This year has been a strange one in terms of celebrity behavior, some of which was concerning if not entirely disturbing, and apparently contagious as well. Examples of skin selfies and exchanges that were once considered private are posted all over the internet. Active participants are all ages, shapes and sizes: beware the visuals of regular people (generally females) sharing their cups overflowing or unsuspecting panties being eaten alive by a ravenous pair of robust cheeks. Who’d have guessed that plumber’s crack would be exalted to such artistic (albeit unsavory) exhibitionist displays?
Yet for some unknowable reason, fans can’t seem to get enough lifestyle advice from entertainers, emulating even the most bizarre spectacles, especially when it comes to diet and beauty.
Female celebs in particular offer infinite health counsel for the masses. And women of all walks eat it up, the more peculiar, the better. Such odd “healthy” behaviors include January Jones ingesting her own dried and encapsulated placenta or Lady Gaga touting her revolutionary “Hangover Diet” consisting of nothing but whiskey… Then of course there is the explosive “Fermented Foods Diet” that Madonna uses to keep her colon free from debris. Sounds delicious.
Everyone knows the pleasures of having his prejudices confirmed by the evidence. The pleasures of changing one’s mind because of the evidence are somewhat less frequently experienced, though none the less real. Among those pleasures is that of self-congratulation on one’s own open-mindedness and rationality. It would therefore delight me to learn that my prejudice about obesity — that it is a natural consequence of overeating, which is to say of human weakness and self-indulgence — was false.
I therefore read with interest and anticipation a recent article in the New England Journal of Medicine with the title “Microbiota, Antibiotics, and Obesity.” The connection of antibiotics with obesity had not previously occurred to me; perhaps the real reason why so many people now have the appearance of beached whales was about to be revealed to me.
In my youth the government encouraged people to eat more eggs and butter and drink more milk for the sake of their health. Perhaps it was the right advice after a prolonged period of war-induced shortage, but no one would offer, or take, the same advice today. Nutritional advice is like the weather and public opinion, which is to say highly changeable.
How quickly things go from being the elixir of life to deadly poison! A recent paper from Sweden in the British Medical Journal suggests that, at least for people aged between 49 and 75, milk now falls into the latter category, especially for women.
Milk was once thought to protect against osteoporosis, the demineralization of bone that often results in fractures. It stood (partially) to reason that it should, for milk contains many of the nutrients necessary for bone growth.
On the other hand, it also stood (partially) to reason that it should do more harm than good, for consumption of milk increases the level of galactose in the blood and galactose has been found to promote ageing in many animals, up to and including mice. If you want an old mouse quickly, inject a young one with galactose.
In other words, there is reason to believe both that the consumption of milk does good and that it does harm. Which is it? This is the question that the Swedish researchers set out to answer.
Do we work out for health or beauty? Yes.
I’m in the middle of reading Making the American Body: The Remarkable Saga of the Men and Women Whose Feats, Feuds, and Passions Shaped Fitness History by Jonathan Black. (Full review to come.)
So far, it’s enormously entertaining and enlightening, and I’m recommending it to friends already. Interestingly, it focuses more on the clash of personalities (and marketing styles) than on the fitness methods themselves. But what stood out to me is how so many marketing campaigns for fitness regimes, dating all the way back to the nineteenth century, played on fear and shame. Apparently every era of American society has teetered on a crisis of emasculation and/or unhealthiness. And that crisis also happens to necessitate buying lots of new equipment, accessories, and specialty food, so we can fit into the clothes that exalt the body type that the fitness trend tells us we must have.
Another thing that stood out to me was the changing shape of the “ideal” woman. One of my favorite stories from the book so far (and a welcome note of positive, encouraging marketing) was that of Pudgy Stockton. Pudgy’s nickname originated in her chunky teen years, but she shed the pounds and gained a very different reputation on Santa Monica’s Muscle Beach. A smiling, playful fitness icon, Pudgy is credited with demonstrating to women of her generation that females can lift weights without losing their femininity — and that lifting can even enhance their womanly curves. It was refreshing to see a female fitness icon who didn’t look like she could fit through the eye of a needle — but was still healthy, attractive, and feminine.
Over the years, I had made halfhearted attempts to lose weight and get in better shape and never seemed to have much luck. I had spent money on fat burners and tried diets that I couldn’t keep. I even joined the new gym in town hoping it would be the answer to all my problems. But on September 13 of last year, I made a commitment. I was going to lose weight no matter what it took, and I set some goals to try to prevent losing weight from becoming another losing battle.
As of last Friday, I’ve lost 25 pounds, reaching my first goal. (I wish I had before-and-after pictures, but I didn’t take one at the beginning.) I managed to lose this weight during a period that included vacation, Thanksgiving, and Christmas, so it wasn’t always easy. I can tell a definite difference in the way I look. My clothes fit better, and I feel great. Several people have asked me what I’ve done, and my answer turns into a long one, because it’s a combination of factors that have helped me.
