Sunday, September 28, 2008

Physiological insulin resistance: The devil in the Prada.

On the surfing trip to Devon we watched The Devil Wears Prada on DVD. The best line for me was the fashion waif screaming at the heroine, with the deepest insulting angst:

"and you eat CARBS"

Well, it made me laugh. What made me think a little more was the same character talking about her latest diet, I paraphrase only slightly:

"My new diet doesn't of course include any food. I simply don't eat until I am about to pass out from hypoglycaemia and then swallow a small cube of cheese"

This was used to maintain the skeletal look so prized in the world of high fashion. Assuming the whole of the film is utterly true to life (except perhaps the too good then fashion corrupted heroine), I started to think about the physiology here, and about the physiology of that life threatening illness, anorexia nervosa.

Now, anyone of us relatively normal people on a lowish carb diet will never become hypoglycaemic. If we don't eat we just convert the stored triglycerides in our adipose tissue to non esterified fatty acids in our blood stream and use these to fuel our muscles. The glycerol from the triglycerides is half a glucose molecule, we can join two of them together to make glucose. Filling muscles with palmitic or stearic acid makes them insulin resistant enough to spare glucose and so maintain an adequate plasma glucose concentration to keep our brains working. Brain tissue cannot suck glucose out of plasma. It gets it by diffusion down a concentration gradient. You need at least 3.0mmol/l in your plasma unless you are in deep ketosis, when you can get by on a shade less.

But fashion waifs clearly can get hypoglycaemic if the script of the film is true. They are comparable to, or thinner than, anorexic patients. Here are the patient details of a group of ten anorexic patients. Note the % body fat in the anorexics is 4.1%, but we don't get the range. Some of these women will have body fat percentages well below 4%. Blood glucose averages below 4.0mmol/l and insulin is low. Click to enlarge.





They are not insulin resistant by HOMA-R guesstimate. They are starving yet they are exquisitely insulin sensitive. No one thought to measure their non esterified fatty acids.

What would happen if a healthy human being, such as the women in the control group with a body fat around 20%, were to eat nothing until they needed that cube of cheese? They would release NEFA from their fat, become insulin resistant and keep their blood glucose at physiological levels. They might LIKE some cheese (me too), but eating it to raise blood glucose is not needed.

Fashion models and anorexics do fast. But they have no significant body fat and their silicone implants (you have to put something in the bust of the clothes) will not release NEFA. So they can't release enough palmitic acid from their non existent adipose tissue to induce insulin resistance, so will be hypoglycaemic enough to faint if they were to move their residual muscles enough to soak up their blood glucose.

They have similar body fat % to patients with lipodystrophies such as Berardinelli-Seip syndrome which deprives people of all adipose tissue, but there the similarity ends. BS patients eat but can't store energy in fat cells so dump it in their muscles (plus anywhere else they can put it!) and become so intensely insulin resistant they become diabetic. Anorexia patients have no fat but lots of empty adipocytes and empty muscle cells, all aching for calories of any sort, glucose included.

The fashion waifs have no glycogen in their liver and no protein in their muscles (you know the look, where upper arm is thinner than the elbow, lovely). Dropping in some saturated fat from the cheese will allow transient NEFA production and the protein will allow a spike of gluconeogenesis. Blood glucose under these circumstances then rises to a level which transiently restores a semblance of brain function.

So there ARE situations where saturated fat (plus some protein) can be used to raise blood sugar. I would strongly suggest no one ever gets in to such dire straits!

Peter

44 comments:

Belmondo said...

Hi Peter, and thanks for the fascinating blog. Now on the topic of anorexia, I'd love the hear your opinion on this "serotonin-theory" of anorexia:

http://www.ncbi.nlm.nih.gov/pubmed/18164737

I have to admit, some of it is beyond me (not an englishspeaker), yet on the whole it sounds credible. I'm of the opinion that excess carbohydrate can cause "depletion" of brain serotonin, but haven't seen any sound proof. What's your take on this?

Keep it up,
Johan

Peter said...

Hi Johan,

I think serotonin resistance, or down regulation of responsiveness, in response to repeated spikes of tryptophan induced by carbs/insulin is the most likely. Ditto depression.

Intravenous heroin downregulates opioid responsivenss. Happiness becomes only possible through the drug. Sugar induced 5 HTP downregulation, as a trigger for anorexia, seems quite plausible to me.

Peter

Anna said...

So, those poor Potatoes, Not Prozac believers are on the wrong track, yes?

Peter said...

Yes Anna, their logic is as good as taking a sulphonyl urea drug for type 2 diabetes

Peter

ItsTheWooo said...

Loved that movie, I did LULz at those lines.

Very interesting perspective Peter!

Personally I think all hypoglycemia is similar. It is possible for low carb or overt fasting to cause hypoglycemia even in people without depleted body fat and the mechanism is probably similar as it is for the anoretics with depleted body fat - a mismatch between insulin production and glucose/fatty acid levels. If anoretics didn't eventually develop relative hyperinsulinemia, they would follow a course like type 1 diabetics. Relative hyperinsulinemia is always what stops weight loss.

First, there's the case of hypoglycemia in fasting people who are *not* at an extremely depleted body fat. For example, it's common for a young girl with a bit of a belly/IR to do a strict carb-free or fasting diet for image reasons, but she finds herself faint and lethargic even well into the adaptation period.
She has plenty of body fat, but there is an overproduction of basal insulin that keeps her on the knifes edge of hypoglycemia at all times. I think there is a subset of obese people who have a poor tolerance to fasting due to insulin hypersecretion which is unrelated to carbohydrate; I think I belong to this class.

