When embarking on a healing journey, whether it is to heal chronic fatigue syndrome (ME/CFS), diabetes, Hashimoto’s hypothyroidism, cancer, or avoid heart disease and Alzheimer’s, you will quickly learn that there are a lot of different approaches.
- Should you take statins or look to prescription drugs to ward off heart disease, or should you be focused on nutrition and lifestyle? Should you be going to a conventional physician for Alzheimer’s drugs (which have minimal to no effectiveness) or seeing someone like Dale Bredesen, who is reliably reversing Alzheimer’s using nutrition and lifestyle?
- Should you choose conventional medical treatments or explore the vast territory of things like integrative, natural, holistic, alternative, and functional medicine (some of which have evidence backing their effectiveness, and some of which do not)?
- If you do decide to look to change diet and lifestyle as part of your healing process, you also learn that there are experts who want you to follow their approach to lifestyle. (Think Paleo vs Vegan vs Keto proponents.)
As you probably know, navigating all of this can be confusing, frustrating and overwhelming.
In this episode, I am joined by Chris Kresser. Chris is a globally recognized leader in the fields of ancestral health, Paleo nutrition, and functional and integrative medicine. He is the creator of chriskresser.com, and author of the NYT bestseller ”Your Personal Paleo Code” and ”Unconventional Medicine”. Chris will uncover what science says about functional medicine and why conventional medicine is destined to fail for virtually all chronic disease treatments, what science says about Paleo vs Vegan lifestyle, what science actually says about adrenal fatigue, and much more!
In this podcast, Chris will cover:
- Why Chris Kresser thinks conventional medicine is destined to fail
- Paleo vs. Vegan – which diet is best according to science?
- How much money is spent on treating chronic disease (it will shock you)
- The myth of adrenal fatigue
- Why functional medicine is superior to conventional medicine (and why both are essential and necessary)
- Why many choose the conventional approach over the functional approach to healthcare (and why it can be a big mistake)
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Functional Vs Conventional Medicine, Paleo Vs Vegan Diet, And The Myth Of Adrenal Fatigue With Chris Kresser – Transcript
Ari Whitten: Everyone. Welcome back to the Energy Blueprint Podcast. I’m your host, Ari Whitten, and today I have with me, Chris Kresser. Who is a globally recognized leader in the fields of ancestral health, Paleo nutrition, and functional and integrative medicine. He’s the creator of ChrisKresser.Com, one of the top 25 natural health sites in the world, and the author of the New York Times bestseller, ”Your Personal Paleo Code”, and this book that I have in my hands right here, ”Unconventional Medicine”.
So welcome to the show, Chris. I’ve been following your work for many, many years and it’s a pleasure to finally have a conversation with you.
Chris Kresser: Thanks, Ari. It’s a pleasure to be here. Thanks for having me on.
Why Chris Kresser thinks conventional medicine is destined to fail
Ari Whitten: Yeah, so ”unconventional medicine”. That’s the, the topic of your latest book. In this book, you talk about why conventional healthcare is destined to fail. And there are three specific reasons that you give in the book as far as why that is. Can you talk about kind of the overarching paradigm here and context of why you think conventional medicine is destined to fail?
Chris Kresser: Sure, yeah. It’s really quite simple, actually. Chronic disease is the biggest challenge we face today from a healthcare perspective. One in two Americans have chronic disease and one in four have multiple chronic diseases. And you know, seven of ten deaths are now from chronic disease and 86 percent of the nearly $4,000,000,000,000 we spend on healthcare every year in this country, goes toward the treatment of chronic disease. So it’s pretty clear that that’s the main issue that we’re dealing with.
But conventional medicine, although it excels at dealing with acute or emergency problems, so if you get hit by a bus, you definitely want to go to the hospital. It’s lousy at treating chronic disease and it was actually never set up to do that.
And so this is why we’re seeing costs just getting out of control. We’re seeing more and more people with chronic disease not getting their needs met in the conventional healthcare system and having to look elsewhere to address their problems.
And you know, there are a lot of estimates that suggest that if healthcare expenditure has continued to grow at their current pace, which is largely driven by chronic disease, they’ll consume the entire federal budget by the year 2040 or thereabouts. So we’ll have nothing left over for education or infrastructure or anything else. So another way to put it as we go bankrupt basically as a government.
So I think the stakes are pretty high in light of that and it’s incumbent upon us to do something about it as soon as we can for our own sake. But more important for the sake of our children and future generations.
Ari Whitten: Yeah, absolutely. Well said. One aspect of sort of the conventional, allopathic paradigm is I’d say is at the heart of it, is kind of this paradigm that says like if we look on a smaller and smaller level and we go down to the microscopic level, we go down to the genetic level or the biochemical level and look at hormones and biochemicals in different kind of molecular pathways, cellular pathways. We’re going to find some particular pathway or biochemical that is abnormal, that is associated with some particular condition.
And once we discover that, then we can create a drug that modulates that biochemical pathway in such a way that it is, is curative of that disease or at least relieves the symptoms. Do you think that paradigm that is driving most of allopathic medicine and most of the research that’s being done by pharmaceutical companies, do you think that paradigm is fundamentally bad and poorly suited for treating chronic disease?
Chris Kresser: I think that paradigm has specific applications that can be very useful in certain contexts. But to assume that that paradigm applied in a general sense to the problem of chronic disease is going to be fruitful, is misplaced. And, unfortunately, this is related to what I was talking about before. Our current medical system really flows out of a dualistic Cartesian, philosophical framework that is very reductionist by nature. So as you pointed out, we were trying to reduce things into their smaller and smaller parts and the assumption is that, our body is really just a collection of these parts.
You know, whether we’re talking about large parts like an arm or very small parts like a cell, and if we understand the parts, then by definition we understand the whole. And that’s actually just been shown to be false in many different ways and it ignores the wholism of an organic and biological system like a human being.
