Inflammation is a popular buzzword these days. Certain foods are demonized as being “pro-inflammatory,” while others are “anti-inflammatory.” Furthermore, there are several people in the fitness and nutrition space selling diets and supplements as “anti-inflammatory.” Inflammation in and of itself is not a bad thing. Short bouts of inflammation are important to help the body deal with stress. Acute inflammation in particular, is a part of the strength and muscle building process. So, in this month’s episode, I’m joined by Dr. Charles Cavo of Pounds Weight Loss. We cover the differences between acute and chronic inflammation, how to test for inflammation, and some practical ideas on how to use nutrition as an intervention.
Erik: Welcome to this month’s edition of Skol Sessions. I am your host, Erik Castiglione, owner and head coach of Viking Athletics. And I am joined today by Charles Cavo of pounds weight loss. Thank you for being here, Charles. How are you?
Charles: Hey, thanks a lot for having me, Erik. Very well. Thanks.
Erik: All right. Charles and I were just talking and what we want to cover today is broadly the topic of inflammation, specifically what it is, the difference between chronic and acute inflammation and anti -inflammatory diets, anti -inflammatory foods. It’s a word that gets thrown around a lot in the nutrition space. You’ll see something advertised as an anti -inflammatory. There are naturopaths out there pushing anti -inflammatory diets. There are other foods that are demonized as being inflammatory. So we kind of want to shed some light on all this and make it digestible, excuse me, on to the lay person. So appreciate your being here, Charles. And if you don’t mind, I want to start out very, very basic. When we’re talking about inflammation, what is it we’re talking about?
Charles: So that is a very broad term, inflammation. So I think that, you know, when you called and asked if I could participate in this, I think that we’re kind of looking at inflammation through a lens of does food cause inflammation? Does exercise cause inflammation? What are the different causes of inflammation? Inflammation is a pattern of you could have an increase in temperature, you could have an increase in pain, you could have an increase in swelling. So they would say in Latin that would be Dolor, which is Spanish for pain, Pelor and Dubor. So that would be kind of the three descriptive terms of inflammation and those characteristics happen through different pathways in our bodies, right? That can be tested through blood work, depending on what kind of inflammation you’re looking for. Basically the inflammatory pathways that I’m more familiar with when it comes to food and that sort of thing, we’d be looking at how your immune system sort of responds to certain foods you may be eating as well as some of the markers that you can see in the blood that can sort of illustrate whether or not there’s inflammation that’s ongoing.
Erik: Okay, so if we want to differentiate between that, which sounds a lot more systemic, rather than localized or acute inflammation, you said, was it color and pain?
Charles: Yeah. Pain.
Erik: Okay. When we’re looking at localized inflammation, so let’s say you get a sprained ankle, what’s the response that we see? We see the swelling, the area might be hot to the touch, it’s probably going to be red. So I feel like in that instance, we’re kind of covering all those bases, and again, in a very localized setting. And for those that are unfamiliar, we talk about rice. It’s not actually pushed by the guy that invented it anymore. He thinks that he was mistaken. Restite, ice compress, elevate. And again, the whole point of that is to try to flush out the inflammation and the swelling in the area. We see that when it comes to response to exercise as well. If I have a very intense, we’ll use bodybuilders as an example, or, you know, I was just going to use the biceps. Let’s take a crossfitter that’s doing 100 chest to bar pull ups in a workout. If they’re not used to that kind of volume, you’re going to get that same kind of swelling in the elbow joint, your biceps might be inflamed, you might get to heat, hot to the touch. And again, that’s another example of acute inflammation. And so the body’s response to that is inflammation, repair and remodeling, which helps you grow back whatever’s damaged a little bit stronger. And that’s how we adapt the training. So from an acute standpoint, the thing I wanted to clear up right away, and we can talk about this with I know in our initial message, you mentioned sauna, cold plunge, that kind of stuff. A small dose of inflammation is necessary to help the body grow stronger and become adapt essentially to the training. So from a localized perspective, it’s not a bad thing per se, it’s just a natural response. If you have a traumatic injury, obviously, people want to reduce the swelling and reduce the pain, but ice and trying to flush out the inflammation through things like ice and compression may not necessarily be the best way to go about it. I find that this where physical therapy helps is you’re moving and trying to flush out waste products through the lymphatic system. But from a systemic standpoint, like you said, when we were talking about foods that people eat that may cause a response to the immune system, or even doses of sauna or cold or anything like that. How is that different? Is it just because it’s spread throughout the whole body? Or is there when you’re talking about immune system responses, is that you know, are we are we triggering white blood cells or something like that? What’s what’s happening when you talk about an immuno response there?
