The PBTH doctors discuss the proper way to recover from surgeries, accidents, and much more!
In addition, they talk about:
-What you should eat to increase your recovery time.
-Why your gut health is critical to your ability to recover.
-Whether eating bread is healthy or not.
-Best brands of tofu.
-Pros and cons of calcium supplements.
Questions Answered
- (00:03) – Why is recovery important?
- (04:39) – My son has agreed for the first time to eat greens in the form of green smoothie. But he's getting incredibly bloated. Is there something we can do to ease the transition?
- (09:31) – Are nightshades problematic for RA sufferers?
- (13:23) – If one has low creatinine levels, what does that mean and what can be done?
- (15:25) – How do you feel about homemade sourdough bread?
- (17:27) – I love to eat bread but I'm concerned about inflammation. What can I do?
- (27:38) – Should you keep plant fats away from fruit for better metabolism and blood sugar?
- (36:20) – What's the role of navigating reducing medication while avoiding inflammation?
- (38:37) – What are your thoughts on tofu?
- (39:47) – What do you recommend for good sleep?
Complete Transcript
Dr. Kim Scheuer
(00:03)
Hey everybody. Well, it's so nice to talk to everybody and welcome from all over the country. So I'm going to talk a little bit about recovery. And so why is recovery important? Well, we need to recover every day. Our bodies, when we sleep, we recover from the day before. We need to recover from surgeries, from illnesses, et cetera. So what is recovery? Well, recovery is a return to the normal state of health, mind, strength and physicality.
Dr. Kim Scheuer
(00:36)
So it's so important to think about all the time, because even when we're young, as we're growing older, we recover every day like I said. And what do we need to think about for recovery? Well, we need to think about what we put in our mouths because what we put in can either hinder or help recovery. We need to reduce our stress so that our bodies can recover. We need to sleep. We need to decrease inflammation, and we can have inflammation for so many reasons. We need to improve blood flow so we can get the good nutrients to our vessels and to our muscles, to repair, to our brain to repair. We need to reduce oxidative stress, which is how our diet may a difference too. We need to alkalinize an acidic environment so you know when you work out really hard, you get lactic acid build up, so we need to alkalinize that.
Dr. Kim Scheuer
(01:36)
So those are some of the things we need to think about. And there's certain things for athletes, there's certain things for the general population. So to think about it, about 48 million people a year need surgeries. Well, the best way to recover from surgery is actually not to have it, to prevent it in the first place. So that's one thing we want to think about, and if we have to have surgery, how do we prepare for surgery? How do we recover from it afterwards? It's interesting there's so many studies now about rotator cuff injuries, knee injuries, back injuries. It's very connected with oxidative stress, inflammation, things like that. So we can actually change our lifestyle to help decrease all that. And hopefully, and in some cases prevent needing to have surgery or needing to recover from that. And so there's a lot of information out there.
Dr. Kim Scheuer
(02:40)
I'll take a lot of questions, but again, fueling our bodies with high quality nutrient dense alkaline forming foods and not toxin our bodies with anything that will make things worse, no smoking [inaudible 00:02:59] that will make our bodies worse, no eating foods that will cause inflammation. That makes a difference. Hydration is a huge deal. So hydrating enough. The sleep is really important that improves our melatonin and helps repair ourselves overnight, so that's great. Exposure to natural light. Getting exposed to natural light, it's not only the vitamin D that you get, but it's also other kinds of radiation that happens that can happen. So getting out into natural light's really, really important. Decreasing stress and continuing to move, even if you're injured. So for example, if you have a shoulder injury, still walk. It's so important because that will help with recovery too. And we want to avoid all of the toxins that animal products, processed foods will bring in that increase inflammation that increase our TMAO, that increase our IGF-1, all these things that will hurt recovery.
Dr. Kim Scheuer
(04:06)
And it's interesting, just like you prepare for a marathon, you want to prepare for surgery. So it's fascinating that way you don't want to… as you're recovering from an injury or getting to surgery, you want to make sure that you have a lot of good healthy complex carbs in you to be able to recover. And then afterwards you want to eat really, really high nutrient dense foods right after an injury or a surgery.
Dr. Kim Scheuer
(04:39)
But I see a question already. So I was looking at that. Let's see. My son has agreed for the first time to eat greens in the form of green smoothie. Excellent. [inaudible 00:04:50] your son. But he's getting incredibly bloated drinking these. I'm guessing he doesn't have the microbiome to digest the greens. Is there something we can do to ease the transition? He's been doing that for two weeks now. Well, I have some ideas, but let's start with some of the other people who are on to see what they have to say. You want to start Chris?
Dr. Chris Miller
(05:16)
Sure. I'll start. Sometimes when you first start and you're not used to it, you're exactly right for whoever asks that question, that your microbiome may not be trained for it and so it can be too much. Sometimes if you have a lot of fruit in there, fruit can be hard to digest. I'm not sure what else you're putting in the green smoothie but I have people start smaller. So if you make your smoothie, just start with a little bit in the morning, a few sips a little bit and then a little bit midday and then a little bit later in the day and just gradually work it up. I also look at what fruits in there as I know some fruits can be a little bit harder to digest than others. And if you're putting anything else in besides fruit and greens, so to make it a little bit easier, those are my initial starting points.
