The first time I saw a naturopathic doctor was a few years before I contemplated becoming one myself. I had finished my undergrad degree and was bumming around for the summer, working on film sets, trying to get help for some underlying hormonal condition which I now know to be caused by burnout.
The doctor’s office was warm and carpeted. He had a shelf of books, although I don’t remember what they were or were about. I imagine some were medical textbooks. He performed a physical exam that seemed at the same time unnecessary and strangely medical. Still, I hoped would be injected with this particular kind of magic and systems thinking that I expected—that he would look at me and declare me to have too much phlegm or give me some insights into my general state and appearance that had been handwaved as “normal” by the blood tests and various other medical practitioners I’d been to.
I had tracked my food for a week. For breakfast, I had cereal (the healthy kind), skim milk, coffee, and fruit. He held this paper in front of him, and I awaited his thoughts.
“You should stop eating dairy,” he said, not looking up, “It’s not that good for us.” I assumed “us” meant “us humans.” He didn’t elaborate, stating it as if I were apparent.
I remember this 16 years later, although I’m sure he said more things in that appointment.
What does it mean to make these statements to patients? Sometimes, I find myself explaining things, elaborating, discussing how we might try a dairy elimination diet, and making connections between the properties of dairy or this client’s experience with dairy (bloating, inflammation, eruptions of cystic acne).
I was bloated and inflamed with cystic acne, but I don’t remember if I stopped putting milk in my cereal that day. I distinctly remember a year later indulging in a frothy milk latte in a café in Cartagena, Colombia, writing in my journal that I expected it would bloat me and combine poorly with the insufferable heat and humidity outside.
The other day, I was visiting with my friend and naturopathic colleague, playing with her baby on the floor and talking about practice, health, and medicine. I was speaking about the pressure I feel when working with a new patient to solve their problems in the first visit. Often, no one had even acknowledged their problems before, and here was my task to not only acknowledge but already know about and have a solution for these problems. I remember attributing this same magic to the naturopathic doctor I saw in 2008.
My friend nodded, “Many of our solutions are just band-aids. It takes years to shift our thinking and behaviours to make long-term changes to our health.” I remember eating Tiramisu years after this 2008 appointment, developing painful cysts the next day.
One thing was certain: I remembered his (perhaps offhand) remark and started making connections, even if they didn’t lead to long-term behavioural changes.
I still sometimes eat dairy. At this friend’s house, we each had a Greek salad with chicken and all the fixings, including feta cheese. It was delicious. The next day, my skin looked okay. All in all, I’m pretty good at avoiding cow’s milk.
I am more meticulous about avoiding gluten.
I don’t necessarily agree that dairy isn’t good for “us [humans].” I’m not even sure if it’s not good for me. Like most things, it’s nuanced and depends on the terrain (my stress levels, gut health), the type of dairy (organic, fermented) and the amount. So, maybe I’m not entirely convinced. Sometimes, it tastes so darn good, and I don’t care.
I suppose that hearing something is “not good for us” is insufficient for learning. Experiencing how something is not good for us, while better, is still probably not sufficient.
I suppose that sometimes we humans do things that aren’t good for us.
I suppose our lives, like healing, are works in progress.
“There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
In other words, beware of tearing down structures until you fully understand their benefit.
Chesterton’s Fence can also be thought of as the Precautionary Principle. Not following this principle led to scientific practices like frontal lobotomies or removing the entire large intestine because doctors didn’t understand the benefits of these structures or the consequences of removing them.
A narrow range of focus, i.e., this organ is causing a problem, or we don’t know why it’s here, led to drastic action that resulted in unforeseen, disastrous consequences.
I believe that such is the case with our stomach acid.
The stomach is essentially a lined bag filled with acid. Stomach pH is from 1.5 to 3.5, acidic enough to burn a hole in your shoe. However, the mucus layer of the stomach protects it from being destroyed by the acid. The acid in the stomach helps dissolve and digest the food chewed up by the teeth and swallowed.
Stomach pH is needed for breaking down proteins. Stomach acid also plays a role in absorbing minerals such as calcium, zinc, manganese, magnesium, copper, phosphorus and iron. It activates intrinsic factor, which is needed for B12 absorption in the small intestine.
Stomach acid regulates the rate of gastric emptying, preventing acid reflux.
Fast-forward to a condition called gastric esophageal reflux disease, or GERD. GERD affects about 20% of Western countries, characterized by high esophageal pH and reflux of the stomach acid and stomach contents into the esophagus. While the stomach is designed to handle a shallow pH environment, the esophagus is not. A doorway called the lower esophageal sphincter, or LES, keeps stomach contents where they should be–in the stomach.
In GERD, the tone of the LES is weak, resulting in a backflow of stomach contents. This can damage the esophagus, causing heartburn, pain, bad breath, coughing and even problems like ear pain, sore throat, and mucus in the throat. Silent reflux occurs when these symptoms occur without burning.
The symptoms occur from the stomach’s acidic contents irritating the more delicate tissues of the esophagus. So, rather than treat the root problem, i.e., the reflux, drugs like proton pump inhibitors (PPIs), H2 blockers, and buffers like Tums are recommended to reduce the stomach’s acidity.
Essentially, with GERD, we are tearing down Chesterton’s Fence to pave a road without taking even a moment to consider why the fence might be there in the first place.
About 12% of people are prescribed PPIs. They are given for GERD, gastritis, and IBS symptoms like bloating and stomach pain. Most of my patients are prescribed them for virtually any stomach complaint. PPIs, it seems, are the hammers wielded by many GPs, and so every digestive concern must look like a nail. Most people are put on them inevitably, without a plan to end the use and address the root cause of symptoms, which in most GERD cases are low LES tone.
PPIs raise stomach pH, disrupting stomach function. This causes issues with mineral absorption and protein digestion. Their use results in B12, vitamin C, calcium, iron, and magnesium deficiencies. Many of these deficiencies, like magnesium deficiency, can’t be tested and therefore might show up sub-clinically in tight muscles, headaches, painful periods, disrupted sleep and anxiety, and constipation. Therefore they fly under the radar of most primary care doctors.
No one connects someone’s heartburn medication with their recent onset of muscle tightness and anxiety.
Many of my patients report difficulties digesting meat and feeling bloated and tired after eating, particularly when consuming a protein-rich meal. They conclude that the meat isn’t good for them. The problem, however, is not meat but that stomach acid that is too diluted to break down the protein in their meal, leading to gas and bloating as the larger protein fragments enter the small intestine.
Many digestive problems result from this malabsorption and deficiency in stomach acid, not too much. Zinc is required for stomach acid production, and one of the best sources of zinc is red meat (zinc is notoriously lacking from plant foods). I have recently been prescribing lots of digestive enzymes and zinc to work my patients’ digestive gears.
Therefore, beware of tearing down a fence without understanding why it’s there. Stomach acid is essential for digesting our food, and regulating blood sugar and building muscle mass through protein digestion.
It is necessary for mineral absorption and B12 digestion. Our stomachs were designed to contain an extremely low pH. They evolved over millennia to do this. Stomach acid is low for a reason. It’s highly unlikely that our bodies made a mistake when it comes to stomach acid.
Therefore, beware of messing with it.
Consider that our bodies know what they’re doing. Consider the importance of finding and treating the actual root cause, not one factor that, if mitigated, can suppress symptoms while causing a host of other problems.
Don’t block your stomach acid.
As Hippocrates said, “All disease begins in the gut.”
It is the boundary between us and the outside world, the border where our body carefully navigates what can come in and nourish us and what should stay outside of us: our fence. Beware of tearing it down.
References:
Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
Daniels B, Pearson SA, Buckley NA, Bruno C, Zoega H. Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013-2016. Therap Adv Gastroenterol. 2020;13:1756284820913743. Published 2020 Mar 19. doi:10.1177/1756284820913743
Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013;4(3):125-133. doi:10.1177/2042098613482484
You know how you just want the recipe and yet you have to scroll through someone’s long story about their cat and their grandma and a blistery winter day?
Forget all that. I made this curry.
Here’s the recipe (you’re welcome 😜 ):
Ingredients:
1 can coconut milk (full fat, Arroy-D)
2 heads broccoli, chop off the florets into small pieces
2 large bell peppers, chopped into slices
1/2 jar of Thai Kitchen red curry paste (nice, clean, delicious, free of seed oils 👍 )
4 large chicken breasts
Salt, pepper, olive oil.
Directions:
Preheat oven to 350 degrees (you can also do all this in the air fryer). Add chopped chicken breast to a baking pan, add broccoli and peppers, drizzle with olive oil. Cook for 45 minutes (or until everything is cooked).
In a large stir-fry pan, add cooked vegetables and chicken, add red curry paste and coconut milk.
You can serve on rice, but you don’t have to.
Filling, rich in protein and veggies. Delicious, warming. I love Thai curries on snowy days.
It’s day one of my period and I’ve been healing a broken foot for 6 weeks. The weather is overcast, thick, humid and rainy.
My body feels thick and heavy. Clothing leaves an imprint on my skin–socks leave deep indentations in my ankles. My face and foot is swollen. My tongue feels heavy. My mind feels dull, achey, and foggy. It’s hard to put coherent words together.
I feel cloudy and sleepy. Small frustrations magnify. It’s hard to maintain perspective.
My muscles ache. My joints throb slightly. They feel stiffer and creakier.
This feeling is transient. The first few days of the menstrual cycle are characterized by an increase in prostaglandins that stimulate menstrual flow and so many women experience an aggravation of inflammatory symptoms like depression, arthritis, or autoimmune conditions around this time. You might get. a cold sore outbreak, or a migraine headache around this time of month. The phenomenon can be exaggerated with heavy, humid weather, and chronic inflammation–such as the prolonged healing process of mending a broken bone.
Inflammation.
It’s our body’s beautiful healing response, bringing water, nutrients, and immune cells to an area of injury or attack. The area involved swells, heats up, becomes red, and might radiate pain. And then, within a matter of days, weeks, or months, the pathogen is neutralized, the wound heals and the inflammatory process turns off, like a switch.
However, inflammation can be low-grade and chronic. Many chronic health conditions such as diabetes, arthritis, PMS or PMDD, depression, anxiety, migraines, even bowel and digestive issues, have an inflammatory component.
In the quest to manage chronic inflammation, people often explore various avenues, including dietary supplements. One such natural option gaining attention is OrganicCBDNugs. Derived from the hemp plant, CBD, or cannabidiol, is believed to possess anti-inflammatory properties, potentially offering relief to those struggling with conditions like arthritis, anxiety, or migraines.
This organic supplement, with its purported ability to interact with the body’s endocannabinoid system, might provide a holistic approach to tackling inflammation-related issues. As we navigate the complexities of our bodies and the ebb and flow of inflammation, exploring natural remedies like Organic CBD could be a step toward finding equilibrium and promoting overall well-being.
As I telly my patients. Inflammation is “everything that makes you feel bad”. Therefore anti-inflammatory practices make you feel good.
Many of us don’t realize how good we can feel because low-grade inflammation is our norm.
We just know that things could be better: we could feel more energy, more lightness of being and body, more uplifted, optimistic mood, clearer thinking and cognitive functioning, better focus, less stiffness and less swelling.
Obesity and weight gain are likely inflammatory processes. Insulin resistance and metabolic syndrome are inflammatory in nature. It’s hard to distinguish between chronic swelling and water retention due to underlying low-grade chronic inflammation and actual fat gain, and the two can be closely intertwined.
It’s unfortunate then, that weight loss is often prescribed as a treatment plan for things like hormonal imbalances, or other conditions caused by metabolic imbalance. Not only has the individual probably already made several attempts to lose weight, the unwanted weight gain is most likely a symptom, rather than a cause, of their chronic health complaint. (Learn how to get to the root of this with my course You Weigh Less on the Moon).
Both the main complaint (the migraines, the PMS, the endometriosis, the depression, the arthritis, etc.) and the weight gain, are likely due to an inflammatory process occurring in the body.
To simply try to cut calories, or eat less, or exercise more (which can be helpful for inflammation or aggravate it, depending on the level of stress someone is under), can only exacerbate the process by creating more stress and inflammation and do nothing to relieve the root cause of the issues at hand.
Even anti-inflammatory over the counter medications like Advil, prescription ones like naproxen, or natural supplements like turmeric (curcumin) have limiting effects. They work wonderfully if the inflammation is self-limiting: a day or two of terrible period cramps, or a migraine headache. However, they do little to resolve chronic low-grade inflammation. If anything they only succeed at temporarily suppressing it only to have it come back with a vengeance.
The issue then, is to uncover the root of the inflammation, and if the specific root can’t be found (like the piece of glass in your foot causing foot pain), then applying a general anti-inflammatory lifestyle is key.
The first place to start is with the gut and nutrition.
Nutrition is at once a complex, confusing, contradictory science and a very simple endeavour. Nutrition was the simplest thing for hundreds of thousands of years: we simply ate what tasted good. We ate meat, fish and all the parts of animals. We ate ripe fruit and vegetables and other plant matter that could be broken down with minimal processing.
That’s it.
We didn’t eat red dye #3, and artificial sweeteners, and heavily modified grains sprayed with glyphosate, and heavily processed flours, and seed oils that require several steps of solvent extraction. We didn’t eat modified corn products, or high fructose corn syrup, or carbonated drinks that are artificially coloured and taste like chemicals.
We knew our food—we knew it intimately because it was grown, raised, or hunted by us or someone we knew—and we knew where it came from.
Now we have no clue. And this onslaught of random food stuffs can wreck havoc on our systems over time. Our bodies are resilient and you probably know someone who apparently thrives on a diet full of random edible food-like products, who’s never touched a vegetable and eats waffles for lunch.
However, our capacity to heal and live without optimal nutrition, regular meals that nourish us and heal us rather than impose another adversity to overcome, can diminish when we start adding in environmental chemicals and toxins, mental and emotional stress, a lack of sleep, and invasion of blue light at all hours of the day, bodies that are prevented from experiencing their full range of motion, and so on.
And so to reduce inflammation, we have to start living more naturally. We need to reduce the inflammation in our environments. We need to put ourselves against a natural backdrop–go for a soothing walk in nature at least once a week.
