Thursday, January 6, 2011

Sex, and Drugs, and Sex

Not too terribly long ago, Jamie Scott made a mockery of Mr. Kellogg, who if legend holds true peddled breakfast cereal as an armament against masturbation and excessive sexual behavior. Now why someone else would care that much what any other random person does while naked is a continuing puzzlement to me (or not really if you want to delve into the psychology, which is a whole different sort of blog post. Let's just say that there is a primitive defense called "projection" and it is typically why outspoken proponents of sexual prohibitions typically exhibit the sexual behavior they loathe the most. Also, never put anything in writing, on facebook, text message, in a blog, or in photos you desperately wouldn't mind showing up in a court of law or public eye later on. Just common sense, people. For doctors specifically - never write anything in the medical record you wouldn't want your patient and his or her lawyer to see.) In the comments on Jamie's post, I made note of the findings that the young men in Minnesota noticed considerable lack of sexual interest during their semi-starvation experiment.

And let's be frank. Evolution is all about sex, genes, and breeding. The latter two topics might not sound sexy, but sex has everything to do with why you and I are here, and why you and I behave the way we do. Sex is ultimately why I write this blog (narcissism, fame, my picture on computer screens far and wide across the world - all should increase my local fitness and enhance the fitness of my children if all goes well, or at least fools my brain into thinking so). I've been reading The Red Queen: Sex and the Evolution of Human Nature, so genetics is a bit on the mind. I'm a psychiatrist, in America a discipline mostly inherited from the theoretical perspective of one dirty old man. Nothing in human evolution makes sense without considering sex. In my mind one of the positives of a paleolithic style diet is the anecdotal reports of (mostly) increased sexual drive. Vegetarians (in anecdote also) will often report a decreased sex drive.

In the comments for Jamie's post I quipped that decreased libido was probably a bad sign if it seemed to be caused by diet. If your body doesn't think you are fit for reproducing, it won't send you signals leading that direction, after all. And if your body doesn't think your diet is good enough to support little ones, it makes sense that your diet is not likely optimal for human health.

So that's the sex part. What about the drugs? Well, as a psychiatrist, I happen to have a lot of experience with drugs that decrease libido. And I hate being a hypocrite. Some of the data can be clouded by the fact that depression itself causes decreased libido. But the fact of the matter is that SSRIs and their cousins seem to cut down sexual desire and other phases of sexuality. With SSRI's it seems that the drugs cause a direct pharmacologic "anti-viagra" in men, and more commonly in women a decreased sexual interest caused by mucking around with certain varieties of serotonin receptors. These are different problems than the low-protein diet - which seems to affect sex hormone production (here's an explanatory bit from a book about pigs, anyway).

Ideally, we could figure out a way to get depressed and anxious people feeling better without messy pharmacologic interventions. I would start with therapy, exercise, and a primal-style diet (Mark Sisson's 100-150g carbs a day with a pass on the starchy tubers as part of the non-toxic carbs, to be crystal clear).

And why sex (and males) in the first place, when parthenogenesis is just so much neater and cleaner and doesn't require all this vast effort to blog, not to mention black eyeliner, platform black suede boots, and haircuts? The Red Queen: Sex and the Evolution of Human Nature (pg 86) has the best argument I've heard - disease.

Sex is about disease. It is used to combat the threat from parasites. Organisms need sex to keep their genes one step ahead of their parasites. Men are not redundant after all; they are a woman's insurance policy against her children being wiped out by influenza and smallpox (if that is a consolation). Women add sperm to their eggs because if they did not, the resulting babies would be identically vulnerable to the first parasite that picked their genetic locks.

It is not an accident that the most polymorphic genes are the immunologic histocompatibility genes. Meaning that each generational variability seeks above all to outwit the pathogens that feed on us. Sex is the best generational bet to supply different MHC genes to confuse the viruses, bacteria, parasites, and fungi. There are no long-lived species without sex. Which, using somewhat un-rigorous thinking, means I will never be a vegan.


