Ski Racer and Low Carb Eater Lindse Vonn

FROM SHELLEY – Readers provide some of the best comments and questions for meandmydiabetes.com.  That’s the case with this series of questions from Fred, regarding high performance athletes and low carb diets, which he posted in an earlier interview with Steve Phinney.  Steve has now responded to Fred’s questions, complimenting Fred’s astute observations and giving further details.  Read on for the exchange between Fred’s  comments and Steve’s replies. 

(PS – For more information on Steve Phinney’s views, check out his books, The New Atkins for a New You, and The Art and Science of Low Carbohydrate Living.  And here on this blog, here all all the interviews that feature Steve Phinney.)

FRED COMMENTED:  I’m familiar with Phinney’s work, mostly through this NIH PubMed article.  Much of what he talks about in your interview is also discussed in his paper but, in his paper, he referred specifically to athletes engaging in sub-maximal activity, around 70% and decidedly aerobic in nature. He also states in the paper that a low-carb diet would probably not be appropriate for competitive athletes.

STEVE PHINNEY REPLIES:

That paper was written 8 years ago, and much has happened since.

1.  We used to have concerns about long term use of low carb where potential risks were not outweighed by obvious benefits (as in diabetics such as yourself).  Since then, we have demonstrated (among other things) that a well-formulated low carb diet reduces serum levels of saturated fats despite copious saturated fats in the diet, that a low carb diet markedly reduces levels of small, dense LDL (the most atherogenic version of ‘bad cholesterol) while raising HDL cholesterol, and that biomarkers of inflammation are reduced by a well-formulated low carbohydrate diet.  Given these demonstrated benefits where we once thought risks might lurk, there are now much lower barriers to looking for more subtle benefits of carb restriction.

Sled Dogs Eat Low Carb

2.  Mike Davis’s work with racing sled dogs adapted to a low carb diet has markedly changed our views about the necessity of glycogen at competition intensities.

3.  A number of professional athletes (eg, Mardy Fish and Lindse Vonn) have gone public about reducing carbs (and there are many others who remain a bit more shy), but it is no longer a secret that both training intensity and volume can be better sustained by some athletes across a prolonged season when carbs are restricted.  See for example the NY Times interview with Lindse Von containing this quote:

Vonn has also sought the advice of a nutritionist, hoping for an energy boost to get her through the nearly 40 races of the World Cup season.

“I always ate healthy, but it wasn’t scientific,” she said. “Now it’s a high-protein diet and no carbohydrates. I have more consistent energy and I don’t get tired after a meal. It does take a very detailed meal plan.”

4.  Jeff Volek performed and published a study of low carb diet plus endurance vs resistance training, showing no restriction in training effects with dramatic improvement in body composition with the combination of low carb plus resistance work.  (Strength & Conditioning Journal:  February 2010 – Volume 32 – Issue 1 – pp 42-47).

FRED COMMENTED:  From your interview, his position appears to have shifted considerably to advocate a low-carb diet for all types of strenuous training, including training for maximal effort activities such as sprinting.

STEVE PHINNEY REPLIES:

For sprinting events, the effects of keto-adaptation are quite variable across athletes and specific events.  One also needs to differentiate between the diet followed in training versus preparation for the event per se.  There are some trainers who advocate ‘train low, perform high’, but I have not seen that supported by objective study.  But given that Lindsey Vonn’s events last about 120 seconds, the neuromuscular intensity of her performance is about as high as it gets.

FRED COMMENTED:  The paper I referenced is from 2004 and could most definitely be out of date if there is more current research from Dr Phinney on athletes engaged in maximal effort. The evidence he presents, on humans, however, seems to be more anecdotal,

STEVE PHINNEY

Certainly the evidence cited above is a combination of both objective research and anecdotes.  In some sports, such as 100-mile ultra-endurance trail runs, individual performance improvement is turning heads.  You can expect to hear more about that in the coming year.

Shelley’s Note – And here’s a lovely video of a very young low-carb athlete.

We lost our dog Brian.  He was 12 years old.  His back legs were rickety and on slippery linoleum, sometimes he would fall.  He was going deaf, and sometimes you had to get right next to him before his ears would prick up and he would hear his name.  Brian was a big yellow lab, and at 85 pounds, he needed a ramp, and my help keeping him in balance, to get into the car.  His dad had died at 9, so we knew he came from a shorter-lived family.  But his eyes were still bright, and once we got on a trail, Brian loved to run.

He still loved to prance up to the other dogs and act like a king.  He was a sweet dog, and a gentle dog.  Years ago, he figured out that cats don’t like a dog’s hello, meaning sniff the nose, sniff the butt and then go play.  He always greeted our cat, Andy, in the catlike way, which meant that Brian would lower his head to the height of Andy, and let Andy rub his face against Brian’s forehead, then he’d let Andy curl back and forth in between his legs.  Brian knew that when our 2-year old neighbor, Rio, came over, it worked the best if Brian would  lie down and wait for Rio to get curious, and get over his bit of fear about dogs.  And then Rio would pet Brian, and Brian’s eyes, clear-eyed until the end, his eyes would shine.

I had planned for some time to do a series about Brian’s health, commencing back in 2010 when the wobbliness in his back legs that was already evident when he was a puppy, started getting much more rickety, and we stepped up our diligence on feeding Brian a low-carb, high fat diet.  I wanted to share how this diet helped him stay in better shape.  I think it did.  Here’s a video of Brian, age 11 1/2, back in June, running to catch the great joy of his elder years, which was a dog-toy – a special soccer ball.

Click here to view the embedded video.

As for what Brian ate, almost every morning, it went like this:

• 1 chopped raw zucchini or other vegetable such as broccoli
• 1 avocado
• about 5 ounces of raw chicken or hamburger (the not lean hamburger, such as 30% fat)
• Something like 30 grams of olive oil or Udo’s choice oil
• Some glucosamine powder for all those rickety joints

That meal came to Brian every morning, in a ritual where Greg required that Brian sit  and wait until Greg grinned and said, “Okay!”  Then Brian would race to his food bowl, and eat in one big inhaled gulp, though really, he always ate his favorite item first, which was almost always the avocado.

Naturally we snuck Brian a few treats all through the day.  A slice of cheese from Greg.  When we’d eat raw, unsalted nuts, Brian would sit and wait quietly, and we’d give him one.  And then there were the special treats of leftover bones from lamb and beef.  In his younger days, Brian never wanted us to see how fiercely he tackled these  He would hurry outside, where he’d dispatch them, showing all his teeth, and keeping at it for hours on end until all that was left was a bone so bare that it looked as if it was fossilized.  Chicken bones?  He ate those like pretzels, in three quick cracks.  In his older years,  he preferred not to take unneeded steps and sometimes chewed bones right in front of us.  Over the years, we learned that if we gave Brian too many bones in a single day, it put too much hard stuff into his digestive tract, and then he’d have a day of constipated poop.  So we gave him bones on a more moderate schedule, and then his digestion settled back into a normal, smooth, regular as a clock, non-smelly poop.  Except when he was spending the night with friends, or with extended family, eating “normal” dog food, in which case his poop got softer and  smelly, and sometimes even runny.  It seemed the way he normally ate really matched with him.

Brian loved to hike . . . any hike.  But as he grew older, he did best on level ground, although a walk on a leash in the neighborhood was terrible for all of us.  Brian would get so bored, he crawled.  He’d realize how much his feet hurt, and  we’d have to drag him home.   As for throwing tennis balls?  He loved that in his younger years.  Out on a trail he’d race those green, fuzzy, zooming balls and catch them in a curling somersault.  He loved to do that, but over time, with his inborn wobbliness already, all those somersaults  messed up his back.  So we threw tennis balls less, and then discovered something better – a dog’s soccer ball.  The ball was soft enough that Brian could grab it in his jaws.  It was tough enough that it never punctured.  It had a handle so that I could carry it without getting all gooped up.  And it was slow enough, he didn’t twist so much.  We all loved that soccer ball, and it made going out on the trails so fun, I learned that Brian had a lot more energy than I had suspected  from taking him for a sidewalk tug-and-pulls around the block.  Out on a trail, with that soccer ball, Brian, age 12, would prance.  He’d run to get it.  We could go three miles and half the time he’d be at a run.

I am grateful for those times with that soccer ball.  I can see in my mind’s eye how Brian would jump into a stream on his gimpy legs to retrieve the ball, over and over until finally, he’d had so much fun, he’d stop and shake in a shower of sparkling water drops, and then he’d gaze up at me ,wag his tail and give me such a happy grin . . . he didn’t notice that he had dropped his beloved soccer ball, and now it was racing away with the creek’s strong current . . . which led me to run into the creek and save it for him.  I loved the way that he was happy when I did that, and his sweetness on those trails, so that even though he had more trouble keeping his balance on the linoleum, and yes, it was clear he was getting older, those times on the trails, those times when he greeted our cats, those times with our 2-year old neighbor, so many times.

The last video I took of Brian with his soccer ball was in the snow, sometime in December.

Click here to view the embedded video.

Brian loved the all that sparkling, fluffy white.  Then just before Christmas, we had an especially heavy snow.  After 2 hours of shoveling and snow still falling,  I didn’t feel like going for a run with him.  So Brian was bored.  I found him chewing on something  – an old leather glove.  He had chewed off three fingers and part of the center.  I took it away, but didn’t worry – he had chewed on socks and shoes and children’s toys from the time he was little.  So what, about a glove?

The next morning, the sky was blue and clear.  We headed to his favorite trail beside the creek.  I threw the soccer ball.  Brian ran, he grinned and had a lot of fun.  But when we got home, getting down from the car ramp, Brian lost his balance and fell off.  I lifted him up, and he wagged his tail and limped inside and seemed to be getting better.  But when we came back from a neighborhood party that night, Brian wasn’t in the house.  We looked all through the yard and finally Greg found him, huddled in a corner, in the coldness of all the brand new snow.  It took Greg and I, together, to carry him to his dog bed.  He threw up, undigested slices of the morning’s  zucchini.  He seemed in the kind of pain that isn’t a wincing, crying out pain, but the kind that calls for serious work, and no noise, and short breaths, and eyes sunken down and far away.  Looking back, I now know what was happening.  At the time, I thought it was all because he had kinked his back when he fell off the ramp.  I slept on the floor, beside him, petting him, waiting for him to get better, as he always had when his back got sore.  By the early morning, he wasn’t better, so we called a 24-hour vet and took him in.

The x-rays indicated the start of pneumonia, but despite Brian’s age, the vet said Brian was healthy, we had caught it in time, and he had an 80% chance of pulling through.  Two hours later, the news grew worse.  There was also an obstruction in Brian’s gut.  Pieces of the glove?  The vet said it would take surgery to get them out.  His chance of survival was now 40%.  But Brian was a fighter, and the vet said that if all went well, in just four weeks, Brian would be back to his old self.  We okayed that surgery, but ten minutes later, the phone rang again.  The pre-surgery blood tests showed that Brian’s blood sugars , which had been in the 70s, had just plummeted to the 20s.  Which meant that  a sepsis infection was gobbling up all the sugar in Brian’s blood.  Which meant a poisonous infection had taken hold.  It was damaging every cell in Brian’s body, and it was getting worse.  It was out of control.  Even this surgeon who loves to save dogs, even he said it was time to let Brian go.

We called our sons in San Francisco.  As we told them the news, all our memories of Brian came flooding back.  All those times when our sons were little, and so was he.  The years of them becoming young men, as Brian grew old and sweet.  We asked our sons if there was a story they’d like us to share with Brian.  Walt said to tell Brian how much he loved how Brian would catch a tennis ball out of the air, without letting it bounce.  Amory said to tell Brian how much he liked that Brian really, clearly, loved all us us, and he also loved that HE was a dog.  We promised that we would tell Brian all of this.  At the pet hospital, they gave us a private room then carried Brian in.  He was clearly sedated.  His eyes were already  far away, and for months he had already been mostly deaf.  We tried to tell him how much he  meant to us.  But each time we began, in a normal, talking voice, it tumbled into sobs.  The only way we could say the words was to whisper them, up close his sweet old head, as though each word was a secret that got told the best where we could smell that nutty outdoor smell of his, and we could touch him, and pet him, and give him one more, final kiss.  We whispered  that there was no way to stop this kind of being sick, so instead of having him linger and get worse and worse, we were going to make it quick.  We shared the stories from our sons.  We told him how grateful we were to know him, and love him.  We thanked him for being such a good dog.  Then we opened the door for the vet to come on in.  Gently, he touched Brian’s paw, then he moved his hand up to where the IV line with the fluids and the sedatives was taped in place.  He stepped back, just for an instant, to adjust a knob on the heart monitoring machine, so its quiet beep went completely silent.  In that silence, as we petted Brian, as we kept on touching him, we watched the vet’s hands deftly moving a needle into the IV, then squeezing the plunger.  Brian’s breathing faded to nothing.  The vet checked his heart and said he was gone.

It was Christmas Eve morning.  Greg and I drove to the trail where Brian loved to chase the soccer ball  The snow was sparkling, the wide blue sky was above us.  The air was still.  It was a beautiful day for a walk like that.  We talked about Brian and how, in his honor, we’re going to keep walking and enjoying life.  Over the weeks since then, we’ve taken many walks.  Many friends have told us how much they, too, loved Brian.  Our sons, in San Francisco, made him a little  shrine.  It has a candle, a photo of them and their sweethearts, from Thanksgiving, all together, all hugging Brian.  And on the shrine they’ve also put an avocado. — Shelley

Barry Erdman is a licensed social worker who learned how diabetes can destroy health, when he was asked to provide counseling for a woman in kidney dialysis.  Over months he got to know her and care about her.  And he watched diabetes lead to her toes being amputated, then her feet, then her legs, and finally, to her early death.  In 2007, Barry was admitted to the hospital with blood sugars at the potentially fatal level of over 600 and the shock of realizing he had become a diabetic.  Since then, Barry has adopted a very low carb, adequate protein, high-fat diet.  His blood sugars now are typically in the 90s.  AND he’s found ways to do this while still being a vegetarian.  In fact, Barry leads a low, carb, vegetarian group on Facebook.   Barry also recommends 30 minutes of exercise a day and learning to manage stress.  Let’s listen in, as Barry tells his story. — Shelley

LISTEN (30 Minutes)

BARRY ERDMAN
I’m a licensed clinical social worker in private practice in Boulder.  I’ve been doing that for over 30 years.

And you also have a condition called diabetes.  How did that happen?

BARRY ERDMAN
Funny you should ask.  Being a vegetarian it never occurred to me that I would have this kind of illness at this late stage of the game.  I’m just about to turn 60.  It was quite a shock.  It was 2007.  It was after Thanksgiving when I started to realize something was wrong.

My eyes were blurry . . .

What were the symptoms?

BARRY ERDMAN
I was kind of ignorant.  I had no information at all and didn’t understand what diabetes was.  But I would sit in my office everyday and there was a digital wall clock and I started realizing it was blurry.  I couldn’t see the time any more across the room.  I decided to call the eye doctor to get an eye exam.  I thought well, it’s just time for my eye exam, and I need to get stronger glasses.

Did you have anything else going on?  Were you up at night urinating, or were you feeling extra tired or extra thirsty or were you hungry for sweets?

BARRY ERDMAN
I was drinking a lot of water and going to the bathroom a lot but that didn’t catch my attention  It was the vision that got my attention.  And even then I didn’t think it was especially wrong.  The eye doctor asked what the symptoms were and I explained going to the bathroom, and she said, you ought to get a blood sugar test.

So they pricked your finger or they took a blood draw to check how much sugar was in your blood.  What did they fine out?

BARRY ERDMAN
It was right around Thanksgiving.  My doctor sent the labwork in and then he went off on vacation and the labwork was sitting there.

So he wasn’t that worried.  He was thinking, let’s just do this as a safety precaution.

BARRY ERDMAN
He said, you probably have diabetes.  Just wait for the results to come back.

He was saying, after the holidays, we’ll check in on this again.

BARRY ERDMAN
I thought I was going to find out right away.  It turned out I didn’t get a call back from him because I learned later that he was out of town.  But I had a friend of mine who’s a physician call into the lab to get the results.

High blood sugars . . . and the emergency room

How high were your blood sugars?

BARRY ERDMAN
550

What is a normal blood sugar?

BARRY ERDMAN
Normal blood sugar varies depending on who you talk to. but below 100 would be nice.

So your blood sugars were five times higher than they’re supposed to be.  Is this dangerous?

BARRY ERDMAN
At the time I didn’t so because other than my vision being blurry, I didn’t think anything of it.  My physician friend and some other people talked me into going to the ER.  They took my blood sugar there.  It was 635.

Six times higher than it’s supposed to be.

BARRY ERDMAN
Still I didn’t understand what that number was. I don’t think anyone knows what the numbers mean unless they know someone who’s diabetic and understand what that’s all about.

That kind of high blood sugar, that can kill people.

BARRY ERDMAN
I suppose so.

Last will and testament . . .

So they said, you’ve got to go into the hospital now, because your blood sugars are so high.

BARRY ERDMAN
That’s right.

That must have been a shock.

