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

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

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!

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

November 6, 2012 in FAQ, Weight Loss/Gain

The autoimmune protocol is, by default, a fairly low-carbohydrate diet.  This is especially true for those with gastrointestinal symptoms, suspected or confirmed Small Intestinal Bacterial Overgrowth, and/or FODMAP sensitivity because these conditions warrant the elimination of starchy vegetables.  Sugar (even from fruits and starchy vegetables) can be a strong trigger for many with autoimmune disease, so many people find that even fruit can aggravate their symptoms.  This is because sugar itself is inflammatory but also because the insulin secreted to help our bodies use and store that sugar is inflammatory.  The most effective version of the autoimmune protocol for most people is a fairly low carbohydrate implementation (although typically not so low that you are going into ketosis).  This is a fabulous way to lose weight and many overweight people with autoimmune disease see the weight loss that goes with this diet as an added bonus to managing their disease (or maybe a silver lining to living with such a restricted diet).

But what if you don’t have weight to lose?!

An often glossed-over fact is that a large percentage of autoimmune disease patients are underweight (or at least not overweight).  The last thing these people need is to follow a diet conducive to weight loss!  And if you suffer from a disease in which flares mean dramatic weight loss (as is the case with inflammatory bowel diseases but also many other severe autoimmune diseases), then you probably prefer walking around with a little extra weight to help protect yourself from getting too ill should you experience another flare–and the sad truth about autoimmune disease is that even following the AIP is not a guarantee that you will never flare again.  This diet is a management strategy and not a cure.

So, how do you gain weight while following the autoimmune protocol?  The most important thing is to increase overall caloric intake.  So, first and foremost, eat more fat–especially healthy, easy to digest, healing fats.

The best fat sources are:

  • Coconut Oil (my preference is Gold Label from Tropical Traditions)
  • Palm Oil (Red Palm Oil from Tropical Traditions is ethical and sustainable) – NOT Palm Kernel Oil
  • Palm Shortening
  • Avocado Oil (not for cooking)
  • Olive Oil (not for cooking)
  • Avocadoes—this is a FODMAP so be cautious
  • Olives
  • Tallow from grass-fed beef or lamb
  • Lard from pastured pigs
  • Fatty cuts of meat and organ meat from grass-fed and pastured animals
  • Fermented Cod Liver Oil
  • Fatty wild-caught cold-water fish (salmon, sardines, mackerel…)
  • Full-fat coconut milk
  • Coconut Butter (aka coconut cream concentrate or creamed coconut)—this is a FODMAP, so be cautious

The fats in coconut and palm are especially easy to digest.  These medium chain triglycerides (MCTs) can be passively absorbed (no digestive enzymes necessary) and used as fuel by your cells without modification.  These MCTs are also antimicrobial, so they are very useful for those with overgrowth of bacteria or yeast in their digestive tracts, and they promote healing.  Saturated fats are not easily oxidized so they supply the body with essential fatty acids without causing inflammation.  The conjugated linoleic acid (CLA) in the fat from grass-fed animals has potent anti-inflammatory properties and can help promote healing.  The omega-3 fats in fish and the fat from grass-fed animals is also critical for reducing inflammation.

Saturated fats are the best for cooking.  This means that good cooking fats are coconut oil, palm oil, palm shortening, tallow, and lard.  Monounsaturated fats are better used raw such as in dressings for salads and steamed vegetables.  Olive or avocado oil makes a great dressing with lemon juice, lime juice, or balsamic vinegar (you can throw some herbs in too if you like).  When mono- and polyunsaturated fats are part of a whole food (as in grass-fed meat, fish, olives and avocado), they are less likely to oxidize with cooking.

In conjunction with eating more fat, it’s important to have enough carbohydrates in your diet for your body to store the fat.  You need some insulin to store fat.  I recommend getting these carbohydrates from higher glucose fruits and from glucose-based starches for those without Small Intestinal Bacterial Overgrowth.

