Friday, January 15, 2010

Paleo and fructose

I've had a couple of queries which tie together neatly and involved some detailed paper reading, so I thought I'd throw them out for general discussion.

A friend is struggling to keep adequate carb intake on a starch free diet. Anyone who has tried this will soon run in to kilos of cabbage. The easiest answer is fruit and honey but this then means about half of your carbohydrate calories are going to come from fructose. Does this matter?

The other query was from David. He looked through Stephan's discussion of this paper and noted the huge intake of fructose from just about every modern fruit or fruit juice that anyone can imagine a hunter gatherer gathering. You know how it goes, gathering was good that day! This is the same quandary as the first query but worse. For a LC paleo person to eat a little fructose is one thing, to eat nearly quarter of a kilo (dry weight!) of fruit and juice to stay politically correct is pushing it a bit. Yet the results of the study are good. How come? Here's the menu.




The column on the right gives the bit we want. Ignore diets called ramp 1,2 and 3. You can see "Paleo diet" is quite fructose rich. Before we can get on to discuss this, a problem needs to be addressed. I'm either going senile or there is a double typo. It's here



Aside: Look at the HDL. Zilch increase. I'm amazed it didn't drop with all those PUFA!


Fasting glucose pre study is 18mmol/l and on the paleo diet it's 17mmol/l. These are wrong. Certainly for people described as healthy. The HOMA scores allow back calculation, first converting the insulin from the nice pmol/l quoted to grubby microIU/ml needed (HOMA seems to mix IU and SI units...) but even this gives a fasting BG of 7.2mmol/l... Still not exactly normal! And it didn't normalise on the paleo fructose diet either. So either it's a typo, my math is useless (that WOULD be embarrassing!) or these folks had fasting hyperglycaemia. Take your pick!

OK, back to working out what is going on. Here is the key:




If you look at the HOMA-change graph Figure 2 you can see that 4 people (upper left) were normal (HOMA <2), two people were almost normal (HOMA<4) and two were frankly pre diabetic (HOMA 6 and 7.5). In my terms rather than ADA classification. None of the normal or near normal people improved HOMA much on the diet. Why? You can't drop HOMA below normal as it's already normal.

I'd guess the people at the upper left had a moderate American fructose intake pre paleo diet and probably didn't change this much on the honey and carrot juice in the study diet. They started normal, they stayed normal and we can forget about them. The two people with IR on the lower right of the graph are the two who did all of the improving. This certainly applies to HOMA scores but, because we don't have the data broken down by individuals for anything else, we cannot see if that was the case for all improvements in all of the other parameters looked at. I think it might be. Is there anything to support this idea?


The thing to look at is the food intake pre and during diet.





People entered the study on a self selected diet averaging 254g/d carbohydrate. But the standard deviation is 128g/d. The rule of thumb is that three standard deviations include about 99% of the population. In the USA I doubt many people with a BMI of 27 were eating below 200g/d of carbohydrate, so a few individuals will have to have been eating much more than 254g to get that big SD. The easiest way to get your carbohydrate intake up towards three SDs above the mean of 254g [ie 254+(3X128)= 638g/d] is to drink Big Gulps. Big Gulps provide 800kcal per serving of HFCS calories. This has to be a guess as the results do not break carbs down by fructose. Sigh.

On the paleo diet food and drink intake was tightly controlled and everyone will have been consuming near identical fructose. The fall in mean carb intake from SAD to the paleo diet is only 5g/d, but the SD of the drop is 126, essentially the same as the 128 of the pre study carb intake's SD. Taking people from a wide range of macronutrient intakes and putting them all on the same diet will do this. The total carb intake during the paleo diet is 254 minus 5, ie 249g/d but this will have a SD of near zero, because all of the subjects were on university prepared meals of precisely controlled calories and composition for the study.

Anyone who is used obtaining large numbers of calories by drinking Big Gulps will have had a marked reduction in fructose intake on this paleo diet.

From hepatically crippling fructose to liveable with, if not ideal, fructose.

