Liver and Ammonia?

[Update 2013-10-14] I traced the ammonia smell to my use of artificial sweetener – talk about "first do no harm"…

Confusion and lethargy may occur if ammonia levels rise in the blood stream (ammonia is a waste product formed from protein metabolism and requires normal liver cells to remove it)
www.medicinenet.com/liver_disease/page4.htm

Is this the "weird" feeling I have? Increased ammonia in the blood stream? Because the metabolism of fructose (or other things like Ibuprofen) tax the liver too much, so it can no longer properly clear ammonia from the blood stream?

[Update] Now in the summer months I wake up in the morning a bit sweaty. And smelling slightly of ammonia – doh. So it is the liver that is part of the problem.

It seems like my liver has a problem metabolising protein, so I shall reduce the consumption of meat as well. Let's see what a potato, coconut-fat and coffee diet does for me…

The One Where I Find Out That Sugar Is Bad For Me

Well, this episode had to come…  I previously poo-pooed the idea that sugar might be contributing to disease – well, I was wrong.

I radically removed sugar (aka "sucrose", which is half glucose and half fructose) and removed fructose from my diet for a couple of weeks now, but continued to consume dextrose (aka "glucose"). And what do you know, the some problems I had with muscle pain went away (mainly the pain during the day and evening went away – my sleep is still not refreshing, and my muscles are awful in the morning).

Now I reintroduced sugar for a short time (ate some fruits yesterday), and today my muscle problems returned. And with it came the indescribable "weird" feeling.

Huh.

As fructose (and fructose in sucrose!) is metabolised in the liver – and unlike glucose, only in the liver – this would indicate a problem with my liver. Which would tie in with the increased GPT value (aka ALT) I had after eating dairy for 10 days in March 2013.

So liver sub-clinical liver problems can manifest with muscle pain. What do you know.

(How I wish I could go back to 2010 and correct some bad decisions I made made back then in order to battle my ME/CFS. I had to find out all by myself and followed the low-carb idiots, and the Paleo beef idiots, and the ME/CFS pathogen idiots – and got seriously hurt as a reward.)

[Addendum] If I take Ibuprofen (commonly known as "Advil") for migraine/headache, then my migraine goes away, but I get both muscle pain (albeit muted) and similar "weird" feeling (even at "only" 300mg Ibuprofen) – more indication that actually I have a liver problem.

Scheibenbogen, WTF?

Knops (from the Scheibenbogen/Charité group) wrote an promotion – thanks Dr. Speedy for pointing us to it. However, I am underwhelmed:

1. Any explanation involving "oxidative stress" or "nitrosative stress"("oxidativer und/oder nitrosativer Stress") makes me wary. This type of explanation is fashionable here in Germany for some people, but I would not bet my life on it.

2. While they are citing these cellular "stresses" very prominently, the Knops/Scheibenbogen group did *not* themselves test anything in that area. They have no own data whatsoever for this nitro/ROS stress. They cite works of other people – people that I find dubious (to put it mildly).

3. They did not use any healthy controls!!!! They compared the results of their patients against the lab reference ranges!!! Seriously, WTF???? And of course they did not compare it with other diseases. How do these results compare to those from MS patients? Or arthritis? A small group of controls from other diseases would have been interesting. What a wasted chance.

4. Personally (mildly) interesting is the MCHC value (page 31) on the high side of the reference value that they did find (which coincides with my MCHC values that are consistent somewhere around 35.5 to 36). But this is not a result that is in anyway a slam dunk for "us".

5. The values that they report are difficult to reconstruct. They should have used plots comparing results for CFS patients with results from healthy controls. By how much are the MCHC values increased in CFS patients? I don't know, as they don't report it. I would not have accepted a study that makes such important things not clear (but then again nobody cares about what I have to say).

6. The immunology results (CD8, IL2, CD57-/CD8-, CD4, IL5) seem interesting. Whether these results can be reproduced in another group of CFS patients, nobody knows.

