Is feeling “good”, good enough? Or could there be a next level of performance and health awaiting you? This is a guest post from Dr. Cate Shanahan, one of the world’s leading primal/paleo-aligned MDs, noted author and speaker on ancestral health principles, and family practice physician in Napa, CA. Cate also designed and now serves as medical director of the Los Angeles Lakers  cutting edge PRO-Nutrition program. She co-authored (with her writer husband Luke Shanahan) the grass roots sensation Deep Nutrition – Why Your Genes Need Traditional Food , and followed it up with the excellent practical shopping and food preparation guidebook, Food Rules .
Dr. Cate’s unique approach to wellness is centered upon a nutrient-intense eating strategy she calls “The Four Pillars of World Cuisine”. Cate blends her formal medical training and scientific research (in biochemistry and genetics at Cornell) with insights she learned practicing medicine and studying ethnobotany at the National Tropical Botanical Garden on the island of Kauai. In particular, she noticed the exceptional health and work capacity of the population she served in rural Kauai, who ate a superior diet of pasture raised animals and locally grown produce, and lived a low stress lifestyle.
Cate and Luke will join us at PrimalCon Vacation Tulum , where Cate will deliver a keynote lecture on the Four Pillars and Luke will conduct an intensive workshop for aspiring writers.
I’ve been a fan of Mark Sisson for a long time but I first became associated with Primal Blueprint Publishing  through Managing Editor Brad Kearns  several months ago. In discussing my medical practice and my Four Pillars strategy to optimize dietary habits, Brad mentioned to me that he had some strange adverse findings on his blood tests. By all accounts, Brad would be considered a healthy, athletic, and Primal-aligned guy – he was a national champion and #3 world-ranked pro triathlete back in the 90s, coached by Mark Sisson!; today at age 48 he participates in high jump , sprinting, and basketball .
With the ancestral health movement in full swing, the CrossFit Games selling out large stadiums and being nationally televised, there is a growing population of folks who are super fit, eat a nutrient-dense, Primal/paleo style diet, but may be unknowingly falling short of peak performance and optimal health. When Luke and I approached the Los Angeles Lakers, this was essentially our pitch to the team training staff – that they had some of the most magnificent and finely-tuned physical specimens in the world on their squad, but that the team, and each individual player, were quite likely missing opportunities for optimal performance and recovery in their diets.
Everyone involved in professional sports – coaches, athletes, trainers – will tell you that recovery is everything at the elite level. While Kobe Bryant has done some amazing things on the court over 1,200 games and 17 seasons, his equally amazing off court discipline keeps him in the game – his intensive workout regimen, and the hours devoted to rehab and recovery practices each day are what enable him to maintain the highest level of play for years and years.
This article is directed to those of you who may be doing things really well overall, performing in a manner that the “average” person would marvel at, but may still be unknowingly falling short of your potential. You may not have any adverse blood findings laying around, but you can certainly ask yourself some important questions: Are you stalled with weight loss progress? Do you have energy level swings relating to workouts, or meals? (One important marker for my athletic patients is to determine if they get hungry a few hours after eating, something that can indicate your metabolism may not be nimble enough to provide you with the energy you need). Do you have any difficulty getting to sleep, staying asleep, or waking up refreshed and energized? Even if things are great, could they possibly be even better?
While Brad’s blood panels showed some awesome numbers after five years of Primal eating and exercise (a triglyceride-to-HDL ratio that was even better than the optimal goal of 1:1; and triple the testosterone he had from age 26 when he was mired in an extreme endurance training regimen), he also revealed some significantly below normal range values for assorted white blood cell values (white blood cells, neutrophils, fibrinogen), as well as elevated fasting glucose (strange for an extremely Primal-aligned/cyclic ketogenic eater).
These lab abnormalities are, to me, red flags. Unfortunately they usually do not draw the attention I believe they deserve. Possibly because they are so common, many docs have gone numb to the possibility that they could mean anything. Or, they may be misattributed to genetics. It doesn’t help that physicians, dietitians and other professionals – at least those who rely solely on their formal training – remain under-educated in the fields of nutrition and metabolism. When I track down old reports of previously done labs on my new patients, the paper trail often shows they’ve had these kinds of warning signs for years.
A doctor lacking nutritional/metabolic expertise is not a criticism – it’s simply not part of their formal training. You could just as easily assume they know nothing about sailing or skydiving. When I started my medical practice, I didn’t have a clue about nutrition or metabolism either. The only reason I have a clue now is thanks to time spent – about five years – updating my education, accomplished by reading a small library’s worth of textbooks and articles from Medline and attending medical meetings held by relatively enlightened societies like the American Academy of Bariatric Physicians and the Nutrition and Metabolism Society. Much of what I learned is now compiled into the two books I’ve co-authored with my husband Luke.
Lab findings like those Brad delivered are likely due to a significant mismatch between nutrition input and metabolic output and I take them seriously because they are powerful gauges of metabolic health. The bone marrow must pump out enough white blood cells to keep our counts between 4,000 and 11,000 WBC per millimeter of blood, and it takes 20-plus hormones to regulate blood sugar. The inability of a person’s diet to keep up with the demands of these two very active metabolic enterprises usually does not lead to significant health problems – until a person experiences major stress.
I have learned that these two tests and a handful of others that I use act like metabolic crumple zones where the pressure of a persons daily routines impact upon a less-than-optimal diet (i.e. not inclusive of all Four Pillars) with visible consequences. Like a car deliberately engineered to collapse at certain points to best protect the driver during an accident, these metabolic crumple zones take the hit first when your metabolism is beginning to crash. This metabolic engineering works so well that you may not feel anything wrong – if you don’t push yourself that hard. But commonly, as in Brad’s case, a bout of athletic competition and peak performance, high-energy output is followed by troughs of low energy, fatigue and even the occasional “burnout headache” as Brad described.
