The Paleo Solution Part 5

Celiac.

Most people are familiar with a condition called celiac, which is an autoimmune disease caused by gluten, a protein found in wheat, rye, barley, and millet. It is clearly understood that celiac is an autoimmune disease caused by lectins. It is also clear that other autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren's, multiple sclerosis, and a host of other autoimmune conditions occur at much higher rates in celiac patients. However, this a.s.sociation, for whatever reason, was largely dismissed as an anomaly until researchers recently made the connection between the development of celiac and other autoimmune diseases.

We now understood that WGA and other lectins have a significant effect on the enzyme transglutaminase (TG). Transglutaminase is an enzyme that modifies every protein we make in our body. How many proteins does TG modify folks? That's right, all of them. Heart, brain, kidney, reproductive organs-all of them. So, if lectins can cause problems with TG, and if TG modifies every protein in our body, how many things can lectins cause problems with? I hope this is obvious-lectins can and do affect every organ system. Reproductive issues, vitiligo (a skin condition where the individual loses pigmentation in the skin) Huntington's, narcolepsy-we have found literally hundreds of conditions in which lectins appear to be the causative factor. Not only do we have science to support this, we have observed clinical resolution of these conditions upon the removal of grains, legumes, and dairy. I hate to do this to you, but we have to go back into the intestines.

Really? Digestion? Again?

Yes, sorry about this, but we need to crawl back through the digestive tract. Don't worry; we will jump right in at the good stuff: the small intestines.

If you recall, when food is emptied from the stomach into the small intestines it is mixed with bile salts that are produced in the liver and stored in the gall bladder. Remember, bile salts are much like soap and are critical for our digestion and absorption of fats. In addition to bile from the gall bladder, the pancreas releases digestive enzymes that are critical to digestion. And lest you forget, much of the digestive process happens at the tiny structures in our intestines-the villi and microvilli. Now let's see how lectins interact with the intestinal lining to produce autoimmunity.

Lectins such as WGA bind to a receptor in the microvilli, allowing WGA to be transported into the body. This is the mechanism of the autoimmune cascade I described above. If the gut wall (microvilli) becomes damaged, the entire contents of the intestines can now make its way into your system. Yes, that's as bad as it sounds. You are not only in a position to create antibodies against WGA, which leads to autoimmunity, but you now have the potential to develop multiple allergies due to a permeable gut lining and inadequately digested food. This is how you can develop allergies to chicken, beef, apples, or other normally benign foods.

Additionally, if your gut is damaged, you expose yourself to a host of chemicals that would normally remain in the intestines. This can lead to conditions such as multiple chemical sensitivity syndrome, which is regarded more as a psychiatric problem than legitimate medical condition.

Let me be crystal clear about this: Anything that damages the gut lining (including bacterial, viral, and parasitic infections, as well as alcohol, grains, legumes, and dairy) can predispose one to autoimmunity, multiple chemical sensitivities, and allergies to otherwise benign foods.

As my Brazilian Jiu-Jitsu coach says, "This no opinion is, this fact is."

"If the gut wall (microvilli) becomes damaged, the entire contents of the intestines can now make its way into your system."

Full of Bile.

While this digestive disaster is taking place, there are several other problems brewing. As you recall, the function of the gall bladder is to release bile salts into a meal as it is emptied into the duodenum from the stomach. When the intestinal wall is damaged, the chemical messenger, cholecystokinin (CCK), is not released. CCK usually sends the "on" switch to the gall bladder and the secretion of pancreatic digestive enzymes. When this signal is blocked, we do not properly digest our foods, particularly fat and protein. The lack of bile release allows cholesterol crystals to form in the gall bladder, which leads to gall stones. The standard medical practice of removing the gall bladder is effectively killing the "canary in the coal mine." Gall stones are a symptom of a problem, an alarm. Instead of treating the cause (remove grains) we cut out the gall bladder. People who have had gall bladder removal are almost certainly undiagnosed celiacs and likely have a number of other progressive diseases. In my experience, these individuals are plagued with digestive problems, culminating in dysphagia, or difficulty swallowing.

Achtung!

The disruption of CCK and related hormones (PYY, adiponectin) in the signaling cascade of digestion is a really big deal. Not only is the digestive process severely damaged, much of our satiety signaling is taken offline as well. We cannot properly digest our food, we are always "hungry," and the very food we crave, refined grains and sugary junk, happens to be the cause of the problem.

