Yearly Archives: 2011 - Page 17

How to Recognize and Fix a Brain Infection

Posted by on July 20, 2011 195 comments

I thought I’d pull up an interesting tale from the comments. It is a great illustration of what we’re trying to accomplish on this blog.

Thomas first commented here on December 31:

I just got your book from a relative for Christmas (I told them to buy me it!) and am reading through it now. Very interesting, although some of it is beyond a simple layman like me.

The part of this blog post that starts “Thus common symptoms of a bacterial infection of the brain are those of cognitive hypoglycemia and serotonin deficiency” and continues for several paragraphs describes precisely the mysterious changes I have experience over the last decade of life (I am now 33), with the one variation being that I suffer extreme fatigue rather than insomnia or restlessness. Every other sympton, including the odd mental state you mention, is a perfect match, and I experience them all to a marked degree….

I have been diagnosed with general anxiety but never depression. I do not feel sad ever, just irritable and anhedonia-ac, if I may coin a word. Anti-depressants, and I’ve tried a bunch, do absolutely nothing for me.

Brain infections are widespread – I wouldn’t be surprised if 20% of the adult population has a brain infection of mild severity – but they are hardly ever diagnosed or treated.

Fortunately, there are some symptoms that are almost universally generated by brain infections, so it’s not necessarily that difficult to diagnose them. But I think no one knows the symptoms. Infections are generally allowed to progress for decades.

One of my crucial steps forward was when I recognized that I had the cognitive symptoms of hypoglycemia when my blood sugar was normal. I could relieve the symptoms if my blood sugar became highly elevated. Thinking about why that might be led me toward the idea of bacterial infections.

Thomas went on to describe the origin of his symptoms:

I began to decline after suffering the second subdural hematoma of my life at age 20 when I was in Italy, followed by a 5 year binge on alcohol.

This was another clue. Traumatic brain injuries, such as hematomas, often initiate brain infections, because they breach the blood-brain barrier. Alcohol is also a risk factor, as I pointed out in my reply to Thomas:

Alcohol abuse depresses bacterial immunity and would be a risk factor for a brain infection: http://www.ncbi.nlm.nih.gov/pubmed/16413723, http://www.ncbi.nlm.nih.gov/pubmed/20161709. Subdural hematomas frequently show infections, e.g. http://www.ncbi.nlm.nih.gov/pubmed/20430901.

We next heard from Thomas on February 22, when he had been on our diet for 7 weeks and had just tried his first ketogenic fast:

I’ve been doing PHD for about 7 weeks now, and tried a ketogenic fast this past weekend. I ended up going 33 hours with some coconut oil and cream. It was a bit tough having to eat a bunch of oil on an empty stomach, but nothing too bad.

I can’t say there was any improvement cognitively or with anhedonia, but there seemed to me to be a pronounced calming effect after about 24 hours of fasting. I often stutter or stumble over words (again, for about 10 years now), which usually goes away only with two or three alcoholic drinks. But the speech problems stopped almost completely during the fast, which makes me thing that there is some link to anxiety and stuttering.

Positive changes in brain function during ketosis suggest that the brain isn’t functioning normally when it relies on glucose as a fuel. There are several possible causes of this, but one is a bacterial infection. Another clue.

I generally recommend getting on our diet and supplement regimen, and reaching a stable health condition, before starting antibiotics. There are several reasons for this, which I’ll elaborate on later, but briefly:

  • Antibiotics work well on a good diet but may fail on a bad diet.
  • Pathogen die-off toxins can cause significant neurological damage and this toxicity may be substantially increased on a bad diet.
  • There is considerable diagnostic value in being able to clearly discern the reaction to antibiotics. Rarely is it certain that a brain infection is bacterial, or that the antibiotic in question is the correct one. To judge whether the antibiotic is working, it’s important that health be stable and as good as possible.

I therefore recommend being on our diet and supplement regimen for 3-4 months before starting antibiotics.

