Podcast Questions for Doc Parsley!

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Howdy folks!

The recent podcast with former US Navy SEAL, Dr. Kirk Parsley, MD has been “wicked popular.” If you missed it, please do check it out as we cover a lot of ground related to Evolutionary Medicine, Sleep and related topics. As you hopefully know, Doc Parsley will be in Reno this weekend for the Evolutionary Medicine talk sponsored by Specialty Health. This seems like a great time to do another podcast with Kirk, so if you have questions related to sleep, prepping for special operations selection, hormonal modulation (adrenal, thyroid issues etc) or how to make a hell of a frittata (Doc Parsley ain’t bad in the kitchen!) put them in the comments. We may do this podcast tomorrow (Friday) morning, so don’t dally!

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  1. Joseph
    June 6, 2013 at 11:12 am

    Doctor Parsley,
    I was diagnosed with stage 3 adrenal fatigue (too much law school, coffee, and not enough sleep). What advice can you provide for getting my adrenal glands back online?
    Robb, I remember you mentioning you suffered from adrenal fatigue; could you talk about your experience recovering?

    Thanks,
    Joseph

  2. David
    June 6, 2013 at 11:17 am

    Hi Rob/Kirk – just had my hormone test results come back from my functional med doc:

    Cortisol – Morning (6 – 8 AM) 16.4 13.0 – 24.0 nM/L
    Cortisol – Noon (12 – 1 PM) 4.3* 5.0 – 8.0 nM/L
    Cortisol – Afternoon (4 – 5 PM) 3.2* 4.0 – 7.0 nM/L
    Cortisol – Nighttime (10 PM – 12 AM) 1.3 1.0 – 3.0 nM/L
    Cortisol Sum 25.2 23.0 – 42.0 nM/L
    DHEA-S Average 1.66* 2.00 – 10.00 ng/mL
    Cortisol/DHEA-S Ratio 15.2* 5.0 – 6.0 Ratio

    I have started with DHEA and pregnenolone. Said it could take 12-18months to fix.
    What is your opinion based on the results? What training can i do in the meantime?

    Tks,
    David.

  3. Jack Penner
    June 6, 2013 at 11:21 am

    What are your thoughts on Chronic Fatigue Syndrome (CFS) as it relates to the HPTA Axis?

    I just finished writing my senior thesis on CFS and nutritional interventions, and I am convinced that a huge part of CFS is just “running ourselves into the ground” with poor sleep, too much stress, bad nutrition.

    As far as I saw, the glucocorticoid and immune profile in the literature seems like people with CFS are all in different places on the spectrum of chronic inflammation and chronic HPA stimulation. Have either of you had experience with Paleo alleviating CFS?

    I would really like to expand the paper to become “Paleo Diet and Lifestyle as a means of alleviating CFS.” Any insights you guys have could help keep me going in that direction.

    Thanks Robb and Dr. Parsley. Really looking forward to this podcast.

  4. William
    June 6, 2013 at 11:28 am

    Hey fever (grass allergy). Is it better to suffer with the allergies (and I assume inflammation) or go with the low dose antihistamines for 4 months of the year?

  5. Patrick
    June 6, 2013 at 11:31 am

    Very excited to hear Dr. Parsley will be back on the show! Many thanks to him, and to you Robb and Greg, for you all are doing with the podcast. It is usually informative and always funny! Only kidding. On to the question.

    Following a period of about 2 months of over training last summer, I’ve had some problems with anxiety and heat intolerance. I’m not sure if they are related, but figured they might be because I’ve never had trouble with either in the past and then they both showed up.

    I was doing Crossfit four times a week and eating about as low carb paleo as you could go. I know Robb is rolling his eyes, but I got caught in the tunnel vision of trying to lean out as quickly as possible and unfortunately thought that was the way to do it. I leaned out but not without consequence. I thought I was doing well just eating paleo, but had yet to discover how activity level should largely dictate your carbohydrate intake.

    I would get lightheaded all the time at workouts and had some gnarly orthostatic hypotension during the course of just a normal day. A shoulder injury made me slow down, and I eventually wised up to the nutrition for that kind of demand. But since then, I’ve had some mini panic attacks and also heat sensitivity. I was born in Florida, was a 3 sport athlete and thrived in the heat. Now I’ll be at the golf range for a few hours and then feel like I’m going to pass out when I come inside, or I’ll get very lightheaded at a sporting event outside (as a spectator).

    I am 30 now, eat very clean with a paleo template, and get good sleep. Stress levels are reasonable with some meditation and lots of walking. I exercise 2-4 times a week: lifting, jogging, jump rope, swimming… I just try to move. Only other health thing is that I have familial hypercholesterolemia, but am not taking medication for it. Statins freak me the frack out.

