March 02 2015

Dear Mark: Peripheral Neuropathy, Primal Compromises for Love, and Carbs in Ketosis

By Mark Sisson
68 Comments

Foot painFor this week’s edition of Dear Mark, I’m answering three questions. First up, what could be causing a reader’s peripheral neuropathy? Could it be gluten, B12 and/or B6 deficiency, diabetes, or inadequate vitamin D? The second question concerns homemade pasta, a beautiful woman, and a dilemma: do you indulge in the former to make the latter happy? My answer may surprise you, or it may not. I’m not sure. But I think you’ll find it helpful regardless. And finally, can carbs and ketosis co-exist? They certainly can, but there’s a little trick to make it work.

Let’s go:

I’m looking for alternative ideas for dealing with neuropathy pain in my legs and feet. Any suggestions?

Sharon

Diabetes is the most common cause of neuropathy, so that’s worth exploring with your doctor. Be sure you’re practicing the basic best practices for blood sugar control: eating adequate protein, exercising (strength training and sprinting or HIIT, especially), managing stress (meditation, various anti-stress herbs and supplements if necessary), sleeping enough and well.

You’re probably already avoiding it, seeing as you’re reading Mark’s Daily Apple, but it’s worth reiterating the importance of gluten avoidance in all types of peripheral neuropathy. Of all extra-intestinal symptoms of gluten intolerance, peripheral neuropathy is probably the most common. I’ll sometimes discuss the occasional bite of bread or cake I have, or tell folks that regular soy sauce is probably okay for most and the residual gluten is mostly inert, but that’s intended for people without overt gluten intolerance or celiac disease. If you have problems with even minute amounts of gluten, or if you’re experiencing symptoms commonly associated with gluten intolerance like peripheral neuropathies, you should avoid all sources. So make sure you’re off gluten entirely.

Vitamin B6 status can also affect neuropathy, so make sure you’re getting enough. That’s why patients who take the tuberculosis drug isoniazid must also take vitamin B6 pills: the drug depletes B6 and causes peripheral neuropathy. This is an easy fix, if it’s indeed the cause. B6 supplements are cheap and plentiful and safe, and fish, poultry, pork, and red meat are the best dietary sources of the vitamin.

Vitamin B12 deficiency is a potential cause. Check out Chris Kresser’s podcast episode on neuropathy for an extensive treatment of the B12 issue. Chris also mentions a few other possibilities, like chronic Lyme disease or fungal infections.

And then there’s vitamin D deficiency, which is an independent risk factor for diabetic neuropathy. Grab some sunlight whenever possible, get your vitamin D levels checked out, and supplement with vitamin D3 if it looks like you need it.

What are the consequences of “backsliding” into the SAD on occasion? For instance you’ve met a beautiful woman who you have yet to convert to the Paleo ways. During this initial courtship she loves to have you over for homemade pasta every other Wednesday. You’ve just recently converted to Paleo yourself (say six months), and you certainly still enjoy pasta, but are at no risk of abandoning the Primal habits due to the biweekly indulgence. Are you at risk of compromising your newly undertaken gene expression? What if dinner is stepped up to every week?

Ben

I don’t usually wax too poetic on MDA, preferring to deal in the empirical and the objective, but I’m going to step out on a limb here and do things differently. Love, or even the prospect of love, trumps all. There is nothing finer or more important to human happiness — and ultimately health, for the two cannot be divorced — than shared human connections. You can’t discount the importance of finding someone you really, truly vibe with, whether on a romantic or platonic level. It trumps every material aspect of health, and any benefits you get from skipping the biweekly (or even weekly) pasta meal aren’t worth compromising that.

Don’t refuse the pasta. Enjoy it. I mean, homemade pasta is special, even if it’s gluten-spiked poison on a plate. It’s a painstaking, arduous process that you only undertake if you really care about the person for whom you’re making it. Weekly pasta? My answer stands. Consider it the 20 of your 80/20 and give it nary a further thought. Just try to serve yourself and scoop a little less of the noodles and a little more of the sauce, meat, and veggies. You’ll live. Trust me.