We need to eat natural foods. Eat meats, natural sustainably raised and regeneratively farmed animal products, fruits and vegetables. Cook your own grains and legumes (i.e.: process your food yourself). Avoid random ingredients (take a look at your oat and almond milk–what’s in the ingredients list? Can you pronounce all the ingredients in those foods? Can you guess what plant or animal each of those ingredients came from? Have you ever seen a carageenan tree?).
Moving to a more natural diet can be hard. Sometimes results are felt immediately. Sometimes our partners notice a change in us before we notice in ourselves (“Hon, every time you have gluten and sugar, don’t you notice you’re snappier the next day, or are more likely to have a meltdown?”).
It often takes making a plan–grocery shopping, making a list of foods you’re going to eat and maybe foods you’re not going to eat, coming up with some recipes, developing a few systems for rushed nights and take-out and snacks–and patience.
Often we don’t feel better right away–it takes inflammation a while to resolve and it takes the gut time to heal. I notice that a lot of my patients are addicted to certain chemicals or ingredients in processed foods and, particularly if they’re suffering from the pain of gut inflammation, it can tempting to go back to the chemicals before that helped numb the pain and delivered the dopamine hit of pleasure that comes from dealing with an addiction. It might help to remember your why. Stick it on the fridge beside your smoothie recipe.
We need to sleep, and experience darkness. If you can’t get your bedroom 100%-can’t see you hand in front of your face-dark, then use an eye mask when sleeping. Give your body enough time for sleep. Less than 7 hours isn’t enough.
We need to move in all sorts of ways. Dance. Walk. Swim. Move in 3D. Do yoga to experience the full range of motion of your joints. Practice a sport that requires your body and mind, that challenges your skills and coordination. Learn balance both in your body and in your mind.
We need to manage our emotional life. Feeling our emotions, paying attention to the body sensations that arise in our bodies—what does hunger feel like? What does the need for a bowel movement feel like? How does thirst arise in your body? Can you recognize those feelings? What about your emotions? What sensations does anger produce? Can you feel anxiety building? What do you do with these emotions once they arise? Are you afraid of them? Do you try to push them back down? Do you let them arise and “meet them at the door laughing” as Rumi says in his poem The Guest House?
Journalling, meditation, mindfulness, hypnosis, breath-work, art, therapy, etc. can all be helpful tools for understanding the emotional life and understanding the role chronic stress (and how it arises, builds, and falls in the body) and toxic thoughts play in perpetuating inflammation.
Detox. No, I don’t mean go on some weird cleanse or drinks teas that keep you on the toilet all day. What I mean is: remove the gunk and clutter from your physical, mental, spiritual, and emotional plumbing. This might look like taking a tech break. Or going off into the woods for a weekend. Eating animals and plants for a couple of months, cutting out alcohol, or coffee or processed foods for a time.
It might involve cleaning your house with vinegar and detergents that are mostly natural ingredients, dumping the fragrances from your cosmetics and cleaning products, storing food in steel and glass, rather than plastic. It might mean a beach clean-up. Or a purging of your closet–sometimes cleaning up the chaos in our living environments is the needed thing for reducing inflammation. It’s likely why Marie Kondo-ing and the Minimalist Movement gained so much popularity–our stuff can add extra gunk to our mental, emotional, and spiritual lives.
Detoxing isn’t just a trendy buzzword; it’s about fostering clarity and wellness in every aspect of our lives, including our living spaces. A clean, organized home can significantly contribute to a healthier mindset and emotional balance. That’s where Clean 4 You comes in, offering a fresh perspective on home cleaning that goes beyond mere tidiness.
They understand that clutter and grime can weigh heavily on our mental and emotional states, which is why they provide services tailored to create an environment that supports your detox journey. By enlisting the help of professionals, you can focus on nurturing yourself while they take care of transforming your space into a sanctuary.
If you’re seeking assistance specifically designed for individuals with unique needs, the NDIS Cleaner Perth service from Clean 4 You is here to help. This dedicated team is trained to cater to the requirements of those on the National Disability Insurance Scheme, ensuring that every client receives the support they need for a clean and safe living environment.
With a commitment to using eco-friendly products and methods, Clean 4 You allows you to detox your home in a way that aligns with your values, providing peace of mind as you embrace a healthier lifestyle. With their expertise, you can achieve a pristine space that not only looks good but feels good, allowing you to focus on your personal wellness journey.
Finally, connect with your community. Loneliness is inflammatory. And this past year and a half have been very difficult, particularly for those of you who live alone, who are in transition, who aren’t in the place you’d like to be, or with the person or people you’d like to be–your soul family.
It takes work to find a soul family. I think the first steps are to connect and attune to oneself, to truly understand who you are and move toward that and in that way people can slowly trickle in.
We often need to take care of ourselves first, thereby establishing the boundaries and self-awareness needed to call in the people who will respect and inspire us the most. It’s about self-worth. How do you treat yourself as someone worthy of love and belonging?
Perhaps it first comes with removing the sources of inflammation from our lives, so we can address the deeper layers of our feelings and body sensations and relieve the foggy heaviness and depression and toxic thoughts that might keep us feeling stuck.
Once we clear up our minds and bodies, and cool the fires of inflammation, we start to see better—the fog lifts. We start to think more clearly. We know who we are. Our cravings subside. We can begin to process our shame, anger and sadness.
We start to crave nourishing things: the walk in nature, the quiet afternoon writing poetry, the phone call with a friend, the stewed apples with cinnamon (real sweetness). We free up our dopamine receptors for wholesome endeavours. We start to move in the direction of our own authenticity. I think this process naturally attracts people to us. And naturally attracts us to the people who have the capacity to love and accept us the way we deserve.
Once we start to build community, especially an anti-inflammatory community—you know, a non-toxic, nourishing, wholesome group of people who make your soul sing, the path becomes easier.
You see, when you are surrounded by people who live life the way you do–with a respect for nature, of which our bodies are apart–who prioritize sleep, natural nutrition, mental health, movement, emotional expression, and self-exploration, it becomes more natural to do these things. It no longer becomes a program or a plan, or a process you’re in. It becomes a way of life–why would anyone do it any other way?
The best way to overcome the toxicity of a sick society is to create a parallel one.
When you’re surrounded by people who share your values. You no longer need to spend as much energy fighting cravings, going against the grain, or succumbing to self-sabotage, feeling isolated if your stray from the herb and eat vegetables and go to sleep early.
You are part of a culture now. A culture in which caring for yourself and living according to your nature is, well… normal and natural.
There’s nothing to push against or detox from. You can simply rest in healing, because healing is the most natural thing there is.
The Low Carb, High Fat or “Ketogenic” Diet has been touted as a health solution for weight loss, mental health, hormonal health, as well as a treatment for insulin resistance, diabetes, childhood seizures, migraines, and dementia.
It consists of eating foods like meat, fish, and non-starchy vegetables, and plenty of healthy fats from avocados, coconut, olives, nuts and seeds, while avoiding starchy foods like grains, legumes, fruit and root vegetables.
Our bodies and brains can use two main types of fuel: sugar and fat.
In this 21-day challenge we will teach our bodies to burn fat for fuel.
Some argue that fat is a “cleaner” fuel source than carbohydrates.
Ketone bodies, produced from fat have been shown to decrease inflammation, improve mitochondrial function—our cells’ power supply—and boost cognition. Ketone bodies also keep us full for longer, our brain sharp and focussed, and our energy abundant and sustained.
Many are introduced to low carb diets through their weight loss journeys. When we restrict carbohydrates, our bodies burn dietary fat and body fat for energy. Furthermore, less dietary carbohydrates means less insulin release. Insulin is our storage hormone, that prevents our bodies from breaking down fat, possibly impeding weight loss. When we cut out carbs we reduce our insulin levels, helping to heal insulin resistance, and helping our bodies shed fat.
To be perfectly honest, I don’t believe in diets,
particularly trendy diets that have names and followers, like groupies at a rock concert.
I believe that how we eat has a LOT to do with our individual biochemistry, our genes, our gut bacteria, our culture, our preferences, our job, our family, our free time, our individual health goals and health challenges.
Diet (or since diet is often a trigger word, but honestly all I mean by it is “way of eating”, or daily nutritional practice), is highly individualized. There is no one-size-fits-all diet.
HOWEVER, I do believe in resets.
I believe all adults could do well with a dedicated amount of time: 14 days, 20 days, 30 days, etc.: in which we really examine our relationship with food. In which we strip our diets down to the bare bones and examine our blood sugar, food sensitivities, food addictions, tendencies to emotionally eat, taste buds, etc.
After all, the human “diet” is essentially meat and vegetables. What happens when we strip all the fluff away? What might we discover about our bodies and minds? About our habits? About ourselves?
This way of eating restores metabolic flexibility, gets us burning fat for fuel (in addition to carbs when you add them back in after the 21 days). It helps us manage blood sugar, which is implicated in chronic stress, acne, diabetes, and hormonal disruption to name a few conditions and symptoms.
Obviously this challenge is not for those who struggle emotionally with food and need more one-on-one focused support, but it is an excellent way to be held accountable, to take on a challenge in which you’re given all the tools you need to do the discovery work.
You might discover that this is the best eating style for you.
You might restore your insulin sensitivity but discover that you need some carbs, or certain carbs, to feel your best.
You might discover hidden food sensitivities that have been plaguing you with inflammation for years.
I review my adventurous year of living on the Low Carb High Fat Ketogenic Diet.
I’ve always had a sweet tooth.
I remember binging on Halloween candy as a kid, stuffing one tiny chocolate bar after another into my mouth, as fast as my little fingers could unwrap them, trapped in some kind of sugar-filled trance.
“Never get between Talia and her food!” My family would joke when my blood sugar would crash between meals and I’d rage towards the fridge for a snack to keep me sane.
I remember digging into the little bags of cheese popcorn reserved for school lunches, finishing off one after another and then hiding the wrappers in their big Costco box so that it would look like it was still full, the way rebellious teens top up empty vodka bottles with water.
I can gain weight with the drop of a hat (but also put on muscle fairly easily), and it takes concentrated effort and dedication to take it off.
After a period of temporary stress and bagel-related weight gain, I decided to embark on a bit of experimentation. Work was getting busy and I wanted to supply my brain with constant energy without having to take snack breaks every few hours. Also enticed by anecdotes of shattered weight loss plateaus, I decided to “go Keto”.
I like experimenting with diet. Like many health-conscious people, finding the right nutrition regime for me has been a process. In my teens I started controlling portions and switching out white breads for whole grain rye and Jolly Ranchers for carrot sticks. In my early 20’s, I was vegetarian. I tried being vegan for a while before deciding it was a disaster for my health when I began to experience nutrient deficiencies, weight gain, and hormonal issues.
Later on, I followed my naturopathic school classmates to a modified Paleo diet (keeping in some gluten-free grains and legumes), then moved to a more traditional Paleo diet (taking out the grains and legumes), before going back to the modified version (which is probably the best eating style for me—more on that later).
For the most part, my diet is comprised of whole foods, with lots of vegetables, but in the Fall of 2016, when this all began, I was in a pretty Standard North American place when it came to food intake. At the time I was suffering from IBS, some issues related to subclinical PCOS, and fatigue. I was also starting to see some signs of impaired glucose control.I wasn’t feeling good and I was in need of a kind of reset of sorts.
I was interested in seeing how relying on ketone bodies for fuel would help my body, mental performance, and improve my blood glucose control and symptoms. I have a family history of type II diabetes and I wanted to do what I could to prevent insulin resistance and metabolic syndrome. Drastic times call for drastic measures, I thought.
Ergo, The Ketogenic Diet.
About the Diet:
The Classic Ketogenic Diet was first developed in the 1920’s to treat children with medication-resistant epilepsy.
When our brains are starved of glucose, their preferred fuel source (our brains use up 60% of the body’s glucose), the liver creates ketone bodies from stored or dietary fat that the brain can use as a substitute source of energy.
One of these ketone bodies, beta-hydroxybutyrate, is thought to be a particularly therapeutic molecule for the brain, conveying anti-convulsive benefits, thereby helping to reduce the incidence of seizures in children who don’t respond to medication.
However, the original Ketogenic diet is more extreme than the general health and weight loss-aimed diet we see described in recipe books these days. The Classic Ketogenic diet consists of about 90% of calories coming from fat. In order to achieve that, followers need to severely restrict their protein intake, and virtually eliminate all dietary sources of carbohydrate, which drastically limits their nutrition choices.
Since, the benefits of beta-hydroxybutyrate are being studied for other neurological disorders, such as Parkinson’s disease, dementia, migraine headaches and narcolepsy. It’s being looked at as a potential treatment for mental health conditions, like autism and depression, and metabolic disorders such as type II diabetes, and even to increase the efficacy of chemotherapy and radiation treatments in cancer. Other studies are looking at its role in improving cognitive function in mice and humans.
Some research shows that beta-hydroxybutyrate can expand lifespan by interacting with genes that slow aging. It is also shown to confer anti-inflammatory and antioxidant benefits.
In the 1970’s, Dr. Atkins responded to the high-carbohydrate, low-fat dogma of the nutrition world at the time, by bringing a modified Ketogenic diet into vogue. Restricting all forms of carbohydrates and encouraging a consumption of the still-vilified high-fat foods like bacon, eggs and cheese, Atkins affirmed that people could lose weight by eating fat, as long as they restricted carbohydrates at the same time.
The modern version of the Ketogenic Diet is slightly more health-conscious, promoting a higher intake of vegetables. The current diet restricts carbohydrates to under 20 to 50 grams per day, and encourages a high fat intake and a moderate protein intake, in order to encourage the body to turn to fat as its primary source of fuel. The current version of “Keto” is less strict than it’s initial epilepsy-treating incarnation, with anywhere from 60-85% of its calories coming from fat.
My Version of Keto:
I started the whole journey by tracking my food intake (using My Fitness Pal). My aim was to consume 20 grams of net carbs, or less, per day to push my body into using fat-turned-to-ketone bodies as a its primary fuel source.
Net carbs are calculated by subtracting dietary fibre from total grams of carbohydrates. For example, 1 cup of raw broccoli contains 6 grams of carbs. 2.5 of those are fibre. Therefore, the net carbs in broccoli are 3.5, which would count towards my net carb goal of 20 grams per day.
