The Paleo View

The Paleo View: Parenting, Science, and Gossip

Welcome back Paleo View, and Sarah welcome back to the state! (0:41)

Sarah is feeling super jet-lagged. On her trip to Canada, Sarah visited her Dad for a few days. While there she cooked about a month's worth of food for him and reviewed dietary changes.

They also reviewed the details of his medications and how these will impact his life.

Sarah found out that her Dad was actually dead for 10 minutes. He had a widowmaker heart attack and less than a 10% chance of waking up from the medically induced coma. Once he did wake up, he had a minuscule chance of not having a crippling level of brain damage. However, he is fine.

While Sarah's Dad is still recovering and healing from all that happened, he beat all the odds and it is amazing. He is feeling motivated by all that he can do from this point forward.

It was a busy few days with her Dad, followed by a trip to Santa Rosa, California where she gave a presentation for a medical school event.

Sarah is home and trying to get back to Eastern times and into a routine. In a lot of ways, this trip was very stressful.

This week's episode is a science-y one. Postpartum thyroiditis is a topic that Stacy wishes she would have known more about early on in her health journey. Stacy's first thyroid crash when she was done nursing Wesley.

The research Sarah did for this show explained a lot of why she felt the way she did when she was pregnant, and how she felt after birth, and then after weaning.

It was actually because of the way Sarah was feeling after she weaned her youngest daughter that brought her to Paleo in the first place. All of the symptoms she was struggling with were very much hyperthyroid symptoms.

This episode is sponsored by EverlyWell; a brand that Stacy and Sarah love because they provide at-home testing kits for a huge range of lab tests.

Most relevant to this episode, they offer a thyroid panel. For more on the many tests they offer and how the at-home testing works, visit here.

If you get the thyroid test and are looking to understand those results, these podcast episodes (245, 341, 134)  would be good resources of information.


Reader Question

Heather's question that sparked today's episode theme: (11:28)

Hey Sarah and Stacy! I love you guys so much and am so grateful to have you and all of the amazingly helpful resources you’ve created as I navigate my life with Hashimoto’s.

My question is this: I’m getting back to exercising after having a baby and am noticing that my heart rate goes wicked high (180, sometimes 190+ when I’m really pushing) during a cardio workout, even if my perceived effort is only a 7 or 8.

I’ve backed off the intensity but am still getting readings into the 170s when my perceived effort is only maybe a 5. (Note: this is based on the readings on the treadmill/elliptical/bike etc. which I know aren’t the most accurate, but until I get a new HR monitoring device it’s all I’ve got).

This is SO FRUSTRATING because I want to push myself but am afraid I may be doing more harm than good.

Is this situation common among people with an autoimmune disease?

All I can find online is that people with this situation should “see their doctor to make sure it’s not something else” (but they never say what the something else is!).

Since so many things are affected by my Hashimoto’s, I can’t help but think it’s playing a factor in this.

PLEASE tell me that this is something I can train back to “normal” or cope with in some way! I NEED to run for my sanity!! Thanks Ladies!


While Stacy does not understand someone who runs, she gets what it is like to feel like you can't do something you love and trying to solve that problem.

Stacy wants to first note that they are going to assume that all of the things like sleep management, sunlight, and grounding are all being incorporated as well.

While these pieces are a lot to put on your to-do list, these are important aspects in hormone health.

The thing that Sarah wants to talk about is that when she sees these symptoms, the first thing she thinks about is postpartum thyroiditis.


Thyroid Health & Pregnancy

On this episode, Sarah is going to share information on how the thyroid changes throughout pregnancy and upon delivery. They will also discuss what postpartum thyroiditis is and who is at risk for it.

Postpartum thyroiditis is a relatively common condition but is rarely diagnosed. However, the sooner you get the diagnosis and start working on the treatment, the more effective that treatment can be.

Sarah does recommend that Heather go to a healthcare provider and talk about these symptoms. She also suggests that Heather brings her thyroid test results with her.

The number one thing to do is to go get your thyroid checked.

Excess thyroid hormone causes heart palpitations and exercise intolerance. This is due to an increase in heart rate and fatigue.

The normal increase in heart rate during exercise is exaggerated with thyroid hormones, which is what Heather is describing.

Rapid heart rate is the most common sign of hyperthyroidism.

During pregnancy, the shift in the immune system puts some autoimmune conditions into remission. For some autoimmune diseases, pregnancy can make them flair. (17:20)

The immune system is changing modes but isn't in remission. The thyroid also changes as a result of pregnancy hormones, which is normal.

Having sufficient thyroid hormones is really important for supporting a healthy pregnancy and a healthy baby.

During the first eleven weeks of pregnancy, it is mostly maternal thyroid hormones that are driving development.

At around eleven weeks, the fetus's thyroid starts to take over producing thyroid hormones.

The two hormones that are driving the change in thyroid function are HCG and estrogen.

HCG accelerates thyroid hormone production. It is increasing the production of thyroid hormone, which results in a slight decrease in thyroid-stimulating hormone. This impacts the feedback loop.

Levels typically return to normal within the second trimester.

Estrogen increases the amount of thyroid hormone-binding proteins.

So we have this stimulation of the thyroid to produce more thyroid hormone, which lowers TSH.

Then we have this increase in thyroid hormone-binding protein, which binds up some of the excess thyroid hormones. This essentially levels out its activities so that levels are not swinging up and down.

If a woman has preexisting Hashimoto thyroiditis you can end up suppressing thyroid hormone, especially in the first trimester.

It is very common for somebody with preexisting Hashimoto thyroiditis to require higher thyroid hormone replacement throughout pregnancy.

Physicians who specialize in this would typically recommend dialing in thyroid hormone replacement doses prior to a woman becoming pregnant.

They would then recommend checking thyroid function as soon as pregnancy is detected. (23:19)

Typically thyroid function would be very closely monitored throughout pregnancy in somebody who goes into pregnancy knowing they have Hashimoto thyroiditis.

They would then get their levels checked every six to eight weeks, but even up to every four weeks depending on how much they are having to adjust the hormone.

Then as soon as the baby is born, the mother would be directed to go right back to her prepregnancy level does of the thyroid hormone she is on.

This is the standard procedure that is done to avoid postpartum thyroiditis that is medication caused.

If somebody has Hashimoto thyroiditis pre-existing and they don't have endocrinologist that is monitoring them throughout pregnancy it can be dangerous.

The combination of not having enough thyroid hormone throughout pregnancy can increase the risk of adverse pregnancy outcomes.

There is also this need to adjust immediately upon birth to avoid going hyper.


Medication & Supplements

It is also worth noting that the iron and calcium in prenatal vitamins inhibit the absorption of thyroid hormone in the gastrointestinal tract.

It is standard operating procedure if you are on hormone replacement to take it at least an hour before even drinking coffee.

Sarah's super pro-tip when it comes to thyroid replacement medication is to put one in a pill bottle next to your bed. This prevents you from taking more than one.

Any mineral supplements shouldn't be taken within four hours of a thyroid hormone dose.

If you are pregnant and taking a prenatal vitamin, Sarah recommends taking that vitamin in the afternoon to separate it from the thyroid hormone.


Postpartum Thyroiditis

Postpartum thyroiditis happens in this one situation of women with preexisting Hashimoto thyroiditis, but it also happens in women who had no idea they had thyroid issues before pregnancy. (28:32)

Studies have shown that women who develop postpartum thyroiditis typically have high concentrations of antithyroid antibodies early in pregnancy.

Antibodies are measurable upon childbirth.

Generally, measurable antibodies would be diagnostic for Hashimoto thyroiditis.

However, in a fairly large percentage of women postpartum thyroiditis might need some treatment to control thyroid hormone levels for a chunk of time. Then the thyroid will sort of return to normal.

What this can mean though is an even higher risk of subsequent postpartum thyroiditis in a subsequent pregnancy. Also, the subsequent risk of developing Hashimoto thyroiditis or a more chronic form of hyperthyroidism.

We know that this condition is sensitive to hormonal shifts. So the most common times to develop Hashimoto thyroiditis is puberty, pregnancy, and menopause.

If you have had postpartum thyroiditis and your thyroid has returned to normal afterward, make sure that you are on guard on what your thyroid is doing as you approach perimenopause.

Postpartum thyroiditis is this very acute level of inflammation but does seem to be driven by autoimmune processes that are enhanced because of the hormonal environment after childbirth.

You get two phases of postpartum thyroiditis.

First, you get a hyper phase, which is what Heather is describing in her question. This means the thyroid is too high. This is a get thee to a doctor time.

The symptoms include things like anxiety, panic attacks, irritability, heart palpitations and rapid heartbeat, unexplained weight loss, increase sensitivity to heat, fatigue, shaking like a tremor, and insomnia.

Typically in postpartum thyroiditis, the hyperthyroid phase lasts one to four months after delivery.

Although, not all women will have a hyperthyroid phase. Some will jump straight into a hypothyroid phase. (32:49)

This is a pendulum swing in the other direction, into an underactive thyroid, which is hypothyroidism.

The classic symptoms include crippling fatigue, increased sensitivity to cold, constipation, unexplained weight gain, dry skin, and typically depression.

The hypo phase of postpartum thyroiditis begins as the hyper starts to go away, which can be anywhere from a few days after birth to a few weeks after birth.

The swing into hypo can last six months up to a year, even a year and a half at most. Some women will never recover from the hypo phase.

While it is less common, some women will have just the hyperthyroid and not actually experience the reactive hypo-phase.

Sarah covered the risk factors and noted that it is really important to be testing thyroid.


Treatment & Care

Graves disease is life-threatening. Hashimoto thyroiditis typically is not, although it is incredibly impactful on the quality of life.

It is really important to dial in diet and lifestyle, but also maintain an openness to conventional medical treatment. Be willing to accept when conventional medical treatment is the best course of action.

Sarah really wants to remind listeners that medication is not a failure.

Stacy reiterated this to listeners. No matter how hard you AIP it, you may still need medical intervention. This is ok, and this is why modern medicine exists.

This is also not an excuse to do the hard work of diet and lifestyle.

The healthiest approach is to prioritize the diet and lifestyle changes that are going to support lifelong health while using conventional medicine judiciously and in an informed way.

It is a matter of using all the tools available to us. (41:29)

We are talking about close medical supervision and frequent thyroid testing, which is why EverlyWell's affordable testing may be a great option for anyone going through this.

It is important to know that needing this close medical supervision and needing to take medication, doesn't make you a failure. It also does not get you off the hook and mean that it is ok to go eat all the fast food.


Closing Thoughts

Stacy thanked Sarah for all of her in-depth science and dose of reality.

What has been interesting for Stacy on her health journey is that she has different thyroid symptoms from Sarah. She technically has thyroid disease, but she doesn't need medication.

Stacy knows that she needs to retest, which is what she plans to do through EverlyWell.

There is a variety of different health conditions, and they impact you differently at different phases in life. (44:54)

The path to healing and health is not linear.

Stacy thanked Sarah for reminding her to check on her health from a numbers perspective.

If you need to do some self-checking, you can do that through EverlyWell and get 15% off your order with the code 'ThePaleoView'.

No matter how nervous you might be about the results, it doesn't actually change what your health condition is by avoiding testing for it.

The testing gives you actionable information.

Thank you again for tuning into this week's episode!

Stacy thanked Sarah for doing all the research she did while jet-lagged, and that we are happy to hear that her Dad is on the path to recovery.

Sarah and Stacy will be back again next week!

Welcome back Paleo View listeners! (0:41)

It has been a week for Sarah, but just a few days since Stacy and Sarah last recorded, as they recorded episode 369two days ago.

Sarah thanked Stacy for pre-recording with her.

While she hasn't talked about this much on social media, Sarah wanted to give this special group of listeners a unique window into her life.

Sarah wanted to share what has been going on in her life. She has been in crisis mode, working through the steps of what she needs to get done.

The next step is going to require that she travel all next week. She knew she wouldn't be able to record a full topic show.

By the time this show goes live, it will have been almost two weeks since Sarah's father had a massive heart attack. He was on a city bus at the time that it happened, going into full cardiac arrest.

Sarah's Dad was dead for three to four minutes, and there happened to be someone on the bus who really knew CPR. They were able to do CPR effectively until paramedics arrived.

Once the paramedics arrived, it took two shocks to get his heart beating again. They were then able to transfer him and treat him at the hospital. Sarah's Dad will have a long recovery ahead of him, but he seems to be on the road to recovery.

One of Sarah's big takeaways from this all was that her Dad didn't have emergency contact information attached to his identification or his file.

The hospital didn't know who to call. Sarah's Dad was in the hospital for two days before Sarah and her family knew about what happened.

Sarah was still waiting to receive her passport from her change in citizenship and hasn't been able to be with her family during this time.

However, Sarah has been so impressed with how her brothers rose to the occasion. Once her passport did arrive, Sarah looked to her brothers to tell her how to jump in and help.

