“How Do I Know When It’s Working?” A Quick Troubleshooting Guide to Paleo

April 15, 2013 in Categories: , by

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yoga1It’s a question that many people new to paleolithic nutrition ask either while they are going through that initial adjustment period (especially when jumping into paleo with both feet but also with gradual transitions) or as the months wear on and the difference is not as magical as anticipated.  How do I know when it’s working?  When will I start to lose tons of weight and have lots of energy?  When will my health conditions miraculously disappear?

Well, the answer is “it depends”.

How different did you eat before committing to paleolithic nutrition?  Generally, the more different you are eating now to before you discovered paleo, the harder and longer your adjustment period.  This is especially true if you ate a lot of carbohydrates before.  It can take up to a month for your body to switch over to a metabolism that runs better on fat and in the meantime, you may feel tired, lethargic, have headaches, and generally feel pretty terrible.  But, this isn’t true for everyone.  And of course, the opposite can also be true:  some people are made so sick by the foods they were eating before that they notice an instant improvement to their health.

What health issues are you challenged with?  In my personal experience, most gut health issues will improve dramatically the first couple of weeks on paleo and then continue to improve slowly over the next six months as your gut continues to heal (for more posts on gut health, see here and here).  Issues relating to inflammation typically take longer to show significant improvement depending on how well you are sleeping and managing your stress (typically another month or two).  Remember that for many health issues, you need to address all of the tenants of a paleolithic lifestyle (get good sleep, manage stress, get outside).

Are you in autoimmune denial?  I was.  While out-of-the-box paleo tackled most of my health issues, I still had unresolved autoimmune issues even after four months of strict paleolithic nutrition.  I had to do the autoimmune protocol (I’ve written about the autoimmune protocol extensively and this is also the topic of my book), in which you also exclude all the gray area foods.  If you have been eating a strict paleolithic diet for two months and are still dealing with health issues, you might have to do this too.  The good news is that after a few months of no eggs, no nuts, no seeds, no nightshades, no alcohol, no NSAIDs, low caffeine and no cheating, with a concurrent focus on eating extremely nutrient-dense foods (lots of vegetables, grass-fed meat, organ meat, fish and bone broth), most people can add at least some of those things back in.

Is your gut in REALLY bad shape?  It is possible that your gut was very leaky before you started paleo, so healing is just plain ol’ going to take a while.  Especially, if you suspect that you have Small Intestinal Bacterial Overgrowth or extensive gut damage, you’ll need to focus on Repairing The Gut, which can take 6 months to 2 years (although you should see continuous gradual improvement).  For all of the posts I’ve written on gut health, click here.

stomach acidHow is your digestion?  You might need to add some digestive support supplements for a little while to help your body heal.  These include digestive enzymes, ox bile, and stomach acid supplements (which are contraindicated for those with ulcers, blood clotting disorders, or taking NSAIDs).  Digestive enzymes and ox bile, while they can be expensive, are generally very safe to take as directed on the bottle (just make sure you actually eat once you take digestive enzymes because taking them and then not eating can cause damage to your gut).  If you are interested in a stomach acid supplement, check out my post on stomach acid here and this post by Steve Wright.

Do you have unknown food sensitivities?  If you’ve had a leaky gut for some time, you may have food sensitivities that you are unaware of.  Many alternative health care practitioners will order an IgG and/or IgA antibody screen which tests for food sensitivities.  The good news is that if you leave those foods out of your diet for a while, you can usually add them back in after your gut has fully healed.  If you have symptoms of Irritable Bowel Syndrome (like diarrhea, constipation, gas, bloating, acid reflux), another possibility is a FODMAP sensitivity.  Other potential culprits include salicylate sensitivity and food allergies (such as latex allergies, citrus, fish and shellfish, tree nuts, eggs, and dairy).

