Podcast Episode #51: Eczema, psoriasis, fuel for running & more.
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Episode #51: Eczema, psoriasis, fuel for running & more.
September 6: “Practical Paleo” Book Signing with Q&A in Mesa, AZ – RSVP here
September 12: “Practical Paleo” Book Signing with Q&A in West Caldwell, NJ – RSVP here
Balanced Bites Workshops:
FALL WORKSHOPS KICK-OFF ON SEPTEMBER 15TH IN NAPLES, FL – CHECK THE SIDEBAR FOR DATES!
#1. Kids, eczema and maintaining a healthy weight [7:49]
# 2 Fuel for running? [20:24]
#3 Doing everything right and still not better [29:06]
#4 Fear of too many calories [36:43]
#5 Psoriasis [46:32]
#6 Grain-free carbs on 21-Day Sugar Detox [55:16]
#7 Happy Birthday Shout-Out [59:59]
Click here to download this episode as an MP3.
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LIZ WOLFE: Hey everyone, I’m Liz Wolfe. I’m a nutritional therapy practitioner and I’m here with Diane Sanfilippo, the certified holistic nutrition consultant behind Balanced Bites and the new book, Practical Paleo, which is available on Amazon. Welcome to episode 51 of the Balanced Bites podcast. Almost a year. I cannot believe it. Remember this podcast is intended as general information only, and is not to be considered a substitute for professional medical advice, diagnosis, or treatment.
So what’s up, D-Sizzle? What’s up, Diane?
DIANE SANFILIPPO: I love how many new nicknames I have. You got D-Sizzle. My gym calls me “Flip” because there are already at least one or two other Dianes there, so I’m Flip at the gym. I’m D-Sizzle on the podcast. Ah, what’s up…so we’re headed to Arizona next week, you and I.
LIZ WOLFE: Yup, yup.
DIANE SANFILIPPO: Poliquin Biosig, which we talked about last week a bunch, so we don’t need to talk too much about it, but I’m excited to get into a classroom typesetting again, or at least an educational setting and start learning some more new cool stuff, so that will be fun. And while we’re done there, I’ll be doing a Q&A and book signing at CrossFit Lifetime Fitness in Mesa, and that’s on September 6th, so it’s a Thursday. It’s a free event. Anyone is welcome to join us. You can bring a book that you have. You can buy a book there. I have a limited number of books available for sale. A bunch of people have pre-ordered them, but I can only send, you know, like x number at a time. It’s a pretty hefty fee to get them shipped across the country, so I have a limited number of them for sale, but if you bring one, absolutely I’ll sign it. And we’re doing probably about a 60 to 90 minute Q&A, and then about a 30 to 60 minute signing, just kind of depends on how long the Q&A runs, but it was really, really fun last week in Portland. In the Portland area in Oregon. Just got a lot of information out, even in that hour and I think a lot of people were just kind of excited, and it actually got them even more encouraged to come to an upcoming seminar that actually is booked in the Civic Northwest-worth, so that’s cool. It was a fun time, and people can come bring their questions and that’s it, just a couple hours. So that’s-I think it’s a 7 to 9 pm, September 6th. And you can check out BalancedBites.com in the sidebar. I’ll make sure that I get the link in there if it’s not already there.
So what’s up with you?
LIZ WOLFE: Oh goodness. Speaking of like kind of that Q&A type of deal, I did a couple of Fireside Chat type things with some athletes at Trapdoor Camp, kind of a summer camp that was put together by Trapdoor Athletics, Fitness Outside the Box, which I just love that tagline. I think it’s so cool. Some athletes from the Philadelphia, like Pennsylvania, South Jersey region came for kind of a grown up summer camp, which was super fun. I’ll definitely be there next year. It’s kind of fun to sit in the summer camp environment talking about, you know, desiccated liver and organ meats. I mean, where else can you do that but in this CrossFit/Paleo community. You know, go down to the lodge and have a Paleo-friendly dinner. It’s just cool stuff. What else?
Some folks may know that I work with a few non-profits, one of which is Steve’s Club National Program, and I want everybody to head over to StevesClub.org to read about the annual fundraiser. It’s called Beat the Streets, and if you’re a member or an owner you think would like to start a Steve’s Club, which basically just provides mentorship, athletic training, nutritional guidance to at-risk kids from any socioeconomic background, or if you simply want to support the National Program by hosting a fundraiser, they’re really, really fun. If you contact Steve’s Club National Program, you’ll work with Lee. She’s the National Program Director to get your event together. It’s basically just a suggested donation for each participant who comes in and does a workout, a team workout. A lot of gyms do guest speakers and post-workout barbecues. It’s just a blast and it supports a really good cause. What else?
Classes are heating up. I took the summer a little bit easy, but the classes are really intensifying for my Master’s in Public Health. Like you said, we’re heading out to the Poliquin Biosignature training, so I’m just firing on all cylinders, and honestly, I am stressed out. But I’m doing my best to handle it. And all that said, you know what? If you’re working on de-stressing, I would not recommend seeing the Expendables 2, even if your husband just came from deployment and [laughs] it’s his birthday. Because I saw it last week, somewhat against my will, and Chuck Norris was in it, but besides that cameo, the only good thing about that trashcan of a movie was that it ended. I just hate the ridiculous shoot and kill everything ever in the entire world ever thing. It’s lazy, and it insults my intelligence, and it stresses me out. And I feel like I’m still not over it. [laughs]
DIANE SANFILIPPO: I’m sorry to hear that. In other news, I recently saw The Hunger Games, so…
LIZ WOLFE: Ahhh.
DIANE SANFILIPPO: I feel at least like I’m catching up on pop culture. Like I’m so out of it when it comes to news and pop culture because you know, I think we both kind of get this way sometimes. So you tend to stay up on things a little bit at least in the vampire fiction realm.
LIZ WOLFE: [laughs]
DIANE SANFILIPPO: But like seriously, I really nerd on nutrition stuff, and I love reading about nutrition and learning more, and whatever’s working, I do so much work all the time that…
LIZ WOLFE: You’re working all the time. Yeah.
DIANE SANFILIPPO: I kind of am, and I don’t…I don’t watch really much TV, which you know, I watch like Cupcake Wars on Hulu.
LIZ WOLFE: [laughs]
DIANE SANFILIPPO: No joke, seriously like I think my Hulu knows I like that.
LIZ WOLFE: Stop it. Stop it.
