Chapter 11. Avoiding the Perils of Transition

“In many cases, the toilet bowl predicts your future with more certainty than a crystal ball.”
Konstantin Monastyrsky, author

A low-fiber diet isn’t exactly chemotherapy. If anyone tells you otherwise and claims that a low-fiber diet isn’t safe, or can harm you, or that fiber is an essential nutrient, that person is misinformed.

Consider Japan, for example. It has the highest life expectancy among developed countries,[1] provides free health care to all of its citizens, and yet its health-care costs relative to gross domestic product are among the lowest—7.9% vs. 15% in the United States. This statistic is salient, because it means that the Japanese are much healthier than Americans, and need to spend half as much precious national resources to deliver, according to all accounts, superior medical care.

Anyone who has ever visited Japan, set foot in a Japanese restaurant, read Japanese cookbooks, or is partial to FoodTV, knows that Japanese cuisine—haute and casual alike—is about as low in fiber as it gets. Aside from white rice, which is the main source of carbohydrates for the Japanese, Japanese cooking is dominated by fish, seafood, white and red meats, tofu, and seaweed (0.5% fiber), which is used in salads and wraps.

One cup of cooked rice (186 g) contains just 0.56 g (0.3%) of fiber.[2] Even a prodigious eater, like a sumo wrestler, consumes less fiber from twelve cups of rice than the average five-year-old American from just one cup (59 g) of relatively benign (fiber-wise) Kellogg’s Raisin Bran (6.73 g of fiber, or 11.4%[3]).

Even though white rice is omnipresent, plentiful, and contains 54 g of carbs per one cup serving, the rate of obesity in industria­lized, modern Japan is 3.2%, compared to 30.6% in the United States.[4] The exceptionally low fiber content of the Japanese diet is one of the reasons behind this stunning 952% difference.

And if someone tells you that the Japanese are different from Americans, that it’s all in the genes—that’s not true, either. The genetic difference between an ethnic Japanese and a Caucasian or African-American is just 0.1%—not a big enough difference to attribute the low obesity rate among the native Japanese to genes alone.

Just a few generations ago, before the fiber menace hit Americans full-force, the obesity rate in the United States was almost as low as it is in Japan today. If that’s not proof enough for you, mo­dern-day Germany, Ireland, and Italy—the countries that provided the largest gene pool of white Americans—have, respectively, 12.9%, 12.0%, and 8.5% obesity rates.[5] Although these rates are higher than they should or used to be, they’re still nowhere near as high as the obesity rate in the United States. So much for genetics.

The obesity rate in Africa is even lower than it is in Japan, except among the very rich, who have adopted Western-style diets. But according to the Centers for Disease Control and Prevention (CDC), 48.8% of adult African-American[6] women are obese, com­pared to 30.7% of adult white women. This isn’t surprising. African-Americans also tend to consume more fiber-rich processed food than do Caucasians.

One diet, highly acclaimed for its high-fiber content from fruits, vegetables, and grains, is the famous Mediterranean diet. But lo and behold, the obesity rate in Greece today stands at 21.9%—not as high as 30.6% in the United States, but it’s catching up. Greece also happens to be one of the poorest and least developed countries in the European Union, hence the higher ratio of cheap and plentiful grain crops (a major source of fiber) in the after all not-so-healthy Mediterranean diet.

So pita bread and Greek salad are out, nori (dry seaweed wrap) and kaisou (seaweed salad) are in. But before you snap your chopsticks, your digestive organs must get reacquainted with a low-fiber diet.

The good, the bad, and the diet-breakers

If a low-fiber diet is safe, healthy, and effective, then why isn’t getting off a high-fiber diet a “piece of cake”? Because the consumption of fiber gradually alters the physiology of the digestive organs. And nobody knows the side effects of sudden fiber withdrawal as well as the untold millions of people who failed on the Atkins diet, which, at the very beginning, happens to be not just low-carb, but also fiber-free. Even Dr. Atkins himself failed with his own diet, and he died morbidly obese.[7]

All that being said, a low-fiber diet isn’t a low-carb diet, unless you consciously decide to reduce carb intake in order to lose weight, or to prevent and treat carbohydrate-related disorders, such as hypertension, diabetes, or kidney disease.

Let me emphasize this point again: a low-fiber diet has nothing in common with the Atkins diet, except that it is purposefully LOW IN FIBER. If you’re healthy and your weight is normal, you may stick with your usual diet, but just cut down on foods high in fiber, such as bran, whole-wheat bread, cereals, or beans. That’s really all you need to change. You may not even notice the transition, except that your stools will become noticeably smaller, and you may go down a size or two and lose five to ten pounds of weight, once your intestines expel fiber, water, and any fiber-laden stools “in transit”—the phenomenon already explained in Chapter 3, Atkins Goes to South Beach.

Unfortunately, as you may already know from health statistics and personal observation, disease-free and normal-weight people are a shrinking minority, and are more than likely not the readers of this book to begin with. So, should you decide to adopt a low-fiber diet for health, weight loss, or any other worthwhile reason, the following information should help you make the transition as trouble-free as possible.

This chapter addresses major conditions that may arise when fiber and carbohydrates are suddenly reduced. The most apparent side effects of fiber withdrawal are constipation and indigestion. Other challenges come from breaking a dependence on carbohydrates (which customarily accompany high-fiber food) without encountering the usual side effects of their withdrawal, such as hypoglycemia, dehydration, and malnutrition. Let’s begin with con­stipation—the undisputed champion of diet-breakers.

Constipation

The complete withdrawal of fiber from one’s diet reduces the daily volume of stools from the usual 400 to 500 g to under 100 g. As Chapter 5, Constipation, explained, 100 g or less of stools daily is considered normal, which makes 400–500 g abnormal, almost freakish. This anomaly isn’t just the outcome of consuming fiber, but also a symptom of chronic constipation, which can be either latent (hidden) or organic (from organ damage).

If this is confusing, let’s look at it from a different angle: Technically, if you’re consuming gobs of fiber, and have three to four comfortable bowel movements daily (each around 100–150 g), your large intestine may be working overtime, but it’s perfectly fine. If you have just one bowel movement daily, however, and its volume is three to five times the norm, and it isn’t comfortable, it means that your large intestine has already been stretched out and desensitized by large, heavy stools.

And therein lies the problem with fiber withdrawal: when stools suddenly become small and light, most people no longer experience an urge to move their bowels, and inevitably miss bowel movements. When that happens, the smallish stools inside the large intestine quickly become dry, hard, and abrasive (to the anal canal), with physical properties similar to the Type 1 on the Bristol Stool Form Scale, and described as “separate hard lumps, like nuts.” Expelling these "hard lumps" is guaranteed to drive anyone nuts from the pain, discomfort, or bleeding associated with a lacerated mucosa.

Nuts or not, the actual perception of constipation differs from person to person. These differences (some subtle, some distinct) are determined by age, gender, health, lifestyle, diet composition, toilet habits, history of colorectal disorders, and other factors discussed earlier in this book.

Regardless of individual perception, the gist of the matter is that stools, when fiber is suddenly withdrawn, can become irregular, dry or hard, cause pain and hemorrhoidal disease, or cause rectal bleeding—all of the usual side effects of severe constipation. These are conditions you’d be better off preventing, rather than giving up halfway and resuming your old diet. Then you’d be back plunging out stools the old-fashioned way—with more and more fiber.

So here is a set of rules to help you along the path of transition. For starters, let’s briefly review the obstacles you may encounter while transitioning from a high-fiber diet to low:

• Colon stretching. If takes years to stretch out the large intestine to accommodate oversized stools. It’s important to understand that “shrinking” it back may take some time. Past a certain age—50 for some, 60 for others—it may not contract back much or at all. It isn’t practical to estimate how long, how fast, or how well the contraction will take place, except by noting the obvious: the younger you are, the faster.
• Muscular atony. Unless a person is bedridden, paralyzed from the waist down, suffers from rare endocrine disorders, or is medicated with drugs that impact neuromuscular functions, the colon retains its function to propel stools toward the rectum. What is commonly referred to as an “atonic” or “lazy” colon is really a continuation of the previous problems—a stretched- out, desensitized colon that can’t propel much smaller stools because it simply can’t “feel” them.
• Nerve damage. Large stools, straining, diabetes, anorectal sur­geries, or the habitual suppression of stools can cause irreversible nerve damage to the rectal cavity and the nerve plexus along the juncture of the rectum and anal canal. When the nerve receptors in these areas are damaged or desensitized, the defecation urge sensation is diminished or absent.
• Dysbacteriosis. Intestinal flora is a major component of normal stools, representing from 50 to 75% of their total weight. When both the fiber and the bacteria are missing, stool volume becomes even smaller, and more difficult to expel.
• Hemorrhoidal disease. Enlarged hemorrhoids constrict the anal canal, and interfere with normal defecation. Although smaller stools help to reduce pain and straining, they may still require a certain degree of straining to expel them (an action of the abdominal and pelvic muscles). Unfortunately, any straining adversely affects hemorrhoidal disease and its complications.
• Anorectal pain. Anal fissures, abrasions, inflammation of the anal mucosa, enlarged hemorrhoids, and similar factors instill a fear of defecation and may cause the withdrawal of stools, which is often unconscious. This condition is especially prevalent among small children, who can’t verbalize their feelings. As with he­mor­­rhoidal disease, smaller stools will help to alleviate pain quite a bit, but it’s imperative not to miss the opportunity to expel them, otherwise they’ll dry out, and become hard, abrasive, and even more painful.
• Organic disorders. Certain conditions such as fecal impaction, hypercalcemia, hypothyroidism, Hirschsprung’s disease, or colon cancer may cause severe chronic constipation or obstruction, which can’t be overcome through toilet discipline, dietary means, or over-the-counter remedies. The screening, diagnosis, and tre­atment of these conditions require a specialist, and discussing them is outside the scope of this book.
• Medication. The list of drugs that contribute to constipation is quite extensive. A recent search for “constipation” of RXList (www.rxlist.com)—a free public access database of over 1,450 prescription drugs—returned 675 matches. Always check the medication you may be taking for constipation-related side effects. If constipation is indeed listed, ask your doctor to prescribe an alternative. Ideally, while transitioning to a low-fiber diet, all external obstacles must be eliminated.

I realize that this is already quite a handful of issues to overcome. Bear in mind that most, if not all of these obstacles, are the outcomes of a high-fiber diet to begin with. In this particular instance, blaming a low fiber-diet for the perils of transition is as sensible as blaming a rape victim for being pretty. Instead of rubbing the victim’s face with tar, it’s the rapist (fiber in this case) who should be tarred.