If you end up eating the pasta (and I think you probably should), there are a couple things you can do to curb the negative response to the pasta:

  • Mitigate the deleterious effects of a carb binge by engaging in vigorous postprandial physical activity. This could be a few sets of kettlebell swings, some air squats, or the hip thrust-centric movement of your choice. Exercising in this manner will lower the blood glucose response and utilize stored glycogen, thereby opening up space for all that dietary glucose.
  • Take a tablespoon or two of raw potato starch (or eat a green banana) an hour before eating the pasta. This provides resistant starch, which will blunt the blood glucose response. RS also helps support the gut bacteria that regulate gluten sensitivity, and it generally improves the health and reduces the permeability of your gut lining.

As always, I’ll insert the necessary disclaimer: if you’re celiac or gluten-sensitive, do not eat the pasta. Only relent if gluten poses no immediate health issues, whether serious (neuropathy, migraines, generally feeling like death) or “mild” (GI upset, diarrhea, etc). If the lady in question is worth your time, she’ll understand.

When you get more comfortable with her, you could always suggest making gluten-free pasta together. That could be a fun project.

I am experimenting with putting my body into nutritional ketosis, but also want to maintain my athletic performance. If I consume some CHO’s (not sure what the magic number of calories is) prior to my heavy or intense resistance training workout to fill my muscle glycogen stores (and hopefully perform better), will I get back to ketosis shortly after my workout assuming I don’t over consume the CHO’s?

Second to that, can you recommend anything to measure blood ketone levels?

Thanks!

Mike

If you eat the carbs before the training session, you’ll knock yourself out of ketosis because you haven’t yet created the “glycogen debt” necessary for carbs and ketosis to co-exist amicably. You’ll secrete insulin to deal with the glucose and that will reduce ketone concentrations and probably knock you out of ketosis.

What you want to do is consume the carbohydrates after the training session. You do this because the exercise will make your muscles extremely insulin sensitive and activate non-insulin dependent glucose uptake, thereby doubly reducing the amount of insulin you’ll require for disposal of the carbohydrates. It also clears out the existing glycogen, making space for the incoming glucose. Double plus good.

As long as you don’t get too wild in the interim, your muscles will be fully stocked whenever your next training session rolls around, and you’ll remain in ketosis as long as you want to.

Also, eat fewer carbs than you think you need. Remember that you’re only burning muscle glycogen in muscles you’re actually using. High rep barbell curls will tear through bicep glycogen given enough volume, but they won’t touch quadricep glycogen. A CrossFit WOD consisting of barbell thrusters, high-rep pullups, box jumps, and kettlebell cleans, on the other hand, is more likely to tap into glycogen from every muscle group. The average person stores about 400 grams of glycogen in muscles and 100 grams in the liver, and you’ll very rarely need to ever come close to replacing all of it. It’s better to err on the side of fewer carbs, just so you don’t overstep your debt and cancel ketosis. If that happens, though, don’t worry about it. You can drift back into it fairly easily.

That’s it for this week, everyone. Thanks for reading and if you have any more advice to contribute, please do so below in the comment section!

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68 thoughts on “Dear Mark: Peripheral Neuropathy, Primal Compromises for Love, and Carbs in Ketosis”

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  1. I love your answer to the second question. I’ve been 80/20 on my diet for years. I tried to be 100% and burned out. Life is to short to pass up pasta and sweets every time!

    1. +1

      I too have found that 80/20 works better than 100%. Becoming too obsessive about one’s food isn’t healthy. My weight is where I want it and I feel good, so I just try to limit the “bad stuff” to an occasional indulgence. Also, a very small amount is usually enough to satisfy.

