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News Topic:
Fatigue and Pain Sent Her to the ED: Medical Mystery Solved
Show Notes:
Aglaee Jacobs M.S., R.D.: Digestive Health With Real Food
Questions:
Intestinal Methane Overgrowth
Keri writes:
Gluten tag from your old home of New Braunfels! I really appreciate you two and your no nonsense, but super informative podcast. It always hits home for me. I have gone back and forth between keto and carnivore since 2019. Felt great at first, but the last 18 months have had weight gain, bloating and constipation. Never really had a weight issue before. I’m 5’7” and have averaged 135 pounds pretty consistently. I was referred to a gastroenterologist, did the breath test, and tested very high for intestinal methanogenic overgrowth (IMO). The doctor gave me a two week dose of xifaxin and that was it. No other protocol or follow up. I just finished the antibiotic with no relief. I am an active 52 year old, weight train 3 to 4 days a week, take my dog for a hour walk almost every day, gets lots of Texas sun, drink only water with LMNT of course. My two part question to the both of you is how in the world was I blessed with this lovely methane bug and is there any way to rid myself of it? Any supplements? I am taking berberine. I also have hypothyroidism and take desicated thyroid for that. The more I research, the more confused and overwhelmed I get. It seems it’s a little different from your standard SIBO. I’ve heard some doctors say to follow fodmap and others go all the way to carnivore. Any suggestions would be super appreciate, as I value your insight greatly.
All the knowledge, how to implement it
Tracie writes:
Hey Robb and Nikki, I’ve been listening to your podcast since my first rebel reset back in 2021 and have greatly appreciated the work that you do and the community I have found here at the healthy rebellion. I feel like I have all the knowledge that I could ever need to optimize myself, but I’m still not implementing it in the right way to improve my body composition. I feel like I’ve been doing B+ work since 2021, and A+ work for the past 3 months but I haven’t seen any results. I’m a type A personality but I’ve learned to forgive myself for not being perfect, and have added a little meditation in my life. I’ll lose 5-10 lbs and then it always comes back. I’m 33, female, 5’4″, and 175 lbs. I was 125 lbs when I was vegan in college at 20 but of course had no muscles and mild anemia, I figured that was still a healthy target weight for me. I don’t even care what the scale says, I just want to look good naked! I slowly gained weight over the last decade due to burritos, pizza, beer, stress, and smoking. I really was a hot mess until 2020. I’ve been approaching my failure through the lens of Boyd Eaton’s evolutionary discordance hypothesis. I’m wondering if it’s appropriate to tackle body composition issues using the old evolutionary discordance hypothesis, and if there have been any recent updates to it?
I figure I’m not losing weight because my nutrition/exercise regime is still too much of a departure from the ancestral model but I’ve been eating paleo since 2021 and feel like I have balanced my 4 pillars. I’m taking Chris Kresser’s Adapt Natural bundle to cover the declining nutritional quality of our foods. I use 2-3 sticks of LMNT a day, sometimes an extra to compensate for the hot and humid east coast summer. I Started doing Paul Saladino’s animal based thing in August 2022 and it was great post gut dysbiosis (that was October 2021) but I also feel like the fruit and dairy are not helping the body composition. I hate to not eat them since they are nutrient dense and I do like how I feel.
I went to see Dr. Ruscio for the gut dysbiosis and feel fully recovered but my relationship with vegetables has never been the same and Paul caters to that. I see people rocking the vegetables in the healthy rebellion though and I sometimes wonder if I could do keto, although I do suffer from hypoglycemic episodes and get really lethargic when I try to get down to 25 grams of carbs. I have taken the Keto Masterclass. I feel like my electrolytes are on point though so I should be lethargic, and I love salting my food and eating salty olives/pickles. I only drink 12-18 ounces of coffee day, so that doesn’t seem like the culprit.
What really annoys me and why I decided to write to you is because I am now exercising the most I ever had in my life and still not slimming down. I still just look puffy all over. I hike 5-7 miles a week with a 10-15 lb backpack, and one of those hikes is up a small east coast mountain. I get 5 miles of walking in most days a week, I run 3-4 miles a week 1-2 miles a day on top of the walking, and am now adding BJJ 3-4 hours a week, I don’t lift weights and know this would be huge but I don’t know how and cant afford a personal trainer yet. Hoping the BJJ does the trick, my training load is high but its enjoyable. I have used chronometer to track what I’m eating periodically, so I know I get 125+ grams of protein, 120 from animal sources (lots of steak, chicken, and pork) but I do eat 2300 calories easy. I’m doing 120-150 grams of carbs from mostly fruit, an ounce of maple syrup sometimes or a few tablespoons of honey also contribute. Diana Rogers suggests 1500 on her sustainavore course as a starting point. How many calories should I go for? That’s got be my issue, I’m eating enough calories to maintain weight and I got to go into a comfortable non-lethargic deficit. Advice would be much appreciated!
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Transcript:
Nicki: It’s time to make your health an act of rebellion. We’re tackling personalized nutrition, metabolic flexibility, resilient aging, and answering your diet and lifestyle questions. This is the only show with the bold aim to help one million people liberate themselves from the sick care system. You’re listening to the Healthy Rebellion Radio. The contents of this show are for entertainment and educational purposes only. Nothing in this podcast should be considered medical advice. Please consult your licensed and credentialed functional medicine practitioner before embarking on any health, dietary or fitness change. Warning, when Robb gets passionate, he’s been known to use the occasional expletive. If foul language is not your thing, if it gets your britches in a bunch, well, there’s always Disney Plus.