DIANE SANFILIPPO: Chopped, all the Gordon Ramsey shows. I have a huge crush on Gordon Ramsey right now, so anyway…
LIZ WOLFE: I don’t even know who that is.
DIANE SANFILIPPO: Exactly. So long story short, and I don’t have a team, like Team Victor or whatever these vampires [laughs] But I saw the Hunger Games, and I commented sort of jokingly on Facebook after I’d seen it. It was slightly about that and Avatar, which I hated.
LIZ WOLFE: Which is not saying much at all.
DIANE SANFILIPPO: Yeah, so anyway, I’m glad I saw it, though, because now I at least feel like I’m in the loop. So maybe you’ll feel that way about this movie one day. No, probably not.
LIZ WOLFE: No, I don’t think so. I think the Sylvester Stallone era is over. Officially.
DIANE SANFILIPPO: So-yeah, so for those folks who are not interested in our witty banter and…
LIZ WOLFE: Witty? That’s cute. [laughs]
DIANE SANFILIPPO: The little moment of catch-up you guys can tune in starting now-ish because we’re going to answer questions now.
LIZ WOLFE: Yes.
DIANE SANFILIPPO: Great.
LIZ WOLFE: So…are you going to read the questions?
DIANE SANFILIPPO: Is it opposite day today?
LIZ WOLFE: It’s opposite day. Let’s do it.
DIANE SANFILIPPO: Like on television, it’s opposite day. Okay.
LIZ WOLFE: [laughs]
DIANE SANFILIPPO: Well, so Liz had a whole bunch of awesome insights on a lot of these questions, which she usually does, but often I’m more long-winded on them than she is, so this time I’m giving Liz a chance to be more long-winded, and I will still chime in with my thoughts, but I’m going to read the questions, and let Liz answer first. So the first question is “Kids, Eczema, and Maintaining a Healthy Weight.”
Christina says:”Made the change to Paleo nutrition in Feb 2011 for my family (2 adults, a boy aged 9, and a girl aged 5) with 95% adherence; some candy and Oreos still exist.” Well, they still exist, but anyway. “Everybody has seen amazing results with asthma, sleeping, activity, weight loss/ gain (as needed) and cholesterol levels; except my son who has eczema. After two ER visits for severe allergic reactions and multiple blood tests by two allergists, we have learned he is allergic to coconut, mustard, sunflower seeds and all tree nuts. I was using coconut oil and flour at the start, then stopped, however we still use almond flour since he can tolerate it and we see some control of the eczema. My son is 4ft & 48 lbs at 9 yrs old. We would like to get better control of his eczema and put some weight on. What kind of Dr do I need to look for or can you recommend in MI to support our Paleo living and get his gut healed/ eczema suppressed? Or is this something we can do online? Thanks. Christina”
LIZ WOLFE: All right, so this is tough, and just want to reiterate that we’re just talking here. This is not medical advice, especially when you’re dealing with a little one. Just make sure that whatever you’re doing, you’re running by your doc. You can go to Paleo Physicians Network or Primal Docs, and we’ll make some recommendations for that. But just make sure that you bounce this off your intuition and your doctor. So all right…so here’s what I was thinking about this. Often we’ll see improvement in skin issues with the removal of processed dairy and a little gut healing. That’s kind of the baseline when it comes to skin issues, in my opinion, and that was certainly the case with me. Eczema is on that food allergy-autoimmune spectrum. The two are really intimately related, in my opinion. But there could also be an association with a lack of magnesium, zinc, glycine, even very low stomach acid. These are just a few different associations that have been postulated, but in the end all of that really does tie back to compromised digestion at some point on that, you know, progression from top to tail. And if your son had these digestive and allergic issues, it’s very possible he hasn’t been absorbing those minerals for some time, both because the stress has suppressed his stomach acid and because overall he hasn’t had the equipment primed for digestion in the first place.
So, and a lot of times when I see folks that deal with allergies, we do-one of the first things we do is make sure that stomach acid is properly breaking down these proteins and Diane, this is something that we talk about in the workshops, kind of how that, those unbroken down proteins can set the stage for these kind of autoimmune and allergic issues. Anyway, we can hope, I think, that he will become more nutrient-sufficient as you continue to provide those nutrients, those kind of just in this Paleo lifestyle as time goes on. And that these potential issues with stomach acid will resolve as well, as his body stress is alleviated and his gut is healed. And that does take time, and it takes detective work, and I think those are two things that Christina has the willingness to do. I personally don’t know that I would, to any extent, do stomach acid supplementation for a child that age, so my focus, as with many things, would be bone broth, the cod liver oil/butter oil blend, which is great for kids, from GreenPasture.org. It’s the Blue Ice Fermented Cod Liver Oil/Butter Oil Blend. A continued supply of good quality animal products chewed very well, maybe put into soups or stews; they’re kind of that pre-digested almost a little bit. I also really like red palm oil, which I’ve gotten from Tropical Traditions. It seems to help me personally a bit with my skin, and I always had a little bit of eczema issues from the time I was young. It resolved mostly, but I still need that support, and you know, but I’m weird, and I’ll take a teaspoon of weird tasting oil just for the heck of it. I think everybody’s kind of figured that out about me at this point. You may not find that same willingness from a 4 year old. You may want to do an autoimmune protocol and eliminate nightshades. Diane, I know you outline autoimmune protocols in your book.
Maybe look at a GAPS practitioner. That’s Gut and Psychology Syndrome, but it also can be really, really helpful with skin issues. A GAPS practitioner can work with getting good gut bacteria colonized and well-balanced, and additionally, it’ll work toward nutrient sufficiency. Any time you support digestion, you’re supporting the pulling in and the assimilation of nutrients. So I do know that nut flours are utilized on the GAPS diet, and I’d be curious to hear what you think about that, Diane. Just nuts in general in this situation.
DIANE SANFILIPPO: So yeah, you’re pretty spot on, I think, with your notes there. I do cover a lot of the sort of add/avoid items for diet and lifestyle related to autoimmunity in the book, and this is definitely one of those cases where I would consider this an autoimmune response and just a gut imbalance, which does lead to this autoimmunity from a lot of people. So I’d review those outlines of the sort of add and avoid and to just make sure you’re kind of following that. So while he’s working on gut healing, I would avoid nuts. I mean, I know-this is even something that was something that was part of my Digestive Health plan. I know that nuts and seeds are “Paleo-friendly” but they also do contain pretty large amounts of gut irritants that most of us when we get rid of grains and refined foods, we feel just fine eating nuts or seeds here and there, but I do think that they’re worthwhile to eliminate, at least for some time. So even those that he didn’t show up allergic to, he could very well be sensitive to, and that could be irritating his gut. So I would just get that stuff out for awhile. I think it seems like his symptoms tell you pretty quickly whether or not something is working, so it’s probably pretty worthwhile.