The caveat to my weight-loss strategy — I refuse to run. My sister and brother-in-law began training around the same time for the Walt Disney World Half Marathon, and while I’m proud of them for it, running just isn’t my thing. So, here are three actions I’ve taken that have contributed to my weight loss.
Week 1 — Something’s Got To Give
As part of my “taking it easier” with my blog, over at According To Hoyt, I’ve been running ‘blasts from the past’ – i.e. posts a year or more old at least a day a week. (For instance on Tuesday I posted Jean Pierre Squirrel, from February 2011.)
The interesting thing going through the blog is seeing how many days I curtailed posting or posted briefer or weirder because I was ill.
Now I was aware of having been in indifferent health for the last ten years or so. It’s nothing really bad or spectacularly interesting, which is part of the issue, because if it were, I could take time off and not feel guilty. I confess I have found myself at various occasions fantasizing about a stay in the hospital. Which is stupid, because no one rests in the hospital. (What I need, of course, is a stay in a remote cottage for a few days. Even if I’m writing.) And I knew that my health got much worse in the last year. 2013 was the pits, at least since August or so. But it is not unusual for me to spend every third week “down.” – Usually with an ear infection or a throat thingy or some kind of stomach bug.
My friends have said for years that this is because I don’t listen to my body’s signals to slow down or stop, so it has to bring me to a complete stop by making me too sick to work.
This is part of the reason Charlie Martin and I (in collaboration) are doing a series on taming the work monster. Part of it is that I have way too much to do, and part of it is that it’s really hard to compartmentalize things when you work from home. Eventually when we sell the house and move, we’d like to get a place where the office is a distinct area. It was pretty much all of the attic in our last house, which meant if I came downstairs for dinner (which I did) I didn’t go up again. But now my office is half of the bedroom (and before someone imagines me cramped in a corner, the bedroom runs the full front of the house. We just couldn’t figure out what to do with a room that size. We don’t sleep that much.) This is convenient in terms of my getting up really early to work, or of my going to bed way after my husband, because I’m right there… It’s also contributing to a 24/7 work schedule, because I can think “Oh, I should write about that” and roll out of bed, and do so. There is no “I have to be dressed, as the sons might be roaming the house” and there isn’t (as in the other house) “the attic will be cold.”
Nassim Nicholas Taleb’s book The Black Swan introduced an old term and then, annoyingly, redefined it. For Sir Karl Popper, the black swan was an observation about logical quantification: if you assert “all swans are white” then the observation of a single black swan falsifies the assertion.
Taleb’s observation is different, although related: he’s observing that really unexpected events are unexpected: we have a model of the world that says “The US mainland is secure from attack” that seems perfectly plausible on 10 September 2001; we believe “Islamist terrorism is on the run” and then a bomb blows up in Boston.
(There’s a more sophisticated way to deal with all of these called Bayesian inference. We’ll leave the details for a science column, but in a few words, a Bayesian starts with an assumed a priori estimate of the probability of an event. After observation, they have a new a postieriori estimate that incorporates new experience.)
But there’s yet a third way to think about these that shows us how mathematics and probability can show us surprising things.
(Yes, this is a diet and exercise column, just a little further down.)
Someone once said that a good epic starts in the middle. (Actually it was Horace, it was in his Ars Poetica around 13BC, and he made the distinction between something that started ab ovo, “from the egg”, or in medias res, “in the middle of things”, but then inserting a lengthy side bar with references to Classical Latin in a diet column might seem erudite but really would be sort of pretentious and silly, don’t you think?)
In any case, we’re starting in the middle of this story. Tomorrow, 5 January 2014, I’m starting the fifth (and sixth, more on this later) of my 13 week experiments in changing and improving my health and my life. The first one started in November 2012, more than a year ago, motivated by the most reasonable of things: I don’t want to die. I most especially don’t want to die young, and I felt like both of my parents had.
I have reasons to be concerned. I’ve had problems with my weight since I was six, and at the time I started this I was around 300 lbs, I was well along into type II diabetes, and I had severe sleep apnea that was manifesting in something close to narcolepsy. I live in a two-story house and I was finding that I was pre-planning trips up and down the stairs because they wore me out.
Now, a year later, I’ve made some significant changes. I’m around 265 lbs, my blood sugar is much improved, and I run up and down the stairs with wild abandon and cups of hot coffee. But I’m not done yet. I want to lose more weight, and I’ve got some new challenges in my life, with a new job and a certain feeling that I have more to do.
I am a regular guy. I have zero resemblance to the guys you see on the countless weight loss commercials currently running on television. I still have work to do to become more healthy. But I did something last year that I’ve never been able to do in a lifetime of weight struggles. I lost a significant amount of weight in a relatively short amount of time. Moreover, I did it in a healthy way, and I was able to keep it off.
