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A Tale of Recovery from Panic Disorder and OCD

Allison is a nutritional medicine student in Australia whose story illustrates many of our favorite themes – the importance of a healthy ancestral diet and good nourishment; the significance of infections in disease; the value of diagnostic profiling such as stool tests; and the potential value of antibiotics and fecal transplants as therapies for diseases not normally considered to be infectious. Most of all, she shows that in chronic disease, there is always ground for hope. Here’s Allison!  – Paul

When you are convinced that it is raining inside of a bus, sensing the rain drops on your skin, you know that something is very wrong. That was my experience after collapsing at work in London in July 2008, where I had moved in 2007 for the working holiday that’s so much a part of the Australian experience for many young people. After working too hard in my job, I’d picked up a virus which started off as a sore throat and then suddenly escalated to much more. I tried going back to work after two weeks at home resting, but it was to no avail. I had no energy, had trouble standing upright and was so spacey, I felt like I was on another planet – or not on any planet at all.

I’m now writing this from the safety of the other side of what can only be described as a personal hell on Earth. Four years on from that virus, and about ten years after I first started to experience post-viral fatigue episodes, I have finally been given the gift of answers as to what has wreaked so much havoc on my life. I feel incredibly lucky after all this time that the universe has given me answers, when so many people I care about in the online health groups I frequent, don’t seem to be so fortunate. I’m not particularly religious, but getting answers is akin to a miracle.

I’ll backtrack a little to 1999 at age 22 when I had a bout of glandular fever (known as “mono” in the US). I’d watched my elder brother deal with chronic fatigue syndrome in the late 1980s and knew just how bad it could be. It took me about 6 weeks to recover, but I don’t think my health was ever really the same. As a young girl, I was very sporty and academic. But as I got older and I experienced these viruses (to this day I don’t know exactly what virus they were), I was not the same healthy person. I always felt much more tired than other people and was prone to depression, stress intolerance and self-loathing. In the early 2000s, I was able to work full time and had a pretty good social life but I had odd reactions to straightforward procedures like wisdom tooth removal, root canal and vaccinations. Those dental procedures left me feeling flu-like for weeks and the Hepatitis B vaccination needed for overseas travel left me with a large grey patch of raised skin on my inner thigh.  In 2006, things started unravelling for me. After a bad relationship breakup, I picked up yet another virus and felt very dizzy and spaced out. I quickly developed severe muscle weakness and could hardly get out of bed. After about 6 weeks, I returned to work but experienced excruciating headaches and a sudden bout of claustrophobia on a train while commuting to work. In early 2007, I had a repeat of the very same thing for the same length of time. Mum would drive me to the beach for some sea air and I struggled to get my leg muscles to work so I could simply walk on the sand. When I returned to work, I resigned as it was quite a negative environment anyway – except for some of the lovely people I had the pleasure to work with. I was determined that my plans to move to London for a working holiday in mid-2007 would still hold. After “recovering” from that latest bout of post-viral fatigue, I found a contract job so I could save money for my big adventure. The only problem was that at that new job, I developed severe anxiety which left me paralysed at work and wanting to flee – almost all day, every day. My stress tolerance was non-existent. I didn’t seek help at all for the anxiety, I wish I had. Somehow, I managed to make it to the end of that contract and felt proud of myself for getting to the end of it and leaving the project in a pretty decent state for handover. With that, I took off for London.

In London, things were great for the most part but I still had anxiety at work, poor stress tolerance and was pushing myself too hard at work in a less than ideal physical environment – think cramped working conditions with not much fresh air and no air-conditioning. Welcome to modern London! I made it to December 2007 and planned a trip home to escape the London winter, but I developed a serious flu which finally subsided after several weeks but not without making me feel awful and scaring the life out of me. I did well when I was back home for three months and then returned to London again. I only lasted a couple of months before that sore throat I mentioned showed up and kicked off a whole lot of problems.

Literally overnight, I developed about thirty upsetting symptoms that were so bizarre I just couldn’t wrap my head around them. This was not the usual virus and post-viral fatigue episodes I had experienced. It was different. The worst symptoms were:

  • Severe thyroid pain that alternated between stabbing sensations and a vague feeling of pressure
  • Hot and cold body temperature fluctuations, so much so that on a 23C day in London, I could only relieve my body heat by taking a cold bath for half an hour
  • Intense muscle aching around my shoulder and neck region that was only partially helped by holding a bottle of frozen drink to the area
  • I needed to urinate every half hour and every hour overnight – that was quite unpleasant!
  • Constant crying at the drop of a hat. I would call my parents back home in Australia every day and cry. I also saw a couple of health practitioners when I was there (some were doctors, some were “alternative” practitioners such as a naturopath) and I would just constantly cry. Obviously, I was really afraid of what was happening to me, but the crying was excessive
  • I had disturbing thoughts, usually at night time, such as thinking I wanted to jump out of the window of my fifth floor apartment. I also had that very odd experience of rain inside the bus
  • The apartment building also had no lifts, so getting back up to the apartment was a real test of my will, since my legs had stopped functioning
  • I was very dizzy and mentally spaced out
  • Alcohol tolerance was non-existent. During this period, it was my birthday and one of my dear new London friends took me out and I felt so drunk on just a few sips of cider.

The doctors that I consulted during this period were not all that helpful. One was very blunt and told me I had chronic fatigue syndrome and to come back in two months for assessment for a hospital in-patient program. A neurologist I had seen in Sydney in 2007 about my excruciating headaches concluded that since an MRI showed no abnormalities, that my problems were all psychological and I should get myself some Vitamin Z, medico slang for Prozac. He also prescribed Endep for the headaches which didn’t help. Of course, being a crying mess out of frustration and fear from all of these post-viral episodes will typically make a doctor assume the whole thing has a psychological basis.

