In any event, people who are eating–well, let me back up. We’ll
talk first about the main sources of copper because if you have excess
copper, you’re gonna want to reduce your intake of copper from food, and
you’re gonna want to reduce your exposure to copper in the
environment. So, copper is mostly found in vegetarian or plant proteins
like nuts and beans and seeds and grains, and meats do contain copper,
but they’re balanced by zinc, which competes for the absorption of
copper, so a Paleo, Weston A. Price type of diet that’s high in animal
protein, it’s unlikely you would develop a copper-zinc ratio just from
eating that way because the zinc competes with absorption for copper in
those foods. Chocolate is high in copper, and actually, in some cases,
when people are really craving chocolate, you often hear that they’re
craving magnesium, and that may be the case, but they may also be
craving copper. Drinking water that is in copper pipes can have copper
in it, so if you test high in copper and you’re living in a house with
copper pipes, that may be something you want to look into. There’s
copper cookware, which I don’t recommend using. Some dental materials
have copper in them. Certain vitamins have copper. If you like
multi’s, you want to check and make sure your multi doesn’t have it if
you have excess copper. Fungicides and pesticides have copper residue,
and then IUDs and birth control pills have copper, as well. So, those
are the primary sources of copper in the environment and food, and then
there are some things that deplete zinc levels, like stress, for
example. Any disturbance of homeostasis or oxidative stress will
deplete zinc levels over time. So, it’s important to manage your stress
if you’re dealing with copper imbalance. One of the first things I
would do with patients like this is order a SpectraCell micronutrient
analysis, which tests micronutrient levels within the white blood cell,
and that can help determine if there are deficiencies of other
micronutrients that help reduce copper buildup. So, these are things
like vitamin B1, B3, B6, folate, inositol, and choline, and those are
all antagonistic to copper, and then there are some minerals that are
antagonistic to copper, like zinc, of course, which we’ve been talking
about, manganese, iron, sulfur, and molybdenum. You want to be careful
with the iron, though, of course, because if you are iron-loaded, you
have too much iron, and you take iron to reduce copper, that may help
solve one problem and cause another, or exacerbate another. And then
there are some studies I’ve seen that suggest that copper might be
excreted by binding with glutathione, so yet another reason to maintain
healthy glutathione levels; and glutathione levels are often depleted in
cases of chronic illness and stress, so that’s another thing to pay
attention to. Then you want to improve the detox function of the liver
and the skin. You can do things like sweats and saunas. And then, of
course, you want to do a diet that is based on animal proteins and lower
in the plant proteins that tend to be rich in copper, like the nuts and
beans and seeds and grains, like I mentioned earlier. So, those are
the basic steps.

Steve Wright: To summarize
those, it’s basically look for any environmental triggers that are
adding a lot of copper to your diet, cut out the high-copper foods, and
then look to possibly supplement with any other micronutrient imbalances
you might have?

Chris Kresser: Exactly. And on
top of that, improving glutathione levels, improving the detox function
of the liver, and improving adrenal function, and managing any form of
stress, whether it’s dealing with inflammation or oxidative damage or
psychological stress and adrenal stress.

Steve Wright: OK, so let’s say that I find out that I have high copper and low zinc. Do I start supplementing with zinc right away?

Chris Kresser:
It’s probably best to get some help from someone who has some
experience dealing with this, because it can get a little bit complex,
depending on the status of other micronutrients, and you know, I
mentioned Wilson’s disease before. That wouldn’t present with high
serum copper. It usually presents with low serum copper, so they’re not
often confused that way, but depending on how you tested for elevated
copper, it may be something that you want to rule out, Wilson’s. But,
in general, just following the steps that I outlined for a lot of people
should be sufficient. Zinc is definitely one of the things you would
supplement with, especially if the zinc is deficient. So, it’s
important not just to test copper. You would test copper and zinc at
the same time, and if zinc is low, then you definitely would want to
bring it back up.

Steve Wright: OK, so to wrap
it up, it’s something you should definitely get tested if you’re
exhibiting any of the problems that Chris was mentioning, and I think
we’re gonna move on to the next question, unless you have anything,
Chris?