7. The same goes for the IG subgroup deficits.

8. The correllation between MCHC and the CD*/IL* results seems *very* interesting. But then again, how does this look for healthy controls? Or other diseases?

Furthermore, I would have added "healthy sedentary controls" (if there is actually such a thing – if someone is sedentary, that person is not healthy IMHO) .

The Paleo Fallback Diet

I was thinking: If I could go back, and start all over with regards to nutrition, what would I do (with what I have learned)? I think I would do (what I would call) a "Paleo Fallback Diet", basically a Paleo based "elimination diet". I think the minimal diet would look something like that:

• Fish (but not shellfish)
• White rice (but not brown rice, nor wild rice)
• Potatoes
• Plantains
• Coconut Fat
• Greens (like green-leaf salad)
• Maybe some tubers or carrots (maybe)
• Salt
• Water

Of course, if someone has known problems with any of that, they should not eat it (and try to find something safe to replace it). But as far as I know, these foods should be "safe" for the majority of people in the world – it should be safe to fall-back to these (and only these) foods for an indefinite time. The only exception might be potatoes (darn, if I knew).

I would try to eat only from the above list, for at least a month. Prepare the foods freshly if possible, and best not to use anything that comes with a ingredient list.

And I would especially remove the following foods from my diet, for at least a month:

• Remove all dairy, beef, veal and lamb
• Remove all cereal grains
• Remove all seed oils (with the sole exception of coconut fat) and remove margarine!
• Remove eggs and chicken
• Remove all other meats and shellfish (except fish)
• Remove all sugar ("sucrose") and fructose (and remove honey, and even go so far and remove all fruits except plantains)
• Remove soy
• Remove beans/lentils/pulse and so on

After I have eaten this diet for a month, I would then go and reintroduce certain foods for a few days at a time. Eat some bread, see what it does, and then remove it again from nutrition, see what that does. Wait a few days, then reintroduce dairy for a few days, see what it does, and then remove it again. And so on. Try pork, then remove again. Then maybe try shellfish, then remove again.

This would still be not a perfect way to find out what health problem is caused by what food, but it would enormously help compared to the blind stumbling that I had to do.

"Simple" Thermodynamics and "Common Sense"

David Berreby – The Obesity Era: (via)

… Moral panic about the depravity of the heavy has seeped into many aspects of life, confusing even the erudite. Earlier this month, for example, the American evolutionary psychologist Geoffrey Miller expressed the zeitgeist in this tweet: ‘Dear obese PhD applicants: if you don’t have the willpower to stop eating carbs, you won’t have the willpower to do a dissertation. #truth.’ Businesses are moving to profit on the supposed weaknesses of their customers. Meanwhile, governments no longer presume that their citizens know what they are doing when they take up a menu or a shopping cart. Yesterday’s fringe notions are becoming today’s rules for living — such as New York City’s recent attempt to ban large-size cups for sugary soft drinks, or Denmark’s short-lived tax surcharge on foods that contain more than 2.3 per cent saturated fat, or Samoa Air’s 2013 ticket policy, in which a passenger’s fare is based on his weight because: ‘You are the master of your air ‘fair’, you decide how much (or how little) your ticket will cost.’

… As the Mayor of New York, Michael Bloomberg, recently put it, defending his proposed ban on large cups for sugary drinks: ‘If you want to lose weight, don’t eat. This is not medicine, it’s thermodynamics. If you take in more than you use, you store it.’ (Got that? It’s not complicated medicine, it’s simple physics, the most sciencey science of all.)

Yet the scientists who study the biochemistry of fat and the epidemiologists who track weight trends are not nearly as unanimous as Bloomberg makes out. In fact, many researchers believe that personal gluttony and laziness cannot be the entire explanation for humanity’s global weight gain. Which means, of course, that they think at least some of the official focus on personal conduct is a waste of time and money. …

It is like the question "Why are some subway cars full of people?" and the answer "Because more people entered the subway cars than left it."

