Fruits and Vegetables with Digestive Disorders – Episode 134

39 Comments

Performance Menu: Journal of Health & Athletic Excellence

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Topics:

  1. [1:51] Coffee and Gluten Sensitivity
  2. [6:35] Dissolving Gall Stones
  3. [10:15] Dry Hair
  4. [15:11] Vitamin D Decline After Supplementation
  5. [17:11] Eating Bugs
  6. [19:54] Carpal Tunnel Syndrome
  7. [26:06] Beastly Deadlifts But Pansy Squats
  8. [28:30] Lifting For A Lumberjack
  9. [34:40] Paleo Fruits and Vegetables For People With Digestive Disorders
  10.  [41:52] Hormones In Meat and Eggs

Questions:

1. Coffee and Gluten Sensitivity

Justin says: Robb, I have been a follower and an advocate of the paleo diet for a few years. I attended one of your nutrition certs about 3 years ago when you still worked for crossfit. It changed my life and I’ve seen it positively effect the life’s of my friends and family members. Thank you for everything you do.

I respect your opinion so I wanted to ask you about this… http://www.thehealthyhomeeconomist.com/gluten-issues-or-celiac-dont-drink-coffee/

I know you attended Paleo FX but I’m not sure if you saw or heard this while attending. Like you, I believe coffee is delicious and makes you feel great! I’d like know if your stance changes at all after reading this?

 

2. Dissolving Gall Stones

Brandon says: Hey, Robb and Greg! Love the podcast and highly appreciate the work that you put into everything you do including your respective websites!

I am a personal trainer and have a female client that weighs over 325 lbs. We have been working together for about 3 months and things have been improving in terms of general strength and conditioning. I decided to try using the Paleo diet as an intervention to aid in her health issues (depression, thyroid issues and potential numerous other problems). About a week in, she said that she was feeling good but then had her first gall bladder attack. I am assuming that this is due to years of poor diet based in high carbs plus the sudden the increase fat intake.

She is currently scheduled for surgery in November but is on an emergency wait list and could go in with under 3 days notice. I know how doctors seemingly love to perform this procedure but I am wondering if there is a paleo friendly, bio-hack-esque solution to dissolve the gall stones and thus avoiding spending time under the knife.

Thanks for reading and sifting through my ramble!

 

3. Dry and tangled

Eva says: Hey Robb and Greg, I’ve been making my way through all 125 podcasts and I haven’t found anything that addresses hair while paleo. (sorry if it’s already been mentioned!)
I’m a 20 year old female, 5’6 140lbs and have been paleo for the last 6 months. I’ve seen some good results, mostly with my energy levels but theres been one thing that has given me issue.
After I went paleo, my hair became really dry and knotted easily… Its mostly the bottom half and its worst directly above my neck from the back.
No matter how much conditioner or the amount of times I comb it out, it still feels really frayed and hay-like.

Any ideas on what it could be or what I can do? And please do not say shave it off! (hair length goes to about mid back)

Thanks for all that you do! (you guys are definitely the most fun paleo podcasters to listen to!)

 

4. vitamin D decline

Marie says:
My son put me on to you and sent me 4 of your books to distribute to family members.
I wonder what you think about this…I had a low Vit D of 30 so I got l,000 mg supplement in addition to my multi vitamin,  that I took daily. When I was retested my D dropped to 15. Any ideas?

 

5. Eating Bugs

Matt says: So what’s the story on bugs?  I can’t imagine that pre-agricultural people didn’t get a decent proportion of their nutrients from bugs.

Why nearly starve trying to atlatl an elk when a feller can just dig around in the grass for a few hours and come up with a big plate of grubs and grasshoppers?

I’ve heard Robb say that Paleo probably isn’t a sustainable or inexpensive way to feed the world’s people.  But what about bugs?

Bugs bugs bugs.

Talk to me about bugs, Robb!

 

6. Carpal Tunnel: Fact or Fiction and What to do?

Mike says: Dear Rob and Gregg, To keep this short, My girlfriend has recently been ‘diagnosed’ with Carpal Tunnel after a year and a half of battling wrist pain.

She’s worked with the Occupational Therapy folks in HR, tried different braces, chairs, positions, desks, stretches, moving every 30-40 minutes, etc

She’s been primal/paleo for the past 2+ years having done 2 whole 30′s in the past 6 months.  Regardless of what she does, her pain fluctuates from annoying to crippling.  I have told her she needs to do more ‘activity’ which is probably her weakest point, but she says it ‘hurts’.  I’ve had wrist pain before myself and found that exercise, rest, and diet fixed this problem.  She thinks she’s getting enough Omega 3 and Vitamin D3 with her supplements, but maybe she’s not getting enough?

Is Carpal Tunnel a real thing that really needs surgery or can it really get better with diet, rest, and exercise (like mine did).  How do you overcome the lack of exercise from the wrist pain? Is there some supplement, stretch, or something she can try?  I’m taking her to acupuncture next! Please help!

Many thanks for your podcast which helped me survive the trip from NC to Los Angeles.

ps: Morgan Spurlock said you were a bad ass and that they never would have had a chance in the caveman show without you.  Here’s the link – http://www.sourharvest.com/2012/01/24/morgan-spurlock-in-discussion-with-andrew-hosner-from-thinkspace-at-the-affordable-art-fair-la/

 

7. Beastly deadlift, pansy squat

Alex says: Hi Robb and Greg, Going to try and keep this short and sweet. 5’8″ at 150ish lbs with a 28-29 in inseam.