Thomas seems to have followed this advice, since he has just reported starting antibiotics:

I’ve been on PHD for a few months, and about a month ago went to the low-carb therapeutic ketogenic version of the PHD. After reading some of Paul’s posts, I believe that I might have a brain infection as a result of a head injury from more than a decade ago (Paul, if you recall, my condition has a lot of similarities to the one you once had). I started taking doxycycline a few days ago, and I have already noticed pronounced improvement (whether due to the diet or the antibiotic or both) in controlling the irritability and anxiety that have plagued me for years….

I definitely feel great since making the diet changes. My blood pressure, which has been creeping upwards over the last few years to 135/80 or so, is back down to 110/70. My testosterone is 824, and I am pleased to see that I maintaining my strength in the gym despite being on a ketogenic diet.

Pronounced improvement in the first days of doxycycline is quite possible, because doxy acts as a protein synthesis inhibitor. It essentially blocks bacterial functions and switches them into a state of hibernation. The bacteria are still there, but they are not interfering with brain function as much as before.

This improvement is confirmation that Thomas has a bacterial infection of the brain. If there were no infection, he wouldn’t notice an effect from the antibiotics.

Over a period of months, the doxycycline plus ketogenic dieting should help his innate immune defenses clear the brain of most bacteria. Combination antibiotic protocols may be even more effective.

In a follow-up comment, Thomas mentioned Ben Franklin and the blessing of good health:

Thanks for the response Paul, as well as all your help. If this works, I owe you my first-born child and then some! Ben Franklin (I think it was him) might have been right about health being the greatest blessing. The improvements I’ve seen recently have done more for my well-being than anything in the last decade, and I am profoundly grateful to you for all your excellent advice.

It’s comments like this that make blogging and book writing worthwhile.

It’s probably hard for those who have never had ill health to appreciate how enjoyable it can be for those with chronic diseases to recover good health. I’ve blogged on this before (Of Recovery, Hope, and Happiness, July 13, 2010 – don’t miss Ladybug’s painting).

Thomas, antibiotics and ketogenic dieting will work, I’m pretty sure. May you come to perfect health, and always remain grateful for the many blessings that are yours.

French Fried Potatoes and Sweet Potatoes

Posted by on July 17, 2011 38 comments

We had a reader request for “classic American dishes.” We decided to start with French fries.

Ingredients

The ingredients are simple:

  • We made three flavors using russet potatoes, Asian sweet potatoes, and American sweet potatoes.
  • For oil we used the Beef Tallow that we showed how to make last week.

Preparation

Start by cutting uncooked potatoes or sweet potatoes into appropriate shapes. We favor finger-sized slices or thin chips, and keeping the skin on. Here are russet potatoes, Asian sweet potatoes, and American sweet potatoes:

After slicing, soak them in a bowl of water as shown above. The purpose of this is to draw out starch. You can rub the potato with your fingers: it will feel slimy as long as there is starch there. You may need to rinse the potatoes 3-4 times to remove the starch. When you’re done, the slimy feel should be gone and the water should be clear.

Removing the starch will make the French fries crispy.

After the starch is removed, lay the fries out to dry:

It is important that they dry thoroughly. There must be no water when they are cooked. Drying takes at least 30 minutes.

Frying the potatoes occurs in two parts: once to cook the potatoes through, and a second time to make them crispy.

Put beef tallow (or whatever oil you are using) into a saucepan to a depth of a few inches, and heat it to a middling temperature about 275 F / 135 C. Add as many dried potato slices as will fit in the oil:

It doesn’t take long to cook: about 3 to 5 minutes. When they’re done, remove the fries; we used chopsticks.

At this stage the fries will look like this:

Set the fries aside for at least 10 minutes — 30 minutes is safer — to let them cool. They should be comfortable to the touch. If you want to freeze fries for future use, this would be a good stage to put them in the freezer.

But if you’re finishing the fries now, heat the oil to a high temperature — more like 350 F / 175 C, which is almost to the smoke point of most cooking oils — and return the cooled fries to the oil. Leave them in for just 2 to 3 minutes and remove. This will make the fries crispy, looking like this:

Sprinkle salt and any other spices you like on them, and they’re done!

