Quite a loaded question without a simple answer due to some ongoing chronic health problems, but I thought I would throw it out there as the paleo diet seems to fit as the backbone of any treatment.
I'm in quite a tricky position - leaky/inflammed gut, sluggish aching liver/gallbladder and whipped adrenals, either as a result or more of a causative factor. As a result I have insomnia, constipation, hypoglycemia, exhaustion, many food sensitivities, irritated gut, liver ache, post nasal drip and a few other niggling things.
I've been round the mill in terms of speaking to nutritionists and not really gotten anywhere. Visits to my regular GP believe me to be 'healthy' and the test results reflect this. Also been paleo for around 6 months fairly strict
Some of the things I've done/tried
My diet consists of...
proteins - beef, pork, chicken, turkey, lamb, occasional salmon, mackeral, sardines, duck, partridge and venison
veg - zuchinni, celery, cucumber, lettuce, asparagus, brocolli, cauliflower, green beans, spinach, fennel and chicory
fats - tallow, coconut oil, olive oil, duck fat, lard, goose fat, fish oil, avocado oil, occasional chicken fat/lamb fat after making broth.
Sensitivies - dairy, nuts, eggs, nightshades (notably tomato's), shellfish, gluten, yeast, onions, garlic.
Does anyone have any thoughts on how I might begin to nurse my gut, liver and adrenals back to health given the complicated nature of my condition?
this situation looks very similar to mine. some points from my experience:
probiotics: most of the time, people with acute digestive problems don't take nearly enough. aim for AT LEAST 100 billion organisms/day (some professional probiotics even have 450b/day). i currently take about 3-4 a day of these: http://is.gd/k9b60 (one with each meal), and it makes a big difference compared to the usual 1-5b/day probiotics.
nasal drip points to cross reactions to a pre-existing pollen, grass or dust mite allergy in my experience. if you look at the lists of cross reactive foods on wikipedia it can be pretty much everything (pretty much all fruits, vegetables, nuts). i had surprising success in identifying these with a "home made" prick test. from now on, for each different item you eat (except meat), do a prick test once on the inside of your arm with a fine needle on which you have put some juice/flesh of the concerned food, and sting or scratch your skin with it. if it looks like a mosquito bite after 10 minutes, you're most likely allergic to it (especially if you have a compromised gut lining). be sure to no be on anti-histamines for this, or it won't work. some food doesn't work well with this test like milk. another clear sign is if you need to sneeze after you eat a specific food, like chocolate for example.
you need to be 100.00% sure to be dairy (and gluten) free. i took a certain brand of digestive enzymes for months, before i noticed that they actually contained MILK! lost about half a year of healing because of this crap. another one was milk powder in a canned fish.. wtf.
in my experience, it's all about filling up nutritional deficiencies, and avoiding 100% ALL allergens, or the body will not be able to recover 100%. even one tiny part of your nutrition, like a spice in a spice mix or something can keep the inflammation going. you need to super sure and super clean 100% time. this is especially true of additives in supplements (as i mentioned, especially for dairy and gluten)
you need to be sure you're not deficient in any mineral or vitamin. do lab tests if needed, and/or supplement with each separately, and see how you react. IF you react one way or the other, one is usually deficient in this specific vitamin, or in one of the needed co-factors. typical candidates are D, B12, iron, magnesium, zinc, iodine, B-complex, choline, etc
there are a ton of great additional supplements that would turn you into superman instantly, but i don't recommend taking them, as it only would mask the remaining problems/symptoms. you need to get healthy without any "boosters" if possible (this includes too much coffee)
if nothing helps, i'd do a comprehensive DNA stool test, as provided by http://is.gd/k9eGM for example (a conventional "petri dish" and microscope stool test is usually not good enough). if still no success, i'd go to a capable functional medicine clinic, like the one of dr. hyman
keep us updated! i'm interested what works/doesn't work for you
I would immediately start a fast.
The single best way to heal intestinal disbyosis (often characterized by leaky gut and small intestine bacterial overgrowth or SIBO), and generally improve your gut flora, is to give your gut a rest.
If you are already eating VLC, you should be adapted to fat burning, so this should be a snap.
