IBS

 Last year I met a girl who was trying the paleo diet and complaining she "felt weird" and her stomach hurt. I asked her what she was eating and it turns out she was eating 5 tablespoons of coconut oil for breakfast! I told her that wasn't food, that it was an ingredient you can use to make foods or a supplement and that maybe she should try eating food. Later she said she felt better. 

I guess there is some impression among certain people that because I and others don't think fat is *bad* that you should drown yourself in it. As far as I'm concerned it's a far cry from a certain Paleo cookbook that advocates trimming fat off of GRASS FED meat, throwing away the fat that is leftover from cooking grass-fed meat,  and avoiding grass-fed "fatty cuts" like shanks to eating a pound of bacon for breakfast with a side of heavy-cream flavored coconut milk. Let's be honest: I don't eat that way. I cook with tallow that I save from the whole goats and lambs I buy, I certainly don't ever throw away any "fatty" cut, and sometimes I use some ghee, bacon, butter, or coconut milk as ingredients. I go through a pound of bacon a month, mostly because of my boyfriend, and maybe a can of coconut milk every two weeks and a pack of Pasture Butter a month. I never make any "paleo" desserts anymore and I don't eat very much dairy unless it's well-fermented and raw. Heavy cream makes my digestive system into sludge. I do eat some grains: I find my stomach is happiest when I include some rice in my diet every few days or so. 

I suspect someone who is more athletic or who doesn't have IBS might tolerate more fat. But this is my personal "sweet spot." I do have experience doing almost-vegan paleo: starches, veggies, fruits, no added fats, and only shellfish as protein. Perhaps it could be perfected, but I found that my keratosis really was itchy and red. I also felt more depressed and had bloating. If I tried it again I would probably use some coconut milk with carrot juice or something in an attempt to get vitamin A, but maybe my body isn't suited for it because of my genetics and health problems. Maybe it's also different for people in different life-stages. I'm a woman of reproductive age, so it's possible my need for certain vitamins is higher. 

I also would note that food sensitivities don't care about the paleolithic. It's very possible to be allergic or sensitive to a host of "paleo" foods from types of meat, to nuts, to eggs, to shellfish. I am personally quite sensitive to vegetables like broccoli, onions, and cauliflower. Honestly, they do a number on my stomach worse than any grain. I think people get caught up in the "paleo" paradigm thinking that because we evolved with foods like it, it must be good. But modern food sensitivities don't discriminate. I find that interestingly my stomach feels much better if I get starch from regular potatoes rather than sweet potatoes. The latter is considered "more paleo" though that stems from botanical ignorance. 

Either way, I don't really follow an orthodox "paleo" diet either, though I do use what I learn about the paleolithic to think about what I eat. I think there is tons of room for experimentation, particularly as the evidence for starch consumption in the paleolithic becomes stronger and stronger.

I don't think there is much room for combining "paleo" with various religious philosophies and I'm a little dismayed that Chinese medicine has somehow crept in and become tolerated. I think if I blogged about how I use Christianity to tell me what to eat I'd get about a million angry comments. Remember, the mechanisms behind Chinese medicine are scientifically implausible and even if a few tiny studies show that Chinese medicine works, it's not because of supernatural forces like conveniently undetectable "energy fields" operating outside of the forces of biology, chemistry, and physics. I know plenty of people who follow a "paleo" diet that is compatible with their religion, such as kosher or halal folks, but they don't claim that their diet is somehow better because of it or that it explains their diet's success. 

There has got to be a scientific explanation or I'm just not buying it...

Addendum:

It seems that some people were upset with the idea that I was attacking alternative medicine in the last post. No, I was attacking scientifically implausible theories of food being integrated by the ancestral food community. It's because people don't want to believe there are both unverifiable supernatural beliefs AND beliefs worth investigating to find out whether or not they have some natural basis or benefit.

Acupuncture, for example, is a system worth investigating because of the possibility that the ancient literature refers to real physiological processes, as Chris Kessler points out, and not energy fields (scientists have looked for these energy fields and NOT found them).

The idea that some Chinese roommates once told me that going to bed with my hair wet would cause demonic possession leading to pneumonia made me wonder if perhaps people in rural China did get sick from chills, but otherwise it is a supernatural belief.

Likewise, I am a huge fan of traditional Chinese foods, but when my waitress at my favorite restaurant in Flushing tells me I eat too much fatty "Yang" food and will get acne and clog my blood (that would be awesome since I have a mild form of hemophilia) I think it's worth investigating, but most of the time Chinese traditional food beliefs have been investigated, they have found to be incorrect or vast simplifications. I'm impressed at the latter, but I won't be basing my food choices on whether or not foods are "Yin" or "Yang." I suspect these beliefs have very little to do with Taoism anyway, as they were probably added on as Taoism blended with local folk religions.

