Fat Fiction Fat, lies and measuring tape

13Jun/115

When Plan A fails…

Everyone needs a plan...

“Never have a plan B. It always gets in the way of plan A”, so said wise philosopher, erm, Will Smith. And so it is with the post last week, which answered the simple question “Does a paleo-ish diet dissolve gallstones?”. And the answer is a resounding no – it’s got a lot worse. So what does this mean? Rip it up and start again or give up? Well, thanks to a lot of really useful feedback last week, I’ve got a good idea of next steps.

First off a recap.

-          I train for a marathon

-          Get gallstones. Research and think it’s to do with white flour

-          Cut out wheat. Lose over 4 stones, most of it rapidly. Think that’s strange. Research more and think that a lack of nutrients drives gallstones and weight gain. Think that’s interesting

-          Discover paleo blogs, looks quite similar

-          Start blog to see if it’s true with an aim to finish it once I’d come to a conclusion

And then by now, I thought I'd be writing a final post and it'd be job done right? But look left. The gallbladder is basically the amorphous blob on the right. You can't even see the walls because it's heavily impacted.

Ironically then, this blog is nearly over. If it carries on getting worse, the gallbladder will stop functioning entirely, and I’ll need to have surgery and have it taken out and someone else will have to take up the mantle as to why we get them.

No gnashing and wailing about this - on a serious scale this sits marginally above forgetting to pay your car tax, but that's not the point - it's no ringing endorsement for the theory that gallstones are due to a lack of nutrients. Although scientists and patients have been trying to figure out why people get gallstones since time immemorial, if I fail at least I'd be in good company. But still. I'm stubborn and I want to figure this out.

Knowns knowns and known unknowns

I know this…

- The Pima Indians never used to have a problem with gallstones until the introduction of white flour and sugar into their diets, which set off an epidemic. Now 50% of men and women over 30 have gallstones. Diet in combination with genes is doubtessly the driving factor
- Based on n=1, even if you then change the diet, the problem continues. Whatever damage caused by the sugar/white flour continues even after you remove them from the diet
- Gallstones can still occur even if you don’t eat processed food – fat, female, fair and forty used to be typical risk factors. I’m only one of those (fair!). Nowadays anyone and everyone seems to be getting them.
- Noone knows exactly why gallstones are formed but they require two things – inbalanced bile (caused by excessive dietary cholesterol or poor bile salts) combined with bile stasis.

My original idea was that a lack of nutrients is driving both inbalanced bile and stasis. Assuming I’m getting enough nutrients now, if it’s still getting worse, there are really only a few likely possibilities left:

-          Bile stasis is caused by food intolerance most likely caused by damage to the GI tract (leaky gut).

-          Something in gut flora is either preventing uptake of nutrients (as Paleoguy recently puts it, ingestion doesn’t equal absorption) or flora is causing problems with bile production/stasis

I didn’t know this…

Gut flora is insanely complicated. Among their many uses, they’re responsible for uptake of nutrients, they battle the bacteria responsible for leaky gut and food intolerances/allergies among many other things. As an area of scientific study, it’s in its infancy; bear in mind we’ve managed to sequence human DNA, but we’ve not managed to identify all the different bacteria in our guts and their function (the Human Microbiome Project is attempting this,  due for completion in 2013).

Plan B

Assuming things are getting worse (of course, I feel absolutely fine but still)... and based on the most likely answers, the obvious things to do are to restore gut flora and avoid foods which have been known to cause gallbladder problems until GI tract is healed. Sounds simple right? Well no …

1)      Restoring gut flora is a big task. Simply necking a few commercial probiotics or prebiotics to restore gut bacteria is I think at best wishful thinking. First off – not everyone’s gut bacteria is the same, secondly many commercial products don’t have any solid peer-reviewed science showing their bacteria actually survive transition to the bowel, and thirdly, most of them contain one or two of hundreds, if not thousands of strains of bacteria. I’m not discounting, but I’m not convinced.

