Dear Family,
"No Disease That Can Be Treated By diet Should Be Treated With any Other Means.”
- Maimonides
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I've been thinking recently that there are two sorts of people in the world: those who are dealing with significant health concerns, to the point where these concerns pretty much take over their lives...and those who aren't.
Then I thought, there is actually a third group: those whose lives are ruled by their health problems, but they (the people) don't realize it.
Anyway, if you happen to be a member of either of the latter two groups, the following letter may be quite boring. In fact, if you're not interested in my personal Opinions and Theories on Diet and Nutrition, you can just delete this now. There will be no other topics addressed below, no -isms, no really good jokes. Sorry! Maybe next time.
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I began some further and continuing dietary reevaluation right before New Years, when I'd chipped a tooth, noted my increasingly terrible calculus, and was experiencing increasingly awful and horrible depression, anxiety, and panic.
I recently enjoyed a person's blog comment, wherein humans were referred to as "complex adaptive systems" (and as such require a much more comprehensive approach when healing is required). In this spirit, here are some of my recent thoughts on healing, food, gut flora/immunity, and Pushing The Envelope. I'm going to over-type things, because sometimes I have this theory that if I explain things to somebody else, then I might finally begin to understand it myself!
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I do not believe, although my family might think I do, that all disease is caused by poor diet. I do believe it's a large piece of a Perfect Storm, though - processed junk "food", industrial oils and sugars, damaged microbiome from industrial herbicides, pesticides, countless other harmful pollutants, and especially antibiotics. After all these indignities and assaults, though, I believe that our diet is is the health- or disease-promoting factor over which we have the most control, by far. And it's the most powerful tool we have for creating lasting changes to our health.
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So just about four years ago, we started the "GAPS" (Gut and Psychology Syndrome) diet, in an effort to "heal and seal" our digestive tracts, particularly Ben's, on the theory that our intestinal microbiome is a hugely important "organ" that must be taken into account, maybe first and foremost, if a person wants to heal from chronic disease.
One of the underlying theories of GAPS is this idea that when a person suffers from things like autoimmunity, gastrointestinal distress, skin conditions, hormonal and other blood sugar imbalances, etc. etc. etc., we're dealing with chronic infections/overgrowth of all manner of microbes. And since these microbes largely subsist on carbohydrates and reside in our digestive tract, GAPS eliminates certain dietary starches and sugars, and dramatically reduces other types of starches and sugars. Basically, it's a starvation diet for microbes...although there's still some types of food for some microbes, like fructose (if we aren't absorbing it properly), and small amounts of other sugars.
At the same time, of course, with a GAPS-type diet, we are trying to provide fantastic nutrition for the body with every bite of food that we do eat, while allowing the gut lining to Heal and Seal. We're removing the foods (starches and sugars) that are the hardest for a compromised gut to digest. And of course, we're eating tons of fermented foods to help "re-seed" the gut with good bacteria, and to allow the probiotics (even the dead ones seem to have value in terms of triggering the immune system) to change the population in our insides. And, we're trying to aid the body in detoxification, by eating super nutritionally dense foods, supporting the liver, preparing foods in easy-to-digest ways, taking epsom salt baths, drinking green juices, etc. etc.
So basically, it's like we're implementing a treatment protocol that goes WAY beyond the totally crude methodology of antibiotics (which kill indiscriminately but of course cannot eradicate microbial life completely, and so therefore affect our internal "landscape" in similar ways as when pesticides and other toxins are dumped on a real landscape: Only The Strong Survive, and they're not always the "strong" that are helpful). But at the same time, I'm increasingly thinking about GAPS as sort of a course of holistic antibiotics. No, we're not killing indiscriminately, and yes, we are positively affecting (we hope) the populations that inhabit our guts...but at the same time, we are reducing the TOTAL population in our guts, which can, I think, cause some instability and fragility during the time when there is a reduction in total carbohydrate intake (carbs being the most preferential food for bacteria, and microbes in general).
