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​The Melanie Avalon Podcast Episode #1 - Dr. Alan Christianson

​​Dr. Alan Christianson is a Naturopathic Endocrinologist who focuses on Thyroid function, specifically Hashimoto’s, Hypothyroidism, and Graves’ disease. He has been actively practicing in Scottsdale since 1996 and is the founding physician behind Integrative Health. Dr. Christianson regularly appears on national media like Dr. Oz, The Doctors, and The Today Show. He is the founding president behind the Endocrine Association of Naturopathic Physicians.

​Dr. Chritianson is also a NY Times bestselling author whose books include The Metabolism Reset Diet, The Adrenal Reset Diet, and the Complete Idiot’s Guide to Thyroid Disease.

SHOWNOTES

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2:50 - JOOVV: Use The Link Joovv.com/melanieavalon With The Code MelanieAvalon For A Free Gift From Joovv!

​4:00 - Dry Farm Wines: Use The Link DryFarmWines.com/melanieavalon To Get A Bottle For A Penny!

​6:30 - Dr. Christianson's Health History

​8:30 - Why Do We Have So Many Health Issues Today?

​9:45 - What Is The Metabolism? Can It Change?

12:30 - What Does The Liver Actually Do?

15:30 - Nutrient Processing Timeline

16:30 - Is Liver Detox Real? What ACTUALLY clogs the liver?

18:40 - How Are Various Food Substrates Processed By The Liver?

​20:50 - How Do The Activation And Conjugation Phases Work In The Liver?

22:45 - How Can We Support Liver Detox?

24:20 - What Does The Liver Require For Function? 

26:20 - Glycogen In The Muscles Vs. Liver

27:30 - How Can We Support The Liver While Minimizing Fuel?

29:45 - Signs The Liver Is Improved

3​1:30 - Liver Regeneration 

32:30 - How Long Does The Liver Healing Process Take?

33:45 - BEAUTY COUNTER:  Non-Toxic Beauty Products Tested For Heavy Metals, Which Support Skin Health And Look Amazing! Go To Beautycounter.com/MelanieAvalon! To Receive A Free Beauty Counter Gift From Melanie, Exclusive Offers And Discounts, And More On The Science Of Skincare, Get On Melanie's Private Beauty Counter Email List At MelanieAvalon.com/BeautyCounter!

35:10 -  What Does The Metabolism Reset Diet Protocol Look Like?

38:15 - How Do Different Amino Acids From Protein Affect The Body?

39:30 - Health Span Vs. Lifespan

41:45 - Do We Need To Eat Fat To Burn Fat? 

44:35 - The Myth Of De Novo Lipogenesis: Do Carbs Actually Become Fat?

45:50 - Is Gluconeogenesis Stressful For The Liver? When Does It Occur?

47:45 - How Do Ketogenic Diets Affect The Liver And Fat Burning?

49:00 - How Are MCTS Used As Fuel?

49:40 - The Importance Of Fiber Diversity And Nutrients

​50:15 - The Unlikelihood OF EFA Deficiency

51:00 - Polyunstaryated Fats In The Body

53:00 - Can We Enter Ketosis While Eating Carbs? Are Low Carb Or Fat Diets More Effective For Fat Burning?

56:30 - How Does Caffeine Affect The Liver?

57:45 - How Does Alcohol Affect The Liver And Glycogen Stores?

​1:00:30 : What Other Lifestyle Factors Play A Role?

1:01:25 - The Role Of Sleep, Cortisol, And Circadian Rhythm (Regularity Vs. Rhythm)

1:05:00 - The Thyroid/Iodine Connection

1:11:40 - Do You Need To Feel Bad When Detoxing?

Alan Christianson's Free Challenge!: https://uo178.isrefer.com/go/mrdc/melanie/


TRANSCRIPT

Melanie Avalon:
Hi friends. I am thrilled to bring you today's guest who I have the personal honor of calling a friend. He is just an amazing, wonderful author, doctor, there's just so much here. I am here with Dr. Alan Christianson. He is a naturopathic endocrinologist. He has a focus on thyroid function, specifically Hashimoto's, hypothyroidism and Graves' disease. You might be familiar with him because he is a New York Times bestselling author. He has quite a few books. He has The Complete Idiot's Guide to Thyroid Disease, he has The Adrenal Reset Diet, and he also has the most recently released, The Metabolism Reset Diet.

Melanie Avalon:
I originally came to Dr. Christianson's work through The Adrenal Reset Diet, which I loved. It's a wonderful book exploring a lot of the adrenal and energy and health problems we have today, but I'm even more excited about his most recent book The Metabolism Reset Diet, which just addresses so many topics, so many issues. I am thrilled to jump into the nitty gritty of it all, so thank you for being here Dr. Christianson.

Dr. Alan Christianson:
Melanie, thank you so much for having me. I'm really glad to be here with you.

Melanie Avalon:
I thought to start things off before we get into the actual topics, if you wanted to tell listeners briefly about your own history and what led to where you are today with your current practice, your work, everything that you do.

Dr. Alan Christianson:
Yeah, kind of a odd story. I was a want to be, I don't know, my big love was space and I think I realized that the astronaut path just wouldn't work for various reasons. Astrophysics was the big love and I really got sidetracked because of my health issues. I guess the social stress of being a fat kid when it was less common, that was probably the biggest single factor, and then just frustration about not being able to do basic physical activities like run in gym and climb rope and stuff like that. I really saw firsthand how much life can suck when your body doesn't work and how when things aren't, you don't look the way you want and you can't do the things you want to do.

Dr. Alan Christianson:
And through reading, through finding information and through trial and error of implementing it and realizing that, "Oh wow, it won't work if I don't do it, if I don't stick with it," lots of trial and errors. I had the experience of realizing that information can change your health, and that can just radically change the experience of your life, and that information may not come from the channels that you might expect. It was powerful stuff and it made me want to just dedicate my life to helping sort out the best information and really get that to people in ways that could help them.

Melanie Avalon:
I feel like that's a common threat with so many people who end up in the health sphere. It comes out of their own health challenges, I like to call them challenge, and the journey to get things functioning correctly and in a healthy way so that you can live your life and pursue your passions. So yep, I definitely relate to all of that. To get into the actual topics, like you were just saying, body weight, health issues, very common for so many people. Why do you think so many people today do struggle with all of these issues?

Dr. Alan Christianson:
It's certainly on the uptick. It's been a big trend, and it's pretty unprecedented. I don't think we really have one answer but just in many ways, modern life is set up to make it more easy for us to do things as we wish and not be held hostage to a certain schedule, and also in that we can have easier access to more calorically dense food for less work. Over the arc of humanity and survival, those were all noble goals but now we've gotten to the point to where these things work against us. Our innate sense of how much food we need, how we respond to the modern timing of life, the modern chemicals of life, it's just really a perfect storm. I've seen a lot of work trying to find a factor, and it's undoubtedly multiple factors together.

Melanie Avalon:
I was just about to say it's like a perfect storm, and then you took the words from my mouth. In your most recent book, The Metabolism Reset Diet, what is the "metabolism?" Because I think that's a very vague concept to a lot of people. People think that it's very specific or that you burn a set amount of calories per day, but what actually is the metabolism and does it change?

