Josh (04:28.993) Today's guest is a registered dietician with a naturopathic background, best known for her books, The Anxiety Diet and The Anxiety Diet Cookbook. For over a decade, she's been using food and nutrients as medicine to heal all sorts of medical conditions. She's been featured in Mind, Body, Green, Women's Health, The Oprah Magazine, Women's World.
Ali Miller RD (04:37.407) Sounds good.
Josh (04:57.633) and even some extremely famous podcasts like Primal Kitchen, Ask the Expert and the Keto Diet. Ali Miller, welcome to Reversible.
Ali Miller RD (05:06.613) Thank you, happy to be here. So I am a mama and of a seven-year-old girl, Stella, and a wife to my husband, Brady, and I am a passionate real food.
Josh (05:10.269) Ali for listeners who may not know you can you tell us a little bit about who you are and what it is that you really do?
Ali Miller RD (05:30.835) dietitian that loves to take an integral role in connecting with the source of what I believe to be food as medicine. So we out here live on 15 acres and have a rain barrel collection system. We're on our own well. We have chickens and an orchard and gardens. And my work over the last 15 years has been in the field of functional integrative medicine.
So I went to a naturopathic college of medicine and really kind of bridged the gap of what is allopathic or conventional with what would be naturopathic through functional medicine. And so I know that's not a new term to your audience, but I've been aggressively seeking the root cause of variety of chronic illness over the last decade and a half of my career. And I found after the first 10 years or so,
that regardless of what we were treating, if it was a gut cleanse or if it was addressing leaky gut or we were addressing hormone imbalance or addressing elevated liver enzymes or Crohn's disease, ulcerative colitis, that the body kind of functions in this multi-systems connectivity. And so it was kind of whack-a-mole if you're just addressing each unique symptom that is manifesting.
And I came up with the hypothesis, if you will, or the concept that anxiety is, you know, the Achilles heel to wellness. And so whether individuals want to deem anxiety or they just want to claim that they're stressed and wired or overburdened with stress or feeling chronically upregulated in a fight or flight mode,
that this will drive ultimately dysfunction in the body. And even if we address one symptom of imbalance, if that access of fight or flight stress response is not harnessed, something else is bound to manifest in the body.
Josh (07:37.393) Hmm. So you talk about anxiety sort of being this Achilles heel. Is anxiety the chicken or the egg? And by that, I mean, is there something that created this physiological imbalance in the gut bacteria, which changed its feedback to the brain, which led to anxiety, or do you feel there's something else that triggered the anxiety causing these physiological in the body changes?
Ali Miller RD (08:00.119) I think it's both. So specifically in the microbiome, there's a lot of reciprocal relationship. In other places, maybe it's more direct, like a micronutrient deficiency.
But interesting with the gut, if the gut is in a symbiotic, optimal symbiotic means that the microbiome which outnumbers us 10 to 1, the number of cells of our body are outnumbered 10 to 1 by the bacteria and flora that we host. If that's working against us and we're in a dysbiotic state, that's going to set us up to be quite wired for a fight or flight response, panic attack.
exacerbated anxiety and that's because in the gut when we're in a symbiotic state we're manufacturing the majority of our serotonin so 80 to 90 percent of our serotonin is manufactured along that gut area also, we manufacture GABA which is really an unsung hero in the mood regulation even academic performance world GABA is a inhibitory compound so
a mellower outer, if you will, for a fight or flight stress surge. And both GABA and serotonin would be upregulated or produced at higher levels in a symbiotic balanced microbiome. However, if the gut is in a dysbiotic state, essentially even worse if it has an infection of a pathogen, this could be anything from a foodborne illness like salmonella.
to Clibsteel and pneumoniae, more of a true gut pathogen, and even yeast overgrowth like Candida or parasite infection. When that's going on, not only do we have suppression of the production of those feel-good neurotransmitters, which already sets the stage for a little bit more heightened anxiety, but when we have dysbiosis and the body's actually battling something that doesn't belong there, we make more epinephrine or adrenaline.
Ali Miller RD (10:04.703) And so this goes even further where now we're missing that, that counter balance of the serotonin and GABA, but we're actually producing something that in itself is driving fight or flight surge. And so the gut is a very powerful place to start. And often for individuals that have no history of mental illness or aren't that type A kind of
go-getter perfectionist mentality, if all of a sudden out of the blue, they start feeling anxious, that's usually a good place to dig into functionally. And I always start with what's called a probiotic challenge in my clinic to first start with introducing good strains of lactobacillus ambifido and see how the body responds.
Josh (10:54.873) you have a really nice, easy to read chart inside your book as well, where you break down these basic probiotics, what they do and some of the neurotransmitters that they produce, you have them written down and here's kind of just some things to consider. Now, is it as simple as just taking these probiotics and those probiotics on their way in and out of the body will produce these neurotransmitters and do this job almost like a medication would, or is it something you really have to build up and cultivate and let your own...
bacteria start to regrow.
Josh (11:36.101) Can you hear me now?
Josh (12:05.291) Maybe that will work. Yeah, if you can't hear me, Ali, no problem. I'm wondering where this is coming from. I'm running at full mass. You still can't hear me. Hey.