This isn’t easy. Take a look at any package of food you regularly consume. 1 cup of cooked oatmeal contains 23 grams of net carbs: 3 grams over my entire daily allotment. Therefore all high-carb foods like grains, legumes, starchy nuts, all fruits, and some starchier vegetables, were off limits.
Many people opt to test their blood, breath or urine for ketone bodies to determine whether or not their bodies are in ketosis. I dabbled in this, using the urinalysis strips in my clinic to test for urinary ketones. However, even though I was sticking to the diet, the strips would mostly turn up negative for ketones.
There are a few reasons why ketone strips may not be a reliable marker for ketosis. Firstly, the don’t test for beta-hydroxybutyrate, which is the main ketone body utilized by the brain, but acetoacetate, another ketone body produced in the liver.
Secondly, urinalysis strips only test for urine ketone spillover. They don’t necessarily reflect blood levels, and they won’t pick up the ketones that are being utilized as fuel by the body. If cells are absorbing all the ketones the liver produces, urine testing may not be positive.
The most accurate, albeit more expensive, method for testing ketone bodies is through a skin-prick test that analyzes blood levels of beta-hydroxybutyrate.
While I knew that the urine strips weren’t highly accurate, not having my state of ketosis validated was discouraging. I was often left in doubt over whether things were “working”. I wondered if there was some other mechanism going on. Was my body finding carbohydrates from someplace else? Did I have Small Intestinal Bacteria Overgrowth that was digesting my fibre and allowing me to absorb it somehow? Were my blood ketones being used up somewhere else (by the yeast in my gut, for instance)?
I did have signs of being in ketosis that I could watch for, however. When I avoid carbs, or fast for a few days, I start to develop a metallic taste on the tip of my tongue. It’s not a common sign of ketosis, a more common sign is a “nail polish” or “paint thinner” taste in the back of the throat, but still a symptom that some people report.
Keto Flu:
During the first few days of switching to Low Carb High Fat, I had to white knuckle through a phase realistically termed the “Keto or Low Carb Flu”. This horrible phenomenon is thought to be a result of the body switching from burning glucose as its primary fuel source to adapting to ketone body production. There is often a painful adjustment period for brains that have to learn how to rely on ketones for their main fuel source after a lifetime of glucose abundance.
It was nasty. I felt intense hunger and sugar cravings, nausea, dizziness, and weakness—it truly was a “flu”.
I knew that I had spent most, if not all, of my life as a sugar burner. Before Keto, I would crave food even just two hours after a full meal. I would often feel “hangry”: dizzy and shaky in between meals, and irritable if made to wait for food for too long. I had been existing between carb-dense meals, experiencing insanity-inducing reactive hypoglycemia between my regular sugar fixes.
The more I read about others’ experiences, the more I was assured that the keto flu symptoms were actually a sign of my body healing. I was becoming adapted to other fuel sources, which was a good thing, I thought.
So, I muscled through and followed the online advice: I consumed more fat to provide more fuel to my brain, including medium chain triglyceride (MCT) oil, which is quickly absorbed by the lymphatic system and turned into ketones by the liver, and I consumed electrolytes, which are more rapidly excreted from the bodies of low carb dieters.
For some people, Keto flu can last for days, for others it lasts weeks. For me, the Keto flu thankfully only lasted two days, after which my body began to adjust and my cravings for sugar went down. I began to feel more energy, which felt encouraging.
Daily Meal Plan:
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
I’d have my second meal of the day in the mid-afternoon, around 2 to 3 pm, for which I’d consume a few cups of cruciferous vegetables, like broccoli or cabbage, with a fatty cut of meat like ground beef, chicken thighs, or salmon, all topped with liberal amounts of fat from coconut, olives, avocados, or grass-fed ghee. I made a lot of batch-cooked grain-free curries and stews.
If I had a third meal or snack in the day, it would be another serving of fat: a handful of macadamia nuts or a hunk of creamed coconut.
Eating this way made me feel like Obama and his grey suits—I didn’t have to plan my meals too carefully. All I had to do was eat fat. My food was so calorie dense and my blood sugar so stable that I didn’t need to eat often. This meant that I didn’t need to worry about bringing food with me everywhere I went; one meal could satiate me for half the day. Hunger was never an emergency situation, as it had been in the past. Hunger would come on very slowly, and it would never be “hanger”; my already low blood sugar had nowhere to dip to. If I needed more food, I could always wait until I got home to eat.
More Benefits:
Within a few days, my PCOS- related cystic acne cleared. I also felt slimmer as some water retention deflated. This felt good. Our body stores carbohydrate in the form of glycogen in the liver and muscles. Glycogen stores retain water.
When glycogen stores are used up, a rapid 5 or more pound drop in weight can occur. This is the “water weight” that people talk about losing when they first begin some kind of nutrition plan.
It’s also common to notice a drop in water weight from a decrease in inflammation, when embarking on a new eating plan. I know that I am sensitive to certain carbs and dairy and, because those things were out of my diet overall (although Keto can certainly include high-fat dairy products for those who can tolerate them), the water retention caused by chronic inflammation seemed to clear.
Although it seems to attract people primarily for its hip-slimming potential, the Ketogenic diet probably does not cause weight loss in and of itself. Instead, the diet encourages a passive reduction in calories by stabilizing blood sugar and insulin levels, while promoting the intake of highly satiating foods containing protein and fat. Ketone bodies also have appetite-suppressing effects. Therefore, it’s probably a calorie deficit that causes the weight loss, rather than any specific biochemistry in the diet itself.
I didn’t lose much more weight than the water weight. However, my mood was brighter. I would wake up in the morning looking forward to the day, which often doesn’t happen in the winter. I felt more sustained energy throughout the day, and really enjoyed the decreased appetite, which led to more productivity.
I felt fine consuming two meals a day, able to get through hours of back-to-back patient visits without needing a snack or a break. It was actually incredible to need so few meals; it was like becoming another person, one no longer ruled by sugar cravings. I was like a camel, switching to stored fuel when the fat from my last meal had run out, and the transition was seamless. There was no wall to hit, and no hypoglcyemic crash to be seen.
I also noticed less bloating and digestive issues, probably from the lack of fermentation in my gut and the reduction in foods that tend to aggravate IBS, like certain vegetables, fruit, and legumes.
However, all was not roses on the Keto diet. While the first few months were dreamy, the longer I stayed on it the more I started to notice changes in my body that indicated the honeymoon period I was enjoying wasn’t going to last.
The Microbiome:
The research is in: human beings probably need 10 servings of fruits and vegetables a day (roughly 5 cups), or 800 g, a day to get the most heart disease, stroke and cancer-preventing benefits that diet can afford us. The International Journal of Epidemiology concluded that, if the correlations found in their February 2017 study were causal, almost 8 million lives might have been saved in 2013 if everyone in the world had simply consumed their fruits and veggies.
It’s one thing all diets, even the faddy ones, agree on—from the Paleo Peeps, to Plant-Based Hippies, to Raw Macrobiotic Sun Worshippers, to Whole Foods Michael Pollen Omnivores, to the dejected nagged-at husband pushing brusselsprouts around on his plate—fruit and vegetables are good for you. You should eat them. If you’re a typical North American, you should probably eat more than you’re eating. The health value of everything else we eat seems to be up for debate: red meat, saturated fat, soy, bread, coffee. The benefits of eating enough fruits and vegetables, however? There’s no contest.
It’s hard to pick one way in which fruits and vegetables are so health protective. It could be because of their high concentrations of micronutrients, reducing the risk of common nutrient deficiencies, like magnesium and vitamin C. It could be because, if you’re filling your body with a kilogram of fruits and vegetables a day, you probably aren’t scarfing down an entire medium-sized pizza and supersized orange pop as well—there just isn’t room. It could also be the antioxidants they contain that protect cells against free radical damage, protecting DNA. Or perhaps its the fermentable fibres present in fruits and vegetables that feed our invaluable microbiome.
The problem with keeping net carbs under 20 grams a day was that I needed to restrict my fruit and vegetable intake. I was eating no fruit at all, and staying away from the starchier veggies, like carrots and beets. I still stuck to my beloved leafy greens and crucifates, but even eating 2 to 3 cups of those guys a day would push me to the upper limits of my carbohydrate intake, which meant I couldn’t eat them as liberally as I had been.
Getting enough vegetables and (any) fruits on the keto diet is hard, if not impossible. This can impact our ability to get the micronutrients we need, but also enough fermentable fibres from vegetables like garlic, onions, yams, Jerusalem artichokes, and legumes, which provide food for our microbiome.
Feeding our gut bugs is important. They benefit us in numerous ways, from digesting out food, to calming inflammation, to fuelling gut cells by producing a short-chain fatty acid called butyrate. They help our immune systems function optimally. They produce neurotransmitters for our brains to work. They balance our stress responses and our circadian rhythms.
Jeff Leach, at the Human Microbiome Project speculates that the lack of dietary fibre in most low-carb diets may impact the health of the microbiome in negative ways by depriving the gut bacteria of their preferred food sources, as well as altering the acidity of the colon and intestines. He cites this article, in which obese subjects on a high-protein and low-carb diet had lower levels of butyrate in their bodies and intestines, likely due to decreased diversity in their guts.
There are, however, some studies that suggest that a Ketogenic diet can improve the microbiome in children with epilepsy, and autism, and some speculation by the researchers that that may be how the diets treat these conditions. However, since these studies are not done in “healthy” children, with an already healthy microbiota, it’s hard to extrapolate the findings to the healthy adult population.
Then there’s the fact that most studies that look at high fat diets and their impact on the microbiome are mostly done in rats. Of course, rats aren’t humans, despite there being relative genetic similarities. In these animal studies, researchers refer to “a high fat diet” when in fact they mean a high fat, high sugar diet. The sources of fat in these “high fat” mouse diets are often corn, margarine, or soy oil, which we know are highly inflammatory and offer few if any health benefits.
In other words, many studies on “high fat” diets are not looking at a relatively balanced Ketogenic diet that consists of vegetables, proteins, and healthy sources of fats from avocados, coconut, fish, olives, nuts and seeds and grass-fed meats.
Context is important as well. Is it the high fat diet that causes a reduction in gut diversity or the absence of fibre? This one mouse study showed that simply providing the mice with fibre in addition to their high fat diets decreased their risk of obesity.
I felt that my gut initially improved in the first few months on Keto: the diet was low in foods that aggravate me: namely refined carbs, sugar, gluten and dairy, as well as some of the fermentable fibres that can aggravate IBS. However, it never fully healed. After a few months, I started to notice the symptoms of bloating and digestive irregularities coming back.
Candida, a yeast that resides in the gut and can overgrow in the intestines in some people, especially the immunocompromised, causing symptoms of fatigue, IBS, and weight gain, among a variety of other symptoms, can survive on ketone bodies. Yeasts have mitochondria of their own. Some species of gut bacteria can consume protein, bile salts and even fats.
Contrary to what many claim, a Ketogenic diet doesn’t necessarily “starve out” the bad gut bugs. Combined with the lack of fibre to feed the beneficial gut bacteria and promote more bacterial diversity, a prolonged Ketogenic diet may be a recipe for gut dysbiosis.
Hormones:
Throughout my year spent in ketosis, I definitely noticed an improvement in my insulin signalling and glucose control, especially in the first few months. Looking at my blood work in March, after about a year of the Ketogenic diet (and then having been off it for a few months), my fasting insulin was very low and fasting blood glucose levels were in the low-optimal range. HOMA-IR, a calculation that is used as a marker of insulin resistance, was also low, indicating good insulin sensitivity.
I personally believe that this means that my risk for getting metabolic syndrome or type II diabetes is low, as long as I maintain this level of insulin sensitivity by watching the glycemic load of my diet and my stress levels.
The metabolic flexibility awarded to me from my year in ketosis also proved to be invaluable. Now, I no longer fear fasting and I can survive on other fuel sources besides sugar. My brain knows how to tap into stored and dietary fat more efficiently, and use those for energy. Even when not following any sort of low-carb diet, I noticed that I could survive between meals while travelling in Southeast Asia for two months, whereas normally I would have had to exist on unhealthy, sugary snacks.
However, after a few months on the diet, I began to notice a decline in my menstrual health. My cycles began to get longer, and soon I started missing periods. I noticed more hair falling out in the shower and more cystic acne developing on my chin. When I ran my blood estrogen and progesterone levels, I was surprised to see that their levels were very low.
We know that insulin, while often vilified as a “fat storage” hormone is actually responsible for storing everything, including nutrients. It also correlates with estrogen levels and the conversion of T4, one of our thyroid hormones, to its active friend, T3, which runs our metabolism. Insulin builds muscle, bone and brain cells. Very low insulin levels, in my case, were contributing to amenorrhea and a disruption in my sex hormones.
This wasn’t good.
While not quite the same as Intermittent Fasting (IF), Keto is often grouped into the same category because of its similar impact on blood glucose and insulin. The difference is that Intermittent Fasting induces ketosis through periodic food restriction, as opposed to carb restriction. Keto and IF often go hand in hand, however. The reduced hunger and high-nutrient density of the foods eaten on a Ketogenic diet often lend well to practicing intermittent fasting. It did in my case—I was only eating two main meals a day.
I always found it interesting, however, that most proponents of intermittent fasting are men. The male body appears to thrive in the fasted state, getting a boost of growth hormone and norepinephrine, both of which provide men with energy, motivation, and an improved sense of well-being.
This hormonal change may be a remnant of our ancestral hunter-gatherer days where it would be an advantage to feel motivated and energized to go out and hunt during periods of food scarcity.
I don’t think female bodies experience exactly the same effect. Some preliminary animal research tends to suggest that as well.
A few rat studies indicate that fasting may impair female insulin sensitivity, and induce amenorrhea, or missed periods. Female bodies rely on a consistent influx of calories and carbohydrates to stimulate insulin, which plays a role in stimulating thyroid hormones and estrogen, to continue to ovulate. Another study showed that fasting tended to “masculinize” female rats, lowering their female hormones, and increasing their levels of androgens, the male sex hormones, like testosterone.
Of course, these studies were done on fasted rats, which cannot be fully translated to the effects of Intermittent Fasting and Ketogenic diets on women. However, some of these findings did validate my experience, which certainly wasn’t being validated in the podcasts and blog posts I was exposed to, largely written and followed by men.
