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Tuesday 23 October 2012

Fish Oil, Krill Oil, and Hepatitis C

Few things in paleo-land are as endlessly debatable as whether supplementing fish oil or cod liver oil is a good idea. When considering the effects of omega-3 VLCFA (very long chain fatty acids, which describes EPA and DHA to a tee, though so does HUFA, highly unsaturated fatty acids) on HCV replication and liver health, things get even more complicated.
There's an action of VLCFA on blood lipids which isn't what we want; an increased demand for cholesterol which sees an increase in LDL-receptors (low LDL is the serum marker for this). If you've read the earlier entries in this blog you'll know that this favours fresh HCV infection of hepatocytes. And fish oil is the most inflammatory oil in models of liver disease exacerbated by excess polyunsaturates.
However, these effects can be minimised by consuming VLCFA in the context of a diet rich in saturated fat and cholesterol. A traditional fish-and-coconut, or herring and mutton,  based diet, with eggs or offal, for example. And no-one is ever going to supplement the amounts of fish oil (35% of calories) used in the alcohol/drug models of liver disease. 1% of calories as EPA and DHA - an effective dose from supplements - is about 6g fish oil or 10mls cod liver oil, about 3% and 5% fish oil calories on your imaginary 2000 kCal diet. Hmmn.
Anyhow, the fish oil-type omega 3s (which you will also find in pastured meat - lamb, goat, venison), and the omega 6 VLCFA arachidonic acid (ditto), are good and necessary things to have in the diet. 
For one thing, they all inhibit HCV replication.
This paper finds EPA and DHA effective: http://theses.gla.ac.uk/133/01/2008hubbphd.pdf
 "In this study, we found that several polyunsaturated fatty acids (PUFAs) including arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) are able to exert anti-HCV activities using an HCV subgenomic RNA replicon system. The EC50 (50% effective concentration to inhibit HCV replication) of AA was 4 lM that falls in the range of physiologically relevant concentration. At 100 lM, a-linolenic acid, c-linolenic, and linoleic acid only reduced HCV RNA levels slightly and saturated fatty acids including oleic acid, myristic acid, palmitic acid, and stearic acid had no inhibitory activities toward HCV replication. When AA was combined with IFN-a, strong synergistic anti-HCV effect was observed as revealed by an isobologram analysis."

Some points: these VLCFA seem to be effective at normal physiological (non-toxic) concentrations; their vegetable precursors (LA, GLA and ALA) are not significantly effective, and neither is oleic acid (the omega 9 monounsaturated fatty acid found in meat fat and olive oil - interestingly it was called a saturated fatty acid here: compared to DHA, it is).

One way to optimize levels of DHA, AA, and EPA while minimizing the unwanted effects of PUFA on liver inflammation is to lower intakes of vegetable PUFA (cut out oils and grain, limit nuts and seeds) while eating adequate amounts of oily fish, eggs, meat and organ meats, in a context of saturated fats from coconut, dairy and animal drippings (or palm, cocoa butter).
"As the dietary saturated fat content increased, liver pathology scores and ALT values decreased (P < 0.05). At 30% dietary saturated fat, ethanol-induced hepatic necrosis was eliminated, and micro- and macrovesicular steatosis and inflammation were markedly reduced, even though the carbohydrate and total fat content of the diets and the ethanol dose were identical to those administered to rats fed the low-carbohydrate, unsaturated fat diets."
http://jn.nutrition.org/content/134/4/904.long

Should we ever supplement fish oils? There is another warning here: The administration of high amounts of n-3 polyunsaturated fatty acids reduces host defense to bacteria, viruses, parasites, or fungi. Inappropriate administration of n-3 polyunsaturated fatty acids in patients at risk of sepsis may cause adverse effects due to an increase in the susceptibility to infection. http://rd.springer.com/chapter/10.1007/978-1-60761-061-8_8
(click on "look inside" link).
Some of the benefit of fish oil might come from this very immunosuppressive action, but obviously we want to stay in the sweet spot between inflammation and infection.
Eat fish when you can; it needn't always be oily fish as the muscle of white fish such as cod is high in DHA.
Don't worry too much about mercury; anyone with Hep C should be getting a higher intake of selenium (seriously, the most important supplement you can take), which protects against mercury toxicity: http://www.ncbi.nlm.nih.gov/pubmed/23033886
Sardines are a good oily fish from low in the food chain. Canned tuna is of little use. Always buy canned fish packed in spring water, olive oil or oil-free tomato sauce; packing fish in soy oil (or "natural oil" on one deceptive mackerel label) counteracts any benefit of omega 3.