After two months of no improvement, I had to make the difficult decision to come home to Australia as it represented the best chance I would have to recover, surrounded by supportive family, friends and an environment more conducive to healing. Sorry London, but sunshine and clean air are a necessity for me! I felt like a failure but I knew it was the best choice I could make. I naively assumed I would be back in London in no time at all.

On the flight back home, I couldn’t access the sea salt I’d put in my bag that had successfully resolved the excess urination problem, so that meant I was visiting the plane bathroom every half an hour for almost the entire trip. I wonder what the passengers next to me thought! I got back home to Australia and remember feeling very, very spacey, cold and out of it. I was very relieved to be back home though without the pressures of paying for rent and looking after myself. My Mum to this day has no idea how I made it home on my own and I don’t either. I guess I was just on auto-pilot, desperate to get back home to start healing.

I had pinned all of my problems on thyroid and adrenal issues – this turned out to be partly true, but these were more symptoms of an underlying problem than an actual cause itself. It took me a while to figure that out, which unfortunately was time I could have been treating the foundations with diet and targeted supplementation. I was unable to convince any endocrinologists I’d seen that I had a thyroid problem. All the testing I had (hormone levels plus antibodies) was “normal”, though an ultrasound showed decreased vascularity. They had no explanation for the thyroid pain I had, which incidentally disappeared once I started taking selenium in London. I was diagnosed by a holistic GP with hypothyroidism based on symptoms and started on T4-containing thyroid medication. Every attempt at any medication with T4 in it, synthetic or dessicated porcine thyroid, was a disaster leaving me even worse than off the medication. I’ve been on T3-only medication for a couple of years now and do quite well on it. I was also diagnosed in 2009 with a significant imbalance between levels of zinc and copper but I didn’t understand the implications of that, nor that I’d need to monitor it for life, so I took the supplements prescribed by a GP (general practitioner – the Australian equivalent of an MD) for only three months and gave up.

In late 2009, on Christmas Eve, I was driving back home after visiting a friend and I suddenly had an overwhelming sensation of intense fear wash over me and I thought to myself “I can’t remember how to drive, I have to stop the car and get out”. Time stood still and I desperately wanted to get out of the car and lie down on the median strip. I luckily made it back home but collapsed in a pool of adrenalin. That was the start of the most intense panic attacks you can imagine, something far worse than the anxiety I’d experienced before. I couldn’t drive because the panic was so intense and then the panic was occurring almost all the time – when I was a passenger in a car, on a train, on a bus, riding an escalator in a store, even going for walks in my beloved local park on the bay. I would get a sensation of primal fear and then think I wouldn’t be able to get home safely. Panic attacks were sometimes like a sudden powerful punch to the chest – at other times like a slowly rising tsunami. Home became my safe haven, but I even developed panic attacks at home. I would dread having to leave the house and cry because I hated that this had become my life. If it wasn’t bad enough having the physical symptoms I’d dealt with for years, the panic attacks almost did me in. I could feel agoraphobia approaching quickly and I knew without any doubt that I did not want this to be my life.

Skip to 2011 and things were so bad that I felt at breaking point. I couldn’t see a way out. I was having not just panic attacks but very intrusive thoughts of jumping in front of trains. I was despairing but not suicidal, so these thoughts scared me greatly and I felt I couldn’t trust myself. It made doing normal things that people take for granted almost impossible. I somehow managed to get by with family support, learning mindfulness techniques and breathing exercises. I tried neurofeedback for many sessions and sometimes felt an improvement only to regress again. I was trying to work during this period but it was just not manageable, my sleep quality was at an all time low and I would go to work in a daze, just waiting for the panic attacks to come which they did without fail every day. Having to commute home for an hour added to the problem – thinking about trying to catch the train home in peak hour was just torture. On one occasion, I had to run off a train as it was pulling in to a crowded station as I felt incredibly claustrophobic and fearful. I had somehow managed to complete a Masters Degree in 2010 but it was a struggle to sit in class with all of this going on. I would always sit near the door and didn’t contribute as much as I would have liked during class discussions. Often when I was a passenger in the car my Mum was driving, I would actually get out of the car at traffic lights while the car was stopped because I couldn’t handle being in the car stopped at lights as time stood still for an eternity – it was torture. Trying to rationalise just didn’t work – wherever this fear was coming from, it sure didn’t respond to rational self-talk.

A doctor that I started to see out of desperation in 2011 ordered a Bioscreen test to look at the gut levels of bacterial strains deemed by the researchers who established the lab to be significant in “mystery” ailments like chronic fatigue, behavioural and mental illnesses. Lo and behold, there were a lot of problems that came up on my results – extremely high levels of particular streptococcus strains and non-existent levels of many other bacterial strains considered essential. I had virtually no digestive symptoms at all though. My doctor didn’t really explain the significance of the streptococcus result as it pertains to mental health. I took a 12-day round of erythromycin, felt no different and left that by the wayside. Shortly after, I went to see another doctor that the neurofeedback practitioner worked with and the zinc:copper imbalance came up again and was confirmed as a likely contributor to many of my symptoms. I also had very low levels of B6 according to a Metametrix  organic acids test. My dream recall was non-existent but returned with P5P and B6 supplementation, so I obviously really needed it. I also had an igG subclass deficiency which has now resolved with guided zinc supplementation. Working on the zinc:copper balance has made a big improvement to my health – my immune system is now much more resilient. I haven’t had a post-viral episode for about two years now. I also made the switch to a Paleo diet in early 2011 after getting frustrated with my lack of progress. That has given me a great foundation with which to repair my broken body.

But, I still had panic attacks and increasing agoraphobia which were preventing me from participating in life and making me despair.  I was doing mindfulness and breath work, but they were really no match for it – they helped me cope but only just. Even the mirtazapine I had been taking, which at first was a godsend, had stopped being effective, so I knew I was in trouble. I stumbled on a blog from a fellow Australian called The Power of Poo when I was looking up some information for someone about histamine. In it, the author detailed the connection between streptococcus and mental health. That was a real lightbulb moment. I took this as a sign, so went back to the doctor who had prescribed the erythromycin and asked for two more rounds to see if it would make a difference. The side effects were awful – I felt like I’d been hit by a truck. But after a few weeks, the darkness enveloping me lifted and I felt so much more calm than I’d felt in a long time. I really couldn’t believe it.