Josh (12:29.969) question was our probiotics.
Josh (12:37.529) Then we can take medication.
Josh (12:51.353) to focus on.
Josh (12:59.838) Hopefully you get that one in there, Ali.
Ali Miller RD (13:29.841) So I refer to probiotics in my book and clinically preceding the book as nature's Prozac. So the correct combination of pro bacteria absolutely can be used as medication. We've seen in double blind clinical.
research studies, which, you know, the placebo control double blind research is the gold standard because we're using humans first versus animals. And the researcher and the individual that's participating in the research, the patient is both not aware of whether they're taking a placebo or the intervention. There was a study that compared fluconazole or I'm
Ali Miller RD (14:19.361) to probiotic strain. And it actually demonstrated that the lactobacillus NCFM and the bifidobacterium BIO5 strains were as effective as the Prozac in mental health scoring, but had less of the adverse digestive effect. In fact, the probiotic yielded beneficial digestive outcomes.
So that's where we can really look to the use of probiotic supplementation or using that qualitative as long as it's a third party tested and we know that strain ID, that could be used as a medication alternative or as a tool to support mental health. But most definitely we want to also work with the host or the individual of the body to
continue that good gut flora or that symbiotic environment to thrive. So when we're looking at probiotic pill selection, I mentioned the concept of strain ID guarantee. This is really important. And I have to note as a disclaimer that in the US, I have a supplement line. And so I'm obviously going to stand behind any of my products that are out there. They're all under the naturally nourished label.
And in my book, I specifically refer to particular products in my supplement line, because that really allows you to have direct application or solution from the intervention or need. But when you're looking at a probiotic, you want to ensure that just like in kingdom of breaking down species, the strain ID will have both the family as well as the strain specificity.
that you're going to want to look for. Like I said, not just lactobacillus, not just lactobacillus acidophilus, lactobacillus acidophilus NCFM is the particular strain that we tend to see that has clinical effects on mental health. It's also the most well-researched probiotic strain out there on the market. So if you are purchasing a product, that would be the particular strain ID to look for as opposed to just any lactobacillus product out there.
Ali Miller RD (16:33.811) Then you also want to make sure beyond the strain ID guarantee that it is potent and pure. And so potency would be how many billions of colony forming units are we looking at in this product? I generally start with about 15 billion CFU or colony forming units. And as I mentioned in my probiotic challenge, which I can send you a link to my YouTube video on that, my probiotic challenge, what we do is we start with three days of baseline measurements.
And what I measure actually is a waist circumference from rise to rest. And we are going to be assessing fermentation essentially, is the belly brewing beer or baking bread. And when we are in a dysbiotic state, there often is a symptom of digestive bloating as well as some GI complications of sort. So in these first preliminary three days we're looking at from rise to rest, is there.
a couple inch variable in that waist circumference for an objective data collection. And then we also are tracking our bowels, we're tracking any changes in sleep or mood. And if the individual is dealing with panic attack, they could be tracking that as well. And then we start after the three days of baseline information, three days of 15 billion CFUs of that combo lactobifidoblend, then we go up to 30 billion for three days.
Then we go up to 45 billion for three days and ultimately 60 billion for three days. So stepping up in three to increments. And what we're looking for is with that intervention shift of a higher dosage, was the gut in a sterilized place and it benefits from higher dose of these two bacterial strains? Or was it in a already symbiotic state where there's no change that would just be a neutral response?
or is the gut in a dysbiotic state where I've heard individuals as a testimony say, it felt like an atom bomb went off in my belly. What will happen in severe dysbiosis is that the gut will battle that pro bacteria as you go up. So you'll actually see a decline or more exacerbated symptoms and we'll see often in that objective waste measurement more bloating or distension as you work up in the higher doses of colony forming units. So,
Ali Miller RD (18:53.651) That's a simple approach that I take clinically as a probiotic challenge to discern, am I in a symbiotic state, which means I'm good and I can pretty much rely on probiotic supplementation at a lower dose and the probiotic rich foods. Am I in a sterilized space and I need to really level up and have two plus probiotic rich foods daily for that biodiversity and a higher dose of CFUs.
or am I in a dysbiotic state and we got to actually hold the probiotics and plow the gut if you will, bringing in compounds like caprylic acid or berberine or thyme oregano doing a six week what I call beat the bloat cleanse and then start to bring back in the probiotics. So for individuals that maybe have been diagnosed with SIBO or have a history of dysbiosis, they may not tolerate the longer fiber or resistant fiber.
high prebiotic foods and prebiotics for a sterilized gut or a symbiotic gut are very good because they feed the gut flora. Prebiotics are prior to pro. And so these are things like Jerusalem artichoke or asparagus, onions, garlic. And if you've looked into any SIBO diet, which stands for small intestinal bacterial overgrowth,
They'll use a FODMAP acronym and the FODMAP diet actually eliminates all of these resistant fermentable carbs in the sense to try to starve off the overgrowth of bacteria. So as far as kind of flourishing and supporting a robust diverse microbiome for the individual, if you're dealing with mental...
health concerns and if you're dealing with anxiety, I would highly recommend first doing a probiotic challenge before you start to level up these prebiotic fibers because otherwise some of the data can get quite conflicting. And then once we know if we are in a sterilized or already symbiotic gut, then we want to up our probiotics with food and consider supplementation and then bring in those prebiotic fibers to help to keep the probiotics viable.