Right. So then there's the rest of our human selves, which require all sorts of micronutrients, and the capacity to absorb them, along with the "macro" nutrients of fat, carbohydrates, and protein. Looking at many/most traditional diets, _fat_ seems to be really key. Right? All these different cultures, eating all sorts of different foods, but they're all getting fat: from fish, from coconuts, from milk, from beef...etc. etc. etc. Paleo people ate fat - they must have. We also need protein - without a certain amount of this, we waste away. But we don't want most of our calories from protein, because it's hard for the body to deal with excess (kidneys, etc.)
And then there are the carbohydrates, all the different sugars and starches and "-saccharides". Glucose is so important to our bodies (and particularly our brains) that we have evolved several different ways of ensuring that we can get it: if our guts are in good shape, we can digest and breakdown starches and sugars and grab the glucose from our food. (Fructose has to go to the liver first, so it's a bit tricky, and not so good to eat a lot of, but at least it's digested differently than starches/most sugars, so it doesn't always feed microbial overgrowths in the gut, IF the liver can grab it first. As far as I can tell, if the liver CAN'T deal with fructose, then you have Fructose Malabsorption, with ensuing fermentative problems in the gut.)
If we don't eat sugary or starchy foods, then our body can turn protein and/or fat into glucose: Gluconeogenesis...right? This happens mostly in the liver, and is a challenging process, but obviously, if carbohydrate metabolism is impaired, as in a GAPS person, it's necessary for the body to use this alternative way of providing our cells (especially in the brain) with glucose.
(When glucose is not available, our body can also turn certain fatty acids into "ketones," which can fuel the brain instead of glucose. This generally seems to happen when the body is cannibalizing itself, during a prolonged fast or when a person is eating fewer calories than are required for sustainability (or if dietary carbs are strictly limited to maybe under 50g per day total)...but it also seems to be possible to provide ketones for brain functioning in the presence of adequate calories INCLUDING dietary glucose, as long as one consumes copious amounts of short chain fatty acids (like coconut oil), which encourage the production of ketones since the fats can't be used otherwise.)
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Our family's GAPS-type protocol has been an amazingly nutritious diet that is, as far as I'm understanding it now, pretty low in USABLE carbohydrate. I know, I know, I always make sure to insist to people that GAPS is not necessarily a "low carb" diet, and "full GAPS" can include all sorts of nuts and fruit and "carbs." But, I'm starting to agree with Paul Jaminet, who wrote the Perfect Health Diet (and maintains a very interesting blog), that there is a difference between a pound of kale and a pound of potatoes, in terms of the _available nutrition_ that can be found.
I've heard Dr. Natasha say that plant foods are generally "detoxifying," while animal foods are "building". Jaminet says something very similar - that while plants like kale and other leafy foods have all sorts of good things in them, they take about as much "energy" to digest as they provide. Therefore, eating a 100 "carb calories" from kale is NOT the same as eating a much more easy-to-absorb (this is ASSUMING your gut can absorb it, of course! Which we know is not the case with a severe GAPS patient) 100 "carb calories" from, say, potatoes. Jaminet includes starchy vegetables in his recommendations (for those who can tolerate them), but makes a distinction between "starchy vegetables" (potatoes, taro, plantain), "sweet vegetables" (carrots, squash, beets), and "all the other vegetables", which can be great and nutritious and provide nutrients for both ourselves and our microbes, but not much in the way of calories for our human digestion.
Nuts have always seemed like a very "advanced" food for a compromised digestive system, and it never made sense to me to base a diet on them (i.e. many "paleo baking" recipes). Our ancient ancestors just wouldn't have had the time to shell all those nuts, and soak them, and prepare them, and have access on them, in order to eat almond bread at every meal!)
Fruit has always seemed a bit iffy in terms of how my kids and I seem to digest it - beyond the sugar itself, I now think that challenged livers just don't do that well with fructose, even the small amounts in fruit, and that this - even as much as how it potentially feeds fungal growth - is a good reason to limit it. (I figure that anyone who is dealing with a chronic disease has a moderately- to very-Challenged Liver, because it's one of our primary detox organs.) Even if the liver is doing better than it used to, fructose malabsorption can be a challenge due to microbial overgrowth, which makes me think that in many cases, fruit is not the best sugar to re-introduce first to a diet (from the perspective of trying to Stabilize things.)