Anyway, I think all fasting hypoglycemia is mediated by this slight insulin overproduction... anoretics may produce just a hair more insulin than they need, even thought the anoretics have no insulin resistance at all.
This insulin overproduction is worst after eating for any starving person. This, at an extreme, causes refeeding syndrome.

Refeeding syndrome can be considered nothing more than a kind of tidal-wave form of hyperinsulinemia/hypoglycemia. The starved body is depleted of electrolytes, the basic components of metabolism. When food (esp carbohydrate) is reintroduced too quickly, the dirge of insulin ushers electrolytes (as well as sugar) out of the blood, producing life threatening consequences.

Anoretics, any starving person really will be plagued by hypoglycemia and it's usually worst after eating anything at all because starvation sets the body up for insulin hypersecretion in response to food. This makes sense physiologically (insulin makes stuff grow like muscle and fat). It shouldn't bee too life threatening in a hunter-gatherer world where the food eaten has veyr little potential to increase carbohydrate metabolism or decrease phosphate dramatically... but can actually be life threatening if you are an anorexia nervosa sufferer who is trying to recover on agricultural product like bread, cereals and ensure drinks.

Lauren said...

I'm new to this board so please excuse me if this has been discussed.

I've been reading about how some people do poorly on LC diets because of low levels of serotonin.

Can anyone explain the relationship of serotonin levels, insulin levels, low carb diet, etc.?

Connie said...

Whoa not so fast Anna and Peter.

I used Potatoes not Prozac program to get *off* physiologic and psych dependence on addictive carbs. Done as written, the program reverses the downregulation of receptors that makes one dependent on drug-like carbs (not only 5HTP but endorphins). The carb amounts of the program can be targeted for the person, and the potato is an intervention, not forever.

Soo... I think it can be an appropriate tool for carb addicts.
From SAD to PnP to OD is a very body-friendly progression or has been in my experience.

(As opposed to the shock and crash of going from one extreme to the other, in the Stalinesque central command manner)

Peter said...

Yes ItsTheWoo, I can see this. That's probably why the choice is cheese rather than a cookie. Always accepting it may be an accident of carb phobia and the film script...

Oh, and I enjoyed the film too.

Hi Lauren,

Any more details about people who do badly on LC? It's really the failures who teach us the most. For me to eat LC and say I feel great, well, so what, shrug... But failures; now they're teaching items! More info?

There is little about insulin/serotonin and carbs here

Peter

Peter said...

Hi Connie,

Point taken. Should read the book (which I haven't) before commenting on it.

Peter

ItsTheWooo said...

Regarding serotonin and eating disorders... anorexia nervosa susceptibility is associated with serotonin excess and dopamine deficiency. This produces the character traits of anoretics (emotionally restrained, anhedonic, perfectionist, inhibited and harm avoidant). Starvation (and low carb dieting BTW) augments dopaminergic activity and decreases serotonergic activity. This works a little bit like wellbutrin or adderall for them (not for normal people with normal serotonin, just for people with too much of it).

Disorders featuring binging/purging such as bulimia nervosa involved heightened serotonergic neurotransmission with unstable and often deficient serotonin levels. This produces a personality which is in some ways similar to the restrictive anoretic (perfectionism and obsessionality due to more sensitive serotonin system) ...but in most other ways the personality is exactly the opposite of the restrictive anoretic (extreme behaviors with novelty seeking, emotional extremes/feeling chaotic moods etc).
Basically, your typical bulimic has crazy unstable moods, probably borderline personality or bipolar disorder, she has more dopamine neurotransmission at a baseline and serotonin is unpredictible and unstable.
Binging occurs during a serotonin low, when thoughts are racing and chaotic and mood is deeply dysphoric. Purging is a response to excessive dopamine, as dopamine produces nausea and a feeling of discomfort after eating (many antiemetics actually work by blocking dopamine receptors).

Above all else, vomiting is about dopamine excess and binging is serotonin deficiency... starvation is about serotonin excess and dopamine deficiency.

Lauren said...

Hi Peter,

Here is a link to Judith Wurtman from MIT claiming that carbs are necessary to maintain serotonin levels for effective dieting and good mood.

http://web.mit.edu/newsoffice/2004/carbs.html

The following is from Barry Groves' site:

Serotonin and tryptophan

To understand why this happens, you need to know a bit about how the brain works.

The brain is a vast network of nerves among which messages are sent. The biochemical messengers – chemicals involved in the transmission of nerve impulses between nerve cells of the brain – are called neurotransmitters. There are about forty of them. Among these is one called serotonin, which plays a crucial role in controlling states of consciousness and mood, particularly promoting sleepiness and relaxation.

The body manufactures these neurotransmitters from amino acids it gets from the food we eat. Amino acids are the building blocks of proteins. Tryptophan, an amino acid found in protein derived from meat, milk and eggs, is the precursor of serotonin. Serotonin levels in the brain are increased by eating pure tryptophan. However, when a protein meal is eaten, tryptophan must compete with all other amino acids for entry into the brain. But tryptophan is relatively scarce in protein foods in comparison with other amino acids. As a result only a small amount makes it into the brain to be converted into serotonin.

Carbohydrates

Carbohydrates don’t contain any tryptophan. You might assume, therefore, that eating sugar will have no effect on serotonin production. In fact the opposite is true. Meals rich in carbohydrates and low in protein, increase serotonin levels.



I'm interested in this and also itsthewoo's post because LC has kept me symptom free from bulimia most of the time but every few weeks I get instense cravings and end up eating a few bowls of cereal. I've been wondering if it's because my serotonin levels get too low and I attempt to deal with it through a carb binge.

