A Journey of Mindfulness--the Remaking of Life in Midstream.

[Scott 2]

Have you looked into a concierge medicine service? A few years ago, my doctor moved to the MDVIP model. He then removed the middle man and went straight concierge.

For about $2500 a year, you get the medicine 3.0 labs array. But also in person stuff. EKG, grip strength, balance on a force plate, etc. And mental health surveys - sleep, depression, etc.

That all feeds into a physical, that's more like an hour, instead of ten minutes. Advice includes stuff like which probiotic or omega-3 to take. You also get a direct number to dial with medical needs, priority scheduling, vetted referrals, easier prescriptions, generally superior service.


My wife has stuck with him. Not for all that, but because of their history. She has complex needs. The canned offering is pretty cool though. If I was still on tech money, it's what I'd be using. High deductible plan, plus concierge.


Looking at the online lab services, I'd be more inclined to go full freight. Especially if the concierge can hit in network insurance for any follow-up. I bet follow-up is the money maker, for the online services.


Concierge is of course horrible for the general pop. Capable doctors run off with the most lucrative patients, leaving everyone else with scraps. But without a fundamental shift in American healthcare, I don't see the pattern getting better long term.

[IlliniDave]

Have you looked into a concierge medicine service? A few years ago, my doctor moved to the MDVIP model. He then removed the middle man and went straight concierge.

For about $2500 a year, you get the medicine 3.0 labs array. But also in person stuff. EKG, grip strength, balance on a force plate, etc. And mental health surveys - sleep, depression, etc...

I haven't really looked much in concierge services per se. Maybe I'll do that once cabin season rolls around and the occasional cruddy weather day keeps me trapped indoors. I spent some time looking for functional medicine/naturopath practices locally and did run across a DO in town who self-described as concierge, but it looked like his slant was more transparent pricing for basic services conventional services rather than an expanded Medicine 3.0 slant. IIRC membership as about $1,000/yr. Something to think about. My plan is to decide today on the Function Health option--if I opt for it I can presumably get the test draws performed soon, before my standard care draws. Not sure how long it takes to get feedback but it would be good to have a handle on at least some of it prior to my regular visit on 5/13. I actually started the sign up process and got on a wait list yesterday, but I haven't committed yet. Even if I just do it for one year and get the full battery plus the subset that's part of the six month follow up it's probably $500 well spent. The paltry annual labs my pcp orders cost me about $80 after insurance, and I imagine that even if I could get them ordered through her the battery wuld cost much more than $500 after insurance.

[IlliniDave]

Welp, I got off the wait list promptly and am all signed up with Function health. The $499/yr membership covers the cost of the standard 109-item annual screen plus the ~60 item subset that get retested on a 6 month interval. To do all the tests requires something like 12 vials of blood need to be drawn so I have to go in twice on different days. Since their protocol is to stop all supplements for at least 72 hours prior to the draws the soonest I could schedule is Friday and Saturday this week. That gives me a fair chance of getting many of the results back prior to my May 13 regular doc appointment. I opted for the standard battery plus addition of two optional (i.e., not included in the membership so come at added cost) tests: a heavy metal screen and adiponectin. Adiponectin will give me some insight into how successful my efforts to reverse insulin resistance have been, as well as some insight into potential atherosclerosis. Their are other means to those ends but the test was relatively cheap (~$20 iirc). The heavy metal screen is more pricey, about $160, but I figure it's worth that to find out if I have anything to deal with. Another optional test that I deferred was the Galleri cancer screen, mostly because it's fairly expensive, around $800-$900 through Function iirc. I'll likely do that later.

I always get a little apprehensive about getting lab tests done because the potential for bad news is always there. So there's an ignorance is bliss factor. But since I've opted to be proactive in my health management, and can't help overlaying my ingrained engineer mindset, there's value in expanding the information I have access too. And even though there's maybe some hubris at play, I feel like I'm rapidly becoming competent at understanding the data and being able to ferret out non-pharma/Medicine 2.0 attack vectors on many of the things prior lifestyle has set me up for, possibly better than a typical primary care doc who wouldn't have interest in most of the data (e.g., despite my past history, I'm having to lobby to get a simple fasting insulin test done).

The information I get should be rather interesting and give me answers to many things I've wondered about like nutrient levels, cholesterol particle size/counts, "biological age", etc., plus a Medicine 3.0/functional medicine interpretation of the results. And apparently they have a "concierge team" available to members for fielding questions. I'm not expecting a whole lot of personalized interaction with that team because of state-by-state medical licensing, but I'll probably put it to the test.

