Preparing for my third 13-week season, working to lose weight, control my Type 2 diabetes, and improve my health. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own. A new 13 week experiment starts June 1 2013. Join in!
Okay, this is a long one, just to warn you. Here’s the basics:
I’ve been rethinking these 13 week sessions and how to do them; I’ve written a new explanation.
I’m starting to see how the emotional part plays into the issue.
I’ve used the pattern as I now see it to start planning my next 13 weeks, and provided that as a “worked example” for other people who want to try it.
I’m looking for people to volunteer to try a 13 week experiment of their own, and possibly to try a web site meant to support 13 week experiments. Volunteers should mail me at email@example.com
Now on with today’s show.
As I said last week, I’m taking a little bit of a vacation from attempting to strictly follow some eating plan while I think about my results and what to do next.
The vacation has been interesting. I gave in to one of the things I’d been missing, and had a McDonald’s Double Quarter Pounder and large fries for lunch, the same day I was going to my niece’s daughter’s first birthday party. Then at the party, I had a nice piece of cake as well as a bunch of things that were actually low carb.
From this I learned two things: I don’t actually like McDonalds as much as I used to, and I really can manage to drive my blood sugar up to the 230′s with carrot cake. But this was a momentary indulgence, especially since I, sure enough, had some of my old stomach troubles for a couple days afterwards.
As they say in Shangri-La, “Everything in moderation — including moderation.”
In the mean time, though, I’ve been thinking a lot about the experiments, and about the emotional/psychological/spiritual aspects of what I’ve been learning. (Let me just say, I don’t really believe there is a difference between the emotional, the psychological, and the spiritual. We’re not made up of a lot of pieces; what we’re thinking is what we’re thinking, and what we’re feeling is what we’re feeling, all together.)
What I’ve realized is that when I started my first 13 week experiment, I was groping toward something that would let me make changes in a way that didn’t scare me with the prospect of endless and unproductive deprivation, didn’t shame me as so many diets had done in the past, didn’t blame me for the lifelong problems I’ve had with weight, and gave me some emotional support in the process.
For me, writing about it has been a good bit of that support — I learned from Twelve Step programs that sometimes the best support you can get is by honestly admitting to the problems and your feelings about them.
Another big part of the support has turned out to be the rooting you, my readers, have been doing for me, and the sense that by talking about this I’m actually helping other people.
I hope to help other people use the things I’ve learned, and that means I need to figure out how to explain them. I’ve made a couple of previous attempts, but in this week’s thought I have what I think is a better explanation.
The First Insight
This is really what got me started: my first insight was not to think of a diet, not to think of of a weight-loss goal, but just to think of performing an experiment. I now realize that this was a first step in insulating myself from the years of fear and shame that had accompanied Dieting.
Simple scientific questions require simple scientific answers; doctors want unequivocal guidance to their practice so that they do not fumble in the dark. But it is easier to ask questions than to answer them, as two papers published in the same week in the New England Journal of Medicine and the Journal of the American Medical Association attest.
The question asked by the two papers was the optimum level of oxygenation in the blood of pre-term infants. In the past it was rather naively supposed that if oxygen were necessary, then more of it must be better; but premature infants who were exposed to high levels of oxygen developed a condition known as retinopathy of prematurity, often leaving them blind or severely impaired visually.
The two trials, one from Britain, Australia and New Zealand, and the other from the United States, Canada, Argentina, Finland, Germany and Israel, sought to establish whether a higher or lower level of oxygen saturation of the blood was better for infants born very prematurely. The results were different, if not quite diametrically opposed.
The first trial found that babies treated so that their blood oxygen saturation was higher had a lower death rate at 36 weeks than those treated so that their levels were lower. 15.9 per cent in the high saturation group died compared with 23.1 per cent in the lower. You would have to treat 14 babies with the high oxygen saturation to save life more than treating them at the lower level.
This week is Bike to Work Week in Washington, D.C., which is a perfect opportunity to point out why the vast majority of bikers are huge jerks who ruin the road for the rest of us. I’m not saying they’re jerks all the time; just when they’re on their bikes. Kind of like how someone turns into a Mr Hyde version of himself when he climbs into a Prius.
I’m not even saying all bikers are this awful. Just most of them. Enough of them to give bikers a bad rep, even when some of us actually try to be considerate, safe, and respectful. So this Bike to Work Week, please do bike to work — just don’t be a jerk about it.
