Stacy Toth is a writer and an author. She is also a co-host and producer of the top rated syndicated podcast, The Paleo View.
Welcome back to the Whole View, episode 4-1-1. (0:27) Does 411 still exist as a resource you can call? This week, we have a really amazing question from Holly. The topic is one that has been bouncing around in Sarah's head for a while. When she talks to someone about how she eats, it can be tricky to navigate what vocabulary to use. So now seems like a really good time to dig into this, especially given the recent podcast name change.   Listener Question Holly writes, "Hey ladies, I’m a long time listener of the podcast and I hope by telling you both how awesome you are that you will answer my question. (2:02) Just kidding! But I know it can’t hurt and it's true! Really, thank you both for all the work you do to keep us in the know. I have been finding the Covid shows so helpful and I feel like I get to rant with you both. On to my question, Sarah I noticed your new book has non-paleo and non-aip foods in it and I know the podcast name has changed, so... do you both even still follow a paleo diet? I would love to know what your diets look like now. Also, what do you both recommend now for all of us looking for general health guidelines, if Paleo is no longer the ‘thing’? Thanks again for all you do!   P.S. Sorry Sarah if you cover this in the book, I admittedly have just done a quick scan, and I promise to read it soon.   Sarah's New eBook Sarah completely forgot to tell our podcast listeners that she just launched her Gut Microbiome eBook. (3:01) The book that Holly is referring to is Sarah's new Gut Health Guidebook. Sarah has been working on a Gut Microbiome book for about six years now. She started this book before writing Healing Kitchen. Healing Kitchen was a book writing tangent, and then Paleo Principles was a second book writing tangent. Since Paleo Principles came out, this book has been Sarah's singular focus. She was wrapping it up earlier this year and then when covid hit, it caused a delay in the publication process. Sarah still doesn't know when it will come out, but her guess is that at this point it will be sometime in 2021. As soon as she found out that this was not going to be the late 2020 book she was pushing for, Sarah took the cohesive storyline of diet and lifestyle and package that up into an eBook. The way that the Gut Microbiome book was coming together made it clear that it couldn't be one book the way Paleo Principles is. Sarah is taking the companion cookbook and is also going to create an eBook out of that content. That will launch late this summer. So the Gut Health Guidebook is now live and you can package it together with a preorder of the cookbook. Sarah is offering a special discount for anybody who wants to do that. To find the offer, see here.   From Stacy's Point of View Stacy and crew just got back from being in the wilderness for a week. (6:24) She won't call it camping because it is more glamping. They prepped a lot of food before they left and cooked over the fire each night. It is interesting for Stacy to think about this question in the context of having just been on that trip. The different kinds of foods that they took this trip versus previous glamping trips Things were very similar, with some exceptions. As we talk about what they are each now doing and why, those points will weave in. Years ago they did not take gluten-free graham crackers for example. Stacy made Paleo chocolate chip cookies and then they made marshmallows and used those homemade creations for s' mores. She also wants to note for perspective that it has been over ten years since both Stacy and Sarah started their journey into what she would call a health awakening. They started with this idea of paleo, but that health awakening really started when Cole was born and Stacy was breastfeeding for the first time. This is when Stacy realized that what she was eating was going directly into him. That transitioned over many years until the birth of Wesley, and that was the point in which Stacy realized that her body was responding to certain foods in a way that was hurting her children when nursing. Stacy has learned from her body what she tolerates vs. thrives on. It is also interesting in this world of covid, how we need our bodies to be thriving and to be as strong as possible. Where you is where you are, and there is no shame in where you have been or where you are going. When we talk about diet we talk about how you choose to eat your food. We are not talking about a fad diet, a way that you eat for short-term results. This has always been a key concept on this show. It has always been about a lifestyle. If you focus on what feels best for you and listen to your body, you can find a way to live a balance in your life to not think about food as something as anything other than fuel.   Healthy Living Stacy wants to refer everyone back to episode 358 on Intuitive Eating. (11:16) This show is very representative of our thoughts on anti-diet and intuitive eating. On this episode, we share how you can incorporate this into a way of healthy living. There is a response that your body has to certain foods, and to ignore that is not beneficial to your long-term health. But how can you incorporate those foods without it being a diet that you punish yourself for? This turns food into a reward, which isn't good either. If you find yourself in a place where food has that kind of control or thought pattern, please go back and listen to that episode. It will really tell the full picture of what we are going to dive into with the way we fuel and nourish ourselves. We try to optimize thriving, while still representing the emotional importance of some of that stuff.   From Sarah's Point of View Sarah loves how Stacy framed the way that her healthy awakening journey began because Sarah's started with Adele. (12:33) In her first pregnancy, she has gestational diabetes and she managed her blood sugar really well with careful measuring. When Adele was one she realized that she was getting that same sickish feeling every time she ate. Sarah still had her blood sugar testing supplies and one day after lunch decided to test her levels. Her levels were 200, which is the cusp between pre-diabetes and type-2 diabetes. She does not recommend this at all, but Sarah never told her doctor. Sarah felt so much guilt around this reality as she was intimately aware of the consequences of diabetes. So that day was the day that she changed her diet, and she went to the thing she knew. Sarah went low-carb, and in many ways, the last ten years has been a road of recovering from that stretch of low-carb. She was able to lose weight and normalize her blood sugar levels and blood pressure. She had markers showing her that she was healthy, but her autoimmune diseases were getting worse. It was a tradeoff. When Sarah's youngest daughter was closing in on two, it was actually the autoimmune flairs that brought her to paleo. Sarah's immediate was response was that paleo was crazy, but as she dug into it the science made sense. Once Sarah got into it, she went cold turkey with it on August 31, 2011, which helped a lot of things. However, it didn't help everything so for her New Year's resolution that year she started the autoimmune protocol. At that time AIP was very poorly defined. So Sarah defined and established what AIP was and is now, at the same time she was doing it. Sarah was very influenced by Dr. Terry Wahls TEDx presentation.   More on Sarah's Journey So she used her knowledge base to understand how foods interact with the human body, throughout this entire experience. (18:36) And she has never stopped continuing to learn. As Sarah has continued to learn, she has continued to tinker with her diet. Over the years this has turned into something that she doesn't know if paleo is the correct label to describe how she eats now. The term paleo, as is typically defined, is still defined as what you don't eat. Sarah doesn't believe that what you eliminate makes a diet healthy or not. It is actually the foods that you eat that is what determines whether or not that diet is healthy. And it is the nutrient density that serves as the primary criteria as to whether or not a diet supports health. Eliminations are things that you add on top of that to address specific health challenges or goals. Sarah's diet has really expanded over that time. This started in October of 2012 with methodical reintroductions after having followed the AIP for about 10-months. A lot of those reintroductions were successful. When she started the AIP Lecture Series in 2019 she realized that she was scared to reintroduce beyond what she had already done. Sarah was so comfortable with where she is at that she didn't want to reintroduce anything further and run into possible setbacks. However, she realized that she really need to change her mindset around that. When you can expand your diet to allow for nutrient expansion, that is making strides towards improved health. This microbiome research has solidified Sarah's feelings towards a lot of the foods that the paleo diet has been criticized for eliminating. Legumes and rice are two examples that Sarah highlighted.   