It Gets Better.

Another piece of the chemical defense system used against us by grains is a group of enzymes called protease inhibitors. Protease inhibitors prevent the breakdown of proteins. This means that when you consume grains you do not effectively digest the protein in your meal. Protease inhibitors also stymie the digestion of lectins such as WGA, making these already difficult-to-digest items virtually indestructible. This leaves more large proteins in the intestinal contents, which increases our likelihood of developing autoimmunity, allergies, or chemical sensitivities.

Osteoporotic Much?

If you do not have a bellyache thinking about grains by now, let's look at one more player: antinutrients such as phytates. Phytates are important for seeds and grains because they tightly bind to metal ions (like magnesium, zinc, iron, calcium, and copper), which are crucial for the growth and development of the grain. If the metal ions are not tightly bound by the phytates, the process of germination can happen prematurely and this can spell disaster for the grain. When we consume grains, the phytates are still active and powerfully bind to calcium, magnesium, zinc, and iron. This means the calcium, magnesium, zinc, and iron are unavailable for absorption. Because of the action of antinutrients such as phytates combined with the gut damaging characteristics of lectins and protease inhibitors, our Neolithic ancestors lost an average of six inches in height vs. our Paleolithic ancestors due to the Neolithic diet of grains and legumes (remember the agriculturalists in chapter 2?). Are you concerned about osteoporosis or iron deficiency anemia? Do you suffer from fatigue or heart problems that might be caused by magnesium deficiency? Have you diligently consumed a "smart" diet of whole grains, legumes, and low-fat dairy as per the recommendations of your dietician and doctor? Do you see how ridiculous that suggestion is in light of what you now know about grains, legumes, and dairy?

Thank You Sir, May I Have Another!

Here is a recap of how grains cause malabsorption issues and how that affects our health and well-being: 1. Damage to the gut lining. If the gut is damaged, you do not absorb nutrients. We need healthy villi and microvilli to absorb our nutrients, be they protein, carbohydrates, fats, vitamins, or minerals.

2. Damage to the gall bladder and bile production. If you do not absorb fats and fat soluble nutrients such as vitamins A, D, K, and other nutrients, you will have problems utilizing any minerals you do absorb, to say nothing of the nutrient deficiencies from inadequate essential fats.

3. Phytates tightly bind to metal ions and make them unavailable for absorption. a.n.a.lytical chemists actually use purified phytates in experiments where it is necessary to quantify the amounts of metal ions like calcium, zinc, or iron in a sample because the phytates bind to these metals tighter than just about any other molecule. The same thing happens when you eat phytates, and this is not a good thing for bone health or iron status.

4. Open door for autoimmunity and cancer. Once the gut lining is damaged, we are at exceptionally high risk of autoimmune disease, such as Hashimoto's thyroiditis, and several types of cancer, including non-Hodgkin's lymphoma. The pancreas is a.s.sailed by grain-induced inflammation due to CCK problems and elevated insulin levels. This inflammation is a potential cause of pancreatic cancer and pancreat.i.tis (inflammation of the pancreas).

Why does all this happen? Because grains are p.i.s.sed that you want to eat them and they are willing, and able, to fight back.

Here is a short list of the problems a.s.sociated with leaky gut and the autoimmune response: Infertility.

Type 1 diabetes.

Multiple sclerosis.

Rheumatoid Arthritis.

Lupus Vitiligo Narcolepsy Schizophrenia.

Autism.

Depression.

Huntington's.

Non-Hodgkin's lymphoma.

Hypothyroidism.

Porphyria.

Yeah, But I'm Not Sick.

Like I said, this is a short list of the issues we know are tied to autoimmunity and that have shown improvement or complete resolution when one eats in accordance with the recommendations in this book. When we get to the prescriptive chapter, I'll provide detailed guidelines to help give you the best chance at reversing or preventing these and other problems.

Some of you, however, may think you have no issues here. You have eaten grains, legumes, and dairy your whole life and are "fine." Well, maybe. But I suspect that is not the case. I'll bet that if you completely remove these Neolithic foods from your diet for one month, you will notice a dramatic improvement in how you feel and perform. Why? Because if you are consuming these foods, I'll wager you have gut irritation and other systemic inflammation issues.