Robb: Welcome back.
Nicki: Folks, welcome to episode 160 of the Healthy Rebellion Radio. As you know, this is coming out on a Monday. Normally we release our episodes on Fridays, but it’s summer-
Robb: Life happens.
Nicki: … and life happens, and we just have some stuff going on. So this episode is Monday. We won’t have one this coming Friday, but we will be back with our regular Friday schedule on July 28th. So this Monday one feels, it’s like-
Robb: It’s like a filler.
Nicki: It’s like a hybrid. It’s like a filler doesn’t seem like the right word.
Robb: It’s the iceberg lettuce of the meal.
Nicki: Yes.
Robb: Or perhaps you want something more.
Nicki: It’s bridging the gap of the Fridays. Yeah, something like that.
Robb: You’re much more inspirational with it-.
Nicki: No, I don’t know that that’s inspiration, but it is what it is do we want to share with everybody?
Robb: Hell, yes. Why should we not?
Nicki: Part of our morning today and just what we’ve… Yeah.
Robb: Did we talk about-
Nicki: We never did. So let’s start at the beginning.
Robb: The beginning is always a fantastic place to start unless you’re one of those artsy filmmakers, in which case you start at the end and then work your way backwards. But we’re not going to do that.
Nicki: We’re not going to do that. We’re not going to go back in time. Well, we are going to go back in time to talk about the beginning.
Robb: Fuck. We’re off to a good start.
Nicki: So as I think we mentioned, my cousin and her family came and visited us from Texas the last week of June, I believe. And her oldest son, Jackson is 13, and he is like Daniel Boone reincarnated, fisher-
Robb: Hunts, fishes.
Nicki: … hunter. All the things might end up being a contestant on a loan one day. Who knows? Anyway, so we, behind our house in Kalispell, there’s lots of water, lots of lakes, and we have in our neighborhood, behind our house, there’s a little kettle lake with fish in it, and the kids love fishing. Whenever we have cousins and family and friends over, that’s always a popular thing. So Jackson, and actually all the kids, all of my cousin’s kids, even the five year old, were out there fishing and catching fish to their hearts galore. But we have these pike in the lake, so mainly-
Robb: Which are invasive. Somebody introduced them in the lake a couple of years ago, and they grow enormous and-
Nicki: And they eat-
Robb: … absolutely crush everything else.
Nicki: … all the bass.
Robb: Yeah.
Nicki: Yeah. Mainly there’s bass, some perch.
Robb: Perch.
Nicki: And then these giant pike, which are just super destructive. So anyway, and they’re huge. And so Jackson wanted to catch one of these giant pikes. So he rigged up this jug line, which I’d never heard of it or seen it before, but basically it’s-
Robb: Because you’re not a redneck, babe.
Nicki: Yeah.
Robb: You’re just married to one.
Nicki: I grew up in Redneckville.
Robb: Somehow the state off the radar.
Nicki: I just was never exposed to a jug line fishing. Anyway, imagine a gallon jug, milk jug, and you tie a fishing line to it with a hook and a bait, and it floats out there, and-
Robb: It’s a passive fishing-
Nicki: … it’s like a giant bobber. So you see the jug line go down or move, then you know you’ve got something on the line. So he rigged that up, and it was early in the morning. I’m sitting, my cousin Nina and I are sitting having our coffee in the morning and looking out at the lake, and lo and behold, that jug just plunged under the water and then bounced up and zigged across, and we’re like, oh my God, there’s something on the jug line.
Robb: It was reminiscent of the scene in Jaws when the shark yanks the float underwater and just starts dragging, it was… And when you think about it, a gallon of water is eight and a half pounds, something like that, eight, nine pounds. To yank that thing underwater, the fish had to displace more than eight pounds. And it’s squirrely, yanking something under like that. And man, it just snapped under, went probably six or eight feet and then popped up, and then it just took off across the lake.
Nicki: And then it just stayed in one spot. So it was like the fish was trying to get away and then resting a little bit. Anyway, clearly our exclamations roused everybody. And so Jackson’s out there in the rowboat rowing towards it with his dad, Andrew, with the net, to try to see what they had. And Andrew grabs a hold of the jug and they can see this fish under the water. It’s giant, and it’s one of these pike. And as he’s holding it and trying to scoop it with the net, the line, it didn’t break-
Robb: The fish just took off.
Nicki: … the line just… I don’t know that Jackson tied it tight enough onto the jug handle, but the line came off of the jug handle and the fish was gone, which was clearly a big disappointment. And he attempted to catch it again, but that did not happen during… That happened on the second to last day of their stay.
Robb: Yeah, yeah.
Nicki: Okay. So there’s that. We were out of town for last weekend, and we come back and we noticed all of these, you notice some buzzards.
Robb: Tons of them on the lake.
Nicki: Down on, just on the shore. And then we noticed this bald eagle that was just camped out eating on something. And-
Robb: It’d go away, it would come back, it’d go away, it would come back.
Nicki: It was just standing right there in the shallows, in the marshy sandy spot, just eating on something. And I really wish I would’ve gone down and checked it out sooner. But we waited a couple days and I’m like, finally, what is this? So walk down there, and lo and behold, it is a giant pike that has been picked over. The head is still there, the teeth-
Robb: It was incredible-
Nicki: … the whole skeleton.
Robb: … the whole skeleton was still intact.
Nicki: … the tail.
Robb: And it had a lot of animals work in it. But these pike are like dinosaurs. They’re really tough.
Nicki: They’re teeth like… Yeah.
Robb: Yeah. Yeah.
