Thank you to everyone for taking the time to fill out and submit the survey. There were about 129 responses in total. 

As somewhat expected, the results are kind of all over the place. That was expected because everyone is coming into this from different backgrounds, dietary histories, ages, etc. But, what’s unexpected, and rather clear is that too few people are making steady progress in regaining their health. Even before conducting this survey, quite a few people had reported that their early progress had stalled, or had even reversed as time went on. That’s a huge concern, and it’s the primary motivation that prompted this survey. The survey results confirmed those early sporadic reports. Many more people (~50%) are indeed hitting the “detox” setback and it’s far more common than I had previously thought. 

At a very high level, here’s my preliminary assessment of the survey results.

1. A restrictive diet alone is just too slow, and too unpredictable.
2. We clearly need an antidote (I think the body has a built-in one, we just need to help activate it, see more on this topic below)
3. It looks like the people with a big VA supplementation history might be the ones more likely to encounter the detox cycle.
4. The majority of people have found themselves in this mess via VA supplementation or from accutane use.
5. Although most people do believe they are on the right track, their real results are still too few / slow.
6. Many more people have encountered the “detox” setback cycle than what I expected / was aware of. I see this as our biggest problem, and it needs immediate and serious attention.

But, it’s not all bad news, there’s still a lot of good news here too.  Although it’s slow going, a lot of people are indeed recovering their health.

What does it all mean?

My private, and previously unstated, criteria for deeming the vitamin A toxicity theory to be considered valid, and on target is that we should see about a 95% success rate for people applying the elimination diet. To help frame the discussion, here are some illustrations (not real data). The following chart is what I think we should be seeing for most people. Of course, we should expect there to be some personal variabilities and small setback cycles too. 

However, we are not seeing that trend, and almost not at all. It’s more like this for most people:

Currently, we are nowhere near the target 95% success rate. Maybe it’s still just too early. Realistically, we are probably closer to around a 5% – 10% rate in clear success. Nevertheless, from the survey, 67 of 130 people have still reported having made a significant improvement in their health. Quite remarkably, on the one hand that is still a far higher success rate in recovering from chronic disease than any pharmaceutical drug has proven to do. On the other hand, that particular comparison is such a pathetically low bar, it’s not very useful or meaningful to us. 

Regardless of things generally moving in the right direction, something is clearly wrong here too. Either the base theory is wrong ( I don’t think so, but it’s possible), or we are missing some important confounding factors.

One of the early concerns I had about the strict elimination diet is that it removed so many other foods and nutrients, that it is easily possible that we are excluding something else from the diet that in the longer term is essential to our health. Say for example, some of the B vitamins, etc.  So, it could really be a deficiency situation building up in resulting in people hitting the “detox” setback cycle. But. I somewhat dismissed this concern when I learned about the new “carnivore” diet being widely adopted. My thinking about it was surely the “carnivore” diet folks would be running into the same potential deficiency issues too then. And, if it’s happening, it is not being reported.

Additionally, over the last year or so, some people here were reporting that their serum VA levels were actually increasing as they progressed with the diet. This also fit with some accounts from published research papers. This makes sense too, because it’s what we should expect when about 70 million Americans adults have NAFLD, and the liver is probably starting to normalize in size and volume. This then better explained the “detox” setback cycle some people encountered. Therefore, it’s likely not a “detox”; rather, it’s really a “more tox” situation. So, my thinking was, OK, people just need to give it more time. Although my personal recovery did take a long time, my trend was generally pretty linear towards better health. I rationalized that I had been spared the big “detox” setback cycle because I had not been directly supplementing with VA, nor did I have a history of eating liver, etc. But, I too did have my share of smaller autoimmune flare ups and setback cycles along the way.

Very early on it became clear to me that we are not dealing with a simple toxicity situation either. Rather, it’s a very nasty and sinister one where the toxin binds to and messes with our RNA/DNA. So, for these DNA damaged cells we pretty much have to grow them off and out of our bodies. That’s just going to take a long time. Additionally, since it’s also a toxin that accumulates in our lipids, as we drop body fat, then more of it is going to be released into serum. Therefore, we are clearly in for a good long haul in detoxifying from this mess. But, that part of it does not quite fit with some of the real-world data reported in our survey. Some people have reported not losing weight, or have even gained weight, and have still slid down into the “detox” cycle.

Regardless of the reasons and mechanisms, I think having people slide backwards into poorer health is just not acceptable. Asking people to stick with it, and struggle through for months on end is not very acceptable either. Therefore, we need to get a clearer understanding of what’s really going on in the detox setback. Most importantly, we need to find an effective means of dealing with it. We need a reliable, safe, and most of all, a predictable recovery strategy. I think if the full recovery process takes say even four years, most people would still be okay with that, just as long as it’s progressive, and almost always in the right direction towards better health. The current non-predictability of it is almost a show-stopper for more people to take on this diet experiment.