Fortunately, the health consequences that arise from metabolic imbalances related to voluntary, athletic outputs that demand more nutrition than the body inputs tend to be short lived. What was likely contributing to Brad’s burnout experience were muscle catabolism (breaking down muscle) and inability to hold on to electrolytes like calcium in the aftermath of his super high intensity workouts of strength training. While Brad’s reported dietary intake was your basic Primal A+ diet (carb conscious, lots of top quality – and not overcooked – grassfed beef and pastured eggs; abundant servings of fresh produce; snacks like macadamia nuts and dark chocolate, and an absence of nutrient depleting foods) I realized, like some other hard-core athletes I treat, that he was pushing his body to the point where he needed not just a great diet, but an optimized one. This is where the Four Pillars come in.
The Four Pillars of World Cuisine detailed in Deep Nutrition  represent how successful cultures use the same four strategies to optimize the nutrition they could extract from their surroundings. They are:
- Fermented and sprouted
- Meat on the bone
- Organ meats
Each of these categories of foods offer a variety of unique benefits, but to give you a taste I’ll share one example from all four categories. Fresh foods are the best sources of antioxidants. Fermented foods offer probiotics. Meat on the bone offers glycosaminoglycans, which trigger collagen development in joints. And organ meats are such intense sources of nutrition they make many other so-called super foods pale by comparison.
Our ancestors’ survival depended, ultimately, on their personal health and vitality. People like to talk about how our lives are so stressful these days. While they’re undoubtedly correct, life has always been stressful. Your village would get invaded, your cousin would get eaten by an alligator, you’d deal with droughts/floods/mosquito born illness, epic battles and on and on. But our primal ancestors managed to survive in spite of all that largely because of the way they ate. And according to the best available evidence from modern science, cultures around the globe included foods from all Four Pillars.
Flash forward to a person today with low WBC (or any of the other subtle abnormalities that typically get ignored) due to the dietary input-metabolic output mismatch – something I see particularly often in adults in their 30-50s and even in those who consider themselves pretty healthy (i.e., paleo-style) eaters. How will he or she handle serious stresses? Even with one or more important metabolic indicators out of alignment, people can go about their business, exercise, work, and keep up with their kids until… something really bad happens. And then, something else really bad happens. And something else. If the stress is unrelenting then, in the aftermath when things finally calm down and the body’s cortisol levels plummet, the consequences upon a person’s health can get pretty devastating.
Life is still is as unpredictable today as it always has been, so we still would benefit from fortifying our bodies pro-actively like our ancestors did. But we don’t. Our culture is re-active, not proactive. Most people wait until something happens to consider making a change. We don’t value optimal nutrition and so have largely forgotten what it even looks like.
I believe that’s why, just about every day, I hear a story of an unbelievable sequence of bad-luck events that are soon followed by life changing health problems. Yesterday’s came from a woman in her fifties who got divorced, then her best friend got cancer, then her son got married to someone she doesn’t get along with, her mother had to go into a nursing home, and somewhere in there she fell off a curb, fractured her ankle and lost her job temporarily – all this in one year. Two years ago, she was fine. Now she’s in my office with a painful and fatiguing auto-immune syndrome that specialists from the Mayo clinic are treating with several powerful immune system suppressing medications, and in spite of those meds just getting dressed in the morning is a painful exercise.
Would this have happened to her if someone had noticed those metabolic crumple zones beginning to wrinkle and optimized her diet? No one can say for sure. But in my view, the odds that significant stress will lead to life-changing health repercussions are greatly increased by ignoring the warning signs and failing to fortify your diet with the same foods are ancestors ate.
Of course, some people have the genetic good fortune to handle stress (not to mention perform physically) better than others. Take world-class athletes who stress their bodies to the limit on a daily basis. They don’t often get outright sick, but they might not have the energy they want game after game, or have the extra energy to play with their kids after workouts. Many turn to sugary blasts of candy or soda on a regular basis, not realizing that they’ve entered a Faustian contract with their metabolism. Before they realize it, this one wrong turn – making a regular habit of sugary treats – has led to metabolic changes that can make the difference between playing another 3-5 years, or finding themselves replaced by a younger, fresher athlete.
But not for players with the Los Angeles Lakers. Thanks to head trainer Gary Vitti’s, the Lakers take a proactive approach to health optimization and in 2012 Vitti invited Luke and I to join a team that includes head strength and conditioning coach Dr. Timothy DiFrancesco and Chef Sandra Padilla. Our coordinated efforts are bringing Deep Nutrition to the Lakers, and those players who are able to make changes have noticed dramatic improvements in their energy levels.
The Lakers had some troubles with injuries last year, so our PRO Nutrition (Performance Recovery Orthogenesis) team can’t brag about any titles just yet. But just wait until Kobe comes back from his Achilles tear stronger than ever! I should also mention Steve Blake and his wife Kristen, who really embraced healthy eating with full intensity. At the beginning of the 2012-13 season, Steve struggled with injuries that kept him on the bench. By the end of the season, he was performing at a career best level (making 42% of his three-pointers) such that they were calling him the White Mamba!
In Brad’s case, he had been almost entirely missing out on two of our Four Pillars. So I recommended he start adding them in by upping his intake of mineral- and glycosaminoglycan-rich bone broths and nutrient intense liver from pastured animals. I made a few other recommendations and less than a month later, after years of being low, his WBC have finally normalized. Normalizing glucose can take longer, and can take dedication to staying on the Four Pillar path. But in my experience, it’s a road well worth traveling.