00:00:01] Nick: On this episode of “In The RACK” podcast.
[00:00:03] Sarah Karaman: Some of the doctors are great. And they're like, I'm working with nutritionist. They're like, cool, she'll handle it. But some of them are like, let's just go on a statin which we don't have to go down what stands do to your body. I'm not saying they're not useful in some instances. So there's obviously that caveat with all medications.
[00:00:29] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, everyone. Welcome to another episode of “In The RACK” podcast. I'm your host Chad and with me is my co-host and fellow physical therapist, Nick. Nick and I have yet another guest on the episode. I think we've been just having a bunch of guests on the episode because nobody wants to hear us talk to him. Just Nick and I anyways. We've been just having guests like every single week. So it's been great. I think so. But the guest that we have on the show today her name is Sarah Karaman. And she is a clinical nutritionist. She has her master's in clinical nutrition. And her big thing is, if I got this right it's “Nutrition and lifestyle consulting” for the most part. She is pretty local to us. She thought she was in Dover, but she's actually in Newmarket now. She actually currently has her practice out of a chiropractic office, which is in Newmarket?
[00:01:56] Sarah Karaman: No, that's in Barrington.
[00:01:57] Chad: It's in Barrington. So I want to definitely let her talk a little bit more about what she's about. Let’s Nick can get in the weeds and just talking with Sarah before this episode, it seems like she can get in the weeds too. So we're going to try to keep out of the weeds as much as we can. But you never know what happen.
[00:02:13] Nick: No, we won't go too deep. We'll stay in the weeds. Now, maybe a few small rabbit holes. I like big family rabbits. First thing I want to say shout out Ryan Coburn. If you listen, we appreciate you. Sarah is our third podcast guest. That was courtesy.
[00:02:36] Chad: But he was the first one.
[00:02:37] Nick: Thank you. First one was John. But we weren't connected with Marissa. So Marissa will be at some point. So two of three keep them flowing. Thanks, man.
[00:02:52] Chad: Cool. So why don't you tell us a little bit about yourself, Sarah, and what's going on in your world?
[00:02:57] Sarah Karaman: Cool. So as you mentioned, I'm a Master's in Clinical Nutrition. I have a half virtual half in person practice at, I don't know if you've ever heard of Middleton chiropractic. They have an office in Dover. And then the one that I met is in Barrington. And I actually met the guy I work with at the gym. So we ended up just having a good relationship, lots of conversations about just health and making sure that we have the same concept going into how we treat people. So my whole thing is more of a root cause approach of let's dig deep into what you have going on as an individual versus just, here's the basic meal plan, have fun, that big picture of you go to the doctor and my labs look fine, but I'm really not fine. So how often do you sit down to somebody and go over sleep stress, diet, lifestyle, medication, supplements, piece it all together to really figure out what are your unique needs as an individual, go over your lab work, all of that kind of stuff? And then just figure out what are the steps to take from there to really help you heal and recover. So it's more of an education behind how the body works, and the most important steps to get there. So we address digestion and inflammation and all of those things, because we could tweak diet all day long. But if your digestive tract isn't working appropriately, and you have all this chronic inflammation, nothing you do is really going to stick until we address all of those foundational things. So that's kind of my approach.
[00:04:19] Chad: I love it.
[00:04:20] Nick: That's awesome. I think I know I do. I can't speak like Chad. We dive into the same types of things with our clients and patients from PT perspective training perspective, we're getting into the nutrition, the sleep, the stress levels and I think the biggest thing that you hit the nail on the head, you said a lot of your job is education. And that's what it is because the body wants to be in a healthy balanced homeostatic state. Sometimes just needs a little push that way. And a lot of that comes from awareness. So if we can make these individuals aware of these things create what is called awake awareness. So they're not just their bodies aware of it, but they're not the consciously aware of it, then that sometimes be all in eat just creates an awareness practice around it, and they can make the changes themselves. So I think that's a huge thing that often gets overlooked. I don't think there's enough emphasis in really. I know in my PT programs specifically, there was a big emphasis on patient education. But I think in all kinds of health fields, there needs to be a little bit more of this focus on education is like number one. You need to give people the tools, because once we take it and put the ball in our court and say, “No, this is our job to do this, we're taking the power away from the individual.” That's not cool.
[00:05:47] Sarah Karaman: And to constantly reiterate the fact that your body has the capability of healing and recovering, because you go and you get this diagnosis, and you're like, that sucks, this is what I have to deal with for the rest of my life. But nothing makes your body incapable of healing, we just have to figure out what's getting in the way. And sometimes just that information, allows people to actually want to get the information they need to heal, because if they've been told they have this diagnosis, that they can do nothing about other than take medications, then really, they just feel like no matter what I do, isn't going to help me feel better. So then I might as well do nothing. So it's really sometimes just encouraging people that they can heal, and nothing separating them from anybody else from healing from everything that they're going through. So that's a big one.
[00:06:26] Nick: It’s so true. And you had mentioned you're more of a root cause person, for people listening, when we talk about medications, pharmaceuticals. In general, they're not typically targeting the root cause. So just know that like a pharmaceutical, it doesn't mean it shouldn't be part of your product, like your recovery process or your healing process. It very much maybe, but just know that usually the pharmaceutical is targeted at a symptom, and not so much a root cause, so the root cause is going to come from the other stuff, the lifestyle factors and those types of things. Same thing with a supplement, a supplement is supporting your body and healing itself. If you feel better on a supplement, don't get the supplement all the credit, your body was able to do that with the support of the supplements, it's kind of like the role player in a sport.
[00:07:11] Sarah Karaman: Exactly. And we can pile all the supplements on top. But if you already have chronic digestive issues, you're not even doing anything with the supplements. You're just swallowing hundreds of dollars of supplements that aren't doing anything
[00:07:23] Nick: That's true.
[00:07:24] Chad: I think I can attest firsthand how many supplements I take. It's funny how much you can get from so much less how much more you can get from so much less.
[00:07:36] Nick: You have a unique perspective to working for GNC and college.
[00:07:39] Chad: Actually, I did. The funny thing was working for GNC and colleges, they were pushing their own products like crazy. So everything that I would sell, I would get a commission on, then the Commission on the GNC products was way more than the Commission on anything else in that store, of course, they want you to push their own shit. I had no shit in college. I was like, “Oh, this is cool. We'll take this one.” That was also back in the day where like, the plastic case was the actual plastic case. Like there was actually some stuff in there. That's completely illegal.