Nicki: So Sagan and I we had gone down to look at it and I was like, oh, we got to go get the camera and get the measuring tape. So we measured this thing. It was 42 inches long. And just-
Robb: God only knows what it weighed-
Nicki: Who knows?
Robb: … probably weighed 30 or 40 pounds. Yeah, it was a big fish. Yeah.
Nicki: Who knows? And you look in close and in the eye socket and part of the facial cavity that had been all eaten away, and flies are all over it. And you can see these swarming, baby maggots just everywhere. So just imagine this gross, stinky fish.
Robb: It’s at least four or five days old by this point.
Nicki: Yeah.
Robb: It’s been sitting out there in the sun, multiple animals picking at it, the flies doing their magic. This would be a pretty good story if we left it here. And we said, okay, let’s get around to our questions. But there is more.
Nicki: There’s a little more. We have this puppy, well, he’s a year and a half old named Griz, and he loves to go down to the water and swim at all the most inopportune times. And so he was down there.
Robb: And if he finds himself some goose poop, he’ll eat it or roll in it. And same with deer poop and other stinky nasty things.
Nicki: So we hadn’t been, I don’t know. We looked out and there he was down by this pike carcass and eating some of it. And so we’re like, Griz here, get him back up. He smelled awful. Gave him a bath, still smelled awful. Smelled like a rotting fish.
Robb: Rotting Fish smells bad. And apparently pike, I haven’t ever caught one or dealt with them, but our neighbor told us, if you catch one, absolutely do not process it inside, apparently pike are just-
Nicki: Don’t prepare in your kitchen, apparently. It’s so stinky.
Robb: … so stinky. Yeah.
Nicki: Yeah. So anyway, this dog smelled so bad, so bad. And so bath won the first day. Second day, more baths. Was it yesterday that he first ate it?
Robb: Yeah.
Nicki: Yeah, it was yesterday. Okay. So just the first bath yesterday. Go to bed last night. And he was so smelly, often he sleeps upstairs with Zoe in her room, but he smelled so bad that we decided to just crate him. And the crate is in our bedroom. So he’s in his crate and I wake up hearing him panting, just so, he’s roasting, and it’s not that hot in our room. And so it’s strange. I’m like, okay, what’s going on here? And I try to go back to sleep, but it’s so loud that at this point I’m not going back to sleep. So I’m like, maybe he’s really thirsty.
So I grab his water. I didn’t want to let him out. So I grab his water, put it in inside his crate with him, and he just stares at me and he’s just panting. He didn’t want any, I tried putting some on my hand and putting it to his mouth, he didn’t want anything else. So I’m like, okay, fine. Screw you. I’m going back to bed. And I put the water back and closed the crate, and I’m laying there and it’s like, just this incessant panting. I’m like, okay, there’s no way I’m falling asleep. So maybe he needs to go outside. But he wasn’t whining or anything. There was no whimpering or nothing other than the panting. So I put his collar on and head out, and he’s like right at the door, he really needs to go out. I open the door and he proceeds to have explosive diarrhea in three different spots around the yard, rushes over, it just squirting out, then finds a new spot, circles around, does it squat three times. And I was like, oh, okay.
Robb: The revenge of the pike.
Nicki: The revenge of the pike. But you would’ve thought that he would’ve whined or something. So anyway, then he seems fine, I put him back in his kennel. No panting at all. He falls right to sleep. Great. Two hours later, we repeat this process, the panting starts, wakes me up. I know what’s up. So I take him straight outside. He does it again, makes it through fine to the morning. And so then morning seemed fine. He spent the morning outside. Then we needed to go do some errands, Costco, all that kind of thing today. So we crated him and I didn’t think about it would’ve been smart had I put some forethought there and moved the crate away from the corner in which it is currently, in which it normally resides in our bedroom, but I didn’t. So we come home from Costco and I walk into our room and I just smell the stench. And then, so I let him out and then I see the mess at the bottom of the crate and on the wall and on the carpet. And let him outside.
Robb: And Griz had walked in it and he got his tail slattered with it.
Nicki: Somehow his tail was on it. And so as he’s running out the door, his tail hits the wall and there’s like a paint, a brush. If you had a paint brush and a nice top color.
Robb: And if you were doing the paint flick.
Nicki: There were some of those.
Robb: And it was about waist high, basically between the bed and the wall all the way on his way out.
Nicki: The revenge of the pike.
Robb: The pike had its last laugh. That is for sure. Hopefully it’s last laugh. Hopefully we’re done.
Nicki: I’m really hoping that it’s… So we gave him some activated charcoal, hoping it helps. Yeah. So we spent a couple hours this afternoon scrubbing-
Robb: The room a stiff up anyway, but-
Nicki: … cleaning carpets, cleaning walls, spraying out the crate. Yeah. Anyway, long story, all of you with pets who have experienced similar experiences with animal bodily fluids will appreciate this one. Probably not as good as the lady, I remember it was a New York Times article about the lady that bought the Roomba and the dog pooped, and then the Roomba zoomed all around the house-
Robb: … all over the house.
Nicki: … and the left. So definitely not, doesn’t rank as high as that story.
Robb: But it was pretty good though. It was pretty good.
Nicki: It’s pretty good one. Yeah. Okay.
Robb: Goddamn, that was a long intro. Apologies.
Nicki: It was a long intro. Yeah.
Robb: Yeah.
Nicki: All right, hubs, we are ready for news topic.
