The Whole View

Episode 455: Covid-19 Vaccines - Real World Data and Updated Vaccine Studies

Welcome to episode 455 of The Whole View! This week, Stacy and Sarah discuss the data from updated vaccine studies in terms of what we knew in previous episodes. 

 

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

The Whole View, Episode 455: Covid-19 Vaccines - Real World Data and Updated Vaccine Studies

Welcome back to episode 455! (0:28)

This is the next part in a series of shows where Sarah and Stacy discuss the science behind the Covid-19 vaccines. 

Sarah and Stacy will be discussing updated vaccine studies from previous episodes. So be sure to check those out before jumping right in:

In episode #440, we examined the history of vaccines, the very real statistics on vaccine-induced injury, and the advances that led to mRNA vaccine technology, along with the inherent advantages of this platform.

Episode #441 looked at the safety and efficacy data from the phase 2/3 clinical trials for both the Pfizer/BioNTech and the Moderna covid-19 vaccines, including subgroup analysis.

In episodes #443 & #444, we answered listener FAQ, including concerns about adverse events including autoimmune disease, fertility, antibody-enhanced infection, the current state of evidence regarding safety concerns for pregnancy and children. We addressed common myths circulating on the internet.

And last week, on episode 454, we looked at how adenovirus vaccines work and the safety and efficacy data from the phase 2/3 clinical trials for both the Johnson & Johnson & Janssen and the AstraZeneca/Oxford University vaccines, including a deep dive into immune thrombotic thrombocytopenia (what the news is reporting as a rare type of blood clot).

All five episodes took a data-driven approach, presenting the science and facts with context, detail, nuance, integrity, compassion, and as objectively as possible. 

Stacy reminds listeners that she and Sarah are not medical professionals or here to tell anyone what to do. Their only goal is to pass along the science to allow you to make an informed decision that works best for you. 

Personal Experiences with Covid & Vaccination

Sarah and Stacy first share their personal experiences with Covid-19. (7:01)

As many may remember, Stacy got Covid in April of last year and is one of the estimated 10% that end up with "long hauler" Covid.

She shares how that's impacted her life for the last year and techniques she's utilized to cope with it, such as focusing on nutrient density and getting enough sleep.

Stacy also took the first vaccine appointment she gets, which was for Moderna. She talks a bit about the mild side effects she experienced. And how the vaccine has actually shown treatment benefits to people, like Stacy, that have developed long-hauler symptoms.

Sarah, on the other hand, was lucky enough to avoid getting infected with Covid. She and her family have lived relatively isolated for the past year. And she is looking very forward to seeing people outside of her immediate family again.

She managed to book a vaccine appointment that was a cancellation. So she had about 3 hours' notice to get there and had no idea which vaccine she was getting. Although, she would have taken whichever they had available.

She shares what side effects she experienced after vaccination, which were a little more on the moderate side than many.

Stacy notes that one of the things she appreciates in previous Covid shows was that Sarah looked into the possibility of adverse side effects.

She notes, however, that if the audience doesn't hear about any of those adverse effects in this show, Stacy and Sarah aren't ignoring them. It's because they covered them in other shows.

 

Updated Vaccine Studies on mRNA Vaccines

Last week, Sarah talked about how the mRNA vaccines slightly altered the spike protein to maintain its prefusion conformation. (24:35)

She erroneously said postfusion. And, this makes sense since we want the immune system to neutralize the coronavirus before it binds to our cells. 

Pregnancy & Lactation

There's a lot more data available for how the vaccine impacts pregnant women than when Sarah previously covered it. (25:55)

V-safe is the community monitoring program for the vaccine. Sarah recommends every sign-up for it regardless of if you're pregnant because it's where a lot of this data comes from. 

It even allowed for this study on pregnancy outcomes. 

A total of 35,691 v-safe participants 16 to 54 years of age identified as pregnant received either mRNA vaccine.

Authors conclude:

"preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes."

This prospective study in pregnancy & lactation study included 131 participants pregnant and lactating women.

No differences were noted in reactogenicity across the groups. Vaccine-induced immune responses were significantly greater than the response to natural infection. And immune transfer to neonates occurred via placenta and breastmilk.

Another lactation study in Israel took breastmilk samples from 84 women for 6 weeks starting 2 weeks after 1st shot.

Sarah explains that this indicates getting the vaccine while pregnant or breastfeeding is protective for the fetus and/or baby.

All studies showed zero increased concern for pregnant women as compared to nonpregnant women.

Sarah does note, however, that pregnancy puts you at greater risk for a more severe infection of covid-19, as well as a greater risk of mortality.

Real-World Data & Breakthrough Infections

Sarah reminds listeners of the roughly 95% effectiveness shown in the phase 2/3 clinical trials for both mRNA vaccines. And that studies defined infection as 1 or 2 symptoms plus positive test. (36:01)

We now have studies showing effectiveness against asymptomatic infections too!

A study of providers tested 3,950 healthcare personnel, first responders, and frontline workers with no documented SARS-CoV-2 infection in six states between Dec. 14, 2020, and Mar. 13, 2021.

They were tested every week, meaning this study captured asymptomatic and symptomatic infection.

Under real-world conditions, mRNA vaccine effectiveness of full immunization was 90% against SARS-CoV-2 infections regardless of symptom status. And Vaccine effectiveness of partial immunization was 80%.

A study of pre-procedural screening at Mayo Clinic looked at 39,000+ asymptomatic adult patients screened before procedures that mainly required general anesthetic. 1 dose prevented 72% of asymptomatic infection, and 2 doses prevented 80% of asymptomatic infection.

Sarah generalizes a: 10% to 20% breakthrough infection rate, ½ to ¾ of which are asymptomatic, and the vast majority of the remaining are mild to moderate cases after vaccination.

This is amazing news - it means the vaccines prevent even most asymptomatic infections and stop 80% to 90% of people from passing along the virus. This is great news for herd immunity!

Here is even more real-world breakthrough infection data.

Updated Vaccine Studies for the Second Dose

An analysis of cases the week of April 12-18 showed ~21,000 of the roughly 470,000 people who tested positive for covid-19 had received their first dose only. Most of this happened within the first two weeks before hitting that 70-80% effectiveness. (43:45)

The second dose not only increases your individual protection but it's also designed to make your immunity last longer.

Approximately 8% (that's about 5 million people) have skipped their second dose. 

This is due to vaccine distribution centers not having the same kind or running out, people getting scared by the side effects of the first dose, or think they only need one dose because they had covid-19 already.

Even if you have a breakthrough case, you may not be as contagious as if you weren't vaccinated. That is not to say you aren't contagious!

Israeli researchers found that people who had been vaccinated with the Pfizer-BioNTech vaccine and later contracted an infection had lower viral loads than unvaccinated people who contracted an infection (source here and source here)

The higher the viral load, the more virus is shedding, which means you're more contagious.

This is great for herd immunity! But it's also why it's still prudent to wear a mask indoors or in crowded outdoor areas, socially distant when possible, and wash hands properly and prudently even after getting vaccinated. 

How long? Until infections are at a low enough level that we can go back to contact tracing every infection.

Variants of Concern Coverage by Vaccines

Sarah reminds listeners that Covid-19 is a very slow mutating virus. (52:25)

However, due to its high rate of transmission and infection, it has had many opportunities to mutate. And this is where we're getting the different variants reported around the world.

However, these variants are still not different from the original virus to be considered different strains.

Recent research from Pfizer looked at 44,000 people worldwide and found that the vaccine remained 100% effective against severe disease and death. This included people in South Africa who were predominantly exposed to the B.1.351 variant.

Real-world data also shows that the Pfizer vaccine held up against the B.1.1.7 variant, which was first detected in the United Kingdom. 

Even in an area where B.1.1.7 was the dominant strain, the vaccine was 97% effective against symptomatic COVID-19, hospitalizations, and death. 

Pfizer and Moderna are both testing the 3rd shot that we could get as early as this fall. Both will be a booster to prolong immunity. However, they will offer more complete coverage for the variants of concern, including B.1.351, B.1.1.7, and P1.

Monoclonal Antibodies for COVID-19

There are also some interesting antivirals being tested. These would be similar to Tamiflu but for covid and hopefully with better efficacy. (1:01:30)

There are some promising therapies, too, including monoclonal antibody therapies. They need to be infused (IV) but are highly efficacious. This is especially true when given early in the disease course.

Eli Lilly's Bamlamnivimab is also a cool treatment for exposed people but not necessarily infected yet. Regeneron's Casirivimab and Imdevimab are other notable treatments being studied. 

Sarah adds that some drugs are still used to prevent or treat Covid when there's no science for it. Hydroxychloroquine is still used in some circles and shown to potentially worsen outcomes. And now we see Ivermectin, which is an anti-parasitic mainly used for animals. Neither are safe or studied! 

There is no natural remedy for fight Covid-19. There are things you can do better your health to better prepare or to take precautions. But without science, this isn't something that's going to naturally go away.

Data from updated vaccine studies show a very low chance of catching covid-19 from surfaces (about 1 in 10,000). 

It's still prudent if someone in the house has been exposed or has it, for example. But we can stop disinfecting groceries.

You can skip wearing a mask outdoors if you can socially distance but should still wear one in crowded outdoor spaces, especially if already vaccinated.

Wearing a mask indoors is still super important. 6 feet is not enough indoors without a mask, and, depending on airflow, 30 feet is what science suggests. With everyone wearing a mask, studies of kids in schools show 3 feet is a safe distance.

The best prevention is vaccination combined with masks, distance, and hygiene.

 

Notable Updated Vaccine Studies

Menstruation irregularities should be added to the vaccine side effects list. (1:09:30)

This is finally being studied, but we don't currently have an estimated frequency like other side effects.

One thing researchers are doing is to look at the frequency data after the HPV vaccine. 

The vaccine was associated with increased age-adjusted odds of hospital visits for an abnormal amount of menstrual bleeding, irregular menstruation, and severe headaches. 

Sarah explains this is due to cortisol which increases during infection. This increase is directly related to disease severity.

There is a large cross-talk between the HPA axis, thyroid, sex hormones, and immune system.

Menstrual irregularities are caused by dysregulated cortisol and can also happen after infection. It's a normal side effect of the flu, for example.

Illnesses can sometimes pause ovulation and delay your period. Stress from the flu can lead to changes in your periods or even amenorrhea. This was studied in a clinical trial in influenza vaccine as well!

There is no information supporting permanent fertility issues.

Pfizer has asked for its EAU to be extended to 12 to 15-year-olds. We'll have that detailed data to pour over soon, but what we know so far:

• 2,260 younger adolescents ages 12-15
• 100% efficacy against symptomatic infection
• This study used the same two-shot regimen that is being used in adults.
• The study also found that younger adolescents who received the vaccine produced more coronavirus antibodies than 16- to 25-year-olds in an earlier study. 
• Vaccine side effects were similar to what was seen in this older age group.

Stacy reminds listeners that kids can be asymptomatic carriers, and we don't know what this could do to children's health long-term.

Sarah also explains that different variants can affect the younger age groups differently than the original virus. For example, outbreaks could cause more severe infections in children and young adults.

Final Thoughts

Stacy loves how inquisitive this audience is and how dedicated you are to science. (1:28:01)

Did you hear about what Spain is doing?!

If you have any additional questions or concerns regarding these covid shows, Stacy and Sarah encourage you to reach out on Patreon.

If you haven't joined the Patreon family yet, your subscription goes directly to supporting this podcast. You'll also gain access to bonus content, including what Sarah and Stacy really feel about the topics they discuss.

Plus, any questions or comments submitted through Patreon take precedence!

We appreciate you! Thank you so much for listening, and we will see you next week!

 

 

 

Episode 454: J&J and AstraZeneca Covid-19 Vaccines

The Whole View, Episode 454: J&J and AstraZeneca Covid-19 Vaccines

Welcome back to episode 454! (0:28)

This is the next part in a series of shows where Sarah and Stacy discuss the science behind the Covid-19 vaccines.

They strive to present you with all the information available to make an informed decision about whether receiving the vaccine is right for you.

Sarah plans to go through the show with the assumption that listeners have background/base knowledge about vaccines and how they work.

So if you have not yet listened to the previous shows in this series, Sarah highly recommends you do before listening to this episode.

Previous Covid-19 Shows

In episode #440, Sarah and Stacy examined the history of vaccines and the very real statistics on vaccine-induced injury. They also looked at the advances that led to mRNA vaccine technology and the inherent advantages of this platform.

Episode #441 explored the safety and efficacy data from the phase 2/3 clinical trials for both the Pfizer/BioNTech and the Moderna covid-19 vaccines.

In episodes #443 & #444, Sarah and Stacy answered listener FAQ. This included concerns about adverse events, including autoimmune disease, fertility, and antibody-enhanced infection. They also examined safety concerns for pregnancy and children and addressed common myths circulating on the internet.

Stacy and Sarah took a data-driven approach for all four episodes, presenting the science and facts with context, detail, nuance, integrity, compassion, and as objectively as possible.

Fact vs. Opinion on The Whole View

Stacy underlines that they are not here to convince you of a certain mindset or push a vaccine agenda in this show.

Although Stacy and Sarah may share their personal opinions on vaccines, they remind the audience that their opinions are just that - opinions. And what's right for them might not be right for you.

They strive to take this same scientific approach today and next week with the J&J and AstraZeneca Covid-19 vaccines. (Yes! You're getting two more vaccine shows!)

Stacy also reminds listeners of Sarah's credentials and that she had a Ph.D. in research science. Like the other shows, they will address the rumors, concerns, and myths.