5. Biking on the road, without following the rules of the road
You know what I’m talking about — the bikers who use the bike lane or actually drive in the traffic lanes, but breeze through stop signs without pause, creep past red lights, cross lanes when they turn, and generally act like the rest of traffic should bend around them. This is incredibly unsafe — for bikers, drivers, and pedestrians. As someone who walks to work every day here in D.C., I could count on two hands (and a few toes) the number of times I’ve nearly been run down by a bike that had no intention of stopping for a red. Hills are no excuse. If your brakes are too poor to come to a full stop when you’re pointing downhill — or your legs are too weak to stop then start again while climbing uphill — then you shouldn’t be biking on the road. Get in shape, get a tune-up, and come back when you’re ready to bike safely.
I was reading Drudge and saw that he and other intense internet users were enlisting the help of Esther Gokhale, author of 8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot:
Mr. Drudge is one of thousands of people who have trained with Esther Gokhale, a posture guru in Silicon Valley. She believes that people suffer from pain and dysfunction because they have forgotten how to use their bodies. It’s not the act of sitting for long periods that causes us pain, she says, it’s the way we position ourselves….
Mr. Drudge read Ms. Gokhale’s book, “8 Steps to a Pain-Free Back,” before training with her in person. “I needed her touch, her observations and her humanity,” he said.
I read and reviewed this book several years ago and it has really helped with computer-related pain:
I tried some of the exercises in the book which show how to sit, stand, bend and walk correctly and was pleasantly surprised that they seemed to ease some of the stiffness of the computer. The exercises with bands (that I already had in the house) were most helpful and stretched my legs out and felt great! I very much recommend the book if you spend too much time on the computer. If nothing else, the photography and illustrations make this book worthwhile on their own.
And if these methods work for Matt Drudge with his sitting up to 17 hours a day, maybe they will work for the rest of us.
Not long ago I bought a book, published in 1922, entitled Syphilis of the Innocent. Needless to say, the title implied a corollary: for if syphilis could be contracted by the innocent (as, for example, in the congenital form of the disease), it could also be contracted by the guilty.
In general, however, physicians do not inquire after the morals of their patients, except in so far as those morals have immediate pathological consequences. They do not refuse to treat patients because they find them disgusting, because they find them unappealing, because they are appalled by the way they choose to live. They try to treat them as they find them; they may inform, but they do not reprehend.
However, in practice things are sometimes more complex than this ecumenical generosity of spirit might suggest. According to an article in a recent edition of the New England Journal of Medicine, some doctors have been turning away patients on the grounds that they were too fat (one physician suggested that she did so because, ridiculously, she feared for the safety of her staff once the patients weighed more than 200 pounds), or that their children have gone unimmunised. Is such discrimination by physicians legitimate or illegitimate, legally or morally speaking? Is there not a danger that physicians may hide behind pseudo-medical justifications to express their personal prejudices or to coerce patients into doing what the physicians think is good for them?
Does practice really make perfect? Does it even lead to improvement? One feels instinctively that it should, that the more experience a physician has, the better for the patient. Much of the skill of diagnosis is pattern-recognition rather than complex intellectual detection, and it follows that the longer a physician has been at it, the quicker he will recognize what is wrong with his patients. He has experience of more cases than younger doctors to guide him.
But the practice of medicine is more than mere diagnosis. It often requires manual dexterity as well, and the ability to assimilate new information as advances are made. These may decline rather than improve with age. Too young a doctor is inexperienced; too old a doctor is past it.
A recent paper, whose first author comes from the Orwellianly named Department of Veterans’ Affairs Center for Health Equity Research and Promotion, examined the relationship between the years of an obstetrician’s experience and the rate of complications the women under his care experienced during childbirth. The authors examined the records of 6,705,311 deliveries by 5,175 obstetricians in Florida and New York. No one, I think, would criticize the authors for the smallness of their sample.
They examined the rate of serious complications such as infection, haemorrhage, thrombosis, and tear during or after delivery, divided by obstetrician according to his number of years of post-training experience. Reassuringly, and perhaps not surprisingly, experience reduced the number of such complications decade after decade. The rate of complications was 15 percent in the first ten years after residency; it declined by about 2 percent to 13 percent in the first decade thereafter, by about 1 percent in the subsequent decade to 12 percent, and by half a percent in the next. In other words, improvement continued, but less quickly as the obstetricians became more experienced; the authors appear not to have continued their study to the age at which the rate of complications started to rise again (if indeed there is such an age).
