Saturday, May 6, 2017

Farewell to Plant-based? Am I Mad or What?

Some people think I am “crazy” and that I “flip flop” on my positions and that I am unreliable as a consequence.  Fine, they can think whatever they want.  What other people think of me is none of my business.

Yes, I am mad (in at least one of the senses of that word), and this post is about the method behind this madness.  This post is pretty long and I thought about putting it out in parts but I decided that it is better to leave it intact.  Its a detective story and if I didn't put it out all at once, a reader might easily lose the trail leading to apprehension of the alleged culprit, who as of May 1, 2017 is now on trial in the court of experiment.  

Although I can agree that I have put too much confidence in conventional nutritional wisdom and some authorities in the past, and unfortunately expressed a certainty of conclusions that my evidence did not warrant, I have nevertheless been sincerely attempting to understand how and why the science of nutrition seems to produce experts who have literally diametrically opposed evidence and theories, such as, on the one hand, those who support low-carbohydrate ketogenic eating and on the other those who claim that the one true healthy way of eating is high in carbohydrate and low in fat and protein particularly from animal products.

My interest has not been idle.  I quite literally have skin in the game.  I’ve been seeking solutions to my own chronic health conditions.  I have changed dietary directions whenever it became clear that what I was doing was not helping me get results I wanted.  The only problem was, I was blazing a trail in unknown territory, dragging along maps that either didn't accurately represent the territory, didn't have the destination I was seeking, or didn’t give me enough clues to make what may have looked to others like more rational decisions.

I started my experiments with various ways of eating, nutritional supplements and alternative medicines in my teen years, motivated by two factors.  First, I was an athlete and wanted to find the best diet for building strength and muscle mass and improving performance.  Second, I had respiratory allergies and skin diseases that conventional medicine was unable to cure.

Here are a couple of photos of the types of inflammatory skin disorders I have been managing for more than 40 years.  These were made in April of 2017.

Above left eye in eye socket.  Emerged in March 2017, one of the reasons I decided to abandon vegan WFPB diet.

Left ear.  Ongoing for more than 40 years. Same in right ear. Itches and sheds big flakes of skin.  Cracks open and hurts.
Hands, plaques in web between 3rd and 4th and 4th and 5th fingers.  Ongoing for years, waxes and wanes.

Scalp, ongoing for at least 30 years. Thickened scalp skin, plaque, flakes and itches.
These are only some of the locations.  The thickened, flaking, cracking skin also occurred on my tailbone starting in my teen years and continuing for many years, then was resolved by a course of Chinese medical treatment (detailed below) and remained absent for about 20 years, then re-emerged in late 2016; more about that including a recent photo below.  One physician diagnosed them as psoriasis, a supposedly incurable inflammatory and auto-immune skin disorder.

Conventional medicine physicians have prescribed only steroid creams, which suppress the symptoms so long as I use the creams, but when I stop they return.  I have also tried treating all of these lesions with antifungal drugs (and antifungal herbs).  That only made the condition worse. 

I was raised on a meat- and dairy-rich, and starch- and sugar-rich diet.  My brother and I consumed gallons of whole milk.  Once or twice a year, my father bought a frozen side of beef from friends who raised Angus cattle.  When I first got interested in strength training, I followed the advice of most strength athletes of the time, which was to eat a meat- and dairy-rich diet.  In high school I competed in some bodybuilding contests, and I used a cyclic low-carbohydrate ketogenic diet to get into a lean condition for those events.

My Dietary Indoctrination

By the late 1970s I was persuaded to adopt a high carbohydrate diet after reading several books written by conventional sports nutritionists and sports medicine physicians, including The Sports Medicine Book by Gabe Mirkin M.D. and various books by Ellington Darden, Ph.D..  Darden is an exercise physiologist who worked closely with Arthur Jones, the creator of Nautilus and Med-Ex resistance training machines.   

I followed their leads. I thought I was on the right track, as it seemed the entire medical profession was advocating reduction of fat intake to reduce heart disease risk.  The McGovern report released in 1975 had urged Americans to reduce meat, dairy, and fat intake.  By the time I was 21 I had adopted to a lacto-ovo vegetarian diet.

When I was in graduate school in the early to mid 1980s, I learned about the macrobiotic diet popularized by George Ohsawa and Michio Kushi based on whole grains and vegetables.  These authors suggested that a strict, very low fat, very low protein whole grain based “macrobiotic healing diet” could heal respiratory allergies and the type of skin conditions I had.