I recommend a keto-fast; completely restrict carbs and protein for 36 to 42 hours, and eat a min. of 6 Tbs coconut oil every 24 hours to maintain energy. You can also eat butter and heavy cream if necessary; you should not feel weak from lack of food. I usually start my fasts in the PM and end in the AM (e.g., Fri-7PM to Sun-7AM, 36 hours). You should also feel free to exercise during the fast (e.g., Sat AM for me).
After 36 or 48 hours, and for the next 7 to 10 days, re-introduce protein and carbs, but eat little to no carbs and only low glycemic vegetables; this is critical if you are to maintain the gains from the fast. I also recommend one of two meal plans during this 7 to 10 day period.
Plan 1: Eat two meals a day, AM and PM only (e.g., 7am & 7pm); if you need food in between, make it conconut oil, butter or heavy cream (i.e. healthy fat). This will give you two ~12 hour fasts each day during which time your gut will be healing.
Plan 2: Pick an 8 hour feeding window and eat as you like during this time (e.g., Noon to 8pm). For example, you might eat at Noon, 4PM and 8PM. This will give you a ~16 hour fast each day during which time your gut will be healing.
Good luck; you should be feeling much better soon if you quickly begin a fast! However, make sure you eat plenty of coconut oil (and other supplemental healthy fats if needed) to maintain your energy or it will be a long 36 or 48 hours!
Limit Fasting, 3 meals a day, always eat post workout even if it means meal #4
Reduce Foods to simplest for a while, drop the extra herbs, spices, and exotic veggies
If you respond well to sweet potatoes, eat them daily. Okinowan ones are easy enough to find and have a better antioxidant count.
Drop Caffeine completely. All other stimulants too.
Sleep more, I strongly recommend a mid day 1-2 hr nap.
meditate, or other personal quiet relaxing stress reduction.
Eat it. Not your own, preferably from a grass fed cow.
reducing lectin load/toxin load. This likely means more meat, less veggies.
Make sure the vegs you do eat are well cooked or prepared to minimize lectin/antinutrient load.
I really recommend you get some testing done for true allergies/sensitivities as well. Fecal test seems best
Your "sensitivies" are most intriguing. It's interesting that you don't mention soy. I wonder if soy is a problem. I suspect it is present in at least one of your supplements. Since much of what you discuss rings true to me personally, I suspect it could be a problem for you as well.
Now, I realize some people have good results with pro/pre-biotics; however, consider eliminating them for a short period of time. It's another suspect variable. Same thing with other supplements (except magnesium, which will help with the constipation).
You mention you have problems with starchy and fibrous foods. What are these problems? If these foods trigger the opposite of constipation (i.e., irritable bowel) this is significant in one way. If it correlates with increased constipation, it is quite another. If the former, you should read about the Specific Carbohydrate diet, which is mostly paleo, but has a list of "illegal" foods that trigger bacterial overgrowth in the small intestine. Starchy foods, fibrous foods, certain fruits--these are all triggers. If the latter, I don't have any good advice.
Incidentally, if the last paragraph rings true to you then probiotics/prebiotics are the worst thing you can take.
My other thought is that there are so many possible causative suspect foods that you should try a very simple, elimination diet. The vegetables you listed include high-oxalate foods like spinach. Could these be a problem for you? I believe if you work on the gut, all else will follow. It's simplistic and only my belief, so please take it as such.
Finally, you mention "binging" and "cravings" (twice). These are also interesting and suggestive. Are you getting enough calories? Are you cheating in ways that negate your otherwise positive diet?
please dont do a cleanse lol...
i had these kind of symptoms when i started paleo from anorexia recovery. ill tell you what i did
at first i went full on paleo with dairy and gained weight with a lot of intestinal discomfort and bloat. after about 6 months it normalized. then i started tinkering...
i dropped dairy(it was raw cheese and full fat yogurt) i started swigging ACV(with mother) before meals took a round, or bottle of NOW super enzymes and when it was gone never got another every meal included a scoop of sauerkraut or fermented veg
*i dropped my meat intake SIGNIFICANTLY. say what you will but i dont think upping protein and meat consumption is going to help you at all. IME, eatoing more seafood(fresh) really helped my gut and hypo issues, as well as the liver/adrenal exhaustion feel. canned seafood wise i do a lot of sardines, salmon, makerel, clams. yes, eat meat but you dont need it 3x a day. eggs are awesome when soft boiled(not pan fried in butter)
take advantage of fresh herbs...chop them up and all some coconut oil and have an herb salad...basil/oregano/dill/thyme etc.... they all have healthy stuff in them
do not cook your meat via frying/roasting/grilling. stick to boiling and steaming. made a world of difference for me
taters are amazing, without skin, i second the okinawan ones are SO TASTY. also, mashed parsnips or carrots or winter squash
eat a raw carrot sometime during the day
dont fear carbs but start with the less fiborous ones
Some sensible advice all thanks.