The family doesn't yet know the endpoint of her Dad's recovery. If he will be able to live independently or if he is going to need someone to come into his apartment.

There is no heart disease in Sarah's family that she knew about. This situation felt very out of the blue. Sarah shared more about how she is processing this event. In addition, Sarah shared more about how this is changing her habits around diet and lifestyle.

Sarah is walking more, making sure that she is going to bed early, eating more vegetables, and eating sardines for breakfast daily. (11:50)

Soon Sarah will be heading home to help out as much as she can. The plan is to take this all one step at a time.

Stacy shared her love for Sarah and her family during this time.

When Matt was in a terrible car accident, Stacy learned the importance of having emergency contact information on hand. Stacy thanked Sarah for pointing this out.

Sarah has found many life lessons throughout this whole experience.

Stacy asked Sarah to share more about the healing and recovery foods she mentioned earlier in the show. (17:36)

Sarah is trying to make soups and stews that will be easy for her Dad to reheat. She is also focusing on the nutrients that will help with his healing process.

A really big thing for heart health is omega-3 fats and monounsaturated fats. One of the things that Sarah will be doing is making sure he has high-quality olive oil to cook with.

When taking fish oil, capsules are better. Capsule form protects from oxidation. Sarah particularly looks for tuna oil as an ingredient, as it is high in DHA.

Sarah will also put her Dad on Just Thrive probiotic.

In addition, Sarah will make sure she is helping to increase her Dad's vegetable intake. At home, Sarah uses pumpkin or overly cooked cauliflower, to then blend and thicken the stew. This is a great way to hide extra vegetables and increase vegetable intake.

Stacy loves this method of stew prep as well. She personally loves to use roasted butternut squash as her thickener.

Before leaving to be with her Dad, Sarah is also working to fill her own freezer with nutrient-dense meals for her husband and daughters.

Sarah will be also checking her Dad's snack supply once she arrives at his house. She will make sure that he has unsalted nuts around, like pecans, walnuts, macadamia nuts, and cashews. To make it even easier for him, she will likely measure out the portions and prepare individual serving sizes for her Dad to grab.

In addition, Sarah plans to talk to her Dad's doctor about adding a CoQ10 supplement.

Sarah will also be looking at her Dad's potassium intake and adding in potassium-rich fruits and vegetables.

When you are sick and recovering from something you don't want to eat something that feels foreign. (27:13)

Sarah has had other friends in her life, where she has seen how challenging it is when you are recovering from something to modify your diet at the same time. If her Dad doesn't like something he simply won't eat it. So Sarah needs to find a way to get the nutrient-dense foods into him while he is recovering and not feeling well.

Eventually, Sarah will also look to get her Dad's vitamin D levels tested.

B vitamins, all of the antioxidant vitamins and all of the electrolyte minerals are really important when it comes to heart health. As long as you are eating good vegetables, you will be meeting these needs. However, since Sarah lives so far away, she isn't sure what her Dad is eating on a regular basis.

Sarah also plans to get her Dad walking on a regular basis, but it will be a slow start as his heart heals.

If any of The Paleo View listeners have cardiovascular disease risk factors and you are interested in digging into it a little bit more, Sarah recommends that you get enough sleep every night. Sleeping less than six hours a night doubles your risk of stroke and heart attack. Stress and activity are also very important. (30:39)

The only other key thing that Sarah recommends, is getting genetic testing for APOE. If cardiovascular disease runs in your family, getting tested for APOE is a really good thing. Sarah personally likes MaxGen Labs for genetic testing. However, even a functional medicine doctor can add it to a blood test and just check for your gene variance of that one gene.

Stacy thanked Sarah for taking the time to both tell listeners what is happening and to share this helpful information. If you have further questions on this topic, please feel free to pass those questions on. They may be incorporated into future shows or blog posts.

Thank you for tuning in and being here! Stacy and Sarah will be back next week! (35:17)

  • (0:40) Welcome

    • Hey listeners - welcome back to The Paleo View!
    • Stacy and Sarah geeked out over the math specialties of this episode number 369
    • Sarah wished Stacy a Happy Birthday!
      • Stacy talked about what happens when you get older and what she is noticing
      • Today on the show, inspired by Stacy's own aging journey, the hosts are going to talk about aging as a woman
        • Specifically perimenopause and menopause

          • As we get older what happens from a physical perspective
          • What can we do about it from a lifestyle perspective
    • Stacy wants to remind people before they dive into this topic that the great think about heading into perimenopause and aging is that you are still alive
      • Stacy feels like this is lost on a lot of people
      • Feeling gratitude to be alive and to focus on finding your best health
    • Sarah gave a shoutout to this week's episode sponsor, EverlyWell
      • Stacy and Sarah love this at-home lab testing company that offers a variety of tests, ranging from Food Sensitivity to Metabolism, to a Thyroid Test, Vitamin D to a comprehensive Women’s Health Panel
      • The Paleo View listeners can use the link below to get 15% off their order with code ‘ThePaleoView’
  • (5:42) The Science

    • Often the term menopause is used as this catchall

      • It actually means the end of the change of life

        • The time in a woman's life when she can no longer reproduce
        • It is marked by at least a year without a period
    • Perimenopause refers to that period of time that is the transition between pre-menopausal (reproductive years) and menopause (no longer reproducing)
      • For most women, the transition will start sometime in their 40's, usually late 40's
      • Some will start to notice some changes in their mid 30's
      • It can be almost instant to more than a decade in time
        • Between 4 to 10 years is average
      • What is happening during this period of time is that estrogen levels are starting to drop
        • As estrogen drops, it can drop rapidly, and that hormone shift can cause a lot of the symptoms
        • Throughout perimenopause, estrogen can cycle in a weird way
          • It stops being the regular cycle that we have during our menstruation cycles
          • It starts being more unpredictable
          • This is what drives all the symptoms
      • Symptoms:
        • Hot flashes
        • Sleep problems
        • Vaginal dryness
        • Irregular periods
        • Worse PMS
        • Breast tenderness
        • Weight gain that isn't linked to diet and lifestyle
        • Changes to your hair
        • More rapid heartbeat
          • Cardiovascular disease risk factors will often increase
        • Headaches
        • Loss of libido
        • Cognitive challenges
        • Challenges conceiving
        • Muscle aches
        • Urinary tract infections
        • Night sweats
        • Fatigue
        • Dry skin
        • Overactive bladder or urinary incontinence
        • Hyperthyroidism
        • Chronic disease risk implications
    • Stacy is feeling a bit of anxiety over all of the symptoms Sarah mentioned
      • Stacy's mom hasn't gone through perimenopause yet and it is interesting to Stacy how much variability there is in one person's experience to the next and the role that genetics play
    • Sarah and Stacy discussed if/how pregnancies impact one's menopause timeline
    • When looking at this list of symptoms, Sarah wants to emphasize that some of these can be driven by stress levels and/or early perimenopause
      • If you have a hormonal imbalance this is a good situation to work with a functional or integrative medicine specialist and do some hormone balancing

        • These symptoms can be alleviated by balancing hormones
        • Hormone balancing protocols are typically very personalized and involve tweaking hormonal doses to get them into the normal range
      • The way to test is to look at the female hormones specifically
        • EverlyWelldoes offer a very comprehensive Women's Health panel
        • Sarah's non-medical recommendation would be to combine this with a cholesterol and lipids test
          • Also measuring Vitamin D levels would be helpful to measure at this point
        • Stacy recommends going back and listening to the Functional M.D. podcast episodeif you are wanting to figure out how to find someone who can help you with some of these things
          • Taking these tests yourself and looking at the information is going to be the best way to not just hear someone tell you that your only option is to get old and medicate
          • Educate yourself with these tests and know where your inflammation markers are so that you are educated when you talk to a medical professional
        • Sarah notes that the conventional medical model is symptom alleviation with prescription medications
          • There are situations where women are on 8 to 10 different medications that are each for an individual symptom of menopause
          • There are some really interesting studies that look at diet and lifestyle interventions and show that they are far more effective
          • Given the link between nutrition and lifestyle and how easy this biological transition/tradition is that we go through, Sarah thinks that it is a real lost opportunity to educate people in terms of a healthy diet and lifestyle
            • There have been studies looking at other cultures and their traditional diets

              • These studies have shown that women in those cultures have a far lower rate of reporting symptoms of perimenopause

                • Ex: Only 10% of women in China, 17% of women in Singapore, and 22% of women in Japan report hot flashes as part of perimenopause
                • In contrast, in the US, 75% of women over the age of 50 report having hot flashes
              • It does look like these diets are much higher in vegetables, fiber, lower in fat content
              • There is a collection of research showing that the typical Western diet (high fat, low fiber, a lot of animal foods) can cause high estrogen levels in women
                • Which means as these women enter perimenopause they are going to experience a more dramatic drop
              • There have been studies now looking at vegetable and fruit consumption and menopausal symptoms
                • These studies show that the higher vegetable and fruit consumption is, the fewer symptoms of menopause are experienced
                • It's inversely correlated with sugars and fats
              • There is a fair amount of evidence showing that fiber is really important
                • Fiber helps to bind with excess hormones and eliminate them
                • So it is a very important element to hormone regulation
  • (36:20) The Role That Diet & Lifestyle Plays

    • There is this new paradigm for understanding the symptoms of menopause where scientists are starting to make a case for them being largely driven by oxidative stress

      • Oxidative stress translates to inflammation, but it means that there are a lot of oxygen radicals in the body

        • Oxygen radicals in the body are not just driving inflammation, but they are also impacting cellular health

          • They are impacting DNA
        • Oxygen radicals are the things that cause aging
      • One of the reasons why cruciferous vegetables are thought to be so beneficial for menopausal symptoms is because they are particularly high in antioxidants
    • The data shows that deficiency in these nutrients can magnify menopausal symptoms, it is really mixed as to whether or not supplementation can help
      • It emphasizes the importance of a healthy diet going into perimenopause and maintained throughout

        • Vitamin E
        • Vitamin C
        • Vitamin B12
        • Vitamin D
        • Vitamin B6
        • Vitamin A
      • Sarah still thinks food sources are the best sources
      • Menopause increases the likelihood of B12 deficiency
        • This likely drives a lot of the insomnia symptoms that are experienced in menopause
      • A diet that includes organ meat, seafood and lots of plants would be the best way to structure a diet to meet these nutrient requirements that mitigate the effects of low estrogen
        • Stacy's favorite way to get the nutrients from organ meat is through liver pills
    • To be completely upfront with the podcast listeners, Sarah noted that neither her nor Stacy are perfect
      • They cycle in terms of what a good job they are doing in terms of diet and lifestyle
      • They have both been really open about this on the show
      • This is a lifestyle that does require a renewed commitment from time to time, as it is important
      • Be able to recommit without guilt or blame
      • Periodically we all need a reset
      • One of the reasons why Sarah blogs and podcasts is to keep her accountable
      • Perfection is an unachievable goal
      • Stacy reminds people that the aging process happens the moment we are born
        • When we can accept this process we can more easily learn how to manage the process
    • Lifestyle is also really important for menopausal symptoms, especially exercise
      • There is certainly a stress link and there are many recommendations in the mainstream health resources available about how to reduce stress

        • Meditation
      • In addition to mindfulness practices, getting enough sleep is another powerful tool when managing stress
        • With sleep disturbance as a part of menopause, the way to get enough sleep is to exercise

          • There have been a variety of studies that tackle this from two ways

            • One: they look at women, their symptoms and how much they exercise

              • Basically moderate physical activity has less than half the amount of psychological and physical symptoms of menopause than those who don't exercise much
              • High levels of physical activity is not beneficial to menopausal symptoms
              • An hour(ish) a day of low to moderately intense activity is what to shoot for here
          • There is a consistent reduction in symptoms with activity over time
            • One study did 50 minutes of unsupervised aerobic training, four times per week

              • They saw a 2% improvement in hot flashes per week, continuously over the 6-month length of this trial
          • Plus there are a lot of other benefits that come with consistent exercise
            • Improve bone mineral density
            • Maintain muscle strength
            • Improve sleep quality
            • Improve mood
            • Reduce anxiety and depression
            • Reduce irritability 
            • Reduce hot flashes
    • If we take all of this, we are boiling it down to: be active and eat a lot of vegetables
      • These are the two recommendations that have the strongest support in the medical literature
      • Make sure cruciferous vegetables make it on the plate every day
    • If you feel like you are doing all the diet and lifestyle things, but the symptoms are still really impacting your quality of life, there is definitely a time and a place for hormone replacement therapy for menopausal symptoms
      • Sarah recommends workings with a Functional Integrative Medical Practitioner who has training in hormone balancing and who is going to do testing and be up to date on the literature
    • Stacy gets a lot of questions around skincare for aging skin, specifically as women enter their 30's
      • This is when women's collagen and moisture in their skin goes down
      • The number one thing to keep your skin from aging is hydration and moisturization 
        • Also preventing oxidative stress with SPF and things like that
      • Damage to our skin is caused by environmental factors, as well and genetics and all the hormones Stacy and Sarah have talked about on this show
        • So you want to make sure you are addressing it from both angles if you want to reduce the signs of aging
      • Hydroxy acids or fruit acids are a powerful tool
        • These are widely studied as far as antiaging goes
        • You can often find them listed as AHA or BHA
        • This is essentially going to slough off the skin through exfoliation
          • It should cause a reduction in acne, scars, and pigmentation
      • Other ingredients that are helpful: 
        • Hyaluronic acid

