Sourdough for mood and hyperglycemia

Not all carbs are equal. Several months ago I made a discovery of gluten-free sourdough recipes and now I eat it almost daily. I obtained a sourdough starter, and now that I have one, it can live on forever, as long as it gets fed. It can definitely outlive me! Feeding the starter is very simple and requires only two ingredients – brown rice flour and warm water. After being on a strict AIP diet for almost a year (a lot of food group exclusions, including grains), it was very exciting to once again eat bread, burritos, and blueberry muffins. I no longer follow the strict AIP diet since it did not turn out to be a magical cure for me. I did improve a bit, but that does not mean that every food group exclusion contributed to my improvement. One person (me) trying the AIP diet is not a clinical trial with test and control groups.

I do see strong correlation between my psychotic episodes and consumption of gluten/cow’s dairy/corn/chocolate/nightshades (bell peppers are fine, small amounts of tomatoes are also OK)/ high-glycemic foods. I haven’t found issues with eating gluten-free whole grains and also found no evidence that grains are inflammatory. I don’t consider any blog post evidence. If a blog post refers to a research paper, then I will consider their claim. I do agree that anecdotal evidence is also useful, it was other people’s stories that helped me to obtain the right diagnosis after being misdiagnosed with schizophrenia by my psychiatrist. Only we can’t know from anecdotes what actually helped, if someone did the AIP diet and they got better – was it because they eliminated all the foods the diet suggests to exclude, or they could have improved just as well if they only avoided refined carbohydrates?

The evidence that I found so far indicated that whole grains are actually anti-inflammatory. For example, whole grain intake was found to be inversely related with inflammatory protein concentrations, while refined grain intake was positively related with the inflammatory markers. “In summary, whole grain intake was inversely related to PAI-1 and CRP plasma concentrations, but these relationships were attenuated by the addition of metabolic variables to the model. Refined grain intake was positively independently related to plasma PAI-1 concentrations.

Whole and Refined Grain Intakes Are Related to Inflammatory Protein Concentrations in Human Plasma

I introduced whole grains after a year of strict AIP diet with no problem. I find that consumption of whole grains puts me in a more relaxed state of mind, I actually consume half a cup of rolled oats with green banana flour in the evening for better sleep. Sourdough is great because the baked goods end up with a low glycemic index after the fermentation process. I have a glucometer that I use to determine my blood glucose response to different food products. The standard test is a two-hour glucose test. Two slices of gluten-free bread increased my blood sugar to over 11 mmol/L two hours after consumption, which is a sign of high blood sugar. I did the same test with sourdough bread and sourdough muffins and my blood sugar was back to under 6 mmol/L two hours after consumption, which is a big difference. Short grain brown rice is also a high glycemic index food, while long grain brown rice was found to have lower glycemic index.

Sourdough allows me to eat the foods that I missed out on for so long, at the same time it does not cause a blood glucose spike for me. I have used sourdough to make pizza crust, tortillas, bread, and muffins. Currently I am learning to use fermented batter to cook dosas, an Indian dish. Controlling blood sugar for me means also stabilizing my mood. A glucose spike and then crash turns me lethargic and weepy, it takes away my energy, I definitely want to avoid that. Sourdough allows me to have blueberry muffins for breakfast, goat cheese toast, burritos – all without the consequences of an emotional roller coaster. High glycemic foods may also promote inflammation and given my diagnosis of autoimmune encephalitis, that is something that I definitely want to avoid as well.

Hyperglycemia can cause inflammation through varying mechanisms that result in the production of free radicals and pro-inflammatory cytokines (19, 24). Thus, high glycemic index and glycemic load diets may stimulate inflammation. Glycemic index is the blood glucose-raising potential of the carbohydrates in different foods. A more accurate indicator of the relative glycemic response to dietary carbohydrates, however, is glycemic load. Glycemic load incorporates the relative quality of carbohydrates characterized by the glycemic index. Consumption of high-glycemic index foods results in higher and more rapid increases in blood glucose levels than the consumption of low-glycemic index foods. Rapid increases in blood glucose are potent signals to the β-cells of the pancreas to increase insulin secretion, which can cause a sharp decrease in glucose levels and lead to hypoglycemia (25). In contrast, the consumption of low-glycemic index foods results in lower but more sustained increases in blood glucose and lower insulin demands on pancreatic β-cells (26).

Dietary carbohydrates and inflammation

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Industrialization, autoimmune diseases, and depression

I used to think that I was in control of my own mind, but it’s clearly not the case. I don’t choose how to feel and how to emotionally respond to situations, just as I don’t choose when to feel hungry. I don’t choose my thoughts as well. I don’t know which thought is going to come next, it’s just going to pop up in my conscious mind and I will observe it, I will react to it. Someone recently told me that all the choice that we have in life is the direction of our view. We don’t choose our emotions, we don’t choose our thoughts, we don’t choose the environment around us, we can only turn our head and change the view, and observe.

That’s why doctors prescribe antidepressants – people don’t choose to be depressed and they can’t just “think their way out of it”. And sometimes antidepressants help, maybe for some people depression is just a lack of serotonin and SSRIs fix that imbalance. The chemical imbalance theory is not 100% confirmed, some scientists debate whether this is a cause of depression at all, perhaps antidepressants help some people not by increasing serotonin, but by decreasing inflammation. Autoimmune diseases are what can cause chronic inflammation.  This is when “the immune system prompts white blood cells to attack nearby healthy tissues and organs, setting up a chronic inflammatory process”. Turns out the brain can be affected by this process as well. “People who had been treated for a severe infection were 62% more likely to have developed a mood disorder than those who never had one. An autoimmune disease increased the risk by 45%. Multiple infections or the combination of severe infection and an autoimmune disease boosted the odds of developing depression, bipolar disorder, or another mood disorder even further.”

