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

April 15, 2013 in FAQ, FAQ, How To Get Started

It’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.

How 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.

Are 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!

Tags: acid, activity, adrenal fatigue, allergies, autoimmune, bacterial, betaine, Breakfast, carb, carbohydrate, carbs, chronic, cortisol, detox, digestion, disease, eggs, enzymes, Exercise, faq, Fat, FODMAP, FODMAPs, Fructose, ghrelin, HCl, help, hormone, How To, hunger, illness, insulin, intermittent fasting, ketogenic, ketosis, leptin, liver, lose, Loss, metabolism, nightshades, nuts, overgrowth, ox bile, paleo, plateau, problem, protocol, seeds, sensitivities, set-point, SIBO, Sleep, stomach acid, Stress, supplements, support, tomatoes, toxin, troubleshoot, troubleshooting, Weight, yeast
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The Hormones of Hunger

January 29, 2013 in Hormone Regulation

I want to delve into the effects of diet and lifestyle on hunger and satiety signals in a series of upcoming posts. I am mostly interested in the hormone dysregulation that occurs during metabolic syndrome, but also in how to optimize diet, exercise, sleep and stress management to achieve an ideal weight.

The feeling of hunger is regulated by a complex system of hormones that interact with neurotransmitters and neurotransmitter receptors within the hypothalamus region of the brain. These hormones essentially activate or deactivate specific neurons in the hypothalamus that control hunger. These neurons have receptors to Neuropeptide Y (NPY), the essential neurotransmitter in regulating hunger. The hormones can increase or decrease hunger either through binding the receptors for NPY or increasing or decreasing NPY itself. Essentially a hormone will increase hunger if its expression activates these NPY neurons whereas you will feel satiated if a hormone’s expression deactivates the NPY neurons. The interplay between these hormones and your brain is complex and only partially understood. However, what scientists do know about these hormones can help inform our decisions and compulsions regarding diet and other lifestyle factors.

New hormones continue to be discovered and their roles in regulating appetite, satiety, metabolism and digestion continue to be studied. As the full list of hunger hormones grows, understanding the complex interplay between these hormones, the types of food you eat, and the amount of muscle and fat on your body quickly becomes overwhelming. I have tried to summarize the key players (at least as scientists currently understand them):

Hormones that tell your body you’re satiated:

Cholecystokinin (CCK) is secreted by the cells that line the duodenum (the first segment of the small intestine) when they detect the presence of fat. This causes the release of digestive enzymes from the pancreas and bile from the gallbladder. Increased levels of CCK signals to the stomach to slow down the speed of digestion so the small intestine can effectively digest the fats. CKK is also a neuropeptide similar to NPY and has a direct action on neurons in the brain to signal satiety. This is the most immediate hunger suppressing signal and is the reason why eating fat with your meals is so important.

Oxyntomodulin is released in response to protein and carbohydrates in the stomach and signals a change in energy status to the brain. Oxyntomodulin enhances digestion by delaying gastric emptying and decreasing gastric acid secretion.

Peptide YY (PYY) is released by cells that line the jejunum, ileum (the next two segments of the small intestine) and colon in response to feeding and is especially sensitive to protein. PYY signals to the gallbladder and pancreas to stop producing digestive enzymes. PYY is important in increasing the efficiency of digestion and nutrient absorption after meal by slowing down gastric emptying, slowing down the speed of digestion, and increasing water and electrolyte absorption in the colon. PYY interacts directly with NPY receptors in the hypothalamus in an inhibitory fashion, thereby turning off hunger signals.

Glucagon-Like Peptide-1 (GLP-1) is secreted in the ileum in response to carbohydrate, protein and fat. It rapidly enters the circulation and is one of the fastest and shortest-lived satiety signals. It inhibits acid secretion and gastric emptying in the stomach. GLP-1 also increases insulin secretion and decreases glucagon secretion. GLP-1 decreases hunger signals by reducing the amount of NPY.

Leptin plays a key role in regulating energy intake and energy expenditure, including appetite and metabolism. Leptin is released both by adipocytes (fat cells) and by the cells that line the stomach, so it signals both that the body is fed and that there is sufficient energy storage. This appetite inhibition is long-term, in contrast to the rapid inhibition of eating by CCK and the slower suppression of hunger between meals mediated by PYY. Leptin both rapidly inhibits NPY production and deactivates NPY neurons in the brain to signal that the body has had enough to eat, producing a feeling of satiety. It is one of the most important adipose derived hormones (read more in this post).

