Dynorphin & a high-fat diet: implications pt.1

When I started eating paleoesque years ago (well before uppity bloggers came on the scene with their foolish dietary declarations and denunciations), I followed the low-fat, no-starch Cordain theory (he has since come to his senses and changed his stance). I bought The Paleo Diet and followed it pretty much to the letter for two months or so, all the while feeling wrong about the whole thing. It just didn’t make sense; why was I not deriving the promised satisfaction from this “perfect” diet that supposedly reflects our genetic heritage?

I started thinking about it with a little internet education behind me, and came to the conclusion that if man was on the hunt for the most calories with the least effort (in accord with our naturally lazy nature), it would make sense that he would know precisely which animals would be the fattest and at what times (in accord with our incredible intelligence). Also, many areas, dense and easy with underground tubers and storage organs, rich with calories, greatly satisfied and comforted those who threw them on the fire, perhaps wrapped in leaves.

~So I started experimenting; I first added starch from tubers back into my diet with a little trepidation. Back in my vegetarian days I based my eating on grains and beans; like every other veg-head, this was my foundation; protein must come from somewhere if not animals. To think that grains and beans could be anything but god’s food was unheard of, like oxygen cut off from the air supply. The problem was however, grass seeds swung my moods like bad ecstasy on a demented dance floor, and beans (speaking of air supply), particularly soy products like tofu and tvp offended not only those around me, but myself as well (let’s be honest, in a normal situation one must be a bit faggy if one’s own farts offend one’s self; but mine was definitely not a normal situation!). They also messed up my peristalsis unpredictably (with weekly bouts of diarrhea)… but tubers behaved themselves wonderfully. They not only gave back the energy I was lacking, they gave me comfort and soul peace too…

…but of course, me being me, I could not simply just leave it alone and keep doing that which worked, and worked well; nope. I had to keep screwing around and make it “better”. I read with interest the blogs that advocated a high fat, low carb way of eating, and stumbled upon Jan Kwasniewski’s Optimal Diet, with its protein/fat/carb ratio of 1:2.5-3.5:0.5. I thought, “heeeyyyy… I’vvve got ann’ ideeaaa… forrrmmin’ in me’ ‘ead. I can do these macronutrient ratios in a paleo context,” and then proceeded to royally fuck myself up for the next thirteen months of my life. Adopting this approach, I immediately felt like an inferno of power. It was great; seemingly endless energy. I thought I’d stumbled onto the holy grail of macro-ratios, an esoteric source of forbidden knowledge, sullied from view by an evil dietary cabal of political/religious/nutritional dictocrats. The better I felt, the more smug and pleased with myself I became, until I was a bronzed, cut, fat-fueled John Galt Übermensch, chuckling down, lovingly, condescendingly, at the little silly people scurrying about with their sandwiches, all the while pondering what I’d do with my new-found powers… should I use my awesomeness for good? for evil?… help the hungry?… world domination?…

…no matter; all that really counted was the fact that I was in the world, and all those within my light might bask in my cleansing glow and be better for just experiencing that which was me.

Normally, I log two or three thousand kms per year backpacking (this actually isn’t bullshit   ;D), hiking, biking, mountain climbing (it’s interesting that people with endorphin deficiencies gravitate to these activities to increase production). One particular weekend I became vaguely aware of the old people and toddlers passing me up on my way to Galatea lake in Kananaskis. I swore I could hear Justin Bieber in the ear buds of 13-year-old schoolgirls as they passed me on the trails looking sideways, then back at me, half-pityingly, like I was an old lady on my way to the church bake-off (ok, this was way before Justin Bieber). I wonder if they thought I was carrying knitting supplies and candy sprinkles for my secret cake recipes in my backpack. My best friend usually walks behind me when we hike together, but this time I was digging for excuses why I was dragging behind in a heart-pounding malaise. It all started going downhill, so to speak, from there. I increasingly began experiencing evening anxiety and a pounding hypertension that, while not too bad in the morning, averaged a systolic of well over 140, an alarming change from my usual circa 118. My days were suddenly adrenaline/cortisol fueled and my nights were spent in bed as a literally vibrating mass of teeth-clenched flesh, pondering his fate; at any given time the mirror showed a pale, cadaverous, gaunt spectre asking his reflection-source what he was going to do about this mess…

…I soon after smacked myself upside the head with a 2×4, went back to my fatty meat and greens/tuber/fruit based diet with some nuts and seeds thrown in, and am back to normal… not before scaring the shit out of myself though.

