Thanks for joining us for episode 53 of The Ancestral RDs 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 are answering the following question from a listener:

“Hello. I love your podcast. I’m an RD with an autoimmune disease living in a place where I have minimal access to high quality foods to heal leaky gut and thus heal my messed up immune system. Plus, I have a hard time with the cost of it all. So I often feel like this conundrum alone leads to disordered eating. I know what to eat but have a hard time getting it all the time. So instead of eating stuff that makes me have symptoms like breakouts, flushing, bloating, fatigue, I don’t eat as much as I should. Can you talk about the fine line between eating to heal disease and disordered eating? I know many people dealing with this situation. Or as dietitians, how you handle patients who can’t financially afford the changes you recommend. Thanks.”

Eating to heal is challenging. It requires approaching food in a new way. It’s tough to figure out which foods you don’t react to and find the foods that will support healing, all while maintaining your budget. It’s common for this situation to lead to a disordered way of eating. Many times people begin to under eat due to an elimination diet, or simply not having access to “perfect” food.

Listen today as we discuss under eating due to stressing over food and the effects this has on trying to heal from autoimmune disease, or any health condition.  We share helpful tips for you to maximize your nutrient intake while on a tight budget without totally sacrificing food quality. You’ll also learn how to de-stress during mealtime to approach food differently. You really can eat to heal!

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

• The effect of skipping meals or under eating on your body’s homeostasis
• How prolonged elimination diets can lead to a viscous cycle of more food sensitivities and under eating
• Why under eating negatively affects your microbiome and therefore can worsen autoimmune disease
• What to expect as you reintroduce more foods into your diet
• How to think about money spent for healthy foods as an investment and future money saver
• Tips to eating with autoimmune disease when finances are low
• Why the foods that you add in are as important as the foods you take out when trying to heal from leaky gut
• Tips to maximizing your nutrient intake while on a tight budget without sacrificing food quality
• Why your protein needs increase as you lower carbs, and vice versa
• The effect of stress hormones on the appetite when chronically under eating
• The negative effect stressing out about your diet has on symptoms and quality of life
• The mind-body connection on how your thoughts affect your immune system and digestion
• A relaxation exercise for taking the fear and stress out of reintroducing foods

Links Discussed:

• WildFoods.co – Use the code WILDRD for a free gift

TRANSCRIPT

Laura: Hi, everyone. Welcome to episode 53 of the Ancestral RDs podcast. I’m Laura Schoenfeld, and back with me today is Kelsey Marksteiner.

Kelsey: Hi, everyone.

Laura: So Kelsey, why don’t you tell us about how your retreat is going?

Kelsey: Oh, it’s really nice. It’s in Calistoga, California, which is like in the Napa Valley area. I’ve never been up here. I’ve been to San Francisco once before in my life when I was pretty young so I don’t really remember a whole lot. So I spent a couple days in San Francisco with some friends and then came up here on Sunday night.

It is gorgeous. It’s so green, it’s so warm. I’ve been trying to take pictures to send to my friends and family and make them all jealous. It seriously can’t even capture how beautiful it is. You go to bed and hear all those nature sounds, which is awesome. We saw a fox the other day while Chris was talking, actually during his talk.

Laura: What?

Kelsey: Yeah, there was a fox. Where he was talking, there’s a patio out beyond it. There’s doors out to a patio, all glass doors. So we just see this little tiny fox just running around on the patio, hanging out. We all paused and admired the cute little fox.

Laura: Everyone’s like hold on Chris Kresser. I know we came to see you talk, but there’s a fox outside. We have priorities

Kelsey: It’s adorable.Exactly, yeah. I’ve seen some clients here. I spoke yesterday for my first talk. Then I have another talk on Wednesday, and I have a bunch of clients that day too. So after I record this podcast, hopefully I’m going to go maybe visit a winery, or drive down the Silverado Trail, just like relax a little bit because yesterday was a lot for me. It was just like to be on all day, like everybody comes up to you all day and asks questions.

Laura: Oh, yeah.

Kelsey: It’s a lot. I fell asleep at like 9:00 last night, no problem, which was great. But yeah, it’s going really well.

Laura: Cool. And I bet it’s a lot different when you’re only working online with clients to suddenly be in person and surrounded by them.

Kelsey: Oh, yeah.

Laura: I mean I personally like to have in person clients here and there. But, it’s definitely a very different experience and you have to be really fully physically engaged, not just with your brain. Because a lot of times, like if you’re just on the phone with someone, you can just kind of just put your head on your hands or not really be worried about what you’re body language is doing. When you’re in person with a client, your whole psychical body needs to be engaged as well.

Kelsey: Exactly.

Laura: It can be a lot more tiring in a weird way. Yeah, I’ve had a similar experience with Paul Jaminet’s retreats where it’s cool to be in that environment, and obviously be on vacation, and get to do some things a lot different than normal, but if you’re talking all day and you’re on all day, it’s exhausting.

Kelsey: Right, yeah.

Laura: So I’m glad you got a chance to enjoy yourself and do some fun stuff while you’re there.

Kelsey: Yeah, Initially I was like oh maybe I can take clients on the days I’m speaking. But I ended up scheduling people only for the days that I’m speaking, which now I’m so happy I  did that because then at least there’s like a day in between each time where I’m not speaking, I don’t have any clients. So I’m still talking to people and hanging out with people in a different capacity, but it’s not quite as intense the whole day.

Laura: Yeah, that’s really good. Its sound like you probably need the break every other day.

Kelsey: Yeah.