Cod liver oil has the benefit of supplying arachidonic acid, retinol and vitamin D not found in other fish oils. 
It should not be taken long-term in higher doses; a 5ml teaspoonful a day (supplying 500mg EPA and 500mg DHA) is probably safe. Concentrated fish oil pills, with more omega 3s, so you need only one or two daily, may be a good bet. But the best option for supplementation, if such is desired, is krill oil.
Krill oil is effective at significantly lower doses than fish oil because the VLCFA are in phospholipid form, not the usual triglycerides, so they get straight into the cell membranes without being oxidized (a similar mechanism might explain why whole nuts and seeds seem to be anti-inflammatory, yet their purified oils are full of pro-inflammatory linoleic acid). Krill oil, but not fish oil, reverses the elevated gluconeogenesis of diabetes, which can be a consequence of HCV infection: http://www.frontiersin.org/Nutrigenomics/10.3389/fgene.2011.00045/full
"We found that ω-3 PUFA supplements derived from a phospholipid krill fraction (KO) downregulated the activity of pathways involved in hepatic glucose production as well as lipid and cholesterol synthesis. The data also suggested that KO-supplementation increases the activity of the mitochondrial respiratory chain. Surprisingly, an equimolar dose of EPA and DHA derived from FO modulated fewer pathways than a KO-supplemented diet and did not modulate key metabolic pathways regulated by KO, including glucose metabolism, lipid metabolism and the mitochondrial respiratory chain. Moreover, FO upregulated the cholesterol synthesis pathway, which was the opposite effect of krill-supplementation."
This is pretty interesting too: http://www.ncbi.nlm.nih.gov/pubmed/21749725
Anandamide can be elevated from long-term consumption of high-omega 6, low omega 3 diets; it's a cannabinoid and and can produce - the sugar-craving munchies, just like the real thing!
(There's a cool discussion of the research by Emily Deans here: http://evolutionarypsychiatry.blogspot.co.nz/2012/09/omega-6-obesity-and-endocannabinoids.html

Anyhoo; what to recommend?

Remember to eat your saturates (see figure 1) http://atvb.ahajournals.org/content/12/8/911.full.pdf 
Eat fish regularly, but cook it in butter or dripping, or serve it with coconut...
Krill oil is the best daily omega 3 supplement, Cod Liver Oil or concentrated fish oil capsules are the best fish oils for temporary use, but are easily overdone. Limit your omega 6 intake from vegetable oils to the sparing use of olive oil, nuts, and seeds, and get some omega 3 intake from cold-weather greens (spinach, silver beet, kale, watercress). Ground flaxseed is a good occasional food for the gut. But vegetable omega-3s are no substitute for animal ones, and flaxseed oil is not worth supplementing.

The standard Paleo recommendation from the most reliable sources (Paul Jaminet, Kurt Harris) is to limit PUFA to 4% of calories. If you eat about 2/3 of your energy as fat, that fat should be about 6% PUFA on average. If half your fat comes from dripping, dairy and coconut, the other half from red and white meat, olive oil, fish,  nuts, seeds and greens, you'll come close enough to this magic figure; but it does kind of rule out taking 10mls of cod liver oil every day of your life.

I figure that we can count PUFAs in whole foods - fish and nuts - as being at least twice as beneficial and half as harmful as their purified triglyceride oils. No exact figures (except for krill oil), but good evidence that this type of difference is real. Peanuts? a) not a nut, b) source of the liver carcinogenic aflatoxins, and worth avoiding. Almonds and brazil nuts, black sesame and ground flaxseed are good sources of minerals, vitamins and prebiotics and worth having in the diet now and then.


47 comments:

Unknown said...

Thanx for Sharing such a hugefull information and lots of benifits of Fish Oil. ya u r ryt, Fish Oil is the one of the best nutrician , it has been show to provide a number of health benifits, and recomended by many health autorities as a part of balanced diet. Fish oil contains omega-3 fatty acids, specifically docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).One of the health benefits linked to Fish Oil is a low risk of heart attack. very healpfull for blood circulations.

Unknown said...

Great job you people are doing with this website.

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julz said...

