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#103 – Can you go paleo as a vegetarian, the three phases of autoimmune protocol, and what’s the best thyroid medication to take? With Dr. Sarah Ballantyne!

Welcome to another episode of the Waist Away podcast! In this episode we have a special guest. Dr. Sarah Ballantyne is an expert on the paleo lifestyle. She is the creator of the award-winning blog The Paleo Mom, the co-host of the top-rated podcast, The Paleo View, as well as a New York Times Bestselling author of four books. We’re so excited to have her on the show this week!

video version: https://youtu.be/yDYtZ56r0GM

Dr. Sarah’s website: https://www.thepaleomom.com/

The Paleo View podcast: https://podcasts.apple.com/us/podcast/the-paleo-view/id553710453

Chantel:            Hey, guys. Welcome to this week’s episode and I’m so excited. We have Sarah Valentine from The Paleo Mom. I’m so happy you’re with us. Welcome.

Sarah:               Oh, thank you so much for having me.

Chantel:            Talk to us a little bit about your journey, and what brought you to creating thePaleomom.com.

Sarah:               My journey is this confluence of being a really sick person. I eventually found out that I have four autoimmune conditions, but as I was going through it, those were the last things to get diagnosed. I was diagnosed with irritable bowl syndrome, asthma, allergies, and migraines. The symptoms each got a diagnosis, rather than the root-cause, which I now know is Hashimoto’s thyroiditis and fibromyalgia, and two autoimmune skin conditions. It was those things that were driving all of my symptoms.

Sarah:               I had that piece of just struggling through day to day life, being in constant pain, having really low energy levels because Hashimoto’s has some interesting depression, anxiety, as symptoms and I definitely experienced those. I pretty much could check the whole list of Hashi symptoms from the time I was 10 on, but wasn’t diagnosed until my late 30s. Awesome.

Sarah:               It was that experience with … I was a medical researcher, so I got a PhD in Medical Biophysics. I am a very hardworking ambitious person. Workaholic would be a fair term to use, and I’ve always been that way. I’ve always been the kind of person who wishes through discomfort and gets very singularly focused on a goal.

Sarah:               I finished a PhD in Medical Biophysics at the age of 26, and did postdoctoral research for four years, before I had my first daughter, which was amazing except she didn’t sleep and had colic. It was this extra little spice into the soup of my daily struggles that meant now I just can’t do it, it’s too much.

Sarah:               I ended up decided to take time off of my research career. At the time, my excuses were I’m going to focus on being a parent. My mom was a stay at home mom and it was so great. I gave myself all of those talking points, but really I recognized from a very deep level, I couldn’t balance it anymore. But that was one of the best things I ever did because that space beyond helping me just survive early parenthood, which is a struggle no matter what you have on your plate, it gave me that space to start working on my own health.

Sarah:               The first thing I did was lose a little over 100 pounds on a low-carb diet, which I was borderline type 2 diabetic at the time, I had metabolic syndrome, so I had a lot of health issues associated with obesity, later discovering, obesity was governed by hypothyroidism, but I didn’t know it at the time. It was a weird thing to lose weight, and get less and less healthy. This was an experience that … It was the frustration of that, that actually brought me to the Paleo diet, the autoimmune protocol because my skin got insane.

Sarah:               My two autoimmune skin conditions were instead of being a few spots on my wrist, a few spot on my ankles, was most of my body. I was having such bad GI symptoms, such bad migraines. Everything just felt like I was falling apart, I had really intense joint pain on a daily level. I had this whole …

Sarah:               I think when you’re overweight, there’s something about that experience where you’re wearing this sign that says, “I’m not healthy.” There’s this deep really personal effect of that struggle that really challenges your sense of self-worth and self-esteem. I had all of those emotional struggles wrapped up with weight. I really very naively thought that, “If I could just lose that weight and get to a healthy weight, my life would be magic, sunshine and rainbows,” and it didn’t. It actually was worse. I was more uncomfortable, and my skin conditions was still wearing that sign on my skin instead of [inaudible 00:04:41].

Chantel:            But your skin is beautiful. I’m looking at you now. If you’re just listening to this podcast, you can always watch it on our YouTube channel as well. Check that out because you could see how beautiful her skin is. She’s glowing.

Sarah:               There you go. That’s a testament to healthy diet and lifestyle.

Sarah:               But it was that frustration that had me seek deeper for answers. It really became the first time in my life where I actually applied my scientific background and my medical research experience to the problem of my own health. I finally went, “Oh. Yo, I know a lot of stuff. I could probably use that.”