Where Paleo Fell Short One of the things that paleo has failed in terms of serving its community, is the way it has lumped foods together. (23:19) The framework of the diet says no grains, no dairy, no legumes, and no processed foods. Sarah feels that it is unfair to lump all of those foods together. There are some terrible grains, and there are actually some grains with science to back their different benefits. This is true for legumes as well. When you look at the gut microbiome you can see very clearly which grains and legumes benefit the gut microbiome and which don't. So as Sarah was pulling together this information, she started methodically challenging legumes, dairy, tomatoes, and switched from white to brown rice. What worked has become very moderate additions to her diet. Sarah's diet is still mostly vegetables, fruit, and a moderate serving of protein. Introducing these other foods requires a more nuanced approach. It requires being able to not lump everything together and select what to eat carefully. If we take this nutrient-density approach, then we are eating what we need to thrive, and it changes how we tolerate some foods that might have antinutrients, but ultimately have a lot of valuable nutrition to provide the body. Stacy thinks that there are a lot of things that we have talked about on this show that are all over the place if you are trying to track when and how Stacy and Sarah's journies unfolded.  We know this sounds very complicated. However, doing simple things like meal planning help to make sure that you have certain foods on your meal plan several times a week will simplify the process. For Stacy, it can be something as simple as making homemade tuna salad.   Stacy's Journey Stacy and Sarah have had a similar approach. (29:57) However, Stacy will admit that her approach is a lot less focused on as many nutrients as Sarah is committed to. If Sarah's is more paleo 80/20, Stacy thinks her approach is more 75/25. However, it is also important to understand that her goal is no longer weight loss. She lost 134 pounds at the peak of her weight loss, but she only got to that number of the scale one day and she did it through disordered eating. Stacy justified the disordered eating with intermittent fasting. As a result of her habits, she had digestive distress which caused nutrient deficiency, and she had a thyroid nodule and a huge flair. Sarah and Stacy, along with a medical professional, had to work to help Stacy restore her health during that period. It got really bad healthwise and she needed to recover. Not just gut health had to recover, Stacy's body was in a bad place. In 2015, Stacy asked the question, is your paleo challenge justifying disordered eating?  This was controversial because at the time many were doing paleo challenges every other month as a "normal" part of their diet. Stacy pointed out that this is not being paleo, and eating to incorporate a nutrient-dense, anti-inflammatory lifestyle. This is using paleo as a yo-yo diet. The more Stacy became aware of what was happening to her and many others in the community, it was where Stacy and Sarah started talking about metrics of health. There was also a lot of fatphobia in the community.   More on Stacy's Journey From Stacy's perspective and awakening in all of this is still very health-focused. (32:19) Stacy wants health, wellness, and longevity for her family. Her original goal with starting Paleo was that she had such low energy and wanting to play with her kids. Thinking about that original goal and where she is at today, Stacy feels that food enabled her to have the energy she needed to get more active. She is worlds apart from where she was in terms of her energy levels and wellness in general. Stacy did put on weight as she came out of that low-carb, paleo period. That was her starved, it was not a real weight. Stacy ended up rebounding and reaching a really good place until she injured her back, which then she couldn't move for a year. Stacy put on weight from that period of time, but she has maintained a significant amount of that weight that she originally lost. However, Stacy really doesn't weigh herself due to her history with how she equates her worth to that number on the scale. Body positivity and self-love have become very important to Stacy as she optimizes her health. Stacy looks at food and asks herself, "is what I am consuming going to give me wellness and longevity?" And sometimes that is the motivating factor she needs to not get ice cream or whatever it is. This comes from a much different place, one without deprivation and punishment and those kinds of things that Stacy did for so long. And it is not linear. For Stacy, she didn't flip a switch and was fixed. These are habits that she has to consistently work on and quarantine has not been easy.   Nutrivore This is where Stacy has really changed her mindset, as she first and foremost thinks of herself as a nutrivore, someone who prioritizes nutrient density. (35:49) Stacy recognizes that they can't have a diet of only white rice, but if they are sick and that is the only thing they are able to keep down, how can they optimize it? They can put in grass-fed ghee, cook the rice in bone broth, put kept on top, and then for their next meal find something else like sweet potatoes to fill the carb cravings. Stacy does focus on adding nutrient density and vegetables to what she describes as a gluten-free, corn-free, legume-free, and night-shade free diet. She would love to be able to eat those foods, but they don't agree with her body. Stacy is not dairy-free in the same way that Sarah is. She can tolerate more dairy, but not every day. The dairy that Stacy tolerates is fat only forms. Stacy feels that there is a big difference in the thought process from where they were, to where they are now.   Sarah's Implementation of a Nutrivore Diet Sarah has something very similar. (38:16) Prior to covid, when Sarah ate in a restaurant she would say she is gluten-free, dairy-free, and soy-free. These are things she knows she can't do.  The term that Sarah most resonates with now is nutrivore. This best describes Sarah's approach because she looks at food as providing her body with the resources it needs to do all the things it wants to do.  And those resources are nutrients. By adopting the term nutrivore, instead of saying "I eat these foods and not these foods", I'm saying that the primary goal of my diet as a whole is to supply my body with all the essential and non-essential nutrients it needs to thrive from my food. That is the goal.  You can basically fit junky calories into your diet if the bulk of your diet is made up of super nutrient-dense foods.  Because those junky calories at that point are not taking away from meeting that goal of getting all of the nutrients that your body needs. This helps us get away from food labels of good vs. bad, and gets into what is the quality of my diet?  Did I meet my nutritional needs today? And did I meet those needs today with some energy deficit?  Sarah likes that this moves us away from stigmatizing foods.  However, it still recognizes foods that aren't good for anybody.  Sarah doesn't believe that everyone needs to be strictly gluten-free. As we get away from demonizing foods, we can get back to the thing that is most important.  Meeting the body's nutritional needs is a top priority.  From there you can layer eliminations on top of that, or add additional nutritional focus on top of that to meet specific health challenges and goals. For example, Sarah thinks of AIP as a sub diet of a nutrivore approach. There is now emerging science showing that the gut microbiome really needs a minimal amount of carbohydrate.  This amount is probably at least 150 grams a day, if not 200 grams a day.    How to Describe It If Sarah were to describe her diet to someone who was serving her food, she would describe it as gluten-free, dairy-free, and soy-free. (43:44) If she was talking to her neighbor who wanted to make some dietary changes she would probably use the word nutrivore. Sarah would then talk about the importance of eating a lot of vegetables, higher-quality meat, more seafood, eating fruit, eating a serving of mushrooms a day, and a palm-full of nuts a day.  She would also talk about snout-to-tail eating. Also why soaking legumes is still a best practice.  The focus would be on eating more nutrient-dense foods and allowing them to displace the foods that aren't doing us any favors.  Rather than eliminating foods that are put into this 'no' category.  Stacy thinks this perspective is helpful.  It is helpful to be reminded of what our ultimate goal is. We are then able to ask, ok, how do we get there in a sustainable way.  If you are overly restrictive and you can't stick with that, it isn't good either.  How can you optimize without boomeranging to the other side?   Customization Stacy wants to point out a few more things that are unique to her since she doesn't have a gallbladder. (46:05)  She has to pay particular attention to fats. Matt and Stacy have added more olive oil and avocado oil, and use less lard.  They also eat gluten-free treats.  Stacy doesn't do oats, and they don't do legumes in their family. They do have brown rice pasta about once a week. If Stacy does have a meal of rice or pasta, she does try to ensure that she has a veggie-rich meal on that day to make up for the overall vegetables and nutrients that she is trying to achieve every day.  She also tries to move her body.  It is about how she feels, and she has to listen to her body.  Sarah doesn't feel bad about cooking brown rice pasta at all. Especially after going through the gut microbiome researching and learning about how good rice is for the gut microbiome. It is not a base food because it doesn't have a ton of nutrition, but in the context of a meal that incorporates other nutrient-dense options, it becomes a good contribution.  