So, in answer to the question, yes, the diet is high in fructose by my standards. But my guess is that it is markedly reduced in fructose intake for those two people who did all of the improving in terms of insulin sensitivity. Most of the other changes will follow on from this specific change. We are very lucky to have Figure 3 to allow us to tease this out! Few papers include individual data nowadays, though it was quite common in early research (1950s etc).

That's how I see this paleo diet. Good, but could do better.

Two asides:

The second aspect is fatty acids. The PUFA increased, which should have worsened liver damage, but omega 3s were added in modest amounts, which should have ameliorated liver damage. Fatty liver from omega threes is unheard of in remotely recognisable human diets. End result of fatty acid manipulation; probably neutral. They didn't hurt anyone. Good.

Finally; endotoxin. Endotoxin is needed to convert the relatively benign condition of NAFLD to the much more serious and cirrhosing NASH. Endotoxin uptake is markedly facilitated by gut damage. Gluten is the primary opener of intestinal tight junctions. There were no grains in this diet. That should reduce liver insult. Liver insulin resistance is primary to metabolic syndrome.




Back to the first query: For those wanting to avoid ketosis when unable to tolerate starch. Some fruit seems relatively benign. You can get away with moderate amounts of fructose for years before it gets you, probably half a lifetime. Unless you make Big Gulps your only significant source of calories.

It really does seem possible to break your liver in childhood if you really work at the Big Gulps.

Peter

46 comments:

Matt Stone said...

I definitely think the fructose issue is a quantity issue. That's how Yudkin felt about it and he was probably right. It's also impossible to compare refined and unrefined carbohydrates. The diet listed above was certainly different than a diet obtaining similar macronutrient profiles from refined carbs. Therein lies the biggest difference.

Lee said...

Hello Peter

Is your starch-free friend following the SCD diet? Do you think that the SCD ideas have merit? Personally, I seem to have problems with milk and cream but not cheese. I assume this is to do with poor lactose digestion which chimes with SCD. But I am far more wary of accepting that potatoes or sucrose cause digestive problems.

Lee

Peter said...

Hi Lee,

Potatoes are anecdotally the absolute worst for IBD. Sucrose is a primary association and probably acts as an osmotic trigger for tight junction damage, especially if gluten has destroyed your brush border disaccharidases. Yes, anyone with GI issues could do worse than start with SCD choices. Same for most auto immune diseases, though rice does seem quite tolerable for many people, obviously white and fresh made to avoid both fibre and resistant starches...

Peter

Kennedy said...

I don't see much reason to bother eating Fructose, since we have the same access to food all year round.

Robert McLeod said...

I think there's strong evidence to support that fructose consumption combined with high insulin levels can result in a fatty liver and local insulin resistance. It's less clear that fructose can cause damage on its own. Certainly your corn oil cirrhosis post didn't implicate fructose as the sole actor.

If you eat say, 50 g of fructose a day, is that going to be a problem if you periodically force the liver to liberate its energy stores? Fasting is without a doubt the best way to get the liver to give up its glycogen and fat stores.

I think we should be emphasizing avoidance of drinking calories (soda, juice) and avoidance of sugar-laden junk food but whole fruit is ok for most. People who are already insulin resistant may want to avoid it while they lose weight.

caphuff said...

what does SCD stand for?

trix said...

SCD = Specific Carbohydrate Diet

Senta said...

Just a thought, could your friend manage pure glucose (dextrose) to get his/her carbohydrates without the accompanying fructose? Assuming it was consumed with a meal and in small quantities?

Peter said...

Senta, yes, we discussed that

Peter

Peter said...

Rob, Yes, it looks like a multi hit issue. I'd also compare fructose to alcohol as many have done, but extend the Drinking Man's Diet to fructose as well as alcohol. Is fructose less toxic in the absence of corn oil and the presence of saturated fats? Probably. The gluten and endotoxin is probably quite important too. The standard degenerators of HG diets on contact with civilisation were sugar and flour. I don't see margarine being such an issue from missionaries in the early 1900s. It's possible to get to a similar end point by several routes

Kennedy, it's a PC certainty that HGs ate pineapple and carrots all year round. Nowadays it's easy to avoid fructose if you are starch tolerant. Not all of us are so fortunate. And especially if you wish to follow Kwasniewski's macronutrient ratios without starch, you end up with fruit and glucose powder. In fact the SCD bans glucose powder too due to contaminating starch. But everything is dose related...