Deadlift is 375 for multiple sets of doubles, Squat is maybe 200 for a double (way below parallel for thigh position).

What gives?  I’ve tried upping the squat volume, changing rep schemes, number of sets, weight percentage and number of days doing squats.

I believe mobility was an issue before, especially in the hip and ankle area.  I’ve been doing Kelly Starrett’s drills which have helped significantly to correct this.

Any ideas how to improve my numbers?

Goals are rock climbing, martial arts and just having a burly strength to weight ratio.

 

8. Lifting For A Lumberjack

Matt says: Robb and Greg, First off I would like to thank both of you for doing this podcast, it is a great resource for nutrition and exercise.

I compete in timber sports at the collegiate level and would like some recommendations for strength training. Timber sports is a rare sport, but it includes events that require a lot of strength and power for no more than a minute. I’m curious as to what kind of lifts, as well has how many repetitions and sets, I should be doing for this type of sport. More specifically, the events I compete in are underhand chop, standing block chop, and single buck cross cut. Since not many people are aware of this sport, at the bottom of this message you can find links to see what these different events look like in case you are not familiar with them.

In order to allow you to include the most accurate response, I thought I should include some personal information about myself.

1) I am a 21 year old male.
2) I weigh 175 lbs and am 6 feet tall.
3) I only have access to a University gym, so something like Crossfit football would be difficult to do where I will be working out.
4) I am comfortable doing lifts like squatting, dead-lifting, and power cleaning.
5) I have no aesthetic goals, only performance.
6) I will be Wildland firefighting this summer, which includes a lot of weighted hikes (around 45 lbs) and high-rep body weight training. So I will be transitioning from endurance focused training to strength and power training.

Here are the links:
Standing Block

http://www.youtube.com/watch?v=VM1obDpJQp4&list=UUAsHmimx9EddfuieCvjGCiA&index=7&feature=plcp

Underhand

http://www.youtube.com/watch?v=BYSKekHY6No&list=UUAsHmimx9EddfuieCvjGCiA&index=1&feature=plcp

Single Buck

http://www.youtube.com/watch?v=o0dJfxWAlkA&list=UUAsHmimx9EddfuieCvjGCiA&index=10&feature=plcp

Thanks again for the help it is greatly appreciated!

 

9. Paleo diet for people can’t tolerate fruits and vegetable well

Rebecca says: Hi Robb & Greg, I’ve only just recently discovered your podcast, so I’m sorry if a similar question has been brought up before.  What do you recommend for people who want to try a Paleo diet, but don’t tolerate fruits and vegetables well?

I am an acupuncturist and I see a lot of people with various digestive disorders such as Crohn’s, IBS/IBD, and “mystery” stomach issues.  I have one patient in particular with Crohn’s who was told by his gastroenterologist that about 3 1/2 feet of his small intestine is now actively infected/inflamed and wants him to start taking Humira and a steroid.  At our first appointment I asked about his diet and he said that he mainly eats bland, white foods.  So rice, pasta, breads, pork, and chicken.  No wonder he’s so inflamed!!  He is unable to eat any greens, bell peppers, seeds, and really most fruits and vegetables in any form.  If he does, it sets off his Crohn’s symptoms with severe stomach pain, diarrhea, and being completely laid up for several days.  I suggested a Paleo diet.  He’s very reluctant to go completely grain-free because he’s afraid he will be left with very little to eat.  He is ok with going gluten-free, and has been doing great with it so far.  He’s reporting some improvement in symptoms, but I think he could be doing better if he went full Paleo.  I’m going to continue to lean in to him about trying it just for 30 days.

I feel that once he gets the inflammation down and his gut is able to heal, then his sensitivity to the fruits and vegetables will decrease and maybe he’ll be able to slowly incorporate them in to his diet, at least in the form of soup or maybe in a smoothie.  Are there particular kinds of fruits and vegetables, as well as types of preparations, that you would recommend someone with Crohn’s or any other digestive condition to start with when trying to reintroduce fruit and veggies in to their diet?  Any suggestions would be greatly appreciated!  Thank you!

 

10. Hormones

Lindsey says: Hi Robb,
I’m eating fairly close to the paleo diet but am still weary about the amount of fat and protein in the diet.  One of my main concerns stems from the large amount of hormones one would consume by eating so much meat and eggs.  I’ve heard that one egg has a significant amount of hormones in it and I just don’t feel comfortable consuming that much animal product because of this.  Could you offer some information regarding this issue, please?

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  1. Lance Strish
    May 29, 2012 at 1:20 am

    Just drink Gunpowder Green tea for strong alternative. (I get it from Adagio)

  2. smgj
    May 29, 2012 at 5:10 am

    Carpal- and cubital tunnell: I’ts well woth to look into hypothyroidism and/or food intolerance (gluten).

    My cubital tunnell comes with low thyroid (hashimoto’s) and/or eating gluten grains.

    It all probably goes back to a compromised gut lining and the grains causing internal swelling. (It did in my case.)

  3. Murph
    May 29, 2012 at 8:13 am

    Robb,

    I am sure you are familiar with Pedro Bastos work since he spoke at AHS2011.

    I already know about IGF-1, but what about the other hormones, specifically the estrogens, in grass-fed dairy? All I’ve heard is that it’s less than CAFO dairy. I take that as meaning GF dairy still has estrogens, but I don’t really know how much. Are they even problematic?