Stacy mentioned this blog post on casserole prep. She also takes supplements of daily collagen but doesn't drink broth as often as she use to.  Stacy also takes liver pills, vitamin D and magnesium.  She is also adding mushrooms with more intention these days.  Stir-fries are a favorite these days, as Stacy finds it easy to add nutrients to these dishes.  Stacy has added things in, but it hasn't been as thoughtful as Sarah's process.  However, she is very aware of what they are adding and what they are or aren't doing.  Stacy strives to be mindful of balance because social and emotional wellbeing in terms of sustainability and disordered eating has been so impactful to Stacy.  She has had to really learn to listen to her body and really find a balance on how she feels in terms of digestion and energy, more than anything else for it to work long-term. It is important to Stacy to not feel bad or to go off the rails. This can be hard if you come from a place of dysmorphia or eating disorders or any kind of stuff like that. For Stacy, she has worked on that stuff and gone to therapy and become self-aware. If you are struggling with this stuff, you can't just solve it in a vacuum.  When there is emotions around your food, you do have to address the emotion or else you will never solve the problem.   Closing Thoughts One of the things that have allowed Sarah to embrace the term nutrivore is to develop a healthier relationship with food. (1:01:03) Just like when we first adopted paleo, nine to ten years ago, that was always going to be a lifestyle.  It has evolved, and her diet has expanded. While Sarah thinks of it as nutrivore, you could also call it AIP maintenance phase, or paleo plus, or 80/20.  There are other labels that we can use, but it is still a lifestyle.  It is about lifelong health and hopefully improving her longevity.  This still includes getting enough sleep, managing stress, living an active lifestyle, and nature time. These are all still pieces of the health puzzle for Sarah.  But what she has been able to do by shedding the dogmatic rules that have been associated with the paleo diet for so long is to develop a healthier relationship with food. One of the side effects this has had is that portion control is much easier, which has always been a real struggle for Sarah.  This healthier relationship with food has allowed Sarah to regular her cravings and appetite. Getting beyond paleo has allowed Sarah to fix some of the food relationship problems that she was still having on the paleo diet.  Stacy and Sarah have been talking about doing some changes on the show for a long time, and you are seeing some of them with the name change of the show.  They are planning to let go of their G-rating soon, so that they can relax a bit on things. Stacy and Sarah's true unfiltered thoughts on things will be coming through in the next few weeks.  That is it for this week's episode.  Thank you for listening, and we will be back next week! (1:07:20)
Welcome back listeners to the Whole View, episode 410. (0:27) Stacy is going to be honest that we have had a quarantine update show on the dockets for a few weeks. However, Stacy has been having some feels and the topic kept getting pushed back. But this week Stacy and Sarah will be sharing their updates, and will also share updates on what is happening in the world and with science. Stacy wanted to first say thank you to all the people who have been so supportive and have participated and supported this community. Sarah wanted to take a moment to share a few emails that we have received. The messages from these fans left Sarah feeling so grateful and she just wanted to take a moment to share them. Thank you to everyone who has taken the time to write to Stacy and Sarah over the last few weeks.   Protesting vs. Covid Stacy wanted to take a moment to share something she is feeling frustrated by. (6:30) Over the last few weeks, there has been a lot. One of the things that Stacy has read about is the idea of why do we need to wear masks and social distance if people are just going to march. And if people are marching, then we don't need to do all this other stuff. Why is it that this is an exception, but this other thing doesn't exist? Stacy wants to share her thoughts on this. When a community of people is being oppressed and are vulnerable from a number of societal abuses and discriminations, and they want to use their voice and their rights as Americans to peacefully protest, and then we turn it around and complain. And most of them are in fact wearing masks to do this. Why do we have a say in this first of all? If you genuinely felt like your life was at risk, that the life of your loved ones was at risk, then the risk of potentially getting covid doesn't really quantify. And it isn't really our job or right to say how someone goes about trying to get equal rights. What Stacy has learned over the last couple of months is that she needs to stop talking and thinking. She hasn't lived that life and she hasn't had that experience and she can't put her thoughts on someone else. So first, this is not your choice. Second, most of these people are wearing masks. And third of all, there are people out there exploiting this. Stacy mentioned this article. This is a hard one for Stacy to understand the thought process behind. If you don't like it, just don't participate. You don't have to be there, you don't have to worry about covid exposure. If you want to support this movement but are afraid to go to a march, you can do things in other ways to show your support. If there wasn't a pandemic, Sarah would be marching in solidarity. However, she is trying to find as many other tangible ways to support the Black Lives Matter movement and this advocacy for equality in the absence of feeling safe going to marches.   What the Science Shows Us Sarah feels it is important to emphasize the importance of mask use. (13:20) One of the things that have been ubiquitous across all the Black Lives Matter protests is that you see a lot of mask use in these marches. A lot of them where they can be practicing social distancing, are putting those measures into place. Of course, these are all done outdoors as well. Sarah's blog post on face masks. Even with regular cloth-fabric masks, it can have a filtration efficiency almost as high as surgical masks. So when everyone is wearing them, if you have two people having a conversation and the person who is sick is wearing a mask, only 10% of the viral particles are able to escape. The other 90% are being trapped. And if you have that second person, the healthy person also wearing a mask, that healthy person is still filtering 90%. So that is now taking 90% of the 10% that went through, so now only 1% is getting through. Add in a little bit of distance and some airflow, you are now talking about a situation where the likelihood of infection is way lower. So when you are in these situations where everyone is wearing masks, that is a huge protecting factor. The other part that is helping to protect the protestors is the fact that they are outdoors. There was a study just published this month that showed that with just sun exposure, 11 to 34 minutes in the midday sun in most US cities was sufficient to deactivate 90% of the virus. And that is because it is quite sensitive to UV. The combination of most protestors wearing masks and these being held outdoors has been what is protecting them.   Number Spikes There are plenty of spikes in covid that are related to indoor gatherings across the country. (16:13) The indoor environments are still very challenging. And a lot of these spikes are also related to indoor gatherings without mask use. Protesting has so far not caused a spike in cases. There were four community testing sites set up in Minneapolis for people who attended protests showed, which showed a 1.4% positive rate. This is basically the same positivity rate that you would expect for community spread for any community in this country right now. Our full positive rate is climbing up towards 10% again in this country. This is obviously different than these community testing sites that were designed to monitor whether or not coronavirus is being spread through the protests. However, at the same time, this is data showing that at least for now, and probably largely attributed to mask use, we are not seeing that the protests are causing spikes.   A Quarantine Update from Stacy Stacy is in a desperate state to get out of her house. (18:40) It has been since February, and she has three boys, and Matt works all of the time. He had off while they were home recovering from covid, but once he went back he has essentially been on demanding work schedules. Virginia is now in phase two of their re-open. Masks are required if you go anywhere in public. Their numbers are going down. Virginia doesn't get to progress to the next level in their reopening phase until they reach certain benchmarks that show improvements. Matt and Stacy have decided to take a glamping trip. They have rented a rustic cabin, so they will bring all of their own linens and pretty much everything. It will be a week outside in the wilderness on a lake where the boys can enjoy water activities and be outside and be active. Their neighborhood hasn't been social distancing as much as Stacy would like. The kids have not been able to leave the yard, and they are over it. They are all over it. So Matt got days off finally. It will be a vacation with the same social distancing plan. Stacy will let listeners know how it goes.   