GERD? Low Carb

The Blog of Michael R. Eades, M.D. http://www.proteinpower.com/drmike

Over my many years of using a low-carb diet to treat patients with various disorders, I noticed that almost all who happened to have GERD found their symptoms resolved. I never started out treating GERD with a low-carb diet, but the huge numbers of patients finding relief told me that somehow carb restriction was helping. They would ask why their GERD went away, and I would have to confess that I didn't really know. I thought and thought about a possible biochemical or physiological mechanism that would explain why a low-carb diet almost always got rid of GERD, but I could never come up with a reasonable explanation. So, I just told patients who had GERD that if they ate low-carb, their GERD would probably go away. But I also told them I didn't know why.

Then a few years ago I ran into a microbiologist named Norm Robillard who had a theory on the cause of GERD that explained the results I had been seeing and made perfect physiological sense.
GERD: Treat it with a low- or high-carb diet

The short version of Dr. Eades' description:
High carb diets, especially those with high fiber, enable bacteria to grow where they shouldn't, in the small intestine.  These carbs can also be fermented, which produces mucho gaseoso, which yields SIBO (small intestine bacterial overgrowth).  This gas back pressurizes the GI tract, in effect driving gas into the esophagus.

The really bad part of this deal is that the current Rx for this problem is to keep eating that high fiber diet (because everyone knows fiber is GREAT for you, although I don't know why they know that) and suppress acid production with the various pills that do that sort of thing.  Well, when you reduce the acid levels in a bacterially overgrown gut, you get more bacteria, and not the ones you want to have.  So the acid reducing pills only work for a while, and then things are worse than when you started taking them.

Dr. Eades continues:
You can find more information about Dr. Robillard's work on GERD and IBS in his books Fast Tract Digestion: Heartburn http://www.amazon.com/gp/product/0976642530/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0976642530&linkCode=as2&tag=proteinpowerc-20 and Fast Tract Digestion: IBS http://www.amazon.com/gp/product/0976642557/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0976642557&linkCode=as2&tag=proteinpowerc-20 both of which contain pages of tables showing the FP of numerous foods.

Crazy CrossFitters - They Want Results from Workouts ... and Liberty

“Our leadership is pretty avowedly libertarian,” said Greene, a libertarian himself. To him, this is just common sense. “We’ve got over 7,000 affiliated gyms. … Don’t you think it would be unnatural if these small businesses were lukewarm about free enterprise?”

The effect of free-market ideology extends even further beyond the personal preferences of the organization’s leadership to the company’s structure and attitude.

CrossFit runs a web of thousands of loosely controlled affiliate gyms that are independently owned and operated. Affiliates are charged an annual fee, as opposed to a paying a cut of their profits as traditional franchises do, but they also control how their operations run, like their hours and prices. Further, the organization’s staff is scattered across the country, with offices in San Diego; Santa Cruz, Calif.; Arizona and Washington, D.C.

“It’s the libertarian idea of free markets,” Greene argues. “You don’t need centralized control.”

http://washingtonexaminer.com/crossfit-openly-exercises-its-libertarian-views/article/2536381?utm_campaign=Fox+News&utm_source=foxnews.com&utm_medium=feed

"I'm a rabid libertarian," says Greg Glassman, 56-year old founder of the worldwide fitness phenomenon called CrossFit.

Glassman opened the first CrossFit gym (or "box" in CrossFit lingo) in the mid-1990s in Santa Cruz, California. Today, there are more than 7,000 CrossFit affiliates around the world. These affiliates are not franchises, they're independently operated boxes owned by entrepreneurs who pay $1,000 to get certified as a CrossFit trainer and then pay $500-$3000 annually for the right to use the CrossFit brand. Each affiliate is free to innovate, which makes CrossFit a kind of open-source fitness community. Despite - or because of - its unconventional approach, CrossFit is projected to generate $100 million in revenue this year.
http://reason.com/reasontv/2013/07/20/fitness-renegade-greg-glassman-and-the-c

Rhabdo Is A CrossFit Unsecret

This article (https://medium.com/health-fitness-1/97bcce70356d) has all of the limitations associated with one person's limited knowledge of a very large and complex topic, which CrossFit is - at least from my view. The hook of the article, that rhabdo is CrossFit's "dirty little secret", is contradicted in the article's own quotes. There are 7,000 affiliates at this point, as I hear, and each of them has several Level I Trainers, and each of those trainers has been taught about rhabdo, because it is rare but potentially lethal, and CrossFit has been sounding the alarm about rhabdo for years.

