"A ship in the harbor is safe, but that's not what ships are for." William Shedd

Saturday, March 28, 2015

My Blood Work

So, in my last post I mentioned the 'helpful' email I received from my insurance company *rolls eyes*; they are so 'helpful' that they are now requiring you to meet their health standards score to save money on your insurance premiums.  You are scored based on your blood pressure, LDL cholesterol, glucose, triglycerides and tobacco use status; if you do not meet a minimum target score, or improve your score next year, your premiums go up.  My indignation over this Big Brother approach and whether it is reasonable, is fodder for another time; I thought some might be interested my blood work as a real life long term paleo/low-carber (sorry, I've only got the last two years on hand). . . 
For context - my diet has been 'paleo' for over seven years now, low carb-ish without carb counting; I've entered my diet into FitDay randomly over the years to see where all the values were falling out, but my diet is pretty consistent, so I don't track day-to-day.  Last fall (again, for context after my 2014 blood work) I made some minor changes in my diet to shift into nutritional ketosis, confirmed via urine test strips - or, as I saw in a comment the other day, measuring my peetones - heh!  Slightly less protein and slightly more fats, primarily from avocado, macadamias, coconut oil and butter; no significant changes in my produce consumption, as I was already fairly low-carb. 
As for exercise, at the same time that I started a paleo diet, I started weight lifting again.  My experience is that weight lifting is VERY beneficial for my rheumatoid arthritis - likely every bit as crucial as diet; in a future post, I'll discuss more. . .  I started out with pretty low weights, but seven years later, I am lifting literally three times as much weight as I was in the beginning (woot!); lifting sessions are typically 20-30 minutes in duration.  I also started mountain biking again about four years ago.  I ride or lift, on average, four to five days a week.  In the deep winter, when the local trails are trashed due to weather, I mostly lift with an occasional ride here and there when the ground is frozen solid.  In the summer, I mostly ride, with one or two weight lifting sessions a week.    Also, I'd like to note for anyone interested, in shifting my diet toward nutritional ketosis I did not experience any noticeable difference in my exercise performance. 
On to the numbers! 
Total Cholesterol
2014        2015          Reference Range
186          198            100-199
2014        2015           RR
87            108             0-99
2014        2015           RR
17            11                5-40
2014       2015            RR
82           79                less than 59 
T. Chol./HDL Ratio
2014       2015           RR
2.3          2.5              0.0-4.4
2014        2015         RR
86            54             0-149
2014        2015         RR
101          103           65-99
Hemoglobin A1c
2014        2015         RR
5.4           5.5            4.8-5.6
So, I'm thrilled with the lower triglyceride and VLDL numbers.  HDL is still nicely in the very high numbers, keeping my Total Cholesterol/HDL ratio low.  The LDL is outside of the lab reference range, but still below the lower target number of 130 used by the insurance company, so I wasn't penalized for that; it's a shame that they don't include HDL or the Total Cholesterol/HDL ratio in their scoring.  I was penalized for having high blood glucose.  I'm not terribly thrilled with the glucose number, although such numbers are not unusual for those who are very low carb (VLC) and/or in nutritional ketosis.  Peter, Mark and Robb have all blogged about this phenomena. 

It is my understanding that this can be 'fixed' by eating a more moderate carbohydrate diet for a short period, which could be a strategy for next year's blood work to ensure I stay within the insurance company's target score and don't end up getting nailed with higher premiums.  I'm well within the target score this year, so there's that. . . On the other hand, I would have expected the A1c number to be a bit lower, and the elevated blood glucose still gives me the willies. . . I know Dr. Terry Wahls advocates a ketogenic diet for a variety of reasons - time to reread that section of her book and confirm whether I want to continue with nutritional ketosis or drop back to my 'normal' paleo diet. 

In any case, Happy Spring all!  The local trails are finally in good shape and although the weather isn't quite so warm as last weekend, the sun is out - I'm off to ride!