  1. I can just see where this will end up...

    Lawyer in court: Did you or did you not, in a public forum, accuse the complainant of producing testosterone-lowering cereals in the name of thwarting young boys desires to engage in vulgar self-pleasurement?

    That Paleo Guy: Um...

    Nice. So I am useful afterall. Except I'm not as most women get so hung up on this whole hanging around after the act to help raise the offspring. And frankly, I'm just far too narcissitic and selfish for that! Helping people build their own personal resiliency by way of education about primal living - yes. Throwing some soldiers up onto their beach so that their kids immunological armoury combination can't be cracked by the plague - not really my bag. Though it is good to keep a bit of practice up... just in case you know (Oh, and to stay away from Mr Kellogs, et al, cereals).

    Saucey boots btw. As much as I love summer, I do like winter for the shear fact that, this far south, many women like to wear thigh-high boots.

  2. I maintain that converts to raw food, vegan and vegetarian diets are largely engaged in status displays.

    Every primate species but humans grooms constantly if they can. Deny any monkey access to grooming or consistently interrupt them during grooming and you will have a depressed monkey on your hands. So why not treat depression with massage?

  3. @Jamie my husband did not want me to return the boots (which I bought on a birthday whim - I'm just as old and decrepit as you are now! Thank heavens for saturated fat, black eyeliner, and suede platform boots)...

    @pangolin - grooming is a very serotonin-influenced activity

  4. @Pangolin - humans groom - probably constantly if they could. It is perhaps that the whole pesky thing of money & mortages & college educations, that your average monkey doesn't have (or need) takes up valuable grooming time and energy. Many a woman (OK maybe not 'many' in a Tim Feriss sort of way, but you know what I mean) has picked my nits, or more accurately scoured my legs looking for ingrown hairs... but it is all the same thing!

  5. apropos drugs: you write "But the fact of the matter is that SSRIs and their cousins **seem** to cut down sexual desire and other phases of sexuality."

    i always wondered if psychiatrists experiment with or try their own standard pharmaceuticals during education (officially, or unofficially) to see how this stuff works first hand. if yes, what were your experiences, and if not, why not? i mean, you (psychiatrists) prescribe this stuff to millions of people after all each year. just curious.. i once tried some of the usual SSRIs to see how i would react, and i def. can confirm the "anti-viagra" part. dead. simply and completely DEAD. glad these effects are reversible *g* (i also didn't like the anti-depressant effects btw. they simply seemed to "cut off" the negative emotional realm in a very artificial and crude way)

  6. Matt Ridley and The Red Queen - a brilliant read.

    I was musing recently about the interaction between American Medicine and American Food Companies and concluded it it was a Red Queen evolutionary process, but Medicine is losing!

    I've read most of the Matt Ridley books. I particularly recommend Nature VIA Nurture.

  7. @qualia- this is off topic, but since you mentioned it, for some the side effect does not reverse. don't know how often it happens, but I was on the tiniest dose for just 6 months and now 1 year since stopping it's still as if I am still taking the celexa. I think it's very unfair to the patient to be told a side effect is only temporary when it's not.

  8. @Homestead i don't think it's off topic. i mean, where else would it be more "on topic" than on this blog ;) sorry to hear, btw. have you introduced any other meds during the same time that you still are taking? maybe your system just needs a nudge. i'd try 2x 400mg SAMe/day on empty stomach, plus 2x 500mg ALC (acetyl l-carnitine) for a start. both can improve your mood and neurotransmitter profile significantly. also try a quality zinc supplement (25-50mg/d) for a few weeks. zinc often has an immediate effect in case you should be deficient. if it still isn't better, try 5-25mg DHEA for a few weeks (reduce to the lowest effective dose afterwards)

  9. @qualia - yes, many people feel numb and uncaring on SSRIs and their close cousin, venlafaxine. I consider that a bad side effect and unless a situation is extremely dire would likely taper someone off or at least lower the dose (which usually helps too, but not always). Along with my religious background and practices, another thing I will not share is any personal history of medication, experimental or otherwise.