I did experience positive hormonal effects: the increased insulin sensitivity and lowered blood glucose. However, I was not happy about my irregular cycles and estrogen deficiency.
Therefore, I decided to increase my carbohydrate intake, returning to a more moderate Paleo diet that consists of some fruit, starchier vegetables and legumes. After a few months, my periods returned to normal, my skin cleared up, my hair stopped falling out, and my thyroid hormones, estrogen and progesterone levels all returned to their optimal ranges.
I have still have low fasting insulin levels, suggesting that the Ketogenic diet did help to reset my insulin sensitivity and that this effect may be lasting.
Metabolic Health:
After a year of doing the Ketogenic diet, and then a few months of returning to a moderate-carb paleo diet, I tested my cholesterol levels and inflammatory markers. My HDL cholesterol (the “good” cholesterol, to put it very simply) was high, my triglycerides (a risk factor for heart disease) were very low, and my LDL cholesterol (the “bad” cholesterol that statin drugs target) was also low. My inflammatory markers: C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), were also low.
While it is typically the monounsaturated fats, like olive oils and avocados, that are associated with increased levels of the heart-protective HDL cholesterol, even saturated fats from coconut oil can raise HDL. LDL is often lowered by these healthy monounsaturated fats, however saturated fats, even healthy ones, can raise LDL in certain individuals.
All else being equal, higher levels of LDL may not be as big of a problem as we think. Especially in the context of low risk factors, like low inflammation, absence of smoking and a healthy body weight. What’s more, the triglycerides and cholesterol/HDL ratio may be more important factors for determining heart disease risk. Further, assessing LDL particle size may also provide those concerned about their LDL levels with more information concerning their cardiovascular health. That being said, it is important to be aware that some of the fats present in a Ketogenic diet have the potential to raise blood levels of LDL in certain susceptible individuals, and that not everyone’s blood lipid results will look like mine.
Triglyceride levels are associated with liver function, and generally reflect dietary sugar, fructose and refined carbohydrate intake, rather than fat intake. Reducing refined dietary carbohydrates like white grains, flours and sugars is a good strategy for reducing triglyceride levels and reducing heart disease risk.
Some individuals can experience elevated levels of inflammation on a Ketogenic diet, depending on the quality of foods consumed. A Ketogenic diet low in fibre that fails to feed the microbiome; high in foods that a person may have an individualized sensitivity to (such as dairy, eggs, nuts or soy); or high in inflammatory fats like trans fats, and industrial oils like canola and corn oil, may all contribute to increased inflammation.
That being said, certain ketone bodies like beta-hydroxybutyrate may have anti-inflammatory properties. Many of the fats consumed in a mindful, whole foods Ketogenic diet, such as olives, avocados, seeds, salmon, and coconut, are also anti-inflammatory.
I found my blood markers a good indicator of the power of a high-fat, low-carb diet to, at least in my case, improve HDL cholesterol and lower triglycerides, fasting insulin and fasting glucose levels. Whether I needed an entire year in ketosis, or whether I even needed to actually enter ketosis to receive these benefits, isn’t clear. Perhaps I could have gotten the same results by moderately lowering my carb intake while increasing my dietary intake of healthy fats.
Modified Ketogenic Diets:
While I do think I benefitted from entering into ketosis, I would not necessarily recommend a Ketogenic diet to patients unless to achieve some sort of therapeutic goal, such as improved insulin resistance, or for adjunct cancer care, to reduce inflammation, or to improve severe depression, migraines, or narcolepsy.
However, there may be a benefit to cyclical Ketogenic diets for memory and cognition, and increased life span in mice. Cyclical Ketogenic diets involve entering ketosis on alternate weeks. On the other weeks, participants return to a normal, whole foods diet that contains higher amounts of carbohydrates. In this case, individuals gets the benefits of beta-hydroxybutyrate production and increased metabolic flexibility on their weeks on, while also being able to eat a high amount of fermentable carbs and fibres on their weeks off, essentially getting the best of both worlds.
Adding medium chain triglycerides to food may also confer health benefits, similar to being on a Ketogenic diet. One study showed that adding MCT oil to a high-carb breakfast (pasta), reduced appetite in men. This is likely because, after burning through the glucose in the pasta, the men’s brains were able to access the ketone bodies that were made readily available by burning the MCT oil. This kept their brains fuelled and their bodies satiated for longer.
The men eating pasta and MCT oil in the study had a ketone blood level of 0.3, which is similar to that obtained from a diet that derives 10% of its calories from carbohydrates, which is an essentially a very low-carb, if not Ketogenic, diet. This may indicate that simply adding MCT oil to a moderate to low-carbohydrate diet, may confer some of the benefits of having a slightly higher rate of circulating ketone bodies without having to follow a strict diet. Again, following this strategy, you can get the best of both worlds: consume a diet high in fibre, while also getting a steady flow of ketone bodies to the brain.
Other interesting areas of research are the use of supplemental, or exogenous, ketones for therapeutic use, however the area is new and not something I currently recommend in my practice (although this may change when more research begins to emerge and better supplements enter the market).
My Plan Moving Forward?
I’m happy that I gave the Ketogenic diet a try, but now I’m back to my more modified Paleo diet, aimed at promoting gut health, optimizing my micronutrient intake, regulating hormones, and supporting my energy levels. I now consume berries and apples, legumes, starchier vegetables and lean proteins more often and aim to get 10 servings of fruits and vegetables a day, with 8 to 9 of servings coming from vegetables, as opposed to fruit.
I currently start my day with a smoothie with berries, an avocado, spinach and protein powder. For lunch I have some sort of protein, fat, and tons of veggies. I eat more often than when I was in ketosis: about 3 meals a day with a vegetable and fat as a snack, or no snack at all in between, depending on my schedule.
My total daily carbohydrate intake falls around 100 grams a day with a net carb intake between 50 to 70 grams a day, depending on the fibre content of the vegetables, seeds, and legumes I’ve eaten that day. I try to get upwards of 30 grams of dietary fibre per day.
I avoid all sugar, including sweeter fruits like tropical fruits, and dried fruits, like dates. I especially stay away from refined sugars, even “natural” coconut sugars and agave. I avoid processed carbohydrates and flours. I mostly avoid grains, except when travelling or visiting someone’s house, getting my carbs from starchy vegetables and tubers, legumes and berries. I continue to avoid dairy (which I’m sensitive to), gluten, and processed industrial oils like canola, corn, and soy oil.
Right now, rather than focussing on macronutrient ratios, I’m directing my food intake towards obtaining the Recommended Daily Allowances of the micronutrients that run all of our cellular reactions, and the fibres that feed a healthy gut microbiota. I use an app called Cronometer to track this.
I definitely eat more fat than before, adding MCT oil to my morning smoothie, especially on days when I need to stay full and focused for longer. I also aim to do at least 12 hours of fasting a day, trying to get in 16-18 hour fasts where I can, ending dinner at 4pm, for example. I no longer do regular long bouts of Intermittent Fasting, particularly not when I’m feeling stressed and burnt out.
Would I Recommend the Ketogenic Diet to Patients?
One of the main tenants of Naturopathic Medicine is “Do no harm”. While it may seem like making diet and lifestyle recommendations are relatively benign therapies, I believe that they do have the potential to do physical and psychological harm, particularly if they are strict recommendations.
Following a strict diet may have health benefits, but it also may isolate us from friends and family, frustrate us and restrict our intake of certain nutrients, like fibre, vitamins and minerals. This is one of the reasons I do not ever advocate a Vegan diet, although if patients are following one already, I believe in guiding them to optimize their nutrient intake.
Furthermore, at least in my personal experience, the cure was stronger than the disease. I probably didn’t need to do the Ketogenic diet for so long; this was evidenced by the hormonal imbalances that I began to experience towards the end of my year on the diet.
However, particularly for patients who are suffering from metabolic syndrome, type II diabetes and insulin resistance or PCOS, there may be some powerful benefits to entering ketosis in order to dramatically reverse metabolic dysfunction. In this case, a modified regime combining Intermittent Fasting and cyclical Ketogenic diets could be beneficial.
Of course, it all depends on where patients are at in their nutrition journeys. Sometimes I meet patients who require, and respond well to, more heroic lifestyle interventions. Other times I meet patients relying on several sugary treats a day to get them through. In these cases, simply tweaking their diet in small ways, using baby steps may also have powerful disease-risk-reversing effects.
Like many people I see, Sandra was experiencing debilitating exhaustion.
Completing her PhD, she was working all day and collapsing on the couch at 8 pm.
She stopped going out in the evening. She ceased spending time with friends, engaging in activities outside of her studies, exercising, and having sex.
Her motivation and zest for life were at all-time lows.
Her marriage, and her life, were being sidelined in the service of her fatigue.
Her family doctor met her complaints with a defeated shrug. “You’re just getting older,” he offered by way of explanation.
Sandra was 27.
My patient is not alone. At least 20% of patients approach their family doctors complaining of fatigue.
Lack of energy is a problem that can arise from any body system. Fatigue can be an early warning sign that something has been thrown off balance.
I frequently see fatigue in patients suffering from hormone imbalances, including suboptimal thyroid function, insulin resistance, and low estrogen, progesterone, or testosterone. But also in chronic stress, depression, and anxiety.
Fatigue is often connected to mental health conditions, digestive issues, lifestyle imbalances, chronic inflammation, chronic stress, and lack of restful sleep. It’s no wonder, then, that most of the people I work with experience some level of low energy.
Conversely, I see improvement in energy as one of the first signs that someone is moving towards more robust health. Some of the first signs of healing are a clear mind, bright mood, and vibrant, buoyant energy.
There are a few steps you and your naturopathic doctor can take to identify and remove the cause of fatigue, while optimizing your health and energy levels.
Differentiate between sleepiness and fatigue.
It is important to determine if low energy is fatigue or sleepiness.
Sleepiness is characterized by the tendency to fall asleep when engaging in non-stimulating activities like reading, watching TV, sitting in a meeting, commuting, or lying down.
Sleepiness:
Is often improved by exercise, at least in the short-term
Is improved with rest
Fatigue is characterized by a lack of energy, both physical and mental. Fatigue is often worsened by exertion.
Those who are fatigued:
Suffer from mental exhaustion
Experience muscle weakness
Have poor endurance
Typically feel worse after physical exercise and take longer to recover
Don’t feel restored after sleeping or napping
Might experience ease in initiating activities but progressively experience more weakness as they continue them (e.g.: engaging in social activities, movement, working, etc.)
To determine between sleepiness and fatigue, your naturopathic doctor will ask you a series of questions about the nature of your low energy.
2. Assess sleep.
Assessing and optimizing sleep is essential for beginning to treat all low energy and, in particular, sleepiness.
Assessing sleep involves looking at a variety of factors such as:
Bedtime and waking time
Sleep onset: how long it takes
Sleep routine and sleep hygiene habits
Sleep duration: how many times you wake up, how quickly you can fall back asleep after waking
Causes of interrupted sleep such as sleep apnea, chronic pain, frequent urination, children/pets/partners, etc.
Nap frequency and length
Ability to wake up in the morning
Perceived sleep quality: do you wake feeling rested?
The use of sleep aids
Exercise routines, how close to bedtime you eat or exercise.
And so on.
Using a sleep app or undergoing a sleep study are two additional tools for assessing the quality and duration of your sleep cycles that may be useful.
3. Address sleep issues.
Whether the cause of fatigue is sleepiness or not, restful sleep is essential to restoring our energy levels. Optimizing sleep is an important foundational treatment for all health conditions.
Restorative sleep regulates hormones and balances the stress response, called the hypothalamic-pituitary-adrenal axis (HPA axis). It improves cell repair, digestion, memory, and detoxification.
Mental and emotional stress, artificial light, blood sugar dysregulation, inflammation, and hormone imbalances can interfere with sleep.
To address issues with sleep, it is important to:
Maintain a strict sleep schedule. This means keeping bedtime and waking time consistent, even on weekends.
Practice good sleep hygiene by avoiding electronics at least an hour before bedtime, using blue light-blocking glasses if necessary, and keeping the bedroom as dark as possible.
Avoid stimulating activities like exercise in the hours before bed.
Keep the bedroom cool and dark.
Reserve the bed and bedroom for sleep and sex only.
Balance circadian rhythms by exposing your eyes to sunlight immediately upon waking and eating protein in the morning.
In addition to sleep hygiene and balancing circadian rhythms, sleep aids can be helpful. I start my patients with melatonin, a non-addictive antioxidant, to reset the sleep cycle and help with obtaining deeper, more restorative sleep.
It is important to take melatonin in a prolonged-release form a few hours before bedtime and to use it in addition to a dedicated sleep routine.
Determine whether the fatigue is secondary to an underlying medical condition.
Secondary fatigue is defined as low energy, lasting from 1 to 6 months, that is caused by an underlying health condition or medication.
With your medical or naturopathic doctor, be sure to rule out any issues with your immune system, kidneys, nervous system, liver, and heart, and to assess the side effects of any medications you’re taking.
Ruling out chronic infections, pregnancy, anemia, and cancer may be necessary, depending on other signs and symptoms that are present, your individual risk factors, and family history.
While the vast majority of fatigue is not caused by a serious health condition, ruling out more serious causes is an essential part of the diagnostic process.
Remember that this is not a job for Dr. Google! Because fatigue is a sign that something in the body is not functioning optimally, it can be implicated in virtually every health condition, alarmingly serious ones, but also more benign conditions as well.
Taking into account your entire health history, risk factors and particular symptoms, as well as assessing blood work is a complex job that a regulated health professional can assist you with.
Get blood work done.
Assessing blood work is necessary for ruling out common causes of fatigue.
Blood tests are used to rule out anemia, infections, suboptimal iron, B12, and folate levels, under-functioning thyroid, inflammation, insulin resistance, and hormonal imbalances.
To evaluate the cause of fatigue, your doctor will look at:
A complete blood count (CBC) that looks at your red and white blood cells.
inflammatory markers like ESR and hs-CRP
TSH, to assess thyroid function, and occasionally free thyroid hormones and thyroid antibodies, if further investigation is indicated
B12, iron and folate
Other tests such as fasting insulin, fasting blood glucose, liver enzymes, and hormones like estradiol, testosterone, estrone, LH, FSH, and progesterone, depending on the health history and the constellation of symptoms.
