9 Steps

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CHRIS KRESSER, M.S., L.Ac.
Chris Kresser L.Ac 2011 All Rights Reserved. No Unauthorized Copying, Editing or Distribution
2011 by Chris Kresser
All rights reserved. No portion of this program manual may be reproduced or transmitted in any form or by any means, electronic or mechanical including fax, photocopy, recording, or any information storage and retrieval system without the written permission of the authors, except as granted under the following conditions: The purchaser may photocopy pages for personal use. A reviewer may quote brief passages in connection with a review written for inclusion in a magazine or newspaper, with written approval from the author prior to publishing.
Disclaimer
This program manual is not intended to provide medical advice or to take the place of medical advice and treatment from your personal physician. Readers are advised to consult their own doctors or other qualied health professionals regarding the treatment of medical conditions. The author shall not be held liable or responsible for any misunderstanding or misuse of the information contained in this program manual or for any loss, damage, or injury caused or alleged to be caused directly or indirectly by any treatment, action, or application of any food or food source discussed in this program manual. The statements in this program manual have not been evaluated by the U.S. Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease. To request permission for reproduction or inquire about private consultations, speaking engagements or workshops contact:
Chris Kresser
E-mail: chris@chriskresser.com Website: http://www.chriskresser.com
9 Steps to Perfect Health

Introduction #1: Dont Eat Toxins #2: Nourish Your Body #3: Eat Real Food #4: Supplement Wisely #5: Heal Your Gut #6: Manage Your Stress #7: Move Like Your Ancestors #8: Get More Sleep #9: Practice Pleasure 3 6 20 32 40 50 55 64 72 79
All Rights Reserved. No Unauthorized Copying, Editing or Distribution
About Chris Kresser

My name is Chris Kresser, and Im a licensed acupuncturist and the author of The Healthy Skeptic. Ive been interested in health and wellness since I was a kid. My high school basketball coach had our whole team on a special diet, and while most of my teammates couldnt stand it, I actually loved the way I felt when I ate healthy food.
I did my undergraduate work at UC Berkeley. There I was introduced to Eastern spirituality and a wide range of health modalities and practices, from nutrition to meditation to tai qi to kundalini yoga to massage. In my early 20s I set out to see the world. A few months into that trip, while traveling in Indonesia, I contracted a mysterious tropical illness. I recovered relatively quickly from the acute phase, but as I continued to travel it became painfully clear that the illness had morphed into a chronic condition. I returned to the U.S. to seek medical care. In the next few years I saw more than twenty doctors around the world and spent thousands of dollars in an effort to diagnose and treat my condition. No one could figure out why I felt the way I did or what to do about it. It became increasingly clear over time that if anyone was going to figure it out, it would have to be me. After all, nobody was even half as motivated as I was to find the answer! So I educated myself thoroughly about any health condition that resembled my own, and I learned to gather and analyze medical research so I could stay abreast of the latest developments. In doing this research I discovered that many of the ideas and beliefs we hold about health in this society are myths. I began to see that even the most prestigious medical journals have become nothing more than sales brochures for the pharmaceutical industry. I saw massive conflicts of interest between drug companies, doctors and researchers everywhere I looked. I learned that errors in medical care are the third leading cause of death in this country each year. I decided to do something about it. I considered medical school, with the intention of helping to reform the industry from the inside out. But while allopathic medicine excels at emergency and trauma care, it isnt very good at fostering health. (In fact the subject of health rarely comes up at all in conventional medical textbooks, which are entirely focused on disease.) I chose instead to study Chinese medicine, which has been successfully used for over 2,000 years to promote health and longevity in addition to treating disease. Whereas Western medicine uses powerful chemicals or invasive surgery to achieve its goals, acupuncture works by stimulating the bodys highly sophisticated selfhealing mechanisms. This made so much more sense to me especially as I learned more about the dangers of pharmaceutical drugs and the impact of medical errors. I have complemented my study of acupuncture and herbs with a thorough education in functional medicine. Functional medicine is a personalized approach to health care that recognizes the biological uniqueness of each patient. In contrast to conventional care, which is almost entirely focused on suppressing symptoms, functional medicine eliminates symptoms by addressing the underlying cause of a problem. It is an evidence-based field of health care that views the body as an interconnected whole, and recognizes the importance of these connections in health and disease. In functional medicine, the patient is empowered, educated and encouraged to play an active role in the healing process. I graduated from the Acupuncture and Integrative Medicine College in Berkeley in April 2010. I passed the California Acupuncture Licensing Exam in August of 2010, and I have a private practice in Berkeley, CA. I also consult with patients nationally and internationally. I launched The Healthy Skeptic last year to help others see through the common myths and misdirections peddled by the media and medical establishment. It is my sincere hope that the information on this blog will lead to greater health and wellbeing for you and those you love.
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TheHealthySkeptic.org
All rights reserved. No reproduction or distribution permitted without written permission of the author
Introduction
In April, The Healthy Skeptic blog turned three years old. During that time Ive written 157 blog posts and eight special reports on topics ranging from heart disease to depression to essential fatty acids and fish oil. Those of you whove been following the blog for most of that time, or whove had the chance to go back and read a lot of those articles and special reports, probably have a pretty good idea of what my philosophy on health and nutrition is. But a lot of newer subscribers and visitors might benefit from a condensed summary of the ingredients I believe are essential to optimal health. I often find myself wanting to refer to something like this a quick primer that gives readers an overview of my approach when Im responding to comments or emails. Because lets face it, not everyone has the time to go back and read 157 blog posts and 8 special reports to get a sense of what this blog is about. I also want to create something that you all can easily share with friends and family who may be completely new to this stuff. In those cases I think its better to start with a broad, not-too-technical overview of the approach we discuss in more detail here. With this in mind, Ive written a series called 9 Steps To Perfect Health. This way you will have something concise and easy to read to send to those loved ones who still think eating saturated fat causes heart disease, or that soy products are healthy alternatives to animal protein.
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The conventional approach to healthcare has failed

Theres no better or more important time to get this information out there. Our health continues to deteriorate at an alarming pace, and the incidence of chronic, degenerative disease is skyrocketing each year. Consider the following: Diabesity (obesity + diabetes) affects more than one billion people worldwide, including 100 million Americans and 50% of Americans over 65. More than half of Americans are overweight, and a full one-third are clinically obese. Recent reports suggest that one-third of people born in 2010 will develop diabetes at some point in their lives. 9 out of 10 Americans will develop high blood pressure before they die. 4 out of 10 people who die each year in the U.S. die of heart disease, and rates of heart disease are projected to double in the next 50 years. Rates of infertility are expected to double in the next decade. According to the World Health Organization, depression is now the leading cause of disability, affecting more than 120 million people worldwide. I could go on but I think you get the point. Our health is getting worse, not better. Over the last 50 years the medical establishment has vigorously promoted a low-fat, high carbohydrate diet, claiming that it would protect us from heart disease and diabetes and make us healthier and happier. How has that worked out for us? The statistics above make it clear that the conventional approach has been a dismal failure that has not only failed to protect our health, but has directly contributed to the epidemic of modern disease.
All modern diseases share a similar cause

One of the most glaring mistakes conventional medicine makes is to assume that all of these modern diseases diabetes, heart disease, depression, autoimmune disease, etc. are unrelated conditions that dont share a common cause. This is a convenient fiction created by the pharmaceutical industry (and perpetuated by the medical establishment) to sell more drugs.
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The truth is that while these conditions do have unique features, they all share a common origin: the modern lifestyle. Poor diet, nutrient deficiencies, stress, lack of sleep, lack of or the wrong type of exercise, toxins and medications all directly contribute to the problems that are ruining our health. The conventional approach is to treat each of these various problems with different drug, and ignore the fundamental factors that are at the root of all of them. That has been a stupendously unsuccessful approach. Its time to replace it with a more holistic view of health, and to empower people to prevent and treat disease without unnecessary drugs or surgery.
Introducing the 9 Steps

Here are the 9 steps well be covering in the articles to follow: 1. 2. 3. 4. 5. 6. 7. 8. 9. Dont eat toxins. Nourish your body. Eat real food. Supplement wisely. Heal your gut. Manage stress. Move like your ancestors. Sleep more deeply. Practice pleasure.
Ill try to cover one each week, so we should be finished with the series by the end of March. If you know anyone youd like to introduce to this material, please send them over to the blog and have them sign up for email updates. And for those that were looking forward to the series on treating male and female hormones naturally, dont worry! Its coming up.
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9 Steps To Perfect Health

#1: Dont Eat Toxins
Imagine a world where:
diabetes, heart diseases, autoimmunity and other modern diseases are rare or dont exist at all we are naturally lean and fit we are fertile throughout our childbearing years we sleep peacefully and deeply we age gracefully without degenerative diseases like Alzheimers and osteoporosis While this might sound like pure fantasy today, anthropological evidence suggests that this is exactly how human beings lived for the vast majority of our evolutionary history. Today, most people accept diseases like obesity, diabetes, infertility and Alzheimers as normal. But while these diseases may now be common, theyre anything but normal. Humans evolved roughly 2.5 million years ago, and for roughly 84,000 generations we were naturally free of the modern diseases which kill millions of people each year and make countless others miserable. In fact, the world I asked you to imagine above which may seem preposterous and unattainable
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today was the natural human state for our entire history on this planet up until a couple hundred years ago. What was responsible for the change? What transformed us from naturally healthy and vital people free of degenerative disease into a world of sick, fat, infertile and unhappy people? In a word? The modern lifestyle. And though there are several aspects of our current lifestyle that contribute to disease, the widespread consumption of food toxins is by far the greatest offender. Specifically, the following four dietary toxins are to blame: Cereal grains (especially refined flour) Omega-6 industrial seed oils (corn, cottonseed, safflower, soybean, etc.) Sugar (especially high-fructose corn syrup) Processed soy (soy milk, soy protein, soy flour, etc.)
What is a toxin?
At the simplest level, a toxin is something capable of causing disease or damaging tissue when it enters the body. When most people hear the word toxin, they think of chemicals like pesticides, heavy metals or other industrial pollutants. But even beneficial nutrients like water, which are necessary to sustain life, are toxic at high doses. In their book The Perfect Health Diet, Paul & Shou-Ching Jaminet apply the economic principle of declining marginal benefits to toxins: It implies that the first bit eaten of any toxin has low toxicity. Each additional bit is slightly more toxic than the bit before. At higher doses, the toxicity of each bit continues to increase, so that the toxin is increasingly poisonous. This is important to understand as we discuss the role of dietary toxins in contributing to modern disease. Most of us wont get sick from eating a small amount of sugar, cereal
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grain, soy and industrial seed oil. But if we eat those nutrients (or rather anti-nutrients) in excessive quantities, our risk of developing modern diseases rises significantly. Thats exactly whats happening today. These four food toxins refined cereal grains, industrial seed oils, sugar and processed soy comprise the bulk of the modern diet. Bread, pastries, muffins, crackers, cookies, soda, fruit juice, fast food and other convenience foods are all loaded with these toxins. And when the majority of what most people eat on a daily basis is toxic, its not hard to understand why our health is failing. Lets look at each of these food toxins in more detail.
Cereal grains: the unhealthiest health food on the planet?

The major cereal grains wheat, corn, rice, barley, sorghum, oats, rye and millet have become the staple crops of the modern human diet. Theyve also become the poster children of the low-fat, highcarbohydrate diet promoted by organizations like the American Heart Association (AHA) and American Diabetes Association (ADA). If you say the phrase whole grains to most people, the first word that probably comes to their mind is healthy. But the fact is that most animals, including our closest relative (the chimpanzee) arent adapted to eating cereal grains and dont eat them in large quantities. And humans have only been eating them for the past 10,000 years (a tiny blip of time on the scale of evolution). Why? Because plants like cereal grains are always competing against predators (like us) for survival. Unlike animals, plants cant run away from us when we decide to eat them. They had to evolve other mechanisms for protecting themselves. These include:
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producing toxins that damage the lining of the gut; producing toxins that bind essential minerals, making them unavailable to the body; and, producing toxins that inhibit digestion and absorption of other essential nutrients, including protein.
One of these toxic compounds is the protein gluten, which is present in wheat and many of the other most commonly eaten cereal grains. In short, gluten damages the intestine and makes it leaky. And researchers now believe that a leaky gut is one of the major predisposing factors for conditions like obesity, diabetes and autoimmune disease. Celiac disease (CD) a condition of severe gluten intolerance has been well known for decades. Celiacs have a dramatic and, in some cases, potentially fatal immune response to even the smallest amounts of gluten. But celiac disease is just the tip of the iceberg when it comes to intolerance to wheat and other gluten containing grains. Celiac disease is characterized by antibodies to two components of the gluten compound: alpha-gliadin, and transglutaminase. But we now know that people can and do react to several other components of wheat and gluten. The diagram below shows how wheat and gluten are broken down in the body: Current laboratory testing for gluten intolerance only tests for alpha-gliadin and transglutaminase, the two components of gluten implicated in celiac disease (highlighted in red in the diagram). But as you can see, wheat contains several other components including lectins like wheat germ agglutinin (WGA), other epitopes of the gliadin protein like beta-gliadin, gamma-gliadin and omega-gliadin, another protein called glutenin, an opioid peptide called gluteomorphin, and a compound called daminated gliadin produced by the industrial processing or digestion of gluten. So heres the thing. Studies now clearly show that people can react negatively to all of these components of wheat not just the alpha-gliadin and transglutaminase that celiacs react to. And the worst part of this is that up until about 2 weeks ago, no commercial labs were testing for sensitivity to these other subfractions of wheat.
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This means, of course, that its extremely likely that far more people are intolerant to wheat and gluten than conventional wisdom would tell us. In fact, thats exactly what the latest research shows. Dr. Kenneth Fine, a pioneer in gluten intolerance research, has demonstrated that 1 in 3 Americans are gluten intolerant, and that 8 in 10 have the genes that predispose them to developing gluten intolerance. This is nothing short of a public health catastrophe in a nation where the #1 source of calories is refined flour. But while most are at least aware of the dangers of sugar, trans-fat and other unhealthy foods, fewer than 1 in 8 peoplewith celiac disease are aware of their condition. A 1999 paper in the British Medical Journal illustrated this well: Patients with clinically obvious celiac disease (observable inflammation and destruction of the gut tissue) comprise only 12.5% of the total population of people with CD. 87.5% of those with celiac have no obvious gut symptoms. For every symptomatic patient with CD, there are 8 patients with CD and no gastrointestinal symptoms. But does that mean patients with CD without gut symptoms are healthy? Not at all. It was long believed that the pathological manifestations of CD were limited to the gastrointestinal tract. But research over the past few decades has revealed that gluten intolerance can affect almost every other tissue and system in the body, including: brain; endocrine system; stomach and liver;
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nucleus of cells; blood vessels; and, smooth muscle, just to name a few!
This explains why CD and gluten intolerance are associated with several different diseases, including type 1 diabetes, thyroid disorders, osteoporosis, neurodegenerative conditions like Alzheimers, Parkinsons and dementia, psychiatric illness, ADHD, rheumatoid arthritis, migraine, obesity and more. The table below from the same 1999 BMJ paper depicts the increased incidence of other diseases in patients with CD:
As you can see, up to 17% of people with CD have an undefined neurological disorder. But even that alarmingly high statistic only accounts for people with diagnosed CD. We know that only 1 in 8 people with CD are diagnosed. We also know that those with CD represent only a small fraction of the population of people with gluten intolerance. With this in mind, its not hard to imagine that the number of people with gluten intolerance that have undefined neurological disorders (and other associated conditions on the list above) could be significantly higher than current research suggests. Finally, we also now know that when you are gluten intolerant which 33% (if not more) of you are you will also cross-react with other foods that have a similar molecular
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signature to gluten and its components. Unfortunately, the list of these foods (shown below) contains all grains, which is why some medical practitioners (myself included) recommend not just a gluten-free diet, but an entirely grain-free diet. As you can see, it also contains other foods like dairy (alpha & beta casein, casomorphin, milk butyrophilin) and coffee (which is a very common cross-reactant). alpha-caesin beta-caesin casomorphin milk butyrophilin cows milk american cheese chocolate coffee all cereal grains quinoa amaranth buckwheat tapioca rice potato corn sesame
Industrial seed oils: unnatural and unfit for human consumption

