This blog is about the intersection between evolutionary biology and food. But also about practical applications, sustainable agriculture, and general tasty things. I originally started eating this way to heal from chronic health problems and...it worked!
Melissa McEwen
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My Diet: Good, local, whole foods. Mostly meat, fish, and vegetables with some traditional whole grains and legumes.
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medicine
07/06/2011 - 18:47
In the next few months I hope to write a couple of posts on irritable bowel syndrome. It's interesting because so many (including myself) get relief from IBS by following a low-carb low-fiber grain-free fructose-free diet with probiotic supplementation. There are many reasons this works, but in the long term people following it might want to wean away from probiotic dependence, since probiotics in pills cannot become part of the permanant microbiome of most adult guts. In addition, there are real benefits from short chain fatty acids produced in the colon by fermentation. It's unfortunate so much fiber research has been done on grains, but more and more is being done on the type of fiber that horticulturalists and foragers consume. Here we are getting into self-experimentation since the research is so thin right now. My own goal has been to establish a gut bacterial population that is an asset (har har) rather than a nuisance. I've been trying to do this by feeding my bacterial population appropriately in a way that encourages good bacteria, but does not allow overgrowth.
On Paleohacks someone said something like "the kind of food you eat cannot affect constipation, just the mechanics of the food, IE, how much fiber and fat." That is the OLD view. The reality is that different gut bacteria react differently to different foods. I've been reading a lot of articles by Dr. Kok-Ann Gwee, who studies IBS in Singapore. His article Fiber, FODMAPs, flora, flatulence, and the functional bowel disorders is a really good one and should be essential reading for all doctors. I'd estimate the majority of primary care physicians are still recommending things like bran to treat IBS when there are mountains of scientific evidence against it.
The issue was in the 70s some papers came out that said, "huh, looks like this African farmers don't have stomach problems. Must be all the fiber in their diet!" Nevermind their methods for measuring fiber were bad and that certainly wasn't the only difference in their diets. Then some poorly-designed studies were done on bran, which the cereals industry picked up in order to promote BRAN FOR EVERYONE1111!!!!! Dr. Kok-Ann says:
In fact, a number of contrarian studies, which had been largely ignored, had suggested that favorite sources of dietary fiber such as bran and other cereals, and vegetables and fruits, might actually aggravate symptoms in IBS. The symptoms that appeared to be aggravated were flatulence, bloating and abdominal pain.
Yikes, that certainly was my experience. The more I ate the high-fiber stuff my doctor told me to eat, the worst I felt.
I didn't have Celiac, so that meant wheat was AOK right? Nope, gluten is not the only bad thing in wheat, the fiber in wheat can be quite bad for people with IBS as well.
Based on the use of an exclusion diet, Nanda et al. from Oxford reported that dairy, grains, in particular wheat and rye, and onions were the major foods implicated by IBS patients, and that patients responding to dietary manipulation were likely to have presented with flatulence as an initial symptom.3 They had also observed that intolerance to either wheat or rye was specifically associated with abdominal distension. Whorwell and Prior from Manchester recorded that 55% of their patients felt worse and only 10% felt better on bran.4 John Hunter's group from Cambridge used a whole-body calorimeter to measure the 24-h excretion of hydrogen and methane in both the flatus and the breath.5,6 They compared the gas production of IBS patients and healthy controls on a standard diet with regular fiber intake, an exclusion diet, and a fiber-free diet. They found that IBS patients had a significantly faster rate of gas production on a fiber-rich diet, which reduced significantly on the exclusion and the fiber-free diet, and this appeared to be associated with an improvement in symptoms. Others have also suggested that malabsorption of fructose and sorbitol, of which fruits are rich sources, may give rise to symptoms in IBS patients.7
So fiber not only doesn't help, it makes you gassy and bloated. This paragraph highlights the foods I found triggered my symptoms through trial and error: onions, grains (esp wheat), and a lot of dairy. These are foods I now know are rich in FODMAPS (Fermentable Oligo-, Di- and Mono-saccharides, and Polyols). Interestingly I've found not all FODMAPs trigger my symptoms.