Unfortunately, some aspects of managing these conditions may be mutually exclusive: on one hand, you may benefit from retaining a certain bulking agent in your diet while “shrinking” the colon; on the other, the bulk will continue to affect anorectal disorders and cause pain. In these cases you must choose the strategy that’s the least harmful.

Below are the rules of constipation prevention while transitioning from high- to low-fiber diet, split into three sections: (1) For people who are free from disorders of the large intestine; (2) For people already affected by constipation and colorectal disorders, such as IBS, hemorrhoidal disease, anal fissures, and nerve damage; (3) Rules that are applicable to both groups.

Rules of transition for healthy people

For the purpose of this section, “healthy” means the following: (a) you’ve never experienced chronic constipation; (b) you don’t have hemorrhoidal disease; (c) you don’t have any colorectal disorders as described in Part II of this book; (d) you don’t take any medications that may have constipation listed among its possible side effects; (e) you don’t take any laxatives; and (f) your bowel movements are easy (don’t require straining), and regular (at least daily). Most children, three-quarters of young adults, close to half of all adults under 50 years of age, and twice as many men as women belong to this fortunate group.

If you “fail” this checklist on any one point, please proceed to the next subsection. Even if you “pass,” keep the following points in mind:

• You may have regular stools, and still experience latent constipation. Large stools, moderate straining, and slight discomfort during or after defecation are the symptoms of latent constipation.
• You may have enlarged internal hemorrhoids and not know it. Straining, discomfort during bowel movements, itching in the anal area, and occasional streaks of blood on stools points to the probability of enlarged internal hemorrhoids.

Regardless of your overall health, you may still encounter constipation-like symptoms during the transition, unless you wean yourself from a high-fiber diet gradually. A slow and deliberate transition to a low-fiber diet is the best preventive strategy for healthy people. Here are the required steps:

• Record the approximate fiber intake you get daily from supplements and food sources, including snacks. Keep the tally for se­veral days to average out day-to-day variances. Fiber content per serving is listed on the food labels in grams. Some packages intentionally minimize serving size to camouflage a high carb content. For food without labels, such as fruits, vegetables, or baked goods, consult the USDA National Nutrient Database for Standard Reference here.

• Nutrients Reference Lookup

  Find nutrients content:

  • Fiber
    • Protein
    • Fat
    • Cholesterol
    • Carbohydrates
    • Sugars
    • Fiber
    • Water
    • Calories
    • Ash

  Within the food group:

  • All food groups
    • All food groups
    • American Indian/Alaska Native Foods
    • Baby Foods
    • Baked Products
    • Beef Products
    • Beverages
    • Breakfast Cereals
    • Cereal Grains and Pasta
    • Dairy and Egg Products
    • Fast Foods
    • Fats and Oils
    • Finfish and Shellfish Products
    • Fruits and Fruit Juices
    • Lamb, Veal, and Game Products
    • Legumes and Legume Products
    • Meals, Entrees, and Side Dishes
    • Nut and Seed Products
    • Pork Products
    • Poultry Products
    • Restaurant Foods
    • Sausages and Luncheon Meats
    • Snacks
    • Soups, Sauces, and Gravies
    • Spices and Herbs
    • Sweets
    • Vegetables and Vegetable Products

  Show order:

  • Highest to lowest
    • Highest to lowest
    • Lowest to highest

  Search

  Go to expanded search

  While you’re at it, consider tabulating the results in a spreadsheet program like Excel. In addition to fiber, record your daily intake of water, carbohydrates, proteins, and fats. This exercise may be quite an eye opener. Remember, over 50% of raw meat is water, and up to 30% is fat. Don’t count the gross weight of uncooked meat as protein. The actual protein content is much, much smaller, usually under 15%. Ditto animal fats: even the “fattiest” butter contains only 82% of fat, heavy cream 37%. After trimming and cooking, most meats contain much less fat, and a good share of the protein becomes useless (denaturated) by heat. Vegetable oils are the “fattiest” of fats because they are 100% fat.
• If you’re doing these calculations on behalf of your children, divide your own ideal weight by theirs (also ideal). The result tells you just how much smaller their digestive organs are than yours. As this book has already pointed out most young children scorn fiber, because their tiny and sensitive digestive organs feel its ill effects much stronger than the already desensitized stomachs and intestines of most adults. You’ll do them and yourself a huge favor by respecting that distinction.
• If your daily consumption of fiber is under 10–15 g, you don’t have to change anything. But if your stools are still large and voluminous, it means that you’re experiencing a sizable accumulation of stools inside the large intestine—a condition specific to latent constipation. In this case proceed to the next section.
• If your daily consumption of fiber exceeds 15 g, first identify foods that have the highest fiber content. These are usually pro­­cessed foods, such as cereals, bran, whole-wheat bread, muffins, bagels, and the like. Ideally, you shouldn’t eat them anyway, because nutritionally speaking all processed foods are unwholesome. If you aren’t inclined to make any changes in your diet, at least replace high-fiber food with low-fiber analogues: corn flakes instead of fiber-fortified cereals, white bread instead of whole wheat, regular muffins instead of bran muffins, green peas instead of lentils, pine nuts instead of peanuts, zucchini instead of broccoli, and so on.

That’s really all you need to do. You should see the results (smaller stools) in about three to four days—the amount of time it takes for the large intestine to expel fiber-laden stools. From this point on, keep your fiber intake low, and follow all of the steps outlined below to keep your large intestine healthy, functional, and well-protected from fiber-related carnage.

And if you don’t see results—meaning your stools aren’t coming out at all, or are dry and hard—it means that your large intestine isn’t, after all, in top-notch shape. If this is the case, proceed to the next section.

Rules of transition for individuals affected by constipation and colorectal disorders

Supplemental fiber must go first. You won’t regret this decision because it doesn’t relieve constipation anyway, and causes exactly the same problems it purports to relieve and prevent—more constipation, and anorectal damage from large stools.

Fiber from psyllium is probably the most offensive, because it’s at once (1) a bulking agent capable of obstructing the esophagus and intestines, (2) an osmotic laxative capable of causing severe diarrhea, (3) a fermentable biomass that causes acidic damage of the intestinal epithelium, and (4) a severe allergen for some people. And all that besides the cramping, bloating, gases, and severe straining required to expel large stools.

According to the 2005 American College of Gastroenterology Functional Gastrointestinal Disorders Task Force,[8] psyllium re­com­­­mendations are based on several “suboptimally designed” (that’s a euphemism for phony) clinical trials. Other bulking agents are just as useless:

Supplemental bran didn’t perform any better in trials than psyllium (Metamucil), methylcellulose (Citrucel), or calcium polycarbophil (FiberCon) laxatives:

Next, you should get rid of all natural sources of fiber that contain gluten—a potent plant allergen, especially for people who are already affected by intestinal disorders. That means all kinds of whole wheat cereals, breads, pastas, and baked goods.

Many people who suffer from constipation swear by the stool softening effect of prune and beet juices. These juices contain sorbitol, a sugar alcohol which is also found in bananas, apples, pears, and some berries. Sorbitol is a strong osmotic laxative, hence its stool-softening effect. Unfortunately, sorbitol also tends to accumulate in the cells, causing nerve damage, blindness, deafness, heart attacks, strokes, and kidney damage. Because excess glucose inside the cells gets converted to sorbitol too, consuming those concentrated juices is particularly dangerous for people who are already likely to have elevated blood sugar: the overweight, prediabetic, or diabetic who are still consuming unrestricted carbohydrates.

Finally, watch out for hidden sources of soluble fiber, which is generously added to yogurts, ice creams, milk shakes, snacks, sauces, dressings, condiments, preserves, soups, and so forth. Some of the most common names are: cellulose, methylcellulose, β-glucans, pectin, guar gum, cellulose gum, carrageen, agar-agar, gum acacia (arabic), guarana gum, benzoin, hemi­cellulose, inulin, lignin, oligofructose, fructooligosaccharides, poly­dextrose, polylos, resistant dextrin, resistant starch, and many others.[11]

Once you’ve eliminated all sources of fiber, your now bulk-free diet may not be able to dislodge the stools that are already accumulated in your large intestine. To prevent constipation from taking hold, take the following steps to normalize stools:

• Use saline laxatives[12] such as Milk of Magnesia and Epsom Salts to lavage the large intestine of accumulated large stools. Follow the manufacturer’s directions. Milk of Magnesia is an 8% water solution of magnesium hydroxide. It has strong antacid properties, and interferes with gastric digestion if taken with food. Individuals with impaired kidneys may develop toxic levels of magnesium from extended use of Milk of Magnesia. Epsom Salts is a brand name for magnesium sulfate. It’s more potent than Milk of Magnesia because it absorbs faster into the bloodstream, and may cause severe diarrhea. Because of their impact on the kidneys, neither Milk of Magnesia nor Epsom Salts are suitable for long-term use. After a thorough lavage you may not have any stools for a day or two. That’s normal because it takes about that long for newer stools to reach the rectum. (Please note that magnesium is an essential macromineral, required, among other things, for the proper assimilation of calcium. The above discussion applies only to laxatives which contain high doses of magnesium, but not to elementary magnesium in general.)
• To overcome a diminished urge sensation (because stools are now small), consider using glycerin suppositories. As soon as the suppository contacts the extremely sensitive nerve plexus situated along the anorectal line, the rectum starts contracting. This action imitates normal defecation. The rectal contraction stimulates the mass peristaltic movement, and the colon advances stools into the rectum for immediate expulsion. For adults, it’s best to insert two suppositories to assure full contact with the nerve plexus. If you have severe nerve damage, glycerin suppositories aren’t effective. It’s easy to determine—if suppositories don’t cause any reaction a few minutes after insertion, the damage has gone too far. In this case you’ll require another long-term approach.
• If you’re under 65, your doctor may prescribe Zelnorm (tegaserod)—the only medication approved for long-term use for people who suffer from chronic constipation. Besides being expensive and requiring a prescription, Zelnorm has many side effects, such as headaches, joint pain, severe diarrhea, abdominal cramping, dizziness, lightheadedness, fainting, irregular heartbeats, intestinal ischemia, ischemic colitis, and some others. Death of patients due to intestinal ischemia—the necrosis (death) of the intestinal tissue caused by insufficient blood flow—prompted the U.S. Food and Drug Administration’s intervention,[13] which required Novartis, the maker of Zelnorm, to provide stronger warnings on the label about these side effects.
• Hydro-C Colonic Moisturizer is a safe alternative to Milk of Magnesia, Epsom Salts, or Zelnorm. I first identified this compound, a derivative of vitamin C, for myself and the readers of my earlier books who couldn’t manage their chronic constipation, hemorrhoidal disease, or anal fissures in any other way. It’s safe, effective, inexpensive, non-addictive, and has a range of healing properties which may benefit constipation-related disorders. You can learn more about Hydro-C’s properties, composition, mechanism of action, and safety at www.FiberMenace.com.

