It’s time for a long overdue gut update. If you remember from my last post, I went to see a gastroenterologist about some IBS-D problems I’d been experiencing.
The gastro send me in for blood tests for: CBC, Amylase, C.Diff, metabolic panel, Creatinine, Giardia, H. Pylori (IgG), Hepatitis, Lipase, and Sedimentation Rate. No results found.
I spent 3 Fridays in the gastro’s office taking Hydrogen/Methane breath tests for lactose intolerance, fructose intolerance, and small intestinal bacterial overgrowth (SIBO). No results found.
I did learn some valuable lessons from this testing though.
Lesson 1: Fasting, Restricted Diet, and White Rice
I was only allowed to eat chicken, baked salmon, and white rice the day before the breath test. This is quite a challenge with my work schedule, so basically I practiced some long fasts with large meals on these days. Rice is also not a normal part of my diet. A pre-testing day might look like:
8:00 am: wake and continue overnight fast
7:00 pm: chicken thighs cooked in chicken broth
9:00 pm: baked salmon and white rice (reheated from frozen)
This protocol alone helped improve my IBS-D symptoms! Why? Perhaps the fast helped reset my GI system? Perhaps the rice added some needed RS to my diet.
Lesson 2: Mindfullness
The second lesson I learned was to hone in on the feeling of my own digestion. After I drank the test mixture for the breath test I started to notice some gurgling and burping. I was of course observing my response closely with a mixture of hope that there would be more of a response. Wouldn’t it be great to KNOW the source of the problem? Even though I didn’t find the source, spending 9 hours this summer noticing this response to food was productive. Coupled with meditation and mindfulness exercises, I am slowly learning to better understand the signals my body is sending me. Taking a few hours off work doesn’t hurt either.
Here are some studies that talk about the effects that meditation and other alternative mind-body interventions can have on IBS-D. CBT and hypnotherapy are both recommended!
- “The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study”
I never even turned in the stool test. After doing the full metametrix panel, I just didn’t feel like it was worth it. Also my symptoms began to improve.
Colonoscopy / Upper GI Endoscopy
I also never went in for the invasive scoping. After seeing my symptoms improve, I decided to hold off. The gastro made it pretty clear that if I was feeling well, then the test might not show anything anyways. I may still go in for these tests in early 2015. I am still weighing the risk/reward.
Based on this battery of testing, it seems like the main problems with my gut are:
- Yeast overgrowth (as indicated by Metametrix panel)
- Diet (too low in fiber)
I’ll write some more in my next post about my improving symptoms.
When I started down this path of traditional and evolutionary health, I didn’t have a GI problem. As my general practitioner told me when I casually discussed my symptoms last year: “if there’s no pain, then you don’t have a problem”. So when I write about my potato starch experimentation and stool test results, I generally think of these as optimization hacks rather than a serious medical problem.
About two hours into my first Weston A Price Foundation conference, I realized that I might actually have a chronic GI problem. Frequent cycling between constipation and diarrhea. “Shutting down a bathroom” at least a few times a month. A year and a half later, I finally gathered up the courage to see a stomach doctor. My new $0 deductible ACA healthcare insurance plan surely helped build that courage. The meeting went quite well. The gastroenterologist was a riot. Through a moderate Arabic accent he called me “baby” as if having watched Swingers one too many times. “What can I do for you, baby”. “Let’s do this thing, baby.” “DEATH TO TECHNOLOGY” he shouted as I was leaving, unable to figure out his newfangled computer system.
His line of questioning was very simple: What are your symptoms? How many BMs and what type? Alcohol use? Intravenous drug use?
Based on my answers, he thinks I may have some kind of “functional” communication problem between my gut and my brain. The testing he recommends seems primarily to rule out other acute root causes. He figures that I’m not going to die anytime soon from my symptoms but was supportive of my desire to alleviate them.
He thinks “there is a lot we don’t know” and likes some “alternative” ideas.
He wasn’t upset that I am on a gluten free diet, but acknowledged that this could skew some of the tests designed to screen for Celiac. He thinks the Genova testing is “very alternative” but does his own version of the same tests. He thinks the idea of yeast overgrowth is “very alternative” but has used anti-fungals in the past on a patient or two.
He wrote out some “alternative” ideas to tide me over until further testing could be done:
- Try Caffeine and Dairy elimination – One week at a time.
- Use a Probiotic – Ultimate Flora or VSL#3
- Ginger or Fennel tea . Cinnamon. Or Circumin? Hard to read his writing.
- Peppermint capsules.
When he said that his strategy is one of aggressive testing, I was very reassured. This is the approach I would love to take and the main reason that I went to see a stomach doctor in the first place. He’s looking for colitis, celiac, bacterial overgrowth, malabsorption, and inflammation.