Ali Miller RD (21:09.563) I always say you don't wanna throw seed on concrete, you wanna make sure that the soil in the body has this symbiotic exchange as well. And so giving those prebiotic fibers works kind of more like an anchor as a fuel source to maintain viability or life of the probiotic flora that you're consuming in either supplementation or diet form.
Josh (21:35.397) Can you hear me now, Ali?
Josh (21:39.429) Am I still frozen?
Ali Miller RD (21:47.573) Yes, you're still frozen.
Josh (21:50.481) Classic.
Josh (22:48.209) Thank you.
Josh (23:04.793) So Ali, we've talked about what makes, hmm. So Ali, we've talked about how good the brain can be with the right probiotics, but the question we really wanna ask is what ruins that gut in the first place to cause us the need for probiotics? I'll just type that question here.
Josh (23:49.125) So we talked about the gut and the brain and how they can benefit from probiotics, but what creates this imbalance in the bacteria in the first place and creates the need for these types of therapies?
Ali Miller RD (24:15.028) Okay, so when looking at the
gut brain access and the impact of probacteria. There is that serotonin and GABA production in a symbiotic gut or that epinephrine or adrenaline made in a dysbiotic gut essentially signaling to the central nervous system that things aren't right. And we can also see though beyond neurotransmitters when looking at the brain-gut access.
other influencing factors that can have a role in fight or flight stress response or also anxiety and mental health. And we could even extend this further into optimal aging, prevention of dementia, et cetera. So one is through BDNF or our brain derived neurotrophic factor.
The BDNF values increase when we're in a symbiotic state or when we have good gut flora. And essentially this BDNF shows on a synapse level and on a neurological level prevention of cognitive decline and better active firing, if you will, within the brain. So better communicative patterns, easier to learn new tasks.
So BDNF is a marker that we're really studying more and more in the world of dementia and Alzheimer's disease. We also see that the ketogenic diet can enhance BDNF values. We know in the brain gut access when connecting microbiome that when we're in a symbiotic state.
Ali Miller RD (25:59.539) We make more butyrate, generally speaking, and butyrate is a form of a short-chain fatty acid that can serve as a fuel source for our body. So if an individual's dealing with more chronic fatigue or irregular energy levels, that might be another symptom of dysbiosis or not having that robust microbiome to produce butyrate. Well,
Butyrate also is a key element connecting the ketogenic diet, because we think of beta hydroxybutyrate, or BHB, as the blood metabolite compound in presence of ketones. And this is relevant because we know that they cross the blood-brain barrier and can have a very harnessing effect on that fight or flight stress response. So.
There's multiple mechanisms beyond serotonin and GABA or epinephrine when we start to look at now BDNF and butyrate and could even dig in our toll-like receptors in our gut and immunological inflammatory regulation as playing a role in mental health because we know that when the nervous system is in a body with a higher systemic inflammatory scoring, that also kind of keys up or puts us in a fight or flight.
surge, if you will. So if we're looking at foundationally the importance of supporting a symbiotic gut and preventing dysbiosis, some of the drivers of dysbiosis to consider are of course, sterilizing agents as one of the first line of defense. And we could even take it a step back and look into the birth story of the individual. So we get our first prime.
kind of imprint on our microbiome through our birth story. When babies are born through the vaginal canal and are vaginally birthed, they are getting that vaginal microbiome in their orifices. So when passing baby through that birthing process, that baby's getting its first inoculation of flora.
Ali Miller RD (28:07.451) Now, cesarean or C-section babies are missing out on that vaginal inoculation, and they're born in a sterilized surgical type environment. So they miss that initial imprint. And then this proceeds onward when we're looking at breast milk and breastfed babies versus formula fed babies. In fact, the food industry is always, and pharmaceutical industry,
I believe always watching nature now, maybe a lot of mainstream doctors don't acknowledge nature as medicine or God as providing the most superior form of medicine, which would be the way I would explain it. But we do try to mimic nature's patterns. And I always say we're always 10 steps behind. So whether that's having a red light in your room versus watching the sunset, et cetera, we see this with
Josh (28:54.353) Thank you.
Ali Miller RD (29:06.355) looking at formulas. So now baby formula will have prebiotics in it and also will have probiotic strains in it. But it's still lacking so many other unique compounds. So breast milk specifically has HMOs or human milk oligosaccharides.
And these particular forms of prebiotic fibers really lay the fertilizer for your microbiome in a very robust way. And there is, you can't mimic that with inulin, for instance, which is often the like chicory root extract that'll be added to baby formula. These human milk oligosaccharides are really superior. And then when a baby is breastfed,
There is this symbiotic connection with mama to baby where the vacuoles of the nipple actually respond to the salivary output of baby. And so mom is actually manufacturing different amount of immunoglobulins, different amount of compounds that help the baby to thrive, to be more resilient or robust based on environmental stress, allergen exposure, et cetera.
