News topic du jour:
Pufa OR Oxidized Pufa?
Its really common lately, in the ancestral / carnivore / animal-based echo chambers, to hear about pufa being a problem, but I’m curious if this is legit, or if the Paul Saladino’s of the world should be saying ‘oxidized pufa’ every single time they simply say ‘pufa’?? I know polyunsaturated fats are relatively fragile to oxidation (if that makes sense), but are all the pufa’s we eat really oxidized? And if not, do you think the non oxidized pufa are really a problem?? Thanks
Salt and insulin resistance
Hi Robb and Nicki,
I am curious of the relationship between salt and insulin resistance. I have heard you say that extra salt will simply give gi side effects in a healthy person. My problem is that i am “prediabetic” My sugar is relatively normal during the day, depending on what I eat, it will go in the 160s, though my fasting blood sugar is often 110-120. I fast for 10-14 hours a day (T R E) and i am mildly overweight. I am 6′ and 210 lbs. I am very active doing remodeling as a hobby and firefighter/ paramedic for a job however I do not really “work out”. I try hard to have decent sleep but the 24 hr schedule for work makes that hit or miss. Is there a concern for too much salt with insulin resistance? Thanks for sharing all of your knowledge!!
Next stop, HRT?
44 yo male, 6’ 210lbs, been weight training consistently for 25 yrs. Mtn bike, run – pretty active. Been struggling with sleep for last two years and for the past yr have been having lower energy, mood swings, lack luster workouts and most recently lower libido. No particular diet except do my best to avoid added sugar on a daily basis. Blood pressure is perfect, cholesterol is in the right ranges per GP guidelines. Thyroid testing ok, cortisol seems inline(14.6 ug/dl) Last Glucose test showed 87 mg/dl – only red flags seem to be elevated iron /ferritin levels which I’m trying to remedy with monthly blood draws. Otherwise eat lots of meat and vegetables- probably 3500 calories +\- daily. Supplement with creatine and whey protein. Considering trying HRT as my total testosterone has been consistently under 400 for the last two years (388 this week) and free was at 6 ng/dl. Am I not sleeping cause of low T or do I have low T cause I’m not sleeping? Not aware of any dietary issues or allergies and not sure what to do next. Love LMNT and the show – any insight would be appreciated!
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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 1 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, folks.
Nicki: Hello, everyone. This is episode 142 of The Healthy Rebellion Radio. Thank you.
Robb: It is episode 142.
Nicki: I know. We were having a little dispute earlier when he wasn’t showing me the page. I’ve been working on episode 143, so that was stuck in my head, but this actually is just 142, which is the answer to the universe plus 100.
Robb: Doesn’t work that way.
Nicki: Doesn’t work that way?
Robb: Or maybe it does. I don’t know.
Nicki: Why not? Says who? I feel like it should work that way.
Robb: Okay. Then there we go.
Nicki: And my feelings are valid.
Robb: There you go.
Nicki: What else? We finally finished Stranger Things.
Robb: Well, we’re caught up to Stranger Things.
Nicki: Yes. Well, we’ve watched everything that’s available. It was fabulous. Really enjoyed it.
Robb: And then we tried to shift into Yellowstone and Nicki couldn’t handle the dysfunctional interpersonal relationships, and drama and everything, so we…
Nicki: I think we’ve mentioned this before, but I don’t like my entertainment to be stressful. Even when-
Robb: Slash interesting.
Nicki: And we watched the first episode of Yellowstone almost a year ago.
Robb: Over a year ago.
Nicki: And it was very stressful from the very first scene of-
Robb: Oh yeah, the horse dying on the road.
Nicki: … this guy shooting his horse. So Robb’s been wanting to watch it and so we finished Stranger Things and he is like, “Okay. We’re watching Yellowstone.” And I was like, “Okay. I’m in it. I’m going to do this.” And we watched episode two and then we get into episode three, and mind you we’re doing cardio and so I’m like rowing and jumping rope. Episode three, there must be at least-
Robb: There was a body exhumed.
Nicki: … 10 different… Totally… I don’t even know. Massively stressful, dysfunctional situations that happen in rapid succession. One of them being like this guy telling his kid to wait in a culvert for him. And so the kid’s waiting there while he goes off to explore or to kill some guys that had abducted-
Robb: Human trafficking.