He sent me away with many test orders:
- Blood tests for: CBC, Amylase, C.Diff, metabolic panel, Creatinine, Giardia, H. Pylori (IgG), Hepatitis, Lipase, and Sedimentation Rate
- Hydrogen/Methane breath tests for lactose intolerance, fructose intolerance, and small intestinal bacterial overgrowth (SIBO)
- Stool Culture
- Upper GI endoscopy
I haven’t decided yet if I even want to do the scoping. When I pressed him on whether or not the scoping was worth the risk, he said “You take risks every day – you drove here, right?” He is right about that. Not only did I drive, but I was uncharacteristically on my phone almost the entire time checking my email as I rushed between two appointments.
Overall the appointment went pretty well. Having paid quite a bit of money out of pocket to this point for a mix of western and alternative testing, I’m hopeful that insurance will assist with these tests. It will be useful to have a baseline now in case an acute problem is found now or in the future. I set up procedures and appointments a ways into the future as is mandated anyways by his incredibly busy calendar.
I received my results today from the Genova 2200 GI Effects Results panel and am sharing some of them here. You can check out a sample report from Genova here: http://www.gdx.net/core/sample-reports/GI-Effects-Compehensive-SR.pdf
This test was taken before starting any potato starch supplementation.
I have much research to do on my own still before even commenting on this. The main target for my functional medicine practitioner side seems to be the yeast issue. While the potato starch has helped, I do not think it has totally stopped the yeast issue.
One interesting side note, the functional med practitioner also identified signs of some periodontal distress.
Proposed action plan:
- Digestive Support (digestive enzymes), L-Glutamine
- Oral Health Items (floss, oil pulling, hydrogen peroxide rinsing)
- Elimination diet: 3 weeks of no sugar/no dairy/no nuts seeds to starve off the yeast. Basically GAPS intro.
- Follow elimination diet up with alternating anti-fungals and biofilm treatments
I had a minor setback in my Resistant Starch self-experiment. Some intense life stress resurfaced in the afternoon and my GI failed less than an hour later.
I also made two very minor food mistakes:
- forgot to refrigerate my lunch
- ate some “paleo snack” candied pecans w/dried fruit.
I blame the stress for the failure though.
I kept going with my normal maintenance diet including the potato starch/probiotic/yogurt drink. The next morning the GI problems were still there.
Time to go back to a basic gut-healing diet. Bone broth and meat. No veggies and no dairy until I feel better. I think I’ll try to keep up with the RS in water.
Metametrix results coming this afternoon.
In an earlier post, I describe a blood test I took in November through WellnessFX. With only a few changes, I have been able to improve some of these markers in just 4 months.
As a reminder, here was my action plan to improve some of the markers:
- 8 hours of sleep every night, measured with a Zeo Sleep Manager Pro
- Betaine HCL and Super Enzymes to better absorb foods
- Bio-Kult Probiotic for better digestion
- Liver Detox support
- Vitamin D supplementation
- Low carb whole foods diet based on combination of a few diets: GAPS Diet, The Paleo Solution Diet, Weston A Price / Nourishing Traditions, and the New Atkins / Low Carb Performance
- Exercise 4x/week using Mixed Martial Arts and Starting Strength weight lifting
I switched to a moderate carbohydrate diet based off The Perfect Health Diet in early 2013. Otherwise I have followed this plan quite well. I also lost about 5 lbs.
I had a follow-up test done at the end of March and saw some great results. The second test was not through WellnessFX, but I mocked-up my new scores alongside their original graphics.
During my WellnessFX consult in November, my practitioner tipped me on to the idea that the low cholesterol that I have had all my life could be the result of malnutrition. While my physician was not on board with this idea, I was concerned enough about my low HDL and low testosterone to make a change.
For those of you unfamiliar with the idea that cholesterol might not be such a bad thing, I’d recommend this article by Dr. Natasha Campbell-McBride: “Cholesterol: Friend or Foe?”. Dr. Mercola also has an article on this topic: “The Truth about High Cholesterol”.
I was already eating copious amounts of saturated animal fats. In order to improve digestion, I eliminated Gluten from my diet and adding Now Foods Betaine HCL and Now Foods Super Enzymes. With these two changes, I was able to raise my total cholesterol by 28%. My new HDL-C score also takes me out of a high risk area for cardiovascular disease. This increased total cholesterol should provide my body more building materials to create testosterone and other hormones.