From the author's uninformed but proud perspective:
"And here we have arrived at CrossFit's dirty little secret. The coach was unusually familiar with what is normally a very rarely seen disorder. It's so rare that one study reported the overall annual incidence of rhabdomyolysis to be 0.06%. That represents single digits of cases out of hundreds of thousands of patients. How, I wondered, is it possible that the layperson exercise instructor is on a first-name basis with a serious, yet rare medical condition?"

I repeat myself, but rhabdo is no secret in CrossFit. CrossFit has been sounding the alarm about rhabdo publically for years, starting in 2005. Here are the articles from journal.crossfit.com from which you can learn about rhabdo:

http://journal.crossfit.com/2005/10/crossfit-induced-rhabdo-by-gre.tpl

http://library.crossfit.com/free/pdf/CFJ_Wright_Rhabdo.pdf

http://library.crossfit.com/free/pdf/CFJ_Ray_rhabdo1.pdf

http://library.crossfit.com/free/pdf/33_05_killer_workouts.pdf

Back to "CrossFit's Dirty Little Secret" (a secret perhaps only to this author):
"Is this a thing with CrossFit? It turns out it is.
A quick search of the Interwebs reveals copious amounts of information about rhabdo purveyed by none other than CrossFit trainers. Scouring the scientific literature in mainstream medical journals, however, reveals a only a few peer-reviewed papers. The science confirms that exertional rhabdomyolysis, as this form is sometimes referred to, is uncommon and normally reserved for the elite military trainee, ultra-endurance monsters, and for victims of the occasional psychotic football coach. Rhabdomyolysis isn't a common condition, yet it's so commonly encountered in CrossFit that they have a cartoon about it, nonchalantly casting humor on something that should never happen."

If you read the articles, I think you would agree CrossFit has not been nonchalant about rhabdo.  I had a class mate at US Navy Aviation Officer Candidate School who rhabdo'ed himself in the pool.  We had to swim a mile.  He was a terrible swimmer.  Tony was mortified of failing the mile swim, which we took towards the end of our commissioning program.  He absolutely worked like an animal and passed the swim with little time to spare, but had pushed himself so hard, he wound up in the hospital a day or two later.  I never knew what he had until I found CrossFit and learned about rhabdo.  In one study, about 40% of those who graduate from US military boot camps have rhabdo, but to a degree that does not require hospitalization.  Apparently about 7 folks annually die from running marathons, and some of these are from rhabdo.  So, his stats above are both right and wrong - rhabdo to the degree that it requires hospitalization is as uncommon as he describes, but it is part and parcel of heavy exertion and there are no stats for those who work hard and have "normal" levels of rhabdo.

The author terms CrossFit's recent discussion of female urinary incontinence during workouts "glorification" of urinary incontinence, but I see it as a continuation of what CrossFit has done ever since I have been associated with it - tell the truth about CrossFit, the good and the bad. CrossFit was so devoted to that concept that they had an injuries thread on the message boards so folks could talk about their injuries with each other. CrossFit has been blunt about the fact that when you exercise for performance, you get results and you get injuries. The perspective has been consistent from the beginning - you get to choose the risk/reward relationship you want. Is it safe to drive? No. But you can drive anyway if you choose. Is it safe to work as a police officer? No. But you can choose that. Is it safe to fly military aircraft fast into enemy territory or low through the mountains on a training mission?  No. But we pay you for that. You name something that you really love to do, and I'll bet you there's an associated risk of death or serious injury - you choose to do it anyway, and you should.
The essence of CrossFit is that it has chosen to offer a fitness program with a different reward/risk curve, and people choose to pursue CrossFit for the rewards. This is only wrong if CrossFit were to be deceptive about the risks.  CrossFit has not been deceptive, which is largely proven by the author's limited quotations in this very short, and limited article. CrossFit is more like the "unsecret" of the fitness industry, and rhabdo is the unsecret of CrossFit.

The article has a gem of a quote, from another article, which goes:
"If you ask a CrossFit coach, the injuries were all my fault. In a culture that drives you to go as hard and fast as possible, it's difficult not to get caught up in the hype. You're supposed to push yourself to the limit, but when you hit the limit and pay the price, you're the idiot who went too far."