Do you need liver detox support? If you had/have an overgrowth of bacteria or yeast in your gut that are now dying off in great numbers, your liver might be working in overdrive.  B-vitamins (rich in red meat and organ meat), sulfur (rich in cruciferous vegetables and vegetables from the allium family), selenium (rich in seafood and organ meat) molybdenum (rich in organ meat) are important to support the liver.  Milk thistle (extract or tea) may also be helpful.  Choosing foods rich in these substances (or supplements) to help support liver detox is also useful for anyone losing weight, especially if the weight is coming off quickly.  This is because the body uses the fat tissues to store some toxins and excess hormones like estrogen (which gets them safely out of the body’s circulation) and rapid weigh loss has the potential to release these putting an additional strain on the liver.

Are you sleeping enough?  Yes, this has nothing to do with diet.  But sleep has a profound effect on every system in your body and if you are not getting enough of it, you can’t heal properly.  Aim for 8-10 hours per night in a pitch black room (see this post if you’re having trouble getting good sleep).  You can read more about the importance of sleep on the immune system in this teaser excerpt from The Paleo Approach.

Are you stressed? If you are not taking adequate measures to manage your stress (like getting activity but avoiding excessively strenuous exercise, spending time outside, having fun, getting enough sleep and developing strategies to manage psychological stressors), then your stress hormones might be out of whack.  If you have been under high stress for a long time and have trouble sleeping, you may have adrenal fatigue.  Both www.RobbWolf.com and www.BalancedBites.com have lots of great suggestions for healing from adrenal fatigue.

Did you go too low carb? What types of carbs (fruit versus starchy vegetables versus both versus neither) and how many carbs we should eat (varying from ketogenic diets and 20g per day to plenty of “safe starches” and upwards of 300g per day) is probably the most hotly debated topic within the paleo community.  One of the reasons for there being no clear answer as to what is best is that the carb intake of historically-studied and modern hunter-gatherer populations varies wildly.  On one end of the extreme are the Eskimos, who consume a diet composed approximately of 50% fat, 35% protein and 15% carbohydrate.  On the other end of the extreme are the Kitavans, who consume a diet composed approximately of 20% fat, 10% protein and 70% carbohydrate.  And of course, everything in between.  This probably reflects the fact that macronutrient ratios are not as important as food quality and nutrient density.  So, if your introduction to the concept of paleo was through a resource that expounded on the benefits of low carb, it is important to understand that this view is not representative of the entire paleo community and no consensus exists.  It’s also important to understand, that while blood sugar regulation is extremely important, going too low carb can be tough on your thyroid and can decrease leptin sensitivity (see this post and this post).  Also, eating adequate carbohydrates and especially insoluble fiber is important for proper regulation of ghrelin levels (see this post).  So, what is a good carbohydrate intake?  That’s actually highly individual (you can read this series of posts about optimizing your carb intake here, here and here), but if you are not feeling very good on a standard paleo diet, adding a little fruit or starchy vegetables is a good idea to try.

Are you inappropriately IFing? There are many enthusiastic supporters of Intermittent Fasting, but it’s important to understand that this is only appropriate for very healthy people.  If your sleep is not great, if your stress in not managed, if you are substantially overweight or if you have any kind of chronic disease, skipping breakfast (or breakfast and lunch) can cause dysregulated cortisol and undermine your other efforts.  This is not something to experiment with early on in your paleo journey.

What are your goals and how far away from them are you?  If you have a lot of weight to lose, you will probably notice a big drop in weight fairly quickly.  This will be mostly water weight, but don’t worry, fat is also being burned and you should eventually settle down into some nice steady weight loss (slow and steady wins the race, so there is no reason to be frustrated with weight loss if you are “only” losing a half pound per week-that’s actually very healthy!).  When your body seems resistant to weight loss, try addressing sleep quality and stress levels, but also be aware of the impact of female hormones and hunger hormones (levels and sensitivity).  For more tips and tricks for losing weight, see this post.