Dr. Alan Christianson:
It can change. Super quick aside, I think I've done about 160 interviews on this topic so far and if I were to give an award for the questions that reflected the best understanding of the book, you'd get the award. You got really good questions here.

Melanie Avalon:
Aw, thank you, thank you.

Dr. Alan Christianson:
So, back to the question. Yeah, two facets of it, one of which is just how fast your body converts food and fuel into energy, the basal metabolic rate. The other facet of it is how much the body can adjust that. How readily can the body adjust that as our needs change? If our food and take is a little higher or lower, or if our output is a little higher or lower, how well can we still maintain steady energy and steady weight? Then the last part, it sure can change. So, stations of life. Some of the biggest things can be like pregnancy and menopause, perimenopause, changes in menstrual cycles, those are huge. Sleep status is a big one, overall body composition, general stress load. These among many other factors can influence all that

Melanie Avalon:
I think people often think that the metabolism is this fixed thing that they can permanently change it one way or the other for better for worse, but something that's really interesting is, do you know the Greek word that it comes from?

Dr. Alan Christianson:
I do not.

Melanie Avalon:
It comes from, I don't know if I'm pronouncing this right, but [metaballe 00:06:20] I think, and that actually means change.

Dr. Alan Christianson:
Oh, that's cool.

Melanie Avalon:
Yeah, it's motivating to know that it is something constantly in flux. Something that you discuss in your book a lot that was a big takeaway for me was that the metabolism, and we'll get into the liver in a little bit, that it should in the correctly functioning way adjust to our calorie intakes and the food we eat. That's something that I really loved. Basically, we should in theory be able to handle different calorie intake, less, more, different food types. In the ideal state that's what we'd be in, but obviously things don't always work out that way. When people see this book, The Metabolism Reset Diet, they might think it's going to be all about metabolism, but really what you really go into in amazing detail and that I'm so excited to pick your brain on is the liver and how the liver is involved in the state of the metabolism. So, quick overview, what does the liver actually do? I guess we'll start with that.

Dr. Alan Christianson:
Just to close, I guess one loop that I left to open, those two parts of metabolism, just how fast it is and how flexible it is, the flexible part can change a lot more, and that's a perfect segue to the liver because that's a big part of how the body can adjust how flexible metabolism is. So the liver, pretty wild, but our body's chemistry, we think about that a lot and by and large, that's the chemistry of our bloodstream, you know, these fluids that flow between our cells.

Dr. Alan Christianson:
If you could go way back really fast to the arc of evolution and show a photo of your dad, your grandpa, your great grandpa and tag on a few million greats, eventually you're going to see a fish, and eventually you'll see something smaller than a fish. And at some point of that, our chemistry was our location. Your chemistry was not separate from that of the seawater in which our little cells were floating and we had to be floating in the right area to have the right chemistry.

Dr. Alan Christianson:
But fast forward to the arc of evolution and especially leaving the ocean, we became almost like astronauts leaving the ocean, but holding this environment within us, like our skin is holding in seawater. I think about an aquarium with fish, you've got to filter that. You've got to add things and take things out, and change the water. By and large that's our liver, and there's just tens of thousands of little reactions going on constantly that are adjusting our body chemistry or the chemistry of our bloodstream to keep Good in alignment with what our current needs are.

Melanie Avalon:
So basically the liver is in charge of everything in a way. I mean, it's processing everything that we're taking in, providing these nutrients, dealing with toxins, all of these things.

Dr. Alan Christianson:
There's things that we need to have, there's things that we need to get rid of and there's things that we need to change. The liver's really relevant to all of that, and those involve nutrients, those involve immune cells, amino acids, hormones, brain chemicals, neuropeptides. And as a generalization, all of this stuff ultimately comes from food of course, but we don't eat constantly, yet we use things constantly and there's never a time where a meal gives all the building blocks we need for a big unit of time. So, the liver is constantly taking things in from our meals and warehousing stuff, and then accessing that later on between me, or if a meal is higher in one thing but lower in another thing and doling things out and converting things to keep the chemistry right.

Melanie Avalon:
What is the timeline on that? As far as the nutrients that the liver requires to do all these processes, does it store nutrients for an extended period of time that it can call on or do we need to be supplying these nutrients on a daily basis, an hourly basis? What does that look like?

Dr. Alan Christianson:
As a generalization, the slowest would be some of the fat soluble vitamins and minerals. Things like the A, D, E, K and then some minerals, especially iron, copper, these can store for longer periods of time. Many of the water soluble nutrients have faster turnover. A few of them are stored longer, B12 is a case in point for that. It's all different, but that's a generalization as far as some nutrients going faster than others. And hormones are not different. It's funny, we think a lot about the importance of the glands in making hormones. For sure they're the source of that, but by and large they make a lot more than we ever need, and they make a lot more in an inactive state. So, the liver is also having effect on some storage but a lot of conversion for hormones as well and getting them correct.

Melanie Avalon:
We often hear this concept of liver detox. It's such a trending word. I use it almost hesitantly because I think it comes with a lot of baggage of people thinking that it's either the bee's knees in everything or that it does nothing, that it's all just something silly and that your ... People often say, "Oh, the liver naturally detoxes. We don't need to do a liver detox." What are your thoughts on liver detox? Does the liver reach a point where it is "clogged and needs to be detoxed?"

Dr. Alan Christianson:
I love the nuance you prefaced that question with. The funny thing is, a lot of the things as far as toxins or waste we're concerned about, most of that accumulate in the body don't really accumulate in the liver. They may be circulating in the body and stuck in the body and that can be stressing the liver, but they're not so much in the liver. The liver can get itself clogged, but by and large when I'm talking about that, it's more so a buildup of just unspent fuel of fatty acid byproducts. And as they accumulate, they just make the liver's job harder for structural reasons and chemical reasons.

Dr. Alan Christianson:
By structural reasons, you can think about the liver, like a filter that's ... an oil filter where oil gets pushed in one end and has to flow out the other end. If the oil becomes too thick or the spaces become just filled up in some way, it takes more pressure and the oil can't come through as well or if it does come through, it's not filtered as thoroughly. And then chemically, when there's a lot of unspent fuel there, that's a source of chemical irritation and free radical damage because the liver cells may not have room to hold on to all about. So yeah, the main thing we get clogged with is just extra fuel more than anything.

Melanie Avalon:
I think that is such a fascinating paradigm shift in viewing the role of the liver. I'm sure there are still like you said, there can be toxic buildup, but switching from this idea that it's all about the toxins in the liver to this idea that you discuss in detail all throughout your book of too much fuel, which is just such a fascinating concept. So, how are the various food substrates that we take in, protein, carbs, fats, ketones, alcohol, how are they processed by the liver and do they all equally build up in the liver and "clog it?" What does that look like?

Dr. Alan Christianson:
Well, at the end of the day, I remember the classic thing about parents saying, don't worry if your peas get in your gravy because it all goes in the same place. It's kind of like that for the liver for the bulk of that stuff. We think a lot about carbs, fats, ketones, something being good or something being bad and they're really all energy dense molecules. They're all things that can be a source of oxaloacetate which can be used in energy reactions. And just like your car, if the gas tank is already full ...