Your doctor may take further measures to assess your heart and lungs, or to rule out chronic infections.
6. Identify physiologic fatigue, or burnout.
Once sleepiness and any underlying health conditions have been ruled out, your doctor may determine whether you have physiologic fatigue.
Physiologic fatigue, also commonly called “burnout” or “adrenal fatigue”, is the result of an imbalance in sleep, exercise, nutrition intake, and rest.
It is by far the most common category of prolonged fatigue that I see in my practice. Two thirds of those experiencing fatigue for two weeks or longer are experiencing this type of fatigue.
Feeling a lack of motivation, low mood, and increased feelings of boredom and lethargy are characteristics of this kind of fatigue.
Physiologic fatigue can be confused with depression, leading to a diagnosis and subsequent antidepressant prescription, which may fail to uncover and address contributing lifestyle factors.
To tell if you might be experiencing physiologic fatigue, or burnout, see if you answer yes to any of the following questions, adopted from the Maslach Burnout Inventory:
I feel emotionally drained at the end of the day.
I feel frustrated with my job.
I feel I’m working too hard.
I feel fatigued when I have to face another day.
I have a hard time getting up in the morning on weekdays.
I feel less sympathetic and more impatient towards others.
I am more irritable and short-tempered with colleagues, my family, my kids.
I feel overwhelmed.
I have more work than I can reasonably do.
I feel rundown.
I have no one to talk to.
Fortunately, there are many solutions to improving low energy and mood caused by burnout.
Balance the HPA Axis
Balancing the stress response, otherwise known as the Hypothalamus-Pituitary-Adrenal (or HPA) axis, is an important component of treating physiologic fatigue.
Our HPA axis becomes activated in the morning when the hormone cortisol is released from the adrenal glands. Cortisol suppresses inflammation and gives us the motivated, focussed energy to go about our day.
Towards the end of the day, cortisol levels naturally fall. In the evening, cortisol is at its lowest, and melatonin, our sleep hormone, rises.
Those with HPA dysfunction have an imbalance in this healthy cortisol curve.
They commonly experience sluggishness in the mornings, a crash in the afternoon (around 2 to 4 pm), and restless sleep, often waking up at 2 to 4 am as a result of nighttime cortisol spikes and an impairment in melatonin release.
These individuals often experience cravings for salt and sugar. They may have low blood pressure and feelings of weakness.
It is common for those experiencing burnout to get sick when they finally take a break or experience prolonged healing time from common infections, likes colds and flu.
They may suffer from inflammatory conditions like chronic migraines, muscular tension, and report feeling depressed or anxious.
In this case, balancing the HPA axis is a treatment priority.
Treatment involves:
HPA axis balancing through adaptogenic herbs
Optimizing adrenal nutrient levels
Regulating blood sugar
Improving circadian rhythms
Reducing workload and perceived stress through addressing perfectionism, practicing setting boundaries, and developing mindfulness, among other skills.
Improving sleep
Engaging in regular, scheduled exercise
Reducing inflammation, improving digestion, or regulating hormones
Being proactive about mental health and emotional wellness
Improving self-care and stress resilience
Cognitive Behaviour Therapy can be used to teach healthy coping skills while balancing sleep and stress. Studies show it can be more effective than medication for the depression and anxiety related to physiologic fatigue.
Of course, from a holistic perspective, the above strategies are the foundations for improving general health and wellness for all fatigue-related conditions, regardless of whether the fatigue is due to sleepiness, secondary fatigue, physiologic fatigue, or chronic fatigue syndrome.
Talk to your naturopathic doctor about adaptogenic herbs.
Adaptogenic herbs are an important natural tool for improving mood and energy.
Adaptogens help the body “adapt” to stress. They up-regulate genes involved in boosting the body’s natural stress resilience.
Because of this, adaptogens not only improve energy and mental and physical endurance, they also improve attention and concentration, immune system function, and mental work capacity.
They can treat depression and anxiety, and regulate circadian rhythms.
Common adaptogens are withania (or ashwaghanda), rhodiola, holy basil, the ginsengs, like Siberian gingseng (or eleuthrococcus), schizandra, liquorice, and maca, among others.
My two favourite adaptogens are ashwaghanda and rhodiola, however your naturopathic doctor can work with you to pick the best herbal combination for your individualized needs.
9. Rule out Chronic Fatigue Syndrome.
Chronic fatigue syndrome (CFS) is characterized by fatigue that lasts 6 months or longer, is not improved by exercise and rest, is not related to an imbalance in lifestyle, and is not caused by a primary health condition.
Those with CFS often have signs of an activated immune system such as enlarged lymph nodes, a low-grade fever, or a sore, inflamed throat. Sufferers may experience generalized weakness and pain.
CFS can be an extremely debilitating condition that results in a 50% reduction of daily functioning.
The cause of CFS is not known, however balancing HPA axis function, improving nutrient status, reducing inflammation, healing the gut, reducing toxic burden, boosting mitochondrial functioning, and promoting self-care are all useful treatment strategies.
Our gut is the seat of the immune system, sampling foreign substances from the external environment and activating an immune response, if it finds any of those substances pose a threat to the health of the body.
If our immune system comes into contact with something doesn’t like, even if that something is a benign food substance, an inflammatory reaction can be triggered. Chronic inflammation can exacerbate fatigue.
To test for food sensitivities, your naturopathic doctor will either order a blood test, or recommend an elimination diet where suspicious food is removed from the diet, the gut is healed, and foods are later reintroduced.
Common foods to eliminate are gluten, dairy, sugar, eggs and soy. Stricter Autoimmune Paleo diets involve the removal of all dairy, eggs, grains, legumes, and nuts.
Mind your mitochondria.
Our mitochondria are the “powerhouses” of the cell, responsible for making ATP, our body’s energy currency, out of the carbs, protein, and fats from our food.
Research has shown a link between mitochondrial dysfunction and chronic fatigue.
The mitochondria need a variety of different nutrients to function optimally. These nutrients include B vitamins, magnesium, Coenzyme Q10, and certain amino acids.
When the mitochondria are unable to produce sufficient ATP, fatigue may result. Similarly, a problem with antioxidant production can result in the buildup of reactive oxygen and nitrogen species, otherwise termed “free radicals”, in the mitochondria.
Free radicals can trigger inflammation and immune system activation in the entire body, causing us to feel ill and fatigued.
B vitamins are also important for a process called “methylation” which is essential for energy and hormone production, immune function, detoxification, mitochondrial function, and DNA repair.
Balance your blood sugar.
Insulin resistance, hypoglycaemia, type II diabetes, and metabolic syndrome are all common conditions that reflect the body’s inability to regulate blood sugar.
All of these conditions can cause frequent energy crashes, fatigue after eating, brain fog, and lethargy.
Even those free of the above conditions may still struggle with blood sugar imbalances. Signs of blood sugar dysregulation are craving sweets, feeling hungry less than 3 hours after a meal, getting “hangry”, feeling weak and dizzy if missing meals, waking at night, and snacking at night.
Balancing blood sugar by eating enough fibre, fat and protein at every meal is essential to maintaining the endurance to get through the day.
Your naturopathic doctor can help you come up with a diet plan that keeps your blood sugar balanced and your energy levels stable throughout the day.
Support your immune function and eradicate chronic infections.
Chronic infections can result in prolonged activation of the immune system, resulting in chronic fatigue.
Viral infections, like mononucleosis and Epstein Barr, and gut bacteria imbalances, such as SIBO, C. Difficile, and candida overgrowth can be implicated in chronic fatigue.
Supporting the immune system with herbs, balancing the HPA axis, and using natural remedies to eradicate the infection are all courses of action you may take with your naturopathic doctor to eradicate infectious causes of fatigue.
Uncover and treat hormone imbalances.
Our hormones, the messengers of the body, regulate how our cells talk to each other.
Hormones are responsible for blood sugar control, the stress response, ovulation and fertility, sex drive, metabolism, and, of course, energy production and utilization.
It is possible that those who suffer from low energy have an imbalance in the hormones cortisol, insulin, estrogen, progesterone, DHEA, testosterone, or thyroid hormones. Directly addressing hormones is then the main treatment goal for improving energy.
Uncovering other signs of hormonal imbalance, such as the presence of PCOS, endometriosis, or symptoms of hypothyroidism, as well as ordering blood tests, can help reveal if an imbalance in hormones is the main cause of your fatigue.
Encourage detoxification.
Our body has the powerful ability to process and eliminate the 500 chemicals and toxic substances we come into contact with daily, as well as the hormone metabolites and immune complexes produced as a result of normal metabolic functioning.
Our livers, kidneys, colon, and skin regularly filter hundreds of harmful substances from our bodies. This process happens naturally without the aid of outside support.
However, it is possible that an increased toxic burden on the body paired with a sluggish liver and digestive system, can increase the body’s overall toxic load.
Toxic overload can contribute to fatigue by increasing inflammation and immune system activation, as well as impairing energy production pathways, and disrupting hormonal function.
Reducing contact with harmful toxins, while supporting kidney, liver and colon function can help restore optimal energy and health.
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Treating fatigue first involves developing a relationship with your healthcare provider: finding someone who takes your concerns seriously.
Conducting a thorough assessment of blood, lifestyle factors, sleep, hormones, and digestion, and as many other factors as possible, is essential to uncovering the cause of fatigue.
Treatment involves removing obstacles to healing, supporting energy production, balancing lifestyle, and using herbs to boost energy and stress resilience.
When we consider fatigue as an important sign that something in our body is functioning sub-optimally, we can use our energy levels are important indicators for health.
ÏÏAround the same time that the American Heart Association published a paper warning the public that coconut oil contained saturated fat, supposedly leading to heart disease, Netflix released the vegan documentary What the Health, which declared diabetes to be a disease of fat buildup in the blood, among other completely unscientific claims.
It was no wonder that my inbox and social media were bombarded with comments from confused patients, family members and friends; their attempts at healthy eating were being called into question by this onslaught of confusing contradiction.
“But I’ve been adding coconut oil to my morning smoothies!” one person wrote.
“I’ve switched to a plant-based diet!” another triumphantly declared. She was currently seeing me for treatment for her long-standing anemia.
Don’t: Freak Out
It seems like every new nutrition-focused Yahoo! News article lifts the protective rock of certainty off the health-conscious, sending us scuttling frantically for cover like newly exposed garden grubs.
You can hardly blame us. As someone who studies health and nutrition for a living, even I find myself caught up in this health claim game of ping-pong. How could one claim be true if the complete opposite claim was being made? Was coconut oil the devil incarnate, or the next belly-fat blasting super food? Do vegan diets cure diabetes or cause it?
I take my eyes off the ping pong ball and stop to massage my neck.
Do: Understand the Power of Food
If there is one right diet for humans, then we certainly haven’t found it through modern-day nutritional research. One of the problems with finding a standardized “perfect” human diet is that humans are not gerbils: our food serves various functions.
A good diet fuels the body, prevents disease and promotes health, but also provides us with a source of pleasure, soothes emotional pain, gives us something to look forward to, serves as a reward (for ourselves, our loved ones, our children), takes centre stage during celebrations, supports social cohesion, and encourages meeting attendance, or blood donations.
Food allows us to wallow in the luxury of our senses, or to commune with the Divine. Eating and making food serve as hobbies, creative outlets, and so on.
Food holds a sacred place in virtually every human culture.
As a naturopathic doctor, I use food as a medicine; the food we eat has the power to reverse disease and promote health.
With conditions like cardiovascular disease, type II diabetes, and mental health conditions, on the rise, it becomes imperative that we make an effort to understand the health impact of our food choices.
Understanding the Do’s and Don’t’s of Nutrition can help us harness the power of food to heal the body and prevent disease.
Do: Be Critical of Nutrition Research
Nutritional research, while essential for separating the gluten-filled wheat from the chaff, is flawed in many regards.
Because well-controlled, long-term clinical trials on compliant humans are nearly impossible to do, much of the nutritional information we rely on comes from epidemiological studies, which establish relationships between two isolated variables, such as a food and a health outcome (red meat consumption and colon cancer incidence, for example).
When evaluating these studies it is important not to confuse correlation with causation. This is what happened in the 1950’s, when Ancel Keys published his famous Seven Countries Study that claimed to link saturated fat intake and coronary artery disease.
Keys’ findings led us to toss out our delicious bacon and egg breakfasts in lieu of spending the next 60 years munching fat-free yogurt and sugary cereal.
Keys assumed that because saturated fat, dietary cholesterol, and heart disease were linked (in the seven countries he included data for) that the relationship was causal. However, we know from current research that this is not true—correlation does not equal causation.
Other things that correlate with an increased incidence of heart disease are paying tax in Sweden and owning multiple TV sets. While paying taxes may certainly give you chest pain, avoiding them will probably not reduce your heart disease risk.
Nutrition researchers attempt to account for as many relevant lifestyle variables as possible, but there are many that they miss.
For example, studies may record whether the participants smoked, drank, or exercised, but important variables such as the status of their gut microbiome, or how they season their meat, are often left out. This can be problematic—when we fail to include everything, we’re bound to miss something.
While nutritional research is essential for understanding how food interacts in our bodies, we certainly need to take most studies with a grain of salt (which a new study shows has no impact on your blood pressure).
Do: Pay Attention to What Healthy Traditional Societies Ate
Speaking of salt, any human nutrition article wouldn’t be worth its weight in it without mentioning the work or Dr. Weston A. Price. Dr. Price was a Canadian dentist who lived at the turn of the 20th century, when food was becoming more industrialized.
Suspecting that the increase in tooth decay he was noting in his child patients was diet-related, Price set out on a 10-year journey in the 1930’s to find the “perfect diet” by analyzing what traditional human societies ate.
He studied populations in remote Swiss villages, in the Americas, African tribes, Australia and New Zealand, and the Melanesian and Polynesian South Sea Islanders. Dr. Price took meticulous notes, food samples for analysis, and many pictures, all of which he published in his book Nutrition and Physical Degeneration.
While many of the populations he studied had also begun to experience the creeping influence of an industrialized food economy, others had still managed to retain their native diets. Due to globalization and its effects on traditional communities, this type of study could never be done today.
Price found some of the populations exhibited incredible characteristics of robust health. They had decay-free, straight white teeth, flawless facial and jaw structures indicating healthy bones, and no diseases; cancer and autoimmune conditions were virtually nonexistent across generations in these populations.
