The Paleo NP Podcast #35: Finding Your Perfect Diet
In this episode I talk about biochemical individuality and what that means for the way you eat. We discuss why there is no one size fits all approach to eating and how to figure out what diet fits your unique individual needs.
Theme music courtesy of soundotcom.com
Resources mentioned in this episode
Chris Masterjohn - Dietary Management of Familial Hypercholesterolemia
Finding Your Perfect diet
Let’s talk about diets. Not fad diets or quick weight loss solutions (because those don’t work and you should stay away from them), but diets in the sense of the food we eat. Specifically I want to talk about finding your perfect diet, so nutrition that is personalized to you. How do you find that? Not the diet that helped your friend Joe lose 20 pounds by putting half a jar of coconut oil in his coffee, not the vegan diet that helped your mom transform herself into a new person, and not the all steak diet that your cousin went on that cured her chronic illness. I’m talking about the diet that works for you.
In his book Biochemical Individuality, Roger Williams talks about how there is actually no such thing as an average person. We are all unique both biologically and genetically and he also discusses that so-called bad genetics alone doesn’t cause disease, nutrition and environment play a huge role in that. I look at this as “genetics loads the gun, and the environment pulls the trigger.” So your genetics determine what is going to go wrong when it happens but the environment that your genetics are in (so the food you eat, the toxins you’re exposed to, your habits, your emotional state, all of those things) are what determines when that thing is going to go wrong.
This plays a role not only in disease and illnesses, but also in the way you eat and what supplements you do or don’t need to take. There are some people who don’t really need to supplement with vitamin C or even some B vitamins because they have a specific strain of bacteria in their gut that produces these vitamins for them.
There are also people for whom it would be very dangerous to supplement with vitamin D because they overproduce calcium and phosphorus when they consume vitamin D (https://www.ncbi.nlm.nih.gov/pubmed/17161336 & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045493/). I have a patient who has a condition that makes it dangerous for her to supplement with vitamin D even though her vitamin D levels are quite low. But then at the same time there are a lot of people, mostly people with darker skin, who aren’t able to produce vitamin D from the sun as well or people with a genetic variant that hinders vitamin d production and without supplementation, these folks can have some serious health issues because they are vitamin D deficient.
It blows my mind that based on the amount of biochemical individuality that exists that there are thousands (or even hundreds of thousands) of books and programs out there that promise to have THE solution for everything from weight loss to overcoming carb cravings to building muscles to fixing your skin. When the truth is that the keto diet that helped your friend Joe look like a bodybuilder could result in serious negative health consequences for you.
And to quote the book I mentioned earlier,
“Genetic influences are far better understood now than in 1956 from major nutrition-related problems such as alcoholism, heart disease, diabetes, hypertension, and cancer yet we seem frustratingly slow to integrate this knowledge into clinical practice and common knowledge. Most clinicians still treat and write about these problems as if inborn differences are unimportant. Professional and lay authors still recommend restrictive diets they assume are best for nearly everyone. They debate heatedly about which one of the conflicting diets is right. High-carb, low-carb, vegetarian, high protein, et cetera. When will we automatically consider that all of these diets likely have merit but only for some individuals?”
So if you’ve ever tried to follow a diet from a book and failed and then thought that you just don’t have the willpower to make it happen, it’s actually that your biochemical individuality doesn’t jive with whatever the diet is and your body is trying to save you.
Let’s just dive right into this and start by talking about the ketogenic diet. First let’s consider that while our ancestors may have technically been keto, they did NOT get into ketosis by eating copious amounts of fat or using exogenous ketones. They were essentially fasting (or starving) themselves into ketosis and the ability to burn fat was a survival mechanism. In our current, modern times, we’ve learned that the ability to burn fat for fuel is good for most of us, but we’ve also learned other ways to access it that doesn’t include fasting or starving. If we are supplementing our way into ketosis, in my mind, that’s the same as taking a pill for something.
The most important point here is not matter how you get into ketosis and no matter how many people claim that it will solve all the world’s problems, the truth is that there are some people who can actually suffer more harm than good by following a ketogenic diet. There’s definitely more nuance to it than this, but my point is that keto isn’t good for everyone. There are people who have a condition called familial hypercholesterolemia (which affects about 10% of the population worldwide) and people who have this tend to end up with extremely high levels of cholesterol when they eat a diet high in saturated fat.
I’m not going to get into the nitty gritty on what to do about this either, but in the show notes I’ll link to a couple of articles and podcasts by Chris Masterjohn where he talks specifically about familial hypercholesterolemia (FH) and what to do about it from a dietary perspective. So for someone with FH, eating a lower fat, higher carb diet that has plenty of polyunsaturated fats is best. Something more like a Mediterranean diet with plenty of plants and olive oil.