Since then, I have re-tested the levels of gut bacteria and taken a few more rounds of erythromycin when I felt the panic attacks returning. I took that to be a sign that the streptococcus was still too high – that was confirmed with the re-testing which showed the streptococcus levels had reduced, but not nearly enough. I still have some episodes of anxiety, but they are nothing compared to the panic attacks I experienced. I am able to do things I had stopped doing – I’m now able to sit through an entire film in a cinema without leaving. I can leave the house without the thought of impending doom stopping me. I am slowly returning to driving but am taking things slow. I feel that the avoidance behaviours that took hold when the panic disorder was at its height need to be addressed somehow, so I try to do some informal exposure, though this isn’t easy when such strong memories are still there. But they are just that – memories.

In 2012, I came across information about a condition that is mostly documented in children and adolescents called PANDAS. The etiology of this condition involves strep throat triggering an immune and neurological response which leads to a range of symptoms including OCD, anxiety, autoimmune complications and excess urination. Bingo! When reading about it, I was convinced that this was what had happened to me. I spoke to one of my doctors about this and he has heard of adults being diagnosed with PANDAS, though there isn’t a lot of awareness of this condition – even less so when it applies to adults and even less so in Australia. My doctor tested my strep titres and one of them was high over range and the other was high in range. This, combined with my history and symptoms was enough confirmation for me. I am considering consulting with an immunologist who recognises PANDAS, though I don’t believe I need a formal diagnosis. I know this is what had tormented me.

I’m now looking at what my options are in the long term as I really do not want to be dependent on antibiotics to keep streptococcus levels under control and endless probiotics to re-populate the bacteria that have been decimated over the years. I’m investigating faecal transplant which has been incredibly successful in Clostridium difficile infections but is not widely recognised as a treatment for much else, especially conditions that are not obvious digestive problems.

Something that I don’t understand that bothers me greatly, is that the medical profession does not currently recognise the link between gut bacteria and mental health. There is acknowledgement that bacteria can cause illnesses such as bacterial pneumonia, endocarditis and rheumatic fever, but there is a gaping hole in the area of mental health and its connection to bacteria. Enlightened health professionals are well aware of this, but the average GP is not. How many people are needlessly suffering and only getting partial relief (if that) with medications? I know from my own experience that if I didn’t get the answer to my situation, I would either be dead, sectioned in hospital or completely agoraphobic and unable to leave my house. I am one of the lucky ones. Lucky that I had a supportive family, lucky that I could get information from the Internet (which often gets an unfair rap from medical professionals) and lucky that in my country, I can access and afford the testing and treatment I need.

I thank my lucky stars every day.

More Evidence for Low-Carb Diets

In our book we point out a number of dietary tactics that appear to substantially decrease risk of cardiovascular disease. They include:

  • Optimizing tissue omega-6 to omega-3 balance by minimizing intake of omega-6 fats and eating an oily marine fish like salmon or sardines once a week.
  • Optimizing various micronutrients including vitamins D and K2, choline, magnesium, iodine, and selenium.
  • Reducing carbohydrate intake to the body’s natural level of glucose utilization, about 30% of total calories.

We cited two main sources for the claim that reducing carbohydrate intake reduces risk of cardiovascular disease:

–          The Nurses Health Study found that risk of coronary heart disease went down steadily as dietary carbohydrates were reduced and replaced by fat. Those eating a 59% carb diet were 42% more likely to have heart attacks than those eating a 37% carb diet. [1]

–          Replacing dietary carbohydrate with saturated or monounsaturated fat raises HDL and lowers triglycerides, changes that are associated with low rates of cardiovascular disease. Blood lipids are optimized when carb intake drops to 30% of energy or less. [2]

I think this is pretty strong evidence. It is not completely bulletproof, because associations don’t prove causation and improving risk factors doesn’t necessarily improve disease risk; but, combined with supportive evidence from cellular biology and clear evidence that evolutionary selection favors a carbohydrate intake around 30%, I consider it convincing.

However, it’s always good to have more evidence; and two new studies provide some. One directly relates utilization of carbohydrates for energy to atherosclerosis, and the other conducted a 12-month clinical trial of a carbohydrate restricted diet.

Carbohydrate Utilization is Associated With Atherosclerosis

Via Stephan Guyenet comes a study that directly links carbohydrate metabolism to atherosclerosis: “Metabolic fuel utilization and subclinical atherosclerosis in overweight/obese subjects.” [3]

The study used intima-media thickness in the carotid artery, which serves the head and neck, as a measure of atherosclerosis. As Wikipedia notes,

Since the 1990s, both small clinical and several larger scale pharmaceutical trials have used carotid artery IMT as a surrogate endpoint for evaluating the regression and/or progression of atherosclerotic cardiovascular disease. Many studies have documented the relation between the carotid IMT and the presence and severity of atherosclerosis.

To assess metabolism it measured the “respiratory quotient” or RQ. RQ is the ratio of carbon dioxide (CO2) generated in the body to oxygen (O2) consumed in the body.

RQ indicates which fuels are being burned for energy in the body. When carbohydrates are burned, the reaction involves carbon exclusively, so for every O2 molecule consumed there is a CO2 molecule created. This makes the RQ 1.0 when carbohydrates are burned.

Fats, however, donate both carbon and hydrogen, and the hydrogens react with oxygen to make water (H2O). So some of the oxygen consumed when fats are burned goes into water, not carbon dioxide, and the RQ when fats are burned is about 0.7. Ketones also have an RQ around 0.7.