    Did I do something to the adrenals with that over training, and could that interact with whatever is going on in my liver? Could this all be related? Or am I just getting older and need deal with it? Thanks again to all of you!

  6. Steph
    June 6, 2013 at 12:28 pm

    Hi there! Thank you guys so much for everything you do – I’ve been 100% Paleo for over a year now and it’s changed my life. Like many people, I found my way to Paleo when I was at my wits’ end with a chronic health problem; in my case, debilitating migraine headaches that lasted 7-10 days, with maybe 5 days in between. I used triptans (Imitrex, Maxalt etc) to control them, which caused an endless rebound cycle. After switching to Paleo and going cold turkey on the pain meds, plus adding a lot of home HIIT to my routine, I’m down to an average of one migraine a month, typically lasting less than 24 hours. I discovered that a 35-40 minute hard-ish workout (a 5km run, 40 mins of moderate intensity rowing, etc) can often drive the headache away completely (although not always), which seems extremely weird. A doctor in Johannesburg, Eliot Shevel, says that migraine pain is caused by dilation of the extra-cranial blood vessels, which accords with my experience of tempering the pain with a super tight bandanna around my temples. Sorry about the looooong intro, but what I would like to know is, can you tell me anything about the impact of adrenaline on dilation of blood vessels? The migraines I do have seem highly contingent on bursts of adrenaline – an overly intense workout, a close race at my masters swim club, a badly stressful day at work – and are clearly tied to a lack of sleep, as well. Then there’s the estrogen connection – I’m far more prone to migraines the week of my period than any other time. I would give just about anything (and believe me, I have given this some thought – 10 IQ points, my left foot, my eyesight for 5 hours a day) to find a way to shut the headaches off entirely. Can you suggest what the physiological process is that creates the pain, and how to avoid it?

    Thank you so much, can’t wait to hear the podcast.

  7. Meesha
    June 6, 2013 at 1:54 pm

    With all this research about sleep and performance degradation, why do medical professionals still work 12 hour shifts and 12 hour night shifts? And I think I’ve heard that some shifts may be even longer.

    Are there studies that show that fewer shift changes have a greater impact on reducing human error than shorter shifts? What, in your opinion, would be a good patient care model as far as shift lengths?

  8. Saul
    June 6, 2013 at 3:34 pm

    Hello Robb, Greg and Doctor Parsley,

    I love the podcast. Sincerely, thank you guys. I am 31, 5’10 270lbs, 10 year police officer, 8 years on night shift, Type II Diabetic since age 25, diagnosed with membranous nephropathy at age 28. A1c normal to normal-high last few years and no more protein in urine for a couple years now.

    I began to suspect and got tested for low Testosterone after among other symptoms,my progress stalled(strength/muscle gain and fat loss)even though I work hard at my diet, strength and conditioning. Free Testosterone level was 280 the first time, 340 a few days later and doc was satisfied and took no further action. I understand why it is low given my medical history, sleep and body fat levels. After looking into the dangers of low T and all the benefits of TRT, I wonder if a TRT clinic is a good option for me.

    Might this be the missing link for me to reach a healthy body fat % and improve all my other related symptoms. I know I have to keep eating paleo, lifting heavy, working on fat loss and bide my time till I can get off the graveyard shift, but is TRT right for me? And for how long? Is there coming off of TRT safely or does it have to be permanent? Or should I go a different route all together?

    Thanks for any help, please feel free to chime in all!

    • Saul
      June 6, 2013 at 9:53 pm

      Maybe notable to mention also, I’ve been at it for almost a year, started at 305 lbs, fat loss stalled for the last 6 mos.

  9. Paddy
    June 6, 2013 at 3:59 pm

    Hi guys, thanks for all the work you do.

    Ironically, I fell asleep during the first episode with Doc Parsley, so apologies if this has been addressed already.

    There seems to be two schools of thought when it comes to sleep. One says establish a routine, go to bed and wake up at the same time everyday. The other says sleep when you can, this includes naps and sleeping in on the weekends. If you’re only sleeping 6 to 7 hours a day, which strategy would you recommend?

  10. Dan
    June 6, 2013 at 4:09 pm

    Hi Doc and Robb!
    Just wanted to know if there is some working guideline to rehabilitate ones self from being stuck in pregnenalone steal. After 3-4 months of continuous immense stress at work, I was still trying to incorporate all my training and of course the first thing to go was my sleep duration.

    Fast forward to the breaking point where I said enough is enough – I was down 5kg (95kg from 100 @ 13%bf), blood tests revealed extremely low testosterone and pretty low thyroid (unfortunately no cortisol levels were taken at the time).

    So trying to come out of the ‘hole’ I was/am in it feels like a fine balance to stay on the right path to recovery without all of a sudden over doing it (in the gym or the unforeseen work/life stressors) and coming crashing into a heap again and practically starting at square one.

    any advice you can give is much appreciated.

