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Sometimes a Little Change Can Make a BIG Difference

February 19, 2013 in 2013, Sarah's Personal AI Struggles

(created as a guest post for The 21-Day Sugar Detox Blog)

21DSD_CoverDid I just call the 21-Day Sugar Detox a “little change”?  I guess I did.  I realize that it’s not a little change for most people tackling 3 weeks of no-sugar eating.  But going into this, I was already following the paleo autoimmune protocol, eating very few starchy vegetables and almost no paleo treats.  I didn’t feel like my eating was out of control and I didn’t feel like sugar cravings were controlling me.  That being said, I was completely in the habit of grabbing a piece of fruit (or two) any time I felt like a little something sweet.  I didn’t limit fruit consumption or the types of fruit I ate.  So, maybe I was in a little denial about having a sugar problem—because 5 or 6 pieces of fruit per day adds up to quite a bit of sugar!  I had known for a while that I was going to have to test what effect this large amount of fruit per day was having on my body and, in particular, my autoimmune disease.  The 21 Day Sugar Detox was the perfect experiment.

If you had talked to me during the first week, I would have privately told you that nothing had changed.  My skin was doing some funny things, but it wasn’t better.  My energy level was about the same.  My sleep was about the same.  I wasn’t having headaches or carb flu type symptoms, so it didn’t feel like change was around the corner.  I was feeling some resentment that I couldn’t just eat those delicious berries or grapes that my kids were eating.  And it felt like I was depriving myself for nothing.

And then week two came.  I lost a couple of pounds.  Bloating that I didn’t even realize was there went away.  My skin completely cleared.  I started to notice differences in the skin lesions from my autoimmune disease.  My sleep seemed deeper.  I had more energy during the day.  My brain seemed to be working faster.  I seemed more productive.  And it just kept going into week three.  I lost a few more pounds.  My clothes started fitting way better (probably more because I wasn’t bloated anymore rather than weight changes, but I’ll still take it!).  My skin lesions looked better than they had in months.  I felt like everything was coming together.  I was seeing dramatic improvement in my health.  I felt great.

And then it hit me.  What all this amazingness actually meant.  I did have a problem with sugar.  Sure, I was choosing vitamin-rich whole food sources of sugar, but I was in a cycle of craving, feeding the craving, then craving more.  I am healthier when I eat less fruit and more vegetables.  Dang.  That first week I kept telling myself was that the upside was I wouldn’t have to change anything when I was done with this whole detox thing.  Now, I know that I need to be more moderate with my fruit intake.

So, what now?  I have relaxed some, but really most days look pretty much like how I ate on the 21-Day Sugar Detox.  I’m working on some autoimmune protocol-friendly dessert and treat recipes for my book and notice that on days when I have that extra dessert, I don’t feel very well (for the rest of that day and the next plus then I crave more sugar).  I’m looking forward to having these recipes done so there won’t be so many tempting sweet foods in my house, because I really do think these need to be much more occasional treats than how I was eating before.  I’m already planning on doing another 21-Day Sugar Detox when the recipes for the book are done.

So, what are great recipes that are both AIP-friendly and 21-Day Sugar Detox-friendly?  Actually, most AIP-friendly recipes are automatically 21-Day Sugar Detox-friendly and a quick browse through the AIP Recipe Section of my blog will provide you with lots of great options.  And of course, there will be over 100 new recipes in my book.  During my detox, I greatly enjoyed eating Egg-Free, Tomato-Free (Hidden Liver) Paleo Meatloaf (made with the suggested AIP-modifications in the recipe and made without the molasses).  I also enjoyed Lemon-Dill Poached Salmon and Greek-Inspired Slow-Roasted Leg of Lamb.

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The Hormones of Fat: Leptin and Insulin

October 23, 2012 in Hormone Regulation, Weight Loss/Gain

Hormones tell your body whether to burn fat and lose weight or to store fat and gain weight or to find balance and weight maintenance in between.  When it comes to your body “deciding” what state to be in, there are two key hormones that regulate food intake and energy balance:  the adipocyte hormone leptin and the pancreatic hormone insulin.  While there are many other hormone players with complex interactions between them, understanding these two hormones (which you could think of as the hormones of fat) will give you important insight into how the diet and lifestyle choices you make can help you achieve and maintain a healthy weight.

