Yearly Archives: 2011 - Page 43

Unfit for the Paleo Rodeo

Posted by on January 7, 2011 3 comments

Diana Hsieh of the Modern Paleo blog does yeoman’s work running the Paleo Rodeo each week, which is a fun collection of Paleo posts. (Here’s this week’s rodeo.)

It turns out that a contribution got rejected from this week’s Rodeo as spam. It was titled “Linguine with Seafood Sun-dried Tomatoes and Lemon”:

I must admit that for a time I couldn’t see anything wrong with this meal, other than that it is rather light in the meat, vegetables, and sauce. But de gustibus non est disputandum. After a half minute of puzzlement I remembered that pasta is forbidden by conventional Paleo.

Of course, the Perfect Health Diet forbids wheat noodles but happily supports rice noodles. In our house we often have rice-noodle dishes, as I mentioned recently to Kratos.

I guess it’s just as well I didn’t submit Cambridge Fried Rice to the Rodeo!

Short-Term Effects of Adding Carbs to Very Low-Carb Diets

Posted by on January 6, 2011 70 comments

In my last post, I noted that

So far, all the negative experiences [from adoption of our diet] I am aware of have come from low-carb dieters who had difficulty after adding carbs and/or cutting protein….

It’s interesting that the same dietary change – adding “safe starches” to a low-carb Paleo diet – made some people feel better and others worse.

In thinking about why adding starches can cause short-term trouble for some people, my first thought was a fascinating post from two years ago by Peter Dobromylskyj of Hyperlipid. Peter noted:

Bacterial endotoxin is a breakdown product of the cell wall of gram negative bacteria. It’s a lipopolysaccharide and even quite small amounts of it are extremely unpleasant….

Now the scary thing is that eating a high fat meal, probably based on any fat which generates chylomicrons, markedly increases your uptake of endotoxin from your gut, which is obviously full of gram negative bacteria. Eating short chain fatty acids or carbohydrate [1] does not have this effect.

Endotoxins are fat-soluble, and so fat carries them into the body. The paper Peter cited actually found an increase in blood endotoxin levels after people were fed a high-fat meal:

In humans, no significant relation was observed between cardiovascular disease risk factors, carbohydrate and protein intakes, and plasma LPS concentration. Conversely, positive correlations were observed with fat and energy intakes. [1]

The same effect was found in mice:

Compared with the control mice, mice fed a high-energy diet showed an increase in plasma LPS. However, in mice fed a high-carbohydrate diet, the increase in plasma LPS was blunted compared with mice fed a high-fat diet.

The conclusion:

Experimental data suggest that fat was more efficient in transporting bacterial LPS from the gut lumen into the bloodstream. [1]

Does this mean that one should avoid dietary fat?  No, because it turns out the body regulates the amount of endotoxin entering the body. So a high-fat diet causes the immune system to exert greater control over gut bacteria. Peter writes:

Then came a fascinating random paper [2] through my wife’s journal club meetings … It’s about superinfection with resistant bacteria when broad spectrum antibiotics are used. This is a routine problem for anyone in medicine, especially patients. The concept is very simple, you kill off the susceptible commensal bacteria in the gut and resistant pathogens have no competition, so they have a field day and superinfection causes severe problems for the unlucky patient.

Simple, straightforward and wrong.

It turns out that the immune system, that is the innate immune system (of course), continuously monitors the contents of the gut by looking at endotoxin production. Lots of bacteria mean lots of endotoxin and an active, on-guard innate immune system. Kill off 99% of your gut bacteria and exdotoxin production drops. The innate immune system goes on vacation and clostridium difficile gets in and wipes out your granny.

Simple administration of oral endotoxin to the experimental mice stopped this effect completely.

Apparently, the human body evolved to favor having a certain population of commensal gut flora. When the population is too low, immune defenses are lowered to allow gut bacteria to multiply. When the population is too high, antimicrobial peptides are released into the gut to control pathogen numbers.

Thus, during gut infections adding probiotic bacteria may help defeat pathogenic infections by causing the body to increase its immune defenses. The body is actually trying to control the numbers of probiotic bacteria, but in doing so it makes compounds that kill pathogens.