  11. Karen
    June 6, 2013 at 10:53 pm

    Dr. Kirk: My husband’s blood tests three months ago were: Cholesterol 313; trigs 226; hdl 46; lipoprotein(a) 75; fasting glucose 119; A1C 6.0. After three months of eating paleo, lost 12 pounds, new numbers: Cho 294; trigs 192; ldl(measured) <130; hdl 51; fbg 118; A1C 5.6. (prior CBC 10 years ago, perfect numbers)

    Doc wants him on statins immediately. Husband says no. He's 64, 189 pounds, BP 120/60. Still surfs. Should we be worried? Mom had massive heart attack at 64, died at 88; dad strong until death at 89 from ALZ, no meds.

    What would you do with these stats? Statins? Niacin? Aspirin? (Hey, Greg and Robb, you rock!)

  12. Brent
    June 7, 2013 at 6:24 am

    Dear Doc Parsley et al.,

    I am applying for Marine Corps OCS. I have been in the application process for about two years, as I’ve needed a few waivers and selection is very tough with the Corps winding down its numbers.

    I have (barely) maintained a 300 PFT score throughout most of this time. When I started, I did not have even a passing score, with 6 pull-ups, 6 AM BREAKFAST: coffee with 6 blocks fat (block = 3g; fat = coconut milk)
    –>12 PM LUNCH: 6 blocks protein, 6 blocks fat, 3 blocks carb (non-starchy veggies)
    –>6PM PWO SHAKE: 6 blocks protein (eggs and grass-fed whey protein), 6 blocks high glycemic paleo carb
    –>7PM DINNER: 8 blocks protein, 24 blocks fat, 7 blocks carb (mix of paleo starch and veggies)
    –>1-2 CHEAT DAYS/wk, but almost always maintaining a 16 hour fast (keeps my mind very sharp; eating in the AM makes me grumpy and unfocused).

    Exercise:
    –>531 squat/press, with oly lifts, weighted pull-ups, and a short “cash-out” crossfit WOD 1x/wk
    –>531 dead/bench, with oly & accessory lifts and a short “cash-out” 1x/wk
    –>Bike 25 miles, with 6x10reps & 1x15reps pull-ups throughout AM & PM 1-2x/wk
    –>Heavy crossfit type AMRAP or RFT, with gymnastic skills & drills 1-2x/wk
    –>One of trail/interval/distance run 1-2x/wk
    –>Rest 1-2 days/wk
    –>Extreme exercise like all-day ruck or ride, 1/2 mara, etc, 1-2x/month
    –>Entire week off b/c of travel once every 2 months or so

    Stress mitigation:
    –>Min. 8hrs sleep/night
    –>Meditation practice 1/2 hr 3-4x/wk

    Is there anything obvious that sticks out, like “well no wonder you can’t get any more pull-ups!”?

    I realize this is horrendously long. Thanks in advance for your help and take care.

  13. Brent
    June 7, 2013 at 6:25 am

    Not sure what happened there, middle of question is missing (?)

  14. Brent
    June 7, 2013 at 6:49 am

    Middle of comment June 7, 2013 at 6:24 didn’t go through for some reason. Here is the missing section:

    I can’t seem to get past a plateau of 20 pull-ups. I’d like to get 25 so I don’t have to worry about the PFT. Here are my stats:

    175lbs, 28 years old, est. BF = 14-16%.

    Diet:

  15. Matt
    June 7, 2013 at 6:50 am

    Hello Dr. Paisley & Robb: you make a great team and I hope this can be a regular thing.

    I suffer from insomnia, but also want to get my steady workouts in. After a night of sleeplessness, should I work out anyway (to not miss a workout + make myself tired enough to sleep) or skip the workout and get some extra sleep the next day?

    Thanks
    Matt

    PS: Robb I know there was a similar question recently, I’m just curious what the good Dr.’s take is.

  16. Charles
    June 7, 2013 at 8:45 am

    Doc Parsley,

    I’ve been dealing with chronic injuries going on 3 years now. I’ve been to many orthopedics and PTs with little to no success. All my MRI/X-Rays do not reveal any obvious structural damage. The problem seems to be relegated to my hips, knees and feet. I am dealing with pain on a daily basis. PT work doesnt seem to have any impact, although I continue to stretch and mobilize. I’ve had cortisone shots that do not really seem to be doing much of anything, which lead me to start doing some blood work.

    I’ve had my CRP checked 3 times in the past year and it has never been higher than .26. Two of the 3 were under .2. As I understand CRP to be a general indicator of inflammation, shouldnt that number be much higher if an injury is present? If the pain is not caused by inflammation, then would could be the cause?

