No Colitis

Hard to believe that it’s been over a year since I updated this blog, and two years since I started it. Where does the time go?

I’ll probably bump in here once a year or so with updates, just to make sure this information is current and honest. If at year three I have a massive flare up and die from meat clogging my intestines, it’d be a good idea to note that rather than let people believe this all worked out.

Of course, I have yet to have meat clog my intestines, and the title of this post is the summary from my latest colonoscopy: no colitis activity. Yay! Two years “cured”. My pipes looked good enough for the gastro to move me off of the once a year colonoscopy schedule – I go back in two years, August 2013. Awesome. This’ll be the first year I go without a colonoscopy since 2002.

What’s perhaps more interesting than the result is my behavior in the past year. I did not continue to eat only meat. Meat continues to form the basis of my diet; most meals are mostly meat. But I have added back in a pretty broad variety of other things. For the first few months post meat, I added back in some vegetables and drank a TON of Lactaid milk to gain weight. After a few months of that, I was up to nearly 200lbs from a starting weight of 160lbs. So that worked.

There were no apparent Crohn’s consequences from the milk or the vegetables. I did get more gassy and bloated at times, but no flare up of symptoms or pain. I did discover that brussel sprouts are not really human food as much as they are gut-bacteria food, and that if I wanted to avoid generating sulphurous methane at a rate which would astonish a cow, I should avoid them. So brussel sprouts = bad, at least for me.

That brings me up to December 2010. At that point I was getting tired of milk, and had started to break out in acne on my upper back. That seemed like a clear indication that milk, even if it wasn’t going to trigger Crohn’s, was probably not helping overall. I also hurt my back and had to take a break from weights for a while, so there was no point in chugging that much milk.

So I decided to give the starch hypothesis a direct test. I started eating potatoes.

I did experience some discomfort at first, but no real Crohn’s symptoms. It seems that my digestive system had to reset a bit to handle a pile of starch. Again, I would have more gas (as in gas at all; the meat only diet left me without any) with the potatoes, but no Crohn’s flare. I’m still eating potatoes now, eight months later, with no obvious consequences and no Crohn’s activity in my latest biopsies.

Hypothesis falsified?

Was Wulfgang Lutz right? Just eat 72g of carbs of whatever source and you’ll be fine?

I don’t know. One could argue that the year of zero starch allowed my intestines to heal sufficiently to the point where the bacterial mimetic necessary to generate the autoimmune response are no longer crossing the gut barrier, and so the starch hypothesis stands. Or maybe I didn’t need to eat only meat for a year – maybe just dropping the total starch load to some lower level would be sufficient, ala Lutz. Or maybe the starch hypothesis is total crap and I just happened to have a flare up and remission which coincided bizarrely well with a radical shift in diet.

The one thing I have not tested myself with is gluten. Maybe all of the above is a red herring, and removing gluten and various grain proteins from my diet caused the gut healing necessary to shut down the Crohn’s reaction. I was tested for celiac and came up negative back when I was first diagnosed, but frank celiac and gluten sensitive are different levels of response. When it comes to generating totally unscientific explanations for the results of my N=1 experiment, I’m coming to think that it might just come down to avoiding bread.

I did have a few moments of insane cramping and diarrhea over the past year. In each case, I could not ascertain a direct cause. It seemed to happen at random, but usually coincided roughly with some deviant behavior. I really can’t say if this is just me finding patterns in chaos, but when I eat a lot of nuts (pistachios are apparently equivalent to crack cocaine for me), I usually end up in trouble. Unfortunately, I was also eating some fruit at the same time I was gorging on pistachio, so maybe it was fructans in the fruit. I have yet to do any real exclusionary experimentation to isolate which food(s) were sending my guts down the toilet, mostly because “success” involves my guts trying to jump out of my body and down the toilet.

So, there you have it. I’m still “cured” despite adding in a number of foods which a year ago I would have predicted would cause a relapse. Who knows what I’ll be saying in a year or two. I’ll make one golden prediction: I’ll be less certain about the truth of the matter than I was when I started.

In the meantime, though: no colitis!

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.

Final monthly roundup of measured data and analysis.

Data

Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:

http://www.forefrontpb.com/phildiet/Diet%20Records.xls

The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.