I recently discovered your site. I have signed up for this paleo diet, and have been researching lots on fats, etc. I have also been taking the Cod liver oil for vitamin D increase because I read on Weston Price site its good for dental health. I am concerned about the high dosage of vitamin A from this suppliment including the vitamin A I get through my daily diet. Half cup of carrots exceed the daily vitamin A intake. I am concerned. I also take vitamin D3. I am a very visual person, can you give me tips on your typical day diet? What you have for breakfast, lunch, dinner, etc. I am lost for recipes and just been eating eggs scared to try anything that has high level of PUFA. I have had hep c SINCE I was 2 months old. I got it transferred through infected needles when I was in the hospital and needed blood transfusion. I am petrified of the treatment they have out and kind of just roaming around with my disease. I do feel the liver often. It hurts almost with every food I eat exept soup. I only used coconut oil and grassfed butter for fats. I love sugar but am now using absolutely none, including in my black coffee. Anyway, I am taking 50 pills a day right now, all natural vitamins but alot of pills like D3, B12, C, SELENIUM, MULTIVEGGIES, SILYMARIN, ALA, E, Cod Liver Oil from green pasture, occasional artichoke, butter oil, Dr. Williams daily vitamin intake which has 7 pills per day...so yea I am loaded and wondering if I am doing too much and if its worth it all or if I am missing another pill!! Anyway, I really hope to hear from you. I am very young, 25...so this is important to me and I am glad to have found you. Thanks for your help.

Puddleg said...

Hi Julz,
The vit A requirement is badly underestimated today and carrots are not a reliable source; besides, if you are eating retinol, carotenes will not be converted.
Higher retinol intakes, within reason, seem to be protective.
I wouldn't worry about omega 6 if a) you don't use seed oils, and b) you get enough omega 3.
I would probably take 5ml cod liver oil daily and take a vitamin D3 supplement for the rest.

My breakfast is usually fried or scrambled eggs with a little bacon (or liver -chicken or lamb - and/or sardines) and fried tomatoes, cooked slowly (low temperature) in beef/lamb dripping. A piece of seasonal fruit (plums are my favourite).
In the afternoon I will usually eat a banana or a handful of white rice (e.g. sushi if I am out).
For dinner, lamb chops (not overcooked, with fat still on), parsnip or pumpkin pureed with cream and reheated, spinach sauteed in butter. (or chicken, pork, fish, beef, but lamb is favourite). Maybe berries after. Dark chocolate. coffee and cream in AM, sometimes with 1/2 tsp soft brown sugar.
Often more carbs (potatoes, rice, kumara, taro) or less depending how I feel. if I feel a bit off, less carbs, if I need more energy, more carbs.

As you go on with paleo you'll be able to cut back on pills. You might already feel better without silymarin, with less selenium, and so on. At any rate there's no need to take them very day. I used to take pretty much what you take, now I use magnesium, low dose multi very occasionally, vit C 2g daily, vit D in winter, grape seed extract when I have it, co-enzyme q10 ditto, and occasional top-ups of selenium and zinc.

Puddleg said...

P.S. Julz,

the book I recommend is the Perfect Health Diet (there's a link by the blog). You might tweak this a bit - extra selenium and zinc, krill oil, try a ketogenic diet - but the essence of it is ideal. It ought to make your liver feel better and save you a fortune in supplements.

julz said...

I am impressed with how simple and little your meals are! I probably eat twice you do, although I am still skinny and I do have 2 active kids, one of which I am still nursing. I am also shocked by the ammount of vitamins you take, barely none! Here I though you take far more than me probably. I am missing some from that list you mentioned so I will be ordering some. I also started taking H2O2 water, foodgrade oxygen peroxide that supposed to kill virus, etc. Goodness I take everything! Thank you for the tips on the diet. I am looking into the book you posted now and I have looked into the diet, already wrote down recipes!! Right now, I still have potatoes in the house ): but after this I will start buying low carb veggies on the list. Thank you so much again, you are a great help...

Puddleg said...

@ Julz,
my meals aren't little in calorie terms but I do try to keep them simple and flavoursome. But that was just a sample, we might have a fish curry made with coconut cream and shredded coconut, a basic salad, a ceasar salad, stroganoff made with butter and sour cream, oxtail soup, comfited leeks or bok choy, steamed beans or brocolli, etc.
Often lots of non-starchy veges reduced to small amounts by slow cooking with butter.