Dr. Kim Scheuer
(06:08)
Jeff?
Dr. Laurie Marbas
(06:08)
Said half a pound of greens, one pound of pineapple and one banana. That's her mix.
Dr. Chris Miller
(06:13)
Half a pound of greens. What else was that?
Dr. Laurie Marbas
(06:15)
A half a pound of green, just one pound of pineapple and one banana.
Dr. Chris Miller
(06:20)
One pound of pineapple? I don't know how much that is but it could be something with the amount of fruit that is… that's possible.
Dr. Laurie Marbas
(06:26)
And a quarter cup of flax and lots of water.
Dr. Chris Miller
(06:28)
So that-
Dr. Laurie Marbas
(06:28)
The flax can be an issue too. It's a lot.
Dr. Chris Miller
(06:30)
Yeah. That quarter cup flax is a lot for a little kiddo who's not used… for anyone basically, if your microbiome's not used to that much. I would start with just a tablespoon or even just a teaspoon for some people and gradually work your way up to that. That may be your goal, but that might be a lot to hit a microbiome with all at once.
Dr. Jeffrey Pierce
(06:49)
Yeah. Dr. Will [Buswits 00:06:52], the gastroenterology fiber fuel guy that we like so much, I think was the one who said it's adding fiber to your diet is a little bit like starting an exercise routine and you wouldn't go from live in an average less than exercise full life to run in a marathon on day two. And so build up your fiber little by little. It's going to pay off huge. It's going to be worth it but a little bit at a time sounds like good idea just like everyone's been saying.
Dr. Laurie Marbas
(07:27)
And remember cooking starts the process also for you, so if you want to steam those greens and then limit, like you said, the ground flax, especially the seed, the nuts and beans are going to be harder to digest than some of the more things like the bananas easier. But again, steaming the veggies might be helpful. Even you could even cook the fruit a little bit too to help break it down, so you can do that as well.
Dr. Chris Miller
(07:53)
You reminded me of something, Laurie, when you said that is for people with irritable bowel syndrome or having a lot of gas and bloating that we often have them freeze it ahead of time. Pre freeze it before you blend it and each step helps break down the fiber a little bit so your microbiome doesn't have to do all that. So when you freeze it, you're breaking it down and then you're blending it, that's two steps. And then reducing those flax seeds, initially, all of that, and I would imagine he'd be able to digest it. And if he doesn't, will you please report back to us on our next Friday webinar and let us know if he's still not digesting, because I would think he would be able to if he do all that.
Dr. Kim Scheuer
(08:31)
The other thing I was thinking is, I agree with the go low, go slow to start, but make sure that he's not just pounding it down all at once because one, you're getting a lot of air in at the same time and so you get more gas. It gives you a big sugar rush and then increases your insulin spike and all that. So going low and going slow should help quite a bit.
Dr. Laurie Marbas
(08:59)
This is interesting. She says, yes, he does great with beans. He eats four cups a day but he does drink it too fast. Thank you. So it might be the rapidity of the intake that's the issue. Excellent, because if he's doing beans four cups a day, he's probably cut a pretty good bite.
Dr. Jeffrey Pierce
(09:13)
That's a lot of beans. Is this a 24 year old child?
Dr. Laurie Marbas
(09:18)
That's a lot of beans. I eat one and a half cups and I'm… Oh he's 21. There you go. They're like empty garbage.
Dr. Chris Miller
(09:27)
[inaudible 00:09:27] is getting from gas and bloating, it might be the beans not the smoothie.
Dr. Laurie Marbas
(09:31)
That's true too. So a few things to think about and yeah, so some other questions here, do you believe that nightshades are problematic for RA sufferers? Chris?
Dr. Chris Miller
(09:43)
I can answer that. So for some people, nightshades have, I think it's an alkaloid. Is it a protein in it? That some people can react to. And so some people will react to it but if you look at the numbers and there's not a lot of data on it, but I did see one study that said about 10% of people have it. And I found that certainly, some people with RA, if you're having joint pains and it's ongoing to take out nightshades, and that's your tomatoes, your bell peppers, your eggplant and your white potatoes, especially remove those. I think goji berries are also nightshades, so remove those and you see how you do but then bring them back in because not everyone is going to have a problem with it. And these are good healthy foods. So if you can eat tomatoes, you want to eat tomatoes, they certainly add to salad, but if they cause new joint pains, then you want to take them out.
Dr. Chris Miller
(10:38)
So I would recommend doing a trial off without them but then bring them back in because if you're someone who can eat it, then you want to eat it. And I have a lot of patients with RA who are able to eat them and a few that I know of that have a hard time. So it's kind of individualized.
Dr. Jeffrey Pierce
(10:55)
And Chris that 10% is probably 10% of people with autoimmune disease not 10% of the general population, if you [crosstalk 00:11:02].
Dr. Chris Miller
(11:01)
Right. It was people with joint pains and I think it was autoimmune. I'll have to go back and look at that study.
Dr. Laurie Marbas
(11:09)
[inaudible 00:11:09]
Dr. Chris Miller
(11:10)
That meant 90% were able to tolerate it and there's so many people. I avoided it for four years. I didn't eat any of those foods because I was told not to with my joint and pains. And then I added them in and I was fine. I was like, I give up four years of eating these delicious foods. So then I was reading about all the benefits of it, so I do want people to bring it back in and try it. I don't want people go that long without those good foods if they can eat it.