That's because you are the idiot who went too far.

Or does that person think you become a child who gives up responsibility for yourself when you enter a gym? If you abdicate the responsibility for what you choose to do, you are the idiot, plain and simple. But let me correct myself; you are not an idiot when you "go too far". You are choosing to test your limits. What would make you an idiot in my view is if you choose to test your limits, and then decide it was the coach's fault that you chose that.  I was chasing performance and testing my limits in many arenas long before I started CrossFit - injuries and martial arts, for example, go together like a hand and glove. Bench pressing, which I used to do but seldom do now, kills about 12 people annually.  Runners have a reported 75% injury rate (nevermind being hit by a car). Cyclists - how many cars pass you, when out for a ride, at speeds that would be fatal if the driver were to make the slight miscalculation that would result in collision? Football? Soccer? Basketball? These sports have very high rates of injury, some fatal or crippling. Shooting? Hunting from a tree stand? Mountain climbing? Drinking booze in a bar? Mowing the grass?  You folks are adults in and outside of a gym, and get to name your poisons.

And just because it highlights the human capacity to discount the high risks we always endure while accentuating (freaking out over) the low risks that are novel too us, let me remind you that every two years, humans kill themselves/each other in automobiles at a rate that exceeds the total casualties from ten years of war in Viet Nam. The vast majority of the rest of us kill ourselves with sugar (or at least "lifestyle driven disease" even if you would quibble about whether sugar/carbs are the killer).

You cannot live unless you choose the risk/reward curve for life every day. Please do not pretend that self responsibility stops when you walk into a gym. Please do not get high and mighty if you make an observation that is as obvious as "you can seriously hurt yourself doing CrossFit." Dude, get a clue, you are about seven years late to that dance.  I have been choosing CrossFit since 2007, and I have been injured from CrossFit workouts - extreme soreness, probably a case of rhabdo or three, back pain, knee pain, shoulder pain, torn skin on my hands, and shredded shins - which is much like what I experience doing martial arts, football, skiing, and bodybuilding.  The different is, I've also been in the highest peak of performance during these last six years that I have ever experienced.  I can do anything I would dare attempt.  It's worth the risk for me, and each year I learn how to throw myself into CrossFit with less and less injury.  My clients will all benefit from my pain.

The author's conclusion:
"Exercise is just about the best thing you can do for your body, but in the case of Crossfit, we're left to ponder the question, is this workout worth the risk? "
This person, as ignorant as they are about CrossFit, wrote an entire article only to arrive at this question, which is entirely germane and applies to everything you do in life at least after you reach age 18. But he reaches his climactic point as if he had never considered it before. It invites one to make comments about removing craniums from rectal orifices.

Because it is clear this author isn't the only one ignorant about the dangers of exertional rhabdo, or the risk/reward consideration inherent throughout one's life, I'm glad he wrote this article. I hope it encourages people to learn about the dangers of rhabdo in CrossFit, marathoning, endurance cycling, and the other inherent risks of each life activity (or inactivity).  I hope it helps people to realize that they can do a lot to reduce their rhabdo risk by tending to the basics (like managing hydration).

What I see in CrossFit is the best gyms let people choose their own intensity level, and do not spend any time exhorting people to "push harder", or any of that cheerleader/drill instructor style of "pushing" people. You work as hard as you choose for your own reasons, and frankly that's the way it should be since IT IS YOUR BODY.  CrossFit attracts intense people who want to compete, who want to push, who want to test themselves.  That is all good with me.

The Easiest Change

Starting with my first experience with the Zone Diet in 1996 or so, and my intermittent success from then until 2007, one of the strongest tools for health maintenance is also a simple one. It involves breakfast, carbs, metabolism, and habits.

Most folks think of breakfast as a carb fest - cereal with sugar, bagel, toast, jelly, milk, and banana. Don't forget the plain yogurt with no additional sugar (yeah right! Four people on the planet eat yogurt without sugar added). A few people, but too few, may add a token dose of fat/protein via sausage/bacon/eggs - which is a hangover I presume from the government's recommendations over the last 30-40 years to avoid fat and eat more carbs. After all, carbs have only 4 kcal/gram whereas the evil of all mankind, dietary fat, has more than twice as many! Therefore you can eat more food, feel more full, eat fewer kcal, and not be hungry.   Pretty simple, if dead wrong.

