The Whole View

Join Stacy of Real Everything and Dr. Sarah of The Paleo Mom as they bust myths and answer your questions about a nontoxic lifestyle, nutrient-dense diet, Autoimmune Protocol, and parenting.

The Whole View, Episode 465: Too Many Food Restrictions?

Welcome back to episode 465! (0:28)

Stacy opens the show with a cryptic message to listeners not to sleep on next week's show because some big news is coming for the Whole View.

Thank you for tuning in each week, leaving reviews, asking questions, and engaging with Stacy and Sarah all these years. Without you, this show would not happen!

This is not a sponsored episode. However, Sandra at ShopAIP created a coupon code just for Whole View listeners. Just use the code "thewholeview" at checkout to receive 15% off your purchase!

Sarah and Stacy's personal health journeys have led them to a place now where they have a lot of flexibility and a solid understanding of what a sub-optimal choice may have on their bodies.

But, it's very easy to forget just how overwhelming the process can be when you're just starting.

This episode was inspired by a listener question:

I'm very grateful to have found your book "The Paleo Approach" at my local library. I have since purchased copies of it and the cookbook for myself and family members because of the vital information in it.

My question is: Having lupus and hypothyroidism causes me to steer clear of various foods and herbs, (nightshades and echinacea) and being gluten-free, dairy-free, sugar-free I am staying away from other groups of foods and dishes. 

How can I reach optimal health benefits and nutrients having to avoid so many things that are supposedly "good for you"? - Sandy

 

Beyond Elimination Mindset

Sarah thinks there's a few things worth talking about under the banner of "mindset." (12:25) 

First is the mindset when we are approaching eliminations, especially when first adopting AIP or any diet protocol that involves eliminations.  

It's worth mentioning that Sarah incorporates a lot of these mindset-type discussions and self-reflection exercises in her AIP Lecture Series. Registration for the next session, Sept 13, just opened up. Early bird pricing goes until the end of July!

Just eliminating wheat, soy, corn, and dairy eliminates most SAD staples.

The same few ingredients make up so many different foods, so it feels like more variety, but it isn't.

This is what Sarah calls the "learning curve," which she likens to when you first move out of your parent's home. You have to learn how to shop and cook meals on a budget. You're doing the same there here, just with different foods.

Part of the learning curve is re-learning what a healthy diet looks like. 

Many foods promoted as "good for you" aren't. Sarah's journey in understanding that came first from founding the AIP, diving into gut microbiome research, and from all the foundational content she's creating for Nutrivore. 

It's crazy how many foods (like whole grains and dairy) are promoted as "the basis of a healthy diet" have very little valuable nutrition. Not to mention, they're even problematic for large swaths of Americans. 

Too Many Food Restrictions: Recipes and Cookbooks

A great avenue to explore is finding new recipes that replicate old favorites or find new favorites entirely.

Sarah recommends investing in a cookbook or two. Don't forget about e-books options, like Sarah's Autoimmune Protocol e-book.

Here's a list of other recommended cookbooks:

Stacy often uses Pinterest to find free recipes online. In addition, many of these bloggers have their own cookbooks and share them regularly online.

Another place to start is looking at the meals you like that are already AIP or can be easily made AIP with a simple swap (teak and salad, roast chicken, and veggies).

You can make simple swaps: sweet potato or green plantain for regular potato, Jovial cassava pasta or japchae, coconut aminos for soy sauce, and homemade salad dressing. 

Check out Stacy's epic nomato sauce recipe and ShopAIP, too!

Don't forget to play around! Stacy has had many trial-and-error recipe disasters while figuring things out and can laugh about it now. It's a process, and it's not always going to work out perfectly!

Too Many Food Restrictions: Try New Foods

The foods Sarah tried in her search for more variety on the AIP include cassava/yucca, boniato root, jackfruit, passionfruit, and dragon fruit. (30:31)

Also, there are some foods that Sarah had before at restaurants but cooked for the first time, like taro root and plantain. 

Experiment with new herbs and seasonings like curry leaf, sumac, tamarind paste, umeboshi paste, beefsteak leaves, coconut aminos, pomegranate molasses, truffle salt (aka, The Best Salt Ever), and fish sauce.

There's way more variety in the health-promoting nutrient-dense foods that are AIP than what other diets eliminate.

Finding new threats and convenience foods is easier than it sounds. ShopAIP is a great resource for this!

Sarah reminds Sandy that the AIP is not a zero sugar diet, but a low added sugar one. Fruit is great, and natural sugars like honey, maple syrup, and molasses in moderation are totally fine.

Stacy and Sarah talked about this recently in TWV Podcast Episode 459: Gluten-Free Baking, Our Best Tips, and Tricks.

There's a vast array of foods that are AIP, but it might mean getting adventurous with new foods, flavoring ingredients, or cooking methods. Instead, focusing on what you do eat is more important.

Meal plans can simplify this. Almost all of the cookbooks I mentioned above have meal plans with shopping lists in them.

Make a collection of recipes for quick weeknight meals when you're in a rush. You can also cook for your freezer, so you always have back up meals on hand.

Decide what you'll eat for breakfast if you sleep in and form a list of your go-to grocery stores, farmer's markets, online vendors.

Think ahead for what you'll serve company, bring to a potluck, or choose at a restaurant.

Too Many Food Restrictions: Individual Challenges

A few individual challenges take some planning and preparation to solve, which favor adaption. (48:21)

Studies looking at taste adaptation to one of a low-sugar, low-salt, or low-fat diet have shown that participants develop a preference for the healthier over a few weeks (4 to 12, depending on the study) foods they've been eating. This is attributable to our taste buds becoming more sensitive. 

Food familiarity and flavor association with positive experiences (e.g., feeling good physically, the food tasting good, or eating in a positive social environment) is another key driver of food preference. 

Studies show that with repeated exposure to foods that we innately dislike, we can not only lose our aversions to those foods but develop a preference for them. We can learn to like new flavors after trying them as few as four or five times. 

Another way to increase adaptation to new foods is to pair them with foods you love. For example, one study looked at ways to increase children's liking and willingness to consume Brussels sprouts through associative learning. 

They looked at the impact of pairing veggies with sweetened and unsweetened cream cheese compared to repeated exposure to plain veggies in increasing how much the children (aged 3 to 5 years) liked and ate bitter and non-bitter veggies. 

The results showed that pairing Brussels sprouts with cream cheese increased liking and consumption more than exposure. For example, less than 25% of children liked the sprouts alone, but 72% liked sprouts with cream cheese.

Also, don't forget about your lifestyle! Getting enough sleep and managing stress can help curb cravings and regulate appetite.

 

Make Sure Your Restrictions Make Sense

It's crucial to make sure the food restrictions you're taking on make sense for you. (54:25)

Stacy and Sarah have already talked in Episode 463: Is There Science Behind Candida Cleanses? and Episode 457: The Problem with a Low-FODMAP Diet about how too many food restrictions in those diets can impact our health. 

Some of these protocols have science behind them, while others don't.

The common theme is avoiding additional foods by combining AIP with another protocol, like GAPS, SCD, low-carb, keto, vegan, in here too. 

These additional restrictions make it hard (if not impossible) to eat enough variety to support a healthy gut microbiome and nutrient sufficiency. And we can get ourselves into trouble if we're abiding by too many food restrictions.

Common Deficiencies in Popular Diets

Vegan and vegetarian diets are commonly deficient in vitamin A, vitamin B3, vitamin B9, vitamin B12, calcium, chromium, copper, iodine, iron, magnesium, manganese, zinc, and omega-3 fats.

Low-carb diets are commonly deficient in vitamin B2, vitamin B5, vitamin B6, vitamin B9, vitamin D, vitamin E, biotin, choline, calcium, chromium, iodine, iron, magnesium, molybdenum, potassium, zinc, and fiber.

Low-fat diets are commonly deficient in vitamin A, vitamin D, vitamin E, vitamin K, calcium, and omega-3 fats.

Calorie-restriction programs are commonly deficient in vitamin A, vitamin B1, vitamin B2, vitamin B3, vitamin C, vitamin E, calcium, iron, magnesium, potassium, and zinc.

Gluten-free diets are commonly deficient in vitamin D, vitamin B3, vitamin B9, vitamin B12, iron, magnesium, calcium, zinc, and fiber.

Paleo and primal diets are commonly deficient in biotin, calcium, and chromium.

Ketogenic diets are commonly deficient in vitamin A, vitamin B2, vitamin B5, vitamin B6, vitamin B9, vitamin E, vitamin D, vitamin K, biotin, choline, calcium, chromium, choline, iodine, iron, magnesium, molybdenum, potassium, selenium zinc, and fiber.

 

Final Thoughts

The problem with so many years of diet culture fixated on elimination is that our first thought is what we can get rid of. (58:01)

What we cut out of our diet is pretty irrelevant because health is determined by what we're putting into our bodies.

This is why the nutrivore focus of AIP is so important. The Autoimmune Protocol promotes nutrient-dense superfoods (organ meat, seafood, and tons of veggies) as the foundation of the diet. 

It's paired with recommendations for nutrient tracking to ensure nutrient sufficiency. So one of the first activities we do in the AIP Lecture Series is nutrient tracking.

Stacy has had a lot of personal experience with elimination diets with the main goal of weight loss (even if she told herself it wasn't).

She had no idea how many nutrients she'd cut out of her diet and how she had the opposite effect despite telling herself she was doing it for her health. Because health and diet culture have been so entwined for so long, the two can be difficult to set apart.

The next session for the AIP Lecture Series is now open (as of July 2021) for September 2021.

Be sure to head over to Patreon for more on how Stacy and Sarah feel about the topics of this show. If you've not yet joined the Patreon family, your subscription gets you access to bonus content. All proceeds go to support this show!

Thank you for listening. We will see you next week!

The Whole View, Episode 464:  Forever Chemicals: What are PFAS?

Welcome back to episode 464! (0:28)

Science has shown, pretty unequivocally, how harmful these chemicals are for decades. It's not recent science. And what we see in modern days is regulatory agencies not being able to keep up with capitalism demands.

This topic is difficult to see in something other than a "conspiracy" lens. But that is why it's important to Stacy and Sarah now, more than ever, to make sure they stick to scientific research as much as possible.

There are specific areas known to have high levels of PFAS. If you know you're in one of those areas, it's possible to test your blood for your exposure levels.

Stacy reminds the audience that she and Sarah are not medical professionals. So, if you have any health concerns around this topic, be sure to see a doctor.

 

What Are Forever Chemicals?

PFAS are a class of man-made chemicals used to make products greaseproof, waterproof, and stain-resistant. (7:30)

They are "forever chemicals" because they and their breakdown products are extremely persistent, lasting thousands of years or more. But, unfortunately, we have no way to speed up the breakdown, so they end up bioaccumulating in the environment and our bodies.

Of the more than 9,000 known PFAS compounds, the U.S. uses 600 alone!

Countless products, including firefighting foam, cookware, cosmetics, carpet treatments, and even dental floss, contain PFAS compounds.

PFAS stands for perfluoroalkyl and polyfluoroalkyl substances- chemicals with at least one aliphatic perfluorocarbon moiety (e.g., -CnF2n-).

PFAS includes multiple subclasses of chemicals:

  • PFAA - perfluoroalkyl acids and perfluoroalkylether acids
    • PFOS - perfluorooctanesulfonic acid 
    • PFOA - perfluorooctanoic acid (C8, used to make PTFE polytetrafluoroethylene, aka Teflon)
  • PFAA precursors
  • Fluoropolymers
  • Perfluoropolyethers
  • other (primarily less reactive) PFAS 

The most consistent feature within the class of PFAS is that their perfluorocarbon moieties do not break down or do so very slowly under natural conditions. This is why PFAS have often termed "forever chemicals."

Because PFAS are persistent, they accumulate or concentrate in the environment, including water, air, sediment, soil, and plants.

Elevated levels of PFAS and their widespread presence in environmental media and drinking water stem from industrial sites that produce or use PFAS, airports, military bases (fire-training and response areas), landfills, wastewater treatment plants, and the spreading of PFAS-contaminated biosolids.

Some PFAS are highly mobile in either air or water. This allows them to travel long distances from their sources. 

It's important to note that we don't metabolize PFAS molecules.

Sarah recommends this great article and this review for more information. 

 

How Do They Harm Health?

A better question might be how do they not harm health because their detriment is incredibly pervasive. (10:50)

Data from toxicokinetic studies of PFAA indicate that they are generally well-absorbed after ingestion.

After absorption, they distribute blood to organs and tissues that receive high blood flow, such as the liver, kidney, lung, heart, skin, testis, brain, bone, and spleen.

Because PFAA can occupy sites on multiple receptors, proteins, and cell interfaces in the body, they can produce physiological effects across various tissues.

Nine nuclear receptors are activated (controls gene expression), including PPAR-alpha, which controls fatty acid beta-oxidation and is a major regulator of energy homeostasis. 

They also bind to a variety of serum proteins, including steroid hormones and albumins, which are transport proteins (e.g., vitamin D-binding protein) 

Scientists have found direct links (with mechanisms identified) between PFAS exposure and kidney and testicular cancer, thyroid disease, liver damage, developmental toxicity, ulcerative colitis, high cholesterol, decreased fertility, pregnancy-induced preeclampsia and hypertension, and changes in hormone functioning.

Immune dysfunction, such as Asthma, Osteoarthritis, Crohn's & U.C., R.A., Type 1 diabetes, Lupus, and M.S, are also linked to PFAS.

PFAA and the Immune System

Effects on the immune system are some of the most well-studied health effects of PFAA. (14:51)

Multiple lines of evidence support PFAA as immunotoxicants and, more specifically, immunosuppressants at small administered doses in rodents and measured serum concentrations in humans. 

Findings of suppressed vaccine response in humans and T cell-dependent antibody response in experimental animals led the U.S. National Toxicology Program (NTP) to classify PFOA and PFOS as presumed immune hazards to humans.

In a recent draft toxicological profile, the U.S. Agency for Toxic Substances and Disease Registry (ATSDR) extended this finding to PFHxS and perfluorodecanoic acid (PFDeA), identifying all four compounds as suppressants of antibody response in humans.

They are also unregulated greenhouse gasses!

Sarah explains that these chemicals are in our environment, all around, which makes them impossible to avoid. Also, there is data showing they can, in fact, be absorbed through the skin, not just when ingested, as many company websites indicate.

Additional associations still need further study to identify mechanisms, but dose responses are very damning!

PFAS Buildup and Our Bodies

Even more worrisome, this study showed 100% of breastmilk tested contained PFAS.

An analysis of the available breast milk PFAS data from around the world showed that while the phased-out PFOS and PFOA levels have been declining, the detection frequencies of current-use short-chain PFAS have been increasing (with a doubling time of 4.1 years).

This is consistent with the idea that they are forever and build-up. So even with using less, we're still seeing a build-up over time.

There is a ton of current legislation pending to limit and/or ban PFAS in cosmetics.

For listeners who might not know, Stacy is a huge advocate for clean beauty and safer skincare. She works with Beauty Counter to help get safer products into consumer's hands and uses her background in government to lobby for safer beauty standards.

With all the safer skincare legislation Stacy has seen in recent years, she decided to research the history of PFAS to see if even more legislation is necessary. It turns out- it is.

Sarah has recently gotten into the "Dark History" YouTube series by Bailey Sarian. Episode 1 is on this very topic, "The DuPont Chemical Poisoning." 

The film "Dark Waters" (which Sarah just watched with a free Showtime trial) is a not-quite-as-cool Erin Brokovich approach to going into detail.