Nicki: … some young girl and then this little kid who’s probably seven or eight and there was just giant rattlesnake. I had to tap out.
Robb: She did.
Nicki: I do not like my entertainment to be stressful. So we’ve moved on to a fabulous show, Reacher.
Robb: Which is pretty good.
Nicki: Which is good. I’m really enjoying it. So we’re obviously… For those of you who watch anything, we are so behind the times because lots of people have already watched all these things like years ago, but we’re just getting caught up with cardio in the morning.
Robb: If anybody cares at this point.
Robb: Okay, moving on.
Nicki: Okay, moving on, moving on. We had several people write in with ideas and just really feeling for Kyle and his wife who we read his question in last week’s episode. Kyle’s wife is the one who was experiencing just incredibly severe constipation that just doesn’t seem to resolve with any of the things they’ve been trying. So we did have several people share just things that occurred to them. I thought I would read some of those just to throw out ideas, not just for Kyle, but for other people who might be experiencing something similar.
So Sarah wrote in and mentioned that… Because in the question Kyle had relayed that his wife had consumed protein powders fairly regularly, at least before this onset of this constipation. And Sarah had a terrible experience with whey protein powder in particular. And so she wanted to pass along that, that could have been the cause of the issue. It was for her. She said it was so miserable.
My heart went out to this lady and I thought I should share this. So a lot of people have difficulty digesting the lactose or casing and whey protein and it can cause severe constipation for some people. So we also had… And hers completely resolved when she stopped including those daily. So then we had Gordon who wrote in and saying he had a similar problem and after many misdiagnoses and an unnecessary surgery, it turned out to be low thyroid. So he said he wasn’t below the reference range, but it was apparently low for him. And so that was a big, big one for him. So that might be something to look into.
Robin wrote in and said that she or he suffered with this for years and it just got so bad to where not having a bowel movement for several weeks. Finally, one of the surgeons I worked for ordered an abdominal series where I swallowed some radio opaque bands and I went in every other day to see the progression through the GI tract. And this determined that he had gastroparesis and megacolon. So at 35, I had an 80-year-old colon. He had a subtotal colectomy and it improved my symptoms and life 100%. So theirs.
Robb: Which is pretty significant intervention, but I mean, yeah.
Nicki: Anna said this might not be the full answer of the problem, but worth exploring. “For 18 months, I struggled with chronic diarrhea 10 to 15 times per day. Tried everything, stool testing, supplements, diets, et cetera. Nothing helped. I eventually did Annie Hopper’s DNRS brain retraining program and that was the thing that got me out of the hole. I stabilized my bowel movements and then got a lot more reaction with supplements and dietary changes to get rid of niggling symptoms. I know it’s not the same situation, but worth exploring, brain retraining if they hit a dead end.” So it was an interesting option.
Also, Marcy, a friend of ours in Reno, mentioned that the ileocecal massage that we had talked about at the end of that episode or during that question has worked for her in some of her physical therapy patients along with MCT oil.
And then Jack, who is one of our fabulous moderators in the Rebellion, he had a very lengthy response talking about carnivore and FODMAPs and different foods to eliminate and all that. But then I’m just going to read a portion of what he shared ’cause I think this is also really, really pertinent. “So she will certainly have a weird relationship with food. If she’s stressed when eating, there’s going to be constipation in all likelihood. Sympathetic tone on the ANS will shut down peristalsis to a significant degree and she won’t be breaking down food chemically in the stomach. Gastric emptying then slows right down.”
“So before eating, she could do five minutes of physiological sigh, nasal breath in, pause, second nasal inhale to fully refill the lungs, and then slow exhale through pursed lips. She’ll really need to focus on being absolutely calm. Then when eating, chew forever and ever. If food’s not breaking down in the stomach for some reason, helps to break it down more in the mouth. And on that note, might be worth trying two to four tablespoons of apple cider vinegar with the mother in a glass of water 15 minutes before eating. A spoon of raw honey makes it super tasty and helps to prop up carb intake because obviously it’s not a good time to go suddenly very low carb.”
He also mentioned, “We had mentioned COVID and vaccination.” He says “There’s currently a spate of people with weird unexplained neurological problems, palsy type symptoms, muscle weakness or shaking pins and needles, et cetera. This seems to be something to do with the virus, the vaccine, or both. I wonder if it’s possible that should be experiencing inflammation in her enteric nervous system that, that would shut down smooth muscle contraction in the gut.”
