THE PALEO DIET INSIDER

HYPERTROPHY

THE

LOREN CORDAIN, PH.D.

Vol. 4, Issue 10

YAMS VS. SWEET

POTATOES

RHEUMATOID ARTHRITIS AND DIET

LITHIUM, BIPOLAR DISORDER & ACNE

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International Society of Sports Nutrition states:11

“It is the position of the International Society of Sports Nutrition that exercising individuals need approximately 1.4 to 2.0 grams of protein per kilogram of bodyweight per day”.

3. They consumed a high amount of leucine7 known to regulate protein synthesis and the formation of new muscle tissue.12,13 Since Paleolithic-type diets were almost certainly universally higher in protein than Western diets,10 and most of the protein would have been derived from animal sources10 (which are good sources of leucine as the following table shows),7 our ancestors most certainly would have ingested a generous amount of leucine.

4. Their diet was net base yielding.14 This is something not often considered in nutrition, but it is an important topic for people wanting to increase muscle mass because a net acid yielding diet can lead to muscle loss.15 To achieve a net base yielding diet, strength training athletes should reduce the chloride in their diet16 (present in table salt), eat a generous amount of vegetables,17 and their main source of carbohydrates should be fruits, roots and tubers instead of the classical net acid yielding17 cereal grains that so many athletes use.

5. Their diet provided micronutrients in higher amounts than the typical American diet or even the so called healthy diet.18,19 For optimum health, sports performance and even muscle gain, this is a very important topic to consider. For instance, zinc is needed to achieve normal testosterone levels, a hormone needed to assure an anabolic environment20 that leads to muscle gain. However, it is estimated that more than

HYPERTROPHYPedro Bastos, MA MS Ph.D.

What methods can a bodybuilder/weightlifter use to gain muscle mass weight and an overall increase in size on the Paleo Diet?

We know from studies with hunter-gatherers and from the fossil record that our Paleolithic ancestors were lean, muscular, fit and healthy1-6 because of their diet and lifestyle.

1. Our Paleolithic ancestors had regular exercise2,6-8 in the form of what modern day exercise physiologists would call Cross Training7 with cycles of physical activity and rest.8 This pattern of regular periods of rest is very important because chronic intense exercise performed everyday can lead to over training and a loss of muscle mass.9

2. They consumed a high protein diet from lean meats, fish, seafood and eggs seasonally,10 as recommended by The Paleo Diet7 and various other authorities. For instance, The

Food Sources of Leucine4

Food (100 K cal) Leucine (mg)

Egg White 1774

Meat (average) 1474

Shellfish 1285

Milk 524

Cereal grains (average) 303

Fruit (average) 31

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70% of Americans are deficient in zinc.18 The Paleo Diet provides more than double the RDA for zinc, and higher amounts of vitamins and other minerals than does the classical so-called healthy diet.7,19

Our Paleolithic ancestors may or may not have been as muscular as modern bodybuilders. For athletes who wish maximize their muscularity and size, we also recommend that you pay special attention to post workout nutrition.

After high-intensity exercise such as intense strength training, there is a window of opportunity that peaks in the first 30 minutes. During this period, it appears that increasing blood levels of insulin, along with amino acids, helps facilitate recovery and increase protein synthesis,21-26 without theoretically inducing insulin resistance.

Many people use a whey protein-based supplement along with a high glycemic-load carbohydrate since whey proteins have a very fast absorption rate,27 and they represent the protein fraction in milk responsible for its high insulinotropic effect.28-30 Although most studies with whey proteins have shown beneficial effects, there are some potential health hazards that we will talk about in an upcoming special report on whey. Essential amino acids, along with net base-yielding, high-glycemic carbohydrates such as bananas could be

a safer alternative that has also been shown to increase protein synthesis.21, 26, 31-33

It should be mentioned that the ingestion of an amino acid/high glycemic carbohydrate drink might trigger a very high insulin release that could be followed by hypoglycemia, which would lead to catabolism (loss of muscle mass). Furthermore, depending on training intensity and duration, it appears that the presence of amino acids and carbohydrates stimulates protein synthesis for up to 3 hours after a workout33 (although the peak is reached in the first 30 minutes after training26). It could be useful to eat a solid meal that is composed of lean meat or fish and a net base-yielding carbohydrate such as yams or sweet potatoes 30 to 60 minutes after the post workout shake. For hard gainers, a second meal identical to the first one consumed within the 3-hour time frame could be a good idea.

