Sugar | The Paleo Mom

Teaser Excerpt from The Paleo Approach: The Trouble with Stevia

March 11, 2013 in Baking Ingredients, Is It Paleo?, Sugar/Carbs, The Paleo Approach Excerpts

I get often get asked why I do not endorse the consumption of stevia (see my post Is Sugar Paleo? for more information on what sugars/sweeteners I do endorse). So, as I found myself including a section on the trouble with stevia for The Paleo Approach, I felt like this was a good topic to include as a book teaser on the blog. I have a section of Chapter 3 that describes the role that sugars, blood sugar regulation, insulin sensitivity, fructose, sugar alcohols and nonnutritive sweeteners play in propagating inflammation in autoimmune disease. This excerpt is included as a standalone text box following the subsection on nonnutritive sweeteners.

This excerpt is from Chapter 3 (The Diet Link to Autoimmune Disease chapter).

Stevia is often recommended as a natural sugar substitute because it comes from the leaf of a plant (Stevia rebaudiana Bertoni). It tastes sweet on the tongue, requires very small quantities to sweeten baking, and contains no sugar. While some experts advise caution against purified and manufactured forms of stevia, green leaf stevia is typically endorsed. On the surface, it sounds like a perfect solution. However, I do not recommend the consumption of stevia, even in its most natural form. The chemicals responsible for the sweet taste of stevia are called steviol glycosides (there are at least ten different steviol glycosides present in the stevia plant). Purified/manufactured forms of stevia often isolate one or two of these steviol glycosides whereas green leaf stevia (which is simply the dried and powdered leaves of the stevia plant) contain all ten.

Steviol glycosides are synthesized in the same pathway and end up being structurally very similar to the plant hormones gibberellin and kaurene. This means that steviol glycosides have a hormone structure. The majority of toxicological studies establish that stevia is safe, however there are some studies showing that it can act as a mutagen and may increase the risk of cancer (these studies are in the minority and tend to use quite high concentrations, so they are readily discarded in discussions of the overall safety of consuming stevia). Whether or not stevia causes genetic mutations is not the only cause for concern, however (even if safety studies focus on this particular property). For those with autoimmune disease, in which hormones have such a dramatic impact on disease development and progression, the impact of consuming stevia on hormone regulation is relevant.

There is evidence that steviol glycosides have contraceptive effects in both males and females. In particular, one specific steviol glycoside, called stevioside, has been shown to have potent contraceptive properties in female rats, implying that stevia may have an impact on estrogen, progesterone or both. In another study, male rats fed stevia extracts showed a decrease in fertility, reduced testosterone levels and testicular atrophy, potentially attributable binding of steviol glycosides with an androgen receptor. Although no studies have been conducted evaluating the impact of stevia on fertility in humans, the stevia plant was traditionally used to control the fertility of women by the Guarani Indians in southern Brazil. While small and occasional consumption of stevia likely has little to no impact on general health, it should not be consumed on a regular basis especially by those with altered hormone balance and dysfunctional immune systems.

Brusick DJ. A critical review of the genetic toxicity of steviol and steviol glycosides. Food Chem Toxicol. 2008 Jul;46 Suppl 7:S83-91.

Mazzei Planas G and Kuć J. Contraceptive properties of Stevia rebaudiana. Science. 1968 Nov 29;162(3857):1007.

Melis MS Effects of chronic administration of Stevia rebaudiana on fertility in rats Journal of Ethnopharmacology 1999 Nov 67(2):157–161

Melis MS. Chronic administration of aqueous extract of Stevia rebaudiana in rats: renal effects. Journal of Ethnopharmacology 1995. July 47(3):129–134

Oliveira-Filho RM et al. Chronic administration of aqueous extract of Stevia rebaudiana (Bert.) Bertoni in rats: Endocrine effects. General Pharmacology: The Vascular System. 1989. 20(2):187–191