The stuff we gravitate towards as our personal means of “getting fit” is often as pointless as rallying around other faulty belief systems — like Scientology, or “the Cubs.” Lost in the fray of strength training, lifestyle coaches, and Zumba! — and essentially lost since the development of agriculture changed our lifestyles — was the obvious regarding fitness: namely, that you are a human. Before you focus on anything extraneous like your golf swing, you should make sure you can do what a human is made to do.
Otherwise, you are a time bomb for injury and preventable surgery, and for difficult golden years.
My three-year-old son loves the Bronx Zoo, but not so much the stroller. So I carry him a lot, either on my shoulders or in my arms. Any parent knows what a day of that can be like — note how many are clutching their lower backs or rubbing their necks after packing up the car to leave, even the ones who are just worn out from a day pushing the stroller.
As a contrast, note that while at the zoo, you never saw, say, a lemur clutching its hammy, or yelling the lemur equivalent of: “F***! Cramp!” while trying to extend his toes.
Kelly Starrett’s Becoming a Supple Leopard – he’s a Northern California dude, the title and tone of the book is best understood if familiar with his video clip site, MobilityWOD.com — fills a huge void in fitness publications. Starrett focuses on the universal need, capability for, and benefit of proper human movement, and provides tips, tests, and benchmarks for reaching your full range of motion, and thus your physical potential.
I’ll call it the most useful fitness book ever written, and endorse it without reservation. (Full disclosure: I once interviewed Starrett for a Men’s Journal piece, and I am otherwise inclined to say nice things about him, since a tip he gave me a couple years ago allowed me to serve a tennis ball again without pain. But that tip is included on page 266 of the book — presumably I’d find it in there if I did not previously know him. And frankly, I’d recommend the book on that tip alone, as it provided instant relief and allowed me to stay on the court.)
This is not a manual written for either beginners or experienced athletes; it should be useful for most everyone, as few at any level of athletic ability have this base of knowledge. As primary as this topic is to general health and wellness, the dearth of information is just as conspicuous. Leopard could improve great-grandma’s quality of life as readily as it could have lessened the chances of Kobe’s Achilles tear, or Derek Rose’s shredded ACL. Further, Kobe might have been jumping a couple inches higher, defending the ball a split-second faster all these years, and as a result of the more efficient movement, might have kept his knees and ankles younger.
The heart of the book — useful to anyone who participates in the activities of walking, standing, or even sitting — is Chapter 2: Midline Stabilization and Organization. Everyone knows “keep your back straight,” and “squeeze your abs,” and commitment to those simple tips will save you a bit of pain and trouble. But you can do significantly better, and you will notice immediate results while doing something no more complicated than not lying down.
Week 11 of my second 13 week season: low-carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own. And yes, I have been slack with the exercise this last couple weeks. Gimme a break, I had a car wreck.
Last week, Glenn Reynolds linked an interesting article in The Atlantic with a fascinating animated map.
Using CDC data, the map shows reported incidence of obesity by state starting in 1985. The reporting didn’t get started uniformly, but as you watch the progress, there is an obvious increase until by 2010 every state is reporting “high” obesity rates.
This image has some obvious problems — among other things, the definition of “obesity” here is using body mass index (BMI), which has flaws we’ve talked about before — but it still makes the point that people in the U.S. have been gaining weight for quite a while now.
There are a lot of reasons for this. Among other things, we’ve gotten to the point that pretty much everyone can afford to get enough to eat. As has been pointed out before, this was the first country in history in which the poor people are the fattest. But I noticed something else: if you watch it carefully, the increase in obesity, first in deeper blue then a sort of funny beige color, and then on to red, starts in the early ’90s. I went looking for historical summaries of the Department of Agriculture’s “food pyramid” and found several (see, eg, this.)
It’s an interesting coincidence that this increase in obesity started roughly at the same time that the U.S. government started to advocate low-fat, high-carb diets. I remember that period pretty clearly, because I thought it was wonderful. Entenmann’s came out with no-fat pastries — the no-fat cherry coffeecake was one of my favorites — I could eat as much rice as I wanted, pasta was good and more pasta was better, as long as you didn’t use butter because of the evil saturated fat and cholesterol. But margarine, rich in transfats made by hydrogenating corn oil, was much better.
Oddly, this didn’t seem to do much about my weight. I was a vegetarian for a number of those years, and while I lost weight during the relatively short interval in which I was vegan, I also had mood swings and health problems until I added back at least eggs and dairy.