Here’s a real-life account of how the Paleo Diet boosted strength and energy for an athlete from the Netherlands:

“I have personally followed the Paleo Diet for the last two years, and many health problems disappeared after a few weeks to a few months. I had often upper respiratory infections, and they slowly healed when on the Paleo and they never came back. Previously I used to have a cold every few months, and now this has improved so much that I only got a cold once in two years, and it disappeared in several days (before it took me over 3 weeks) on the Paleo diet and adding high doses of vitamin D3.

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“I also noticed considerable fat loss, although I was not overweight to start with (15% body fat); it has decreased now to 7% at the age of 63! I did not lose any strength; the weights I am using are at least 20% heavier without extra effort...I further noticed many other health improvements, much more energy and much better concentration.”

Bernhard van Meelen

For sources see References: Section I

YAMS VS. SWEET POTATOESNell Stephenson, BS USC EXSC

I must admit, I’ve found myself guilty of using the nouns yams and sweet potatoes interchangeably, although they are actually NOT the same. When I checked online, I realized many others do this also.

One website (http://plantanswers.tamu.edu/vegetables/sweetpotato.html) explained that when orange sweet potatoes were introduced in the southern United States, producers and shippers desired to distinguish them from the more traditional white types. To do so, they adopted the African word “nyami” that referred to this starchy, edible root in its English form, “yam”. Yams in the United States are actually sweet potatoes with relatively moist texture and orange flesh. Sweet potatoes originate from the tropics, but are now grown in Florida. Yams are mainly grown in West Africa and Asia. The USDA website suggests that unless you get your ‘yams’ from an ethnic store, they are probably sweet potatoes! To add to the confusion, the USDA requires that the food label yam must also say sweet potato.

Nutritionally, both yams and sweet potatoes are great sources of starch, particularly for high-training athletes who need to replenish glycogen stores. According to the USDA’s Nutrient Data Laboratory (which has a fantastic online search engine at http://fnic.nal.usda.gov/nal_display/

index.php?info_center=4&tax_level=2&tax_subject=279&topic_id=1387 to look up almost any food), the macronutrient breakdown of the two is as follows:

Not a huge difference between the two; but the lower glycemic load is preferable if you can find a real yam!

Personally, when I know I’ve got a long run or ride coming up the next day, there’s nothing I’d rather prepare my body with than a nice, baked sweet-potato-yam with my protein and veg dinner!

100g serving (about 3.5 oz)

Yam 116 Kcal 1.5g PRO 28g CHO 1g Fat

Sweet 90 Kcal 2g PRO 20g CHO 1g Fat Potato

Yam Glycemic Index:37 Glycemic Load: 10.2

Sweet Glycemic Index: 61 Glycemic Load 14.8 Potato

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COOKING IN THE CAST IRON SKILLETNell Stephenson, BS USC EXSC

As much as I love visiting my fave cooking shoppe, Williams-Sonoma, with their huge variety of pots and pans, if you’re on a budget and not quite sure what to buy, I suggest the cast-iron skillet.

Here are but a few advantages of using a cast iron skillet:

*Cooking in one will provide more iron in your food. Sauté spinach in one, and add an orange to quadruple the amount of iron you’ll absorb with the help of the Vitamin C!

*A cast iron skillet is an insanely cheap kitchen tool. I recently saw a large one (AT A HARDWARE STORE!) for $25.

*These skillets will last forever if you care for them correctly (they should be seasoned).

*You can use one both on the stove and in the oven! Sear a marinated, skin-on, bone-in, chicken breast in one over a hot flame for two minutes on each side. Then put it in the oven to finish baking at 450 degrees for about 20 or 30 minutes (until it reaches an internal temp of 160 degrees.) The moisture is retained and the meat is extremely tender!

*Cast iron skillets retain heat quite well so your food is done much more evenly.

So, if you’re going for simplicity or you’re new to the kitchen, this approach will make learning to cook a bit less daunting. If we start simply with just a few things such as one pan and a few ingredients, we’ll learn quickly and are more apt to explore healthy cooking more adventurously!

