Are we getting enough nutrients from our diet? And why do nutrient deficiencies persist even in those of us who are putting a lot of attention to what we’re eating? Join me and Chris Kresser as we dive into all things nutrient insufficiencies on this episode of New Frontiers. Chris is the founder of the Kresser Institute and the co-founder of the California Center for Functional Medicine, the bestselling author of The Paleo Cure and Unconventional Medicine, and a highly respected clinician in our space. We talk about the inadequacies of RDAs, the latest statistics on nutrient insufficiencies, the importance of nutrient bioavailability and nutrient synergy and why taking supplements on top of a really poor diet is not going to help. We also marvel at the wonders of magnesium, the interplay between vitamins D, K2 and A, and calcium plus so much more! It is a conversation filled with clinical pearls and practical implications, so get ready to take notes and tune in! ~DrKF
Nutrient Synergy: Why Supplements Can’t Compensate a Poor Diet with Chris Kresser
Is there a hidden nutrient insufficiency pandemic? What are the factors that reduce nutrient bioavailability and absorption? In this episode of New Frontiers, Chris Kresser MS LAc discusses why nutrient insufficiencies are so common – and what we can do to reverse them. He’s the founder of the Kresser institute, a renowned clinician who’s trained over 2,000 practitioners, and has been named as one of the hundred most influential people in health and fitness by greatest.com. Drawing on decades of studying nutrients and clinical practice, Kresser has recently launched, ADAPT Naturals, a supplement line designed to add back in what the modern world has squeezed out and help people perform and feel their best.
Kresser also explores the difference between insufficiency and deficiency, why we certain nutrients shouldn’t be mega dosed, how nutrient synergies can prevent deficiencies and excess, why supplements should not replace good whole foods diet and the most nutrient-dense foods.
In this episode of New Frontiers, learn about:
- Nutrient deficiency epidemic
- Deficiency vs insufficiency
- Drawbacks of RDAs
- Magnesium insufficiency
- Causes of nutrient insufficiencies
- Testing & assessing nutrient status
- Goldilocks nutrients
- Nutrient synergy
- Nutrient forms & bioavailability
- Most researched phytonutrients
- Top nutrient-dense foods
Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine. Of course, today is no exception. I’m really excited to be talking to Chris Kresser again. He doesn’t really need an introduction. Everybody knows who he is, and hopefully if you listen to my previous podcast with him, in fact, we’ll link that on the show notes, if you’d like to, but let me give you his background, nonetheless. It’s pretty impressive.
He’s the co-founder of the California Center for Functional Medicine. The founder of Kresser Institute. The host of the top ranked health podcast, Revolution Health Radio, the creator of chriskresser.com. He’s a New York Times bestselling author of The Paleo Cure and Unconventional Medicine. He’s a highly respected clinician in our space and he’s trained over 2,000 clinicians and health coaches from over 50 countries on his approach. He was named one of the hundred most influential people in health and fitness by greatest.com. He’s appeared on Dr. Oz. He’s been in the Atlantic, NPR, Fox & Friends, and plenty of other outlets. He’s recently launched, ADAPT Naturals, a supplement line designed to add back in what the modern world has squeezed out and help people perform and feel their best. Chris, welcome to New Frontiers, again.
Chris Kresser: Kara, it’s a pleasure to be back with you as always.
Dr. Kara Fitzgerald: It’s fun when you do a dive into a topic because you go deep and you come back with information to teach all of us. I know you’ve launched ADAPT Naturals. You’ve been really wrapping your head around an area near and dear to my heart and that is are we getting enough in our diet? Can we do it even those of us who are putting a lot of attention to what we’re eating? How common is nutrient deficiency?
Chris Kresser: It’s epidemic, really. I mean, that’s the only word for it. I’ve been treating patients and training people for 10 to 15 years. I always test for nutrient deficiency with every patient that comes through the door. There are various ways of doing that and we can get to that later, but no matter which way you do it, I would say, less than a small handful of patients have ever come back without at least one nutrient deficiency.
These are people, my patients are highly motivated. They’re not typically people who are just not paying much attention to their health. They’re among the most motivated and educated folks out there. They’re already following a whole foods, nutrient dense diet. They are often supplementing. They’re paying a lot of attention to what they’re doing and yet almost always, they came back with one or more typically several nutrient deficiencies. That’s consistent with the statistics as well.
The Linus Pauling Institute out of Oregon State, which is an organization that has really devoted decades to paying attention to nutrient sufficiency in doing a lot of original research and collating the existing research. There’s a page on their site and I can send you the link and you can include it in your show notes…
Dr. Kara Fitzgerald: Mm-hmm. Yeah.
Chris Kresser: … but basically 100% of Americans don’t get enough potassium, 94% don’t get enough Vitamin D, 92% don’t get enough choline, 89% vitamin E, 85% magnesium. I could go on, but that we’re not talking about an issue that just affects a small number of people. We’re talking about the majority of Americans not getting enough of most nutrients.
I want to be clear here, we’re not talking about full-fledged deficiency that would cause like scurvy or rickets or pellagra or beriberi. We’re talking about people who are falling short on the amount that’s needed for just long term health and wellbeing not like acute, clinical deficiency that’s going to land you in the hospital.
In many ways, that’s one of the reasons this is such an insidious problem is because there’s no red light on the dashboard that goes off when you have a mild nutrient deficiency. What it’s going to end up doing is increasing your risk of diabetes, heart disease, autoimmune disease, skin problems, cognitive issues, depression, and all of the other chronic issues that affect our health today.
Dr. Kara Fitzgerald: Great.
Chris Kresser: It’s a lot to talk about there.
Dr. Kara Fitzgerald: Great start to our conversation. I think it’s important to distinguish that deficiency. I think you’re talking about what they would use in the literature, a nutrient insufficiency versus a frank deficiency, but we see insufficiency. You’re saying that this might not be captured, the ramifications of insufficiencies. However, that’s been investigated with vitamin D.
They look at vitamin D insufficiency versus frank vitamin D deficiency. You see just plenty of horror show fallout when you’re in the realm of just an insufficiency with vitamin D. Again, just what you mentioned, the chronic diseases you’ve listed off. Of course, we know acute viral infections, like COVID are always, always more problematic or influenza when there’s an insufficiency.