Industrial seed oils (corn, cottonseed, soybean, safflower, sunflower, etc.) have not been a part of the human diet up until relatively recently, when misguided groups like the AHA and the ADA started promoting them as heart-healthy alternatives to saturated fat. The graph below shows how dramatically seed oil consumption has risen over the past several decades:
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Throughout 4-5 million years of hominid evolution, diets were abundant in seafood and other sources of omega-3 long chain fatty acids (EPA & DHA), but relatively low in omega-6 seed oils. Anthropological research suggests that our hunter-gatherer ancestors consumed omega-6 and omega-3 fats in a ratio of roughly 1:1. It also indicates that both ancient and modern hunter-gatherers were free of the modern inflammatory diseases, like heart disease, cancer, and diabetes, that are the primary causes of death and morbidity today. At the onset of the industrial revolution (about 140 years ago), there was a marked shift in the ratio of n-6 to n-3 fatty acids in the diet. Consumption of n-6 fats increased at the expense of n-3 fats. This change was due to both the advent of the modern vegetable oil industry and the increased use of cereal grains as feed for domestic livestock (which in turn altered the fatty acid profile of meat that humans consumed). The following chart lists the omega-6 and omega-3 content of various vegetable oils and foods: Vegetable oil consumption rose dramatically between the beginning and end of the 20th century, and this had an entirely predictable effect on the ratio of omega-6 to omega-3 fats in the American diet. Between 1935 and 1939, the ratio of n-6 to n-3 fatty acids was reported to be 8.4:1. From 1935 to 1985, this ratio increased to 10.3:1 (a 23% increase). Other calculations put the ratio as high as 12.4:1 in 1985. Today, estimates of the ratio range from an average of
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10:1 to 20:1, with a ratio as high as 25:1 in some individuals. In fact, Americans now get almost 20% of their calories from a single food source soybean oil with almost 9% of all calories from the omega-6 fat linoleic acid (LA) alone! (PDF) This reveals that our average intake of n-6 fatty acids is between 10 and 25 times higher than evolutionary norms. The consequences of this dramatic shift cannot be underestimated. So what are the consequences to human health of an n-6:n-3 ratio that is up to 25 times higher than it should be? The short answer is that elevated n-6 intakes are associated with an increase in all inflammatory diseases which is to say virtually all diseases. The list includes (but isnt limited to): cardiovascular disease type 2 diabetes obesity metabolic syndrome irritable bowel syndrome & inflammatory bowel disease macular degeneration rheumatoid arthritis asthma cancer psychiatric disorders autoimmune diseases
The relationship between intake n-6 fats and cardiovascular mortality is particularly striking. The following chart, from an article entitled Eicosanoids and Ischemic Heart Disease by Stephan Guyenet, clearly illustrates the correlation between a rising intake of n-6 and increased mortality from heart disease:
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As you can see, the USA is right up there at the top with the highest intake of n-6 fat and the greatest risk of death from heart disease. On the other hand, several clinical studies have shown that decreasing the n-6:n-3 ratio protects against chronic, degenerative diseases. One study showed that replacing corn oil with olive oil and canola oil to reach an n-6:n-3 ratio of 4:1 led to a 70% decrease in total mortality. That is no small difference. Joseph Hibbeln, a researcher at the National Institute of Health (NIH) who has published several papers on n-3 and n-6 intakes, didnt mince words when he commented on the rising intake of n-6 in a recent paper: The increases in world LA consumption over the past century may be considered a very large uncontrolled experiment that may have contributed to increased societal burdens of aggression, depression and cardiovascular mortality.
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And those are just the conditions we have the strongest evidence for. Its likely that the increase in n-6 consumption has played an equally significant role in the rise of nearly every inflammatory disease. Since it is now known that inflammation is involved in nearly all diseases, including obesity and metabolic syndrome, its hard to overstate the negative effects of too much omega-6 fat.
Sugar: the sweetest way to wreck your health

About 20 years ago, Nancy Appleton, PhD, began researching all of the ways in which sugar destroys our health. Over the years the list has continuously expanded, and now includes 141 points. Heres just a small sampling (the entire list can be found on her blog). Sugar feeds cancer cells and has been connected with the development of cancer of the breast, ovaries, prostate, rectum, pancreas, lung, gallbladder and stomach. Sugar can increase fasting levels of glucose and can cause reactive hypoglycemia. Sugar can cause many problems with the gastrointestinal tract, including an acidic digestive tract, indigestion, malabsorption in patients with functional bowel disease, increased risk of Crohns disease and ulcerative colitis. Sugar can interfere with your absorption of protein. Sugar can cause food allergies. Sugar contributes to obesity.
But not all sugar is created alike. White table sugar (sucrose) is composed of two sugars: glucose and fructose. Glucose is an important nutrient in our bodies and is healthy, as long as its consumed in moderation. Fructose is a different story. Fructose is found primarily in fruits and vegetables, and sweeteners like sugar and high-fructose corn syrup (HFCS). A recent USDA report found that the average American eats 152 pounds of sugar each year, including almost 64 pounds of HFCS.
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Unlike glucose, which is rapidly absorbed into the bloodstream and taken up by the cells, fructose is shunted directly to the liver where it is converted to fat. Excess fructose consumption causes a condition called non-alcoholic fatty liver disease (NAFLD), which is directly linked to both diabetes and obesity. A 2009 study showed that shifting 25% of dietary calories from glucose to fructose caused a 4-fold increase in abdominal fat. Abdominal fat is an independent predictor of insulin sensitivity, impaired glucose tolerance, high blood pressure, high cholesterol, high triglycerides and several other metabolic diseases. In a widely popular talk on YouTube, Dr. Robert H. Lustig explains that fructose has all of the qualities of a poison. It causes damage, provides no benefit and is sent directly to the liver to be detoxified so that it doesnt harm the body. For more on the toxic effects of fructose, see The Perfect Health Diet and Robert Lustigs YouTube talk: Sugar, The Bitter Truth.
Soy: another toxin promoted as a health food

Like cereal grains, soy is another toxin often promoted as a health food. Its now ubiquitous in the modern diet, present in just about every packaged and processed food in the form of soy protein isolate, soy flour, soy lecithin and soybean oil. For this reason, most people are unaware of how much soy they consume. You dont have to be a tofu-loving hippie to eat a lot of soy. In fact, the average American who is most definitely not a tofu-loving hippie gets up to 9% of total calories from soybean oil alone. Whenever I mention the dangers of soy in my public talks, someone always protests that soy cant be unhealthy because its been consumed safely in Asia for thousands of years. There are several reasons why this isnt a valid argument.
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First, the soy products consumed traditionally in Asia were typically fermented and unprocessed including tempeh, miso, natto and tamari. This is important because the fermentation process partially neutralizes the toxins in soybeans. Second, Asians consumed soy foods as a condiment, not as a replacement for animal foods. The average consumption of soy foods in China is 10 grams (about 2 teaspoons) per day and is 30 to 60 grams in Japan. These are not large amounts of soy. Contrast this with the U.S. and other western countries, where almost all of the soy consumed is highly processed and unfermented, and eaten in much larger amounts than in Asia. How does soy impact our health? The following is just a partial list: Soy contains trypsin inhibitors that inhibit protein digestion and affect pancreatic function; Soy contains phytic acid, which reduces absorption of minerals like calcium, magnesium, copper, iron and zinc; Soy increases our requirement for vitamin D, which 50% of American are already deficient in; Soy phytoestrogens disrupt endocrine function and have the potential to cause infertility and to promote breast cancer in adult women. Vitamin B12 analogs in soy are not absorbed and actually increase the bodys requirement for B12; Processing of soy protein results in the formation of toxic lysinoalanine and highly carcinogenic nitrosamines; Free glutamic acid or MSG, a potent neurotoxin, is formed during soy food processing and additional amounts are added to many soy foods to mask soys unpleasant taste; and, Soy can stimulate the growth of estrogen-dependent tumors and cause thyroid problems, especially in women.
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Perhaps most alarmingly, a study at the Harvard Public School of Health in 2008 found that men who consumed the equivalent of one cup of soy milk per day had a 50% lower sperm count than men who didnt eat soy. In 1992, the Swiss Health Service estimated that women consuming the equivalent of two cups of soy milk per day provides the estrogenic equivalent of one birth control pill. That means women eating cereal with soy milk and drinking a soy latte each day are effectively getting the same estrogen effect as if they were taking a birth control pill. This effect is even more dramatic in infants fed soy formula. Babies fed soy-based formula have 13,000 to 22,000 times more estrogen compounds in their blood than babies fed milk-based formula. Infants exclusively fed soy formula receive the estrogenic equivalent (based on body weight) of at least five birth control pills per day. Click here for a complete list of studies demonstrating the harmful effects of soy products.
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#2: Nourish Your Body
Most of the calories we get from food come from protein, carbohydrates and fat. These are referred to as macronutrients. We also get other important nutrients from food, such as vitamins and minerals. These dont constitute a significant source of calories, so theyre called micronutrients. For the last 50 years weve been told to follow a diet low in this or that macronutrient. From the 1950s up until the present day the American Heart Association and other similarly misguided and pharmaceutically-financed consumer organizations have advocated a low-fat diet. More recently, low-carbohydrate diets are all the rage.
Not all macronutrients are created equal

The problem with these approaches is that they ignore the fact that not all macronutrients are created equal. Theres a tremendous variation in how different fats
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and carbohydrates affect the body, and thus in their suitability for human consumption. Grouping them all together in a single category is shortsighted to say the least. What many advocates of low-fat or low-carbohydrate diets conveniently ignore is that there are entire groups of people around the world, both past and present, that defy their ideas of what constitutes a healthy diet. For example, the low-fat crowd will tell you that eating too much fat especially of the saturated variety will make you fat and give you a heart attack. Tell that to the traditional Inuit, who get about 90% of calories from fat, and were almost entirely free of obesity and modern degenerative disease. The same is true for the Masai tribe in Africa, who get about 60-70% of calories from fat (almost entirely from meat, milk or blood.) And then theres the modern French, who have the lowest rate of heart disease of any industrialized country in the world despite the highest intake of saturated fat. The low-carb crowd is very much aware of these statistics, which are often used in defense of low-carb diets as the best choice. Tell that to the Kitavans in Melanesia, who get about 70% of calories from carbohydrate and, like the Inuit and Masai, are almost entirely free of obesity, heart disease and other chronic, degenerative diseases that are so common in industrialized societies. We see a similar absence of modern diseases in the Kuna indians in Panamaand the Okinawans of Japan, two other healthy indigenous populations that get about 65% of calories from carbohydrate. These rather inconvenient exceptions to the low-fat and low-carb dogma vigorously promoted by advocates of both approaches show us that humans can in fact thrive on a wide range of macronutrient ratios, ranging from extremely high fat (Inuit, Masai) to very high carb (Kitavans, Kuna & Okinawans). They also hint at the idea that perhaps not all carbohydrates are the same in terms of their effects on human health.
Human fuel: food that nourishes the body

We need to shift away from the idea of macronutrients as Dr. Kurt Harris of PaleoNu recently suggested and move towards the idea of nourishment or fuel. This means we
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classify foods not based on their macronutrient ratios, but on their ability to provide the energy and nutrition the body needs to function optimally. Gasoline and diesel are both fuel that cars can run on. If you put gasoline in a diesel engine, or vice versa, the engine may run but it wont run well or for very long. In a similar way, the human body can run on the entire range of fats, carbohydrates and proteins. But it runs much better on the ones it was designed to run on, and if you put too much of the others in, the body will eventually break down. With this classification in mind, lets look primarily at how the different types of fat and carbohydrate (our primary sources of energy) affect us, and which of them we should choose as our preferred human fuel.
Know your fats

