User stephen - PaleoHacks.com

Answer by Stephen for Mysterious Anemia - not Iron, B12 or Folate defficiency

2013-03-16T00:11:25Z

I realize this post is really old, and you haven't been on in over a year, but maybe someone else will have a similar problem and stumble upon this question, so I'll try anyway.

You have a strange, mild anemia that is unexplained by iron, folate or B12 deficiency.

But your parathormone (PTH) is elevated. Have you had your vitamin D status checked? Elevated PTH hints at low vitamin D levels, which are associated with stubborn anemia. You might have kidney problems: if your kidneys aren't producing EPO for any reason, then you'll end up anemic even if your diet is nutritionally adequate.

So:

check your vitamin D levels,
have your kidneys checked,
have your EPO levels checked,
eat more! Some of your symptoms are characteristic of starvation (Right after writing this, I read the bit where you mention anorexia. There's probably most of your answer. Kidney failure is a late-stage sequela of anorexia.)

Finally, the ferritin level can be very misleading. It's an acute phase reactant, so it elevates in response to inflammation, even in iron-deficient patients. You need to look for other possible causes of the elevated ferritin. What's the TIBC or transferrin saturation?

Answer by Stephen for When/should I introduce gluten to my baby?

2013-01-17T23:18:10Z

I wouldn't wring my hands for being "1-2 mo. too late". That's not how nature works. Every individual is different, and genetic and environmental factors play a role in food tolerance.

My advice to you:

Stop worrying about this.
Don't go out of your way to force exposure. Just keep feeding your child a variety of complete foods (fruits, vegetables, fish, meats, nuts).
Let your kid play in the dirt!
When the opportunity for exposure presents itself, don't fret about it, just relax and let it happen. The odds are excellent your child will tolerate the new food just fine. Despite what the paleo hardcore may insist: humans are incredibly adaptable to different foods. That's part of what has made the species so successful. Difficulty with food is more the exception than the rule.

When you keep only whole, real food in the house and celebrate it, you are laying the groundwork for a lifetime of good habits and good eating for your child. Letting food turn into a neurosis does rather the opposite.

Where is the evidence -- real evidence -- that vitamin K2 is so important?

2012-11-22T08:58:58Z

Thanks largely to the Weston Price Foundation and all its adherents, we never stop hearing about vitamin K2.

My efforts to find the actual evidence to support a benefit of K2 over, say, other variants of the vitamin (such as K1) turn up very little, however.

I am happy to be enlightened, though. Can anybody show me solid evidence from RCTs, epidemiology or anything clinically validated that K2 is worth specifically seeking out?

Answer by Stephen for Where is the evidence -- real evidence -- that vitamin K2 is so important?

2012-11-23T13:45:08Z

Clearly, I touched a nerve here. If anybody felt personally attacked by my question, I apologise.

I said I hadn't found anything valid, and was prepared to be corrected. What I got, though, was stuff I'd seen before, and I'm sorry, but I am not convinced. Note that I am not saying that vitamin K isn't important, I'm questioning the assertion that K2 has some special magic that K1 doesn't. There have been very few comparisons of the two; the doses of K2 used in the few trials that have been done are enormous, far beyond what even the best nourished person could expect to get from diet, and to my knowledge, nobody has tried doses of K1 that large.

I'm comparing it to the standard of evidence for other nutrients, like vitamin D -- there's much better, more expansive evidence there, probably because it has been studied more. But even in the realm of vitamin D, people make outrageous claims that simply aren't supported by that evidence, such as arguing that the optimal serum 25(OH)D level is between 50-80 ng/mL. I tried for a long time to find the basis for those assertions, and turned up nothing. It is speculation, nothing more, and it might even be dangerous advice. We don't know.

Let's be honest, though -- who's pounding the K2 drum loudest? The Weston Price Foundation, whose official position on raw milk is hardly uncontroversial. The reason I asked the question is that the people who write for WAP are not actually doing any research of their own. They're analysts and essayists. They read papers, and write opinions and speculation based on what they read.

That is, for sure, an important part of science, since you can't study anything without a hypothesis, but it is not, on its own, science. People read these articles, say, "hmn, sounds right!" and make choices based on that, including spending big bucks on supplements. Does that sound like a good idea?

Price's book is often cited and gets many people on to real food, but it suffers from exactly the same methodological weaknesses. It reads like an ethnography and makes connections which are plausible but fails on the rigorous testing. I want to believe this stuff, but if I am expected to, I have to be able to verify the claims myself. With the material provided by WAP, that is not possible. I have to take Price's word for it.

In any event, I question any importance ascribed to a nutrient that would require the continued consumption of dairy products into adulthood. That doesn't wash - 70% of humanity is lactose intolerant. Are they all K2 deficient? Or is adequate K1 enough? What's the answer? We don't know one way or the other, because the evidence isn't there - yet.

Last point: people often confuse basic research -- like this -- with clinical or epidemiological studies. Basic research can tell us how substances and cells behave in certain, specific circumstances, but it is absolutely useless when trying to predict how diet will impact health. If you've ever tried to model a biological system, even a simple one, you know that this is so incredibly difficult that one wonders why anybody would bother trying. This is why intervention trials, preferably blinded and with large sample sizes, are so important. Population studies that use clinical markers are next. Studies that rely on food frequency questionnaires (like the Rotterdam study) are notoriously unreliable. How many people can remember what they ate last week, let alone last year? At the risk of whipping a dead horse... correlation is not causation.

I had hoped that somebody knew of something that I may have missed. The nice thing about science, though, is that our understanding changes all the time. Right now, as I said -- I'm not convinced. I'll change my opinion tomorrow, though, if somebody shows me enough evidence of the kind I've already described.

Answer by Stephen for BMI sucks, how do I find out what an appropriate weight for me is?

2012-11-22T08:39:02Z

For 99% of the population, the BMI is a perfectly acceptable indicator, especially if you have ever been obviously overweight.

I'm concerned that the rising incidence of obesity is causing a change in the "cultural set point". People go through real contortions to discredit the BMI. Wishing for something doesn't make it true, however.

Yes, BMI doesn't reflect muscle mass well, and yes, it can also miss visceral fat in skinny people, but these are edge cases, and the muscle mass argument is only really relevant at BMIs that are close to the upper threshold. If your BMI is 30 -- unless you're a competitive bodybuilder in the top weight class -- then you have a problem and you should, if you can, bring that number down.

A final point:

You should know that, although things didn't start out that way, the BMI thresholds are based on population statistics. Simply put: your disease and mortality risk increase measurably at BMIs beyond 25. Everybody likes to think, "yes, but I am so different, I am the statistical outlier!"... but is that something you want to gamble on? The truth is different. Very, very few people are that special.

Congratulations on losing the 30 lbs you've already dropped. Keep it up! It is doable!

Answer by Stephen for Conventional chicken eggs and dark circles

2012-11-22T08:19:24Z

Is it possible that you are mildly allergic to eggs? Some people get "allergic shiners". Although that is often in conjunction with hay fever, hay fever itself can be triggered by foods.