I want to say one other thing just as a sidebar, I was one of the contributing authors to Laboratory Evaluations in Integrative and Functional Medicine, and also as a side, sidebar, have looked at tons of laboratory data over my career. I agree with you 100%, we always see insufficiencies and sometimes frank deficiencies, regardless of the attention to diet.
In Laboratory Evaluations, I was the lead author in the minerals chapter. I said, “You guys, let’s pull together a table looking at mineral deficiencies or insufficiencies, and the top causes of death in the US.” It’s a great table. It’s featured on a blog. We’ll, actually link to it in the show notes so people can pull it up and take a look at it and you will see exactly what you just said, Chris, magnesium deficiency, potassium, selenium, et cetera, zinc, and the top causes of death in the US. There’s a close association.
Chris Kresser: Yeah, absolutely. I don’t think this issue gets enough attention. I mean, you’re aware of it. I’m aware of it. Lots of people in the functional and integrative medicine communities are aware of it, but even within those communities, I think, it’s underrepresented. It strikes me because, in some ways, it’s very low hanging fruit.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: We know how to deal with this. It’s not like an issue, somebody has mold or chronic inflammatory response syndrome.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: That can be really hard to deal with.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: It’s not easy sometimes to remediate the mold damage in your house and then make sure you’re in an environment that’s safe for you. I mean…
Dr. Kara Fitzgerald: Yes.
Chris Kresser: … that’s one of the trickiest and most difficult things to address, but we know how to address nutrient inadequacies.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: It’s not that hard. I just look at this as a huge problem, but also one that has enormous potential for correcting, reversing this tide of chronic disease and giving people a relatively simple thing that they can do to turn their health around without, yeah, relatively simple. That’s the easiest way to put it. It doesn’t require massive changes like some other health interventions might require.
Now, you mentioned magnesium. I want to linger on that for a second because I think it’s a really good example of how we only often really see the tip of the iceberg in terms of these problems. The RDA for magnesium right now for an adult, that’s over 31 years old is 420 milligrams for men and 320 milligrams for women, but that RDA was based on average body. Most RDAs are based on average body weight.
This magnesium RDA was last published in 1997, using average body weight of 133 pounds for women and 166 pounds for men. In 2021, just last year, researchers published a study arguing that the RDA for magnesium should be updated to reflect the dramatic increase in average body weights for the US population. Today, the average body weight for women is 169 pounds.
Dr. Kara Fitzgerald: Wow.
Chris Kresser: That’s 36 pounds in 25 years, okay? Then, for men, it’s 196 pounds. That’s also a 30-pound increase. When they recalculated the RDA, based on this increase in body weight, for women instead of being 320 milligrams, which is what it still currently is, if you look at any reference, it would be 467 to 534 milligrams, and for men instead of 420, it would be 575 to 657.
Now, the average intake for magnesium for US adults is around 340 milligrams for men and 250 milligrams for women. That tells us right there that virtually everybody is deficient, or at least getting inadequate amounts of magnesium, but nobody knows that because if we’re just using the current RDA that has not been updated, you’re going to come away thinking, “Oh, it’s fine.” Maybe we’re falling slightly short, but this tells us that people, most adults are falling hundreds of milligrams short per day on magnesium.
As you know, very well, magnesium is required for 6 or 700 enzymatic reactions in the body. That number keeps going up every year. It was 300 when I first started this work.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: Now, in the past few years, researchers keep discovering more and more enzymes that magnesium plays a role in. I mean, that’s just, to me, a really good example of how thorny and difficult this problem is and how so few people actually understand the depth of it.
Dr. Kara Fitzgerald: Yeah. Yeah. I find it a little hard to believe that men and women in this country are ingesting those numbers that you just said that they were. I think that’s generous. I bet the gap is even wider.
Chris Kresser: Yeah, that’s true. I mean, and it gets worse because it’s like 60% of calories now are ultra-processed and refined foods that have zero magnesium in them.
Dr. Kara Fitzgerald: You know what? If there’s any magnesium added, it’s going to be some complete 100% non-bioavailable form like magnesium oxide.
Chris Kresser: It’s just going to go right through you.
Dr. Kara Fitzgerald: Yes. Yeah, anyway.
Chris Kresser: Literally. Yeah.
Dr. Kara Fitzgerald: Yes, literally. It’s exactly right. Yeah. It’s its purpose.
Chris Kresser: Yeah.
Dr. Kara Fitzgerald: You might as well eat a rock, got in the driveway, crunch on a rock.
Chris Kresser: That’s right.
Dr. Kara Fitzgerald: Again, just going back to my lab days, it was when I was, since we’re on the magnesium, and the minerals topic, we included in the book, an image of ATP. I developed a deep appreciation for magnesium when I realized that it actually hangs on to the two phosphates in ATP. Two of the end phosphates, it sort of keeps them in place before those phosphates are used to generate energy. So any energy, anything requiring energy in the body, there’s magnesium. I mean, you could put it that fundamental if you want an appreciation for how widespread and how exquisitely essential it is. Anything requiring energy, you will find magnesium.
Chris Kresser: Right, which is everything. Cellular energy powers everything that happens in the body. If we’re falling short and there’s so many nutrients, as you know, that are involved in the Krebs cycle and other processes for producing cellular energy that involve ATP and other pathways, and based on the numbers I just gave you from Linus Pauling Institute, most people are falling short in most of those nutrients.
When I started to really dive into this, I knew a lot of this. It’s sort of like, but the depth of it and the extent of it still surprised me. It’s work that I’ve been doing for years, but I kept looking, like pulling my head out of the research and going, “Wait a second, am I in alternate universe here? Why aren’t people screaming from the rooftops about this?” Because, from my perspective, this is one of the biggest public health issues that we face. That was highlighted even more during the pandemic.
I actually, I did a presentation at UCSF at the Integrative Health Symposium with Dr. Akil in 2021 in the springtime. The topic was nutrients in COVID, looking at what the existing research shows in terms of what nutrients the immune system needs to thrive and function optimally. What happens if we don’t get enough of those nutrients, how that could increase our risk of all kinds of different infections. It’s all right there in black and white. Yet, we heard almost nothing about that throughout the entire course of the pandemic and still haven’t.
Dr. Kara Fitzgerald: Yeah, that’s right. That’s right. Finally, vitamin D is getting a little bit of attention.