Adiponectin is secreted from adipose tissue into the bloodstream where it signals decreased gluconeogenesis (when the body converts fats and proteins into glucose for energy), increased glucose uptake, lipid catabolism (breaking down of fats), triglyceride clearance (storage of fats), increased insulin sensitivity, and control of energy metabolism. Adiponectin acts directly on NPY neurons similarly to leptin but with additive effects.

Hormones that tell your body you’re hungry:

Ghrelin is considered the main hunger hormone. It is secreted by the cells that line the stomach when the stomach is empty and also by the pancreas when it detects low blood sugar. Also, the liver secretes ghrelin when its glycogen storage runs low (and glucagon is high). When ghrelin is released into the circulation, it directly activates NPY neurons to stimulate appetite. Increased levels of ghrelin are directly associated with the sensation of hunger. It is considered the counterpart of the hormone leptin. Importantly, ghrelin is a potent stimulator of growth hormone (GH) secretion and regulates nutrient storage, thereby linking nutrient partitioning with growth and repair processes. Ghrelin activates several anti-inflammatory pathways in the body and promotes cell regeneration thereby promoting healing, especially within the gastrointestinal tract. Ghrelin regulates glucose homeostasis through a direct action on the pancreatic islet cells (the cells that secrete insulin). It is also important for memory function and gastrointestinal motility.

Cortisol is well-known as a stress hormone, but it has key roles in regulating metabolism and hunger. Cortisol levels determine whether the body uses glycogen stores or triglyceride stores for energy (stored carbohydrate or stored fat). Cortisol can also stimulate gluconeogenesis, the process of converting amino acids (proteins) and lipids (fats) into glucose in the liver. It is believed that cortisol directly influences food consumption by acting on NPY neurons in the brain as well as affecting the levels of NPY and leptin. Cortisol seems to have a particular effect on the desire to eat foods high in fat and sugar. This is why stress management (which really means controlling any factor that might mess with your natural cortisol levels) is so important.

Glucagon is a hormone secreted by the pancreas when it detects low blood glucose levels (typically between meals, but this can also happen as part of that “sugar crash” after eating something very high carbohydrate). Glucagon signals the liver to convert stored glycogen into glucose, which is released into the bloodstream, a process known as glycogenolysis. When glycogen stores are low, high glucagon levels drive gluconeogenesis, the process of creating glucose from amino acids and fatty acids. Increased glucagon amplifies the hunger sensation.

Insulin is secreted by the pancreas in reaction to high blood glucose levels (for more on insulin, see this post). Insulin causes cells in the liver, muscle, and fat tissue to take up glucose (and fatty acids in the case of adipocytes) from the blood, storing it as glycogen. While insulin is released as a result of eating carbohydrates, it paradoxically increases hunger as opposed to decreasing it. This is caused by direct action on the NPY neurons and is the reason why eating a carbohydrate-rich meal is not as satiating as eating a meal that includes fats and proteins. It also explains how quickly we feel hungry again after a high-sugar snack.

These hormones have important roles both in regulating aspects of digestion and signaling to the brain whether or not you need to eat. Many of these hormones are also critical in regulating your blood sugar both after a meal and between meals (fed and fasted states). Some of these hormones also affect other systems in the body, for example, interacting with the immune system and controlling inflammation. Understanding how your diet and lifestyle affect these hormones will help you make choices that regulate these hormones properly, allowing yourself to listen to your hunger cues and trust that your body knows what it’s doing. And regulating hunger hormones is a key part of healing and being healthy.

Tags: adiponectin, amino acid, appetite, carbohydrate, cholecystokinin, CKK, colon, cortisol, digestion, duedenum, eat, Fat, full, ghrelin, GLP-1, glucagon, glucgon-like, gut, hormone, hunger, hungry, ileum, insulin, intestine, jejunum, leptin, lipid, meal, metabolism, oxyntomodulin, paleo, Paleolithic, peptide, peptide-1, Protein, PYY, satiety, stomach, Sugar, why, YY
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The Link Between Gallbladder Disease and Gluten Sensitivity

December 1, 2012 in Beyond Paleo, Gut Health

(Created as a guest post for Paleo Parents.)

