How can I help you?

    147: How Ketosis Can Help Heal Your Body w/ Ali Miller, RD

    The only medicine we truly need to live a long and healthy life comes from the food we eat. I’m joined by Ali Miller, RD to talk about her approach to nutrition that focuses on ketosis to treat long-term and chronic health conditions.

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    About Ali Miller, RD

    Ali Miller is an integrative functional medicine practitioner with a background in naturopathic medicine. She is a Registered and Licensed Dietitian, Certified Diabetes Educator, and has a contagious passion for food-as-medicine developing clinical protocols and virtual programs using nutrients and food as the foundation of treatment. She’s also the author of Naturally Nourished: Food-as-Medicine for Optimal Health cookbook (2016) and The Anti-Anxiety Diet (2018).

    Her Food-As-Medicine philosophy is supported by up-to-date scientific research for a functional approach to healing the body. Ali’s message has influenced millions through media with television segments, features in O!, Women's Health, and Prevention Magazine, her award-winning podcast, Naturally Nourished, and within the medical community. Find Ali’s expertise throughher website offering her blog, podcasts, virtual learning, and access to her practice, Naturally Nourished.

     

    About This Episode

    Ali is a firm believer that food is medicine and that almost everything our bodies need comes straight from what we eat. Her preferred way to eat is keeping the body in Ketosis to help it heal from inflammation and other long-term and chronic health conditions.

    She explains how long most people should stay in ketosis and how to effectively refeed. Her recommendation is to eat with your cycle if you’re pre- and peri-menopausal, or to eat with the moon cycle if you’ve gone through menopause. 

    The other aspect of keto that’s vital for Ali is to enjoy the food you’re eating. This is why it’s so important that you cook your food from scratch wherever possible and make meals that you enjoy. It’s also why you should slow down to savor your food - no more eating on the go!

    Ali provides a great example of how a 55-year old post-menopausal woman with 50 pounds of excess weight to lose should go into ketosis. The biggest difference to what keto approach is the best comes down to how much weight you have to lose - and Ali explains why this example woman should stay in keto much more strictly than a woman with less or no weight to lose.

    We also talk about the current COVID-19 pandemic. We both agree that touch, body language, and smiles are essential for everyone, but especially for our young children returning to school. We talk about our beliefs surrounding the pandemic; the overarching belief is that you need to trust the science, not the fear, always.

    Finally, I ask Ali about her opinion of the Carnivore Diet that I talked about in the last episode of The Girlfriend Doctor. Other than for Crohn’s and Colitis patients or people with severe IBS, she doesn’t recommend this kind of diet. Ali knows the importance that comes from eating a variety of plants.

    How long do you normally keep your body in ketosis? Have you implemented a refeed period that follows either your cycle or the moon cycle? As always, you can ask me anything and let me hear your thoughts in the comments below. If you have questions, email team@drannacabeca.com.

     

    In This Episode:

    • How ketosis can help heal your body from antiinflammatory and other long-term diseases
    • How long you should keep your body in ketosis for it to work most efficiently
    • Why it’s so important for you to enjoy the food you’re eating
    • How a 55-year old post-menopausal woman with 50 lbs to lose should approach the keto diet for ultimate nutrition
    • Why you have to follow the science, not the fear
    • Why we need to eat the biodiversity present in plants

     

    Quotes:

    “When Gabba levels are optimized, it releases this steam train valve that allows the body to feel safe again, it regulates all of those things: the tremors start to reduce, we get this peripheral release from tension, we can see blood pressure regulation, and we can see less of the rumination or “what ifs” in the mental space.” (13:16)

    “Most people are not in a parasympathetic state when they are taking in nourishment. The importance of something like a digestif, a digestive stimulator, or bitters is that it does drive that bile flow for digestion.” (26:26)

    “For any virus coming in the next 5, 10, 15 years, metabolic health is really key for optimized immune function.” (43:05)

     

    Resources Mentioned

    Buy Ali Miller RD's Books Online

    Listen to the Naturally Nourished Podcast

    Check out Episode 42: Food As Medicine To Help Anxiety w/ Ali Miller

    Find Ali Miller, RD Online

    Follow Ali Miller RD onFacebook |Twitter |Instagram |YouTube |Pinterest

    Join the KetoGreen Community on Facebook

    Buy Keto-Green 16

    Find Dr. Anna Online

    Follow Dr. Anna on Facebook | Instagram | Twitter

     

    Transcripts

    Ali:
    Sometimes we need those plant-based botanicals to assist in an actual gut cleanse. So if we're seeing those gut pathogens, we want to employ things like Berberine root, and we want to employ things like caprylic acid. And I think it's really important as well when we're looking at why you don't tolerate vegetables, let's get to the root cause. So is it that you're not getting enough digestive enzymes because you're eating in a stressed environment? Or is it a gut pathogen or yeast overgrowth that's fermenting the fibers that you're eating. Either way, we want to reset the button and get you back to tolerate it for optimal health.

    Dr. Anna:
    Welcome back to The Girlfriend Doctor Podcast. I am thrilled to be here and talk about food as medicine. Food as medicine to treat anxiety. Food as medicine to treat diabetes. Food as medicine to improve our immune system and keto as medicine. I am here today with a keto expert, Ali Miller. She's been on my podcast before, be sure to check out that episode. And join us in this episode as we talk about keto as medicine, and moving from fear to freedom, and how there are important modifications we can make regardless of the season that we're in that will really support us and those we love.

    Dr. Anna:
    Ali's, a mom of a four-year-old. My youngest is 12 so we've had a great mom discussion in here, too, that I know you'll enjoy and want to share. So let me introduce you to Ali Miller. She is a registered dietitian with a contagious passion for developing clinical protocols and programs using nutrients and food as the foundation of treatment. Her food as medicine philosophy is supported by up-to-date scientific research for a functional approach to healing the body.

