Episode 19: Supplementing Your Health: The Facts Behind Natural Products Research with Dr. Chris D’Adamo

Evelyne: Thank you. Chris D’Adamo has a PhD in epidemiology. He is the director for the Center for Integrative Medicine at the University of Maryland, and he is on the scientific advisory board at Designs for Health. Welcome to the show.

Chris D’Adamo: Thank you.

Evelyne: You have led many clinical trials, you have written many research proposals. What is the current state of natural products research and what are some of the challenges?

Chris D’Adamo: Well, I think it’s probably the most exciting time to be a natural products researchers because there’s been an explosion in studies in recent years. There’s still challenges though, as you noted, and there are many, ranging from financial, we need grants to do studies and most of us in academic medicine get our grants from the National Institutes of Health, and they historically haven’t funded many dietary supplement clinical trials and natural products clinical trials. They fund some, but it’s a very small amount. We’re left essentially with needing industry funding to do these studies, and there’s no patent protection for doing these, so you get these financial challenges for doing it. I commend the companies that do invest in clinical trials, because it’s not something they have to do. There’s all these copycat companies out there that will just piggyback on the research that other companies have done.

That’s one of the challenges. There are others when it comes to what we actually can study. A lot of times we hear, “There’s no evidence for whatever this supplement is for this condition,” and it’s tough to generate that evidence when you can’t look at disease outcomes in many instances without what’s called an investigational new drug from the FDA. We can talk about some of the details with that. But these challenges, not withstanding, there’s still just an explosion of clinical research that is, I think, really validating. We’ve known for a long time that dietary supplements can support optimal health in many ways.

Evelyne: Talk about some more of the problems with getting studies approved by IRBs.

Chris D’Adamo: Yeah, so for those that aren’t really familiar, IRB is an institutional review board, and it’s there to protect the safety, really, of human subjects that are in research. That’s a good thing, obviously. There’s been some exploitation research in the past certainly. But with that, a lot of times IRBs aren’t really familiar with DSHEA and some of the provisions that it has where dietary supplements are regulated differently than drugs and as a result what’s required is different. You don’t need, technically an investigational new drug, D stands… IND drug, dietary supplements aren’t drugs. What you end up with is you get some confusion at the IRB level in a lot of academic medical institutions. Fortunately, mine has been pretty good at University of Maryland. It helps that the IRB Vice chair was a classmate of mine and I got to sit down and explain, “Look, this is how this all works.”

But other institutions, it can be quite difficult. There are a lot of private IRBs, and this can actually be I relevance because dietary supplement research isn’t just limited to academicians and PhD and so on. This is something that can be done certainly in clinical practice, usually with some partnership with a research or clinical research of some sort. But there are a lot of private IRBs that have a solid understanding of what’s DSHEA and how dietary supplements and the research are a little bit different than drugs.

Evelyne: You’ve mentioned DSHEA twice. For anyone not familiar with DSHEA, can you talk about that?

Chris D’Adamo: Yeah, so DSHEA is the Dietary Supplement Health Education Act going back to 1994 that established a dietary supplements among other things defined what they are, something to supplement the diet orally. Things like probiotic skin creams and hair products that are not actually considered dietary supplements, but there’s different classes that we all know, vitamins, minerals, amino acids, botanicals and so on. But basically, it just established that they are regulated, but they’re regulated as foods and not as drugs.

Evelyne: Thank you. You mentioned the INDs. What are some of the differences between clinical trials, say in pharma and in our natural product space? What is the cost of doing a trial just so people have an idea of the difference?