DIET AND RHEUMATOID ARTHRITISLoren Cordain, Ph.D., Professor Emeritus

Editor’s note: The following article is based on a review article titled “Modulation of immune function by dietary lectins in rheumatoid arthritis” published in the British Journal of Nutrition in 2000 by Loren Cordain, L. Toohey, M. J. Smith and M. S. Hickey. While this paper is now almost 9 years old, it is still accurate but little-known information. There are a few new mechanisms and dietary elements we have identified in the past few years - some of which we cover in the new How to Treat M.S. with Diet program, and some of which we will detail in a future newsletter.

Rheumatoid arthritis (RA) affects approximately one percent of the adult population, and females are two to four times more susceptible than males.1 This disease is characterized by persistent inflammation of the synovium (a membrane in freely moving joints that secretes fluid), destruction of bone and cartilage, and possible functional disability.

Numerous case studies have shown that RA symptoms can be alleviated with grain-free diets.2-5 Likewise, withdrawal of food during fasting has reduced aspects of the disease.6 A more recent experiment also showed significant improvement in sore joints when RA patients followed an elemental diet (a purified diet of amino acids, sugars, fatty acids, vitamins and minerals) for three weeks.7 In the only controlled study of elemental diets to treat RA, patients showed improvement in grip strength.8

This link between diet and RA may depend on substances crossing the gastrointestinal barrier and entering circulation. In genetically susceptible individuals, this may result in RA symptoms. There is considerable evidence that intestinal permeability may be increased in patients with RA,9-10 particularly when the joint disease is active.11 Patients with RA have also shown a high frequency of intestinal bacterial,12 particularly anaerobic bacteria.13-14 Although this connection is not entirely clear, there is convincing evidence that antibiotic therapy helps rheumatic activity.15-16

Common dietary staples, such as cereal grains, beans, and legumes, contain lectins. Lectins have anti-nutritional properties that influence enterocytes (cells that line the intestinal wall) and lymphocytes (cells in

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the blood, lymph, and lymphoid tissues).17-18 Because lectins are able to cross the gastrointestinal barrier rapidly and enter circulation intact,19 they may be able to interact directly with synovial tissue that is impacted during RA.

Many lectins derived from bean species negatively affect intestinal structure and function.20 Lectins from peanuts produce similar results.21 Lectin activity has also been found in wheat, rye, barley, oats, maize17 and rice.22

Collectively, these studies indicate that eliminating lectins may help alleviate RA symptoms. Because the Paleo Diet focuses on foods that our Paleolithic ancestors were likely to eat, cereal grains, beans and legumes are all replaced with healthier choices. Those following the Paleo Diet have shared their success stories about alleviating joint pain. Here are a couple of their stories:

“A good friend who had great weight loss and increased health success with the Paleo diet gave me a copy of your book...I have found the joint pain I’ve had from 20+ years of power-lifting and 14 years of stunt work have greatly diminished and much to my surprise even I have lost body fat and increased lean muscle mass.”

William

“I am thrilled to tell you that I have been on a strict Paleo diet for six weeks and I now believe in miracles. Five years ago at the age of 64, I stopped playing golf because I had too many aches and pains in my muscles, joints, bones and my energy level was very low. At that time I thought it was old age! Now, within six weeks I play golf and I work and/or exercise 10 hours a day.”

George

For sources see References: Section II

LITHIUM, BIPOLAR DISORDER & ACNEPedro Bastos, MA MS Ph.D.

We are sharing the following question because it presents interesting concerns that deal with the medication lithium, bipolar disorder and acne:

“I am 50 years of age, and it has really only been the last four years or so that my acne has been of real concern. Prior to that, there have been minor breakouts on rare occasions. Before ordering The Dietary Cure for Acne my acne was minor to mild at best - on the cheek, chin area. I have strictly followed the diet for 2 individual months now, as per page 60 Phase 1. My face certainly improved, still I am only experiencing approx 80 - 90 percent success. Therefore, my question is this. Is the medication I’m taking affecting the results? I have been taking Lithium Carbonate (900 mg) per night for bi-polar disorder, for approx 17 years now. Is the Lithium counteracting the diet??”

Dennis L. Dear Dennis,

There are associations between antipsychotics and metabolic syndrome,1-3 and as you know from reading The Dietary Cure for Acne, metabolic syndrome and acne share a common cause4 ― insulin resistance. There is also a positive association between bipolar disease and metabolic syndrome/weight gain/obesity.5 Furthermore, the activity of the erythrocyte transport system, sodium/lithium counter transport, may be elevated in subjects with insulin resistance.6-8 In light of this, we think it is possible that excessive lithium intake over the long haul may adversely affect this ion channel, and potentially impact insulin metabolism.