And there are a lot of really good the sciences have evolved in our understanding of these kinds of complex biological systems have evolved in the past 100 or 200 years. But unfortunately the medical paradigm is, has not caught up and they’re still very much based on that reductionist view. And we see it everywhere. I talked about it recently in a podcast debate that I was with Joe Rogan and then maybe we’ll come back to, but, in the context of nutrition, it’s that we’ve been obsessive really focused on macronutrients like carbohydrate and protein and fat and micronutrients, doing studies on Beta-carotene or vitamin A and the risk that those carry associated with mortality or morbidity. Instead of focusing on the things that really matter in the diet, which is the quality of the diet.
The quality of the kinds of fats and carbohydrates and proteins that we eat in the quality of the nutrients that we eat. So I think that paradigm certainly can be utilized for example, if you’re doing research on a drug to treat a particular condition or cancer research or something like that, but it’s not, it really falls short when it comes to the interventions that will make the biggest impact on preventing and reversing chronic disease.
Why conventional medicine is not necessarily better than functional medicine and why functional medicine is vastly superior when treating chronic disease
Ari Whitten: Yeah, yeah. Absolutely. So one other aspect that I want to get into a, you addressed this to some extent in your book is kind of this idea that many people within conventional medicine have many MDs have also many skeptics or many people in the general public who kind of have this idea of everything in conventional medicine is backed by a huge amount of science and everything that is not accepted within conventional medicine is sort of by definition not scientific or a pseudoscience.
And with the idea being, if it were backed by science, as soon as there’s evidence supporting it, then it’s automatically sort of incorporated into conventional medicine. And you know, I forget the uh, the phrase, but it’s something like, hey, if alternative medicine that actually has science behind it, we just call that medicine or alternative.
Yeah. So, what do you say to the person who has that assumption of conventional allopathic medicine as being really evidenced based and the idea that certain things outside of that, like for example, functional medicine, which we’re going to get into and you’re a big advocate of, is not evidence-based?
Chris Kresser: Yeah, I’d say that that’s demonstrably false. And you know, we can use just a few examples. So one would be PPIs, which are the drugs that are used to treat acid reflux and GERD. They were only ever approved by the FDA for short-term use of a couple of weeks. And yet there are many people out there, probably many who are listening to this show who have been taking them for years, if not decades. And there’s no research to support that. There’s a lot of research that actually shows that long-term PPI use can cause a shockingly diverse a range of problems from an increased risk of kidney disease to an increased risk of infection because stomach acid protects us against infection to nutrient deficiencies, some of which can be highly problematic, like b, 12 deficiency and can mimic the signs and symptoms of dementia and Alzheimer’s and the aging population that is taking these drugs. So, that’s a use of a drug that’s not evidenced based at all.
Similarly, antidepressants are prescribed off-label ways all the time that have never been studied. And in populations like children, that have never been extensively studied and where safety data has never really been clearly established and what data do exist actually suggests that there’s an increase in suicidal ideation in that population and some other. And those drugs may cause changes to the developing brain that could become permanent and lifelong. So, you know, those are just two very basic examples, but there are many that I go through in my book and, it’s, it’s certainly true that many conventional treatments do have a research behind them. But it’s not true to say that all convinced from medicine as we know it as well, supported by conventional scientific research.
Nor is it true that functional medicine is not supported. So the problem with asking the question, is there any research to support functional medicine? Is that, that’s like saying, is there any research to support conventional medicine? We’re talking about entire paradigms. And if you go into Pubmed and your search for conventional medicine, you’re not going to find very many studies on the topic of conventional medicine, just like you won’t find studies on the topic of functional medicine.
And functional medicine is a methodology or an approach that is based on identifying and addressing the underlying cause of a problem instead of just suppressing symptoms. So if we use irritable bowel syndrome as an example, if a patient has IBS and they have diarrhea, they’re going to get prescribed immodium. In the conventional model, they might get analgesics, are antispasmodics for the pain, they might get an antidepressant. And yes, there are studies to support some limited efficacy in terms of symptom reduction for those treatments.
In functional medicine, we’re going to do a breath test to see if they a SIBO, because there are studies that show that SIBO can be a contributing factor, bacterial overgrowth in the small intestine for IBS, we might test them for parasite undetected parasite infections are disrupted gut microbiome because those, those have both been connected with. With Ibs. We might look at the HPA axis to assess gut brain access dysfunction, that’s definitely been validated as a driver of IBS and then we might use treatments, you know, botanical protocols to eradicate the SIBO which had been validated in the scientific literature or treatments to address the HPA axis dysfunction also in the scientific literature. So in the same way, there are lots of studies to validate the approach of functional medicine.
They’re just not called functional medicine study. So I think that’s part of the confusion and why people think there isn’t any research to support it.
Ari Whitten: Right. Yeah. I think it’s worth emphasizing. You mentioned a couple examples within conventional medicine where there are drugs being prescribed and you literally just mentioned to have, probably, I’m guessing maybe dozens of examples that you could have given where literally millions of people are being treated with drugs where there is literally no evidence in that particular context that [inaudible]
Chris Kresser: We’re doing an uncontrolled scientific experiment with potentially life-altering consequences and without anyone’s explicit informed consent.
Ari Whitten: Yeah.
Chris Kresser: One way to put it.
Ari Whitten: Absolutely. So how does functional medicine become better or more efficient and effective in actually solving some of these chronic disease issues? And I know you just covered a bit of this in passing, but can you give a couple of examples of where a functional medicine type intervention is going to be vastly superior to what someone would get in conventional medicine?
