Q & A: October 2, 2011

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1. Question: Advice On Eating Parmesan Cheese?

Hi Ann Marie,

Since Parmesan cheese is traditionally made from part-skim milk, is it best to eat it with another source of fat? If so, how many teaspoons of fat is best per ounce of Parmesan cheese?

Thank you,


Parmesan has 7 to 8 grams of fat per ounce. Not as much as Camembert (almost 12 grams per ounce) but more than Feta (6 grams).

Personally I would not worry about it. I use Parmesan for all kinds of things — for risotto, for pesto, and on top of brown rice pasta with meat sauce. If you want to eat Parmesan plain, go for it.

2. Question: OK To Drink Raw Milk With Milo And Not Soy?


I know we are supposed to drink raw milk from grass-fed cows, but grass is hard to find here in Texas with the drought and all.  I contacted the farm where my milk comes from to find out what they are feeding.  They said the feed contains milo, but no soy, at least.  So, is it still OK to drink?  Or should we avoid it altogether?

Thanks for your time!!


Most grass-fed dairy cows are fed some grain. Even here in California where the cows eat green grass all year long, I’m pretty sure they get a little grain at milking time. There is nothing wrong with this.

As long as the grain is organic and non-GMO, and the cows are not being fed junk food like doughnuts and leftover chips (don’t laugh; this is common practice in conventional dairies,) it’s fine for them to have a little grain.

The best way to find raw milk in your area is to contact your local Weston A. Price chapter leader and ask them where they get their raw milk locally.

3. Question: Recommendation For Hemorrhoids?

About three months after the birth of my son in February I started suffering from hemorrhoids. This also coincided with my switch to a real food diet. Is this common with a change to real food? The hemorrhoids don’t seem to be severe, and I am only uncomfortable during bowel movements. What can you recommend?

Thank you!


According to BabyCenter:

Hemorrhoids are common during pregnancy, particularly in the third trimester. Some women get them for the first time while they’re pregnant. And if you’ve had them before pregnancy, you’re quite likely to have them again now. They may also develop while you’re pushing during the second stage of labor and are a common early postpartum complaint.
In most cases, hemorrhoids that developed during pregnancy will begin to resolve soon after you give birth, especially if you’re careful to avoid constipation.

Hemorrhoids are not particularly common with a change to real food. I used to have hemorrhoids, which often develop due to chronic constipation, prior to eating this way. Now that I eat this way, the only time I get constipated is when I travel and I’m eating more unfermented (unsoaked) flour.

That said, whenever I go on a low-carb diet, I do tend to get constipated at first. I just started the GAPS diet again a few days ago and I was constipated for the first few days. If you are eating low-carb and you think this might have caused it, try adding more high-fat fermented dairy products such as sour cream and cultured butter to your diet. In general, fermented foods help to reduce constipation, but full-fat dairy products are especially good because the fat helps to lubricate the stool. Sorry to be so graphic! 😉

If the constipation continues, I’d consult with a naturopath or holistic doctor.

4. Question: Advice For Healing Acne?

Hi Ann Marie,

I struggle with acne (since I was 25, which was 7 years ago) and infertility and hormone problems in general.  I just finally got diagnosed with polycystic ovary syndrome (PCOS). It took a long time to diagnose because I have the “lean” variety of PCOS (5’8.5″ and 135 lbs). Currently I am looking for some encouragement to keep going here.

I have been eating traditionally for about 3 years, including 1 year of low carb, followed by this past year when I’ve been on GAPS.  While I have seen some good improvements in my overall health, I still break out with cystic acne before my (painful and heavy) period begins.

After the initial improvements I experienced after going on GAPS a  year ago, I’ve really been at a standstill for the last 9 months while on the diet. I have been back on the intro diet for the past month and haven’t seen/experienced very much improvement at all.  Is this as good as it gets for me?  I used to really believe in my body’s ability to heal if given the chance, but now I’m not so sure.

I’ve also done some natural progesterone, which seems to help some, especially with hormonal migraines.  However, I am seriously considering Metformin at this point to see if it might help.

I appreciate your thoughts on this,



I’m not a doctor; any advice I give should not be construed as medical advice.

Are you working with a naturopath or holistic doctor? That’s the very first thing I’d do if I were in your shoes. Find a holistic doctor who is familiar with the WAPF diet and the GAPS diet.

Personally, I would definitely avoid taking Metformin. It depletes both CoQ10 and Vitamin B12. Read more about the dangers of Metformin.

Here’s a really good post written by a former-low-fat-vegetarian-now-paleo woman who is recovering from PCOS and cystic acne: PCOS and Acne Update She has/had a lot of the same symptoms as you: PCOS, hormonal imbalance, and cystic acne.

