Keto – Day 25

About 3.5 weeks into a ketogenic diet and I’ve lost 0 pounds or inches.  I know what’s going on though, thanks to my handy Kentonix meter, which I got about a week ago.  Indeed my problem with low carb in the past (and the present) has been eating too much meat (protein), not enough fat.  It’s been extremely hard for me to eat 70%+ of calories from fat because it leaves me hungry.  Why is that?  Because my insulin is perpetually too high.  Becoming fat adapted – burning fat for fuel instead of glucose – is not something that happens overnight. About a week ago I dropped dairy again, since that seemed to work some magic last time around.  Since then my hunger has dropped off a little but I’m still nowhere near being able to fast more than 12 hours or so.

A few days ago I got a fasting insulin level to see exactly what it looks like after 3 weeks of no starch or sugar.  It was 20.7 (range 2.6-24.9).  That’s after 3 weeks of very low carb living.  So I added exercise this week – HIIT, specifically – based on the this study and others that indicate quick bursts of intense exercise can help lower insulin.  I think by eating 200-300 grams of carbohydrate a day for 4 months from September through December of last year I managed to raise my base insulin level so high that now it’s going to take time and intention to bring it down.  I wish I would have tested before starting low carb, but I didn’t.

In any case, I’m sticking with this because I feel so much better throughout the day now and my sleep is so much better.  When I eat too much meat the Ketonix lets me know I’m no longer producing ketones…so my diet is a lot of avocados, homemade mayo, spinach and kale for calcium and other nutrients, eggs, coconut oil, and some meat.  My hunger is dropping gradually.  This will be a slow and steady process.

Peat vs PHD: A Comparison

Ok, I finished the Perfect Health Diet (PHD) book by Paul Jaminet and his wife, Shou-Ching Jaminet (I notice she doesn’t get much credit in PaleoLand, but she’s the co-author and also a Ph.D.). I was drawn to it in the first place because they advocate a moderately low-carbohydrate diet (just enough carb to meet the body’s needs, which they say is around 600 calories or 150g per day), and that a good chunk of those carbs should be starches, which I’ve recently started eating.

I thought it would be fun to compare the recommendations made by Ray Peat and those made in the PHD. First, let’s look at the similarities.  They both recommend a whole-food diet, liver once a week, shellfish once a week, and both caution to avoid PUFAs, grains (though both seem to make exceptions for rice), and legumes.  Peat says keep PUFAs low – real low – like 1-2% of your dietary calories low.  The PHD says under 4% is probably ok. Potatoes seem to be ok with both of them.  Both say that saturated fats are awesome – butter, coconut oil, and cream being fabulous in both camps. Both are fairly noncommittal about non-starchy vegetables: Peat says they’re ok if they’re well-cooked, but I get the distinct impression he finds them fairly optional, and the PHD says you can eat around a pound per day of non-starchy veggies, but there’s no firm guideline.  They say, “Eat vegetables to taste – they are nourishing and add flavor to meals – but don’t consider them a calorie source.” (PHD, KL 3217). Both recommend getting lots of your nutrients from liver, shellfish, eggs and bone broth.

Ok, that’s about where the similarities end.  The greatest areas of disagreement between Peat and the PHD are with regard to calcium/dairy/phosphorus, fructose/sugar, and Omega 3s.  Peat strongly recommends getting enough dietary calcium to maintain between a 1:1 and a 1:2 ratio of calcium to phosphorus, ideally closer to the former. His views on this topic are expressed well here:

A diet that provides enough calcium to limit activity of the parathyroid glands, and that is low in phosphate and polyunsaturated fats, with sugar rather than starch as the main carbohydrate, possibly supplemented by niacinamide and aspirin, should help to avoid some of the degenerative processes associated with high phosphate: fatigue, heart failure, movement discoordination, hypogonadism, infertility, vascular calcification, emphysema, cancer, osteoporosis, and atrophy of skin, skeletal muscle, intestine, thymus, and spleen (Ohnishi and Razzaque, 2010; Shiraki-Iida, et al., 2000; Kuro-o, et al., 1997; Osuka and Razzaque, 2012). The foods naturally highest in phosphate, relative to calcium, are cereals, legumes, meats, and fish. Many prepared foods contain added phosphate. Foods with a higher, safer ratio of calcium to phosphate are leaves, such as kale, turnip greens, and beet greens, and many fruits, milk, and cheese. Coffee, besides being a good source of magnesium, is probably helpful for lowering phosphate, by its antagonism to adenosine (Coulson, et al., 1991).

