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.

Welcome back to the Whole View, episode 4-1-1. (0:27)

Does 411 still exist as a resource you can call?

This week, we have a really amazing question from Holly.

The topic is one that has been bouncing around in Sarah's head for a while.

When she talks to someone about how she eats, it can be tricky to navigate what vocabulary to use.

So now seems like a really good time to dig into this, especially given the recent podcast name change.

 

Listener Question

Holly writes, "Hey ladies, I’m a long time listener of the podcast and I hope by telling you both how awesome you are that you will answer my question. (2:02)

Just kidding! But I know it can’t hurt and it's true!

Really, thank you both for all the work you do to keep us in the know.

I have been finding the Covid shows so helpful and I feel like I get to rant with you both.

On to my question, Sarah I noticed your new book has non-paleo and non-aip foods in it and I know the podcast name has changed, so... do you both even still follow a paleo diet?

I would love to know what your diets look like now.

Also, what do you both recommend now for all of us looking for general health guidelines, if Paleo is no longer the ‘thing’?

Thanks again for all you do!  

P.S. Sorry Sarah if you cover this in the book, I admittedly have just done a quick scan, and I promise to read it soon.

 

Sarah's New eBook

Sarah completely forgot to tell our podcast listeners that she just launched her Gut Microbiome eBook. (3:01)

The book that Holly is referring to is Sarah's new Gut Health Guidebook.

Sarah has been working on a Gut Microbiome book for about six years now.

She started this book before writing Healing Kitchen.

Healing Kitchen was a book writing tangent, and then Paleo Principles was a second book writing tangent.

Since Paleo Principles came out, this book has been Sarah's singular focus.

She was wrapping it up earlier this year and then when covid hit, it caused a delay in the publication process.

Sarah still doesn't know when it will come out, but her guess is that at this point it will be sometime in 2021.

As soon as she found out that this was not going to be the late 2020 book she was pushing for, Sarah took the cohesive storyline of diet and lifestyle and package that up into an eBook.

The way that the Gut Microbiome book was coming together made it clear that it couldn't be one book the way Paleo Principles is.

Sarah is taking the companion cookbook and is also going to create an eBook out of that content.

That will launch late this summer.

So the Gut Health Guidebook is now live and you can package it together with a preorder of the cookbook.

Sarah is offering a special discount for anybody who wants to do that.

To find the offer, see here.

 

From Stacy's Point of View

Stacy and crew just got back from being in the wilderness for a week. (6:24)

She won't call it camping because it is more glamping.

They prepped a lot of food before they left and cooked over the fire each night.

It is interesting for Stacy to think about this question in the context of having just been on that trip.

The different kinds of foods that they took this trip versus previous glamping trips

Things were very similar, with some exceptions.

As we talk about what they are each now doing and why, those points will weave in.

Years ago they did not take gluten-free graham crackers for example.

Stacy made Paleo chocolate chip cookies and then they made marshmallows and used those homemade creations for s' mores.

She also wants to note for perspective that it has been over ten years since both Stacy and Sarah started their journey into what she would call a health awakening.

They started with this idea of paleo, but that health awakening really started when Cole was born and Stacy was breastfeeding for the first time.

This is when Stacy realized that what she was eating was going directly into him.

That transitioned over many years until the birth of Wesley, and that was the point in which Stacy realized that her body was responding to certain foods in a way that was hurting her children when nursing.

Stacy has learned from her body what she tolerates vs. thrives on.

It is also interesting in this world of covid, how we need our bodies to be thriving and to be as strong as possible.

Where you is where you are, and there is no shame in where you have been or where you are going.

When we talk about diet we talk about how you choose to eat your food.

We are not talking about a fad diet, a way that you eat for short-term results.

This has always been a key concept on this show.

It has always been about a lifestyle.

If you focus on what feels best for you and listen to your body, you can find a way to live a balance in your life to not think about food as something as anything other than fuel.

 

Healthy Living

Stacy wants to refer everyone back to episode 358 on Intuitive Eating. (11:16)

This show is very representative of our thoughts on anti-diet and intuitive eating.

On this episode, we share how you can incorporate this into a way of healthy living.

There is a response that your body has to certain foods, and to ignore that is not beneficial to your long-term health.

But how can you incorporate those foods without it being a diet that you punish yourself for?

This turns food into a reward, which isn't good either.

If you find yourself in a place where food has that kind of control or thought pattern, please go back and listen to that episode.

It will really tell the full picture of what we are going to dive into with the way we fuel and nourish ourselves.

We try to optimize thriving, while still representing the emotional importance of some of that stuff.

 

From Sarah's Point of View

Sarah loves how Stacy framed the way that her healthy awakening journey began because Sarah's started with Adele. (12:33)

In her first pregnancy, she has gestational diabetes and she managed her blood sugar really well with careful measuring.

When Adele was one she realized that she was getting that same sickish feeling every time she ate.

Sarah still had her blood sugar testing supplies and one day after lunch decided to test her levels.

Her levels were 200, which is the cusp between pre-diabetes and type-2 diabetes.

She does not recommend this at all, but Sarah never told her doctor.

Sarah felt so much guilt around this reality as she was intimately aware of the consequences of diabetes.

So that day was the day that she changed her diet, and she went to the thing she knew.

Sarah went low-carb, and in many ways, the last ten years has been a road of recovering from that stretch of low-carb.

She was able to lose weight and normalize her blood sugar levels and blood pressure.

She had markers showing her that she was healthy, but her autoimmune diseases were getting worse.

It was a tradeoff.

When Sarah's youngest daughter was closing in on two, it was actually the autoimmune flairs that brought her to paleo.

Sarah's immediate was response was that paleo was crazy, but as she dug into it the science made sense.

Once Sarah got into it, she went cold turkey with it on August 31, 2011, which helped a lot of things.

However, it didn't help everything so for her New Year's resolution that year she started the autoimmune protocol.

At that time AIP was very poorly defined.

So Sarah defined and established what AIP was and is now, at the same time she was doing it.

Sarah was very influenced by Dr. Terry Wahls TEDx presentation.

 

More on Sarah's Journey

So she used her knowledge base to understand how foods interact with the human body, throughout this entire experience. (18:36)

And she has never stopped continuing to learn.

As Sarah has continued to learn, she has continued to tinker with her diet.

Over the years this has turned into something that she doesn't know if paleo is the correct label to describe how she eats now.

The term paleo, as is typically defined, is still defined as what you don't eat.

Sarah doesn't believe that what you eliminate makes a diet healthy or not.

It is actually the foods that you eat that is what determines whether or not that diet is healthy.

And it is the nutrient density that serves as the primary criteria as to whether or not a diet supports health.

Eliminations are things that you add on top of that to address specific health challenges or goals.

Sarah's diet has really expanded over that time.

This started in October of 2012 with methodical reintroductions after having followed the AIP for about 10-months.

A lot of those reintroductions were successful.

When she started the AIP Lecture Series in 2019 she realized that she was scared to reintroduce beyond what she had already done.

Sarah was so comfortable with where she is at that she didn't want to reintroduce anything further and run into possible setbacks.

However, she realized that she really need to change her mindset around that.

When you can expand your diet to allow for nutrient expansion, that is making strides towards improved health.

This microbiome research has solidified Sarah's feelings towards a lot of the foods that the paleo diet has been criticized for eliminating.

Legumes and rice are two examples that Sarah highlighted.

 

Where Paleo Fell Short

One of the things that paleo has failed in terms of serving its community, is the way it has lumped foods together. (23:19)

The framework of the diet says no grains, no dairy, no legumes, and no processed foods.

Sarah feels that it is unfair to lump all of those foods together.

There are some terrible grains, and there are actually some grains with science to back their different benefits.

This is true for legumes as well.

When you look at the gut microbiome you can see very clearly which grains and legumes benefit the gut microbiome and which don't.

So as Sarah was pulling together this information, she started methodically challenging legumes, dairy, tomatoes, and switched from white to brown rice.

What worked has become very moderate additions to her diet.

Sarah's diet is still mostly vegetables, fruit, and a moderate serving of protein.

Introducing these other foods requires a more nuanced approach.

It requires being able to not lump everything together and select what to eat carefully.

If we take this nutrient-density approach, then we are eating what we need to thrive, and it changes how we tolerate some foods that might have antinutrients, but ultimately have a lot of valuable nutrition to provide the body.

Stacy thinks that there are a lot of things that we have talked about on this show that are all over the place if you are trying to track when and how Stacy and Sarah's journies unfolded. 

We know this sounds very complicated.

However, doing simple things like meal planning help to make sure that you have certain foods on your meal plan several times a week will simplify the process.

For Stacy, it can be something as simple as making homemade tuna salad.

 

Stacy's Journey

Stacy and Sarah have had a similar approach. (29:57)

However, Stacy will admit that her approach is a lot less focused on as many nutrients as Sarah is committed to.

If Sarah's is more paleo 80/20, Stacy thinks her approach is more 75/25.

However, it is also important to understand that her goal is no longer weight loss.

She lost 134 pounds at the peak of her weight loss, but she only got to that number of the scale one day and she did it through disordered eating.

Stacy justified the disordered eating with intermittent fasting.

As a result of her habits, she had digestive distress which caused nutrient deficiency, and she had a thyroid nodule and a huge flair.

Sarah and Stacy, along with a medical professional, had to work to help Stacy restore her health during that period.

It got really bad healthwise and she needed to recover.

Not just gut health had to recover, Stacy's body was in a bad place.

In 2015, Stacy asked the question, is your paleo challenge justifying disordered eating? 

This was controversial because at the time many were doing paleo challenges every other month as a "normal" part of their diet.

Stacy pointed out that this is not being paleo, and eating to incorporate a nutrient-dense, anti-inflammatory lifestyle.

This is using paleo as a yo-yo diet.

The more Stacy became aware of what was happening to her and many others in the community, it was where Stacy and Sarah started talking about metrics of health.

There was also a lot of fatphobia in the community.

 

More on Stacy's Journey

From Stacy's perspective and awakening in all of this is still very health-focused. (32:19)

Stacy wants health, wellness, and longevity for her family.

Her original goal with starting Paleo was that she had such low energy and wanting to play with her kids.

Thinking about that original goal and where she is at today, Stacy feels that food enabled her to have the energy she needed to get more active.

She is worlds apart from where she was in terms of her energy levels and wellness in general.

Stacy did put on weight as she came out of that low-carb, paleo period.

That was her starved, it was not a real weight.

Stacy ended up rebounding and reaching a really good place until she injured her back, which then she couldn't move for a year.

Stacy put on weight from that period of time, but she has maintained a significant amount of that weight that she originally lost.

However, Stacy really doesn't weigh herself due to her history with how she equates her worth to that number on the scale.

Body positivity and self-love have become very important to Stacy as she optimizes her health.

Stacy looks at food and asks herself, "is what I am consuming going to give me wellness and longevity?"

And sometimes that is the motivating factor she needs to not get ice cream or whatever it is.

This comes from a much different place, one without deprivation and punishment and those kinds of things that Stacy did for so long.

And it is not linear.

For Stacy, she didn't flip a switch and was fixed.

These are habits that she has to consistently work on and quarantine has not been easy.

 

Nutrivore

This is where Stacy has really changed her mindset, as she first and foremost thinks of herself as a nutrivore, someone who prioritizes nutrient density. (35:49)

Stacy recognizes that they can't have a diet of only white rice, but if they are sick and that is the only thing they are able to keep down, how can they optimize it?

They can put in grass-fed ghee, cook the rice in bone broth, put kept on top, and then for their next meal find something else like sweet potatoes to fill the carb cravings.

Stacy does focus on adding nutrient density and vegetables to what she describes as a gluten-free, corn-free, legume-free, and night-shade free diet.

She would love to be able to eat those foods, but they don't agree with her body.

Stacy is not dairy-free in the same way that Sarah is.

She can tolerate more dairy, but not every day.

The dairy that Stacy tolerates is fat only forms.

Stacy feels that there is a big difference in the thought process from where they were, to where they are now.

 

Sarah's Implementation of a Nutrivore Diet

Sarah has something very similar. (38:16)

Prior to covid, when Sarah ate in a restaurant she would say she is gluten-free, dairy-free, and soy-free.

These are things she knows she can't do. 

The term that Sarah most resonates with now is nutrivore.

This best describes Sarah's approach because she looks at food as providing her body with the resources it needs to do all the things it wants to do. 

And those resources are nutrients.

By adopting the term nutrivore, instead of saying "I eat these foods and not these foods", I'm saying that the primary goal of my diet as a whole is to supply my body with all the essential and non-essential nutrients it needs to thrive from my food.

That is the goal. 

You can basically fit junky calories into your diet if the bulk of your diet is made up of super nutrient-dense foods. 

Because those junky calories at that point are not taking away from meeting that goal of getting all of the nutrients that your body needs.

This helps us get away from food labels of good vs. bad, and gets into what is the quality of my diet? 

Did I meet my nutritional needs today?

And did I meet those needs today with some energy deficit? 

Sarah likes that this moves us away from stigmatizing foods. 

However, it still recognizes foods that aren't good for anybody. 

Sarah doesn't believe that everyone needs to be strictly gluten-free.

As we get away from demonizing foods, we can get back to the thing that is most important. 

Meeting the body's nutritional needs is a top priority. 

From there you can layer eliminations on top of that, or add additional nutritional focus on top of that to meet specific health challenges and goals.

For example, Sarah thinks of AIP as a sub diet of a nutrivore approach.

There is now emerging science showing that the gut microbiome really needs a minimal amount of carbohydrate. 

This amount is probably at least 150 grams a day, if not 200 grams a day. 

 

How to Describe It

If Sarah were to describe her diet to someone who was serving her food, she would describe it as gluten-free, dairy-free, and soy-free. (43:44)

If she was talking to her neighbor who wanted to make some dietary changes she would probably use the word nutrivore.

Sarah would then talk about the importance of eating a lot of vegetables, higher-quality meat, more seafood, eating fruit, eating a serving of mushrooms a day, and a palm-full of nuts a day. 

She would also talk about snout-to-tail eating.

Also why soaking legumes is still a best practice. 

The focus would be on eating more nutrient-dense foods and allowing them to displace the foods that aren't doing us any favors. 

Rather than eliminating foods that are put into this 'no' category. 

Stacy thinks this perspective is helpful. 

It is helpful to be reminded of what our ultimate goal is.

We are then able to ask, ok, how do we get there in a sustainable way. 

If you are overly restrictive and you can't stick with that, it isn't good either. 

How can you optimize without boomeranging to the other side?

 

Customization

Stacy wants to point out a few more things that are unique to her since she doesn't have a gallbladder. (46:05) 

She has to pay particular attention to fats.

Matt and Stacy have added more olive oil and avocado oil, and use less lard. 

They also eat gluten-free treats. 

Stacy doesn't do oats, and they don't do legumes in their family.

They do have brown rice pasta about once a week.

If Stacy does have a meal of rice or pasta, she does try to ensure that she has a veggie-rich meal on that day to make up for the overall vegetables and nutrients that she is trying to achieve every day. 

She also tries to move her body. 

It is about how she feels, and she has to listen to her body. 

Sarah doesn't feel bad about cooking brown rice pasta at all.

Especially after going through the gut microbiome researching and learning about how good rice is for the gut microbiome.

It is not a base food because it doesn't have a ton of nutrition, but in the context of a meal that incorporates other nutrient-dense options, it becomes a good contribution. 

Stacy mentioned this blog post on casserole prep.

She also takes supplements of daily collagen but doesn't drink broth as often as she use to. 

Stacy also takes liver pills, vitamin D and magnesium. 

She is also adding mushrooms with more intention these days. 

Stir-fries are a favorite these days, as Stacy finds it easy to add nutrients to these dishes. 

Stacy has added things in, but it hasn't been as thoughtful as Sarah's process. 

However, she is very aware of what they are adding and what they are or aren't doing. 

Stacy strives to be mindful of balance because social and emotional wellbeing in terms of sustainability and disordered eating has been so impactful to Stacy. 

She has had to really learn to listen to her body and really find a balance on how she feels in terms of digestion and energy, more than anything else for it to work long-term.

It is important to Stacy to not feel bad or to go off the rails.

This can be hard if you come from a place of dysmorphia or eating disorders or any kind of stuff like that.

For Stacy, she has worked on that stuff and gone to therapy and become self-aware.

If you are struggling with this stuff, you can't just solve it in a vacuum. 

When there is emotions around your food, you do have to address the emotion or else you will never solve the problem.

 

Closing Thoughts

One of the things that have allowed Sarah to embrace the term nutrivore is to develop a healthier relationship with food. (1:01:03)

Just like when we first adopted paleo, nine to ten years ago, that was always going to be a lifestyle. 

It has evolved, and her diet has expanded.

While Sarah thinks of it as nutrivore, you could also call it AIP maintenance phase, or paleo plus, or 80/20. 

There are other labels that we can use, but it is still a lifestyle. 

It is about lifelong health and hopefully improving her longevity. 

This still includes getting enough sleep, managing stress, living an active lifestyle, and nature time.

These are all still pieces of the health puzzle for Sarah. 

But what she has been able to do by shedding the dogmatic rules that have been associated with the paleo diet for so long is to develop a healthier relationship with food.

One of the side effects this has had is that portion control is much easier, which has always been a real struggle for Sarah. 

This healthier relationship with food has allowed Sarah to regular her cravings and appetite.

Getting beyond paleo has allowed Sarah to fix some of the food relationship problems that she was still having on the paleo diet. 

Stacy and Sarah have been talking about doing some changes on the show for a long time, and you are seeing some of them with the name change of the show. 

They are planning to let go of their G-rating soon, so that they can relax a bit on things.

Stacy and Sarah's true unfiltered thoughts on things will be coming through in the next few weeks. 

That is it for this week's episode. 

Thank you for listening, and we will be back next week! (1:07:20)

Welcome back listeners to the Whole View, episode 410. (0:27)

Stacy is going to be honest that we have had a quarantine update show on the dockets for a few weeks.

However, Stacy has been having some feels and the topic kept getting pushed back.

But this week Stacy and Sarah will be sharing their updates, and will also share updates on what is happening in the world and with science.

Stacy wanted to first say thank you to all the people who have been so supportive and have participated and supported this community.

Sarah wanted to take a moment to share a few emails that we have received.

The messages from these fans left Sarah feeling so grateful and she just wanted to take a moment to share them.

Thank you to everyone who has taken the time to write to Stacy and Sarah over the last few weeks.

 

Protesting vs. Covid

Stacy wanted to take a moment to share something she is feeling frustrated by. (6:30)

Over the last few weeks, there has been a lot.

One of the things that Stacy has read about is the idea of why do we need to wear masks and social distance if people are just going to march.

And if people are marching, then we don't need to do all this other stuff.