Dr. Kim Scheuer
(11:33)
And Chris, [crosstalk 00:11:35] people who weren't able to eat it for a while and then as their body healed, they could eat it more later.
Dr. Chris Miller
(11:42)
[inaudible 00:11:42] you've got heals and these are food sensitivities and so they do improve. Yeah, they can't improve but if you keep eating them when you're sick, they're going to keep it going. And so you want to take it out for a little bit but not everyone has to that again, that's the thing… It's not a one size fit all with those. It's just to remember, keep it in mind that it could be but not that it isn't necessarily.
Dr. Laurie Marbas
(12:03)
I think that's where a food diary's really, really key so you cannot just be guessing, that like, oh I ate the potato again and you're having a flare.
Dr. Chris Miller
(12:11)
I just remembered back to the gut microbiome, you want a diverse microbiome. The goal is not to be on a limited diet so far like, you got to take this out, you got to take this out, you got to take this out. Then we're not doing anything good for people but we do want to simplify the diet while you're having this inflammation and let your gut heal for a little bit but then hopefully bring all those foods back in.
Dr. Laurie Marbas
(12:31)
Yeah. And I'm just going to… don't forget the hot peppers. So sometimes in spices, chili peppers, red pepper, cayenne, those are also-
Dr. Chris Miller
(12:40)
[inaudible 00:12:40] paprika.
Dr. Laurie Marbas
(12:41)
… nightshades. Yeah. Paprika, pimentos, potatoes, sweet peppers, Thai peppers, [inaudible 00:12:46].
Dr. Chris Miller
(12:46)
Of all those four, the one that is probably the most reactive is white potatoes. So a lot of people [inaudible 00:12:52] the other three but not white. So that's a tricky one for sure. I still [inaudible 00:12:57].
Dr. Laurie Marbas
(12:56)
Yeah. And even some herbs like Ashwagandha is considered one, gooseberries, which some people take amla powder, so just some things to think about there.
Dr. Chris Miller
(13:08)
And there's different ones. Just because you react to one doesn't mean you're going to react to all of them too. So I just look at it as just try each individual food. And we can work with you guys, if this sounds confusing, please work with one of us because we're happy to help you figure this out.
Dr. Laurie Marbas
(13:23)
Absolutely. And then another question is if one has low creatinine levels, what does that mean and what can be done? I'm hopefully plant based on five milligrams of statin now and amlodipine 2.5 milligrams twice a day. It's improving slowly. So you guys want to talk about kidneys and the creatinine?
Dr. Chris Miller
(13:46)
Well, one reason for low creatinine is what are you eating and are you getting enough protein taken? And not only the protein intake but muscle building. So if you don't have muscle mass, creatinine goes up… it's a breakdown product of muscle and of protein, so you want to make sure you're eating enough protein and hopefully plant-based protein and you want to make sure you're building muscle. So when I see a low creatinine on my patient, the first thing I do is I look at their kidney function. And the second thing I do is I look at their diet, their protein intake. And the third thing is I ask them how much they're working out and doing resistance training and actually putting on muscle mass. So those are my initial thoughts on that.
Dr. Jeffrey Pierce
(14:28)
The situation where I most often see low creatinine is in pregnancy. I'm not making any assumptions here but it's a sign of actually better filtration that you see, better kidney filtration in pregnancy. So in general, a lower creatine is much better to have than a higher creatine in the sense that as your creatinine is going higher and higher, it shows that your kidneys are not filtering as well. That's the other thing that I think about when I'm looking at the creatinine. So maybe if your creatinine's coming down from where it was before, that might actually be a good thing that your kidneys are getting more blood flow and functioning better, in that thought.
Dr. Chris Miller
(15:12)
I meant before the lower than the normal range, so I agree with you though. In general, you wanted to have a lower creatinine but when it gets the low, like even the normal ranges, that's when I look at that. Sorry, I was answering a different part of that question.
Dr. Laurie Marbas
(15:25)
Well now we've covered the entire thing. There we go. Marie Grace ask, glad you guys are debunking a lot of these rules of limits. Absolutely. How do you feel about homemade sourdough bread? All right. You guys.
Dr. Chris Miller
(15:39)
Yum, first of all-
Dr. Laurie Marbas
(15:41)
That's what I say. Yum. Bring it on over. Send it all over.
Dr. Chris Miller
(15:44)
Yeah, we'll taste it for you and let you know what we think of it.
Dr. Laurie Marbas
(15:49)
Do you guys think, I mean, Jeff, you've got gardens and made cooking things. What do you think, please?
Dr. Jeffrey Pierce
(15:55)
So I am a big fan of making bread. I make bread every week, sometimes sourdough and oftentimes not. So I'm a fan. If you can handle the higher calorie density of breads in general with something like 1,500 or something calories per pound. And so I've been enjoying watching the truth about weight loss summit this week that Chef AJ puts on with some phenomenal speakers including our own Nikki Davis as part of it this year, but of course, calorie dense foods like breads and other dried starchy type things can add up the calories. But if you can handle the calories, then that I think it's great. It's satiating sourdough or what I traditionally made and a few with the blue zones areas and they have some lower gluten loads because of the sour process. And they taste great. And especially if you're not dipping them in a half quart of olive oil or spreading a whole bunch of butter on it or even vegan butter and stuff, and just enjoying it for what it is.