Increased Vitamin D
Vitamin D supplementation seems to be one of the favorite topics of the Paleosphere and my WellnessFX practitioner felt I should be supplementing. I used these Green Pastures Cod Liver Oil and Life Extension Vitamin D3 supplements to increase mine 62%. I do also make an effort to get sun exposure each day. Unfortunately with the winter temperatures that sun only seems to hit my face, head, and hands. I may add brief weekly tanning into my wellness regime.
There is another possibility here which is that my low cholesterol was preventing my body from generating sufficient Vitamin D.
Regarding Vitamin D supplementation, Todd Becker makes an excellent point here about how this supplementation could be a bad thing in his post at gettingstronger.com: “Why I don’t take Vitamin D supplements”. I have to say that I was not amused by getting the stomach flu and a two-week cold over the past few months. I am also in favor of the most natural way of fixing a problem. In his other excellent post “An Alternative to Vitamin D supplements”, he suggests calorie restriction, intermittent fasting, brief strenuous exercise, and general hormetic stressors (such as cold showers) as alternatives to Vitamin D supplementation.
Elevated Liver Enzymes
The final piece of the puzzle during my WellnessFX consult was my Liver Enzyme levels. My practitioner felt my liver was working overtime to process toxins in my body and suggested Apex Energetics Clearvite-SF, a protein powder designed to help detoxify the liver. I will confess that this sounded like some new age voodoo magic to me – I am still not comfortable with the generic word “toxins.” In addition, each serving contains 15g of carbs which did not jive with my low-carb diet. What I did do was take a Thorne Research SAT capsule each morning. This product contains Silymarin (milk thisle), Circumin (tumeric), and Cynara (artichoke) – all of which are purported to help the liver.
As you can see from my updated test results, some of my Liver Enzyme tests improved and some worsened. My action now is to double my dose of the SAT and further reduce my alcohol intake .
I found a great resource “When and How to evaluate mildly elevated liver enzymes in apparently healthy patients” that also describes Liver enzymes in much more detail.
I would also add that my physician was not concerned about these scores. I’ve had some slightly out of range Liver enzymes scores like these since my first blood work over a decade ago (they blamed Ephedra back then!) yet I am still keen to try and improve them.
I recently read this post “Is HCG the Dirty Little Secret of Low Carbers” at a blog called “The Carb-Sane Asylum.” In the article the author first speculates that popular paleo blogger Jack Kruse is taking HCG. She then goes on to discredit another Gurus arguments in favor of Low Carb because that person had taken HCG. But this is the the kind of thing that wakes me up in the middle of the night and here I am at 3 AM wondering: are my favorite internet gurus juicing?
As far as I am concerned, any nutrition or fitness guru should be viewed with suspicion like a competitive athlete when it comes to expectations for the use of Performance Enhancing Drugs. These are people whose careers are based on their own performance and body image. Many have access to cutting edge medicine. This means that the advice we consume, especially the results of n=1 self-experimentation, needs to be taken with some suspicion.
Don’t get me wrong, I think they have the right to do whatever they want with their body. In the same way, they also have the right to keep that use private. And they also have the right to share their advice. I believe that their advice can co-exist with their right to privacy.
While I don’t think this is something they should have to disclose, two people stand out to me an examples who are even more credible because they admit to using hormone replacement therapy:
One of my favorite podcasts is the Joe Rogan Experience. Joe Rogan is a comedian, MMA commentator, and podcast host who is also very interested in health and fitness. One of his primary advertisers is a company called Onnit that sells nootroptics, supplements, and fitness equipment like kettlebells. Joe Rogan advertises this gear in every episode, but he’s also admitted to using Hormone Replacement Therapy. He’s 100% open about this which I completely respect. When I listen to thoughts about taking a $60 bottle of mushroom extract to get better performance in the gym though, I definitely take this into account.
Another person that I respect is the Bulletproof Executive Dave Asprey who mixes biohacking and quantified self techniques with anti-aging principles. Dave says he can lose weight and grow abs on a 4,000+ calorie ketogenic diet and I believe them – he posted photos to prove it. Dave is also very open, even in his most recent podcast, about taking advantage of testosterone replacement therapy and nootropics like Provigil. Based on his overall philosophy, I know and expect him to use a variety of other chemical and mechanical techniques to achieve this. That’s awesome, it’s what I expect from him.
Do you think it’s OK for people to give health advice if their taking performance enhancing drugs?
I spent some time graphing some of the numbers I track using moving averages. Here’s an example for my daily Fitbit steps.
The key data point here is the mark on 2/18 though and the real reason I bought the Fitbit – it’s a day I worked from home and failed do to any extra walking.
Here’s a chart of my Zeo Sleep Score (SQ) for 2013:
I find it interesting that my sleep seems to follow these trends alternating between better than average sleep and worse than average sleep.
Finally, weight for 2013: