Balanced Bites Podcast #125: “The Paleo Approach” with Sarah Ballantyne, autoimmune Paleo

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Balanced Bites Podcast #125 | Special Guest Sarah BallantyneTopics:
1.  Our guest, Sarah Ballantyne [3:03]
2.  Sarah’s arm [4:34]
3.  Sarah’s journey to paleo [8:41]
4.  Stopping all medication [18:52]
5.  Sarah’s book, The Paleo Approach [24:45]
6.  Should I do the autoimmune paleo protocol while still on immunosuppressants?  [33:58]
7.  What are some steps to take to get a diagnosis when doctors can’t figure it out [43:24]
8.  While on an elimination, and you have an accidental exposure, do you start over?  [51:08]
9.  FODMAPS and autoimmune protocol on paleo [57:09]
The Paleo Approach
The Paleo Approach Cookbook
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Diane Sanfilippo: Hey everyone! Diane here, back with another amazing interview. And, before…well, actually, I should say welcome to episode 125 of the Balanced Bites podcast. And, I’m here with a really, I don’t even know. I don’t even have a good enough introduction for my guest today. She’s amazing and I’m super excited to talk to her, and we’ve actually already been talking for 30 minutes, and I decided, shoot, we should probably start recording. So, anyway, let me just talk about our sponsors quickly, and then we will get into this weeks’ episode. So, let’s see. Paleo Treats is a fantastic resource if you are looking for some individually packaged paleo goodies, so you can enjoy one and not dive headfirst into an entire dozen of cookies that you just baked, or paleo-friendly, grain-free brownies. Paleo Treats are delicious. You can pick from, I think they’ve got 4 or 5 yummy different treats, so definitely check them out. You can get 15% off your order when you enter the code BALANCEDBITES at checkout. So, that is Pete’s Paleo, bringing fine dining to your cave. Pete’s Paleo makes eating real food easy, even when you don’t have tons of time. You can order some amazing grass-fed organic all paleo-friendly locally sourced where they are out in San Diego, California meals. You’ll be able to keep those on hand and have dinner ready in a flash. Pete’s Paleo is offering our listeners a free pound of bacon with the purchase of any meal plan. So, just enter the code BALANCEDBITESROCKS at checkout. And that’s And then, of course, Chameleon Cold-Brew, our favorite smooth, organic, fair trade caffeinated beverage. You can find out where you can buy Chameleon Cold-Brew locally by checking out their website, or you can get an amazing discount off of your online order when you enter the code BALANCEDBITES at checkout. That’s
1. Our guest, Sarah Ballantyne [3:03]
Diane Sanfilippo: So, now I would love to introduce my guest today; Sarah Ballantyne, who is a PhD. She earned her doctorate degree in medical biophysics at the age of 26. She spent the next 4 years doing research on innate immunity and inflammation before becoming a stay at home mom. After her second daughter was born, she began to experiment with the paleo lifestyle. It had an amazing effect on her health. Over time, she healed herself of a long laundry list of physical complaints including: Irritable Bowel Syndrome, allergies, and the autoimmune disorder, I don’t know if I’ll say this right, lichen planus.
Sarah Ballantyne: Yeah, that’s right.
Diane Sanfilippo: {laughs} An inflammatory skin condition. Inspired by her success, Dr. Ballantyne created the popular health blog, and became a co-host of a top rated podcast, The Paleo View, which I have been a guest on several times. A great show. Her passion for providing straight-forward explanations of the science behind her diet and lifestyle recommendations for managing autoimmune disease, plus her love of food and cooking, formed the foundations of The Paleo Approach. Welcome, Sarah!
Sarah Ballantyne: Thank you so much Diane! It is so awesome to be back, and to be back with you!
Diane Sanfilippo: I know. I was so bummed to miss out on the interview that you did with Liz. It was many months ago, now.
Sarah Ballantyne: It seems like not that long ago, but that’s in part because my sense of time is completely warped {laughs}
Diane Sanfilippo: You’ve been in the “I’m finishing a book” time warp.
Sarah Ballantyne: For like 8 months! {laughs}
Diane Sanfilippo: I know {laughs} it’s crazy.
Sarah Ballantyne: It was the longest finishing of a book ever.
2. Sarah’s arm [4:34]
Diane Sanfilippo: Before we kind of get into the interview, how’s your arm? We all saw that you burned it recently.
Sarah Ballantyne: Yeah. It’s itchy. I mean, I’m really, really lucky that it hasn’t been more painful that it has been, and of course it’s not that painful because I probably burned all the nerve endings in it.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: But it really hasn’t been that painful. But I saw a burn specialist Tuesday morning because it got infected over the weekend. And, he scrubbed it.
Diane Sanfilippo: Oohhh!
Sarah Ballantyne: Which is as painful as it sounds.
Diane Sanfilippo: Ok.
Sarah Ballantyne: It was not fun. It only lasted like 3 minutes, but I was like, in my head, singing Row, row, row your boat.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: For those 3 minutes! {laughs} And, then he put on this special bandage. It’s got this like foam sticky thing that provides a matrix for the new skin to grow into.
Diane Sanfilippo: Hmmm.
Sarah Ballantyne: So it encourages the new skin to grow more quickly but also more smoothly, and then it’s  adhered to my arm. It has to stay on for a week. So it’s like having a slightly more mobile version of the cast.
Diane Sanfilippo: Oh my goodness.
Sarah Ballantyne: Because I can move my wrist and my hands. But the itchiness.
Diane Sanfilippo: Yeah.
Sarah Ballantyne: Is driving me crazy! And it’s not like I can stick a coat hanger down there, because I’ve got, you know…
Diane Sanfilippo: Do you know why our skin itches when it’s healing?
Sarah Ballantyne: It is a low-grade form of pain.
Diane Sanfilippo: Interesting.
Sarah Ballantyne: So, it actually is the fire…
Diane Sanfilippo: I love that you had an answer for that.
Sarah Ballantyne: {laughing}
Diane Sanfilippo: By the way.
Sarah Ballantyne: I, um…
Diane Sanfilippo: I kind of had a feeling you would, which is why I asked.
Sarah Ballantyne: If only Trivial Pursuit questions were made from my knowledge base {laughs} I would be so awesome at that game. Unfortunately, their science questions are usually not the type of science I know. Yeah, so it’s actually a firing of the pain neurons.
Diane Sanfilippo: Interesting.
Sarah Ballantyne: But not in a coordinated way as you would with an actual, true pain stimulus.
Diane Sanfilippo: Right.
Sarah Ballantyne: So there’s really nothing I can do about other than try to distract myself.
Diane Sanfilippo: Interesting. So, for people who didn’t see this, Sarah was pulling a pan of baked bacon, right? Out of the oven.
Sarah Ballantyne: Yeah.
Diane Sanfilippo: And the grease just kind of splattered. I think it’s really important that people bake bacon in a deep, like a deeper rimmed baking sheet, if you can, because that really does help.
Sarah Ballantyne: Well this was, I mean, I bake bacon all the time.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: And in fact, I’ve done it since.
Diane Sanfilippo: Yeah.
Sarah Ballantyne: So, I’m clearly not that shell shocked from the experience {laughs}.
Diane Sanfilippo: I’m not scared of you, bacon grease!
Sarah Ballantyne: No, I figure you got to get back on the horse. But, this was fattier bacon than I’m used to baking with.
Diane Sanfilippo: Mm-hmm.
Sarah Ballantyne: And it just, there was just so much more grease than normal, and I was distracted and I was rushing, because I really wanted to eat my bacon, and the biggest problem was that my shirt was so tight that I couldn’t get the heat off my skin quickly enough when the grease splattered on my sleeve. And so it was a few seconds before I just stuck my whole arm under the cold water tap, but by then, and this is really TMI, and I apologize to all of the Balanced Bites podcast listeners.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: But I’m going to saying it anyways. By then, the skin had fused to the shirt.