The "Weight Chart Daily Graph" worksheet shows the daily morning weight.

The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.

I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.

Analysis

July was spent largely on vacation. My data for the month is thus somewhat sketchy, but generally speaking I was fine. We went hiking in the Adirondacks again (just like in August of last year) and once again I felt fine walking up mountains. Well, maybe fine is the wrong word – I was able to do it and fight through the pain of walking up the side of a mountain.

There’s not much to say. I feel fine. I weigh about 15 pounds more than I did when I started. My bowel movements are regular, healthy and I rarely get diarrhea. It’s been a year and I’m pretty sure I’m in a drug free remission. Success?

The final colonoscopy is scheduled for July 30^th. I’ll find out then.

(Note: Posting this pretty late because I'm lazy. The next post will deal with the post-colonoscopy review and concluding thoughts)

June Weights and Measures

Elevent monthly roundup of measured data and analysis.

Data

Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:

http://www.forefrontpb.com/phildiet/Diet%20Records.xls

The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.

The "Weight Chart Daily Graph" worksheet shows the daily morning weight.

The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.

I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.

Analysis

June featured a long vacation which thoroughly disrupted the data. I went to England to visit my parents, and discovered the wonders of the British dairy aisle. Shockingly enough, each container of “double cream” contained… just cream. No random other crap added in for no good reason. Tasted great and very thick as well.

I was pretty digestively sound in England, returned for a week, and then embarked on a trip to the beach, which also disrupted my record keeping for the start of July. Thus, this entry will be short – except to note one important thing:

My year is almost up!

It’s incredible that July 20 is approaching so quickly. One year without eating anything but animal products and not only am I not dead, I’m feeling fine, have plenty of energy for strenuous activity like paintball and appear to be in excellent general health. Such subjective measures mean nothing, of course. The only real test will be my colonoscopy on July 30^th and what the biopsies show.

I initially intended to make some predictions, but this past year has taught me that I know too little for that to be a worthwhile exercise. I find myself with little confidence in any prediction I can come up with. The polyp found last year might have become cancerous, or maybe it’s gone completely, or maybe there’s been no change. I’m definitively asymptomatic when it comes to overt Crohn’s symptoms like cramping and diarrhea, but I do get a twinge now and then which makes me wonder what’s going on down there. What will the biopsy show? Maybe I’ll look like hamburger, or completely cured, or maybe I’ll just look like a guy with mild colitis like always. Gotta love uncertainty.

Suffice it to say that I’m anxiously awaiting the results and hope that they’re as positive as the experience itself has been. There’s nothing worse than thinking, “Wow, this must be really working!” only to get a cold bucket of medical reality in the face.

My next post will be a look back over the past year, focusing on the things I was wrong about, lessons learned, and what I’ll do with the next year. Till then… one month to go!

The Hypothesis

The Hypothesis

In my travels through life and the internets, I’ve recently had a bunch of people ask me exactly what it is I’m doing, and why I’m doing it. Looking back at my initial explanation post, I realize that it doesn’t really do any scientific justice to my thoroughly unscientific experiment, at least not when it comes to explaining and justifying my course of action through the statement of a hypothesis for testing.

So here‘s the hypothesis:

By eating no starch and no fiber, I will put my Crohn’s Disease into clinical remission by reducing or eliminating the activity of Klebsiella Pneumoniae in my gut.

Ok! But what the hell does that mean? Why do I think this will work? What’s the end game? Let’s start with the most compelling piece of theoretical science, move to the only significant tests of that science, and then on to how (and why) to test it yourself if you have Crohn’s, Ulcerative Colitis or IBD/IBS.

Theory

(In the spirit of credit where credit is due, I must thank AJ for telling me about Ebringer’s work and taking the time to talk to me about the implications. I owe him a great debt of gratitude! AJ is also attempting a low starch diet with success in treating his Crohn’s.)

Alan Ebringer, a professor of Immunology at King’s College, London, lead a research team studying ankylosing spondylitis (AS), which is a condition of auto-immune arthritis of the lower back. They discovered that patients with AS tended to have anti-bodies in their bodies to a ubiquitous bacterium called Klebisella Penumoniae (KP). KP is present in everyone’s intestines, but if everything is working properly your body’s immune system should not be required to control it. In AS patients, something was wrong with the way their guts and immune system were handling this bacteria.

