Thanks for joining us for episode 42 of The Ancestral RD podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show!

Today we’re answering the following question from a listener:

Paleo update: “Where are we on gluten, dairy, legumes, potatoes, and the low carb bias?”

Are you wondering if there have been revisions to the seemingly strict Paleo diet guidelines of approved and restricted foods? Today we’re updating you on the latest findings about all of these grey-area foods so you can decide for yourself if these foods should be allowed in your diet!

Here’s what Laura and Kelsey will be discussing in this episode:

1. The current stance of the Paleo diet community on gluten, dairy, legumes, potatoes, and carbs
2. The gluten debate and who should avoid it
3. Problematic types of dairy
4. The misunderstood legume may surprise you
5. Reconsidering white potatoes
6. Thoughts on the low carb bias

TRANSCRIPT

Kelsey:  Hi, everyone. Welcome to Episode 42 of the Ancestral Rds. I’m Kelsey Marksteiner and with me, as always, is Laura Schoenfeld.

Laura: Hi, Kelsey.

Kelsey: How are you doing, Laura?

Laura: Good. A little tired from watching the Super Bowl with some friends last night.

Kelsey: Yeah, I know. It was funny. You texted me last night about the Xifaxin commercial and we were talking about… I don’t know if anyone was watching the Super Bowl yesterday, because I wasn’t. But, Laura informed me that there was a commercial for Xifaxin, which is the brand name for Rifaximin, which is used to treat SIBO, which was kind of exciting and I think probably the only time I’ve ever been excited to say that I’ve seen a pharmaceutical commercial.

Laura: Right. Well, it was funny. We were all paying attention to the commercials equally as much as the game as you do during the Super Bowl.

Kelsey: Yeah, of course.

Laura:  And we had seen a couple of these, I guess pharmaceutical commercials. I was joking about one of them being a pharmaceutical commercial for basically an opiate induced constipation commercial.

Kelsey: Oh yeah, I’ve seen that one. Or I’ve seen something like that on Hulu Plus.

Laura: Right, and then so it was an advertisement for a drug that was basically fixing a symptom of another drug, which I was like, are we at that point now that we’re advertising symptom fixing, or I guess medication side effect fixing medications?

Kelsey: I know. It’s crazy.

Laura: Yeah. Then this IBS commercial came on, and none of my friends are in the health field so they didn’t really understand that IBS is actually really common. They were like, why are they advertising a drug for IBS in the Super Bowl? Are they really that many people with IBS? And I said, actually, I think the stats are one in five people have IBS. I mean it’s a pretty good chance that somebody watching, or one-fifth of the population watching, is going to have it.

When I was watching the commercial, I didn’t realize what drug they were advertising for and I wasn’t really paying attention that much. But then I saw the name Xifaxin come on, and it just kind of hit me. I was like, oh my gosh! They’re advertising Xifaxin for IBS treatment. And I just started getting really excited and my friends were kind of looking at me like I had three heads or something, like why do you care about this? And I just started saying, oh no, this is actually a really big deal because I have a lot of clients that have SIBO and SIBO is a major cause of IBS in a lot of people, if not the majority of people with IBS. And I have so many clients that have such a hard time getting either a SIBO diagnosis, or if they did get a SIBO diagnosis, getting on the correct medication is always a battle, and then insurance doesn’t want to cover it. It’s actually kind of a big deal because if you’re not having insurance coverage, a round of Xifaxin can be over a thousand dollars.

Kelsey: Right.

Laura: And if it’s being advertised on the Super Bowl, then it must be hitting mainstream awareness that that’s a legitimate treatment for IBS and thus SIBO.

Kelsey: Right.

Laura: I just got really excited. It was funny. I texted my mom who’s also a dietician and I was like, did you see that they were advertising Xifaxin for IBS? And she was like, yeah, it’s pretty wild, right? And I’m like, at least somebody knows why I think this is so weird.

Kelsey: Somebody understands

Laura: I thought that was kind of interesting just because again, it’s been kind of a battle for a lot of my clients, and I would imagine your clients as well, where even just getting a SIBO diagnosis is like a wild goose chase to find a doctor who will diagnose it.

Kelsey: Right.

Laura: I had a client recently whose doctor said that he wasn’t convinced that SIBO was even real. And I’m like, really? I feel like that isn’t really up for debate at this point.

Kelsey: Yeah, not at all.  Wow! That’s crazy!

Laura: And he was a GI doctor. Yeah, so that’s why I got excited so I was like, oh, maybe this means SIBO is actually getting recognized and the treatment is going to be to be approved for use and then maybe insurance will cover it.

Kelsey: Yeah, and I’m pretty sure it is FDA approved for IBS, one of the IBSs. We were talking about it yesterday and now I already forgot. I think it’s IBS-D maybe.

Laura: Well the ad I think was for IBS-D. I kind of missed it, but the impression I got was it was saying,  oh, doesn’t it stink to have to run to the bathroom all of a sudden? Which yes it does. I imagine that was the IBS-D that they were talking about.

Kelsey: Right, yeah. So, I guess it is probably is IBS-D. But I know that it is definitely approved… I think it’s only for one of them though, not for both, as far as I remember. And I think that was approved some time in 2015, which was pretty exciting because we were talking about this last night. But, it means that typically insurance will hopefully cover it more often.