Laura: Cool. We’re in our fifth week of our five week program for Paleo Rehab and it’s been really cool to see some of the improvements that people are already having after just a few weeks. I’ve also found it fun to watch the interactions on the Facebook group where people are asking questions, and obviously you and I are not attached to Facebook 24/7.

Kelsey: Right.

Laura: Thank goodness. But if we don’t a chance to respond right away, a lot of times I’ll see that another participant, or even some of the alumni, are actually answering questions for each other. Obviously we’re going to moderate that and make sure nobody is sharing completely inaccurate information, but luckily I don’t think I’ve really seen that being an issue.

Kelsey: I know. All of the answers have been fantastic I’ve found. Yeah.

Laura: Yeah. So I think that’s really cool to see that community aspect, obviously seeing how a lot of the people there are enjoying getting to talk to other people that are in their same position. I think a lot of time people can feel a little isolated if they are dealing with a chronic health issue that nobody in their immediate lives really understands or doesn’t think it’s even real.

Kelsey: Right.

Laura: Being able to talk to other people and say, this is how I’m feeling, and here’s what worked for me, and have you tried that? It’s really cool because it means we don’t have to necessarily be solving everyone’s problems for them. There’s not only a lot of not only community involvement, but a lot self-direction that happens. Which in adrenal fatigue/HPA axis dysregulation, I actually think self-guided healing is really important because it’s so easy to just get caught up in what X Y X guru says about how to heal and people really kind of shut off their intuition when it comes to things they should or shouldn’t be doing for their health.

What I really like is in this group program because we’re not telling them here’s the plan to follow, and here’s exactly what to do, and don’t do that because if you do you’re going to get screwed up or whatever, it allows them to check in with their own experience and allow themselves to make decisions that fit their needs better than if they were just totally following our recommendations without any personal input.

Kelsey: Yeah because everybody is different. You can only give people a kind of guideline to follow first. But from there, it’s really great I think for them to be able to interact with other people, especially the alumni who have gone through this before and they’re still working on things, or they feel like they’ve healed really well and so that gives some encouragement.

We had a post the other day kind of asking, has anybody healed from this? And we had some people saying, yes, I feel so much better, which is so amazing to see. And I bet that’s even more amazing as someone going through the program for the first time thinking, ugh, I don’t know if I’m ever going to heal from this. It’s so encouraging to hear from other people who have done it before that yes, you can get through this.

Laura: Yeah, and I think it’s really cool that we have some alumni that are active.

Kelsey: Yeah.

Laura: Because I think in general, the activity has been mostly new people, which totally makes sense. When you go through a program, like even you and I went through B-School.

Kelsey: Yeah.

Laura: I know I don’t do anything on those B-School Facebook groups anymore because it’s just only 24 hours in a day and I can’t be stuck in Facebook world all the time.

Kelsey: Right.

Laura: We do have a handful of people who are really being supportive and it’s really cool to see that. If you’re listening and you’re one of those people, you get a little shout out because you guys are doing a great job. And it’s just really awesome to see the community, and encouragement, and people actually being okay with the experience they’re having and committing to the changes that we recommend to get them on the path to health.

Kelsey: Right.

Laura: Even though it’s a five week program, it’s not a five week experience. It’s not like at the end of that five weeks they’re just totally back to normal. You really need a lot of positivity to stick with this stuff for the long haul, and I like to see that even when people start to feel a little negative, there’re that community building that allows them to kind of switch into more of a positive mindset.

Kelsey: Yeah.

Laura: It’s really cool. I mean part of me is a little sad that it’s ending this week.

Kelsey: I know.

Laura: Part of me is also excited to have some free time to do some other projects because I know we’ve been working on this for so long that it almost feels weird that we would not be working on it.

Kelsey: Right. Totally.

Laura: But it’s time to let our students kind of graduate and start to implement this stuff on their own. I’ll be excited to see how they do over the course of the long run since I know our community tends to continue to be active even after the five week period is over.

Kelsey: Yeah. Definitely.

Laura: Alright. Well that’s our update for this week and let’s get into the meat of our podcast. But before we do, here’s a word from our sponsor.

Kelsey: Alright. So here’s the question for today.

“Hello. I love your podcast.”

Thank you. I forget your name, but thank you for saying that.

“I’m an RD with an autoimmune disease living in a place where I have minimal access to high quality foods to heal leaky gut and thus heal my messed up immune system. Plus, I have a hard time with the cost of it all. So I often feel like this conundrum alone leads to disordered eating. I know what to eat but have a hard time getting it all the time. So instead of eating stuff that makes me have symptoms like breakouts, flushing, bloating, fatigue, I don’t eat as much as I should. Can you talk about the fine line between eating to heal disease and disordered eating? I know many people dealing with this situation. Or as dieticians, how you handle patients who can’t financially afford the changes you recommend. Thanks.”

Laura: Alright. This is defiantly a problem that comes up for a lot of people, including some of our clients. The financial thing, maybe not so often since we work with people who are paying us out of pocket. But that’s not to say that people who are working with us don’t also struggle with the finances of eating a diet that’s “perfect” for their particular health problem.

I think one the biggest things I’d like to point out is that under eating or skipping meals because you can’t eat, is probably just as damaging for your healing or for your autoimmune disease as eating something that maybe isn’t perfect.

Kelsey: Yeah.

Laura: It’s one of those things that, if it’s once and a while, if it’s like you’re traveling on an airplane, and you literally have nothing to eat, and it’s just a couple of hours that you need to go before you eat something, that’s one thing. But it sounds like this person is having a pretty regular occurrence where she’s not eating instead of eating something that she’s not totally comfortable with as far as her symptoms are concerned.

Kelsey: Right.