To answer your question directly, lithium is known to cause a variety of dermatological problems, including acne, and there are a number of studies and review papers corroborating this.9-27 Lithium carbonate

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WHICH FOODS SHOULD BE FROM ORGANIC SOURCES?Nell Stephenson, BS USC EXSC

While it would be fantastic if we could all eat everything organic all the time, chances are that the cost of this simply gets too high for many of us. Does that mean you should throw it all out the door, and keep eating canned green beans? Not at all! Just determine which foods are most important to eat from an organic, versus a conventional, source.

After lots of research, I’ve determined the following foods to be the most important ones to me to buy from an organic source:

*Meat and poultry (it is equally important to be sure they come from places where animals are raised humanely and fed a diet natural to them, and to oppose buying from factory farms!)

*Soft fruits with thin or no skin, such as strawberries, grapes, tomatoes and apples

*Lettuce and other leafy greens

On the other hand, some things you may opt to buy from conventional sources are:

*Fruits with thick skins, such as banana and pineapple

*Vegetables that don’t retain as much pesticide residue, such as cabbage and broccoli

Of course, do wash everything before you prepare it. Even though it may be organic, organic doesn’t mean “ready to eat” and it may have bacteria on it

appears to be the lithium form that causes the more severe reactions. Remember that lithium is also associated with several other adverse effects, especially kidney damage.28,29

Moreover, the pharmaceutical versions of lithium (carbonate and citrate) are not well absorbed by our cells where lithium’s effects occur. To obtain a therapeutic effect, high amounts of these forms of lithium are prescribed, which may increase blood levels to levels that can be toxic long term. That’s why psychiatrists regularly monitor blood levels of lithium as well as kidney function, such as creatinine.

This is the reason that alternative medicine specialists recommend lithium orotate. Presumably, the therapeutic dosage of orotate is much smaller than the dosage of lithium carbonate or citrate. Unfortunately, there are very few conclusive studies with this lithium salt,30-34 so we can’t give you our opinion on it.

Should you decide to stop taking lithium, please do so under the advice and supervision of your health care provider. You could also show her or him some references showing that omega 3 fatty acids (EPA and DHA) in high dosage are safe, and may be effective for bipolar disorder.35-44

Nevertheless, based on the biochemistry of omega-3 and omega 6 fatty acids and the available studies,45-49

we believe that a diet containing a low omega 6/omega-3 ratio (as is the case with The Dietary Cure For

Acne) may decrease the effective dosage of omega 3 fatty acids for bipolar disorder.

For sources see Reference: Section III

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PRIMAL IN THE KITCHEN

PALEO TURKEY BURGERS

2 lbs. lean ground turkey breast 1 egg 1 Tb. extra virgin olive oil 1 small shallot, chopped 1 garlic clove, minced 1 t. freshly ground black pepper 1 t. dried oregano 1 medium beefsteak tomato, diced 1/2 small red onion, sliced into 1/4-inch slices 1 small head Bibb or Butter lettuce

Preheat oven to broil. Combine turkey with egg, oil, shallot, and garlic. Mix well and shape into six patties. Season with pepper and oregano.

Broil patties for five minutes on each side. Remove from oven and serve topped with tomato and onion. Place inside lettuce, and top with your favorite Paleo condiments.

Copyright © 2011. The Paleo Diet Cookbook. All Rights Reserved.

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Contributing writers from The Paleo Diet Team:

Pedro Bastos MA MS Ph.D. candidate in Medical Sciences at Lund University, Sweden; International College of Human Nutrition and Functional Medicine

Nell Stephenson, BS USC EXSC, ACSM H/FI, Paleo Nutritional Counselor, co-author of The Paleo Diet Cookbook, author of Paleoista, Gain Energy, Get Lean and Feel Fabulous with the Diet You Were Born to Eat. Paleoista

REFERENCES: SECTION I1. Eaton SB, Konner M, Shostak M. Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. Am J Med. 1988 Apr;84(4):739-49.