How do you know if you have FH? I’ll link to an article with the diagnostic criteria. There’s some genetic testing that you can do to determine if you have the specific genes, but you can also diagnose it based on LDL cholesterol levels and family history. Also, if you’ve ever been on a ketogenic diet or eaten a lot of saturated fat and then had your cholesterol levels tested and they were extremely high (or much higher than they were prior to keto), then chances are good that you have FH.
So, it turns out that no matter how many people on the internet tell you that everyone can do keto and that keto is good for everyone, there are people who don’t thrive on a higher fat lower carb diet and who actually are healthier on a lower fat higher carb diet.
Another example is related to omega-6 fatty acids. Omega-6 fatty acids, much like omega-3s, are polyunsaturated fatty acids and are found in eggs, poultry, nuts, seeds, and vegetable oils. Omega 6 is a precursor to molecules called eicosanoids. In general when eicosanoids are derived from omega-6s, they promote inflammation, and when they are derived from omega-3s, they are anti-inflammatory.
The problem with omega-6s is disproportionately high intake compared to omega-3s. So eating foods that have omega-6s in them, like nuts, isn’t a problem, but the problems arise when you eat too much omega-6 food without a high intake of omega-3 foods. Here’s where the biochemical individuality piece comes in, the process of converting omega-6s into inflammatory compounds (a process called elongation) is genetic. So in some people, this process is upregulated and causes a higher rate of conversion of omega-6 to inflammatory compounds. So if you are one of those people and you are consuming high volumes of foods like nuts and seeds (which some people do on a keto diet, spoonfuls of nut butter anyone?) then a significant portion of the linoleic acid from the nuts and seeds gets converted into arachidonic acid, which is a direct precursor to inflammatory compounds.
So in order to make sure that this doesn’t happen, you either need to get rid of these common sources of omega 6s, so foods like nut, seeds, nut butters, and possibly even limit consumption of foods like poultry and eggs. Or if you do eat these foods, make sure that you are increasing your intake of omega-3 fatty acids from sources like salmon, tuna, herring, and sardines. This is another thing you can determine with a genetic test.
Other good examples of biochemical individuality can be seen in the huge variations in blood sugar responses when eating foods like cookies or bananas or oatmeal. Robb Wolf talks about this in his book “Wired to Eat” We are led to believe that eating something like a banana is good for us and eating a cookie is bad for us. But in the study that Robb talks about in his book they did a controlled dietary study and tested blood sugars of people after eating various sources of carbs (I believe they controlled for grams of carbs, so everyone ate 100g of banana, 100g of cookie, etc.). But what this study determined is that you can’t predict the blood sugar response to any of these foods. So some people had a huge blood sugar increase with the banana and barely a blip with the cookie, and others were the opposite. So while I might do better with cookies as a source of carbs (ha! I wish, right), you might do better with bananas.
I think Lily Nichols, who is a whole foods based RD just did an n=1 study on herself where she wore a continuous glucose monitor and did a similar experiment to what Robb talks about in his book. He also has a carb test that you can do that’s detailed in his book and I’ll be sure to link to all of these things in the show notes. I’m not sure if Lily’s experiences are published anywhere yet, I saw her post about it on Twitter, but I’ll do some digging and post those things in the show notes.
Anyway, the point of this is that your specific genetics and internal environment determine how you react to foods, so just because there is an arbitrary recommendation out there that bananas are a better carb source than cookies, doesn’t mean that’s true for you. However, if your blood sugar responds the same to both cookies and bananas, I’d recommend choosing bananas because they are a whole food and have other beneficial micronutrients that are found in cookies.
There is a project happening in Europe called Food4Me, and the study they did looked at 1500 participants who were given personalized dietary advice based on their genetic data or they were told to follow some standard dietary guidelines such as eating lots of fruits and vegetables or lean meats and whole grains. And the people in the personalized diet group did much better eating based on their genetics than the standardized group did.
We also talked about coffee a few weeks ago and that’s another great example of biochemical individuality, so those with a variant of the CYP1A2 gene which is responsible for caffeine metabolism have an increased risk of heart attack and hypertension if they consume more than two cups of coffee per day whereas the current dietary guidelines state that four to five cups of coffee per day is fine.
So what does all this mean? It means that depending on your unique genetic makeup, your gut microbe, your health history, your environment, your family history, and even your emotional state, you may need to consume more or less of any given nutrient than others or than what is recommended. Please don’t feel overwhelmed or discouraged by this, because you can figure out a lot of this on your own and what you can’t figure out on your own, you can get genetic testing for.