      1. My thinking is eating unhealthy 20% of the time is unhealthy. I’ve been on the primal lifestyle for 2 years now and anything other than primal food isn’t even appealing anymore. To each his own though but if you’re not 100% primal, don’t even suggest you follow a primal lifestyle.

        1. Honestly, if you’re going to be that rude about it, then no one is truly primal other than the surviving hunter-gatherer groups. I’m 100% paleo- no dairy even, but these folks that do 80/20 are doing pretty good.

        2. This depends entirely on your definition of “healthy.” I never found feeling excluded at social events because of a painfully restrictive diet to be “healthy” in terms of my overall well-being.

          And I’m sorry, but is there some official definition of “primal lifestyle” you’re in reference to? If we’re being literal about it, it’s hard to say that someone posting to a forum on the internet has any business realistically suggesting that they are “100% primal.” Shouldn’t you be spear-hunting wild game somewhere instead?

        3. The concept that only “primal” food is healthy is absurd. Primal isn’t even “real” anyway. It a man-made concept that is constantly being refined and updated as new information becomes available. So to claim the primal badge of purity is a bunch of baloney. Primal..is..not…real. It’s made up. Beans, rice, dairy, legumes and yes, even grains…these aren’t unhealthy foods that kill you. These are whole foods loaded with nutrients.Some do better without them, some thrive on them. But acting like someone who eats pasta once a week is a phony is just being ignorant all the way around.

        4. Primal was never meant to be a jail sentence, Roger. Your idea that it has to be all or nothing is ridiculous. 80/20 or 90/10 works well for most people who are of normal weight and are in good health and want to stay that way. Believe it or not, it even works for those people who aren’t. Moderation is often better over the long haul than strict, OCD-type adherence. It means controlling the lifestyle instead of letting the lifestyle control you.

        5. Those that posted that this lifestyle should not be labeled “primal” are correct. Then call it whatever you want but it’s basically being disciplined to eliminate junk foods and yes according to primal blueprint that includes all grains, beans/ legumes. And to Clay starting that “beans, rice, dairy, legumes, and yes even grains aren’t unhealthy foods and won’t kill you”. These are the foods excluded in the primal blueprint. No they aren’t going to kill you, anyway not right away but over years of ingesting them will cause health issues. I believe that as much as you believe they won’t. I just don’t understand if those that read MDA believe what they read is true then why wouldn’t you follow it 100% if it’s going to keep you healthy? I guess the answer is that most don’t believe it’s true and that’s fine. Happy medical bills in your elderly age if not sooner.

        6. Roger, since we’re referencing the Primal Blueprint like a bible, I’d like to point out that the 80/20 rule is in there.

          Before you label me someone who is not convicted enough to follow through, I do eat primal 100% or maybe 98% of the time… so I chose to ignore the 80/20 myself because it’s just easier for me not to mess with temptations and old habits that I worked so hard to move past.

    2. Same here. I do better than 80/20 most of the time, but when I have friends visit, I take them out and leave my nutritional theories at home. If they fall in love with the beautiful bread at the bakery, I keep my mouth shut about it and will sometimes buy a treat that someone is drooling over and share it with the group. Who wants to ruin someone else’s fun and waste good company arguing about carbohydrates? I can do that with strangers on the internet! And the friends know I’ll share whatever they are interested in if they ask. So.

    3. The biggest lie I’ve heard over and over since going paleo-ish is that once you get accustomed to eating “real food” that you won’t even care about the “bad stuff” anymore. In my experience, this is a lie the paleo fascists tell themselves and, worse, tell other people who are new to the lifestyle.

      While I have found that certain foods I used to eat make me feel really horrible now (donuts, which I’ve barely touched in two years) I can still wolf down a terrible meal every now and again and, dare I say, really enjoy it!

      I love baked goods. I love ice cream. I love pizza. I don’t feel bad about it. The key is to make a treat a treat and not something you have every other meal or even every other day.