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But after eliminating the carb-rich foods, and the difficult-to-digest foods, this leaves us with...if you agree with Jaminet and others...a Low _net_ Carb Diet. Which - again, [if you agree](http://perfecthealthdiet.com/2010/11/dangers-of-zero-carb-diets-i-can-t…)- can possibly cause problems after awhile. Basically, though, it's a super nutritious diet with a seriously low amount of available glucose.
I'm starting to think that the body can handle this low-carb situation for a long time...and that it is DEFINITELY one of those trade-offs where the benefit analysis for a GAPS patient shows up in favor of this approach at first: it is better to force the body to deal with Making Carbs From Protein (and fat breakdown), while slowly healing and dealing with certain infections, than it is to eat the starches and sugars that are feeding the infections in the first place. The gut has to heal, and it's better to force Gluconeogenesis for a while.
But I've often felt that while Ben was definitely healing over the past few years, certain things became oh-so-fragile. Which is maybe inevitable, and maybe won't ever change...but lately I've started thinking that there may come a time when the benefit analysis tips the other way. When the benefits to carbohydrate restriction are not in our favor any more. Or another way: when the body has healed enough to be able to absorb certain types of starch and sugar, then a hugely wider variety of foods becomes available to nourish and continue the healing process, and possibly can make someone like Ben (and myself!) stronger, because he can (I hope!! Soon!!) be able to consume a diet that includes all the macronutrients that his body needs, without forcing his system to deal with more fat/protein and less carb than might be optimal.
I've been sort of parroting, for the past four years on GAPS, that carbs are optional because after all, we've only been eating grain for 10,000 years. But very recently I realized...it's not just seeds that contain carbs: there are TUBERS! And these sources of starch have been around for as long as there have been people, surely. This is the argument that while a "paleo" diet may rightfully exclude many/all grains, it should not exclude starch per se. Certain isolated Northern societies haven't had so much of it, but in general, maybe whole "paleo" thing - when it focuses on low-fat/high protein/low-carb, or even high-fat/low-carb - _as the ideal diet for everybody_...is slightly misguided. (Of course, there are many different definitions of "paleo": Jaminet uses this term often, as does Chris Kresser, and they are not advocating low-carb in every situation).
I have heard theories that while restricting certain carbs for a while is instrumental in beginning to curb certain bacterial/fungal infections, that _after a time,_ it's necessary to switch gears. Reduced carbohydrate at first = reduced microbial overgrowth. BUT..._after some more time,_ = fungal and other infections adapt and begin to thrive, using fats or proteins or ketones to survive and throw things off again.
I have also read about the potential for low-carb diets to, over time, cause insulin resistance and blood sugar problems - and Jaminet is convinced that this can also lead to hypothyroid and high cholesterol. (And once again, just because I try to remember that there is no one perfect diet for every situation: I am NOT saying that I now think that ALL high-fat/low-carb diets are bad. I am just starting to realize that pretty much any dietary choice that one chooses has both therapeutic and long-term implications that may go beyond what we consider at the beginning, and that the effects we feel when initially making a dietary change can sometimes be distinct from what the diet will do long-term.)
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Okay, so now we come back around to something that I've been thinking about for years. The "What's After GAPS?" question, along with the "How do we get the Good Bacteria and Yeasts and Everything to repopulate our children's and our guts, especially if we're mostly starving them???"
Over the past few months, I tried to honestly reflect on these questions: is our family still seeing improvements? Or are we just holding steady? Or are we seeing improvements in some things but...worsening symptoms in other respects? Is it time to make some changes in what we're eating (since I always come back to Food as being _the_ most important controllable factor in bettering or worsening our health)?
In December, I read Jaminet's personal health account on his website halfway down [this page](http://perfecthealthdiet.com/2010/11/dangers-of-zero-carb-diets-ii-mucu…). And it really resonated with me. I have definitely experienced fluctuations in my own health over the past two years! And while I'm glad I have weathered the stress thus far, I Want More Better-ness. And while I really believe that it's important to give any non-drug health interventions some _time_ before making a judgement about their efficacy...at some point, you have to make the call about whether certain effects are good, bad, or Need Optimization. I'm the first to say that you can't necessarily know how your cells are reacting to a new food (or lack thereof) after only three days (or even three weeks or three months)...but there are times when you have to make this call or risk stagnation.
