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Inspired by Crossfit, I decided to try going Paleo for a month. The first four days weren't too bad; just a little tired and craving starches.

That night (after the fourth day), I woke up at 1AM and my stomach hurt like crazy. It felt tight, achey, and BURNED like nothing I've ever felt before. An hour and a half later I threw up everything I'd eaten for dinner (salmon and asparagus, nothing new to my normal eating habits.) This was only the third time I've ever thrown up in my whole life so I'm inclined to take it pretty seriously.

Pre-Paleo I ate pretty healthily; I very rarely ate dairy or added sugar (had already noticed they made me feel bad). I had been eating a moderate amount of complex carbs (whole grains) and legumes.

From searching around the internet, it doesn't seem like this is a normal response to the Paleo Diet. Does anyone have a guess for why this happened?

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*TMI WARNING*-- the barf itself was really weird too (not that I'm any kind of veteran...) It didn't look very digested, and there wasn't any kind of liquid/stomach acid in it-- pretty much just chewed up food. Gross. – April Jan 12 2011 at 22:07
If I were to scale back this dietary change a little, do you have any recommendations of the 'best' grains or legumes I could reintroduce? (like lentil soup or something...?) – April Jan 12 2011 at 22:29
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Right now your body doesn't need what's best according to paleo, it needs what it's used, and you know what your body is used to better than anyone. Give it that and slowly scale it down over a couple of weeks. If you usually have lentil soup, have that and decrease the portions with every meal. If you usually have a sandwich with whole grain bread, have that and cut it down to one slice of bread per sandwich for a few days. – Austin Keller Jan 12 2011 at 23:55
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See a doctor! You might have food poisoning. – Bread-Eating Beelzebub Jan 13 2011 at 4:46
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Heather and Paul WCC pointed out to me that I most likely was increasing my fat intake much too quickly, and I just couldn't make enough bile to keep up with it. Throwing up must have been my stomach saying, "Sorry, try again later!" haha : ) I ruled out food poisoning because I've felt a lot better since that one rough night. Thanks for everyone's thoughtful feedback. – April Jan 13 2011 at 18:26
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16 Answers

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Honestly? I'd see this as a fluke or, perhaps, a virus.

You seem to be doing everything by the book. This seems like an abberation. I mean, it's only been a few DAYS.

the Paleo lifestyle takes several weeks / months to really settle in with some changes and adjustments in between.

I think you just got hold of some food that didn't agree with you or have nabbed a passing gastro-intestinal bug. Hang with it for a bit and see how it goes. :)

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Agreed. Vomiting and diarhhea are part of the body's natural defense to things it doesn't like - virus or bad bacteria. If you want to add some carbs, try sweet potato or some fruit. Lentils might not be too bad either, or even white/wild rice or white potatoes. But only if you feel that you need the carbs. Stay off the gluten for sure and I would avoid most beans (a few now and then isn't such a big deal) – Dave S. Jan 13 2011 at 0:02
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Sounds like you ate some food that had gone bad. If it were a virus, I would expect there to be more episodes. I makes no sense to me that it would have anything to do with not eating whole grains or other complex carbs.

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I've had oxidized (overcooked) salmon make me sick. I get sashimi salmon and eat it raw or lightly seared.

I highly incredibly doubt you got sick because you aren't eating something like grains...

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Hi, April. It came out in the comments to Austin's answer that you had been significantly increasing your fat intake. I can say from my own experience that it took me a while to get better at consuming fat; I experienced a lot of nausea when I first started eating paleo. I have even thrown up, and could tell that it wasn't food poisoning, since I felt better immediately afterwards.

I've seen a lot of other anecdotal evidence of this in paleo circles, people getting gradually better at digesting fat. The obvious thought is that your body can get better at producing bile. Bile is a major player in digesting fats: it breaks down big units of fat into smaller little droplets so the enzymes in your small intestine can have at it. Consider this discussion from way back when on Dr. Harris's forum, about eating paleo without a gall bladder (which stores and concentrates bile). Consider also the case of the 88-year-old guy who ate 25 eggs a day, much quoted for pro-cholesterol reasons because he had pretty good blood cholesterol levels. But the interesting thing I just noticed about that article is that he had double the rate of bile-acid synthesis compared to normal subjects. The authors obsess over the fact that bile acids help regulate cholesterol, but bile acids also help digest fat -- and a high-egg diet is also a high-fat diet. So maybe he also increased his bile production in response to all the fat. Anyhow that's the best I could come up with in tonight's research for finding some evidence other than anecdotal that we can get better at digesting fat. But the anecdotal evidence is pretty strong.