    I know you say you eat grass-fed butter, so I’m guessing it can’t be to problematic.

    Your thoughts much appreciated.

  4. Tony
    May 29, 2012 at 9:15 am

    Yeah… I was drinking my coffee while listening to that first question. I stopped to listen to Robb’s answer, looked at my coffee for about 3 or 4 seconds, and said the hell with it and kept drinking. Not giving that one up!

  5. saulj
    May 29, 2012 at 9:51 am

    Regarding the carpal tunnel issue, in addition to being strict on your diet, also check out the back, shoulders and neck. There is too much information to discuss here but in my experience my wrist issues were related to my shoulder and back issues. My suggestion is to review the anatomy and physiology from the mid back up to the neck and down to the hand (not in depth, about half an hour should be good enough, you can start here: http://education.yahoo.com/reference/gray/subjects/subject/121 and here: http://education.yahoo.com/reference/gray/subjects/subject/111). Then check out this video: http://www.stopchasingpain.com/2011/05/15/carpal-tunnel-secret/.

    The idea here is that the location of the pain is not always the spot of dysfunction. The issue could be anywhere from the neck down so you have to check everything on that chain. You also have to check the upper back as lack of proper shoulder function can overwork your neck. As Dr. Nickelson states, be gentle at first as the site of the dysfunction can be super tender. Again as Dr. Nickelson states, if it is tender, that probably means you need to address those areas. Symptoms should be reduced in a few days if cause of the CT was the tender areas.

    If you need more information about the back, check out mobilitywod.com and search for “internal rotation,” “external rotation” and spinal extension.”

    Finally, I got my relief through a combination of acupuncture, massage and chiropractic. Anytime you are dealing with hands, it is a good idea to see a professional.

    Good luck on your treatment, hope it works out.

  6. Stacey
    May 29, 2012 at 12:37 pm

    I have Crohn’s and have been Paleo about 1 1/2 years. I can only eat my veggies cooked. I don’t eat a lot of fruit, but definitely peel the ones I do. Salads, smoothies, etc. cause irritation. I have to be very strict with the diet. Can rarely cheat with gluten free grains without consequences. Recently swapped to the NOW Foods enzymes and having a lot less trouble overall. Hope that is helpful.

  7. Eddie
    May 29, 2012 at 4:27 pm

    Lindsey, mail me your unwanted eggs, I’ll sure as hell eat them (and throwing in some bacon is good karma)

    Cheers

  8. Tom C
    May 29, 2012 at 6:11 pm

    Hi Robb just listened to your response on the Carpal Tunnel Syndrome question and had a few points I would like to add as a chiropractor that has experience dealing with carpal tunnel.

    Whilst on a whole I agree with most of your points that a low inflammatory diet with adequete vitamin D yada yada yada is super important and that myofascial release as you described is very effective I would have to disagree with how much emphasis you put on diet and how reliable you describe the Tinel test to be.

    I have in fact seen a patient with carpal tunnel/wrist pain that would only flare up when exposed to gluten (confirmed celiac after seeing a GP) so it definitely is a factor in some people.

    There is a huge orthopedic/ergonomic side to this though that in my opinion is the major cause. Often these people will have poor biomechanics in the fingers, wrist, elbow, shoulders and neck and almost universally have “upper crossed” posture. A double crush syndrome with impingement in multiple regions of the median nerve is fairly common. Thus a good manual therapist of any description would be beneficial in guiding treatment/improving the bio mechanics of the kinematic chain.

    Below I have outlined (/ copy pasted) the variety of testing for “confirming” carpal tunnel- Tinnel being one of the least useful. The most useful clinical way to determine the cause is using a combination of all the different tests a detailed clinical history. Given this lady in question has been on a “paleo” diet for 2 years I would be fairly confident that her problems are not diet alone (unless she was severely metabolically deranged or eating a poor paleo diet).

    Without knowing occupation/hobbies/activity preferences it really is all speculation. Certainly our ancestors didn’t sit for 12 hours a day and use a computer- which seems to describe a large portion of people with carpal tunnel. It is not uncommon for a cervical disc protrusion to cause wrist pain and mimic carpal tunnel. Really in this case I would recommend getting more information- see a physician and get some guidance.

    See below for wall of text :)

    Testing/ Diagnosis for Carpal Tunnel

    Katz Hand Diagram (B): A relatively recent review published in the Journal of the American Medical Association (JAMA) found a probable or classic Katz hand diagram, in combination with hypalgesia along the median nerve and weakness of thumb abduction, to distinguish between patients with likely CTS. Lack of these findings indicates probability that CTS is not present (1). Inter-examiner reliability of hand diagrams is high with kappa values of .83 and .88 reported (2). Others differ in their opinion citing lack of sensitivity of the hand diagram. Ferry et al found sensitivity to be only .40 when compared to delayed conduction of the median nerve (3). Overall hand diagrams are best used in conjunction with the other diagnostic procedures listed below (4).

    Thumb Abduction Weakness (B): Two studies have demonstrated the value of weak thumb abduction in diagnosis of CTS. Both studies rated sensitivity and specificity in the range of .62 to .66 (5;6). Two other studies have cast doubt on the value of strength testing for thumb abduction. These studies found thumb abduction weakness is generally spared in CTS (7;8). This test is best used in conjunction with hand diagrams and hypalgesia along the course of the median nerve according to D’Arcy et al (1).