I’ve had a lot of clients where they’ll have to call into their insurance at the very least. Sometimes they’ll have to do an appeal. I think I had one woman this past year who had…she wrote an appeal for Rifaximin just because they decided they wouldn’t cover it for whatever reason, but basically she cited in her letter to the insurance company that it is approved for her kind of IBS. So, it’s kind of ridiculous that they wouldn’t cover it. I think it’s becoming more and more common for it to be covered, even though there’s still is like a little bit of that hurdle that some people will have to get over to get them to do it. It’s not automatic I don’t think at this point for a lot of people.

But, it’s really exciting, and like I was talking about, it’s sort of silly to get excited about a pharmaceutical commercial because for the most part I think that doesn’t really make sense to have any commercials for these things. But, in this case we’re actually dealing with the root cause, which is very, very different form a lot of drugs, and that is very exciting.

Laura: Yeah. And even just knowing that it’s starting to become something more mainstream is good because I think a lot of this stuff…as I said before, a lot of doctors don’t even think SIBO is real, so if the pharmaceutical companies have established it’s worth creating a Super Bowl ad for, then I feel like that’s indicating that it’s going to be something much more commonly accepted and hopefully standard of treatment for people since it is so effective.

Kelsey: I would hope so.

Laura: Speaking of the Super Bowl, I know you said that you weren’t really watching last night.

Kelsey: No.

Laura: You don’t really watch football at all, right?

Kelsey: No, I don’t. I don’t really care.

Laura: I’m definitely a football fan. I’m embarrassingly a Giants fan, although they have been a good team in the past. But I usually watch the Super Bowl every year. Even if I’m not interested in the game itself, it’s kind of just fun to go watch the game, and watch the commercials, and the concert in the middle, the half time or whatever.

Kelsey: Right.

Laura: And I was telling you before we got on that I had a kind of interesting experience with the food, since I’m sure a lot of people have had this experience as well when you go to a super bowl party and there is just like a smorgasbord of horribly unhealthy, disgusting, fried everything, everything’s dipping into gross cheese.

Kelsey: Mm hmm.

Laura: It’s definitely not known for its healthy food. I feel like Super Bowl parties are the one party where eating a ton of junk is acceptable.

Kelsey: Yeah.

Laura: I was at a party, and to be fair, there wasn’t a ton of junk food there. My friends that I was watching it with aren’t super gluttonous people that just have this table full of gross food. But, I’ve been to parties like that before, so I’m not saying that doesn’t happen for a lot of people. And there’s been times in the past where I’ve been at parties like that and I either was…my thoughts were a little bit consumed with the food where it was like, I don’t want to eat this, but I’m hungry, but just kind of thinking about it more than I should have. Or I would eat stuff, and then eat it to excess, and then feel like, oh, that was disgusting. Why did I eat that much?

That was in the past. So for the party last night I was…first of all I brought my own gluten free pizza, which I don’t quite feel awesome when I eat regular pizza, so that was kind of like let me skip the regular pizza and bring my own so that way I’m not feeling horrible the next day. And I brought some nice beer to drink, so not totally being gluten free, but I like to have a dark beer too when I’m watching football. I was mentioning to you before we got on the phone that there was a tray of brownies that got put out at half time or something, and I thought to myself, hmm, that might be nice to have a brownie. I didn’t have anything sweet. Maybe I’ll have one. And then I got distracted by the game, or chatting with my friends, or just kind of doing party things as you do. And I think it must have been a half an hour later, I kind of glanced at the brownies again and I’m like, oh! I never had a brownie. And then I had this thought like, do I really want one if I forgot about it and they’re not super special? They’re just kind of run of the mill box brownie mix or whatever. And it was such a non-dramatic realization that I was like, you know what? I don’t really think I need one. Or if I really want one in 20 minutes, I’ll have one, but I really don’t want it right now.

Kelsey: Right.

Laura: Then I never ended up eating one. And it was just kind of an interesting…when I looked back on the experience I was kind of interested by it, and this is going to lead into our topic today. But, in the past when I’ve been way more restrictive about what I eat and way more kind of, I don’t want to say judgmental because I’m not judgmental about other people, what they eat. But I’m judgmental about myself if I eat bad things. I’ve gotten so much more relaxed about what I eat and not taking things so seriously.

Kelsey: Yeah.

Laura: And it was just really cool to have that experience where the food didn’t have any sort of pull on my either mental energy, or emotions, or anything like that. And if I’d eaten the brownie, I don’t think I would really feel any different today. So it’s not like I’m like, oh, I feel so great because I didn’t eat that brownie.

Kelsey: Right.

Laura: But I also was kind of pleasantly surprised that it was so easy to not care.

Kelsey: Yeah.

Laura: I don’t know if you’ve had that experience at all, or if you had the same level of inner turmoil from being at parties where it’s like, I don’t want to eat this, but I want something nice, and I never eat these things.

Kelsey: Right.

Laura: It’s having this obsessive thought process about the food. Whereas this time they had a lot of food. Actually, they had wings, they had crackers, and chips, and salsa, and all this stuff. And I literally just ate my two slices of gluten free pizza. I think I had a piece of pepperoni and cheese as part of the little appetizers, and then I had two beers and that was it. And I was totally cool with it.

Kelsey: Yeah. I think going to parties and stuff like that…I do think that idea of just really checking in and saying, am I actually going to really enjoy this? Is it something that I really actually want to eat, or is it just because it’s in front of me? And it’s really easy to fall into that trap of, oh, this in front of me. It looks pretty good. Maybe I should just eat it. And I’m not saying there’s never a time and a place for that. I certainly do that, but it does always feel nice when you can recognize that hey, maybe that’s not going to taste so great. Like you said, it was just like a box brownie mix. It’s nothing special.  For the most part, most of the time, that’s probably not going to be worth it to you, just it’s not all that exciting.