Laura: That in itself is super common. Even if we’re leaving out the financial part of it, just physically having symptoms to so many foods and then avoiding eating anything because you’re afraid of having those symptoms. It’s a really viscous cycle because what I’ve seen in my clients that are in this position, is a lot of times their symptoms actually start to get worse over time the less and less that they eat to the point where…like I’ve had clients where basically anything they eat causes these symptoms. Have you had that experience?

Kelsey: Oh yeah, absolutely. I think it’s really common and I think it makes people think that they are sensitive to everything, which at that point potentially they are sensitive to a lot things. But oftentimes it’s due to the fact that they’ve been so restrictive for so long. We’ve talked about this I think before in relation to the GAPS diet and how that can be useful sort of as a short term therapeutic diet. But when people continue that for a really time, not only do you tend to under eat on a diet like that because it’s so restrictive, but that under eating over time can kind of mess with the gut in its own way, too, where you may develop more intense sensitivities to some of the foods that you’ve been avoiding for a long time or just really not feel good overall because of the chronic under eating.

Laura: Yeah and I mean there’s two different things I think that cause these problems when someone is  under eating. The first is just physically we talk about something called metabolic reserve and this is something that Chris Kresser as talked a lot about in his practitioner training program and also when he did a Q&A with the participants in our Paleo Rehab program. Metabolic reserve is basically just the extra energy or nutrition, or just there’s a lot of different things that keep your body functioning normally. And in the short term, if you skip a meal or if you don’t sleep as well a certain night, that’s not going to totally deplete you because you have this metabolic reserve to kind of get you back to normal after a not so ideal eating or sleeping schedule, or maybe a tougher workout than you should have done. But over time, when you’re chronically under eating, that metabolic reserve just starts to essentially waste away. So you don’t have anything extra to deal with even minor shifts in your homeostasis.

Homeostasis is just the body’s way of keeping everything normal and in a healthy range, so things like blood sugar, blood pressure, immune function, all these things that have a general range of healthiness that your body wants to keep normal. All of that is dependent on having this metabolic reserve so that when things don’t go as planned, or you have a day that you don’t get to eat as much, you’re not basically running out of the fuel that you need to function normally.

If you’re in this chronic under eating state, even if you’re not losing weight, or you might even be gaining weight if you’re under eating sometimes. There’s a lot discussion about whether that’s true or not, but if we’re talking about the way your body’s metabolic rate drops when you’re in a chronic under eating state, and then you might actually be in a calorie surplus because of the way your metabolism has dropped. When you don’t have that metabolic reserve, everything gets way more sensitive. Your blood sugar is going to be all over the place. Your immune system is going to be either over active or under active. Your cortisol is going to be either high or low. High cortisol will actually suppress your immune system. If you have low cortisol then your immune system can run rampant.

Kelsey: Right.

Laura: Your inflammation can get affected. That would be the first thing that I’d say is the biggest impact of being in this under fed state all the time is just not having the ability to deal with homeostatic change where anything that requires homeostasis, if it gets a little bit out of whack, you’re going to have symptoms.

The other thing that I think is pretty typical that gets affected by under eating all the time is your gut bacteria. We’re not just feeding ourselves when we’re eating, we’re also feeding our gut bacteria. And if you’re on this super restrictive diet, or you’re actually skipping meals multiple times in a week or even once or twice a day, your gut bacteria are not going to thrive. That’s when certain gut bacteria will drop. So a lot of times your beneficial bacteria flora that thrive on prebiotic fibers, carbohydrates, those are going to drop, and then you’re potentially going to have a growth of pathogens that doesn’t really need that kind of fuel. Maybe they fuel better on fat, or maybe their actually eating your intestinal lining to survive.

There’s a lot of different things that you gut bacteria can do to function and the beneficial flora that keep those pathogens from thriving need a steady input of food on a regular basis. Now I’m not saying that you have to be eating all day at every hour of the day. But two to three meals a day on average is enough to keep those bacteria normal. Especially if somebody is on a super restrictive type of diet, even if they’re eating enough calories but their eating it mostly from like ground lamb and collards or something and that’s all their eating and maybe some coconut oil or something, that’s only going to be feeding certain types of bacteria. The diversity and abundance of a normal gut microbiome really depends on not only the amount of food, but having as broad of a variety of food intake as possible.

Kelsey: Yeah. I talk to my clients about this all the time because it’s kind of the biggest mistake that I think people make when they’re trying to heal from gut conditions and that is thinking of diet as a treatment for gut issues verses a symptom management tool while you’re actually treating the gut imbalance. When you kind of use diet as treatment you, like you said, kind of starve that bacteria. You starve bacteria by not eating enough food, but also again, what you just mentioned, not having diversity in your diet.

That’s super common anytime you’re doing any kind of restrictive diet. GAPS, SCD, low FODMAP, any of those of things, you’re really restricting the different types of foods that you eat. And while that can make it a little easier and you feel a little more confident about food, like that it’s not going to cause a problem for you, it does in a way because it really shrinks the diversity of your gut bacteria, and that diversity is so important.

Not to mention that a lot of different types of fruits and vegetables, they have different polyphenols, they have different kinds of antioxidants. All of things are really helpful and they help to help fight inflammation. Anytime time you’re keeping yourself to like three to five vegetables or fruits for what you’re eating for months at a time, that can be really damaging I think. I honestly think that that is really not looked at enough because especially when you’re dealing with gut stuff, it’s seems almost everyone these days recommends some kind of super restrictive diet that in the end, personally, I think for a lot of people may cause more harm than good because they’re reducing diversity, they’re starving gut bacteria, and more than likely they’re under eating as well. That combination of everything is really not helpful.