gray foodsAre you truly complying with paleolithic nutrition?  There are few things worse than being “almost paleo” (depending on your health challenges and what “almost” actually means for you).  While many people can successfully navigate the murky waters of cheats and occasional gluten consumption, if you are asking the question “when will I feel fabulous” while not actually following a paleo diet as strictly as you can, then you might be a person who just can’t cheat or tolerate occasional gluten exposure.  And from a metabolism, hormone and taste-bud adaptation standpoint, allowing yourself the occasional slice of pizza or pie a la mode can really derail your efforts to get healthy and perpetuate cravings, food addictions, and feelings of deprivation.  I advise eating very strict paleo for at least a month before you play with eating small amounts of dairy or legumes or allowing yourself cheat meals (and I recommend a lifelong avoidance of gluten for most people).  If strict paleo isn’t enough to make you feel great, look at the gray area foods in your diet (eggs, nuts, seeds, nightshades, alcohol, caffeine).  Maybe one of them is the culprit (nightshades are my number one suspect).  But if you are truly sticking to it, my guess is you are already feeling much, much better!


Thank you for this! I’ve been following a Paleo diet since October, 2012, and a Paleo AI diet since December. In the 7 months since I started, I’ve lost 30% of my body weight! However, within the last 2 months, I’ve been cheating a bit with sugar, especially since it was my birthday and Easter. Now, I’m recommitted to strict Paleo AI with no cheats. Hopefully that will help me finish healing. Oh, and I have to work on sleep.

Thanks for all you do. Can’t wait until the book comes out!

This is so timely. It seems everything I am doing, nothing is working. So frustrating and scary too! Thank you for your sharing 🙂

My 5 month Paleo AI was yesterday. Of course I’ve experienced dramatic transformation, but at the same time, my symptoms have changed over those months and sometimes I think tracking them to tweak the diet is nigh on impossible. I feel this way even after reading your impressive and important post today. I am becoming more resolved that deducing my body’s reaction to food will take years.

Thank you for this article. I have been following a paleo/AI diet for 7 months now and am finally beginning to feel like a normal human again more days than not. I was very sick when I started and expected to be back to healthy in a month, so it was distressing that I’m still dealing with some difficulties but I have since realized thanks to people like you that I need a lot of healing and had to accept that it takes as long as it takes. Thank you for all the information you put out there, it’s helped me enormously.

I get so confused about what to eat and what not to eat these days that it causes stress, especially when it comes to what to and not to feed the kids (let alone myself!). We’re all gluten, dairy, and egg free (and free of a few other things individually). I’ve read/considered GAPS, but thinking in terms of 2 years for healing just seems daunting. I’ve seen some progress with some aspects (no more canker sores from gluten! Huzzah!), but other problems just linger a bit (bloating only in the evening), carb cravings. I’ve gone back and forth between paleo and gluten free (adding back in buckwheat, steel cut oats and sometimes (not successfully) rice). As a nursing mom, I find that I have a hard time keeping my glucose levels up enough to be functional if I only eat meat, vegetables and fruits. My oldest daughter is caught in a downward spiral (it seems) towards white gluten free food (sigh). She is getting in a phase where she is feeling left out, rather than empowered and food is becoming a fight. Thanks for this post. Perseverance…hopefully we’ll get there.

Nursing mom here, too. 🙂 When my youngest was **really** little, I ate starchy carbs with every meal; basically replaced the pasta/bread/rice in a meal with an equal amount of potato, yam, carrot, beet, parsnip, or winter squash. I’d snack on mashed potatoes, root vegetable purees, and vegetable fritters. One of the keys, for me as a nursing mom, was to ignore the people who say “breakfast should be so satisfying, you don’t feel hungry until afternoon!” and make sure I still had a morning and afternoon snack.