 

History: Discovery to Litigation 

Stacy runs through a quick timeline: (25:52)

  • 1930 General Motors and DuPont formed Kinetic Chemicals to produce Freon.
  • 1935 Dupont opened "one of the first in-house toxicology facilities" on the advice of a DuPont in-house doctor named George Gehrmann. The facility was meant to thoroughly test all du Pont products as a public health measure to determine the effects of du Pont's finished products on the "health of the ultimate consumer" and that the products "are safe" before going "on the market". 
  • 6 April 1938 a 27yo research chemist worked at the DuPont's Laboratory with gases related to DuPont's Freonrefrigerants. When an experiment he was conducting produced an unexpected new product: polytetrafluorethylene (PTFE), a saturated fluorocarbon polymer—the "first compound in the family of Perfluorinated compounds (PFCs) marketed commercially." It took ten years of research before polytetrafluorethylene (introduced under its trade name Teflon) became known for being "extremely heat-tolerant and stick-resistant."
  • 1950s 3M manufactures PFAS, according to the 2016 lawsuit brought against 3M, 3M had "disposed of PFCs, and PFC-containing waste at a facility is owned and operated in Oakdale, Minnesota (the "Oakdale Facilities")" during the 1950s. It contaminated residential drinking water wells with volatile organic compounds (VOCs) and heavy metals. It later became a city park after extensive cleanup.
  • 1951 "The DuPont chemical plant in Washington, West Virginia, began using PFOA in its manufacturing process."
  • 1954 DuPont received an inquiry about C8's "possible toxicity."
  • 1956 A study at Stanford found that "PFAS binds to proteins in human blood."
  • 1960s DuPont knowingly buries hundreds of drums of C8 on the banks of the Ohio River 
  • 1963 The Navy began to work with 3M to develop aqueous film-forming foams (AFFF). 1961 A DuPont in-house toxicologist said C8 was toxic and should be "handled with extreme care."
  • 1965 DuPont sent an internal memo describing preliminary studies that showed that even low doses of a related surfactant could increase the size of rats' livers, a classic response to exposure to a poison.
  • 1970s 3M (appears to) discover PFAS accumulate in human blood. 3Ms own experiments on rats and monkeys concluded that PFAS compounds "should be regarded as toxic."
  • 1976 The Toxic Substances Control Act provides EPA with authority to require reporting, record-keeping and testing requirements, and restrictions relating to chemical substances and/or mixtures. Certain substances generally excluded from TSCA include food, drugs, cosmetics, and pesticides. This list did not disclose any PFAS contaminants.
  • 1983 3M announced their $6 million hazardous waste cleanup from their disposal processes. 
  • 1998 "Dark Waters" lawyer, Robert Billott, took a case representing Wilbur Tennant, a W.V. farmer, whose had a herd of cattle decimated by strange symptoms.
  • 1998 The EPA was first alerted to the risks of PFAS—human-made "forever chemicals" that "never break down once released and they build up in our bodies." In a 2000 Times article, the EPA said that they first talked to 3M in 1998 after they were first alerted to 3M's 1998 laboratory rat study in which "male and female rats [received] doses of the chemical and then mated. When a pregnant rat continued to get regular doses of about 3.2 milligrams per kilogram of body weight, most of the offspring died within four days." 
  • Summer of 1999 Bilott filed suit.
  • 2000 a study widely detected PFOS in wildlife throughout the world" and that "PFOS is widespread in the environment." They said that "PFOS can bioaccumulate to higher trophic levels of the food chain" and that the "concentrations of PFOS in wildlife are less than those required to cause adverse effects in laboratory animals."
  • 17 May 2000 3M stopped manufacturing "PFOS (perfluorooctanesulphonate)-based flurosurfactants using the electrochemical flouorination process," which is a "class of chemicals known as perfluorochemicals (PFCs). Stacy didn't even get into how the Navy and other public services used them to fight fires and increase environmental fire with Aqueous Film Forming Foams (AFFF).
  • 17 May 2000 3M stops manufacturing Scotchgard because of their "corporate responsibility" to be "environmentally friendly." Their tests proved PFOS, an agent that 3M used in the fabrication of Scotchgard— which lingers in the environment and humans. Barboza said that 3M's "decision to drop Scotchgard" would likely affect DuPont's use of PFOAs in the manufacturing of Teflon. Their testing showed "it does not decompose, it's inert—it's persistent; it's like a rock."
  • August 2000 Bilott discovers PFOA or C8 in DuPont's dumping sites
  • Fall of 2000 Bilott gets access to 110,000 pages of documents dated back to the 1950s of DuPont's "private internal correspondence, medical and health reports and confidential studies conducted by DuPont scientists."
  • March 2001 DuPont settled the lawsuit filed by Billot on behalf of Tennant for an undisclosed sum. Bilott sends a 972-page submission to directors of all relevant regulatory authorities: EPA and US AG demanding "immediate action to regulate PFOA
  • 31 August 2001 Bilott files a class-action suit on behalf of thirteen individuals in the "Leach case."
  • 23 November 2004 The class-action lawsuit settled and "established a court-approved scientific panel to determine what types of ailments likely linked to PFOA exposure." This led to thousands of residents then opting to pursue individual lawsuits after medical monitoring showed harm. 
  • 2005-2006 The C8 Health Project undertaken by the C8 Science Panel "surveyed 69,030 individuals" who had "lived, worked, or attended school for ≥ 1 year in one of six contaminated water districts near the plant between 1950 and 3 December 2004."
  • 2006 The EPA brokered a voluntary agreement with DuPont and eight other major companies to phase out PFOS and PFOA in the United States.
  • 2014 The EPA's Federal Facilities Restoration and Reuse Office (FFRRO) developed and published a fact sheet which provided a "summary of the emerging contaminants perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), including physical and chemical properties, environmental and health impacts, existing federal and state guidelines, detection and treatment methods.
  • 2016 The EPA "published a voluntary health advisory for PFOA and PFOS," which warned that "exposure to the chemicals at levels above 70 parts per trillion, total, could be dangerous."
  • 13 February 2017 The 2001 class-action suit that Bilott had filed against DuPont, on behalf of the Parkersburg area residents, resulted in DuPont agreeing to pay $671 million in cash to settle about 3,550 personal injury claims. These claims involved a leak of perfluorooctanoic acid—PFOA or C-8— used to make Teflon in its Parkersburg, West Virginia-based Washington Works facilities. DuPont denied any wrongdoing.
  • Fall 2017 abnormally high levels of PFAS found in Belmont, Michigan, became one of the first places where PFAS contaminations caught the media's attention.[71] Wolverine Worldwide, a footwear company, was said to be the cause due to their use of Scotchgard to "treat shoe leather" and had dumped their waste in that area decades ago.
  • 2017 PFAS are on Canada's 2019 chart of substances prohibited by the Canadian Environmental Protection Act, 1999 (CEPA) and by Prohibition of Certain Toxic Substances Regulations, 2012. These substances are under these regulations because they are "among the most harmful" and "declared toxic to the environment and/or human health," are "generally persistent and bioaccumulative." The "regulations prohibit the manufacture, use, sale, offer for sale or import of the toxic substances listed below, and products containing them, with a limited number of exemptions." [72]
  • 10 January 2018 According to the U.S. Department of Health & Human Services's Agency for Toxic Substances and Disease Registry (ATSDR), studies in humans with PFAS exposure show certain PFAS may affect growth, learning, and behavior of infants and older children, lower a woman's chance of getting pregnant, interfere with the body's natural hormones, increase cholesterol levels, affect the immune system, and increase the risk of cancer."
  • 30 January 2018 three branches of the EPA exchanged chains of emails with OMB, DoD, HHS, and the Pentagon, to put pressure on the Agency for Toxic Substances and Disease Registry (ATSDR). It aimed to censor a report that measured the "health effects" of PFAS that are "found in drinking water and household products throughout the United States." An email by an unidentified white house administration forwarded by OMB said that "The public, media, and Congressional reaction to these numbers is going to be huge. The impact to EPA and [the Defense Department] is going to be extremely painful. We (DoD and EPA) cannot seem to get ATSDR to realize the potential public relations nightmare this is going to be." 
  • March 2018 The United States Department of Defense's (DoD) 's report to Congress said the test they conducted showed the amount of PFAS chemicals in water supplies near 126 DoD facilities "exceeded the current safety guidelines." [65] The DoD "used foam containing" PFAS chemicals "in exercises at bases across the country." The DoD, therefore, "risks the biggest liabilities" concerning the use of PFAS chemicals, according to Politico (published May 2018)
  • 21 June 2018 The Department of Health & Human Services Agency for Toxic Substances and Disease Registry(ATSDR) 697-page draft report for public comment, "Toxicological Profile for Perfluoroalkyls," was finally released.
  • June 2019 Described as a "huge step toward cleaning up the prevalence of and prevent further contamination from PFAS chemicals in-ground, surface and drinking water," the Department of Environmental Services of the state of New Hampshire submitted a "final rulemaking proposal" for new, lower maximum contaminant levels. They then filed a lawsuit against Dupont, 3M, and other companies for their roles in the crisis in drinking water contamination in the United States. The lawsuit claims that the polluted water results from the manufacture and use of perfluorinated chemicals, a group of more than 9,000 compounds collectively known as PFAS.[2]
  • September 2019Andrew R. WheelerEPA Administrator, met with industry lobbyists and said that "Congressional efforts to clean up legacy PFAS pollution in the National Defense Authorization Act for fiscal 2020" were "just not workable." Wheeler refuses to "designate PFAS chemicals as "hazardous substances" under the Superfund law."
  • 1 October 2019 A lawsuit filed in the Merrimack County Superior Court by 3M and two others against the state aimed to prevent the new permitted levels for PFOA, PFOS, PFNA, and PFHxS from implementation. 
  • 4 October 2019 over 100 scientific experts representing many countries "recommended that a group of hazardous chemicals"—"Perfluorohexane sulfonic acid (PFHxS), its salts, and PFHxS-related compounds"—be eliminated to better protect human health and the environment from its harmful impacts."
  • 10 March 2020 EPA announced its proposed regulatory determinations for two PFAS in drinking water. In a Federal Register notice, the agency requested public comment on whether it should set maximum contaminant levels for PFOA and PFOS in public water systems. 
  • April 2021: Landmark bipartisan legislation proposed to protect all Americans and our environment from harmful forever chemicals known as per- and polyfluoroalkyl substances (PFAS). The package establishes a national drinking water standard for select PFAS chemicals, designates as hazardous to allow the Environmental Protection Agency (EPA) to clean up contaminated sites 
  • https://debbiedingell.house.gov/news/documentsingle.aspx?DocumentID=2975
  • June 2021: No PFAS in Cosmetics Act introduced with bi-partisan support, coinciding with the publication of a study finding over half of cosmetics contain them. One study found toxic 'forever chemicals' widespread in top makeup brands. The act would require the Food And Drug Administration to ban the chemicals' use in such products within 270 days.
  • June 2021 They also reintroduced the Personal Care Product Safety Act, a bill that would take a major step forward to update our laws governing cosmetics. These laws have largely stood unchanged since 1938.

[caption id="attachment_45315" align="aligncenter" width="740"]Source: https://www.ewg.org/pfaschemicals/what-are-forever-chemicals.html[/caption]

See this link for an even more detailed timeline of PFAS and toxic chemicals.

 

What Are PFAS In?

PFAS functions in many capacities, including surfactants, friction reducers, and water, dirt, and oil repellents. (50:01)

As such, they are used in a wide variety of consumer products to confer nonstick (waterproof, greaseproof, and stainproof) and low-friction properties. 

Examples of products that contain or coated with PFAS include:

  • Some grease-resistant paper, fast food containers/wrappers, microwave popcorn bags, pizza boxes, and candy wrappers 
  • Nonstick cookware 
  • Stain-resistant coatings used on carpets, upholstery, and other fabrics 
  • Water-resistant clothing 
  • Umbrellas, tents, any fabric that repels water (pet bed covers, some mattresses, shoes, etc.)
  • Cleaning products 
  • Personal care products (shampoo, dental floss) and cosmetics (nail polish, eye makeup) 
  • Paints, varnishes, and sealants
  • Electronics
  • Some industrial glass and plastics

PFAS are also used directly or as technical aids (dispersants and emulsifiers) in many industrial applications like metal coatings, lubricants for machinery, membranes, and firefighting foams. 

PFAS are used in the synthesis of or as adjuvants in pesticides, in medical procedures and products, and in many other applications.

PFAS in Cosmetics

The FDA has a voluntary registration program (VCRP) which shows an overall decrease in use (about half from 2019 to 2020). 

But their site states- "because registration and product listing are voluntary, this data cannot draw definitive conclusions about the types and amounts of PFAS present in registered cosmetics or to determine which cosmetics may contain PFAS but have not been registered in the VCRP."

[caption id="attachment_45319" align="aligncenter" width="740"]Source: https://www.fda.gov/cosmetics/cosmetic-ingredients/and-polyfluoroalkyl-substances-pfas-cosmetics[/caption]

The Environment and Water Supply

Because of their widespread use, release, and disposal over the decades, PFASs show up virtually everywhere: soil, surface water, the atmosphere, the deep ocean—and even the human body. 

The U.S. Centers for Disease Control and Prevention's Web site says that the agency has found PFASs in the blood of nearly everyone it has tested for them, "indicating widespread exposure to these PFAS in the U.S. population."

Scientists estimated that more than 200 million people—most Americans—have tap water contaminated with a mixture of PFOA and PFOS. These are at concentrations of one part per trillion (ppt) or higher.

 

Problems with PFOA-Free (PFOS-free, PTFE-free)

The most well-studied of these substances, PFOA, and PFOS, have been linked to various health problems. (59:45)

Bad press and class-action lawsuits have put pressure on companies to discontinue the use of PFOA and PFOS, but not PFAS as a chemical class.

The regulatory bodies have not kept up with the chemical industry either!

When some major manufacturers phased out long-chain PFAS, most industries turned to structurally similar replacements. These include hundreds of homologues with fewer fluorinated carbons (short-chain PFAS) or other less well-known PFAS (e.g., per- and polyfluoroalkylether-based substances).

Producers marked these replacement PFAS as safer alternatives because of their presumed lower toxicity and lower level of bioaccumulation in human blood.

However, several lines of evidence suggest that short-chain PFAS are not safer alternatives. 

Research demonstrated that short-chain PFAS can be equally environmentally persistent and are even more mobile in the environment and more difficult to remove from drinking water than long-chain PFAS.

Bioaccumulation of some short-chain PFAS occurs in humans and animals. For example, fish research suggests they can do more than the long-chain compounds they aim to replace. 

Short-chain PFAS also can be more effectively taken up by plants. However, a growing body of evidence suggests they are associated with similar adverse toxicological effects as long-chain PFAS.

The ongoing accumulation of persistent chemicals known or potentially hazardous increases human and environmental health risks over an indefinite period.

Look for PFAS-free specifically. It's not enough to be PFOA, PFOS, and PTFE-free.

 

What Can We Do About It?

The problem with these chemicals is that there unavoidable. However, we can take steps to protect ourselves. (1:05:01)

Make sure the makeup brands you're using test for safety! PFAS and toxic chemicals are the kind of thing someone wouldn't know about unless they checked and tested the product for them. If you shop Beautycounter, use code cleanforall20 for 20% off your purchase. Of course, you can always email Stacy for advice at stacy@realeverything.com!

Avoid plastics and coated papers for food storage whenever possible.

Also, avoid nonstick cookware or look for ceramic coatings that are PFAS-free, like Le Creuset or Greenpan or silicone liners.

Filter your water. Stacy and Sarah love AquaTru, which they talked about in Episode 406.

Also, be sure to think about other exposure areas, such as clothing, carpeting, etc.