Wednesday, February 4, 2015

Down For the Count

"The formula for weight loss sounds simple: You need to burn more calories than you take in. That usually means moving more and eating less. But does the thought of cutting back on what you eat leave you, well ... hungry?"
This is a direct quote from an email I recently received from my insurance company, accompanied by an article explaining that reducing my caloric intake by just a few hundred calories a day will help me lose those unwanted extra pounds.  Oh, really? - well, it depends. . . My insurance company is not the only one bringing up calories in recent months; Mark's Daily Apple had a great post about 7 Common Calorie Myths We Should All Stop Believing and just today, a post on Robb Wolf's site asks, Do Calories Even Matter?  And, for a not so recent post about the almighty calorie, Gary Taubes' post, What would happen if. . . ? Thoughts (and thought experiments) on the calorie issue.
Look, it IS true that reducing calories (see the Twinkie Diet),  or tons of exercise, or both (see Biggest Loser) can reduce your 'weight', but what happens when you can't fight your body's need for 'food' any longer, or when you have health conditions that preclude hours of vigorous exercise (or, you know, you work for a living instead of living at the Biggest Loser enclave)?  And what kind of 'weight' are you losing?  Many conventional weight loss plans often reduce muscle mass right along with fat mass - maybe not such a good idea.  And what happens when you go back to eating (and exercising) in the way you always have?  Aaaaand, while dropping some weight may reduce the stress on your arthritic joints, if your focus is exclusively on counting calories, are you getting the nutrition to build healthier joints?
People like to measure things - how cold (or hot) is it today?  How many miles to grandma's house?  How much money is in the bank?  How many calories are there in this meal?  But we need some context in what we measure - If it's 35 degrees outside, am I dressed appropriately?  Am I just standing around or am I doing vigorous exercise?  Am I walking to grandma's house?  Or am I driving there?  Flying?  Did I just deposit my paycheck in the bank?  Or did I just pay all my bills?  The same context is important when it comes to calories; it is too simplistic to reduce calories in/calories out  (CICO) to a simple mathematical equation.
I recently read a discussion on a cycling forum about weight loss.  It was interesting (and occasionally highly entertaining) to read through the opinions of a diverse group of people whose only common denominator is their obsession with two wheels (and if you think that a group of people whose hobby directly relates to physical activity don't struggle with their weight, think again!).  There were a number of proponents of the conventional calories in/calories out weight loss model (cycle more, eat less!!), and a surprising number (at least to me), that advocated for a 'paleo diet', as well a few people who claimed weight loss success using supplements (or thought some illicit drugs might be in order).  There were a couple of real gems, in my humble opinion; below is one, paraphrased for context. . .
"Calories are a unit of energy, just like a joule is. 

 As such calories are not ingested, processed and stored. A vast array of simple and complex compounds are ingested and metabolized and each of these have an associated energy gain which can simplistically be related to the caloric value of the food. It is massively simplistic and in some cases not at all relevant, hence the discussion here and how different foods will aid weight loss better, but it's been taken as a standard because the concept is easy for people to understand and generally is applicable when deciding total amounts of food to eat.

 It seems a nit-picking point, but it isn't. Two foods with the same caloric value can be metabolized in a vastly different way and have a very different impact on the body.