It's critical to walk through the facts first. And remember- facts don't have opinions. Stacy and Sarah's primary agenda is to give the data for you to interpret for yourself.

 

Adenovirus Vector Vaccines

J&J and AstraZeneca Covid-19 vaccines are both DNA vaccines that use an adenovirus vector. The concept is similar to the mRNA vaccines but not wholly the same. (5:20)

Sarah reminds the audience that to make proteins, DNA is first transcribed into mRNA, which is then translated into protein.

So, both J&J and AstraZeneca vaccines deliver instructions to make the full-length covid-19 spike protein.

Only slightly different from the instructions for the mRNA vaccines, which have a couple of mutations to stabilize the tertiary structure into what's called the postfusion conformation and the transmembrane anchor added

Both adenovirus vaccines encode full-length spike protein without the postfusion conformation stabilization mutations (say that 5 times fast!) but still add the membrane anchor.

Sarah recommends this source for more information.

So, these work similarly to the Pfizer/BioNTech and Moderna mRNA vaccines. 

However, J&J and AstraZeneca Covid-19 vaccines require two steps to make the spike protein instead of one. They also require a special delivery agent to get into the cell nucleus. That's where adenoviruses kick in!

Adenovirus Vectors Research

There are about 50 years of research on adenovirus vectors as DNA delivery vectors. (8:48)

Adenoviruses are basically common cold viruses that can cause illnesses ranging from cold-like symptoms to bronchitis, gastroenteritis, and conjunctivitis.

They are non-enveloped DNA viruses that can't alter our DNA because (unlike retroviruses such as HIV or lentiviruses) wild-type adenoviruses do not carry the enzymatic machinery necessary for integration into the host cell's DNA. 

Basically, they do not enter our cell's DNA.

Adenoviruses deliver DNA that can enter the cell nucleus, are transcribed into mRNA, leaves the nucleus, and then translated into protein. That's exactly what makes them good vaccine platforms for infectious diseases.

I used adenovirus vectors (Ad 5, the same used in the Russian sputnik V and China's CanSino covid-19 vaccines) for gene therapy research during my Ph.D. and even have a patent using them!

Different Adenovirus Serotypes

There are at least 88 human adenovirus types. Most serotypes cause mild illness, although data links adenovirus serotype 7 with more severe illness. (12:25)

When used for gene therapy research or vaccines, research engineers them to be incapable of replicating and causing disease.

There are adenovirus vector vaccines already in use. The rabies vaccine our pets get and the Ebola vaccine.

One problem with using adenoviruses in vaccines is that people may already have antibodies to them, overwhelming them before they can do their assigned work. 

Researchers get around that issue by using adenoviruses that humans are unlikely to have encountered before.

The AstraZeneca/Oxford vaccine uses the ChAdOx1 platform based on a modified version of a chimpanzee adenovirus (causes colds in chimps and nothing in humans).

The Johnson & Johnson & Janssen (J&J) vaccine uses a proprietary AdVac platform made up of recombinant human adenovirus (adv26). 

It's the same platform used in the company's Ebola virus vaccine (approved in Europe) and its investigational Zika, RSV, and HIV vaccines.

 

Adjuvants in J&J and AstraZeneca Covid-19 Vaccines

Like the mRNA vaccines, J&J and AstraZeneca Covid-19 vaccines don't require an adjuvant. (14:40)

Stacy and Sarah talked about adjuvants in-depth in previous episodes.

The viral vector itself helps to prime the immune system in a specific way to fight a virus- not generally the way aluminum-based adjuvants do. Then the real stimulant is the spike protein our cells make.

The interesting thing about viral vector DNA vaccines is that our bodies react to it the same way as if we were actually sick with the illness. 

Therefore, we get the same immune benefits as natural illness, minus the coronavirus's ability to manipulate the immune system and even more robust and durable immunity.

Stacy shares that she was very surprised at how clean they were when she reviewed the vaccine ingredients.

Sarah confirms this, saying newer vaccines (such as the recent ones for Covid) are missing many ingredients from early vaccines that cause many people to be hesitant about getting vaccinated.

Ingredients in J&J:

• Recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein
• Citric acid monohydrate and trisodium citrate dihydrate - pH buffering, both naturally found in citrus fruit
• Ethanol
• 2-hydroxypropyl-β-cyclodextrin (HBCD), cyclic oligosaccharide containing seven D-(+)-glucopyranose units that are widely used to improve the aqueous solubility of various compounds, especially those containing a phenyl group, toxicology studies show very safe
• Polysorbate-80, emulsifier, pretty safe option
• Sodium chloride (aka salt)
• Source for Reference 

Both AstraZeneca and J&J Covid-19 vaccines have reported that their vaccines were well tolerated with no serious safety concerns.

However, there have been recent reports of blood clot issues, which Sarah and Stacy will cover.

 

J&J and AstraZeneca Covid-19 Vaccines Clinical Trial Results

Like the mRNA vaccines, scientists could develop them quickly because of the decades of research scientists built from. (22:50)

It's the same technology used in rabies vaccines for our pets and the Ebola vaccine (the only widespread vaccine used in humans).

Johnson & Johnson

• One-shot (they are testing a 2-shot version test for efficacy increase)
• Stable at normal refrigerator temperatures, so cold-chain requirements are easier
• J&J Vaccine Fact Sheet
• FDA Fact Sheet for J&J
• Safety and Efficacy of Single Dose
• Efficacy against symptomatic disease 66.9%
• Vaccine efficacy was higher against severe–critical Covid-19 (76.7% and 85.4%)
• Prevented 100% of deaths from covid-19 
• No observable differences in vaccine efficacy according to sex, race, or ethnic group
• Similar to mRNA vaccines, no red flags from a safety perspective came up -- The incidence of serious adverse events balanced between the vaccine group and placebo.

AstraZeneca

• Two shots
• 62% effective against symptomatic disease
• 100% against severe disease, hospitalization, and death
• Again, no red flag from a safety perspective
• Source for Reference 

 

What About Adverse Side Effects?

Stacy points out that the media always leads with the lowest number of something potentially problematic instead of leading with the bigger number, such as preventing 100% of deaths. (24:50)

Sarah adds that the risk of developing a treatable reaction isn't the worst thing if the same treatment is keeping you from something way more serious - such as death.

Stacy shares that it's not just the death toll, it's the risk of future complications and the way the symptoms can linger for months- two things she has personally experienced after having Covid last spring.

She hates how the media is so ready to focus on the drama of the vaccine but completely skips over how much it's actually doing to protect us despite those few risks.

AstraZeneca Not Approved In US

Sarah explains that AstraZeneca's US trial is still ongoing and not yet approved for use. (34:00) 

However, she points out that no "red flags" were presented during the clinical trials for either of these vaccines.

That's important to put into context since both have shown complications when used in the community (which researchers expected, and Sarah explains why).

The delay in the AstraZeneca trial lasted nearly seven weeks in the fall due to an adverse reaction in a UK participant. This was later determined as unrelated to the vaccine. 

The initial trial results in November puzzled many experts from all around the world:

• The company combined data from its Brazil and UK groups, even though they had different sample sizes and demographics. 
• It also averaged the results of two different dosing regimens (one administered by mistake).
• Just 12% of participants in AstraZeneca's UK and Brazil trials were over 55 (but one quarter will be in US trial)

Now, scientists hope that results from AstraZeneca's US trial will clear up much of the world's confusion. 

According to a press release, key interim results of the trial, which included more than thirty thousand participants, and the data looked excellent.

The vaccine appeared to be 79% effective at preventing "symptomatic COVID-19." 

The press release said that no one given the vaccine in the trial became severely ill, hospitalized, or died due to COVID-19. Also, the study did not turn up any serious safety concerns.

They'll likely apply for an EAU in the states in the next month or two.

Why The Pauses Were Important

The pause allowed the collection of more data to see how prevalent this adverse effect is. This way, they can find more cases, and the total was 15 out of about 8 million doses had this effect.

The pause gives researchers time to educate patients on what to look out for and doctors on what to test for and how to treat. Sarah stresses that this is so important!

Here's some perspective: 

• For one million J&J shots, researchers expect about 2 cases of TTP
• This contrasts with over 2,000 fewer deaths and 6,000 fewer Covid-related hospitalizations

It's important to know that the agencies tasked with community monitoring are actually doing their job. This is how it's supposed to work!

New stories have called this pause a bad thing, which has increased vaccine hesitancy. The media then inflamed the issue in an inaccurate and unhelpful way.

Yes, plenty of people way they want Moderna or Pfizer instead of J&J right now. However, it takes time to educate people. Journalists need to focus on how the system works the right way to protect us instead of increasing fear.

Just because AstraZeneca isn't approved yet doesn't mean it's unsafe. It means researchers want to devote enough time to understand the data as much as possible.

Moderna, Pfizer, J&J and AstraZeneca Covid- 19 Vaccines

Sarah explains that it's impossible to make an accurate comparison of efficacy between these trials. (47:10)

Tests performed at different times, in different countries, with some variants may have impacted results.

For example, the USA tested Moderna first, and now we see it undergoing testing elsewhere.

The USA and Germany originally tested Pfizer (before B.1.1.7 became dominant). It is now undergoing testing elsewhere. 

Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa, and the United States tested the J&J vaccines.

Brazil, South Africa, and the UK tested AstraZeneca initially. It is now running trials in the US, Japan, Russia, Kenya, and Latin America.

Also, many areas define "symptomatic reactions" often vary.

Sarah explains that to actually and accurately compare, we'd need a head-to-head trial with far fewer variables.

 

What About the Blood Clots?

Stacy decides now is the time to talk about the elephant in the room: the reported risk of blood clots from the J&J vaccine. (52:45)

Sarah explains that this is nowhere near clot risk from birth control pills (some many women take regularly), which is 1:1000.

Also, it isn't a good comparison. "Run-of-the-mill" embolisms or thrombosis are easily treated. However, large ischemic stroke or myocardial infarctions, pulmonary embolism are more serious. 

The rates of these types of blood clots after the vaccines are about what you'd expect in the population normally. 

However, this rare adverse event following J&J and AstraZeneca Covid-19 vaccines is NOT run-of-the-mill. 

• https://www.bmj.com/content/372/bmj.n774
• Cerebral venous thrombosis and portal vein thrombosis risk is 10x higher after covid-19 than after AstraZeneca vaccine
• https://www.bmj.com/content/373/bmj.n931

Immune Thrombotic Thrombocytopenia (ITT)

Sarah underlines that calling this side effect "blood clots" isn't entirely accurate. What's actually happening ITT- an autoimmune response.

Immune Thrombotic Thrombocytopenia (ITT) is blood clotting at the same time as low platelets. However, if treated properly and promptly, ITT is very treatable!

This is so important because the normal way you treat blood clots (blood thinners like heparin) can cause death by hemorrhage.  

With ITT, mortality is high (~90%) if untreated. The median age of onset 40 years and, like most autoimmune diseases, has a 3:1 female-to-male ratio.

Stacy also reminds listeners that autoimmune diseases cannot be "caused" by something. Immune diseases are latent in the system until triggered, which is bound to happen at some point regardless.

Autoimmune suffers aren't necessarily at higher risk. Some HLA risk alleles for other autoimmune diseases protect against TTP, and many don't increase risk at all.

• GREAT REVIEW PAPER 
• https://www.nejm.org/doi/full/10.1056/NEJMe2106315
• https://www.nejm.org/doi/full/10.1056/NEJMoa2104882

 

Importance of J&J and AstraZeneca Covid- 19 Vaccines

First, it's cheaper to make, ship, and store. So, they can get to places that are really tough to get the mRNA vaccines to, like rural America and developing nations. (1:12:10)

Stacy and Sarah remind the audience that the pandemic isn't over until the whole world is protected.

The high infection rates lead to the variants of concern, which we'll talk a bit more about next week. 

This virus mutates slowly, but it has so many opportunities to mutate because of high infection rates, including in the USA.

J&J is great for people who dislike needles, unhoused people, and people with schedules that make getting the second shot hard (e.g., truckers or flight attendants who travel a lot). 

More References for J&J and AstraZeneca Covid-19 Vaccines

• Watanabe, Y. et al. (2021) Native-like SARS-CoV-2 Spike Glycoprotein Expressed by ChAdOx1 nCoV-19/AZD1222 Vaccine. ACS Central Science, ​See source here
• https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext

 

Final Thoughts

These vaccines are just more tools in our toolbox to get through this pandemic. (1:15:10)

Stacy and Sarah have dedicated the last 8 years to do this podcast to focus on everyone's health, safety, and wellness.

Stacy adds that we often get so caught up in our own health, wellness, and safety that we forget part of what a vaccine does is protect others. 

It's easy to be fearful and hesitant because there's so much to the science that an average person might not easily understand.

And the more the media talks about it from a negative perspective, the less confident people get to go and get something that might be lifesaving- not just for themselves but others around them.

Stacy takes a minute to talk about the difference between one mild/moderate complication right after the vaccine (heavier period) compared to more long-term complications from "long hauler syndrome" (brain fog, i.e., brain damage).

Stacy reminds listeners that Patreon is a great way to connect. So if you haven't joined the family yet, be sure to pop over for bonus content like how Stacy and Sarah really feel about the topics they discuss.

Thanks so much for listening, and we'll see you next week!

Episode 453: Should We Eat Breakfast Before 8:30am?

The Whole View, Episode 453: Should We Eat Breakfast Before 8:30am?

Welcome back to episode 453! (0:28)

Stacy reminds listeners that science is an evolutionary process and, like life, things are constantly changing and growing.