          • Using a moisturizer with hyaluronic acid in it is going to help maintain the moisture in your skin
        • Collagen
          • Stacy takes it as a supplement every day, also drinks bone broth, and eats cuts of meat that is rich in collagen
          • You can increase topically your use of Vitamin C which helps synthesize collagen
      • Most of the antiaging skincare products out there targeted to women's skin that is aging contain hormone-disrupting ingredients purposefully
      • The two things that Stacy has found the most results from are:
        • Dermabrasion 

          • Stacy has a tutorial on this process on her Instagram stories
          • Once you remove that top layer of skin, you are going to want to nourish that fresh skin
          • Stacy uses BeautyCounter's Overnight Resurfacing Peel
            • This product is free through the month of September 
            • You can learn more here
      • Sarah uses a mix of brands that work for her skin
        • However, Sarah did use the Resurfacing Peel that Stacy shared with her and was very impressed with the results
      • Stacy shared on how BeautyCounter tests their products for safety
  • (1:15:27) Closing Thoughts

    • EverylyWell offers a lot of really great testing kits for accessing that health piece

      • Including addressing hormone imbalances, thyroid health, cardiovascular disease risk factors, cholesterol, vitamin D levels, and all the other things that are really important to women's health
      • You can visit this linkto get 15% off your order with the ‘ThePaleoView’
    • Stacy knows that this was a topic that has been highly requested by listeners, and she hopes everyone enjoyed it
    • Stacy thanked Sarah for all the time she put into the research required for this show
    • If you have follow up questions, Stacy and Sarah welcome them
    • Please remember that neither Stacy nor Sarah are medical professionals and they cannot give listeners specific advice for your particular health issue
      • However, they are happy to address things from an overall perspective
    • Use the comment forms on either Stacy or Sarah's site to submit questions
    • Stacy and Sarah love to hear from listeners on social media
      • Please keep tagging Stacy and Sarah when you share
    • If you learned something and enjoyed the show, please be sure to share it with someone who you think could also learn from this episode
    • Thanks for listening! 
  • (0:40) Welcome

    • Welcome back to the Paleo View listeners!

      • Episode 368!
      • Not 369, even though episode 368 was already recorded, but with a tech glitch
      • Stacy and Sarah hope you enjoy the benefit of them already practicing this show one time through
    • Special thank you to this week's sponsor, Joovv
      • A speaker reached out with a question about his Joovv:

        • Lorenzo has the Quad Joovvand there is a little bit of a gap between where his Joovvpieces connect. Should he stand still or move side to side for max benefits?

          • Sarah shared details on the design of the Quad Joovvand the way it is designed to be full-body
          • Sarah has this model as well and what she does is move a little left to right
          • Ideally, you should be standing about one to two inches away
          • Sarah does 10 minutes facing her Joovvand 10 minutes with her back to it
          • Stacy does a little bit longer with her back to the Joovvas she finds that it helps with her injury and joint pain
      • Stacy and Sarah both love their Joovvsand you can learn all about them by visiting this link:
      • Sarah shared information on a recent study that Joovvshared on how it impacts sleep hygiene
        • Sarah uses her Joovvbefore bed for these reasons, and it is a natural part of her evening routine
        • Stacy uses her Joovv first thing in the morning
    • Stacy is looking forward to being a student on this week's podcast recording, as she knows nothing about varicose veins
    • Sarah is bringing both personal experience and science to this week's episode
  • (15:05) Q & A

    • From Christine: 

      • Before I get to my question, I want to thank you for all that you do, Sarah and Stacy.

        • I especially love your podcasts! I will admit, I am digging into your podcast archives, so don't judge me.
        • I listen to them while I log core at work, enabling me to be doubly nerdy!
        • As a fellow scientist, I appreciate your no-none-sense approach to tackling questions and information with science.
        • Even my husband (who is a chemist) loves how informative and science-based your podcasts are! Ahem, I curate select episodes for him, as it has helped him immensely in understanding AIP and profoundly improved our marriage.
        • The information and advice you provide, has empowered me to ask the right questions and find the right medical providers.
          • Prior to finding your websites and podcasts, I sought medical treatment from a primary care physician.
          • I remember the last time I saw him: I was sitting in his office, feeling horrible after eating lunch, asking him to test me for Celiac Disease.
          • I started explaining my symptoms, then he proceeded to tell me that I didn't have Celiac Disease because I didn't have diarrhea (sorry Stacy).
          • When I explained that another symptom, infertility, was an issue, as my husband and I had been trying to conceive for 4 years without any success whatsoever; he told me, "Sometimes, it's just not in God's plans."
          • I swallowed my tears and persisted. Finally, he conceded after I told him that my family has a history of Celiac Disease.
          • The two of you have made me feel empowered enough so that I moved on from that physician and found the right one for me.
          • I feel like I can intelligently speak to my provider and be my own advocate. I am so deeply grateful.
      • Now for my question... I have been making leaps and bounds on AIP over the last couple of months, after being treated for SIBO and supplementing my meals with HCl.
      • I noticed for the first time in my life that my skin became soft and my nails also soft and lustrous... but, what really surprised me the most was that my varicose veins have almost disappeared.
      • I've had them on both of my calves for about 15 years and thought that I was stuck with them for life. I was so self-conscious of them, that I rarely wore shorts or shorter dresses in public, or if I did, I wore tights or pantyhose.
      • This has led me to wonder... What causes varicose veins?
        • How are they autoimmune-related?
        • Are they specific to certain autoimmune diseases?
        • What can I do (from a diet standpoint) to keep promoting the elimination of the varicose veins?
      • I love that AIP has opened so many doors to good health for me and so many others.
      • AIP has helped me feel confident and beautiful again...something I thought never possible. I am so deeply grateful for what you have given me.
    • Stacy wants to pause to say how mad she is at that doctor and how proud she is of Christine
      • She is so proud that Christine was empowered and is giving her long-distance fist bumps
      • Sarah is sending all the high fives
      • Stacy wants to be friends with Christine
    • Varicose veins affect about 24% of Americans and there are estimates that upwards of 40% of adults will get them at some point in their lives
    • Unless you are one of these adults, you don't typically hear about varicose veins in the national health conversations
      • This is because they are considered relatively benign
    • Varicose veins are a vein where the walls have gotten weak and essentially collapsed on itself
      • Because it collapsed it gets twisty
      • It creates spots where blood can either backflow or pool
        • Veins have valves in them that stop blood from flowing backward in between heartbeats
        • Because of the weakening of the wall in the vein, the vein will kind of expand
          • This then pulls the valves apart and the valves end up failing which is how you get this backflow or blood pooling
      • Most of the time they are asymptomatic
        • They have this characteristic dark blue or purple appearance and they can bulge out
        • They don't often feel like anything - they are typically just there
        • They can be very uncomfortable
          • They can ache, feel heavy, cause muscle cramps, itchy, burning, throbbing sensation, the skin around them can be irritated
        • Overall they are benign, but there is this extreme symptom version of them
          • When people start feeling these symptoms, this is typically when they will get varicose veins treated
    • Having varicose veins does slightly increase the risk of blood clotting
      • It is called thrombophlebitis
      • These are big problems and require immediate medical intervention
      • It is a small fraction of the people with varicose veins that have this complication
    • Causes of varicose veins
      • It is not super well understood
      • There is a fair amount of research being done of them, but it is from the angle of how to treat varicose veins
      • There are little bits and pieces to the puzzle that have been figured out:
        • The weakening of the vein wall might be due to changes in collagen or elastin
        • There is some kind of chronic inflammation type part of the recipe for making varicose veins
        • There are other possible scenarios:
          • Ex: the blood clot coming first that then causes the varicose vein
          • Physical trauma can also cause them
        • There is also a familial link
          • However, no genes have been identified, but it does tend to run in families
        • Other risk factors are:
          • age
          • being a woman
          • being obese
          • sitting or standing for too long
          • having high blood pressure
          • pregnancy
            • Sarah first developed varicose veins during her pregnancy
        • It all boils down to things that are more likely to make the vein varicose
  • (26:01) The Role That Diet & Lifestyle Plays

    • There is no known link between varicose veins and autoimmune disease

      • There are a couple of autoimmune diseases that affect connective tissue, which has an increased risk of varicose veins
      • But they are not linked to autoimmune disease in general
    • It is such a high-frequency condition that it is really hard to make a link to other chronic diseases
      • The statistics show that basically varicose veins are its own vascular disease

        • Inflammation may be part of it, but there is no autoimmune component to it
    • It is interesting to Stacy that varicose veins do have an inflammation component to it, and that going to an autoimmune protocol reduces inflammation
    • Sarah noted that the autoimmune protocol is designed to help the immune system regulate itself
      • It means that it's applicable in more than just autoimmune disease conditions
    • There are some diet links, but the science is still very preliminary
      • The best understood dietary link with varicose veins is dietary fiber

        • Sarah shared more on these studies and the reasoning behind their findings
        • A squatty potty would be a great way to help with this scenario
        • However, if you are following an AIP you are already getting a high fiber intake from your vegetable consumption
      • The other nutrients linked to varicose veins:
        • Vitamin D deficiency

          • Supplementation seems to help them
        • Folate deficiency
        • Flavinoids in general
        • Plant extracts have also been tested in clinical trials and have been linked to reducing varicose veins
      • There are other nutrient deficiencies links that have been found, but it isn't known if supplementation helps in these scenarios
        • Not getting enough protein
        • Vitamin C
        • Omega 3's
        • Zinc
    • It doesn't surprise Sarah that the autoimmune protocol would benefit varicose veins
      • Or at least make them shrink
      • There are going to be times where the damage is enough that there is no amount of good diet and awesome flavinoids that are going to reverse that
      • From a stopping the progression perspective and from helping veins that still have enough structure to return to normal, that makes a lot of sense
    • The other link to the autoimmune protocol that makes sense for varicose veins is to add in exercise
      • There are a lot of studies showing that the more active you are the lower your risk for varicose veins

        • There have been a few intervention studies that have taken people with really bad varicose veins and put them on some kind of exercise regimen
        • It seems like exercises that are specifically geared at increasing leg muscle strength are particularly helpful
      • Sarah explained the explanation behind this link in greater detail
    • Stacy asked Sarah is collagen supplementation could help with varicose veins
      • Sarah tried to be as thorough as possible in her research, and couldn't find a study where collagen supplementation was actually tested
      • From an intellectual perspective, it makes sense to Sarah that supplementing with collagen and making sure that you are hitting all those other nutrients that are really important for collagen formation will help
        • However, she can't point to a scientific study that says that is the case, or how much to take
    • If varicose veins are the only thing you are dealing with, you probably don't need to go full board AIP
      • You can look at the nutrient density of your diet
      • Address things like long periods of sedentary time
    • There is very little data comparing the different types of medical interventions for varicose veins
      • They are all thought to be good for a while, but the chances of another vein blowing are really high

        • The treatments are not treating the root cause
    • Compression stockings can help varicose veins but are working to simply keep things where they are
      • Veins can still continue to varicose if you have a lot of these other risk factors
    • If your legs are starting to ache your doctors will tell you to eat more fiber
      • Sarah's translation to that is to focus on the nutrient density of your diet by increasing your vegetable intake

        • She would also suggest exercise and compression stalkings
      • This will help some people, but will not be sufficient for others
    • The medical treatments that are available right now are surgery, laser therapy, and Sclerotherapy
      • There are a lot of options for treatment
      • Sarah recommends doing your research about all the available options
    • However, Christine is a wonderful testament to the power of diet and lifestyle
      • Sarah definitely recommends trying some tweaks to diet and lifestyle and compression stalkings first
  • (47:04) Closing Thoughts

    • Stacy learned a lot today and thanked Sarah for her research
    • Thank you, Christine, for your wonderful question!
    • Please feel free to submit YOUR questions through the forms on Stacy and Sarah's websites
    • A special thank you again to this week's sponsor, Joovv
    • If you enjoyed the show and know someone who can benefit from it, leave reviews and share with those you know
      • Leave comments on social media as well to help Stacy and Sarah broaden their reach to get this information to as many people as possible who are looking for healthy living resources
  • (0:40) Welcome