Why is it that this is an exception, but this other thing doesn't exist?

Stacy wants to share her thoughts on this.

When a community of people is being oppressed and are vulnerable from a number of societal abuses and discriminations, and they want to use their voice and their rights as Americans to peacefully protest, and then we turn it around and complain.

And most of them are in fact wearing masks to do this.

Why do we have a say in this first of all?

If you genuinely felt like your life was at risk, that the life of your loved ones was at risk, then the risk of potentially getting covid doesn't really quantify.

And it isn't really our job or right to say how someone goes about trying to get equal rights.

What Stacy has learned over the last couple of months is that she needs to stop talking and thinking.

She hasn't lived that life and she hasn't had that experience and she can't put her thoughts on someone else.

So first, this is not your choice.

Second, most of these people are wearing masks.

And third of all, there are people out there exploiting this.

Stacy mentioned this article.

This is a hard one for Stacy to understand the thought process behind.

If you don't like it, just don't participate.

You don't have to be there, you don't have to worry about covid exposure.

If you want to support this movement but are afraid to go to a march, you can do things in other ways to show your support.

If there wasn't a pandemic, Sarah would be marching in solidarity.

However, she is trying to find as many other tangible ways to support the Black Lives Matter movement and this advocacy for equality in the absence of feeling safe going to marches.

 

What the Science Shows Us

Sarah feels it is important to emphasize the importance of mask use. (13:20)

One of the things that have been ubiquitous across all the Black Lives Matter protests is that you see a lot of mask use in these marches.

A lot of them where they can be practicing social distancing, are putting those measures into place.

Of course, these are all done outdoors as well.

Sarah's blog post on face masks.

Even with regular cloth-fabric masks, it can have a filtration efficiency almost as high as surgical masks.

So when everyone is wearing them, if you have two people having a conversation and the person who is sick is wearing a mask, only 10% of the viral particles are able to escape.

The other 90% are being trapped.

And if you have that second person, the healthy person also wearing a mask, that healthy person is still filtering 90%.

So that is now taking 90% of the 10% that went through, so now only 1% is getting through.

Add in a little bit of distance and some airflow, you are now talking about a situation where the likelihood of infection is way lower.

So when you are in these situations where everyone is wearing masks, that is a huge protecting factor.

The other part that is helping to protect the protestors is the fact that they are outdoors.

There was a study just published this month that showed that with just sun exposure, 11 to 34 minutes in the midday sun in most US cities was sufficient to deactivate 90% of the virus.

And that is because it is quite sensitive to UV.

The combination of most protestors wearing masks and these being held outdoors has been what is protecting them.

 

Number Spikes

There are plenty of spikes in covid that are related to indoor gatherings across the country. (16:13)

The indoor environments are still very challenging.

And a lot of these spikes are also related to indoor gatherings without mask use.

Protesting has so far not caused a spike in cases.

There were four community testing sites set up in Minneapolis for people who attended protests showed, which showed a 1.4% positive rate.

This is basically the same positivity rate that you would expect for community spread for any community in this country right now.

Our full positive rate is climbing up towards 10% again in this country.

This is obviously different than these community testing sites that were designed to monitor whether or not coronavirus is being spread through the protests.

However, at the same time, this is data showing that at least for now, and probably largely attributed to mask use, we are not seeing that the protests are causing spikes.

 

A Quarantine Update from Stacy

Stacy is in a desperate state to get out of her house. (18:40)

It has been since February, and she has three boys, and Matt works all of the time.

He had off while they were home recovering from covid, but once he went back he has essentially been on demanding work schedules.

Virginia is now in phase two of their re-open.

Masks are required if you go anywhere in public.

Their numbers are going down.

Virginia doesn't get to progress to the next level in their reopening phase until they reach certain benchmarks that show improvements.

Matt and Stacy have decided to take a glamping trip.

They have rented a rustic cabin, so they will bring all of their own linens and pretty much everything.

It will be a week outside in the wilderness on a lake where the boys can enjoy water activities and be outside and be active.

Their neighborhood hasn't been social distancing as much as Stacy would like.

The kids have not been able to leave the yard, and they are over it.

They are all over it.

So Matt got days off finally.

It will be a vacation with the same social distancing plan.

Stacy will let listeners know how it goes.

 

A Quarantine Update from Sarah

There was a similar conversation in Sarah's household about going on a camping trip this summer, but they decided not to go. (22:44)

They typically go to a state park up in the mountains when they go camping, and while they are in a tent, they use shared bathrooms at the camping sites.

Sarah is experiencing a lot of stress around how her state is opening up.

In part, this is because of mask use.

If you look at a poll of what people think of masks, everyone has positive things to say.

Eighty to ninety percent of people are pro-mask.

Around 1/3 of Americans are wearing masks at all times outside of their homes.

One-third of Americans are sometimes wearing masks outside of their homes.

And 1/3 of Americans are not wearing masks at all.

Last time when Sarah went grocery shopping, she only saw 1/4 of people wearing masks.

Sarah is definitely concerned about the possibility of having a more severe course of covid if she gets it.

So to be in a grocery store when 1/4 of the people were wearing masks and social distancing, and the other 3/4 of the people not wearing masks were not being respectful of boundaries.

Sarah feels like it is selfish to behave like this, and has since been having her groceries delivered instead.

She has not had an anxiety attack as she did after that experience in years.

It was such an awful experience to be put into that position.

The thing that stresses Sarah out is watching decisions being made that aren't supported by the data.

 

Stress Around Opening Back Up

In Georgia, they have seen this plateau of cases, but the plateau is at a very high level. (27:12)

There is no place that is exempt.

It feels harder for Sarah to protect herself when it is not a community action to protect each other anymore. 

This is not to say that everyone is disregarding the recommendations being made, but there are just enough people disregarding it to make Sarah feel like it is not safe to go out.

That has been the hardest part for Sarah.

They haven't announced how they are going to handle school in the fall.

Sarah's husband's work is still trying to figure out all of their logistics for what they will do.

So they are still waiting on information there before making decisions on how they will respond.

Sarah feels much safer at home and in her own yard and her own neighborhood.

It has been really challenging for Sarah psychologically.

There are ways that we can be opening up the economy that is safer than what she is observing around her.

 

Antibody Testing

One of the questions that Stacy has gotten many times is, does she have antibodies. (29:39)

Stacy does not have antibodies.

Matt and Stacy took a test early that they knew had a high false-negative rate, so she attributed it to that and she wasn't worried.

Then they special ordered a more accurate test and Stacy took that last week and was crushed to find out that she does not have antibodies.

This news overwhelmed Stacy because she had chickenpox twice, and there is some research to suggest that there are different types of immune responses to getting different kinds of illnesses.

The body could then have a worse case the second time.

Sarah also did antibody testing two weeks ago, which also came back negative.

There are three different pieces to talk about this.

One, how good the antibody tests are, and the answer for most of them is not that.

Our immune systems are not fully developed until we are about one.

It is fairly well-known that if you get one of these childhood diseases, like chickenpox, before you are one, there is a higher likelihood of not developing immunological memory.

Immunological memory is the ways that our immune system remembers a specific pathogen so that the next time you are exposed to that pathogen it can mount a response before it replicates enough time to have symptoms.

This is why the vast majority of people only get chickenpox once.

For some people who are immune-compromised, this can definitely impact immunological memory.

There have been hundreds of antibody tests that have gotten this emergency use authorization, and they are not all good.

In fact, a small percentage of them are good.

It is really important to know three different things about that test before selecting which one to use.

The false-negative rate, the false positive rate, and if the test looks for both IgG and IgM. 

Stacy and Sarah both used Access Labs.

For more on tests, see here and here.

 

More on Testing

We still don't know with covid what level of antibodies is enough to say you are protected. (38:54)

This is where things get really complicated.

There was a study published in Nature Medicine two weeks ago that actually looked at antibody production and compared severe cases versus mild.

All of these antibody tests have sensitivity and specificity rates that are measured by confirming their test against samples from patients who were hospitalized with covid.

So all of these antibody tests are confirmed against severe cases.

What this Nature paper showed is that 40% of the people who were asymptomatic had no antibodies by the time their infection was over.

So they actually showed that these people who were asymptomatic were shedding virus for an average of nineteen days.

By the end of those three weeks, they had no measurable antibodies.

12.9% of their symptomatic group also has no antibodies by the time their symptoms were over.

So if you are not going to measure antibodies in that perfect window there is a really high percentage chance that you are missing antibodies.

If you have a mild case you don't even know necessarily know when that window is.

We can deduce just from what we know about how the immune system works that a mild case would be much more similar to an asymptomatic case in terms of antibody production, then to a severe case.

So antibodies might not be a really great test for measuring immunity.

 

Immune System Detection

What is fascinating about the SARS-CoV-2 virus is that it evades detection by our immune systems. (41:17)

Which is one of the reasons why it is a long illness.

It gets a much longer time than normal to ramp up its viral replication before our immune system recognizes an invader.

The virus itself can evade detection from our immune system by two different mechanisms.

One is by interfering with the production of a class of pro-inflammatory cytokines.

Long-term immunity may be via T cells and not antibodies, and Sarah explained this in greater detail.

We have all of these studies showing now that the immune response to covid is type 1 driven.

And that actually there is no change in B cell activation compared to a healthy person.

So our immune response is not actually antibody driven.

What is happening is that our immune system is going around and killing infected cells, not going around and making antibodies that neutralize the virus directly.

There is a little bit of that, but not a ton.

This is why we are not seeing the type of antibody formation that would help us measure immunity, which is not how our immune system is responding to this virus at all.

So there are a lot of different ways that our immune system can remember a pathogen.

We can have immunological memory through T cells.

So we actually know from studies of SARS-CoV-1, which caused the SARS epidemic in 2002 and 2003, that that virus was also the response was also Th1 driven and not Th2. 

We know that memory T cells can persist in patients for at least four years after infection.

However, we don't know yet what happens to those memory T cells if it is long-term immunity or just a few years.

Either way, at least for the near future, we can deduce that if you have had it you are still immune, but it is through this thing that we don't really have the testing capacity for.

Research labs can test for memory T cells via a blood sample, but there is no test that has been developed to measure immunity in this way for anything else.

It is not a normal test, it is not a normal thing, it is a technique used in research, but not phlebotomy.

What a negative antibody test means for someone like Sarah is that she probably hasn't been exposed.

For Stacy, it shows that she had a mild enough case that she didn't develop antibodies.

However, her immune system is remembering it through T cells.

For more information on the research surrounding T cells see here, here, here, and here.

 

Closing Thoughts

The answer is the same answer that brings us back to the top of the show. (47:46)

Stacy doesn't wear a mask for her, she wears a mask for somebody else.

This is a topic that she wants to reiterate one more time.

Had Stacy not have been wearing a mask and protecting others, who knows what could have happened to someone else.

You never know if you have something and you are asymptomatic and could be passing it along to someone who is higher risk.

No matter how healthy and fit you are, you are not safe from a severe course. 

We don't want this for anyone.

It is our job to keep people protected and wear masks.

If someone is going out and not wearing a mask, you are impeding your decision on somebody else in a way that could harm them. 

It is our job to be mindful of and take care of others.

Stacy understands that wearing masks is new and different, but that is ok - that is what change is.

We are implementing these changes to protect not just ourselves but other people.

Sarah appreciates Stacy for raising these points.

She has been shocked to see people's vehemence against masks that she has seen online.

Sarah can fully appreciate the feeling of being over it and just wanting things to return to normal.

The problem is that wanting things to be normal is not enough for things to actually be normal.

We risk the lives of the most vulnerable in our community by pretending that it is done and over.

We are at 2.2 million confirmed cases in the US, granted this also includes the people who have recovered.

But we are seeing in roughly half of the states, cases are spiking again.

This is in large part because of the reliance on opening things back up because we all are eager for things to get back to life as normal.

However, normal can only be achieved if we each take responsibility to not just protect ourselves, but to also protect others, which includes social distancing, wearing a mask, and hand washing. 

It is the thing that we do to take ourselves out of the pool of people spreading, which is how we get the reproductive number below 1 so that this can be a virus that fizzles out.

Sarah feels the frustration and the longing for normalcy, but at the same time, this pandemic is still here.

Until we have effective treatments or preventatives, this is what we've got - social distancing and mask-wearing. 

If we can't figure out masks we are going to end up shut down and stuck in our homes again.

One of the reasons why we have a plateau in so many states or cases decreasing is more related to the weather than it is related to mask-wearing and social distancing.

When things get going in the fall, if we can't figure this out by then, the consequences are going to be more cases and more people dying.

Sarah will not contribute to that and will wear a mask and social distance for as long as it takes us to get through this pandemic.

Thank you listeners for tuning in.

Stacy hopes that you are doing well, she knows this is a difficult time.

Please remember that we are trying to help others as well as help ourselves.

The things that are shown to reduce risk to continue to be done even if it is not required.

We hope that you stay safe!

And we will be back again next week! (58:53)

Welcome back, Whole View listeners. (0:27)

Stacy is so excited for 410 because it is one of those shows that she asked for.

She has taken other magnesium before years ago and did not feel a difference.

So she asked Sarah why BiOptimizers magnesium makes her feel so good.

And Sarah decided that this would make for a great podcast episode, as opposed to leaving the information in a text exchange.

Stacy is super excited to dive into the science of magnesium.

But first, a quick shout out to this week's sponsor, BiOptimizers

We reached out to them asking if they would sponsor this week's show because Stacy personally loves and feels different on their magnesium.

If you haven't felt a difference when you take other magnesium supplements, Stacy recommends that you give BiOptimizers a try. 

You can get 10% off with the code WHOLEVIEW10.

However, if you visit this link, the code will automatically be plugged into your shopping cart.

There are some bundle sets at that site link as well that will save you additional money on your purchases.

Sarah noted that this is actually episode 409.

She too is very excited to talk about magnesium.

Sarah feels that this is an undervalued nutrient.

It is the fourth most abundant mineral in the human body.

One of the things that Stacy wants to point out is that in light of the recent sleep issue podcast episodes, magnesium is a helpful tool when taken in the evenings.

 

Magnesium's Role in the Human Body

Magnesium is necessary for more than 300 different enzymes to work. (5:14)

Whether as a co-factor or a stabilizer, this nutrient is critical in the human body.

Among the enzymes that magnesium is required for to work is every enzyme that uses or synthesizes ATP.

ATP is the basic energy currency of all cells.

So our cells cannot make energy or use energy without magnesium.

ATP is required for everything related to metabolism.

If you start to look at every single action that uses cellular energy or makes cellular energy as magnesium-dependent, it starts to become really easy to see why magnesium is so important for human health.

Plus, it has such a diverse range of effects.

It is also required for the enzymes that synthesize DNA and RNA.

Magnesium is an essential cofactor for many enzymatic reactions involved in neurotransmitter synthesis.

It is also a constituent of bones and teeth and regulates bone formation.

Likewise, magnesium is necessary for the production of testosterone and progesterone.

It is also important for the metabolism of phosphorus, calcium, potassium, sodium, B-complex vitamins, and vitamins C and E.

Magnesium is necessary for all detoxification functions.

It also regulates vascular tone, heart rhythm, platelet-activated thrombosis, blood pressure, and cholesterol production.

When we are not consuming enough magnesium, there is a high connection to hypertension and cardiovascular disease.

Lastly, modulates insulin signal transduction and may have a role in regulating insulin secretion. 

This is taking a look at magnesium through a micro-view.

For more on the basics of magnesium, see here.

 

At the Macro Level

Sarah wants to take a step back and look at magnesium function from a macro sense. (9:03)

Magnesium plays a critical role in the stress axis.

Every single aspect of the HPA axis (our flight or fight response) is sensitive to magnesium.

Because over activation of that axis is tied with anxiety and depression, we can see through magnesium's action on the HPA axis how each hormone in that system is communicating.

In order to function normally, all of that is relying on magnesium.

We can see that magnesium deficiency is probably a necessary precondition for the development of generalized anxiety disorder and depression.

There have been animal studies where they simply don't give them enough magnesium, and the animals show behaviors that are representative of depression and anxiety.

They can treat those animals with antidepressants and show benefits.

However, when treated with magnesium they show a reversal in symptoms.

In humans, a low level of magnesium in the blood or in the spinal fluid has been associated with depressive symptoms as well as suicidality.

For more on the connection between magnesium and stress, see here.

 

Sleep

The other link to look at is sleep. (11:27)

We know that inadequate sleep is also linked with mood.

Now there is a fairly good understanding that magnesium plays a role in regulating sleep.

So it actually regulates the central nervous system excitability and has a calming effect on the central nervous system.

This is the reason why we want to take magnesium in the evening.

Magnesium also helps to promote the activity of GABA.

GABA is one of the main neurotransmitters involved in relaxation and sleep.

There have been a variety of studies showing that there is a direct relationship between the amount of magnesium in the blood and how much people sleep, and how much deep sleep people have.

If you have lots of magnesium in your blood you tend to get a lot better quality sleep, a lot more deep sleep, and less REM sleep.

Studies have shown that supplementation with magnesium improves sleep.

There have even been studies that show that magnesium deficiency may contribute to insomnia.

For more on the insomnia link, see here.

Stacy noted that magnesium is one of those things where it is relatively easy to not have enough of because of how much we actually need it.

 

Absorption

Magnesium levels in our blood are generally controlled by our kidneys, and we have this reserved storage that is in our bones at any given time. (14:57)

One of the things that the kidneys can do is take magnesium from our bones to restore it into our blood system.

However, there are certain conditions where we burn through magnesium and we can't access the stored magnesium fast enough to keep blood levels at an optimum level.

This is primarily related to stress.

When we are stressed, we burn through magnesium really quickly.

It happens in both acute and chronic stress.

Chronic stress can cause magnesium deficiency through a constant turnover of magnesium.

We will come back to the conversation on absorption but are first going to touch on a few more roles of magnesium that Sarah wants to highlight.

Sarah wants listeners to understand how diverse the negative impact is of insufficient magnesium.

 

Exercise Performance & Recovery

Magnesium is also really important for sports performance and recovery. (17:18)

There have been a variety of studies that show that exercise performance is compromised with insufficient magnesium.

These studies have shown that any way that you can measure performance (ex: grip strength, jumping performance) is sensitive to magnesium.

There are studies showing that having enough magnesium is really important for muscle recovery.

Supplementation with magnesium has a fairly small effect on how muscles recover.

Our bodies cannot metabolize vitamin D without magnesium.

If we are taking a large amount of vitamin D and we aren't getting enough magnesium via our diet, that vitamin D stays inactive in our bodies.

There have been studies showing that when patients have optimum magnesium levels, they require far lower doses of vitamin D in order to bring their vitamin D levels up.

For more on magnesium and vitamin D, see here and here.