Pain is obviously one of the most important symptoms with which doctors deal, but measuring its severity objectively is difficult. Some people turn a twinge into agony, while others raise not a murmur in the last extremities of torture. And it is universally accepted that a person’s psychological state or disposition has a profound effect on his perception of pain.
Philosophers, indeed, have used the phenomenon of pain to debate what seemed to them an important question, namely whether there were such things as private languages or inner states inaccessible to others.
Clever experiments reported in a recent issue of the New England Journal of Medicine offer the hope, perhaps illusory, that brain imaging techniques might one day distinguish between real and severe pain on the one hand from exaggerated or false pain on the other (people may exaggerate or lie about pain for a variety of reasons).
Week 10 of my second 13 week season: low carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own.
On Tuesday the 9th of April, about 2PM, I was at work and feeling very strange. I was sleepy, felt sick and shaky, and couldn’t think clearly. I decided to take off early. But driving home, not more than a mile from my house, well, something happened. I zoned out, I fell asleep, I fainted — whatever it was, I was looking at a green light at the interesection and then I was looking at a red light with traffic starting to cross the intersection. I hit the brakes, I swerved to drive around the front of the CenturyLink truck in front of me, and I almost made it. But not quite. I caught the front bumper of the truck with my left rear fender. I bumped my head against the door frame, and came to a stop crossways in the intersection. After a minute, I pulled off the road.
At first I felt — considering the circumstances — okay. I made sure the other guy was okay (he was) and went to stand by the car and wait for the police.
Then I realized I was feeling really really cold, and even shakier than I had felt when I left the office. I went to sit down in the car and when the police arrived told them I thought I needed the EMTs. Or else it was someone who was calling 911, I don’t remember it very clearly.
Anyway, both an ambulance and a fire truck arrived, and a rather cute female firefighter interviewed me for about 30 seconds before trotting to the EMTs, who came and walked me to the ambulance. I’m somewhat proud of myself for resisting my initial urge, which was to tell the firefighter “Hey, I’m just sick, I’m not on fire.”
Having recently returned from Madrid, I confess that I saw little evidence of the Mediterranean diet being consumed there (apart, that is, from the red wine): though, of course, Madrid is in the middle of the peninsula, far from the Mediterranean. Perhaps things are different on the coast. Nevertheless, at over 80 years, Spain has one of the highest life expectancies in the world.
Is this because of the much-vaunted Mediterranean diet? Spanish research recently reported in the New England Journal of Medicine provides some – but not very much – support for the healthiness of that diet.
The researchers divided 7000 people aged between 55 and 80 at risk of heart attack or stroke because they smoked or had type 2 diabetes into three dietary groups. One group (the control) was given dietary advice concerning what they should eat; the two other two groups were cajoled by intensive training sessions into eating a Mediterranean diet, supplemented respectively by extra olive oil or nuts, supplied to them free of charge.
They were then followed up for nearly five years, to find which group suffered from the most (or the least) heart attacks and strokes. The authors, of whom there were 18, concluded:
Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.
The authors found that the diets reduced the risk of the subjects suffering a heart attack or stroke by about 30 percent. Put another way, 3 cardiovascular events were prevented by the diet per thousand patient years. You could put it yet another way, though the authors chose not to do so: 100 people would have to have stuck to the diet for 10 years for three of them to avoid a stroke or a heart attack. This result was statistically significant, which is to say that it was unlikely to have come about by chance alone, but was it significant in any other way?
The unexamined life, said Socrates, is not worth living; but sometimes I wonder whether the too-closely examined life is not worth living either, for examination uncovers dilemmas where none existed before.
Two articles in a recent edition of the New England Journal of Medicine ask the question of whether employers should, or have the right to, refuse to employ smokers, as increasing numbers do in the 21 states that permit such discrimination against them.
As is by now no secret, smokers are more likely to suffer from many types of illness than non-smokers, and their health insurance is therefore considerably more expensive than that of non-smokers. They impose costs on their employers which weigh upon all workers, smokers or not. (The authors do not take into account that smokers not only contribute to taxes by their habit but, by dying early, reduce pension costs.)
The authors worry that refusal to hire smokers would be discriminatory against people of lower social class, since it is among the latter that smoking is most prevalent. I am not sure that this is right: the majority of people in all social classes now do not smoke, while people who apply for jobs at any particular level are likely to be of the same social class. Except in the case where there is only one applicant for a job, then, it is likely that there will always be an applicant of any given social class who does not smoke. The discrimination remains against smokers, therefore, and not by proxy against members of lower social class.
Week 8 of my second 13 week season: low carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own.