      I shift between 80/20 and 90/10 and when I’m on a weekend vacation I don’t sweat what I eat too much at all.

      You don’t have to be religious about this for it to work well unless you’re dealing with some very specific conditions.

      1. That’s interesting. One of my problems sticking with Primal is that I haven’t ever lost the cravings for non-Primal foods (bread in particular — sorry, there is NO gluten-free substitute for a really nice, hearty, chewy bread), and it makes me feel like a loser when I hear all these gung-ho paleo types saying that I shouldn’t want those foods anymore. So then I go on a big bread binge with the idea that “starting tomorrow, I’ll be perfect!”

        Your approach seems to make more sense.

        1. If there is something that Mark hits on pretty regularly—and I think it’s great advice that goes hand-in-hand with 80/20—is, “Don’t left great be the enemy of good.” If you’re eating fast food every day and suddenly replace HALF of those meals with healthy, primal meals you’re going to improve. Some people handle cold turkey well. It worked for me. Some people don’t. Some people need to take steps and that’s fine too. If you go from 0/100 to 50/50, that’s an improvement. Then 50/50 to 70/30, etc.

          Another reality I’ve found among friends, family and associates who are trying to make healthy lifestyle changes is they get into ruts where they feel like a “loser” for something they’re eating. That’s not a healthy way to look at things. A treat’s a treat. You’re not cheating on your spouse. You’re not stealing. You don’t need to feel guilty.

          What you’ll find—at least what I found—when you improve what you consume is even when you’re treating yourself, you tend to be more selective and focus on what you want. When I eat my ice cream, I don’t get the cheap grocery store HFCS crap. I either make it from my ingredients or get something higher quality. If I want pizza, I get the stuff I love and skip the breadsticks.

          And don’t let the gung-ho types intimidate you and don’t try to be them. The only person you’re competing with is yourself. The only person you need to improve upon is yesterday’s you. That’s it.

          Another thing that’s very important, this is a very personal journey. There are ups and there are downs. There are things they come quickly to some and slowly to others. People also have completely different goals. If 100% compliance is a goal, fine. If you have some kind of chronic condition that requires a strict diet like GAPS or you’re trying to fight back raging diabetes or you have Celiac’s you have different needs and goals than someone who simple wants to lose some weight and be healthier.

      2. + 1

        Completely agree Josh! Being of Italian heritage, it’s unrealistic to say I will abstain from pasta, pizza and fresh ciabatta for the rest of my life!

        I often go months without any of the foods mentioned above, however, if I happen to be with my parents, friends and or at a sporting event and want a slice of pizza, my lifestyle allows me to do so! My daily dose of quality lifting, sleep and meditation nulify the ‘minimal’ negative effects and I carry on with my primal lifestyle.

        1. As someone whose grandfather’s family name is “Pizzorno” I know exactly how you feel.

      3. One problem with Paleo is that because some people still eat things with honey, maple syrup or coconut sugar, all of which are just sugar, full of fructose, they never truly get rid of sweet cravings or used to sweet tastes. If you stop eating these alternative sugars, you will find that you no longer find sweet things appealing. I say this as a person who used to eat plenty of chocolate every day, and now find 85% chocolate too sweet.

        1. I don’t think that’s universally true. When I started I was extremely strict for several months. (Not eating pizza for 18 months was a pretty major achievement for me.) While my sweet cravings mostly subsided (they always come knocking when stress kicks into high gear, but I recognize them for what they are and usually ignore them) I never hit a point where I found sweets repulsive in any way. I still clearly remember eating gelato after basically being junk free for months. It was so, so good.

          The funny thing is, I hit a weight loss plateau and decided to add more carbs since I was working out heavily. Most of it was sweet potatoes but every couple weekends, I’d indulge in something like pizza or ice cream. That change lead to shaving off about 12 more pounds and having more energy.

