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Banning Nutrition Advice Without A License; Keto For Autoimmune & Thyroid Dysfunction; Antibiotic Prophylaxis; Moms, Lack of sleep, Exercise; Keto and HPA Axis Dysregulation\\xa0

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Show Notes:

News topic du jour

Exposure to Sunlight Boosts Good Gut Microbiome Bacteria, and Vitamin D Levels

Fiber did not provide the same benefit!!

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1. Banning Nutrition Advice Without A License? [9:53]

Carli says:
Hi Robb & Nikki --
Longtime follower, podcast listener, and fellow libertarian here. Thanks for all you do!

My question/comment is regarding the recent decision out of FL that upholds a ban on providing individual nutrition advice without a state-sanctioned license -- have you heard about this? I\'m a recent Nutritional Therapy Practitioner (NTP) graduate and have already helped clients in my home state of Virginia make ancestral-type changes and seen speedy benefits. If I lived in FL this would be illegal. \\xa0I\'m trying to start a coalition of some of the big guns in the nutrition space (you!) to spread awareness (state legislatures across the country are trying these bogus regulations to squash small business and anything that goes against conventional wisdom) and maybe help this particular case while there is still change. I\'m hopeful bigger platforms can come together and make a big deal about this -- it is an important freedom of speech issue with public health ramifications.

The post below from IJ explains the case, and I\'d be happy to help in any way possible connecting you to people in that world (I work at a public policy think tank in DC and have lots of connections through my network I can put you in touch with).

https://ij.org/press-release/federal-court-upholds-censorship-of-dietary-advice/

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2. \\xa0Keto For Autoimmune & Thyroid Dysfunction? [17:59]
Krysti says:
Hi Robb! Your podcast is one of my favorites among all of the health and fitness voices out there.

I have a question regarding something my nutritionist said to me the other day. I have SIBO, Celiac and Hashimoto\'s and was discussing treatment protocols with her for the SIBO. I\'ve done a 2-3 week elemental diet before and it was pretty rough - two years later I still can\'t look at a spoonful of coconut oil the same...

This time I suggested trying a zero carb diet like Shawn Baker\'s carnivore diet for the 2-3 week therapeutic period then transition to keto as a long term way of eating. I\'ve heard that some people with SIBO get drastically better this way. However, my nutritionist specifically objected to the lack of carbohydrates that would, in her opinion, cause my thyroid dysfunction to get worse. She said something about not having insulin spikes means my thyroid hormones would drop. She prefers something like Integrative Therapeutics Elemental Diet formula which is 69% carbohydrate (dextrose and maltodextrin), 17% fat, and 14% protein.

What is your opinion on me as a woman eating a keto/carnivore diet with autoimmune/thyroid conditions? Thanks!

Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto\\u2019s Thyroiditis

A-Online health coaching pilot study looking at AIP in Hashi\'s

B-Antibody titer did not change much, but quality of life, symptom reporting improved, CRP reduced

C-If on meds, thyroid is not really an issue

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3. Antibiotic Prophylaxis? [24:50]
Whitney says:
Hi Robb, I\\u2019m a huge fan of all you do! I\\u2019m a dental hygienist and I love combining my passion for health with my dental career (thank you for introducing me to Dr. Steven Lin through your podcast by the way). For a long time it was recommended that patients take an antibiotic before there dental appointments if they had a joint replacement, due to the risk of bacteria entering the blood stream at those appointments and causing infection in the new joint. In recent years the rules have changed and it is no longer required. However many orthopedic surgeons are still advising some of my patients to take this before all appointments for life! I try to educate them on risks of altering their gut microbiome as well as creating resistant bacteria strains. But of course most people side with their surgeon and not their dental hygienist. I don\\u2019t have a lot of time to spend with them on the topic and I\\u2019m not well versed in this enough to educate appropriately. What can be my \\u201celevator pitch\\u201d, so to speak, to explain this thoroughly, quickly, and effectively? Or maybe I\\u2019m overreacting? Should I recommend a probiotic if they insist on pre-medicating? You have a way of putting things so I always understand them so I thought you could help. I know this isn\\u2019t your typical question but I would appreciate your input.

Thank you so much if you even read this long rant :)

Antibiotic prophylaxis for dental treatment after prosthetic joint replacement: exploring the orthopaedic surgeon\'s opinion

The concerns:

A-PJI....can easily be fatal

B-but, antibiotics can have a host of problems ranging from anaphalaxis, to unforeseen gut alterations.

