First, some personal history to flesh this question out with some context:
26 year old male, around about 90kg (13-15% bf), ex-weight-lifter (currently recovering from tonnes of niggly injurys in back, knees, ankles, wrists and shoulders...yeah, I know...). I have eaten in a paleo style to varying degrees for around 2 years now, initially beginning my quest to improve well-being generally and improve body composition. I have tried quite a few slants at different points for different reasons, including whole30, primal (80/2), low-carb, high-carb, Robb Wolf-esque, Pefect Health Diet-esque. Throughout this time I have read much in the community and are at least partially aware of the many hypotheses, both evolutionary and biological, that are attached to this way of eating. In all my time with paleo, I have never found a solid answer to my question below.
Most recently, for New Years, I began a strict auto-immune protocol (no grains, no dairy, no legumes, no nightshades, no nuts, no eggs, no coffee/caffeine, no alcohol) in order to see if I could improve some psoriasis that has maintained its infliction throughout my paleolithic experiments. I had some concerns that my psoriasis was turning into psoriatic arthritis (read injurys above) and thought that if one could be manipulated through dietary means, likely so could the other. I read some (tentative) hypotheses (on 'paleomum') that immune system dysfunction could take up to 3 years to fully heal, particularly in the brain, where immune dysfunction can contribute to psychiatric disorders. Since I have also suffered with anxiety and depression (rapid cycling periods of both, to various levels of intensity, generally baselining between non-existent to mild/moderate symptoms) since my middle teens, experienced a bout of stress-induced psychosis after a particularly intense meditation retreat, and are aware of the possible connections between gut and brain dysfunction....I thought what the heck. My cyclical optimism got excited that this really may be the answer.
In short, I was strict for 3 weeks. During that time my psoriasis healed by around 70%, with healing occurring rapidly. There was no change in joint/tendon difficulties, although I remember my back feeling 'cooler' at times (self-suggestion? not sure). Psychiatric difficulties worsened if anything, primarily mediated by the severe lack of fun and pleasure that such a regeime brings, not to mention the larger percentage of the little free-time I do have going over to cooking and preparing food. By the end of the three weeks I was beginning to doubt whether it was worth the trouble (particularly as I might not see psychiatric improvement for a long time), and are well aware of concurrent negative side-effects to such restriction (increased anxiety about food, frustration, endless hypothesising....).
I am also trying to get out of debt and the auto-immune protocol was setting me and my partner back around ??550 per month ($865 USD). This is as cheap as we could make it, strangely cheaper than our normal habits (less alcohol etc). In short, I got fed up with the taxation on my free time, my wallet and a significant amount of food/health anxiety and frustration. I had a blood test one week after starting the diet - no inflammatory markers were raised (I would exepct CRP to drop quickly after removing dietary aggravation, but ESR was also in the normal range). Doc said my injuries were likely bio-mechanical and my psoriasis was changed by modulation of the immune system.
There is a sure-fire why to save money on food - eat carbs. If possible, eat grains. I have been eating moderate quantities of oats and white rice the past week or so. The first time I ate rice, I ate a large quantity and had a tight chest for around 6 hours. I had loose stools the first morning, although these have returned to normal, leaving mild gut pain at various parts of the day and my gut feels more dystended and bloated than usual, particularly in the mornings. In days past, I would have acknowledged the normal paleo wisdom on such matters and 'listened to my body. But, my question now is:
If I continue to eat rice/oats, will this 'intolerance' adjust back to pre-paleo levels (i.e. no apparent difficulties/symptoms with ANY food - excepting the presence of psoriasis and something happening there).
Since going paleo, I have become apparently more and more sensitive to more and more foods. Is this just a psycho-somatic suggestion? Is there a period of adjustment when re-introducing almost any food?
Because if there is, 'listening to our bodies' may not always be in out best interest.
Apologies for such a long post. My thanks in advance to anyone who answers - any suggestions are welcome. I welcome scientific references if they exist!
EDIT (12/02/2013) - Update: After 1.5 weeks of re-introducing oats and white rice (Guinness, beers and potatoes at the weekend), my psoriasis changed after the 3 consecutive days of around about 1 potato per day. This is the only time I can be confident of some kind of psoriatic reaction since finishing the autoimmune protocol, despite exposure to gluten (beer). Whilst my re-introduction has been messier than ideal (more than one food at a time etc), it seems that nightshades cause the most consistent effect. This also correlates with a previous attempt at eliminating nightshades, which also caused psoriasis improvement. It is worth noting I am still getting mild gastrointestinal pain and bloating. I seem to experience chest 'tightness', behind the sternum area, at some point during each day.