LONG-CHAIN SATURATED FAT Well begin with long-chain, saturated fats (LCSFA): myristic, palmitic and stearic acid. These fats are found mostly in the milk and meat of ruminant animals like cattle and sheep. They form the core structural fats in the body, comprising 75-80% of fatty acids in most cells, and theyre the primary storage form of energy for humans. In other words, when the body stores excess energy from food for later use, it stores it primarily as long-chain saturated fat. Unlike polyunsaturated fats (PUFA) and carbohydrates like glucose and fructose, saturated fats have no known toxicity even at very high doses presuming insulin levels are in a normal range. Long-chain saturated fats are more easily burned as
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energy than PUFA. The process of converting saturated fat into energy the body can use leaves no toxic byproducts. In fact, it leaves nothing but carbon dioxide and water. This means that, assuming you are metabolically healthy, you can eat as much saturated fat as youd like without adverse consequences. Im sure this will come as a surprise to many of you, since weve been collectively brainwashed for 50 years to believe that saturated fat makes us fat and causes heart disease. If you still believe this is true, watch these two videos and read all of the articles in my special report on cholesterol, fat and heart disease. Verdict: eat as much as youd like. The majority of the fats you consume should be LCSFA. MEDIUM-CHAIN TRIGLYCERIDES Medium-chain triglycerides (MCT) are another type of saturated fat. Theyre found in coconut and in mothers milk, and they have unusual properties. Theyre metabolized differently than long-chain saturated fats; they dont require bile acids for digestion and they pass directly to the liver via the portal vein. This makes MCTs a great source of easily digestible energy. Theyre so easy to digest, in fact, that theyre used in the liquid hospital formulas fed to patients that have had sections of their intestine removed and arent able to digest solid food. In addition to being a good energy source, MCTs have therapeutic properties. Theyre high in lauric acid, a fat found in mothers milk that has anti-bacterial, anti-viral and antioxidant properties. Verdict: eat as much as youd like. Coconut oil is an especially good cooking fat, because it is not vulnerable to the oxidative damage that occurs with high-heat cooking using other fats. MONOUNSATURATED FAT Monounsaturated fat (MFA), or oleic acid, is found primarily in beef, olive oil, avocados, lard and certain nuts like macadamias. Like saturated fats, MFA form the core structural
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fats of the body and are non-toxic even at high doses. Interestingly, monounsaturated fats seem to be the only fats that typically fat-phobic groups like the AHA and fatfriendly groups like Atkins and other low-carbers can agree are completely healthy. Verdict: eat as much as youd like. But be aware that certain foods that are high in monounsaturated fats, like nuts and avocados, can contain significant amounts of the dreaded omega-6 polyunsaturated fats, which well discuss below. Exercise caution. These three fats long-chain saturated, medium chain triglycerides and monounsaturated should form the bulk of your fat intake. In addition to their lack of toxicity, eating these fats will: Reduce your risk of heart disease by raising your HDL, lowering your triglycerides and reducing levels of small, dense LDL (a type of LDL associated with a higher risk of heart disease). If you dont believe me, read this. Increase muscle mass. Muscle is composed of equal weights of fat and protein. Stabilize your energy and mood. Fat provides a steadier supply of energy throughout the day than carbohydrate, which can cause fluctuations in blood sugar. POLYUNSATURATED FAT: OMEGA-6 & OMEGA-3 Polyunsaturated fat (PUFA) can be subdivided into omega-6 and omega-3. PUFA are fragile and vulnerable to oxidative damage, a process that creates free radicals in the body and raises our risk for everything from heart disease to cancer. As I pointed out in Step #1: Dont Eat Toxins, both anthropological and modern research suggest that for optimal health we should consume roughly the same amount of omega-6 and omega-3 fat (1:1 ratio), and that our total intake of PUFA should be no more than 4% of calories. But Americans omega-6:omega-3 ratio today ranges from 10:1 to 20:1, with a ratio as high as 25:1 in some individuals! This means some people are eating as much as 25 times the recommended amount of omega-6 fat. And it is this excess consumption of omega-6 PUFA not cholesterol and saturated fat that is responsible for the modern
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epidemics of cardiovascular disease, type 2 diabetes, obesity, metabolic syndrome, autoimmune disease and more. Omega-6 PUFA (linoleic acid, or LA) is found in small or moderate amounts of a wide variety of foods including fruits, vegetables, cereal grains and meat. But it is found in very large amounts in industrial processed and refined oils, like soybean, cottonseed, corn, safflower and sunflower. These oils are ubiquitous in the modern diet, present in everything from salad dressing to chips and crackers to restaurant food. LA is also relatively high in most nuts and in all poultry, especially in dark meat with skin. Linoleic acid is an essential fatty acid. This means it is required for proper function but cannot be produced in the body, and thus must be obtained from the diet. However, the amount of omega-6 that is needed is exceedingly small:less than 0.5 percent of calories when supplied by most animal fats and less than 0.12 percent of calories when supplied by liver. When consumed in excess amounts as is almost always the case in industrialized countries like the U.S. omega-6 contributes to all of the diseases mentioned above. Omega-3 PUFA can be further subdivided into short-chain (alpha-linolenic acid, or ALA) and long-chain (EPA & DHA). ALA is found in plant foods like walnut and flax, whereas EPA & DHA is found in seafood and to a lesser extent the meat and fat of ruminant animals. While ALA is considered essential, the long-chain EPA & DHA are responsible for the benefits we get from eating omega-3 fats, and they form the denominator of the omega-6:omega-3 ratio. A common misconception is that we can meet our omega-3 needs by taking flax oil or eating plant foods containing ALA. Its true that the body can convert some ALA to EPA & DHA. But that conversion is extremely inefficient in most people. On average, less than 0.5% of ALA gets converted into the long-chain EPA & DHA, and that number is even worse in people that are chronically ill or have nutrient deficiencies (common in vegans and vegetarians).
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This means that it is probably EPA & DHA that are essential, in the sense that they are crucial for proper function but cannot be produced in adequate amounts in the body, and thus must be obtained from the diet. Of the two, evidence suggests that DHA plays the more important role. Verdict: for optimal health, eat no more than 4% of calories (about 9g/d for a 2,000 calorie diet) of polyunsaturated fat, with an equal amount of omega-6 and omega-3. Make sure the omega-3 you eat is long-chain EPA & DHA (from seafood and animal sources) rather than short-chain ALA from plant sources like flax. It is very difficult to limit omega-6 to 4.5g/day. See this article for tips. TRANS-FATS There are two types of trans-fats: natural (NTF), and artificial (ATF). The primary natural trans-fat, conjugated linoleic acid (CLA) is found in small amounts (about 2%) in the meat, fat and dairy fat of ruminant animals. CLA does not have the harmful effects of ATFs, and may have anti-cancer properties and other benefits. Artificial trans-fats have been linked with a variety of diseases. I think most people are aware of this, so Im not going to belabor the point. Weve still got carbs to talk about. Verdict: avoid artificial trans-fats like the plague. Natural trans-fats like CLA are harmless and probably even beneficial, but as long as youre eating long-chain saturated fats, youll get CLA. You dont have to go out of your way to find it. SUMMARY OF FATS Long-chain saturated fat, monounsaturated fat and medium chain triglycerides should form the bulk of your fat intake. Long-chain omega-3 fats (EPA & DHA) should be consumed regularly, while omega-6 LA should be dramatically reduced. Click on the fat pyramid below for a graphic representation.
Know your carbs

Carbohydrates are broken down into either indigestible fiber, glucose or fructose. Lets discuss the suitability of each of these as human fuel.
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Glucose Glucose is a simple sugar (monosaccharide) found mostly in plant foods like fruits, vegetables, starchy tubers and grains. It has three main uses in the body: It forms structural molecules call glycoproteins; Like fat, it is a source of energy for cells (especially in the brain); and, Its a precursor to compounds that play an important role in the immune system.
Glucose preceded fatty acids as a fuel source for living organisms by a very long time, and it is the building block of foods that have the longest evolutionary history of use by mammals like us. The fact that glucose can be produced in the body from protein is often used as an argument that we dont need to eat it in the diet. But I agree with Dr. Harriss interpretation that, rather than viewing this as evidence that that glucose isnt important, we should view it as evidence that glucose is so metabolically essential that we evolved a mechanism to produce it even in its absence in the diet. One of the few differences between our digestive tract and that of a true carnivore, like a lion, is that we produce an enzyme called amylase. Amylase allows us to digest starch a long-chain polymer of glucose molecules we cant absorb into single molecules of glucose that easily pass through the gut wall into the bloodstream. Presuming we are metabolically healthy, the glucose and starch we eat is digested and rapidly cleared by the liver and muscle cells. It is only when the metabolism is damaged usually by years of eating toxins like refined cereal grains, industrial seed oils and fructose that excess glucose is not properly cleared and leads to insulin resistance and diabetes. Verdict: the range of glucose that is tolerated varies widely across populations and individuals. Assuming no metabolic problems and an active lifestyle, glucose may be consumed relatively freely. However, many people today do have some form of metabolic dysfunction, and live a sedentary lifestyle. If you fall into this category, glucose should probably be limited to 400 calories (about 100g) of glucose per day.
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Fructose Fructose is another simple sugar found primarily in fruits and vegetables. While it has the same chemical formula and caloric content as glucose, it has an entirely different effect on the body. As I pointed out in Step #1: Dont Eat Toxins, fructose is toxic at high doses. It damages proteins in a process called fructation, which disrupts metabolic function and causes inflammation and oxidative damage. To prevent this, fructose is shunted directly to the liver for conversion into glucose or innocuous fats. But this process damages the liver over time, leading to non-alcoholic fatty liver disease (which one in three Americans now suffer from) and metabolic syndrome. Another issue is that excess fructose is not well absorbed in the gut, which in turn leads to its rapid fermentation by bacteria in the colon or abnormal overgrowth of bacteria in the small intestine. Small-bowel bacterial overgrowth, or SIBO, is now believed to be the major cause of irritable bowel syndrome (IBS), a common functional bowel disorder that is the second-leading cause of people missing work behind only the common cold. Most people without metabolic dysfunction can handle small amounts of fructose (as found in a few servings of fruit per day) without problems. But on the scale that fructose is consumed in the U.S. including 64 pounds of high-fructose corn syrup per person each year on average fructose wreaks havoc on the body. It should therefore be limited as a source of carbohydrate. Verdict: 3-4 servings a day of fruit is fine for people without metabolic problems. Those with fatty liver, insulin resistance or other issues should further limit fructose intake, and everyone should avoid high-fructose corn syrup and other concentrated sources like agave syrup. Fiber Fiber is plant matter that is indigestible to humans. But although we cant digest it, some of the 100 trillion bacteria that live in our gut can. In fact, up to 10% of the bodys caloric needs can be met by the conversion of glucose into short-chain fats like
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butyrate, propionate and acetate by intestinal bacteria. These short-chain fats are the primary energy source for intestinal cells in the colon, and butyrate in particular has been associated with several benefits. These are outlined in The Perfect Health Diet, by Paul & Shou-Ching Jaminet. Butyrate: Prevents obesity. Heals the intestine. Improves gut barrier integrity. Relieves constipation. Improves cardiovascular markers. Reduces inflammation. Stabilizes blood sugar.
The evidence clearly suggests that vegetable fiber is beneficial. However, just as not all fats are created equal, not all fiber is created equal. Grain fiber which the AHA and other so-called heart healthy organizations have been promoting for decades is toxic for two reasons: it contains toxic proteins like gluten, and it is prone to injure the intestinal wall. Weve been bullied into believing that grain fiber prevents heart disease and provides numerous health benefits. But this claim has only been tested in a single clinical trial, and the results were less than spectacular. The Diet and Reinfarction Trial, published in 1989, included 2,033 British men who had suffered a heart attack, and compared a high-fiber group with a control group. The high-fiber group ate whole grains and doubled their grain fiber intake from 9 to 17 grams per day. How did that work out for them? Not too well. Deaths in the high fiber group were 22% higher over the two year study. 9.9% of the control group died vs. 12.1% of the high fiber group. There are other reasons to limit all types of fiber. Fiber isnt essential. Human breast milk doesnt have any, and traditional people like the Masai who are free of modern, degenerative disease eat almost no fiber at all (subsisting on a diet of meat, blood
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and milk). And while fiber can feed the good bacteria in our gut and increase the production of beneficial short-chain fats like butyrate, it can also feed pathogenic and opportunistic bacteria in the gut. Verdict: vegetable (but not grain) fiber is beneficial in moderate amounts about onehalf pound of vegetables per day. But think about vegetables and fiber as accompaniments or flavorful condiments to fat and protein, which should form the bulk of calories consumed, rather than the other way around.
SUMMARY OF CARBOHYDRATES Assuming a healthy metabolism (which isnt necessarily a safe assumption these days), glucose and starch can be eaten relatively freely, which fructose should be limited to 2-3 servings of fruit per day. Vegetable fiber is beneficial but should also be limited, to about one-half pound of vegetables per day. See the carb pyramid below for a graphic representation.
Know your protein