 As for metabolism being a simple concept. Errr... No."
To repeat, 'as for metabolism being a simple concept, errr. . . No'.  Below is a 'simple' diagram of metabolism (woe-is-me, I remember memorizing some of these pathways in college).  Please note, the word 'calorie' is not in there. . .
If this diagram seems complicated, think of all the complex structures you body is busily building and rebuilding, over and over and over, ad nauseam.  To quote Taubes, "the mantra that ‘a calorie is a calorie is a calorie' serves only to direct attention away from the meaningful characteristics of the macronutrients in our diets...".  What is the purpose of eating after all?  To keep the number of calories under an arbitrary number based on your size, sex and amount of physical activity, or to provide your body with the nutrients it needs to maintain a fully functioning h. sapiens sapiens?
So, what has/is working for me? 
A low calorie/high exercise regimen worked to get my weight down to around 115 in my twenties.  Of course, by my thirties I had rheumatoid arthritis, irritable bowel syndrome, cystic acne and my weight had ballooned to about 190, so I guess maybe rice cakes and jogging (and later biking), wasn't entirely. . . optimal.  As the weight piled on, I tried.  I really tried; over the years, more biking, stair-master, aerobics, low-fat, low-cal, vegetarian.  Getting 'the shakes' and brain fog, signs of  blood sugar dysregulation, was an almost daily occurrence.  I'd lose a few pounds, gain back those and five more.  It was maddening, and I felt like such a failure.  Flash forward to the adoption of a paleo/primal diet and intermittent fasting, combined with moderate weight lifting.  Over a period of years, my rheumatoid arthritis and IBS improved and my weight dropped to around 125 (based on the scale at the doctor's office, as I didn't own a scale at this time).  No over night magic, but steady progress.  I didn't count calories.  I didn't count carbs.  I ate nutrient dense meals of meat/fish/fowl and vegetables; no processed food, no grains, no legumes.  Regularly planned 'cheat' meals.  Sometimes my workouts were gung-ho, sometimes they were half-assed.  Nonetheless, I had life changing results.
Having achieved these life changing results, I got a bit cocky.  I began mountain biking, stopped using intermittent fasting and became less stringent with my paleo/primal food template . . . and over a period of years, I regained around fifteen pounds (evidence, if I needed it, that up to two hours of vigorous 'cardio' four days a week, plus some weight lifting, won't do a darn thing to keep my weight stable) and I began having more significant trouble with my IBS (I also attribute this to a bout of severe food poisoning and antibiotic treatment).  So, I bought a scale and rededicated myself to quality paleo food and. . . nothing happened; I could NOT make a single pound budge.  Maybe because I'm now in my forties, maybe because my gut flora got all out of whack, maybe because the stars were not longer aligned; I just don't know.  What I DO know is that by switching to a ketogenic paleo template with a daily (most of the time) 16 hour fast (Wahls Paleo Plus ring a bell?), I've gone back down eleven pounds (only four more to get (back) to 125).  Not such a big change really; slightly (very slightly) less protein and slightly more fat (think avocado, macadamias, coconut oil) in my basic no grains, no legumes, no processed food, nutrient dense meat/fish/fowl and vegetables meal plan.  Again, I'm not counting calories, or carbs, or for that matter, grams of fat (although I do confirm ketosis with urine test strips); sometimes my work outs are gung-ho, sometimes they're half-assed, and now that it's winter, I miss more days mountain biking than not. . . the body is a living system, not a static machine and I'm still learning.

A final thoughtful gem from the cycling forum:
"You've still missed the point. "Weight loss" is what? The loss of fat? The loss of muscle? Both? Going to the toilet?  Sweating?

Weight gain is what? Adding fat, adding muscle, ingesting food/water?"

It's all about context. . .

 In honor of Old Man Winter, and the snow currently falling outside my window, some pictures from the winters I've spent here in Missouri.

Wednesday, December 3, 2014

All Things NOT Being Equal. . .

I'm a bit of a news junky - I often have the 'news' on the TeeVee in the background while  I'm puttering around doing housework and the like. . . In any case, I heard in passing early last week that there was a new study out showing that reducing carbohydrates (ie a low carb/high fat diet) trumped reducing fat (ie a high carb/low fat diet) in both weight loss and in improving blood lipid profiles that (supposedly) are markers for cardiovascular health.  At the time, I thought - meh, nice to know that the "establishment" is catching up with "us", us being all the people that have been practicing low carb/high fat diets for many years.  That is, I thought 'meh' until the next time this study was mentioned on the TeeVee, and then I got pissed. . .
As I passed through the room on Sunday, the news was on and I realized they were discussing the study again; interviewing a doctor, who on this station is the in-house medical expert. . . His take on this new study?  "Everything in moderation".  Yep, that was his final word regarding this study - everything in moderation. . .  Jebus wept!!!  This type of message is why I see people at my workplace struggling to lose weight on Weight Watchers, or eating a precisely measured number of jelly beans in the afternoon while taking daily medication for their diabetes, or coming back from the cafeteria with a mound of iceburg lettuce garnished with a few baby carrots and cherry tomatoes and covered in low fat dressing, and then snacking all afternoon.  And this type of thinking is why every. damn. time. there is a catered meeting at work, the breakfast menu consists of an assortment of muffins, pastries and low fat yogurt, and the lunch menu consists of sandwiches, bags of chips and an assortment of cookies (in all honesty, the rare 'high-brow' meetings do include some actual edible foods, which most of my coworkers view as a 'naughty' treat they've earned by attending these marathon meetings).    People listen to the messages coming from mainstream doctors, medical 'authorities' and nutritionists and they really try to do the 'right thing' - but the mainstream medical establishment WILL NOT admit that they let us down in recommending low fat diets for the past several decades - can they not SEE how these recommendations have worked for the general public!?!
And then I got pissed all over again when I tried to look up the study.  First, there's nary a print article to be found. . . I found one article in Men's Journal, and that was at least helpful in finding out the name of the lead researcher, Lydia Bazzano (although MJ misspelled her last name, d'oh).  Then, when I tracked down a brief article from Tulane University discussing the study, I wondered why these researchers tried to sabotage their own study. . . It started out with some promising commentary; Dr. Bazzano notes "we found those on a low-carb diet had significantly greater decreases in estimated 10-year risk for heart disease after six and 12 months than the low-fat group.”  The article then goes on to say "While the low-carb dieters got 41 percent of their calories from fat, most were healthy monounsaturated and polyunsaturated fats like olive or canola oil. The group only got 13 percent of calories from saturated fats like butter."  Canola oil?  CANOLA OIL?!?  And a quote from Dr. Bazzano ends the article - "It’s not a license to go back to the butter, but it does show that even high-fat diets – if they are high in the right fats – can be healthy and help you lose weight". 