Robb: Okay. This is a med page today piece, which is usually garbage. But this one was interesting. It’s a gal who’s manic, but she is talking about a medical mystery that they uncovered. And it was a gal who ended up with, she was training for a 5K run and then started experiencing a lot of pain and edema and had a weird rash on her leg. And they went through all this testing and differential diagnoses and everything. And it’s interesting and it’s good medicine. The good doctors that think and think critically, God bless them, we really need them. And we don’t have enough of them out there. But what was interesting is as they narrowed this thing in, they just couldn’t figure out all of the usual stuff just wasn’t fitting the lab work and just wasn’t coming together. But when the doctor went back and talked to this woman again that she had mentioned that she had been developing a number of food intolerances, and so it had been limiting her diet more and more and more. And so then they started thinking about, well, could this be a vitamin C deficiency, and basically scurvy?
And when they checked for that, that ended up being the case.
Nicki: Oh, interesting.
Robb: So this was a documented case of scurvy in the modern world. And I just thought it was interesting because it was a beautiful medical investigation story. It was diet related. I find it interesting too, and it’s really unfortunate that they didn’t, at least in this piece, it would be really interesting to follow up with this gal and know exactly what did she pull out of her diet. And in part because so many people in this space that we’re in do carnivore, and they don’t do fruits, they don’t do vegetables, and they don’t end up with scurvy. And this is something that has been talked about quite a lot, but I thought it was interesting. It’s worth checking out. Again, the gal’s pretty manic. It’s about a 13 minute video. If you put it on 1.5 speed, it makes it more tolerable and it’s worth checking out.
Nicki: Interesting. All right. The Healthy Rebellion Radio is sponsored by our salty AF electrolyte company, LMNT. And as you all know, everyone needs electrolytes. And especially if you’re an active person or on a low carb diet, then you really need electrolytes to feel and perform your best. Whether you are training for strength endurance, or just trying to make it through a grueling workday, don’t skip the electrolytes. Coffee or a caffeinated energy drink might seem like a good idea, but it won’t sustain your energy levels the way that adequate sodium will. Believe me, your body and your brain will thank you. From citrus salt to raspberry, watermelon and grapefruit salt, LMNT has several amazing flavors that you can add into your rotation to keep you hydrated, energized, and ready to perform at your best. You can grab yours at drinklmnt.com/robb. That’s drinklmnt.com/robb. And hubs, you actually have an LMNT concoction that you’ve-
Robb: Oh, yeah.
Nicki: … been enjoying of late.
Robb: So I’ve known the folks that founded Mammoth Creameries. It’s a, I guess technically it’s not an ice cream, it’s a custard. And I don’t know what the distinction is.
Nicki: It doesn’t have any of the dairy proteins that cause you to-
Robb: Yeah. Yeah. So a lot of these low carb ice creams I used to enjoy every once in a while, but almost all of them have a little bit of milk protein in them and it just fires up what I believe is probably the rheumatoid arthritis that I have, and if I stay largely dairy free with the exception of cream, I can handle bovine cream, then I’m okay. And so Mammoth is one of the only things out there that’s in this kind of low carb, ice cream space that it’s just cream natural flavors, which I have a natural flavor blog coming out for element related, but people lose their minds over natural flavors and it’s ridiculous. If it’s vanilla flavored, it’s probably from vanilla. If it’s raspberry flavored, it’s probably from raspberries. It’s just ridiculous the stuff that goes on there.
Anyway, I took this vanilla Mammoth and I put a chocolate salt with it. I probably had two, two and a half servings from the Mammoth container, mixed it all up. So it was, the chocolate salt doesn’t really dissolve. It’s speckled, it looks almost like cookies and cream type deal. Phenomenal. Absolutely blew me away. And Todd, the founder of Mammoth, I had tagged them in it. He’s like, I got-
Nicki: You posted this on Instagram, yeah.
Robb: … I got to try this. And he did it and he’s like, life changed. Yep.
Nicki: Yeah. Yep. So anyway, if you can get your hands on any Mammoth creamery ice cream or another vanilla of your choice, if you tolerate dairy, you can try the Robb Wolf LMNT chocolate salt, vanilla ice cream summer.
Robb: Oh, this would be good. Any-
Nicki: Anytime of year.
Robb: Anytime of year. Yeah.
Nicki: Okay, moving on. We have two questions for you today. The first one is from Carrie on intestinal methane overgrowth. She says, gluten tug from your old home of New Braunfels. I really appreciate you two and your no-nonsense, but super informative podcast. It always hits home for me. I have gone back and forth between keto and carnivore since 2019. Felt great at first, but the last 18 months have had weight gain, bloating and constipation. I never really had a weight issue before. I’m five foot seven and have averaged 135 pounds pretty consistently. I was referred to a gastroenterologist, did the breath test and tested very high for intestinal methanogenic overgrowth, which is abbreviated IMO. The doctor gave me a two week dose of Xifaxin. It’s X-I-F-A-X-I-N. Not sure how you pronounce that. And that was it. No other protocol or follow up.
I just finished the antibiotic with no relief. I am an active 52 year old. I weight train three to four days a week, take my dog for an hour walk almost every day, get lots of Texas sun, drink only water with LMNT, of course. My two-part question to the both of you is how in the world was I blessed with this lovely methane bug and is there any way to rid myself of it? Any supplements? I am taking berberine. I also have hypothyroidism and take desiccated thyroid for that. The more I research, the more confused and overwhelmed I get. It seems it’s a little different from your standard SIBO. I’ve heard some doctors say to follow FODMAP and others go all the way to carnivore. Any suggestions would be super appreciated as I value your insight greatly.