    • Hey listeners - welcome back to The Paleo View!
    • Stacy is just going to jump right in because this week's topic has been something she has been ranting about for a few weeks now
      • Sarah looked into it after Stacy brought it up, and also agreed that a show needed to be done on this topic
      • When Sarah started to do the research on it she too got fired up
    • Stacy wants to give a little preface and introduction to those listeners that might not know what Sarah and Stacy are talking about or who might come to it from a different perspective
      • Stacy is going to talk on her own about her personal experience
      • Sarah has also dealt with the struggle with weight her whole life
      • The perspective that both Stacy and Sarah have, and what Stacy wants to focus on, is that Stacy's weight loss journey was never about calories in - calories out
        • There were emotional issues and there were health issues
    • Today Stacy and Sarah are going to talk about weight loss for children
      • The message that Stacy wants to share is that the foundation that we set for our kids at a young age is what is the foundation for their lifetime

        • Stacy's concern is that when we introduce something like a weight loss program for kids, not only are we dealing with all the science that Sarah is going to cover on why this can be detrimental to their health

          • But from Stacy's perspective, this was the start of an emotional relationship with food that went the opposite of a good direction
          • Stacy did end up getting therapy for bulimia and binge eating disorder as a teenager
            • She went on diets on and off so much
            • Diets were a part of her family culture
              • Stacy doesn't feel like they knew better back then
              • People encouraged family members to go on diets because they were thinking about their health
              • Now there is a much better understanding of health at any size, and there is more to health than just your weight
      • There is an insane amount of diet culture pervasiveness
        • To add to this blew Stacy's mind

          • We now know that asking children to diet creates this yo-yo roller coaster for them
          • It strips away the confidence or perceived support that they might have from focusing on positive healthy activities vs. counting calories
        • When this weight loss program for kids came out, Stacy got so angry
          • She wanted to hug every single one of these children and tell them that they are wonderful just as they are
          • We need emotional support for these kids and teaching them good habits
            • Focusing on and praising the things that are really good in their life
            • And doing it with them
      • Stacy shared on her experience with being obese and why she is so passionate about this topic
      • Sarah noted that kids are more emotionally vulnerable
        • Teaching our kids that they are doing something wrong around the culture of weight significantly impacts their emotional health
      • Sarah was a robust kid, but she wasn't overweight until her early teens
        • It became a self-fulfilling prophecy
        • There were many external influences that led to Sarah developing a binge eating disorder and eventually reaching a morbidly obese weight
          • In part, because she had an underlying health issue that was driving her weight gain and this went undiagnosed for something like 30 years
          • It felt to Sarah like nothing worked and it didn't matter what she did
            • The things that Sarah was doing were the popular diets at the time
          • As Sarah digs into the data, she thinks that this weight loss program is not just everything wrong in supporting healthy habits in kids
            • But it goes so much beyond that because we have this culture now where 91% of American woman have dissatisfaction with their bodies
            • This is what we are doing to ourselves, and then teaching our kids
              • We are teaching them that there is something wrong with them and that they have to fix themselves
          • Diets themselves can be physiologically harmful
            • It is not just the psychological effects
          • Sarah thinks that this is a symptom of a cultural phenomenon that is corrosive
            • We put these underweight body types on this pedestal of being the height of beauty
            • When what is healthy is actually heavier than this
            • We then shame everybody else
            • We shame people if they are not underweight
          • This was eyeopening to make Sarah think about how she talks to herself and how she treats herself
    • Sarah wants to emphasize that the fixation in our community on weight instead of health is wrong
      • Sarah wants every one of The Paleo View listeners to look at your actions and self-talk and really think about it as objectively as you can
      • How can we together as a community move forward to address every aspect of this
      • What are we teaching our children about how to navigate healthy choices in life based on how we talk to ourselves
    • Stacy encourages you, the next time you talk to yourself - if you were saying that to your child, mother, or best friend would you say it the same way that you talk to yourself?
      • You can both accept yourself and love yourself and respect yourself as you are today
      • AND make healthier habits and changes
        • However, the guilt and shame associated with the negative self-talk and mindset is so pervasive that it causes self-destructive habits when you don't achieve perfection
        • It begets this negative cycle telling yourself that you are a worse person when you don't achieve an appearance
      • Stacy has challenged herself over the last year to no longer acknowledge people's bodies
        • If she comments on appearance, she makes it about how happy someone looks or how healthy they look

          • Words that don't associate with emptiness
        • This has been a habit she has had to shape
    • As Stacy and Sarah jump into the rest of the show, Stacy encourages you to think positively about the changes you can make in the future and feel good about it
      • This is the kind of thought process that will help you achieve your goal
      • If you get caught up in reflecting back and thinking negatively, you will get sucked up in a black hole
  • (19:50) The Research on Diets Longterm Effects

    • Sarah wants to go through some data to reinforce the importance of taking some time and revisiting these periods of self-reflection when it comes to how each one of us in contributing to diet culture
    • It has been known in the medical literature for about 20 years that going on a diet as an adolescent dramatically increases the risk of developing an eating disorder
      • This was all launched by this well-done study from 1999 where they looked at 2,000 teenagers and did a whole pile of medical analysis

        • They looked at:

          • Lifestyle factors
          • Surveys to look at mental health
          • Starting weight
          • Activity levels
          • Gender
        • They discovered that the single biggest predictor of an eating disorder (looking at just anorexia and bulimia):
          • In the kids who were on a severe diet, they were 18x more likely to develop an eating disorder
          • In the kids who were on a moderate diet, they were 5x more likely to develop an eating disorder
        • Things that didn't affect the chances of developing an eating disorder:
          • How active the kids were
          • What their starting BMI was
    • There have been a variety of follow up studies that have confirmed these results
      • They have added binge eating disorder and obesity
    • There was a 2016 studypublished in the American Academy of Pediatrics that was like a review paper showing that dieting (defined as caloric restriction with the goal of weight loss) was not only a risk factor for developing eating disorders but it doubled the risk of obesity
      • Often the diets that these kids and teens are going on are not nutrient-dense
      • It is not just calorically restricting, it is nutrient restricting
        • Even on some of the more forward-thinking diet plans that have unlimited vegetables, are not actually teaching people how to eat enough nutrients
    • We are seeing that the psychological damage is almost certainly from that cycle of body shame, the stigma that is associated with it, and the anxiety, stress, and depression
    • Sarah now talks a lot about healthy weight loss in her workshop and educational resources
      • She has an online course that is very much about health goal setting and addressing habits to normalize weight in a healthy way
      • It ditches this mentality of losing a certain amount of weight for a life event
    • One of the reasons that weight-loss maintenance is so challenging (especially the higher the caloric restriction), your hunger hormones increase
      • Your metabolism decreases, and your hunger increases
      • Most of these diets are not rich enough in protein to maintain lean muscle mass
      • It is essentially a recipe for weight gain
      • Unless you approach this in the right way, which is:
        • Healthy habit development

          • Eat more vegetables
          • Get more sleep
          • Live an active lifestyle
          • Manage your stress
          • Make sure you are eating enough protein
        • These habits will allow you to normalize weight and keep it off
        • It is very much about healthy choices and not necessarily a particular goal
    • What is happening in these kids the diets that they are going on is setting them up to fail and to yo-yo
      • They are very goal-driven with an emphasis on, 'the faster the better'
      • They are not focused on a nutrient-rich approach
      • Losing weight is inflammatory and increases oxidative stress
    • Weight loss is a process that requires an education
      • The problem with these weight loss centers is that they said you up to yo-yo

        • There is this assumption that if you don't lose weight fast enough you won't stick to it
        • But if your approach is not making you healthier, it is hard to stick to
        • This process magnifies shame
          • You end up in both a physiological and psychological cycle

            • The physiological cycle is changing body composition in a way that is increasing the risk of health problems with every cycle
            • The psychological cycle is a cycle of shame and failure and reward
              • It magnifies the shame when you cannot stick to this thing that you physiologically set yourself up to not be able to follow
    • Sarah feels strongly about not distilling diet or lifestyle choices to yes's and no's - the things to do and the things to not do
      • Not to put this stigma on no foods
      • And to not express things so simplistically that you cannot understand the why behind the choice
    • Kids do not understand things like muscle weighing more than fat or how hormones and metabolism play into things
      • So think about the impact to a child who is being publically weighed
      • When we introduce these ideas to kids they see it more simplistically
    • The more that we can learn the lingo, the science and the information (the why and the how), so that we can help our children understand it, the more we can combat diet culture within our households and communities
    • Nutrient deficiencies are one of the strongest links to chronic disease risks
      • It turns out when you eat a nutrient-rich diet it supports the reduced risk of disease, which is really the thing that matters

        • Not if you fit into those jeans or look good in a bikini
        • We have trained ourselves to not look for the visual cues of health
          • Thick, shiny hair
          • Glowing skin
          • A giant smile
          • Energy
          • Muscle
    • Sarah says that body composition, as opposed to your weight on the scale, is very important
      • It is far more important how much muscle we have, as opposed to fat
    • This paper that looked at diet and risk for eating disorders showed that exercise did not increase the risk of eating disorders
      • So just being active is a super healthy lifestyle choice that improves our health in a number of ways
      • If we can separate activity away from weight loss goals and diet mentality, it is a super healthy thing to do
    • Metrics of health, we can also look at inflammatory markers in the blood, lipid panels, mood, energy levels
      • These are far more important things for us to evaluate both in ourselves and in our kids

        • Are our kids getting enough sleep?
        • Are they active?
        • Do they have energy throughout the day?
    • People can be underweight, overweight, and average weight and have tons of health issues
  • (42:28) The Impact Beyond the Scale

    • For Stacy, she never saw anybody who looked like her in her early life

      • Healthy at any size wasn't an actual thing
      • It didn't make her feel good to not see anyone who looked like her in pop culture
        • Which only further enforced this idea that she needed to be thin to fit the ideal

          • Thin was healthy and that was the marker of health Stacy was taught to work towards
    • Now there is so much more information than there use to be
      • Stacy has such hope that the next generation will have this information and will go back to the way that their grandparents lived

        • Not just eating whole, nutrient-dense, low-inflammatory foods, but also using less plastic and all the other things that go into health
      • If where we are going is putting children on weight loss programs and not talking about the things that really matter and helping them understand the emotional and physical impacts of nutrient and caloric restriction, then we are doomed
      • Stacy says we have to be change agents
    • One of the things that Sarah finds really interesting is what it is doing to our epigenetics to go on these weight loss programs
      • There is data from the last 10-15 years showing that under-nutrition is linked to a dramatic list of negative health consequences that transcends generations

        • One of the most interesting studies is the Dutch health study that looked at times of famine and how those impacted the health of the people depending on how they were and the health of their children, and now their grandchildren

          • The kids who were the same age as those who these weight loss programs are targeting (8 to 17) were a particularly sensitive group

            • Women who were between 10 and 17 at the start of the famine had later in their life a 38% increased risk of coronary heart disease
            • It does damage our body to have severe caloric restriction
              • It increases our risk of some cancer, type-2 diabetes, obesity, immune suppression, mental health disorders, and more
            • The children of these women are shorter
            • The study is now showing the increased rate of diseases through turning on these adaptations genes so your body is trying to survive a time of famine and this is turning some genes off and some genes on
              • And they are seeing that this is inherited
      • We need to fix this for our children's generation
        • We can actually point to genetic changes as a result of dieting that can then be passed on to their children that is then going to increase their risk of chronic disease

          • This is the opposite of health
    • While Sarah was talking, Stacy had a moment of guilt thinking about her history, but then she snapped herself out of it and reminded herself to not go into backward thinking
      • She is instead thinking about all the things that she is doing now to benefit her boys so that they can have a better future
  • (51:25) Closing Thoughts

    • What are the positive things we can do to not just address how we talk to ourselves, but really help our kids develop those healthy habits that will support a healthy weight (whatever that is for them) and lifelong health?