What about protein? As it turns out, eating the right type of protein is easy if you simply follow Step #1 (dont eat toxins) and base your diet on the healthy fats I listed above.
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Protein is mostly found in animal products, seafood, nuts, legumes and grains. Legumes and grains have toxic compounds that can damage the gut. These toxins can be partially and in some cases completely neutralized by traditional preparation methods like soaking, sprouting and fermenting. But the vast majority of people in modern industrial societies dont do this and arent willing to do it, so I generally recommend that people avoid them altogether. As I explained above, nuts are often high in omega-6 LA, which we get far too much of as it is. So nuts should not constitute a significant source of protein. Walnuts are especially high. Just 100g of walnuts a day amounts to a whopping 266g of omega-6 per week. Keeping in mind that we want a 1:1 ratio of omega-6 to omega-3, youd have to eat 34 pounds of salmon a week to achieve a balance. Good luck with that. Poultry, especially dark meat with the skin on, can also be very high in omega-6 and should also be limited. For example, chicken skin has about 14 times more omega-6 than even grain-finished beef, and 10 times more than grain-finished pork. That leaves the meat and milk (including butter, cream and cheese) of ruminant animals (beef & lamb), pork, and seafood as the most suitable sources of protein. Animal protein is easy to absorb, is not toxic and is rich in beneficial long-chain saturated fats and natural trans-fats like CLA. Seafood is similarly easy to absorb, and is the primary dietary source of long-chain omega-3 fats DHA & EPA, as well as micronutrients like vitamin D and selenium. We dont need a pyramid for protein; you can simply follow the fat pyramid and youll naturally get the right type and amount of protein.
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#3: Eat Real Food
In the first article of this series we talked about the negative impact of 4 common food toxins: wheat, industrial seed oil, fructose and processed soy. In the second article we discussed which fats, carbohydrates and proteins are the best source of fuel for your body. In this article were going to importance of eating real food. Real food is: Whole, unprocessed and unrefined pasture-raised (a.k.a. grass-fed) and wild local, seasonal and organic
Lets look at each of these in turn.
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Whole, processed and unrefined: if it comes in a bag or a box, dont eat it!
The introduction of industrial food processing has without a doubt had the most detrimental effect on our health of any other factor in the last few hundred years and possibly in the entire history of humankind. Food refining has brought us all four of the food toxins destroying our health: white flour, white sugar & HFCS, industrial seed oils and processed soy products. It has also brought us chemical additives and preservatives, some with known negative effects and others with effects still unknown. New research is revealing the harm these newfangled processed foods have on us almost every day. A recent study was published demonstrating that emulsifiers used in packaged foods ranging from mayonnaise to bread to ice cream increase intestinal permeability (leaky gut) and cause a chain reaction of inflammation and autoimmune disease. Another study showed that diet soda consumption increases your risk of stroke and causes kidney damage, possibly because of the phosphoric acid used as an acidifying agent to give colas their tangy flavor. To avoid the harm caused by processed and refined foods, a good general rule is if it comes in a bag or a box, dont eat it. Of course not all foods that come in bags and boxes are harmful, so this isnt meant to be taken literally. Its just a helpful guideline. Butter is often packaged in a box, and Trader Joes (for some strange reason) packages vegetables in sealed plastic bags. That doesnt mean you shouldnt eat butter and vegetables. But in general, if you follow this guideline, youll avoid most common food toxins. And thats more than half the battle.
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Pasture-raised animal products and wild-caught fish: as nature intended

While the reasons to eat pasture-raised animal products and wild-caught fish span social, political, economic and nutritional considerations, Im only going to focus on nutritional factors here. For a more comprehensive discussion, check out Eat Wild. Several studies have been done comparing the nutrient content of pasture-raised (PR) and grain-fed (confinement animal feeding operations, or CAFO) animal products. PR animal products are superior to CAFO in 2 primary respects: they have a better fatty acid profile, and higher levels of vitamins and other micronutrients. Omega-6 ratio If you remember from Step #1: Dont Eat Toxins, for optimal health we want to consume a roughly equal amount of omega-6 (n-6) and omega-3 (n-6) fats. This ratio, referred to as the n-6 ratio, should be as close to 1 as possible. Studies have shown that grainfeeding animals depletes their omega-3 levels, thus raising the n-6:n-3 ratio. The following chart depicts the effect of grain-feeding on the omega-3 levels of cows: Ducket and colleagues studied the omega-3 and omega-6 content of both pasture-raised and grain-fed animal products. They found that grass-fed beef had an n-6 ratio of 1.65, whereas grain-finished beef was 4.84. They also found that grassfeeding decreased total fat content by 43%. Rule and colleagues found an even more significant difference. They looked at the n-6 ratio of several different types of meat, ranging from pasture-raised bison and beef to wild elk to chicken. They found the following ratios:
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Range-fed bison: 2.09 Feedlot bison: 7.22 Range-fed beef: 2.13 Feedlot beef: 6.28 Elk: 3.14 Chicken breast: 18.5
What is apparent from both Ducket and Rules studies is that pasture-raised beef has approximately three times the amount of omega-3 than grain-fed beef, and is much closer to the ideal n-6 ratio of 1. In fact, grass-fed beef has a superior n-6 ratio to even wild elk. This means that grass-fed beef falls within evolutionary norms for the fatty acid content of animals that humans have eaten throughout our history. Grain-fed beef does not. Another interesting thing to note, which I mentioned in Step #2: Nourish Your Body, is the high n-6 ratio of chicken. In fact, it has about 14 times more n-6 than pasture-raised beef. This is why I recommend eating mostly beef, lamb and pork, and limiting chicken to the occasional meal (assuming you like it, that is). And when you do eat chicken, its best to choose skinless breast and cook it in a healthy traditional fat like butter or coconut oil, because the dark meat with skin has the highest concentration of n-6 fat. Conjugated linoleic acid (CLA) Meat, fat and dairy from pasture-raised animals are the richest source of another type of good fat, called conjugated linoleic acid (CLA). CLA may have anti-cancer properties, even in very small amounts. In animal studies, CLA at less than one-tenth of one percent (0.1%) of total calories prevents tumor growth. In a Finnish study on humans, women who had the highest levels of CLA in their diet had a 60 percent lower risk of breast cancer than those with the lowest levels. In another human study, those with the highest levels of CLA in their tissues had a 50 percent lower risk of heart attack than those with the lowest levels. Pasture-raised animal products are the richest known source of CLA in the diet, and are significantly higher in CLA than grain-fed animal products. When ruminant animals like
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cows and sheep are raised on fresh pasture alone, their products contain from 3-5 times more CLA than products from animals fed grain. Minerals, vitamins and micronutrients The Ducket study I mentioned above also found that pasture-raised animal products have much higher levels of several vitamins and minerals, including: 288% greater vitamin E content 54% greater beta-carotene content Twice as much riboflavin (vitamin B2) Three times as much thiamin (vitamin B1) 30% more calcium 5% more magnesium
Grass-fed products also have a lot more selenium than grain-fed products. Selenium plays an important role in thyroid function, has antioxidant effects and protects the body against mercury toxicity. Grass-fed bison has 4 times more selenium than grain-fed bison. Pasture-raised eggs We see a similar difference between eggs from hens raised on pasture, and those raised in confinement. Pasture-raised hens contain as much as 10 times more omega-3 than eggs from factory hens. Pastured eggs are higher in B12 and folate. They also have higher levels of fat-soluble antioxidants like vitamin E and a denser concentration of vitamin A. Wild-caught fish Farmed fish contain excess omega-6 compared to wild-caught fish. Tests conducted in 2005 show that wild-caught salmon contain 10 times more n-3 than n-6, whereas farmed salmon have less than 4 times the amount of n-3 than n-6. Another study found that consuming standard farmed salmon, raised on diets high in n-6, raises blood levels of inflammatory chemicals linked to increased risk of cardiovascular disease, diabetes, Alzheimers and cancer.
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Wild salmon also contains 4 times as much vitamin D than farmed salmon, which is especially important since up to 50% of Americans are deficient in this important vitamin.
Organic, local and seasonal: more nutrients, fewer chemicals

More nutrients Organic plant foods contain, on average, 25 percent higher concentrations of 11 nutrients than their conventional counterparts. In particular, they tend to be higher in important polyphenols and antioxidants like vitamin C, vitamin E and quercetin. Even more relevant in determining nutrient content is where your produce comes from, and in particular, how long its been out of the ground before you eat it. Most of the produce sold at large supermarket chains is grown hundreds if not thousands of miles away, in places like California, Florida and Mexico. This is especially true when youre eating foods that are out of season in your local area (like a banana in midwinter in New York). A typical carrot, for example, has traveled 1,838 miles to reach your dinner table. Days maybe more than a week has passed since it was picked, packaged and trucked to the store, where it can sit on the shelves even longer. The problem with this is that food starts to change as soon as its harvested and its nutrient content begins to deteriorate. Total vitamin C content of red peppers, tomatoes, apricots, peaches and papayas has been shown to be higher when these crops are picked ripe from the plant. This study compared the Vitamin C content of supermarket broccoli in May (in season) and supermarket broccoli in the Fall (shipped from another country). The result? The out-of-season broccoli had only half the vitamin C of the seasonal broccoli. Without exposure to light (photosynthesis), many vegetables lose their nutrient value. If you buy vegetables from the supermarket that were picked a week ago, transported to the store in a dark truck, and then stored in the middle of a pile in the produce section, and then you put them in your dark refrigerator for several more days before eating
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them, chances are theyve lost much of their nutrient value. A study at Penn State University found that spinach lost 47% of its folate after 8 days. This is why buying your produce at local farmers markets, or even better, picking it from your backyard garden, are better options than buying conventional produce shipped from hundreds or thousands of miles away. Fruits and vegetables from local farms are usually stored within one or two days of picking, which means their nutrient content will be higher. And as anyone whos eaten a fresh tomato right off the vine will tell you, local produce tastes so much better than conventional produce it might as well be considered a completely different food. Fewer chemicals Another important benefit of organic produce, of course, is that its grown without pesticides, herbicides and other harmful chemicals that have been shown to cause health problems especially in vulnerable populations like children. A study published in the journal Pediatrics concluded that children exposed to organophosphate pesticides at levels typically found in conventional produce are more likely to develop attention deficit hyperactivity disorder (ADHD). A panel of scientists convened by President Obama to study the effect of environmental toxins on cancer released a report in 2010 urging Americans to eat organic produce grown without pesticides, fertilizers or other chemicals. The report states that the U.S. government has grossly underestimated the number of cancers caused by environmental toxins. The report especially highlights the risk of toxins in conventionally grown foods to unborn children. Exposure to harmful chemicals during this critical period can set a child up for lifelong endocrine disruption, hormone imbalances and other problems. Supporting local economies and preserving resources Aside from having more nutrients and fewer chemicals, there are other non-nutritional reasons to eat local produce. These were summarized well in Cornell Universitys Northeast Regional Food Guide:
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Community food systems promote more food-related enterprises in proximity to food production, marketing, and consumption. Such systems enhance agricultural diversity, strengthen local economies (including farm-based businesses), protect farmland, and increase the viability of farming as a livelihood. Local food systems mean less longdistance shipment of the produce we enjoy, which means decreased use of nonrenewable fossil fuels for food distribution, lower emission of resulting pollutants, and less wear on transcontinental highways. Ive also found that forming relationships with the people that grow my food leads to a greater sense of community and connection. In an increasingly technophilic, hyperactive world, that is especially welcome.
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#4: Supplement Wisely
In the first three articles in this series, we discussed which foods to eat and which foods to avoid. In this article were going to talk about when to supplement and how to do it wisely. Weve got a lot of material to cover, so you might want to grab a cup of tea and get comfortable! There are three principles to supplementing wisely: Get nutrients from food whenever possible. Take nutrients in their naturally occurring form whenever possible. Be selective with your supplementation.
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Get nutrients from food whenever possible

Humans are adapted to getting nutrients from whole foods. Most nutrients require enzymes, synergistic co-factors and organic mineral-activators to be properly absorbed. While these are naturally present in foods, they are often not included in synthetic vitamins with isolated nutrients. In a paper published in the American Journal of Clinical Nutrition called Food Synergy: An Operational Concept For Understanding Nutrition emphasizing the importance of obtaining nutrients from whole foods, the authors concluded: A person or animal eating a diet consisting solely of purified nutrients in their Dietary Reference Intake amounts, without benefit of the coordination inherent in food, may not thrive and probably would not have optimal health. This review argues for the primacy of food over supplements in meeting nutritional requirements of the population. They cautioned against the risk of reductionist thinking, which is common in conventional medicine and nutritional supplementation. Instead, they urge us to consider the importance of what they call food synergy: The concept of food synergy is based on the proposition that the interrelations between constituents in foods are significant. This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level. They go on to provide evidence that whole foods are more effective than supplements in meeting nutrient needs: Tomato consumption has a greater effect on human prostrate tissue than an equivalent amount of lycopene. Whole pomegranates and broccoli had greater antiproliferative and in vitro chemical effects than did some of their individual constituents. Free radicals were reduced by consumption of brassica vegetables, independent of micronutrient mix.
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In short: get nutrients from food, not supplements, whenever you can.
Take nutrients in their naturally occurring form whenever possible

Synthetic, isolated nutrients dont always have the same effect on the body. It matters whether the nutrients have been produced by technologic or biological processes, because industrial processing sometimes creates an entirely new compound with different physiological actions. Trans fat produced in ruminant animals (such as conjugated linoleic acids in dairy products) are beneficial to health, whereas trans fats produced in the processing of industrial seed oils are highly toxic. Folic acid is another example. The naturally occurring form of folate is not folic acid, a compound not normally found in food or nature, but tetrahydrofolate. While folic acid can be converted into folate, that conversion is poor in humans. Its also important to note that unlike natural folate, folic acid does not cross the placenta. This is significant because folate is a crucial nutrient for pregnancy, and while folic acid can prevent neural tube defects it doesnt have the other beneficial effects of folate. Whats more, several studies have suggested that folic acid but not natural folate may increase cancer risk. Unfortunately, folic acid is whats often used in multivitamins, because its significantly cheaper than natural folate.
Be selective with your supplementation.