In [the Cambridge study], total gas, as well as breath hydrogen production, was similarly reduced with metronidazole (an antibiotic with activity against intestinal anaerobic organisms) treatment despite a fiber-rich diet. This observation brings us back to our recent appreciation that the flora of intestinal microbes is a key player in the development of IBS.10 Even Segal and Walker, two of the early proponents for the high-fiber diet, have recently acknowledged that reduced dietary fiber intake has not resulted in increased colonic diseases in Africans.11 In fact they have now recognized the importance of the “quality of the intestinal bacteria”, and the impact that this has on the fermentation of malabsorbed carbohydrates.12 In their recent paper they have assembled measurements for various classes of immunoglobulins, and other markers of immune activation, that support a high level of exposure to gastrointestinal infections in childhood.11 Their new hypothesis is that it is this early priming that gives the African a more robust gut microflora, better able to withstand the insults in adult life. The corollary is also that if we expect fiber and oligosaccharides that are promoted as prebiotics to enhance the proliferation of ‘good bacteria’, we have to start feeding these substrates to our gut in the early years of life. In the meantime, it appears that eating a ‘healthy Western breakfast’ of milk with high-fiber cereals, whole grain bread with honey, washed down with apple juice, is perhaps the worst way to start off the day for an adult IBS patient!
What about those of us who didn't get that advantage? Is there hope to normalize? In his other article he points to several factors anyone with IBS should think about:
- The role of gut flora in their end products, immune mediators, and neuroendocrine factors
- Beneficial and pathogenic parasites
Then there are some more factors to think about from Irritable bowel syndrome: towards biomarker identification:
- The gut-brain axis
- Hypothalamic-pituitary-adrenal (HPA) axis dyfunction
- Inflammation
- Stress
More soon!
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06/28/2011 - 09:35
Some of my readers might be interested in The Atlantic's debate on "alternative medicine." Reading it, what amused me is that opponents of alternative medicine accuse it of not being "evidence-based." Unfortunately our "normal medicine" isn't really evidence-based either. What doctors and hospitals do often seems more about the status quo than science. That explains why my sister (a biologist) and I are not exactly our doctor's favorite patients. We don't accept treatments based on outdated science, particularly when they have harmful side effects.
For example, the idea that GERD is a disease of acid burning the esophagus is several years outdated, but doctors continue to hand out medicine based on that theory (proton-pump inhibitors) like it's Halloween candy, despite a growing body of evidence that it causes immune dysfunction and bacterial overgrowth!
The list really could go on and on, from unwillingness to adopt life-saving safety practices to the handing out of antibiotics to children for every little thing (even illnesses obviously caused by viruses!) to the use of questionable materials for hip-replacements just because they are "new."
Another example showed up in my RSS reader today: Keeping Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding. I suggest you read that post, as it has great information. Basically, in our species, the time immediately after birth is critical. Direct skin to skin contact between mother and baby is important for establishing breast feeding, bonding, and regulating the baby's physical health. That's how our species evolved, it's the infant's natural ecology. This isn't about just doing what our ancestors did; science has confirmed that these practices have important functions. Despite that, hospitals often fight this practice and a woman who wants to simply do what is appropriate for her as a Homo sapians must exert an effort to convince the hospital staff, find a sympathetic birthing center, or arrange for a home birth.
Interestingly, NICU's (new born intensive care units) have been the first to adopt this practice. For babies on the edge, everything counts, but it's something all babies deserve.
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05/26/2010 - 20:04
In news from stupid-land: The FDA cautions against high dosages or prolonged use of acid inhibitors.
It's kind of criminal that these medicines are still in use, given that the latest studies published in journals show that the cause of GERD is not too much acid. So while proton pump inhibitors might mask the symptoms, they get rid of stomach acid, which we kind of evolved for a reason- to help digest food and to protect against pathogens.
The agency said it would order revised labeling on packages of the drugs to reflect the fact that they have been associated with an increased risk of fractures of the hip, wrist and spine…The drugs have previously been linked to an increased risk of contracting pneumonia and the troublesome bacterium Clostridium difficile, as well as to an increased risk of dementia. A recent study found that the drugs increase the risk of bone fractures by about a quarter. It is not clear what the mechanism of the increased fractures is. Most researchers believe it is due to decreased absorption of calcium from the diet because of the reduced stomach acid, but it is possible that the drugs interfere with bone maintenance.