[00:08:13] Nick: It look, crazy. It's pretty wild.
[00:08:15] Chad: And that was only 20 years ago.
[00:08:19] Sarah Karaman: People think of them as very benign. I have this understanding. The pharmaceuticals have symptoms, and they have to be used appropriately for specific things. But for some reason, when it comes to natural substances, herbs, supplements, all of these things. They're like, “Oh, whatever, we can take that that's not going to do anything.” Like they can harm you just like a medication can harm you. Medications were originally synthesized from natural substances, so they can do the same thing.
[00:08:44] Chad: We had that very interesting podcast with John, about that whole situation with how they pretty much rebrand pharmaceuticals. Like they just changed the chemical structure by just a little bit.
[00:08:59] Nick: It's pretty funny. Once the patent on a pharmaceutical ends, they stopped pushing it because they can't make money. So then they have to make something new that is just similar enough, but different enough to be having a new patent, essentially, which is unfortunate. So always think about that when I took this medication a while back. And now the doctor is not recommending it, because there's no money to be made off of it anymore. Unfortunately, it's the reality of it. But just everyone needs to understand this is something that everyone should know is that the supplement industry is not regulated. Pharmaceutical industry, we dive into that rabbit hole, it's regulated technically. But is it technically regulated? I don't know, there's a lot of controlling forces there that can manipulate the regulations. But nonetheless, there are standards are in place for pharmaceuticals, but supplements is kind of the Wild West. There's really not much regulation. So you need either do your due diligence or work with someone who better understands the industry and can guide you towards a good quality supplement because you will be more likely to get an adverse effects from something that is more synthetic or from a bad source. And that is a real thing that happens in the supplement world, unfortunately. So it is something to consider without a doubt. And people are like, “Oh my gosh, supplements” they are less likely to then pharmaceuticals typically. But it is a thing. So it's something to be considered. It's not to be taken lightly for sure without a doubt.
[00:10:34] Chad: So what got you into nutrition? So I'm talking about you now, let's stop talking. Stop talking about, Nick.
[00:10:41] Sarah Karaman: I'm not gonna make this into a rabbit hole. So I have hip dysplasia, I've had seven reconstructive hip surgeries ended up having a peripheral nervous system disorder kind of developed from all of that series of nerve block injections was supposed to go through disability just because they were like, we're gonna have to completely reconstruct everything, and you're just not going to be walking. So as a 17 year old was told I was just gonna go on disability and essentially, not do anything for the rest of my life. So that led me to kind of figure out al, well, doctors aren't helping, they just keep being like, here's more drugs. And I just ended up being on opioids for years trying to make it through college sitting there on it and trying to pay attention. So I was in my undergrad for exercise science. And my professor was amazing. She kind of took me under her wing and started showing me like, “There are these different substances that can help just as much if not more than these opioids, so you can use at least help your body heal a little bit”, because I was in a walker on college, in college, because to choose my college based on how close it was to my surgeon, so that I could actually like not delay going to school. So she kind of started bringing awareness to there's all this research out here about natural things that can help you Why don't we at least try some of them, so is going to pain management doing all of these injections and that kind of stuff, they wanted to surgically implant a stimulator in my spine, that was like the next thing, or like, there's nothing else that can help you just stay on the opioids get this surgically implanted as like a 17 year old and I kept going back and being like, what else can I do? Does my diet impact this? How about supplements, and she was like, no, nothing can help this this is just what you have to do. So I just don't feel like that's the way that I don't accept the idea that as a 17 year old, I'm just going to be on these meds for the rest of my life. And that's the only way I'm going to be able to function. So through her, I started realizing there's a lot of other substances and things that you can do, and exercise that can help and movement that's going to really help your body actually heal, to the capacity that it can with these types of structural issues. So then, towards the end, I was gonna go on to get my doctorate as a naturopath, but then to school I was gonna go to is very dangerous.
[00:13:01] Chad: Was it Springfield?
[00:13:02] Sarah Karaman: No, in Connecticut to the point where you had to have these like trackers, and you press the button for the release to come out here.
[00:13:10] Chad: In Connecticut. What school was it?
[00:13:12] Sarah Karaman: You would say that and I wouldn't forget.
[00:13:15] Nick: What city was in here? Was it New Haven?
[00:13:19] Sarah Karaman: Anyways, it was a very long rabbit hole conversation that just turned into her being like, well, , what, you also just are so passionate about the things that you really like. So she was like, That would include a lot of things, but you're very passionate about helping the body just heal and recover through more of nutrition, and herbs and that kind of thing. So then I ended up pursuing my master's in clinical nutrition selfishly of like, I'm trying to learn more about how to help myself heal. And then that kind of leads into the passion of the chronic illnesses that everybody else has, that they just think they have to deal with, and that they have no tools to help them actually heal and recover. So turned into a passion of helping other people. But it selfishly was like, because I've had this own my own chronic pain kind of journey.
[00:14:03] Nick: You can only help others once you're in a good place, so I wouldn't even call that selfish, like you needed to find yourself a good place first before you could really refine that passion of helping others because I think same thing for us. Like me, personally, I got into physical therapy because I dealt with my own injuries. , post op and that kind of stuff. Chad, same thing. His brother went through an amputation when they were in high school, so he experienced physical therapy firsthand from that perspective. I think our experience absolutely shape our path for sure.
[00:14:39] Chad: I think you really never know how that's gonna work out, you think it's gonna be a bad path. And then you find out that everything, I'm a true believer, and everything happens for reasons. One thing you might think it might be the worst thing in the world, but if maybe you had not had that situation, you don't know where you'd be now.
[00:14:55] Sarah Karaman: I wouldn't have found the career that I'm so passionate about helping other people if I hadn't gone through this whole chronic pain and physical therapy has played a big role in that too.
[00:15:08] Nick: So how does everything feel now, back hips, everything.
