Tuesday, May 28, 2013

Diagnosing and Treating Vitamin B12 Deficiency video

Just briefly: People know I don't have the sort of life which leads to watching YouTube videos. This is a long one. I watched it all when I should have been at comments on the blog or answering emails (oops).

Diagnosing and Treating Vitamin B12 Deficiency

I have a (severely coeliac) friend who has recently, and rather belatedly, been diagnosed with catastrophic neurological B12 deficiency. The biggest problem with getting a diagnosis in most cases is folic acid supplementation. Folate eliminates the anaemia associated with the term "pernicious anaemia". Your haematology is normal. Your myelin falls to pieces. Your doctor diagnoses all sorts of things except the one which might avoid neurological melt down.

As a vet I use serum low B12/folate as surrogate markers for GI malabsorption problems and, in these days of crapinabag, we do a lot of testing. In my patients B12 deficiency is very, very common and we probably miss a fair number of "atypical" B12 deficiencies. We treat the ones we see. It's a good idea.


BTW I've never seen a low folate in a cat or dog. They do happen, but B12 is the very common one.

EDIT WTF, Paula had a low folate, normal B12 result from a dog today. Upper GI signs and vomiting. Well, there you go! Bed time now. END EDIT

BTW two, myelin failure as a loss of insulation is self explanatory. But the schwann cells also supply the lactate for normal neurological energy generation. Loss of lactate is a metabolic catastrophe for nerve cells.

Tuesday, May 21, 2013

What do I eat? 2013 update

OK, what do I eat? It's been a long time since I posted anything about myself. Another hastily written post during Hazel's nap.

Breakfast is always the same. I melt about 100g of butter in a frying pan. I crack 11 eggs yolks in to this (I fry the whites later for the chickens!) and fry them until they hold their shape. I then pour 8 yolks for myself and Hazel, with all of the free butter, in to a bowl and mash them with a fork before stirring the mix in to an "egg soup". Hazel has a dollop, I have the rest. We like it quite solid. I finish any Hazel doesn't want, hopefully I get six yolks worth. Daniel likes his yolks just fried, he has the other three.

If I feel like it, I have a creamy cocoa, ie about 4g cocoa powder, 2ml honey, maybe somewhere between 30 and 60ml double cream. Usually a decaff coffee too. Sometimes with caffeine, though I tend to prefer my caffeine in the evenings.

Lunch on work days is portable stearic acid as 100g of Lindt 90% cocoa solids chocolate. Sometimes with 100g macadamias, sometimes not. Occasionally 300ml of soured cream along side some chocolate.

Supper is a meal. It varies a lot. If you scroll down the index to the set of posts starting with "Food" you get the idea of the sort of things I eat for a main meal. I have been known to eat green leaves with supper. I have been known to eat parsnip chips. I have been known to have gluten free home made cake for desert under a centimetre of butter or drowned in soured cream. If fat has been a little low with supper I might make ice cream with just a little added sugar. Or rhubarb baked in cream and flavoured with cinnamon. Or another creamy cocoa.

Alcohol, some. I like dry wine and gluten free beer. Never a huge amount.

I don't weigh any food nowadays (I went through the Fitday kick years ago), especially since the digital scales passed away. I weigh myself about once a year. My jeans are 28" waist, depending where I buy them.

There are oddities that need to be borne in mind, ie that I have never been overweight. I eat this way as a result of an accident at an anaesthesia meeting, chatting with a friend who had dropped from 18 stone to 12 stone on Atkins induction. I had just discovered Pubmed and devoured studies voraciously.

It didn't take long to realise that Kwasniewski's Optimal Diet was where I wanted to go. I don't eat enough offal and I don't make enough bone broths, but otherwise I keep fairly close. My biggest transgression is excess protein.

Quite why excess protein is bad is interesting. If you read the DNA chapter in Nick Lane's "Life Ascending" it brings home quite how closely  integrated amino acid metabolism is to the TCA. It's way too complex to see how any given protein would interact, so aiming for high grade low quantity is how I work, when practical. If you eat more than you need it goes in to the TCA.

In my Fitday days I used to run at around 2000kcal/day for weight stability but I probably run a fair bit higher than than nowadays, most days. But no two days are the same and there is far too much to enjoy in life without agonising over +/- 5g of butter.

Is it worth it? Well, I sort of forget that eating this way is odd. You have to giggle at the nurses with their little tubs of salad and half an apple but they're just kiddies... But I went from being early middle aged to pretty much how I felt as a teenager, once I had adapted (full adaptation took me about 6 months). I don't feel I have changed much, beyond the needs of a second family, in the last 10 years healthwise. Beard is a little greyer.

I feel well. You sort of forget what it used to be like to need to eat NOW. And to fall asleep for three hours after a huge bowl of rice before being awake half the night. Anyone with a bad back will be very familiar with using one foot to pull your underwear up the other leg to where you can actually reach it without bending down. All gone, along with the little pot belly.