But let us take a look at a few numbers. The government says you need 2000 kcal/day if a female, and 2700 kcal/day if a male (these numbers are estimates and highly variable by individual, so they are just a starting station for this train of thought). The government also says you need low fat, 30% of kcal or less, low protein, 15% or so, and thus you'll get the other 55% as carbs. You carb dose then is 275-370g/day respectively (by gender). If you get 30% of that dose at breakfast, your carb intake will be 82.5g/111g. This my friends is a fairly hefty dose of carbs, all of which will be metabolized to glucose (unless some of your breakfast is fructose, such as table sugar, or an HFCS flavored fake OJ of some kind, and to a lesser degree, OJ too). This dose of sugar, will rocket your blood sugar higher (which you can easily measure for yourself), especially for those of us old or fat enough to care about our diets. Blood sugar is both essential to keeping your brain working, and a neuro-toxin when above a certain concentration in the blood - about 160mg/dl.  Those with out of control blood sugar, aka diabetics, lose their vision and peripheral nerves, if they don't die from cardiovascular disease, kidney disease or cancer first.

The body is not well equipped to dispose of large quantities of blood glucose, but it has an emergency mechanism, insulin secretion from the pancreas, to help the body pack away sugar where it can, and to turn the rest into fat via the work the liver does in the presence of high insulin levels. This emergency mechanism works in many of us like most emergency mechanisms - it does too much too fast and leaves a mess. One consequence is that many of us have crashing blood sugar levels after we overeat carbs and suffer the insulin response. In the presence of falling blood glucose levels, we feel hungry, because keeping the brain fed is a very high metabolic priority.

We learn by experience we can rapidly restore glucose levels via ingestion of high carb snacks.

So the high carb crazy train starts with a high carb breakfast followed by a "see food" diet in which we often perpetuate the high carb/insulin/hunger cycle. In the later stages, we feel "mind fog", grumpy, and often cold as the body reacts to falling blood sugar just as it would to starvation. In short, this is no way to live.

So, there's an obvious solution - skip the carbs in your breakfast. You actually don't need any breakfast carbs, although most of us will do better if we break our fast rather than skipping the morning meal. Instead of the Neolithic monstrosities that we think of as "breakfast", I recommend you start the day with a serving of protein and fat. Keep protein/fat snacks handy throughout the morning, and eat when hungry. Have a lunch plan that will allow you to eat some good quality carbs - a big salad for example, or a grapefruit/avocado.

When you are sleeping, great stuff is happening for your metabolism. By eating on fat/protein for breakfast, you allow these metabolic health and healing stages to continue. You make room for your body to store any excess carbs you eat for lunch/dinner/snack, and allow insulin levels to fall, restoring the possibility for insulin sensitivity. Most importantly, you set up a situation that puts a demand on your body to provide its own fuel, from its primary storage source, fat. AND, you keep up the demand for your body to make enough fat oxidation enzymes (at the cellular level) to keep your cellular fires well stoked all day long.

Any day that you follow this pattern is a day your body is allowed to move towards a normal metabolic state, without excess insulin and all the related consequences of the high carb crazy train. Once you are very comfortable running your body's fuel system this way, you can consider skipping breakfast altogether, a state termed intermittent fasting (more on which I will write later; and you can check the archives for info about IF).

IOW - if you want to make the easiest change towards a thriving you, a leaner you, a healthier you, skip the carb fest in the AM, and enjoy some bacon, sausage or eggs (or all three!) with your coffee or water tomorrow morning. 

Wolf on Low Carb Paleo - Or Not?

Slowly I realized, both by experimentation and by really looking at the literature: CALORIES MATTERED MORE THAN CARBS FOR BODY-COMP.

