Kill Phase

After writing my last post I started reading and following the Gut Health Protocol by John Herron.  The author has a Facebook group and willingly gives guidance to the confused and sickly masses.  An all-around decent and altruistic guy.

So, a summary of my gut-struggles thus far.  Interestingly, a gut problem was the last thing I suspected over the years, since I don’t have much in the way of GI distress.  After finally connecting my awful mood swings to eating certain things (fiber and starch) I tested for SIBO (it was negative). Stool testing, however, indicated there is an overgrowth of a bacteria called Citrobacter Braakii.  What I know is that whenever I eat starch or fiber – with few exceptions – I become depressed, tired, unable to pay attention, irritable, and basically a giant pain in the ass to live with. I’ve learned that gram-negative bacteria  (Citrobacter Braakii is one) put out lipopolysaccharides (aka “LPS”, aka “endotoxin”) when they grow.  This bacteria seems to feed on fiber and starch, and the only way I’ve been able to avoid this debilitating depression is to completely avoid fiber and starch.  This leaves out many fruits, vegetables, and all starches – and it’s much worse when those starches are the low-glycemic variety, such as brown rice, lentils, and beans.

So why is this a problem?  Can’t I just avoid starches and call it a day?  Well, sure…and I have for the last 2-3 years.  However, in that time I’ve developed type-2 diabetes and gained about 20 pounds (now about 50 pounds overweight), and I have high levels of persistent hunger despite eating over 2000 calories a day.  When I eat simple carbohydrates (non-starches) my triglycerides shoot up to 500 and I gain weight rapidly.  I’m unable to lose weight, even following a LCHF diet with 98% dilligence for months at a time. I suppose I could get over the vanity aspect of being obese if my health was improving, but it’s not.  I’m taking 2 Big Pharma medications to control high blood pressure, and I’m going against doctor’s recommendations by not taking the others she has prescribed (statins and Metformin). My labs indicate that I have a high level of chronic inflammation, despite diet changes. None of this is getting better.

I’d like to be able to eat low-glycemic carbohydrates that will keep me full and satisfied between meals, so I can follow a lower-calorie diet.  I’m also tired of getting depressed and irritable – because despite being pretty damn vigilant, it’s really hard to avoid all starches and fiber all the time(Side note: I’ve actually had to put a “yelling jar” in my house to ameliorate the psychological damage I do to my kid by yelling at her.  Every time I yell I put a dollar in the jar that she and her dad can spend together.  She takes great joy in this.)  I’m also concerned about my prognosis.  Type-2 Diabetes, LPS toxicity, and my genetic profile (APOE4 gene) likely adds up to Alzheimer’s Disease in my future.  I’m fairly sure the inflammation that is being caused by the LPS put out by this pathogen is responsible for a lot of my health problems (check out that C-Reactive Protein…not good.)

My Great Garlic Experiment (thanks to Ray Medina) a couple years ago gave me temporary freedom from the beast – the depression – the pathogen.  I felt much better but stopped using garlic when I started getting bloated all the time.  (I now realize I probably let yeast overgrow by not using probiotics at the right time or in the right amount.)  A couple weeks ago I started using raw garlic again along with some other antimicrobials and antifungals recommended in the Gut Health Protocol.  I’m currently in the kill phase and feeling pretty great.

John Herron recommends fermented foods starting day 1, including during the kill phase.  I’ve been eating (and starting to crave) unpasturized sauerkraut and kefir, and have also been taking soil-based probiotics – several hours apart from antimicrobials – twice per day.  Lots of good coming in and lots of killing of the bad.  In my next post I’ll detail exactly what supplements I’m using. My goal is to fix my gut problem – that means killing off The Beast, improving the integrity of the intestinal wall, adding probiotics and fermented foods, and eating LCHF (for now).  I’m taking a lot of supplements right now, but it feels like the right thing to do.  The kill phase will be another couple of weeks or so….maybe longer.

