Supplements: Overview and Vitamin D3

A good and balanced paleo inspired diet should in theory provide all nutrients. But reality does not meet the theory very well. There are several issues because of which we may not get enough nutrients. In this article we will just discuss the general reasons and Vitamin D.

Digestion may not be very good
Many people these days have bad digestion. Bad digestion results in incomplete absorption of nutrients. Bad digestion normally occurs due to impaired gut flora, which provide some of the important nutrients, Biotin and Vit K. We should improve the digestion, but while we get it fixed it would be best to get some extra nutrients in the form of supplements.

Food restrictions
Many people in India are vegetarians. Vegetarians need to eat enough ghee and curd. Unfortunately its very difficult to get very good quality of either easily in the present environment. This results in reduced Vit B12, Zinc, and Fat soluble vitamins like K2 and A.

Reduced nutrient content in food
This is by far the major reason for malnutrition. These days fruits and vegetables have undergone modification, via breeding, Genetic Modifications, enforced mutations, etc. These are done in most cases for increasing production. A breed that provides a larger fruits and vegetables or in a significantly increased quantity will have a much lowered nutrient content. Plants are also bread for blander and sweeter fruits and vegetables, further reducing the nutrient contents.

Consumption of refined foods, salt and water
People these days are eating refined flours, refined sugars, refined salts, and purified water. These might be prudent in some cases, but overall affect the nutrient intake. Refined flours, white rice are not a problem if the intake is not significant. Sugars are bad even if not refined and should be avoided. Refined salts are created to remove the problematic magnesium chloride, which is hygroscopic, and makes the salt absorb water. Unfortunately it is difficult to find unrefined salt. In Bangalore it was easier, but in Delhi I haven't been able to source it. Purified water is mostly a necessity because of the chlorination process that goes in the potable water, but it also removes important nutrients like magnesium.

Lack of Sunlight or Vitamin D3 (Cholecalciferol) deficiency
Vitamin D is generally very low in people, because we are living in houses, and work in offices, both confined spaces, with no exposure to sun. Contrary to popular belief, sunlight does not cause damage to the skin, as you can observe in people working the whole day under the sun. The problem normally is bad nutrition, and very occasional sunlight exposure. UVB component of Sunlight is used by the skin to create vitamin D. This vitamin/hormone is a very important nutrient. It is required for the proper functioning of the immune system. It is required by the liver for handling toxic chemicals. It is also required for absorbing Calcium from food.

The best way to get vitamin D is from the sun. If you are fair skinned, an hour or two of morning sun in the summers in Delhi would be enough to produce enough vitamin D. But for darker skinned people the whole day in winters in Delhi may not be adequate to meet the demand. The skin color is mostly determined based on the vitamin D requirement, sun and genetics.

It is also possible to get Vitamin D from Fish and fats of animals that have been exposed to sunlight most of their lives.

Majority of the people are deficient in Vitamin D, with values less than 20ng/ml. The best values are somewhere between 30ng/ml and 50ng/ml. There is quite a controversy regarding what is the healthy range. Read Chris Masterjohn's post on the subject if you want to get more technical information. He is of the opinion 30ng/ml - 35ng/ml is the best range. Vitamin D can have some significant negative effects, if attempted to increase by exogenous intake. Many people handle it well though.

Normal bad reactions are increase in serum calcium, if there are issues with excretion (ie impaired kidneys), or increase in calcium deposition. Serum calcium increase is easy to detect if you are aware and mindful of the symptoms. Calcium deposition is much more probable and difficult to determine.

Calcium absorbed by Vitamin D requires several cofactors to utilize it. Some of them are Vitamin K2, Vitamin A and Magnesium. These nutrients should also exist to prevent calcium deposition.

Cod liver oil is the most natural way of getting extra vitamin D. It contains Omega3s, Vitamin A, Vitamin E, and some other good things as well. In India Seacod sells cod liver oil in 100ml bottles. They also sell capsules. Each capsule contains only 300mg of the oil. This is quite less. A person can consume 1 to 2 tea spoons, ie 5-10ml of the oil. If you wanted to get that much oil from caps you would need to consume 10-30caps. Clearly, excessive. Another issue is that taste can tell you whether the oil has gone bad. This is not possible with caps. Each 5ml of Seacod contains.

EPA - 333ml
DHA - 500ml
Vit A - 4700 IU
Vit D - 470 IU


It does not contain a lot of vitamin D, but it is a very good supplement. You will see your immunity improve a lot with it.