If this is the case, how would I manage the benefits of LC/OD with the need to deal with low serotonin?

Connie said...

Wurtman's article describes what people feel when they go low-carb suddenly, while their serotonin receptors are downregulated. If they wait for a longer adaptation period, the receptors will adjust.

(that's why there's a 2-3 week adjustment period when changing ADs too. re-regulation happens at the speed of growing things.)

I think the research on serotonin status with a high-fat diet is like all the other research with high fat diets - not there.

Lauren - there is more to bingeing than serotonin. The endorphin/dopamine axis is in there too. Have you noticed an association of binge with huge endorphin-generating events? Or is the 4-6 week binge cycle a gradual predictable thing?

If it's gradual, then maybe it's serotonin, and you could try tewaking carbs (gasp!) to see how your body reacts. Not a lot of them. Like the OD tweak Peter mentioned where JK says have carbs in the evening.

If it's endorphin-related that would be a different deal (too long for here).

I speak from binge experience myself just so you know.

mtflight said...

This is very enlightening! So that's why we don't get lightheaded if we skip a meal or two.

Did you by chance get my comment on the Atrial tachycardia and fibrillation post? I'd be interested in your opinion.

Thanks!

GK said...

You wrote, "...The glycerol from the triglycerides is half a glucose molecule, we can join two of them together to make glucose."

Sorry, I am getting confused. Is this a guess or a known fact glucose metabolism? I ask because I thought that in the absence of dietary carbs, glucose will be obtained from protein breakdown (gluconeogenesis). Is this a second metabolic pathway?

Lauren said...

Thanks Connie. It does seem gradual and predictable and I will go ahead and eat a few complex carbs before bed to see if that helps.

I've been eating a near zero carb diet for a number of months and I suspect that my less than 20g of carbs per day is just too low.

I would love to see a study of serotonin levels on the OD- maybe someday.

ItsTheWooo said...

Lauren - I sometimes get a "low serotonin" states, it is a distinct state of very unstable moods (one minute happy, the next minute dysphoric) and there is usually lots of hunger, impulsive or rageful behaviors, and insomnia.

What I do in that situation is attempt relaxing behaviors, like isolate myself in a room, read a book, dim the lights... this will help calm the intense storm inside that can lead to regretful behavior. A long walk listening to headphones is another good mechanism to cope. White noise is a blessing - whirring fans, running water of a bath, in fact steam itself can help raise serotonin. The chaotic impulsive emotions that cannot be kept in check by deficient serotonin is the cause of so much self destructive behavior. Isolation, zoning out, tuning out, white noise, anything distracting and numbing will help the impulse.

5-htp is a great cure too which i take as a last resort (explain later why). It produces this sleepy, calm, enorphiny, melatonin-blitzed "just woke up" feeling for me.
I think I metabolize serotonin rather quickly and I tend toward melatonin excess if I"m not careful (my depression on carbohydrate was probably mostly related to very low dopamine, with low but relatively high serotonin, and melatonin dominance). When I get melatonin dominance it is like serotonin deficiency x10. I become a raging emotionally chaotic beast with thoughts of suicide. I can't even take pure melatonin pills without going insane the next day. So I use 5-htp with caution, but in the short term it's awesome.

My personality is very much like a restrictive anoretic, I've had a past issue with a mild restrictive eating disorder so my issues are mostly more like that... but there are definite "serotonin unstable" traits to my personality too so I know how that is.

If a binge cannot be avoided, it is best to crash land safely into protein and fat. When I get like that, I let the monster lose on meats and salad vegetables. I don't know if this would be helpful for you with bulimia, since I don't have a significant problem with binging / purging... but it does help me when I get into a binge space.

BTW, regular sleep rhythms are hugely important for people like us with unstable neurotransmitters. Many bulimics have a form of borderline personality or bipolar disorder... the chaos begins when we lose sleep.

ItsTheWooo said...

Actually there is a lot of research which shows that serotonin biosynthesis decreases when insulin does... this would include a low carbohydrate diet (which is low enough to be effective, as effectiveness follows insulin/glucose pattern). Serotonin is really overhyped as a "feel good" brain chemical. It's more appropriate to call it numbing rather than antidepressant. Of course adequate serotonin is necessary for euthmia but serotonin is hardly one of those dose-related things like "the more you have the happier you are".

Most of america is a good example of serotonin dominance. Numb, lazy, apathetic, drugged out, crap for attention span (either hyperactive or inattentive types relate to carb-induced low dopamine)... and depressive. SSRIs don't even work by increasing serotonin. Good evidence shows most people feel worse when they start SSRIs (hense the black box warning on them that risk of suicide increases initially). They work by changing receptor concentration, allowing the brain to heal via stress suppression, and disinhibiting dopamine through higher endorphins.

Binging does definitely implicate more than deficient serotonin... high dopamine-stress must be present. The pre and intra-binge is a state of intense dopamine-driven excitement. Thoughts are quieted and the brain is numbed post-binge when glucose and insulin surges once digestion begins. Peripheral high dopamine leads to intolerable feelings of nausea and discomfort, as well as psychic guilt/dysphoria (mediated via abnormal serotonin receptor concentration/types). This mental and physical malaise can prompt very strong urges to purge (compulsive eaters and pure binge eaters are different from bulimics in this sense; people who keep it in don't have very high dopamine and their serotonin receptors are not patterned in such a way as to promote an obsessional, perfectionsitic, moralistic type personality).

Lauren said...

Wow. Thank you itsthewoo. My head is spinning.