A few days ago, PJ Lifestyle ran an excerpt from Leonard Mosely’s book Disney’s World, in which Walt Disney, in a letter to his partner Ub Iwerks, expressed his frustration with the his first sound cartoon, the now-iconic Steamboat Willie.
He’s pretty depressed. he doesn’t like Hollywood, he doesn’t like being away from home, and he’s losing confidence in the still-unfinished film. You can see why, when he was having trouble selling the idea, and animation is a frustrating process anyway. This was in the days of the most primitive hand-drawn animation, where every frame of the film had to be hand drawn on clear acetate, with tiny changes from frame to frame. Twenty-four times for each second of film. In this 7 minute 23 second film, that’s something like 10,600 frames. He was tired, and he was bored, and he had trouble seeing any progress.
Why did this strike me, he asked rhetorically? Well, it reminds me of my ongoing glucose/bodyfat/weight project. Here I am, eight weeks into my second season, 147 days since I first started tracking this, and it’s a little frustrating and hard. I’ve been less diligent about the exercise, and I do find myself missing things I used to eat. Like chocolate. And pasta. And bread. And while I have lost some weight, it’s slow and the day to day variations make it hard to see. It’s like Disney must have felt — another 24 frames, another day’s work, and what did he have? Another lousy second of film. That no one wanted to distribute. He was past the initial excitement and into the slog.
Right now, this project feels much the same. I’m actually losing weight, and I can see changes — more muscle coming back to my arms, and to put it bluntly, my boobs are smaller. I’ve lost six inches around my waist, and I can feel that every time I put on a pair of pants that were in the back of the closet because I hadn’t been able to wear them. But at the same time, the progress is a little slow and hard to see, and it’s a little hard to explain why it should matter to anyone — especially me.
But then I got thinking, and a little Excel-fu got me this. Here’s my actual weight, charted over the last sixty days, with a trend line. This is very much like the other charts I’ve been posting.
Trend line is down. This is good. It’s not down very fast, and the added muscle certainly explains that — but also notice that individuual weights vary pretty wildly around that trend line. So here’s another chart.
Twenty-seven years ago I found what seemed to be the only functioning storm-drain in Tanzania, in East Africa, and fell down it, severely injuring a knee in the process. The journey to the mission hospital in the back of a pick-up truck over sixty miles of rutted laterite road was one of the more agonising experiences of my life.
I had an arthroscopy when I returned home several weeks later — I could not even hobble until then — and the orthopaedic surgeon told me that unless I did physical therapy every day for a very long time it was inevitable that I should be crippled by arthritis within twenty years.
It was equally inevitable that I would not do physical therapy every day for a long time; and here I am, twenty-seven years later, without so much as a twinge from my knee. My faith in the predictive powers of orthopaedic surgeons has been somewhat dented.
That was why I read with interest a paper in a recent edition of the New England Journal of Medicine comparing physical therapy with surgery for meniscal tears in the knees of people with osteoarthritis. To cut a long story short, there was no difference in outcome, an important finding, since 465,000 people undergo operations for precisely this situation every year in the United States alone.
Actually, the uselessness of operation had been established before — the uselessness from the patients’ point of view, that is. Two previous trials had compared real with sham operations, and with no operations at all, and found no difference in the outcome two years later. One might suppose that, in the light of these findings, the 465,000 operations still performed annually constituted something of a scandal.
The clinical trial reported in the NEJM is, like all such trials, not definitive. The follow-up period was only 6 months, relatively few patients were recruited to it, and some patients initially allocated to physical therapy had an operation nonetheless for reasons that are not entirely clear. Moreover, the trial is only that of operation versus physical therapy; strictly speaking, there should also be a comparison with patients who had no treatment at all.
The Duke of Wellington, surveying his soldiers before the Battle of Waterloo, famously said that he did not know what they did to the enemy, but by God they frightened him.
No one thought in those days of the psychological effect upon the soldiers of witnessing so much violence (more than 30,000 were killed during the battle, about one in six of those who took part in it); nor could anyone have done so if he had thought of it. But it is now accepted wisdom that active military service leads men subsequently to commit crimes of violence, though the reasons for this are unknown.
A recent paper in The Lancet examined the association of military service and subsequent crimes of violence, which turned out to be much weaker than suspected. The authors examined the criminal records of 8,280 British soldiers who had served in Iraq and Afghanistan with that of 4,080 of those who had not. When controlled for such factors as age, level of education, pre-service record of violent offenses, rank, and length of service, there was no significant difference in the criminal records of those who had served in Iraq and Afghanistan and those who had not.