Celiac disease is estimated to affect approximately 1 in every 100 people, but only 5% of these people receive a positive diagnosis ¹. This is, in part, because celiac disease often doesn’t present with what are thought of as the classic symptoms (abdominal pain, bloating, intermittent diarrhea, weight loss). In fact, more often, celiac disease presents as a collection of symptoms that many physicians don’t associate with the disease (irritability or depression, anemia, stomach upset, joint pain, muscle cramps, skin rash, mouth sores, dental and bone disorders such as osteoporosis, neuropathy, and/or micronutrient deficiency) ². However, the recognition and understanding of celiac disease is improving and more and more people with the disease are receiving positive diagnoses.

The same is not so true of gluten sensitivity, which includes immune reactions that are currently tested for (IgE, IgG or IgA antibody formation against gluten), immune reactions that are not currently tested for (IgM antibody formation, T-cell activation and/or immune complex formation), and non-immune reactions (increased zonulin production and/or gut dysbiosis resulting from deficiency of appropriate digestive enzymes). Gluten intolerance (where antibodies are formed against gluten) is thought to affect upwards of 20-40% of the general population ^3-4. There are no estimates of the percentage of people who are sensitive to gluten in other ways. Genetic tests (HLA-DQ, DR, etc.) exist but it is still unknown if current genetic tests accurately identify all individuals who are gluten sensitive ⁴.

A wider and wider range of health issues are being linked to gluten sensitivity and/or celiac disease. This is a positive development in medical research because it is starting to bring more focus on how detrimental these grain proteins are in the human diet. One such health issue is gallbladder disease, although the link between gallbladder disease and gluten sensitivity/celiac disease has not permeated through the public knowledge. Because so many people are unaware that their gallbladder problems might be linked to gluten in their diets, it seemed like a good idea to write a post about this topic!

Let’s take a step backward and first talk about what exactly a gallbladder is. The gallbladder is a little pear-shaped sac, nestled toward the front and a little underneath of the liver. It has a very simple job:

store bile (which is produced by the liver) between meals
concentrate bile by reabsorbing water
release bile into the small intestine when there’s food that needs to be digested

Bile is composed of water, bile salts, bile pigments (products of red blood cell breakdown that are normally excreted in the bile), cholesterol, and various electrolytes. Bile salts are the only components of bile that actually have a digestive function. Bile salts are not the same as digestive enzymes (which are produced by the cells that line the stomach and by the pancreas). Instead, bile salts aid the actions of digestive enzymes and enhance the absorption of fatty acids and fat-soluble vitamins.

The most important action of bile salts is that of an emulsifier. In essence, bile salts break up fat globules in the small intestine into tiny droplets that are able to mix with water. The enzymes that break fat up into fatty acids (lipases) can then perform their function more effectively. Bile salts also aid in the absorption of fatty acids and cholesterol (some of the cholesterol released into the small intestine in the bile is reabsorbed). Fat-soluble vitamins (such as A, D, E, K1 and K2) are also absorbed.

If the gallbladder is not functioning properly, fats cannot be properly digested (fats are essential for survival and health) and fat-soluble vitamins cannot be effectively absorbed, leading to micronutrient deficiencies. Gallbladder health is critical for digestive health and overall health.

As is so often the case with research linking gluten sensitivity to other health complications, the research is strongest in the context of celiac disease. Approximately 60% of celiac disease sufferers are known to have liver, gallbladder, and/or pancreatic conditions ⁵. While some of these conditions may be a result of the malnutrition and/or directly linked to the gut damage that occurs in celiac disease, others are thought to share common genetic factors or have a common immunopathogenesis (i.e., the condition originates from the same immune system attacks on the small intestine also attacking these organs) ⁵. Specifically, primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune forms of hepatitis or cholangitis are thought to have a common immune system/inflammation origin as celiac disease itself—and that means gluten.

What does this mean? In celiac disease (and in non-celiac gluten sensitivity, albeit to a lesser extent or perhaps just in a slightly different way), gluten triggers an autoimmune response. The body’s own immune system attacks the cells that line the small intestine, resulting in the characteristic shortening or pruning of the intestinal villi (microscopic, finger-like projections of small intestine wall tissue made of columns of gut epithelial cells). As you can imagine, this creates a very leaky gut, which also stimulates the immune system, causes inflammation, and allows toxins and foreign proteins into the body. In the majority of celiac disease patients, the immune system does not limit its attack to the cells that line the small intestine. This is why second and even third autoimmune conditions are so common in celiac disease.

