Wednesday, August 11, 2010

Concluding Thoughts

I woke up from my colonoscopy with my traditional confusion and disorientation. I recall the doctor walking up and saying that things looked fine and that they had removed a polyp. He let me take home the pictures from the polyp removal and his writeup about it. Nice guy.

I guess that polyp that my previous gastro thought might require surgery to remove had morphed into a non-problem over the past year. I compared the pictures from my 2009 colonoscopy and the polyp looked fairly different – in 2009 it was white and puffy, in 2010 it was the same color as everything else and looked smaller and denser. I have no idea if these statements make any sense or are even true, given that I’m just comparing pictures on a piece of paper, but there you have it.

I got a call from the doctor’s office yesterday saying that the polyp was benign and everything is fine. I should come back in a year for another colonoscopy.

So here I am. One year after embarking on what I thought was a fairly radical experiment, and the sum total of my medically noted results is “Everything looks fine.” Talk about an oddly deflating experience. On the one hand, this confirms that I am in a medicine free remission, that I am generally healthy and free of Crohn’s activity. That is massively good news and a confirmation of the Hypothesis. On the other… well, everything’s fine. Could just be a fluke. Who knows?

So with that little humbling thought, here are my takeaways from a year of very-low-carbohydrate, zero starch eating:

1) It appears to have been effective at maintaining remission. My first three or four months were quite turbulent and felt as if I was having a flare up, but I stuck with it and the reward is more than worth it. Or maybe I’m just lucky? Epistemic crisis here I come.

2) It is not hard to do, provided that one actually is interested in the outcome. I’ve been continually perplexed by the hangups people have about food and the preconceptions they refuse to let go of in the face of evidence like my lack of dying. How on earth can anyone say, “Oh there’s no way I could do that.” Seriously? There are people on this planet whose entire lives are spent in a brutal daily struggle for food that they eventually lose based on the arbitrary whims of an unfeeling universe, yet the idea of eating a calorically and nutritionally complete diet of meat, eggs and cheese for a year is inconceivable.

A lot of this has to do with not having any stake in the outcome of the experiment. It’s easy to not think through a statement about the diet if the only time you think about it is the once a month you happen to notice what I’m eating, and then make some idiotic claim about how it’d be impossible to handle. It’s not only not impossible, it’s trivial. You simply have to know some basic facts about why it’s a worthwhile approach, commit to a goal, and then do it. Perhaps I’m too impatient with other people’s frailties, but even that is hard to accept because I’m about as frail as they come. So why is it that this wasn’t a disastrously difficult experience for me despite the near unanimous outcry of how hard it must be?

People just don’t ever think about what it means to eat, about why they eat, or they just don’t care about their health enough to do so. If they did, they might find giving up certain foods to be fairly simple. Ignorance is bliss, I suppose. Of course, I was and likely still am one of the ignorant, but man oh man do I hope I wasn’t so blatant about it in the past.

3) Ebringer’s research really, really deserves more attention in the Crohn’s patient and research communities. Maybe I’m a fluky n=1 random event, but I doubt it. Browsing through the mainstream articles and forums is an incredibly depressing exercise in watching the conventional wisdom of “there is no cure, prepare to suffer” stifle people’s attempts to find relief. The CCFA’s criticism of the Specific Carbohydrate Diet was a ludicrous read - I hate conspiracy theories, but it’s like the mainstream doesn’t want there to be a way to manage the disease without constant medication, so anything that promises such must be attacked with tenuous logic and absurd “warnings” like “children might not get enough calories”. What?! Fearmongering bullshit at its worst.

4) Just try it. It’s one year of your life and it may improve every other year you ever live. We like to talk about putting in your time and making investments, but it’s rare that we have the opportunity to do so in our own lives with such a radical payoff. There is no guarantee of success, but there is a guarantee of failure if you do nothing.

I went back and reread my introduction post and I wanted to offer up some thoughts about how my perspective has changed since then.