Call Your Representatives! April 13, 2021, House representatives introduced the PFAS Action Act of 2021, a comprehensive 40-page piece of legislation that would require the Environmental Protection Agency (EPA) to take several significant PFAS regulatory actions.

Keep Food Containers Safe from PFAS Act (H.R. 2727) is soon to be reintroduced by Michigan Rep. Debbie Dingell.

Call your representatives to support the proposed environmental justice plan that specifically calls out forever chemicals, tackles PFAS pollution by designating PFAS as a hazardous substance, setting enforceable limits for PFAS in the Safe Drinking Water Act, prioritizing substitutes through procurement, and accelerating toxicity studies and research on PFAS."

The new administration could carry out all of these goals unilaterally through executive action without Congress's cooperation.

Dan Kildee (MI) and Brian Fitzpatrick are heading the bipartisan PFAS Task Force. They have a LONG list of people in the task force with goals. 

  • No PFAS in Cosmetics Act
  • Personal Care Product Safety Act
  • Natural Cosmetics Act (not updated since introduced in 2019)

Also, Stacy encourages you to text Better Beauty to 52886, which will cover these bases. 

Support advocacy groups like Environmental Working Group, Toxic-Free Future | Science, Advocacy, Results, Safer Chemicals, Healthy FamiliesEarthjustice: Environmental Law: Because the Earth Needs a Good Lawyer | Earthjustice other local groups.

EPA says reverse osmosis (but not filters, like Brita, unfortunately) removes PFAS

Lastly, don't get suckered into PFAS detoxes! Currently, there is no established treatment for PFAS exposure. However, blood levels will decrease over time after a reduction in exposure to PFAS. 

 

 

 

 

The Whole View, Episode 463:  Is There Science Behind Candida Cleanses?

Welcome back to episode 463! (0:28)

Sarah always thought Candida cleanses wouldn't align well with AIP. The sheer amount of food elimination makes it nearly impossible to get the variation needed for nutrient sufficiency.

She's since has done tons of research regarding the science behind Candida cleanses and has dug up some surprising information that will debunk a lot of internet claims.

Just Thrive, Stacy and Sarah's favorite probiotic for gut health support, is sponsoring today's show! Get 15% off your purchase with code THEWHOLEVIEW at checkout.

This is far from the first time Stacy and Sarah have talked about Just Thrive. See episodes 346417445, and 457 for more on Just Thrive!

A listener question inspired this topic! Olivia says:

I got diagnosed of candida, and my integrative doctor said to cut out honey or maple syrup for two months, knowing those are what I typically would use as a sweetener. When I look up the candida cleanse diet online, apparently fruits high in sugar and caffeinated drinks would be off the table also-not that my doctor recommended me to though.

I know Dr. Sarah would say that our body needs the nutrients in fruits too for various reasons, and blackstrap molasses are a superfood.

I am aware that even for healthy individuals, sweetener should only be consumed in moderation. However, for a Sjögren’s syndrome warrior now also diagnosed with candida, should I cut out maple, honey, molasses and fruits high in sugar even in moderation? Is AIP okay with candida? Are there any drawbacks of starving the candida with a cleanse to reset my microbiome before resuming on the recommended AIP lifestyle? 

Alas, life of an autoimmune disease warrior!  

What Is Candidiasis?

Candidiasis is essentially an overgrowth of yeast. (8:50)

Candida albicans is a species of yeast that is a member of the healthy microbiota, asymptomatically colonizing the gastrointestinal tract, reproductive tract, oral cavity, and skin of most humans (1, 64, 87, 97, 99).

It's commonly found both on and in the human body and generally causes no problems. 

Certain conditions, however, can lead to an overgrowth of this benign organism. The resulting infection is candidiasis.

Potential Causes

The most common cause is alterations in the host-microbiota due to the use of antibiotics.

Research in mice suggests that bacteria in the gut usually out-populate yeast and other fungi by three orders of magnitude. 

During antibiotic treatment (which can kill good bacteria in your gut in the process of attacking the invader making you sick), the gut yeast population skyrockets 40-fold. Typically, levels return to normal within eight weeks.

So the best thing you can is to support the recovery of the gut microbiome. Stacy and Sarah talked about this more in-depth in Episode 460.

People with a suppressed immune system and/or diabetes can be more susceptible to yeast overgrowth.

Chronic stress can also increase risk, as shown in the morning rise of salivary cortisol levels in women with recurrent vulvovaginal candid.

Another cause is variations in the local environment such as Vitamin D insufficiency and low sun exposure(separately), B complexZinc, and Selenium.

Yasmin et al. proved that increased dietary fat intake (39% of energy from fat), especially total fat, saturated fat, and monounsaturated fat, can increase vaginal pH and the risk of bacterial vaginosis. 

High estrogen levels can also be a risk factor, which is why yeast infections are more common when women are pregnant or taking hormones.

Before making a lot of health changes to her lifestyle, Stacy suffered chronic yeast infections. Like many, she often thought of avoiding sugar such as carbohydrates.

 

Complications from C. Albicans Infection

C. Albicans infections can cause a spectrum of other complications. (19:26)

Vaginal yeast infections (which affect up to 75% of women at least once in their lifetime), superficial mucosal infections (such as thrush), and superficial dermal infections (like diaper rash and cutaneous candidiasis) are common results of C. Albicans Infection.

Cases of invasive candidiasis are very rare. It happens when blood or internal organs become infected and usually occurs in hospitalized patients. It has high morbidity and mortality rates (approaching 40% in some cases).

Candida albicans may also play a role in the persistence or worsening of some chronic inflammatory bowel diseases!

Some research has linked yeast, such as Candida, to a few gastrointestinal conditions including Crohn’s Disease and Graft-Versus-Host Disease. 

With Crohn’s, researchers are careful to note there’s no evidence that fungi cause the disease. However, they do seem to aggravate the inflammatory response in mice. However, Crohn’s patients often have higher-than-normal levels of antibodies against components of Candida and other yeast. 

But the associations between yeast and other gastrointestinal conditions are still just associations. 

So far, no one knows whether the yeast plays a causal role or whether changes to yeast populations might be a consequence of the conditions.

Candida infections are especially serious in immunocompromised individuals and healthy people with implanted medical devices (96, 201).

Diagnosis of Candida Infection

Symptoms of the condition for oral and vaginal thrush may be diagnostic if there’s a history of previous candida infections, weakened immunity, and steroid or antibiotic use. 

For vaginal yeast infections, your health care provider will perform a pelvic exam and take a sample of the discharge from your vagina.

In the diagnosis of oral thrush, the appearance of the lesions is characteristic. But your healthcare provider may also take a small scraping to examine under the microscope.

For suspected yeast infection on the skin or nails, your healthcare provider may use a blunt-edged instrument to scrape off a small bit of skin or part of a nail for examination.

For invasive candidiasis, healthcare providers will take a blood or tissue sample to see if it will grow Candida in a lab culture.

 

Blamed for Everything: the Science Behind Candida Cleanses

There is a trend towards blaming candida for everything. However, Sarah has found no science to support this. (27:55)

She adds there's not a shred of science supporting Candida overgrowth as the root cause of society’s collective fatigue, insomnia, autoimmune diseases, food cravings, or acne.

Also, there is no evidence that Candida cleanses and anti-fungal drugs can cure any of these conditions.

In a small clinical trial, researchers at the University of Alabama recruited women who had repeated vaginal yeast infections and also other vague symptoms like brain fog, allergies, and digestive issues. They split them into groups and gave them different combinations of antifungal drugs or sugar pills. 

Although the antifungal drugs did control vaginal yeast growth and symptoms, they did not improve the subjects’ other symptoms any more than did the sugar pills.

There’s also a trend towards diagnosing candida overgrowth based on symptom questionnaires. However, for a proper diagnosis, you need to do testing!

What most people end up doing if they or their doctor suspect Candida goes on this "Candida Cleanse."

 

The Science Behind Candida Cleanses

Stacy remembers years and years ago she and Sarah talked about real detoxes(29:45)

She also notes a lot of what we see in regards to fads comes down to predatory marketing designed to make us feel inferior and pressure us into buying expensive products.

The most common advice for a Candida Cleanse is to limit sugar and carbohydrates, avoid yeast and fungus-containing foods, and increase your intake of probiotic foods.

Sarah wants to go through these claims one by one to see what the science behind Candida cleanses says.

Low-Carb and Low-SugarThere is no science to support the idea of eliminating fruits and starchy vegetables for candida. 

In a 1999 interventional study, researchers in Germany tracked the habitual carbohydrate intake of 28 healthy people. They found how many carbs they ate bore no relationship with the numbers of Candida growing in their bodies. 

When the researchers put the subjects on high-sugar diets, they didn’t see a corresponding increase in Candida growth either.

So, the popular idea that sugar causes Candida overgrowth and limiting sugar will cure you of it doesn’t have much science in support of it. In fact, some research directly challenges it.

A 1984 study found cutting down on the consumption of dairy products, table sugar, and artificial sweeteners reduced the incidence and severity of Candida vulvovaginitis and yeast infections in women prone to them.

2009 study found that fat was the culprit, not carbs! However, it suggests we need further research to clarify the mechanism of the relationship between dietary fat intake and increased risk of BV.

“Starving” the candida by eliminating fruits and starchy veggies means starving good bacteria too.

For a lot of people, a candida cleanse means eliminating refined grains, added sugars, and eating more veggies and ferments. Eliminating all those things is going to make you feel better regardless of candida, which is why you think it's helping!

2: Avoiding Yeast-Containing Foods

The yeast is commonly eliminated foods is a completely different type of yeast than what causes Candida!

Brewers and baker’s yeast are both Saccharomyces cerevisiae. It's a relatively neutral yeast from a gut microbiome perspective but can actually inhibit the growth of Candida!

Fermented foods tend to contain Saccharomyces boulardii, which is a very important probiotic yeast that can also inhibit Candida growth.

Sarah gets asked all the time about mushrooms with candida and there is no science to support avoiding mushrooms. If anything, the science points to mushrooms being potentially very helpful!

  1. Probiotics

Adding a probiotic to your regimen, on the other hand, is a very good idea when dealing with Candida.

The beneficial bacteria in yogurt and other fermented foods may help keep the candida population in check. 

Probiotic supplementation during or after antibiotic use may also help reduce the risk of antibiotic-related yeast infections. 

Lactobacillus species are well-known to reduce the ability of Candida albicans to infect cells and induce inflammation and stimulate the production of antibodies. (Find more information here and here!) 

Research shows probiotics can help with bacterial vaginosis as well!

One 2009 study found combining antifungal therapies with a probiotic supplement (Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14®) presented even better results.

Additionally, a 2013 paper showed that eating yogurt can reduce the proliferation of Candida in both the mouth and the vagina.

Antonio et al. found agreement between Lactobacillus species in the rectum and vagina, suggesting that the rectum may serve as a potential source of vaginal colonization. 

For more science, see Candida albicans Biofilms and Human Disease and Candida albicans, plasticity and pathogenesis.

 

It’s All About the Microbiome

Once again, we come full-circle to the gut microbiome. (1:02:30)

Sarah goes even more in-depth into the gut microbiome in her Gut Health Guidebook.

The AIP is really great for the gut microbiome! AIP eliminates foods like nuts, seeds, A2 dairy (especially fermented), rice, oats, corn, legumes. Sarah notes none of these are as important as the nutrient-dense foods incorporated into the AIP

This is why it's so important to support gut health. 

Make sure you are consuming enough veggies, fruits, and mushrooms. Each family is independently beneficial, so treat them as their own food groups! (See episodes 281286304307335346373392424435)

Nuts and seeds should be consumed in moderation (episodes 413 and 452).

Make EVOO the go-to fat (episodes 326 and 414).

Lots of fish and shellfish (or a fish oil supplement) is also great for nutrient sufficiency while supporting gut health (episodes 366415451)

Be sure to focus on nutrient density, especially vitamin A, vitamin D, and minerals. Our gut bacteria can make most of the B vitamins and K.

Fermented foods (like wild-fermented kraut, kefir, kombucha) are amazing probiotics that support your gut.

Lifestyle choices are just as important! Sleep, activity, and stress management have a bigger impact on overall health than we realize. 

Consider adding a Bacillus-based probiotic like Just Thrive to your regimen as well. (Again, use the code THEWHOLEVIEW at checkout for a 15% discount!)

 

Final Thoughts

Sarah reminds listeners that she and Stacy are not medical professionals. So it is very important to speak with your doctor for a proper diagnosis. (1:05:04)

Many of the claims found online are not supported by the science of Candida cleanses. That's not to say there aren't dietary changes you can make to help with the infection.

To answer Olivia's question- yes, AIP is comparable with Candida. However, be sure you're not cutting out fruits, veggies, and other nutrient-dense foods that have no science-backed reason to eliminate.

Thank you, Just Thrive, for agreeing to sponsor this show. Be sure to take a look at all of their great products!

For exclusive bonus content and front-line access to Sarah and Stacy, be sure to head over to Patreon! Your subscription goes directly to support this show!

Thanks for listening and we will see you next week!

Welcome to episode 462 of The Whole View! This week, Sarah and Stacy revisit previous episodes on ADHD and update the science behind natural approaches and medication. 

If you enjoy the show, please review it on iTunes!

The Whole View, Episode 462: ADHD Update: Natural Approaches and Medication

Welcome back to episode 462! (0:28)

Science is an evolutionary process, and things change as we learn and grow. Stacy and Sarah have years of content they want to bring to the forefront as relevant and update any information that might have since changed.

Stacy's son Cole has inactive ADHD (previously called ADD), an attention deficit without the hyperactive traits associated with ADHD.

Because of the differences, Stacy's family manages Cole's ADHD is very different from how they manage her youngest's, Westley's, who has hyperactive traits.

Medication is not a failure. However, at the beginning of Stacy's journey, she operated under the mindset that not medicating is better.

No matter how much you diet and exercise, it doesn't change a medical condition. There is nothing wrong with utilizing medications to manage a medical condition, and it doesn't mean you've failed yourself or your kids.

Stacy tried everything she could to manage Cole's ADHD and admits she waited too long to try medicine. 

Seeing her child less anxious, less angry, more attentive, and in control of himself made her grateful to have found a medication that worked for him. She also feels very strongly that it made her a better mother because she was helping him to be his best. 

Stacy's husband, Matt, was on a stimulant, and it worried her because of the long-term health risks. She wants to share updates with the audience and options she wishes she'd known sooner. 

Sarah has the science, but Sarah and Stacy are not medical professionals. Be sure to consult with your doctor for what best for you.

For the notes on the prior shows, Stacy and Sarah revisit episodes 145 and 185.

 

Cole's Update: One Year Later

Stacy's oldest son, Cole, joins us once more to update us on ADHD and how he's managing it in 2021. (1:17:50)

Cole makes his lunch every day to ensure he's adhering to his dietary constraints. Cole's teacher keeps a stock of gluten-free snacks in the classroom for Cole to have. And whenever it gets low, she lets Stacy know to restock it.

In terms of his ADHD, they've tried supplements and coffee for the caffeine content. Both did not work for Cole.

Cole has started walking to school to get rid of excess energy before his day starts. His teacher also allows him to work on his homework when there's time in class.

When he's not interested in a subject, it's really difficult for him to remember what he learned about it. This comes from the inattentive side of his ADHD.

However, Cole is finding many more things that he enjoys and is overall happier than he was at the start of this journey.

Stacy and Cole found increasing his physical activity has been very helpful in managing his ADHD symptoms. She's also noticed he's been less physical with roughhousing with his brothers.

Managing Screen Time

Every week, Cole gets 1 hour of video game time as long as he doesn't abuse it and he's had a good week. (1:37:20)

It's also limited to computer games and not console games. Stacy has noticed overstimulation from console games that she doesn't see when he plays on the computer.