Multivitamins have become increasingly popular: half of Americans currently take one. But is this a good idea? Most studies show that multivitamins either provide no benefit, or may even cause harm. A study in the Archives of Internal Medicine showed that multivitamins have little to no influence on the risk of common cancers, CVD or total mortality in postmenopausal women. A now infamous meta-analysis in the Journal of American Medical Association, which looked at over 68 trials with 230,000 pooled participants, found that treatment with synthetic beta carotene, vitamin A and vitamin E may increase mortality. The problem with multivitamins is that they contain too little of beneficial nutrients like magnesium, vitamin D and vitamin K2, and too much of potentially toxic nutrients like
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folic acid, calcium, iron and vitamin E. This means that multivitamins can actually cause nutrient imbalances that contribute to disease. Another problem is that multivitamin manufacturers often use the cheapest possible ingredients, such as folic acid instead of natural folate the consequences of which we discussed above.
Which supplements may be necessary?

At this point you might be thinking Im against supplementation entirely. Not so. No matter how well we eat, some nutrients are difficult to obtain enough of from food alone. There are also circumstances where are need for certain nutrients may increase, such as vitamin C during infections and magnesium with blood sugar imbalances or metabolic problems. In these cases, it makes sense to supplement selectively with beneficial nutrients. The five nutrients I recommend most people supplement with are: Vitamin A Vitamin D Vitamin K2 Magnesium Vitamin C
Vitamin A (Retinol)
Vitamin A is important catalyst for a variety of biochemical processes in the body. Its required for assimilation of protein, minerals and water-soluble vitamins, and it also acts as antioxidant > protecting body against free-radical damage and diseases like cancer. Vitamin A plays a crucial role in reproduction, promoting full-term pregnancy and proper development of face (eyes, nose, dental arches & lips). The RDA for vitamin A (2,600 IU) is woefully inadequate, and even then, over 25% of American consume less than half of the recommended amount. Native populations such as the traditional Inuit which were free of modern, degenerative disease got
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much more vitamin A than the average American. The Greenland Inuit of 1953, prior to much contact with the Western world, got about 35,000 IU of vitamin A per day. Vitamin A (retinol) is only found in significant amounts in organ meats, which explains why many Americans dont get enough of it. If you follow my recommendations in #2: Nourish Your Body, and you do eat organ meats (especially liver), youre probably getting enough vitamin A and thus dont need to supplement. However, if youre like most Americans and youve never eaten liver in your life, you would benefit from supplementing with A. Theres been a lot of discussion in the media about the toxicity of vitamin A. Some researchers and doctors now recommend avoiding cod liver oil because of this concern. Even Dr. Mercola has jumped on the vitamin A is toxic bandwagon. But is this true? It is true that vitamin A is potentially toxic. Some evidence suggests that excess vitamin A increases the risk of osteoporosis. For example, this study showed both low and high serum A carried double risk of fractures as did optimal levels. But if we dig deeper we find that excess vitamin A only causes problems against a backdrop of vitamin D deficiency. In his excellent article Vitamin A on Trial: Does Vitamin A Cause Osteoporosis, researcher Chris Masterjohn summarizes evidence demonstrating that vitamin D decreases the toxicity of and increases the dietary requirement for vitamin A. Studies show that supplementing with vitamin D radically increases the toxicity threshold of vitamin A. In a hypothetical 160 lb. person, vitamin D supplementation increases the toxicity threshold of vitamin A to more than 200,000 IU/ d. Youd have to eat 22 ounces of beef liver or take 5 TBS of high vitamin CLO each day to get this amount. Not likely! To meet vitamin A needs (assuming youre not up for eating organ meats), I recommend taking high vitamin cod liver oil (CLO) to provide a dose of 10-15,000 IU per day. Cod liver oil is really more of a food than a supplement, but since its not a normal part of peoples diet well consider it as a supplement. CLO is an ideal vitamin A
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source because it also contains vitamin D, which as we just learned, protects against the toxicity of A.
Vitamin D
Much has been written about the need for and benefits of vitamin D supplementation over the past several years and with good reason. Its absolutely critical for health, and up to 50% of Americans are deficient. We can get vitamin D from two sources: food, and sunshine. Seafood is the only significant source of vitamin D, but youd still have to eat a lot of it to get enough. 8-9 ounces of herring provides about 2,000 IU of vitamin D, which is a minimum daily requirement for most people to maintain adequate blood levels. Sunlight converts a precursor called 7-dehydro-cholesterol in our skin to vitamin D3. This D3, along with the D3 we get from food, gets converted by the liver into 25hyrdroxy-vitamin D (25D), which is what typically gets measured when you have a vitamin D test. The optimal 25D level is somewhere between 35 and 50 ng/mL. Contrary to what some researchers and doctors have recommended, theres no evidence that raising blood levels of 25D above 50 ng/mL is beneficial, and theres some evidence that it may cause harm. Studies show that bone mineral density peaks at 45 ng/mL and then falls again as 25D levels rise above 45. Other studies have shown thatthe risk of kidney stones and CVD increase with high 25D levels, due to elevated serum calcium levels that accompany excess vitamin D. However, we also know that vitamin A and vitamin K2 protect against vitamin D toxicity, and vice versa. As I explained in the vitamin A section, fat soluble vitamins exist in a synergistic relationship. Its possible that the people in the studies above that experienced problems with excess 25D levels were deficient in vitamin A or K2, or both. This is why its so important to supplement with all of the fat-soluble vitamins together. What about sunlight? Well, in summer mid-day sun with pale skin, 30 minutes of direct sunlight will produce 10-20,000 IU of vitamin D. But this is a best case scenario. With
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darker skin, or different times of year, or buildings that block the sunlight, or increased time spent indoors, we wont be producing that much. Its also true that aging, overweight and inflammation reduce our conversion of sunlight to vitamin D. This is why sunlight alone isnt normally a sufficient source of vitamin D. With this in mind, most people should supplement with D. The amount needed to maintain blood levels of 35-50 ng/mL varies depending on some of the factors Ive listed above, but in my clinical experience its usually somewhere between 2,000 5,000 IU. With vitamin D, its important to test your levels, begin supplementation, and then re-test a few months later to determine the correct maintenance dose. As with vitamin A, the best source of vitamin D is high-vitamin cod liver oil. It contains not only vitamins A & D, but also natural vitamin E and other quinones.
Vitamin K2
Vitamin K2 may be the most important vitamin most people have never heard of. Its needed to activate proteins and it also regulates calcium metabolism (keeping it in the bones and teeth where it belongs, and out of the soft tissue where it doesnt belong). Elevated blood calcium significantly increases the risk of cardiovascular disease (CVD), which explains why vitamin K2 has been shown to prevent atherosclerosis and heart attacks. It also strengthens bones. Unfortunately, many (if not most) of Americans are deficient in vitamin K2. Its important to point out that vitamin K2 is not the same as vitamin K1, which is found in green, leafy vegetables like kale and collards. Some K1 is converted into K2 in our bodies, but that conversion is inefficient in humans. It is efficient, however, in ruminant animals which is why grass-fed dairy is the most convenient source of vitamin K2 in the diet. This is only true in animals raised on pasture, because it is eating the K1-rich grass that allows them to convert it into K2. Most people should aim for at least 100 mcg/d from a combination of food and supplements. If you eat a large amount of cheese from grass-fed cows and pastured egg yolks, you may be able to get this amount from food alone. 100 g of hard cheese
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contains 67 mcg, and 6 pastured egg yolks contain about 32 mcg. Otherwise, supplementation is probably beneficial. I recommend a dosage of 1 mg/d in the MK-4 form, which is the form of vitamin K2 found in pastured dairy and the one shown to have the most benefit in clinical studies. There is another form, MK-7, that is found in fermented foods like natto, but it has not demonstrated the same properties as MK-4 in clinical studies.
Magnesium
There are few compounds in the body more important to overall health than magnesium. Over 300 enzymes need it, including every enzyme associated with ATP, and enzymes required to synthesize DNA, RNA and proteins. Magnesium also plays an important role in bone and cell membranes, as it helps to transport ions across the membrane surface. Studies show that most Americans are deficient in magnesium. The median intake across all racial groups is far below the RDA, which is 420 mg/d for men and 320-400 mg/d for women. Although half of Americans take a multivitamin daily, most dont contain enough magnesium to prevent deficiency. Magnesium is also difficult to obtain from food. Nuts and seeds are the highest source, but its difficult to eat enough of them to meet magnesium needs without getting too much polyunsaturated fat. Another issue is that magnesium levels in food have dropped as modern soils have become increasingly depleted. What this means is that if youre not supplementing with magnesium, youre probably not getting enough. And magnesium deficiency is no small thing. It has serious even fatal consequences. It produces symptoms like muscle cramps, heart arrhythmias, tremor, headaches & acid reflux, and its associated with CVD, hypertension, metabolic syndrome, diabetes, migraines, PMS, asthma, hypothyroidism. In fact, its hard to find a modern disease magnesium deficiency isnt associated with. Because of this, I think everyone should supplement with magnesium. Intake of 400 800 mg/d from a combination of food and supplements is an optimal range to shoot for.
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Since most people get less than 250 mg/d from food, a dose of 400 600 mg/d in supplement form is ideal. I recommend using chelated forms of magnesium like glycinate and malate, because theyre better absorbed and tend to have fewer side effects.
Vitamin C
Vitamin C is needed for building the structural components of the body, and for maintaining levels of glutathione, the master antioxidant in the body. But vitamin C deficiency is also common: studies suggest that 34% of men and 27% of women dont get enough. This is especially true for the elderly and those struggling with chronic illness. 400 mg/d is the saturation range in healthy people, and that number is probably higher in the elderly and the sick. As with the other micronutrients in this article, its difficult to obtain adequate levels of vitamin C from the diet. Acerola cherries are the highest food source, with 1677 mg per 100g. A cup of cooked red peppers has 235 mg, which is one of the highest dietary sources. Im somewhat less certain about the need to supplement with vitamin C, but in general I recommend approximately 500 mg to 1 g of vitamin C each day. If youre dealing with a chronic health challenge, or fighting an infection, you can take several grams a day with no toxic effects. Its best to space the doses out to avoid diarrhea, however.
Other contenders
In addition to the fat-soluble vitamins A, D & K2, and magnesium and vitamin C, some may want to consider supplementing with selenium and iodine. Selenium plays important role in thyroid function, which affects every aspect of physiology. The recommended dose is approximately 200 mcg/d. Selenium is plentiful in organ meats, ocean fish, and in brazil nuts. One brazil nut contains 100 mcg of selenium, but it also contains a whopping 1 g of omega-6 linoleic acid, which as you know from previous articles in the series, we want to limit
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significantly. This is why I dont recommend brazil nuts as a source of selenium. Ocean fish are also good sources of selenium. 100 g of cod contains about 150 mcg. Iodine also plays a crucial role in thyroid function, and it prevents brain damage and strengthens the immune system. The amount iodine needed for thyroid function is incredibly small: we need about a teaspoon of iodine over a lifetime to avoid deficiency. Im not convinced humans need to supplement with iodine above what can be obtained from seafood, but some research does suggest that increased intake of iodine is beneficial. This is especially true if youre fighting a chronic infection or dealing with a hypothyroidism caused by iodine deficiency. But be careful: iodine can trigger and flare autoimmune diseases, especially Hashimotos and Graves(autoimmune thyroid disease). In the U.S., 9 out of 10 women with hypothyroidism actually have Hashimotos, so the typical advice to supplement with iodine if you are hypothyroid is dangerous. Ive written extensively about this in my special report on thyroid disease. For those without autoimmune disease, a dose of 12.5 mg 50 mg per day may be beneficial, but its best to work up slowly over time, beginning at a much lower dose.
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#5: Heal Your Gut
All disease begins in the gut. - Hippocrates
Hippocrates said this more than 2,000 years ago, but were only now coming to understand just how right he was. Research over the past two decades has revealed that gut health is critical to overall health, and that an unhealthy gut contributes to a wide range of diseases including diabetes, obesity, rheumatoid arthritis, autism spectrum disorder, depression and chronic fatigue syndrome. In fact, many researchers (including myself) believe that supporting intestinal health and restoring the integrity of the gut barrier will be one of the most important goals of medicine in the 21st century. There are two closely related variables that determine our gut health: the intestinal microbiota, or gut flora, and the gut barrier. Lets discuss each of them in turn.
The gut flora: a healthy garden needs healthy soil

