Sunday, July 31, 2011

Reflections on the Whole30

Good morning!  It is the last day of July, and thus Day "31" of the Whole30, a strict 30 day plan designed by (the gorgeous) Melissa and Dallas Hartwig with no processed food, no alcohol, no legumes, no grains whatsoever, no white potatoes, no dairy (including butter), no sugar or sugar substitutes (even honey and whatnot).

I don't do diets, by the way.  They don't work.  And they make you crazy.  And yet, in many ways, the Whole30 is unsustainable perfection unless there is a darn good reason.

So why did I do the Whole30?  An experiment.  And there is scientific validation for elimination diets - it is the gold standard way to determine certain food intolerances.  What I admire about Dallas and Melissa is they make that clear - the Whole30 is about health and seeing if you find some positives with a strict month, it is not the rest of your life, it is not about losing weight. It is not a "diet" in that sense.

It was interesting to go forward with the Whole30 when my regular eating pattern was already fairly similar. That way, if there were issues, it would be easy to figure out the exact problems.  And there are exactly seven differences between the Whole30 and the way I ate for most the year before the Whole30 (there is a Whole30 meal template that I did try to stick to also, which constitutes another difference, but just in terms of types of food consumed):

1) Rare added sugar (usually honey).  By rare I mean rare.  A teaspoon of honey in tea every couple of weeks.  Honey in a flourless chocolate cake twice in six months.  Except chocolate, which was usually a piece of a 85% dark chocolate bar every other day.  A bar would usually last a week.
2) Artificial sweeteners (gum and Diet Coke)
3) Cheating (usually gluten in homemade pizza, sometimes Mexican food - but not that often - once a month)
4) High fat dairy - after 3 months of NO dairy at all last year, I added back butter regularly, sometimes yogurt, sometimes cream with berries, sometimes cheese.  All told I probably ate high fat dairy not counting butter 3X a week.
5) White rice and white potatoes - these and other starchy carbs (winter squash, sweet potatoes, turnips) once daily - you are supposed to eat starchy carbs like winter squash and sweet potatoes on the Whole30, but not rice and potatoes.
6) Alcohol - 5 glasses of wine a week (I did try to keep it away from 2 hours before bedtime, as even one glass of wine will disturb my sleep if I drink it too close to bedtime)
7) IF ing - prior to Whole30, 24 hours usually on Monday, 16 hours a couple of other times during the week

Things I deliberately didn't change - amount of exercise and amount of starchy carb.  I did try to eat Whole30 approved starchy carb in about the same amounts in my meals as I did before Whole30.  In all likelihood I did consume more fruit on the Whole30 than before.

As I wrote about a week ago, I did go on vacation to a city with very fine restaurants, which means my Whole30 was not pristine.  In addition, ever since having rather extreme morning sickness during my pregnancies, sometimes I still get very nauseated in the mornings, and a half a teaspoon of honey in tea cures it instantly.  It's psychosomatic plus my typical lowish blood sugar, I believe.  Anyway, I did have honey once, and several cheat meals involving a touch of dairy on the trip - fish with a very sparse crust of parmesan and (literally) a drizzle of buttermilk dressing on some romaine, for example.  Which is fine, because it means that my Whole30 was more like my real life and the number of "differences" up there drops to 5 - forget 1) and 3).

So, what were the results and what was it like?  I've lost 7 pounds - five of that happened in the first 10 days (I think - that is when the dress size loss happened).  I feel energetic.  I'm sleeping through the night better, but it is much harder to get to sleep - I used to collapse around 9 or 9:30 and wake up at 2-3am for a few hours.  Now I can't generally get to sleep before 11, but I don't tend to wake up until 5am.

So fairly dramatic.  I started out with a BMI of 23.2 and now it is 21.8.   I'm wearing size 4-6 currently,  which is typically a small.  My clothes from 10 years ago (which was usually 6 or 8 or 10 or medium but sizes have ballooned in the intervening years) fit or are a little loose.

And I'm pretty convinced the major causative factor is the high fat dairy - because I had done little experiments in the past year removing artificial sweeteners or alcohol for a couple of weeks, and my weight was rock steady.  And I don't see a qualitative difference between a similar amount of sweet potato and a regular potato or rice with respect to sudden weight loss that happens in a week.  Also, there is a family history (two first degree relatives) with dairy intolerance so I should just buck up and cut it out (both family members can tolerate butter). But it could also be the chocolate or the insidious cheat creep that can happen.