Conclusion

French fries are really easy, if a bit time consuming, to make, and really hard to stop eating.

Our potatoes and Japanese sweet potatoes were superb, but the American sweet potato discs were only good — a little soft. Perhaps this species has extra water, or perhaps the disc shape needs more cooking time than we gave it.

We use our beef tallow for at most 3 batches — that is, 3 rounds at the low temperature and again at the high temperature — and then discard it. Because beef tallow solidifies at room temperature and can clog pipes, don’t pour it down a kitchen drain; let it solidify and discard it as solid trash in an appropriate container.

French fries have a tremendous taste to expense ratio — especially if you’ve been able to get beef fat for free from your butcher, like Paolo! Highly recommended.

Around the Web; Do You Know Where Your Neurotransmitters Were? Edition

Posted by on July 16, 2011 20 comments

We have guests this weekend and so I’ll be brief.

Just a reminder: Our meet-up at the beach is next Saturday, July 23, 4:30 to 6:30 pm, at the Massachusetts state park on the south end of Plum Island, which you access through the Parker River National Wildlife Refuge in Newburyport. I’ll have more detailed directions next week. We’ll picnic and will be delighted to chat, share food, play Frisbee, and just hang out with whoever cares to join us.

[1] Interesting posts this week: Emily Deans has been a rich source of information this week. She touched on an interesting topic – the ability of germs to produce human neurotransmitters:

Lactobacillus and Bifidobacterium species are known to produce GABA.  Escherichia, Bacillus, and Saccharomyces produce norepinephrine.  Candida, Streptococcus, Escherichia, and Enterococcus produce serotonin.  Bacillus and Serratia produce dopamine, and Lactobacillus species produce acetylcholine. That’s pretty much the entire hit parade of major neurotransmitters (there’s histamine and glutamate and a few others – and histamine is known to be produced by some bacteria that infect shellfish, for example, causing food poisoning).

It seems that many bugs may come pre-equipped with tools to modulate human moods and behaviors – if they can infect the central nervous system. No wonder the mechanisms of mental illness are so hard to understand.

Ned Kock explains why fasting might cause weight gain. Stan the Heretic thinks that statins and low-fat diets may cause osteoporosis.

The New York Times gave us evidence that maintaining immune function is the key to avoiding dementia (“Small Woes Increase Risk of Dementia”):

A runny nose, fallen arches and dentures aren’t risk factors typically associated with brain health. But new research suggests that small health problems can add up, and the combined effect can increase a person’s risk for dementia….

Taken alone, none of these health conditions are related to a person’s dementia risk. But when investigators combined these relatively minor physical ailments into a single “frailty index,’’ they found a significant cumulative effect on dementia risk.

Some economists find that food deserts only correlate with obesity, they don’t cause it.

Brian St Pierre finds papers showing that brown rice isn’t more nutritious than white rice. Doug McGuff reports that exercise reduces inflammation in diabetics. Lucas Tafur reports that ketogenic diets help clear environmental toxins.

I was intrigued by the headline “Nutritionists salute First Lady’s burger binge.” It turns out what the nutritionists like is Michelle Obama’s “balance and moderation,” which is to say, her unwillingness to consistently follow her own health advice. I’m inclined to agree: the burgers may improve her health!

Via John Durant, photographic evidence that standing desks used to be widespread.

[2] Music: I believe the musical term for this is “a cupola”:

Via The Brothers Judd.

[3] Good hair day:

Via Yves Smith.

[4] It’s smart to eat rice: Emily Deans, with a hat tip to Jamie Scott, offers more evidence for the superiority of rice to wheat. Apparently kids who eat rice have more brain matter and 5 more IQ points than kids who eat wheat:

Japanese researchers (funded by a national Young Scientists’ grant) studied 290 healthy children ages 5-18 years.  In Japan, apparently boiled white rice or white bread make up a typical breakfast.  (I remember eating a lot of this cereal plus sugar in skim milk when I was a kid. Kapow!)  The scientists were able to split the children into groups of habitual rice-eaters, habitual white bread eaters, and those who consumed both regularly.  Then they tested the IQs (using standard measures for kids <16 and a separate standard test for 16 and older), scanned the kids in a MRI, and collected their data.  Questionnaires were filled out by the kids or their parents with respect to morning eating habits, health, wealth, etc.