Their recommendations appeared to be just stricter version of the low-fat, high carbohydrate diet that many physicians of the time recommended for prevention of heart disease and many sports nutritionists recommended for optimizing physical performance.  I thought I had nothing to lose except the allergies and rashes, so I tried. the strict healing macrobiotic diet.

The diet Kushi recommended for those conditions consists of boiled or pressure cooked whole grains, small amounts of whole legumes, vegetables, small amounts of sesame oseeds, and very restricted amounts of fruit (to limit sugar intake).  All other plant foods are extremely restricted, including any rolled grains, whole grain flour products (e.g. bread and pasta), all sweeteners, plant oils, and all animal products are to be avoided unless craved, in which case one is to eat very small portions of white meat fish.

I found that when I followed this diet strictly, I was unable to consume sufficient calories to maintain my weight. I would just be stuffed to the gills with brown rice and vegetables before getting adequate calories.  I was never a fat person.  I weighed 155-160 pounds at 5’9” when I started my experiments with macrobiotics.  Within a few months during which I was quite physically active, I dropped below 130 pounds.

I looked like a starving person; some would have said “death warmed over.”  Concerned family and friends thought I had a terminal disease.  I wish I had photos but I didn’t own a camera at the time.  But I did this style of healing diet several more times, with modifications, and I have some photos below of what I looked like afterwards after one of those experiments. 

But, lo and behold, during this time, both my usual spring pollen allergies and the skin disorder affecting my ears disappeared and the rash on my tailbone area subsided.  As a result of this experiment, I developed the idea that a plant-based diet was an effective cure for these conditions. (I will return to this later.)

There was one catch.  I couldn’t maintain that diet indefinitely.  I was just too thin and getting thinner, and did not have energy or strength for my mental or physical pursuits while eating that extremely restricted diet.

I didn’t keep diet records at the time, but based on the rapid rate of weight loss over a few months I estimate that my diet contained no more than about 1200 calories per day.  I was about 23 years of age and very physically active (a bicycle and my feet were my sole means of transportation, and during several months of this time I did physical labor as a seaweed harvester), so my caloric requirement was more like 3000 per day.

I had to broaden the diet to increase the caloric, protein and fat intake.  When I did, the rashes returned or got worse.  At the time, I really didn’t understand why all that happened, but the experience SEEMED to confirm that eating excess protein and fat was the cause of the condition.  

What a conundrum.  I wanted to be rid of the rashes, but I also wanted to live a productive life.

I chose to aim for the productive life.  And I held the belief that eating the right, highly restricted plant-based diet was the cure for my diseases.  I just hadn’t figured out how to eat that low protein, low fat diet and maintain my energy intake and weight and not suffer from daily digestive distress (see below).  This one experience gave me the idea that my condition was caused by eating too much protein and fat.  At the time I had no other interpretation and this interpretation became a belief that kept leading back to a blind alley called the low fat, high carbohydrate, whole foods plant based vegan diet, hoping to get different results by just making minor adjustments.

My Gut Feelings on Plant-Based Diets

A calorie-adequate whole foods plant based diet presented other problems for me.  Whether based on high calorie fruits or whole grains and legumes, I got lots of bloating, flatulence and loose stools.  Also, after some months on the grain-based regime, I would get acid reflux after meals containing amounts of whole grains barely adequate to provide me with calories I needed.  Sometimes I would think that the reflux was due to stress, but when I ate a paleo diet, I never had reflux  despite going through my share of stress (e.g. a divorce). 

Advocates of plant-based diets consider bloating and flatulence to be “normal” on a high plant food diet and they are for most people eating high fiber diets.  There is no way to remove those indigestible fibers from whole grains and beans, so they will feed intestinal flora and those flora will produce gas that will cause bloating, which in turn causes pain due to distention of the intestines.  Proponents of plant-based diets interpret this as a positive effect.  But is it reasonable to consider a painful symptom, due to distention of the intestines, a “healthy” condition?

From an evolutionary perspective, the pain is evidence that the intestines are not adapted to the diet.  Its just like the pain you feel when you put your hand on a stove.  The message is: Don't do that!  But when you are made to believe that fiber is essential for gut health and the more the better, you can learn to accept the pain as a price you pay for "healthy eating." According to some experts, this idea that high fiber diets benefit the intestines is hot air and science fiction  [17, 18].  Indeed, according to Tan and Seow-Choen writing in the World Journal of Gastroenterology, we have evidence indicating that high fiber diets are harmful to the intestines, rectum and anus: 

"A high fiber diet has also been shown to be associated with excessively long colons and a higher incidence of megacolon and volvulus[7] suggesting a negative effect of excessive fiber on colonic transit.