She explains PCOS really well:

PCOS is the condition of having cystic ovaries, which is caused by a hormone imbalance. When women have too many androgen (male) sex hormones, and not enough estrogen, we do not ovulate properly. We develop cysts on our ovaries, and often exhibit other symptoms: we might stop menstruating, become infertile, have irregular periods, or exhibit testosterone dominant characteristics such as male-pattern facial hair, loss of head hair, and acne.

She makes the point that this really is hormonal. She also makes the point that she really has to watch her omega 6/omega 3 ratio.

I also think I have a lot of inflammation left over in my body from my previous lifestyle and diets, so I need to really watch my omega 3s and 6s… In Taiwan, I have been eating a whole hell of a lot of fish, which I think definitely helps.
I stop eating chicken, and I eschew dairy 100 percent. I also start eating seaweed. I notice that this helps, I think, considerably. This makes me wonder: is my low thyroid being fixed by iodine consumption, and is that in turn helping my PCOS?

I think it’s a really helpful post because it shows that she is making progress (and it shows how NOT healthy a low-fat vegetarian diet is). But if I were her, I’d be working with a holistic doctor.

With imbalanced hormones, you really need to work with someone who can give you added supplementation for your particular hormonal issues. Find someone who can do a full hormonal panel. Then if they determine that you are, for example, hypothyroid (low thyroid) they may need to give you supplements such as thyroid gland. If they find that you have adrenal fatigue, they may put you on adrenal gland.

Best of luck to you!

5. Question: Is It Necessary To Dehydrate Nuts After Soaking?

Hi Ann Marie,

Is there really a need to dehydrate nuts after soaking? Can one just let them dry out in the kitchen?

Thank you,


We need to dehydrate or dry nuts in the sun because otherwise they will get moldy.

6. Question: Can I Take Cod Liver Oil If I Am Allergic To Shellfish?


Recent bloodwork shows that I am Vitamin D deficient. I’m 2 months into GAPS intro and am on Stage 4, so this would probably be a good time to introduce fermented cod liver oil.

However, I am allergic to shellfish. Even the slightest cross-contamination gives me hives, nausea, cramping, diarrhea, and, the last time I was exposed, swelling of the throat.

Can I take CLO if I am allergic to shellfish? If not, what would be the best option for Vitamin D supplementation?



Cod liver oil does not come from shellfish; it comes from the livers of cod. If you don’t have any problems with fish (just shellfish,) you should be able to take it.

You can start with a skin sensitivity test (as described in the The Gut & Psychology Syndrome book). If you find that you react to cod liver oil, I would wait until your gut heals more and try again.

You can also get vitamin D by sitting out in the sun. This would be helpful anyway because people with a compromised gut do not absorb nutrients as well as those with healthy guts. Absorbing vitamin D via sunshine is something you can do right away (if you live in the right climate,) if you do find that you react to cod liver oil.

The amount of the exposure you need depends on your latitude. If you don’t live in southern latitudes, you may not be able to get enough vitamin D from the sun in the winter months. It is important to sit in the sun for an adequate amount of time between the hours of 10 am and 2 pm in a bathing suit or with as much skin exposed as possible.

Only sunning between 10 am and 2 pm during summer months (or winter months in southern latitudes) for 20-120 minutes, depending on skin type and color, will form adequate vitamin D before burning occurs. Source

Read more about vitamin D here.

7. Question: Help Finding Other Teens Interested In Real Food Nutrition?

Hi, Ann Marie –

I actually submitted a question to you a few months ago, and last week I was pleasantly surprised to find that another teen was interested enough to inquire about a medical problem! Like Lena, who submitted a question to your last Q and A, I am sixteen years old, and I am VERY interested in nutrition.  Although I tend to support more of a Paleo lifestyle, the WAPF has really shaped my way of thinking (pastured eggs, coconut oil, organ meats sometimes, etc).  But it is so hard to find other teens who truly care about the food they eat (and I’m not talking about those little princess vegetarians).

Like Lena, I am also suffering from weight loss (at 5’3 I am even thinner than she is, at 80 lbs.  My lowest was 76.) I have Crohn’s disease, and since I was diagnosed three and a half years ago I have struggled to regain any weight. Although changing my diet cured me of my symptoms, it seems there is still an underlying problem my nutritionist and I are struggling to solve.  I also do not have my period (never got it).

If it’s possible, could you contact Lena and ask if she’d be interested in keeping in touch with me?  We are going through similar battles, and it is virtually impossible to find other teens who understand what it’s like.



Hi, Julia,

Thanks so much for writing! I think it’s great that you and Lena are so passionate about nutrition. I will email her today and ask her if she is interested in corresponding with you — I bet she will be! Can you do me a favor and please email me at annmarie @ realfoodmedia dot com. That way I can just forward your email to her.