    Hypalgesia in the Distribution of the Median Nerve (B): Golding et al reported sensitivity of hypalgia to be low at .15 (9) while Kuhlman and Hennessey reported sensitivity at .53 (6). Both of these studies demonstrated good specificity at .93 and .85 respectively. Again D’Arcy includes this test in his triad of tests leading to a diagnosis of CTS (1).

    Electrodiagnosis (B): A recent study examined 68 patients that had NCV studies performed prior to, but not analyzed until after, open CTS surgery. 63 patients had good short term results based on prompt resolution of pre-surgery symptoms. Of the five patients with less than good results, two had normal NCV studies. Interestingly 14 of the successful cases also had normal NCV studies. The conclusion of this study stated “neurophysiological studies contribute little to the diagnosis in typical cases of CTS” (10). Another study of 387 patients found sensitivity and specificity of NCV was 70% and 82% respectively (11). A systematic review in 2002 found 7 studies examining the utility of electrodiagnostic testing. It concluded where clinical symptoms are clearly defined or as a predictor of surgical success, electrodiagnosis is not warranted except where the diagnosis is unclear. Additionally this review stated there was no “statistical difference in surgical outcome between those who were electrodiagnostic test positive and those who were negative” (12). Although still considered by many to be the “gold standard”, the shortcomings of electrodiagnostic testing demonstrate the continuing need for good clinical evaluation of the patient based on “best practice” criteria.

    Magnetic Resonance Imaging (MRI) (B): In a study of 42 hands with a clinical diagnosis of CTS, MRI findings were positive in 100% of the hands while electrodiagnostic testing was positive in 84% (13). Another study concluded that MRI was a useful adjunct in the diagnosis of suspected CTS (14). Surprisingly few studies have evaluated MRI for the diagnosis of CTS.

    Ultrasonography (B): In a study of 156 patients US was compared to electrodiagnostic testing and found to have high diagnostic accuracy with the added benefit of being able to define the cause of compression (15). A second study found combining US with electrodiagnostic testing provided sensitivity of 84% and specificity of 94% (16). Again only limited studies are available on US and CTS diagnosis.

    Phalen’s Test (B): There are several studies which find Phalen’s test a valuable aid in diagnosis of CTS with sensitivity and specificity values as high as .97 and .91, respectively (17). Other studies conclude it has limited, if any, value in the diagnosis of CTS. Sensitivity values for this test are as low as 34% (18). Clinical Neurology and Surgery (19), JAMA (1) and the Journal of Orthopedic Medicine (20) all found Phalen’s test wanting.

    Hoffmann-Tinel Sign (B): Just as in Phalen’s test, this test has support for its use (9) while others have found it to be an ineffective tool for diagnosis of CTS (1;19;20). Overall the Hoffmann-Tinel sign is considered less reliable than Phalen’s test.

    Pressure-Specified Sensory Device (B): This is a relatively new device that has a cost of approximately $300. Although studies are limited, it has been evaluated in one study and has demonstrated a sensitivity of 91% and a specificity of 82%, which is comparable to NCV studies (21). A second study published in early 2009 reported sensitivity of 81% and specificity of 65% (22).

    1. D’Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 2000; 283(23):3110-3117. [ Medline ID 10865306 ]

    2. Dale AM, Strickland J, Symanzik J, Franzblau A, Evanoff B. Reliability of Hand Diagrams for the Epidemiologic Case Definition of Carpal Tunnel Syndrome. J Occup Rehabil 2008 Jun 3. [ Medline ID 18521726 ]

    3. Ferry S, Silman AJ, Pritchard T, Keenan J, Croft P. The association between different patterns of hand symptoms and objective evidence of median nerve compression: a community-based survey. Arthritis Rheum 1998 Apr;41(4):720-4. [ Medline ID 9550482 ]

    4. Walker-Bone KE, Palmer KT, Reading I, Cooper C. Criteria for assessing pain and nonarticular soft-tissue rheumatic disorders of the neck and upper limb. Semin Arthritis Rheum 2003 Dec;33(3):168-84. [ Medline ID 14671727 ]

    5. Gerr F, Letz R, Harris-Abbott D, Hopkins LC. Sensitivity and specificity of vibrometry for detection of carpal tunnel syndrome. J Occup Environ Med 1995 Sep;37(9):1108-15. [ MANTIS ID 171393 ] [ Medline ID 8528719 ]

    6. Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. Am J Phys Med Rehabil 1997 Nov;76(6):451-7. [ MANTIS ID 39555 ] [ Medline ID 9431262 ]

    7. Agabegi SS, Freiberg RA, Plunkett JM, Stern PJ. Thumb abduction strength measurement in carpal tunnel syndrome. J Hand Surg [Am] 2007 Jul;32(6):859-66. [ MANTIS ID 311484 ] [ Medline ID 17606067 ]

    8. Li ZM, Harkness DA, Goitz RJ. Thumb strength affected by carpal tunnel syndrome. Clin Orthop Relat Res 2005 Dec;441:320-6. [ MANTIS ID 231364 ] [ Medline ID 16331021 ]

    9. Golding DN, Rose DM, Selvarajah K. Clinical tests for carpal tunnel syndrome: an evaluation. Br J Rheumatol 1986 Nov;25(4):388-90. [ Medline ID 3779325 ]