So pretty powerful stuff. And then, you know, beyond looking at the association from birth and first foods, we open up the world of antibiotics as far as medications. And many children are given antibiotics early on for ear infections or other unnecessary interventions.
and at higher doses or prolonged or too frequent of doses than would be fitting for a balanced microbiome. And then in municipal water, we get chlorine in our tap water out here and that is put into the tap water to combat pathogen but it's a sterilizer. So just drinking water at a restaurant or maybe in your household would be another sterilizing agent.
Ali Miller RD (31:13.219) And then beyond the sterilizing agents out there, the antibiotics, the chlorine, we know that stress in itself can sterilize the microbiome, which is quite wild. There was a research study done on mice that I've referenced in my book. And the one I noted before with the Prozac comparison, fluoxetine was the drug I was trying to think of. Fluoxetine is the generic for Prozac.
I have those referenced in the anti-anxiety diet. It's very robust in medical references. So those are all things that y'all can check out in the reference section of my book. But when we look at the mouse study that I referenced in the microbiome chapter, they actually looked at a electrical shock and the mouse with its mother, and it was a stress response with the electrical shock.
and then removing the mother from the mouse, which was an emotional stressor or a relationship associated stressor, a social stressor, if you will. And they looked at the gut flora of that mouse and in both cases, the lactobacillus bacteria reduced significantly. So we know that emotional stress can be as significant as physiological stress on depleting the good gut flora.
So we have a multitude of factors working against our microbiome. And then not to mention just in modern day society, we are overly sterilizing with antibacterial everything. A lot of children's toys are made now with antibacterial agents. And then what's more is when we eat a diet of refined carbohydrates, especially one that is high in sugar.
that this elevation in glucose or blood sugar response also fuels imbalanced gut flora. So we can see that, for instance, especially with candida or yeast overgrowth, a high refined carbohydrate diet can set us up for that continued bacterial overgrowth.
Josh (33:25.413) Hmm. I mean, it's pretty obvious we need our bacteria, they outnumber ourselves 10 to one, they're everything we need them so much. They're arguably more important than our very DNA, but we hate them so much in society. Why do we hate our bacteria? Why do we treat them so flagrantly?
Ali Miller RD (34:18.431) So I think that the, I guess, fear association of bacteria ties into, I would bring it back to this again, man versus God element, if you will, of trying to outsmart nature, trying to get ahead of nature instead of understand and work with nature.
And this is an issue that we're seeing really throughout our food system beyond influence on the human body. We're seeing with prophylactic use of antibiotics, especially in confined animal farming. So the way that the majority of the meat is produced out here in the COFA operations, we're putting upwards of a quarter pound of antibacterial.
biotics in cattle feed per day as prophylactic antibiotic. And this goes into our groundwater, it passes through the feces of the cow, it also just spills off from the feedlots themselves and is creating more superbugs. So again, it's one of those faux pas where man tried to sterilize because of the dingy environment.
of kofas because the cows aren't able to roam and range on grasses as again one would say God intended and man tried to mass produce and control the variables. We can't. And so the idea was that the prophylactic antibiotics in the feed would keep at bay the infections that would otherwise be present due to the dingy living environments of keeping cows confined.
And we're seeing now that the increase of superbugs, or basically these bugs that are now antibiotic resistant, now are antibiotics which should really be kept in the hospital setting for the elderly and those that are at risk of sepsis or systemic bacterial infection, and don't have the immunological capability to battle.
Ali Miller RD (36:26.683) that now those antibiotics are rendered useless. So we're starting to see things like C. diff as a huge pathogen that's wiping out the elderly population. And so, I think that as a society, we try to treat bacteria or get rid of bacteria and we have this mistaken understanding that we can sterilize or over clean to be safe.
But really we're better working with the terrain or the base of the body. We know even in this, it's interesting, even in the functional medicine world, there's now such a huge conversation about parasite. And for hundreds of years, humans have lived in a symbiotic environment with parasite. And so again, there's this understanding of working with when something is in an overgrowth mode and it's creating imbalance.
yes, we might need to treat. And in treating, we don't wanna throw an atom bomb and just completely sterilize the host, which makes them susceptible to more aggressive bacterial imbalance overgrowth. We want to be strategic and do some kind of plowing or weeding, if you will. And so that's where then I would lean into more of these natural bacterial regulators or antimicrobial and antifungal compounds.
that we see in our botanical family. These can yield clinical outcomes without being fully sterilizing. And I think as a society, we see enough compelling research. It's just, again, that dance of the pharmaceutical industry not being able to make a buck on nature. But we see in clinical studies that, for instance, households with dogs have less.
asthma and food allergy. Well, that's because the littles in the household are crawling on the floor and are exposed to more bacteria that the dog bringing in the house from its paws, and even from its bum, you know, all the things and that this is creating actually a stressor for the immune system to up regulate. And when we have small amounts of stressor, this makes a more robust shield or the human body functions better.
