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I have never been a purse person, but when my kids were little, I carried a bag that was always full of crap. My crap and everyone else’s crap. I could dig around in the bottom of that bag and find things that I could not even identify.  Not surprisingly, I have come to find […]

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Research of the Week

Statins increase Lp(a).

In mice, a high-fat maternal diet protects against Alzheimer’s in the offspring.

Neanderthals ranged into western Iran.

Among Chinese seniors living in an elderly community, higher LDL predicts lower rates of dementia.

Heated canola oil worsens gut inflammation.

Dairy still has no relation to mortality.

New Primal Blueprint Podcasts

Episode 368: Bela Gandhi: Host Elle Russ chats with dating expert Bela Gandhi.

Episode 369: Q&A with Brad: Host Brad Kearns answers questions about gaining weight on keto, a military success story, and more.

Primal Health Coach Radio, Episode 24: Andrew Sillitoe comes on the podcast to discuss practicing what you preach, structuring effective client offers, and the importance of taking action.

Each week, select Mark’s Daily Apple blog posts are prepared as Primal Blueprint Podcasts. Need to catch up on reading, but don’t have the time? Prefer to listen to articles while on the go? Check out the new blog post podcasts below, and subscribe to the Primal Blueprint Podcast here so you never miss an episode.

Media, Schmedia

Because it has a few grams of saturated fat, olive oil misses out on a “healthy” rating in Australia.

Extreme athletes tend to have bad teeth.

Interesting Blog Posts

Peter wonders if “loss of the gene for lipoprotein lipase, or similar loss, might not have been a big deal when humans lived by eating elephants. Or even until corn oil took off as a cholesterol lowering scam.”

Social Notes

I agree with some of these “healthiest pantry staples” on Amazon.

Interesting thread on atherosclerosis.

Everything Else

Turkish beekeeper makes lemonade.

Dutch consumers form a “people’s farm.” Good idea.

Viking winter sports.

Worrying figure.

Things I’m Up to and Interested In

Study result that people need to hear: Protein intake has no effect on kidney function in healthy adults.

Concept I found interesting: Human emotions as personal narratives. And how aging affects the narratives we create for ourselves.

I can see it now: Statins for crows.

ATM I’d use: Salmon ATM.

This was a cool podcast: The ultimate lipid podcast with Dave Feldman and Siobhan Huggins.

Question I’m Asking

Have you noticed a shift in the way people in everyday life approach health, fitness, diet, and lifestyle?

Recipe Corner

  • This doesn’t get a link because it’s incredibly simple: frozen watermelon slices. If you want to get crazy, dip them in a mix of salt, cayenne, and lime juice.
  • Carnivore pizza.

Time Capsule

One year ago (Aug 25– Aug 31)

Comment of the Week

“Good work Mark – Why is TMAO linked to kidney and heart disease?
The TMAO that is soi linked is being made from trimethyl-lysine, TML.
TML is formed in the body when cells are trying to make carnitine,
If this doesn’t happen, the TML can be converted to TMAO.
TML seems to be a better predictor of heart disease as TMAO.
It looks to me that TMAO can be a sign of diseases that lead to carnitine insufficiency, rather than the other way round
https://academic.oup.com/eurheartj/article-abstract/40/32/2700/5477386?redirectedFrom=fulltext

– Great work, George. You always find interesting connections.

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Can you drink wine if you’re Paleo? In this article, I’ll share my tips for choosing a Paleo wine and I’ll explore whether or not the beverage is a healthy addition to an ancestral diet.

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Turmeric is an unassuming orange root, quietly used for years in Indian cuisine to bring that particular flavor and color that so epitomizes curry and other Eastern dishes. In recent years, however, it has risen to superstardom among health and culinary enthusiasts in the United States. So what’s so great about this golden spice, and […]

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A special thanks to Courtney Hamilton at Paleohacks.com for today’s keto recipe roundup.

Cook up keto-friendly meat, veggies, chips, and fries in a snap with the air fryer!

The air fryer works similar to a convection oven, and it’s becoming every bit as ubiquitous as the crock pot. It’s a must-have kitchen appliance for when you want to save time while making healthier meals—which you’ll definitely want when you’re on the keto diet.