Dr. Alan Christianson:
I actually did this thing a couple months ago. We've got three cars that my wife and my son and I use. I know she was going to use the Jeep to haul some furniture and I had seen that it was lower and gas, so I'm like, so I want to make a quick trip down and fill the Jeep up so she's got it. I don't know, I just like to fill the gas tank for her. So I went and did that, and I put the nozzle into the tank and immediately it shut off like it was full. And I'm like, "Well shoot, what's up?" So I started pumping again, and now it's overflowing like, "This is ridiculous." You customize stuff on a Jeep right? So, I got the custom gas cap and I said, "Shoot, did I put something together wrong back when? Is there something loose in here?"

Dr. Alan Christianson:
After thinking about it really well, I realized she filled it up already. It was just trying to pour gas in and it didn't need it. That's kind of what happens. All these things can become like gasoline to a car and how well the liver does with them is a function of how much the liver needs and any of those things in excess can cause issues. There's really two storage places there's, glycogen and triglyceride and all those can make triglyceride. Carbs can make glycogen and once all the storage is filled up, any extra just becomes harmful stuff like the gas that was running down onto my foot that day.

Melanie Avalon:
That is hysterical, and also I've done that before where the gas actually starts coming out. Speaking of toxins, I do have a question I'd like to clarify as well. The actual detoxification phases at the liver, because you talk in the book about the activation and the conjugation phases. How do those work as far as processing toxins and things like that? I think when listeners get a better picture of what all the liver is actually doing, we can see more why it being over-fueled and clogged could be a problem.

Dr. Alan Christianson:
You know, this is something where you can lump or split. You can talk about more pathways or fewer pathways and a lot of subtypes of them, but the general picture is that there's a couple steps and in the first step, you're taking something and making it more reactive. The goal is to take whatever's trapped in there, in this case these fat molecules, you want to get them activated and then packaged up with something else, and then sent on their way. Both those steps are important but as a generalization, we talked about that perfect storm in the modern world, that perfect storm seems to really speed up activation, the first phase and it can have no effect or maybe even slow down the binding, the conjugation part.

Dr. Alan Christianson:
A lot of the things that the book talked about were ways to help make sure that the first step is not over activated. It's like you're wanting to get rid of something, but it won't really react until it's turned on, so you've got to turn it on. But if you turn it on and you got no place to send it out, now you've got the toxins that are worse than they were before, but they're not leaving. So it's really important to have both these pathways working, and then working in good proportion to one another.

Melanie Avalon:
I've been fascinated with the phases at the liver because that was my understanding, that when you get the first phase going, you actually make these toxins potentially, or they do become more toxic to the body. So if they're not dealt with in the later stages, then it's not a good scenario to be in. How can we support those detox phases? Because I know, man, I do so much research and I read about all these different herbs and supplements. Some stimulate the first phase and some help the second, do you think that there is a way to support that with specific supplements or is it better to do an overall approach of just declogging the liver in general? What are your thoughts on that?

Dr. Alan Christianson:
You know, I don't know. I might be dating myself but over the decades, I just get more excited about how can food and lifestyle work? I've had so many disappointments to where we get excited about this supplement or that one based upon a mechanism, based on hypothesis, and then a large human study is done and it turns out nope, it didn't work or it worked the opposite way. There are certainly many things that can have their place supplementally, but by and large that can happen through food. In the diet, this often comes down to the ratios between all those things that make fuel and all those things that provide the carriers that get junk out, which are by and large the proteins and amino acids sources. So, you're getting those proportions right. Also, getting a real nice array of diverse types of fiber. Not just total fiber, but a lot of fiber diversity. That goes a long ways towards helping those pathways work well also.

Melanie Avalon:
I'm so glad to hear you say that because like I said, I am always researching all the supplements, but I feel like in the ideal world we wouldn't any supplements. We would just get it from real food, dietary, lifestyle approaches. You were speaking briefly about protein being needed to support the liver. Would you like to talk a little bit briefly about what the liver actually does require to do its functioning, and then how we can actually implement an approach to support it while also declogging it? Because it can seem like difficult to both provide the liver with energy and substrates, but then not over-provide energy and substrate. It's quite a puzzle to figure out, which thankfully you have your book.

Dr. Alan Christianson:
Dude, you totally figured this stuff out. You completely got the nuance of all this, and that's just it. The energy and substrates, that's the fuel. People think a lot about, why not just fast and make everything better? It seems intuitively to make sense, but yeah, you mentioned the drawback is that when the liver is working in general, it needs various building blocks and substrates. But when it's working harder to clear a backlog, if anything it only needs those more and many of those come down to essential amino acids. A common pitfall is, someone can go on a diet that is really low in food overall and they might see a really exciting change on the scale at first.

Dr. Alan Christianson:
We always hear about the water weight that's lost, and it's kind of misleading. It's not so much that it was just random water that was sitting around doing nothing, it's by and large glycogen. Another difference about glycogen as a stored fuel is that it's hydrophilic. It carries a lot of water and it's a lot less space efficient, it takes a lot more room. So when someone dumps out their glycogen stores, they can lose a lot of weight. And it's not just random water, it's more so that carbohydrate store. If you look really closely at inches, it's often not that there's as much dramatic loss around the waist as it is overall weight loss, but that's the big difference that way. I actually got lost on where ... I got in that direction, my apologies.

Melanie Avalon:
Actually, I do have a tangent question that I've always wondered. As far as glycogen storage goes and water retention, is that only the glycogen that's stored in the muscles that adds on that extra water? Because I know some people, especially when they're doing like fasting type protocols or they're doing more limited carb approaches, that they might just be filling their liver glycogen rather than relying on muscle glycogen. Do you know if liver glycogen A, is it processed different from muscle glycogen and B, does it come with that water weight as well?

Dr. Alan Christianson:
Also, how much glycogen you store and how it's preferentially gained or lost from your liver to your muscle tissue, that's a function of how activated the muscle tissue is, how active the GLUT4 receptors are. That's a lot of exercise or training. If Someone's highly trained, their muscles can suck up a lot of glycogen and store quite a bit about. The liver's a little more finite in that what it stores is more a function of its mass, which is largely a function of just total body size, and roughly body composition. So your liver can hold a certain amount, your muscles have a lot more leeway based upon just training and training adaptations. But when you are seeing that water weight loss, it is coming from both of those places.

Melanie Avalon:
Got you. Going back to the puzzle to figure out how to properly fuel our liver but not over-fuel our liver, support our liver, but not over-supported, what does that look like practically? You do discuss this in great detail in your book but for somebody who's looking to de clog their liver, get back through liver health, what type of dietary approach would you advocate that they try? Which again listeners, get the book because it's all in there, but just so they have an idea.

Dr. Alan Christianson:
The Cliffs Notes of that are getting adequate protein while limiting total fuel intake, but still getting a lot of micronutrients which you get from a diversity of different plant foods especially. Then one quick orienting concept too is, I wouldn't encourage the listeners to expect that a normal day's maintenance diet would achieve those goals. It really does take doing things in a way that deliberately is shortchanging your fuel needs, but still supplying these building blocks and a healthy maintenance diet shouldn't be expected to do that. It's more of a deliberate thing you set out to do with a finite time frame.

Melanie Avalon:
It's a very calculated approach for sure because if you're not being careful, I feel like things could be, you could potentially do a lot of damage if you are under-supplying nutrition and calories at the same time. I mean, that could be very, very bad. I feel like it's very important to have an approach where you are supplying all of the substrates that you need.