(By the way, I was also intrigued because Jaminet, like Dr. Natasha, is not selling things. He has a book, but much of his ideas are on his blog, and he links only to a few supplements that he recommends and can be purchased at Amazon, etc. He doesn't sell much himself. Which I really, really, really appreciate.)
So when I read this and a bunch of other things that Jaminet has written, I was intrigued. Especially after my New Years 2014 bout of Horrible Depression/OCD/Horribleness when I couldn't get off the floor for several hours... [If you really want more details](http://www.lifeisapalindrome.com/updates/thinking-about-me-and-ocd)
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So anyway. At the same time that I was reading Jaminet's theories about the possibility of acquiring a "glucose deficiency", I started reading about [resistant starch.](http://freetheanimal.com/2013/12/resistant-primer-newbies.html) It's called "resistant" because it resists _human_ digestion...and instead, if all goes well, ends up in the colon where our hopefully-large population of microbes Chow Down. Of course, if we've got microbes in places where they shouldn't be, then RS causes problems - like if you have "small intestinal bacterial overgrowth," and you eat some RS, your small intestines get "fed" and you can get gas of epic proportions... Which is why things like green bananas are "GAPS-illegal," because they have so much resistant starch, and a compromised gut can't deal with more food for the microbes. (Ripe bananas don't have much starch at all, since it's converted to sugar at that point...)
But even though there are all sorts of kinds of carbohydrate intolerances, and one can certainly be dealing with microbial overgrowths that will really respond poorly to resistant starch consumption, I am starting to think that resistant starch is different - especially _after_ a course of time on a gut-healing protocol, when you're trying to figure out What's Next. For a person with severe gut dysbiosis, even after Healing and Sealing the gut with a very careful diet - eating fruit or onions or wheat or lots and lots of other foods...can just push the unstable gut flora into painful, gassy consternation. These foods might not be the best first foods to re-introduce to a person who has embarked upon a GAPS-like healing protocol, even if many symptoms of gastrointestinal or immune dysregulation have abated. These foods can feed populations of microbes that may have greatly reduced in number...but may still be living happily - albeit less abundantly - in All The Wrong Places.
Resistant starch (most studies have looked at unmodified raw potato starch, or "hi maize" corn starch that has been specially treated to retain its resistant starch) seems to be different. It doesn't provide quick-to-digest sugar (like sucrose), and it doesn't have lots of fructose, and commensal (symbiotic and good) bacteria seem to favor it as a food source. Also, it takes a few hours for it to ferment, which allows it time to get through the stomach and small intestine, and down into the colon where we WANT most of the fermentation to be happening.
I'm interested in RS partly because it's such a great "prebiotic" for the probiotics we're always eating, and partly because it seems so good at getting where it's going before the fermentation starts...and also because it seems to attract the "good bugs" to glom onto it along the way, possibly even encouraging them to leave the spots where we don't want them: the small intestine, the stomach, etc. Resistant starch sort of seems like a _stabilizing_ sort of carbohydrate, just the thing to start eating after a course of GAPS-type healing, to begin to feed the good microbes, and to attract and sustain a more robust population of them. Once this population is bigger, in theory, the microbial overgrowth that caused the carbohydrate intolerance in the first place might actually be healed (as long as one doesn't go back to eating refined sugars, flour, gluten, or other severely offending/challenging substances). And...one might be able to start eating other types of starches and sugars again, even the non-resistant kind, also due to the stabilizing effects of the gut micro biome's renewed robustness.
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So I started thinking: here I've got a family who's been eating GAPS for years, and hopefully doesn't have much in the way of SIBO ("small intestinal bacterial [or fungal] overgrowth") anymore, but quite possibly does have fungal and digestive issues that aren't getting any better with our current lack of starch/sugar...and maybe some resistant starch supplementation would be a good thing. And maybe some non-resistant starch, too! What if we might start digesting more carbohydrate foods in the _human_ part of our digestion, while _also_ feeling the probiotic bacteria that we so carefully consume with every meal, if we start eating the "right" types of carbohydrates??