Sarah:               But that really, it not only helped me find the answers for my own health, but it has really formed the basis now of everything that I do because part of finding my own health was finding this different [foreign language 00:05:38], this different reason to live my life, which was to help other people find that information because I struggled with my health for 25 years before I started finding those answers. It would have completely changed the structure of my life to have that information 10, 15, 20, 25 years earlier.

Sarah:               I really see it as my privilege that I get to educate people and keep this education really rooted in science because I, as a scientist, value scientific evidence at an extremely high level. I keep everything that I do rooted in scientific evidence and try to give people that broad education about diet and lifestyle choices to empower them to make better choices, but also to give them the information they need to troubleshoot, and refine, and individualize for their own challenges.

Chantel:            I think a lot of people who are listening on this podcast now really understand what the Paleo diet is. But I wanted you to talk about how the autoimmune protocol is different from the Paleo diet, and how those two are different.

Sarah:               My view of the Paleo diet is maybe a little bit different than what other people may have heard. A really common explanation of Paleo is eating the way our Paleolithic ancestors ate, eating the way we are genetically adapted to eat. I take a very modern scientific approach. It’s really about understanding the nutritional needs of the human body, so what nutrients do and how much of those nutrients we need, and what foods have those nutrients.

Sarah:               Then understanding what compounds in foods can potentially undermine health by interfering with gut health, or immune health, or hormone systems. Basically taking foods and putting them on a scale. How much good stuff is in this food and how much bad stuff is in this food? A food that is an obvious, like tons of good stuff, nutrients and not very much bad stuff is a win. That’s a yes food. A food that doesn’t have much nutrients to offer, and potentially a high amount of problematic compounds is a no food.

Sarah:               That’s how I view both Paleo and the AIP. The difference is where you draw the cutoff. There’s all of these foods in between that have some compelling nutrition, but also a higher level of problematic foods. If you are a robust healthy person, you don’t have autoimmune disease risk genes, you’re going to be able to tolerate more potentially problematic compounds for the sake of those nutrients than somebody who has those health challenges, who has an immune system that’s already very easily triggered by environmental exposures.

Sarah:               If you’re someone with autoimmune disease, you’re just more sensitive. It’s just the differences where we make that cutoff in terms of whether or not hat food is a yes food or a no food.

Chantel:            I love that. One of the things I talk about in my book is that you don’t want to deprive yourself because when you deprive yourself, that’s just a recipe for gaining weight because you’re like, “Oh my gosh, I can’t have this.” But there’s a difference.

Chantel:            I have a little section in my book called … I have the second edition of my book coming out. What I talk about is called don’t deprive, but you still want discernment. It’s called discernment, not deprivation.

Chantel:            For me, if I want a cookie, if I know that if I eat this gluten cookie that’s got tons of chemicals in it, I’m going to feel terrible. But if I want a cookie, make a Paleo cookie that maybe has almond flour in it, or whatever, I’m going to eat that cookie, I’m going to satisfy my craving of the cookie, but also feel like a million bucks. That’s discernment.

Chantel:            Now I’m not depriving myself because I’m still having that cookie, but I also know that for my body, how do I feel after I eat this.

Sarah:               I love that because I think that a lot of people come into Paleo or the AIP from this challenge mentality. We’re going to do a three-week, or a 30-day challenge, and I’m going to force myself. We’re muscling it through. That’s diet mentality, that’s the lose 10 pounds to get into the dress for the wedding type mentality. That doesn’t help us be healthy.

Sarah:               I really see Paleo and the autoimmune protocol as tools for lifelong health. Of course, it doesn’t help you be healthy for the rest of your life if you don’t follow it. A huge part of I think both of those templates is addressing human nature, sustainability. Recognizing that we like to celebrate with food, we like to nurture our social bonds with food, we like to nurture ourselves with food. Allowing space for that I think is really important while also addressing behavioral challenges around food, while addressing addiction around food.

Sarah:               As somebody who comes from a history of food addiction and binge eating disorder, it really resonate with me of trying to nurture that piece of me that really needs to feel loved with flavor, and allowing that space to exist, but not allowing it space to be dysfunctional and detrimental to my mental health.

Chantel:            That’s great. I love your website. It has so many amazing things, but one of the things I saw that you talked about on your website was called three phases to AIP. Can you talk about that?