BARRY ERDMAN
Sitting there, I was just kind of thinking, I need to get back to work tomorrow.  What am I doing in the ER so late.  I should go home and get some rest.  They were saying, no, you’ll need to stay here overnight and cancel your day tomorrow.  I wasn’t too happy about that.  They kept me overnight because I was so dehydrated. They rehydrated me with some solution.  Salt solution, I suppose, and they were taking my blood sugars and watching them come down.

One reason a person’s dehydrated at that point is because there’s so much sugar in their blood, their body is trying desperately to get the sugar out, so there’s a lot of urinating to try to get the sugars out.

BARRY ERDMAN
I was going to the bathroom, probably on the hour.

Your urine probably had huge amounts of sugar that your body wasn’t able to handle, so your body was dehydrated because of that.

BARRY ERDMAN
I think so.  At 3:30 in the morning, the nurse was asking me all sorts of interesting questions such as do I have a last will and testament and who is your next of kin.  And I was thinking, this is crazy.  I’m just here because my eyes are blurry.  Around 4 AM they brought in a folder from the hospital staff person who sits down with the patients to talk about diabetes.  She was away for Thanksgiving so they just had a folder with information for me to read.  Because I wasn’t getting much rest, I started going through this folder, which I later learned was the American Diabetes Association recommendations about what to eat, and what I need to do now as a diabetic.  So that was a rude awakening to go through this pile of literature.

Hospital food raised my blood sugars  . . .

At some point, they asked me what I wanted to eat for breakfast.  They were going to serve me breakfast.  My usual breakfast was a bagel or a banana, or some granola and soy milk.  When they delivered the breakfast, they told me I was on a restricted diet, and I said, no I’m not.  I’m a vegetarian but I’m not that restricted.  They said, no, we can only give you half a bagel and half a banana because you have to have a different diet now.

Because you’re a diabetic.

BARRY ERDMAN
Because I’m diabetic.  So they were attempting to serve me a diabetic recommended breakfast.

How did that work out for you?  Did it help your blood sugars stay level?

BARRY ERDMAN
At that stage I still didn’t understand what that was all about.  So I gladly ate the breakfast and later learned my blood sugars were still going up.

You mean that the food that you ate for breakfast that was supposed to help your blood sugars stay down made your blood sugars go up?

BARRY ERDMAN
That’s what was going on.  At the time I wasn’t aware of it. I just knew they were taking blood sugar samples and telling me they were keeping me there for awhile, and calling into the doc on call to find out what should be done.  Right before lunch, they were telling me I could go home.  Just as I was about to leave, they said, well your lunch is here.  It turned out to be vegetarian lasagna.  I thought, that looks pretty good.  I think I’ll eat that since I’m paying for this, I might as well scarf this down.  Before I got up to leave, the nurse came in to take my blood sugar one more time.  Then she said, sit down, you’ve got to inject some more insulin.  You’re not going anywhere.

You mean after you ate the vegetarian lasagna, zoom!  Your blood sugars went up again.

BARRY ERDMAN
I imagine in hindsight, they were giving me foods that made my blood sugars go up.

Why were these professionals, supposedly trained in helping diabetics stay healthy, why were they giving you foods that made your blood sugar go up?

BARRY ERDMAN
Well that’s a good question.  Someone ought to answer that someday.  My guess is that they were just following protocols that have been set up for a long time without ever being changed.

They were following protocols to give you foods full of carbohydrates, whether it’s vegetarian lasagna or half a bagel or half a banana.  All those have a lot of carbohydrates.

BARRY ERDMAN
Anyone who’s diagnosed with diabetes and they get their general advice from a doctor or even a specialist who’s certified to sit down with you as a professional and explain how to eat, the guidelines that they’re telling you about don’t necessarily have the goal of helping you stay healthy on your own.  The guidelines help you to stay in some kind of regime that requires medication or insulin to keep you eating something you’re familiar with.

What kinds of medications were you given in the hospital?

BARRY ERDMAN
I think one of them was Actos, and they also started me on Metformin.  They didn’t require me to be on insulin.  What was important is they had me set up with an endocrinologist the next day.  In the hospital, I think they were just there to hold me over until I could get a more accurate diagnosis and treatment for what I needed.

So while you were in the hospital, they did give you some insulin to get your blood sugar numbers down to a place that wasn’t so dangerous.  Then they said get out of here and go see and endocrinologist right away.

Get rid of potatoes, peas, pizza, (p)read . . .

BARRY ERDMAN
They happened to set me up with one of the better endocrinologists in town and an appointment the next day.  That’s when I started the real education into what’s needed.

You went to see Mel Stjernholm.  He’s been the head of the Boulder County Medical Society.  He’s been a longtime student, and expert, on diabetes.  And he believes that diet can make a big difference.

BARRY ERDMAN
He had a reasonable plan.  He said, just begin eliminating foods that start with the letter “P.”  Potatoes, peas, pizza, and he spelled bread with a P.  He said to do better, you need to eliminate the carbohydrates.

Goodbye pasta.

BARRY ERDMAN
Goodbye pasta.  It turns out those foods that begin with “p” are often staples for anyone who subscribes to a vegetarian diet.  Rice, pasta and bread are things most people would never think are unhealthy.

Not only do most vegetarians consider those healthy.  But the American Diabetes Association says people are fine eating those, sort of in half-portion sizes.  Meaning not as much as before, but the American Diabetes Association encourages diabetics to still eat these items.   Do you believe that’s good advice?

BARRY ERDMAN
I believe that’s what they tell people.  For myself, I learned quickly that it’s better not to eat any of those.  I personally recommend to other diabetics that the best way to stay healthy is to avoid carbohydrates at all costs.

Was that a slow transition for you, or was it quick for you because you didn’t want to have the symptoms of diabetes?

Kidney Dialysis  . . .

BARRY ERDMAN
It was quick in my case, because a memory that I had early on, was that, some years ago, I was called in from the Mental Health Center to work with a client who was diabetic in dialysis.  At the Dialysis Unit here in town.

Is dialysis where they basically filter your blood with a machine because your kidneys don’t work anymore?

BARRY ERDMAN
Dialysis is when you have no more kidney function and you have to be hooked to a machine to filter your blood.  It could be six to eight hours two to three times a week.

Dialysis is more common among people who’ve had diabetes a long time, because diabetes, if it’s not controlled, can destroy the kidneys.

BARRY ERDMAN
That’s right.  So at the time, as a mental health clinician, I was there with a Hispanic woman who they told me was suicidal.  When I got to interview her, I found out she was considered suicidal because she was drinking too much water.  They were warning her to go home and not drink water and instead suck on ice cube.  It was summer and it was hot, and she was thirsty and drinking more water than they recommended.  They thought this meant she was suicidal and losing her will to live.

Because she was thirsty and if you’re a dialysis patient, you have to limit your water intake.

Amputation . . .

BARRY ERDMAN
That’s right.  So weekly, I’d go over to the dialysis unit while she was there.  We’d pull the curtain, and we’d have a nice chat about her life and what she was going through.  There wasn’t much discussion about diabetes then.  It was more about person concerns.  Then one day, I came back to visit with her, and she had a bandage on her toes, and I asked her what was going on, and she said she had to have some toes amputated.

Because she was a diabetic.

BARRY ERDMAN
At the time, I was still so naive.  But I started to learn the hard way by learning that the amputation was part of what was going on with the symptoms of diabetes.  There’s something going on with diabetes that affects circulation in the body, and it affects the extremities first.

So, if this followed a typical progression, perhaps it started when poor circulation and nerve damage caused by the diabetes meant her toes lost their feeling.  Perhaps they had been scratched or had some other minor injury that went unnoticed, and they’d gotten gangrene or some other horrible infection that meant they had to be amputated.

BARRY ERDMAN
That was a kind of sad moment for her, though she wasn’t too discouraged.  But in my weekly visits with her, I saw how it all progressed.  First it was toes.  Then she had a foot amputated.  Then she had a leg amputated up to the knee.  Then the other leg.

Death . . .

BARRY ERDMAN
Then finally I came in one day and she wasn’t there.  I asked the nurses about where she was.  The nurses said, Oh, didn’t anyone tell you?  She passed away last week.”  So that was my rude awakening to what diabetes is all about.

Diabetes is the main cause of amputation in the United States.  Outside of war and accidents, it’s the main reason people have limbs amputated.

BARRY ERDMAN
Sad that’s the case.  And it’s totally preventable, and has a lot to do with how we take care of ourselves.

Getting back to your story, when you left the hospital in 2007, you were told you had diabetes.  You talked with a diabetes expert who is more open-minded than many, an endocrinologist named Mel Stjernholm who said stop eating carbohydrates.  And when you thought about what would happen if you did not follow his advice, you could picture this woman who had kidney dialysis and amputations and eventually died of her diabetes.

BARRY ERDMAN
She gave me the first hand experience of being with someone who’s suffering.  Being with someone in that empathetic dialogue as a therapist would be with a client, to really understand deeply what impact a chronic disease can have, and what toll it takes on someone’s emotional state and spiritual state and how it affects them and their family and shortens their life.  Hard to erase that.  That’s a memorable moment when you care about someone and then they pass away, slowly before your eyes.  So when I was diagnosed in 2007, I found myself thinking, now that I have this disease, I ain’t going to lose my toes.  What do I gotta do?  Immediately, I thought of a friend of mine who I had known for many years, who was a long-time vegetarian, like me, and who was also was a diabetic, and I remembered that he also was in dialysis, due to kidney failure.  So I immediately called him up and said, “Hey Tommy, can I come visit you in dialysis?  I want to check in with you and talk about what you’ve been going through.”  He said sure, so I went to the dialysis unit that he was in, and sat there with a roomful of people, perhaps mostly diabetics, who were there who had kidney failure also.  He began to remind me of his story of how, unlike me, he was diagnosed early on in life.  Like me, he was a long-time, tried and true vegetarian.  He went on to tell me that when he was first diagnosed he had thought that maybe if he ate brown rice and vegetables, maybe he could lick it.

Well Barry, your doctor had told you that you might be able to slow down your diabetes if you really cut out a lot of carbs.  Including rice.  Your friend in the dialysis unit is a vegetarian.  He’s a diabetic.  Does he cut out the carbs?

BARRY ERDMAN
My friend’s like many diabetics.  He has tried to eat reduced carbs, and he tries to stay away from them.  But he’s late stage, because he’s dependent on insulin and had no kidneys left.  He tries to be careful, but I noticed in having some meals with him that he would eat things that I wouldn’t eat.

Like what?

BARRY ERDMAN
He’d eat the potatoes and peas or vegetables that have more carbohydrates in them than I’m comfortable eating.

You observed all this, and you observed him in the kidney dialysis unit.  What did this lead you to think?

BARRY ERDMAN
I became highly motivated to do everything I absolutely could to avoid the scenario of needing insulin, and also like him, naively thinking I can lick this in some way.  So I’m going to try hard, at least for a while and see if I can reverse some numbers and prove the doctors wrong and maybe find some way that my pancreas can heal and perhaps produce some more insulin.

How is your friend doing?

BARRY ERDMAN
Sadly he’s not doing very well.  He’s moved from the area, so I’m less in touch with him.  But he continues to have very complicated health problems.

How are you doing?

BARRY ERDMAN
I’m happy to say that now, my blood sugar numbers are pretty close to being normal compared to someone that doesn’t have diabetes.

Low carb, lower blood sugars, lower weight . . .

When you went into the hospital you had blood sugars somewhere around 500 or 600.  Five times higher than normal.  What are your blood sugars now?

BARRY ERDMAN
My fasting blood sugars are sometime in the high 90s, low 100s if I snack the night before.  After a meal, I rarely see it go above 120.

There’s a number called the hemoglobin A1C that tracks the average blood sugar over the last three months.  What were your HA1Cs when you went into the hospital, and what are they now?

BARRY ERDMAN
My A1C at the hospital was 11.  And I thought, well that’s a small number.  No big deal.  Now I know that anything below 6 is preferred.  My last A1C was down at 5.4. Actually I checked again, it was 5.3!,)

When you went into the hospital, your hemoglobin A1C was double what it’s supposed to be, and now it’s below the threshold that’s considered dangerous.  It’s below 6.   What would you say about your weight before you went into the hospital?

BARRY ERDMAN
When I would go to the 9News Healthfair every year to get my bloodwork, I was told that I was overweight, and I was shocked, because I have always been fairly active, and I thought healthy.  I was even joking with the people that their measurements must be wrong because they’re considering me to be overweight.

Your height had stayed the same.  You’re just about sixty.  What is your weight now?

BARRY ERDMAN
After switching to a low carbohydrate diet, I pretty much dropped 30 pounds within a few months and an additional 10 pounds stretched out over more time.

Were you hungry?  Were you consciously trying to lose weight?

BARRY ERDMAN
Losing weight was never on the agenda.  It was just sort of a side effect of changing my diet and lifestyle routine.

You cut out carbohydrates and you lost weight.  Did you just eat fewer calories or did you eat something besides carbohydrates?

BARRY ERDMAN
I was mindful of eating smaller proportions, and I became pretty strict in cutting out specific food groups, like all grains, for example, and also continuing as a vegetarian, increasing certain foods that I wasn’t really eating much of before.  So I increased my intake of eggs and nuts, particularly the kinds of nuts that I wasn’t really partial to before.  And eliminating fruit, I think that’s the biggest tricky one, because I love mangoes and fruits and of course had a sweet tooth.  But since switching over to a low carb, high fat regime with moderate protein, I don’t have the sweet cravings anywhere near where I used to prior to being diagnosed

30 grams of carbohydrate a day . . .

Well, you’re eating more fat.  You’re eating fewer carbohydrates, you’re not eating all that much protein but you’re eating enough.  How many grams of carbohydrate a day do you think you eat?

BARRY ERDMAN
I don’t spend a lot of time trying to count it, but my guidelines are to shoot for 12 grams of carbohydrate for lunch and 12 for dinner, and lower for breakfast time.  Probably around six carbohydrates or less.

About 30 grams of carbohydrate a day is your rough ballpark.  The American Diabetes Association says that if anyone has fewer than 100 grams of carbohydrate a day, it can mean that they have poor brain function.  How is your brain?

BARRY ERDMAN
I had a lot of trouble, before I was diagnosed, focusing and paying attention.  Especially after lunch.  Looking back, I realize how much I was struggling, and no one told me anything about what was going on.  Since changing my diet, not only do I feel 20 years younger than ever before, my mind is sharper and I have a greater capacity to work with people and to think and to function better than I can remember.

Barry Erdman, the American Diabetes Association says that if you have fewer than 100 grams of carbohydrate a day, it might impede your health and it certainly it will mean that you have less energy.  And you’re eating around 30 grams of carbohydrate a day.

BARRY ERDMAN
Let’s not pick on them too much.  Let’s just focus on what’s important for people to know

For most diabetics, the American Diabetes Association is where they get their advice on how to take care of their condition.  If someone is in a standard public health program.  If they go to a doctor.  If they go to a registered dietician, they are very likely to hear advice that undermines someone’s attempt to eat a very low carbohydrate, high fat diet.  So there is a large institutional bias toward higher carb diets, even though much of the science, and many people’s personal experiences, match in better with what you’re finding for yourself on a high fat, low carb diet.  That’s why I’m picking on the ADA.

BARRY ERDMAN
While I join you and believe that is true, I think the dilemma is much greater than that.  What we really are facing is our own global beliefs about food and food production and what is a healthy diet and what’s a balanced diet.  The ADA and our medical consultants, even if they were to recommend what you are discussing today, very few people would be able to accomplish and feel successful at taking on such seemingly restricted guidelines, because of the way our culture is.  Because of our lifestyle.  The way that we depend on going out to eat and the way we cook and prepare food at home.  It may be that, due to the influence of drug companies and the difficulty of changing a culture, the advice that the ADA gives is kind of like shooting for what’s doable, rather than what’s ideal.

Breakfast is my favorite meal . . .

Vegetarian Omelet Spinach-Mushroom-Cheese

Well you’re doing this, though.  It’s not just an ideal.  You are doing a very low carbohydrate, high fat, moderate protein diet.  What do you have for breakfast?

BARRY ERDMAN
Breakfast is my favorite meal.  Each morning I have two or three eggs in the way of an omelet, stuffed with green leafy vegetables, or onions or peppers or mushrooms, sometimes with cheese, or with cheese alone.  I usually also prepare a kefir drink.  Homemade kefir.

Kefir’s a fermented milk drink where the microbes have eaten most of the sugar out of it and left behind other nutrients and microbial health.

BARRY ERDMAN
The reason I’ve chosen to have kefir drinks in the morning is because of the natural fermentation, where the bacteria and the yeast grow off of the sugars in the milk, the lactose, and about a third of it turns into lactic acid.  It has a yogurt consistency or flavor, but it’s a little better than yogurt because there’s additional probiotic benefits that occur in the fermentation process.

That’s what you have for breakfast is this combination of an omelet and kefir drink with a little bit of blueberries. Now is it a cup of blueberries or is it less?

Blueberries - Only 15

BARRY ERDMAN
We’re talking about maybe 10 or 15 blueberries.

You’re cautious about having a lot of blueberries, because you want to have less than six grams of carbohydrates in that breakfast.