Chris D’Adamo: Oh, yeah. Well, I think one big difference is just a very practical one is that pharma can and does patent their medications. They have much more financial incentive to do so they can pump tons of money into clinical trials and then they can reap the rewards of that investment. In natural products, we don’t have that, so they’re not patentable and there’s not as much an incentive, which is again why I commend the companies that are doing the clinical trials because we need it. We know we’re… In functional medicine, integrated medicine, we’re expanding the toll set to help our patients, and we want to have evidence for doing that. The slam is, “Oh, there’s not enough evidence,” as I mentioned before, but so we need the better players in the industry to take a role in funding good, solid clinical trials. There have been quite a few and a wide variety of categories, which is encouraging. I just think it’s helping result in better clinical care and better self-care for people. I take a number of supplements because I think the evidence supports it and I feel like it’s helped me.

Evelyne: Yeah. I think sometimes people perceive it as a negative thing if a trial is funded by a manufacturer or by a supplier, but we need somebody to fund the study.

Chris D’Adamo: That’s really interesting because it’s like, what’s that, seven degrees of Kevin Bacon or something? It’s like two degrees of industry behind pretty much everything at the very least. What I mean by that strange analogy is that the industry funds most nutrition studies period, if you look at it, they’re funded like the blueberry studies are funded by the Blueberry Council or walnuts or whatever it might be. That’s not actually a bad thing, if it goes through peer review and the data are made transparent. There’s a trend, although it doesn’t happen at all in some controversial areas now especially, you don’t always get the data, but a lot of times now when a study’s published, the journal actually will request that you make the data available for other researchers to take a look at. I think as long as that happens, as long as it goes through a good, fair peer review, the data are available for other researchers to look at, that’s a good thing.

A lot of pharma studies, most of their products are funded by… These are things that are FDA approved and become standard of care. When I hear about it singled out in natural product industry, I’m like, “Well, that’s just the way research largely works.” What I mean by the one degree separation is that a lot of times, even things that are NIH funded, there’s an NIH foundation that’s funded by industry. NIH’s budget comes from Congress, you know there’s big lobbies that fund the NIH. This is just reality of if you look at most research, this is just the way that it is. Is that ideal? Maybe not. But I think as long as you’ve got honest researchers and transparency and data that you can go out and see, then I think we’re okay.

Evelyne: Yeah. How can practitioners evaluate clinical trials? What are some of the things to look for?

Chris D’Adamo: That’s a great question. You want to make sure that it’s registered on clinicaltrials.gov, and most of them are. What that is that was a safeguard put into place really for pharma. Clinicaltrials.gov is there, it’s the A priority, when you do the study, “These are the outcomes that we think are of interest, these are our primary outcomes, secondary outcome,” because a lot of times what was happening was pharma was doing three clinical trials and only publishing the ones that had good results. Now, this applies to everybody, and that was a positive development, clinicaltrials.gov registration. Did they follow what’s called the consort statement, which is a guidelines on transparent reporting. You look at the conflicts of interest and they’re going to be there a lot of times, but as long as they’re transparent and so forth, published in a PubMed index journal, that kind of thing. Those are the types of things to look at. What is it? Are the conclusions reasonable? If it feels like an advertisement, it may be. But those are just some of the things that I would stress looking at.

Evelyne: Yeah. What about some of some companies I’ve seen them using maybe a survey where it’s not published, it’s like unpublished data. Can we still draw conclusions from that? Is that fair?

Chris D’Adamo: Yeah, there’s all different levels of evidence. There’s your published trials and so on, but there, there’s all different levels. I think there’s even the level of traditional usage of something or “We know X number of people are using this and there’s been no adverse events or something.” I think it can be reductions to look just at randomized controlled trials. There are people that are that way. I think that’s important, but I think there’s a variety of different levels of evidence. Would a survey that hasn’t been published in some and be as rigorous as a good clinical trial? No, but it still could give us good information sometimes.

Evelyne: Yeah, I definitely agree with that as an herbalist, because many botanicals have thousands of years of usage.