2. Cordain L, Gotshall RW, Eaton SB, Eaton SB 3rd. Physical activity, energy expenditure and fitness: an evolutionary perspective. Int J Sports Med. 1998 Jul;19(5):328-35.

3. Lindeberg S, Eliasson M, Lindahl B, Ahrén B. Low serum insulin in traditional Pacific Islanders--the Kitava Study. Metabolism. 1999 Oct;48(10):1216-9.

4. Cordain L, Eaton SB, Brand Miller J, Lindeberg S, Jensen C. An evolutionary analysis of the aetiology and pathogenesis of juvenile-onset myopia. Acta Ophthalmol Scand. 2002 Apr;80(2):125-35.

5. Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002 Dec;138(12):1584-90.

6. Eaton SB, Eaton SB. An evolutionary perspective on human physical activity: implications for health. Comp Biochem Physiol A Mol Integr Physiol. 2003 Sep;136(1):153-9

7. Cordain L; Friel J. The Paleo Diet for Athletes. Rodale, 2005

8. Chakravarthy MV, Booth FW. Eating, exercise, and “thrifty” genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. J Appl Physiol. 2004 Jan;96(1):3-10

9. Rogero MM, Mendes RR, Tirapegui J. [Neuroendocrine and nutritional aspects of overtraining]. Arq Bras Endocrinol Metabol. 2005 Jun;49(3):359-68

10. Cordain L, Brand Miller J, Eaton SB, Mann N, Holt SHA, Speth JD. Plant to animal subsistence ratios and macronutrient energy estimations in world wide hunter-gatherer diets. Am J Clin Nutr 2000, 71:682-92.

11. Campbell B, Kreider RB, Ziegenfuss T, La Bounty P, Roberts M, Burke D, Landis J, Lopez H, Antonio J. International Society of Sports Nutrition position stand: protein and exercise. J Int Soc Sports Nutr. 2007 Sep 26;4:8.

12. Kimball SR, Jefferson SL. Amino acids as regulators of gene expression. Nutr Metab (Lond), 2004 Aug 17;1(1):3.

13. Koopman R, Wagenmakers AJ, Manders RJ, Zorenc AH, Senden JM, Gorselink M, Keizer HA, van Loon LJ. Combined ingestion of protein and free leucine with carbohydrate increases postexercise muscle protein synthesis in vivo in male subjects. Am J Physiol Endocrinol Metab. 2005 Apr;288(4):E645-53.

14. Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC Jr. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr. 2002 Dec;76(6):1308-16.

15. Frassetto L, Morris RC Jr, Sebastian A. Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab. 1997 Jan;82(1):254-9.

16. Frassetto LA, Morris RC Jr, Sebastian A. Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet. Am J Physiol Renal Physiol. 2007 Aug;293(2):F521-5.

17. Frassetto L.A., Morris Jr R.C., Sebastian A. A practical approach to the balance between acid production and renal acid excretion in humans. J Nephrol. 2006 Mar-Apr;19 Suppl 9:S33-40.

18. Cordain, L.; Eaton, S.B.; Sebastian, A. et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr; 81(2):341-54, 2005.

19. Cordain L. The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Nutraceut Assoc 2002; 5:15-24.

20. Antonio, J., Stout, J. Supplements for strength-power athletes. Human Kinetics, 2002

21. Manninen AH. Hyperinsulinaemia, hyperaminoacidaemia and post-exercise muscle anabolism: the search for the optimal recovery drink. Br J Sports Med. 2006 Nov;40(11):900-5.

22. Cribb PJ, Hayes A. Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci Sports Exerc. 2006 Nov;38(11):1918-25.

23. Betts J, Williams C, Duffy K, Gunner F. The influence

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of carbohydrate and protein ingestion during recovery from prolonged exercise on subsequent endurance performance. J Sports Sci. 2007 Aug 13;:1-12

24. Tang JE, Manolakos JJ, Kujbida GW, Lysecki PJ, Moore DR, Phillips SM. Minimal whey protein with carbohydrate stimulates muscle protein synthesis following resistance exercise in trained young men. Appl Physiol Nutr Metab. 2007 Dec;32(6):1132-1138.