The hormone insulin, which is released by the pancreas in response to increased blood sugar, facilitates the transport of glucose into the cells of your body and signals to the liver to convert glucose into glycogen for storage.  When glycogen stores are maxed out, increased insulin levels stimulate conversion of glucose into triglycerides (fat) for long-term storage in adipocytes (fat cells) 1.  But beyond this important action for the metabolism of fuels, insulin has an additional role as an adiposity signal to the brain, i.e., it tells the brain whether or not you should eat and informs the brain about the energy status of your body.

The major stimulant of insulin secretion is an increase of blood glucose levels, as detected by the pancreas (blood glucose levels go up when you eat carbohydrates).  Circulating insulin enters the brain (proportionally to the amount that is circulating in the blood) where it binds to receptors in the hypothalamus region of the brain.  Although the exact details are unknown, it is understood that through this interaction with the central nervous system, insulin stimulates a decrease in food intake 2,3.  This makes some sense.  You eat, your blood sugar level rises, your body releases insulin to store all that glucose, and that increase in insulin tells your brain that you’ve got enough energy, thank you very much.  Importantly, the degree of glucose-stimulated insulin secretion by the pancreas is a direct function of body fat 4,5.  The more body fat, the more insulin is secreted both at a basal level and in response to feeding.  There is also a maximum amount of insulin that can actually cross the blood-brain barrier to stimulate satiety.  As the blood concentration of insulin increases beyond this level, no further signaling to the brain can occur.  Insulin resistance occurs when more insulin is required to maintain a normal level of blood glucose, and potentially when there is a decrease in insulin receptors in the brain, meaning that those high levels of circulating insulin don’t decrease appetite the way they are supposed to.

Fat storage cells, called adipocytes, produce the hormone leptin, which acts as a negative feedback control for adiposity (fatness).  Leptin is secreted by adipocytes (fat cells) in direct proportion to the amount of stored body fat, in particular, the amount of subcutaneous fat.  Similar to insulin, circulating leptin enters the brain where it binds to receptors (there are receptors for leptin in the hypothalamus but also several other areas of the brain).  Again, the exact details are unknown, but it is understood that leptin’s interaction with the brain stimulates a reduction in food intake and increasing energy expenditure 6.  This also makes some sense.  You have a good amount of fat stores, leptin is released and tells your brain that you have enough energy so you don’t need to eat anymore and hey, let’s get moving!  And analogous to insulin resistance, the body can also become leptin resistant, although this can happen from both obesity and overconsumption of energy 7 and by fasting or consuming too few calories and losing weight 8!  Uh, yeah.  Leptin is tricky.

It was initially believed that leptin’s dominant role was to tell the brain to stop eating.  However, recent studies have shown that it mediates the adaptation to fasting 8.  Fasting or consuming too few calories on a regular basis can lower sensitivity to leptin, which leads to increased hunger, cravings and lack of energy.  This has a very important implication in weight maintenance after weight loss since reduced leptin sensitivity is likely responsible for lowered metabolism and increased hunger, a combination that tends to lead to weight gain (why it’s so hard to keep weight off after going on a diet).  There is also a link between leptin and cortisol release, potentially explaining the cortisol spike that many people experience in response to intermittent fasting.  The many roles of leptin in the human body are still being studied.  It has also been implicated in the regulation of the reproductive, thyroid, growth hormone, and adrenal axes, independent of its role in energy balance.

To date, only the hormones leptin and insulin are known to act as adiposity signals 9.  The amount of leptin and insulin in the blood correlates with adiposity.  There are receptors in the brain for both insulin and leptin in areas of the brain known to be important in the control of food intake and energy balance.  Studies which have injected insulin or leptin show that this causes a reduction in food intake, whereas injection of antibodies to block insulin and leptin causes an increase in food intake.  Importantly, recent studies have demonstrated that insulin and leptin have additive effects when administered simultaneously 10.

What are the implications of this information for those who want to lose weight?  I think there are two major take home points here:

  1. Controlling insulin by avoiding high blood sugar is important for regulating hunger.
  2. Slow and steady wins the race in terms of weight loss and leptin sensitivity. 

I will be continuing to discuss many different hormones and the roles they play in health and weight loss over the next few months.  Leptin and insulin will feature prominently in these posts.