Chris Kresser: Yeah, I think the IBS example is actually a really good one. Another’s any kind of autoimmune disease, so we could talk about a patient with Hashimoto’s, which is an autoimmune condition where the body starts attacking the thyroid gland and then they eventually develop hypothyroidism. And in the conventional model, what will happen, what happens is the patient goes into the doctor once they’ve already become hypothyroid. So the autoimmune attack in that case, it’s probably been going on for years, if not decades. According to the research, that autoimmune process begins decades, often before clinical symptoms happen, so they weren’t properly screened in the first place.
Then they go into the doctor once they’re already hypothyroid and then the doctor determines that they’re hyperthyroid and they prescribe a thyroid hormone replacement medication like Synthroid and that’s the end of it. And then usually the patient will go away that the drug might help for a little while, or it might not help.
And then they might go back to the doctor and the doctor prescribes a higher dose and maybe that works for a little while and then it stops working and then they go back to the doctor and they get a higher dose and then at some point the dose or taking is so is suppressing their TSH almost to zero. So they can’t go up anymore on the drug and they’re feeling kind of wired and not good on such a high dose of the drug. But their original symptoms haven’t been addressed anyways.
So why is that? Well, because in conventional medicine they’re looking at the symptom. In this case, which is poor thyroid function is a symptom of immune dysregulation or the autoimmune attack is the underlying cause.
But that’s not even tested for by most doctors in the conventional model, much less treated or addressed.
Chris Kresser: So in functional medicine, someone comes in with hypothyroidism, we’re gonna test their thyroid antibodies. If they, if they’re producing high levels of thyroid antibodies, then we say, oh, this is a problem with the immune system. It’s not a thyroid problem. It’s a problem with the immune system that happens to be affecting the thyroid.
So yes, we might need to give that patient thyroid replacement hormone, but we can’t only do that. We have to actually a balance and regulate the immune system so that the thyroid stops attacking or the excuse me, the immune system stops attacking the thyroid gland. So how do we do that?
It’s kind of two phases. One would be to identify and address any triggers that could exacerbate immune dysfunction or causing immune dysfunction. So those could be things like GI issues. I mentioned some of them, and when we were talking about IBS, SIBO, gut infections like h-pylori or parasites or a leaky gut, intestinal permeability, disrupted gut microbiome could be HPA axis dysfunction could be nutrient deficiencies. Particularly Selenium Iodine and zinc could be other kinds of late and chronic infections, could be other hormone imbalances, etc.
So we looked through all of these things that could be contributing and then once we’ve addressed those things, if the immune system hasn’t already just snapped back into normal function on its own, we can take additional steps to, balance and regulate the immune system. And that means that, in some cases that could eliminate the need for medication at all, but in other cases the patient still needs to take medication, but they usually need a much lower dose to achieve the same result and they don’t continually have to keep upping the dose over time because the immune attack has been reduced or stopped.
And that is what stops the progression of the condition over many years. So it’s really, again, the difference between just trying to put a kind of a band-aid on the problem and really addressing it at the root.
The potential HUGE financial difference between conventional and functional treatments
Ari Whitten: So on a big picture level, and kind of on a financial level, almost on a national scale. One of the things you mentioned with regard to why conventional medicine is destined to fail is that the cost of how much it’s gonna, it’s gonna cost the nation to take care of all these sick people. It’s going to be so high. Just to be clear, how does functional medicine if it’s implemented on a broad scale, how does that solve that financial issue?
Chris Kresser: Well, to be clear, I think there’s still a question that hasn’t been fully worked out. But I’ll give you an example of what that could look like. So we know that the costs of treating a patient who already has type two diabetes is about $15,000 a year. And just for that one condition and its complications, it’s not unusual now for a diagnosis of type two diabetes to be made in, mid-thirties or even early forties. And it’s just getting younger and younger every year.
And because of our the conventional medicine does excel so much at, at heroic interventions pretty far along in the disease spectrum. It wouldn’t be unexpected for someone even with type two diabetes to live now until they’re 75 or 80 years old or even older. So let’s just assume conservatively that someone gets diagnosed at 40 and they die at 80, that’s 40 years at $15,000 a year, $600,000 over the course of that patient’s lifetime just for that single patient and that single disease.
Now, if we use a functional medicine approach, it’s truly might need to spend a little bit more upfront. So what that would look like is doing testing earlier along that disease spectrum to screen that patient when they have prediabetes rather than full-on type two diabetes because we know that the earlier that you intervene with blood sugar issue, that the greater the chances are that you can completely reverse it with without having to use medication.
So if we can, we catch that patient by doing some screening earlier on, that would cost a little bit more money. And then we used a collaborative care team that includes a nutritionist and health coach, which we can talk about more to actually give meaningful, real support to that patient to make the diet and lifestyle changes they need to make to reverse the condition.
That’s another big difference in the model that I’m advocating. So that’s actually baked into it. So again, that would cost a little bit of money up front, but let’s just, let’s be just super generous. I don’t think it would cost this much, but let’s say it costs $10,000 to do that testing and employ the health coach and then nutritionist and let’s even throw in a personal trainer and work with that patient for a year to totally revamp their diet and lifestyle habits so that they not only go from pre-diabetic blood sugar to normal blood sugar, but now have the tools that they need to prevent that from happening ever again in the future.
I would say, and I think most people would agree that a $10,000 investment to save $600,000 over the course of that patient’s lifetime as a pretty good return on investment, right? So it’s totally feasible. It’s just a question of having the political will and the ability to shift our current system in that direction and to deal with the powers that be, that are invested in maintaining the status quo and may not be interested in, you know, supporting these types of changes.
The main challenge functional medicine experiences today
Ari Whitten: Yeah. I want to play devil’s advocate for a minute because… I’ll preface by saying that I completely agree with you, but I do think that there are a couple of big obstacles. One you just mentioned is kind of the powers that be in pharmaceutical companies and more interested in maintaining the status quo. They stand to lose billions of dollars, obviously, if the kind of practices that you’re talking about become commonplace.