Ebringer and his team eventually developed the following hypothesis. I am probably simplifying this through my ignorance of the full meaning of the terms in the papers, but I think I have the gist correct:

90% of their patients with AS produced the HLA-B27 antigen. KP produces a particular enzyme to break down starch for digestion which happened to partially mimic the structure of the HLA-B27 antigen, as well as the structure of several types of collagen in your body. When you eat a large bolus of starch, not all of it will be digested before your KP has a chance to eat some. The KP will merrily eat and reproduce until the starch is gone, at which point they slowly die back until the next meal.

If you have good gut permeability (that is low gut permeability), and little damage to your intestines from your diet, chances are that the products of bacterial action will never cross the tight junctions in your gut and into your body. If, however, you are at all sensitive to gluten, lectin, or any of the other common allergens in the modern diet, or you have recently suffered trauma to your gut, you may have a compromised gut which will allow minute amounts of KP and KP byproducts to by pass the gut wall. Your body’s immune system will respond like it does to any foreign protein – it will being producing anti-bodies which are coded to attack that protein.

But that’s the catch. If you are HLA-B27 positive, your immune response may be confused and attack not only the foreign proteins, but any protein which mimic them. You are now experiencing an auto-immune response, and in AS patients, this manifests itself as chronic inflammation of the spine and pelvic joints.

Ebringer and his team noticed an association between AS and IBS, so they decided to see how Crohnies fared in terms of KP anti-body counts. They discovered that Crohn’s sufferers also had very elevated KP anti-body activity, but they were predominately HLA-B27 negative. So they went looking and discovered that KP also mimics several kinds of collagen which are helpfully present in your intestinal wall: right where you get the colitis that characterizes Crohn’s! They concluded that people who are HLA-B27 positive have a high propensity to develop AS if they compromise their gut, while people who are HLA-B27 negative would get Crohn’s, Ulcerative Colitis, and the other inflammatory bowel disorders.

Ebringer and company developed what they call the “low-starch diet” and prescribed it to their AS patients. Unfortunately, funding for their research appears to have dried up and Ebringer himself has retired. Presumably someone will be along to pick up this line of inquiry, but until then we’re in limbo in terms of further theoretical advances, at least that I’ve seen. I make no claims to being all knowing and all seeing so maybe I’m pleasantly mistaken and there is a full blown clinical trial going on somewhere!

In the absence of that miracle, however, we are left with no published clinical tests run by Ebringer to establish whether or not the low-starch diet would work for AS or Crohn’s patients. Which leads us to the next question.

Testing

There are two “tests” of this theory available, one strong, one weak. I’ll lead with my low card here.

The Specific Carbohydrate Diet was created by Sidney Haas in the 1920s in an attempt to address celiac, Crohn’s and other digestive disorders. It was fairly successful, but it was supplanted once the actual mechanism behind celiac was discovered. This probably buried Haas in the footnotes of celiac disease and the effectiveness of the diet for Crohn’s was lost until Elaine Gottschall wrote Breaking the Vicious Cycle. Since the book was published, many people suffering from various bowel disorders have reported success if they were very strict in following the dietary recommendations Gottschall laid out.

I call this my weak evidence because anecdotes are not data. There are also a substantial number of people who fail on the SCD – adherents might say that’s because the failures couldn’t stick to the program, a view which I tend to agree with, but which must be taken into account when applying proper skepticism. SCD also lacks a specific mechanism for how it treats the diseases it appears to alleviate, which makes it less useful when one is trying to synthesize disparate sources into an overall hypothesis or worldview. So the SCD is intriguing, but barring clinical trials will remain only intriguing for the mainstream.

For our purposes, the collective anecdote of the SCD community provides a partial test of the hypothesis. The SCD also allows invert sugar (honey) and nuts in the form of nut flours in the diet. I’m somewhat curious about the nut flours, since many nuts appear to have a fair amount of starch in them, and leery of the sugar for other reasons. I wonder if some of the SCD failures have been caused by people falling into the candy cigarettes trap of trying to fake themselves out with “bread” made from walnut flour.