Seacod unfortunately prefers selling the capsules, so we had quite a bit of trouble finding the real values. Kudos to Raj Ganpath for finally nailing someone there to provide sensible numbers.

The fresh cod liver oil will have very little fishy smell. Unfortunately it is difficult to find it very fresh. So try to find as fresh as you can, and store them in fridge or even in freezer for longer term storage. If it tastes very bad, its better to throw it.

One important point is that never supplement calcium along with Vitamin D. Vitamin D supplementation is already has dangers of calcium deposition, adding more calcium to the mix can only be worse. An aside, milk is not required for calcium, as many cultures which can't handle milk have shown (asians are an example). There is plenty of calcium in green vegetables and tubers. Pastured full fat dairy is ok as it contains enough K2 to handle extra calcium. It would be better to avoid reduced fat dairy, when supplementing with Vitamin D.

Gelcaps are the best way to get extra vitamin D (over and above cod liver oil), because they are filled with an oil to improve absorption. NOW foods has a very reasonably priced 5000IU, with 240caps in a single bottle. I have used this almost exclusively.

Where to get Vitamins and Minerals
iHerb and Swanson Vitamins are good online stores in the US. I have used them. The trouble is with the shipment and customs part. I personally never faced any issues with the shipment and customs, but my brother has faced problems. The cost of supplements in the US is very low. The shipment and customs can add quite significant costs to the supplements. This option may still be quite a bit cheaper if the cost of supplements being ordered is at least a couple of hundred USDs.

If you cannot get someone to bring them for you and you want to order only a few items, then you may want to check out local companies. There are two online shops in India, which are selling supplements, Healthkart and Biovea. I haven't tried these yet.

Latest learnings on Hypothyroidism

I have been trying to find more information on Hypothyroidism.

One interesting paper shows that there is a circadian rhythm to Thyroid hormones. Some practical implications of the graphs are
1) T4 is lower in the night, while TSH and T3 are higher in the night.
2) Sometime around 10:00 both TSH and T4 rise, while T3 dips.
3) The time when all 3 are steady for some time is afternoon 3:00 pm.

This means that the best time to get tested is around 3:00pm.

If you are supplementing T4, the best time would be when it is lower, ie night time. Also Mary Shomon reports that patients see the best results when they consume it just before sleeping. There is also a research paper published in 2007, where they saw significant difference between taking it in the night and taking it in the morning.

Remember the same strategy will not work for T3, because T3 is higher in the night. T3 is best consumed split up few times during the day, as it has a very low half life.

I came across a document explaining the various thyroid tests. It also has a table at the end summarizing the tests.

Feedback from a glucometer for a prediabetic.

I collected some data from a friend, who is pre-diabetic, on how his blood sugar reacted to different foods.
I had asked him to get his blood sugar below 140, preferably below 120. And to do this he had to experiment with what he ate.
With a diet he self selected based on the feedback from glucometer, he could normalize his blood sugar within 2 days.
I analyze the first 5 days of his food log, and these provide some very interesting information.

Day 1
Fasting 140
Upma aampana, half apple -190
Ghiya Chana dal bhindi 2 rotis curd - 193
predinner 112
3 drum sticks + salad (tomato + cucumber) 118.

From this we can see that Upma caused a massive increase in bg level, due to the high content of carbs in upma. The lunch caused another big increase again because of the high carb content in the daal and rotis. The dinner was low in carbs and medium in fiber and resulted in very little increase.

Day 2
Fasting 127
methi rotis-2 apple pommegranate 175
pre lunch 96
moong dal cauliflower soup rotis-2 curd 169
lassi 105
salad(cuc+tomato) soup 110
   
The fasting has dropped due to the low carb dinner. Again a 50point increase due to rotis and fruits at breakfast. The lunch increase was huge >70points due to the dal and rotis. Dinner was low carb.
The lassi shows that curd is being handled very well, and not causing much rise.

Day 3
Fasting 108
4 eggs baked anar, jamun, water melon 112
pre-lunch 100
poha(1/2 bowl uncooked) dahi 164
lassi
roasted chicken 123(2 o'clock late night)

Fasting has actually become good, in just two days. A low carb and low fat breakfast, not much increase. Poha caused 64 point increase, due to being mostly carbs. 123 at 2 o'clock is probably more due to the late night stress rather than the (lack of) carbs in the chicken.            