 

The Microbiome

Some of the benefits might be mitigated through the gut microbiome as well. (19:53)

There have been studies showing that a magnesium-deficient diet reduces gut microbial diversity.

Some of the most important bacterial species reduce in a magnesium-deficient diet.

The kidneys are really important for controlling the amount of magnesium in our blood.

It looks as though we can donate magnesium to our gut microbiome when we are chronically not consuming enough magnesium.

Eventually, that magnitude of the effect will diminish, but again it is another reason why getting enough magnesium into us is so important.

Stacy and Sarah briefly chatted about the importance of kidney health and how it relates to your magnesium levels.

High vegetable and fruit consumption, in addition to hydration, are the most important things we can do for our kidney health.

There have been studies in chronic kidney disease where they have done fruit and vegetable interventions, in humans, and they have shown restoration of kidney function by diet alone.

As we talk about high magnesium foods, also knowing that a lot of these are high in potassium, these are really important minerals for kidney function.

If you have kidney disease, please talk to your doctor about whether or not you need to do anything special diet-wise, knowing about these intervention studies surrounding diet modifications.

There is no reason to avoid potassium or magnesium-rich foods if you have healthy kidneys.

 

Dietary Magnesium

The recommended daily allowance for magnesium is 420 milligrams for men, and 320 milligrams for women. (26:50)

If we look at the highest magnesium content food, a 6 oz. serving of fresh tuna would contain 109 milligrams.

And if you consume a cup of cooked spinach (which is the equivalent of 10 cups raw) that would have 157 milligrams of magnesium.

The other foods that are considered magnesium powerhouses are chocolate (65 mg), banana (27 mg), avocado (58 mg), and a 1 oz. serving of almonds (77 mg).

In general, things that are dark green tend to be really high in magnesium.

Nuts and seeds generally have a good amount of magnesium, as well as fish.

You have to be aware of your magnesium content to make sure you are getting enough.

 

Deficiency

Then there is this whole other piece of chronic stress basically increasing our magnesium needs in a way that is not quantifiable. (29:24)

Quantifying stress is a very hard thing to do in studies.

However, we do know that the more stressed we are, the more magnesium we need.

The standard American diet only provides only about half of the magnesium that we actually need.

Studies estimate that approximately 3/4 of us in Western countries, in general, are magnesium deficient.

There are also racial disparities in magnesium dietary insufficiency.

There was a study published in 2018 that actually looked at dietary intakes of a wide sampling of ethnic backgrounds.

They found that on average 83.3 of the participants were not meeting the recommended level of dietary magnesium intake.

It was about 82.8% in white Americans, 84.4% in Hispanic Americans, and 90.6% of African Americans not getting enough magnesium.

There was an 'other ethnic group' that lumped everyone else together and that was 71.8% of those people were not getting enough magnesium.

This 2003 paper makes a case for lower magnesium being a mechanism behind increased hypertension and diabetes.

There have been a couple of papers that are making the case that this lower magnesium intake may be one of the contributing factors to the racial disparities seen in chronic illnesses.

This paper that was looking at different magnesium intakes in different cultural backgrounds, they tried to do statistical analysis to try to hone in on why there are racial disparities in magnesium deficiency.

They say it was due to two factors.

One factor was a socioeconomic disparity, which is the dominant factor.

And the second factor was cultural differences.

Stacy really appreciates that Sarah pulled that data, and finds the information to be fascinating.

 

Multi-Form Magnesium Supplement

What is really neat about magnesium supplements is that all of these absorbable forms are bound to another thing. (36:46)

So now instead of going through ion channels, we can use the amino acid transport channels to get into the body.

One of the things that you can do is manipulate how magnesium is absorbed by binding it to different amino acids, and by combining forms of magnesium where you are going to take advantage of multiple different transporters.

Magnesium amino acid complexes (or chelates) behave differently from magnesium salts.

The strong and stable bonds between magnesium and the amino acids keep the whole molecule intact in acidic environments.

For more on this, see here.

When complexes travel through the intestinal tract, they bypass the ion channels.

Instead, they use other transport sites called dipeptide channels.

Here, the amino acid and magnesium are carried across the intestinal membrane together.

There are a few key advantages to this.

For one, there are far more dipeptide channels than there are ion channels in the gut.

Magnesium complexes do not compete for the same ion channels used by other minerals.

Another advantage is that the stable bonds protect magnesium from unfavorable chemical reactions that might lead to the creation of unabsorbable precipitates.

Mineral amino acid complexes are actually quite common in nature and a natural way we get magnesium from our diet.

Some of this magnesium is already bound to amino acids, but even when we consume magnesium from salts, amino acids can help!

Peptides and amino acids can bind to magnesium ions and form complexes right in your body.

 

The Different Forms of Magnesium

Taurine is an amino acid. (40:38) 

When combined with magnesium, the two can have a calming effect on both mind and body.

This form is promoted for improving immune function and protecting the heart.

Magnesium Malate is the form of magnesium that is often used for patients who suffer from fatigue or fibromyalgia.

Magnesium Threonate is the newest form of magnesium and it’s still emerging in the marketplace.

It appears to absorb more easily than the others and is used for people suffering from Alzheimer’s and other neurological disorders.

Magnesium Citrate is among the most bioavailable forms of magnesium, meaning that it’s more easily absorbed in your digestive tract than other forms.

This combination includes citric acid, which has mild laxative properties.

Magnesium Glycinate (aka Magnesium Bisglycinate) is easiest for your body to use because it absorbs this form most easily.

This form is commonly recommended for people trying to correct a magnesium deficiency.

Magnesium Orotate includes orotic acid, which is a natural substance involved in your body’s construction of genetic material, including DNA.

It’s easily absorbed and doesn’t have the strong laxative effects characteristic of other forms.

Magnesium chelate has a 90% absorption rate.

And the lysine is important for growth and tissue repair, which may play a role in reducing anxiety and normalizing cortisol.

Sarah explained why certain forms of magnesium work as a laxative, and which forms of magnesium you should avoid.

The forms to avoid are Magnesium Oxide, Magnesium Sulfate aka Epsom Salts, and Magnesium Hydroxide.

 

The Perfect Supplement

So this is why BiOptimizers Breakthrough is so cool is because it has all seven of these forms in one supplement. (47:53)

Bioptimizer Magnesium Breakthrough contains Magnesium Chelate, Magnesium Citrate, Magnesium Bisglycinate, Magnesium Malate, Magnesium L-Threonate, Magnesium Taurate, and Magnesium Orotate.

Sometimes you will find magnesium supplements that will combine one or two forms, but that is it.

This allows us to maximize absorption because now we are using all of these different amino acid transporters.

And this allows us to not overwhelm one transporter, which would trigger us to not absorb our magnesium that well which leads to the laxative effect.

So when you are using all of these transporters you are providing all of these additional amino acids that have each been shown to be beneficial in different circumstances.

Stacy loves all of this information because it so clearly answers her question about why this supplement is working so well for her.

This particular magnesium doesn't cause Stacy with any digestive issues.

The fact that this particular supplement has a 90% absorption is one of the things that Stacy really wants to highlight.

As someone who has looked into a lot of supplements, she knows that this form actually works and matters.

Stacy does not like taking pills so when she does take any, she wants to make sure that they have a purpose and make a difference.

We need to take a look at the supplements we are taking and make sure that they are quality.

This doesn't just pertain to magnesium, but all of the supplements we are taking.

In America, we are eating a diet that is deficient in nutrients, and the answer for many is to simply take a supplement.

However, the actual answer should be to pull back and look at the source to investigate how we can alter our diet to get the nutrients in their food form.

And if not, can we take a supplement that is more bioavailable and is more helpful.

 

Closing Thoughts

Sarah wants to emphasize how challenging it is to get sufficient magnesium from the diet when stress is not managed. (52:53)

Our listeners know that Stacy and Sarah take nutrient density very seriously, and they both work really hard to consume a nutrient-dense diet.

Sarah has been taking magnesium supplements for eight years, and she has experimented with different forms.

However, Sarah is super excited that Bioptimizer Magnesium Breakthrough exists.

Magnesium was one of the earliest supplements she added to her diet.

She really felt a huge difference when she took it just because of this aspect of the impact that chronic stress has on her body.

So Sarah knew that magnesium was something that she needs.

Be sure to talk to a medical professional about any supplement you want to take and run it past them.

Stacy referred listeners to this podcast episode if you need to find a medical professional who you can talk to about supplements and nutrient absorption.

If you haven't talked to a medical professional in a while, you may want to revisit with them to check that your regimen is still what is best for you.

If you want to try BiOptimizers visit this site and use the code WHOLEVIEW10 for 10% off your order. 

Thanks for listeneing!

We will be back again next week! (58:31)

Welcome back to the Whole View, episode 408. (0:27)

Stacy has a feeling she is not the only one struggling to get quality sleep right now.

So she is looking forward to covering this week's show topic on insomnia.

We dove previously into sleep with episode 399 when we talked about amber glasses.

Stacy has been using her BLUblox glasses five times a week, and the nights she sleeps well coincides with those nights when she is using them.

Speaking of, let's take a moment to thank this week's sponsor, BLUblox.

We have a code for the Whole View listeners to receive 15% off their order using this link and the code THEWHOLEVIEW.

Stacy also wants to point out that the prices you see online are Australian prices.

So by the time you do the conversion if you are American using US dollars, using the code provided, it makes a significant difference in the price.

Stacy feels that the science of quality sleep makes these glasses worth the investment if you are looking to biohack your sleep cycle.

 

Listener Question

This week we have a really awesome question from Caroline that Sarah felt was a great way to talk about sleep. (2:54)

Any long-time listener is probably pretty aware that sleep is really important.

However, Caroline's question gets to one of the bigger challenges surrounding the challenges with insomnia.

Caroline says, "First, I want to let you ladies know that I really appreciated last week’s podcast.

As a long time listener, I was really glad you both chose to speak out.

I know times are crazy right now, (Thank you for all your timely Covid-19 shows too) and this may not be a current topic of interest, but I would love an episode all about insomnia.

I know you ladies have spoken a lot about the importance of sleep on the podcast but what about those of us who actually suffer from insomnia? 

It’s been worse than ever this past week. Is there help for those of us who spend hours getting to sleep only to wake up a few hours later and not be able to get back to sleep?

Thank you again for all the work you both do."

This question is so timely!

For those who are just listening to this week's podcast, Caroline is referring to this podcast episode from last week.

 

What is Insomnia?

Sarah thinks that a lot of people suffer from insomnia without recognizing it as that term. (6:22)

Insomnia is a condition that is diagnosed purely based on symptoms.

There is short-term insomnia and chronic insomnia.

Chronic insomnia is something that lasts at least three months, in which you have symptoms at least three days a week.

In this scenario you would have one of the following symptoms: difficulty falling asleep, difficulty staying asleep, waking up in the morning earlier than desired, having some kind of resistance to going to bed on an appropriate schedule, and difficulty falling asleep without a partner or caregiver.

Short-term insomnia is the same thing but lasts less than three months.

So again, showing any of those symptoms three times a week.

These symptoms at that frequency are very common.

There are predisposing factors that make you more likely to have insomnia.

For chronic insomnia, one of the biggest predisposing factors is chronic stress.

There are personality features associated with chronic insomnia.

Various conditions are linked to insomnia as a condition, such as mood and anxiety disorders.

Obstructive sleep apnea, restless leg syndrome, chronic pain conditions, and alcohol and drug abuse are all other examples of health conditions that carry insomnia as a symptom.

External factors can also cause insomnia, such as having an undesirable sleep environment.

The predisposing symptoms for short-term insomnia are pretty much the same things.

Short-term insomnia can even be a presenting thing of other underlying conditions.

 

Symptoms

Insomnia is diagnosed with the symptoms of not being able to fall asleep and not being able to stay asleep. (10:30)

Not being able to sleep long enough is also part of the diagnosis equation.

There are other symptoms that are the consequence of that inadequate sleep.

Symptoms of insomnia include not feeling well-rested when you wake up, feeling tired during the day, irritability, is a trigger for depression and anxiety, can hinder cognitive abilities, and ongoing worry about sleep.

It can end up being this endless snowball bad effect, where the stress of not sleeping, erodes sleep, which then magnifies stress.

 

How Common is Insomnia?

Insomnia is ridiculously common. (12:03)

The prevalence of both acute and chronic insomnia in multinational cohort surveys has varied from 3.9% to 22%, depending on the definition used and the age group studied.

When using the ICSD-3 diagnostic criteria the prevalence of chronic insomnia is 9% to 12% with transient symptoms of insomnia reported in 22-35% of the population.

 

Racial Disparities in Insomnia

Given the very strong between insomnia and stress, it shouldn't be a surprise that there are racial disparities in insomnia. (15:12)

Black Americans are approximately 67x more likely than whites to have insomnia.

This study published in 2016 took a look at racial disparities in sleep.

They looked at all of these other chronic illnesses that are linked with inadequate sleep.

So what they found is that the lack of sleep itself was what was linking the chronic illnesses.

You could actually predict the occurrence of chronic illnesses based on sleep.

We talked last week about the Black community being much more high risk of chronic illnesses.

You can draw the same line of systemic racism increasing stress, making it more likely for any of those predisposing factors to exist, and that being responsible for people of color, in general, being much more likely to not get enough sleep.

And not get enough sleep whether or not they technically have insomnia.

So what is really interesting is when you take insomnia out of the question, Black Americans are still more than twice as likely to not get enough total sleep compared to white Americans.

What is fascinating is that this particular study was able to show that the lack of sleep is the thing that is contributing to racial disparities in chronic illness.

There was another really fascinating paper that followed people over 10 years and looked at how insomnia changes over time.

There were able to show that for white and non-Hispanic and Black people in their cohort, the accumulation of insomnia was very tied with health conditions.

However, in Hispanics, it increased disproportionality.

The Hispanic population saw a much more dramatic increase in insomnia with age.

When you corrected for all these health conditions, it was still there.

This is an interesting racial disparity in the sense that it really points to some kind of chronic stress for being a contributor.

 

What Are the Causes?

Insomnia is a fairly unique chronic illness, in the sense that there is not a marker that we can pinpoint. (20:38)

It really is like a behavioral symptom in some ways.

However, it is a consequence of things like stress or having a travel/work schedule that is messing with your internal clock.

You can have insomnia without melatonin being diminished.

It really is some of all of these different factors.

Insomnia can be the direct result of poor sleep habits.

Examples include evening snacking, screen time too close to bedtime, and uncomfortable sleep conditions.

This condition that we give a name to is really a culmination of the effects of stress, plus behavioral or routine type contributors to how our body prepares for sleep and initiates sleep.

Stacy shared a look at how Matt's medications impact his sleep cycles.

Sarah noted that there are a lot of medications that can interfere with sleep.

Many antidepressants, medications for asthma and lower high blood pressure, cold and allergy medications, and the weight loss magic pills are also filled with stimulants.

Caffeine, nicotine, and alcohol are all very well known to disrupt sleep.

It is worth having a conversation with your healthcare provider about other options if you suspect that your medication is impacting your sleep.

There are some medical conditions where you will not be able to get around that, like ADHD medication.

Stacy shared a look at how Matt was able to modify his ADHD medication to improve his sleep quality.

It is a priority for all medical professionals to ensure their patients are sleeping.

So if your not, please let them know and work on that.

It is always ok to ask your doctor questions if something doesn't feel right to you.

 

Treating Insomnia

When it comes to treatments there are basically sleeping pills and nonpharmacologic options. (29:11)

There are basically side effects of every sleeping pill option AND they are almost all habit-forming AND they are not as effective as drug-free treatments.

Every single option has pretty awful side effects that impact the majority of people.

These are side effects that are broadly experienced and can include things like dry mouth, upset stomach, headache, dizziness, and sleepiness throughout the day.

There are many scary stories about those who have done things at night while asleep with no memory of what they had down the night before.

Stacy noted that they have experienced no symptoms with melatonin.

Matt and Stacy have found it to be a helpful tool without side effects.

Sarah referred listeners back to the melatonin show for more information on where melatonin can be really helpful.

It is really helpful in circadian rhythm dysregulation conditions.

Stacy shared examples from her personal experiences in her family where they see a ripple effect in disruptions in their sleep routines.

She also shared examples of ways they positively reduce sleep disruptions and improve sleep habits.

Sleep is very important to health, but it takes consistency.

When stress is high, you have to be all the more diligent about focusing in on those sleep habits.

You can't decide one day to fix your sleep habits and then all is fine.

These are habits you will always need to be mindful of.

 

Drug-Free Treatment Strategies

Cognitive-behavioral therapy for insomnia (CBT-I) has shown to be more effective than drugs, over and over and over again. (38:15)

There is a huge number of clinical trials showing hands down CBT-I is the most effective treatment for insomnia.

For more on this, see here and here.

CBT-I is typically done in a group therapy setting, but it can also be done one on one.

It is typically a couple of hours a week.

What is does, is that it basically looks at the causes of insomnia and what can be mitigated.

It has a variety of different components.

One component that studies have separated out and shown that this is a really important part of how CBT-I works is called sleep restriction therapy.

What this does is recognize is the homeostatic drive for sleep.

We have these chemicals that build up in our brain throughout the day that eventually make us feel really sleepy at night.

When we sleep it flushes those chemicals out.

Caffeine inhibits the ability of those chemicals to bind, which is why caffeine makes us feel more awake.

So sleep restriction therapy basically tries to reset that homeostatic drive for sleep by cutting naps and setting a late for you bedtime.

 

Additional Components of CBT-I

Another aspect of CBT-I is called stimulus control instructions.

This basically looks at sleep habits and pinpoints different things that you might be doing to overstimulate in the evening that may be inhibiting sleep.

And this includes sleep hygiene education.

So there would be a whole list of things that are customized to you that are essentially your yes and no list.

These are all habits that we discuss on this show.

One of the things that they will always instruct you to do is to sleep on a consistent schedule.

This is because of the hormone regulation that is controlling sleep.

Another part of CBT-I is relaxation training, which often involves mindfulness practice.

There is something that they teach to help people remain actively awake.

The last piece of CBT-I is biofeedback.

You might do this with some kind of tracker or observe your own levels of muscle tension.

These strategies may be incorporated into a mindfulness practice.

The idea is to be able to understand your daily patterns of markers that might be reflected in your sleep quality.

 

Exercise Interventions

One of the things that can be layered on to the CBT-I practices is exercise interventions. (43:49)

Exercise interventions have been studied as part of CBT-I and separately.

One of the old school recommendations for not exercising before bed has been debunked in the scientific literature.

They have basically found that there are certain people who exercising in the evening will disrupt their sleep.

However, as a general rule, it is not the case.

Exercising helps support sleep.

There are a bunch of studies showing that aerobic exercise, compared to resistance training, is very good for supporting sleep.