          I’m even less strict now, as I indicated above (80/20 to 90/10). It’s nice to be able to go to a party and eat what’s there and it’s also nice to be out of the mindset that eating anything remotely “unclean” will lead to 5 extra pounds the next day, brain fog, a leaky gut, premature death and, “Oh no! I ate pizza last night at my friend’s party and now my entire gut biome is destroyed.”

          Like I said, if you’re dealing with specific conditions that’s another story. I’m not. I like pizza and ice cream now and again so I eat them without feeling bad and flat out take pleasure in them for pleasure’s sake. I like not being “that guy” at social gatherings who won’t touch a burger unless the veggies are all non-GMO, there’s no bun and the beef is grass fed.

          If anything, I enjoy sweet much, much more than I ever did before.

        2. Agreed. Paleo isn’t supposed to include any sugar or paleo desserts. That is how you achieve the place where you truly no longer care about the SAD foods. It takes a few months of perfect compliance too, but it happens if you really want it. This is coming from someone who used to have a food addiction and would put down 5-8,000 calories of junk food a day…

        3. Simply not true. We are hard wired for sweets. In the wild sweets are rare and represent instant concentrated energy. So every human being on the planet is hardwired to detect and appreciate sweet. Same for salty. Will you generally crave it less on a clean diet? Yes. I know my desire and tolerance for sweets have gone down greatly. But to say that you are doing it wrong if you still appreciate sweets has no scientific bases at all and definitely no real life evidence of it among the world’s population.

      4. Totally agree with not losing the love of pizza, ice cream, baked goods, and for us any and all desserts, and we’ve been mostly primal for nearly 4 years. We are both gluten intolerant, though, which makes cooking at home easier, and, fortunately, there are fantastic grain-free pizzas which we can buy at our local health food store –

        http://againstthegraingourmet.com/gluten-free-breads

        Since I’m originally from the East Coast, I can unequivocally say that their bagels are not real bagels, but their pizzas are fantastic and their baguettes are a very good substitute for the real thing. It’s all made with tapioca starch and cheese, even the breads, so if you can’t do dairy this isn’t an option. I am SO happy to have this as an option when we need a pizza fix!

        1. In my personal experience a little sugar is like a little heroin.
          It makes me crave anything sugary or white carb laden, and opens the door for all sorts of rationale at the end of the day for not giving it up.

          I can eat a sweet potato and some macadamias after an arduous hike, but not a sugary treat ever, except fruit, or an avocado thickened green smoothie sweetened with some stevia.

          I can now watch others eat anything they want, and I don’t envy them at all.
          I don’t feel deprived because I don’t crave it at all and I’m no longer interested in food that doesn’t make me feel well.
          Now, I get compliments on my appearance regularly and have enough energy to hike ten miles and not even break stride.

          I loved ice cream, cheesecake, etc., as much as the next guy, it got me all the way to 350lbs, but if you have any type of binge personality especially coupled with autoimmune issues, it’s very difficult to manage effectively in the long term.

          I also found that when sad items were consumed, whole food lost much of it’s appeal.
          The result was a lot of ups, downs, and gnashing of teeth trying to keep cravings in check.

      5. Just because you’re not one that still craves SAD food, it doesn’t mean it’s a lie. There are exceptions to every rule. The idea that such things suddenly become “repulsive” is also not really accurate. It’s not repulsive, it just no longer garners much interest and can be passed on when offered.

        I’m one such person who no longer particularly cares for most SAD stuff. A good ice cream or gelato is about it. Pizza? Pasta? Bread? Eh…I’m just as happy without, and they used to be regular staples in my diet. They’re not repulsive, but they also don’t taste as great as I remember, and usually aren’t worth the consequences I experience when I do consume such things. “Okay” is about how I’d describe such things.

        And while we’re hardwired to appreciate sugar, sources of sugar in nature pale in their sweetness in comparison to most man made sweets. Even the fruit we have now, that’s been bred for sweetness isn’t as sweet as something like a slice of cheesecake from Cheesecake Factory.