Laura: Right. Unfortunately, what I think what a lot of people miss when they do these elimination protocols is that the elimination itself is really only supposed to last for maybe a month.

Kelsey: Right.

Laura: There is supposed to be a reintroduction of foods as broadly as possible. Now obviously we understand that certain foods you’re not going to be able to eat. If you have celiac disease, we’re not saying you should be eating gluten because you want to have diversity.

Kelsey: Right.

Laura: You don’t need wheat. You can eat other foods that would be providing the same types of fibers, the same calories, the same carbs. There’s specific foods that if you’re sensitive to, you don’t need to eat those, it’s fine. But there are people that go on these restrictive diets, they feel better at first because they’ve removed something that was causing problems. But then then they don’t add the foods back in and that’s where that issue comes up where suddenly they’re on this 10 different food diet for 6 months or zero grams of carbs and they’re mostly eating fat and protein, if that.

Kelsey: Right.

Laura: Sometimes the protein ends up kind of low too. It’s just like there’s never any intention of adding the foods back in. Even if we’re talking about a Paleo approach, if you do like a Whole 30 or a Paleo Reset type of thing, you don’t have to stay on that strict Paleo Whole 30 type diet forever. I mean I’ve read a blog post by Dallas Hartwig that he posted recently about, I think he called it the post Whole 30 lifestyle, or something. He was describing the Whole 30 as a method for determining if you have food sensitivities and not a diet that should be adhered to indefinitely.

Kelsey: Right.

Laura: Which I though was really good that he addressed that problem because I think a lot people get stuck in their elimination diet because it helped and they think oh well I have do this to keep having that health benefit. It’s really not necessary, and a lot of times actually harmful.

If you do something like an autoimmune protocol, or you do a Whole 30, or you do the GAPS diet, or whatever therapeutic approach to your diet that you’re experimenting with, you should keep in mind the whole time that the goal is to reintroduce as many foods as possible. That’s a problem that I see in a lot of my clients. I know you see it a lot too.

Kelsey: Yes.

Laura: It’s probably one of our specialties, is helping people get foods back into their diet in a safe way that’s not going to cause severe symptoms. The one thing that makes it challenging, like we said earlier, is that if someone’s been on a restrictive diet for a really long time, they’re going to be overly reactive to things in general, even if technically the food is probably fine for them.

Kelsey: Right.

Laura: I’ve worked with a couple of clients in that situation, and that’s a really hard situation to work through because as a dietician, I don’t want my clients to feel bad.

Kelsey: Mm hmm.

Laura: I don’t want them to be having to eat food that makes them feel terrible. However, there’s a lot of things when you’re in the re-feeding process, that you’re going to experience simply because you’re adding food back in and it has nothing to do with the quality or the type of food you’re eating.

Kelsey: Right.

Laura: So things like bloating and fatigue especially, that’s very, very common with the re-feeding. Bloating happens because you’ve been under eating for so long and you’re adding this food back in that your digestive capacity is not prepared for.

Kelsey: Mm hmm.

Laura: That digestive function will rebuild itself and it’ll come back, but it’s only going to come back if you’re eating. If you get gun shy and you stop eating because of the symptoms, you’re going to go right back to where you were. The fatigue is something I think is a lot more common that people realize when you’re in the re-feeding process.

Kelsey: Right, right.

Laura: When you’re underfed, you have that high cortisol, high adrenaline, those stress hormones that are keeping you energized and keeping you functional when you’re under eating. Once you start eating what you’re supposed to be eating, those stress hormones drop. Then when that happens, you don’t have this artificial sense of energy anymore and you start to feel tired. Which a lot of my clients when they go through that period, they get frustrated because they’re like I don’t understand why my energy’s worse if I’m eating more, I’m exercising less. The fact is that if they’ve been running in this fight or flight mode for the last two years or something because of their diet, they’re going to feel tired once they actually start to give their body an opportunity to rest.

It’s a temporary situation and it’s one of those things that again, working with someone can be really helpful here because you have somebody that actually tell these things to you, and have an objective response to, and kind of encourage you to stick with the protocol because it can be really scary to do this stuff on your own. I know this person says she’s an RD. I don’t recommend RDs trying to be their own nutritionist because we all have very subjective opinions about our own health and approach to diet.

Kelsey: Absolutely, yeah.

Laura: We need someone with an objective opinion to kind of tell us what we’re doing wrong and make sure we’re not deciding that something isn’t working for us unnecessarily.

I would say with this particular person, getting adequate calorie intake should probably be her first goal. Once she’s getting enough calories, then working in some of the diversity that she’s a little bit either confused or concerned about that she thinks she might have symptoms to, and seeing if those things are actually because those foods are not appropriate, or just because of the under fed state is causing her to over react to things she’s eating.

Kelsey: And its sounds like too, obviously the cost here seems to be a big piece of this to the point where she’s maybe eating things, like she says, that cause some symptoms for her because she can’t afford to eat the things that don’t make her have some of these symptoms. When that happens, I know it’s such a tough situation.

First thing I like to say about that is generally that…I’ve been ill personally and I’ve had to spend money on stuff that I didn’t think I was going to have spend money on, and a lot more than I thought I was going to. I view that as an investment in my future health because if you’re sick all the time, that’s going to cost you money in some way or another. I know it can seem like a lot to sort of put that financial piece in here. It can be a lot of money, but I do encourage people to think about it as investment.

