Diet, Detox and Die-off Reactions
After starting the basic package of nutritional supplements (Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong) , and any other indicated interventions, including, of course the Paleo-Ketogenic diet (for everyone - see The Paleo Ketogenic Diet - this is a diet which we all should follow) many people feel worse.
See this as a good sign! Below I explain why this happens and what to do about it.
“The darkest hour is before dawn” Old English Proverb now universally used.
Meant metaphorically, this phrase is not ‘actually’ true although it can be said that it is coldest before dawn – please see Davidson Weizmann - darkest before dawn for more detail on this.
Sometimes, just before sunrise, the sun casts a shadow of the earth into the visible sky and this gives an impression of a sweep of darkness, much akin to that experienced in a total solar eclipse. It could be that this sweep of darkness gave a ‘physical’ truth to this phrase and led to its common use.
Expect to get worse before you improve. Possibly demoralising but it depends how you see it…..and I am an optimist so I see progress in the right direction. Such reactions are a well-recognised phenomenon and are given comforting names such as a “healing crisis”. Symptoms can be very severe. Often when patients are so ill, they cannot afford to become any worse. I have great sympathy but no easy answers. Understanding the mechanisms may help. You must be a patient patient.
Expect a bumpy ride - these reactions do not follow a smooth course. The internet meme as below is often posted in my Facebook Group, run by Kathryn Twinn and Craig Robinson - link - ‘Support for followers of Dr Myhill’s protocol’ Facebook Group
We are fighting a war, but this is composed of many battles. Battles are fought by the macrophage foot soldiers and the lymphocyte officers of our immune system. They can be activated by infections, allergies and toxins. The army throws its all at the invaders and kills them with cytokine bullets. The inflammatory friendly fire that results makes us feel ill. Then the immune armies rest and recover (we feel a bit better) before attacking again – I told you it was a bumpy ride! Then the immune system sweeps up the mess - the parts of dead microbes look like the parts of live ones and this explains Herx reactions (see below).
Diet reactions – there are three common players
The Metabolic Hinterland
The transition from burning carbs to burning fat is difficult and takes time – usually 1-2 weeks. The body has been used to running on carbs and there is an inertia in the system – it is as if it takes time to “learn” fat burning. During this window of time the body cannot get fuel from carbs (because they have been cut out) so it uses adrenalin to fat burn. To the patient this gives some of the symptoms of low blood sugar because adrenalin is partly responsible for such. We call this keto flu but was also given the dreadful and confusing name “ketogenic hypoglycaemia”. It was first described in the 1960s in children treated for epilepsy with a ketogenic diet. Let me explain further.
We have the collective symptoms of low blood sugar for reasons of low blood sugar AND the hormonal response to such vis: 8Poor energy delivery due to low sugar: fatigue, foggy brain (and indeed for some, especially diabetics on medication) and loss of consciousness
- Adrenalin release - feeling “hyper”, shaky, anxious, possibly palpitations and fast heart rate
- Gut hormones - feelings of hunger and the need to eat.
If all is well with metabolism, the body switches into fat burning (and it takes 1-2 weeks for this to happen) and all the above symptoms which we associate with low blood sugar disappear.
If all is not well with the metabolism then these symptoms do not disappear and the clinical picture which results is called ketogenic hypoglycaemia. I suspect two causes: lack of carnitine (easily corrected with 1 gram daily) and, more commonly, lack of sufficient thyroid hormone to fat burn . That clinical picture is characterised by:
- Blood sugar levels are normal or (even better) low and stable
- You are in ketosis (confirmed by blood and urine tests)
- The body is burning fat to produce ketones, but it does not have sufficient thyroid hormone to do so – it relies on extra adrenalin to fat burn
- BUT the adrenalin release gives us nasty symptom of being “hyper”, shaky, anxious, possibly palpitations and fast heart rate
- AND STILL gut hormone release – which” follow” adrenalin release ie feelings of hunger and the need to eat
- Clinically this feels like hypoglycaemia
Analyse your symptoms. We know keto-adapted athletes improve their performance and the foggy brain clears……..despite perhaps feeling dreadful in other respects.