“Other things that might do that could be, for example, undiagnosed celiac, but let’s say for a moment that she has some sort of neurological inflammation going on, it may be that a doctor could try her on a steroid to see if that helps acutely. I’m the last person to encourage people to go on steroids, and I don’t imagine she could remain on them for any period of time, but this would perhaps answer the question of is this a muscle? Is this an intolerance, dysbiosis, or dietary, et cetera?” So those were some really good suggestions too. So thank you all for pinging us with those suggestions and again, hoping that Kyle and his wife find some resolution to this.
Robb: We are going to circle up and consolidate some of these thoughts and-
Nicki: We’ll send them off.
Robb: … fire that off to Kyle. So thank you all again. You want me to jump into the news topic?
Robb: So this one is from the Free Press, Bari Weiss’s platform.
Nicki: Newly branded.
Robb: Newly branded platform. And she, in addition to her generating some great content, she has some really wonderful contributors. And this is from a guy Teddy Kennedy, Drink Your Way to Sobriety in 2023. And this really has less to do with the drinking piece, although it is interesting and that it gets in and talks about abstinence versus moderation and one works in some circumstances, one doesn’t work in other circumstances, but it talks a fair amount about using some naltrexone in similar opiate blockers to modify the response in the brain that people get from basically enjoying alcohol.
It’s always been interesting to me because I’ll enjoy a cocktail, but it’s honestly almost more a social drudgery in a way. It’s like I’m hanging out with people, everybody else is having a drink and I’ll have a drink too, but I just don’t think I get the same response from alcohol that some people get.
Some people really, really like it. And this is part of what this article talks about, and I think that there’s something to be learned from this with regards to food also. And not just a food, but different types of food. The addictive characteristics of food, alcohol, different types of drugs. We know that there’s something to that. We know that it varies from person to person and although therapies like low-dose naltrexone, which blocks the opiate receptors in the brain, at least for a brief period of time, they don’t work for everybody. But I think that it shines a bit of a light in the direction when we are contemplating what do we do to try to help people modify their diet and lifestyle and whatnot.
We have to acknowledge that if they’re getting a disproportionate good feeling from a particular food or a particular activity or what have you. We have to factor that in and have a strategy. And sometimes pharmacotherapy is a good way to look at this stuff. So I just think it’s an interesting piece. Alcohol consumption is clearly a big factor with folks health, but I was thinking about it more being able to repurpose some of these techniques and methodologies for addressing food.
Nicki: It ties into the podcast that we started yesterday about the science of individualism. We’re only about halfway through. It’s the micro podcast, the way I heard it, and the guest is a man named Todd Rose who’s a scientist who’s written several books. It’s a very fun episode. It’s a good show. But talking about individualism and we do a lot of things based on the average or this is how most people respond to a thing. And as you guys all know, because we talk about N equals 1 a lot, I mean different people are having a disproportionately strong feeling of euphoria after consuming a thing and a lot of people don’t. Again, we can’t tailor treatments and protocols to the average when there’s lots of individual outliers.
Nicki: So interesting. Okay. The Healthy Rebellion Radio is sponsored by our salty AF electrolyte company, LMNT. Whether you work hard or play hard, whether you’re in the office or on a job site, on a mountain or a playground, help your body perform its best with LMNT. LMNT provides all the electrolytes you need without the sugar or other crap contained in other electrolyte beverages. Plus, you actually get a meaningful amount of electrolytes, particularly sodium, which is what your body really needs. And whether like you like your LMNT hot or cold, there is a flavor for every taste bud. There’s still some LMNT chocolate medley left. I think we’re down to our last little bit.
Robb: It’s going to be gone soon.
Nicki: It’s going to be gone, so if you want some more of that, make sure you grab it. You can grab that and all of our other flavors at drinklmnt.com/robb. That’s drinklmnt.com/robb.