Peter

Lee said...

On the near ubiquitous subject of gluten as a complicating factor, Peter, did you see that programme recently on BB3 about kebabs?

They unsuccessfully tried to frighten us by saying that various bits of connective tissue are put into the lamb mince before being made into kebabs. But then moments later they succeeded by saying that rusk is added to the mixture.

Terrible news! Apologies if I have just ruined your meal.

Lee said...

BB3 should be BBC3

Greta from www.bigbottomblogger.blogspot.com said...

I eat paleo and eat my fruit separate from anything else...as per the food combining principles. I usually have fruit in the morning, first thing. Then sometimes an apple mid-afternoon.

It would be interesting to see the results of this study had the honey and fruit and juice not been consumed along with the other food.

Ryan Koch @ Health Matters to Me said...

Peter,

In your opinion, is there a difference metabolically between natural fructose and chemically altered fructose? I've never seen a study that reveals the harmful effects of fruit or honey, but I've seen plenty on the effects of HFCS and other artificial forms of fructose.

pyker said...

Are cashews and chestnuts off the menu for your carb-seeking friend? (Are the higher-carb nuts too starchy?)

blogblog said...

Professor Jennie Brand-Miller at Sydney University is a leading authority on low GI nutrition - she often collaborates with Cordain. She has published a book on the nutritional values of Australian native plants.

The traditional fruits eaten by Australian aborigines are typically small, somewhat sour, have very low levels of sugar and massive vitamin C contents - up to 40x as much as oranges. Some of these native fruits are delicious with very interesting flavours. I have a native blue quandong tree in my back yard. It produces a vivid blue fruit which tastes similar to an olive. Some of the palm fruits taste like bubblegum. However it is unlikely that aborigines would have obtained more than a 10 grams/day of sugars from fruit or nectar.

blogblog said...

My personal view is that paleolithic northern Europeans were probably almost pure carnivores and that fruit and vegetables are not only unnecessary but probably unhealthy for those of us of descended from these people.

Lord Strathcona lived entirely on eggs, butter and milk.
http://www.second-opinions.co.uk/eggs.html

I discovered long ago that going (almost) zero carb is by far the simplest approach. It takes a few weeks of adjustment but after that it is easy. The only carbohydrate I have is incidental such as in cream or eggs. I manage perfectly well without fruit or vegetables just by taking some vitamins, a magnesium supplement and adding some potassium-based salt substitute to my diet.

Byron said...

Hello Peter,
why does your friend refuse a ketogenic way? I gave up fruits last year. Either I got a binge or bad stomach because of the fructose/acid. Eating more than 12 bananas to stop diarrhea resulting in much worser running it´s not really normal. Because of allergies there is no way with starchs/vegs either. So I stay -by accident- in keto. Best results with eczema and my asperger´s mind. Regards.

Gluten Free Food Freak said...

Interesting stuff on how to get the carbs in when starch intolerant.

With that slightly dubious link, and with apologies for highjacking the post somewhat, I'll get onto the reason for my post: I have a similar problem, if slightly more complicated.

I was fairly low carb for 2 years (under 150g per day) but steadily lost weight. When my weight reached 10 stone (140lbs) - I'm 6' 6" - I decided something had to be done!

So I upped my carbs (root veggies only - no sugar) and have put on 11 lbs in 4 months. Which is good. I feel better generally, my moods are more stable and my concentration better.

What is not good is the palpitations, and the other inevitable effects of a high carb diet.

I would love to go high-fat, low-carb, but when I up the fat content in my diet I stop sleeping. Yes, weird I know - I can't find anyone else who experiences this.

Basically what happens is I fall asleep fine, then wake around 4am and am awake. Not bouncing off the walls awake, but definitely not asleep!

A couple of days back on lower fat (under 40% of calories) and my sleep normalises again.