The Whole View has years of shows that may contain outdated science. Both Stacy and Sarah feel it's important to bring some of these episodes back to the forefront and re-examine how science has changed.

So in honor of revisiting some of our favorite shows with the updated science, Sarah decided to start with re-examining the science behind eating (or not eating) breakfast before 8:30am.

See Episode 381: Is Breakfast the Most Important Meal of the Day? for more notes from the last episode!

Updates

Stacy reminds listeners that when you go through long periods of not eating (intermittently fasting), it signals to your body that it's time to rest. This can mess with your circadian rhythm. (58:26) 

Studies link eating breakfast can lower stress levels, help manage mental health, and improve physical health.

Stacy also reminds listeners that coffee doesn't count as breakfast and can actually inflame stomach issues.

You can also spread out breakfast throughout the morning "breakfast" window by eating a series of small things.

Endocrinology Conference: Breakfast Before 8:30am

The study was designed to look at restricted feeding, comparing shorter windows to loger windows. (1:04:20)

Previous studies have found that time-restricted eating, which consolidates eating to a shortened time frame each day, has consistently demonstrated improved metabolic health. 

But research shows that an early time-restricted feeding window is better: 

• TPV Podcast Episode 386: Intermittent Fasting 
• Intermittent Fasting: Secret to Weight Loss or Dangerous Fad?

Researchers analyzed data from 10,575 adults who participated in the National Health and Nutrition Examination Survey. 

They divided participants into three groups depending on the total duration of food intake: less than 10 hours, 10-13 hours, and more than 13 hours per day. 

Then, they created six subgroups based on eating duration start time (before or after 8:30 am).

They analyzed this data to determine if eating duration and timing were associated with fasting blood sugar levels and estimated insulin resistance. 

Fasting blood sugar levels did not differ significantly among eating interval groups. 

Insulin resistance was higher with shorter eating interval duration but lower across all groups with an eating start time before 8:30am.

What they discovered instead was that eating breakfast early reduced insulin resistance, and feeding window didn't matter.

• Is Breakfast the Most Important Meal of the Day?
• Is Breakfast The Most Important Meal of the Day? New Science Has Answers!

People who start eating before 8:30 am had lower blood sugar levels and less insulin resistance. This could reduce the risk of developing type 2 diabetes.

Sarah surmises that it makes sense from a cortisol vs. insulin perspective!

Breakfast & Cortisol

Stress, breakfast cereal consumption, and cortisol: recent research has shown that regular breakfast cereal consumption is associated with lower stress levels and reports of better physical and mental health.  

The present study examined this issue using an objective indicator of stress, salivary cortisol. 

Results showed that stress was associated with higher cortisol levels, and daily consumption of breakfast cereal was associated with lower cortisol levels. 

Meal Timing Regulates the Human Circadian System and affects glucose tolerance, substrate oxidation and circadian-related variables: A randomized, crossover trial.

Another study showed female breakfast-skippers display a disrupted cortisol rhythm and elevated blood pressure.

Not to mention, chronic stress is associated with indicators of diet quality in habitual breakfast skippers.

New Science About Breakfast Before 8:30am

Skipping breakfast is also associated with cancer-related and all-cause mortality in a national cohort of United States adults. 

Data associates habitual nightly fasting duration, eating timing, and eating frequency with cardiometabolic risk in women. 

Association between Breakfast Consumption and Depressive Symptoms among Chinese College Students: A Cross-Sectional and Prospective Cohort Study.

The ORs (95% CI) for depressive symptoms with decreasing breakfast consumption frequency were 1.00 (reference) for ≥6 times/week, 2.045 (1.198, 3.491) for 2-5 times/week, and 2.722 (0.941, 7.872) for ≤1 time/week (p for trend: 0.005).

Final Thoughts

Changing any sort of habit can be difficult, and Stacy reminds the audience that it won't be the easiest fix if you're not a breakfast person. (1:13:50)

She tries planning ahead by hard boiling eggs to grab and go in the morning. Stacy also makes a lot of smoothies in the morning using whole fruit.

If you haven't joined Patreon yet, now is a great time! It supports this show and gives you behind-the-scenes content, including how Sarah and Stacy really feel about these revisiting episodes.

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

 

Episode 452: New Science on Soaking or Activating Nuts

Welcome to episode 452 of The Whole View! This week, Stacy and Sarah look back at soaking or activating nuts and reflect on how data has impacted previous science.

 

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

The Whole View, Episode 452: New Science on Soaking or Activating Nuts

Welcome back to episode 452! (0:28)

Facts are facts; science is science, and no matter how we felt about it before might change if we are open to hearing new information.

Sarah adds that there was science available in previous shows that allowed us to infer some of these things. As more data has become available in the past year, we see that it's actually not the case.

• Episode 188, Paleo-Friendly Bread: 
• Episode 413: The Gut Health Benefits of Nuts

Stacy reminds listeners that this isn't a one-size-fits-all concept. To make sure the science on this show, which is specific to soaking or activating nuts, isn't extrapolated into different areas.

We have a question from listener Vanessa:

I'm interested in getting nuts and seeds back into my diet but am wary due to my autoimmunity.

I've read all the articles I can find on the subject on your website (even your dehydrator article) and ran a search. Still, there is no mention of soaking (and dehydrating) nuts and seeds to break down the enzyme inhibitors that cause digestive issues. Some nuts give me a stomach ache and bloating (I've experimented here and there with low Fodmap nuts), and I have also purchased activated nuts (that have already been soaked and dehydrated). I seem to get on fine with the activated nuts, but if you don't mention this process in your articles, is this not something you advocate? Thanks - Vanessa

Summarization of Nut Benefits 

20 grams of tree nuts per day shows substantially reduced risk (think 20-70%) of cardiovascular disease, cancer, neurodegenerative disease, kidney disease, diabetes, infections, and mortality from respiratory disease. (3:05)

Even three 1-ounce servings per week can lower all-cause mortality risk by a whopping 39%. This means that eating nuts regularly improves health, but they can potentially extend lifespan.

Nut consumption is also known to decrease inflammation markers, including some endothelial markers (called adhesion molecules). 

There's emerging evidence of beneficial effects on oxidative stress, vascular reactivity, and hypertension. 

Numerous studies show that people who regularly eat nuts tend to have more favorable blood lipid profiles. 

One meta-analysis of 25 clinical studies showed that nut consumption had a dose-response cholesterol-lowering effect. 

Interventional studies consistently show that increasing nut intake has a cholesterol-lowering effect, even in the context of healthy diets. 

Plenty of research suggests that, despite their energy density, nuts and seeds don't contribute to weight gain, and they may even protect against obesity and diabetes.

The health benefits of nut and seed consumption can be attributed to their nutritional content, rich in antioxidant vitamins, essential minerals, dietary fiber.

They also include L-arginine, polyphenols, and some nuts that contain high levels of heart-healthy monounsaturated fats and the omega-3 fatty acid α-linolenic acid. 

We went into detail in Episode 413: The Gut Health Benefits of Nuts.

The Health benefits of nut consumption do not continue to increase beyond about 20 grams per day. 

And there's some evidence that consuming large amounts of nuts daily can increase disease risk (at least for stroke). 

That means we get benefits with about a palmful of nuts and seeds per day, but that eating more than that won't do us any favors (and may potentially undermine our health).

Why Aren't They AIP?

Tree nuts are among the most allergenic foods, with true allergies (meaning the body produces IgE antibodies against proteins in nuts) estimated at about 1% of the total population. (9:00) 

Some preliminary scientific studies show that nut intolerance may affect a whopping 20 to 50% of us.  

People with autoimmune disease are more likely to test positive on food intolerance panels than healthy people.

One 2018 study evaluated the level of IgG antibody production in autoimmune disease sufferers. 

This is compared to healthy controls and found that autoimmune disease sufferers produce double and up to 10X more IgG antibodies against foods than healthy people.

The most common food intolerances in people with autoimmune disease are the foods already eliminated on the AIP. 

This is because they are inflammatory, disrupt hormones, or negatively impact gut barrier health, including grains, dairy, egg whites, and legumes. 

See How Gluten (and other Prolamins) Damage the Gut, Worse than Gluten: The Agglutinin Class of Lectins, 3 Myths About Legumes — Busted!, The WHYs behind the Autoimmune Protocol: Eggs).  

The other foods that test positive with high frequency are nuts and seeds.

Another 2015 study compared the frequency of IgG food intolerance in Inflammatory Bowel Disease sufferers compared to healthy controls.

What The Data Shows

Nut and seed intolerance was very common, especially in Crohn's disease sufferers. (13:30)

This is also something that won't improve over time with exposure. Mouth and lip-tingling is a pre-anaphylaxis sign.

Nuts & Seeds	% Crohn’s patients with IgG Ab	% healthy controls with IgG Ab
Almond	16	0
Pecan	38	0
Sesame	7	0
Sunflower seed	11	0
Walnut	7	0

In a 2004 study of people with unexplained gastrointestinal symptoms, cashews are among the most common nut intolerances and affect upwards of 50% of study participants. 

Compared to intolerance to almonds, about 28%, Brazil nuts were 23%, and walnuts were 3%.

Food	% IBS Patients with IgG Ab
Almond	28
Brazil nut	22.7
Cashew nut	49.3
Walnut	2.7

In yet another 2016 study of people with unexplained allergy symptoms, also common among autoimmune disease sufferers, pistachios were among the most common nut intolerances, affecting upwards of 60% of study participants.

 

Does Soaking or Activating Nuts Reduce Risk?

New Science Says don't bother soaking. (16:49)

We're going to talk about 4 new studies, two from 2020, one from 2019, and one from December 2018. 

All consistent with each other and point to no benefit from soaking nuts.

Sarah mentions that this is actually quite surprising. 

There's lots of evidence, especially in legumes, that soaking, sprouting, and fermenting reduce agglutinins and phytates.

The amount of deactivation of antinutrients in legumes depends on the specific legume and how it is prepared. 

For example, soaking pigeon peas for 6 to 18 hours reduces the problematic lectin content by 38 to 50%, and 

soaking kidney beans for 12 hours reduces the lectin content by nearly 49%.

New Data to Study

 Likewise, one study found that for white beans, broad beans, lentils, chickpeas, and soybeans, soaking for 12 hours at 78°F reduced phytate levels by between 8 and 20%. 

Additional research shows that longer soak times in warmer water result in the greatest phytate decrease. 

Lastly, fermentation—which occurs after extended periods of soaking—can reduce phytates and lectins even further. 

One study found that fermentation reduced phytates by 85% in kidney beans, 77% in soybeans, and 69% in mung beans, particularly to the bacteria Lactobacillus bulgaricus.

Many of us assumed that nuts would be similar, but this hasn't been evaluated in the scientific literature until just the last year!

In fact, when Sarah wrote The Paleo Approach (published in 2014), she said:

"It is commonly postulated that soaking nuts in salted water and then drying them improves digestibility, reduces enzyme-inhibitor activity, and decreases phytic acid. This has not been documented in the scientific literature. Still, anecdotal accounts suggest that many people can tolerate nuts that have been soaked and dried even if they do not tolerate raw or roasted nuts."

Plus, she never actually included a recommendation to soak nuts on her website or in her books. This is because there hasn't been science to say yay or nay… until very recently!

Sarah's References: Soaking or Activating Nuts

Sarah references and explains findings from these studies: (25:30)

Lee LY, Mitchell AE. Determination of d-myo-inositol phosphates in 'activated' raw almonds using anion-exchange chromatography coupled with tandem mass spectrometry. J Sci Food Agric. 2019 Jan 15;99(1):117-123. doi: 10.1002/jsfa.9151. Epub 2018 Jul 15. PMID: 29808577.

Taylor H, Webster K, Gray AR, Tey SL, Chisholm A, Bailey K, Kumari S, Brown RC. The effects of 'activating' almonds on consumer acceptance and gastrointestinal tolerance. Eur J Nutr. 2018 Dec;57(8):2771-2783. doi: 10.1007/s00394-017-1543-7.

Feng Y, Lieberman VM, Jung J, Harris LJ. Growth and Survival of Foodborne Pathogens during Soaking and Drying of Almond (Prunus dulcis) Kernels. J Food Prot. 2020 Dec 1;83(12):2122-2133. doi: 10.4315/JFP-20-169.

 

Why Would This Be?

My hypothesis is that this is due to the botanical difference.

A legume is typically a pod with multiple seeds that will start to open on its own as it becomes ready for harvesting. Dried beans are those seeds.

A nut is typified by a hard outer shell protecting a single seed that we would call the "nut" and does not open on its own. 

Certain temperatures and moisture for very long times, etc., needed to get a nut to sprout, which point the shell splits.

See for example https://www.wikihow.com/Plant-a-Walnut-Tree 

A drupe is basically a nut with a pulpy fruit around it.

If you wanted to plant a nut to grow a tree, you'd plant the whole nut with the shell and husk around it.

If you wanted to plan a legume to grow a plant, you'd plant just the seed outside of the pod.

Legumes will sprout (and you could plant those sprouts) on your kitchen counter, but nuts won't.

What About Making Nut Milks, Yogurt, "Cream Cheese"?

The difference in minerals and phytates is small, +/- ~10%, so if you have to soak for a recipe, don't worry about it. (41:10)

BUT, soak at a cooler temperature (like 15C, better yet soak in the fridge) to make sure that if your nuts have E-Coli on them, that you don't' create an environment where they can grow

After doing this research, I'm actually amending some recipes to have the nut soaking occur in the fridge.

Final Thoughts

Nuts are a healthy food in moderation and great for the gut microbiome.