About six weeks ago I was put on a massively restricted diet by my dr for my ongoing gut issues. After a couple frustrating weeks (not to mention some tears) I made a ‘safe food’ list. Because the list of ‘can’t have’ is so long, I found it easier to make a list of ‘safe’ foods, foods that I could actually eat. I divided it up by food groups (i.e. meat, carbs/starch, fruits/veggies, etc.) and hung it on my fridge (I carry a copy in my purse as well). I was sure to save a copy in my computer so I could update it as needed. It’s been a big help.

Here’s an idea for a future post: I find that I can still enjoy a social life (at people’s houses and at restaurants with friends) with a Paleo diet. But with AIP, especially with the intention of never cheating, that social life is so complex, I find it has an isolating effect. Sometimes I would rather stay home than make a fuss. Fuss includes grilling the waiter and settling for salad, no dressing. Or stressing a host by limiting ingredients. Or worse giving the host a list and then the salad has nightshades. Or chili powder or even ground fennel in the dressing. Staying away from seed-spices and chili spices is excruciating for a cook. Could you address the psychological aspects of a diet so strict as AIP? Not tips for being a guest, but the bunker mentality of it. I have an autoimmune disease (lupus) which I already strive to keep from separating me from people and social activities. But AIP is hard. Thanks for all your encouragement!

I find on AIP that you offer to bring your own dish to share. It is too much to expect a host to understand or comply no matter how well intentioned they are. As for restaurants, they are a bit of a minefield though a good steak is usually on the menu. good luck!

Great reading.
I am on paleo food now for more then a month, But do not feel much better, in fact i have less energy but my spirit has improved. I am wondering now if i have a leaky gut. My problem: i have diarea ones a week ( for at least 5 years, but never realy bothered me) in between days are quite normal apart from the fact that my stools are floating, indicating high fat and or gas. My question: Can these symptoms indicate a leaky gut syndrome? ( I have not excluded the possible culprits in my diet yet, I love egss and nuts and the nightshades, )
Thank for all the info. I found your website via a Dutch paloe site that is running an article from you.
greetings from Holland.

Yes, that could indicate leaky gut, or just indicate sluggish digestion. Before you omit anything new from your diet, I would suggest adding an ox bile supplement and digestive enzymes and see how you do.

Hi! I have Hashimoto’s and long story short, ended up starting a Candida Elim in April. I felt initially fantastic, lost weight very quickly in the first 3 weeks etc. The weight loss stalled after that but I stuck with it. Then 11 weeks in, after an agreed indulgence with my medical herbalist for my birthday, I ended up on a 9 day binge. After getting straight back on the wagon I never returned to feeling well. I assumed it was to do with the binge and carried on with the elim and added in carb cycling with IF once a week (a program that is designed to get Leptin firing again). I got NOWHERE with it. Eventually, I came across your articles around too low carb causing stress and cortisol spikes (I have a pad of fat on my tummy that looks like it’s been inserted through my side). That linked me to the article on IF not being a good idea either :-/ So, I’m now coming to the end of week 4 of having majorly fallen off the wagon after having a hissy fit about it all. Feeling guilty for essentially poisoning my body but unable to break the cycle of eating rubbish. I know I can do it because I did it for 4.5 months. My main confusion now is around what carbs I can eat. I love the idea of Paleo but I get full up on protein and struggle to eat the carbs. I tend to stick to salads and onions as an accompaniment to my protein. This is obviously where I’m going wrong but I’m told not to eat fruit or starchy carbs such as sweet potatoes due to Candida overgrowth. I’m thinking of just focusing on eating for health and not so much for the Candida initially. I need some ideas for carbs as I’m now petrified of them and what to eat. TIA I really hope you see this as I don’t know who else to ask this question . You’re unique in that you also have AI issues and know what it’s like.

So, the whole candida diet thing is not supported by the medical literature. And going too low card can be very hard on the thyroid since insulin is required for T4 to T3 conversion. The two diet factors that have the greatest corrective influence on gut microorganisms is omega-3 fatty acid intake and fiber intake (especially insoluble, but also soluble). I would recommend reducing your protein servings to make more room for a variety of vegetables.