Amino acids from protein have variable amounts of hydrogen and carbon, some amino acids are ketogenic and some are glucogenic, and so the RQ of protein depends on its amino acid mix. Typically RQ from different types of food protein is between 0.8 and 0.9.

However, most people eat a fairly consistent amount of protein, around 15% of energy, so the variable that generally determines RQ in practice is the ratio of carbs to fat in the diet. Higher RQ indicates a higher-carb diet.

Another study had previously shown that calorie restriction, which also reduces RQ by replacing dietary carbohydrate with fat released from adipose tissue, reduces the thickness of the carotid intima-media. [4] This study was the first testing whether the RQ-CIMT relationship holds also in subjects not known to be restricting calories.

The study found that indeed it does: the lower RQ, the less atherosclerosis the subjects had. Unfortunately they don’t present data in a visually useful way (a scatter plot of RQ vs CIMT would have been helpful); here is what they do show:

RQ was better than waist circumference or BMI at predicting degree of atherosclerosis. Only age was a stronger predictor of atherosclerosis than RQ.

RQ predicted atherosclerosis equally well in subjects with and without obesity. This tells us two things:

  1. It supports the idea that it was habitual diet rather than recent calorie restriction (which decreases RQ by replacing food-sourced calories with fat from adipose tissue) that generated low RQ and low CIMT.
  2. As the authors say, it indicates “the main role of metabolic factors rather than BMI” in generating atherosclerosis – metabolic factors meaning burning glucose for energy rather than fat.

It is also supporting evidence for one of the more controversial lines of our book, that “mitochondria prefer fat.”

One caution: Most of the subjects in this study were eating diets that were around 50% to 55% carbohydrate, so the study was testing whether it’s better to eat a little above or below this carb intake. It tells us, I think, that a 45% carb diet is healthier than a diet with more than 50% carbs. It doesn’t tell us what carb intake is optimal.

The Clinical Trial

In a trial lasting 12 months, restricting carbohydrates to 600 to 850 calories per day – that is, about the 30% of energy that we recommend – in the context of a slightly hypocaloric diet improved cardiovascular risk factors. [5]

Overweight and obese subjects in the trial lost 2.8 kg (6 pounds) over the year-long trial, so it couldn’t have been severely calorie restricted. Changes in other risk factors:

–          Blood pressure dropped from 121/79 to 112/72;

–          Fasting blood glucose dropped from prediabetic 106 mg/dl to normal 96 mg/dl;

–          Lipids improved, with triglycerides decreasing from 217 to 155 mg/dl and HDL increasing from 39 to 45 mg/dl.

They conclude:

The results of this study indicate that a moderately restricted calorie and carbohydrate diet has a positive effect on body weight loss and improves the elements of metabolic syndrome in patients with overweight or obesity and prediabetes. These results underscore the need to provide dietary recommendations focusing on calorie and carbohydrate restrictions … Our results are in agreement with reports produced by other authors who also assessed a carbohydrate-reduced diet …

Conclusion

A number of simple dietary and nutritional changes appear to reduce the risk of atherosclerosis and cardiovascular disease generally. One of them is reducing carbohydrate intake.

I believe the optimum carbohydrate intake is around 30% of energy. Many studies generate clear evidence of benefits as carbs are brought down into the range of 20% to 30% of energy, especially in metabolic disorders like metabolic syndrome, diabetes, and obesity. It’s good to see that evidence from other diseases, such as CVD, also supports the same carb intake.

Because most people’s diets are flawed in so many different ways, and fixing an individual factor is often associated with a reduction in CVD risk of 40% to 70%, it’s possible that we could reduce CVD risk by 90% or more by implementing all of the dietary optimizations described in our book.

It’s well worth pursuing all these little optimizations!

References

[1] Halton TL et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women.  N Engl J Med. 2006 Nov 9;355(19):1991-2002. http://pmid.us/17093250.

[2] Krauss RM. Atherogenic lipoprotein phenotype and diet-gene interactions. J Nutr. 2001 Feb;131(2):340S-3S. http://pmid.us/11160558.

[3] Montalcini T et al. Metabolic fuel utilization and subclinical atherosclerosis in overweight/obese subjects. Endocrine. 2012 Nov 28. [Epub ahead of print] http://pmid.us/23188694.

[4] Iannuzzi A et al. Comparison of two diets of varying glycemic index on carotid subclinical atherosclerosis in obese children. Heart Vessels. 2009 Nov;24(6):419-24. http://pmid.us/20108073.

[5] Velázquez-López L et al. Low calorie and carbohydrate diet: to improve the cardiovascular risk indicators in overweight or obese adults with prediabetes. Endocrine. 2012 Sep 1. [Epub ahead of print] http://pmid.us/22941424.

Around the Web; Why I Blog Edition

[1] Why I Blog: A few weeks ago Joan asked my advice for her sister, who has suffered from eczema for over 40 years:

My 59 year old sister has Chronic Fatigue Syndrome…. Since her teens she has had from time to time small scaly patches that resolve with omega-6 supplementation…. At the present time she is taking 2 tablespoons of organic cold-pressed safflower oil 4X a day to control it. If she misses a dose her arms and face rapidly develop eczema which in a short time opens up and oozes.

As it happens, the primary symptom of an omega-6 deficiency is eczema. We discuss this in the book on p 55:

In humans, the main symptom of an omega-6 deficiency is a dry scaly skin rash. In the 1940s and 1950s, it was common to feed infants a fat-free milk formula – skim milk with sugar.  After some months, these infants developed eczema which could be cured by providing lard, which is about 10% PUFA.

Why was she becoming omega-6 deficient despite eating 8 tbsp (120 ml) a day of safflower oil? If omega-6 is deficient the body won’t consume it for energy. But omega-6 (and omega-3) fats are also destroyed by oxidation; our book discusses this on pp 65-67. Controlled oxidation of the longer 20-carbon omega-6 fatty acids to eicosanoids is exploited by the body as a signal of infections and stimulant of immune activity. Uncontrolled oxidation turns omega-6 fats into dangerous aldehydes.