If it upsets you that there isn’t some neat trick that can somehow override years of colorectal damage, well, it upsets me too. But such is life. I would rather endure the hassle of a low-fiber diet for the rest of my life than let a high-fiber diet cut my life short. Speaking of hassles.

Common rules of transition to a low-fiber diet

The following are the “must do” actions for anyone considering a low-fiber diet. These rules must be abided by not just daily, but for the rest of one’s life. If you ignore them, either you’ll slip back to a high-fiber diet, or get constipated, or both. In either case, some of the digestive disorders described in this book may eventually catch up with you. Consider these rules cheap health insurance.

Don’t miss the urge

While stools are still large and heavy, the defecation urge is more pronounced because of the strong pressure inside the colon and rectum. When stools are becoming small and light, there is very little pressure, so the urge becomes subtle and barely noticeable. But the urge is even more critical now, because if you miss or ignore it, the small stools will rapidly dry out, harden up, and may become even more difficult to expel than the large ones.

As you may recall from previous chapters and perhaps from your own experience, the urge sensation is related to eating: food stimulates the gastrocolic reflex, the gastrocolic reflex stimulates the mass peristaltic movement, the mass movement propels the colon’s content toward the rectum. In turn, the rectum contraction propels stools toward the anal canal, which stimulates the nerve plexus, and that stimuli is what sends you flying to the bathroom.

When you switch over to a low-fiber diet, you should get to the bathroom as soon as you sense the first inklings of the gastrocolic reflex, because the stools are way too small and light to reach and stimulate the nerve plexus, unless you’re already “in position”—meaning sitting down on the toilet bowl and ready “to go.” If you aren’t prepared, you may have to wait for another reflex. Unfortunately, a true mass peristaltic movement, also known as “peristaltic rush,” occurs only a few times daily, usually during or shortly after a meal. If you wait too long or miss those reflexes too often, the stools will dry out, harden up, and you’re back to square one.

Though all of the above sounds easy and logical, many cultural (can’t go to the bathroom in the middle of a meal), logistical (bathroom is too close to the kitchen), behavioral (a habit of resisting stools), parental (Johnny, wait until we get back home) and other factors complicate things. Partial nerve damage complicates things even more, because the urge sensation is even less perceptible. Hopefully, you can overcome all of these obstacles, and discipline yourself to be in the bathroom not in the nick of time, but in advance. Eventually, this will become visceral and much easier to accomplish.

If you do have partial nerve damage, insert glycerin suppositories before sitting down for a meal. This way, when the gastrocolic reflex strikes, you’ll have a double-action working in your favor—mass peristaltic movement from the top, and suppository stimulation from the bottom. Hopefully, as you get more and more disciplined and perceptive, unconditional reflexes will set in and you won’t need suppositories.

Does reading material in the bathroom help? Yes, it does, a lot! First, it takes your mind off the conscious control of defecation. Secondly, it lets you pass the time easier. Finally, it relaxes you, because you aren’t as tense as you might be if you were just sitting and waiting for something to happen. Just make sure whatever you’re reading is fun and light. You don’t want to read anything that may make you tense, because the tension spreads throughout the entire body, including the large intestine, and inhibits involuntary contraction of smooth muscles and defecation.

“Tight ass” isn’t just a figure of speech—it’s a bona fide obstacle caused by stress and mental tensions. In this context, meditation (especially in the lotus position) is a very effective “laxative,” because it relaxes you and your anal muscles at the same time. A hot bath is also an effective relaxant, as are stretching exercises, a leisurely walk, relaxing music, or anything that takes your mind off of daily worries.

“Urge management” represents probably 80% of constipation prevention. Ideally, if you really get the hang of it, you’ll have a bowel movement after each major meal. Inversely, “urge mismanagement” also represents 80% of the reasons why most people become constipated in the first place. That’s why people in simple cultures, especially those living alfresco, are constipation-free regardless of their diet—they never have to resist the urge to move their bowels, and they don’t have any particular shame associated with defecation.

When social mores and conditions override basic instincts, anyone can become severely constipated. You’d be surprised how many people search the Internet daily for the subject of dog or cat constipation. Nobody’s immune, not even pets.

Speaking of pets, we have two wonderful cats, who have never been constipated. To keep it this way, we feed them only organic canned cat food. It took me just one sighting of their huge stools on a dry food diet, prescribed by a vet, to ban dry food as a “main course” forever. They do get 10–15 bits of organic dry food to snack on after evening meals, because we think (perhaps erroneously) that the chewing action helps keep their teeth clean.

Back to people... You’re probably aware of the management postulate that the remaining 20% of any task requires 80% of the work. Indeed...

Eliminate dysbacteriosis

Easier said than done. You really can’t replace 400–450 kinds of innate intestinal bacteria with supplements, which at best may contain up to ten common strains. Nonetheless, the regular use of good quality acidophilus supplements helps to increase stool mass, make stools softer, and also make them more water-retentive.

It’s imperative to take high-quality brands without any additives, such as bovine colostrum. Some people are incredibly allergic to bovine colostrum, which may cause allergic shock (anaphylaxis). After all, bovine colostrum is intended for calves rather than people, most of whom have never tasted raw milk, and haven’t had a chance to develop a limited immunity to bovine flora.

Logically, it may appear that liquid acidophilus preparations may be more effective than encapsulated supplements, because they have more bacteria per dose and contain live, rather then sublimated, flora. Unfortunately, some of these preparations are literally too effective, especially lactic acid bacterial strains, such as L. acidophilus, L. bulgaricus, L. casei, and others that are preceded with the capital L, which means Lactobacillus.

When these bacteria reach the intestines, they proliferate with dramatic speed, and produce both lactic acid and gas, which may sometimes cause severe distress, abdominal pain, and bloating. This pain may be easily confused with appendicitis, and if you have a low pain threshold, you may have to take antibiotics to wipe the pain out—not a desirable action because all the good bacteria will get wiped out as well.

Even though milk enhances the survival of intestinal flora, commercial yogurts and other fermented dairy drinks are rarely as active as therapeutic preparations, because they are often treated with high heat to stop fermentation and prevent spoilage, which kills bacteria.

To be effective, liquid preparations must be taken on an empty stomach, otherwise gastric acid kills bacteria. Quality encapsulated supplements are provided in enteric capsules, which disintegrate only inside the intestines. Keep in mind that lactic acid bacteria are the main culprit behind dental caries (cavities), so it’s a good idea to brush your teeth with sugar-free toothpaste after drinking liquid preparations, fermented dairy products, or eating naturally ripened cheeses.[14]

If you’d like to try liquid preparations, proceed slowly and observe their actions for 48 to 72 hours. If, during this time or shortly thereafter, you begin experiencing gases and bloating, discontinue using them at once. Similar caution should be exercised when taking supplements in capsules or in any other form. A fiber-free diet won’t prevent bacteria from procreating, because bacteria get all the nutrients they need from the glycoproteins secreted with mucus.

If you aren’t experiencing much bacterial action, you may add supplemental doses of fructooligosaccharides (same as FOS), inulin, apple pectin, or acacia gum—soluble fibers intended to stimulate the procreation and development of bacteria. They are available in supplement form in health food stores. Follow the manufacturer’s directions. Reduce the dose or eliminate it al­to­gether if you experience excess gas and bloating.

You can find a more detailed discussion of dysbacteriosis​ here

Diet composition

Diet influences bowel movements in ways completely contrary to conventional thinking. Let’s repeat the quote from Chapter 5, Constipation:

Interesting! How much you eat makes no difference, fiber isn’t even mentioned, carbohydrates and proteins are irrelevant, and fat rules! But why?

Fat in food initiates the release of bile stored in the gallbladder. Bile stimulates the peristalsis of the small intestine, which in turn stimulates the gastrocolic reflex, and so forth. This effect of fat on morning stools didn’t escape enlightened Europeans: a cup of fresh-brewed coffee, heavy cream, fresh butter, triple-fat brie, and fat-laden croissants are customarily served for breakfast in much of Western Europe. Lo and behold, Europeans scorn fiber, and are much skinnier and healthier than Americans, despite the predominantly low-fat diet in the United States.

Bitterness in coffee is another strong and fast-acting stimulant of gastric and biliary digestion. For this reason drinking coffee on an empty stomach is a bad idea. When food isn’t forthcoming, hydrochloric acid and gastric enzymes irritate the stomach’s epithelium and find their way into the even less protected small intestine. When fats aren’t forthcoming to utilize and neutralize the bile, the lower intestine is also affected by its high astringency, Gastroenteritis (chronic inflammation of the stomach and intestinal epithelium) is a common side effect of morning coffee. This condition is the precursor of peptic ulcers, irritable bowel syndrome, and inevitable intermittent diarrhea and constipation. For this and many other good reasons, I no longer drink tea or coffee, nor do I endorse them for the prevention of constipation.

If you do drink coffee, at least make sure it’s always freshly-ground and brewed (to avoid trans fats in instant and packaged coffee) and consumed with fatty meals, or, at the very least, heavy cream. In addition to breakfast, Europeans drink coffee as an aperitif and digestive aid after meals. When dining out, I sometimes enjoy a cup of decaf espresso to complete a memorable meal. Since we dine out rarely,[16] and memorable meals are even rarer, this doesn’t amount to very much.

Mineral and water status

Potassium is the mineral that retains water in stools. Because it’s found primarily in plant foods, low-carb diets are universally low in potassium. Supplemental potassium causes digestive distress and isn’t desirable. To prevent potassium deficiency, drink one to two glasses of cucumber juice daily (with skins) an hour before a meal. Cucumber juice is rich in potassium (about 350 mg per 8 oz). Because it’s practically free of sugars, refrigerated cucumber juice stores well. Juice a batch once or twice a week from large seedless cucumbers (each yields about a cup of juice).