        So yeah, my sweet tooth hasn’t gone away, but that piece of cake with buttercream frosting is now too sweet for my taste and makes me feel physically ill if I eat more than a small piece. At least the ice cream has some fat to counterbalance its sugar load.

  2. A new development in regard to ketone measurement: measuring by breath is much more accurate than the monitors. A Ketonix stick that you blow into, and it hooks up to your computer via USB port to record, or you could use a regular breathalyzer–the higher the blood alcohol reading on it, the higher your ketone levels.

    Ketonix is sold at Amazon, but they’re currently out of stock.

  3. “…or the hip thrust-centric movement of your choice” aka bow chicka wow wow?! Haha love the discrete suggestion 😉

    1. And thought here. I think Mark deserves to be awarded the comment of the week for this one.

  4. I have a Ketonix and have been using it daily for a couple of months. I find it to be very accurate, and they have great customer service if you have questions on usage, etc.

  5. my husband’s neuropathy has been diagnosed as Mortons Neuroma. Any suggestions for dealing with it?

    1. I stuggled with Morton’s Neuromas in both feet for a couple years, finally escalating to the point where the pain and burning was waking me at night. I finally ‘saw the light’, with the help of Mark, as well as Sock Doc and Dr. Ray (links below). The answer? Use the feet. I got rid of all my overbuilt shoes, orthotics, etc., and started going barefoot as much as possible. The transition was a slow go, but the Morton’s symptoms disappeared after a few weeks.

      I’m now running again after a 10 year layoff, and wear minimalist shoes (Vibrams!) 100% of the time when not barefoot, as Mark suggests. Good luck.

      From Mark: https://www.marksdailyapple.com/how-to-prepare-for-barefooting/#axzz2vbjSAJ7R
      Sock Doc: http://sock-doc.com/2012/03/healthy-people-barefoot-people/
      Dr. Ray: https://nwfootankle.com

      1. I am a bodywork therapist practicing Structural Integration (similar to Rolfing). Neuromas are caused by compression of the foot. Doctors “cure” it with surgery. I cure it by manipulating the foot to increase space in the foot and untrap the nerve. A 1 hour session is typically all it takes.

        1. I have a Morton’s neuroma. My podiatrist said I should have a series of 6 shots that would, basically, kill the offending nerve in my right foot. I almost did it too, as I was in a fair amount of pain at the time. But instead of neutering my foot, I decided to use it more. A bit of PT helped too – at least it felt good! A year later and the only time it ever flares is when I’m wearing heavy boots, which I need to do outdoors in the winter. But a pair of mukluks is on my wish list. I will check out the links too, thanks.

        2. My Morton’s neuroma went away after a set of acupuncture treatments and a switch to shoes with a wider forefoot. Three years, pain free. And I still wear orthotics, because I have hallux rigidus. Feet, man! They’re complicated.

  6. Dear Mark, You nailed it again. I went Primed for your Life one year ago on Sunday. It was because I listened to you in February 2014 and it changed my life. We set up our blog to help other people and have been doing so here in the Philippines and our readers world wide. Thank you for helping turn a slightly over-weight, over-trained, brain fogged Aussie into a happy, healthy and fit person. I do my Ironman events following our Primed Lifestyle which we acknlwledge came from your legendary self, paleo and HFLC combined. You improve lives daily and I cannot thank you enough for changing mine immeasurably for the better. If ever you visit the Philpppines you have a place to stay with us. With untold respect and admiration, Chad.

  7. Ben, maybe on the off weeks, invite her to your place (clean your toilet you filthy animal!) and cook something primal together.