It's better to eat raw or roasted and not bother soaking, sprouting, or activating.

Sarah adds that none of these studies were performed on seeds, so we're still unsure how this affects seeds. 

Big shout out to Georgia Grinders, which offers slow-roasted nuts that Stacy and Sarah love- completely unsponsored. 

Be sure to pop over on Patreon to hear what Stacy and Sarah really feel about soaking or activating nuts. 

Episode 451: ConspiraSEA: Is Sustainable Seafood Impossible?

Welcome to episode 451 of The Whole View! This week, Stacy and Sarah address the health benefits, the question of sustainable seafood and Seaspiracy as a whole. 

 

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

The Whole View, Episode 451: ConspiraSEA: Is Sustainable Seafood Impossible?

Welcome back to episode 451! (0:28)

Stacy and Sarah have received many questions on Netflix new documentary, Seaspiracy. 

Stacy took almost eight pages of notes, while Sarah has also prepared many sea-related puns for you.

First off, the name ConspiraSEA was right there, and she totally feels they missed the boat (ha!) on that one. 

Stacy also mentions they gathered thirteen pages between them to ensure you are provided with as much information as possible and not just Stacy and Sarah's opinions.

The message the show tries to deliver is the opposite of this show's top recommendations. 

Stacy could tell within minutes that the filmmakers had an agenda. She and Sarah plan to review the science-based facts from the claims made in the film. 

The goal is to help listeners navigate safe, sustainable seafood because despite what the film attempts to present, seaweed and plant-based options do not compare to the health benefits.

So Stacy and Sarah want to dive right in. (Get it?)   

 

Benefits of Seafood

It's important to emphasize what we'd be missing out on if the premise that sustainable fishing is impossible is true. (4: 01)

Eating more seafood can reduce cardiovascular disease and prevent obesity and diabetes.

High amounts of vitamins, minerals, carotenoids, fats, and protein all contribute to these benefits. (Intro to Nutrivore)

Fish is a great source of vitamins B1, B2, B3, B6, B9, B12 and E, zinc, phosphorus, magnesium, iron, copper, potassium and selenium. Oily, cold-water fish provide substantial amounts of vitamin A and vitamin D as well.

Fish with bones remaining (such as canned salmon and sardines) are the best dietary sources of calcium in the food supply. Marine fish are an excellent dietary source of iodine.

High Selenium Content

• protect against some cancers, 
• enhance bone health, 
• maintain thyroid health, 
• reduce the risk of infection,
• assist in DNA production, and 
• protect the body from free radical damage

Omega-3 Fats EPA and DHA

• reduce inflammation, 
• lower blood pressure, 
• protect against some cancers (including breast), 
• increase insulin sensitivity, and 
• improve endothelial function
• Improves gut microbiome composition

Salmon 

Or any fish with a similar salmon-pink or orange color also contains the antioxidant carotenoid astaxanthin.

• helps reduce LDL oxidation
• boosts HDL levels, and 
• protects against skin damage.

 

Fish protein is the BEST!

Also supports a healthy, diverse gut microbiome (in addition to omega-3s) - better than any other protein source: beef, pork, chicken, soy, casein, and pea. (11:20)

Many fish benefits are mediated via protein, and fish protein is easy to digest. 

In a meta-analysis of five prospective cohort studies, lean whitefish's high consumption reduced the risk of stroke by 19% (which was even more than fatty fish intake, which reduced stroke risk by 12%). 

A study of Swedish women shows that three servings of lean fish per week reduced the risk of stroke by 33% compared to zero servings per week. 

In Norwegian men, weekly lean fish consumption (including whitefish) was associated with a lower risk of metabolic syndrome, lower triglyceride levels, and higher HDL cholesterol. 

Likewise, a randomized crossover trial found that simply adding 100 grams per day of whitefish (Namibia hake) to the diet significantly lowered waist circumference, diastolic blood pressure, and LDL levels! 

And another trial found that eating 150 grams of cod per week caused significantly greater weight loss in young overweight adults than a same-calorie diet without seafood.

 

Seaspiracy "Documentary"

Sarah poses the question: what if eating fish and shellfish is destroying the ocean ecosystem and is actually full of toxins? (17:30)

This is what Seaspiracy claims, so let's talk about this propaganda.

Stacy reminds us documentaries are a filming style, and the information contained within is not regulated. 

They can be amazing ways to learn about history or science. They can also be manipulative propaganda. So just because it's in documentary format does not mean it's news or that it's true.

This documentary was made by the same people who made What the Health and Cowspiracy.

• What the Health… is Wrong With This Documentary?!
• Handling Critics, Conflicts and Vegans

We don't want to get into a point-by-point discussion but let's bust the two biggest myths purported by this documentary:

Sustainable Seafood Claims

The "movie" claims that there's no such thing as sustainable seafood what so ever. Commercial fishing is destroying the oceans. 

They claim fisheries aren't regulated, and fish farms are even worse. Also, the proportion of fish sold in the U.S. is caught illegally, and the ""sustainably caught label is meaningless.

The second claim is that we should all be vegan. Seafood is full of toxins (like mercury and PCBs) and microplastics. It's destroying the oceans, and we can get the same nutrients from algae.

 

What is Sustainable Fishing?

Sarah adds that her first research job in college was research for the Canadian Department of Fisheries and Oceans. (22:01)

It entailed actually doing research for sustainable salmon fishing. They even published a paper based on her research! 

The United States is recognized as a global leader in sustainable seafood because we rely on strong science, responsive management, and enforced compliance.

Fish, shellfish, and marine algae are renewable resources because they reproduce and replenish their populations naturally. 

That means we can sustainably harvest fish within certain limits without depleting their populations. 

Sustainability has two basic steps:

• Scientists perform a stock assessment to recommend how much fish should be harvested.
• Fishery managers and regulators follow and enforce that recommendation.

Fishery management uses science to determine these limits and entails catching some fish while leaving some to reproduce and replace the fish that are caught.

What It Means For Sustainability

The United States is actually a global leader in seafood sustainability in general. Interesting enough, Stacy notes the "documentary" left this detail out entirely. (25:03)

The argument centers around that our global population are rising, but our global abundance of wild fish is not. 

Food and Agriculture Organization of the U.N. (FAO) estimates that 66% of fisheries are sustainable, contributing 78.7% of consumed seafood. 

This means there's room for improvement since 20% of the fish eaten in the world are from overfishing. 

However, this doesn't mean give up on fish. It means you need to be an informed consumer!

One of the amazing things about our oceans is that fish stocks can recover and replenish if they are managed carefully for the long term. 

Some stocks that have come back from the brink include the Patagonian toothfish in the Southern Oceans. 

Other examples include the recovery of Namibian hake, after years of overfishing by foreign fleets, or the increase in some of our major tuna stocks globally. 

Research shows that fish stocks that are well-managed and sustainable are also more productive in the long term. This means there is more seafood for our growing global population.

Outlying Scientific Data on Sustainable Seafood

In 2006, a study predicted a global collapse of fish species and empty oceans by 2048. However, it was later busted here: https://sustainablefisheries-uw.org/fisheries-2048/ 

Stacy adds that while watching the "documentary," she noted all the studies referenced were at least 5 years old. 

Sarah mentions that when she comes across studies considered "outliers" and goes against most other data, she looked a bit closer at the details. 

Nowadays, we're seeing many of these "outlier" articles being overly weighted and fueling pseudoscience claims on the internet.

She notes that it doesn't mean that they are necessarily wrong. We just need to look a bit more critically at the science to figure out what exactly is happening. 

 

Commercial Fishing is Highly Regulated

Stacy notes one important aspect she learned from the "documentary" is that people can be bribed anywhere. (38:06)

She adds that given details in contrast to the "documentary" agenda can be cut out to strengthen the case.

Because bribery exists, the "documentary" claims you can't believe anything anyone in the industry says. However, they fail to provide any instances of this so-called bribery.

Commercial fishing is not equivalent to CAFO's or industrial farming. All it means is catching fish to sell.

It can be done large scale, but the industry is highly regulated. In fact, U.S. fishermen abide by some of the most rigorous environmental measures in the world.

Both large and small scale fishing boats are regularly inspected to ensure fisheries are protected, and we're abiding by sustainable seafood guidelines. 

Fishery management in the United States is guided by several laws, including the Magnuson-Stevens Act, Marine Mammal Protection Act, and Endangered Species Act.

10 national standards of sustainability manage U.S. fisheries. These standards aim to prevent overfishing, protect other species and habitat, and minimize bycatch on non-target species. 

It is the case that some fish sold in the U.S. were caught elsewhere. 

If you're looking to uphold sustainability, ensure you shop local or see where the fish was caught, or the fishery is located.

It's important to note that the main economy of Pacific island nations is fishing. So outlawing the sustainable seafood industry would result in their economy's collapse.

 

Farm Fishing Isn't Evil

Stacy notes one claim the "documentary" makes is that fish farms have a "organic waste" (aka the fish poop in the water). (51:35)

Fish poop is not a toxic substance and used as food for organisms like algae. 

Aquaculture, or farming in water, plays a critical role in ensuring that our need for seafood is met sustainably. It's also a resource-efficient way of increasing and diversifying U.S. seafood production. 

The future of sustainable seafood must include both farm-raised and wild-capture seafood! 

Increasingly, seafood farming (if done responsibly as it is in the United States) is recognized as one of the most environmentally sustainable ways to produce food and protein.

We discussed antibiotics use and "coloring" in farmed fish in Episode 366: Seafood Safety Concerns.

Sarah notes there's a mandatory withdrawal period for each type of antibiotic fed to fish before the fish can be slaughtered. So, there is ample time to make sure there's no residuals in the meat by the time we eat them. 

Additionally, the dye used is actually astaxanthin: the same red carotenoid pigment found in red algae makes wild fish flesh that distinctive color. It's an important antioxidant and makes them healthier! 

Because of feed ingredients, the nutrient profile of farmed fish usually isn't as good as wild. But, it's still a great choice!

Marine Stewardship Council Certification

At Whole Foods, the seafood counter displays blue labels from the Marine Stewardship Council (MSC), an international, nonprofit organization. (58:52)

The MSC is a prime example of an economic trend: private groups, not the government, tell consumers what is good or bad for the environment. 

The MSC says its label guarantees that the wild seafood was caught using methods that do not deplete the natural supply. 

It also guarantees that fishing companies do not cause serious harm to other life in the sea, from coral to dolphins.

Unilever and the World Wildlife Fund joined hands in 1997 to establish MSC as an independent not-for-profit, more than 20 years ago over concerns about overfishing, 

This certification process is not carried out by the MSC. It is independent and carried out by expert assessment bodies. Also, it's an entirely transparent process, and NGOs and others have multiple opportunities to provide input. 

All the assessments can be viewed online at Track a Fishery. 

Only fisheries that meet the rigorous requirements of Standard get certified.

Check out their rebuttal to Seaspiracy here!

Other labels to look for:

• The Monterey Bay Aquarium labels products like a traffic light — green, yellow or red — to urge shoppers to buy or avoid a particular fish. 
• The Blue Ocean Institute has a similar system.
• The Tuna Tracking and Verification Program (TTVP), established under the Dolphin Protection Consumer Information Act, is how NOAA Fisheries monitors compliance with dolphin-safe tuna labeling. (Reference)
• What about the BAP cert for responsibly farmed fish?

This topic is very important to Sarah and Stacy, and they want to make sure they're supporting the right companies and share this with listeners for their own knowledge.

 

Conspiracies

The "documentary" claims that sustainably sourced labels are lies and all dishonest. (1:12:20)

It was organized in a very manipulative way where it starts with a fact but shows footage as a representative that isn't a fact. 

Stacy shares these examples:

Fact: enough single-line is used daily to wrap around the world 500x.

• This does not mean that much line is discarded into the ocean daily- just used. 
• It's phrased as though it's being dumped in the ocean every day, which it's not. 
• In fact, single line fishing is a good thing!

Fact: 250,000 sea turtles are "captured, injured, or killed" in U.S. annually from fishing vessels. 

• When fact-checked, you realize that that number includes the ones returned to the ocean after capture or healing from injury.
• This species is protected now, so many are rescued and returned. 
• However, the "documentary" conveniently leaves that out to manipulate the impact of the number. 

Sarah adds that we are biologically herbivores (solely plants) or carnivores (solely meat) but omnivores. This means our body is designed to gain nutrients from a combination plant and meat diet. 

 

Fish Toxins

Can't we just eat algae? No- it's not the same as seafood. By this logic, we'd get the same nutrients eating grass that we do from eating beef.

Stacy and Sarah did a whole episode on it: TPV Podcast Episode 366: Seafood Safety Concerns.

There have been a few European studies showing a U-shaped response curve to fish consumption. Moderate fish consumption reduces all-cause mortality and cardiovascular disease risk. However, higher fish consumption increases the risk of all-cause mortality. 

The studies have postulated that this may be due to increased exposure to some of the toxins that can accumulate in fish. These toxins include methylmercury, dioxins, and polychlorinated biphenyls (PCBs)

However, this isn't seen in North American or Asian cohorts studies where fish is equally as likely to contain these toxins. 

The authors of a rigorous 2017 meta-analysis proposed an alternate explanation for a U-shaped curve in Europe. Traditional preparations of fish in many parts of Europe include deep-frying, pickling, or salting. 

This high-salt and/or trans-fatty acid intake may be to blame for the higher all-cause mortality seen with higher fish consumption.

What about microplastics?

We've talked about single-use plastics on the show before in TPV Podcast Episode 352: Sustainability & Mother Earth.