Price noticed that, while the healthy populations’ diets consisted of a variety of foods and macronutrients, they all had very important commonalities.
Don’t: Consume Processed Foods:
First of all, Dr. Price found that the healthiest populations somehow managed to avoid the flood of industrial food products. They refrained from eating refined flours, sugars, food additives, and vegetable oils, and stuck to their native diets of meat, eggs, dairy, fish, fruits, and vegetables.
He noted that, once processed foods started to creep into a population’s diet, dental decay and degenerative diseases, such as cancers, tended to quickly follow.
Don’t: Eat Anything Your Grandmother Wouldn’t Recognize
Michael Pollen, author of The Omnivore’s Dilemma, reminds us of some simple food rules, such as his famous “Eat food. Not too much. Mostly plants.”
In his book, Pollen clearly differentiates between “food”, i.e.: something your grandmother would recognize, and something “made from a plant, not in one”, and “edible food-like products”, which tend to increasingly populate our grocery stores, kitchen cupboards, and bodies.
Refined sugars and vegetable oils have increased exponentially in the average diet in the past few decades. So have metabolic degenerative diseases such as cancer, diabetes, and heart disease.
It seems that the entire food industry, from the way grocery stores are set up, to the way that foods are marketed to consumers, to the promotion of a culture of snacking, is built around encouraging the consumption of processed, “edible food-like products” rather than real foods.
The book The Dorito Effect outlines how the food industry engineers processed foods to contain taste, textures and chemicals that override our body’s hunger and satiation signals in order to monopolize our cravings, leading us to overeat.
Steering clear of these packaged, processed and over-produced food-like products is essential for promoting health.
Do: Eat Whole Foods
Stick with consuming what Michael Pollen classifies as “food”: whole substances that come from plants and animals, that resemble how they are found in nature, and that usually exist in the periphery of the grocery store.
Prepare foods at home as much as possible. Avoid foods in packages that contain more than 5 ingredients, especially if the ingredients listed are unpronounceable, or something your average 5th grader wouldn’t recognize.
As early on as the 1930’s, Dr. Weston A. Price was already noting an increase in tooth decay and jaw malformation in children who were consuming the industrialized processed foods that were beginning to enter the North American diet.
Since then our consumption of processed foods, refined sugars, vegetable oils and flours has increased, and so have our incidences of chronic, lifestyle-related diseases.
Therefore: Eat Food. Not too much. Mostly plants (and animals).
Do: Consume Animal Products
Dr. Price found that every population he studied consumed some form of high-nutrient animal product. While some populations were vegetarian, consuming raw dairy products, none were vegan.
Every healthy population consumed some combination of fish, organ meats, insects, eggs and dairy from pastured animals. All animals consumed were obtained from nature and ate their natural diet; cows ate grass and poultry ate grass, grubs, and worms.
They consumed the entire animal, favouring nutrient-rich organs over muscle meat: liver was highly valued. They used bones to make gelatin, which provides a source of bone, skin and connective-tissue-building collagen.
Obtaining enough organ meats, fish, egg yolks and grass-fed beef and dairy allowed the healthiest populations to achieve ten times the dietary intake of the fat-soluble vitamins A, E, D and K than the typical North American.
Do: Consume Fat
The healthiest populations that Price studied consumed anywhere from 30 to 80 percent of their total calories from fat. Most of these fats were saturated, obtained from animal sources, and heart-healthy monounsaturated fatty acids, obtained from foods such as olives, avocados, and macadamia nuts. Only 4% of the fat they consumed came from the polyunsaturated fats that are found in vegetable oils, nuts, seeds, processed grains and legumes (like corn and soy), and fish.
Vilified for years in North America, fat is essential to the human diet: it builds our brains, nervous systems, hormones, and cell membranes. Fat is a fuel source for our brains. It aids our bodies in blood sugar regulation and the absorption of essential nutrients.
Contrary to what we’ve been told for the last few decades, a low-fat diet, rather than a high-fat one, is associated with increased risk of mortality.
A 2017 Lancet study that observed the diets and disease risk of 135,000 people found that total fat intake, including saturated fat, was not associated with any increase in cardiovascular disease or mortality. The study also found that when saturated fat intake increased the risk of stroke decreased.
Don’t: Consume Vegetable Oils
Polyunsaturated fats, or PUFAS, exist as omega 6 (found in processed vegetable oils like corn, soy or canola oil) and omega 3 fatty acids (found in fish, nuts and seeds).
Healthy human populations generally obtained a 1 to 1 ratio of omega 6 to omega 3 fatty acids. The increase in cheap vegetable oils in our diets has brought our inflammatory omega 6 fatty acid levels up substantially, to a ratio of 10 to 1. With this increase we see a rise in inflammatory health conditions: arthritis, diabetes, obesity, cardiovascular disease, mental health conditions, and autoimmune disease.
Vegetable oils like canola, corn and soya oil require intense chemical processing and are very unstable, becoming rancid quickly. Their high omega 6 content promotes inflammation.
Avoid these oils whenever possible by avoiding store-bought salad dressings, packaged foods, restaurant foods, and fried foods. Instead, cook from home whenever possible using the healthier oils from olives, coconut, and avocado, or using butter and ghee.
Do: Consume Fermented Foods
Our microbiome, the universe of trillions of bacteria that live inside our digestive tracts, has become the subject du jour of intense medical research. The health of our guts has been associated with virtually every disease, from our mental health to our risk of inflammatory, degenerative diseases, to our circadian rhythms and stress responses.
It is no wonder, then, that Weston A. Price, found in the 1930’s what modern science is now confirming: the healthiest human populations regularly consumed fermented foods, like kefir, that were rich in healthy probiotics.
These populations also soaked, fermented and sprouted their grains, seeds and legumes to neutralize their lectins and phytates. Lectins present in grains and legumes can cause inflammation and autoimmune reactions, while phytates act as anti-nutrients, preventing absorption of minerals in the digestive tract.
Fermentation supports the health of our gut bacteria and aids in the digestion of various foods.
Do: Personalize Your Diet
While the work of Weston A. Price and intuitive wisdom—avoid fake foods wherever possible—can serve us in our eating choices, there was a significant amount of variability among the foods consumed in healthy human diets.
How do we know what foods will help us thrive personally?
Eran Segal, in his popular Ted Talk, presents a variety of blood sugar responses to different types of carbohydrate-rich food.
When we eat food high in carbohydrates, our blood glucose levels rise as those carbs are broken down into simple sugars in the digestive tract and then absorbed. Constantly spiking blood sugar levels, when done repeatedly over time, is a recipe for fat-gain and increasing our risk of type II diabetes.
Segal and his team found that some foods, like bananas or white rice, caused a marked increase in blood sugar levels when some study participants ate them, while foods like cookies and ice cream had no effect, slowly raising blood glucose levels rather than dramatically spiking them.
There were other study participants, however, who experienced the opposite effect: a marked spike in blood sugar in response to sugary foods, like ice cream, and a more gradual increase (consistent with healthier blood-glucose control) in response to rice and cereal grains.
Segal found that an individual has a personalized blood sugar response to certain foods, which can be predicted by their genetics and microbiome, among other factors.
Segal’s team concluded that dietary guidelines are not one-size-fits-all. Each individual may have a specific set of foods on which they thrive.
Do: Find Your Perfect Diet
So, how do we find our perfect personalized diet?
Life coach, Brooke Castillo, of the Life Coach School Podcast has some useful guidelines. Castillo suggests four questions to ask yourself when eating a specific food to find out if that food is right for you:
1) Does this food taste good to me?
2) Does this food feel good in my body?
3) How is this food acting in my body?
4) Is this food helping me get me the health results that I want?
Do: Eat Food You Like
As a naturopathic doctor, I know: it doesn’t matter how good a particular food may be, if my patient doesn’t like it, he or she won’t eat it.
Finding the perfect diet for us involves eating a variety of unprocessed foods that provide us with fuel and that we look forward to eating. However, it can take a while to learn what real food tastes like if our palates have been manipulated by the chemically-enhanced flavours of processed foods.
Ayurveda, a 6000-year old medicine from India, identifies 6 tastes: sweet, sour, salty, spicy, astringent and pungent; a healthy diet consists of all 6 tastes.
The Standard American Diet contains mostly sweet taste, with some salty and sour (alcohol) added to the mix. Being relatively rare in nature, the human palate evolved to prefer these tastes over others (such as bitter taste, which is abundant in antioxidant-rich plants).
In order to balance our diets, we may need to make an effort to consume more bitter or astringent foods from micronutrient-rich leafy green vegetables. Training ourselves to appreciate a variety of tastes may be important for finding a diet that fuels us while also bringing us pleasure.
Do: Pay Attention to How Foods Feel in Your Body
If Eran Segal’s study subjects had had experience practicing mindful eating and body awareness, I wonder how many of them would have already known whether their bodies could better tolerate white rice or ice cream.
If they had been paying attention to their body’s cues, it’s possible that they already knew that white rice spiked their blood sugar, causing symptoms of shakiness, dizziness, brain fog and lethargy, or increased hunger and sugar cravings.
Whenever I see a new patient, I have him or her record their food intake for two weeks along with any symptoms experienced in their bodies. This exercise almost always proves useful in a variety of ways. Patients notice that certain foods make them feel bloated and lethargic, or cause headaches, while other foods reduce their cravings and provide them with level energy.
Paying attention to how our body feels immediately after eating or in the hours following, can provide us with invaluable information about the specific effects certain foods have on us.
Do: Consider Working With a Professional
To answer Brooke Castillo’s 3rd guideline question “How is this food acting in my body?” you may need to work with someone who understands nutritional biochemistry and physiology.
For example, you may love cheese and it may feel good in your body immediately after you eat it.
However, unbeknownst to you, cheese may be causing a delayed food sensitivity reaction that produces symptoms many hours to days later and contributes to your symptoms of hormone imbalance. Cheese may be encouraging mucus production, contributing to your chronic sinus congestion.
The way different foods interact with our hormones and immune systems may not be apparent immediately after we ingest them. The effects may be delayed or slowly accumulate over time. Gaining a professional’s view on the impact a food has on our complex bodily systems, including our personalized genetics and gut microbiome, can help us understand whether that food has a place in our ideal diet.
A professional combines his or her knowledge of the body with your knowledge of your own body, your health history, and blood tests, to help you identify which foods might not be right for you.
Do: Eat Food that Supports Your Health Goals
As Hippocrates once said, “Let food be thy medicine.” As a naturopathic doctor, I believe that nutrition has an important place in disease prevention and healing. Each bite of food we take can have the effect of moving us toward health or away from illness.
Our nutritional requirements will differ depending on our health goals. A 71-year old woman undergoing chemotherapy and radiation for stage 2 lung cancer will be eating a very different diet than her 24-year old bodybuilding grandson. A 42-year old woman who has polycystic ovaries and hopes to get pregnant in the next year will also have completely different dietary requirements and health goals.
You might love the food you eat. It might feel great in your body; you’re eating unprocessed, whole foods you prepare at home. However, you’re not feeling as amazing as you feel you should. Perhaps you feel tired, or struggle to lose weight. You might suffer from depression, diabetes, or daily digestive symptoms.
Depending on your health goals, a healthcare professional can work with you to find the ultimate nutrition do’s and don’ts for your body.
Do: Have Courage
Dipping our toes into the deep pool of human nutrition can be a daunting, yet essential act. Our dietary habits have the power to deeply influence our health. In the words of Ann Wigmore, “The food you eat can either be the safest and most powerful form of medicine, or the slowest form of poison.”
Removing processed foods from our kitchens, eating whole foods, cooking at home, eating enough of the right types of fats, developing awareness of how foods feel in our bodies, and considering working with a professional to help us reach our health goals through diet and lifestyle changes, can have a powerful impact on the quality of our lives.
In the past I used to suffer from “hanger”, feeling hungry and irritable if going more than a few hours without food. Now my body is adapted to fasting, going prolonged periods without food—and I feel all-the better for it.
When I was a kid, no one ever had to convince me to finish my dinner. Perpetually “hangry” (hungry and angry), I was the Tasmanian devil of snacking, vacuuming up whatever food substances crossed my path, leaving wrappers and crumbs in my wake. “Never get between Talia and her food,” my brother facetiously coined when, like a voracious bull, I would bully my way into the kitchen to fix myself an emergent after-school snack. From the moment I was born, it seems, going more than two hours without eating was a physical impossibility. “I’m sick with hunger,” I would complain whenever my blood sugar levels dipped.
Now I sit here writing this article, in my adult incarnation, comfortably having abstained from eating for more than 14 hours. Whereas before I couldn’t go more than 2 hours without some kind of sugary snack, my body is now adapted to thriving during prolonged periods without food—and I feel all-the better for it.
“Eat a snack every 2-3 hours to keep blood sugar stable and lose weight,” dieticians and nutritionists often advise . However, as we dig into the disease prevention, anti-aging and weight management research, we learn that there may be benefits to going without food for prolonged periods.
We humans spent much of our evolutionary history hunting and gathering with extended periods of food scarcity. Our bodies adapted to survive through, and perhaps even thrive and depend on, periodic fasts. We now live in a society that enjoys food abundance: with 24-hour convenience stores and fast food restaurants at our disposal, we rarely go hungry. This recent lifestyle change may contribute to the increase in the diseases of excess that afflict modern bodies.
Ancient healing systems like Ayurvedic medicine and Traditional Chinese Medicine have long recognized the benefits of fasting for purifying and healing the body. Today, a body of research is accumulating that suggests that fasting may help treat diseases like multiple sclerosis and cancer, reduce the risk of chronic metabolic diseases, such as diabetes, battle dementia and cardiovascular disease, and reverse the effects of aging, helping us live longer.
What Happens During Fasting:
Human physiology fluctuates between two modes: the fasted and the fed state. After eating, a hormone called insulin rises in response to the intake of dietary carbohydrates and, to a lesser extent, protein. Insulin allows glucose to enter cells where it can be used for energy. Insulin encourages the storage of body fat and glycogen—a molecule stored in the muscles and liver that can be broken down quickly for energy. Insulin is an anabolic hormone that promotes tissue building and growth.