Charles: Yeah, so I would say that when you’re talking about food response, your gut, which is where obviously food is going to be all processed, loaded with immune system defenses, because it’s such a thin layer between the outside world and your inside world, your body. And so 70 to 80% of your immune system and the functionality is right down there in your intestine. And so there will be certain foods that may trigger a response in the immune system, which is a bit different than the kind of response that you’re talking about. When you twist your ankle, for example, it’s not necessarily your immune system, there’s a completely separate pathway for that. But nevertheless, when there’s inflammation, it can be an okay thing for the body, depending on the dose and the time of the dose, and it can be determined for your health also, again, depending on the dose you’re getting of the inflammation and duration. And I think that’s kind of where the differences come in between your inflammation that you might experience from a sauna or a cold plunge, or a high intensive interval training kind of workout, where there’s a lot of what we would call oxidative stress, where there’s a lot of free radicals, but only for a temporary period of time where your body’s going to react to those stressors by increasing inflammation for a short period of time. But then that time goes away, it stops and you go back into a healthy environment. And those small pulsatile situations where you have increased stress and increased inflammation are actually beneficial to the body as it recovers from that short burst of inflammation. If you’re talking about chronic inflammation, chronically, perhaps eating something that causes pain, causes a chronic inflammatory response from your immune system, chronically having abnormal cells like cancer, chronically eating foods that we know can cause inflammation like sugar or processed foods. That’s when people can get into trouble with chronic inflammation and the problems that it may cause.
Erik: So when we’re talking about foods, you know, there’s various lists out there that you’ll see, depending on who you’re reading, I’ll see it a lot in men’s and women’s health, it’s like, don’t eat these 10 inflammatory foods. And typically, you know, I tend to eschew the men’s and women’s health and the clickbait articles. Um, if you look at the list pushed out by the Chan School of Public Health at Harvard, they do list, I don’t want to say, I feel like processed has become a buzzword as well, because technically speaking, anything that you eat, unless it’s raw is processed. So let’s call it hyper processed food. You know, we were talking about the super hyper palatable, high fat, high sugar, that makes the list number one. They also throw in red meat, dairy, and some other, um, I forget what else was on there, there was five or six instead of the usual 10. And those were the top three. Um, does that mean that we should avoid them? Or like you said, does the dose and the frequency matter and is that, or is that even highly individual, depending on you as a human being?
Charles: Yeah, there you go. It’s very individualized. And I think you also have to talk about symptoms that you see behind what you’re looking to identify as maybe a product that’s causing inflammation. We generally see in practice in medicine, when you’re talking about nutritional medicine, I’d say from the list that you just went over, we would be pretty confident in saying that sugar and processed foods are capable of causing inflammation in most individuals. Additives that are in a lot of the processed foods are chemicals that our bodies haven’t really ever evolved to have introduced into our system. These can cause inflammation, but when you talk about other foods like meats or vegetables or naturally occurring kind of foods, it’s very individualized. I’d say top of the list would be wheat seems to be one that causes a lot of inflammation in certain people, not everybody. Dairy is something particular. Yeah. Yeah. Yeah. Dairy is another one that some people will have a hard time being out of process and they’ll have some symptoms behind it. But to have a generalized list that would say everybody should avoid these foods is a little bit, it’s misguided.
Erik: Kind of end up throwing out the baby with the bathwater in most situations without them.
Charles: Yeah.
Erik: Okay, so when you’re working with clients, then do you, I imagine it’s a combination of subjective and objective data. Imagine you’re going to listen to your client and they’re like, Oh, well this, you know, I feel like crap after I have this. What exactly are you looking for? Are you doing like genetic testing to see if you know, I’m not, I’ve had blood work done. And you know, they do the allergen tests and all that. What I see get thrown around a lot when people are trying to talk about systemic inflammation is your C reactive protein. Are there other blood markers? Like what blood markers would you be looking at to see if somebody is in that kind of state of chronic systemic inflammation? Or if they are susceptible to it from specific foods? Do you tap you guys test for that? Or how do you
Charles: So I haven’t found much utility in just the food allergy testing where you just test everything under the sun for a person that has complaints about how they’re feeling and when you’re trying to identify whether it’s a food allergy or and it’s not even really food allergies as much as it’s food sensitivities to be honest because the allergies will be a bit more severe and you want to identify those but sensitivities are sort of that chronic inflammatory response that you might get from food and identifying those it really starts with listening to the patient and hearing what they’re eating and what kind of symptoms they’re experiencing and as far as the lab work that we get the C -reactive protein it’s been in our toolbox or any physician’s toolbox for a long long time so C -reactive protein is something it’s a it’s a protein that’s made in the liver and basically when your immune system lights up when there’s a lot of activity from the white blood cells which make up the immune system C -reactive protein is sort of like the fire alarm that lets the body know that there’s a fire somewhere so it’s not very specific with regards to what’s going on but when it’s elevated with the CRP greater than 10 we could say that there’s inflammation you can get an elevated CRP and you got to be careful on how you look at that data by the way too Erik because you can get elevated CRP like you said from exercise so as far as so as far as when you test that CRP you have to be pretty specific as to when you’re testing it otherwise it’s a very non -specific inflammatory marker and you might be making a mistake with regards to identifying a food sensitivity when in fact a person may have had other reasons for having elevated CRP.