Chris Kresser: No, I think that’s it.

Steve Wright: OK, copper and zinc. Got it done.

Is 5-HTP safer than SSRIs for anxiety and depression?

Steve Wright:
All right, this one’s from Breaking All Illusions. “What do you think
about the use of 5-HTP as a natural supplement for anxiety and
depression? Do you consider it safer or more effective than SSRIs? And
do you consider it safe/effective at all? If so, how would you
recommend using it?”

Chris Kresser: OK, so 5-HTP
is an intermediate in the conversion of tryptophan to serotonin, so
tryptophan gets converted to 5-HTP, and then 5-HTP gets converted to
serotonin. As I’m sure many people know, some people who are depressed
have issues with serotonin synthesis or metabolism, and that can cause
depression, and in those cases, 5-HTP might be helpful. There is some
research that’s fairly promising, but I think the jury is still out on
it. But as I pointed out, I wrote an entire series on depression,
ChrisKresser.com/depression. Hopefully that will be updated soon
because there’s a lot that I’ve learned since I wrote that. It’s all
still completely valid, but I want to add some information about the
inflammatory cytokine model of depression, which I’m gonna talk about in
a minute. But in that series, I pointed out that not all depression is
as simple as being a serotonin deficiency, and that is really just a
convenient fiction that’s been manufactured by drug companies to sell
more antidepressants. Doctors in 2009 wrote 235 million prescriptions
for antidepressants, which is just a mind-boggling number. It’s a 14
billion dollar market for antidepressant drugs, so it’s a huge business,
and the drug companies know that if they create a really simple model
for depression, which is basically depression equals serotonin
deficiency; therefore, if you take a drug that raises serotonin, that
will cure and treat depression. But the reality is a lot more complex
than that, as anybody who works with depression knows or who has
experienced it knows, and the drug trials on antidepressants, when you
really look at them and you look at careful meta-analyses that have been
performed by Kirsch and colleagues and others, you see that for mild to
moderate depression and even fairly severe depression, antidepressants
are often no more effective than placebo. And a lot of the natural
treatments, which we’re gonna talk about here in a second, are just as
effective as antidepressants, with far fewer side effects. So, 5-HTP
may be one of those, but it doesn’t have the research behind it that
some of these other natural therapies do. So, if you’re gonna try
5-HTP, I would recommend starting with a pretty low dose, which would be
maybe 20 mg in the morning, and it’s important to take it on an empty
stomach. And then you can continue to increase your dose every few days
up to 100 mg, and I wouldn’t go above 100 mg. Some people out there,
some of the studies recommend 200 or 300 mg, but I don’t recommend that
for a number of reasons. So, somewhere between 20 and 100 mg. If you
take it before bed, it can sometimes help with sleep, so that’s another
possibility, but I’ve found with patients that it’s more effective for
depression if you take it in the morning. But that’s not the first
thing I would try with depression, and in fact, these days I’m looking
at it much more as an inflammatory condition, which again I’ll come back
to in a moment. I wanna talk a little bit about some of the natural
treatments that have been proven to be effective. Psychotherapy is, of
course, one of them, and it’s often left out when we talk about natural
treatments for depression because I think a lot of times we’re thinking
of, you know, nutrients or herbs or pills or things that we can take,
but psychotherapy, particularly cognitive behavioral therapy, which is a
specific type of psychotherapy, has compared favorably with
antidepressant drugs in a lot of trials, especially in the short term,
even when the depression is severe, and over the long term, it actually
appears to be superior to medications. And then some studies have
looked at medication plus psychotherapy versus just medication alone,
and of course, that’s almost always more effective, so that’s something
to certainly consider, and I would definitely recommend it as part of a
protocol for depression in any case.

Steve Wright: When you say medication, are you talking about SSRIs and SNRIs?