So, obviously, they don’t want that to happen and the shareholders and those companies don’t want that to happen. But also on an individual level, aside from any sort of big picture, corporate level corruption, or influence, we have just individuals and in this culture, a lot of people are resistant that they maybe don’t want to change their diet and they don’t want to go to the gym and workout with a personal trainer and they want to continue eating how they’re eating and they want to take a drug or maybe in the future there there’ll be some other advanced technology intervention that they can use that maybe provide some level of symptomatic relief in they say ”that’s primitive to change my diet and start exercising. I just want to pop this pill every day and that helps me manage my blood sugar.” And that sort of no effort, quick fix solution has a lot of appeals. So how do you, how do you overcome that level of obstacle on an individual level?
Chris Kresser: So for the first example, with big Pharma you’re right, they’re not going to like it and they’re not going to go along with it easily. But I think it is instructive to look at how other countries deal with this issue. We are, along with New Zealand, the only two countries in the world that allows direct to consumer drug advertising. Pharmaceutical companies charge way, way more for their drugs in the US than in any other country in the world. Those are political decisions. So if the political will is there, we as a people can put some guardrails around what pharmaceutical companies are able to do in this country. So I’m not saying that that’s going to be an easy fight or that I have all the answers there, but I think it is valuable to look at this issue in virtually every other industrialized country.
It’s not the same as far as the individual question. I think it’s also helpful to look at other industrialized countries that they don’t have the same level of uh, problems that we do here with obesity and diabetes and many other chronic health conditions, although they’re certainly on the rise in those places as well.
And it’s also instructive to look even 50 years back in this country when the rates of obesity were far lower than they are today, when people were getting an average of seven to eight hours of sleep pretty regularly and only maybe two percent, we’re getting than six hours versus 35 percent today. And yes, there have been significant technological and societal level changes that have contributed to these shifts in behavior. But my point is that there can also, there can be new shifts that can actually contribute to supporting different types of behavior and those shifts can happen either voluntarily or involuntarily.
So, I think if there was a pill that solves the problems in the way that you’re suggesting, like if someone could take a pill and you know, just experience a perfect blood sugar and no symptoms and lose all the weight they wanted to lose.
And we, yeah, that would be a tough battle to win because we’re fighting against very hard-wired biological programming in our brains that where human beings are, you know, we conserve energy as a default because in the natural environment where we had to be active a lot, it made sense to be, to conserve energy when we could. We’re also drawn to eat highly calorie dense and rewarding foods. for this, for a similar reason. We evolved in an environment of food scarcity and are the ancestors that were most successful in seeking out those very calorie dense foods are the ones that pass their genes on to us.
So that backfires, of course, when you can go to Costco and then there’s the 7:11 on every corner in a fast food restaurant and every town. but I do think that through public health policy education and, you know, proactive changes that we can make, we’re only spending three percent of our federal healthcare budget on public health and we spent 86 percent on treating chronic disease.
So we could set up a healthcare system that really focuses a lot more on supporting people and making diet, lifestyle and behavior changes right from the beginning even from the time when kids have their first interactions with the system and is focused a lot less on, on drugs, these are big changes. They are at the, I think I’m at a level of maybe not quite the level of what’s being asked of us in terms of climate change now.
Whatever your views. There was a report that was just issued that outline some ideas of what a, how humans, how we need to respond in order to prevent significant outcomes there. And I don’t think it’s quite at that level with this issue, but it certainly would require a huge effort and a huge reorganization of society. But similarly with climate change, we’re not really going to have a choice like the way that chronic disease is exploding now. I use that a example of how much costs to treat type one person with type two diabetes.
Well guess what, one in three Americans now has either prediabetes or type two diabetes, a $100, million people and all. You have to do some quick math to figure out that that expenditure to treat 100 million people if they eventually developed type two diabetes is that’s game over. That’s we even that one condition could bankrupt this country, so the writing’s on the wall and we can either shape, make these changes proactively or we can wait essentially until the system falls apart and then react to it and you know, different people will have different ideas about what outcome is more likely based on, I their, their viewpoint, their overall viewpoint.
Ari Whitten: Yeah. I have one more layer of this that I want to play devil’s advocate, which is part of what you’re preaching, which I love obviously as you’re trying to get at root causes. Now even within that, let’s say some of these examples that you gave like a conventional medicine versus functional medicine in the way that they would deal with something like IBS or the way they deal with something like Hashimoto’s.
You as an advocate of, of an ancestral nutrition and lifestyle know very well that I think the real solution that if you actually want to solve this health crisis and the disease, the chronic disease epidemic that are going on that are going on right now, if you actually want to solve it in a way that really dissolves the financial burden and the health burden of this and all of the suffering or you know, a huge percentage of the suffering is to fundamentally overhaul our nutrition and lifestyle from the beginning of life and, and, and that’s obviously a huge undertaking that I don’t think anybody has a really good answer as to how to actually accomplish that.
But that is fundamentally the only way to really address things at a root cause level. Would you agree with that?
Chris Kresser: I would. Yeah. But I, I would say that sometimes it changes don’t necessarily need to be as dramatic as we think they do. So for example, in the nutrition realm you have, yeah, what we might conceive of as an ideal diet and there’s of course a lot of controversy and disagreement about exactly what that is. But uh, if we just started with like, let’s eat real food like mostly fresh whole foods that don’t come in a bag or a box that would probably get us 70 to 80 percent at least of the way there in terms of the gain or the benefit that we could get from nutrition. I think Michael Polland had a good way of approaching that with his second to last book. I think the one, the one on just cooking at home like if you cook at home you’re much more likely to eat real foods.