I’m curious — have you ever tried the GAPS diet? It’s very similar to the Paleo diet, only you add a lot more bone broth and fermented foods, plus probiotics. I was just listening to Dr. Natasha Campbell-McBride yesterday (a recorded lecture) and she was saying that anorexia is caused by abnormal gut flora/leaky gut. (Crohn’s disease is, too.) She says that what she does with people with anorexia is use amino acids (like Julia Ross recommends in  The Mood Cure) and the GAPS Diet. She says negative body image is actually caused by physiological changes due to a lack of neurotransmitters (which come from amino acids). It’s not just in the anorexic’s head.

It makes sense to me, because when you have abnormal gut flora and a leaky gut, you’re not absorbing nutrients. So you have to heal and seal the gut (via the GAPS diet) to be able to absorb nutrients properly. And then you will gain weight and you will feel good about your body. Unfortunately Dr. Natasha’s new book The Gut and Physiology Syndrome is not out yet. But you can order The Gut & Psychology Syndrome for now. I also recommend The Mood Cure if you have not already read it. I think the combination of the amino acids and the GAPS Diet could be just the ticket for you. Please keep me posted on your progress. You can always reach me on Facebook; I’m on there almost every day.

Big (virtual) hugs to you!

8. Question: Will Rami Nagel’s Book Help Me With Peridontal Disease?

At age 35, I was diagnosed with peridontal disease (mild) earlier in the year which my dentist treated. She acted like it was successful. Pain in my mouth daily (usually in morning or lunch time) on one side which is actually where the disease was worse.

I know what my dentist will recommend: fluoride treatment and referral for possible root canal. I don’t want another root canal! I am gluten intolerant (have not pursued diagnosis of celiac) and lactose intolerant. Will the Rami book work for me possibly?  My stomach health has been much better in the past year (since removing gluten) but I’m wondering if I would be able to recognize if it is possible my gut could still need healing (despite feeling so much better) & that that could impact my teeth?

I’m desperate for advice because I don’t want to hurt in my mouth and I don’t want to pay thousands for an awful root canal!



Hi, Heather,

I hate to sound like a broken record, but you need the GAPS diet. Avoiding gluten does not heal the gut, and people who have gluten intolerance can have many other intolerances they are not even aware of.  I’d pick up a copy of Gut & Psychology Syndrome and plan to get started on the GAPS diet.

I think it would be a good idea for you to read Rami’s book, Cure Tooth Decay, too, because it would help you understand how powerfully nutrition impacts dental health. When we have a leaky gut and abnormal gut flora, we can’t absorb the nutrients in the food we are eating. It is the nutrients we eat that keep our teeth healthy.

And, yes, absolutely AVOID fluoride treatments and root canals! I really regret the two root canals I had. All root canals leave infection in the gum line which cause all kinds of long-term problems. If I were you, I’d look for another dentist.

Hi AnnMarie,

I just learned that I am pregnant today and know I should be taking my Green Pastures Cod Liver Oil/Butter mixture that’s sitting in my fridge…  I just can’t do it!  I’m looking at the capsules on their website, but how many do I need to take everyday if I were to order them?  Also, if I am able to stomach the oil again, how much am I to be taking?  I know you Facebooked about it recently, but I do not remember how much you said.

Thanks so much,


Congratulations! How exciting! I wrote a post about this recently: Are You Taking Enough Cod Liver Oil?

Of course, these are just estimates and some people will need more and others will need less. Listen to your body and your intuition. And I really recommend getting your vitamin D levels tested.

10. Question: Help With Crispy Almonds Recipe? / A Substitute For Sprouted Flour? / Recommendation For A Vendor For Soaked Or Sprouted Almond Flour?

Hi, Ann Marie.

Thanks for offering a weekly Q & A.  It is very much appreciated, especially for a newbie like me venturing into Sally Fallon’s world of
Nourishing Traditions.

I’ve been saving up my questions for you. 🙂

Here they are:

1. I attempted to make Crispy Almonds twice using organic, raw, unpasteurized almonds imported from Italy.  After soaking, I put the almonds in the dehydrator at 115 degrees for 12 hours, and when I checked on them, they were already super dry (overly dry, it seems) and not crispy.  I tried a second batch, dehydrating them at 100 degrees for 9.5 hours with the same result (overly dry and not crispy).  Do I need to dehydrate for even less time even though Sally Fallon recommends 12-24 hours at up to 150 degrees, or is the problem that I am actually not letting the almonds dehydrate long enough (in other words, that it needs more like 12-24 hours to get crispy even though they are fully dry already)?