    Dr. Anna:
    Ali is a renowned expert in the ketogenic diet with over a decade of clinical results using a unique wholefood approach tailored to support the thyroid, adrenal, and hormonal balance. She is the author of best-selling books, the Anti-Anxiety Diet, and The Anti-Anxiety Diet Cookbook, and also has an amazing podcast called Naturally Nourished. So she's been all over the web in so many places. I know you'll love her as much as I do. So join me in welcoming Ali Miller. Thank you. Well, hello, girlfriend. Good to see you.

    Ali:
    It's so good to see you. And I'm so sorry. We missed our 3D connection that we annually get but this is a good second best.

    Dr. Anna:
    I know, I know. This is, I say, we're not socially distancing. We are physically distancing but virtual hug, virtual kiss.

    Ali:
    Yes. I love that clarification. It's important.

    Dr. Anna:
    It is. it is really important. It's important as both of us as moms, right? And thinking about okay, well what are the messages that we're giving our children right now? And how do we use our terminology and our conversations with those we love, our interactions in the world right now to influence them and to have them be good humans and responsible for the environment, responsible for their health that they're thinking about it, too. And I definitely want to hit on this topic with you. We're going to get into keto as medicine because you're so big on food as medicine. I said your next book should be Keto as Medicine, and that's a good topic, and you are a forefront leader in food as medicine.

    Dr. Anna:
    And especially I loved your book. So many of my clients have used it. I've recommended it to patients, your book, The Anti-Anxiety Diet, and your Anti-Anxiety Diet Cookbook. Fabulous recipes, oh my gosh. And I have eaten some of your cooking. I'm just going to share this with the audience. I've eaten some of her cooking at the last Keto Con. You had a pre-event get-together and I was blessed to be invited. I brought my daughters who were with me, and we feasted on some amazing stuff. I'm trying to remember all the amazing food. You had amazing slow cook Wagyu, I don't know, was it hazelnut-fed or something?

    Ali:
    Delicious. There were those Wagyu lollipops, as we were calling them, and we were using that. It was called the beefinator, something, some very fast broil where they're basically campfire-roasted hunks of Wagyu steak that that caramelization of flavor. It's just phenomenal. It's the A5 Wagyu, they're olive-fed.

    Dr. Anna:
    Olive-fed, that's it, I knew was something special fed.

    Ali:
    Some things are hazelnut-fed though for sure. And then we did the cauliflower salad with ... One of my big things with keto is that I don't abide by the yes or no food list similar to you. So we are all about metabolic flexibility. So there's a little bit of date chopped in there. It was roasted cauliflower and massage kale with pine nuts and a really yummy vinaigrette with champagne vinegar. And then we did some kidney and organ meatballs that we had in like a marinara. We had, let's see, another salad with avocado and cumin and pickled onions. And then the big hit, which I know one of your daughters really dug, was the lavender macadamia nut CBD balls.

    Dr. Anna:
    Oh, yes. Those were amazing. Those were amazing. Is that recipe on your website somewhere in your book?

    Ali:
    It's only in The Anti-Anxiety Diet Cookbook, yes.

    Dr. Anna:
    Oh, man. I forgot about that. Oh, my gosh. We have to get that recipe out and cook that for sure. I know my daughters love that. That was so good. And that also, again still very, very low carb. So delicious, melted in your mouth. It was a perfect touch. Perfect touch.

    Ali:
    Yes, and then what's funny, because Ryan Lowery was there with a CGM. So Dr. Ryan Lowery, who is with ketogenic.com, and all of his stuff that he does. And he had a continuous glucose monitor, CGM, and he ate all of the things and he's like not really into having the honey that was in the nutballs and other things. And he was like, "Look, my glucose ..." I was like, "Exactly, food is medicine. It's all about the synergy and the relationship, not this myopic yes or no foodless." So it was really cool to see various people experience things that are outside of the box.

    Dr. Anna:
    Yes. And that's so true because that's something I noticed. I've worn the continuous glucose monitor, the Freestyle Libre, for over a year, and that's how I created help to fine-tune my recipes and my plan for Keto-Green 16. And something that I've noticed is also the timing of when we eat something.

    Ali:
    Totally, totally.

    Dr. Anna:
    The timing of when we eat just can make such a big difference. So like adding the lavender nutballs at the end of the meal versus at the beginning of the meal, and when you're triggering your body's glucose surge or insulin surge and actually it just stays nice and steady. Very little bump, a very little bump, none of that peaks and valleys. And sadly though, I have to admit that I do have, and my daughter was talking to me about this today because she has the same issue, we have a terrible affinity for French fries. And we're like we know it takes us up and takes us down. We cannot do it. We cannot do it.

    Ali:
    [crosstalk 00:07:11] feedback.

    Dr. Anna:
    It's good to have that feedback but also that you recognize, too, how that's a trigger to make you have cravings, to decrease your willpower, to just put you on this glucose rollercoaster.

    Ali:
    Most definitely.

    Dr. Anna:
    So keto as medicine for sure. And talk about how you have gotten into this area. And I want to let our listeners know I've interviewed Ali Miller before and on her book, The Anti-Anxiety Diet, you guys go back and listen to that podcast. It is fabulous, one of my highest rated podcasts. So be sure to listen to that and definitely pick up her Anti-Anxiety book, Anti-Anxiety Diet book, and her Anti-Anxiety Diet Cookbooks. I got to pull that off the shelf and get that recipe, too.

    Ali:
    Good, good. Thank you. So yes, I've been working as a functional dietitian for over a decade and I've always been in the ketogenic space. One of my biggest rotations as a dietitian in the Med Center was at a weight loss clinic. And they were using a VLCD, a very low-calorie diet. It was not quality-based, it was these very processed shakes that were working as meal replacements as an alternative to bariatric surgery. And as an intern there, I remember I had an eight-week rotation and I started to talk about, "Okay, so you guys are doing ketosis. I had only heard about the term ketosis in the state of ketoacidosis as a danger and harmful condition for uncontrolled diabetics."