Now having said that, even that of course is a big undertaking when you have 60 percent of the calories that most Americans get in their diet or now currently coming from ultra-processed highly refined foods. So just asking moving from that to even just a whole food, real food diet is a big undertaking. And then of course you have all of this, a sociopolitical issues there are lots of people living in food deserts in inner city urban communities that don’t really have access to fresh whole foods.
And there’s the question of economic resources and again I don’t think we’ve come anywhere close to figuring out how this is going to happen on a society-wide scale, but we need to keep asking these questions, so that we can continue to brainstorm together and figure out what the best approach is. I think just my bias is that it’s going to happen more on a grassroots level and a in a bottom up. We’re in a bottom-up way than it is a top down way. And I already see a lot of encouraging changes in that regard. We still have a very long way to go.
Paleo vs Vegan
Ari Whitten: Yeah. Excellent. So, well I, I love what you’re preaching on. Another note I want to transition into talking about some specific kind of health issues and specific controversial subjects within the field of health and nutrition. one thing I really appreciate about your work is a commitment to stick to the evidence and to let evidence guide your views.
You don’t go along with fads and trends and you actually look at the evidence on specific subjects. I’ll give a couple brief examples. you know, there’s the grain brain thing, kind of the, the blaming of neurological disease on grains and I know you have an article where you’ve kind of systematically analyzed some of those claims as to whether the evidence supports that or not. You’ve also done some analysis around low carb and the insulin hypothesis of obesity and a number of other subjects.
Also adrenal fatigue, which I hope to get into with you. that’s also a passion of mine where I’ve spent many months exploring the literature and it’s a fascinating topic as I know so as, as one segue, you mentioned earlier your recent podcast on Joe Rogan. Your recent interview with Joe Rogan, where you had a debate with Dr Joel Kahn, who’s also a friend of mine and has been actually on this podcast a couple of times and it was sort of the vegan versus omnivore debate. Obviously I don’t have Joel here today, so I want to ask you, I guess too, if you can, and this is a big task, but maybe summarize kind of the essence of the debate by like giving maybe the most, what you feel is the most evidence in support of the vegan argument and maybe the most compelling evidence in favor of omnivory.
Chris Kresser: yeah, I mean, I say this genuinely, like if I thought there was really compelling evidence supporting the vegan argument, I probably wouldn’t have done that debate. I think if you mean compelling by like at first glance when looking in the scientific literature, you can see that there are tons of observational studies that suggest that switching to a Vegan diet will improve your blood lipids and lower your blood sugar and reduce inflammatory markers and lead to weight loss, etc., etc.
And that’s all true, but you have to consider what they’re comparing against. And in those studies in almost every case they’re comparing a vegan diet against the standard American diet where people are eating crap process food and I don’t deny that a vegan diet is going to be an improvement over that diet and we’ll have all of those effects.
My fundamental point in that debate is that we don’t, that’s not a good way of answering the question is, are animal foods beneficial in the context of a healthy diet? Which I think is the question that, that is the really important one to be asking. Because nobody that I know is arguing in support of the standard American diet of eating hot dogs and fast food, cheeseburgers and that sort of thing, which is what most people eat. We know from studies, the question that I’m interested in is our animal foods beneficial and not harmful in the context of a whole foods nutrient dense anti-inflammatory diet. And my core argument was that not only does research you know, we don’t have a lot of research comparing those diets, but what we do have suggests that animal foods are not harmful and in fact may be beneficial because of the, the higher potential of nutrient deficiencies on a vegan diet that are not always ameliorated by supplementation even when vegans are aware and are supplementing. So I would say that’s the, that was my core argument.
Ari Whitten: Yeah. I will, encourage everyone to also listen to it as a fascinating conversation. And that was an amazing job of summarizing a three. I think it was over three hours.
Chris Kresser: Almost four hours.
Ari Whitten: Four hours before our conversation. I think you just summarized the essence of it and about two and a half minutes. So. Well done. so another issue that I want to talk to you about, you’ve been an advocate of paleo and ancestral diet and lifestyle for, for a long time now, what, 15 years, something like that.
Chris Kresser: More or less.
Ari Whitten: There’s been a weird sort of, there was a weird marriage of paleo nutrition with low carb. And the low carb sort of insulin hypothesis of obesity that carbs and insulin specifically are the factors that drive fat gain and sort of Gary Taubes’si stuff and Atkins’s stuff more recently kind of a marriage with the keto movement. I’m, I’m curious as to your thoughts on low carb and keto and maybe why they got sort of mixed up and married to paleo and what you think to know should they be married or should they be treated as separate concepts?
Chris Kresser: Uh, yeah, definitely separate. I mean, if you look at the evolution just from a 30,000-foot view of these dietary approaches paleo was first introduced as a concept as a nutritional concept or framework by Boyd Eaton and Lauren Cordain. I’m back in the eighties. and uh, what they were talking about was not a low carb keto diet at all.
And in fact, if, when you look at the ethnographic studies of an extent, hunter gatherers that were still around in the 20th century, early 20th century and mid 20th century in some places, they, there were many studies done in these groups that found that the macronutrient ratios varied, of course, from place to place. you know, intAke of carbohydrates was much lower in fat, as much higher in the nun, for example, simply because they didn’t have access to carbohydrates for large portions of the year.
They would absolutely have eaten them if they had access to them, but they lived in a very marginal environment. Likewise, then you had on the other end of the spectrum you had the two sent… New Guinea who got like 97 percent of their calories from carbohydrate, mostly just eat sweet potatoes and a little bit of protein and fat they get was from the insects that were on the sweet potatoes they were eating.