Erik: So it’s funny that you say that my father had bloodwork done recently, and he went on a call it a 45 day cleanse, where he was practicing intermittent fasting, not drinking, and then went and got his bloodwork done. And I decided to get mine done. Let’s see, it was October 30. And then November 2, I gave enough that they needed two samples. And let’s just say I had a very fun October, so much so that I opted not to partake in alcohol the entire month of November as a result. And it was kind of a conversation with him. He’s like, you’re getting bloodwork done. Why are you shouldn’t be drinking right now? Why aren’t you? Why are you not preparing for this? And, you know, my thought was, if they get me at my worst, you know, I imagine that my CRP will be elevated, we’ll see what my cholesterol is doing after a month of eating junk and everything else. And if that’s my worst, I can go from there and be like, All right, when I get back to baseline, I imagine all these will improve. But even with all that, I had a when I actually got my CRP test done. I had had a few nights of lots of Halloween parties, and then not a lot of sleep. And I had a cold. And my CRP was up to eight. So I thought that was funny. I was like, according to this, and according to the metric, I hear people thrown out, you know, my CRP is elevated, that means that I’m inflamed. And it’s like, again, that’s kind of what I wanted to point out. Is that relative to the fact that I have a cold and I’ve been dehydrated? Or is that a fact? You know, is that chronic? And we wouldn’t know that unless I repeat the test, and I won’t be going back until March to get it done again. But that’s, that’s the indicator I hear thrown around a lot by people that are occupying the nutrition space and pushing one approach over another. Particularly people, the ones that I’ve seen, they’re, I want to say almost carnivore, you know, they’re pushing against phytic acid and things like that. And they’re like, Oh, you shouldn’t eat that. That’s got, you know, they’re looking at one isolated compound, never, you know, never considering the fact that it’s the dose that makes the poison. But from a blood work perspective, obviously that you like you said, that’s one indicator, it’s a warning sign that potentially something could be wrong. When we’re talking about chronically elevated or chronic inflammation, what other markers are we looking at people were to get blood work done? I know you said you don’t get a out of that necessarily. But what would somebody look at if they’re concerned about it?
Charles: So again, I think if somebody is having issues, gut issues, or skin issues, and are concerned that maybe food or nutrition is causing that sensitivity and that reaction, you could certainly look at a CBC, which is going to be looking at your immune system that’s looking at white blood cells and those sort of things. There’s metabolic panels that you can get where inflammation or changes in the way in which your body’s tolerating certain foods can show and demonstrate inflammation. Uric acid is one of the markers that we’ll look at specifically in our clinic to see whether or not a person might be having some sort of inflammatory response. Uric acid is a breakdown from fructose type of sugar. Your body can make it or you can eat it. It also comes from certain proteins that people eat, fish, and these kind of things. But in any case, that’s a nice marker. Triglycerides can sometimes go up in states of inflammation. We can look at that. That CRP that you’re talking about, it is a pretty decent way of looking at just chronic inflammation, but it just doesn’t really get to the crux of what’s causing the inflammation. You really have to take the history from a person and sort of understand what might be the source of that inflammation.
Erik: So basically it tells you that something’s wrong, it doesn’t tell you what is wrong. Yeah.
Charles: And you can start, as a person starts to explain to you what their problem is, and let’s just say its origin is in the gut, they feel bloated, they are always hungry, they have changes in their bowel habits, these kind of things, or they’re always full. Well, then you get your blood work and you see the CRP is elevated, and you can start to knock out the more common foods or ingredients that you know can elevate inflammation and cause some distress in the gut. Foods like fried foods, like the sugars, processed foods, processed meats is another one that can do it. You take out the obvious stuff, the dairy.
Erik: I see that lumped in when people are talking about red meat. I like the caveat in there that it’s, you know, they’re talking about deli roast beef for the most part. Yeah. Yeah, as opposed to. Yeah, that’s.
Charles: Yeah, that’s why I threw that in there because that’s where it gets kind of confusing, you know, and then you can start to Substitute some of the foods that you’ve gone and knocked I can start to swap them with things that you know are gonna be Anti -inflammatory so we know that vitamin D can certainly help so getting people on vitamin D fish has a mega 3 fats I know we know that helps olive oil is another one You can use certain you can use certain spices like ginger and turmeric and these kind of things can help out and then you can repeat your CRP and listen to the patient and see how they’re responding to some of the things that you’ve gone and changed in their diet and If you’re seeing improvements You can then ask a person what they’re missing the most and start to add back what they’re missing and follow their symptoms And you can also follow their CRP if you can demonstrate that you knocked it down and then start adding things back Tracking both their symptoms and CRP kind of give you an idea as to where their food sensitivities might lie rather than getting a whole Giant panel and knocking out everything which can be really problematic for people because then they walk away with so many restrictions that they don’t necessarily need to have-
Erik: So real quick, you mentioned supplementing with foods that are shown to be anti -inflammatory. A while back, people were pushing Acai and blueberries and other berries being antioxidants. And they were supposed to eliminate free radicals. And since I’m a huge Bond fan, I don’t know if you’ve ever seen Never Say Never Again, the last one that Sean Connery did with Kim Basinger that was not part of the other ones. It was basically a remake of Thunderball. He’s at a health clinic in the very beginning. And he tells Moneypenny that his assignment is to eliminate free radicals. Has that actually been shown to do anything? Or was that another call it food marketing ploy to try to get people to eat a specific product?