So this is something to manage with behavior (isolation, white noise, enough sleep, etc.) rather than diet.

"If a binge cannot be avoided, it is best to crash land safely into protein and fat. "

This has helped some. It's what I've been doing most of the time. I overeat meat and veg and that seems to keep me from a binge/purge most of the time. There are other times however when I just can't seem to hold it.

"obsessional, perfectionsitic, moralistic type personality" This is definitely me.

"this will help calm the intense storm inside that can lead to regretful behavior" - I've chosen an isolated office at work to minimize the damage. It is a relief to read your posts- to know that there are reasons behind the feelings and behaviors.A lot of this is new to me and I'm letting it sink in.

Thank you for your posts.

Connie said...

(hey sorry Peter we seem to have hijacked the topic!)

Right Lauren, I get slow depletion of serotonin on 20 g carbs also. 40-50+ quality whole food carbs is great though.

My favorite treatments of the affect of carbs on brain chemistry:

- DesMaisons' Potatoes not Prozac
- Richards' Leptin Diet (weirdly enough)
- Schwarzbein's second book
- Lights Out ! Sugar Survival etc

They contradict each other (they interpret the unsettled science through their filters?) - but it's fun to put together the picture FOR YOU from all these.

Sue said...

Wow, great post and great comments.
I've got a question about fasting. Would a 3-day water fast for someone who has LOTS of fat stores result in usage of the fat for energy or will it mostly come from the protein in the muscle. I suppose it depends on the person? Also, if you go from eating high carb to fasting I presume it would be harder then going from low carb to fasting?
Itsthewoo said it here:
"She has plenty of body fat, but there is an overproduction of basal insulin that keeps her on the knifes edge of hypoglycemia at all times. I think there is a subset of obese people who have a poor tolerance to fasting due to insulin hypersecretion which is unrelated to carbohydrate"

Lauren said...

Thanks Connie. I will head to the library and check out those books.

Yes, sorry for the hijack Peter.

Peter said...

Hi all,

I'm learning here. Several comments suggest that going to zero carb is not beneficial to your neurotransmitter systems. I can buy that. Potatoes are undoubtedly one of the preferred carb sources on the OD, and if 40-50 grams produces better mood than <20g/d, there's another reason to follow Lutz, Groves or JK, rather than the more extreme Atkins induction or fully meat only protocols. Fine for some, not for all. For those with relatively stable appetite, like myself, drifting in and out of mild ketosis seems no big deal.

Lauren, I disagree with Judith Wurtman about needing carbs for happiness, or rather, using carbs to spike serotonin. I'd still draw the parallel with heroin (an endorphin mimetic); a single IV dose may make you feel good (and vomit), taking more to deal with the crash afterwards is not the way to go. It stops working. I've mentioned Mark Johnson's autobiography "Wasted" before. He "obtained" an unlimited supply of heroin and crack cocaine (a dopamine mimetic) and simply mainlined both until he couldn't even obtund the withdrawal syndrome with an unlimited IV dose of the mix. At that point he stopped doing drugs and survived.

Connie, yes, the science of LC diets is in its infancy. The science of LC, adequate protein (without using it as a calorie source) and high saturated fat nutrition while avoiding driving yourself in to ketosis is not even on the radar, let alone the drawing board, of mainstream yet.

Hi GK: Glycerol for gluconeogenesis, yes it happens.
http://jcem.endojournals.org/cgi/content/abstract/75/3/789

Alex, yes but it's slipped through to "do it now" net. WPW is undoubtedly accepted as a piece of aberrant wiring that can be burned out with a RF ablation catheter. So not diet related. But that's pretty well the approach to AF or flutter. The denial of diet affecting AF is, of course, wrong. I never got round to googling PSMF until just now and I think it basically comes back to avoiding crash dieting, eating real food and keeping on the edge of ketosis rather than plunging waaaaay in at the deep end on day 2 or 3 of a major diet change. Discussions like current thread about the need for some carbs, but not too many, for serotonin stability keep bringing me back to JKs carb recommendations. My guess about the "revelation" of WPW in your friend would be deep ketosis, raised sympathetic tone through stress response and improved conduction through the re entry pathway facilitated by the increased sympathetic tone. The three people I know with tendencies to AF all eat low but not ketogenic levels of carbs and are doing fine. None went anywhere near PSMF.

Also watch the acute electrolyte changes as you mentioned with sudden very low carb approaches. Low potassium predisposes to rhythm abnormalities.

You're getting the impression, like I am, that too low doesn't suit us all..... Whole foods, about 40-60g carbs per day. View it as a way of life rather than a diet. I wonder what I would have done, long term, if I had dropped in to WPW on day three of Atkins induction?

ItsTheWoo:

"Actually there is a lot of research which shows that serotonin biosynthesis decreases when insulin does... this would include a low carbohydrate diet (which is low enough to be effective, as effectiveness follows insulin/glucose pattern)"

So here is another role for physiological insulin resistance. The fasting level of insulin should never fall as low if your body is producing NEFA effortlessly as there will still be a little glucose around to stop the pancreas going in to overdrive... I've seen just one study linking very low fasting insulin levels to poor overall mortality. Of course this was probably not a LC eating cohort!

Connie:

"Right Lauren, I get slow depletion of serotonin on 20 g carbs also. 40-50+ quality whole food carbs is great though"

OK, there is a pattern here. That 40-50g/d of carbs... JK never tells you why. He's just usually correct.