Tomatoes are another excellent source of potassium, and should be consumed raw, preferably without skins (they contain indiges­tible fiber). One medium-sized tomato contains almost 300 mg of potassium and less than 4 grams of carbs. The rest is water (117 g). Commercial tomato drinks, such as V-8, are loaded with fiber to give them body, and should be avoided. Just squeeze a regular tomato to see the striking difference in taste, color and texture vis-à-vis supermarket tomato juice.

Other good sources of potassium are fermented dairy products (yogurt, buttermilk, kefir), slow-cooked beef or chicken broth, and vegetables with a low-fiber/low-carb content, such as zucchini, squash, and eggplant.

You do not need to drink more water to enhance stools’ moisture. 100 g of stools require about 50–70 ml of water to stay moist—a tiny fraction of the total daily water turnover inside the alimentary canal. In fact, the more you drink, the more water and potassium you are going to lose through the kidneys. This issue was addressed in Chapter 2, Water Damage. Furthermore, stools become dry not because there isn’t enough water, but because getting water out of stools is the primary job of a healthy large intestine. Expel them timely and regularly, and they’ll never get dry.

Moderate physical activity

Just like with any other organ, blood vessels and intestinal muscles benefit from a healthy workout and the vigorous oxygenation that any form of exercise brings. Exercise is particularly effective in expunging stress hormones, triglycerides, and excess glucose from the blood that directly or indirectly impedes circulation and muscular contraction. Just as exercise firms up the skeletal muscles, it also conditions, strengthens, and rejuvenates the vascular and intestinal smooth muscles. Even a brief daily walk brings a considerable improvement in bowel function.

You do not need to exercise your abdominal muscles to improve your ability to strain, because (a) with smaller stools you will not need to strain any longer, and (b) because you want to avoid straining as much as possible to prevent hemorrhoidal disease, anal fissures, bleeding, and pain. If you want to exercise to have great looking abs, that’s fine. Just don’t use them for the wrong tasks.

Quality supplements to enhance overall health

A multivitamin formula by itself isn’t going to do much to relieve constipation or improve stools. However, high quality supplements taken regularly improve overall health, restore damaged nerve receptors, improve digestion, circulation, and muscular health, stimulate metabolism, and serve a broad range of other positive functions. You can find additional recommendations at www.GutSense.org.

What to do with small, hard stools

So you missed a stool or two because of a business trip, honeymoon, stressful event, or whatever. That’s no reason for despair. Just take several reduced doses of an osmotic laxative, such as Milk of Magnesia or Epsom Salts, to rehydrate them. If you take too large a dose, you may get diarrhea before these hard stools have a chance to rehydrate. Hydro-C is an effective and safe alternative. Once your stools are normalized, try not to miss expelling them again.

As you can see, constipation is a complex syndrome, which tends to become more and more challenging with age. If your constipation hasn’t advanced too far (i.e. just functional constipation, related to a change in diet), there is more information on these pages about managing it than you’ll find anywhere. If you have a more complicated history of chronic constipation and associated intestinal disorders, such as chronic diarrhea, irritable bowel syndrome, Crohn’s disease, ulcerative colitis, hemorrhoidal disease, anal fissures, and others, you may benefit from reviewing additional publications dedicated specifically to these subjects. Please check www.FiberMenace.com for more information.

Mother Nature, anticipating a thorny destiny for her offspring, made the stomach a much sturdier organ than the large intestine. But even she couldn’t anticipate the onslaught of so much factory-made fiber in today’s food supply while conceiving and executing the human body. And this brings us to the number two challenge of transitioning to a low-fiber lifestyle—indigestion.

Indigestion

Indigestion is a broadly used term that encompasses numerous disorders, such as heartburn, abdominal or upper chest pain, nausea, belching, and a feeling of fullness. Over the past few decades, the pedestrian “indigestion”has been gradually replaced with the more respectable “dyspepsia.” During the same time period the plebian “heartburn” became the impressive-sounding GERD, or gastroesophageal reflux disease.

This section, however, isn’t about GERD or dyspepsia, but, lite­rally, about incomplete digestion—the original true meaning of the term indigestion. Since the stomach digests nothing but proteins, indigestion also means the incomplete digestion of proteins. Paradoxically, a low-fiber diet is the best defense from indigestion, yet when some people suddenly drop fiber and carbs from their diets they may experience the temporary indigestion of proteins. After constipation, indigestion was one of the most common complaints from people who attempted the Atkins and similar diets.

What’s the big deal? Well, even a brief episode of indigestion, especially in people past the age of 50, may cause stomach or esophageal inflammation. Inflammation can turn into ulcers and po­lyps, and some of these may eventually become cancerous. The presence of H.pylori bacteria inside the stomach speeds up ulceration. Since half of all people with peptic ulcers aren’t infected with H.pylori, and half of those who are infected don’t develop peptic ulcers, H.pylori probably plays second fiddle in the pathogenesis of ulcer. This means that you can take all of the antibiotics and acid blockers you want to eradicate H.pylori, and still get inflammation and ulcers, unless you guard yourself against indigestion.

A more immediate concern is the putrefaction (rotting) of undigested proteins inside the stomach and intestines. Some of the by-products of putrefaction are extremely toxic neurotoxins that can cause nausea, vomiting, diarrhea, paralysis, and even death. One such substance is called cadaverine—a deadly toxin that’s present in all decaying animal flesh (i.e. cadavers). Because putrefaction inside the intestines is slow and gradual, full-blown poisonings are rare, but nausea, muscular apathy, and severe headaches are quite common among people affected by the indigestion of proteins.[17]

So it’s best to prevent indigestion regardless of your diet, and even more so while transitioning to a low-fiber one, because a complete recovery from even a brief encounter with indigestion often requires medication that blocks gastric acid and produces... well, even more indigestion, because the acid was intended by nature not to harm the stomach but to digest proteins and to protect it from viruses and bacteria.

Why, then, does indigestion occur during transition? If you’ve been consuming high-carb/high-fiber fare for breakfast and lunch for many years, your stomach has adapted to passing them along to the intestines without secreting much, if any, gastric juices and enzymes. When you suddenly replace breakfast cereals with eggs and sausage, your stomach fails to secret enough gastric juices on a moment’s notice, because, as Ivan Pavlov illustrated with his dogs, digestion isn’t altogether conscious, but also a reflexive process.

So it takes some time to condition new digestive reflexes to respond to new foods. But there’s more to it than just reflexes. Other, less obvious, factors that impede gastric digestion are: inadequate chewing (also a mostly unconscious action that requires retraining), dental problems, overconsumption of fluids, enzymatic deficiency related to malnutrition, chloride deficiency (hypochloremia) related to low-salt or salt-free diets, scaring of the stomach’s epithelium, antacids (i.e. Mylanta, Pepto-Bismol, Tums) or acid-blockers (i.e. Zantac, Prilosec, Prevacid), stress, bland food, and others.

So the operative terms of a smooth transition are the gradual introduction of new foods, elimination of obstacles, and awareness of perils.Here are the rules:

• Begin with the smallest possible amount of new foods, particularly proteins, so the stomach can process them fully and completely. Keep increasing the amount in very small increments until the stomach is fully adapted.
• Less processed foods are easier to digest. Begin with sashimi instead of baked salmon, steak instead of meat loaf, brie instead of aged cheeses, and so on.
• People in-the-know order their steak rare because it’s juicier, tastier, and digests faster than well-done steak. Use cooking techniques that yield the most digestible, succulent food: stewing instead of broiling, slow cooking instead of frying, finely chopped instead of ground, rare instead of well-done, and so on.
• Avoid ground meat. On the surface, it may seem that ground meat will digest faster, but in reality it doesn’t, because most people don’t chew soft ground meat enough to break down the fibers. That’s why there’s more food poisoning related to hamburgers than steaks, and indigestion may cause some of them rather than just Listeria or E.coli bacteria. If you have difficulties chewing, use a food processor to chop meats.
• Drink a glass of good-quality mineral water thirty to sixty minutes before a meal.[18] If you consume lots of fluids with or after a meal, they may dilute the already insufficient digestive juices, and impede digestion.
• Abstain from hard liquor, because alcohol blocks gastric digestion. If you have any digestive disorders, or are predisposed toward them, or would like to lose weight, it’s best not to have any alcoholic beverages, including beer and wine, because they stimulate overeating, impact the liver, kidneys, and blood sugar, lower the metabolism, and cause weight gain.
• Avoid mixed meals (i.e. carbs and proteins together) during the transition because excess carbohydrates interfere with the gastric phase of digestion. In other words, sandwiches and sides are out of the question.
• Eat in a timely way. If you eat protein-dense food outside of the usual time frame, indigestion is almost guaranteed for the same Pavlovian reasons cited above. That’s why so many people get food poisoning while on an intercontinental vacation. The combination of abundant food and bad timing is a prescription for indigestion. Experienced travelers keep their food schedule close to their home schedule regardless of what and when the locals eat.
• Chew well. Unlike bananas or cereal, meats, fish, and seafood require thorough chewing, otherwise more gastric acid, more enzymes, and more time is required to break apart and digest large chunks of inadequately chewed flesh.
• Avoid stress. Stress inhibits gastric digestion regardless of diet com­position. If you happen to be under a great deal of stress, you’re better off skipping proteins altogether, and instead having a light dish such as broth, a cup of yogurt, or rice pudding. The pudding may sound like a sacrilege, but getting gastritis is even worse.
• Give it time. Unlike carbohydrates, proteins need time to digest—anywhere from 4 to 6 hours under normal circumstance, and much longer for older individuals. Do not eat close to bedtime, because once you’re lying down, the gastric content spills down into the upper stomach chamber, which isn’t protected from acidity as well as the lower chamber is. Ditto for the esophagus. At the very least, sleep on a raised pillow.
• No antacids. Antacids neutralize gastric acid or block its secretion. Acid is essential for proper digestion of proteins and to protect the stomach from pathogens ingested with food and water.[19] You aren’t likely to have heartburn anyway if you follow all of these rules. Consult your doctor regarding any GERD-related prescription medication you may be taking.
• Moderation. Limit protein-based meals to once a day,[20] pre­ferably with dinner, so that you have time to chew slowly, digest leisurely, and enjoy a stress-free meal. If you begin your day with scrambled eggs and sausage for breakfast, it will digest from 8 am to 2 pm. If you eat a chicken sandwich for lunch, it will digest from 2 pm to 8 pm. If you have a stew or hamburger for dinner, it will digest from 8 pm to 2 am. That’s a grand total of 18 hours of non-stop digestion. And that’s in an absolutely healthy individual. No wonder so few people enjoy healthy digestion past the age of forty, and are so drained for most of the day; the body needs a lot of energy for digestion.
• Essential enablers. Two ingredients are an absolute must for adequate gastric digestion. First, the body needs table salt (sodium chloride, NaCl) to make hydrochloric acid (HCl). Second, fat stimulates gastric digestion, enhances satiety, and is essential to neutralize the bile secreted by the liver.
• The right attitude. There’s a tendency in all of us to look at people we know, and ask ourselves the question: Why can’t I eat just like he/she/they can? That’s a valid question that no book can answer. The right question to ask should really be: What can I eat without causing harm to myself?