2)      If the world’s scientists haven’t established the best ways of establishing gut flora, I have no chance. Seriously. I recently dug out a school report from when I was 15, and my Biology teacher gave me a C-, stating that “Michael lacks maturity and concentration”. Meh, he lacked a sense of humour, what can I say?

3)      Some restoring flora dietary regimes doubtlessly work but you’d have to have the patience of a saint to follow them – the GAPS diet is recommended to follow for 2 years. 2 years! Of eating like a monk. Also, see point 2 above

4)      Gut flora and intestinal permeability is different in different geographic groups across the world, which suggests it’s mostly environmental. Food is but one element of the environment, but it’s a damned important one.

5)      You can, obviously, catch stomach bugs. Travellers are especially prone to it, which is why eating local yoghurt is always recommended when you land somewhere. So it would follow foods which eliminate disease through targeting certain bacteria are not necessarily going to work with different levels of efficacy depending on where you’re from.

So how am I going to go about doing it? Not sure yet so all ideas welcome…

Plans photo (c) Floodlama

Comments (5) Trackbacks (0)
  1. The ave. GI transit time is 24-48 hrs. What about a 72 hr water only fast to allow for GI tract emptying and rest, followed by a paleo diet which includes at least one fermented food at every meal (yogurt, kefir, sauerkraut, etc)?

    I don’t think you can infer that you have worsening gallbladder disease. The visualized gallstones may be the same on both ultrasounds versus continuing to manufacture them or further constricting the duct.

    How’s your Omega 3 intake? You might want to consider upping it so that cholesterol will not be struggling to take over O3 duty.

    Best-

    • Thanks AEK, I’ll definitely be doing something along those lines. I don’t think the worsening is pessimistic, it just is – it appears like many more stones have been created since. We’ll see. Thanks for your suggestions

  2. How exact a science is reading an ultrasound? Could it be that your doctor’s interpretation of the results was biased based upon her expectation that there would be more gallstones? I mean all I see is a blob. I don’t see any defined stones. Maybe she decided because there weren’t any clearly defined stones that this meant it was chock full when in reality it means something else? Perhaps the lack of defined stones means there are no stones, but she couldn’t wrap her brain around that explanation? I don’t know anything about reading these things, but it sure seems pretty subjective to me when you can look at a dark blob and make some kind of diagnosis out of it.

  3. I think Nancy’s comment is worth exploring further. There are several differences between the two images: 1. the first appears to be primarily of the gallbladder (text “GB” in top-left), the second of the common bile duct (“CBD”); 2. there is a 40% difference (100mm vs 140mm) in something – I’m not sure whether it’s depth / magnification / scanning speed / other, but it’s still a 40% difference and it might be significant; 3. the viewpoint / angle / rotation could all be different; 4. the frequencies are different – I’m not sure whether this just alters resolution or causes different tissue densities to become more visible.

    I know it can be difficult to get this sort of thing on demand on the NHS, but I think your ideal situation would be to take along image 1 and ask the person doing the ultrasound for a view exactly like that with all the same parameters for purposes of a decent comparison. Might be worth getting it done privately if the NHS won’t oblige – probably £200-300.

    BTW, I too, am not a medical practitioner.

    Good blog – keep it going and good luck.

    • Hi David, good observations. I didn’t post them but there’s actually dozens of images. I chose those two because they’re roughly the same angle, but one is taken slightly further left. The GB should be to the right of the CBD in the second. The key point though was that there was no visible wall which they’re definitely should be in a ‘normal’ functioning gallbladder. The ultrasound woman pointed this out and said it was v. advanced (in not a good way), and the pictures showed the same. There’s another picture taken from a different angle below the GB showing a very small space in between stones in the centre, basically showing that there’s little space left.

      I actually reckon it should be fairly quick from here on in – if it doesn’t improve, I’ll know about it sharpish because at the same rate of growth so far, that gap will completely close up in weeks. If in 3 months time I’ve had no problems it’s almost certainly improving I would say.


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