If I was you I'd remove supplements, not take more. With 50 pills the chances are good that on any given day not everything is helpful. I wouldn't take peroxide. I'd take most herbs intermittently and have days without minerals and vitamins (they do stay in the body for a while, even B vitamins). What dose of selenium are you on?

Puddleg said...

I didn't mention probiotics; this is very important and over time will substitute for supplementary nutrients trough better absorption.
Lactobacillus rhamnosus and reuterii, bifidus bifidus or animalis are good ones to look for.

Unknown said...

Thanks for giving me information about fish oil. Your blog is very helpful and appreciable.Healthgenie.in provides wide ranges of Home care, Wellness, Nutrition (fish oil for weight loss), Baby Care, Personal Care products.

julz said...

I see what you are saying. I am on 400 mg per day.. I just ordered probiotics, thank you for the tip! I am so glad you told me about this diet. Up until now I have been eating alot of dry and burger type things. It was on low heat and all but I never knew how to make savory, watery and creamy dishes... I have been looking at lots of recipes and believe it or not i have never used coconut or dairy cream in any cooking before, so this is very exciting. How often to you eat fish per week, and which kind would you say is best? And how about nuts?
Thank you!

Puddleg said...

I recommend the Perfect Health Diet
http://perfecthealthdiet.com/

for ideas about low-PUFA, low-fructose grain-free eating.
Old books (1960s, 1970s) on meat/fish cookery or French quisine are full of ideas too. Just substitute ground almonds or tapioca starch for any flour, if needed (it usually isn't important).

Some weeks I have sardines every day, some much less. I try to eat a can of sardines for every time I have pork or chicken.

400 mcg selenium is too much unless you're at death's door. Probably 100-200 is enough, and a paleo diet will supply more than you're used to. The need for selenium relates to your viral load, if you know that; iodine deficiency could also make it more essential, I recommend getting a bit of seaweed or kelp powder now and then.

Artichoke is a good herb when needed but too much bitters - artichoke and silymarin - might stress the gall bladder and cause pain. I don't know if traditional uses of milk thistle saw it taken for very long periods of time, I'd suggest stopping it, seeing what happens, taking it as you need it.
With every supplement you should feel what it's doing for you and know if it's still working. If it seems to stop working, stop taking it for a while.
There are a few exceptions like vitamin A, K, D3 or zinc where you wouldn't expect to know, so just need to keep intakes in the middle ranges.

julz said...

I see. Last time I checked was when I was pregnant with my son, that was 1 year ago, my viral load went form 10k to 1 mil. I never checked after that but hope it went down. Any tips on lowering the viral load? Thank you for the tips on the vitamins, I really had no idea I am actually supposed to listen to my body. I didn't take anything yesterday and today and just took vitamin c today and d3. I want to take things little by little and increase to see where I stand. Any particular books you have spacificly that of the french cuizine that you like? I looked into that site you gave me, I really love what he is writting on there, although I see he does have high carbs and grains on there, the safe kinds but he does. I have some sort of addiction to grains and breads and all that. Once I start I cannot even stop honestly. My brain doesn't tell me to stop for some reason and I just keep eating and eating and will eat until I become foggy, tired, blah feeling. I am wheat free but even with regular grains like rice I don't have a switch. So eliminating them is good for me. Why do you eat so much of sardines? Why not other fish?
Never thought about sea grasses, I will have to look into that too, thank you!

julz said...

how much chocolate do you eat per day? Do you make it yourself since most have sugars in them?

Puddleg said...

10K is very low. Low-carb and low PUFA eating will keep it low. Do you know yr genotype?

You can leave rice out of the PHD, if I want to go low-carb on it I eat pumpkin etc, peas, and root veges like carrot, parsnip. These are easy to add fats to.

Fruit and berries seem ok on low carb. I don't worry about a little sugar in chocolate or relish, but I understand they use more sugar in some places - I do avoid HFCS.

Sardines because they come cooked in tins and my family doesn't like me cooking fish in summer. Also, a good omega 3 fish.

julz said...

I am gen 1. Do you mind telling me how much chocolate is ok to eat per day lets say? I was reading I am only supposed to eat two little squares from a bar and I am eating like half a bar per day right now. That is my only source of sweet since I eliminated all sugars. Would be a great help, thank yoU!!!!