Charles: I think it’s, again, kind of individualized, to be honest with Erik. I think that, you know, there are there are certain foods out there that will be helpful when you talk about causing the anti -inflammatory pathway to fire up. And so some of the polyphenols that you get and some of the darker fruits that you just mentioned, they can be advantageous. Certainly, the omega -3 fats can be helpful and that’s why. you
Erik: Are the Omega -3s anti -inflammatory in and of themselves, or is it just about balancing out the Omega -6s? You’ve heard both. I’ve heard that it’s not really the Omega -3s, it’s maintaining that ratio. And then I’ve also heard that Omega -3s in and of themselves open up the anti -inflammatory pathways. So I’m just curious.
Charles: Yeah, I would say the omega the balance is important. First of all, so having an omega six omega three balance is definitely helpful when it comes to just overall health. And our diet is usually very
Erik: you’re doing organic foods or grass -fed, free range, all that, yeah.
Charles: Yep. And as you increase your omega -3 fatty acids, you do increase your anti -inflammatory pathway. It’s not to say you’re going to take an omega -3 for a sprained ankle, you would probably take Motrin, but you do see an increase in anti -inflammation. And that’s not necessarily always a good thing also. I mean, you do want to have the ability to launch inflammation for times when you have a viral infection and you want to have a fever in order to inhibit the virus from causing more harm. So the balance is probably more important than anything else. More is not always better.
Erik: Okay, that’s good to know. I was just curious because I’ve heard. Yeah. And hearkening back to our pre recorded conversation when you were talking about alulose. Does that have the same effect on your uric acid as fructose or is it completely separate completely different since it is
Charles: Yeah. So first, let’s back up a little bit because a lot of people don’t know what alulose is. So I’m psyched they just brought that up. Because not a whole lot of people know anything about
Erik: By all means.
Charles: I have, I don’t have any financial benefits from plugging away on Alulose, other than the fact that I think it’s amazing when it comes to what it can do to somebody’s health. So Alulose is a naturally derived sugar. And as such, you hear the word sugar, and you think, well, man, this could potentially do harm. And it actually doesn’t. It’s a healthy sugar. It is a sugar that we know reduces insulin, which can cause inflammation, by the way. So if you can reduce your insulin, you end up faring a bit better when it comes to being in an anti inflamed state. And then as far as other benefits from Alulose, it reduces the insulin and also stabilizes and reduces blood sugar. So, Alulose, which tastes like sugar and looks like sugar, is, I would guess, it’s marketing or positioning itself to really take on the entire sugar industry just because of the health benefits that you see from it. We can give Alulose to patients who have diabetes and see their blood sugar drop by about 20 to 30 points and watch their A1 season. We can give Alulose to people with insulin resistance and have their insulin resistance resolved. And we can give Alulose to people who are taking the new weight loss medications like Ozemptic and Wogovian, these kind of medicines. And since we know that Alulose works on the exact same receptors as those medications do, we can expect to have the same benefits with Alulose, which is quite a bit cheaper and much more accessible than the medications are. And you don’t need to inject it. You don’t need to inject it. You put it in your yogurt, you can put it in your smoothie, you can put it in your coffee, on your pancakes, whatever you want. And you can experience a reduction in your blood sugar, a stabilization of your insulin. You can, we hypothesize, can see a reduction in your uric acid and certainly a much better appetite from the benefits that you get from the different hormones that can trigger appetite. So it’s pretty impressive what it’s capable of doing.
Erik: So let’s go back even further then, when we’re talking about sugars, obviously, there’s a wide range of different types of sugars. And for our listeners who maybe don’t get into, I’m sure everybody’s heard of, at least in the context of high fructose corn syrup, they hear of fructose. But there’s also glucose, you know, what and then you’ve got the sugar alcohols and you’ve got sugar substitutes like sucralose and anything ending in. Oh, more or less is a sugar. What’s the difference between those and what makes something, you know, bad, we’ll call it in quotations, as opposed to a good sugar? Or, you know, when we label things as when we’re talking about inflammation, obviously, you know, high sugar foods tend to spike the inflammatory response. I see that get blown out of proportion and people are nowadays even advocating for avoiding fruits because they have fructose in it. So how do we kind of differentiate between what may be more inflammatory and what’s probably not?