Sarah:               The autoimmune protocol is really designed to be a self-discovery process. It eliminates the foods that are most likely to be problematic for autoimmune disease, floods the body with nutrients and it incorporates a lifestyle focus as well, so it’s a very holistic approach. But the idea is that it’s not supposed to be a life sentence. The idea is that we get to heal, but then we also get to understand our own body’s thresholds, our own body’s triggers because there are foods that are going to work for some people and not work for others. If we just cut them all out, well maybe that food works really well for you. You’re missing out. It’s not about deprivations.

Sarah:               Part of the process of the autoimmune protocol is something called the reintroduction phase. The elimination phase is go all-in strict, it’s designed to maximize healing. The reintroduction phase is designed to test your tolerance to foods that are eliminated, and really learn about your body. Then there’s a maintenance phase. What happens is as you’ve gone through the reintroduction phase, you get to a point where you have learned what your body tolerates and what it doesn’t, and hopefully also what it tolerates in different situations.

Sarah:               When you’re stressed, your tolerance for suboptimal foods typically goes down because your stress response magnifies an immune response to a trigger. Understanding that give and take, “Okay, I’m stressed or I’m fighting off a cold. I need to be a little more discerning with my diet right now,” versus, “Hey. I’ve been getting enough sleep, I’m feeling really great, I’ve been moving a lot. I can indulge now.” Really understanding our own bodies is such a critical part of the process.

Sarah:               Once you get there, you end up at something that is usually somewhere between Paleo and autoimmune protocol. It might include some foods that are not even traditionally considered Paleo. The autoimmune protocol makes room for reintroducing foods like lentils, or gluten-free grains. It really is about respecting bio-individuality, and respecting that the best diet for each of us is potentially going to look a little bit different, and so giving us a protocol for discovering what that is.

Chantel:            Great. Walk me through. I ask everybody, what do you eat, breakfast, lunch and dinner? What does a day in the life of Sarah look like? Talk to us about yesterday, what did you eat breakfast, lunch and dinner?

Sarah:               Four days a week I start off my day at the gym, and I don’t like to eat before I go to the gym. I do pretty hard workouts, so I tend to get quite nauseous if I’ve got food in my stomach. I’m at the gym early enough that I can’t get up early enough to have a good two hours to digest before I’m there.

Sarah:               I usually have coffee before I go, and I blend collagen peptides, goat milk ghee and some mushroom powders into my coffee in the morning. It is a coffee with some heft to it.

Chantel:            Let me ask you, when you do your ghee, you do find if you have goat milk ghee versus cow’s milk ghee, is that right? Your body …

Sarah:               That’s correct. That is something that I discovered about myself through reintroductions, that I’m incredibly sensitive to cow’s dairy products. I don’t do well with goat proteins, so like goat cheese I don’t do well with, but goat milk fat that is … Ghee is virtually protein-free, not quite. It’s 99.7-ish percent fat, so there is that 0.3% that is protein. But I have discovered that goat milk ghee, it works really well for me, and I really like the flavor in my coffee.

Sarah:               I remember the first I had it thinking it tasted really strange, then by the time I was done the cup I was like, “Yes, strange good. This stuff’s awesome.”

Chantel:            I have a lot of people who say they do great on goat’s, like goat cheese, but they can’t have regular cheese. Have you heard that, a lot of people they’re fine with goat’s cheese?

Sarah:               Yeah, and the reason actually is in the structure of the casing molecule. Goat is what’s called A2 dairy, which refers to beta-casein. It’s just a slightly different structure than what most cow’s milk is A1. A1 we know is not as good for the gut microbiome, it’s potentially inflammatory. There’s some links even maybe with cardiovascular disease risk, but it’s also much higher in allergenicity, so it can create allergens to dairy much more easily.

Sarah:               That’s why a lot of people who can’t do cow’s milk, can do goat, or sheep, or camel, or donkey, and it’s because the casein molecule is slightly different. A2 casein is linked with a better gut microbiome, it’s linked with reduced inflammation. It does see to have a very different health profile than A1.

Chantel:            How do you feel? Do you say, “Hey, every once in a while I’ll do goat’s cheese”? Or do you just say, “No, I don’t do it at all”?

Sarah:               It’s a no-go for me. For me, different foods cause different triggers, or different symptoms, and different lengths of time. For example, my reaction to gluten cross-contamination is typically six to eight hours delayed, but then I am violently ill. It’s like food poisoning. Both sides, it’s awful. It’s three, four days before I can eat again. It’s really intense. Dairy, if I was to have cow’s dairy, I get a crippling migraine within about 10 to 15 minutes. It’s a different length of time and different symptom.