I would also even pull eggs out of his diet, and again that may seem like, oh goodness, one more food that I can’t eat. But again, I would start with pulling out the nuts for maybe a week, and then move on to eggs for about a week or two. You don’t have to do it necessarily for a full month, but at least a couple of weeks, and if he’s feeling better, then it may be worthwhile elimination to have all the time. Or on the other side of this, another way to sort of manage foods that may be irritating, but not allergenic, is to rotate them, and I haven’t talked about this a ton, but it is a very worthwhile approach, and it may be something that they talk about with the GAPS diet-I’m not positive-with a later introduction of each food, but if he shows that he’s sensitive to eggs, it may just be something that you want to make sure he only eats every like 4 days or so. That he doesn’t eat them every day or even every other day. So it’s just something to keep in mind, that if some of these foods are potentially irritating, but not directly allergenic, they may just need to rotated. So rather than like rubbing your arm in poison ivy every day, you rub your arm in poison ivy, then you let it go away, and then you do it again. So it’s like you’re not flaring up this huge rash. That’s…I mean, it’s the best analogy I have, and it’s basically what I think is happening inside your gut to some degree when you basically beat it up with foods that are irritating. It’s sort of like, okay, well, you’re going to have this level of irritation, and you can either continue to, you know, add insult to injury, or you can let it calm down for awhile, and then potentially reirritate it, and you know, that’s up to you and how much you feel that, and feel the negative effects of it is going to vary greatly. So I-I can’t even say this. I absolutely agree on the bone broth thing. So if it means more stews and soups or even just like pureed veggies with broth can make a great soup. I think carrots are pretty innocuous across the board for most people with digestive issues. Pretty easy to handle.
LIZ WOLFE: Mm-hmm.
DIANE SANFILIPPO: So like a pureed carrot soup. Put something pretty mild with broth.
LIZ WOLFE: Some soluble fiber with broth, yeah.
DIANE SANFILIPPO: It also-totally. You could also work with something like the herbal tea gelatin cubes, which I have a recipe for in my book. Those are really fun for kids, a great way to get some more gelatin, the glycine, some of those gut healing amino acids in, that just is a little more kid-friendly. I mean, I think it’s adult friendly too because it’s just nice to have something other than soup sometimes, if you just want something a little different. So people have been really taking to that recipe. And I pretty strongly believe that this whole psoriasis issue…
LIZ WOLFE: Isn’t this eczema? This is eczema. Psoriasis is later. [laughs]
DIANE SANFILIPPO: So sorry. So it’s pretty similar though. It’s a pretty similar issue. So I think the issue of just like gut flora balance is pretty important, so I’m going to get into this a little bit later when we do talk about psoriasis in a little more detail, but for him, because she really was asking, you know, can I go to a certain doctor or…
LIZ WOLFE: Mm-hmm.
DIANE SANFILIPPO: she wasn’t really even asking for a bunch of solutions, but it’s always good to have ideas. If he’s not getting probiotic foods in, I would strongly, strongly recommend that. So fermented veggies like sauerkraut or carrots or beets, don’t assume he won’t like them. Try it because kids will surprise you. And if you like it, and you eat it, chances are he’ll try it at some point. Just keep working on it. You could even try something like the Zukay Live Foods, I think, is the brand. Their beet kvass is very, very sweet, and I think it’s good if you cut it like with some lemon or orange, fresh squeezed, and then a little bit of water, so that it’s a little bit less sweet.
In terms of a practitioner, obviously I would also say like a GAPS practitioner, so that’s kind of it there. And we can maybe link to the Paleo Physicians Network and Primal Docs. But one other note on supplements is that l-glutamine might be really useful for him in repairing his gut lining. You could even just do like 2 to 4 grams a day. That’s a pretty low dose. It’s a very low dose for an adult, so it should be safe for a kid. You might just want to do a little bit of research on that, but it’s just helpful for rebuilding the gut lining. And I would get with that along with some probiotics to really make a positive change, you know, looking also at those couple of other potential food eliminations, and understanding that those may not be for forever. Like I know that that’s always so hard for people when we tack on more and more food eliminations, but they may not all be for forever.
So a couple of notes on brands of probiotics that you may want to research that have children formulations specifically. I think Klaire Labs, spelled with a K. K-L-A-I-R-E. They have a children’s specific. There are a couple of other brands I know of that are pretty easy to find-Dr. Ohhira’s and New Chapter. Not positive they have children’s formulations, but I would look into that. And a lot of times with kids, it’s just-I see this all the time. It’s just a matter of really getting that gut flora balanced because there are not a lot of other factors environmentally. There absolutely can be, you know, new carpet has been installed or the house has been painted and they’re very sensitive to chemicals. Like that’s really the only other major factor with this besides just general gut health, so you know, if that’ something else has happened in your world. You know, if you guys installed new carpets or you had something painted or something to that effect where there’s been large amounts of you know, potentially very toxic chemicals around, you know, you may not feel anything but a child’s system is way more sensitive, so…
LIZ WOLFE: Exterminations, stuff like that.
DIANE SANFILIPPO: Anything where there’s some chemicals. Even, you know, if you just use a lot of harsh cleaning products, that kind of thing.
LIZ WOLFE: Mm-hmm.
DIANE SANFILIPPO: I mean, it goes on and on, but…yeah, that’s what I’m thinking.
LIZ WOLFE: Good job.
DIANE SANFILIPPO: So ready for the next one?
LIZ WOLFE: Ready.
DIANE SANFILIPPO: We’ve got a question about fuel for running. Lauren says: “I am a marathon runner and have been gluten free for 3 years and somewhat paleo for a while as well. I need the carbs to run well and am allergic to coconut! I can’t seem to be able to run without some kind of carb like oatmeal or eating some Clif Shot Bloks before I run. I don’t eat much in the way of grains other than occasionally having some brown rice but I do eat these Bonk Breaker bars”
LIZ WOLFE: [laughs] It just sounds funny.