The strict elimination diet may be an idea. Could perhaps try going just meat and fat for a few days and try working things back in. My diet seems incredibly hypoallergenic though and when does it become too much of an obsession. I'm fairly strict on good quality supplements as well so don't think there are any nasties.
My 'hunger' dictates that I eat probly around 2600-2700 calories a day, mostly from fat in the ratio 80/20 (fat/protein). I control my blood sugar splitting this into 5 meals a day, 3 of which contain a small amount of veggies on the side from the list above. I haven't 'tested' an alternate eating pattern but suspect having such weak digestion would make say 3 meals of 800+ calories tough. I have seen improvements in my hypoglycemia since going low carb but it certainly is still there lurking.
I've always been extremely thin, but am currently about 9.7 stone, for a 6ft 2 male.... which will make you understand why I'm fixated on trying to get the right carb combination. Horrible situation to be in being so lean and sensitive to carbs with insulin resistance and hypoglycemia. Seemingly not much information and advice for those of us out there as it's all obesity obesity obesity when it comes to previous carb binging, hypoglycemia and insulin resistance.
I may have to give up the ghost with regards to probiotics as you suggest which leaves me in a bit of a pickle knowing what to try/approach to take to reduce the inflammation and toxic loop with my liver. Need to get the inflammation down somehow whilst not stressing the liver too much.
I'm not currently cheating and haven't for around 6 months now so I remain pretty strict. Been gluten free and soy free for years, bar the occasional sprinkling of lecithin for the choline, which I've not had for months either. I'm also pretty much following an SCD/GAPs type diet however without any fruit, and their recommendation to avoid all starches I'm left with no carb options. My digestion certainly isn't strong enough to load up on leafy greens to the point where it reaches an adequate carb intake.
Will perhaps bite the bullet and try to incorporate some sweet potatoes and see how I feel, maybe just 50g a day split between meals to start with. Whether I will digest them, feed the yeast, feel woozy, irritate the gut as a result is another matter.......
Despite the bleak outlook and severly reduced quality of life I remain optimistic!
Get ahold of some Raw milk and start making your own raw milk kefir.
Paleo purists will scoff at this but honestly, I avoided all dairy for 4 months, including ghee, and I improved with all my health issues 100% when I started making my own raw milk kefir and began drinking a TON of raw milk.
In my experience so far, I have not found raw milk to be allergenic at all. Just have it away from meals and don't gulp it down, sip it.
I would always react to pasturized dairy... even fermented, now I can even get away with having some cheese here and there.
Elimation diets are great for food allergies/gut problems... but if you eliminate too much you are actually hurting your gut flora. They adapt to your diet and even if you have some sensitivities you should persist and your gut flora will adapt. Dr. Ayers advises this with his "raw dirty veggies" recommendations. You will suffer discomfort and reactions at first, but in small, consistent amounts, the gut flora adapt.
It is about a functional gut flora with diversity.
The first thing would be to read the book "Adrenal Fatigue the 21st century syndrome" - tonnes of info on adrenals and how to help the body to heal, including what to eat, when to eat, when to sleep, how to organize your day, supplements to help, etc. Secondly, the product "Xtra" by Univera is really good for the adrenals! Third, seeing a Classical Homeopath for a Constitutional Remedy can help overall to get your body working well. Slippery Elm is good for digestive issues, Milk Thistle is good for the liver. Avoiding 'scratchy' foods (raw veg, fried food that's crisp, nuts- exceptions to nuts are nut milk and nuts ground to a smooth butter) can also be helpful with digestive issues. Google Dr Matsen and people who eat to well- the article is very informative, as well as his book "Eating Alive 2"