Chris D’Adamo: Yeah, for sure. Definitely. Even ones that are modern supplements that there may not be a lot of studies in a particular area, but we talk about the safety. I feel like when we think about evidence, we think about how well do we know that it’s safe. A new product, I don’t care how big the single clinical trial is, if we’re talking about a medication, a vaccine, something like that. If it’s new, it’s new, but if it’s turmeric or ginger, it’s been used for thousands of years. Not to say that it can’t ever hurt somebody. Sometimes they’ll have lead and in some of them, but the better companies are doing third party lab testing to make sure it’s not the case. But we know that people have been using those things for a very long time.

Evelyne: Yeah, absolutely. I think when we’re looking at pharmaceutical trials on drugs, you’re looking at a specific outcome. But in functional medicine and integrative medicine, there are so many factors, and often we’re not looking at someone’s genetic SNPs. We’re not looking at what they’re eating because we’re just trying to test one specific thing. But I feel like when practitioners are treating a patient, they’re looking at the whole picture. Of course, in research we can’t account for that. Do you have any thoughts on that?

Chris D’Adamo: Yeah, definitely. I think that’s one of the things that makes research in our field challenging sometimes because yeah, if you’re looking at a pharmaceutical, it’s usually a single pathway at least that we know of, at least that’s how it’s designed, and a single outcome. But I think we think about biological systems as we do in functional medicine, it becomes a little bit more complicated. Sometimes, we are also very aware of the need for personalization. I think if we look at some of the recent vitamin D trials that don’t look at that, I think we need to look at baseline levels of a nutrient, certain variants that may influence it, someone’s age.

There’s so many different factors that can influence the response. I think we’re maybe a little bit more aware of that in functional medicine. In conventional medicine, you might do a subgroup analysis. We looked at it and see how did the product do among… I don’t know. Some factor, those that had worse disease or those that were older or whatever it might be. But we’re constantly thinking about those things. I think in that sense, personalization is built into the DNA of what we do.

Evelyne: It would be cool if we could do that in pharmaceutical trials also.

Chris D’Adamo: Yeah, I think there’s been this whole era of personalized medicine and so on that we were able to make great discoveries with the genome and so on. But I’m not sure that’s really reaped the true potential of what’s there yet. I think because it’s more than just the genes, it’s our microbiota, all kinds of other, or exposome, all the chemicals are around. It’s our lifestyle, all these other things that I think a lot of people in our field can take a leadership role in bringing to the forefront.

Evelyne: What are some of the other factors that practitioners should look for when choosing a dietary supplement? You mentioned third party testing.

Chris D’Adamo: Yeah, that’s a great question. I get the practitioners and consumers alike is how do you make those decisions? Because product A and product B have the same nutrient or a supplement could be very different. You mentioned third party lab testing. There’s a number of good ones, NSF, USP, and a variety of other ones. I really commend that because it’s voluntary, it’s a sign that the company cares enough to invest extra resources to make sure that their product has on the label what it says it has and doesn’t have things you don’t want, like heavy metals, high micro counts, other things like that. That’s a really big one.

When you can find published research on the finished product, that’s great too, for certain. Those that I’m not a real big fan of proprietary blends. I get it from a business case sometimes, but that makes it difficult for the consumer to know exactly how much is there. Now you do know that the ingredient listed first is one that’s in the highest amount and the one in the bottom. You see, we call some of those pixie dusting where you’ll see, “Oh, look, all the good stuff’s at the bottom because those are the expensive ingredients.” I think typically proprietary blends or something that I’m not real crazy about. But yeah, third party lab peer-reviewed research on it, a brand that’s been around for a while I think, too. Those are some things that I think of.

Evelyne: What are resources that practitioners can go to and maybe even share with their patients to make informed decisions about supplement usage?

Chris D’Adamo: This is great. I’ll even tell you, you would think my first place to go is PubMed, and it’s always a backup, but I actually usually go to examine.com first because it’s got such a good team and everything links to PubMed. That’s my first pass if there’s some, with most supplements at this point. But if there’s something that I don’t know a whole lot about, I’ll go and take a look at that. I recommend that to patients and practitioners because with that, for those that aren’t familiar with the site, it will provide a high level overview of any supplement, but then it gets into usage considerations. Like if you go to for curcumin, like the solubility and these kinds of things, how much you take for certain conditions, it’s going to vary what potential interactions are there. Then even not only is there links directly to all the studies in PubMed, but deep mechanisms and all types of things.