I had to stop eating eggs; a repeated set of A-B-A-B tests showed that I always feel worse when I eat them (I get mentally foggy).

I have also been suffering from iron deficiency, and in the worst phases I had pretty severe dark circles under the eyes. I think eating eggs impairs my iron absorption, which might explain the confusion.

Answer by Stephen for Strange Vitamin D Reaction

2012-11-03T09:20:08Z

There is some evidence that 25(OH)D, the storage metabolite of vitamin D that is used to assess vitamin D status, also binds the vitamin D receptor weakly. The trouble is that this effect has so far only been demonstrated when the 25(OH)D3 levels are sky-high, which seems unlikely in your case.

The trouble with supplementation is that the dose-response curve is so steep; it's not really natural in this respect. When you get your D from sun exposure, the curve is much flatter and the effects are longer-lasting.

It's conceivable that a large dose of cholecalciferol (D3) can have pharmacological effects, enough to cause a reaction like this. From my post you'll have read that things worsened as I increased the dosage to 2000 IU (though I was already having symptoms at 1000 IU, which is really insane and makes no sense to me whatsoever).

Please get your 25(OH)D (calcidiol) level checked. I would be keen to compare notes.

EDIT: I looked through my lab results from last year, when I was taking 750 - 900 mg/d, and to my great surprise, the serum magnesium was only 0.73 mmol/L, which is just barely above the low end of the reference range. Around this time my vitamin D level was about 60 ng/mL. So, even if I was taking it, either something was preventing me from absorbing it, or there was some other metabolic disturbance. At the time, I felt awful. The calcium level was not even particularly high (it was lower than it has been on other occasions).

The one difference between then and now is that I was still very iron-deficient then, although it hadn't yet been diagnosed. Now, the deficiency is being treated and I'm on a daily iron replacement.

I started taking a much larger dose of magnesium on the weekend (450 mg/d), and though it's early, I feel markedly better; though I'm not supplementing D at the moment, I've just had a couple of full-body UV treatments; I've had the reaction, but it's been much milder. The magnesium could be helping, or it could be that the vitamin D production is not all that strong from artificial sunlight.

My head is cooler and my concentration and sleep have improved noticeably.

This site (sorry, in German) says that, in a person with symptoms, the target serum Mg should be 0.9 mmol/L, and I've never had it come back that high, even when supplementing, so either my kidneys work extremely well, or I'm not absorbing it in the first place.

I'm going to keep this up and see if the improvements hold, then give supplementation of D another whirl. It does seem very strange that an amount you'd get from a short time in the summer sun would cause so much grief, so I'd sooner believe that this is unmasking a deficiency of some other nutrient.

Why am I unable to tolerate supplemental vitamin D?

2012-11-03T00:35:08Z

I do not seem to be able to tolerate any amount of additional vitamin D anymore. It being October, I could sense that I was losing my verve, and decided to start taking it again -- I had last taken it in March. I have kept a meticulous symptom diary in the past, and I'd connected my vitamin D supplementation with a range of very scary symptoms, including

frequent urination
confusion, especially in the mornings
impaired memory and trouble with word-finding - this is the scariest one
dry "crunchy" skin, especially in the face
dry eyes
pain in the lumbar region
muscle stiffness in the neck and shoulders

The symptoms do have a lot in common with hypercalcemia, but every single time I've been tested while symptomatic, my serum calcium has been well within normal limits. I've had electrolytes done out the wazoo, and they've always been normal (oh, I did have one serum potassium which was borderline low).

Due to my past experience I decided to take things very slowly this time, and started with a modest 1000 IU/d, for seven days, before bumping it up to 2000 IU/d. After four days at 2000 IU/d, the above symptoms were returning, and I had to stop again. That was on October 20th. On October 26th I sent a blood spot test off to the NHS lab at Sandwell and West Birmingham hospitals because I didn't want to pester my doctor. Given how I was feeling, I thought for sure the level would come back somewhere well above 100 nmol/L (40 ng/mL).

I got the results today. Imagine my horror: it was 48.7 nmol/L (under 20 ng/mL)! In all the tests I've done - it must be half a dozen in the last three years now - it's never been that low.

I have to admit to being totally stumped. These symptoms I get when I supplement are real, and the mental effects are severe enough to make me really afraid to try this again. It took roughly as many days for my mental function to normalize as days I took the vitamin D (10). I need my mind to work!

I am fairly sure it is the vitamin D, because I have had similar symptoms after sun exposure.

At the same time, it's not like I am now symptom-free, either -- my joints are noisy as hell, for one thing -- and that level is low enough to concern me for all kinds of other good reasons.

I've considered the following possibilities:

I've got sarcoidosis that hasn't been detected. That seems mad, since I have no other symptoms of sarcoidosis, and you'd expect my labs to be totally out of whack.
I've got some other endocrine disturbance that hasn't been detected, but I've been to two endos in the last 18 months and the labs were all normal (apart from one vitamin D level which came back flagged -- at 66 ng/mL. Desirable, right? That's what everyone says. Well, I felt atrocious at the time, and my mental function was horrible, much worse than it is now.)
I've got an allergy to the supplement. It's D Drops, which is just MCT oil and cholecalciferol, and is supposed to be among the best tolerated. It certainly gets my levels up faster than anything else I've tried.
I'm not getting enough magnesium -- this is the argument Cannell makes when people complain of weird symptoms like this -- but I've tried magnesium supplements, and after a few days, I have other muscle problems -- stiffness, increased muscle tone, etc. I've been battling an iron deficiency, and magnesium can interfere with iron absorption, so it's possible those effects are due to that. But they haven't done much for these vitamin D effects.
The test result is inaccurate. Really, though? This is an accredited NHS lab that has been doing research in this area for decades. I've had levels as low as 52 nmol/L before.
These symptoms are the result of an adaptation to a low vitamin D store, and will go away with continued supplementation and getting the levels above 40 ng/mL. I would really like to believe this, but I've had my levels that high as recently as April, and felt worse then than I do now. It's possible that the symptoms are the result of a combination of other factors -- the iron deficiency was much worse in April -- but you can understand why I'd be nervous.
I'm just an unusual case, and my levels don't need to be above 30 ng/mL. Honestly, though... I don't think I'm that special.

It would be reasonable to think this is a sign of some other more serious problem, but I've been turned upside down by physicians and the only detectable problem has been iron deficiency with occasional anemia, and that's being treated (things have improved massively since then, I should add).

So, Paleohackers, enlighten me. Have you experienced reactions like this? Should I try again, and just persevere? Should I try larger weekly doses? A sunbed? Is there something else I should take with the D that would help? Is there something else I should have tested? (PTH has always been normal, by the way)

Answer by Stephen for Another vitamin D thread. Low vit D despite getting sun exposure

2012-11-03T18:56:11Z

Ah yes. The "Marshall Protocol". It's not based on any real science. You can safely ignore it. In fact, following it is likely dangerous.

Have you actually been diagnosed with an autoimmune disease, or is this just a hunch you have?

At what latitude do you live? 20-25 minutes of midday sun is not likely to be sufficient at latitudes north of 38° at this time of year.