Dr. Jeffrey Pierce
(17:13)
And then making your own bread, of course, allows you to control how much salt you put into it, either none or less than you would get in breads that you'll buy in the store, are some of my thoughts on it. So I'm a fan.
Dr. Laurie Marbas
(17:27)
Excellent. And she goes, yes, I can handle the calories. I'm lower weight. So there we go. Marine ask, I have a diagnosis of psoriasis and an anti CCP, a 3.5. The skin has healed over time. However, when I eat wheat even just as Eco Bread or plant strong pizza, I seem to get uncomfortable joints. I don't have a diagnosis of celiac my blood test, but I have never had a gut biopsy. My BMI is 21. So I love to eat bread but I'm concerned about this feeling of inflammation. How can I know for sure? So Chris, any Dr. Kim, Jeff?
Dr. Chris Miller
(18:05)
So my first thought was you had a celiac test. So I don't know what that means because there's different types of celiac testing. So there's blood testing and they can look and see if you're actually reacting to the gluten or if you're reacting to yourself. So they look for antibodies against yourself or against the gluten. And that would mean you're actively reacting. So that's one, and then there's also celiac genes and that's a little bit different. And so if someone has a celiac gene, they are more likely to have a sensitivity to gluten. So if that's ever been checked, that would be helpful as well. I like to know both of those. And then on top of that, there is a link, especially with psoriasis and lupus, but also with a lot of other autoimmune diseases between gluten and the autoimmune disease.
Dr. Chris Miller
(18:47)
And so there was a study that I think that Dr. [Famann 00:18:50] published and it was in the international journal of disease, reversal and prevention and it was about psoriasis people doing better off gluten and having a significantly approved response. And so you might be someone who either you have… if you have a celiac gene, you still might be likely to have a link there but you might just have this sensitivity with your autoimmune. So I definitely recommend avoiding it because you recognized this, that's causing you inflammation and so you want to keep that out. I mean, I guess as you improve later on, you could retest it, but otherwise I would keep out the gluten. The other thing is that sometimes if people go to Europe, they actually tolerate the wheat there because it's not GMO or there's not the pesticide that we use on it. So it may be something else as well but there's clearly a link with wheat and gluten.
Dr. Kim Scheuer
(19:43)
Yeah, I'd agree. I'd avoid it with your sensitivity, whether it's a full on intolerance, we don't know, but you don't don't want… Again, this is recovery. Let your body continue to recover and don't put in things that you know will make it worse.
Dr. Chris Miller
(20:03)
Nope. You're on mute.
Dr. Kim Scheuer
(20:04)
You're muted.
Dr. Laurie Marbas
(20:06)
There he goes. Sorry. She said I have positive celiac gene, but only one of two.
Dr. Chris Miller
(20:10)
Oh, there you go. That increases your risk that you're going to have a sensitivity to it.
Dr. Laurie Marbas
(20:17)
Okay. And Colleen has asked in terms of preventing surgery, she says I've been diagnosed with [inaudible 00:20:25], I can't never say that word right, disease and I'd like to prevent the surgery that comes with it. So is there a way to slow the progression of the disease via lifestyle changes? So that's usually like a potential genetic predisposition or injury causing. So any thoughts or things there guys on-
Dr. Chris Miller
(20:41)
I can talk about the recovery and Kim, will you explain to everyone what it is so they know what [inaudible 00:20:48].
Dr. Kim Scheuer
(20:50)
Actually, if I'm remembering right, isn't that a trigger thing?
Dr. Laurie Marbas
(20:53)
It's a fibrous scarring down and I think you get the hands down. Yeah. It's been a while since I've seen that because I'm not [crosstalk 00:21:01].
Dr. Kim Scheuer
(21:00)
I know. Me too but absolutely. So again, everything is anti inflammatory as possible. So again, do not put things in your body that will increase inflammation. So no meats, no processed foods, no oils, things that will increase your inflammation, you want to avoid. Then you want to add things in that will help prevent inflammation and help recovery. So there's lots of things that can help recovery there. I have recovery recipes, like there's a recovery drink that has all kinds of things that have beat roots and hemp seeds and flax seeds and greens, lots and lots of greens, some spices like cinnamons, which help bring things, turmeric is a wonderful thing. So you can have a little bit of turmeric every day like a half a teaspoon with a crack of pepper, black pepper, which will help get the [inaudible 00:22:06] out and help with recovery.
Dr. Kim Scheuer
(22:10)
So those are some things I would absolutely do. You want to make sure you're not doing things like certain supplements that can increase. I wouldn't be doing a lot of protein powders or things like that because then you're going to get some inflammation by having things come in so quickly. You want to have whatever you're eating. Again, you want to have slow absorption, so you don't have increase of inflammation from that. So all the green leafies, all the fruits and veggies with lots of multiple colors that have phytonutrients and things like that will help. Walnuts for some people will help too and making sure you have a nice omega three to omega six ratio. So you can come see us and we can test for that, make sure your ratios are good because you want the more anti-inflammatory omega three versus the inflammatory omega sixes. So some people may need to supplement for that. Those are some of the things I can think of but if anybody else has some other ideas too, let's see what you guys have.
