Sunday, 3 July 2011

Response to Farewell to Paleo

Recently Don Matesz on his Blog "Primal Wisdom" announced a major change in his dietary philosphy in a post entitled, "A Farewell to Paleo". There was quite a response from his followers and from disemblers and it really got me to thinking.

The comments (some of them pretty harsh) reminded me that I had been mulling over a post anyway about self-righteousness. When people become converted from one life style to another they frequently repent of their past and at the same time become very judgmental. I am always more than a little concerned when we low-carbers complain about how we were duped by self-righteous scientists who "knew" (believed) they had found the truth (that fat is bad for us) and then we go on to become equally self-righteous about our own ideas of health. While Gary Taubes raises very good and (I believe) scientifically better-backed points, I think we should be wary of proclaiming we know the answers and pronouncing it sad that others are so deluded. A food nazi is a food nazi is a food nazi, to modify Gertrude Stein.

It is quite likely that people with different genetic backgrounds do better on different diets and thus there may not be one specific diet that is better than another. I tend to side with the common human physiology group that thinks there must be a general better way, but some of us have deficient genes and allergies and we don't process things as well as others. For this reason, I think it is a mistake to get on our high horses and to decry the lifestyles of vegans, high carb dieters, Zone enthusiasts, cannibals, you name it, etc. (Okay, well maybe cannibals! wink!)

First, we have to publicly admit, that the science in favor of low carb that Gary Taubes looks at isn't definitive - it may be, for example, that there are levels or types of carbs (or proteins or fats) that are processed in other ways than we currently understand and it could be, we simply don't
know how to distinguish them yet. There are many, many variables and we may not have stumbled on the correct combinations yet.

Mataez writes in his blog that despite having written a book in support of the paleo diet and having followed the life style for some 14 years, he can no longer do so. I would like to look at Matesz' points briefly one at a time because they relate to some questions I have been having about Low Carb. (Why it seems to stop working for some people, Why thyroids seem to become a
problem for some people, Whether allergies and mucous are related to a low carb diet, etc.)

Mr. Matesz' intro states:
I have endured increasing cognitive dissonance because the currently popular concept of paleo diet—animal-based, relatively high in protein and fat and relatively low in carbohydrate—
conflicts with empirical nutrition knowledge accumulated over the course of 5 thousand years in both Asian and Western medicine, including a rather large body of clinical and laboratory data
accumulated since the 19th century, all pointing toward humans being more adapted to a plant-dominated, high-carbohydrate diet supplying significantly less than 30% of energy from fat.

I've decided I don't think this is strictly true. For Asian Medicine, it may be
so, (and I will confess to being underinformed) but as we know from Gary Taubes' book Good Calories, bad Calories (in which he looks carefully (one might even say obsessively) at the research on weight loss, medicine of the 19th (and early 20th) century suggested that carbs were not good for us and that to lose weight we should stop eating potatoes, bread, rice, (starches and
sugars). Recent research also seems to suggest that carbs and sugars are also a problem, it is only a brief period in the middle of the 20th century when experts claim that a low fat diet is. (See Taubes, Chapters 2 and 3 particularly)

Matesz relates a list of ailments that have "returned" after a long period of paleo dining.

1. Dry skin/skin lesions
2. Return of Allergies/sinus/mucous
3. Abdominal distress
4. Irregular bowel movements/constipation (supposedly from lack of
5. Lipomas
6. Muscular stiffness/cramps
7. Anxiety Attacks
8. Chronic tension in the shoulders and neck.

He also chronicles problems experienced by his wife (Tracy ):
t1. Progressive weight gain
t2. Headaches and Tension
t3. Mitochondrial discomfort
t4. Constipation
t5. Fatigue
t6. Breast tenderness (premenstrual)
t7. Hot flashes/night sweats
t8. Bloating (a sign he claims of fat intolerance).

Both have changed their tune about the health benefits of the paleo diet. Tracy notes on one Paleo website, that "I've been transitionting into a full Paleo 'Cave Girl' since meeting Don last spring, and have greatly improved my health, especially extreme blood sugar swings. As a holistic healing practitioner, this diet is the foundation for lasting health!"

I think several very interesting and important issues are raised and I'd like to discuss them in terms of the aforementioned symptoms..

1. Dry skin is generally something that people say improves with addition of fat to the diet and reduction of carbs. (The Eades for example take up the issue of less dryness and improved skin in their book Protein Power). Often dry skin is also frequently associated with an under-active
thyroid something that has been associated with low carbing for some people. (It is difficult to know whether the low carb diet reveals the pre-existing condition or whether it is connected. A reduction in calories can result in the thyroid supressing metabolic activity that also masks a s a thyroid condition and because of the interconnectedness of all hormones in the body, when you monkey with one (such as insulin) you will probably affect the others.) A second reason why people get dry skin is aging. This too relates to hormones, because we produce fewer sex
hormones (androgen and estrogen especially) and our skin gets drier. It may be that the dry and itchy skin is simply a result of aging.

2. Allergies / sinus / mucous - I am also having this problem and find this the most interesting aspect of the blog. I have been reading the Eades' work on Protein Power and note that they say that some people have reactions to the arachidonic acid in red meat and eggs, this
might relate to the problem Matesz mentions here.