BARRY ERDMAN
That’s right.  Blueberries have sweetness, but they also have fiber and anti-oxidants.

Do you have any mid-morning snacks?

BARRY ERDMAN
I’ll snack on some raw or organic cheese, and I’ll have some almond butter or almond nuts as a snack.

What about lunch?

BARRY ERDMAN
Because of my work schedule, I’ll just have some foods that are from leftover meals.  Sometimes it’ll just be raw salad with olive oil.  Sometimes just snacking on an avocado or flax seed crackers.

Sometimes it’s just a salad . . . a lot of people think diabetics need to constantly have something sugary along, just in case their blood sugar starts to go low.   Keeping a little sugar nearby just in case.  It doesn’t sound like you’re doing that.

BARRY ERDMAN
No sugar.  We rely on stevia if we want some sweet snacks or sweet drinks.  And the fat helps you to feel satiated and takes the cravings away.

Do you find that you have a mid-afternoon crash eating this way, or does your energy stay more stable?

BARRY ERDMAN
Energy is very stable.  No crashes at all.  Nothing anywhere near what I was doing before when my blood sugar was going up and down so frequently.

What about for dinner?  What do you eat?

BARRY ERDMAN
Dinners oftentimes are stir-fried green leafy vegetables. Tempeh dishes.  Stir-fried curries, vegetables or stews over something called shirataki noodles which are high fiber noodles.  Dinners are fun because often people will say, what do you eat.  Do you only eat vegetables?  When I think about the joy of cooking and the way of preparing food at home, there’s so much variety and taste of flavor.  It does take some time.  I don’t mind having shifted my lifestyle to spending more time shopping for more fresh organic produce and cooking at home.

You have created all kinds of vegetarian recipes that are low in carbs, and you’ve created a website where people can exchange these ideas.

BARRY ERDMAN
We have a group on Facebook where people from around the world who are diabetic and subscribing to vegetarian lifestyle are chatting and exchanging personal stories and recipes.

Cashews?  Visualize Kidney Dialysis . . .

So there’s a whole group of people who are eager for advice on how to share ideas about low carb and vegetarian.  And there are fine points to figure out.  You told me a story about cashews versus walnuts, pecans or almonds.  You don’t eat very many cashews.

BARRY ERDMAN
Cashews are off the list.  My doctor said to avoid things that start with P, such as pasta and potatoes.  And so I spell cashews with a P, because they’re high in carbohydrates.  I used to love eating handfuls of cashews before.  Now I think, if I eat cashews, I’m going to get sick.  I’ll have my toes amputated.  If I eat almonds, I’ll be healthy and be able to go for a hike.  In my own mind, I do this visualization at times to justify, or to keep myself motivated.

Cashews – kidney dialysis.  Almonds, pecans, hike.

BARRY ERDMAN
Sounds right.

You have been known to say that that anyone who has diabetes should find some opportunity to visit a kidney dialysis center.  What are those like?

Diabetes magazines should show amputees eating cake . . .

Front Cover of a Diabetes Magazine

BARRY ERDMAN
What was so striking after being in the dialysis unit and then looking at the diabetes magazines — the cover of each of the magazines usually had some luscious piece of chocolate cake or someone enjoying eating a dessert.  The cover would say something like, “you can eat anything you like.”  When you read the article it says, as long as you have a small sliver, you can indulge.  I’ve often thought what they should be doing is showing someone with their legs amputated eating a piece of cake on the cover of the magazine, because it would tell the true story of what’s going on.

You don’t eat small portions of cookies and pastas and cakes and grains.  Is it because you don’t want to deal with those numbers of carbohydrates, or are you concerned this would wake up the desire to eat that kind of food, when you’ve made your peace eating low carb food, and you find it delicious.

BARRY ERDMAN
I still am tempted and want to eat sweet desserts at times.  My commitment is to find recipes that substitute and recreate the same kind of pleasure of eating certain desserts, but finding out how to design them or develop them or create them with low carbohydrates in mind.  So flour-free desserts, sugar free desserts, still are part of my diet on occasion.  Turns out I feel guilt-free eating things I know are keeping my blood sugars in the normal range.

And you can think about the kidney dialysis unit where you told me once, it’s such a tough place to be.  It’s a hard place even for people to work.

BARRY ERDMAN
It’s a place with a lot of sadness and depression.  People don’t enjoy sitting there for most of their waking hours, hooked up to a machine that’s trying to purify their blood.  People are very affected at that stage of life and don’t have a lot of freedom.  They can’t really do things the way they used to if they’re dependent on sitting in the room several times a week.  It’s not a happy place.  It’s not like a childcare center where kids are running around playing.  These are people at the latest stage of life who are facing loss and grief.

You’d rather not be in a sad place like that yourself, three times a week.

BARRY ERDMAN
I don’t think anyone deserves to be living their life that way.

Waking up in a more youthful body . . .

As a result you’ve found a way to eat, and a way to live where your energy’s better, your alertness is better, your blood sugars are healthier, you can make gourmet, vegetarian meals without the carbs.

BARRY ERDMAN
You know, Shelley, one interesting thing that has happened as a result of this, unexpectedly, was that when I started losing weight due to the low carb diet, I started to feel a body that I hardly remembered.  Turned out that my weight in high school was 165, and that’s the weight I am currently.  It really is a pleasure to wake up in the morning and feel a more youthful size and shaped body than the one I used to live in.   Anyone who’s interested in improving their health deserves to take a careful look at their diet and what they’re eating and how they’re eating and know that no matter what you’re doing, you can do better.  There’s other ways to make improvements.  Perhaps we should just mention Dr. Richard Bernstein’s book, The Diabetes Solution.  He being a diabetic himself, has spelled out the science and rationale for eating low carbohydrates and maintaining a long healthy life, being able to do all the things that anyone would be able to do, even if you’re diabetic.

Here’s an interview with Dick Williams, co-author with Binx Selby and Linda Fong of a new e-book Eating Your Heart Out?, and why he believes there are many big fat lies about heart disease.  The interview with Dick broadcast on the KGNU Boulder-Denver Science Show, How on Earth.  Scroll about 10 minutes into the show (about halfway) for the audio interview.

Loren Cordain is a professor at Colorado State University.  He’s an expert on paleolithic lifestyles.  His most recent book is the Paleo Answer.  We did this interview in November, 2011.  It starts with Loren giving the evolutionary reason for why grains can be irritating to the human gut.  — Shelley Schlender – meandmydiabetes.com

Listen to Loren Cordain (20 Minutes)

Grains and Leaky Gut

Why do grains irritate the human gut?

LOREN CORDAIN
Grains are the seeds of a plant.  They’re its reproductive material, and plants don’t make their reproductive material to give away for free to other animals.  If they did they’d become extinct, and so the evolutionary strategy that many plants, particularly cereal grains have taken to prevent predation is to evolve toxic compounds so that the predator of the seeds can’t eat them, so that they can put their seeds in the soil where they’re meant to be to grow a new plant and not in the gut of an animal to feed it.

We hear that whole grains are especially valuable because of their many vitamins and special nutrients.  Why don’t you like the parts of the grain that make it a “whole grain?”

LOREN CORDAIN
If we look at the outside part of the seed, that’s the part that comes in contact with the environment and that’s the one that has the concentrated sources of anti-nutrients, so all these nasty things that we’re finding in grains that cause problems are concentrated in the outside portion of it.  So that’s where the fiber is, is in the bran portion, and that’s where many of the anti-nutrients are.

I had a friend whose knees ached when she ate whole grains, but they felt fine when she ate white French bread.  Now, I’m not advocated white bread as a health treat, but why might it cause less problem for her achey knees than a whole grain bread?

LOREN CORDAIN
Whole grains are concentrated sources of anti-nutrients, more so than white bread.  White bread certainly isn’t good because of high glycemic load.  It also contains gliadin which is one of the elements that open up the gut, but lectins do too, and lectins are more concentrated in the outside layer of wheat berries.  People think grains are a good source of fiber and actually they’re not.  Fruits and vegetables contain orders of magnitude, at least vegetables do, contain an order of magnitude greater amount of fiber per calorie than grains.  There’s no human requirement for grains.  That’s the problem with the USDA recommendations.  They think we’re hardwired as a species to eat grains.  You can get by just fine and meet every single nutrient requirement that humans have without eating grains.  And grains are absolutely poor sources of vitamins and minerals compared to fruits and vegetables and meat and fish.  When you state the obvious, anyone can do that.  Get a computerized dietary analysis program and put in the eight whole grains and then put in the 20 most commonly consumed fruits and the 20 most commonly consumed vegetables and look at the nutrient density.  The nutrient density is much greater in fruits and vegetables than it is in grains.  So why are we putting grains at the base of our food pyramid and telling people that they have to eat them?   There’s absolutely no nutrient in grains that we can’t get elsewhere.

Many nutritionists argue that we need to eat grains for the fiber, in order to avoid constipation.  Do you agree?

LOREN CORDAIN
You do need bulk and what we call prebiotics, which is fiber, but there are basically 2 types of fiber, soluble and non-soluble.  And grains, except for oats, contain mainly non-soluble fiber.  Fruits and vegetables contain soluble fiber which tends to be therapeutic because it slightly lowers cholesterol and benefits some other blood parameters.  But even more, it provides soluble fiber which is an environment for healthy bacteria to live in our gut, and so what we’re finding now is that probiotics along with prebiotics, help us to have a healthy flora of bacteria in our gut, and when we have a healthy flora of bacteria in our gut, it tends to prevent leaky gut, and it tends to prevent chronic low level inflammation that occurs when our gut is colonized with gram negative bacteria more than gram positive bacteria.  In contrast, if you eat an average low reside western diet, high glycemic load diet, it tends to promote flora that is not therapeutic.

Paleo Diets and Diabetes

Once somebody has full fledged diabetes or they’re on the way to that, while they could have eaten a paleolithic diet before that might have helped prevent their diabetes, they may not be able to have as many carbohydrates as a paleo-diet tends to have.  Are you comfortable when people tend to modify a paleo diet so they eat more fats and they eat fewer fruits and starchy vegetables?

LOREN CORDAIN
There are two types of diabetes.  The most common type in the US is Type 2 diabetes, and that’s the type that is essentially a lifestyle issue.  People with obesity, people that are insulin resistant, develop Type 2 diabetes, and that can be cured.  It’s not an incurable disease, and so by losing weight and changing diet and reducing carbohydrate in their diet, these people can end up becoming non diabetic, and coming into complete remission with their disease.  The other type of diabetes is Type 1 diabetes which is  an autoimmune disease in which the immune system attacks the beta cells that produce insulin in the pancreas and destroys those beta cells.  The thinking has always been there’s no such thing as remission from Type 1 diabetes because once the Beta Cells in the pancreas are destroyed, then you have to inject insulin for the rest of your life.  What we have found now, surprisingly in the last three or four years, we have had two or three anecdotal cases of people with physician diagnosed Type 1 diabetes, who were insulin brittle, so they were injecting themselves with insulin, we have at least three cases that I’m aware of where they have actually come into complete remission, and myself, I was the biggest skeptic of all.  I said you can’t come out of the disease, and but we heard these people did, and so they stopped injecting insulin, and there are certain blood parameters you can measure to determine whether or not someone still has the disease, and so I’m working on this with a colleague here in our department, and another immunologist outside the U-S, and we think what’s going on is that the immune system all but destroys most of the beta cells in the pancreas, but there are what are called stem cells, and a few stem cells are left that can become beta cells, and if you can stop the immune assault on the beta cells, on the body’s own tissues, if you can completely stop it, then those stem cells might be able to regenerate beta cells, sufficiently to restore pancreatic function.

Now, beta cells only regenerate at a rate of about 1 percent per year, so it’s not very fast.  Is it possible that sometimes there are beta cells that are almost dead, but they’re not all dead, and when the body stops attacking them, they start functioning again.

LOREN CORDAIN
What we’re thinking in both anecdotal cases we’re aware of, is the people that came into function were younger people, they were two young women that had recently been diagnosed, and so our thinking is that they perhaps had 10 or 20 percent of their beta cell function remaining, and then with the cessation of the immune system assault, on the beta cells, that stem cells started to regrow, and the remaining cells in the stem cell regrowth perhaps were the explanation.  We didn’t know, because most researchers had never heard about this before.

Now one of the women that you had mentioned to me before who was a type 1 diabetic who stopped taking medications, on her website she says she is now taking medications.  

LOREN CORDAIN
I don’t know if she gave up on the diet or what.  I haven’t spoken to her directly.  I do know of a younger girl in her early teens, and I have been in correspondence with her mother, and this young teenage girl is and has been in remission.

There is also a woman who is advertising on the web right now about her twin boys, who she put on a what I believe she describes as a plant-based diet, where they were both diagnosed as Type 1 diabetics, and now they don’t take any medications.

LOREN CORDAIN
That doesn’t make a lot of sense to me because the only way you can eat a plant-based diet is by eating grains and legumes, and those are two factors that can irritate the gut. Hundreds of scientific papers show that legumes and grains increase intestinal permeability, and they do it through the mechanisms we talked about earlier, through lectins and saponins, and what are called thaumatin-like proteins, so I would say that vegetarian or vegan diets would be one of the worst ways a person with autoimmune disease could go.  I recommend not doing that.

Plus those have a fairly high carbohydrate content, sugar turning into content, which would be more likely to stress the pancreas and the insulin system.

Yes, a higher carbohydrate diet before insulin was synthesized and before people could inject themselves with insulin one of the few ways that people could counteract the disease, because it wasn’t until the early sixties that the distinction was made between Type 1 and Type II diabetes, was to reduce the carbohydrate in their diet,  prior to the day and age of the synthesis of insulin and injecting it.

Wish List for Data to Determine the Ideal Diet

You have mentioned several blood-carried protein markers that indicate when someone is not digesting foods completely, making the proteins in those foods “leak” into the bloodstream, where they can trigger inflammation.  Those could be a powerful way to figure out whether someone is eating foods that lead their own gut to be leaky.  That could be helpful for people with arthritis, MS, autism . . . a huge list of ailments.  It would be fun, wouldn’t it, to get all these markers together and have experts look at them and comment on the same thing.  It wouldn’t mean we’d answer all the questions.  There would always be more questions, but it would be a neat thing to look at.

LOREN CORDAIN
There’s a biological template that allows scientists to look into the future, and it’s called the evolutionary template, and if you don’t use it, it’s like playing soccer, running uphill on a soccer field, against a team that’s running downhill.  And any nutritionist or biologist or physician that doesn’t use the evolutionary template to help guide them to the correct decision is inevitably going to to end up with the wrong answer.  And that’s part of the problem with the governmental recommendations right now by the USDA is that we’re not putting the evolutionary template over the problem of diet and health.

I’m kind of in an odd role here in what I do research wise.  I’ve pushed pieces around on a chess board.  We’re kind of a think tank here and me and my graduate students I work with around the world, we’re not bench scientists per se.  We don’t do the cooking, we invent the recipes.  Or rather, we suggest the recipes, and some scientists are interested in our ideas and testing them, but many scientists many bench scientists are very close to a very narrow idea and that’s what they pursue.  They don’t look at the big picture, and I have the luxury of looking at the big picture.

Removing Wheat and Dairy May Not Be Enough  – What about Beans and Potatoes?

LOREN CORDAIN
If the numbers are correct, with 1% or 2% of the U-S population testing positive for Celiac Disease now, there’s no way in God’s green earth that we should be recommending whole grains to the entire population.  It absolutely makes no sense.

I’ve got an article from the New York Times, Loren Cordain, that came out on November 25th, 2007, titled, Should we all go gluten free?”  it talks about a recent convention where people flocked to a breakfast where they could eat pancakes that don’t have gluten in them.  They were offered many gluten free products which I suspect, you would say, still have potential to cause a leaky gut.  It’s not as simple as having a gluten free bread.

LOREN CORDAIN
Exactly.  You can make gluten free products,.  You can have gluten free breads that are made out of rice and potato flour, and god knows what else, and they can have even a texture that is similar to bread, but you’re still getting a gigantic glycemic load, you’re still getting a variety of the antinutrients that are potentially not very healthful.

I suspect you’ve seen some markers that would among other things, tell whether people are eating what they think they’re eating . . . or not eating.  There are some markets you’ve looked at that could indicate whether someone’s getting wheat or gluten in their diet without realizing it.  If there was an inexpensive way to check this, I can imagine that kids with autism whose parents are sure they’re doing the “Defeat autism now” diet, where they’ve diligently pulled all the glutens out of their child’s diet, they could actually take a blood sample and see whether they’ve succeeded.  After all, it’s so easy to inadvertently get gluten into a person’s diet.  The Celiac Disease Center at the University of Chicago has pointed out that it takes less than a tenth of a teaspoon full of gluten once every two months, to keep to keep the inflammatory attack from Celiac Disease going on the gut.  That’s not very much.  That’s as much gluten as there might be in seasoned salt if it’s used every day.  It’s really a startlingly small amount.  

LOREN CORDAIN
You have to be very very careful if you have gluten sensitivity or celiac disease.  No amount is too little.