Follow these simple, commonsense maxims, and your transition to a low-fiber/low-carb diet will be quick and trouble-free. In addition to transition, you may encounter unpredictable events, such as trauma, surgery, or food poisoning, when your usual diet and routine suddenly goes down the drain. During moments like these, you need all the nutrients you can get, and you don’t need to create even more problems. So keep these rules in mind while getting back to your customary diet.

Where there’s smoke, there’s fire. Where there’s fiber, there are carbohydrates, a lot of them. So when fiber is shown to the door, carbohydrates get thrown out as well. But not without putting up a frantic fight to keep their usual place in your breakfast, lunch, and dinner. Which brings us to the next peril of transitioning to a low fiber lifestyle—an addiction to carbohydrates, and its nasty accomplice: hypoglycemia.

Carbohydrates are broadly promoted as “comfort food” because, presumably, they alleviate bad moods, crankiness, and irritability related to mild hypoglycemia—a medical term for low blood sugar caused by elevated levels of insulin, which is the blood sugar’s regulating hormone.

The levels of insulin and blood sugar (plasma glucose) influence a person’s mood because (a) glucose provides energy for the brain and oxygen-carrying red blood cells, and (b) insulin happens to lower glucose levels more than any other factor. Naturally, when (a) collides with (b), (a) falls down precipitously and impacts one’s mood just as much as failing light impacts one’s vision.

This relationship between carbohydrates and mood has led to a popular myth (a euphemism for nonsense, actually) about the connection between dietary carbohydrates and serotonin, commonly known as “good mood hormone,” while completely ignoring hypoglycemia. In reality, serotonin has absolutely nothing to do with glucose metabolism or insulin production, and vice versa: carbohydrates have no influence whatsoeverover the levels of serotonin.

Serotonin isn’t even a hormone, meaning a regulating substance secreted by an endocrine gland. Serotonin is a neurotransmitter, a chemical agent involved in the transmission of nerve impulses. It is synthesized from tryptophan—an essential amino acid that can be obtained only from the diet. Tryptophan is abundant in meat and some plant proteins. Vitamin B6 (pyridoxine) is also required for the synthesis of serotonin, and, just as with tryptophan, is available mainly from animal sources.[21]

For those reasons, depression, anxiety, and insomnia (the ingredients of a “bad mood” in otherwise healthy people[22]) have less to do with serotonin, and more to do with too much insulin, too little protein, or both. That’s also why tryptophan supplements and selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, are marginally effective alone, because they do not eliminate hypoglycemia, hyperinsulinemia, and malnutrition—true triggers of functional mental disorders.

The liver and muscles store glucose in the form of glycogen for use between meals. When these stores are completely exhausted, required glucose is synthesized from muscle tissue. This process is called gluconeogenesis. Because gluconeogenesis produces glucose on demand, the level of insulin remains very low. That’s why carb-free diets don’t cause hypoglycemia or create problems as long as you consume enough protein to prevent muscle wasting. The same mechanism allows a body to function normally during a fast, except for ongoing loss of muscle tissue.

Sugar cravings[23] are one of the most notorious and best-known symptoms of hypoglycemia. If a sugar fix reduces the cravings, it means that your pancreas is functioning well, and that your body’s sugar uptake[24] is adequate. In other words, you’re free from two primary components of the diabetic syndrome: insulin deficiency and insulin resistance. Paradoxically, the healthier you are, the more bothersome the symptoms of hypoglycemia become, precisely because your pancreas is able to produce so much insulin, and your body is able to uptake blood sugar so quickly.

A 70 kg (155 lbs) human body contains about 5 liters (5.3 qt) of blood. The glucose in blood is measured in milligrams (1/1000 of a gram) per deciliter (1/10 of a liter) of blood. At 80 mg/dl—an ave­rage normal concentration of glucose between meals—there are only 4 g of glucose in the whole bloodstream; a rather tiny amount. That’s why a sudden surge of insulin in a healthy person can bring the level of glucose dangerously low before other regulatory mechanisms kick in to stabilize it.[25]

The leading causes of hypoglycemia in people affected by diabetes (whether diagnosed or not) are insulin resistance, insulin therapy, and drugs that lower blood sugar. Insulin resistance is a metabolic syndrome that describes an impaired body’s response to both insulin and glucose. Simply speaking, it means that a person requires more insulin and glucose to maintain a level of blood sugar above the hypoglycemia threshold. It also means that “normal” blood sugar is a relative value: what may be normal level for one person, may represent hypoglycemia for another. That’s why there isn’t a specific fixed blood sugar level that tells you where normal blood sugar ends and hypoglycemia begins. Some people, for example, can function perfectly well at 60–70 mg/dl, while others may faint. In general, a level of 40–50 mg/dl is considered the cut-off point—meaning that the blood sugar level is low enough to cause severe symptoms of hypoglycemia.

Fainting (hypoglycemic syncope, coma) is the body’s defensive mechanism of recovering from severe hypoglycemia and preventing brain damage. Most people recover from fainting in less than a minute. Nevertheless, the experience is quite jarring, especially when one is “operating machinery.” By the time a recovered victim is presented to a doctor, the blood sugar and other vital signs are already normal. Diagnosing hypoglycemia from a blood test taken even minutes after the fainting episode, is, obviously, impossible.

The treatment of hypoglycemic syncope has become a profitable business for hospitals, whose emergency rooms receive a steady stream of relatively healthy people affected by it. The profit comes not so much from stabilizing a patient, but from admitting him or her to a hospital for a comprehensive checkup, often at the patient’s or family’s insistence. Besides wasted time, money, and nerves, this kind of testing is never without harm: a full-body CT scan or angiography, for example, exposes the patient to a huge dose of radiation, but without any worthwhile cause. Radiation exposure is cumulative, and can contribute to cancers down the road.

The symptoms of drunkenness—dizziness, blurred vision, muscle weakness, slurred speech, sugar cravings—are identical to the symptoms of hypoglycemia, because alcohol impairs glucose metabolism and affects our behavior by depriving the central nervous system (CNS) from its fuel. This, incidentally, is why very sweet cocktails, such as a Kamikaze (vodka, triple sec, sweetened lime juice) or Long Island Ice Tea (gin, vodka, rum, tequila, orange liqueur, and sugar syrup) keep your brain, at least for a while, quite sharp, while your wobbly legs can barely hold you: your brain is flooded with high blood sugar, but glucose uptake by the muscles is literally turned off..

If you do get tipsy from drinking, suck on sugar cubes or glucose tablets to recover your composure somewhat. If you’re irrespon­sible enough to drive while drunk, this technique will make you a bit less dangerous to yourself and others. It will not reduce your blood alcohol level in any way, but will only increase the immediate availability of glucose to your brain. Correspondingly, this may slightly improve your vision, concentration, and reaction time. If you do get caught and lose your driver’s license—you deserve it. So don’t drink and drive. My family may be crossing the intersection in another car.

Diabetics are trained to anticipate and prevent extreme hypoglycemia. Similar techniques, sans measuring blood glucose with a personal glucometer, apply to healthy people. They are described at the end of this section.

You may not experience hypoglycemia while consuming carbohydrates as usual, but it may hit you over the head hard as soon as you cut down on them, or drop them altogether. That’s what the Atkins and similar diets have done to hordes of unsuspecting people who went from a high- to zero-carb diet overnight, completely unprepared. You don’t really want to repeat their unfortunate experiences: relentless migraines, severe fatigue, alarming drowsiness, intense depression, obnoxious irritability, impaired speech, blurry vision, lapsed memory, sometimes a scary bout of fainting. To prevent all that from happening to you, too, aren’t you better off knowing why it’s happening and what you could do to avoid it?

Let’s address the why question first. It’s simple: When you cut down on carbohydrate consumption, your pancreas, still unaware of the sudden change, releases more insulin than is now required. This happens because a healthy pancreas releases insulin in two stages. The first stage is an unconditional release of stored insulin in anticipation of, or in response to, a meal. The second, and much later stage, is a response to glucose as it gets assimilated from digested carbohydrates.

When you cut down on carbs, the unconditional release of stored insulin is adjusted to your new eating pattern gradually. While the adjustment is taking place, you may still experience moderate headaches, similar to ones that can happen while waiting for a meal or missing one. I call this condition the “hungry spouse syndrome,” because, in addition to the headache, elevated insulin makes people irritable and angry. For the same reasons, hyper­insulinemia is often at work in abnormal behavior patterns such as road rage, spousal abuse, workplace violence, and the like. The more insulin and glucose in the system, the more violent and aberrant the behavior.

So if you don’t rush things, and reduce carbs step-by-step, the pancreas will gradually adapt to your new diet, and insulin-induced hypoglycemia will go away for good. For a trouble-free transition, your strategy must be preventing hypoglycemia from occurring in the first place. Tactically, you have to be ready to address its symptoms without resorting to carbs. First, let’s establish the strategic rules:

• Gradually exclude nutritionally marginal sources of simple carbohydrates, such as soft drinks, ice cream, candies, pastries, preserves, fruit juices, and fruits with a high sugar content, such as grapes or mangos. Spread this phase out over several weeks, until you no longer experience cravings.
• Substitute fresh milk with natural yogurt. One cup of milk, whether skim or whole, contains almost a tablespoon of milk sugar (lactose, 12.8 g per 244 g cup). Natural yogurt is practically lactose-free.[26]
• Gradually reduce the most “offensive” sources of complex carbohydrates, such as cereals, pasta, bread, baked goods, pizza, potatoes, beans, and the like.
• White rice is the least “offensive” source of dietary carbohydrates, especially during the transition to a low-fiber diet. In addition to a relatively low ratio of carbs-to-weight after cooking, it’s also fiber- and gluten-free. Consumed in moderation, it is a versatile substitute for grains and potatoes.
• Avoid artificial sweeteners. The oral sensation of sweetness causes an almost identical (by volume) release of insulin, even when the source of sweetness is 100% sugar-free. From a hypoglycemia point of view, artificial sweeteners present a double jeopardy: lots of insulin in the blood on one hand, zero carbs coming from food on the other. This means no diet sodas of any kind, especially on an empty stomach.