Chris Kresser: A little bit. Yeah but not enough, like how about zinc and how about all of the other nutrients that contribute to good immune health, and it’s not just immunity. As you said, if you look at the top 10 causes of death that are not accidents and acute things, but chronic conditions, every single one of them is characterized by nutrient deficiency. It’s again, a relatively low lift thing that we can all do is make sure we’re getting the nutrients we need just to give our bodies a chance…
Dr. Kara Fitzgerald: Absolutely. Absolutely.
Chris Kresser: … a fighting chance.
Dr. Kara Fitzgerald: Yes, yes, yes. I actually want to just say that I think acute needs to be included. I think COVID taught us that acute illness really needs to be included.
Chris Kresser: That’s right. Yeah. Maybe not car accidents or texting while driving, although, you could argue that some nutrients might support your brain in a way that you might come to understand that’s not a good idea, right?
Dr. Kara Fitzgerald: Yeah.
Chris Kresser: You might be thinking more clearly, but yeah, I agree with you 100%.
Dr. Kara Fitzgerald: I think you’ve already outlaid, you’ve already answered this question or at least touched on some of them, but it’s just interesting because you’ve done such a nice drill down into it, why are they so common now? I mean, of course we’re bigger, so we need more, which is concerning, but why are deficiencies so, so, so common and even in, as you and I both talked about, people paying attention to how they’re eating.
Chris Kresser: Yeah. This is what changed for me over time. If you go back 10 years ago, I was not, I really was hanging on to the belief that we should be able to meet all of our nutrient needs from food. I still have the belief that we should be able to. That should be the operative word, but now I no longer believe that we can. That was a bitter pill for me to swallow because certainly, our distant ancestors were able to get all of the nutrition they needed from their diet and they weren’t taking supplements. I think it’s pretty safe to say that. It just, I think we’re human beings are adapted to get as many nutrients as we can from food because of nutrient synergy and bioavailability and all kinds of other factors.
I still, 100% believe that a healthy whole foods diet should be the foundation of any nutrients strategy, but there are, unfortunately, several challenges that we face today that make getting all of our nutrient needs from food met really difficult, if not impossible.
Dr. Kara Fitzgerald: Let me just ask you, I just, because I’m so curious about what your aha moment was that prompted you to, that changed your mind and then move on and then answer that question about.
Chris Kresser: Yeah, sure. I can’t trace it to a particular moment in time, but I definitely, it was like several, cascading, realizations, I think I would say. One was just testing every patient that I had in the clinic. As clinicians, we can’t rely on just anecdotal data that we have in the clinic, but it’s often the starting place for generating a hypothesis, and saying, “Huh, I’m noticing this. I’m seeing it in real people. I’m seeing the effects of it in real people. I wonder what’s going on here.”
That was the first part of it, because again, I wasn’t seeing patients who were eating cheese doodles and drinking Big Gulps all day and having hot dogs for dinner. I was seeing people who were already on super nutrient dense diets and doing all the right things and they were still showing nutrient inadequacies. That was the first flag.
Then, that led me into the scientific literature. I’m like, “Okay, this has been my experience so far, but let’s see what’s the research has shown about the broader population.” Study after study, in country after country, developed world, developing world, the UK, the US, Australia, the East, et cetera, it’s all the same. People are not getting enough of several nutrients and then it dawned on me that it’s even worse than it seems on the surface.
I used one example of magnesium where if most of the studies are still using the RDA for magnesium, the existent, the current RDA, if we were to actually run studies where we’re using that higher cutoff that’s adjusted for body weight, my guess is that 100% of people would not be getting enough magnesium just like potassium.
B12 is another example. As you know, Kara, the lab range goes down to 200 in some cases. There are studies that show clear DNA changes and significant metabolic shifts when levels are between 2 to 400. In Europe and Japan, sometimes the lower end of the range is 450 or even 500. Once again, most of the B12 deficiency studies are using that lower cutoff. If we started using markers like methylmalonic acid or homocysteine, which are able to detect B12 deficiency at an earlier stage or even holotranscobalamin, we would see rates of B12 deficiency that are way higher than what we see in the literature. That was the third step or second step.
Then, the third step was just time. Seeing all of the conversion factors that decrease nutrient availability and I’ll talk about those in a moment, come together, it really ended up manifesting as a perfect storm and that’s the world that we live in right now. Those factors are changes in soil quality, which reduce nutrient availability. The easiest way to describe this is there’s been a shift in the microbiome of the soil, just like there’s been a shift in our own gut microbiome.
The result of that is that the nutrients that are in the soil are not as available for the plants that are growing in them. The plants that grow in them don’t have as many nutrients. Then, when we eat the plants, we don’t get the same level of nutrition that we would’ve if we ate those same plants 50 years ago. There was one study I came across that said, “We’d have to eat eight oranges today to get the same amount of nutrition from a single orange there that even our grandparents ate.”
Dr. Kara Fitzgerald: Wow.
Chris Kresser: That’s a big one. Another is a growing toxic burden. Heavy metals and things like glyphosate and the food supply bind to nutrients and decrease the bioavailability of those nutrients. In fact, that’s a positive role that some minerals like calcium play, right? They can bind to those toxins so that we don’t absorb the toxin, but then we don’t absorb the nutrient in the same way and benefit from the nutrient either. Those toxins have become ubiquitous in the environment.
Another is a shift to a global, rather than a local food system. We know that nutrient levels in produce begin to decline as soon as the food is taken out of the ground. A food that’s been shipped for 3,000 miles, which is not uncommon today has far lower nutrient levels than a food that was, you would buy from the farmer’s market or that you harvested out of your backyard.
Another factor is increase in chronic disease, which is a double whammy because we know that chronic diseases increase the demand for nutrients. Then, they reduce absorption of nutrients. Obesity is a good example. Obesity decreases the conversion of sunlight to vitamin D in our skin, so that an obese person would have to spend more time in the sun to get the same amount of vitamin D than a lean person would have to spend.
Then, that same thing happens in the digestive system, where there are various mechanisms where someone who’s obese is going to absorb less vitamin D from the same amount of food than someone who is lean. Just across the board in so many different disease states, a similar phenomenon occurs, and yet people with those conditions often have an increased need for various nutrients.