DIANE SANFILIPPO: It does. “Other than that it’s just sweet potatoes or regular potatoes but not every day. How do I get off the Clif Shot Bloks?? Any suggestions??” We’ll post a link to what these “bloks” are and I will say, I have eaten those, and they are like gummy deliciousness in my race training days. Those were short lived. So Liz, what do you have to say about this?
LIZ WOLFE: Well, I am not a runner. I never have been. I think I topped out at like 4 miles. I remember when my husband and I were first dating, he had done a half marathon, and I was like, I want to do it, too. And I went out and ran one day. I was convinced that I ran at least, you know, a quarter marathon, and I came back, and I had run for 15 minutes. And I sent him a picture of me flipping him off in the mirror, and that was the end of my running days. So I can’t necessarily commiserate, but I have heard many runners say they need the carbs to run well. And I just want to throw in there that a good percentage of those people, at least the ones that I’ve spoken to or worked with, they really, really hang on to that. But when they have the time and you know, the opportunity to at least see if they can get fat-adapted, they really do well.
Now that’s not everyone, and at times that fuel source transition, not just from carb to fat, but from one type of carb to another can take time and effort and a little bit of-steal a little bit of sanity in the meantime. But it is possible to, at the very least, just change the less desirable carb to a slightly better option. So let’s look at a Clif Shot Blok ingredients. I have this in here, in this document here. Organic brown rice syrup, organic dried cane syrup, organic brown rice syrup solids, pectin, citric acid, green tea extract, colored with carrot, blueberry, and black currant juice concentrates, natural flavor, organic sunflower oil, carnauba wax. So what you’ve got is some sugar, some more sugar, more sugar, some caffeine, some color from vegetable concentrates, fruit concentrates, some binders and texturizers from the pectin and the sunflower oil and the wax. So this is basically sugar and caffeine formed into a block with wax, for convenience, basically. And it’s colored pretty. So what’s going to fit into your lifestyle that’s not packed up like this? And she’s talking about, I think, pre-run, so you know, it might not even a matter of getting something that’s portable enough for her to take with her on these runs, but what about working with applesauce? Sweet potato, even honey wafers, and by that, I just-I basically mean raw honey. Molasses. Some instant espresso. Things that are easily assimilated when your body is not concerned with digestion. Could she make her own Lara Bars with raw honey or blackstrap molasses, some espresso, some dates. Our buddy George of the Civilized Caveman has a recipe we can put in the show notes for her to play with, which might contain some coconut but that could easily be substituted with ghee for a more savory flavor or even palm shortening from Tropical Traditions. I’m not sure whether she’s okay with palm, but Tropical Traditions does have a sustainably sourced palm shortening that’s as solid as coconut oil and it’s basically flavorless, so you could go have a look at that. You do have to kind of buy in bulk, but it will last forever. It’s really convenient. I have some in my cabinet.
Now I do now that the original marathon runner did not have Clif Bars with him on his way from Marathon to Athens, so but then again, I think he also died at the end, so that might not be the best example. Anyhow. Diane, do you have any thoughts on this one?
DIANE SANFILIPPO: Yeah, [sigh] I have that chart. I don’t know where it is right now, but there’s a chart of sort of this whole list of how well we are fueled for activity on sugar vs. fat. And so I definitely think that people who are doing endurance athletics really need to start to educate themselves on this idea becoming more fat-adapted. I think Jamie Scott did a talk on this at AHS, and either it was too early in the morning or I just was in another talk, I can’t remember exactly what the scenario was, but it was a very stressful week for me, so I wasn’t at some of the very earliest talks. But it will be available online, and I know he talked about fat adaptation for endurance sports. But our bodies can only run on carbohydrates for about a maximum of 60 to 90 minutes, I think. I’m pretty sure we use up all of our glycogen stores in that much time. So if you’re not training your body to figure out how to use fat for fuel, then you constantly have to rely on these bloks and shots and goo type things, and so if that’s sort of how you’re operating, and I think that when you’re running at a marathon pace, it’s not a sprint, right? So when you’re doing like a CrossFit workout, that might be 15 minutes, and that’s a little long for a CrossFit workout, but it’s a very intense 15 minutes. You tap into that glycolitic pathway, right? You’re using that glycogen store that you have. If you’re doing endurance athletics and you’re running at this, you know, I guess what they used to call it on a cardio machine, is you’re in that fat burning zone. You know, where you actually are not…your heart rate’s not quite as high, right? You’re not pushing to where you can only do that for about 10 or 15 minutes. You’re pushing so you can run for 2 to 4 to 5 or 6 hours, however long a marathon takes. You have to be burning fat for fuel at some point during that.
So I think part of the issue is, and we don’t know what her body composition is like, but a lot of marathoners can be very, very lean, don’t have a lot of body fat to use. But the other issue is consistently putting sugar into the tank makes your body continue to look for sugar. So what you’re doing is essentially just burning out what’s there and then continuing to replenish that with the bloks. Or fueling up before the run…I don’t really know, but that’s really my kind of solution for that is to really work on becoming much more fat adapted, and that doesn’t mean that you don’t also store some glycogen, but you may need to cycle how you’re eating and how you’re replenishing glycogen, so that you’re not just constantly sugar burning. So that being said, I think your recommendations on what to eat, in terms of like the sweet potato, even adding some of that honey. You know, people get really down on fructose, but fructose is okay for athletes who are burning through all of their glycogen in their activity. So glycogen is the stored form of carbohydrate. We put it in our liver and in our muscles, and we’ll top off our liver first with fructose, but when you’re doing this type of activity, you’re burning through all of it. You’re emptying out your liver stores, you’re emptying out your muscle stores. So it’s not really as concerning to me for an athlete of this nature to be getting honey, which is pretty high in fructose into their sort of pre-workout little mix, if they need it. But I really would…I really would tinker around with training in a way that even if you have some longer runs, that you’re not relying on as much sugar. That you’re figuring out how to get your body used to burning fat for fuel. That’s it.
LIZ WOLFE: Beautiful. Beautiful.
DIANE SANFILIPPO: All right, so question 3, and this is a bit of a doozy. But we’re going to throw it out there because I know we have a lot of people who have kind of similar types of questions even if they’re not the exact same question. So this one is “Doing Everything Right and Still Not Better” from Regina.