    Ali:
    And then I had a small component probably of a single lecture that talked about the ketogenic diet as a tool for epilepsy and neurological health. And aside from that, I really was not exposed until this rotation. And it was really cool to start to see that when we brought people's carbohydrate levels down, their energy levels became more regulated. So like you said, they got off that blood sugar spike and crash of hunger, low blood sugar, and shakiness, and that vicious cycle of the cookie cycle of another pick me up and drop me back down. We saw cravings regulated substantially. We saw a big impact on body composition change that was really accelerated beyond mere calorie restriction.

    Ali:
    And so I started to look at what this plan was of these process shakes and started to put together well, what if though we did this with whole real foods? So my first job out of my dietetic rotations was running a clinic for three years, and I did a food as medicine ketogenic program. And this was done through a physician's clinic and then opened my private practice and continued to do that as a piece of the puzzle. But the interesting thing is up until my first five years of using nutritional ketosis, I really thought of it as a mere tool to accelerate weight loss. And I did acknowledge some of those other changes like body composition, cravings, and energy.

    Ali:
    But it wasn't until the fourth or fifth year where I decided, "Oh, this individual got off their HUMIRA. This individual is able to not only get off of their diabetic drugs, which was a known like their Metformin or get off insulin completely, and whatnot, I was starting to see that depression and anxiety was being influenced. I was starting to see these miracle keto babies. And so I really started digging into the biochemistry and what was going on. And one of the really powerful components of ketones and why I use the ketogenic diet in my anti-anxiety diet protocol is that ketones cross the blood-brain barrier.

    Ali:
    And so the similar mechanism of how they reduce epileptic seizures is very similar in the way that they are very calming, very grounding, and they reduce the excitatory stress response for our entire neurological system. And so when ketones cross the blood-brain barrier we see a reduced output of epinephrine or that dynamic excitatory neurotransmitter, and we see an enhanced expression of GABA. And GABA is the most powerful neuro-inhibitory calm down the compound. And so I find that that plays a huge role to kind of take blood sugar control to the next level.

    Ali:
    My first intervention for all ages is blood sugar control and low glycemic but if I feel like the individual needs a little bit more of a leg up, we tighten up the carbs even further so that we can have the magic of ketones to get things to the next level. And that GABA expression and the reduced oxidative stress in the brain, less inflammatory fuel source are hand in hand really big components for mental health.

    Dr. Anna:
    So let's talk about that. Again, that GABA-nergic component of the ketogenic diet, of getting into ketosis.

    Ali:
    Yeah, so I think that serotonin is thought of as the star of the show in the world of neurotransmitters as a natural antidepressant, and also anti-anxiety or an anxiolytic tool. And I think that it's widely known because it's one of the biggest drug markets, the SSRIs. But the other inhibitory compound in our brain and in our central nervous system, as well as our enteric nervous system or our gut, the second brain of the body is GABA. And GABA I think of as more of a physiological responder. So when we think of Parkinson's disease, it's a very good classic visualization of an individual that is not having optimal GABA response in their body and GABA depletion so they're dealing with tremors.

    Ali:
    And so we're looking at GABA as having this physiological ability to reduce that stress response. So even the type of shakes that you would get going on stage or a first date, or having a difficult conversation with your partner, that adrenaline surge or stress response that we experience has a lot of physiological impacts. It can increase our blood pressure, it can drive, as I said, the shakes or tremors, dryness in the mouth. These are all types of feelings that some of us might now be experiencing just going to the grocery store during a pandemic because we know that there's this palpable anxiety just keying us all up.

    Ali:
    So when GABA levels are optimized, it kind of releases the steam train valve, if you will, and it allows the body to feel safe again. It regulates, like I mentioned, all of those things. So the tremors start to reduce. We get this peripheral release from tension. We can see blood pressure regulation and we can see less of the rumination or anticipatory what-ifs in the mental space.

    Dr. Anna:
    Yes, yeah. I know, and like I would say, GABA just think of the rock group ABBA and think of the musical Mamma Mia and that feeling like aah. That's GABA, that's how it makes you feel like it's a good thing, and it helps us get to a good, restorative night's sleep. It's so essential for regeneration and repair. So it is [crosstalk 00:14:01] rejuvenating. So yeah, that's a good point and that ketosis that enables that surge, too, in GABA, and I think that makes the difference.

    Dr. Anna:
    And also, how important it is, something that I've written about, too, as you will know, that as our hormones decline, like estrogen, and really it's more so progesterone, as progesterone and estrogen decline as we hit perimenopause, menopause, our brain's ability to use glucose for fuel as well as our muscle's ability to use glucose for fuel diminishes tremendously. But not for ketones. Ketones bypass that mechanism. And that's why not only is it important for us and perimenopause and postmenopause, but it is mandatory. Mandatory. Now, Ali, how often should you stay in ketosis? When do you cycle out? Because both you and I believe in metabolic flexibility. It's nice to say that I just love feasting. Let me be honest.

    Ali:
    Yeah. So, I think that's a really good point when we're talking about metabolic flexibility as far as with that perimenopausal population, less glucose uptake in their peripheral tissue, and in their muscle musculature. So there is a hindrance to metabolic flexibility as opposed to in a premenopausal state because we're able to utilize glucose more efficiently. So metabolic flexibility, I always look at from the individual how much muscle mass do they have? Because that's going to play a role in their utilization of glucose or their flexibility of their carb threshold. So what's the muscle mass like? What's the activity factor like?

    Ali:
    I also look at, of course, lifecycle and hormone, which will play an impact. The status of insulin resistance or how handicapped they are metabolically in the sense of has this individual been diagnosed as a type two diabetic for over a decade? Or are they just starting to tip into an A1C at the 5.8, 5.9 worlds. So that's going to play a role of how tight we have to be with their carb control to get them into a state of nutritional ketosis. And I think that what you and I preach with this is that it's not about necessarily, the higher the better in the number of ketones produced. It's just about tapping into this ancestral hybrid capability of using ketones and glucose.