What Next?

One of the key statements I’ve repeated over the last few years is that we need an antidote. Diet alone is not cutting it, and being such a restrictive died it will never gain widespread acceptance. But, diet is the only tool we have in our collective toolkit right now. Therefore, I was seeing the diet-alone approach as just a starting point in this investigation.  My thinking was that if we could use it to prove the case, then others would pitch in and help develop an effective antidote. Unfortunately, we are not at that point yet. 

However, there are some other very important facts we need to remember. One is that humans have been dealing with vitamin A (in its various forms) for millions of years now. Yes, it is a toxin to humans, but plants love it, and it’s not going away. Therefore, we just have to learn to deal with it more safely. The supercritical and obvious conclusion is that the human body has already developed mechanisms to deal with, neutralize , and detoxify the retinoids. These biological processes are reasonably well understood by current medical science, and are actually quite well documented too. The key point to know here is that In addition to the physical elimination pathways, via the liver, skin, and the RBPs, the body has very likely already developed the needed antidotes to retinol and retinoic acid. I think these antidotes are primarily the alcohol and aldehyde dehydrogenase enzymes. These enzymes effectively slowly chop up the retinoid molecules.

So, why isn’t the alcohol and aldehyde dehydrogenase enzyme production keeping up with the new demand? One possibility is that they’ve been too overwhelmed or drained. Another possibility is that the needed manufacturing feedstock of nutritional elements is missing from our now very restrictive diets.

There’s yet another possibility, and that is that as people go very low on the consumption side of vitamin A, then the body’s perceived inbound threat is reduced, and the production of the dehydrogenase enzymes is slowed or even shutdown. Whereas, the backflow of retinyl esters from the liver is not quite the right molecule to trigger production of the dehydrogenase enzymes. This little sub-theory is actually supported by several people who have reported that keeping just some vitamin A content foods (like a single egg per day) in their diet prevents and quickly abates their “detox” setback cycle.

But, I want to be clear that I am NOT making the recommendation here that people start reintroducing VA foods back into their diets. That’s because other people have reported just the opposite effect. Clearly, it’s an individual thing, and people are going to need to experiment with it and find what works best for their own situations.

Next, there’s another really important possibility. Is there something else being included in our diets that would consume and preferentially compete for the same alcohol dehydrogenase enzymes?

Hmm, could it be the Cauliflower?

About 36 of the survey respondents reported including cauliflower in their diets. I suppose that I am probably responsible for starting that with the diet I document in my eBooks.

Although cauliflower has little to no vitamin A, one surprising thing to know about cauliflower is that it can have a pretty high content of formaldehyde (source). It’s not massively over the top, but it’s still relatively high. The thing is that the same alcohol and aldehyde dehydrogenase enzymes are needed to neutralize and detoxify that formaldehyde. Other foods to be on the lookout for in this regard are Asian pears, canned pears, and other canned fruits, and to a lesser extent even bananas. The other major culprit is the artificial sweetener Aspartame. Aspartame is a big problem because the breakdown pathway for it is that it first gets converted into formaldehyde. The resulting formaldehyde will therefore compete for our precious alcohol and aldehyde dehydrogenase enzymes.

Could it be that the cauliflower, and possibly these other foods, is sabotaging people’s recovery progress? I don’t know, but I’d sure like to find out. Therefore, for anyone currently including them in your diet, can you please try dropping them for a while and report any changes.

One more thing to be aware of is some of the pharmaceutical drugs are documented to interfere with the detoxification process of the retinoids too. The two that I am most aware of are the Statins and the SSRIs. But, we can assume that any pharmaceutical drug that is processed by the liver as being competitive for the liver’s detoxification resources. Obviously, consuming anything more than just minor amounts of alcohol is not going to help us either. So, any of these factors, combined with an environment where more retinyl esters are suddenly back flowing into circulation, could lead to the dehydrogenase enzymes being overwhelmed and exhausted. 

Boosting our alcohol dehydrogenase enzyme production

Back in February when I posted my discussion on Statins and Cholesterol I made the suggestion that regular consumption of Apple Cider Vinegar would help ameliorate any calcium buildup in the arteries. And I still believe that it almost surely will do exactly that. But, what I did not know at the time was that ACV has some other major benefits. It helps boost bile production, and the source bacteria contains aldehyde dehydrogenase enzymes. ACV also helps boost our own production of the human version of enzymes. There are other foods that can help safely boost ADH and ALDH enzyme production. Dr. Garrett Smith is actively looking into this aspect of it.

Zinc – here it is again

It’s also important to know that zinc is a critical mineral needed for the formation of the dehydrogenase enzymes, just as it is for the RBPs. Therefore, if you are not eating red meat, you really should make sure that you are getting enough zinc from other sources. It looks like some of the B vitamins are also involved in the process of building the dehydrogenase enzymes.

The actual survey responses are summarized below.

The raw survey data are available here in an .xls format.