It goes really deep. Curcumin, I’ll give you an example, I think it has 400 citations on the examine.com page. Then, of course, I’ll go and I’ll look at PubMed for, they’re usually pretty nicely updated, but if there’s something else, so like that. Natural Medicine’s database is another one. I like, not all products are on this, but labdoor.com, Consumer Lab, these are other ones that they go and get off the shelf. They’re not perfect. We don’t have to get into the details of that, but it’s something again, you can recommend to patients to look at sometimes. Then I like Mytavin, too. That’s something that, because a lot of times… Again, I think in functional medicine, our patients are a little bit more aware of the impact that medications can have on nutrient depletion, but Mytavin will very clearly say… Well, we know statin is CoQ10, we’re taking a statin and saying, “This can deplete CoQ10 and other things like that, too.” It makes a very clear indication that because this is a really under-recognized problem in medicine right now. Those are some that jump to mind.

Evelyne: Great, thank you. What do you think are some of the most underrated supplements based on research that have demonstrated effectiveness?

Chris D’Adamo: You’re probably going to think I’m going to say some red hot news supplements. The ones that I think are underrated or actually some oldies but goodies. My first would be creatine monohydrate. I think it’s a fantastic supplement. We typically think of that for athletic performance and strength and so on, for which it’s very good, but it’s also got some really interesting data for cognition and even as a monotherapy for depression. That’s because it basically helps our body make ATP so it can provide energy. It’s especially important for vegetarians and vegans because creatine we typically obtain through animal products. If you look at some of the studies that looked at different subgroups, they’re the ones that tend to benefit the most from creatine because they’re not getting get in their diet, but I think it is great for anybody, especially older adults that are wanting to preserve muscle mass. But I love it. I take it, I’ve taken it for a long time.

Evelyne: What amounts for depression?

Chris D’Adamo: Usually five grams a day. With creatine, there’s this old bodybuilding thing where you would have to load, but that really doesn’t seem necessary where you would take a whole bunch of it and that’s where you might get some side effects. It has very few side effects, but that’s where you could get some of the water retention, some of those types of things. You want to stay hydrated when you’re drinking it, it helps draw water into the muscles. But yeah, I think five grams a day typically, and then you let it build up over time. I think that’s a wonderful supplement with an excellent, talk about excellent track record of safety, hundreds of publications used for all kinds of things. That’d be one. The next one’s not an oldie but goody, but glucosamine chondroitin. Again, we think of it typically for joint health and most of the studies are positive. We won’t get too much into the rabbit hole. The GAIT trial is the one that a lot of people say, “Well, didn’t that big trial show that it didn’t work?” It actually didn’t.

Maybe I’ll get into this a little bit. It is pretty interesting.

Evelyne: Yes, please.

Chris D’Adamo: Yeah. The GAIT trial was a large NIH funded trial that compared glucosamine to chondroitin, to the combination, to placebo, to Celebrex, and in the primary analysis, so they did a WOMAC as a composite arthritis pain and function. The 20% improvement was the primary outcome, it seems arbitrary and maybe it was, but that’s what they chose. Again, they registered that on clinicaltrials.gov. That’s the value of going back and checking that. But what they found was that in the main analysis of all people, those with knee arthritis, that there was a huge placebo effect. It was like 60%. We know that that’s pretty big for pain, right? There’s a big placebo effect.