Then, the last, I mean, there are many more, but last one I’m going to talk about is over the counter and prescription medications that deplete nutrients or affect nutrient bioavailability. One example is Metformin, which is a common medication used to treat type two diabetes. Metformin is well known for its inhibition of absorption of B12 and folate. Lots of people who take Metformin end up with B12 deficiency for that reason, and they don’t even know it. It’s not widely talked about. A lot of clinicians who prescribe it aren’t even aware of it. They’re not able to give their patients informed consent when they prescribe that medication.
Those are just a few of what I think are the most significant factors. There are several others, but even with just those, you can see how it has become very difficult to meet our needs.
Dr. Kara Fitzgerald: Yeah. Yeah. I think if we do a broad sweep of what’s happening metabolically, and look at nutrient levels, as you and I both do in our practice, you can catch some of these things, but yeah, by and large, it’s not happening. I just wanted to throw one other contributor in there, because I’ve seen it change over my career and that is just our ability to absorb nutrients.
SIBO is epidemic, SIBO, IBS, just dysbiosis, you talked about the soil microbiome, and all of us are influenced. Again, as intentionally as we’re eating, we’re in this era of really tough guts, as I call it, some challenging presentations clinically, and there’s always some level of malabsorption happening, regardless of what they’re taking for medications or their body size, et cetera.
Chris Kresser: Absolutely.
Dr. Kara Fitzgerald: Would you agree?
Chris Kresser: Absolutely. I mean, that’s one of the chronic conditions that IBS is now the second leading cause of people missing work behind the common cold. You have tens of millions of people suffering from that. Even if someone doesn’t have overt digestive symptoms as you know, that doesn’t mean that they don’t have disrupted gut microbiome that can manifest as skin rashes. It can manifest as fatigue, cognitive issues, insomnia, autoimmunity, any number of other problems.
This, again, just goes back to all of those same challenges in the modern world. A lot of people, exposure to antibiotics growing up, not being breastfed, poor diet, highly processed and refined foods, other medications like birth control and NSAIDs that disrupt the gut microbiome. There’s so many factors. The modern life…
Dr. Kara Fitzgerald: Yes.
Chris Kresser: … unfortunately, is just not…
Dr. Kara Fitzgerald: Challenging.
Chris Kresser: … a supportive environment for our health. That’s obvious.
Dr. Kara Fitzgerald: It’s like human 2.0, what do we do to survive this next leg of the journey? Extra nutrients really seems to be one of them, like most of us have air filters now. We’re doing things that we wouldn’t have done in my lifetime. We’re needing to be more mindful. What nutrients are people… We’ve already touched on some of the big players, but what are the big nutrients individuals are most likely to be deficient in this country?
Chris Kresser: Yeah. If we go back to the Linus Pauling survey, 100% don’t get enough potassium. I know you’ve talked a lot about this sodium-potassium balance in the developed world is way out of whack, relative to what it was in Paleolithic era, where some of our ancestors got up to 10,000 milligrams a day of potassium, and very little sodium relative to that amount of potassium.
Now, it’s flipped where people are getting a lot of sodium and very little potassium, and that has pretty severe consequences all throughout the body. That’s a big one. Vitamin D of course, I think there’s more awareness about vitamin D now, but unfortunately, that hasn’t really translated yet into, more people becoming vitamin D sufficient. It’s still 94% of Americans, according to the Linus Pauling Institute, are not getting adequate levels of vitamin D, 92% not getting enough choline.
Choline is a nutrient that I think is there’s not a high awareness around, even in the medical community. A lot of patients are not being asked about their choline intake and foods with choline. It’s absolutely vital nutrient for cellular health, just the function of the cell membranes, neurotransmitter production, the nervous system in general and the brain. If you don’t get enough choline, your brain’s not going to work well. You’re going to have brain fog, poor memory, difficulty focusing, and you’re going to have a wide range of problems in the nervous system. That’s a big one.
It’s one that most people are not aware of. 89% don’t get enough vitamin E, that’s important. Vitamin E is a critical antioxidant. It plays very important roles in skin health and eye health and heart health. Dietary vitamin D deficiency is correlated with cardiovascular disease, metabolic disease, autoimmunity, et cetera. That’s a big issue.
Then, I would say, magnesium is, the Linus Pauling has magnesium at around 55% if I recall, but again, that’s using the current RDA. If you were to use the higher RDA, I think it would be right up there with vitamin D and choline and potassium in that 90% plus range. You’ve got vitamin A is around 50%, but that’s lumping together beta-carotene and retinol.
I think if we looked at retinol separately, which is the active form of vitamin A, you would see much higher rates of deficiency because there aren’t a lot of sources of preformed vitamin A in the diet. You’ve got pasture-raised animal products, pasture-raised egg yolks, pasture-raised dairy, organ meats, especially liver being probably the highest source of preformed retinol in the diet. People are just not eating organ meats very often at this point, cod liver oil, et cetera. That’s another issue and that’s an important nutrient for immune function and overall health.
Zinc is similar. I think that’s around the like 40-50% range of people who don’t get enough, but that’s not considering bioavailability. If you look at zinc, you can see that lots of foods have zinc on paper, but those plant foods that contain zinc also tend to be, contain high levels of phytate, which is phytic acid, which inhibits zinc absorption. The same is true for calcium.
In calcium, for example, spinach has a fair amount of calcium on paper, but the bioavailability of calcium from spinach is only about 5%. You’d have to eat a lot of spinach to meet your calcium needs and it’s an amount that most people are not going to be able to eat on a daily basis to do that. There’s the published rates of deficiency and then again, there’s when you start considering bioavailability as a whole another very critical factor, I think that those rates are even lower or even higher rather than what is published in the literature.
Dr. Kara Fitzgerald: Yeah. Yeah. I just wanted to say to folks listening, again, we’ll link to Linus Pauling Institute so that you can look at what Chris is talking about right now. It’s just Linus Pauling Institute is such a good resource, but you can get, I just want to say to our audience that those of you who are not clinicians and are concerned about what you’re hearing, you can ask your primary care doctor, whoever your care provider is to order some basic measurements and get insurance coverage.
It isn’t rocket science. You may not get the same level of sophistication that you would if you can go to a functional medicine provider, but you can look at a blood, a red blood cell magnesium. You can look at a red blood cell zinc. You can get a methylmalonic acid, as Chris mentioned earlier, as a surrogate marker of B12 activity in the body and get insurance coverage for those. Don’t be shy to bug your care provider, to get these as part of your annual or semi-annual workup.
