Written by Christopher Kelly
Oct. 4, 2014
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Christopher: Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and today I'm joined by Nicole McPherson. Nicole is a biomedical scientist with a Research background in Clinical Research.
Hi, Nicole, how are you doing?
Nicole: Hi, Chris, I'm good, thanks. How are you?
Christopher: Good, thank you.
So Nicole and I first met by way of the Robb Wolf podcast, that's where she heard me and some of what I said resonated with her and she got in touch. So maybe we should start by learning a little bit more about your background, Nicole.
Nicole: Sure.
So really my kind of journey into health was through discovering Paleo probably around three years ago and I did that through joining a CrossFit gym. My time at CrossFit was short-lived but I really love the whole Paleo ancestral health scene and that really resonated with me. So I got into Paleo, it cleared up a lot of digestive issues that I've been having and just brain fog and tiredness and things like that. So loved Paleo, I was really on board.
But over really the past kind of two years, I started to develop other symptoms so tiredness, really, really excruciatingly bad period pain, and just not feeling as good as I kind of had when I started Paleo. So I went through the conventional medicine route, that led me down many paths but unfortunately, nothing that was able to solve it.
I did a lot of my own kind of troubleshooting as well with supplements and I've probably spent thousands of dollars on supplements over the last couple of years and none of those really helped either.
Christopher: Yup. Been there, done that.
Nicole: Yeah, totally. I have like a cupboard of supplements that I don't use.
Christopher: The supplement graveyard.
Nicole: Absolutely.
So yeah, probably around the start of this year, I decided that I didn't really like how the conventional medicine was going and I was looking into the Paleo kind of doctors here in the UK and I ended up seeing a lady. I kind of found out after we'd had a few consultations that she agreed with the Paleo principles but she was using conventional medicine behind that. So she didn't really know about things like the adrenal stress test and other kind of tests so didn't really work out.
And then I heard you on Robb Wolf's podcast and thought "I have to get in touch with this guy. He seems to get it." A lot of the problems I knew that you'd kind of studied through The Kalish Method, and yeah, that kind of led up to where we are today.
Christopher: When the complaints began, was there something that you noticed before you even went Paleo, when did that happen?
Nicole: To be honest, my digestion's never been great my whole life. I had my gallbladder out when I was 19 and my diet was pretty appalling. I've always been thin and I've never thought I needed to worry about what I ate. And I only really discovered that that wasn't true when I discovered Paleo.
But probably around that time, I went to India on a holiday and I got an awful stomach bug. And it took probably six months for the kind of acute symptoms to disappear. And I didn't go to the doctor because to be honest, I haven't had a lot of luck with the NHS here in the UK so "I'll just deal with it" and it kind of went away. Yeah, just went back into normal which still wasn't great.
But around that time, I'd also been really stressed out with work and going through a property renovation so these things kind of all coincided. So looking back now, it's really obvious where all the problems stemmed from but at the time, I really had no idea.
Christopher: You've already gone ahead one question for me.
So yeah, that's the really common pattern that we see is… you ask the question when did this all began, what also was going on at that time, and everybody's unique. For me, I was under too much stress from training but for someone else, it's like moving house or having a baby, but there's almost this commonality -- the period of increased stress. And a big red flag there is getting sick whilst on holiday and never feeling the same since. That's not uncommon. That's actually Kalish's story as well was like that and Chris Kresser. There's a number of people that had that story.
I just actually watched a TV series you might want to check out, it's called Bugs, Bites and Parasites, I think. It's like the ER format, that type of thing, fly-on-the wall documentary but it's set in the Liverpool School of Tropical Medicine. So it's like I sense that there's nothing else like it basically in the world so people with all kinds of weird parasites and stuff end up showing up at this place in Liverpool to get treated. It's really quite interesting actually.
Nicole: Very cool, I'll check that out.
[0:05:14]
Christopher: Yeah, they mentioned a couple of the parasites that I know the test that you did looked for. Giardia definitely came up.
So what were your food sensitivities and cravings like at the time that we first spoke?