The glucosamine chondroitin was like 66% that improvement, but statistical significance was P value 0.09 and Celebrex was statistically significant. But if you look at the moderate to severe group, which is most people who are taking it, glucosamine chondroitin was statistically significant and Celebrex wasn’t, that wasn’t anywhere in all the media reports about this, that Celebrex, this big blockbuster drug did not improve osteoarthritis in those with moderate to severe pain. It’s just that selective reporting that we get with a lot of this stuff. I won’t get into too much on the why’s of that, but that study notwithstanding the vast majority of studies show that it’s actually non-inferior to Cox-2 inhibitors like Celebrex and can improve joint pain and function.

Now, what I think is interesting about why I think it’s underrated is that beyond joint health, which is a big problem for a lot of people, it actually has been shown to reduce all-cause mortality after adjusting for a bunch of different things. That’s other supplements that are really good ones like Omega-3 fats and vitamin D and so on actually did not, but glucosamine chondroitin did.

Evelyne: That’s fascinating.

Chris D’Adamo: It is really interesting. We don’t hear a lot about that. These are repeated big studies with 25,000 people plus, and I think it’s larger because it’s such a nice anti-inflammatory. It’s an old product, but it’s a really good one. It’s a little newer… Last one, I won’t bore you with this. I take a bunch of things, but I would be astaxanthin. I like that, too. That’s a carotenoid and I like it for its ability to go to the macula. Lutein zeaxathin are good ones too, and even to serve as a bit of a mild sunblock in a way. I think there’s a lot of interesting activity, how that protects cells, a little bit layer of cells. I think that’s another cool product.

Evelyne: Very cool. Can you share some of the trials that have been done on astaxanthin?

Chris D’Adamo: Astaxanthin doesn’t have as many trials. Let’s say, it’s a little bit different than the other two. There’s been hundreds of studies on both of those, but they’ve looked at eye function, they’ve looked at cellular protection, some of these are in human beings that I think is pretty interesting. We’re still in the early innings. There haven’t been the large multicenter trials as there have for the others. But I think mechanistically, just as a way to protect ourselves from oxidative stress, which we’re all around all the time, is helpful and it’s hard to get in the diet. It’s red. If you get a really nice wild caught salmon, sockeye salmon, that red is the astaxanthin, but it’s not in food as much as a lot of other carotenoids are.

Evelyne: Since you’re always evaluating research, what are some of the biggest nutrient deficiencies that we see?

Chris D’Adamo: Well, I think the biggest one’s probably vitamin D that became especially apparent during Covid when just unbelievably strong protection against adverse and severe outcomes from Covid for those who were vitamin D replete. I don’t think I got nearly enough attention. I was screaming from the mountaintops, “Let’s get vitamin D in everybody,” because it was so profound. If you look at it consistently, systematic review in meta analysis, those that had higher vitamin D levels were much less likely to have hospitalization, death and so on. Some would say, “Well, there’s some confounding in” observational studies of vitamin D, but also the clinical trials look quite good as well. I think vitamin D would be the one probably the most important, I think, especially as we spend more time inside and this type of deal, especially if you live in northern latitudes.

Then magnesium would be the other one too. We’re just not getting sources, enough sources of it in our diet from leafy greens and so on. Although, sometimes there’s controversy about whether leafy greens are really the best source because sometimes you buy these things are bound to antinutrients, oxalates and those kinds of things, but it’s like salmon bones and these kinds of things that people don’t really like to eat very much. We’re not getting very much magnesium either. I think supplementing with both of those two nutrients is an important thing than to do.

Evelyne: Let’s talk a little bit more about vitamin D. I’ve noticed that in conventional medicine we stopped testing vitamin D. A lot of doctors don’t want to test for it, and insurance is not covering it a lot of times. Why is that?

Chris D’Adamo: Yeah, so I think a lot of this is deriving from the study called the VITAL trial and accompanying New England Journal of Medicine editorial. Basically the VITAL trial found that… This was a study that was looking at among other things, osteoporosis, and they found that in that trial, vitamin D supplementation did not decrease the risk of osteoporosis. In this particular group though, there’s some really important caveats that are, I’d say they’re more than just caveats. They’re like hit you over the head, important factors that didn’t get discussed, though, the authors themselves talked about them. That was that they didn’t actually test who was vitamin D replete or deficient at baseline. Again, everyone’s a little bit different. We need to personalize this, and we have a robust literature, Cochrane reviews of many, many trials over the years that show that vitamin D reduces the risk of osteoporosis and fractures.