And I believe from the research that you’ve done, you’re aware of some other markers that would be worth going after in a blood test.  If there was a comprehensive panel that had those kind of things on it, it could answer a lot of questions for people with chronic conditions.

Leaky Gut and Autism — Gluten, Dairy and Beans and Potatoes?

LOREN CORDAIN
I think that  looking at gluten and gliadin, Dr. Alessio Fasano, for instance, of the Center for Celiac Research in Maryland, and people that are looking at leaky gut, they’re missing some of the antinutrients that go beyond gluten.  For instance, with autism, we know there’s leaky gut.  And it presents frequently, but we’re looking at this uni-dimensionally.  For instance, in autism, they’re looking at wheat and dairy, and they remove wheat and dairy, but I can tell you right now, potatoes contain substances that cause a leaky gut, as do legumes, just to the extent that gliadin does.  So if you’ve got an autistic kid, and you get them off of wheat and dairy, well good.  There’s one meta-analysis that has looked at all six studies that either removed wheat or removed dairy, and it shows a therapeutic effect for autistic children, but if a leaky gut is indeed involved, and it is autoimmune related, then you’re only halfway there, and you have to get the legumes and you have to get the potatoes out of the diet.  These saponin containing foods, we know, cause leaky gut.  In healthy normal humans, there are two Glycoalkaloids in potatoes.  One’s alpha-chaconine and the other’s alpha-solanine.  In healthy normals, after you eat mashed potatoes, within half an hour, those two Glycoalkaloids are found in the bloodstream of healthy normals.  What does that tell us?  It tells us they’re breeching the gut barrier.  Those are ubiquitous foods.  Chili Beans, potatoes, french fries, mashed potatoes.  People eat those things every day.  So if  we’re looking at a leaky gut, then you need to look at these other substances.

And also you would suggest that even though there are no saponins and no lectins in sugar, that can can lead to leaky gut, too.  In a very different pathway, but that can do it too.

LOREN CORDAIN
High glycemic load carbohydrates we know cause increased intestinal permeability, and one of the mechanisms may be the change in gut flora we’re seeing when people eat those kinds of foods, when people eat a lot of sugar and refined carbohydrates.  It could potenially alter the gut flora in a manner that can increase intestinal permeability.

Loren Cordain, you have a new book coming out.  

LOREN CORDAIN
I do indeed, and it’s published by John Wiley and Sons and the title of the New Book is The Paleo Answer, and I’ve written about everything that I haven’t written about in my other two books, and it’s got all of the latest information right up to 2011.  So we’ve got the best science in there showing you that saturated fats are okay to eat, and why vegetarian and vegan diets are not a good idea, and why taking antioxidant vitamins might shorten your life.

I guess I’d better read it.

LOREN CORDAIN
Have you been following the antioxidant story?  All the meta-analyses are now showing that if you take Vitamin C, Betacarotene, Vitamin E, if you take all of those, it increases overall mortality, so you’re much more likely to die if you take them than if you don’t

Some of the exercise studies about supplements have been interesting, and it makes taking supplements seem similar to taking antibiotics.  That the body is best off if it gets its chance to fight things on its own first, whether it’s oxidation, or whether it’s a bacteria or a microbe.  If the body sends forward its own troops first and understands how to do that, it’s better prepped to deal with the challenge, and whether it’s Vitamin C or an Antibiotic, if it’s added too early, then the body’s own response never gets smart enough to deal with the challenge on its own.  So, I believe the study of supplements indicated that that athletes who are always taking antioxidants didn’t do as well as athletes who kick them in now and then.

LOREN CORDAIN
They don’t recover as well.  And men who take Vitamin E have a 20% greater risk of dying from prostate cancer than men that don’t.  The people at the cutting edge of nutrition are now advocating real foods and not vitamins and minerals and supplements or these designer foods like yogurt with this that and the other vitamin in it.

One time an editor told me he was tired of the stories from me, because it was always the same thing.  It was about a whole food and basic things.  Why couldn’t I talk about a new pill that was going to help people out?

LOREN CORDAIN
There are two magic pills.  One is called Vitamin D and the other is called Fish Oil.  If you go in the sunshine, you don’t have to take Vitamin D, and if you eat fatty fish a couple of times a week you don’t have to take fish oil.  So we’re going right back to the way our bodies were designed.  Humans are good field animals and we’re designed to be outside, outdoors, exercising, in the sunshine, eating real nutritious foods.

Loren Cordain, Colorado State University Professor and author of The Paleo Diet has a new book:  The Paleo Answer.  7 Days to Lose Weight, Feel Great, and Stay Young.

Here is an interview with Loren from 2010, where he explains the biochemistry of why autoimmune diseases such as MS, arthritis and Type 1 diabetes might be made worse by grains, beans, dairy, and in some people, egg whites and tomatoes. In addition to the audio interview, this now includes a written transcript of the interview.  Thanks to Sandy Grabowski for transcribing.

Listen to Loren Cordain (45 Minutes)

LOREN CORDAIN
We started off with rheumatoid arthritis, that was our original model, and we’ve parlayed into a more universal understanding of all autoimmune disease. So with multiple sclerosis, we chose that because there is epidemiologic evidence that implicates diet in multiple sclerosis. We think that in order for the immune system to lose the ability to recognize self and non-self, which is what autoimmune disease is, there has to be peripheral antigenic stimulation, meaning that there has to be antigens or proteins that come in constant contact with the immune system that we believe enter into the immune system from the gut.

The gut normally is impervious to proteins. We normally break proteins down in our gut to the constituent amino acids. The proteins are broken into peptide fragments, and peptides are broken into amino acid sequences. So normally what we end up with are amino acid fragments that we absorb, and what we think is going on is, we think that these larger peptide fragments, as well as amino acid sequences that may be 10 to 15 bases long, can also get in. We think that this content leaking of antigenic peptides and proteins from the gut into circulation primes the immune system to do nasty things in certain generally predisposed individuals. Normally these large-size peptides and proteins simply would not be able to get through, so we’ve hypothesized that there’s one of three potential mechanisms whereby they can get through.

Two of the mechanisms aren’t unique to our group. Other people have suggested the same thing. One is what’s called the paracellular pathway, which is whereby these peptide fragments are leaking through the cell-to-cell connections. The gut cells are called enterocytes. These are called tight junctions. So the dimensions of the tight junctions actually increase, allowing for a larger molecule to get through.

And that happens when there’s more inflammation?

LOREN CORDAIN
That’s right. Tight junctions loosen up with inflammation, when the gut is chronically inflamed. People who have rheumatoid arthritis tend to have inflammations of the joints occur at the same time the gut occurs. We don’t believe that this is serendipitous. In nature we believe that inflammation of the gut is associated with inflammation of other tissue.

The second mechanism is the transcellular pathway, where these elements are going through the cell itself. We think that this pathway with active transport is probably the way that it is happening. We believe that there are receptors in the gut that are acting as Trojan horses that are allowing these molecules to get through.

And this is the human epidermal growth factor receptor?

LOREN CORDAIN
That’s right. This is an unusual receptor, because the way the body works its that when we secret hormones, hormones bind to receptors at cells, and that causes the cell to express genes and make proteins and do all kinds of things. So the crazy thing about the gut is, the inside of the gut that’s exposed to the food and so forth, is actually the outside of your body. So the question comes up, why, from an evolutionary perspective, would we ever find a receptor that is facing luminally or towards the outside? It faces the lumina of the gut, which is the outside of the body. In theory, there shouldn’t be any hormones there for it to bind to.

Turns out that in our saliva, we have the key to the lock. The receptor could be envisioned as a lock. The receptor itself is bound in what we call the glycocalyx of the gut. The glycocalyx is kind of this wavy series of carbohydrate molecules that prevent anything from binding this receptor. What happens is, when the gut becomes damaged, either through mechanical damage or through GI tract irritation or whatever, that information causes the glycocalyx to be shed and it allows the receptor to bind its normal ligand. The ligand is the word for a key. A ligand is like a key, a receptor is a lock. So it allows the key to bind the receptor, and the body’s endogenous key is epidermal growth factor. That’s found in our own saliva. So when we swallow our own saliva, if the receptor has been exposed at the glycocalyx, then the hormone, epidermal growth factor, the key, can bind it’s receptor, epidermal growth factor receptor, and when it does that, it causes tissues to be healed inside the gut.

So if you’ve ever noticed a dog licking wound, there’s method to the madness. When you lick an open wound, the hormone, epidermal growth factor, in the saliva promotes healing. We know that from animal studies in which we’ve prevented animals from licking their wounds, or we’ve taken their own saliva and swabbed it onto the open wound. It heals faster when saliva is there. So we believe that’s what’s going on in the gut, that the epidermal growth factor receptor is there on an evolutionary basis to help us heal our own wounds.

The luminal side of the intestine doesn’t have a whole lot of receptors that we know about. We know the epidermal growth factor receptor. There’s another receptor in the lower gut called the Thompson-Fridenright [?] receptor. But there’s very few receptors per se in the gut. And the way the gut actually makes the immune system aware of the contents of the gut, because the immune system needs to know that, is through what we call M cells. These are specialized cells that line Peyer’s patches in the gut, bumps that are found in certain parts of the gut, and within those Peyer’s patches are M cells. Their function is to sample tiny amounts of the bacteria and the pathogens and everything that’s in the gut so we can tell the immune system what’s going on.

But the M cells we don’t believe are exploited by dietary antigens and most of the bacterial gut pathogens.

They’re too little.

LOREN CORDAIN
Right. They’re tightly controlled, too. The way that T and B cells operate in conjunction with these M cells is, the T and the M cells don’t allow much antigenic material to bypass the gut, or what we have is, we have another part of our immune system called the gamma globulins, and the gamma globulins form complexes that prevent any of these proteins from doing any damage to our system. So at least in theory, the M cells, combined with the gamma globulin system, prevent any of this from going on.

So our hypothesis is, the gut becomes damaged by certain dietary elements, which strips the glycocalyx, which exposes the epidermal growth factor receptor, which allows these certain dietary elements, along with these viral and bacteria peptides, to get into the bloodstream. The epidermal growth factor receptor is what we call a very promiscuous receptor. Most receptors have one or two endogenous ligands, but the way this thing work is what’s called a dimer. This dimer of a receptor has 10 or 12 endogenous ligands that it binds. So it binds this whole series of things, and it has to do with the structure of the receptor. Because it binds so many endogenous ligands, it has the potential for binding everything, and that’s the problem, that it has the potential to bind lots and lots of factors that at least in the Western diet are very, very common.

0:08:38.8
So one problem is that the foods that you’re implicating have an easy way, they tend to damage the glycocalyx. They tend to get at it through cooking. Stomach acids don’t break them down enough. When they get into the gut, they’re irritating.

LOREN CORDAIN
That’s right. And what we’re talking about is dietary lectins. For instance, when you eat whole wheat, you eat a lectin called wheat germ agglutinin, WGA. We know that WGA, when it gets into the gut, causes the glycocalyx to be stripped, which opens the door to bind the epidermal growth factor. We know that WGA indeed binds the epidermal growth factor. How we know this is, there are animal models where we take insulin and we bind insulin to WGA, so we have a complex. We have an insulin WGA molecule, and what happens is, WGA, because it has an affinity for the epidermal growth factor receptor, binds that receptor, and in rats, it lowers the blood glucose. Normally you can’t get insulin into your system because it’s a large molecule. That’s why we have to inject ourselves with insulin. So when you bind it to WGA, you can actually lower blood glucose. But the problem is, WGA is like superglue. It doesn’t just bind the receptor and go on its merry way? Anything and everything that’s in the gut it will bind.

So it has a high affinity for bacterial cell wall proteins, and there’s a bacterial cell wall protein called LPS, lipopolysaccharide. We know that WGA binds lipopolysaccharide. In the gut, bacteria are just like proteins. They get busted up, too. So when you eat meat, that gets broken down into its peptides and amino acid components in the same way as the bacteria. So bacterial cell wall gets broken down, and if you have WGA in the gut, it binds these bacterial cell wall proteins, and it then binds the epidermal growth factor receptor, acting like a Trojan horse, and bringing WGA plus this antigenic bacterial molecule into plasma.

I’m picturing it like a sticky lollypop stick, and what it grabs to be the top of the lollypop is unfortunately quite often a bacteria.

LOREN CORDAIN
That’s right. So even if these bacterial peptides were to get past the gut, and even if they were to get into cells, cells have an enzyme called lysozyme. Lysozyme specifically acts on bacterial cell proteins to break them down. So even if you do get bacteria in your bloodstream, the lysozyme in the cells breaks it down and there’s not a problem. However, WGA is resistant to this enzyme lysozyme, so WGA, when it’s bound to the bacterial peptide, it’s like putting a Superman invulnerable shield around itself. The peptide remains intact, and then it can be transported to any other cell in the body that expresses the epidermal growth factor.

And as it gets transported, it also carries along whatever it stuck to it?

LOREN CORDAIN
That’s right, it gets carried along whatever is stuck to it, and this is the universal mechanism. We started off using rheumatoid arthritis as the model. We now believe that this probably is a universal mechanism that acts in many types of autoimmune disease. If you don’t have a specific genetic makeup, this process won’t work.

Or at least the risk of it is significantly lower?

LOREN CORDAIN
Is significantly, significantly lower. You have to have what we call an HLA haplotype. This is the human leucocyte antigen haplotype.

You don’t have to have that, it just increases your chances?

LOREN CORDAIN
Right, it increases the probability. And we haven’t completely ironed all this out. When I say “we,” science in general. We believe there are multiple HLA haplotypes that can combine with multiple dietary lectins, which can combine with multiple gut antigens to express a disease.

What you’re describing is, some people happen to have the kind of DNA that looks more like these Trojan horses than other people? So the immune system is more likely to get confused?

LOREN CORDAIN

All DNA does is code for a protein. And one of the proteins that it codes for is the HLA protein. And what an HLA molecule is, it’s just simply a little molecule that spans the cell membrane and it presents proteins from within the cell to circulating white blood cells, or T lymphocytes. When the circulating T lymphocytes see a molecule that’s foreign to the body’s own self, it mounts an attack on not just the molecule that it sees here, but any other place in the body where it encounters that foreign molecule, it will mount an attack. That’s how we get rid of infections. That’s how our body recognizes foreign material. What we believe is, through a process of three-way molecular mimicry, the T lymphocytes become confused. And how they become confused is through a process that we call monster molecules, these chimeric molecules, which you’ve called the lectins attached to the bacterial cell walls. We call those chimeric or monster molecules, and when they come in, they look a lot like the bacteria, but they also look a little bit like the tissue that’s being attacked.

The T lymphocytes lose the ability to recognize themselves in a foreign bacteria because the confirmation of what it sees is so similar to a foreign molecule and itself. It’s like you have somebody speaking English and somebody speaking Chinese and you have somebody in the middle that’s doing the translation. And the guy in the middle is the HLA molecule. What the HLA molecule does is, it sees that chimeric molecule that’s digested, and the HLA molecule then presents this monster molecule at its cell surface. The shape of the HLA molecule is determined by our genes. Everybody has a slightly different HLA makeup. That’s why we believe that people have a genetic susceptibility for autoimmune disease, because for those people that see this little monster molecule, it’s slightly changed by our middleman, our translator. So the HLA molecule slightly changes the confirmation this monster molecule, and when it does that, it totally confuses the immune system, and the immune system loses the ability to recognize self and non-self. That’s the underlying concept.

This sounds like Homeland Security going after terrorists.

LOREN CORDAIN
[laughs] Well, I don’t know if that’s an apt analogy, but the immune system is the most complex part of our genetic makeup. The HLA system is what’s called a polymorphic molecule, and there’s more than 3,000 different versions of this. It’s a very, very complex system. It’s designed that way. A more apt analogy is cops and radar systems. Cops are trying to catch speeders, and the companies that build radar detectors build a better radar detector, they build a better radar gun, and there’s this one-ups-manship. The same thing has happened over the course of hundreds of millions of years with the immune system. We have this one-ups-manship, and that’s why the system is so polymorphic. There are so many multiple versions of this thing along the way.

You’ve described WGA as bad, bad, bad every step of the way. Cooking it doesn’t stop it. Stomach acids don’t stop it.

LOREN CORDAIN
Lysozymes within cells don’t stop it.

It gets through the gut barrier and lysozymes don’t stop it. Not only that, but it’s an adjuvant. What is an adjuvant?

LOREN CORDAIN
When we were first trying to make vaccines to prevent diseases, like the polio vaccine that Jonas Salk won the Nobel Prize for back in the ’40s or ’50, they tried to simply get the virus and make a weakened version of the virus, dry it out, whatever, inject it into the body’s system. What they wanted to do was to build an immune response so that the T cells and the B cells and the rest of the system would mount an attack on this weakened version of the polio virus. But the problem is, the immune system was smart, and the immune system says—it’s like going fishing. “I’m not going to go for that, because it just doesn’t look like a problem.” So what they have to do it, they have to tack on what’s called an adjuvant molecule. When the adjuvant molecule is tacked onto the weakened virus or bacteria, that adjuvant serves like red pepper. It totally inflames the immune system, and now the immune system will make an immunologic response to that antigen.