The PHD barely mentions phosphorus.  A search of the Kindle version of the book indicates it’s mentioned 7 times within the body of the text, each time as part of a list of nutrients (e.g., “magnesium, calcium, and phosphorus…”).  There’s no discussion at all about potential deleterious effects associated with high phosphorus intake.  It’s interesting because overall the PHD does a great job of describing deficiencies and toxicities of all of the main micronutrients.  They didn’t touch on this one though.  The calcium/phosphorus ratio recommended by Peat is one of the things I’d never heard before I began studying his work.  He says that calcium gets blamed for a lot of negative effects in the body when phosphorus is the real culprit.

The PHD talks about the effects of too much calcium, citing studies that indicate 600mg per day is adequate and maximizes bone health (PHD, KL 5175).  It goes on to say:

Calcium supplementation was a mistake.  The true culprits in osteoporosis are deficiencies of Vitamin D, Vitamin K2, and magnesium.

and…

Studies have found that supplemental calcium increases the incidence of strokes and heart attacks by over 30 percent and increases the overall risk of death by 9 percent. One analysis concluded, “Treating 1,000 people with calcium or calcium and vitamin D for five years would cause an additional six myocardial infarctions or strokes and prevent three fractures. (PHD, KL 5183)

It goes on to blame calcium for brain lesions, the promotion of biofilms, and hypercalcemia.  Apparently this study found that calcium balance occurs at an intake of 741mg/day – that’s the amount of calcium retained by the body each day. So that’s what the PHD recommends – about 700mg/day, in the form of bone broth, green leafy vegetables, maybe some dairy.  The PHD was kinda wishy washy on the dairy thing.  They didn’t give it a section in the book, which I find odd.  I mean, “Alcohol” had it’s own section. Lots of people eat dairy and to not really acknowledge it doesn’t make sense to me.  Plus in the beginning “Milk” is listed among the items to avoid, “…but DO eat fermented or fatty dairy products: butter, sour cream, ice cream, cheese, yogurt,” (PHD, KL 198).  I should avoid milk (and sugar!) but ice cream is ok?  Kinda loopy.

Ok, so Peat says we’re gonna die if we don’t get enough calcium, and PHD says we’re gonna die if we get too much.

Another big area of disagreement between these guys is with regard to fructose. The PHD says fructose is only bad in high doses or when eaten with PUFAs – but since most Americans eat a high-PUFA diet, it’s a big deal on a societal scale.

Fructose appears most problematic when study subjects are obese or overweight and when they are eating diets high in polyunsaturated fat.” (PHD, KL 3904)

The PHD goes on to say that fructose is toxic to the liver and causes metabolic syndrome, diabetes, endotoxemia, poor blood lipid profile, high uric acid (an aside: my uric acid went DOWN on a higher-fructose diet), gout, kidney disease, obesity, liver disease, cognitive impairment, and retinopathy.  Still though, they recommend up to 25g of fructose per day, and at most 10g per meal.  The dose makes the poison, apparently.  Keep your PUFAs low and a little is fine.

Peat says fructose has been wrongly maligned:

Many people lately have been told, as part of a campaign to explain the high incidence of fatty liver degeneration in the US, supposedly resulting from eating too much sugar, that fructose can be metabolized only by the liver. The liver does have the highest capacity for metabolizing fructose, but the other organs do metabolize it.

If fructose can by-pass the fatty acids’ inhibition of glucose metabolism, to be oxidized when glucose can’t, and if the metabolism of diabetes involves the oxidation of fatty acids instead of glucose, then we would expect there to be less than the normal amount of fructose in the serum of diabetics, although their defining trait is the presence of an increased amount of glucose. According to Osuagwu and Madumere (2008), that is the case. If a fructose deficiency exists in diabetes, then it is appropriate to supplement it in the diet.