Reducing needless carbs isn’t rocket science. There aren’t too many strategic rules, and these rules are plain simple and grounded in common sense. Just don’t rush. If you’ve been consuming carbohydrates for years, cutting them down in the too-quick span of a week or two isn’t going to make any difference. Your goals are health and happiness, not coma and misery.

Let’s get down now to the day-to-day tactical rules. While implementing the above strategy, concentrate on the following spe­cifics:

• Do not drop your morning tea or coffee while still reducing carbs, because the double impact of caffeine and sugar withdrawal is too severe. Once you’re done with carbs, you may consider reducing coffee and tea consumption gradually, because caffeine stimulates metabolism, and contributes to hypoglycemia as well.
• In the overall scheme of things, one or two teaspoons of sugar (5–10 g) with your morning tea or coffee is safer than any factory-made ersatz sweetener. I’m not encouraging sugar consumption, just emphasizing the obvious.
• Avoid alcohol[27] in any form, because it causes intense sugar cravings, as strong as those from too much insulin. If you still like your glass of wine with dinner, don’t drink it on an empty stomach, only after you’ve eaten some food. This prevents the easy passage of alcohol into the intestines, ensuing quick absorption, and a rapid sugar-lowering effect.
• Low-fiber (preferably skinless) vegetables, such as spinach, zucchini, squash, eggplant, tomatoes, and cucumbers are acceptable, because their carb content is low.
• If you don’t have any digestive disorders, and chew your food well, leafy vegetables such as lettuce, spinach, chard, collard greens, watercress, and the like are acceptable in reasonable amounts. In larger amounts they should be avoided, because they may impede gastric digestion and intestinal transport.
• To keep your sanity intact, the occasional piece of bittersweet dark chocolate is acceptable to reduce strong sugar cravings. Just don’t abuse it, and don’t swallow the chocolate quickly, but allow it to melt under your tongue. This way the sugar absorbs right into the bloodstream, so you can quickly relieve the craving with the smallest possible amount of carbohydrates.
• If you do experience severe hypoglycemic symptoms as described previously, always carry sublingual glucose tablets. They are intended for people with diabetes to manage insulin overdosing, and are available at any drugstore.
• Each glucose tablet contains from 3 to 4 g of pure glucose, almost as much as the total normal volume of glucose in the blood. When placed under the tongue, the glucose rapidly absorbs into the bloodstream, and quickly relieves hypoglycemic symptoms.
• In an emergency, you may substitute glucose tablets with lollipops, hard candies, sugar cubes, grapes, grape juice, or non-diet soft drinks. All of these are acceptable substitutes, but only if kept in the mouth until hypoglycemic symptoms are reduced. Swallowing them will not have any rapid effect.

Keep in mind that drinking sweet juices or soft drinks after a meal is only marginally effective for hypoglycemia relief, because carbs can’t get down quickly enough into the intestines where most of the glucose normally gets absorbed. The absorption of complex carbohydrates is even slower, because pancreatic enzymes must first break them down.

The relative speed of digestion and assimilation of carbohydrates is measured by the glycemic index (GI), which breaks them down into “fast” carbs (like glucose, at 100 GI) and “slow” carbs (like barley, at 22 GI). This measure is widely used by people affected by insulin-dependent diabetes to balance medicinal insulin with carbohydrate consumption.

The glycemic index doesn’t measure carb content, meaning that consuming 28 g of sugar and 100 g of cooked barley will yield the same amount of carbs (the rest is water), but barley will take five times as long to digest and assimilate completely. For healthy people, low glycemic foods are even more harmful than sugar, because they force the pancreas to secret insulin for much longer periods of time, and are the primary culprits behind chronically high levels of insulin.[28]

The glycemic index isn’t a helpful measure for managing hypoglycemia in diabetes-free individuals because carbs are carbs no matter what, and to curb insulin production you must first curb carbs. There isn’t such a thing as “less offensive” or “healthier” carbs. After all kinds of carbs get digested, the blood “sees” nothing but glucose,[29] and it doesn’t care in the least what the name of its original source was—sugar or barley.

Finally, keep in mind that stress, physical as well as emotional, lowers the blood sugar, and stimulates the rapid release of stress hormones, including insulin. That’s what’s happening to young, healthy girls during rock concerts—their blood sugar level goes down from mind-bending excitement, and they faint. If you, too, have been experiencing moderate symptoms of hypoglycemia, rock concerts or not, carry easily accessible glucose tablets with you at all times, and instruct people close to you where to find them, if needed.

Depending on your age and shape, a transition to a low-carb diet takes anywhere from a few weeks to a few months. To “uncondition” the pancreas from flooding the body with insulin in response to stress (a very palpable reaction in the area of the solar plexus) is a much longer process. When you’re no longer experiencing a dry mouth, trembling fingers, bulging veins, and emotional rage in response to family disputes, job-related altercations, or to someone cutting off your car, you’re finally “unconditioned.”

As you can see, it’s really very simple: common sense, a basic knowledge of human physiology, a small preventative (glucose tablet), and more attention to details. Do all this, and your transition to a low-carb diet will be easy, safe, and enjoyable.

When incompetence colludes with ignorance, good becomes bad, and vice versa. That’s essentially how we got hooked on carbs and fiber in the first place. High-carb diets happen to be high-water diets. When carb consumption goes down, so does water consumption, and the mouth feels dry. If you ask carb advocates what’s going on, they tell you that low-carb diets causes dehydration. If you ask me what’s going on, I’ll tell you: Drink a glass of water! Of course, there is more to this oddity than just a glass of water, and that’s our next subject.

A low-carb diet doesn’t cause dehydration per se. It’s quite the opposite. People who eat less carbs urinate less and perspire less because excessive blood sugar isn’t affecting their kidneys as much, and their body temperature—one of the yardsticks of metabolism—isn’t as high.

Nonetheless, a lot of unscrupulous or misinformed medical professionals claim that a low-carb diet does cause dehydration, because people who switch to low-carb diets experience certain dehydration symptoms, such as dry mouth, reduced output of urine, low blood pressure, fatigue, etc. So let’s take a look at what’s actually going on:

• When you are cutting down carbs, this often means reducing soft drinks, juices, fruits, milk, and so forth—all foods with a very high intrinsic water content. Naturally, when you are consuming so much less fluids, the urine output goes down as well.
• Low blood pressure is related to three factors: less fluids in the diet, a reduction of triglycerides, and a reduction of insulin. These are all cause for celebration, not concern. You may feel a slight dizziness for a short while because the body needs time to adjust to normalized blood pressure.
• Fatigue is more likely a function of transitional hyperinsulinemia than dehydration. To make sure you aren’t fatigued from dehydration, just drink a glass or two of quality mineral water on an empty stomach.
• The temporary vestiges of hyperinsulinemia cause a dry mouth condition (xerostomia), because insulin action deprives the salivary glands of essential fluids. This creates a perception of dehydration.
• The assimilation of water from food and beverages among people who consume mostly carbs is different from people who consume mostly proteins or who eat a mixed diet. Since almost all water absorbs in the intestines, it can’t get down there while the stomach is busy digesting. That may also cause temporary (while food is digesting) mouth dryness.
• Drinking more water after a meal doesn’t alleviate a dry mouth for the same reasons. Hence you need to change your pattern of water consumption—not with a meal or after a meal, but always thirty to sixty minutes before a meal.
• The digestion of protein requires significantly more saliva, gastric and pancreatic juices than does the digestion of carbohydrates, up to 7–8 liters during one day. All of these fluids are derived from interstitial fluid, plasma, and lymph (collectively, extracellular fluids).
• When all extracellular fluids are mobilized for digestion, a person may temporarily feel some symptoms of dehydration. Most of the water is absorbed back after digestion is completed.
• A moderate to high consumption of proteins requires more innate fluids for the digestive process, while carbs require almost none, because of their intrinsic water. Some people fail to compensate for this difference, and experience dehydration.
• A low-carb diet is often a low-potassium diet. The deficiency of potassium may cause a dry mouth condition, and create the perception of dehydration, even when the levels of water in the body are adequate.
• People who consume low-sodium diets may experience dehydration, because sodium is an essential electrolyte responsible for water retention. People on low-carb diets usually increase the consumption of proteins, but fail to adjust their salt intake.

As you can see, transitional dehydration is partly perceptual, partly actual, but easily correctable and preventable. Here are the steps, some of them already mentioned in other chapters:

• Hydrate in advance. Get used to drinking liquids before a major meal to build up the water reserves needed to produce saliva and digestive juices. Most of the water that you consume with a meal will not get absorbed until it gets into the small intestine hours later, especially if your meal contains protein.
• There are no rules. The volume of liquid very much depends on what you are going to eat and drink, i.e. the water content of food, and how much food. Just experiment until you hit a sweet spot—your mouth is neither getting dry, nor are you constantly running to the bathroom.
• Supply base liquids for digestive functioning. If you haven’t had soup or a salad containing water-rich vegetables, such as tomatoes or cucumbers, wash down a protein-rich meal with a glass of mineral water, preferably noncarbonated. This water will be used by the stomach to concentrate the gastric juices. If you don’t provide enough liquid, the stomach will draw water from the blood plasma. This is one of the reasons why certain meals make you drowsy—it’s a response to lowered blood pressure.[30]
• Limit liquids with meals. Do not consume too many liquids with meals, because an excess of liquids lengthens digestion, delays stomach emptying, and may cause heartburn. Also, the more liquid you ingest, the more hydrochloric acid and digestive enzymes your body must produce to properly break down food.
• No liquids after meals. If you are experiencing thirst an hour or two after a major meal, don’t drink. First, water will not relieve your thirst anyway, because it can’t get assimilated while food is still churning in the stomach; second, excess water will prolong digestion and will make it even more difficult and inefficient. Wait from four to six hours before taking any liquids.
• Keep the mucosa moistened. To relieve dry mouth and the perception of thirst after a meal, take small sips of carbonated, sugar-free mineral water and swirl it around—bubbles stimulate the saliva glands and break down dense saliva. There are some other methods, such as chewing gum, lozenges, mouthwashes, and saliva replacements, but I can’t vouch for any of them.
• Don’t abuse salt. Once the meal begins to be absorbed, excessive sodium chloride can cause thirst and dry mouth, even though you may already have plenty of fluids inside the body. To avoid overhydration and resulting edema, swelling, excessive urination, potassium depletion, and other perils, be aware of the hidden salt in all processed food.
• Add natural potassium. Drink one to two glasses of cucumber juice (with skins) daily, an hour before meals. Salt to taste. Cucumber juice is rich in potassium (about 350 mg per 8 oz) and practically free of carbs. Because it’s free of sugar, refrigerated cucumber juice stores well. Juice a batch once or twice a week from large seedless cucumbers—each yields about a cup of juice.
• Watch out for alcohol. A dry martini isn’t called “dry” for nothing. After one too many the mouth indeed feels quite dry. Beer, wine, and spirits represent triple jeopardy to the digestive pro­cess: alcohol is a potent diuretic (drying factor), excess water (with drinks such as beer and wine) disrupts digestion and electrolyte levels, and alcohol is a major stimulant of appetite, because it disrupts glucose metabolism (lowers blood sugar). The outcome of too much alcohol, too much food, and too much water all at once is as predictable as nightfall—indigestion causes vomiting, vomiting causes dehydration, dehydration causes hangover. More temperate drinking spares you of the vomiting, but causes all the same side effects nonetheless (indigestion, dehydration, hangover). If you can find a way of drinking that causes none of the above, here’s to you, pal!