So WGA by itself, as do other dietary lectins, act as adjuvants. We believe then that this adjuvant response promotes autoimmunity in certain individuals.

So the WGA on its own increases inflammation and irritation inside the body, but when it’s stuck to something like a bacteria that happens to look like one of the body’s cellular components, it makes the immune system more likely to be fiercely attacking that kind of bacteria and also human cells that remind it of them?

LOREN CORDAIN
We don’t have in vivo data because this is such a new concept, meaning that in humans, does this actually happen within their body? The best evidence that we have is what’s called in vitro data. What we take are little Petri dishes and we put in white blood cells, and then we also put in WGA. If we put WGA into a Petri dish with white blood cells, the white blood cells, which are called macrophages, elicit an inflammatory response. The inflammatory response occurs because they secrete localized hormones called cytokines. These are inflammatory cytokines. We know then if you put WGA into a Petri dish with white blood cells, the inflammatory response is even greater than if you would put bacterial cell walls, this LPS protein I talked about. It’s 30% to 40% greater than what would occur with a bacteria.

That’s a good response. When a bacteria gets into your system, you want an inflammatory response to get rid of it. When a dietary antigen gets into your system, it’s causing a low level of inflammation, and that’s not a good thing, to have chronic low-level inflammation.

Some fans of Sally Fallon and Weston Price asked me to ask you what about fermenting grains? Does that flatten out the WGA lectins enough that they don’t cause a problem?

LOREN CORDAIN
What we do know about fermentation is that the bacteria that are responsible for fermenting dairy foods and other foods, beans and so forth—

And how about wheat?

LOREN CORDAIN
—and even wheat, they reduce another antinutrient called phytate or phytic acid. The phytic acid content is reduced with fermentation. In WGA, fermentation has little or no affect upon the appearance of lectins. As a matter of fact, if you take dry kidney beans and boil them for two or three hours, there’s still physiologically significant lectins after boiling for two or three hours. The only way that you can remove lectins, because of their molecular confirmation, they are such sturdy molecules the way they’re built, that they’re resistant to not only proteases that are found in these bacteria that cause fermentation, they are resistant to heat. The only way you can get rid of them is to pressure cook them. If you pressure cook them for an hour or so, then you will degrade all the WGA. But frequently we eat our legumes and beans from the dried form, we just soak them and boil them, and they are still significant sources of WGA.

If you buy canned legumes, part of the process of preventing horrible bacterial contamination is to pressure cook them, so most canned foods are pressure cooked, and if you’re eating beans you don’t have to worry about it if they are canned, typically.

Bread is cooked at a very high temperature.

LOREN CORDAIN
Not even close. The WGA that’s found in cooked bread or even roasted peanuts is the same concentration as what you find in raw, uncooked.

And sourdough bread, the bread that was traditionally done in Switzerland where they left it out for a week before they cooked it so it fermented a great deal, that doesn’t affect lectins?

LOREN CORDAIN
The information that we have is that the fermentation process does not significantly reduce the lectin content of bread. What does do it is that the WGA that we find in bread is primarily found in the germ and the bran. So if you look at the concentration of WGA in whole wheat, it is significantly higher than what it is in white bread. So white bread, even though it’s not necessarily a good food because of the high glycemic load, has a lower lectin content.

So white sourdough French bread might be OK for some people?

LOREN CORDAIN
The concentration of WGA in white flour is about 3 to 4 milligrams per 100 grams, whereas in whole wheat it’s 10 times that, it’s an order of magnitude higher. But at physiologic levels, we’re only talking nanogram concentrations in bloodstreams. We know from tissue studies, these in vitro studies, that cells respond at nanogram concentrations, so nanogram concentrations can easily be achieved by consuming 4 to 7 milligrams per 100 grams.

It sounds like if somebody actually has a sensitivity or a vulnerability to this WGA, it may be an all-or-nothing food for them.

LOREN CORDAIN
If you have celiac disease, we know that gliadin proteins have been complicated in celiac disease. How they specifically get through the gut is not completely clear, but those individuals can’t have any wheat.

For some people with autoimmune diseases, your guess is that it might be the same thing?

LOREN CORDAIN
That’s right. In animal models, we can induce type 1 diabetes by simply feeding wheat.

And not very much wheat?

LOREN CORDAIN
You have to go back and look at the literature. In the animal models where it’s been done, it’s been done at typically higher values in which ___ wheat comprises 20% to 30% or more for the energy.

But once somebody’s sensitized, once their immune system is hypervigilant for this protein, it may not take very much.

LOREN CORDAIN
Right, memory cells become attuned or agitated to these peptides, so it doesn’t take much.

You have also been looking at other foods besides wheat that you say, “Watch out for these if you have an autoimmune disease.” What’s on the list?

LOREN CORDAIN
Legumes, like kidney beans, contain a lectin called phytohemagglutinin, PHA. We think that people should definitely stay away from legumes. Soybeans as well contains a lectin SBA. Animal models tell us that these legume lectins get across the gut very easily, just like wheat germ agglutinin. We currently have conducted an experiment here at CSU where we fed wheat germ agglutinin into humans as well as peanut agglutinin to humans, and we’re in the process of measuring blood concentrations of these lectins to see if it gets through. We’re working with a group in Austria, Franz Gabor [?], and we’re working with a group at the University of California at Davis in their plant physiology laboratory that are measuring the lectin concentrations in the human plasma. So we hope to have this information shortly, and this will represent the first human studies to show that these lectins get through.

And that’s the very first step, to show definitively that in healthy, normal people without gut disease, which is what our subjects were, that with the consumption of these foods, we see lectin appear in the bloodstream. And after that, then hopefully in the ensuing years we’ll be able to measure this inflammatory response that we see in vitro, in tissue models, we want to do it in vivo, to show that if we give people a big dose of lectin from kidney beans or wheat germ, that it causes an in vivo inflammatory response, and then the next step is to do what are called Elisas , a kind of an immune-type way of looking at these complexes, so we can identify these molecules to see if they are actually getting in the bloodstream as well.

How about dairy?

LOREN CORDAIN
Dairy goes back to this whole notion of this receptor that is willing to bind just about anything. This gut receptor, the epidermal growth factor receptor. The problem with dairy is that dairy doesn’t contain lectins per se, so you would think that if this is how lectins are dragging these gut molecules through, dairy shouldn’t be a problem. But dairy contains something else, the body’s own endogenous ligand for the epidermal growth factor.

That means it sticks to things?

LOREN CORDAIN
A ligand is a key, a receptor is a lock. The ligand binds the receptor, it’s like binding a lock, and opens the door. We think about milk as being a perfectly harmless white substance that’s got a lot of calcium and a lot of healthy nutrients for us. But it also contains a profile of many of the hormones that circulate in a cow’s blood, because milk is essentially filtered blood. Most of the hormones that are in a cow’s blood are also found in a cow’s milk. Most of the hormones have very, very rapid half-lives, like any other hormones, so by the time the cow’s milk is pasteurized and process, three days later it appeared on the grocery shelf, most of the hormones are degraded.

However, there’s an exception to this, and there’s a very, very stubborn hormone called betacellulin, which is the body’s own endogenous ligand for the receptor. Remember we said that the epidermal growth factor receptor is very promiscuous. It has 10 different ligands. One of the most powerful ligands for the receptor is betacellulin. It causes downstream signaling greater than epidermal growth factor itself. So when you drink cow’s milk, even pasteurized, processed cow’s milk, even cheese, that goes through this entire process of degrading and everything else, cheese contains betacellulin. Three months later there’s very high concentrations of betacellulin in cheese. So when you drink milk, whether it’s been pasteurized, processed, whether it’s goat’s milk, cow’s milk or anything, you’re get a big shot of betacellulin, which then has the capacity to bind the epidermal growth factor receptor. And betacellulin also binds the casein fractions of milk. Not only does betacellulin get in, these other peptide fragments that are found in the casein fragment, the whey side of milk, they also get through as well.

It sticks to these big monster milk proteins and brings them through?

LOREN CORDAIN
That’s right. And then if you throw WGA into the mix, you can get even potentially more of these monster molecules.

If somebody eats yogurt that’s been drained of the whey, does that get rid of all this nasty stuff in milk?

LOREN CORDAIN
At least in theory. One of my colleagues, Pedro Bastos from Portugal, is the man to talk to about that, but apparently there are different ways in which the whey is separated from the rest of the milk proteins. The separation process has to do with whether or not betacellulin ends up in there. I don’t know that we have any experiments to date that show what the betacellulin content is of these various separation processes.

That might be another one where if somebody has an autoimmune disease, maybe no dairy products, not even strained yogurt?

LOREN CORDAIN
That’s kind of the approach we would take. It’s a lot like elimination diet. These are the most likely candidates that cause this three-way molecular mimicry and peripheral antigenic stimulation in the gut. Our idea is that people with autoimmune disease, there’s a variety of foods that they ought to eliminate initially and then carefully monitor their symptoms. With a disease like multiple sclerosis, basically there’s different versions of it, but the most common version is relapsing and remitting, where people have these symptoms that come on and go off, come on and go off. At least to date, it seems somewhere serendipitous how it happens, although there’s an association once again with inflammation. So when they get viral diseases or bacterial diseases, they seem to have a flare-up of their symptoms. So we believe that these dietary antigens also potentially can cause flare-ups in relapsing and remitting MS patients.

Let’s go through the whole list of foods. Tomatoes. You don’t like tomatoes either for people with an autoimmune disease. Why not?

LOREN CORDAIN
Of the two known lectins that have been shown in human plasma, the first is peanuts. That was show in 1998 by the ___ group in English. So we know that peanut lectin gets into plasma. We’re replicated that study as we speak. The second lectin that we know gets into human plasma is tomato lectin. Tomato lectin in 1972 was shown, when they labeled tomato juice with a radioactive isotopic tracer, a person drank tomato juice, and a half hour later the isotope was in their bloodstream. So we know that tomato lectin also gets through.

But the thing about tomato lectin is that if you put it in these little Petri dishes with white blood cells, it doesn’t cause an inflammatory response. WGA and PHA cause inflammatory response. Tomato lectin doesn’t. We know from epidemiologic studies that people who eat tomatoes have reduced incidents of cancer and heart disease and so forth. So on paper it looks like tomato ought to be a very, very healthy lectin. But once again, tomato lectin doesn’t just nicely bind the receptor, shut the door, and go in. Anything that’s in the gut, just like WGA, can be drug through with tomato lectin.

It’s sticky?

LOREN CORDAIN
It’s sticky, that’s right. And so we believe that if tomato lectin binds specific antigens in the gut, then those antigens can gain access. And once again, we have this monster molecule formed by tomatoes. We don’t have any direct evidence that any of these things cause autoimmune disease. We have circumstantial evidence. What we do have is a dietary trial going on right now in Ireland where people are going on diets that are wheat-, grain-, dairy-free. They’re not tomato- or egg white-free yet, because we’ve just identified those. And they are having amelioration of symptoms. This has not been published, and this is anecdotal at this point. We don’t believe that this is a cure-all for everybody, but we think that in certain people, dependent upon how long they’ve had the disease, they can improve the symptoms. The longer they’ve had the disease, they may stabilize, but the less likely it is they will ever regain function. If they have had the disease for a short period, within one to three years, there’s a good chance that they can go into complete remission, not all people, but some people, and many people can have an improvement of symptoms.

So we’re not trying to provide false hope in that we have a panacea for all MS patients. When we’re saying is that we have a potential mechanism where a percentage of people can improve.

You went by egg whites pretty fast. What’s wrong with egg whites?

LOREN CORDAIN
We talked about lysozyme. In the body’s own cells, it has these very, very powerful enzymes that bind bacteria and destroy them. For instance, if you look at your conjunctiva, if you look at the tissues that line your eye, the eye is constantly exposed to bacteria in the air, so we’ve got this open, as it were, reservoir that can potentially get infected every day of your life. But what happens is that the tears in your eye contain a very, very high concentration of lysozyme. Lysozyme busts up these gram-positive bacteria, as well as gram-negative bacteria, and it destroys them. The bacteria don’t have any way to counter lysozyme. Lysozyme is something we build ourselves, and it shouldn’t be problematic, because we’ve got it in every cell of our body.

But what happens with egg white is, egg white contains very, very high concentrations of lysozyme, and guess what lysozyme binds? It binds our promiscuous epidermal growth factor receptor. Now remember, what lysozyme does is attack bacterial cell walls. When we put high concentrations of lysozyme in our gut, it busts up these bacteria. When it busts them up, it forms these fragments of lysozyme, because lysozyme is resistant to the gut’s proteases, it forms these complexes of lysozyme plus bacteria. Because lysozyme can bind the epidermal growth factor receptor, then lysozyme, just like tomato lectin, even though in vivo it doesn’t do anything by itself, when it’s drawn through the gut, it can potentially cause an immune reaction.

Let me get this straight. So lysozyme doesn’t stick to things, it just busts them up?

LOREN CORDAIN
That’s a good point. A lectin agglutinates—the older definition of a lectin is that it agglutinates red blood cells. So lysozyme does not agglutinate human red blood cells. But lysozyme does stick to bacteria. When it sticks to bacteria, it forms a complex, the lysozyme can bind that receptor, and then it can drag this stuff through.

Another monster molecule?

LOREN CORDAIN
Potentially a monster molecule. Having spoken with multiple sclerosis patients who have come into remission on a wheat- and a dairy-free-type diet, a couple of them have told me that egg whites exacerbate their symptoms. I said eggs, not egg whites. But that kind of was the stimulus for this thought. And having gone through the biochemistry of lysozyme to see how it actually works, lysozyme in theory has the potential to act like a lectin and get into circulation.

Now, none of this has been shown in humans as of yet, except for the tomato and the peanut agglutinin. We are replicating those studies as we speak.

And you’re also showing in the laboratory the mechanisms for why you think these things might be a problem?

LOREN CORDAIN
That’s right. Well, we haven’t gotten to the laboratory stage yet. We’re still at the theoretical stage, because the epidemiology studies point towards that. If you look at the epidemiology of milk-drinking and multiple sclerosis, for the last 30 or 40 years we know that there’s a very good epidemiologic association. You drink more milk, it increases the risk of multiple sclerosis.

And go ahead and add some of the other autoimmune diseases that you increase the risk for if you drink milk.

LOREN CORDAIN
Type 1 diabetes. With type 1 diabetes, we not only have epi studies, we also have animal studies, just like those little rats where we fed them increased wheat diets and they had and increased incidence of type 1 diabetes, the same thing is true. My colleague Frazier Scott in Canada has shown that if you feed them more milk, they also have an increased incidence of type 1 diabetes.

Do you sometimes think that if you look closely enough at any food, you would find some nasty lectin or lysozyme or something that would bind with the epidermal growth factor receptor hormone and cause a monster molecule to get through? Is all food suspect?

LOREN CORDAIN
Absolutely not. And the reason for it is because we need to look at the foods that were traditionally in the human diet. Milk was not ever traditionally in the human diet. Milk is a very recent newcomer. Milk has only been around for 6,000, and if a human generation is 30 years, we’re looking at a very, very small time for milk to be in the human diet. The same way with wheat and whole grains. Even though we call them the staff of life and the staple of all civilizations, on an evolutionary time scale, they’ve only recently been domesticated and adopted. The same thing with legumes. They were never traditionally a staple in the human diet.

And I suppose eggs were only a seasonal food.

LOREN CORDAIN
That’s right. Eggs were a seasonal food, as were all plant foods. So even if you had the susceptibility haplotype and you started to get the disease, then the exposure was very, very short, whereas in the modern world, we eat grains and legumes and dairy products almost every single day. So we are exposing ourselves on a daily basis. We believe, then, that these are diseases of civilization, these autoimmune diseases, had they been present two and a half million years ago, natural selection would have weeded them out by now, and that’s why they haven’t been weeded out, because they have such short exposure to the human genome. The human genome would normally, through negative selection, get rid of these things, because they’re killing us at a younger and younger age. Multiple sclerosis attacks young women in their prime reproductive years. Had that been going on for hundreds of thousands or millions of years, we would no longer have multiple sclerosis, or we would have it at a very, very low percentage of the population.

You also implicate a deficiency in vitamin D.

LOREN CORDAIN
Animal studies, human studies, epidemiologic studies also point to the role of vitamin D. And vitamin D really isn’t a vitamin, it’s a hormone, because it acts in every cell of the body. We also believe that it’s a potent hormone that influences hormone function. And once again, from animal models, there’s an animal model of a multiple sclerosis EAE that can be prevented simply by dosing the animals on high levels of vitamin D before implication of the disease.

Here in Colorado we don’t get much sunshine compared to the tropics.

LOREN CORDAIN
Here in Fort Collins, we get more days of sunshine than they do in San Diego, but what’s important is the height of the sun relative to the latitude, because in the tropics, you get direct sunlight, and the direct exposure of UV causes a greater synthesis of vitamin D. So in terms of the blood concentrations of vitamin D, we are significantly lower here in Colorado than we would be in the tropics.

The foods that you’re choosing to say are problems are ones that have been traditionally chosen also by naturopathic physicians, by acupuncturists, by people who study those alternative fields. Does that make sense to you?