Overall, Cole's attitude, mood, and more have drastically improved since he podcasted with Stacy and Sarah.

One of the best things Stacy had done was experimenting with lifestyle changes, such as monitoring screen time.

Sarah loves how Stacy's approach has been very intuitive and adapted depending on how Cole's body reacts.

Parenting for Stacy has been all about intuition, and they do a lot of alternative things, such as allowing the kids to curse at home.

 

ADHD Update: Natural Approaches and Medication for ADHD

Jumping back to the present day, Stacy explains how much working with a medical professional has helped her, Cole, and Westley on this journey. (1:51:00)

She's so happy to have found a medication that worked for them and helped alleviate the symptoms of ADHD outside of inattention.

Stacy equates this to epilepsy: you can try lifestyle changes to help alleviate the symptoms, but if your child is still having seizures, you should also seek medical help.

The same philosophy can and should be applied with other cognitive conditions like ADHD.

Stacy learned that there's a non-stimulant option and that it's worked very well.

Central nervous system (CNS) stimulants are the most commonly prescribed ADHD medications. These drugs work by increasing the amounts of the brain chemicals dopamine and norepinephrine.

Examples of these drugs include methylphenidate (Ritalin) and amphetamine-based stimulants (Adderall).

Stimulants have been used to treat ADHD for several decades for their ability to help you focus and ignore distractions. 

Stimulant meds work for 70% to 80% of people and treat moderate and severe ADHD. They also may be helpful for children, teens, and adults who have a hard time at school, work, or home. 

Some stimulants are approved for use in children over age 3. Others are approved for children over age 6.

If stimulants don't work or cause unpleasant side effects, your doctor may recommend a non-stimulant.

Certain non-stimulant medications work by increasing levels of norepinephrine in the brain.

These medications include atomoxetine (Strattera) and some antidepressants such as bupropion (Wellbutrin).

 

Natural Approaches and Medication: Stimulants

Stimulants are the most commonly prescribed medications for ADHD. They're often the first course of drugs used for ADHD treatment.

You might hear this class of drugs called central nervous system (CNS) stimulant medications. They work by increasing the amounts of the hormones called dopamine and norepinephrine in the brain.

This effect improves concentration and decreases the fatigue that's common with ADHD.

Amphetamines 

Amphetamine, dextroamphetamine, and lisdexamfetamine are all stimulants used to treat ADHD.

They come in immediate-release and extended-release oral forms and can include brands such as:

  • Adderall XR (generic available)
  • Dexedrine (generic available)
  • Dyanavel XR
  • Evekeo
  • ProCentra (generic available)
  • Vyvanse

Methamphetamine 

Methamphetamine is related to ephedrine and amphetamine and also works by stimulating the CNS. However, it's not known exactly how this drug works to help ADHD symptoms. 

Like other stimulants, methamphetamine may increase the amounts of hormones like dopamine and norepinephrine in your brain. It can also reduce your appetite and increase your blood pressure

It comes as an oral tablet taken once or twice per day.

Methylphenidate

Methylphenidate works by blocking the reuptake of norepinephrine and dopamine in your brain to help increase levels of these hormones.

It comes in immediate-release, extended-release, and controlled-release oral forms. If oral doesn't work for you, a transdermal patch under the brand name Daytrana is also available. Brands include:

  • Aptensio XR (generic available)
  • Metadate ER (generic available)
  • Concerta (generic available)
  • Daytrana
  • Ritalin (generic available)
  • Ritalin LA (generic available)
  • Methylin (generic available)
  • QuilliChew
  • Quillivant

Dexmethylphenidate

Dexmethylphenidate is similar to methylphenidate and is available as the brand-name medication Focalin.

Side effects of short-acting stimulants include loss of appetite, weight loss, sleep problems, crankiness, and tics. Long-acting medicines may have greater effects on appetite and sleep. 

The FDA warns about the risk of drug abuse with amphetamine stimulants. Safety advisers are also concerned that all amphetamine and methylphenidate stimulants used for ADHD may make heart and psychiatric problems more likely.

The risks associated with the long-term use of ADHD medication include:

  • Heart disease
  • High blood pressure
  • Seizure
  • Irregular heartbeat
  • Abuse and addiction
  • Skin discolorations  

 

Natural Approaches and Medication: Non-stimulants

Non-stimulants affect the brain differently than stimulants do. 

These drugs also affect neurotransmitters, but they don't increase dopamine levels. So, it takes longer to see results from these drugs than from stimulants.

These drugs come in several classes, and a doctor might prescribe them when stimulants aren't safe, ineffective, or avoid the side effects of stimulants.

Atomoxetine (Strattera)

Atomoxetine (Strattera) blocks the reuptake of norepinephrine in the brain, allowing it to work longer.

The drug comes in an oral form you take once or twice per day.

Atomoxetine has caused liver damage in a small number of people, so if you have signs of liver problems while taking this drug, your doctor will check your liver function.

Signs of liver problems include a tender or swollen abdomenyellowing of your skin or the whites of your eyes, and fatigue.

Clonidine ER (Kapvay)

Clonidine ER (Kapvay) is used to reduce hyperactivity, impulsiveness, and distractibility in people with ADHD. Other forms of clonidine can treat high blood pressure.

Because it also lowers blood pressure, people taking it for ADHD may feel lightheaded.

Guanfacine ER (Intuniv)

Guanfacine is normally prescribed for high blood pressure in adults. Only the time-release version and its generics are approved for use in children with ADHD.

The time-release version is called Guanfacine ER (Intuniv). It may help with memory and behavioral problems, as well as improve aggression and hyperactivity.

Non-stimulant medications can take up to several weeks to start working. Also, they may not work as well as stimulants. 

Some non-stimulant medications may raise the risk of suicidal thoughts and death by suicide in teens. This is why the FDA warns anyone taking atomoxetine (Strattera) is monitored for suicidal thoughts, especially during the first few weeks. 

Common side effects of these drugs include fatigue, upset stomach, dry mouth, and nausea. Your blood pressure often rises when you stop taking them.

 

Final Thoughts on ADHD Natural Approaches and Medication

Stacy has found that the most effective way of handling ADHD symptoms is through natural approaches and medication. (2:02:00)

She chose a non-stimulant option because Cole didn't need to dopamine increase that many people with ADHD benefit from. His focus was more on impulse control.

As a parent, if you've done everything you can from a lifestyle perspective, but you and your child are still not performing optimally, it's okay to seek additional help with modern medicine.

Just know that it's an effort you are making to help your child be their best self. 

Be sure to hop over to Patreon to hear how Stacy and Sarah really feel about the topics they discuss. If you haven't yet joined the Patreon family, your subscription helps to support this show and gets you direct access and bonus content.

Want more info on our Real Life? Healthy recipes, parenting tips, and general lifestyle stuff goes out in our Real Everything newsletter, join here.

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The Whole View, Episode 461: Oats-M-G, Are These Actually Healthy?

Welcome back to episode 461! (0:28)

Stacy has mentioned in the past how great she feels when she includes some oats in her diet. She clarified that it's not something she loads up on daily.

Finding high-quality, gluten-free, and non-glyphosate was a game-changer for her as well.

For years, Stacy and Sarah have talked about how grains were problematic for digestion, proper absorption of nutrients, and gut health. However, it's important to revisit how we look at food with a scientific approach as often as possible.

Both Stacy and Sarah's health journeys took a path through the Paleo Diet to a point where they are now very open to experimenting with foods they were not maligned to for a long time.

For Sarah, that means revisiting the science of these foods to get away from the idea of grouping foods together and instead look at the pros and cons of individual foods and how they can fit into an overall healthy diet to empower others to experiment.

Sarah is a self-described Thrive Market junkie, and many of the (non-sponsored) products she and Stacy will be discussing can be found on their site. 

They also have a great feature called subscribe and save, where you can save money on products you buy regularly!

Listener Question

Sarah and Stacy have received many questions on this topic. This question in particular resonated the most:

First off, I ADORE you both. I feel like you are my best friends and just don't know it yet :) I want to eat raw heads of lettuce (I've done this for years!) and get angry about poorly conducted research with Sarah, and go lift heavy weights while discussing clean beauty with Stacy. I can't get enough of you guys!

So, my question is related to oats. Because my diet has been restrictive for so long while I've tried to heal my digestive system after being diagnosed with celiac three years ago, I have now developed anaphylactic responses to a lot of paleo foods. I was really happy this month when I was successfully able to reintroduce rice and oats, finding them to actually feel calming on my stomach. Because my list of paleo foods that I am reacting to keeps growing longer the more I rely on them, I am finding myself turning to these other foods like legumes, rice, and oats, on a daily basis in order to simply get enough food in. While I seem to tolerate it, it makes me nervous that I may be doing long term damage. I know you have discussed briefly how rice and some beans are actually not bad for the gut, but that was still always with the caveat of them being eaten "occasionally." And I don't think I've heard you discuss oats much at all. 

Could you perhaps address the effect of GF oats on the microbiome, as well as the overarching effects of a diet that includes a lot of these "non paleo" foods, but in the context of an otherwise veggie and fruit rich diet with only healthy fats, high quality meat and organ meats, and no refined sugars? 

Thank you! I love you both and am so thankful for all you do! - Anna

Dogma of Paleo and Other Rigid Diets

Stacy shares how much this question resonates with her. She first started on this health journey from guilt and feeding into the dogma of paleo that glorifies some foods and demonizes others. (8:00)

In fact, what qualifies as a "paleo" food will vary from person to person.

It's okay to lean into foods that make you feel good even if they don't fit a diet "framework" of what good and bad for you.

For example, it was easy for Sarah to lump oats in with wheat and other grains and not critically evaluate it independently.

Paleo has a very rigid set of rules, and it's important to Sarah to give listeners the tools and confidence needed to find what works best for them as individuals.

Even if you stray from the framework of a particular diet but still identify with the term Paleo, there's nothing wrong with that.

What works today might not work two years from now. It's okay to change to something better suited for what we need in a moment.

Stacy stresses that they are not here to tell you what good, bad, and qualifies under a certain label.

 

Health Benefits of Oats

Oats have been very well studied for at least 30 years and have some well-established health benefits. (16:27)

Whole grain oat products have shone to positively impact coronary heart disease, diabetes, satiety/weight management, low glycemic index, and blood pressure. 

These characteristics are mainly attributed to the high content of oat-specific beta-glucans, which are soluble food fibers.

However, some people don't do well with oats. This is likely due to gluten cross-contamination.

Gluten is a prolactin that is inflammatory that increases intestinal permeability, and is linked to adiposity signals. But avenin, prolamin type lectin, may not be as bad.

Oats are often grouped in with wheat and barley as problematic, but not because oats themselves are a problem.

Avenins are present at a lower concentration (10%–15% of total protein content) in oat as compared to gluten in wheat (80%–85%).

The avenins in the genus Avena are free of the known CD immunogenic epitopes from wheat, barley, and rye. T cells that recognize avenin-specific epitopes have been found very rarely in CD patients.

In fact, avenins are highly digestible and don't come out half-digested like gluten often does.

Unlike gliadin peptides, oat peptides are also sensitive to digestion by pepsin, trypsin, and chymotrypsin in the gastrointestinal tract. They are unlikely to have any clinical relevance.

Some cultivars of oats are gluten cross-reactors, meaning that if your body forms antibodies against gluten. But this appears to be a fairly low-frequency cross-reactivity and even not a problem for most people with celiac.  

High Likelihood of Cross Contamination

However, oats are often processed on the same wheat, making the potential contamination pretty high.

For example, the U.S. specification for No. 1 oats allows the presence of up to 2% foreign material, which could be all wheat and barley!

So yes, the biggest con of oats is that it's frequently contaminated with gluten. As we discussed on a recent show, upwards of 55% of people, have at least one gluten sensitivity gene. 

Stacy references Oat O's and Thrive Market (not sponsored on this show!) for reduced risk of cross-contamination and what she personally leans on.

For more information, Sarah recommends:

Oats Nutrient-Density

Although oats fare better than other grains, they are nutritionally underwhelming per calorie. (26:50)

A 100-gram (2/3 cup) serving of oats has a moderate glycemic load (37) but serves a fairly high (389) in calories.

That serving of oats does provide an impressive 246% DV for manganese and 40-50% DV for vitamin B1, magnesium, and phosphorous. It also provides 20-30% DV of iron, copper, zinc.  

Not too shabby... but not crazy impressive either.

Sarah has been calculating Nutrivore Scores, and oats are the third-highest grain after corn and buckwheat. She adds that this is neither a pro nor a con for oats but shouldn't really be considered a "foundational" part of your diet, but rather fit in for added benefits. 

Revisit 29:30 to figure out what Stacy is talking about with more context.

 

Oats and the Microbiome

That same 100-gram serving contains a whopping 10.6 grams of fiber, including being particularly rich in a very special soluble fiber: mixed linkage beta-glucan. (34:31)

This is a highly fermentable fiber that feeds anaerobic microbes in the gut and significantly increases the production of the short-chain fatty acids butyric and propionic acids. Oats contain 3-7% beta-glucan!

Studies show over and over again that beta-glucans from oats significantly increase the growth of very important probiotic strains of Bifidobacterium as well as the Lactobacillus-Enterococcus group.  

And oat beta-glucans seem to be better than beta-glucans from other grains.

One study showed that an oat-based diet resulted in higher Bifidobacteria levels than either a barley-based or wheat-based diet supplemented with equivalent amounts of beta-glucan.

In addition, these high levels of beta-glucan appear to be the "magic ingredient" behind oat's most famous properties, including their cholesterol-lowering effects. 

This occurs because beta-glucan increases the viscosity of the chyme in the upper GI tract, leading to increased binding and secretion of bile acids. 

In turn, plasma cholesterol becomes a substrate for newly formed bile, causing blood levels to decrease.

Beta-glucans contribute to the maintenance of normal blood cholesterol levels.

Consumption of beta-glucans from oats and barley as part of a meal (4 g/30 g carbohydrates) contributes to reducing the blood glucose rise after that meal (EU 432/2012).

Oat grain fiber contributes to an increase in fecal bulk (EU 432/2012).

Reducing saturated fat consumption contributes to the maintenance of normal blood cholesterol levels (EU 432/2012).

Oat beta-glucan (3 g/day) has been shown to actively lower/reduce blood cholesterol. High cholesterol is a risk factor in the development of coronary heart disease (EU 1160/2011).

In addition, oat fibers increase the fecal bulk, which contributes to a normal stool and positively impacts the functioning of the microbiome.

Oats in particular also have high bioactive potential and relatively high lipid content relative to other grains. Their unique composition contributes some special benefits to gut health compared to other whole grains.

 

Surprise! Oats Are Super Digestible

Protein content in the oat groat is relatively high (15%–20% by weight), as is the digestibility of oat protein (90%), and the majority (85%–90%) of oat protein consists of globulins. (43:15)

This is in contrast to wheat, in which the vast majority consists of gluten. 

Starch (about 60% of the total dry weight) is a major component of the oat grain. The amylopectin: amylose ratio is about 3, and the digestibility of oat starch is about 100%. 

Oat starch digests slowly, partly due to high amounts of fiber and the high oil content in whole grain oat, which retards stomach emptying and improves digestion. 

This results in a gradual supply of glucose to the intestine, which maintains a long feeling of satiety. As a result, whole grain oat foods have a low glycemic index (GI), which is advantageous in cases of diabetes and obesity.