Some of these folk beliefs lead to some absurdly unhealthy behaviors. I know Thai people who believe it's good to wash down beef, which is a "hot" food, with Coke, which is a "cold" food. And Chinese people who follow their fried chicken with heavily sugared red date tea because it's "Yin" and replenishes their "Qi." Since these beliefs are not based on real concepts, they are particularly vulnerable to industrialization. 

Religions/folk beliefs and food: worth investigating and important tools for believers, but not always scientific. 
 

Last month I got some test results back. One of the tests was for the gene that is linked to celiac disease.

Apparently I don't have it. So I thought I'd celebrate with a beer. Predictably I felt horrible the next day. Why? Well, gluten isn't just bad for celiac individuals, it's possibly bad for almost everyone.

First of all, it's got some seriously bad stuff in it. One of these things is a protein called gliadin, which celiac individuals are sensitive to. But it turns out that others are sensitive to it as well: Is gliadin really safe for non‐coeliac individuals?

The answer is NO:

The data obtained in this pilot study support the hypothesis that gluten elicits its harmful effect, throughout an IL15 innate immune response, on all the individuals. This innate response is found in both patients with and without CD, although the triggering of an adaptive response is CD specific.

So for celiac individuals it's really really bad. For most people it's not so bad, it only "induces epithelial stress and reprogrammes intraepithelial lymphocytes into natural killer (NK)‐like cells leading to enterocyte apoptosis and an increase in epithelium permeability" a little. Enjoy your bagels! 

Even though the media has run a slew of wheat-industry sponsored garbage about how eliminating wheat if you don't have celiac is "dangerous," more and more scientific publications have been running articles on non-celiac gluten sensitvity. It's real.

Whole Health Source has many great posts about it. This one on the genetic test I had is enlightening:

Gluten sensitivity is determined in large part by genetics. A gene called HLA-DQ is intimately involved. It encodes a protein that is expressed on the surface of cells, that serves to activate immune cells when certain foreign substances are present. Different versions of the gene are activated by different substances. HLA-DQ2 and HLA-DQ8 are classically associated with celiac disease. Roughly 42% of the US population carries DQ2 or DQ8. According to Dr. Fine, every allele except DQ4 has some association with gluten-related problems! Only 0.4% of the U.S. population carries HLA-DQ4 and no other allele.

Sadly my genetic test didn't tell me whether I carry HLA-DQ4. It just told me I didn't have the celiac markers. But I think it's pretty unlikely I'm homozygous for it. I'll let the symptoms speak for themselves.

"But I eat bread and I feeeel fiiiiiine" I hear people say. Do you really? What about that Claritin you have to take everyday? Or the inhaler you have to carry? Or the bottle of ibuprofen you have to keep by your bed? Gluten is bad news. Try a month without it and see the difference.

Edit: Yipes, here's one for the .4%! Modern wheat also messes your insulin up.

Edit 2: Gluten increases gut permeability (AKA leaky gut) in non-celiac individuals, though not as badly as in true celiac disease.

Last weekend the fridge at work was left ajar, which was overall a complete disaster. But I did notice that a jug of apple cider was bulging. Aha! A sign of fermentation. I poured it into a glass. It was fizzy and smelled kind of alcoholic. I took a swig. It was fairly tasty, though later I realized I didn't need the alcohol at 11 AM. 

A few years ago I would have been aghast at eating "spoiled" food like that, but since becoming intimate with fermentation, I am much more daring. The fridge is a recent invention and our ancestors might not have had the luxury to turn up their noses at food that's a little...um...off? But "off" sort of implies the food is bad, when  actually in many cases it's good. 

The status of fermentation in the paleo diet is controversial. Many paleo books do not mention it and Cordain's Paleo Diet newsletter recently knocked kombucha for containing acetic acid and yeast (they also said it causes metabolic acidosis...of which there is one case in the medical literature and the person in question also had other serious problems).  

That's nonsense. Our our bodies are full of yeast and acetic-acid producing bacteria and our natural environment would have also been rich in these. Think about the life of a hunter-gatherer. From birth to death they are surrounded by dirt. Of course this is bad when you have a wound that gets infected, but this immersion in dirty nature probably means their bodies are more biodiverse than ours. 