Charles: So the fructose, let’s just talk about fructose because that particular sugar just is so, it really does permeate our foods and I think people don’t really understand what happens with fructose. So when you take fructose in and your body sees it as a sugar and wants to pull the energy out of the fructose that the cell thinks that it’s gonna be able to use for the functions the cell has to do, it has to put energy into that compound in order to break it apart and then get the currency, ATP, out of the sugar for the cell to do what it has to do. So the cell’s gonna put energy in to break that particular sugar apart and hopefully end up with more energy that required it to break that sugar down. So probably,
Erik: anyone tuning in that’s listening to any of our other stuff, we call that thermic effect of food. And correct me if I’m wrong, but for sugars, it’s usually maybe five to 10%. So you’re, you’re netting 90% to 95% of the energy from the sugars.
Charles: Yep. Okay. But not from fructose, because the energy that you that the cell is going to get out of the energy that I put in is a lot less. And that surprises the cell because it made the deposit, you know, of its own energy to break that apart, but didn’t get back what it thought it was going to. And so that causes a problem. And one of the problems that you get from that breakdown process, you get a metabolite uric acid. And that’s a cell signal of starvation. And that will trigger an increase in your insulin, that’ll increase it, that’ll cause an increase in your appetite, that will cause inflammation, fatigue, these kind of things that go along with basically a starvation effect.
Erik: Eventually, if I can sum that up, you are not getting the energy expected, so your cells are now hungrier because they didn’t get the energy that they expected to get.
Charles: Exactly. So you get what you wanted to get you get something sweet on your tongue satisfy, but you know, you satisfy your taste buds. But from a health standpoint, metabolic picture, you don’t necessarily get what you thought you’re going to get. And alulose, this, this new sugar, the new guy on the block is quite a bit different than that, because your body can’t break that one down. It tastes just like sugar does, but it doesn’t get processed. It doesn’t get broken down by the cells. So it, it has a way in which it actually stabilizes blood sugar, the mechanism of action is a little bit confusing still, and they’re trying to tease that out. But you see a reduction in blood sugar. So there’s a lot of benefits to that. And I think that again, if you have the accessibility to use alulose in any kind of product that you’re having that requires some sweetness, then you could, you certainly could do that. And when it comes to like the other sugars that you mentioned, you don’t you don’t run into that kind of cellular problem when it comes to breaking down glucose and the cell ends up with lesser energy than it had to put in ends up with a decent amount of energy. And it can use that fuel for its own metabolic function, that sort of thing. So the sugars are all different. And it kind of depends on how they’re arranged molecularly, you can talk about a disaccharides and polysaccharides monosaccharides, that all just has to deal with how many of the rings you’re putting together and how your body is going to be breaking those down and what it’s going to do to you at the end of the day. But that might be a happily true. Yeah.
Erik: I feel like again, it’s people demonizing it because it has fructose in it, but they’re not considering the glucose content and the fiber content. So does that all kind of balance out or how would that work with fruits?
Charles: So fruits, another interesting sort of source of fructose for sure. And like you said, there’s fiber and water, sugar, there’s vitamins and minerals, there’s good stuff in fruit. Unfortunately, sometimes people with metabolic syndrome or metabolic problems when it comes to blood sugar, these kind of things can sometimes overdo the fruit thinking that it’s good for them. And they have too much of the fruit. And the next thing you know, they’re seeing blood sugars that are reacting to the amount of fructose that they actually took in. And the other aspect of fruit that, you know, we see as sometimes problematic in our practice, just from the patients we see is having fruit in its natural state is usually is an okay thing. But a lot of times people will choose dried fruit, which is devoid of the hydration, it’s taken out the water, it’s taken out the fiber. And that’s just basically mainlining fructose right to your liver. I did not consider that. Yeah, so dried fruit is very, it’s not a great thing to be having people that think dried cranberries, dried raisins, you know, raisins, and raisins, raisins, pineapple is the worst next to mangoes. I’d stay away from that if I were you but
Erik: And then the other way I was thinking of juices.
Charles: Yeah, juices is another one that’s just basically, again, you’re just mainlining pure sugar, pure fructose, right, to your liver. And the net effect is, like we just described, you’re going to end up having some cellular dysfunction and a massive increase in insulin to try to handle that load, along with some other inflammatory responses, like increases in uric acid. So fruit, in and of it by itself, in a moderate amount, is usually a good thing. But I think that people sometimes, you know, they hear there’s a problem with it. And then the next thing you know, people are saying you can never have any of it. And then people will say, well, it’s got all this great stuff in it. So then next thing you know, everybody’s eating all of it that they can, you know. And so, you know, again, there’s a balance. But there’s also, you got to have the ability to sort of recognize, well, how is the fruit coming into the system? Because if it’s coming in dried without water and without fiber, well, you might as well just go have candy.