Don't trust any "common sense" explanations with regards to nutrition or health. I now lost 12 kilograms weight in the four month since April 2013. Yes, I eat less – but more importantly I eat no dairy, I eat no cereal grains, I radically reduced the consumption of seed oils and PUFAs (poly unsaturated fatty acids) and I now radically reduced the consumption of sucrose ("sugar") and fructose (to the point that I at the moment even don't eat the supposedly "healthy" fruits). I eat saturated fats from coconut fat, I eat meat, I eat potatoes (preferentially fried) and I eat salad. So fuck you very much Mr. Bloomberg, and fuck you very much Mr. evolutionary psychologist – since when do have animals have to have "willpower" to stay non-obese?

Consider, for example, this troublesome fact, reported in 2010 by the biostatistician David B Allison and his co-authors at the University of Alabama in Birmingham: over the past 20 years or more, as the American people were getting fatter, so were America’s marmosets. As were laboratory macaques, chimpanzees, vervet monkeys and mice, as well as domestic dogs, domestic cats, and domestic and feral rats from both rural and urban areas. In fact, the researchers examined records on those eight species and found that average weight for every one had increased. The marmosets gained an average of nine per cent per decade. Lab mice gained about 11 per cent per decade. Chimps, for some reason, are doing especially badly: their average body weight had risen 35 per cent per decade. Allison, who had been hearing about an unexplained rise in the average weight of lab animals, was nonetheless surprised by the consistency across so many species. ‘Virtually in every population of animals we looked at, that met our criteria, there was the same upward trend,’ he told me.

I say, it is more and more seed oil (supposedly "healthy"), with its high content of PUFAs (as well supposedly "healthy") that is making animals obese (including the human animals).

Some Thoughts On Diseases (And Nutrition)

Just some thoughts I had lingering in the back of my mind and which I want to write down (rather quickly and crudely):

• If an chronic disease has no clearly determined cause, assume nutritional causes.
• To determine if your chronic disease has an nutritional cause, you need to do what is basically an elimination diet – there is no way round that. Probably the most popular such diet is the Paleo Diet, which has the advantage of having lots of recipes out there. Personally I think it is best to Remove evolutionary novel foods from nutrition (e.g. remove milk, remove dairy, remove seed oils, remove wheat, remove cereal grains) and then to see if it helps. You can start small (e.g. only remove milk, or reduce the amount of dairy), and if that helps, then you can try to make the next step (e.g. remove all dairy).
• If gluten-free grains (or lactose-free dairy) helps, consider removing all grains (or dairy) because even these "free" products can contain other substances that can make problems (like lectins in cereal grains or cow-milk protein in dairy) .
• If something helps partially, make sure to remove all foods of similar origin, and see if it helps further. E.g. if removing milk helps, then remove all dairy, and remove beef, and remove veal (consider removing lamb as well!). Or if removing wheat helps, then remove all cereal grains. Or if removing eggs helps, then remove poultry (chicken, turkey, …) as well.
• Once you have removed a food for some time (e.g. a month or two), then consider to do a challenge to see if the symptoms return (e.g. for a couple of days). Make sure you change noting else during that time!
• If you buy food: Milk and cereal grains tend to be in everything.
• With some diseases I suspect that one can get (almost) full remission. With other diseases one might only stop the active disease process and avoid further damage (which might be plenty for some disease).
• You need to test removing foods yourself! Do not trust a lab to find this for you, do not trust a doctor to know what nutritional problems you have, and actually while we are at it: do not trust anybody (not even me). You have to run these nutritional trials yourself, to see what causes the problems you have.

Anecdote: Lactose Messes Up Libido

Just a short anecdote: I recently ran an natural experiment. I wanted to see if removing all fructose from my diet (and therefore all sucrose as well) would have an (hopeful positive) impact on my health. As I need some sweetness in coffee, and as coffee with pure dextrose ("glucose") tastes like dish water, I used some artificial sweetener as well (in tablet form, that my mother had bought for herself).