When you eat, the cells that line the duodenum (the first segment of the small intestine) detect the presence of fat and protein and react by releasing a hormone called cholecystokinin. This hormone stimulates both the release of digestive enzymes from the pancreas and bile from the gallbladder. It also signals to the stomach to slow down the speed of digestion so the small intestine can effectively digest the fats. When the gut is damaged (whether from celiac disease or other gut pathology), the cells that line the small intestine (called enterocytes or gut epithelial cells) are less able to secrete cholecystokinin. This means there is not enough signal to the gallbladder that it’s time to release bile salts into the duodenum. Reduced cholecystokinin release is reported in celiac disease and may be one of the key causes of the gallbladder malfunction that occurs concomitantly with celiac ^6-8.

Importantly for this discussion, the dominant gallbladder symptoms that might be caused by gluten sensitivity is cholecystitis (inflammation of the gallbladder) or malfunctioning gallbladder, and not gall stones (reported in 20% of elderly celiac patients, but only 2.5% of the more general celiac population). The frequency of liver and gallbladder conditions suffered by celiac disease patients has allowed researchers to make the converse argument. It is now recommended that those with unexplained liver and/or gallbladder symptoms be evaluated for celiac disease ^9-11. If you have been diagnosed with gallbladder disease (especially if it is not gall stones, but don’t rule out this possibility if it is), it is important to investigate gluten sensitivity or celiac disease as the possible cause. No one has yet studied how frequently someone with gallstones actually has undiagnosed celiac disease (or gluten sensitivity) and there is a feeling within the celiac community that this may actually be quite frequent.

What if you test negative for celiac disease and gluten intolerance? Unless you had the DNA test done for gluten sensitivity, these tests actually are embarrassingly inaccurate in the sense that the false negative rate is very high (false negative means that you do have celiac but the test showed that you don’t). There are a variety of ways that false negatives can occur and no one likes to put a number on just how likely they are. But, if you remember from the beginning of this post, these tests generally only test for antibody formation (and a biopsy only looks at one very small piece of your small intestine). The best way to be sure that gluten is not the problem is to eliminate it completely from your diet for several months (those with celiac disease can take up to 5 years to heal from the damage caused by gluten ¹²). It is not enough to eliminate gluten however, as antibodies that your body may have formed against gluten may also recognize proteins in other foods. This means that even if you aren’t eating any gluten, your body still thinks that it is (see this post for a complete explanation and list of foods to avoid).

The take home message? There is a strong link between gallbladder health and celiac disease. In fact, a failing gallbladder may be your first symptom of celiac disease. Of course, I believe that a grain-free, legume-free, dairy-free, refined sugar-free, modern vegetable oil-free diet is optimal for our health in every way; however, if you are suffering from gallbladder problems, then I recommend addressing your diet as soon as possible. The earlier you adopt an anti-inflammatory diet that prioritizes gut health, the more likely you are to save your gallbladder.

1 Lohi S et al. “Increasing prevalence of coeliac disease over time.” Aliment Pharmacol Ther. 2007 Nov 1;26(9):1217-25.

2 http://www.mayoclinic.com/health/celiac-disease/DS00319/DSECTION=symptoms

3 http://www.gastroendonews.com/ViewArticle.aspx?d=In%2Bthe%2BNews&d_id=187&i=October%2B2010&i_id=672&a_id=16015

4 http://www.glutenfreesociety.org/gluten-free-society-blog/the-many-heads-of-gluten-sensitivity/

5 Freeman HJ.” Hepatobiliary and pancreatic disorders in celiac disease.” World J Gastroenterol. 2006 Mar 14;12(10):1503-8. http://www.wjgnet.com/1007-9327/full/v12/i10/1503.htm

6 Masclee AA et al. “Gallbladder sensitivity to cholecystokinin in coeliac disease. Correlation of gallbladder contraction with plasma cholecystokinin-like immunoreactivity during infusion of cerulein.” Scand J Gastroenterol. 1991 Dec;26(12):1279-84. http://www.ncbi.nlm.nih.gov/pubmed/1763298

7 Fraquelli M et al “Gallbladder emptying and somatostatin and cholecystokinin plasma levels in celiac disease.” Am J Gastroenterol. 1999 Jul;94(7):1866-70.

8 Nousia-Arvanitakis S et al. “Subclinical exocrine pancreatic dysfunction resulting from decreased cholecystokinin secretion in the presence of intestinal villous atrophy.” J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):307-12. http://www.ncbi.nlm.nih.gov/pubmed/16954951

9 Biecker E et al “Autoimmune hepatitis, cryoglobulinaemia and untreated coeliac disease: a case report.” Eur J Gastroenterol Hepatol. 2003 Apr;15(4):423-7. http://www.ncbi.nlm.nih.gov/pubmed/12655265

10 Parfenov AI et al “Asymptomatic celiac disease in patient with chronic acalculous cholecystitis” Eksp Klin Gastroenterol. 2011;(3):122-4.