2. How does one substitute sprouted flour in a recipe that calls for soaking flour, since one doesn’t need to soak flour?  I figure I could mix the flour with the buttermilk/yogurt/acid base and immediately proceed with the recipe rather than let the flour soak, but it seems like a waste of buttermilk/yogurt to do that.  However, if I don’t mix the flour with the liquid, how might I account for it in the recipe?

3. Can you recommend a vendor through which to purchase soaked or sprouted almond flour?  I don’t have a mill to grind my own flour (I could use my Vitamix?).

Thanks for your guidance!

With appreciation,


Hi, Pamela!

1. I just dry my nuts until they are completely dry. I don’t think you need to let them get “crispy” but maybe Sally recommends this so they keep longer — I’m not sure. Maybe others can comment below.

2. I don’t see why you couldn’t just soak the sprouted flour. That is what I would do.

3. You can use your Vitamix. Actually, any old blender will work. Or a coffee grinder.

11. Question: Suggestions To Help Rid Body Of Water?

Hi Ann Marie,

My pastor is on high doses of steroids due to a rare medical condition. Thankfully he will be off of them in a few weeks but in the meantime he has swelled to more than twice his “normal” size — he honestly looks like he gained 100 lbs! I told his wife that I would ask you if you had any advice. I suggested green tea to help rid some of the water. Do you have any other suggestions? I’m really concerned for him.

Thanks a bunch!


Sorry, but I don’t know. I would just try to taper off the steroids and he will normalize. Maybe someone will have an idea and can post in the comments.

12. Question: What Are Your Thoughts About Phytates?

What is the real skinny on phytates? Are they different than phytic acid? I soak all my rices, grains, flours, beans etc. like NT and you recommend. Then reading on the internet, they will tell you phytates are good for you as they contain cancer fighting antioxidants. I’m confused.

Also, if you made the food pyramid, what would it look like? How many percent of fats, carbs, veggies, and proteins would you do?

Thank you.


According to Wikipedia:

Phytic acid (known as inositol hexakisphosphate (IP6), or phytate when in salt form) is the principal storage form of phosphorus in many plant tissues, especially bran and seeds. Phytate is not digestible to humans or nonruminant animals, however, so it is not a source of either inositol or phosphate if eaten directly. Morever, it chelates and thus makes unabsorbable certain important minor minerals such as zinc and iron, and to a lesser extent, also macro minerals such as calcium and magnesium.

As far as people on the internet saying that phytates are good for you, Sue Gregg has the following to say:

…phytates also have promising benefits. Research shows that they may be involved in curbing free radicals in the body that contribute to heart disease and cancers, as well as preventing excessive mineral build up in the body, especially of iron, which also contributes to free radical formation. It is thought that it may be the phytates in the bran layers of whole grains, in legumes, and in nuts and seeds that are providing these protections. However, I question the fear of excessive mineral buildup when real whole foods are consumed…
First of all, neutralizing phytic acid to release nutrients bound up in the form of phytates is not 100% accomplished except under ideal conditions of temperature and pH. These conditions cannot be easily achieved in home baking. Perhaps they are best achieved in making sourdough breads, a time-honored practice for millenia. Second, take a realistic look at your habits. Home baking notwithstanding, commercial whole grain products not processed by a two-stage process will find their way to our tables (as whole grain pastas, commercially purchased breads, e.g.).
Likewise, only the most dedicated will do the two-stage process with every recipe. Stop worrying that you will ruin the benefits of phytates by using the two-stage process. Many more people lack essential minerals and have difficulty with the digestion of gluten in grains. The two-stage process, therefore, plays a valuable role in baking with whole grains.
Kaayla T. Daniel, PhD, CNN, author of The Whole Soy Story, points to the Hebrews as an example of consuming both leavened and unleavened bread. The former, which was produced through the fermentation process from wild yeasts, was practiced most of the time. The latter, unleavened bread, was part of the the Hebrew preparation for Passover in early spring, “a natural time for fasting, a practice that encourages detoxification.” Daniel suggests that these yearly short periods “might have been a very effective way to rid the body of any heavy metals through the action of phytic acid.” On the other hand, she reminds us that “decades of research on the phytates of real foods have shown that phytates are antinutrients — more likely to contribute to disease than prevent it.”
I suggest that occasional consumption of whole grains that are not processed by one of the three two-stage methods (soaking, fermenting, sprouting) is not likely detrimental to health and may contribute a plus, while those that are properly processed as the main dietary choice will be greatly beneficial to health. (Source)

So, keep soaking your grains, nuts, seeds and legumes.

As far as the food pyramid, I really recommend this one, created by Sandrine Hahn, founder of the Nourishing Our Children campaign:

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