      • The first one that Stacy wants to mention is that we have to live and lead by example

        • And genuinely believe it
        • Think about your wording and mentality around habits
          • Build fun into healthy habits
          • Bring your kids into the kitchen to cook with you
      • Sarah points out the importance of gathering for family meals
        • This bonding translates to other healthy habits
      • Focus on higher vegetable consumption
      • Creating healthy sleep habits
      • Outside play
    • When we focus on these things as the healthy habits that we work on as a family, we are setting the stage for naturally achieving a healthy weight
      • We are also naturally achieving health
    • Remember, healthy and thin does not mean the same thing
      • These two things can go together, but they don't always
      • If you are going to choose one or the other, Sarah highly recommends choosing healthy
    • Stacy thinks this will provide structure for an easy way to talk to children about healthy and habits
      • Stacy shared on how Matt and Stacy worked together to collaboratively work on their healthy habits and their health groove

        • She shared insight into how we approach conversations and our word choices can make a huge difference
    • Sarah shared on how her mental health plays a role on her physical health
      • She has to be really mindful about self-destructive, self-talk

        • Also to let go of judgment and guilt
    • Stacy challenges herself to only focus on the things she really likes about herself to shift that negative mindset
      • Every time she thinks negatively about herself, she then comes up with two things she likes about herself
      • This was an activity they did with the kids while traveling this summer as well
    • We all deserve to focus on the good things and to be complimented and to compliment others
      • The more we do it to others, the more natural it will be to do it to yourself
    • Sarah wants to reiterate that there is no part of this conversation that is helped by blame, guilt, or remorse
      • This is about moving forward and embracing these health journies as a family-focused on healthy habits and the bonding that comes out of these experiences
    • Stacy sent all her love to the audience
      • Please share this episode with your community and those who you think would benefit from this information
      • Please also leave a review, which helps others see this show in their podcast feeds
      • Please also share it on your social media channels to help get this information to others
    • Thank you so much for your support!
      • Help others find these shows in a way that can help heal themselves and potentially heal their families
      • Stacy would love to hear from at least one parent how this episode shifted their thoughts and actions around how to help their family
    • Thanks again for listening - Stacy and Sarah will be back next week!
  • (0:40) Welcome

    • Welcome back to The Paleo View listeners!
    • This week Stacy and Sarah are talking about seafood
      • All the seafood and all the things people are concerned about when it comes to seafood
      • And whether or not these concerns are legitimate
      • Stacy and Sarah did discuss this topic on a previous episode (here), but it was time to revisit the discussion
      • Eating seafood is a common talking point on this show since it is so nutrient-dense, anti-inflammatory and healing
    • Before the hosts dive into the topic, they want to take a moment to thank this week's sponsor, Butcher Box
      • They have a special seafood promo that is being offered to The Paleo View listeners and this discount is not being offered anywhere else
      • Butcher Box is starting to move into the realm of seafood
        • Sarah thinks that they have the best salmon she has ever had
        • You can always add salmon to your standard meat subscription
        • However, they now seasonally sell scallops
      • The Paleo View listeners can visit this linkbefore 9/5 to redeem free bacon and free scallops
      • No code is needed
      • After 9/5, The Paleo View listeners will receive $15 off and a free pack of bacon
  • (7:10) Q & A

    • Sarah is going to break down Alana's question and take it step by step to look at every pollutant/processing chemical that might be introduced to fish

      • There are dyes added to some low-quality fish to make it look redder
      • There are times when farmed-fish are fed feed that contain dyes to change the color
        • If dyes are added after the fish are processed, that is going to be added to the label
      • Things that are not going to be on the label:
        • Mercury

          • It irreversibly binds to selenium based proteins and enzymes in our bodies so that those proteins can't do their job

            • It impacts 3 different systems the most:

              • thyroid hormone productions
              • liver detoxification
              • protecting the brain against oxidative damage
          • Seafood is one of our best food sources of selenium and the mercury that the fish are exposed to actually binds with selenium based proteins in their bodies
            • Once it binds with the fish's selenium it can't bind with our selenium
          • When we are consuming that fish, almost all of the time, we are consuming more selenium than we are getting exposed to mercury
            • Even fairy contaminated fish and top predators will have more selenium than mercury
            • So that selenium that we are ingesting in fish is actually still helping to protect us from mercury exposure
          • The surveys that have been done now show that with the exception of a few top predators in fairly polluted waters there is typically much more selenium than mercury in all ocean fish
            • And probably with 97% of lake fish, you are getting more selenium than mercury
          • If you are eating these top predator fish, don't eat them that often
            • Examples: mako shark, pilot whale
          • Your body can still detoxify some of this mercury
            • You can handle a little bit of exposure if you are eating a healthy diet and have a healthy lifestyle
            • A little bit here and there is not a big deal
          • Swordfish is probably fine if it comes from non-polluted waters
            • And again is something you shouldn't eat every day
    • Fish and shellfish are some of our best sources of zinc
      • On average 73% of Americans never meet the RDA of zinc

        • Zinc is supposed to be the second most abundant mineral in the human body

          • It is phenomenally important for a whole host of functions within the human body
    • We are getting really interesting nutrients from fish that are hard to get from other sources
      • Fish protein is the best protein for the gut microbiome

        • There have been studies that actually show that consuming fish protein can make up for high sugar diets
      • The omega-3's are really important for every system in our body
        • Our neurological system, immune system, gut bacteria
        • The omega-3's from seafood are the long-chain that our body can use directly without having to convert them
          • The kind from flax or chia have to be converted before our bodies can use them
    • Fish has all of these amazing things so as we go through the less than ideal things, the cons are outweighed by the pros
    • Alana asked about other heavy metals as well (lead and cadmium)
      • There have been some environmental impact studies that have looked at heavy metal in farmed fish

        • The study found that the levels in the fish are still extremely low and below the World Health Organization's guidelines
        • In places where there are more environmental protections you are going to end up with basically levels of heavy metals that are far below any level that we would want to worry about
      • The other heavy metals are a moot point
      • Fish has been demonized as a source, while it's actually much much richer in nutrients that will help us detoxify
        • It is also much lower than other foods, and yet it gets all the blame
      • Stacy finds it interesting how pervasive mainstream media can be when it comes to creating cultural assumptions
      • Sarah shared information on MTHFR gene variance and MTHFR enzyme function
  • (28:41) More on Contaminants in Fish

    • Cesium isotopes from Fukushima

      • There have been levels detected in fish caught off the California coast
      • Fukushima was the second-worst nuclear disaster ever after Chernobyl, and there is a lot of fear around the aftermath from this event
        • This is an ongoing challenge
        • There is a small amount of cesium-134 and cesium-137 in the ocean thanks to Fukushima
        • What is important to understand is that there are radioactive isotopes in nature all over the place
          • We are exposed to them on a daily basis
          • If you live somewhere with high radon levels you are exposed to more
          • Our body is fairly resilient to these low levels of exposure
          • The amount of cesium isotopes in the most contaminated fish's flesh is even 2,000 times lower than the threshold for health effects
      • So as it pertains to eating fish from the Pacific ocean; no we should not be concerned
      • For more on this, check out this blog postfrom Sarah
    • The equation is:
      • If you consumed 12 ounces (which is a very large portion) of contaminated bluefin tuna every day for an entire year, the cumulative dose of radiation that you would consume from all of that tuna would equate to 12% of the radiation dose from a one-way cross country flight from LA to New York
    • Stacy appreciates that analogy - it is so helpful
    • Sarah and Stacy had a sidebar discussion about personality types
      • Gretchen Rubin's 4 tendencies personality categories
      • Enneagram
      • Sarah shared a story about her experience playing with her kids at the playground recently
    • Concerns around BPA in canned fish packaging
      • Sarah wrote a blog postabout BPA and its' impact as an endocrine disruptor

        • This has been confirmed
        • Sarah shared more on the links between BPA exposure and various medical conditions
      • Our dominant BPA exposure is through our plastic use, not through BPA lined cans
        • It is added as a coating inside a can to stop acidic liquids from corroding the aluminum
      • You can reduce your exposure by:
        • Not heating your food in the can
        • Not letting your canned goods sit in a hot car for a long amount of time
        • Be careful when you are removing food from the can so that you are not scraping the edge coating into your food
      • The BPA alternatives for canned good linings have been minimally tested for safety
        • Many of them have also been shown to be endocrine disruptors
        • There are a lot of unanswered questions around these alternatives
      • The benefits of fish still outweigh the potential harm of BPA exposure
        • If you are making efforts to reduce BPA exposure from other places (plastic food storage, plastic water bottles, plastic wrap)
        • Where you can, mix it up with some fresh and frozen
        • But overall Sarah thinks that again the benefits of eating canned fish outweigh the risks
    • Stacy shared her experience with canned goods and why she doesn't worry about the canned goods they consume
      • How they balance the quality of foods they consume
      • Don't let perfection be the enemy of good
      • If you are unable to afford or find canned goods that are BPA free, don't lose sleep over it
    • Antibiotic use in farmed fish
      • While wild-caught is the best, avoiding fish because wild-caught is not monetarily accessible is probably doing more harm than consuming farmed fish
      • Ask the worker at your fish counter where the fish comes from and they are grown
      • In most Western countries, there are regulations on how much antibiotics can be used and how long they have to be discontinued before fish can be harvested
        • Antibiotic residues are linked with all kinds of problems, so if there isn't a washout period then yes the antibiotic residues can cause health problems
        • Where we see this is in developing nations where the practices are not as tightly regulated and they don't have a vet administering the antibiotics
          • Or using the right dosage and/or are failing to follow directions
      • Don't eat farmed fish when traveling to developing countries
    • Stacy shared on her food evaluation approach
      • Looking for sustainable practices
    • If you don't have access to sustainability sourced seafood, remember to check out Butcher Box
  • (57:37) Closing Thoughts

    • Thank you for joining Stacy and Sarah on this seafood-rich episode!
    • Stacy and Sarah will be back again next week
    • Don't forget to leave a review
    • A listener touched base to share this feedback:
      • "Hi Stacy, I just wanted to tell you that I am listening to the beginning of the last Paleo View podcast where you are giving an update on the little girl who has alopecia. Thank you so much for giving that update! I remember that show. I remember balling my eyes out. I have alopecia too and it got pretty bad towards the end of a really stressful job I had about a year and a half ago. AIP has definitely helped, so has less stress. I too am moving away from super strict AIP because after five months I can tolerate pretty much everything now. Not gluten - I will be gluten-free for life. That is crazy to me. Two weeks into AIP, I broke down and had rice and had a horrible reaction. Eczema being the easiest way to tell I was having a reaction. I never imagined healing to the point of reintroducing so many foods, but it has happened. Thanks for sharing the update! Alopecia can be hard to talk about and there is not that much info out there. So thank you for getting the word out!"
    • Stacy reminds listeners that no matter where you are at in your healing journey, know that the time will come when you can reintroduce foods
      • It takes some people more time than others to heal
    • Sarah loves reading comments like this
      • And seeing the different ways that Stacy and Sarah are able to communicate with people and provide resources
      • She loves to see the different ways the information resonates
    • Thank you, listeners, for being here!
    • Thank you again to Butcher Boxfor supporting this episode!
  • (0:40) Welcome

    • Welcome back to The Paleo View listeners!
    • Stacy is home and is so excited to jump into this week's very science-y topic!
      • Snuggling her pets and sleeping in her own bed, Stacy is so happy
      • Stacy also shared an update on a family that she visited with while in Texas
        • Their daughter has alopecia and her hair is starting to grow back after following an AIP approach and working with her family to heal her body
        • Sarah shared her feelings on how significant this is and what this specific case shows us about the autoimmune protocol
    • This week's show sponsor is Just Thrive probiotics
  • (11:13) The Study that Sparked the Discussion

    • Recently, ahuman study was publishedlooking at how long-term adherence to a Paleo diet affects the gut microbiota and TMAO

      • Mainstream news picked it up the day it was published

        • Using headlines like, "Study linking Paleo diet to increased heart disease risk strengthens diet industry concerns"
      • There are a few physician-focused websites that publish news to keep doctors up to date on the medical literature
        • The headline was, "Paleo diet increases the risk for heart disease"
      • Sarah's inbox and The Paleo View's inbox was flooded with questions
      • It is common in these situations for mainstream media to pick up on any anti-fad diet study
        • The standard response from our community is to find some reason why this study is irrelevant
    • TMAO is often linked with red meat consumption
      • It is thought to be one of the mechanisms behind the link between increased cancer risk and increased cardiovascular disease risk and high red meat consumption
    • The reason why Sarah wants to dedicate an entire episode to this study is that it was very well done
      • It has some results that we need to pay attention to
      • Sarah doesn't see this study as a nail in the coffin on the Paleo diet
      • Instead, Sarah sees this as a very serious warning about a very particular type of implementation of Paleo
        • We need to make sure we are incorporating all the key principles of Paleo, instead of combining Paleo with other dietary approaches
    • This study shows us that there are problems with the longterm implementation of a low carb Paleo diet
      • Really what it is telling us is that root vegetables and fruit are awesome
    • The study was performed in Australia and they took people who self-reported following the Paleo diet for over a year
      • The controls were following the national dietary recommendations of Australia

        • These are similar to the recommendations made by the USDA/MyPlate
      • Within the Paleo group, they further divided them into two subgroups
        • The people who followed Paleo very strictly were called strict Paleo
        • The other group was called pseudo-Paleo
          • These people were consuming about one serving of grains or dairy per day