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I agree with this, especially in the case of something like additional oils which require a lot of bile to emulsify. Your body might be just making the bile requirement for a high fat meal, and then you hit it with a bolus of oil and it capitulates. – pfw Jan 13 2011 at 10:48
I had eaten about 10 eggs that day, started cooking with coconut oil, PLUS dipped all my asparagus in garlic & olive oil. OOPS. This seems to really click with why the food didn't seem digested when it came back up five hours later... Thanks for the interesting links. – April Jan 13 2011 at 18:23
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There are too many variables to blame that on paleo. In time, you too will be eating previously disgusting foods even for breakfast without batting an eye. Take my breakfast this morning for example: mackerel fried last night with buttered yams and natto.

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It definitely wasn't a matter of anything being "disgusting" that made me throw up. – April Jan 12 2011 at 22:44
Even so, I can say that there is nothing about a far less GI-tract-inflaming diet that would lead to this. I would imagine that it was a coincidence. – Travis Culp Jan 12 2011 at 22:47
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My transition was also rough in that I experienced about 2 weeks of diarrhea, during which my immune system was very weak (as gauged by swollen lymph-nodes, oral cold sores, etc).

Barring the possibility that we got something like food poisoning, rapid changes in gut flora might help explain our rough transitions. Different bacteria populations thrive on different inputs or diets. When they cannot properly break down the inputs, the system responds with a 'flush,' which is what I understand diarrhea to be. Things stabilize once the appropriate bacteria have come to dominate the population.

Don't forget that during this period your body is forming new chemical pathways for burning energy. Until this happens, the lack of carbs is a deficit shock, while the larger amounts of fat and protein are surplus shocks. Also, your brain has to adapt to using glucose that is internally produced. All of these processes help explain why in the beginning many of us experience 'low carb flu.' I think that this term encompasses a phenomenon that has many dimensions - cognitive, digestive, energy-burning, immunity, etc.

Importantly, though, none of this suggests that what carb flu symptoms are indicative of a dietary change that is unnatural in any sense. Rather, it merely indicates a radical change to which the body's systems need time to adjust.

As for me, since those initial two weeks, which was over three months ago, I haven't gotten sick once. This is quite miraculous considering that I spent the past 3 winters sick in bed almost every other week.

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Why would glucose that is internally produced be any different for the brain than dietary glucose? I guess maybe you just mean as a shorthand that your body has to adapt to producing more of the glucose itself (which is then used by the brain)? ... I agree that changing gut flora could be an issue. Wish science understood more about that topic. – Paul Jan 13 2011 at 7:38
Yep - that's what I meant exactly. – Eric S Jan 18 2011 at 21:58
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I can't really answer your question but I've noticed that salmon can make me queasy. I had some for breakfast this morning and walking to work I thought for a minute that it was going to come back up. I also couldn't finish the fillet that I had cut for myself - I almost started gagging. Too much on an empty stomach? I'm not sure what the problem is but I'm going to be cautious with salmon for awhile.

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large quantities of salmon makes me really acid, lots of heart burn. never thrown up, but i don't usually do that too often. – MikeD Jan 12 2011 at 23:16
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If you've ruled out things like food poisoning or a virus, then think about your fat intake. When I first started upping my fat intake, I felt like I had indigestion (probably my gallbladder wasn't used to dealing with that level of fat). My husband will throw up if he goes way over his body's capacity for dealing with butter or cream, which has happened a handful of times when something was really yummy and he didn't pay attention to his body's signals (and if you're new to paleo, you might not know the signals at all). The vomit was always barely digested, even if it had been hours. And when I had morning sickness I felt like I absolutely couldn't digest any fat without something sour like vinegar or lemon juice to help emulsify it, as though my body just couldn't produce enough bile. It felt just like going paleo again, except I knew how to deal with it by then.

So if you think that might be the issue, go back to the amount of fat you used to eat, and SLOWLY build up from there. Sour things seem to help, too.

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Thanks, this sounds like me-- it wasn't really digested at all. I'll start keeping track of everything I eat and make sure I'm more gradual with the fat intake! – April Jan 13 2011 at 18:10
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I have no idea why this happened but I can say that my digestion of meat - and likely fat - was greatly helped after a short course of hydrochloric acid (HCl) to assist my stomach acid production.

S&C coach Charles Poloquin has an article about it here:

http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article.aspx?ID=27

Even if you don't have any of the symptoms he lists, I think it's worth a shot as I find his arguments for better digestion pretty compelling.

HTH

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You may have experienced ketoacidosis. If that's the case, you need to eat more carbohydrates. I had a similar reaction 4 days after going strictly paleo. I felt the same burning, like the worst heartburn I'd ever had, headache, and aching, though no vomiting. I kept myself from vomiting so I could keep down the carbs I knew I so desperately needed. I had been eating a lot of grains prior to going paleo as well.

Try eating some grains with every meal and gradually reduce the amount of grains you eat to nothing over one to two weeks. Make sure that while you're decreasing your grain intake, you're greatly increasing the amount of vegetables you're eating with every meal to keep your carb intake up.

