Welcome back to the Healing Pain Podcast with Leanne Ely
Nutrition is often one of the first interventions that I recommend for pain relief, especially if you have pain from an inflammatory disease such as fibromyalgia, CRPS, rheumatoid arthritis, osteoarthritis, or even headaches. Anti-inflammatory nutrition has a sound evidence base to support it, but it’s often ignored when it comes to chronic pain care management. When it comes to implementing it into a physical therapy practice, nutrition is very important because most of the patients that are being treated are people who have chronic pain or other types of pain syndromes. Nutrition consultant and chef Leanne Ely discusses the anti-inflammatory nutrition and introduces a particular diet that’s showing up on people’s plates more and more, the ketogenic diet, which is now being explored in many clinical studies.
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If you have followed this blog for a while, you have noticed that nutrition is often one of the first interventions that I recommend for pain relief, especially if you have pain from an inflammatory disease such as fibromyalgia, CRPS, rheumatoid arthritis, osteoarthritis or even headaches. Anti-inflammatory nutrition has a sound evidence base to support it, but it’s often ignored when it comes to chronic pain care management. This is such an important topic that I’ve even written two blogs for the American Physical Therapy Association about how important nutrition is when it comes to implementing it into a physical therapy practice. Most of the patients that we treat are people who have chronic pain or other types of pain syndromes. We will be discussing anti-inflammatory nutrition. You’ll be introduced to a particular diet that’s showing up on people’s plates more and more and that is the ketogenic diet, which is not only booming on the blogosphere, but it’s also being explored in many clinical studies.
Joining me to discuss anti-inflammatory and ketogenic nutrition is my friend and colleague, Leanne Ely. Leanne is a Nutrition Consultant and a Chef. Many of you may know her from her popular website called SavingDinner.com. She features informative daily blogs, delicious recipes, and the tools you need to eat healthily and prepare delicious family dinners. It’s what you’re putting on your plate that’s important. On this episode, you will learn who should and who should not try a ketogenic diet, who might benefit from a ketogenic diet, how to get into ketosis faster, how to test for ketones or ketone bodies, what you can and what you cannot eat on a ketogenic diet, and how the ketogenic diet has evolved over the past decade. To help you get started with the ketogenic diet, Leanne has provided you with a great freebie that includes a bunch of ketogenic recipes to get you started.
All you have to do to receive the free ketogenic recipe download is text the word 99Download to the number 44-222 or you can open up your browser on your computer and type in the URL, www.DrJoeTatta.com/99Download and you’ll receive the instant access to this gift. If you are a practitioner and you’re interested in learning more about nutrition, hop on over to the Integrative Pain Science Institute website page and check out my function nutrition course for chronic pain which will go live in just a few weeks. The exact URL for the course is www.IntegrativePainScienceinstitute.com/Nutrition-Program. To get to that page on the Institute, you can sign up for the wait list.
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Anti-Inflammatory And Ketogenic Nutrition with Leanne Ely
Ms. Leanne Ely, welcome to the show. It’s great to have you here.
It’s great to be here. Thanks, Joe.
I can’t wait to talk to you about food and especially the ketogenic diet. I know you’ve done a lot of work and research into it and are helping a lot of people. First, let’s go to some basics. Let’s get down and dirty to some simple things. Why should people with chronic pain or any chronic disease cook for themselves and prepare their own meals?
I hear this all the time, “I just don’t cook,” almost as if that’s a badge of honor. I think to myself, “I’m so sorry,” because when we cook for ourselves, when we are the ones who are picking our own ingredients, cooking with our own things in our kitchen and whatever, we have absolute control over every single ingredient, the cleanliness factor and it goes on and on. If we can control everything, we can control how much inflammation we’re introducing into our diet. We all know that inflammation is basically the pathway to pain.
If we can control the inflammation, we can make sure that the ingredients and everything are of top-notch, we’re not going to be wondering, “I just ate at that nice restaurant. Why am I feeling like this? Why are my joints aching?” The answer usually is because they’re not using the same ingredients you would in your house. Even though they’re saying farm to table or whatever, they still got some crappy oil, I promise you, that they’re cooking with that.