Robb: Well, thank you for that. And it’s an interesting question. Just as an aside, these tests can be helpful, but mine was different. I’m just going to share a little bit of my background, but you can have sulfuric acid producing bacteria or hydrogen producing bacteria. This is another test. And what’s interesting with that, and I always get it confused. One of them tends to produce constipation, one of them tends to produce diarrhea. I was a little bit overgrown with the one that’s supposed to produce, and it was just barely so, but in theory, I should have constipation, but I don’t, I go exactly the opposite direction, which was super perplexing. I ran it by Kresser and Ruscio and all kinds of people, and it is just perplexing. They’re like, none of your stuff, none of the testing fits the clinical outcomes. And I find a lot of people end up in that spot.
It’s like this testing is great and sometimes it directs one to a good solution and not infrequently a round of antibiotics can fix this stuff. And this is an interesting aside. I’ve had alternating gut issues for the last 25 years basically. And a weird thing that I noticed, I have no doubt that the multitude of antibiotics I took as a kid, and even that I’ve taken later are probably part of my problem. But every once in a while I would end up with a really bad sinus infection when I was traveling and things like that. And I would go on a round of antibiotics and for a period of time my digestion was better. It seemed to knock back whatever the problematic stuff was and then it would slide back out and get worse. And so it’s one of these weird things. Are antibiotics good? Are they bad? It’s so situational.
There are natural antimicrobials like olive leaf extract, and there are folks out there, I believe Ruscio details some of these protocols in his book. Any and all of this stuff is worth doing. The FODMAP specific carbohydrate diet, even shifting a little bit more carnivore can… I think any of these things are beneficial. The goal in my mind is to just figure out a way of being in which you are not sick, in which you don’t show clinical signs of the weight gain and maybe foggy headedness and the things that go along with that. And then once we get to that stabilized spot, then we start tinkering with what type of latitude you have. And there is the weed and seed protocol, which is using either prescription or more natural antibiotics to try to knock back ideally the bad bacteria, although it can knock down the good bacteria too. And then you start seeding with something like the product seed or some of these really hoity-toity prebiotic, probiotics using fermented foods, a host of different prebiotic fibers, potato starch, green bananas, on and on and on.
Nicki: Where would you start though, if there’s a lot of different approaches and she’s going to need to do this N equals one to figure out what actually works for her? Where would you start?
Robb: So it’d be great to work with someone directly so that they can be the brains behind this and help you do this stuff. Mike Ruscio folks can work with him. Agley Jacobs is also phenomenal and folks can work with her. I think that they also have practitioners that they’ve trained that you can work with or people who’ve gone through the Chris Kresser adapt program that you know could check their database and see someone who specializes in dealing with this. You could also use Agley or Dr. Ruscio’s books if you want to just run this thing on your own and they walk you through a protocol. And so definitely having a game plan is critical in this. I do recommend doing a specific carbohydrate diet or something like that first makes sense to me because it’s just less onerous. It’s not that full investment of full on carnivore and whatnot. Just gives you a lot more latitude. But you need a game plan.
Ideally, you’ve got somebody who can objectively look at this stuff. You might benefit from some additional testing. But man, the more I’ve gone along this testing is helpful, but I think a couple of shows back I posted another med page piece that was talking about how the microbiome changes hour by hour. And this is where we’re taking a snapshot of something that is a movie and it changes constantly. And I guess it may be helpful when we see something overtly pathogenic and this thing ostensibly like the excessive methane production, that is a sign of pathology. Okay, what do you do? Do you weed and seed? Do you do it with over the counters? Do you do it with prescription? What type of dietary alterations do you do? Usually minimizing the fermentable fibers can be helpful, but man, it’s a lot, it is definitely a lot to unpack all that stuff. And that is where I think finding somebody who’s a good practitioner who has some success in this arena. And then you just got to get in and be willing to go wherever the clinical outcome takes you.
So if the specific carbohydrate diet approach isn’t addressing the clinical symptoms, then you may have to go a little more restrictive, a little more restrictive. We’ve seen numerous people in the Healthy Rebellion that they did a carnivore type reset for six months and then started reintroducing foods and did really well with that. I think about Denise and some of the other people that really remarkable. And there are other people that have done it multiple times and it just doesn’t work. And those are people like me. And I think Jack is in that camp to some degree. I think he’s developed a little bit more latitude than what he used to have. But there are some people, SIBO I think is similar where there’s just, if you’re going to be relatively symptom free, you just end up having these fairly narrow lane lines that you operate in. And she asked what could have gotten you there? I have no clue. I don’t know. I don’t know.
It could have gotten exposed to a bad bug. It could have been just bad luck. Maybe your diet slid for a little while and we started getting just some shifting and because there’s definitely a relationship between loss of metabolic health and a change in gut health. And I think that both of those can push, pull on that. The gut can be altered and then it can affect your metabolic health, or metabolic health can slide and then it can alter the gut health. And it’s just this multivariate calculus problem that maybe somebody smarter than me has this all figured out, but man, I bump into so many people that are just so sure about what to do with this stuff. And I think for certain cross sections of people, the standard deal, just cleaning up sugar, just doing this, just doing it, just making sure vitamin D levels are adequate. It addresses most of the issues for some people and then for other folks, it’s a big gnarly puzzle to unravel.
Nicki: It’s almost like human beings are complicated.
Robb: Yeah. Yeah.
Nicki: Complex. I will put links to Agley Jacobs and Dr. Ruscio’s books and websites in the show notes for anybody that wants to check those out.