Day 4
fasting 111
4 eggs scrambled anar, jamun   98
2 eggs 2 med potatoes veg curd 131
predinner 94
chicken curry   cucumber

Fasting is higher than PP after a low carb breakfast. This happens because the insulin spike causes the glucose in the blood to be absorbed making the bg level lower. In some people it can trigger hunger, so eating breakfast can make you hungrier. After lunch is a bit higher, possibly because of eggs and potatoes and curd. Protein can and does convert to glucose, when they exceed the requirement. Breakfast and lunch proteins due to eggs is 40gms. Breakfast protein must have been utilized but this protein may have got converted.

Day 5
fasting 111
3 eggs boiled  
Rice chicken 1 spoon icecream 111
roasted fox nut, roasted chana 183
curd rice sambhar 158      

A very low carb and medium fat breakfast must have resulted in a low bg level, though it was not measured. This is probably why rice did not cause the level to go very high. The evening is very interesting. A small amount of roasted nuts and chana caused the level to rise to 183. This effect is called Chinese restaurant effect. It is caused by a very high fiber with very low carbs and very low fat food. This shows that snacking should be avoided, by diabetics. If you need to snack do it with something high in fat. A moderate carb dinner probably did not cause much bg rise, as the pre-dinner bg level would already be higher due to the snack.

I hope the above analysis gives people some idea on how easy it is to control your blood sugar level.

Important Note: This information only applies to people on medicines like Metformin. It does not apply to people on Insulin. Insulin users please do not try this unless you know how it affects your insulin intake.

Hypothyroidism: Tests, Diet and Supplements

I have seen a couple of cases of hypothyroidism very recently.

Hypothyroidism is basically an inavailability of T3 hormone to the cells. The cells need the hormone for energy production. T3 hormone is the means by which the brain controls energy utilization in the body. The Hypothalamus indicates to the Pituitary gland that more energy is required. The Pituitary generates TSH to signal the thyroid to create T4/T3.

There are 4 tests that can distinguish different cases of hypothyroidism.

1) Free T3

2) Free T4

3) TSH

4) Reverse T3

For best feeling Free T3 must be in the upper half of the normal range. Free T4 must also be in the upper range. TSH should be around 1, preferably below, but not lower than 0.3. If T4 is high and T3 is low, its quite likely that T4 is being converted to RT3. The RT3 range can distinguish the case.

If T3 and T4 are low and TSH is also low, then there is a problem with the Pituitary gland.

If T3/T4 are high and TSH is also high, then also there is a problem with the Pituitary, and possibly there is a tumor there.

The normal hypothyroidism case is that T3 and T4 is low and TSH is high.

If T3/T4 are high and TSH is very low, then it is a hyper thyroid case. But if the symptoms are hypothyroid then it is probably a thyroiditis case, where the autoimmune attack is ongoing. It could also be a Zinc Deficiency case, but that would be rare.

So how do we get hypothyroidism?

There are two reasons.

1) Thyroiditis - An Autoimmune disorder where, the body's immune system is killing the Thyroid cells. This is the most common cause.

2) Iodine Deficiency - This can happen due to Iodine, Selenium deficiency. This is also fairly common.

3) Zinc Deficiency - Zinc is required for absorbing T3 in the cells. This is quite rare.

4) Other reasons - These are rare, and occur due to medicines or surgical procedures.

Thyroiditis normally happens due to overactive immune system which is not able to identify the right proteins to attack. The ability to identify properly rests a lot on VitD levels. This vitamin unfortunately is pretty low in most people in the present times. The immune system becomes over active because some offensive proteins are entering the blood stream. This is most likely due to a leaky gut, but in rare cases the immune system can get primed from the gut itself.

There are several types of Thyroiditis

1) Hashimoto's - This probably occurs due to leaky gut causing the immune system to become overactive.

2) PostPartum - This occurs after pregnancy, because the immune system undergoes a change at the time. This could also be related to the leaky gut.

3) Others related to medical procedures or radiation.

Thyroiditis can be tested with the following

1) Anti-ThyroGlobulin 

2) Anti-TPO

Diet and Supplements

Diet and supplement depend on the cause of the hypothyroidism.

First we need to supplement to get the T4/T3 hormone to the right level.

The easiest is to supplement with a form of Thyroxine (T4). T4 converts to T3, and both the required hormones are available. This works for most people. But for some additional T3 hormone supplementation is required. People whose thyroid gland is inactive to a very large extent, should consider Dessicated Thyroid gland supplements, because these provide other hormones as well. Particularly calcitonin hormone is required to prevent a possibility of osteoporosis.

Generally people take the Supplemental hormone without monitoring. The monitoring via FT3/FT4/TSH is very expensive. A much cheaper solution is to find the body temperature and monitor it to find whether the supplementation is sufficient.