Two other dietary approaches that are all the rage right now are the carnivore diet and veganism. I’m not going to talk about my specific thoughts about those here (if you want to know them you can listen to the podcast episode I did with Melissa from Avocado Grove Nutrition, I’ll link it in the show notes, we talked specifically about both the carnivore diet and veganism in that episode), but I want to talk about some potential issues from a genetics standpoint.
First we need to get nerdy about methylation. Methyl groups (which is a carbon atom attached with three hydrogen atoms attached to it) are typically attached to larger molecules. Methylation is the process that occurs when a methyl group is taken from one compound and transferred to another.
This process is responsible for turning genes on and off, so when your body has normal methylation, genes that you don’t want are turned off (like those that are responsible for cancer or autoimmune disease), and helpful genes are switched on. Methylation is required for a lot of processes like cell division, detoxification, energy metabolism, neurotransmitter synthesis, and more. This means that that when methylation doesn’t function as you want it to, things can go very wrong in your body.
Undermethylation is when your body isn’t able to transfer methyl groups appropriately or when you don’t have adequate intake of foods of compounds that easily donate methyl groups. Overmethylation is when this process happens too easily or too frequently.
One interesting thing about undermethylation is that it can cause people to be more susceptible to depression because methylation is involved in serotonin synthesis. Overmethylation is associated with things like anxiety, panic attacks, and sleep disorders.
So if you’re an undermethylator (or prone to undermethylation), you would probably do pretty well eating more meat (not necessarily full on carnivore, but definitely higher meat intake) because you don’t have enough methyl groups being transferred to places where you need them and muscle meat has a high amount of methionine which is a strong methyl donor. This would be especially true if you tend to consume higher amounts of plants and folate because those don’t supply adequate methyl donors for and undermethylator.
So if you’re prone to undermethylation, a plant rich diet that has no meat in it is not going to allow you to be optimally healthy (in fact it might actually cause you to be sick). But if you’re prone to overmethylation, the very last night you need is to have a high intake of methyl donors like muscle meat. So this would be a person who would benefit more from a mostly plant based diet. You do still need to consume protein if you’re an overmethylator, but becoming a carnivore where most of your plate is meat (or all in some cases), is going to make you sick. Unfortunately the only way to know which way things tend to go for you is to do a genetic test, though something like a DUTCH hormone test can give you some clues because it does look at some of these pathways in relation to hormone metabolism.
I’m not huge on having lab testing determining what you should and shouldn’t be eating. But I do think that certain testing can tell us where there are holes that need to be filled, but I say that with the caveat that you need to do some digging into understanding why there are those holes. So if you’re B12 deficient is is because your intake is low or because you’ve got the MTHFR mutation which affects your B vitamin status, or is it because you have some gut dysbiosis or are lacking intrinsic factor so not matter how much B12 you eat, you still aren’t getting it into your bloodstream. But things like blood sugar, vitamin and mineral status, thyroid status, cholesterol, red and white blood cells levels, and vitamin D status can give us clues into the way your diet is affecting your health.
I do NOT like food sensitivity testing, and I’ve got a whole podcast episode about that which I’ll link to in the show notes about that. The only situation where I think this is a good idea is when you’ve been actively working on finding your perfect diet and you are struggling with symptoms that don’t seem to want to go away. Then it might be helpful to see what a food sensitivity test says, but I rarely do these.
One other test that I’ve already mentioned that can be really helpful is the DUTCH test. It’s a great test for hormones and it also tests some organic acids (which reflect micronutrient status). You can also get a more comprehensive organic acids test, which isn’t something that I have a lot of experience with at this point, but I’m looking to add it to what I do because I think there’s a lot of good information in them.
So now you understand what biochemical individuality is and you have a basic understanding of how you can go about learning some of these things about yourself. What do you do with that information?
I’m going to talk about some specific diets that solve specific problems that you can DIY. I also have an online course where I walk you through the exact process that I go through with my patients, because I go through this all the time with it’s actually probably the number one question I get asked, “what should I eat?” So if you feel like all of this information is completely overwhelming and you aren’t really interested in getting any of this testing done and you need a little bit of accountability and support through this process of figuring out what you should eat, then my course might be right for you.
It’s a self-paced course, but I’ve got a Facebook group that goes along with it where I provide some direction and support and you get the support and hive mind of some of the other members of the course, so it can be really helpful in getting you started and keeping you going. I’ll talk a bit more about details of the course as I discuss some of these other diets.