Dr. Alan Christianson:
Yeah, on a day to day basis in most cases. The data is a little ambiguous as far as exact timeframe, but clearly when you're talking about more than six weeks of being at a big deficit, a lot of negative things happen. You do start to impair both of those facets of your metabolism and you often disrupt the body's stress regulation pathways. If you do it well, you can do it for a brief period of time and effect some desirable change, but not create negative harm. But you shouldn't expect to live in a state of ongoing progressive weight loss.

Melanie Avalon:
For your protocol, I know you've practiced this with so many patients. What do you see with your patients? Do you see that they do radically improve their liver? And also, how would one "know" their liver has improved? I mean, do you encourage liver enzyme testing or is it more just overall general health? What do you see in your practice, and what type of testing would people want to do if that is a route to go?

Dr. Alan Christianson:
Yeah, someone certainly can do the diet and not have to do thorough blood tests, but any adult I would argue should have a relationship with their chemistries and a health care practitioner and they should see these things on a regular enough basis. I do talk in there about how even lab values that are in the normal range can be indicative of early liver issues. So yeah, those things do improve and people can know that the liver is getting healthier based upon that. The other simple metric I talked about was the height to waist ratio, so just how tall we are versus how long the circumference is around our belly buttons. That's a strong, easy indicator of liver health.

Dr. Alan Christianson:
And then, also subjective changes. The single testimonial that excites me the most is when someone writes in after doing this once in the past and says, "Hey, yeah I had these early pounds of weight that came off and these early changes in energy which were good, but now I'm six, seven months out and I'm not as mindful of my diet as I was before. I'm eating good food and being deliberate about that, but I'm not micromanaging it and I'm maintaining my weight just fine and my energy is staying steady." That's the coolest part, when someone shows signs of a clear change that lasts. That's the best sign of it being successfully completed.

Melanie Avalon:
That is absolutely amazing and encouraging. Talking about healing the liver, I know a lot of people are familiar with the idea that liver can regenerate itself. Is it true that it is the only organ that can regenerate itself? That's always thrown around.

Dr. Alan Christianson:
Well, only would be strong but it's amongst the most if you can make a continuum because everything regenerates. Like right now, the bags of skin that we define as ourselves, if we went back to June of 2018, those same bags of skin carried less than a few percent of the atoms that they carry right now. We're really almost like one point in a river. You'd never put a stick in the same river twice, well our bodies are kind of like that. Everything does regenerate, but some things have just really great capacity to have big change. For example, people can donate liver tissue. You can lose theoretically 80% of it and given reasonable health, that remaining part can grow right back again and that's not true of other organs. You can donate a kidney, but you can't donate half of a kidney and have your other half come back.

Melanie Avalon:
That is very reassuring though. It's wonderful news for the liver lovers and liver lovers. How long does the actual regeneration of the liver and declogging it and the whole process typically take, and can anyone heal their liver?

Dr. Alan Christianson:
I always try to avoid absolute terms, almost always.

Melanie Avalon:
I agree, I agree.

Dr. Alan Christianson:
I've seen late stage liver disease I'm sorry to say, and I've seen how it can be a real tragedy when someone's hoping for a transplant but doesn't receive it or failed the transplant, so for sure those things happen. But, those aren't things that you would walk around and have happening and not know about, so the things that could happen that wouldn't be at that level of transplant by and large can get better. In terms of time frames, I don't have good numbers on the more garden variety, early levels of clogged liver early liver disease, but rather progressed liver damage when it's acute like from Tylenol overdose, there's pretty good data on that, that shows that 28 days is really all it has to take. Some of those worst scenarios can change in that time frame. Given that, I've constantly stated about the lesser scenarios can change then if not quicker.

Melanie Avalon:
That's really motivating. Less than a month, 28 days. Can you talk a little bit more briefly about what the protocol looks like as far as what people are eating during the day? I love what you talk about, how the actual meals, they have a protein and a fuel and a veggie. I'd love if you could talk a little bit about that, but there's also like the shake aspect as well. What does it look like practically?

Dr. Alan Christianson:
I spent a lot of time trying to iron this out and the goal of the grams of protein that work well relative to the total fuel intake and the micronutrients, it was tricky. Achieving the grams of protein, one could just throw in a lot of chicken or a lot of meat, but the drawback is it ended up being rather specific in some micronutrients, but lacking in a lot of diversity from plants. Another pitfall if there was too much animal protein is that the body does have a certain acid burden that it clears during times of rapid fat loss. There's a lot of waste like uric acid that are stored. So, I wanted it to be less of an acid burden as well.

Dr. Alan Christianson:
Then the pitfall about some other foods is that many other sources of protein carry quite a bit of fuel. Beans are a wonderful protein, but they're five parts of carbs to one part protein, so they're not going to help that protein to fuel ratio. Nuts and seeds, same story. They're great foods, but they're more so fat than they are protein, so also not to push that ratio in the right direction.

Dr. Alan Christianson:
Then the other thought was during a time like this, people are eating less food and no bones about it, the first several days of that can be tough. You're hungry, you're not used to that. So, I wanted it to have fewer moving parts and not a zillion rules to memorize and complicated things to do. Crunching all that together, I built this around making a shake, which you can do one for breakfast one for lunch, even the exact same one, and then a pretty good evening meal and you've got the option of some unlimited food snacks if need be between those times.

Melanie Avalon:
Well, I could really tell in reading the book that you really did your homework obviously and that there was so much time spent creating this plan because like you said, it is difficult to find the right approach which will cover all the bases while still providing not too much fuel. I mean, there's just so much there. I think it would be very hard for somebody to take this general concept and just figure it out themselves. I think it is pretty important to have a nice guideline that you can follow. There's tons of recipes in the book as well so listeners, definitely check it.

Dr. Alan Christianson:
I guess it's important to me too, is that we've tested this, we've done trials, we've seen the outcomes. And so I'll often get questions about, what if I do this part different? They might be questions that this sounds like a totally plausible idea and I have to say, "Well, it's kind of like making a cake." I use these ingredients and the cake comes out like this. If we change them, I'm not sure if it'll come out the same way. So the cool thing is that it's tried and true and we know that it can work well in that format. Other formats might work, might not, but we know that this one can.

Melanie Avalon:
Also, I'd love to go a little bit more detail to the different macronutrients. You're speaking about protein, this is something I researched a lot and obsessed with. How important or how much does the actual composition of the various amino acids of various types of protein affect a person? I know some meat will be higher in methionine or the different ones and I've heard that you should limit certain versions and that can also relate. That can affect mood or anxiety. Do you think people should just gravitate towards the proteins that make them intrinsically feel best or do you think the actual specific amino acid composition should be taken in mind?

Dr. Alan Christianson:
Well, if you're in the ballpark of quality proteins, then I don't think it becomes quite as critical because that's more stuff the liver does sort out. If you're talking about very poor quality proteins that are just devoid of things that the body cannot make, that's different. But if you've got the basic building blocks there, then their proportions can be adjusted by a reasonably healthy body.

Dr. Alan Christianson:
You know, the methionine, super quick point on that. A funny paradox is that there's two ways you can think about the relevance of total protein and also types of protein. You can think about that in terms of health span or lifespan. Health span is, let's say that your genetic potential is 110, 120 years. Do you make it there or do you die early of a heart attack? That's your health span. Then there's this idea that perhaps if we have some version of caloric restriction or something along those lines, that maybe we could go past 120 years to 150 years. That would be a change in the lifespan.