Oh, the high fat also give me a feeling of pressure under my right ribcage, which I am guessing is gall bladder. Being coeliac, I have been told gall bladder problems may be an issue.

So I find myself in a bit of a catch-22, and if anyone has any ideas about what is going on (and what I might do), I'd love to hear them!

Thanks for the fascinating and enlightening blog Peter.

Roger

Senta said...

Gluten Free Food Freak:
The night waking can be a sign of nocturnal hypoglycemia. The hormones released to raise your blood sugar (adrenaline, cortisol) are what wake you up. A small protein snack before bed can help this.

Low-fat diets can cause bile to back up in the gall bladder, it thickens into a sludge and stones can form. You generally won't notice any problems until you try to eat high-fat.

There are herbs like gentian, milk thistle and turmeric that can help the flow of bile and the acid from betaine HCL can help as well if you have low stomach acid. There has to be a high enough level of acid to cause the stomach to release its contents into the duodenum and signal the gall bladder to release bile. Here is a great article on how to use HCL: http://www.healingnaturallybybee.com/articles/dig5.php

weetabix said...

i tried to get onto the OD at xmas...dificulty digesting sugar means that i have to stick to the SCD diet for the moment (no starch)..one good thing though..i have upped the amount of fat im eating..able to tolerate cream and some (non lactose)..cheeses..energy levels have certainly upped with the higher fat content of my diet and aleviated my eczema..small amounts of fruit seems to be a good idea..aim for the 40-50g per day mark..David.

Rob said...

I'll have to thumb through my copy of the Paleo diet, but does Cordain really advocate that much juice? My god. The breakdown of macronutrients also does not seem very paleo-ish. It doesn't seem that this diet really adhered to what the diet is all about. Granted, I do see Cordain's lipophobe self coming out in the food selection, I'll give it that.

Olga said...

Hi Gluten Free Food Freak:

I have the same problem with sleep. You are not the only one. I discovered it over Christmas. My sleep has been deteriorating over the last few years on a low carb diet. I was away from home at Christmas and as a result veered off my customary diet, with the result being improoved sleep. I don't have any answers but for the moment I am increasing carbs to about 70 g per day and decreasing fat), and will be slowly lowering the amount of carbs until I find the lowest level that alows me to sleep well. Dr Eades also suggests that ketosis causes some people to have disturbed sleep and suggests a teaspoon of sugar before bed. I've tried taking protein alone at bedtime and that does not help. Dr Schwarzbein also suggests that some people require more carbs to sleep properly. What I'm wondering is if timing the largest carb load makes a diffrence. Would it be best to eat the biggest does of carbs before bed, in the morning, or evenly throughout the day? If any one has any suggesting about this I would be greatful.

Senta said...

Olga:
I can see how a teaspoon of sugar would "work" to solve the night waking problem but it will prolong the cause of the nocturnal hypoglycemia, disturbed insulin regulation - which may actually be pre-diabetes.

Gluten Free Food Freak said...

Thanks for the rapid reply Senta - I did wonder about hypoglycaemia and so tried a small teaspoon of sugar at 4am, but that made no difference. Also, when I wake I don't feel nauseous or any of the typical low sugar symptoms. It feels like being tired, but without that 'dropping off' feeling you get just before you sleep.

I've tested my stomach acid a couple of times and get a good strong HCL response to protein ingestion, so all seems good on that front.

I am currently trying a 'bile thinner' called Beta TCP, which is based around beetroot extract. I've tried it in the past but not managed to complete a 'full test' for one reason or another. We'll see if that improves things.

Olga, it's reassuring to hear someone else with similar problems, thank you. What I'm wondering is whether anyone has an idea of what physiological process might be causing the sleeplessness. It's such a clear, repetitive pattern it seems like something happens in the body at that time that precludes falling asleep again.

I'm wondering about body temperature, which I believe has to drop before sleep onset, and whether some aspect of fat metabolism might interfere with that.

It's a conundrum! Anyway, off to bed. Today has been the 3rd lower carb day in the latest pattern and the problem was definitely improved last night. We'll see what tonight brings.

Thanks again.

Roger

Senta said...