Regina says: “I wrote in a question for your (Diane’s) recent Underground Wellness Radio show with Stefani Ruper. My question was: “potential causes of amenorrhea, acne, and digestive issues. been dealing with it all since puberty (7 years now). Went paleo 2 years ago. my condition has improved, but I’m certainly not “cured.” I’ve had numerous blood tests and everything appears to be normal. Birth control makes me feel TERRIBLE (bipolar, anxiety, horrible digestion, and insomnia) and I definitely have issues with gluten and dairy, but I’m hardcore clean paleo. No cheats ever. Help!!!”
I just wanted to thank you for responding and add a little more so perhaps I can get to the bottom of this problem for once and for all. I started menstruating at 13 (I’m 20 now) and it have never been regular. My period is always very short and very light and comes very randomly many months apart. At first I was in denial about all this. When I finally talked to a doctor about it (many actually) they said I had PCOS, despite the fact that all my hormone panels came back normal. I was then put on birth control which I hated and made me totally crazy and really messed with my digestion (everything just grinds to a halt).
Around this time I went cold turkey Paleo. I was 18. When I went to an endocrinologist with all this, she did another hormone panel and told me my hormones are actually fine and all in ratio and diagnosed me with “ovarian resistance”, whatever that means. She then put me on a third round of birth control, which never actually made me bleed and gave me horrible insomnia and anxiety, and exacerbated my already troubled digestion. There was no time or effort put in by her, or any other doctor, as to why my ovaries might be “resistant”. In my first round of testing it showed that I was severely deficient in D and B.” Those are vitamins she’s referring to. “I also run cold – my temperature”
LIZ WOLFE: [laughs] Not letters, but vitamins.
DIANE SANFILIPPO: “My temperature is always around 96.
Luckily through a strict paleo diet and good supplementation my nutrient levels are back up. However, I still rarely menstruate, have acne, and feel as though I have a ton of bricks in my guts. This can make me extremely exhausted in a can’t-get-off-the-couch-watch-7-hours-of-Downton-Abby kind of way.” That’s really funny.
LIZ WOLFE: Diane, Diane, Diane. It’s Downton Abby.
DIANE SANFILIPPO: Is that really what it is?
LIZ WOLFE: Yes.
DIANE SANFILIPPO: I told you I don’t watch TV. TV shows. Okay. So here’s what she says.
“So, here’s what I know. I have problems with gluten and dairy. I haven’t touched gluten in 2 years now, though I’ve done some tinkering with raw dairy since then. I’ve come to realize that dairy doesn’t treat me well either. I make everything from scratch to make sure I avoid those two. I’m also religious in my avoidance of sugar. When I want chocolate, I make my own, lightly sweetened with figs/dates and a bit of honey. My body weight in normal and has always been. I’m fit – I love to get outside in my barefoot shoes and I do a ton of yoga.
So, what am I missing here? I feel as though I’ve been doing everything right for so long now, and while things have improved, nothing seems to tip the scales. Stefani’s talk about hypothalamic amenorrhea really hit home. That is me! Though I think my stress is induced by my own denial of my body’s natural and necessary cycles and years of nutrient deficiencies due to gluten consumption. In your professional opinion, could that just be it? If so, what do I do? Just keep on going, stay healthy, and let time heal? Any advice and words of wisdom you could pass on to me would be greatly appreciated (and needed). Thank you so much.” I guess she came to my party, and was at AHS. Maybe I already spoke to her. I probably did.
LIZ WOLFE: Maybe you did. But I don’t think she’s the only woman that’s dealing with this. I actually…it sounds really familiar to what a friend of mine is actually dealing with as well. And obviously, you know, Stefani is just so…just so brilliant about this stuff and she may want to talk to Stefani. I know Stefani does see clients and referral bonus. I’m just kidding. We don’t do that. But I’m just kind of wondering, you know, a few things. What kind of birth control? I’m assuming it’s the Pill. Besides commending her on her excellent choice in British melodrama and her really great instincts with regards to patience and healing, I think all I would do and this is clearly something that kind of exists in the medical realm, at least a little, in large part. I just would do everything I could to make sure that the foundations were there. That digestion was well-healed. That she was absorbing and utilizing minerals, that she was nutrient deficient in general, and just kind of lay all those foundations as much as possible. Just so that’s there, and it can’t kind of stymie progress in other areas. That’s really my biggest thought.
And I’m curious about…I’ve been doing a little bit of reading on vitamin D, and it’s unclear to me whether low vitamin D is a consequence or a driving force in other problems. Does that make sense? Like I’m just not sure, and there’s a little bit of debate out there whether certain issues cause low vitamin D, or if low vitamin D causes certain issues. So, you know.
DIANE SANFILIPPO: I don’t think there’s definitive about that stuff, ever, so like low stomach acid. Why does somebody have low stomach acid? You know, we know stress can cause low stomach acid, but, you know what I mean? Like…
LIZ WOLFE: Yeah.
DIANE SANFILIPPO: having a low level of something doesn’t mean that you’re not getting enough of it in. It just…it may be a breakdown somewhere, so anyway. One thing that kind of resonated, which it didn’t really hit me when I first read her question, but it did as I was reading it out loud, is that she’s describing symptoms of some pretty classic thyroid imbalances, so I would make sure…she says she’s gotten hormones tested. I’m not sure if those were just female sex hormones and cortisol, if she got thyroid hormones tested.
LIZ WOLFE: Oh, yeah.
DIANE SANFILIPPO: Get a whole thyroid panel done, and that includes things like both T4 and T3, and maybe even Reverse T3. I would get a TPO, which is a Thyroid Antibody Test. Just to make sure that those are all looking okay or normal, and I would go to Chris Kresser’s website to look at what all of the measures are to get. We’ll put a link to Chris’s series on thyroid health, but it’s probably more than maybe either recommended by your doctor in a standard setting or that insurance will cover outright, so you may be, you know, have to just kind of step up and say, okay, I’ll cover this extra test, just so that you know, because not having a period and being constipated are two really, really classic symptoms of a hypothyroid situation, and you may just not be exhibiting the weight gain, but being very lethargic is also classic, classic hypothyroid, so those are things that I would definitely…if this were me, that’s what I would have checked, absolutely. If I was not going to the bathroom, but, you know, not going to the bathroom, too, when you’re on the Pill, and that’s throwing off your hormone balance, like yeah, that’s kind of where I would go. Check out thyroid.
LIZ WOLFE: Nice.