"Fiber is fermented rapidly and may lead to a massive surge in microbial activity in the colon. Hydrogen, methane and carbon dioxide are then produced, causing cramps, bloatedness and distension[8].

"Indeed, the incidence of diverticulosis and complications of diverticular disease have been increasing in the West despite increase in dietary fiber intake[9]. This is probably related to the massive gaseous build up associated with a high dietary fiber intake.....
"The need to evacuate large bulky stools frequently may also give rise to various anorectal disorders including haemorrhoids and anal fissures. The most important factor in the pathogenesis of haemorrhoids is repeated straining when passing stools[53]. This results in the disruption of the suspensory ligaments of Park at the anal cushions leading to prolapse of haemorrhoidal tissue. We believe that the frequent straining and passage of large bulky stools will in fact result in compromise of these suspensory ligaments.
"Passage of large bulky stools will also result in direct trauma from stretching of the anal mucosa leading to anal fissures. With the development of chronic fissure, secondary anal sphincter spasm with resultant anodermal ischaemia, it does not make sense to further worsen the spasm by trying to force large bulky stools through the anus." [18]
Thus, the fiber hypothesis is cast into question by simple physics; the larger the stool, the harder it is to get it to pass through the small passageway offered by the anus.  By the way, there is no fiber in human mothers' milk, indicating that the human gut does not have a fiber requirement. 

If I greatly restricted my food intake, some of these digestive problems would of course abate a bit, simply because eating less food meant less fiber, but of course that was not sustainable.  I could not function normally or maintain body mass on 1500 calories per day.

If At First You Don't Succeed....

Some years later, I tried the high carbohydrate, low fat vegan whole foods plant-based macrobiotic healing diet again, that time in combination with herbal medicines and acupuncture provided by Stefan Brink in Royal Oak MI.  Brink was the first health care provider to test me for zinc deficiency; I was found deficient, so a zinc and B-complex supplement was added to the macrobiotic diet, herbal medicines, and acupuncture.  Over the course of a three or four months, the rash on my tailbone disappeared, while at the same time I again dropped from 155-160 pounds to less than 140.  However, the program did not completely resolve any of the other rashes I was dealing with. 

This inspired me to become a practitioner of Chinese medicine myself, and it also reinforced my belief that the whole foods plant based diet low in protein and fat was the cure for my disease.  For some reason I didn’t completely integrate the fact that this resolution was achieved only with the combination of herbal medicines, acupuncture, and a zinc supplement. 

In my Chinese medicine practice I have treated several patients with recurrent psoriasis or eczema with herbal medicines, generally with success, without changing the patient’s diet or giving zinc supplements. When I was eating a paleo diet, I used herbal medicines for myself when I had skin flare ups; although I haven’t been able to get rid of all my most durable lesions with any herbal treatment, I have been able to control new outbreaks with herbal medicines alone.  Zinc is very important for skin health, and this experience was adequate to show that my plant-based diet alone had made me zinc deficient, and adding in zinc was necessary to achieve skin healing.  The bottom line is that when I worked with Dr. Brink, we employed several potentially beneficial therapies so it is impossible to know which of them was responsible for the remission of that one rash. 

Further, as in the past, the healing diet was not sustainable due to its severe restrictions.  I had to broaden it.  Amazingly, this time, when I started eating more broadly, but still plant based, the tailbone rash remained at bay.  Was it because I was, at least temporarily, in a zinc sufficient state again?

As long as I maintained a plant based diet, I was always balancing my daily digestive discomfort and energy fluctuations (post-meal fatigue and sleepiness) against my belief that a plant based diet and absence or extreme limitation of animal products was the cure for my skin diseases....even though the skin issues were only really markedly affected by the diet alone (absent herbal medicines, acupuncture and zinc supplements) when I ate the strict, very low calorie, unsustainable version.  I found that I could reduce the post-meal fatigue and sleepiness only be reducing the carbohydrate and increasing the fat and protein components of the meal.  So-called 80-10-10 meals were like sleeping pills to me.