And regarding the effect of fructose on obesity:

Starch and glucose efficiently stimulate insulin secretion, and that accelerates the disposition of glucose, activating its conversion to glycogen and fat, as well as its oxidation. Fructose inhibits the stimulation of insulin by glucose, so this means that eating ordinary sugar, sucrose (a disaccharide, consisting of glucose and fructose), in place of starch, will reduce the tendency to store fat. Eating “complex carbohydrates,” rather than sugars, is a reasonable way to promote obesity. Eating starch, by increasing insulin and lowering the blood sugar, stimulates the appetite, causing a person to eat more, so the effect on fat production becomes much larger than when equal amounts of sugar and starch are eaten. The obesity itself then becomes an additional physiological factor; the fat cells create something analogous to an inflammatory state. There isn’t anything wrong with a high carbohydrate diet, and even a high starch diet isn’t necessarily incompatible with good health, but when better foods are available they should be used instead of starches. For example, fruits have many advantages over grains, besides the difference between sugar and starch. (Emphasis his.)

I can say my own experience of eating sugar (mostly fructose/glucose in fruit juice and honey) did not result in fat production – my weight was stable the entire time I avoided starches. So score one for Peat. However, I was hungry all the time. And in the past week or two of eating starches it has NOT been the case for me that they stimulate my appetite. I can forget about eating now for the first time in months – what a relief.  Starches do make me sleepy though.

Speaking of which, I’m getting tired…time to wrap this up!

The last big area of disagreement seems to be regarding Omega 3 fatty acids – should we eat salmon and other fatty seafood or not?  Peat says NO, PHD says YES (once a week).  I’ll go into this in greater detail in another post. I have more reading to do on this topic.

My conclusions (for me): I think I’m going to keep eating dairy.  Peat makes a better case.  And I think I’ll avoid fructose – not because of what the Jaminets have to say, but because I don’t particularly like fruit and I don’t miss it at all…and because it did seem to mess up my lipid profile to a point that I’ve become concerned…but seriously, I’m pretty broken.  It probably doesn’t take much to tip those scales into the danger zone.  As for omega 3s – the jury is still out. So dairy is a YES, with phosphorus limited relative to calcium intake.  Fructose, for me, is a NO. But just cuz I don’t like it. You go ahead. Just keep your PUFAs low and you’ll probably be just fine.

Two Steps Back

I’ve been struggling a bit eating Peat style.  I think this would be a great way of eating if weight loss isn’t a goal.  The food is delicious and makes me feel great.  Only problem is I’ve been gaining weight.  I’m now up to 209.4 – almost 8 pounds over my previous unacceptable weight prior to learning about Dr. Peat.

It has to stop.  I simply cannot continue to gain weight.  My clothes don’t fit.  I avoid mirrors.  I’m discouraged.  I’ve tried to count calories, and I find it impossible to stay on a low-calorie diet while eating sugar.  There’s one woman on my Ray Peat Facebook group who has been losing weight, and she has generously shared her eating plan with us.  I’ve tried to follow it, and I just can’t.  I feel too hungry.  I guess my body is just not healthy enough yet to metabolize sugar effectively.  I think a lot of the sugar I’m eating is being wasted, my liver not effective at storing glycogen.

I’m considering doing a lower-carbohydrate version of Peat’s principles for a couple of months (and yes, I realize “a lower carb Peat plan” is an oxymoron) – just long enough to get some of the weight off.  I think my low-carb diet didn’t result in weight loss before because I was eating too much meat and no dairy. Also I was eating lots of PUFAs in daily consumption of dark-meat chicken and conventional eggs.  Now that I see how damaging those things are, of course I would continue to avoid them.

I don’t know all the answers.  I just need to do something else. I can’t continue to gain weight.

Estrogen Sucks, Part 2

Have I mentioned that estrogen sucks?  Why yes…yes I did.

It has become very clear that high estrogen is one of my biggest health issues. I’m mad at myself for exacerbating this by ADDING estrogen  (BHRT)…for a period of 8 months (See blog posts between July 2012 – March 2013 for details and to watch my transformation from high-functioning full-time working 182 pound adult to demoralized part-time working 203-pound adult).  On the other hand I’m glad I know what’s really going on with my moods, and now what there is to do is treat it.  I’ve started supplementing with DIM and milk thistle, and have ordered calcium D-glucarate.  Each of these is instrumental in eliminating excess estrogen.  I’m continuing the progesterone (Progest E, 2 doses a day of 10mg each).  Over a period of 2 days my headaches went away, my breast soreness has diminished about 90%, and my dark mood has lifted.