Even thirty minutes, three times a week show a modest effect, but still a measurable effect.

So this can often be part of CBT-I.

For most people, research has found that it matters more that exercise is regular and on a schedule than what time of day it is.

You can learn more about this here.

 

Mindfulness Intervention

Keep an open mind about what falls under the umbrella of the word meditation. (46:38)

Sarah loves Stacy's disdain for meditation when she meditates nightly.

With mindfulness and insomnia, there is basically two different approaches.

One is what is called mindfulness-based stress reduction.

This is a whole independent program that teaches meditation and is typically done in group classes.

There is mindfulness-based therapy for insomnia, which basically incorporates that mindfulness practice into CBT-I

What has been really interesting to see is that mindfulness all by itself is very effective.

However, it is even more effective when combined with CBT-I.

Mindfulness by itself has been shown to be just as effective if not more effective than drugs.

And there seems to be this better effect when you combine it, especially long-term.

 

Amber-Tinted Glasses

The last thing that can be layered with CBT-I, which has been shown in a couple of recent studies to be very effective, is wearing blue-blocking glasses. (49:54)

One study that was published in 2018 took 14 people with insomnia and they had them either wear blue-light blocked amber lenses or placebo lenses for two hours before bedtime for seven consecutive nights.

What they showed was that there was a marked improvement in total sleep time for the people wearing the amber glasses.

They did a variety of different measures to reach this conclusion.

Amber glasses actually made a large difference to sleep quality and total sleep time in just seven days.

Another study that was just published in February 2020 layered amber-glasses on top of CBT-I.

They had 30 patients all with chronic insomnia.

And they all went through the same CBT-I group therapy program.

Again, they were randomly assigned to either have blue-light blocked glasses or placebo.

And they again had all these different ways of measuring sleeping, including wrist actigraphy.

They also compiled scores looking at anxiety, depression, and quality of life in general.

So they were also looking at symptoms for chronic sleep deprivation.

They found that the group that had the amber glasses had a really huge improvement in how many minutes they were sleeping.

Whereas, the people who did the CBT-I alone and had the placebo glasses, actually over the period of time that they were watching these patients, actually had their sleep get worse.

The amber-tinted glasses group had a really significant improvement in their various measurements in sleep and their measurements in anxiety, depression, and the hyperarousal score.

They were basically able to show that not only sleep time was improved, that all of these other markers of sleep quality were also improved.

Between these two studies, we show that blue-blocking glasses by themselves can be very very helpful.

They are even more powerful when combined with this more comprehensive, holistic approach to addressing insomnia.

 

Closing Thoughts

Stacy knew at the top of the show that she was going to be reminded of all of the reasons why sleep hygiene is important and what she can do better.

She is really grateful that we took the time to revisit this. 

And also appreciates all the work that Sarah did to dive deeper into the research on this. 

Stacy shared more on how stress builds up in her life and eventually compounds within both her sleep quality and quantity.

She personally experiences good results when she takes magnesium before bed, as well as wearing blue-blocking glasses. 

Putting her kids to bed at a regular time is also critical. 

If you are a parent, letting the kids stay up later can contribute to poor sleep habits. 

Stacy doesn't think everything can be solved without medicine, but she does think that before jumping into that there are a lot of behavioral and lifestyle factors that we can choose to do.

 

Diet & Sleep

The other idea that Stacy and Sarah wanted to revisit is the importance of not being low-carb before bed. 

When it comes to habits to support sleep, this is one that is very important. 

There is a very strong link between diet, meal timing, and sleep quality. 

Eating a higher fiber diet and moderate fat has been shown to decrease the amount of time it takes to fall asleep. 

It also improves the quality of sleep in people. 

A slow-burning starchy carb at dinner has been shown to be very very helpful for sleep.

Low-carb diets have been shown to disrupt sleep quality.

Part of what we can do to support sleep quality is actually eating breakfast (check out this and this podcast episode for more information on why).

Eating dinner on the earlier side is also helpful. 

Ideally you want at least two hours between when you eat dinner and when you go to bed. 

However, four to five hours is optimal.

The science is really compelling on an earlier dinner and actually shifting our caloric intake towards the earlier part of the day. 

It is a really healthy eating pattern to eat a bigger breakfast and lunch and then a lighter dinner, on the early side. 

If you are someone who is not drawn to large breakfast, Stacy strongly suggests listening to this podcast for recommendations.

Stacy shared her personal experience with the benefits she experienced when she shifted her meal timing.

Listeners, don't forget if you want to check out the blue-light clocking glasses that we recommend, please visit BLUblox.

Use the code THEWHOLEVIEW for 15% off. 

Thanks for listening!

We will be back again next week. (1:08:21)

Hey listeners, welcome back to the Whole View, episode 407. (0:27)

Stacy knows that this might sound a little unusual, but this is one of the reasons that we do weekly recordings so that we can address things that are happening in the real world.

With everything that is going on right now, it didn't seem right to record the podcast as planned.

However, Stacy and Sarah wanted to instead open up a conversation with listeners.

We have been having conversations amongst ourselves, and feel passionate that it is important to talk about the racial disparities that cause things we talk about on this podcast all the time.

To dive into that a little bit deeper is important, and to discuss what all of us can do to support the Black Lives Matter movement.

If you are listening to this podcast at a later time, this is being recorded during the first week of June.

This is a week where we as a nation are examining how we treat the black community.

Stacy noted that we will not be perfect in this show, but both she and Sarah are going to give it their best effort to bring these topics to the table.

Sarah feels it is important to preface this show that they are going to do what they always do and discuss health, wellness, and safety, driven by science, and intersect that with the real-life emotional and physical experience.

And that is what we are going to do in this week's episode, and dive into how all of these things are disproportionally affecting the black community.

We are going to discuss how this has been a major contributor to this moment in history.

It is also really important to preface this entire conversation by expressing our solidarity with the black community against racism, against injustice, and against senseless violence.

 

Stacy's Reflection

Stacy wants to also note that both Sarah and Stacy are college-educated, white women who live in the suburbs. (2:36)

They cannot possibly understand the black experience.

However, we stand with the ideals of quality, safety, and wellness for all, as we talk about on this show all the time.

Stacy personally felt like her beliefs aligned with that, but she had this moment of realization when a reader called Stacy out and held her accountable.

She is so grateful for this.

At first, she felt defensive of this, but the more that she thought about it the more she realized how it was important to not just personally not be a racist but to instead be anti-racist.

The thing that really clicked for Stacy was when this reader said, "but being gluten-free and using non-toxic skincare won't matter if I am dead in the street."

Stacy was also reading another resource on the principles of the hierarchy of your psychological state of well-being.

At the very core, at the lowest rung, is safety.

If you don't feel safe, you can't get to anything else.

There is no ability in your cognitive thought process to handle more complicated mattes.

Putting those things together and realizing that gluten doesn't matter if you are worried about your safety when you go out having done nothing wrong.

Stacy didn't at first talk about this because she didn't feel like she had the right words or she didn't know where to start.

However, she wants to put it out there that as all of us start to have these conversations it is going to be hard.

And it will be uncomfortable, but doing that hard work (including putting ourselves out there right now) creates a sense of fear from backlash.

But Stacy wants to say that choosing not to speak is part of that privilege that most of us are born into.

When Stacy imagines that fear of discomfort as being something you have your whole life because of the color of your skin, that is the black experience all the time.

Stacy just can't sit by and say that is ok.

We can do something.

We can help people try to understand, and that is our goal today.

Stacy appreciates your patience with us as we tackle something new but very important.

 

Sarah's Reflection

For Sarah, her experience has been similar in the sense of starting with a sense of discomfort around finding the right words to express herself. (6:44)

Trying to find the right way to express solidarity with the black community.

The feelings of nervousness and awkwardness have been compounded with being an immigrant.

This part of the immigration experience where Sarah feels she is not supposed to criticize her adopted home.

However, she has come around to really viewing the data that we will share in this episode, as something more important.

It is about building awareness of a systemic problem that needs to be fixed so that our country can be better for everyone in it.

 

The Start of a Political Uprising

We are talking about centuries of systemic racism. (8:19)

And now, we are talking about a situation where the global pandemic has really drawn the curtain back and revealed the extent of how systemic racism is impacting people of color.

How covid has so disproportionally affected those communities and how the economic depression that has been caused by covid has centralized within those communities.

It has created distinct energy within this climate.

In fairly rapid succession, we had Amy Cooper in Central Park who called the police on Christian Cooper.

We had the murder of Ahmaud Arbery.

Then we had the Breonna Taylor shooting, where she was killed by police in her home.

And then most recently we had the homicide of George Floyd by a police officer while three other officers watched.

This is not the first tragic example of police violence against a person of color.

However, it is the spark on this that has lit this powder keg that is the frustration of all of these events coming together.

It is this unique period of time where the depth of systemic racism is so visible in the covid-19 data and then ignited by these recent examples of racism.

For a deeper look at this, please refer to this link.

What we are going to do is get into the actual science and the data behind these events that have led to the current events.

There are 140 different cities and towns, at least, in the country where there are protests supporting the Black Lives Matter movement.

All of those of us who are in the periphery need to be able to support this community.

Stacy reflected a bit more on Sarah's perspective as an American immigrant.

She feels passionate that immigrants and people of color make America what it is today.

Stacy hopes that this information they are going to share can help highlight how things are pulling us apart instead of pulling us together.

Here is an opportunity to change.

There is nothing we can do about the past.

This is an opportunity to take in the information and ask, now that I know better, how can I do better.

 

Racial Disparities in Covid-19

What has really been problematic is that there isn't comprehensive data on race and ethnicity in the covid-19 data. (15:18)

There are isolated places that are keeping data and there are a variety of organizations that are trying to gather and analyze that data.

The CDC does have an entire page dedicated to the racial disparities in covid-19.

There are only looking at data from about 580 patients.

The APM Research Lab has found that Black Americans have mortality rates that are more than twice as high as other races.

There are more covid cases amongst the African American community because they are much more likely to work in the service industry and much more likely to not have paid sick leave.

And there is a higher mortality rate because of pre-existing racial disparities in both chronic illness and access to health care.

So what is happening right now, looking at the data, is that the disparities are different in different regions.

On average, the disparity is that African Americans are dying at a little over twice the rate as white Americans.

However, there are places where the disparity is closer to five times higher (ex, Louisiana).

In Michigan, it is 10 times higher.

We can see a greater disparity in different regions of the country where this data is being collected, we can see a greater disparity.

And In North Carolina, the difference is 50%, which is still not ok.

What this is showing us is this collection of different factors that are contributing to this.

For example, nearly a quarter of employed African American workers work in the service industry, compared to only 16% of non-Hispanic whites.

They are far more likely to be considered an essential employee.

For example, even though Black Americans only make up 12% of all employed workers, they make up 30% of practical and licensed vocational nurses.

They are caring for people with covid-19, so they are high-risk by the sheer nature of the work they are doing.

Here are three articles to refer to for more information: one, two, and three.

 

Racial Disparities in Chronic Disease

We are compounding that onto a pre-existing problem where there are huge racial disparities in chronic disease. (19:19)

There are a variety of reasons for this.

Sarah has seen this referred to as being a “complex disparity ecosystem”. 

This basically means that there are a lot of factors that are all contributors to this disparity.

It includes things like lower levels of economic resources, lower levels of access to health care, delays in treatment, lower health literacy rates.

This also includes environmental factors.

Black Americans are more likely to have contaminated water or being exposed to environmental pollutants, and less likely to have access to a grocery store that has fresh produce.

All of these are contributing to a much higher prevalence of all of the risk factors for a severe case of covid-19.

African Americans have a 70% higher rate of diabetes than white Americans.

There are higher rates of cardiovascular disease, especially stroke.

And there is nearly double the rate of hypertension, high blood pressure, which is one of the strongest risk factors for a severe course of covid-19.

There are also higher rates of cancer.

For example, the cancer rate in African Americans is 35% higher than for whites.

 

Digging Deeper into the Statistics

This is one of the big challenges for the Black community.

It is not just the increased exposure to covid, it is not just that they make up a larger proportion of the people who are getting it.

However, it is that they are far more likely to have these pre-existing conditions that make them more likely to have a severe course of the disease.

And on top of all that, compared to white Americans, African Americans are about twice as likely to uninsured.

If you look at various surveys, Black Americans are much more likely to report not being able to see a doctor because of the cost.

They are far less likely to have employer-based health insurance.

So there is increased exposure because of economics.

Then there is the more likely to have a pre-existing condition that increases the likelihood of a severe course of the disease.

And then there is the less likely to see a doctor get the appropriate levels of healthcare.

All of that together has led to these disparities as to how covid-19 is impacting the Black community.

 

Economic Disparities

The other thing that we have seen is an economic depression. (22:47)

We haven't seen rates of unemployment like this ever, and this has disproportionally impacted people of color.

A Pew Research Center survey shows that Latinx and Black households are being hit with more job losses than White ones.

Sixty-six percent of Latinx households and 44 percent of Black households have had a job or wage loss due to the pandemic, compared to 38 percent of White households.

There’s also a wealth gap, so these are people who are much less likely to have savings, own a home, etc.

According to our Racial Wealth Divide report, the median Black family, with just over $3,500, owns just 2 percent of the wealth of the nearly $147,000 the median White family owns.

One of the things that Stacy has come around to understand more is the different ways to represent economic disparities.

When we say something like a Black family has less wealth than a white family, let Stacy give some tangible numbers in an article she read based on where she lives.

The average median household income for a black family is $84,000.

Matt and Stacy live in one of the most expensive costs of living areas in the country.

However, if you look at the white median income, it is $118,000.

So it is not just the difference between whether someone is college-educated or not, this goes back so long into things that have built systemic racism into our country.

Oftentimes we don't even realize our culture is making racial assumptions for.

Stacy feels that this goes into a lot of bias in the healthcare world as well.

Because it is more likely that these conditions exist in Black Americans, it is also assumed, or bias is given, and lack of care.

You are seeing not just an impact from the fact that they have an increased risk of health conditions.

But you are also seeing they are not getting proper medical care because of bias and assumptions that are being made by healthcare professionals.

 

We Can Do Better

We, as white people, are never going to understand the Black experience. (27:30)

But we can try to put ourselves in a situation where we can know that things are happening are not ok.

We can use our voice to speak on behalf of those that are being marginalized or being oppressed.

Stacy tries to do this for all communities who affect health, and realizing now is not something she has been doing for people of color who find themselves in these situations regularly.

We as a country can do better, and there is so much that we need to learn to do that.

 

Where to Start

One resource, a podcast episode that Sarah listened to a few days ago, that she would like to point listeners to is Hidden Brain, The People Like Us. (28:21)

This podcast episode broke down how covid-19 disproportionally impacts people of color and then looked at ways healthcare could be improved to address these inequalities.

One of the things we want to do in this episode beyond bringing the data into this conversation is to help our listeners with at least some starting places of resources that both Stacy and Sarah have found helpful.

Stacy and Sarah are being very intentional in trying to reflect and learn and educate themselves in this time.

The more that we listen, the more that we learn, the more that we read, the more we support the communities that need us to understand and speak on behalf of.

One of the things that Stacy is doing is having an activity to teach her children about racism, privilege, and how we as privileged white people can use our voice on behalf of those who are not as unfortunate.

There are videos she has been showing them, and then asking questions afterward.

They have also been watching a movie at night to learn about Black culture, racism, or civil rights every single night as well.

Stacy feels that her kids do not need to consume the negativity of the news, but they do need to be aware of what is happening in the world.

These children will inherit this earth and can continue to make changes.

Learning not just why it is important to vote, but how to also participate in local elections and that it is our responsibility to do so.

Stacy is realizing how grateful she is for quarantine because of the opportunity we have to control the narrative on what our kids are seeing and hearing.

We can shape how kids reflect and learn about this.

 

Statistics on Police Brutality

This is one of the problems is that there is no comprehensive federal database on violent incidents with police. (34:44)

After Michael Brown's death in Ferguson, Missouri in 2014, there were a variety of independent third parties that took up the mantle of tracking this data.

There are now a few that do this called Fatal Encounters, Mapping Police Violence, and the Washington Post's Fatal Force Project.

They collect data in different ways, tracking slightly different, and also counting different things.

Over the last six years, they have revealed some statistical trends.

On average there has not been much change in the past six years in terms of police violence and lethal force being used.

There is some shift where it is decreasing in some of the big cities that have had initiatives to not use lethal force and have really worked on really changing the police culture.

In big cities, the rate of people being killed by police has gone down, but it has gone up in suburban and rural communities.

On average, it is about the same.

Last year, there were a little over 1,000 people killed by police as found by Mapping Police Violence.

Black people are about 2.5x more likely to be killed.

They are disproportionally represented in that group.

In addition, they are more likely to be unarmed than a white person when they are killed.

There are people who are looking at this data trying to tease out and understand ways to address it.

Some ways have been shown to be completely ineffective.

For instance, body cams have been shown to not impact the police brutality rates at all.

Bias training, on the whole, has been shown to be relatively inaffective as well, which may have to do with the variety in which bias training is conducted.

There was a study published last fall in the Proceedings of the National Academy of Sciences that estimated that a black man in America had approximately one in one-thousand chance in being killed by police in his lifetime. 

The chance is of course much higher in that twenty-five to thirty-five age range.

That statistic is really eye-opening.

Sarah pointed out that the mortality rate is not much different from covid-19.

For more information on this topic, see here, here and here.

Stacy noted that whatever bias or assumption you have on these statistics, those have already been corrected for.

 

Ways to Support the Black Lives Matter Movement

This is what we mean by learn and seek out this information for yourself. (39:44)

Knowledge is power.

The more knowledgeable we become on this, the more we can have those conversations that say something contrary to support Black Lives Matter.

If you have the education and information you can help do the hard work.

Black lives matter, and these conversations need in order to protect those lives that we have talked about.

We can stand up, and get comfortable being uncomfortable speaking up for the marginalized group and people of color, and Black Americans specifically.

One of the things that Sarah has been learning about in particular is learning about the language used to describe the Black Lives Matter protests right now. 

This has also led Sarah to examine her own language and unconscious bias.

A Black Lives Matter protest is much more likely to have the words violent used to describe it, or to be called a riot. 

Examine the language being used.

The current protests are standing up to injustice, and they are very important.

They are demanding change that should have already happened. 

The other thing that Stacy wants to say is that this is not to say that there are not numerous people across all walks of life who are not wonderful allies. 

One of the things that we can do is be an ally in the future.

The more we acknowledge and apologize for what is happening and openly come out and be an ally going forward, the more we lend to that positive protest.

This is our way of being able to support change.

Another thing that Stacy has been trying to do is share content from Black voices to help amplify them.

The example she brought up was following Charlotte on Instagram.