As a result of all that time spent on plant-based dieting in an effort to get rid of those skin conditions, most of that time I was too weak and thin to pursue athletics.  Here are some photos of what I looked like during the year immediately following this limited success (healing the rash on the tailbone completely, but little or no effect on other lesions):

The Thin Man on the macrobiotic WFPBD. Photo of a photo.
My Paleo Diet 1.0

After some years I wanted relief from the post meal fatigue, the bloating etc and a restoration of my muscle mass and physical vitality.  In the late 1990s, I decided to try the paleo diet. I was afraid that it would cause the rash on my tailbone to return, because I still held the belief that somehow animal foods had been the cause of that skin condition; after all, a diet without animal foods SEEMED to have been part of the cure. 

However, I was really tired of bloating, flatulence, and inability to maintain a healthy body weight and even energy levels, so I gave my version of paleo a shot.  Of course, getting rid of the whole grains and legumes always greatlyl reduces the bloating and flatulence issue, but I was also pleasantly surprised that the tailbone rash never returned during the years up to 2011 when I ate the animal-based paleo diet.  That made me question whether the cure was the plant-based diet, or the zinc supplement, or the herbs and acupuncture treatment, or the combination, or some other factor which was shared by both the plant-based diet and the paleo diet.

However, my Garden of Eating version of paleo was fairly rich in carbohydrates (more about this later) and it didn’t do much if anything for my skin.  The very itchy rashes in my ears and on my scalp remained active, only fluctuating in intensity from time-to-time, for reasons I could not determine.  As usual, I also had new psoriasis-type rash outbreaks in various places, which were responsive to herbal medicine treatment.  I figured I just had this disease that is generally considered incurable, that the only way to relief I knew of was to starve myself, so I was not going to expect improvement of that condition.

During the years I ate my version of the paleo diet, which included significant amounts of starch and sugar from potatoes, sweet potatoes, and fresh and dried fruits, as outlined in The Garden of Eating, I developed skin tags, my total and LDL cholesterol increased, I had some small lipomas come and go, and I had some intermittent bouts with urinary difficulties consistent with prostatitis.  The latter seemed to come and go in relation to whether or not I supplemented my paleo diet with either calcium-rich minerals or dairy products (which have been linked to prostate issues).

The Farewell to Paleo

Based on these and other experiences, concerns, beliefs, thoughts, and hypotheses I detailed in my post Farewell to Paleo, including my still held memory of relief from the skin conditions on a calorically restricted macrobiotic diet, I was motivated to try whole foods plant-based again in 2011.  I thought that perhaps I had accumulated enough knowledge to make a plant based diet more sustainable and beneficial.  Between Autumn 2011 and Spring 2017, about 5 and a half years, I tried different versions of whole foods plant-based eating: high raw, etc.. 

As had been always my experience, when I resumed eating a low fat plant based diet I lost about 15 pounds of healthy body weight, which means I was in caloric deficit.  The interesting thing was that in my last round with this, I lost the 15 pounds quickly (down to 140 again) but my waist circumference and skinfolds hardly changed.  I lost muscle, strength, and fat from other areas, but my body was hanging on to a 34" waist, 3" larger than it was when I weighed 155-160 in my teens.

Gradually, I had some issues change.  By 2012 my cholesterol levels declined from 231 to 180, but there is a reasonable debate whether that was a good thing or not, and my LDL was still 106 and flagged as high.  By 2013 my cholesterol had dropped only to 178, and my LDL was still 97. 

A skin issue that was on the root of my nose resolved after about 1.5 years on a diet very high in fruits and vegetables and lower in grains and calories, i.e. on a reduced caloric intake. Resolution of this issue was one of the signs that encouraged me to stick to the vegan diet longer, to see if anything else might improve.   

2012, look at the red spot on the left side of my nose.
2014. No more inflamed spot on the nose.

However, so long as my whole foods plant based diet was high in unrefined starches and low in protein and fat, I I had to deal with bloating and gas, loose stools and energy fluctuations (fatigue and sleepiness after meals, irritability after fasting short periods between meals and after overnight fasting).  And, by tracking my nutrient intake, I could see clearly that I had difficulty getting adequate choline, zinc, and vitamin E.

Through the 4th and 5th years of this most recent plant-based adventure, I gradually increased the plant protein in the vegan diet (from legumes and soy products) partly because it reduced the post-meal sleepiness and fatigue and stabilized my between meals energy levels, and partly because I was trying to restore muscle mass that I had (again) lost after adopting the plant-based diet, this time despite intensive resistance training. 