Thanks for the wealth of info and for sharing your life, Sarah! I’ve been AIP for 11 months and had wonderful improvements with environmental allergies. I was wondering if you could provide more info about candida, both in overgrowth and natural scenarios? Ever since a trip to Brazil about 14 months ago I have recurring and/or I’m on-the-verge of yeast infections. I have eaten homemade sauerkraut and fermented vegetables and coconut milk yogurt daily while on AIP and kept the carb and fruit intake reasonable. One doctor suggested more probiotics, another prescribed a double dose of fluconazole, which is in coarse. I have PrescriptAssist on the way. There is so much conflicting info out about candida, it is difficult to determine whether I should tweak anything else in the diet or just stay the coarse and allow time to do its work. But I see you mentioned the Candida Diet is not supported by science. Also, how do you tell the difference between it being an overgrowth or rather a symptom of insulin resistance? Thanks!

Is the Nutricology Ox Bile that you recommend from an organic grass-fed source, similar to the bovine gelatin that you recommend for healing the gut?

this was timely for me. i’ve been following a primal diet for almost a year now, but no weight loss. kinda frustrating, but then i have also been healing from low thyroid function, and still nursing a toddler, so i’m thinking my hormones haven’t balanced out yet to result in weight loss.

Another tremendously helpful post for an AIP newbie! I’ve been advised to go on AIP with FODMAP restrictions due to interstitial cystitis and chronic yeast. However, this has now eliminated cauliflower, broccoli and mushrooms which were a core of my prior diet. Do you have good recommendations for replacing these veggies and their starch and nutrients? They provide bulk for me and I’m having trouble keeping from getting ravenous between these very limited meals.


I understand the no cheating on gluten. EVER. But what about the once off dairy? I didn’t have any trouble when I reintroduced it after 6 months of AIP but subsequently dropped it again. Just wondering about those odd occasions..

I am 3-4weeks into the AIP, I went cold turkey, though at the beginning I did discover a few things that had hidden grains. Since then, my joint pain has gotten worse. What I’m realizing is I’m either introducing new foods or greatly increasing my intake of others I’ve had before. My intake of avocado, coconut and red meat are greatly increased, and I am trying new vegetables all the time to gain nutrition. I wonder if one of these foods is increasing my joint pain?

I have RA & asthma and digestive problems(&lactose intolerance). I have been on a Paleo diet for 5 weeks now. In the beginning I was eating some grains(rice & buckwheat) for a while but then found the Autoimmune Paleo and stopped eating them. I made my first bone broth a week ago and also started to eat organ meat at the same time. I have been drinking bone broth everyday and eaten quite a lot of liver. During this week my joint pain has gotten worse(I only had it in 2 finger joints and one ball of my foot and sometimes my knee). Now I’ve gotten flares in many places I’ve never had before! I was hoping it was only because of a “die off” reaction but I’m a bit worried it might be because of something I’m still eating. I’m not going to stop the AIP diet but I don’t know what I should do..

Some people have trouble with broth, or it’s possible to eat too much (or to add too much into your diet too quickly) or are eating too much liver (most people recommend no more than three servings a week due to the high amount of iron and vitamin A). If the problem continues, it’s something that should be discussed with your healthcare provider. – Christina, Sarah’s assistant

While I understand the role of avoiding NSAID’s in adopting a paleo and AI diet, what can safely and successfully be used in place of NSAID’s for pain?

Hi Sarah, I bought your book and have been following the AIP diet for over two months now – as far as I know, I only have alopecia areata, and mild excema, so I am very concerned/confused as to how to re-introducing something (or have something non AIP/PALEO as a one off) and determine if it will cause more of my hair to fall out. Would it possibly just have some impact on my gut and likely never result in additional hair loss? It would be very difficult to track since I’m sure the hair would not fall out very shortly after eating something that doesn’t work for me…any guidance you could provide would be so very much appreciated. Thank you so much!!

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