What do I plan from here?  I'm going to experiment with adding back in rice and white potatoes - they are cheap, convenient, and the kids love them.  I will not add back artificial sweeteners.  Honestly my strongest motivation for the Whole30 was not weight loss so much as kicking the Diet Coke habit that had crept back in over the last 6 months.  I will drink wine, but will tend keep it more to special occasions, parties, meals out, etc. instead of "Woo it's friday night!"  Heh.  And life is too short not to have chocolate - maybe it won't be a bar a week.  Chocolate keeps well.  Chocolate is pretty much awesome in every way.

Oh, and IFing.  I like the health data behind the intermittent fast, and I did like the "buzz" I got in the afternoon (probably cortisol, however), and I like the convenience.  I didn't IF on the Whole30 because I was hungry, and I believe in eating when one is hungry.  I'm guessing I will add it back in but not as aggressively as before.  I hadn't realized how IF added stress in some ways until I stopped doing it.

So life after the Whole30 will be mostly similar to life on the Whole30, with more chocolate and alcohol.  I'll do a more careful experiment with rice and potatoes.  I'm very glad I decided to do the Whole30, even though I wasn't perfect and I already knew a lot about myself and diet from the "paleo" experiment of the previous year - I still learned a great deal.  Elimination diets can be very useful for a variety of reasons.

Once again I am traveling this week - flurry of work to do then leaving Thursday morning for the Ancestral Health Symposium.  This will likely be the last blog post (save, perhaps, some quick uploads to Psychology Today) until then.  

26 comments:

  1. Hello Dr Deans -

    Regarding your comment about IF-ing and being hungry. I am trying to relate your experience to Stephan's Food Reward theory. Since one can reasonably assume the reward of your Whole30 diet was lower than your previous one, I would have expected spontaneous caloric reduction absent more frequent hunger (I'm not suggesting you would never be hungry!). Do you have any thoughts as to why you were actually hungry, more so than your previous diet, and how it relates to the Food Reward theory? Thanks!

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  2. Aravind - I am a bit flummoxed by the hunger - I did eat more fruit on the Whole30. Also, while I was often in ketosis when I woke up in the morning, I was almost never in ketosis later in the day, as I was many days with my previous strategy. Ketosis suppresses hunger in my experience. Have you had any success with Diet Coke eliminination yourself?

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  3. I'm on day 3 sans the diet soda. I've taken 2 Excedrin per day for the caffeine withdrawal on days 1-2 (none today yet) and am drinking enough San Pelligrino to hydrate a small village. So far so good, but only time will tell. The biggest problem for me is at work where I am just conditioned to constantly have a soda in hand while in a meeting, at my desk, etc.

    I've done this before. I went 5 years without any soda, caffeine, sugar/artificial sweeteners and then like an alcoholic that never is "cured", one day I decided "oh, 1 mountain dew would be nice". Within days I was back to 2+ liters per day.

    Not sure if this is related to your experience - Based on my previous readings, I thought the significant reduction of caffeine along with the elimination of the artificial sweeteners (and the related insulinogenic effects) that I would see potentially some weight loss due to reduced hunger. I've been eating essentially the same Paleo compliant foods, yet I've actually gained 2 lbs in the last 3 days and feel a bit hungrier throughout the day. I am not worried about the weight (yet), but I am actually very surprised by this outcome. Oh well.

    I will let you know if I make the 30 day mark successfully. Thanks for the inspiration!

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  4. i hate to point out the obvious, but mainstream weight loss advice would say you lost weight because you cut out calorie dense foods (full fat dairy, etc) for calorie sparse foods (fruit).

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  5. i gave up all artificial sweetners and diet products when i began recovery...talk about a clutch. i use to go through TWOOOOOOOOO 12 packs of diet sunkist and diet rootbeer A DAY. i gave it up cold turkey, it WAS SO HARD. i was also obnoxiously addicted to splenda. how much brain damage i did in those years is prolly beyond repair but wow, i would never be able to go back now. still to this day though, 3 years later, when i get overwhelmed in the office i REALLY crave popping open an ice cold diet sunkist...get the tea lol

    also, i gave up dairy for lent because i needed a reason to and i knew but wouldnt admit it did not work for me. there is a HUGE history of IBS and bowel disorders coupled with obesity and diabetes in my family as well as cancer. i knew dairy wasnt doing good for me. my results... i swear my metabolism sped up and i leanred theres a huge difference between replacing the density. avocados dont process like dairy trying to exchange fat and i overall had to eat a lot more!

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  6. Jeremy - I removed frequent fasting and added extra fat (coconut oil and olive oil, primarily) to the Whole30 meals as they specify in their program. 1500 calories a week (let's say) of alcohol, chocolate, and cheese would be compensated by skipping 4-5 meals a week as I was before, and I never snacked except a little hunk of chocolate. With Whole30 I ate 3 meals daily and snacked. I'm sure I ate fewer calories as I lost weight (ad libitum), but it is not quite so obvious to figure out where.