When, however, those who were deployed in a combat role were compared with those who had not been so deployed, it was found that the former had higher levels of violent offending as measured by their criminal records. Interestingly, however, those who were involved in actual fighting had considerably higher prior levels of violent offending than those not so involved, suggesting that more aggressive types either volunteered or were selected for combat service. Somewhat alarmingly, nearly half of soldiers involved in the fighting had criminal records for violence.
Week 6 of my second 13 week season; low carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own.
So let’s just end the suspense right away: yes, I am feeling a lot better this week.
At one point or another, the draft of last week’s column started with the line “Okay, ‘despair’ may be a little strong…”. I cut it because as I thought about it, I realized despair was the right word. Look it up and we find “Noun: The complete loss or absence of hope. Verb: Lose or be without hope: ‘to despair of ever knowing’” (via Google.) That’s exactly what I was fighting against — the feeling that there was nothing to be done, that there was no real hope. That’s the real enemy of any attempt to change, or to do anything extended really — that moment of no hope, when you don’t see the end in sight. It’s not just diets, either — it happens to me in writing, when I hit the point at which I think “oh, this is awful, no one will want this.”
That’s why I started this on the basis of a 13 week “season” — it was long enough to see some real changes, short enough to be bearable. Even so, about the fifth and sixth weeks of the first season, I’d reached the point where I was wondering if it was going to really do any good.
So look at the results this week: my 7-day average weight is down 3 pounds, my 7-day average blood sugar is down 16 points. What happened? I don’t know for sure, but I can tell you one thing I did differently, based on a lot of suggestions from others who’ve done the low carb thing. I broke training. I got out of the no carbs jail for a couple days. I had my ice cream, and I had some congee (zhou, Asian rice porridge). I didn’t go real far off the overall diet except for violating the carb rules, and based on calories I was actualy doing fine.
So now I’m back on the low-carb diet. What did I learn?
First, yes, you can break the diet for a day or a few days and get back on. What’s more, for me at least, if you do it with rice and ice cream, you don’t get sick like I did after Thanksgiving.
Second, your body can get used to anything. In weight training, they tell you to change routines fairly often if you want to keep making gains. The trick is to watch what happens. I broke the rules a little bit, up to maybe 100g of carbs one day, and didn’t have my blood sugar go nuts, didn’t gain back lots of weight. (Right now, I’m on a little bit of a bounce, but I’m basically up to where I was complaining about not being able to break in the downward direction.)
And third — there’s a new-ish idea in the nutrition world: orthorexia. It means an unhealthy fixation on a healthy diet. Maybe, just maybe, an occasional 4 oz cup of ice cream (26g carbs) is good for you.
|Date||7 day Weight||7 day Glucose||7 day Bodyfat||Sum Fitocracy Points||Weekly Fitocracy Points|
|Δ since 2-1||-2.64||-14.57||-3.00%||N/A||N/A|
For a long time doctors were subject to contradictory imperatives with regard to AIDS. On the one hand they were enjoined to treat it as they would treat any other disease, without animadversion on the way in which the patient had caught it; on the other hand they had, before testing for the presence of HIV, to seek special permission of the patient and to ensure that he or she had had counselling before the test was taken – quite unlike the testing for any other disease, syphilis for example. So AIDS was at the same time a disease like any other and also in a completely different category from all other diseases.
It cannot be said that pre-test counseling is universally popular among patients. There was an Australian clinic that famously offered the test with “guaranteed no counseling” and it did not lack for clients. For quite a number of years, however, HIV-test counselling has provided a living for the kind of people who like to hover around the edges of human catastrophe.
However, the recommendation by the United States Preventive Services Task Force (USPSTF), reported in an article in a recent edition of the New England Journal of Medicine, that henceforth the screening of adults for HIV infection should be routine will, if adopted, put paid to all such pre-test counseling. One cannot counsel scores or hundreds of millions of people.
Seven years ago the USPSTF came to a different conclusion on the question of screening for HIV, believing that the benefits were insufficient to recommend it. Since then, however, evidence has accumulated that treating people early in the course of their infection not only prolongs their life but reduces spread of the infection.
For some reason that I have never quite fathomed, immunization against infectious diseases has from its very inception in Jenner’s time been one of the most viscerally feared and bitterly opposed of all medical techniques. Perhaps people felt that to immunize was to interfere sacrilegiously with the course of nature, and that people, especially children, had the duty to die of infectious diseases just as Nature “intended.” Perhaps they felt that, if it worked, it would allow the survival of the unfittest. At any rate, few medical procedures have been as persistently, minutely, and fervently examined for harmful effects as immunization has.