Sue, you've mentioned ItsTheWoo's comment about inappropriate over secretion of insulin. There has been talk in comments in the past about the failure of cross talk between insulin secreting cells and glucagon secreting cells. Failure of glucagon secretion due to amyloid obstructing the cross talk produces failure to modify the hypoglycaemia of a poorly judged insulin surge. Many people secrete poorly regulated amounts of insulin in response to several substances. Not least vegetable (or pharmaceutical) derived salicylates and industrial food derived free glutamic acid, even bone broths if you are unlucky. That's more Emma's blog stuff. Her refs are good.

ItsTheWoo, interesting comments about melatonin. We had good results with melatonin and 100% blackout blinds while my wife was working as an intern. You may or may not know what it's like to do 2 weeks of night shifts or how hard the average intern works. As she finished her internship the poor person taking her place dropped straight in to the night shift (someone has to) and was 5 days without sleep when we left her our melatonin supply. Plus a room heater (interns need warmth? Wow, there's a revelation, interns need warmth AND sleep???? Greedy). The new intern emailed thanks for the "magic" tablets. They work well for some people. Oddly enough the few times I tried them, I slept really well, woke feeling great, but never wanted to make any sort of a habit of them. Just didn't want to. I sleep well anyway...

Phew.

Peter

Christie said...

I think I've followed most of the comments. Very interesting. I'm a newbie to LC dieting and have had on-going, low-grade depression. I started LC at the end of August. Most years by this time in September I experience lows that I have previously attributed to SAD and the changing of light. But this September has been vastly different from every September of recent memory. No lows!

The best I can figure, I've had a pattern of summer eating that reduced my carb intake (more vegetables, less baked bread as it heats up my house) followed by increased carb consumption as the cooler weather returned. But this year my doc said to eat LC. And my moods are stable. Wonderfully stable!

BTW the biggest symptoms of my depression have always been irritability and fatigue. I'm beginning to think that my depression has really been carbohydrate addiction/reaction all along. What a revelation!

ItsTheWooo said...

Hi again,
Sorry for the lengthy comments as well (terrible habit, really got to work on this).

I think when serotonin decreases as part of a LC diet, this actually provides beneficial changes in mood and alertness for most people. I think eating too much protein can cause serotonin to drop too low, but if one is eating a proper diet (50g carb high fat) all of that can be avoided. I eat 60g carb, perfect.

Oh melatonin works fantastic to put me to sleep. The problem is the next, or two days after I've been using it... I go crazy, and in a specific way that I used to when I was on carbs. I think it is melatonin dominance leading to serotonin and dopamine suppression. Of course I am slightly bipolar and have mood disorders so this might be why I am so sensitive to it (bottle actually says "don't take if yer a bipolar crackpot").

That's why I like 5-htp. It works just as effectively as melatonin for sleep (possibly because I metabolize serotonin quickly) but it doesn't cause the massive imbalances that have me insane (becaues it raises serotonin and melatonin together).

My sympathy for ms hyperlipid, being an intern sounds quite insane... I could never do it, ugh. At least she has your help to figure out the good natural cures for stuff :)

I'm very interested in this salicylate/food sensitivity thing ... could easily be part of the hypoglycemia picture for me.

mtflight said...

the problem with supplementing melatonin or anything else for that matter is that melatonin supplements atrophy the pineal gland, the same way that taking thyroid hormones shuts off the thyroid.

"Lights Out: sleep, sugar, and survival" is a good book if I can ever get around to finishing it.

Thanks for the reply Peter--good one!

Sue said...

Itsthewoo, do you take your 5HTP in the evning with or without juice? I think LaValle recommends taking it with juice.

Sue said...

This is what I was talking about:
"It’s important to take 5HTP on an empty stomach, thirty minutes before bedtime, along with 4 ounces of grape juice. The juice helps 5HTP cross the blood-brain barrier and pass into the brain, where it turns into serotonin."

team smith said...

so since depression has been brought up...i just discovered something regarding my depression--tell me if i am on the right track. the last couple of weeks were horrible for me--i felt almost as bad as 3 years ago when i was total SAD eater and carbaholic. i was dreading this b/c i have been LC/OD for at least 6 months now and had been doing great.

i looked at what had changed and the only thing i noticed is that i quit taking my magnesium supplements out of sheer laziness and i think i just got way imbalanced. i eat a lot of dairy and then meats, fats and only a few veggies and of course, potatoes. there is no magnesium in these foods.

so i checked out "Miracle of Magnesium" from the library and lo and behold there was my answer! also has a supplement protocol for Raynaud's, which i also have and have been trying to figure out how to get rid of for many years, so i am trying this as well.

the little bit of dietary advice in this book is not great as they advise the same ol' same ol. but what do you all think about the LC diet being deficient in magnesium? so far i am doing better after reinstating mag into my regimen and i will continue since i really hate feeling the way i did last week!

thanks, amanda

team smith said...

i should also say that i started taking 5-htp also after reading "Miracle of Magnesium" and it suggests to take one capsule 1/2 hour before each meal and then one 1/2 hour before bedtime on empty stomach. do you think this is too much and if i don't take it with juice it won't do any good?

this is for anxiety, too, which i have had/have huge issues with!

thanks, amanda

Connie said...

Macadamia nuts are great for magnesium.

you folks taking 5HTP - I got great results, for both anxiety and depression, just with timing a potato ala PnP and letting my body work out the levels.
It makes me nervous to take non-food doses of isolated nutrients like that...

ItsTheWooo said...

Sue - Insulin will always help raise serotonin, but it is not necessary for me to have the 5-htp work. I ususally take it with a light low carb snack or nothing.
5-htp can cause a small spot of hunger since it does affect insulin a smidge after... but it's nothing that a little bit of food can't fix.