When your body metabolizes lipids, ketone bodies are created as an intermediary, which are then broken down to create energy. This process is ketosis. However, when your body is relying too heavily on lipids, ketone bodies build up in your blood to the point where your blood pH drops. This is ketoacidosis. Your body is more susceptible to ketoacidosis when you suddenly decrease your intake of carbs. You may be eating a perfectly balanced paleo diet, but if your body hasn't had time to adjust, you'll experience ketoacidosis.

Sources: http://www.livestrong.com/article/297064-low-carb-diets-ketoacidosis/

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If there is problem with amount of carbs in diet there are much better sources then grains. Best to cut them out and replace them with fruit and vegetables. – Kruno Jan 12 2011 at 23:56
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The only people who experience ketoacidosis are those with severe issues like diabetes or kidney problems. Normal people will not experience it even if they go cold turkey zero carb. The link you provide cites the typical bullshit conflation of ketosis with ketoacidosis, which has been debunked to death by everyone. If you truly suffered a ketoacidosis event you almost died and should probably talk to a doctor. What's much more likely is that you ate enough fat that your body freaked out and you got dehydrated. – pfw Jan 13 2011 at 0:08
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For starters, here's what ketoacidosis actually is: en.wikipedia.org/wiki/Ketoacidosis . Note that ketosis is normal and you can (easily) survive with zero carbs in your diet; your claim that over-reliance on fat will cause ketoacidosis is simply false, as is your claim that you will definitely experience it if you go too quickly. Unless you have a metabolic issue coming in (diabetic), you can go from high carb to zero carb in a single day without entering ketoacidosis. You will enter ketosis, which is a metabolically normal state that doesn't cause the sympytoms you listed. – pfw Jan 13 2011 at 1:18
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For more information, I suggest you make the rounds of the various paleo bloggers out there (panu, hyperlipid, etc), or read Lyle McDonald's book on Ketogenic Diets, or do a literature search on ketoacidosis. If you're wondering why I'm so animated about this, it's because ketoacidosis as a bogeyman has been raised over and over again by ignoramuses trying to scare people away from low carb diets; incidentally, I don't think you're one of them, but you certainly have been misled by them, and to see it appear here of all places is frustrating. – pfw Jan 13 2011 at 1:21
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April, I too have gotten nauseous from eating too much fat too quickly (especially too much oily fat). In fact the first time I took cod liver oil, I spent the next few hours on the toilet wondering what the hell was wrong with me. Turns out a straight oil shot can be very hard for your body to emulsify and digest if it's not accustomed to it, and I had eaten a lot of fat at dinner, so I overloaded myself. So gradual definitely helps. Austin, not a problem, sorry to blow up your comments with diet-nerd rage :) – pfw Jan 13 2011 at 10:46
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To specifically answer your question, throwing up is not "normal" under any circumstance, Paleo diet or other. That said, four days? I encourage you to be a little more patient. Most reliable sources say to try it for thirty days. If you keep throwing up, then maybe you should consider whether this is the correct option for you.

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Vomiting could be a sign of protein toxicity. When people say to eat "lean meats", they are giving bad advice. You can't have a sustain protein intake of over 30-40% of your caloric intake. Review what you have eaten and see if you didn't have enough carbs and fat to balance it out. Seafood is 60-90% protein by calories and will be a problem if you eat it at most meals. If you eat lean meats, you have to add in fat (olive oil, coconut oil) and/or carbs (sweet potato, potato, parsnips, fruit).

Ground beef is good paleo staple. Get 75-82% lean and you won't run into protein toxicity. Chicken and turkey can be too lean to use as a staple.

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I didn't have issues with vomit- but I definitely had issues with diarrhea. This took care of me super quick:

http://www.amazon.com/Barleans-Organic-Oils-Greens-Container/dp/B0009ET4KE

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many times when I eat and I start getting an upset stomach its mainly because it isn't digesting properly. I drink a tablespoon of raw apple cider vinegar with an 8oz glass of water and usually it helps to bring the PH in my stomach back to a stable level and digestion resumes as normal.

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I'm also going to cast my vote for food poisoning here. Happened to me last month; I remember reflexively licking the spoon I was using to cook dinner and thinking, "That was just sitting in raw hamburger; I shouldn't have done that." And sure enough, that night (or hours later, early the next morning, after a very painful night), I had the same experience you did - right down to the texture of the puke. Hope you feel better now. Stay hydrated!

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I got that exact same thing day 5, I was rendered useless throwing up all day, I am 99% sure it was a severe wheat withdrawal. I've read something like wheat activates the same receptors in the brain as heroin and alcohol so the withdrawal process (sickness, headaches, sweats, vomitting) can be a milder version. I realise this is purely anecdotal, but it was my experience anyway.

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