Using varying statistical techniques and a couple varieties of imaging data collection, the researchers found that the gray matter ratios (gray matter volume divided by intracranial volume) were significantly higher among the rice eaters vs. the white bread eaters, even after adjusting for age, gender, wealth, average weekly frequency of eating breakfast, and number of breakfast side dishes.  The Verbal IQ in the rice group averaged 104.7, in the bread group 100.3.  The Performance IQ was 102.1 in the rice group and 97.9 in the bread group. This difference was non-significant.

As the kids became older, the differences in gray matter ratio increased between bread and rice groups.

If only I hadn’t wasted my youth eating Wonder bread.

[5] Sitting is bad for you: Obesity Panacea cites a review of prospective studies on the effects of being sedentary. It turns out that time spent sitting affects mortality much more than it affects weight:

Based on inconsistency in findings among the studies and lack of high-quality prospective studies, insufficient evidence was concluded for body weight–related measures, CVD risk, and endometrial cancer. Further, moderate evidence for a positive relationship between the time spent sitting and the risk for type 2 diabetes was concluded. Based on three high-quality studies, there was no evidence for a relationship between sedentary behavior and mortality from cancer, but strong evidence for all-cause and CVD mortality.

So a standing desk may not cut your weight, but it will reduce your chance of dying. That’s pretty good.

If you want to lose weight too, try eating some kimchi at your standing desk.

[6] Thomas Edison anticipates the Perfect Health Diet approach?: Every once in a while someone asks if I know of health care providers in their area who are familiar with our ideas and recommend our diet. Chris Kresser, who is located in the Bay Area but can do Internet consultations, is one. I know some other doctors recommend our book – for instance, a woman in the UK wrote to say that her doctor suggested our diet as a treatment for PCOS – but I don’t know their identities.

Well, I can offer another name, because Dr. Jay Wrigley of The Art of Living Center in Charlotte, North Carolina tells me that he is recommending our diet to his patients. That caused me to look up their site and it features this excellent quotation:

Doctors of the future will have less use for medicines of any kind. Instead, they will instruct patients in the proper care of the human mind and body through correct ways of eating, proper care of the human frame and the right attitude that facilitates healing of both the mind and body.

— Thomas Edison

I suppose that this was a failed prophecy: Doctors today must be more dependent on medicines than ever before. Perhaps Edison over-estimated the intelligence of the future. But as prescription, I have to agree. Diet and a healthy lifestyle are keys to good health.

[7] Shou-Ching’s photo art:

[8] Weekly video: As a former physicist with artists in the family, I like to see the two subjects married:

Low Serum Cholesterol in Newborn Babies

Posted by on July 14, 2011 59 comments

Don Matesz, who has embraced low-fat and low-cholesterol dieting, recently stated that “I now consider anything over ~160 mg/dl [to be] excess serum cholesterol” and cited in his support the Cordain-Eaton claims that healthy hunter-gatherers had low serum cholesterol. Of course, we looked at that and found that healthy hunter-gatherers generally had serum cholesterol over 200 mg/dl and that hunter-gatherers with low serum cholesterol generally had high infectious burdens and short lifespans. See:

When Erik referenced our series and asked, “What do you think of the argument that low cholesterol in hunter gatherer populations stems from infections and parasites?”, Don replied:

Mean total blood cholesterol of healthy human neonates is about 72 mg/dl.

Is this due to infections and parasites?

In case this question was not merely rhetorical, let me answer: No.

But it’s an interesting biology question. Why do neonates have low serum cholesterol?

Neonates and Infants

The study that Don cited [1] looked at cord blood from neonates. Cord blood is blood that circulates on the fetal side of the placenta in utero. As soon as the baby is delivered, the cord is cut and blood ceases to circulate.

