Episode 209

Performance Menu: Journal of Health & Athletic Excellence

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  1. [3:55] Hemochromatosis And Pregnancy
  2. [10:28] Arguments Against Paleo
  3. [18:48] Persistence Hunting
  4. [24:27] 70 Day Bed Confinement Study
  5. [29:09] Dr. Perlmutter’s Advice
  6. [34:11] Back Pain While Back Squatting



1. Hemochromatosis and pregnancy

Susie says:
Hi Robb and Greg!

First, a little background: I recently discovered that I am a carrier for hemochromatosis.  As I’m heterozygous and a woman, at 32 years old I think I’ve just always flown under the radar with this issue.  However, my husband and I lost a pregnancy a few months ago around the 6 week mark, so I started exploring any additional protocols I could find for the iron overload issue.    Currently my ferritin level is at 169. My CRP is .8, serum iron is at 96 and my iron saturation is at 34%.  Also, my insulin sensitivity is on the sluggish side, no shocker there.  I manage this with a moderate to low carb diet and avoid most sweeteners, paleo treats and fruit.  Based on a Spectracell nutrient panel, I am not deficient in any of the major minerals.  I’ve been grain/legume/dairy free for 2 years now thanks to you Robb, and consume copious amounts of traditional foods such as kraut, kombucha (which I cut back on when pregnant to be safe), liver, bone broth and fermented cod liver oil.  I also have the Healthy Baby Code and follow it pretty religiously.  Doctors never even blink twice when they see my numbers since my ferritin is under 300 (the “traditional” model for what constitutes high ferritin) and I suspect that since they are probably used to seeing anemic women all the time, showing a high normal level of iron is probably a breath of fresh air.  They don’t seem to register the genetic mutation at all.  I know from Chris Kresser’s talk entitled “Iron Behaving Badly” which he presented at AHS (I believe you attended, but I’ve included the link to the article/video below for reference) that for women, a ferritin level over 142 is indicative of serious increase morbidity and mortality.  Things get even trickier for me because I also have a homozygous MTHFR mutation, yikes!  So much for supplementing with delicious beef liver pate.

So now to my questions: I’ve gathered Chris’ recommendations for reduction in red meat and liver/vitamin C/cast iron and regular blood donation, your past podcast recommendations including phenolics from coffee/tea/dark chocolate and phytic acid  to lower iron absorption (from episode 103 and 116 for the folks at home) and Greg’s Performance Menu article on bleeding for misanthropes, but I have been able to find ZERO information on Dr. Google about hemochromatosis during pregnancy, other than the basic premise that women tend to keep their ferritin/iron levels manageable for their reproductive years thanks to blood loss from menstruation and pregnancy.  The blood loss from actual birth makes sense, but I’m curious about what this means for both mom and baby DURING the pregnancy.  I understand we need a good dose of iron to create the 40% boost in blood volume that occurs during gestation, so part of me thinks that this moderate elevation will be eliminated or used up during the pregnancy and the use of that iron will act like a sort of internal phlebotomy and bring my levels down to a healthy normal while I’m pregnant.  The other part of me worries that having naturally high iron levels and increased absorption/inability to excrete will result in a bigger build up of iron as my blood supply grows and will lead to gestational diabetes and oxidative stress on the pregnancy as well as my organs. What are your thoughts on this issue?   Generally blood donation during pregnancy is not recommended, but in this situation is regular phlebotomy advised? What protocol do you recommend to someone trying to get pregnant and for those already pregnant with this issue?  At what iron level do you think more aggressive measures should be taken?  Are there any other dietary or supplement considerations that spring to mind to include or avoid (obviously coffee/tea/chocolate with caffeine need to be limited during pregnancy so that kind of limits the options from what I’ve gathered thus far)?  Thanks much for your time!  I appreciate all that you guys do.

P.S. Hoping for another dose of Controversial Truth soon.

Reference: http://chriskresser.com/iron-behaving-badly-the-role-of-iron-overload-in-metabolic-disease


2. In your opinion, what are the most compelling arguments against paleo?

Mike says:
Hi Robb, Greg, and Squatchy.

First off, a sincere thank you for everything that you do. I’ve been paleo now for a good three years. My asthma has nearly disappeared, my eczema is gone, and cats don’t make my eyes water. At 27, I know I’m still a youngin, but I feel like I’m actually getting stronger and healthier as I age. Which is amazing. I’ve also convinced my mother to give paleo a try, and she is happy to report that her arthritis is continuing to get better.