Dr. Alan Christianson:
There are some chemical animal models from which we base the idea of extending the lifespan via protein restriction or methionine restriction, but so far we have really strong human evidence that the elderly who are higher on their protein intake have a higher rate of achieving a good lifespan. So yes, stronger evidence shows that protein, especially later in life is a big win for lifespan and less frailty, less chronic disease. And there's hypothetical evidence about it changing, I'm sorry health span. Hypothetical evidence about it changing lifespan, but so far we don't really have that data vetted in humans just yet.

Melanie Avalon:
I'm so fascinated by the relationship between protein and longevity because I think more and more now, people are advocating lower protein intakes for longevity. But from my understanding and from the research I've done, I think it's ... I'm completely open to new research and my thoughts might change on this, but currently I'm just thinking the problem might not be overall amount of protein, just if you're hitting yourself with protein constantly. So, you're constantly in this anabolic, stimulating growth promoting state versus having maybe still a lot of protein, but not constantly in our ever fed society.

Dr. Alan Christianson:
Well, you got to pull apart longevity to health span and lifespan. Those are more so lifespan arguments, and the health span arguments are pretty much the opposite and there's a lot of human data around that. We need to look at ways that animal data we're talking about or animal models or human data. Health span versus lifespan, they're both parts of longevity so yeah, it's an intriguing thing.

Melanie Avalon:
I personally love my proteins, so I'm always on the team protein plan. So that's protein, how about fat because I think, especially with dietary fat, there's this idea that we need to eat fat to burn fat. But something that you discuss in your book is that it's not quite that simple and that there's actually a difference between beta oxidation, so breaking down energy and getting it from the fat that we eat versus lipolysis, which is breaking down fat cells and getting energy from that fat. So, what's the deal with that? Do we need to eat fat to burn fat?

Dr. Alan Christianson:
Well, the short answer is no. The funny thing too, is that we can never not eat fat, we can ever not eat carbohydrates. Even foods that we think about as being a food that's fat free for example, still has some fat. Grains have fat, vegetables have some fat, we can never be devoid of it. But, the body gets fat from three places. There is the fat that we get from just the fat cells turning over. Remember about the whole never put a stick in the same river twice, your body's always turning over? Fat cells turnover really fast. They're always breaking down and releasing triglycerides in the bloodstream and if we're at a state of energy balance, they're getting new ones in and about that same rate, so there's parts of that coming in and out of fat cells.

Dr. Alan Christianson:
But the part coming out, that's one big source of fat in circulation and to our livers, it's just the fact that we're normally letting go of. The other source is just from the diet, and again, we'll always have some. Even if we're not eating huge amounts of oils and butters, there's always fat coming in. The third thing is called de novo lipogenesis. I don't want to digress too far, but that's the process by which carbohydrates turn into fat and just kind of interesting aside, it does work in humans, but to such a small degree people are often shocked. Also, the other shocking part about it is that the more someone is obese or overweight, the less active their de novo lipogenesis tends to be.

Dr. Alan Christianson:
Typical people, actually the highest amount ever recorded, it was a woman who was a Native American, a Pima Indian. She was given a 660 gram dose of glucose, which is a lot. It's more than your days ... It's probably twice her day's caloric intake all at once in just pure glucose. Of the 660 grams, her body managed to convert about 20 of those grams into fat, so she made about 20 grams of fat from about 660 grams of glucose. Most people max out between five or so, five grams, so it's pretty minimal. So we never don't have fat and our bodies don't have to ... It's not that they forget how to use fat because they always are and whether we're eating it or not, we're still getting tons of it from ourselves and we're always getting some from the diet.

Melanie Avalon:
I'm so glad you brought up the de novo lipogenesis because that's something I've thought a lot about. It's because people will often say, "Oh if you eat too many carbs, the carbs will turning to fat," when really that's not necessarily the case.

Dr. Alan Christianson:
They've done some tracer studies and the funny thing is, this is not really different for fructose either. But in tracer studies, if someone, let's say that their diet is just whatever it is. They're eating breakeven diet, and they add carbohydrate on top of their diet, they can gain body fat, no doubt about that. But when you actually trace where each molecule goes, what happens is, that extra food just caused the body to quit burning whatever fat was coming in and to just more aggressively store any fat in circulation. So, your total food intake being above a threshold will stop you from burning any fat and in that case, the fat even from the most low fat diet is just directly stored as fat. So yeah, you can overeat on any kind of food, but there's actually not a chemical property by which carbohydrates or even fructose are efficient packages that become made into fat.

Melanie Avalon:
I just find that fascinating because I think it just flies in the face of what people think as far as carbs and weight gain, but it's much more complicated obviously, than carbs turning into fat. Speaking of the genesisis, gluconeogenesis. Something I've always wondered, is that stressful for the liver, if for some reason we are using the gluconeogenesis process? Especially this comes up with people doing ketogenic diets or maybe they're doing super high protein intakes. Questions about it A, is it stressful for the liver? B, I've heard that it occurs automatically and then I've heard that it only occurs on an as needed basis. That basically if you don't need the glucose but you have a high protein intake, that that won't be converted to glycogen?

Dr. Alan Christianson:
Well, one more nuance is that almost all these chemical pathways, it's almost never all or nothing. We almost always have all them occurring at once believe it or not, but the proportions can be radically different. So gluconeogenesis, this is funny, it's not so much deriving from dietary protein, that's not an effective pathway for it. Sadly, it's more so from the skeletal muscle tissue. It's not so much a stress on the liver to do so, but it involves the stress response pathways. The process is highly mediated by cortisol and there's a diurnal cycle with cortisol, but the liver itself makes more cortisol.

Dr. Alan Christianson:
The liver has a enzyme called 11-beta-Hydroxysteroid dehydrogenase that can convert cortisone, which is an inactive adrenal hormone that's always in circulation, the liver can grab that and make that into cortisol. So in states where the liver needs to undergo gluconeogenesis or make new glucose, it simply takes more cortisol and utilizes that to break down stored proteins from skeletal muscle tissue, and then convert that to glucose. It's an example of how glucose is nonnegotiable. We can say that it's not essential, but that doesn't mean that we don't need, it just means that we don't need it from the diet and if we don't get from the diet, we get it from our muscle tissue.

Melanie Avalon:
Speaking to that, like ketogenic diets for example, what are your thoughts on them? How do they affect the liver? What's happening there?

Dr. Alan Christianson:
You know, the data as far as how they affect the liver function over periods of time, we have no long term human studies to base on that. But, we do know that the liver is one of the few parts of the body that can't utilize ketones as a fuel source. So when you are in a low fuel state and now you're unable to really have an energy source, that would be expected to create more stress and more metabolic strain. And in the absence of a low fuel state, there's some that think that just by default of forming ketones, somehow that makes your body burn fat, and it's really the exact opposite of that.

Dr. Alan Christianson:
Ketones are what are formed when your body is unable to burn fat and you can gain weight just fine on a ketogenic diet. It's only when you're below your body's energy needs that you ever tap into fat stores, and it's harder to do that because ketones, they're just what you make when you couldn't burn fat anyway, you make them into another fuel type. It's like you swap unleaded into diesel, and so ketones are diesel and fat is unleaded, they're just different fuels.