On to the second test of the hypothesis. Wolfgang Lutz was an early low-carbohydrate diet promoter. He practiced in Austria in the 1970s, and wrote a book entitled Leben Ohne Brot, or in English, Life without Bread. The book is fairly standard low-carb fare until the end, where the authors detail how various medical conditions responded to low-carbohydrate diets.

When I hit this part in the book, I started skimming until I hit the gastrointestinal disorder section. That’s when I discovered a truly jaw-dropping graph for any Crohn’s sufferer. If I weren’t suddenly inspired to obey copyright law, I would reproduce the original here, but instead I’ll just describe the results: Lutz claimed an 80% remission rate after six months of nothing more complicated than low carb dieting.

That’s either complete bull or a very powerful, if overly broad, confirmation of the hypothesis. People following Lutz’s diet are allowed 6 “bread units” a day – basically, the amount of carbohydrate in six slices of bread, or 72 grams – and so one can imagine that the diet of the 80% who were successful contained plenty of starch. If so, then the hypothesis would actually be falsified, since the starch and fiber restrictions would be shown to be irrelevant, or at least overly strict. But that information is not forthcoming in the book and I doubt that it would be possible to obtain the food logs of patients from the 70s at this point.

We can’t fully trust the Lutz results because they were not verified via clinical trial. The patient records of a practicing doctor can be considered very powerful arguments in the justification of a trial, but are not themselves as compelling as the results of a well run trial. So again, we must remain skeptical.

Thankfully, we don’t have to leave it at that.

How (and why) to test this yourself

The essence of science is the testing of ideas by experiment. Here we have an eminently testable idea, one you can test in your very own home. You don’t need a particle collider to change your diet and observe the results. Here’s how to run the test:

1) Start eating according to the low-starch diet outlined by Ebringer. This may not be readily available on the internet so I’ll reproduce the basics here:

a. Eliminate grains, sugar, all starchy vegetables and legumes (basically anything that isn’t green and crunchy), fruits and nuts.

b. Replace the eliminated foods with fatty meat and non-starchy vegetables.

Your goal is to completely get rid of all the starch in your diet. All of it – don’t compromise, don’t wimp out, don’t pine away for an ice cream cone and cheat. Your mindset should be that of a boxer stepping into the ring or a marathoner taking the first step in the race – you are in a fight here, a fight where you don’t get to make many mistakes, a fight which quite literally might determine how the rest of your life plays out.

2) Continue this diet strictly for at least six months. Work with your doctor on your medications; most aren’t too happy if you just drop them cold turkey, and if you are on steroid therapy quitting cold turkey can be very dangerous to your health. I’ll say that again: if you are taking predisone or another steroid, do not quit cold turkey!

3) Let us know how it turned out!

Many people respond to the diet proposed with horror. No more cookies? No more cake? No more bread? Are you insane?

My response is simple: no, I’m not insane. You give up all of those things, but you also might get to throw your pills away forever. You get to take your health back forever. Rather than cycling through flare-ups and getting progressively more disquieting reports on your colonoscopies until you eventually end up with a colostomy bag, you can take control of your future and maybe avoid that fate. You can avoid a huge increase in risk of prostate and bowel cancers. You can avoid the late night sessions sitting cramped on the toilet wondering what the hell is going on and when it’s going to end, and the creeping despair inherent in the knowledge that tomorrow you’re going to have to pop several grams of medication just to stay alive.

I can’t promise anyone that this diet will work. I still don’t know if it will work. I can say with certainty that I do not have any symptoms of Crohn’s – I have no pain or diarrhea, I’m gaining rather than losing weight, I feel great – but even if my next colonscopy is so amazing that doctor thinks I lied about the diagnosis I still can’t say with certainty that the diet did it. I’ll probably live my whole life wondering. But at least that life won’t be lived as a slave to a bottle of pills, and maybe, if I’m lucky, enough people will try this diet and diets like it that the mainstream will take notice.

So if you’re still with me at this point, I sincerely hope you give it a shot. By way of offering support, feel free to shoot me an email and ask for help or let me know how things are going. I'm always interested in hearing from people who have tried a dietary approach - whether it worked or it didn't.

Good luck!

May Weights and Measures

Tenth monthly roundup of measured data and analysis.

Data

Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:

http://www.forefrontpb.com/phildiet/Diet%20Records.xls

The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.