To destroy 100 ml of safflower oil per day requires a huge level of oxidative stress. It indicates some sort of infection, and a severe deficiency of antioxidants. So I advised supplementation with zinc, copper, selenium, vitamin C, vitamin E and glutathione, as well as vitamins D, A, and K2 which help fight infections.

This week Joan gave us an update:

Hi Paul,

You will remember 12 days ago I asked you about my sister who has CFS and was taking 100 mls a day of safflower oil to keep eczema under control….

Your advice was spot on and the results have been miraculous. She started supplementation with zinc, copper, selenium, vitamins C, E, D and K and NAC. Within 24 hours her eczema was much improved and she began reducing the safflower oil. Now 10 days later she is down to 10 mls of safflower oil and is confident she can discontinue it completely in a few days. Her eczema has completely cleared and her skin is looking good.

Not only that, but some of her CFS symptoms have improved. Her constant headache is not as severe, irregular heartbeat episodes have almost completely stopped and she is tolerating slightly more physical activity. Needless to say she is absolutely delighted and wants me to pass on her deepest gratitude to you. Her words are, “It’s a miracle”. Once again Proverbs 13:12 springs to mind. “Hope deferred makes the heart sick, but a longing fulfilled is a tree of life.” Her sense of despair and resignation has gone and you have given her hope of a better future. Words seem inadequate to express thanks for that.

Congratulations, Joan’s sister! And thank you, Joan, for passing on your sister’s results. It made my day. And that’s why we blog – to try to develop and share knowledge of dietary and nutritional healing methods that, without our work, would be overlooked, leaving people to suffer needlessly.

[2] Vigilance is the Price of Liberty: Steve Cooksey, Diabetes Warrior, is being threatened by the North Carolina Board of Dietitians for giving dietary advice without a license. His crimes can be seen on this notice from the official investigation review:

If people are writing you with diabetic specific questions and you are responding you are no longer just providing information – you are counseling – you need a license to provide this service.

Here you are giving this person advice based on what she has said to you…. Counseling/advising requires a license.

You guided her (for her friend) to your meal plan – indirectly you conducted an assessment and provided advice/nutritional counseling.

The director of the Board of Dietitians consoled him: “even IF convicted, it would only be a misdemeanor.” Steve is looking for an attorney.

Of course, laws like this would make it illegal for me to respond to questions too. “Miracles” like that of Joan’s sister would be outlawed, in the hope that a few politically connected dietitians might make a few more dollars.

And it doesn’t end with licensing. The licensees get subject to standards of practice and have to conform or risk loss of their livelihood. Their ability to innovate is stifled; in time bureaucraticized medicine can sap even their will or ability to serve patients.

All of us should be outraged at these corrupt attempts to deprive us of freedom of speech, and of freedom to enter a profession as entrepreneurs with innovative approaches.

[3] Music to Read By: Rhapsody in Blue, played by piano and tap shoes:

[4] Interesting Items this Week:

Friend of the blog Allan Balliett is up and running with his Biodynamics Now podcast at www.bdnow.org. He’s kicked off the podcast with two star guests: Joel Salatin, self-described “Christian-libertarian-environmentalist-capitalist-lunatic-Farmer,” and Sally Fallon Morell, leader of the Weston A Price Foundation. An interview with Dr Thomas Cowan, author of The Fourfold Path to Healing and a Weston Price Foundation affiliated doctor, is coming up soon; visit Allan’s blog to leave questions for Dr Cowan.

Via Allan’s interview, I learned that Sally Fallon has fulfilled a dream. She owns a farm and is making cheeses.

We were very happy to see our diet mentioned in the Sunday, Jan 22, 2012 US Wellness Meats newsletter. GrasslandBeef.com, of course, is a great source of PHD-compatible food.

Chris Kresser has a new podcast: Why It’s So Hard To Lose Weight – And Keep It Off.

Prof Dr Andro compares BPA, soy, and corn oil: which is the best endocrine disruptor?

Via Russ Farris, a new paper suggests that high levels of vitamin D increase inflammation and raise CRP.

Dan’s Plan credits bacon with saving the life of a 4 year old boy.

Chris Masterjohn says zinc defends against AGE production, and that vitamins A and D protect against autoimmune disease.

Michael Ellsberg explains how he overcame bipolar disorder.

Gary Taubes has an update. His colleague Peter Attia is blogging at “The War on Insulin” and they are starting an “insurgency” to wage this war. Meanwhile, a medical student at Virginia Commonwealth, Larry Istrail, has started the Ancestral Weight Loss Registry.

Seth Roberts defends personal science.

It pays to have a good marriage: an 85-year-old woman beat off a moose attack on her 82-year-old husband.

Future Pundit gives us an interesting fact about autism: the twin with the smaller birth weight is more likely to become autistic.

Iodide heart scans confirm that it’s risky to suddenly increase iodine intake: people who take a high dose of iodine for imaging studies are more likely to develop thyroid disease in subsequent years. Iodine is good for us, but protect your thyroid by starting low, combining it with selenium, and increasing the dose very slowly.

A testimonial at robbwolf.com: Paleo works better than immune suppression for ulcerative colitis.

Homeopathy for nematodes? Drinking 0.01 proof alcohol is sufficient to extend the lifespan of worms.

A mystery illness is afflicting upstate New York teens. Video at the link. Erin Brockovich is involved.

Jamie Scott continues his series on the adipogenic nature of omega-6 fats.

Emily Deans reports that Lactobacillus rhamnosus knows how to control our mood.

CarbSane reports that saturated fat is more likely than polyunsaturated fat to induce gestational diabetes.

Stephan Guyenet adds a nail to the coffin of the insulin-obesity hypothesis, but Peter Dobromylskyj pulls one out: he shows that adipose tissue needs insulin receptors if hypothalamic damage is to be obesogenic in mice.