Losing Sight of Important Things

Another issue that alarmed me was a dramatic change in my vision.  I never needed to wear eyeglasses for close reading until about 2014.  Some people may think this has nothing to do with diet, and they would be wrong.  Myopia is related to diet and hyperinsulinemia [1] and age-related myopia is considerably more prevalent among people eating high carbohydrate agricultural diets than among people of similar genetic stock who eat lower carbohydrate, hunter-gatherer diets [2. see here]. The fact that both Tracy and I relatively quickly developed a need for reading lenses a couple of years after adopting a high carbohydrate diet made me wonder whether the diet change produced the decline in visual acuity.

The Skin in the Game

During the 3rd year of strictly whole foods plant-based eating, low in fat and high in carbohydrates, I started having a problem with skin fungus and jock itch, problems I never had while eating paleo and which hadn’t bothered me for decades.  I wasn’t using any public bathing facilities regularly.  It occurred to me that my high carbohydrate diet might have something to do with it.  Due to their constantly high blood sugar levels, diabetics are more prone to cutaneous fungal infections than non-diabetics.  Was my high starch and sugar diet making me a petri dish for fungi?  I didn’t want to go there because I was still invested in the WFPB and vegan ideology.  

In addition, my scalp was itching and flaking like mad, seemingly moreso as I reached into the 4th and 5th years of the vegan diet.  It was unpleasant and unsightly to have large flakes of skin falling from my head to my shoulders throughout the day.  My pillow was covered with skin flakes falling off my head.  Thick piles of skin built up on my scalp. The problem had been with me for years but it was a little better when I was paleo and worsening the longer I ate a vegan whole foods plant based low fat high carbohydrate diet.  Its worth noting that itching is another common skin issue for diabetics (i.e. people with high blood sugars).

About this time (in the 3rd year of this last vegan adventure)  I also noticed that I was losing hair at the vertex of my skull.  This is known as male vertex balding.  Few people know that this type of balding is diet-related. 

By late 2016, after 5 years eating a high carbohydrate, low fat diet, while still eating no animal products, the rash on my tailbone started to reappear, followed by a new rash of the same type on the upper eye socket of my left eye. 

Tailbone lesion.  Thickened skin plaques, cracking, itching.  Re-emerged late 2016 after 5 years vegan WFPB.
At first I had trouble understanding and even believing it was happening.  How could this itchy, ugly rash come back after 5 years on a vegan diet but not on a paleo diet?  Wasn’t it caused by eating animal protein and fat?  Wasn’t it the avoidance of animal protein and fat that had healed it?  How could I make sense of this?

And from this questioning I realized that one thing was certain, the progression of these conditions was NOT caused by eating animal protein, cholesterol or fat, because at this point I had not eaten any animal protein, cholesterol or fat for 5 years.

Then, at the end of November 2016, I had a blood test that showed I had globulin protein and phosphorus levels significantly below the normal ranges.   I was also experiencing other symptoms of zinc deficiency, which as mentioned above I had previously developed on a whole foods plant based diet.  In 2017 I took a test which confirmed zinc deficiency.  I reached the end of my patience with the plant-based diet.

Unraveling My Beliefs

What happened?  It took me some weeks reviewing all of the above in my mind to come to my hypothesis. 

In order to understand my confusion, I needed to find its origin. 

I first got really hooked on the idea that a plant based diet could heal what ailed me as a consequence of my first experiment with eating the very strict macrobiotic diet, when dropped about 25 pounds of healthy body weight in a few months and I experienced total relief from the skin rash in my ears and some relief from the rash on my tailbone.  I thought that I was getting results because I wasn’t eating animal products or fats.  It was an easy conclusion.  But was it correct?  

There is another perspective.  It requires a bit of math.  Since I was eating only about 1200 calories per day, but needed 3000, I was obtaining 1800 calories per day from burning my own body mass, which consisted of animal protein (muscle) and fat. 

The food I was eating was about 80-85% carbohydrate, 5-10% protein, and 5-10% fat.  The diet provided only about 40% of my total caloric expenditure, while 60% came from the meat and fat on my own body. 

The diet provided about 960 calories from carbohydrate, and 120 calories from each of protein and fat.  Meanwhile, I was getting 1800 calories from some combination of body fat and muscle protein.  Since probably half of the weight loss was muscle, I am going estimate that I burned up 10 pounds of muscle over 16 weeks.  That means I was burning 41 grams of muscle protein daily, about 164 calories, which is less than 10% of the 1800 calorie deficit I was running daily.  Hence, the other 90% of the 1800 calorie deficit came from fat.