How did I do it? Well, first let me tell you the basics. On January 1 of 2013 I weighed in at 283 pounds. I was significantly overweight. I was unhealthy, ate poorly, was very inactive, and took blood pressure medicine that I desperately needed. By May 1, 2013, I dropped 40 pounds, was eating much better, exercised 5-6 days a week, and was off blood pressure medicine. And most importantly, I felt great doing it. Well, what did I do? I could probably list 20 things, but I narrowed it down to five. And these are five things that I think can help anyone get healthier if they are ready for a change.
5. Make water your friend.
Have I lost you already? Is this too boring for you? Is this too simple? I don’t care. Do it! Drinking a ton of water was a key to my weight loss and I guarantee it’ll be a key to anyone else’s weight loss. Get yourself a big bottle that you don’t mind making your friend. Take it to work, drive with it, work out with it, and have it with you always. And then take sips all day, every day.
What’s the big deal about water? It has too many benefits for me to list them all, but here are a few: water suppresses your appetite, has zero bad stuff in it (drink filtered), increases metabolism, helps your body retain nutrients, is what your body is made of, helps maintain normal digestion, and energizes muscles. There are more, but those are enough reasons for any of us to start diving into some H2O.
Water is your new friend. Save money by drinking water instead of other beverages. That’ll free up some income to buy healthier foods. Drink a full glass of water before a meal and it’ll both speed up your metabolism and make you eat less. Get at least 64 ounces a day. And if you think that’s a lot, then check out your biggie cup of soda. I bet it’s at least 32 ounces. Put down the soda and pick up a big bottle of water.
You’re going to need to be well-hydrated if you are going to do number 4.
So it’s a week until my next 13 Weeks experiment, and I’m trying to get my head in order around what to do next, so I’m going to write about it to you folks.
There were some interesting comments last week, the most interesting being, essentially, “don’t think so much, just relax, get out and do stuff.”
Which, well, that’s easy for you to say. But let’s resort to some somewhat discredited pop-psych here: I’m an INTJ/INTP on Myers Briggs, I’m fairly high up the Asperger’s scale, I’ve lost a lot of time and energy to severe depression, and yes, for me this is kinda grade school. I want, even this late in life, to make some things work that frankly most people figure out early.
If you haven’t grown up by 50, you don’t have to.
Now, this has hardly been all bad. From childhood the two things I really wanted to do are work with computers and write, and by golly, that’s what I’ve done, and I haven’t done badly at it despite some of the other challenges: I’ve got around a dozen patents, I’ve done some significant work in software architectures, I’ve written at this point hundreds of articles for actual cash money, including supporting myself entirely through writing for months at a time. But I don’t see any reason to stop; there are still things that would make my life better — and of course there are things to do so I not only make life better but I’m alive to enjoy it.
Prevention is better than cure provided (which is not always the case) that prevention does less harm than the disease it prevents. Since obesity is now of epidemic proportions all over the world, and it is estimated that in just over a decade’s time there will be 500,000,000 people with type II diabetes consequent upon obesity, prevention of obesity is devoutly to be wished – which is not to say that it will be easy or even possible.
An article in a recent edition of the New England Journal of Medicine asks the question of how early in life prevention of obesity should begin, given that once it is established it is refractory to treatment. Although the epidemic may have peaked in the United States, there is no room for complacency because the proportion of fat people is already enormous. A half of American pregnant women are seriously overweight or outright fat, and fat women tend to have fat children. They gain even more weight during pregnancy, and women who gain weight excessively during pregnancy are especially likely to have fat children.
The article is a typical example of what might be called risk factor medicine. A disease or disorder is found to be associated statistically with some independent variable which may or may not be causally related to that disease or disorder, so that doctors hope that by reducing the prevalence of the risk factor in some way they will also reduce the prevalence of the disease or disorder. Since many of the risk factors are behavioral rather than biological, and there is nothing as difficult to change as human behavior, doctors’ hopes are often frustrated.
Okay, look, the first thing is I owe you folks an apology: with the new day job and holidays and a half-dozen other ordinary-life crises, I’ve just not gotten columns done. I’m sorry.
The most important thing I think I’ve learned in the last year has been just how complicated the whole issue of body weight and glucose regulation can be. Here’s just a selection of diets that have had reports of dramatic weight loss and health effects:
- Low Carbohydrate Diets
- High Fat
- South Beach
- Low Fat
- Stillman’s Quick Weight Loss Diet
- High Fat
- Glycemic Index and Glycemic Load diets
- Low Fat, High Carb diets
- Ornish Eat More, Weigh Less
- The Okinawa Diet
- Balanced, Calorie Restricted diets
- Diabetic “Exchange” Diets
- Weight Watchers
- Radical Calorie Restriction
- Scarsdale Diet
- Duke Rice Diet
- Protein-Sparing Fasts
- Intermittent Fasting
- Fasting 2 days a week
- Sixteen hour fasts every day.