A recent study looking at children with type 1 diabetes (an autoimmune condition) found that a significant number of them had overt gut pathology, i.e., celiac. Some had a positive antibody test for celiac, but a number of kids were negative on both the WGA antibody test (a common blood test for celiac) and on an intestinal biopsy. So doctors would think there was no gluten influence in their condition. Interestingly, however, nearly all the kids showed antibodies in the deep tissues of the microvilli to . . . transglutaminase.

The study authors suspected most of the kids would at some point develop what is commonly described as celiac. What this tells us is gut damage can be fairly benign (few symptoms) but still lead to autoimmunity. Once initiated, autoimmunity can and does progress to other problems. Your doctor or dietician will likely dismiss this information, especially if you are "negative" for any of the standard blood work or lab tests for celiac. They are foolish in this regard, but hey, it's only your health.

Trust your medical professionals, they always know best. Or, try a simple experiment: Follow a Paleo diet, and a.s.sess how you feel and perform. I know, I can hear the MDs now, that it's "just anecdotal." If you are going to save your a.s.s you are not likely to get much support in this matter unless you have a forward-thinking and aggressive primary physician.

What is the ultimate gold standard in all this? How do you know for sure you do or do not have an issue with these foods? The answer seems obvious: remove the potentially offending foods! Reintroduce them after thirty to sixty days. See what happens. Now there is a caveat to this. You only need to be exposed to things like gluten once every ten to fifteen days to keep the gut damaged. This can bedevil people as they "cut back on gluten" but do not notice an improvement in their overall health. I'm sorry but there is not a pink "partic.i.p.ant" ribbon given out for doing this "almost correctly." You need to be 100 percent compliant for thirty days, then see how you do with reintroduction.

Now, I'll be honest, the reintroduction is for you, not me. If I did a phone consult with you, I'd ask, "How did you do when you had that piece of bread?" I know exactly how you did-I've seen this scenario thousands of times, but you are the one who needs convincing. When you reintroduce gluten you will not feel good. Sorry kiddo, it's just the way it works. Now it's up to you to decide if health and a long life are worth forgoing some of these foods more often than not.

Does all this seem hard to believe? Well, remember how I described the effects of poison oak on your skin? It's a similar deal here with gut irritation and lectin exposure. If you want to get the full power of this program, you need to actually give it a shot. Worst-case scenario: You spend a month without some foods you like. Best-case scenario: You discover you are able to live healthier and better than you ever thought possible. If you cannot suck it up for a month to discover that, well, b.u.t.tercup, you might be beyond help. And let's be honest, most of your arguments have nothing to do with the science-you are likely addicted to these foods.

But I Like Bread and Pasta!

Yes, I like that stuff too, but they make me sick. I suspect it makes you sick, as well. Not only do grains make you sick by raising insulin levels, messing up your fatty acid ratios (n-3/n-6), and irritating your gut, but they are also addictive. Grains, particularly the gluten-containing grains, contain molecules that fit into the opiate receptors in our brain. You know, the same receptors that work with heroine, morphine, and Vicodin? Most people can take or leave stuff like corn tortillas and rice. Suggest that people should perhaps forgo bread and pasta for their health and they will bury a b.u.t.ter knife in your forehead before you can say "whole wheat!" Sorry folks, I don't make these rules, I just have the lovely task of educating you about them.

Why I had to focus on gluten-free living, exercise, and trying to get you healthy, I will never know. I should have just peddled hookers, cocaine, and pastries! So much easier.

But, But, But!

Egad! I can hear it now: What about whole grains? What about brown rice? What about Ezekial Bread? What about the China Study? What about fiber and vitamins? Want more science, more convincing? To this I have one word: Do.

I could make this book a thousand pages of science and technical investigation, but someone could still find a stone I have left unturned. This is a stalling technique, nothing more. If you want to be healthier, look better, and perform better, you need to do. Ultimately, it is your personal experience that matters. Want more science? Want to argue about it? Read every citation I have in this book, the published research on my website, and then come to town, buy me a NorCal margarita, and be ready for a chat. But first, you still need to go thirty days grain, legume, and dairy free. I have "tried it" your way. Take thirty days, do it my way, then tell me what happened. Read the literature and be articulate in the science, and have thirty days of personal experience to speak from. Arm-chair quarterbacks do not get a say in the matter, capisce?