Diane Sanfilippo: Which is sort of what you’re trying to do with this new grafting type whatever is on your arm now, but just not to a fabric.
Sarah Ballantyne: But just not to the point where when you take it off, it’s going to rip the skin off with it.
Diane Sanfilippo: Aye-yai-yai.
Sarah Ballantyne: Yeah.
Diane Sanfilippo: Alright. Well, I’m glad it’s healing.
Sarah Ballantyne: It’s healing.
Diane Sanfilippo: I did have a question from Facebook of somebody who wanted to know how your arm was doing.
Sarah Ballantyne: Awww, thank you!
Diane Sanfilippo: So I figured I would ask you.
Sarah Ballantyne: It’s doing well, but I’m not enjoying being on antibiotics.
Diane Sanfilippo: I bet not. I think you’re uh, for people who want to see what you’re doing about all that, they should definitely check you out over on Facebook, I know you’ve posted on The Paleo Mom about dealing with, you know, taking antibiotics, and what you’re doing about that. But let’s, really quickly, you know super, well I guess, you know, you gave an interview with Liz not that long ago, but we always have new listeners, and they haven’t all always had the chance to kind of go back and listen through the archives yet, so I do want to ask you to just make a quick introduction beyond whatever I kind of read off of your bio there, and just let folks know how you came into this little world of paleo and autoimmunity. And I might say, pretty quickly in my view, too. Quickly, not meaning too quickly, but just quickly meaning, you know, you are like a freight train with this information. I think you’ve pretty much bolstered yourself to a position where you are my go-to resource for autoimmune paleo and the real true, not implications of it but really like, ok, we want a yes or no {laughs}
Sarah Ballantyne: {laughing}
Diane Sanfilippo: On this, you know, food or this, whatever it may be, on autoimmune and paleo. And, fortunately or unfortunately, that makes you that go-to resource all the time, but you know, you’ve really taken that place in the community, so I just kind of want to have you let folks know how you came to this spot.
3. Sarah’s journey to paleo [8:41]
Sarah Ballantyne: Um, ok. So, I guess the really short answer is that I’ve had health problems most of my life, including autoimmune disease, and what really brought me here was my search for solutions for my own health. I was an overweight teenager, and in my early 20s, I was not just overweight, I was morbidly obese. And in my early 20s, I was introduced to the concept of a low-carb diet. And, I had great success with it, and lost 100 pounds in about a year, at which point I sort of, you know for me at the time being an overweight teenager is a really, really, it’s a hard time in someone’s life to be different in any way, and so my definition of health at that point was, you know, alright, I’m thin now, now the next thing is to become really athletic, so I took up marathoning and ran a couple of marathons, and then had a major health crisis a couple of years later where I developed adult onset asthma, but at the same time, I developed a bunch of skin conditions, including lichen planus, which is an autoimmune condition, and psoriasis and eczema, and irritable bowel syndrome, and acid reflux, and the adult onset asthma was so severe that my lungs were bleeding. And so I was put on very, very high doses of oral steroids and inhaled steroids, and I gained 50 pounds in the first 6 weeks. And, another 70-ish pounds over the next year, which was more weight, you know, I ended up bigger than I had been in my late teens and early 20s.
Diane Sanfilippo: Wow.
Sarah Ballantyne: And, I got married during that year. I cannot tell you the amount of denial I was in about what I looked like, because when I got married, you know I had been hanging out around 160 pounds when I was running marathons. When I got married, I was 235, and I was so sure that I would just figure out how to lose that weight again, even though at that point nothing was working because of the steroids, that I postponed buying my wedding dress until 2 weeks before my wedding.
Diane Sanfilippo: Wow.
Sarah Ballantyne: Because I just, I didn’t want to do it.
Diane Sanfilippo: Yeah.
Sarah Ballantyne: I didn’t want to buy a wedding dress. And then, you know, I just kind of felt… I was on inhaled steroids for a long time. I was working 100 to 120-hour weeks in a high profile medical research lab in Toronto for my first post-doctoral fellowship. And, you know, nothing…the effort that was required for me to lose weight was not something that I had the mental strength to do because I was not getting enough sleep and I was incredibly stressed, and I was not getting enough activity because everything I did was work. And, I went from that to a much more relaxed second post-doctoral fellowship in Tucson, Arizona at the University of Arizona, and started to lose some weight, and then got pregnant. So I had a very complicated first pregnancy because I was morbidly obese. I had gestation diabetes. When I went into labor, I had preeclampsia. I had a 96-hour labor, which is 4 days. {laughs} Four days of labor. I mean, I just, I can’t even…fortunately I don’t remember much of it. And then, you know, I had this colicky baby who wouldn’t sleep, probably because she was having food sensitivities to what I was eating at the time, but that’s all, you know, hindsight at this point. And then I found that my weight was creeping back up again, and I discovered that I was pre-diabetic, just by self diagnosis, because I had my blood sugar testing supplies from having gestational diabetes. And so then I, you know, I really found the mental strength. I was a stay at home mom at this point, to go back on a low-carb diet, and really found my groove with it again, lost 100 pounds again, had a much healthier second pregnancy, and then when my youngest was closing in on 2, and I was back to a good weight, I had one of those moments where I started to think about health differently, really for the first time in my life, because I was back to a good weight, I was a stay at home mom, I was fairly active. Neither one of my kids were sleepers, but I was getting, you know, half-decent sleep, anyways. And I was having, I was on 6 prescription medications, and I was having a lot of skin issues, and my lichen planus started to flare, and I was getting new lesions. It’s a very, very itchy, sort of painful skin condition. And I suddenly realized that being thin was not the only definition of health. And I really had never thought of that before. So I started on the internet looking for possible causes of eczema and lichen planus and psoriasis, and I happened on an article on Loren Cordain’s blog that was about lichen planus, and I was like… “the Paleo diet. That’s interesting.” As a scientist, I really, you know, was really drawn by the types of descriptions and rationale, and I basically spent 3 months reading everything I could get my hands on for free before deciding to try it. And then I went cold turkey, and in literally 2 weeks I was off of every medication. And, then I became a zealot {laughs} because I had never experienced the kind of energy that I had, I had never experienced a digestive system that had actually worked. I mean, back to being a child, I had always had problems. And, you know, all of a sudden, I was like, “well I don’t need this medication anymore, I don’t need this medication anymore, I don’t need this medication anymore.” And so that was when I started the blog, which was sort of an outlet so that my husband could talk to me about something other than diet. And we, you know, we really at that point decided to do it as a family. So that became, you know, a topic for blogging, recipes I was developing, and also because I have this really strong science background, for me I always just enjoyed reading and understanding why, and especially understanding why from a contemporary science point of view, and so then, you know, the blog became my outlet for distilling that information and explaining the more detailed science in a way that was sort of approachable for the general public. And, you know, my journey really took off from there, because I was still dealing with autoimmune issues and trying to optimize my diet and my lifestyle to really put that disease into remission. And that was when I discovered the autoimmune protocol, and how little information there was for autoimmune disease. I mean, there was almost nothing. There was the autoimmune caveat in The Paleo Solution, and this was before even Practical Paleo came out. So there was, you know, really no good information other than, oh yeah, if you have autoimmune disease, avoid these other foods. You know, Terry Wahls talk came out around that time where she was really talking a lot about nutrient density, which was very influential for me. And, as I started trying to piece together the whys and I started writing about it on the blog, I found a real niche, because that information just wasn’t out there but there was such a hunger for it. And I think I didn’t realize at the time just how big the autoimmune disease community is, and how many people are out there struggling with it. Struggling with medications that make you ill, that increase your chances of cancer, or like, the steroids that I was on that make you gain weight and completely mess with your metabolism, and that’s a huge community of people who need a better solution than conventional medicine can offer. So, that sort of became my… you know, it was really for figuring out my own health was what got me started on the journey, and then it became about sort of really understanding the immune system and understanding autoimmune disease more as a whole rather than focusing on what I needed to do just for my disease. And so when I had the opportunity to write a book, it was a no brainer. I mean, for me it was just, well there’s nothing out there for the autoimmune community to bridge that gap between, you know, patient and doctor but also to introduce the concept of the importance of diet and lifestyle in regulating the immune system for these people.