How much cod liver oil do you take, and what's the concentration of vitamin D and A on the label?

How much fat are you getting in your diet?

Are you drinking milk? (Where do you live?)

All other things being equal: You need to correct this. You are in rickets/osteomalacia territory. 9 ng/mL is deficient by any standard, even the most conservative. I'd supplement, unless you want to hit a tanning bed twice a week. If you get your vitamin D level up above 30 ng/mL you might even find that your acne clears up. The cod liver oil is not normally enough to correct deficiencies as pronounced as yours.

Get a liquid supplement if you can, preferably with as few additional ingredients as possible. Start with 1000 IU a day, to see how you tolerate it, and inch it up to 3000 IU, then retest in two or three months.

Answer by Stephen for I have a leaky gut

2012-11-03T16:51:18Z

The weakness and difficulty concentrating sound like classic iron deficiency. Have you had that checked? You don't need a specialist for that.

How do you know for sure that you have fatty liver? What do your liver function tests look like? If you are not or have never been overweight, a fatty liver is exceedingly unlikely.

Answer by Stephen for Magnesium for constipation?

2012-11-03T16:43:34Z

Your constipation is chronic -- that hints at a nervous system issue. What did your doctor give you? (I'm guessing it was domperidone -- also known as Motilium, Motinorm Costi, Nomit, there are probably other names in Peru). I hope it wasn't metoclopramide, because that would definitely make you anxious!

Magnesium oxide is perfectly ok if you can't find anything else. You can also try getting some pharmaceutical grade magnesium sulphate (Mg2 SO4, or Epsom salt, or "sal inglesa") and mix a solution to drink. It's rather bitter, but better absorbed than magnesium oxide, not at all chalky, and perfectly safe to take orally.

This may sound crazy at first, but have you had your iron levels checked?

Answer by Stephen for Inflated ferritin levels

2012-11-03T14:22:06Z

A ferritin level of 28 µg/L is low whether you have an infection or not -- but to partly answer your question, yes, ferritin levels do rise in response to infections.

How much is hard to say, because nobody has ever done the work of validating ferritin levels against bone marrow iron stains or liver biopsy (which are better tests of iron status) in a test population.

A ferritin of 28 means the probably you are short of iron is extremely high, and that's whether you have an infection or not.

What was your transferrin saturation and your total iron binding capacity?

Answer by Stephen for Ferritin levels help...

2012-11-03T09:02:21Z

How much beef are you feeding him? Whatever you're feeding him, feed him more, it's one of the best sources of iron, and that iron is highly bioavailable (substantially more bioavailable than the iron in the supplement you give him). Liver is also good. If he dislikes the taste you can mix it into a stew, as others have suggested.

What kind of iron supplement is he getting? Iron sulfate, gluconate, glycine-sulfate, fumarate? When you say "28 mg", is that the elemental (ionic) iron, or the amount of the compound? (Explanation: Sometimes the supplement will list the amount of compounded iron, such as "325 mg ferrous gluconate", but the elemental iron will be 35 mg, for example.)

When do you give him the supplement? It should be

on an empty stomach, and
at least an hour before the next meal.

Mornings are best; I can see how that could be difficult with a school age child, but you have to be absolutely fastidious if this is going to work; lots of foods bind iron.

Do you give it to him with vitamin C and lots of water? That increases absorption also.

Here's a biggie: is he still drinking milk or eating dairy products? If he is, that would be the first thing I would fix. Milk is terrible if you have iron deficiency. It is both poor in iron (despite what the dairy industry would have you believe) and it binds iron from other sources in the gut so that it can't be absorbed. Are you doing breakfast cereals with milk? Dump them! Lose the cheese, too!

And don't be frightened off iron supplementation by some of the people here. Iron deficiency is the world's most common nutritional deficiency and at your son's age, it must be treated aggressively, because failing to fix it can have life-long consequences. He is not at risk of iron overload, and being chronically iron-deficient can reduce his life expectancy and overall quality of life.

He is 13 years old. His iron needs are huge. If he has absorption problems, that makes the situation even trickier. Make the changes I've suggested, and talk to his doctor about bumping the dose up. I've had an iron deficiency with intermittent anemia that didn't improve until my ferritin was over 220 µg/L; I have to stay on a maintenance dosage of 70 mg Fe/d (two "green" tablets), and that only really works if I take them both at the same time, on an empty stomach, in the mornings long before breakfast. But just to get to this point took more than 7 months and much larger daily dosages.

There is lots of room upwards, here. Talk to your doctor, and don't be afraid to be bold.

Answer by Stephen for Nighttime clenching?

2012-05-30T12:09:30Z

I suffered from bruxism for most of my life. I have tried all the above mentioned tricks. Because of what happened to me, I no longer believe that bruxism has a whit to do with "too much stress".

Bruxism seems to run in my family, so there is probably a genetic component, but that still doesn't explain why it happens. Because it's hardly a life-threatening condition (and I do believe it is abnormal, there's nothing adaptive about grinding your teeth to powder while sleeping) it doesn't get a lot of research attention.

One of the suggestions frequently made to people with bruxism is to try taking magnesium. Magnesium helped me a little. Correcting a vitamin D deficiency helped a lot more. My bruxism didn't completely resolve, though, until I corrected the iron deficiency I didn't even know I had.

If that surprises you, you're not alone. It surprised me. Never in a million years would I have connected this problem to iron.

The iron deficiency turned out to be very stealthy and took nearly a year to properly diagnose. It wasn't until about three months after I started iron replacement that I noticed a panoply of symptoms I had come to accept as being "part of who I am" were disappearing. Some of them I had lived with nearly my entire life.

My sleep improved dramatically. I went from chronic insomnia to sleeping like a baby and awaking refreshed after 8 hours of sleep. I am very excited about this.

For years, I have had recurrent neck and shoulder tension that was barely responsive to physiotherapy. Strangely, it would sometimes come and go for no discernible reason. Three months into iron replacement, it is gone.

Deep muscle twitching, which had become severe, is almost totally gone.

The tooth grinding has stopped. I know this because first, my girlfriend has pointed it out, and second, my jaw muscle is no longer sore and my teeth are no longer sensitive upon waking. My teeth sit solidly in the bone.

There are other things that have improved -- no more chronic joint pain, I am less anxious, I am less tired, my physical performance is better, and so is my color -- but those really deserve special attention in a more complete post on the subject.

I am all for meditation and relaxation exercises, and I do both myself, but this change was so dramatic that those things now seem so ridiculously inadequate in treating bruxism that they are almost a waste of time. None of the typical, conventional treatments actually address the cause. They're just palliative, and in my experience (now that I have experienced what actual relief feels like) they don't work.

This link may appear unrelated at first, but I encourage you to watch this entire presentation and see if you find yourself reflected in any of what Dr. Pickett describes.

Here are a few observations that might also be relevant:

Bruxism is most common in children. Children start out with very little iron in tissue and spend the first 6 - 10 years of life building it up. Iron demand during this period is tremendous. Kids have trouble getting enough iron to meet that demand, especially if they drink milk or eat dairy products.

