Email to [Redacted]

It’s been a while since I’ve posted anything to the ol’ web-log. Writing, shooting, or editing content has been in the almost-gotten-to portion of my to-do list for months. So recently, when a friend asked me if I knew anything about a chronic issue, I decided to write an email that might serve double duty. Generally, I do my best not to proselytize, but if someone asks me the right (wrong?) question, all bets are off. Below is a redacted and lightly edited email.

Hi Redacted,

I’m going to bombard you with a whole lot of info of varying usefulness in this email. If even a little is a little helpful that would be great. I take this stuff seriously enough to write pages and pages about it, but not so seriously that I can’t tell you that the answers I think you were asking for probably come at the very end. If all this is too much then by all means skip to the bottom.

To start at the very beginning, my own personal approach to health is informed by vitalism. Vitalism was the theory which was competing with the germ theory at the turn of the century. While the germ theory obviously proved to be true, I don’t think this invalidates vitalistic thinking.

Vitalism, at least my understanding of it, is grounded in a few basic premises. The body evolved to harness available energy surpluses to maintain homeostasis and continually refresh and repair itself. The body can use multiple pathways for most tasks, so while some are more efficient than others, the body is able to work around a wide variety of challenges. Evolution being the elegant process it is, even challenges to homeostasis (at least those which were regularly encountered in ancestral environments) are not wasted. Periods of food scarcity for instance, trigger autophagy in cells, and both hot and cold challenges to body temperature maintenance can be valuable.

The body is constantly prioritizing some processes over others, and when presented with an acutely dangerous situation, the body will almost always choose short-term safety – even when the solution is not sustainable in the long-term. Thus, at the root of nearly all chronic conditions is an unsustainable choice the body has had to make repeatedly. In a very real way your body has almost certainly chosen whatever chronic condition ails you – over some even more dangerous alternative.

Obesity, viewed through this lens, is the inevitable sum of adipose tissue removing glucose (which in excess is acutely toxic) from the blood. Unfortunately, although the cause is in some ways simple, because of accompanying damage to signaling systems, it is usually much more difficult to reverse. It’s difficult to unscramble an egg. But a supermarket egg is not a living thing. An injured chicken on the other hand, with appropriate support, has a much better prognosis.

This vitalistic frame of thinking has important implications for self-healing. The fact that the body has a (limited) capacity to regenerate and can often take advantage of multiple pathways means that it isn’t always necessary to track down the specific cause of a mysterious complaint. On the flip side, focusing too closely on any particular chronic symptom can be a failure to recognize that the body essentially “chose” that outcome over an even riskier alternative. Simply preventing one pathology from erupting risks the development of new pathologies of ever-increasing severity. Of course, sometimes an issue progresses far enough to leave little choice, and symptoms in and of themselves can stress the system. At some point an issue really can become too acute to handle indirectly, and acute issues are where Western medicine actually does shine. (If I get in a bad car crash I hope the ambulance doesn’t take me to an acupuncturist!)

With this lengthy preamble out of the way, I’ll try to give you all the info I can think of. Hopefully some of it will be helpful.

To me, the best approach starts with universally healthy diet and lifestyle practices, and from those minimum requirements, is modified to fit your body and genes, and then finally (but importantly!), adds considerations for the specific challenges or weaknesses which precipitated your symptoms.

I’ll offer my thoughts in the same order.

You won’t be surprised that I’m a proponent of a paleo diet. As Dr. Nesse pointed out in a talk that I filmed at the Physicians for Ancestral Health winter symposium, medicine without evolution is like engineering without physics.

In practical terms, this means avoiding foods which are evolutionarily novel and making a special effort to eat foods which are nutrient-dense or in some way expected by the body.
At the top of the list of foods to avoid are trans-fats, industrially processed seed oils (e.g. soy oil or corn oil), refined sugars, and fortified/enriched flours.

There is some disagreement about legumes within the paleo community. It may be the case that they are significant source of “anti-nutrients.” On the other hand, they are very good sources of “prebiotics” which feed the good bacteria in the colon. If you do eat dried legumes it is very likely best to prepare them by traditional pre-industrial methods such as can be found in Nourishing Traditions to reduce the levels of anti-nutrients and increase the availability of nutrients.