4. Stopping all medication [18:52]
Diane Sanfilippo: It’s huge. Can you just mention quickly, you said you were on 6 medications?
Sarah Ballantyne: Mm-hmmm.
Diane Sanfilippo: Which ones they were? Just because I think folks who are listening, they start to really identify and realize that if they hear, you know, that you were on something that they may be on, it just gives people that, oh, there’s a possibility that this might not be for forever?
Sarah Ballantyne: I was on Nexium for acid reflux, I was on rotating laxatives for chronic constipation. At the time, I was taking Miralax on a daily basis, but I had just switched to Miralax from, what was the one before it? Oh my gosh, I think I’ve taken every laxative that there is out there. Um, I was on, I had steroid creams for the lesions. I had inhaled steroids for asthma. I had a long acting bronchodilator, and a short acting bronchodilator. That’s already 6, but that’s not all the medications that I was on, because I also had chronic sinus infections, so I had nasal steroids for whenever I had a chronic sinus infection, and I had, oh that’s what it is, because the laxative wasn’t actually prescription. And I had this like standing list of prescriptions I had, not at the time when I went paleo, but in the years before it, I had topical antibiotics for acne and for psoriasis.
Diane Sanfilippo: Mm-hmm.
Sarah Ballantyne: And topical steroids for psoriasis.
Diane Sanfilippo: Well, and medications, just because they are over the counter, they are still medications. So, for you know, people who are like, well, “I just take this antacid, or I just take this pain killer, just this, you know, it’s still medication.”
Sarah Ballantyne: Yeah.
Diane Sanfilippo: Even if it’s not a prescription medication.
Sarah Ballantyne: Right. So, I was on, I mean, basically it was asthma drugs and irritable bowel syndrome and acid reflux drugs, and then topical steroids for all of my various skin conditions, and it was in various forms. I was not, at the time, on oral steroids but that is something that in the years previous, I mean, the last time I had been on it I think was about a year before I went paleo. Every time I got a really bad lung infection, I would have to go back on prednisone. You know, and it would be like a week or a 10-day course with the tapering, but it was one of those things that I sort of chronically dealt with. And I have not had a lung infection that has required steroids since. And so it’s been just, you know, it’s been such a huge lesson for me in the importance of nutrition. I always thought of diet before that as being, you know, what makes you fat or what makes you thin.
Diane Sanfilippo: Or what makes you just not hungry anymore, right?
Sarah Ballantyne: Right {laughs} You know, and I had always thought of food as just, you know, its food.
Diane Sanfilippo: Right.
Sarah Ballantyne: And I didn’t think of it as nutrition.
Diane Sanfilippo: Yep.
Sarah Ballantyne: And that is something that has really changed in my perspective, to the point where I am like a huge micronutrient nerd now. And it’s something that I never thought of before. Like, it just never occurred to me my research was not in nutrition, it was in critical care medicine and inflammation in the innate immune system and then a little bit of basic epithelial cell biology, and actually tight junction formation, which is so funny to me now because it’s so relevant to leaky gut.
Diane Sanfilippo: Yeah.
Sarah Ballantyne: But, even when I started paleo I didn’t, at the time, realize how relevant my research experience was to understanding the interaction between what I was eating and health.
Diane Sanfilippo: I think, you know I actually; so this is going to air before my interview with Dr. Terry Wahls, which that will be in, I think that won’t air for another 5 weeks or so, so those of you who are listening who want to hear more about this stuff too, definitely tune in in a few weeks to hear that one, but you know, the same kind of revelation, I think, there’s a paleo diet from this one perspective of mostly about what we’re avoiding, right?
Sarah Ballantyne: Yeah.
Diane Sanfilippo: That was, I think, you know one of the things that Dr. Cordain laid the ground work for, was ok, let’s not eat these things, and let’s eat these things instead, but what I know you do a ton in your book, and the same thing that Dr. Wahls said, but more specifically, she’s kind of focused on MS, but not really. You know, it’s really synergistic with what you’re teaching.
Sarah Ballantyne: Yeah, her book, I mean really our recommendations are extremely…
Diane Sanfilippo: The same.
Sarah Ballantyne: Similar.
Diane Sanfilippo: Yeah. Very Similar. So, but really, like what you’re saying here is, it’s not just about what you’re avoiding. It’s really also about what you’re adding and how you get that depth of nutrition. Which is funny, because one of the interviews I did with a couple who are now friends of mine, Mira and Jayson Calton, when…
Sarah Ballantyne: Ahh, I love the Caltons.
Diane Sanfilippo: Yeah when they, I mean, not just because their book was awesome, but because they are just like amazing fun-loving people, and just great to be around.
Sarah Ballantyne: And also micronutrient geeks!
Diane Sanfilippo: Micronutrients. So, I think micronutrient is Jayson Calton’s favorite word.
Sarah Ballantyne: {laughs}
Diane Sanfilippo: But I think my interview with them and reading Naked Calories was one of those things that, like, I always knew what they were talking about, but it just gave it this other perspective or a different basis to talk about food and nutrition and a better way to frame things, exactly what you said. It’s not just about appetite or not, or fat or thin. It’s not about that. It’s about what is your body getting from that food, and it’s not just those macronutrients that hold the calories. It’s those micronutrients that actually aren’t where we’re getting calories at all, we’re just actually fueling our body really well with those micronutrients. So, um, that’s not really even a question it’s just kind of like, an I agree with you.
Sarah Ballantyne: {laughs}
Diane Sanfilippo: But I do, you know, want to talk a little bit about the book, and then I’ve got a bunch of questions from Facebook, if we can get to a few of them.
Sarah Ballantyne: Sure.
5. Sarah’s book, The Paleo Approach [24:45]
Diane Sanfilippo: That I think are some really good ones. But, basically what I’m going to say about the book right now is, I mean, I got the book maybe about a week or so ago, and I definitely haven’t read it yet, because it is literally, if you’re listening and curious what this book is all about, it’s not like any other book out there, and I think when I put Practical Paleo together, I did set out to make a book that was that way. Not like any other paleo book, and not like any other book out there on nutrition where it combined, you know, some basic information and meal plans and recipes, and like really gave you this tool, and now your book is…it’s literally a textbook. Like I know people think my book is a textbook {laughs}
Sarah Ballantyne: {laughing}
Diane Sanfilippo: But this is literally, I opened this, and I’m like, I feel like I am back in school, and it’s a textbook. And what is so cool about it is that it’s a textbook where I can believe everything. You know what I mean?
Sarah Ballantyne: Awww.
Diane Sanfilippo: Like, it’s not going to be, like, one of those situations where I’m like, ok, well this is biochemistry and this is factual, but then this other part where they’re kind of drawing conclusions from it might not really be true. Like, I’m so excited to dive into this and give to other people to dive into to heal themselves. Why did you want to make a book that was so, not only rich in content, but, you know, broken up into easily digestible pieces of content, pun intended, but also so visual. What was it about this material that made you feel like, ok, I don’t just want to sit down and write a book that’s, you know, what I call just reading. Like, obviously there’s tons of reading to do here.
Sarah Ballantyne: {laughs}
Diane Sanfilippo: It’s all words, but tons of pictures and really lot’s of visual examples. Like, what was it about this content that made you feel that was important?
