Wednesday, June 13, 2012

Fibromyalgia Relief Diet: How to DIY

Readers interested in the raw paleo+supplement diet that I've proposed for fibromyalgia might be wondering how to put this into practice. There's a lot to read--you can skip parts if you want to--but the better you understand how this works, and the more lousy conventional wisdom you dispense with, the more likely you are to stick with it and fine-tune it to your needs.

The basic ideas:

Fix any leaks in the gut. A strict paleo diet eliminates foods like grains, potatoes and legumes that can cause this problem, allowing the gut to heal. (UPDATE 6/27/2012: Avoid an additive called carrageenan. It's a neolithic food and an inflammatory.) This may also help with autoimmune diseases.

Stop ingesting antinutrients that interfere with magnesium absorption. Grains and legumes have antinutrients (search for "phytate" at Google Scholar if you're interested). Antacids keep you from absorbing magnesium (and calcium, zinc and iron) and interfere with protein digestion (scroll down for the pictures). The good news here is that this same diet will cure acid reflux--as long as you go easy on the carbohydrates. (I had acid reflux so bad that it gave me an esophageal ulcer. A low-carb diet cured it, and I quit my acid blocking medication for good.) A suggestion: do low carb (roughly 50g of carb per day or less) for a few days before quitting your antacids. If you need an antacid later, drink 1/2 teaspoon of baking soda (sodium bicarbonate) dissolved in a cup of water.

Eat a magnesium-rich paleo diet. What is a paleo diet? It's food that our ancestors lived on for millions of years (the Paleolithic Age) before the advent of farming (the Neolithic Age, starting about 10,000 years ago). Think of foods you could get with a spear or your bare hands in the wilderness, and prepare with simple stone tools. Don't think of this nonsense. (Where does Dr. Oz think prehistoric man got pasta makers?) Vegetables, seafood and nuts are the food groups with the highest levels, gram for gram, of magnesium. Like Julianne Taylor, I think lightly cooking the food is fine. The idea is to avoid foods like grains, potatoes and legumes that must be cooked, as well as dairy.

Supplement with magnesium. Dr. Michael Eades, who has treated thousands of patients with a low-carb diet, has some tips on magnesium supplements (what kind and how much), as well as getting started on a low carb diet. I say low carb--unless you are already on a low carb or Zone type of diet, a paleo diet will likely see you reducing the amount of carbohydrate you eat. Since conventional diet advice (low-fat, low-sodium) will make you feel lousy on a low-carb diet, it's important that you read Dr. Eades's blog posts linked to above. If you take blood pressure or diabetes medications, start your low carb (or reduced carb) diet with your doctor's supervision: you'll likely need to reduce or stop your medications. If your doctor gives you a hard time, don't argue. Just ask him or her to monitor you.

Stick with it. It's important to have some support and not to get bored with your new diet. Mark Sisson runs a positive, supportive blog called Mark's Daily Apple; he also wrote The Primal Blueprint and The Primal Blueprint Cookbook. The cookbook isn't strictly paleo, but with a few substitutions (coconut milk for dairy, coconut oil for butter) it's a terrific resource. Julianne's Paleo & Zone Nutrition has some good archives; here's a post on what you can and can't eat on a strict paleo diet. Dr. Seignalet's raw paleo program is here on her blog. Fluent French speakers can order Dr. Seignalet's book or join a site for aficionados of his program. Information junkies should get The Paleo Answer by Dr. Loren Cordain; his blog, published research and other information from his 30 years of research in paleontology are on his site.

What to expect. Here's a case study of a patient of Dr. Robert Hansen, a board certified physician at the Therapeutic Pain Management Clinic in Redding, California. (I don't know how typical this case is.) Dr. Hansen started seeing this patient in early June 2010, and she took a month or so to start strictly adhering to a paleo diet. Results:

A follow-up phone call on November 29, 2010 revealed that she continues on the Paleo Diet and has required no opiate pain medications. This patient had suffered symptoms for over two years, and had a dramatic response to Paleo and exercise. Her irritable bowel syndrome is completely resolved, though she ate beans one day and suffered GI symptoms. As a result she has been strictly Paleo since that time.

Her diffuse joint pain is completely gone, though she does experience muscle pain ranging from 3-5 on a scale from 1-10 on an intermittent basis. The frequency and duration of these painful episodes are markedly diminished compared to their initial presentation. She is sleeping well, and is enjoying a physically active life in marked contrast to the prior two years of symptoms.

Dr. Hansen adds,

My experience with prescribing the Paleo Diet has been that when patients comply they lose weight and feel better. I have had a patient with severe Rheumatoid Arthritis who achieved dramatic improvements within one month of Paleo. He was able to cease using a medication that he had used for 10 years. Previous attempts to stop that medication resulted in a worsening of his Rheumatoid Arthritis pain and joint swelling....My son and I have been following the Paleo Diet for about one year (following a one year trial of a vegan diet). My weight is down 40 pounds from its peak, and my waistline has decreased from 40 to 34. My symptoms of osteoarthritis have improved and my blood pressure is down to the "normal" range. We take omega three supplements (EPA and DHA) and Vitamin D-3. 