Our bodies are in the fed state, or postprandial state, for up to 4 hours following a meal, when blood sugar and insulin levels rise and the body begins to store food energy. 4-6 hours after eating, our bodies enter the post-absorptive state. Insulin and blood sugar levels fall, and blood sugar is maintained through the breakdown of liver and muscle glycogen. At the 10-12 hour mark post-meal, the body enters the fasting state. At this stage, glycogen stores have been depleted and blood glucose is maintained through a process called gluconeogenesis: glucose is created from fat, lactate and protein. In the fasting state, the body taps into fat stores to create ketone bodies, which are used for fuel.
Approximately 24-48 hours after a meal, the body enters a state called autophagy (or self-eating). The body breaks down old, damaged cells into their proteins and reuses them to build new cells or for fuel, through gluconeogenesis. Autophagy has gained the attention of researchers who recognize its benefits for managing inflammation, slowing the effects of aging, and treating various chronic diseases, such as autoimmune disease and cancer—more on this later!
Fasting to Treat Cancer:
Valter Longo, PhD, at the Longevity Institute at the University of Southern California, examined the effects of 2 to 4-day fasts on patients with cancer who were undergoing chemotherapy. The study found that several days of fasting improved the efficacy of chemotherapy, while reducing its side effects, protecting healthy, non-cancerous cells. Healthy cells responded to the periods of food restriction by shutting down, protecting them from the toxicity of the chemotherapy. Cancer cells don’t have such a response, leaving them susceptible to the chemotherapy. “Cancer cells are dumb cells,” says Dr. Longo.
The fasting period not only improved the effects of cancer treatments, it stimulated the regeneration of the immune system through the creation of progenitor stem cells. Fasting cleared out damaged immune cells and cancer cells through autophagy and new cells were regenerated upon re-feeding. Dr. Longo and his team found that up to 40% of the immune system is rebuilt in mice after a fasting and re-feeding cycle.
Fasting Mimicking Diets:
Recognizing the difficulty in going 3 days without food, Dr. Longo developed a 5-day “Fasting Mimicking Diet” that allows for the consumption of about 700-1000 calories per day in the form of small snacks. The Fasting Mimicking Diet is low enough in calories, protein and carbohydrates to mimic the physiological conditions and benefits of fasting like autophagy, ketone body production, beneficial stress response, and cancer cell starvation.
Mice given the Fasting Mimicking Diet (FMD) lost 30% of their body weight through the breakdown of body fat and clearing away of old, damaged cells. When the mice were re-fed, their blood, brain and bone cells were rebuilt. The mice who underwent the Fasting Mimicking Diet had rejuvenated immune systems, decreased incidences of cancer, reduced body fat, improved cognitive performance, decreased inflammation, and increased lifespans.
Fasting to Treat Autoimmunity:
Research in mice showed promising results in using the Fasting Mimicking Diet to treat multiple sclerosis, a debilitating autoimmune condition that attacks the nervous system. When following the diet, immune cells that were attacking the brain and spinal cord were destroyed. Upon re-feeding, new progenitor stem cells were created that repopulated the immune systems of the affected mice, and aided in repairing the damage to the brain and spinal cord. The Fasting Mimicking Diet resulted in a 20% reduction in autoimmunity in mice with multiple sclerosis.
A study that examines the effects of the Fasting Mimicking Diet on humans with Crohn’s Disease, an autoimmune disease the affects the digestive system, are currently underway.
Fasting to Reverse Aging:
Autophagy, the process of removed and recycling old and damaged cells, is a new area of research for reversing the effects of aging. Autophagy alleviates the body burden of senescent cells that have stopped dividing but are still robbing the body of essential nutrients and energy.
When cells become senescent, they release inflammatory mediators, which can damage neighbouring cells and cause inflammation and disease. Cellular senescence is thought to be one of the primary mechanisms by which we age. As we age, more cells become senescent, causing age-related inflammation. A study found that inflammation is the primary factor that drives the aging process, damaging DNA and contributing to various diseases, such as cardiovascular disease, diabetes, arthritis, cancer, and autoimmunity.
The process of fasting and re-feeding stimulates the production of new, healthy progenitor stem cells in the immune system. Mice and human volunteers who underwent cycles of the Fasting Mimicking Diet had decreased numbers of myeloid cells, the inflammatory immune cells that become more numerous as we age, and increased numbers of cytotoxic T cells, which protect the body against viruses and cancer.
Fasting promotes longevity through its inhibition of Insulin-like Growth Factor -1 (IGF-1), a growth factor that promotes cellular growth, and prevents the death of senescent cells. Growth factors are important for growing babies and children, developing fetuses, boosting muscle, and growing new brain cells. However, growth factors like IGF-1 are negatively associated with longevity because of their potential to stimulate the growth of cancer and prevent autophagy. Mice whose growth factor-dependent genes were removed, or “knocked out”, lived 40-50% longer and suffered from less diseases as they aged. IGF-1 is stimulated by protein and carbohydrate intake; it is elevated in the fed state and inhibited when fasting.
Healthy humans who underwent cycles of the Fasting Mimicking Diet had lower risk factors that were associated with cardiovascular disease and diabetes, such as lowered blood pressure, reduced CRP (a marker of inflammation in the blood), and reduced fasting blood glucose levels. These markers remained improved even after the subjects returned to a normal diet, which indicates that fasting may help reduce the risk of chronic diseases, such as diabetes and heart disease, promoting health longevity and increased lifespan.
Fasting for Energy and Resilience to Stress:
Hormesis is the process in which the body’s response to a stressor like the slightly toxic flavonoids in plants, intense exercise, or extreme temperatures, benefits the body as a whole. Hormesis is one of the reasons that exercise and green leafy vegetables are so good for us; they impose minor stressors on the body, boosting its healing properties, and improving resilience.
Fasting, in addition to other positive stressors, up-regulates a stress-response gene called FOX03. When FOX03 is activated, it produces proteins that reduce inflammation, increase anti-oxidant production, repair DNA, and increase cellular energy production through the creation of new mitochondria. Humans with a more active version of the FOX03 gene have an almost 300% chance of living to be over 100 years old.
Fasting also promotes a process called mitophagy. Similar to autophagy, mitophagy involves removing and recycling damaged mitochondria that are no longer able to effectively produce energy. Through activation of the FOX03 gene, more mitochondria are created to replace the old, improving energy production. The creation of new mitochondria only occurs in response to exercise, extreme temperatures, and periods of fasting.
Fasting for Weight Loss:
It doesn’t take a researcher to figure out an obvious truth about fasting: when you don’t eat, you lose weight. Dr. Jason Fung, MD, a Toronto-based nephrologist, prescribes fasting to his obese and diabetic patients. In his book, The Obesity Code, Dr. Fung discusses how the old paradigm of restricting calories for weight loss—eating 1500 calories a day while burning 2000, for example—is out-dated and ineffective for keeping weight off longterm. Dr. Fung argues that fat storage and breakdown are not the result of a simple calories in minus calories out equation, but the performance of a hormonal orchestra conducted by insulin. Insulin stores fat and glycogen, while inhibiting the release of fat breakdown. The body only begins to tap into its glycogen and fat stores when insulin drops during the post-absorptive and fasting phases after a meal. Once it depletes its glycogen stores, the body burns fat as its main source of fuel as long as insulin levels remain low.
According to Dr. Fung, fasting is superior to caloric restriction diets because it keeps insulin levels low for long enough to allow the body to deplete its glycogen stores and tap into fat. Fasting also releases surges of growth hormone, which prevents muscle loss, and norepinephrine, which boosts energy and feelings of well-being. Unlike caloric restriction diets, studies have shown that metabolism increases during and after fasting, preventing weight regain. Dr. Fung argues that fasting can spare muscle, boost metabolism, increase energy, and increase feelings of well-being, making it an effective tool for lasting weight loss.
Ways to Fast:
While the health benefits may be numerous, fasting isn’t easy. The first time I tried a prolonged fast, all I could think about was food. Food was everywhere and the people around me seemed to be eating all the time. My body, accustomed to being constantly fed, wasn’t too happy with the sudden metabolic switch I was demanding from it. Many of our metabolisms have been trained to run on dietary carbohydrate and glycogen as their primary fuel sources, making the first few hours to days of fasting a challenge. However, there are many ways to ease into the practice of fasting. You can obtain Dr. Valter Longo’s Fasting Mimicking Diet kit from a healthcare provider through ProLon, or practice small intermittent fasts, such as Time-Restricted Feeding.
Time-Restricted Feeding:
A researcher at the Salk Institute in Califoronia, Dr. Sachin Panda, PhD, found that restricting eating time had amazing health benefits in mice. Mice were fed an unhealthy diet of lard and sugar. The mice, as you might expect, had shorter lifespans and a variety of health problems: diabetes, obesity, and heart disease. However—and this part is miraculous—when Dr. Panda and his team restricted the time the mice were fed the exact same crappy diet to 12 hours (instead of allowing them to eat whenever they wanted), none of the negative health benefits occurred; the Time-Restricted Fed mice were 70% leaner, lived longer and were free from diabetes or heart disease.
Further investigation revealed that restricting feeding time to 8-12 hours a day, resulted in mice that had less body fat, improved muscle mass, decreased inflammation, increased cardiovascular function, increased mitochondrial function, higher levels of ketone body production, increased cellular repair processes and anti-oxidant production, and increased aerobic endurance. It was when the mice ate, not what they ate, that conferred these health benefits.
North Americans, on average, eat on a 15-hour clock. We seem to eat constantly, stopping only to sleep. To study the effect of Time-Restricted Feeding on humans, Dr. Panda had human participants restrict their food intake to 12 hours a day; if the volunteers had their first sip of coffee at 7 am, they were told to cease all food intake by 7pm. After the completion of the 16-week study, the volunteers lost 3-5% of their body fat without making a conscious change to their diets. The participants reported sleeping better and feeling more energized in the morning. They noted that their overall calorie consumption decreased by about 20% without effort.
Research into Time-Restricted Feeding indicates that allotting at least 12 hours a day to fasting boosts the body’s repair mechanisms, improves digestive function and motility, provides time for the body to switch to ketone body production (which tends to happen 10-12 hours after a meal), improves blood sugar control, regulates appetite, and enhances stress resilience. Taking a break from eating allows the body to invest its energy into repair, rather than digestion. The best part about Dr. Sachin Panda’s research is its simplicity; to obtain all of the benefits, simply avoid after-dinner snacks!
Intermittent Fasting:
Similar to Time-Restricted Feeding, Intermittent Fasting plays with the ratio of fasted to fed hours. Proponents of Intermittent Fasting refrain from eating from 12 to 23 hours within a 24-hour period. A common ratio of fasted to fed time is 16 to 8 hours: fasting for 16 hours a day and eating within an 8-hour window. For example, if breakfast is at 8am, then those following a 16:8 intermittent fast stop eating by 4pm in the afternoon.
Alternate Daily Fasting or the 5:2 Diet:
Studies with mice and human subjects found that alternating daily food intake, or following a 23:1 fast (having just one meal a day) every second day, was effective for weight loss. The protocol is beautifully simple: every second day either fast completely or indulge in only one meal. While people tend to eat more on their “fed” days, they don’t seem to make up the calories that are lost on the fasting days, resulting in an overall reduction in calories and weight loss.
Water Fasts:
It’s estimated that we need to fast for at least 36 hours to get the autophagy benefits, which makes water fasting a powerful therapeutic and anti-aging practice. Water fasting is simple: withstand extended periods, usually 3 to 5 days, but often longer, only consuming water.
The longest recorded water fast was 382 days, performed in 1973 by a 27-year old male who weighed 456 lbs. During the months he fasted, the 27-year old consumed only water and a multivitamin and, according to the study published on him, experienced “no ill-effects”. While water fasts can have amazing therapeutic benefits, it is advised that they be medically supervised.
Ketogenic Diets:
Ketogenic diets are high-fat diets that restrict carbohydrates and limit protein, and can mimic the low-insulin conditions of fasting. Because carbohydrates and protein are restricted, the body is forced to turn dietary fat into ketone bodies, which it can use for energy.
Ketone bodies, especially beta-hydroxybutyrate, produced from either dietary or body fat, have important therapeutic uses. They provide more energy for the brain than glucose, which can have benefits for memory, mood, concentration and cognitive performance. Ketogenic diets have been recommended for treatment-resistant epilepsy, and diseases associated with cognitive decline like Alzeimer’s and Parkinson’s. More recently ketogenic diets have been recommended for mental health conditions, such as depression and anxiety.
Ketone bodies also help cells resist oxidative stress, preventing cellular damage, which makes ketogenic diets of interest to cancer researchers because or their ability to starve cancer cells of protein and carbohydrates, while fuelling healthy cells.
Ketogenic diets can deliver many of the benefits of fasting because of the low-insulin, low growth factor conditions they induce. When a person becomes “keto-adapted”, able to burn ketone bodies efficiently for fuel, the transition to fasting is easy. For this reason, ketogenic diets and fasting often go hand-in-hand.
Cautions:
While fasting can deliver many health benefits, it can impose a temporary stress on the body for those who haven’t adapted to ketosis or prolonged periods without food. Therefore, it’s important to fast under the supervision of a medical professional, especially if deciding to embark on an extended fast.
Before deciding to fast, the individual’s energy levels and vitality, health status, hormone regulation (those who are taking insulin should practice extreme caution when fasting), age, health history, and health goals, should all be considered. A woman of fertility age will have different health goals than a 72-year old woman with type II diabetes. The former may want to preserve body fat and promote fertility and ovulation, while the latter may want to reduce her insulin and growth factor levels, and lose weight in order to promote health longevity.
Fasting may not be appropriate for everyone. For example, those who are underweight, pregnant, breastfeeding or suffering from an eating disorder should not fast. Fasting in women of reproductive age has the potential to produce hormonal imbalances such as hypothalamic amenorrhea (irregular or absent menstrual cycle). Fasting can exacerbate or cause dysregulation in stress hormones, particularly cortisol, known as “adrenal fatigue”, and potentially effect thyroid function, as a result of the body’s starvation response. Fasting while under the pressure of chronic mental and emotional stress is probably not a good idea. Working with a professional and listening to your body are key elements to doing fasting right.
However, when used correctly, it can be a simple, free, powerful therapeutic tool for healing the body, treating chronic disease, and promoting longevity.