Treatment of ketogenic hypoglycaemia: take acetyl L carnitine 1 gram daily and sort the thyroid problem! But we have to go gently here. In the short-term thyroid and adrenal hormones have very similar actions – ie to speed things up. If one is still in the metabolic hinterland you may still be spiking adrenalin as the body has yet to “learn” to use thyroid to fat burn. If you add thyroid to this mix you will end up with the combined effects of thyroid and adrenalin and feel constantly “hyper”. See chapter 30 for how to do this.
We use addiction to mask unpleasant symptoms such as fatigue, foggy brain or pain. Stop the addiction and those symptoms return. Ghastly in the short term, great in the long. Obviously sugar and starch addiction is illustrated by the metabolic hinterland but chocolate, caffeine, alcohol, nicotine, coca cola and other such all have the potential to cause “train spotting” pain.
Allergy and addiction seem to be two sides of the same coin. I once had a patient who, before I was allowed to introduce myself, declared that when he died, he would like to take a cow to heaven with him to ensure a supply of his favourite food. The diagnosis was not difficult. I am not sure of the mechanism by which allergy has this addictive effect, but it is very real!
In the short term the body can deal with a spike of some toxins by stuffing such into fat. When I do fat biopsies, results come back in mgs per kg. By contrast blood results come back in micrograms per kg. This alone tells us toxic levels in fat are a thousand-fold higher than in blood. Losing weight, heating fat or perhaps even physical massage may mobilise these toxins into the blood stream and cause an acute poisoning. These toxins, especially pesticides and volatile organic compounds, “boil off” through the skin with heating regimes and these cause rashes as the skin reacts allergically to them passing through. The commonest include urticaria and acne like rashes. The clue can be found in the skin reaction to organochlorine poisoning, so called chloracne. I have seen several patients who have been chemically poisoned, developed acne whilst detoxing with heat treatments (such as saunaing), have persisted with treatment regardless and eventually the acne reaction has resolved. I can only explain this by a reaction to toxins as they are excreted through the skin.
Some being treated with vitamin B12 by injection and/or iodine also get an acne reaction. Both B12 and iodine are good at mobilising toxins from the body. Again, this resolves with time if the sufferer is prepared to put up with the acne.
Heavy metals stick to proteins and bioconcentrate in organs, particularly the brain, heart, kidneys and bone. They can be mobilised by techniques described in chapter 34 and this too may result in detox reactions.
Mobilising such chemicals is akin to throwing a handful of sand into a finely tuned engine - this may produce almost any symptom. In the very short-term energy delivery mechanism are impaired. Many toxic metals and chemicals are immuno-toxic - ie they switch on inflammation.
Die-off Reactions (Herx)
These were first described by two immunologists Drs Jarisch and Herxheimer in patients with syphilis treated with anti-microbials. It is partly due to endotoxin-like products released by the death of microorganisms within the body and partly by immune activation (I think of this as “allergy to dead microbes” – this may explain why Herx is not universal). Such reactions are potentially very serious and must always be taken seriously by at least reducing the dose of any antimicrobial employed and relaxing the regimes that may have triggered such. In the treatment of chronic infection with anti-microbials I suggest starting with a tiny dose and building up slowly over a few days.
Symptoms of diet, detox and die-off
In practice one can experience:
- systemic symptoms (fever, malaise, aches and pains, depression and fatigue) or local (acute cold, cough, catarrh, diarrhoea, cystitis etc). See chapter 7 for symptoms of inflammation.
- local symptoms: it seems to be characteristic of sniffing with an iodine salt pipe that there is an initial increase in mucous and catarrh production – I suspect as the iodine kills the microbe then body recognises such and sweeps it out with snot.
- Fatigue: when the immune system is active it takes all our energy, so there is none to spend physically.
- Foggy brain: the inflamed body is paralleled by the inflamed brain and symptoms of poor energy delivery to the brain result in particular with foggy brain, depression and malaise.