Compared to other cereals, oat grains have a relatively high oil content of on average 7% oil, but some varieties can have up to 18%:

  • The three most abundant fatty acids are palmitic (C16:0; 20%), oleic (C18:1; 35%), and linoleic (C18:2; 35%) acids, which account for about 90%–95% of the total fatty acids. 
  • The largest part is thus unsaturated, but there is more omega-6 than omega-3. 
  • Alpha-linolenic acid (18:3, omega-3) is notably present in the oat germ. 
  • The high lipid content can also hurt the sensory quality of oat products because of lipid oxidation, which produces fatty acid hydroperoxides and volatile aldehydes, causing rancidity. 
  • Therefore, before further processing, oats are kilned—a high-temperature treatment to inactivate especially lipases.

 

So, Which Oats Are Best?

Sprouted is best! Sprouting happens the seed is trying to turn itself into a plant. However, they are tough to sprout at home unless you buy unkilned oat groats. (48:35)

The nutritional and bioactive properties and key enzymatic activities were studied in sprouted oat powder and compared with those of oat grain powder (control). 

Sprouted oat powder was an excellent source of protein (10.7%), β-glucan (2.1%), thiamine (687.1 μg/100 g), riboflavin (218.4 μg/100 g), and minerals (P, K, Mg, and Ca). 

This presented better amino acid and fatty acid compositions and levels of γ-aminobutyric acid (54.9 mg/100 g), free phenolics (507.4 mg GA/100 g), and antioxidant capacity (1744.3 mg TE/100 g) than control. 

Enhanced protease and α-amylase and reduced lipase activities were observed in sprouted oat powder. Promising features to improve its nutritional, sensorial, and health-promoting properties!

Since 2009 (EC 41/2009) and 2013 (FDA), oat products may be sold as gluten-free in several countries provided a gluten contamination level below 20 ppm. Note: 20ppm may still be too high for celiac or gluten allergy!

Types of Oats

Interestingly, when it comes to oats, the size of the flakes appears to make a difference in how the gut microbiota are affected. 

One study found that thick oat flakes, but not thin oat flakes, increased Bifidobacterium levels during fermentation while also producing 2.5 times more butyrate than the thin oat flakes. The authors of this study suggested the resistant starch content of the thick oat flakes may explain these differences.

Steel-cut oats have a little more resistant starch, slightly higher beta-glucans, and higher total fiber than old-fashioned rolled oats. Remember, old-fashioned rolled oats are better than quick oats.  

One small study showed slightly higher butyrate production with steel-cut oats than old-fashioned, but it wasn't statistically significant.  

Sarah recommends One Degree brands for the best-sprouted oats (not sponsored! Just a Sarah-approved favorite).

Personally, Stacy and Sarah have both Old Fashion and Steel Cut oats currently in their pantries. Sarah recommends using an instant pot as well!

Sarah's ideal recipe is 2 cups steel cut oats, 5-6 Cups of water (depending on how thick you like your porridge), and 1/2 a teaspoon of salt (scale up or down as desires).

In Instapot, cook for 4 minutes on high pressure and then let the pressure naturally decline. Add flavoring as needed, such as maple syrup to slightly sweeten.

Stacy also recommends trying this pumpkin oatmeal recipe, which has always been a crowd-pleaser.

 

How to Experiment 

Sarah recommends starting by utilizing a food journal to see if you're reaching your nutrient targets for the day.

If you are, first cut out the food from your diet for at least two weeks, even including trace amounts.

This ensures you're testing your actual reaction and not the reaction you're currently having while already consuming the food. This helps you isolate and identify.

Next, pick a day to challenge when you're feeling good, slept well, not stressed, and not eating anything else out of the ordinary.

If you're worried about an allergy response, make sure you go slow since they can get really big very fast.

If you check for sensitivity, like mood, stomach, or skin issues, it's okay to go more all-in.

If you're not sure if something was a reaction (mild reactions can be tough), give yourself a few days to reset, and then try again to see if you have the same experience.

If you're thinking about experimenting with oats, Sarah recommends buying sprouted oats (which reduces anti-nutrient content) that are certified gluten-free. 

Be sure to follow a methodical reintroduction protocol!

 Also, oats are way less likely to be tolerated by people with celiac disease (and potentially other autoimmune diseases) or anyone who has tested positive for wheat/gluten or oats on a food allergy/intolerance screen in the past. 

 

Final Thoughts

Sarah views oats as a "sometimes food" due to the importance of quality. (1:01:30)

Stacy's philosophy is all about variety and introducing foods to develop a palate. And the more science we look at, the more we can emphasize foods we know are beneficial to our gut and health overall.

It's important not to emphasize "yes" and "no" in terms of food, but instead look at each food as an individual in terms of a healthy diet overall.

Identifying your triggers is very important, and knowing that not every food will work for every person.

Be sure to head over to Patreon for bonus content on how Stacy and Sarah really feel about this topic and more! Your subscription supports this show and gets your questions first in line.

Thank you for your great question, Anna, and thank you, listeners, for joining us! We will see you next week.

Welcome to episode 460 of The Whole View! This week, Sarah and Stacy look at the science behind antibiotics' impact on the gut microbiome and what we can do to break the Stress-Flare-Antibiotic Cycle as much as possible. Stacy gives insight into actions you can take outside the body, while Sarah dives deep into foods and lifestyle habits that can help from within.  If you enjoy the show, please review it on iTunes!

The Whole View, Episode 460: How to Break the Stress-Flare-Antibiotic Cycle

Welcome back to episode 460! (0:28) This week's episode was inspired by a lister question. As always, Stacy and Sarah pick questions that really resonate with the: First off, my mother and I love your show and have been listening to the show for years. I love how you can tackle complicated topics and boil them down to easy to understand and enjoyable shows. Stacy, your journey with your son through ADHD was such a help for me when my oldest son was diagnosed. It gave me a place to go when I wasn't sure where to go next. Now to the reason I'm writing to you.  I have been battling rosacea flares ever since 2010 when I had my first son. Pregnancy seemed to set everything off and I now deal with flares off and on. I know stress is a trigger. My dermatologist's answer is always to put me on antibiotics for months at a time and it's killing my gut health.  I had finally gotten my gut health to a pretty good place and hadn't needed to be treated for quite some time and then Covid hit, my mother-in-law moved in, and I started remote schooling 3 extra kids in my home along with my own children. No stress here! My question is, how do I maintain my gut health when I have Rosacea and have to use antibiotics to control the flare? Thank you for all the hard work you ladies put into your shows!  -Sara Sometimes, the flare itself can be additional stress and can snowball the problem.  Lifestyle changes aren't going to solve the issue independently, but adding different choices in where you can certainly help manage symptoms. 

First, Medication Isn't Failure!

In some situations, antibiotics are absolutely needed. (7:09) It's definitely smart to avoid antibiotics when they aren't really necessary (like viral flu and colds). But when it comes to certain illnesses and infections (the ones used to wipe out huge chunks of the human population!), antibiotics can prevent serious complications and even save our lives.  There's no reason we should ever feel guilty or like we've "failed" just because we need to take antibiotics.  While following a healthy diet and lifestyle typically supports much stronger and well-regulated immune systems, it does not (sadly) make us invisible.   The necessity for antibiotics doesn't mean that you didn't "Paleo/AIP/Nutrivore hard enough," so don't be hard on yourself.   While it's always a good idea to reflect on ways to improve the quality and consistency of our diet and lifestyle choices, what's most important while recovering from illness is making science-based, informed choices that give us the best chance of getting healthy efficiently!

Preventative Skincare 

Stacy refers listeners back to the episode on Dry Winter Skin because of the information on the moisture barrier in that show. (12:15) She also recommends checking out Science of the Skin Barrier. Beauty counter has a great Safe SPF Stacy loves! She cautions listeners to be wary of the ingredients in their products when shopping for sunscreen.  Studies have shown that many modern SPF on the market (chemical and mineral) have large amounts of Benzine contaminants, a known carcinogen. There are prescription topical medications to help with issues such as Rosacea. That is another option to talk to your doctor about.  Another known thing to irritate Rosacea is using hot water and dairy consumption.  Sarah adds that red light therapy is another interesting avenue to look into to add to your preventative care.

Self Care and Stress vs. Sleep

Stress is a huge trigger for Sarah, and despite being proactive at preventing stress, it's not 100%. (18:01) Sarah and Stacy have talked about the stress, work-life balance, and stress-sleep cycle on quite a few recent shows:

Sarah explains that her biggest obstacle is her perfectionist tendencies. It's critical to put self-care on our busy to-do lists! Self-care doesn't have to mean a mani-pedi. It can be as easy as giving yourself time to do something you enjoy. Resilience activities like going for a walk, meditating, or cuddling with a pet are great ways to give yourself some time away. Stacy reminds listeners that they are allowed to let go and say no.  Focusing on sleep when we can't control stress is another great way to help your body as much as possible. 

Antibiotics vs. Gut Health

The word literally means "against life" from its Greek roots. (27:10) Antibiotics stop or slow down the growth of microscopic organisms (bacteria, fungi, and some parasites), in turn, treating potentially dangerous infections.  Antibiotics can also destroy beneficial bacteria and yeast that mediate an incredible array of processes in our body. This can include gut barrier integrity, tuning the immune system, and increasing the bioavailability of nutrients from our food!  So, whenever we embark on antibiotic therapy, the goal should be to protect, preserve, and restore these beneficial organisms as soon as possible. Antibiotics, by design, are very destructive to the gut microbiome, which is why so many gastrointestinal side effects are reported.

Taking Probiotics While on Antibiotics

It's a myth that we should wait until we've finished a course of antibiotics before trying to rebuild our gut flora with probiotics. (29:52) In reality, taking probiotics during antibiotic therapy is one of the most helpful things we can do to maintain gut health! Even if the probiotics we ingest during antibiotic therapy don't take up permanent residence yet, they can still help keep pathogens at bay and prevent crazy microflora imbalances. Several studies have examined the effects of probiotics on antibiotic-induced side effects, and the results have been impressive!  Probiotics can go a long way to reduce unpleasant symptoms, especially gastrointestinal distress like diarrhea. This can occur when antibiotics wipe out the competitors for pathogenic bacteria and allow diarrhea-inducing strains to flourish.  One meta-analysis looked at 63 trials on probiotics to prevent antibiotic-associated diarrhea and found a major reduction in diarrhea when people took Lactobacillus-based probiotics. Other meta-analyses found that Saccharomyces boulardii and Lactobacillus rhamnos, in particular, were very helpful for reducing antibiotic-associated diarrhea.  And, additional studies have found various probiotic strains (especially Lactobacillus) can help reduce nausea, taste disturbance, headaches, hypersensitivity, and other symptoms when taken during a round of antibiotics! One study tested the effects of starting probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) after antibiotic therapy versus during antibiotic therapy.  The group that started taking probiotics while still on antibiotics had more stable microflora levels and less gut dysbiosis throughout the experiment!

Taking Action Against the Stress-Flare-Antibiotic Cycle

Sarah recommends loading up on fermented foods teeming with natural probiotics. These include raw, unpasteurized sauerkraut, kimchi, fermented carrots, fermented beets, pickles, fermented fruits (chutneys, jams, pickled jackfruit, green papaya), kombucha, beet kvass, coconut milk kefir, coconut milk yogurt, and raw condiments.  For people who aren't sensitive to dairy or soy, unpasteurized yogurt and kefir, natto, miso, tempeh, and tamari sauce are also great options.  For the best results, eat these foods 2 to 4 hours after an antibiotic dose. Sarah also recommends taking probiotic supplements, especially if you're yeast or histamine sensitive or otherwise don't do well with fermented foods.  For preventing antibiotic-associated diarrhea and other side effects, an intake of at least 5 billion CFU/day for children or 10 billion CFU/day per adult is recommended.  Several existing trials show that Lactobacilli, Bifidobacteria, and Saccharomyces boulardii are the most effective types for reducing antibiotic side effects.  All probiotics should be consumed with food, and bacterial strains should be taken at least 2 to 4 hours after each antibiotic dose so that they don't get inhibited by the antibiotic itself.  Saccharomyces boulardii is actually a form of probiotic yeast, making it particularly useful while taking bacteria-killing antibiotics.  Don't forget to consume plenty of gut barrier nutrients!

What to Do After Taking Antibiotics

Stacy adds that reintroducing known trigger foods should only happen when your flare is over to prevent the stress-flare-antibotic cycle. (39:02) Once we've completed antibiotic therapy, it's time to seriously buckle down and get our gut microbiome back in shape. Chances are, the antibiotics caused a major loss in microbial diversity, wiped out many beneficial species, and may have allowed pathogenic strains to flourish.  So, the goal is to rebalance the microbiome and restore as much (good) diversity as possible! There's a really immense amount of information in The Gut Health Guidebook, but it all boils down to 20 keys to gut health.  A healthy gut microbiome eats a nutrient-dense and varied diet that is moderate-fat and moderate-carb to best support a healthy gut microbiome. That includes plenty of veggiesfruitmushrooms, and seafood, rounded out with nuts, seeds, grass-fed meatsfermented foods, and phytochemical-rich foods like herbs, teacoffee, cacao extra virgin olive oil

Lifestyle Choices that Help Fight the Stress-Flare-Antibiotic Cycle

Be sure you're hydrating without alkaline water. Lifestyle factors are also essential, like getting enough sleep on a consistent schedule, entrenching a solid circadian rhythm, eating distinct meals instead of grazing, fasting overnight (12-14 hours, not IFing), living an active lifestyle managing stress. It's also super important to optimize vitamin D levels. For more info, see Episode 354: Everything Vitamin D. A handful of traditionally excluded foods on the Paleo diet is a boon to our gut microbiomes. This includes A2 dairy like goat, sheep, or camel), most legumes (not soy or peanuts), pseudo-grains, corn, rice, and gluten-free oats.  However, none of these latter foods are fundamental for a healthy gut microbiome in the same way that mushrooms, seafood, and individual families of vegetables and fruit are. Continue eating plenty of raw, unpasteurized, fermented foods throughout the day. These typically contain a huge spectrum of probiotic species and offer greater microbial diversity than most probiotic supplements.  Lacto-fermented fruits, vegetables, and beverages tend to be high in Lactobacillus and Bifidobacteria, while kefir and kombucha are great sources of Saccharomyces boulardii.  Eat from as many fermented foods as possible to get a variety of awesome microbes, both bacterial and yeast! For more information, see Episode 329: The Link Between Carb Intolerance & Gut Health and Episode 457: The Problem with a Low-FODMAP Diet. Studies have shown that SBOs like Just Thrive helps Lactobacillus grow and can help restore the gut microbiome after antibiotics.  Just Thrive is not sponsoring this episode, but you can still use TWV link for discounts on their products and get 15% off with the code THEWHOLEVIEW at checkout! Stacy and Sarah recommend two probiotics from Smidge: Yeastbiotic and Probiotic.

Final Thoughts

The most important thing to do when managing the stress-flare-antibiotic cycle is to give your body what it needs to perform optimally. (50:50) This is also why modern diet-culture is such an issue. Our goal is health, and when we focus on it, we see a lot of the claims made by diet culture aren't scientifically supported to optimize health.  The idea of weight loss is often enough to justify choices that make us feel sluggish or sick, and it takes rerouting our mindset toward health to see through it.  There's no one-size-fits-all recipe for feeling good. It's about listening to your body and finding out what makes you feel your best. It's not about how much you weigh.  Stacy reminds listeners interested in Beautycounter safer skincare to use the code CLEANFORALL20 for 20% off their purchase.  Be sure to hop over to Patreon for Stacy and Sarah's unfiltered thoughts for more on this topic. Your subscription helps support this podcast and gets you front-line access to the Whole View. Thanks for listening and we will see you next week!   Want more info on our Real Life? Never miss a post with our Real Everything newsletter (and get our best selling book, Eat Like a Dinosaur, as a welcome gift). Join here Wanna be Healthy Inside & Out? Get educational info and exclusive sales with our non-toxic living newsletter (and get free samples as a thank you for joining our safer skincare community). Join here  

The Whole View, Episode 459: Gluten-Free Baking, Our Best Tips and Tricks. 