- Eating more often
- Body For Life
- Dietary Restrictions
- Eliminating wheat or grain
- “Never Eat Anything With a Face”
The last two 13 Weeks columns could have been confused with science columns, which is good because I’ve actually missed the science columns, but bad because I haven’t talked about my progress or lack thereof at all. Well, the last couple of weeks have been confusing to me too, if it’s any consolation — I spent a week in San Francisco in an extended interview/audition for a new web startup called Sumazi. I’m now doing consulting for them, but they’re still operating under the radar so I can’t talk a lot about it, except to say they’re doing exciting things with social media data. But the result is that I’ve been busier than a — oh, hell, pick your own cliché. I’ve been really busy.
As a result, the whole diet-and-exercise thing has gotten away from me — hell, I haven’t left the house since last Sunday and last night I resorted to eating frozen burritos I didn’t even know I had because gleanings were getting pretty slim.
Yes, frozen burritos have wheat.
The results are interesting; my weight has crept back up to 269 — that same old stuck point. Glucose is doing fine, and with the exception of the burritos I have been quite good about eating few carbs — what carbs I’m getting are mostly in the yoghurt I’ve continued eating.
Of course we’re heading for the Season of Diet Horror — Thanksgiving, Christmas, and New Year’s Day.
So here’s my plan. I’m declaring this 13 week season a Learning Experience. As my old therapist Joe Talley called it, an AFOG (“Another F-ing Opportunity for Growth.”) This season would be over on 1 December anyway, so I’m gonna roll with it, and just maintain blood sugar and weight until 1 January — or rather until 4 January, which is the convenient Saturday after New Year’s Day. That will give me a chance to consolidate my other life changes.
In the mean time, the plan is to make this first year of 13 Week Experiments into a book, so I want to use the column to consolidate some of my thoughts about this, and to think more about what I can do to help other people start making their own experiments.
So, in no particular order, here are some thoughts about the process and the results.
Today is 19 October. Yeah, I know, you can see it at the top of the article, but that’s an important date, because it’s now exactly a year since I determined I had to take some actions about my weight and glucose. (I came out about it in my first 13 Weeks post, “A Fat Nerd Does Diet,” on 28 October last year.)
The results overall have been good. I had several different issues when I started.
- I weighed 301.5 on the 19th.
- My A1c was 7.5. Although I struggled with admitting it, that’s real no-kidding diabetes mellitus. For me it appears to be type 2, (T2DM) characterized by lowered sensitivity to insulin. That was on a pretty much maximum dose of metformin, 2500 mg/day; if I were depending on drug treatment alone, I was heading for insulin.
- I had a long-term problem with gastric reflux (GERD) and irritable bowel syndrome (IBS); I was on omeprazole every day and had been since a severe esophageal spasm and put me into the ER with chest pain two years before.
- My total lipids were reasonable on 20mg/day of simvastatin but my high-density lipoproteins (HDL) were low, and my low-density (LDL) were high.
- I also had a long-term problem with depression, although I hadn’t had a really acute episode in some years.
Now, a year later:
- I’m down nearly 40 pounds; my recent low was 264.
- My A1c is been between 5.9 and 6.4. The T2DM appears to be under control. I’m down to 1000 mg/day of metformin, and did a long stretch at 500 mg/day.
- My lipids are enough better that I’m off statins, at least for this 13 week period.
- The IBS no longer troubles me — I can’t say it’s completely resolved because, frankly, how would I know? But I haven’t had a painful episode in certainly almost a year. The GERD is also considerably better, and I’m slowly weaning myself off the omeprazole.
- I think I can say the depression is significantly better. I haven’t had an acute episode this year, but then I hadn’t had a really acute episode in some years. But I had also been chronically dysthymic, which in combination with acute depression is called “double depression.” I really feel like that’s significantly better. I plan to write more about depression in the coming months; there are interesting suggestions that there may be some physiology that connects depression, obesity, and T2DM.
What did I do?
- I’ve adopted a consistently low-carb, high-fat diet. I’ve played around with variants, and right now I’m around 50g carbs a day, with most of the carbs coming from fruits and yoghurt.
- I’ve nearly completely eliminated wheat. Occasionally eating wheat seems to result in immediate exacerbation of the GERD and possibly of the IBS.
- I’ve experimented with high-intensity interval training and high-intensity strength training, although I’ve had trouble making that a consistent practice.
- I recently tried a broad-spectrum probiotic, which seems to have had very good effects.
- I’ve largely structured these changes into a series of 13 week long experiments, which appears to be a sufficiently powerful model that a number of other people have adopted it for their own changes.