Via Shari Bambino on Facebook, it seems you can’t trust cheap supermarket olive oil. Much of it is soybean oil mixed with low-grade olive-pomace oil.

Mat Lalonde critiques evolutionary arguments for Paleo, but some of his counter-arguments are just as flawed as the views he criticizes.

Steve Phinney and Rick Johnson discuss ketogenic diets.

[5] Cute animal:

Via naked capitalism.

[6] Dr Mercola finds our dietary advice helpful: The “safe starches” debate is still making converts:

After trying both approaches, my experience suggests that Dr. Jaminet’s position is more clinically relevant….

When I eliminated all my grains and starchy vegetables, I actually experienced some negative effects. My energy levels declined considerably, and my cholesterol, which is normally about 150, rose to over 200. It appears I was suffering a glucose deficiency and this can trigger lipoprotein abnormalities. It also seemed to worsen my kidney function. So, while carbohydrate restriction is a miracle move for most people, like most good things in life, you can overdo it.

This information really underscores how important glucose is as a nutrient, and some people can’t manufacture glucose from protein as well as others, so they need SOME starches in their diet or else they will suffer from metabolic stress….

My experience now shows me that I need to have some source of non-vegetable carbs. I still seek to avoid nearly all grains, except for rice and potatoes. I typically limit my total carbohydrate calories to about 25 percent of total daily intake, and my protein to about 15 percent, with the additional 60 percent coming from healthful fats like butter, egg yolks, avocados, coconut oil, nuts and animal fat.

However, that is what works for me. You must listen to YOUR body and perform your own experiment. The bottom line is how your body responds, and you’re the ONLY one who can determine that.

On Facebook, A.b. Dada noted health improvements when adding rice and potatoes to a too-low-carb diet:

I added back white potatoes and even white rice based on Dr. Harris’ advice and definitely feel better (less orthostatic hypotension) — plus I’m actually slimmer than I’ve ever been, yet my muscles are much stronger.

Low carb for 12 years before this year!

There were a lot of nice comments on the “Is It Good to Eat Sugar?” post, including good ones from ET and Jim Jozwiak that I’ll probably discuss this coming week.

[7] More cute animals: From the BBC, “That’s Life,” 1986:

[8] Shou-Ching’s Photo Art:

[9] Weekly Video: Jazz concert:

2011 in Review: Top Posts

It’s been a great year for us, full of fun and learning. In this last post of 2011 I’ll review the year’s most interesting posts. Early next week, I’ll add a few more thoughts about 2011 and preview our plans for 2012.

But first let me give a shout out to Stabby Raccoon’s “Guide to Binge Drinking,” at the new group blog “Highbrow Paleo.” If you plan to drink alcohol on New Year’s Eve, either for pleasure or to raise your HDL, you might want to look up Stabby’s advice.

The Puzzle of High LDL on Paleo

One of the more interesting puzzles we delved into this year was the problem of high LDL on Paleo.

Reader Larry Eshelman had this problem, and gathered a large number of examples of low-carb Paleo dieters with high LDL: Low Carb Paleo, and LDL is Soaring – Help!, Mar 2, 2011. We suggested a possible remedy – repairing deficiencies in micronutrients known to be crucial to vascular function – in Answer Day: What Causes High LDL on Low-Carb Paleo?, Mar 3, 2011.

That remedy worked for Larry, and we’ll do an update on his case soon. But it wasn’t the whole story, and later in the year we looked at another cause of high LDL on Paleo – low thyroid hormone levels – in High LDL on Paleo Revisited: Low Carb & the Thyroid, Sep 1, 2011. Going too low-carb causes a reduction in T3 thyroid hormone levels, which leads to inactivation of LDL receptors and potentially large increases in LDL levels. Gregory Barton shared his case history.

Blood Lipids as Diagnostic Tools

We were also led to think about blood lipids because lipoproteins are immune molecules of considerable importance in fighting infectious diseases. We talked about the immune functions of HDL in HDL and Immunity, Apr 12, 2011, and HDL: Higher is Good, But is Highest Best?, Apr 14, 2011. We talked about the immune functions of LDL, VLDL, and Lp(a) in Blood Lipids and Infectious Disease, Part II, Jul 12, 2011.

With help from blogger O Primitivo, we looked at what serum lipid levels optimize health in Blood Lipids and Infectious Disease, Part I, Jun 21, 2011. It’s higher than most think: TC between about 200 and 240 mg/dl is optimal.

We discussed ways to improve immune function by raising HDL in How to Raise HDL, Apr 20, 2011.

Don Matesz objected that newborns have very low serum cholesterol, so we looked at Low Serum Cholesterol in Newborn Babies, Jul 14, 2011. Breast-fed babies achieve normal serum cholesterol of about 200 mg/dl at age six months, which is also when their immune function normalizes.

Another objection was based on the claim by Paleo pioneers Boyd Eaton and Loren Cordain that hunter-gatherers had low serum cholesterol. That led us to a number of posts: Did Hunter-Gatherers Have Low Serum Cholesterol?, Jun 28, 2011; Serum Cholesterol Among the Eskimos and Inuit, Jul 1, 2011; Serum Cholesterol Among African Hunter-Gatherers, Jul 5, 2011; Serum Cholesterol Among Hunter-Gatherers: Conclusion, Jul 7, 2011. The upshot: healthy hunter-gatherers had normal serum cholesterol, with TC usually over 200 mg/dl. The cases of low serum cholesterol were either in stale samples collected from remote sites in the 1930s to 1950s without use of refrigeration and delays of weeks to months in measurement, or from hunter-gatherers with high rates of infectious disease from parasitic protozoa or worms.

This literature survey led us to the belief that there are really only two common causes for low total serum cholesterol (not counting statin consumption): eating a lipid deficient diet, such as a macrobiotic diet; or having an infection with a eukaryotic pathogen.