Keto: 2 Month Review and a New Plan

My Keto 2 month anniversary came and went 5 or 6 days ago.  It was without fanfare.  I’m fairly confident I was sticking to a high fat, low carb diet that should have been ketogenic.  Unfortunately, my Ketonix meter indicated I was producing only “small traces of ketones” every day.   I tried lots of different food combinations and timing exercise differently, but wasn’t able to get up to “moderate” ketone production, according to the meter.  I tried to not eat till later in the day.  I tried to eat 90% fat.  I went days at a time eating only egg yolks, oil, and olives, with a little meat here and there just to hush my hunger.  No dice.  Only “small traces of ketones”.  This resulted in very slow weight loss, and in the last few weeks, increasingly poor sleep.

I started getting tired of oily egg yolks, olives, and avocados.  I could have lived with it if I was losing body fat, pounds, or feeling better….I guess I was feeling ok most days, but it was tiresome eating weird food – and not too much of it – and not seeing much progress.  I only lost a few pounds in 2 months.

So a few days ago I started eating some carbs at night, and sleep improved right away.  The very first carbohydrate meal I ate involved about 3/4 cup of rice noodles.  Unfortunately the next day – Depression.  It’s as if I hadn’t JUST spent the last 2 months eating absolutely nothing starchy.  First time I have it again, the depression is back.  Poisoned again by endotoxin (aka lipopolysaccharides, aka LPS).

So I got to thinking about this.

For years now, whenever I eat lots of fiber or starch my monster of a gut pathogen dumps all over the place, screwing up my ability to think, reason, and get through the evening without yelling at someone.  It makes me depressed, irritable, tired, hopeless, and mean.  A while ago – I don’t know when – maybe after my 2nd round of antimicrobials last year that made no difference – I came to accept that this intruder was always going to be with me and I just had to work around it.  Never eat starch, and if I did, follow it with lots of activated charcoal.  I said to myself, I’ll just never eat raw fiber – I’ll accept that vegetables must be well cooked.  Say good bye to salads, apples, and most other things that normal people eat when they try to eat a nutrient-dense diet.  (Side note: I have no idea why I’m able to eat avocados. They have lots of soluble fiber in them.  Must not be what my pet pathogen likes to eat.)  I’d already said good bye to dairy, sugar, starch, polyunsaturated fats, most processed food, nightshades.  Not much left, but I was willing to do it.

But not if I’m getting no results.

Anyway, I’ve decided to refocus.  Stop worrying about weight loss (I took the scale out of my house, in fact), stop worrying about what I can and can’t eat.   My singular focus right now is on eradicating this endotoxin-producing gram-negative madness from my gut.  I think my gut is keeping me inflamed, hence my inability to lose weight.  Sure, it’s possible insulin is still playing a role (and I haven’t tested it again since 1 month into keto when my level was 20), but really…I just can’t believe that with exercise and LCHF it’s not come down to an acceptable level by now.

I saw some progress in my attempts to slay The Beast with my Great Garlic Experiment in 2014.  I was able to eat starches for a while afterward, without depression.  I think that it’s susceptible to the antimicrobial properties of garlic.  I’ve decided to do the garlic thing again.  In the meantime I’m learning everything I can about LPS, how to kill it, how to neutralize the inflammation it creates. There’s really no good how-to manual on this.  Nourish Balance Thrive had me take probiotics with lots of fibers.  Maybe that works for most people, but for me that turned out to be a very bad idea.

I’m going to kill this bitch.  Pubmed is going to help me.

High Fat/Low Cal – An Experiment

I got discouraged by high hunger and inability to reduce protein or calories, which was resulting in very slow weight loss.  So a few days ago I tried something new.  I ate fat all day long. And guess what – I can’t say the hunger disappeared completely, but it dropped so low I was able to keep overall calorie intake very low:

3-2-16 diet.png

I know peanut butter is not an ideal food – I make it a little better by pouring off the peanut oil and mixing in melted coconut oil.   But the point is I’ve struggled for years with reducing calories because of hunger.  Hence, my fatness.  Once I reduce the insulin-generating foods significantly (protein and carbohydrates) I’m able to eat much less. I did this 2 days in a row and lost 4 pounds (down a total of 6 now).  Here was day 2:

3-4.png

The last 2 days I’ve increased calories to over 2000 and haven’t lost any more, but haven’t gained anything back either.  I’m considering alternating 2 days of very high fat/low calorie with 2 higher-calorie days for a while.  Today is another high fat/low cal day.  All the while I’ll be continuing LCHF.