Puddleg said...

This tongue-in-cheek post sets a daily dose...
http://perfecthealthdiet.com/2012/11/chocolate-what-is-the-optimal-dose/

Some people can be allergic or sensitive to chocolate. This may be behind any cravings; but if you space it out and don't have many other caffeine sources, there are a lot of worse things to be hooked on.

Puddleg said...

35g is 7 squares -nearly 2 rows - of Cadbury's.

Puddleg said...

Geno 1- I just got this from the top local hepatologist, Ed Gane:

"Good evidence indicates that patients with chronic hepatitis C receiving standard-of-care (pegylated interferon α plus ribavirin) could significantly benefit by taking vitamin B12 supplements. In particular, patients who carried the type 1 strain (difficult-to-treat patients) responded significantly well."

http://gut.bmj.com/content/early/2012/06/28/gutjnl-2012-302344

julz said...

SORRY to be replying late...its has been a tough week. Thank you for the research on B12. I actuallly have been taking it with ALA for about 3 months now. So, after your wisdom I ended up getting CQ12 and Zinc and Magnesium. Do you ok Stevia as a sugar replacement for all sources> I have heard really conflicting information on this sweetener. Some say its awesome, some say it causes cancer. What do you use as sweeteners, occasional that is?

Puddleg said...

Stevia is supposed to have anti-HCV activity; studies on this are limited but the effect seems to be quite strong. I know of no reason why it would cause cancer, it is an approved sweetener and must have passed the Ames test. Probably a lie spread by makers of aspartame or sugar.
I use soft brown sugar or honey in small amounts if I want to sweeten coffee. I think at the levels of carbohydrate I eat, 50-100g/day, fructose loses any special properties it might have (except perhaps the addictive one, if eating sugar makes you crave sugar and eat more than you planned that's a good reason to avoid it).
Having a small amount of sugar as some of the carbs in a low-carb diet doesn't bother me now, though I think going without it as much as possible for a few years was helpful. I'm pretty sensitive to the taste now and more than 1/2 tsp in coffee makes it too sweet.
I would use stevia if I could afford it, but it's a luxury.

julz said...

Oh...I cannot afford it either! I cannot afford the white powder and all the drops. So I actually buy the green leaf stevia which is actually the leaf itself. Its 2 bucks per pound at my local natural store. Its also online for the same price I saw. And if I am baking, I just use that and often can't tell the difference, Like yesterday I made cereal from coconut flour for the kids and put a spoon of that in there and, yeah, that was too sweet....Stevia is REALY sweet. I could barely eat that with just one little spoon. I noticed when I eat any sugar on top of lets say 3 fruit, or if i ate 4 or 5 fruit, my feet and bottom legs itch a little under skin, as though my body can't handle all that sugar. But stevia, I can eat all day and do fine. Obviously I don't eat it all day, in fact yesterday was the first time I ate it in 3 weeks but you get my point.
The last controversy I read was by this lady, she is a nutritionalist of some sort...http://www.thepaleomom.com/2013/03/teaser-excerpt-from-the-paleo-approach-the-trouble-with-stevia.html

Also, about the green leaf stevia, When needing a little sweetener for my tea, I put a small amount of green leaf in a coffee filter baggy and twist it so solids won't come out and put THAT in a little container with boiling water and let it sit there for 10 mins. I then take the green leaf out and use the sweet water as droplets to sweeten my teas, etc. You will taste the green grass a bit if putting it in your coffee, etc. It doesn't bother me but sometimes it does. You can also grow your own stevia plant. I am thinking of doing that! It's a little plant and you just take little leaves off as it grows, dehydrate them and that's green stevia for ya!
How are you on dairy. I recently started drinking raw goat milk that is grassfed from my local farm. I grew up on goat milk so this was a taste of my childhood and I am obsessed thinking of making cream cheese from it, yogurt, etc. But have read that dairy can be a problem for liver?

Puddleg said...

If you're not allergic to dairy there's no problem with it, I think.
I am a bit allergic and I prefer cheese, cream and butter to milk itself, and I prefer to cook cream.

The Stevia article's interesting because those hormone pathways are probably how stevioside inhibits HCV.

Puddleg said...