25. Kreider RB, Earnest CP, Lundberg J, Rasmussen C, Greenwood M, Cowan P, Almada AL. Effects of ingesting protein with various forms of carbohydrate following resistance-exercise on substrate availability and markers of anabolism, catabolism, and immunity. J Int Soc Sports Nutr. 2007 Nov 12;4(1):18

26. Kerksick C, Harvey T, Stout J, Campbell B, Wilborn C, Kreider R, Kalman D, Ziegenfuss T, Lopez H, Landis J, Ivy JL, Antonio J. International Society of Sports Nutrition position stand: Nutrient timing. J Int Soc Sports Nutr. 2008 Oct 3;5:17.

27. Boirie Y, Dangin M, Gachon P, et al. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc Natl Acad Sci USA 1997;94:14930–5

28. Nilsson M, Holst JJ, Björck IM. Metabolic effects of amino acid mixtures and whey protein in healthy subjects: studies using glucose-equivalent drinks. Am J Clin Nutr. 2007 Apr;85(4):996-1004.

29. Drucker DJ. Enhancing the action of incretin hormones: a new whey forward? Endocrinology. 2006 Jul;147(7):3171-2.

30. Frid AH, Nilsson M, Holst JJ, Björck IM. Effect of whey on blood glucose and insulin responses to composite breakfast and lunch meals in type 2 diabetic subjects. Am J Clin Nutr. 2005 Jul;82(1):69-75.

31. Tipton KD, Ferrando AA, Phillips SM, et al. Postexercise net protein synthesis in human muscle from orally administered amino acids. Am J Physiol 1999;276:E628–34.

32. Tipton K. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise. American Journal of Physiology Endocrinology and Metabolism. 281:E197-E206, 2001

33. Rasmussen BB, Tipton KD, Miller SL, Wolf SE, Wolfe RR. An oral essential amino acid-carbohydrate supplement enhances muscle protein anabolism after resistance exercise. J Appl Physiol. 2000 Feb;88(2):386-92

REFERENCES: SECTION II1. Grossman JM & Brahn E (1997) Rheumatoid arthritis: current clinical and research directions. Journal of Womens Health 6, 627–638.

2. Shatin R (1964) Preliminary report of the treatment of rheumatoid arthritis with high protein gluten free diet and supplementation. Medical Journal of Australia 2, 169–172.

3. Williams R (1981) Rheumatoid arthritis and food: a case study. British Medical Journal 283, 563.

4. Beri D, Malaviya AN, Shandilya R & Singh RR (1988) Effect of dietary restrictions on disease activity in rheumatoid arthritis. Annals of the Rheumatic Diseases 47, 69–77.

5. Lunardi C, Bambara LM, Biasi D, Venturini G, Nicholis F, Pachor ML & DeSandre G (1988) Food allergy and rheumatoid arthritis. Clinical and Experimental Rheumatology 6, 423–426.

6. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K & Forre O (1991) Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 338, 899–902.

7. Haugen MA, Kjeldsen-Dragh J & Forre O (1994) A pilot study of the effect of an elemental diet in the management of rheumatoid arthritis. Clinical and Experimental Rheumatology 12, 275–279.

8. Kavanaghi R, Workman E, Nash P, Smith M, Hazleman BL & Hunter JO (1995) The effects of elemental diet and subsequent food reintroduction on rheumatoid arthritis. British Journal of Rheumatology 34, 270–273.

9. Katz KD & Hollander D (1989) Intestinal mucosal permeability and rheumatological diseases. Baillie res Clinical Rheumatology 3, 271–284.

10. Mielants H (1990) Reflections on the link between intestinal

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permeability and inflammatory joint disease. Clinical and Experimental Rheumatology 8, 523–524.

11. Smith MD, Gibson RA & Brooks PM (1985) Abnormal bowel permeability in ankylosing spondylitis and rheumatoid arthritis. Journal of Rheumatology 12, 299–305.

12. Henriksson AE, Blomquist L, Nord CE, Midtvedt T & Uribe A (1993) Small intestinal bacterial overgrowth in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 52, 503–510.

13. Benno P, Alam M, Henriksson K, Norin E, Uribe A & Midtvedt T (1994) Abnormal colonic microbial function in patients with rheumatoid arthritis. Scandinavian Journal of Rheumatology 23, 311–315.

14. Eerola E, Mottonen T, Hannonen P, Luukkainen R, Kantola I, Vuori K, Tuominen J & Toivanen P (1994) Intestinal flora in early rheumatoid arthritis. British Journal of Rheumatology 33, 1030–1038.