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  7. Aravind - My caffeine usage was never that high and was adequately substituted by 1-2 cups of black tea a day - the last two weeks I typically used green tea instead.

    Malpaz - yeah, I suspect dairy irritates my system as it does (more overtly) my family members. Inflammation, inflammation, inflammation!

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  8. Very interested to hear about the dairy perspective and weight loss. Although completely different, I've heard a few parents comment that when their child (with autism) went on the casein-free diet that there was some positive changes to weight also. I always put it down to the fact that less was probably being eaten (calorifically) but if there are any other ideas (from things like lactose intolerance or other casein perspectives), I would be interested to hear.

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  9. In regards to Diet Coke, I had to use a substitute for a week to break the habit. It truly does have some addicting qualities, as I craved it for another week following. It was in the fall, so there was a steady supply of apple cider at nearly any grocery store around. I mixed half of a glass of Apple Cider with half a glass of Sparkling water over ice. It wasn't sweet enough to make a big difference, and the bubbles filled in for the fizzy part. I would have a apple bubbly with dinner, and the desire to have a soda was covered with a healthy alternative. This was my crutch until the cravings went away. After a couple weeks of no soda, especially diet or splenda, if you try to drink one again it will taste like a chemical plant.

    I have to note that I still have not given up coffe, nor do I plan on it. I simply switched to a higher quality cup, and use a French Press so I actually drink less. I drink a pour-over or espresso when I'm not on shift, and have more resources available.

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  10. Hi Emily. Very similar to my Whole30 experience, with my eating being relatively close to the Whole30 prescription anyway - it was only a few tweaks such as dropping the chocolate, and actually eating more Whole30-compliant foods such as boiling up some eggs for a snack rather than just grab a carrot, piece of fruit, or chocolate. I would typically aim to fast from 8-9pm through to 10am-12pm the following day, and have only done this on days where I am traveling or presenting and it is easier to fast than cram an early breakfast in.

    I definitely leaned out whilst maintaining my strength in the gym and power on the bike. A fiddly week last week with snow storms and work travel saw a bit of creep come back in, but otherwise I kept to it at the level I was aiming for.

    I found that I lost my craving for chocolate (it wasn't strong, but if chocolate was around or on offer, I'd have it). I am now happy to say no to it. And generally my appetite control is improved. With the exception of confirming that I react to pork (consistently end up with night sweats if I eat pork chops... but not bacon, thankfully), my sleep has improved, with me generally getting to bed and asleep 30-45 minutes earlier than normal.

    With your sleep, Emily, do you think there has been a shift in your cortisol cycle? You said you would previously crash at 9:30pm but awaken at 2-3am, but that now seems to have shifted sideways by 2 hours. Any insight there?

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  11. Interesting.

    I gave up dairy about three months ago - the only thing remaining is a very small amount of butter each day (10-20 g possibly - so negligible milk proteins).

    Result - leaner, much leaner and few grazing triggers - the insuliongenic effect of those dairy proteins definitely does affect me adversely. And it killed my sweet tooth stone dead after a couple of weeks of no dairy, so I'm convinced the insulin aspect was at play.

    I've also now given up alcohol - more than half a glass and I just don't feel so good the next day and I can't stop at half a glass. I definitely have some reward centre (addiction) issues (recovered from bipolar by going low carb and essentially de facto keto). A month on and I really do feel better without the alcohol as much as I liked a good red wine. I will remain teetotal from now on I think.

    The processing of alcohol and fructose in the liver is very similar as I understand it and fructose triggers me into addictive behaviours too (think entire punnets of cherries disappearing ... doesn't happen so readily with lower sugar berries).

    I cut out caffeine (except for the small amount that may remain in my instant decaff and very dark chocolate).

    As for Dr Deans greater hunger, I would put that down to more carbs (in the fruit - and more constant insulin triggering through more meals and snacks), I'd be interested to see what the balance between the macros was between pre-July and July's whole30 eating.

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  12. I think your results have much to do with your current gut situation. Emily have you ever considered doing a quantified self approach to see what really is driving your metabolism? As physicians it is pretty easy for us to do in our facilities. When I did it five years ago it absolutely opened my eyes to how important the gut and energy biogenesis were to our optimal health. I now do it quarterly as a scheduled check and make adjustments based upon what I find. Dr. K

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  13. Cortisol timing… I don't know. I would like to get more than 6 hours sleep, frankly, but that is not in the cards for a working mom. When I woke at 2:30-3 I would fall asleep usually by 4 to wake up a couple hours later, however.