I have to say this was a pretty big shake-up for me. I’d assumed one could eat as much fat as one desired and STILL get leaner. As I mentioned above, when I first started eating LC, or more specifically, cyclic low carb (CLC) I was leaner than ever in my life. I know based on blood work and fat deposition that I had insulin resistance while vegan, and CLC helped with this immensely, but it was my new-found energy and activity level that drove my leanness, not an inability to store fat in the absence of significant insulin. I think this is one of the most damaging messages that comes out of the LC camp to this day, I was duped by this, so I’m not going to do what a lot of other recovered LC writers do and make folks out to be idiots for still believing this…but, it is time to face facts. In every damn study it is clear that for fat loss we’d like adequate protein, and a calorie restriction scenario. LC is fantastic for this in that one typically feels satisfied on high protein, moderate fat, loads of veggies. If one is insulin resistant, this approach can be nothing short of miraculous. HOWEVER! If one manages to cram enough cheese, olive oil and grass-fed butter down the pie-hole, this is in fact, a “mass gain” diet.

http://robbwolf.com/2012/12/19/carb-paleo-thoughts-part-1/

I think there were a few of us that thought this was true, but we all learn - low carb is like magic for rapid weight loss when one is fat, insulin resistant and sick.  Low carb done with good precision can make it easy to be healthy - 10-15% body fat and insulin sensitive - but that won't get you to epic leanness and magazine cover ready.  And that's just fine, we should probably have known better anyway.

Strangely, body builders use low carb to get that epic low fat at the end of their cycle because they are not low carb otherwise - so there seems to be an efficiency factor - those who do low carb all the time get better at using fewer calories than those who are new to low carb.  If you are trying to lose fat and regain lost health while attack correlates of poor health like gout, hypertension and reactive hypoglycemia, low carb is of course the heavy weaponry at your disposal.

All that being said, it is still easier to eat less on a carb restriction plan than on any other approach I have tried because of the excellent appetite control.

Exercise and LIVE

In this study, researchers looked at tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and leptin as chronic inflammation markers.

Leptin is known primarily for its role in appetite suppression, but it can also show inflammation, and these two roles are related.

In this study, subjects showed a 29% decrease in TNF-α, 33% decrease in CRP, and an 18% decrease in leptin after resistance training for 12 weeks.

The control group showed no similar change. Knitting and general socializing didn't alter the inflammatory proteins.

IL-6: A different story
Unlike the other inflammatory markers studied, there was no overall change in IL-6. However, IL-6 is a bit of a special case. That's because, depending on where it originates, it can be either pro-inflammatory (i.e. it increases inflammation) or an anti-inflammatory (i.e. it reduces inflammation).

IL-6 deriving from immune cells (macrophages) is pro-inflammatory, while IL-6 from muscle cells (myocytes) is anti-inflammatory. Contracting muscles (as in exercise) produce IL-6 that is anti-inflammatory, causing a huge spike in muscle-produced IL-6.

In this study, exercisers showed a 40-60% increase in IL-6 immediately after exercise, which was expected. But training for 12 weeks didn't result in an overall change.

Here's another interesting result: There was also a 20% increase in IL-10 (interleukin-10), an anti-inflammatory protein.

Quick recap.

Inflammatory markers: decrease

•TNF-α: 29% less
•CRP: 33% less
•Leptin: 18% less
Anti-inflammatory marker: increase

•IL-10: 20% more
Another cool finding:

There was an inverse relationship between strength and inflammation. The stronger the women were, the lower their CRP and leptin.

Conclusion
Understanding how chronic inflammation works and how to stop it is crucial, because chronic inflammation is at the root of most lifestyle disease, from Alzheimer's to cancer to stroke to everything in between.

http://www.precisionnutrition.com/research-review-inflammation-exercise

In other words, exercise is to have a good long and active life, exercise is to feel good.  Don't exercise to burn calories, be active and exercise to be alive while you are living.

CFJ: The Benchmark WODs

The workouts of the first group, Angie, Barbara, and Chelsea, are super simple (being comprised entirely of common calisthenics), very tough, dramatically reinforce the pull-up, and yet each presents a different metabolic challenge.
Angie and Barbara, contain pull-ups, push-ups, sit-ups, and squats. Chelsea contains pull-ups, push-ups, and squats but no sit-ups.
For each of these three workouts the pull-ups clearly present the greatest challenge. And, in the workouts' aftermath, most athletes expressed surprise at their significant lat, rear delt, and biceps soreness. At CrossFit the pull-up is sacrosanct and everyone needs more. Angie, Barbara, and Chelsea support these values and aims.
http://library.crossfit.com/free/pdf/13_03_Benchmark_Workouts.pdf

I don't know how many times I have read this article, but I am always surprised to find how much I forgot when re-reading the original CFJ articles.  Good stuff!