Removal of tiny numbers of probiotic bacteria can lead to a huge multiplication of pathogens:

Administration of the broad-spectrum antibiotic combination metronidazole, neomycin and vancomycin (MNV), to which vancomycin-resistant Enterococcus (VRE) is resistant, markedly increases colonization of the small intestine, caecum and colon with VRE…. It remains unclear, however, why elimination of the relatively sparse microbial flora of the small intestine increases the number of VRE by over 100–1,000-fold. [2]

It’s possible that this effect may be able to work in reverse – that addition of the small number of bacteria in a probiotic capsule can diminish the much larger population of an acute infection by 100-fold. I’ve noticed that swallowing probiotic capsules can be extremely effective against food poisoning. If you ever get diarrhea from a bad meal, take handfuls of probiotics every few minutes. You’ll be cured remarkably quickly.

The Gut of a Zero-Carb Dieter

On a zero-carb diet – especially an entirely plant-free diet like the one Charles Washington eats – lack of food will cause the population of gut bacteria to dwindle.

As in a gut depopulated of bacteria by antibiotics, this diet will cause the gut to let down its immune defenses. The body will reduce its production of antimicrobial peptides in order to help gut bacteria survive.

Perversely, this may make any pathogens that enter the body with food more likely to enter the body. It also may allow pathogens to gain a foothold in the gut. Thus, heightened infectious disease risk could be another long-term danger of zero-carb diets.

What Happens When A Zero-Carb Dieter Reintroduces Starches?

When a zero-carb dieter starts eating plant foods, suddenly gut bacteria have a lot of food, and can multiply many-fold. Bacteria can double their numbers in 20 minutes, and yeast in a few hours. That means that bacterial populations can increase 8-fold in an hour, 4000-fold in 4 hours, and ten million fold in 8 hours. Yeast can increase 4000-fold in 24 hours.

So it doesn’t take long – the very first day – before gut bacteria have multiplied by huge proportions. In the course of their fermentation, they’ll release a lot of gas, causing some bowel distress.

And along with greater numbers comes greater endotoxin release. Any dietary fats carry these endotoxins into the body. This rise in endotoxin load triggers an immune response that includes release of antimicrobial peptides, killing gut bacteria and releasing more endotoxins.

This rise in endotoxin levels and the resulting immune response may resemble a brief illness. Some known effects of a sudden rise in systemic lipopolysaccharide levels:

  • Depression [3] and depressive-like behavior [4].
  • Impaired athleticism [5]. 
  • Reduced appetite [6, 7].
  • Fever, vasoconstriction and endothelial dysfunction. [8]

Of course these effects would be only temporary. In a matter of days to a week, the immune system should re-establish an equilibrium with the gut flora and the new diet. Gas and bloating in the gut should be reduced (unless pathogens have been able to establish an enduring infection first). Endotoxin levels in the body should return to the evolutionary optimum. Higher production of antimicrobial peptides will maintain a limited gut bacterial population, even though carb intake has increased.

My Experience

My own experience is consistent with some of these expectations. When I went from zero-carb to including carbs – in my case, the change was adding fruit only, starches didn’t start for another year – my abdomen became bloated and I had gas. It was remarkable:  the very first day I ate fruit, my belly bloated up. It seemed to leave me with a lasting infection, because both the bloating and various digestive problems lasted several years. Probably the scurvy that I also had at that time was a big contributor; until I fixed the scurvy I also had gallbladder problems, and developed diverticulitis during this period, diagnosed by a barium enema.

I believe the main factor in the bloating was a colonic yeast/fungal infection that may or may not be completely gone today (it is certainly much diminished). The bloating was increased whenever I developed fungal skin infections. I suspect the yeast took over my colon while my immune defenses were depressed on the zero-carb diet and vitamin C deficiency, and multiplied immensely as soon as they had access to plant foods.