Hint, there is no canola plant; canola oil is typically produced by heating and crushing rape seed, then refining the resulting wax with high heat, hexane, and organic acids, followed by bleaching and deodorization.  The omega-3 to omega-6 ratio is about 2:1.  Dr. Bazzano et al. appear to have been buying in to the fear mongering surrounding saturated fats before they even started the study - one wonders what the results of the study would have been if they hadn't used freakin' highly processed vegetable oil as a primary source of dietary fat?  This is NOT how people In The Real World are typically implementing a LCHF diet!  Geez louise.
In any case, this is not really News, with a capital N. . . There have been a number of low carb/high fat vs high carb/low fat comparison trials over the years - below is a presentation by Dr. Jason Fong extensively discussing this research.  The video runs long, about an hour and 20 minutes, but it's well worth your time.  The video is Part 3 of a six part video series titled "The Aetiology of Obesity" - maybe you can fire up your favorite mobile device and listen to this, and the other five installments, as you putter around the house - it certainly would be more educational than listening to the news, am I right?

Sunday, November 30, 2014

Get A Grip

So frustrating - I can grip a bar for chin-ups, or grip the handlebars of my bike for a wild and wooly rock strewn downhill with no problem (most of the time), but opening a jar of pickles or the cap on a new tube of mascara is next to impossible. . . The below strap wrench is a lifesaver for opening everything from the largest jar to the tiniest screw-on cap.   If you have arthritis in your hands (or even if you don't), you want one of these!

Sunday, November 16, 2014

Get Your Google-Fu On

I've got several posts in draft, but until those are finished. . .
This week, a not uncommon scenario played out at work; one of the other programmers I work with was tasked with a request from our boss.  This task was something they had never done before, so the first thing they did was email myself and the other programmer in our group to find out if we already had a program they could use to do this. . . As it turns out, no, neither of us already had a program written to perform this task, and in fact neither of us had any experience with how to do it at all - BUT, when I ran a simple google search, pages of code snippets and support documents detailing how to code for this type of data appeared on my screen.  And it was really pretty simple; just a few lines of code and, bob's your uncle, all done.  Hmmm. 
This event got me thinking about the difference between being handed an answer and learning to find information on your own.  I learned to code in an environment where there was no one to give me code they had already written, or even anyone to tell where to find the information on how to begin - I spent a lot of time on the net searching and a lot of time writing and rewriting code until it worked.  JUST AS I DID, AND STILL DO with food, exercise, and their relationship with my autoimmune disease.  In my work life, this means that if I'm given a project that involves unfamiliar territory, and there is no one available to guide me, I'm not lost - I know where to go to find the lay of the land, and I know with a little work, I can build my own map.  In my search for better health, I can do the same.
Paleo has really exploded in the past several years - there is a LOT of information available; everything from MD's (here and here), to researchers (here and here), to fitness coaches (here and here and here (had to throw the last one in special for the ladies!)),  to former researchers turned fitness coaches (here) and many, many plain jane/joe bloggers (here, heh); they're all talking about using paleo concepts as a foundation for better health.
So get your google-fu on!  Learn to use and evaluate all the information available at your fingertips and take responsibility for finding answers that work for YOU, and then you'll never find yourself dependent on others finding the answers FOR you! 
Got the camera out a couple weekends ago to capture all the gorgeous fall color. . .
Loved the look of the leaves in the creek. 
What IS that?
Two shots of 'Put the camera down and hurry up already!'
 Parting shots.