Sarah Ballantyne: I think there were a few influences that came into that. When I was in grad school, I gave the, like, named lecture that our department has. It was an award, there was some money associated with it, and I gave that lecture in my second year of my PhD, which was very unusual. I was the first junior graduate student to ever do it. It was usually what students would do as they were wrapping up their thesis and getting ready to graduate. And, so I was very nervous. I put a ton of time into my talk, and I presented my research in this sort of 20-minute talk for the whole department, and at the end, this Professor Meridis, that had actually worked with my grandfather, my grandfather was a biochemist, he had actually worked for my grandfather when my grandfather established the medical school at that university, you know, 35 years prior. And he came up to me. So this is like a man who I deeply respected. And he said, Sarah, I think you’re in the wrong field. At which point, tears welled into my eyes
Diane Sanfilippo: {laughs}
Sarah Ballantyne: And I felt like my entire world came crashing down. And he said, I don’t think you should be in research, I think you should be on TV explaining science to people.
Diane Sanfilippo: Awww.
Sarah Ballantyne: At which point I actually was quite offended.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: {laughs} I think about that all the time now, because that’s essentially, other than the TV part, I mean these were in the early days of the internet.
Diane Sanfilippo: Right.
Sarah Ballantyne: But, you know, I think about that now because that’s essentially what I’m doing. I’ve become a person who takes detailed science and explains it in a way that, you know, hopefully most people can grasp. And, it’s not something that’s particularly easy to do, and it’s not something that very many people can do.
Diane Sanfilippo: I would agree with that. {laughs}
Sarah Ballantyne: Yeah! {Laughs} So it came from a sort of passion for scientific literacy, and also a geekiness of wanting to understand the material at that level myself. And then, really wanting, you know for me it’s easier for me to make a choice if I really understand why. And I know that there is many, many other people out there who are similar. Who are hungry for the real whys. And I really wanted to create a book that would give that depth, but then I didn’t want, you know, to make a book that was just for people with bachelor’s degrees in biology. I wanted to make a book for, like, people. Like, everybody.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: So, for me, keeping it visual is a way of making it less intimidating, but also, you know, I think that visual elements for many, many people are really key for sort of reinforcing concepts. Like, I think it’s so much easier. You’ve got, you know, two pages that are describing what’s happening inside of a cell, and without that picture of the cell with the arrows of first this, then this, then this…
Diane Sanfilippo: Right.
Sarah Ballantyne: It can be really, really hard for people to remember and to really incorporate that information into their knowledge base, and then as soon as you give someone that picture, it becomes, you know, a concept that is tangible. And, you know, really when I started on the book, I was so inspired by Practical Paleo, because Practical Paleo came out, I think, 2 months before I started working on this book.
Diane Sanfilippo: Mm-hmm.
Sarah Ballantyne: And I just was like, I want my book to be just as visual as Practical Paleo, and then as I got more and more in depth
Diane Sanfilippo: {laughing}
Sarah Ballantyne: With the material and realized just how detailed the science I was presenting was going to be, then I was like, this book needs to be even more visual!
Diane Sanfilippo: Yeah!
Sarah Ballantyne: And it became something that I wanted it to also be fun to look at it, because it is a little bit like a textbook, and I didn’t want it to feel like someone was taking a course. I didn’t want it to feel like, you know, so many people have really negative associations with school, and I didn’t want people to look at my book and be like, oh man, that’s just so much science. You know, I wanted people to be able to look at my book and be like, wow, this is fun! And not intimidating in any way. So that became, you know, the sort of visual elements chosen to accomplish all of those goals. Sort of make the book fun, and just inviting, and comfortable, but then also have visual elements to help reinforce the concepts, and help with the explanations.
Diane Sanfilippo: Ok, I’m not going to lie. I think it looks both fun and exciting, I think it does intimidate me just a little bit.
Sarah Ballantyne: {laughing}
Diane Sanfilippo: But in a good way. Honestly, like, not in a stuffy, I don’t want to learn this way. It intimidates me in a good way, which is for me, like, not much intimidates me, so {laughs} this is like, wow. It intimidates me in a way that like, actually tells me that I am going to learn something new from a book that is basically talking about information that I already know. Does that make sense?
Sarah Ballantyne: It does. Yeah, it does!
Diane Sanfilippo: Like, how many paleo books are out there? And when I put my book out, I was like, you know, I want to put information in here that talks about nutrients that are supportive for different issues people are dealing with, what those nutrients do, where to find them in foods, and you know, kind of put that together and then talk about lifestyle factors, like you do in this book where it’s giving people information that they didn’t get from somewhere else, and I’m just, I’m really excited. You know, I told you when I got the book, I was like, ok, cool, there’s no way I can read this before I talk to you
Sarah Ballantyne: {laughs}
Diane Sanfilippo: Because when I read, it’s like this whole other thing happens. I don’t just read and get through the pages. Like, I want to interact with the material. So, it’s, I’m really excited for this, and I’m honestly really excited to learn a lot from what you’ve done, because I think that, like the day we stop learning or the day we think we know everything is the day we should realize that we know nothing, you know what I mean? {laughs}
Sarah Ballantyne: Yeah.
Diane Sanfilippo: So, I’m really excited about it. You know, that’s just kind of like the overview of the book itself in terms of content and visual. You know, you’ll flip through, and it’s lots of, like I said, easily digestible kind of small sections, so you can just kind of tackle one chapter at a time, and just really go through it, and take your time with the book and the material. It’s not a book that you’re going to pick up and read cover to cover in one sitting, I don’t presume.
Sarah Ballantyne: Unless you’re my mother.
Diane Sanfilippo: Unless you’re Sarah’s mother.
Sarah Ballantyne: {laughs}
Diane Sanfilippo: So, I’m just super excited for it. I mean, I think, I’m excited to be able to point people to it and have them be that much more empowered about learning about autoimmunity because, you know, deeply and specifically it’s not something that I’ve been able to help them with, you know, on that level. So, I’m thrilled for you and for the book. And so what I want to do, we have about 30 minutes left here. I want to get to some of the questions folks have from Facebook, because I do think that some of these are really good questions, and they kind of apply to autoimmune and autoimmune paleo in general.
Sarah Ballantyne: Ok.
6. Should I do the autoimmune paleo protocol while still on immunosuppressants? [33:58]
Diane Sanfilippo: One question that I see here from Katherine, she’s asking what your opinion of doing an autoimmune paleo protocol is if someone is still on medications. So, I’m going to guess, yeah, she says she knows many people who are on multiple immunosuppressants, and they are looking into the diet but they’re kind of concerned, you know, is it ok to do this if I’m still on medications, or, you know, this is also a question I’ve heard, is everyone guaranteed to get off of their medications, or are there still going to be some cases where you know you may still need them, and don’t freak out. So, what’s your take on that?
Sarah Ballantyne: Ok, that was like 3 questions in one.