What I don’t understand is why the effects of estrogen have recently gotten so bad.  I’ve never had breast soreness within the first week of my cycle before, I’ve never had headaches associated with hormone changes before, and usually my depression is pre-menstrual, not mid- or post-menstrual.  Why is this happening now?

Bottom line, I’m not sure.  I don’t think it has anything to do with adding progesterone a month ago. This really seems to be an estrogen problem, and progesterone makes it better almost immediately after dosing.  The other thing I changed in the past month is I changed from skim milk to 2% milk for a few weeks, and then gave milk up completely after I realized it was making me asthmatic. I have continued eating cheese though, which doesn’t cause as many problems with my breathing.

I’ve been doing some research:

This study says dietary fat in dairy is a source of estrogenic hormones. This one says that goats milk has much less estrogen than cow’s milk (both regular and organic). This study says both estrogen and progesterone are increased after drinking commercial milk, and this one says there is a “considerable quantity of estrogens” in milk produced from pregnant cows, and that intake of animal products (especially milk and cheese) are highly correlated with hormone-related cancers. (On the other hand, this one is a meta-analysis which indicates dairy product consumption does not lead to breast cancer, and that estrogens in dairy are minute.)

Maybe it’s time to give up cow dairy altogether.  I think it’s also time to add more fiber to my diet – it helps eliminate estrogens so they don’t get reabsorbed into the bloodstream.

Unfortunately, the more I experiment with Ray Peat’s recommended dietary approaches, the more problematic my own symptoms become. I can’t conclusively tie my recent high-estrogen problems with dairy, but I don’t know what else would have caused them.

I think it’s time for me to follow a more conventional high-vegetable/fiber moderate calorie diet, and get a lot more exercise to manage my blood sugar.

Next post: Resistant Starch.  Another experiment in the works.

Bye Bye Dairy

I haven’t had much milk at all in years, but seemed to tolerate it well as a child, so when I saw that Ray Peat recommended it (in large quantities!) for nutrition and weight loss, I didn’t hesitate. Bring on the milk.  I drank between 8 and 16 oz and started eating several ounces of cheese a day.

Fast forward 2 months…it occurred to me yesterday that my 7-week long stint of wheezing, coughing and phlegmy-ness might not be a side effect of having a child in daycare after all, but rather might be related to drinking milk. I’d heard of this happening, but never had that experience with milk myself.  So I decided to hold the milk/cheese for a day and see what happens.  Well, 24 hours later, no more coughing and my voice no longer sounds like it’s underwater.  I’m cured!  But wait…what if I just got better because of the passage of time?  I mean, colds go away too over time…maybe it was a coincidence.

So I decided to use a reversal design.  Drink more milk and see if it comes back!  So this morning with my eggs I had 16oz of 2% milk and an ounce of cheese.  And guess what happened.  Within an hour my cough was back and I was again hawking up phlegm and hitting the inhaler.

So suddenly I have an intolerance to milk?  WTF?

I looked it up and found this article. Apparently I have the perfect storm of phlegm production related to dairy intake.  If you have asthma (yup) and you drink A1 milk (mm-hm), and inflammation is present (indeed it is), dairy can cause excess respiratory track mucus production:

This association may not necessarily be simply cause and effect as the person has to be consuming A1 milk, beta-CM-7 must pass into the systemic circulation and the tissues have to be actively inflamed. These prerequisites could explain why only a subgroup of the population, who have increased respiratory tract mucus production, find that many of their symptoms, including asthma, improve on a dairy elimination diet.

So now it seems I’ll be taking a big step back from dairy too.  I gave it up before, I can do it again. I’m not going to go out of my way to pound expensive goat’s milk (which apparently is A2, not A1), but maybe some goat cheese here and there would be ok.

Pretty soon I’ll be back to plain-old Paleo.  Minus the nuts.  And the chicken.