Finally, if anyone tells you that a low-carb diet is dangerous for the kidneys, that’s simply not true. You may hear two ubiquitous arguments:

• A low-carb diet causes dehydration, and dehydration is dangerous for the kidneys. Well, we already debunked that myth above. To neutralize that nonsense, instead ask why kidney disease, kidney failure, and dialysis are the most common conditions among people who are overweight or diabetic, and are consuming a high-carb diet?
• Elevated protein in urine results from consuming too much protein. That’s an interesting deception. “Protein in urine” is actually an albumin, a blood protein manufactured by the liver. Albumin main­tains proper osmotic pressure in order to prevent blood plas­ma fluids from flooding and exploding the blood cells. When the kidneys are healthy, large molecules of albumin can’t pass its filtration membranes. Damaged kidneys let albumin out, and that’s what’s being measured and detected during a test for “urine protein.” This condition is called albuminuria.[31] It’s true that digestion breaks food proteins down into amino acids, but albumin isn’t one of them. To neutralize that “protein in urine” non­­sense, ask what kind of proteins are detected in the urine, and in what way are they related to proteins in food?

Live and learn! No wonder the well-learned live longer.

Rejecting fiber and reducing carbohydrates also means giving up lots of processed foods that are artificially fortified with iron, calcium, and A, D, and B-complex vitamins. For most people, whose diets have already been sub-optimal for some time, this final step will cause malnutrition related to the acute deficiency of those nutrients, unless they are replaced with quality supplements. That’s our final challenge.

Does the above mean that a high-carb diet is better and safer, nutritionally speaking? No, it doesn’t. Cereals, orange juice, and skim milk—foods you are close to giving up—are all considered “health foods.” Here is the rational behind this thinking, and the actual results:

• Wheat cereals, nutritionally speaking, are useless—just starch, added sugar, and extra fiber. To make cereals a “health food,” synthetic vitamins B1 (thiamin), B2 (riboflavin), B3 (niacin), folic acid, and iron (ferrous sulfate or fumarate) are added to flour during milling. The fortification of wheat flour is mandated by the U.S. government in order to prevent deficiency-related diseases, particularly birth defects, iron-deficiency anemia, and developmental problems in children. Ironically, the widespread allergy to gluten—a protein in wheat—blocks the digestion of iron and folic acid, and is one of the leading causes of pernicious anemia among millions of young and old Americans alike. That’s on the one hand. On the other, if gluten causes you no harm, according to the research team from the Center for Food Safety and Applied Nutrition (a division of the Food and Drug Administration), the remedy is worse than the problem:

And these are problems on top of the already certifiably harmful content of breakfast cereals: gluten (allergies), sugar (obesity), fiber (digestive disorders), and trans fats (cancers). Some “health food,” isn’t it?

• Skim and reduced fat milk[33] is fortified with synthetic vitamins A (retinyl palmitate) and vitamin D3 (7-dehydro-cholesterol), because natural vitamin A is lost during the removal of fat, and milk is naturally low in vitamin D. Some dairy products are also fortified with calcium, because natural calcium is bound by milk proteins, and digests poorly. The fortification of dairy with vitamin A is mandated by the U.S. government in order to prevent blindness and poor immunity, both vitamin A deficiency disorders. Vitamin D is supposed to protect children from rickets, teenagers from scoliosis, and adults from osteomalacia. Ironically, the fat-soluble vitamins A and D found in skim and reduced fat milk are mostly useless, because they don’t digest without fat. Adding insult to injury are widespread allergies to casein (milk protein), and lactose intolerance, which affects tens of millions of Americans. Both conditions cause intestinal inflammation, and render vitamins A, D, calcium, and everything else futile. In addition to zero health benefits from drinking skim or low-fat milk, kids are getting fat:

That’s the conclusion from a survey of 12,000 children between 9 and 14 years of age, conducted by Harvard University researchers, and published in the Journal Archives of Pediatrics & Adolescent Medicine in June of 2005.

• Orange juice is routinely fortified with synthetic vitamin C to compensate for oxidative losses of natural vitamin C during its manufacturing, packaging, storage, and transportation. To make additional health claims, some producers of orange juice have begun adding supplemental calcium. There is a trend toward adding vitamin D to orange juice as well, even though it wouldn’t get absorbed from a zero-fat beverage. Besides, the high sugar content and high acidity of orange juice causes more minerals to get depleted through the urine than what’s added at the factory. The problem is so acute that the American Academy of Pediatrics has been telling parents to avoid excessive juice consumption:

The authors don’t specify what’s excessive. Well, here’s the math: on a body weight-basis, a glass of juice for a three-year-old at 40 lbs is equivalent to four full glasses for an adult at 160 lbs. You wouldn't drink four glasses of orange juice a day, would you?

And it doesn't sound like a description of a “health food,” does it? Nonetheless, a bowl of cereal with skim milk and a glass of orange juice has become more American than the proverbial apple pie.

If that’s your breakfast, check out the table below. As you can see, along with a meager fix of mostly synthetic vitamins, inorganic iron, and supplemental calcium, this kind of breakfast also “delivers” 15 g of fiber and 61 g of carbohydrates, or the equivalent of 5 tablespoons of sugar. That’s over one half the daily total requirement for an active 7-year-old, and over one third for an adult, all from just one breakfast which, by conventional standards, is pretty paltry and more like a sustenance ration for prisoners of war than your average American breakfast.

Not surprisingly, most adults who start their day with this kind of “healthy” and “natural” breakfast are fatigued from hypoglycemia by the time they get to work, while many children can’t concentrate or sit still at school because they’ve already ingested over half of their daily energy requirement. Adults counteract this problem with a cup of strong coffee, children—with Ritalin.

It’s easy to understand and appreciate the intentions behind the fortification of basic food. A humane society must take care of all of its citizens, no matter what their income, social status, education, or age. So, beginning in 1941, the U.S. government begun formulating paternalistic nutritional policies for society’s most disadvantaged—inmates in prisons and psychiatric asylums, children in orphanages, patients in nursing homes, conscripts in the army, underprivileged kids in urban ghettoes, and so on. Had the govern­ment failed to provide its less fortunate citizenry with a sustenance ratio of essential nutrients, the budgetary burden of treating scurvy, rickets, and birth defects, providing dogs for the blind, or funding more and more nursing homes would be enormous.

That’s what the standard “healthy nutrition,” promoted by the so-called “Dietary Guidelines for Americans,”[37] represented by the Food Guide Pyramid[38] (called MyPyramid, after 2005) is all about—sustenance, and the prevention of birth defects and degenerative diseases. It isn’t about maintaining good looks, youthful bodies, vibrant sexuality, ageless minds, boundless longevity, and, of course, a healthy and functional large intestine. There is absolutely no way to get “quality out” of a diet developed for the impoverished.

But, then, you read this book, take its reasoning to heart, and decide to reduce carbs from your diet and cut out the fiber. No more bread, no more pasta, no more cereals, no more orange juice, no more milk, no more food that harms your digestive, endocrine, nervous, and reproductive systems. You avoid eating too many obesity-causing carbs, too much gut-busting fiber, too much allergenic gluten, too much diarrhea-causing lactose, and too many cancer-causing trans fats, while finally getting enough essential fats and primary proteins.

There is just one problem with this smart decision—just as a high-carb diet without fortification would be, a low-fiber diet is also notoriously deficient in iron, water-soluble vitamins, minerals, and microelements. And that’s on top of the distinct probability that your body is already seriously lacking essential nutrients from years and years of dietary neglect. Where do you get these indispensable nutrients from, if fortified cereals, breads, pasta, juices, and milk are no longer desirable or acceptable? Well, there are two options:

• Best: Move to the countryside, drink unprocessed well water, eat pristine, organically grown produce, and hope that your neck of the woods isn’t deficient in iodine, affected by acid rain, or contaminated by dioxin and DDT.
• Second best: Take quality supplements to augment the essential vitamins, minerals, and microelements lacking in the low-carb diet you’ve adopted.

If the first option isn’t yet a viable one for you, then the question is: What kind of supplements should you take for best results? Now you have three options:

• Consumer-quality supplements that contain USDA Recommended Dietary Allowances (RDA)—the standards similar to those found in fortified food. These are your typical One-A-Day, Centrum, Therargram, and the like. To minimize price and maximize profit, some of them are made in Asia, compressed into one large tablet, and covered with artificial coloring to mask oxidation and enhance shelf life. These supplements are available just about anywhere, are inexpensive, and are definitely better than nothing. Just like with iron and folic acid in wheat flour, they’re intended to prevent degenerative disease, not to promote vigorous health and longevity. If you believe you can get long-lasting health benefits from a single daily tablet, you may as well ignore much of what you’ve learned in this book.
• “Natural” supplements from well-known brands, such as Twin­lab, Country Life, Schiff, Solgar, and others, which use the Optimal Daily Allowances(ODA) to formulate their products. ODA is a set of more evolved nutritional standards, which recommends a higher intake of essential nutrients well within the upper limits of safety. These supplements have been used for decades by tens of millions of Americans without side effects or objections from the Federal Drug Administration, U.S. Department of Health & Human Services, the Surgeon General, or the National Institutes of Health. The “natural” designation has more to do with marketing than content. Quality, value, and effectiveness-wise, these supplements are in the middle.
• “Professional” supplements. Also formulated around the Optimal Dietary Allowances (ODA), these are made from pharma­ceutical-grade ingredients, and marketed primarily through nutritionally-oriented medical professionals. They’re optimized for maximum bioavailability, meaning the best possible safety, assimilation, and effectiveness. Doctors who specialize in performance medicine, preventive healthcare, and longevity, recommend and distribute these type of supplements, hence their “professional” designation. Not surprisingly, the majority of big name celebrities, big league athletes, big shot politicians, bigwigs in business, and medical professionals big on knowledge (the kind of people whose careers are built on their energy, vigor, and healthy appearance), take these kinds of supplements to protect their biggest asset—themselves.