Add people to your network and community - seek them out and engage. 

When we only see our own type of people (whether it is gender, age, the color of skin, etc.) we are all better served when we have diversity in our life. 

Being able to find Black voices who are talking about this, or going forward you want to make sure you are supporting the work and shops of Black people, this will help their ability to get past those economic disparities. 

There are a lot of people outside of our communities who will bring joy and depth and knowledge and interest and comedy to our lives. 

Stacy knows she is better when she is bringing diversity into her life. 

 

Additional Ideas

Sarah read an article in the Independent that really spoke to her in terms of giving her an action list for ways that she can support the Black community at this time.

Here was an expert Sarah wanted to share from “Not Racist” to Antiracist, article by Michael Crawford:

“Make a commitment to fighting for racial equity and move to action by challenging racist words and actions from people you know, donating money to civil rights organizations like Color of Change, Minnesota Freedom Fund Inc. and Fair Fight; signing petitions by groups like MoveOn; giving your children books featuring diverse characters; posting antiracist articles on Facebook; writing letters to the editor of your local newspaper urging justice; calling your city council members and demanding better oversight of the police department; calling the offices of progressive candidates to volunteer; and making sure you're registered to vote.”

Danielle Coke is another Instagram account Stacy noted.

This YouTube video is another great resource to reference.

And here is a list of books to reference for additional education surrounding this discussion.

Laslty, here is a list of organizations you can volunteer for or donate to. 

Closing Thoughts

If you are feeling some kind of way right now, like Stacy, and are realizing that you want to do more and that you are struggling with having not done those things previously, remember what we always say. (49:33) 

Looking behind with shame and guilt does not help you move forward.

However, being of service, making a difference, and focusing on what you can do going forward is going to help effect change for this community. 

Wallowing in guilt or shame or feeling confused and not doing anything will not help to bring change.

We are putting all these references in the show notes for you and we hope that it serves as an opportunity for you to continue the discussion. 

Stacy has heard and read from Black voices over and over again that the best we can do is apologize for what has happened in the past. 

It is not ok. 

We can acknowledge that we are an ally and want to affect change going forward. 

Then we can listen and learn so we can do just that. 

These are Stacy's principles going forward. 

Listeners, Stacy hopes that this is helpful for you to go forward. 

Take a deep breath and think about what can you do. 

There are little things that we can all do, that will lead to big change.

Sarah wants to again acknowledge that both Stacy and Sarah are trying to use their platform to acknowledge where they know they can do better. 

They are not trying to just express their solidarity with the Black community, but also bring awareness to the social injustices and racial disparities that have built this moment.

We encourage our listeners, please remember that this isn't about being perfect, it is about taking those first steps down the road. 

Stacy and Sarah are hoping to use their platforms to build awareness so that they can encourage all of our listeners and the people in your lives to advocate for equality. 

That is what this is about. 

Know better, do better. 

We can apply that to every facet of our life. 

We hope that this can help you find a way to do that in your own life. 

Thank you for your patience as we worked through this, we hope that this inspires you to do your best. 

Huge thank you for listening and we will be back again next week! (54:05)

Welcome to the Whole View, episode 406. (0:27)

Stacy is so jazzed about this show.

Sarah and Stacy have been talking about it and preparing for it since this show was called the Whole View.

Stacy personally is jazz hands about educating a dear loved one on why filtering water is a good idea.

To kick things off, Stacy is going to share a little story from their trip last summer.

While on the road, Stacy saw what she thought was a fresh spring and encouraged the boys to fill their water bottles.

Stacy basically gave her kids dysentery.

This is Stacy's story about why water filtration is important.

Stacy ran a poll last week and only 21% were on team Stacy and thought it was a harmless stream.

What Stacy thinks is fascinating is that it is not just runoff water that is not good for you.

Oftentimes our municipal water is not meeting the standards.

It is important to understand that, and beyond that, it is important to know what you should be aware of when it comes to water.

Sarah has so much science.

 

This Week's Sponsor

But first, Stacy wants to take a moment to thank this week's sponsor, AquaTru. (4:27)

Their reverse osmosis system has been sitting on Stacy's counter for a month now, but there is one person in the house who is not convinced that it is a good idea.

Stacy first loved this system because of the information that Sarah shared, but second loved that it is endorsed by Erin Brockovich.

Sarah has had an AquaTru for over four years, and what she loves about them is how different their technology is.

It’s the only counter-top reverse osmosis system —  in a category all its own.

It is not bottled water, not a fridge filter pitcher like Brita or Pur, and is not an under the counter or whole house system needing installation.

AquaTru is the only purifier to remove the ‘forever chemicals’ known as PFOAs and at the center of the movie Dark Waters.

Most reverse osmosis (RO) systems waste four gallons of water for every one gallon they produce.

AquaTru uses a patented water conservation technology that is about 12x more efficient than professionally installed under-the-sink RO systems.

RO is the best way to filter water.

They are giving our podcast listeners $150 off their AquaTru purchase.

 

Listener Question

Jessica says, "new podcast name! Love it! (10:44)

Thanks for continuing to podcast.

Crazy times in the world and you and Sarah’s voice is so utterly comforting.

Anyway, podcast question! Water intake.

I don’t think you guys have done a, 'how much water do we need', podcast episode.

A deep dive into this would be really helpful.

The standard advice seems to be either one amount for men and one amount for women, or, half your body weight in oz. 

Which is correct? Or is there another answer? What about just drinking when thirsty?

I also have wondered, how much water did our ancestors drink?

I assume the water was maybe harder to come by back then so maybe they were drinking less?

This is the assumption I’ve always made and has led to me drinking intuitively, which has more than likely led to me being chronically dehydrated :)

I feel like with all the conflicting info, it would be great to hear the science. 

By the way Stacy, as a side note, after about a year I finished catching up on the podcast.

I know you are sorry, I am not ;).

When searching for a water-related episode, I and came upon an episode called Thirsty Brain.

I was like, for sure this has to be about how water intake affects our brain. Nope. Lol.

But that was a great episode about Matt’s podcast, called Thirsty Brain :) love you guys.  

Thanks again for all you do!"

 

How Much

Let's start with how much water. (14:15)

This has been a debated topic within the medical and scientific community.

The classic 8, 8 oz. glasses a day is actually not enough.

However, this original recommendation was based on how much water we lose over the course of a day and was not based on how much we actually need.

The question now is, how much water makes us healthy?

The latest research suggests that men should consume about 13 cups (104 ounces, or 3 liters) of fluid per day, and women should consume about 9 cups (74 ounces, or 2.2 liters).

The reason it is different between men and women is basically a reflection of body size and BMR.

This amount is not pure water intake.

It includes the water that we get from all sources, factoring in all beverages, and the water we get from food.

From there, our needs would shift up if we are highly active, if it is hot out, certain dietary needs, etc.

Sarah thought the hunter-gather aspect of Jessica's question was very interesting.

So she spent some time trying to track that information down.

However, she couldn't find a good estimate.

That being said, Sarah did find a really interesting paper looking at human evolution.

We only find remains of early humans near water sources, and so we know that early humans tended to congregate near water.

Communities were and still are centered around ways of getting water.

There has been some anthropological research showing that this might have been very important in human evolution.

Our brains use a lot of energy, which creates a lot of metabolic byproducts, which have to be filtered by the liver and kidneys, which increases our need for water to make urine to effectively detoxify.

So our ability to grow these awesome brains would have relied on proper hydration, in addition to high-quality food.

We can't say how many ounces of water hunter-gathers consumed on average, but we can say that it was very likely that they drank a lot of water and likely drank intuitively.

 

Intuitive Hydration

Studies looking at hydration have been really interesting. (19:56)

Overall they show that humans in general as a species are pretty good at drinking intuitively.

Studies have come at this from a bunch of different ways, where they have looked at what happens when you have given people free access to water and you measure how much water they drink?

In general, people are really good at staying hydrated, provided water is around.

On average people will drink about two liters of water per day, just driven by thirst.

Which is probably the right amount of water, considering other beverages and water from food sources.

There have been studies showing that this is true in different populations.

Athletes' performance is best when they just follow their thirst for drinking.

'Follow your thirst' does seem to work best for performance.

However, there are a variety of things that have been shown to reduce our thirst relative to our water needs.

Which basically means you are not thirsty enough for how much water you need.

These people need to focus more on hydration and drink with intention, versus just following thirst.

There are a bunch of drugs that are used for cardiovascular disease that impact thirst.

Elderly people also tend to end up dehydrated and are do not have strong enough thirst signals for their water needs.

Menopause causes this is women and high estrogen in general.

Swimming can actually reduce our thirst.

Exercising in the heat can also impact our thirst awareness.

When Sarah looks at this list this means that there are so many exceptions that overall it is a pretty good idea to at least be mindful of hydration.

There are bad things that happen when we don't drink enough water on a regular basis.

Stacy shared her experience with her lack of thirst and dehydration.

 

What Happens if you Don't Drink Enough?

What is interesting is that acute dehydration will make you feel extremely ill, but chronic-mild dehydration kind of creeps up on you in terms of the symptoms. (27:03)

Like so many chronic things, the human body is remarkable in terms of how it adapts to not feeling good.

You can end up not noticing for a while.

There has been a huge variety of studies showing that even mild dehydration puts a strain on the kidneys, which can cause high blood pressure, reduced energy, fatigue, constipation, dry skin, and more.

What is interesting to Sarah is the number of cognitive issues associated with mild dehydration.

It can cause frequent headaches, impair mood, increase anxiety, reduce concentration, impair memory, reduce cognitive performance and it also has a pretty measurable impact on exercise performance.

The thing that nerds Sarah out is that our microbiome is sensitive to our hydration status.

This is because we have this whole collection of bacterial species that actually live in or attached to the mucus barrier.

Sarah explained the mucus layer in greater detail.

This is why inadequate hydration can cause constipation.

What happens when we are not drinking enough, that the mucus layer gets harder and less viscus.

This makes it a less hospitable environment for really important probiotic bacteria.

It also makes it a more hospitable environment for pathogens.

This has been confirmed in some really interesting animal studies.

Acute hydration would include feeling dizzy, rapid heartbeat, rapid breathing, extreme fatigue and sleepiness, confusion, and irritability and it can cause things like fainting.

You would see severe dehydration in having UTIs, kidney infections, and kidney stones.

 

Alkaline Water

Sarah feels that alkaline water is one of the biggest scams in the health community. (34:48)

Alkaline water has an alkaline pH.

Commercial alkaline water typically has a pH of 8.8 or higher with high dissolved mineral content, typically calcium, potassium, and magnesium.

Alkaline water is known to neutralize stomach acid, which on the surface may sound like an awesome thing for anyone who suffers from acid reflux.

However, because the acidity of chyme is a key signal to the pancreas to secrete digestive enzymes and to the gallbladder to secrete bile, neutralizing stomach acid can hinder digestion in a big way!

So anything that neutralizes stomach acid actually hinders digestion, which can cause a whole pile of problems.

The other thing is the impact on the gut microbiome.

If you are neutralizing those acidic molecules with alkaline water, you are actually suppressing the growth of really key probiotic species and increasing the growth of potential pathogens.

Studies confirm that drinking alkaline water causes an undesirable shift in gut microbiome composition.

One study in mice showed that drinking alkaline water for 4 weeks caused a huge decrease in probiotic Clostridiumspecies with smaller decreases in Bifidobacterium and Lactobacillus, and a rise in Prevotella.

A randomized, controlled cross-over intervention in adult men compared the impact on the gut microbiome of consuming 2 liters per day of alkaline water (pH 9) compared to neutral water (pH 7) for two weeks.

While the alkaline water had no effect on overall species diversity or richness, the men benefited from higher hydration levels from neutral pH water, which significantly increased richness by 15% when comparing pre- and post-intervention samples.

The benefits of alkaline water that have been measured are probably completed attributed to the fact that many of us are not getting enough calcium or potassium.

So we can benefit from getting these in their elemental form dissolved into water.

 

Spring Water

Spring/mineral waters can be slightly acidic. (38:50)

Most natural sources of mineral water in the world are acidic, not alkaline.

Acidic water, because our gut bacteria love living in an acidic environment, has been shown to improve the gut microbiome to reduce a diabetes-associated microbiome.

It also improves the growth of probiotic species, at least in animal studies.

So it is much more important to look for mineral water or to add mineral drops to your water.

Sarah adds mineral drops to her water before she drinks it.

There is definitely benefit to mineral content, but that alkaline water is not doing your gut any favors.

Stacy has experienced this with the digestive piece before.

 

Tap Water

The water that comes out of our taps originates from lakes, rivers, and or groundwater. (41:37)

Then it goes under extensive filtration and then disinfection.

Disinfection uses one of two chemicals - chlorine or chloramine.

It is important for safety to go through this disinfection process.

When you think about the community of microbes that live in our gut and think about a disinfectant being added to our water, you think about the impact this has on your gut bacteria.

Studies have shown that they absolutely do.

The chlorine/chloramine that is added to drinking water not only decreases the growth of really important probiotic species, but it actually allows the growth of multi-resistant pathogens.

There have been a variety of studies showing that feeding animals chlorinated tap water actually increases the number of bacteria that are growing in their digestive tract.

These bacteria strains are associated with hospital inquired infections.

Studies have shown that there is a potential link between chlorinated drinking water and the incidence of colorectal cancer.

To understand whether this effect is mediated via the microbiome, a study compared the effect of drinking chlorinated water versus tap water in transgenic mice susceptible to colon cancer.

Chlorinated water causes a substantial increase in tumor development in the colon, associated with reduced levels of Clostridium perfringens, a species believed to have anti-tumor effects.

Interestingly, mice drinking tap water tended instead to develop tumors in the small intestine.

Removing the chlorine/chloramine after the water comes out of our tap before we drink it, is a really good idea for our gut microbiome.

 

More on Fluoride

There are also a lot of municipalities in North America that add fluoride to tap water, with the rationale of reducing tooth decay.

In episode 34 Stacy and Sarah discussed fluoride, and the science has not changed.

The science showing that fluoride is beneficial for dental health when it makes prolonged contact with tooth surfaces is really strong.

However, the science showing any benefit to oral health from drinking fluoridated water is basically nonexistent.

There have been some really large studies showing that fluoridation does not increase the risk of anything of the things that have been rumored to be true.

However, there have been a few studies showing a correlation between fluoride levels and lower IQ in children.

This has opened up the question if fluoride can open up the blood-brain barrier, and potentially negatively impact early brain development.

But this is still a big open question where more science is needed.

We do know that fluoride seems to accumulate in the pineal gland as we age. 

The pineal gland is located in our brain and secretes melatonin to help us sleep.

We don't know if this is what is behind sleep disturbances, but its something to point to that shows how fluoride crosses the blood-brain barrier.

Overall, more research is needed to clarify if there are actual risks with fluoridation.

We do know that the benefits are not measurable.

In a study of broiler chickens, high levels of dietary fluorine resulted in lower microbial diversity, significantly lower levels of Lactobacillus and Bifidobacterium species.

The study also showed significantly higher levels of Escherichia coli and Enterococcus compared to the control group.

In a mouse study, 12 weeks of exposure to fluoride altered the oral microbial community by selectively depleting probiotic Parabacteroides distasonis, Bacteroides uniformis, and an unclassified Bacteroides species.

However, if we are using fluoridated toothpaste, drinking non-fluoridated water appears to pose no risk to oral health.

There is a strong case for filtering water for removing chlorine, chloramine, and fluoride.

Stacy isn't yet adding minerals to her water but is going to give it a try and is excited.

You can get those minerals on the AquaTru.

 

Pesticide Residues in Tap Water

While an inexpensive activated carbon (charcoal) water filter can remove chlorine, chloramine, and fluoride from tap water.

Unfortunately, these common water filtration systems can’t remove pesticide residues.

Heavy metals are a well-known problem. (53:57)

If you have lead in your tap water there is so much information out there that you would understand the importance of not showering in this level of contaminated water.

We talked about how glyphosate impacts the gut microbiome in last week’s episode (405).

Glyphosate exposure increases the ratio of pathogenic bacteria to probiotic microbes, reducing Bifidobacteria, Lactobacillus, and Enterococcus while increasing Salmonella and Clostridium.

There is no dose-response.

Any glyphosate exposure is problematic.

In the US, glyphosate has been used for over 40 years and is used mostly to kill weeds that interfere with agricultural crops (typically corn, soy, and canola).

We know that runoff from industrial agriculture is a major source of contaminants in streams, rivers, and lakes, which is where we get our tap water from.

Third-party testing was done on 85 tap water samples by Moms Across America and Sustainable Pulse.

The results showed that 35 of the samples had glyphosate levels up to 0.3 ppb.

On average, 87% of Americans have measurable glyphosate residues inside their bodies.

For more on how glyphosate impacts our health, see this study.

We know we are getting exposed to glyphosate and it looks as though tap water may be a key root of exposure.

This is the most compelling reason for filtering water using reverse osmosis.

 

Closing Thoughts

Sarah is so grateful for AquaTru for giving our listeners such a steep discount on their filtration systems.

Last week we talked about foundational principles, and Sarah considers filtering water as a foundational principle.

Reverse osmosis is the next level thing.

However, depending on where you live, if you live in an area where your water is likely to be contaminated, that shifts that priority.

Stacy and Sarah are on a mission to educate, they never want to make listeners feel burdened with one more thing to worry about.

Instead, you make informed decisions from education and we are here to educate you.

Stacy doesn't want someone to spend a lot of money on a water filtration system without looking fully into the research and which system to buy.

It is fascinating to Stacy that this is beyond heavy metal contamination, it is beyond glyphosate, that three out of four homes have contaminants beyond the prescribed measures in America.

This was a fact that once she heard it, Stacy couldn't un-hear it.

Is this a burden that you should be stressed out about - absolutely not.

This is to educate you so that you can plan for if you want to make changes.

A great place to start is to look at what is in your water.

Use this site as a reference point.

For you to be aware and to start looking at that is all that we are trying to provide.

If you are concerned about your water quality and do feel like a good water filtration system is a good investment to make, AquaTru has given our listeners $150 off.

Simple visit this site to get that discount.

Sarah wanted to thank AquaTru again for sponsoring this week's episode and for being such a good sponsor to provide listeners with such an amazing discount.

Thank you listeners for being a part of the show.

We love hearing from you and your feedback.

Jessica, thank you for your nice complement.

If you have questions that you want us to follow up on or different topics that you want to hear about, we welcome you to email us using the contact forms on our blogs.

Please engage with us on social media.

If you learned something from listening to one of our shows, the best thing you can do is share about it.

Please also leave a review in whatever platform you are listening to.

Thank you so much, listeners!

We will be back next week. (1:05:22)

Welcome back to episode 405 of the Whole View. (0:27)

Today Stacy and Sarah are talking about a super interesting topic submitted a listener.