Gluten Free Food Freak:
You are welcome! Taking the sugar at 4 am is too late (not that I recommend it at all), you have already been awakened by the hormones which raise your blood sugar very quickly (they cause glycogen to be released from the liver). And since your blood sugar is already back to normal, you won't really have any discernible symptoms. What you are experiencing is pretty mild compared to what a diabetic who has miscalculated an insulin dose experiences.

Take a look at Atkins, Protein Power or other low-carb discussion forums. It's uncanny how many people say the same thing, that they wake up at 4 am. Once one adapts to a ketogenic diet, which can take several months in some cases, this problem goes away. I never had the sleep problems but I did have heart palpitations for a few weeks when I first went low-carb.

I've never heard of beta TCP - looked it up and see that it's made from beets, just like betaine HCL so that's interesting! Good luck with it.

Neonomide said...

Peter said...

"Potatoes are anecdotally the absolute worst for IBD."


You should have told that to my gastroenterologist, when I had badbadbad ileus (gut obstruction) four years ago, following Crohn's acute. I managed to get sent home without a knife trip, yet I simply farted and burped for MONTHS trying to figure out how in hell I could be swallowing more air than I usually did. That was the only explanation I ever got.

According to my gastroenterologist the mashed potatoes were the perfect food after surviving the ileus for a while, since "it can pass the obstruction point without much of a problem". Oh really ?

I would definitely have been the runner up for this guy, honest:

http://www.youtube.com/watch?v=nd5CyNyzasQ


Since then, I managed to figure out that most grains, excess sugar and POTATOES were major culprits in my IBD, so I tried some SCD stuff during that. I figured out the gluten/gliadin connection much later, yet I was very happy that I did. No more official diet consultation for me - thanks.

Celiac adolescents have a lot of mental problems compared to healthy ones, thoug I think this is not news for anyone:

"Relative to the comparison subjects, the celiac disease patients had significantly higher lifetime prevalences of major depressive disorder (31% versus 7%) and disruptive behavior disorders (28% versus 3%)."

http://psy.psychiatryonline.org/cgi/content/full/45/4/325

Dr. B G said...

Wonderful post Peter :) I wanted to go back too and look at the carbs here (though I think the authors did a great job in 'matching' the macronutrients in the study). It will be interesting what Frasetto et al at UCSF do next... What can I say? The Bay Area (california) ROCKS!! Now you have had TWO hits from the Bay Area -- Frasetto and Krauss for 2010. *haaa*


Roger/Gluten Free

Try SUPER ENZYMES to digest the fats. You'll probably sleep better too. My patients say it cures their GERD/heartburn gas bloating within 24-48 hrs as well (esp if they are already semi paleo/grain-free).

Good luck!

-G

Gluten Free Food Freak said...

Thanks for the info on the blood sugar Senta. I hadn't realised that it was the glucagon release that would wake me up in the event of hypoglycaemia.

I'm somewhat reassured by the prevalence of the problem amongst new low-carbers, and I'll certainly check those forums out to see what I can learn.

Dr BG - I have used enzymes before but never specifically when trying to increase fat in my diet. On my next attempt (once I've got more info on the problems I've experienced), I'll give that a try.

One idea that I've been toying with is that increasing my fat levels makes me more insulin resistant (something I have learned from reading Hyperlipid). I wonder if keeping quite a high level of carbs in my diet while increasing the fat is part of the problem.

Thanks again for all your help folks, it is much appreciated.

All the best

Roger

Gluten Free Food Freak said...

Oh, meant to say that the sleep was better again last night, so does it seem that backing off the fat has improved matters.

Senta said...

Hi Gluten Free Food Freak:
Not sure were you got the idea that glucagon was waking you up, it's adrenaline and cortisol, the "fight or flight" hormones that are released to raise your blood sugar. Possibly you were confusing glycogen (animal "starch," the way we store glucose) with glucagon, a hormone.

Hopefully you will eventually be able to tolerate a low-carb, high-fat diet. Sounds like you need to ease into it. Good luck!

Peter said...