Chris Kresser: Absolutely. Yeah. I mean, vitamin D especially, right?
Dr. Kara Fitzgerald: Yeah.
Chris Kresser: That will shift from season to season, if you’re getting sun exposure and you live somewhere where sunlight is a viable source of vitamin D, you should be asking your provider to do that at least a couple times a year, maybe in the fall leading into the winter, and then again, in the spring after the winter, because you need to have a sense of how it shifts seasonally.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: Yeah, I fully agree. There are some nutrients that are notoriously difficult to test for like vitamin K2, for example, is a tricky one and calcium actually is a tricky one because it’s so critical to the function of the body. It has to be maintained in such a tight range in the serum of the blood that if our dietary intake of calcium falls, we just pull it out of the bones. That’s of course, why low calcium intake is associated with osteopenia and osteoporosis, but calcium will rarely fall out of the normal range in the blood, unless it’s a very severe problem.
That is also one of the challenging parts of this whole nutrient status issue is that for some nutrients, like vitamin D, it’s relatively straightforward to test for them. For others, it’s quite tricky. That makes it difficult for clinicians. It makes it difficult for just individual people.
Dr. Kara Fitzgerald: Yeah, that’s right. If you’re of the age where a DEXA scan is appropriate, I mean, that’s a reasonable tool if you’re leaning anywhere towards osteopenia. Calcium’s going to be one of the nutrients that you’re treated with.
Chris Kresser: Absolutely.
Dr. Kara Fitzgerald: You know the other interesting thing is chromium. There was a researcher about a decade ago just proposing that any blood sugar imbalance is functional evidence of a chromium deficiency.
Chris Kresser: I would agree with that. Yeah. I mean, there was a paper by Peter Havel called, there was a big review of the role of chromium in insulin resistance. He made the same argument. This was back in early 2000s, if I remember, and he said, “Chromium is generally poorly absorbed in the diet and chromium levels decreased with age.” If you see any signs of insulin resistance, you should basically consider that to be a sign of chromium deficiency. Yeah, exactly what you just said.
Dr. Kara Fitzgerald: Of course that’s most Americans are needing chromium if you consider that as your surrogate marker of chromium deficiency.
Chris Kresser: You probably saw the study. It was the last week or the week before estimating one in two Americans either has type two diabetes or is at risk of having it, meaning they have either prediabetes or high normal blood sugar and are well on the way to developing it. One in two Americans, I mean, it’s just mind boggling.
Dr. Kara Fitzgerald: Yeah. Yeah, it is. It is. What do we need to be supplementing with taking all of this into consideration? People are just running out the door right now, listening to our podcast, going to buy supplements, but what do we need to be thinking about? Let me ask you this, so you have concern around diet being insufficient, the nutrients being insufficiently bioavailable, completely understood. We do use Cronometer in practice so that we can get an idea of what people are ingesting.
Chris Kresser: Yeah, I use that too.
Dr. Kara Fitzgerald: Then, we are also doing a lab sweep to identify those, and to your point, not all labs are equal and it’s difficult to identify some nutrients, but just how do you, what do we need to be taking, just in light of what I’m, evaluate. What are the core things we need to be considering with or without lab data?
Chris Kresser: Again, I want to reiterate that you cannot supplement yourself out of a bad diet. What I don’t want to happen, and I doubt this would happen with your audience Kara, but I like to just be clear that taking supplements on top of a really poor diet is not going to save the day. We need the foundation of nutrient synergy that we get from foods that contain multiple different nutrients and enzymes and cofactors and all the good stuff that really makes us function at a high level.
Having said that, as we’ve discussed throughout this whole show, that’s made probably not enough for most people. I look at supplementation as the word truly implies, a supplement is something that you add to something else. It’s not meant to stand on its own. I think a high quality multivitamin, which just covers all of the basis is a really good option for most people, because it can help ensure that they’re not only meeting, but exceeding the RDA for most nutrients.
There’s a caveat there, which we can talk about separately, which is that with some nutrients, you don’t really want to exceed the RDA.
Dr. Kara Fitzgerald: Mm-hmm.
Chris Kresser: The caveat there is we don’t necessarily want to exceed the RDA with every nutrient. Some nutrients are what we call Goldilocks nutrients, because there’s a pretty narrow range that we want to hang out in. We don’t want too little of that nutrient, but we don’t want too much either. Calcium is a great example. Iron is another one, iodine.
When I formulated my multi, it was with that in mind, it was like, what are the nutrients that people need, tend to fall short in and we need to bolster? Then, what are the nutrients that people don’t fall short in typically, or that we have to be careful with? I didn’t put iron in my Multi. I didn’t put iodine in there. I put a very low dose of calcium. I didn’t include high dose of alpha tocopherol because that’s been linked with increased risk of prostate cancer and heart disease if you take it at a high dose over a long period of time.
Again, just going back to the Linus Pauling Institute list, we’re talking about vitamin D and choline and vitamin E, but I think tocotrienols are better source than tocopherols, magnesium, of course, vitamin A, vitamin C, vitamin K2, which we’ve learned a lot about over the last few years is being really critical. Then, phytonutrients.
This is a newer topic. So far, we’ve mostly been talking about essential vitamins and minerals, which are critical, but there are a lot of nutrients that we get from plant foods that we now know are also very important for our health. Bioflavonoids, beta-glucans, lignins, sterols, these are not really encapsulated in some of these nutrient analyses that tend to just look at things like iron and zinc and vitamin A and vitamin D, but they are every bit as important for our health, I believe at this point.
Dr. Kara Fitzgerald: Yeah. I agree with you. I think their, I mean, their time is coming, but it’s complex. I mean, you’ve heard of the dark matter in nutrition, this is like wide swath of nutrients that have yet to even be identified.
Chris Kresser: Yeah.
Dr. Kara Fitzgerald: It’s extraordinary. The majority of the nutrients present in certain plant foods are yet to be identified, let alone there’s synergistic interactions with each other, as you mentioned earlier, but I agree that a fundamental appreciation of the import of these is beginning to be established.
Chris Kresser: Yeah. I think, realistically, we probably will need AI to really help us figure out those relationships because just think of how vastly complex it can be. You’ve got multiple new, magnesium alone affects 700 different enzymatic reactions. Imagine trying to map that out with pen and paper, trying to figure out how other nutrients interface with magnesium in that way. It’s hopeless for our human brains.