            • In the real world, most of us who have been following Paleo for a longtime fall closer to that pseudo-Paleo group
            • Strict Paleo is often the challenge Paleo group or is utilized by those who are using it for therapeutic purposes
      • They had these people do a three-day weighed diet record
        • Measure and record everything they were eating
        • They then did urine tests to measure nitrogen and the Goldberg cut point
          • If those urine tests didn't match the dietary records they were eliminated from the study
        • They eliminated anybody who had been on antibiotics, cholesterol medication, blood pressure-lowering medication, previously diagnosed with cardiovascular disease, anyone with any kind of GI disorder, or anyone who has had surgery on their GI tract
          • They were eliminating anyone who would predictively be an outlier
      • They then did a series of measurements (TMAO, blood work, stool analysis)
        • The two measurements that turned out to be different between the Paleo and pseudo-Paleo group was the amount of TMAO in their blood and what was happening in their gut microbiome
      • Sarah explained more about why TMAO was a focal point in this study
        • Studies that pool all of these studies together show that if you have higher TMAO in your blood you have a higher risk of cardiovascular disease

          • 23% increased risk
          • And 55% increased risk of all-cause mortality
            • Which is a general marker of health and longevity
    • The interesting thing that Sarah notes, is that there has also been a lot of research that fails to show a causal link
      • The majority of the science from the last few years makes this picture of TMAO as an indicator or a symptom as opposed to the direct link between high red meat consumption and heart disease
    • How we get TMAO:
      • Some we absorb directly from food
      • Most of the TMAO is made by our gut bacteria when they metabolize choline, lecithin, and carnitine
      • So it is a multi-step process
        • Sarah shared more on this process and how TMAO is created
    • Researchers have discovered over the last few years that how much TMAO is in your bloodstream is far more correlated to your gut microbiome than to how much carnitine you ingest
    • There are certain bacteria that have been shown to be TMA producers
    • There is now this really interesting picture being painted with all the scientific literature showing that TMAO is potentially, rather than a causal link between red meat consumption and cardiovascular disease and cancer, that it's an indicator of a gut microbiome that is conducive to disease development
      • As we start to look at TMAO it is probably less related to red meat consumption, so much as a dysbiosis in the gut

        • One of the best pieces of evidence for this is that fish is really really high in TMAO

          • People will get 300x more TMAO in their blood after eating fish than after eating beef, even if they have a microbiome that produces TMAO

            • And fish is uniformly beneficial and reduces the risk of heart disease
    • Sarah has seen in relation to this new scientific study is arguments that say, "TMAO probably doesn't cause heart disease, therefore Paleo causing high TMAO is nothing we need to worry about"
      • This isn't something Sarah agrees with

        • High TMAO, especially when it is not timed with TMAO rich foods, generally is an indicator of something going wrong with our gut bacteria that needs to be paid attention to
        • The way that this study was designed to measure high TMAO food consumption is not taking into account seafood, which is something worth paying attention to
  • (27:40) Testosterone Deficiency

    • What is happening in this particular new study looking at strict Paleo and pseudo-Paleo adherence is not that TMAO is going up because the Paleo people are eating more fish

      • But rather that the TMAO is going up as a result of a shift in the gut microbiome
    • The study also took a deeper look into the gut microbiome
      • They found overall big trends
      • However, the study did find that two particular genres of probiotic bacteria were really low in the Paleo and pseudo-Paleo groups
        • Bifidobacteria
        • Roseburia bacteria
      • This is something really important to pay attention to
      • Bifidobacteria are some of our main vitamin producers
        • They are important for inhibiting pathogen colonization in the gut
        • They help to modulate our immune responses
        • They modulate the gut barrier
        • They can reduce inflammation
        • They can improve glucose intolerance
        • Low bifidobacteria is associated with a ton of different health problems
      • We get bifidobacteria from fermented dairy and sauerkraut
        • They love starch loving bacteria, especially fermented starch
      • There is a little less known about roseburia bacteria and fewer species
        • We do know that they are very important for maintaining gut barrier health

          • So if you have low roseburia you have a leakier gut
        • They are very important immune regulators, especially at reducing inflammation
        • Low roseburia is also associated with many health conditions:
          • Cardiovascular disease
          • Autoimmune disease
          • IBS
          • Neurological disease
          • Allergies
          • Asthma
        • They are really important members of a healthy gut microbiome
          • The levels of this bacteria were tanked in the study
          • Another genus had taken their place, called Hungatella
            • This strain isn't as well studied as bifidobacteria or roseburia
            • But hungatella are TMAO producers
            • They are absolutely associated with TMAO
              • And this is probably why given that these people following Paleo were also consuming more red meat than the controls

                • So they were consuming the precursors at the same time as they were shifting their gut bacteria towards a TMAO producing bacteria type
                • Their gut bacteria was making more TMAO
                • We don't super understand if high hungatella might be linked with disease but we do know that the low roseburia and low bifidobacteria is potentially a problem
    • As this study looks at high TMAO and all these different measurements of what these people are eating and we have this shift in the gut bacteria
      • We have all of this really fascinating correlation analysis to try to understand what aspect it was of the study diet that was actually causing these shifts
      • While TMAO itself was mostly aligned with red meat consumption, the shift in the gut microbiome that was driving TMAO production was actually most closely related to total carb consumption as well as resistant starch consumption
      • In the control group, those people were mostly eating grains as their carb source
      • In the Paleo and pseudo-Paleo group, they were mostly eating non-starchy vegetables
        • Hardly any roots and tubers
        • Hardly any fruit
        • So both groups were only consuming 90ish grams of carbs a day, but getting quite a bit of fiber
          • They were consuming 6 to 7 servings of vegetables a day
          • As you dig into the details of what they were eating, they were not eating as much resistance starch
        • This indicates that this particular implementation of Paleo in this particular study is a low carb  Paleo template
          • Less than 100 grams of carbs a day
          • Close to 30 grams of fiber
        • This is where the change in the gut microbiome is really predictable
          • Both roseburia and bifidobacteria thrive in starchy conditions and are very sensitive to the types of carbohydrates we consume
          • Out gut bacteria have an amazing ability to digest carbohydrates
            • Sarah shared more on this process
          • If we don't feed our bifidobacteria the right type of food it can't survive
            • This is why this is such a sensitive species
    • There is this whole other fascinating to Sarah link with TMAO and what is happening in a low carb diet and the gut bacteria
      • This whole other life form is called Archaea

        • These are normal residents of the gut
        • They are the main methane producers
          • These particular methane-producing Archaea use compounds like TMAO and TMA to produce methane
        • The diet factor that most strongly correlates with Archaea in the gut is carbohydrate consumption
          • We know that Archaea are fruit and starch lovers
      • Sarah dug deeper into the picture being painted by the results from this study
        • All of the things that would fix this gut microbiome and reduce TMAO production is to eat starchy roots and tubers and fruit
      • When you dig into these details this study makes a very strong case for high starchy vegetable consumption not being sufficient to support the gut microbiome
        • It is not enough to get fiber from non-starchy vegetables
        • We need the type of fiber that is in fruit and resistance starch in root vegetables that is going to support a healthy gut microbiome that is going to reduce the risk of disease
        • This study very cleverly used TMAO as a marker of those gut microbiome changes
          • It is the mainstream media that is then making the leap to it actually impacting cardiovascular disease risk
    • Stacy said that it is shocking to see another study supporting this idea that vegetables are good for you
    • Sarah is really starting to see the evidence accumulate for problems associated with long-term low carb approaches
      • We need a diversity of fruits and vegetables and need to not be afraid of the carbohydrates in starchy vegetables
      • Even if you can't do nightshades there are plenty of wonderful options
      • We need to not be fruit-phobic
      • The science is mounting up that we actually do best with moderate carbs, moderate fat, moderate protein
        • These approaches that are driving macronutrient extremes and even macronutrient imbalance have problems associated with them
    • Why have these diets lasted so long as weight loss approaches?
      • It is because it is a set of rules that result in ditching hyper-palatable foods and trick you into reducing your caloric intake
    • When we can formulate a much healthier option that embraces whole food sources of carbohydrates without demonizing them
      • It this uphill battle against the amount of misinformation that is out there on the internet that needs to be fixed
      • Sarah's call to action (besides everyone going home and eating a sweet potato) is to contribute to this conversation of avoiding carb phobia
        • The manufactured food carbohydrates are clearly bad, but we don't need to lump these super nutrient-dense roots, tubers, starchy vegetables and fruit and demonize them with cupcakes
    • Stacy shared her thoughts on how we as humans are drawn to very dogmatic ideals
      • The truth of the matter is that not all carbs are the same
  • (49:42) Closing Thoughts

    • If you found this show fascinating, go back and check out the insulin showfor more on gut health and overall human health

      • It will help to make a lot of sense of the study
    • Stacy shared examples of cases when kids are put on extreme diets and does it make sense to put kids into these dogmatic bubbles?
      • If you answered no, then why does it make sense to put yourself into these bubbles?
      • Is it just purely weight loss, or are you really thinking about health?
    • Studies like this always make Stacy go back to the mentality of, just focus on health
      • Colorful, rainbow foods exist for a reason
      • There is so much science to support why it is healthy for you
    • Stacy reminds people that none of us are perfect
      • Making healthy choices every day is something we need to be mindful of, and that is hard
      • It can be overwhelming, but there are things you can do to make it easier on yourself and to be excited
        • Take your kids with you to the grocery store and let them pick out vegetables and fruits that they love
        • When you get home from the store cut them up and have them on hand in the fridge
        • We as adults can do this to
    • This is the kind of thing where it is easy to get frustrated and overwhelmed with mixed messages  and not sure what to do and to feel like you can't win
      • And this isn't the case
      • If good quality gluten-free oats agree with you and your family, enjoy them
        • Add some antioxidant-rich fruits, mix in some yogurt if that agrees with you because these things are feeding your gut in a good way
        • It is about balance, and if we just relaxed into real food a little bit it would come easier and more natural to us
    • Sarah agrees with Stacy
      • Gluten-free oats are a gut microbiome superfood

        • These won't agree with everyone
      •  There are a list of foods that we define as not being Paleo, but they are great for the gut microbiome and when prepared correctly are nutrient-dense whole foods
      • Sarah identifies with the label Paleo, but she thinks of Paleo as a diet that looks to Paleoanthropology in terms of understanding human biology and then confirms with contemporary studies with a biological systems approach
        • It has a rooted in science approach
    • This study is a really good illustration of the importance of taking this really thorough broad look at what foods do for us and don't do for us
      • And also understanding that one of the biggest problems that we have run into over the last 50 years is this idea that we have to just make a list of yes foods and no foods

        • We define all of these diets by what you cut out, not based on what you eat
        • When people are troubleshooting they cut out more
        • It isn't what you don't eat that makes a diet healthy, it is what you actually put in your face that makes your diet something that supports your body or not
        • Sarah thinks it is important for this community to stop with the memes, the soundbites, and the lists and the rules
          • Start embracing a broader education around health topics that help us really understand what is in foods that help our bodies and what is in foods that may potentially undermine our health
          • We need to start looking at the gray and not just the black and white so that we can start making informed choices
          • Look at universal truths as opposed to arbitrary rules
          • Dig in and understand
    • If you want to help your gut health, be sure to check out Stacy and Sarah's favorite probiotic
    • Thank you Sarah for taking the time to do all of this research
    • Thanks for listening everyone! We will be back next week!
  • (0:40) Welcome

    • Welcome back to The Paleo View everyone!
    • This is the last week that Stacy will be coming to you from a location other than Virginia
      • Matt and Stacy have been on the road for 61 days
      • They are heading back to Virginia the day after this show was recorded
      • Stacy is looking forward to being back home and snuggling her pets
    • Stacy is looking forward to discussing this week's topic, as Sarah and Stacy have been wanting to cover this topic for a while now
      • This week's episode will include information on hormones and body parts, so if you typically listen to this show with little ears around you may want to be careful, depending on your comfort level
      • Sarah noted that this week's episode is about men's health, which is a really fun topic for the hosts
        • The discussion will focus on men's hormonal and reproductive health
      • If you aren't yet ready to discuss these topics with your little one, be sure to listen to this show without your little people around
      • Stacy is looking forward to sharing this discussion with her three teenage boys
    • This episode is sponsored by EverlyWell
      • This is an awesome sponsor for this episode since Stacy and Sarah will be talking about testosterone
      • EverlyWellis an at-home lab testing company that offers a variety of tests, ranging from food sensitivity to metabolism, to a thyroid test, vitamin D, testosterone and general men’s health
      • The tests are private, simple and all processed through certified labs
      • All you have to do is head to EverlyWell, choose your tests, and they’ll be shipped directly to your doorstep
      • Then, once you complete your sample collection and send it back into EverlyWell’scertified labs, they will process your sample and send you your results via EverlyWell’ssecure online platform within just 5 days
      • EverlyWelltakes all of the guesswork out of lab testing and puts the power into your hands to complete a range of important health tests all from home
      • To check out EverlyWellvisit:
        • You can get 15% off with the code 'ThePaleoView'
    • For Stacy, while this week's topic doesn't particularly pertain to her, she is looking forward to applying this week's information to the men in her life
  • (6:52) Q & A