Dr. Jeffrey Pierce
(23:25)
I was just looking it up briefly because it's also been years since I've seen someone with the case of it. One thing that they mentioned is maybe with early disease, wearing padded gloves if you're doing work to help reduce the, I guess honestly the microtomes and friction and stuff in your hands. And then there are areas in lifestyle medicine that we have excellent research on for diabetes and heart disease and stuff like that. This is probably an area where there is a dearth of strong scientific evidence to say definitely eat this and you will see that, but like Michael Gregor likes to say, even if everything that we are recommending today doesn't help your Dupuytren's contracture. It'll also help you from having a heart attack or developing diabetes and all the other benefits that are associated with it. So it's worth doing it for many reasons.
Dr. Kim Scheuer
(24:28)
One other thing too, is when you mentioned the pads, if you're doing a lot of weight lifting, if you're doing pull down things or pull up things, or if you're like me, I move a lot of wood because I'm in the middle of the woods, you can get these wrist scar things that you can put on with a little hook that helps protect your hands. So it's a nice one too.
Dr. Laurie Marbas
(24:53)
Cool. Very good idea. So we have another unique condition. She says, my daughter has CIDP, which I'm assuming is the chronic inflammatory demyelinating polyneuropathy. Are you familiar with this diagnosis? If so, do you offer suggestions that help with that? Because I don't think they know what causes it but it's got the demyelinization and nerve pain inflammation. So any suggestions on nerve health? I think we could maybe generalize it to that.
Dr. Jeffrey Pierce
(25:28)
I'll say one thing while the smart people on the team are thinking of their answers. Just one other thing, for the last case of the Dupuytren's contracture, I just ran across that it is associated with type two diabetes. So all these changes will help with that association and cigarette smoking and alcohol drinking and I realize a lot of the people who tune into these websites or to our show are not doing any of those. But if you are, that would be another good reason to stop that.
Dr. Laurie Marbas
(26:03)
Nerve health. I mean, the first obvious one for me would be make sure your B12 is adequate. At least above 500 when you measure it and it's cyanocobalamin and not a methylcobalamin but any others thought suggestions?
Dr. Chris Miller
(26:16)
Well, if it's inflammatory, that goes back to everything we've just been talking about. So reducing inflammation with the anti-inflammatory diet or whole food plant-based diet and your greens and making sure your omega threes are okay. So that all is super helpful. And then I would also say I don't know if there's an autoimmune component to that but if there is, I would also always think about the gut microbiome and make sure your gut health is in good shape, that you're not having any gut issues, that you are not having inflammation that starts in the gut and you're not eating anything pro-inflammatory or worsening that whole area. So that's one thing I think of and then after addressing those, then I look at nutrients. And so that's what Laurie was talking about. Your B12, your vitamin D, some of your basic nutrients, make sure you're not deficient, make sure you don't have thyroid disease, anything like that. And that would be my basic start.
Dr. Chris Miller
(27:13)
I have a few supplements I sometimes use for nerve issues, but I wouldn't start with that probably with the [inaudible 00:27:20] anything because MS can improve so I'm not sure if this can as well or not, but I certainly would do everything to be as antiinflammatory as I could and watch because our bodies have a remarkable way of healing when we give it the right stuff. So I would want to watch and see what it did.
Dr. Laurie Marbas
(27:38)
Absolutely. Marie Grace's asking, should you keep plant fats away from fruit for better metabolism and blood sugar? Any thoughts on being worried about mixing different food, macronutrients, things like that?
Dr. Kim Scheuer
(27:56)
So I'm thinking about what do you mean by plant fat? So if you were talking about things like an avocado, that already is packaged in fiber and your own things that can help. If you're thinking about avocado oil, get rid of it. If you are thinking about walnut versus… or olives versus olive oil, I would always go for the whole food because it's already packaged in something that's going to help you not absorb quickly and not have problems with it. And as far as I remember, she was talking about keeping it away from fruit. So there are some fat soluble vitamins, A, D, E and K, which you do need some fat associated along with it to be able to absorb it. So I haven't particularly thought about keeping it away from fruit. I don't know if anybody else has any other ideas about that.
Dr. Jeffrey Pierce
(28:55)
You hear the discussion of in nature, we were never having really highly sugary stuff and really highly fatty stuff at the same time, usually. And when eat the chocolate shake with the cheeseburger and the fries that your body is using the carbohydrate calories and immediately storing the fats and there seems to be worsening health outcomes when you're combining the sweets and the fats at the same time. But I think if you're already like, oh, I'm having a handful of almonds and a handful of raisins at the same time, is this going to be dangerous? I think we're probably… you've bypassed so many of the bad parts of eating and you've come to this lovely place where if that's our biggest worry, we're probably parsing that out too much would be my thought.