I have no expectation of living for ever. But I have no intention to going back to where I was at 40 years of age. Aging un-noticed would be nice. When you find something which works this well you don't throw it away.


Monday, May 20, 2013

A bit more on ketones and diabetic nephropathy

Just in haste, sorry for the missed typos! Liz sent me the full pdf of this paper:

Treatment of Diabetes and Diabetic Complications With a Ketogenic Diet

It's primarily a review, both of the work by Phinney and Westman and of the lab animal studies by the group producing the review.

Deranged glucose metabolism appears to be what causes the problems in diabetes, type 1 or 2. More on this when I get back to the chronic hyperglycaemia post. It's not forgotten.

Ketones, the metabolism of which remains normal, appear to be key in replacing abnormal glucose metabolism, more so than simply achieving normoglycaemia without ketosis.

Protein limits ketosis and the use of low carbohydrate diets with unrestricted protein intake may explain some of the failures to maintain the benefits of carbohydrate restriction. I have to say, Jimmy Moore comes to mind here. I like his success with ketosis.

It looks to be as easy to substantially reverse diabetic nephropathy in mice as it is to limit nephropathy progression in humans, but ketones are essential.

Mouse, human, diabetic nephropathy, reversal with ketosis. Shrug.

The take home message is very simple. If you have severe metabolic problems the answer is not simply carbohydrate restriction. It also involves protein limitation, to adequate but not gluconeogenic levels. Low carb, adequate protein, high fat. With the emphasis on the fat.

Taterism is fine for any Tato Head without metabolic problems. As everyone will eventually develop metabolic problems, so Taterism will eventually injure everyone. Some folks probably have dialysis blood on their hands already.

The high fat brigade are correct.


Wednesday, May 15, 2013

A Peek at Paleo

I don't eat a paleo diet, I'm just a saturophile. If it's saturated fat and it happens to come from a neolithic block of butter, that's fine by me. But I hadn't realised going paleo could be actively worse for your health than eating some version of the SAD. You can download Eric Trexler's thesis from here. Catchy title is:

"Paleolithic Diet is Associated With Unfavorable Changes to Blood Lipids in Healthy Subjects"

Some people may have noticed that I have minimal interest in blood lipid levels. I know people angst about them, but I've yet to be convinced that they have anything to do with heart disease other than as a surrogate for how much sugar you eat.

The thesis reports pre and post diet lipids but only gives end-of-paleo-diet food breakdown, and only the fat/saturated fat at that. Go figure. Guess they forgot to ask what folks were eating to have better lipids than their study diet was going to produce! Perhaps they had a defective crystal ball.

I've always viewed HDL as a surrogate for saturated fat intake. The sub population with the best HDL on pre diet lifestyle (around 82mmol/l) dropped it to around 69mmol/l on paleo diet plus exercise and weight loss. My assumption is that these folks actually dropped their saturated fat intake or increased their PUFA intake by so much that even the exercise induced rise in HDL and weight loss induced rise in HDL couldn't offset the fall in HDL induced by the study diet. Impressive.

Triglyceridess rose non significantly. I view trigs as a surrogate for sugar intake. You have to guess how much SAD high fructose corn syrup was replaced by paleo fruit. Or whether fruit juice [Peter vomits quietly in the corner] was allowed. Well, the trigs went up (slightly), not down... Gathering was good that day, every day, for 10 weeks!

OK, so what sort of a paleo diet was this? Quote:

"Subjects were advised to increase their consumption of lean meat [Peter vomits quietly in the corner again], fish, eggs, nuts, fruit, and vegetables and were instructed to strictly avoid all grains, dairy products, and legumes."

Obviously spuds appear to have been on the menu in paleoland and animal fat is the devil incarnate!

What was their source material for these well thought out recommendations? They were based on Eaton and Konnor's 1985 paper:

"Paleolithic nutrition. A consideration of its nature and current implications"

You can't get at the full text or even an abstract on line. Luckily Anna, over at Lifextension, fills in the details for us. She pasted a copy of her information over on ItsTheWoo's blog here, explaining both where Eaton got the data and pointing out the 2000 correction he published, amending his paleo fat intake estimates (upwards of course). I get a faint impression that Anna may not be best impressed by Eaton's ideas. Or by Taterism in general. BTW, did anyone run through the list of references? Given a year or two I might try one day, but perhaps just sticking with simple saturophilia might be easier.

I rather like Anna's commentary. I like her suggestion that Eaton's ideas seem uncomfortably influenced by politically correct beliefs aligned with the AHA's diet advice. Reading Trexler's thesis I was also struck that it could easily have been written by an AHA cardiologist. The naked fear of LDL cholesterol shines through the whole text.

My take home message is that if you are going to align your paleolithic diet advice with the AHA, people are going to get hurt.