For measuring the body temp use an analog thermometer. Keep the thermometer in the mouth for around 5 minutes for proper temperature. Also try to avoid doing anything during the test.

Take the temperature at 3hr 6hr and 9hr after waking up. Average the 3 numbers. The aim is to get the temperature to 98.4F, with supplementation.

If there is a lot of variation (>0.6F) in day to day average temperature, then the adrenal might be implicated. This may cause problems while supplementing with T4, and Cortisol (Hydrocort)  supplementation may also be required.

If the supplementation of T4 is not helping raise the Body Temperature, then FT3/FT4/TSH/RT3 tests should be made to determine, what is going wrong. It maybe that T3 supplementation is also required. If a lot of T4/T3 hormone is required then it might be that a large part of the thyroid gland is not working, then it would be better to check the thyroid gland with radiology. If indeed a large part is inactive then it is much better to use dessicated thyroid gland.

If the cause is Thyroiditis, then it is important to eat a very strict paleo diet (ie no grains/legumes/milk) without nightshades. Specifically avoiding things that are major sources of allergies, like wheat, soy, peanuts, milk solids.

For Thyroiditis it is also important to normalize Vitamin D. A low vitamin D is normally associated with Auto-immune diseases.

In any case an effort should be made to normalize Selenium and Iodine intake. Goat/Lamb Kidneys and Brazil nuts are the major sources of selenium. Kelp powder/Lugol's solution/Iodoral are some of the sources of Iodine. Effort should be made to raise the intake of iodine to 1.5-3mg/day, except in case of Thyroiditis.

Update:
It is important to remember that T3 levels vary a lot during the day. Even T4 can vary a lot. In case of Thyroiditis the levels vary a lot if the attack is on going. This is why, the body temperature test can be more reliable indicator of Thyroid function if it really Thyroid problem. The 4 hormone tests are important to distinguish where the problem exists.

My presentations

I have created in all 4 presentations.

1) This presentation is the super set, contains whatever I know about losing weight.
https://docs.google.com/open?id=0B72aAxb5oUwxMTRmdjMyRTJycWM

2) This presentation contains information only about the requirements for good health.
https://docs.google.com/open?id=0B72aAxb5oUwxakdERElXUnk3T0E

3) This is a new short presentation, which can complete in one hour.
https://docs.google.com/open?id=0B72aAxb5oUwxbzljUl9jSVk5OEE

4) The common myths slide.
https://docs.google.com/open?id=0B72aAxb5oUwxdFpnVDU0QmpKbTg

A small primer on Genetics, and its implications for a Paleo diet and lifestyle.

This blog has been dormant for long. From now on I will be making an effort to keep the articles flowing.

I heard this question from a person, who thought that since our digestive system adapts to new food we should be able to adapt to chemicals in our lifetime. This is grossly erroneous. This article will attempt to explain why it is wrong.

There are several questions on why to use a Paleolithic Diet. Paleo diet gurus say that there has been very little evolution since the start of the Neolithic Period. While Scientists say that the rate of evolution has quickened since the advent of Agriculture.

Which one is to be believed?

I would side with the scientists. Yes evolution has quickened with the advent of agriculture. And it must be so, because a changed environment (eating habits) necessitates adaptation. This would increase the pace of evolution. By this logic the pace of evolution must be maddening in the present century. And it must be so. You must be hearing news of increased cases of birth defects :-).

Evolution does not involve only good things. It can create adaptations that are good only on the average. For example Sickle Cell anaemia. It evolved for enabling adaptation to malaria. It is not a good adaptation. Some people get too much of it, that is it becomes the dominant factor then it can cause a much increased mortality. Faster adaptations are generally a trade off.

Over time evolution will find a way to solve a problem that does not have any bad side effects, but this takes a very long time.

Remember that evolution is measured in generations, not in time. So a species like humans who have a very long time between generations (20yrs), will take a long time for the same evolution, as bacteria, where the time between generations is measured in minutes. Bacteria can also evolve by direct DNA transfer, so they don't even need a generation.

Now lets consider another question. Is it really genetic adaptation we see in the nature? Do you know that genetic difference between Chimpanzees and us is less than 1%. So why are we so different than Chimpanzees.

The answer is really Epigenetics. Epigenetics is responsible for most of the genetic conditions that we blame genes for. And the good news is that you can affect epigenetics with your lifestyle.

So what is Epigenetics?

Genes are basically recipes for creating proteins. The Nucleus can be considered to be a huge dynamic library of such recipes. The infrastructure used to organize the library is called epigenetics. There is so much genetic information in the nucleus that it would not be possible to make everything available efficiently. So the library arranges itself to provide the most used recipes in the most efficient way.