Contrast that with my birth, which was a C-section done in a clean environment. Science shows that C-sections alter gut bacteria, which is bad news, because largely the species established when you are young are the ones that stay with you for the rest of your life. There is plenty of science supporting the Hygiene Hypothesis, which posits that children growing up in clean environments have higher incidences of allergies, asthma, and other diseases of civilization. There is emerging evidence that gut bacteria plays a role in metabolic syndrome as well.

There is no question in my mind that our modern gut biodiversity caused by our divorce from dirt is a bad thing. 

Having a history of stomach problems, managing my gut bacteria is important to me. I do it two ways: not eating foods that seem to encourage the proliferation of misery-causing bacteria and then balancing my bacteria with probiotic foods. "Cleansing" is a bad idea because it gets rid of both bad and good bacteria and irritates the gut...and an irritated gut can't be a good habitat. 

A few times since starting the paleo diet I've gone off the band wagon. My IBS soon returns with a vengeance. I can tell the wrong bacteria are having a feast at my expense. My strategy for getting it under control borrows a lot from the Specific Carbohydrate Diet, which treats colitis by reducing such fermentation. Last time this problem happened, after a week of staying up late to plan a food event and then eating lots of carby sugary food at the event, I calmed things down by eating zero carb for a week. I particularly enjoyed a tonic of egg yolks cooked in bone broth. 

Soon my stomach was feeling much better, but I don't think zero carb completely solves the situation. I think fermented foods are the missing link, providing valuable bacteria and truly digestible nutrients. 

While the scientific studies show that it's very hard and perhaps impossible to add new species to your gut, probiotics can still have an effect, though it will go away if you discontinue them. Furthermore, fermented foods often are simply easier for your body to digest and contain many beneficial bioavilable nutrients. 

That brings me to Wild Fermentation, which was really a groundbreaking book for me. It taught me to embrace and take advantage of wild crazy bacteria.

 This book is of the post-vegan canon. Sandor was a vegan, but a serious health problem propelled him to become omnivorous. In his case, it was AIDS. 

But Wild Fermentation contains a wide variety of ferments suitable for all diets. The exception is meat ferments, which he does himself, but does not include instructions for in his book. He refers readers to The Indigenous Fermented Food of the Sudan, which apparently tells of how the Sudanese ferment meat nose to tail. Unfortunately that book seems to be unaffordable. 

That's OK with me actually...I'm not sure meat fermentation is something I want to dabble in right now.  The main ferment I consume is lacto-fermented vegetables. It's quite funny because just a few years ago I wouldn't have eaten pickles or sauerkraut if you paid me. I think my tastebuds were to put it lightly, shallow from years of consuming industrial food lacking in complexity. I admittedly had to force myself to eat my first batches of pickled vegetables, but at this point I LOVE them. They are tangy and delicious. The best part is that I now crave sour foods rather than sweet foods.

Pickled ginger carrots vs. Snickers? I'll take the former. The variety of flavors, the spicy and sour ginger with the tart carrots, is just superior. 

An important thing I learned from this book was the distinction between vinegar preservation and lacto-fermentation. You can make pickles by just putting some cucumbers in vinegar, but they will not have the same health-giving or flavor properties as vegetables that have been fermented. 

Sandor particularly praises sauerkraut: he talks about a study that shows that it is much richer in cancer-fighting compounds than plain old cabbage. I personally find that the best sauerkraut is made in a heavy crock with a water seal that allows the cabbage to breath, but doesn't allow mold to get in. Luckily, I have access to one, but if I didn't I would make kimchi, which is just as tasty and more resistant to mold. However, Sandor says not to worry too much about mold, as it seems to be a surface phenomonon that doesn't affect the overall welfare of the cabbage buried beneath the brine. 

One of the joys I experienced when I first ate Korean food was all the delicious pickled vegetables they bring you. I realized after my first Korean meal that you really can pickle almost any robust vegetable. Vegetable fermentation has become trendy in NYC and the local farmer's markets are full of pickled beets, radishes, onions, carrots, peppers, and silky wonderful mushrooms. The most surprising pickle I had recently was pickled beet stems, which is a revelation since I usually throw those away. The pickling process had muted the bitterness, but preserved the crunchiness and added a rhubarb-like tartness. 

Some of the other ferments Sandor addresses are less relevant to the paleo diet, but great if you eat grains to get the full nutrition out of them. Kefir is relevant to everybody since you can make it from ruminant milk, nut milk, and anything that has fermentable sugars like coconut water. 

Overall, my digestion feels better when I consume fermented foods and I have noticed that my seasonal allergies are much better. But of course, the main reason to eat them is that they are delicious and nourishing.