So during that weight loss period my actual daily caloric expenditure was approximately:

1620 calories from body fat plus 120 from dietary fat = 1740 calories from fat
180 calories from muscle plus 120 calories from dietary protein = 300 calories from protein
960 calories from dietary carbohydrate

This means that my body was consuming 58% of calories from fat, 10% of calories from protein, and 32% of calories from carbohydrate during that “healing macrobiotic diet” phase.

I was metabolizing a high fat, low carbohydrate diet when the rashes in my ears and on my tailbone improved without any other intervention.  During this time, since I was in a deep caloric deficit and burning lots of fat, I was also producing more ketones than I would have on a calorically adequate diet.  Since I was in a deep caloric deficit, my insulin level was also low (although it would have been even lower if my diet had been lower in carbohydrate).

I hypothesize that the positive result of improvement in my skin condition was NOT due to my being on a high carbohydrate, low fat whole foods plant based diet, but a result of the metabolic state – including reduced insulin levels – due to being in a deep caloric deficit for several months on what was, metabolically speaking, a high fat, rmoderately low carbohydrate fuel mix.  It is well established that deep caloric restriction and fasting both reduce inflammation. “Prolonged caloric restriction or fasting reduces inflammation as immune system adapts to low glucose supply and energy metabolism switches towards mitochondrial fatty acid oxidation, ketogenesis and ketolysis [3].”

In fact, it has been shown that metabolism of glucose, the main fuel on a typical whole foods plant based diet, promotes production of destructive,  inflammatory free radicals, and reduces levels of vitamin E, a key fat soluble antioxidant that is often in shortage on a low fat diet [4, 5].   

Thus a low fat whole foods plant based diet diet may be anti-inflammatory when calorically restricted, and neutral or proinflammatory when calorically adequate.  I was misled into thinking a high carbohydrate diet was the cure, but the fact that the rashes only disappeared when I was actively catabolizing my own body mass, and returned, did not improve or even worsened when I ate a calorically adequate high carbohydrate diet tends to negate the idea that a high carbohydrate low fat whole foods plant based diet is inevitably anti-inflammatory.

So what when wrong when I ate my interpretation of paleo diet?  Well, in the Garden of Eating,  on pages 32-33, in alignment with conventional wisdom, I argued that humans require dietary carbohydrate from fruits and vegetables to prevent ketosis, maintain positive moods, and obtain adequate vitamin C. 

Consequently, my paleo-esque diet contained plenty of high carbohydrate, high glycemic index foods on a daily basis: white potatoes, bananas, sweet potatoes, dates, etc.  A favorite daily desert was date rolls smothered with almond butter, or chocolate covered dates. If I am a carbohydrate sensitive person, then this level of indulgence might have had adverse effects.

And as a matter of fact, I was flat out wrong about carbohydrate.  According to page 275 of the National Academy of Sciences Food and Nutrition Board Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids, "the lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed."

Humans, particularly those of European ancestry, would not exist today if we did not have the ability to thrive without carbohydrate, because only people who could thrive in ketosis could have survived and reproduced during the Ice Age, the Pleistocene epoch, which began about 1.8 million years ago – when the first members of the genus Homo appear in the fossil record – and lasted until only 11,700 years ago.  Humans are the hominins specifically adapted to survival during the Ice Age.  This epoch is marked by cold, dry climate with sheets of ice covering all of Antarctica, large parts of Europe, North America, and South America, and small areas in Asia. In North America they stretched over Greenland and Canada and parts of the northern United States.  During this time, humans lived by hunting large game in search of fat.  Fruits and vegetables were scarce and it would have been impossible for Ice Age humans to meet their caloric and nutrient needs eating a plant-based diet.   The harsh conditions of the Pleistocene certainly weeded out any humans who had a dietary requirement for carbohydrate, whether digestible (starch or sugar) or indigestible (fiber).

Miki Ben-Dor, M.B.A., Ph.D—Man The Fat Hunter: Animal Fat Shortage as a Driver of Human Evolution and Prehistory from Ancestral Health Society on Vimeo.

Diagnosis: Metabolic Syndrome

Hyperinsulinemia has been linked to skin tags, high LDL, male vertex balding, and prostatitis [6, 7].  
Psoriasis has also been found to be a harbinger of metabolic syndrome. Metabolic syndrome was found to be 3 times more common among psoriasis patients [8, 9].  Hyperinsulinemia also leads to difficulty losing waist fat; as mentioned above, on hypocaloric plant based diets, I repeatedly had the experience of losing body mass but seeing little change in my waist skin folds or circumference. 