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  14. Thanks for sharing your experience.
    I too was surprised that I lost weight, as I ate whenever I was hungry. I specifically lost fat off my abdomen - my measurements are back to my leanest that I achieved in the past only by eating a really strict diet with increased exercise - and feeling very hungry. (This time I did increase exercise, but didn't go hungry)

    My desire for alchohol has pretty much gone, and also chocolate.

    I don't know how you do 6 hours a night sleep Emily, I'm a wreck with that little!

    @Jamie - what it it in the pork you react to? Do you react to free range and farmed? I've heard of others reacting to pork - both were O blood types and put it down to the fact that is a 'do not eat food' for O types, but I suspect it is something else. My son dislikes pork, he says he's allergic. But I think he doesn't feel good eating it. He'll eat bacon and any other meat.

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  15. Very interesting. Thank you for sharing your experiences. I'm intrigued by your thoughts on IFing. Like you, I like the convenience it provides: when I'm caught on ward rounds the last thing I want is to continuously think about food. However, we probably need to balance the cortisol issue.
    I love my high fat dairy and need some good arguments to make me stop it. Vanity might just do it but I will never admit it ;). Did you have any obvious intolerance symptoms prior to Whole30?
    Overall it seems there is less variety (some might say less enjoyment?) but some people might find the returns worth it.
    Good educational exercise. Food for thought.
    Anastasia

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  16. Paul Whiteley - I've read on various health blogs that cow's milk seems to have an insulinogenic(sp?) effect independent of its carb content. Apparently that's why a lot of people lose weight when they cut out dairy but are still consuming the same calories. I've read conflicting information on whether goat's milk has the same effect.

    Dr. Deans - I noted with interest your comment on how a little honey helps relieve nausea, which you attributed to low blood sugar. I've had digestive issues for several years and noted as well that sugar helps relieve my gut most of the time. I'm not quite willing to attribute the nausea to low blood sugar though. Why would sugar relieve nausea, if the nausea is not caused by low blood sugar? I don't think it's psychosomatic, either. I know other people who've noticed the same thing.

    I also have what I consider to be a similar problem most mornings in general - I can't eat a lot of meat or fat for breakfast, all I can handle well is a glass of whole milk or something starchy or sugary, like a pancake (no, I'm not pregnant, and never have been). If for breakfast I eat meat and fat without carbs, I get nauseous for a few hours (and sometimes even with carbs). It's frustrating for me because I have to eat low-carb due to blood sugar issues. Once late morning rolls around, though, it improves considerably, and I can eat a carb-less meal in the evening with no problem at all. I've heard of other people with this problem, but I haven't been able to find a reason why this occurs (sensitive tummy in the morning). Does anyone know why this happens?

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  17. I suspect dairy may have the same effect on me as it does on Emily, and that's probably why I've still got residual love handles and a slightly bulgy tummy even after 2 years of HIT resistance training, intermittent fasting and a pastoralist's diet.

    But God how I love cheese and yogurt! And where am I going to get the fat to keep me satiated? Coconut oil only goes so far.

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  18. @Julianne - I'm not sure what it is, but it is a consistent reaction. I have always tended to screw my face up at even the thought of pork... just something about it and never something I have gone out of my way to buy or eat (would never order it at a restaurant, for example). But in recent months I have tried it 3 times now with the exact same reaction every time - gut pain within 30-60 minutes of eating it, temperature skyrockets, and I end up soaking the sheets with night sweats that night. I do not get even remotely close to any reaction like this from bacon. I'm happy sticking with lamb!

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  19. Regarding cortisol and IF, Martin Berkhan has written about it here: http://www.leangains.com/2010/10/top-ten-fasting-myths-debunked.html

    There seem to be no truth in the statement that fasting raises total cortisol, at least not when fasting less then 24 hours.

    I get a buzz as well right before breaking my fast but I figured that was norepinephrine.

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  20. Interesting insights Emily, thank you. Regarding Diet Coke and non-caloric artificial sweeteners. Through trial and error I have found the following:

    - Drinking just one glass of Diet Coke makes me hungry. I dont know exactly if it is because of the excessive sweetness (via insulin/reactive hypoglycemia by acesulfame K, aspartame, etc.) or because of the general composition of the drink.

    - They make me sleep worse and give me nightmares. Everytime I drink a considerable amount of diet soda (500ml and up) I have bad sleep and really bad nightmares. When I dont drink them, I sleep much better. Not sure what the mechanisms are but definately an interesting effect.