In general, the results have been disappointing for those who wished to show that immunization was invariably followed by Nature’s retribution, particularly in the neurological sphere. Scare has succeeded scare without ever being confirmed, though those who hold to the anti-immunization faith refuse to abandon it. Now, at last, there seems to be evidence of a genuine association between a certain type of immunization and a neurological condition.
That association is that between the immunization of children with an anti-influenza virus and narcolepsy, a condition characterized by chronic, excessive daytime sleepiness and a tendency to cataplexy, that is to say a loss of muscular tone triggered by strong emotion. It was first observed in Finland and Sweden; subsequent studies in other European countries and in Canada failed to find an association, but a further study, this time in England, and reported in the British Medical Journal, confirmed that the Finnish and Swedish findings.
In October 2009, children at risk of pulmonary complications during a pandemic of influenza were immunized against it with a vaccine against the causative virus. Most of the children immunized suffered from asthma (interestingly, one of the theories to account for the recent rise in the proportion of children suffering from asthma and other allergic conditions is that, having been immunized against all the common childhood infectious diseases, their immune systems have not developed as Nature “intended”).
Week 4 of my second 13 week season; low carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy and follow my daily exercise.
I haven’t published new charts recently, so I think it’s time. Here’s the first one, my weight.
OH, NOOOOOES! My weight is going up! I’m a failure! Eeeek!
Well, maybe not, although certainly if all I was tracking were my weight I’d be mildly hysterical. (And I have to admit I get qualms looking at it this time, even though I swear I’m not primarily interested in my weight. But 50 years of dieting doesn’t go away quickly.)
The thing is, that weight in general isn’t really our primary interest. I asked whether weight itself was a primary concern over at my Facebook page, and got a lot of different interesting answers; almost none of them included weight. “Feel better”, “better health”, “more attractive”, “sexier” all did show up. Now a couple of people with bad knees and backs did say weight in itself was a problem, but for most people it’s more a symptom of something else that troubles them. Certainly so with me — blood sugar, health in general, and as I realized during the first 13 weeks, simply feeling ugly and disgusting were my major issues.
What people use as a proxy for all this is weight, of course, and especially with daily weighings, this can be very disheartening.
What’s worse, I’ve been at least as diligent with the diet — in the last full week, according to LostIt!, I’ve been 8200 kcals in deficit, with an average of about 9g carbs a day net of fiber. Being diligent with the diet isn’t so awful, but still I’d sure like a chocolate bar or a plate of spaghetti sometimes. In anything, I’m doing better with the diet plan that in my first 13 weeks.
Add to that I’ve been pretty diligent with the exercise — not every day but at least five days a week (I’ve got more to say about the exercise, below) so I’m lots more active than I was in the first 13 weeks — and probably more than I’ve been in the last 13 years.
But still, I’m actually gaining weight.
The joy of children also comes with the horrors of what motherhood does to the body. Trying to recapture some semblance of my former self, I joined a few fancy corporate gyms with salons and spas and pretty associates selling banana-choco-gluten-free $12 shakes, but I never achieved the results I wanted. It turns out that quitting was the answer. I finally discovered how to get fit and have a great time doing it. I joined a family-owned, martial arts gym. The following truths will convince you to ditch your corporate gym membership in favor of a much better option that actually produces results while improving every area of your life.
9. “Do you believe in love at first sight or do I have to walk by you again?”
A simple Google search on “picking up girls” will lead to hundreds of smarmy articles advising men on how to hook up at the gym. This particular sentiment — from someone claiming to be a gentleman — sums it up about perfectly:
Utilized properly, the gym is one of the finest hunting grounds for the well prepared cocksman.
Wow. Where to begin? If you’re 20 and this is the kind of thing you’re into, I’d say that guy is right. Big corporate gyms with lots of young, dumb girls would be a good place for a sexual predator to stalk his kill. However, when you’re a married mom or dad, this is not the kind of environment that will encourage your marriage. Further, it’s uncomfortable to feel as if you are being sized up by people who refer to themselves as “cocksmen.” It’s also disconcerting trying to avoid that one guy who stalks you with his eyes when you’re trying to use that embarrassing machine where you pretend to strangle someone with your thighs. Awkward.