A great many degenerative conditions that stem from malnutrition, such as nerve damage, muscular dystrophy, mucosal atrophy, endocrine disorders, emotional problems, and atherosclerosis, can be partially reversed by using quality supplements. Besides, anything that can make sick people well again, makes healthy people great. Here’s the basic list:

Professional-quality multivitamins

The key to professional-quality multivitamins is flexibility. Unlike consumer or natural brands, they aren’t packaged into a one-size-fits all one or two hard tablets, but into easy-to-digest capsules. These type of supplements usually don’t include iron. This way, to prevent iron overload and associated toxicity, women who are pregnant, lactating, or of child-bearing age, women past menopause, children, teenagers, and adult men (all of whom have varying needs) can safely supplement iron on an individual basis.

Other considerations are safety-related: the type of manufacturing, the quality of components, and the level of testing used for professional supplements is similar to the pharmaceutical industry, where the stakes are higher and the oversight of safety is more rigor­ous than for food-grade supplements.

Professional supplements are usually obtained through medical professionals. They are manufactured in small batches to avoid adding fillers, preservatives, stabilizers, glazing, and artificial co­lor­ing. For these reasons they’re considered hypoallergenic.

Nutritionally-oriented doctors, nutritionists, and dieticians can point you in the right direction. Or you can consider using Ageless Protection multivitamins that myself and readers of my earlier books have been taking since 1999. They are manufactured in the United States by a top-tier professional supplement company, which is considered the leader in this area.

Additional information about Ageless Protection multivitamins, including a list of components, warnings, dosage, and other considerations, is available at www.FiberMenace.com.

In addition to Ageless Protection multivitamins, three ubiquitous supplements are recommended for people recovering from fiber dependence, constipation, and more serious digestive disorders, such as irritable bowel syndrome, ulcerative colitis, and Crohn’s disease:

Dietary iron

Unprocessed water from springs and wells, red and organ meats from pasture-fed animals, and cast iron cooking utensils used to provide dietary iron to our ancestors. Not anymore. Tap and bottled water has little or no iron; red and organ meats are out of vogue, consumed infrequently, or kosherized (the blood—a main source of iron—is removed); non-stick and stainless steel cookware has replaced cast iron; and people with intestinal disorders aren’t able to digest iron even when it’s plentiful.

Hair loss is one of the most prominent symptoms of low-carb diets, which is caused by iron deficiency. Actually, a low-fiber diet is great for one’s mane, because it supplies the essential proteins and fats required for the maintenance of a healthy scalp and hair. Besides, a low-fiber diet inhibits the production of dehydrotestosterone—the hormonal trigger for age-related male pattern baldness.

The prevention of iron-deficiency anemia is essential for overall health and well-being in general, and intestinal health in particular. Conventional iron supplements are known to cause constipation and digestive distress, which makes them unsuitable for people with intestinal disorders, who need extra dietary iron the most.

Water-soluble iron carbonyl is considered the most efficient and the least side-effects prone form of iron. You can obtain iron carbonyl supplements at better health food stores.

Vitamin B12

Normal intestinal flora on the inside, and red and organ meats in the diet, used to be primary sources of vitamin B12. Digestion of dietary B12 is complicated by the need for the intrinsic factor—an actual term used in medical books, meaning an enzyme whose biochemical nature is unknown. This intrinsic factor is produced by the stomach and intestines during digestion and absorption, and is usually missing in people with digestive disorders.

A deficiency of vitamin B12 affects the formation of red blood cells (pernicious anemia), causes nerve damage, intestinal malabsorption, Crohn’s disease, and is implicated in chronic alcoholism and indirectly in an array of other degenerative disorders.

Here are the most prominent deficiency symptoms of vitamin B12, grouped by the affected systems:

• GI tract: sore mouth and tongue, loss of appetite, anorexia, diarrhea, and constipation.
• Nerve damage: loss of anorectal sensitivity, inability to have an orgasm, numbness and tingling of hands and feet, ringing in the ears.
• Anemia: weakness, fatigue, paleness, and shortness of breath.

A healthy person won’t have any problem assimilating vitamin B12 from an adequate diet or oral supplements. But for someone with a history of digestive disorders, constipation, and fiber-dependence, a regular diet and oral supplements may not be effective because of an intrinsic factor deficiencyand compromised absorption through the intestinal mucosa.

In those cases the most efficient path for Vitamin B12 into the body is via intravenous infusion, which isn’t practical on a day-to-day basis. The second best is a sublingual form of vitamin B12, because it absorbs through the mouth’s mucosa directly into the bloodstream.

You can obtain sublingual vitamin B12 at better health food stores.

L-Glutamine for intestinal recovery

The amino acid glutamine is the principal metabolic fuel for the intestinal mucosa, or, more specifically, for the cells that line the intestinal epithelium (enterocytes). For this reason, the small and large intestines require more glutamine than any other organ.

A deficiency of glutamine causes atrophy of the intestinal mucosa, a condition commonly associated with chronic enteritis, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. All of these disorders, in turn, are associated with chronic constipation, something you want to prevent and avoid during the transition.

Glutamine is readily synthesized in human cells. It is also the most prevalent amino acid in intestinal tissue, blood, skeletal muscles, the lungs, liver, brain, and stomach. When the demand for glutamine exceeds the internal supply—because of trauma, disease, infection, medical treatment, digestive impairment, dietary deficiency, starvation, and similar circumstances—the body must get it from the diet or from supplements. For this reason glutamine is designated as a “conditionally essential” amino acid.

Just like with any other amino acid (except essential), when the diet lacks the adequate amount of protein required to synthesize glutamine, the body draws it from itself. Muscle and bone-wasting (i.e. osteoporosis) is one of the first and most prominent symptoms of acute glutamine deficiency.

Meats, fish, poultry, dairy products, and beans are the main dietary sources of glutamine for people with normal digestion. Because beans cause flatulence and bloating related to their high-fiber content, they are an inappropriate source of glutamine for anyone but the young and healthy.

For people who already suffer from intestinal disorders, regular diets can’t provide adequate glutamine regardless of the source, because they have difficulties digesting dietary protein to begin with. Ironically, this impasse is caused in part by... glutamine deficiency. There is only one way to break this vicious cycle: by using glutamine in supplemental form.

Glutamine supplements are available in three forms: (1) as L‑Glutamine, a free-form amino acid, which means it’s identical to the glutamine present in the body; (2) as glutamine peptides, which means it is bound with other amino acids; and as (3) a mix of both.

Glutamine peptides are considered more stable during storage, but are known to cause constipation and bloating, and are contraindicated for people with kidney disease, and women who are pregnant or nursing. For these reasons glutamine peptides aren’t appropriate for the treatment of constipation and digestive disorders.

There are no known side effects associated with pharmaceutical-grade supplemental L-Glutamine, because, as has been already said, it is identical to naturally-occurring glutamine in the body, and doesn’t need to be predigested, as glutamine peptides do.

Glutamine supplements are especially popular among athletes and body builders, and are broadly available in health food stores in the form of water-soluble powders, tablets, or capsules. Depending on the degree of intestinal damage, you may require from 15 to 30 grams of L-Glutamine daily, hence neither tablets or capsules are practical or economical to accomplish this goal.

Pharmaceutical-grade L-Glutamine is best for supplementation because of its purity and exceptional digestibility (bioavailability). For best results it must be taken on an empty stomach, so it gets down into the intestinal tract without being held up by gastric digestion. Most of the supplements for athletes sold in health food stores contain food-grade L-Glutamine, or are mixed with glutamine peptides.

You may want to consider the Glutamine Powder. It is manufactured in the United States by a professional supplement company from pharmaceutical-grade L-Gluta­mi­ne. It is specifically formulated for intestinal recovery, particularly during the transition to a low-carb diet, and for improving the retention and survival of intestinal flora on fiber-free diets. To better accomplish this task, it contains small quantities of natural soluble fiber (acacia fiber and inulin) which are preferred by normal flora, but do not “appeal” to pathogenic bacteria. In these small amounts, neither causes the bloating or flatulence associated with soluble fiber.

And that brings us to the final challenge of transition...

If you are slightly bewildered by the “what’s for dinner (breakfast, lunch)?” question, don’t be! This book isn’t about what to eat, but about what NOT to eat!

Thus, if you like an Italian-style diet—reduce the fiber! If you prefer a French-style diet—reduce the fiber! If a kosher diet is your thing—reduce the fiber. If you love Japanese food—keep loving it, because it is naturally low in fiber. Whoever you are, whatever your heritage, no matter what your means are, you don’t need to change anything in your diet, other than reducing the darned fiber. No fiber equals no menace; no menace equals no harm.

Granted, this book (particularly this last part) sounds like a sermon for a low-carb diet. But not because I particularly care for a low-carb diet, or hate carbs—not at all. To the contrary, I love bittersweet chocolates, enjoy luscious strawberries with heavy cream, can’t resist the crunchiness of a fresh baguette smeared with a dollop of triple-cream brie, eat a dish of plain rice twice a day, can’t say no to a raspberry mousse at the end of a good dinner, and even indulge in a scoop of homemade ice cream from time to time.

So what? If you’re of normal weight, full of energy, free of diabetes, hypertension, heart disease, depression, and insomnia, as I am, keep doing what you’ve been doing. But if not, it’s critical to do the right thing: drop the fiber, reduce the carbs, be patient, and eventually, you’ll be able to have your cake and eat it, too!

Still not sure what to eat? Following the acclaim of the Atkins and South Beach diets, more books have been written about the low-carb/low-fiber lifestyle than about any other “dietary” subject. Get any one you like. Fortunately, this time around, you wouldn’t have to suffer through constipation, indigestion, hypoglycemia, dehydration, or malnutrition.
Bon Appétit!

Footnotes