Especially the oil, that’s probably the big one. It doesn’t show up on the menu. It’s not listed and people don’t ask about it. Oftentimes, even the waiter doesn’t even know. He has to go back and ping the staff and figure out, “What are we really using?”
I was eating in a five-star restaurant, open concept in Santa Barbara. It was absolutely gorgeous and that’s when it hit me because they had this beautiful kitchen and they’re cooking and you see the cook staff grab for this little thing of oil that’s in one of those squeezy bottles that you would see at the ballpark for mustard. It was clear with this white, yellowish liquid. I looked at it and I went, “Catch you, this is exactly what I’m talking about.”
For a long time now, you’ve been putting up some great meals and recipes on SavingDinner.com. What I want to know is when you go shopping, when you prepare your grocery list, when you’re pulling things off the shelves in the grocery store, what are your pillars that you’re looking for?
Go Paleo Without Going Crazy
I wrote a book a long time ago called Part-Time Paleo. My whole thing then and my whole thing now, even though I’ve expanded my borders a little bit into dietary things that you can and cannot do, is always to look for the anti-inflammatory type of foods. I had Hashimoto’s disease. I still technically do, but I don’t have the goiters. I had huge nodules, but those are completely gone. I don’t have the pain. I don’t have all the things that just completely afflicted me when I had Hashimoto’s. That is the pillar of the food. Anti-Inflammatory food has to be the first thing that you consider. One of my favorite things back then was lentil soup. I would make lentil soup by the buckets.
I loved lentil soup but lentil soup didn’t love me back and it caused me a lot of pain. There are lectins in there. For anybody who doesn’t understand, the lectin is like a little fish hook and it’s a quality of any kind of bean, seed, whatever because this is how nature keeps things rolling. They make sure that the animal that tries to eat it get sick so that they can keep the species going. It’s nature’s way of protecting its own. There are ways that you can dissipate the lectin somewhat, but that will happen with lectins when we eat them. Some people are sensitive to them, other people are not. I am on the sensitive scale and so for me, eating a cup of lentil soup was the equivalent of four pounds, a big bloated stomach and pain.
To get yourself, you have to start from scratch and go, “What is the most anti-inflammatory way I can eat?” We know, number one, eat as organically as possible. Get rid of all those pesticides and hormones and what have you. Eat organically as possible and eat as simply as possible. Get rid of the things that we know could be possibly the top ten inflammatory foods and work from there. For me, it’s lots of greens, tons of salmon, I eat lots of wild salmon and just keeping a very simple diet to get rid of that pain, to get rid of the bloating, and to get rid of all the other symptoms. That’s what starts you on the path.
Lectins hit or miss with people. Some people they are fine with it and other people, especially if you’re on the autoimmune spectrum, do not do well with them. I had lentil soup, which I was raised on, it’s pretty big in Italian culture, it does not agree with me at all, gives me awful IBS. When you had lentil soup, would it give you any other types of symptoms other than bloating and stomach pain?
I’d get achy joints, definitely stomach pain, and just this lethargy and brain fog where I was just off. I would make lots of this stuff. It’s so good for you. Look at the fiber content, look at the protein, and look at everything that’s in there. Nutritionally, you look at the label and you’re thinking, “This stuff’s off the hook,” and it is. It also has the little hooks and so we have to be careful of that. That just brings me to an important point of mine, which is that we all need to be our own nutritional guru. Go ahead, get your information, “Leanne Ely says that lentil soup is bad.” No, Leanne Ely says lentil soup is bad for her. Find out if lentil soup works for you. Find out where you are on the lectin thing. We all need the basics of a good anti-inflammatory diet, but then you have to start personalizing it for what works for you. Obviously, Joe, you can’t handle lentil soup any more than I can, but for some people, lentil soup is a godsend. It’s a great stuff. It doesn’t bother them. Other things bother them. They can’t take citrus or something, I don’t know.