Dr. Kara Fitzgerald: Well, it’s just a forkful of a well-designed salad, entering into the alimentary canal and being exposed to the various enzymes and digestive juices and then into the microbiome.
Chris Kresser: That’s right.
Dr. Kara Fitzgerald: That they’re all transformed and directed…
Chris Kresser: Totally. I mean, this is why we always recommend food as the basis of everything because I’ve thrown around the term nutrient synergy a few times without really explaining what it means, but let me just take a moment to do that. Nutrient synergy refers to the fact that nutrients are not isolated from each other in our bodies. They’re not siloed off, just operating on their own. They have complex and often synergistic relationships.
A few examples are that magnesium is required for the absorption and activation of vitamin D. Let’s say you’re actually getting enough vitamin D, you’re taking it as a supplement or you’re getting enough sunlight, but if you are deficient or getting an inadequate amount of magnesium, you can still exhibit all of the characteristics of vitamin D deficiency because magnesium is basically blocking the absorption. The magnesium deficiency is blocking the absorption and utilization of vitamin D.
A similar relationship exists between copper and iron. I’ve seen patients, I’m sure you have as well, over the years who are getting plenty of iron, but they’re still exhibiting iron deficiency anemia. Then, you test their copper levels and their copper deficient and that’s what’s causing iron deficiency anemia. You can give that patient, all the iron in the world and it’s not going to make a difference. In fact, it can make them worse because it’s really the copper deficiency that’s the problem.
Then, we mentioned osteopenia and osteoporosis and calcium and bone health, vitamin D and vitamin K2 and to a lesser extent, vitamin A play an important role in calcium metabolism and make sure that calcium that we get through our diet ends up in our bones and teeth and hard tissue where we want it and stays out of the soft tissues, like the blood vessels and kidneys where we don’t want it.
There’s been speculation like Chris Masterjohn has written about this, others as well, that the RDA for calcium might be one of the few examples that’s too high. That if we meet our need for vitamin D and vitamin K2 and vitamin A and magnesium, that we might not actually need 1,000 or 1,200 milligrams of calcium per day, it might be more like 6, 7, 800 milligrams a day if you have those other nutrients that are contributing to calcium metabolism.
It’s fascinating when you really dive into this and it really does mean that you have to be certain that whether from diet or supplements that you’re getting the right amount of all of these different nutrients that work together synergistically.
Dr. Kara Fitzgerald: Yeah, yeah. Amen to that. Certainly, clinically, anecdotally, I can say that we don’t give our patients with bone loss very high calcium because we are giving them all those accompanying nutrients. Yeah. I agree with Chris Masterjohn on that. We see clinical turnaround when we look at their bone density.
Chris Kresser: Absolutely. I mean, just think of it this way. It’s pretty hard, if our Paleolithic ancestors, it would have been pretty difficult for them to get 1200 milligrams a day of calcium, without dairy products or without eating fish bones or something like that because, broccoli, cruciferous vegetables are pretty good source, but a lot of the other plants, food sources are not very, the calcium’s not very bioavailable.
I think they got some from bone, like eating bones or chewing on, eating meat that were they on the bone and things like that, but I doubt that many of them got 1,000 plus milligrams of calcium and yet their bones from anthropological studies, we know that they had very strong bones, stronger than our bones today. That, I think, is good proof of what we’re talking about here.
Dr. Kara Fitzgerald: Yeah, yeah, absolutely. You mentioned a little bit about tocotrienols versus tocopherols but any other nutrient, the forms of the nutrients in, or I think are incredibly important and any others that you want to point out that we need to be looking at?
Chris Kresser: Yeah. Lots. This could, of course, as you know, be like three podcasts.
Dr. Kara Fitzgerald: I know. I didn’t know. I’m thinking…
Chris Kresser: This is hard
Dr. Kara Fitzgerald: … what are your top players because I’ve got other questions?
Chris Kresser: Let’s see. Yeah. The top players for sure would be folate versus folic acid. I know this is a big topic for you, methylation and the impact of these nutrients on methylation, but folic acid, for some people, not all people are not able to process folic acid well and convert it into the more active forms the folates. They can end up with unmetabolized folic acid in their blood. That has been linked to a wide range of conditions and in some studies cancer. It’s a fairly controversial topic, but I’m pretty convinced that consuming natural folates in a form that we would typically find them in our diet is a better option.
Another one is B12. The cyanocobalamin is a form that’s often used in supplements. Some patients or some people are able to convert that into the more active forms, methylcobalamin, and adenosylcobalamin, but some are not. I think methylcobalamin is a better option there for most people.
Magnesium, we touched briefly on that. You have magnesium oxide that hasn’t been chelated or prepared in any special way is going to be very poorly absorbed. What it will tend to do there is just draw water into the bowel and promote more bowel movements. That’s why magnesium is often used as a laxative, but if you use a chelated or buffered form of magnesium, that will be much more bioavailable. It’s absorbed through a completely different pathway. You’re going to end up getting, seeing a much more significant increase of magnesium in your blood than you would if you were just taking the inferior forms of magnesium.
Then, you have vitamin K. Vitamin K1 is certainly beneficial. You can get it from a lot of plant foods. Again, some vitamin K1 can be converted into K2, which has unique benefits. It helps to regulate calcium metabolism, plays a big role in cardiovascular disease protection, but many people don’t do that conversion very well. Even if they’re eating diets that are pretty rich in K1, they might not have enough K2. Eating preformed K2 is important.
Then, we already talked about the difference between carotenes and retinol, vitamin A precursors, getting some preform retinol in the form like from liver really important. Then, tocopherols versus tocotrienols. I’m happy to go into that more. It’s a fascinating story, but those are probably the biggest ones for me.
Dr. Kara Fitzgerald: Awesome. Okay. Then, we’ll just, for folks who want to do more of a drill down into Chris’s work, we’ll obviously link to your site and your resources. In your multi I’m curious, what kind of, are you including a single folate or are you including multiple folates? What’s in the moment?
Chris Kresser: It’s true. It’s a single folate. It is Quatrefolic. It’s a 5-MTHF, but it’s a more conservative dose. It’s around 600 micrograms. We didn’t want to include 2 milligrams or some of the higher doses that I’ve seen in some products. Then, for B12, we have methylcobalamin, riboflavin R5-P, pyridoxine P5P, vitamin K. We have a full spectrum K, so it’s MK-6, MK-7 and MK-9. We didn’t even get into the different forms of K2, but each as you know, we suspect that MK-7, MK-4, MK-6, MK-9 have slightly different properties. I wanted to include a full spectrum there.