A small, family-owned gym that caters to both children and adults has a totally different vibe for more mature members with the goal of family fitness. Many people don’t know that most martial arts programs have cardio classes and training for adults. My family belongs to Randori Jiu-Jitsu, where we can take a variety of classes like jiu-jitsu, kickboxing, boxing, judo, karate, mixed martial arts, and conditioning and strength training all without a nightclub atmosphere or threat of venereal disease.
Release date: August 7, 2012
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No doubt I have forgotten much pharmacology since I was a student, but one diagram in my textbook has stuck in my mind ever since. It illustrated the natural history, as it were, of the way in which new drugs are received by doctors and the general public. First they are regarded as a panacea; then they are regarded as deadly poison; finally they are regarded as useful in some cases.
It is not easy to say which of these stages the medical use of cannabis and cannabis-derivatives has now reached. The uncertainty was illustrated by the on-line response from readers to an article in the latest New England Journal of Medicine about this usage. Some said that cannabis, or any drug derived from it, was a panacea, others (fewer) that it was deadly poison, and yet others that it was of value in some cases.
The author started his article with what doctors call a clinical vignette, a fictionalized but nonetheless realistic case. A 68-year-old woman with secondaries from her cancer of the breast suffers from nausea due to her chemotherapy and bone pain from the secondaries that is unrelieved by any conventional medication. She asks the doctor whether it is worth trying marijuana since she lives in a state that permits consumption for medical purposes and her family could grow it for her. What should the doctor reply?
Homeostasis. This is our vocabulary word for today.
Homeostasis is “[t]he ability of the body or a cell to seek and maintain a condition of equilibrium or stability within its internal environment when dealing with external changes” (via Biology Online.) On any diet or exercise program, homeostatis may not seem to be your friend.
|7-day weight||7-day glucose||7 day bodyfat||Weekly Fitocracy Points|
Certainly, for the last six weeks it hasn’t seemed to be mine. Above is a table of the current results of this second season (I’ll be running similar tables for comparison for the rest of this 13 week season.) I’ve been keeping to the diet pretty religiously, with a very few days in excess of my 30g carbs target. According to LoseIt!, I’ve run a total calorie deficit in the previous six weeks of roughly 42,000 kcals (Calories), or on average about 7000 kcals a week. It only requires the tiniest application of higher math to see that at 3500 kcal/pound, I should have lost 12 pounds, or should have been losing 2 pounds a week. While I’ve hit several new lows, including breaking 270 about ten days ago, I haven’t lost any weight, according to the 7-day running average, since the second season started. In fact, what has really happened in is that I’ve actually gained something like 1.3 pounds.
This could be depressing. Believe me. What this is, is a demonstration of my body trying to preserve homeostasis. Basically, bodies don’t want to change, and they have mechanisms to prevent it.
Luckily, this isn’t a weight-loss experiment, this is a better-health and better-glucose experiment. (Repeat after me….) And I’m doing much better there — my cholesterol is now great, my glucose is near normal (and it’s been ten days or so since I cut my metformin dose in half, with no apparent damage to the glucose level), and — here’s the kicker — my body fat has dropped from around 33 percent to just over 29 percent — which means I’ve changed my body composition fairly radically in these three weeks.
Now, part of this is another demonstration that the naive “calories out minus calories in” model of weight loss is once again breaking down. Of course, since that model is so entrenched in so many people’s minds, the usual doctor’s explanation would be “you must be cheating”, as I talked about in an earlier episode; presenting the food diary and such wouldn’t deter them.
Another possible explanation is that it’s water — just as when they tell you rapid weight loss early in a low-carb diet is “only water”. But just as when I was dropping weight quickly, we’re talking about a lot of water. “A pint’s a pound the world round”, and that means we’re talking about 12 pints, 6 quarts, a gallon and a half of water. Call me crazy, but I’m thinking an additional gallon and a half of water would be pretty obvious in edema and puffiness and heart failure and such.
But the body composition — and one other thing — are hints at what I think is actually happening. That other thing is that after weeks of little change, I’ve begun to have measurements changing. Specifically, I’ve lost 2 inches around my neck and 5 (!!) inches around my waist from when I started the first 13 weeks.
The third favorite explanation of this would be that I’m gaining muscle as well as losing fat, and that one I think is plausible. What’s more, you can do that even when you’re running a big calorie deficit, as I have been, because a pound of fat contains about twice as many calories as a pound of muscle. The explanation that makes sense is that I’ve lost fat at 3500 kcals a pound, and gained muscle at 1800-odd kcals a pound, leaving me slightly heavier, and a good bit skinnier.
I can live with that.
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