Also, Sarah has written about it here: https://www.thepaleomom.com/my-journey-towards-zero-waste/

Plastic pollution is a problem! They did get that right. For more information on this, see articles here and here. But solving this problem doesn't include avoiding seafood (buy sustainably caught).

Look to lower your carbon footprint, reduce the use of single-use plastics, avoid cycling, recycle properly, and look to reusable bags and containers.

There are better ways to learn about how to protect our oceans:

• Planet Earth documentary
• Blue Planet
• Nova
• National Geographic
• Scientific American magazine

Where Do Stacy and Sarah Get Fish?

My favorite source is ButcherBox  https://www.butcherbox.com/thepaleoview

Stacy has a local fishmonger at farmer's market, plus Costco, Trader Joe's - tons of vendors now sell Alaskan and/or certified sustainable seafood

Farmed shrimp, Alaskan / farmer's market salmon, dolphin-safe line-caught tuna, local shellfish

Great Resources

• https://sustainablefisheries-uw.org/start-here/
• https://www.fisheries.noaa.gov/feature-story/5-things-you-should-know-about-sustainable-seafood
• https://www.msc.org/media-centre/news-opinion/news/2021/03/26/response-to-netflix-seaspiracy-film
• https://pubmed.ncbi.nlm.nih.gov/31932439/ 
• https://oceanservice.noaa.gov/facts/microplastics.html 

 

Final Thoughts

Sarah reminds listeners that documentaries are not grounded in scientific fact and can be skewed. (1:31:40) 

The truth is the oceans are in trouble and need help, just not wholly in the ways stressed in the "documentary" Seacpiracy. 

We need to look at this practice to find an action we can walk away with feeling good about. 

If you haven't joined the Patreon family yet, joining supports this podcast and provides you with bonus content on what Stacy and Sarah really feel. 

Thank you so much for listening, and we'll see you next week!

Episode 450: Spices on the AIP? What’s In, What's Out, and Why.

The Whole View, Episode 450: Spices on the AIP? What’s In, What's Out, and Why.

Welcome back to episode 450! (0:28)

Stacy and Sarah both have sensitivities to nightshades due to inflammation-driven health issues. 

Nightshades are common trigger foods and can be super problematic to autoimmune diseases and chronic illnesses as well.

This is because the immune system is already in overdrive. Adding an immune stimulant (such as nightshades) to the equation can cause symptom flare-ups.

The logic that goes into the autoimmune protocol requires a little bit of reasoning about how best to apply it to your day-to-day choices.

When writing her book on AIP, Sarah's research really focused on how the immune system works and how it intersects with nutrients, lifestyle, hormones, etc.

Understanding how foods can be problematic for some people is never irrelevant. Even if you're perfectly healthy, the science behind AIP can be applied to optimize diet and troubleshoot any future health issues.

In this episode, Stacy and Sarah plan to do a deep dive into what herbs and spices are awesome when on AIP, which are considered early reintroductions, and which ones are best avoided until the very end of the healing process.

For more references, please see:

• When Do We Re-Do the Elimination Phase of the AIP?
• Can Food Intolerances Be Fixed?
• Food Allergy, Sensitivity, and Intolerance: What’s the Difference?
   
• What Do I Do After a Bad Reaction?

Listener Question

This episode was inspired by this listener question from Jeff. (10:30)

Hello,

I'm a chef of 20 years and as most of us in the hospitality industry have experienced, things are not good. During my temporary retirement I've decided to help out a family who has started an AIP diet. I haven't cooked specifically for a person who has said they are specifically AIP, but I have had plenty of experience with similar dietary needs. It will no doubt be a challenge, but it will be a fantastic learning experience and chance to change a persons experience while on their path to recovery.

In my journey I'm looking for ways to infuse the flavors which I like to use in ways that will be in line with the protocol. My inquiry has to do mainly with flavor infusion. Take for example a brine for pork. I use products like whole black peppercorn, whole coriander seed, mustard seed, etc. to add layers of flavor to the brine. Is the main issue with these spices the pieces of the seeds? Are the extracted oils also off limits? My main concern is around spices. I would venture to believe that nightshade oils are the problem (i.e. dried chilies, capsicum, etc).

- Jeff

Stacy reflects on how much she enjoy's Jeff looking at it from a chemistry perspective in the cooking.

Alternatively, people who find out they can't eat raw tomatoes might discover they can have cooked ones as they reintroduce foods back into their diet.

It's very bioindivideal, meaning Stacy and Sarah can't answer what foods will affect you and why. AIP is a way to isolate triggers for you personally to optimize your health.

Overall Philosophy Spices on the AIP

Sarah believes the most helpful place to start is taking a step back and looking at herbs and spices in general. (13:30)

The autoimmune protocol first tries to flood the body with nutrients- both essential and nonessential. Sarah references this show for more information on nutrient toxicity.

Another thing AIP tries to do is remove inflammatory properties from the diet. Herbs are derived from the leaves of fragrant plants and sometimes flowers. 

They are safe to use whole, fresh or dried. It's actually very beneficial to include them since the same phytonutrients that provide the flavor tend to be awesome antioxidants and anti-inflammatory. 

Other properties they often have are anti-cancer, liver protective, neuroprotective, and more. See our Essential Oil show for more on extracts, though. 

These can be more complex and don't get an automatic pass. TPV Podcast, Episode 272: What's the Deal with Essential Oils?

Spices often derive from non-reproductive plant parts like barks, roots, styles, and arils, but it's not always the case. 

Herbs don't generally need to be ground before using in a recipe, whereas spices often need to be ground before using.

Why Spices on the AIP Are Eliminated

They are eliminated on AIP if they derive from seeds, berries, fruit, or the nightshade family. (21:20)

This is due to their unusually high food allergy and intolerance rates. 

Seed spices should be avoided at first, even though many seed-based spices haven't been specifically studied. 

Spices that derive from berries and fruits of plants typically contain more seed than fruit. You are still consuming the ground seed.

Depending on your individual autoimmune challenges, some people tolerate the very small doses of seed-based spices used in cooking. This happens during Phase 1 Reintroductions. 

As a result, seeds are often early reintroductions because they aren't something that necessarily will show up on an allergy test.

However, something can cause inflammation or stomach issues without being an actual allergy. In that case, passing a test doesn't mean you're in the clear to eat it without complications.

Proteins that are unique to seeds as a reproductive part of the plant cause complications. 

Also, the nightshade family causes problems for most people with autoimmune disease.  

Nightshades are restricted on the Autoimmune Protocol due to high glycoalkaloid content and agglutinin content. They increase gut permeability and act as an adjuvant, exaggerating immune responses.

Spices from the nightshade family (mainly peppers) also contain capsaicin (one of the chemicals that give them heat), a mucus membrane and gut irritant.

Safe Herbs and Spices on the AIP

There are plenty of safe spices to have while on the AIP. (29:35)

However, extracts are not an automatic pass because you're not necessarily getting everything from a plant. Some compounds might be concentrated and or skewed into being unbalanced.

When Sarah talks about "safe spices" she's talking about the whole leaf, flower, root, or bark:

• Balm (lemon balm): Leaf of Melissa officinalis L.
• Basil Leaves (Sweet): Leaf of Ocimum basilicum
• Bay Leaves (Laurel): Leaf of Laurus nobilis
• Chamomile: Flower of Anthemisnobilis L. or Matricaria chamomilla L.
• Chervil : Leaf of Anthriscus cerefolium
• Chives: Leaf of Allium schoenoprasum
• Cilantro (Coriander): Leaf of Coriandrum sativum
• Cinnamon/Cassia: Bark of Cinnamomum spp.
• Cloves: Bud of Syzygium aromaticum
• Dill Weed: Leaf of Anethum graveolens/Anethum sowa
• Garlic: Bulb of Allium sativum
• Ginger: Root of Zingiber officinale
• Horseradish: Root of Armoracialapathfolia Gilib.  *(Read ingredients for horseradish sauce!)
• Lavender: Flower of Lavandula officinalis Chaix.
• Mace: Aril of Myristica fragrans
• Marjoram Leaves: Leaf of Majorana hortensis Moench
• Onion Powder: Bulb of Allium cepa
• Oregano Leaves: Leaf of Origanum vulgare/Lippia spp.
• Parsley: Leaf of Petroselinum crispum
• Peppermint:  Leaf of Mentha piperita
• Rosemary: Leaf of Rosmarinusofficinalis
• Saffron: Stigma of Crocus sativus
• Sage: Leaf of Salvia officinalis/Salvia triloba
• Salt: Mineral - moderation is important!
• Savory Leaves: Leaf of Satureia montana/Satureia hortensis
• Spearmint: Leaf of Menthaspicata
• Tarragon: Leaf of Artemisia dracunculus
• Thyme: Leaf of Thymus vulgaris/Thymus serpyllum/Thymus satureioides
• Turmeric: Root of Curcuma longa
• Vanilla Bean*: Fruit of Vanilla planifolia/Vanilla tahitensis Moore

*Vanilla gets a pass because the seeds are so small that they are intact when you consume them, putting vanilla bean (which is not a legume) in the same category as berries.

Moreover, Vanilla and vanilla extract is also okay, provided it's certified gluten-free (often grain alcohol is used).

If it's not a nightshade and comes from bark, root, leaf, or flower, you're good to go!

 

What to Avoid

There is also a list of spices to avoid altogether, and some you should reintroduce at different stages in the AIP. (59:03)

Early Reintroduction Spices (Berries & Fruit)

• Allspice: Berry of Pimenta officinalis
• Star Anise: Fruit of Illicium verum Hook
• Caraway: Fruit or Carum carvi Maton.
• Cardamom: Fruit of Elettariacardamomum
• Juniper: Berry of Juniperus communis
• Black Pepper: Berry of Piper nigrum
• White Pepper: Berry of Piper nigrum
• Green Peppercorns: Berry of Piper nigrum
• Pink Peppercorns: Berry of Schinus terebinthifolius

Early Reintroduction Spices (Seeds)

• Anise Seed: Seed of Pimpinella anisum
• Annatto Seed: Seed of Bixa orellana
• Black Caraway (Russian Caraway, Black Cumin): Seed of Nigella sativa
• Celery Seed: Seed of Apium graveolens
• Coriander Seed: Seed of Coriandrum sativum
• Cumin Seed: Seed of Cuminum cyminum
• Dill Seed: Seed of Anethum graveolens/Anethum sowa
• Fennel Seed: Seed of Foeniculum vulgare
• Fenugreek: Seed of Trigonellafoenum-graecum
• Mustard Seed: Seed of Brassica juncea/B. hirta/B. nigra
• Nutmeg: Seed of Myristica fragrans
• Poppy Seed: Seed of Papaver somniferum
• Sesame Seed: Seed of Sesamum indicum

Avoid (Nightshades)

• Capsicums: Seed of Capsicum spp.
• Cayenne: Fruit of Capsicum annuum
• Chili Pepper Flakes: Many Varieties, fruit of Capsicum genus
• Chili Powder: Blend of fruit of Capsicum genus
• Curry: A spice mixture typically containing coriander, cumin, fenugreek, and red pepper.
• Paprika: Fruit of Capsicum spp.
• Red Pepper: Fruit of Capsicum

 

Common Spice Blends To Watch Out For

In general, Sarah doesn't recommend against using any spice blends because the ingredients list often doesn't actually say everything in it.

Sarah has no idea where it became okay to say "spices" or "natural flavors" on the labels.

But, here are some common spice blends you might have in your kitchen with components to worry about:

• Curry Powder: Mixture typically containing coriander, cumin, fenugreek, and red pepper.
• Chinese 5-Spice: Contains Star Anise, Peppercorns, and Fennel Seed
• Garam Masala: Contains peppercorns, cumin seeds and cardamom pods
• Poultry Seasoning: Often contains pepper, nutmeg
• Steak Seasoning: Usually contains pepper, chili, cumin, and cayenne

What About Brines, Broths and Oils?

For brines, broths, and oils, it really comes down to why we're eliminating this food. And is the thing we're eliminating fat or water-soluble. (1:08:05)

Proteins are water-soluble, so yes, you can get this in broth or brine.

For seed and berry/fruit-based spices, the concern is common food intolerance.

However, you can use these in flavored oils because little to no protein is imparted.

Also, with nightshades, avoid brines, broths, and oils. Glycoalkaloids have a detergent structure and help water and oil mix.

 

Final Thoughts

When it comes to nightshades, Sarah has not met very many people who have gone all the way through AIP and have successfully reintroduced all nightshades. (1:11:35)

Stacy has met a lot of people who are in denial that nightshades are an issue for them. 

She adds that she was at the stage where, like Sarah, she could have a little nightshade spice every so often. 

Then she got Covid and is a long-hauler. That, mixed with the stress of a pandemic and virtual school, she's been very strict with avoiding nightshades.

She doesn't want to risk undoing all the work she's done by consuming nightshades when her body isn't operating optimally due to her current stress.

But just because nightshades might be an issue for you, that doesn't mean you can never have them ever again.

If eating your mother's curry is an act of self-love and comfort, go ahead and eat it if that's what you want to do. Just know and prepare yourself for a possible flare-up.

If you want to hear what Stacy and Sarah really think about today's show, be sure to join the family on Patreon for some bonus behind the scenes content. 

Thanks so much for listening, and we'll see you next week!

Episode 449: Navigating Shift Work in a Healthy Way

The Whole View, Episode 449: Navigating Shift Work in a Healthy Way

Welcome back to episode 449! (0:28)

There are many people throughout the US and the world with careers that involve working on alternate shifts.