Ali Miller RD (38:48.563) And when we try to get ahead of that and try to remove any bacterial threat, then the human body becomes, it's like if you don't use it, you lose it. It doesn't become as effective as being able to upregulate against a pathogen or to have the access for immunological response. And then this is what makes us more susceptible again to reactive airway or asthma.
less ability to clear antigen from particles that we inhale, or in the food world, more food allergy, because again, that immune system hasn't been challenged. We see also with research on hand soap, for instance, that bar soap is superior with friction and with creating lather, as opposed to antibacterial solvents, and that those antibacterial, especially hand sanitizers,
can be quite harsh, can drive eczema, can also create skin cuts, and some of them can be highly as stressful as a neurotoxin to the body. So I call it kind of like a low gene movement. Like I said, we live out here in our gardens and our orchard, and I do make sure that I take my shoes off when I'm in the chicken coop so I'm not trampling chicken poop in my household, of course.
But we know that the more that we work with what nature provides, that in its own has a whole host of benefits. So there's soil-based organisms that I'm not a fan of taking orally. This is a new buzz in the probiotic world. I don't like the soil-based organism pills available, but I do recommend gardening to get an influence of inoculation of the robust soil bacteria.
rhizomes and protozoa, et cetera, that can also have great mood stabilizing and antidepressant effects as well. So the recommendation would be go get dirty, send your kids out to play, get them off those screens and the more that we can work with nature, the better.
Josh (40:59.033) I'm a big fan of getting out there and getting into nature and doing as much as we can. It's truthfully something I don't do often enough, but I know we need it, right? We're supposed to. The closer we get to nature, the further we get from disease, and all these things are fantastic. Now, obviously probiotics and bacteria are incredible, right, in the right context, if we get them in the right way. Something I get asked all the time is like, what supplement is best? What probiotic should I take? What supplement should I take? And it's a loaded question because everyone's individual.
which is why I advocate for things like stool testing if we're talking about the gut bacteria, but how do you determine what people need?
Ali Miller RD (41:54.035) So like I said, I start with that probiotic challenge and in the probiotic challenge, I use the two most well clinically researched strains. So like I said, the Lactobacillus acidophilus NCFM and the Bifidobacterium BIO5.
In my supplement line, I have two formulas with just those strains alone. So it's my restore baseline probiotic and then my targeted strength probiotic, which is just four times the potency. So I do start with those and I do start with those before stool. I'm a big fan, of course, as a functional medicine practitioner of test don't guess when it comes to interventions that.
have a risk reward association, but in something like a probiotic challenge, I find it to be effective and cost affordable and a really good way to determine what's going on. And then if an individual has a diagnosis of inflammatory bowel disease, or is having quite severe gut imbalance with
seven bowel movements a day, bowel urgency, severe cramping or pain, and they're actually seeking medical treatment for their gut, at that juncture, I would go in for a stool test, and or if the individual has done the six week beat the bloat protocol, and we're only 50% improved, then we would invest in a stool test.
And I like a stool test that looks at your short chain fatty acids. So I mentioned butyrate earlier, looking at a total short chain fatty acid and getting a count of butyrate is important because butyrate also protects against colon cancer. I like to look at calprotectin as a marker of inflammation in the gut. And this is what would be diagnostic of inflammatory bowel disease. And that would be done in a stool test.
Ali Miller RD (43:48.575) So all of my Crohn's ulcerative colitis patients are tracking their calprotectin score. A stool test should also look at malabsorption, which is interesting to see if there are undigested meat compounds or fats or vegetable fibers. This can help us strategize digestive enzyme need. And then a stool test should look absolutely at the microbiome strains that are viable. So are there higher amounts of
Common soul flora, common soul we think of as like wild flowers. So maybe they're taking up space in the garden bed of the gut, but they're not necessarily a pathogen. The pathogens would be like the weeds, if you will, that we do want to make sure we pull out. A pathogen would be the form of bacteria, yeast, or you know, parasite infection that we would want to make sure we do eradicate or remove from the body to not create imbalance.
And then we might just see sterility. Maybe there is not a high amount of common cell. Maybe there's not any pathogen, but there's also low or no growth of the lactoambiphyto strains. In this sense, it would be an easier fix of just higher dosage of said compounds and consuming rich sources of those. There is of course, like I said, via the story of the microbiome diversity having an imprint immediate from birth through breastfeeding.
through childhood exposure to antibiotics, through teens, maybe with acne, et cetera, that everyone's gonna have their different risk association, also where they're living, if they're swimming in lakes, rivers, you name it. So based on your region, you'll have different flora exposure, and based on your terrain or the host, you'll have different growth patterns of said flora exposure, whether you can tolerate and get rid of something that doesn't belong.
or whether you don't have an ample army set up. So I do look at stool if there's indicators of infection, but again, generally speaking, we look at otherwise these lifestyle criteria and then doing that probiotic challenge.
Josh (45:59.497) So we talked about a lot of different moving parts and pieces around what can create anxiety, contribute to it, kind of the start and finish and all these bits, but I really want to organize this for our listeners as best we can. And in your book, you talk about the six Rs or the anxiety six Rs. Can you break those down a little bit for us and sort of give us an overview of what that roadmap would look like to get into the roots of these anxiety conditions?