    @Leon it is a remarkable book - and seems to begin right when I graduated with my molecular biology degree, so exceedingly useful as well.

    @homestead that sounds very unusual. Hopefully you have other medical issues ruled out.

  10. I think you got it (at least) half right.

    1. I started out based on the work of Wolfgang Lutz and his approach (from the sixties!) was mainly that carbs wreck the endocrine system by increasing insulin (which increases/decreases other hormones, and so on and so forth). So (right after Omega-3/Omega-6) this is the first thing I think of and I think that applies here.

    Lutz reports that a cut in Carbs decreases the sexual "Drive", but that will normalize somewhat within a year or two. He attributes it to the changes the carbs make in the endocrine system so the Adrenal Glands (mainly the cortex of the adrenal glands) end up producing more sexual hormones/steroids. He reports of one patient where he suggested taking out one of the adrenal glands, the patient refused and with low-carb he was ok within a year. He mentions men balding because of too much steroids and the stop of hair loss when you decrease carbs.

    So I would say carbon eaters (at least men) have an increased Libido, compared to what was "evolutionary normal"

    2. Lutz reports that some people get adipose with a diet high in carb, but a few have problems getting their weight up to something "normal". So when you introduce with a high-carb-diet a systematic disturbance into the human body, it can go both ways - depending on what your environment (the composition of the food, not all high-carb diets are alike) and history is (genetic heritage).

    3. Anecdotal from personal experience, I can say that that my "Drive" deceased and I am glad as heck about it. Without going into details, it has reached levels I would call addictive (I guess this was more than I should write in a blog...).

    At the moment I eat only meat, fish, cheese and leafy vegetables, so I get about 10 (max 20) grams per day of mainly "slow" carbs. If I take a few grams of sugar (Glucose from some unwary bought meat-product or Lactose from 100 ml Milk) I get a drive a 6 to 12 hours later... One time there was one (!) 300ml beer involved, and it took longer (around 36 hours) for the Drive to come. I will make some more controlled experiment (alas, not double blind, not even single blind), let's see.

    4. Again anecdotal, when I had one of those accidental drives, I took around 20 ml linseed oil to increase Omega-3 (that's my other first after carbs) and the drive slowly ceased. Maybe placebo, maybe not. As CB-1 and CB-2 are related to feeling pleasure AND have a connection to the Omega-3/Omega-6 metabolism, I would hunch a connection. IMHO would this warant a addiction study: No fast carbs, reduced Omega-6 and increased (or balanced?) Omega-3 to treat addiction?

  11. @emily too bad, but understandable, considering some of your patients (or colleagues) could read this blog.. ;)

  12. I have always loved the associative brain processes.

    Here is one: Red Queen -> Alice quotes -> My other favourite:

    “When I use a word,” Humpty Dumpty said in rather a scornful tone, “it means what I choose it to mean, neither more nor less.”

    Naturally I adore Jabberwocky.

  13. 1. One more thing about SSRI: Fluoxetin decreased my Drive (and I was glad about it), but when I slowly stopped taking it, the Drive came back with a vengeance.

    2. And you should be careful: There are transitional effects of a diet change (up to year and more according to Lutz) and effects that stay. Lutz explains it that once the systematic disturbance to the endocrine system is gone (or reduced to a minimum) the endocrine system has to "settle in" and find a new "balance" (number of receptors, quantity of hormones release, ... in engineering term: transfer function). Imagine a gland developing an adenoma as response to constant demand for its hormones - after a diet change this will not go away over night. Or think of a gland underdeveloped, because its hormones are not very much in demand - it will not grow over night as well...

  14. @Tony there is a whole separate literature on very low carb diets and libido which I was not prepared to get into yesterday - I personally prefer a moderate carb diet with several forays into ketosis every week (typically via intermittent fast) and one can also have a bit more carbohydrates and use coconut oil or other MCTs to promote ketosis. For others there may be a different diet that is ideal for their situation. I should also mention that there are anecdotes of decreased libido on a primal diet, and increased libido on vegan diets (one only needs do a google search) but the preponderance of anecdotes I saw lead in the direction I noted above, however, the anecdotes are hardly scientific evidence and I want to make that clear.