I am particularly incensed because last year my younger sister started having problems with GERD. She is only 19 and the doctor's recommended Prilosec. Instead she is now paleo and her symptoms have resolved. It's lucky that she knew that the paleo diet could treat GERD and she didn't get on the PPI wagon of dooooom like I did. Here is what I can remember:
It started when I was 18 or so. I was overweight and had terrible stomach problems. My internist gave me Zantec but my mom thought it was unnecessary and I never took it. Over the next two years I lost some weight on a vegetarian and then vegan diet, but the heartburn just got worse and worse. I couldn't sleep or concentrate on my school work. My school doctor finally convinced me to get on Prilosec. The spiel for these pills is that you take them for a month and it helps heal your esophagus, but of course it never works. I try to go off them after a month and the heartburn returns with a vengeance.
So I stay on them, but my IBS just gets worse. My allergist, who is treating me for severe asthma gives me an anti-spasmodic for my IBS and tells me not to worry about the PPIs. He says I'll probably be on them for the rest of my life, but not to worry since they are mostly harmless. At least I can eat pizza as much as I want now...
At some point I get really really sick. My doctor at school thinks it's just my IBS, but when I collapse and end up in the E.R. I finally get diagnosed with chronic salmonella. What should have been a one day bout of food poisoning decided to settle down in my weak digestive system. I take heavy antibiotics and recover...sort of. Now pretty much EVERYTHING upsets my stomach and even worse....I get chronic burping "attacks" all the time. I'm sickly in general- I get yeast, urinary tract, and sinus infections constantly. I get tested for all sorts of things like celiac and Crohns, but no dice. I do some research and find that PPIs might be causing some of my problems. Through looking at Pubmed I find out about a small study that effectively treated GERD with a low-carb diet. I try that for awhile, but using foods at the dorm cafeteria. I just end up feeling crappy... and no wonder with the factory farmed meat and gluten-laced sauces.
When I encounter Art De Vany's site through Marginal Revolution, I am intrigued by a more vegetable-heavy version of low-carb. I try it and it helps my IBS, but I'm still on the PPIs. When I try to go off I feel really terrible. I find a site where people tout apple cider vinegar as a cure. I start eating mostly paleo and taking apple cider vinegar diluted in water after every meal. I start eating a wide variety of vegetables and trying fish for the first time. It's not perfect, but I'm finally at the point where I can at least function without PPIs. I do an egg fast for a week. It takes about six months, mostly very low carb, but eventually I find myself...not taking any medicines at all.
A journey to get rid of heartburn fixed much more than that. At my worst I was on thirteen different medications and dependent on antibiotics every month. I haven't taken antibiotics in two years now...nor had to go to the doctor for IBS, GERD, or asthma. PPIs are hard to kick, but it was worth it.
My sister and my father have been sucessful with this approach as well, though they were lucky that they never took PPIs. PPIs alter your digestive system and it can be hard to get it in working order again.
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01/16/2010 - 14:40
I looked in the mirror with dismay. Right on my left eyeball was a blood vessel that had swelled to the size of a small red lightening blot. I knew I had been spending too much time on the computer, working on server migrations and slogging though the process of learning PhP. The effects were written all over my poor eye.
Last year I lived in Uppsala, Sweden and whenever I had such a problem with stress, I would always eat some seabuckthorn. I had gathered it from the agricultural school's garden, a free bonanza in the autumn of currants, apples, rosehips, and wide assortment of berries. As I child I had always loved the Edible Plants field guide, even though my mother warned me it was unwise to wander around and eat things from the yard. Since then I've learned enough about agriculture to know that your yard is probably a better and safer environment than where most grocery store foods are grown. But Sweden was a gatherers dream and I was immensely lucky to live there. It's downright prohibited in Sweden to spray in the forest and people regularly go there to gather wild mushrooms and berries. Unlike in the United States, where planting sterile trees is considered a wise thing to do because it prevents rotten apples from dirtying the streets, there were wonderful fruit trees everywhere.
