Wheat Belly 10-Day Grain Detox (12 page)

Infrequent consumption of seafood, aversion to organ meats, and overreliance on processed omega-6 oils in modern foods have led to deficient levels of omega-3 fatty acids in the majority of people at the start of the detox. Now that the absorption-blocking, inflammatory grains have been removed, omega-3 fatty acid absorption may improve, but intake typically remains low for most people and supplementation is necessary to achieve healthy blood levels (for everyone except the most enthusiastic fish-consuming individuals).

There are plenty of other reasons to supplement omega-3 fatty acids beyond the initial detox experience. There are, for instance, an abundance of clinical studies that demonstrate that omega-3 fatty acids, as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) obtained from fish and fish oil, yield reductions in sudden cardiac death, heart attack, heart rhythm disorders, autoimmune inflammatory conditions (especially rheumatoid arthritis and lupus), and a variety of cancers. While linolenic acid—found in flaxseeds, chia seeds, walnuts, and other sources—is biochemically an omega-3 fatty acid and is, for other reasons, a truly healthy oil, it does not yield the same benefits provided by EPA and DHA from fish and fish oil. Krill oil is likewise not a useful source of EPA and DHA, as the quantities contained are too small to make a difference, despite the over-the-top misleading marketing claims made by some manufacturers.

I advocate an intake of 3,000 to 3,600 mg per day (the dose of combined EPA and DHA, not the total weight of fish oil), divided into two doses taken before breakfast and before or after
dinner.
This quantity yields an ideal level of omega-3 fatty acids in the bloodstream, subdues the flood of fatty acids, provides maximal protection from cardiovascular disease, and yields anti-inflammatory benefits.

IODINE: FORGOTTEN BUT VITAL TRACE NUTRIENT FOR THYROID HEALTH

While we cannot blame grains for messing with our iodine status, deficiency is so common and can be such a stumbling block in health that it is worth knowing about. Failure to correct iodine deficiency can substantially impair your ability to lose weight, while adding to cardiovascular risk, hypertension, risk for breast conditions like fibrocystic breast disease, and water retention.

Most people have forgotten that, up until the first half of the 20th century, disfiguring goiters occurred in 20 percent of the population: large bulging thyroid glands on the front of the neck due to lack of iodine. This was an especially serious problem for people living inland, away from ocean sources of iodine. The connection between goiters and iodine deficiency led to the introduction of iodized salt in 1924, and the FDA urged the public to use more salt. (Even the old Morton's iodized salt slogan used to be “Use more iodized salt. Keep your family goiter-free!”) Unfortunately, excessive salt consumption caused health problems in some susceptible individuals, prompting new advice: Reduce salt and sodium consumption. Now, in the 21st century, health-conscious people avoid iodized table salt. Others have turned to alternative sources, such as sea salt (very little iodine content), kosher salt (no iodine), and potassium chloride–based salt substitutes (no iodine). As a result, iodine deficiency and goiters are making a vigorous (and often unnoticed) comeback.

Iodine is an essential trace mineral for health. Because salivary glands and breast tissue concentrate iodine, it is required for
oral
health and protection from conditions such as fibrocystic breast disease. Iodine is essential for normal thyroid function, in particular, since thyroid hormones, T4 and T3, are composed of iodine (the “4” and “3” referring to the number of iodine molecules). Iodine deficiency over time leads to a thyroid gland that enlarges—a goiter, seen as a bulge on the front of the neck. However, it is not necessary to have a goiter for thyroid dysfunction to be present.

If you are marginally iodine deficient at the start of your Wheat Belly 10-Day Grain Detox, your ability to lose weight will be impaired and benefits such as reduction in triglycerides, lower blood pressure, and improved mood will be blocked. Simply meeting the RDA of 150 mcg per day of iodine will prevent a goiter from developing and maintain a normal level of thyroid hormone production for most people, though you might do better by taking higher levels, as discussed below. Athletes and those engaged in frequent heavy physical effort are at a higher risk for iodine deficiency because of iodine loss through perspiration. Vegetarians who avoid seafood and iodized salt also have a greater likelihood of iodine deficiency than omnivores.