Okay. Three questions today. This first one is from Mike on polyunsaturated fatty acids. “Hey Robb, it’s really common lately in the ancestral carnivore slash animal-based echo chambers to hear about PUFA, polyunsaturated fatty acids being a problem. But I’m curious if this is legit or if the carnivore influencers of the world should be saying oxidized PUFA every single time they simply say PUFA. I know polyunsaturated fats are relatively fragile to oxidation, if that makes sense, but are all PUFAs we eat really oxidized? And if not, do you think the non-oxidized PUFA are really a problem?
Robb: It’s a big topic and one of the things that’s perplexing for me around this is… And I know the correlation studies, food frequency questionnaires, you always have to look at those with a critical eye, but consumption of nuts and seeds broadly is really highly correlated with how health and good endpoints. Although, truth be told, consumption of whole grains is similar, although I don’t know what even constitutes a whole grain at this point because people just frankly don’t eat pearled barley. They eat a little bit of instant oatmeal and stuff like that.
So even that stuff gets a little bit tricky. But that’s been a perplexing thing for me about this. Without a doubt, our consumption of these polyunsaturated fat via corn oil, soybean oil, it is exploded in the 1930s. This stuff effectively for the food system did not exist. It was nowhere to be found.
If we get into the notion that systemic inflammation via oxidative stress could be a real problem, and we see this with hemochromatosis, active celiac disease where the gut is damaged, there’s a lot of different ways that we could get an inflammatory response via oxidative stress. It’s bad news for the body overall. It’s perplexing too and that we had the unpublished until more recently Ancel Keys study where they had people in mental hospitals that you would never get this thing through an IRB at this point, but they fed people.
It was as close to a metabolic ward as you could really get. They fed people of very specific diet. Some of them pretty high in saturated fat. Others higher in polyunsaturated fat. The folks who consumed the higher polyunsaturated fat diet had significantly lower cholesterol levels and had higher all cause mortality and higher cardiovascular disease end points. So it’s really damning. It really is remarkably damning. I think if people are cooking consistently with corn, soybean oil, et cetera, I think that that’s a real issue.
Nicki: You’re eating out a lot.
Robb: Eating out a lot.
Nicki: And the restaurants you’re eating out are using those oils.
Robb: But even then, this is where it gets a little bit tricky for me. And I’ve heard about some of the celebrities in this space that they would go to a restaurant and it’s a nice restaurant and they would grind the whole meal down to a halt with a group of people there because they’re in interrogating the person about what oils do you use on the griddle that you’re going to cook the steak? And my personal opinion, I think that that’s just a bridge too far, if you have significant health issues or what have you.
But if you’re generally pretty healthy, the amount of oil that the meat is going to come in contact with, well, cooking on a griddle, it just seems trivial to me. If you want to ask him, I guess it’s fine, but I think that people do… Just floundering around here. Is this a problem? Yes, it’s a problem. But this is a problem when you’re eating donuts and if you have a salad, it’s corn and soybean oil and it’s this just massive load. I do think that we’re probably resilient enough. If you go out to eat and they don’t have an extra virgin olive oil available and you just want to have a goddamn salad, then I don’t think that that one meal is going to derail all of your efforts.
Nicki: It’s sort of like, the poison is in the dose, right?
Nicki: So if your daily consumption from… If you’re cooking with those things at home and you’re eating snacks that contain those things and you’re eating out at fast food type places that certainly cook with poor oils, then your overall load is super, super high. But somebody who is watching this carefully and you’re using olive oil and coconut oil and butter or whatever at home and then you go out to a restaurant and you’re with people with your community and you’re supposed to be there for fun. You don’t want to grind the whole thing down over a thing, especially if you don’t react to it.
Robb: Part of the thing, I guess is that oxidative stress is this slow insidious process that wears us down over time. So I could get that. So I don’t think that this is in either or story like is there a problem here? Is there not a problem? Yeah, I do think that there’s a problem. I do think that there’s almost certainly this linkage between a host of increased health issues and the consumption of these seed oils.
But I don’t know that people need to be quite as fastidious about avoidance is what they’re being. I guess that this is one of these things when you are newly to a way of eating and you’ve been sick, you have ulcerative colitis, you go carnivore and it saves your life. You’re going to be… What are the… What’s the saying-
Nicki: That was about it.
Robb: There’s none so holy as the newly converted like you’re going to be a zealot. And that’s okay, but I think over time you can find a little bit more of a medium area and that medium area though still, I’m not saying that you should eat industrial seed oil based bread and fry your foods in corn oil and stuff like that. That’s a bad idea. It’s without a doubt a bad idea.