A Quarantine Update from Sarah There was a similar conversation in Sarah's household about going on a camping trip this summer, but they decided not to go. (22:44) They typically go to a state park up in the mountains when they go camping, and while they are in a tent, they use shared bathrooms at the camping sites. Sarah is experiencing a lot of stress around how her state is opening up. In part, this is because of mask use. If you look at a poll of what people think of masks, everyone has positive things to say. Eighty to ninety percent of people are pro-mask. Around 1/3 of Americans are wearing masks at all times outside of their homes. One-third of Americans are sometimes wearing masks outside of their homes. And 1/3 of Americans are not wearing masks at all. Last time when Sarah went grocery shopping, she only saw 1/4 of people wearing masks. Sarah is definitely concerned about the possibility of having a more severe course of covid if she gets it. So to be in a grocery store when 1/4 of the people were wearing masks and social distancing, and the other 3/4 of the people not wearing masks were not being respectful of boundaries. Sarah feels like it is selfish to behave like this, and has since been having her groceries delivered instead. She has not had an anxiety attack as she did after that experience in years. It was such an awful experience to be put into that position. The thing that stresses Sarah out is watching decisions being made that aren't supported by the data.   Stress Around Opening Back Up In Georgia, they have seen this plateau of cases, but the plateau is at a very high level. (27:12) There is no place that is exempt. It feels harder for Sarah to protect herself when it is not a community action to protect each other anymore.  This is not to say that everyone is disregarding the recommendations being made, but there are just enough people disregarding it to make Sarah feel like it is not safe to go out. That has been the hardest part for Sarah. They haven't announced how they are going to handle school in the fall. Sarah's husband's work is still trying to figure out all of their logistics for what they will do. So they are still waiting on information there before making decisions on how they will respond. Sarah feels much safer at home and in her own yard and her own neighborhood. It has been really challenging for Sarah psychologically. There are ways that we can be opening up the economy that is safer than what she is observing around her.   Antibody Testing One of the questions that Stacy has gotten many times is, does she have antibodies. (29:39) Stacy does not have antibodies. Matt and Stacy took a test early that they knew had a high false-negative rate, so she attributed it to that and she wasn't worried. Then they special ordered a more accurate test and Stacy took that last week and was crushed to find out that she does not have antibodies. This news overwhelmed Stacy because she had chickenpox twice, and there is some research to suggest that there are different types of immune responses to getting different kinds of illnesses. The body could then have a worse case the second time. Sarah also did antibody testing two weeks ago, which also came back negative. There are three different pieces to talk about this. One, how good the antibody tests are, and the answer for most of them is not that. Our immune systems are not fully developed until we are about one. It is fairly well-known that if you get one of these childhood diseases, like chickenpox, before you are one, there is a higher likelihood of not developing immunological memory. Immunological memory is the ways that our immune system remembers a specific pathogen so that the next time you are exposed to that pathogen it can mount a response before it replicates enough time to have symptoms. This is why the vast majority of people only get chickenpox once. For some people who are immune-compromised, this can definitely impact immunological memory. There have been hundreds of antibody tests that have gotten this emergency use authorization, and they are not all good. In fact, a small percentage of them are good. It is really important to know three different things about that test before selecting which one to use. The false-negative rate, the false positive rate, and if the test looks for both IgG and IgM.  Stacy and Sarah both used Access Labs. For more on tests, see here and here.   More on Testing We still don't know with covid what level of antibodies is enough to say you are protected. (38:54) This is where things get really complicated. There was a study published in Nature Medicine two weeks ago that actually looked at antibody production and compared severe cases versus mild. All of these antibody tests have sensitivity and specificity rates that are measured by confirming their test against samples from patients who were hospitalized with covid. So all of these antibody tests are confirmed against severe cases. What this Nature paper showed is that 40% of the people who were asymptomatic had no antibodies by the time their infection was over. So they actually showed that these people who were asymptomatic were shedding virus for an average of nineteen days. By the end of those three weeks, they had no measurable antibodies. 12.9% of their symptomatic group also has no antibodies by the time their symptoms were over. So if you are not going to measure antibodies in that perfect window there is a really high percentage chance that you are missing antibodies. If you have a mild case you don't even know necessarily know when that window is. We can deduce just from what we know about how the immune system works that a mild case would be much more similar to an asymptomatic case in terms of antibody production, then to a severe case. So antibodies might not be a really great test for measuring immunity.   Immune System Detection What is fascinating about the SARS-CoV-2 virus is that it evades detection by our immune systems. (41:17) Which is one of the reasons why it is a long illness. It gets a much longer time than normal to ramp up its viral replication before our immune system recognizes an invader. The virus itself can evade detection from our immune system by two different mechanisms. One is by interfering with the production of a class of pro-inflammatory cytokines. Long-term immunity may be via T cells and not antibodies, and Sarah explained this in greater detail. We have all of these studies showing now that the immune response to covid is type 1 driven. And that actually there is no change in B cell activation compared to a healthy person. So our immune response is not actually antibody driven. What is happening is that our immune system is going around and killing infected cells, not going around and making antibodies that neutralize the virus directly. There is a little bit of that, but not a ton. This is why we are not seeing the type of antibody formation that would help us measure immunity, which is not how our immune system is responding to this virus at all. So there are a lot of different ways that our immune system can remember a pathogen. We can have immunological memory through T cells. So we actually know from studies of SARS-CoV-1, which caused the SARS epidemic in 2002 and 2003, that that virus was also the response was also Th1 driven and not Th2.  We know that memory T cells can persist in patients for at least four years after infection. However, we don't know yet what happens to those memory T cells if it is long-term immunity or just a few years. Either way, at least for the near future, we can deduce that if you have had it you are still immune, but it is through this thing that we don't really have the testing capacity for. Research labs can test for memory T cells via a blood sample, but there is no test that has been developed to measure immunity in this way for anything else. It is not a normal test, it is not a normal thing, it is a technique used in research, but not phlebotomy. What a negative antibody test means for someone like Sarah is that she probably hasn't been exposed. For Stacy, it shows that she had a mild enough case that she didn't develop antibodies. However, her immune system is remembering it through T cells. For more information on the research surrounding T cells see here, here, here, and here.   Closing Thoughts The answer is the same answer that brings us back to the top of the show. (47:46) Stacy doesn't wear a mask for her, she wears a mask for somebody else. This is a topic that she wants to reiterate one more time. Had Stacy not have been wearing a mask and protecting others, who knows what could have happened to someone else. You never know if you have something and you are asymptomatic and could be passing it along to someone who is higher risk. No matter how healthy and fit you are, you are not safe from a severe course.  We don't want this for anyone. It is our job to keep people protected and wear masks. If someone is going out and not wearing a mask, you are impeding your decision on somebody else in a way that could harm them.  It is our job to be mindful of and take care of others. Stacy understands that wearing masks is new and different, but that is ok - that is what change is. We are implementing these changes to protect not just ourselves but other people. Sarah appreciates Stacy for raising these points. She has been shocked to see people's vehemence against masks that she has seen online. Sarah can fully appreciate the feeling of being over it and just wanting things to return to normal. The problem is that wanting things to be normal is not enough for things to actually be normal. We risk the lives of the most vulnerable in our community by pretending that it is done and over. We are at 2.2 million confirmed cases in the US, granted this also includes the people who have recovered. But we are seeing in roughly half of the states, cases are spiking again. This is in large part because of the reliance on opening things back up because we all are eager for things to get back to life as normal. However, normal can only be achieved if we each take responsibility to not just protect ourselves, but to also protect others, which includes social distancing, wearing a mask, and hand washing.  