Nicole: At the time we first spoke, I discovered when I kind of went Paleo three years ago, and to be honest, I probably always knew that I had an issue with gluten and dairy. I think I just kept my head buried up until that time thinking I was fine. It wasn't until I cut those things out and then reintroduced those like whoa, a massively strong reaction so obviously kept those things out.
But the interesting thing is I recently did have a dairy exposure and I seemed to be okay. But I think going on past experiences is probably something that I want to keep out of my diet regularly.
Christopher: Yeah, that's interesting and I've seen that too. And it's one of the reasons why we don't do food sensitivity testing. They do exist those tests but I don't think they're particularly useful partly because we already know which foods are likely to be problematic and obviously dairy is one of them and then they can change over time.
So if you've got a whole bunch of digestive issues of course in sensitivities in the first place and you fixed those issues, then you might not be as sensitive as you once were and the other thing that varies is the amount of stress that you're under. So I definitely notice that on the bike and if I go to a bike race then I need to be much stricter with my diet although I'm already pretty strict. I'm talking about "Oh, I can't eat green beans or eggs" versus… yeah.
What about pain and inflammation? Did you have any physical stress or was it all just the digestive and PMS?
Nicole: I had last year, it was really weird. I went away for weekend to Europe and the joints in my hands and fingers blew up like balloons and I'd never ever had any kind of reaction like that before. And I still don't really know what it was. I think I'd had a latte or something like that around that time and that's the only thing I really attributed to.
But yeah, I travel quite a lot for my job so there's usually at least a few times a year I get a gluten exposure through kind of no fault of my own, just there might be some soy sauce in something and I definitely feel like brain fog and headaches and things like that.
But almonds is something I've discovered recently too. I used to be able to tolerate them and it was kind of a staple when I first went Paleo. But even now, the tiniest bit of almond in something is kind of I have almost not an anaphylactic shock, I don't think it's that serious, but I get a headache and my throat swells up a little bit.
Christopher: Oh, wow, you're really sensitive then.
Nicole: Yeah. So it's really kind of come on the last few months. Before I was like "Oh, there's a little bit of almond flour" and it used to be okay but even the tiny amount now, I react to so I think I have to be strict with that.
Christopher: So did you do any interventions with a normal medical doctor at all? Did you take any prescriptions or anything to try and fix your problems?
Nicole: Yeah. So I originally went to this kind of Paleo-ish conventional doctor with my kind of PMS symptoms. I did some tests and it showed my progesterone was low. All my other hormones seemed okay. I think my insulin was slightly high so they were thinking maybe PCOS.
So I did see a gynecologist, she was 100% conventional and she said "It's PCOS and you've got to have surgery" and all of these. My other doctor didn't really agree with what she was saying so I never had surgery or anything like that but I did take some progesterone which kind of helped at the beginning but yeah, after a couple of months I started feeling worse than ever and that's pretty much when I started reaching out to you. Just because I had seen something about cortisol being involved with this and I've never been told about that before so I thought "Aha, this could be it."
Christopher: Yeah, that's an interesting one I've heard a lot of. Was it a topical cream that you were prescribed for the progesterone?
Nicole: It was, yeah. And I'd heard through other podcasts, I think Chris Kresser had mentioned that you should never use hormone creams because they kind of store in your skin. My heart sank after hearing that because I've been applying it for months and I immediately stopped.
[0:10:09]
Christopher: Yeah. So that's what happens it starts to seep and saturate in the subcutaneous fat and then you start to down-regulate your own production of the hormone and then also becomes slightly insensitive to it.
And so quite often I see people do this saliva test and the progesterone is in the thousands where it should be between say 200 and 400 would be more normal and yet they're still experiencing PMS and other symptoms of low progesterone which is not great. It's a very short term solution; the use of creams is I wouldn't recommend it at all.
So you did the saliva test, this is the 4-point cortisol test and we found a total of 16 points of cortisol for the day which is really, really low. Ideally it'd be more than double that. And so normally when I see that, the person is experiencing really low energy but not necessarily so. What were your energy levels like?
Nicole: They really only deteriorated probably about three months before you and I spoke. Before that, I'd been fine. I'd been weight training and just generally felt pretty good. The only kind of real symptom I had and my boyfriend would attest to this is I just could not get out of bed in the morning. So over the weekends, he was like "Let's go get coffee, breakfast" and I'm just like "Ugh, I don't want to get up" and that just seemed to get worse and worse just before I met you to the point that I couldn't even cope with going to the gym. Even if it was just for like a light workout, I just couldn't even stomach the thought.