The more I read about resistant starch, the more it made sense. Humans did evolve with starch. And not just potatoes, the ones that have been bred for mass production, but little tubers and big ones, and ones with all sorts of kinds of "-saccharides," and lots of types of fiber...and SOIL BACTERIA that cling to them (the bacteria are symbiotic with the plants! Like the ones on cabbage...) Anyway, like I said before, it makes sense that humans have probably been eating roots for a long while. Maybe much much longer than grains.
And possibly these tubers weren't all cooked. We have amylase in our saliva, so maybe early humans chewed on tubers that tasted good, and digested the parts of them that we could absorb...and sent the rest on down to the colon, where the Resistant Starch nourished our Good Microbes! Just like refined sugar favors the pathogenic microbes, maybe our guts NEED resistant starch and other Good carbs in order to favor the good microbes. And, I thought, maybe Now is the time to re-introduce them.
It's not clear, of course, what early humans really did. But it is clear that there are at least four types of Resistant Starch, and that while you can obtain these from many different sources, they're not all intuitive. Rice has hardly any resistant starch when it's cooked fresh...but when it's cooled, RS forms. Sweet potatoes have lots of starch, but very little of it is resistant, even after they cool. Potatoes...have a ton of resistant starch UNTIL they are cooked, but again, like with rice, they regain some RS once they sit in a cool place for a day or two.
Potato starch has become synonymous with RS in some blogs like "Free The Animal," simply because it's really really easy to dose. Bob's Red Mill potato starch is a raw food (if it gets cooked, it actually doesn't act like starch anymore, which is why "potato flour" - dehydrated cooked potatoes - is different). Also, the processing in lots of water washes away most of the nightshade toxins, so most people seem to tolerate it just fine, even if they have nightshade sensitivities. And it's just about 80% pure Resistant Starch (and 20% water), as opposed to cornstarch or tapioca or arrowroot, which have varying amounts of resistant and absorbable starch. Grokking Resistant Starch feels equivalent to understanding the "specific carbohydrate diet" (which excludes counterintuitive foods like parsnip, simply because of the structure of the carb, even while carrots are just fine).
Anyway. Soooo...the idea is, you eat the resistant starch (in this case, raw potato starch mixed into some cold water), it heads on down to your colon, and your starved good bacteria finally get a meal. It's very simple meal, and probably very much lacking in complexity (micronutrients, etc.), but more in the realm of Prebiotics than your good bugs have gotten in a long time. Lots of research has been done with RS in terms of diabetes, and how it seems to help regulate blood sugar. Nobody really knows exactly how, but our gut bacteria have a large impact on glucose metabolism. And I read about lots of formerly VLC dieters whose blood sugar had gradually become dysregulated _until_, paradoxically, they began to include more resistant and then non-resistant starch in their diets.
Years ago, I remember listening to a podcast by Donna Gates', who talked about butyric acid, this fantastic fatty acid that we just really really need in order to have finely functioning guts, and to prevent colon cancer etc. Unfortunately, where we need it most is in our colons - and eating all the butter in the world is not going to get it there, digestively speaking. It gets broken down and digested long before that point. The only way we can get our colons flooded with butyric acid (which is anti-inflammatory and all that) is by getting Good Bacteria to produce it. And they just aren't going to produce it in any quantity unless they're fed.
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So...I read all this right around New Years', but in much expanded format, and I'm misinterpreting and over simplifying, for sure. The basic idea that I think is really important, is: Our Gut Bugs Absolutely Need To Be Fed, and we need to selectively feed Good Ones, and we need Good Ones, period. Resistant starch is only one of [many, many types of carbohydrates/fibers that need to be consumed by us in order to do this.](http://freetheanimal.com/2014/06/refining-resistant-starch.html)
I decided to have us try the potato starch. I also began incorporating [resistant-starch-containing foods](http://freetheanimal.com/wp-content/uploads/2013/08/Resistant-Starch-in…), but first I wanted to see if we could tolerate _just_ potato starch, and see if it would stabilize some of Ben's digestive/diarrhea/mental issues, and my increasingly horrendous mental state, and Jeff's irritated gut that in some key and Important ways hasn't improved in three years...along with Eliza's eczema and reflux, and Jem's bedwetting and constipation and lack-of-appetite....
One thing I can say for sure is that we conclusively noted Effects. Really, really quickly. Also, at least SOME microbes were...shall we say: Obviously Happy To Be Getting Fed.