Higher glucose fruits include:

  • Bananas (the best choice)
  • Pineapple
  • Apricots (FODMAP, so use with caution
  • Plums/prunes (also FODMAP)
  • Grapes
  • Raisins
  • Figs
  • Dates

Because you don’t want to overdo the sugar, dose is important here.  Whether your carbs come from fruit or starchy vegetables (see below), aim to consume between 15g and 30g of carbohydrates with each meal (perhaps as much as 45g with a large meal).  This will ensure your blood glucose doesn’t get high enough to cause problems, but that there’s enough insulin to help store fat.  Other lower sugar fruits are just fine too, such as berries, citrus and some melons.  Look for any fruit that is at least half glucose compared to fructose.  If the sugars are more than half fructose, then avoid those fruits (there’s a great table here; look for the fructose number being smaller than or the same as the glucose number).

Lower starch starchy vegetables are often well tolerated.  These include:

  • Winter squash (e.g. butternut, acorn, spaghetti)
  • Onion (FODMAP)
  • Beet (FODMAP)
  • Carrots
  • Rutabaga
  • Jicama
  • Kohlrabi
  • Turnips
  • Pumpkin

If you know from experience that you can handle denser starch starchy vegetables, then by all means go for it.

Don’t forget the protein.  Protein from quality meats and fish is still essential.  You should be aiming to consume anywhere between ½ and 1 gram of protein per pound of your bodyweight per day.  For me, this amounts to at least 6oz of meat or fish with each meal.

For those with difficulty digesting food (basically, if you have any digestive symptoms), cooked vegetables (and even stewed fruits) will be the easiest to digest.  Some people report diarrhea from coconut and palm oils, which may be due to die-off (the excess bacteria in your get dying).  If you do experience diarrhea from too much fat with each meal, pull back on the dose.  You can add a teaspoon of coconut oil between meals several times a day, which is typically a small enough dose to be well tolerated.  If you digest animals fats better, then it’s perfectly fine to just stick with that.

Other factors that will help with normalizing weight are getting enough rest, managing stress, and making sure you have enough Vitamin D.  Anything you can do to help reduce inflammation and heal the gut will help you absorb more nutrition from your food, regulate hormones, and regulate your weight (basically following the autoimmune protocol is designed to do this).  L-glutamine and zinc can be very useful supplements for those with autoimmune disease to help restore gut barrier function.  Probiotics, either as a supplement or from live fermented foods, can also be beneficial since our gut microflora have an important role to play in our digestion.

I don’t advocate eating more frequently to try to gain weight since there is pretty good evidence that spacing out meals (4-5 hours between them) is better for regulating some hormones that are key in reducing inflammation.  However, a mid-day snack would be appropriate (try to get at least 3 hours between your meal and snack) for those with schedules that would mean that more than 5-6 hours would pass between meals.  Also, while eating shortly before bed can completely undermine one person’s attempt to lose weight, it might be a good tool for those trying to gain weight.  This is because eating carbohydrates (whether on their own or with a meal) can suppress the release of human growth hormone, which is required for the body to convert stored fat into glucose.  If there is less human growth hormone in your system, your body cannot as easily burn fat while you sleep.  There is a balance here because this can also affect sleep quality, which is why people who have difficulty sleeping are advised to not eat for at least 2-3 hours before bed.  If sleep is an issue for you, try to eat around 2 hours before bed, otherwise, you can try as close to bedtime as 1 hour, but watch for signs that your sleep is not as restorative as usual (getting up to pee in the night, remembering many dreams when you wake up, having a harder time getting out of bed in the morning, a crash of energy in the afternoon, feeling moody or feeling like you’re thinking clearly).

It might take a little self-experimentation to figure out how to eat to achieve a healthy weight while following the autoimmune protocol, but gaining weight is completely achievable.  Remember that slow and steady wins the race and don’t get too frustrated if it takes a few weeks to figure out exactly what is going to work for you.

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Do I Have To Do the Full AIP?

September 8, 2012 in FAQ

The autoimmune protocol of the paleo diet (AIP) is very effective at addressing autoimmune disease (and related conditions like allergies and non-autoimmune skin conditions) and for identifying food sensitivities.  It is an elimination diet which restricts all of the most common food allergens/sensitivities as well as foods containing substances known to prime the immune system (like nightshades).  If you combine this approach with food sensitivity testing, it’s even more powerful at addressing a huge variety of health conditions.  However, it is really hard.  It can feel very restrictive for those of us who have been following a paleo diet for a while; and for those completely new to paleo, it can be completely overwhelming.