So yeah, the energy levels kind of towards the end really dropped off. Sometimes I wouldn't even leave the house. I work from home and I just wanted to kind of lie in bed all day. So it was a relief to find out that my cortisol was the reason that's why I was feeling so bad.
Christopher: Yeah, this cortisol which is involved in energy balance. And also there's another hormone, a neurotransmitter called norepinephrine, and that's the one that gives you motivation to move your body. So that's another thing I hear all the time is "Just the thought of getting up or just the thought of going to the gym exhausts me." So you've not actually done physical, it's really the thought that's the problem.
Robert Sapolsky has got some excellent presentations on the internet about norepinephrine and its role, which are very interesting, but it's definitely that his work is very much in keeping with what we're seeing on the lab tests.
So yeah, it makes sense. Your progesterone was actually pretty good. It was 350 where you'd expect to see between 200 and 400 but I'm wondering now how much of that is the cream and how much of that is really you because normally I see much, much lower progesterone especially in someone that's suffering from PMS symptoms.
All of these hormones, it works as like an orchestra, they all sing together in unison. And it makes sense that they should end up low when you're under a ton of stress because they're all derived from the same molecule called pregnenolone. So you can have a situation where all of the pregnenolone is diverted towards creating cortisol and then none is used for making the sex hormones for making babies.
I've said this before in the podcast. If you're being chased by a tiger then maybe now is not the time to be making babies so these hormones tend to suffer.
Nicole: Yup, that's totally how I felt for sure.
Christopher: So we did some organic acid testing on you, it's a urine test which I thought was very insightful. This revealed a ton of problems that were quite easily fixable with some targeted supplementation.
So we talked about the supplement graveyard, trying things that potentially could work but you don't really know and sometimes there's no way of knowing whether it has worked or not, like it's just so difficult to tease out the cause and effects.
But for you we found you definitely need L-carnitine. So L-carnitine is a micronutrient that is required to shut off fatty acids into the mitochondria. All that fancy stuff means that you need it to burn fat and that's going to affect your energy levels and your body composition.
And then also CoQ10, I think was going to be really important. There are three markers that came up with the organics profile that showed that you needed more enzyme CoQ10 and again, that's involved in energy production.
So have you seen any changes but first of all, did you manage to get a hold of the supplements in the UK and secondly, did you see any change in your energy levels?
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Nicole: I did. Most of them I could get in UK and there was some that I ended up getting with free shipping actually from the US. But yeah, I located everything with no problem and I think even within two weeks, I had everything I had ordered.
But yeah, there's some great supplement shops here in the UK, kind of online that supply most of them, so there wasn't an issue at all.
Christopher: That's great. And then there was also, did you manage to get ahold of the result from your testing in the methylation section? I'm sure a lot of people have heard about methylation and MTHFR and those mutations in the genome. But in this test we can -- this is not a genetic test; this is just looking at how well your methylation is actually working so this is really important for detox and expression of the genetic material.
It showed that you needed more folate and the safest way to get that folate is through 5-methyltetrahydrofolate. So did you manage to get a hold of some of that?
Nicole: I did. I'm taking massive kind of tub of multivitamin. I think it's a Thorne product. But I think there's another one available here. I think it's pure encapsulations. But yeah, I'm taking the Thorne one, and it's great. I feel like it's making a difference.
And I think… all of the supplements, I'm feeling a lot better. It's just nice to have kind of targeted amount of sups that I take every day and I'm not worrying about other stuff that I think may be helpful.
Christopher: And did you manage to get a hold of any N-acetylcysteine?
Nicole: I did. I'm taking an effervescent product which --
Christopher: Is it PharmaNac?
Nicole: Yes, it is.
Christopher: Oh, good!
Nicole: I've never really liked kind of effervescent things but this is fun. I just put it in a tiny bit of water so yeah, it's no problem really.
Christopher: Yes. So again, this is something specific that we saw on your organics profile. And cysteine is an amino acid which is the rate-limiting factor in the production of glutathione which is the body's primary endogenous antioxidant.