Listen, I'm not trying to be a jerk here. I'm trying to help improve, possibly save, your life. This book is full of "science," but none of that matters compared to your personal experience. Get in, do it, and then evaluate critically, OK?

I will lay out how to do this. I will show the nutrient inferiority of grains compared to fruits and vegetables (I hear fruits and veggies have vitamins, minerals, and even this wacky stuff called fiber. Apparently, this info has not been pa.s.sed along to registered dieticians). I will show what to expect with regard to fat loss and what lab values to track. It's easy to do. It may be new to you, but you can do it. Put down that cookie! It's time to learn about fat.

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Legumes and Dairy.

Believe it or not, I don't want to bury you with technical details, but I'm trying to tell you what you need in order to understand the material. With this in mind, it is important to address the topics of legumes (lentils, beans . . . you know, fun foods that make you toot!) and dairy.

In simple terms, dairy and legumes have problems similar to grains: Gut irritating proteins, antinutrients, and protease inhibitors. In rheumatology circles, it has long been understood that bean sprouts are highly problematic for folks with autoimmune diseases such as rheumatoid arthritis and lupus. Some doctors have made the connection to dairy as well. I could have included a chapter similar to the one I did on grains for both dairy and legumes, but to what effect other than burying you with repet.i.tious material? In an effort to prevent brain implosion from information overload, you need to understand that these foods are also on the thirty-day "no fly" list.

I've included research in the reference section specific to the autoimmune and metabolic problems a.s.sociated with dairy and legumes. So, if you want to geek-out on that stuff, by all means go for it. What you will find are mechanisms eerily similar to grains: Gut irritation, protease inhibitors, antinutrients, and inflammation. When we get to the prescriptive chapter, I will walk you through specifically what items to avoid, and how you can tinker with the occasional reintroduction of these foods.

PS. OK, I have this sneaky suspicion you're going to be slippery about this topic. As you will see in the prescriptive chapter, it is critical that you consider grains, legumes, and dairy all in the same category. This is particularly true if you have weight loss goals, inflammation, or autoimmunity. Yes, honey, cut the cheese.

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SEVEN.

Fat.

Have a Seat, This May Take a Little While.

One night I took my wife Nicki out to our favorite Thai restaurant. You would likely walk right by the place fearing some significant health code violations, but this little hole-in-the-wall is amazing and typical of the best eateries: All the love is in the food, not fancy decor. Our waiter was a college student we had seen several times on previous curry-binges, but this was the first time he waited on our table. He is a very upbeat kid, boisterous, funny, and pretty d.a.m.n overweight. He seated us, made some small talk, and then asked us for our order: 2 orders of chicken satay (chicken skewers that are marinated in coconut milk and spices).

2 fresh coconuts (these are young coconuts full of water and with a jelly-like consistency on the inside. AMAZING).

2 orders of red curry. Mine mild, Nicki's medium-hot.

Instead of rice, we asked for a steamed vegetable medley that included carrots, broccoli, several types of mushrooms, and bamboo shoots. Part of why we love this place is they give us over a pound of steamed veggies instead of rice.

Our very nice, very funny, very overweight waiter looked perplexed, almost upset. I thought it was because Nicki and I have the annoying couples' habit of ordering the same things. No, our waiter was concerned for our health. Our overweight waiter said to Nicki and me, "Are you guys trying to stop your hearts?"

I still left him a tip, just not a large one.

Nicki and I are in pretty d.a.m.n good shape and our blood work leaves our doctors jabbering about how we will "live forever." All is well until the discussion of what we actually eat. Then we get the same look from the doctor as from our waiter. Our waiter was convinced that our high-fat meal, particularly of high saturated fat from coconut, was going to kill us before we finished eating. Our doctor was (and is) convinced we were ticking time bombs, just waiting for the day when our blood chemistries take a turn for the dead.

Oy-vey!

Fat Confusion.