    I have been fighting low Vitamin D levels as well. I’m not sure how long my Vitamin D has been low, but i checked it for the first time in June 2012. Below is a Test history:

    June 2012 Vit. D 27.2 – Started taking 4000IU daily
    November 2012 Vit D 22.9 – Upped the dose to 8000IU daily
    January 2013 Vit D 27.4 – Decided to stop supplements and try 3xweek in tanning bed for 1 month
    March 2013 – Vit D 29.7 – Trying bolus dose of 30,000IU twice a week.
    May 2013 – Vit D 28.6 – Upped Bolus Dose to 52,000 twice a week

    Any advice would be greatly appreciated.

    Thanks

  17. Amy B.
    June 7, 2013 at 8:52 am

    Great to know “the sleep doc” is coming back for round two. As Robb would say, I guess his professional reputation wasn’t trashed enough by his first appearance. (HA! JUST KIDDING!)

    I’ve heard Robb (and others) say that sleep deprivation–both acute and chronic–can cause insulin resistance, and that following one night of very poor sleep, you can be as insulin resistant as a type 2 diabetic. This makes sense to me in a “big picture” way, but I was hoping Robb or Dr. Parsley could explain some of the actual mechanism that’s at work there.

    Am I right in assuming it’s at least somewhat tied in to cortisol? (My logic: lack of sleep is perceived as a stressor. After all, from an evolutionary standpoint, if we’re not sleeping, there’s got to be a reason for it, like something in our camp/environment is wrong, or there’s some kind of danger or threat going on.) So cortisol is up, blood glucose is up, and insulin is up — *even if we’re eating on the lower-carb end.*

    (Is this why I crave a donut come Friday, when insufficient sleep all week long has accumulated? :D )

  18. David
    June 7, 2013 at 11:58 am

    David June 6, 2013 at 11:17 am

    Some supplementary info: 38, married,3 kids(5months-5yrs), run my own business with lots of travel. Eat a 95% paleo diet, supplement with vit d 1500-2500iu, mag citrate, bone broth, homemade sawerkraut. Would describe my self as a fit, type A, ectomorph, 79kg, 6’1 – built for speed not for comfort! Always lifted weights and played a lot of soccer. Picked up CrossFit 9 months ago – fucked me up big time. 2 chest infections since Xmas that lasted 9 was in total. Below is where I am now. Hope this gives some context…

    Hi Rob/Kirk – just had my hormone test results come back from my functional med doc:

    Cortisol – Morning (6 – 8 AM) 16.4 13.0 – 24.0 nM/L
    Cortisol – Noon (12 – 1 PM) 4.3* 5.0 – 8.0 nM/L
    Cortisol – Afternoon (4 – 5 PM) 3.2* 4.0 – 7.0 nM/L
    Cortisol – Nighttime (10 PM – 12 AM) 1.3 1.0 – 3.0 nM/L
    Cortisol Sum 25.2 23.0 – 42.0 nM/L
    DHEA-S Average 1.66* 2.00 – 10.00 ng/mL
    Cortisol/DHEA-S Ratio 15.2* 5.0 – 6.0 Ratio

    I have started with DHEA and pregnenolone. Said it could take 12-18months to fix.
    What is your opinion based on the results? What training can i do in the meantime?

    Tks,
    David.

    Reply Permalink

  19. Eddie
    June 7, 2013 at 12:21 pm

    Seems kind of interesting,I like a couple of what has been said here. What works for me when I’m having rough nights is If I keep a steady sleep schedule. Lately I have been going to bed at 5 am(lol), but that’s hopefully only temporary. But what has worked when I’m actually able to sleep normally is if I have a set routine in order in terms of a schedule. I have to build up the rhythm in my habits ex: consistently go to bed at 11 p.m for a week or two straight, before my sleeping pattern fixes itself. I know it isn’t anything miraculous, but it is what worked for me.

    My blog on Intermittent Fasting
    Ed’s Intermittent Fasting Tips

  20. Eddie
    June 7, 2013 at 12:22 pm

    If all fails you could always just try Nyquil(lol), just kidding don’t do that.

  21. Matt
    June 9, 2013 at 1:42 pm

    Kirk Parsley is great, I have learned a lot from him.

    Rgds,
    Matt

  22. Kim
    June 12, 2013 at 7:51 am

    Hi All!

    I’m really stuck and frustrated…I’ve been Paleo for 3 years (with some cheats) and I’ve lost 40 pounds :) but now I’ve been stuck for at least a year. I can’t seem to get under 195! I’m a 42 year old woman trying to figure out how to blance my hormones, eat paleo, work full time at the office and help out with our Box night/weekends and also work out 4+ days per week.

    My question to all the experts out there is before I give up on Paleo…IS only sleeping 5 hours a night really what’s holding the weight on?

    Thanks!

    • Robb Wolf
      June 12, 2013 at 7:55 am

      Kim…lordy, yes. If you do not sleep, you will have a hell of a time leaning out…

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