Now that I’m pretty sure it’s protein that’s been keeping me hungry I’ll be adding vegetables back into my diet.  Hey here’s a fun keto tip…Did you know that sauteed radishes taste a lot like fried red potatoes?

2016-02-29 14.32.58.jpg

I make them with a lot of butter or bacon grease (ideally from grass-fed beef bacon, if I have it), salt and garlic.  Fry them until they’re soft and some of them are browning (about 10 minutes).  I would probably cook them a little longer than the ones in the picture.

A 16-oz bag of radishes is dirt cheap ($1-2), has 72.6 calories, 3.1g protein, 15.4g of carbohydrates (7.3 of which are fiber), and 0.5g fat, and has the following micronutrients:

radishes

Obviously the macro/calorie load shifts when you add a bunch of fat to the pan.  And that’s what makes them so delicious.   Best of all I can eat a whole bag of radishes cooked up like this without noticeable endotoxin problems (e.g., depression) and without any impact on my blood sugar.  I can’t say that for potatoes.

Hey one last thing on the topic of eating straight oil and calling it a meal.  I have been feeling great on the days I do this – focused, high energy, great mood.  I’m not sure if it’s the MCT oil itself or the reduced brain fog from having lower insulin.  I’ve been smiling for no good reason.  When you catch yourself doing that it’s a wonderful thing.

 

Keto – 2 weeks in

I started eating a LCHF diet 2 weeks ago.  I’m down only a couple pounds, which doesn’t surprise me really.  I’ve learned that for me it takes a little while for my insulin to drop enough to utilize body fat for fuel…at least, that’s what I suspect is going on.  Last time I kicked the carbs out of my life it took about 2 weeks to see anything measurable on the scale.  The scale is so passe anyway…all the cool kids are doing circumference measurements anyway.

Other than weight, I feel so much better now that I’m not eating stuff that feeds my endotoxin-prone gut.  Mood is better, energy is better, everything is better.  It’s easy to accidentally trigger that though – a raw salad or other gut-irritating foods and I’m right back there again, irritable and tired.   (Tried that yesterday so it’s fresh in my mind).   Generally things are going well.

I mentioned the metformin I started taking a few weeks ago is causing hormonal changes, as evidenced by the disappearance of my hot flashes a few days after starting it.  I guess that’s why it’s prescribed to treat PCOS.  I can’t tell what hormone changes exactly, but it’s making my breasts sore and bigger.  They didn’t need any help in that area, and I wish they would stop it.  I’m considering stopping the Metformin if this doesn’t go away.  I googled it and I’m not the only one with this symptom.  Apparently it’s not an increase in estrogen, or I would expect there to be a correlation with breast cancer in the literature…and there doesn’t seem to be.  The opposite, actually…Metformin may have an ant-cancer effect.  So maybe it increases progesterone or behaves like progesterone in the body?

Dunno.  Research for another day.

Metformin, Part 2

I have become discouraged, and I started taking Metformin, again.

I started exercising last week – some high intensity interval training (HIIT) or just walking as well as some basic resistance training (squats and planks, mostly).  My hunger increased.  I can’t leave for work now without packing half of the refrigerator in my bag, just to get through the day without becoming desperately hungry.  I calculated what I’m eating and when left to my intuition and one rule (Eat Real Food) I eat about 2700 calories a day, about 50% fat, 25% protein, 25% carbs.  It’s a lot of flippin food, but otherwise I feel like I’m starving.  I’m unable to keep my blood sugar stable while eating carbs unless I just eat a ton of them, and if I do that my triglycerides are 500.  I can’t tolerate too much fiber because of the endotoxin (serotonin?) problem, so a diet of low glycemic carbohydrates (beans, brown rice) is out.  And somehow in the middle of this I’ve managed to gain weight in the last week.   Bah.