Hi Lee,

We missed that (we have a TV, a license but no ariel, it's a low priority) but it was actually a series of three doner kebabs (not all at once!) that finally allowed us to pin down a source of gluten. When we started LC/gluten free I asked at two kebab shops and was told meat and vegetables, mostly onion, were the ingredients, no wheat. Obviously that was too good to last and has stopped lasting!

Thanks for the heads up.

Greta, yes, but don't forget that it's difficult to get a HOMA less than 1 and still be alive! I guess this is why many paleo studies do enroll heavy people or T2 diabetics. There is more room for improvement!

Ryan, I'm not sure there is a difference. There is alpha and beta fructose as per glucose but glucose can spontaneously convert between forms so I suspect fructose can too. I think fructose is fructose is fructose...

Pyker, he's making choices from the SCD list, I doubt chestnuts are allowed, dunno re tree nuts but I think consume with caution in the early days is the rule. ie skip them for a while!

Blogblog, yes, Brand Miller did some good work in her early days. Pity about more recent stuff.

Byron, He's trying the specific Optimal Diet. It specifies a certain amount of carbohydrate for reasons which are apocryphal.

Roger, how saturated is the fat you consume? Certainly if any of the ideas about hypoglycaemia are correct increasing your insulin resistance and dropping your glucose utilisation might work. Re weight loss, ultimately calories DO count. Eat more of them... Under the circumstances saturated fat ones might help. Re the tender upper right quadrant, I'd make sure I was 101% gluten free. If you have a track record of low fat in the past also watch for a gall stone sitting there from past dietary sins! As per Senta's comment.

David, yes, not everyone gets everything they need from the simple OD. A little tailoring... But in JKs on going work no one is instructed to avoid gluten. That's hard for me!

Rob, I've never read Cordain but I doubt anyone can really think we drank that much juice. But it got funding and is a step in the right direction so...

Neonomide, well thank you for that! There is a decent groundswell suggesting that autism and related problems are digestive in origin. I have a lot of time for that. Congratulations on avoiding surgery and working out what had passed your specialist by. I believe it is an absolute belief of many gastroenterologists that food has nothing to to with IBD/Crohns etc. Hmmmmmmmmmm... It may relate to the lack of availability of a broad sample base. If everyone eats cr@p, shades of cr@p make little difference. That's true.

G, the stuff may not be perfect but at least they are looking in the correct direction and they do leave some evidence around as to what is really going on! A lot of papers in NM do have simple line plots of all of the individual responses in small studies like this, that's even better. And there are often either outliers or individuals who buck the trend.

Peter

caphuff said...

Roger/GFFF:

FWIW, my own n=1 experience with gallstones (diagnosed years ago while still on the SAD)jibes with Peter's suspicion of gluten as the guilty party. Since going low-carb/high-fat (sans wheat) I notice the gallbladder only seems to kick up a fuss when I re-introduce wheat. Otherwise copious fat has been copacetic, surprisingly.

Dr. B G said...

Peter,

Glad ur back!!!

Maybe Kenyon and Frasetto need to get together! *haa*

-G

Olga said...

Hi Senta:

Thanks for the info. I was able to tolerate a very low carb, high saturated fat diet just fine for 5 years. I felt great, until, I had unnecessary thyroid surgery. I had a benign thyriod nodule after my second pregnancy. The surgeon insisted it was suspicious, after an inconclusive biopsy, despite my reservations. I never felt well on thyroid hormone replacement (synthetic or natural) so I have been trying to see if my TSH will come back down to normal on it's own. I had an iodine loading test 1 year ago to rule, and it was fine, so I'm not iodine deficient. I started out at a TSH of 12 and am down to about 5 now. My pre surgery TSH was a perfect 1.8. So I know that the night waking is due to the thyroid problems. I'm not sure why it makes me hypoglycemic. And why I get a cortisol/adreniline spike at 3 am. I'm not sure if it's best to press on with the low carb, or if I should eat more carbs in the mean time until I feel better. I feel very much the way I did when I was a tween, going through a growth spurt. I used to wake up in the middle of the night then also for a snack. Eventually it stopped on it's own. Any advice would be greatly appreciated.

Senta said...