    Ali:
    And the goal is to really regulate the glucose levels, get off that roller coaster, and stay into a very moderate speed bump or almost flat, consistent range and using the ketones as needed for fuel. Whereas we know sometimes when those levels get higher, especially in a blood meter over 3.5, and so I know personally, that's when my epinephrine kicks up, and my leptin levels go down. So I'm in a very different ... I'm 35 years old, I had a baby five years ago so my metabolic threshold or capacity is going to be very different than a different individual.

    Ali:
    And we want to take that into account because since I don't have an extra 30 pounds of body fat to lose if I was to do super tight, less than 30 grams of total carbs a day, every day, my leptin levels would totally tank and leptin is a part of the HPA axis. Leptin is this satiety hormone, and in the Greek language, it translates to the word thin. And so leptin plays a huge role in weight loss and satiety. But it docks with the hypothalamus, the part of the brain that is a huge regulatory center of our body temperature, our sleep cycles, our energy cascades, and really appetite regulation and calorie burn.

    Ali:
    And so for someone that has 30 pounds of weight to lose, they're probably entering it at some level of leptin resistance, just as impaired with insulin resistance. So tightening up their carb threshold on a tighter wrench or 50 pounds of weight loss even further compared to someone who's looking to lose that last five pounds or optimize body composition, because that individual is going to be more prone towards leptin deficiency, and then that tells the body it's not safe. It tells the body it's not fed, it's not nourished. And we can see reproductive hormone decline, we can see sleep cycle issues, insomnia, and that chronic stress response.

    Dr. Anna:
    And ghrelin goes up so you're hungry all the time.

    Ali:
    Yes. So that's usually the indicator when leptin is off, is when all of a sudden, like I always say to people, are you getting hungry all of a sudden? I can see your body percent fat is going down. Let's check in on that. And let's work some re-feeds in. So I focus on carb cycling in that same concept and capacity. So what are we looking to achieve with this? There's a couple of possibilities. One is food freedom, which we should all enjoy food. Food should be something that has a celebratory component and a heritage component and a familial element that's joyful. And I always want to ensure that all of my clients enjoy what they're eating. And I'm a foodie first and foremost.

    Dr. Anna:
    Variety, right?

    Ali:
    Yes.k

    Dr. Anna:
    Variety, they say, is the spice of life. So it's important for the microbiome that variety, diversity.

    Ali:
    Most definitely. So I'm really always encouraging more carbs than your standard pie chart in the ketogenic diet would be. But with that being said, based on the individual's body composition, I might keep them tighter for longer. And for individuals that have less body fat to lose, I'm going to be more proactive in recommending carb cycling, especially in a woman that is in a premenopausal state because it's going to help their menstrual cycle regulate. And in my perimenopausal and postmenopausal state, I will help them to follow the moon because they're not following ovulation and menstruation. Or I'll have them follow their social calendar for the food freedom element. And I generally will recommend two to four days a month that they would do a blip on their radar of higher carb intake.

    Dr. Anna:
    So like with the full moon in that essence?

    Ali:
    Yes. So the full moon, in theory, represents ovulation, and then the new moon would represent the first day of the cycle. So sometimes that's a just easier way for women that have had prior disordered eating or feel like they don't want to select based on that that will throw off their diet plan. I'll have them follow the moon. And that tends to be a really harmonious way to balance out their hormone as well.

    Dr. Anna:
    That's interesting. I never thought about it. So full moon with ovulation, new moon with the first day of your cycle.

    Ali:
    Yeah, so they kind of we'll do their carb up in that luteal, the moon, Luna, luteal phase. And then they're doing the potential option of a carb cycle on the new moon but I do recommend for sure those two days of the full moon.

    Dr. Anna:
    Two days a full moon. Very, very cool. I'm gonna have to pay attention now.

    Ali:
    Yeah. [crosstalk 00:20:49]. Anyone, if you're craving those French fries, it's a new moon.

    Dr. Anna:
    It's always those French fries, Ali. It's always those French fries, because after wearing a glucose monitor and continuous glucose monitoring and you see that spike in value, you're like, "Oh, no wonder, right? No wonder." And so yeah, it's definitely that addictive. So let's talk about this fine-tune keto as medicine, like our whole Keto Green plan for the 55-year-old woman who has 50 pounds to lose.

    Ali:
    Yeah. So for that individual, until they lose that first 15 pounds, maybe 20, I would not recommend carb cycling. I would keep them in tight carb control.

    Dr. Anna:
    Ketosis.

    Ali:
    Yes, in ketosis, continual ketosis, exactly. And I always, some of the elements of my food is medicine, which is very along the lines of the Keto Green, is two to three cups of greens per day minimum, and that's across the board regardless of age range and whatnot. But if that individual was postmenopausal and has 50 pounds of weight loss, we want to make sure we support their liver in the weight loss process. Because when we lose body fat ... We'd of course, be doing keto and some calorie restriction to support that liberation of body fat because we want the body to go into its own fat stores as fuel.

    Ali:
    So we're not looking to fat feed on an aggressive level, which is why I would not follow a pie chart of like a classic keto, I would probably do a more high protein focus of a ketogenic diet for this individual, and do that calorie deficit in their fat. So they may be getting, let's say, like 80 to 90 grams of protein a day. They may be getting only 80 to 90 grams of fat or 70 to 80 grams of fat because again, I want them dipping in, and then they'd be staying at that like 30-ish grams of carbs.

    Ali:
    And as we're seeing that weight loss tick, we want to ensure that we're supporting the liver in the detox process. Because those adipocytes or those body fat cells are going to also liberate toxins, which can be endocrine disruptors. These are toxins that have been stored in our body fat to protect our vital organs, kind of keep them away from doing damage in the body, and we see these endocrine disruptors in our plastics or perfumes or pesticides, and they disrupt as endocrine disruptors all hormone, so sex hormone, thyroid hormone. They can drive insulin resistance as well as neurological concern.