Erik: Yeah. So I see that a lot. Also, we’ve seen it when paleo was big in the CrossFit space. I would see that with nuts, like everyone’s pushing nuts as a healthy snack. And they’re, you know, it’s got protein in it. And like, it’s really a fat source. And they’re, you know, when we talk about, you know, if you look at precision nutrition, and what they prescribe using the hand method for estimating, food servings, one thumbs worth of nuts is a serving. And I’m like, if you’re looking at almonds, what’s that six almonds, so men get maybe 12 in a serving. And you’ve got people just shoveling them in by the handful because supposedly healthy for you. I mean, yeah, we see that a lot as soon as people apply that that label to food that it’s good or it’s bad. It’s like you said, it’s either the all or nothing approach. And there’s no thought given to how much of this is actually good. So that’s why, you know, I was curious about fruit as you I see that getting demonized. Now we’ve seen obviously red meat. And for people that actually read the study that led to that it was more what they were pushing was like you said, the processed deli meats. There was some concern that if you’re grilling red meat, it’s it’s probably a little bit more carcinogenic than something else because you’re grilling it. And it’s like, well, yeah, no shit. I’ve got Okay, don’t overcook your meat. But we see that a lot the extreme responses, and there’s just this general lack of nuance. So to kind of tie this all together, you were talking about your approach using Okay, we’ve got a problem. My patients describing all these symptoms, CRP is a little bit high. Maybe the other, you know, uric acids high or triglycerides are elevated. You talked about kind of eliminating things and then possibly reintroducing them. What would that protocol look like? You said you start with the obvious culprits, what kind of timeframe are we looking at? And then forgive me, but I was dealing with a member that I was told they went on a cleanse. And that is a trigger word for me. I wanted to bash my head into a wall when I heard that. Because when I hear cleanse, it’s usually people drinking water with hot sauce or something like that, you know, the juice cleanses. And then
Charles: Mm -hmm.
Erik: upon further discussion, I learned that it was basically an elimination diet with the premise that they were going to reintroduce foods. But the timeframe that was given to me did not seem substantial enough. I think it was one week of elimination. And I’m like, that’s no time at all for your body to adapt to what you’re doing. So if you guys are going to be, let’s say you’re looking at dairy as a possible culprit, what kind of timeframe are we looking at for the elimination and the reintroduction of foods?
Charles: I think now that’s a really good question. And I think, again, it’s very individualized with regards to the degree of sensitivity that the person might be experiencing. Somebody that has a dairy sensitivity that has resulted in lots of chronic discomfort and has severe pain from being maybe lactose intolerant or that sort of thing. It might take that person a much, and they’re having, let’s say they’re also having dairy frequently. It might take them a lot longer to recover from the time in which you remove that from their diet versus somebody else that has a dairy intolerance but really is only having dairy on Fridays. Does that make sense?
Erik: And essentially, the more damage you’ve done, the longer it’s going to take to recover and you won’t know that until you try it.
Charles: I would say that’s very true and you have to really, from a patient standpoint who’s doing an elimination diet, you really want to be aware of your symptoms and how they’re improving if they’re improving. You want to have somebody, a healthcare provider or somebody in your corner understanding the information that you’re giving back to them with regards to how you’re feeling. A lot of times using a scoring system from 1 to 10 helps identify how things are going. And then using the CRP is another really good way to see whether or not inflammation’s going down and drawing that can be helpful also to see what kind of headway you’re making and when you can start to reintroduce something. So there’s that, there’s also, you know, we didn’t talk about it, but there’s the entire gut microbiome, which I know a lot of research and a lot of physicians, natural paths, people are jumping on board with the improving the microbiome can sometimes make food sensitivities improve significantly.
Erik: So we can talk about that real quick. Do you follow South Park at all? No. Oh, they did a great episode on that where Kyle’s mother ends up with a fecal transplant and she sheds all this weight. She’s like a beacon of health. And then the other mothers are jealous. And so they keep trying to like undo her plumbing to steal her sample. And it all comes back to Tom Brady. And Tom Brady has the spice melange, like his is the most coveted sample of all. It was hilarious. Yeah, that sounds good. We hear microbiome. I hear leaky gut. These are other terms that get thrown around a lot. What exactly are we looking for? Are we looking for specific strains of bacteria? Like the gut microbiome is obviously a big thing. And we have trillions of different kinds of bacteria and things in our. Is there a way to test what we’re looking for? You know, probiotics are huge. How do we make sense of all that in a way that’s going to mean anything to the layperson?