This one study comes along, a big study admittedly, and then all of a sudden we have editorials that we should stop testing vitamin D, and we don’t think about all of the other conditions that vitamin D has been associated with. Everything from like IBD, again, certainly osteoporosis and falls, and headache, depression and so on. It was a baffling suggestion given how fundamentally we know vitamin D is to human health. It’s not a very invasive or expensive test. Actually, a number of us wrote letters to the editor of New England Journal Medicine, didn’t get published, but it’s an area where I think there’s been rightful pushback because it seems like of all of the waste in medicine today, testing vitamin D is very low on my list in terms of the cost that has and the potential return that you could get by getting levels.

Evelyne: Yeah. Let’s talk about something else that’s controversial right now in the literature or maybe on social media. There’s a lot of controversy around protein intake. Some are saying, “We need to be consuming more protein. Everybody’s under consuming protein.” Some are saying now… Or some research has shown that high protein intake is related to shorter lifespan. What are your thoughts on this and what does the research show?

Chris D’Adamo: Yeah, so I have many thoughts on this. I’ll try to condense it as much as possible. I think that my doctoral work was in hip fracture recovery and looked at micronutrients and how that influenced physical function and so on after that. My lens is from that aging side in human beings and seeing just how devastating sarcopenia or loss of muscle mass is to not just longevity, but health span, the ability to function well. Study after study shows that sarcopenia is associated with all-cause mortality and lots of other sequela of aging. You want to keep your lean body mass. We know that with age, our ability for muscle protein synthesis decreases. We need to get more protein to compensate for that. I think pretty much everyone agrees on that part, though it still gets missed sometimes. I think when you think about challenges in society today with things like obesity and those diseases related to that and issues with diet quality and so on, protein’s the most satiating macronutrient. It has the highest thermogenic capacity.

It’s one that I think we really ought to… I think people generally actually under consume, but I think even more importantly than how many grams they’re eating, and this is what I think is really important is the quality of protein. They’re not all created the same. The quality of the protein you’re going to get in broccoli and a grass fed steak is very, very different. Not to say broccoli is great too, but it’s not a great protein source. You need to look at the bioavailability of that protein so it’s not just be the number of grams. There’s been a number of good scales that have been put forth, and I always have a hard time remembering what the acronym stands for. There’s the PDCAAS is one way, basically it gets down into protein digestibility and looks at different things. Start the top you get whey, it’s really bioavailable.

You’re able to take those amino acids, they’re in the right ratios that we want as humans, and then you get things like wheat and rice and so that are lower. I think we need to think about the quality of the protein. Generally speaking, all protein is of higher quality. You can get, there are good plant-based protein powders today that will actually look at and mirror the amino acid content that we want ideally as humans. Think about amino acids and not just the number of grams of protein would be my suggestion to people. This can have a really big effect. All kinds of studies that are interesting, just in terms of to get the same amount of amino acid, you have to eat a lot more plants, so you’re going to get a lot more food and calories and potential GI distress and that kind of stuff than you would from good sources. I think whey is probably the ultimate, certainly as far as supplemental protein goes, but I could probably leave it there. We could go on, but…

Evelyne: Can you talk a little bit more about human research versus maybe animal research when it comes to protein?

Chris D’Adamo: Yeah, I think it’s interesting, and this ties a little bit into the time-restricted eating stuff too. There’s a lot of interest in mTOR. I think there is a time and place potentially for restricting mTOR, but definitely not all the time, especially not as we, I guess we’re all aging, but especially not as you get into older age. Because what happens in mice, we’ve seen this in all kinds of studies, is different in rats, is different than what happens in humans. This also touches into the time restricted eating a little bit, too, how long you need to go. I’m a big advocate of it, as you know, but getting into autophagy, and it may take a mouse 12 hours or 24 hours actually, but that’s a lot longer than a human.