Ali Miller RD (46:28.779) And something I'll note in the world of another driver of sterility. So we talked about how refined processed carbs can create dysbiosis or can feed that imbalance of bacteria or yeast. But it's equally important to note that non-caloric sweeteners, so this can be anything from stevia to erythritol to the new kid on the block, allulose.
We do see that the non-caloric sweeteners out there can have unfavorable effects on blood sugar and insulin response, can have unfavorable effects, of course, with the continued craving of sweet and not being able to actually rewire the palate into savory. But on the microbiome level, we also see that these can be what are called bacteriostatic or sterilizing for the gut microbiome.
So I'm a huge proponent of, although I like a lower carbohydrate approach to eating, and I'm a huge proponent of a ketogenic diet, all only using whole real food sources. So I'm one of the only keto experts out there that uses, for instance, raw unfiltered honey, or dates, or robust maple.
and we're not eating these in copious amounts, we are going to start with quite a limited carbohydrate intake at 30 grams per day, which actually also can help to starve off dysbiosis and set a little bit of bacterial reset. But then over time, once the body starts to tap into using fat as fuel and has the access of nutritional ketones,
then we can start to play with what's called metabolic flexibility. So based on the individual's activity factor, their muscle tone, and also their level of or history of insulin resistance and their stress response, because we know stress creates blood sugar dumping from the liver and that can disrupt ketone production. Based on all those factors,
Ali Miller RD (48:34.895) I do feel it's essential for the human body to function as a hybrid using both ketones and glucose as fuel. There's such an array of benefits of ketones, which I'll sidebar on and we can re-circle back on. But even though we want to be in a ketogenic state, we don't want to take the shortcut of these keto products and a lot of these diet products or non-caloric sweeteners because those in themselves can again sterilize and throw off the microbiome.
So over time if you are wanting to make keto treats or a little bit more of a mindful indulgence I work with my patients using a continuous glucose monitor and or doing blood tests of ketones to understand what their Carbohydrate threshold is for metabolic flexibility So for me for instance, I'm able to consume somewhere between 50 to 65 grams of carbs, which feels quite robust for me
Uh, and as long as I'm having ample fat or protein in those sittings and my exercise timing is strategic, that in itself will ensure that I'm getting more phyto compounds or plant-based antioxidants higher of the prebiotic fibers more in this Mediterranean approach to keto, right? Where we're getting two to three cups of leafy greens and berries, et cetera. Uh, but that's a place where I kind of step outside the box, if you will, of
keto experts where my low carb collagen zucchini muffins, which are in the book and are made with almond flour as the base and have six tablespoons of coconut oil and six eggs and then they're going to still have one banana in the entire recipe. And so a lot of people that are myopic or tunnel vision would say,
That's not keto. You can't have a banana in a keto low, how can you call it low carb when there's a banana in it? And my answer would be, well, the banana you're consuming is 1 12th of a banana. A medium sized banana is somewhere around 25 grams of carbs, you know, so you might be getting about two grams of carbs of contribution in a single muffin. I'm hoping that you're slathering that muffin with grass-fed butter.
Ali Miller RD (50:48.323) And again, the base has a lot of fat and protein in it. We have the collagen peptides, the eggs, the coconut oil, and then the base of almond flour, which is lower glycemic and higher fiber, et cetera. And so, you're getting some of this prebiotic fiber in the banana, the banana's adding a little bit of natural sweetness. It's not gonna have a remarkable blood sugar effect. And even those that are more classic keto and don't have a lot of metabolic flexibility can still have this low carb.
collagen zucchini muffin with banana and it go figure a no keto food and stay within a total of 30 grams of carbs. So I really start first with the concepts of is it a whole real food and these noncaloric sweeteners I think are a shortcut that ultimately has a negative impact on our microbiome as well as our nutritional status. We know a lot of these noncaloric sweeteners cause loose stool.
can throw off mineral and nutrient absorption in the body, and some of them out there even deplete glutathione, which is our master antioxidant. So that's another area that I'm kind of a unique approach to, and I think anytime we're putting something in our mouth, we wanna consider first, before getting out our macro calculators, of the human experience of, is this a whole real food?
And one way that you can assess that is, is this food made by God? Is this a food that has all of its edible parts intact? Least has been done since harvest. This is something that comes from nature, not man. These are all really good thought processes. And then you might play with your plate or your distribution of ingredients to make sure that.
the glycemic index works for you, and if looking to make ketones, that you're keeping that balance of that carb to protein and fat ratio.
Josh (52:38.169) Well, just for my editor on this one, maybe snip up my last question, because that was a great riff. Now, Ali, we've talked about a lot of different parts and pieces of anxiety. We kind of talked about food and bacteria and medication and probiotics, nutrition, fats, keto, all of it, as well as some causes contributing factors. But I'd love to get a bird's eye view of the roadmap on what steps people can take. Can you kind of walk us through the anxiety six Rs that you talk about in your book?
Josh (53:15.873) Just a bird's eye view is fantastic. I know it's a lot to get through. It's quite a lot of bulk and volume.