This means that anyone eating a high-fat diet who has low serum cholesterol should get checked out for eukaryotic infections, probably protozoa or worms. We’ve encouraged half a dozen people or so to do this.

Brendan is a great example. He first left a comment in May asking for advice:

I have rosacea, puffiness in my cheeks, post-nasal drip, frequent headaches, severe constipation (IBS), hypothyroidism, extremely low cholesterol, and a variety of neuropsychiatric symptoms (depression, anxiety, insomnia, and cognitive and motor problems).

“Extremely low cholesterol” is the tell-tale clue. He reported back in December: he did indeed have whipworm and entamoeba infections, and is now seeking treatment.

I like this story because it is a great example of what we’re trying to achieve on this blog. Diet, nutrition, and infections interact to product one’s health; we want to understand how to troubleshoot any problems. I’m excited that blood lipids are turning out to be good diagnostic markers for certain types of infection that are often overlooked.

The Challenge of Obesity

Our diet was designed to help people become healthy; it was not designed as a weight loss diet. Nevertheless, Shou-Ching and I were well aware of the failure of most weight loss diets to cure obesity – rather they tend to produce temporary weight loss followed by yo-yo weight regain – and we strongly suspected that a diet designed for general health might be the best strategy for long-term weight loss. So entering 2011, we were very curious how our diet would work for people trying to lose weight.

From Atkins to the Dukan Diet, recently embraced by Kate Middleton, popular diet books generally recommend high protein consumption, which seems to be very effective at promoting short-term weight loss. A few posts explored the place of protein in a weight loss diet, and whether there are alternatives to high protein: Protein, Satiety, and Body Composition, Jan 25, 2011; Low-Protein Leanness, Melanesians, and Hara Hachi Bu, Jan 27, 2011.

A few people who transitioned to our diet from very low-carb diets noticed an immediate gain of 3 to 5 pounds. This caused us to look into the issue of water weight: Water Weight: Does It Change When Changing Diets? Does It Matter?, Jan 14, 2011.

We also did a bit to link obesity to our favorite causes of disease – malnutrition, toxins, and infections – in Why We Get Fat: Food Toxins, Jan 20, 2011. Another post along this line was Obesity: Often An Infectious Disease, Sep 20, 2010.

Losing weight is especially hard for post-menopausal women, especially if they can’t exercise. Calorie needs may be as low as 1500 calories per day, making it hard to be well nourished on a calorie-restricted diet. The case of erp, a 76-year-old women with bad knees who needed to lose weight for knee replacement surgery, led us to clarify where the calories should come from when few can be eaten: Perfect Health Diet: Weight Loss Version, Feb 1, 2011.

We were happy that erp did indeed lose weight, dropping from size 16 to size 6. Another impressive case of weight loss was recorded by Jay Wright, who started our diet in March at 250 pounds and reached his goal weight of 170 pounds in October. Jay generously shared his story: Jay Wright’s Weight Loss Journey, Dec 1, 2011.

Stephan Guyenet, one of the finest diet and nutrition bloggers, introduced us to “food reward” and to the role in obesity of the brain modules that manage appetite and energy homeostasis. He had a back-and-forth with Gary Taubes over their differing views. I chimed in on a few occasions, notably in Gary Taubes and Stephan Guyenet: Three Views on Obesity, Aug 11, 2011, and Thoughts on Obesity Inspired by Stephan, Jun 2, 2011.

The Guyenet-Taubes debate gave me an opportunity to present a figure from a classic study by Maria Rupnick and colleagues. Giving or withholding an angiogenesis inhibitor causes ob/ob (obesity prone) mice to cycle between obese and normal weight:

It is hard to see how either a brain-centric view or a carb-and-insulin-centric view can account for this. I see this data as testimony to the complexity of biology.

I’m going to be developing my own theory of obesity in 2012; I previewed this theory in my talk at CrossFit NYC on November 19. One element was the subject of a 2011 post: How Does a Cell Avoid Obesity?, Jan 18, 2011. Leptin resistance and insulin resistance – two of the hallmarks of obesity – are symptoms of the disease of obesity, not its cause.

Therapeutic Ketogenic Diets

Ketogenic diets are potentially highly beneficial to neurological function, and are an under-utilized therapy for neurological conditions.

One reason they’re under-utilized is that clinical ketogenic diets have been poorly designed and malnourishing. We discussed how to make a diet ketogenic while minimizing health risks in Ketogenic Diets, I: Ways to Make a Diet Ketogenic, Feb 24, 2011, and Ketogenic Diets 2: Preventing Muscle and Bone Loss on Ketogenic Diets, Mar 10, 2011.

But the goal is to demonstrate that ketogenic diets can be therapeutic for various conditions. We had several great stories from people trying our version of the ketogenic diet.

Kate was able to relieve migraines and anxiety: A Cure for Migraines?:, Mar 29, 2011.

In a poignant story, we learned about a genetic disorder called NBIA (Neurodegeneration with Brain Iron Accumulation). Children with this disorder develop extremely painful muscle spasms and are usually in agony from around age 6, before dying in their teens. It turns out that a ketogenic diet effectively prevents the spasms and pain. Two parents of NBIA children shared photos of their kids in Ketogenic Diet for NBIA (Neurodegeneration with Brain Iron Accumulation), Feb 22, 2011. From being in constant pain, the boys had gone to “smiling and laughing all the time”:

Hypothyroidism

Thanks to our resident expert on hypothyroidism, Mario Renato Iwakura, we had a number of excellent discussions of how to optimize diet and nutrition for hypothyroidism.

First, Mario defended our support of selenium and iodine supplementation in cases of hypothyroidism, including Hashimoto’s autoimmune hypothyroidism, with a thorough review of the literature: see Iodine and Hashimoto’s Thyroiditis, Part I, May 24, 2011, and Iodine and Hashimoto’s Thyroiditis, Part 2, May 26, 2011. It is crucial to get selenium in the range 200 to 400 mcg per day, and to avoid an iodine deficiency. With optimal selenium, a wide range of iodine intakes are healthy, including quite high iodine intakes.