This constant fluctuation in waking and sleeping hours can make navigating shift work difficult since your circadian rhythm never gets the opportunity to fully stabilize.

However, if you work regular shifts like Stacy and Sarah, you can still utilize the techniques in this show for things like jet lag and daylight savings.

Sarah explains that there aren't many differences between jet lag and working alternate shifts because they impact circadian rhythms.

This show was inspired by this listener question:

I have been dialing in my nutrition, activities and sleep and feel so much better for it. But due to my work schedule everytime I come off a rotation of night shifts it takes me 3 days to recover back to my new normal again. I started working 12 hour shifts (7am to 7pm for 4 days then 2 days off. Then 7pm to 7am for 4 nights, then 6 days off to rest).   

It's like having jetlag every 16 days! Is there anything I can do to help and support my body through this? Many thanks,

Sophie

This is a common issue for many over the last year- specifically front-line workers through the pandemic.

Many thanks to front-line workers and medical staff for their flexibility to be there when we've needed them.

Sarah remembers when this alternation between day shift and night shift was introduced. Before it, people would work days or nights and stick with that one shift all the time.

Balance and fairness are important in the workforce, yes. However, Sarah feels it's important to talk about why having a consistent night shift would be better than going back and forth.

Ideal Circadian Rhythm Entrenchment

Forcing our circadian clock to adapt is harder on our bodies than living out of sync with the sun. (6:40)

Things like bright lights indoors in the evening, not spending enough time outside, eat at weird times or too late, and even over air condition our house during the day can mess with that entrenchment even if we work during the day.

Working a shift that's out of sync with the sun requires us to "overwhelm" the signal we get from the sun.

We can do this by ensuring our sleeping environment is very dark, challenging if we're sleeping during the day.

Double layered blackout curtains can help block out the sun from windows.

Sarah also recommends covering anything with LED lights (especially blue and green) with duct or masking tape.

Temperature shifts are also big signalers to our circadian rhythms. Ensuring our sleeping environment is cold when we're sleeping and warmer can help make navigating shift work easier.

Bright lights can inhibit our body's melatonin production, which signals that it's time for sleep.

Amber-tinted glasses block blue light and can help support sleep.

Even when you're not asleep during your "night," turning off lights, keeping the blinds closed, programable LED lightbulbs and avoiding screens an hour before bed can help you trick your body into thinking it's nighttime.

Stacy and Sarah have talked in past shows about how melatonin is sometimes used for sleep disorders. It also works great for jet lag and shift workers. 

Manage stress since dysregulated cortisol can hinder circadian rhythm entrenchment.

Make sure you're not vitamin D deficient since vitamin D is vital for biorhythms, and if you sleep during the day, you may not be getting enough sunlight.

 

Navigating Shift Work On Nights Off

Staying on one schedule isn't always practical when you work nights because most of the world operates on daylight hours. (18:45)

Seeing friends and family members and running errands are all things you'd probably do during the day on days off. 

Sarah recommends shopping at the end or beginning of your day, right when the store opens at 7am or before it closes at 7pm.

Meet your friends for your breakfast and dinner, or vice versa, to keep a generally similar schedule to your workdays. 

It is also possible to shift your day partially, say 2-3 hours instead of a full 12 hours. This frees up more time for family activities but not so jarring for your body.

Shift work is often associated as a cause of insomnia due to the constant changing of when we're awake.

Adequate sleep is also tied to insulin production, metabolism, and immune system function!

Shift work impacts sleep quality through disruption of the circadian clock.

If we don't find ways to healthy manage it, it impacts insulin production, metabolism, immune system function, and more.

 

Navigating Shift Work That Alternates

Sarah turns her focus toward Sophie's situation of constantly switching from days to nights through her workweek. (24:20)

She adds that experiencing 3 days of jet lag for a 12-hour time shift is actually pretty normal-whether it's through changing time zones or work change.

A lot of the studies done on this topic use jet lag as a model. However, it is well understood in the science community that the two are basically the same thing and affect the body in the same way.

You can help your body adjust to the new time is by going outside and have that light signal to jumpstart resetting your clock. 

If you're flying, you can do this by reorienting your time to the time of your destination as soon as you get on the plane. 

You can also use melatonin (higher dose, up around 1mg) for those first few nights.

Make sure you're managing stress! Cortisol has to shift, too, and having dysregulated cortisol, to begin with, makes the transition harder. Vitamin C, omega-3s, and magnesium super helpful here.

If you're going to be shifting back and forth, having a lightbox to use at the breakfast table, no matter what time of the day it is, is an ideal setup. 

It doesn't matter when you exercise, but rather that it's on its own predictable schedule. If you like going to the gym before work, do it before work no matter when your shift starts. 

So if you work out in the morning, keep doing that whenever your "morning" is (aka 6am on day shift days, 6pm on night shift days)

Basically, keep your schedule the same but shift it to 12 hours. 

Meal timing is crucial to shifting, so don't skip breakfast on "jet lag" days. You might feel hungry, but make sure you keep habits and patterns. 

Eat similar size breakfast, lunch, and dinner whichever "time zone" you're in and your same "fasting periods" over at least 12 hours.

 

Nutrients That Help

Because Sophie has tackled some big nutrition changes, it's essential to look at what roles nutrition can play in navigating shift work in healthy ways. (33:15)

Vitamin D is important for biorhythms, so always take it during your "morning."

Vitamin C, magnesium, and omega-3s all support healthy stress responses, including cortisol rhythms. Extra vitamin C may be helpful due to the increased oxidant formation during jet lag.

Avoid low-carb, low-fat, and low-protein because studies show it can make jet lag worse! 

Another study suggests that a balanced diet containing carbohydrates, protein, lipids, and vitamins/minerals may be effective for inducing phase shifts in the peripheral circadian clock. 

It also indicates simple diets such as 100% sugar, 100% protein, and 100% oil are inadequate for inducing entrainment signals. 

The gut microbiome also has biorhythms, and 12-14 hours of fasting while you're sleeping are important to regulate it.

We work on things like muscle repair when we're sleeping and less on digestion. This means if we eat too close to bedtime, digesting that food can actually interfere with our ability to enter deep REM.

This means you shouldn't "graze" to keep yourself awake.

Stacy adds that they speak of a "low carb" diet they speak in terms of very low-carb, not what you'd normally get from recommended amounts of fruits and veggies. 

When you're sleep-deprived, one of the first things your body craves is those refined carbohydrates.

Filling that craving with fruits and veggies can balance hormones and get you back into a healthy rhythm.

 

Symptom Management

It's important to recognize that a few days of that jet lag feel will be pretty normal regardless. (43:35)

Some caffeine in your "morning" is okay. However, be careful not to overdo it or to take it too late in the day.

There's many studies showing how great power naps are for improving cognitive performance and energy without taking away from nighttime sleep. These are naps between 10 to 30 minutes long naps to stay in Stage 1 and Stage 2 sleep. 

You need at least 3 minutes of stage 2 sleep for them to work. If you get into Stage 3, you'll know it by feeling groggy when you wake. 

Make sure not to rely on sugar or snacking as a crutch to stay awake as they will prolong the feeling of jet lag long-term.

Activity can keep up energy levels, so make sure you're getting enough regular exercise. Just be sure that the first day's activity doesn't require great judgment since you might be tired.

 

Final Thoughts

Stacy revisits the importance of breakfast and how eating shortly after we wake up can signal our bodies that it's time to wake up. (47:45)

Sarah references these two shows: Intermittent Fasting and Is Breakfast the Most Important Meal of the Day?

Instead of taking energy shots or drinking a lot of caffeine, add daylight and liver pills to your regimen.

Anything that happens inside our bodies uses energy, so ensuring we give our bodies things they can use to make that energy is crucial to optimally functioning.

Supplements are great, but getting nutrients from whole foods is better (i.e., liver pills).

If you've yet to join the Patreon family, pop over for more behind the scenes. Patreon gives you access to how Sarah and Stacy really feel about these topics and supports shows like this one that aren't sponsored.

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

 

Episode 448: Marijuana and Gut Health

The Whole View, Episode 448: Marijuana and Gut Health

Welcome back to episode 448! (0:28)

Sarah and Stacy have done shows on the topic of marijuana and wellness, including CBD, CBD for pets, and pain management. 

This show is sponsored by One Farm, both Sarah and Stacy's favorite CBD brands.

One Farm's goal is to create the highest quality hemp extract on the market.

Their products are made with the best hemp, grown organically in the perfect climate, extracted without toxic solvents, and mixed with quality ingredients.

One Farm and their handling/processing facility are USDA Organic, which very few companies have.

By controlling everything from seed to shelf, One Farm gives you the assurance that everything they make is from our USDA Certified Organic hemp, lovingly raised, cultivated, and processed 100% by One Farm in Colorado.

Stacy notes that they also 3rd party test every batch that comes out of their USDA Certified lab.

Use the code WHOLEVIEW at checkout to receive 15% off your order!

Listener Question on Marijuana and Gut Health:

Today's question about Marijuana and gut health comes from Dana (6:15):

"I love focusing on gut health. I've read your books plus Dr. Terry Wahls books. I rely on cannabis to help me manage some of the residual MS symptoms I have while I work on healing my body. I am greatly aware of the risk of developing CHS as it has been on the rise in the Medical marijuana community here in Portland. It's terrifying to know that something that helps us so much, can harm us too.

My question: How does THC affect the gut and gut motility? How can we prevent CHS medical users who use regularly and sometimes heavily to help manage our diseases? There isn't a lot of research I've found surrounding the effects of thc on the gut. I know it can slow down gut motility, but how much is too much and is there a way to counteract this effect? Does CBD have the same effect as thc on the gut or is it different? Can they work together in the gut to create a safer gut effect versus using a higher thc ratio?

Ratios are big in the medical world. We rely heavily on the science we are presented in regards to the best ratios for our specific disease. There needs to be more talk on the potential risks of cannabis and how to lower our chances of developing something like CHS since so many of us meet the criteria of being at high risk of developing it. Would love to hear your thoughts on this. Seriously. Thank you."

 

CHS: Cannabinoid Hyperemesis Syndrome

As Sarah explains, CHS is a very rare syndrome that occurs in long-term, heavy users of THC-rich cannabis. (7:50)

It was only first reported in medical literature in 2004.

The reported symptoms include nausea, vomiting, and abdominal pain. Also, they are episodic, lasting for 24 to 48 hours, and not returning for several weeks or months.  

More than 90% of cannabis users who experience these symptoms also have a compulsion to bathe in hot water during the episode. 

This is often what helps doctors and patients determine CHS as the cause.

Sarah adds that vomiting can be severe and can leave CHS patients extremely dehydrated, acidosis, decreased serum bicarbonate, acute renal failure, and damage to the esophagus. 

Because cannabis is usually known to help keep nausea and vomiting at bay, these users may end up using cannabis to keep the CHS symptoms at bay.

Hyperemesis symptoms are very resistant, and typical antiemetics, such as ondansetron and promethazine, don't work. The treatment of choice is abstinence for a prolonged period.

The only other effective treatment currently is IM injection with Haloperidol (normally used to treat schizophrenia, schizoaffective disorders, and Tourette syndrome) or Olanzapine (normally used to treat schizophrenia and bipolar disorder).

Because of the use of antipsychotics, this suggests it's not working through the "normal" ways that induce vomiting.

That it's something more related to the central nervous system and not the GI tract.

 

The Difference Between THC and CBD

Sarah believes it's critical to look at the differences between THC and CBD to see why CHS is rising. (13:15)

Both THC and CBD are plant chemicals that interact with the endocannabinoid system, an ancient lipid signaling system. It mediates between our emotional and physical reactions to pain. 

THC is the most abundant chemical in cannabis. It's also the cannabinoid responsible for the sense of euphoria or "high" that comes from using the plant. 

CBD is the second most abundant chemical and doesn't have the same psychoactive effects as THC. 

The difference comes down to how each chemical binds with different receptors in our bodies and activates them.

CBD binds but doesn't activate, which is why you don't get the same sense of euphoria as THC. 

Instead, it appears to modulate or adjust how the receptors respond to stimulation from other compounds.

THC creates mental status changes, motor function, memory, and body temperature by interacting with CB1 and CB2 receptors. This can manifest as euphoria accompanied by increased heart rate, anxiety, hunger, and eventually sleepiness.

CBD

CBD does not have psychoactive effects for most people or very weak effects on sensitive people. (17:30)

Instead is associated with:

• Neuroprotective
• Anti-inflammatory
• Antioxidant
• Analgesic 
• Antipsychotic
• Anti-anxiety & antidepressant

As we talked about in TWV Podcast Episode 420: CBD for Pain Management, both THC and CBD have been shown to reduce pain.

Both CBD and THC also have strong antiemetic effects.

Also, THC increases appetite and can have a sedating effect useful for insomnia.

Because of the combo of increasing appetite and decreasing nausea, cannabis is often used by cancer patients when they're undergoing chemotherapy.

High-THC Marijuana And Gut Health

Stacy adds that the drug industry has actually altered these plants and bred them to yield higher THC concentrations. (20:01)

The decreasing levels of CBD are an unintended consequence of that practice. 

In the old days of finding wild marijuana, THC and CBD's typical levels would be about 50/50. 

In the 1990s, typical "joints" contained 1–3 mg of THC. The typical joint in Colorado now contains 18 mg of THC or more.

Also, Emergency room patients have self-reported smoking up to 2,000 mg or more of THC in a day.

Higher potency products are associated with an increased risk for CHS and an increased risk for psychosis and other types of weed sickness, such as Cannabis Use Disorder.

However, CHS is still considered a pretty care complication.