For me it’s like, oh, if someone made these nice homemade brownies with great ingredients, yeah, I probably would have one just for that experience, and tasting it, and everything, and it’s not going to do anything really terrible to me. But, yeah, if it’s something that I’m probably not going to even enjoy all that much in the act of eating it, it’s really nice to be able to recognize that before you start eating it.

And that’s a skill that needs to be trained, and I feel like retrained over and over again because you can very easily forget that skill too.

Laura: Yeah. Well especially being dietitians, I know you and I probably think about food, and health, and lifestyle even more than…I mean there’s days where I’m like, man, it would be so nice to not worry about this stuff at all. And worry is probably a strong word because sometimes it’s worrying for other people. It’s more, oh, I really want to figure out what this person’s issue is and now I’m reading all this stuff about nutrition and it can get really kind of consuming.

But, it’s nice to be in a point at my life where I can be less, not neurotic, but like I can just not care as much and it’s not like I’m having a bad health result because I’m not caring as much. It’s almost like I’ve gotten to the point where I kind of know what I can get away with. I know the foods that make me feel the best. If I eat too much of something and I have some gut discomfort or I break out or something, then I’m like, okay, maybe I should lay off the gluten or something for a couple weeks or whatever. But, there’s no drama around it. It’s just kind of like, oh, I know what happened. Let me change course a little bit and fix that without being like, oh my gosh, I have to go on a Paleo reset for the next month because I had a brownie the night before.

Kelsey: Yeah. Exactly.

Laura: And to be fair, I think a big part of it was also the environment of the party. I was with friends that I am super comfortable with; I spend a lot of time with. I feel like the socialization and enjoyment factor was so much higher than other parties I’ve been to where maybe I don’t know any of the guests that are there, or I just feel a little bit anxious around the people that I’m with, and then I start to use food as a coping mechanism because I feel uncomfortable or something. So that was probably a big part of it as well, that I was just really enjoying myself and I didn’t need the brownie to actually enjoy myself anymore.

Kelsey: Yeah.

Laura: And I know we’ve talked about that, about parties in general, how really enjoying your time and being present for the party and not just being like, I’m here to eat. It can be really helpful.

Kelsey: Yeah, for sure. And that brings us into our question for today a little bit I think. So before we jump into that, here’s a word from our sponsors.

Kelsey: All right. Our question for today came from someone who submitted this to us and just wanted an update on where Paleo stands currently. They asked, “Where are we on gluten, dairy, legumes, potatoes, and the low carb bias?” So just really asking, what’s the deal with these foods at this point? Have we learned more about them to change any of the original, strict Paleo guidelines that tell us that we should not eat any of these foods?

Laura: Short answer: I’ve probably eaten gluten, dairy, legumes, and potatoes in the past, probably in the last 24 hours to be honest. I’m trying to think if I had legumes. Yeah, I think I did have legumes. Well I don’t know. I went out to brunch with some friends yesterday after church and there may have been beans in the food that I ate. But it was defiantly potatoes, dairy, and then I had gluten in the beer.

Kelsey: Yeah, I’ve definitely eaten all those in the last week.

Laura: At least as far as we’re concerned, we’re not super strict in our own lives about these foods, and I know that for our clients we tend to try to find that whole, “what can I get away with?” strategy with those kind of foods.

But as far as Paleo is concerned, Paleo as a community, I don’t know. Sometimes I feel like I’m not as deep into that as I used to be. Well, I’m definitely not as deep into that as I used to be because I think there is little bit of ridiculousness that I’ve seen sometimes when it gets too insular like that. But I think in general, Paleo is probably still no gluten.

Kelsey: Yep.

Laura: Dairy, I think again, is it appropriate for an individual? I want to say they’re probably still legume- free. Would you agree with that?

Kelsey: I would agree. I mean I would agree that they are. My personal opinion, I think, is very different from probably that. We’ll talk about it. But yeah, I think for the most part, the strict Paleo still says no legumes.

Laura: And I think white potatoes, I know Whole 30 has added them to their approved list.

Kelsey: Mm hmm.

Laura: With Paleo it’s one of those questions like, who are we talking about when we talk about Paleo? Because if you want to talk about the trademarked Paleo diet by Dr. Cordain, then I don’t think he allows any of those foods, even while potatoes.

Kelsey: Right.

Laura: He’s pretty strict about why those are not allowed and he’s written blog posts about why anyone who says legumes are okay to eat is wrong. That kind of thing. As far as the carbs are concerned, I don’t know if Dr. Cordain’s recommendations addresses carb intake so much.

Kelsey: Yeah, that’s a good question.

Laura: But, I think if you’re avoiding legumes, potatoes, dairy, gluten, grains, and probably fruit; I think he’s kind of low fruit as well. I think that just kind of forces it into low carb diet anyway. So it’s maybe not being addressed in any specifics, but he probably still is promoting a low carb diet.

Kelsey: Yeah.

Laura: Now, again, there’s the Whole 30, there’s Mark Sisson’s primal approach, obviously Chris Kresser has his own diet recommendations, Robb Wolf has diet recommendations, there’s a lot of different people that have their own slant on Paleo. But, I’d say if you’re going to be talking about Paleo as a strict recommendation, then I’m pretty sure the only thing on that list that, or I guess the two things on that list that would be gray area possible approved would be dairy and potatoes.