Melanie Avalon:
Some follow up questions about that. The idea that taking in MCTs for example, I mean, that's always posited as providing instant fuel for the liver. Is it not, through the ketone process, is that incorrect?

Dr. Alan Christianson:
Well, that is incorrect. It's not a fuel utilized by the liver at all.

Melanie Avalon:
It's just processed by the liver and then ...

Dr. Alan Christianson:
It's not even processed, it's distributed, and MCT is the same thing. They are ultimately another version of a fuel and if the body is in a high fuel state, they end up being stored as fat. They can't be used effectively by the liver as a fuel by its cells and if you're in a low fuel state, then they're just part of the things that you are burning and running through the various pathways. All these energy molecules, fructose, MCTs, ketones, we always think that one of them is good and one of them is bad, and it's just the whole fuel load. I don't quite break down to calories because like we've mentioned, protein plays out a little differently but all those fuel molecules, you can have too much, too little of any of them.

Dr. Alan Christianson:
One thing that I do think about that's relevant is your intake of fiber diversity and your intake of micronutrients. There are some things that are high fat sources that are really good sources of fibers and micronutrients like nuts and seeds for example, and there's other foods that have other good micronutrients like fish. Essential fats, it's really easy to meet your needs for essential fats. We never really hear of essential fatty acid deficiency. The body can pretty much make omega-s out of most any substrates. And we can run low on omega-3s and it can be suboptimal, but overt deficiency states have never been documented in humans. It's good to get healthy amounts of omega-3s in the diet and some omega-6s, but that's a pretty easy bar to cross. And then all the diversity of plant foods that don't tend to have as much fat, they have so many more other micronutrients or types of fiber that it makes sense to leave room in the fuel load to have plenty of them as well.

Melanie Avalon:
Not to get on too many tangents, little rabbit holes here, but that's something I've been researching a lot recently is the potentially inflammatory nature of polyunsaturated fats in general and the argument for letting the body naturally create the ratio of omega-6s and omega-3s that it would need from other substrates.

Dr. Alan Christianson:
a big paradox with fat one is, that's another place where there's a lot of conversion that occurs in the body. A lot of that is by the desaturase family of enzymes. The more fat we consume, the more demand there is on those enzymes. So paradoxically, higher fat diets, people on the highest fat diets, they have the most difficult time converting a variety of internally made fats. They have the hardest time for example, converting ALA from flax oil into DHA or EPA. But when there's less fat consumption, there's less demand. There's less things that have to be desaturated, so there's often a better spectrum of essential fats present believe it or not.

Melanie Avalon:
That's fascinating. I mean, not that it's making your body lazy but that's what it sounds like to me in a way. Because if you're taking in all of these fats, you're not-

Dr. Alan Christianson:
Well, a lot of fats that are not necessarily nutritionally dense, that are just empty calories just various fats to process like palmitic, or stearic, or oleic acid, high amounts of those still have to be desaturated. When they're already saturated, there's less capacity to desaturate fats that could be made into more relevant subtypes.

Melanie Avalon:
So fascinating. I think that's something that is going to become more and more, I don't know, researched or talking about, is this whole concept especially polyunsaturated fats and the role there. Because for the longest time, I feel like people were really saying take all the fish oil and all these things when I think it might be a little bit more complicated than that, not to even talk about the potential of toxins in that as well. Continuing with our paradigm shifting, you talk about how A, ketones and I guess even ketosis can occur even in the presence of a high carb diet because it's more about the low fuel. You also talk about how glycogen, which is coming from carbs most likely, can also help us burn fat. I think that's a radical shift for a lot of people. Is it true and possible that you don't necessarily have to do a high fat, low carb diet to burn fat or create ketones?

Dr. Alan Christianson:
You know, the funny thing is that you can talk about plausible models in a million ways, almost like a connect the dots that aren't numbered. You can connect the dots in different ways. I think a lot about just human studies, and there was a study done in which you probably read one of the Hall studies in which participants were put into groups. They were given a controlled caloric intake and one group was on a ketogenic diet and one group was on a very low quality, higher carbohydrate diet, like a quarter of the calories were from processed sugar. It was not a good quality diet, and overall it was like 50 to 55% carbohydrate but it was calorically controlled.

Dr. Alan Christianson:
It was funny because it was not set to be a weight loss study. But whenever participants are in calorie controlled environments, even at a high calorie load, it often ends up being less food than they eat on a regular basis. We eat so much more than we realize. But the finding of that was, the overall changes were very similar from each group, but the actual body fat loss was higher in the group on the high processed carbohydrate diet. They've also done studies in which you can do studies that look at if the body is burning fat, is that fat from your body or fat from your diet? You can differentiate that.

Dr. Alan Christianson:
Some studies just looked at the rate of fat burning and failed to differentiate, and they'd say, "Oh yeah, no low carb diet they're burning much more fat," and that seemed very encouraging. But then when the studies differentiated burning dietary fat versus burning stored body fat, it was completely true that isocaloric, low carbohydrate diets would be burning more fat. They were just burning the fat they were eating. But when you look at the differentiation, there was more dietary fat burned on low carbohydrate diets, but there was more total fat and more body fat burned on the isocaloric, lower fat diets. So you're burning less fat total, but more body fat. A lot of the fat that's being burned when you're eating a lot of fat is just the fat that you're eating. It's like you pour kerosene your gas tank, well, your car is going to burn some kerosene, that's all

Melanie Avalon:
Technicalities. I think there's a big disservice in the terminology. It's unfortunate that the word fat, that we use the same word for dietary fat and body fat. I think if we had two different words there, it could probably change, I mean, it could change how people be fat completely.

Dr. Alan Christianson:
Triglycerides should be a different term too, yeah for sure.

Melanie Avalon:
Boy, semantics.

Dr. Alan Christianson:
I've got a Walter Mitty fantasy of shutting down society for about a year and fixing a lot of random things and one of those is language, the fact that we have so many words that create confusion by having just redundant meanings like that.

Melanie Avalon:
So true, or like the word calorie. So much there.

Dr. Alan Christianson:
It's so loaded with baggage.

Melanie Avalon:
Or even carbs. All of these things, all of these things. This is a question I know that a lot of people are going to want to know, the role of caffeine and alcohol in the liver. So caffeine, what are your thoughts on caffeine?

Dr. Alan Christianson:
You know, a healthy liver, no big issues typical amounts people consume. Most of the average sources we take in are probably high sources of polyphenols, the teas and the coffees. There's a lot of range in how we break down caffeine from person to person, how we respond to that, how it affects our cardiac rate. But for almost all people, the amounts they would probably be consuming has neutral or some net positive effect on a day to day basis.

Melanie Avalon:
Okay, so there is a place for one's coffee in their liver health.

Dr. Alan Christianson:
I don't happen to be in that continuum of good metabolizers, but most people are.

Melanie Avalon:
Oh, I know. I feel like I already knew this, but I've done my genetic testing and basically it told me that I'm a very slow metabolizer of caffeine. I'm not even kidding, I will have like a spoonful of coffee in the morning, a spoonful and then I'm good. It almost I think has a minute hormetic type effect. Just having that really small stimulate gets things going.