    Ali:
    So we want to make sure they're getting these sulfur-containing vegetables, leafy greens, and some anti-inflammatory roots, as well as some bile drivers all in conjunction with their food as medicine plan. They also are going to liberate in their body fat cortisol and estrogen. And so this is where we can get fluctuations in women's hormones during the weight loss process. And so the leafy greens are a big priority, two to three cups. I would do something like my lemon turmeric shooter probably to break the fast and this is just juicing lemons with turmeric root or blending it in the blender and you can do a little bit of crack pepper and you take two ounces of that like a little liver shooter. Really great to stimulate bile flow and so that's going to move in the liver and help with that emulsification or that gathering of these compounds.

    Ali:
    We would also be getting in a lot of alium, so this is our garlic, shallots, leeks, onions, and incorporating at least a half a cup of these daily. And then we'd be looking for about a half cup to one cup of cooked cruciferous vegetables, which would be like our broccoli, cauliflower, cabbage, Brussels sprouts. And then of course, the lean clean proteins to distribute throughout the day.

    Dr. Anna:
    I love it. I love it. So things that stimulate bile. What are some other things? You said the turmeric lemon shot we're doing.

    Ali:
    Lemon turmeric, yep. And then you also want to look at bitters. So in your leafy greens, yeah, anything that really creates that saliva pooling when you bite it, that's going to create that same kind of action I imagine from the liver. That bile will shoot up. And so the lemon and olive oil in your salad dressing is really fantastic for bile support, adding leafy greens that are bitter like endive and also dandelion, radicchio, incorporating some of those mixed into your salad greens and your tub mixes. Really fantastic support as well.

    Dr. Anna:
    Beet greens one of my favorite alkalinizers, and it is that bitter, add some lemon and olive oil into that, and it's just like, for me, it's the perfect food and I threw them away for decades.

    Ali:
    Yeah, right. It's like, "Oh, no." Absolutely. Beet greens are fantastic. And artichoke is another really good one.

    Dr. Anna:
    Artichoke, good for sulfation, too, and glutathione production. So good. And now just there are so many beautiful bidders that are on the market. My friend Magdalena [inaudible 00:25:41] she has hormones balanced, and she has a great, great series of recipes for making your own bitters. I'm like, "I'm just having ..." right now Magdalena sends me some but in the meantime until I start making my own but just beautiful things to make. And when you think about it, but that is traditional medicine. That is what our grandparents, great grandparents used very much in their diets also in drinks and beverages the medicinal drinks.

    Ali:
    Swizzles and yeah, is there burdock root in it? Or what does she have in her bitter blend?

    Dr. Anna:
    I'm not sure. I'm not sure.

    Ali:
    A bunch of herbs, yeah.

    Dr. Anna:
    Bunch of herbs, yeah. Bunch of herbal medicine.

    Ali:
    What's interesting now with my work with anti-anxiety and also stress right now, it's so important to acknowledge that most people are not in a parasympathetic state when they are taking in nourishment. And so the importance of something like a digestive or a digestive stimulator or bitters is that it does drive that bile flow, but it also, just like that saliva pooling, we have salivary enzymes. We have enzymes, of course, made by the pancreas, and also along the brush border of our intestines, but our digestive enzymes are reduced to about a quarter of what they would be in a parasympathetic state when we're in that sympathetic fight or flight.

    Ali:
    And unfortunately, so many of us are eating while we're picking up the kids in a carpool, a quick bite, or while we're working on a deadline. And we're not taking the place to transition our mental space and even allow the brain to register that this is mealtime. And so if we're not smelling our food, we're not engaging with our food, that's also why cooking is fantastic. When you're cooking, you're pre-digesting. That whole process of cooking is getting your system revved up for eating. You're smelling, you're cutting, and that active process is going to enhance the way that you absorb nutrients at that meal.

    Dr. Anna:
    Absolutely. And just again, taking that time to smell. Smell the food, smell the spices, smell the herbs, and have that for full flavor initiation so that you do start salivating even before you start eating. And how important? That's so important. Great point. Now, Ali, food as medicine, keto as medicine, these are, and again as mood stabilization, so much I see this in my Keto Green community, once we are detoxing there's that period of detoxification that occurs. I'm like the journal, pray, drink a lot of water. We're going to get through this detoxification at night and it's so true, you can definitely understand that our body is energetic, an energetic body, right, and we're going to move things through our organs energetically, as well as physically.

    Dr. Anna:
    And so we're going to be releasing toxins, moods, emotions. But getting into this steady state of maintaining healthy, steady blood sugar, I mean, it's really, really fabulous. I want people, too, especially if they start using glucose monitoring, not to worry. If it's a steady-state low, that can be very therapeutic. Some people get concerned when it's under 80. I'm like no big concern. I've been in the 40s and fasting states and so it's really not to be afraid. What do you advise on that with that blood sugar, that stabilization budget because it does help with mood? Is there a high and low that you want in that range for continuous glucose monitoring?

    Ali:
    Yeah, I mean, I generally say sticking between 65 to 95, and then of course, the postprandial influxes, depending on your intake falling into 110 world. Diabetic control is being at 120, two hours postprandial, but we're generally not even going to see our influx hitting that if we are staying in a lower-carb state.

    Dr. Anna:
    Yeah, yeah, so true. So that's good ... And you just see these little bumps in the roads pretty much. Now, let's switch gears a little bit, and let's talk about preparing our children, preparing our households, preparing our children for school in the fall here. How are you approaching this and what ... I know there are rules and regulations and I'm not sure if schools are going to be open. They're not going to be opening with their ... What's going on? But right now it's kind of there's some scary rumors going on. Tell me what [inaudible 00:30:01].

    Ali:
    Yeah, so May 19th is when the CDC put out their back to school guidelines. That date is scarred in my brain. I know it. My daughter is four years old and she went back to her Montessori School on May 11th. And in that process, I was very proactive, probably beyond, that's the kind word, who knows what the school called me, but-

    Dr. Anna:
    [crosstalk 00:30:27] maybe.