[00:15:12] Sarah Karaman: Not fantastic. My last surgery was a little over a year ago. So I'm hoping that that was the last one. But I like mostly because I push myself too hard. I love lifting, I was doing squat, which was the worst I deal with hip dysplasia, I got a complete SLAP tear again for the third time of my labrum. So they constantly go in and are reshaping bone repairing labrum is that kind of stuff. So I'll always be in pain, I do have like a lot of nerve damage and that kind of stuff that I deal with. But now I have tools. So it's instead of going to the opioids or being like, I just can't lift anymore. I kind of have recapitulated, like using different movements that I've learned, maybe instead of like, going too far, and a squat, I do a lot of split squats and single standard stuff, and that kind of stuff. And then I have all sorts of herbs and supplements and that kind of stuff that helped with pain just as much if not more than the pharmaceuticals I was on for years. So that led to like gut problems and all that stuff that so many people deal with.
[00:16:13] Nick: We have to go into because people would be listening like, what hurts What hurts what supplements. Because that's how people like, what do you like, please talk about that. And so what am I doing next? So what supplements or what herbs have helped you in that regard?
[00:16:29] Sarah Karaman: Have helped me specifically. So this is long one. And because I'm in this space, like keep that in mind, I'm always trying big disclaimer. There's some simple ones that even like people that don't have chronic pain can use like tart cherry juice has the same enzyme that helps block the pathway that something like ibuprofen does. So it's not a miracle doesn't work better than ibuprofen, but it works about the same. And in studies, those results actually last a little bit longer. It's like a longer amount of pain relief to so I use my little nerdy concoction is I get tart cherry juice. And then I'm mixing a bunch of tinctures because I don't like swallowing pills. So I'll do things like antispasmodic herbs. I don't know if you've heard of like wild lettuce, cramp bark, St. John's California Poppy, I have like all of those in tincture forms. And I make myself a little mixture, nice high dose, magnesium, all of those are really big. And then I also do a really good quality CBD. So that helps me in particular, but it doesn't help everybody. So it's kind of figuring out what works for you. And then just getting down to controlling inflammation in general, like you can't just keep putting out the fire from chronic inflammation, you have to make sure that inflammation is at a maintainable level so that all of those things actually help.
[00:17:47] Nick: Yeah, that's a big one. The inflammation thing, because now that the medical system is aware of inflammation, I feel like for so long, it's just like, what's causing this? And now they say, it's inflammation causing all this stuff. But inflammation is also a symptom of something underlying. So the medical system is still struggling to peel back that next layer. We're just blaming everything on inflammation and I get it. But now everyone's so kind of hell bent on like, I didn't get my inflammation and control, like, and it's turning into kind of this culture of inflammation is all bad. Everybody needs it. It's about not being chronically inflamed, or overly inflamed. And that's what you were just alluding to, and I think that's important for people to understand, because everyone's just like, “Oh no, I need to, like, completely blunt my inflammation.” Well, hold on. You're just had a hard workout. You're gonna be inflamed a little bit and that's normal. That's how your body heals. So herbs are great in that instance, because they don't completely shut it off. They support the body systems during that time of inflammation. So that's certainly an important aspect of that, but that's the tinctures. I've come around a tinctures in the last year or two because I growing up had a lot of issues falling pills myself.
[00:19:06] Chad: I love how he says growing up. He literally just started swallowing pills two years ago.
[00:19:10] Nick: I'm still growing up. I’m 31 year old man. I'm still growing dude. I think I'm catching up to Ryan. I think I'm gonna be 6’8”. I'm still growing. I can't grow beard yet. I think my growth plates are still open. So don't take me. You're gonna be trying to take me down all day. No, it's still growing. So I'm a growing boy. So I think that is important for people to understand that that inflammatory pathway is very much a normal thing for a body.
[00:19:43] Sarah Karaman: And you're contributing factors to inflammation are going to be different, like not everybody has the same contributors to inflammation, things like IBS. All that does is mean that there's inflammation in the GI tract. So that's not a root cause like you have IBS. That's like why is there inflammation present in that organ, so the inflammation one is a big rabbit hole. But there's some underlying factors that everybody should consider like your omega six to omega three fatty acids ratio. Like, there are some ways that just the human body works in general that if those things aren't addressed, you're going to have inflammation.
[00:20:17] Nick: Or like, sleep. Everyone's getting better sleep. I don't want to talk about the time of sleep, because everyone's slightly different. But everyone should be getting good quality sleep, because that's when your body's gonna kind of smooth all that stuff out, flush all that stuff out. So if you're not getting it, you're going to start the next day at a disadvantage, and then you go to your stressful job, do your hard work-out, and I'm doing all the healthy stuff, but you're still not sleeping. Well, there's gonna be some problems at some point. And that's like, where genetics would come into play too. I talked about this a lot, especially lately, I feel medical system loves the two scapegoats have age and genetics because if I'm the provider, and I blame it on genetics, I have no control of that. So I took the onus off me completely. But when I blame it on, that you also take the power away from the individual, so you make them feel helpless, which is wrong. And do genetics play a role, does it play absolutely plays a role, but it's not the only factor there and something needs to pull that lever, so people have these genetic predispositions to the pattern of IBS. When they have too much inflammation, it presents itself as IBS, whereas someone else may have it as rheumatoid arthritis or whatever. They might get it in their joints. But everyone's like, it's genetics, I just have to take this medication for the rest of my life and that's it. No, you don't have a deficiency in that medication. And there's something else going on that we have to address and that's just not being addressed in the modern medical system.
[00:21:49] Sarah Karaman: And the role of epigenetics too, we can't just blame our genetics anymore, because you can turn on and off the expression of specific gestures with these dietary and lifestyle patterns on age with that whole blaming sleeping issues on, there's a bunch of different things that can contribute. But what's your blood sugar looking like, that's a huge thing that I discussed with everybody, almost everybody that's in that age category, just by the time they've made it to that age, with all of the dietary and lifestyle kind of habits that they've built up. Most people have some form of blood sugar dysregulation, and that's contributing to their sleeping problems. So most of the time, once we get blood sugar really managed and under control, they wake up a lot less, they're getting much deeper sleep, and therefore they're actually able to recover from their workouts and just life and be able to mitigate some of that chronic inflammation in general.
[00:22:36] Nick: Do you use a lot of continuous glucose monitors or not?
[00:22:39] Sarah Karaman: I love continuous glucose monitors, it depends. So I work with a lot of women who have a lot of disordered eating stuff in their past. Sometimes it can kind of teeter the line of going back to much data all the time. I use it for myself, I think they're fantastic. And I use it with specific people. But with a lot of women coming to me, it could just like spark that disordered eating pattern. So I'm careful with it. But I really like nutrious sense. I work with them.