Potential Challenges

If you go on a low carb diet (50-100g per day, depending on your size), you'll go through what's called keto-adaptation. That means your body converts from running on sugar to running on fat. Dr. Eades makes an analogy:

When you’ve been on the standard American high-carb diet, you’re loaded with enzymes ready to convert those carbs to energy.  You’ve got some enzymes laying in the weeds waiting to deal with the fat, but mainly dealing with it by storing it, not necessarily burning it.  All the pathways to deal with carbs and their resultant blood glucose are well-oiled and operating smoothly.  Then you start a low-carb diet.  Suddenly, you’ve idled most of the enzyme force you have built to process the carbs in your diet while at the same time you don’t have a ready supply of the enzymes in the quantities needed to deal with your new diet.  It would be like a Ford automobile factory changing in one day into a plant that made iPads.  All the autoworkers would show up and be clueless as how to make an iPad.  It would take a while – not to mention a lot of chaos – to get rid of the autoworkers and replace them with iPad workers.  In a way, that’s kind of what’s happening during the low-carb adaptation period.

Over the first few days to few weeks of low-carb adaptation, your body is laying off the carbohydrate worker enzymes and building new fat worker enzymes.  Once the workforce in your body is changed out, you start functioning properly on your new low-carb, higher-fat diet.  The carbs you used to burn for energy are now replaced to a great extent by ketones (which is why this time is also called the keto-adaptation period) and fat.  Your brain begins to use ketones to replace the glucose it used to use pretty much exclusively, so your thinking clears up.  And the fatigue you used to feel at the start of the diet goes away as ketones and fat (and the army of enzymes required to use them efficiently) take over as the primary sources of energy.  Suddenly you seem to go from not being able to walk out to get the morning paper without puffing and panting to having an abundance of energy.  Because of this low-carb adaptation period, we never, ever counsel our patients to start an exercise program when they start their low-carb diets because a) we know they’ll be too fatigued to do it, and b) we know that in a short time they will start exercising spontaneously to burn off the excess fat on their bodies once the skids are greased, so to speak.

Again, don't do low fat (think low carb, high fat, adequate protein) or low-sodium (your kidneys will be dumping excess fluid) or low-calorie (eat if you're hungry).

I'll be honest: if you're coming off a major sugar habit, like Jimmy Moore describes in The Art and Science of Low-Carb Living, you could be in for a rough few days:

In those first few days, I went through major carbohydrate withdrawal. After all, up to that point I'd had a 16-cans-of-Coke-a-day habit, along with eating whole boxes of Little Debbie snack cakes (among other things). For a while, I felt like I wanted to kill myself--I'm not kidding! The sugar withdrawal was excruciating--perhaps as strong as someone trying to detox from crack cocaine.

Like any detox, the unpleasantness was temporary.

Now that I was consuming a satisfyingly health high-fat, moderate (adequate) protein, low-carb diet, my body seemed to be "at peace" metabolically speaking. I could sense that this was the way of eating my body had been longing for all along, and now it was rewarding me for feeding it properly.

Some people get wheat withdrawal--seriously. Dr. Williams Davis, a practicing cardiologist who prescribes a wheat-free diet for all his patients, writes in Wheat Belly,

Approximately 30 percent of people who remove wheat products abruptly from their diet will experience a withdrawal effect. Unlike opiate or alcohol withdrawal, wheat withdrawal does not result in seizures or hallucinations, blackouts, or other dangerous phenomenon.

The closest parallel to wheat withdrawal is the nicotine withdrawal that results from quitting cigarettes; for some people, the experience is nearly as intense. Like nicotine withdrawal, wheat withdrawal can cause fatigue, mental fogginess, and irritability. It can also be accompanied by dysphoria, a feeling of low mood and sadness. Wheat withdrawal often has the unique effect of diminished capacity to exercise that usually lasts from two to five days. Wheat withdrawal tends to be short-lived; while ex-smokers are usually still climbing the walls after three to four weeks, most ex-wheat eaters feel better after one week....Removing sugar sources forces the body to adapt to mobilizing and burning fatty acids instead of more readily accessed sugars, a process that requires several days to kick in. [Remember keto-adaption? -Ed.]

Yes, these are challenges, but look at it this way: would you give cigarettes to someone in nicotine withdrawal? Or encourage them on their path to better health?


tess said...

terrific article, Lori -- concise and comprehensive! "Where does Dr. Oz think prehistoric man got pasta makers?" [evil grin]

Lori Miller said...

Thank you very much, Tess.

Dr. Oz needs to take a sabbatical to catch up with the research from the past few years.

Rachel said...

Hi Lori! I just found your blog by doing a search for Fibromyalgia and paleo :) Sorry I'm so late to the party. I've also gotten rid of my Fibromyalgia pain by going paleo. Although now I'm just gluten, dairy, and soy free. So happy to see others blogging about it. When I first started my blog I felt like no one was talking about how Fibro pain could be helped with diet changes.
Looking forward to reading more of your posts. Does your blog have a Facebook page or twitter account?

Lori Miller said...

Welcome, Rachel. I'm not a fibromyalgia sufferer myself, but started LC (mostly paleo) because of GI problems. The fibro articles were for a friend of mine.

Sorry, no facebook or twitter account, but Michael Eades is always posting something interesting on Twitter.