It seems possible that by eating a “paleo” diet that included a meals that combined both high carbohydrate foods and high fat foods on a daily basis (e.g. sweet potatoes with butter atop, bowls of dates with nuts or nut butter atop, chocolate covered dates), I was sustaining some degree of insulin resistance and metabolic dysfunction, which might explain the issues I experienced.

I never had any blood work to test directly for insulin resistance, but when I look at my  fasting blood sugars from that time period, although they were not abnormal, they were on the higher end of the normal range of 66-99.  In 2006 my FBG was 85, TC 179, and LDL 95, HDL 74, trigs 58.  In 2007, my FBG was 93, TC 231 and LDL 138, HDL 85, trigs 47.  I don't know if the LDL of the 2007 test was large fluffy or small dense, but since the FBG was elevated "normal" I would guess it was small dense, the atherogenic type of LDL [16].

This was in spite of those tests being taken at the end of 14-16 hours of intermittent fasting.  At the time, I was unaware that research has shown that young men with high normal fasting blood glucose (85 + ) have an increased risk of diabetes compared to men with FBG below 81 [10].   “The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range [11].”

High “normal” blood sugars (85 or higher) are also associated with a 34-52% increased risk of cardiovascular disease compared to fasting blood sugars below 80, and high fasting glucose was found a stronger predictor of cardiovascular disease than cholesterol.  “The importance of each risk factor for CVD was ranked independently by the Wald score: for FPG levels the score was 15.3, after age (171), gender (39) and smoking (17.9) similar to hypertension (15.2) and more significant than BMI (3.6), family history (10.6), cholesterol (12.4), and TG (7.2).” [12]

It is clear that my so-called paleo diet and my whole foods plant based diets both were supporting high glucose levels, and promoting conditions linked to hyperinsulinemia.  Thus, it is reasonable to hypothesize that I have been suffering from a mild or early metabolic syndrome condition.

And it is clear that eating a whole foods plant based diet for 5 years did not improve, but instead worsened the condition.

When I first went plant based, I dramatically reduced the fat content of my diet, which initially put me into a caloric deficit (as usual, I lost weight, both muscle and fat) despite my attempts to eat enough, and this reduced my insulin levels and insulin resistance, which caused the aforementioned problems related to hyperinsulinemia to abate. 

By 2013, after more than 2 years on a whole foods plant based diet, my FBG was found to be 86, TC 178, LDL 97, HDL 58, and Trigs 115.  I still had a high “normal” blood glucose, which is not a good thing because it is “normal” to develop diabetes.

The fact that 18 months after adopting a whole foods plant based vegan diet my total cholesterol had still not gone below 180 also suggests that I was somewhat hyperinsulinemic.  The fact that I was unable to lose waist fat despite losing body mass also suggested hyperinsulinemia.

In late 2016, after 5 years on the plant based diet my fasting blood sugar was still 88.  Essentially, I maintained prediabetic blood sugar levels that are also associated with an increased risk of cardiovascular disease through paleo-esque and whole foods plant based diets [10].

Between 2013 and 2016 I was able to get my total cholesterol, LDL and triglycerides down without reducing my HDL only by eating less starch and sugar and more plant proteins and fats, by reducing intakes of whole grains and increasing legumes, tofu, pea protein isolate, plant-based meats like Tofurky sausages, and nuts.  This also supports the conclusion that I am a carbohydrate intolerant individual.

This table summarizes what I have presented above.  The 2006 and 2007 tests were while I was paleo-esque.  The 2012 and 2013 tests were taken when I ate a high carbohydrate (60-75% of energy), low fat (10-15% of energy) vegan whole foods plant based diet.  The 2016 test was done while I was eating a high protein (110-130 g per day, 20-25% of energy), moderate fat (20-30% of energy), and lower carbohydrate (~50% of energy) whole foods plant based diet for about a year. 

Eating a high carbohydrate vegan diet (2011-2017) kept my fasting glucose in the high normal range (and possibly climbing slightly), and also doubled my triglyceride levels and reduced my HDL levels by about 30%.