Nicki: I’m sure somebody’s probably going to make some sort of paleo effects. They used to have this gluten scanner thing.
Robb: Which was bullshit.
Nicki: Which was bullshit, I know, but I’m just thinking how could you tell if your PUFA was oxidized? If there’s no odor, there’s like… Is there a way to tell?
Robb: This is another thing that is still a little bit confusing for me. Oxidized fats really have a powerful flavor and a powerful scent because they are damaging to the body. So the body has a pretty wired up feedback mechanism for detecting these things. This is also why if you look at a bottle of corn oil, they usually add vitamin E and stuff like that to-
Nicki: To mask the smell?
Robb: No, to antioxidant. To prevent it from oxidizing. This is where it’s like there’s a claim and then you can put that claim to bed. It may not be oxidized in the bottle, but once you put it in your body, it incorporates into your cell walls and that can become oxidized. It’s got a higher oxidative potential. And that’s true. That’s legit. But I know that Brian Curley with Seed Oil Disrespecter is working on a lot of material here. And I got to say the stuff that he in particular has shared where folks had all kinds of problems and then they just remove seed oils, and they get remarkable improvements in their health.
They didn’t go paleo. They didn’t go keto. They just really fastidiously removed seed oils. I really trust Brian. He’s a super sharp guy. So it’s one of those things where even though I want to push back against it. It’s like, okay, here’s this empirical evidence and we have other things supporting the correlation between consumption of seed oils and obesity, and systemic inflammation and cardiovascular disease and on and on and on. But also so often in general, people aren’t just eating seed oils as [inaudible 00:23:12].
Nicki: No, the seed oils are usually combined with something that’s relatively high in fat and carbohydrates. So it’s like you’re removing-
Robb: Yeah. Some sort of like Frankenfood baked good, corn chips.
Nicki: You’re removing the junk. You’re going to improve your health also. So it’s like, which one is it? Or it’s the combination.
Robb: And that sort of stuff for me. Did mention the Masa corn chips on here? There’s an outfit-
Nicki: I think a while ago, yeah.
Robb: And they’re making corn chips with lard. Or not lard, but tallow, beef tallow.
Robb: Grass-fed beef tallow. It’d be fascinating to just have a group of people and they eat 15% of their diet from corn chips that are… Which would be super easy for me to do, cooked in beef tallow and 15% of them cooked in corn oil and we just track them for six months and we look at systemic inflammatory markers, maybe some gut permeability and some different things like that. See if there’s a tendency for people to consume more calories within the corn oil group versus the other one.
I don’t know that anybody’s ever going to do something like that, but we do just have history to look at and there was a time when things like corn… McDonald’s used to cook their french fries in beef tallow and then they shifted over to corn oil that I think corn or soybean oil at this point. And people were not as sick. People were not as overweight.
But there’s so many different moving parts that have changed in the food system. We have bigger sizes. We have more engineering of the food and everything.
Nicki: More sugar in the food.
Robb: More sugar in the food. One of the things I’m concerned about with the seed oil thing is maybe this is 100% the thing. I guess one of the benefits of this is that in general seed oil avoidance means that you are going to avoid most processed foods. I remember my parents bought corn oil and used it in salad dressing. That was what they would mix up their salad dressing with. I don’t think too many people do that today, but maybe some people do and so shifting away from that.
Nicki: It’s actually an interesting… I’m thinking a million things right now, but when I was vegan for two years, I used to think of anything that had any kind of animal product in it as toxic and then I didn’t even want it. It was like you’re saying where it has a cat turd laying on it. Or it’s been dragged through a litter box. It was just like, eh. But maybe this could be a helpful… Because all about how we think about things and the stories we tell ourselves in our head when we’re trying to accomplish something.
So maybe it could be a powerful way to leverage the brain for people who are trying to and have been struggling to avoid certain foods because they want to get healthier. They want to improve their body composition to think of, “Okay. It has a seed oil in it, it’s toxic.” Skull and crossbones.
Nicki: We really are that simple. Our animal brains really are that simple and maybe that’s a really powerful way for people to just like, “Nope, I don’t eat those.”