Diane Sanfilippo: Ok. Do it. {laughs}
Sarah Ballantyne: So, the first part of the question of, you know, if you’re on immunosuppressants, if you’re on, Humira, or methotrexate, or if you’re on prednisone, is it safe? And the answer is yes. You are basically consuming a very nutrient dense diet that is devoid of immune stimulators. And what it does is it actually provides the nutrients that your body needs to regulate the immune system. And that doesn’t mean suppress the immune system, it means regulate. And it actually becomes much easier for the body to respond normally to things that would stimulate or suppress the immune system. Now, what I always would recommend is that you do this while being monitored by a doctor, because there may be situations where medication doses need to be adjusted fairly quickly. Some people respond to, you know, these diet changes literally within a couple of days. I have had people who have, you know, emailed me and said I’ve been on the autoimmune protocol for 3 days, and I can’t believe how amazing I feel. You know, I have no symptoms whatsoever in just 3 days. Other people it’s a long slog. And it’s months. But it’s still gradual improvement, and I’ve had people who have, you know, required a lot of tinkering and trying to figure out where the missing pieces are, but then they manage to put their reactive arthritis into remission and get out of a wheelchair. And so, you know, for some people there can be a lot of troubleshooting required, which is why I have a troubleshooting chapter in the book. But it’s definitely important to do this with the guidance, if you are on any kind of medication, with the guidance of a health care practitioner. And that’s especially important if you are on any kind of organ support drugs, like hormone replacement therapy for, you know, Addison’s disease or Hashimoto’s thyroiditis. Because if those organs start working, that means your dose of your medication is going to be too high, and that can come with some really serious health risks. So it’s something that you’ll want to talk with your doctor about getting testing more frequently. Not everyone can get off medications. Medication free is wonderful when it happens, but it doesn’t happen in all cases. Especially when you are talking about an autoimmune disease that say affects an organ. There may be damaged tissue that just cannot regenerate. So, you’re thyroid might work a little bit better and you might need to adjust your hormone levels, but you may not ever get off thyroid hormone replacement, because your thyroid may just be too damaged from, you know, however many years your immune system was attacking it before you were able to regulate your immune system. So you just need to support, but, you know, it’s the same thing as if you know you were in an accident and that organ was damaged. You would need to support it because it’s just never going to work again. Or, at least at 100%. But one of the things that sort of can surprise people is just how much organ function can come back. And there’s situations even with type 1 diabetics of being able to completely go off insulin. There’s many, many stories of people out there with Hashimoto’s thyroiditis who are able to go off thyroid replacement. How long that takes is also really dependent on things like how micronutrient deficient you are. How bad your digestive system is, so how well you’re assimilating the nutrients from your food, and then it depends on not just diet but all the lifestyle factors, like managing stress, and getting activity and protecting circadian rhythms by being outside during the day, getting enough sleep, and those things, often for people, are actually harder to modify than diet. You know, we kind of feel like, ok we can just buy different food and cook different food and just eat in this way, but I can’t go to bed earlier because I have a job and I have to work in the evenings, and I have to get up early to get the kids to school, and it just seems like as a society we face more barriers towards the lifestyle aspects, which are just as important at regulating the immune system. So, how quickly sort of depends on basically what your immune system is doing, what your gut health is like, how aggressive your disease is, how long you’ve had it, but also sort of how well you draw all of the pieces of the puzzle for regulating the immune system and supporting healing together. Did I answer all three of those questions, or did I only answer two of them?
Diane Sanfilippo: Yeah, I think so. No, I think that’s it. I’m trying to see if there was anything else. No, I think that’s it. And I think that was a really good point. So, like, one thing that kind of came to mind as you were going through your recommendations there is that, you know, you want to make sure that you work with your doctor, that you are talking to them about what you are doing and that you are going to be changing your diet, and I think one of the things that people run into a lot is just, you know, whether or not their healthcare providers are kind of on board with this whole paleo thing. And I think that, you know, if you’re going to change your diet, and you have a feeling it might affect your health in a positive way, if you’re worried about saying paleo, or you already know that your doctor is just, may not be with you on it, just say, you know, you’re going to stop eating refined foods or junk foods or just, you’re going to make a nutritional change and you want to have another appointment, maybe, maybe even have an appointment ready to go back pretty quickly, like within a week, or maybe call and make an appointment and make it so that you can cancel it within however long, but just have something ready. I don’t know how quickly everybody’s doctors are available to them, but just kind of be prepared for the fact that your body may start healing really quickly, or that you may need to go in and have a conversation about those medications pretty much right away, and at the same time, if that isn’t you, like not to freak out because it doesn’t mean that it’s not working, it might take months for your body to really respond, although it probably won’t. Right? I mean, you’ll probably feel something in a positive direction within weeks, at the very least. That’s just with everybody that we see that gets off of refined foods and onto a more paleo type of diet.
Sarah Ballantyne: Well, and one thing to sort of emphasize, because I think there’s this desire to, you know, oh ok I understand that if I change my diet, and I get more sleep, and I manage my stress, that I’m going to be able to go off all of my immune suppressing drugs, and I’m going to be able to heal myself, and there’s this desire to sort of get to the endpoint really quickly, and it’s really important to emphasize that you need to get the diet and lifestyle stuff in place first, and start seeing improvements before you start messing around with your drugs.
Diane Sanfilippo: Right.
Sarah Ballantyne: And you can’t just say, ok, well Tuesday I’m going to stop taking my methotrexate and I’m going to eat this way, because that is a recipe for a health crisis. So, it’s really, really important to be monitored for changes, and have a doctor who’s going to help modify doses of medications, but also know that the diet and lifestyle need to be there first. And a lot of the medications actually that are used to treat autoimmune diseases actually cause a leaky gut by themselves. So, there’s this desire to get off those medications so you can completely heal the gut, but you really need to get, you know, as far as you can get with diet and lifestyle while having this extra hindrance of a medication before you take that medication out because you want to be in the best possible nutritional status. You want to make sure your sleep is awesome so that when you take that medication away, your body can adjust quickly, and it can promote healing as opposed to, you know, sending you three steps backwards.
Diane Sanfilippo: I think that’s an excellent, excellent point. OK, so let’s see. There’s soooo many questions here on Facebook, it’s crazy. Some of them are really specific so I want to try and hit some that might help a lot of people. One that someone, Mary was asking is, and this may be covered in the book and so let us know if there are more details on this in the book, which I’m going to guess there are.
Sarah Ballantyne: {laughs}
7. What are some steps to take to get a diagnosis when doctors can’t figure it out [43:24]
Diane Sanfilippo: She was wondering if you have suggestions for the best medical tests to push for from their doctor, or if they have to go elsewhere to make a diagnosis if they suspect that something they are dealing with is autoimmune or related, but the doctors just can’t seem to figure out what’s wrong.
Sarah Ballantyne: That is a really good question. And, unfortunately, a really hard one to answer, because there is no one test that can determine if you have an autoimmune disease. So there’s a variety of tests for specific antibodies that are associated with some certain diseases. For example, you can be tested for antibodies against transglutaminase, which is a hallmark for celiac, but it’s also seen in thyroid diseases. You can get, you know, white blood cell counts done. You can look at levels of secretory IgA antibodies. You can look at an ANA, you can look at a C-reactive protein, and all of those will give your doctor a clue, but there’s a lot of autoimmune diseases where there just really isn’t a medical test for them, and the way they are diagnosed is basically the disease has to progress and get severe enough that the symptoms are predictable and fit within a pattern that, you know, fits the definition of X-disease.
Diane Sanfilippo: Right.
Sarah Ballantyne: And that’s one of the huge frustrations within the autoimmune disease community, because people will literally go decades of being sick and miserable and in pain with no diagnosis. And it’s such a common story, that the American Association of Autoimmune and Related Diseases, wait, I put association in the wrong spot. The American Autoimmune and Related Diseases Association has done surveys, and they actually estimate that 45% of patients who are later diagnosed with serious autoimmune diseases are labeled as hypochondriacs in the early phases of their disease. And that is a very common experience within the autoimmune disease community, to be basically told there’s nothing wrong with you, it’s all in your head, you know, see a psychiatrist, and be dismissed by the medical community. And unless you’re, I don’t want to say lucky enough
Diane Sanfilippo: Right.
Sarah Ballantyne: But lucky enough to have a disease that, like, celiac disease that can be tested with a biopsy, or a disease like hypo or hyperthyroidism that you can see what the thyroid levels are doing on a standard thyroid panel, you know unless you have a disease like that where there’s a really solid gold standard test for diagnosis, it can be really, really tricky. And, I would argue that a confirmed diagnosis is not going to change what a person is going to do about it.
Diane Sanfilippo: Right.
Sarah Ballantyne: Because, if you are experiencing unusual fatigue, unusual joint aches, bizarre skin things, bizarre mood issues, I mean, all of these things can be… I mean, whether they are autoimmune or not, they can be helped with a standard paleo diet, and especially a standard paleo diet with a focus on nutrient density, so eating more organ meat, more seafood, tons of vegetables until you can’t fit more vegetables into your body, and if you’re definitely, like, you know really suspecting autoimmune disease. If autoimmune disease runs in your family, then you might want to try the autoimmune protocol, at least use it as an elimination diet to figure out what your personal tolerance is for nuts, or nightshades or alcohol. Figure out how important the stress management piece is for you, how important the sleep piece is for you, and get those things really figured out for you as an individual.