[00:23:04] Nick: Nice. Cool. That's awesome. That's great. The blood sugar thing is super interesting, because most people think I don't have diabetes. It's like, you don't need to be diagnosed with diabetes temperature dysregulation. And we're seeing a lot of children with it right now. And sleep issues and children, largely related to that. So it's a real issue that everyone should be cognizant of and pay attention because there's a lot of just bodily cues that you can you can focus on to address and manage those types of issues. Because it's a gradual thing over time. It's progressed over time, it's not just like one day, my blood sugar's dysregulated all of a sudden, over time.
[00:23:50] Sarah Karaman: It could take 20 years versus resistance before you even for sure change in your labs. And like, you could be at 91, one year, and then all of a sudden the next year, they're like, you have pre diabetes. Like how did this happen all of sudden, it's like you were inching your way there slowly.
[00:24:04] Nick: Oh man, that too, with the medical system, blaming things on age genetics, but then also like, you get this one data point, you're like, “Oh, that's it.” And then they diagnose like hypertension. They do it all the time. They get this blood pressure reading. That's high. And then we had Hayden yesterday, take the C bet. And he started out he's, he's getting all jacked up for the stress test. So his blood pressure was 160 or 80, when he was at rest, and then all of a sudden, he started exercising and it dropped to 120. So the one time reading is, is you gotta be careful with it. You really have to track data over time. And that's, that's super important.
[00:24:43] Sarah Karaman: And then what do they tell you to do? Cut out salt. They don't go into that.
[00:24:50] Chad: We go to a bag a month.
[00:24:52] Nick: So that's probably our biggest increasing protein and then de-educating the salt nuts with people is huge. So we use a lot of that and we love Redmond's. So they have their relight that my wife and I've been using for a while now that which flavor do you use? So we go on flavor it actually, I know it sounds crazy. Strawberry lemonade, so the flavors aren't good. Don't get me wrong. We go on flavored with puts like a little pinch in and I'm like, I don't think you're getting that much. They're like, “No, I tasted it, taste it.” And I'm like, “I still haven't figured it out”. But she like, we go unflavored but in terms of the flavors, I usually just stick to like the lemon. I like lemon lime. Like, that's usually my go to.
[00:25:54] Sarah Karaman: It's like vanilla ice cream.
[00:25:56] Nick: These brands usually can't mess up. Like, it's hard to get some of the fruit of your life. Like when you get into something like strawberry, watermelon, stuff like that. Sometimes they can take a butcher and a little bit but that was a weird rabbit hole. No, it wasn't a rabbit. But the salt thing is interesting. , people have a lot of preconceived notions from decades ago, and they're still operating into that. But the biggest thing, in my opinion with salt is that you can actually cause more harm by going to buy over restricting salt. And that's our big thing is like, we don't mean take an excessive amount of salt because that can pose some issues. But our thing is like, most people are under consuming sodium for in terms of electrolytes, we don't want like bad quality salt. But if you're under consuming sodium, you are going to cause more imbalances in the body and potentially more harmful than too much because your body has natural mechanisms to get rid of excess sodium. Whereas your mechanisms for excess sugar, it just gets stored. So we have the ability to pee out excess sodium, the excess sugar doesn't get peed out as much as it does get stored. And that's where we get this blood sugar dysregulation.
[00:27:17] Sarah Karaman: And then they're lightheaded fatigue, they get all these muscle cramps, they're not recovering from their workouts. And they're like, my doctor told me not to eat any salt.
[00:27:24] Nick: I know. So because of the culture we live in. If you're listening to this, we can pretty much guarantee you that you could consume more salt, because most people are under consuming it because of our culture. , so and more so it'd be fine.
[00:27:38] Sarah Karaman: And only 2% of the population is actually sodium sensitive once they have high blood pressure. So it's not just high blood pressure. Once you already have high blood pressure, still only 20% of the people in that category actually respond negatively to too much sodium.
[00:27:53] Nick: There's literally doctors out there that treat hypertension with increasing salt. They just change to a better quality salt. So once you hear that just that that's happening out there. So how is it the salt? If the if doctors are doing it with salt, how is it the salt?
[00:28:12] Sarah Karaman: It just as messed up the whole cholesterol.
[00:28:16] Nick: Let's do this. You did it. We don't have to go. We can go there. It's actually a good topic. It's about nutrition related. So go down the rabbit hole. You need to go down the cholesterol, go down the cholesterol rabbit holes.
[00:28:31] Sarah Karaman: Because it kind of correlates to the same thing. We're talking about high blood pressure and just damage and then people that come in, and they're super confused of like my doctor said, I have high cholesterol. What am I supposed to do? Some of the doctors are great. And they're like, I'm working with nutritionist and they're like, “Cool”. She'll handle it. But some of them are like, let's just go on a statin, which we don't have to go down what statins do to your body. Don't do that. I'm not saying they're not useful in some instances. So there's obviously that caveat with all medications. But in general, the recommendations for total cholesterol keep being lowered over time and people don't realize your cholesterol is required for so many functions in the body for you to synthesize Vitamin-D through your skin, you need cholesterol for all hormone production and hormone shuttling around the body. You need cholesterol, specifically LDL cholesterol, which is your “Bad Cholesterol”. And so when people have high LDL, they also don't realize that you have different particle sizes of LDL. So if it's the large, buoyant, fluffy type, those are the type you need for hormone production for all of these beneficial things. Those little small dense ones are the ones that potentially can jam into the artery wall and cause issues. But I heard one great analogy once and I don't remember where I stole it from. But it's like blaming a firefighter for a fire, like they showed up at the scene. Those type are there and they're present in the foam cell that caused some of that like blockage to the artery, but that's trying to patch a wound. It's not why the wound in the artery was there to begin with. So it really is the firefighters that they're trying to put out the fire, but they're not the ones that set the building on fire to begin with. So this whole total cholesterol, they keep lowering it over time because it puts more and more people on statins when they're like, “Oh, you're over 200. But it used to be 250, and heart disease is getting worse, not better.” And in this huge, massive study, they did have people that had a heart attack. 75% of them didn't even have high cholesterol. So if cholesterol is to blame, then why do so many people without high cholesterol have heart attacks? Clearly, we're missing something.