Relying on iodized salt is not the best method for obtaining iodine because it's difficult to know precisely how much iodine you're getting when sprinkling salt over food. The iodine content of iodized salt is also inconsistent, evaporating from the container within 4 weeks of opening. (A canister of iodized salt that's been sitting in your cupboard for, say, 6 months contains little to no iodine.) Many multivitamins or multiminerals contain the RDA for iodine. If there is any indication of hypothyroidism—such as inappropriately cold hands and feet, low energy, constipation, or thinning hair, and certainly if an enlarged thyroid is present—or you wish to supplement an iodine dose more likely to be the ideal level, then an increase in iodine to the 500 to 1,000 mcg per day range may increase thyroid hormone output if lack of iodine is
the
limiting factor. Iodine is readily obtained from supplements such as potassium iodide drops or kelp tablets, which are made from dried seaweed that approximates the natural, ocean-derived source. (I prefer kelp, as it provides a mixture of iodine forms.)

If symptoms of hypothyroidism are present, it is worth considering having a thyroid assessment by your health care provider. Even though wheat and grain elimination removes a common cause for autoimmune thyroid disease (especially Hashimoto's thyroiditis) that often results in hypothyroidism, thyroid tissue is fragile and usually does not recover after grains are removed. This can be identified through thyroid testing that includes measures of the thyroid hormones, free T4 and free T3 (reflecting the “free,” or unbound, fractions in the bloodstream), thyroid stimulating hormone (TSH), as well as thyroid antibodies that cause inflammation and thyroid damage. Though not understood by most conventional doctors, a reverse T3 level can also be helpful, as this may reveal whether you have a blocker of the T3 thyroid hormone present that might be responsible for symptoms of hypothyroidism even when other measures are favorable. Thyroid testing can also suggest iodine deficiency with a low free T4 value (at or below the reference range), along with a slightly higher than optimal TSH of 1.5 mIU/L or greater. This is usually corrected after 3 to 6 months of iodine replacement if iodine deficiency is the cause, especially if thyroid enlargement is present.

Rarely, someone with hypothyroidism or a goiter will develop an abnormal hyperthyroid (overactive) response to iodine. This occurs because the iodine deficiency present before correction distorts thyroid function; adding iodine worsens the situation temporarily by activating hyperthyroidism, experienced as palpitations, sleeplessness, and anxiety. In this uncommon situation, iodine replacement is best undertaken several months after wheat and grain elimination has allowed thyroid inflammation to subside and with monitoring of thyroid function, as well as other assessments of thyroid status (such as thyroid ultrasound), by your
health
care provider. Once cleared of trouble spots such as abnormal thyroid nodules, some people succeed by increasing their dose of iodine gradually: They might start at a level below the RDA of 150 mcg per day and gradually build up by 50 to 100 mcg monthly increments over 6 months until the desired dose (e.g., 500 mcg per day) is achieved. Anyone with a history of Hashimoto's thyroiditis, Graves' disease, thyroid cancer, or thyroid nodules should supplement iodine only under the supervision of a knowledgeable health care provider.

IRON: AN IRONIC SITUATION

Some people, especially menstruating females and athletes, benefit from an assessment of iron status to stack the odds in favor of full recovery and high performance. This is particularly important if symptoms such as low energy, light-headedness, inappropriate feelings of coldness (also caused by hypothyroidism), breathlessness, or difficulty concentrating are present; these are symptoms of iron deficiency and anemia caused by iron deficiency. After blood loss, grain consumption is the second most common cause of iron deficiency anemia in the world. Recall that the phytate content of a bagel or two slices of bread is enough to reduce iron absorption by 80 to 90 percent, a situation not remedied by fortification.