Reconsidering Options

I really wanted Ray Peat’s work to be The Answer for me. I think Peat’s work benefits some people greatly – in fact, it may be the most brilliant nutrition and health advice ever.  But when it comes to deciding what I should put in MY mouth at mealtime, I don’t think it’s for me.  Here’s my analysis:

The Pros:

Progesterone – I had given up on sex hormone supplementation after my disastrous encounter with the Wiley Protocol.  I blamed progesterone for the fact that I gained 20 pounds, had heart palpitations, and became so fatigued that I could barely get out of bed.  At the time I concluded that progesterone was the culprit because I found a website on which a bunch of lay people decided it was so.  I was so fatigued and depressed I would have believed anyone.  Recently I’ve started supplementing with Progest E, the progesterone supplement developed by Ray Peat himself.  I find Progest E alone – without the estrogen that Wiley had me taking – to be wonderful, balancing, and soothing.  I imagine I’ll take it for the rest of my life.  Estrogen, not so much.

Liver – I’ve gone on and on about how eating liver once a week has made my skin look great.  This week I tried eating all 4 oz raw, washing it down with milk.  I thought it was a lot easier than trying to eat it cooked.  I’m considering just having an ounce or so raw every day or two.

Shellfish, bone broth, raw carrot, coffee, aspirin, vitamin K2 – all of these things I don’t mind taking or using and will continue to do so, just because the promise of better health is worth the effort.  I also love the smell of broth cooking in the crock pot.

The Cons:

Sugar – Yesterday I tried all kinds of things.  I tried a teaspoon of granulated fructose with breakfast and tested my blood sugar after – it was up 25 points at one hour and up 35 points at 2 hours. That part was ok, but also I felt hungry soon after, despite eating a 300 calorie meal.  So I ate ANOTHER 300 calorie meal and paired it with the smallest wedge of an orange ever.  It was a clementine orange – small as a baby’s fist, and I ate one small section of it.  An hour later my blood sugar had dropped 50 points and I was hungry again.  I then ate several hundred calories of protein/fat along with a very small amount of sugar (cuz Ray Peat said to), and within 45 minutes I was hungry.  Now, keep in mind, a pure protein/fat breakfast – without any sugar – normally keeps me satisfied for hours.

I thought about eating for 5 hours straight.

This is what pisses me off about those who say people get fat because of “food reward and palatability” (translation: fatties get fat because they eat too much cuz food is so damn tasty).  I HATE BEING HUNGRY AND WANT NOTHING MORE THAN TO JUST BE DONE EATING ALREADY.  IF I DIDN’T GET HORRIBLY UNCOMFORTABLE I’D BE CONTENT TO NOT EAT AT ALL.

So at that point I was fed up (not literally) so I got fed up (literally).  I ate a huge meal that would keep me satisfied for the rest of the day – it included all kinds of terrible things, including mayonnaise (PUFAs!), bread (gluten!  starches!), and industrial meat (inhumane! hormones! antibiotics! PUFAs!).  Some might call it a binge.  It was less food than I used to eat back in my binge-eating days, but I guess it was a binge.  And FINALLY, I was done being hungry.  That meal lasted through the rest of the day, all night, and well into today.  I didn’t get hungry again till 1:00PM – almost 22 hours later.  It was wonderful.

Dairy – I’ve had some sort of nasal congestion or phlegmy cough for the last…oh, about 6-7 weeks.  About the same amount of time I’ve been following Peat’s dietary recommendations.  I thought I was just getting one cold after another.  But it occurred to me today that maybe the addition of lots of dairy into my diet was causing this.  I’m going to take a break from dairy for a few days and see if my forever-cough clears up.  Then I’ll add it in again to see what happens.

So what’s next for me?   I’m fairly desperate to lose the 5-or-so pounds that I’ve gained in the last 2 months since eating carbs.   As well as the 20 pounds I gained following the  Wiley Protocol.  As well as the 40 pounds I was overweight when I started this blog.  So now, I’m going back to eating what makes me feel good – mostly low carb with small amounts of potatoes here and there.  I know low-carb isn’t ideal.  But what I’m doing now – getting fatter and hoping there’s magic in milk – isn’t doing my health any favors.  No more fruit.  No more sugar.  Maybe no more dairy.  I’m going to stay away from PUFAs as much as I can.  I’m going to exercise at least 30 minutes a day to manage my blood sugar.  I’m going to count calories again, and stay at or around 1500/day.  Finally, I’m going to continue to supplement with thyroid hormone, so my broken metabolism has a shot at making it’s own steroid hormones.