Four weeks into the RS experiment, we ate rice for the first time in four years. Digestion for many of us actually _improved_ (although I'm planning to avoid all but white or properly fermented rice, and will carefully limit "paleo baking" recipes). And "improved" has not been a word I've used ever, during the past four years, when I've first tried to introduce a carbohydrate source! We then started introducing other starchy vegetables (I like that vegetable starches are nutrient-dense, possibly containing many of the nutrients that help us metabolize them!), basing our experimental new macronutrient proportions (more starchy carbs!) on Jaminet's revised edition of The Perfect Health Diet.
I've begun to think that starchy foods are perhaps a more important food to add in (at first, when coming off of a therapeutic low-carb regimen) than are the sugary foods like fruits, partly because of the potentially stabilizing effects of resistant starch and "prebiotics,", and partly because of how the starches break down into glucose, rather than mix of glucose and fructose. So for the first time, I've been increasing our starchy vegetable intake, rather than our sweet fruit intake alone.
I shall refrain for now on passing judgement on (or even trying to describe our individual reactions to) this latest round of dietary experimentation. It is very very hard to figure these things out, and understand whether a reaction is just BAD, or worse-before-making-things-better, or GOOD. Especially when the reaction is not your own body, which is hard enough to fathom.
But you better believe I am keeping a written inventory of all of our symptoms, good and bad. I am so eager to see whether, perhaps, some of the same foods that were hurting us back in 2010, might actually help HEAL us now. The jury is definitely still out...but when I can be as purely intellectual as possible, I think: context is everything, right?! Back then, we ate rice in the context of a vegetarian diet that included tons of vegetable oil, soy, wheat (although Ben and Jem didn't eat that), pasteurized dairy...AND some moderate-to-severe gut dysbiosis. Now, if all goes well, maybe we can eat sweet potatoes and rice in the context of a diet that is rich in fatty, pastured animal products, fermented foods, all those Fantastic Vegetables, diverse and nutritious fats, no vegetable oil or soy or wheat, and if we're super lucky, Better Guts...
Anyway...I am so dying to read more and more and more research, and try things, and I wish for more Patience along the way. And I am learning about all sorts of starches, and other carbohydrates that are "prebiotic" in nature, and sugars-that-break-down-into-glucose (rather than fructose). What I am sure about is that "after" GAPS (or, as I prefer to say, "when continuing the healing journey that we're on"), we've got to feed the microbes in our guts.
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Basic Upshot:
After a course of GAPS-style gut-remodeling, in the quest for achieving some sort of gut stability, I've started thinking that a certain amount of carbohydrates are necessary - especially those that favor a desirable microbial population ("prebiotics"). Up until now, none of the carbs I'd repeatedly tried to introduce (fruit, nuts, sweet vegetables - ironically in my quest to be "conservative") seemed to promote stability in any way. Not until "resistant starch", followed shortly by "safe starches". ("Safe starch" refers to Jaminet's definition of plant starches that are naturally or prepared carefully to be low in toxins.)
To be clear, when I say that the introduction of starch "worked," I am going by the presentation of digestive symptoms. Some of us are like canaries in coal mines, and the tiniest bit of an offending food will nearly immediately cause diarrhea (or constipation). I generally look for these symptoms first, when evaluating whether a food "works" for our family. It was actually very surprising when the rice worked! Although Ben was confused: "But I thought you said rice is BAD?!"
I told him: We are continuing on our healing journey...and some foods that you couldn't handle before just might be a Good Idea, and Beneficial, now. He just shook his head...
Maybe others wouldn't find resistant starch/potato starch to be stabilizing, and instead, for them, mushrooms (beta glucans) or okra or fruit sugar or sweet vegetables or starchy potatoes would be better. But my working theory is that resistant starch, because of its specific prebiotic activity, is the stabilizing carbohydrate that you want to re-introduce to your diet first after eating "low-carb".
Of course, the unanswerable question I can't help but ask, many many times, is: should we have tried resistant starch after only two years of GAPS? Could Ben's digestion have gotten stabilized back then, and could he have been able to digest sweet potato and rice and starchy vegetables _two years ago_, if only we'd done this first? Have we suffered ill-effects from a too-long course of time on a low-net-carb diet?