Robb: But if you tackle this, if you get into it, I’d love to hear follow up, good, bad or otherwise. It’d be really interesting to know what you do with this because these are, again, these N equals one data points to know again what the outcomes are of just anything that you’re doing.
Nicki: Cool. All right. Our next question today is from Tracy, all the knowledge, but how to implement it. Hi Robb and Nicki, I’ve been listening to your podcast since my first rebel reset back in 2021 and have greatly appreciated the work that you do and the community I have found here at the Healthy Rebellion. I feel like I have all the knowledge that I could ever need to optimize myself, but I’m still not implementing it in the right way to improve my body composition. I feel like I’ve been doing B plus work since 2021 and A plus work for the past three months, but I haven’t seen any results. I’m a type A personality, but I’ve learned to forgive myself for not being perfect and have added a little meditation in my life. I’ll lose five to 10 pounds and then it always comes back. I’m 33 female, five foot four and 175 pounds.
I was 125 pounds when I was vegan in college at 20, but of course had no muscles and mild anemia. I figured that was still a healthy target weight for me. I don’t even care what the scale says. I just want to look good naked. I slowly gained weight over the last decade due to burritos, pizza, beer, stress, and smoking. I really was a hot mess until 2020. I’ve been approaching my failure through the lens of Boyd Eaton’s evolutionary discordance hypothesis. I’m wondering if it’s appropriate to tackle body composition issues using the old evolutionary discordance hypothesis and if there have been any recent updates to it. I figure I’m not losing weight because my nutrition/ exercise regime is still too much of a departure from the ancestral model. But I’ve been eating paleo since 2021 and feel like I have balanced my four pillars.
I’m taking Chris Kresser’s adapt natural bundle to cover the declining nutritional quality of our foods. I use two to three sticks of LMNT a day, sometimes an extra to compensate for the hot and humid East Coast summer. I started doing Paul Saladino’s animal-based thing in August of 22 and it was great post gut dysbiosis. That was October of 21. But I also feel like the fruit and dairy are not helping the body composition. I hate to not eat them since they’re nutrient dense. And I do like how I feel. I went to see Dr. Ruscio for the gut dysbiosis and feel fully recovered, but my relationship with vegetables has never been the same and Paul caters to that. I see people rocking the vegetables in the Healthy Rebellion though, and I sometimes wonder if I could do keto, although I do suffer from hypoglycemic episodes and get really lethargic when I try to get down to 25 grams of carbs.
I’ve taken the keto masterclass. I feel like my electrolytes are in point though, so I shouldn’t be lethargic. And I love salting my food and eating salty olives and pickles. I only drink 12 to 18 ounces of coffee a day. So that doesn’t seem like the culprit. What really annoys me and why I decided to write to you is because I’m now exercising the most I ever have in my life and still not slimming down, I still just look puffy all over. I hike five to seven miles a week with a 10 to 15 pound backpack. And one of those hikes is up a small East coast mountain. I get five miles of walking in most days of a week. I run three to four miles a week, one to two miles a day on top of the walking, and I’m now adding BJJ three to four hours a week. I don’t lift weights, and I know this would be huge, but I don’t know how and can’t afford a personal trainer yet. I’m hoping the BJJ does the trick. My training load is high, but it’s enjoyable.
I’ve used Cronometer to track what I’m eating periodically, so I know I get a 125 plus grams of protein, 120 from animal sources, lots of steak, chicken and pork, but I do eat 2300 calories easy. I’m doing a 120 to 150 grams of carbs for mostly fruit, an ounce of maple syrup sometimes, or a few tablespoons of honey also contribute. Diana Rogers suggests 1500 calories on her sustainable course as a starting point, how many calories should I go for? That’s got to be my issue. I’m eating enough calories to maintain weight and I’ve got to go into a comfortable non-lethargic deficit. Any advice would be appreciated.
Robb: Do you want to jump in on this?
Nicki: I will. And I think Tracy, you hit the nail on the head at the very end and I was experiencing much the same thing. So we train jiu-jitsu-
Robb: Two days most week, sometimes three.
Nicki: … two to three days a week, an hour of class, and then a full hour of open mat, which is pretty-
Robb: Pretty frisky.
Nicki: … intense. Yeah. And then have been doing a strength training program through our friends. Sarah and Grayson of Basis New York. But in our house, Robb does all the cooking and I’m a good eater, I like to eat. And so I think you may have heard us mention that we were weighing and measuring our food, me particularly because that was something I hadn’t done regularly in quite some time. And turns out that it’s pretty easy to eat far more calories than is appropriate for one’s frame and activity level.
Robb: Particularly with this carnivore esque, the Saladino flavor of carnivore where you’ve got enough palate options between meat, dairy and fruit and even the honey and stuff like that. There’s some pretty good tasting foods and it’s remarkably easy if your digestion accommodates that to overeat. Part of the problem that we ended up in is that my digestion is dodgy enough and my activity level is high enough that I struggle to get enough food most days. I love a good steak, but I just can’t do two rib eyes back to back like Sean Baker. I just can’t. I’ll do part of one and then I’m done, but I still need to get some calories from somewhere else. And it’s funny, even a handful of macadamia nuts or something, just something else will go down, but cooking some suet and eating beef fat, I’m just maxed out. I just can’t do it. So my cooking has shifted ever more towards this calorically dense, carnivore esque thing, which works for me and was getting Nicki into trouble because it’s really easy for someone with healthy digestion to overeat on that.
Nicki: And I love protein. So Robb would make, even if it was just hamburgers, I would have two of them, two of the patties, well, once I started weighing and measuring if they’re 85%-
Robb: Lean.