[00:30:31] Nick: When you look at graphs at different times are two different things that we're trying to link and they're opposite. And it's pretty much tells you , if they're trending in that same direction, which I've seen other people refer to this as like, “Oh, look at heart disease, and then look at the consumption of seed oils. They're the same, literally, like almost identical graphs.” And so there's something there. The cholesterol thing is, I have heard and I was trying to think of it where I heard that. I heard the firefighter analogy as well. I probably feel like it may have been Steven Hussey, do you follow him? So he actually he's an interesting person. He wrote a book called under abilities called “Understanding the heart” but he’s a type one diabetic and had a heart attack at like, 33. And they told him all these things. And he was just like, I don't know, this doesn't seem okay. And he's a chiropractor by trade. So he's kind of shifted his whole career now. He's like, the heart guru kind of guy. And he wrote this book and everything. And he gets into the weeds and some of the stuff talking about the different zones of water and all that. It's crazy. I believe he uses the firefighter analogy as well. It makes sense. And I think that it's indicative of us doing the health care system, do we know a lot of stuff. Like, we're constantly blaming the firefighter, we got to figure out what lit this fire in the first place.
[00:31:54] Sarah Karaman: And then people keep saying if all this information is out there, then why is this still the current recommendation? One because it sells meds but two because it takes 17 to 20 years for current research to integrate itself into the medical recommendations. So it's like most of the time, these doctors don't have time to go through and dig into all of the current research and be like, are we prescribing the wrong thing for the wrong are we like chasing our tail? Are we getting down to the root cause, so that some of it too, but then also with cholesterol, there's triglycerides, like if you have high triglycerides, instead of focusing on cholesterol, let's focus on blood sugar. And then very often, your total cholesterol will start to regulate itself, in general. So it all starts to come back to really blood sugar regulation.
[00:32:36] Chad: Absolutely. I think it's a good time to transition too. Sarah made a good point about talking about the reference ranges for labs. And how it's the reference ranges for labs are correlating with how healthy people or unhealthy population people are currently. So as we become unhealthier as a population, the lab values continue to shift down because now the normal values are continuing to become less optimal. So everybody has to fit within this reference range, or else now, either insurance has to pay for this or that or whatever it may be. We kind of talked about this firsthand a lot with testosterone in men, women too, but the reference range for testosterone in men is like 300 to 900, summer 220. So all depending on that all depends on which lab company you go through, like LabCorp, it'll be like 264, you go to quest, it'll be like 283. And then you've got the one urology Academy that's like, no, anything under 300 as low it's like, so who's here, what ? So you've got all this confusion, not knowing where people need to be. And I think that's just like going across the board is as we become unhealthier as a population. The range either gets wider or gets lowered shifts, in any mean, what we just talked about recently, lab values that just shifted. Do you remember? We're talking about kids. I can't remember what it was now. They increased the excess of BMI for children. So it'd be amazing. Obviously, it's obviously a measure. But still, it's the principle, the principle is pretty sensible.
[00:34:33] Sarah Karaman: And what parents don't realize is the fat cells you put on as a child will carry on with you for the rest of your life. So you're gonna struggle with obesity forever. Even if you turn into a very healthy active person, you can only shrink those fat cells. So working on making sure that your children don't just eat whatever they want, whenever they want, and they're active and move. That's important. You're setting them up for the rest of their life. They can't just lose it and then be able to maintain that easily forever. And that's a sad Part Two of our society of like, just eat whatever you want rainbow waffles, why not?
[00:35:04] Nick: And be comfortable in your own skin, we had a podcast, the health shaming one. And it's just wrong because if you are saying be comfortable in your skin, but now that the child is literally unhealthy because they're overweight and they're being told, that's your body. No, that's wrong because you're setting them up for a lifetime of issues. And from the physical therapy perspective, we know that too much weight on the body is going to break down joints faster, it's going to cause excess stress and forces on certain areas of the body muscles, tendons, ligaments, joints. But also, when you carry these, these fat cells that Sarah was just referring to fat is where you store toxins. And we've talked about this on numerous podcasts, the most recent podcast, we talked a lot about it, but toxins are ubiquitous at this point in our environment in our world. And you're trying to minimize the exposure to that. But now if you have excess fat cells, you store more of them. ? So it's no wonder you feel like crap, if you're in that state your body is loaded with these toxins. And it's a problem, it's a big problem for sure. And it's gonna be harder to shed that that fat too, because now the toxins need to be released before the fat cell can go away. And that that is something that people are struggling with day in and day out is trying to read these their body these toxins, for sure.
[00:36:29] Sarah Karaman: And if you do something drastic, and you lose a lot at once, now you have this accumulation of a lot of toxins floating in your system, and then they get a ton of symptoms starting to come out of the woodworks, like, I just lost 50 pounds, I thought this was a good thing. Now I'm having all of these weird symptoms, crazy joint pain, crazy brain fog, sleeping issues, all the stuff that comes along with toxin accumulation. So then it's supporting your detoxification pathways, which is a huge in this world of like, just do juice cleanses.
[00:36:59] Nick: Like, that's not how your body works. So that's a whole rabbit hole. I think that is sometimes a deterrent, like when that's not talked about, and someone is going to someone who's making these decisions, and their body does detox all at once. And then they feel bad. They're like, “Man, this isn't right.” So then they resort back to what they were doing before because they're like, Well, no one told me I was gonna feel like crap for a little bit, , and it's your body shedding the some of that toxic stuff, but which is a good thing, sometimes we're just gonna go a little slower. , and I was having this conversation with someone this morning, actually, because everyone wants to do the Fed tie where they lose 30 pounds in six weeks and that kind of stuff. It's like, well, we have to slow down if you lose way too fast. We in a lot of cases, we want people to lose some weight. But you got to you got to do it at the right pace. Because if you go too fast, number one, it's a stressor to your nervous system is a stressor to joints, muscles all that stuff. But it's also a stressor to liver, kidneys, all the stuff that needs to flush out these toxins that are then released. So we have to go at a good pace and appropriate pace for the individual. Everyone's different. Some people can go faster, some people have slower, but you find what works based on how your body's responding or your body's reacting. And that's super important for sure.