Unlike our other Wheat Belly 10-Day Detox supplements, iron is one that requires a blood test before you proceed. This may not be an issue you tackle during your detox experience but something to address long term after wheat and grain removal, especially if the above symptoms were present prior to your detox and persist during and afterward. Removal of grains permits normal iron absorption to resume, and supplemental iron intake will only be necessary if low levels of the iron storage protein ferritin or if iron deficiency anemia is identified by blood tests. In these situations, several months of either over-the-counter or
prescribed
iron supplements may be necessary and can accelerate correction.

If iron deficiency is identified, look for iron supplements in the ferrous form: ferrous fumarate, ferrous sulfate, and ferrous gluconate. Of these, ferrous fumarate is the best absorbed (33 percent absorption) and gluconate is the least (12 percent). (There are also ferric forms that are poorly absorbed and are not recommended.) The elemental iron RDA is 8 mg per day for males, 18 mg per day for menstruating females, and up to 27 mg per day for a pregnant mother. The various supplements should be dosed by the quantity of elemental iron, not the total weight of the tablet. Iron supplements should not be taken without a diagnosed iron deficiency, ongoing blood loss (such as through menses or pregnancy), and careful monitoring as iron overload can occur and can be toxic.

Due to inflammation of the small intestine, people diagnosed with celiac disease and Crohn's disease may require iron supplementation for longer than usual to compensate for reduced absorption. Iron deficiency, especially mild degrees as represented by low levels of ferritin but without anemia, is common in vegetarians, menstruating females, athletes, and people with hypochlorhydria (low stomach acid from prior grain consumption, diagnosed by your doctor). A ferritin level and complete blood count can determine whether these situations apply to you.

ZINC: BACK IN THE PINK

Zinc is a fascinating mineral, but one often neglected. If your goal is to recover health as quickly as possible during your detox, then addressing zinc can help. Recall that grain phytates that impair iron and magnesium absorption also impair zinc absorption, resulting in widespread deficiency among grain-consuming people. Zinc deficiency can account for symptoms such as skin
rashes,
distortions of taste perception, unexplained diarrhea, impaired growth and development in children, increased susceptibility to infection, and poor wound healing.

Zinc supplementation can be especially important during your first few grain-free months as gastrointestinal health recovers from the destruction previously wrought by grains. The RDA of zinc for adults is 11 mg per day for males, 8 mg per day for females, 11 mg for pregnant females, and 12 mg per day for lactating females. Much of your daily zinc needs can be obtained through food. For example, 6 ounces of beef chuck roast provides 6 mg of zinc, 2 slices of pork loin provide 5.8 mg, 4 ounces of chicken breast provides 1.0 mg, and 3 ounces of Alaskan king crab provides 6.5 mg. After the first few months, just including such foods in their diets is all that most people need to do.

A zinc supplement should be considered during the 10-day detox and continued for the first several months. Look for zinc gluconate, zinc sulfate, and zinc acetate and examine the quantity of elemental zinc in the preparation, not total weight. Because zinc supplements are indeed meant to supplement dietary intake, a modest additional intake of 10 to 15 mg of elemental zinc per day is all that is needed. Vegans and vegetarians typically require larger doses, such as 15 to 25 mg per day, since they avoid zinc-rich animal products and commonly rely on legumes that also contain phytates that block zinc absorption. Soaking legumes for several hours reduces their phytate content, a useful strategy for people with marginal zinc intakes. People who begin their grain-free journey with inflammatory bowel diseases or other malabsorptive conditions or who take thiazide diuretics (such as hydrochlorothiazide, chlorthalidone, or metolazone) almost always start with severe zinc deficiency, so higher levels of supplementation may be required. Blood zinc levels are of limited usefulness, as they underestimate tissue levels. Nonetheless, if a blood level is obtained and is below the “reference” range, or is at the lower end of that range, zinc deficiency is highly likely. Zinc supplementation of 10 to 15 mg per day in this situation is safe and effective.