Tags: androgen, balance, baren, estrogen, female, fertility, genotoxic, glycosides, green, healhty, hormone, inflammation, leaf, male, mutation, non-nutritive, nonnutritive, paleo, Paleolithic, Pregnant, primal, progesterone, Raw, safe, safety, sterile, sterility, stevia, steviol, subsitute, Sugar, testosterone
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Sometimes a Little Change Can Make a BIG Difference

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

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

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

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

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

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

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

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

Tags: 21, 21DSD, autoimmune, blood, Change, day, detox, fruit, improvement, inflammatin, insulin, lichen planus, protocol, regulation, Sugar
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Gluten-Free in the News (some Yay! some Nay!)

February 6, 2013 in Paleo Philosophy

Two news stories centered around gluten-free diets were published in the New York Times in the last week, one the magazine section and one in the science/health section. I’d like to take this opportunity to give a huge shout-out to the NYT for having staff science writers (who actually have science backgrounds!). So few media outlets have science reporters any more and I believe this is one of the biggest hurdles we face as a society in battling the enormous amount of misinformation out there. There is a need for people with science backgrounds and a talent for distilling and explaining science to report on it in the media. There’s a need, but there’s no money–most media outlets aren’t hiring.

The first story The Boy With a Thorn in His Joints was published February 1st. It excited many people with its explanation of the link between gut health (and specifically a leaky gut) and inflammation. It shares the story of a 5-year old boy named Sheperd, diagnosed with the intensely painful autoimmune disease juvenile idiopathic arthritis at 3-years old, who found no answers with conventional medicine (either NSAIDs or DMARDs). The story is told by Shepherd’s mother and her reports of interactions with her son’s pediatric rheumatologist make me angry. I had similar experiences with my daughter’s pediatric gastroenterologist (one of the top in the country) who thought that putting my daughter on a dairy-free, gluten-free diet was nonsense (and yet is cured her of her obstructive sleep apnea, so there!).

Shepherd’s parents finally hit a desperate point where they were willing to try “complimentary medicine” approaches. They switched Sheperd to a gluten-free, dairy-free, nightshade-free and refined sugar-free diet in conjunction with supplements including fish oil, probiotics, sour Montmorency cherry juice and a Chinese herbal supplement called four-marvels powder. In 6 weeks, Shepherd starting recovering, feeling less pain and having more mobility. Not long afterward, they were able to wean him off of DMARDs and now report that the only times that Shepherd has had flares in the last year is after accidentally eating gluten or needing to go on antibiotics.

This story is powerful. Emotional and triumphant. The agony of waiting for something to work for six whole weeks, not knowing if it will, the stress the anxiety are palpable. The sheer joy at being able to “fix” your child’s problem, but with always that seed of doubt of whether it will return, hit home. And the explanation that arthritis is caused by a leaky gut which causes inflammation and stimulates the immune system is a very good one. I have no doubt that there are many families now researching gluten-free, dairy-free diets for their children. Maybe some of the will take that small extra step and try a paleo diet.

The second story Gluten-Free, Whether You Need It or Not, published February 6th, presents the mystery and controversy around gluten sensitivity. The controversy is really one of definition. It is now being recognized that there exists celiac disease, wheat allergy, gluten intolerance and gluten sensitivity. This paper in the very high impact research journal Gut (I always did love that name) suggests using the term “gluten-related disorders” as an umbrella term for all of these related but disparate conditions. The problem is that gluten sensitivity is not well defined or well understood (hence the mystery). There are medical professionals at both ends of the extreme, those that say it doesn’t exist versus those that claim that most people are actually gluten sensitive because humans are not adapted to digesting grains.

The article explains some very important points. The incidence of celiac disease is increasing. This might be because GMO grains contain more gluten. The vast majority of celiacs remain undiagnosed. Those who have gluten sensitivity are simply those who feel better when they follow a gluten-free diet (there is no test). There is research showing that people with Irritable Bowel Syndrome felt better and had fewer symptoms when following a gluten-free diet (in a very cleverly designed blinded trial). This is important information to be out there in the mainstream media!

