Glucose | The Paleo Mom

AIP FAQ: “I am confused about fruit on the paleo autoimmune protocol. Could you explain?”

February 4, 2013 in FAQ

I am going to be addressing many Frequently Asked Questions about the Autoimmune Protocol in some posts over the next few months. If you have a question that you think should be answered, you may e-mail me at thepaleomommy@gmail.com.

I get asked about fruit on the AIP very frequently. I am intentionally vague with my recommendations for and against fruit in the Autoimmune Protocol because tolerance and need are highly variable. The short answer is, it’s individual.

I will, of course, be going into extreme detail to answer this question in my book. However, I feel like this question also needs to be answered here.

There are a couple of factors that are going to determine whether or not fruit is okay or beneficial for you to include in your diet, which fruits and how much fruit.

Many autoimmune diseases are very sensitive to blood sugar changes. This is more likely to be true if you’ve had a history of obesity or metabolic derangement. In that case, limiting to one serving of fruit with each meal seems to work well. Lower sugar fruits like berries tend to be better for blood sugar regulation. Berries are also high in several vitamins and antioxidants, which can be very beneficial for resolving inflammation. Other good low-sugar fruits include grapefruit (one of my personal favorites) and other citrus, melons (except watermelon), kiwis, apricots, and tart green apples.

For others with better blood sugar regulation, fruit can be an important source of carbohydrates in the absence of starchy vegetables. Because of the high frequency of gut dysbiosis in autoimmune disease, most people with autoimmune diseases need to be very careful about starchy vegetables, at least at first. But, going too low carbohydrate can also be problematic (increases leptin resistance which stimulates inflammation). So, increasing fruit intake can be very helpful for anyone who is underweight to normal weight (and not needing to lose weight) but who also doesn’t tolerate starchy vegetables. In this case, higher sugar fruits and larger portions are typically well tolerated. High glucose content fruits will be the most helpful for those who want to gain weight. These include bananas, grapes, apricots, figs, plums, cherries, and pineapple. Citrus, berries and melon (except watermelon) also tend to have more glucose than fructose.

Fructose contributes more to inflammation than glucose. So, keeping portions of very high fructose content fruits on the small and infrequent side is a good idea even for those who don’t have FODMAP sensitivities (they aren’t explicitly banned, but do be aware of how you feel after you eat them). These include mango, red apples, papaya, and watermelon. Dried fruits tend to concentrate the sugars so extra caution is required in terms of portion size.

As a quick aside (but seems relevant here), starches are avoided for everyone with overgrowths (bacterial or yeast), which is the majority of those with autoimmune diseases. But, some people suffer undergrowths in which cases starches are very valuable (starches tend to be high in “prebiotics” which is anything hard for you to digest but easy for your gut bacteria to digest). That mostly applies to people with gut disorders like celiac disease and IBD, but also anyone who has frequent diarrhea as a symptom of their disease.

More information on starches:

More information for anyone who is underweight:

How to Gain (or Maintain) Weight on The Autoimmune Protocol

More information about my book:

Announcing My Book: The Paleo Approach–Reverse Autoimmune Disease and Heal Your Body

Tags: AIP, autoimmune, disease, faq, Fructose, fruit, gain, Glucose, how much, illness, Loss, protocol, starch, underweight, Weight
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The Science and Art of Paleofying—Part 4 Sugars

December 8, 2012 in Baking Ingredients, Cooking Tips

Creating paleo adaptations of our favorite recipes (a.k.a. paleofying) helps us stay on board with paleo through the holidays (and many other times of the year), help us feel like we can still celebrate and partake in all of the fun and food luxury of the season. I know that many of you are pulling out your old favorite recipes and wondering what to do with them (I’ve had many questions lately about rules of thumb for flour substitutions, and alternatives for those with nut or egg allergies). I am too. I have several family favorite recipes that I am tackling this year.

Paleofying is as much an art as it is a science. I vaguely remember a time when I did not have extremely well-honed cooking instincts (I think that was back in middle school). But even starting out as a fairly good cook, there was still a learning curve to all of these new ingredients and to baking without gluten. After a year of paleo baking (and blogging!), I have a much better understanding of how to adapt conventional recipes now and thought it was high time I share some of this knowledge and experience with you, in addition to my perfected recipes.