Robb: And heuristics are there because they save our lives. Heuristics are simple stories that address complex topics. The bugger there is that you throw out something like avoid sugar and then you get a Layne Norton type person who will pull up a metabolic word study where people were living in a hospital and they feed them an isocaloric diet of mainly sugar and they don’t become insulin resistant. They don’t become dyslipidemic, but they also are not eating sugar in the context of a mixed diet of hyperpalatable foods. They’re just eating sugar.
Or if they are eating a mixed diet of hyperpalatable foods, they’re literally locked in a room and they’re monitored for what food they eat. They can’t overeat. And it starts becoming… The danger of these heuristics, these simple stories is that you then can have… If there’s a little crack in the truth, then you have people out of the evidence-based crowd that will say, “This is not true. You just need to do moderation.”
And then back to my point about the first thing that I mentioned as we rolled today, moderation doesn’t work for everybody. Not moderate like I can moderate sweets. I can’t moderate salty, crunchy things like nachos and corn chips. There’s just no off switch for me with stuff like that. I think you have to then acknowledge the real world, the individuality around this stuff.
Nicki: Well, that’s where if people could approach it without the dogma, but as a tool. My tool is I’m not going to eat this stuff because it’s poison or it’s toxic or whatever you have to tell yourself so that you actually like, “That’s not even appealing to me that. It’s been drugged through the litter box.” So use that as a tool, but knowing that I’m not going to be super zealous about this because there are circumstances.
Nicki: And nuance to the whole thing and it’s an N equals 1, but I’m going to use this as part of my journey. I don’t know. Just…
Robb: Almost nobody is getting healthier as we move along. I was just looking at this report today. The United States and Israel are leading developed nations in loss of average lifespan. And there’s a host of factors. COVID is a factor. The vaccine might be a factor. The truth of that is 100% dependent on the background of everybody’s fucking sick.
Nicki: We were sick before 2020.
Robb: Yeah. We were super sick before and we were already on a downward trend before that and it’s only gotten worse. So to some degree, the only thing that matters is that at a clinical endpoint, people get healthier. They figure out strategies for how to make things work for them. The hesitation that I have… I’m not even going to go down that road. I think that that’s worth leaving it there. I’m just going to muddy the waters.
Nicki: Okay. Mike, good question.
Robb: Yeah, good question.
Nicki: Thank you.
Robb: The person he referenced, it’s easier in that world because it’s like they’re bad. Avoid them at all costs. Be such a prick about asking about seed oils at the restaurant that you don’t get seed oil, but you get pubic hairs and spit in your food because you’re such a dick.
Nicki: Okay. I don’t know. I think I’d rather have some seed oils.
Robb: I think I would rather have the seed oil too.
Nicki: Okay. Our next question. Oh no, I didn’t put who the question was from. Maybe they didn’t give a name. This is from-
Robb: Person unknown.
Nicki: … person unknown about salt and insulin resistance. “Hi, Robb and Nicki. I’m curious of the relationship between salt and insulin resistance. Heard you say that extra salt will simply give GI side effects in a healthy person. My problem is that I am prediabetic. My sugar is relatively normal during the day depending on what I eat and it will go in the 160s. Though my fasting blood sugar is often 110 to 120.
I fast for 10 to 14 hours a day, time-restricted eating and I am mildly overweight. I’m six foot tall, 210 pounds, very active doing remodeling as a hobby and as a firefighter slash paramedic for a job. However, I don’t really work out. I try hard to have decent sleep, but the 24 hours schedule for work makes that hit or miss. Is there a concern for too much salt with insulin resistance?
Robb: There is. And this is one of the caveats that I throw out there that an individual that is insulin resistant is not likely to benefit from significantly more salt in sodium. The flip side of that though is that a low sodium diet is also not super likely to… It’s not going to undo hypertension specifically or undo the underlying insulin resistance, but it’s the real thing that needs to happen here is that we need to address the underlying insulin resistance.
The firefighter shift work type thing is probably very, very challenging. Sounds like this person is pretty active, but I would say that if you could do a two, three-day week full body workout, it could be calisthenics, it could be weights. It doesn’t sound like maybe it’s super their jam, but it’ll help. It’ll help that.
Nicki: Even walking after your meal.
Robb: After a meal.
Nicki: And if he or she is doing this long kind of fast, but maybe after your main meal, doing an hour of walk. Just getting out and moving a bit more.