1. Click here for more information on insulin and its role in metabolism.

2. Begg DP and Woods SC. “The central insulin system and energy balance.” Handb Exp Pharmacol. 2012;(209):111-29.

3. Woods SC et al “Signals that regulate food intake and energy homeostasis”. Science. 1998 May 29;280(5368):1378-83.

4. Polonsky K S et al “Twenty-four-hour profiles and pulsatile patterns of insulin secretion in normal and obese subjects.” J Clin Invest. 1988 February; 81(2): 442–448.

5. Polonsky KS et al “Quantitative study of insulin secretion and clearance in normal and obese subjects.” J Clin Invest. 1988 Feb;81(2):435-41.

6. Ahima RS et al. “Leptin regulation of neuroendocrine systems.” Front Neuroendocrinol. 2000 Jul;21(3):263-307.

7. Enriori PJ et al “Leptin Resistance and Obesity” Obesity (2006) 14, 254S–258S; doi: 10.1038/oby.2006.319

8. Ahima RS.  “Revisiting leptin’s role in obesity and weight loss.” J Clin Invest. 2008 Jul;118(7):2380-3.

9. Benoit, SC. “Insulin and Leptin as Adiposity Signals” Recent Progress in Hormone Research 59:267-285 (2004) (link to the paper here)

10. Air EL et al “Insulin and leptin combine additively to reduce food intake and body weight in rats.” Endocrinology. 2002 Jun;143(6):2449-52. (link to the paper here)

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The Great Dairy Debate

October 13, 2012 in FAQ, Foods in Moderation, The WHYs of the AIP

The value (or lack thereof) of dairy products is the second most fiercely debated topic within the paleo community (after carbohydrate intake).  Opinions vary dramatically from consumption of no dairy whatsoever, to only consuming dairy fat (such as ghee, butter and heavy cream), to only consuming raw grass-fed dairy, to only consuming fermented dairy or aged cheeses, to including any dairy on a regular basis.

The reason for this diversity of opinions is that the science is not clear cut.  There are strong arguments to be made both for and against.

Let’s start with the arguments against dairy.  Prof. Loren Cordain dedicates an entire well-cited chapter in his most recent book The Paleo Answer (a fantastic book for describing the nitty gritty scientific details behind the paleo diet) to the many reasons why milk should not be consumed in any form.  To summarize, what I view the strongest parts of this argument:

  • Milk is not as nutrient-dense as meat, fruits and vegetables.
  • Milk is highly insulinogenic, meaning it causes a large spike in blood insulin levels, disproportional to the amount of sugar and protein in milk.  This may contribute to the development on insulin resistance, at least in the context of a high carbohydrate diet.  Insulin is also pro-inflammatory.
  • Milk contains active bovine (cow) hormones which have the potential to alter our hormone levels.  The effects of dietary intake of most of these hormones have not been studied.  However, other hormones have been studied.  For example, the milk hormone Insulin-like Growth Factor-1 (IGF-1) has been linked to risk of breast, colorectal and prostate cancer, with the strong indication that consumption of dairy protein is a large contributor to blood IGF-1 levels 1.
  • Milk contains protease inhibitors which may contribute to the development of a leaky gut (see this post for a more in depth explanation as to why)
  • Milk increases mucus production.  This may aggravate conditions such as asthma but also creates excess mucus in the gastrointestinal tract which may irritate the gut lining and inhibit nutrient and mineral absorption.
  • Lactose is poorly tolerated by adults.  Approximately 25% of Caucasians (American and European) are lactose intolerant.  97% of Native Americans are lactose intolerant.  This argument does not apply to drinking raw milk since raw milk contains enzymes to help digest lactose.
  • Dairy is highly allergenic.  This is where I believe the chief argument against dairy lies and I will discuss this further below.

There are also some very compelling arguments for including dairy products in our diets.  Studies have shown that consumption of dairy, especially full-fat dairy products and fermented dairy products, can protect against Metabolic Syndrome (cheese, full-fat dairy, and fermented dairy), Type II Diabetes (fermented dairy only) and Cardiovasular Disease (cheese, full-fat dairy, and fermented dairy) 2-6.

Grass-fed dairy, especially the fat from grass-fed dairy, is an excellent source of fat-soluble vitamins and Conjugated Linoleic Acid, an anti-inflammatory and healing fat.  Fermented dairy is an excellent source of probiotics.  There are also some valuable proteins in dairy, such as glutathione (very important for reducing inflammation and protecting against oxidative stress) and whey (which may help prevent cancer).