I relied almost entirely on ethnographic observations to get me to this diet. The only modern clinical evidence I saw was Lutz’s claim of 80% remission with a low carb diet. While this was a happy outcome, I’m now much more leery of relying on such a shaky foundation for diet – I don’t think I posted anything that’s outright false in that introduction, but I far prefer the work of Ebringer as a foundation for low starch eating in inducing/maintaining Crohn’s remission to a collection of random observations about the general health of primitive populations.

Those biases eventually lead me to the “paleo diet” movement that is bouncing around the internets as we speak. Basically, the theory goes that since humans evolved over a time span of millennia, we should focus on eating the foods which most closely resemble those we evolved to eat, while avoiding those which are too recent for humanity to have adapted to. The closer to the present a food was invented or introduced into the pool, the more skepticism it should be viewed with.

I have my disagreements with various takes on paleo. I dislike the magical thinking and speculation that it seems to breed, the caveman metaphor, the constant optimum seeking and above all the orthodoxy of thought that any principled approach to eating engenders. However, I like the basic premise and I like how it provides a pretty simple and accurate mental model for selecting healthy food. Sure, maybe a given individual can tolerate gluten better than someone else, but they don’t really miss out on much by eating more meat instead of bread. And if they experiment and have no problems, hell, add it back in.

Generally speaking, I think I went through the process of being a new convert and now I’m back to being a relatively cynical skeptic with some new biases based on some new experiences. We’ll see how well that bears out.

So, that’s it. I did it. I ate pretty much an all meat diet for a full year. I did not die. I did not get scurvy or any evident deficiency. I ate a lot of cow and I’m in apparently good health.

I turned 26 this weekend and for the first birthday in about five years, I didn’t have to take four grams of pills.

Best present ever.

20 comments:

  1. Awesome!
    And thanks for posting - great feedback/info for the world.

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  2. My pleasure! Hopefully some random Crohnsie will find this blog someday and give it a shot with the same result.

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  3. Congrats! Lex Rooker has been eating an all meat diet (which includes animal fat, organs and water along with muscle meat) for over 5 years and the gastroenterologist that performed his last colonscopy said that his colon was in such good shape that he "would have no need to have this procedure done again." (http://www.rawpaleoforum.com/health/crohn's-disease-for-10-years-need-dietary-suggestions!/msg18688/#msg18688).

    Check out his fascinating journal too: http://www.rawpaleoforum.com/journals/lex's-journal/

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  4. Hi, could U pls give ur exact food list? Do U it raw or cooked? I found ur blog thnks to Rawpaleo forum/

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  5. Paleo Phil: Yep, Lex was an inspiration, both for the fact that he's a living example of the fact that this diet doesn't kill you, and because he has managed to stay thoroughly skeptical throughout. You can see some of my posts in the thread you linked actually. I drifted over to PaNu after a while.

    Roman: I ate raw for a few days and then bailed. I ate things cooked rare for the rest of my time. Raw wasn't really BAD, but it also wasn't very appetizing. For now I'm happy enough with the results on cooked meat and animal products that I haven't thought about doing a raw experiment.

    As for my food list:

    Breakfast: Eggs and maybe bacon
    Lunch: Steak or hamburger w/cheese
    Dinner: Steak, roast or other cow chunk

    Occasional heavy cream rounded out the extra fat if necessary. I would occasionally eat fish or pork (aside from the bacon) as well. Chicken was a rarity towards the end because I had purchased a grass-fed cow that I had to work through.

    I have all my food logs written down but I haven't had the time to type them up. They're not all that interesting really, since they're all variations on the above theme.

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  6. Hi,

    I also have crohn's and I read your blog and I love it.
    How are you since you stopped to blog here?
    I'm curious about symptoms, energy level etc.

    What do you eat ?
    Do you blog somewhere else?

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  7. manvsbowels: First off, awesome username. I wish I had thought of that.

    I stopped blogging because I'm basically fine as far as I can tell, and I'm not as good as other bloggers at randomly writing articles about whatever. Energy levels are fine, symptoms are nil. Now that I'm in this pattern of eating it's hard to get worked up enough to write anything about it.