I just have too much going on now.  I can’t manage it all anymore.  I can’t have marital difficulties, a socially demanding 6 year old, 1.5 jobs, and also be dealing with blood sugar swings all the time.  Plus, my former relaxation time – my lunch break – is now being used for exercise.

I give up.  Bring on the drugs.

Upswing

Ok, I’m feeling better again.  No more!  No more crazy anything!  I’m just going to accept that I’m fat and get about the business of feeling better.  Forever.  No more deviations from the plan. I’ve been eating a lot of garlic, trying to make the endotoxin die down.  I think I’ve managed to poke enough holes in my intestine now from various experiments (let alone my unhealthy pre-Peat life), and now I accept that I don’t EVER get to eat starches and I don’t EVER get to eat fibrous fruits and veggies.  For at least…oh, a year or so.  Then MAYBE once a week or once every 2 weeks I can have an apple or a serving of potatoes.  But now, NO.

I recovered my energy and my mood by eating non-fibrous whole fruit, juice, meat, and lots of dairy (all forms).  Not gonna fuck it up again.  NOT GONNA.  YOU HEAR ME ENDOTOXINS?  YOU SUCK.

On another note…

One of my favorite bloggers in the entire world, Ray Medina, has moved his website to here.  I was poking around his site and came across this excellent article called Ulcerative Colitis and Dietary PUFAs.  I don’t have UC so I would normally have skipped right by it, but for some reason I decided to read it.  He discusses a mouse experiment that really makes a great case for avoiding omega 3 fatty acids.  In fact, I’ve never really understand the Peatarian assertion that Omega 3s only APPEAR to be good for you by “suppressing the immune system.”  This article explains it really well.  In essence, if you eat a diet high in PUFA, adding some Omega 3s (or fish oil) will make your labs look better.  BUT YOU’RE ALSO MORE LIKELY TO DIE SOONER.  hahahaha.  Good stuff.

Go read it.  And then stop eating salmon.

The end.

Resistant Starch: Follow Up and Discussion

I think it’s time for a follow-up on the Resistant Starch (RS) experiment embarked upon by my husband and me.  We both started consuming Bob’s Red Mill Potato Starch on December 23rd, 2013.  We are both considered “pre-diabetic” (although I’m definitely closer to crossing that line than he is).  Many people in the Paleosphere (which is now beginning to look more like a “starchosphere”) who have tried RS have reported improvements in their fasting and post-prandial blood sugar, as well as improved digestion, lowered inflammation, and fun dreams.  We wanted all these things too.

I’ll start with my husband’s experience.

He had no problems taking it.  As far as side effects go, he experienced a little more gas and softer stools (though digestion/elimination wasn’t much of a problem to begin with, reportedly).  He got in the habit of taking the potato starch with meals.  Every meal he’d take a heaping tablespoon or so, for combined total of about 4T of RS a day.  He continued to do this for 4 weeks.  Here is a graph of his fasting blood sugar throughout this period of time:

DXL

If you drew a trend line through those data points you’d see a flat line.  No change.  Now, proponents of RS say you should give it 6 weeks.  So he quit a bit early.  Why would he quit?  I’ll get to that in a minute.

But first, let’s talk about my experience with RS.

On 12/23/13 I started small because I didn’t know what to expect – a teaspoon a day, then two, and then I got bold and tried a tablespoon.  BAD NEWS.  I had massive bloating and abdominal pain for 24 hours…and was in the bathroom a lot during that time.  Painful, burning, awful.  Ok, but I was committed to this experiment!  I went back to my previously well tolerated dose – 2 teaspoons a day (in 2 doses), and figured I’d work my way up more gradually.  Did that for a week or so, and then tried 2 teaspoons at one time – again, BAD NEWS.  So I started taking a fancy (read: expensive) probiotic along with 1 teaspoon of RS a day, hoping to cultivate some happy gut colonies that would “fix” whatever is wrong…because that’s what the potato starch people on the interwebs are recommending. Did that for a couple weeks. Then I stopped. Why did I stop?  Same reason my husband did. And again…I’ll get to that in a minute.