I get asked the question frequently:  “do I have to follow the full AIP?”.  I also get asked “does it matter if you cheat/fall off the wagon on the AIP?” and “Isn’t it easier to just get tested for food sensitivities?”.  Let me try and answer these questions one by one.

I believe that following the full autoimmune protocol is the most expedient way to address autoimmune disease and identify food sensitivities.  However, it only works if you can stick to it!  If it is simply not possible for lifestyle, budget or psychological reasons to follow the full autoimmune protocol 100% strictly, you can try to limit a couple of the food categories instead of all of them.  I have explained many of the whys behind the various restrictions in the autoimmune protocol (see this page for a list) and you can use these posts (and your personal history) as a general guide for prioritizing what foods you omit from your diet.  As a basic starting point, I would highly recommend at the very least omitting nightshades from your diet.  Egg whites would be the next most likely culprit, in my opinion.  This may be an iterative process for you.  Instead of jumping in with both feet, you can try omitting nightshades, see how you do, add in the omission of egg whites, see how you do, omit whole eggs, nuts and seeds, see how you do…  The full throttle, cold turkey approach works well for some and, for those who can pull it off, is more likely to yield fast and dramatic improvement in symptom.  But it isn’t for everyone; and it doesn’t need to be.

If you are new to paleo, you may find great relief of your symptoms with a standard paleo diet, so it is definitely worth trying that first before tackling the challenge of the autoimmune protocol.  It can take a while to get used to this way of eating, depending on how you ate before, both in terms of figuring out where to buy quality ingredients and how to cook them, and also in terms of resetting some basic assumptions about what meals should look like.  You may have to reprogram your basic responses to food; for example, you may need to stop reflexively recoiling from high fat foods in fear that they will make you fat and cause heart disease.  You might have to let go of the concept of “healthy whole grains” or that you need to drink milk for healthy bones.  You might have to get over your fear of organ meat.  You might have to get used to cooking more often.  And your body may go through a sluggish, cravings-filled adjustment period as it adapts to a lower carbohydrate/sugar diet.  After a month or two of a regular paleo diet, once you feel like you have adjusted and it doesn’t seem in itself to be so overwhelming, then you can evaluate whether additional dietary restrictions may be helpful for you.  However, I do need to add that if you are really struggling with disease, you might consider adopting a nightshade-free paleo diet from the start and try to find alternatives to eggs for breakfast that work for you.

Does it matter if you cheat on the AIP or fall off the wagon temporarily?  Well, the answer to this is “it depends”.  It depends on what you cheat with, how much you eat, how often you cheat, and what your specific health conditions and food sensitivities are.  I think it’s very important not to eat any of the basic paleo diet restricted foods.  This means absolutely no grains (and especially especially no gluten-containing grains), absolutely no legumes (especially especially soy and peanuts), and I urge strong caution with dairy (especially pasteurized conventional dairy).  You can try some grass-fed butter or ghee and see how you do, but it would be better to omit dairy completely at least for a few weeks.  Refined sugars and processed food chemicals may also cause a shockingly strong reaction, especially once you’ve been following a paleo diet for a while.  As for the AIP-restricted foods: tomatoes have the ability to rev the immune system so alarmingly that it can take months to calm it back down again.  Other nightshades can have similar effects, although maybe not as dramatically as tomatoes.  Egg white proteins can act as carrier molecules to bring proteins that activate the immune system across the lining of the gut, which is especially a problem if you are reacting to bacterial proteins from your gut microflora.  And any food that you have a food sensitivity to will cause an exaggerated response (in my case, that’s almonds).  But as for a little bit of wine, a small handful of nuts, a square of dark chocolate, egg yolks, a sweet potato, a coconut-flour pancake with maple syrup?  You might tolerate those things.  Even if you don’t tolerate them, they may only set you back a little.  Of course, they might be disastrous.  The trick is to find a balance between what your body will tolerate and what it needs to heal.  This needs to be sustainable for you so you adhere to the protocol as strictly as is possible.  If that means allowing yourself a little dark chocolate (and providing you don’t react very strongly to dark chocolate), then that makes a whole lot of sense.  Will completely falling off the wagon for a couple of days set you back to ground zero?  It might or it might not.  It is certainly an opportunity to reevaluate what you need to change to make this work for you so that you can have success at addressing your health conditions.