Shortly after taking 5-htp it's a bit as if I just took a percocet. I want to lay in my bed, enjoy the feeling of the breeze or sheets against me, listen to music and drool off to sleep. No post-melatonin next day crazies either although I might be slightly groggy in a "just woke up from a nap" pleasant way..


Hi amanda - I think the solution to magnesium on low carb is simply to eat lots of nuts. I eat about 2 oz every day and it has fixed a LOT of issues for me.

People are afraid of nuts, not sure why, I guess they remind of junk food like chips?

A lot of the websites and books recommend ridiculous doses of 5-htp. Personally I notice an effect after 1 capsule, it's very obvious, and if it's not then 2 capsules is even more obvious... I think on a low carb diet we are much more sensitive to the effect of pretty much everything, carb eaters might need the mega doses though. I would feel like a tranquilized zombie if I took 5-htp throughout the day. Best to take it before bed.

ItsTheWooo said...

BTW, for depression specifically, I have had fabulous results with the herb st johns wort. A nice side effect of SJW is that it helps keep my glucose under control (possibly a secondary effect of higher serotonin/dopamine, but some evidence suggests the herb itself helps increase glucose use in the body).
When I tried to wean myself off of SJW not only did I develop depression gradually but hypoglycemia was pretty outrageous.


I love SJW. Magical stuff, helps lots. 5-htp is more calming and balancing whereas SJW Is frankly antidepressant and energizing.

Sue said...

Thanks for that as I didn't want to take 5HTP with juice.

ItsTheWooo said...

BTW, a lot of research suggests that bulimia is related to depression, esp bipolar type, and getting control of depression makes a huge difference in frequency of binge and purge symptoms. Lithium and other mood stabilizers/antidepressants invariably show a reduction in binges of like 50% or more over placebo.

So, I just thought I would contribute this to the discussion... the bulimia is a disease, but apparently it is also a symptom of depression. It might be more prudent to focus on the primary affective disorder and life stresses.

Connie said...

"primary affective disorder" and "life stresses" ?

In my experience, fix the nutrition (remove the poisons) and the problem goes away 95%. The rest of the 5% is old habits and they fade away without the biochemical underpinnings.

"it's not what's eating you, it's what you're eating"

See also the sections in Taubes' Good Calories, Bad Calories on turning physical feeding behaviors into psychiatric ones in the last 50-60 years. Especially the parts about Le Magnin.

Interesting experiential factoid: we once ran an informal survey on about 300 people with some kind of ED who had been in treatment programs. ALL reported that they'd had a period of lack of nutrition before the behavior started. (lack of nutrition as we now know is healthy, that is - lots of SAD)

And NONE of the treatment programs asked what people had been eating before the onset of the behavior. Just as a data point that the ED world was not looking at nutrition then (15 years ago)

Not to downplay the work of getting back to health of course. MDs and shrinks and NDs and behaviorists can all help.

Lauren said...

When I think about all of the time I've wasted treating my eating disorder as a psychological problem, I feel regret.

Changing my diet has in fact cured my bulimia 95% and I agree that last 5% is habit and/or maybe a brain chemistry problem.

I also used to wake up every night, NEEDING to eat. At home, I got it down to eating apples (pre cut) and cheese but in years past it was cookies, cereals, etc. I hated sleeping at other people's houses because I would raid their cabinets and feel awful the next day.

I read everything I could on "night eating" and all suggestions were psychological or pharmaceutical in nature and none of it worked for me.

Since going high fat/low carb, the night eating (and night sweats) are COMPLETELY gone. This problem had plagued me for 15 years or more!

I hate to think that it is as simple as eating the right diet but I have made more progress in the last year than I had in the previous 30.

ItsTheWooo said...

I completely agree that eating disorders are overwhelmingly nutritional... but I also think mood disorders play a role. I speak as someone who has had disordered eating too. I used to weigh 280 lbs (5'5) and I got down to 104. I know in myself, my mood disorder played a big part in all of my problems with eating... but then again, my nutrition also profoundly affects my mood. It's impossible to separate these three things, but that doesn't mean that one absolutely causes the other.

What I mean is, I think it is a little naive to assume all mood issues are caused by food. I still have mood issues now, they're a lot better. I probably always will. I have a ton of mental illness in my family. I fully believe some of it is simply genetic (or at least predisposition is strongly genetic).

I didn't mean to imply to ignore nutrition. The first thing I would recommend to any bulimic is to go low carb, high protein. If they're already doing that, if they are feeling lots better on their eating program but they still can't seem to get a hold of depression and disordered eating, maybe this is the sort of person who should be thinking about treating the depression specifically rather than expecting nutrition alone to fix it.


I totally agree eating disorders are not psychological. Or at least it is true that the psychology is a result of the eating disorder, not a cause.
Then again, mental illness isn't psychological either. Depression, bipolar disorder, even the borderline personality - all are pretty much biological illnesses which have little to nothing to do with psychology.

Connie said...

I would agree with all of that except for two items:

direct people to OD instead of high protein. The fat is important.

Also, if that doesn't correct all of it, I still would not go to psych treatments, but instead look at sleep, crisis-making, and risk-taking. But maybe that will take the help of a counselor.

Pooh-poohers of animal studies can stop here as this will probably set up a storm of pooh-poohing.

As to the genetic component: Dr. DesMaisons' big "aha" was that there is a whole class of people who are like the C57 lab mice. (they are used in diabetic, alcohol, and depression studies).

In the following quote she is talking about the C57 mice (with the genetics we're talking about) and DBA mice (without).