There is also evidence that dairy proteins are beneficial for children due to their growth-promoting effects.  Traditionally, children would have received some breast milk until approximately 5 years of age.  In our current society, most children are weaned by age 1.  The current scientific view is that, provided cow’s milk is not introduced too early, it is a good substitute for human milk in terms of its growth promotion 7.

Yes, the science is not clear, although there seems to be a good case for including dairy fat in our diets.  This is why the standard paleo diet allows for ghee and butter, and in many cases heavy cream and full-fat sour cream.  Many people also include fermented dairy in their diets with great success.

However, one thing that is abundantly clear is that milk allergy is common.  Beyond lactose-intolerance, which can be treated with the aid of digestive enzymes or consumption of raw milk, allergy to milk proteins is very common.  Epidemiological reports of cow’s milk allergy (IgE antibody reactions to cow’s milk proteins) range between 1 and 17.5% in preschoolers, 1 and 13.5% in children ages 5 to 16 years, and 1 to 4% in adults 8.  It is not known how prevalent cow’s milk sensitivities are (IgA and IgG antibody reactions to cow’s milk proteins).  It’s important to note that goat’s milk is not as allergenic as cow’s milk.

Cow’s milk proteins are also known gluten cross-reactors, which means that those with gluten intolerance may produce antibodies against gluten that also recognize dairy proteins.  For these people, eating dairy is the same as eating gluten (more information in this post).  Very importantly, for people with allergy, intolerance or gluten cross-reactions to dairy proteins, even the trace dairy proteins in ghee can be a problem.

So, what do I recommend?  Caution.  I believe that dairy is probably okay for many healthy adults, especially full-fat, grass-fed dairy.  In fact, for healthy individuals, the benefits likely outweigh the risks.  However, for those battling autoimmune disease or other conditions where a leaky gut is a potential contributing factor, it makes the most sense to omit dairy from your diet for now.  As is my standard recommendation for all of the gray-area foods, I suggest leaving it out of your diet for at least 1 month, then try reintroducing it and see if you notice any obvious symptoms (this is the best way to determine if you are allergic or sensitive).

I am still trying to gauge my own tolerance for grass-fed butter.  My daughters both seem to do better without cow’s dairy in their diets (except grass-fed butter, which seems okay), but I have reintroduced grass-fed goat mineral whey protein powder into their diets and they seem to do really well with that (especially my oldest).  I also have intentions to try them with some grass-fed goat’s whole milk.  This is another highly individual aspect of a paleo diet and you really don’t know whether or not milk is good for you until you try living without and then try living with.

1. Crowe FL et al “The association between diet and serum concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 in the European Prospective Investigation into Cancer and Nutrition.” Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1333-40.

2. Louie JC et al “Higher regular fat dairy consumption is associated with lower incidence of metabolic syndrome but not type 2 diabetes.” Nutr Metab Cardiovasc Dis. 2012 Sep 26. pii: S0939-4753(12)00193-7. doi: 10.1016/j.numecd.2012.08.004. [Epub ahead of print]

3. Warensjö E, et al. “Biomarkers of milk fat and the risk of myocardial infarction in men and women: a prospective, matched case-control study.” Am J Clin Nutr. 2010 Jul;92(1):194-202. Epub 2010 May 19.

4. Sonestedt E et al. “Dairy products and its association with incidence of cardiovascular disease: the Malmö diet and cancer cohort.” Eur J Epidemiol. 2011 Aug;26(8):609-18. doi: 10.1007/s10654-011-9589-y. Epub 2011 Jun 10.

5. Sluijs I et al “The amount and type of dairy product intake and incident type 2 diabetes: results from the EPIC-InterAct Study.” Am J Clin Nutr. 2012 Aug;96(2):382-90. Epub 2012 Jul 3.

6. Bonthuis M et al. “Dairy consumption and patterns of mortality of Australian adults” European Journal of Clinical Nutrition (2010) 64, 569–577; doi:10.1038/ejcn.2010.45; published online 7 April 2010

7. Agostoni C and Turck D. “Is cow’s milk harmful to a child’s health?” J Pediatr Gastroenterol Nutr. 2011 Dec;53(6):594-600.

8. http://www.worldallergy.org/publications/WAO_DRACMA_guidelines.pdf

Chris Kresser has a terrific post Dairy: food of the Gods or neolithic agent of disease?

The Paleo Answer by Prof. Loren Cordain is an excellent resource.

 

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