15. Trentham DE & Dynesius-Trentham RA (1995) Antibiotic therapy for rheumatoid arthritis. Scientific and anecdotal appraisals. Rheumatic Disease Clinics in North America 21, 817–834.

16. O’dell JR, Haire CE, Palmer W, Drymalski W, Wees S, Blakely K, Churchill M, Eckhoff PJ, Weaver A, Doud D, Erikson N, Dietz F, Olson R, Maloley P, Klassen LW & Moore GF (1997) Treatment of early rheumatoid arthritis with minocylcline or placebo: results of a randomized, double-blind, placebo-controlled trial. Arthritis and Rheumatism 40, 842–848.

17. Liener IE (1986) Nutritional significance of lectins in the diet. In The Lectins: Properties, Functions and Applications in Biology and Medicine, pp. 527–552 [IE Liener, N Sharon and IJ Gold-stein, editors]. Orlando, FL: Academic Press.

18. Pusztai A (1993) Dietary lectins are metabolic signals for the gut and modulate immune and hormone functions. European Journal of Clinical Nutrition 47, 691–699.

19. Pusztai A, Greer F & Grant G (1989) Specific uptake of dietary lectins into the systemic circulation of rats. Biochemical Society Transcations 17, 527–528.

20. Liener IE (1986) Nutritional significance of lectins in the diet. In The Lectins: Properties, Functions and Applications in Biology and Medicine, pp. 527–552 [IE Liener, N Sharon and IJ Gold-stein, editors]. Orlando, FL: Academic Press.

21. Ryder SD, Smith JA & Rhodes JM (1992) Peanut lectin: a mitogen for normal human colonic epithelium and human HT29 colorectal cancer cells. Journal of the National Cancer Institute

84, 1410–1416.

22. Tsuda M (1979) Purification and characterization of a lectin from rice bran. Journal of Biochemistry 86, 1451–1461.

REFERENCES: SECTION III1. Yumru M, Savas HA, Kurt E, Kaya MC, Selek S, Savas E, Oral ET, Atagun I. Atypical antipsychotics related metabolic syndrome in bipolar patients.

2. Ketter TA, Haupt DW. Perceptions of weight gain and bipolar pharmacotherapy: results of a 2005 survey of physicians in clinical practice. Curr Med Res Opin. 2006 Dec;22(12):2345-53

3. Correll CU, Carlson HE. Endocrine and metabolic adverse effects of psychotropic medications in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2006 Jul;45(7):771-91

4. Cordain, L. Implications for the role of diet in acne. Semin Cutan Med Surg 2005;24:84-91.

5. Fiedorowicz JG, Palagummi NM, Forman-Hoffman VL, Miller del D, Haynes WG. Elevated prevalence of obesity, metabolic syndrome, and cardiovascular risk factors in bipolar disorder.Ann Clin Psychiatry. 2008 Jul-Sep;20(3):131-7.

6. Herlitz H, Bokemark L, Alenhag EL, Wikstrand J, Fagerberg B. Sodium/lithium countertransport, insulin resistance, insulin peptides and microalbuminuria in clinically healthy 58-year-old men. Clin Sci (Lond). 2001 Apr;100(4):443-9

7. Gaspardone A, Ferri C, Crea F, Versaci F, Tomai F, Santucci A, Chiariello L, Gioffre PA. Enhanced activity of sodium-lithium countertransport in patients with cardiac syndrome X: a potential link between cardiac and metabolic syndrome X. J Am Coll Cardiol. 1998 Dec;32(7):2031-4.

8. Canessa M. Erythrocyte sodium-lithium countertransport: another link between essential hypertension and diabetes. Curr Opin Nephrol Hypertens. 1994 Sep;3(5):511-7.

9. Aithal V, Appaih P. Lithium induced hidradenitis suppurativa and acne conglobata. Indian J Dermatol Venereol Leprol. 2004 Sep-Oct;70(5):307-9.

10. Yeung CK, Chan HH. Cutaneous adverse effects of lithium: epidemiology and management. Am J Clin Dermatol. 2004;5(1):3-8. Review.

11. Oztas P, Aksakal AB Oztas MO, Onder M. Severe acne with lithium. Ann Pharmacother. 2001 Jul-Aug;35(7-8):961-2

12. Chan HH, Wing Y, Su R, Van Krevel C, Lee S. A control study

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