One of the best parts of using an air fryer is the ability to make deliciously crispy recipes like onion rings or fish sticks—but without any grease.

If you’re new to keto or the air fryer (or both), these 22 recipes for appetizers, sides, healthy snacks, and mains are a great way to get started! Serve it alongside a slice of keto bread, and you’ve got yourself a great fat-burning meal!

1. Air Fryer Keto Onion Rings

These perfectly crispy fried onion rings taste like they came from your favorite restaurant, but without the gluten and grease. Serve it with Paleo mayo for a winning app.

Air Fryer Keto Onion Rings | Wholesome Yum

 

2. Crispy Air Fryer Fish Sticks

Whether you’re cooking for kids or yourself, these golden crispy fish sticks will satisfy every time.

Crispy Air Fryer Fish Sticks | All Day I Dream About Food

3. Keto Air Fryer Meatloaf Sliders

Jazz up Grandma’s meatloaf recipe by making them into sliders. Comfort food meets convenience in this main dish meal that will become a regular in your weekly rotation.

Keto Air Fryer Meatloaf Sliders | A Girl Worth Saving

4. Air Fryer Green Beans with Bacon

Bacon adds a delectable salty and savory flavor to the green beans. It’ll convert even the harshest vegetable hater!

Air Fryer Green Beans with Bacon | Two Sleevers

5. Air Fryer Keto Low-Carb Fried Chicken

Low-carb and grain-free fried chicken? Yes, it’s possible! Serve it with your favorite keto side dish and you’re good to go.

Air Fryer Keto Low-Carb Fried Chicken | Wholesome Yum

6. Air Fryer Salmon Patties

“Fry” up these golden patties and serve them with your favorite veggie chips and avocado for a yummy keto lunch.

Air Fryer Salmon Patties | Berry & Maple

7. Air Fryer Keto Popcorn Chicken

Kids and adults alike will love snacking on these grain-free, crispy bites.

Air Fryer Keto Popcorn Chicken | What Great Grandma Ate

8. Easy Baked Zucchini Chips

Kale chips get lots of attention, but you won’t look back when you try these crispy keto zucchini chips.

Easy Baked Zucchini Chips | Sweet C’s

9. Air Fryer Chicken Breast

You don’t have to worry about dried-out chicken here. This crispy, juicy bird rivals even the Instant Pot® cook quality.

Air Fryer Chicken Breast | Love Food Not Cooking

10. Air Fryer Brussels Sprouts

You don’t need any cooking skills to get these Brussels sprouts perfectly crisp. They’re a great veggie for when you’re craving a hearty dose of nutrients.

Air Fryer Brussels Sprouts | Sustainable Cooks

11. Easy Air Fryer Roasted Broccoli

Speaking of perfectly cooked veggies, this air fryer broccoli is a delicious way to up your veggie intake on a keto diet. You’ll like them even if you aren’t watching your carbs!

Easy Air Fryer Roasted Broccoli | Stay Snatched

12. Crispy Avocado Fries

There’s more to the avocado than guacamole, as proven by these tasty avocado fries. Serve as an appetizer, a snack, or a side dish!

Crispy Avocado Fries | Broke Foodies

13. Keto Air Fryer Shrimp Scampi

You don’t have to hit up a seafood restaurant to get perfectly cooked shrimp scampi. These golden brown shrimp pair nicely with keto onion rings or avocado fries!

Keto Air Fryer Shrimp Scampi | Two Sleevers

14. Air Fryer Bacon Wrapped Asparagus

The classic Paleo and keto dish gets an air fryer makeover. You can prep them in just five minutes, and they’re on the table in less than 30 minutes.

Air Fryer Bacon Wrapped Asparagus | Monday Is Meatloaf

15. Easy Keto Low-Carb Vegetarian Air Fryer Cauliflower Buffalo Wings

You won’t have trouble boosting your veggie intake with these spicy cauliflower Buffalo bites.

Easy Keto Low-Carb Vegetarian Air Fryer Cauliflower Buffalo Wings | Stay Snatched

16. Air Fryer Steak Bites and Mushrooms

Bust out the air fryer for your next steak night! This recipe cooks juicy mushrooms together with steak bites for an easy meal you’ll come back to time and again.