What have I learned in this year? It’s complicated.
As I wrote last week, I started using probiotics, along with fruit juice, whole fruit, and yogurt, on a vague intuition based on some reports that probiotics might improve my blood sugar, and somewhat better intuition that it might improve some other, er, passing problems.
So I’m just finishing my second jar of the 5-day probiotics (which lasts me about 7 days) and the results are that:
- I’m down to 264, which is now a couple of standard deviations below where I was stuck for so long (and getting close to 40 pounds off my starting weight);
- my morning fasting blood sugar has ranged from 95 to 117 with the average about 105, which is also a couple standard deviations down from what it had been.
Several people have also emailed me at firstname.lastname@example.org or commented on that last piece to tell me their experiences, and they’ve seen similar (or greater) improvements in blood sugar and comparable weight loss.
So, with n equal to about 5, there’s some success to report, and lots more questions to ask.
“I once heard a man say that the creation of the refrigerator was one of the worst inventions for our health.”
At first glance that statement seems preposterous, and at face value it is. According to Jordan Rubin, the essence of the man’s lamentation was not the actual refrigerator, rather the loss of fermentation as a preservative and all the health benefits that we once derived from it.
As more people are seeking new and healthy lifestyles, the lost art of fermentation is making a comeback.
There is a new trendy drink that is actually centuries old, it’s called Kombucha. Kombucha starts out as little more than a sweet tea that would make any southerner smile. Then, with the help of a pale colored disk a “symbiotic culture of bacteria and yeast,” otherwise known as a SCOBY, your sweet tea transforms into a probiotic-laden powerhouse.
Health food stores carry shelves of the stuff in all flavors. One of my favorite coffeehouses actually sells Kombucha on tap and it costs about the same as a Latte.
In this week’s mining of The Maker’s Diet, the author explains that every long-lived culture in the world consumed fermented vegetables, dairy and meat. Fermentation reaches back six thousand years into Chinese culture, the Aboriginal peoples of Australia buried sweet potatoes, and ancient Roman manuscripts describe lacto-fermented sauerkraut.
“Fermentation is especially effective in releasing important nutritional compounds through “pre-digestion” that would otherwise pass through the human digestive system, undigested and unused.”
According to the author, our modern large scale vinegar-based fermentation techniques won’t do the trick. It’s the lactic acid fermentation, driven by the beneficial microorganisms that we need to break down foods into usable compounds and inhibit “putrefying” bacterial growth.
It’s common knowledge that prolonged heat, processing and pasteurization kills all enzymes. What isn’t so well known is that, according to Dr. Howell, author of Enzyme Nutrition we are all born with a finite number of enzymes. That’s why it’s important to consume as many outside enzymes as possible from raw food sources.
My PJ Lifestyle colleague Charlie Martin explored the need for a healthy gut in his popular 13 Weeks post “I Got Bugs“:
“One of the interesting research areas recently has been a number of reports that obesity, type 2 diabetes, irritable bowel syndrome, and more serious problems like various kinds of inflammatory bowel disease all seem to associate with differences in the population of the bugs in your gut.”
Charlie’s approach is to use probiotics from Garden of Life Raw Probiotics 5-Day Max Care– and so far he is having great success. This isn’t surprising, Garden of Life was founded by our featured author Jordan Rubin.
We’ve also used probiotics over the last year and the benefits are numerous. So much so, I really don’t want to be without it.
The problem is that probiotics are expensive — especially a good quality brand. My philosophy on dieting and health is that it must be a sustainable change that can last throughout a lifetime. Call me cheap or rebellious, but I just hate being dependent on any product, no matter how good it is.
A healthy gut is vitally important. So over the last couple of months I’ve been experimenting with Kombucha for a more natural intake of “good” bacteria, yeast and probiotics.
Making it at home is ridiculously easy and inexpensive. Here’s how I did it.
One of the interesting research areas recently has been a number of reports that obesity, type 2 diabetes, irritable bowel syndrome, and more serious problems like various kinds of inflammatory bowel disease all seem to associate with differences in the population of the bugs in your gut.
Long-time readers of this column may notice that list is not unlike what I’ve been troubled with since I started it a year ago.
While I’m not quite ready to look for a skinny donor for a fecal transplant (eewwwww), I’d still been rather frustrated with the continuing weight plateau and difficulty lowering my blood sugar, even after raising the metformin dose.
I was also suffering from what I’d have to say was the worst constipation I’d ever had. (I know, TMI, but this is significant.) Let’s just say that for the first time since I swallowed a big wad of chewing gum when I was 4, I learned to appreciate “Fleet” as a brand name.