Infection, autoimmune disease linked to depression

Next I am going to speculate and talk about the possible causes of rising incidence of autoimmune disease. I am going to mention the idea that the lifestyle that we obtained through industrialization turned out to be pro-inflammatory. I am not proposing to go back to living in a village, but I want to propose making practical lifestyle changes that can help reduce chronic inflammation and in turn depression.

We are participating in less physical activity and are gaining higher body weight

One result of industrialization is we are eating more sugar, moving less, and weighting more. “How could carrying extra weight and sofa-sitting be connected to higher levels of inflammatory chemicals in the body and the development of diabetes?

Researchers discovered that excess body fat, especially in the abdomen, causes continuous (chronic), low levels of abnormal inflammation that alters insulin’s action and contributes to the disease.

The body becomes less sensitive to insulin and the resulting insulin resistance also leads to inflammation. A vicious cycle can result, with more inflammation causing more insulin resistance and vice versa. Blood sugar levels creep higher and higher, eventually resulting in type 2 diabetes.

Are Diabetes and Inflammation Connected?

We are eating high glycemic foods

We are eating more processed and high glycemic foods. The bread that people used to eat when they lived in villages was usually not the white bread from refined flour, it was sourdough, which has more nutrients, and a low glycemic index. I doubt anyone used to eat pasta, pizza, or fries often, if at all. I know that in peasant Russia there was fermented cabbage, sourdough rye bread, barley, and broth, sometimes meat and fish. Also fermented milk products. None of those foods have a high glycemic index.

According to Harvard researchers, healthy, middle-aged women who ate the meals with the lowest glycemic load had the lowest levels of C-reactive protein, a marker of inflammation in the body.

In overweight women who had greater levels of C-reactive protein to begin with, eating higher amounts of low glycemic index foods had an even greater impact on their inflammatory markers.

The Link between Glycemic Index, Diabetes, Inflammation and Heart Disease

We are eating fewer fermented foods

How often do you drink kefir or yougurt, eat kimchi or sauerkraut? Do you eat natto or fermented bean curd? Tempeh? Sourdough bread? Cassava fufu? If the answer is pretty often, I would say that’s good, but many people in US and Canada rarely eat fermented foods. Maybe sometimes yougurt, but it’s questionable whether store bought yougurt has live probiotics. Previously people ate fermented foods more often. They didn’t really have much choice since refrigerators weren’t available. Milk goes bad pretty quickly, so you need to make it into kefir or yougurt. In winter you don’t have fresh vegetables, you have fermented vegetables in jars that you prepared during the summer. Same with fruits. There have been several papers recently linking fermented foods to mental health, here is what is stated in one of them: “The extent to which traditional dietary items may mitigate inflammation and oxidative stress may be controlled, at least to some degree, by microbiota. It is our contention that properly controlled fermentation may often amplify the specific nutrient and phytochemical content of foods, the ultimate value of which may associated with mental health; furthermore, we also argue that the microbes (for example, Lactobacillus and Bifidobacteriaspecies) associated with fermented foods may also influence brain health via direct and indirect pathways.

Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry

We have lost our “old friends”

One of recent theories is that the rise in autoimmune disorders could be due to our gut microbiome depletion. With sanitary toilets, pasteurized milk, less time with animals (urban citizens rarely hang out with farm animals, neither do they milk cows, and now few even have pets due to smaller apartment sizes), we have lost many microbes and parasites that used to inhabit our gut. Turns out this might not be a good thing. It could be that because we as species cohabited with these organisms for so long, our immune system evolved to train on these parasites, and now we are lacking this training. “Diminished exposure to immunoregulation-inducing Old Friends in the perinatal period may enhance the consequences of psychosocial stressors, which induce increased levels of inflammatory mediators, modulate the microbiota and increase the risk for developing all known psychiatric conditions. In later life, the detrimental effects of psychosocial stressors may be exaggerated when the stress occurs against a background of reduced immunoregulation, so that more inflammation (and therefore more psychiatric symptoms) result from any given level of psychosocial stress. This interaction between immunoregulatory deficits and psychosocial stressors may lead to reduced stress resilience in modern urban communities.

Microbial ‘Old Friends’, immunoregulation and stress resilience

Do we need to move back to the village? Or to a cave?

Well I’m hopeful that I won’t have to, because my job is in downtown Toronto, and it would be hard to commute there from a remote village. I hope that given the recent research, we can use this information to improve our immune system function, while still living in a city. We can cook more food at home instead of buying processed food. I rarely buy anything at the food court during the work day, I bring everything from home. I am also making fermented foods – kefir, yougurt, sourdough bread, kombucha. I also purchased some at Asian grocery stores – they have fermented bean curd, natto, fermented Chinese cabbage.

In terms of moving around, I try not to sit at my desk at work for too long. I get up to make tea, go for a walk during lunch. Walk to the subway in the morning instead of taking the streetcar. Walk home after work with a friend. Gym I personally found very boring, but I do exercise at home with an aerobic step. Doctors suggest at least 30 minutes of aerobic exercise a day, heart rate needs to go up!

In terms of bringing back “old friends” – this can partly be done by consuming probiotic and prebiotic foods to increase gut microbiome diversity. There are also soil bacteria that are considered beneficial, we can obtain them by spending time near soil and breathing in the particles. Having a dog is stated to have beneficial effects on our gut microbiome. There is also experimental helminthic therapy – infecting yourself with parasites on purpose. I am planning on trying this therapy and I will write more on this topic later on.