Conclusion

This hypothesis matches some but not all of the first-couple-of-days symptoms experienced by Don Matesz and his commenter SamAbroad when they cut protein and increased starches. SamAbroad became “hungry and cranky”; Don noted “decline in mood and … increase in hunger and intestinal gas and a disruption of bowel function.” In short:

  • Gas, bloating, intestinal distress.
  • Cranky mood.
  • Hunger.

The first two are consistent with a rise in endotoxin levels. The last isn’t.

However, I can imagine a few reasons why a shift from meat to starches may have made them hungry:

  • Protein is notably satiating, one reason why high-protein diets are often effective for weight loss. Mixed carb and fat, on the other hand, makes a good dessert. As we have all witnessed, many people say they are stuffed after dinner but get hungry again when they see desserts.
  • Or maybe the calories lost from the reduction in meat were not fully replaced. Plant foods have far fewer calories per pound than meat, and many people overestimate how many calories are found in plant foods. In cutting meat from

The body should adjust appetite to the diet, but this may not happen in the first few days. In short-term (3-day) trials of food mix alteration, people who increased carbs ate more food than people who increased protein. [9]

I don’t know if these explanations are correct in the specific cases of Don and SamAbroad. (Indeed, I was very surprised Don had any trouble at all, since he already eats our safe starches and I am pretty sure he also eats within our recommended optimal range of macronutrients — hat tip to commenter Beth Mazur of WeightMaven.org for a link to one of Don’s meal analyses in which he ate our recommended calorie ratio.) However, I think many people who have been on zero-carb diets can expect short-term gut distress when they first restore carbs to the diet.

In people with healthy gut flora, this should disappear in a few days. In others, like me, who have pathogenic gut populations, a gut infection may become entrenched and take longer to get rid of. Still, overall I think the inclusion of dietary carbs, and the resulting enhancement of intestinal barrier immunity, is likely to lead to long-term improvement in the body’s protection against infectious diseases that enter through the gut.

References

[1] Amar J et al. Energy intake is associated with endotoxemia in apparently healthy men. Am J Clin Nutr. 2008 May;87(5):1219-23. http://pmid.us/18469242.

[2] Brandl K et al. Vancomycin-resistant enterococci exploit antibiotic-induced innate immune deficits. Nature. 2008 Oct 9;455(7214):804-7. http://pmid.us/18724361.

[3] Weidenfeld J, Yirmiya R. Effects of bacterial endotoxin on the glucocorticoid feedback regulation of adrenocortical response to stress. Neuroimmunomodulation. 1996 Nov-Dec;3(6):352-7. http://pmid.us/9266546.

[4] Fu X et al. Central administration of lipopolysaccharide induces depressive-like behavior in vivo and activates brain indoleamine 2,3 dioxygenase in murine organotypic hippocampal slice cultures. J Neuroinflammation. 2010 Aug 2;7:43.  http://pmid.us/20678226.

[5] Sparkman NL et al. Effects of intraperitoneal lipopolysaccharide on Morris maze performance in year-old and 2-month-old female C57BL/6J mice. Behav Brain Res. 2005 Apr 15;159(1):145-51.  http://pmid.us/15795008.

[6] Stengel A et al. Lipopolysaccharide differentially decreases plasma acyl and desacyl ghrelin levels in rats: potential role of the circulating ghrelin-acylating enzyme GOAT. Peptides. 2010 Sep;31(9):1689-96.  http://pmid.us/20599577.

[7] Rorato R et al. Prostaglandin mediates endotoxaemia-induced hypophagia by activation of pro-opiomelanocortin and corticotrophin-releasing factor neurons in rats. Exp Physiol. 2009 Mar;94(3):371-9. http://pmid.us/19074588.

[8] Feng SY et al. Acute and chronic effects of endotoxin on cerebral circulation in lambs. Am J Physiol Regul Integr Comp Physiol. 2010 Mar;298(3):R760-6. http://pmid.us/20071615.

[9] Coelho JS et al. Selective carbohydrate or protein restriction: effects on subsequent food intake and cravings. Appetite. 2006 Nov;47(3):352-60. http://pmid.us/16844265.