Nicki: … lean then you enter it into Cronometer or whatever you’re using. And so then those two patties were a significant amount of calories. And so a lot of what I was learning was a lot of my protein sources were really like, we would do pot roast or we would do, what was another cut back? Lots of stew meats in the slow cooker.
Robb: Back in the winter.
Nicki: Back in the winter. And when you start actually looking at the caloric load of some of these cuts of meat that carry more fat and then I’m eating the fruit or some nuts and whatever else I ate during the day and I was easily at that 2300 calories, even more. And so when I started really tracking it, that actually made a little bit of a difference. So I did the keto gains calculator and that had me at 1,750 calories. I’m five foot seven, I like to say I’m five foot eight, but I’m really five foot seven if I’m not wearing shoes. And I was hovering right around a 150 pounds, which is a little heavy for me. I run great at 140.
So I was a little bit on, little heavier than I wanted to be. And so doing the keto macros at 1,750 calories, I noticed a little bit of a difference, and I’m not sure why this is, but we had our, it was April, end of April, our former jiu-jitsu coach, Ray Price from Reno came up to do a seminar in Kalispell and we were talking about nutrition. He was talking about-
Robb: Renaissance periodization. Was it that app?
Nicki: It’s the RP app.
Robb: Yeah.
Nicki: Yeah. And he had been doing that and his wife and his wife’s mom and everybody was leaning out amazingly. And so I was super curious. So I just put my, and it’s a paid app, but I just plugged it in to his just to see how did it compare the calorie-wise with what I was doing with keto gains. And lo and behold, it was exactly the same calorie count right at that 1,700, 1,750. It was just a different macro ratio. So still had the 135, 140 grams of protein, only 60 grams of fat and a 150 grams of carbs, which I was before doing under 50 grams of carbs. And that really works for me. I ran with that. I’ve been eating that way.
Robb: And I would say that it was slow to kick in. It was-
Nicki: Because the thing that was bothering me is that since November I’ve been doing zone two cardio with Robb in the mornings-
Robb: Most mornings. Yeah.
Nicki: … two, three days a week are the days that we don’t do jiu-jitsu. And I still wasn’t noticing any body composition change, nothing significant. My clothes fit the same, nothing was changing. So it’s similar to what Tracy’s relaying. She’s doing all this activity, but nothing is changing physically for her. And I was in the same boat. And then I don’t know why, I know that I do fine with carbs. I don’t have any kind of GI issues from carbohydrates, I don’t get-
Robb: … hypoglycemic. Yeah.
Nicki: … hypoglycemic. And so I just started shifting. I was leaner protein, and I think I mentioned this on a previous podcast, but if the main cut of protein that Robb is making has more fat in it, I’ll have some of that, less of it and then add shrimp or some things, or another protein source-
Robb: Lean protein. Yeah.
Nicki: … that’s lean. So I get my protein, but I’m keeping that fat on the lower side of things. And then I’m having sweet potatoes, I tolerate rice. So I’ll have some of that. I’ve actually thrown in some oatmeal here and there, fruit and I haven’t weighed myself in two months because we don’t have a scale at the house, but I definitely, my tight pants test, we talk about the tight pants test in the keto masterclass and in rebel resets that we’ve done in the past. And so, you put on a pair of pants and you see how they look. And my tight pants test is definitely much improved. So I don’t know, I don’t know why that is, but it works for me.
Robb: So even at a given caloric load, there’s a reality that… And it’s so interesting because you get the very, say Gary Taubes esque insulin is the driver of weight gain. And I think insulin’s a really important hormone to control. I think it’s important for hunger in particular, but there is a reality that fat is the easiest calorie to store, there’s like, it just is. And it’s not in and of itself the most satiating, protein is arguably the most satiating, arguably plain boiled potatoes is the most satiating food apparently, it’s the hardest food to over overeat or something like that.
So there’s these non-linearities with all the food theories out there. Do I think controlling glycemic load is important? Yeah, it’s super important for a lot of people. And then for other people it’s way less important. And for someone like Nicki who is metabolically healthy, metabolically flexible, interesting thing. She’s been keto off and on for years just because of eating the way that I eat. Because the way I cook didn’t really see a massive performance change with jiu-jitsu by reintroducing the carbs, you still performed well and your zone two cardio was really important. You just did your Iron Man and you had good gas for that. You didn’t get crushed with it. But it was probably due more to training that-
Nicki: It was definitely the zone two. Had I not been doing that, I would’ve died.
Robb: So that’s all interesting because you have people who are like, you can’t perform without carbs. Well that’s not necessarily true, but we have these sacred cows out there with different things. And then you just have to get down to the person and be like, well, what is working and what’s not working? And for you, I do think that there’s something about the somewhat less efficient storage of calories around eating some carbs like you do, yeah, you can have de novo lipogenesis and all that, but you got to really overeat. And it’s still, even in that scenario, the thing that I remember way back when Gary Taubes and Stephan Guyenete, who I like both of these people a lot, but Stephan will cite some stuff about people will go back and forth over this stuff. Are we eating more carbs? Are we eating more fat? We’re definitely eating more calories than what we did in the past. When you really look closely at things, it looks like we’re eating more fat than what we did in the past in addition to just generally more calories.
But the thing is that people aren’t oddly enough, with the exception of extreme keto and carnivore, they’re not eating just rendered liquid fat except for these weird things. What they’re doing is they’re eating refined foods that have a matrix of both fat and carbs and flavorings and all this stuff that it makes it really easy to overeat. So at the end of the day, I think that this is where… The one thing that’s interesting, whether you look at the keto gains approach to this or the Renaissance periodization, they ended up giving a calorie prescription that was virtually identical. They had a protein-
Nicki: The protein was identical-
Robb: … virtually identical.