Dr. Alan Christianson:
I could probably tolerate a spoonful. Much more would throw me off. I'm about in your boat with that.

Melanie Avalon:
Alcohol. I know that's a loaded question. Do you think there's no room for alcohol in liver health or is moderate alcohol intake possible? Does it depend on the state of your liver? We see very long lived societies with moderate alcohol intake, so I think clearly it can be in the lifestyle, but what are your thoughts on alcohol and the liver?

Dr. Alan Christianson:
Something I'd say pretty similar with normal liver function. There are those that have the acetaldehyde enzyme deficiencies that get more of a flush and have more esophageal cancer risk. This is more common in Asian populations. But apart from things like that, and I guess also American Indian populations, Native American populations we see other risks that are more predominant. But most of Europeans, most other ethnicities, a certain amount doesn't have a big effect upon liver function. Excessive amounts for anyone can be harmful.

Dr. Alan Christianson:
A question I guess that's more pertinent to the book that I wrote was about how these things ... If we're for making this artificial situation to try and let the liver fix itself, what role do these things play? And during that 20-day process, I do encourage avoiding caffeine and alcohol, just to maximize all the factors aligning phase one, phase two pathways, and also supporting glycogen repletion in the liver. And one thing about alcohol we don't hear much is that it does actively break down stored glycogen in ways to where the liver runs out of that fuel. That's a big part of the later stage fatty liver disease, is just that depletion of liver glycogen.

Melanie Avalon:
I do have a question about that. Would that not be a benefit to have the alcohol deplete the glycogen so then you have more room to when you have your meal, store your glycogen?

Dr. Alan Christianson:
You know, it's a logical question but the difference there is that glycogen is not so much the culprit, it's more so triglycerides. Glycogen, we can't store a lot and we don't have ... We have very limited space for it, so we never really get too much glycogen because it's got a set place it's going to go in. It's there or it's not there, but it can't overflow basically. It can't leak out of where it belongs. But triglycerides, there's almost no limit. Glycogen can only build up in small compartments, vesicles made for it within the cells. Triglycerides, you can form new vesicles and you can also put it between the cells. And then, triglycerides depend upon glycogen to get broken down. The pitfall is really an overgrowth of triglycerides within and between the liver cells, especially between the cells, and then a lack of an adequate proportion of glycogen to beta oxidize those triglycerides. So yeah, lack of glycogen is really one of the earlier steps of alcoholic liver disease or a nonalcoholic fatty liver disease.

Melanie Avalon:
Okay, got you. Then there's a whole nother aspect of your book. You do address a lot of the lifestyle factors as well. It's not just the diet, there's also the stress factor, there's sleep, there are so many things. What are your Cliff Mote thoughts on the other environmental and lifestyle factors that also need to be taken into consideration beyond the diet?

Dr. Alan Christianson:
They're big things both in terms of the logistics. One thing is that when you embark upon a diet, your energy, your cravings, your mental focus, those things are, they're no joke and they're for real. If they're bad enough, they will derail your best efforts. You can't hold your breath as long as you want in the same way you can't control your food intake when those things are working against you. So in one sense, those are factors that help you do better during a time of dietary change.

Dr. Alan Christianson:
Then there's also ways in which they work just independent of all that, especially sleep and liver function, so back to glycogen. The timing of that is also critical. It seems that we need long breaks without surges of cortisol to replenish those liver glycogen stores and that means quiet, restful, steady sleep, and consistently timed sleep. One action step I encourage is that if nothing else, just wake up at the same time each day. That's step one towards getting a better circadian rhythm and better restorative sleep.

Melanie Avalon:
I love that. I think that takes a little bit of the stress off. I mean, I know there's the idea with circadian rhythms that we are best suited to being early risers and early to bed, but I don't know. Are you an early bird? Because I'm a night owl.

Dr. Alan Christianson:
I'm a pretty ridiculously early bird.

Melanie Avalon:
I am so jealous, I'm so jealous. Every single time I ... I mean, I will make so many concentrated efforts to become a morning person and it never pans out. I always naturally gravitate back to the-

Dr. Alan Christianson:
You know, my sleep expert friends tell me that that's probably not as important of a distinction as to which type that you are and which timing. It's probably more so the regularity and the consistency, and the total amount of sleep.

Melanie Avalon:
I've heard the concept that those that like staying up later, that they have a naturally longer circadian rhythm. I don't know if you've heard this, and that actually-

Dr. Alan Christianson:
Yeah, I've heard it both ways and I don't know. Mine has changed at various points of life but if I always wake up at the same times in the morning, I get tired at night. A certain amount of hours later and I fall asleep naturally, and then I wake up and I ... Yeah, I think that it consistently tends to change. I guess one thing that I do think, make up some math, let's say that you sleep for eight hours, so you got 16 hours to deal with. We've all got a certain number of hours that we have to spend on biological needs, eating and self care, whatnot, exercise. We've got a certain amount of productive hours to work with and that's about it.

Dr. Alan Christianson:
And what I observe in myself and also from talking to people during patient care is that those spare hours, if you get up really early, the things you do with those spare hours are different than the things that most people tend to do with their spare hours if they're late at night. Me at least if I stay up late, I don't really do productive things with those hours.

Melanie Avalon:
See, I do.

Dr. Alan Christianson:
Okay, that's different.

Melanie Avalon:
I get my creative spur at night, then I'm super productive. Then I can feel like I could just go on forever, which is the problem because then it's self perpetuating. Then similar to what you were saying, you were saying that you naturally get tired in the evening regardless. Even if I wake up, because sometimes I'll be like, "I'm going to be a morning person," so I get really, really early and I'm like, "See, now I'll be tired at night." Come night time, I don't know.

Dr. Alan Christianson:
How long do you play out the experiment for?

Melanie Avalon:
I've been in situations where for some reason I was getting up early for certain projects. I mean, maybe recently like a week, but it just never ... I don't know.

Dr. Alan Christianson:
I've not seen data saying it's important to be one of those patterns or another.

Melanie Avalon:
That's what I like. I like the takeaway of I think, finding a lifestyle that is supporting your health and nutrition, and not having overstressed state of being is so key. And I purposely didn't ask any questions about the thyroid because that is your, I mean, that's your expertise. You're so amazing about that and I knew that if we talked about it, I would just-

Dr. Alan Christianson:
I wouldn't mind doing a few if you had some.

Melanie Avalon:
Yeah, we could. I was also wondering maybe in the future if we could come back and have a thyroid specific episode.

Dr. Alan Christianson:
That's the next book and I've been just super obsessed about that. It's the whole iodine story at a deeper level than I've ever even come across. I'm really excited to share more of that whenever we can.

Melanie Avalon:
Oh my goodness, you just made me so excited. I cannot wait.

Dr. Alan Christianson:
Here's one number that hasn't existed before, but the rate of change of thyroid disease after iodine fortification in the US. It was actually may 1st if I remember correctly. Yeah, it was May 1, ... It might've been March 1st, shoot. I was an M month, but it was May or March. It was 1924, and it was Michigan at first started fortifying with iodine. It wasn't a state project, it was an elected project by the Public Health Department. They had a really high rate of goiter, and iodine is a function of ultimately sea access, ocean access. So if you're a long ways away from it ...