The "Weight Chart Daily Graph" worksheet shows the daily morning weight.

The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.

I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.

Analysis

So may got interesting!

The pain from my mystery steak buffet illness subsided until it was time for the endoscopy. Of course, at that point I was something of a hypochondriac and I was aware of every burp or stomach rumble, but by that point nothing hurt anymore. As I walked into the center I thought, “Great, do I really need this?” Nothing like wasting money on a medical test you don’t need. But I was there and I hadn’t had an endoscopy in years, and ignoring medical conditions has bitten me in the ass repeatedly, so in I went.

The nurse prepping me asked what I was in for. Eventually he found out that I had Crohn’s and said, “Oh I have that too. How do you manage it?” That put me in the awkward situation of trying to explain this great diet that’s working really great except for that whole two day crippling pain episode. I think he was just trying to kill time though, so I didn’t get much of a reaction.

My gastro arrived and started reviewing the results of my blood tests while I was lying on the gurney. My fasting blood glucose was pretty low (73) and he joked that I should eat a piece of bread. Har har. I am somewhat intrigued by the low reading and I’ll probably get around to doing a glucose meter experiment one of these days.

Then they knocked me out. I woke up and the doctor said, “Doesn’t look like anything significant. We took some biopsies, we’ll let you know how they turn out.” Great! Nothing significant. I had just wasted everyone’s time – outstanding.

I went about my life as usual for the next week or so. I started lifting weights again at the end of April, just squatting. I wanted to see if I could break my previous record and didn’t really care about the rest of the lifts. Of course, that’s “not doing the program”, and I wasn’t eating enough, so all in all it was a moderate to severely stupid plan. More on that later.

I got a voicemail from a nurse at the endoscopy center saying, in total, “We got the results of your biopsy and you definitely have GERD. You really need to be on Nexium. Call us if you need a prescription or if you’ve run out.” Since it was a voicemail I couldn’t respond with, “Wait, the doctor said it wasn’t anything serious. What the heck?”

I did a quick research blitz, which lead me to Jonathan Wright, who claims that low stomach acid is the cause of 90% of heartburn cases. I dutifully tried the acid treatment recommendations: take one betaine HCl pill with a meal, see if you “feel a burn”. Keep adding a pill until you either feel a burn or something bad happens, and then back off one pill. As near as I can tell after three tries, the result of taking a stomach acid supplement was nausea and diarrhea. Since I didn’t have visible heartburn symptoms to begin with, I had no way of evaluating its reflux fighting power. Ok, back to square one.

I scheduled an appointment and talked to the gastro. He showed me the biopsy report, which did indeed claim that I had “moderate chronic reflux”. The “chronic” part was surprising, since I hadn’t noticed any reflux or heartburn symptoms at all until that one event. The doc mentioned that some people don’t feel the reflux, and that perhaps I was one of them. He rattled off a few meds I could try, none of which were appealing. He was unimpressed with the acid hypothesis and said that I was too young to have to worry about that. End result: I walked out with a prescription for some drug “if I wanted to try it” and a recommendation for another endoscopy in a year to see how I was doing.

More research. This time I ran across Ricardo de Souza Pereira, a doctor from Brazil who had compared a supplement with a Nexium precursor drug to see which was better at controlling heartburn symptoms. The supplement won hands down. That caught my attention. Dr. Michael Eades (see blog) had apparently come across this before and tried to market it in the US with no success. He’s got a very interesting blog post about that whole process. He also hosts a summary of the study, which helpfully gives the supplement ingredients.

After doing some more research, I discovered that melatonin appears to be the critical ingredient. There’s an anecdote about a woman who was able to control her heartburn with 6mg of melatonin before bedtime. The therapy is founded on the fact that melatonin, often associated only with the pineal gland and sleep, is also secreted by your gastrointestinal tract for unknown reasons. The way it works on hearburn is, in theory:

“However, others concluded that the esophagoprotective activity of melatonin against GERD might be related to the inhibitory effect of this indole on gastric acid secretion and due to stimulation of gastrin release, which might attenuate the gastro-esophageal reflux by stimulation of the contractile activity of the lower esophageal sphincter”

A more recent study (quote above) comparing melatonin with omeprazole had some very interesting results. (Sidenote: omeprazole is basically Prilosec, which, when its patent expired, was trivially altered into Nexium, which was then patented again. Gotta keep those patents. So Prilosec is widely used in research as a stand in for prescription heartburn medications.)