I do want to mention that you should always choose real food first. Even if you are eating a low-carb/keto diet or a paleo diet, or a vegan diet and you’ve got a really great keto-friendly green powder for your smoothie, you should ALWAYS choose to eat the real food versions of that food first. Even if the ingredients are essentially the same. Choose the real food and save the convenience and packaged foods for a time when you are in a hurry or traveling.
And one other quick thing here is that any of these diets that I’m going to talk about are meant to be a short term solution to get a set of symptoms under control and then needs to be adapted into something that fits with your overall lifestyle and is sustainable.
If you have any sort of gut distress or your inflammation markers are high, then you need to follow some sort of protocol for anywhere from 4-12 weeks, and this is something I talk about in my course. I’d say a minimum of 4 weeks, but really 12 weeks is better. And how long you have to follow this kind of depends on how “sick” you are. So the longer you’ve been dealing with some of these issues then the longer it’s going to take to get rid of them. So you’ve got to be patient.
One really great place to start if you’ve got any sort of chronic illness is the autoimmune paleo protocol. It’s a very strict version of the paleo diet and it eliminates a LOT of foods. Grains, dairy, eggs, nightshade vegetable, legumes, and I think nuts, seeds, coffee, and chocolate too. It’s a good place to start for people who are have a lot of inflammation or an inflammatory condition and need to feel better. The problem I have with it is that it’s so restrictive that it’s hard for a lot of people to stick to for the length of time needed to see healing.
The protocol that I start with in my Find Your Perfect Diet course eliminates some of the most common food triggers (so things like dairy, gluten, soy, and a few others). Because the goal with any of this is to decrease inflammation. But I also give you some options based on what you’re dealing with, so I typically recommend that (based on the AIP template) if you have an autoimmune disease that you go beyond what I initially recommend and eliminate grains and a few other things right off the bat. Because that’s what is going to get you the most healing in the shortest amount of time.
So one other thing I like about AIP is the way that they reintroduce and test foods. So you eliminate all these foods for 12+ weeks, I think the book says that some people need to follow the elimination phase for up to 6 months or a year depending on symptoms, which while I agree with, is so hard for a lot of people, so I have a different recommendation. So on AIP you eliminate all of these foods and then you test them and look for symptoms. If you tolerate something then you get to add that back into your diet.
I have found that asking people to restrict what they are eating for a really long time makes them more likely to not stick with something, even if they feel better. So I’ve modified my approach in the Find Your Perfect Diet course into a more phased approach where after your initial elimination period, you get to tweak and revisit some things and then when you come out of this process, which takes a few months total depending on how you do it, you’ve got all the information you need to know what foods you should be eating and what foods you‘d do better to avoid.
Another option would be the specific carbohydrate diet, and that was originally designed as a way to manage celiac disease, so it’s a gluten and grain free diet. This would be a good place to start if you have IBS or any symptoms that are brought on by gluten or grains.
Another one that I actually really like, but can be hard to follow because it’s got a lot of rules and steps is the GAPS diet. Which stands for Gut and Psychology Syndrome and it was derived from the SCD diet. So I like the theory behind it, but the barrier to entry is pretty high. I’ll link to a book that I like that lays it all out and makes it a little bit easier. But I’d say this is not a good place to start unless you are desperate. Though it does focus on a lot of common inflammatory foods so if you felt comfortable modifying it, then it would be easier to do.
If you want to start with just the basics, I’d say that a clean paleo diet is a good place to start there, or even a Whole30. I like to recommend a Whole30 to my patients when they need a way to get started with changing their diet but who aren’t necessarily complaining of any GI symptoms. I like the Whole30 because there are a lot of free resources online, so it’s easy for folks to DIY. So that’s a good option if you’re really just looking for a place to start with cleaning up your diet and you need some rules to follow.
Another one I really like is the Wahls Protocol. This is a really plant centric lower carb paleo diet that focuses on getting tons of nutrients. This is also good for anyone who has a serious or chronic health issue (Terry Wahls essentially put her MS into remission with this diet, so it’s powerful) but doesn’t necessarily suffer from any symptoms of GI distress.
If you find yourself not tolerating plants very well, you can check out the Plant Paradox diet, this eliminates all lectins and significantly limits sugar. This is a good place to start if you want to focus on nutrient density but your gut doesn’t like green smoothies and piles of vegetables.
I will say that with any of these approaches, the Find Your Perfect Diet course included, the magic is in the reintroduction of foods. I focus a lot of my course on this part and what you should look for when reintroducing foods and then how to take that information and use it in creating your perfect diet to serve you for the rest of your life. So what my course does that a lot of these other protocols don’t do, is help you to bridge the gap between the protocol itself and real life, because that’s the hard part for a lot of people, especially when some of the foods that make them feel terrible or give them symptoms are foods that they like and are having a hard time giving up.