Let’s start to shift into why you’re here and talk about the ketogenic diet. I think this is the year of the ketogenic diet, which is interesting because I talked about it in a book I released. I saw it coming through the research and I saw it coming through the nutritional waves. Take us on a little tour of what did the diet look like twenty years ago versus now?
I think that’s interesting because twenty years ago it was used more medically than it is now. Medically, they were using it for all kinds of things including brain disorders like epilepsy. More holistic practitioners were even using it for cancer, autoimmune issues, PCOS, and all kinds of different issues. To me, it’s a very interesting diet because it can, not always but with some people, it can correct these things and even Type 2 diabetes. It’s a very interesting diet. Back then, when they were doing it versus when they’re doing it now, it was just heavier fat-type of a diet and a lot of intermittent fasting, lots of fasting as matter of fact.
Now we can eat potatoes but we can sure do the sour cream butter and bacon on everything and just minimal. It’s all about the macros and it’s about everybody’s measuring their blood and peeing on little sticks and all this other kind of stuff. In the olden days, they weren’t doing that necessarily. It was just more of an approach to, let’s take away a little bit of protein, add a little bit more fat, and then go long periods of time without eating and see how you do. It’s really changed a lot.
I’d be pretty hungry if I had to go long periods of time without eating.
I’d be super hungry but if it’s done right, it can be done without the hungriness.
Without a lot of big creamy sauces because back in the day, there were a lot of cheese drippings and creamy sauces. What’s your approach to the ketogenic diet? Do you or do you not allow dairy into it?
I think dairy for a lot of people is on the same wavelength as lectin. It’s triggering, especially for people with autoimmune diseases. Those little dairy molecules can look a lot like autoimmune antibodies so you need to take that away. When I took dairy out of my diet, I suddenly lost the weight. I was doing everything because I didn’t want to give it up. I understand, dairy is delicious but when you stick your toe in that little pool, you can’t get rid of symptoms until you get rid of them. You can go back and experiment, but you’ve got to take it out first and see where you are on that. What I dislike about now’s keto diet is that it’s an invitation to just go crazy with the butter, sour and creamy sauces, and all of that.
It doesn’t address anti-inflammatory symptoms and problems. The ones that we have and you would know even more so now than we did twenty years ago. If we’ve got all these issues, I think we need to drill it down to basics, go back to what it is, go back to an anti-inflammatory diet. Now, let’s lower the protein a little bit. Let’s up the fat with good and healthy stuff, not with a bunch of cheese and cream and all of that. We’ll throw a little bacon in there for fun. Who doesn’t like a little bacon, but do it that way?
When I was doing my research for it, because it took me about six months to do it, I kept saying, “I can’t do this. This is crap. How do people eat like this?” They will do anything and they will experiment with anything. They will prick their fingers and they will bleed into these expensive meters that they’re buying. They’ll do all this incredible math just so that they can stay into this ketosis and maybe lose some weight, maybe not, and sometimes they are always in this constant state of not feeling good. To me, that all adds up to junk. What if you took the ketogenic diet principles and you made it into an anti-inflammatory approach. You added into it intermittent fasting and you go back to the old research from more than twenty years ago and see what is it that brought people into ketosis. How does this work and how does this medically help you and how does it just drop away? That’s what we did with hot melt.
Of course, everyone can download some free recipes. You can go to DrJoeTatta.com/99Download or you can text the word 99Download to the number 44-222 and Leanne has some great recipes to get you started on her hot melt diet. If I’m going to start on hot melts, what might my dinner plate look like?
Your dinner plate is going to look like a little less protein than you normally eat. Let’s say you’ve figured out how much protein is right for you and let’s say you ate eight ounces of protein, maybe you can bring that down to about six ounces. Then you’re going to have an unbelievable amount of green leafy vegetables on your plate and whatever other low-carb vegetables that you happen to like that will fit into that. We have one recipe, and I believe your readers are going to get that, is the hot melt spaghetti recipe, which is delicious. It has an incredible sauce with tomatoes and sausage and onions and all kinds of things. There are few carbs in there, but it’s on top of zucchini that you ribbonize.