New Question: Can nightshades aggravate psoriasis if there are no gut permeability issues? (If they cannot, I must assume that either the gluten or alcohol exposure created a situation of leaky gut, and that my entire 2 years on various levels of paleo have no resolved a leaky-gut situation!)
Bounty offered due to complexity and length of question! :)
asked byZenFire (281)
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on February 12, 2013
at 01:57 PM
Answer to question #2:
Can nightshades aggravate psoriasis if there are no gut permeability issues?
First let me say I accept that some people are not going to like this answer.
The autoimmune protocol has shown some benefit to some people. It has not been definitively linked to reducing issues we believe are caused by leaky gut. But it is not the answer for everyone. The science is very shaky and based entirely on anecdotal evidence and a few small N studies. It is good science, but honestly, from a applicability in people standpoint, it is in its infancy.
So to get at the root of your question, we first need to make the assumption that gut permeability issues are real. Ok, check. And then assume that you do not have gut permeability issues. check.
Ok, given those two assumptions, is it still possible to get psoriasis?
First, we do not have a true "cause" of psoriasis. What we do know are things that increase the occurrence of psoriasis.
What could increase the occurrence of nightshade-induced-psoriasis? Allergies
Unfortunately, currently there is not a definitive link between the two: http://www.mayoclinic.org/medical-edge-newspaper-2011/may-27b.html. However, there is anecdotal evidence that the link exists and if you have a food-based allergy that could cause psoriasis without a leaky gut.
Other, non-nightshade-induced causes of psoriasis:
- Dry Weather
- Hormonal imbalances
These could also be contributory to your proiasis.
So what next.
I understand how difficult this is, and how hard you are looking for a solution. I do not believe there will be any one 100% solution. Also I do not believe that a quick fix exists. You mentioned that you saw a 70% improvement in three weeks. That is an amazingly fast turn around. To have then stopped and moved into a different direction, or assumed that you see a change within 3 days... I don't think you are giving yourself enough time. The body wants to maintain homeostasis. And will likely push back against any change.
Personally, I would go back to what worked and rather than give it 3 weeks I'd try to give it three months. I know the cost was an issue for you, and that is a very personal decision. Good luck
on February 05, 2013
at 10:18 AM
First of all thanks for posting this, it is a rare good question here on PaleoHacks. Hopefully people will vote it up for future reference.
From what I understand about food sensitivities, there appears to be some mechanism by which the healthier the gut, the more sensitive it becomes to the normal offenders. If anything it means that you are reacting how you should, or perhaps more acutely.
Personally I think 'listening to our bodies' is about as useful as 'everything in moderation'. I would rather aim for perfection and reap the benefits of almost getting there.
On your comment of 'psycho-somatic suggestion', honestly I think there is something to this which I think can be seen in the carb-phobia that manifests itself in all manner of symptoms not actually produced by the carbohydrate itself. I.e. Someone franticly worries about their last 'binge' only to find out later that 500g of starchy vegetable is still less than 150g of carbohydrate. Funny how a lot of previous healthy low-fat individuals used to say eating fat made them sick and now they are bathing in the ecstasy of butter.
Anyway I think more focus specifically on restoring healthy gut flora (http://bit.ly/WNMbk9), would be the way forward and if you are still unsure about white rice (http://bit.ly/WjdG8B).
I think there is little reason to use wheat when there are equally cheap and less toxic 'staples' such as white rice. Sorry I haven't really answered your question, if I find any better information I will update this.
on February 05, 2013
at 12:57 PM
In my mind, food intolerances all come to leaky gut and gut health. They are a symptom rather than a cause of health issues. There's a reason that most people can consume wheat and other grains without issue (this does fly in the face of paleo wisdom). Grains are, in and of themselves, not harmful. Goes for just about all foodstuffs.
Now, whether you'll adjust back to grain consumption and what effect that will have on you. That depends on the state of your gut. But after 2 years, if your gut was going to be healed, it should be healed. There are many people who have irreversibly damaged their gut, and simply cannot fix the damage enough to tolerate some foods. Speaking from personal experience, I never had overt intolerances. I only ever experienced minor malaise adding grains back after being paleo for some time, and eventually even that stopped. I take that as meaning I had a slightly leaky gut, with reversible damage/inflammatiaon, which over time was healed and proper gut/immune function was restored.
Of course, I could be misinterpreting what my body is telling me. Listening to your body is not an exact science. My whole theory could be junk.
on February 05, 2013
at 07:36 PM
ZenFire, 70% psoriasis clearance in three weeks is quite extraordinary. You've hit upon something important. It would be unfortunate to back track after this success, albeit financial constraints is very understandable.