[00:38:16] Sarah Karaman: And as you guys know, you can't lose just fat fast. So when you're losing weight fast, you're losing a lot of water weight, you're breaking down your own muscle tissue. And when you break down muscle tissues, six months later, you see people that have way more fat than they did six months ago, because you just lost your metabolically active tissue. So like healthy fat loss is between a half a pound and a pound a week, if you're being really regimented. And if you're not a female with hormones going all of it. But that's not the sexy thing to talk about on the internet of like, you could lose a half a pound. It's more of like you could lose 30 pounds in this short amount of time. And that's just not how it works.
[00:38:56] Chad: Instant gratification, that's the culture. Where we live right now.
[00:39:02] Nick: When you hear, it's gonna take some time. I need another. There's another option out there.
[00:39:08] Sarah Karaman: I'll take these weight loss.
[00:39:09] Nick: Let’s see ChatGPT how to do it. They'll know that the robot will know. What do we call the robot? How does the robot identify? That's way, way off topic. What do we have next? I don't have questions in front of it.
[00:39:34] Chad: It was lab work. And I think we could dive a little bit more into the supplements because people are always asked questions like that, what are your maybe top five recommendations or whatever? I don't wanna say most people, everybody falls into a different category.
[00:39:49] Nick: What do you find yourself recommending the most based on the clientele you work with or based on what you see?
[00:39:54] Sarah Karaman: So there's two like foundational support products that I pretty much use with everybody. I'm unless you have some obscure type of issue in which we can't use them. So obviously, as with everything, it really depends on the person. But usually I ended up using a really high dose high quality fish oil for the first three months, because that will help balance out. And then we remove seed oils and all that to balance out the Omega-6 to Omega-3 fatty acid ratio. So I do two grams of EPA and DHA with people for three months. And then we get on a maintenance type of dose. And then some people from there get enough omega threes in their diet, but like 99.9% of people do not. So then I keep them on some type of maintenance, fish oil, high quality tested for heavy metals, that kind of stuff. And then magnesium is another big one. And the dose and form is what matters. So most people have tried magnesium, and they're like it did nothing. But if or it gave me diarrhea, because you were taking magnesium citrate so like it depends, but usually I try to use more of a glycinate. It can cross that blood brain barrier mallet gets absorbed into the tissues. So it's finding the dose and for and that's very individualized. But those are the two that I tend to use with pretty much everyone. And then from there, there's different ones that we use for digestion. And those are like shorter nap protocol type of things, but shorter term ones. So we'll kind of reset digestion with like bitters and enzymes. So I use those with a lot of people more than I ever thought when I first started, I didn't think just addressing gut health with everybody, it's like one of the first things that we have to do is like, let's make sure that your gut is working appropriately. So those are kind of the foundational support ones. And then from there, there's a lot of other ones that I'll use a lot of herbs to help with detoxification pathways over time, just a lot of those digestive ones. Demulcent herbs like marshmallow root and that kind of thing, which I guess you could consider a supplement.
[00:41:47] Nick: That's always tricky when he starts talking about herbs, because in other cultures just eat the herbs. It's just the US is such a supplement driven company, which is it a bad thing now, because some of these companies are doing good work and make it so easily accessible. Because otherwise, you're trying to find a good quality source of upset urban in food for because you're not gonna find a stop shop, or even Whole Foods, because it's all the same herbs and spices, the spice aisle only has three rows, and it's all the same stuff in different brands. And those are just like the only supplement or the only spices we think there are on planet Earth. There's so many of them. It's insane. But that's the way that it kind of the US culture is for sure.
[00:42:36] Sarah Karaman: There's ones that I find everybody on. That ended up being like, just problematic for most people are just not doing anything. Everybody's taking these like four or five foundational things that they think are foundational, like you could easily get that through food, or it's causing harm, or that's not even the form that you find in food, and it cost the manufacturer 30 cents to make your $30 bottle of Vitamin-C, that like the whole foods complex of Vitamin-C is not just ascorbic acid. It's like Vitamin-C is one that everybody's on that we can really just get through food or through like a whole food version. And then calcium is like so calcium activities on calcium. It's crazy. And it can calcify your tissues. I've actually seen X-rays of people that have all of this like calcification on their ribs. And they were told by their doctor to take high dose calcium because they're at risk for osteoporosis. And then it's actually making their bone structure worse, because it's not absorbing into the bone like we think it is. . So I tried to get most people off calcium, like let's get it through food where your body knows how to do it. And then with vitamin C, you're just not getting the form you think you're getting by taking it over the counter.
[00:43:43] Nick: How long have you been on calcium long time? How your bind? It's like they're constipated. To get it's just binding everything up? So that is a big one with calcium for sure. I don't know. Where that came about? I feel like it's like a blanket thing for doctors. Like once you hit a certain age, takes some calcium. Do you know where that came from?
[00:44:06] Sarah Karaman: I think it's in this culture where we like to single everything out of like calcium was required for bone health, your bones start to weaken over time, which as you guys know, it's because people stop exercise. And that exercise is going to make sure that you have that healthy stress that's going to make sure that your bones are drawing in the nutrients that they need. But in general, people aren't moving. And doctors are like, calcium is needed for bones, let's just give you calcium, without realizing that is not being absorbed into the bones like we think it is. And now nobody eats dairy products anymore. So that's also a part of like, we're not now getting enough of it from our food. So it makes sense. I guess they're trying to be helpful and being like, it's a natural substance that can't do any harm but in reality that one does do harm.
[00:44:47] Nick: A couple of things that you had said, for sure. Magnesium is one I find recommending a lot because in times of stress, which is pretty much everybody all the time. You just burn out your body's magnesium stores because it's required by the adrenal glands. Same thing with the B-Vitamins, you blow through B-Vitamins, because your liver needs it, your adrenals need it like and it's water soluble. So you're paying it out. So those are two that that I often find that a lot of people could benefit from and the B-Vitamins are tricky, because I know you mentioned this earlier in the podcast, the methylated form is or you maybe it was unfair, actually. So a lot of people are out there taking a B-Vitamins, that's way too synthetic, and it's not methylated it's actually taxing their liver too much because their liver then has to methylate it and then make it usable. So a good high quality is certainly is something I find myself just recommending at least for a period of time for people to kind of get out of whatever they're dealing with for the meantime. But the herbs for liver support. What's your go to herbs for detox pathways?