Carbsane may have lost the plot recently (a statement which won't help to date this comment) but she was the author of the "cellular fats may be different from acellular fats" idea as far as I was concerned.
Here's another paper to confirm that:
http://www.nutritionandmetabolism.com/content/10/1/23

n-3 PUFA added to high-fat diets affect differently adiposity and inflammation when carried by phospholipids or triacylglycerols in mice

julz said...

I reallly tried to understand that article and I got the nature of it. I am not from this country! so very heavy language is tough for me to understand. So! I cut back on most of my vitamins, I barely take anything now....I noticed this, I started drinking 2 cups of coffee per day and when I started, my liver has been hurting non stop. So, I stopped and it stopped hurting. I tried tea. Liver doesn't hurt, but I am soo tired every time I drink tea. I just drank tea and I am just falling asleep typing this. When I don't drink tea though, I am extremely energized, I haven't experienced this in a while. I also noticed when taking zinc, my leggs and feet get extremely itchy when standing or walking. I started drinking raw goat milk and it has been fantastic. So, I wanted to update you on my status. I am really figuring things out and listening more to my body. Have you ever heard of nourishing traditions? Someone told me about this book...its full of fermented foods and things from scratch, even bread.... I found a recipe there for beet kvas, or fermented beet juice, I heard great things about it. I also heard keffir is supposed to be good for you if made from keffir grains.

Puddleg said...

Nourishing traditions has a lot of good stuff especially around animal foods and fats. The grains are highly prepared - personally I think it's better to cut them out (except white rice) for a time because so many people with hep c, and other issues, have sensitivities and allergies to many grains and legumes.
The Perfect Health Diet is the diet book I recommend, it has much in common with Nourishing Traditions without the grains, and it's fairly flexible.
Take a probiotic that contains L. Rhamnosus (with or without other probiotics) every day; take the zinc (chelated) and some selenium, and magnesium; perhaps drink coffee if you can (don't be afraid of a little sugar if it's just to make a coffee nicer) but black tea is OK.
With infected blood transfusion you may have more problems than with dirty needle alone. Are you sure which it was?

Puddleg said...
This comment has been removed by the author.
julz said...

I see.. Well, I am at no grains at this point. Sometimes, I have a little rice and feel so tired afterwards, so I just can't do grains. One thing I wanted to ask, the diet you are referring to, I have looked into it and read much on it. But I did notice it is LOADED with carb veggies. I think a while back you suggested for me to go on the kento diet and I have been buying sort of VERY LOW carb veggies, exept for rutabaga in my soup, just a little, maybe 1/4 or less of the head. So, I am wondering should I just stick to that diet? I know you are not a doctor to solve my problems! So, please don't feel like you have to respond to me comments. I appreciate everything you have done thus far...it has helped me so much. They have checked for other diseases, and nothing....several times...I just have hep c, thank GOD. I do have stuff like low platelets and those things because of my liver but nothing like AIDS, etc

Puddleg said...

Stick to the low carb veges if it works. If you have side effects (I got pains in extremities, sore eye sockets) very small amounts of starches or natural sugars (which don't matter at very low carb intakes and may have the benefit of being absorbed faster so not feeding bacteria) will fix it- the PDH is about trouble-shooting on a low carb diet. If you ate rice every day I think you would adjust within a day or 2, but no reason to do that if the keto stage is working fine. Many people are happy in ketosis long term. Just make sure you're getting enough calories, enough fat, especially if you're underweight, as so often with HCV, and eat plenty of tomatoes (the low-carb fruit) for the potassium.
ALA is great but it can cause thiamine deficiency, it revs up the mitochondria and they get greedy for other B vitamins. You wouldn't need as much ALA on a high-fat diet as on a high-carb.

julz said...

I see. I think I am not 100% percent on the low carb diet. The other day I had few bites of a sweet potato in my coconut flour panckake....so that's not low carb /: I was considering buying that book nourishing traditions but not sure if it will serve me any because I am already aware of fermented foods, broth, etc. You have been a great help. I appreciate ya.

Puddleg said...

You only have to go below about 50g carb a day to be ketogenic; I think there are advantages to getting about that much, from fruit and starch and some natural sugars like honey, esp. if they are low GI i.e. taken with fat, vinegar, fibre. Coconut and butter both supply some extra ketones (from MCT fats) that don't depend on carb restriction.

Unknown said...
This comment has been removed by a blog administrator.
M said...
This comment has been removed by the author.
M said...