It is the thing that we do to take ourselves out of the pool of people spreading, which is how we get the reproductive number below 1 so that this can be a virus that fizzles out. Sarah feels the frustration and the longing for normalcy, but at the same time, this pandemic is still here. Until we have effective treatments or preventatives, this is what we've got - social distancing and mask-wearing.  If we can't figure out masks we are going to end up shut down and stuck in our homes again. One of the reasons why we have a plateau in so many states or cases decreasing is more related to the weather than it is related to mask-wearing and social distancing. When things get going in the fall, if we can't figure this out by then, the consequences are going to be more cases and more people dying. Sarah will not contribute to that and will wear a mask and social distance for as long as it takes us to get through this pandemic. Thank you listeners for tuning in. Stacy hopes that you are doing well, she knows this is a difficult time. Please remember that we are trying to help others as well as help ourselves. The things that are shown to reduce risk to continue to be done even if it is not required. We hope that you stay safe! And we will be back again next week! (58:53)
Welcome back, Whole View listeners. (0:27) Stacy is so excited for 410 because it is one of those shows that she asked for. She has taken other magnesium before years ago and did not feel a difference. So she asked Sarah why BiOptimizers magnesium makes her feel so good. And Sarah decided that this would make for a great podcast episode, as opposed to leaving the information in a text exchange. Stacy is super excited to dive into the science of magnesium. But first, a quick shout out to this week's sponsor, BiOptimizers.  We reached out to them asking if they would sponsor this week's show because Stacy personally loves and feels different on their magnesium. If you haven't felt a difference when you take other magnesium supplements, Stacy recommends that you give BiOptimizers a try.  You can get 10% off with the code WHOLEVIEW10. However, if you visit this link, the code will automatically be plugged into your shopping cart. There are some bundle sets at that site link as well that will save you additional money on your purchases. Sarah noted that this is actually episode 409. She too is very excited to talk about magnesium. Sarah feels that this is an undervalued nutrient. It is the fourth most abundant mineral in the human body. One of the things that Stacy wants to point out is that in light of the recent sleep issue podcast episodes, magnesium is a helpful tool when taken in the evenings.   Magnesium's Role in the Human Body Magnesium is necessary for more than 300 different enzymes to work. (5:14) Whether as a co-factor or a stabilizer, this nutrient is critical in the human body. Among the enzymes that magnesium is required for to work is every enzyme that uses or synthesizes ATP. ATP is the basic energy currency of all cells. So our cells cannot make energy or use energy without magnesium. ATP is required for everything related to metabolism. If you start to look at every single action that uses cellular energy or makes cellular energy as magnesium-dependent, it starts to become really easy to see why magnesium is so important for human health. Plus, it has such a diverse range of effects. It is also required for the enzymes that synthesize DNA and RNA. Magnesium is an essential cofactor for many enzymatic reactions involved in neurotransmitter synthesis. It is also a constituent of bones and teeth and regulates bone formation. Likewise, magnesium is necessary for the production of testosterone and progesterone. It is also important for the metabolism of phosphorus, calcium, potassium, sodium, B-complex vitamins, and vitamins C and E. Magnesium is necessary for all detoxification functions. It also regulates vascular tone, heart rhythm, platelet-activated thrombosis, blood pressure, and cholesterol production. When we are not consuming enough magnesium, there is a high connection to hypertension and cardiovascular disease. Lastly, modulates insulin signal transduction and may have a role in regulating insulin secretion.  This is taking a look at magnesium through a micro-view. For more on the basics of magnesium, see here.   At the Macro Level Sarah wants to take a step back and look at magnesium function from a macro sense. (9:03) Magnesium plays a critical role in the stress axis. Every single aspect of the HPA axis (our flight or fight response) is sensitive to magnesium. Because over activation of that axis is tied with anxiety and depression, we can see through magnesium's action on the HPA axis how each hormone in that system is communicating. In order to function normally, all of that is relying on magnesium. We can see that magnesium deficiency is probably a necessary precondition for the development of generalized anxiety disorder and depression. There have been animal studies where they simply don't give them enough magnesium, and the animals show behaviors that are representative of depression and anxiety. They can treat those animals with antidepressants and show benefits. However, when treated with magnesium they show a reversal in symptoms. In humans, a low level of magnesium in the blood or in the spinal fluid has been associated with depressive symptoms as well as suicidality. For more on the connection between magnesium and stress, see here.   Sleep The other link to look at is sleep. (11:27) We know that inadequate sleep is also linked with mood. Now there is a fairly good understanding that magnesium plays a role in regulating sleep. So it actually regulates the central nervous system excitability and has a calming effect on the central nervous system. This is the reason why we want to take magnesium in the evening. Magnesium also helps to promote the activity of GABA. GABA is one of the main neurotransmitters involved in relaxation and sleep. There have been a variety of studies showing that there is a direct relationship between the amount of magnesium in the blood and how much people sleep, and how much deep sleep people have. If you have lots of magnesium in your blood you tend to get a lot better quality sleep, a lot more deep sleep, and less REM sleep. Studies have shown that supplementation with magnesium improves sleep. There have even been studies that show that magnesium deficiency may contribute to insomnia. For more on the insomnia link, see here. Stacy noted that magnesium is one of those things where it is relatively easy to not have enough of because of how much we actually need it.   Absorption Magnesium levels in our blood are generally controlled by our kidneys, and we have this reserved storage that is in our bones at any given time. (14:57) One of the things that the kidneys can do is take magnesium from our bones to restore it into our blood system. However, there are certain conditions where we burn through magnesium and we can't access the stored magnesium fast enough to keep blood levels at an optimum level. This is primarily related to stress. When we are stressed, we burn through magnesium really quickly. It happens in both acute and chronic stress. Chronic stress can cause magnesium deficiency through a constant turnover of magnesium. We will come back to the conversation on absorption but are first going to touch on a few more roles of magnesium that Sarah wants to highlight. Sarah wants listeners to understand how diverse the negative impact is of insufficient magnesium.   Exercise Performance & Recovery Magnesium is also really important for sports performance and recovery. (17:18) There have been a variety of studies that show that exercise performance is compromised with insufficient magnesium. These studies have shown that any way that you can measure performance (ex: grip strength, jumping performance) is sensitive to magnesium. There are studies showing that having enough magnesium is really important for muscle recovery. Supplementation with magnesium has a fairly small effect on how muscles recover. Our bodies cannot metabolize vitamin D without magnesium. If we are taking a large amount of vitamin D and we aren't getting enough magnesium via our diet, that vitamin D stays inactive in our bodies. There have been studies showing that when patients have optimum magnesium levels, they require far lower doses of vitamin D in order to bring their vitamin D levels up. For more on magnesium and vitamin D, see here and here.   