Experiences, Good and Bad, On the Diet

Posted by on January 4, 2011 185 comments

A number of people have now given us feedback after starting the diet, and I think this is a good time to review the effects, good and bad, that people have experienced.

In upcoming posts, I’ll discuss the negative experiences further and explore possible causes.

Positive Experiences

It’s gratifying that most people who have tried our diet have reported very positive experiences. Those who read the comment threads or Amazon reviews will have seen some of them; I get others via email.

Here are two from Amazon reviews:

I have battled Celiac disease for some time and got about 80% better with a Paleo diet… but the Perfect Health Diet was the first book that could finally answer that last 20% with science based logic. (Jordan Reasoner)

UPDATE: Jordan has an e-book, SCD Lifestyle: Surviving to Thriving, which looks great for bowel disease sufferers. He gives us an update on his personal progress in the comments.

I can’t believe how much better I feel!…

I had been eating (very) low-carb and high-protein for the better part of a decade – and I had gotten a lot of practice arrogantly dismissing suggestions (from any source) that I should change anything about my diet….

Results: (after 1.5 months or so.)

  1. I’m no longer “brain-dead” and unable to think in the evenings after work.
  2. I no longer have fruit or chocolate cravings.
  3. I’m much happier, and wake up looking forward to the day.
  4. I’ve been much more social.
  5. The extra starch has not resulted in weight gain. (I always gained weight when eating carbs before.)
  6. It looks like the fasting (which I’ve never tried before) is helping my alertness and also contributing to healthy weight loss.

It took less than a week for me to notice dramatic changes….

I can’t recommend this book highly enough. (gp2x)

Here are two from the last few days’ comments.

Yours is by far, the best Paleo / Ancestral diet that makes sense….  I was very strict Paleo for a good 8 months, and yes felt fantastic and lost 10ks etc.  But then started feeling tired, moody.  Enter some carbs (from the suggestion of your book) in the source of potato and rice and taro – and now I’m feeling a whole lot better.  Did I put on weight.  Of course not!  Essentially now I eat what my body craves.  I can listen to it now and it responds accordingly.  It knows when it needs more carbs (eg., after exercise).  And it knows how much as well. (Lisa Weis)

Since reading Gary Taubes’ Good Calories, Bad Calories my life has been transformed. Who knew that butter was a healthy food.  Previous to reading GCBC I was a fruit fiend.  I ate bowls and bowls of cherries this past summer and wondered by I could not lose weight.  I reached my weight loss goals by eliminating grains and limiting dairy to butter and cream and reducing fruit intake.  That said, over the last month or so, I was wondering why my body seemed to be drying out from the inside out.  I want to tweak my diet to optimum health and found your book. The information about the importance of mucin was helpful.  What was missing in my diet was the carbs that you and the missus recommend.  Sweet potatos, white rice etc.  Maybe less protein than I’ve been eating and more saturated fat.  (I’m alarmed by the stomach and other cancers suffered by long term adherence to the Optimal diet …)  I’m having better results every day.  I am fascinated that I have a laboratory of my own body to put your ideas to a test and have them show positive results.  Thank you both so much for your work and above responses to questions and comments. (Doris)

I think these positive experiences are impressive considering that most of our readers have come from the low-carb Paleo community. Low-carb Paleo diets are far healthier than the Standard American Diet, and so improving health further is quite an accomplishment.

Another group that we are trying to help are people with chronic diseases. Probably most readers who did not arrive from the low-carb Paleo community have come from the chronic disease community. It’s a little early to report results, but at least some people are finding promise in our diet. Natalie wrote:

As someone dealing with chronic disease (a very unfun combination of Lyme, Babesia, and Bartonella), I know I’m always looking to find out more of what has worked and what did not work for others.

This blog along with many of the readers of this blog have been a tremendous help to me personally.  For example, I now know I can avoid the daily “coma naps” if I don’t go crazy on the carbohydrates.  I’ve actually received some excellent diet advice from my doctor, but he never told me to chill on the carbs!  (Natalie)

Ketogenic diets are frequently mentioned by us as potentially therapeutic for many diseases. I’ve blogged previously about Claire’s discovery that ketogenic diets help her gastroparesis and Rob’s suppression of his lifelong migraines through fasting and ketogenic dieting.  