There’s a long history, there’s been a lot of good papers on it, too, about how we’ve missed the target a lot of times with agents that didn’t work well in mice that would ultimately work well in humans. Then agents that worked well in mice but didn’t work very well in humans because we’re different. I think when you look at diets, we’re probably best, this is controversial I guess, too, but probably most likely, I think most argue we’re omnivores. I know there’s strong vegan and strong carnivore contingents too, but mice and rats are different. They’re not us. I think diet studies in particular also have some questionable translation to humans.

Evelyne: Yeah. What are some of your personal favorite supplements and why?

Chris D’Adamo: Well, the creatine and glucosamine, for sure. I take a couple different kinds of magnesium. I get a pretty good amount in my diet, but I take magnesium L-threonate. I like the fact that it gets to the brain and I take citrate for the rest of my body. I have a poor methalator, so I like methyl donating agents, so TMG. Actually, I really like collagen, so I take quite a bit of collagen. I take a variety of those. Those are some of the ones that are coming down. I like cod liver oil. These are all things that I think are helpful.

Evelyne: Since you mentioned collagen, you gave a lecture a few months ago on collagen, on research on collagen. Can you share some highlights from that?

Chris D’Adamo: Yeah, there’s a lot of good research on collagen for skin health, for joint health. It’s just a major component of connective tissue, and we really don’t get the amounts that we used to get when we’re eating broths, and stocks, and knuckles, and these things that most people don’t eat these days. I think that’s one of the things that, again, I think animal proteins is health promoting, if it’s from a good well sourced animal, those kinds of things. But if there were issues with methionine, which some people argue… Again, there’s a lot of debate on this stuff, getting more glycine that you get from collagen. I think that’s one of the keys to collagen. Now, you can just take glycine too, but I think one of the keys of collagen is it’s a really good source of glycine that can balance out methionine. Glycine has a lot of other potential benefits for sleep, and it’s got some interesting effects on neurotransmitters and so on. I think collagen is a great thing to add to the diet, for anyone interested in joint, skin and hair health.

Evelyne: What are your top health practices for personal health and wellbeing?

Chris D’Adamo: Yeah, so I think the obvious stuff like eating a nutrient dense diet, not eating as many ultra processed foods, getting good sleep, trying to be consistent with that, having some form of stress management practice. Those are the cornerstones. I also have really gotten into, I like time restricted eating. I’ve tried doing longer fasts and so on. I think some people can overdo it, the fasting, for sure. I think being somewhat sensible with that, you feel yourself getting… Because it’s a stressor. If you’ve got too many hermetic stressors, which we see a lot of people doing sauna, and ice baths, and real intense exercise and fasting. That can be a little bit much, especially if you’ve got a stressful life. But I think some form of time restricted eating, specifically on the giving yourself ample time before going to bed, not eating a real heavy meal, giving three hours or so.

You’ll see it you in my Oura Ring here. You’ll see typically your sleep scores improve from doing that. I also really like chronobiology just in general. That’s part of it, but light and being aware of that, blocking blue and green light at night. We have actually gotten in our house red light bulbs in the bedroom and got those dorky red glasses and those things. A lot of the red will also block green, so you get the orange ones. Then also getting morning light. I think again, kind of tapping into that and also being aware of lighting throughout the day. Light, this is blank as medicine, but light is medicine. Getting bright light during the day, getting outside where you can think about what I think is interesting. You can get these little lux meters to measure how much the brightness of the lights you’re getting.