The Microbiome Some of the benefits might be mitigated through the gut microbiome as well. (19:53) There have been studies showing that a magnesium-deficient diet reduces gut microbial diversity. Some of the most important bacterial species reduce in a magnesium-deficient diet. The kidneys are really important for controlling the amount of magnesium in our blood. It looks as though we can donate magnesium to our gut microbiome when we are chronically not consuming enough magnesium. Eventually, that magnitude of the effect will diminish, but again it is another reason why getting enough magnesium into us is so important. Stacy and Sarah briefly chatted about the importance of kidney health and how it relates to your magnesium levels. High vegetable and fruit consumption, in addition to hydration, are the most important things we can do for our kidney health. There have been studies in chronic kidney disease where they have done fruit and vegetable interventions, in humans, and they have shown restoration of kidney function by diet alone. As we talk about high magnesium foods, also knowing that a lot of these are high in potassium, these are really important minerals for kidney function. If you have kidney disease, please talk to your doctor about whether or not you need to do anything special diet-wise, knowing about these intervention studies surrounding diet modifications. There is no reason to avoid potassium or magnesium-rich foods if you have healthy kidneys.   Dietary Magnesium The recommended daily allowance for magnesium is 420 milligrams for men, and 320 milligrams for women. (26:50) If we look at the highest magnesium content food, a 6 oz. serving of fresh tuna would contain 109 milligrams. And if you consume a cup of cooked spinach (which is the equivalent of 10 cups raw) that would have 157 milligrams of magnesium. The other foods that are considered magnesium powerhouses are chocolate (65 mg), banana (27 mg), avocado (58 mg), and a 1 oz. serving of almonds (77 mg). In general, things that are dark green tend to be really high in magnesium. Nuts and seeds generally have a good amount of magnesium, as well as fish. You have to be aware of your magnesium content to make sure you are getting enough.   Deficiency Then there is this whole other piece of chronic stress basically increasing our magnesium needs in a way that is not quantifiable. (29:24) Quantifying stress is a very hard thing to do in studies. However, we do know that the more stressed we are, the more magnesium we need. The standard American diet only provides only about half of the magnesium that we actually need. Studies estimate that approximately 3/4 of us in Western countries, in general, are magnesium deficient. There are also racial disparities in magnesium dietary insufficiency. There was a study published in 2018 that actually looked at dietary intakes of a wide sampling of ethnic backgrounds. They found that on average 83.3 of the participants were not meeting the recommended level of dietary magnesium intake. It was about 82.8% in white Americans, 84.4% in Hispanic Americans, and 90.6% of African Americans not getting enough magnesium. There was an 'other ethnic group' that lumped everyone else together and that was 71.8% of those people were not getting enough magnesium. This 2003 paper makes a case for lower magnesium being a mechanism behind increased hypertension and diabetes. There have been a couple of papers that are making the case that this lower magnesium intake may be one of the contributing factors to the racial disparities seen in chronic illnesses. This paper that was looking at different magnesium intakes in different cultural backgrounds, they tried to do statistical analysis to try to hone in on why there are racial disparities in magnesium deficiency. They say it was due to two factors. One factor was a socioeconomic disparity, which is the dominant factor. And the second factor was cultural differences. Stacy really appreciates that Sarah pulled that data, and finds the information to be fascinating.   Multi-Form Magnesium Supplement What is really neat about magnesium supplements is that all of these absorbable forms are bound to another thing. (36:46) So now instead of going through ion channels, we can use the amino acid transport channels to get into the body. One of the things that you can do is manipulate how magnesium is absorbed by binding it to different amino acids, and by combining forms of magnesium where you are going to take advantage of multiple different transporters. Magnesium amino acid complexes (or chelates) behave differently from magnesium salts. The strong and stable bonds between magnesium and the amino acids keep the whole molecule intact in acidic environments. For more on this, see here. When complexes travel through the intestinal tract, they bypass the ion channels. Instead, they use other transport sites called dipeptide channels. Here, the amino acid and magnesium are carried across the intestinal membrane together. There are a few key advantages to this. For one, there are far more dipeptide channels than there are ion channels in the gut. Magnesium complexes do not compete for the same ion channels used by other minerals. Another advantage is that the stable bonds protect magnesium from unfavorable chemical reactions that might lead to the creation of unabsorbable precipitates. Mineral amino acid complexes are actually quite common in nature and a natural way we get magnesium from our diet. Some of this magnesium is already bound to amino acids, but even when we consume magnesium from salts, amino acids can help! Peptides and amino acids can bind to magnesium ions and form complexes right in your body.   The Different Forms of Magnesium Taurine is an amino acid. (40:38)  When combined with magnesium, the two can have a calming effect on both mind and body. This form is promoted for improving immune function and protecting the heart. Magnesium Malate is the form of magnesium that is often used for patients who suffer from fatigue or fibromyalgia. Magnesium Threonate is the newest form of magnesium and it’s still emerging in the marketplace. It appears to absorb more easily than the others and is used for people suffering from Alzheimer’s and other neurological disorders. Magnesium Citrate is among the most bioavailable forms of magnesium, meaning that it’s more easily absorbed in your digestive tract than other forms. This combination includes citric acid, which has mild laxative properties. Magnesium Glycinate (aka Magnesium Bisglycinate) is easiest for your body to use because it absorbs this form most easily. This form is commonly recommended for people trying to correct a magnesium deficiency. Magnesium Orotate includes orotic acid, which is a natural substance involved in your body’s construction of genetic material, including DNA. It’s easily absorbed and doesn’t have the strong laxative effects characteristic of other forms. Magnesium chelate has a 90% absorption rate. And the lysine is important for growth and tissue repair, which may play a role in reducing anxiety and normalizing cortisol. Sarah explained why certain forms of magnesium work as a laxative, and which forms of magnesium you should avoid. The forms to avoid are Magnesium Oxide, Magnesium Sulfate aka Epsom Salts, and Magnesium Hydroxide.   The Perfect Supplement So this is why BiOptimizers Breakthrough is so cool is because it has all seven of these forms in one supplement. (47:53) Bioptimizer Magnesium Breakthrough contains Magnesium Chelate, Magnesium Citrate, Magnesium Bisglycinate, Magnesium Malate, Magnesium L-Threonate, Magnesium Taurate, and Magnesium Orotate. Sometimes you will find magnesium supplements that will combine one or two forms, but that is it. This allows us to maximize absorption because now we are using all of these different amino acid transporters. And this allows us to not overwhelm one transporter, which would trigger us to not absorb our magnesium that well which leads to the laxative effect. So when you are using all of these transporters you are providing all of these additional amino acids that have each been shown to be beneficial in different circumstances. Stacy loves all of this information because it so clearly answers her question about why this supplement is working so well for her. This particular magnesium doesn't cause Stacy with any digestive issues. The fact that this particular supplement has a 90% absorption is one of the things that Stacy really wants to highlight. As someone who has looked into a lot of supplements, she knows that this form actually works and matters. Stacy does not like taking pills so when she does take any, she wants to make sure that they have a purpose and make a difference. We need to take a look at the supplements we are taking and make sure that they are quality. This doesn't just pertain to magnesium, but all of the supplements we are taking. In America, we are eating a diet that is deficient in nutrients, and the answer for many is to simply take a supplement. However, the actual answer should be to pull back and look at the source to investigate how we can alter our diet to get the nutrients in their food form. And if not, can we take a supplement that is more bioavailable and is more helpful.   Closing Thoughts Sarah wants to emphasize how challenging it is to get sufficient magnesium from the diet when stress is not managed. (52:53) Our listeners know that Stacy and Sarah take nutrient density very seriously, and they both work really hard to consume a nutrient-dense diet. Sarah has been taking magnesium supplements for eight years, and she has experimented with different forms. However, Sarah is super excited that Bioptimizer Magnesium Breakthrough exists. Magnesium was one of the earliest supplements she added to her diet. She really felt a huge difference when she took it just because of this aspect of the impact that chronic stress has on her body. So Sarah knew that magnesium was something that she needs. Be sure to talk to a medical professional about any supplement you want to take and run it past them. Stacy referred listeners to this podcast episode if you need to find a medical professional who you can talk to about supplements and nutrient absorption. If you haven't talked to a medical professional in a while, you may want to revisit with them to check that your regimen is still what is best for you. If you want to try BiOptimizers visit this site and use the code WHOLEVIEW10 for 10% off your order.  Thanks for listeneing! We will be back again next week! (58:31)