This chapter has proven to be one of the toughest for me to write because I was stumped where the h.e.l.l to start. People seem to generally understand the insulin/refined carbs concept. Kinda. People have heard of low-carb, perhaps even dabbled with it, but even though most of you are OK with the idea that refined carbs are bad, you still think fat is bad. Our governmental agencies have done a great job of convincing us that fat, particularly animal fat, is pure evil. We were told to cut fat, increase "complex carbs," and all would be well. That is true if you are in the business of coronary artery bypa.s.s, statins, diabetes meds, or gastric bypa.s.s.

The government high-carb, low-fat fantasy is turning out to be amazingly profitable for sectors of our medical and pharmaceutical establishment. Unfortunately, it's not been kind to our friends, family, and coworkers.

I'm going to touch on the history of this story because it's a reasonable question to ask, "How did seemingly smart people make such a dumb mistake?" I will not, however, do an exhaustive a.n.a.lysis of this multibillion-dollar farce. If you want a full accounting, check out the books Protein Power and Good Calories, Bad Calories. It seems silly for me to rehash the details of this medical history, as I would prefer to focus on how to fix your situation. So, if you want to dig deeper on this topic, check out the aforementioned books and the resources in the appendix. For now we will look at how the McGovern Commission has cost us billions of dollars and millions of lives.

Remember, the reason why we need to look at all this is because you, your doctor, and your uncle Fred will ask the probing question, "Won't eating fat kill you?" I wish I could just put people in a headlock and give them a noogie until they agreed to try the recommendations in the book, but my parole officer and lawyer have explained to me this const.i.tutes "a.s.sault." Hence, the science.

Ancel Keys and the McGovern Commission.

In the early 1950s a biochemist named Ancel Keys submitted a paper for publication t.i.tled, "The Seven Countries Study." This was an early bit of epidemiological work that appeared to show a strong statistical relationship between the amount of fat consumed in a given country and the incidence of heart attack. It appeared to be an airtight case that the more fat a country consumed, the more heart disease. In fact, the data Keys reported did follow this trend line, but only when he conveniently threw out all of the conflicting results!

Numerous countries with high fat intake also showed remarkably low CVD. Other countries showed high CVD while eating little fat. When considered in its entirety, the Seven Countries Study should have involved twenty-two countries, and the conclusion from this larger (accurate) data set would have been, "There is no relationship between fat intake and CVD. Some other factor must be at play here."

Unfortunately, this is not what happened. Keys had a bit of a puritanical streak and felt people needed to restrict their rich food intake, particularly meat and saturated fat.

Keys recommended a "prudent diet" based on vegetable oils (like corn and soy) and grains, thus theoretically emulating the diet seen in the Mediterranean countries of Italy and Greece, both of which sported better average health than North America. Unfortunately, neither Keys nor anyone else noticed that the recommended "Mediterranean" diet looked nothing like the diets the French, Italians, and Greeks actually ate.

You Can't Eat a Meme.

Good and bad ideas alike gain footholds largely because they are, to use Malcolm Gladwell's term, "sticky." People are exposed to the ideas, like them, and for good or ill, pa.s.s them along. Take this sticky idea, add capricious G.o.ds or dumb luck, and we have set the stage for toppling governments or killing millions of people because of bad policy.

In this situation, the idea that fat was the cause of CVD (eventually fat would be both condemned and subsequently acquitted of being the cause for cancer, cognitive decline, and host of other ills) was appealing to people. In addition to this, we had a postWorld War II sense of government do-goodery that drove the McGovern Commission to champion the fat-heart hypothesis. This occurred despite ma.s.sive outcry from the scientific community that dietary fat, in particular saturated fat, was not the causative factor in CVD. In a congressional hearing, scientists voiced their concerns over these sweeping, low-fat recommendations. In return, McGovern quipped that senators do not have the luxury of scientists, who wait for all the data to come "in" before making a decision. Something needed to be done!

So, we had one part "cooked" scientific data (which scored Keys a Time magazine cover), and one part governmental do-goodery. This might not have been enough to breathe this lipid-heart hypothesis monster into life, but we had one other unfortunate problem: human gullibility. Researchers reasoned that if Americans were fat, and suffering from more heart disease than other countries, they should reduce the fat in the diet. It was like a balanced chemical equation: Fat in the diet = FAT People.