Do you have any idea why in Western traditional gastronomy there doesn't appear to be any seaweed? Are our seaweeds different and undigestable compared to the Asian ones? Also, unlike Asians, we only seems to eat fish roe, but throw away the rest of the innards of fishes. It seems counter-intuitive at this point, knowing as we do that the innards are the most nutritious part of any animal. Could there be some kind of ancestral wisdom at work here? Like, for instance, it's ok for Asians to eat soy because they process those beans in all kinds of ways that make them harmless and digestible. Could out Western ancestors found out, through personal experience, that the oil of the liver of a fish is useful, but that there is actually some kind of counter indication to eating the liver itself? Thanks!

Puddleg said...

That's an interesting question. Paleo and neanderthal peoples ate pond algae, perhaps similar to spirulina and chlorella today and related to seaweed. Coastal dwellers in the west do I think traditionally eat some seaweed (Ireland, Hebrides). According to Wikipedia,
Seaweeds are used extensively as food in coastal cuisines around the world. Seaweed has been a part of diets in China, Japan, and Korea since prehistoric times.[4] Seaweed is also consumed in many traditional European societies, in Iceland and western Norway, the Atlantic coast of France, northern and western Ireland, Wales and some coastal parts of South West England,[5] as well as Nova Scotia and Newfoundland. The Māori people of New Zealand traditionally used a few species of red and green seaweed.[6]

As for fish guts, this may have to do with parasites which hang out there.

But here, I found this blog which answers every possible question about cooking and eating fish guts!
http://www.pennilessparenting.com/2012/12/eating-fish-scraps-and-fish-guts.html

M said...

I didn't know that there was at least one Mediterranean country (France) where seaweeds were consumed, as this appears to be the exception. I come from Portugal, and we have a very long coastal line, right from the North to the South, facing the Atlantic. In spite of this we've never used seaweed, and if you want to so much as see the innards of a fish you have to buy it whole and specifically ask the person not to remove anything! You do eat fish roe, that is a part of traditional cuisine, and in fact you can find it in the frozen section in most supermarkets, but that's it. It was extremeley kind of you to have gone to the trouble of finding those links, thank you very much, I'll check them out! :)

Mac said...

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Iamwhoiam said...

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Unknown said...

Is there a particular brand of krill oil you take/recommend? OR anything I should look out for when getting a krill oil supp. Thanks

Puddleg said...

Hi Jimmy,

I used to shop for krill oil by value for money, but I would look for information about the astaxanthin context. If they bother to list that it implies they've taken some care.
I found it a much better anti-inflammatory than fish oil, however after being very low carb for a few years I don't seem to need either any more.

Unknown said...

Got that sorted thanks. I have a few questions.

Back when I wasn't struggling with health issues so much if I went without eating for a while ( like a small fast ) I would feel quite good. Very low water retention, skin looks nicer etc. These days the opposite is true. Not eating for extended periods of time makes me look WORSE. I also feel much worse than can be explained by hunger. In fact by comparison I'm less hungry which makes me suspect some sort of toxicity. Based on my historical eating patterns ( american junk foods ) my best guess is that the discrepancy in my response to fasting boils down to 1. Excess omega-6 in fat stores being released and 2. excess iron. Another thing I notice is if I eat a lot of of sugar + starch my symptoms will be relieved to some degree which again leads me to believe omega-6s being liberated for fuel is an issue. Of course my issues are even better with high saturated fat but that was just a little something I came across through experiment.

So my questions are

a) Do you think this is a reasonable assessment of my current situation or may I be missing something big?

b ) IF that's accurate what would you suggest? I eat basically as you recommend ( high sat fat and nothing heavily processed ) + will be soon adding the krill oil. I basically never ate fish nor supplemented any fish oil throughout my life so this will be new for me.

c) Through work ( that I am no longer at ) I came into contact with quite a bit of powdered aluminum which really screwed me up. Had to take time off I could barely afford to do, no fun. Anyway do you know of anything to approach that problem? I've read chlorella may help but rather weakly.

Puddleg said...

Hi Jimmy,

you don't say whether you're losing weight when you fast, or if that's your reason for fasting. If it isn't, I wouldn't do it often, as you are activating stress responses that may not always be beneficial.
If you are losing weight quickly, it's entirely possible that you're releasing persistent toxins such as PCBs and DDT from stored fat, and feeling toxicity from these. There is some research on this. If that's likely (depending where you've worked or lived and your age as levels of these toxins have dropped in recent decades) I'd make sure that most of the fat you use is relatively toxin free (dairy in the UK not always such a great option because of lindane used there, coconut oil would be safest of all). Chlorella will probably increase excretion of this too.