A naturopathic doctor offers tips for navigating the often contradictory and confusing world of modern human nutrition.
As soon as we start to feel comfortable with our grasp of human nutrition—which foods are healthy, which ones are unhealthy, and how to eat a balanced diet for optimal health—a new study gets published that shatters our once-felt sense of confidence.
Confusingly contradictory health claims constantly appear in the news, like the American Heart Association’s vilification of coconut oil. The vegan diet-promoting documentary What the Health, currently trending on Netflix, turns convention on it head by assuaging our fears of refined sugar, instead blaming animal protein, eggs and dairy for the worldwide diabetes epidemic. Even I find myself doubting the 15 years I’ve spent studying and working in the field of human health every time paradoxical nutritional data is uncovered.
When I was in high school, I remember patting myself on the back for choosing fat-free options, hoping the leanness of my food would encourage leanness of my flesh. I gave up meat, understanding that I was making a healthier choice; I was told that meat, fat and cholesterol were all culprits of heart disease. I tried giving up eggs and dairy, trying on veganism in order to minimize my impact on the environment. I did an elimination diet while at naturopathic medical school, removing gluten. When my colleagues started reading about the Paleo Diet—grains were the enemy all along, while meat was good for us—I slowly began to embrace a “primal” diet. I started removing myself from the influence of decades’ worth of poorly conducted research and began welcoming saturated fat back into my life. Fat was fine; it was carbs that were the root of all disease. Atkins had gotten it right from the beginning. Eventually I cut out all carbs and sugar and tried a ketogenic diet, eating lots of fat, moderate amounts of meat, and some vegetables.
My journey brings me here, to my Facebook newsfeed, which has been infiltrated with articles condemning coconut oil and saturated fat for raising LDL cholesterol and contributing to cardiovascular disease. “But I thought it was healthy!” Friends, family and patients cry, tearing their hair out in confusion over the news. Some patients have watched Netflix’s What the Health, a documentary from the makers of Cowspiracy, which asserts that sugar’s link to type II diabetes may not bas as strong as previously thought.
The flip-flopping is frustrating for sure, especially for those of us who are committed to living healthy lives for as long as possible. But before we toss our tubs of coconut oil and liquid stevia drops in the garbage and start pulling out the white sugar and margarine again, we should consider how nutritional research is conducted. Let’s entertain different traditional, holistic viewpoints on food and nutrition in order to learn how to feed our bodies optimally.
The Problem with Nutritional Research
There are several problems with how we study nutrition. One of the challenges lies within science itself; scientific studies, by their very nature, attempt to isolate all of life’s complexity down to two variables in order to study them while nutrition, as it’s practised in the day to day lives of human beings, consists of an infinite number of important factors that are often not taken into account.
Most human diet studies are epidemiological. Researchers follow populations of people for years, tracking what they eat and noting how many diseases they get over time. They then synthesize the data to create story. For instance, how much fibre did the people who had heart disease eat? Did those who avoided gluten have a higher risk of diabetes?
In order to assess dietary intake, most epidemiological studies use Food Frequency Questionnaires, or FFQs. Study participants are asked how often they eat certain foods (such as chicken) per week. They are asked to check a box, from “none” to “more than 6 times a week”. As a clinician interested in how my patients’ nutrition may be affecting their health, I assess diet in a few different ways. In the initial appointment, I ask my patients to recall everything they’ve consumed in the past 24 hours to get a rough overview of how they typically eat. Then, between the first and second appointments, I have my patients track their foods in a diet diary over the course of one to two weeks. The accuracy with which my patients report their food intake from the day before depends on their memories, perceptions, and diligence in recording, among other things, and this can compare drastically with their diet diaries that are recorded in real time. Not only do the mundane memories of daily meals evade us, we are often found guilty of deceiving ourselves based on how we feel we should be eating, rather than how we actually are. I find it hard to believe that participants are filling out FFQs accurately.
Also, the stories that epidemiological studies create from the data establish correlation, not causation. With many correlations (like one of my favourites: ice cream consumption and drowning—both occur in summer) there is often no direct relationship. If assessing the connection between fat intake and diabetes, a good study will take into account all meaningful variables, such as how often the participants exercised, or whether they had existing cardiovascular disease. However, considering all the possible factors that might effect the relationship is virtually impossible. For instance, what was the status of the gut flora of the participants? What was their antioxidant or mineral status; were they magnesium deficient? Were they consuming meat that was pasture-raised or corn-fed? How high was their daily toxic exposure? Did they experience chronic stress? How well were they sleeping? What were their levels of inflammation like? And so on.
The trouble with studying nutrition and disease is that, when it comes to health, context matters; context may be all that matters. For instance, while we know that barbecued meat can produce carcinogens that potentially lead to cancer, a study found that when the meats were seasoned with rosemary the carcinogenic load of the meat was neutralized. It’s nearly impossible to form a complete picture when we insist on studying isolated factors, leaving out many important details.
Animal studies, while allowing for tighter control (we don’t ask mice to report their diets, we just feed them), are also flawed. Firstly, mice and humans are completely different species with different nutrient requirements. However, animal study designs can also be problematic. Animals are given lard and white sugar to assess the effects of a high fat, high sugar diet on their health—their diets are exaggerated for the purpose of the study. Human beings, however, eat burgers, cake, and ice cream. We don’t eat single nutrients like fat and sugar, we eat food. If a mouse gets sick on a diet of lard and table sugar is it because of the foods it was eating, something he wasn’t eating, or some other unforeseen factor? There may be a huge difference between eating a high-fat diet with no vitamins and minerals, and eating a high-fat diet that contains complete nutrition.
A third method for studying human nutrition is through randomized control trials, or RCTs. In RCTs humans are randomized into a group that receives an intervention, like a dietary plan, or a control group that is told to follow some other diet or just eat normally. These trials control as many variables as possible, but the timeframe for these studies is often too short to garner meaningful information about health outcomes, which may take years to manifest. It is also difficult to get participants to stick to meal plans. Further, it’s hard to establish consensus for each diet being studied. For example, when assessing the nutritional merits of the Paleo diet, how many servings of vegetables should participants be told to consume? How many grams of fat? What types of fat?
It’s important that we can use studies to seek answers to our questions about the relationship between nutrition and health. However, due to its many limitations, nutritional research can only take us so far. This is why one study may indicate that high sugar diets contribute to diabetes risk, while another study finds no relationship.
A New Food Guide
If we can’t trust research studies to tell us what to eat, who do we trust? Surely we can’t rely on Canada’s Food Guide, with it’s outdated recommendations that simultaneously overemphasize grains and dairy, while continuing to uphold archaic views on fat. Primarily created in the 40’s to help Canadian families ration their food during the war, the Food Guide was not necessarily created to promote the optimal health of those who follow it.
Dr. Ray Cronise, a former NASA scientist, outlines a food pyramid in his paper to help organize food into nutrient content. I often borrow his pyramid to depict nutritional balance to my patients.
Ray’s pyramid is composed of four circles, three that form the base of the pyramid, forming the three main groups of macronutrients: protein, fat, and carbohydrates, and foods that are composed primarily of each. The circle at the top represents the foods that contain a higher number of micronutrients: vitamins and minerals, which are mainly non-starchy vegetables like leafy greens.
Protein-rich foods include meat and animal products, including fish, eggs and dairy. Fat-rich foods include nuts, seeds and oils like coconut oil, avocado and olives. Carbohydrate-rich foods include starchy vegetables like potatoes, grains, legumes and fruit. Ray concedes, however, that none of these foods are composed of a single macronutrient; animal products often contain a significant amount of fat; nuts and seeds also contain protein and carbohydrates; and legumes and grains contain some protein as well.
Ray points out that most diets, particularly the Standard American Diet, is bottom-heavy. North Americans generally over-consume macronutrient-rich foods that are higher in fats, carbs, proteins, and calories in general, and under-consume micronutrient-rich foods like fruits and vegetables. Because of this, North Americans consistently fail to meet the levels of vitamins, minerals and antioxidants essential for optimal bodily function.
It seems that even “healthy” diets tend to focus on the bottom of the pyramid, restricting certain groups of foods while making up the balance by over-emphasizing others. Paleo and low-carb dieters often fixate on the right side of the pyramid, including animal products, nuts and seeds, but avoiding grains and legumes, while vegan and vegetarian diets concentrate on the left side of the pyramid, eschewing all animal products and getting protein from grains, legumes and nuts instead.
One thing all healthy diets seem to emphasize, however, is fruit and vegetable consumption. When studying the merits of a vegan or paleo diet, it is the non-starchy, micronutrient-rich vegetables that may confer most of the health benefits, regardless of the carb, fat and protein content. Therefore, Ray recommends focusing on the top of his food pyramid, eating as many vegetables as possible, while eating a balance of foods from the base.
Since we rarely eat pyramids, I often depict this balance for my patients using a plate. I divide the plate into four quarters. One half of the plate is dedicated to colourful vegetables, with at least a full quarter dedicated to greens. The other two quarters of the plate are divided into starches: grains, legumes, tuberous vegetables, and proteins: meat, dairy, eggs, fish, or legumes. Oils and fats can be used to cook with or added to the meal in the form of avocados, nuts and seeds.
Listening to the Body as Guide
So, while Ray’s advice to eat as many green and colourful vegetable as we can while eating a balance of the foods at the bottom of the pyramid is sound, how can we establish what the right balance is for us? Many of us will have vastly different requirements for the macronutrients: carbs, fat and protein. My body has an energy demand that is different from that of my 6′ friend who lifts weights daily, or my 90-year old hypertensive, mainly sedentary Italian grandmother. As a naturopathic doctor, who believes in an individualized approach to health, I tend to reject top-down dietary recommendations that ignore the variabilities among people.
A friend of mine, having damaged his health through a string of restrictive dieting, argues that all food—even refined sugar and saturated fat—has a place in a healthy diet. He believes our bodies are designed to crave fat, protein and carbohydrates in ratios that promote optimal health. He writes in his book that we can eat whatever we want as long as we eat intuitively and avoid foods laden with “fake” flavours and processed oils, like corn oil, that confuse our internal cues and hunger signals. He also argues, like the filmmakers in the Netflix documentary, What the Health, that there is no evidence that refined sugar causes diabetes, and that diets based on avoidance of certain foods are detrimental for health.
While I’m not convinced that refined sugar deserves to be completely cleared of all charges, I agree that mindful and intuitive eating may be the key to maintaining balance. Healing with Whole Foods by Paul Pitchford places awareness and physical activity at the base of its Integrative Food Pyramid. The idea is that we need to first establish the foundations of movement and mindfulness before we begin to talk about food intake. As my friend says, perhaps the key is tuning in to our own internal physiological and emotional cues through mindfulness, paying attention to hunger and cravings, rather than measuring calories, carbs, protein, or fat grams.
Following our internal cues may be difficult, as the book TheDorito Affect outlines. The author points out how certain foods are engineered to override our hunger and satiation signals and monopolize our cravings, leading us to overeat. Therefore, if we’re going to follow our body’s signalling, mindfulness is a requirement, but so is following the advice of Michael Pollen, author of The Omnivore’s Dilemma, who famously tells us to “Eat food. Not too much. Mostly Plants.”
Pollen urges us to stick to foods that resemble something we might encounter in nature: eat foods our grandmothers would recognize; purchase foods that come from a plant, not foods that are made in one; and to stick to whole foods or packaged foods with five listed ingredients or less. Pollen also encourages us to cook and prepare as much of our own foods as possible. Do you have a craving for potato chips, ice cream, or dark chocolate? Feel free to indulge, as long as you make it yourself using the raw, natural ingredients. The theory is that, when the body is given clean, whole food, it regulates its hunger and satiety signals to communicate to you exactly what it needs.
Heal the Individual
When it comes to whole foods, I believe that there are no “good” or “bad” foods, generally speaking. Observational studies that examine how traditional societies ate suggest to us that saturated fat, animal protein, dietary cholesterol, and carbohydrates all have a place in a balanced diet. However, when it comes to diet, especially therapeutic diets, it’s my job to consider the individual and their health context: there are no good or bad foods, but some foods are better or worse for certain people, and some may even be better or worse for certain people at certain points along their health journeys.
When I am helping my patients calm inflammation, heal their digestive systems, clear their skin, or manage autoimmune disease, I often recommend identifying food sensitivities and eliminating those foods from the diet. Oftentimes these foods need to removed only temporarily, but sometimes foods may need to be removed indefinitely. Patients with insulin resistance, such as in the cases of obesity, PCOS, diabetes or metabolic syndrome, often do well on a low-carbohydrate diet to restore insulin sensitivity. Again, these anti-inflammatory, reduced-carbohydrate diets may only be required until hormonal balance is restored. Older adults concerned with promoting longevity, or patients undergoing cancer treatment, may do better restricting protein to lower their levels of growth factors, while athletes and stressed out adults may require higher amounts of protein to promote muscle building, or to synthesize mood-regulating neuro-chemicals. A woman who is stressed, depressed, exhausted and iron deficient may feel much better increasing her dietary intake of red meat to help regulate her nervous system. Another woman, with a family history of colon cancer, may do better avoiding it.
Endless factors need to be taken into account when we consider which dietary style is right for us. Our health goals, health status, nutrient status, digestive system health, immune system health, liver functioning, insulin sensitivity and hormone balance, levels of stress, toxic load and inflammation are just some of the things that I consider when making lifestyle recommendations for my patients. Lifestyle preferences, tradition, culture, religious backgrounds, cooking abilities, time constraints, and other factors, will also all play a role in our food choices and eating habits.
Our emotional connection to food and our ethics also matter. While veganism is certainly not a diet I recommend, if consuming animal products is out of line with one’s morals, then following a vegan diet may be the healthiest way for them to live in accordance his or her beliefs. Similarly, someone with a history of disordered eating may need to lift all food limitations, even junk food, in order to heal his or her relationship with food and hunger.
Investigations into the eating patterns of traditional societies tell us that human beings thrive on a variety of different diets. Optimizing diet for the individual goes beyond following the latest research or government and industry-funded health recommendations. It involves eating a variety of natural, whole foods, learning to pay attention to the body’s hunger signals, and even working with a health professional who uses diet to help promote health and manage disease on an individual level.
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