In the autumn much of my food was free. I never managed to get much in the way of mushrooms given the competition for the beautiful yellow chanterelles and the fact that unlike the Swedes I had no experience in spotting them. Some of my Swedish roommates gathered bushels and bushels of that forest gold. The other major gatherers were the Thai immigrants, some who had come to Sweden expressly to be hired as gatherers for the various companies that sell wild products in Sweden. In the Uppsala Saturday market they sold them next to Thai specialties like sweet sticky rice wrapped in banana leaves. I usually bought my mushrooms from them and spent my time gathering apples and berries.
The berries were like free medicine, all of them not too sweet, but rich in medicinal and health-giving nutrients. Sea buckthorn was my favorite, a rather bitter berry, but a beautiful bright orange color with a creamy interior rich is delicate fatty acids. I ate them fresh and froze a store for the winter. I also gathered rosehips, which I dried, and a wide variety of currants. It was wonderful after class to just wander for hours finding these and always new surprises like a small withering looking tree that somehow managed to provide tiny golden plums with a unique musky fragrance. The apple trees in the college genetic garden were a goldmine. I remember my favorite, a tart apple with a pale dusky pink flesh. Tantalized, I went to the library and checked out all I could on wild edibles, ätliga växter.
Come colder months and I ate the frozen berries from my store, but when I ran out I simply bought wild berries at the grocery store. Once I treated myself to a box of frozen cloudberries, a rare beautiful mottled pink and orange berry I never did find in the wild. They had the most unusual texture: a mild honey-like sweet bursting flavor mixed with white "stones" that yielded to my teeth with a muted crunch. I also bought wild moose and reindeer often. I marveled at the fact that wild foods could be sold in any grocery store. In the US to suggest such a thing is to be told how the forests would soon be stripped of everything and the population soon crippled by terrible bouts of worms. But the forests in Sweden were verdant and the population far from sickly, had fewer cases of food poisoning than in the US.
Come warmer months and I bought gloves to harvest the nettles that feature in many Swedish recipes, either cooked and eaten as a green or dried to make tea. Back in New York nettles recently came up in a meeting as a potential candidate for our food education program, but most people were surprised that they were actually edible. They are nutritious and grow like weeds, probably because they are weeds. Actually, they are sacred as a medicinal and spiritual food in several cultures. It's a shame that more people don't consider them edible. They play a fairly important role in biodynamic agriculture, so it's possible that they will show up more and more at farmers markets as the biodynamic movement grows in the US.
Did I mention the wild onions and the wild strawberries, more delicious and wonderful than their cultivated cousins. I am always a little miffed when people say that wild fruits aren't sweet, because wild strawberries certainly are, though their lilliputian size keeps them from providing much in the way of total sugar.
But I realized later, after talking with more experienced Swedish gatherers, that my own harvest was the tip of the iceburg. I had missed cattails, hazelnuts, and sloes, but still had enjoyed quite a bounty.
Since moving back the US I had often missed this culture. The "forests" in the parks are fenced off from people, who are relegated to cultivated lawns sprayed with god knows what. American friends tell me that without those fences the park were certainly be destroyed. I now recognize this as part of the nature vs. man disease that afflicts so many Americans who view nature as separate and man as not part of it. With this philosophy being so prevalent, the only hope for wild foods is to know a good landowner who might let you gather and to learn how to hunt. I not only miss eating these foods, but the psychological benefits of enjoying nature. The same part of my brain that hunts php code for errors was hunting the forest for porcini.
Myself, if I stay in the US, I would like to have some sort of permacultured land. I have some tree catalogs and I often find myself perusing them, selecting in my mind the variety of chestnuts I would plant. At a permaculture workshop I recently attended, I even learned it is possible to grow a variety of kiwi this far north.
I write this because this morning I read an article featuring Ray Mears, an expert on primitivist skills, chiding paleo dieters for "pigging out on meat and pretending to have hunted it." One of my goals in this site and in my actions as a co-organizer of the Eating Paleo in NYC meetup group is to get people beyond this. So many paleo dieters think of it as just a way to lose weight and end up eating a bunch of chicken breasts, steak, and coconut milk ice cream. They not only miss out on nutrients, but on the overall holistic benefits of thinking evolutionarily and rewilding not only the self, but the world around you. I want to exhort people to think harder about where their food comes from, how much is out there that we should be eating and we aren't even thinking about whether its sheeps eyes or wild nettles, and how they can be involved in actual hunting and gathering.
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