    10. Finsen V, Russwurm H. Neurophysiology not required before surgery for typical carpal tunnel syndrome. J Hand Surg [Br ] 2001 Feb;26(1):61-4. [ MANTIS ID 47961 ] [ Medline ID 11162020 ]

    11. Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003; 4:9. [ MANTIS ID 130043 ] [ Medline ID 12734018 ]

    12. Jordan R, Carter T, Cummins C. A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome. Br J Gen Pract 2002; 52(481):670-673. [ Medline ID 12171229 ]

    13. Bagatur AE, Zorer G, Oral B. [The role of magnetic resonance imaging in carpal tunnel syndrome. Correlation of clinical, electrodiagnostic, and intraoperative findings and staging]. Acta Orthop Traumatol Turc 2002; 36(1):22-30. [ Medline ID 12510107 ]

    14. Deryani E, Aki S, Muslumanoglu L, Rozanes I. MR imaging and electrophysiological evaluation in carpal tunnel syndrome. Yonsei Med J 2003; 44(1):27-32. [ Medline ID 12619172 ]

    15. El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests? Rheumatology (Oxford) 2004; 43(7):887-895. [ Medline ID 15100417 ]

    16. Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve 2002; 26(6):798-803. [ Medline ID 12451604 ]

    17. LaJoie AS, McCabe SJ, Thomas B, Edgell SE. Determining the sensitivity and specificity of common diagnostic tests for carpal tunnel syndrome using latent class analysis. Plast Reconstr Surg 2005 Aug;116(2):502-7. [ Medline ID 16079681 ]

    18. Hansen PA, Micklesen P, Robinson LR. Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome. Am J Phys Med Rehabil 2004; 83(5):363-367. [ MANTIS ID 107288 ] [ Medline ID 15100625 ]

    19. Mondelli M, Passero S, Giannini F. Provocative tests in different stages of carpal tunnel syndrome. Clin Neurol Neurosurg 2001; 103(3):178-183. [ Medline ID 11532560 ]

    20. Rayegani SM ADKM. Sensitivity and specificity of two provocative tests (Phalen’s test and Hoffmann-Tinel’s sign) in the diagnosis of carpal tunnel syndrome. Journal of Orthopedic Medicine 2004;26(2). [ MANTIS ID 113760 ] [ Medline ID 113760 ]

    21. Weber RA, Schuchmann JA, Albers JH, Ortiz J. A prospective blinded evaluation of nerve conduction velocity versus Pressure-Specified Sensory Testing in carpal tunnel syndrome. Ann Plast Surg 2000 Sep;45(3):252-7. [ Medline ID 10987525 ]

    22. Slutsky DJ. Use of nerve conduction studies and the pressure-specified sensory device in the diagnosis of carpal tunnel syndrome. J Hand Surg Eur Vol 2009 Jan 7. [ Medline ID 19129354 ]

    Obesity (B+): Obesity has established itself as one of the most important risk factors in CTS. Several studies have shown that obesity doubles (6) to quadruples (5) the incidence of CTS.

    Diabetes (B+): Several studies have shown diabetes to be a risk factor in CTS, especially for women (7-9). An even greater risk is present in Type 1 diabetes (10).

    History of Hand/Finger/Wrist Tendonitis (B): A history of tendonitis has been implicated as a risk factor in CTS (11).

    Female Gender (B): Obviously you can’t prevent this risk factor. It is valuable to know that females have a 4X higher risk of developing CTS and the rate peaks during the fifth decade of life (12). Risk also increases during pregnancy but usually resolves during the immediate postpartum period (13).

    Vibration (B): Although vibration has been identified as a risk factor, diagnosis is often difficult due to the frequent co-morbidity of hand-arm vibration syndrome (HAVS) (14;15). Individuals in high vibration environments should be wearing anti-vibration gloves (16).

    Extending Wrist > 20 Degrees at the Keyboard (B): Working with the wrists extended at the keyboard can be a risk factor for CTS (17). Negative angle keyboards have been found effective in reducing this risk (18;19). One of these studies (18) identified the Microsoft Natural Keyboard as the only one of 4 tested that were of benefit.

    Hand and Wrist Anthropometrics in Females (C+): A square shaped wrist in females is a risk factor for CTS (20;21).

    Repetitive Flexion and Extension of the Wrist (C+): Although it has been generally accepted that this is a common risk factor for CTS (22), there is some disagreement as to the significance of its role as a risk factor.

    References
    1. Manktelow RT, Binhammer P, Tomat LR, Bril V, Szalai JP. Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers. J Hand Surg [Am ] 2004; 29(2):307-317.

    2. Nancollas MP, Peimer CA, Wheeler DR, Sherwin FS. Long-term results of carpal tunnel release. J Hand Surg [Br ] 1995; 20(4):470-474.

    3. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282(2):153-158.

    4. Nordstrom DL, DeStefano F, Vierkant RA, Layde PM. Incidence of diagnosed carpal tunnel syndrome in a general population. Epidemiology 1998; 9(3):342-345.

    5. Roquelaure Y, Mariel J, Dano C, Fanello S, Penneau-Fontbonne D. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory. Int J Occup Med Environ Health 2001; 14(4):357-367.

    6. Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg 2002; 48(3):269-273.

    7. Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002; 113(9):1429-1434.

    8. Ferry S, Hannaford P, Warskyj M, Lewis M, Croft P. Carpal tunnel syndrome: a nested case-control study of risk factors in women. Am J Epidemiol 2000; 151(6):566-574.