So oxidative stress is a real problem with people that are over-exercising or have some kind of infection or disease state going on and you can up-regulate your production and balance by taking this supplement. And so PharmaNac is the one that we like.
The thing about cysteine or N-acetylcysteine it's a sulfur-containing amino acid and so it oxidizes easily and then it just becomes kind of gross and smelly and sulfurous, I'm not sure, even worse at that point. So PharmaNac have solved this problem by putting the supplement into a foil blister pack and then you just drop it straight into some water that stops it from oxidizing and falling apart before you even consume it. Yeah, again, it's cool.
And so the last thing we found on the organics profile was intestinal bacterial overgrowth. This is not the best test in the world for SIBO which is something people have probably heard of but it does give you some insight. And you know for sure that these not-beneficial species of bacteria when you see some of the organic acids elevated on this test and you know also for sure that it's in the small intestine so not where you want this bacteria to be.
Normally when I see this, the person is feeling kind of bloated especially after eating carbohydrates and generally feeling quite yuck. So did you notice any bloating or change in bloating at all?
Nicole: Yeah. So this is a strange one because I'm not a big carb-eater. I probably vary between 30 to 80 grams a day, some days more than others. But yeah, I never really noticed bloating when I'd eat carbs. It would be once or twice a week I would eat like chicken and broccoli or something and just get majorly bloated and I just wonder why that was.
But I'm guessing yeah, since I've been training all of that, I haven't noticed at all. So I'm guessing it's some nasty bacteria in there somewhere.
Christopher: Yeah, it's very non-specific. It's just an organic acid that shows up in the urine. And that organic acid comes from a number of different species of bacteria and the test doesn't tell you which is so you don't know. It might be the sort of bacteria that loves to eat something like sweet potatoes and it might be a bacteria that likes to eat something else so you don't really know.
And the thing I should say is it's really common for people to gravitate towards a low-carb diet, they're suffering from this kind of overgrowth just because the carbs that make them feel good, right, if you're not consistent and something doesn't kind of make you feel good.
I was kind of weird. I just kept eating foods that make me feel really bloated anyway. I don't know why. I think it's partly because the sugar is so addictive, right, even in sweet potatoes, I find quite moreish.
Nicole: Totally.
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Christopher: So the stool testing was perhaps the most significant finding for you especially with respect to your story. Now when did this all begin? "When I went to India and I have never really been the same since."
So the stool test is actually a stool antigen test. So what that means is the microbiologist at the lab is actually looking for the physical presence of an antigen which is some kind of pathogenic organism. So it could be a bacteria like H pylori or C. difficile or it could be a parasite.
In this case, that's what they found. It's something called Blastocystis hominis. And it's a low-grade infection, I don't think anybody ever died of this but it definitely can cause joint pain, it's the leading cause of fatigue that I see so I think this is a really significant finding. Again, we were able to design you a protocol now that we knew what bug was there. Artemisia and then a broad spectrum antiparasitic and some oregano oil, it's pretty effective at getting rid of these bugs.
So first of all, did you manage to find everything that I've been using here in the US?
Nicole: I did. And actually all of those are available in the UK. Yeah, they got to me pretty quickly and yeah, since I've been taking them -- I think I'm three weeks into the parasite treatment -- I've totally noticed the difference with my digestion, it's just a lot better than what it was and I never kind of realized how bad it was before.
Christopher: That's a really interesting point and I experienced that massively. I didn't even really understand what was normal anymore. I know I've been eating the wrong foods my entire life so the problem definitely got worse over time but I just didn't know what normal was anymore. And it was only once you remove the symptoms you suddenly get a feel for what's normal. So that part's really interesting.
So did you get the Amazon form and it's because I know I'm using it here in the US, it's a UK company. So you managed to find that?
Nicole: I did, yup. That was actually the first supplement to arrive so I'm guessing they're somewhere near me in London.
Christopher: Okay. Yeah, that's great.
So I'm sure the thing to do with the stuff is to retest, right? I think a number of things that worked to get rid of bugs that we find on the stool test. The key to success is doing the adrenal support so that you have a normal amount of cortisol. Cortisol is involved in amino regulation amongst other things so I think that part's important.