Chris Kresser:
I’m talking, yeah, about both, but primarily SSRIs. They’re the bigger
drug class by far still even though there has been more of a trend to
SNRIs lately, but a lot of the research that has been done in the
comparisons has been more with SSRIs. Exercise is at least as effective
as antidepressants in treating depression, according to the research
literature, and the good news about exercise is the only side effects of
exercise are usually other health benefits and reducing your risk for a
number of other diseases. Light therapy, and there was a study in 2005
in The American Journal of Psychiatry that found that it was
just as effective as antidepressants. One of the arguments about that
study was that it could have been placebo, and that’s true, but if
that’s the case, you know, who cares? If there’s no negative impact
other than spending the 75 bucks or whatever on the machine, actually
maybe we can put that in the show notes. There’s a machine that I recommend on Amazon;
I think it’s about 75 bucks. You know, the only thing you might lose
is a little bit of time in the morning and a little bit of money to buy
the machine, but there really aren’t any significant side effects
associated with it. St. John’s wort, which I’m sure a number of people
have heard of, it’s probably the most popular treatment for depression
in Europe. It’s just as effective as antidepressants in clinical
studies, but it has 10 times fewer side effects. One important thing to
keep in kind with St. John’s wort is that it takes several weeks often
for the effect to come on fully, so it’s not something that you just
start taking and you feel the benefit right away. It takes about three
to four weeks to really get the effect. Another thing I’ll mention is
not to mix these treatments together with drugs. I mean, exercise and
psychotherapy, of course, is fine, and even light therapy, but I would
not recommend combining St. John’s wort with antidepressants without
supervision. That can be dangerous. And the same with 5-HTP and any
other nutrient-based or herbal-based remedy. Acupuncture has been shown
to be pretty effective for depression. In fact, there was a Cochrane
review, Cochrane being one of the prestigious group that does
meta-analyses of available research on a particular subject. They
found, “There is no evidence that medication was better than acupuncture
in reducing the severity of depression.” And again, just like
exercise, acupuncture has very few side effects except feeling better in
other ways. So, those are a number of options for someone who is
dealing with depression and doesn’t want to take the drugs or eventually
wants to get off the drugs. Again, it’s really, really important if
you are taking a medication for depression not to stop taking it
abruptly and to do it under the supervision of someone who is
experienced in getting people off SSRIs and other forms of
antidepressants, because stopping them cold turkey can really wreak
havoc with your brain chemistry, and the problems with suicide that are
associated with antidepressants most often occur when people are just
starting the medication or just coming off of it. So, it’s not
something to play around with, and it’s really important to find someone
who has experience getting people off of those drugs, if you choose to
come off of it.

Why antidepressants could permanently alter your brain chemistry… in a bad way

Steve Wright: Is there also a long-term consequence of staying on the drugs for a number of years?

Chris Kresser:
I think there is, and I wrote about this in my series. There’s a lot
of pretty disturbing research that shows that SSRIs can cause permanent
changes in brain chemistry, and it’s difficult to talk about this
because, you know, a lot of people are on antidepressants, and some
people are helped by them. Even though the research is pretty
equivocal, you have to consider that research is about averages. You
know, when you do a study and statistically at the end of the study
there was no difference between placebo and the intervention, in this
case an antidepressant, it doesn’t mean that there weren’t some people
that benefited from the antidepressant in the study. It just means that
on average, when you take all the results together, there was no
statistically significant difference between the two treatments. I know
people that have taken antidepressants and that have benefited from
them, and of course, I know people that haven’t, so I’m not saying they
never work. I’m just saying that statistically speaking, from a
research perspective, they are not better than other treatments, in
general, except in the cases of very severe depression. So, I’m not
making any judgements of anyone who chooses to take antidepressants, and
it’s a little bit scary to tell someone that a drug that they’re taking
can cause permanent changes in brain chemistry, but I also feel it’s
important to get the word out about this so that people think really
carefully about going on these drugs before they choose to do so. So,
the research shows essentially that those changes that are made in the
brain can basically predispose you to depression more for the rest of
your life. So, they create changes in the brain that make it more
likely that you’ll need to be on an antidepressant or have some other
kind of treatment for depression indefinitely, and that’s what scares me
the most about these drugs, and unfortunately that is not, you know,
very few patients are told that before they go on a drug. I think very
few doctors even know about that research, but I wrote about it pretty
extensively in the Depression Series.
There are a lot of references there, and there are some great books
that I linked to as well, where you can read all about that research if
you’re interested in it.

The surprising cause of depression (and no, it’s not low serotonin)

Chris Kresser:
So, before we finish up with this question, I want to talk a little bit
about a newer perspective on depression that we discussed in an earlier
show. We talked about it in the gut-brain axis program, and this is
known as the inflammatory cytokine model of depression, and the theory
essentially is that inflammation, which often originates from the gut,
produces inflammatory cytokines, and these cytokines travel through the
blood, they cross the blood-brain barrier, and then they suppress
activity in the frontal cortex, and then that, of course, causes
depression, the frontal cortex being responsible for some of the higher
brain function. So, one of the most important things you can do if
you’re dealing with depression, if you haven’t already done this, is eat
an anti-inflammatory diet and fix your gut. Anti-inflammatory diet
being a Paleo-ish diet, a Personal Paleo Code-ish type of diet,
and then all of the steps that we have discussed lots of different
times towards healing your gut, and I think that those are kind of the
first steps that should be done when somebody is dealing with
depression, and then if you eat that diet and you fix the gut and deal
with any other potential sources of inflammation like a chronic
infection; for example, a viral infection or a bacterial infection that
may not be in the gut but outside of the gut. So, if you deal with all
of those sources of inflammation and you’re still experiencing
depression, that’s when I would turn to some of these other natural
remedies.

Steve Wright: So, when you start
fixing the gut, it’s not necessarily advisable to look towards trying to
replace any neurotransmitter losses in the dopamine or serotonin areas?

Chris Kresser:
That’s kind of the last step, maybe. You know, it’s like fix the gut,
reduce inflammation, any other sources of inflammation, then consider
some of these other natural treatments that we just talked about that
would indirectly regulate brain chemistry: psychotherapy, acupuncture,
St. John’s wort, light therapy, exercise, possibly 5-HTP. And then
there are some products that I might use that improve serotonin or
dopamine or acetylcholine or GABA synthesis and metabolism, but even
then, they’re a milder, safer, and more natural approach than SSRIs or
SNRIs. I consider those drugs to be a last resort.

Are chocolate cravings related to magnesium deficiency?

Steve Wright:
All right. Well, let’s roll on here. You mentioned it earlier in the
show, but chocolate cravings — both Martin and Evan were asking about
magnesium, and so here’s Evan’s question: “What are your thoughts about
chocolate cravings being related to magnesium deficiency? As a raw
vegan, I didn’t touch chocolate for two years probably, and now I can’t
get enough of it. I’m way beyond your recommendation of a piece about
the size of a silver dollar. A full bar or more is reasonable,” and I
think that’s on a daily basis, so he would like to know more about the
topic of magnesium, chocolate, and magnesium oil applied topically.

Chris Kresser:
Yeah, OK, so one of the easiest ways to figure that out is just start
doing some fairly high-dose magnesium glycinate or malate
supplementation. So, you know, take 600 mg a day for three or four
weeks, and if the craving for chocolate disappears, then you could
suspect that it had something to do with magnesium deficiency. But if
you’re still eating that full bar of chocolate every day after a month
of that kind of magnesium supplementation, then I have a feeling that it
has something more to do with something else in the chocolate, maybe
the sugar or the caffeine or, you know, some other substance or
combination of substances. Perhaps copper. I mean, we mentioned that
earlier, although copper deficiency is fairly rare in people who are
eating a — I just don’t see copper deficiency very often, but you can
check for it. Transdermal magnesium oil — it’s another one that I’m a
little bit uncertain about, and when you look in the scientific
literature, there are no studies other than studies that are done by
companies that sell magnesium oil that show that it’s an effective way
of delivering magnesium. However, I have patients who have not
experienced any benefit from taking even the chelated forms of
magnesium, like glycinate and malate, but have experienced a fairly
dramatic change after using transdermal magnesium oil. So, I don’t see
how it could do any harm, and if you try it and it helps improve your
symptoms, then maybe it does work. And, you know, lack of proof is not
necessarily proof against, so it’s possible that we just don’t have the
research on this yet. I remember trying it a while back, and I didn’t
really notice that much of a difference, but I don’t think that I was
significantly magnesium deficient either, so I’m probably not the best
test case.

Steve Wright: Were you eating a bar of chocolate a day?

Chris Kresser:
No, I wasn’t. You know, I’m irritating to some people in my discipline
around those things. It’s not even discipline. I just don’t crave
it. I have sometimes a little piece that size after a meal, and that’s
all I really need to satisfy the craving, so I’m no hero of discipline.
I just, for whatever reason, don’t have that kind of relationship with
it.

Steve Wright: It’s interesting. So, with
the magnesium supplementation, would you recommend that before bed? Is
there a certain time there?

Chris Kresser: Yeah,
two times a day usually, so in the morning and then in the evening. If
people are using it for constipation and they want to promote a healthy
bowel movement in the morning, you could take two times the dose in the
evening and maybe a smaller dose in the morning. Or, you could even
take it all in the evening, maybe with dinner as a good approach. If
you’re using it for muscle pain, muscle fatigue, and just general
health, it doesn’t really matter as much when you take it.

Steve Wright:
OK, and with magnesium glycinate, just to remind everyone that there is
gonna be an upper level for them at which they’ll start to cause loose
stools probably, right?

Chris Kresser: Yeah,
it’s a higher upper level than with oxide or citrate, which is one of
the reasons I recommend it, but one approach is dosing intolerance, just
like you do with vitamin C. So, you can keep increasing the dose until
you hit the loose stools, and then you can go back a little bit, but I
find that for most people, unless they’re severely magnesium deficient, a
dose of somewhere between 400 and 600 mg a day will be sufficient.

Steve Wright: OK.

How to get your Vitamin A and D ratio within healthy ranges

Chris Kresser: So, I think we have time for one more short one. How about the vitamin A-D ratio question?

Steve Wright:
Sure. This comes from Michel, and he or she, I’m sorry, is asking
about the ideal ratio between vitamin A and vitamin D. Should one be
higher than the other, and by how much? They’re worried that vitamin D
is being hyped so much that people are going to tend to consume too D
and not enough A.