Robb: Yeah. And I guess one other piece on this is if you notice lethargy, fatigue, brain fog, the things that we commonly associate with kind of a poor hydration electrolyte status, then by all means use something like LMNT during that time. But I would do a little bit of diligence, particularly because this person is a firefighter/paramedic. Take your blood pressure. Just see what type of blood pressure response you get to that and just monitor it.
I would just keep an eye on blood pressure. Not everybody with insulin resistance develops high blood pressure, but I think it’s something like 60 to 80% of people do. And that’s really the danger here. And again, it’s a difficult thing to deal with because more sodium in a hypertensive situation isn’t going to help things, but a low sodium diet doesn’t necessarily improve it. It improves it a little bit, but not massively, and this is one of the confounders around sodium intake and just hypertension.
Nicki: He or she doesn’t say that they’re actively working on addressing the pre-diabetes, but it goes without saying that that is addressable and focusing on protein and whole unprocessed foods will really help things go in the right direction with regards to your blood sugar.
Robb: This is straight out of the work that we did with the Reno Risk Assessment Program where we identified police and firefighters at higher risk for type II diabetes and cardiovascular disease. And because of the shift work, because of the hypervigilant state of doing this type of work, it’s difficult to address all of the lifestyle pieces. You’re going to do shift work. You’re going to have stressful situations and whatnot and that is where a lower carb diet, lower glycemic load diet really was magic in that scenario because it’s the one lever you still have that you can really control.
Nicki: You have full control over.
Robb: In addition to some walking, some zone two cardio, a little bit of resistance training that can all augment or improve your insulin sensitivity.
Nicki: Cool. Okay. Final question. This week is from Adam regarding HRT. He says, “Hi, I’m a 44-year-old male, six foot tall, 210 pounds. I’ve been weight training consistently for 25 years. I mountain bike, run. I’m pretty active, but I’ve been struggling with sleep for the last two years. And for the past year I’ve been having super low energy, mood swings, lackluster workouts, and most recently lower libido. No particular diet except I do my best to avoid added sugar on a daily basis. Blood sugar is perfect, cholesterol is in the right ranges per my GP guidelines. Thyroid testing okay. Cortisol seems in line. And last, glucose test showed 87 milligrams per deciliter.”
“The only red flags seem to be elevated iron and ferritin levels, which I’m trying to remedy with monthly blood draws. Otherwise, I eat lots of meat and vegetables, probably 3,500 calories plus or minus each day. I supplement with creatine and whey protein. I’m considering trying hormone replacement therapy as my total testosterone has been consistently under 400 for the last two years. It was 388 this week. And free testosterone was six nanograms per deciliter. Am I not sleeping because of low T or do I have low T because I’m not sleeping? I’m not aware of any dietary issues or allergies. I’m not sure what to do next. Any insight would be appreciated.”
Robb: The last question there is really great and it’s hard to tell. For sure disordered sleep can alter proper hormone production, but then we know for sure you see it whether it’s andropause or menopause when hormones start altering one of the first things that go sideways is sleep quality. So it really is a chicken and egg kind of scenario there. Something that you could do is try to address the sleep side of the equation first and see if you get some improvement.
Something like Doc Parsley Sleep Remedy, BluBlockers. Somewhere on the interwebs we have a whole sleep hygiene guide. Maybe we can track that down and put it in the show notes here. And just like three months diligent trying to address-
Nicki: No screens before bed. No random lights on your alarm clocks or lights from fire alarms in your room. If you have a street light outside your window, blackout curtains, that kind of thing.
Robb: And then the flip side during the day, get outside early. Huberman podcast has been phenomenal with this stuff. Get light on your skin. Where we live, which is pretty far north, I think I’m four days away from being able to make vitamin D out for us.
Nicki: Robb has been checking each day as it goes by, checking it off.
Robb: I remember when I looked at dminder and it was like 122 days until your next D opportunity and I was like, “Oh, fuck.” So I would, Adam, address… I would try sleep first. See if improving sleep addresses this stuff. Give yourself three months. You’ve got some baseline already and then you could recheck and see if things modify from there. If it doesn’t, and I should write this up in a Substack and just, it doesn’t have to be exhaustive, but there’s a lot of different things that folks could do on this HRT front.