Then that allows you to think about it a little bit differently because you’re kind of fueling the healing process with good food. And even though that’s expensive, the idea here is that eventually you would be able to eat some of these other foods and not have these symptoms, which would allow you to not only increase the diversity of your diet, but typically that’s going to make it a little cheaper for you too if maybe you can eat some legumes or something that are grey area foods on a Paleo diet and not experience these symptoms, and that’s going to save you some money.

Laura: Yeah.

Kelsey: But that said, also if it’s truly financially not feasible to eat only the foods that you have zero symptoms to, focus on eating…if you have to eat foods that give you symptoms…eat the foods that give you sort of the less severe symptoms.

Like bloating, depends on how bad it is. If it’s causing abdominal cramping and you’re really not feeling well, I’d say let’s stay away from that. But if it’s just a bit of bloating, it’s not too terrible, that’s not that bad. Breakouts too, again, not ideal. But in the scheme of things, it may be okay just while you’re trying to kind of figure out the underlying cause of everything going on.

Because with autoimmune disease, gut balance issues are very common. So microbial imbalances, whether that’s SIBO, whether that’s having some sort of parasite, or opportunist pathogen in the gut, I would highly suggest if this person hasn’t looked at that to take a look at those things. That may really help to heal leaky gut as well because leaky gut is typically caused by something else. Of course it’s very involved in autoimmune disease and sometimes the question is well what’s the chicken or the egg here? But I do think that there’s been research showing that leaky gut is required to develop an autoimmune disease.

To me, leaky gut, at least that I’ve seen, it doesn’t happen randomly. It happens because of something else going on whether that be stress, whether that’s microbial imbalance like we just talked about. So you have to sort of figure out why am I having leaky gut? And work on those factors and that should help your autoimmune disease to be better.

Laura: Now one thing I want to mention about the leaky gut question is that I think a lot of people when they think about healing from leaky gut, they’re always thinking about what foods do I need to take out to heal from leaky gut.

Kelsey: Mm hmm.

Laura: It’s very much of a removal approach, which I think there’s certain foods that you do want to remove, things like gluten, maybe dairy, certain autoimmune protocol foods like eggs, or grains, or legumes, those kind of things that could potentially be causing leaky gut, that’s fine. But you also have to think about what foods are you adding in that are going to help you heal from leaky gut.

Kelsey: Right.

Laura: Leaky gut is not always just a food sensitivity thing. It could also be an immune issue where you’re having immune attack on the gut. It could also be a micronutrient deficiency. So you think about some of the nutrient that are required to keep your gut integrity good, things like vitamin A, zinc, vitamin C, the different nutrients that allow your gut lining to regenerate, and be strong, and be capable of doing the job it’s supposed to do. That’s going to require adding foods in that are going to be very nutrient dense.

They don’t necessarily have to be expensive. I mean I know we talk about liver a lot of the time. Liver is a very cheap food. I’m not saying people should be eating liver every day. Obviously that’s not healthy either. But instead of having grass fed rib eye steak or something, or whatever high cost food item in your grocery cart, maybe look at getting some organ meat. Look at getting some liver, some kidney, or some of the more off cuts of meat like oxtail, or something is not a muscle meat. Which to be honest, muscle meats are not exactly the most nutrient dense part of the animal anyway. So if you’re trying to maximize your nutrition intake without overwhelming your budget, you’re going to want to look at the different parts of the animal that you could potentially eat instead of the more expensive cuts.

Kelsey: Right.

Laura: You can also look for farmers that maybe do a CSA that you could do a bigger purchase of meat all at once. That will save some money there. Remembering that even though grass fed meat is preferable, if you can’t afford grass fed, I’d rather someone eat something that’s not grass fed than just skip a meal.

Kelsey: Yeah.

Laura: Which a lot of people would say, oh well conventionally raised meat is so bad for you, and it’s got all these hormones, and blah blah blah. It’s like if we’re talking about skipping a meal versus eating some conventional animal protein, I’m definitely going to recommend eating the conventional foods.

Kelsey: Mm hmm.

Laura: That can go for vegetables as well. So obviously we don’t want to be eating a ton of pesticides, but if you want to just look at something like the Environmental Working Group’s Dirty Dozen and Clean 15 lists, maybe just only get the organics when they’re in the dirty dozen, and then everything else, especially the clean 15 can be not organic. So you can save some money there.

Kelsey: Right.

Laura: Instead of buying almond milk from the shelf which can be kind of expensive, maybe make your own almond milk.

There’s a lot of ways to cut down on costs that don’t require a huge sacrifice in the quality of food that you’re eating. It’s not like you have to decide between eating grass fed, Paleo, organic diet or eating McDonalds.

Kelsey: Right.

Laura: There’s a lot of in between and you can decide, okay, I think it’s really important for me to have these vegetables that should be organic, but all the other ones are not going to be organic. And I’m going to get grass fed liver, but when I get chicken breasts they can be not pastured. And just making decisions there to see, okay, what’s important to spend money on? What isn’t’ that important? And how can I eat a diet that’s a little bit less expensive? Like you mentioned before with legumes, legumes tend to be pretty cheap, and if you can tolerate them, they’re a great source of both carbs and a decent amount of protein.

Kelsey: Mm hmm.

Laura: Not quite as much as meat, but it’s certainly better than not eating anything. Also, some of the gluten free grains like white rice, or buckwheat, those can be a nice carb source that can really stretch your meals, give you a little extra calories without having necessarily things like gluten in them. I think root vegetables are also usually pretty inexpensive.

Kelsey: Yeah.

Laura: So potatoes, sweet potatoes, those kind of things. A single potato might be like, I don’t know, 50 cents, a dollar, or something.It shouldn’t be something that is so expensive that you have to skip carbs.

Kelsey: Right.