~It’s funny how people can find themselves trapped within any kind of paradigm, out of which they can easily step, but refuse because this or that belief, whatever it may be, is “The Way”, even if it might be killing them. Something like this is happening in the diet blogosphere these days, and people are turning into idiots following advice that may very well work for some, but because we’re all different, may quite literally destroy the health of others.

For those readers who haven’t the foggiest idea what I’m on about, there is an infantile mutual tantrum going on in the paleo/traditional dietsphere between various camps that has basically completely turned me off reading them… I refer you to the links to the right on my site. If you’re new to this nonsense and can stomach it, read them. But fair warning: besides one or two, they’re all full of shit these days and are no longer interested much in learning and giving humble opinions, just throwing mud and rhetoric at each other and defending pet theories. So you’ll have to go back into the archives of these blogs to a more wide-eyed and less jaded time.

…I haven’t linked to the biggest shit birds, but you’ll find them soon enough… they’ll make sure of that.

…so, allow me my own little declaration: let any self-proclaimed textpert of a diet blog, who preaches that a diet high in starch from whole foods is unnatural and will be your downfall, rot in the same fatty quagmire into which he sent many others…

…likewise, let one who has never known obesity and never experienced a broken metabolism, and turns up his nose at the obvious benefits for some of a low-carb/high-fat diet, shut his mouth and acquire a little humility and knowledge before he buries himself alive in his own stupid.

~Everyone is different, idiots… grow up.

~My involvement is emotional because I’ve been self-experimenting longer than most of these needledicks have pondered what they’d been shovelling down their pie holes, and I’ve consistently disproved the opinions of almost everyone with an opinion.

…Let it be known that this blog will never devolve into a mess of cracking, rigid dogma, with ideas locked in stone, made Official and thereby set upon a museum shelf to slowly rot, shrink and petrify with a semblance of truth in it, but covered with old webs of tenets…

…I will remain young-hearted and open with this, and want those who read this to understand that I will never let a broken desperate obese person leave here hurt and as confused as other sites may have left them. I will tell you to figure things out for yourself, in a paleoesque context (because that’s my open and particular bias). In my opinion, grass seeds, beans and dairy are unnecessary and insulinogenic, but one broken person may achieve great success with a whole-food, high tuber, very bland carby diet with zero food reward, while easily keeping calorie consumption down; while another may attain magical success with a healthy high-fat ruminant/seafood and greens approach, with no starch or sweet.

~next: pt 2

Is there a case for tramadol?

Tramadol is a mild opioid analgesic with weak agonist actions at the μ receptor; it also releases serotonin and inhibits the reuptake of noradrenaline. It’s scripted for moderate pain, restless legs syndrome and fibromyalgia.

Tramadol has been prescribed for refractory depression for years, overtly in the US as a last-line drug for depression and somewhat otherwise to trusted patients by intelligent doctors in other countries. Lurking around the internet however, one finds there isn’t as much love for this drug as for its opiate cousins. Because of its unusual actions, some are fairly content to use it with a few reservations, a very few love it (maybe because they have uncommon genuine serotonin issues), and most become disillusioned with it after a time (maybe because, like so many depressives, they don’t have serotonin issues); and tolerance is kind of an issue because of potential serotonin poisoning (god, I have a hate-on for serotonin), so in my opinion long-term use is not advised…

…but, and here’s the kicker, because of lack of knowledge patients who are scripted on-label for pain get caught in a trap of dependence and withdrawal hell. The net is filled with stories like these… …be aware.

Tramadol acts as a μ-opioid receptor agonist, serotonin releasing agent, norepinephrine reuptake inhibitor, NMDA receptor antagonist, 5-HT2C receptor antagonist, (α7)5 nicotinic acetylcholine receptor antagonist, TRPV1 receptor agonist, and M1 and M3 muscarinic acetylcholine receptor antagonist. This is one hell of a mechanism of action, and the very reason I’m wary of this drug. Calling it a “mild opiate” is like calling someone the world’s tallest midget… “like, so what?” Opiate withdrawal and PAWS are bad enough; now let’s combine O withdrawal with a SNRI-type withdrawal (Effexor discontinuation syndrome, anyone?), and fun and happy-happy joy times are right around the corner (I can see the balloons, confetti and flying ribbons already). I’ve been through SNRI discontinuation syndrome, and I cannot imagine dealing with, both at once, O withdrawal and SNRI withdrawal.  If one must abruptly discontinue for any reason (there are many…) and is into this stuff up to his neck, one had better get ready to take some time off work and possibly check into a medical facility; there ain’t no staying in bed with the Thomas Recipe, benzo’s and classical guitar cd’s with this stuff.