Sarah:               With tomatoes, peppers, I get joint pain. Feels like someone threw shards of glass in between all the small bones in my feet and hands. I have and that’s usually I wake up the next morning with that. That will last three to four weeks

Sarah:               I’ve had it one time where I was given something that I had the whole conversation, “Okay but I can’t do nightshades, so there’s no red pepper, cayenne, paprika.” I went through the whole list because I’m a very informed consumer of food and, “Mope, nope. None of those things. None of those things.” I put it in my mouth and it was instantly incredibly spicy.

Sarah:               This was at a conference. I spat it out and I said, “Why is it so spicy?” It was like, “Oh well it has chilies.” So I said, “I said chili pepper.” “Oh.” It was one of the most frustrating experience because I felt like I had been advocating for myself and was still undermined with poor information, that I had joint pain after that. I didn’t even swallow the mouth full, and I had joint pain for about three months after that. It really triggered a full autoimmune flare.

Sarah:               For me, those are foods that are never a go because there’s never a convenient time to have … There’s no amount of ice cream that is worth a migraine. It’s never an okay trade. There’s no amount of baguette or croissant that is worth being on the toilet all night for a couple of days. For me, that cost-benefit analysis is really, really obvious.

Sarah:               I have other foods that I will eat in a restaurant. I can do a little bit of potato. That’s the only nightshade I can do. If it’s once in a while, I’ll be fine. But if I started to have it more, like a couple times a week, then I would start to notice joint pain. Those I call them slow-build reactions, are some of the harder ones for people with autoimmune disease to identity, especially when it’s a food we really want to work. I really like potatoes. That’s really want to have those in my life. To be able to admit that if I have them more than once a week, I really notice the effects was challenging for me just on an emotional level.

Sarah:               I’ve been doing this for eight years now, so I have had foods that didn’t use to work for me, and I’ve healed enough now that I’ve been able to completely reintroduce them. Eggs, for example, used to give me really bad acne. Now I’m able to eat eggs with no effects whatsoever.

Sarah:               There is part of this that is identifying foods that are problematic, and understanding how they’re problematic, and what quantities they’re problematic, and what frequency they’re problematic. But then also recognizing that doesn’t mean you can’t test it again down the road, if it is going to be a problem food for us, because there’s a lot of the reaction to foods that is reliant on immune regulation and gut health in general.

Sarah:               As we do continue to heal, and dial in things like nutrient density and all the lifestyle factors, that can actually reduce the reaction to [inaudible 00:20:47] to some of these foods.

Chantel:            Let’s talk a little bit more about the difference between the Paleo and the AIP diet. Let’s talk about some of those differences of exact things. For example, on the Paleo diet, someone would say, “Eggs are fine.” Eggs would be out on the AIP diet, but what I’m hearing you say is now you’ve tested eggs, and you do fine with eggs now.

Sarah:               Right. Eggs would be eliminated during the elimination phase of the AIP. There are actually, especially egg yolks are an early reintroduction. The problematic compounds in the eggs are in the egg whites. It’s a compound called lysozyme, and it’s just very good at getting into our blood stream, but it also binds with other proteins inside the gut, especially bacterial cell wall proteins, which can be inflammatory. It acts a little bit like a little backpack and it’s like, “Hey, everyone. Hop on, we’re going into the body.” That, if you have immune system that is already overstimulated, that addition of bacterial cell wall proteins, they’re inflammatory, and so they can drive inflammation even higher.

Sarah:               This happens in all of us. The difference is, if you have a healthy gut, and a well regulated immune system, you can handle a little bit of inflammatory stimulus without it driving immune activity into overdrive. If you have autoimmune disease, you just can’t.

Sarah:               That substance is problematic in the whites, not the yolks. Yolks are … Whole eggs are eliminated because yolks have a fairly high allergy rate, and it’s also quite challenging to isolate the yolk 100% from the white. But egg yolks are a very early reintroduction because they’re incredibly nutrient-dense. They’re some of our best sources of some B vitamins.

Sarah:               All of the early reintroductions, the things that I would encourage people to try first are all the things that have the most nutrients to offer us, and the lowest probability of being problematic. Then we build up the risk scale.