    1. I agree! Try something ambitious like a wheat free chestnut tagliatelle, sweet potato gnocchi or 100% buckwheat soba. There are plenty of recipe resources on line. And in addition to the bathroom, make sure you have clean sheets

    2. We love spaghetti squash in place of regular pasta. Just make sure to add butter and sea salt or it will be too bland. It’s great underneath spaghetti sauce, which is also easy to make primally. A nice side salad and you won’t miss the bread.

  8. “Human Physiology: An Integrated Approach” (4th ed. Silverthorn, 2009), pp.729:

    “People who go on [ketogenic diets] are often pleased by initial rapid weight loss, but it is due to glycogen breakdown and water loss, not body fat reduction. Sticking with ketogenic diets decreases caloric intake and eventually results in loss of body fat, but any diet that restricts calories will do the same. Among the risks associated with ketogenic diets are dehydration, electrolyte loss, inadequate intake of calcium and vitamins, gout, and kidney problems. The only recommended use of ketogenic diets is for children under 10 who have epilepsy that is not responding fully to drug therapy. For reasons that we do not understand, maintaining a state of ketosis in these children decreases the incidence of seizures”

    1. I highly recommend reading Keto Clarity. Nutritional ketosis is a perfectly natural metabolic state. Many, many other practical application of being ketogenic, most notably for overweight people and those with Type 2 diabetes.

      1. Agree with You Chris.
        Or read Volek and Phinney’s book(s) – The Art and Science of Low Carb Living

    2. Textbooks contain mostly outdated information. A text published in 2009 likely contains info from seversl years before that so reading textbooks for information which is quite likely to change as research is done over time such as ketosis (as opposed to what a human cell looks like through a microscope which I daresay won’t change much at all) is not really a recommended way of information gathering if you want up to date information and the latest research…

    3. “Among the risks associated with” = weasel wording.

      Among the risks associated with eating *anything at all* is choking to death.

      It’s meaningless. And the kids on ketogenic diets are often fed seed-oil laced crud (which the CW believers promote as they think it’s better than those dreadful animal fats).

  9. Wouldn’t a metabolic workout *before* eating a big plate of carbs have a better effect for insulin response? I feel like doing a load of kettlebell swings after a suboptimal meal would not go well.

  10. I’m more in favor of telling her you prefer not to eat pasta because eventually it’s going to come out and she’ll think you hated her food all those spaghetti evenings. It’ll hurt her feelings less the sooner you speak up. It would bother me if I spent all that time MAKING PASTA then finding out it wasn’t something my significant other liked to eat. If you don’t speak up now, you’ll have to accept that you will be compromising a lot more as the relationship progresses. Be honest. It’s easier. I also think it’s better in the long run (If you want a long run, that is. If not, screw it, eat the pasta).

    1. I think that’d only become an issue if she started trying to make him pasta multiple times a week. If it’s only 1 meal a week, it easily falls into the 80/20 rule.

    2. Well, he actually said that he doesn’t mind it and likes it, but knows health wise it’s not something he should be having all the time. I think there’s a middle ground, though…It wouldn’t be hard to work your lifestyle into the conversation. “Wow, this homemade pasta is SUCH a treat! I don’t really eat a lot of pasta or bread anymore because blah blah blah.” And wrap up by again saying how great hers is and he enjoys having it occasionally. If she can’t handle the fact that he cares about health and what he eats, and isn’t open to hearing about something that makes him happier and healthier….well, I suspect there won’t be a long run. 😉

      1. Stacie, I think that’s a brilliant approach! Completely honest, yet appropriately appreciative & nothing that would scare her off (if there’s more to the relationship than food). Perfect!

    3. I agree whatever he does, he needs to tell her about his preferred style of eating. It’s just being dishonest otherwise. You know, if he’s thinking possible long term here.

  11. Love your blog! However, the study you link to in the the section regarding diabetic neuropathy is talking about diabetic nephropathy (kidney disease) NOT neuropathy (nerves). “Try a ketogenic diet for a few weeks, too, as that has been shown to completely reverse diabetic neuropathy in an animal model.”