As more chronic disease sufferers try the diet – for instance, Darren who has Lyme disease – we hope to prove that the Perfect Health Diet in conjunction with antibiotic therapies can lead to cures for these difficult-to-treat conditions.

Negative Experiences

So far, all the negative experiences I am aware of have come from low-carb dieters who had difficulty after adding carbs and/or cutting protein.

Don Matesz is an interesting case, because his own diet was already a “Perfect Health Diet.” His diet, if I’m not mistaken, was in the low end of our carb range and high end of our protein range. As a test he reduced protein and added carbs, heading toward the high end of our carb range and low end of our protein range. He didn’t like the results:

Just to experiment, for a couple of days Tracy and I reduced our meat intake by half.  I reduced my meat intake from more than a pound daily to just about one-half pound, and, as the Jaminets suggest, replaced the protein with starchy carbohydrates (potatoes and sweet potatoes).  For both Tracy and I, this resulted in a noticeable decline in mood and a dramatic increase in hunger and intestinal gas, along with a disruption of bowel function….

UPDATE: Don says that he does best eating above the bottom end of our optimal carb range, but that for years he has gotten into trouble whenever carbs reach 100g/day (the middle of our optimal range). It sounds to me like an unresolved gut dysbiosis.

Don’s commenter SamAbroad had a similar experience with reducing protein intake:

But I’ve also been following the PHD, and to be honest, I am so hungry and cranky when I restrict protein.

UPDATE: SamAbroad turns out to be our Sarah, and she says that the Perfect Health Diet “has been one of the best things I’ve ever done for my health.” Maybe we should move her to the Positive Experiences group!

I’m still following the diet, I eat circa 100g carbs from starch a day not including veg and this has been one of the best things I’ve ever done for my health along with including a vitamin C supplement. My low-level depression and anxiety have completely disappeared and the diet is considerably more varied and easier to stick to than VLC.

Sarah’s issue is that she needs to eat at least the midrange of our carb+protein “plateau range,” for reasons as yet unknown.

Chris Masterjohn had trouble with sweet potatoes:

Although sweet potatoes are considered a safe starch on the Perfect Health Diet, they are not very safe for me. When I discovered how yummy sweet potato fries are, I started eating several sweet potatoes per day. Within a few days, I was limping and my neck was stiff. By the end of the week, my limp was extreme. I looked online to see if I was eating anything high in oxalates, and sure enough, sweet potatoes are loaded with them. My symptoms dramatically improved after one day off sweet potatoes and were gone the second day.

Chris’s commenter Lisa also had trouble with sweet potatoes:

I’ve been very achy since I started eating sweet potatoes daily. Why would some of us be maladapted to oxalates?… I’m wondering if after a long stint of LC/paleo eating I’ve become intolerant to oxalates or to starch in general.

UPDATE: We discuss possible reasons for problems with sweet potatoes here.

Several people have gained weight after starting the diet. This Amazon review doesn’t come right and say that the reviewer experienced weight gain, but I’m guessing that was the case:

It is worth emphasizing what another reviewer noted: The Perfect Health Diet is not focused on weight loss. In fact, if you are coming to the diet from a zero-carb or very-low-carb regimen, you can count on an immediate and substantial weight gain if you suddenly adopt the recommended intake of “400 carb calories [100 grams] per day of starchy tubers, rice, fruit, and berries.” (K. Hix)

From the comments, Maggy reported weight gain:

Following your advice, I added back a bit of “safe starch” last week, and decreased protein intake, keeping sat fat and MCF pretty high. Well, I got on the scale today and have managed to put on 5 pounds! I’m trying to figure out what is going on and what I need to tweak. I do need to lose a good 20-30 lbs, and while I don’t want to compromise health, I also don’t want to put back on what I managed to lose doing a VLC diet.