People are more and more advocating tramadol as a possibility for refractory depression, but I wonder if they’ve done their homework or don’t take seriously the potential for pain caused by this drug. Again, I have experience with these side effects and have no problem with the thought of saying “uhh… no.” Consider too, possible seizures for some, and tramadol starts to sound like not so much fun anymore. Indeed, a growing awareness regarding seizures appears to be another of tramadol’s bad raps…

…so, if one thinks combining tramadol with most mainstream antidepressants to increase efficacy might be the ticket, I would be inclined to put that thought away; maybe I’m wrong, but possible serotonin complications make this idea hard to defend.

~If your doctor is willing to script tramadol (imo, stacked with no other ADs), and you’ve done your homework and are aware of the negatives, you might be presented with an opportunity because it’s a “mild opiate” and maybe not so stigmatised by patronising (or just simply worried about a patient) doctors; maybe it is worth trying. As long as the supply doesn’t get abruptly cut off, you don’t develop a scary tolerance and this funny little opioid works as well as other “normal” opiates for refrac-depression, maybe try it out. There is evidence that tramadol binds to kappa receptors, but no evidence of wretched κ effects; so this is a big point in its favour. Just be careful and don’t beat a dead horse if it doesn’t work the way you want it to in the long-term…

…a blog-mate recently wrote that she takes a very small dose every few days to excellent effect. Maybe this is the way to go with this stuff. Little to no tolerance is built, and the potential for bad side effects is reduced big time.

I might look more into tramadol later, if my interest is piqued; but I can’t help feeling like a bit of an opie-snob with this stuff. Because of its obscure actions, this drug may be the holy grail for someone with an obscure kind of depression, but probably not much fun for most. I just don’t know if it comes close to “real” opiates for a person with EDS/refrac-depression…

…personally, I’d try LDN before tramadol.

Post-acute withdrawal syndrome & EDS: a PAWS for thought

When one hears vanilla horror stories about opiate addiction, the talk usually targets abrupt withdrawal following a tolerance level developed over time; this is a nasty state immediately following cold-turkey that lasts from a few days to, uncommonly, many weeks depending on the opiate involved and the person kicking (age, length of addiction, tolerance and amount, etc). However, most don’t realise that kicking is the easy part; who but the experienced has heard of post-acute withdrawal syndrome? Who but the experienced understands that PAWS, not the initial painful kick, is the reason why the ex-user becomes a re-user? Hell, even the oft-referenced and usually quite accurate Wikipedia when perused doesn’t really get into it until specifically unearthed, as a kind of aside, or curiosity.

PAWS has implications for the EDS depressed. Because depression during PAWS is increased to levels not experienced pre-opiated, one must make a difficult and informed decision. I can understand that it is better to be judged by twelve than to be carried out by six if antidepressants just don’t do it and existential despair is the only road ahead; but a possible lifetime of dependence is a frightening investment because, though the brain usually goes back to its pre-opiate state subsequent to kicking after some time… there is evidence that a somewhat unretracted state is possible…

…do you wanna roll the dice?

I suppose if I was a sixty year old man the decision to become dependent would be a no-brainer, provided I had permanent access to product. But a young person has more to think about… looking at a future married with kids and a lifetime of potential difficulties because of opiates, even if small non-abusive doses are taken. As well as PAWS, complications like hypogonadism and adrenal dysfunction, though usually reversible, are possible, and enough to scare any young person away from potential refractory depression relief via opiates (but that’s another post).

~The crux of the issue is that EDS depression can be controlled or eliminated with rational opiate therapy; but… a lifetime of opiate use will probably be necessary and, who knows, might in the long run make depression worse with decades of use or when one is forced by circumstances to quit dosing… and the future is filled with circumstances…

…but then again, what about decades of “legitimate” antidepressant use?

No one said making this choice would be easy.