  15. Emily, that mirrors my current flirtation with ketosis while mostly staying in the range of moderate carb intake.

  16. @Emily: Don't get me wrong, I'm not saying everyone should do what I did. It's more like that there is not the "one size fits all" transitional diet, after one has lived 2 or 3 decades with a wrong diet.

    I guess when one has lived a relative low-carb, balanced Omega, diet for some longer time, one can go from no carbs to 30% carbs and back as one pleases, without noticeable problems (or doesn't have to watch Omega intake as much). But as my glands seem to only work in digital-mode (OFF or MAX) with relation to Libido, I very much prefer the OFF-position at the moment :-) I need to avoid carbs (or my Libido kicks in), I need to keep my Omega-6 intake (reasonably) low (my acne was getting worse, now it is going away after 20 years!) and I need to maintain my Omega-3 intake (or my depression comes back). Maybe in a year, maybe in two. I'll see.

    And oh, I did not mention, when I first went form my Standard European Diet to a moderate-carb-diet, I noticed panic an hour after a meals. I had slight angst/fear/panic most of the time before, but after I experienced the direct influence of "food" on my mental state, I decided to got no-carb (basically Atkins Phase 1 at that time) rather fast. So for me, No-Carb and Balanced-Omega means getting my life back, or to be more precise to get the life I was denied since my early teens...

    (Word verification CAPTCHA: litium)

  17. I just looked Lutz up again (and the english version is better in this case than the german...).

    He looks at hormones and if they contribute to the anabolic (like Insulin) or catabolic side. With a high-carb-diet insulin is increased, then the anabolic side is increased. One "solution" for the body is to decrease other anabolic hormones (like growth and sex hormones). The other is to increase the hormones from the catabolic side like Corticosteriods and T3/T4 (according to Lutz the cause of Thyroid problems).

    So, there you have it: when a person looses his balance, does he fall to the left or the right? It depends on the history, I guess. So does a high-carb diet increase or decrease libido? And does *changing* to a low-carb-dieat decrease or increase libido?

  18. I went to a lecture here in Cambridge UK by a guy from the USDA. He pointed out that in the Minnesota semi-starvation experiment Keys wanted results fast so he chose the leanest guys he could find. The psychological and libido changes do not usually occur until most body fat has been lost, there is no comparison between an overweight person on a low calorie diet and an underweight one. Millions of overweight people go on 1600 calories a day or less without serious psychological problems or loss of libido but of course they get hungry.
    My personal n = 1 anecdote is this.
    From the age of 16 my weight has varied from 142#(pounds)/64kg to 196#/89kg but mostly has been around 154#/70kg. At the age of 54 I had Chronic Fatigue Syndrome and tried the "Raw energy" diet - 75% raw food. My weight was absolutely constant on that diet for three years at 145#/66kg. It made my CFS slightly worse and my teeth suffered considerably but my libido was fine.
    Just before my 65th birthday (at 160#/72.5kg) I tried a calorie restricted diet - 1100kcals per day, three meals with 20g protein per meal and the rest divided equally between fat and carbohydrate with supplements at 100%RDA. This diet was grain-free with starch from chestnuts, carrots and pumpkin/squash, some fruit, no added sucrose and no dairy except 22g whey protein isolate/day. The hunger was quite bearable and my libido was fine. I walked 5 miles a day and went folk dancing 4 hours a week.
    Suddenly at day 53 I had problems, I was much more hungry and felt really lethargic. I weighed myself and was 145#/66kg. I cut down the walking and dancing and upped the diet to 1400kcals/day.
    I remained at 145#/66kg for another 35 days but had little energy and no libido.
    At day 88 I switched to an unrestricted very low carb (<20g/day) diet with just salad and green veg for carbs, my energy improved but not the libido.
    I was eating about 4000kcals/day and within 18 days was at 154#/70kg.
    Every day of this low carb diet I woke with a headache that lasted until about one to two hours after breakfast. For the last week I measured ketones but they were only just registering Traces on the ketostix although a few months later I tried a zero carb day and when I got a headache at about 4pm the ketostix registered Medium 0.4g/l.
    At day 149 my weight was 158#/72kg but my libido was still zero and I realised that low carb was not for me so I had a bowl of boiled chestnuts at about midday (and some fruit later). My headache disappeared within half an hour but otherwise I noticed no effect before I went to bed at about 10pm.
    At 2am I was woken by something hard in my bed, the firmest erection I had had for years. I soon ejaculated with considerable force. I woke again at 5am for the same reason and this continued in a declining manner for about a week until things got back to normal.
    So I gained 9 pounds (4kg) in 18 days on a very low carb diet but 61 days on an unrestricted low carb diet did not restore my libido when 14 hours on a medium carb diet did! My libido needs carbs.