Or, for the visual learners: In support of this fat = fat idea, people like to throw around big words like "thermodynamics." Fat has more calories (9 calories/gram) than protein and carbohydrate (4 calories/gram). If one consumes more calories than one burns, this will lead to weight gain. So, reduce fat, and the likelihood of consuming too many calories would be reduced. This idea makes sense. It made so much sense that no one bothered to actually do their homework and make sure it was actually true. No one considered that carbohydrate, and the insulin it releases, drives hunger and fat storage. Also overlooked was the fact that protein and fat reduced total calorie intake by increasing satiety via PYY, adiponectin, and similar appet.i.te-control mechanisms.

As I mentioned previously, researchers quickly discovered a number of "paradoxes" among people like the French, Spanish, and Greeks, who ate significantly more fat than Americans, yet were slimmer and suffered a fraction the CVD. We were so blinded by our fat phobia we could not see the facts for what they were. Instead we have tried to hang the health of the French and Greeks on things like red wine and olive oil.

If You Meet the Paradox on the Road...

There are no paradoxes in biology, only our mistaken a.s.sumptions about biology. The a.s.sumption that fat makes people fat and causes heart disease makes sense, but that does not make it true. In every clinical trial performed, carbohydrate-controlled (low-carb) diets provide more weight loss and better cardiovascular disease prevention than high-carb, low-fat alternatives. High-carb pundits keep peddling this failed approach, but it's as simple as trying the various approaches for one month so you can see which one allows you to look, feel, and perform your best.

The story above is a brief history of the inaccuracies surrounding the lipid-hypothesis and, honestly, it just scratches the surface. We have over fifty years of failed governmental policy to keep track of and millions of lives lost in the process. If you want to dig deeper on this topic, the resources mentioned above, along with those in the appendix, are waiting for you. Now, however, we need to look at what fat actually does do with regard to our performance, health, and longevity.

Fats! Bomp, Bomp, Bomp! What Are They Good For?

For most of us, fat is a dirty word. It's something that makes our f.a.n.n.y look terrible in a bikini. A few enlightened folks recognize that fat is important as a fuel and is a building block for many of our cell membranes and hormones. However, the reality is that fat is far more than just fuel or raw materials. It is us. Our brains are mainly fat, most of our nerves are fat. Reproductive hormones, yep, fat. Now there are different types of fat, and we will look at those sub-types because, if you can believe it, there are even essential fats. Fats that if you do not get enough of, or the right ratios, you will become sick or die.

When considering fats, it's helpful to understand just a little bit about their chemical structures. This is because their names and their physiological actions are tied to their structures. Fats come in varying lengths and they are divided into one of three general categories: saturated, monounsaturated, and polyunsaturated.

Now, most of you have heard the terms saturated and monounsaturated. Some of you might have even heard of polyunsaturated fats. What the names indicate is how many, if any, double bonds exist in a given fat. This is important because double bonds (or saturation), along with chain-length, are what separate one fat from another.

Stearic acid, for example, is an 18-carbon fat that contains no double bonds. In chemist geek speak, it is "saturated" with hydrogen, hence the name. In the case of oleic acid, we have an 18-carbon molecule with one double bond, which earns oleic acid the term monounsaturated. Finally, we have a fat like alpha-linolenic acid, which is also an 18-carbon-long molecule, but in this case it has several double bonds. We have arrived at the "polyunsaturated" fats.

As a final wrinkle, fats are usually bonded three at a time to an alcohol-like molecule called glycerol. This folks is what we call a triglyceride. If we eat something like steak, olive oil, or coconut, we take in triglycerides that are made up of different fatty acids. Most foods have a characteristic mix of fats, but some variation does occur, as we will see with the difference between gra.s.s-fed and grain-fed meats.

The chemical and physical properties of fats (are they liquid or solid at room temperature, do they go rancid (oxidize) easily or not?) are dramatically altered by how long the molecule is and by how many (if any) double bonds are present in a particular fat. Saturated fats tend to be inert. Coconut oil, which is mainly a short-chain saturated fat, does not go bad even when exposed to the air for years. Linseed oil, by contrast, is a polyunsaturated fat that oxidizes so quickly one can start a fire by leaving linseed oil on things like rags or paper. Monounsaturated fats, not surprisingly, fall between the other two fats in how rapidly they go bad. I know you were dying to learn all this stuff. You will be ready to impress friends, family, and colleagues with your newfound knowledge. Feel smug.