Grains (excepting white rice) are more universally avoided in paleo circles, although they may be tolerated by some people without gut dysfunction. If you are going to eat grains it is probably advisable to follow traditional preparation methods there as well.

Dairy is another food which is tolerated to varying degrees. There are two components of dairy which can potentially cause problems: the lactose and the casein. Ghee is the most likely to be tolerated since it essentially has neither. As I’m sure you know, if fermentation is allowed to continue long enough it will remove nearly all of the lactose from milk, so kefir, yogurt, and hard cheeses are often tolerated better than milk. Butter and cream also have very little lactose. When it comes to casein it appears that some european breeds of cattle produce a casein which is particularly problematic. A2 cow’s milk or using sheep or goats milk (which are all A2) may be easier on the body.

Finally, it is apparently not uncommon for people with autoimmune or inflammatory issues to see some benefit from avoiding nightshades such as peppers, potatoes, tomatoes and eggplants.

Especially when trying to support the body’s healing capacity you’ll want to emphasize nutrient density in the foods you eat. It’s one thing to take a selenium supplement, it’s another to get selenium in Brazil nuts or kidney where it will be accompanied by other cofactors and nutrients – the context that the body expects to find it and knows how to deal with it.

Liver may be the most nutrient dense food. Beef or lamb liver is highly recommended by Paul Jaminet but apparently shouldn’t be eaten more than 1/4lb a week because of the copper content. Chicken liver can be eaten more regularly. Egg yolks and oysters are also very nutrient-dense.

Bone broth is a very nutritious food and can be very helpful in repairing the lining of the gut.

Cold water fish are an important source of long-chain omega three fatty acids (which our ancestors may have gotten from brains earlier??) as well as other nutrients.
Seaweeds are probably the most nutrient-dense vegetables, especially considering the state of depleted soils, but probably should not be consumed to excess.

This is true of vegetable foods in general. Most plants contain various toxins which, among other things, protect them from being overeaten by animals. Thus with vegetables it’s best to mix and match and get small doses of various toxins, rather than large doses of one particular toxin. Your body can cope with (actually expects) lots of different small doses. One large dose may overwhelm the system though. I think I remember hearing somewhere that a woman in South Korea managed to poison herself by juicing too much bok choy.

A few years ago a woman named Jo Robinson collected a bunch of data on the nutrient density which until that point had never been presented together. She wrote a great book called Eating on the Wild Side, whose aim is to help consumers choose the most nutrient-dense varieties of fruits and vegetables. Generally speaking, domestication has occurred at the expense of nutrient density, so choosing varieties which retain important wild characteristics can make a big difference. Interestingly, certain methods of preparation and storage have also been found to be significantly superior. It’s too much to summarize here, but I’d be happy to lend you the book.

When it comes to vegetables, I think flavorful root vegetables such as tumeric, ginger, garlic, and beets as well as darker leafy vegetables have important roles to play.
Dark chocolate and coffee are also fantastic sources of micronutrients. (Though some delivery mechanisms are healthier than others…)

Circadian rhythm entrainment has enormous health benefits. Artificial lights at night, and especially staring at blue screens, can be very disruptive to our natural rhythms. Many people are now recommending limiting screen time before bed. If you must stare at a screen in the evening (I certainly do on occasion!) you can lessen the impact by wearing a pair of blue-blocking glasses which can actually be quite inexpensive.

The other end of the circadian equation is wakefulness in the morning, and getting some sort of movement outdoors first thing in the morning is a great way to help the body orient in time. I generally do, at minimum, some chicken chores and yard work very shortly after getting up in the morning.

Sun can be another important source of energy. Not only is vitamin D manufactured in the skin when exposed to sunlight, but so is cholesterol sulfate, which is a critical nutrient if Dr. Stephanie Seneff is to be believed. I try to get as much sun exposure as I can without burning. Although skin cancer is positively associated with sun exposure that is driven by squamous and basal cell carcinomas which are less dangerous. Melanomas are not associated with increased sun exposure and are actually often found in areas which are usually covered.

Breath is another critical element of health and something which I am working to improve in myself. One exercise I like is from Wim Hof and involves breathing in as deeply as possible and then a shorter breath out. This brings in extra oxygen and purges extra co2 I try to do 40-60 cycles every morning, followed by pull-ups and push-ups with breath held. Really makes you appreciate breath!