Laura: Fruit doesn’t have to be that expensive, especially if it’s in season, and if it’s local it tends to be less expensive than something that is shipped in from another country. If you have apples and you’re looking at a local apple versus an apple from New Zealand, you’re probably going to see the local apple does not cost as much as the one from New Zealand.

Kelsey: Right.

Laura: I think a lot of times people, especially when they’re knowledgeable, like I’m sure this girl is very knowledgeable being an RD about nutrition. Sometimes having all that knowledge can actually be a detriment because you start to panic about not doing everything perfectly. I don’t know. I just think the stress of being worried about your food all the time, and then also skipping meals when you can’t find that perfect item that you think is just not going to cause any symptoms, that’s probably doing her more harm that just having some food that might cause a little bit of those symptoms every now and then.

Kelsey: Yeah, absolutely. And just to go back to the meat part for a bit here, because I know for most people that’s where the big expense comes, too. You have mentioned seeing if you could buy a meat share, meaning like half a cow or something. But even just going to, if you have a local farmer who is raising cattle, or raising pigs, raising chickens, you can even talk to them and just ask them what are the cheaper cuts. I’m looking for something that’s really not going to be expensive because I’m on a special diet, I’m trying to heal.

Oftentimes there’s a lot of cuts that people don’t really buy that are going to be lot cheaper. Those are things that you’re typically not even going to see in a grocery store because again, nobody really buys them so they’re not going to stock them a lot of the time. But they end up being really cheap and you can kind of slow cook them. Often that’s going to be the cheaper meats. You’re going to use your slow cooker or your pressure cooker a lot. But hey, those things are really convenient. So it works out from a time perspective and from a money perspective.

So I really encourage people to talk to their local farmer if they have one because you’d be surprised what sort of deals you can get. They may not even put it in the fridge. They might have it in the back that just for people ask for it because it’s not really that popular.

Laura: Right.

Kelsey: So defiantly talk to people. That can really, really help.

Laura: Another things I think people should remember about meat is that… I feel like in the Paleo community the emphasis on meat as being a huge component of a person’s diet is really overblown.

Kelsey: Mm hmm.

Laura: One of the problems I see in a lot of my clients is that the reason they need to eat so much meat is because they’re on such a low carb intake.

Kelsey: Right.

Laura: If we think about what happens when you’re on a low carb diet, essentially you’re body has to take amino acids to create glucose to keep your brain and your red blood cells, and anything that requires glucose to function normally. It’s going to need proteins basically to create that glucose. You’re either getting that protein from the food you’re eating, or you’re getting it from your muscle stores.  Now I know most people don’t want to be catabolizing muscle to get the glucose that they need, so they’re going to end up eating a lot more protein to make up for that glucose need.

Now when you’re on a higher carb diet and you basically never get to the point of you needing to create glucose from protein, you’re protein needs are actually pretty low. I mean we talk about having a higher protein diet as being helpful for healing from things like HPA axis dysfunction, or helping people lose weight, or keeping blood sugar steady. But my experience with a lot of my clients and also in my own life, is that when you’re eating a lot of carbs and you’re not eating so low carb that you’re body has to create glucose, your protein needs end up dropping probably around like 60 to 70 grams a day at the most.

Kelsey: Mm hmm.

Laura: Which, honestly I think, what is that? 6 to 8 ounces of meat would probably get you to that amount per day.

That’s something I want to caution people who are on these very low carb diets about, is that if you’re eating more carbs and you’re not needing to go into gluconeogenesis to create glucose, you’re protein needs are going to be a lot lower and you can get away with eating a lot less protein at each meal.

Protein tends to be more expensive per calorie than something like potatoes, or rice, or even fruit. That’s something I wanted to mention because I think it’s really common on Paleo to be eating a diet that does require turning protein into glucose, and then people have to be a very high protein diets because they experience muscle loss if they didn’t have that high protein diet.

Kelsey: Or they’d just be starving.

Laura: Well that too, yeah. I mean that’s one of those things that sounds very obvious, but I think people tend to think that the Paleo diet being so high on fat that you shouldn’t be hungry ever. Your stress hormones can be elevated to the point where you don’t feel as hungry.

Kelsey: Right.

Laura: Which is not necessarily a good thing either. You don’t want to never be hungry. But whether or not you’re hungry, may not be a true indicator of whether you’re getting enough carbs to offset that gluconeogenesis process. Certainty if you are hungry, you can pretty much guarantee that it’s not functioning optimally, unless you’re just getting that normal hunger right before you eat a meal. If you’re hungry all the time, that’s a good indicator that you’re under eating, obviously.

Kelsey: Right.

Laura: Honestly, I think it’s, with my clients at least, it’s less common for them to be hungry. In fact they usually don’t feel hungry because of the way the stress hormones will suppress the appetite.

Kelsey: Especially if you’ve been doing it for a long time, too.

Laura: Yeah.

Kelsey: You get to that state. Appetite, I can’t tell you how many people in my practice their appetite is messed up in one way or another. Like you said, having really low appetite, to me, is just another sign that someone is potentially not eating enough because they kind of just shut down their metabolism and their appetite because of that.

Laura: Right. Yeah. It’s unfortunately super common and I don’t think there’s a lot of information in the Paleo community about how chronic under eating can actually affect these health issues.

With autoimmune disease, you really want to be supporting your immune system as best as possible. If you’re in this chronic elevated cortisol state, or maybe your cortisol drops because your under eating all the time, you’re immune system is going to get out of whack and that can exacerbate your autoimmune disease. If you’re micronutrient deficient, if you’re not eating enough and you’re not getting those vitamins and minerals that you need for a normally functioning immune system, you’re going to have exacerbation of symptoms as well.