Iron is an essential co-factor in the action of tyrosine hydroxylase, the rate-limiting enzyme in the production of dopamine. This helps to explain its role in muscle stiffness and hypertonias. It also goes some way to explaining why it fixed my sleep problems. I suspect bruxism has something to do with dopamine also.

Ferritin is not a very accurate indicator of iron status. It is not simply a proxy for iron storage, it is also an acute phase protein, so it is elevated in inflammation. This makes a proper assessment of iron status a whole lot more complicated than most doctors like to think. At the very least, the 30 µg/L lower limit is probably way too low for somebody who has symptoms. I had a ferritin level which was initially considered well inside of normal (95 µg/L) after repeated tests, and all the while my blood counts were repeatedly showing anemia. Because I am male, things had to get really bad before the doctor was comfortable prescribing iron replacement, at which point the anemia corrected pretty quickly. Let me just sum it up this way: most doctors think that blood count is the first thing to suffer when you are iron deficient. To my knowledge, there is no peer-reviewed, published evidence to support this assertion. Functioning blood is vital for survival, so the opposite is probably true.

The only pleasant way to find out what the iron picture in your body looks like is to measure

serum iron, and
total transferrin, or
total iron-binding capacity.

This will tell you roughly how much iron you're getting from your diet and more importantly, whether your tissues are getting the iron they need to function. Tissues produce more transferrin when iron-starved, irrespective of the ferritin level. If TIBC or total transferrin are high, it is a sign that you are iron-starved. It is possible to have what looks like a normal ferritin, and still be iron-poor. This is especially true if you have an inflammatory condition, or if you are physically active.

(By the way: the unpleasant way, but the gold-standard for diagnosis, is a bone marrow biopsy. Yuck.)

Iron metabolism is very poorly understood. We used to think there wasn't much in the way of active regulatory mechanisms for iron, until a major, iron-regulating hormone (hepcidin) was discovered. In 2000. After everybody thought the book was closed on iron. That's how clueless we are about this. There are likely other transporter proteins and hormones which remain undiscovered. For this reason, I recommend being very skeptical of classical definitions of iron deficiency. If you remember nothing from what I've written here, remember this:

Iron deficiency is not the same thing as anemia, and not even the same thing as iron deficiency anemia.

Lastly, if you decide to treat: it is not easy. Iron replacement can cause all kinds of digestive havoc, ranging from constipation to diarrhea to stomach upset and nausea, especially at the beginning. It is difficult to absorb, so it's worth taking the time to find a formulation that works for you. (Eating meat certainly helps, but it was not enough for me.) The body does adapt. A good thing, too, because fixing this can take a really long time (up to a year in some cases). Some physicians treat with intravenous iron, but this hasn't been evaluated for safety or efficacy in large trials yet, so it is a controversial practice. Personally, I feel safer sticking with oral iron. At least then, the body can put some brakes on if it needs to.

Answer by Stephen for Fed up with acne - starting a very low dose (i.e. 10mg a week) accutane treatment

2012-09-03T21:45:27Z

Vitamin D was what finally fixed my acne after what seemed like a lifetime of suffering. I was in my mid-thirties. The key point -- one I'd missed before -- was that I was not getting nearly enough of it to make any difference.

I had to take a liquid form of cholecalciferol at doses more than of 5000 IU a day before things really changed. I noticed that my skin temperature went up. Lo and behold, my skin started to clear up. I verified my levels with blood testing. The improvements did correlate with the 25-OH-D level.

I also eventually found, after a few self-experiments, that vitamin A actually made the acne worse, unless I took doses so high I started to get the toxicity symptoms (joint aches, super dry skin; the "therapeutic action" of Accutane - isotretinoin - is really just a toxicity symptom of vitamin A).

Along with that, I took substantial amounts of Omega 3 from fish oil (four capsules a day was typical for several years). The striking thing about this is that it took months before I saw the biggest improvements. I realize in retrospect that I gave up much too soon on some of the things I tried.

Oh, and my diet? It is essentially paleo, and devoid of junk. The only sweet things I eat are fruits, and then in very limited amounts. This is really hard for many people to do. I often meet people who claim they are strict, then when I observe them see that they cheat - a lot.

All these things together have given me the clearest skin I have had in my whole life.

I suspect that there is a connection between acne and intestinal health. All those years of antibiotics have likely screwed up your intestinal flora completely. You might want to consider an anti-inflammatory regimen typically used for reactive arthritis, in which you actively try to repopulate your large intestine with beneficial organisms. One thing I have not heard anyone try for this sort of thing yet, but would be curious to test, is a fecal transplant, but those are not generally used for things like acne and you will probably have a hard time finding a physician willing to do something like that.

All the other things, though, are doable, and if you haven't tried them, I'd give them a look. Acne sucks.

Remember that acne is primarily an inflammatory condition. Anything you can do to mitigate inflammation is likely to help and certainly won't hurt. Good luck!

Answer by Stephen for What should I do with this kohlrabi?

2012-07-20T17:02:04Z

Cook it gently in a coconut milk sauce. Mmm... delicious!

Answer by Stephen for How quickly are we still evolving?

2012-07-20T08:28:46Z

It's true that culture and our ability to modify our environments has resulted in a neutralization of the classic selection pressures (such as disease and access to adequate nutrition) on humans. In animal populations with low selection pressure overall, we often see genetic and phenotypic diversification. This is really quite remarkable: it means that the likelihood of some portion of the population surviving the moment a significant selection pressure appears is increased.

People like to say that the dinosaurs were wiped out by the mass extinction event of 65 million years ago, but that's not completely accurate. The big animals that needed lots of food were wiped out, but their descendants still live among us as reptiles and birds. That's the legacy of a diverse population that lived under small selection pressures for many years.

"We" are not evolving toward anything -- every individual is a point sample, a result of all the selections and mutations (that last one is important!) that came before. Also important: whatever came before, every person is unique, and I don't mean that in the "everyone is special" sense. Every person is unique because, whatever you get from mother and father, you're lugging around, say, anywhere between 8 and 15 functionally significant mutations that happened during gametogenesis. In that respect, you're different from both of them and from everything that came before.

Harry is right: rate of mutation and the efficiency and quality of DNA repair have as much an impact on evolution as selection pressures.

And Harry (and others) are also right about this: selection pressure is not gone, it has simply changed in nature. Consider the people who choose to go childless, for whatever reasons -- something about their makeup has influenced them, in the current circumstances, not to have children. (Then there are those who are childless due to any number of other factors: reckless behaviour resulting in premature death of the children, or disease, or failure to socialize sufficiently, etc.) In this way, they can be said to not be optimally suited for the conditions, and the genes responsible for these vulnerabilities, under these prevailing conditions, will be gradually selected out of the population.

In humans, selection is now influenced by culture and technology. The ability to form social groups and to cooperate has conferred an enormous survival advantage, but it also means that individuals need to maintain the ability to socialized; that's a selection pressure. In a high technology society, the ability to work and provide for your family also depends increasingly on higher cognition; that's also a selection pressure.