Chris Kresser: Yeah, I think
that’s a valid concern, and one of the reasons that I like the Weston A.
Price Foundation approach is they put a lot of emphasis on the
importance of fat-soluble vitamins, and that’s not something that’s
really discussed in the Paleo world very often. Fat-soluble vitamins —
we’re talking about A, D, K2, and E — they play so many crucial roles in
health, and they’re difficult to obtain from food in most cases,
particularly K2 and A, you know, and D, if you’re not eating seafood.
But there has been a lot of hype about vitamin D, and then there’s been a
lot of hype in the other direction about the danger of vitamin A,
particularly for pregnant women or women who are trying to get pregnant;
they’re really freaked out, unfortunately, about vitamin A because it’s
a crucial nutrient for healthy development of the fetus, which I talk
about in The Healthy Baby Code.
The important thing to understand about these fat-soluble vitamins is
they exist in a synergistic relationship, and when you have problems
with toxicity of one of them, it’s almost always contributed to by, or
even only possible in the face of, a deficiency of one of the others.
So, for example, all of the problems with vitamin A toxicity that people
are afraid of are only really possible in the presence of concurrent
vitamin D deficiency, and Chris Masterjohn has done some great work on
this. I think there’s an article on the Weston A. Price website that he wrote
called — I think if you search for vitamin A / osteoporosis in the
search engine on their site, you’ll find it, but he talks about a study,
and I mention this in The Health Baby Code,
too, where when people are supplementing with vitamin D or they have
adequate vitamin D levels, the toxicity threshold for vitamin A goes up
to like 200,000 IU a day, which is an absurd amount of vitamin A. Like
to put that in perspective, 3 ounces of liver have about 27,000 IU of
vitamin A, so you’d have to eat 30 ounces of liver every day to exceed
the toxicity threshold, and I don’t know anybody who is eating 30 ounces
of liver a day, so that’s just not going to happen. And likewise,
vitamin D toxicity will happen at a lower level if vitamin A and vitamin
K2 are deficient, because vitamin A and K2 protect against vitamin D
toxicity. So, as I’ve said on the show before, I think an ideal range
for vitamin D is somewhere between 35 ng/mL and maybe 60 or 65 ng/mL. I
don’t see any reason to go higher than that. I don’t agree with, you
know, some of the people pushing vitamin D levels above 100 ng/mL.
Studies show that you’re at risk for hypercalcemia because vitamin D
regulates calcium metabolism, so you start to get issues with kidney
stones and stiffer arteries, which, of course, increases the risk of
cardiovascular disease. Whereas, vitamin K2, which also has an effect
on calcium metabolism, it makes sure that the calcium ends up in the
bones and teeth and the hard tissues, and not in the soft tissues. So,
the key thing here is balance and making sure that you have enough of
these fat-soluble vitamins. Vitamin A is only really found in
significant amounts in organ meats and cod liver oil. It’s found to a
lesser extent in grass-fed dairy, and that’s why I’m always talking
about cod liver oil, especially for people who are on a strict Paleo
diet and who aren’t eating grass-fed dairy or organ meats, like liver.
So, getting back to the question, which I’ve kind of gone off on a
tangent from, there’s not a lot of research on the ideal ratio between
vitamin A and vitamin D, but there was a recent paper by Dr. Holick that
suggested that ratios between 4 and 8 times as much vitamin A as D
would be ideal, and then the lead author on that paper, Dr. Linda
Linday, had used cod liver oil with a ratio in that range to
successfully protect against upper respiratory infections, and then
there was some other research showing that that range of ratios is ideal
in chickens. I don’t know how applicable that is to humans, but if you
look at the amount of vitamin A and D in foods like cod liver oil, then
it’s a roughly similar ratio, and that’s, I think, a good ratio to
shoot for, and if you eat liver, 2 to 3 ounces of liver once or twice a
week, or you’re taking cod liver oil on a daily basis, and then you’re
getting exposure to sunlight and maybe taking some supplemental D in the
winter, then that’s probably where you’ll end up. Vitamin K2 you can
get from butter oil or ghee and smaller amounts from all grass-fed
dairy. Cheese is actually a particularly high source of vitamin K2,
hard cheeses, and goose liver, which is I don’t think a very commonly
eaten food, which again, if you’re on a Paleo diet and you’re not eating
dairy and you’re not eating goose liver or natto, it’s probably a good
idea to supplement with K2.

Steve Wright: I usually eat natto and goose liver every night.

Chris Kresser: I bet. Natto is one of the nastiest things I’ve ever tasted. Have you tried it?

Steve Wright: No. It’s on my list for 2012 to explore.

Chris Kresser:
Oh, God! Yeah, it’s wrong. But it’s one of those things where people
either like it or absolutely can’t stand it, and that’s kind of what
liver is, I think, too. You know, either people were raised on it and
they have a taste for it, or they weren’t and they can’t stand it.

Steve Wright:
Yeah, I think there’s a lot of things you can do to liver to make it
taste pretty good. I started off being a little squeamish with it, and
now I actually enjoy it.

Chris Kresser:
Incidentally, I just published an article today, I mean, you won’t hear
this podcast for a little while longer, so on Friday, the 6th, about why you should eat more cholesterol,
and the article is about choline and the importance of choline, but at
the end of the article there are several recipes for liver from some
great blogs. So, check that out if you want to get some more liver in
your diet and you’re wondering about some ways to make it more
palatable. There are some good recipes there on that blog post.

Steve Wright:
So, the biggest takeaway of this A-D conversation is that if you’re
just taking a D3 pill, you need to look at adding some liver or some cod
liver oil to your diet?

Chris Kresser: Yep, that’s it, and K2 also, if you’re not doing that.

Steve Wright: All right. Well, I think that brings us to the end here.

Chris Kresser:

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