50 grams is still on the low side in terms of getting those really critical nutrients out of vegetables that we know we need for long-term health, and that's not to deter from anybody's personal experiences on a ketogenic diet. There are certainly health conditions in the medical literature in which ketogenic diets have proven the only sustainable solution, for example, severe epilepsy, but it's definitely something that -- you know, my main concern with this is long-term health.
[1:05:06]
If somebody wants to experiment with the ketogenic diet, by all means. I think that the number one thing that's important for people is to find what's working for them, but I think that some people can get so excited about some benefits of the ketogenic diet that they're experiencing better sleep, better energy, weight loss, and start ignoring some of the other things.
I just want people to be really aware that health should be help in all areas and that some things work for a while and they stop working, and to just be really aware and continually reevaluate how that approach is working for them.
Chris: Yeah. You've got to be open to change, definitely, absolutely. I want to ask you about what you do with family and friends that could clearly benefit from some of your work and they just don't get it.
So you've explained to them -- take Hashimoto. Nearly all thyroid disease in the US is autoimmunity, so that affects -- how many percent of women in the US? It's like 20% of something, ludicrous. I'm sure you know 10 women that have been affected by this. Probably at least one of them just doesn't get it.
They're like, "Well, I can just take my Synthroid and I'm going to be just fine. I don't need to worry about this problem. If that changes, maybe I'll look at your diet. That's an interesting option." Obviously, they haven't really got it and that they don't really understand just how important the immune system is. Do you just ignore those people? What do you do?
Sarah: There are clearly autoimmune genes in my family, I have a number of family members who I think could benefit from Paleo diet or even an autoimmune Paleo diet who aren't doing it. I see it in my family. I see it in my friends. I don't see it as my responsibility to convert them. I see it as I can be there when they want the information and I'll give them the information when they're ready to ask for it and they're ready to make changes.
I can give them a copy of my book, but the thing that I have to remind myself frequently is you can bring a horse to water, but you can't make them drink. Some people can have all the information at their fingertips and they still aren't ready to do it, and I can't make them ready. I can support them in every other way and I could have the information. I could help them figure out if they live local where to buy the food, but I can't move in to their homes and make them change what they're doing.
I often say if my knowledge can't help the people I know, my friends and family, then what's the point? But at the same time, we're all individuals and we're all responsible for our own choices. The most that I can do is help educate when they want that information, and some people really don't want that information.
I'm not cutting anybody out of my life or anything. I hope that they respect what I'm doing. Typically, I don't think I've encountered -- well, maybe one person, but for the most part, they respect what I'm doing. If I'm in their home, they'll work to cater to how I eat, but generally, people make these changes when they're ready.
For some people, it just takes time. For some people, it takes hitting rock bottom. For some people, it just takes a moment of inspiration, something that gives them drive and motivation. It's just a question of waiting for that to happen and then being there when they need me.
Chris: Yeah. I've got one guy I'm thinking of in particular that's kind of unusual. He's being very strict. He played by all the rules and he'd seen some nice improvements. He actually suffers from Hashimoto's, but he's known to have other things like his hair has gotten darker and has grown back in.
[1:10:06]
Some other nice benefits are his energy's improved and he's lost some weight. Now, he's saying, "Okay, I'm done with this gluten-free thing. Can I go back?" What do you think about that? Can you ever heal a leaky gut and then go back to eating some of these foods that we know cause insult to the gut and it'd be okay?
Sarah: That's a good question. I think it's possible that some people might, but I think that as a general rule, people who have the genetic susceptibility for autoimmune disease have the genetic susceptibility to have bodies that overreact to these types of inflammatory substances that are in things like wheat and soy and other grains, corn, legumes, peanuts.
And so, I think that there's a line that I think people have to find for themselves once they're really starting to see huge improvements. For example, I will occasionally eat popcorn and I'm fine. I have absolutely no reaction to popcorn. I maybe have it two or three times a year and I enjoy it. I know that it's not something that I should be including in my diet on a normal basis, not because it's completely empty calories, but that's a treat that I seem to tolerate and I really enjoy when I have it.
I don't even mean like good popcorn. I do buy local, organic, non-GMO popcorn from a farmer that I will periodically make for my kid. We hired a babysitter and went to the movie and I got the junkie popcorn at the movie, and I actually really seem okay with it, but I don't think I'd be okay with it if that was something I did every week.