So I was walking through one of the local sprouthead stores. (Alfalfa’s, which through a complicated series of maneuvers was taken over by Wild Oats, which was acquired by Whole Foods, which had to spin off some stores, which were then re-acquired by the original owners of Alfalfas and renamed Alfalfa’s. Boulder is the Peyton Place of hipster grocery stores.)
My doc had already talked to me about probiotics for my digestion issues, and on her recommendation I’d gotten Arbonne Essentials Digestion Plus, but hadn’t started with it yet.
So there I was in Alfalfa’s, and I decided to look at the probiotics there.
There are a lot of probiotics there. Hell, there’s a whole refrigerator case full of probiotics. They have more varieties of probiotics than most grocery stores have kinds of yogurt. It’s a little intimidating, plus (damned cataracts) I can’t really read the fine print, so I find something by the heuristic of “if it has more kinds of bugs, it must be better,” and buy it. It’s called Garden of Life Raw Probiotics 5-Day Max Care and it says it has 400 Billion something and 34 live strains. It says something about taking it with juice, so I buy some 400ml mixed orange and mango juice bottles, plus a cranberry juice and an apple juice. It also says take it with yogurt, so I buy some greek yogurt, full-fat (which is harder to find than you might imagine) and live cultures, and I buy some apples.
Yeah, I know, where’s the low glycemic load thing? Bear with me.
A good friend of mine had a heart attack the other day. She did everything right — went to the ER right away when she had the first mild angina, she’d been taking care of herself with exercise and controlling her weight. In other words, pretty much the opposite of what my mother did two years ago.
It turned out to be mild, and she was given a stent and is rehabbing now. There were, however, two things that very possibly contributed: her blood sugar was elevated into “pre-diabetic” ranges and had been for years, and her blood lipids, cholesterol and the like, were pretty elevated.
So, now as well as doing the cardiac rehab routine of mild exercise, she’s starting to manage her blood sugar, and she’s on a statin drug for the lipids.
So we were talking about it this morning and she said something that struck a chord.
I bet you will identify with how much I cringe at the word diabetic. It is so associated with not taking care of yourself because of the media.
That really struck me, because I have noticed the same thing: I’ve found it very difficult to come out and say “I am a diabetic.”
Movies and fiction about people who recover from alcoholism pr drugs usually have this dramatic, climactic scene where, after hitting bottom in some dramatic and more or less disgusting way, the main character has the “moment of clarity” and stands up in a meeting and says “I am an alcoholic.” (Two great examples, by the way, are an under-appreciated Michael Keaton film Clean and Sober, and the Matthew Scudder books by Lawrence Block.) It’s an important moment in recovery because it marks the point at which you are — at the risk of sounding like I live in Boulder — taking ownership of the problem. Your wife isn’t driving you to drink, if it’s genetic it’s still your problem, and however you got there, that’s where you are now and you have to deal with it.
It’s also really hard to say because of the social stigma: socially, we see drunks as morally flawed. Same thing with obesity, with depression, and with drug addiction. Theodore Dalrymple has an instructive, if in my opinion mistaken, piece on this in PJM, where he questions whether we’d think of having “Arthritics Anonymous” where someone stands up and says “I am arthritic.”
Have you ever heard a child say “I can’t wait until I grow up so I can do whatever I want.”? You may have said it yourself or at least thought it.
What an irony. When you think about it, at no other time in our lives than childhood do we have more real freedom. Our days are spent in self-indulgence, playing, learning and growing into who we are meant to be. At least, that’s how it’s supposed to go.
Children tend to bristle under rules, testing their validity usually by breaking them to see if consequences will follow. Some of mine bucked up against them on a daily basis. In a child’s eyes, adults make the rules. Their narrow view of life makes incapable of understanding the multitude of laws adults abide everyday.
Since most traffic laws are color-coded, children catch on to what means stop and what means go fairly quick. When the rambunctious toddler doing the back-car seat driving squeals to “Go faster!” the sign along the side of the road or the police car you just passed, makes a good visual aid for explaining the law you are currently trying to follow.
However, not all laws are as visual or as well enforced. A society runs on a host of laws. There are moral laws, social and criminal laws. All must be followed, the extent to which they are written or enforced does not, in any way, negate the law.
The same goes for dietary laws. Our heavenly Father put them in place. I don’t believe they are meant for our salvation, but for our health and happiness. Much the same way we as parents place rules in our homes for our own children.
Being our human condition lends us with a natural bent toward rebellion, most of us would prefer to roll the dice on our health. Then when the consequences — such as pounds or a frightening diagnosis — we cling to the newest fad diet hoping it will serve as a get out of jail free card.
“You can always tell a first time mother,” she said, as we sat in the kitchen sipping our coffee. “They’re always jumping up, running after the baby, worried about every little thing she touches. By the time the third one comes along, she’s like, ‘Oh look, the baby’s licking a shoe–isn’t that cute?’”
