Sarah Ballantyne, Ph.D. is the blogger behind the award-winning blog The Paleo Mom, cohost of the top-rated and syndicated "The Paleo View" podcast, and author of two upcoming books "The Paleo Approach" and "The Paleo Approach Cookbook."
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!      
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!
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!  
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. 
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Creator Details

Location
Atlanta, GA, USA
Episode Count
501
Podcast Count
22
Total Airtime
2 weeks, 5 days
PCID
Podchaser Creator ID logo 349965