Diane Sanfilippo: Right.
Sarah Ballantyne: And really, you know, if you’re struggling with health issues, there’s nothing in here that is a bad idea. I mean, every recommendation, it’s a focus on nutrient density and managing stress, and getting more sleep. And that reduces your risk of every chronic disease. I mean, it’s not just autoimmune disease, but it’s immune diseases, because those still require regulation of the immune system, and its cardiovascular disease, and it’s cancer, and it’s obesity, and it’s diabetes. All of those things can be helped with these kinds of, you know, dietary approaches that we all talk about every week. You know, I would argue that even if you can’t get a firm diagnosis, that doesn’t mean that you can’t jump in and make some diet and lifestyle changes to feel better.
Diane Sanfilippo: Right. I think, and this is something that I talked about, or will talk about, with Dr. Wahls, that people, you know, I think because sort of what you were talking about with the hypochondriac sort of situation, right, where the symptoms tend to be so nonspecific sometimes, there are so many different kinds of symptoms, because we know once you have one autoimmune condition, the propensity to develop others because of what’s happening with your whole immune system is that much greater, and so the symptoms aren’t just like, oh obviously you have a thyroid condition. They become so broad-sweeping that it’s almost like we can’t pinpoint what’s going on, but the obvious answer should be, well your immune system is not working right. Like, that’s the obvious answer at some point, and it doesn’t really matter what the diagnosis is, but I think we, as a society, have become so tied to that diagnosis, treatment approach, and thinking that that works generally when it comes to medicine, specifically that the diagnosis gives the person some reason why, you know, my body isn’t working right, and that becomes the thing that we rely on to tell us why I’m not healthy. You know what I’m saying?
Sarah Ballantyne: Exactly.
Diane Sanfilippo: Like, ok, I have this, and so that’s why I’m tired. But, the truth of the matter is, the diagnosis only matters a little bit, because the way that you nuance what you’re doing nutritionally based on one specific autoimmune condition or another, it’s minor. You know, there are minor differences in the ways to approach these things, and what you’re saying, you know, the foundation of everything you are explaining in your book, it’s the same thing for a healthy human across the board, and so getting your body healthier regardless of that diagnosis should really be the goal, and I really hope that people start to sort detach a little bit from the diagnosis, because while it can be interesting and helpful in some ways, it’s not telling you the story of how to approach healing. At least not the whole story, right?
Sarah Ballantyne: Yeah.
8. While on an elimination, and you have an accidental exposure, do you start over? [51:08]
Diane Sanfilippo: I mean, it may be a piece of it, but it’s just, healing is getting the human body back into balance and letting our innate immune system work properly is really kind of at the core of all of it. So, there was one thing that kind of came to mind that I wanted to mention or ask you about, and it keeps slipping my mind until we kind of start talking about something else, and then it comes back up and then I forget what I want to say again. Anyway {laughs} I have another question here from Mindy. She’s saying if you are in the elimination portion of an autoimmune protocol, and you have an accidental exposure. She didn’t say to what, but say something like gluten, do you need to start over on day 1 and delay the reintroduction phase until you’ve had an actual full 30 days of the protocol?
Sarah Ballantyne: Generally, yes. It depends a little bit on exactly how your body is reacting to that reintroduction. You know, I’m guessing that she’s asking because she accidentally got exposed to, you know, something like gluten and is having symptoms of that reaction. Those symptoms are because the immune system has been stimulated. But some people, you know, if other than that reaction she’s been feeling really good, and if she recovers from that reaction relatively quickly, you know, if you’re using, some people use the autoimmune protocol as an elimination diet to figure out what the trigger foods are. Other people use it as a purely therapeutic diet without really as much focus on reintroductions. And it becomes the, yes, in the future if I get to add eggs back, that will be great, but right now I’m just focusing on healing myself and this is how I’m going to heal. You know, if she’s feeling great and using it as an elimination diet, I would say as little as 2 weeks before trying reintroductions would probably be ok if she’s feeling great. It takes at least 2 weeks for the gut to heal from that sort of inflammatory insult of a really irritating food. Four weeks would be better, which I guess, you know, for most people who are looking at it as a 30-day elimination diet, that’s pretty much the whole time. That’s kind of a, you know, I know that’s sort of a disappointing answer, but it’s really much easier to isolate the foods that you are reacting to once you’ve gone through that sort of window of time that’s required to heal the gut and have enough new immune cells being produced that you can sort of isolate the reactions really easily. It becomes much, much easier to tell what the trigger foods are when you wait that little bit longer.
9. Where do fermented foods fall into the autoimmune paleo lifestyle? [53:35]
Diane Sanfilippo: I think that’s good advice. It’s like becoming rush hour by my house now, and so loud trucks are driving by, so I apologize. {laughs} We have a question from Stephanie that’s very food focused. She wants to know where do kombucha, fermented cod liver oil, and fermented foods fall into the autoimmune paleo lifestyle. Should they be avoided during the first 30 days then test tolerance? All 3 seem to have elements that fall into a celiac cross-reactive list, so she’s curious about that.
Sarah Ballantyne: Um, yeah. So, there is a little bit of concern that because some strains of yeast can potentially cross-react with gluten that that means you should avoid any probiotic foods that contain yeast. There are two elements to this; the cross-reaction rate of yeast with gluten is actually fairly low. It’s in the single percentages. And the other thing is, these foods are so beneficial, especially fermented vegetables. A fermented batch of sauerkraut might have 600 different probiotic bacteria and yeast in it, in addition to the food being sort of partially digested already, so the nutrients in that food are much more bioavailable for the body, which can help address micronutrient deficiencies even more quickly, so there’s so much to gain from probiotic foods that my general recommendation is, unless you’ve had a Cyrex array 4 done, and you’ve tested positive for yeast as a sensitivity, or if it’s showing up as a sensitivity on ALCAT, in that case if you have a diagnosed yeast sensitivity, avoiding fermented foods, at least initially, and probably initially for the first couple of months, is a good idea. If you don’t have a diagnosed yeast sensitivity, I think there’s more to gain from leaving those foods in your diet than there is to gain from leaving it out. And I would recommend sort of keeping that in the back of your head as a possibility if you aren’t seeing huge success, you know, 2-3 months down the road. But generally, I think that the diversity that we can get from probiotic foods in terms of different strains to reinoculate the gut, in orders of magnitude, there’s my science background coming in
Diane Sanfilippo: {laughs}
Sarah Ballantyne: Better than, my husband’s an astrophysicist. Orders of magnitude are just part of the conversation.
Diane Sanfilippo: Yeah, but I think that’s, yeah. That’s understandable.
Sarah Ballantyne: But it’s just so much more
Diane Sanfilippo: Right
Sarah Ballantyne: Than you can get from any kind of supplement. And so I think the exception is, if you have a diagnosed yeast sensitivity, then definitely those are better foods to ignore until you’ve seen really substantial improvement in your gut health and your immune health, which you would evaluate based on your digestive symptoms and any symptoms of your disease. But I really, I’m a really big fan of probiotic foods, especially fermented vegetables because of just how many different strains, and the strains vary from batch to batch, so especially if you’re making them at home, you will end up with slightly different probiotics with every batch you make. And plus it’s really yummy.
Diane Sanfilippo: I love that. I, like, insisted that sauerkraut would be on the cover of my book with Practical Paleo came out. I was like, I don’t care if nobody knows what this is, I’m putting sauerkraut on the cover of my book.
Sarah Ballantyne: I love that. I love, especially, that you have, I think 3 different variations of sauerkraut in there.