Now, here’s the cool thing about having a blog.  You have a written record of everything that’s going on…and even if things don’t make sense at the time, they often make sense in retrospect, and you can go back through your archives and try to put the pieces together.  On 12/26/13, 3 days after I started taking potato starch as a supplement, I wrote this post.  In it I wrote

I’ve shared myself honestly in this blog in the hopes of helping other people struggling to regain their health.  I doubt I’m helping anyone, because I have no answers.  I’m less healthy, heavier, more depressed, and less happy than I was 2 years ago when I started this blog.

That’s me – depressed.  I remember writing it and I felt terrible.  I had enough energy to mumble out a few lines on the blog, but I was a really dark cloud for a few days there.

I reviewed other posts I’d written around that time, and discovered that on 12/28/13 – 5 days after starting potato starch, I wrote this:

What I don’t understand is why the effects of estrogen have recently gotten so bad.  I’ve never had breast soreness within the first week of my cycle before, I’ve never had headaches associated with hormone changes before, and usually my depression is pre-menstrual, not mid- or post-menstrual.  Why is this happening now?

Hm….

I now realize it was the potato starch.  I didn’t put it together at the time – after all, why would potato starch cause me to feel like I was sideswiped by the estrogen train?

It wasn’t until I heard a podcast by Ray Peat, released a few days later on 1/1/14, that the pieces of the puzzle started coming together.  When asked about the nutritional value of eating potatoes he said the following:

Adding butter or cream slows the digestion so it isn’t such a powerful insulin stimulant, but it also reduces the chance of what’s called persorption of starch granules. […] A potato starch granule happens to be very big. Other starches are more the size of a red blood cell, but a potato starch granule is several times fatter than that. But even these huge granules bigger than cells can get squeezed right through the wall of the intestine, enter the lymphatics and the blood system, so within 30 minutes after you eat starch without fat, you see the starch grains circulating through your blood, and if they’re big they’ll plug up your arterioles. Studies in mice showed that a high raw starch diet accelerated their aging. You can demonstrate areas of every organ that were being killed by plugging up the arteries.

Hm…we’ll that didn’t sound good.  Didn’t explain my recent symptoms, but it did clue me in that Peat didn’t think raw potato starch was a good idea.  That spurred some more research. I came across this article at Ray Peat’s website.  In it he states something similar to the quote above:

Volkheimer found that mice fed raw starch aged at an abnormally fast rate, and when he dissected the starch-fed mice, he found a multitude of starch-grain-blocked arterioles in every organ, each of which caused the death of the cells that depended on the blood supplied by that arteriole. It isn’t hard to see how this would affect the functions of organs such as the brain and heart, even without considering the immunological and other implications of the presence of foreign particles randomly distributed through the tissue.

Reading on in the same article:

The premenstrual estrogen-dominance usually leads progressively to higher prolactin and lower thyroid function. Estrogen is closely associated with endotoxinemia, and with histamine and nitric oxide formation, and with the whole range of inflammatory and “autoimmune” diseases. Anything that irritates the bowel, leading to increased endotoxin absorption, contributes to the same cluster of metabolic consequences.

Aha! Anything that irritates the bowel (resistant starch), leads to endotoxin absorption (headaches, feeling like crap) and estrogen-dominance including higher prolactin (sore breasts) and lower thyroid function (depressed mood, lack of energy).  Well, that makes sense. Obviously, not everyone reacts to RS this way.  My husband didn’t.  Dozens (hundreds?) of people commenting over at Free the Animal aren’t having problems (although a few are).  But for me this stuff felt bad in doses over 1 teaspoon.  That’s not why I stopped taking it though.  My husband and I stopped taking it because of the persorption issue.  Peat seems to think this is a significant reason to avoid starches, unless they’re well-cooked and served up with fat – essentially making them more digestible and definitely not “resistant”.