Hi Olga:
I wish I could help you but your situation is complicated and beyond my knowledge, I can only guess like you are doing about what it going on. It is also my understanding that thyroid problems can cause hypoglycemia.

It's such a shame about that unnecessary thyroid surgery, when was it? It's encouraging that your TSH has improved that much, do you think there is a chance it will get under 3 in time? Have you had all the other levels tested (free T3, free T4, reverse T3)?

If you do decide to add back in more carbs, watch out for fructose (to stay on topic here!) and all the neolithic anti-nutrients. You don't want to trade one problem for another.

Olga said...

Hi Senta:

Thanks for your input.

Yes, it's very unfortunate indeed. I found the lump 3 months before I went on the low carb diet. And once I started the diet, I felt better than I had my entire adult life (I am currently 43, and yes, menopause has been ruled out as a cause of the hormonal problems). I continued with the diet for the next 2 years feeling great. And then the surgeon insisted that the lump needed to come out since they could not rule out cancer. A scary word for anyone.

The surgery was 5 years ago. I decided to go off the thyroid meds 2 years ago, because I could never find a dose that made me feel well. When I asked the Dr. if I could go off them because I had read that it's an antiquated practice to put hemithyroidectomy patients on synthroid, she asked, "why are you on them anyways!!!" after prescribing them for 3 years.

So I went off them and felt not too bad for about 4 months, and then started developing joint pain, hypoglycemia, and most maddening sleeping problems. I've had every thyroid test, and the T3, T4 do not change regardless of synthroid supplementation or not. I've tried going back on the lowest does of synthroid (I was originally on 75 ug and now a mere 25 ug will bring my TSH back to normal, so I know that it is slowly improving) but, there is no improvement in my symptoms, so I've stopped taking it again.

At the moment I feel better when I eat more carbs, so I'm wondering if I am in "repair mode" and that when my TSH is back to normal the hypoglycemia will end and I will be able to go back to low carb. I definately need a big load of carbs when I exercise. If I don't I definitely don't sleep on days when I exercise. This did't happen before I went off the thyroid meds. Of course weight control which was effortless on low carb, is now a problem. So I am being careful to increase carbs and lower fat. So what do you recommend to increase carbs without overdoing fructose? I can tolerate bread just fine. Do I eat fruit exclusively, which is about 50% fructose, or favour white bread since it's basically glucose? I eat lots of low glycemic carbs such as lettuce and berries. In fact it's difficult to eat sweets since I no longer have a taste for them. And does timing make a difference? Is it better to eat the carbs alone since this will minimize fat absorption during the higher insulin phase? Do I eat carbs with protein (which will have some fat associated with it, ie. eggs, etc.)? Do I eat most of the carbs at breakfast, or evenly throughout the day? And, should I have a big carb snack at bed time to increase melatonin production? Any suggestions along these lines would be very helpful.

When I try to talk to my Dr. and the endocrinologist I saw last week (after waiting for a year, I'm in Canada, after all), their eyes glaze over at the mere mention of low carb or diet in general. No body wants to touch this one, so I'm on my own looking for logical things to try, keeping in mind that there does seem to be slow recovery. One thing that has helped with some of the symptoms is vit D. I now suspect that it may have been the original cause of the nodule. There is evidence in the litterature that low D can cause thyroid problems, particularly during pregnancy. So that's it in a nutshell. Thanks again.

Senta said...

Hi Olga:
Don't risk your pancreas thinking you are healing your thyroid. If you are truly hypoglycemic, you also have insulin resistance and hyperinsulinemia. Eating a lot of carbs may reduce your symptoms for a while but at what cost?

Stay away from wheat and other gluten grains, your thyroid nodule may have even been caused by an autoimmune attack. Eat greens, starchy tubers and root vegetables for your carbs, no fruit. And no sugar and no PUFAs, but you know that.

How about using a blood sugar monitor to see for yourself what different meals do to you? That way you can determine what content and timing give you the most level readings, minimizing peaks and valleys.

Olga said...