    I have doubts about the sweetness because I drink regularly lemon juice made with 4 lemons/1L of water + stevia. I also drink 2-3x week my customized version of "Chicha Morada", made from purple maize, plus lemon, cinnamon, cloves and stevia. Lastly I eat my full fat milk cream with stevia, some little vanilla and sugar-free cocoa.

    There must be some other neurological effects from these artificial substances not related to flavor.

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  21. Hope this helps all of you struggling with the dairy connection. Believe me I didn't want to give up wonderful artisan cheese, double cream and full fat Greek yoghurt but I know my system is highly insulin sensitive and too much leads to dopamine/serotonin issues so here are two links ...

    http://www.canibaisereis.com/download/milk-promoter-of-chronic-diseases.pdf

    and

    http://www.the-scientist.com/2010/10/1/52/1/

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  22. @Aravind: I think that possibly reward does not matter for everybody. It is just another signal, that might get impaired.

    I was reading J.Stantons satiety and satiation theories. This one splits reward into 2 categories. Need for reward, and satiation with too much reward. Similarly hunger and the quenching of hunger are another two drives.

    So if you have a strong drive for reward, then you will be more easily addicted to food items that supply you the reward. Possibly Caffeine in your case, which causes the triggers. For some people it can be wheat. These people will have difficulty giving up wheat.

    The other part is quenching of the reward. So if you have that part missing then you might not be able to stop eating the rewarding food. These people will generally overeat the rewarding food. This might also be a problem for you, which results in over consumption of diet coke. But some people might not be able to stop eating wheat.

    The reward can be just a smell also. My wife for instance loses appetite when she has cooked some really appealing food for guests. She says smelling the food for so long kills her appetite. She gets her reward from the smell, and the reward is easily quenched. She has difficulty eating foods that don't smell proper.

    For me it seems all 4 are lacking. I can eat almost anything. I eat on fixed times. Don't really feel normal hunger. I normally come to know of it in a peripheral way. Never come to know when to stop. Have to count what I eat. Only physical discomfort stops me. The taste also doesn't go away after smelling a lot of pleasant foods. Never got addicted to anything, and can stop eating whatever I want.

    Hunger and quenching of hunger will have similar broken signals.

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  23. I've been neglecting this comment thread a little due to a whole lotta stuff going on…

    Dr K - what kind of quantified self tests do you mean? I'm a bit of a lab test anarchist.

    Angel - your symptoms sound almost like a bit of fat intolerance - sometimes the pancreas isn't up to the high fat primal style after a long time of low fat, perhaps. I have always struggled with hypoglycemia symptoms if I ate too low fat or too much sugar - haven't been able to drink "real" soda or juice by itself in 20 years. During pregnancy the shakiness and weakness associated with hypoglycemia changed to severe nausea, and it's been that way ever since. I very rarely have such symptoms on my moderate to lowish carb diet, even while fasting, but it still happens, and honey is curative.

    I personally do not get GI symptoms from dairy (my relatives do, and lactaid does not help, which makes me suspect casein) - but I do seem to get a generalized bloat that is visible in my face.

    Thanks rodeo - I will be more precise. Norepi increased dopamine for sharp focus and a nice buzz.

    Lucas - both Diet Dr. Pepper and Diet Cherry Coke with ZERO calories give me serious hypoglycemic "sugar crash" symptoms about 60-90 minutes after consuming them. At fist I didn't realize what it was, but was able to replicate it. The only soda I can drink at all is Diet Coke. It is all very strange.

    Thanks Cavegirl - I am very bummed Ricardo is retiring from blogging!

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  24. Silly question, perhaps: what are "white potatoes"? Does the "white" refer to the skin (as opposed to "red" potatoes), or to the flesh (as opposed to sweet potatoes)?

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  25. Daniel - new potatoes, Yukon gold, Idaho, etc. are all white. Yams, Asian yams, and sweet potatoes are all allowed on the whole 30, due to increased nutrient density compared to white potatoes.

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  26. Dr. Deans,

    Thanks for your response. I too seem to do best on a moderate to lowish-carb diet. I just have a hard time convincing myself to maintain moderate carb because I really want to lose weight, and am convinced that lowering the carbs will do the trick. But lowering the carbs pretty much just leaves me miserable with carb cravings, with little noticeable weight loss.

    I found an interesting set of posts today about breakfast at Gnolls.org, by J. Stanton. They convinced me I need to be more flexible in how I view the necessity of breakfast.

    http://www.gnolls.org/2131/the-breakfast-myth-part-1/

    http://www.gnolls.org/2181/the-breakfast-myth-part-2-the-art-and-science-of-not-eating-breakfast/

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