And then the other thing I think is important is to retest. So after you finished the program, it's a 60-day program, you'd want to wait at least a couple of weeks but really you could wait any amount of time and then do the retest and make sure it's gone. But I think you're going to know from the way that you feel whether or not it's gone.
Nicole: Totally, yeah. I 100% believe that you need to kind of retest.
And just going on how I feel now, I want to make sure that the bugs are gone so that I don't have to worry about it really. But yeah, just knowing that I've gone on for so long without testing and then you just have this complete picture of what's been wrong with you, it's really powerful and just so nice to know that you're not going crazy and that there is a reason why you aren't feeling so great.
Christopher: Of course, yeah, and that reason is so rarely genetic. I think a lot of people -- certainly me -- I thought "Oh, it's just my luck in life. Maybe this is my genes." But I think in most cases, that's not true. Something else is going on and that something else is fixable.
So going back to your original complaints, have you seen any changes -- I mean it's kind of early days for you -- but have you seen any changes in your tiredness, in your PMS symptoms?
Nicole: Tiredness, definitely. I find it a lot easier to get out of bed. I started walking pretty much every day. I actually feel like getting out and being active. And I know with the kind of adrenal fatigue that is not great got overboard. But yeah, I'm just getting out, getting some fresh air.
And generally, I feel good. I mean the PMS, I guess you only have once a month to find out if it's working with regards to that and it did seem to be a little better. But I know that that will probably take some time. But yeah, just going on everything else, I feel like I'm going the right direction. So it's really encouraging.
Christopher: And then have you seen any changes in other biomarkers that you might have measured? So blood glucose or anything you might have -- lipid panels -- anything you've had done with the doctor?
Nicole: Blood glucose, I got a blood glucose made a couple of months ago and it seemed like my blood sugars were all over the place. I have been testing the last couple of weeks and I did seem to be going down.
[0:25:04]
So yeah, I'm not testing it too much. I'm kind of once or twice a fortnight, I'm doing, but yeah, it seems to be heading the right direction because my fasting blood glucose was I think 110 kind of before even though I wasn't really eating any carbs. I'm guessing that was to do with the other hormones and cortisol that I'm hoping will keep going down.
Christopher: What is it now?
Nicole: I think the last time I tested it was 96 fasting.
Christopher: Okay. So they're slowly going down. Again, this is something that's taken a long, long time to go away for me and I'm sure the problem is multi-factorial. The infection won't be helping, I'm certain of that. Then there's these other things. I don't know what your diet was like in the past or whether you've got a history of carbohydrate abuse like I do --
Nicole: Awful.
Christopher: Oh, really? Okay, yes.
Nicole: How about it.
Christopher: Yeah. So I'm noticing the same. I used to wake up with 110 which is really not good, that's definitely not a good place to be. And now it's more like high 70s, low 80s.
Nicole: That's great.
Christopher: But it's taken me two years to get there. It's not something that's going to change overnight.
Nicole: Yeah. I think there definitely needs to be an attitude. I think when I first started testing my blood sugar, I thought "Oh, if I don't eat carbs through a day, tomorrow it's going to be 70." And yeah, you're right. It takes a lot longer than what you think. You just got to keep going and you know it's going to get better.
Christopher: Yeah. I mean you have to bear that in mind that it probably didn't happen overnight and it's probably not going to be fixed overnight either. It takes time.
So what about -- I presume that you're doing a good amount of walking, it sounds like. And then what about strength training? Does that thought still exhaust your or it's something you're thinking about?
Nicole: I love strength training. I can't wait to get back into it. I've got a particularly kind of stressful period with work and study at the moment so I kind of made a conscious decision that I wasn't going to go back to the gym until the end of the year just because I'm travelling literally around the world over the next kind of six weeks.
So I think after that and after I get back and have a little bit of a break, I'm definitely going to get back into it because I feel so much better when I strength train. Yeah. I couldn't imagine not doing it so I think just for the moment, I'll be walking but I would definitely be back in my program soon.
Christopher: That's great. You're so smart. I need to find… like everyone needs to be as smart as you.