With a global population of seven billion, all of humanity is hurtling toward the really big test: Who will survive when the environmental limits are reached? Or, will we -- collectively -- realize what needs to be done to prevent a cataclysm and find a way to do it?

You could think of that as a kind of cultural natural selection.

While it is true that there have been genetic changes in the last 10,000 years, and while it is also true that the population continues to change, it's undeniable that big portions of what most humans are evolved not simply over the last 100,000 years, but over millions of years, and a great place to see that is in the brain: going inward from the cortex towards the brain stem is like taking a trip through time. It's a matter of how you weight things.

I can see no way that the rate of biological human evolution can possibly keep pace with the huge changes to our lifestyle and environment of the last two centuries. The conditions of my life are so vastly different from those of my father that we might as well have lived on different planets.

An evolutionary perspective on biology and behaviour isn't going to lose its relevance as long as we are mortal, reproducing organisms.

Answer by Stephen for Is paleo worth it with a newborn?

2012-07-19T22:42:53Z

Are you co-sleeping? Some people find that helps with the nighttime feedings and reduces fatigue. When it's time to nurse, you just roll over, and it's done :)

Seconding MathGirl72: cook in batches. Get some big pots. Look into buying bulk, into food co-operatives, into delivery. Do you have a freezer? If yes, use it -- if no, think about getting one.

Having a newborn, it is exactly the time to be eating as little processed food as possible. What you do now and for the next six years will have the biggest impact on your child's long-term health, vitality, and intelligence. If it were my child, it would be worth it to me.

Think about developing systems to make things work easier and better. How can you streamline things?

And another thing... you have a newborn. Your kitchen doesn't have to be constantly spotless :) (I promise I won't tell anyone!)

Answer by Stephen for Help me make a very iron rich meal plan?

2012-07-16T18:28:08Z

Hi Jaych,

Dumping the dairy is the single biggest thing you can do to improve your iron absorption. Not only does calcium inhibit it, but the apo-lactoferrin in the dairy strongly binds iron -- if any of it is unsaturated, it will mop up any free iron it comes into contact with.

As someone who suffered a stealth iron deficiency for years, I can tell you that the impact of calcium is underestimated. I think it even impacts iron metabolism -- I am still on iron replacement and expect to be so for the foreseeable future, and I always feel worse whenever I eat anything with significant calcium content. (You'd think I'd learn -- it happens every time.)

Salads can be a source of iron, if they are eaten with catalysts. Those are acids (like a nice, sour vinaigrette) and -- perhaps surprisingly -- heme iron. Eating a salad with your meat will mean you take up the iron in the salad better.

Spinach is also an excellent source. The same caveats about catalysts apply. Eggs too -- though while they contain iron, egg protein is also used to bind iron in the treatment of iron overdose.

Crucifers -- like broccoli -- can be problematic, perhaps because of their calcium content, which is higher than most other vegetables.

The sweet potatoes are not a problem. Eat away.

Are you taking vitamin C with your iron supplement? What kind of iron supplement are you using? I have -- unfortunately -- not had good results with ferrous gluconate, and am now taking ferrous glycine-sulfate instead.

Answer by Stephen for hack my weird feeling

2012-07-16T18:04:30Z

Your symptoms are awfully consistent with overtraining. You are training a lot, especially considering what you are eating. Your carbohydrate intake sounds inadequate. A few potatoes four times a week, plus a couple of pieces of fruit is nothing.

How much vitamin D are you taking?

Are you eating any seafood?

Finally, and very importantly: have you seen a doctor?

Answer by Stephen for if inflammation is bad, and saturated fats are good, then...

2012-07-16T17:57:27Z

There is one problem with nutritiondata.com:

There are no references.

How am I supposed to know if what they claim there is on the level? If you are going to claim that something is inflammatory, then back it up. Coconut milk is inflammatory? According to whom?

In fact -- that's a great idea! while we're here, let's take a look at where this information comes from.

clicks link

Hmnn...

The IF Rating™ System

Monica Reinagel, a noted nutritional researcher, is the creator of the IF (Inflammation Factor) Rating™ system. Before creating her system, she spent years studying systemic inflammation, and compiled data from hundreds of different research studies. Her system considers the inflammatory and anti-inflammatory effects of more than 20 separate nutrients. In Nutrition Data's opinion, this rating system is the most sophisticated approach to date for predicting the inflammatory effects of foods.

Early in 2006, Monica authored the book The Inflammation Free Diet Plan, which provides simple guidelines for using her system to plan your diet, and includes IF Ratings for 1,500 common foods. Nutrition Data recommends this book to anyone considering using the advice of the IF Rating™ system. You can also learn more by visiting InflammationFactor.com.

The first warning sign is language like this:

"Monica Reinagel, a noted nutritional researcher..."

If you have to tell people you're notable, you aren't. (The moment I read something along the lines of "...has appeared on CNN, MSNBC, Fox, [insert cable channel desperate to fill airtime here]", I move on.)

"Before creating her system, she spent years studying systemic inflammation, and compiled data from hundreds of different research studies."

Hundreds and hundreds, for years... and years and years. Maybe two? Maybe ten? In a lab, or in the den?

It gets better:

"Her system considers the inflammatory and anti-inflammatory effects of more than 20 separate nutrients. In Nutrition Data's opinion, this rating system is the most sophisticated approach to date for predicting the inflammatory effects of foods."

Right, thanks for the tip! I'll be sure to add Nutrition Data to my list of journals to read.

"Early in 2006, Monica authored the book The Inflammation Free Diet Plan, which provides simple guidelines for using her system to plan your diet, and includes IF Ratings for 1,500 common foods. Nutrition Data recommends this book to anyone considering using the advice of the IF Rating™ system. You can also learn more by visiting InflammationFactor.com."

Houston, the Benjamin has landed! Nice work, Ms. Reinagel!

I have found that asking a lot of questions in general is useful in life. It saves me time and money.

Answer by Stephen for Is Paleohacks losing its steam/momentum (gasp - going down)?

2012-07-14T07:53:32Z

I've only been here for a few months, and I can tell you what's already getting on my nerves: the questions that begin with "Does anybody else experience [insert form of social ostracism here]?" In general, I find questions that start with "Does anybody else [blank]" to be pointless and clearly intended to shore up the self-esteem of the poster or fill silence. They don't teach the other members anything, which is the point of Paleohacks -- or so I thought.

This is one of the things I have long appreciated about Ask Metafilter: all the members have to pay a (tiny) 5 dollar membership fee, and questions that begin with "Does anybody else..." are not allowed, period. The quality of the discussion is much better as a result. Quality discussion attracts quality posters, and quality posters mean better questions and better answers. It's a self-feeding mechanism.

The next area for improvement I can see is in the software. Paleohacks uses the Stackexchange engine, but it's clearly an archaic version of it. Would it cost anything to use the newer one? (Perhaps it isn't under a public licence, I don't know). In any event, the search tools and formatting features are much better with the current software, and the new engine even supports chat, which I think would go a really long way to reducing the number of "Does anybody else [blank]" questions (can you tell I'm very fond of those? ;) ).