    9. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg [Br ] 2004; 29(4):315-320.

    10. Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes. Diabet Med 2005; 22(5):625-630.

    11. Werner RA, Franzblau A, Gell N, Hartigan AG, Ebersole M, Armstrong TJ. Incidence of carpal tunnel syndrome among automobile assembly workers and assessment of risk factors. J Occup Environ Med 2005; 47(10):1044-1050.

    12. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58(2):289-294.

    13. Turgut F, Cetinsahinahin M, Turgut M, Bolukbasi O. The management of carpal tunnel syndrome in pregnancy. J Clin Neurosci 2001; 8(4):332-334.

    14. Hill C, Langis WJ, Petherick JE, Campbell DM, Haines T, Andersen J et al. Assessment of hand-arm vibration syndrome in a northern Ontario base metal mine. Chronic Dis Can 2001; 22(3-4):88-92.

    15. Hirata M, Sakakibara H. Sensory nerve conduction velocities of median, ulnar and radial nerves in patients with vibration syndrome. Int Arch Occup Environ Health 2006.

    16. Jetzer T, Haydon P, Reynolds D. Effective intervention with ergonomics, antivibration gloves, and medical surveillance to minimize hand-arm vibration hazards in the workplace. J Occup Environ Med 2003; 45(12):1312-1317.

    17. Liu CW, Chen TW, Wang MC, Chen CH, Lee CL, Huang MH. Relationship between carpal tunnel syndrome and wrist angle in computer workers. Kaohsiung J Med Sci 2003; 19(12):617-623.

    18. P Tittiranonda et al. Effects of four computer keyboards in computer users with upper extremity musculoskeletal disorders. American Journal of Industrial Medicine 1999; 36:647-661.

    19. Woods M, Babski-Reeves K. Effects of negatively sloped keyboard wedges on risk factors for upper extremity work-related musculoskeletal disorders and user performance. Ergonomics 2005; 48(15):1793-1808.

    20. Boz C, Ozmenoglu M, Altunayoglu V, Velioglu S, Alioglu Z. Individual risk factors for carpal tunnel syndrome: an evaluation of body mass index, wrist index and hand anthropometric measurements. Clin Neurol Neurosurg 2004; 106(4):294-299.

    21. Moghtaderi A, Izadi S, Sharafadinzadeh N. An evaluation of gender, body mass index, wrist circumference and wrist ratio as independent risk factors for carpal tunnel syndrome. Acta Neurol Scand 2005; 112(6):375-379.

    22. Ugbolue UC, Hsu WH, Goitz RJ, Li ZM. Tendon and nerve displacement at the wrist during finger movements. Clin Biomech (Bristol , Avon ) 2005; 20(1):50-56.

    23. McCabe SJ, Uebele AL, Pihur V, Rosales RS, Atroshi I. Epidemiologic associations of carpal tunnel syndrome and sleep position: Is there a case for causation? Hand (N Y ) 2007 Sep;2(3):127-34

  9. Debbiejburke
    May 30, 2012 at 6:02 am

    I usually love all things Robb Wolf but just listened to a Podcast for the first time and though I did get some valuable information, I was shocked at the amount of foul language. I hope they might realize that it might offend a lot of people. And if by a slim chance that Robb is reading this he might be saying a curse word at me and basically ” if you don’t like it, don’t listen” , but I think there’s others who might feel the same. I was going to refer my 74 year-old father to your Podcasts to listen to your stuff about Paleo and Crohns (which he suffers greatly from) but no way. He’d have a heart attack listening to the cursing. I will continue to use your site and I have loaned my Paleo solution book about 10 times, referred tons of people to your website and I always sing your praises to everyone that asks me about my Paleo lifestyle but I won’t refer them to your podcasts for sure. I feel like I’ve been let down a little by my Paleo “hero” since Paleo has been one of the best things that has happened to me (no more digestive disorder symptoms yay!).

    • Amy B.
      May 31, 2012 at 1:40 pm

      Debbie — the podcast is usually pretty clean with the language. Every now and then something slips through. This week’s had a lot more swearing than usual, but Robb specifically mentioned at the beginning that he was sleep deprived and not in the greatest frame of mind. I’m not defending it, just explaining a little. Don’t let a few words here and there prevent you from accessing all the amazing information Robb offers completely free of charge.

      • Amy Kubal
        May 31, 2012 at 2:59 pm

        Debbie – Amy B. is right-on. Robb is one of the nicest guys you could ever meet. And he’s brilliant – the knowledge he dispenses is definitely worth a couple F-Bombs every once and a while. It adds to the podcast experience. Robb and Greg are ‘real’ – not actors with scripts and yet, they are damn entertaining! :)

        • LJH
          May 31, 2012 at 8:24 pm

          +100

          The F-bombs don’t bother me a bit and the information, both from the book and podcast, has pretty much saved my sorry ass – not to mention the rest of my formerly pathetic & unhealthy 65 yr. old bod.

  10. Dineen
    May 30, 2012 at 6:14 am

    Eva’s “damaged” hair is (sounds like) the older hair that probably was grown prior to her eating paleo. The damaged appearance is the contrast with the healthier hair growing now. The spreadsheet recommendation is a good idea to find out why/how the change happened. The healthy oil from her scalp just isn’t making it down to naturally condition the hair (and perhaps the artificial conditioning is overdoing it).

  11. Dana
    May 30, 2012 at 7:00 am

    I would like to add on to Robb advise for Eva regarding your hair.