One of the things that I do to give people the flexibility to do is, if you want a little bit of cheese, the rules are you have to have a cheese that has at least been aged 120 days to get rid of the lactose. It also makes the casein a lot more digestible. If you don’t have a dairy problem, you could do a little bit of that. My suggestion is to keep it out, add it back later, experiment with yourself and see how you do. That’s what it looks like. You’re eating this humongous plate of vegetables and then you’ve got a salad on the side and it’s just you’re eating a ton of greens, a ton of vegetables, keeping the protein down and then adding up the fat. Lots of avocado on my diet.
People get a little confused around the fat. You’ve mentioned bacon, there’s some saturated fat in there which we should not be scared of, but other than avocado, what else is going into your meals, your breakfast, your lunch and even your snacks?
One of the things that I’ve noticed as I experimented on myself with this, and also back to that research, is how long can you go without eating? We have our own protein that we use that we make some hot milk smoothies. These smoothies, I can stay full for six hours on them. Six hours, that’s crazy. Sometimes there’s a little MCT oil and sometimes there’s avocado in there. You can add things like nuts, little almond butter or whatever. There are few carbs in there. You just take care of that. I’m also of the belief where some people that are into the crazy keto, that it’s not about net carbs, it’s about all carbs. The research shows us what happens to carbs with fiber. I’m going to go with that. You always want to do net carbs. Things like that, almond butter, all kinds of nuts, avocado, some delicious oils, good avocado oils, good olive oils and things like that and ghee.
I love avocado oil. It’s the one thing that people don’t think of or grab. It’s got such a nice neutral flavor to it and you can use it in a lot of different dishes.
Things that people don’t understand too is about smoke point. When you’re cooking and if you want to take a good fat and kill it, watch it smoke in your pan. If it starts smoking in your pan, you’ve just taken that gorgeous extra virgin olive oil and turned it into a trans-fat. You might as well be eating buckets of Parkay margarine. You’ve just got to watch that, you’ve got to respect the smoke point.
It can be a little tough for certain people to start to pull the carbohydrates out, especially it’s a little tough for them to get into that little range of ketosis. How do you help people enter into ketosis in a way that’s comfortable for them and for them to break that barrier? Once you break that barrier, you’re like, “I feel I’m full, I have energy, I can think better and my pain is less.” All these things start to open up and you’re like, “Why did I not get here sooner?”
There is that little thing called the keto flu that some people suffer with and some people do not. The whole thing is where are you starting from? If you’re starting from a place where your breakfast is in and out of donut shop and you have sugar problem or carb problem, then it’s going to be a little tougher. The way that we dissipate that is with tons of bone broth, eating, and getting some of the Nuun pills. The electrolyte pills really help. Your electrolytes just go all over the place. That’s one of the reasons why you feel crappy. Drinking a lot of water and then just having a lot of patience and kindness to yourself. Just know, “If I just get through this, it will be good.”
We found that with our folks, we’ve got hundreds, almost thousands of people on this diet. We’ve found that when we make these recommendations, the electrolyte pills Nuun, you can get them on Amazon, you can find them in Walgreen’s or whatever, but these little Nuun pills help to get those electrolytes back in. A lot of water, just being super kind, taking a lot of rest, Epsom salt bath, going to sleep early, all of these things and you’ll get through. Usually, it’s about three days.
It’s oftentimes not the kind of diet that you want to start when you’re very stressed. When you have a really big project. Take about three or four days where things are going to be quiet, you can meal plan, you can recipe plan, get those Nuun pills and oftentimes that can just be the one thing that really helps. The other thing which we probably should mention is exercise.
Sweating is fine, but when you’re just starting on a ketogenic diet and going through this whole transitionary period and you’re feeling a little woozy in your brain, you’re feeling you’ve got the keto flu or whatever, my suggestion is just to bring it down a notch. Plain old walking is your best friend. Stretching is your best friend. Don’t go out there and just, “It’s time for CrossFit.” You are dead in the water. You’ll probably pass out. I wouldn’t do that. I would just bring it all down. Listen to your body. Your body is good at telling you what you need to do next. Don’t listen to the gurus. Don’t go into these keto boards and Facebook groups and what have you. It will make you insane.