Kelsey: Now, I think there’s definitely a reason to start on this strict Paleo idea first for pretty much everyone. And I definitely think that that’s a good thing for most people to do just because there will be people certainly who can’t eat some of these things, or maybe even all of these things, and so to start there and take all those things out is a great idea. But, then to not be afraid of adding them back in or at least trying them to at least see how you do is going to be the way to go. But, I think when people read a book or they read a blog post that’s trying to convince them to try a strict Paleo diet, the evidence that’s put out there really makes these things seem not good for you at all. And I think that scares people away from potentially adding them back in.  And so I think what you and I are trying to do with just doing this podcast, our blogs, or working with clients one on one is to just make people not afraid to try them because there’s going to be many, many people who are perfectly fine with at least a couple of these things on this list, if not all of them.

Laura: Right.

Kelsey: It’s really worth trying to add them back in and seeing how you do.

Laura: Well, and as far as the evidence for things concerned, unfortunately, and this is the state of nutrition science, I feel like anyone could make a pretty solid case for any dietary recommendation.

Kelsey: Right.

Laura: Obviously there’s a lot of vegan books out there, and there’s a lot of low fat recommendations out there showing evidence that fat causes problems. Then you have the other end of the spectrum where there’s ketogenic Paleo recommendations. I mean I even had some opinions on my Facebook page when I shared an article showing that low fiber diets in mice actually changed, or I guess they caused irreversible changes in the gut bacteria of these mice after four generations. So they’re feeding the mice low fiber intake, and then by the fourth generation of these mice there’s changes that happen that the only way they can fix is if they do a fecal transplant for these mice.

Kelsey: Wow!

Laura: My argument was that that was showing obviously the western diet is pretty low in fiber. Usually it’s refined carbohydrates and that kind of stuff.

Kelsey: Right.

Laura: But, there was a few people that came on my Facebook saying that there’s evidence that we don’t need dietary fiber and that too much fiber is bad for us. And I’m just like, are you serious? I’m not saying that too much fiber in the sense that you’re doing fiber supplements and having a ton of grain fiber and bran and that kind of stuff. I don’t think that that’s required, but to say that we don’t need dietary fiber and the evidence for that is that the Inuit didn’t eat fiber containing foods is I don’t think accurate.  You get these people can make these really strong sounding cases for dietary recommendations. And I honestly feel like at the end of the day I’ve seen so many people that read a book, or read an article, or got recommendations from another practitioner that were very strict about some kind of dietary approach and they developed new health issues that they didn’t have before changing their diet. But then they have this thought in their head that, well, I can’t go back to eating X Y Z because this person said that it’s going kill me basically.

Kelsey: Exactly.

Laura: I think a really great example is legumes because that’s one that I don’t think has been accepted by the Paleo community as being potentially fine to eat and possibly even healthful to eat for some people. And I have one client that I’m working with right now; time will tell how this works for her. But, when she went Paleo, she used to have very good digestive function and she’s been Paleo for the last, I guess, two years and she has such bad constipation. And she basically came to me…I almost think she came to me for permission to start adding carbs back in because she was just like, I read Wheat Belly and I’m just really afraid of eating too many carbs because I know they’re so bad for you. And I’m just like, this is what happens when people read these books that are really, really strong opinions about certain dietary approaches, and they craft this really good sounding argument for why everyone should eat a certain way. And then somebody changes their diet, and even though they might have some improvements, and maybe they got rid of something they were eating that wasn’t good for them, then they have these new symptoms comes up. But it’s like, oh, but I can’t change my diet because it’s bad for you.

Kelsey: Right.

Laura: I feel like being really open-minded about what dietary practices can be appropriate. I think realizing that there’s a huge spectrum of carb intake, of types of foods, of amount of protein, of amount of animal foods; and there’s a lot of diets that are very high carb, low animal foods; there’s a lot of diets that are low carb, higher animal foods that can provide good health to people. But, at the end of the day, if you’re not experiencing good health on a diet, that you have symptoms that came up from changing your diet, then that’s really a sign that you need to reassess how those rules are working for you.

Kelsey: Yeah. I totally agree, and I can’t tell you how many patients I’ve had that have the same exact thing. And it can be across the spectrum, too. It’s not necessarily like it’s always only low-carb that’s being problematic. It could be that, it could be vegetarian, veganism. Even somebody who maybe originally was on a low-carb diet and went to super high-carb diet because they just wanted to try something a la Ray Peat, or something like that, and that really didn’t work for them. It can be totally across the spectrum what doesn’t work for a particular person.

But yeah, like you said, at the end of the day if it’s not working, it’s not working, and you have to figure that out and it’s going to take some experimentation. But know that people can survive and thrive on a variety of different types of diets, and you’re not really going to know which one is going to do best for you without trying them.

Laura: Right.

Kelsey: If you’re doing perfectly fine, you’re in great health based on how you’re eating currently, no reason to change anything. But if you are stressed out about your diet even though it’s giving you good health, that’s something to pay attention to because that stress is going to cause some health issues as well.  You just really do have to experiment a little bit and see what works best for you, and at the end of the day that’s all that you can really do, right?

Laura: Right. And I think with Paleo, like you said earlier, there’s benefits to doing a Paleo reset type approach where you do remove these foods. And I think as dieticians, RDs in general get a little flack about, well and I shouldn’t say its undeserved, but people will say, oh, well dieticians just say you shouldn’t remove grains, or you shouldn’t remove legumes, or that removing a food group is a bad diet approach, even though that doesn’t really seem to translate to vegan and vegetarian diets, which that’s always allowed in the dietetics world for some reason. But, I would never say that gluten, dairy, legumes, potatoes or, well I don’t know, I’m a little mixed thoughts about carbs. But, let’s just say individual foods: gluten, dairy, legumes, and potatoes. If you don’t eat any of those foods, you’re not going to have health problems necessarily.