I’ve also taken a lot of my favorite parts of many of these approaches and incorporated them into my course. So I’m not prescribing you a specific list of foods that you can and can’t eat, instead I’m helping you to figure out what your body does and doesn’t like and what makes you feel good and what causes you problems. So it turns into a mishmash of all of these things. And while I typically recommend that people avoid a lot of soy and potentially never eat gluten, I talk about how to eat those things occasionally (such as special occasions) if you do tolerate them. It’s all about making informed choices around food and understanding how it affects you so you can eat in a way that supports your optimal health and performance.
So hopefully that gives you a starting place. And if you’re interested in the Find Your Perfect Diet course, I’ll put a link in the show notes where you can sign up to be notified when I open registration again. I’m working on some updates and I think I’ll be opening registration once a month or once every other month for now and that’s just so I can be sure to be able to provide plenty of support to those who are just getting started, because that’s when most of the questions pop up, so it’s definitely easier to manage if there’s a bunch of people who are starting around the same time rather than trickling in. So there will be a link in the show notes for that.
One other thing that I want to point out is that while I’m not at all a huge fan of the idea of a low carb diet for everyone, I DO think that minimizing the blood sugar rollercoaster is ideal. And how you do this will vary from person to person. Going back to our discussion of how different carbohydrate sources affect different people, that matters a lot here. But also if you are an athlete or a very active person, in general you can probably eat more carbohydrate than someone who is sedentary.
Again, your genetics plays a role in this too, so if you’re someone with FH, then eating a lower carb diet might not be the best idea, but the carbs you do eat should be nutrient-dense, whole food carbs, not junky carbs like cookies and cereal. If you take them time to test your carb tolerance as Robb Wolf laid out in his book, then you have actual data to back up your food choices, but a lot of people don’t have the time, the resources, or even the desire to do that.
So, in that case I’d encourage you to work on finding your own perfect diet, but making the base of that real, whole foods and then using the data you gathered during that process to drive the choices you make that deviate from your baseline whole foods diet.
So I’ll use myself as an example. 80-90% of the time my diet adheres pretty closely to a strict paleo template (I use that label because that’s the easiest way to describe it). Once a week or so I’ll include rice in a meal and occasionally (maybe once every other week or so) I’ll make some sort of GF treat. There are a few vegetables that I haven’t been eating because I’ve pinpointed them as the cause of some bloating that I’ve had (FODMAPS in this case), so I avoided them pretty exclusively for about a month and have been eating small amounts of them on a few times per week with no issues.
When I go out to eat I deviate from this template even more, but I also know where my tolerances for certain foods lie. So a gluten-free pizza once a month is fine, but eating cheese more than once a week or every other week is a recipe for disaster.
The point is that I know what my baseline template is that makes me feel good. Right now it’s a low FODMAP paleo template. And I know where I can make choices that deviate from that baseline because I’ve done a lot of experimenting and tweaking and trying things out. So gluten-free pizza once a month and the occasional gluteny food (again maybe once a month) doesn’t cause me any grief.
How do I measure this? A lot of people use weight as a way to measure their dietary success and that’s not at all the right approach. For me it’s my levels of fatigue. I struggle with chronic fatigue and EBV and after it got really really bad a few years ago, I have my gauge. If I workout and need a three hour nap or it takes me multiple days to recover from an easy workout, things are not going well. If I sleep for 8 hours, can’t get out of bed, drink too many cups of coffee, and then pass out on the couch for a three hour nap at 2 in the afternoon….I need to make some adjustments. And to be completely honest, it’s mostly diet.
As I was working on all of these things, suddenly I found that after napping every day at 2pm suddenly I made it through one and then three and then a whole week where I didn’t absolutely have to have a nap. Sometimes it’s hard to see these patterns and notice what’s happening, which is why I always encourage peopel to keep a food and symptom journal. It’s really hard to notice patterns based on your recall alone, so writing those things down is helpful.
So my point is that while it’s important that you follow a diet that works for you and not one that worked for someone else, you also have to be willing to invest a little time and energy into the process in order to figure all of that out.
Feel free to use any of the templates that I’ve talked about here and tweak those to work for you if you are good with following something laid out in a book. But if you feel like you could use a little more support and guidance and you want help with the PROCESS, then check out the Find Your Perfect Diet course. None of these are a quick fix, and even some of the specific diets that I talked about aren’t a long term solution, but more of a place to get started. But it’s my goal with this course to help you find a diet that will work for you forever. And as things change (because they will) you’ll have the skills and process in place to be able to adapt to your changing needs rather than having to move on to the next diet that might have worked for someone else.