So on the supplement side, I believe it’s called tongkat ali has some pretty proven efficacy with improving both total and free testosterone. This is another sideline too, and it is why I should do a post on this. You really do need to know your sex hormone binding globulin or protein levels, estrogen, estrodiol, dihydro, testosterone. You want a full picture of this story because if we just bump up total testosterone levels, but SHPG goes up also, it doesn’t necessarily mean that you’re going to have biologically active testosterone to work with.
So it is something that you want to monitor in this. And people on low-carb diets tend to have higher sex hormone binding globulin. So that can be a problem. Maybe you need a few more carbs or some post-workout carbs in addition to what you’re doing. But you could go the basic supplement route with the tongkat. There are things like enclomiphene or HCG, which you need a doctor to prescribe that. But these things can turn on the signaling between the pituitary and the testes to produce normal testosterone, or to induce a greater degree of testosterone production.
The nice thing about doing that is it’s working as close to your body, just functioning the way it should as you can possibly get. You get all the conversion of like DHEA sulfate down the cascade into testosterone. You get the normal cascading of testosterone into estrogen and hydro testosterone. It’s goosing you back towards what your youthful levels were in as gentle way as you can be. The enclomiphene works by blocking the brain’s sense of estrogen in the environment, and so it will upregulate testosterone and HCG has kind of a similar effect there. Although it works via kind of different mechanisms.
Then the next step along the line is actually doing testosterone replacement therapy. Most doctors, when they embark on this process, one, they don’t manage people very… Well, they don’t monitor people very well. They don’t do really all that good a job of doing pre and post follow-ups.
And then what they tend to do is one giant testosterone bolus every two weeks. There’s still an enormous number of doctors out there that will prescribe this huge bolus at testosterone. You go super physiologic for about five to six days, then you’re norma physiologic for a couple of days, five, six days, and then you’re sub-physiologic for a couple of days.
When you drive the testosterone levels up really high, you down-regulate the receptor site so your body can’t even sense the super high level that’s occurring there. It’s that super physiological state that causes most of the downsides with TRT thickening of the red blood cell count increase and stuff like that. So doing micro doses like a daily or every other day, subdermal microdose relatively, I think makes a ton more sense. It looks much more like normal biological activity and all that stuff.
And then again, even mixed into all this stuff, if the sleep issues are still a problem, we still need to do all of the diligence on sleep and lifestyle and the rest of that stuff because simply sticking testosterone therapy into an individual that is suboptimized in diet and lifestyle, usually what we find is their estrogen levels go up and they further downregulate their own endogenous production and we end up with more side effects.
So it’s not like you can do this and have kind of a get out of jail free card and not address these other things. Sounds like Adam is active, but it’s almost a deal where the more aggressively you go on to TRT, in my opinion, the more vigilant and diligent you need to be on the diet and lifestyle side to both get the benefit from the TRT, but also to avoid the potential downsides.
Robb: Good questions.
Nicki: And then it’s a matter of finding somebody… Maybe if you do this Substack post you could write… How do you screen a doctor for being good?
Robb: What I’ll do as part of it is a list of questions to ask the doctor. And one of the big questions is describe for me a protocol for how you would diagnose this? Where would you start a person? Ideally the doctor suggests something like a diet and lifestyle first, sleep modification. Hopefully, they turn over every stone before that and then I would really be impressed if they’re like, “Oh, let’s try some enclomiphene or HCG or something like that.” Beyond that, if they do get into testosterone replacement therapy, hopefully they’re knowledgeable about or at least open to the notion of smaller daily or every other day doses versus like, “Oh no, we do like a palate once a year or every two weeks subdermal application.” I just don’t see those work all that well. Not remotely the same way.
Nicki: Gotcha. Cool. Good questions this week folks. Again, thank you for your feedback for Kyle and his wife. And just thank you for following us and listening to our inane banter week after week. We appreciate you. I hope you all have a fabulous weekend. Be sure to check out LMNT for all your electrolyte needs. You can grab that at drinklmnt.com/robb. That’s drink L-M-N-T slash…
Nicki: .com/R-O-B-B. Any closing comments, thoughts?
Robb: We’ve had a little bit of sun, so happy about that.
Nicki: We are happy about that. All right, folks. We’ll catch you next time.
Robb: Bye, everybody.
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