Kelsey: Right.

Laura: And then some of these symptoms that she’s mentioning like break outs, and flushing, and bloating, and that kind of stuff, that can all be from gut dysbiosis, which again, it’s going to be affected by the volume of food, the types of foods, the variety of foods, and then also it’s going to be affected by your immune function as well.

So your immune system does modify the types of bacteria in your gut. If you have an under or over active immune system, that can end up messing up the balance of gut flora. You don’t want to be eating in a way, or I guess we should say not eating in a way that is going cause you’re immune system to get either suppressed or overly active. Because that in itself can cause the gut symptoms because of the way it affects your gut flora.

Kelsey: Right.

Laura: Then not to mention how stress affects your gut flora. So if you have a lot of stress from not eating, or even just stressing about what you’re going to eat, that in itself can cause these symptoms regardless of what you’re eating.

Kelsey: Mm hmm.

Laura: We talk about this like it’s so easy to fix this, it’s not. It’s actually very challenging to fix this kind of mindset when it comes to eating. I think there’s this huge myth in the alternative health Paleo community that if you can just get the perfectly clean diet that that’s going to solve all your health problems.

Kelsey: Right.

Laura: And you’ll never have any symptoms, your gut will be just running like a corvette, and it’s like you’re never going to get sick, and your autoimmune disease is going to disappear. And you see all these success stories being like, I put my autoimmune disease in remission. And I’m not saying that those things don’t happen.

Kelsey: Right.

Laura: But I think it sets people up for this expectation that if they can just find the perfect diet, everything is going to be fine, and they’ll feel great, and their disease will go away. It doesn’t always work like that. And the more people stress about trying to find that perfect diet, the worse their symptoms are going to be, or the worse their quality of life is going to be. Even if they’re symptoms are not affected by it, if they’re constantly paranoid about what they’re eating, and they’re stressing about it all the time, I can guarantee their quality of life is going to suffer.

Kelsey: Mm hmm.

Laura: It’s important to keep searching. It’s important to not give up on being healthy. But you also need to be able to accept the level of health that you have right now as being the way things are and not just be in this constant state of negativity, and fear, and just paranoia that if you make any sort of mistake that you’re going to completely ruin your health and ruin ay progress you’ve make. That’s going to keep your body in a fight or flight mode at all times. Again, that stress can be the cause of these symptoms in itself.

Kelsey: Yeah. I honestly think that cannot be overstated. Stress has such an effect on basically every facet of our being to the point where stress can make someone sick. Someone can be perfectly healthy and just be under an intense amount of stress, and I’ve seen this happen with my clients, and that in and of itself I think is the key factor to why they got sick in the first place. You may have these genetic predispositions toward certain types of diseases, they run in your family, but it’s all about the epigenetics. How are we turning on those genes with our environment? Part of our environment is our stress level.

Laura: Right.

Kelsey: If you are crazy stressed, that can in and of itself trigger health problems. Just to go back to the gut for a second, too, because this woman is very concerned with her gut health because she has an autoimmune disease. The connection between stress and the microbiome, again, that can’t be overstated either. I mean that has such a negative effect on the microbiome. It messes up the balance of bacteria. You get more bad bacteria, less good bacteria. It causes leaky gut in and of itself. Just being stressed opens up those intestinal gates basically. It fuels inflammation because of that bad bacteria. It’s producing a lot of lipopolysaccharides. That’s going to cause inflammation. Then that inflammation makes everything else worse. It just creates this really not good situation in the gut on its own, never mind the effects that stress has on everywhere in your body as well.

Laura: This is something I think we see in our Palo Rehab program a lot as well. It’s been really interesting to see the way some people react to things that happened.

Kelsey: Right.

Laura: They’ll be describing something that happened, or maybe there is something that they’re asking us about, and just the way that they write these questions, you can just feel the tension and feel the stress. I’m not saying that we are going to be able to totally avoid stress in all forms, and just be like living on a tropical island somewhere, and just be totally not stressed.

Kelsey: Right.

Laura: But I think a lot of times gets exacerbated by people’s mindsets as far as are they generally having a negative attitude in certain situations, or taking things to an extreme where something barely stressful happens, but then they kind of turn it into something that’s way more stressful than it needs to be.

Or, are they kind of taking this approach where, yeah, things are stressful. Yeah it sucks to be sick, it sucks to have chronic health issues. But do you need to change how you’re approaching either the way you eat, the way you exercise, the way you sleep, the way that you’re even just responding to the stress that you do have so that you’re not amplifying it?

You can’t avoid stress and we’re not saying that this person should just eat any food at all, and it doesn’t matter, and she should just totally give up on any sort approach to healing. But you don’t want to be having every time you eat to be just surrounded by anxiety, and negativity, and fear.

Kelsey: Right.

Laura: And just thinking you’re doing something wrong, or worrying that, oh my gosh, if I eat this I’m going to feel bad.

It’s such a dangerous mindset to get stuck in. You do really get stuck in it unless you actually make efforts to change the way you approach this. It’s a neurological pattern and it’s going to be the way you respond to food. It’s almost like PTSD or something where something that is a negative experience trains your brain to respond a certain way.

And if its food, I mean it’s going to be happening three times a day or something if every time you eat you’re having this stress response because you’re so worried about it.

Kelsey: Yeah. It’s a self-fulfilling prophecy basically.

Laura: Right. It’s not easy to make that balance between caring about what you put in your body and caring about finding a healthy way to live so that you minimize the symptoms of your condition. Like I said, it’s hard to find a balance between that and getting into this state where you’re just on high alert all the time and everything that happens, even a minor symptom you’re feeing so upset about that it ends up becoming a major symptoms.