And you know, same with the traditional Okinawans, very high intake of carbohydrate, but generally the basic average carbohydrate intake for most hunter-gatherer groups was somewhere in the 30 to 45 percent range. So absolutely not what we, most people would consider a low carb diet. And then I think later in the nineties and certainly into the aughts, the earliest adopters of the paleo approach came over, I think from Atkins, and looked at it as more of like a real food alternative to Atkins. [inaudible]
Atkins kind of went the way of like lots of packaged and processed Atkins kind of, I would call Frankenfoods that. and you the, as long as they were high fat, as long as they were a high fat and low carb, doesn’t matter what’s in them. It’s again that reductionist approach and the downsides of that way of looking at things. and so the Atkins early adopters came over into, into the, the paleo camp and then paleo starts like move more and more in the low carb direction. and then you have a lot of people who are interested in weight loss who were of course had done the Atkins thing and now who are coming to paleo.
And I do think a low carb diet can actually work really well for weight loss for many people. And so I think then that became something that, that further drove it in that direction.
And then when keto came onto the scene more recently, that’s of course an extremely low carb high-fat diet and also works very well for weight loss as well as some neurological conditions. and it just kind of pushed it further over. And in my conversations with people recently who are not really part of my field, I’m noticing that ketosis being used interchangeably with paleo and some by some people and in some contexts which really shows that in terms of the general population, there’s not a clear understanding of what the differences…
Ari Whitten: I’ve even heard people Actually refer to a paleo ketogenic diet. And like you said, they’re kind of using paleo and ketogenic as synonymous terms. That’s interesting as to my knowledge, there doesn’t seem to be any hunter-gatherer tribe that study that is actually in ketosis. And I think even the inuits were found not to be in.
Chris Kresser: No, because yeah, I mean there are different ideas about why they aren’t, but yeah, not, not typically in ketosis. And even if they were, it wasn’t voluntary. Like I pointed out, it was a function of living in very marginalized environment, and not having access to carbohydrate.
So again, 30,000-foot view, I think that let’s start with ketosis and move backward. Ketogenic diets. Ketogenic diet in my mind is a therapeutic tool. And it as a tool, just like any other tool that has some really a great uses but in the same way that you don’t use a hammer for every other thing that you need a tool for, you don’t use, I wouldn’t suggest using a ketogenic diet to solve every problem, but that’s kinda how it, that’s how it goes with fat. That’s right. You know, if it works well for weight loss and it works well for neurological problems like epilepsy and even Alzheimer’s and Dementia, then it must work well for my problem. Whatever that problem is.
And that’s often how it starts. And yeah, there Is some interesting research on animals. For example, there was a new study came out in mice, so big caveat there that showed that ketones reduced the certain processes involved aging. And that’s interesting. I think from an evolutionary perspective, it’s likely that our, most of our ancestors and even contemporary hunter gatherers spent some short periods of time and ketosis as a result of being in a fasted state when there was some kind of food scarcity.
And I do believe that there are certain processes that happen in the body like autophagy in a fasted state or when ketones are produced that are beneficial in, in, in that cyclical fashion. But to extend that to the idea that we should always be all people should always be in ketosis and that and that there’s any precedent for that or even any evidence to support that that’s safe or beneficial for most people is a real stretch to put it lightly.
Ari Whitten: That was very diplomatic.
Chris Kresser: And that doesn’t take away from the ketogenic diets. Incredible a potential impact on conditions like type two diabetes and the neurological disorders that I mentioned and traumatic brain injury perhaps and many other things that are still being elucidated. but it’s really much better to understand it as a tool then that kind of default way of eating. I think.
As far as low carb, I think most of what I would have just said for mutagenic diets kind of applies there too. I mean, I would say that I think it’s in some cases probably quite safe for someone to follow a low carb diet for the rest of their life and there are more examples of cultures that were closer to that and I’m just mechanistically, I think that an argument could be made for someone with type two diabetes, for example, who can control their blood sugar without medication, by following a low carb diet and if as long as you’re eating real nutrient dense foods and eating a broader variety of foods as possible within that context, I think I don’t, I don’t see, and doing what they can and nourish their gut microbiome, which is one of the potential downsides of perhaps of a, of a long term low carb diet.
Then I think you can make an argument for that. But again, I don’t just automatically put every patient that comes to me on a low carb diet because there are some people who will be harmed by that and some people who will do better on a moderate carbon, perhaps even in a high carbohydrate and lower fat diet.
So my fundamental point, which I didn’t mention on the Joe Rogan show that I actually started off with, was that there, the nutrition research and health understanding in general has been incredibly harmed by this idea that is tied to the reductionist philosophy that we talked about earlier, that there’s one size fits all approach, that one diet that will work well for everybody and let’s just all our resources and trying to figure out what that one diet is.
How many carbohydrates should everybody, how much protein should everybody, how much fat should everybody eats. And we’ve been asking the wrong question for so many years, which is why everyone is so confused and why we still don’t have an answer. Because if you ask the wrong question over and over again, you don’t get the answer that you’re looking for.
What studies say to be the best diet for weight loss
Ari Whitten: Yeah. On that note, that was even a study published by, or not a study, but an opinion piece that came out from some obesity scientists a few years ago. That was a call to end the diet wars. And it was basically nothing like, hey, we have dozens of studies comparing low carb to low fat at this point and it’s pretty clear if you take an honest look at the evidence that there isn’t one amazing diet that is the fix or obesity and most of the studies that are long-term and well-controlled don’t even show remarkable differences between low carb and low-fat approaches if the diets are actually adhered to. and so it’s like, hey, we need to stop. We need to end the low carb versus low-fat debate. This is clearly not the answer.
Chris Kresser: You know, the, you probably saw this study. It was, I think it was 2016, late in 2016. The Gardner study out of Stanford. It was fantastic. I mean, we, I wish we had more research like this. They explicitly set out to answer this question the way that they designed the study. They took two groups of people and who wanted to lose weight.