Welcome back to episode 459! (0:28)

Today, Sarah and Stacy will discuss baking and sharing their tips and recommendations for gluten-free baking.

They've received quite a number of questions regarding this topic.

Stacy recently revised a Lactation Cookie recipe from several years ago and realized just how much her mindset has changed since then.

Sarah and Stacy started from a one-sided Paleo approach but gradually moved toward a nutrivore, nutrient-dense mindset.

Sarah mentions she's currently working on a new website dedicated to Nutrivore! So listeners should keep an eye out for updates.

It's important to get away from this dogmatic approach to food to ensure you're giving your body enough variation for it to heal.

Heritage Wheat for Gluten-Free Baking

Actually, the gluten content of heritage wheat is about the same as modern wheat, so from a celiac perspective, they're both problematic. (13:30)

Stacy adds that gluten-sensitive vs. celiac is where you might notice a difference. As someone with Celiac Disease, even trace amounts of gluten will cause her issues.

It's often thought that ancient wheat has less gluten, which is simply not true.

Estimates as much as 55% of the population have gluten sensitivity genes.

However, if you aren't wheat or gluten-sensitive, ancient/heritage wheat is definitely a better choice than modern wheat.

Studies do show that ancient wheat has an overall anti-inflammatory profile, whereas modern wheat has a pro-inflammatory profile. 

Sarah recommends this great review article for more information.

Scientists have a hard time pinpointing exactly why. Still, it seems to be a collection of small nutritional differences, slightly more digestible gluten, slightly more polyphenols, more carotenoids (lutein), and a slightly better effect on the microbiome.

Benefits of Almond Flour

Sarah has had a pretty long journey with almond flour. She used to use it all the time, then not at all, and it eventually started to creep back in. (19:40)

There are definitely health benefits to an ounce or two of nuts per day, which translates to ⅓ to ⅔ cups.

Almond flour is one of the more nutrient-dense flour alternatives, meaning it has more essential nutrients per calorie. And, like we covered in episode 413, it's good for the gut!

But, when we're talking about a treat, we're accepting that it's not going to be super nutrient-dense, generally.

Sarah prefers the chemistry of cassava flour for most applications. But, she also still uses almond flour. 

She adds she does have some other more obscure flours in her pantry but rarely uses them (plantain, tigernut, sunflower, coconut, sweet potato, chestnut).

Stacy makes it less about what the flour is but rather what will work better for what you're making. Some flours are heavier or denser than others, so the nature of the flour means it sometimes won't rise.

Stacy keeps tapioca, oats, arrowroot, and rice flours in her pantry as well.

Cassava Flour for Gluten-Free Baking

Cassava does contain some cyanogenic glycosides (other foods that do include almonds, apple seeds, stone fruit pits, bamboo, flaxseed, lima beans) (32:50)

You can find the Legit Mixes here.

The sweet cassava that is available as an imported vegetable in Western countries has only about a tenth of the cyanogenic glycosides of the bitter cassava grown in South America and Africa, which makes it pretty low on the cyanide scale to start with.  

And the even better news is that these compounds can be completely removed with proper preparation, which the major manufacturers of cassava flour, like Otto's do.

And, when cooking with whole cassava, you can too! That's why my recipe for cassava fries includes a boiling step before roasting.

Gluten-Free Baking on AIP

For questions regarding AIP baking at altitudes, Sarah and Stacy recommend checking out Elana Amsterdam(39:05)

She does live at altitude, and she has great information available. She also has MS, which is autoimmune, and she's been doing grain-free recipe blogging for a very long time.

Jovial has an AIP cassava-based pasta that's so good!

Typical AIP substitutions for eggs are gelatin eggs, apple sauce, canned pumpkin, tapioca starch, mashed root veggies (especially cassava and taro, thanks to the mucilage fiber they contain).

Sarah also recommends trying fresh, mashed cassava (tapioca) in your recipes.

Sugar on Paleo and AIP

Sugar is about dose rather than being on a yes list or no list. (45:45)

Table sugar (cane sugar or beet sugar) is predominantly sucrose, a disaccharide made of one glucose and one fructose molecule. 

Sucrose is digested and absorbed quickly, and the glucose it contains has a rapid impact on blood sugar levels and insulin secretion. Consumption of glucose increases the production of oxygen radicals and markers of inflammation, even in healthy people. 

However, it is exaggerated in people who are obese or have type 2 diabetes, high cholesterol, or metabolic syndrome. 

High sugar consumption can also lead to nutrient deficiencies. 

Sarah covers this in-depth in How Does Sugar Fit into a Healthy Diet and 5 Nutrients You're Deficient In… If You Eat Too Much Sugar.

High fructose consumption (the other half of the sucrose molecule) has been linked to obesity, insulin resistance, hypertension, fatty liver disease, type 2 diabetes, cardiovascular disease, metabolic syndrome, and increased cancer risk. 

In fact, the biological effects of too much fructose are likely the driving force behind the association between high sugar intake and chronic diseases.

This is particularly important because of the rise of high-fructose corn syrup and because many sweet treats marketed to diabetics use fructose-based sweeteners. These are additives like agave syrup. Just because they don't cause a rise in blood sugars doesn't mean they're harmless! 

In fact, the evidence points to fructose-based sweeteners being even worse:

Natural Sugars

It's important to note that there is evidence that fructose from whole fruits is not the same as fructose-based sweeteners. 

One recent study compared the metabolic effects of consuming 100 grams of fructose from high-fructose corn syrup versus fresh fruit. While both showed some problematic effects, it was much worse in the HFCS group. 

Studies also show that eating 300 grams of fruit daily (about 4 servings and up to about 45 grams of fructose) causes the biggest decrease in all-cause mortality (a general marker of health and longevity), so eating fruit is good!

One piece of good news is that we don't need to count fresh fruit towards sugar intake. The cusp for the negative effects of high-sugar intake really is around 10% of total calories from added sugars. 

So, we don't have to give up all sweet foods to be healthy, but rather choose our sugars wisely and moderate our intake!

The most important sugars to limit are refined ones, which don't offer any redeeming nutritional qualities. Find Sara's lists here:

The sweet taste of sugar is highly addictive, so it can be tough to reduce our intake or give it up. Sarah and Stacy covered this more in episodes 323: Cheat or Treat, Let's Talk Sweets! and 300: How Do You Handle Sugar and Salt Cravings?

Other Sweeteners

Sadly, we can't cheat sweets! Sweet substances that are not sugars are called sweeteners. (58:40)

They are artificial or natural substances that taste sweet but don't contain caloric sugar molecules like glucose and fructose. 

You won't be surprised to learn that the artificial sweetener aspartame causes even more health problems than sugar. But you might not know that other nonnutritive sweeteners like sorbitol, mannitol, xylitol, and erythritol cause gut dysbiosis and increased intestinal permeability. 

Sarah and Stacy discuss this more in, Is It Paleo? Splenda, Erythritol, Stevia, and other low-calorie sweeteners  and Episode 309: Aspartame Is Evil

Even the two "natural" sweeteners predominantly used in products marketed to health-conscious communities — stevia and monk fruit — are problematic.

Just because something is "natural" doesn't mean you should eat it. There is a health trade-off to everything. And just because it won't raise blood sugar levels in diabetics doesn't mean it's safe to eat in large quantities.

There are now high-quality studies proving that stevia is an endocrine disruptor and problematic for the gut microbiome. This applies to the stevia plant and whole leaf stevia, too! 

And monk fruit extract isn't even approved as a food additive due to toxicity concerns and is only approved for supplements. For more information on this, see The Trouble with Stevia and What's the Next Superfood Sweetener?

Allulose is the molecular mirror image of fructose. While it hasn't been extensively studied, it's brought into the body by the same receptor (GLUT5). So we know that it can biologically behave similar to fructose, and we'd therefore expect similar problems.

What Do Sarah and Stacy Suggest?

Sarah thinks it's important to focus on the best way to enjoy a sweet treat - real, natural sugars, in moderation. (1:10:20)

The best choices are unrefined sugars that offer some nutritional value, like unrefined organic cane sugar, molasses, maple syrup, and honey.

Blackstrap molasses is so nutrient-dense that it contains 1.5 times more calcium per calorie than cheese and 5 times more iron per calorie than steak! 

Plus, it's rich in copper, selenium, manganese, magnesium, potassium, and vitamins B2, B3, and B6. Just one tablespoon contains 20% of the DV of calcium, iron, copper, and manganese, for only 42 calories.

Honey

Honey has known antioxidant and antimicrobial properties and may promote tissue health. 

Even though it's natural sugar, there's evidence that honey can help regulate blood sugar levels in diabetics and improve the efficacy of metformin! 

It's also been shown to be therapeutic in both chronic constipation and chronic diarrhea because it acts as a selective prebiotic for Lactobacillus and Bifidobacterium. It also inhibits the growth of undesirable microorganisms that can act as pathogens. 

There's even some evidence showing that eating honey can reduce cardiovascular disease risk factors and cancer risk. 

Plus, honey contains calcium, potassium, magnesium, phosphorus, selenium, copper, iron, manganese, chromium, zinc, and vitamins B1, B2, B3, B5, B6, B9, C, and K. When we examine all of the health problems associated with high-sugar intake, honey seems to reduce risk. 

All this to say that there really isn't a way to cheat sweet, but we also don't need to if we're conscientious about how often and how much sweet treats we're indulging in. 

Natural sugars in moderation absolutely can fit into a healthy diet.

Final Thoughts

Stacy and Sarah are not here to demonize the choices you make and why you make them. They want to empower you to make those decisions for yourself and not be influenced by this idea of being afraid. (1:21:45)

You can never give up everything in life. It's about making things sustainable for you and giving you the knowledge to make informed health decisions to help you live your life to the fullest.

Stacy encourages listeners to have freedom from the pressure and dogma that the entire culture has created around being afraid of certain foods.

Sarah adds that we need to be aware of how these marketing campaigns aren't only about buying that product but make you feel bad about your alternate choice. And it's not always grounded in scientific evidence.

You can join Sarah and Stacy over on Patreon for their unfiltered thoughts on this episode. If you've not joined the Patreon family yet, joining gets you access to bonus content and is first in line with any questions.

Thanks for listening, and we will see you next week!

The Whole View, Episode 458: Collective Trauma and Re-Entry Anxiety

Welcome back to episode 458! (0:28)

With the decline of covid-19 cases, hospitalizations, and deaths, many places around the United States are starting to open again.

Stacy has realized this last year was trauma, as much as that might sound like an exaggeration.

Trauma is very individual, but we've all experienced a collective trauma as a group, and now we're recovering it as we're re-entering into the new world.

This resonates especially with Stacy due to her experience with the effects of trauma with her foster kids.

She adds that this is not a dig at or to minimize anyone with different types of trauma or medical conditions regarding mental health. But we need to be willing to acknowledge that this is something people out in the world are going through and ways to support each other.

Sarah is also experiencing quite a lot of re-entry anxiety. She finds the world feels very different, and it's particularly challenging to reintegrate with people.

Why Are We Experiencing Re-Entry Anxiety?

We've made some very different choices during the last 15 months. Even now, we're making different risk analyses on masks and social distance. 

Sarah adds that she's vaccinated, but her entire family has not been yet, so she's still choosing to wear a mask. She's already been mask shamed the same way she was as an early-adopter of masks earlier in the pandemic.

This is a lot of change. Going back to normal after so long of isolation, virtual work, or school, and our old routines is a lot like establishing them.

Sarah manages by giving herself a lot of grace and just introducing one thing at a time. It's helpful to put those emotions into the mindset of trauma to better understand it.

We want our listeners to know that many people are going through the same thing as you. Society has gone through a collective trauma. 

Stacy wants to underline the idea that "group trauma" is very real despite it being something we don't really think of trauma as a collective and gives the example of a community experiencing a hurricane or other natural disasters.

Increases In Mental Health Issues

Scientists studying the aftermath of the global pandemic look at it from a very umbrella view, looking at increases of anxiety, substance abuse to cope, signs of PTSD, and even suicidal ideation. (10:30)

Last summer, a study reported that the biggest increase in trauma symptoms was in the first few months of the pandemic when things were changing quickly.

Anxiety disorder showed approximately three times more reported in the second quarter of 2019 (25.5% versus 8.1%), 

Depressive disorder showed approximately four times what was reported in the second quarter of 2019 (24.3% versus 6.5%) (2). 

Suicidal ideation was also elevated; approximately twice as many respondents reported serious consideration of suicide in the previous 30 days than did adults in the United States in 2018, referring to the previous 12 months (10.7% versus 4.3%).

During August 19–31, 2020, through December 9–21, 2020, scientists observed significant increases in the percentages of adults who reported experiencing symptoms of an anxiety disorder (from 31.4% to 36.9%), depressive disorder (from 24.5% to 30.2%), and at least one of these disorders (from 36.4% to 42.4%).

More adults (22.4% to 25%) reported taking prescription medications or receiving mental health counseling during that time. More adults said they needed but did not receive counseling (9.2% to 12.4%).

While the researchers found an increase in symptoms among all demographic groups, the trend was highest among individuals aged 18 to 29 and those with less than high school education.

This additional study showed similar results. 

Mental Health Issues Before Covid-19

Stacy shares that she had high-functioning anxiety before Covid-19, which impacts how she dealt with the stress of the pandemic.

Sarah shares that she has 20+ years of experience with panic attacks, which are better or worse during specific times of her life.

So while we might have this collective trauma, our experiences within that trauma might be very different. There's no one way to experience depression, anxiety, etc.

Stacy and Sarah want to acknowledge this collective trauma and discuss how behavior is driven by emotion, which means we need to support emotion rather than address bad behavior.

Stacy adds that she and Sarah are not medical professionals, and it's incredibly important to talk to your primary care doctor. Medication, therapy, and/or asking for help is not a failure! 

Stacy and Sarah have done many shows on mental health that can act as a foundation for what they'll be talking about in the episode:

How Does Trauma Affect the Brain?

Some common symptoms of PTSD include nightmares, flashbacks, panic attacks, startle response, and preoccupation with the traumatic event. (26:00)

Memories are stored through fragments of visual images, smells, sounds, tastes, or touch within our brains. The brain can easily be triggered by sensory input. 

Those with PTSD have more severe reactions to specific inputs that remind them of that trauma. We might not even realize we're responding in the way that we are, like assuming the worst of others. 

In terms of collective trauma from the recent global pandemic, we've been conditioned to be wary of things like large crowds or people not wearing masks. Finding yourself in those situations now can trigger re-entry anxiety symptoms similar to how the brain triggers responses for PTSD patients.

Source: https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(11)00103-2

The American Psychiatric Association defines trauma as "an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others." 

Such events can include military combat, natural or human-made disasters, torture, and/or violent personal attacks. 

Traumatic experiences induce physical and psychological symptoms that affect aspects of life. It can involve significant distress and impairment in social, occupational, and other more.

These experiences can also lead to structural, functional, emotional, and cognitive function and processing. 

Behavior vs. Emotion

What all this means is it's normal to see people behave on a range of spectrums, from scared, passive, and fearful to enraged, aggressive, and impulsive.

Stacy highlights that all these emotions, regardless of where they come from, will change your behavior. This is something she'd noticed significantly from her experiences at home.

It's not so much about correcting the behavior because the behavior is triggered by an emotion the person is feeling inside.

Unless we understand where that emotion is coming from and how to deal with experiencing it, correcting just the behavior isn't helping anything.