Chantel:            Tell us, so before you eliminated eggs in the beginning, did you feel like there was something in the eggs that when you ate an egg before you were like, “Mm, I don’t feel great”? Did you have a reaction? Or [inaudible 00:23:10] you reintroduced it?

Sarah:               Yeah, so even I would say, even when I went Paleo before the autoimmune protocol, I had no idea that these foods were so problematic for me. It wasn’t like I felt crummy every time I ate bread. But I wasn’t healthy.

Sarah:               I didn’t have timed reactions to when I ate. I had migraines a few times a week, but there was never any obviously, “Of course I did, because I just had cheese.” None of that was something that I could identify. It was likely because everything was so revved up that when your immune system is so overstimulated like that, you end up losing that one-to-one correspondence. It starts to become much more stochastic, much more just random and a little bit unpredictable. I didn’t know that those foods were so problematic until I cut them out and then ate them.

Sarah:               Gluten, I never ate intentionally. The first time I was exposed to gluten, I never challenged it. Instead, I accidentally consumed it, and then got incredibly ill.

Sarah:               I think that’s really common. I think people will follow a Paleo diet, or autoimmune protocol, they’ll go to challenge something and they’ll have this really exaggerated reaction compared to how they felt before. The very common interpretation of that is like, “Uh, Paleo made me gluten intolerant.” You hear that fairly frequently. That’s not actually the case. It uncovers an intolerance that’s already there.

Sarah:               This is why allergists use elimination and challenge diets as a diagnostic tool is actually the gold standard for identifying food sensitivities and food allergies, better than skin prick tests, or blood tests. It is the gold standard. A good allergist will always confirm other testing results with an elimination challenge. The reason is, our immune systems have thee two different sides.

Sarah:               We have all of these cells that are responsible for the reaction. There are the cells that attack a virus, or that kil a cell that’s infected, or also that create antibodies that drive an allergic reaction or a food intolerance. Then we have these other cells whose job it is to constrain the whole system. They’re the ones who once you’ve defeated that flu virus, turn off the immune system. Otherwise, you get sick once, you have systemic inflammation for the rest of your life. They are the ones who literally just keep the roof on the house. When it comes to food allergies and food intolerance, the cells that restrain the system die off faster than the cells that are responsible for the reaction.

Sarah:               When you do an elimination diet, you cut that food out for it’s typically two to four weeks is what an allergist would do, with the autoimmune protocol, it would be say one to three moths before you try any reintroductions. You hit that window where you still have those cells that drive the reaction, but not as many that help constrain the system. So you do actually react in a more magnified way, but in a way that is uncovering the reaction that was always there, rather than in a way that created that reaction from scratch.

Sarah:               It is a really powerful tool because it makes it very clear that food was not doing us any favors beforehand. It makes it very, very hard to ignore that data.

Chantel:            Gotcha. For you, I heard you talk about potatoes. How do you do with sweet potatoes? White potatoes you don’t do well, but sweet potatoes you do fine?

Sarah:               Yeah, it’s a completely different family of vegetable. Sweet potatoes are not eliminated on the autoimmune protocol. The autoimmune protocol is not low-carb. I would argue that Paleo is not low-carb, I would argue that it’s moderate-carb. Whole food sources of carb, healthy carbohydrates, but it’s not low-carb, it’s not low-fat, it’s not low-protein and it’s not high any of those things either. It’s very balanced macronutrients.

Sarah:               Sweet potatoes are a gut microbiome super food. Our gut bacteria loves sweet potatoes. Those slow burning carbohydrates are really, really good for hormone regulation, for improving sleep quality. Things like sweet potatoes, cassava root, winter squash, green plantains, technically a fruit but tastes like a starchy vegetable, those things are basically a food group on the autoimmune protocol.

Chantel:            Nightshade vegetables, for people who don’t know, are tomatoes, eggplants, peppers and white potatoes. What do they do for people? When someone says, “Okay, I don’t do well on a nightshade vegetable,” what happens to you when you eat them, and what do you see other people? What are the common symptoms they get?

Sarah:               I think symptoms of autoimmune disease vary. There are some commonalities. For example, fatigue, and either joint and muscle pain are extremely common autoimmune disease symptoms, and those are definitely my earliest symptoms when I’m having a reaction to a food, But a symptom could be basically any symptom of your disease, or any GI symptom, or any skin symptom, or any neurological symptom. So like a headache, mood issues, trouble sleeping would fall under that banner.