Our gut is home to approximately 100,000,000,000,000 (100 trillion) microorganisms. Thats such a big number our human brains cant really comprehend it. One trillion
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dollar bills laid end-to-end would stretch from the earth to the sun and back with a lot of miles to spare. Do that 100 times and you start to get at least a vague idea of how much 100 trillion is. The human gut contains 10 times more bacteria than all the human cells in the entire body, with over 400 known diverse bacterial species. In fact, you could say that were more bacterial than we are human. Think about that one for a minute. Weve only recently begun to understand the extent of the gut floras role in human health and disease. Among other things, the gut flora promotes normal gastrointestinal function, provides protection from infection, regulates metabolism and comprises more than 75% of our immune system. Dysregulated gut flora has been linked to diseases ranging from autism and depression to autoimmune conditions like Hashimotos, inflammatory bowel disease and type 1 diabetes. Unfortunately, several features of the modern lifestyle directly contribute to unhealthy gut flora: Antibiotics and other medications like birth control and NSAIDs Diets high in refined carbohydrates, sugar and processed foods Diets low in fermentable fibers Dietary toxins like wheat and industrial seed oils that cause leaky gut Chronic stress Chronic infections
Antibiotics are particularly harmful to the gut flora. Recent studies have shown that antibiotic use causes a profound and rapid loss of diversity and a shift in the composition of the gut flora. This diversity is not recovered after antibiotic use without intervention. We also know that infants that arent breast-fed and are born to mothers with bad gut flora are more likely to develop unhealthy gut bacteria, and that these early differences in gut flora may predict overweight, diabetes, eczema/psoriasis, depression and other health problems in the future.
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The gut barrier: the gatekeeper that decide what gets in and what stays out
Have you ever considered the fact that the contents of the gut are technically outside the body? The gut is a hollow tube that passes from the mouth to the anus. Anything that goes in the mouth and isnt digested will pass right out the other end. This is, in fact, one of the most important functions of the gut: to prevent foreign substances from entering the body. When the intestinal barrier becomes permeable (i.e. leaky gut syndrome), large protein molecules escape into the bloodstream. Since these proteins dont belong outside of the gut, the body mounts an immune response and attacks them. Studies show that these attacks play a role in the development of autoimmune diseases like Hashimotos and type 1 diabetes, among others. In fact, experts in mucosal biology like Alessio Fasano now believe leaky gut is a precondition to developing autoimmunity: There is growing evidence that increased intestinal permeability plays a pathogenic role in various autoimmune diseases including [celiac disease] and [type 1 diabetes]. Therefore, we hypothesize that besides genetic and environmental factors, loss of intestinal barrier function is necessary to develop autoimmunity. The phrase leaky gut used to be confined to the outer fringes of medicine, employed by alternative practitioners with letters like D.C., L.Ac and N.D. after their names. Conventional researchers and doctors originally scoffed at the idea that a leaky gut contributes to autoimmune problems, but now theyre eating their words. It has been repeatedly shown in several well-designed studies that the integrity of the intestinal barrier is a major factor in autoimmune disease. This new theory holds that the intestinal barrier in large part determines whether we tolerate or react to toxic substances we ingest from the environment. The breach of the intestinal barrier (which is only possible with a leaky gut) by food toxins like gluten and chemicals like arsenic or BPA causes an immune response which affects not only the
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gut itself, but also other organs and tissues. These include the skeletal system, the pancreas, the kidney, the liver and the brain. This is a crucial point to understand: you dont have to have gut symptoms to have a leaky gut. Leaky gut can manifest as skin problems like eczema or psoriasis, heart failure, autoimmune conditions affecting the thyroid (Hashimotos) or joints (rheumatoid arthritis), mental illness, autism spectrum disorder, depression and more. Researchers have identified a protein called zonulin that increases intestinal permeability in humans and other animals. This led to a search of the medical literature for illnesses characterized by increased intestinal permeability (leaky gut). Imagine their surprise when the researchers found that many, if not most, autoimmune diseases including celiac disease, type 1 diabetes, multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease are characterized by abnormally high levels of zonulin and a leaky gut. In fact, researchers have found that they can induce type 1 diabetes almost immediately in animals by exposing them to zonulin. They develop a leaky gut, and begin producing antibodies to islet cells which are responsible for making insulin. In Step #1: Dont Eat Toxins, I explained that one of the main reasons we dont want to eat wheat and other gluten-containing grains is that they contain a protein called gliadin, which has been shown to increase zonulin production and thus directly contribute to leaky gut. But what else can cause leaky gut? In short, the same things I listed above that destroy our gut flora: poor diet, medications (antibiotics, NSAIDs, steroids, antacids, etc.), infections, stress, hormone imbalances, and neurological conditions (brain trauma, stroke and neurodegeneration).
Leaky gut = fatigued, inflamed and depressed

Heres the takeaway. Leaky gut and bad gut flora are common because of the modern lifestyle. If you have a leaky gut, you probably have bad gut flora, and vice versa. And when your gut flora and gut barrier are impaired, you will be inflamed. Period.
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This systemic inflammatory response then leads to the development of autoimmunity. And while leaky gut and bad gut flora may manifest as digestive trouble, in many people it does not. Instead it shows up as problems as diverse as heart failure, depression, brain fog, eczema/psoriasis and other skin conditions, metabolic problems like obesity and diabetes and allergies, asthma and other autoimmune diseases. To adequately address these conditions, you must rebuild healthy gut flora and restore the integrity of your intestinal barrier. This is especially true if you have any kind of autoimmune disease, whether you experience digestive issues or not.
How to maintain and restore a healthy gut

The most obvious first step in maintaining a healthy gut is to avoid all of the things I listed above that destroy gut flora and damage the intestinal barrier. But of course thats not always possible, especially in the case of chronic stress and infections. Nor did we have any control over whether we were breast-fed or whether our mothers had healthy guts when they gave birth to us. If youve been exposed to some of these factors, there are still steps you can take to restore your gut flora: Remove all food toxins from your diet Eat plenty of fermentable fibers (starches like sweet potato, yam, yucca, etc.) Eat fermented foods like kefir, yogurt, sauerkraut, kim chi, etc., and/or take a high-quality, multi-species probiotic Treat any intestinal pathogens (such as parasites) that may be present Take steps to manage your stress
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#6: Manage Your Stress
Of all the 9 steps, stress management is probably the most important. Why? Because no matter what diet you follow, how much you exercise and what supplements you take, if youre not managing your stress you will still be at risk for modern degenerative conditions like heart disease, diabetes, hypothyroidism and autoimmunity. I see this every day in my practice. I have a lot of patients that are following a perfect diet, and yet they are still sick. Stress is often the cause. (Ill define stress more clearly in a moment.) Yet as pervasive as stress is, many people dont do anything to mitigate its harmful effects. The truth is its a lot easier to make dietary changes and pop some pills (whether drugs or supplements) than it is to manage our stress. Stress
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management bumps us up against core patterns of belief and behavior that are difficult to change. I suspect this is why all of the articles Ive written about stress management are among the least shared on Facebook and Twitter and have elicited the fewest comments. I think many of you may feel defeated or overwhelmed by stress. I understand this. Stress management is hard. It asks a lot of us. It forces us to slow down, to step back, to disengage (if only for a brief time) from the electric current of modern life. It asks us to prioritize self-care in a culture that does not value it. While I feel your pain, and still struggle with stress management myself, Ive got to lay down some tough love here. If youre not doing some form of regular stress management, you will sabotage all of your best efforts with diet, exercise and supplements. Stress management is absolutely crucial to optimal health and longevity. If most health conscious people spent even half the amount of time they spend focusing on nutrition and exercise on managing their stress, theyd be a lot better off. Im going to suggest several strategies for stress management at the end of the article, but first lets define stress more explicitly and learn more about the harm it causes.
What is stress?
Hans Selye, the famous physiologist who coined the term stress, defined it this way: the nonspecific response of the body to any demand made upon it. The prominent psychologist Richard Lazarus offers a similar definition: any event in which environmental demands, internal demands, or both tax or exceed the adaptive resources of an individual At the simplest level, then, stress is a disturbance of homeostasis. Homeostasis is the bodys ability to regulate its inner environment. When the body loses this ability, disease occurs.
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The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones such as cortisol, epinephrine and norepinephrine that regulate the stress response. Because of this, the adrenals are what determine our tolerance to stress and are also the system of our body most affected by stress. Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life. But other factors not commonly considered when people think of stress place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems, inflammation and overtraining. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones. Adrenal stress is probably the most common problem we encounter in functional medicine, because nearly everyone is dealing with at least one of the factors listed above. Symptoms of adrenal stress are diverse and nonspecific, because the adrenals affect every system in the body. But some of the more common symptoms are: Fatigue Headaches Decreased immunity Difficulty falling asleep, staying asleep and waking up Mood swings Sugar and caffeine cravings Irritability or lightheadedness between meals Eating to relieve fatigue Dizziness when moving from sitting or lying to standing Digestive distress
How does stress harm the body?

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The short answer is in every way imaginable. It would take books to explain the full effects of stress. And those books have been written. Check out Why Zebras Dont Get Ulcers by Robert Sapolsky and When the Body Says No: Exploring the Stress-Disease Connection by Gabor Mate for a more thorough investigation. Im just going to summarize here. When stress becomes chronic and prolonged, the hypothalamus is activated and triggers the adrenal glands to release a hormone called cortisol. Cortisol is normally released in a specific rhythm throughout the day. It should be high in the mornings when you wake up (this is what helps you get out of bed and start your day), and gradually taper off throughout the day (so you feel tired at bedtime and can fall asleep). Recent research shows that chronic stress can not only increase absolute cortisol levels, but more importantly it disrupts the natural cortisol rhythm. And its this broken cortisol rhythm that wreaks so much havoc on your body. Among other effects, it: raises your blood sugar weakens your immune system makes your gut leaky makes you hungry and crave sugar reduces your ability to burn fat suppresses your HPA-axis, which causes hormonal imbalances reduces your DHEA, testosterone, growth hormone and TSH levels increases your belly fat and makes your liver fatty causes depression, anxiety and mood imbalances contributes to cardiovascular disease
These are all well-documented in the scientific literature, and the list of health problems caused by stress goes on. And on. In fact its not a stretch to suggest that stress contributes to all modern, chronic disease. But most people dont need much convincing of this. Youve witnessed the negative effects of stress firsthand, every day of your life. So the question is, what do you do about it?
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How to reduce the impact of stress

There are two different approaches to reducing the impact of stress, and both are important: 1. 2. Reduce the amount of stress you experience. Mitigate the harmful effects of stress you cant avoid.
Reducing the amount of stress you experience Reducing stress means just what it sounds like: reducing your total exposure to all forms of stress, whether psychological or physiological. Of course its never possible to completely remove stress from our lives. But even in the most stressful of circumstances, its still possible to reduce stress. The first step is to avoid unnecessary stress. This often seems obvious, but it isnt. Its easy to overlook habitual patterns of thought and behavior that cause unnecessary stress above and beyond the stress we cant avoid. Here are a few guidelines for how to avoid this kind of stress: Learn to say no. Know your limits, and dont take on projects or commitments you cant handle. Avoid people who stress you out. You know the kind of person Im talking about. Drama kings and queens. People who are constantly taking and never giving. Limit your time with these people or avoid them entirely. Turn off the news (or at least limit your exposure to it). If watching the world go up in flames stresses you out, limit your exposure to the news. Youll still find out whats going on, and still be able to act as a concerned citizen. But youll have more time for yourself. I stopped getting the paper years ago, and dont even have TV. And believe it or not Im still well-informed. The difference is I get to choose what Im exposed to. Give up pointless arguments. This is especially true for useless internet debating. There is obviously a place for discussion and debate, and working towards change. But have you noticed that most arguments dont lead to change? In fact, they tend to have the opposite effect each side becomes more
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defended and entrenched in their worldview. Find other ways to get your point across, learn to listen with empathy, and dont waste precious time and energy trying to convert fundamentalists to your religion. Escape the tyranny of your to-do list. Each day spend some time in the morning really considering what needs to be done that day. Drop unimportant tasks to the bottom of the list. Better yet, cross them off entirely. The world will go on. The second step in reducing the amount of stress you experience is to address any physiological problems that are taxing your adrenals. These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies and environmental toxins. If you have one or more of these conditions, its probably best to get help from a skilled practitioner. Mitigating the harmful effects of stress you cant avoid Obviously there are times when we just cant avoid stress. Maybe we have a highstress job, or were caring for an ailing parent, or were having difficulty with our partner or spouse. In these situations its not about reducing stress itself, but about reducing its harmful effects. How do you do that? There are several different strategies: Reframe the situation. We experience stress because of the meaning we assign to certain events or situations. Sometimes changing our perspective is enough to relieve the stress. For example, being stuck in traffic can be a disaster or it could be an opportunity for contemplation and solitude. Lower your standards. This is especially important for you perfectionists out there. Dont let the perfect be the enemy of the good. Let good enough be good enough. Practice acceptance. One of my meditation teachers used to say All suffering is caused by wishing the moment to be other than it is. Many things in life are beyond our control. Learn to accept the things you cant change.
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Be grateful. Simply shifting your focus from what is not okay or not enough, to what youre grateful for or appreciative of can completely change your perspective and relieve stress.
Cultivate empathy. When youre in a conflict with another person, make an effort to connect with their feelings and needs. If you understand where theyre coming from, youll be less likely to react and take it personally.
Manage your time. Poor time management is a major cause of stress. When youre overwhelmed with commitments and stretched too thin, its difficult to stay present and relaxed. Careful planning and establishing boundaries with your time can help.
In addition to everything Ive listed above, one of the most important things you can do to manage stress is to bring more pleasure, joy and fun into your life. This is the subject of Step 9, so Ill just mention it briefly here.
Stress management practices and techniques