So the cord blood serum cholesterol of 70.3 mg/dl is really sampling fetal cholesterol – the blood of babies who have never eaten and never breathed.

The not eating part is relevant, because HDL is generated from the metabolism of chylomicrons created in the intestine when fat is eaten, and LDL is generated from VLDL particles that carry excess calories as triglycerides from the liver. So eating generates LDL and HDL. We might expect that LDL and HDL, and thus TC, levels will rise as soon as the neonate starts feeding.

We can check this out by looking at cholesterol levels in infants. The following data is from Japan [2], but any healthy population would give similar results:

Serum total cholesterol in infants, mg/dl, by feeding method

Infant Age Formula-fed Partially breastfed Breastfed
One month 117 142 163
Six months 140 162 194

Source: Tables 2 and 3, Isomura et al 2011.

The key data is in the rightmost column, the breastfed babies. By one month postpartum, TC is 163 mg/dl (“excess serum cholesterol” on Don’s view). By six months, it is 194 mg/dl.

Formula fed babies had a much smaller rise in TC.

To understand the pattern of this data, let’s look at three issues:

  • Why do formula-fed babies have lower TC than breastfed babies?
  • Why do neonates have low TC?
  • Why do breastfed babies end up with TC near 200 mg/dl?

Formula is a lipid-deficient food

Why do formula fed babies have lower serum cholesterol? One contributing factor may be a dietary lipid deficiency.

Human breast milk is rich in cholesterol. One study found that the cholesterol content of human breast milk follows a diurnal rhythm with a low of 140 mg/L during sleeping hours and early morning, and a high of 220 mg/L in the afternoon and evening. Other studies agree that human breast milk always has more than 100 mg/L cholesterol. Babies typically drink 750 mL/day, so a breastfed baby’s daily cholesterol intake is 100 to 200 mg.

Scaled by body weight, this would be the equivalent of 1.5 to 3 grams cholesterol per day for adults – approximately ten times the typical cholesterol intake of American adults.

Clearly, evolution thinks babies should get plenty of cholesterol.

But cholesterol levels in formula are much lower:

Since … infant formulas contain very little cholesterol (10 to 30 mg/L) (Huisman et al., 1996; Wong et al., 1993), it is not surprising that plasma cholesterol concentrations are higher in infants fed human milk than in formula-fed infants.

I guess the formula makers don’t consider cholesterol to be a desirable nutrient. This may be an extremely consequential mistake.

Low TC in Neonates May Have Evolved to Suppress Immunity

So why do neonates have a very low TC?

In addition to fat and cholesterol transport, LDL and HDL both have immune functions. Low serum cholesterol signifies a loss of these immune functions. Normal immune function is associated with TC around 200 mg/dl or higher.

But infants are well known to have suppressed immunity. This is important: if the fetus had an ability to generate antibodies and mount an immune response, it might generate immune attacks against the mother leading to miscarriage.

After birth, a baby’s immune system gradually matures:

A baby’s immune system is not fully developed until he/she is about six months-old. In the meantime, pregnant mothers pass immunoglobulin antibodies from their bloodstream, through the placenta, and to the fetus. These antibodies are an essential part of the fetus’s immune system. They identify and bind to harmful substances, such as bacteria, viruses, and fungi that enter the body. This triggers other immune cells to destroy the foreign substance….

Immediately after birth, the newborn has high levels of the mother’s antibodies in the bloodstream. Babies who are breastfed continue to receive antibodies via breast milk…. This is called passive immunity because the mother is “passing” her antibodies to her child. This helps prevent the baby from developing diseases and infections.

During the next several months, the antibodies passed from the mother to the infant steadily decrease. When healthy babies are about two to three months old, the immune system will start producing its own antibodies. During this time, the baby will experience the body’s natural low point of antibodies in the bloodstream. This is because the maternal antibodies have decreased, and young children, who are making antibodies for the first time, produce them at a much slower rate than adults.