    Ali:
    A bear mama, bear-hearted mama, because I said, "I will not send my four-year-old back to school until I can feel confident that her teacher can smile at her. I will not send my daughter back as a four-year-old to a space that does not feel safe. And here are my reasons why I want to make sure that her classroom does not mandate masks, and here are my reasons why I want to ensure that her classroom includes touch. I think, for the record, and I know this is slightly controversial, but children of any age, until you hit 15 or some level of personal responsibility, and even within the 15 to 18. We know there's variances dynamically, but to have a child and a mask for eight hours when we know that children deal with rhinitis, when we know that children are touching, and it is a vector for pathogen.

    Ali:
    It is not going to support their immune system, it's actually going to hinder it. And that's wildly concerning for me as a parent when I look at this back to school model. My concerns for my Stella were that children need to feel safe, they need to have the reassurance of a smile if they fall and bump their knee if they're getting frustrated with writing a lowercase letter E or whatever is going on in her schooling right now. They need the reassurance of nonverbal communication. And a smile is one of the most international signs and symbols of connection and that feel-good oxytocin boosts that we get as a neuro compound.

    Ali:
    I was concerned about how do you have advancements in pathology in a language without looking at the way the lips move and the tongue functions in late language skills. So that was another element. And then the big idea of collaboration, which is concerning when we're looking at the models of there's language in the CDC guidelines saying, "Discouraged sharing," there's a language like not to be touching or ... So literally to the level of every kid should have their own [inaudible 00:32:19]. They talked about, someone who was doing an interview where they're saying, "Well, each kid could have their own ball at PE." And it's like, I just can't logically wrap my mind around this.

    Ali:
    And when I look at statistics of cold and flu, and we look at 2017 to 2018, the flu took out 186 children, and we're looking at, as of the first five months run of COVID, 26 mortalities in children. And so it's a seven-time variance. And my concern is, if we take all these precautions of putting our children in a bubble, discouraging desks facing one another, having them all one way facing, one-directional hallways, sanitization of levels that are beyond EPA recommendations without ample filtration system providing them endocrine-disrupting compounds, sterilizing their microbiome, my concern is, how does that goalpost move when we transition into a season that has been known to kill more children? How is that rhetoric going to change? And it's a very significant concern when I look at endocrine health, cancer, and neurological disease as well as child development.

    Dr. Anna:
    Yeah, I know. No, no, keep going. Because I couldn't agree more. And also hand sanitizers and we have this unhealthy understanding that it's destructive to our microbiome. Whereas there's the movement like get dirty, get out in nature, go barefoot, get in the ocean and the sea and things like this. And we've got to, again, really recognize how pollution, environmental pollutants are affecting us. But what we're doing with this whole concept of hyper disinfection, everywhere you go there are disinfectants, and I think that's a bit alarming for me.

    Dr. Anna:
    And I also wonder to the cultural changes that are going to resolve as of this situation I think about traditional cultures around the world, cultures that wear masks as part of their attire, cultures that hug instead of a handshake, right? How did these things come about? What is the way that we will now meet people like knowledge people? Is it going to be quite this distancing? Because we know that giving a hug and the cultures that give hugs or kisses on each cheek when they greet have a higher level of trust. And so that a higher level of trust is peacemaking.

    Ali:
    Yes. And that makes the body, the individual feel safe. And so it is, it's oxytocin, serotonin, dopamine, all of these neuro compounds are influenced by physical touch. And so the importance of touch is so significant. And I really feel the dynamics of touch within the community beyond what just a household can offer. Because otherwise that trust is very, to only within this space, and then there's that fear component. And a lot of us are in this amygdala lizard brain right now of just fear, reaction, fear, reaction. And the body again, back to the concept of my anti-anxiety diet, I truly believe that anxiety is the Achilles heel to wellness.

    Ali:
    And if we are in this sympathetic survival mode, we will see an onset of chronic health conditions, and that includes immune distress that includes neurological conditions, and so much more. And so in these really vital developmental times, I think it's important that we advocate for sound policy, and we really apply critical thinking, and we really look at the literature and the research because why employ something that is known to drive infertility, neurotoxicity, and diabetes as far as if we're talking about propylene glycol, or we're talking about the ammonia [crosstalk 00:36:11]

    Dr. Anna:
    Alcohol.

    Ali:
    Right, that's used in these compounds, that we're using in defoggers that are spraying things in these parts per million particles. So we have known data that these are harmful. There's evidence-based literature, there's controlled randomized studies on these compounds. And then there's the unknown of is this going to help reduce a pandemic? So why employ something that is a known hazard for a possibility? And we're still on the air about whether an asymptomatic carrier can truly drive infection.

    Dr. Anna:
    Right, right. And I think that's a really important part, too. And the things that are being implemented like our beaches were closed and pools closed and hiking trails closed and like wait, what's the data behind those recommendations? There's no good data. I'm not aware of any, Ali. Are you? Like exposure outside and transmitting COVID in that way or ...

    Ali:
    In fact, it should be health-supporting because being outside makes us more parasympathetic. Again, just seeing the rhythm of sunshine and the wind through the leaves and hearing birds chirp, that was something that was very grounding to me through this whole time of unknown, was just hearing that every day the birds acted like nothing was going on. And just having that reassurance of the birds chirping outside and it still being spring and the seasonal stuff still happening, that was a constant that I could rely on that could help to keep me balanced when all the talking heads and the other sounds and the high stimulus of blue light and screen time was in an upregulated state. To have that grounding, to actually have your feet on the earth, to be able to see again the sun and the moon and have that wide scope impact, beyond vitamin D from the sun is very therapeutic for immune health and for the whole body and mental health.