This is the fourth in a 6-part post series to help you start the process of adapting your recipes (did I call this a 4-part series before? Yes, I have realized I needed two extra parts and I reserve the right to expand this to a 7-part series if needed!). In the first post, I discussed paleo flours and other ingredients that add bulk to a recipe. In the second post, I discussed binders (ingredients that hold baking together). In third post, I discussed leavening agents and fats. In this part, I will discuss sugar. Part 5 will discuss liquid ingredients and wet-to-dry ratios. Part 6 will discuss some strategies for doing iterations and troubleshooting your recipes. You may also be interested in some of my posts that reference paleo baking ingredients: Important Pantry Items for The Paleo Baker, Paleo Flour Substitutes, Sugar vs. Sweeteners, and Is Sugar Paleo?).

I’ve written about sugar in a couple of posts (see Sugar vs. Sweeteners, and Is Sugar Paleo?). I don’t want to get into the merit of different sugars in terms of health in this post, partly because I’ve already covered that and partly because this isn’t about which sugar is less bad for you. We’ve already agreed that we are making a special treat, which means we’ve already decided a little sugar is okay. This post is just about the chemistry of different sweeteners in your recipes.

Granulated sugar:

Most of the recipes you will be adapting will call for granulated sugar, typically white, light brown or dark brown. It would be a completely valid choice to just use refined sugar in your recipe (see Is Sugar Paleo?), but really, I know that most of us feel better if we can use healthier options. So, if your recipe calls for white sugar, the best substitute is Sucanat (also called Evaporated Cane Juice). This will have a bit of a molasses flavor to it, which you may or may not like in your baking (and depending on what other flavors you have going on, you might not even notice). Sucanat can be fairly large granules so you might want to pulse a few times in a food processor to replace white sugar in terms of texture too.

Dark Brown sugar can best be replaced by Muscovado Sugar (a.k.a. Barbados Sugar). This is a rich, dark brown, very molassesy moist sugar that behaves just like dark brown sugar in a recipe (but is unrefined). I love this stuff. Light brown sugar is also better replaced by muscovado sugar because of the moisture that it has compared to sucanat, however the molasses flavor is stronger. You could also replace light brown sugar with sucanat. and a little honey or molasses to replicate the moisture of light brown sugar. The general rule of thumb is to replace 1 cup of brown sugar with 1 cup of white sugar (or sucanat in this case) + 1 ½ Tbsp molasses (or honey).

The other granulated sugar options that I like in terms of health are is date sugar and maple sugar. Date sugar can replace either white or brown sugar in your recipe (although again, you may want to add a little molasses or honey for moisture). Maple sugar has a very strong maple syrup flavor, which may or may not be desired. No, I don’t like powdered sugar alcohols, stevia, or coconut/palm sugar. I don’t like palm sugar (a.k.a. coconut sugar) because it is very high in inulin fiber, which is a FODMAP and is not easily digestible by most people. I don’t like stevia because it has a hormone structure and the longterm effects of regular consumption have not been studied. I don’t like sugar alcohols because they are gut irritants (with the possible exception of erythritol, but I’m not comfortable enough with its benign-ness to actually recommend it). Just stick with glucose/sucrose (your body knows what to do with it) and don’t eat too much.

Generally, 1 cup of granulated sugar equals 1 cup packed brown sugar or 1 cup of super-fine sugar. Really, you can replace granulated sugar cup for cup with any other form of granulated sugar.

One of the biggest things that you will probably consider doing with your recipes is decreasing the overall sugar content. I typically use as little as a quarter the sugar called for in the original recipe when I’m paleofying. In this case, it helps to know if sugar is a dry ingredient or a wet ingredient so you can figure out what other adjustments need to be made. Even though granulated sugar feels dry, it’s really a wet ingredient (although, when it’s creamed with butter, it also adds to the lightness of a recipe and in that respect behaves a little more like a dry ingredient). It doesn’t contribute that much moisture though, so I’ve been relatively successful drastically reducing the amount of granulated sugar in a recipe without any other adjustments. However, if you choose to replace sugar with honey, molasses, dried fruit, applesauce etc., you will almost always have to adjust the wet and dry ingredients accordingly.