Understanding that everyone is re-adjusting to "life as normal" puts a lot of perspective on your own re-entry anxiety. That's it's not just you, and they're not treating you a specific way because of something you've done.

Stacy and Sarah also talked about this in the context of Generalized Anxiety Disorder in TPV Podcast Episode 383: Anxiety.

You can learn some things you can do to help people when you see this happening. However, simply pointing it out isn't actually helpful to someone whose amygdala is in protective mode.

 

Brain Food, Lifestyle Activities, and Re-entry Anxiety

There are many ways that PTSD and other mental health issues also have a profound effect on our physical health. (43:01)

Stacy and Sarah talked about nutrition and lifestyle for mental health in detail in:

It's crucial to take advantage of experts, whether a psychologist, psychiatrist, primary care, specialized physician, or all of the above.

Sarah also acknowledges that certain diets and lifestyles can increase susceptibility to PTSD. However, this does not mean it's to blame for it. But can looked at as an action step toward helping yourself through your experience.

Studies have shown an association between post-traumatic stress disorder, lack of exercise, poor diet, obesity, and co-occurring smoking.

Meta-analysis revealed that PTSD sufferers were 5% less likely to have healthy diets, 9% less likely to engage in physical activity, 31% more likely to be obese, and 22% more likely to be current smokers.

An additional study looked at post-traumatic stress disorder (PTSD) in mid-age and older adults. They wanted to know if PTSD differs by immigrant status and ethnicity, nutrition, and other determinants of health in the Canadian Longitudinal Study on Aging (CLSA).

Ways to Support Your Mental Health & Re-Entry Anxiety

Science has linked nutrient deficiencies to increased depression/anxiety, and that supplementation helps. 

A variety of RCTs show exercise interventions reduce symptoms. However, there's not enough data to have an optimal "walk 30 minutes per day" or "cardio 4X per week."

Data also shows that therapy and mindfulness (meditation) reduces symptoms more effectively than stress management education. 

Helpful stress management techniques are fresh air, sunlight and nature, walking (low-intensity activity), getting enough sleep on a consistent schedule, and social connection.

 

Final Thoughts

If your sleep is being impacted by anxiety or depression, it's more difficult for these health techniques to stick. (1:04:11)

Sarah reminds listeners that sleep regulates our bodies and stress hormones, which can impact our health in various ways. 

Social connections are crucial to feeling better, and depression can cause us to isolate and further the problem.

Lifestyle and relationships can be toxic and also impacting your health. Stacy reminds listeners that there's nothing wrong with setting boundaries with others, self-care, and creating a healthier connection. 

Sarah adds that there is nothing wrong with asking for help and that we're all in this together. 

Be sure to check Sarah and Stacy out on Patreon if you've not already joined the family. It gets you bonus access to what they really feel about the topics they talk about on The Whole View. 

Thank you for listening, and we will see you next week!

 

The Whole View, Episode 457: The Problem with a Low-FODMAP Diet

Welcome back to episode 457! (0:28)

Sarah and Stacy last covered FODMAPs in detail in TPV Podcast Episode 238, What's a FODMAP and Why Do Some People Avoid Them?

The science on them has definitely evolved, so it's time to revisit what FODMAPs are and why there can be a problem with a low-FODMAP diet!

This show is sponsored by Stacy and Sarah's favorite probiotic company, Just Thrive!

Formulated by microbiologists, Just Thrive Probiotic includes four science-backed, clinically proven, super-beneficial Bacillus species. It is free of wheat, gluten, Dairy, nuts, soy, salt, sugar, artificial colors or flavors, binders, fillers, allergens, and GMO's.

Stacy and Sarah only invite brands they love to be a part of this show and never endorse something they don't use themselves.

Just Thrive is offering 15% off with code THEWHOLEVIEW at checkout, or follow this link!

Quick Review of FODMAPs

The term FODMAP is an acronym for Fermentable Oligosaccharides, Monosaccharides, Disaccharides, and Polyols. (4:10)

FODMAPs are sugar alcohols and short-chain carbohydrates rich in fructose molecules. 

These molecules are inefficiently absorbed in the small intestine but are highly fermentable by our gut bacteria in the large intestine.  

Many dietary carbohydrates that have prebiotic actions are members of the FODMAP group of carbohydrates: Fructo-oligosaccharides (FOS), galactooligosaccharides (GOS), xylooligosaccharides (XOS), polyols, and fructose. 

These FODMAPs selectively stimulate the growth of super beneficial specific types of bacteria. They include Bifidobacteria, Lactobacillus, Akkermansia municiphila, Faecalibacterium prausnitzii, Roseburia intestinalis, Eubacterium rectale, and Anaerostipes caccae.

When FODMAPs enter the large intestine full of those wonderful beneficial bacteria, they increase the metabolic activity of our gut bacteria. This increases the production of SCFAs and gasses. 

Because of the increase in production, we might notice even if we eat a ton of FODMAPs all at once is an increase in flatus frequency. Sarah adds that this is perfectly normal.

 

FODMAP Intolerance

Where it flips into FODMAP intolerance is when it becomes uncomfortable. (10:34)

Typical symptoms of FODMAPs include bloating, gas, cramps, diarrhea, constipation, indigestion, and sometimes excessive belching. 

This is why a typical diagnosis is Irritable Bowel Syndrome. Some researchers even believe that 100% of IBS is caused by FODMAP intolerance.

So, what causes FODMAP intolerance? There's three potentially overlapping, causes

  • Gluten and/or Dairy sensitivity
  • Fructose malabsorption
  • Gut dysbiosis

Gluten Sensitivity

The biggest source of FODMAPs in the Standard American Diet is wheat. 

This is because wheat is consumed in large quantities, not because it is a concentrated source of FODMAPs.

Additionally, up to 55% of the population (in North America) has gluten sensitivity genes! 

Symptoms of non-celiac gluten sensitivity include IBS bloating, gas, cramps, diarrhea, constipation, indigestion, and belching.

PLUS extra-intestinal symptoms, such as brain fog, fatigue, lethargy, skin rash (including eczema), headaches, fibromyalgia-like symptoms (joint and/or muscle pain), carpal tunnel and peripheral neuropathy-like symptoms, depression, anxiety, and anemia

2012 double-blind elimination and challenge study showed 30% of IBS was wheat sensitivity.

Stacy and Sarah discussed these genes in detail in TPV Podcast, Episode 293: Do I Have to Be Gluten-Free Forever?

Dairy Sensitivity

And lactose is a FODMAP! Lactose intolerance is caused a deficiency in the enzyme lactase.

Rates of intolerance vary widely based on ethnicity, ranging from 5% among Northern Europeans to over 90% of the population in some Asian and African countries. 

In fact, in the US alone, somewhere between 30 and 50 million people are lactose intolerant!

Also, epidemiological reports of cow's milk allergy (IgE antibody reactions to cow's milk proteins) range from between 1 and 17.5% in preschoolers, 1 and 13.5% in children ages 5 to 16 years, and 1 to 4% in adults. 

The prevalence of cow's milk sensitivities (IgA and IgG antibody reactions to cow's milk proteins) in the general population is unknown.

But one study in patients with Irritable Bowel Syndrome showed that a whopping 84% of participants tested positive for IgG antibodies against milk proteins. 

Other Food Sensitivities

Soy is also a high-FODMAP food. The rate of soy IgG intolerance in IBS is about 23%.

IBS is strongly linked to food sensitivity. And up to 65% of people have symptoms resolved if they do IgG testing and eliminate all the positives. 

Some people eliminate FODMAPs, and their symptoms go away. So they think it's FODMAP intolerance, but it's really gluten, Dairy, soy, or other sensitivity.

So, they're eliminating a ton of healthy fruits and veggies needlessly! Sarah and Stacy will get into why that's important.

 

Fructose Malabsorption

After digestion, monosaccharides are absorbed into the bloodstream by being transported through the cells that line the small intestine, the enterocytes. (20:54)

Enterocytes have specialized transporters, or carriers, embedded into the membrane that faces the inside of the gut.  

FODMAP intolerance may be due to insufficient carbohydrate carriers, specifically GLUT5, which is the specific carbohydrate carrier for fructose. This can happen, for example, in celiac disease, where you have intestinal villous atrophy.

Fructose uptake rate by GLUT5 is also significantly affected by diabetes mellitus, hypertension, obesity, and inflammation. This uptake rate is also influenced by diet!

The simultaneous presence of glucose can inhibit uptake, which is why whole fruit might be tolerated where something like agave might not. Additionally, the simultaneous presence of sorbitol can inhibit this.

It's important to note that while fructose malabsorption causes symptoms extremely similar to IBS, it's considered a separate diagnosis.

However, due to the similarity in symptoms, patients with fructose malabsorption often fit the profile of those with irritable bowel syndrome.

Stacy adds that she and Sarah are not medical professionals. If you are struggling with symptoms like those listed, it's best to arm yourself with this knowledge and seek trained professionals to help narrow down your diagnosis.

 

Gut Dysbiosis

The most likely cause of symptoms is actually Gut Dysbiosis. 

If there's an imbalanced gut microbiome, such as the right species for cross-feeding (or a high consumption of FODMAPs all at once), this causes a variety of digestive symptoms, 

For example, it has been shown that consuming fructans increases the production of butyrate. But the two main types of bacteria that ferment fructans (Bifidobacteria and Lactobacilli) are lactic acid-producing bacteria.

Many other bacteria (including Eubacterium, Roseburia, and Faecalibacterium) account for this bump in butyrate production.

Acetate serves as an essential co-factor and metabolite for key bacteria like Faecalibacterium prausnitzii, which requires acetate to grow. 

The Most Likely Culprit

Studies confirmed that gut dysbiosis is the most likely culprit in IBS.

This study compared participants with IBS to healthy controls. 

Another study detected dysbiosis in 73% of IBS patients vs. 16% of healthy individuals. 

This basically captures all the people with IBS symptoms that don't have food sensitivities (with some overlap)

And studies confirm more gas production from FODMAP consumption in people with IBS.

This study aimed to compare the patterns of breath hydrogen and methane and symptoms produced in response to diets that differed only in FODMAP content. They concluded dietary FODMAPs induce prolonged hydrogen production in the intestine that is greater in IBS.

Sarah has taken part in several different breath tests in her lifetime and always finds them interesting.

 

The problem with a low-FODMAP Diet

A huge number of studies show that when people with IBS follow a low-FODMAP diet see about 75% of symptom alleviation. (32:15)

But can it make the problem worse by increasing dysbiosis?

Important gut health superfoods are high-FODMAP:

  • Vegetables include: Asparagus, Brussels sprouts, cauliflower, cabbage, chicory leaves, globe and Jerusalem artichokes, garlic, onions, leeks, mushrooms, and snow peas
  • Fruits include: Apples, apricots, cherries, figs, mangoes, nectarines, peaches, pears, plums, and watermelon
  • Legumes and pulses include: Baked beans, black-eyed peas, broad beans, butter beans, chickpeas, kidney beans, lentils, and split peas

All these foods are great for the gut microbiome! See Sarah's Gut Health Guidebook and Gut Health Cookbook for a deep dive on all of these.

Because many FODMAPs have prebiotic actions, there is concern that their dietary restriction leads to dysbiosis with health consequences!.

Studies do show that low-FODMAP diets both in healthy individuals and in IBS cause dysbiosis!

This study randomly allocated twenty-seven IBS and six healthy subjects into one of two 21-day provided diets, differing only in FODMAP content. And then crossed them over to the other diet with ≥21-day washout period. Fecal indices were similar in IBS and healthy subjects during habitual diets. 

It concluded that diets differing in FODMAP content have marked effects on gut microbiota composition. And the low FODMAP diet should not be recommended for asymptomatic populations.

This study associated a low-FODMAP diet with changes in the microbiota and reduction in breath hydrogen but not colonic volume in healthy subjects—the low FODMAP diet associated the reduction in Bifidobacterium and breath hydrogen in healthy volunteers.

Another study in IBD shows a low FODMAP diet helped symptoms but had a significantly lower abundance of Bifidobacterium adolescentis, Bifidobacterium longum, and Faecalibacterium prausnitzii. 

 

High FODMAP & Prebiotic Supplementation Diets

Interestingly, there have been studies looking at high-FODMAPs and prebiotic supplementation diets for IBS. (35:50)

Studies consistently demonstrate the clinical effectiveness of the low FODMAP diet in patients with IBS. However, the impact on the microbiotaone is an unintentional consequence of this dietary intervention. 

This leads to an interesting paradox! Increasing luminal Bifidobacteria through probiotic supplementation is associated with a reduction in IBS symptoms. However, the low FODMAP diet has clinical efficacy but markedly reduces luminal Bifidobacteria concentration.

Similarly, another study found no differences in severity of abdominal pain, bloating and flatulence, and QoL scores between prebiotics and placebo. 

Conclusions

Food intolerance can cause IBS. In this case, identifying exact triggers through elimination and challenge is important. That way, you aren't cutting out important foods.

Dysbiosis causes the vast majority of the rest. Low-FODMAP may help alleviate symptoms, but it also perpetuates gut dysbiosis. This means every time you eat a FODMAP, you'll get symptoms. They may even worsen over time.

Stacy adds that we tend to focus more on what we can take away than add. We need to focus on both sides to ensure our solution to symptom relief isn't furthering the problem causing those symptoms.

What to Do: The Problem of a Low-FODMAP Diet

Support gut health and go slow! (42:30)

Be sure to keep FODMAP consumption low enough that symptoms are tolerable while supporting gut health. 

Consume lots of veggies, fruits and mushrooms (Episodes 281, 286, 304, 307, 335, 346, 373, 392, 424, & 435). 

Eat nuts and seeds in moderation (Episodes 413 & 452).

Use EVOO as your go-to fat (Episodes 326 and 414).

Be sure you're consuming lots of fish, shellfish, or a fish oil supplement (Episodes 366, 415, & 451)

Avoid prebiotic-enhanced foods, inulin, and overdoing one type of fiber. It's best to get fiber from whole-food sources.

Be sure you're getting enough sleep, activity and are effectively managing stress.

A good Bacillus-based probiotic like Just Thrive can help immensely! Plus fermented foods (not the same probiotic species, so both are important).

Bacillus species (like what are in Just Thrive) are keystone species known to create a gut environment conducive to the growth of Lactobacillus and Bifidobacterium.

It's also important to gradually increase high-FODMAP foods but go slow.

 

Final Thoughts

Stacy really appreciates their ability to revisit these topics and the science as it changes. (50:45)

This show is all about facts, not opinions, and sometimes those facts can change.

Stacy loves the idea of dieting in terms of what we can add to it to better ourselves, rather than focus solely on what we could take away. 

Sarah highly recommends her books, The Gut Health Guidebook and The Gut Health Cookbook, for even more information about the gut microbiome and combating the problem with a low-FODMAP diet.

This show was sponsored by Just Thrive, which Stacy and Sarah both use and love! Remember, use code THEWHOLEVIEW at checkout for 15% off. 

Be sure to head over to Patreon for even more from Stacy and Sarah! It's a great way to connect with them and get first in line for answers to whatever questions you might have!

The Whole View, Episode 456: Foster Care and Mental Health Awareness

Welcome back to episode 456! (0:28)

It's foster care awareness month, and this topic is something very important to Stacy.

She hopes that in talking about foster care, she can dispel some of the system's myths and miseducation. And let listeners know how they might be able to get involved even without becoming an official foster parent.