    I'm tempted to take it up again simply because I can't find any good source on the internet anywhere for using this approach with Crohn's, and if it really is effective it would be a damn shame to keep it hidden away on some obscure blogspot form blog. But real life is busy, so I never actually start again.

    What I'm eating nowadays:

    - Eggs/cheese for breakfast
    - Ground beef/cheese/salsa for lunch (sometimes sour cream)
    - Steak/aforementioned ground beef thing for dinner/sometimes a green vegetable like asparagus drenched in butter.

    I'm also drinking a ton of Lactaid milk as part of a weight training program. The negatives from that so far appear to be some acne and heartburn, so at some point I'll be dropping the milk again. But my Crohn's symptoms are still completely absent despite the massive simple carb dose. I haven't tried to drink actual milk yet (to see if I'm still lactose intolerant; might be interesting), so I'm not sure if Lactaid actually breaks down all the lactose or if it just does it enough for me to survive.

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  8. Hey CC, I was diagnosed with crohns 3 years ago after going to the hospital with horrible pains and then getting some inflamed intestine taken out. I was told I would never have regular bowels again. I was told this wasn't diet related, it was genetic related, and therefore I could not do anything about it besides taking a lot of pills.

    Over the months and through my first year of college I kept suffering bloody stools, arthritic pains, cramping and all kinds of discomfort..meanwhile upping my daily pill intake from 15 to 18 assorted pills per doctor request.

    Then I had enough of it, started researching, and realized the medical establishment is IN THE DARK on crohn's or they are so in bed with pharma companies that they don't want you to know what to do to help yourself. I realized there are remedies and that led me to paleo eating and removing a lot of fiber intake.

    I started first by fasting for a few weeks to focus healing on my intestines by giving it rest time. I removed all processed and wheat foods from my diet. Coinciding with this change, my canker sore problem and sebhorreic dermatitis improved dramatically. It took months but I saw improvement weekly until I literally had no pain anymore, no blood, no cramps..and I ditched the pills.

    It's been over a year and a half now and I've had no problems!! Now what I do is drink a cup of raw milk a day and eat meat, thats it. It feels nice taking control of my health when doctors did nothing for me. I am now convinced that my immune system was compromised by heavy antibiotic use as a child per doctors requests and that led to leaky gut syndrome, immune deficiencies, inflammation disorders and finally crohns.

    I am really glad to hear your story and that you came through it too. The word needs to get out that there are ways to heal.

    By the way, I have regular bowels again =)

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  9. Awesome story! Sounds like you had it way worse than I did, and diet still worked. That's very good to hear.

    Congratulations on healing yourself and thanks for posting your story here.

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  10. PFW, congratulations to you. Your success is inspiring.

    It does seem to take a sense of adventure to leave the usual paths. Once I did, life got much better. I didn't have Crohn's disease, but other digestive challenges.

    A very low carb, Paleo food plan has helped me tremendously. Food plan includes: beef, with liver and bones, chicken liver, egg yolks, fish, herbs, a few low-starch vegetables, butter/cream, and a bit of fresh lemon juice and black or white pepper. Cream is mostly made into yoghurt. Water and tea are the only beverages.

    No nightshades, nuts, or chocolate. (I mention not eating those because they are popular with some on a pre-agricultural food plan.)

    Thank you very much for your blog.

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  11. H., thanks for posting your story. I've had a few people with IBS ask me if this would work for them, and since I've mostly said, "give it a shot", it's nice to hear from someone without Crohn's that still got some relief.

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  12. Hi pfw, just wanted to make sure you saw this,

    http://high-fat-nutrition.blogspot.com/2011/02/dr-wolfgana.html

    , that Wolfgang Lutz passed away towards the end of last year -- at age 97. I only just now heard about it.

    Paul.

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  13. http://askcolleenbean.blogspot.com/2009/09/cure-for-ulcerative-colitis.html

    Here is another similar story of low carbs that cured my daughter (well so far for 7 years) of UC.