Sunday, October 5, 2014

A New Beginning

It's time to start blogging again. . .  This post has ended up being rather long - making up for lost time I guess.  When I moved to St. Louis, the new complexities of my life here took precedence over time spent at the computer.  However, over the years I've spent a lot of time searching around the paleosphere, applying these ideas in my life, discarding what doesn't work and refining what does work - and it's still an ongoing process.  I really, really wish I had a record of where I've been, what I've done, and what I've tweaked over time. . . That, and occasionally feeling like I stumbled across the golden ticket and should be sharing the wealth, is why I decided to re-open the blog.

My own story, in a nutshell (more in later posts) - I always considered myself 'athletic', moving from jogging and some weight lifting in high school and college into road biking and eventually mountain biking in the years after college.  My understanding of nutrition was crude at best and based around the food pyramid/low fat dogma; if it was low fat or no fat, it was ok to eat, protein and carbohydrates were vaguely interchangeable components of all foods and vitamins/minerals could be topped off with a 'One A Day' pill.  Following a bad car accident and back injury that curtailed my physical activity, I began gaining weight, and then began having occasional bouts of general 'malaise' and intermittent bouts of diarrhea.  About nine years ago, I began suffering from chronic joint pain and fatigue, and eventually got to the point I seldom consumed anything solid at work because about 90% of the time, I would have explosive diarrhea within twenty minutes of eating accompanied by severe abdominal cramping and belly pain (but ironically, I had gained more than 60 lbs at this point).  I also developed severe cystic acne over this time, bad enough that I tried an extended course of the drug Accutane (the cystic acne came right back after I went off the drug).  I was eventually diagnosed with rheumatoid arthritis, irritable bowel syndrome (IBS) and diverticulosis (likely related to the chronic diarrhea/IBS); my rheumatologist at the time was not entirely convinced that I didn't have Chron's disease or ulcerative colitis, even though full upper and lower GI's didn't show any active lesions at the time.  At this stage of my life, I was no longer able to do many of the things I enjoyed doing, was struggling to make it through each work day, in bed or on the couch sleeping through the weekends, and I wondered just where my life was going to end up.  I was only in my early/mid-thirties.

After a year or so of taking NSAIDS/DMARDS/biologics to treat my disease, and finding that not only were my symptoms not improving, but that the treatment was often as sucky as the disease, I began to research 'alternative' treatments, and began my journey into the world of paleo.  Today, while not entirely symptom (or pharmaceutical) free, my state of 'sick' has improved beyond my wildest hopes and I am living a full life; working full time, and spending a lot of my free time playing hard!  An avid mountain biker and roadie in my twenties, I thought that beloved activity was lost to me forever; I started mountain biking again about three years ago!  I hike, I lift weights; I am generally able to physically do anything I want to do, without excessive planning around, or stopping my life because of, my disease.
Thumbing through my old posts, I realized again how much I've learned since the early years on this journey.  I'll admit that I deleted a number of posts as, lets be honest, they were depressing.  The blog was originally more of a place to rant and rave at the injustice of being saddled with an autoimmune disease and a shitty (pun intended) colon.  And really, there wasn't a whole lot in those posts that was useful information ;-). 
So, my intention for today is to do some housekeeping and in later posts, quoting a phrase some of you may recognize, to outline "what it was like, what happened, and what it's like now". 
I will acknowledge that, depending on where you've been spending your time, you may be suspicious of paleo.  Paleo is a bit of an umbrella term that has gotten a bad rap in certain circles.  If the only exposure you've had to this paleo thing is an article in the NYT, your image of what this is all about is probably pretty limited.  Out in 'public', I tend to simplify things by saying that I eat a whole foods diet and leave it at that.  I'm always glad to talk about these ideas and how they've transformed my life, but I've found that most people, even those with severe health issues, just aren't interested.  It's familiar/easier/safer to stay mired in the habits that got one to dis-ease to begin with. . . And for those that are skeptical that food itself can have such dramatic results in the way the body functions, next time you go to the gas station, fill up with diesel (no, don't, really! - I worked with someone who's 16 year old daughter did this accidentally with the family car - EXPENSIVE!).  Same concept; use inappropriate fuel, fuel your biochemical engine wasn't designed to run on, and the engine may fail (depending on your genetic predisposition).