And they put one group on a lower carb diet and one group on a lower fat diet, but the difference was they explicitly advise them to eat in both groups to eat nutrient-dense whole foods and they had some good techniques for, for making not more likely. And just as you pointed out, after a year long, both groups actually lost significant amounts of weight because they were eating real foods and not crap, but there was very little difference.
Maybe a slight advantage in some ways to, to the low carb group have very little difference between the two groups. So that goes back to what I was saying before, if we just ate real food, we would get 70, 80 percent of the way there and then you can kind of do any fine tuning that needs to happen after that.
But I think the point I’ve often made is, and you know, I think I mentioned this in the article about grains being the problem the cause of our brain problems and stuff. I know Dr. Perlmutter, I have great respect for his work. I think he’s made amazing contributions and I agree with him on a lot of things and he I imagine you’d probably agree with what I’m about to say, which is that I don’t think people eating keenwa or you know, brown rice is driving the epidemic of Alzheimer’s and Parkinson’s and neurodegenerative diseases.
I just don’t. I think if people were eating whole foods that included whole grains, we would not be seeing the increase in those conditions that we’re seeing now. I think those conditions are driven by processed and refined carbohydrates like flour and sugar and there’s really no evidence that I’m aware of. It’s compelling.
That suggests that whole grains are are contributing to these problems. And even in my first book, which had the word paleo and the title, it was really not a paleo book because I was saying that full-fat dairy products are beneficial when they’re well tolerated and that even grains and legumes in moderation can be part of a healthy diet if they’re well tolerated. And nobody like that book.
Lauren Cordain and was really mad that that book had the word paleo and the title because he said this is not a paleo diet, and then of course you know, people in the vegan vegetarian world that might it because of animal products. So that’s, that came out of my research and my experience about what works best for most people.
Ari Whitten: Well, I know the feeling of being a no man’s land with some of my intellectual positions on the subject of nutrition as well. It’s actually an interesting segue. I was actually just about to ask you that exact thing about, for example, legumes and dairy and grains which are traditionally outside of sort of the keto list of the paleo list of good and bad foods. And yet there are layers of evidence that have come out that saying, hey, like we have anthropological evidence showing that some of our ancestors did eat grains and, and, and lagoons are pretty unequivocally associated with health benefits in the literature. Why are we avoiding these as if they’re devil foods?
Your take on that is kind of sort of modified paleo, if you want to call it that, which is that like, hey, let’s also look to the evidence and if the evidence for its benefits of a particular food, let’s include it.
Chris Kresser: Yeah. Yeah. I mean I’ll be perfectly frank. I’ve said this many times, so like if I could go back in time, I probably would take the word paleo out of that book title because it’s not, it’s really Lauren Cordain was right. It’s really not I’m not advocating necessarily a strict paleo diet for everybody and it’s not that I have a problem. I mean, of course I think it works really well for a lot of people and I do know. In my clinic, the way we do it is when someone comes in, if they’re dealing with a ton of health problems, which they always are, when they come to see me, nobody comes to see me for a sniffly nose. We say, try this for 30 days and let’s see what happens. If you get a lot better and a lot of your symptoms go away, great.
And then if you want to add back in legumes and full-fat dairy, I actually think that’s pretty good idea because it makes you diet more diverse. Legumes can be a fantastic source of fermentable fiber, which is really important for our beneficial gut. A full-fat dairy is a great source of bioavailable calcium and all of the literature suggests that the vast majority of studies suggest that it’s inversely associated with metabolic and cardiovascular disease and obesity probably because of the beneficial fats in the dairy, like conjugated linolenic acid.
It’s got, if you pasteurized dairy, it’s got meaningful amounts of vitamin a and other nutrients that come from the grass that the cows eat. So I say add that back in. Let’s see what happens. If you’re able to add that back in and you don’t experience any resurgence or recurrence of your symptoms that went away when you did the paleo reset the full paleo diet, fantastic.
Lucky you. Enjoy those foods as part of your diet. But for some people when they add those foods back in, they start breaking out again or they have digestive problems or whatever. And even then we try to say, okay, well let’s see if there’s something we can do to let’s test you for SIBO, let’s do this. And maybe after we treat those problems you will be able to tolerate those foods again.
So I’m always, my mantra is always to eat the broadest, most diverse diet that your body will tolerate because if there’s one difference between our modern diet and our ancestral diet that’s not talked about a lot, is the variety of foods that we’re consuming, particularly of plant foods, the number of species.
Now most Americans eat about four or five vegetables like lettuce, tomato on a burger, broccoli and carrots and maybe one other…
But if you look at, again, some of these anthropological studies, you see a lot of a hunter-gatherer groups eating anywhere from 40 or 50 different species of plants to upwards of 100. So that’s a really big difference in terms of the exposure to different nutrients and not only for us and our benefit, but for the benefit of the gut flora that needs to be healthy. So yeah, I, I’ve never been a strict paleo zealot because I don’t think the research really supports that.
The myth of Adrenal fatigue
Ari Whitten: Yeah, there’s a lot we could dig into that a, I think a lot of different rabbit trails we could follow there. But I know you have a hard cut off in about five minutes and there’s one more topic I wanted to ask which is adrenal fatigue and you’ve done some debunking in this space. I’ve done some debunking and some very extensive analysis of the research in this area relevant to the concept I should say because as there is really no research on adrenal fatigue specifically, but what, what is your take on adrenal fatigue?
Chris Kresser: It’s a made-up diagnosis in short. So the idea is that your adrenal glands get really tired and they can no longer produce cortisol. And then that Is what leads to all of the symptoms or the symptoms that people describe an attribute to adrenal fatigue are very real. And I don’t mean to diminish anyone’s experience. I’m not suggesting that the symptoms aren’t real and the effects of it aren’t real.