    I came across your blog after I was searching CCFA for references to Lutz. There are none. I then looked at the board of trustees at the CCFA, and they appear intelligent and not employed by big pharma. Why the incorrect nutrition advice then?

    Colleen (askcolleenh@gmail.com)

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  14. Probably because the Lutz approach and similar approaches are not yet backed by a significant body of studies. The CCFA has to stick to the mainstream scientific view. Of course, since it's quite a difficult thing to test - you need a large group of people to comply with strict dietary advice for years plus, and pay for studying them - there may never be enough study to warrant mainstream acceptance.

    What frustrates me is not so much the CCFA emphasis on "it's not proven to work" (because it isn't) but the attempts to scare people away from even trying. THAT is indefensible. There's no legitimate reason to suspect that a low-carb or low-starch diet is going to be harmful, so why try to wave people off?

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  15. PFW, if you don't mind a question, have you kept your diet similar to what you posted in your comment in October or have you made any changes of note?

    I have been reading more about FODMAPs and lactose, and noticing that I do better making all my cream into yoghurt, than drinking it. And that it helps to incubate the yoghurt 7 or 8 hours or longer, to reduce lactose rather than the mere 5 it takes to make yoghurt.

    Avoiding nightshades and onions helps me.

    Do you post anywhere in addition to Paleohacks? I enjoy reading your answers and comments there.

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  16. Actually, I have made a lot of changes, mostly in an attempt to test the starch hypothesis. Results have been confusing at best. I'm still trying to get a handle on it, and I think I will work on an update post to answer the precise question you're asking.

    Briefly, though, I started eating potatoes to see if I would suffer a relapse. The goal was to try to falsify the starch hypothesis, which predicts that starch intake should cause symptoms. As of yet, I have not noticed any change, so perhaps the starch hypothesis is incorrect. The only difference is occasional, vague stomach cramping, which never correlates well with anything I ate - but which does match the sort of IBS you'd expect from FODMAP consumption.

    It's also pretty obvious that there are many factors working together. Maybe my long-term elimination of gluten allowed my gut mucosa to heal to the point where infinite starch consumption wouldn't matter - there's no longer any leaky gut to allow problem proteins near the immune system, so KP or not, I don't have a Crohn's response. Maybe starch/gluten restriction for a while can allow you to heal to the point where you don't need to worry.

    Or maybe I just was in remission to begin with and could have eaten cake every day for a year without a problem?

    Impossible to say with just one subject in the trial!

    As of now I don't really comment anywhere but paleohacks and occasionally on the various paleo health blogs. I haven't found a good paleo forum to join since Kurt Harris shut his down.

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  17. PFW, thanks for your comment. The starch question is a tricky one. I find small amounts of parsnips all right, and may test beets this summer. I don't eat potatoes and am not fond of sweet potatoes, or carrots, as they taste sugary. I'm looking forward to your post about food.

    I enjoyed reading your forum posts at PaleoNu. I miss being able to read things on that forum, but can well understand why Dr. Harris deleted it.

    I find eating herbs and vegetables I grow less problematic than store-bought, even store-bought organic.

    Along with "Archevore", I read Dr. Emily Dean's, "Evolutionary Psychiatry", and Peter Dobromylskyj's, "Hyperlipid", regularly, and Whole Health Source occasionally. I like their science and practical applications, written with graciousness and good will. The other blogs don't quite meet those parameters.

    I hope the talks from the Ancestral Health Symposium get posted on youtube or somewhere else. I'd especially like to hear Dr. Harris'.

    Thanks again for taking the time to comment. I always enjoy reading what you write.

    All the best to you.

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  18. Hi

    I have Constipation prone uc, mostly likely from nerve damage due to mycotoxins/dysbiosis. I can only go and prevent the flares by eating tons of soluble fiber in the form if dates (like pounds per day... It sucks). Was ur issue constipation or diarrhea?

    Would a low/no fiber diet help in my case?

    Also, are no starch veggies allowed?

    I also have chronic KP, among other pathogens like parasites a d probably h pylori. Thanks

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