Kelsey: Right.

Laura: There’s no nutrient that those foods are providing that you can’t get elsewhere, either through other foods or supplementation, if necessary. And I’m even just thinking things like vitamin K2 or something if you can’t eat dairy. Or, actually I really feel like that’s the only one that’s really coming up for me right now.

Kelsey: Yeah, that’s probably the only one.

Laura: But, just because something isn’t necessary to eat for health, doesn’t mean that you might not benefit from eating it. An example there is potatoes. No, nobody needs to eat potatoes for good health. But, if you’re having a hard time getting enough carbs, if your super active, if you can’t eat sweet potatoes because maybe you have gut discomfort from sweet potatoes, then yeah, maybe white potatoes are something you should eat for better health.

Kelsey: Right.

Laura: I think having really, really, strict universal rules about food is kind of dangerous on any diet. Any time somebody’s saying never eat this, I think you need to question what the reason is. I feel like we’ve had this conversation before, but for me, really the only thing I feel comfortable saying never to eat would be probably vegetable oils.

Kelsey: Um Hmm. I agree.

Laura: That’s something that absolutely has no benefit in our health and certainly can cause a lot of problems, and I think there’s a lot of research coming out on more problems that those oils cause that we’re not even paying attention to.

Kelsey: Right.

Laura: And it’s an easy replacement.  You can get plenty of other healthy fats from whole foods. So there’s really no benefit to eating them. But, other than that, I mean I think most of the foods that are eliminated on a strict Paleo diet, there are some people that if nothing else, could tolerate to eat regularly, and maybe some foods that people would benefit from eating because they can’t eat other foods or because have certain lifestyle factors that mean that they should be eating a broader diet. Or, maybe they just don’t feel badly if they eat a pretty diverse diet.

Kelsey: Right, and worrying about it, never eating it again is going to be more problematic than just having it once and a while when it’s there and it makes sense for them to eat that food.

Why don’t we go through each of these foods and just talk a little bit about them because there are certainly some caveats, some things to consider with each of these foods for particular people that we may just want to get into a little bit more.

Laura: Sure.

Kelsey: Let’s start with gluten, and this is probably the one that you’ll see the most across the board in any books, blogs, etcetera saying that you should never eat it. And there is some fair evidence for that. Basically, what we’re looking at there is that anytime even someone without celiac, or without gluten sensitivity is eating gluten they tend to get intestinal permeability. Now whether there’s some degree of intestinal permeability that is normal when we eat anything, I haven’t seen that study done. So if anybody knows of any study that’s looked at that, especially comparing it to somebody eating a gluten containing meal and a non-gluten containing meal when they do not have celiac disease, or do not have gluten sensitivity, and looking at if there’s a difference at all between the amount or length of intestinal permeability that happens, I’d be really curious to see that because our bodies have this ability for a reason. Not that it’s good. We definitely do not want you to have consistent intestinal permeability that goes on for a long period of time. We’ve certainly seen that that can be problematic. But, to say that there’s no degree of intestinal permeability that’s somewhat normal when you eat food, I think is maybe a little bit naive to say.

Laura: Yeah. We were talking about this before we got on the recording that obviously our bodies have the ability to make the intestines permeable for some reason. It’s not just there to make us sick. Our bodies produce zonulin and have the ability to either get slightly permeable after eating foods, or there’s probably varying degrees that are normal versus not normal.

Kelsey: Right.

Laura: There’s probably varying lengths of time that’s considered normal, and to say that all intestinal permeability is pathological I think, like you said, is not accurate. If people are using the argument that gluten causes intestinal permeability in all people and that’s why you shouldn’t eat it, I don’t know if that’s enough evidence to say that nobody should eat gluten, ever.

Kelsey: Right.

Laura: And like you were saying, I don’t know if there’s a lot of research that really shows either way. And if gluten is something that you are comfortable avoiding, and you don’t really care to have it ever, and it doesn’t bother you that you’re not having it, and you could care less if you ever have gluten again, you’re not going to get any sort of nutritional deficiency by not eating gluten.

Kelsey: Right.

Laura: When people argue that gluten free diets are dangerous, I think that’s totally unreasonable as well. But, to say that everyone should be on a gluten free diet with no question, then again I don’t really see there being strong evidence to support that philosophy.

Kelsey: Right, and it’ll be interesting to see if there ever is. Because of all of these things, I have to say that if I had to pick one that I had to choose that one hundred percent of people had to avoid for the rest of their life, just because I had to choose one, it would be gluten of all of these things just because of the state of evidence there. I think it makes the strongest case for avoiding it so far. But, I still don’t think that means we one hundred percent should not be eating this based on the current evidence, and I personally don’t avoid it completely.

Laura: Right.

Kelsey: It’s not something that I’m eating every single day or anything like that. But, I don’t go crazy trying to keep it out of my diet completely.

Laura: And we’ve talked about this before, but stress is actually a pretty significant intestinal permeability factor. If your diet is causing you a ton of stress, and you’re avoiding these foods that you’re not even sure you’re sensitive to, or if they’re actually causing any problems, then the stress from that diet might actually be more of an issue for intestinal permeability than just eating a little bit broader of a food intake.

Kelsey: Right.