    • This week's episode is inspired by a question from John

      • John writes:

        • "Hi ladies! I know if I say nice things, there's a better chance my question will be answered. Fortunately, that's easy to do. As a researcher myself I love that the Paleo View emphasizes facts over dogma. I know when you answer a question, I will learn something, and that is about the highest compliment I can give a podcast. I love that the two of you are interesting to listen to, and I have been a regular listener since (about) episode 20 (the early shows were good too!!). As one of your '6 male listeners', my question involves men's health. While there have been a number of shows dedicated to women's health, I have often wondered if there would be any link between a Paleo diet (or other dietary factors) and testosterone and/or erectile dysfunction. There's also a pretty substantial supplement business that claims to raise testosterone; any truth in these claims? I know there's the basic 'eat a healthy diet and exercise' but I thought maybe you could bring a more scientific approach to the question. I also feel that many women who have husbands/boyfriends dealing with these issues would be interested in understanding whether/how Paleo might help. Thanks!!"
    • Stacy noted that testosterone is not just a male hormone
      • She isn't sure what all this hormone effects and is looking forward to Sarah diving in on this
    • Sarah wants to take John's question and focus in on:
      • The role that testosterone has on men's health
      • The things that cause testosterone deficiency
        • What this looks like
        • What diet and lifestyle factors might be involved
        • What supplements will help raise testosterone levels
    • Testosterone as the predominantly male sex hormone has a major role in development and puberty
      • It also has a fundamental role in health
      • The crossover with women's health happens as testosterone regulates muscle size/strength, the general turnover of muscle tissue, bone growth and strength, sex drive, sperm production, it impacts mood, cognition, attention, memory, spatial awareness, behavior, negotiation abilities
        • It regulates libido in women as well
      • Sarah shared details from a study that was done on the correlation between testosterone levels and men's negotiation tactics and skills
      • Overall testosterone has a pretty big impact on psychology and physiology
      • Low testosterone can be seen in lack of motivation, lack of healthy competitive nature
        • Stacy thinks about the way healthy competition can be a really good thing
      • Sarah noted that in the male body you really only see testosterone excess in the context of a bodybuilder or a professional athlete doping with testosterone
        • It is not a common physiological occurrence that the male body will make extra testosterone
        • In women, we see testosterone excess in PCOS
          • This condition is hallmarked by elevated testosterone levels
          • Women have so little in our bodies compared to men that we have this room for excess
          • With men, this is not the case
            • The health challenge with testosterone for men is low levels
    • Testosterone generally decreases with age, starting in middle age
      • We see this at a rate of 1 to 2% a year
      • This is considered part of normal aging
      • It is not as dramatic as menopause since it is a gradual decline
        • There are some symptoms that echo menopause though when a man's testosterone is low
    • Symptoms of testosterone deficiency:
      • Hot flashes
      • Reduced body and facial hair
      • Loss of muscle mass
      • Low libido
      • Erectile dysfunction
      • Impotence
      • Small testicles
      • Reduced sperm count
      • Infertility
      • It can lead men to form breast tissue
      • Irritability
      • Depression
      • Low concentration
      • Osteoporosis
    • As is the case with all hormones there is a spectrum
      • A small deficiency in this hormone is going to cause an amount of these symptoms that might be easily dismissed

        • We typically see this in something so minor that we brush it off
      • It is not until it is a really big problem that we ask the question - what is going on
      • With a lot of these symptoms, you might not even tie them with testosterone levels unless you have a really good functional medicine specialist or you go and do the men's health panel from EverlyWell 
    • The problems with elevated testosterone levels we classically associated with bodybuilders
      • We see:

        • Really bad acne
        • Liver damage
        • An increase in heart attack risk
        • Weight gain
        • Aggressive behavior
        • Irritability
        • Impaired judgment
        • Delusions
      • The dominant studies of this are on athletes who dope
    • Stacy noted that she feels there is a stigma around low testosterone levels and the idea of doping or supplementing to raise these levels
      • She reminded listeners that Stacy and Sarah are not judging men for what they might need to do for their health
    • Sarah noted the difference between doping and hormone replacement
      • Doping specifically refers to taking excess

        • You are not trying to achieve normal levels
        • You are trying to achieve high levels for the sake of performance
      • If your levels are low, hormone replacement may be the best treatment
        • This is a conversation to have with your doctor
        • The best treatment may be to take exogenous testosterone
          • This is the exact same thing that an athlete would take

            • The difference is the philosophy behind it
            • If you are taking it as a hormone replacement your goal is to reach normal levels and to regulate your levels
            • As opposed to an athlete who is taking it to increase performance, and their cost-benefit analysis is very different in the context of testosterone excess
  • (23:08) Testosterone Deficiency

    • Beyond the symptoms associated with testosterone deficiency, the health risks include some other bigger risk factors

      • Deficiency increases your risk of:

        • Metabolic syndrome
        • Cardiovascular disease and mortality
        • Inflammation
    • It is worthwhile doing some investigating and really trying to dig a little deeper in terms of measuring testosterone levels and potentially either addressing diet and lifestyle factors and/or testosterone hormone replacement in order to bring levels up to normal in order to reduce those other risk factors
    • Stacy asked how one would know about normal levels
      • Sarah noted that the "normal" range for testosterone levels is huge

        • There is not really a good indicator if one should be at the higher or lower end of the range in order to have optimal whatever it is
        • It is typically diagnosed based on the combination of the actual number and the symptom checklist
        • This is why working with a functional integrative medical practitioner can be very helpful
        • Again, EverlyWellhas a straight testosterone test that is quite inexpensive and also a Men's Health Panel that includes testosterone, DHA, estradiol, and cortisol
    • There are no studies that look at named diets and men's sexual health
    • There is still a lot of information about the role that micronutrients, lifestyle factors and broader dietary factors that can help influence how we implement a Paleo diet to best support testosterone regulation
      • Exercise is one of the best things that both men and women can do to support testosterone levels

        • Specifically resistance training
        • Endurance training does tend to lower testosterone when combined with calorie restriction
      • Sleep is one of the biggest lifestyle influences on testosterone
        • Sarah shared the findings from studies done in an institution

          • When participants were only getting 5 hours of sleep a night, they saw a 15% decrease in testosterone

            • This is basically the same levels as what is seen in a 65-year-old man
            • Testosterone levels seem to be closely tied to the amount of REM sleep we get each night
      • Stress levels are also an important factor to consider when looking for ways to impact testosterone levels
        • Chronic stress is linked to low testosterone
      • As far as diet, there is not much data out there in terms of big dietary trends
        • The relation with diet and testosterone is much more micronutrient focused

          • Deficiency in a few nutrients can cause low testosterone

            • Vitamin A
            • Vitamin D
            • Zinc
            • Magnesium
            • Vitamin K
          • Supplementation in all of these nutrients can restore your levels
            • Through liver, you can get vitamin A
            • Testing your vitamin D levels will be best to see how to reach sufficiency
            • Omega 3 fats help to support testosterone metabolism
          • If you supplement men with these nutrients it doesn't cause testosterone excess
            • It is only related to deficiency in these nutrients driving low testosterone
            • Once you have enough, the system can help regulate itself
      • Chronic alcohol consumption can also cause low testosterone and antioxidants in general
        • If you are not getting enough nutrients from your diet, magnifies the reduction in testosterone
      • There is not a good link between testosterone and BMI
        • But there are some interesting studies that show that losing weight can boost testosterone levels
      • Sarah recommends looking at your intake of the micronutrients mentioned above, evaluating sleep and other lifestyle habits, and see if there is an obvious place where you can make some changes that are likely to help regulate testosterone
        • If testosterone is really low, you are going to want to go right to a functional medicine specialist and look at testosterone replacement therapy
      • Supplements Sarah looked into and recommends based on how safe the supplements are:
        • Get a professional opinion before taking supplements to address a deficiency
        • DHEA
        • Creatine
        • D-aspartic acid
        • Fenugreek
        • Ginger
        • Ashwagandha
      • Stacy wants to reiterate that before you make a smoothie with all the things, that testing your hormone levels and knowing where you are is so impactful
        • While you could do this a variety of ways, Sarah and Stacy both use and recommend EverlyWell
        • You or a loved one can test your hormone levels for under $50 using the code 'thepaleoview'
        • Once you know where your levels are, then you can work with a functional medicine professional to look at your hormone levels and develop an action plan on how to handle
        • Sarah emphasized how important it is to make decisions based on data when we are talking about hormone levels
  • (59:04) Closing Thoughts

    • Thank you so much for tuning in listeners!
    • We hope you found this show helpful
      • There are a number of other topics related to both female and male hormones and health that Stacy and Sarah are hoping to cover in upcoming episodes
    • If you liked this episode, be sure to leave a review on iTunes and share it with people you love
    • Thank you again so much for being here!
    • Stacy looks forward to joining the show from Virginia
    • Sarah thanks EverlyWellfor sponsoring this episode
      • As a reminder, get 15% off with the code 'thepaleoview' at this link
  • (0:41) Welcome

    • Welcome back listeners to episode 363 of The Paleo View!

      • Stacy is joining in from Austin, Texas will solid WiFi

        • Also known as rant quality WiFi
      • After taking a peek at the show outline, Stacy is feeling pretty excited about this week's episode
    • Sarah had a great camping trip, but they were rained out the second night
      • What started as scattered thunderstorms quickly evolved into strong storms with a wind advisory and severe weather water

        • This was going to last 12 hours
        • So they decided to have dinner, pack up and head home at 9:00 p.m.
        • After traveling so late, Sarah had to spend an entire day resting up to offset the lack of sleep from the night before
      • The time that they did have to camp was wonderful
        • They hiked up to a mountain, down to a waterfall and they savored their time together in full-on nature mode
    • Stacy is grateful that she has never had to experience a major storm while camping
    • Matt, Stacy and the boys are excited to explore Austin and to eat at some of their favorite spots
      • They went from cool temperatures at their last stop in Santa Fe to warm temperatures in Texas
      • Before Santa Fe, they were able to visit the Petrified Forest and it was an incredible experience
        • Listeners, add this spot to your bucket list of places to visit
    • This week Stacy and Sarah will be talking about fad diets
      • The question that kicked this all off Stacy received from a friend and had to do with phytonutrients in vegetables as being problematic

        • This friend follows a ketogenic diet
        • Phytonutrients in vegetables are one of the 'why' points that people in the ketogenic community mention when defending their dietary choices
  • (14:06) Phytonutrients

    • Sarah finds this 'why' point to be interesting

      • It is looking at things like phytates and oxalates as being somehow problematic when it comes to mineral and nutrient absorption

        • This isn't true, they don't stop you from absorbing nutrients and they don't leach nutrients or minerals from your body
        • You have bacteria in your gut that actually processes oxalates and phytates and liberate the minerals that are bound
        • Having a healthy gut microbiome is key for being able to absorb the minerals that are bound with phytic acid and oxalic acid
      • There are plenty of other nutrients in even the highest phytate and highest oxalate vegetables that will be absorbed without our gut bacteria there to help
        • So you can't say that you have poor gut health, so it is better for you to avoid these high phytate and oxalate vegetables
        • The way that you grow those bacteria that help to break those down is by eating those foods
        • High oxalate foods include organic radishes, turnips, spinach, and arugula
          • We eat these foods raw and organic, and then we will expose our gut to basically nurture the colony
      • There is no science that would point to any kind of risk associated with eating these vegetables
      • This myth has been busted so many times, and yet it keeps coming back
        • There is a lot of confusion around Phyto versus anti

          • Phytonutrients and antinutrients are not the same things
        • There is a huge body of scientific  literature showing us that a high phytonutrient diet is one of the most important aspects of reducing cancer risks and cardiovascular disease risk
          • Most phytonutrients are incredibly potent antioxidants

            • They are anti-aging
            • They are anti-inflammatory
            • They stop DNA from mutating
            • They can protect against depression and dementia
          • The range of phytonutrients and their effects is spectacular
          • We know that there are two things in vegetables that are responsible for all of the benefits that come with a high vegetable consumption diet
            • One is fiber because fiber regulates our digestive system and feeds our gut microbiome
            • And the second is phytonutrients because of the huge range of benefits that phytonutrients have
              • Sure there is a very very tiny percent of phytonutrients that in isolation could have a negative effect
              • However, they are packaged in this package with so very many more positive effects
            • Vegetables are really really really important
    • Stacy is reminded that this is an exercise in being an educated consumer of information
      • Evaluate the sources of your information
      • Know where these sources are getting their information and look into those sources yourself
    • Sarah and Stacy strive when preparing The Paleo View to provide listeners with the base knowledge to evaluate whether or not something makes sense
    • Sarah has been working to educate people on how to evaluate science and how to value science
    • This podcast should be a place where listeners can ask questions when the information they are seeing is too confusing and to give you the base knowledge that you need to see something in all of the scientific research
  • (29:53) Q & A