We’ve got palmitate as well as carotenes for vitamin A. For niacin, we have niacinamide and niacin. We have all of the minerals are chelated. Calcium, we have calcium malate. For magnesium, we have a buffered magnesium chelate. For zinc, we have zinc bisglycinate chelate. For selenium, we have SelenoExcell. For copper, we have copper bisglycinate chelate. These are all the most bioavailable absorbable forms.
Dr. Kara Fitzgerald: That’s just, that’s great. What about fiber?
Chris Kresser: Yeah, fiber is not in the… The multi is interesting. I didn’t want to just include the essential vitamins and minerals. I also wanted to include phytonutrients. We have wild blueberry blend, muscadine grape powder, citrus bioflavonoids, broccoli seed extract, quercetin, broccoli sprout powder, but for fiber, one of the other supplements that we launched with as part of our core plus bundle, which is the daily stack of five products that I curated to help people kind of meet all of their nutrient needs is a mushroom product.
Kara, you know that mushrooms are a phenomenal source of betaglucan, which is a unique soluble fiber that not only feeds the beneficial bacteria and does what other fibers do, it also is known as a biologic response modifier because it has a potent impact on immunity. It helps balance and regulate the immune system, but it also promotes immune defense against pathogens, which has obvious benefit in the era that we’re living in today.
Dr. Kara Fitzgerald: Yeah. Nice. That’s great. Let me ask you-
Chris Kresser: I love, I love mushrooms by the way.
Dr. Kara Fitzgerald: I do too.
Chris Kresser: I’m an herbalist by training too. In Chinese medicine, mushrooms have been used for at least 5,000 years. They were mentioned in the earliest medical text that’s ever been discovered. They’ve been used by Chinese nobility, Egyptian pharaohs, Vikings, in so many different contexts for so long and they have pretty amazing healing properties.
Dr. Kara Fitzgerald: Yeah, they do. They’re just very, they’re extraordinary. They’re complex. Yeah. In my work, we definitely recommend using a complex of mushrooms as possible, but we created this dynamic dozen. We had to come up with a list because everybody wants a list. Shiitake made that, but enoki, maitake, reishi. There’s so many that deserve a spot there. I agree with you.
I’m just curious about the compliment of phytonutrients that you selected. How did you determine which were your top players and in what dosing would be meaningful? I know that this is to supplement, as you said earlier. This isn’t taking over a good diet, but how did you figure all that out?
Chris Kresser: Yeah. Mostly just looking at research on the compounds that I felt had the most evidence behind them. Then, again, assuming that this was coming on top of a nutrient dense whole foods diet, the intention here was not to provide doses that would replace the need for eating plants. If you look at, for example, the dose of lycopene, it’s 3 milligrams, lutein esters it’s 3 milligrams, resveratrol, it’s 10 milligrams. The thing about some of these plant nutrients is I do think these have a Goldilocks range.
Dr. Kara Fitzgerald: Yes.
Chris Kresser: We’ve seen studies that show that if you isolate a compound like resveratrol, or any of these plant-based antioxidant compounds and take them for a long period of time, you can actually increase the risk of the very diseases and conditions that you’re trying to lower the risk of. That’s because most antioxidants are actually, I think they’re misnamed. They’re pro-oxidants. They produce oxidative stress, which then upregulates our own endogenous antioxidant defense system. When you get those compounds in smaller moderate amounts, that’s beneficial because it basically is like provoking your immune system to self-regulate and your antioxidant defense system.
If you take those oxidants in much higher dose over a long period of time, you can actually induce oxidative stress. I think that’s what was happening with those studies that showed that high dose alpha-tocopherol increased the risk of cancer and heart disease is that it was taken at a level that you would never really be able to obtain in the diet. I was quite conservative in the phytonutrients that I included, but I still wanted to include some because I think most people aren’t getting enough.
Dr. Kara Fitzgerald: Yeah. That’s pretty interesting. Yeah. That’s compelling. Do you think that’s true with the beta-carotene research, the negative beta-carotene research also isolated?
Chris Kresser: Yeah. Isolated, ramped up, higher dose than you would typically get.
Dr. Kara Fitzgerald: Synthetic.
Chris Kresser: Synthetic and also not with not together with all of the other…
Dr. Kara Fitzgerald: Yes.
Chris Kresser: … nutrients that would work to reduce that risk. Let me give you an example of that, which I know you’re aware of, but for your listeners, there’s a lot of studies on vitamin A toxicity that if you take, which we’re talking about now, carotenes and retinol, you take really high doses of vitamin A, it can cause a problem, but if, the studies have shown and Chris Masterjohn, again, I have to give a hat tip to him because, I first learned about this through him, if you have adequate levels of vitamin D and vitamin K2, both of which protect against toxicity of vitamin A, the toxicity threshold of vitamin A increases by orders of magnitude by at least tenfold.
Put another way, if you’re vitamin D and K2 deficient, which most people are, then you could have experienced vitamin A toxicity at a relatively low dose of supplemental vitamin A, whereas if you have adequate levels of D and K2, then you would have to take a ridiculous amount of vitamin A. You’d have to be eating like six ounces of liver every day, or you’d have to be taking tens of thousands of supplemental IU or retinol equivalents of vitamin A every day before you develop toxicity. That’s a good example of nutrient synergy.
Dr. Kara Fitzgerald: Yeah, yeah. Yeah. Interesting. That’s cool. Given our conversation, what are the foods that people must be eating, in your opinion, the most nutrient dense foods that need to be in somebody’s core diet?
Chris Kresser: Yeah. Well, this might not be super popular response, but it’s what’s from the research. There’s a great study that was published earlier this spring by Ty Beal and Flaminia Ortenzi, they work, I forget the name of the NG. I think it’s an NGO that’s concerned with malnutrition around the world. They set out to answer the question, what foods should we focus on in these countries where malnutrition is rampant that would provide the biggest bang for the buck nutritionally, that would help people to meet their needs for essential nutrients. Here, they were focusing on essential nutrients because that’s zinc…
Dr. Kara Fitzgerald: Survival.