Air Fryer Steak Bites and Mushrooms | Best Recipe Box

17. Air Fryer Chicken Wings

Whether you want to serve them as a snack, appetizer, or main dish, these chicken wings are crispy, juicy, and finger-licking good.

Air Fryer Chicken Wings | Keto Adapted

18. Air Fryer Garlic Lime Shrimp Kebabs

You don’t need a grill to make kebabs! Coat shrimp with fresh lime for a zesty, savory dish that will definitely wow dinner guests.

Air Fryer Garlic Lime Shrimp Kebabs | Berry & Maple

19. Air Fryer Salmon and Asparagus

Yes, you can make a lighter meal in the air fryer! You’ll save time and dishes when you whip up this easy keto meal that preps and cooks in under 15 minutes.

Air Fryer Salmon and Asparagus | Eat the Gains

20. Air Fryer Kale Chips

Cook a big batch of these keto kale chips and munch on them all week!

Air Fryer Kale Chips | Berry & Maple

21. The Best Air Fryer Whole Chicken

Better than rotisserie and easier than the oven, this whole chicken is great for special occasions. Try small turkeys, too!

The Best Air Fryer Whole Chicken | Recipe Diaries

22. Air Fryer Roasted Asparagus

Season your asparagus however you like, then cook it to perfection in the air fryer.

Air Fryer Roasted Asparagus | Berry & Maple

Thanks again to Courtney Hamilton from Paleohacks.com. Interested in seeing a certain recipe or roundup of a certain category—Primal or Primal-keto? Let us know below!

BBQ_Sauces_640x80

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With the last few weeks’ definitive guide and follow-up on fish, a reader asked me about trimethylamine N-oxide, or TMAO. What is it?

TMAO is the latest justification given for why eating meat just has to be bad for you. Saturated fat didn’t take. Animal protein didn’t work. Iron was a dud. IGF-1 hasn’t panned out. Methionine isn’t enough. So now they’re using TMAO to convince you not to eat that steak.

How’s it supposed to work?

How TMAO Happens

When certain gut bacteria encounter choline (found in eggs and liver) or carnitine (found in meat, especially red meat), some of it is converted to trimethylamine, or TMA. TMA is the compound that gives fish its “fishy odor.” Fish is actually extremely high in TMA, which I’ll discuss later on. Then, the liver converts a portion of the TMA to TMAO. Studies have shown that elevated serum levels of TMAO are linked to heart disease, type 2 diabetes, kidney disease, and even all-cause mortality. There’s definitely some heterogeneity among the studies, but enough have found a strong connection between TMAO and all manner of poor health conditions that researchers have focused on this compound.

Okay, so anything that contains choline or carnitine will increase TMAO, which should in theory increase your risk of heart disease. Right? Let’s go down the list.

Dietary TMAO Precursors and Their Effects On Health

Eggs. The best source of TMAO-precursor choline in our diet—eggs—should absolutely skyrocket TMAO levels. Except it doesn’t happen.

Three eggs a day has no effect on TMAO levels, even as it increases choline levels and HDL cholesterol.

Okay, so maybe the choline slipped past the TMA-producing gut bacteria in that study, but what about if you quickly switch people from eating oatmeal for breakfast to eating eggs. Surely bad things will happen, right?

No. Eating eggs instead of oatmeal has no effect on TMAO levels. It increases carotenoid and choline levels, though.

Liver. Okay, liver has to do the trick. It has high levels of both carnitine and choline. But no: feeding liver (among other foods) to men fails to increase TMAO levels above control.

Carnitine. Forget meat. What if you go straight to the offensive precursor itself and give actual human women a big daily dose of carnitine for, I don’t know, 24 weeks? Surely it will do something bad.

Nope. TMAO skyrockets, an indication that these ladies’ gut bacteria are converting carnitine to TMA and TMAO, but serum C-reactive protein, interleukin-6, L-selectin, P-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and lipid profile markers are completely unaffected. If gut bacterial conversion of carnitine to TMAO is the preeminent risk factor for heart disease, you’d think some of these ladies’ cardiovascular risk factors would have responded. They had half a year to respond. They did not.

Okay, but maybe there’s lag time between TMAO increases and deleterious changes to health. Nope. They followed those same ladies after cessation of carnitine supplementation. Their TMAO levels dropped, but their health markers stayed the same. No change.

And here’s a study where they used carnitine to increase TMAO levels in patients on dialysis. Not only did nothing bad happen, but the carnitine even reduced markers of vascular injuries. Higher TMAO, better health.

Seafood. As I mentioned earlier, fish and shellfish come pre-contaminated with the TMAO precursor TMA. It’s what gives the characteristic fishy odor, and it definitely gets converted to TMAO. In fact, a human study from a few years ago found that feeding people fish spiked TMAO levels by 60 times. A more recent study even concluded that elevated TMAO levels are a reliable marker for cod intake. The more fish you eat, the more TMAO your body will process.

If you’re going to claim that TMAO is dangerous and causes heart disease, you’ll have to make the case that fish is dangerous and causes heart disease. All the evidence we have points in the opposite direction—that fish and shellfish are protective against heart disease.

So, Why Is TMAO Linked To Poor Health Then?

How do we explain the connection between increased TMAO and poor heart health?

Here it is linked to atrial fibrillation.

Here it is linked to stroke.

Here it is predicting heart events.

The connection is there. And in animal models, TMAO even appears to mechanistically increase atherosclerosis. The mice they dosed with TMAO to increase atherosclerosis were genetically engineered to be ApoE knockouts, a strain of lab mouse that gets heart disease from almost everything, but still.

The connection isn’t causal. It’s an observation. There are no controlled studies giving people foods (or even supplements) that raise TMAO and increase disease or death. There aren’t even prospective observational studies where they track a group’s food intake, TMAO levels, and death/disease over time.

You know what I think (and have always thought)?

High TMAO can be a marker for metabolic disease. It could indicate inhibited kidney function, as the kidneys are response for disposing of excess TMAO. It could indicate poor health in general.

The latest evidence is confirming what I’ve long suspected: the reason high TMAO levels are linked to cardiovascular disease and overall mortality is that both type 2 diabetes and chronic kidney disease cause elevated TMAO levels. The causality is reversed.

What’s one of the kidney’s primary jobs? Excreting waste materials and toxins. What’s going to happen if the kidney begins to fail or lose its functioning? The stuff that used to be excreted starts backing up. TMAO is supposed to be excreted in the urine via the kidneys. If the kidneys aren’t working, TMAO levels skyrocket.

But even then, high TMAO isn’t even necessarily a bad thing. Check out that study I linked to earlier where women were given carnitine every day. Their TMAO levels skyrocketed but nothing bad happened. No health markers worsened. In one study, they even improved.

The Takeaways…

That’s the thing with biology. There are dozens of reasons TMAO could be elevated, some of them bad, some of them harmless, some of them good.

There simply exists no credible evidence that increased TMAO because you’re eating fish, or eggs, or liver, or meat, does anything untoward to your health. I’m not ruling it out. But the evidence just isn’t there. There’s far more evidence that eating fish, eggs, liver, and meat improve your health.

That’s it for today, folks. If you have any further questions about TMAO, leave them down below. Until then, enjoy your choline and carnitine!

Thanks for reading.

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References: 

Schiattarella GG, Sannino A, Toscano E, et al. Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis. Eur Heart J. 2017;38(39):2948-2956.

Dimarco DM, Missimer A, Murillo AG, et al. Intake of up to 3 Eggs/Day Increases HDL Cholesterol and Plasma Choline While Plasma Trimethylamine-N-oxide is Unchanged in a Healthy Population. Lipids. 2017;52(3):255-263.

Missimer A, Fernandez ML, Dimarco DM, et al. Compared to an Oatmeal Breakfast, Two Eggs/Day Increased Plasma Carotenoids and Choline without Increasing Trimethyl Amine N-Oxide Concentrations. J Am Coll Nutr. 2018;37(2):140-148.

Zhang AQ, Mitchell SC, Smith RL. Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999;37(5):515-20.

Samulak JJ, Sawicka AK, Hartmane D, et al. L-Carnitine Supplementation Increases Trimethylamine-N-Oxide but not Markers of Atherosclerosis in Healthy Aged Women. Ann Nutr Metab. 2019;74(1):11-17.

Samulak JJ, Sawicka AK, Samborowska E, Olek RA. Plasma Trimethylamine-N-oxide following Cessation of L-carnitine Supplementation in Healthy Aged Women. Nutrients. 2019;11(6)

Fukami K, Yamagishi S, Sakai K, et al. Oral L-carnitine supplementation increases trimethylamine-N-oxide but reduces markers of vascular injury in hemodialysis patients. J Cardiovasc Pharmacol. 2015;65(3):289-95.

Svingen GFT, Zuo H, Ueland PM, et al. Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation. Int J Cardiol. 2018;267:100-106.

Liang Z, Dong Z, Guo M, et al. Trimethylamine N-oxide as a risk marker for ischemic stroke in patients with atrial fibrillation. J Biochem Mol Toxicol. 2019;33(2):e22246.

Haghikia A, Li XS, Liman TG, et al. Gut Microbiota-Dependent Trimethylamine N-Oxide Predicts Risk of Cardiovascular Events in Patients With Stroke and Is Related to Proinflammatory Monocytes. Arterioscler Thromb Vasc Biol. 2018;38(9):2225-2235.

Jia J, Dou P, Gao M, et al. Assessment of Causal Direction Between Gut Microbiota-Dependent Metabolites and Cardiometabolic Health: A Bidirectional Mendelian Randomization Analysis. Diabetes. 2019;68(9):1747-1755.

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Lifestyle change often fails because we try to do too much and we train too little.

Have you ever been driving down the interstate when it occurred to you that a sharp turn of the steering wheel in either direction would send you and your cargo flipping to an early grave? Not a pleasant thought, but it is surprisingly common. We all have these moments of recognition where we are reminded and possibly frightened by the immense power we hold. Perhaps you’ve had similar thoughts when holding a newborn or a ladder for a friend.

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Honestly, it would be easier to list the problems that coconut oil can’t solve rather than the ones it can. Keep a jar of this all-purpose oil in your bathroom and your kitchen to help with everything from dry elbows to halitosis. If you’re still not sold on coconut oil, check out our list for […]

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For today’s edition of Dear Mark, I’m answering several questions you guys asked in response to the fish post from last week. First, is being a pescatarian enough? Can you get what you need from seafood without eating meat, dairy, or eggs? Next, how important is fish for a carnivore? Third, how’s that Whole Foods farmed salmon? Healthy or not? Then I write a bit about canned cod liver, the underrated seafood, followed by a short blurb about whether we should worry about wild salmon sustainability as well as a question about taking chlorella to reduce heavy metal absorption from fish.

Let’s go:

Adore this Mark! Thank you!

As a basically pescatarian this has been a wonderful insight. I find it too difficult or just a bit heavy digesting meat often, but I live for seafood!

Quick follow up question- anything I could be missing not eating meat, dairy or eggs and just seafood? If so how best can I combat those issues?

I’m struggling to come up with any major deficiencies you’ll incur eating only seafood for your animal products.

However, simply eating fish probably isn’t good enough. You need to also eat shellfish, particularly the bivalves oysters and mussels.

Most people get their zinc—important for hormone optimization and thus everything—from red meat, but the best source in the entire world is the humble oyster. Just one oyster gives you nearly 100% of your daily zinc, selenium, and copper. But don’t just eat one. Eat multiple oysters often.

An affordable way to obtain oysters is to buy canned or buy the pre-shucked ones. If you get the shucked oysters, make sure they’re fresh as can be. Pick jars with “use by” dates as far off in the future as you can. Sauté these in butter or avocado oil until a crust develops on both sides, or just simmer them in some hot bone broth.

I’d also recommend getting some salmon roe, aka ikura. They usually come salt cured, little globules of DHA, vitamin D, and astaxanthin-rich phospholipids that pop in your mouth. They are far more potent a source of nutrients than salmon flesh (which is already one of the best). You can get them at Japanese markets and sushi restaurants, or order them online in bulk.

I’d eat a variety of fish. If you had to just pick one, wild salmon would be great, but you’ll be better served eating many kinds. Halibut gives great magnesium. Salmon gives great selenium, vitamin D, and omega-3s. Cod is a nice way to pack in the protein. Smaller fish provide calcium, omega-3s, and iron.

Oh, and throw in some shrimp or crabs if only for the cholesterol. I’m of the opinion that dietary cholesterol can be very helpful.

Is it okay for carnivores to skip fish?

No, it’s not. I’ll get flack for this, which I actually welcome, because the truth simply is that carnivores should be eating seafood.

For one, fish is meat. Fish are animals. Carnivores eat animals. Carnivores should eat fish.

For two, every human group who’s ever lived on the coast or within sniffing distance of it has eaten fish, shellfish, and other seafood. Hell, one of the traditional peoples that carnivores like to cite as justification for their diet are the Inuit, who ate an enormous amount of seafood—at least the coastal-living ones.

Three—and this is the most important—fish and other seafood offer nutrients that are often missing from land-based animals. Traditional soil-based foods are less nutrient dense than ever before. Feed for most livestock is more subpar than ever.

Seawater also has a different nutrient profile than soil. Sea animals are rich in iodine, copper, selenium, and manganese. I’m not saying you can’t get selenium, iodine, copper, and manganese from land foods, but it’s much harder and less reliable than eating seafood. And manganese in particular is very hard to get from land-based animals. If you’re not eating sweet potatoes or wheat germ or brown rice, you should eat some mussels—the richest source of manganese on the planet.

Also, opinion on Whole Foods farmed salmon? They convinced me it’s good, and it sure is delicious, but I’m still skeptical.

Whole Foods farmed Atlantic salmon is better than most farmed salmons.

They teamed up with a company that makes a specialized salmon feed containing fish trimmings and microalgae, which increases the omega-3 content of the salmon who eat it. They monitor and remove the PCBs (a common sea-borne toxin) from the feed before the salmon get it.

They use no antibiotics, hormones, or artificial colorants. So, while the farmed salmon at Whole Foods isn’t as brilliantly red as wild salmon, the light pink color it has comes from actual feed, not artificial dyes.

Often overlooked is canned cod liver in its own juices. It delicious and nutritious by itself. And you eat eggs, you can mash it with a few boiled eggs. Also, stay clear of seafoods that comes from the Far East.

Yes, canned cod livers are quite mild and tasty. They’re canned in their own cod liver oil and make a great source of vitamin D, vitamin A, and long chain omega-3s.

Find them in European markets or online.

If you’re not getting enough vitamin D or retinol (animal form of vitamin A, far more bioavailable) from your diet and lifestyle, cod liver oil can help. A big spoonful of cod liver oil used to be standard protocol for kids growing up for good reason—it’s great for immune function.

I believe we can leave the salmon a bit out (besides worries about contamination) – what about the other animals in the planet besides the humans that also deserve to consume these species?

Salmon is the oldest word in the Indo-European family of languages. Humans have been eating them for tens of thousands of years. They’re that important to us.

The more well-caught wild salmon we all fork out our money to buy, the more sustainable the salmon industry gets. Money talks. You won’t save the salmon by not eating them. That’s not how this works. Even the Monterey Bay Seafood Watch, the global leader in analysis of sustainable seafood, calls wild-caught salmon a “best” choice.

Mark,
Great article. I usually take some chlorella when I eat high mercury fish. Will that provide adequate protection fro the heavy metals?

Chlorella can definitely remove heavy metals from humans. In one study, 90 days of chlorella supplementation lowered mercury levels in people with dental implants. In rats given cadmium, taking chlorella increases urinary excretion of cadmium and decreases its absorption.

That’s promising. However, I’m not sure if taking a single dose of chlorella as needed will inhibit acute absorption of mercury. It might need to be an ongoing process.

Thanks for stopping in today, everybody. Have a question for me on these or other Primal related topics? Let me know down below.

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Conventional treatment for PTSD often means suppressing the symptoms associated with the disorder, rather than treating the underlying cause. In this episode of Revolution Health Radio, I talk with Dr. Michael Mithoefer about how MDMA, given in conjunction with psychotherapy, can address the root cause of PTSD for some individuals.

The post RHR: Treating PTSD with MDMA, Dr. Michael Mithoefer appeared first on Chris Kresser.

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