Later in the year, readers asked us to address claims by Anthony Colpo that low-carb diets would lead to “euthyroid sick syndrome,” a condition of low T3 thyroid hormone. We found support for that idea, but only for “very low-carb” diets, ie those with carbs below 200 calories per day (more in athletes or those with inadequate protein intake). Thyroid problems were also exacerbated when omega-6 fat intake was high. A literature search was unable to find instances of thyroid problems on low omega-6 and adequate carb diets. The main posts: Low Carb High Fat Diets and the Thyroid, Aug 18, 2011; Carbohydrates and the Thyroid, Aug 24, 2011; Mario Replies: Low Carb Diets and the Thyroid, II, Aug 30, 2011.

This was a useful discussion, as it led us back to the problem of high LDL on Paleo due to low T3 thyroid hormone levels caused by very low carb consumption.

The Place of Starches in a Paleo Diet

Given that some carbs should be eaten, what form should they take? There are two main food types of carbohydrate, sugars and starches.

I was surprised by the vehement opposition to starch consumption displayed by many low-carb advocates polled by Jimmy Moore in October. Most low-carb diets support the eating of sugary fruits and vegetables, and I would have thought that opposition to starches would be no greater than opposition to sugars. How wrong I was!

My original reply to the many low-carb gurus polled by Jimmy can be found here: Jimmy Moore’s seminar on “safe starches”: My reply, Oct 12, 2011. A week later I added a discussion of why the glycemic index or starches doesn’t matter when they are eaten the way we advise eating them: How to Minimize Hyperglycemic Toxicity, Oct 20, 2011. Dr Ron Rosedale enthusiastically continued the conversation, and I replied to Ron: Safe Starches Symposium: Dr Ron Rosedale, Nov 1, 2011.

Shortly afterward I spoke at the Wise Traditions conference of the Weston A Price Foundation – a great meeting! – and was asked about the GAPS diet of Dr. Natasha Campbell-McBride. It is an excellent diet which embodies a lot of clinical lore about how to heal gut dysbiosis, but its recommendation to avoid starches, while usually helpful, is not always the best course. There are pathogens capable of exploiting every human ecological niche and diet, including very low-carb or fructose-containing diets, and so there is no one diet that is perfect for every patient. Some cases of gut dysbiosis actually benefit from added starch. There seemed to be a bit of controversy about what I said, and I clarified my off-the-cuff comments here: Around the Web; Revisiting Green Meadows Farm, Dec 3, 2011.

Infectious Diseases

I thought I was going to blog a lot more about infectious diseases in 2011, but didn’t get around to it. Still, I got started in February with a few posts: They’ve Got Us Surrounded, Feb 8, 2011; Jaminet’s Corollary to the Ewald Hypothesis, Feb 11, 2011; and Evidence for Jaminet’s Corollary, Feb 15, 2011.

Circadian Rhythm Therapies

I’ve known for a long time that circadian rhythms were important for health. Disruption of circadian rhythms, for instance, by night shift work, is associated with higher rates of disease.

What I didn’t know, until I began to read Seth Roberts, is that simple dietary and lifestyle tactics can have a big impact on circadian rhythms. Seth Roberts and Circadian Therapy, Mar 22, 2011, looks at Seth’s work; “Intermittent Fasting as a Therapy for Hypothyroidism,” Dec 1, 2010, applies circadian rhythm therapies to hypothyroidism.

Cancer

We made a start toward discussing how to eat if you have cancer in two posts: Toward an Anti-Cancer Diet, Sep 15, 2011, and An Anti-Cancer Diet, Sep 28, 2011. Cancer is another disease in which circadian rhythm therapies seem to be important.

However, there’s much more to be said about cancer. We’ll probably discuss HDAC inhibition and anti-viral dieting in 2012.

Miscellaneous Disorders

Check out the “Diseases” categories in our Categories list for other disorders we’ve blogged about. A few items from 2011: Causes and Cures for Constipation, Apr 4, 2011; An Osteoarthritis Recovery Story, May 17, 2011; Around the Web; and Menstrual Cramp Remedy, Mar 5, 2011.

A Year of Food

In 2011, we decided to write a cookbook, and made an earnest start by posting a recipe once a week. Some of our favorite food posts:

Ox Feet Broth, Miso Soup, and Other Soups, Jan 2, 2011

Homemade Seasoned Seaweed, Jan 9, 2011

About Green Tea, Jan 30, 2011

Dong Po’s Pork, Feb 13, 2011

Pho (Vietnamese Noodle Soup), Feb 27, 2011

Pacific Sweet and Sour Salmon, Apr 10, 2011

Crème Brûlée, May 29, 2011

French Fried Potatoes and Sweet Potatoes, Jul 17, 2011

Chicken Wings, Sep 19, 2011

Sarah Atshan’s Lovely Food, Sep 11, 2011

Bi Bim Bap, Oct 16, 2011

Fermented Mixed Vegetables, Nov 27, 2011

Bengali Fish Curry (Machher Jhal), 2: The Recipe, Dec 27, 2011

Art

Shou-Ching wanted to be an artist but settled for being a scientist. This year she began to share some of her art work. We showed some of her paintings in Thank You From Shou-Ching, April 24, 2011, and her Photo Art appears weekly in our Around the Web posts. A complete compilation can be found on the Photo Art page.

Cute Animals

There were too many cute animals in the Around the Web posts to pick a favorite; but here’s one of my favorite places – Logan Pass, Glacier National Park, Montana:

Conclusion

It was a delightful year for us. We made a lot of new friends. Best of all, our diet seems to have improved the health of hundreds, maybe thousands, of people – often dramatically.

We wish all of our readers a very happy New Year! May all of us enjoy improved health in the year to come.