LOREN CORDAIN
I think that people that are in the trenches, making careful observations with naturopaths and some of these others, they see hundreds if not thousands or tens of thousands of patients, and they have at least anecdotal evidence from their experience that there’s something going on. But in support of these folks are part of the medical community that are concerned with allergies, particularly food allergies. If you look at the scientific peer review journals in the allergy field, the same picture is painted: milk, wheat, corn, dairy, tomatoes, and so forth often are the same foods that are allergenic. And we have in the allergy community IGG responses, which are considered more valid than an IGA response. So we have these IGG complexes to these food allergens.

So I think that if you triangulate it, and you look at the evolutionary perspective, we seem to be focusing in on these same types of foods. These are the foods that have been recently introduced into the human diet. And even though they seem like staples and they seem like everybody eats them and there’s no problems with it, if you look at the incidence of celiac disease, we know now the roughly 1 in 100 people have celiac disease in the U.S. We know that from blood bank studies. So if we go into blood banks and get a huge random sampling of blood, and we measure specific antibodies, we find 1 in 100. That’s three million people in America who shouldn’t be eating wheat. That’s an enormous amount. And I suspect that when we finally do, maybe not in my lifetime, I’m getting to be old here, I would suspect in maybe the next generation that we will see autoimmune disease unlocked. We will find out what the chain of environment events and genetic events is that cause it. This disease has been going on probably for at least 10,000 years, maybe longer. That disease knows exactly how it’s doing it. Humans just haven’t unraveled this complex disease.

Do you get a little bored or frustrated by how much money goes into drug treatments for autoimmune diseases while this other area is somewhat overlooked?

LOREN CORDAIN
We need novel thought. We need to think outside the box. People, when they look at autoimmune disease or any other disease, they look at an allopathic treatment. Cure the symptoms, don’t cure the cause. And from a fundamental perspective to understand the disease processes, we can perhaps build better drugs, if that’s an option, but perhaps it’s better to use the system the way it was designed genetically, and that’s my bias. If the system is genetically designed to operate under these conditions, maybe that’s what we should be doing if it’s practical rather than continuing to try to operate it under conditions under which the genome wasn’t selective.

PART 1 on YOUTUBE:

Click here to view the embedded video.

PART 2 on YOUTUBE:

Click here to view the embedded video.

 If you can’t view YouTube or if you want to download these videos, then . . .

SEE PART 1 – Net Carb Test — Part 1 (3 1/2 Minutes)

SEE PART 2 -  Net Carb Test — Part 2 (4 1/2 Minutes)

SEE DATA SUMMARY (PDF)

Editor’s Note:   Many companies advertise high-fiber, “net carb” products as safe for diabetics to use liberally, but many people with diabetes have observed that these products can drive up their blood sugars more than expected. When people make these observations one person at a time, they may feel like outliers, especially in the face of industry and scientific studies that state that net carb products do not raise blood sugars.  But some experts and advocates have persisted at looking more closely at “Net Carb” product, including:  Jimmy Moore at his Livin La Vida blog, David Mendosa through Diabetes Central, and Ron Rosedale through his Facebook blog.

To check this out from a first-hand perspective, Boulder’s Very Low Carbohydrate Diabetes Support Group conducted a citizen-based “test” of a “4 net carb” Quest Protein bar.  The Quest company donated the bars for this test.  Type II diabetics Barry Erdman and David Mendosa, Type 1 diabetic Jeff Roaderick and others helped develop the protocol.  The group is aware that their experience is not a scientifically conclusive test, due to the small sampling size.  Nevertheless, this first-hand experience, in a group setting, led many of the roughly dozen people who participated to wonder whether some other community groups might want to conduct similar tests, on similarly labeled “net carb” products.  Perhaps, together, community groups can find some clearer answers about these products than those being provided right now by food  companies and by regulatory agencies such as the FDA.  Questions this Boulder citizens’ group have include:

1.  What’s a good rule of thumb for calculating the effect of fiber carbs on blood sugar?  (The group is inclined toward 1 fiber carb = 1/2 regular carb)

2.  Why do some people have a stronger response to fiber carbs than others?  This group, for instance, is wondering whether insulin resistance and insulin production affect blood sugar response.  Additionally, this group wonders whether inflammatory responses to substances such as glutens, grains or dairy might affect blood sugar response.

3.  How representative is this result?  In this group,  half the participants saw a 50% rise in their blood sugars, within 1 hour of eating the Quest Protein Bar.

As an additional note, in this experiment, we tested Quest Protein Bars that were donated by the Quest Protein Bar company.  That company is continuing to work with us to figure out what, in their protein bars, seems to raise blood sugars in some people.  Is it the fiber?  (their science studies seem to say no)  Is it the whey (it shouldn’t, supposedly, but we’re going to check it out.)

TEST PROTOCOL (Provided by Jeff Roaderick)

If any other groups are interested in trying this kind of test, here is the protocol we used:

 Food Item : one peanut butter Quest Bar  – David Mendosa will provide.

Testing protocol:

Test 1: Fasting Blood Sugar Before Breakfast AND before 8am

Test 2: 10:15 am (Just before eating Quest Protein Bar)

Test 3: 11:15 am (This is the 1-hour after eating Quest “Net 4 Carb” Protein Bar

REQUIREMENT #5:  Fill out forms that:

1.  Record Your Blood Sugars at each testing time

2.  Identify your Diabetes As:  Type1/Type2?

Listen to Jeff (3 minutes)

Transcript of Jeff’s Account of How his Blood Sugars Reacted to a 1 Net Carb Bread.

“My name is Jeff Roaderick.  I’m 46 years old, and I have Type 1 diabetes, diagnosed in 1993, so about 18 years.  You know, I’m always looking for lower carb items to eat.  Julian Bakery, their 1 net carb product came up on my radar.  I got on line and I purchased some.  I was looking for a grain product, so I gave it a try.  You know, 1 net carb is a low amount of insulin for me.  I gave myself about half a unit of hemolog to digest that.  And unfortunately, an hour and a half later, my blood sugar went over 300.  It went up over 205 points.

It has been the beginning of a distrust in the whole net carb movement, because I see it advertised in Forecast Magazine from the ADA, they have products in there that really promote the low carb thing.

I have better success in managing my blood sugars by giving myself a dose for the total carbs rather than the net carbs.  I haven’t found a net carb product where I gave myself too much insulin.  I’ve always given myself the total carb dosage rather than the net carb dosage and it’s always worked out fine for me.

My friend Shelley contacted Julian Bakery.  They came back and said that 85% of people have success with their bread.  I am curious why am I in the 15%?  Is it that I have type 1 diabetes and I process the carbohydrates differently?  But I’m also very attuned to what my body’s doing.   I check my blood sugar 6 to 8 times a day.  I know how my body responds to certain foods that I eat.  That’s been cultivated over the last 18 years of having diabetes.  If it’s not unique to me, those folks who are newly diagnosed . . . how overwhelming is this for them.  How many folks are getting duped by the whole net carb craze?

Here are links to other experts who are looking skeptically at net carb products:  Jimmy Moore at his Livin La Vida blog, David Mendosa through Diabetes Central, and Ron Rosedale through his Facebook blog.

Background from Shelley:

It all started last March, when a friend of mine, named Jeff, emailed a puzzle to a community group I belong to, named the “Very Low Carb for Health Diabetes Support Group.”  This group includes many people diagnosed with diabetes who are serious about sticking to a low-carb diet.  Jeff is one of the members of this group.  He has Type 1 diabetes, and he monitors his blood sugars and his carbs very closely.  Jeff reported that one day, just before he was going to eat one serving of a popular “1 net carb” bread from Julian Bakery, he decided first, he would check his blood sugars.  He did, and they were in the 90′s.  Taking the bread’s name at face value, Jeff injected enough insulin for 1 net carb and then he ate the slice of Julian’s 1 net carb bread.  When he checked his blood sugars 1 hour later, they were over 300.   This was a disturbing puzzle.   How can only 1 gram of digestible carbs raise blood sugars over 200 points?

Jeff looked more closely at the Julian Bakery 1 Net Cab Bread and found the Nutrition Fact label on the back.  It  listed 13 grams of total carbohydrates and 12 grams of fiber.  Many nutrition professionals and physicians tell their diabetic patients that “fiber” is non-digestible, and since it’s included as part of “Total carbohydrates,” you simply subtract the fiber from the total carbohydrates to figure out just how many carbs are digestible, and thus, how the “net” carbs will affect your blood sugar.  Following that logic, Jeff subtracted 12 grams of fiber from the 13 grams of total carbohydrate in his “1 net carb” bread, and his arithmetic got him to 1 net carb.  Just as the Julian Bakery Bread had said on its label.

But his 200 point rise in blood sugars told him there was more than 1 gram of digestible carbs in that 1 net carb bread.

So last March, I emailed Julian Bakery and described his question.  I ended the email to Julian Bakery by writing,

TO:  Julian Bakery:

“What gives?  Are you being accurate about the actual number of carbs in your product, or not? Please explain.  — Shelley”

Heath Squier at Julian Bakery emailed me back with this response.

“Dear Shelley:

85% of Diabetics can eat our bread with no Insulin. Our bread has been independently verified so we are sure it is accurate. We have found that some diabetics breakdown fiber in different ways and those 15% need to take more insulin as they are more resistant to fiber offsetting the carbs in products.. This bread was tested on Type 2 Diabetics to ensure that they did not have any problems. We sell to 1,000′s of type 2 diabetics nationwide without any problems.” — Heath Squier Julian Bakery

Now it was good of him to respond promptly, but something about his reply didn’t make sense.  After all, how could a bread be low-carb for some people and not for others?  And even if this was so, how come?  If most diabetics don’t get a rise in blood sugar, but 15% do, is the group where blood sugars spike just weird in some way, and they digest fiber differently than everybody else?  Or is there something in the metabolism of diabetics who don’t show a blood sugar rise that masks the effect of what they’re eating?  It seemed such an unlikely puzzle, I wanted to let it go, but that supposedly “low carb” bread has raised my friend Jeff’s blood sugars by more than 200 points.  He had trusted marketing label that calls that bread “1 net carb”, and it had not been trustworthy for him.

So, I wrote back to Julian Bakery like this:

To:  Julian Bakery:  Something here doesn’t make sense to me.  So, please tell me how you determine “Carbs” for your nutrition fact label.  Is it:
1) Fibrous, non-digestible carbs plus digestible carbs = total carbs (meaning that out of the 13 grams of carbs in your product, only 1 gram is digestible)
OR
2) Digestible carbs and fibrous carbs are two separate categories and you do NOT add them together to make total carbs.  They stay separate categories. (meaning that out of 25 total grams of carbs in your bread, 13 grams are “carb,” meaning digestible, and 12 grams are fiber carbs, meaning not digestible)

Also, who is the independent expert group who verified the carb count?

Julian Bakery gave this reply:

Shelley,

I replied like this:

TO:  Julian Bakery

Nope, that’s not clear enough yet.  When you say 13 grams of actual carbs, does that all start out as digestible carbs?  That is, if you didn’t have any non-digestible fiber in your product, would it have 13 grams of digestible carbs or only 1?

Also, what is the independent group that verified your counting method?

William Davis, MD, is the Medical Director for Track your Plaque.  In Wheat Belly, he explains why he believes that modern wheat is a leading culprit in health problems today.  And, he says there are no bagels or muffins in his cupboards.  Here’s William Davis, talking about his new book:

Listen (20 Minutes)

(EDITOR’S NOTE:  This conversation is with Sam Henderson of Accera  in Broomfield, Colorado.  We did this interview a week or so before the Wall Street Journal published a story about Axona, which is Accera’s “milkshake” for mild cognitive impairment.   The “milkshake” comes in a small pouch.  You open it up and it’s filled with cream-colored granules that you mix with something, such as water, and it makes a sort of milkish-thickness drink that, due to a tiny bit of sugar and some artificial sweeteners and flavors, tastes mildly sweet, and while it’s probably not something you’d order on a night out with a friend just for the taste of it, it’s not so bad.  The key in this conversation is . . . are we really talking about Axona, the milkshake, which helps the body produce ketones despite eating carbs?  Or are we talking about why ketones may be part of neuro-protection through a diet, for instance.  Sam Henderson says in many ways that a ketogenic diet is more effective than eating carbs and taking a ketone-producing supplement.  As for the rest . . . well, you’ll see.)

Sam Henderson, it was 10 years ago, maybe 15, that you decided you wanted to find ways to slow down or reverse Alzheimer’s.

SAM HENDERSON That’s correct, when my mom was diagnosed with Alzheimer’s disease, I made that my new scientific line of investigation.

The focus that you gave to this was different than most other researchers, though. It went a different direction than clearing out the sticky, tarry A beta and tau-related plaques in the brain that many researchers assumed were the cause of Alzheimer’s.

SAM HENDERSON Yeah, you know, I looked at the current data which was out at the time, which was focused on A beta and tau, and I looked at the stuff that was being done at the company I was working at at the time, and it was too long-term for me. My mom was diagnosed then, and all these other treatments were five, ten years out. I thought we needed something sooner and faster.

At that time the focus was on trying to melt out the gummy tars in the brain with the thought that that would make Alzheimer’s go away.

SAM HENDERSON

Cerebral Edema

Yeah, that’s still pretty much the focus. We’ve had several really big trials recently. There’s one drug developed by Pfizer and Elan called bapineuzumab, which is a humanized antibody to the sticky plaques that accumulate in your brain. They’ve been having all sorts of trouble with that trial, unfortunately. What it is, it’s an infused antibody, so you have to sit in the doctor’s office and they infuse you with the antibody, it binds to the protein and then clears it out of your blood. Unfortunately, some of the patients, particularly the ones who carry the genetic risk factor for Alzheimer’s disease, develop really bad cerebral edema, they get swelling in the brain, so they’ve had to back off on the high dose in those patients.

For well over a decade, a small band of maverick researchers have warned that dissolving out those tarry plaques in the brain of a dementia patient is a bad idea. They’ve said that those plaques may be bandaids to deal with the damage that’s in there, and if you melt them out, you could cause more bleeding and the release of toxins into healthy sections of the brain. And you could get things like cerebral hemorrhages.

SAM HENDERSON – There’s a lot of people questioning now the whole A beta hypothesis for Alzheimer’s disease. But I think the big bapineuzumab trial and Eli Lilly has another monoclonal antibody, and I think BMS, Bristol Myers Squibb, has one as well. I think once they do these trials, if they really don’t get any cognitive improvements, then that’ll be a good piece of data to have to move the field somewhere else.

And all this time you’ve been moving in a different direction from that idea of melting the plaques with drugs. You’ve been thinking, what can we do to nourish the nerves so they function better?

SAM HENDERSON – Right. The hypothesis that we work on is that there’s this well-known problem that occurs in Alzheimer’s disease in that your brain has difficulty metabolizing sugar. Sugar’s the main source of energy for your brain.

Let’s back up. Does sugar have to be the main source of energy for the brain, or is it the one that most people in modern countries are habituated to using? That is, their brains are accustomed to using sugar as the main food but the brain could be adapted to using something else?

SAM HENDERSON – Your brain doesn’t really use fats, like most of the rest of your body does. It pretty much wants to run on glucose all the time. There’s only one other fuel that it can use efficiently, and that are what are called ketone bodies. And as you mentioned (before we started recording), in modern Western society with diets very rich in carbohydrates, you almost never enter ketosis. That’s considered a disease state, almost.

Perhaps we could say that being in a state of nutritional ketosis is so unknown among most traditional healthcare practitioners that they’re scared of it?

SAM HENDERSON Oh, yeah, absolutely. I gave a talk recently, and one of the physicians got up and said, “I spend most of my time trying to keep my patients out of ketosis. Now you’re telling me to put them into ketosis? It doesn’t make any sense.” There’s been a very long bias in the medical literature against ketosis.

That literature focuses on the truly dangerous condition of ketoacidosis, where a diabetic’s blood sugars are high at the same time that their ketones start running high. But when a person adapts to fat-burning by eating a low-carb diet or a very reduced calorie diet, with their blood sugars running more in the normal range, and THEN they’re producing ketones, that’s a different situation. And if we look back at traditional cultures, there are a number of those where a whole culture of people, for thousands of years or maybe tens of thousands or more, maintained bodies that were in ketosis most of the time because they didn’t eat carbohydrates. You can probably name some of those cultures.

SAM HENDERSON Absolutely, like the Inuits. The farther north you go in latitude, the less plant matter and carbohydrates people eat in their diets. Inuits live close to the North Pole, where there’s virtually no carbohydrate sources there to eat, so they eat almost entirely fat and protein. And mostly fat. SAM HENDERSON Mostly fat. The Plains Indians, in what’s now the U.S., the warriors especially really preferred to eat mostly fat and meat, a little bit, and as little of what they considered, “that wimpy” carbohydrate as they could.

SAM HENDERSON There’s a really good book out, Good Calories, Bad Calories, by Gary Taubes. He points out that in the 1800s, it was very well known that carbohydrates made you fat, which is common knowledge. But then we went through this big shift where we went to vilify fats and promote carbohydrates in people’s diets, and now people eat 55%, 60% of their core intake from carbohydrates, which is probably very evolutionarily discordant. For most people, practically everyone, that’s not a good diet.