DIANE SANFILIPPO: Anyway…we’ve got one here. “Fear of Too Many Calories.” Laura says: “I have one main question as I start this journey…. I have PMDD and I’ve discovered through support groups that using a Paleo Diet helps so much with the symptoms. My “fear” is…I am also right at 200 pounds 5’6″ and need to lose weight. I am already exercising daily and keeping my calories about 1200-1300 plus exercise calories.” I don’t know what that means, if she’s eating extra for the exercise. “I’ve lost about 15 pounds but obviously have about 40-50 more to lose. I can see eating meats and oils are going to push me over my calorie limit quickly. How can I wrap my mind around losing weight/keeping calories under control and the added bulk calories in the ingredients? Thanks for your time and the passion that is obvious on your blog.”
LIZ WOLFE: So this involves much more than food. Obviously. And it’s clear that Laura knows that, but this is a situation where, in my opinion, we need to go very, very deep down and start at the foundations, which is, for me, the concept that we are supposed to look like any one particular body type. So of course, there are health problems associated with overweight. We understand that, and this is something that we discussed a little bit with Stefani Ruper when she was on the podcast. Stefani at PaleoforWomen.com. There is a healthy, kind of spectrum of body weight for women. So the quest to lose weight is not, you know, in error. And Laura’s definitely doing the right thing in trying to work towards that healthy range. But I imagine if she’s like me or most women that I’ve worked with, there is a fairly specific idea of what she does and doesn’t want to look like, and this image is directly dependent upon caloric load. So thinking if I eat x amount of calories, then I will not look this way, or I will not drop weight, you know, according to whatever the standard, I don’t know, 2 pounds per week or a pound and a half per week, or whatever that is. So, you know, eat too many calories equals goals not met. But living in that space just adds baggage to this journey that doesn’t need to be there. So what Laura needs is patience. She needs to focus on enjoying the process of learning and nourishing and allowing her body to make the adjustments that need to be made internally irrespective of how quickly a certain amount of weight is lost to what end and with what caloric window. I know how hard that is, but it’s not only vital that we shift this weight loss thing to a commitment to nourishment instead, but that we alleviate all that other stress and baggage of calories and scales and just other garbage that just makes folks second-guess themselves. When you’re eating real food, meat, healthy fats, and veggies, and working to heal digestion and get those nutrients in while enjoying the process of just on-going learning and self-determination, realizing that you’re in control of your destiny, you’re not forcing your body to cannibalize itself against a prolonged starvation/calorie deficit. You’re giving it the tools to make adjustments over time. You’re caring for your mind as well. Nobody got to an unhealthy weight overnight, so expecting to use severe restriction or any kind of real restriction as is still seemingly the gold standard of most weight loss programs targeting the overweight, it’s just nonsensical. It doesn’t work.
So what I want Laura to know is that first, she is in control. Not her calories, or the food scale, or the human scale. You should go fully at the reins of your own life when you make decisions confidently. So that’s what comes first, just learning and just owning everything you’re doing and why you’re doing it, so you can have that confidence and feel good about what you’re working towards, and be more inclined to kind of treat yourself with patience. Take joy in this process of nourishment, and you know, things fall into place over time much more pleasingly and lastingly than calories restriction or any kind of behavior that even in any way mimics this kind of modern diet regimen obsession. So I also think for some people in this situation, it does help to work one on one with a practitioner because you can voice this concerns individually and stay on track. I’ve built consultation packages for folks where you know, they can text me if they’re feeling a little bit unsure of themselves. This is a really, really hard mentality to break. That’s it. That’s pretty much what I wanted to say.
DIANE SANFILIPPO: Yeah, I think that people need to understand that 12 to 1300 calories and I don’t know if I talked about this on the podcast in the last couple of weeks, but I’ve been talking about it a lot with people who are really wrapped up in calories, that you need 1200 calories a day just to be alive and breathing and laying in bed. That’s what your body needs just for that. So that’s to stay alive, and if you’re trying to replenish nutrients that you haven’t probably eaten for the last, you know, 20 years or so, I don’t know how old she is, but most of us are trying to play catch-up, right? We’re eating these really nutrient dense foods not realizing we hadn’t been for so long. To deny yourself of calories that your body needs to denying yourself nutrition, and I’ve said that a lot of times. But it’s really important to understand that because what your body needs in order to let go of weight, and I don’t…I think that that’s kind of a better…it’s almost like a better way of seeing what happens. It’s not that you personally lose weight, or, you know, accomplished this weight loss, which of course it feels great and I don’t mean to discredit the work that you’re doing, but you have to work in a way that makes your body healthy, so it will let go of the extra weight that you don’t need. That’s really what it’s about, and this is about hormonal balance and nutrient sufficiency. Getting your body to a place where, like I say this a lot, like your body [xxx] you, that what you’re doing is what’s going to be what you continue doing…that didn’t sound right, but it will be what you continue doing, so when people do like a crash diet or something like that, or they really cut calories, you could lose weight doing that because you’re starving your body. But what will happen in the long run, and this is why those kinds of diets don’t work, is that you’re not putting nutrition into your cells, and eventually, they’re going to hold onto everything that’s there, and not let go of that body fat because the balance that you’ve created is completely off. So you want to be replenishing those nutrient stores. You want to be keeping your stress levels down, and that means you’re doing your exercise, but you’re not trying to crush yourself, and this is not, you know, the Biggest Loser. That stuff is not realistic. It’s not really what people should be doing at home. And it’s just not [xxx].
So I think consistency over the long term, working on your mindset and the mental aspect is the largest part of this game. It’s getting your head wrapped around it, with all the stuff that Liz just talked about. Getting your head really in a different place and your body will follow suit.
LIZ WOLFE: I mean, you do have to be patient with that adjustment period. And sometimes people feel this process of rearranging and sometimes plateau, and they get frustrated. But the people that find success are the people that nourish themselves through that, and sometimes it takes some patience. But I’m telling you, I just hit a workout with a client who absolutely has changed her entire life. And way back when she and I first started, I had to coach her through probably a 6 week period, where she didn’t feel like she was making progress, where she wanted to restrict calories, she wanted to restrict carbs. And I just had to tell her, you didn’t get here overnight. You need this time to adjust. And just, you know, for some context, a lot of people will look at like vegan or vegetarian diets as this gold standard for weight loss, and literally, it…with those diets, you’re actually not extracting calories from food. So that can be responsible for some pretty dramatic and somewhat unhealthy weight loss in that kind of long term context. The book Catching Fire by Richard Wrangham talks about that a little bit. It’s not entirely about that, but it is somewhat about that. And it’s a really valuable resource. And I just feel like this Paleo/Primal/Ancestral diet is different. Your body loves these foods, and like Diane was talking about, your cells love these foods and you have to kind of build up those foundations and that infrastructure. If you expect whatever it is, you build on top of that to last and be sustainable.