Finally -- perhaps this is a "nice to have" -- a simple private messaging feature would be really helpful, if only to have a reasonably secure way to exchange e-mail addresses.

To get back to the question -- if Paleohacks is in decline, it's because it's not evolving. It's free, so I suppose I can't complain too much, but Stackexchange is also free, and it's improved immensely since its inception.

It would be nice to see Paleohacks do the same.

PS: I don't see any advertising because I use Firefox and Adblock Plus.

Answer by Stephen for How much coconut milk should/can I have?

2012-07-07T13:47:45Z

I'm not sure where you got the idea that the stuff in cans has more fat in it -- perhaps because many of the canned coconut milks are been thickened with guar gum? Fat does not equal thick.

There is no functional difference between canned or boxed coconut milk; any difference you perceive is down to the ingredients. Lots of manufacturers cheat with fillers and thickeners. If the coconut milk is any good, that is totally unnecessary.

I second the others who advise steering clear of cans, and can also recommend the Aroy-D product in aseptic packaging. It is also highly prized by Thai people. It's more expensive (although in my experience, not much more) for a reason. (Note that I cannot be sure that it is free of BPA -- but given that there is no epoxy liner in aseptic brick packages, I think the probability is low. It may contain other potentially hormone disrupting plasticizers, but this is the risk you take with any processed and packaged foods.)

I drink about a cup of coconut milk a day, sometimes more. Unlike some others, I have never had issues with loose stools from it. It's delicious, very filling, and can be used for sweet or savoury cooking.

It does seem to make my cholesterol go up, but I think the response varies from person to person (I have some genetic predisposition to a higher LDL). It seems to raise my HDL also, so on balance I think it's okay.

How can I assess the freshness of an Omega 3 supplement in a gelcap?

2012-07-05T19:31:24Z

I bought a large batch of fish-oil-based Omega 3 from London Drugs more than a year ago, and I am wondering if it is still safe to use. I took it out of its original container and put it in plastic bags (because I was transporting it and I wanted to reduce the bulk), and different batches are mixed. I believe some of it might be expired, most is not.

This is a molecularly distilled fish oil product produced under contract for London Drugs by Ocean Nutrition (some of you might recognize this, they produce for a variety of brands and the products are often labelled with Ocean's logo). These are fatty acid ethyl esters. Though this is some distance from the totally natural stuff, I appreciate the fact that it is essentially free of heavy metals and is minimally oxidized. If I recall correctly, there is dl-alpha-tocopherol in the solution as well, presumably to prevent exactly the kind of oxidation I am worried about (though again, I cannot be sure).

My main questions are:

how can I determine whether the stuff is still safe to consume? At the moment, it does not smell strange, in fact it hardly smells at all.
how air-tight is a gelcap, and how long does a gelcap typically retain its integrity?

Answer by Stephen for Can you have inflammation and not know about it? (and how it relates to ferritin levels)

2012-07-04T19:24:19Z

Hi Daz -- I saw this a couple of days ago and thought, "This is right up my alley", but didn't answer because I wasn't sure I completely understood your question.

I'll give it a try now :)

The first part:

Which made me think, even if your tested ferritin level comes back as a good number, could it still be possible that it is actually at a ‘good’ level due to it being raised by inflammation...and without the inflammation the real ferritin level would be below optimal (inflammation may be raising tested ferritin levels, from sub-optimal to optimal).

The answer to this question is: it absolutely can. This case report describes an 83 year-old man who had restless legs syndrome that was unresponsive to drug therapy. He had a history of heart disease, slightly elevated erythrocyte sedimentation rate, and a ferritin level of 93 µg/L. There was no anemia:

Blood tests were essentially normal. In particular, hemoglobin was 12.7 g%, mean corpuscular volume was 89, transferrin saturation was 25% and serum ferritin was 93 µg/L. ESR was slightly elevated at 52.

He was treated with oral iron, ferrous fumarate equivalent to 90 mg of oral iron per day. After 4 months, the ferritin level was 136 µg/L. (By this point his RLS had almost totally resolved.)

The interesting thing about this case report is the astounding finding that a bone marrow biopsy tested negative for iron, despite a ferritin level of 93 µg/L and a blood count which would not qualify as anemia!

Where to set the point at which an elevated ferritin level rules out an iron deficiency is an open question. I know of no published evidence that establishes a relationship between other markers of inflammation and ferritin levels, so this is one area where a great deal of care and attention is needed to avoid missing what may indeed be an iron deficiency.

The British Columbia Ministry of Health's clinical practice guidelines remind physicians that the ferritin level is a factor in determining the probability of iron deficiency:

Serum ferritin levels and iron status:

Adults (ug/L)

less than 15 → diagnostic of iron deficiency

15 - 50 → probable iron deficiency

50 - 100 → possible iron deficiency

more than 100 → iron deficiency unlikely

persistently more than 1000 → consider test for iron overload

Children (ug/L)

less than 12 → diagnostic of iron deficiency

Of note, the guidelines also say:

may be unreliable in patients with chronic disease or malignancy
non-hematologic symptoms can occur when the serum ferritin is in the low normal range (less than 50 ug/L)
higher levels of serum ferritin do not exclude iron deficiency
persistently elevated serum ferritin levels (greater than 1000 ug/L), but without chronic inflammatory disorder → recommend testing for iron overload (refer to Iron Overload - Investigation and Management)

The second last one is what gets people into trouble.

You asked about my labs. Here they are:

Test 1: December 14, 2010:

RBC 4.2 * 10^6 /µL [L!]

hemoglobin 129 µg/L [L!]

haematocrit 38% [L!]

platelets 222 * 10^3 /µL [L!]

MCH 30 pg

MCHC 34 g/dL

MCV 89 fl

This is mild anemia. No intervention recommended. Gamma globulins were elevated on this test, so the doctor suspected an infection as the cause of the anemia.

Test 2: January 4, 2011

RBC 4.7 * 10^6 /µL

hemoglobin 14.2 µg/L

haematocrit 42%

platelets 214 * 10^3 /µL

MCH 30 pg

MCHC 34 g/dL

MCV 89 fl

ferritin 95,7 µg/L

Suddenly, the anemia is gone. The ferritin has been tested and is normal. Note that at this point, all I have done since the last appointment is take some B-vitamins. I was not eating a paleo diet yet. By now, the doc has ruled out an iron deficiency as the cause of my troubles.

Test 3: June 3, 2011

This was done by the endocrinologist. By this point I have seen not one but four specialists. I am getting sick of doctors.

RBC 4.6 * 10^6 /µL

hemoglobin 139 µg/L

haematocrit 39%

platelets 199 * 10^3

MCH 31 pg

MCHC 36 g/dL

MCV 86 fl

ferritin 99.3 µg/L

Test 4: June 6, 2011

Three days later, I am back at my primary physician. For some reason, he orders a serum iron alone, and thinks to check CRP:

RBC 4.6 * 10^6 /µL

hemoglobin 139 g/L

haematocrit 40%

platelets 240 * 10^3

MCH 31 pg

MCHC 35 g/dL

MCV 87 fl

serum iron 188 g/L [H!]