You’ve looked at the popular literature and know some of the history of how other people ate, but mostly you’ve looked at this as a scientist, and a scientist whose mom had Alzheimer’s, and you wished that she could have been healthier. And you look at other people and you wish they could be healthier. You’re interested in this stuff called ketones that the brain can use that our bodies manufacture from fat, and something all of us can make. Tell us more about that.

SAM HENDERSON Ketones are a natural part of your physiology. For instance, when you wake up in the morning, your ketone levels are slightly elevated because you fasted overnight.

Meaning, they become elevated in your bloodstream because you didn’t eat anything overnight?

SAM HENDERSON Right. Your blood glucose gets a little low, and your body starts to burn its fat to make ketone bodies. The literature about how this works goes back to the 1960s, where they did a really interesting experiment where they took a bunch of obese people and they starved them. They didn’t eat anything for five weeks, literally all they had was water and a vitamin and some salt. In that paper. The researcher who did this shows that there’s this huge spike of ketone bodies that occurs, and so he talks about—and particularly these ketone bodies are used to fuel your brain, because your brain needs a lot of energy. Your body can make glucose, sugar, so he raised the question, why doesn’t it just make more sugar to fuel your brain, instead of using these ketone bodies, which everybody thought were bad?

Let’s slow down for just a second here and let people take that in. If we aren’t eating anything, our bodies can choose to make either sugar from the tissue in our bodies, or it can make fat from the stored fats in our bodies, including ketones that our brain can use. In other words, if you stop eating, your body can make either one, and you say that in this situation it chooses to make which one?

SAM HENDERSON It’ll make the ketone bodies. He explains in this paper why that occurs. The major source for glucose or sugar to be made in your body is amino acids, proteins. When you’ve run out of fuel for an extended period of time, your body will start to break down its major source of proteins, which is your muscles. So you can imagine, if you’re starving and you start breaking down your muscles, this is very bad, evolutionarily. You can’t hunt, you can’t gather, you can’t find food if you’re weak and tired. And your body doesn’t really carry that much stored energy as protein anyway. On the other hand, if you think about it, a typical person carries tens of thousands of calories around as fat.

Even if you’re skinny?

SAM HENDERSON Even if you’re pretty skinny. And unfortunately in America, with the obesity epidemic, there are people who have literally hundreds of thousands of calories that they’re carrying around as fat.

For some reason, the metabolism of a person who’s overweight can get locked out from reaching into that store of fat. But if somebody stops eating, the lock on the metabolism gets released, and it gets easier to reach the energy stored in fat?

SAM HENDERSON Right. It makes a lot of sense if you think about it, because your body will then start to tap that very abundant source of energy in fat, to provide these ketone bodies, which can be used by lots of tissues in your body, particularly your brain. The thought I had over 10 years ago now was that if in Alzheimer’s you’re having difficulty metabolizing glucose, maybe we can provide the brain with a ketone body, which is a normal fuel for your brain anyhow.

If your body will make it if a person just stops eating, why not just have Alzheimer’s patients just stop eating so they make their own ketones?

SAM HENDERSON [laughs] You could do that, but it’s probably not a good way to go. You could also try these ketogenic diets, high-fat, low-protein diets, low carbohydrate as well, because remember, you’ll make glucose from the proteins, so in a true ketogenic diet, you eat very low amounts of protein. You’re basically eating very, very large amounts of fat.

In a ketogenic diet, a person could eat that their whole lives? The Eskimo up in the Arctic Circle, this is how they lived, and this is how the Maasai warriors lived and how the Plains Indian lived, on that kind of diet. It’s not like it’s a starvation diet, it’s just a certain way to eat.

SAM HENDERSON Yeah. There was a paper that came out this year showing that a ketogenic diet improves cognitive performance in people with what’s called “mild cognitive impairment,” which is thought to be a prodromo syndrome of Alzheimer’s disease.

What does “prodromo” mean?

SAM HENDERSON A precursor syndrome. You’re going to start with MCI (Mild Cognitive Impairment) and progress into Alzheimer’s disease eventually. So I think the field is coming around to this idea that ketone bodies are not a bad thing and that it makes sense to provide your body with ketone bodies. These cultures that practice fasting, there’s probably a reason they developed that. They knew intuitively that it was good for you. But having said all that, it’s very difficult to fast, and it’s very difficult to do a true ketogenic diet, because carbohydrates are everywhere.

You say it’s very difficult to fast, but Sam Henderson, you or I could just go, “Hey, we’re going to stop eating for a couple of days and see what happens.” But then, you’re probably healthy enough to do that, feel a little tired and sleepy, but you could probably get everything else you want done, even while you’re fasting. What about somebody who is frail and is already having trouble with their brain and they’re struggling? What would if you say to that person, “Let’s just have you stop eating for a couple of days”?

SAM HENDERSON Once that disease state has set in, it’s probably going to be very difficult to do that. For example, in Alzheimer’s disease, there’s a very well-known shift in food preference. People with Alzheimer’s disease tend to like very, very sweet foods. One hypothesis is that’s the brain saying, “Look, we’re starving up here, we need some sugar, we need something to eat. So quick go out and get some Pop-Tarts or donuts or whatever.” For an Alzheimer’s to not eat or eat a ketogenic diet is going to be a compliance challenge.

Meaning that they’ll be suffering? They’ll be unhappy?

SAM HENDERSON They’ll be very unhappy.

Is it like telling a cocaine addict or an alcoholic, “Look, it’s time to stop having cocaine or alcohol”? Would it be better just to stop?

SAM HENDERSON I think any of your listeners who try to do an Atkins diet, you know that after a while of not eating carbohydrates, after a week, you really get that craving. You really want to go out and eat a donut. Serotonin levels go up when you eat carbohydrates, so there’s probably an addictive quality to it.

With quitting tobacco campaigns, quitline counselors generally tell people that about 10 days into quitting, you’re really going to miss it.

SAM HENDERSON And I think that’s very true of carbohydrates as well. You’re definitely going to crave those.

Well, one choice people have is to get through that period of intense craving and get to the other side. We all know people who quit smoking, and they don’t crave cigarettes any more, meaning they just keep them away so they don’t have the craving again.

SAM HENDERSON Absolutely. Once you get over that hump, that phase where you really, really want it, you’re probably OK, for the most part, unless you start falling off that wagon again, which is very, very easy to do in our society when it comes to dieting.

Despite the fact you have a product that provides ketones to people who have not switched into fat-burning mode, you’re acknowledging that eating a low-carb, adequate protein, high fat diet could be once choice that people could make?

SAM HENDERSON It’s the preferred choice. If you can cut your carbohydrates down and do that for most of your life, it’ll probably greatly reduce a lot of disease state, type 2 diabetes, Alzheimer’s, lots of other conditions. If you can stick to that kind of diet, obviously I think that’s the way to go.

Just from a philosophical and personal standpoint, that’s what you say. But at the same time, you expect a lot of people would rather have their cake and their ketone bodies, too?

SAM HENDERSON Exactly. That’s the ideal condition you want. Eat anything you want but not develop those disease states. That’s where everyone would want to go.

And given the fact that a lot of people have such trouble making the shift away from carbohydrates even though carbohydrates are harming them, that’s where you thought of your product, to give people a way to take in ketone bodies without adapting their body to making them themselves.

SAM HENDERSON It’s very difficult to restrict carbohydrates, so could we find an ingredient or a compound that you could take that would induce ketosis while you were still eating carbohydrates in things in your diet. That was the genesis of the idea. What we use are these things called medium-chain triglycerides, which are fats that are very different from traditional long-chain triglyceride fats.

Is a medium chain triglyceride like fish oil?

SAM HENDERSON Fish oil is a long-chain triglyceride, but a long-chain triglyceride is basically any triglyceride that contains fatty acid chance over 14 carbons. Almost every fat that you eat is a long-chain triglyceride.

Is butter a long-chain triglyceride?

SAM HENDERSON Yes.

The fat in meat?

SAM HENDERSON Yes.

Olive oil?

SAM HENDERSON Yes.

Fish oil?

SAM HENDERSON Yes.

So it’s just anything that tastes fatty?

SAM HENDERSON Almost 98% of the fat you take in in your diet will be a long-chain triglyceride. The medium-chain triglycerides are somewhat difficult to come by in pure form.

EDITOR’S NOTE – Coconut Oil is one of the best natural sources of Medium Chain Triglycerides, even though it’s NOT the main source of fat in that oil.

Someone once told me that a medium- or short-chain triglyceride tastes like vinegar.

SAM HENDERSON If it’s a pure medium chain triglyceride and it has no pre-fatty acids in it, there’s no taste. It’s odorless, tasteless, colorless liquid.

Does it have a mouth feel of fat?

SAM HENDERSON Yeah, it’s got kind of a slippery oil-like feel to it.

Do you have some here in your office that is tasteable? Could anybody taste it? Could I buy it at a pharmacy or Wal-Mart?

SAM HENDERSON You can get it from some specialty nutrition places online, things like that. It’s not that hard to find.

Is it a stable product?

SAM HENDERSON They’re very stable, since they’re fully saturated fats, they do not get oxidized readily at all . They’re very, very stable.

What made you think that this would be a good line of product to start making for the sake of Alzheimer’s who don’t want to give up carbs? What was your thinking on how it could help them?

SAM HENDERSON The thought was that since their brains are having difficulty metabolizing sugar, glucose, is there another fuel that we can give them that maybe they’ll be able to metabolize easier and more efficiently? That fuel is these ketone bodies. The idea is that when you take in these medium-chain triglycerides, your body will oxidize those or metabolize those regardless of your metabolic state. For example, you can take in MCTs with a large amount of carbohydrate and your body will still metabolize them to produce ketone bodies.

I’m envisioning something where somebody takes in this product that makes it easier to make ketones and their body just pours it out again, it just comes out in the urine, in the feces, and it never gets processed. Do you have evidence that shows that the body will gladly take this in and use it for energy?

SAM HENDERSON There are studies that demonstrate this, where they take normal, healthy people and infuse them with ketone bodies and then follow their metabolism through the body. You can see when people do this, there’s several good studies from in the ’90s where they show that when you infuse people with one particular ketone called beta-hydroxybutyrate, you can see a big increase in the uptake of that compound into the brain and metabolism of that compound in the brain, with a concomitant reduction in glucose metabolism in the brain. This paper clearly shows that when you elevate ketones in circulation in your body, your brain sort of switches over to metabolizing the ketones instead of the glucose.

That’s an interesting study, but you’re not describing something where these people are starving or on a fast. Instead, they just got this special nutrient and the brain went, “Yahoo! This is what we’d rather have!”

SAM HENDERSON The benefits of the ketone body is, it’s very easily metabolized. It’s only a four-carbon molecule, so it can very readily be metabolized and enter the citric acid cycle in your mitochondria, unlike glucose, which is a fairly large molecule and has to go through the steps of glycolysis to be broken down.

There’s this little engine in your cells called the mitochondria. It’s a few steps for glucose, sugars, to be metabolized and burned inside that mitochondria or anywhere in the cell. But oil just kind of slips right in, and the mitochondria has a very easy time turning that into energy.

SAM HENDERSON There are only three steps before it becomes acetyl co-enzyme A compared to glucose, which is, I think, 12. So it’s much easier for your body to metabolize it than it is for a molecule of glucose.

And that’s why the brain might like it better?

SAM HENDERSON Yeah. It’s a very efficient fuel, because it’s basically a ready to go molecule for the mitochondria.

In a healthy person, does it reduce their cravings for sugar?

SAM HENDERSON There have been a number of studies looking at MCTs for things like satiety and weight loss. Some of them show that it will reduce the desire to eat food. But the caveat with these studies is that MCTs are a little difficult to digest.

Medium-chain triglycerides?

SAM HENDERSON When you take them in, there tends to be, especially if you take a large amount, some diarrhea and nausea and things like that from the rapid metabolism of the MCT.

So your bloodstream might say there’s a fuel inside the bloodstream to give to cells, but the digestive tract, just as a liquid to be taking in, is a little challenged by how to process it?

SAM HENDERSON Yeah, especially if you take the straight oil, it can be quite hard—just imagine taking any straight oil, it’d be a little hard to digest. So we spent a lot of time formulating it to make it easier to digest. We titrate people on the dose to get them acclimated to the fairly large does that we give them.

Would it make a good salad dressing?

SAM HENDERSON I don’t know. I’ve never tried that.

That would give some roughage to eat with the oil so that it might slow down the digestion enough to let the digestion take it in more.

SAM HENDERSON We typically recommend people take it with another fatty fat source. What you’re trying to do is give another fat to compete out the lipases that break down the MCT, so you don’t have quite as rapid a digestion of the MCT.

So lipase is a digestive enzyme in the gut, the stomach?

SAM HENDERSON Yeah, it’s mostly in your small intestine.

Is it in the duodenum?

SAM HENDERSON Yes.

The little pouch that’s just below the stomach. It breaks down fatty acids to their very simplest form, which is more like a vinegary kind of stuff. But you would rather have these medium-chain triglycerides be undigested when they hit the bloodstream?

SAM HENDERSON The lipases attack the triglyceride and cut off the fatty acids, and then for a medium-fatty acid, these little fats then go directly via the portal vein to your liver, which is a very different pathway than a long-chain fatty acid would take.

The medium- and short-chain fatty acids, this is kind of geeky, but let’s explain it. The big complicated ones, like butters and olive oils, they go into these kind of balls of fat that go into your lymph system?

SAM HENDERSON That’s correct. When you go to McDonald’s and eat a Big Mac that’s full of long-chain triglycerides and you eat some carbohydrate with it—well, it doesn’t matter if you have carbohydrate or not, the long-chain triglyceride, the lipases will attack that. They’ll cut off the fatty acids off that. Then the cells in your gut will reassemble it back as a triglyceride and then take that and make it into these big ball, big lipoprotein particles, and then dump that into your lymph system in your neck, which then enters into circulation.

It just kind of floats along, drifts through the lymph system, up to the vein in your neck, and then it goes whoosh! into your heart and on from there?

SAM HENDERSON These little protein particles people know as LDL and HDL.

You have these big things called chylomicrons?

SAM HENDERSON What you don’t want are these LDL particles floating around in your bloodstream, because that means you’re not breaking down the fats. You want the HLDs, the “good” cholesterol, people call it, which are basically the fat-depleted versions of these little protein particles.

This is a long and detailed explanation as to why there’s some thought that goes into what kind of fat you want people to eat. You want to have a fat that slips by this slow barge-like system of the lymph system, that’s small enough that the body goes, “We can just send this right to the liver.”

SAM HENDERSON So when a medium-chain triglyceride gets cleaved, those little medium-chain fatty acids are very soluble and they’re small, so they don’t get reesterified and reassembled back in the triglycerides and don’t get assembled in these lipoprotein particles. Instead, the medium-chain fatty acids go directly to ___, straight to the liver. And once they get to the liver, again, they’re not reesterified. The liver just says, “Oh, OK, here’s some medium-chain fatty acid, we’re just going to oxidize it. We’re just going to start metabolizing it regardless of anything in the diet. We’re just going to burn it.”

It says, “Oh, great! Here’s some of those good old medium-chain triglycerides. We don’t have to do anything to them. Let’s just send them right on because the body needs them.

SAM HENDERSON Right. It’s going to break them down no matter what.

And so your thought about eating a little bit of other kind of fat with your formulation is so that the lipases go after that and let the MCTs go through just like they are, because that’s the best way for the body to use them.

SAM HENDERSON The MCTs are metabolized very efficiently, so those medium-chain fatty acids are cut off very quickly. When you take in an large amount of the MCTs, you can get this large amount of medium-chain fatty acids in your duodenum, which can be for some people hard to tolerate. So if you can slow that digestion down a little bit, then you can reduce the adverse events you see with the MCTs. In our formulation we mix in some long-chain triglyceride, and we recommend people take it with a meal. It’s better if they take it with a fatty meal, a little bit of cheese, maybe, or something that can slow the digestion down a little bit.

In a way, it might be good to be adapted to a higher-fat diet anyway, if you’re taking this product?

SAM HENDERSON Oh, definitely, yeah. People have known for a long time on these ketogenic diets that they give to kids that if you slowly titrate people up on both normal fats and medium-chain triglycerides, that they can tolerate very high amounts over time. You’re right, there definitely is an adaptation that occurs over time.

What is the benefit of this to someone with Alzheimer’s? If you give them this product or if they adapt to a high-fat diet over time, what happens to their cognition, to their food cravings?

SAM HENDERSON We’ve done two clinical studies with our product in people with mild to moderate Alzheimer’s disease. The outcomes we measure are change in cognition. We use a test called the ADAS-Cog test [Alzheimer’s Disease Assessment Scale-Cognitive], which is a test of a variety of measures of cognition, in particular short-term memory, which people know is one of the first things that’s affected in Alzheimer’s disease. In our first study that we published in 2004, you can see a very rapid change in improvement in cognition when people take the MCTs.

How long did that improvement in cognition last?

SAM HENDERSON The way the study was done was, they were given one dose of the MCTs and their cognition was tested 90 minutes later, and we could see an improvement in cognition in 90 minutes. But we didn’t measure any time points after that.