Sarah:               I would say in the people that I interact with, joint pain is a really, really common symptom for nightshades in particular. But also that’s just a really common autoimmune symptom, or a symptom of high levels of inflammation. I’m not sure that it speaks to nightshades specifically, so much as it speaks to their inflammatory capacity.

Sarah:               Nightshades are really interesting because they are definitely one oft those 50-50 foods. They have some really compelling nutrients. We all talk about, but the lycopene in tomatoes, they’re really nutrient dense. They’ve got lots of especially B vitamins. Really great nutrient value while also having several compounds that are inflammatory. So they have glycoalkaloids, which drive … They basically drive immune activity, they’re also not very good for gut health. They also have lectins. Specifically a subclass of lectins called glutenins, which act as adjuvants, which is anything that ramps up the immune system.

Sarah:               There’s actually two compounds in tomatoes that have been investigated in the research for use in vaccines for driving immune activity because the way the vaccine works is dead polio virus, because we don’t want to give you real polio, that defeats the whole purpose, along with some kind of compound to make sure that your body produces antibodies against this dead virus. That’s that compound that drives the immune system is called an adjuvant.

Sarah:               Both tomato lectin, which is in the glutenin, and alpha-tomatine, which is in tomatoes, have been investigated and shown to be pretty good adjuvants. They haven’t been added to vaccines, but I think that data to me is a very, very strong reinforcer that these are compounds that if you have an immune system that is easily triggered, are going to be really, really problematic.

Sarah:               If you have an immune system that’s accidentally learned how to attack your own body, that means every time you consume those foods, you’re going to be driving antibody production of whatever is going on in your body at the time. For me, with Hashimoto’s thyroiditis, that means my immune system always has the capacity to create antibodies against my thyroid. Anytime I eat those, that is something I can expect to happen.

Chantel:            Now are you taking any kind of thyroid medication yourself right now?

Sarah:               Yes. I think it’s really important to emphasize that the autoimmune protocol is not a substitute for conventional medicine. Ideally, it’s most compatible with a functional medicine or integrative medicine approach, but it is a complementary approach. So it is diet and lifestyle that can be used hand in hand with judicious and informed use of conventional interventions, and the goal isn’t always drug-free.

Sarah:               Ideally you’d be able to get off of any disease modifying drugs. Those increase life long risk of cancer. They’re not awesome. You’d be able to get off any pain medications, so NSAIDs are not great for our gut health. You’d ideally be able to get off of those, and off of any steroids. Ideally you’d be able to get off of those things.

Sarah:               But for me, my symptoms started when I was 10. I was diagnosed when I was 37, I think 37. I’m terrible at keeping track of time. I had 27-ish years of my immune system attacking my thyroid gland before I really understood what was going on. For me to expect that my thyroid gland could ever achieve full function, that it doesn’t have permanent damage to it is an unrealistic expectation. Given that also thyroid hormones help regulate the immune system, it was one of the most important things that I learned through my healing journey was that I actually do have Hashimoto’s thyroiditis because the addition of thyroid hormone to my regimen actually really accelerated my healing.

Sarah:               I think there’s plenty of cases of people being able to reduce their medication, there’s the occasional case of people being able to go off, but I think it’s important to emphasize that there is no true cure for autoimmune disease. So diet and lifestyle can put disease into remission, but once the body’s learnt the ability to attack itself, it never actually forgets. It could be triggered by a stressful event, a death in the family or something like that, it could be triggered by an infection, it could be triggered by going out and partying late one night. It [inaudible 00:33:00] always going to underlie decisions for the rest of our lives.

Sarah:               Medication-free isn’t always the right goal, especially medications that support hormone systems that have been damaged. If you were a type 1 diabetic, that’s the immune system attacking the pancreas, the chances of getting full pancreatic function back are relatively low. Anecdotally, there’s examples of this out there, but I would say that’s the exception, not the rule. The chances of you continuing to need insulin, at least at some level, are really high. That’s not a failure. That doesn’t mean that you didn’t AIP hard enough. It is the reality of the situation of there’s internal scarring. Our organs have been attacked by our immune systems for at least some period of time before we got diagnosed, and before we figured out this complementary approach to healing. It’s not always possible to regenerate an organ to the level of normal function.

Chantel:            Can you tell us, will you share with us what kind of thyroid medicine you’re on and what dosage you are on personally?