Liquid sugar:

If a recipe calls for molasses, honey, or maple syrup, then you’re in luck. If you want to use less that your recipe calls for though, you will have to adjust your wet and dry ingredients, either by adding to your wet ingredients or by reducing your dry ingredients.

If a recipe calls for corn syrup, honey makes a pretty good substitute most of the time. It doesn’t have quite the thickness or the ability to form long strings (unless you’re making a candy and then it works very well). You can also replace each 1 cup of corn syrup with 1 cup granulated sugar (like sucanat) plus 1/4 cup whatever liquid is used in the recipe (water, coconut milk, etc.).

If you want to replace granulated sugar with a liquid sugar, then typically adjusting the wet and dry ingredients is necessary. The exception is if you plan to replace some or all of the flour in a recipe with coconut flour. In that case, replacing sugar with honey or molasses can actually really help a coconut flour based recipe hold together since coconut flour is such a thirsty flour (it absorbs water like crazy!).

When can you replace granulated sugar with liquid sugar? This is tricky to do in cookies, but it is possible (see my Orange-Strawberry (Nut-Free) Cut-Out Cookies and Chocolate Cut-Out Cookies (Nut-Free)). It’s much easier to do with cake and muffin recipes where there’s naturally more wet ingredients.

If you are trying to figure out sweetness levels to gauge how much honey or maple syrup to add, here’s a general guide (this is by sweetness):

3/4 cup sugar = 1 cup unsulphured molasses.
Also, decrease the liquid by 1/4 cup for each cup of molasses, omit any baking powder and add 1/2 teaspoon baking soda instead.

1 1/4 cups sugar = 1 cup honey or maple syrup. Also, decrease liquid by 1/3 cup.

No, I don’t like agave nectar because it is high in fructose (what’s the point in avoiding high fructose corn syrup if we’re just going to eat agave?). It might be important to mention that some honey can be high in fructose too. If you have a FODMAP sensitivity and honey is a problem, there’s a huge variability in the fructose content from batch to batch and brand to brand, so simply trying another brand may be better tolerated. Honey also has the highest quantity of monosaccharaides, so often those with SIBO can tolerate honey but no other sugars.

Some flavor tips: I like the combination of maple syrup and honey to provide a more neutral flavor (neither the honey nor the maple syrup overwhelms) such as in my Best Paleo Pumpkin Pie recipe. Molasses pairs very beautifully with chocolate and coffee flavors and can actually trick the palate into thinking a chocolate flavor is stronger.

Icing/Confectioners sugar:

Icing sugar (a.k.a. confectioners’ sugar) contains corn starch and is not paleo. You can make a very fine powder by wizzing sucanat in your food processor or blender for a minute (careful when you take off the lid because it does that same powder in the air thing that icing sugar does). If you need the drying effects of the corn starch in icing sugar (which you may if you’re making a frosting or icing to pipe onto cookies), try adding some arrowroot powder, perhaps as little as 1-2 Tbsp per cup of sugar. As a general place to start, replace

1 ¾ cups icing sugar = 1 cup ground granulated sugar + ¾ cups arrowroot powder.

Other Ways to Get Sweetness into Your Baking:

Depending on how long you’ve been paleo (and exactly what version of paleo you follow), your sweet tooth will have adapted quite dramatically. You might even find that your baking is sweet enough with the inclusion of some fruit ingredients and that you don’t need sugar or honey at all. Here are some other ingredients that add sweetness to baking.

Fresh or Stewed Pureed Fruit—This is anything like mashed banana, applesauce, pearsauce, reconstituted dates, etc. You might be using this as a binder, but remember that is also adds sweetness to your recipe.

Dried Fruit—dates are magical, but they aren’t the only dried fruit around. Raisins, dried cranberries (typically sweetened), dried apricots, dried papaya, dried pineapple, dried blueberries, dried strawberries, dried cherries, dried figs and dates all add sweetness and a lovely chew to a recipe. If a recipe calls for raisins, try replacing with a mix of dried fruit for a different flavor. Blended, these dried fruit can also help bind a recipe.