Which, if you didn't know this already, we love it when you email us.

Sarah shared some behind the scenes information on where listener questions come from.

There are Stacy's requests, listener questions, and the really challenging listener questions.

The question in discussion in this episode is one of those really hard ones that has been in the queue for a long time.

Sarah was able to pull together the information for this show because she actually did a lot of research on this topic for her gut microbiome book.

And of course, Sarah did extra research to address the many facets of this challenging question.

Stacy is excited about this science rich show.

 

Listener Question

Is the EWG's dirty dozen list based on strong science? (3:37)

My husband listened to two episodes of the Skeptoid podcast on organic vs. conventional farming.

Mr. Dunning said that we are being duped into paying extra for organic produce.

It is sprayed with larger amounts of pesticides than those used in conventional farming and the organic pesticides have been shown to cause disease.

My husband believes Mr. Dunning because he provides references and appears to be liberal and non-biased in other podcasts.  

I have been purchasing organic produce according to the Environmental Working Group's dirty dozen list.

It says on the Activist Facts website that "There’s really only one thing you need to know about the Environmental Working Group when it comes to its studies of toxins: 79 percent of members of the Society of Toxicology (scientists who know a little something about toxins) who rated the group say that the Environmental Working Group overstates the health risk of chemicals.

I am walking around with holes in my shirts, and I haven't gotten the air conditioning fixed in my car, so that I can afford organic food.

Am I wasting my money?

I feel like I cannot trust anyone but you.

 

Preface

Stacy wanted to refer listeners to listen back to previous episodes for information on how both Stacy and Sarah have evolved the way they purchase and prioritize their own foods within their budget. (5:06)

Neither Stacy nor Sarah buys everything organically.

Nothing that Stacy and Sarah are going to discuss in this episode is intended to be a judgment on you or your family or what you did in the past or what you are doing now.

This is all education so that you can be empowered to make the choices that are best for your family at the correct time for you.

Where Stacy's family is today, ten years later, is a lot different than where they were ten years ago.

The goal of this episode is to help you so that you can walk away and ask questions.

There is a larger philosophy that each family needs to adapt to what works best for them.

No one is perfect.

If you are starting in your journey, you don't need to forego the necessities to have organic food.

There is a way to prioritize your budget in a way that is consistent with what your family believes in.

Healthy living choices are so personal.

 

Foundational Choices & Next Level Choices

Sarah wanted to emphasize that there are foundational health principles.

Nutrient density diet, eating a lot of fruits and vegetables, getting enough sleep, managing stress, and living an active lifestyle.

Then Sarah thinks of the next level steps like adding some biohacks, supplements, purchasing grass-fed beef, and organic fruits and vegetables.

We need to first make sure that we are focusing on the foundational principles and adding in the next level choice if and when it makes sense.

Eating organic is beyond the basic principles, but is overall a better choice.

The EWG's overall approach is in many ways more rigorous than the American regulatory agencies.

The EWG tends to align with the European Union, Health Canada, and these other regions of the world where the criterion for approving a chemical or pesticide is firmer.

In America, the thought process is that chemicals are assumed fine unless proven bad.

In Europe, a chemical is not ok until proven safe.

 

Conventional Evaluation of Pesticide Safety

The FDA's safety assessment for chemicals in foods have a variety of criteria. (13:11)

They look at acute chronic and subchronic toxicity, carcinogenicity, genotoxicity, reproductive and developmental toxicity, neurotoxicity, and immunotoxicity.

Pesticides also go through additional impact evaluation on the environment and ecology.

The vast majority of the studies evaluating the effects of pesticides show problems to human health only with occupational exposure, rather than the much lower exposure the majority of us would have simply by eating produce from crops treated with these chemicals.

However, there are some challenges with this.

We can see high exposure in rodents causing all kinds of problems.

The assumption is that acute exposure is not the same as low dose chronic exposure.

 

Where the Standards Differ

One of the challenges that we have in evaluating pesticides is that our exposure is already so vast.

There are no humans that don't already have multiple points of exposure to pesticides.

There are studies that are linking the chronic low dose exposure to pesticide residues that have correlated pesticide exposure in the food supply with a number of health issues.

In the United States, there are 72 pesticides that are routinely used that are completely banned or are in the process of being completely phased out in Europe.

Of the pesticides used in USA agriculture in 2016, 322 million pounds were of pesticides banned in the EU.

Twenty-six million pounds were of pesticides banned in Brazil and 40 million pounds were of pesticides banned in China.

Pesticides banned in the EU account for more than a quarter of all agricultural pesticide use in the USA.

It is important to understand that the European Union is looking at the same science as the EPA.

And they are making a different judgment based on the strength of the data.

We have a challenge that our metric is, 'is it toxic' and 'does it cause cancer'.

WHO Guidelines for Safety of Chemicals in Food are much more thorough, and add to the above.

They include general system toxicity, allergy and hypersensitivity, and GI Tract Considerations (includes microbiome).

 

Pesticides and the Microbiome (Sarah’s Biggest Concern)

Microbial diversity is generally considered to be the most important measurable criteria for a healthy microbiome. (24:31)

The more different species you have, they tend to keep each other in balance.

The bacteria basically control the growth of each other.

We are also looking for the growth of these really important probiotic strains.

In addition, we are looking for completely absent levels of pathogens.

We are also looking at the balance between the two main phylum of bacteria in the gut.

It is important to understand that rodent studies are actually really good studies for understanding the gut microbiome.

We would want to eventually be able to do a similar study in humans.

But what Sarah wants to emphasize is that these rodent studies are a really good model for understanding what is happening in humans.

Let’s go through some of the most commonly-used pesticides in agriculture for food crops.

Permethrin is a broad-spectrum chemical often used as an insecticide for cotton, corn, alfalfa, and wheat crops—unfortunately, it’s also lethal to bees.

It’s also used to treat lice, ticks, and scabies. 

For more on this, visit this link here.

PEM has higher antibacterial activity against some beneficial bacteria, (including Lactobacillus paracasei and Bifidobacterium).

Than against pathogens (such as Staphylococcus aureus and Escherichia coli, which only respond to higher concentrations of PEM).

Carbendazim (CBZ) is a broad-spectrum benzimidazole fungicide, widely used in agriculture.

In mice, 28 days of exposure to CBZ resulted in gut dysbiosis.

It suppresses the growth of some of the most important probiotic families while increasing the growth of some problematic families of bacteria.

And it decreases bacterial diversity.

To learn more about this pesticide, see here.

Epoxiconazole (EPO) is a broad-spectrum fungicide often used on grain crops, and that works by inhibiting the metabolism of fungal cells.

It reduces the production of conidia—the asexual spores of a fungus that facilitate reproduction.

In rats, EPO for 90 days decreased the relative abundance of Firmicutes and increased the abundance of Bacteroidetes and Proteobacteria, while also selectively enriching Lachnospiraceae and Enterobacteriaceae.

To learn more about this pesticide, see here.

 

More Commonly Used Pesticides

Imazalil (IMZ) is a systemic fungicide used to combat fungi on vegetables and fruit (especially citrus), as well as tubers during storage. (30:39)

In mice, IMZ exposure (at doses of 100 mg per kg of body weight daily for up to 14 days) reduced the cecal relative abundance of Bacteroidetes, Firmicutes, and Actinobacteria, while also reducing microbiota richness and diversity.

The IMZ-treated mice also exhibited colonic inflammation.

In another study of mice, low-dose, environmentally relevant exposure to IMZ (0.1, 0.5, or 2.5 mg per kg of body weight daily) for 15 weeks resulted in gut microbiota changes.

These changes included reduced mucus secretion, decreased the expression of genes related to cystic fibrosis transmembrane conductance regulator (CTFR) in the ileum and colon, and generally disturbed intestinal barrier function.

Stacy shared her perspective on how she looks at this information.

Think through the way how these pesticides are more heavily used on grains.

Chlorphyrifos (CPF) is an extremely common organophosphate pesticide used to kill insects and worms, by interfering with acetylcholine signaling and disrupting their nerve processes.

It’s commonly used on fruit and vegetable crops, as well as vineyards.

This is one that was going to be banned in the USA, but Scott Pruitt reversed the planned ban.

You can learn more about this here.

Sarah shared on this study, this study, this study, and this study.

This information should stimulate a reevaluation of the use of these chemicals in the food supply.

Diazinon is an organophosphate insecticide used on a variety of crops—including fruit trees, rice, sugarcane, nuts, potatoes, and corn.

You can learn more about this pesticide here.

It causes different changes in male rodents versus female rodents.

The researchers speculated that these differences—with male mice experiencing the most severe changes—were due to sex-dependent gut microbiota profiles present before treatment.

You can read more about this study here.

 

Two More Commonly Used Pesticides

Propamocarb (PMEP) is a systemic fungicide used to control root, leaf, and soil diseases caused by oomycetes (water molds) by interfering with fatty acid and phospholipid biosynthesis and therefore changing the membrane in fungi. (41:41)

It can accumulate in fruit at high levels, thus reaching humans. 

You can find more information on this pesticide here.

In mice, 28 days of exposure to PMEP (at levels of 300 mg/L in drinking water) induced gut dysbiosis and changes in 20 fecal metabolites, including SCFAs, succinate, bile acids, and TMA.

You can read more about this study here.

Glyphosate is a broad-spectrum herbicide that can kill both grasses and leafy weeds.

It works by inhibiting an enzyme (5-enolpyruvylshikimic acid-3-phosphate synthase, or EPSP synthase), which is used by bacteria, archaea, fungi, algae, some protozoans and plants to synthesize folates (vitamin B9), ubiquinone, menaquinones (vitamin K2), phenolic compounds, and the aromatic amino acids tyrosine, tryptophan, and phenylalanine.

The pathway this affects doesn’t exist in animals, which is part of why glyphosate has historically been considered to have low toxicity in animals. 

Now that we understand that we have at least as many bacterial cells living within our body as we do human cells and that those bacteria are essential to our health, the relevance of glyphosate exposure comes into focus.

Many bacterially-derived compounds that benefit human health are produced via the shikimate pathway.

One rat study evaluated the impact on the microbiome of two weeks of glyphosate consumption, and showed a dose-dependent increase in fecal pH attributable to a reduction in acetic acid production, implying the metabolomic impact of glyphosate exposure.

 

More on Glyphosate

It's not that glyphosate is necessarily directly impacting our cells, but it is dramatically impacting the gut microbiome at levels that we are already being exposed to in the food supply. (48:50)

In studies in poultry, cattle, and pigs, glyphosate exposure increases the ratio of pathogenic bacteria to probiotic microbes, reducing Bifidobacteria, Lactobacillus, and Enterococcus while increasing Salmonella and Clostridium.

In a long-term rat study, the impact on the gut microbiome was evaluated following nearly two years of glyphosate exposure via drinking water at three different doses.

Glyphosate caused a large increase in the Bacteroidetes family S24-7 (associated with obesity and inflammation) and a decrease in Lactobacillus species in females (more modest changes in males).

It also altered the Firmicutes to Bacteroidetes ratio to one more closely associated with chronic disease.

The authors concluded “our data suggests that the exposure to an environmental concentration of [Roundup] residues could have a role in the current epidemic of gut dysbiosis”.

This occurs even at levels well below the US ADI of 1.75 mg/kg body weight /day. 

There is no strong dose-response.

Sarah wants to emphasize that our glyphosate exposure in food is quite high.

It is definitely above the cusp for an impact on our gut microbiome composition.

The FDA has a report where they have been mandated to measure glyphosate residue in the food supply.

In their 2016 report they measured measurable levels of glyphosate residues in 63% of corn food crops and in 67% of soybean food crops.

However, they did not say how much residue was there.

The 2018 report goes to a dead link now.

A Swiss study of foods purchased at a grocery store showed that legumes had the highest concentrations of glyphosate residues, up to 2.95 mg/kg.

United Kingdom government testing of glyphosate residues in wholegrain bread showed levels up to 0.9 mg/kg.

A study of foods purchased in Philadelphia, USA metropolitan area showed 59 percent of honey samples contained glyphosate residues, and 36 percent of soy sauce contained glyphosate residues.

Third-party testing of popular breakfast cereals, crackers, and cookies by the Detox Project and Food Democracy Now! showed alarming levels of glyphosate residues in all products.

Roundup Ready GMOs have the highest level of glyphosate residues.

Studies prove that our current levels of exposure are sufficient for measurable amounts of glyphosate to get into our bodies. 

One study showed that 44% of city dwellers in 18 countries in Europe had detectable glyphosate residues in their urine, despite Europe’s more aggressive campaign against GMO foods.

A pilot study in the United States of America evaluating 131 urine samples from across the country detected glyphosate residues in the urine of 86.7% of them.

The highest observed detection frequency in the Midwest was at 93.3% and the lowest in the South at 69.2%.

 

How to Look at this Science

The EWG is looking at this much more broad group of criteria and they are taking a very similar standpoint to the European Union. (58:09)

A small effect is still an effect and we need to be concerned about it.

When Sarah does a deep dive look to look at the impact on the gut microbiome this is where Sarah sees the biggest area of concern.

Sarah thinks it is especially important because it is not currently part of the criteria by the FDA and the EPA for whether or not these chemicals are going to be approved for use.

This is the thing that Sarah really thinks needs to change.

The good news is that a healthy gut microbiome and high fiber consumption can actually protect us from absorbing a lot of these pesticides. 

There have been studies that showed that lactobacilli can help reduce how much pesticide on our food gets into our bodies. 

There are also studies that show that higher fiber consumption can at least partially reverse the gut dysbiosis.

As we get back to the heart of this question, there are studies that show that the answer is no.

High vegetable consumption is still really important because it does support a healthy gut microbiome, to begin with.

And a healthy gut microbiome is going to protect us in a lot of ways.

For example, they can protect us against heavy metals.

Even if we can't afford organic to not let that dissuade us from eating that high vegetable consumption because of this.

Sarah sees this as an exciting two-way street.

Even though pesticide residues are impacting the composition of our guts, the composition of our gut is influenced by more than just that.

It is influenced by how many fruits and vegetables we eat, mushrooms, nuts and seeds, variety, how much fish, how quality the olive oil is that we are consuming, etc.

All of these things help to determine the composition of our gut microbiome.

Doing all of these foundational things becomes more important when we are not necessarily in a position to be able to seek out and afford the highest food quality.

It is still really important to eat a vegetable-rich diet.

That's why Sarah wants to classify all of this science as the next level.

The foundational principle is still eating a lot of fruits and vegetables, even if our only access to that is conventional.

Beyond that, yes the Dirty Dozen and Clean Fifteen lists from the EWG are a wonderful tool.

Not that Sarah agrees with everything the EWG has said, Sarah thinks that these are spot on in the sense of trying to minimize our exposure to pesticide residues.

 

How to Limit Pesticide Exposure

Stacy feels that the podcast referenced and the information they are sharing aren't so far apart. (1:02:10)

Sarah and Stacy discussed a point shared in the documentary Food Inc. that really hit this information home.

We do the best that we can with what we can, and become educated on what other things we can do to support healthy living.

Nothing is ever perfect.

Prioritize the foods you purchase and do the best you can.

It is not good to stress about these things.

The dirty dozen list includes strawberries, spinach, kale, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery and potatoes

The clean fifteen list includes avocados, sweet corn, pineapple, onions, papaya, sweet peas (frozen), eggplants, asparagus, cauliflower, cantaloupes, broccoli, mushrooms, cabbage, honeydew melon, and kiwifruit.

If you are going to get something off the dirty dozen conventional, look at ways that you can wash that food very well or ways you can peel the food to remove the majority of the pesticide residue.

USDA certification is very expensive, so a lot of small family farms are growing organically, but don't have the certification.

Talk to farmers and find out how they are growing their food.

Stacy can't handle the sight of bugs in her fresh vegetables.

Eating fruits and vegetables is a good thing.

Perfection is not the goal.

Neither Stacy nor Stacy eats 100% organic, they both do the best that they can.

Sarah has found that the prices at her local farmer's market are best.

Develop relationships with your local farmers, and shop at the end of the market.

Stacy subscribes to Hungry Harvest, which has a waiting list right now.

Sarah prescribes to MisFit Market, there is also one called Imperfect Produce.

One of the things that Sarah loves about her subscription is the surprise element of it, which forces her to get creative with her meal planning.

At Stacy's house they meal plan when their box arrives, based on what they received.

Stacy shared more information on their meal planning process as a family, and how focused they have become to make sure they are not wasting food.

Building relationships with your local farmers is a point that Stacy echoed from Sarah.

Buying things in season or frozen can also be a helpful way to save money.

Stacy's organic box is at least 30% off had they purchased those items at a grocery store regularly.

The thing that Stacy most loves about Hungry Harvest is that they give back to the community.

 

Closing Thoughts

Stacy thanked Sarah for all the research she did for this show! (1:23:13)

If you have any follow up questions on all of this, you are welcome to email Stacy and Sarah using the contact forms on their blogs.

You can comment on social media posts as well.

Stacy and Sarah are always happy to hear from you!

If you have been loving this show, please help spread the word to others by sharing a link to an episode you enjoyed with a family or friend, or leave a review.

Stacy and Sarah so greatly appreciate your support!

Thank you again for tuning in!

Next week is another science-heavy show that builds off of this week's episode.

We will be back again next week! (1:25:57)

Welcome back to episode 404 of the Whole View. (0:27)

Stacy is almost getting use to saying that.

It has been a month since they changed over.

Sarah is proud that she has been using the correct name of the podcast, especially since she has puppy sleep deprivation.

Stacy is feeling well, and thanks everyone for the positive vibes they have been sending her way.

Her heart rate is completely back to normal, and she is now symptom-free.

Even though you recover, it still takes time to rebuild and get back to full strength.

It takes time for inflammation in the lungs to heal.

Sarah has been wanting to do antibody testing to see if she had it.

The quality of the antibody tests is a huge range, so Sarah is yet to research this just yet.

Stacy firmly believes that knowledge is power.

From her entire coronavirus experience, that is really her big takeaway.

Stacy is so excited to host another pet show this week!

The last pet show they hosted felt like an uplifting conversation.

Remember, while Stacy and Sarah will refer to their dogs in this episode, they are also both cat owners and love their cats dearly as well.

They are talking about pets in general.

 

Listener's Question

This was a question that Stacy wanted Sarah to cover for a while. (9:09)

However, just recently, this question was received from a podcast listener, before the last pet show was hosted.

When Sarah announced that she was getting a dog, this was the most common question she received.

What do I feed my dog?

Ashley says, "Hi Sarah and Stacy! I started listening to the podcast several years ago while I was living in New York City.

Every evening after work I would get on the train, put in my headphones, and listen to an episode.

I guess I am one of the listeners you are always apologizing to for the early episodes.