- 'Sickness behaviour' - “Leave me alone I just wanna go to bed”. This is an energy saving strategy
Summary: getting worse with 'Groundhog' regimes when they should be making you better
(Groundhog is a term I use in my books for basic packages that everyone should have in place.)
|Metabolic hinterland with ketogenic hypoglycaemia…||Adrenalin is high||Stick with the PK diet. Do not cheat (many do without realising such) or you will never exit the metabolic hinterland. Wait two weeks|
|…if persists||Hypothyroidism||Sort the thyroid. T3 is the fat burner|
|Lack of carnitine||You need acetyl L carnitine to fat burn. Suggest 2 grams daily for 2 months then maintenance 500mgs daily (but a good PK diet and this should not be necessary in the long term)|
|“Glycogen storage disorder”||May be associated with poor adrenal function.Work out the cause!|
|Detox reactions as chemicals mobilised from fat||Acute poisoning|| Heating regimes bring toxins out through the skin and this reduces the poisoning effect.
Consider zeolite clays which adsorb (not absorb) fat soluble toxins in bile to pull them out in faeces
|Addiction withdrawal. Social, recreational (this really is a misnomer) and prescription drugs||Addiction masks unpleasant symptoms||If too awful, then take a tiny dose of your addiction and wean off slowly. Confession time – I love caffeine, consumption waxes and wanes with detox windows when I avoid it completely. See Footnote.|
|Allergen withdrawal typically grains or dairy||Do not know for sure – many possibilities||Stick with the PK diet|
|Improving micronutrient status||Mobilising and excretes toxic metals||Consider zeolite clays which adsorb (not absorb) fat soluble metals in bile to pull them out in faeces|
|Heating regimes and/or weight loss||Mobilises pesticides and VOCs from fat||Difficult! Slow the regimes down to a point that is bearable|
|Reducing microbial loads - eg using anti-microbials||Herx reactions||Relax the regime. Once tolerated get up to speed again|
|Adrenalin spiking with high blood sugar, blood pressure or loss of sleep||Any one of the above is a stress and the body responds with adrenalin||Stick with it and hang on to your hat! This expression may derive from the need to do just this on rollercoaster rides - according to lexicographer Eric Partridge. [Colloquial; first half of 1900s]. This rather suits our ‘Reality’ graphic above! Eric Honeywood Partridge (6 February 1894 – 1 June 1979) was a New Zealand–British lexicographer of the English language, particularly of its slang.|
|Skin rashes - urticaria, itching, acne||“Allergic” reactions to toxins coming through skin||Stick with it! It will pass and as it does so other symptoms will improve|
Footnote re caffeine from Craig – Sarah is not alone in her love of caffeine. I drink Green Tea every day and I make a cup of coffee for my wife, Penny, first thing in the morning every day too! 89% of Americans consume some caffeine every day of their lives – see ‘Trends in intake and sources of caffeine in the diets of US adults: 2001-2010.’. According to new research, humans have been drinking caffeinated beverages since at least 750AD – please see ‘A Brief History of Humans getting their caffeine fix’
All the above illustrate the point that time is a vital part of the diagnostic and therapeutic process. I expect patients to get to this stage after an initial consultation with me that usually concludes with me saying “you may love me now but in a week’s time you will hate me”. It is no consolation to tell them that I too have been on the same journey and been equally grumpy about the whole process…………I am sure Craig has experienced the same! Craig replies "Indeed, I have but I have never ‘hated’ Sarah! When going through these DDD reactions, I always have Penny on hand to remind ‘This is just what Sarah said might happen!’ "
- Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong
- The Paleo Ketogenic Diet - this is a diet which we all should follow
- Davidson Weizmann - darkest before dawn
- ‘Support for followers of Dr Myhill’s protocol’ Facebook Group
- ‘Trends in intake and sources of caffeine in the diets of US adults: 2001-2010.’
- ‘A Brief History of Humans getting their caffeine fix’
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