Charles: So yes, the gut microbiome is huge. You have more bacteria in your gut than you do your own cellular makeup, believe it or not. And when it comes to testing the gut microbiome to see whether or not that could be the culprit in symptoms that you might be experiencing, I find it always kind of interesting in splitting sort of hairs when you talk about food sensitivities versus a gut microbiome or bacteria in the gut that are causing people to experience symptoms because you can test the gut microbiome to see whether or not that could be causing a problem when it comes to people’s sensitivities to foods. For example, a person that’s experiencing constipation and bloating, you could send them to a lab where they can do a breath test. And what that entails is at the lab, we would give the person a certain type of sugar. It’s a different one we haven’t talked about, lactulose, and only the bacteria can really break that particular sugar down. Human cells can’t. And just like how we break down oxygen and blow out carbon dioxide, these bacteria will take in this type of sugar and break it down and make methane gas and hydrogen gas, which are gases you can’t make. And then there’s a machine that will quantify how much methane and hydrogen you’re blowing out. And if you end up expiring enough methane or hydrogen gas into this machine that meets criteria for having too many plumes of that particular bacteria, then you can go on and hypothesize that the person has a disruption or an abundance of this one particular several different types of bacteria that can make that gas. And if you have a way in which you can decrease the amount of bacterial load, you can resolve those symptoms. We do it all the time. The GI people do it all the time. It’s kind of newer as far as people accepting it. It’s been around for a while, but people are starting to recognize the importance of the gut microbiome and trying to make it as healthy as possible.
Erik: Yeah, I was gonna say the gut microbiome, I’d say in the last probably seven or eight years has finally started to make its way into the medical community. For a long time, I know that was pushed off as kind of pseudoscience. And let’s just say I’ve had conversations with, you know, my history with physicians. I’ve had some interesting conversations in them, again, dismissing it as a load of hooey.
Charles: No, I think it’s an exciting time because I think people are trying are starting to like, accept the fact that there’s a lot of information that we need to still work out when it comes to what’s going on with the gut microbiome. I think that, again, we were we were pretty new on the scene and accepting that there is a story behind the gut microbiome, and we certainly got a lot of pushback when we were treating it. And now we get referrals and plenty of people calling and asking us questions on how to treat it. Because you can do it with targeted probiotics, you can do it with different supplements, and you can do it with antibiotics, it kind of depends on what the person wants and what they’re willing to tolerate for side effects. But there certainly is a lot of ways in which you can reduce where we started inflammation by getting the gut microbiome right. There’s a lot of inflammation caused just by a gut that’s not very well balanced.
Erik: So too many of one strain, not enough of another. And I imagine that is also highly individual. So really what would be the biggest influence for that then? Obviously I imagine genetics are a factor, but we’re talking years of dietary habits probably plays a huge role in that as well.
Charles: biggest influence on the gut microbiome and the health of it.
Erik: Yeah.
Charles: Boy, you name it and you’ve got it. But in this day and age, what I think is really big as far as disruptors go is chronic use of antibiotics just being thrown at people who have a cold. Stress can certainly do it. Alcohol, different diet, different diets that aren’t all that great, smoking. I mean, there’s an awful lot of pollutants that will do it. But medications even, you know, you take a dose of Motrin and you think no big deal. It’s a huge deal to the gut microbiome with regards to what some of the medications that you’re using over the counter, some of the medications that you just want for a quick Z -pack for a sniffle or a snuffle that that can really be very, very disruptive to what, you know, your health is going to look like after the fact.
Erik: Okay, it’s funny you mentioned that I’m still combating the tail end of bronchitis and went in for a chest X -ray and all that to make sure it wasn’t pneumonia. And that was one of the things I said was, can you differentiate between, I was like, let’s say it is pneumonia. Can you tell the difference between viral and bacterial just from a chest X -ray? Like, I don’t want antibiotics if it’s not bacterial. And she said, thank you for saying that. And yes, they can. And, you know, to your point about alcohol, cheers. We’ve got money.
Charles: Yeah, I think the, you know, these days, again, when it comes to the antibiotics, I’m getting more and more impressed with how many people are getting put on antibiotics, but the person putting them on the antibiotics is also giving them a probiotic to use to help reduce that kind of burden that you might get from the antibiotics. So again, some people you have to take an antibiotic if you need it, but you don’t necessarily have to take the hit to your gut microbiome.
Erik: That’s interesting. I had not heard that. My big concern is obviously the resistance of bacteria to antibiotics and we see the increased resistance since antibiotics are overprescribed for the most part. I want to get a super bacteria that is resistant to everything. So that’s my own paranoia. But I had not heard that. That’s interesting. Probiotics in addition to the antibiotics. Yeah, that makes sense.
Charles: Yeah.
Erik: Cool. So we kind of want to wrap this up. I do want to respect your time. It’s been just about an hour. Essentially, we talked about acute versus chronic inflammation. And the biggest thing for chronic inflammation, I shouldn’t say the biggest, but obviously diet is a huge part of that. And to give your recommendations, if somebody is suffering from symptoms, what would we do? We could explore certain anti -inflammatory foods. We could focus on eliminating certain foods from the diet and then kind of reintroducing them and monitoring C -reactive protein and their symptoms. And then obviously we got into alulose versus other sugars and using that as a potential substitute so that we are not intaking a lot of possibly inflammatory sugars. What other recommendations would you just give? You know, dehydration was another one, vitamin D and dehydration. If you had to end by giving some generic recommendations to people, I’m sure it’s going to be pretty much what everybody is told all the time. But let’s have them. What would your what would your generic recommendations be for people to try to help avoid systemic inflammation?