Some of those groups are actually very similar to the chronic pain groups. It’s great that people share information of course, but some people are just in there espousing information that really has little value. It doesn’t give any benefit and sometimes it can actually be quite harmful. Do you recommend that people test their ketones? Do you have them pee on the stick? Are you doing a little ketone tester? A lot of all these products coming to the market now, which again, can help sometimes and other times can be a little confusing for people.
We both know Terry Wahls, who’s one of my nutritional heroes. I had an intense conversation while I was creating this diet. I said, “What do you think?” One of the things that stuck with me that she said is, “It’s good for a season and sometimes you need to go out of it.” She said, “I happen to think that when hunter-gatherers back in the day, the Paleo days, were out there doing their thing, they got into ketosis part of the year because it’s just what was available.” It makes sense and then summer comes along, they fatten up and they’re eating all the berries and stuff and they’re putting sugar back into their diets and then they changed, not like, they were these paradigms of health. They have huge, long lifespans. No, but it makes sense for us as people. I don’t think that for long periods of time it’s a good idea.
However, I will say this, that the testing stuff is all part of the crazy network. Also, the macro thing is all part of the crazy network. If you just keep these things. I give people the information on the hot melt diets because they want it. I know if I don’t give it, they’re going to go crazy here. Here are the things you need to look at. To get into ketosis you need periods of time where you can go without eating. That’s the fastest route into ketosis. If you could fast three days, you’ll get into ketosis like that. I’m not recommending that. I’m just saying that that’s the thing. The second part about it is that you will smell it in your urine. It smells like nail polish remover. There’s your best test. Your breath will feel funky, almost like a metal tasting in your mouth. That’s your best test. That is proven with everybody across the board.
You can poke your finger all day, you can pee on a stick all day, those keto sticks are not that accurate. Blood is more accurate. That’s expensive, so why not go with your breath or whatever. The macro thing is crazy. I think it’s nuts. Do you know how much protein you normally eat? Bring it down a couple of ounces, add some more greens to it, and see how long you can go without eating. Make sure that there’s fat in your diet and it’s not all about the fat, it’s about increased fat. It’s not having this greasy diet. That’s where I think people also get a mistake. It’s a shift. It’s getting rid of the glycogen that’s in your liver and using the fat stores that you have in your body as your fuel. That’s all it is.
There are tons of great points there. We had Terry Wahls on the podcast at least once, maybe even twice. She’s definitely been on my summit. You’ve mentioned intermittent fasting. Of course, if you can instrument and fast for three days right now, which I don’t recommend. What’s your recommendation for someone starting out in ketosis? Do you recommend one meal a week or one day a week? Do you have a general recommendation for fasting?
Especially for women, if you respect your hormones, I think you need to do it every other day. It’s interesting because the research that’s out on intermittent fasting, there’s hardly anything for women. We have to also look at women who are either menstruating, perimenopause, menopause, post-menopause. There’s a whole spectrum there of different hormone profiles. In order to not make yourself nutty, it’s an every other day thing and this is how I recommend it. Have an early dinner, the next day, just see how you feel. Right now, I’m in intermittent fasting. I have not had breakfast today, I’ve had some black coffee, I’ve had some lots of water, but I’m intermittent fasting. I’m going to see how long I can go. Twelve to eighteen hours is great. You don’t have to make it days on end.
If suddenly in an hour I feel hungry, I’ll go make a smoothie. It’s just that simple. You listen to your body, your body will tell you. That’s the one thing on intermittent fasting. The second thing is that we have a lot more control over what we think our appetite is than we know. The one problem that we have is that people snack constantly. It keeps their blood sugars levels up. They’ve never felt hungry. Not feeling hungry is a problem. It screws up your Leptin and Ghrelin. It’s a big hassle. That’s why I recommend just say no to snacks and if you’re absolutely dying, keep something in your purse so you’re not tempted to drive through something or do something. Keep something with you at all times as an emergency backup, but train your body to eat meals and not snacks.