Over all, the 2006 test, taken when I was eating paleo-eque with at least a tablespoon of flax oil and a teaspoon of cod liver oil every day, omega-3 rich eggs most days, and 6-8 ounces of wild salmon at least 4 days each the week, but no grains or legumes, was the best, with the lowest fasting glucose, the highest HDL, an LDL under 100, and the lowest triglycerides.  Nevertheless, all of them show high normal fasting blood sugars, with the 2016 test taken after 5 years vegan, after some months on a high plant protein diet, having the second highest fasting blood glucose.

I have had high normal fasting blood glucose for at least 10 years, but it was lowest when not on a plant-based diet.  This data supports the conclusion that for me, a higher protein, higher fat, reduced carbohydrate intake produces the best blood lipid results. 

As mentioned already, blood sugar levels higher than necessary increase free radical damage in the body, promoting inflammation and degeneration of cells, tissues and organs, such as the skin, blood vessels, and lens of the eye. If you don't think sugar can damage your arteries by this same route, you are wrong.  Experiments have demonstrated that high carbohydrate meals damage the arteries:
"Using 56 healthy volunteers, the researchers looked at four groups. One group ate a cornflake mush mixed with milk, a second a pure sugar mixture, the third bran flakes, while the last group was given a placebo (water). Over four weeks, Dr. Shechter applied his method of "brachial reactive testing" to each group. The test uses a cuff on the arm, like those used to measure blood pressure, which can visualize arterial function in real time.

"The results were dramatic. Before any of the patients ate, arterial function was essentially the same. After eating, except for the placebo group, all had reduced functioning."[19]
 Note that ALL of the test meals damaged the endothelium of the arteries, including the high fiber bran flakes.  All starches are digested to glucose, which raises your blood sugar, and will have the same kind of effect.  I doubt there exists a desirable sugar or starch solution.

The Experiment

All this leads me to the hypothesis that I never considered seriously in the past, because I was attached to believing incorrectly that every human needs dietary carbohydrate.

The hypothesis is:  I am a very carbohydrate-sensitive individual. 

Since I experienced remissions, on different occasions, of two of the most persistent and uncomfortable locations of the inflammatory skin conditions I have suffered with for decades (those in my ears and on my tailbone) when I was metabolically on a diet which provided about 60% of my calories from fat (mostly from my own body fat) and only about 35% of energy from dietary carbohydrate, I have decided to embark on an experiment.

Benign dietary ketosis (BDK) induced by a high fat, very low carbohydrate diet is metabolically similar to fasting without requiring caloric restriction.  Like fasting, BDK produces significant increases in the ketone body beta-hydroxybutyrate (BHB) and research indicates that BDK may have a strong anti-inflammatory effect by increasing BHB levels [13, 3].

Candi Leftwich has reported remarkable relief from her psoriasis in just a month eating a very low or "zero" carbohydrate diet.  Take a look at the photos of her skin before starting a "zero carb" diet and after 30 days on the diet.  The healing is dramatic.  Her experience is consistent with the finding that ketosis suppresses inflammasome-mediated inflammatory diseases [3].

Hence, my experiment:  I am going to eat a very low carbohydrate, high fat, calorie-adequate diet, providing a fuel mix that is at least 70% of calories from fat.  Instead of getting my animal protein and fat from catabolism of my own muscle and fat as happened when I did the calorie-restricted high carbohydrate whole foods plant based diets, I am eating a calorie adequate diet rich in animal protein and animal fats, which have a similar composition to human body fat. 

We have been taught that fruits and vegetables are good for us, but like grains and beans, many other plant foods, particularly seeds, nuts, and vegetables contain many naturally occurring potential toxins that, like air-borne pollen, can cause many severe symptoms.  Based on my symptoms and history, I may also be salicylate sensitive (another hypothesis to test) [14, 15].  If necessary, I will attempt a dairy- and plant-food-free diet.

I am running this experiment, which I have never before run on myself, to find out whether I can produce a healing of my skin conditions by spending a prolonged period of at least several months in a metabolic condition that resembles fasting through the restriction of dietary carbohydrate. 

This is an experiment, and the above is my rationale for the experiment.  I am not making any claims as to the efficacy of a ketogenic diet for any health condition, nor am I encouraging others to follow in my footsteps.  I just want to find out if it can have a positive effect on my inflammatory skin conditions.  We'll see what happens as the experiment proceeds.  If you have some inflammatory condition you would like to heal and you find the rationale compelling, or if you just want to follow my progress, I will welcome you as a fellow explorer of possibilities.  If you don't like my dietary choices and only want to criticize me for making this choice based on your ethical principles, don't comment along those lines or you will be blocked.


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