"And, if we return to our friends the C57 and the DBA mice, we discover that the C57s have a 35 times more powerful reaction to morphine than do the DBAs. Think of that. Insert sugar in the place of morphine, and we begin to see why some body and brain types seek it, love it and get addicted to it. Now the sugar story and the connection to C57's is well researched through out the scientific literature. But no one in the science lab is yet making this leap from the C57 profile to the sugar sensitivity profile in people. But the "match" is extraordinary.

How We Are Like Those C57 Mice

If we start thinking of ourselves as little C57 mice, we can have LOTS of clues about why we act the way we do. And we can start understanding why our DBA friends cannot in any way understand why we keeping going back when they are able to just say no.

As we continue this discussion, let's stop for a moment and take one cautionary note about our attitudes towards the different types of mice (or people). Scientists do not look down upon the little C57s. Nor do they laud the DBA. They simply know that they are two very distinct strains with different body chemistries. If they wish to look at the effect of a given intervention and want to see the differences in different body types, they order both kinds of mice."

More fun at

The C57 Story

http://www.radiantrecovery.com/resourcecenter/C57story.htm

Lauren said...

"What I mean is, I think it is a little naive to assume all mood issues are caused by food."

Yes itsthewoo, you are right. I was too quick to imply this. It's just that I have been so impressed by how significantly a change in diet can improve disordered eating. I do realize that it is more complicated than that.

That is an amazing weight loss. Are you still 104? That seems very thin for 5'5". Are you able to maintain that weight easily? I'm not being critical, just curious.

Caroline, I loved that link to the C57 mice page on Radiant Recovery. It brings to mind a conversation I had with a relative who is a nutritionist in a hospital. This relative is thin, eats a healthy balanced diet with minimal sugar, never over eats or over drinks. We were talking about "Good Calories, Bad Calories" which she dismissed because she can eat carbohydrates and not gain weight. She did not read the book and is completely incurious about it which I find amazing.

What I thought about after that conversation is that she can't possible understand because she is not that kind of person (C57). I can't drink or eat sugar without losing control and it is not a problem for her at all.

The two kinds of mice really illustrates that difference beautifully.

ItsTheWooo said...

Hi Lauren - I comfortably maintain 120.

When I was 104 I had disordered eating. My body is naturally bigger, even 120 is probably pushing it, so 104 was just like "GTFO". I was quite insane mentally, I was terrified of weight, I hated food and every time I had to eat it was this big battle of anxiety and guilt. It was like a torture chamber because I couldn't stop the obsessive thoughts. The physical stuff was pretty miserable too, I was constantly freezing even when everyone else was hot, my fingers and toes were blue and often bloated/swollen due to poor circulation in the winter even at higher weights (110s), I was obsessed with food and hunger and I used to horde things food related... I was absolutely batshit really. In spite of how miserable I felt because of my weight and eating, all I could think about was a fear of eating, a fear of gaining weight. Any sane person would simply eat more and gain weight. I was not sane.

The weight I am now, 120s, it was pretty much horrendously terrifying back in those days. I feel fine at this size now. I'm so glad to be sane, really. I often just take pleasure in the fact that I can eat whenever I want, that I am not cold, that I am not terrified about weight gain or horrified by my body...it's something we take for granted until we experience what it is like not to have it anymore.


I never saw a doctor or anything but I am pretty sure I had what is considered EDNOS, anorexia type. At the time I went back and fourth over whether or not I had a disorder (I thought I ate plenty of food and wasn't anywhere near thin enough to be considered truly eating disordered). The more sane you become, the more painfully obvious insanity is. I can't even imagine truly believing, feeling, experiencing what I did, but I know at one time it was very real.

And long after you look normal and start eating more normally, the brain is still crazy. The crazy takes many months and years to go away. It's a very slow process.

Bruce K said...

Amanda: "i eat a lot of dairy and then meats, fats and only a few veggies and of course, potatoes. there is no magnesium in these foods."

There's magnesium in all those foods. If you eat fish, lean ones like pollock and halibut are high in magnesium. I don't eat fatty fish often, because I want to minimize all kinds of PUFAs.

Connie: "Macadamia nuts are great for magnesium."

No, they're not. You would have to eat a cup of macadamias to get about 56% daily value of magnesium (155mg). That's near 1,000 Calories. Animal foods are better sources, like pollock, halibut, oysters, and scallops are better. The problem of mineral deficiencies is exacerbated with diets that limit protein arbitrarily and focus on fat for calories. There are no minerals in fat, period. A high-fat diet low in protein is deficient IMO.

Bruce K said...

ItsTheWooo:"I think the solution to magnesium on low carb is simply to eat lots of nuts. I eat about 2 oz every day and it has fixed a LOT of issues for me."

There is not a lot of magnesium in nuts, relative to calories. Most nuts are very high in PUFAs. Pumpkin / squash kernels are fairly high in magnesium, Watermelon seeds are also pretty good, but they're all very high in PUFAs too. An ounce of pumpkin kernels has almost 6g of PUFAs. An ounce of watermelon kernels has just under 8g of PUFAs.

http://www.nutritiondata.com/facts/nut-and-seed-products/3066/2
http://www.nutritiondata.com/facts/nut-and-seed-products/3147/2

"People are afraid of nuts, not sure why, I guess they remind of junk food like chips?"

Jan Kwasniewski and others have warned people against eating high fiber, high PUFA foods, like nuts, seeds, etc. I've seen no benefits from eating them and a lot of benefits from avoiding them. Mac Nut Oil has helped me more than eating macadamia nuts. I think a low-residue diet is best for nutrition. Fiber is an anti-nutrient, as Peter has pointed out over and over again.