It takes a long time to get out of this pattern and it really does require working with someone on it, whether that’s a dietician, or a therapist, or whoever you’re working on to get out of this mindset. But it is very important because honestly, if you’re scared everything time you’re eating, that is at a minimum going to make the symptoms worse and could actually be the underling root cause of the symptoms.

Kelsey: Right.

Laura: But it’s tough.

Kelsey: It’s really tough.

Laura: I don’t think we have any specific answers for how to get out of that other than working with someone and maybe doing some journaling about your experience and emotions. I think also deciding that you’re going to eat something and it’s okay if you have a symptom is another way to do it. Like was Kelsey was saying before, if you know that something is causing a little bit of bloating, but you’re like I just need to eat.

Kelsey: Yeah.

Laura: Then, just be okay with having a little bit of bloating. Certainty we don’t want people to have severe reactions, and again, that celiac disease example where we’re not telling a celiac person to go eat a piece of pizza just to relax. We know that there are going to be some major health effects of that food that we don’t want them to experience.

But the question is, can they have some potatoes? Or could they have some plantains? Or could they have some rice? There’s a lot of different foods out there that even if there’s a few things that you know you can just absolutely not tolerate, that doesn’t mean that your whole diet needs to be totally restricted to hardly anything.

Kelsey: Right. To end this, I think one tip that I give to many of my patients who have this fear around food, they’re introducing foods because they’re sensitive to every single thing, or they think they are, and they’re very sort of worried about the whole process. What I do is I tell them to, when they get a meal, sit down, make sure you’re not doing anything while you’re eating. Put your meal in front of you. Sit there, take some deep breaths, so maybe take five or ten deep breaths in and out. Smell your food. That’s starts the digestive system, it makes it start working. You start producing the enzymes, the hydrochloric acid that you need to break down food.

Then I know I know it sound a little woo-woo and some people don’t necessarily like it, but I also think it can be very  useful to create a little mantra that you say to yourself that is something along the lines of, “My body is ready for this food. It will accept this food and the food will nourish me.” And you can make up your own little iteration of that. But you get the general concept of that. It’s that this food is going to be accepted.

And even if you end up having symptoms after that, that’s okay. And I talk to my clients about how to kind of deal those emotions when they realize that maybe their body hasn’t quite accepted that food yet. That’s fine. But you need to kind of start the meal off with putting your body into rest and digest mode because that’s going to help you accept a food, your body to not respond as negatively to a food if it’s ready to digest food.

Then you just kind of get your mindset into the right place as well. That can be achieved by the deep breathing, which also kind of turns on that rest and digest system. But also that mantra if you can get yourself into that. I have have heard from many, many clients that it really helps them to kind of just get over that fear a little bit and more be more comfortable trying things.

Laura: Yeah. That’s a great tip. I think meditation, or having a mantra, or if people have any sort of religious meaning, sometimes praying saying Grace before a meal, having gratitude for the food and asking to have the food nourish your body. You say it’s woo-woo, but I think the mind-body connection has a lot of evidence supporting it. Even though it sounds a little bit weird, it’s actually quite well researched.

Kelsey: Right.

Laura: You’re thoughts significantly affect many different systems in your body including your digestion, including your immune system. They’ve recently found, I think it’s… different lymphatic vessel that actually connect your brain to your immune system. So negative thinking or positive thinking can actually have a big impact on your immune function.

Kelsey: Totally.

Laura: All of that stuff as much as it seems weird and you might be like, alright, this doesn’t really make sense why I’m doing this, but I’ll just do it. You’ll be really surprised the benefit it can have. So I’m glad you brought that up.

Hopefully this helps this particular person. Like we said, this is not easy and it really shouldn’t be done alone if you’re trying to move past even accidental disordered eating, which is a lot common than I think people think. You don’t’ have to have body image issues to have an eating disorder.

Kelsey: Right.

Laura: Even though disordered eating a lot of times comes from the desire to control your body’s appearance, it can also often come from these symptoms where you’re trying so hard to avoid these symptoms that you end up totally changing not only your relationship with food, but just the physical amount of food you consume.

Kelsey: Absolutely.

Laura: Highly recommend to work with someone. Either way, even if you chose to work on it on your own, I think we’ve given you some ideas on how to start approaching food differently. Hopefully your budget will benefit from some of the tips we gave you as well since obviously eating a perfectly grass fed, organic diet is not the answer to the situation either. And just remember, you’re doing your best. Seriously, don’t be so hard on yourself thinking that if you’re not perfect that you’re causing harm.

Kelsey: Right.

Laura: Just do your best and remember that there’s other things that are important to focus on beyond your health. As much as it’s important to try to be healthy, you can’t just get so wrapped up in the pursuit of health that you totally lose sight of any other thing in your life.

Kelsey: Mm hmm.

Laura: Because again, it’s stressful, it lowers your quality of life, it really can take a lot of time out of your daily life to be so focused on this stuff. Just try to pick your head up and look around little bit here and there and make sure you’re not totally ignoring the other things in your life that do affect your health, things like relationships, socialization, that kind of stuff.

Kelsey: Absolutely.

Laura: Great! Well, I’m really glad we got to talk about this question.

I’m glad you’re having such a good time on your retreat, Kelsey. Hopefully you will enjoy the rest of your afternoon. Do something fun today to decompress and relax yourself.

We’ll be back next week with another Q&A. We’ll look forward to seeing you guys here next time.

Kelsey: Alright. Take care, Laura.

Laura: You too, Kelsey.