The most interesting, and I think important, dichotomy here is the fact that melatonin generated significant increases in LES tone while the omeprazole only created “non-significant” increases. Since reflux is fundamentally a disorder of acid entering the esophagus, melatonin does a better job of treating the fundamentals of the disorder.

In any event, after reading up on that I went to the store and started taking 6mg of melatonin before bed. Again, since I have no obvious heartburn symptoms, this experiment is very difficult to judge. As far as I can tell, the only result has been MUCH deeper sleep. That was a welcome side-effect, since I’m usually the sort of sleeper who will wake up if a mouse farts in the house next door. I’m still looking for studies on the long term effects of melatonin supplementation, but so far I’m happy. We’ll see how it goes.

Since GERD is a clear indication of dietary failure, I went back and reviewed my food choices up until now. My clear reliance on dairy might be a significant contributing factor, but it’s really damn hard to get enough fat without dairy. So I’m not sure if I can give that up as of yet.

I had always been intrigued by the specific carbohydrate diet, which I suppose I am now doing a rather extreme version of, and thought, “Well they eat yogurt. I should see how.” The end result of that line of inquiry was me making homemade yogurt for the first time. It came out pretty watery, but after letting is strain through a cheesecloth for a couple hours it thickened up into some pretty decent (super sour) greek yogurt. I bought a tub of full fat Fage yogurt at the grocery store and my stuff tasted about the same, just a bit more sour. I suspect this was because I fermented mine, or at least tried to ferment mine, for 24 hours, whereas the commercial operations probably only do it for half as long.

If the Klebsiella Pneumoniae connection is true, I really don’t want lactose getting into my large intestine, so I might have to start fermenting my own yogurt from here on out. I need to make some modifications to my system before that’s really a sustainable activity, but it’s actually a pretty simple thing to do.

A final note on weight lifting. It turns out that only working one exercise and not eating a lot of food still results in you stalling. I can’t seem to get 170lbs for 3 sets of 5 on my squat. Since this is a pathetically weak squat for an adult male, I suspect that it just happens to be the weight at which underlying form issues are exposed to the point where I can’t force my way through it. So I guess I’ll be working on form for a while, eating a lot more and doing the damn program.

Ten months down, two to go (holy crap!)

April Weights and Measures

Ninth monthly roundup of measured data and analysis.

Data

Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:

http://www.forefrontpb.com/phildiet/Diet%20Records.xls

The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.

The "Weight Chart Daily Graph" worksheet shows the daily morning weight.

The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.

I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.

Analysis

April was uneventful up until the weekend of the 17^th and 18^th. I was driving back from VA after a weekend of paintball and noticed a sign advertising 20oz Porterhouse steaks for $14. I demanded that the whole team pull off the highway and eat dinner there, so we did. It turned out to be a steak buffet (they have those!) and everything seemed to be great. I ate some steak, a porkchop, and a piece of meat from some stew thing.

Within a few hours I was burping like crazy and felt like the top of my stomach was bloated. The next day, Monday, everything I swallowed hurt like hell as it entered my stomach. I ignored it for Monday, but when things continued on Tuesday I capitulated and went to a GP. She referred me back to a gastroenterologist in the region.

I got my medical records from my previous gastro and went to my appointment. The new guy flipped through everything, raised an eyebrow when I told him I wasn’t taking any medications, and then dropped an offhand bombshell when he said, “Well there’s some debate as to whether Pentasa actually helps people with Crohn’s.” So what the fuck have I been doing for the past five years?

He seemed slightly bemused by my approach but was otherwise supportive and even mentioned a couple of probiotic supplements that he had heard worked well. Overall, I think I definitely came out ahead by switching gastros: closer to my house, more supportive, less rushed and actually appears to be willing to listen when I talk rather than wait for me to shut up.

Anyway, the pain subsided in a day or two and now I just burp all the time. This is, of course, annoying, and I will be getting an endoscopy in early May to rule out any serious problems. Meanwhile, I get to wonder how it is a diet which is usually a cure for this sort of problem appears to have given me massive indigestion. Hmm.

Nine down, three to go. Wow.