Laura: And I can’t say that everybody is in that situation, and I think that’s when working with a practitioner and getting testing done to show if you are having permeability from certain foods is really helpful because then it’ll give you an actual test result saying, yes, you do create antibodies to this food and thus you probably shouldn’t be eating it if you want to avoid autoimmune disease or prevent autoimmune symptoms. But, I think this is where this broad scale, universal dietary recommendations gets, I’d say, almost impossible.

Kelsey: Right.

Laura: And gluten is one of those things that again, avoiding it is probably not a bad idea for most people. And like you were saying, I’m the same way. We don’t buy tons of wheat products. We don’t eat wheat at every meal. We don’t think gluten-free is a dangerous diet. But, I have beer once and a while. I might have a bite of cake at a restaurant, or at a wedding, or something. And I’ve been Cyrex tested, so I’ve seen that I don’t have any antibodies against gluten, or gliadin for that matter. I don’t feel that worried about having a bite or two of it, or even having a whole piece of cake.

Laura: Right.

I don’t feel like I’m causing irreversible damage to my body by eating it. But, on the same side of things, I don’t buy gluten-containing bread because, A- It doesn’t really sit well with me digestively, and, B-I just don’t care about it. It doesn’t need to be part of my diet. But, you’re right. Gluten is one of those ones that I think has the most evidence supporting removing it, and that’s probably why I wouldn’t eat gluten as a health product. I might have dairy as a health product. I might even have legumes as, oh, some beans, those are fine.

Kelsey: Yeah.

Laura: Properly prepared legumes, there’s evidence for their healthfulness. Whereas even potatoes, white potatoes have nutrients, and minerals, and carbs, and there’s things in it that I’m like, actually, this is a good thing for me to eat. Whereas with gluten is just…this is my 20 percent where I like to enjoy my life.

Kelsey: Yeah, exactly. And I’d say for people who are consuming gluten sometimes, I think would say that if you can eat it in some sort of fermented format, like beer…I’m advocating beer and cake, no…but something like that, beer, or sourdough bread, anything like that I would say just in general is probably going to be little bit better of a choice. But, that said, don’t worry about it if every once and a while, like you Laura, you’re going to a wedding or something, you have a little bit of cake…not the end of the world.

Laura: Right, and I mean there is some evidence that symptoms from wheat products are more related to the FODMAP content than the gluten content. I know I feel really sick if I eat regular pasta. So, that’s a food that I never eat, and I don’t have any desire to eat it because it makes me have digestive issues.

If you’re having symptoms from eating gluten, depending on where the gluten is coming from, it could actually be more of a wheat issue as opposed to something like if you have soy sauce that has some gluten in it. Is that something that is actually going to cause some problems? Or beer, which is like you said, a fermented product that might not really be super high-gluten or FODMAP containing and you feel okay drinking it. But, if you have a piece of bread maybe that doesn’t work so well for you.

Kelsey: Right.

Laura: I think with gluten, if you’re really concerned about it then getting tested for gluten sensitivity is probably a valuable investment because then you can just have that question answered for you and you don’t have to worry about it. Maybe the same for dairy if it’s something you’re not sure causes symptoms or not. Again, that could be a FOODMAP issue, too, if it’s something like yogurt or….

Kelsey: Milk.

Laura: Milk or some of the softer dairy products will still contain lactose, even though yogurt tends to be lower lactose, I know it still contains some. Maybe that’s why you’re reacting to it, whereas something like butter, or hard cheeses, or something maybe don’t bother you at all and you don’t have to worry about it.

Kelsey: Exactly. Yeah. So let’s jump into dairy. What you were just saying makes perfect sense. If you’re really worried about it, definitely get tested. That can be in the form of lactose intolerance testing, which is a breath test where you drink a solution of lactose and then you breathe out into a tube. That’s a pretty easy test to replicate at home if you want to do that. You can just say, okay, I’m going to drink a glass of milk and see how I feel.

Laura: Just thinking about that makes me feel nauseous.

Kelsey: Yeah. You can definitely do that at home, or at least some little bit less scientific version of that test at home and just see where your threshold is. If you are lactose intolerant because like Laura was just saying, some people who are lactose intolerant can definitely eat hard cheeses. They can eat butter. But, it’s those softer cheeses or things like yogurt, definitely milk, that would potentially cause issues for a person. And everybody’s threshold is different. Even being a category of lactose intolerant, one person whose lactose intolerant can maybe handle a little bit more lactose than another. You really have to figure out what your threshold is for lactose intake.

Laura: Yeah, and then with casein and whey, the main way to figure that out is if you have any dairy products and they bother you. Or if you get the Cyrex testing to show if you have antibodies produced against things like whey and casein. Again, the testing is really going to show you for sure if you’re creating any sort of immune response to those foods. But, you should also use your symptoms as a guide. For me, certain dairy products, like pasteurized milk, I cannot tolerate more than just a splash in coffee.

Kelsey: Um hmm.

Laura: But, I can drink raw milk just fine. I can have ice cream just fine. I can have most cheeses with minimal….I guess soft cheeses if I ate too much of it I’d be pretty ill.  But, you just start to be able to figure out what your threshold is. I’m sure if I ate a gallon of ice cream I’d probably feel horrible, but having a scoop of ice cream is totally fine. I can put heavy cream in my coffee with no problem.

I think people really need to trust their own experiences a lot in this situation. And if they’re reacting to certain foods don’t feel like, oh, it’s because I can’t have any dairy. Every time I drink milk I get sick, so I’m just going to cut dairy entirely. Maybe it’s the lactose. I think in general there’s a lot of evidence that dairy can be a part of a health promoting diet, and certainly full-fat, grass fed dairy, fermented dairy. Those are going to be the better choices than something like a conventional low-fat milk, which I wouldn’t consider a health food.