[00:45:57] Sarah Karaman: Oh gosh, this is another whole rabbit hole. So I use a lot of dandelion root people, dandelions great, I use a lot of milk thistle, which doesn't necessarily help with just the detox pathway silymarin. And it helps actually heal the liver itself. So those cells can recover a little bit better, because that's almost like protective kind of sheath. So I use a lot with that detoxification type of pathway support. Glutathione is one that a lot of people take because it's your body's master antioxidant. It was not well absorbed through supplement form. So you could be shelling out all sorts of money and have it be doing nothing. So if you want to take glutathione the liposomal form is one that like can absorb into the cheek tissue. However, it tastes like rotten eggs. Like it's horrible. It tastes so bad seeking health.
[00:46:46] Nick: I haven't had seen it. I go through a company Quicksilver Scientific. So there's actually they have like a lemon mint into central oil and some lemon balm essential oil. So it's really not as bad because with the liposomal for those listening, and they're not sure what that is, basically, you need to let it sit in your mouth for usually like 30 seconds or so. So it can absorb into the bloodstream through the mouth mucosal layer and, and it is absorbed faster because it's encased basically in like a fat cell. So it's protected from being broken down right away. So liposomal has been shown to be way more effective. Glutathione is a tricky one. Because if you take like a capsule form, it takes upwards of like six months to actually increase your body's levels of glutathione. So it's probably not worth it for a capsule form. If you were taking it every day for that long, you probably can assume that your levels have increased some, but liposomal has been shown to be rather effective. Obviously, the best form would be injectable or there are certain things there's even foods that increase your glutathione level like beets, part of the reason people rave about something because they increase they upregulate glutathione production as does I believe milk thistle like milk thistle part of the reason it's so beneficial for the liver is because it up regulates glutathione milk thistle also increases gallbladder contractions and bile flow. So that's helpful from that perspective to
[00:48:17] Sarah Karaman: Be cheap and easy to find. Good quality water shot expensive. , for glutathione sometimes you use N acetyl cysteine instead, which is the precursor for something I've more recently found out is it's actually also a biofilm breaker. So if people take NAC for too long, you can be starting to break down some of your healthy bacterial strains. So I use it when we're like killing off overgrowth too.
[00:48:40] Nick: Having an NAC in the medicine cabinet not taking it every day but having it available like you start to feel something because NAC is also in the research been shown to be super helpful for like sinus stuff especially kind of post nasal drip stuff that won't go away like that's just been lingering. It really helpful for that so a short term strategy whereas some of the liver supporters like milk fissile, like should you take it every day? And maybe now you could argue but like, “Would you be fine if you did?” Probably it's just like a food, so a lot of licorice too.
[00:49:16] Sarah Karaman: But again, one that you have to take breaks from can cause damage if you take it too.
[00:49:23] Nick: And licorice can be a tricky one too, because that can go as well. So it can have effects on blood pressure and sometimes like depending on someone's like immune type like if their immune system tends to be kind of more dominant one way or the other. It can be tricky with that too. So people sometimes have to be careful that with licorice root but it's one of the most things should be short term cyclical. You use it every so often. You're trying to drive a certain pathway I love like just because like we've talked about before the toxins you being ubiquitous in our environment at this point, I would love for everyone to know my liver needs to detox this stuff and do kind of like liver support, whether they do a week here. They have like a kind of like liver reset week, or they do a day a week or whatever. So you mix it in whatever works for you. And you just do some of these, these herbs that we're talking about to support your liver pathways during this time, maybe not 365 days a year. But at certain points throughout the year, you're just kind of assisting this process along because it's more important now than ever, just because we have so many of these environmental toxins that are just flying under the radar for sure.
[00:50:43] Sarah Karaman: And what we do is like we focus on how do we help detox versus how do we also cut down on the amount of toxins coming in? What are you putting on your skin? What are you putting in your hair? What's in your food? How can we actually start to minimize the amount of toxins that's bombarding our liver? So we can still support it, because we can't avoid car fumes. And we can't avoid some of these things. But we can reduce our overall stress load, because that's still a stress on the body. So sometimes we think of stress is just mental emotional stress. But all of these toxins and toxin accumulation is your environmental chemical stress, and it's just contributing to your overall stress load too. So that's a big one is just making sure that not only are we trying to support our detox pathways, but we're not bombarding them to begin with as much as possible. For sure.
[00:51:28] Nick: For sure. It's so true. As it relates to liver detox, there's six detoxification pathways in the liver. So some of these herbs are more specific to other things. So that's another reason that mixing and matching recycling and doing this one at this time, and then a different one can be helpful, because they're a little bit more specific. I know, she signed was another one that I liked that she signed for Barry, that it has been shown to support all six of those. So that's pretty cool about Cassandra that it does. That is another one to kind of throw into the mix. But there's a ton out there that you could find all these other ones. This supports deliver to and nature has got it all figured out. We're still trying to figure out nature, but it's all out there in nature. So we need to just break away from just our three rows of spices.
[00:52:24] Sarah Karaman: And that's a great helping your shirring all functions, stress responses are all connected anyway. Nothing in the body works in a vacuum. I like to think like this has an effect on this, versus it has an effect on all sorts of different organ systems because they all communicate with each other. So many herbs have like multifactorial help and aid in the body versus just you're taking it for this one thing, but it's also having other downstream effects on other systems.
[00:52:51] Nick: Absolutely. That's the cool thing about herbs too, whereas pharmaceuticals tend to be very, like specific to one function. Whereas herbs have they're a little bit broader spectrum, which is fantastic. Like you mentioned to bitters before bitters or what do you use for a brand typically on that one?
[00:53:11] Sarah Karaman: I use Flora a lot. There're Swedish bitters. Again, it's like a tincture type of form. Because you want to taste it in your mouth, like you have bitter receptors from your mouth all the way through your GI tract, we just try to bypass the mouth, and we’re missing half of the benefit of the benders, because it stimulates acid production. So 10 to 15 minutes before a meal, it's going to help start stimulating adequate amounts of stomach acid to actually digest proteins. It's gonna turn on motility. So again, we've talked about constipation being kind of the root of a lot of these issues of it'll start to turn on motility. So things are actually moving through your GI tract. And proteins aren't just sitting like a rock in your stomach. Because so many people would be like, I don't digest red meat, so it's not good for me. And you just don't have enough stomach acid and motility to actually break it down. So bitters are really helpful. It's like a corrective.