    Dr. Anna:
    Yeah, lowering cortisol, increasing dopamine, increasing serotonin. It's so much more, so much more, right. I agree completely. So I will tell you on a personal, and we'll play this day-by-day as things go but I'm keeping my daughter out of school. I'm homeschooling her, doing an online homeschool curriculum. And we've got some travel to do as she ... We have horses, we'll be in your state in Texas for a little bit. Our horses don't know that anything's going on so I'm glad about that. And so she'll have that interaction, that social interaction. She'll have her disciplined study.

    Dr. Anna:
    Because I don't want that fear-based model. I don't want her to be worried that "Oh my gosh, did I give this? Did I make someone sick?" Or, "Is that person going to make me sick? Or what about my teacher? I can't hug them. I can't ..." like pulling you out of that equation and we'll do non-traditional online schooling, which I think most people are going to end up. At least there's going to be time next year that the schools are going to be closed again and I'm worried about that because it didn't work out so well this round. Not with me during book launch trying to homeschool, I didn't.

    Ali:
    I know my husband and I, if we have to pretend kitty one more time. Here, Kitty with me. That three-year-old imagination is just not the same as pure play. Not, dude.

    Dr. Anna:
    Oh my god. I so appreciate and love my daughter's teachers. I am telling you, teachers out there, every teacher that's listening, educator, God bless you. I mean, seriously, you are amazing. And it is a calling and it is a gift. And yeah, so I'll let you know day-by-day how I do.

    Ali:
    Yeah, most definitely.

    Dr. Anna:
    But I think that's important. It's important too because we're going to look at education as it transitions, but I want people, everyone who's listening, Ali and I are very on board with this. I'm a physician and I have seen, I've been exposed to many worse things than COVID in the clinics, in the ICUs, in the wards. MRSAs, cytomegalovirus as a pregnant mom, I mean, just named the high-risk exposures that I've had without any choice, without any choice. And we don't think of that but I want to tell you that I want to do everything possible to keep your immune system strong. And it comes from understanding the science behind the recommendations.

    Dr. Anna:
    And as long as we are following the real science beyond the recommendations and creating a strong fortification system, fortified defense system, fortified immune system to support us, and we're going to fare very much better than anyone who's not. So what is our next right step and then just your next right step and your next right step. Follow the science, not the fear.

    Ali:
    Yes, yes. And I think that's one of the biggest disservices and frustrations is that we are putting out headlines like we don't know why the elderly aren't dying at a higher mortality.

    Dr. Anna:
    That's not true. We do know.

    Ali:
    [crosstalk 00:41:22] there's vitamin D deficiency, there's insulin resistance, there's malnourishment because they've been on PPIs for three decades. I mean, there's a gamut of-

    Dr. Anna:
    Hypoglycemia.

    Ali:
    ... iatrogenic impact that [crosstalk 00:41:36]

    Dr. Anna:
    Multi-pharma, poly-pharma, let's call that out. There are typically three or more medications. Has anyone called that out? We need to call that out. That's huge. There's no science looking at three or more medications in any population over time.

    Ali:
    And Medicare doesn't reimburse vitamin D testing and we thought 88% increased mortality with insufficient vitamin D. When vitamin D drops below 29, it is a substantial factor. And what a simple intervention and a cost-effective intervention to employ in this country to provide 5,000 IUs of vitamin D, ideally with a combination K1, K2.

    Dr. Anna:
    Absolutely.

    Ali:
    But you know what, that hasn't been discussed to the level that it could be, nor the connection of insulin resistance. So that's where, again, it's full circle keto as medicine. If you are regulating your glucose levels, your insulin docking requires your T helper cell function. So when we're talking about immunological function, we see when glucose levels spike, I mean, study after study after study when glucose levels spike, we see hindered white blood cell function, and our white blood cells are our initial defenders of our immune system. They upregulate all of the compounds that drive the inflammatory response, as well as a lot of the immunological response.

    Ali:
    And so if you can optimize your blood sugar control, you will have a better base system to defend from any pathogen. And that's any virus coming in the next five years, 10 years, 15 years, metabolic health is really key for optimized immune function. And you get the added benefits of looking better in your holiday dress and feeling better and your skin, having enhanced confidence, sleeping better, better hormone balance, and the list just goes on.

    Dr. Anna:
    I love it. Yes, absolutely. And so I couldn't agree more. So no better time for the anxiety diet cookbook and the anxiety diet book as well as Keto Green 16. You guys, lots of recipes, lots of philosophy behind it. And it's not just about what we eat, it's how we live, how we think, how we interact, how we socialize. So join us in this movement getting stronger, healthier, and better. Ali, I want to thank you for being with us. tell our audience where they can get more of you. And definitely, everyone, follow her Instagram and her story. She pops up with her gorgeous daughter Stella and it's just amazing. She's always sharing some great information. So your Instagram and your website.

    Ali:
    Sure, so everything's really simple @alimillerrd, so it's just A-L-I-M-I-L-L-E-R-R-D. So that's on Instagram and Facebook and then the website is alimillerrd.com.

    Dr. Anna:
    Easy, easy. Thank you. And your book, Anti-Anxiety Diet Cookbook.

    Ali:
    Yeah, these are both on the website. We have a bundle with both so that's 20% off if you do the book and the cookbook, which is a great option. And they stand alone. I will say the Anti-Anxiety Diet is the nonfiction, science, nerdy deep dive.

    Dr. Anna:
    Love it.

    Ali:
    For those of you that want to do all the HPA axis stuff and understand deeper, I have a table on neurotransmitters and the different forms of pro-bacteria strain that drive production, and X, Y, Z. But the Anti-Anxiety Diet Cookbook could stand alone for a little bit of an introduction to give you a taste. It kind of compresses the first book in the first chapter and then it's all recipe-driven?

    Dr. Anna:
    Yes. And you have a great podcast on iTunes, Podcast Addict, wherever you listen to podcasts. I've been on there a couple of times. I love, love your interviewing style, too. So much good.

    Ali:
    Thank you.