Like you, I have psoriasis and I have used diet as a means to tackle it. Just by going gluten free and dairy free cleared up my symptoms tremendously within a few months. But I also suffered from IBS, and so it was pretty obviously my gut was a mess ... and a contributor to psoriasis flares. Going grain/starch free really did a great job in healing my gut, and my psoriasis improved further ... at glacial speed. Going low carb, getting H. pylori eradicated, and taking the supplements recommended in Perfect Health Diet has helped further (..my IBS is just about gone). Like you, I want to reintroduce forbidden food at some point. Rice and/or potato is my first choice. But I want to wait at least a full year of being on Paleo before pushing the envelope, and I have a couple of months to go.
Finally, the effectiveness of a Paleo diet on an autoimmune disease is highly variable. I think in > 50% of the cases Paleo can help significantly. But there will be a large number of folks who will remain frustrated.
Best of luck to you.
on February 05, 2013
at 01:18 PM
One thing you may want to research is whether taking some enzyme supplements could help jump start your body during re-introduction. My understanding is that enzymes are not particularly long lived (I've seen estimates in the 6 month - 2 year range -- probably based on the enzyme, and your gut health). If you stop eating a certain food type (like wheat) your body's supply of enzymes will eventually die out, and the body will see no reason to work to repopulate them (which makes sense from an evolutionary stand point). In addition you are not receive any enzymes from the food (since you are not eating that food type).
For re-introduction of wheat you might benefit from: Beta-glucanase; Peptidase; Malt diastase; Glucoamylase; Cellulase; Amylase; and/or Alpha-galactosidase.
Hope that helps.
on February 21, 2013
at 07:03 PM
It would seem, the re-formulated question, boils down to this:
"If reintroduction of foods previously eliminated foods can cause symptoms that were not historically experienced, and fade with consistent reintroduction of said foods, without obvious pathology, how does one distinguish between problematic and 'normal' symptoms?"
Of course, we can answer this by saying that symptoms must be associated with some other measure of pathology (blood work, diagnosis of syndromes etc), but this is somewhat a mute point considering the vast majority of people trying paleolithic approaches to nutrition are doing so from a non-clinical and subjective observational perspective. Not to mention that any concerning syndromal presentation is likely to persist with time, not disappear in two weeks! If it were to do so, it is by definition a non-issue.
I believe the jury is still very much out on this. It is very tempting and comforting to smother these concerns by lip-servicing the most common brands of paleo ideology, but that is simply not rigorous enough for real world application.
So, paleohacks, what do we think?
on February 20, 2013
at 03:58 PM
Great question, I've actually been wondering the same thing. I'm currently on the autoimmune protocol and am now attempting to reintroduce a number of foods (eggs/nightshades/nuts/dairy) that I eliminated well over 2 months now. I've only strayed once or twice during that period, on minor things like black pepper and other seed-based spices. Curiously enough I had an immediate reaction to everything I've tried to reintroduce so far. No reaction has been really severe but all of them have been sufficient to make me concerned about eating that particular food (I'm talking tense pain in the neck, headaches, stuffed nose, gas, joint pains, etc.).
Now, I've never been diagnosed with an autoimmune disease but have suffered from IBS-like symptoms, depression and generally feeling like crap for years. This improved significantly after cutting out gluten, dairy and all processed foods (including all sugar) about 3 years ago, but I had some remaining issues that motivated me to try Paleo. The change in my health has been significant, so I'm not doubting I did something right, but I find it very hard to believe that I am sensitive to ALL the things that I cut out of my diet. A bit of anecdotal evidence seems to confirm my skepticism:
1) I had a friend joining me on the elimination diet for a very brief period (even though she had no overt health issues) and on reintroducing wheat etc. she had symptoms akin to mine for about a week. She did not revert to the elimination diet and kept on eating SAD and her symptoms disappeared completely after about a week.
2) I've read a lot of reports from raw food dieters (who have no particular autoimmune diseases) who get similar flu-like symptoms when accidentally eating cooked food.
All of this makes me wonder: To what extent is the reaction that we are getting from reintroducing food actually just a 'normal' readjustment to a food that has been avoided for a long time? There's hardly any information on this that I've seen, but if any such readjustment reaction exists then it seems hardly unreasonable to expect it to be particularly outspoken when cutting out an entire food class (like, all seeds).
I guess this is not an answer to your question, more a reiteration of it, but it seems this is a question that needs to be seriously considered. I'ld love to know how your reactions to the oats/rice are at the moment? Have they abated?