Ali Miller RD (53:35.947) So when I put together the anti-anxiety diet, I kind of entered again with that hypothesis of anxiety being the Achilles heel to wellness. Well, I also very quickly acknowledged that it's not just about the gut, right? And there are...
as I see it, six different entry points or drivers that can exacerbate anxiety or could be the primary for one individual where another individual might have a difference. So I break down the anti-anxiety diet into six R's. So the first one is to remove inflammatory foods. The second one is to reset
the microbiome, making sure that we're in that symbiotic state. The third is to repair the gut lining. And that's where we really delve into leaky gut. And what's interesting there is, just like I said, how stress can drive sterility of the microbiome. Interestingly enough, we've seen in studies with social anxiety or stress response,
that there is a marker of gut integrity that's greatly influenced from just mental emotional stress alone. So we've tested on individuals, this compound called secretory IGA, and secretory IGA when suppressed or low is actually showing serious gut integrity damage or a gut that's been through a lot and needs some serious repair.
when secretory IGA is high, it actually creates more leaky gut. And so secretory IGA will often be high in the presence of a gut infection where the immune system is pumping out this secretory IGA to say, hey, we can't handle this gut infection. We need to allow it to permeate into past the gut.
Ali Miller RD (55:36.767) blood barrier into the lymph and into the immune system for the body to deal with. And that in itself is creating these holes, if you will, or drilling holes in the gut. What's interesting is social anxiety drives up secretory IGA. And as we get into a status of adrenal insufficiency or adrenal burnout, that secretory IGA tends to deplete as well. And so another area, the third R is repairing gut lining. Very chicken and egg there as well.
The fourth one is to restore micronutrient deficiencies. So when we dig into this chapter, I start to explore things like methylation, the importance of MTHFR gene and folate and B12. We look at mood stabilizing minerals in this chapter. So I really highlight compounds like zinc. The fifth R is to rebound the adrenals.
And this talks about this HPA access, if you will, which is the hypothalamus pituitary, both in the brain, and adrenal, the little tiny walnut glands that sit above our kidneys. Hypothalamus pituitary adrenal feedback is what regulates our autonomic nervous system. That is the feedback cycle that puts us in this parasympathetic regulatory mode or sympathetic fight or flight mode. And taking that just a little step,
further, I incorporate also sex hormones into this chapter because we know, for instance, progesterone is an anxiolytic or anxiety reducer. And there is this feedback mechanism when the HPA access is in fight or flight surge mode, where we shunt all of our sex hormone production to survival and the adrenals. And really, if we look at human survival,
a high-stressed individual, what's happening there is we're down-regulating the fertility or the ability to carry a child. So we'll see now in today's society amenorrhea or loss of menstrual cycle in an extreme case, but we might first see an indicator of low progesterone. And that's the body actually pulling from the building blocks, pregnant alone, and stealing that to make cortisol versus allowing the progesterone levels, which we know...
Ali Miller RD (58:01.723) Low progesterone is one of the major causes of miscarriage or infertility. So chapter, that fifth section, that fifth R is rebounding adrenals and it kind of goes into that HPA axis, how to harness that, how that's connected to the thyroid and sex hormones. And then the final R is to rebalance our neurotransmitters, which is so interesting because in more...
Allopathic conventional medicine, the doctor is generally just gonna throw a dart at a dart board to try to modulate a receptor, often an SSRI or a selective serotonin reuptake inhibitor on just one neurotransmitter of serotonin without looking at the beautiful symphony of expression. So when I do neurotransmitter testing in clinic, I'm going to look at...
the serotonin and the GABA, I'm also going to look at norepinephrine and epinephrine. So epinephrine is that adrenaline fight or flight surge. Norepinephrine is its kind of counter regulator and even dopamine, which plays a role with reward and association of addictive tendencies. The adrenal glands produce the norepinephrine, epinephrine and dopamine. Whereas again, the gut plays a role in the serotonin and GABA.
So I look at a whole suite of neurotransmitters and in that chapter, I have a lovely table that helps you to understand, you know, both the highs and lows that you might see with imbalance in those neurotransmitters. And the really cool thing is before we have to intervene with a pharmaceutical drug to manipulate the receptor, that we can actually work with the amino acids or the protein building blocks that actually are the precursors to said neurotransmitters. If we feel that we're coming in.
at a deficient stance. And then you can further test not guess there if you wanna level up higher dose supplementation strategy, et cetera. So for instance, tyrosine rich foods would be a great building block for dopamine. We would see this in our egg yolk, in our dark poultry like our chicken thighs. Salmon is another great source of tyrosine as is turkey. We see tryptophan as a precursor to serotonin, et cetera.