But, I felt irked as I read this article. It was written by one of the NYT’s staff science writers, Kenneth Chang, who does a good job of presenting most of the many sides to this issue. But not all the sides. Maybe I was feeling overly defensive, being obviously part of one of the fringe and fad extremes that the article presents, but I took issue with a few statements in this article..

The article gives an anecdotal example of a women who lost weight and had her allergies go away after adopting a gluten-free diet. The article then goes on to explain that experts are skeptical. Quote: “It does not make obvious sense, for example, that someone would lose weight on a gluten-free diet. In fact, the opposite often happens for celiac patients as their malfunctioning intestines recover.” Can I jump in here? Celiacs gain weight when their intestines recover because they can finally absorb nutrients from their food. People who are gluten sensitive but non-celiac often lose weight when they remove gluten from their diet because they are reducing inflammation, regulating hormones, and cutting out a major source of nutrient-poor sugar-rich foods. It actually makes total sense.

Two other statements just riled me, both implying that gluten-free diets are less healthy and so people who aren’t diagnosed with gluten-related disorders should not adopt gluten-free diets. The first statement is a quote from Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center. “It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.” Yes, that is a biased opinion. And in my biased opinion, it’s an uninformed one. The second irksome statement: “They [experts] also worried that people could end up eating less healthfully. A gluten-free muffin generally contains less fiber than a wheat-based one and still offers the same nutritional dangers — fat and sugar. Gluten-free foods are also less likely to be fortified with vitamins.”

Can I jump in again? Okay, yes, I obviously think that the vast majority of gluten-free baked goods available are not healthy. They tend to still be grain-based and loaded with emulsifiers. Clearly, I do not believe in simply substituting wheat with rice and corn. But, how about those of us who choose to replace gluten-containing foods with vegetables!? I don’t need to remind you about how much healthier vegetables are than any grain, do I? I don’t need to say that vegetables contain more of every single micronutrient than grains, for a fraction of the sugar and at least the same amount of fiber, do I? The same can even be said of fruit, although fruit is somewhere in the middle in terms of sugar content. And while people who eat gluten-free (and not paleo) typically do buy some gluten-free breads and pastas, they also typically consume fewer of these types of products than people eating the Standard American Diet. So while gluten-free baked goods might not be fortified, you can’t judge an entire diet based on them. Yes, I’m sure there are gluten-free folks out there chowing down on empty sugary gluten-free junk and who really are eating a less healthy diet. But, to label gluten-free as less healthy is wrong. Cutting gluten out of your diet does not deprive you of any nutrients. I suppose I could also mention that whole vilification of fat thing here too. But, it’s late. So, I’ll summarize: fat is not bad for you. Sheesh.

I’m sure someone else reading the story would have focused more on the other positive aspects. Gluten-free in the news is good. Explaining that it’s a spectrum and that it’s not just celiac is good. Encouraging people to have a dialogue with their doctors is good. It’s just hard for me to gloss over the fact that this article put big warning signs on gluten-free diets like somehow cutting gluten our of your diet might deprive you of vital nutrition. Did I already say sheesh?

Let’s end on a positive note though. Paleo is gaining momentum and, while many still consider it a fad diet, the scientific basis behind it is providing traction. More and more, people are healing themselves by changing how they eat. More and more, wonderful success stories like Shepherd’s stories are making headlines. And it’s very exciting to watch people take back their health!

Tags: ancestral, arthritis, article, celiac, Chines, Dairy-free, disorder, Fat, fiber, fish oil, Gluten, Gluten-Free, heal, idiopathic, intolerance, Irritable Bowel Syndrome, juvenile, leaky gut, mainstream, media, medical, medicine, micronutrient, New York Times, newspaper, nightshade, nutrient, Nutrition, opinion, paleo, Paleolithic, primal, professionals, refined, sensitivity, Sugar, supplements, vegetable
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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.