All of the stress management tips above are important, and can make a huge difference in your health and well-being. However, theres a certain amount of stress in modern life that is simply unavoidable for most of us. Thats why its so crucial to have a regular stress management practice. There are a lot of options here, of course. Things like exercise, yoga, tai qi, qi gong, a walk on the beach, etc. can all relieve stress. Ill just share the practices Ive found to be most helpful for myself and my patients over the years. Meditation In spite of the fact that Im listing it here, I dont consider meditation as a stress management technique although it can certainly have that effect. Meditation is an awareness practice. Through meditation we learn to witness our thoughts, feelings and sensations and dis-identify with the story we tell ourselves about them. We learn to stay present to our lives even in the face of great difficulty or pain.
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Contrary to popular belief, you dont have to be able to relax to meditate. Sometimes we are relaxed during meditation, sometimes we are quite agitated. We dont meditate to manipulate our feelings, but to learn to observe them without reacting to or becoming them. One of the books I often recommend to people whod like to learn more about meditation practice is Opening the Hand of Thought, by Kosho Uchiyama. You may also want to check out Don Mateszs recent article, 10 Reasons Why I Practice Mindfulness Meditation, for more on the benefits of meditation practice. Mindfulness-based Stress Reduction Mindfulness-Based Stress Reduction (MBSR) combines mindfulness meditation and yoga to cultivate greater awareness of the unity of mind and body, as well as of the ways the unconscious thoughts, feelings, and behaviors can undermine emotional, physical, and spiritual health. It was developed by Jon Kabat-Zinn at the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979. Through clinical research at the University of Massachusetts and elsewhere, MBSR has been shown to positively effect a range of autonomic physiological processes, such as lowering blood pressure and reducing overall arousal and emotional reactivity. MBSR is offered as an 8-week intensive training in hospitals and medical centers around the world. It is also offered as an online course, and can be done via home study with books and audio recordings. MBSR is particularly effective for anyone struggling with chronic illness or pain. Rest Assured Rest Assured is a program for healing insomnia naturally. However, the way this is accomplished is by maintaining a greater state of relaxation and ease throughout the day. We cant run around all day in a state of constant hyper-arousal and expect to fall into a deep and peaceful sleep at night. The body doesnt turn on and off like a light switch. This is why sleep medications have become ubiquitous. Theyre the equivalent of hitting yourself over the head with a sledgehammer so you can fall asleep.
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The Rest Assured program contains simple exercises that coordinate breath and movement. Many of the exercises can be performed in as little as 3-4 minute throughout the day, while some take 20-30 minutes and can be done when you have a little more time or while youre laying in bed before sleep. Ive found these to be incredibly helpful myself, and my patients have as well. Stress management is one of the most important things we can to do protect our health, yet its often the first thing that slips through the cracks in a busy life.
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#7: Move Like Your Ancestors
Theres no question that regular exercise is essential to health. Our paleolithic ancestors had a different word for exercise: life. For the vast majority of our evolutionary history, humans had to exert ourselves often quite strenuously to get food. We naturally spent a lot of time outdoors in the sun, walking, hunting, gathering, and performing various other physically-oriented tasks. We had no concept of this as exercise or working out. It was just life. Things are different today. 60% of American adults are not regularly active, and 25% are complete couch potatoes they get no exercise at all, other than walking back and forth between the car, the cubicle and the refrigerator. This lack of physical activity has profound consequences. Regular movement protects us from disease in several ways, but most importantly it prevents oxidative damage and inflammation the primary
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mechanisms underlying most modern, degenerative diseases. This explains why those who are completely sedentary have between 1.5 and 2.5 times the risk of developing heart disease and a higher risk for virtually all modern, degenerative disease. On the other hand, weve got the exercise fanatics. Many Americans have been caught up in the fitness craze over the last 40 years, devoting countless hours to jogging, the Stairmaster or the treadmill in the hopes of slimming down, getting healthy and preventing disease. But while this type of activity may help with stress management, research suggests that its useless for weight loss and may in fact be detrimental to health. If you doubt this, youll have to explain why Americans have continually gained weight over the last 40 years, in spite of increased leisure time exercise and increased energy expenditure.
Why cardio doesnt work for weight loss

When I say cardio, Im referring to steady-state, repetitive activity done at a moderate intensity like jogging outdoors, running on a treadmill or climbing the Stairmaster. [Side note: the idea that you have to perform this type of activity to benefit your heart and vascular system is false. Anything that places a demand on the muscles - including socalled anaerobic activities like weightlifting - will also condition the heart and vascular system.] Most people are surprised to learn that cardio doesnt work for weight loss. How could this be? There are three main reasons: caloric burn during exercise is generally small; people who exercise more also tend to eat more (which negates the weight regulating effect of exercise); and, increasing specific periods of exercise may cause people to become more sedentary otherwise.
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In an example of the first reason, a study following women over a one-year period found that in order to lose one kilogram (2.2 pounds) of fat, they had to exercise for an average of 77 hours. Thats a lot of time on the treadmill just to lose 2 pounds! In an example of the second reason, a study found that people who exercise tend to eat more afterwards, and that they tend to crave high-calorie foods. The title of this study says it all: Acute compensatory eating following exercise is associated with implicit hedonic wanting for food. I love it when researchers have a sense of humor. In an example of the third reason, one study assigned 34 overweight and obese women to an exercise program for 8 weeks. Fat loss at the end of the study was an average of 0.0kg. Not very impressive. But the researchers noticed that some women did lose weight, while others actually gained. What was the difference? In the women that didnt lose weight, the increase in specific periods of exercise corresponded with a decrease in overall energy expenditure. Translation: they were more likely to be couch potatoes when they werent exercising, which negated the calorie-burning effect of their workouts. If youre still not convinced, the Cochrane group did a review of 43 individual studies on exercise for weight loss. Study length ranged from 3 to 12 months, and exercise sessions lasted on average 45 minutes with a frequency of 3-5 times per week. The results? On average, the additional weight loss from exercise averaged about 1 kg (2.2 pounds). Meh. Assuming they worked out for 45 minutes 4x/wk over 6 months, that means they had to exercise 69 hours to lose that 1 kg.
Why cardio may be harmful

Too much cardio exercise has a number of harmful effects on the body: increases oxidative damage increases inflammation (the root of all disease) depresses the immune system decreases fat metabolism disrupts cortisol levels
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causes neurodegeneration
Overtraining is especially damaging because of its effects on cortisol. We discussed cortisol at length in Step 6: Manage Your Stress, but in this context whats important to understand is that too much exercise can disrupt our natural cortisol rhythm and drive levels too high initially, and depress them over time. Cortisol dysregulation promotes abdominal fat gain and muscle loss, which in turn causes further weight gain. Theres also some evidence that frequent endurance exercise may promote rather than prevent heart disease. Dr. Kurt Harris summarized a study performed on 102 active marathon runners and 102 age-matched controls to determine the effect of aerobic exercise on cardiovascular health. The marathoners were between 50 and 72 years of age, and they ran an average of 35 miles per week. They had no known history of heart disease or diabetes. The control group was similarly aged and also had no history of cardiovascular or metabolic disease. You might be surprised to learn that the marathon runners were three times more likely to have heart damage than the non-runners. Among the runners, there were 12 heart attacks vs. 4 attacks in the non-runners. In another study by the same authors, the more marathoners ran, the higher their likelihood of heart disease. In fact, the number of marathons ran was an independent predictor of the likelihood of irreversible damage to the heart tissue.
No cardio? Then what should we do instead?

In short, we should move like our ancestors. They didnt strap on a heart monitor and take off for a 45-minute jog, nor did they go down and swim laps for an hour in the local lake. Yet they were extremely fit and almost entirely free of the modern diseases that plague us today.
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They performed low-intensity movements like walking, gathering foods or working in other capacities on a regular basis. These periods of low-intensity activity were punctuated by brief periods of much higher-intensity activity such as going on a hunt, running for a predator or fighting for survival. This is the type of movement our bodies are adapted for, and thus this is what we should aim for in our daily lives. But how do we do that? As Mark Sisson suggests, we should: 1. 2. Move frequently at a slow pace Lift heavy things and sprint occasionally
Move frequently at a slow pace

Moving frequently at a slow pace means approximately 3-5 hours a week of low level activity like walking, cycling, gardening, hiking, performing manual labor, etc. This mimics our ancestral pattern of movement, helps maintain a healthy weight, promotes proper metabolic function and provides a foundation for more strenuous activity. Another benefit of this type of activity is that its often performed outdoors. Spending time outdoors reduces stress, increases vitamin D levels, and brings us pleasure, joy and a sense of connection with the world around us. I think one of the best ways to do this type of movement is to integrate it into your daily life. This could include commuting to work and doing errands on foot or by bicycle, taking the stairs instead of the elevator, doing your own gardening and yard work, etc.
Lift heavy things and sprint occasionally

In contrast to cardio, this type of exercise involves performing movements at very high intensity for short periods of time usually between 30 seconds and 2 minutes. This is sometimes referred to as high intensity interval training (HIIT).
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Several studies have been done comparing HIIT to low-intensity, steady-state (chronic cardio, as Mark Sisson calls it) exercise, and HIIT has been shown to be superior in nearly every meaningful marker. In this study, one group was assigned to chronic cardio, while the other was assigned to intervals of 8-second sprints. After 15 weeks, the researchers concluded: Both exercise groups demonstrated a significant improvement (P less than 0.05) in cardiovascular fitness. However, only the HIIE group had a significant reduction in total body mass (TBM), fat mass (FM), trunk fat and fasting plasma insulin levels. A pair of studies done at McMaster University found that 6-minutes of pure, hard exercise once a week could be just as effective as an hour of daily moderate activity, according to the June 6, 2005 CNN article reporting on the study. The study itself was published in the Journal of Applied Physiology, and it revealed that HIIT resulted in unique changes in skeletal muscle and endurance capacity that were previously believed to require hours of exercise each week. A follow-up study confirmed the results. Despite the fact that the more conventional endurance exercise group spent 97.5 percent more time engaged in exercise, both groups of subjects improved to the same degree. The group that exercised 97.5 percent more received no additional benefit whatsoever from doing so. Considering the wear-and-tear and increased risk of injury associated with that much more exercise, theres absolutely no point to doing chronic cardio when you can receive the same benefits with a fraction of the time and risk by doing HIIT.
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The Cochrane study I linked to earlier in the article also found that high-intensity exercise was superior to chronic cardio. In particular, the researchers found that high-intensity exercise led to a greater decrease in fasting blood glucose levels than low-intensity exercise.
Why high-intensity exercise is better

In his excellent book on high-intensity strength training, Body By Science, Dr. Doug McGuff explains that high-intensity training is superior to chronic cardio because it produces a greater stimulus and thus more effectively empties the muscles and liver of glucose. This stimulus can last several days with HIIT, as opposed to just a few hours with low-intensity training. HIIT also activates hormone-sensitive lipase (HSL), which mobilizes fatty acids for energy use. This means that during HIIT, both glucose and fatty acids will be burned, leading to greater fat loss and restoration of insulin sensitivity.
High-intensity strength training: best of all?

Both high-intensity running or bicycling sprints and high-intensity strength training are effective. But I believe high-intensity strength training is probably a better choice for most, simply because the wear-and-tear and risk of injury is lower especially if the strength-training is performed using weight machines as described in Body By Science. This is, in fact, the method of training Ive been doing since April of last year. I admit I was somewhat skeptical about it all before I read Body By Science. But the research and the physiology was convincing, so I decided to give it a try. The results have been incredible. My workout varies in length between 5 and 9 minutes a week. Thats right, I said minutes. With only a few exceptions, Ive increased the amount of weight I can lift, the time I can lift it, or both, with each
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successive workout. My strength has increased and my physique is, if anything, better than it was when I was lifting 3x/week for much longer periods.
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#8: Get More Sleep
Insomnia has reached epidemic proportions. Its estimated to be the #1 health-related problem in America. More than 1/3 of Americans have trouble sleeping every night, and 51% of adults say they have problems sleeping at least a few nights each week. 43% of respondents report that daytime sleepiness interferes with their normal daytime activities. These problems are getting worse, not better. The number of adults aged 20 to 44 using sleeping pills doubled from 2000 to 2004, and the number of kids ages 1-19 who take prescription sleep remedies jumped 85% during the same period. Prescriptions for sleeping pills topped 56 million in 2008 up 54% from 2004 with over $5 billion in sales in 2010. This isnt surprising in a culture that values productivity and activity above all else, and is almost scornful of rest and relaxation. Resting for many people means watching TV, browsing the internet or engaging with some other kind of electronic device that is anything but restful for the brain and the body. We have not only forgotten the value of rest, we have forgotten how to do it.
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You cannot be healthy without adequate sleep. Period.

Unfortunately for us, the body hasnt forgotten the importance of sleep. Its absolutely essential for basic maintenance and repair of the neurological, endocrine, immune, musculoskeletal and digestive systems. The hormone melatonin naturally increases after sundown and during the night in a normal circadian rhythm, which increases immune cytokine function and helps protect us agains infection. (This is why youre so likely to get a cold or flu after not sleeping well for a few nights.) In fact, sleep is so important to our overall health that total sleep deprivation has been proven to be fatal: lab rats denied the chance to rest die within two to three weeks. Among other things, a full nights sleep: enhances memory and mental clarity improves athletic performance boosts mood and overall energy improves immune function increases stress tolerance
When things fall apart: how sleep deprivation destroys your health
Fewer than 6 hours of sleep per day is associated with low-grade chronic inflammation and worsening insulin resistance, as well as increased risk for obesity, type 2 diabetes and cardiovascular disease (CVD). This is highly significant in light of a recent cross sectional study demonstrating that nearly one-third of US adults get less than 6 hours of sleep per 24 hour period. Inadequate rest impairs our ability to think, to handle stress, to maintain a healthy immune system and to moderate our emotions. Its associated with heart disease, hypertension, weight gain, diabetes and a wide range of psychiatric disorders including depression and anxiety.
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The following is an abbreviated list of some of the more damaging effects of sleep deprivation: Impaired immune system: a study from the University of California found that even modest sleep loss weakens the immune systems response to disease and injury. Overweight and obesity: Recent studies have shown that even one night of poor sleep can result in dramatic changes in appetite and food intake. Others have shown that restricting sleep to 5 hours a night for just one weekimpairs carbohydrate tolerance and insulin sensitivity. Researchers now believe that sleep deprivation is the single best predictor of overweight and obesity in children which has become an alarming problem. Finally, a brand-new study shows that not getting enough sleep causes fatty liver disease. Cognitive decline: sleep deprivation negatively impacts short-term and working memory, long-term memory and the generation of nerve cells all of which effects our ability to think clearly and function well. Mood and mental health: anyone who has had a few nights of poor sleep can tell you that insomnia is associated with depression. Insufficient sleep shuts down the pre-frontal cortex and can cause or exacerbate a number of psychological conditions, ranging from anxiety to PTSD to depression. Systemic inflammation: as I already mentioned above, sleep deprivation causes chronic, low-grade inflammation. And we now know that inflammation is the root of all modern disease. Increased risk of death. Last, but certainly not least, not getting enough sleep reduces your lifespan. Of course we could go on. Theres really no disease or medical condition that sleep deprivation doesnt either contribute to directly or make worse. I firmly believe that lack of sleep and stress are the two biggest health challenges we face today. If youve been reading this series (and this blog over time), you know how much value I place on proper nutrition. But its much easier for most people to make changes in their diet than it is for them to improve their sleep and manage their stress.
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And heres the thing: you can eat a perfect diet and take all the right supplements, but if youre not sleeping well and managing your stress, all bets are off. I see this every day in my private practice.
How to get a good nights sleep