So, where to start learning about these paleo concepts?  Marks Daily Apple  is an excellent place to start.  One of the things I really like about his site is how well rounded it is; it's not just about food - changing what you eat is a great (and crucial) beginning, but there are plenty other behaviors that influence health, or lack of health, as the case may be.  Mark Sisson offers the Primal Blueprint, which I think is a comprehensive collection of the essential elements that everyone should consider a foundation of good health - that goes double if your starting point is 'sick'.  Spend some time there - there is a Primal Resource Guide that is very handy in laying out a metric shit ton of information right at your finger tips.  I've also provided links to two of Mark's books.

Robb Wolf is another favorite; although you'd never know it to look at him now, he came to the paleosphere from case of the 'sick' himself.  He has some extensive information about the paleo diet in relation to diseases of autoimmunity, and Robb's book (I've provided a link) has section dedicated his specific 'Autoimmune Protocol'.  Robb has also worked with one the men that got me started down this road.  Watching this video series of Prof. Lorain Cordain's talks about multiple sclerosis and 'neolithic agents of disease' were one among many of the early light bulb moments for me over seven years ago.

 And now to move from the 'general' paleo ideas, to more specific autoimmune focused paleo concepts.  Terry Wahls is a real MD, with a real autoimmune disease - multiple sclerosis.  She found, as so many of us do, that conventional medical treatment of autoimmune disease is at best, a way to slow the progression of disease through pharmaceutical intervention and at worst, a path to continuingly progressive disease with a slew of medication induced side effects. Seven years after her diagnosis, with the best of the medical establishment's available pharmaceutical treatment, she found herself in a wheelchair, and thus began her own journey.  By researching the biochemical foundations of disease, and how specific nutrition and lifestyle behaviors can improve that biochemical landscape, she eventually developed The Wahls Protocol.  Her 2011 TEDx talk is a condensed outline of her experience, and is also powerfully motivating for anyone with an autoimmune disease, as well as any 'I want better health' average joe. 

Most of Terry Wahls work came out during a time (actually, over a period of years) when I was completely buried at work, and mountain biking or hiking every spare moment as a stress reliever; I wasn't aware of the majority of her work until recently.  Her Wahls Paleo Plus diet (there ARE less stringent levels) is very similar to the diet I've settled into over time; a ketogenic based paleo diet with a daily 16 hour fast.  And I love, love the importance she places on moving the body/exercising as much as one is capable of.  Her book (I've provided a link) is a MUST READ (did I say that loud enough?) for anyone with autoimmune disease.  It's chock full of information that is easy to understand, even if you have no background in the sciences - and her writing voice is incredibly powerful and inspiring.  Terry has a gift with words; her almost poetic turns of phrase will light a fire in you to take back control of your health!

Peter at Hyperlipid will blow your socks off with some of the heavy duty science behind nutrition research, high fat/low carbohydrate nutrition in particular.  He holds an honorary place for a series of posts that led to some my early internet searches about insulin/inflammation and eventually led to my introduction to the world of paleo.  And this post introduced me to the benefits of intermittent fasting (IF) in relation to autoimmune/inflammation (more about IF in the future, I promise).

So, I've tinkered with setting up my links and composing this post for several days, and it's time to hit publish.  I'm heading out week after next for our annual family fall vacation at a cabin in the area known as the Arkansas Grand Canyon (hopefully temps will be cooler this year) and I leave you with a couple of photos from last year and a promise to post again when I get back.

Had to capture this on camera, the rolling hills and clouds and sun intermingled - beautiful!

A break in the shade; last year's vacation weather was hot and humid - Holly and Mikey NO LIKEY!