Ali Miller RD (01:00:12.899) And so those are the six Rs. Remove inflammatory foods, reset the microbiome, repair the gut lining, restore micronutritional status, rebound the adrenals, and then rebalance the neurotransmitters. And what's super cool is that, again, everyone reading the book,
is going to have a different aha, that's me. And that was my focus as the author is to be able to speak to the masses or as many individuals as I could, again, even those that don't identify with anxiety and don't feel that they're exacerbated in that fight or flight, but they know that they're just taking on a lot.
would greatly benefit from the resource of the anti-anxiety diet book because this helps us to feel more grounded, helps us to understand how stress is impacting our body and where we're showing the greatest area of need to amend or level up. So for instance, you know, someone that's maybe evacuated from a hurricane or wildfires or has recently gone through a gnarly divorce.
they might be really honing in on that rebounding adrenals chapter because they just went through a serious survival impact. Um, if it's, or of course anyone dealing with abuse, right? If it's a listener or a reader that just had a baby and breastfed for a year and then got pregnant with another baby and has been literally giving their bodies reserves to growth and development of children.
they're probably gonna be entering at that restoring micronutrient status, because they're coming at quite a heightened area of need for micronutrient repletion. If it's someone that has skin conditions, maybe eczema, this would be someone that we would look at more in that gut lining issue. If it's someone with acne, maybe we would look more at that.
Ali Miller RD (01:02:15.059) Resetting the microbiome because we know that gut dysbiosis can be seen through the skin as well So I try to in each of these six our chapters Present quizzes for you to be able to score yourself in what area again You're the most vulnerable or is the most shown in your body your day-to-day experience in your body And then I provide you with potential labs to consider but before the potential labs
Supplement strategy and food as medicine and so with the food as medicine comes a bunch of recipes and There'll be unique recipes based on what area again you need more support in and so We might use my bacteria battling chimichurri as a sauce on a grass-fed steak If we're dealing with that reset the microbiome, so there's a lot of garlic and olive oil and oregano a lot of compounds there
that are going to combat that dysbiosis in conjunction with maybe that beat the bloat supplement approach. So I'm quite strategic in that synergy of food as medicine to help to build back or break down in a status of imbalance to support the areas where you find your body in the highest need.
Josh (01:03:38.386) Hmm. Now, Ali, obviously we've covered quite a lot of ground, but it can be, you know, we've obviously covered quite a lot of ground, but obviously it's quite a deep dive process for people to explore by themselves, right? Taking these things on can feel like so much, and it's almost overwhelming. And obviously when dealing with anxiety, we don't wanna do that. We want people to feel less overwhelmed. So in order to make this easier to digest, let's talk about how they can get some help. Who would be looking for you?
and what sort of information can you give them and where can they reach you and find some of that?
Ali Miller RD (01:04:29.343) So I know this is a vast amount of information to cover. And I've been told by many that I'm kind of a high powered hose of information in my delivery. So of course we don't want you all listeners to feel stressed from the information itself. I have.
A multitude of resources out there for you guys. So the more bite sized stuff is on my YouTube channel, Naturally Nourished. I have three foods to remove from your diet to eliminate anxiety today. For instance, I have over 100 videos there.
on all sorts of topics from adrenal fatigue to hormone imbalance to micronutrient imbalance. I have a video on how to do the probiotic challenge that I've referenced a couple times, how to support a gut cleanse and so much more. So the YouTube at NaturallyNourished would be a great, naturallynourished.rd would be a great place to start. And those are like eight to 15 minute videos in length.
Ali Miller RD (01:05:38.629) more deep dive nerdy level information there. Of course, the books that I've put out, the Anti-Anxiety Diet and the Anti-Anxiety Diet Cookbook. You can get those on Amazon, but even better yet, if you get them at alimillerrd.com, you can even get them in a bundle of the two books with savings. And then over at alimillerrd.com, I have a whole array of protocols.
and I also have my naturally nourished supplement line. So we put a ton of resources out there. You can also follow me on social media at Allie Miller RD. I'm often sharing a lot of chicken TV these days, but what I'm feeding my seven year old from back to school lunches, priming our metabolism to be flexible to produce ketones in a modern day world and so much more. So.
Hopefully those are all helpful resources for you and I'd love for you to come on over and engage and ask your questions through my social media or present those on my podcast.
Josh (01:06:48.269) Ali, you've been an absolute delight. Obviously I wanna get to the end of this one here. I know we're having trouble with the tech today, but I appreciate you, Ali. So appreciate you sticking with us. It's been a bit of a morning with all these tech issues, but this has been great and very informative. So to help promote the episode, we're actually creating social short clips for social media and we can share those with you if you'd like.
Ali Miller RD (01:07:17.768) Yeah, sure, share them with me, that's great. It's been fun and awkward and awesome, but hopefully neither of us got anxiety during the interview.
Josh (01:07:31.853) The irony would be on us. Well thanks so much Ali, we appreciate you.
Ali Miller RD (01:07:38.359) Thanks, Josh. I think I'll just say a thank you, assuming that. Thanks so much. It's my pleasure. It's really a passion project of mine. And I have seen thousands of success stories. And I hope if you're listening and this resonates with you, you share this episode with a friend or family member.
And I hope that my book, The Anti-Anxiety Diet, or my virtual program, Adrenal Rehab, or any of the resources I have out there are helpful to get you back in the driver's seat of the vehicle of your body, back in charge, versus dragging on that bumper and just getting by day by day. We're all about optimize and thrive, and I'd be super stoked to help support you in your journey.
Josh (01:08:28.581) Thanks so much, Ali. Appreciate you being here and hopefully we'll have you back again in the future.
Ali Miller RD (01:08:32.322) Okay, bye, thanks.