A quick glance at my toddler revealed the source of my friend’s caffeinated blurt of wisdom–my eight-month old daughter, sitting quietly at my feet was teething on a sandal.
No, I didn’t give it to her; she slipped it off my foot without me noticing. And no I didn’t think it was cute, but I didn’t panic either.
She was right.
You might be tempted to say a mother of several children just gets lazier. I say, she gets wiser or she won’t survive.
It always seemed curious to me that children in small families, living in town with mothers that kept immaculate homes and doted over them– were constantly sick. I noticed these families because, well in some ways, I envied them.
Although I couldn’t stand the thought of raising a large family in a subdivision, raising kids in an old farmhouse was a lot of hard work.
Open windows welcomed the dust in from the fields, and a constant stream of little feet imported dirt and mud from every corner of the yard. It was hard enough to keep the house clean, but keeping it sterile was not an option.
Oh, and their favorite place to play? The barn. Followed closely by the large eight-by-eight foot sandbox under a magnolia tree. The boys built
treetop shanties tree houses and played army barefoot in minefields of manure the pasture.
In this week’s reading of Jordan S. Rubin’s The Maker’s Diet I found the reason my kids were seldom sick. To this day, even as adults– it takes a lot to knock them down. I used to think it was because I was such a good mother. Wrong. It was because God is such a good Father.
Rubin explains how science is just now discovering how the Creator designed our environment to keep us healthy. Which, it turn, also explains how we’ve messed up the process.
Week 1 of my fourth 13 week season: a low glycemic load diet, tracking my weight and blood glucose. 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.
Diabetes mellitus, especially the type-2 variety that used to be called “adult onset”, is a serious problem that’s been growing along with people’s waistlines. The name comes from “diabetes” (διαβήτης in Greek, and more or less adopted whole into Latin) meaning “to pass through”, and “mellitus” from Latin, meaning “sweetened with honey.” So the name means “pees sweet.” In fact, the test for diabetes was originally to taste the patient’s urine; if it was sweet, that meant diabetes.
This is why doctors are glad they no longer do their own lab work.
Type 1 diabetes is caused when the pancreas stops secreting insulin, for reasons that aren’t completely clear; type 2 happens when the body stops responding to insulin normally. No one is quite clear why that happens either, although an interesting new line of research is suggesting that people with type-2 diabetes have abnormal populations of bacteria in the gut. (I’ll be writing more about this soon, I’ve got a stack of papers full of long Greek-root words to read.)
Whatever the cause, the effect is that your blood sugar goes too high. This has a lot of bad effects, including a greater risk of heart disease and strokes, pain and numbness in the limbs, and not to put too fine a point on it, peripheral body parts becoming gangrenous and falling off, leading to slow creeping painful death.
This explains why, when I was diagnosed as actually being type-2 diabetic (familiarly called T2DM in medical conversations) I took it somewhat seriously, leading me to the first of these 13 Week experiments last year. I’ve experimented with several different diets and exercise plans, and lost a little over 30 pounds — followed by a near plateau of very slow weight loss. I was rather more successful with controlling my blood glucose — a little too successful back in April, in fact.
So, at the end of this most recent experiment, I had an HbA1c test, which measures your average blood glucose level over the lifetime of red blood cells. (I explained that in more detail last January.)
For the previous 13 weeks, I changed the diet, adding more carbs and reducing my metformin dose to 500 mg/d to see if I could avoid the hypoglycemic episodes. I was successful; haven’t had another fainting spell. Last Friday I had another HbA1c, though, and it’s up to 6.4 percent, which still counts as good control of the T2DM, but lower would be better. So, after talking with my doc this week, I’ve made some changes in my meds: back up to 1000 mg/d of metformin, back down to 20 mg/d of Prozac, and I’ve cut out the simvastatin completely because my cholesterol is actually low. All this for this 13 weeks; I’ll have another set of blood tests at the end of this 13 week experiment, in December.
Aside: Just making it one thing after another, my current doc, who I really like, just told me that the effects of the Affordable Care Act, and the required changes in paperwork and all, have taken so much time away from doctoring, which she likes, and put so much of her time into doing clerical work, which she hates, that she’s hanging it up in February. I’m starting to look for a concierge doc in this area.
As well as changing the medications, I’ve changed the diet somewhat. I found it very difficult to maintain the “slow carb” diet. I just didn’t feel as good as I had (mostly) on the low carb diet, but I didn’t want to go back to that and have more hypoglycemic episodes. So this 13 weeks, I’m trying a low glycemic load diet.
Have I ever mentioned how much I hate to cook? If I haven’t, I’d be really surprised. I say it often. In fact, I’ve said it so often, that at one point, my husband fired me from cooking for the family.