    Dr. Anna:
    And all your podcasts are amazing. You really dig out some stuff. Just one quick note as we go, because we just published an interview on the carnivore diet. What is your feedback on the carnivore diet?

    Ali:
    So they've used the carnivore diet clinically with inflammatory bowel disease. And that's the one population that I really see that potentially is warranted as needed. So the carnivore diet it kind of took steam with the ketogenic movement, but also with Dr. Gundry's Plant Paradox. And so the idea of anti-nutrients, whether they are in the form of solanine or lectins or all these different compounds that plants have to protect themselves, I think that that's a sound concept. And I think in the idea of an animal sitting and obliterating an entire crop and eating to gorging, that yes, that would cause digestive distress and over time would potentially be toxic to that feeder.

    Ali:
    Unfortunately, I just don't see, aside from like a raw, vegan diet, I just don't see an intake that would actually create harm in the human body, aside from someone that has truly bleeding intestines. So if someone is dealing with severe Crohn's disease or ulcerative colitis flare, I will remove all plant matter, and I will work really aggressively with a bone broth like fast for the first five days where we're just loading them with that connective tissue support and that L-glutamine, and we're really lowering their digestive tract to completely rest. And then I do bring in meat and fish as the next step. And then I slowly will bring in vegetable fibers.

    Ali:
    But for certain by that sixth week, I want them to be getting these detoxifying compounds, these antioxidants, because I've just seen clinically that even if we're going to say that turmeric is a stressor to the body or this other bioflavonoid is actually a toxin, if we see in the literature that that toxin serves as a hormetic stressor, meaning that it pushes the body to become stronger, just like lifting an arm weight. So you could argue that lifting five pounds is hazardous because it tears your musculature.

    Ali:
    But what happens after you lift the weight? If you lift five pounds for 20 reps, you're going to gain muscle mass, you're going to rebuild those muscle fibers, and you're going to get enhanced metabolic health. Now, if you had to lift that five-pound weight for 24 hours or even eight hours, you're going to get such severe atrophy and muscle damage that that would throw off your allostatic load and that would be too much of a stressor. We just don't take plants in that level that they tip the pendulum in a dangerous way.

    Ali:
    I feel that plants serve as a hormetic stressor from those anti-nutrients and those stimulate the body to put out more detoxifying compounds and more health-supporting compounds. And namely, one of the big ones that I would highlight with this timestamp of the pandemic is glutathione. And this is the grandmama antioxidants, the vitamin C being a little kid sister, which we also get in all of our produce. And so when we work these antioxidants, we've seen glutathione levels when insufficient endogenous glutathione status being a big impact of this respiratory virus in the pandemic. And so I think that that's another connection argument of why we need that biodiversity.

    Dr. Anna:
    I agree. Biodiversity again, that diversity we don't villainize any ... I don't villainize any food source. And I think that's just a matter of when, where, how, and how we do that. It really does remind me of being an obstetrician and delivering babies and it baffled me. I ask the nurses, "Like it just seems like these cocaine moms have these babies that are amazing. 10 out of 10 Apgar scores. And they said, "Absolutely. They've been so stressed in utero, they're just thriving. It's amazing. Well yet, some of the yoga moms, they really just did everything right. The babies would be like seven nine.

    Dr. Anna:
    And I was like, "What is going on?" But that stress and that is not good. That's not good stress. Don't have cocaine if you're pregnant. I'm not saying that. But it was just fascinating to me. There's good stress and bad stress. That's why we exercise, that's why we do high-intensity interval training. That's why we have diversity. That's why we feast and we fast. And I agree to and healing irritable bowels, any type of gastric issues. I've had clients with Clostridium and Pseudomonas. They fast with ... Typically, they'd use my keto alkaline shake that has additional nutrients in it. And 100% bone broth. Bone broth, extra collagen, that fasting, that healing, restorative sometimes adding in [inaudible 00:49:58]. But just to heal the GI tract as much as possible with that rest.

    Ali:
    And sometimes we need those plant-based botanicals to assist in an actual cleanse. So if we're seeing those gut pathogens, we want to employ things like berberine root, and we want to employ things like caprylic acid and all of these, again, coming from the vegetation kingdom, if you will.

    Dr. Anna:
    Allicin.

    Ali:
    So I think it's really important as well when we're looking at why you don't tolerate vegetables, let's get to the root cause. So is it that you're not getting enough digestive enzymes because you're eating in a stressed environment? So you're dealing with mechanical cramping, and that's creating GI stress or that bloating? Or is it a gut pathogen or yeast overgrowth that's fermenting the fibers that you're eating? Either way, we want to reset the button and get you back to tolerate it for optimal health.

    Dr. Anna:
    Absolutely, absolutely. All right, Ali Miller RD. A-L-I millerrd.com. Thank you, Ali. Thanks for being ... I always enjoy our time together.

    Ali:
    Always fun. Yes, take care.

    Dr. Anna:
    I can't help but love that woman. I tell you, Ali Miller is one of the brightest individuals and so knowledgeable, as you can tell. Really, I recommend her book, The Anti-Anxiety Diet and her cookbook, well-balanced meals, and just an additional resource for you to have. And think about it this time, how important it is for you to gain a healthy community, gain a healthy community, and it's virtual right now as much as possible. And with that, I am going to plug our Keto Green community on Facebook. Our community is amazing at encouraging, at being authentic, at really taking the next best step. So join us in taking your next best step in our Keto Green community on Facebook. So be sure to share this episode and join us in the community. Thank you for being with me. This is Dr. Anna Cabeca, The Girlfriend Doctor, here 'til next time.

    Dr. Anna Cabeca

    Dr. Anna Cabeca

    Dr. Anna is a Triple Board Certified OB/GYN, Anti-Aging Medicine expert, and author of the best selling book, The Hormone Fix.

    Dr. Anna helps women heal the 9 most dreadful symptoms of menopause with natural, safe solutions. Follow her for content on hormonal imbalances, vaginal dryness, menopause (and more) that are medically backed, and created to empower women — not just treat them.