Now if I can just get her to deadlift…

On to my question. Most of the attacks I’ve seen on you guys (including the durianrider video where he calls your pregnant wife overweight) seem pretty damn weak, and guided more by vitriol and spite than by research.

With this in mind, I would be fascinated to hear what you feel are the most compelling arguments against paleo. I’m not asking you to tear yourself down, I just think it would be a really interesting discussion. One of the greatest things about science is, after all, it’s ability to accept and deal with criticism in the cold light of reason, without resort to name calling.

Thanks again for your time and everything that you do.



3. Persistence Hunting

Chris says:
Hey guys, I was linked about persistence hunting today and I wonder what your take is on it with regards to marathon running and health. Are these hunter gatherers adapted to run long distances? Obviously one would choose to run over death from starvation so that would be a good point in favour of this.


Here is a video: http://www.youtube.com/watch?v=826HMLoiE_o


4. 70 day Bed Confinement Study

Pat says:

As with every question… you’re awesome, we love you, keep up the good fight.

I recently applied to and was accepted into the next round of consideration for the following NASA Study:


(*Squatchy’s note, use http://webcache.googleusercontent.com/search?q=cache:Wo7wQN3RR2oJ:https://bedreststudy.jsc.nasa.gov/cft.aspx&client=firefox-a&hl=en&gl=us&strip=1

instead since NASA website is down currently)

My question is what do you think are the possible short term and long term side effects of laying in bed for 70 straight days besides the obvious muscle atrophy?


5. Your thoughts on Dr. Perlmutter’s advice to you

Peter says:

Tuesday has been one of my favorite days for the past couple of years–thank you for that.  Yesterday’s podcast with Dr. Perlmutter was no exception.  Having read your discussion of carbs in the diet a few months ago, and hearing what Dr. Perlmutter was advising you to do, I would love to hear if you are pondering adjusting your rudders and trying out a lower carb approach again.  I wonder just how much it compromises one’s cognitive future if, for example, one does a cyclic low-carb approach, only having sweet potatoes (etc.) maybe twice a week after the most intense training days?  I know you are a busy guy, not sure if this is best addressed on the podcast, in a blog post, or, due to massive uncertainty and/or your personal time constraints, something I’ll find out in about 50 years as I enter my 90s.

Thanks man, don’t start that coconut farm quite yet, the world needs you!



6. Back squat woes

Duey says:
Whenever I do back squats I have low back pain several hours later.

It doesn’t ever hurt while I am actually lifting

Interestingly front squats and overhead squats never give me this problem though. Have either of you dealt with ppl with this issue? What kind of rehab stuff should I do?

Goals are to get better at weightlifting right now.

I have had this problem for 2 years (I am 25 years old)


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Robb Wolf’s 30 Day Paleo Transformation

Have you heard about the Paleo diet and were curious about how to get started? Or maybe you’ve been trying Paleo for a while but have questions or aren’t sure what the right exercise program is for you? Or maybe you just want a 30-day meal plan and shopping list to make things easier? Then Robb Wolf’s 30 Day Paleo Transformation is for you.


  1. Martin says

    Robb, I wonder if during your 12-week keto-experiment you reduced, spontaneously or not, the caloric intake?

    Also, you mention using creatine during this period of time. I myself tried to take both creatine and beta-alanine during my ketogenic periods and these supplements seemed to give me the extra energy during high-intensity workouts.

    • says

      Body weight did not change much (other than what I’d expect from glycogen loss) so I think cals were pretty good.

      All i can say is I CANNOT roll as hard on keto as I can on mixed diet. If i were a black belt and super efficient this might be great, at the intermediate level that I find myself it’s just not my best option. I’ve also been tinkering with potato starch for the resistant starch and interestingly enough find my blood sugar to be MUCH more stable.

  2. Chris says

    Wow, the guy mentioned in the question about paleo arguments, Durianrider was banned from the Cervelo bicycle company rider forum because he was so argumentative and destructive that multiple users ask the moderator to ban him after multiple posts and threads by him were created.

    Who’d have thought I’d run across him and his b@t$#!t craziness here..

  3. Lindsey says

    Hi Robb,

    Could you please expand on the information presented on the heart and its effects on over-exercising? More specifically, the “talk” you were referring to in the podcast. Who was it that presented this information and where can I find it?

    Thanks for your help! Love your work.


  4. says

    In your answer to the arguments against paleo question you seemed to suggest reintroducing grains & legumes. I’ve never heard you recommend going back to a sad diet after paleo before, Why would someone do that?

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