It’s true. Although he did do it nicely. He offered me a deal I couldn’t refuse. “You keep the kitchen clean” he said, and then promised, “I’ll do all the cooking.” What fool wouldn’t jump on that? Especially since, at the time, we had four young children and I owned and ran a small business.
Mistakenly, I took his offer as a sign of his love and appreciation. When I excitedly thanked him with a kiss on the cheek, the truth fell out: “I’m just tired of the [expletive] you’ve been feeding us.”
He was right — it was bad. My motto at the time, “If I can’t nuke it, or pick it up in a hit-an-run, we don’t eat it.” When asked, what do you want for dinner? My children would call out names of their favorite restaurants rather than actual food.
His cooking and my cleaning arrangement only lasted until I closed my business to take care of our growing family full time. Once back on my own, and without the means or excuses for eating out all the time, I began complaining again — this time to the neighbor.
She didn’t offer me the same deal.
However, she did make me her pet project. Her new goal in life: Teach me to cook and love it. She only partially succeeded. Much to my family’s delight, she taught me how to cook venison, make homemade pizza and twice baked potatoes. But most of all, she showed me the happy faces of my children around a dinner table.
After expressing my sentiments on cooking to a recent houseguest, she looked at me in total disbelief. In fact, if she wasn’t such a lady, she might have called me a liar.
She may be right, and I just really didn’t notice the change. Preparing food for my family has taken on a completely different meaning now. It has become a life saving medicine for my husband, and a new way for me to see God’s provisional hand in every area of our lives. Taking extra pains to be sure we have meals that are as rich in nutrients as they are in flavor has become a small pleasure.
In this week’s reading of Jordan S. Rubin’s The Maker’s Diet I realized why what we eat, and eating together, actually brought joy to a drudgery I hated. The author has a scientific explanation:
We all have a “second brain” in our gut that controls more than we think.
How time flies when you’re having fun.
I’d actually expected to be at WorldCon in San Antonio this weekend, neatly bracketing this thirteen week experiment — you may recall I was in San Antonio at a wedding on the first of June — but the universe apparently was having other plans. I was laid off my day job on Tuesday, and it really didn’t seem practical to go for various reasons, including having several companies wanting to talk to me on Thursday and Friday. (I haven’t got a new day job yet, so if any of my readers are looking for senior geeks, you can find me on LinkedIn.)
It wasn’t a terrific surprise, as I’d been fighting with the management above me for a good while; in fact, it was a bit of a relief. It’s an interesting coincidence that it comes in the last week of 13, though, because — as you probably deduced if you read my last couple of weeks’ columns — I’ve been unsatisfied with this experiment. So, now we’re at the end of the experiment, and the question is: pivot or persevere?
My answer? Both.
Changing the diet and cutting the metformin in June has improved the low end of my blood sugar; unfortunately, it has done so by moving the band up. I don’t have a new A1c value yet, but my morning fasting blood sugar has averaged 121, up a bit fron the last experiment.
The “slow carb with vacation days” diet has probably contributed to that; what’s more, for me, it was harder to maintain that diet than the low-carb diet. Something that undoubtedly contributed to that was that I stopped keeping a detailed meal diary.
I did discover a way of fitting exercise into life that continues to work pretty well — slipping Tabata intervals into my Pomodoro routine.
So, part one of the pivot: I’m changing the diet again. I continue to think that carbs along with whatever physiological differences go with metabolic syndrome to type-2 diabetes are a major contributor to weight gains and higher blood sugar. At the same time, the really low carb diet stopped working for me for weight loss, and was associated with the episodes of really low blood sugar.
Even non-hypochondriacs such as I sometimes worry fleetingly about their health when, having reached a certain age, some of their friends and acquaintances fall foul of a disease, namely (in this case) cancer of the prostate. But my anxiety does not last long and so far I have managed successfully to resist all attempts by my medical colleagues to measure my prostate specific antigen (PSA). I want to have as little to do with doctors as possible, other than socially of course, and there is nothing quite like a high PSA level to provoke doctors’ interference in a man’s life.
Would this interference, though, prolong my life if I allowed it to take place? A recent paper in the New England Journal of Medicine starts optimistically and ends pessimistically. It draws attention to the fact that mortality from prostate cancer has fallen drastically and attributes this to improvement both in early diagnosis of the cancer by means of screening and of treatment once diagnosed.
The body of the paper, however, is less sanguine. First 18,880 elderly men were divided into those who were given finasteride, a drug that was hoped would prevent cancer, and those given placebo. Some years later it was discovered that finasteride did indeed reduce the numbers of patients who developed cancer, in fact by nearly a third.
So far so good: but this is not the end of the story. Unfortunately, prostate cancer is a very variable disease such that, while some men die of it, many more men die with it than of it. And while finasteride seems to have prevented many low-grade cancers, those that would not have killed the men in any case, it seems also to have increased both the number and proportion of the more serious kind.