Nicole: I try to be. I think I've learned from my mistakes.
Christopher: I've gotten really lucky that all the people that we work with is smart. But definitely you meet some people when you're out and about and you're like "I don't know whether you're ever going to get it." When I hear you say things like that I know that you're going to be successful just because you understand how it works, you understand how to balance the stress and that takes a great deal of emotional intelligence.
Nicole: totally, it's hard work. And I think that's the pace I struggle the most with. I always been someone that wants to be busy 24 hours a day so I really fight now to build breaks into every day and have unstructured time and meditation and walks and everything.
So I think, in a way, it's kind of been a blessing getting this adrenal fatigue now because I can make some changes in the future and hopefully, I won't have any further problems.
Christopher: Yeah, that's what I think. I think that it's the stress that lowers immunity that leads to the problem so it's not that you just got unlucky when you're exposed to this bug. I think it's the poor stress management that leads to the issue.
So guided meditation, have you been using Headspace or something else?
Nicole: I am, yeah. I love Headspace. I discovered it probably a year ago and it took me ages to kind of get into it. I'd do it for a day and then think "Oh, yeah." But now yeah, love it and use it pretty much every day for at least 15 minutes. I love how they just have kind of single use ones as well if you're particularly stressed out. You can just do like a three-minute kind of guided session as well.
Christopher: I've not noticed those actually.
Nicole: Yeah. There are SOS they're called and they just really get you to calm down if you're having a meltdown or something.
Christopher: I'll check that out.
And then tell me, you're doing a Master's in Functional Medicine. Where are you doing it and how does that work?
Nicole: I am, yes. So my background is in Biomedical Science, I work within Clinical Research at the moment. But I've always been really interested in health and I thought that conventional medicine was the only way. But I've discovered through myself and just researching on my own that Functional Medicine seems to be the way forward. It's certainly the case having worked with you and learned all I have in the last couple of months.
[0:30:13]
Yeah, I'm studying for my Master's, I graduate next year. It's with the University of Western States in Portland. So I'm doing an online course. Yeah, my intention is really to take this to Australia. I think healthcare has a long way to go over there and they're still very much in the whole "Saturated fat causes heart disease" and a lot of nutrition dogma and all of that which I know the US has the same.
So yeah, I'm really motivated to do my bit and educate people about nutrition and just lifestyle factors like stress and how to fix their health. So yeah, planning on opening a clinic in Australia next year and yeah, I can't wait.
Christopher: You think the situation is as bad then? There's a National Health Service in Australia, right?
Nicole: Yeah. It's called Medicare. It's good. I think you need to find a doctor that kind of understands… a lot of the test I think you can get through your doctor but maybe not some of these kinds of more functional tests like adrenal stress.
I think Paleo and Functional Medicine is starting to get on the radar over there but it's still very much probably seen as quackery which I hate to admit but yeah. So I want to change that and I'm seeing family members and friends get sick and the doctor's telling them to eat less fat and all of that stuff. So I feel like I want to do my bit and try and change that and help Australia get healthier. Because the disease rates there are just really going downhill with diabetes, heart disease, cancer. The same as the US I think now and probably even worse I think so yeah.
Christopher: Yeah, it's that. Something I constantly wrestle with all these stuff is like "Could just this be the placebo effect, is that possible?" And then "No, that's ridiculous" because I saw like my belly used to be like I was pregnant, like there was a football in there. And then I took these botanical herbs and then it went away within days even and there's no way, I can't just believe that I could possibly be placebo. No way, it's not just possible.
Nicole: I know. It's amazing really. I work in Clinical Research in the pharmaceutical industry and I was always one of those people that if someone said that they changed their diet and they'd gotten healthier, I just wouldn't believe it. And just through my own experience, I started to realize that I was wrong.
But there's still a lot of people that look at you when you say you've made changes and you say you're feeling belter and they just don't believe it. Yeah, it's crazy, I feel like it works. And there's so much anecdotal evidence out there now that it's kind of impossible to ignore.
Christopher: Yeah, definitely.
Brilliant. Well, thank you so much for taking the time to this call with me. I really appreciate it.
Nicole: No problem, thank you.
Christopher: Okay, cheers.
Nicole: Bye.
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