Hi Senta:

Thanks again for the suggestions. I'm pretty sure the hypoglycemia is related to the thyriod issues. I didn't have hypoglycemia before discontinuing the synthroid. Also, I experienced similar symptoms of hypoglycemia during both pregnancies which resolved shortly after delivery despite being on a very high carbohydrate diet at the time. Dr. Wolfgang Lutz suggests in his excellent book "life without bread," that all hormones must be in a state of balance. Since thyroid hormones and insulin are on opposite sides of this equation, it stands to reason that the hypoglycemia will exist until the thyroid hormones are stabilized. Thanks for the diet suggestions. I'll try to stick with the root veggies as my higher carb sources, trying not to exceed about 70-100 g of carbs per day.

Ryan Koch @ Health Matters to Me said...

Gluten Free Food Freak,

I have the same exact problem and have had it ever since I've increased fat and protein in my diet. Like you, it seems more related to fat increases, as when I go lower fat I have less problems.

My take on it is that my gut is somehow responsible for the sleeplessness in the early morning. I notice my gut has a certain stiff, bloated quality to it when I can't sleep, and when this passes, every time, I'll fall right back asleep.

Fat stimulates peristalsis (intestinal waves) and so more fat = more peristalsis. If you have intestinal malfunction, fat can easily exacerbate the situation, particularly if you have irregular peristalsis (i.e. choppy muscle contractions). The gut is where much of the serotonin in our bodies is created, and if the gut is stopped up or erratic, there may be a possibility that it's robbing the body of it's normal serotonin levels. Serotonin is converted to melatonin which allows us to sleep. In this regard, we can lose sleep through disrupted serotonin levels through the gut.

I am trying antibiotic therapy soon in hopes that I have SIBO and can simply kill the overgrowth which may be causing my issues. My bloating, stiffness, discomfort is mainly in my small intestine, it seems. So I hope this addresses the cause!

Good luck, and let me know if anything helps you!

Olga said...

Hi Senta and Gluten free food freak.

Thanks for the suggestions. Here is an interesting article about low carb, and serotonin that you mighcarbs only before going to sleep. Here's the link:

httpt find useful. I'm going to try the author's suggestion to eat ://comfort-eaters-diet.blogspot.com/search/label/serotonin

mtflight said...

Genius as usual. Awesome break-down of the data, and translation.

Keep it up!
Alex

dave said...

"You can get away with moderate amounts of fructose for years before it gets you, probably half a lifetime."

what evidence is there this is true...that moderate fructose with high fat will eventually "get you"?

Peter said...

Alex,

The post is really guesswork but life has to be logical.

Dave, my assumption is that living on Big Gulps has you diabetic by 10, in the pre Big Gulp epoch most people became diabetic in their 50s...

That's ignoring OCs in our fat, bisphenol A and any other alternative cause of type 2 diabetes of course.

Peter

Corpse8700 said...

Olga, thyroid autoimmune disease can be wheat/grain related. Have you looked into that?

Kirill

Eva said...

My advice would be to check out hypoglycemia with a cheap glucometer from the drug store before assuming it. Those symptoms are vague enough to be a lot of things. It seems all the rage now to assume hypoglycemia for various kinds of symptoms such as those, but everyone I know who has actually checked for it using a glucometer and trying to catch any hint of low blood sugar has not been able to find any hint of it in the actual blood sugars themselves. The only people I know who were able to actually positively identify hypoglycemia were those already diagnosed with really bad diabetes and turned out to also have reactive hypoglycemia (in some diabetics, blood sugars not only surge high but also can spiral low like a crazy seesaw situation) NO one I know without high blood sugars was able to find any hint of low blood sugars either. If we really want to get to the bottom of it, better not to assume without checking things out. I also have sleep disturbance issues, often combined with a feeling of high body temperature. I feel hot and sweaty but when I check my temp with a thermometer, it's totally normal. Been happening for 15 years and comes and goes but I haven't figure out the parameters, SAD, Paleo, high fructose, no fructose, tons of wheat, moderate wheat, zero wheat, still haven't cracked the code. The symptoms have improved with overall healthy eating but they are not gone. Seems clear though that my blood sugars are rock solid in the normal range at all times, never high, never low. Currently trying a run of zero dairy. (oh I do miss my cream!)