 

What Are the Chances of Developing CHS?

About 75% of CHS cases report daily or more than daily cannabis users, most of the remaining use at least weekly, very few cases are less often than that. (25:50)

Sarah adds that there aren't many good epidemiological studies out there right now. But there are a lot of case reports and series to look at for data. 

About ⅔ of patients diagnosed with CHS have been using cannabis for at least 2 years before symptom onset.

So far, CHS cases' demographics reflect the demographics of cannabis users, so it doesn't look like any particular population is at greater risk.

So, this increase likely reflects increased use. A study that investigated trends of marijuana use between 2002 and 2014 indicated that prevalence is increasing among both men and women. 

Data from the US national survey on drug use and health show that 12.4 million men and 7.7 million women used marijuana in 2002. This number increased to 18.4 million men and 11.7 million women in 2014. 

Sarah notes that we're not quite sure why some people who use cannabis daily develop the condition and others don't.

Current estimates are that 12% of Americans are active cannabis users.

Another study showed that CHS sufferers had to seek medical attention an average of 7 times before getting diagnosed.

Sarah does this quick math: 

• This would place CHS risk for near-daily to daily users of cannabis anywhere between about 0.2% and 1%. (1 in 100 to 1 in 500)
• The risk for more casual users would be much, much, much lower, using the same back of the envelope math, about 0.003% (1 in 30,000)

A similar study in Colorado showed the incidence of CHS about doubled after legalization of cannabis.

What Does It Mean?

Medical marijuana is on the ride in many areas. Stacy wonders about the implications this could have on health.

Sarah reminds listeners that this is very rough data. She did very rough math to give everyone a general idea of how common this complication.

She also dug deep, looking for similar health issues caused by high-CBD use, and found one paper so far with very little data listed.

Sarah found a narrative article that mentions it can very rarely be seen with high CBD use, but not a single published case study to look at. So, it's unclear if the claim is actually true.

In fact, there's a postulation that increasing CBD could protect against CHS. The combination of high THC and low CBD in high-potency cannabis is driving whatever maladaptation is behind CHS.

The Mechanisms Behind CHS

Sarah explains that, so far, no good quality data pointing to exactly what is causing CHS. 

Cannabinoids may bind to CB-1 receptors in the gastrointestinal tract and decrease GI motility and gastric emptying. This may override brainstem-mediated antiemetic effects and precipitate hyperemesis. [9, 92, 95, 132]

Chronic cannabis use leads to desensitization and downregulation of CB1 receptors that ordinarily have peripheral antiemetic effects. This causes rebound vomiting and spasmodic pain that abates with abstinence and corresponding recovery of CB-1 receptor activity. [98, 136, 185]

In chronic cannabis users, cannabinoid metabolites may accumulate in the brain and fatty tissues, inducing a toxic effect. [90, 94]

Patients susceptible to developing CHS may have a genetic variation in their metabolic enzymes resulting in toxic levels of cannabinoid metabolites [131]

THC may act as a partial agonist on CB1 receptors and thus relatively antagonize the effects of full endogenous agonists on these receptors. This would precipitate sudden withdrawal and hyperemesis in sensitive patients. [97, 105]

THC causes dilation of splanchnic vasculature, resulting in CHS. Hot bathing leads to peripheral vasodilation and shunts blood away from the splanchnic bed, resulting in symptom improvement. [102, 137]

Marijuana and Gut Health

Stacy adds that if you live in an area where marijuana is legal, people who work in the shops that sell it are educated on the topics and can point you to what will work best for your needs. (46:30)

Sarah underlines that she doesn't want this show to scare away anyone from using CBD that might benefit CBD.

Results show normalization of overall appetite and increased/decreases in some circumstances. It also shows a reduction preference for fatty foods- especially polyunsaturated fats. 

It's also believed to relieve diarrhea and abdominal pain, improve appetite in IBD, reduce inflammation and histamine in the gut, prevent mast cells from releasing histamine, and reduce intestinal inflammation in various models and humans.

Data also suggests that THC and CBD's use improves gut barrier health and reduces intestinal permeability in a variety of models.

The Gut Microbiome

The blocking endocannabinoid system causes gut dysbiosis and endotoxemia.

A 2015 mouse study showed THC reduced weight gain, fat mass gain, and energy intake in Diet-Induced Obese but not lean mice.

This 2019 mouse study showed THC and CBD could improve experimental MS (reducing inflammation and clinical signs of paralysis) with effects at least partly mediated via improvements to the gut microbiome, preventing dysbiosis normally associated with MS.

Another 2020 study used CBD plus fish oil in the mouse model of colitis and showed that CBD and fish oil had small benefits. However, both had additive benefits when used together, including reducing inflammation, reducing intestinal permeability, and improving the gut microbiome. 

More of Sarah's Citations:

Epidemiology of cannabis use:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719106/
• https://www.cdc.gov/mmwr/volumes/65/ss/ss6511a1.htm

Basics:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

CHS Review articles:

• 2011 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/ 
• 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330965/
• 2019 https://digitalcommons.chapman.edu/physician_assistant_articles/6/
• 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194425/
• 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599351/
• https://pubmed.ncbi.nlm.nih.gov/33208685/ 
• 2021 https://pubmed.ncbi.nlm.nih.gov/32673642/
• Seems to be due to THC to CBD ratio: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690288/ 

CBD and Gut Health

• https://pubmed.ncbi.nlm.nih.gov/31803950/
• https://pubmed.ncbi.nlm.nih.gov/33162890/
• Inflammation https://pubmed.ncbi.nlm.nih.gov/31764093/
• Cannabis https://pubmed.ncbi.nlm.nih.gov/27792038/
• THC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669115/ 
• Endocannabinoids https://pubmed.ncbi.nlm.nih.gov/27792038/ 
• Gut barrier https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333598/

 

Final Thoughts

When Sarah looks at all this data together, she definitely feels it's worth having a conversation with your healthcare provider if you're planning to use marijuana for medial purposes. (57:22)

Sarah and Stacy are big fans of CBD for its diverse benefits. And that it doesn’t have the problems associated with chronic cannabis use.

Thank you to One Farm for not only sponsoring this show but having a trustworthy and high-quality product.  

Stacy adds that she's so appreciative of their third-party testing because that's not a practice that's regulated.

If you've not yet joined the Patreon family and want to know how Stacy and Sarah really feel about this topic, hop over for more bonus content and stories.

Thank you for listening!

Episode 447: Basic Needs Don’t Count as Self-Care

Welcome to episode 447 of The Whole View! This week, Stacy and Sarah

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

The Whole View, Episode 447: Basic Needs Don’t Count as Self-Care

Welcome back to episode 447! (0:28)

Stacy kicks off this show by speaking about this article about women's tendencies (especially moms) to put others' needs above their own.

This often takes the form of attributing "self-care" status to activities that fill a bare-minimum, basic need.

Taking a hot shower or going on a quiet trip to the store without the kids isn't going to fill your cup and allow you to pour more into others. 

Sarah laughs that a part of her wants to clap her hands over her ears and not listen.

If any listeners feel similar ways, like if you don't call the bare minimum stuff self-care, then can't call anything you do self-care, Sarah wants you to know you are not alone.

Stacy adds that in Sarah's defense, there is a lot of things that she does she might not realize count as self-care.

For example, Sarah spends a lot of time with her dog, going for walks and training, That's something Sarah does out of pure enjoyment that recharges her.

Stacy explains that what self-care looks like is different for all of us. It's not just facials and massages. It's what makes you feel full and refreshed.

If you can't love yourself, how are you going to love somebody else?

-Ru Paul

If you don't take time to fill your cup up and love yourself, how can you love and take care of someone else?

Stacy knows she's am a better mother, wife, and friend to other people when she's taken care of herself and not at the precipice of losing her patience. 

Doing something that's not draining is different than doing something restorative.

Types of Self-Care

Stacy breaks down self-care into four different types, and that they don't have to be the cliche versions to count as self-care. (12:01)

Stacy challenges listeners to really think about what outcome has them feeling lighter and better?

It might not necessarily feel like something that's self-care upfront. Maybe it makes you feel a little uncomfortable at the moment. But it also might be something fully restorative to you. 

 

Mind: Emotional Self-Care

Stress is incredibly inflammatory and can negatively impact your health if you're not effectively managing it. (20:13)

Mental health is so important. It's often one of the most overlooked ways of giving yourself love because of the stigmas attached to them.  

Stacy asks the audience to remember that even the healthiest of minds need a break and help. 

If you're a frequent listener, you probably know how much Stacy struggles with the idea of meditation. 

However, science shows meditation can rewire the connectivity between different brain areas, limit the overactive flight-or-fight response, and help regulate our hormones. 

If guided mediation just isn't your thing, there are alternatives you can try. 

Sarah shares that she's much more comfortable with breathing exercises than she is with gratitude meditation. It's not one size fits all, and there are many different shades and colors of it!

In Episode 432: Giving Thanks, Stacy and Sarah dig deeper into meditation's science and practice. 

It can seem a little ridiculous, but it really is a great way to reflect on mindset while focusing on wellness!

If you haven't already, you should check out Stacy's favorite show, Episode 421: Body Image. 

Stacy's said it before, and she repeats it now: there is nothing wrong with asking for help. 

Talk therapy is a great way to decompress the everyday stresses of life. It allows us to target and work on any toxic traits we're harboring that can sabotage our self-care efforts. 

If you're unsure where to start, Stacy explains one avenue is to get a referral from your primary care physician. There are also many online counselors and apps specifically designed to help!

Self-acceptance is vital to good self-care.

Stacy shares how difficult it can be to accept your body when you feel like it's failing you due to autoimmune issues. But beating yourself up about things you can't control won't help you feel any better. 

 

Body: Loving Your Physical Self

Move your body! Health is so much more than BMI or the number on the scale. (36:15)

Science has shown that BMI is actually more inaccurate than it is correct. Many thin people have health issues, and many overweight people do not! 

Moving your body is an act of self-love because it's good for you – but also because it makes you feel good.

Stacy reminds listeners that what we put inside our bodies is just as important as what we put on the outside.

Sarah advises listeners to do it because they like it and they like doing it. 

There are foods that nourish our bodies, and there are foods that nourish our souls. Respecting yourself enough to prioritize both is self-care.

A great place to start is gut-healing with a broad range of macronutrients from a nutrivore approach!

Getting enough sleep is crucial to taking care of yourself. 

Do what you need to fully relax your mind and enjoy deep restorative sleep. It is when your cells replenish themselves. 

Those with poor sleep patterns are at high risk for a myriad of health conditions – so, taking a nap and going to be early is the ultimate act of self-love!

 

Interpersonal: Your Relationship with Other

This is the one both Stacy and Sarah struggle with the m0st, which is your connection with others. (43:01) 

Stacy shares her personal experiences with Zoom fatigue and trying to turn off her phone to disconnect.

Working on interpersonal health means occasionally unplugging from a screen whenever you can, but not unplugging from people. 

Voxer or Marco Polo are free apps where you can leave short or long voice and video messages for an individual or a group. 

It's the perfect way to let out a vent of frustration or a primal scream to a trusted friend. You aren't uninterrupted, and the friend gets to listen when it is convenient for them. 

Stacy uses it for both personal and work purposes.

Take intentional screen breaks. Playing games, baking, watering the plants, and working on re-arranging the house are ways to disconnect online and connect with people in our lives.

Sarah also unplugs from 8am-8pm, so she has 12 hours of uninterrupted time. She doesn't use her phone on her morning hikes and uses that as a time to unplug.

Also, it's important to take time this week to schedule your annual appointments. It's so easy for those in a primary caregiver role to put their own wellness aside, but so important to keep upon.

Setting boundaries is critical to self-care. 

No one can read your mind. If you aren't telling people what you need, you can't expect them to give it to you.

Sarah adds that it is often even helpful for the other people in our lives when we make boundaries. When you set that expectation, they don't need to worry about how to act. 

 

Personal: The Things That Bring Joy

If you're an extrovert, this part could have been hit hard by quarantine if your hobbies involved going out in public and doing things. (58:01)

But there are small ways that you can bring that deeper connection to your soul through intentional practices!

Personal self-care means doing things that you enjoy just because they bring you joy. 

Plus, hobbies are great ways to cope with stress and trauma in life. Stacy shares 

She also decided to get back into houseplants during the quarantine. It's one way she can intentionally focus positive energy on something. It gives her an avenue when she needs a pick-me-up.

Stacy and Sarah both love playing with their pets and have talked at length in the past about how great pets can be for mental health.

 

Final Thoughts

Self-care is something that's been really hard for scientists to define. (1:03:14)

Science defines it most in terms of the stress response and how that response impacts our overall health. 

In its essence, self-care is reversing that stress response to reign it in and turn it off. 

Having a regulated stress response positively impacts the body in terms of hormones, gut health, tension, and more!

Self-care allows us to regain mental space for the important things in life. 

Stacy reminds listeners that self-care is suggestive, and a restorative activity for one person might not be restorative for you. 

Be sure to pop over to Patreon for some bonus content about this episode! And to hear how Sarah really feels about all this.

Episode 446: Nutrient Deficiencies Caused by Stress

The Whole View, Episode 446: Nutrient Deficiencies Caused by Stress

Welcome back to episode 446! (0:28)

This show is a direct follow-up to last week, where Stacy and Sarah talked about supplementing while on AIP and the philosophies that couple different strategies together.

In that episode, Sarah mentioned certain nutrients, such as Magnesium and Vitamin C, which depleted during times of chronic stress.