DIANE SANFILIPPO: Amen.
LIZ WOLFE: Amen. Namaste.
DIANE SANFILIPPO: I’ve had a lot of people hit plateaus and just…it’s about the consistency, and then the weight loss starts up again.
LIZ WOLFE: Yeah.
DIANE SANFILIPPO: I’ve seen this happen many times. So it’s really about just being consistent. Staying on your long road trip until you reach your kind of destination and not worrying about stopping so much, and just kind of staying on the trip. We’re all on our own long road trip here. All right. Psoriasis. Sorry, I was confusing the eczema with the psoriasis before. Number 5 is Psoriasis. Keely says: “Our family has been doing the paleo diet for a little over 2 months and we all feel great! My only problem is that my psoriasis is worse than ever. I have suffered from scalp psoriasis for most of my life. The only times that it has cleared is when I am pregnant. I figured that is would get better since we’re eating so clean. I do not want to take medication or put chemicals on my skin, so I am wondering what my other options could be? Thank you!”
LIZ WOLFE: Okay, so this is my favorite thing to do is to read in to the way people punctuate their questions, like literally punctuate, use punctuation in their questions, and then make entirely uneducated guesses about their personalities. So Keely used 4, and I’m not making fun of you, Keely, I promise. But Keely used 4 question marks in a row here, so [laughs] I just get the feeling that there’s a very active, very enthusiastic, very go personality here that may possibly change and mellow a little during pregnancy. Now this is very, you know, mystic-ish, and not very Western, but psoriasis is in some circles thought to be worse in individuals with very active, highly kind of kinetic personalities. It’s just thought to be kind of a physical manifestation of that very energetic type. Now of course that’s not everybody, but who knows? I think it’s kind of worth throwing out there. It might be worth thinking about.
I also think from a nutrient standpoint the first place I would go is sunlight, and vitamins A and K2, first line of defense. If it were me, I’d probably, and this is me as an adult, speaking to another adult, I probably would push a higher intake of the cod liver oil/butter oil blend at least for a short period of time. I always like to look at sulfur. I’m poorly educated on this whole sulfur thing, but Stephanie Seneff has spoken about it a lot. She’s a genius. She’s involved with the Weston A. Price Foundation. She’s a researcher at Midland she’s talked about the role that sulfur has to play in everything, basically. And everything in your body, and especially with skin health. So making sure people get enough cholesterol, which you can actually look at it as cholesterol sulfate and vitamin D sulfate. All of those things, I think, could be powerful. Diane, what are your thoughts on this?
DIANE SANFILIPPO: So I’m going to take this back to gut because that’s where I always go…
LIZ WOLFE: Do it.
DIANE SANFILIPPO: Gut health and poop. But definitely I agree with your intuition on that in terms of stress and we know that stress will absolutely exacerbate psoriasis, as it’s nearly entirely linked to leaky gut, at least from my understanding. So gluten contamination can be a pretty huge issue with psoriasis because I know there are a ton of people who are experiencing symptoms with psoriasis, who are eating gluten and if she’s not eating gluten, I would really challenge her to make sure she looks through everything she’s eating, any sauces, anywhere she dines out, and makes sure that that’s not contaminating her food. And you could refer to my guide to gluten. There’s a downloadable one on the website. There’s one in the book as well. The one on the website currently has a ton of like ingredient additives that could be a gluten containing, so I would just check those out. It really hides in a lot of things. It can also hide in body care products. So, you know, she’s saying she doesn’t want to use medication or chemicals, but she may be using a shampoo right now that has gluten in it. And that could just be totally setting it off, and that could be a very simple fix. I mean, we have no idea if that’s the case, so I would check that out.
Liz, do you know of a list of where to find gluten free shampoos?
LIZ WOLFE: I would go to gfsoap.com. I’ve used their shampoo. It’s lovely. I do the no ‘poo method, which I’ve got a client right now that’s dealing with some kind of psoriatic type issues, and I don’t…it may be a little bit harsh for her, so I would definitely go to gfsoap.com. That’s really the only one that I know is like dedicated gluten free facilities from A to Z.
DIANE SANFILIPPO: Okay. That’s kind of my thought process is, you know, any gluten contamination would really be watching that closely. So psoriasis can also be strongly be linked to things like a fungal infection or just gut bacterial imbalances, which also are contributed to again by leaky gut. So if you haven’t kind of learned more about what leaky gut is, it is an increase in your intestinal impermeability, so the cells that line your small intestine have between them what are known as tight junctions, and for different reasons, some of them can be stress, so increased cortisol throughout your system. Food intolerances, so foods that you’re trying to eat that you don’t break down, or this bacterial imbalance can all contribute to a weakening of that tight junction. And potentially things like gluten can literally open that tight junction almost like a key because it acts on this enzyme called zonulin. So what zonulin is known to do is to be able to open that tight junction and this is something that Dr. Alessio Fasano has done a lot of research on. If you’re interested in reading more about that, but when it comes to something like intestinal permeability, if you’ve got gut bacteria imbalances, and I talk about this because it’s pretty easy to work on this. You can either, you know, go to your doctor and get some kind of a stool test, see if there’s a infection or pathogen, and you will need to take antibiotics, then you follow it up with probiotics as we know, so we rebalance things. If you need to kill some things off, that’s really the way to do it. Or you can start by just trying to get the good bacteria back in there.