[00:54:00] Nick: It's so interesting, because so many people, everyone talks I love salty LFC. No one ever talks about bitter and everyone's just like, “No, that's too bitter. It's like, why wouldn't we get to that point?”
[00:54:13] Sarah Karaman: The only sponsors that doesn't have bitter things. Part of our s doesn't diet. Which is sad, because we're kind of a mishmash of all sorts of cultures. We don't have a lot of cultural foods in general, which is to our detriment, because other cultures have like bitter teas, and arugula and greens and things that are actually stimulating these better receptors. Even in Italy, olive oil is considered a bit a better lemon is a bitter, these things that we try to hide and mask versus eat by themselves. Even black coffee is a better but what do we put in our coffee all sorts of stuff. I think bitters is really important of like a long term, keep stimulating those receptors. They wouldn't be there if we didn't need bitters in our diet for sure.
[00:54:53] Nick: For sure. That's one of my biggest recommendations for people right off the bat. Dealing with any kind of GI issues. Every time you drink water, I want you to add fresh lemon or lime. Like just keep it cut up and it's everywhere because it can do some wonderful things for that gallbladder and that's so cheap. Like you can get limes two for a buck like it's so cheap and affordable but so can be so vastly impactful. So people think of that as like, “Oh no, it's a citrus. It's a sweet and now they're a bitter, have you tried to eat one like an orange?” It's not fun but bitters are something that I've certainly come around to more. You learn about things like rosemary, artichoke, that kind of stuff. That's their suit can be super helpful for the body.
[00:55:40] Sarah Karaman: And speaking of gallbladder, over a million gallbladder removed a year, and that's not just a willy-nilly organ, we just like why we don't know why it's there. It serves a function and it starts to become dysfunctional before you get stones before you're after remove it. Start to get the signs beforehand. So things like bitters, and ox bile and digestive enzymes, and all of those things can help your gallbladder function. Speaking of detox, like your bile salts, and your that bile acid actually helps remove toxins for that third phase of detoxification to that elimination phase. So we think of, oh, I just don't digest fats well, but like you're also not detoxifying, well, you need to make sure that your gallbladder is functioning properly.
[00:56:22] Nick: Without a doubt. We talked about that. So one of our employees had her gallbladder removed. And we talked about it on one of the podcasts, and we do this, we're talking about all the detriments of the medical system which is good, it's needed. But we just kind of assumed that parts of the body are faulty, I'm a big from a physical therapy perspective. It's called the foot guy. But we just assume in the world of podiatry, and all that kind of stuff, no feet are frail, like feet are fragile. So we're gonna have to support him at some point. So how did we get there and we just kind of assumed that certain parts. Gallbladders were just faulty sometimes, and it's like, “Wait, hold on, we got to peel this back farther”. But we don't we just remove it and say, “No, you couldn't live without it”. And on one hand, it's really cool that your body can actually survive without that. Like, it speaks volumes with significant modification. But still, you don't. No, it's unnecessary, or you're but you don't die. It speaks volumes to how robust the human body and being is. But it's also like know, if we want to avoid that at all costs, but it's blocked. Let's just remove it. It's like, why not try a coffee enema first?
[00:57:40] Sarah Karaman: And on that ultrasound getting there, you don't have stones, you're fine. But they can tell if it's become sludgy, like that bile become sludgy before it turns into stones. So they can have that preventative aspect if they wanted to, if they didn't just want you to wait until it turns into stones.
[00:57:56] Nick: But they'd have to know how to?
[00:57:58] Sarah Karaman: So you can tell.
[00:58:01] Nick: We haven't made a medication that's better.
[00:58:08] Sarah Karaman: Just with everything, like let's just wait until it turns into a disease even though you have these blaring warning signs, like something is going wrong for sure.
[00:58:14] Chad: You went to this problem that about for sure. That's so true. You were kind of quiet bitters talk. No, that's not my forte, but it's very interesting. I would like to leave it as with Sarah, we have this one question that we ask everybody. And the question is, what is one piece of health advice from your experience that you could offer our listeners today that they could implement?
[00:58:40] Sarah Karaman: Oh, my God, that's a hard one.
[00:58:42] Chad: I know it's a tough one, narrow it down.
[00:58:46] Sarah Karaman: Without really knowing the person or what they have going on, in general, it's really looking at making sure that you're at least taking something like that magnesium and fish oil that we talked about, because that is going to make sure that you're getting stuff that you're not getting through your diet, or that our food system is very depleted. And we could go down the hole, why we're not getting enough magnesium and why we can't get enough through food. But those two will usually help you address some of these energy issues and mood issues and inflammation issues. Like it'll start to help you address that so that you can then have more energy and put more towards all of the other changes that need to be made. So kind of starting to address those foundational things, so that you can then have more mental aptitude to do the other things that we're going to talk about later on.
[00:59:32] Chad: Cool. So if somebody was interested in working with you, Sarah, how could they find you whether it's Instagram, Website, Email?
[00:59:41] Sarah Karaman: So my Instagram was just SarahK_nutrition. Same thing with Facebook, which I find funny because my Facebook has way more followers but I won't actually use Facebook. It's just how it goes. And then my website is also just Sarah Karaman Nutrition. Same thing with my email, it's all pretty straightforward, but I'm pretty widely available on there. I take clients virtually in person.
[01:00:07] Chad: I'll put that in the show notes too. So everybody has that. Any anything else you wanted to add, Nick?
[01:00:11] Nick: We covered it. We need a part two though because there's more. There's more. We didn't go too deep in a rabbit hole. I almost made a joke to it. But when we talked about cholesterol, I was gonna call it the rabbit cholesterol.
[01:00:25] Sarah Karaman: They would have had a good one. I would have had for all these guys.
[01:00:30] Chad: Makes a dad of 8 months and he still thinks that dad jokes are cool.
[01:00:40] Nick: They’re. I don't see the issue.
[01:00:42] Chad: There's going to be an issue when your kids needs to make. It's going to be awesome. He's going to be. You're going to embarrass someone for. We thank you for stopping by and we look forward to round two for sure when it happens.
[01:00:57] Sarah Karaman: Thank you for having me.
[01:00:58] Chad: Thanks, Sarah.
[01:01:02] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.