I feed my family rice and they do really, really well with rice. I've had it a few times and been okay with it, but also that's a lot of carbohydrates for my body and I tend to feel a little bit sluggish afterwards, so it's not something that I consume frequently again a few times a year, mainly at sushi restaurants because sushi has a lot of them.
And so, those are things that are generally much less inflammatory than if I was going to go have a baguette or some other bread, something with gluten in it. In fact, I have pretty bad reactions to gluten even still. I got accidentally exposed to gluten last month and I woke up in the middle of the night extremely nauseous and I was fairly certain I was going to throw up, although I never did, but I just felt terrible.
It was a while before I could fall back asleep because I felt so ill. The only thing I could figure out was that I had supper in a restaurant and I had a bunless hamburger and maybe they'd cook that hamburger on the same grill as they toast the hamburger bun, and I hadn't asked and I should've.
Chris: Yeah. I've become quite fearful of restaurants actually for this reason.
Sarah: Well, I very rarely eat in restaurants, but I was travelling. It was actually my brother and his new wife's rehearsal dinner and I had to go to that. I hadn't eaten all day and was really hungry. So whether or not people can actually reintroduce things like wheat products on a daily basis, I find it unlikely that people who come from a history of autoimmune disease would ever be able to do that.
I even find it unlikely that people with a history of autoimmune disease would ever be able to tolerate it even as an occasional treat, but we are all different and there's definitely some genetic adaptation to consuming and digesting bread products and legumes and these other proline-rich proteins in plant that most of us still don't digest very well. And when you don't digest them very well, they also tend to feed the wrong kinds of bacteria and they're very inflammatory when they manage to sneak across the gut barrier. I don't like making these sweeping statements like nobody should ever eat gluten.
Chris: So it comes back to tracking progress a bit in a way, doesn't it?
Sarah: Yeah, and body awareness again and also understanding that you might be able to tolerate bread while you're on vacation in Europe in part because European bread has less gluten than American bread, but in part because your stress is so low because you're on holiday and you're having an amazing time.
It's a very common experience for people to say, "I went on a holiday and I was able to eat all these foods I could never eat, so I thought when I'd come home, I'd be able to eat them."
[1:15:03]
They come home and they're just as inflammatory as they were before their holiday and it's because of the stress link.
Chris: Yeah, absolutely. I have the same experience with bike racing. Clearly, a bike race is a stressful event and I'm sure it gets my cortisol going pretty good. Of course, everybody wants to stop for food at some ropey restaurant, usually a Mexican on the way home.
I don't ever do it, but I know even when I don't make any kind of -- even bell peppers in a salad on a day that I've done a bike race can really crush me in terms of my digestion. I'm sure that's the link. It's like the stress is what does it.
Sarah: I think so.
Chris: Well, I'm so glad that you came on today. This has been absolutely amazing and I owe you this huge debt of gratitude because like I said, if it wasn't for you, then I might still be messing around with allopathic doctors and colonoscopies. I'd probably be on some sort of prednisone or some kind of synthetic corticoid, so it would've been awful.
I have an awful lot to thank you for. We're having the same amazing results. It's a question every time. If somebody presents us with a bunch of things that point to leaky gut, if they come back with a stool test that has a parasite on it or if they have overt symptoms of autoimmunity or a ton of stress, then it's obvious that they can probably benefit from the autoimmune protocol. I don't ever feel bad about directing someone in that direction because of the nutrient density thing.
That's the reason why I still eat it. As a bike racer, I need to make sure that every mouthful is getting my best bang for my buck, so I never feel bad about directing people towards this diet and they always feel better. They always come back to me two weeks later and say, "Oh, you know what? I thought I didn't have diarrhea, but I think I did because it's so much better now." People don't even know.
We've just been having such great results, so I'm directing people towards your work, the book, and the website. Now, I'm sure the cookbook will be just as equally successful, so we're really thankful for all of that. Thank you.
Sarah: Thank you. We've been in contact now for a couple of years and definitely there's been a mutually beneficial relationship because I've learned a lot from you over the last couple of years as well.
Chris: Thank you.
Julie: That's wonderful.
Chris: Excellent! Well, thank you so much for your time.
Sarah: Thank you for having me. This is wonderful.
Chris: Okay. Cheers, Sarah!
[1:17:34]End of Audio
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