Because if you do have an overgrowth of the wrong type of bacteria, it’s known as dysbiosis, so it just means that imbalance, and what those sort of bad bacteria are doing, are giving off these compounds known as gram negative bacteria. So on the exterior of these bacteria are what known as lipopolysaccharides. You don’t need to really know that. I’ll abbreviate it as LPS. But what we know about lipopolysaccharides or LPS is that they also interact with the lining of our small intestine, and also with the immune layer, what’s on the other side of our small intestine known as GALT: gut-associated lymphoid tissue. And what that does is it upregulates our immune system, so this can also be contributing to the leaky gut. And so really, you might not even be eating gluten at this point, but if you’ve got some kind of irritation in your gut that’s going on, some kind of infection throwing this whole balance out of whack. There are a lot of other foods that could just be plain irritating that are still considered, you know, legit Paleo foods, but they can be irritating to your system, so we really want to make sure that you’re working on figuring out what’s happening in your digestive system because whenever anything’s happening visually on our skin, you know, on your scalp, in how you look, that’s…you can’t directly relate to well, I’m really tired, so maybe my eyes don’t look so alert, or oh, I got a sunburn so my skin is pink, you know, if it’s pink for a reason that you can’t explain, it’s usually something that’s happening in your gut. So that’s kind of the track that maybe you figuring that out, so again if she just wants to try getting some probiotic foods in, which we already talked about earlier, or even a probiotic supplement to see if that starts to rebalance things a little bit, and I would also steer clear of anything sweet or sugary for at least a few weeks, and see if that helps it subside. Because that’s may show whether there’s a fungal infection in there. So…ready for the next one?
LIZ WOLFE: Oh lord, yes.
DIANE SANFILIPPO: Are we coming up on an hour here? I don’t have a…
LIZ WOLFE: I think we might be because we were on the phone a little bit before we started recording, so it’s possible, but it’s about time.
DIANE SANFILIPPO: So let me do this last…it’s time sensitive in a…
LIZ WOLFE: [laughs]
DIANE SANFILIPPO: I know. Sorry. It’s about the Sugar Detox and we’re kicking off a new one in just a few days, so I want to just get to this.
LIZ WOLFE: Do it.
DIANE SANFILIPPO: So I’ll give my answer and then we have a quick shoutout at the end here. And then we’ll wrap it up. All right, so number 6, “Grain free carbs on the 21 Day Sugar Detox.” Karen says: “Hi , I just started the 21 sugar free detox and I am now on day 4 things are getting better but I am trying to find something for breakfast to replace my toast and peanut butter with banana. I need something that will seem like a carb. I tried the coconut flour muffins and the coconut cookies and they were ok, not much taste. Do you have anything with sweet potato as I need the carbs in the morning before I work out. Also any suggestion for IBS and foods that I should stay away from. I am also cutting out all nuts to see if that helps with my stomach issues.”
So we actually answered some of this already in the little like workout fueling section, right? When we were talking about the marathon training. But just a few notes I’d like to share with Karen about this, and since the 21 Day Sugar Detox is my program, I guess I should really be answering these. I’d like to encourage her to really get past what she’s thinking about currently as breakfast foods, and what breakfast foods should be. Because we’re the only animal in existence who eats “breakfast foods” and it’s pretty unnatural especially when you consider what types of foods really fill the plate in the morning of most kind of Americans out there who haven’t really reconsidered breakfast. So pastries, cereal, juice, toast, etc. All sugar laden, high carb, low nutrition. Not a great way to start the day. So you know, the taste that’s missing from the baked goods that she’s making on the Sugar Detox is really sugar. Like without sugar, these things don’t taste the same, and surprise, surprise, without sugar, your whole wheat toast probably wouldn’t taste great either. I would definitely read the ingredients because they usually have at least one kind of sweetener in there, if not several. So you know, while those things can be good interim substitutes, they’re not meant to be super amazing, palatable, etc. Unfortunately. They’re really just meant to be vehicles for things like your nut butter, for example, but you said, and I would recommend, that you avoid nuts if you’re experiencing IBS symptoms.
So what I would recommend in terms of something pre-workout in the morning, first of all, I’d like to know, are you awake more than 2 hours before the workout? So if you’re training at like 7 am, are you awake before 5 am, which first of all, why are you up that early? Secondly, unless you have at least 2 hours before your exercise or at least even maybe 90 minutes, I wouldn’t eat. So I do tell most people to train in the morning fasted, and then eat a large meal after that. Now that’s kind of harsh for somebody who’s just beginning to come off a high carb diet. So perhaps this is where something like the allotted green-tipped banana, which is something you can do on the Sugar Detox or even half of that with some coconut milk, maybe blended together. That might be a good way to kind of kick off your day. You’re getting a little bit of the carb, but you’re more so getting fat. The point is that we’re trying to move you away from all the carbs and towards more fats. And a better way to fuel for morning exercise is really to eat the carbs in your dinner the night before or to just eat them in the meal that follows your workout. That will replenish your stores of the carbohydrate. You’re not going to burn those the rest of the day. You’ll burn them when you go to exercise. So anything you eat right before the workout, that’s going to be in your bloodstream still circulating, and you’re not actually to access your stored nutrients and your stored body fat for energy. If you put fuel in the tank, and you top it off, you’re burning that first. So this is a common thing that I’m trying to get people out of the habit of is extra food for a workout. If you’re training for 4 hours, that’s one thing, but if you’re training for somewhere between 10 and 60 minutes, for example, you don’t need extra fuel for that, especially if you sit all day long for a job, and that’s an assumption I’m making because I don’t know if she has an active job or not. But I see this a lot. People will take in extra food for a 15 minute workout after sitting all day, and I just don’t understand how they can rationalize that if they’re trying to lose body fat. If you’re trying to maintain or gain, then that’s one thing. But if you’re trying to tap into some body fat, which, you know, I’m not…it’s a little bit of an assumption here, but a lot of people who are on the Sugar Detox, that’s definitely a positive side effect for a lot of people that they’re looking for. So that’s kind of what I would say there. And I would really just rethink breakfast, and then be putting in those carbs after your workout to replenish after your workout. And that’s it.
Do you want to say our happy birthday shoutout?
LIZ WOLFE: I do. A very sweet person named Lance let us know that it was his wife’s birthday tomorrow. I believe it’s tomorrow, and we’d like to do a little shoutout to Candy. Happy birthday, Candy! We won’t sing because unless you want to sing, Diane…I mean, I’ll do it. [laughs]
DIANE SANFILIPPO: No..
LIZ WOLFE: I’ll just sing the last line. [sings] “happy birthday to you…Candy” Happy birthday, Candy. We’ll see you in Naples.
DIANE SANFILIPPO: We will.
LIZ WOLFE: Yup.
DIANE SANFILIPPO: All right, well, you want to close us out.
LIZ WOLFE: Let’s do it. That’s that, everybody. We will be back next week with more of your questions. Until then, you can find Diane at BalancedBites.com. You can find me, Liz, at CaveGirlEats.com or LizWolfeNTP.com. Thanks for listening. Talk to you next week.
Diane & Liz