Welcome back to the Whole View, episode 408. (0:27) Stacy has a feeling she is not the only one struggling to get quality sleep right now. So she is looking forward to covering this week's show topic on insomnia. We dove previously into sleep with episode 399 when we talked about amber glasses. Stacy has been using her BLUblox glasses five times a week, and the nights she sleeps well coincides with those nights when she is using them. Speaking of, let's take a moment to thank this week's sponsor, BLUblox. We have a code for the Whole View listeners to receive 15% off their order using this link and the code THEWHOLEVIEW. Stacy also wants to point out that the prices you see online are Australian prices. So by the time you do the conversion if you are American using US dollars, using the code provided, it makes a significant difference in the price. Stacy feels that the science of quality sleep makes these glasses worth the investment if you are looking to biohack your sleep cycle.   Listener Question This week we have a really awesome question from Caroline that Sarah felt was a great way to talk about sleep. (2:54) Any long-time listener is probably pretty aware that sleep is really important. However, Caroline's question gets to one of the bigger challenges surrounding the challenges with insomnia. Caroline says, "First, I want to let you ladies know that I really appreciated last week’s podcast. As a long time listener, I was really glad you both chose to speak out. I know times are crazy right now, (Thank you for all your timely Covid-19 shows too) and this may not be a current topic of interest, but I would love an episode all about insomnia. I know you ladies have spoken a lot about the importance of sleep on the podcast but what about those of us who actually suffer from insomnia?  It’s been worse than ever this past week. Is there help for those of us who spend hours getting to sleep only to wake up a few hours later and not be able to get back to sleep? Thank you again for all the work you both do." This question is so timely! For those who are just listening to this week's podcast, Caroline is referring to this podcast episode from last week.   What is Insomnia? Sarah thinks that a lot of people suffer from insomnia without recognizing it as that term. (6:22) Insomnia is a condition that is diagnosed purely based on symptoms. There is short-term insomnia and chronic insomnia. Chronic insomnia is something that lasts at least three months, in which you have symptoms at least three days a week. In this scenario you would have one of the following symptoms: difficulty falling asleep, difficulty staying asleep, waking up in the morning earlier than desired, having some kind of resistance to going to bed on an appropriate schedule, and difficulty falling asleep without a partner or caregiver. Short-term insomnia is the same thing but lasts less than three months. So again, showing any of those symptoms three times a week. These symptoms at that frequency are very common. There are predisposing factors that make you more likely to have insomnia. For chronic insomnia, one of the biggest predisposing factors is chronic stress. There are personality features associated with chronic insomnia. Various conditions are linked to insomnia as a condition, such as mood and anxiety disorders. Obstructive sleep apnea, restless leg syndrome, chronic pain conditions, and alcohol and drug abuse are all other examples of health conditions that carry insomnia as a symptom. External factors can also cause insomnia, such as having an undesirable sleep environment. The predisposing symptoms for short-term insomnia are pretty much the same things. Short-term insomnia can even be a presenting thing of other underlying conditions.   Symptoms Insomnia is diagnosed with the symptoms of not being able to fall asleep and not being able to stay asleep. (10:30) Not being able to sleep long enough is also part of the diagnosis equation. There are other symptoms that are the consequence of that inadequate sleep. Symptoms of insomnia include not feeling well-rested when you wake up, feeling tired during the day, irritability, is a trigger for depression and anxiety, can hinder cognitive abilities, and ongoing worry about sleep. It can end up being this endless snowball bad effect, where the stress of not sleeping, erodes sleep, which then magnifies stress.   How Common is Insomnia? Insomnia is ridiculously common. (12:03) The prevalence of both acute and chronic insomnia in multinational cohort surveys has varied from 3.9% to 22%, depending on the definition used and the age group studied. When using the ICSD-3 diagnostic criteria the prevalence of chronic insomnia is 9% to 12% with transient symptoms of insomnia reported in 22-35% of the population.   Racial Disparities in Insomnia Given the very strong between insomnia and stress, it shouldn't be a surprise that there are racial disparities in insomnia. (15:12) Black Americans are approximately 67x more likely than whites to have insomnia. This study published in 2016 took a look at racial disparities in sleep. They looked at all of these other chronic illnesses that are linked with inadequate sleep. So what they found is that the lack of sleep itself was what was linking the chronic illnesses. You could actually predict the occurrence of chronic illnesses based on sleep. We talked last week about the Black community being much more high risk of chronic illnesses. You can draw the same line of systemic racism increasing stress, making it more likely for any of those predisposing factors to exist, and that being responsible for people of color, in general, being much more likely to not get enough sleep. And not get enough sleep whether or not they technically have insomnia. So what is really interesting is when you take insomnia out of the question, Black Americans are still more than twice as likely to not get enough total sleep compared to white Americans. What is fascinating is that this particular study was able to show that the lack of sleep is the thing that is contributing to racial disparities in chronic illness. There was another really fascinating paper that followed people over 10 years and looked at how insomnia changes over time. There were able to show that for white and non-Hispanic and Black people in their cohort, the accumulation of insomnia was very tied with health conditions. However, in Hispanics, it increased disproportionality. The Hispanic population saw a much more dramatic increase in insomnia with age. When you corrected for all these health conditions, it was still there. This is an interesting racial disparity in the sense that it really points to some kind of chronic stress for being a contributor.   What Are the Causes? Insomnia is a fairly unique chronic illness, in the sense that there is not a marker that we can pinpoint. (20:38) It really is like a behavioral symptom in some ways. However, it is a consequence of things like stress or having a travel/work schedule that is messing with your internal clock. You can have insomnia without melatonin being diminished. It really is some of all of these different factors. Insomnia can be the direct result of poor sleep habits. Examples include evening snacking, screen time too close to bedtime, and uncomfortable sleep conditions. This condition that we give a name to is really a culmination of the effects of stress, plus behavioral or routine type contributors to how our body prepares for sleep and initiates sleep. Stacy shared a look at how Matt's medications impact his sleep cycles. Sarah noted that there are a lot of medications that can interfere with sleep. Many antidepressants, medications for asthma and lower high blood pressure, cold and allergy medications, and the weight loss magic pills are also filled with stimulants. Caffeine, nicotine, and alcohol are all very well known to disrupt sleep. It is worth having a conversation with your healthcare provider about other options if you suspect that your medication is impacting your sleep. There are some medical conditions where you will not be able to get around that, like ADHD medication. Stacy shared a look at how Matt was able to modify his ADHD medication to improve his sleep quality. It is a priority for all medical professionals to ensure their patients are sleeping. So if your not, please let them know and work on that. It is always ok to ask your doctor questions if something doesn't feel right to you.   