Powdered aluminium is an immune stimulant, it's used in vaccines to potentiate the antibody response, so will give you a high-Th2 to Th1 type of immune imbalance - I recommend probiotic supplements (one that includes Lactobacillus Rhamnosus LGG is a good place to start) and a Chinese herb called astragalus if you can find it cheaply in whole herb form (should be easy if you live near Chinese supermarkets). Use about 9 grams per dose, broken up, soaked in water overnight, drink the water, then simmer gently for a while and drink that. Getting enough vitamin A (as retinol) is important for taming the inflammatory Th17 response. Omega-3s will also help here.

I think it's okay to eat some starch, from lower-carb veges such as pumpkin, broad beans, sweet potato, unless you're specifically wanting to be in ketosis.
I met someone recently who got their HCV viral load very low just by cutting out sugar and using butter instead of vege oil.

Unknown said...

Thanks for the response!

The fasting thing is just an observation I've made, not intentional as a weight loss strategy. I'm only 21 but regardless I've eaten a SAD my entire life even growing up as a toddler, high omega 6 pufa and all. While I can't speak to PCB or DDT specifically, I'm sure I was exposed to plenty of toxins in general.


I appreciate all the supplement recommendations. I eat plenty of yogurt but I checked and the brands I eat don't have that l. rhamnosus strain. Hopefully the yogurt should be doing some good now and a more tailored probiotic can come later. In addition to my diet I'll be adding in the krill oil, chlorella, and astralagus.

Vitamin A...yep I was just going to order some of that seeing how I can't stand liver. I was a bit hesitant after reading it needs to be in balance with the other fat solubles. How many IU would you recommend I take? I read of people taking up to 100k IU daily with good results I'm just concerned about throwing things out of whack. I do eat 1-2 eggs per day and most of my butter comes from a good grassfed source if that's of any relevance.

Puddleg said...

There's 5,000 iu of retinol in a teaspoon of cod liver oil, seems a good reference dose. I never found that even large doses (60,000 iu for a cold) produced any side effects; retinol has been used in HCV therapy

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803131/

The retinol group, in addition to above treatment, received retinol 30,000 units per day orally for 3 weeks from one week before the start of interferon α-2b plus ribavirin combination therapy. The hepatitis C virus (HCV) RNA negativity rate at 1 week after the end of interferon α-2b and ribavirin combination therapy was 46.7% (28/60) for the retinol group and 31.7% (19/60) for the control group, which was significantly higher for the retinol group. The level of serum HCV RNA in the retinol group was significantly lower at 1 week after beginning treatment as compared to the control group (p<0.01).

I think 10,000 IU is a safe enough long-term dose - 3 oz of beef liver would supply 22,175 IU, but you wouldn't eat that every day. You'd be trialing it to see if it helped with the aluminium effect; I would expect aluminium to promote flu-like reactions to things people aren't usually allergic to.

Unknown said...

Alright and regarding the probiotics I have some questions.

1. I'm going to start on a mixed probiotic including the rhamnosus strain, I'm curious if they ever end up taking permanent residence or do the benefits only last as long as I take it?

2. What do you think of saccharomyces boullardi?

Thanks

Puddleg said...

It may not be that any probiotic produces permanent colonisation of a new strain, though I'm not sure of this; however, this isn't necessary for benefit as effects on immune cells are long-lasting; also, even dead bacteria exert these effects. Another influence of probiotics is to favour a better mix of your own bacteria - lactobacillus has a "good shepherd" effect on your native strains.
I'm not sure about the SB yeast, I've never tried it, but it's worth trying.

atoma said...

You recommend the Perfect Health Diet. Back when the book came out, I asked the author about the Perfect Health Diet for someone with Hepatitis C, and he said people with hep c shouldn't do intermittent fasting or a low carb / high fat diet. Thoughts?

Puddleg said...

Hi Atoma,

simply, when Paul wrote the book he didn't know anyone with Hep C, and was playing safe.
There's a lot more known today about how a fatty liver responds to LCHF. Breaking up the fat and restoring insulin sensitivity is key to inhibiting HCV replication. Keto or well-fed fasting does this.