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1. Joint Pain [14:15]

Justin says:

Hi Robb, Nicki,

I must start with the obligatory -- first time caller, long time fanatic!

I have a varied medical history, but the main highlights being: 6ft, 360lbs (2016) down to 185lbs (2018). Keto and fasting made this possible -- meandered back to 215 with the help of higher calories and some light weight training. I also don't have a thyroid (papillary carcinoma). My maintenance calories are really low for some reason (1700 cal) but I eat my protein first (160-180g) and tend to feel better if I fill the remaining calories with fat rather than carbs.

I know I'm healthier without the weight (cholesterol, trigs, a1c all on the lower end of normal now), but I don't feel better. Mild lethargy and joint pain are what plague me. The lethargy is a struggle but isn't debilitating... the joint pain is just frustrating. Knees, ankles, hips, shoulders, and elbows nag enough to make even bodyweight workouts a challenge. The pain in my wrists and hands can be excruciating (I'm a couple years post-carpal tunnel release as well). No redness or swelling. I've been cleared for gout as well as RA (RNP 1.6, SSB/LA IGG 1.4, were positive, but nothing warranting more than a pat on the back from a rheumatologist).

I'm turning to you Robb because I've heard you mention hand pain in the podcast, but I'm not familiar with your backstory there. The hardest part about all of this is I unintentionally removed red meat from my diet (temporary bro diet -- lots of chicken) and my hand/wrist pain *almost* vanished. Spoiled myself with a homemade double cheeseburger the other night and woke up with throbbing hands/wrists. As a devout keto-er and meat-asaurus, I was all in on Sacred Cow and even considered carnivore as my starting point for an elimination diet to test various sensitivities. My brain just doesn't know how to process this recent information. Can you help me make sense of all this?

Thank you both for all you do!

Justin

2. Achilles Tendon Rehab options & diet [24:46]

Cory says:

Hi Rob and Nicki,

Love the show and the well balanced opinions the two of you provide. I recently tore my Achilles’ tendon shooting some hoops. The ultrasound revealed a grade two tear. I am fairly active playing hockey two to three times a week and weightlifting a couple times a week as well. I’m a 45 year old high school Physical Education teacher, so on my feet most of the day, as well as demonstrating sport specific skills in class

My questions for you are:

1. Which rehab option do you think is best for my case (surgical or non-surgical)?
2. What sort of dietary interventions could I be making to optimize my recovery?
3. What can people do to prevent Achilles tendon injuries from occurring/reoccurring?

I live in Ontario, Canada so although the healthcare is “free” it does move at a slower pace for access to orthopaedic surgeons and sports medicine doctors.

Hope you can shed some light on this for me,

Kind regards,

Cory

3. PCOS in 14 year-old girl [33:40]

Krista says

Hi Guys-

LOVE all that you do! 15 years ago my functional medicine doctor put The Paleo Solution book in my hands to help with my gut issues and I've never turned back!

My 14 year-old niece just got diagnosed with PCOS. To back up, she was a very sick newborn, minutes away from an ECMO machine and miraculously made a full recovery. I believe having all those drugs in the beginning of her life, while saving her life, has really jacked up her microbiome and created an insatiable appetite!!!!! starting around 2 years-old. She sneaks food, eats until stuffed (she's thrown up in the past from too much food) and hence she has steadily put on weight and now she is at 195lbs. She's the most incredible kid and my heart is breaking for her!!

Her parents have kept her active through sports and helped her keep a pretty clean diet, but nothing super steady and as she gets older they lose more of how and what she eats. Her most recent doctor's appointment reviled the PCOS and there was talk of birth control pills and metformin. The next stop is an endocrinologist and a natural path.

Rob & Nikki, what would you do if this were your kid???

THANK YOU SO MUCH:):)

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