Chris Kresser: … B12, iron. Yeah. Survival. Exactly. What they found, and again, I can include the link for this, but was that 5 of the 10 most nutrient dense foods were organ meats: liver, heart, kidney, pancreas, and spleen. It wasn’t even close. In the scale that they used, which by the way, this was the first nutrient density study ever published that took bioavailability into account. I was so excited to see this paper come out because all of the previous nutrient density work that I had seen that had been published was only looking at nutrient levels on paper of a food. They didn’t actually consider the bioavailability of nutrients. This one did.
Liver had the top score of 11 and then that was like 20 times as nutrient dense as even muscle meats like beef and then eggs. Then, if you go down to dark leafy greens, it was probably 40 times as nutrient dense. If you go then, below that was 60 times more nutrient dense than vitamin A rich fruits and vegetables, like the brightly colored fruits and vegetables. Then, I think it was 600 times more nutrient dense than whole grains. Organ meats are ounce for ounce, the most nutrient dense foods that we can eat and nobody’s eating them.
Dr. Kara Fitzgerald: Yeah.
Chris Kresser: They’ve just ran out of favor.
Dr. Kara Fitzgerald: They are… Yeah. Yes. They’re actually the liver made our dynamic dozen. I mean, we included on our Younger You program because of the nutrient density and it’s in a whole food matrix. It’s a whole food. It’s a multivitamin in a food matrix. It’s extraordinary. I will say, that I am not, I like pate but I can’t cook, I don’t cook liver. I take you can get clean, encapsulated, organ meat.
Chris Kresser: Yeah.
Dr. Kara Fitzgerald: If you’re a little freakish about it, but appreciate its importance like I do.
Chris Kresser: Well, Kara, you won’t be surprised at one of the five products in my daily stack is, drum roll, organ product.
Dr. Kara Fitzgerald: Is it?
Chris Kresser: What organs does it have? Liver, kidney, heart, pancreas, and spleen. I wanted all of the, what I release to be evidenced-based. When you see a study that is the only study that’s ever taken bioavailability and to count on nutrient deficiency in 5 of the 10, most nutrient dense foods you can eat are organ meats and probably one out of a thousand Americans, if that are eating any organ meats at all, then, it’s pretty obvious that a supplement can be helpful in that situation because, I’ve said this for years, I mean, I’ve been beating the drum of liver and organs for since I started doing this work and I don’t like the taste of organ meats. I have to work really hard.
One thing I do is I chopped liver up into like ground beef and then I put spices on the ground beef, like Mexican food style spices, or whatever I can do to kind of disguise the flavor. Sometimes, I’m successful and sometimes I’m not. I supplement with them because I want to make sure I’m getting the benefits of them on a regular basis. I’m not consistent enough with cooking them. Pate, yeah. There’s some other products like that I’ll eat occasionally, but I’ve just, I’ve struggled to make it a part of my daily routine to be honest.
Dr. Kara Fitzgerald: Yeah. I know. I know we’re in the capsule area. It’s a little bit depressing though, but at least we have them and…
Chris Kresser: That’s right.
Dr. Kara Fitzgerald: … you were able to get clean source organ meat.
Chris Kresser: Yeah, 100%, grass fed cows from New Zealand is what we source from.
Dr. Kara Fitzgerald: Awesome.
Chris Kresser: Feel good about that.
Dr. Kara Fitzgerald: Yeah. That’s awesome. It’s really cool. I know, just knowing you and following you for so many years, I’m completely confident in how badass the products are that you’ve created.
Chris Kresser: Oh, thank you. Appreciate that. I waited. A lot of people over the years were like, “Why don’t you have your own supplement line? You spend so much time geeking out on this.” I’m like, “I’m not ready.” I still have more to learn and I finally feel like I’m ready. This is a 15-year project basically.
Dr. Kara Fitzgerald: Well, I’m excited to check your products out and I’m happy to introduce them to my audience. This was a great conversation, Chris. I just really appreciated the level of study that you’ve put into this and there’s no surprise, from the work that you do over the years that you would be putting that degree of intention on this creation. Congratulations on ADAPT Naturals and we’ll have to circle back as you learn more and want to share more and continue the conversation.
Chris Kresser: Of course. Yeah. Always enjoy our conversations because we get to totally geek out. I know. We’re two of the most geeky people that I know in this field. It’s always a pleasure to speak with you. I know when I talk about a study, that there’s a pretty good chance that you’ve read it and vice versa. It makes the conversations fun but…
Dr. Kara Fitzgerald: Yeah, for sure.
Chris Kresser: … I also appreciate how you can make it all accessible for your people and easy to understand because that’s what it’s all about. That’s what we’re here for, right?
Dr. Kara Fitzgerald: Absolutely. Yeah, absolutely. Folks, to that point, we will circle back and get all the citations that Chris has mentioned. We’ll get the links to Linus Pauling. We’ll get the links to his sites. We’ll get the link over to ADAPT Natural so that you have on the show notes everything that you need that we’ve talked about today. Thanks again, Chris.
Chris Kresser: Thank you, Kara. It’s been a pleasure.
Dr. Kara Fitzgerald: As always, thank you for listening to New Frontiers in Functional Medicine, where our sponsors help bring the very best minds in functional medicine, and today is no exception. Not everyone can be a sponsor on my platform, and I so appreciate the good work, relentless research, and generous support from my friends at Rupa Health, Biotics, TA Sciences, and Integrative Therapeutics. These are brands I know and trust in my own clinic and can confidently recommend to you. Visit them at RupaHealth.com, BioticsResearch.com, TASciences.com, and IntregrativePro.com, and please, tell them you learned about them on New Frontiers.
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Chris Kresser M.S., L.Ac. is the co-founder of the California Center for Functional Medicine, the founder of Kresser Institute, the host of the top-ranked health podcast Revolution Health Radio, the creator of ChrisKresser.com, and the New York Times best-selling author of The Paleo Cure and Unconventional Medicine. He is one of the most respected clinicians and educators in the fields of Functional Medicine and ancestral health and has trained over 2,000 clinicians and health coaches from >50 countries in his unique approach. Chris was named one of the 100 most influential people in health and fitness by Greatist.com and has appeared as a featured guest on Dr. Oz, Time, The Atlantic, NPR, Fox & Friends, and other national media outlets. He has recently launched Adapt Naturals, a supplement line designed to add back in what the modern world has squeezed out and help people perform and feel their best.