Nicki: … and the only thing that was different was the calories from fat went into carbs for the RP diet and versus keto, you’re having more fat and fewer carbs.
Robb: Yeah. And so she has-
Nicki: And when Tracy’s eating, she’s getting her protein, she’s doing 120 to 150 grams of carbs. So the question is, what is the fat and what is the fat content of that protein? I’m not seeing that she’s adding extra fat anywhere. I don’t see that, but if-
Robb: If she’s doing some whole fat dairy, it’s going to be really easy to-
Nicki: So Tracy, I think you’ve used Cronometer periodically, use it religiously for a couple of weeks. You’ll get a really good sense of, okay, wow, because I put in my numbers and I’m like, oh wow, what I just ate was 600 calories at breakfast and I’ve only got seven. It’s an eye opener if you haven’t been tracking pretty consistently. Weigh everything. Try to find the cut of meat or whatever it is that… Cronometer has a really extensive food list, which I love. I tried using that RP diet thing and I know some people love it, but they didn’t have half-
Robb: Had a very limited-
Nicki: … half the things that I-
Robb: … database.
Nicki: Yeah.
Robb: Yeah.
Nicki: Yeah. And it was frustrating. So I just took that macro prescription and put it into Cronometer and that’s what I do.
Robb: And probably use the keto gains macro calculator. It’s free, it’s very spot on. It will email you your results and then what I would do is find your protein from that, find your calories from that, and then you can adjust in that macro, your macronutrient ratio. So I would maybe top off your fat at 60 or 70 grams of fat per day.
Nicki: Probably 60 or… Compared to, I don’t know. Obviously we’re different bodies, but she’s five four, I’m five seven. It has me at 60 grams of fat, maybe a little bit less.
Robb: Maybe a little bit less, but the thing is, is it’s going to adjust the carbohydrate-
Nicki: Accordingly.
Robb: So you’re going to boost the carbohydrate, it’s going to automatically adjust down the fat. And so maybe 60 grams is a good place to start. But I would religiously weigh and measure your food and stick to those macros. And it’s probably what you’re going to find is that you’re going to need to shift to leaner cuts of protein. If you do dairy, it’s going to be sacrilege, but you may find that you’re doing some non-fat dairy. I remember Diana Rogers followed Marty Kindle’s program, and I’m blanking on it right now. It’s really, really good, the data driven fasting and some of the other stuff that Marty Kindle does. He’s a genius with this stuff, but it’s all very, very similar. But what she was finding was that for her breakfast she would do one egg yolk and then three additional egg whites. And she was like, this seems crazy. But she needed the protein, she didn’t need that much fat. And she leaned out really, really quickly with it and it was super effective. Are egg yolks good? Yes. Is butter good? Yes, all that stuff’s good, but it’s easy to overdo it.
Nicki: But sometimes if something… And if you’re at the spot where you’re like, gosh, I’m trying all the things, it seemed counter to me having been relatively low carbon, and a 150 grams of carbs is still on the lower carb absolutely side. But-
Robb: Particularly with your activity.
Nicki: … but having been more low carb, it was, okay, I’m going to try this. I couldn’t see how it was going to make a difference, but it actually did. So it’s like if you are hitting the wall and you’re trying all these things and your body composition just isn’t shifting, A, you’ve got to track pretty religiously and weigh in measure so you actually know what you’re getting. But I think you hit it on the head Tracy in the beginning with, it’s got to be the calories. I’m not sure if the 1,500 that Diane that’s-
Robb: I wouldn’t use that as a start. I would go into keto gains or something like that and get a custom made-
Nicki: Plug it in based off of your height and your weight and your activity level and all that stuff.
Robb: … your activity level. Yeah.
Nicki: Yeah.
Robb: Yeah.
Nicki: And then let us know how it goes. I think your activity, you’re doing a ton of movement, which is great. You didn’t say how sleep was, but I… Did she say anything about sleep?
Robb: Not sure, but clearly she said that she has balanced her four pillars really well.
Nicki: Yeah. Okay.
Robb: So we’ll assume that’s pretty buttoned up.
Nicki: Yep. Yep. Anyway, let us know what you change and how it works. I definitely feel a lot better. I know I haven’t weighed myself, but I’ve…
Robb: Well, and your dad hadn’t seen you for four months-
Nicki: Couple months.
Robb: … And he was like, oh wow, you’ve really leaned out.
Nicki: Yeah.
Robb: So yeah.
Nicki: Yeah. All right. We only had two questions for you today folks.
Robb: Because they were long.
Nicki: Because they were longer on, yeah, on time.
Robb: And we had to tell the story of the pike.
Nicki: And we had to tell the story of Griz and the pike and the bodily fluids. Anyway, wishing you all a fabulous week, two weeks. We’ll be back on July 28th with a new episode for you then. In the meantime, be sure to check out our show sponsor LMNT for all of your electrolyte needs. You can do that at drinklmntcom/robb. Robb, any closing thoughts?
Robb: Don’t let your dogs eat rotting pike. That’ll go on my tombstone.
Nicki: Yeah, that could be us. We could make a song out of that.
Robb: [inaudible 00:50:39] be good.
Nicki: All right. We’ll leave it at that before we derail this thing further.
Robb: Take care everybody.
Nicki: Bye everybody. See you later.
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