3 & 4. I personally have never had this problem even when eating primarily meat - Both the Eades and Taubes cite the experiment of Vilhjahmur Stefansson and Karsten Anderson showing improvement in health on a diet of red meat alone. The Eades suggest that diarrhea is more likely issue, so I wonder if something else is going on. (see below) A commenter on the blog, Diana, claims to have almost died from doing zero carbs (eating absurd amounts of fat and protein only). One wonders, however, if she was getting sufficient protein to sustain her bodily functions and whether she also restricted food intake too severely or some other health issue at the time - it is impossible to know without further information.)

5. Lipomas - a commenter points out these are usually considered genetic and that noticing one 5 years after being on a particular diet and then that it has gone away 6 months later when a different diet is applied leaves room for a lot of other variables to play a role - I just don't know about this one.

6. Muscular stiffness (also I'll include here all of Tracy's symptoms (except Mitochondrial discomfort which I don't know what to make of either since as someone points out Mitochondrial discomfort is not something that one is generally able to "feel")). What does one make of muscle stiffness as a symptom? I certainly experienced it and night cramps. A commenter on Mataesz' blog notes that aging causes increased stiffness in the muscles. Matesz tells us he is in the second half of his 50s and although there is no age listed for his wife, I believe from looking at her picture that she may be of a similar, if perhaps slightly younger age. I am not trying to make this personal, but it suggests to me that Tracy is probably facing menopause. There is no doubt that hormonal interactions are very complicated and that carbs affect insulin production and insulin production affects other hormones and vice versa. If one hormone changes then all the other hormone amounts and production can be modified by the body. I learned this when hitting menopause and doing low carb at the same time. Personally (and anecdotal evidence is not scientific, but it MAY be instructive), I discovered that taking magnesium supplements relieved me of night time muscle cramps and stiff muscles in the morning. The Eades also speak of potassium deficiencies as a common occurrence for
low carbers (especially at the beginning). This begs the question of whether something about a low carb diet is insufficient (because of the insufficiency of these minerals). As far as the menopause symptoms (and even the dry skin mentioned above which for women is
also a symptom of menopause) I hardly think that low carbing should be blamed for this. In fact most of the women I know who have horrible symptoms, have improved greatly when moving from a high carb diet to a low carb one. When I got replacement hormone (testosterone, estrogen, and progesterone) therapy, my thyroid problems cleared up completely and I am no longer having thyroid problems on a low carb diet. (YMMV.) Too severe a reduction in food amounts can cause the thyroid to suppress the metabolism, but it is unclear if there is serious damage at stake here as a result of low-carb diets, so I think we need more information.

7-8. Anxiety attacks, chronic tension (also Tracy's t2) - Hmm,.... I
wonder if this isn't part of the problem - it sounds to me like Mr. Matesz is having tension/stress issues aside from diet (I guess this could be caused by the cognitive dissonance he mentions above, but more likely this seems like it is external to his diet.) Maybe not, though - I do know many people who claim to have less night anxiety after moving to low carb, so it seems like it could be a result of allergies or a sensitivity to arachidonic acid mentioned by the Eades (p 97 Protein Power). Many of the symptoms that Matesz mentions are listed by the Eades here as a problem for individuals sensitive to arachidonic acid. "If you suffer from elevated blood pressure, elevated cholesterol, marked fluid retention, or inflammatory conditions such as arthritis, bursitis, asthma, allergies or skin rashes, you may want to limit your intake of red meat and egg yolk somewhat." Thus many of Matesz' symptoms could be clarified, the allergies, the bowel issues (Increased water retention might explain constipation (not enough water for flushing the colon,)) and the skin issues. Of course things may not be that simple since as far as I can tell, arachidonic acid is manufactured by the body and almost all forms of animal protein contain it. Seafood evidently tends to have less and thus Mr. Matesz' improvement by going to a more seafood based and reduced protein diet would make sense and would support a move away from the Paleo diet (maybe for everyone, but especially for individuals that are sensitive to arachidonic acid).

Anyway - for me the bottom line is that most of Mr. Matesz' evidence is anecdotal and does not have enough isolation of variables to indicate that the low carb diet is the actual problem. He bases some of his argument on Paleo's inconsistency with Traditional Chinese Medical tenets. I have respect for Traditional Chinese Medicine, but so far it has not been helpful tome in terms of weight loss and insulin regulation. Without controlled research studies to support Matesz' viewpoint, I will wait to act.

Here are some interesting aspects that I have taken from Don Mataesz' blog:

1. I was very interested by what some commenters wrote about gluten grains versus other carbohydrates and will watch to see if there is any important distinction to be made there in terms of blood sugar and insulin response.

2. As noted above I am curious as to whether certain mineral imbalances are inherently a problem with this diet (magnesium and potassium in particular).*

3. I also found the comments about Ötzi the alpine Neolithic man who had evidence of milled grain in his colon interesting, because it undermines part of the argument about paleolithic diet and how long we have been adjusting to digestion of grains. I suspect that a certain amount of grain carbs is actually okay as long as one hasn't damaged the system by repeated excessive carb input. Probably Cut the Carb's Hans Keer's 15-30 % carbs in the diet is not unreasonable given a healthy digestive and circulatory system (?)

In the mean time, I do not belong to that healthy group, so I am remaining very low carb. I am currently losing weight and will stick with the very low carb program.

*I may have found an answer to the question of magnesium deficiency - Dr. Eades just addressed it on a recent blog post. He suspects that our filtered and treated water has far less magnesium (and other minerals) than we would be drinking if we got our water from nature.

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