CRP (standard) <0.8 mg/L

The MCV on the last two tests has been lower. The serum iron is high; it has a circadian rhythm and can vary enormously, but as this is a single measurement and not alarmingly high, and since everything else looks okay, the doc doesn't think it is of interest.

Test 5: August 2011

I saw a second endocrinologist in August. (Unfortunately, I do not have a copy of the labs. I am due for a follow up this coming September, and I'll ask for one.)

On reviewing the labs with me, he said I appeared mildly anemic, asked about my dietary habits and recommended I make an effort to get more iron in my diet (I presume he measured ferritin and did a blood count; he wrote me a letter that covered only the endocrinological aspects of the test results).

Test 6: December 12, 2011

RBC 4.5 * 10^6 /µL

hemoglobin 136 g/L [L!]

haematocrit 41%

platelets 206 * 10^3 /µL

MCH 30 pg

MCHC 33 g/dL

MCV 91 fl

Vitamin D is checked at this visit because I was complaining of joint pain and had been deficient in the past. It is 21 ng/mL (52 nmol/L), so I go back on supplementation.

Test 7: February 19, 2012

I am back in my old hometown and go to see my previous doctor. He has seen me every year or so the past few years. Some things have gotten better over the last 18 months, other things worse. To rule out inflammatory disease he orders a range of tests.

I have been paleo for about two months at this point, but I still don't feel right. My sleep -- never good to begin with -- is getting worse, and I'm depressed. All my muscles are sore and tense. I can't concentrate, which makes work difficult.

lipid panel

total cholesterol 5.52 mmol/L [H!]

triglycerides 0.49 mmol/L [L!]

HDL cholesterol 2.26 mmol/L

total:hdl ratio 2.4

LDL, calculated 3.04 mmol/L

His words: "This looks fine. You have lots of the good stuff, so I see no reason to be concerned about your cholesterol."

Inflammatory markers:

erythrocyte sedimentation rate 7 mm/h

CRP (sensitive) 0.1 mg/L

The blood count:

RBC 4.3 * 10^6 /µL [L!]

hemoglobin 132 g/L [L!]

haematocrit 39% [L!]

platelets 208 * 10^3 /µL

MCH 30.6 pg

MCHC 33.8 g/dL

MCV 92 fl

The "anemia light" is back, and...

ferritin 11 µg/L [L!]

to which I can only say, what the hell happened here?

The doctor prescribes iron replacement. Minimum duration 3 months, with a follow-up recommended at 4 weeks. I started taking 70 mg of elemental iron per day, in the form of ferrous gluconate.

Test 8: April 13, 2012

After five weeks of iron replacement, now back with the doctor who ordered the first three tests:

RBC 4.8 * 10^6 /µL (Never in all my years has the RBC been this high.)

hemoglobin 142 g/L

haematocrit 45% (Ditto for hematocrit.)

platelets 253 * 10^3 /µL (Ditto.)

MCH 29 pg (My poor bone marrow has never been so happy in its entire existence. Finally getting enough iron, it's churning out red blood cells so fast the MCH is actually dropping.)

MCHC 33.8 g/dL

MCV 93 fl

iron panel:

serum iron 124 µg/L

ferritin 35.9 µg/L [L!]

transferrin 296 µg/L [H!]

transferrin saturation 29.7% (I had taken an iron tablet about 90 minutes before testing.)

The total iron binding capacity is high. Even though ferritin has gone up 25 µg/L, it's clear that the system is still iron-hungry. (This throws a new light on Test 4 from the previous June, after I had started running regularly; without a TIBC result, I can only speculate, but my hunch is that the serum iron was elevated because my TIBC was going up. More transferrin means increased absorption from diet.)

Upon seeing this result, the doc says he wants me on iron for at least three more months, with follow-up testing at that time. That's scheduled for the end of July.

The hematological response to the iron replacement is apparent and this response is considered (quite apart from the low ferritin on the previous test) diagnostic of iron deficiency.

This is despite the fact that I had anemia sometimes, and sometimes not, and always very mild. The hemoglobin was nearly always normal. Ferritin was normal as late as June 2011, and all the while -- already in 2010 -- I had the same symptoms which are now going away on iron replacement.

So: In a person with symptoms, these tests are simply inadequate.

I honestly can't say whether the ferritin at 95 µg/L was an accurate reflection of my iron stores. The other inflammatory markers were unremarkable, but I suspect that something was going on. It may have been as simple as light inflammation caused by lots of physical activity. I am very physically active. I'm convinced that an active person "consumes" iron in ways a sedentary person does not (one does refer to "runners anemia" in the medical literature.)

But apart from all the labs, which are really just tools, I feel the best I have in years. All the things I mentioned in this answer still hold true, only even more so a month later.

And that's what counts.

Answer by Stephen for What can I do about my teeth grinding?

2012-07-03T18:06:56Z

I'm going to practice my clairvoyance skills. Tell me if I am wrong about any of this:

you're a female
you have recurrent tension and stiffness in neck and shoulders which seems to come and go
you have had trouble sleeping
you often have to get up in the night to pee
you are often very tired
the above have been a problem for years

I think it will eventually be shown that teeth-grinding is a result of iron deficiency. It's really a type of parasomnia (like sleep-walking and restless legs). Restless legs especially is known to be associated with iron deficiency or impaired iron metabolism.

I wrote an extensive answer to another, very similar question a month ago.

Answer by Stephen for Dont feel right after 4-5 days of Paleo, stomach, constant need to burp, pressure in chest

2012-06-23T15:06:07Z

At the risk of sounding like a parrot, "drop the soda! drop the soda!".

Having addressed the obvious, I have to ask -- how much fat are you eating?

Because what you are describing (abdominal distention and postural pain, disruptions in bowel routine) sounds an awful lot like....

[drumroll]

gallbladder trouble! :)

Monarchs living high off the hog used to get this. In France they call it crise de foie ("liver crisis") and the standard treatment is what you'd expect -- back off the fat for a while and give your liver and gallbladder a chance to recover. (Should it surprise us that the French are experts on this? Mmmm... delicious FAT!)

It's possible you may already have stones, because ordinarily the gallbladder would just empty into the gut. The stones can be harmless for a long time, because they just rattle around in there until there are so many that one of them blocks the duct, at which point you go from 0 - 4000 on the pain scale, and then it's off to the OR for you.

If a milder version of paleo ends up resolving the problem for you, though, I wouldn't waste much time worrying about it.

And in closing...

"drop the soda! drop the soda! bcaw!"

Answer by Stephen for Stomach problems, the GS191 Genoset, and NSAID intolerance

2012-06-23T14:48:30Z

You wrote:

The GI bleeding must just be the tip of the iceberg, there much be other damage occurring before it comes to that.

Actually, GI bleeds are probably the initial and biggest side effect of NSAIDs. It happens very quickly, it can even start with the first dose. Nobody is quite sure what the mechanism is, but one of the leading working theories is that the inhibition of prostaglandins leads to localized attenuation of gastric mucus secretion, such that the stomach lining is directly exposed to stomach acid. This is a topical effect, so things get started right quick.