Going outside, even on a cloudy day, you’re going to get maybe not as many as with these bright lights here, but you’re going to get a lot then too. I’d say even when it looks overcast, trying to get outside and getting light during the day, I’m a really big believer in that for mood. You’re going to get the vitamin D, but you’re also going to get, there’s more to it than that. From sunlight, you’re going to get its nitric oxide production and other benefits from that. Those are some things, and just toxin mitigation and a lot of different things. I think HEPA purifier, air purifiers and with water and these kinds of things, and just being aware of our, not using too many chemical cleaners in the house, and fragrances, and that kind of stuff. That’s a variety of things, but I think those are all things that are fairly accessible, it doesn’t cost much to do those things, but I think they can have great returns.

Evelyne: Yeah. I know you’re a big fan of fasting. What was that longest fast you did recently?

Chris D’Adamo: Yeah, I did five days. I don’t think I’m going to be doing that again either. I was really struggling. I think some people do really well with that. But I had done it coming up to a conference. A lot of days I travel, a lot of times I don’t eat, and then I was like, “Oh, just keep it going,” then wanted to push myself. I do think for me, everyone’s a little different. I do pretty well by doing 24 hours, maybe once every few weeks, but I typically do 16… I don’t do anything too extreme. I found that works pretty well for me.

The times where I’ve gone much deeper or done much longer fasting, I would feel a little bit of that overstress where it’s like, because when you’re doing the time restricted eating, you’re going to get more norepinephrine. That can be good. You’re going to get more orexin, these alertness chemicals, but you get too much of that for too long, it can be a little bit of an issue. I think it’s like anything else. You don’t want to exercise for six hours a day, but you do want to exercise. I think it’s the same kind of thing of not pushing it too much with a lot of these things.

Evelyne: Next time, maybe four days.

Chris D’Adamo: Yeah, I know. Let’s see. I think I’m going to… That was an eye opening experience, and other people have done that and they’ve felt great. Other people have done 10 day water fasts or longer. I don’t know. We’ll see. It’s going to be a little while before I do that again, but I think I’ll probably do 24 hours tomorrow, at least, when I get back home.

Evelyne: What is something that you’ve changed your mind about through all of your years in integrative medicine?

Chris D’Adamo: I think one is the importance of breathing. I think some of those things I talked about too, about not eating. I used to eat right before I went to bed, so I did in power lifting and stuff like that. I always heard, “You’re going to go catabolic if you don’t have your casein right before you go to bed,” that kind of stuff, it’s just not at all true. I think that’s one thing that was, I realized that years ago, but more recently, the importance of nasal breathing I think has really, I felt the differences with that. I mentioned to you, I’ve had my nose broken a few times, and I basically became a mouth breather, maybe as long back as I can remember and have just more consciously been breathing through my nose, being more aware of my breathing, being aware of email apnea. I suggest that to anybody too. That’s such a common phenomenon that I found myself doing it all the time, not just emails, but when you’re really concentrating on something like I’m not breathing.

Evelyne: I just realized I’m doing it right now.

Chris D’Adamo: Yeah, I think a lot of us do. It was took a long time of awareness like, “Am I breathing? Am I breathing?” I’m just going to make a mantra, and I’ve gotten much better at that. I think the combination of… How it’s manifested was that I feel like I need less coffee. I feel like my mental endurance is better because I’m breathing more regularly and it’s hard to do while you’re talking. But I think that’s been, so for those who haven’t heard it look up email apnea, you’re probably doing it and you’d probably benefit by not doing it, and then mouth taping, these things. I’ve had to do that just some people just naturally breathe through their nose, but I’m really not one of them, I had to do some work. But that’s one that I kind of picked up in integrated medicine and I’m glad I did. ****

Evelyne: Great. Well, thank you so much. Thank you so much for being here and sharing, and thank you for your expertise and all your contributions to this field.

Chris D’Adamo: You’re very welcome. Thank you, Evelyne.

Evelyne: Thank you for tuning into Conversations for Health. Check out the show notes for the resources shared on today’s episode. Please share this podcast with your colleagues follow rate or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts exploring evidence-based, cutting edge research and practical tips.