    I had a incident where after being on Paleo for nearly two years I started to lose my hair. I found out that I was iodine deficient. So please follow Robb’s advice and find out if you are deficient in anything.

    But, I have a few questions for you. Is you hair color treated? Did you switch to a new conditioner? You mentioned that it is the bottom half of your hair. Have you had a haircut lately to cut off the damaged ends? Also, you mentioned, “no matter how much conditioner or the amount of times I comb it out, it still feels really frayed and hay-like.” You could be over conditioning your hair! The conditioner that you are using could actually have chemicals (like most) in it that actually dries out your hair. How often do you wash your hair? Remember that the oils on your scalp are there to lubricate your hair shaft and keep it soft and shiny.

    I took going Paleo another step nearly two years ago and started not using shampoo or conditioner on my hair. I use baking soda and water as my shampoo and apple cider vinegar and water as my conditioner. Once I week I use a coconut oil treatment on my hair. But I only wash my hair twice a week. I have long hair down to the middle of my back that is not colored treated at all.

    I hope this helps. I feel your pain Eva. Feel free to contact me if you wish.

    • Eva
      June 7, 2012 at 9:49 pm

      Hey Dana,

      Thanks for all the advice – I actually did a little experimenting and I found that including raw dairy has reversed the hair issue completely.

      It seems to work for me! But I’m thinking about getting any deficiencies tested as well..

      Thanks Robb and Gregg! (And no gluten free crackers … :P)

  12. Josh
    May 30, 2012 at 1:16 pm

    Hey Robb,

    So I’ve heard the Vitamin D dry tablets are poorly absorbed, but just to be sure you mentioned that capsules/softgels such as this one are no good either ?

    http://www.nowfoods.com/Supplements/Products-by-Category/Vitamins/Vitamin-D/M103118.htm

  13. Amy B.
    May 31, 2012 at 6:41 am

    Wow…no coffee and completely jacked up sleep patterns make Rob swear a lot. Me likey! Sometimes there’s nothing like a good F-bomb to really drive home a point!

    And I agree 100% – green tea might have a ton of health benefits, but compared to coffee it might as well just be dog piss!

    • Amy B.
      May 31, 2012 at 8:41 am

      …and apparently 1/4 my usual amount of morning coffee wasn’t enough to make me remember that Robb has TWO Bs. ;)

  14. Stephanie
    May 31, 2012 at 6:55 am

    More baby stories please. I’m still laughing at the thought of you standing shock-still in the hall, bottle in one hand, baby in the other, baby poop dripping everywhere and the only thing you wanted to do was get to the toilet.

  15. Nicole
    May 31, 2012 at 7:07 am

    Hey Guys! Love your Podcast, but I think you missed the boat on question ten. It sounds like she’s asking about the endogenous hormones found in meat and eggs–you know, the ones needed to grow a baby chicken? You call out specific proteins like gluten and other prolamines as damaging and able to make it through our systems partially undigested, and then able to cause a whole host of problems from there. I think a little due time discussing the hormones naturally contained in all protein sources (plants included) was warranted. Do we digest them more thoroughly? Are we better equipped to take them apart so our bodies don’t see them as endocrine disrupters?

    I hope you’ll go Round 2 on this one.

  16. AJ
    May 31, 2012 at 8:09 am

    Great podcast Robb and Greg.

    I would love to hear more info on the Vitamin D caps not being useful.
    What are some other quality brands of D drops other than Carlsons?

    Thanks

    • paleoslayer
      June 1, 2012 at 7:31 am

      I use Ddrops
      Ddrops® contains vitamin D and a thin vegetable oil. The oil is purified from coconut and palm kernel oil. There is no chemical treatment involved. The oil is distilled and is similar to the oils present in breast milk.
      It is wheat-free, gluten-free, soya-free, sugar-free and peanut-free. It is tasteless, odourless with no artificial flavours, no colouring and requires no preservative.

  17. Patti Bohaty
    May 31, 2012 at 10:46 am

    I’m in my cube with my headphones on laughing my ass off at Robb’s poop story. And thanks for telling off Lindsey. You guys are the best.

  18. paleoslayer
    June 1, 2012 at 6:52 am

    More angryRobb! that’s what makes me keep listening.
    There is a palpable sense of anger there. Prob stemming from the fact that hes had to repeat himself over and over and listen to the same BS arguments.
    But in defense of Lindsay and all other ‘uninformed ppl out there I will say that its not stupidity that’s the cause of this problem. What is the main problem then?

    It’s the prevailing cultural paradigm of what constitutes good health and fitness. The paradigm that’s pushed by mass media, national health organizations and even medical professionals. And folks, its being done on purpose.
    The only defense one has to this ‘mental programming’ is to think critically,logically at the facts and arrive at a conclusion for oneself. But who has time for that when the ball game is on? And those hot dogs, peanuts and beer taste so good.
    —-
    PS thanks man for the floor press tip. No shoulder probs and Im starting to make good progressions again.

  19. Patty Dewey
    June 1, 2012 at 9:09 am

    I love you guys!! Between your response to Lindsey and the poop story you had tears streaming down my face. I remember times like that Robb, shitty all the way from their calves to their nipples….mine are now almost 17 and 13….time flies

  20. Jen
    June 2, 2012 at 8:22 am

    Robb, I’m pretty sure it’s “lather” THEN “rinse” and repeat. But don’t do it. It’s a total scam that’s used to sell twice as much shampoo. If you’ve been following the directions you’re a sucker.