Once healthy babies reach six months of age, their antibodies are produced at a normal rate.

LDL particles, by presenting pathogen toxins to macrophages which can then present them on MHC molecules, play an important role in the generation of antibodies. (See Blood Lipids and Infectious Disease, Part II, July 12, 2011.) Low LDL signifies a reduced ability to generate antibodies.

Low LDL is therefore highly desirable as long as the baby remains in the womb, and in fact LDL levels are very low in utero.

But persistent low LDL after birth is dangerous: it makes the infant vulnerable to infections. Likewise, HDL has important immune functions (see HDL and Immunity, April 12, 2011). So LDL and HDL gradually rise to normal physiological levels, finally reaching a TC of 200 mg/dl after 6 months in breastfed babies – precisely when the babies attain normal immune function.

If TC of 190 mg/dl or higher signifies normal immune function, then formula fed babies are still immune suppressed at 6 months. Extrapolating the rise in TC, partially breast fed babies might achieve normal immune function at 12 months and formula fed babies might not achieve normal immunity until age 24 months!

Immunity Matters for Infant Health

I don’t want to delve too deeply into this, but infants are vulnerable to infections – this is why infant mortality has always been high. It still is today, and 6 months of age is still the canonical age when the danger lessens:

Globally, approximately 4,000,000 children less than 6 months of age die each year at a rate of 450 deaths per hour. In addition, high hospitalization costs for infected infants are incurred in the United States with an annual estimated cost of $690,000,000.

Formula feeding definitely escalates the risk:

In the United States, more than 40% of all infant hospitalizations are attributable to infectious disease … Diarrhoeal diseases and digestive tract infections are the most common infectious diseases in infants….

Breast feeding has been shown to have a number of beneficial effects in infants, including protection against infectious and allergic diseases. [3]

In this study, 41% of formula-fed infants developed infections between ages 5 and 8 months. [3]

A study from Brazil [4] shows that breastfeeding makes a huge difference in infant mortality:

In a population-based case-control study of infant mortality in two urban areas of southern Brazil, the type of milk in an infant’s diet was found to be an important risk factor for deaths from diarrhoeal and respiratory infections. Compared with infants who were breast-fed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhoea and respiratory infections, respectively. Part-weaning was associated with corresponding relative risks (RR) of 4.2 and 1.6. [4]

Now, deficient serum cholesterol is not the sole factor accounting for higher mortality in formula fed babies. But it is a contributing factor.

Conclusion

If serum cholesterol is healthiest below 160 mg/dl, then formula fed babies have excellent blood lipids despite a high disease and mortality rate, but breastfed babies are already in trouble at age one month and are suffering a shocking dyslipidemia at age six months, despite excellent health.

I think that’s absurd. A more logical interpretation of the evidence is this.

Healthy babies achieve serum cholesterol levels around the adult norm of 200 mg/dl by age six months.

Serum cholesterol levels below 190 mg/dl or so indicate immune suppression and increased risk of infectious disease – whatever the age of the human in question. Formula fed babies are immune suppressed for an extended period – well beyond the six month period of a healthy breastfed baby.

There are multiple causes of low serum cholesterol. A high infectious burden is one; never having eaten is another; a lipid-deficient diet is a third. But there is no evidence I am aware of suggesting that low serum cholesterol is a desirable condition.

References

[1] Mishkel MA. Neonatal plasma lipids as measured in cord blood. Can Med Assoc J. 1974 Oct 19; 111(8):775-80. http://pmid.us/4370703.

[2] Isomura H et al. Type of milk feeding affects hematological parameters and serum lipid profile in Japanese infants. Pediatr Int. 2011 Mar 21. http://pmid.us/21418403.

[3] Picaud JC et al. Incidence of infectious diseases in infants fed follow-on formula containing synbiotics: an observational study. Acta Paediatr. 2010 Nov;99(11):1695-700. http://pmid.us/20560895.

[4] Victora CG et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet. 1987 Aug 8;2(8554):319-22. http://pmid.us/2886775.