I can’t say Peat is completely alone in his assertion that RS has the potential to be dangerous…but he’s almost alone.  A Google search indicates very few people talking about the issue of persorption; most of the ones doing so are bloggers who follow Peat like Rob Turner and Andrew Kim. Now, it’s no secret I love me some Ray Peat, and the folks who follow his recommendations I’ve found to be invariably very intelligent and science-oriented.  But I trust no one….so I do my own research.  I did a search of pubmed for “persorption” – there’s not too much there, and a search for “persorption + starch” yielded even less, but a few studies stood out as relevant, including:

1. Persorption of raw starch: a cause of senile dementia? by BJ Freedman.  The full article is not available, and the abstract suggests this is a review, rather than an experiment.  So it’s someone’s opinion about research that has been published.  It seems the conclusion is that exposure to raw starch could result in the loss of many neurons, and long term this could mean dementia.  Honestly, I don’t typically put a lot of stock in theory pieces like this.  I’m sure he raises good points, but I want empirical science.

Here’s another:

2. Oral cornstarch therapy: is persorption harmless? by Gitzelmann and Spycher.  Another review.  “The possibility of late adverse reactions to persorbed starch should not be disregarded.”

Pretty much all the rest of the articles involved studies by G. Volkheimer, the scientist Peat refers to when he discusses the importance of starches being well cooked.  Here, Peat cites this article by Volkheimer: [Persorption of microparticles] (Original article in German).  The abstract states:

Since persorbed microparticles can embolise small vessels, this touches on microangiological problems, especially in the region of the CNS. The long-term deposit of embolising microparticles which consist of potential allergens or contaminants, or which are carriers of contaminants, is of immunological and environmental-technical importance.

Another of Volkheimer’s articles is available full text for free, and details his experiments:  Passage of particles through the wall of the gastrointestinal tract.  He describes how they dyed the potato starch (and other substances with relatively large particle size) with Lugol’s solution so they could watch where the particles moved around the body.  Apparently they moved all over the place including cerebral spinal fluid, the milk of lactating women, and the placenta of pregnant women. Toward the very end of the article, it says,

Enzymatic degradation of starch granules in the body fluids was demonstrated.

Well that sounds good, right?  The starch granules are degraded by enzymes.  And the graphs do show that in the case of each of the substances tested the quantity of particles found in the blood diminished over a fairly short period of time.  So no worries then?

It goes on to say:

Deposition of embolized starch granules and other persorbed particles in the lumen of the smallest vessels was observed in animals after long-term oral administration.  in pigs, dogs, chickens, and rats fed with particles, we found individual particles as microemboli in the lumen of the smallest vessels a long time later.

I had to look up “embolized.”  It means blocking a blood vessel.  So apparently they found that these large persorbed particles blocked small blood vessels, and did so for a “long time.”  If I took the time to read all of Volkheimer’s work maybe I’d know what he means by a “long time.”

In any case, I don’t know what long-term use of RS would do to my itty bitty blood vessels, or to the organs they’re attached to and I don’t really want to find out.  That’s why I stopped the potato starch, and recommended to my hubby that he stop too.  And he did.

I asked Richard Nikoley for his take on all this.  He and Tim “Tatertot” Steele have  been spearheading the RS movement, and are in the process of writing a book together on the subject. They responded to my inquiry quickly, and after researching my questions for a bit suggested that current research indicates that persorption is very common, occurring with particles much smaller than potato starch, and may have some beneficial effects:

It is possible that these particles have beneficial health effects not only in the intestinal lumen but directly in the blood stream and on the endothelial surface of vessels.

Hm…Ok, that could be. But this article doesn’t refute Volkheimer’s research that says the large starch particles clog up little blood vessels.  In any case, Richard suggested I research this and write it up on my blog.  So here it is.

Ray Peat has been right about many things for me, and I’m just getting started with him.  I have no reason at this point not to trust him.  So, I’m choosing to trust him and his interpretation of Volkheimer’s research, and I’m avoiding the raw potato starch.  In spite of this, I truly hope the conclusions drawn as a result of this research are wrong, and that RS is actually as healing as the many current anecdotes suggest it is.  But just in case, here’s a thought: Maybe RS combined with probiotics is a way to get your gut in good working order, after which its use should be discontinued, in order to avoid potential problems associated with long-term use.  It may be wise to think of it as an intervention, rather than as a way of life.

Something to think about.