I have to say I have truly enjoyed them all and have learned so much valuable information.

Thank you for all your hard work to both educate and entertain your listeners, I feel like we are friends at this point and I still look forward to a new episode every week.

The Paleo View is my favorite podcast hands down! 

As a person eating a nutrient-dense, anti-inflammatory diet myself, I am wondering how to feed my dog in the same way.

My husband and I recently added a Bernedoodle puppy to our family and he is the most adorable and mischievous little guy.

There is so much conflicting information out there about what diet is best for dogs - they need grains, they don’t need grains, raw is best, raw is dangerous.

Most dog food is so highly processed and contains ingredients that to me seem highly inflammatory and nutrient-poor.

The organic and grain-free foods look good on paper, but then I read about concerns with grain-free diets and heart problems in dogs.

I like the idea of a raw diet, but that also requires a lot more work on my part to source and prepare his food which just isn’t practical for my life right now.

I would love to know the science on this topic so I can feel confident in what we are feeding our dog so that he can continue to be a healthy and happy pup! Please help!"

 

Knowledge is Power

Stacy is excited for Sarah to help. (12:11)

After a bit of research when Matt and Stacy for Penny, Stacy made a food choice and Sarah looked into as she was preparing to get a pup.

Sarah found that it actually isn't that bad of a food choice.

Stacy has had two veterinarians that a grain-free diet for a dog isn't good and that a raw diet for a dog is not good.

So when Stacy asks what is a good option and why the foods that they recommend are exactly as Ashley indicates.

They are foods that would be highly inflammatory.

After seeing Penny's symptoms when she was adopted and knowing what kind of diet she was on, Stacy knows that she has sensitivities from her inflammatory diet.

So Stacy is excited to learn more about what is an ideal diet.

As a reminder to listeners, just as we humans make our own choices, we do the best that we can with the knowledge we have.

If you decide that you are going to transition your pet to a new food after this, or maybe not, there is no shame or guilt.

This is not Stacy and Sarah telling listeners what you need to do.

However, this is knowledge for you to be empowered to make your own choices.

Neither Stacy or Sarah are medical professionals, and information on this podcast should not be treated as medical advice.

Sarah thought it would be interesting to answer Ashley's question with the ancestral diet approach.

This is so consistent with how we approach food.

Meeting the body's nutrient needs is the primary criterion for a healthy diet.

So what are the nutritional needs of a dog?

And what is the ancestral diet that would help to meet those?

 

Let's Start with Wolves

So let's start talking about what wolves eat. (17:34)

Dogs and the modern gray wolf share a common extinct ancestor.

There is great debate among biologists about whether or not dogs and wolves are the same species.

Some biologists believe that dogs are a subspecies of the gray wolf.

While other biologists believe that they are their own species and that wolves and dogs are separate species.

Wolves are scavengers and hunters, and they really eat anything they can get.

They always eat the whole animal, and organ meat is the first thing they consume.

The highest levels in the pack get the most nutritious diet so they stay the healthiest and the fittest.

Then they eat the ribs, a lot of small bones, and nearly all of the hide.

Even the large bones are gnawed on.

The other thing that Sarah found really interesting is that by eating the stomachs and the intestines they are getting a fair amount of partially digested plant matter.

They also eat grass.

Researchers believe that wolves eat grass to purge the intestines of parasites.

The earliest evidence of dog domestication is about 40,000 years old.

And the earliest proof of domesticated dogs is about 14,000 years old.

Domestication has more points of change, in terms of genetics, than agriculture does in humans.

The genetic differences refer to changes in the nervous system, and it is thought that these are all underlying the behavioral changes that were central to dog domestication.

There are also ten genes that have changed that all have key roles in digestion and fat metabolism.

These genetic changes show a dog's ability to digest starch relative to the wolf.

There are these well-measured changes in dogs compared to wolves that have made them more adapted to eating more starch.

This doesn't mean that starches are the foundation for their optimal diet.

However, it implies that they need a little bit more starch and carbohydrate than the wolf.

 

Facultative Carnivores

So not a grain-based diet, as dogs are still considered facultative carnivores. (25:29)

Facultative carnivores are species that are not strict carnivores.

They eat some plant foods in addition to animal foods.

However, they can't thrive on a truly omnivorous diet.

They still need to eat a dominant amount of calories from meat.

But they are well adapted and still need a small amount of their diet to come from plants.

Where science is pointing is that really the optimal diet for dogs is similar to wolves, with a whole-prey, whole-animal, approach. 

Eating really every bit of the animal that is edible.

This should probably make up 85% of the diet, with a variety of plants making up the other 15%.

Which leads really well into the question of raw vegetables versus cooked.

Sarah shared on the research she did and specifically pointed out the details found from this study.

They showed that the safety profile of raw diets is very high.

Stacy asked about the risks associated with raw dog food being contaminated and recalled.

Sarah pointed out that there have been tons of recalls on grain dog food.

Stacy noted that it is helpful to be armed with information when you visit the vet.

If your vet isn't working for you, remember that they are providing a service to you and you are choosing to go there.

You can always find another one when you feel that their beliefs don't align with your beliefs.

Sarah shared some data on the recall rate for dog food.

Raw diets are highly digestible. 

Processed kibble diets were not as digestible. 

There was a 10% difference between the two.

High quality cooked diets were also found to be highly digestible.

So it wasn't a question about whether or not the ingredients were raw, so much as how processed they were.

Sarah also referred to this study.

Personally, Sarah cares much more about the quality and processing of the ingredients, instead of whether or not each ingredient is cooked or raw.

This thesis also went into how the fiber content of food impacted digestibility.

This made a case for animal fiber.

You don't want too much fiber, which decreases digestibility.

However, you do need some fiber, which should come from some plant foods.

When Sarah was doing this research she was expecting that they would be better adapted to consume cooked diets, and she shared why.

 

Grain-Free Foods and Diet-Induced Dilated Cardiomyopathy

The other part of Ashley's question asks about the link between grain-free food and diet-induced dilated cardiomyopathy.(43:38)

This was a huge research point for Sarah because she doesn't allow gluten in her house.

In July 2018, the United States Food and Drug Administration (FDA) issued a public notification about an uptick of reports of canine dilated cardiomyopathy (DCM) – a type of heart disease that can lead to congestive heart failure.

Symptoms include enlarged heart, decreased energy, lethargy, cough, difficulty breathing, loss of appetite, and episodes of collapse.

However, many dogs will not show symptoms of the disease right away.

If you suspect that your dog is affected, consult your veterinarian immediately.

In the FDA’s July 2019 update on diet and canine heart disease, they examined labels of dog food products reported in DCM cases to determine whether the foods were “grain-free” (defined as no corn, soy, wheat, rice, barley or other grains).

They also looked at whether the foods contained peas, lentils, chickpeas, beans, or potatoes (including sweet potatoes).

Their report states that 91 percent of foods reported in DCM cases were grain-free, 93 percent of reported foods contained peas and/or lentils, and 42 percent contained potatoes/sweet potatoes.

91% were eating grain-free food. 

This is research that is ongoing.

The most likely mechanism is that that is some kind of antinutrient in legumes blocking taurine absorption.

Taurine is an amino acid found exclusively in meat.

It is not considered an essential nutrient for dogs because they can synthesize their own.

Some breeds appear to be predisposed to taurine deficiency from low-taurine diets.

Taurine deficiency is one potential cause of DCM.

Golden retrievers made up 20% of the effected dogs from diet-induced dilated cardiomyopathy. 

There were a ton of other breeds represented in the findings.

Many of the dogs have responded to taurine supplements, even if they didn't appear to be taurine deficient.

Taurine supplementation may be more effective as a prophylactic than a treatment, but this still needs to be studied.

So the culprit isn't necessarily the lack of grains in the diet, but the fact that grain-free don't automatically mean good, high-quality, or nutritionally balanced.

Remember, this is still an active area of research.

Look for options where legumes, especially peas and lentils aren’t in the top 10 ingredients.

Taurine is naturally high in organ meat.

There are no gluten-free dog foods that are also grain-free.

77 million dogs in USA, DCM reported in 560 probably under-reporting but still very low incidence.

CF 50% of dogs will get cancer in their lifetime.

 

What Sarah Feeds Soka

Sarah is looking to reduce the risk of everything bad that can happen to her. (55:21)

This was an area of high-importance to Sarah when they were preparing to get a dog, and she did a ton of research on her options.

Sarah was looking for dog food that was nutrient-dense, with a whole prey ratio of animal ingredients at 85%.

Probiotics were also on her wishlist.

She was also looking for a food that didn't have too much protein.

Too much protein can be hard on a dog's kidneys, so Sarah was looking for a brand with no more than 40% protein.

If the brand had legumes, they had to be at least eleven ingredients down.

The other thing that Sarah is doing is giving her pup a mixed diet so that not every meal is kibble. 

She is buying a different flavor every time, of the same brand that she found.

Then Sarah is also doing a rehydrated freeze-dried food, which preserves nutrients better than the canning process.

So her dog is getting one wet can food meal a day. 

In addition, Sarah's dog is receiving training treats and chews.

The brand that Sarah selected is Orijen.

However, they are not the only good brand out there.

Orijen checked every single box of what Sarah was looking for, which was such a relief to find. 

On the advice of her vet, Sarah is also giving Soka a taurine supplement. 

The supplement is vetriscience cardio strength, which contains Carnitine, Taurine, Glycine, vitamin E, EPA, coQ10, GLA, vitamin B9, Magnesium, Potassium, and Selenium. 

Sarah is mixing things up with training treats and Soka's favorite is pastured turkey breast, cooked in the Instant Pot.

The other high-quality training treats that Soka likes are Grizzly’s Smoked Wild SalmonPupford Liver Training Treats, and Pupford Sweet Potato.

And Sarah just ordered Vital Essential Freeze-Dried Minnows and is excited to have her dog try those.

Sarah shared some of her training tricks and current approach. 

So with, a focus on a nutrient-dense approach, the whole-prey ratio, and then round out her diet with mixed, diverse add-ins.

Sarah rounds it out with as many high-quality ingredients, using different training treats each time.

Soka is also getting natural chews like grass-fed beef bone (K9 Connoisseur), naturally-shed deer antler (Whitetail Naturals), and beef trachea. 

Everything that Sarah is doing with Soka is about nutrient-density and nutrient variety, which are the same principles of how she chooses her own foods. 

Stacy loves that all of the brands they pick are helping with the sustainability and the respecting of animals that she feels so passionate about with our food supply chain.

Eating nose to tail is so important.

Thank you dogs for helping us respect the whole animal!

 

What Stacy Feeds Penny

Like Stacy mentioned, they really struggled for almost a year in figuring out what to feed Penny. (1:06:05)

They started off transitioning her to a higher quality kibble because she came to them on the fast food of dog food kibble. 

The easiest thing was kibble since that is what she was used to.

They found Stella & Chewy's and they put her on a puppy kibble to start.

Stacy didn't want her to be on kibble longterm. 

However, to get her to like it they would mix in ghee or very gelatinous broth or homemade gravy.

They were trying to also help her be less underweight.

The problem though was that Penny grew accustomed to things tasting delicious and when they tried to feed her dry kibble alone she wouldn't eat it. 

While Penny is extremely motivated for treats, her food is an entirely different thing. 

One time she went for almost four days without eating. 

The process of trying to modify Penny's diet felt a lot like sleep training. 

Sarah pointed out that it is very important to recognize that there is no one way.

There are always going to be exceptions, and you need to do what feels best for you and your pet. 

They eventually started adding a stew from Stella & Chewy's on top of the kibble and then mixed it up. 

However, this was an expensive route.

Stacy's dog is very high maintenance with food.

Penny was underweight, and it was very important for them to figure out how to get her to eat something that was both healthful, as well as nutrient-dense for weight-gain promoting purposes.

Eventually they were able to find a long-term approach for Penny that she absolutely loves and is so much easier for them. 

They now feed Penny freeze-dried patties from Stella & Chewy's.

These patties also have taurine added to them, kelp, and are very clean for a dog.

They crumple up the patties and add a little bit of hot water. 

Ninety percent of the time they also add two spoonfuls of rice for her. 

Penny is still on the low side of what is considered her normal weight. 

Her rice is cooked in broth once a week, and saved in the fridge for meals.

They trust and really like Stella & Chewy's, and best of all Penny really likes their stuff.

 

Closing Thoughts

Stacy shared stories on Penny's pickiness when it comes to even training tricks. (1:16:40)

Sarah shared on Soka's adventures with trying to bring home pine cones to eat.

Soka even has a pile spot where she collects things she finds. 

She is still learning what things are toys. 

As they wrap up this episode, Sarah wants to mention that Soka does have her own Instagram account.

Stacy considered making Penny her own Instagram account but decided not to. 

She felt like she couldn't manage another Instagram account. 

This show was very focused on dog food so if you need the same rundown on cats, let Stacy and Sarah know. 

They both have been longtime cat owners, and both feed their cats Orijen.

Stacy uses Amazon Subscribe & Save to get the best deals on Penny's food and treats. 

This episode was not sponsored by any of the brands mentioned. 

As always, Stacy and Sarah tell listeners what they use and why in a genuine way. 

We will be back again next week, and very much appreciate you being here!

Thanks for listening! (1:24:23)

Welcome back to the Whole View, episode 403. (0:27)

It has been quite a journey since they last recorded.

Sarah is so glad that they prerecorded 402 because puppies are a lot of work.

It was also great timing for Stacy though because she could not have recorded an episode last week anyway.

Stacy slept for three days because she got covid-19.

She is recording this episode on day 13 and she is doing well and doesn't want anyone to worry about her.

Huge thank you for the positive vibes.

You will notice throughout the recording that Stacy gets breathless from time to time and will need to slow down.

Stacy wants to share her experience with listeners.

Thankfully for the information from this episode, this one, this one and this one, Stacy was relatively prepared.

She feels like she was able to manage it as best as she could for her family.

Her experience is in no way reflects what would be a medical recommendation.

This is simply Stacy giving her personal experience.

There is nothing they are going to cover that will prevent it, that will make a guarantee of a mild course for you, and is certainly not a cure.

However, what Stacy can do is share her experience so that you can relate to the information if you or someone around you contracts covid-19.

Sarah pointed out that we can know all the facts, but seeing the experience is very eye-opening.

This episode is going to be very experience focused.

Sarah will be sharing a bit of the updated science and a few points that we haven't covered yet.

However, please be sure to revisit the four previous episodes (linked above) for the basic science.

 

This Week's Sponsor

Before Stacy jumps into the experience, she wants to take a moment to thank this week's sponsor, Just Thrive probiotics.

This is the brand of probiotics that both Stacy and Sarah personally take, and they have shared about them before.

You can find them at this link, and our code has been updated to 'thewholeview'.

When you enter that code at checkout, you will receive 15% off your order.

Sarah has been taking Just Thrive for years.

They are very different from what you can find on grocery store shelves as they are soil-based organisms.

Thank you to Just Thrive for sponsoring this episode!

Stacy took advantage of their subscribe and save option partnered with the code.

 

The Toth-McCarry 's Have a Mild Case

So, first Stacy wants to say that both her and Matt are lucky for only getting mild cases.

There are a couple of reasons this could be the case.

This virus is known for taking a turn, which is a fear that Stacy has been heavily carrying.

The fear has been shared by her children.

Since Stacy and Matt are outside of the risk ages, Stacy feels fortunate.

Both Matt and Stacy are active and have a relatively healthy heart and lungs.

They focus on nutrient-sufficiency and an anti-inflammatory diet on a daily basis.

One of the decisions that they made beyond their daily diet was to not drink during the quarantine.

Stacy referred to this study on alcohol consumption and pneumonia.

The biggest reason that Stacy thinks they got so lucky is that Matt's exposure was probably a low dose through a mailer, from touching an object.

As discussed in episode 401, Matt was reusing a mask and not washing it.

However, when that was recorded, they had likely already been exposed.

Since Stacy got sick so quickly after Matt did, it implies that Matt brought the virus home.

They were careful, but there is only so much you can do.

None of the steps that we take are perfect.

They reduce the risk of transmission, which is very important, but we know that this virus is ridiculously contagious.

Quite a few studies have confirmed that the exposure dose does dictate the severity of the course.

However, this is a complicated equation, impacted by other factors as well.

The more we implement the precautions, the more we increase our chances of a mild case.

There is nothing we can do but be diligent.

Stacy is so grateful that she took precautions as seriously as she did because she ultimately avoided giving her Dad covid-19.

 

How Did We Get It?

Everything from asymptomatic to mild pneumonia is classified as a mild case. (21:26)

This is one of the things that Sarah thinks science terminology has done a huge disservice to the public.

To have this huge range of symptoms is a really unusual situation.

A lot of the challenges we are facing are due to the fact that this is a novel virus; a virus that is brand new with many unknowns.

We are only testing roughly 20% of people who have a severe case.

This is heavily skewing the data.

There have been a lot of advances on how to treat covid-19 and they are preventing a lot of people from requiring ventilators.

This is really good news since this lightens the burden on the healthcare system.

However, the 5.8% fatality rate is so high because we are not testing all cases.

The denominator is not accurate.

Some experts think that we are undercounting cases in the US tenfold.

We are probably looking at 12 million cases in the US as of May 5th.

There is very little immunity in the community, which means this virus can spread without being stopped.

This is why our only big tool right now is to stay at home.

 

How Did Stacy Know?

Matt had a headache, which isn't uncommon for him. (27:47)

That evening once he was home from work, he started to feel dizzy.

He didn't realize it was dizzyness, he thought a migraine was building.

Fatigue was also a thing, but he just thought it was all linked to getting a migraine.

The next morning he got up and went to work.

When Stacy woke up she felt dizzy.

So she texted Matt and told him that she thought they were both getting sick and she thinks he should come home.

They both thought they had the regular flu since they didn't have fevers or coughs.

Matt and Stacy both slept for three days straight as they were dealing with extreme fatigue.

It was, fortunately, the weekend, so they didn't have to worry about schoolwork with the kids.

After doing more research, Stacy realized that she didn't think they were dealing with the flu.

Matt notified his boss that they think they might have covid-19, and would need to not go into work on Monday.

On Monday, the CDC released information on six additional symptoms.

The additions included chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. 

What they didn't have was a cough.

However, on day four they started getting shortness of breath.

We discussed the full range of symptoms reported in scientific studies to date in our first Covid FAQ show, episode 396.

At that time, loss of taste/smell was just starting to be recognized.

 

More on Symptoms

Sarah discussed this symptom in her free online public lecture, which you can still sign up to watch the replay here. (34:57)

Everything she covers in that is 100% valid.

There has been a continuous addition of symptoms and complications.

They are starting to see a lot more neurological symptoms, which we are seeing as brain fog, confusion, and anxiety.