Here's a list of some famous people who were once in foster care:

  • Eddie Murphy
  • Colin Kaepernick
  • Steve Jobs
  • John Lennon
  • Marilyn Monroe
  • James Dean
  • Willie Nelson
  • Ice T
  • Louis Armstrong
  • Cher
  • Alonzo Mourning

Source: Famous Foster Children Who Have Been Through Foster Care | EHSD

Stacy wants listeners to understand that neither foster nor biological parents with children in foster care don't need to be demonized or stereotyped negatively.

The goal of foster care is always reunification first, meaning the idea of having the child return to their biological family.

Stacy adds that this doesn't always mean parent, but sometimes caregiver or guardian. Sometimes this is by the parent's choice for what is better for the child.

 

Types of Foster Families

There are many different types of foster families. (5:15)

Many children go through the state directly. Stacy had a friend who just adopted her foster daughter this way.

Others go through agencies that provide administrative and emotional support to foster families. States have many different foster care laws, so agencies will look a little different depending on where you're located. 

There is also Therapeutic Foster Care through an agency. This is what Stacy and her family do. 

They are uniquely approved to foster and adopt children and teenagers who are working to overcome trauma, abuse, or struggle with emotional, behavioral, and/or medical challenges.

It involves extensive training to be licensed (not just as foster parents but also as a therapeutic foster resource family) and receives comprehensive, ongoing support. 

As a foster parent, you undergo investigation from extensive background checks to validating your financial independence. There is an extensive interview process families go through that involves friends and neighbors as well. And it's much more difficult than it's portrayed in movies to just "get foster kids for the money."

The Goal of Reunification in Foster Care

The length of time kids spend in foster care varies, but the goal is no longer than 18 months, and there are always "goals" written by the state that both sides need to abide by. 

In Stacy's experience, the state goes above and beyond to reunify the kids with their families. This includes support services to the biological parents. 

Fostering to adopt really varies from state to state. Where Stacy lives, it's only possible to be approved for both through an agency.

Stacy and her family aren't wholly looking to adopt at this time. However, they wanted that flexibility if it makes sense for kiddo to stay, which is why they chose an agency that did both.

The kiddo currently staying with Stacy is estimated to be with them for about a year. This is to allow proper time to evaluate the child's situation and ensure that they receive the held and care they need.

 

Need for Foster Care

The more kids in the system, the longer the process is. Stacy mentions that in her state, the need for foster care is at an all-time high. (16:01)

An estimated 437,283 children were in foster care on September 30, 2018. For perspective, that's one chilling entering care every 2 minutes.

On September 30, 2018, nearly one-third of these children (32%) were in relative homes, and nearly half (46%) were in non-relative foster family homes.

Over half (56%) had a case goal of reunification with their parents or primary caretakers.

About half (49%) of the children who left foster care in 2018 were discharged to be reunited with their parents or primary caretakers, and close to half (43%) who left foster care in 2018 were in care for less than 1 year.

Stacy adds that the estimated 437,283 children in foster care on September 30, 2018, were in the following types of placements:

  • 46% in non-relative foster family homes
  • 32% in relative foster family homes
  • 6% in institutions (such as juvenile detention centers as holding spots)
  • 5% on trial home visits (State retains supervision of the child)
  • 4% in group homes
  • 4% in pre-adoptive homes
  • 2% in supervised independent living
  • 1% had run away (that's over 4k kids!)

The Importance of Trust and Support

Even before covid, Stacy was shocked to learn that foster kids in her state are often placed in Juvenile detention centers, not for having committed no crime but because they have no place to go. 

This often puts those kids on a path they would otherwise have been able to avoid in a safe, stable environment.

Stacy explains that of these kids that run away, a lot of it comes down to trust. They've seen and experienced so much that they don't trust others to take care of them. So they'd prefer to take their chances on the streets.

However, Stacy shares success stories where the families can establish that trust and bring the kids back in.

Of those 437,283 children:

  • 56% had a goal of reunification with parent(s) or principal caretaker(s).
  • 27% had a goal of adoption.
  • 5% had not yet had a case plan goal established.
  • 4% had a goal of emancipation.
  • 4% had a goal of guardianship.
  • 3% had a goal of living with other relatives.
  • 2% had a goal of long-term foster care. 

And of those same 437,283 children:

  • 49% were reunited with parent(s) or primary caretaker(s).**
  • 25% were adopted.
  • 11% went to live with a guardian.
  • 7% were emancipated.
  • 7% went to live with another relative.
  • 1% had other outcomes.

Re-entry Into The System

Stacy notes that kids who are returned but then later re-enter the system are a different statistic. (26:45)

Re-entry in child welfare is traditionally viewed as a child exiting to permanency and then re-entering the child welfare system. 

Using this approach is effective for understanding child welfare practice from a single-system lens. However, it gives an incomplete picture of how children may move between related child-serving systems. 

The present study expands the definition of re-entry by examining re-entry for 2259 children who either return to the child welfare system or move into the juvenile justice system after reunification from foster care. 

When measuring a broader concept of re-entry (into either system), the rate of re-entry went from 18% to 25% (a 33% increase!)

Sarah asks about statistics on why there is so much re-entry. A lot of children end up needing care due to the epidemic of drug use. Relapse is a very real problem in recovering addicts and can easily result in children once more needing care.

The amount of support given to families while the kids are in the system is fantastic. However, once the kids go home, the families are once more on their own. Stacy believes better transitional programs would help.

Stacy also notes that a child entering foster care will likely live in more than four homes during the first year of care.

If things don't go "as planned," it's common for children who grow up in foster care to move more than 15 times. Each move can mean falling further behind in school and having to make new friends.

 

Parental Rights And Outcomes

Stacy has 4 foster kids in her home in the last 18 months. 3 had a goal of reunification: 2 are still on that path while 1's parent chose to terminate parental rights. (30:10)

If parents are unable or unwilling to meet the goals established when the child enters the system, either the state or the parents can choose to terminate parental rights. This can be voluntary or involuntary.

For teenaged children also have significant input in the decision. The state tries to support parents as much as possible to reunify with addiction treatment, therapeutic services for abuse, helping them get financial support, etc.

Stacy reminds listeners that terminating parental rights isn't something to be demonized. Sometimes, having the biological parent act as the primary caregiver isn't what's best. 

In this case, terminating rights gives the child a chance at getting adequate care and support to flourish. And it doesn't mean the parent relinquishes any and all relationship with their child. 

The 4th child that stayed with Stacy had a goal of adoption. However, it was not their outcome. 

They had been in the system for 4 years (in multiple institutions, group homes, and over a dozen foster homes), and sometimes trauma from consistent rejection and abandonment can be too much.

Every case is different. Outcomes can be influenced by many different, complex reasons, including the child no longer wanting to be with that family anymore.

Respite Families as a Way to Help

Everyone needs to be happy with the placement, including the parents and the child. This is why many agencies have "short-term placements" while finding the best fit for the child's situation.

Respite is also a program for families, biological or like Stacy's, who just need a week or so for a break to breathe. Stacy has both used respite and been a Respite family.

Respite isn't like a "time out" or a failure. Stacy has fostered the same kids repeatedly while acting as a respite for another family because you get to know these kids, and having them come stay with you for another week is exciting.

 

Maslow's Hierarchy of Needs

Maslow's Hierarchy of Needs is based around this idea that there's a broad hierarchy of basic human needs that are universal. (36:50)

Sarah adds that this concept has received some criticism over the years of its existence because many cultural and biological things can impact needs.

However, it's commonly excepted as a general umbrella of human needs.

Maslow's theory states you can't move up to the next stage without meeting all the levels below it first. And you have to address all the base needs before reaching your best self.

Foster kids, statically, struggle with school. Stacy explains that it's hard to occupy yourself with math when safety needs aren't being met. 

Attachment, food, safety, and shelter are things that come up again and again as something these kids have had ripped away from them. So even though you know you're providing it to them, it's difficult for them to let their guard down.

 

Foster Care Support For Families

Each child entering into the system have a team of people to help them and their families throughout the process. (44:50)

CASA is a volunteer position and is perfect for people who want to be involved and help but cannot serve as a foster family. They advocate for what the child wants.

GAL is a legal advisor to act as a judge for what that child wants.

The child and the biological family each have their own court-appointed lawyers to help see them through the legal side of the process.

A DSS worker is a legal guardian for kiddo while they're in care. They sign school forms, medically advocate for the child, and take on other roles usually held by a legal guardian.

They have medical service providers and treatment providers, such as wrap-around services, to prevent foster care, intensive in-home therapeutic services, and therapy for both the child, biological parent and foster family.

Stacy also has a 'therapeutic foster care worker' and a team of supervisors who support her as a foster resource parent and family because it's a lot!

Over Medication of Youths

In 2010, the Tufts Clinical and Translational Science Institute estimated that the rate of psychotropic medication use for youths in foster care is anywhere from 13 to 52%. This is compared to about 4% for youth in the general population. 

2014 Government Accountability Office (GAO) report found that at least 18% of children in foster care were taking at least one psychotropic medication. 

Some of the medications have not even been approved as safe and effective for children by the FDA.

Children with one consistent caseworker have a 75% of permanent placement while those with 2 drops drastically to 17%. Those with 3 or more have a .1% chance of being placed!

She wished tons of things differently, but Stacy genuinely sees kids' best interests at play.

 

Covid And Foster Care

Stacy notes that Covid has had a significant impact, and the system is so overwhelmed it cannot provide adequate safety for many. (59:15)

They are expecting a significant increase from the 2018 numbers in 2020 due to the pandemic.

Sarah shares these news articles she's found on Covid on the foster care system:

Issues can stem from families not wanting to foster anymore because they're afraid it might bring covid into the home.

Others can be from families now overwhelmed with the kids being home and unable to provide adequate care or put the kids in dangerous situations.

 

Systematic Child Welfare

Stacy is privileged to live in an area with the funding for all the roles and programs offered to these kids. (1:05:30)

In fact, white families are more likely to prevent foster treatment than black or brown parents.

seminal 2017 study found that a shocking 53% of Black children in the U.S. will be investigated as potential victims of child abuse by age 18. That's 16% higher than the rate for all children! 

Despite studies showing no relationship between race and child maltreatment, Sarah points out that systemic racism could fuel it.

Once in the system, black children also are more likely to stay in foster care, less likely to be reunified with their families, more likely to be placed in group care, age out in greater numbers, and become involved in the criminal justice system.

The pipeline that feeds youth in foster care into the adult criminal system has an especially harmful impact. As of 2015, black youths were 5x as likely as white youths to be detained or committed to juvenile justice facilities. 

In 2019, The Kansas City Star surveyed nearly 6,000 incarcerated people in 12 states, and 1 in 4 responded that they had been in foster care.

Black children are separated from their families and placed in foster care at a far higher rate than white children, often repeatedly. In 2019, Black children accounted for 23% of the children in foster care, although they make up only 14% of the country's children age 18 or younger.

They are also more likely to be placed in a group home where they face additional trauma and abuse.

Notable Cases

In a devastating tragedy earlier this year, staff members restrained and killed a 16-year old black boy, Cornelius Frederick, while being held in a for-profit foster care group home facility. (Source)

Another example is Ma'Kai Bryant, a black foster teen fatally shot earlier this year. 

Stacy is confident Ma'Kai's situation would have ended differently had she had the treatment team Stacy's kiddos were fortunate enough to have in their corner. They can call a social worker for concerns, process, or cope, rather than having to wait until a physical altercation to call the police.

Stacy breaks down the following are the races and ethnicities of the estimated 437,283 children in foster care on September 30, 2018: 

  • 44 percent were White
  • 23 percent were Black or African-American
  • 21 percent were Hispanic (of any race)
  • 10 percent were other races or multiracial
  • 1 percent were unknown or unable to be determined

The percentage of Black or African American children in care on September 30 decreased between 2008 and 2018, while the percentages of White children, Hispanic children, and children of other races or multiracial children increased.

 

Aging Out of the Foster Care System

There is a huge lack of support for children as they turn 18 and age out of the foster care system. (1:15:00)

Within four years of aging out, 70% will be on government assistance, and about half will not complete high school. Only 3% of youth in foster care graduate from college, and 25% are incarcerated within 2 years. (Source)

Children and adolescents with foster care experience are diagnosed with PTSD at twice the rate of U.S. war veterans.

Within four years of aging out, 50% have no earnings and those who do make an average annual income of $7,500. 

After foster youth ages out, homelessness and unemployment become a huge issue linked to increased risk of drug addiction, unwanted pregnancy, and human trafficking.

Trafficking Risk

In the U.S., 60 percent of domestic child trafficking victims have a history in the child welfare system.

Traffickers target youth in foster care because of their increased vulnerability due to a lack of family and emotional relationships and support.

74% of child trafficking cases involved sex trafficking, and the majority of those involved pimp-controlled prostitution.

According to the National Center for Missing and Exploited Children, the average age of child sex trafficking victims is 15, according to the numbers of children reported missing. Source: Child Sex Trafficking - Children's Rights

The overwhelming majority of missing children reported are endangered runaways. The statistics tell us that 91 percent of missing kids reported missing were children running away from home or foster care last year.

The second highest rates of missing children were abducted by a family member who did not have custody. Less than one percent were non-family (stranger) abductions. 

For more info, see Child Sex Trafficking (missingkids.org)

This is why foster care families, support, and funding are so important for these kids. We need ongoing support after they age out or reunify with their families.

LGBTQ+

2019 study found 30.4% of youth in foster care identify as LGBTQ+ and 5% as transgender, compared to 11.2% and 1.17% of youth not in foster care.

The Williams Institute also found that around 40% of unhoused youth identify as LGBTQ+. 

LGBTQ+ unhoused youths are roughly 7.4x more likely to suffer acts of sexual violence than heterosexual unhoused youths who have been in foster care. 

Without safe foster care placements and without the vital support of caseworkers and other child welfare professionals, LGBTQ+ youths often flee abuse in foster care only to face homelessness and exploitation.

 

What Can We Do?

One of the best things you can do is volunteer and donate time, money, or goods. (1:24:45)

There's a huge need for foster parents, but it's not always feasible. Other ways you can help are through respite, becoming a CASA, or providing resources for agencies or families.

Talk openly and honestly about what foster care is and what it isn't. There are so many misconceptions from T.V. and film, and people often assume the worst.

You can donate a "birthday box" through Together We Rise, a non-profit organization that will ensure a kid with the same birthday gets a pre-packaged birthday box to their social worker.

You can support kiddos aging out of foster care through the Dreammaker's Project Shop, where kiddos' creations are available for purchase. Stacy has personally bought the spices and artwork cards!

Dreammaker's Project allows you to sponsor kids aging out who need basic needs to survive. This helps provide things like bus money to get to their job or for a computer to finish school. 

You can also donate or sign-up for a children's rights membership at Children's Rights (convio.net)

Stacy's specific Agency, UMFS, is always looking for support. Or you can find one in your local area by donating goods (like suitcases and car seats) they may need, your own time, or money.

This month, Stacy will be donating 20% of all her proceeds from Beautycounter to these organizations. Last month, she raised $2500 for Children's Rights, which fights for systemic change.

Just $1 donated is equal to $100 into the system because of the broad impact it makes.

 

Final Thoughts

These kids don't have access to that next-level diet and lifestyle that's so often talked about on this show because they're struggling with basic needs. (1:30:00)

There's so much room to nurture these kids by showing that support and avocation to the foster care system.

How can you be worried about health from non-toxic living if your life is in danger and aren't safe and stable?

The Whole View has always advocated for health, wellness, and safety for all, and while we talk about our personal wellness, there's a lot more going on out in the world.

Being a foster parent is not easy, but it's so rewarding. Stacy has learned so much from these kids, and they deserve to be just as well, healthy, and safe as everyone else.

Thank you so much for joining us this week! For more behind the scenes on this topic, be sure to join us on Patreon for exclusive content.

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