Another breathing practice that has worked for me involves a simple biofeedback device. Several years ago I managed to find a device called the Stress Eraser on eBay. The stress eraser measures your heart rate variability, displays it on a little screen, and guides you through a practice of syncing your breath to these cycles which helps you to relax. The interesting thing about biofeedback is it gives you another window into your own physiology. Using the the feedback from the device I learned how to recognize and release some of the tension in my chest. This is something I can now do to some degree without the feedback, although the Stress Eraser is still useful for breath timing. I’d be happy to lend it to you if you want to give it a try.

Paul Jaminet has a twist on a Tolstoy quote which I quite like: “All healthy persons are alike; each unhealthy person is unhealthy in his own way.” Once you have a fairly solid foundation of diet and lifestyle, the next layer of specificity is your body and the context you’re in.

Your genes are the starting point for the context of your body. Genetic testing through 23 and Me is now (relatively) inexpensive and can provide clues to weaknesses in your particular system. (Though of course it should be noted that genes are not the final word – epigenetics – which genes are “turned on” or “off”, can mitigate an unfortunate draw in the chromosomal lottery.) I have not yet gotten the 23 and Me test, but after seeing a presentation at Physicians for Ancestral Health about some of the services which can provide advice based on your data, I plan to get tested once my coffers are a little more full. One of the key areas I would be interested in is methylation which is a critical process which takes place over a billion times a second in the body. Methylation is a complex process with many potential choke points. Using 23 and Me data a service such as MTHFR support can tell you where the slower points in your own cycle may be, and therefore what kinds of support you might look into to get things running smoothly.

Genetic insights are valuable, and will only grow more valuable as tests become cheaper and the data pool increases. However, it is still early days for these kinds of interventions. Other kinds of personalized protocols have been out in the wild much longer.

Although I talked up organ meats earlier, these may be more helpful to some people (like me) than others. Metabolic typing is not mainstream by any stretch, but I’ve seen surprising differences in myself with different eating patterns and I think it’s actually something worth paying attention to.

The simplest method to determine your “type” involves simply reflecting on the quality and frequency of your hunger. If you are hungrier and hungrier more often you could probably stand to eat more protein and fat, and more “heavy” proteins like red meat and organ meats. If you aren’t hungry as often and have a smaller appetite you might benefit from eating less protein and fat. In fact, most of us see this change to some degree or another between winter and summer, and I think that is probably the type of biochemistry which underpins the different types. Some people, for whatever reason, are usually in a summer mode, and others, like me, are either winter type people or stuck in winter mode. The bottom line is listening to your hunger – while being aware that signaling can break down, especially with foods that were hard to come by 20,000 years ago.

If you want to go a little further down the rabbit hole, there are a few different questionnaires you can fill out which can categorize your metabolic type with a little more depth. Many of the questions are about the type and size of your appetite, and not particularly surprising or different from self-reflection. Other things, however, seem to come totally out of left field, and I would have thought to be completely unrelated to diet, except that I’ve seen them change in myself as I changed my diet.

I thought the color of my ears in relation to the rest of my face and the oiliness of my skin were simply part of who I was. When I reduced the amount of carbs I was eating though, both qualities quickly changed. When I went too far in the low carb direction I started to get dry eyes, which had never been an issue for me. Asking about the relative size of someone’s pupils seems silly, but when we were doing a questionnaire as a family activity it turns out that my aunt, whose appetite is very different from my own, has a very different pupil type. Of course these are all anecdotes, but they are seemingly unexpected and do conform to the model. The most in-depth questionnaire is available online and I think costs $40. However, if you’re interested, a shorter version is available in The Metabolic Typing Diet book (which I can lend you). A similar simple questionnaire used to be available at Mercola.com, but it seems to be behind a pay wall now.

The next step in customizing your diet and lifestyle is to get as good a snapshot as you can of which body systems are functioning well, and which could use support.

