Problems with chronic IBS, constipation, etc

I’ve had chronic IBS and associated problems most of my life.  My solution to this is to take 1 tbsp of soluble fiber daily; works great.  If you’re into supplements, you can also add 1 tbsp of Natural Calm, which is a magnesium supplement (Mg is a natural laxative). The psyllium-based fibers are too rough for me.  Look for a soluble fiber that doesn’t have sugar or sweeteners and that isn’t wheat-derived.  Apple pectin or glucomannan are other options.  Increasing fluid intake slightly is also helpful.

[[MORE]]I had a fair amount of gut-related discomfort when making the initial switch to Paleo.  Among its many other effects, I’ve read that it encourages a completely different type of gut flora.  The good news is that 80% of the achiness associated with my IBS is now gone, for the first time ever.

Long-term low-carb tips

Something that happens to many people on a low-carb diet is that their insulin resistance increases slowly over time.  In an initial low-glucose environment, the large muscles begin to burn fat (ketosis).  As they do so, they need less glucose, and therefore become resistant to insulin.  The result is that fasting blood glucose levels increase, along with HbA1c.

[[MORE]]In addition to further lowering your carb intake, which should help, isometric training is another good approach to addressing this (isometrics is better at increasing insulin sensitivity than aerobics).  It also helps a lot to exercise only after you’ve been fasting for 12 to 15 hours (exercise after fasting improves insulin sensitivity more than when you’re not fasting).  The idea is to work on two fronts: decreasing carb intake to further lower blood glucose (BG) and insulin, and working on the muscles to increase insulin sensitivity.

If you’re into supplements, you can also add some insulin-sensitizing ones, such as resveratrol, melatonin (also helps with sleep), vanadyl sulfate, lipoic acid, and N-acetyl-carnitine.  Those last two also help reduce the glycation that creates HbA1c, as do benfotiamine (B1), B6 and carnosine.

You might also be interested to know that the shakiness you might feel when your BG gets low is usually due to the release of adrenaline, which is part of the mechanism your body uses to raise BG in the absence of food.  It’s one cause of insomnia in some people.  Improving insulin sensitivity and cutting back on protein (which releases insulin) will help there too.

Another tidbit: there’s good documentation out there that a glucose tolerance test isn’t very meaningful when you’ve been on an extended low-carb diet.  The usual suggestion is to have carb-rich meals for at least two days before the test (at least 150 gr carbs each day), to help re-establish insulin sensitivity.  A few scientists I know also recommend having one day a week of high-carbs, partly for the same reason – the idea is to come out of ketosis, but only for 24 hrs per week or so.  I don’t do that myself, although I think it might make sense for some people.

What about legumes?

Legumes contain anti-nutrients such as phytoestrogens and phytic acid (both are particularly high in soy).  Phytoestrogens encourage the growth of certain cancers, and are pseudo-hormones that can wreak havoc on the body.  Phytic acid can block the uptake of essential minerals, including calcium, magnesium, copper, iron and especially zinc.

Unlike animal products, legumes are actually not safe to eat unless they've been either fermented or sprouted or soaked and cooked, but even then, the toxins aren't completely gone.  In fact, the phytic acid in soy is actually resistant to long, slow cooking.

More scientific support for Paleo

Those looking for additional technical / scientific support for a Paleo-style diet might enjoy the following books:

Life Without Bread: How a Low-Carbohydrate Diet Can Save Your Life
By Christian Allan PhD and Wolfgang Lutz MD

Dangerous Grains: Why Gluten Cereal Grains may be Hazardous to Your Health
By James Braly MD and Ron Hoggan MA

[[MORE]]Both are rich with technical citations (as is Taubes, of course).

Then there’s the Hyperlipid blog: http://high-fat-nutrition.blogspot.com/, also written by a scientist.

One post that I found particularly enlightening:
http://high-fat-nutrition.blogspot.com/2009/03/cholesterol-within-nations-studies.html

It includes the graphs below (derived from published papers), which say that your relative risk of heart disease is much more strongly correlated to your HbA1c level than to total cholesterol.  How do you minimize HbA1c (glycated hemoglobin, which is caused by high levels of blood sugar)?  With a low-carb / paleo diet.

What is a "Paleo" diet, anyway?

My interpretation of the "Paleo" diet is that it’s not about eating the exact same things that the Paleolithic people ate, or somehow returning to the primitive.  Rather, it’s about duplicating the human metabolic environment of the period.

Quite a bit is known about the diet and lifestyle of the period.  For example, have a look at Catching Fire: How Cooking Made Us Human, by Wrangham, or  Meat-Eating and Human Evolution, by Stanford and Bunn.

[[MORE]]While dairy wasn’t consumed in the Paleo period, it is certainly compatible with Paleolithic metabolism in the sense that it’s an animal product, high in fat and protein.  Two of the best tools you have to replace carbs are butter and milk fat.  They may not be “orthodox” Paleo, but they are definitely acceptable in terms of metabolic affects, provided you aren’t allergic.  Many dairy allergies seem to be provoked by gluten; once gluten is removed from the diet, those sensitivities often go away; sensitivities are also minimized by using dairy products with a high fat (and therefore low protein) content.