9. FODMAPS and autoimmune protocol on paleo [57:09]
Diane Sanfilippo: I do. I know, it’s so funny. So, let’s see. There’s one; we might have time for one or two more here. Another food related question, because this is really, you know, there’s so much too it. Like, we’re not getting into detail in what’s happening in the book because there’s just so much information on how all of this is working in your body, and you know, for people who want to know even more about your different immune cells, like all of that, all these reactions, that’s where Sarah really kind of breaks it down for you, but I know that these are kind of the, just hot button questions that folks have and I figure we’re just going to run them by you. But, somebody is asking, let’s see, there was one talking about FODMAPS. This one is from Patrick, and he’s wondering for someone with severe digestive issues, you know, they’re being told to avoid FODMAPS, and obviously I know for you and for what Dr. Wahls recommends in her book, obviously there’s tons of cruciferous vegetables for example, because they are so rich in nutrients, but doing an otherwise paleo diet, is it recommended to go ahead and try autoimmune and then try and like ease some things back in, or what’s your kind of take on the issues that some folks are having with FODMAPS and other digestive problems?
Sarah Ballantyne: Yeah, that’s a really good question. So, it’s tricky because most of, I think some of the most nutrient dense foods would be eliminated on a low FODMAP diet, but low FODMAP diets have been shown to have incredible clinical power in just about any kind of digestive distress. And things like irritable bowel syndrome, those types of like, oh you have something wrong with your digestive system but we don’t exactly know what it is, but we’ll treat the symptoms. Those conditions tend to respond really, really well to low FODMAP diets. My suspicion is, in clinical trials some of the major reasons why is because a low FODMAP diet removes grains and dairy. I think that it kind of depends on how severe a person’s digestive system is. Because there is really conflicting evidence out here. There’s evidence that shows that a high vegetable intake can speed healing. And, there’s evidence that shows that high insoluble fiber from vegetables, not insoluble fiber from grains, but insoluble fiber from vegetables can speed healing of even colitis, and diverticulosis. And so my general recommendation is sort of similar to the yeast is, unless you have diagnosed fructose malabsorption, so you’ve done the hydrogen breath test, is to start with an autoimmune protocol that includes these vegetables, and if you’re noticing that you have digestive distress when you eat them, there’s two really great strategies for mitigating that. One is to consume them cooked. A lot of people will have an easier time cooking some starch to break down the fiber, so the fiber is sort of easier for your body to break down. It does actually provide less food for your gut bacteria, but it helps ramp up your firmicutes family of bacteria. {laughs}
Diane Sanfilippo: I love it. What is that? Tell me about it.
Sarah Ballantyne: Which are the … This is a family of probiotic bacteria that are really, really high in the digestive tracts of hunter-gatherer population and much, much lower; much, much, much, much lower, in fact they can make up more than half the bacterial strains that are in the hunter-gather, compared to a western diet, and they are a group of bacteria that are really, really good at breaking down plant matter. And they break down fiber. And actually, they are really beneficial for us, not just because of the sort of short-chain fatty acids and things that they produce is that they break down this fiber, but because they release nutrients from plant matter, so they actually help our bodies absorb more of the vitamins and minerals from plants. So, what happens when you start a diet is that, if you’re coming from a western diet, and you are jumping into a really heavy plant matter diet, which my recommendations are just because of the huge, huge benefits that you get from feeding your bacteria the right kind of food, and also the vitamin, mineral, and antioxidant content of eating lots of plants. So, what happens is, you are basically nurturing that particular family of bacteria, and so by feeding them cooked vegetables, you are not overwhelming the system so much and you can kind of gradually build up your numbers. The other thing that can be really helpful is taking plant enzymes. Plant enzymes sort of will help your body; it’s sort of like pancreatic enzymes, but they are very specifically helpful for digesting plants, as opposed to pancreatic enzymes, which would be more helpful in digesting animal products, typically. And between sort of both of those strategies, most people find that they can ramp up the vegetable matter, and ramp up the raw vegetables over time. And how quickly that is? You listen to your body. And there’s no race. So, you just basically do what you can to slowly increase vegetable matter, and what helps the digesting is really changing the type of bacteria that are in your gut. But what is so great about that is you’re also supporting the growth of bacteria that tend to be the best immune regulators, they tend to produce the best neuroactive compounds, so they tend to be the ones that will help with brain health and gut-brain axis problems, they tend to be the ones…they can actually, there are byproducts the bacteria produce that change gene expression in the liver that control metabolism. So, it becomes this sort of overarching thing, and this is where it becomes really about the health, your bodies health, is directly linked to the health of the bacteria that are living in your body. And so, I like that approach sort of support digestion of these plants by consuming them cooked, but that being said, there are definitely situations where a low FODMAP diet can be very therapeutic. It doesn’t actually take very long. You can actually start reintroducing FODMAPS in as little as 2 weeks. And you can start playing with, am I more sensitive to polyols or am I more sensitive to fructans, am I more sensitive to free fructose?
Diane Sanfilippo: Yeah.
Sarah Ballantyne: And you can start to dissect that. So, in my book, I have it more as a secondary thing to try if you are having a lot of digestive distress initially, or if you’re just not seeing improvement initially. But it’s definitely sort of a, it’s one of those cans of worms where there’s arguments for and against, and it’s kind of a grey area. It’s not, you know, the science doesn’t really give us a clear answer on whether it’s better to start from the beginning as a low FODMAP and introduce those later versus start with them in and then use it for troubleshooting.
Diane Sanfilippo: Yeah.
Sarah Ballantyne: I like the latter because I am so passionate about the importance of the nutrients in plants, and I tend to see in the people I’m interacting with in the community that one of the big things that will accelerate somebody’s healing is adding in more vegetables. So that’s kind of why I had to pick a side, so I picked that side.
Diane Sanfilippo: Yeah, well I think too, like, you know, for the folks who are saying, they are experiencing really bad distress, I think this is the same recommendation that I’ve given. Look at some of the charts of different FODMAP categories are, and see if you can start to pinpoint which category is really the most problematic for you, because, you know, it’s usually not all of them are equally as harmful. You know, they don’t equally affect you in the same most serious or potent way, you know. So if you can kind of narrow it down to which ones are most problematic and getting rid of those for a little while, and then reintroducing them. You know, remembering that for most people just a general FODMAP intolerance is a sign that something else is wrong. It’s not, I don’t think it’s super common. I don’t know if you have a number on that, but you know the fructose malabsorption or the people who just are intolerant to fructose across the board, or fructans or just some of the different carbohydrate classes that may be tough to digest, I know there are some people who just, they can’t ever have them. You know, they can’t process them. But for most people, it’s really just a sign of this overall imbalance, and taking them out, you know, a little bit at first and then starting to reintroduce them a little more quickly will probably be more supportive than detrimental over the long-term.
Sarah Ballantyne: It’s one of several different types of sensitivities that, not necessarily, and I wouldn’t want to say that there aren’t genetic…
Diane Sanfilippo: Mm-hmm.
Sarah Ballantyne: Situations where you just don’t produce the right, you know
Diane Sanfilippo: Right.
Sarah Ballantyne: The right type of carriers to get fructose into the body. I mean, I’m sure that there are situations like that. But there are a number of food sensitivities that are really indicative of probably both a damaged leaky gut and just the cells that are lining the gut not being able to do their job because there is so much damage, and the wrong bacteria growing in your gut. And, you know, both of those things are fixable, but sometimes it does involve removing the aggravating food while your body heals itself. You know, sort of histamine intolerance would be another sort of example of, you know, your gut is so damaged that you’re not producing enough diamine oxidase in order to neutralize the histamine that is produced, and you’ve got maybe too many bacteria that produce histamine in your gut and not enough that would actually help clear it for you. And, really, the jury is out on how effective elimination diets are at dealing with that
Diane Sanfilippo: Right.