Kelsey: Um hmm.

Laura: But, as far as it being something that if you had occasionally being dangerous to eat, for most people I don’t think that’s going to completely destroy their health at any given point.

Kelsey: Yeah, and the good thing about intolerances versus sensitivities is that intolerances you’ll tend to notice a little bit more quickly. If you had a glass of milk you’d probably notice in the next couple hours that you’re going to have some symptoms. They’re are a little bit easier to track and kind of recognize a pattern of symptoms that are occurring when you’re eating certain foods. Whereas sensitivities can be a little bit tougher to keep track of just because those reactions can happen the next day, can kind of happen two days later. It really just depends, and so that’s where testing like the Cyrex testing for food sensitivities is going to be a little more useful because it can just be really hard to determine what you’re sensitive to without that, just because they’re so long lasting or it just doesn’t happen for a while.

Laura: Right, and just to be clear, the Cyrex panel is not going to show you if you have something like lactose intolerance, or FODMAP sensitivity.  So you may still have issues eating wheat, and dairy, and legumes if you’re FODMAP sensitive. Those are not going to show up on a Cyrex panel necessarily. The Cyrex panel is going to test for more of immune response to those foods, which can definitely cause similar symptoms in some people. But, you may still have a clean Cyrex panel, but then have symptoms from eating certain things, which for me, that’s the case where I don’t have a dairy immune response. But, if I had a glass of normal low-fat milk, I would be pretty much in bed for the next day. That’s one of those situations where the testing is helpful, but it’s not the say all, end all of what you should and shouldn’t eat.

Kelsey: Right. Exactly.

Laura: There’s been a lot of talk about legumes being perfectly ancestral, and the whole Paleo thing whether or not people even ate legumes however many thousand years ago you want to look back, I think is a little bit arbitrary. There’s a lot of cultures that eat lots of legumes and they’re perfectly fine.

I’d say the main reason you wouldn’t want to eat legumes is if you have, again, a severe FODMAP intolerance, and generally those are higher FODMAP foods. I mean as far as autoimmune disease is concerned, I’d wonder if legumes are more of an issue for any certain gut dysbiosis than causing actual immune responses. I don’t know if that’s a big immunogenic food. It could be, of course any food can be immunogenic. But, I’d say that the main people who would be questionable about whether they should ever eat legumes or not are people that are having major gut symptoms from FODMAPs.

Kelsey: Definitely, and the lectins that are in involved with legumes, I think, for some people can cause some issues. There are certainly some things with legumes to be somewhat wary of, especially like you said, if you have digestive symptoms to begin with.

But, my opinion on legumes is honestly that they’re actually kind of a health food. That’s sort of how I feel about them because especially from a gut health perspective for someone who already has pretty good gut health, I think they could be really useful because there’s a lot of good fibers in there. Yeah, prebiotics. They’re actually really good sources of a lot of things that we want to be getting in our diet for gut heath. Yeah, I really don’t think that avoiding them should be kind of a go-to recommendation.

Laura: Universal.

Kelsey: Yeah, it should be where you start from and just see if you do okay with them because there certainly are people that will have trouble with them. But otherwise, if you do fine with them, I actually think they’re really healthy.

Laura: Right, and being sure you’re cooking them properly I think can make big difference since the cooking process really does destroy most of the proteins of concern: lectins. There’s always the chance that you go out to eat and they have undercooked legumes. Which I’ve had that experience before and first of all, they’re disgusting. I hate undercooked beans, and lentils, and that kind of stuff. But, I find that those bother my gut if I eat a bunch of undercooked beans. Whereas if I have ones that are really well cooked, or even that whole refried process where they’re not only boiled but then recooked again, I feel perfectly fine eating those. I actually really love refried beans. I find them really delicious. I think they’re a comfort food for me as a child or something.

So legumes, I agree. I think you can put that in the category of potentially healthy foods in probably at least fifty percent of people.

Kelsey: Yeah.

Laura: I think the danger with legumes is when people start using legumes as a meat replacement.

Kelsey: Exactly.

Laura: Could be an add on, could be a good source of carbs for people, perfectly fine to eat. But, whether you want to be only eating rice and beans for your protein as opposed to getting any animal protein, I’d say that is arguable of whether it’s healthy in the long run.

Kelsey: For sure, and I think at least when I talk to my clients and everything, I’m telling them if they’re eating legumes that really they should just be considered their carbohydrate intake for that meal.

Laura: Yeah, I agree.

Kelsey: That makes sense.

Laura: And potatoes, again.  I think they at this point are still approved for certain Paleo plans. I personally don’t understand why people say they’re not Paleo. If we’re using the hunter gatherer, like what a Paleo person might have access to as far as food is concerned, I don’t really understand how potatoes aren’t on that list.

Kelsey: Right.

Laura: I do realize that there are compounds in potatoes that can cause problems for certain people. But again, certain people is not everybody.

Kelsey: Right, and honestly you could probably say that about most foods.

Laura: Yeah, any food. Somebody with a latex allergy can’t eat bananas. Does that mean bananas are unhealthy? No.

Kelsey: Right.

Laura: I think white potatoes are perfectly fine for most people to eat. I think they also get a bad rap where people are like, oh, they’re white carbs and they don’t have nutrients in them. Potatoes actually have a significant amount of nutrients. They’re quite mineral dense. They have lots of B6 in them. They’re a great source of carbs. They’re usually pretty well digested by people with FODMAP issues. I think if somebody tolerates them, they are on the healthy list.