11 Galán Bertrand L et al. “Acute lithiasic cholecystitis as an exceptional presentation of celiac disease” An Pediatr (Barc). 2006 Jul;65(1):87-8. Spanish

12 Rubio-Tapia A “Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet.” Am J Gastroenterol. 2010 Jun;105(6):1412-20.

Tags: allergy, bladder, celiac, cholangitis, chole, digestion, disease, gall, gallbladder, gallstones, Gluten, inflammation, intolerance, link, reason, removal, removed, sensitivity
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TPV Episode 16 Show Notes: The Gallbladder Show

November 30, 2012 in Show Notes

Our sixteenth show!
Ep. 16: The Gallbladder Show

In this episode, it’s all about the gallbladder! Stacy doesn’t have one and shares her experiences and how it was certainly linked to gluten intolerance. We invite over the nutritionist who convinced her to use supplements to make up for her gall functions, Diana Rodgers of Radiance Nutrition!

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The Paleo View (TPV), Episode 16: The Gallbladder Show

0:00 – Introduction
1:18 – News and Views
- Poor Sarah had her Thanksgiving with Influenza A
- To find out more about our paleo/vegan Thanksgivings, see this year’s post and last year’s
- Stacy occasionally posts about our “friendly competition” on our Facebook page
- We do make our own candies and treats for friends for the holidays.
- Stacy’s post on Balanced Bites
- Sarah’s post on Paleo Parents
- Stacy’s How to Enjoy Bacon Without a Gallbladder
15:22 – Science with Sarah: What is a Gallbladder and Does React Poorly to Gluten?
- Wikipedia on Gallbladder
- There is definitely a published and accepted link between celiac and gallbladder disease
  - A good overview from Celiac.org
  - Gallbladder disease presents even in otherwise asymptomatic celiacs
- The most common test for celiac is blood analysis for gliadin (a gluten associated protein) antibodies. On a gluten-free diet, no antibodies would be produced.
- An article that mentions the link between malabsorption and insatiable carbohydrate cravings
23:00 – Questions and answers
- Our guest is Diana Rodgers, who really helped Stacy when she was debating supplementing. Her Nutrition practice can be found at Radiance Nutrition, and her blog is a Sustainable Dish. She was also the host of the Sustainable Feast during AHS.
- 25:22 – Does you body need a gallbladder?
  - Organs you can live without: Gallbladder, Spleen, Appendix, Tonsils, and pretty much all of your reproductive organs. Everything else, you need to keep at least part of them!
  - What’s it like to live without a gallbladder? See here.
  - Even this site recommends not immediately jumping to removal
- 29:30 – What changes after removing your gallbladder and how can you deal with it?
  - Practical Paleo! Definitely check out the poop parade as illustrated by Alex Boake!
  - Beta Plus by Biotics
- 33:49 – What foods do you recommend for fats after having your gallbladder out?
  - Definitely make your own animal fats!
  - Coconut Oil
- 38:44 – Do you recommend any supplements for living without a gallbladder?
  - I think you mean B-12, Stacy? The most active ingredient in Red Bull!
  - Why ox bile? Because it is chemically similar to human bile, surprising. Taurine, an extract from ox bile is also an active ingredient in Red Bull!
  - And to keep the trifecta, Glucuronolactone is found most prevalently in bone broths and is a third active ingredient in Red Bull! So I guess I should chug the stuff, right?
  - The Stomach Acid Connection
  - Diane’s post on Stomach Acid
- 49:13 – Is it true the you need to go low fat or vegetarian because of gallbladder issues?
  - The link Stacy is talking about.
  - Eating Academy posts on cholesterol
  - The Weston A. Price Foundation (presided over by Sally Fallon, who we visited)
  - Eat Fat, Lose Fat
  - Fathead
- 57:51 – What should you do if you’re having issues after surgery?
  - Paleo View Episode 13 includes a Science Segment on cross reactivity
  - Gluten Cross Reactivity by Sarah
- 1:02:00 – Can you dissolve gallstones?
  - Have at all these articles on LiveStrong on dissolving gallstones. I assure you that neither EPO nor anabolics are in here.
- 1:12:23 – Happy email
1:17:30 – Outro