Unfortunately, most are unwilling to eat a low-residue diet, even though all the evidence proves it is better for the gut than a high-residue diet. Fiber is worse than pure carbs, in my experience. I see an increases in hunger and a decrease in energy from 85% dark chocolate. The same does not occur with white chocolate made with cocoa butter, even though it's much higher in sugar. This is repeatable with other foods too. Strained juices are far less harmful than juices with pulps. Not even whole fruits are benign, because of the fiber. I feel best with no fiber in my diet, except occasionall potatoes or cooked root veggies. Eliminating residue caused a consistent weight loss, around 7-10 pounds, whereas addition of residue foods caused weight gain.

http://www.gicare.com/pated/edtgs02.htm

I hope this information helps people. It has provided all kinds of benefits to me personally, by eliminating high-residue foods completely. It makes sense even on a logical level that fiber does no good for us and just messes up digestion and elimination, degrading nutrition in many ways as well by absorbing vitamisn and minerals, carrying them out of the body. Peter has brought up many reasons not to eat fiber, but for some reason he keeps eating it. I don't get this. Either the fiber is good or bad, necessary or not. There is no middle ground, like "fiber is bad, but it's OK to eat berries and tomatoes and cocoa powder." If fiber is bad, it should be avoided. All evidence says that it IS bad, except meaningless epidemiological studies. Here are a few articles to make sure everyone's on the same page and maybe someone can tell me what I'm missing in these articles that suggests fiber is good for us.

http://high-fat-nutrition.blogspot.com/2007/08/vegetables-damage-your-dna-latest-study.html
http://high-fat-nutrition.blogspot.com/2007/09/fruit-and-vegetables-last-post-almost.html
http://high-fat-nutrition.blogspot.com/2007/12/fruit-and-vegetables-in-holland.html
http://high-fat-nutrition.blogspot.com/2007/12/fruit-and-vegetables-re-post.html
http://high-fat-nutrition.blogspot.com/2008/01/there-are-people-like-these-scientific.html

http://high-fat-nutrition.blogspot.com/2008/02/fiber-inulin-and-cancer.html
http://high-fat-nutrition.blogspot.com/2008/04/fiber-sucrose-and-ulcers.html
http://high-fat-nutrition.blogspot.com/2007/12/fiaf-whos-fat-is-it-anyway.html
http://high-fat-nutrition.blogspot.com/2007/12/fiaf-starving-amidst-plenty.html
http://high-fat-nutrition.blogspot.com/2007/12/fiaf-where-next.html

Peter said...

Before we all rush off to strain our orange juice here are some quotes from Homo Optimus

Chylinski: What about plant derived fats, should we totally eliminate them from outr diet?

JK: A minor portion of the total amount of consumed fats may be plant derived fats. The best fats are contained in products humans are able to consume raw: Nuts, almonds, olives sunflower seeds and coconut flesh.

Allowed foods section 13: Nuts, sunflower seeds.

JK on fish: ...fish can be practically eliminated from our menu, especially those sorts which have LITTLE fat content...

My comment: Here the objection appears to be the LACK of fat, not the omega 3 content. Low fat fish are not recommended at all. High fat fish are not recommended because pork fat is much cheaper and the fish protein less biologically appropriate for humans. No anti omega 3 suggestion.


Chylinski: At one point you suggested that all the apple orchards should be uprooted and replaced with plantations of hazelnut trees.

JK; It is not necessary to cut down the orchards. There is so much barren land in any country which would be ideal for hazel...

Peter said...

Hi EdC,

The fence is perfectly OK, you need somewhere to sit while you follow the data. If I found convincing evidence that Dr Ornish was on to something and I am completely wrong, I'd have to go and look very hard at what I do nowadays. There is no right or wrong opinion, just facts. When convincing facts come to light, believe them! If that means accepting you have been incorrect, so be it.

OK, re FOS in traditional diets, it seems quite a high estimate, but so be it. If you get as far as discussions about Kitava and carbs here and at Wholehealthsource, you can see that almost all macronutrient ratios can be used by humans, why not diets high in FOS? It is certainly true that there are FOS in milk.

In terms of generating a population of bifidobacteria in my colon, I'm unenthused at trying to achieve this. If I simply starve them all out, the composition becomes unimportant and my energy balance is then between me, my food and digging the allotment. There's a lot about this in the fiaf posts.

So why the FOS in milk? Well, that depends a bit on what you consider a human to be and which is the dominant organism, the human or the gut microbiota they serve. Obviously gut bacteria would be nicest (ie provide a survival edge) to a human who feeds them. There is likely to be a close symbiotic relationship between maternal skin bacteria and milk bacteria and the support system provided by milk for those bacteria. This should provide happy bugs in a happy human. The system gets screwed up if the only organisms available to colonise the gut are pathogens in a neonatal intensive care unit. Feeding those bacteria may not have such a happy outcome.

Certainly on Kitava the diet is mostly yams and sweet potatoes and, though Lindeberg doesn't mention it, there is no suggestion that they develop the ankylosing spondylitis which was so common in ancient Egypt and is still common today in the UK. Many humans who are HLA B27 positive and who are using Ebringer/Sinclair's low starch diet are crippled by FOS, even in small amounts.

So in the same way as a non diabetic can happily eat LC where as a diabetic MUST eat LC, then avoiding FOS, even if gut function is normal, is a perfectly reasonable option. For people with the digestive equivalent of diabetes then avoidance of FOS, starches and fibre becomes obligatory. For these people modern food has broken their gut, making them live within certain limits. Everyone's limits are different. I can get away with far more starch and fiber than many people. Lucky me!

Peter