Sarah:               Yes and no. I make point of not sharing the supplements and medications that I’m on because I work with a functional medicine specialist, and I understand the desire to if that works for someone else, it must work for me. I really want to discourage people from taking a pill without medical supervision. I really want to encourage people to work with a functional medicine specialist.

Sarah:               I will tell you that I went through four formulations of thyroid meds before I found one that worked for me. It was about a four year process of inching up the dose, giving up, going to another formulation, you always have to pull back, inching up the dose, testing every four to six weeks, making a change. I did that with my functional medicine specialist. That was really fantastic because I take something that is now uniquely formulated by a compounding pharmacy for me.

Sarah:               That is one of the reasons why working with a functional medicine specialist is generally superior than working with a conventional endocrinologist for this because they will take the time to do that high-level of tinkering.

Chantel:            Now let me ask you, are there any foods that you feel like … I’ll give you an example for me. For the AIP diet, or for the Paleo diet, they say try to eliminate grains such as quinoa, or legumes such as green beans. There’s two foods that I can eat, that I just feel like I have no inflammation, I feel like a million bucks. One of them for me is quinoa. I can eat quinoa all day long, and I feel like a million bucks. I can eat green beans, and I don’t have any inflammation, and I feel like a million bucks. Are there any foods like that for you that you say, “Hey, I know that in general this diet says this causes inflammation,” but for you personally, it doesn’t?

Sarah:               Yeah. There’s a few actually.

Chantel:            Okay, will you share those?

Sarah:               Yeah. Yes, this I will share. Everyone who follows Paleo diet and is really fanatical about it, close your ears right now because this is going to be hearsay.

Sarah:               I do great on corn. It’s a grain. I only buy heirloom corn, organic, so that may be why, and I still avoid things like corn syrup, but I can do … I make homemade popcorn, or corn on the cob, and my whole family does well on corn. That’s become not a foundational food, but I would say regular treat food in our house.

Sarah:               I do well on white rice. I always cook it in broth, which increases the nutrient value, and I always eat leftover life. Rice in one of those foods that cooking it and then cooling it increases the resistance starch content of it, which lowers the glycemic index, but it’s also a really great food for our gut microbiome. It’s a food that has much more compelling value after being cooked and cooled. Also, I’ll make rice, if I know I want it for dinner, I’ll make it in the morning and stick it in fridge, and then we’ll have it reheated for dinner.

Sarah:               I’ve been playing with … I’m working on a new book on the gut microbiome, and I’m not bringing any dietary template into that book. I’m really looking at what does the research say about our gut bacteria love and what they don’t love, and I’m trying to basically build an optimal diet from the ground up, from the perspective of the gut microbiome.

Sarah:               There are some other foods that I’ve started playing with, and I’m still in this evaluation process. I think it seems to be going well, but I’m not ready to be like, “Yes, this food is awesome for me,” but I’ve playing with gluten-free oats and with lentils as foods that are really great for our gut bacteria, traditionally would not be considered Paleo or AIP. I would put it on the AIP reintroduction list, for sure, but certainly not these are foods that do have a higher capacity to drive inflammation for a lot of people, so it will never get added to the elimination phase.

Sarah:               Those have foods that have been really compelling for me to play with because our gut bacteria basically control everything about our bodies. They’re highly involved in autoimmune disease activity, but also cancer, and cardiovascular disease, and obesity, and diabetes, and chronic kidney disease, and mental health challenges. They control just about every process going on in every cell. That’s been really interesting to me, to play with those.

Sarah:               I would say actually, what’s been really fun about writing this book I probably will be able to wrap up this fall, is that as you go through all this information, you basically end up at a Paleo plus type diet, and that …

Chantel:            Ooh, I like that.

Sarah:               Rice, gluten-free oats, lentils, peas and garbanzo beans.

Chantel:            I love that, Paleo plus. That’s great.

Chantel:            I think the key is for people to ask the question, “How do I feel when I eat this food?” It’s not that I’m following Paleo or following AIP. Really making it your own and saying, “How does my body respond when I eat this, and how do I feel?” But not only that, the key is the amount.

Chantel:            It’s there is certain foods, if I only eat a small amount of it, goat cheese is a perfect example for me. When I eat goat cheese, if I eat a small amount of it, I feel okay. If I start eating too much of it, I start not feeling good. There’s certain things that your body can tolerate in small doses, but when you start overeating on that particular food, that’s when you go, “Oh great, my body is not responded.” But there’s some things where you go, “Hey, I’m not going to deprive myself because eating small amounts of it, my body somehow processes it and it’s fine.”