Chocolate—unless you are using 100% cocoa dark/baking chocolate or cocoa powder, you are adding sugar to your recipe. I have had great success with some recipes using only semisweet chocolate as a sweetener (see my Decadent Double Chocolate Cookies (Nut-free, Coconut-free, Egg-free) and Chocolate Cupcakes with Ganache Frosting (nut-free) recipes).

A note on candy making: it’s very challenging to reduce the amount of sugar when making confections because heating the sugar and making long strings of sugar molecules is the whole reason why you can achieve the desired result (whether a chewy toffee or crunchy brittle). While changing the total amount of sugar doesn’t typically work, you can often change the type of sugar (replace granulated sugar and water with honey for example). You can also reduce the total sweetness with other tricks, like adding more nuts to a brittle.

I hope this will get you started on your paleofying adventures. As you play more and more with these ingredients and get to understand their properties better, it will be easier to intuit what will work in any particular recipe. But, I still have recipes that take me many iterations to get right. And of course, if you adapt a recipe that is absolutely awesome, you are welcome to e-mail it to me to share on the blog: thepaleomommy@gmail.com

Tags: adapt, agave, ancestral, Baking, barbados, best, coconut, date, Diet, erythritol, evaporated cane juice, FODMAP, Fructose, GAPS, Glucose, honey, How To, low-carb, maple, maple syrup, muscovado, paleo, Paleolithic, palm, primal, Recipe, SCD, SIBO, stevia, substitute, substitution, sucanat, sucrose, Sugar, Sweetener, syrup, treat, what to use, xylitol
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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:

Controlling insulin by avoiding high blood sugar is important for regulating hunger.
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)

Tags: adipocytes, blood, carbohydrates, Diet, Fat, fat cells, Glucose, glycogen, hormone, hormones, hunger, insulin, leptin, maintenance, paleo, Paleolithic, resistance, satiety, sensitivity, signal, Sugar, Weight Gain, Weight Loss
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Managing Stress

January 12, 2012 in Hormone Regulation, Stress and Sleep

After following a paleolithic diet, I think managing stress is probably the most important thing you can do for both your short- and long-term health. Did I say the exact same thing about sleep? Okay, sleep and stress are tied for second place. They are also interlinked, so usually working on one will also help the other; and conversely, problems with one will affect the other.

What do I mean by managing stress? Really, I mean managing your cortisol levels. In a perfectly healthy individual, cortisol is high in the morning and decreases throughout the day. But, when our bodies react to stressors, not only are our cortisol levels higher than normal, but also the pattern of expression changes to a spike in the late afternoon or evening. And cortisol affect everything in our bodies: insulin release, insulin sensitivity, hunger hormones, mood, gut health, immune system function, even libido.

How do you know if your cortisol is high? Do you carry much of your extra weight around your middle? Do you have to pee in the middle of the night? Do you have trouble sleeping? Does your energy tank in the afternoon but then pick up again after supper? Are you having trouble losing weight even though you should be based on what you are eating? Are your workouts getting progressively harder rather than easier? If the answer to any of those questions is yes, then cortisol may be to blame.

Our bodies and brains react to stressors like work, kids, relationships, deadlines, inadequate exercise, poor diet, inadequate time outside, lack of sleep, and too much caffeine. So how do you go about regulating cortisol levels? First, the easy stuff: Do what you can to get more, better-quality sleep. Give up or severely restrict your caffeine intake (at least for a little while). Reduce your carbohydrate intake (again, at least for a little while). Make sure you are eating a strict paleolithic diet and getting plenty of omega-3 fatty acids. Get outside, but still take a vitamin D3 supplement. Get more low-strain, moderate exercise (like yoga, swimming or walking). Make time for fun, whatever it is that you find fun. Make time to relax, especially in the evenings.

The rest is more individual. You need to find the best way for you to manage the people/places/events in your life that cause you stress. What small things can you add or remove from your life to help? Can you take a minute to just breathe? Can you take a bit longer to meditate? Can you carve out some time for yourself? Can you ask somebody for help? Can you take some time for something fun? Can you just take a moment to appreciate what is good and wonderful in your life right now? Yes, life is stressful, but you do not need to be stressed. Your health and the health of your family are more important. So, change what is in your power to change, and divest yourself emotionally from those things you can’t control.