Paleovalley also has a great Central C Complex, a great source of Vitamin C, and they agreed to sponsor this show!

Stacy shares that she uses many products from Paleovalley and highly recommends this brand because they make their products from Whole Foods.

Studies have shown that supplementing with Vitamin C can support a healthy stress response, which in turn can help improve sleep, regulate appetite, improve immune function, lower cardiovascular disease risk, improve depressive and anxiety symptoms, and even reduce migraine headaches! 

Nearly half of Americans aren't getting enough daily! Plus, infection, inflammation, and stress all increase our vitamin C needs.

Why PaleoValley?

Sarah and Stacy both love and regularly use Paleovalley products. (7:35) 

Paleovalley's complex uses three food-based vitamin C sources: unripe acerola cherry, camu camu berry, and amla berry. This means you get the full spectrum of nutrients, minerals, and bioflavonoids from Whole Foods. 

Food-based vitamin C has concurrent phytonutrients that make this type of vitamin C up to 2.5X more bioavailable.

Even though it's bioidentical to non-synthetic Vitamin C, many people with sensitivities to corn aren't able to take synthetic vitamin C. 

Paleovalley uses no synthetic (GMO corn-derived) vitamin C in their complex! Plus, there are no wonky fillers, and it uses a simple gelatin capsule.

Review of the Stress Response

Stacy expresses how excited she is for Sarah to get into what exactly she's been putting her body through all these years! (8:04)

Sarah and Stacy did a deep dive into how chronic stress impacts health in TPV Podcast Episode 351: Stress on Health.

A stressor is a chemical or biological agent, environmental condition, external stimulus, or event that activates the hypothalamic-pituitary-adrenal axis (HPA axis) and releases stress hormones.

Stressors:

• Physical (e.g., injury, a vigorous workout, sitting for prolonged periods, not getting enough sleep, extreme environmental temperatures)
• Sensory (e.g., loud noises, too-bright lights, overcrowding)
• Chemical (e.g., tobacco, alcohol, drugs, allergens)
• Psychological (e.g., deadlines, traffic, bills, societal and family demands)

This is responsible for our fight-or-flight response caused by complex communication between three organs:

• The hypothalamus: The part of the brain located just above the brain stem. It's responsible for the autonomic nervous sys­tem, such as regulating body temperature, hunger, thirst, fatigue, sleep, and circadian rhythms.
• The pituitary gland: A pea-shaped gland located below the hypothalamus. It secretes hormones, such as thyroid-stimulating hormone, human growth hormone, and adreno­corticotropic hormone.
• The adrenal glands: Small, conical organs on top of the kidneys. It secretes hormones, such as cortisol, epinephrine (also known as adren­aline), norepinephrine, and androgens.

This response helped our early ancestors pay closer attention, run away faster, or jumpstart healing in times of crisis.

It also reduces the effectiveness of bodily functions the body aren't crucial to survival in that moment, such as our digestive or reproduction systems.

Nutrient Deficiencies Caused by Stress in the Modern Era 

Sarah explains that the body doesn't differentiate between types of stress.

So when we experience acute stress over long periods, such as at our jobs or physical stress, our body is constantly shutting down those "non-necessary" functions because it's in chronic survival mode.

In modern life, when we never have a break from stress where our bodies can return to baseline, we suffer from what's called "chronic stress."

The brain borrows hormones from other functions to make things we need in a crisis. All of that together is why chronic stress is so problematic to lifelong health.

If we're chronically stressed, we're constantly using up key nutrients we need to perform their normal jobs in our body.

Lifestyle factors are very important to managing chronic stress and nutrient replenishment, and getting enough sleep.

Anxiety is a consequence of chronic stress. Chronic stress can also increase the risk of depression, cardiovascular disease, obesity, diabetes, autoimmune diseases, chronic headaches, memory problems, digestive problems, infections, and poor wound healing. 

Plus, chronic stress influences other behaviors, influencing our food choices (due to cravings for energy-dense foods and increased appetite). This can make us more vulnerable to addiction.

Sarah references these shows for more information on anxiety:

• Episode 383: Anxiety
• Episode 303: Are Certain Foods Causing My Anxiety?

Nutrient Deficiencies Caused by Stress

When Sarah talks about nutrient deficiencies caused by stress, she means normal, run-of-the-mill chronic stress, not the mental health challenges that can arise from chronic stress. (19:30)

She also recommends this review paper for more information on the effects of stress on the body: https://pubmed.ncbi.nlm.nih.gov/31504084/

Sarah decides to start with the nutrients with the most evidence of depletion by the stress response.

Magnesium 

More than three hundred different enzymes in your cells need magnesium to work. 

This includes every enzyme that uses or synthesizes ATP and including enzymes that synthesize DNA and RNA. 

It is also a constituent of bones and teeth, is important for neuromuscular contractions, and is necessary for testosterone and progesterone production. 

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

Magnesium is also a cofactor in methylation and is necessary for detoxification functions.

Numerous animal studies showed that serum reduced magnesium concentration and increased urinary magnesium excretion in animals exposed to acute and chronic stress. Studies in humans show the same thing.

A 2006 study reported increased urinary magnesium excretion in university students during their examination period compared with the beginning of their academic term, correlating with self-reported anxiety.

Another study conducted in 2000 showed significant decreases in plasma ionized magnesium and total magnesium concentrations in young volunteers exposed to chronic stress or subchronic stress. 

In a 2015 study designed to simulate a Mars mission, a 6-man crew was kept in isolation. The study recorded numbers of all magnesium measures with the biggest effect between days 0 and 30. 

Similar studies have shown magnesium reduction in response to sleep deprivation stress, physical stress (marathons), and environmental stress (loud noise for 4 hours).

Sarah sums up that magnesium depletion shows the same results no matter what kind of stressor is triggering it.

If you're looking for more information about magnesium, Stacy and Sarah did a whole show on it!

Vitamin C

Vitamin C is mainly an antioxidant and an enzyme cofactor. (28:00)

As an antioxidant, vitamin C is essential in protecting proteins, lipids, carbohydrates, nucleic acids, and more from damage by free radicals and reactive oxygen species.

Vitamin C is also used as an enzyme cofactor to generate critical compounds for joint and bone health, such as collagen. Plus, it helps to generate neurotransmitters like dopamine and serotonin!

Vitamin C's role as an enzyme cofactor is likely why it's so important for the stress response due to cortisol and catecholamines production. 

The main catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine.

Adrenal glands store A LOT of vitamin C. (source) 

An important 2007 study in humans showed that ACTH causes adrenal glands to secrete vitamin C and cortisol. 

It's thought that this release of vitamin C helps protect the brain from the behavioral effects of stress by preventing maladaptations (like anxiety and depression).

Zinc

Zinc is the second most abundant metal in the body. It has many important roles, including nearly every cellular function. (37:07)

It is essential for the "reading" of the DNA map to make proteins. And it controls gene expression and communication within cells and the production of proteins. 

It is important for the absorption and activity of B vitamins, required for muscle contraction, and needed in insulin and testosterone production. 

Collagen formation, a healthy immune system, and the body's ability to heal from wounds also depend on zinc. 

It also plays a role in skin health and maintaining sensory organs (which links zinc deficiency with loss of smell and taste) and is a vital nutrient for immune system function. 

Several animal studies show that chronic stress decreases serum zinc concentrations and some tissue-specific zinc stores.

Sarah adds that there aren't many human studies, but general data shows similar findings.

A 1991 study measured plasma zinc concentrations before and after 5 days of sustained stress in Navy SEAL trainees ("Hell Week"). Plasma zinc levels decreased by 33% at the end of the 5 days but returned to baseline 7 days later. 

There have been similar decreases in zinc measured in released POWs.

There is an even larger body of evidence with physical stress, like endurance sports.

Iron

Iron is a critical component of hemoglobin. This is a protein in red blood cells responsible for carrying oxygen from the lungs to cells in the body. (44:20)

Heme is a critical component of a family of proteins involved in protection from oxidative damage. 

Iron is also needed to metabolize B vitamins, is a necessary cofactor for various enzymes, and is important in protein metabolism. 

Animal studies show chronic stress can decrease serum iron concentrations, ferritin, whole blood iron concentration, and hemoglobin. Sarah adds there are limited studies in humans.

In that same Navy Seal study, iron concentrations decreased by 44%. Ferritin concentrations increased by 59% after 5 days of Hell Week. 

And a 2018 study of maternal perceived stress during pregnancy showed an increased risk for low neonatal iron at delivery and storage iron depletion at one year. 

In physical stress, a 1990 study showed decreased ferritin. 

However, studies in trained athletes don't show this. This indicates that there's some sort of adaptation to increased physical fitness.

Calcium 

In addition to forming bone, calcium is essential to many processes, including neurotransmitter release and muscle contraction. (48:15)

Calcium also helps to regulate the constriction/relaxation of blood vessels, nerve impulses, muscle contraction, and secretion of hormones like insulin.

Sarah reminds listeners that bones are remodeled continuously throughout our lives. A hormone called parathyroid hormone (PTH) closely regulates the amount of calcium in our blood. 

It does this by occasionally "borrowing" calcium from bones that will hopefully get deposited back if there is enough calcium intake. In this case, there are more robust human data than animal studies.

Previously mentioned 2000 study of young volunteers exposed to chronic stress showed significant decreases in plasma calcium concentrations.

In the previously mentioned Mars simulation study, total serum calcium concentrations decreased by 16% from baseline after 30 days of isolation. It then stabilized at these lower concentrations during the remaining 75 days.

Niacin (B3)

Vitamin B3 is a water-soluble B complex vitamin and used in all cellular metabolism within our mitochondria. (53:30)

We need it to produce energy from any macronutrient (fat, protein, or carbohydrate). 

Specifically, vitamin B3 is necessary for oxidation-reduction reactions, which involves transferring electrons across a membrane in the mitochondria. 

Plus, B3 is used to produce many molecules important for health (like cholesterol and L-carnitine), which is important for lipid metabolism specifically.

Vitamin B3 helps improve circulation, aids the body in manufacturing various stress and sex hormones, and suppresses inflammation.

One study identified the effects of cold exposure, calculation exercise, and dark exposure on niacin metabolism in female adults. 

Cold exposure significantly increased the urinary excretory output of niacin metabolites, although no change in urinary niacin concentrations was found after exposure to mental or emotional stress.

 

Nutrient Deficiencies that Magnify Stress

Sarah moves away from nutrient deficiencies caused by stress for a moment to talk about deficiencies that can actually magnify stress. (56:56)

If you don't have these to start with and are then exposed to stress, results show it can make stress worse.

Omega-3

A 2018 study associated HPA-axis dysregulation with lower n-3 PUFA, especially DHA, plasma levels. 

Another separate 2017 study confirms this is specific to DHA, not EPA, and EPA supplementation did not reduce stress levels.

A 2004 study showed DHA supplement has an adaptogenic effect on stress. A significant reduction in perceived stress is supplemented with 6 g of fish oil containing 1.5 g per day DHA, while the placebo group is supplemented with olive oil. 

Stacy and Sarah have talked about omega-3 supplementation specifically in episode TWV Podcast Episode 415: Fish oil, Healthy or not?

Vitamin C

Sarah explains that the link between vitamin C and stress is a two-way street. (59:35)

Guinea pigs made deficient in vitamin C hyper-secrete cortisol (source).

Another study in rats showed vitamin C (equivalent to 2-3 grams in people) blunted cortisol secretion in response to stress (source).

Supplementation of ascorbic acid in humans is associated with a decreased cortisol response after a psychological or physical stressor (source). 

Also, Vitamin C deficiency is widely associated with stress-related diseases! (source) 

Several reports have suggested a relationship between behavior under stress and ascorbic acid. 

A 2015 study in high-school students with anxiety, given 500mg vitamin C daily or placebo, showed a reduction in perceived stress and heart rate.

Sarah briefly covers several more studies referenced here:

• 1. https://www.sciencedirect.com/science/article/pii/0009898175902508 
• 2. https://europepmc.org/article/med/1963054 
• 3. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02730-w
• 4. https://pubmed.ncbi.nlm.nih.gov/31001107/ 

Sarah adds that higher vitamin C levels increase cognition, and it doesn't matter if it's by food or supplement!

Vitamin C is on Both Sides of the Equation!

Vitamin C is so important because it both regulates the stress response and is depleted by stress. So low Vitamin C can become a snowball of badness.

Also, nearly half of Americans aren't getting enough daily! Plus, infection, inflammation, and stress all increase our vitamin C needs.

Although synthetic and food-derived vitamin C is chemically identical, fruit and vegetables are rich in numerous nutrients and phytochemicals, which may influence its bioavailability.

Sarah briefly covers several other studies referenced here for more information:

• 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847730/
• 2. www.researchgate.net/profile/Joe-Vinson-3/publication/242087621
• 3. https://pubmed.ncbi.nlm.nih.gov/18915110/
• 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847730/#B68-nutrients-05-04284

 

Final Thoughts

Stacy tells listeners that there will be more bonus content on this topic over on their Patreon channel. (1:05:01)

So for anyone curious as to what Stacy and Sarah really think about nutrient deficiencies caused by stress, it's definitely worth checking out on Patreon. 

She also thanks Paleovalley for sponsoring this week's show.

Be sure to check out their vitamin C complex and bone broth proteins - both of which are Stacy's and Sarah's favorites.

Stacy reminds the audience that many vitamin C products use corn-sourced products. She is sensitive to that, and finding Paleovalley's supplements was a blessing.

She and Sarah only partner with brands that they love, use, and are confident in recommending.

Stacy adds they she loves their organ complex and meat sticks as well!