In mild cases, respiratory symptoms may never occur.

One study showed that coughs only appeared in 44% of the people.

The research is being done on the people who have a more severe course of the disease, so the information on the symptoms is potentially different than people who have a mild course of the disease. 

Stacy said that Matt and Stacy are also dealing with body odor like never before.

However, skin rashes and covid toes are not something that Stacy and Matt dealt with.

If you want to know what those are, Google them.

When there is a lot of inflammation, it does increase the risk of throwing a clot.

There have been five different rashes associated with covid, and not all are related to clots.

Some can look like a hand-foot-mouth disease, others can look like a nettles rash.

What is important with this development, research is identifying rashes as the first symptom for some patients.

If you develop a rash anywhere, you have to quarantine yourself and watch for other symptoms to develop.

Some people get GI symptoms, some people get a runny nose, but generally not.

The symptom range is so wide.

It can look so different from person to person.

Stacy noted that all five people in their house had different symptoms.

Things developed slowly for Stacy and Matt, to the point where they didn't realize their shortness of breath.

Stacy's friend had an extra oximeter and shipped it to them.

Videos from YouTube showing various breathing exercises helped Stacy find that deep breath again and maximize her oxygen production.

Stacy recommends this one and this one.

She was able to improve her oxygen saturation and reduce her heart rate, which she thinks was critical during that time when her symptoms were at their worse.

Focusing on breathing exercises was a very helpful stress and anxiety management tool.

Breathing exercises help to clear your lungs.

 

Testing Experience

Matt and Stacy weren't able to get a test until they had a request from Matt's essential employee-employer. (52:28)

So his supervisor sent a request for him to get tested, and he was able to test within a 24-hour time period.

He had to drive 30-minutes to the facility by himself.

Fortunately, he wasn't dealing with severe dizziness.

After waiting awhile he spoke with the doctor who confirmed he has covid-19.

They diagnosed him by giving him a flu and strep test.

When both of those came back negative, the doctor could formally diagnose him with covid-19.

In Virginia, they are not giving people coronavirus tests unless they need to be hospitalized.

Sarah said this is common in most states.

Stacy was not tested but presented the same symptoms as Matt.

Both Matt and Stacy will have their antibodies tested on the 14th of May.

Depending on where you live, you may have access to one of the two labs that are offering appointments for antibody testing.

What baffles Stacy is that Matt was likely not counted as a case since he didn't take an official coronavirus test.

She knows for certain that neither her nor the kids were counted, even though they all had symptoms as well and were in close proximity.

This paints the picture for the level of undercounting that is happening.

How can we possibly go back to normal if we aren't identifying who is sick?

Stacy and Sarah have shared more on their fears surrounding this challenge.

One of the challenges that we have as a society is that we have taught ourselves how to persevere even when we are sick.

On the other side of this, this will have to change societal wide.

We need to normalize staying home even when we feel like we are just starting to get sick.

 

Recommendations from the Doctor

The doctor said that even if she had given him a test, there is a 30% chance of a false negative. (1:03:07)

So the doctors have had to use multiple tests on people sometimes.

The doctor told us if it was 93 or lower to go to the hospital, and that we wanted to see 95+.

Matt was told to stay home and was given paperwork to isolate from his essential employee job.

The doctor emphasized that he needed to simply go home and rest.

 

Answers & Explanations from Sarah

We don't yet know the false-negative rate on the covid-19 tests. (1:04:43)

There were early studies showing that the false-negative rate could be as high as 30%, but the studies since have shown that they are closer to 10%.

However, the challenge with this is that the error probably comes from two places.

The first is from testing too early.

The second is from sampling error.

Sarah explained the difference between diagnostic testing and screening testing.

Now, let's talk about pulse oximeters.

Sarah wants to refer listeners to an informative interview from PBS with Dr. Levitan.

Doctors are starting to recognize that by the time patients are experiencing shortness of breath alarming enough that would bring them to the hospital, the virus has already progressed too far.

At that point, the treatment options are more limited.

As Stacy said, symptoms are a very slow build and people are adapting without noticing it.

This is being referred to as silent hypoxia.

Note >95 is normal, <90 is hypoxia, <80 life-threatening oxygen deprivation, brain damage.

Dr. Levitan recommends that every medicine cabinet should have a thermometer and pulse oximeter. These should be standards. 

The consumer pulse oximeters are sold for people with conditions that require monitoring on a regular basis.

They are not the same as the medical grade.

So this is different from the N-95 mask shortage.

If you suspect you have covid or you received a non-test diagnosis, it is recommended that you monitor your oxygen saturation and if it drops to 90 that is when you go to the hospital. 

Incorporating breathing exercises, monitoring oxygen saturation levels, and avoid lying down on your back for long periods of time can all impact your treatment course.

One of the studies showed way better oxidation just by putting patients on their stomachs.

Monitoring oxygen saturation can help you if you need to get medical help, it can help you make that decision with data. 

Having hypoxia by itself causes damage.

The other thing that you should watch for if you have covid that would tell you it is time to go to the hospital is a high fever.

In adults, a high fever is considered a temperature over 105, or a temperature of 103 that lasts 48 hours or longer.

 

Self-Care and Dealing with Symptoms

Stacy put the thermometer and the pulse ox in the restroom. (1:18:10)

So Stacy would you a visit to the restroom as a prompt to check her vitals.

With this routine, Stacy was able to identify her trends and data points so that she could stay informed on how she was doing.

This is the pulse oximeter Stacy recommends.

Stacy wants to be clear that the personal experience she is sharing is not her telling listeners what they should do to prevent getting sick or how to treat yourself when you are sick.

Being nutrient-sufficient is always a goal.

The supplements that Stacy takes on a regular basis are probiotics and liver pills.

When covid started she started taking vitamin C, vitamin D, and magnesium.

Once symptoms onset, Stacy started taking zinc and melatonin.

Please check out this podcast episode for more information on melatonin as an antioxidant.

They also ate a lot of beef, shrimp, and broccoli that all have zinc in them.

While they craved simple carbs, Stacy would make recipes to add nutrients to their diet.

Shrimp fried rice was a favorite, along with a beef casserole.

They found ways to add nutrients to their cravings.

Probiotic-rich foods were also added in.

Stacy focused on staying hydrated.

They also roasted a big batch of veggies and soup to have easy to grab nutrients.

All of them were craving and consuming dairy more than what is normal for their household.

Sarah doesn't take any supplements without reason related to some kind of data point that she can measure.

She is very specific about the supplements she takes and she doesn't like to share the supplements that she takes.

Sarah feels that we have a tendency to rely on supplements instead of eating a nutrient-dense diet.

We should not rely on supplements for basic nutrition.

However, supplements are great in food-based forms.

Sarah wanted to be transparent that she takes glutathione. 

This is the study on glutathione that Stacy was referring to.

Oranges were a go-to, as well as berries.

Stacy was grateful that they had these foods on hand before their fatigue got very bad.

 

When the Fatigue Hit

When the symptoms fully set in, is all Matt and Stacy wanted to do is sleep. (1:30:14)

As Sarah mentioned, Stacy was careful to make sure that they did not lie on their backs.

She also made a point to make sure that she was getting up every few hours to stretch.

They didn't just rest, they slept, and did the breathing exercises and made sure that they were in the proper position.

The things that Stacy would recommend to a loved one to do are the breathing exercises now, to get more sleep than you think you need, and make sure that you nourish and hydrate to support your immune system.

Stacy was worried that she was going to get pneumonia, so she wanted to make sure that she wasn't in a nutrient-depleted state.

Another thing that Stacy would encourage others to consider is to take a break from alcohol right now.

Find other ways to de-stress when you feel compelled to reach for alcohol.

There is science to support that leaning on alcohol right now is not the best choice.

Alcohol suppresses immune function and is not good for gut health.

The other thing that Stacy wants to mention is not reading the sensationalized news stories.

She leaned on statistics that you can find on reputable websites.

Reading articles that are scary or stressful is not going to be productive for you.

 

Antibodies Testing

We make a lot of different types of antibodies. (1:38:22)

Sarah explained how our body creates antibodies.

Neutralizing antibodies are really important because they remember foreign invaders and protect us from that invader ever coming in again.

With viral infections, our body remembers them and we typically don't get them twice.

We have memory cells that hang around in our bodies and make antibodies.

These ramp-up really quick to neutralize the invader basically before we ever get symptoms.

There have been studies showing that people with covid-19 are making neutralizing antibodies but interestingly enough not everybody.

Something like 10% (please note the studies are small) are not.

One of the things that we are still trying to understand about covid-19 is what antibodies are being produced and how long they are going to last in the body.

We don't know why some people are making these neutralizing antibodies and others aren't.

And we don't know how much we need to make in order to be immune.

These are all questions that need to be answered before antibody testing can translate to something like an immunity passport.

For right now, scientists are basically using best guesses on what we know from previous infectious organisms. 

They are making the assumption that if neutralizing antibodies are detectable in your bloodstream that you are immune. 

Hopefully, that will turn out to be the case.

It is definitely the most likely scenario based on what has happened to date. 

 

Closing Thoughts

Sarah recommends that listeners go back and listen to episode 401 if you haven't yet. (1:43:40)

There is a wide range in the quality of testing available, so it really does matter where you are getting your testing from.

Hopefully in the next few weeks that won't be the case anymore because it will be better regulated.

The data that we have right now shows that the coronavirus is not mutating anywhere near the rate that influenza does. 

For right now, the data shows that this is not mutating rapidly enough for the virus to be seasonal. 

As long as our immune system is remembering it well, once you get it and get through the other side, then you will be good. 

Stacy is crossing her fingers that they have neutralizing antibodies and that the virus does not change.

That is her best-case scenario at this time.

Stacy and Sarah know this has been a long episode and that they have hosted four other covid-19 episodes already. 

They wish they could move on from this topic, along with the rest of the nation. 

However, they hope that this was helpful and positive minded for you and that you feel equipped with information to prepare yourself before and potentially during, if you or a loved one contracts this. 

Stacy's intention is to be helpful. 

She is not a medical professional and she cannot answer your questions if you send them to her about what she recommends for you personally. 

The goal is to empower listeners to make choices alongside their medical professionals. 

Sarah thanked Just Thrive for sponsoring this week's episode.

Get 15% off your order when using the code 'thewholeview'. 

Thank you, everyone, we will be back next week! (1:48:10)

Welcome back to the Whole View, episode 402 - not 42. (0:27)

Sarah is full of punny jokes.

Stacy and Sarah are excited to finally share Sarah's big news!

This episode is being pre-recorded because on the normal recording day, Sarah is bringing home a brand new puppy.

Sarah grew up with all kinds of pets, and as an adult, she has had cats.

However, she has wanted a dog forever, but she has been waiting for the right time.

Sarah's husband grew up with no pets and doesn't have much comfort with dogs.

The girls have also been skittish around dogs to date, and she knew that a puppy would be a good starting place for them.

Sarah has been waiting for a long enough break from travel to be able to commit to a puppy.

When Sarah's health crashed last fall her daughter told her it was the perfect time to get a dog, and Sarah couldn't have agreed more.

This has been in the works since then.

 

Sarah's Experience with Finding a Dog

Sarah has been researching dog breed characteristics and they decided to get a Portuguese water dog.

She did her research to not just find the right breed for her, but for her family as well.

With various levels of anxiety in Sarah's family, she knew that supporting mental health was a key piece in this all.

She wanted a dog that was social, cuddly, and interactive.

Having a dog that gets Sarah out of the house was also key, as she wanted a breed that needs a lot of activity.

The other piece that Sarah was looking for was a smart, highly trainable dog.

Portuguese water dog checked all of these boxes.

They need physical exercise as well as mental exercise every day.

Getting a hypoallergenic breed was also a must.

Once they found the breed they wanted, they did a ton of research to find the right breeder.

Sarah shared more on how she selected the breeder.

They will have a new family member!

 

Stacy's Experience with Finding a Dog

Stacy noted that we are all individuals in our health and lifestyle needs. (12:30)

We are also individuals in our pet needs.

From personal experience, Stacy's family has rescued probably about twenty animals over the course of her life.

Stacy shared more on her experience with bringing a rescue dog into their family.

They were not considering bringing a dog into the house again until the boys prepared a presentation about the different types of dogs and their traits.

The kids selected three breeds and provided explanations on why they thought these were good options for their family.

It was Matt and Stacy doing more research that allowed them to determine that an emotional support therapy animal was actually a really good idea for their family.

In doing research and finding a breeder who specializes in emotional support therapy animals, they were able to find the right dog for their family.

Selective smart breeding, like Sarah, was a key detail that Matt and Stacy looked for.

 

The Impact of a Pet Joining the Family

Stacy has never had a dog that she has bonded with that has made such a difference in her life the way that Penny has.

There is a difference in a special needs home, and an animal (regardless of what kind) can have a lot of benefits to the mental health of each family member.

Stacy wants to put it out there that this is not an advertisement for purchasing a puppy mill puppy.

She is not here to tell anybody what they should or should not do, or that the choices they made are either right or wrong.

There is no guilt or shame associated with the route you take.

Just like with health and lifestyle, looking back and having negative emotions is never productive.

What we can do is say, now I'm educated and I'm going to make the best choices that I can with the knowledge that I have.

It is important that you understand what kind of pet you are getting, especially if you have a high needs home.

Be mindful of what you are getting into, which encompasses so many different perspectives.

There are different animals that have different temperaments based on both genetics and how they have been raised.

It can be a wonderful experience.

Stacy couldn't have imagined that getting a dog would have gone so well for her family.

When Penny came into the family, Stacy saw an immediate change in one of their children who has depression and anxiety.

Penny also fulfills an important emotional need for Matt.

We all have emotional needs that need to be met, and a pet might be that for you!

 

What Do You Need to Know

There were a couple of articles that Sarah read from the American Kennel Club (the AKC) that were very helpful for Sarah to understand the myths around purebred dogs. (20:35)

These articles helped Sarah feel comfortable going in this direction.

The information helped her understand what to look for in a rescue organization, as well as what to look for in a breeder.

Every other animal Sarah has owned has also been a rescue and this was the first time that she is not.

This really was a very carefully thought out decision made with her family with all of their diverse needs in mind.

Sarah does not want to make a statement about which way is better.

If you are looking for a dog now, it is important to be aware of how inhumane the puppy mill industry is and how problematic it is.

It is important to avoid that awful in-between.

If you did get a dog from a pet store, don't feel guilty about this - just be aware of the information for next time.

There are two very ethical ways to go about this.

And it is about finding the right fit for you as an individual.

Right now with covid-19 and shutdowns, there are a lot of animals looking for foster homes.

So even if you think you can't continue pet ownership once life returns to normal, there are some organizations that are looking for temporary homes for their pets.

Here is some great advice on where to start whether you’re choosing a rescue group or looking for a responsible breeder (this article and this one).

It is better to give you the knowledge to help you find a local group near you, then it is to start calling out groups all over the country.

There are plenty of options when it comes to ethical rescue.

 

Science on Pets

What is really interesting about the science on the benefits of pet ownership, is that in many ways it doesn't matter what kind of pet you have. (25:45) 

What matters is the bond with the animal, not the type of animal it is.

The bond in the relationship with the animal is key.

There have been a huge amount of studies looking at pet ownership.

In the last couple of years, researchers have been teasing out the mechanisms behind what is responsible for these benefits.

It seems to be benefiting our health from a number of points.

There is the connection point, and we know that owning a companion pet reduces stress and depression.

Sarah explained what is happening internally on a hormonal level with these outcomes.

A lot of research has been done (on people of all ages) shows that a pet can actually provide connection and reduce the sense of isolation.

Feeling isolated is a health risk factor.

Companion animals can reduce blood pressure, cholesterol, triglycerides, and they have been shown to increase cardiovascular disease outcomes.

There is a huge range of different benefits.

 

Digging Deeper Into the Science

Understanding the science behind this has been a big focus of research. (30:15)

Dog owners are more likely to have healthy habits.

This is partially because a dog, in general, need to be walked every day.

You can find more information on this research here.

If you own a dog you are far more likely to be physically active, and you are far more likely to have a healthy diet.

There is a strong interaction between lifestyle and cravings and appetite regulation.

A variety of studies have shown that having any kind of companion animal has been shown to reduce depression, anxiety, and reduce feelings of social isolation.

We are seeing this mediated through hormones.

In particular, this study showed measurably higher oxytocin with lower cortisol and alpha-amylase levels.

Stacy and Sarah discussed oxytocin and the many ways it impacts our physical and mental health.

 

The Impact on Stress

There have been some really interesting studies looking at the benefits of pet ownership through the lens of the stress response. (35:00)

This study that was done in 2002 was one that Sarah particularly enjoyed reading.

Being in the presence of a dog causes a more powerful reduction in cardiovascular stress than being in the presence of a friend or spouse.

Relative to people without pets, people with pets had significantly lower heart rate and blood pressure levels during a resting baseline, significantly smaller increases (ie, reactivity) from baseline levels during the mental arithmetic and cold pressor, and faster recovery.

There have been a bunch of other studies that have looked at this in different ways.

One of which looked at dopamine, endorphins, and cortisol in people who spent just thirty-minutes with a dog.

Spending 30 minutes interacting with a dog has been shown to boost dopamine and endorphin levels, while also decreasing levels of cortisol.

The same found a similar effect in health-care workers after only 5 minutes of petting a dog.

Stacy and Sarah discussed how to ease discomfort with dogs if that is a challenge that you run into with members of your family.

Another interesting study that Sarah wanted to share is this one.

Stacy wanted to share that it is not impossible to overcome.

Through bonding, Matt was able to find comfort with being a pet owner and now really loves having a pet in the house.

Remember, the mental health benefits are associated with owning any pet, not just dog ownership.

The memories that you hold towards certain pet experiences are particular to that individual animal, and do not represent what you can expect from other pets.

It's kind of like the phrase - not all humans are good humans.

 

Closing Thoughts

Sarah's family knows what they will be naming their new dog.

They have been FaceTiming with her and have a good sense of her personality.

They will name her Soka after Ahsoka Tano.

Matt came on and shared more background on who this is. (49:02)

Sarah elaborated on fandom, nerdy shares.

When Soka is naughty they will call her snips.

Thank you, listeners, for joining in!

Stacy is excited for Sarah's family to welcome the newest member of their family.

They are in for such a treat!

Sarah knows it is going to be a lot of work to have a puppy, but not nearly as much as a baby.

There are follow up questions on this topic, which Stacy and Sarah will cover in a future episode.

If you have questions about pet ownership, be sure to submit those via the contact forms on Stacy and Sarah's individual sites.

And please don't forget, if you enjoyed this show, please leave a review and share with your friends and family.

Thanks again for listening!

We will be back again next week! (56:02)

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