Here’s Dr Kurt Harris’ step-by-step approach to the paleo diet, which I think is fabulous (and is what I’m following).  See his blog at http://www.paleonu.com/.  He thinks that by the time you get to step #9 you have 80% of the benefits, and by adding proper exercise at step #10, you have 99%; eliminating dairy provides only a very small benefit after that.

1. Eliminate sugar (including fruit juices and sports drinks) and all flour
2. Start eating proper fats - animal fats and monounsaturated fats like olive oil - substituting fat calories for carb calories. Drink whole milk or half and half instead of skim.
3. Eliminate grains
4. Eliminate grain and seed derived oils (cooking oils) Cook with butter, coconut oil, olive oil or animal fats.
5. Get daily midday sun or take 4-6000 iu vit D daily
6. Intermittent fasting and infrequent meals (2 meals a day is best)
7. Fruit is just a snickers bar from a tree. Stick with berries and avoid watermelon which is pure fructose. Eat in moderation.
8. Eliminate legumes
9. Adjust your 6s and 3s. Grass fed beef or bison avoids excess O-6 fatty acids and are better than supplementing with 0-3 supplements.
10. Proper exercise - emphasizing cross-fit or interval training over long aerobic sessions
11. Eliminate milk (if you are sensitive to it, move this up the list)
12. Eliminate other dairy including cheese (now you are "orthodox paleolithic")

One natural consequence of this approach is that it tends to be relatively low carb. If you start with a SAD-like diet and eliminate sugar, grains, fruit and legumes, the resulting diet will have fewer carbs than when you started.

Effect of grain on livestock

It’s interesting to think about why farmers feed grain (including corn) to livestock: they do it to make them fat.  Grain-fed livestock don’t just “mature early”; they’re obese.  Unfortunately, feeding them grain also weakens their immune systems and makes them prone to infection, which is why they require antibiotics.  Grass-fed livestock don’t have those problems.  In fact, grass-fed cattle can be amazingly lean animals.

[[MORE]]What’s surprising to me is that more people don’t make the connection between the obvious effect on livestock, and the same effect on people: grain makes us fat, and weakens our immune systems, too.

Oh, and FWIW, I would avoid livestock that are finished with grain, as well as those who are raised on it.  Just a few weeks on a grain-based diet can completely distort / reverse the omega-6 to omega-3 ratio in favor of omega-6 – which encourages inflammation, pain, etc.

Paleo questions from a newbie

1. Do we know the quantities of types of foods that Paleo people ate?  If not, would this knowledge change the diet recommendations?

One thing we know is that a typical hunter-gatherer tended to eat a few leftovers in the morning, hunt/gather all day, then have a big meal at the end of the day.  They were metabolically well-equipped to handle food scarcity / fasting.

[[MORE]]An important aspect of the diet recommendations is that they are based on the metabolic conditions that we evolved under.  Since those conditions are only loosely associated with quantity, I think even if we knew more details about exactly how much the Paleo people ate, that it wouldn't significantly affect the recommendations.

2. Humans obviously ate grains (they got the idea to cultivate them after all), but was the quantity just greatly reduced to the post- agriculture quantity? Or perhaps they started eating them just recently before agriculture was developed?

Monocot grass seeds and gluten cereal grains were at best inconsistent and trivial sources of food prior to the advent of agriculture.  Also, the fact that a food was available or sometimes used tells us nothing about its long-term impact on health, or whether it's better to eat that food vs. something else.

Unfortunately, cereal grains (and legumes, including peanuts) contain anti-nutrients with clinically significant health effects -- and we are poorly adapted to consuming them.

4. Honey, agave nectar, coconut sugar, stevia, maple syrup....good, bad, same as cane sugar? I don't understand the differences well. From what I've read, people seem to think that while they may be less processed and have a lower GI than cane sugar, they all still have the same addictive properties.

From a health perspective, there are three primary factors to consider with sweeteners: total carb content, and the fraction that's fructose, and whether it's artificial.  It turns out that GI or GL are poor indicators.  What's more important for long-term health is total insulin produced, rather than the size of the post-meal spike -- and the total is directly correlated to carb content.

Fructose is evil, and I would avoid it as much as you can.  It's responsible for conditions like gout; it goes directly to the liver, where it's converted to triglycerides; it drives insulin resistance in the liver.  Fructose may be the single biggest cause of a broken metabolism (although gluten is right up there too).

For artificial sweeteners, history says they don't have a good record when it comes to health effects.  Also, even though they're artificial, they can still cause insulin to be released.  Even brushing your teeth with an artificially sweetened toothpaste can cause an insulin spike.

The sweetener I prefer is glucose, also known as dextrose -- although I only use it in very small amounts.