I’m suggesting that the proposed mechanism or the explanation of those symptoms which is at the adrenals are exhausted or fatigued and can’t produce cortisol. There’s no research to support that idea. And really it’s a, we know that it, it, it’s mostly about the brain and the brain is the primary regulator of cortisol production. And in the vast majority of people the adrenals are perfectly able to produce cortisol.
They’re just not getting the right message from the brain. Then there are also tissue-specific regulatory mechanisms that impact the bioavailability of cortisol and the ability of cortisol to activate… to enter the cells and do all the things that it’s supposed to do that can change and shift and inflammatory conditions, which of course pretty much every modern a chronic disease involves. And so I think it’s a much more complex problem that has typically been understood in a kind of functional or integrative or alternative medical worlds. And that explanation caught on because it’s, it’s simple, it’s easy to understand, it kind of fits with people’s own experience and narrative of, of their symptoms. and it’s a much catchier term then my term for this condition, which is HPA axis dysregulation. So I just don’t see that catching on like adrenal fatigue. But I am seeing, I am seeing people using that term. So it’s, something’s happening.
Ari Whitten: Yeah, there are definitely people using HPA axis dysregulation. There’s, there’s one more layer I want to mention, which is I’ve actually looked very extensively at the research on since there’s nothing on adrenal fatigue, on related conditions like stress-related exhaustion disorder, burnout syndrome, vital exhaustion. There are a few different terms that this goes by, but basically chronic stress leading to fatigue and exhaustion. There’s research on that and there’s research on it specifically looking at whether there is any sort of cortisol or even HPA axis abnormality.
And actually, the vast majority of those studies concluded that most people with burnout syndrome or stress related to exhaustion disorder have perfectly normal cortisol levels that are indistinguishable from healthy people. So I, I personally, I actually don’t necessarily even think while HPA axis dysfunction is certainly going on in many people, I don’t think you can make a case that it’s the primary cause of those conditions.
Chris Kresser: That’s, I think I would agree with that for the most part, but I think that there’s a, the problem is how cortisol is being assessed in some of those studies and then whether things like cortisol resistance or being considered, which is just like any other hormone, insulin resistance where you have adequate levels of cortisol, but they have become resistant to it because of the inflammatory cascade and that’s been shown to happen and acute infectious illnesses and it’s a body’s protective mechanism to prevent being harmed by the upregulation of cortisol that’s chronic over time.
So I wouldn’t necessarily dismiss cortisol from the equation just yet. And I think it does play a role, especially when you get into the nitty-gritty and you compare free cortisol levels with metabolizing and total cortisol levels and use urine assessment to look at cortisol metabolites in addition to saliva and serum when it’s appropriate.
But I would agree that in many cases, there’s something else going on that’s not explicitly were caused by the HPA axis and might be more of this simpatico adrenal modularity system, for example, which is the part of our, a stress response. It is, tends to be more impacted by trauma and certain aspects of the modern lifestyle.
So I think there’s a lot we still don’t understand about it, but the good news is that a lot of the interventions that would be recommended for HPA axis dysregulation are those that will also help the burnout syndrome. And you know, whatever we want to call it, you as a consumer or just a person, you don’t. You don’t need to necessarily understand the mechanism perfectly to know what you need to do about it.
That’s the message. I often liked to remind patients of when, I like going down these rabbit holes and I can see that you do too, but you don’t have, you don’t have to become an expert in these mechanisms to know how to respond in an appropriate way.
Ari Whitten: Right? Whether the HPA access dysfunction is the primary cause or not. We still know that sleep and circadian rhythm and distressing and good nutrition and movement and all those things,
Chris Kresser: sunlight and being outdoors and social connection and support and play and fun and that. I mean that’s what is so encouraging to me and with all this stuff, it’s like it all comes. It always comes back to the basics in terms of the levers that we can actually push on as individual human beings. The other stuff is fun. It’s just fun for me to understand those mechanisms and geek out and all that, but at the end of the day, it really just comes down to the choices we make and the behaviors that we engage in on a daily basis that drive our health.
Ari Whitten: One hundred percent. I think that’s the perfect way to end. I know you got to run right now. Chris, this has been an absolute pleasure. I would love to talk with you for three more hours. I feel like this went by way too fast, but thank you so much for the time and learn more about what you do and, and get a hold of your work. And where do you want to send people?
Chris Kresser: Hey. Yeah, chriskresser.com is my main website. Everything’s there. Social media where you can find me on social media, lots of free stuff and if you’re interested in training that would be kresserinstitute.com. and thanks for having me. I’ve enjoyed this conversation.
Ari Whitten: Yeah, me too. Yeah, it’s been a pleasure and I highly recommend everybody look into functional medicine and Chris Kresser his work and, and his functional medicine training program. So thank you again so much Chris and I look forward to doing another session with you sometime soon.
Chris Kresser: Great, I’d like that. Take care.
Ari Whitten: Bye.
Functional Vs Conventional Medicine, Paleo Vs Vegan Diet, And The Myth Of Adrenal Fatigue With Chris Kresser – Show Notes
Why Chris Kresser thinks conventional medicine is destined to fail (1:12)
Why conventional medicine is not necessarily better than functional medicine and why functional medicine is vastly superior when treating chronic disease (7:00)
The potential HUGE financial difference between conventional and functional treatments (17:23)
The main challenge functional medicine experiences today (27:00)
Paleo vs Vegan (31:28)
What studies say to be the best diet for weight loss (45:20)
The myth of Adrenal fatigue (53:00)
Learn more about Chris Kresser’s work here
Get Chris Kresser’s book Unconventional Medicine here
Studies and resources mentioned in the podcast
Listen to the podcast with Joe Rogan where he interviews Dr. Joel Kahn and Chris Kresser here
Read ”End The Diet Wars” here