  19. Thought I report on my findings.

    So I did a bit of testing and ate one apple last weekend: no noticeable effect on sex-drive, still zero (as I want it right now). Only a carb-flu the next days... I guess my gut flora multiplied and my immune system kicked in ( )

    I have reintroduced fresh fruits and yoghurt this weekend (but still rather low-carb): No effect on sex-drive, still zipp (yeah!).

    So no immediate effect by carbs. I think it might have been that I was sloppy with my fish-oil and not taken enough. Now I try to stay arround 1.5 to 2.0 grams of EPA+DHA per day. And I will no longer continue my No-Carb diet and go Low-Carb, introduce safe starches (Paul Jaminet scared me with his series on too-low-carb).

    So far for the good news. I got the lab results for a hormone test I did last year (the results got stuck in some spam filter...). DHEA elevated, morning cortisol rather low. While this was what I expected when I ordered the test, the confirmation that I have CAH was bit much. I went to my doctor the next day (I had ordered the test myself because she didn't wanted to order it). Guess what? She didn't care much, said that she didn't believe that this was my problem. Yeah, right, like that I need up to 3 hours every morning to get out of bed is not related to my morning cortisol. And that I have a lousy stress resistance. She even told me I should seek another doctor, if I am not happy with her...

    While I think that the chance that CAH might simply "go away" with Paleo are pretty slim (after all the conventional wisdom is that this is a life-long condition), I am glad to have finally something tangible to work with. Will try to get some tests done (antibodies and other adrenal gland related test, plus some thyroid tests, and vitamin status), my guess currently is cereal-induced autoimmunity or maybe dairy-induced. Let's see from there, one step after another.

  20. Or maybe I should be more optimistic.

    1. There is a relation (direct? causal?) between panic and high DHEA / low Cortisol, as far as I know.
    2. There is direct causal reaction between my food and panic. I changed my food and the panic went away.

    So there might be a direct influence of some food-pathogen on either DHEA or Cortisol or both. Removal of the pathogen has lead to an improvement, so maybe I need to give it more time.

    On the other side, my "getting out of bed" improved significantly with the change to No-Carb (in November) but is now slowly deteriorating since the begin of January...

  21. Then again, it might be just Iodine Deficiency and Hypothyroidism. From what I read one needs T4/T3 to "free" Cortisol.

    But I be damned if cereal-grains weren't involved somehow...

  22. One book that suggests Kellog may have been correct in his premise is Natural Hormonal Enhancement by Rob Fagin. Fagin is a body builder-whose basic idea is to _raise_ testosterone levels-which he purports to do by eating much smaller meals-and restricting carbs most of the time(he'll allow carefully timed cheats). Fagin's idea is pretty contoversial-even in the body builder community-but the guy has a LOT of scientific references on this point.

    The point is this:Fagin and Kellog had fundamentally different objectives. It is plausible that they both have a grain of truth in what they are talking about.

    What I think is probably more established is that high sugar/alcohol intake can lower testosterone levels(that is in Fagin's references).


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