It’s possible my body will be running on cortisol till the day I die.

Right now, I’m ok with that.

That’s all.

One week down….and done.

Today is Day 7 of my plant based diet.  And I’m done with it.

I know that will come as a shock…me quitting an eating plan and all…feel free to flame me in the comments.  I don’t mind.  I have my reasons.

Here they are:

1.  The Forks Over Knives bubble has burst:

A thoughtful commenter brought my attention to a really excellent article: Denise Minger’s analysis of the science behind Forks Over Knives….the movie that got me interested in giving up animal-based protein in the first place. (Aside: Denise is such a great writer.  I wonder how long it took her to research and compose this article.) I won’t go into a ton of detail – you can read the article if you wanna – but I will say that a LOT of information was omitted from the movie, like the entire context of a lot of the studies that were presented as evidence that healthy living starts and ends with plants.  For example, the diets that folks were put on which led to great before/after stories were not just free of meat and dairy – they were free of all processed food and fat too. Confounding variables, anyone?  Also, massive conclusions about cause were drawn based on correlational data (and not very good correlational data at that).  The original science was good but the reporting on it was terrible and completely misleading.  It’s like a group of militant picket-waving PETA members got together and decided their slaughterhouse horror movies weren’t doing the trick so they better try a new angle – hey I know!  Let’s find some really good science on nutrition and get a couple of doctors [i.e., not scientists] to interpret it for us using their own personal bias!  We’ll just have to hold the camera steady.

Too bad, because it was an entertaining film.

2.  My tic has returned.

I know this is going to sound a little weird – I’ve never told the internet about my weird tic.  For years I have had this odd motor behavior, probably best described as a tic. It’s something I’m able to control enough that I don’t do it around other people in any obvious way, but basically it involves my wrists.  When the urge hits to engage in this tic, my wrists absolutely must be stretched or straightened out or shaken vigorously, or I can’t stop thinking about it.  It’s a little like OCD but just for this one very specific behavior.  It gets worse when I’m under stress – like, when I had that horrible job in California, it was all the time and my wrists became sore.  I haven’t noticed the tic at all for many months…until 2 days ago.  Nothing in my life has changed except my diet.  I don’t know for sure that I can blame the diet, but as soon as I felt that old familiar, obnoxious urge, I started wondering if there’s some amino acid or micronutrient that I’m not getting since I stopped with the meat/dairy.  I guess it could be a complete coincidence.  Having worked with people that have Tourette’s though, I can tell you for sure that tics have a basis in neurological processes and are affected by things that affect the brain and the neurotransmitters.  They’re not just weirdness or mental illness – there’s something going on biochemically.  It’ll be interesting to see if going back to eating meat/dairy makes it go away again.

3.  Doing no harm (to myself).

One thing I learned about eating a plant-based diet is that it’s REALLY hard to eat a balanced diet with enough protein and a good array of micronutrients.  I think it’s possible to research the food combinations that MUST be included and in what quantities and frequencies in order to have a nutritionally balanced diet and to avoid the many processed vegan foods out there that contain things that are downright dangerous, like soy and polyunsaturated fatty acids (PUFAs).

I like animals just fine, but am I going to be the first in line at the PETA rally?  No.  It’s just not a cause that happens to touch me emotionally.  One would need to be fully committed to this way of life in order to have it be healthy – and even then it’s questionable.  I’m just not that committed.

4. Heartburn

After eating starches I get heartburn.  Not always, but enough that there’s a definite correlation.  I haven’t had heartburn in so long because my starch consumption has been really low for about 2 years.  And it’s been back for…oh, about a week.

5.  Gut flora

I don’t really want all of my meat-lovin’ gut flora to go away and be replaced by exclusively plant-lovin’ flora, especially since I don’t feel committed to doing this for life.

6.  I don’t really like it.

Vegan food is probably satisfying – again, if you’re that gal researching, planning, shopping, and cooking and lovin’ every minute of it.  But otherwise I find myself eating potatoes for dinner.  An apple and an orange for breakfast.  It’s like side dish hell.  I know this is just my preference, and honestly of all the above reasons for abandoning ship, this is the least important.  I do believe it’s important though to like what you eat.  This is just meh.

So there you have it.

And now, I’m going to go eat some cheese.

Ciao.