I've been eating paleo (with IF) for more than two years, high-fat paleo for almost 1.5 years, and 6 months ago I decreased exercise and protein intake and added root vegetables. I am currently suffering from a number of symptoms, which appear to have come on gradually:
- Inexplicable food cravings which are unresolved by eating anything currently in my diet (often resulting in hyperphagia)
- Very bloody gums upon brushing
- Constant fatigue, sleep does not feel restful unless it's 10+ hours
- Low sexual drive
Another friend of mine who eats a nearly identical diet has the same symptoms, plus increasing carbohydrate intolerance, poor wound healing, decreased mood and a harder time gaining weight/muscle, and he is getting worse... I also suffer from diarrhea, even while eating fully paleo, which is sometimes alleviated by digestive enzymes. Added: another friend eats a nearly identical diet without these symptoms, and the only difference we can tell is that she eats more fermented foods (especially sauerkraut).
My lab work from less than a year ago showed low vitamin B-12, normal magnesium, high-normal testosterone, low-normal TSH. Currently not supplementing with anything except vitamin D and cod liver oil.
My diet consists of: beef (often grass-fed) and rarely other meats, grass-fed beef liver, non-pastured heavy cream, hard cheeses, Fage Total yogurt, Kerrygold butter, coconut products of all kinds, dark chocolate (85%+), potatoes and sweet potatoes, a small variety of vegetable matter. Very occasionally I have fruit, nuts, a cheat with rice or legumes, alcohol, or something sugary - no gluten.
Until more recently I was not eating liver very often, and did not always eat pastured butter, so nutrient deficiency seems possible. In response to these symptoms, in the last month I have greatly increased my variety of vegetable intake (as did my friend), as well as adding substantial amounts of seafood. Thus far we have not seen any difference.
My friend tried vitamin K (edit: he tried MK-7), which seemed to partially but not fully alleviate the bleeding gums, so I have started supplementing that (edit: MK-4) as well. My friend and I both tried a vitamin C megadose regimen, 4g/day then 4g/hour until intestinal intolerance, that did not seem to help. He has now started supplementing with selenium, the results are still too early to tell.
So everyone, what do you think? Something is very clearly missing from our diet. In every other regard we seem to be quite healthy.
Hypotheses and interventions:
- Malabsorption - this fits with my diarrhea and B-12 deficiency, and his lack of weight gain. What else are we potentially not absorbing? Can we ever repair this?
- Vitamin B-12 - I had a known deficit, tried oral B-12, have not gotten this retested. Oral might still fall prey to malabsorption, so my next step is to try sublingual.
- Selenium - we may know soon. I tried supplementing this a while back, and I eat brazil nuts out of nut mixes whenever I see them.
- Magnesium - just about everyone doesn't get enough, and malabsorption can be an issue here. Blood levels were within the reference range, but hypomagnesemia is distinct from magnesium deficiency...
- Added: Iodine - it is entirely reasonable my intake is low, due to historical lack of seafood and only sometimes adding table salt. But the symptoms don't seem to fit, and my thyroid is functioning excellently as far as I can tell from TSH levels and basal metabolic rate.
- Added: Intestinal parasite - this could explain various nutrient deficiencies, and my friend's lack of weight gain. Never had it tested, but I don't seem to have the same weight problems my friend does.
- Added: Dairy intolerance - if I can't process dairy products for some reason this could result in diarrhea, which alone could potentially cause malabsorption. I have never tried a full dairy elimination since switching to paleo, so this is worth considering. Lactose seems much more likely to be problematic than casein.
- Added: Fermented foods - as noted above another friend without problems eats similarly, except for more fermented foods. But we tried Vit K MK-7, and I do eat yogurt, not sure what else is missing here.
- Added: Bone stock - contributes mostly gelatin, plus a handful of micronutrients. Seems fairly unlikely to be the culprit - my healthy friend doesn't eat it either. May be missing minerals.
- Added: Multiple problems - maybe the gums are just gingivitis, sleep issues due to any number of problems, the food cravings some other minor micronutrient deficiency, etc, etc. Much less parsimonious theory. Predicts we would see some symptoms clearing up but not others.
What else might be missing?
Thank you all for your help. I look forward to days without food cravings and nights of restful sleep again.
Update, May 21st: Began a sublingual B-12 regimen, 1.2 mg a few times per day. It could take a couple of weeks to significantly replenish liver stores. My friend is currently trying selenium.
Update, May 31st: Still tired and bleeding gums after B-12 supplementation, food cravings fluctuating a bit. I am going to add a multimineral supplement next, possibly liver and fermented foods. Friend still taking selenium, eating liver every other day, added magnesium, added kimchi for fermented food, no lactose except for butter - bleeding appears to be less substantial. Will try lactose-free for two weeks next.