  12. “Mitigate the deleterious effects of a carb binge by engaging in vigorous postprandial physical activity. This could be a few sets of kettlebell swings, some air squats, or the hip thrust-centric movement of your choice.”

    … hip thrust-centric movement … In others, eat the pasta and then go make some primal children…

  13. The moral of the story is: earn, don’t pay for, your carb indulgences.

  14. Ben, thank you so much for the question and Mark, thank you greatly for answering!

    I kind of knew the answer to this question, but to hear it from you is very relieving, as I look up to you. My bf cooks such amazing food, and primal in most cases, but occasional pizzas, or rice should not scare me, especially if it’s made with love and tasting just delicious. Thank you for all of the advices and opinions and the time you put into making my life a healthier one (and with healthy attitude towards food and society, because being too extreme can be as harmful as gluten in some cases.)

  15. I broke up with a guy who was 60 (I’m 46) because I didn’t want to end up being his nursemaid. He ate candy and sugar constantly, his hands shook, he had a big gut and basically said he had to be careful hiking because he’s afraid if falling. I had told him about paleo and while he accepted it, he wasnt changing anything to improve his health. So I decided to bail before it became an issue. Hoping to find love that is a bit more compatible health wise.

  16. “..Mitigate the deleterious effects of a carb binge [from your lovely, pasta-making date] by engaging in vigorous postprandial physical activity. This could be a few sets of…hip thrust-centric movement of your choice.”

    Love it.

  17. ALA can help with peripheral neuropathy, esp IV to get your through a bad patch

  18. Be careful of supplementing with b6 if you don’t know if you are deficient. Too much b6 is as bad as too little. I developed some neuropathy and my doc suggested b6 50 mg but without testing me. Went to a neurologist and found my b6 levels too high. I was taking a melatonin product that had b6 in it.

  19. Katy Bowman speaks about neuropathy and how it is related to alignment and natural movement. http://www.katysays.com Her DVD’s are a good way to start learning about her mindboggingly effective methods, since she is so prolific it is easy to get overwhelmed. It looks like the fix your feet, and the rx for diabetes ones are specific for neuropathy. https://www.alignedandwell.com/shop/

  20. I have been looking to changing my diet to simply cutting out all fast foods and only eating foods I have prepared myself at home. It’s not a paleo diet, but a diet of fruit, veggies, meat and plenty of salads and raw foods. I will eat salad sandwiches, or the occasional pasta, and even a homemade pizza!
    Some people will say I eat unhealthy by eating breads, pasta and drinking milk.
    Others that struggle with a junk food addiction will say they wish they could stick to healthy eating and pat me on the back for eating healthy.
    As long as I eat a salad sandwich instead of a hotdog, or a pasta salad over fish & chips, I believe I am eating healthy.

    1. Just do not confuse eating objectively healthfully with eating more healthfully than a typical SADer.

  21. “Double plus good”

    Hah! I love the subtle references you throw out. Good stuff.

  22. On the peripheral neuropathy – I might advise getting a gut test for H Pylori or other gut critters. I never had neuropathy before and developed it on primal/paleo diet, My neuropathy is gone since treating H pylori (with antibiotics and a PPI). Fingers crossed it stays away. It’s something to consider if, despite supplementing B6 and B12, you still have the symptoms.

  23. On the pasta – if this is the same sort of homemade pasta that I grew up with, it is made with eggs, olive oil, and flour. The fat and protein slows down the absorption of the carbs, and the pasta is not just carbs. So it is not as bad as commercial pasta would be. And it is delicious… Relax and enjoy it once a week or so!

  24. It should be noted that there are genetic causes of neuropathy. Hereditary Motor-Sensory Neuropathy (aka Charcot-Marie-Tooth Disease) is one of the most common genetic neurological disorders, many people have it and don’t even realize it. Diet may prevent additional neuropathy pain, but it won’t prevent it all if the cause is genetic.