Do you have some clients, are there some patients who have been on your product long enough for there to be any measurements of what happens to their cognition over time?

SAM HENDERSON We did another study that we published in 2009 where we looked at people who were on the products for 90 days. We saw improvement both at day 45 and at day 90 in a particularly genetic subpopulation of the subjects. So we can see the long-term benefit, at least for 90 days.

If it was my grandmother or my aunt, I’d like to see it work for nine years.

SAM HENDERSON We would have to do that study, which would be a very difficult long-term study. Our next study we setting up is for six months, so we’ll get another, longer data point. To do these very long-term longitudinal studies is very challenging, especially for a small company like us.

Are you getting any help from the National Institutes of Health or any groups that are concerned about Alzheimer’s?

SAM HENDERSON We have not got any grants from National Institutes of Health.

What other conditions do you think this might potentially help, to have somebody be on a higher-fat diet, or just on more of these medium-chain triglycerides?

SAM HENDERSON If you look in the literature, there was an experiment done a couple years ago in Parkinson’s disease where they tried a ketogenic diets and they noted some improvements in measures of movement in Parkinson’s disease. There’s some suggestion in the literature for some other conditions, like epilepsy, obviously, which has been known for a long time that pediatric epilepsy, especially for non-responders to the current therapies, when they’re put on these ketogenic diets they see very strong reduction in seizure frequencies. Those are the two ones that I think have a good probability of success.

I’m thinking now that a lot of these that we’re talking about are nerve diseases, diseases that involve nerve systems or brain as nerve, so systems that are damaged that have nerves in them. Could we put possibly multiple sclerosis in there, muscular dystrophy, possibly Lou Gehrig’s disease? Anything that has a nerve damage component to it, people with brain injuries?

SAM HENDERSON We haven’t studied any of those conditions, so we can’t make any sort of off-label claims to any of those conditions.

But what about as a scientist, as you look at just how nerves function and how metabolism functions? What’s your guess?

SAM HENDERSON There’s good reason to suspect that ketone bodies may be advantageous in numerous neurological conditions, mostly because the neurons will constituently metabolize glucose. This is why you see a lot of neural problems in people with diabetes, because their blood glucose gets too high and they generate lots of what are called reactive oxygen species when they metabolize glucose. So ketone bodies may be beneficial in a lot of those neurological conditions, but we haven’t studied that, so we can’t make any claims to that.

You can’t make any official claims, which makes me think you have gotten approval to make claims about some diseases. What has the FDA approved your product for?

SAM HENDERSON Our product is a medical food. There’s no official approval from the FDA. For a medical food, you just basically have to do studies, you have to demonstrate that it actually works in clinical studies. You need two adequate and well-controlled studies. And then it has to be backed up by scientific evidence. Then you can actually make a disease claim. Like, our label claim is for the metabolic processes associated with mild to moderate Alzheimer’s disease. So we can make a disease claim, and right now it’s mild to moderate Alzheimer’s disease because that’s what we’ve studied in our two studies.

So you can make that claim because you have two peer-reviewed studies that have been published in scientific journals? That’s the certificate?

SAM HENDERSON For medical food, that’s what’s required.

If I wanted to get this product, where could I go to get it?

SAM HENDERSON Medical foods have to be administrated under medical supervision. That means for our product you need a prescription. You have to go to your doctor and have them write you a prescription. Then you go to your pharmacy and you can get it at any pharmacy in the U.S., Wal-Mart, Costco, Rite-Aid, Walgreen’s.

Is it expensive?

SAM HENDERSON It retails for about $80 to $90 a month.

Is that for the size of a bottle of olive oil?

SAM HENDERSON No. It comes as a powder that you mix up. You get a 30-day box, which is a fairly large box, which contains 30 little pouches or packets. You mix that with water or juice or whatever you want.

I’m picturing that it’s oil that’s been suffused with some kind of coating that dissolves in water, and then lets the oil be out and there you have it?

SAM HENDERSON We use a matrix to encapsulate the oil. It’s quite similar to the matrix that’s used in ice cream, sort of a protein-maltrodextrin matrix, which is very stable and creates a very stable emulsion which helps digestion and relieves some of those adverse events. You can mix that product in whatever you want. We have people who mix it with puddings and soft foods, which people seem to like. I kind of like it in orange juice, because it has a sort of Orange Julius-type flavor to it.

So there are ways you can take it in. What if the logic of eating a higher-fat diet and a lower-carbohydrate diet appeals to someone? You wouldn’t want to mix it in orange juice then.

SAM HENDERSON If you’re trying to cut out your carbohydrates, you’d just mix it in water. It’s vanilla flavored, so you can just mix it in water alone.

And it doesn’t have enough carbs in it to pop somebody out of ketosis?

SAM HENDERSON No. I think it only has two grams of sugar in it.

What size of serving?

SAM HENDERSON That’s a 40-gram serving.

So one time a day you would add 2 grams of sugar to your total load of sugars?

SAM HENDERSON Right, which is pretty low.

If a person could inform their doctor about this product and their interest in it, they could use it for anything they’re curious about?

SAM HENDERSON If you could get your doctor to write the script for it, yeah.

Doctors write scripts for a lot of off-label uses. I’m wondering, if somebody was curious about this, where it would be potentially the most helpful, there are a number of studies that say if somebody’s switching to fat-burning or they’re going to do a fast, the first 24 hours is the toughest part. After someone gets through 48 hours, there’s some metabolic shifts that tend to happen where it’s a smoother process. But for some people, that first 24 hours is really uncomfortable and might even be stressful on their body.

SAM HENDERSON I’ve done those at-home experiments where you try and drive yourself into ketosis as quick as possible. Usually if you read around the Internet, body builders tend to do this a lot. If you exercise very vigorously on that day you quit the carbohydrates, you can deplete your glycogen stores, and that’ll push you into ketosis much more quickly. Or you can drink some Axona, which will push you into ketosis in 20 minutes.

Does that feel different? Once you’re in ketosis, can you feel it? Is it just a subtle thing?

SAM HENDERSON We haven’t had any reports of people feeling any differently other than improved cognition in Alzheimer’s patients.

How about somebody who has trouble shifting into an Atkins-style diet? Could it be like the Nicorette of switching to fat-burning, to take in this medium-chain triglyceride?

SAM HENDERSON [laughs] I guess you could think of it that way, if they’re trying to acclimate themselves to being in ketosis.

And we’re talking theoretically. Nobody has tried this?

SAM HENDERSON Not that I know of.

In a true fat-burning mode, there’s other things that happen besides having ketone bodies. For instance, insulin levels go down, leptin levels go down, the cells become more sensitive to the signaling of a lot of hormones. If somebody’s taking in carbs, that’s not going to happen. Are there some benefits that could be lost if somebody just takes in this kind of product and keeps eating ice cream and cookies and sodas?

SAM HENDERSON If you keep eating carbohydrates in your diet, you’re not going to lose weight, obviously, because you’re stimulating your insulin signaling, which is a fat storage protein hormone, you’re going to stimulate the storage of fat. So the studies that have looked at MCTs for weight loss mostly focus on the satiety thing, that once you take the MCTs you don’t really feel hungry any more. That’s probably due to that queasy feeling that you get in your stomach and you just don’t want to eat. Also, people who have been on an Atkins diet know that people self-limit their caloric intake when they’re on that kind of diet. I’ve done this many times, but after a while on eggs and ham and tuna and steak is just like, “Bleah, I don’t want to eat that any more.” People just naturally limit their calories without having to consciously do it.

There’s another theory of that. You get bored with that kind of diet, is what you’re saying.

SAM HENDERSON Yeah.

One could argue that maybe you need a better chef who can make a low carb diet more varied for you.

SAM HENDERSON That’s probably true. I’m a terrible chef, so I always have a hard time sticking on it.

The other side of it is that it may not just be the boredom of food that changes somebody’s attitude towards the food, it may be that appetite signals, as hormones become more sensitive, go down, so that a person isn’t just bored with their food, but their body is telling them accurately, “You had enough food. You don’t need more food.” And we know that because our energy metabolism signaling is more clear now. It’s not as gummed up and muddied by having insulin and leptin and all kinds of other hormone signals be way too high. The body’s operating more intelligently.

SAM HENDERSON I think that’s absolutely right. Because fat is one of the main satiety signals to your body. If you take in a lot of fat, if that’s all you’re eating, you’re absolutely right, your body is saying, “I’ve had enough. I don’t want to eat any more.”

And it’s partly a satiety signal for your stomach, getting that kind of nutrient, but metabolically, once it’s in the bloodstream, your body doesn’t really want to be fat. It wants to have enough fat, but it doesn’t need to be super-fat. And your body knows that if the signaling is accurate for it.

SAM HENDERSON I personally think your body wants to be fat. What your body wants to do is store fat for when you run out of food later.

I’ve always wondered about that argument. There’s a lot of debate about that. Why is it that people when they’re older, past their reproductive years, is when they’re most likely to be fat, and when they’re young is not when they’re likely to be fat? Our temperatures don’t go up every year just because we’re getting older.

SAM HENDERSON I think when you’re younger, you’re competing for mates. You tend not to want to be fat. But you look at the obesity epidemic now, high school kids, they’re pretty fat. I think the big issue is, it’s this “thrifty genotype” hypothesis that Neel came up with in the ’60s, that you want to store fat for when you’re going to run out of food. For most of human evolution, people probably ran out of food fairly regularly, so they want to store fat as readily as they can. So when you take in all these carbohydrates, what your body does is, it says, “Let’s just store fat. Let’s get fat, because we’re going to run out of food next week and we’re going to need all this fat.” To me, that’s the fundamental shift that occurred in human diets. As soon as we found this very abundant source of carbohydrates in terms of grains, people could get as fat as they wanted easily, whereas in the past it was probably difficult for them to find carbohydrate-rich food all the time.

Maybe there’s some truth to that, or maybe the thrifty gene hypothesis is fundamentally wrong. Who knows? But to get back to your product and the idea of what people need when they’re sick, and especially with a neurological disease, there may be reasons to have them try out a way to pull back on carbohydrates, find ways to nourish their system with foods that make it easier to shift into making ketone bodies. This may be kinder to their appetites. They might not be tortured by carbohydrates the way they are when their body is really starving, because that whole system has gotten so messed up, every sugar that they eat doesn’t get to their cells as energy.

SAM HENDERSON The idea of shifting to a low-carbohydrate diet has lots of benefits, not only weight loss and neurological conditions, but probably other things as well.

Theoretically, what do you think about this kind of product, the medium-chain triglycerides, for serious illnesses, someone who is at a very dire strait in terms of a neurological disease? Would there be any harm for them trying this kind of product as a way to see if their damaged nerve cells might get a little more nourishment and might be destructed more slowly?

SAM HENDERSON That’s one of the benefits of using this. It’s already a GRAS-approved food additive. GRAS generally recognized as safe by the FDA, which is a much higher standard of safety than any drug. Most drugs I wouldn’t want to take because of the side effects. Food additives and these GRAS substances have to be reviewed by the FDA as to whether or not they’re safe for human consumption. Since it is a food ingredient, it’s pretty safe, other than some GI upset you can get with taking large doses of it.

You think that this product might help people with cognitive impairment, some studies you’ve done have shown that, if they have Alzheimer’s. You think it has some potential for some other nerve diseases that haven’t been officially studied. And you think it might not hurt somebody to try it if they’re curious about this, even with a serious condition, or if they just have cravings and they want to see what happens to their cravings if they get more ketone bodies into their bodies earlier.

SAM HENDERSON If you look at the literature on ketosis, especially in the last couple of years, you can see a lot of potential applications.

Sam Henderson, it’s not just people that you’ve studied that product in, you’ve also looked at it in some animals, such as dogs. What happened when you used it in dogs? How did you use it?

SAM HENDERSON We did a few studies in dogs to look at a couple things. One is cognition in the dogs, in older dogs. Dogs suffer from an Alzheimer’s-like syndrome called canine cognitive decline. If anyone has an old dog, they probably know the symptoms of that, a bit of wandering, less human interaction, less like a puppy, less like a young dog. We supplemented their diets with the MCTs and we noted improvements in several measure of both canine cognition and motor control. They were able to do motor tasks better and their cognition was better. That study was replicated by a scientist at Purina, so it’s been independently validated.

What does “motor cognition” mean?

SAM HENDERSON It was a motor task. What they did was, they had to reach their paw out and grab a little treat and pull it towards them. They dogs who were given MCTs could do that task better than the dogs who were given the placebo. Their motor skills improved. These are older animals. We also looked at how the mitochondria were functioning in their brain.

That’s the little engine that’s the furnace inside the cells that helps our whole body get energy?

SAM HENDERSON We knew that ketone bodies act mainly in the mitochondria, so we looked to see if this induction of ketosis could improve the function of these mitochondria in the brains of the dogs. You could see a big improvement in their respiration rate. They were able to more efficiently utilize the fuels that they were given.

Meaning that they didn’t have to work as hard to breathe?

SAM HENDERSON They could generate more energy using less oxygen, so they were much more efficient. The other thing we looked at was the composition of lipids, fats, in their brain. The reason we did that was that Dr. Taha, who wanted to do this study, had worked on these ketogenic diets, and he knew from these previous studies that when you put kids on these ketogenic diets— (You mean children with epilepsy, for instance?) Right.

By the way, that ketogenic diet for epilepsy has been tested at Johns Hopkins especially, and it is one of the most effective, often more effective than most drugs in terms of eliminating or reducing epileptic seizures.

SAM HENDERSON Absolutely. There’s probably 50 years of research on that. It’s a very effective treat. So in this study that Dr. Tata had looked at, previously he found that when you put these kids on these ketogenic diets, their blood levels of these omega-3 fatty acids goes way up, even if you don’t supplement the diet with things like DHA and EPA. The blood levels go way up, the idea being that when you stimulate fatty acid oxidation, your body releases these polyunsaturated fatty acids, PUFAs, which are really good for you, as everyone has heard about the benefits of fish oil and things like that. What he wanted to see is, if you tricked the animal into thinking it’s in ketosis, does this same thing happen?

When you say “trick” the animal, this is not like hiding a treat and saying, “My beloved dog, I’m going to try to trick you,” this is fooling their body cells into doing something, not just the dog’s behavior, right inside of their trillions of cells?

SAM HENDERSON Right. Instead of putting them on a ketogenic diet, we just gave them the MCTs so the liver would make ketones out of that, instead of the liver being in a carbohydrate- and protein-restricted environment where it would make ketones. That’s sort of the trick. When we did that, then we measured various lipid levels in their brain. You see a big change in the lipid environment in the brain of these old dogs. People think fat is bad, but your brain is mostly fat. There’s a very large amount of fat, and as you age, the cholesterol levels and fat levels in your brain go down. This is bad. This is also the sort of thing that happens in MS. You get this depletion of fatty acids in your brain.

And in a lot of other neurological diseases, Parkinson’s …

SAM HENDERSON  Exactly. What was interesting was that we found that the total lipid content of the brain went up and you could see specifically increases in those omega-3 fatty acids in the brain, like DHA and EPA, which are used in the composition of the lipid membranes in the cells of your brain.

You don’t know whether that’s because those nutrients were supplied in greater amounts or that the body, once it wasn’t burning inefficiently, was able to save those fatty acids and use them more effectively as building materials. It could be that it already had these materials there but it used them in a better way once it was a cleaner metabolism?

SAM HENDERSON Right. His hypothesis was that once the body is in this fat-burning mode, once you switch it over, either by dietary means or giving it an MCT, your body will start to release all these polyunsaturated fatty acids, these omega-3s and omega-6s, which then enter the brain and can be used to rebuild the lipid membranes in your brain. It was an interesting study we did. We published that in 2009.

Sam Henderson, this makes me very curious about all the different ways that product might be used. I know you only have one FDA-approved official medical use for this product, which is the Alzheimer’s disease, but I can’t help but think of all kinds of ways that I might like to use this and try it out and experiment with it if I had all kinds of different diseases. You don’t mind if I just express that wish, do you?

SAM HENDERSON No, but keep in mind that medical foods are not approved by the FDA. They look at it, and if they think it meets the thing—but they don’t ever issue an approval letter for a medical food.

But I can claim an interest in the possibility that this kind of food might help people with a lot of different conditions. It’s intriguing that it might. I can say that. Can you say that?

SAM HENDERSON No, I really can’t say that.

Why not? You’re a scientist. You can talk about the theory of these things. Why can’t you say that, with all that you know? It’s obvious to me that this has the potential. Why can’t you say that, too?

SAM HENDERSON Since we’re selling a product, we’ve done—to our credit, we’ve actually done studies to demonstrate that this product works in Alzheimer’s disease, for us to speculate that it would work in MS or PD without actually doing the studies would be a little bit irresponsible on our part. We really need to do those studies and then make those claims.

So I can say as a person asking you questions, “Boy, it seems like common sense that this might be a potential mechanism that might help somebody with Parkinson’s disease or with MS or with another neurological condition. It might be something that might be worth looking into.” I could say that. I could be curious about that, but because you’re selling a product, you really can’t say that?

SAM HENDERSON That’s correct.