Before we get into natural tips on improving sleep, I want to say a few words about sleep medications. In spite of their popularity, they are not without risk including dependence, rebound insomnia, drowsiness, memory loss, bizarre sleep walking behavior, changes in brain chemistry, constipation and much more. On the other hand, there is a point at which the harmful effects of sleep deprivation start to outweigh the potential adverse effects caused by sleeping pills. This is when I believe sleep meds should be used as a last resort, presuming all non-drug approaches have failed. Once you get into extreme sleep debt, it can be difficult to make it out without some biochemical assistance. That said, there are many ways to prevent this from happening in the first place and to naturally improve the quality of your sleep if its poor. Reduce your exposure to artificial light Artificial light disrupts our circadian rhythm and throws off our sleep. Just a single pulse of artificial light at nightdisrupts the circadian mode of cell division, which can not only impact our sleep, but also increase our risk of cancer. Another study showed that the blue light emitted from alarm clocks and other digital devices suppresses melatonin production in a dose-dependent manner. Follow these tips to avoid light exposure: Dont use a computer for 2 hours before going to bed. No staying up late on Facebook and Twitter! Use blackout shades to make your bedroom pitch black. Cover your digital alarm clock or get an analog clock. Turn off all digital devices that glow or give off any type of light.
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If you cant do these things for some reason, use a sleep mask.
Dont be too full or too hungry Some people sleep better after eating a light dinner. This is especially true for those with digestive issues. Others like those with a tendency toward hypoglycemia do better with a snack before bed (and possibly even during the night). Go to bed earlier Youve all heard the saying an hour before midnight is worth two hours after. It turns out there is some truth to that. When you fall asleep, you go through a 90-minute cycle of non-REM sleep followed by REM sleep. But the ratio of non-REM to REM sleep within those 30 minute cycles changes across the night. In the early part of the night (11pm 3am), the majority of those cycles are composed of deep non-REM sleep (stages 3 and 4) and very little REM sleep. In the second half of the night (i.e. 3am 7am) this balance changes, such that the 90-minute cycles are comprised of more REM sleep (the stage associated with dreaming) as well as a lighter form of non-REM sleep (stage 2). Whats important about this is that deep stage 3 and 4 sleep is where our body regenerates and repairs tissue and engages in other restorative processes. If we dont get enough deep sleep, we cant rejuvenate and heal. So you say youre a night owl? Patients often tell me theyre naturally night owls, and theyve always preferred to stay up late and sleep in. But in truth theres nothing natural about this. For millions of years of human evolution sleep patterns remained in synch with the daily variation in light exposure. We rose with the sun, and went to be soon after sundown. This is what our bodies are adapted for. In almost all cases, having a lot of energy late into the night is a sign of a disrupted circadian rhythm. Normally, cortisol should be high in the morning and taper off throughout the day and into the evening. This gives us the energy we need to wake up in the morning, and allows us to start winding down after dark so were ready to sleep. In people whove been exposed to significant chronic stress, this rhythm goes haywire.
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They have low cortisol in the morning (which makes it very hard for them to get going) and high cortisol at night, which gives them that late second wind. While drinking several cups of coffee in the morning mitigates the morning fatigue to some degree, it also perpetuates the pattern by revving them up in the afternoon and evening. When I treat these so-called night owls for cortisol and melatonin rhythm dysregulation, one of the first things they report is feeling tired at night. And thats a good thing! It takes them a while to adjust their lifestyle, but ultimately theyre better off for it. For more good recommendations on improving sleep, read Mark Sissons Definitive Guide to Sleep.
When good sleep hygiene isnt enough

Im reluctant to make any recommendations about supplements and nutrients for sleep problems, because the decision about what to take depends on what the underlying cause of the problem is in the first place. In general, though, magnesium is a good choice. Most people are deficient in it and it is not toxic at daily doses up to 800 mg. Its also cheap and easy to find. I prefer the chelated forms of magnesium like glycinate and malate, but others like a product called Natural Calm which is mixed in warm water before bed. Be careful it can have a laxative effect. Melatonin is another commonly used sleep aid. But I dont recommend it for anything more than emergency, short-term use. Why? Because melatonin is a hormone. Taking any supplemental hormone disrupts our natural regulatory mechanisms of that hormone and throws our internal production of it out of whack. This can create dependence over time and disrupt our circadian rhythm, which is crucial not only to sleep, but to overall health. What I recommend instead to all of my patients with sleep issues and what I use myself is a program called Rest Assured. The premise behind the program, which I
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agree with completely, is that the most important factor in getting a good nights sleep is managing stress during the day. Most of us run around like chickens with their heads cut off all day, and then wonder why we cant fall right asleep as soon as our head hits the pillow. If our nervous system has been in overdrive for 16 hours, its unrealistic to assume that it can switch into low gear in a matter of minutes simply because we want it to. Of course this is why sleeping pills are growing in popularity each year. The Rest Assured program has simple, easy-to-follow breathing and movement exercises designed to promote daytime relaxation and a good nights sleep. It helped me and my patients tremendously. You can try a sample exercise (audio and pictures) here.
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#9: Practice Pleasure
In Step #6: Manage Your Stress, we talked about how chronic stress contributes to everything from insomnia and anxiety to obesity and heart disease. Scientists have devoted vast amounts of attention to understanding the mechanisms of the fight or flight response. We know that when were faced with stress, a cascade of physiological changes occur triggered by stimulation of the sympathetic nervous system: blood flow increases to the muscles, lungs and other areas needed to mobilize us for action, and decreases to areas like the digestive and reproductive system that arent necessary for immediate survival. Hormones like adrenaline pump through our body to make us stronger and faster. Extra fuel (glucose) is released from the liver so that it can be burned quickly for energy.
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But theres another nervous system response thats just as important as fight or flight to our survival thats often ignored in the scientific literature and in mainstream articles about stress. Were not only set up to deal with stress or challenges, but also to enjoy life, to relax, to bond and to heal. This is the parasympathetic state, often referred to as the rest and digest or calm and connect response. It has the opposite biochemical effects on our body to fight or flight. Our heart rate and respiration slow down, our blood pressure drops, our blood flow increases to the digestive tract, our skin and reproductive organs and our stress hormones decrease.
Were not built for chronic stress

Both fight or flight and calm and connect are essential to life. We need the ability to meet challenges and mobilize our physical and mental resources to take action. But we also have the need to digest food, replenish our stores and heal ourselves. In paleolithic times, its likely these to different systems existed in a state of relative balance. Imagine a day of mostly relaxing, interacting with others, gathering food or building shelters. This might be punctuated by an acutely stressful event, such as a hunt or an encounter with a predator. But it would likely be followed again by more rest and digest time, such as gathering around a fire and feasting on the days hunt. Human beings are adapted to have this kind of balance between pressure and calm, stress and relaxation, sympathetic vs. parasympathetic stimulation. But today things are different. Fight or flight isnt usually a temporary situation like warding off immediate physical danger or engaging in a hunt that quickly passes. Instead its an almost continuous reaction to the excessive demands placed on us by modern life. Worrying about your 401k plan, watching the news, being skipped over for a promotion, getting cut off in traffic while these dont literally threaten our survival, our bodies react as if they do. The problem is that chronic stress impacts us in much the same way that acute stress does. We have the exact same physiological response only to a lesser degree. Our heart rate and blood pressure increase, stress hormones start pumping, and blood flow
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to the digestive and reproductive organs decreases. Is it any wonder that conditions like IBS and infertility have become epidemic? When fight or flight is no longer simply an acute mobilization of our bodys resources, but instead becomes our default physiological state, were in a state of chronic stress. And as you saw in Step 6, chronic stress wreaks total havoc on our bodies.
Pleasure: the antidote to chronic stress

In their book Feeling Good Is Good For You, researchers Carl J. Charnetski and Francis X Brennan set out to review the emerging evidence that pleasure can boost our immune systems and lengthen our lives. According to the authors: In every way, stress is the antithesis of pleasure. It jangles your nerves, juggles a whole host of your bodys hormones, elevates your blood pressure, and makes your pulse race It also weakens your immune systems ability to resist illness and disease. If stress is the antithesis of pleasure, then it follows that pleasure is the antithesis of stress. So the best way to fight stress is with pleasure. Our bodies secrete chemicals called endorphins when we experience pleasure. Animal research has revealed, for example, that endorphin levels are up to 86 times higher after animals experience multiple orgasms! But endorphins are also released, albeit at lower levels, in more mundane daily activities such as playing with a pet, watching a funny movie, listening to our favorite music, visiting a favorite place or connecting with loved ones. The chemicals released when we experience pleasure do more than counteract stress hormones and improve mood. They also: Improve immune function by producing an antibacterial peptide Enhance the killer instincts and abilities of various immune components, including B cells, T cells, NK cells, and immunoglobulins
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Enable certain immune cells to secrete their own endorphins as a way of improving their disease-fighting capacity
The persistent state of chronic stress in our lives makes the counter-balancing effects of pleasure even more important. This is especially true for anyone dealing with chronic illness or pain, which are both stressors on the body.
Pleasure vs. distraction: not the same!

It might seem strange to you that Im recommending seeking more pleasure in life. Maybe youre thinking, Our entire culture is slavishly devoted to and obsessed with the hedonistic pursuit of pleasure! And you want more? But Id disagree with that assessment. Our culture is devoted to distraction, not pleasure. And theres a big difference between the two. Distraction is something that prevents us from giving full attention to ourselves and our lives. Pleasure is almost exactly the opposite. When we experience pleasure we are more fully present to life, more grounded in our bodies, more alive and aware. Pleasure activates our calm and connect system; distraction does not. For example, watching TV and browsing the web are often distractions that divert our attention from our own experience. But getting a massage, listening to our favorite music or taking a walk barefoot on the beach are pleasurable activities that connect us more deeply with ourselves and the world around us. It is this experience that is crucial to our health and I would argue our happiness. But does that mean theres never a role for distraction? No. I believe distraction (when used consciously and wisely) can be a helpful and sometimes even necessary way of releasing the pressure valve or hitting the reset button. Sometimes were too stressed out, too sick or in too much pain to experience pleasure or figure out how to bring it into our lives in that moment.
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In these moments distraction can be a gift. In fact, my Zen teacher Darlene Cohen, who passed away earlier this year, had a special name for this kind of distraction: downand-dirty comfort. She described it in her book Turning Suffering Inside Out: How do we live through unbearable situations like a catastrophic disease without being destroyed? How do we deal with the mundane anguish of our everyday lives? How do we continue to live under crushing stress? And even further, how do we not just get through these things but have rich, full and worthwhile lives that we actually want to live under any circumstances? The important thing to understand here is that pleasure and distraction both have a role to play in protecting us from the ravaging effects of stress. Most people these days are pretty good at distraction. In fact, distraction has become a national past-time. What were not so good at is pleasure.
5 ways to bring more pleasure into your life

In their book, Charnetski and Brennan examined several pleasure inducing experiences that have been scientifically proven to promote health and well-being. Music (listening to it or making it) Touch (including massage, sex and simple human contact) Pets Humor (laughter) Light, sight & insight (spending time outdoors, prayer/meditation and positive attitude) Most of us are already aware of the healing power of those things listed above at least on some level. But in this culture, there is also an overwhelming reliance on medicine, surgery, diet and other physiological interventions to treat disease. Though we may pay lip service to the idea that stress causes illness and pleasure can prevent it, how many of us actually attribute the same importance to listening to music or watching a funny movie as we do to taking a pill? The evidence is crystal clear now that our thoughts, beliefs, emotions and behavior are all capable of inducing the same physiological changes in our bodies as foods, supplements, pills and even surgery are.
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If you doubt that this is true, consider the placebo effect. It has been proven over and over again that pharmacologically inert substances like sugar pills can have identical or even greater therapeutic effects than drugs in certain cases. Even more impressive are the trials that have shown that sham surgery (when small incisions are made to convince the patient they have had the operation, but no surgery is performed) is at times as effective as the actual surgery. Clearly this points to the power we all have to heal ourselves. If only the suggestion or belief that we will heal is enough to induce the physiological changes that lead to healing, without the presence of any active pharmacological substance or surgical intervention, then clearly our thoughts, beliefs and emotions have the potential to be powerful medicine. Here is your homework: for the next week, make sure to do something pleasurable for yourself every day. Then report back and tell me how you felt at the end of that week.
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CHRIS KRESSER, M.S., L.Ac.

2011 by Chris Kresser

9 Steps to Perfect Health

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About Chris Kresser

The conventional approach to healthcare has failed

All modern diseases share a similar cause

Introducing the 9 Steps

9 Steps To Perfect Health

Cereal grains: the unhealthiest health food on the planet?

Industrial seed oils: unnatural and unfit for human consumption

Sugar: the sweetest way to wreck your health

Soy: another toxin promoted as a health food

9 Steps To Perfect Health

Not all macronutrients are created equal

Human fuel: food that nourishes the body

Know your fats

Know your carbs

Know your protein

9 Steps To Perfect Health

Lets look at each of these in turn.

Pasture-raised animal products and wild-caught fish: as nature intended

Organic, local and seasonal: more nutrients, fewer chemicals

9 Steps To Perfect Health

Get nutrients from food whenever possible

Take nutrients in their naturally occurring form whenever possible

Be selective with your supplementation.

Which supplements may be necessary?

9 Steps To Perfect Health

The gut flora: a healthy garden needs healthy soil

Leaky gut = fatigued, inflamed and depressed

How to maintain and restore a healthy gut

9 Steps To Perfect Health

How does stress harm the body?

How to reduce the impact of stress

Stress management practices and techniques

9 Steps To Perfect Health

Why cardio doesnt work for weight loss

Why cardio may be harmful

No cardio? Then what should we do instead?

Move frequently at a slow pace

Lift heavy things and sprint occasionally

Why high-intensity exercise is better

High-intensity strength training: best of all?

9 Steps To Perfect Health

You cannot be healthy without adequate sleep. Period.

How to get a good nights sleep

When good sleep hygiene isnt enough

9 Steps To Perfect Health

Were not built for chronic stress

Pleasure: the antidote to chronic stress

Pleasure vs. distraction: not the same!

5 ways to bring more pleasure into your life

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