    • Jackie says, "what do you think of the Paleo Green diet, Keto Green diet, or the Pegan diet? I have heard Dr. Hyman and Dr. Perlmutter talk about them as it relates to keeping the microbiome healthy by getting tons of low-carb veggies & prebiotic fiber in the diet.
    • This is a few different variations of recognizing limitations within keto
    • Stacy and Sarah have talked about the problems with a keto diet in two previous podcast episodes (hereand here)
    • There were two papers published in 2019 on the ketogenic diet that showed very undesirable shifts in the gut microbiome
    • Sarah has been talking about this for five or six years now, that her deep concern about keto is that it simply doesn't provide enough fiber
      • It's so low carb that it is extremely difficult to get sufficient fiber to support a healthy gut microbiome
      • It is also low fiber diversity
      • Yes, there is a therapeutic benefit to incorporate a ketogenic diet when treating a neurological and neurodegenerative disease
        • People in these situations are taking on a keto diet under medical supervision
      • When we discuss people using a keto diet to support weight loss, this is a different conversation
    • What is happening now that this research is out showing that keto has all these problems:
      • 1) Some people are dismissing every paper that shows that keto might not be great
      • 2) Other people are looking at the information and trying to figure out how to get the benefits of keto while mitigating the detriments
    • Dr. Anna Cabeca is one of the leaders of the Green Keto movement
      • This dietary approach basically combines keto with the alkaline diet

        • The alkaline diet is rich in veggies, low meat, which has also been well busted in the scientific literature
        • The idea is that by eating a lot of vegetables that it is healthy for the kidneys because  the kidneys control the Ph of the body and the phytonutrients in vegetables provide the raw materials for the kidneys to effectively do their job
        • However, there is no scientific evidence supporting the low-meat part of this diet
          • High meat consumption is not strenuous on the kidneys
      • Dr. Cabeca has combined that philosophy of consuming tons of vegetables (especially green vegetables to keep the carbs low) and has basically created a more plant-focused version of keto
        • She recommends using supplements to maintain ketosis on this plan
      • The thought process in this is overall good because you are getting a larger diversity of vegetables and you are getting a lot of fiber
      • However, there are still other concerns that Sarah has about why this dietary approach is not ideal
        • There are things that keto triggers in a low insulin environment

          • We do need to make some insulin because it is important for thyroid health, muscle and bone health, hormone health, and memory
          • There are a lot of things that this super hormone does in the body
        • Low carb diets have this fundamental flaw of not providing us with nutrient sufficiency and missing out on some nutrients that our body really needs
      • It's an interesting thought to try to get the best of keto, but the best of keto is not great
        • There have been a couple of studies that have shown that when you lose weight on a ketogenic diet that you lose more muscle per pound of fat than you do when you are just counting calories
        • It is a fad diet that doesn't live up to its promises
        • Even though Green Keto is a really good thought, it's still not enough
    • Stacy feels that any lifestyle or diet that requires the purchasing of anything to add to your diet means you are missing something
      • If you are being told you need supplements or you need this thing to test your ketones, it means that it's not complete in an of itself
      • It also means that it is not sustainable longterm
    • Both Stacy and Sarah choose to take supplements because they aren't getting all that they need of certain nutrients (like vitamin D) from diet alone
      • But Stacy and Sarah are not here to tell people that they need to take certain supplements because it is missing from the lifestyle they advocate
    • Stacy pointed out the way in which fad diets tend to get hung up in labels
      • She loves the way Sarah describes the way she eats as a low-inflammatory, high nutrient-dense diet
      • It is super important for people to understand
        • This description is a nuance that doesn't sell well as a fad diet book
        • However, it does really help health as it relates to a longterm lifestyle for people to figure out individually what works for them
  • (44:20) The Pegan Diet

    • Jackie also asked about the Pegan Diet which is the terminology spearheaded by Dr. Hyman

      • Dr. Hyman saw limitations in both a vegan and Paleo approach
      • He wanted to take the best of both and combined them into a Pegan approach
      • It's plant-based Paleo, but not in the way that Stacy and Sarah talk about it
    • Sarah wants to preface this part of the conversation about what Pegan is by talking a little bit about what her upcoming book, The Gut Microbiome is all about
      • It is not available for preorder just yet, but she is working really hard on it
      • This will not be a Paleo book
      • She is going through the gut microbiome research and writing about what the research says
      • There is no branded diet in it whatsoever
      • She is building the principles of a healthy diet from the ground up based on our microbiome health
      • When you build this diet from the ground up it looks like a very veggie-rich Paleo diet with that Mediterranean, olive oil type, healthy fat focus
        • Moderate fat
        • Moderate protein
        • High vegetable consumption, including fruit and root vegetables
          • So it is moderate carbohydrate
        • There is room for non-Paleo foods that actually may be very beneficial for us
          • This includes lentils, chickpeas, split peas, gluten-free oats, rice, and A2 dairy
      • This book has no diet dogma behind it and simply reflects the research
    • Dr. Hyman's recommendations include:
      • No sugar
      • Nothing that has pesticides, hormones or GMOs
      • Nothing that is refined or manufactured
      • High vegetable consumption
      • Not too much fruit
      • Healthy fats
      • Limiting or avoiding dairy (goat or sheep instead of cow)
        • Always organic and grass-fed
      • 4 to 6 oz. serving of meat per meal
      • He has a strong focus on food quality
      • Recommends avoiding all gluten
      • Gluten-free whole grains sparingly
      • Lentils are the best
        • Only eat starchy beans every once in a while
      • Functional medicine is also another point that he highly recommends
    • Sarah thinks that this is the best of the trademarked version of a plant-based diet combined with Paleo
      • This might potentially still be a little carb phobic
      • However, it does increase Phyto content consumption
    • Overall Sarah thinks that there is a lot of confusion within the Paleo community, which is why she wrote the Paleo Approach
      • As new research emerges, there are no prominent figures within the community who shares on these findings
      • This means that there are people within the community who are not highly informed individuals who are making recommendations that are not based on scientific evidence
      • There are still people who are following a very high meat consumption version of Paleo
        • There is still a high level of people who follow Paleo as a meme instead of a way of life
      • Stacy and Sarah's approach is to try to correct the record about what Paleo is so that people coming into the community understand the importance of vegetables, eating snout to tail, nutrient density, seafood, toxin concerns, etc.
      • They are trying to create an evidence-led robust scientific foundation for Paleo to stand on
        • So that people coming into the community are not adopting a fad version of Paleo where they are just eating a ton of meat and bacon and dark chocolate
        • Where people instead are eating a low-inflammatory, nutrient-density diet
    • Dr. Hyman has looked at those communication challenges within the Paleo community and has decided to rebrand and create a new thing with a new name that can fall under his umbrella
      • It's a different solution to the challenges that Paleo has right now as it grows and absorbs different alternative health communities and the different priorities that different health communities bring to the Paleo community
    • The Pegan approach is interesting to Sarah because it's basically giving up
      • Paleo has become this unmanageable giant thing, and its a ship now that is getting really hard to steer
      • Let's just create a new thing and rebrand
    • In general, Sarah thinks that Pegan is standard Paleo with room for self-experimentation
    • This generally seems like a thing about branding
      • Sarah just isn't sure what she thinks about that
      • She sees the Paleo community as this really amazing group of people who are really invested in their health and she doesn't want to just jump ship on that to simply have a different framework to say the exact same thing
      • She would rather stay rooted and embedded in this community and help to continue to provide that scientific foundation for her choices and call out where influences from other alternative health communities come into Paleo are misled or nuanced
      • Sarah wants to make sure that this community is really well informed and understands why one food is great, why one food isn't, and all the world of gray in between where foods can have pros and cons and might work for you and might not
        • To be able to approach Paleo in not just a balanced way, or a science-led way, but in a non-dogmatic, non-rule based way
    • Stacy says that it makes so much sense to live in a non-dogmatic way, but use principles
      • This is consistent with what Stacy and Sarah have been talking about on the show for years
      • If you look at the way the Paleo community has gone with Chris Kresser's Paleo Code, Rob Wolff's Wired to Eat, and The Perfect Health Diet, you can find countless resources that show the ways in which the Paleo template has evolved as science has evolved
      • Stacy thinks that it is a lot more difficult for people to wrap their mind around the idea of these are guiding rules about food
        • But they are guiding, and they are not hard and fast
        • You will have to figure out what works for you
      • For Stacy personally, she thinks about food and asks is this nourishing me? Or is it not?
        • And there is the additional factor of, is this detrimental to my health?
      • Stacy and Sarah both shared how they personalize based on the years of experimentation they have done
    • Stacy is baffled that we are still trying to put labels and rules around what everyone can or can't eat
      • She feels like we are all individual people who come from different genetic backgrounds
      • And because of these differences, we tolerate different foods differently
      • It's as simple as getting back to basics
        • Eating real food that supports health
      • The more that we really have this mantra with ourselves, "is it helping me get healthier?"
        • And if it's not, is it harming my health?

          • Am I using it in a way that develops social or emotional development for myself
        • It's not just a vacuum
  • (1:08:37) Closing Thoughts

    • Sarah has to share one really exciting thing before they wrap up with is week's show

      • Next week is The Paleo View's seven-year anniversary!
      • Stacy feels that seven years is a very long time
        • And yet it is interesting, that here they are revisiting the principles that brought them here, to begin with
        • It changed both Stacy's and Sarah's lives in terms of their energy, their health, their weight loss, and so much more
        • The science is still pointing to the guiding principles that got us there, to begin with
      • Sarah finds it amazing that even after recording for seven years, they are not running out of topics to discuss
        • Which is a testament to how important it is to approach diet and lifestyle as an education rather than a sound bite
    • Sarah is so grateful for not just this platform, but The Paleo View listeners
    • Stacy shared on the level of deep connection that she feels towards this community of listeners
    • Stacy would love to meet listeners at her final events
      • Be sure to check out the details here
    • Thank you so much listeners for being here for seven years
      • For showing up at events or each week to download and be with Stacy and Sarah
      • They adore you and hope to share something clever to celebrate the monumental milestone
    • Thank you again so much listeners - Stacy and Sarah will be back again next week!
  • (0:41) Hellos & Happenings

    • Hello, listeners from sunny Arizona!

      • Stacy is loving everything about the southwest, except the internet connection
      • Matt and Stacy were in Sedona when this episode was recorded
      • This stop along their trip has been a great rest and restore spot
    • This week will just be a check-in show since Stacy is having some trouble with the internet reliability
    • There is a topic on the docket for episode 363 that both Stacy and Sarah are super passionate about and incredibly excited to discuss and share with listeners
      • They don't want to record this epic discussion with the chance of the internet going out mid recording
    • Sarah is about to head to the mountains for a family camping trip
      • Sarah's mom is in town and will be joining them for a trip to the mountains
      • They will be escaping the heat, internet connection, and cell service
    • Sarah and Stacy chatted about screen time limits
      • Sarah's husband suggested that she give the time limit features a try but Sarah passed
      • Stacy tried them for a little while when she was still working
        • She set the bedtime feature which was helpful
      • Sarah does use the 'do not disturb' feature on her phone to set boundaries on her time
    • Stacy reminded listeners that if you have been busy working all summer, that simply turning your phone off is a great way to create time to recharge
      • You can even set up your 'do not disturb' feature so that certain people (spouse, kids, etc.) can still reach you via phone call
      • Stacy thinks that having those occasional breaks from your internet is really special
    • Let it be known, Stacy does not like sand.
    • Matt, Stacy and the kids rode ATVs in the desert and had a blast disconnecting and being in the moment
      • Disconnecting is such a great and truly easy way to reconnect with those you love and to fully live in the moment
      • Ask yourself what you need and what really matters and make more time for these things and people
    • Sarah gives talks at business conferences and shares on work-life balance
      • Sarah shares the research on how much you can get done when you take breaks for movement, manage stress, and get enough sleep
      • The very information she shares is a great reminder to Sarah on how and why to take digital media detoxes
      • The mountains are very restorative to Sarah for many reasons, but especially because of the digital downtime the getaway provides
    • Matt and Stacy's boy's first interaction with a cactus
    • Sarah is going to be an American citizen in a week!!
      • She passed her test

        • Sarah worked so hard to pass this test and ultimately over-prepared for it
      • On July 29 she will take her oath
        • By the end of that ceremony, she will have her documentation showing she is an American citizen
      • Sarah's husband will have his ceremony on his birthday
      • Sarah shared on why this is such a meaningful moment in her life
      • America's naturalization process is really unique and special
    • Stacy doesn't think there is much more she can add to Sarah's amazing cherry on top of this check-in show
    • Have a wonderful week!
    • Next week Stacy and Sarah will be back with an amazing episode!
    • Thank you, listeners and huge congratulations to Sarah again!

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