After maybe a week or two of using this sweetener, with maybe some 6 to 8 tablets a day, I noticed an pathological increase of my libido, something I have not had since I reduced dairy in 2010. What was wrong? What was different? What the hell had I eaten? Of course the sweetener! Duh. Checking the little ingredient list on the bottle, written in that tiny tiny font, what did my eyes see? Lactose.

O.o

I have then exchanged the tablet sweetener (with lactose) for a similar one in liquid form (sans lactose, with a tab bit of fructose). And all is well again (at least considering THAT problem).

Anecdote: Dairy And Beef Causes Somnolence

One more personal anecdote: I was having problems with somnolence (excessive sleepiness during the day) – even caffeine tablets did not help. These problems got better once I reduced the consumption of milk and dairy (during my Atkins diet in November 2010).

But as I was thinking that ghee (clarified butter) was "pure" fat, that this would be a "safe" milk product, I increased the consumption of ghee. At the same time I ate a lot of beef, which I did think back then to be "good". During that time I got more somnolence again (Again and again and again: Always watch your symptoms and don't change too many things at a time!).

During my "10 days milk&dairy reintroduction" in March I again got more massive problems with somnolence again, which subsided again afterwards.

Now that I had removed beef (in December), reduced caffeine to 3-5 cups of coffee a day (and no tablets!) and finally in April replaced ghee with coconut fat * – both of which should have a roughly similar composition of fatty acids – did my somnolence retreat for good.

A lesson for me: After I found out that milk and some forms of dairy are clearly problematic for me, I should have become suspicious of all forms of dairy and suspicious of beef (and veal!), even if I did not see any obvious correlation to my remaining health problems.

In extension: If one thing from a nutrition group does cause clear problems (e.g. some cereal grains), better remove everything from that group (e.g. all cereal grains, even gluten-free) from the diet, to see if it helps. And then reintroduce them again to do a challenge.

So after I learned that clearly veal is a problem for me, that beef might be a problem for, I will try to remove all meat from my diet for at least a week and replace it with fish. I already reduced meat somewhat (and am currently on a rather high-carb and high-fat diet! and continue to loose weight, if only slowly) and then tried going vegetarian, but I got a "strange" hunger that made me feel somewhat "jittery", a hunger that subsided only after I ate some meat. I need animal protein, my body makes that much clear. We'll see what fish instead of meat does.

* I initially replace ghee with palm fat, which has an higher content of PUFAs (poly-unsaturated fatty acids). This increased my hunger for carbs, and sometimes gave me a slightly low blood sugar. Only after I switched to coconut oil – with a low content of PUFAs that is comparable to butter/ghee – did my hunger (or rather problem) decrease to a level I would consider "normal" or "adequate".

Anecdote: Even Gluten-Free Bread Does Cause Unwanted Symptoms

Yesterday evening, my mother made some gluten-free bread. I had not eaten any form of cereal grains in a long time and wanted to try it out. After I had eaten a nice (but not excessive) portion of this gluten-free bread, I started to get some unwanted symptoms:

• First of all within maybe 15 to 20 minutes I started to get (mildly) sweaty, without any apparent cause – it wasn't particularly warm, and I did not do any unusually demanding physical activity which would explain this
• On the same evening, I noticed a very very slight case of heartburn
• Then now, at 4 in the morning I awake (something I had not done in a long time; Now in summer I usually awake at around 7), slightly sweaty, and with a slightly stronger case of heartburn than yesterday

Needless to say, I feel – after that little sleep – more awful than usually.

So this is my interpretation:

1. Whatever the cause, it is not caused by gluten – as the bread was gluten free
2. Whatever the cause, it is not caused by carbs (or starch) – as I have been eating (lots) of potatoes and glucose in the last weeks
3. I have to assume, that the symptoms are the direct result of eating this piece of gluten-free bread