C-BUT, reviews of this topic paint a picture that for dental treatment, this may be overkill

From the paper:

"There is limited evidence demonstrating an association between dental treatment and PJI [1]. Case reports and retrospective studies that suggest a relationship between dental treatment and PJI are usually cited as justification for continuing to use antibiotic prophylaxis [8], [9], [10], [11]. Current international guidelines do not support the use of antibiotic prophylaxis to prevent PJI [7], [12], [13], [14], [15]. The Australian Therapeutic Guidelines recommend reducing the risk of infection by comprehensive medical management perioperatively [15]. Despite these recommendations, some dental and orthopaedic surgeons continue to prescribe antibiotic prophylaxis hoping to protect patients from the dire consequences of PJI [16], [17]."

D-Quick note to the Evidence Based Medicine crowd:

The recommendation were once to do X, upon review, they are now Y, yet many practitioners still rec X. NONE of this is writ in stone and it\'s ridiculous to hide behind the evidence based moniker...this current recommendation may modify with time!

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4. Moms, Lack of sleep, Exercise [33:12]
Brenna says:
Hi Robb and Nicki,

As a new mom to a 4.5mo old I\'m curious to know your thoughts, experience, etc on exercise and diet after a night of very little sleep. \\xa0I used to love working out through walking, lifting weights/swinging a kettle bell, however life changes when you have a baby. \\xa0Around 3mo postpartum I started doing some body weight exercise and built back into swinging a 15-20# kettle bell for 15-30min in the morning. \\xa0Diet wise, I tend to follow a lower carb paleo template (50-80g/day) and yes I\'m breastfeeding. My goal is simply to maintain health and support hormone levels for fertility. My weight is fine, but I also want to support good insulin sensitivity and keep some muscle mass since I lost quite a bit right after the baby was born. \\xa0However, after a night or two or three... of little sleep <5hr is it even a good idea to try and exercise due to higher cortisol levels. \\xa0Could adding in short bursts of exercise spike cortisol further and increase insulin resistance, or would trying to get in a few burpees be supportive of reducing insulin resistance brought on by the lack of sleep? I live in Minnesota so going for a walk with baby right now is very hit/miss due to weather. Are there any diet recommendations that you would make to also support these goals such as when to consume carbs vs not. \\xa0I find that going too low carb just leads to hunger and cravings right now.

Thanks!

-Brenna

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5. Keto and HPA Axis Dysregulation [37:20]
Peter says:
Hey Robb and Nikki,

I was curious if you could offer insight regarding keto and HPA Axis Dysregulation.

I have done long stretches of keto, completing both your MasterClass as well as the ketogains boot camp \\u2014 I saw amazing body comp changes from both. I have no doubt when it comes to body comp and lifestyle keto is the way to go for me.

However, when I\\u2019m in keto sometimes I dip into severe bouts of what feels almost like depression (like can\\u2019t function depression) and I become super prone to stress. Basically like severe keto flu, but it occurs when I am long past transitioning into keto.

My first thought was electrolytes. But I\\u2019ve tried as high as 15 grams of sodium to no avail (& 5/1 potassium). I\\u2019m pretty stubborn so I stuck out the boot camp and masterclass despite feeling at times emotionally horrendous.

I haven\\u2019t been able to pinpoint what the issue is but it\\u2019s scared me enough to from keep me from keto for fear of dipping into a bout of debilitating depression.

The most frustrating thing is I really thrive off keto. I don\\u2019t see other people complaining about this issue so I continue to be baffled as to why it happens to me. Basically I want to stay keto, but can\\u2019t unless I get this stress aspect under control.

I recently came across an article by Chris Kresser talking about who Keto isn\\u2019t for (https://chriskresser.com/do-you-need-to-increase-your-daily-carb-intake/) where he talks about HPA Axis Dysregulation being a reason to stay away from Keto. As soon as I read this I began thinking this could be my issue.

After some evaluating \\u2014 I realized in most other facets of my life I think I am pretty sensitive to stressors (training too hard, poor diet, not sleeping well, etc). Additionally, I\\u2019ve done a number on my system with reoccurring treatments for Lyme.

I\\u2019m curious for those prone to stress how might you recommend approaching keto? Is there any hope? Is there anything I could be missing here, like maybe stress isn\\u2019t my issue? I know I if there\\u2019s a high side of electrolyte recommendation (over the 15g I tried) \\u2014 it would be for me. So should I go higher?