In your case we already know [redacted bits]…

Symptoms can be an important clue, but most symptoms have multiple possible causes, so the more information you can gather the better – enter functional labs. A couple of years ago I signed up to take a course on functional lab work, mostly to be able to run the labs on myself. It was an interesting process and though the course was expensive it was worth the money for me due to the personal attention I got going over my own situation. I have not to this point finished the course because I ran the labs on myself and don’t have any plans to take on clients. However, I recently decided to try to finish up the course, and if the process sounds like something you’re interested in I would be happy to get those labs run for you.

Through the course we are supposed to run the labs on two test clients with the help of our mentors. Since I’m not a trainer or a therapist and don’t have clients myself, they agreed to allow me to skip the client search and use existing test cases, so there’s absolutely no pressure from me. I don’t need test clients, but if you’re interested I would be able to run those tests and go over them with experienced mentors.

The first lab that they start everyone with is a salivary hormone test measuring your cortisol rhythm as well as 6 other hormones (DHEA-S, testosterone, estriol, estradiol, melatonin, and progesterone). In one regard this test might not tell us a lot because we can make a good guess that your endocrine system is quite taxed and many of your numbers will be low. On the other hand, having those numbers as a baseline could be informative if you want to see how your body as a whole responds to therapies. There is of course also the chance that some numbers would be in unexpected places, and that could provide valuable insight.

The second test measures three markers in your urine and will give you an indication of how your gut and liver are functioning and the antioxidant/pro-oxidant balance in your body. I would not be surprised to see challenges in any of the three areas, and trouble in one area could challenge other areas, but knowing more specifically could inform how you proceed and give you a yardstick by which to measure progress.

Beyond these saliva and urine tests the system would allow us to run a whole host of other functional labs, but in order to go through that program we would have to follow procedure and run the basics first.

I mentioned methylation earlier in the context of genetic testing. The other way to to approach methylation is to look at different markers in the urine which can go beyond your inherited weak spots and tell you what is currently happening, providing the opportunity for even more targeted support.

Functional labs a great, but they are not cheap, and unfortunately they are not something for which insurance will often pay. (Since, being proactive, they fall outside the dominant paradigm of chasing disease…) As useful as the labs were for me, I have not been following up after the first three rounds simply because I can’t afford it.

Happily, there are a few other, less expensive ways to gather data on the status of your systems. I imagine you have a thermometer. A pulse oximeter and blood sugar monitor are also affordable. (I use a Wal-Mart exclusive glucometer – Relion Prime – whose test strips are way cheaper than anyone else’s – one tiny consolation from the fact that a huge number of Wal-Mart customers must be diabetic).  Using these three tools every typical morning I take my basal temperature, pulse, and oxygen saturation before rising, and my blood glucose shortly thereafter. I don’t typically change anything specific based on the measurements, but they give me something by which to measure progress.

My fasting blood sugar for instance, varies from morning to morning and seems quite random. (The only thing I’ve noticed which will have a definite noticeable effect is three or four drinks in an evening, which will raise my morning blood sugar for at least two mornings.) Though I haven’t been able to improve my morning blood sugar with specific interventions, over the course of the past three years I’ve seen the levels slowly drop closer and closer to the ideal range, which tells me things are moving slowly in the right direction.

Of course, these tools can also be useful for short-term course corrections, especially the glucose meter. I found that on my current diet my own blood sugar is quite stable, so I stopped taking more than one measurement a day. However, you may find that some foods in particular challenge your blood sugar regulation. Using a glucose meter, a diary, and some trial and error you may be able to root out foods which are particularly problematic for you. Dysregulated blood sugar is a stress to your system in and of itself, so getting a handle on that will preserve your body’s reserves for other challenges.

I think a constellation of symptoms can show more about an underlying cause than any can individually. I have a number of questionnaires which might help clarify a situation by seeing if symptoms fall into a recognizable pattern. I can email some symptom questionnaires to you if you’re interested. Take them with a grain of salt, but they’re free, and they could give you a new avenue of inquiry.

At the end of all of this we get to specific symptoms, and the question I think you were actually asking. I don’t actually know much about [redacted] except [redacted].

Two things that might be worth considering to take up some slack from [redacted] are [redacted] and [redacted]. [redacted].

[redacted]

So there’s a much, much, longer message than probably either of us anticipated! I hope something in there can be somewhat helpful. Take care and see you soon!