The reality was, whenever I introduced what I thought was the logical next, "more advanced" food - like fruit or nuts or even new types of fermented foods - Ben would get all sorts of digestive and behavioral symptoms, among others. And I just didn't know about resistant starch at all, so there's no way I could have tried it.
But it's worth thinking about these things. Of course I couldn't try what I didn't know about, back then. I will say that if I could go back in time to when my hormonal symptoms were worsening (after initially becoming a whole lot better), in 2011, this is what I would have tried for myself - not more fruit.
I'm thinking that the order of carbohydrate introduction I'd try, in the context of a super-nutrient-dense diet, would be:
1. Well-cooked and fermented non-sweet and non-starchy vegetables of all types, gradually working up to more-fibrous ones (artichokes, etc.)
2. Cooked sweet vegetables like carrot, winter squash, etc.
3. Raw vegetables, if tolerated.
4. Fruit, if tolerated.
5. Resistant starch in supplemental form, whether or not #s 3. and 4. were working out.
6. Re-introduction of higher-FODMAP foods and other previously-not-well-tolerated-foods, if these had been eliminated at first.
I'm very curious what other folks have found, when coming from a state of severe dysbiosis (IBS, ASD, etc.), and then incorporating RS. I often wish for a control group for my life! :)
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Some inconclusive statistics:
Back last November, I happened to track my dietary intake very carefully, using an online tracking tool, for a very different purpose (don't
2676 calories per day
61.1% fat (185g, of which 84g was sat. fat)
18.9% protein (129g.)
19.8% carb (135g.).
Bear in mind that ALL of those carbs were coming from non-starchy vegetables and a little bit of fruit, and the total includes indigestible fiber as well as digestible portions.
Now, I'm planning meals that roughly approximate the PHD, which is:
Minimum protein+carb intake of 600 calories per day, which is about 30% of calories for a sedentary adult, with up to 30% of calories coming from starches (like plantain, potato, sweet potato, etc) (carbohydrate fraction excluding carbs from non-starchy vegetables).
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The worse our health problems, I think, the more challenging it is to try to think through what is going on. On the one hand, the more you research, the more you can understand intellectually. But sometimes it makes a lot more sense to focus on _what_ to do, rather than exactly _why_. What is the basis for all medical interventions? I would argue that they all depend on the underlying ability-of-the-body-to-heal. How can we BEST support our bodies to heal, at home, every day? We can choose what to eat.
This is what I always, always come back to.
I've come to my personal conclusion that supporting the health of our gut and its microbes is the sort of sub-important factor when making dietary choices. Which is why a gut-healing protocol, incomplete as it might be, seems like a good approach when a person is really compromised. I'm sure I could have done a lot of research into methylation pathways and fixing Tight Junctions and Eliminating Current Food Allergens when Ben was at his sickest. But in retrospect, I don't think that it would have healed him any faster than simply trying to figure out _the_ most nutrient-dense and absorbable foods for him, at that point in time, and later, at every step along the way.
I think that one of the most powerful dietary tools we have, in terms of nourishing our gut biome, helping our immune function, and dealing with chronic infections, is to alter the macronutrient proportions of our super-nutrient-dense-diets to personalize them for whatever is ailing us. I wish I knew more of how to do this! But I'm pretty sure it's one key to something. It sounds very simple, but when you sit down and start figuring out what you're eating by the numbers, it's fascinating to contemplate where things can go, biologically speaking, if you just change the proportions of the exact same meals.
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Here's an interesting post: [Beyond Resistant Starch.](http://drbganimalpharm.blogspot.com/2014/06/contupdate-2-rs2-and-rs3-ar…)
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Along with these new dietary tweaks, I am adding a few targeted supplements just for me, like iodine, occasional selenium, vit. c, vit. k, vit. d, maca and vitex. I'm experimenting with soil probiotics (Primal Defense, Prescript Assist, AOR 3), and other probiotics (Jarrow EPS, Bio-kult). I continue to think that no supplement will do much unless the dietary context is "right." I'm hoping that one of these days we'll tweak both factors to create lasting, sustainable Robustification.
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I'd love to hear what you think!
Love,
Sarabeth