Sarah Ballantyne: If you are doing a protocol that is already focused on gut health. So, if you’re doing something that’s focused on healing the body and restoring a good diversity in numbers of gut bacteria by eating a variety of vegetables and some fruit, and not overfeeding it by eating things that are really hard to digest, like grains and legumes, you know, if you’re already doing that, do you need to do a no starch strategy in order to starve an overgrowth? There really is no scientific evidence to support that if you’re already doing something that’s focused on healing the gut. But, we’re all individuals and we all respond to these things slightly differently. So, I think number one, if you find something that works for you, do it.
Diane Sanfilippo: Yeah. I think that’s one of the big things and I think we’re probably going to wrap up with this one, but one of the big things that I talk about with leaky gut and the whole, you know, why paleo works so well for so many people is that, you know, we’re removing offending foods, but I think what a lot of people don’t realize or don’t remember, because when that group of foods is just maybe grains and dairy, or grains and legumes, it’s like no big deal to get rid of those for a lot of people and never bring them back, and so the minute you realize that your exclusions may also be, you know, FODMAP vegetables, eggs, nightshades, nuts and seeds, that’s when the question is, will I ever be able to eat them again. And that’s where I’m reminding them, eliminating foods is only the first step in giving your body a chance to heal so that you can then do those repair stages and reinoculate and then reintroduce foods again. Like, that’s the thing that people are forgetting so much, and this is one thing that I meant to say before that, just basically after our introduction to this whole thing and how huge the autoimmune component has become in paleo, a lot of folks have interviewed me and have asked, you know, why do I think that paleo has become so popular. You know, why is it becoming this really growing sort of niche of nutrition, and why are all these books all over the bestseller lists, and all of that, and it’s really because it has become such a powerful way for us to heal, and it’s not just about people who want to get lean, and it’s not just about Crossfit and paleo anymore. It’s really about healing, and it’s about healing these chronic diseases that people have never really before had any sort of foundation or inkling that they might be able to heal themselves by changing what their eating, and then also changing the entire structure of what’s going on in your body by supplying a much deeper set of nutrients, and really just getting a lot more high quality food into your body and remembering how important that is, to allowing the body to do what it’s supposed to do and kind of calm down a lot of what is going on with the autoimmunity. Because, you know, the autoimmunity is just a sign that your body is out of balance ,and that is the stuff that people, they want to take that shock on approach, ok I’ll change my food, but it’s like, wait a minute, what’s going on with your stress levels? And you’re at that job that you hate still, so every day it’s mental and emotional stress, and all those other components. So I think that’s why paleo has grown so much. People are finding improved health, and I’m really excited for just, I think it’s going to be like a sleeper hit underground movement
Sarah Ballantyne: {laughs}
Diane Sanfilippo: The whole like autoimmunity, like, more and more people are going to get this book and start, they’re going to have all these light bulbs turn on and all these ah-ha moments, and all these, like, I can’t believe my doctor never told me this moments, and start to really heal themselves and come out of the woodwork and tell everybody else that they’ve done it using your book and with so much guidance and support along the way, so I’m just really excited for you and I’m excited for everyone who’s going to get their hands on this book and take control of their own health, as Dr. Mercola would say.
Sarah Ballantyne: Thank you so much. I mean, that was exactly the goal, was to empower people with the right information to be able to, you know, solve their own health problems when conventional medicine doesn’t really offer them much of a solution. It offers them drugs with worse side effects than the diseases in many cases. So, thank you. Yeah, that’s the goal.
Diane Sanfilippo: Good. Well, thank you so much for spending time with me. I have a feeling I’m going to probably hit you up within the next few weeks, or so
Sarah Ballantyne: {laughs}
Diane Sanfilippo: And be like, we should just talk more about this, and I think as more people have more questions, I know you’re going to talk more about it I’m sure on The Paleo View. You guys can all check out The Paleo View podcast if you haven’t already. I know so many of you listen to Liz and myself on your commutes, and I’m sure you need more amazing, fun listening to do, definitely check out The Paleo View. And, Sarah’s website is, so definitely check that out. The Paleo Approach is the book, and The Paleo Approach Cookbook is slated to come out, when?
Sarah Ballantyne: In August.
Diane Sanfilippo: Oh, good. I’m glad you have a little bit of time.
Sarah Ballantyne: Well, I found myself, because of the not taking my own advice.
Diane Sanfilippo: Mm-hmm. Mm-hmm.
Sarah Ballantyne: And letting myself not get enough sleep and get too stressed to get this book to the printer, I found myself having some health issues that I hadn’t had in a very long time, and it became a, I’m not a very good role model on what to do if I burn myself out and, you know, keep at this pace
Diane Sanfilippo: Yeah.
Sarah Ballantyne: To the point where I have a massive health crisis. So we’ve delayed the cookbook until August.
Diane Sanfilippo: It can wait. It’ll be ok.
Sarah Ballantyne: Well it’s going to take some people until August to read this one, so {laughs}
Diane Sanfilippo: I honestly, yeah. I think that that’s the right thing to do. I know you’re not the only one in this community with an autoimmune situation, and also writing a book, and I’ve seen some other folks posting about, you know, really dealing with the stress of that, and I’m always like {laughs} like, the waiving finger mother across all of this, like, you guys, the book can wait. Please don’t hurt yourself to get this book out there. None of our fans, or readers, or followers would be upset if we said, you know what, I have to look out for my health. I want to get this book done for you, but I need a little more time {laughs} Like, it’s ok. And I don’t have a diagnosed autoimmune condition, and I’m sure I told Erish, our publisher, several times I felt like I was going to die working on Practical Paleo. Like, I literally felt so much stress and anxiety that I, like, was like paralyzed by. Like I just wanted to sleep. I couldn’t figure out what was wrong with me {laughs} I went to the doctor, and I had blood work, and I was just stressed. That’s all it was, was stress. So, anyway.
Sarah Ballantyne: Well, stress is an incredibly, you know, potent s
Diane Sanfilippo: That’s right.
Sarah Ballantyne: Stimulator of bad things happening in the body.
Diane Sanfilippo: {laughs}
Sarah Ballantyne: And, you know, there’s so many things that we, in the paleo community, I think we’re very gung ho about our diet changes
Diane Sanfilippo: Yep.
Sarah Ballantyne: And how important it is to eat these nutrient-dense diets that are devoid of toxins, and you know, it’s only really recently become part of the discussion about how important it is to have the lifestyle
Diane Sanfilippo: Yep.
Sarah Ballantyne: That goes with sort of a hunter-gatherer lifestyle where you’re not, you know, doing a 2-hour commute, and you’re not, you know, in front of bright lights in the evening, and you’re not sedentary all day and then doing these like super intense workouts in the evening to compensate for it. And, yeah, stress is, it’s brutal.
Diane Sanfilippo: {laughs} Well, I’m glad you’re taking a little more time. So, August. Folks can look for The Paleo Approach Cookbook, and I think that’s pretty much it. So, just to wrap up, you can find me, Diane at Don’t forget, you can find Liz at And again, you can find Sarah’s blog and website at And the book is available on Amazon, Barnes & Noble, and stores all over the place. Definitely check it out. It’s big; I believe it’s the same number of pages as Practical Paleo, or a little further?
Sarah Ballantyne: It’s 20 pages longer {laughs}
Diane Sanfilippo: It says 432, but maybe …
Sarah Ballantyne: Yeah, 432. No, it’s 432, is Practical Paleo 432?
Diane Sanfilippo: Yeah, it’s the same.
Sarah Ballantyne: Oh, with the extra.
Diane Sanfilippo: Yep.
Sarah Ballantyne: So, it’s identical.
Diane Sanfilippo: Yeah, so check it out. You’re going to learn a ton. And thank you, so much, for spending time with me.
Sarah Ballantyne: Thank you! It was fun.
Diane Sanfilippo: Have a good one.
Sarah Ballantyne: You too.
Diane Sanfilippo: Bye-bye.

Diane & Liz

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