I did a trial of low-dose daily aspirin last year to see if it would help what I and my doctor thought were migraines. I got stomach aches from day one. Spacing the doses made no difference, and it took a couple of weeks to recover after I stopped (this makes sense, since what I was really doing was punching holes in my stomach).

My feeling today: they're best avoided, unless you've got a life-threatening fever. Sadly, acetaminophen is not any better, even if it's for different reasons.

Answer by Stephen for Why am I getting canker sores?

2012-06-23T14:26:02Z

Stress is an obvious culprit, but why is it that some people handle stress better than others? Genetic factors aside, it comes down to adequate nutrition.

I used to get canker sores all the time. I tried all the standard tricks -- avoiding certain foods, trying to manage stress, changing toothpastes -- but nothing worked. I found out long ago that calcium helped get rid of them, even though I used to get them back when I still ate dairy (which says something!). It helped, but it didn't solve the problem completely.

What did that, strangely, was vitamin D. After I got tested in 2010 and was found to be low, I increased my intake of vitamin D (I live in a northern climate) to 5000 IU a day. I have honestly not had a canker sore since (I've had sores from accidentally biting my lip, but since fixing my D shortage, those heal faster than my spontaneous sores ever did). This was one of the many things that made me a convert to vitamin D.

I'm not saying that's your problem, though I don't think it's a coincidence that calcium used to help me and vitamin D both raises serum calcium and increases calcium absorption. There are other things that can make a person more susceptible to canker sores. B-vitamin deficiency and iron deficiency (which often gets missed) are all possible causes worth investigating.

One tricky aspect of a paleo diet is that it is not always easy to get enough calcium, so that would be the first thing I would look at (and along with that goes an investigation of your vitamin D status).

"Stress" is kind of a blanket explanation for problems whose objective cause isn't obvious, and it doesn't really help people because it's too inspecific and very difficult for most of us to control. Plus, many of the physical effects of stress are the result of the accelerated nutrient depletion it is known to cause, whether by inadequate diet, increased nutrient demand, or both.

But if you're well-fed (which is harder to achieve than most people think) and well-rested, then you have the tools to cope with stress. Now I can eat just about whatever I want (within the scope of a healthy and nutritious diet mostly devoid of dairy :P ) and I never get them.

Answer by Stephen for Any recommendations for Paleo and OCD (obsessive-compulsive disorder)?

2012-06-23T14:03:22Z

If this friend has OCD, then he (or she, you didn't specify) should have a look at this presentation by Dr. Mary Pickett. Don't let the title fool you; she does go into OCD in some detail later on in the talk, and even has a clinical case example.

Comment by Stephen

2013-02-22T03:25:05Z

I have taken up to 900 mg magnesium (in the form of citrate) in a day without having anything close to diarrhea. Everybody responds differently.

Comment by Stephen

2012-11-22T20:58:40Z

You know, this was a legitimate question. If I had been satisfied with the results of five minutes of research, I wouldn't have asked the question in the first place. Your list contains duplicates, mouse studies, and three trials, all of which have serious methodological flaws. One paper was from a journal published by Thorne Research, which manufactures K2! The Rotterdam study is the only one of sufficient size to be really interesting, and yet even it is weak, since it relied on food frequency questionnaires.

Comment by Stephen

2012-11-22T19:38:25Z

@wildwabbit: Thanks for the kind words.

Comment by Stephen

2012-11-22T08:46:15Z

I think the morning/evening difference has to do with circadian rhythms in hormones, serum minerals and electrolytes. Levels are all highest between 9 am and 1 pm, then they decline, hitting a nadir in the middle of the night. I find that my head clears up -- just about every day -- at around 1.

Comment by Stephen

2012-11-04T23:28:13Z

And why are you not in a position to do medical tests? This is not a particularly expensive test...

Comment by Stephen

2012-11-04T23:27:43Z

You said you had a fever. Do you know you had a fever? That is, did you measure it with a thermometer? Or did it just "feel" like a fever? As in, your head was "hot"?

Comment by Stephen

2012-11-04T23:26:40Z

The system responds to or prevents transient hypercalcemia with calcitonin. Without this regulatory mechanism, we would be hypercalcemic after meals, when a bolus of calcium is absorbed from the food. I couldn't tell you what the mechanism is, but because CGRP has been linked to migraines, I wonder if the calcitonin secretion necessary to keep serum calcium levels normal might be part of the reason. As for magnesium, it's a mild calcium channel blocker and has been shown to be effective in reducing frequency and intensity of migraines.

Comment by Stephen

2012-11-04T15:11:35Z

@kashperanto: yeah, you'll see I posted there last year (post by user "rhombus"). Nobody ever answered my post, which was disappointing, but that's the Internet for ya. Still, though these things people experience are real, there's no good explanation for them. It's likely the vitamin D, because I react the same way with normal sun exposure, but why? It doesn't make sense that one would respond this way to a dose of vitamin D that you get just from being outdoors in shorts on a sunny day. There has to be another factor...

Comment by Stephen

2012-11-04T15:03:55Z

As for the level dropping fast -- though you were getting lots of sun, you can't have known what the level was during the summer without actually measuring it. (Have you had your iron levels checked? I'll bet you're iron-deficient, especially if you're drinking milk.)

Comment by Stephen

2012-11-04T15:02:03Z

You also never mentioned if you'd been actually diagnosed with an autoimmune disease. Are you seeing a doctor?

Comment by Stephen

2012-11-04T15:01:31Z

If you want to get rid of the acne, I would lose the milk. I would even stop the cod liver oil. Why? Because I discovered, after years, that preformed vitamin A (retinol, as you would find it in CLO) actually made my acne worse. Yes to the magnesium.

Comment by Stephen

2012-11-04T14:57:59Z

When you ask to have your iron checked, get the doc to do the full panel: serum ferritin, serum iron, and total iron-binding capacity. Ferritin alone is not a terribly reliable indicator of iron status. (An Hb of 12-13, while technically "normal" and not unusual in women, is not particularly great. Hb shouldn't be used as a measure of iron level on its own, anyway.)

Comment by Stephen

2012-11-04T14:43:35Z

...or my system is very sensitive to calcium. Or I really do need to take a second look at more supplemental magnesium intake. Or or or...

Comment by Stephen

2012-11-04T14:42:33Z

It's enough to make me wonder if the symptoms might just be caused by a declining PTH, since it's conceivable that PTH has functions other than Ca regulation. But I have no symptoms of hypothyroidism per se: for one thing, the calcium level has usually been mid-normal to high-normal, a sign that the vitamin D was doing its job very well. The lowered PTH is most likely to be a response to the increased serum calcium.

Comment by Stephen

2012-11-04T14:35:40Z

My doc is good about this -- he always reqs a PTH and electrolytes when he checks the D. This last test result was a standalone test I ordered myself, but an all previous occasions they were both checked and well within normal limits (which always surprised me, because I was really symptomatic). In fact, the PTH was typically on the low end of normal and seemed to correlate inversely with the vitamin D and serum calcium level (what you'd expect, really).