Dr. Chris Miller
(29:54)
And I want to go back and remind everyone about whole by Dr. T. Colin Campbell and how he talks about how it's a symphony. So nutrients are healthier when they're together. So a little bit of fat helps you absorb fats soluble vitamins and all these broccoli's healthier with tomatoes and things work together and even have better benefits. So the only caveat I would have is if you're having digestive issues, then we may look at it a little bit and maybe having too much fruit at once or too much fat at once or something. And then there's certain people that I may play with it a little bit and cut it back. But in general, I think that's going to be beneficial when you eat it all together as a healthy meal. That's what we want I think people to do.
Dr. Laurie Marbas
(30:39)
With the majority, it's not a big deal. Don't worry about it. Just enjoy your food.
Dr. Chris Miller
(30:43)
Yeah, exactly.
Dr. Laurie Marbas
(30:43)
There we go. Do you have a few more questions? Got you good for 15 more minutes. Does that sound okay guys? Docs? Yeah. Okay. And are peanuts high in omega six? I can just answer quickly. They're high in the ratio, so that's the thing. They're higher in omega six, but they're also low in omega three. So they're high in mega six, three ratios I guess, is the best way than most other but it's also a legumes. It's not really a nut so to speak, but anyway, I just wanted speak of that. And then there was another question. Is there a test for omegas? Yes, there is. It's called an omega check. We'll be happy to order that and then help you interpret those results and what that means for you. Lots of good stuff there, but this is a good question.
Dr. Laurie Marbas
(31:22)
We'll move to another one for you guys. Osteoporosis and calcium supplementation. I don't smoke. I eat low sodium, no caffeine and I started weight training exercises. My local doctor wants me to take calcium one gram per day. Dr. Greg says that taking a calcium supplement does not indicate increased absorption and calcium supplement may increase heart attack risk. Absolutely. What do you think a plant milks that have calcium added to increase the total intake of calcium? Should I drink a simple plant milk or a calcium enhanced version? Any thoughts, suggestions there?
Dr. Kim Scheuer
(31:58)
So one thing I would ask, first of all, are you on a medicine that they're giving you for the osteoporosis where you have to get your calcium higher or not? That makes a difference, but you're going to get a lot of calcium from… Good, no medicines. Then you're going to get a lot of calciums from your foods and so one thing you could do, I mean, you can have some plant-based milks and that'll help supplement but I definitely don't necessarily say increase your calcium for that. Other people on that?
Dr. Laurie Marbas
(32:33)
Yeah. So I say test don't guess. So get out the chronometer, which is the more reliable app. You can do My Fitness Pal but they allow just regular consumers to put in things, so you're never really quite sure. But as far as making sure that your calcium intake on that [inaudible 00:32:48] you're put in your food for a period of weeks that you're normally doing and try to get that 1,200 milligrams per day. And if you're finding that your consistently low then yeah, I think the calcium enriched plant milks would be a great source, the calcium rich soy. Get the soy products in there at least two servings daily, great help with your bone density. Make sure your vitamin D intake is appropriate and you can add some K2 to that as well.
Dr. Laurie Marbas
(33:10)
So all those things will enhance calcium absorption but also bone building. But as long as you're not in medicines, like Kim said, that's a caveat where these medicines can be a big deal and you want to make sure your calcium levels are higher. And if you can't eat enough, like my tiny people, they're like I can't eat anymore, that may be where a very small supplementation is appropriate, but not always. Most of the time people get it in their diet just fine.
Dr. Chris Miller
(33:35)
And there was a study that came out a few years ago that they were looking at women who were supplementing with calcium and women who were taking higher amounts of calcium were having more heart attacks because the calcium from the supplements, the large doses were depositing in their blood vessels. And it looked like it was a cutoff the more than 500 milligrams at a time. Not a cutoff, but it's a gradual thing but that was an area like that, it's definitely dangerous. And that's when all the calcium supplements I think cut back and instead of giving it to everyone. It now it's dangerous to do that. So for people who do need a little bit extra calcium because you're just not getting enough or you need it for a medication to make sure you're taking it in like small amounts at a time, like two or 300 milligrams, I would not go higher than that. So if you need a little more ticket twice a day but spread it out, do not take 1,000 milligrams all at once. That's dangerous actually.
Dr. Laurie Marbas
(34:29)
It's surprising that your doc's doing it because that's just general consensus and practice regular medical practices at this point.
Dr. Chris Miller
(34:35)
[inaudible 00:34:35].
Dr. Laurie Marbas
(34:35)
Right. It's like literally family practice guidelines, general eight. That's just what you should be doing. So add another question-
Dr. Jeffrey Pierce
(34:43)
Can I-
Dr. Laurie Marbas
(34:43)
Yes.
Dr. Jeffrey Pierce
(34:43)
Can I say one more thing Marbas?
Dr. Laurie Marbas
(34:46)
Yeah.
Dr. Jeffrey Pierce
(34:46)
The calcium question's really interesting because the recommendations of how much calcium we should take in the US is at 1,000 to 1,200, but UK says 700 and WHO says 400 and 500. So I think we don't really have a full grasp on it. And so that ties into the fact that we're all very glad that you mentioned that you're working on exercise and that you're in and thinking about other things, because this is not as much as the dairy industry would like us to think about, just a deficiency of calcium. It is are we using our bones, which is really the most important part of preventing osteoporosis and trying to work with osteoporosis if you already have it. So getting outside the sun, weightbearing exercises and making sure that you do have calcium in your diet.
Dr. Laurie Marbas
(35:39)
And making your sufficient calories too because the protein, you can exercise them but you also need the nutrients to build your building, so to speak. So make sure you're eating enough of those protein rich foods, like your legumes and your whole grains. So many people, especially these are my thinner frailer, older women, and they're not eating a lot of calories, so try to focus in on those foods that either bigger bang for your bite, nutrient dense wise. So really think about that. Don't get me wrong. I love salad, but you don't have to have a pound of salad if that means you're not going to have room for your beans and your whole grains. So just want you to kind of be thinking about that in a thoughtful sense like, if I'm going to eat today, and I only have this much space, what should that be?
Dr. Laurie Marbas
(36:20)
And we had an RA question. Chris, I think you might help this lady. Jane asked, I have RA that is about 85 to 90% control through a combination of medication and the diet. She'd like to reduce in her medications but she says that when she eats regular food like pizza or does anything, she has no reaction. She wants to know what's the role of navigating that like reducing medication and knowing that she's actually being flared by food. So how is someone thinking about that when they're looking to maybe come off of those type meds?
Dr. Chris Miller
(36:57)
Mm-hmm (affirmative). Great question and good for you for wanting to do that and to get into this point. I would say, so you said it was 85 to 90% controlled. So I would want to know what that means. So obviously you're still having 10% of some sort of symptoms. So whatever your symptoms are, that's what you want to pay attention. And I usually don't really recommend reducing until that's under control, until your CRP is normal, your sed rate, these are your inflammatory markers. If you reduce too fast, it's going to flare back and it's going to be a nightmare. And I know from experience and from working with a lot of patients, that it's a nightmare. And so you definitely want to get that under control before you even think about cutting back. And so if you're still having 10% of flaring, you want to keep a food symptom journal and take a look at what days is it when you don't sleep well? Is it when you're stressed out on days you work? Is it something that you're eating and it's not necessarily food. There's other things that cause it too.
Dr. Chris Miller
(37:49)
So take a look at your lifestyle things and see if you can get it under control where between medications and lifestyle, you don't have any symptoms anymore and you're doing great. And at that point you'd want to cut back and then are looking for those symptoms. If symptoms return, then you need to either make quick lifestyle adjustments or you're cutting back too fast. And when you do cut back, you always want to go really super slow because your immune system can reflare, like it's being suppressed. It's sitting there ready to jump back out at you so you need to go slowly with it. And that's why we recommend doing it with doctor's help so that you don't get yourself in trouble with end organ damage or joint pains or something that you didn't mean to happen but now you have this inflammation, but hopefully you can get it under control and then you'll be ready to start coming back.
Dr. Laurie Marbas
(38:37)
Absolutely. And someone asks about tofu recommendations. What are you guys… Someone's asking, is tofu GMO? Which brands? Or where would you get these? What do you think? Go tofu.
Dr. Chris Miller
(38:50)
[inaudible 00:38:50] eat as long as hang on such a [inaudible 00:38:53].
Dr. Laurie Marbas
(38:53)
We're soy fans here.
Dr. Chris Miller
(38:56)
I know we like it. I recommend organic if you can or at least not snow, because soy is one thing that's known to be GMO. And it's better to not put that in your body if you can. So I recommend organic. I don't have a brand though. I buy it all over the place.
Dr. Laurie Marbas
(39:12)
Yeah. I would buy anything that's organic personally, but any-
Dr. Chris Miller
(39:15)
Jeff, you probably make your own. Do you make your own tofu or? You make everything else, so I don't know. Some people make it themselves. I never tasted homemade tofu.
Dr. Jeffrey Pierce
(39:24)
We've tried to grow soybeans and have generally failed pretty bad at it, but no. I'm a fan of tofu and tempeh and all those silly stuff for all those benefits with hormonal health and just the protein and that's part of it and all that stuff. It's great.
Dr. Kim Scheuer
(39:45)
It's a daily for me too.
Dr. Laurie Marbas
(39:46)
Sorry?
Dr. Kim Scheuer
(39:46)
It's a daily for me too. I love it.
Dr. Laurie Marbas
(39:47)
Oh, it's so good. One last question. I'm a 66 year old that is whole food plant based and has problems sleeping. I've eliminated all caffeine and no medication. What do you recommend for good sleep? Go for you guys.
Dr. Kim Scheuer
(40:05)
So there's a lot to recommend for good sleep. One thing I would suggest is maybe seeing one of us so we can go into really why you're not sleeping. When are you last eating? What are you eating for dinner? Are you not sleeping because you can't get to sleep? Are you waking up in the middle of the night and then can't get back to sleep? Is it stress? Are you worried? There's so many reasons that people can't sleep. Are you a coffee metabolizer or a caffeine metabolizer or do you have it at eight o'clock in the morning, but it's still in your system at 10 o'clock at night. There's lots of reasons. So definitely we can work on diet, we can work on behavioral things. There's some behavioral therapies we can talk to you about, but I'll leave it to others right now. For more specifics.
Dr. Chris Miller
(40:54)
I agree with that. There's a lot to it. And I think maybe the basic recommend start with your sleep hygiene. So take a look at all your habits. Are you relaxing? Are you turning off blue lights for at least an hour before bed? Are you doing mind body work? Meditation and yoga have been shown to help people sleep better. Exercise, being out in the sunlight during the day, not having stressful conversations a little right before bed, things that you're ruminating on or worrying you. So those are basic sleep hygiene and we go over it with every patient that we see and so they get a handout on a little information on that. But so you start with that. And then from there, that's where you'd want to be talking to someone because there is a lot more to it than just that.
Dr. Chris Miller
(41:39)
So that's enough to help a lot of people I think really improve their sleep, is sleep hygiene alone. So that's a great starting point, but then you want to look at other things that could be going on keeping you awake or waking you up or more specifics. And that's where you start talking about cognitive behavior therapy or there's a lot more you can do if you're still not sleeping well and you want to make sure you don't have a sleep disorder like restless legs or sleep apnea or getting hypoxic at night. And now they have all those sleep rings and watches and things that you can wear at home that can give you a better sense of it too. So there's a lot of information you can collect as well that can help you. So it's complicated, but yeah, it's great when you… it's important to work on to get to good sleep.
Dr. Laurie Marbas
(42:21)
Yeah. Okay. I have some recommendations for everyone. So first of all, I would like you to check out the Huberman Lab Podcast episode two. Fantastic overall. In depth, this is from Andrew Huberman. He's a neuroscientist at Stanford, has some really cool stuff and if you go to his… Google just go to Huberman lab and sleep toolkit. He has this nice little summary of some things that he's seen in the literature and some of the interviews and stuff that he's doing. That's really cool. So a couple of things that he's been mentioning here is basically view sunlight by going outside within 30 to 60 minutes of waking, do it again in the late afternoon prior to sunset. And what that's doing is it's basically getting your circadian rhythm in check. You wake up, you see light, you're like, oh, let's get things moving. And that's when the clock starts going often saying that in about 14, 16 hours, I'm going to be ready to go to sleep.
Dr. Laurie Marbas
(43:18)
And then as the sun is setting, we have receptors in our eyes that are seeing that angle of the sun and also what we call luxe, where there's intensity of the light where our bodies are like, okay, it's getting time to go to bed. If you're inside, keep the floor lamps and again, it's that the inflection of the angle of the light into the eyes, which is really interesting. Wake up at the same time each day and go to sleep when you first feel sleepy. Pushing through this late evening, feeling sleepy, you may be too late and that may be why you're waking up early in the morning.
Dr. Laurie Marbas
(43:55)
They're saying, if you have sleep disturbances, insomnia, or anxiety about sleep, they're recommending the tool called Reveri. It's a sleep hypnosis app which I've been working with. It's really interesting. Definitely, think about using it because I know sometimes I'll wake up in the middle of the night, I'm pretty good at that actually. And I just going through the sleep hypnosis and I'm actually falling back asleep. Don't open your phone. Don't look at the bright lights because you want to avoid the lights between 10:00 PM and 4:00 AM because that sets and turns off your sleeping. The light is so key here. Like Chris was saying, it's like, oh it's time to wake up. Well, you're messed up for the rest of the day. And that's what they're saying here. Limit daytime naps to 90 minutes or no nap at all. Most people want to… If you're going to do a nap between like one to three or somewhere in that timeframe.
Dr. Laurie Marbas
(44:49)
He also mentions a scene called the NSDR, which is basically, it's a non sleep deep rest. There's some really interesting, you can Google it if you like and I'm sure there's stuff on YouTube. Yoga Ninja is one. You can get it on YouTube. It's not a yoga, but it's a self meditation type thing. And then before bed, he mentions some supplementation. If you choose to do that and then he says taking a hot shower 90 minutes before bed can be helpful because that sets off your internal mechanism of cooling, which your body wants to be cooling down. As you go into bed, that may help. Avoid alcohol. And then sometimes, we just need adjust our sleep. So we may be used to sleeping at a certain time. And other times later in life, again, I don't sleep like I did as a teenager now that I'm in my 50s. That's like half in it.
Dr. Laurie Marbas
(45:43)
But those are some really cool… Those are just a few of the things he mentioned. I mean, there's so much more, but really check it out. If you like the deep dive into the science, I would subscribe to his podcast. It's really good. So he's fascinating. All right. I think we're at our 45 minute mark. Any final things you guys would like to say? Good. All right now. And someone did mention finished digesting. So yes, I would make your last meal at least two to three hours before you go to bed. Absolutely. Okay. Well thanks everyone. Thanks Dr. Scheuer, Dr. Miller, Dr. Pierce. We are going to be back next Thursday. Same place, different time, different day at 11:30 Mountain Time. And I'm going to let y'all figure out where that is according to your locale, but that'll be my time.
Dr. Chris Miller
(46:32)
It will be at 12:30.
Dr. Laurie Marbas
(46:34)
So 12:30. I'm sorry, my bad. 12:30 Mountain Time on Thursdays, 11:30 on Fridays Mountain Time. Thanks Chris. All right, guys. Thanks again. Thanks everyone for joining us.
Dr. Chris Miller
(46:45)
[inaudible 00:46:45] thank you guys.
Dr. Laurie Marbas
(46:46)
You have a great one. Bye.
Dr. Chris Miller
(46:48)
Thanks.
*Recorded on 2.18.22