Treating Insomnia When it comes to treatments there are basically sleeping pills and nonpharmacologic options. (29:11) There are basically side effects of every sleeping pill option AND they are almost all habit-forming AND they are not as effective as drug-free treatments. Every single option has pretty awful side effects that impact the majority of people. These are side effects that are broadly experienced and can include things like dry mouth, upset stomach, headache, dizziness, and sleepiness throughout the day. There are many scary stories about those who have done things at night while asleep with no memory of what they had down the night before. Stacy noted that they have experienced no symptoms with melatonin. Matt and Stacy have found it to be a helpful tool without side effects. Sarah referred listeners back to the melatonin show for more information on where melatonin can be really helpful. It is really helpful in circadian rhythm dysregulation conditions. Stacy shared examples from her personal experiences in her family where they see a ripple effect in disruptions in their sleep routines. She also shared examples of ways they positively reduce sleep disruptions and improve sleep habits. Sleep is very important to health, but it takes consistency. When stress is high, you have to be all the more diligent about focusing in on those sleep habits. You can't decide one day to fix your sleep habits and then all is fine. These are habits you will always need to be mindful of.   Drug-Free Treatment Strategies Cognitive-behavioral therapy for insomnia (CBT-I) has shown to be more effective than drugs, over and over and over again. (38:15) There is a huge number of clinical trials showing hands down CBT-I is the most effective treatment for insomnia. For more on this, see here and here. CBT-I is typically done in a group therapy setting, but it can also be done one on one. It is typically a couple of hours a week. What is does, is that it basically looks at the causes of insomnia and what can be mitigated. It has a variety of different components. One component that studies have separated out and shown that this is a really important part of how CBT-I works is called sleep restriction therapy. What this does is recognize is the homeostatic drive for sleep. We have these chemicals that build up in our brain throughout the day that eventually make us feel really sleepy at night. When we sleep it flushes those chemicals out. Caffeine inhibits the ability of those chemicals to bind, which is why caffeine makes us feel more awake. So sleep restriction therapy basically tries to reset that homeostatic drive for sleep by cutting naps and setting a late for you bedtime.   Additional Components of CBT-I Another aspect of CBT-I is called stimulus control instructions. This basically looks at sleep habits and pinpoints different things that you might be doing to overstimulate in the evening that may be inhibiting sleep. And this includes sleep hygiene education. So there would be a whole list of things that are customized to you that are essentially your yes and no list. These are all habits that we discuss on this show. One of the things that they will always instruct you to do is to sleep on a consistent schedule. This is because of the hormone regulation that is controlling sleep. Another part of CBT-I is relaxation training, which often involves mindfulness practice. There is something that they teach to help people remain actively awake. The last piece of CBT-I is biofeedback. You might do this with some kind of tracker or observe your own levels of muscle tension. These strategies may be incorporated into a mindfulness practice. The idea is to be able to understand your daily patterns of markers that might be reflected in your sleep quality.   Exercise Interventions One of the things that can be layered on to the CBT-I practices is exercise interventions. (43:49) Exercise interventions have been studied as part of CBT-I and separately. One of the old school recommendations for not exercising before bed has been debunked in the scientific literature. They have basically found that there are certain people who exercising in the evening will disrupt their sleep. However, as a general rule, it is not the case. Exercising helps support sleep. There are a bunch of studies showing that aerobic exercise, compared to resistance training, is very good for supporting sleep. Even thirty minutes, three times a week show a modest effect, but still a measurable effect. So this can often be part of CBT-I. For most people, research has found that it matters more that exercise is regular and on a schedule than what time of day it is. You can learn more about this here.   Mindfulness Intervention Keep an open mind about what falls under the umbrella of the word meditation. (46:38) Sarah loves Stacy's disdain for meditation when she meditates nightly. With mindfulness and insomnia, there is basically two different approaches. One is what is called mindfulness-based stress reduction. This is a whole independent program that teaches meditation and is typically done in group classes. There is mindfulness-based therapy for insomnia, which basically incorporates that mindfulness practice into CBT-I What has been really interesting to see is that mindfulness all by itself is very effective. However, it is even more effective when combined with CBT-I. Mindfulness by itself has been shown to be just as effective if not more effective than drugs. And there seems to be this better effect when you combine it, especially long-term.   Amber-Tinted Glasses The last thing that can be layered with CBT-I, which has been shown in a couple of recent studies to be very effective, is wearing blue-blocking glasses. (49:54) One study that was published in 2018 took 14 people with insomnia and they had them either wear blue-light blocked amber lenses or placebo lenses for two hours before bedtime for seven consecutive nights. What they showed was that there was a marked improvement in total sleep time for the people wearing the amber glasses. They did a variety of different measures to reach this conclusion. Amber glasses actually made a large difference to sleep quality and total sleep time in just seven days. Another study that was just published in February 2020 layered amber-glasses on top of CBT-I. They had 30 patients all with chronic insomnia. And they all went through the same CBT-I group therapy program. Again, they were randomly assigned to either have blue-light blocked glasses or placebo. And they again had all these different ways of measuring sleeping, including wrist actigraphy. They also compiled scores looking at anxiety, depression, and quality of life in general. So they were also looking at symptoms for chronic sleep deprivation. They found that the group that had the amber glasses had a really huge improvement in how many minutes they were sleeping. Whereas, the people who did the CBT-I alone and had the placebo glasses, actually over the period of time that they were watching these patients, actually had their sleep get worse. The amber-tinted glasses group had a really significant improvement in their various measurements in sleep and their measurements in anxiety, depression, and the hyperarousal score. They were basically able to show that not only sleep time was improved, that all of these other markers of sleep quality were also improved. Between these two studies, we show that blue-blocking glasses by themselves can be very very helpful. They are even more powerful when combined with this more comprehensive, holistic approach to addressing insomnia.   Closing Thoughts Stacy knew at the top of the show that she was going to be reminded of all of the reasons why sleep hygiene is important and what she can do better. She is really grateful that we took the time to revisit this.  And also appreciates all the work that Sarah did to dive deeper into the research on this.  Stacy shared more on how stress builds up in her life and eventually compounds within both her sleep quality and quantity. She personally experiences good results when she takes magnesium before bed, as well as wearing blue-blocking glasses.  Putting her kids to bed at a regular time is also critical.  If you are a parent, letting the kids stay up later can contribute to poor sleep habits.  Stacy doesn't think everything can be solved without medicine, but she does think that before jumping into that there are a lot of behavioral and lifestyle factors that we can choose to do.   Diet & Sleep The other idea that Stacy and Sarah wanted to revisit is the importance of not being low-carb before bed.  When it comes to habits to support sleep, this is one that is very important.  There is a very strong link between diet, meal timing, and sleep quality.  Eating a higher fiber diet and moderate fat has been shown to decrease the amount of time it takes to fall asleep.  It also improves the quality of sleep in people.  A slow-burning starchy carb at dinner has been shown to be very very helpful for sleep. Low-carb diets have been shown to disrupt sleep quality. Part of what we can do to support sleep quality is actually eating breakfast (check out this and this podcast episode for more information on why). Eating dinner on the earlier side is also helpful.  Ideally you want at least two hours between when you eat dinner and when you go to bed.  However, four to five hours is optimal. The science is really compelling on an earlier dinner and actually shifting our caloric intake towards the earlier part of the day.  It is a really healthy eating pattern to eat a bigger breakfast and lunch and then a lighter dinner, on the early side.  If you are someone who is not drawn to large breakfast, Stacy strongly suggests listening to this podcast for recommendations. Stacy shared her personal experience with the benefits she experienced when she shifted her meal timing. Listeners, don't forget if you want to check out the blue-light clocking glasses that we recommend, please visit BLUblox. Use the code THEWHOLEVIEW for 15% off.  Thanks for listening! We will be back again next week. (1:08:21)
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Creator Details

Location
Fairfax, VA, USA
Episode Count
443
Podcast Count
8
Total Airtime
2 weeks, 2 days