Episode 431 - Q&A with Robb and Nicki #24

It's time for Episode 431, Q&A #24. You've got the questions, we've got the answers! Submit your own questions for the podcast at: https://robbwolf.com/contact/submit-a-question-for-the-podcast/ If you want to see the video for this podcast, be sure to check out our YouTube channel.   Show Notes:   1. Ancestral Case For Salt Supplementation? [0:53] Dan says: You've recently been talking a lot about salt and electrolyte supplementation and I like to look at things in an ancestral context.  Did pre-agricultural peoples supplement with salt somehow? I do know that the Hopi Indians in northern Arizona had a ceremonial "Salt Trail" into the Grand Canyon and I assume that they were able to retrieve salt from geologic deposits, but the amount of salt that feels optimal for me seems like it would be hard to attain in prehistoric times in many parts of the world.  Are there other examples of this besides the Hopi?   2. Resistant Starch On Keto? [11:48] Bethany says: Hi there! I'm about 2 and a half weeks in to a ketogenic diet (following the Keto Masterclass) and feeling pretty good. I've been trying to figure out how to add in some resistant starch for overall gut health without pushing carb levels too high. I think I would try tapioca starch first - I live in Asia and that's what's most readily available. According to nutrition facts online, a 1 oz. serving of tapioca starch has 6 grams of carbs. Would this number contribute at all to my overall carb count for the day, or does this factor out because of the fact that most of it is resistant to digestion? Hope my question makes sense. Thanks for your time!   3. Optimal Fructosamine Range? [16:39] Steven says: Hi Robb, I've heard you recommend checking fructosamine to help triangulate glycation and see what's happening with blood sugar, but I can't seem to find any references for an optimal fructosamine range. I recently did some blood work and had a fasting glucose of 80 (mg/dL), A1c of 5.6, and fructosamine of 250 (umol/L). I have been experimenting with a glucometer recently and my average blood glucose based on dozens of readings during carb testing is in the upper 90's, so I am thinking my A1c looks artificially high due to red blood cells living longer. Curious what you think of this, and what I can take away from the fructosamine value of 250. For context: I am a 29-year-old male, 160 lbs, between 10-12% bodyfat and have been eating a mostly low-carb paleo diet for the past year, recently gravitating closer to carnivore. I appreciate you and Nicki and all the work that you do! Best, Steven   4. Finding Time For Writing a Book? [22:34] Thuy says: Hi Robb: I'm a big fan. Thanks for your life's work that filters out the vast ocean of information out there for a smarter living. I'm so glad you are doing what you do reminding me to sit back to look at the big picture of everything in life. In your last few podcasts, you mentioned that you are again working on publishing more books. Congrats and I can't wait! I've been trying to write my first book. It has been such a slow process. It has been 4 months and I'm able to get in about 6000 words or so. Holy cow it is such like a text book but I've got to start from somewhere! The book has a mix of East meets West medicines for those undergoing cancer treatments. Needless to say, the topic is not easy and there is so much development out there every week that it is hard to keep up. I'm a full-time oncology pharmacist. My husband also has a full-time job and soon will go back to school while working for the next 2 years. We have four kids ages 5, 7, 9 and 10 so their activities are endless Mondays through Sundays on top of their normal school work, church, and of course we have to add Vietnamese school in there because all others are not enough! I started out with trying to get a few words in during my lunch hour, but it seems that it takes me a good 15-20 min to get into a good writing mode but then I have to go back to work before I get much further into the book. If my kids have a long 1-2 hour activity, I can get more done then while waiting for them but I then I feel guilty for not paying attention to them. I also exercise daily, either before work or during lunch, whichever works out for the day. The past 2 months, I've been exercising during lunch rather than working on my book because I feel my brain needs a break from thinking all day long. Then I find myself slacking off for whatever excuse because, honestly, I'm just exhausted mentally and physically. So that's my background story. My question simply put, how do you do it? I feel the need to write this book because I know it will help so many people going through cancer treatments particularly clarifying the effectiveness/safety on herbal products and the big hot marijuana, so it's almost like a calling; leaving a mark on this earth before I die. There is a war inside me between fulfilling this calling vs taking care of my health (recently discovered I have Hashimoto's - oh boy that's for another day) vs being a good mother, wife, sister (brother has Hypokalemic Periodic Paralysis; also another story for another day), daughter. At first I set out a goal to finish this book in 2 years but maybe not until 5 years. Worst yet, it will never be finished. I'm starting to doubt myself that I can climb this Mount Everest of mine. Any suggestions will be great. Thanks for reading this. -Thuy ("twee") PS: Hi Nicki! My husband used to work at Coffee Bean & Tea Leaf decades ago and I don't think they roast their coffee beans either! :D Cute story. Notes: https://www.nytimes.com/2018/08/20/well/family/let-kids-play.html https://robbwolf.com/2018/09/25/episode-411-tim-grahl-publishing-a-book/   5. Advice For A New Clinician? [38:38] Matthew says: Hello Robb and Nicki, I've recently become a newly minted nurse practitioner and am starting a job in an endocrinology clinic in a few weeks where I will be managing mostly type II diabetes and thyroid disorders. First, thank you for your work. 8 years ago you inspired my interest in fats, carbs, exercise, and all things hormonal and it is very unlikely I would have landed here without your influence. My mom read the "Paleo Solution" after I mentioned your name and effectively reversed her type II diabetes through diet, exercise, and a sprinkle of metformin (which she has since discontinued). The clinic I'll be working in serves a population with low health and nutrition literacy that typically follow the standard american diet. As an example, one of my colleagues expressed that she would consider it a win if she could teach some of her patients that mountain dew is not actually considered juice (this is an extreme example, but you get the picture).  I've been working as a bedside nurse for 6 years so I am well aware of the shortcomings of conventional medicine and the reluctance of patients to change long held behaviors. One of the reasons I've been drawn to diabetes care is that diabetes 2 is so amenable to diet and lifestyle change that ideally the pharmacological approach need only play a supplemental and transient role. My question is this: What would you consider effective strategy for fostering health literacy and behavior change in a population such as this? Also: What would you consider the lowest hanging fruit in terms of behavioral change to positively affect outcomes in diabetes? Thank you for your time, your work, and your example   Where you can find us:     Submit questions for the podcast: https://robbwolf.com/contact/submit-a-question-for-the-podcast/   Transcript: Download a copy of the transcript here (PDF)