If you use different recipes the organization will rearrange to allow the new access to be made more efficiently. This rearrangement can take a long time, even generations.

An important caveat is that the reorganization can only help with conditions that have already been encountered before. It cannot help with new conditions. That is where mutations are required for experimenting with the new conditions. And adapting to a new condition takes a much longer time than adapting to a condition that has occured before.

When you eat modern processed foods, the body is struggling to work with them, many of the chemicals in them, it has never encountered before. It does not know what to do about them. They can and do confuse the system.

When you eat neolithic foods, ie grains/legumes/milk, the body knows how to handle them, although the handling may not be entirely good. Some people may react to them badly, eg Coeliac disease, some may handle them sub optimally, ie gas, bad digestion, others may be able to handle them perfectly well.

With paleolithic foods, chances are that the foods themselves have evolved so much, and have created proteins and ezymes that we cannot handle, but mostly they will be handled very well. Allergies to paleolithic foods are rare, but not rare for neolithic foods. With Modern chemicals, the system does not even know how to react. They mostly cause damage, without system reacting to them.

The good thing is that epigenetics can allow us to reverse that bad effects of the modern foods, if the damage is not extensive.

One more important point is that our digestive system is very much dependent on our gut flora, ie the bacteria and other microbes in our digestive system. The microbes do adapt very fast to new inputs, so the digestive system adaptation is very fast, but this doesn't mean that our body will be able to absorb or discard the modern chemicals correctly. They can still enter our system. They can and will still cause damage to us.

The best option is to start a strict paleo diet for a couple of months, then slowly add neolithic stuff, to determine whether we are able to handle them well. Avoid the modern processed stuff completely. That stuff should not even be part of food.

When you eat a good diet that your body can handle well, you will see marked improvement in your well being, as the epigenetic structure will align to where it should be, slowly over time.

Why its ethical to eat meat?

This was the question posed by New York Times. Following is my entry.

Evolution, Health, Resource Utilization, Animal's survival, all require that we eat meat. I am touching upon these major reasons in this note.

Humans evolved from Primates. It is a very well established fact that eating meat and their fatty brains and marrow was a very crucial factor in the growth of human brain, which made us human. Humans evolved as omnivores eating meat and plants both. It is what we are. With time and tools we learnt to be a skilled hunter, and caused extinctions of a large number of mega fauna species. Later we learnt agriculture and domesticated animals which provided a stable source of food. This allowed us to stay in one place and form societies, and improve technology. Slowly with agriculture we started transforming the landscape, destroying forests and the livelihood of animals staying there to create agriculture farms. Now humans are so advanced and so much in control of the planet that the only way animals can survive is by hiding from us, or providing us some value. Yes they can be kept in small sanctuaries or zoos. The largest stock of animals in the present times are the animals that are used for food. If humans became vegans, we will render all these animals extinct, because they will not be required.

We are too many on this planet. To feed the whole world we should try to utilize as much solar energy as possible. This can be done by growing more plants and utilizing as much as is possible of it. When we grow plants there are many things that we cannot eat. The problem is that currently we are too fixated on grains. Through cereal crops we utilize only the seed part of the plant. The rest dries out before we can obtain the seeds. This is a collosal waste of energy. Instead we should use plants that give edible food while they are alive. The unedible parts of the plant can be fed to animals, and the edible parts can be eaten by us. The animals will convert the unedible part of the plant, into edible meat. This will maximize energy utilization. Also land that does not grow anything except grass can be utilized. Only an omnivore society can maximize utilization of the production of plants.

We have evolved as omnivores. The longest continuously vegetarian society is in India, which started only some 2500years ago. Veganism has only come into being since 100 years ago. Veganism more than vegetarianism requires technology to be possible. This in itself means its not a natural diet for us. Although we know how to make vegetarian way of eating sustainable for a number of generations, this experiment has still to go for several generations for veganism. There are no uncivilized tribes that are vegetarian. Yes we could equate being vegetarian with being civilized, but for me that is arrogance. It takes a lot of hubris to say that we are better than other animals, and the body that mother nature created for us, should have been created differently. We are not herbivores, we don't have the ability to digest cellulose, doesn't matter how much we may want to. Nor are we carnivores, our brain needs a lot more glucose than those small brained carnivore animals.

Lets remember our place in the world and be omnivores as mother nature intended us to be, for our sake and for the animals that feed us. Growing animals for food in a humane way is possible and is required of us as ethical humans.