Sarah:               I think part of that has to do with not just the amount of food, but what that food’s displacing. Sometimes, it’s not about …

Sarah:               A healthy diet is not about what you eliminate. That’s not what makes a diet healthy, or not healthy, it’s what you actually eat that makes the diet healthy. I would argue that there’s universal truths about a healthy diet, and that there’s a variety of different ways to implement those universal truths so that they describe the healthy diet.

Sarah:               I would argue the most important thing about a diet is nutrient sufficiency, so we’re actually getting all of the nutrients that our bodies need for all of the chemical reactions that are happening in every cell, in every moment. You can formulate a nutrient-sufficient diet in a variety of different ways.

Sarah:               There’s different ways that you can put these foods together, and there’s even ways that you could implement Paleo or AIP that wouldn’t reach nutrient sufficiency. That’s one of the reasons why nutrient sufficiency, nutrient density is part of all of my educational resources because I think it’s really fundamental.

Sarah:               When we overdo one food, and it starts to make us not feel well, it’s often because we’re eating that food to the exclusion of something else that our body really needs. Sometimes it’s not just about the volume of that particular thing, but about the overall balance in our diets.

Chantel:            That’s great. Well we’re about out of time. I’m only going to ask you one of our listener questions, we’re going to ask the rest of them at another time. But this is from Mimi in Boulder. It says, “I’ve been a vegetarian for 15 years. Is it possible to also go Paleo as a vegetarian?”

Sarah:               Okay, so I think there’s two different interpretations of Mimi’s question. One is, can I transition to a Paleo diet as a vegetarian? The answer for that is an easy yes. The Paleo community is full of what people refer to as reformed vegans and reformed vegetarians. The big challenge there is when you’re vegetarian or vegan for a long time, is you actually downregulate your stomach acids, so you don’t need as much stomach acid to digest plant foods as you do to digest animal foods. That is why if you’ve vegetarian or vegan for a long time, and you eat animal foods, it can feel really heavy in your stomach like it’s hard to digest.

Sarah:               A really good tool for transition, checking with a healthcare provider before you take anything in pill form, so take digestive support supplements to help go through that process. Also, note that fish is much easier to digest than other animal foods, so that can also be a really good bridge food from vegetarian or vegan to Paleo.

Sarah:               The other interpretation of that question though is, can I do vegetarian Paleo? When I talk with people who want to be vegetarian for moral and ethical reasons, there’s a broader conversation to have about humane treatment of animals, sustainability, and the environmental impact of how we raised our food.

Sarah:               The Paleo community has really embraced the local food movement. That part of eating grass-fed beef is that it’s healthier, but another huge part is that it’s much more humane, it’s much better the environment. The carbon footprint is much lower. There’s these other bigger than us as individuals reasons to go that route. Part of it is having that conversation.

Sarah:               The other part is, again, steering towards a pescatarian Paleo. The challenge with a vegetarian Paleo, I love all the vegetables that includes. I consider Paleo to be a plant-based diet. Our plates should be two-third to three-quarters, a variety of vegetables hitting all the colors at every meal.

Sarah:               However, there are … It’s important to recognize there is nutrients we get from plant foods that we can’t get from animal foods, and nutrients we get from animal foods that we can’t get from plant foods. Animal foods can just be seafood. Especially shellfish is basically as nutrient-dense as organ meat. We can actually hit that nutrient sufficiency primary focus of any healthy diet with a pescatarian implementation. It’s a little bit more challenging if eggs, and let’s say A2 dairy products are the only animal foods you’re consuming. There’s still some animal nutrients that are really easy to miss out on doing it that way.

Sarah:               Which ever is Mimi’s actual question there, I hope that gives her some guidance. It’s a little bit more challenging when people are vegetarian for a religious reasons that there’s sort of a different conversation, and that’s where you can start looking at supplements to fill in the gaps. But if it’s moral and ethical reasons, I think there’s a lot of roadway in the middle where we can find a nice happy medium.

Chantel:            Well, you guys have to go check out her website. It’s thepaleomom.com. She’s got some amazing recipes on there. I was looking at your cookie recipes, and those look amazing as well. There is just so much great, great information, so check out thepaleomom.com.

Chantel:            Sarah, thank you so much for joining us today.

Sarah:               Oh, thank you again for having me.

Chantel:            If you have a question that you want answered, go to quesitons@chantelrayway.com. We’ll see you next time. Buh-bye.