You’ve also mentioned that people should be cycling between a ketogenetic diet and whatever their version that’s right for their body of an anti-inflammatory diet. When I was doing research for my book, one of the best studies I came across for the ketogenic diet was you were on an anti-inflammatory diet for four months, cycled into ketosis for about two, back to an anti-inflammatory diet for four and then back again into ketosis for another two months. That was what these research participants, that was their year basically, the amount of inflammation, their inflammatory markers, their body weight, their fat went down, all their blood sugar, the HbA1c, everything just dipped. It was only from the cycling because the group that didn’t cycle actually wound up getting fatter.
Your body adapts. That’s why I say I don’t think you should be doing it on a constant basis. I think that there are people who, this is their zone and that they can just sit there and they’re happy. A lot of times there are people who have 100 pounds or more to lose. I’ve had just amazing stories from people who have been on this plan and doing this and it’s great. It’s back to what Terry said, what you just said about the research and you need to cycle out, which doesn’t mean that you start adding inflammatory foods back and you stay anti-inflammatory. Your body needs to be surprised a little bit. Otherwise, it will adapt and that’s why intermittent fasting needs to be intermittent and not on a constant basis. It’s like you see people at the gym, what do they do? They get on the treadmill and they always look the same because they’re just doing their thing. Your body is smart. You need to outsmart your body.
You’ve mentioned earlier that you’ve had some pain. Once at a conference, we were evaluating your shoulders because you had a little bit of shoulder pain, which is very common in people with thyroid problems. How do you approach pain in your life? For some people, it can be very concerning. It can make them feel hopeless and helpless. How do you approach pain and just keep going?
I certainly am thankful that I have a whole lot less pain than I used to have. I used to have it really bad. A couple of things that I do that I think are tremendously helpful, when I was a freelance writer way back in the ‘90s, I constantly had new assignments coming my way and I thought carpal tunnel like nobody’s business. I would be typing on the computer and just crying in pain. I had a friend of mine who’s a Functional MD back before anybody knew what a Functional MD was. He said, “Here are a couple things that you need to do.” He told me to go magnesium, Epsom salt baths, SAMe because I was doing the Chondroitin and all this other kind of stuff.
I’m doing SAMe 400 mg and for me, it was like the thing. Every single morning, I take it. I don’t have any joint pain whatsoever but my diet’s also on point and very anti-inflammatory. I will dip my toe in the 120-day cheese maybe once or twice a week, maybe on top of my hot melt spaghetti. You just have to do that. When you find your little zone of where you don’t have pain or you have lesser pain, you need to do more of that. That’s how I looked at it. It was that simple.
I had been speaking with Leanne Ely. You can find her at SavingDinner.com. She got some great recipes and great diets. You can access all of those there. Make sure to download the hot melt keto recipes that she’s giving us all for free. You can grab that by going to DrJoeTatta.com/99Download, or you can text the word 99Download to the number 44-222. I want to thank Leanne for being here. Make sure to check her out on SavingDinner.com. Hop on to iTunes and give us a five-star review. I’m Dr. Joe Tatta and we’ll see you next week.
About Leanne Ely
Leanne Ely began creating Menu-Mailer on SavingDinner.com in 2001 to help families get back to the dinner table. Within just a few years, Readers Digest declared a new industry had been born — the menu planning industry — and Leanne was dubbed the “mother” of menu planning.
SavingDinner.com’s goal is to bring families closer together by enjoying healthy and easy-to-prepare meals. We do this by creating innovative menu planning products like Premium Menu-Mailer, which includes delicious and nutritious recipes, shopping lists and nutritional information!
SavingDinner.com also features an informative daily blog where you can find nutritional tips and tricks, delicious recipes and the tools you need to eat healthy and prepare delicious family dinners!
The Healing Pain Podcast features expert interviews and serves as:
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A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.
If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at [email protected]. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.
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