Is this an adjustment period I need to get through? Maybe I’m one of those broken metabolism folks who has to stick with VLC? (Maggy)

These negative experiences will be the subject of my next few posts.

Because individuals are so variable, it is often not possible to figure out what is going on without experimentation with different dietary variations and considerable communication. Therefore, I’m most grateful to people like Maggy who are willing to experiment and share their experiences with us.

Conclusion

It’s interesting that the same dietary change – adding “safe starches” to a low-carb Paleo diet – made some people feel better and others worse.

This series may also lead us into the question of trade-offs in diet. These trade-offs may cause different people to prefer different diets. For instance:

  • Shifting from lean-meat-and-vegetables to starches and fats may increase the pleasure of eating and improve health in some, but promote weight gain in others.
  • Higher protein may promote athleticism and fertility, but shorten lifespan (as it does in some animals).

In writing our book, we tried to present the evidence underlying all of our recommendations, and provide healthy ranges for the various nutrients with explanation why the reader might prefer to be at the high or low ends of the range. Our goal was to empower each reader to find his or her own “perfect health diet,” not to rigidly prescribe a specific way of eating.

But negative experiences on a diet can also have diagnostic value. For instance, when I first adopted a low-carb Paleo diet I developed severe fungal skin infections. The new diet revealed an infection I hadn’t known I had. For this reason, even negative experiences can be beneficial, as they may open a path to curing an underlying but hitherto concealed health problem.

We see this blog as a communal enterprise, in which we and our readers together try to discover the truth about diet and health. Therefore, we hope that anyone who does have negative experiences on the diet will not hesitate to report them in the comment threads and work with us to discover the cause.

Ox Feet Broth, Miso Soup, and Other Soups

Posted by on January 2, 2011 75 comments

We’ve mentioned that we prepare a soup broth every weekend and have soup as the first course of dinner most days of the following week.

But we haven’t mentioned that it’s possible to have a slightly different soup every night of the week. Here’s how.

The Broth

One of our favorite broths is a beef broth soup made from ox feet. First, find an Asian supermarket and buy some ox feet:

The ox feet will have been sawed so that collagen and sinews are exposed and can dissolve in the broth.

The longer you cook it, the more nutritious the broth gets. Here’s what it looks like after 3 hours:

There’s some fat on the top, which is delicious! You can also add some dried anchovy to the broth — say 10 anchovies per gallon — which we think improves the flavor.

When you eat the soup, be sure to eat the gelatin off the cooked ox feet. According to Ray Peat, this is very good for you.

The broth can serve as the base for a wide range of soups. Here are some of the ones we make.

Miso Soup

Miso is a classic Japanese soup. To make it, you’ll need Wakame seaweed and miso paste. The Wakame seaweed can be purchased at Amazon.com (see our supplement page). 

Wakame seaweed expands about five-fold in water, so use the dried seaweed judiciously. Set some aside to soak and expand in water:

Here we’ve also put some kelp (kombu) in the water. That’s the brownish square on the right. Kelp is much less tasty than wakame, but has more iodine.

Put some of the ox feet broth with a few ox feet in a smaller pot for the evening’s soup. Here the broth includes some dried anchovies:

Put aside a small amount of the broth in a bowl and dissolve the miso paste in the broth. Make sure it is thoroughly mixed before returning it to the pot:

After the seaweed has expanded, add it to the soup and cook for half an hour. When it’s nearly done, add miso paste and scallions and cook another 5 minutes. It’s now ready to eat:

Other Choices

You can add any other ingredients you like to the broth to make soups of different flavors.

Here we’ve added diced potato, shiitake mushrooms, and scallions:

Here we’ve added egg, tomato, and scallion:

Here we’ve added sliced ribeye beef, enoki mushrooms, and cilantro. Since thin-sliced beef and enoki mushrooms cook very quickly, you can treat this like a Vietnamese “pho” and simply put the beef and mushrooms in a bowl and pour the hot broth over them:

The making of the broth is the only time-consuming part of this. After the broth is prepared on the weekend, new soups can be prepared in 15-30 minutes. Season each soup with salt, pepper, and your favorite spices.