  21. NT
    June 2, 2012 at 8:35 am

    “YOU NEED TO DO YOUR F’IN RESEARCH.” BIG TIME LOL! When I heard that question, I looked at my husband and said, oh this answer is going to be GOOD. Love the podcast – and we decided to order some additional books to let others “do the research” too. We constantly get questions and get told how our diet “shouldn’t work” and “wow, have you had your cholesterol checked lately?” and “Well my doctor just said I need to go on a low-fat diet because my family has a history of heart disease” and “That’s not a sustainable lifestyle in the modern world!” REALLY? We’re going to just give out books on “loaners” and see hope to see them come back. In the end, I think it’s the best introduction to those who ask us about our lifestyle and want to know more. We can be an example and the first “nugget” of information to them, but in the end – the book has all the bread and butter (or lack thereof!) Thanks for writing it!

  22. Mike L
    June 3, 2012 at 9:30 am

    This will forever be known as Podcast #134 Lindsey. Short and simple yet so perfect. ahah

  23. Lindsey
    June 5, 2012 at 4:46 pm

    I don’t think my question was understood properly. Like Nicole said, I’m not asking about hormones that are being injected into animals and yes, I HAVE done my research, thanks. I am talking about the naturally occurring hormones in animals such as, estrogen, testosterone, etc., which occur in humans. I’ll go find my information elsewhere.

  24. Ashley North
    June 6, 2012 at 10:49 am

    I like the idea of creating a spread sheet of the Paleo foods that you have eaten over the past few days. That is such a smart idea to enable you to be able to zero in on any potential vitamin and mineral short comings. I wouldn’t bother typing up a sheet of the CW foods I used to eat in a regular day, though. It’s hardly reliable to calculate all the vitamins and minerals you are actually absorbing when a large portion of your diet is grains. Don’t grains inhibit you from absorbing a lot of the vitamins and minerals that you are eating??

    Awesome podcast, as usual.

  25. Cameron MacLellan
    June 7, 2012 at 4:08 pm

    This episode is so funny! All this meat talk is making me hungry, I think me and my 2yr old are going to eat steak and eggs for dinner tonight. End I am on the same page with the Vegetarians, more meat for us. And I am pretty sure I have told somebody I would eat a vegetarian too! All in all great ending to this podcast. Cheers!

  26. David Fisher RD
    June 14, 2012 at 3:53 am

    If Brandon’s client has lost a lot of weight fairly quickly gall stones would be very likely. Gastric bypass patients are virtually guaranteed to get gall stones, so much so that sometimes the gall bladder is removed along with the procedure! This might be the simplest explanation for her stones and it is very well documented.

    On another note I think I am still laughing at Robb’s diaper explosion story. Hilarious.

  27. Nicole B
    June 19, 2012 at 3:39 pm

    Re: Coffee Disappointment

    I don’t know if any of you have looked into it, but have you looked into or tried yerba mate? Roughly around the time I discovered and started paleo, I discovered yerba mate. It’s an awesome drink; you prepare it like tea (but it isn’t technically tea) and it claims to provide a lot of health benefits. I’ve made it a regular part of my daily ritual and I can’t imagine not having it be a part of my diet. I don’t know if any research has been done into it and gluten sensitivities/autoimmunity, but so far I don’t know that I’ve experienced any side-effects so far as that goes.

    I know of quite a few individuals who’ve broken their coffee addiction by taking up a yerba mate habit. :p

  28. Tricia
    August 11, 2012 at 7:32 pm

    In regards to the hair question(I’m glad the raw dairy helped in Eva’s situation) I just wanted to mention that aside from diet and illness contributing to dry brittle hair, build up can play a factor as well. A lot of low end (and even some high-end) shampoos and conditioners contain silicone which coats the hair. It will make hair shiny for a while, but it can dry it out and make it frizzy over time. Well water and some city water as well chlorinated pools can cause build up. Also, using too much protein in hair products when your hair isn’t damaged can dry it out as well. A good clarifying treatment at the salon will get the build up out and using a clarifying shampoo very 4-5 washes will keep hair brighter and softer. Argan oil has become really popular for smoothing and supporting the health of the hair without weighing it down, but because it is so popular there is a bit of over saturation in the market and you will find that you have to do a little ingredient analysis to get a good quality.

  29. Lynne
    January 13, 2013 at 10:46 pm

    Ha ha, Robb, great reply to the last Q, classic health guidance fatigue. I have a few friends like Lindsey. You wanna help them but it gets a bit frustrating sometimes when they just want you to do all the work researching and evaluating the info and not use their own brains. Love you guys and Cris Kresser cos you’re pretty balanced and not total food fascists xx

    • Robb Wolf
      January 14, 2013 at 8:54 am

      this is why I really insist that they just give it 30 days…minimal questions. Let the results speak for themselves.

  30. Sentinel
    May 25, 2013 at 11:58 am

    Regarding carpal tunnel syndrome: I had ulnar impaction syndrome, which is very similar. Every few days my wrist would be engulfed in pain so bad I could not sleep or use my wrist for a day or two. I tentatively determined it was caused by the mindbody illness “TMS,” and after reading Dr. John Sarno’s “Mindbody Prescription” and seeing a TMS specialist MD, the pain went away and did not return. Worth looking into. I think Sarno’s work is basically an elegant paleo-compatible “mind hack.”

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