Dr. Alan Christianson:
We talk now about the virtues of food being grown locally. Well 100 years ago, if your soil was bad, that sucked because that's all you had, was locally grown food and you had no variety and no diversity in your micronutrient status. So if you were somewhere like Michigan where you got a lot of freshwater around you with the Great Lakes and no coastal access, you got a substantial risk of goiter developing. And to help with the goiters, they started fortifying with iodine. There was a doctor in Olmsted County, Minnesota who did a diligent job tracking his patients. They started fortifying about 10 years later. He tracked patients from 1934 to 1967 and looked at the rate of autoimmune thyroid disease amongst his female patients, and women right around the age of 39, their rate of autoimmune thyroid disease do you want to guess what the change was over those decades after iodine fortification?

Melanie Avalon:
I'm on the edge of my seat right now, because I actually honestly don't know if you're going to say that it helped or hurt. I actually am not quite sure.

Dr. Alan Christianson:
Well, first guess which way then guess how much.

Melanie Avalon:
I want to say that it helped, but then what if it's this twist ending where it hurt?

Dr. Alan Christianson:
Because I'm asking, you got to think it's got to be counterintuitive, right?

Melanie Avalon:
Did it hurt?

Dr. Alan Christianson:
Well, it changed, it worsened it.

Melanie Avalon:
Okay, yeah I knew it.

Dr. Alan Christianson:
It's no coincidence that Hashimoto's was not named O'Malley's disease and we see the most ... It was most prevalent in Japan, it always has been. They've got the highest iodine intake. In the United States in that area ... That was the best tracking that we had, and the rate change was 26-fold. There was a 26-fold increase over that time frame. A quick modern corollary, one last thing I'll mention, Denmark did the same thing but they did it recently. They did it in the year 2000 and cool thing about it is that it made a really good natural experiment. Denmark's a socialized country.

Dr. Alan Christianson:
We actually had a Danish foreign exchange student live with us for a year, so we got to really get the culture. They're cool people, but they've got central tracking of all medical diagnosis and all medical treatments because it's a socialized medical system. So, they can easily punch numbers on how many times someone got diagnosed as having Hashimoto's, how many people were prescribed thyroid medications. They knew that this has been a pitfall in a lot of places that fortified, so they were really on the lookout. They took some large cohorts before fortification to compare to others afterwards, and also they tracked all these numbers before and after. They looked at it in many ways.

Dr. Alan Christianson:
The upshot of it was from '97 when they started tracking and planning on fortification to 2016 when the most recent data was reported, each year after fortification, the rates of Grave's disease, hypothyroidism in general, Hashimoto's specifically, thyroid cancer, thyroid surgery, thyroid ablation and prescription thyroid medications, they've all gone up every year and the increase has been by 50% or more.

Melanie Avalon:
Okay, that is fascinating and not what I think a lot of people would expect. I mean, I personally have cut out, intentionally cut out iodized table salt for the past decade probably.

Dr. Alan Christianson:
A bizarre thing is that sea salt maybe as much or even more. Sea salt is really inconsistent for its iodine content I've learned.

Melanie Avalon:
There's only been I think, one time that I can remember where I took some ... We were talking about supplements in the beginning, where I took a supplemental nutrient and so strongly reacted to it that it scared me. That was when I experimented with taking supplemental iodine, per the suggestion of my doctor actually. My eyes turned bloodshot red, which I'd never seen before. It scared me and it's made me really fascinated. I haven't done a lot of research, but I would love ... I can't wait till your new book comes out. I want to go down this whole iodine route and talk more about thyroid and everything. Do you know sort of when the book will be coming out?

Dr. Alan Christianson:
I know exactly when. It's going to be January of 2021. It's funny in terms of my timing. I'm so jazzed about this book. I told the publishers, "Look, I'll finish this sooner." In the publishing world, a lot of the biggest projects they're doing because they're excited about this one to, a lot of their biggest projects they're not wanting to put out in 2020. I wouldn't have ever thought of this, but they expect the presidential election to suck the wind out of everything else that goes on that year?

Melanie Avalon:
Oh my goodness, that is so interesting.

Dr. Alan Christianson:
So, I'm going to be leisurely writing this book over this next year and going super deep in it but yeah, I'm really jazzed.

Melanie Avalon:
I cannot wait. All right, well this has been absolutely amazing. Is there anything that you would like to tell listeners that we didn't discuss that didn't come up that you feel is really important?

Dr. Alan Christianson:
No. The questions were great, we covered all the main basis. I guess just the one concept I'd love to leave with them is just the fact that this is, your liver is critical to this. The struggle that many have in terms of getting their energy, getting their weight right, having those things both line up, it's not a matter of having to push harder or try harder or deprive yourself further, something's not working right, and it's something you can fix. You can fix it in a short period of time and it can stay stable. I just want to give people the inspiration and know that those things can improve for them.

Melanie Avalon:
I'm really glad you brought that up because that actually was one of my questions. I think people anticipate that if they're going on some "detox protocol," that they're going to have to feel miserable or that there should be, that if they have a lot of bad symptoms, that's a sign that they're doing something right.

Dr. Alan Christianson:
Not necessarily.

Melanie Avalon:
It's really motivating. It sounds like we can support our liver health, we can "detox," we can do all these things and we can feel good while doing it if we have the right protocol in place that's working with our body. Well, thank you so much. For listeners, the show notes for this episode will be at melanieavalon.com/metabolism-reset. If you go there, I'll put links to any of the studies we mentioned, all of the social media and links for Dr. Christianson. Is there any links or social things that you'd like to throw out for listeners?

Dr. Alan Christianson:
You know, something helpful. We can get one that's specifically for you for this, but we do a free challenge every month. If someone's curious about these ideas, they can come on in and learn everything they need to know for free and get guided through a week's worth of the challenge and if they find it helpful, they can choose to do more and go further with it. But yeah, I'll give you a custom link for that and you can share that.

Melanie Avalon:
Perfect, I will definitely do that. We'll have a link in the show notes. My last question that I ask every single guest on this podcast, and it's not exactly related but it sort of is, and it's just because I realized how important mindset is for health and how our thoughts really affect our biology. So I was wondering, what is something that you're grateful for?

Dr. Alan Christianson:
Something I'm grateful for? Wow. You know, this is tangential but, no it's not, but the thoughts in biology. I guess I'm really grateful for having had the chance to learn about thoughts and getting some perspective on them. We often take them at face value, and there's a lot of different training methods out there. I've gained a lot from ACT therapy, which is a subset of cognitive behavioral therapy. You can learn how you don't have to really attach to your thoughts or fuse with them, but they can ... Sometimes they're helpful, sometimes they're not and when they're not helpful, it's cool to be able to let them do their thing and you keep doing your thing. So yeah, I'm grateful to have the capacity to not feel identified with my thoughts at all times.

Melanie Avalon:
That is wonderful. I couldn't agree more. It's really amazing once you start realizing that you are not your thoughts, and you are not the voice in your head.

Dr. Alan Christianson:
Oh, thank goodness.

Melanie Avalon:
But thank you, thank you so much for being here. This was an absolute pleasure and hopefully I can get you back on with the launch of your book in 2021.

Dr. Alan Christianson:
I'd love to do that. Thank you so much Melanie.

Melanie Avalon:
All right, thank you so much!

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