Is it easier to just get tested for food allergies and sensitivities?  Well, it is and it isn’t.  Some people will have food sensitivities to foods that are allowed on the AIP.  In this case, even following the AIP 100% will not be sufficient to see substantial alleviation of your symptoms (and I have a whole post about this coming soon).  In the case of nightshades, eggs, caffeine and alcohol (and NSAIDS, even though they aren’t a food), they can be problematic in a way that is not a food allergy or sensitivity, so you will very likely have to try an elimination diet strategy with those foods anyway.  Food sensitivity testing also won’t tell you if starchy vegetables are feeding Small Intestinal Bacterial Overgrowth or if you have a FODMAP-sensitivity.  However, if getting food sensitivity testing done is within your budget, then I definitely recommend it as the information will still be very useful for you.  Also, if you continue to have issues after following the AIP very strictly for several months, food sensitivity testing may help you find the missing link.  However, not all foods are tested for and some sensitivities may still be missed.  In this case, you may wish to work with a naturopathic physician or nutrition-savvy physician or chiropractor to do an even stricter elimination diet approach to narrow in on the culprits.

So, do you need to do the full AIP?  I think that following the AIP strictly for at least a couple of months is the fastest way to see improvement in your symptoms.  But no, it is not completely necessary and there other ways to approach disease management and identification of food sensitivities.  Just like everything else in the paleo world, this is individual and you need to find what works for you.

 

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TPM Tidbit: Are There Other (Non-Nightshade) Food Sources of Solanine?

August 29, 2012 in FAQ, The WHYs of the AIP, TPM Tidbits

Last week, Paleo Parentsand I released Episode 2 of The Paleo View, the topic of which was the Autoimmune Protocol.  In conjunction with this, I posted my explanation of why nightshades can be problematic for those with autoimmune disease (and also why it is a common food sensitivity).  I received a fascinating comment from Tina that launched me into several hours of research.  Here is what Tina wrote:

“I’ve used Balanced Bites’ Nightshades Guide as my info source for what is a nightshade and what is not. She indicates blueberries, huckleberries, okra, and artichokes have properties similar to nightshades, but you and Stacy both mentioned blueberries as a great snack. Do you feel these foods should be removed initially with the autoimmune protocol with the nightshades?”

This is a great question!  I found dozens of websites (in addition to Balanced Bites) that list blueberries, huckleberries, okra, and artichokes as sources of the glycoalkaloid solanine (which is found in potatoes and eggplants).  I also found many websites that listed apples and sugar beets as sources of solanine (some websites also list cherries but this is confusion with ground cherries, which are a member of the nightshade family).  If solanine is indeed found in these fruits and vegetables, this is cause for concern for those sensitive to nightshades.

I could not find a single website with a citation for blueberries, huckleberries, okra or artichokes containing solanine.  All of the websites cite each other and simply provide this list as fact.  I also could not find a single scientific paper that discussed the presence of solanine in these fruits and vegetables.  I did however find a handful of scientific articles that listed apples and sugar beets as sources of solanine.  These articles all reference back to a single paper published in the magazine Food Technology in 1991.  My wonderful husband was able to track down this original article for me (yay for university libraries).  The original article has nothing to do with apples, sugar beets, OR solanine (although it does measure amylase inhibitors in beans, which is interesting).  After my exhaustive research, I feel comfortable making the following statement:  there is NO scientific evidence that solanine (or any other glycoalkaloid) is present in any fruit or vegetable that is not a member of the nightshade family.

This is good news for those with reasons to avoid nightshades.  No, there are not any additional fruits or vegetables that need to be avoided. 

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