Charles: Uh, so avoiding systemic inflammation would be have a, have a healthy diet, right? Avoid being malnourished. Don’t lose that for when it comes to malnourishment. Yeah, so a healthy diet is a loaded term, just like a lot of the terms that we threw around that are kind of just terms that grind my gear like a cleanse, like you said, it’s just, you know, so a healthy diet, again, it really is, I hate to say this, but it is individualized, you can be very basic and say a healthy diet should lean a bit heavier than most people lean into protein, protein is something that should be heavy on your plate. There are essential amino acids, which come from protein. And the word essential means that your body can’t make them. So you better eat them. There are fats that should be part of a healthy diet. And there are essential fats that we didn’t get into. But again, essential means you can’t make them. So you better eat them because those fats play a role in the inflammatory and anti inflammatory pathways. And then the third fruit food group carbohydrates are there’s not any such thing as an essential carbohydrate because your body can make all of them. And it doesn’t mean that you need to eat no carbohydrates to be on a healthy diet, you probably benefit from eating some. But the balance of a healthy diet doesn’t have to be carb heavy, protein, moderate and fat light. I think that a healthy diet has a better individualized approach of having the proper amount of protein, the right amount of carbohydrates to make a person feel okay and not too restricted. And then some fats also to make sure that you’re having essential fats. Staying away from processed foods, obviously, staying away or you know, not having a whole lot of sugar, obviously good vegetables, fine, these kind of things. But when it comes to preventing inflammation, that would be one way to do it. Get a good night sleep, exercise plenty. If you want to do those stressors that you talked about, like saunas or cold plunges, that’s another good way to reduce inflammation is to give yourself certain pulsatile episodes where you actually are causing purposely some degree of inflammation in order to not have chronic inflammation. And if you think that the diet is causing any inflammation, look at your symptoms. Are you feeling more fatigued? Do you have irritability? Are you experiencing pain? Do you have skin rashes, bowel movement changes, these kind of things. And if the answer is yes to that and you think it might be your food, then starting at the top with the most obvious things like sugar, like processed foods, like additives, like dairy and like wheat, you take those things out sugar, alcohols, alcohols, artificial sweeteners, and then see how you feel. And the degree of time of which you’re going to start to feel better, usually is around seven days or so people will start to turn the corner, which is interesting. When that starts happening, you can add back some of the foods that you knocked out and see and monitor your symptoms as you’re adding them back. We also typically will use different strains of probiotics. There’s three classes or four classes of probiotics that you can choose from. And the stores pretty much just take one strain that everybody has. And so if you have the ability to sort of differentiate what type of probiotics are out there, as you’re adding foods back, you might be able to tolerate a lot more than originally thought. But yeah, that’s Omega -3s and turmeric or ginger or something like that, maybe it’s prophylactic as well.
Yeah, vitamin D is very good. Magnesium is something that most people could benefit from because they’re deficient for one reason or another when it comes to that. Having omega -3s, if you can have fish in your diet a few times during the week, right? If you can’t, then omega -3 that you don’t feel like you’re repeating the taste of would be advantageous. Anybody that’s repeating the taste of an omega -3, it means that that oil has been oxidized and that’s not good for you. So you shouldn’t have it. You should take that back and get a fresher brand.
Erik: So you’re repeating the taste, that’s fish burps, right? Yeah. OK. Yeah.
Charles: Yeah. Yeah, that means the oil’s been ran, the oil’s rancid. And just like if you were to drink sour milk, you don’t feel very good and you get sick. Having fish oil that you taste is means that the person manufacturing didn’t put the oil into the capsule fast enough, it was exposed to oxygen and actually does more harm than good. So cheap omega threes and cheap fish oils is not the way to go spend the extra dime to make sure that you got quality stuff.
Erik: Okay. And yeah, I really wanted to get into that because obviously with the new year coming up, we see a lot of people push the whole 30 or the hard 75 or something like that, which tends to be I mean, the whole point of the whole 30 is that it is an elimination diet. And if done properly, as with any elimination diet, there’s a slow reintroduction of foods afterwards to kind of see what people can tolerate as opposed to just saying, fuck it, I’m done. I’m going back to what I was doing. So I really appreciate your thoughts on the matter. And, you know, like you and I have chatted about, there are these loaded terms and buzzwords that get thrown around a lot. And I view my job, obviously, in that space is to help educate people to make sense of this. And that’s really what we want is people get caught up in the headlines and take things to the extreme. And we want to see that everybody is hopefully somewhat educated on the subject so they don’t get taken advantage of. So I really appreciate your time. I’m going to go ahead and stop this recording and we’ll catch everybody next month.
Charles: Thanks.