Kelsey: Yeah. I’m totally with you and I think we’ve talked about this before because it’s mind boggling to us, I feel like, that potatoes aren’t on that list. But yeah, I mean I would say of all the clients I’ve worked with, I don’t even know if I could count on my hands how many people have actually had issues with potatoes. Meaning, there’s less, not that there’s more.

Laura: Right. Less than ten.

Kelsey: Yeah. Exactly.

Laura: Most of my clients that can’t do potatoes either have really severe gut infections that they basically can’t tolerate any carbs at the moment, or they are nightshade sensitive.

Kelsey: Yeah, and that’s fair. If they’ve got nightshade issues, then yes, that’s definitely going to exclude potatoes. But again, not all nightshades are going to be problematic for people who are nightshade sensitive. And potatoes are probably one of the biggies though that they will tend to be sensitive to, at least in my experience if they are nightshade sensitive.

Laura: Right.

Kelsey: But yeah, I think a case can be made for potentially not even starting with a strict Paleo diet that excludes potatoes because unless you have an autoimmune disease and you’re already just going to start with an autoimmune Paleo sort of diet.  I would say it’s probably not worth taking those out.  Again, unless it’s super easy, you don’t mind taking that out and swapping it for something else.

Laura: Just to kind of recap where our stance is, now this is not where the Paleo community’s stance is, but our stance is that gluten is not really a health food per se. So if you don’t want to eat it you’re not missing out on anything. But, we don’t think that everyone needs to avoid it one hundred percent of the time. It’s one of those probably could include in your twenty percent of enjoyment foods, but you don’t really need to be eating it for regular consumption for any reason.

Dairy, I’d say, can be healthy. It just depends on the quality of the product, how much fat is in it, if you tolerate lactose or not, and if you tolerate the proteins.

Legumes: health food if tolerated.

White potatoes: healthy food if tolerated.

Carbs in general: definitely healthy food when tolerated, which I’d say most people can tolerate at least some amount of carbs in some way.

Kelsey: Right.

Laura: Yeah, I’d say gluten really is just the one that I don’t care if people want to avoid that. I’m perfectly fine with someone being on a gluten free diet if it doesn’t stress them out.

Kelsey: Exactly. Yea, and with everything on this list too, you can certainly start from that, where you take all these foods out.  The only one, like we said, that you maybe don’t want to take out would be potatoes, unless you’re already starting on an autoimmune Paleo diet.  But, yeah, take all these out to begin with if you’ve never done that before and then add them back in one at a time and see which ones you tend to be sensitive to, or intolerant of I guess I should say would be more accurate. And then if you want to do some sensitivity testing through Cyrex, that can also be a good idea if you’re a little bit more worried about any one of these in particular.

Laura: Right, and I think one final caveat to mention here is that if somebody has been avoiding certain foods for a really long time, like let’s just say legumes for example.  If you haven’t eaten legumes in two years or something. If you’re going to add them back in, just be aware that you may have some transient gut symptoms from eating a food you haven’t eaten in such a long time: mild gut discomfort, maybe a little change in your stool function, or frequency, or consistency.  That’s not necessarily an indicator that you can’t tolerate that food. I’d say give it a couple days. Try a couple of small portions of legumes and see what happens. You may find that that stuff balances itself out.

Kelsey: Yeah.

Laura: I’ve had clients before that were like, well, I haven’t had beans in so long and I had them and I felt a little bloated after ate them. I’m like, well, you also haven’t eaten them in two years, so your gut might have not really had the enzymes to prepare for that consumption.

Kelsey: Definitely.

Laura: Just being reasonable about symptoms and if you have a major bloating incident and it feels like you’re going to die, then yeah, don’t keep eating those legumes for three days. But, if it’s just a little bloating, or you have a little bit of constipation for a day or two, that’s not abnormal. So, just kind of keep that in mind when you’re reintroducing foods and don’t think that any sign of any sort of gut issues is one hundred percent abnormal.

Kelsey: Right, and especially for legumes because they’re such a potent source of prebiotics. If your gut bacteria isn’t used to having a lot of prebiotics coming in at one sitting, that can cause some bloating, just because when that bacteria eats that prebiotic it produces gas as a result. So, you’ll get a little bloating, maybe you’ll get a little gas.  All that stuff is really pretty normal and I really just start to get concerned, if like you said, it’s excessive or it seems really abnormal. But for most people, especially if you haven’t eaten it in a while, you’re likely going to get a little bit of symptoms or something going on. But, I definitely think giving it a couple days is a good idea.

Laura: Right. Cool. Well, I think that covers that question. I’m sure people have more questions about this topic and maybe we’ll do shows on individual foods that we want to talk about.

But, I’d say in general, Kelsey and I both are on the same page when it comes to gray area foods in Paleo. And like I said earlier, honestly, other than omega-6 industrial seed oils, there’s not a lot of foods that are eliminated on Paleo that I think are one hundred percent required for everyone to avoid all the time.

Kelsey: Right. Yeah.

Laura: Great! Well, it’s always nice to know that we’re always on the same page. I feel like Kelsey and I never argue about anything. It would be interesting to see if we ever get to the point where we are like, no, I don’t agree with you about this.

But, anyway we would love to hear your feedback about this episode if you want to write any comments in the comment area below the post for this episode.

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Thanks for joining us everybody and we will look forward to talking to you next time.

Kelsey: All right. Take care, Laura.

Laura: You too, Kelsey.