I guess the $680 I just dropped will have to count as my (slightly early) birthday present to myself, lol.

[Scott 2]

I'm very interested to see what value you find from the service. Access to a Galleri test is one of the "exclusive" perks of my wife's concierge doctor. Pricing is similar. It's not something we've pursued, due to age. I think there's a time where it's worthwhile, if one has the resources.

The risk to all this being - false positives, leading to excess energy spent on medical care. I'm with you on the engineer's mindset though. I also find myself desensitized to the blood draw and waiting game. When the measurements become habitual, they stop being stressful.

[IlliniDave]

I'm very interested to see what value you find from the service. Access to a Galleri test is one of the "exclusive" perks of my wife's concierge doctor. Pricing is similar. It's not something we've pursued, due to age. I think there's a time where it's worthwhile, if one has the resources.

The risk to all this being - false positives, leading to excess energy spent on medical care. I'm with you on the engineer's mindset though. I also find myself desensitized to the blood draw and waiting game. When the measurements become habitual, they stop being stressful.

I'm fairly certain I'll be updating on the topic in the future, ha. With this battery of data and my annual foray into Medicine 2.0 happening so close together, there's bound to be something that catches my interest. Hopefully I'll have good news, at least more good than bad.

I sometimes wonder if it's a little weird to spend so much time on health and fitness and such in a journal thread while being a fairly healthy dude relative to my age cohort (and relative to where I was 1.5 years ago). But other than my willingness to spend moderate $ pursuing health it's probably one of the most ere-aligned things I do. If successful it will promote independence further into the out years, and keep me out of the Medicine 2.0 sickcare system. My whole life I've needed a thing or two to focus on mentally (almost obsess, really) and now that I've said no to accumulating more wealth and stepped away from a career, diving into my physical health and well being seems like a nice addition to my palette, along with guitar/music and fishing seasonally. It sort of replaces attention to my longer-term financial health. In hindsight I probably did things backward in the sense I should have started getting serious about my health at a much younger age. It's not like I ignored it completely, but I just didn't have the bandwidth while juggling work and all the financial stuff to really dive in and learn what I needed to learn. I could have made more time for it without derailing retirement. At the same time it seems like the amount of information out there has really blossomed over the last 5-10 years so maybe my late start is just a matter of convergence of timelines. I suppose on some level I hope someone might come along and read some of this and start asking the right questions about their own situation and ultimately find ways to impact their own healthspan in a positive way. And by that I don't mean mimic my actions/regimen, but rather to take some time to start the process of finding what's optimal for them/their lifestyle/temperament/etc.

You're right about their being some risk to juggling an avalanche of information. Back during the 2022/2023 transition I was relatively stressed for me when I started diving into the implications of my standard panel numbers at the time. Fortunately the energy I put into the endeavor turned out to have been expended efficiently. At some point I'll hit marginal or maybe even diminishing returns when it comes to this pursuit existing within in a holistic life balance. Good reminder to be wary of that. And you're right about becoming accustomed to receiving feedback. At this point in time I actually look forward to getting a quantitative assessment of my regimen despite a dash of trepidation this first go around with Function that will come with seeing a lot of my biomarkers for the first time. But once absorbed they just become part of the baseline I'm twiddling knobs to improve or preserve for as long as possible.

I'd heard of the Galleri before signing up with Function, but never gave it much thought. My understanding is that it much more accurate detecting later stage cancer than early, and of course early stage detection is much more advantageous. I'm not sure about its false positive rate. Since it'll be at least 6 months before I consider taking it again, I'll have plenty of time to dive into it and calibrate my expectations should I opt for it. In the meantime I'm trying to be careful about mitigating the metabolic component of the risk, and a huge fraction of supplements and nutritional approaches that show promise of a reasonable expectation of improving healthspan or even longevity have some potential anti-cancer properties to them (which makes sense due to the fraction of overall mortality being due to cancer). It's pricey but not beyond what I'd consider deploying if I convinced myself the data would be useful.

[IlliniDave]

Yesterday I finally got below 165 lb on the scale, which was my goal for 2023 that I failed to make. I started 2023 a little over 210 lb and bottomed out somewhere around 174 iirc in early May. Started 2024 in the low 180s and hit 164 yesterday. My original goal was to hit 165 while maintaining a strength regimen to bias the loss of ~ 45 pounds heavily towards body fat. And so it took 16-17 months but I think I achieved that. The next phase of the plan is to build back up to about 170-175 by carefully adding lean mass. It's still likely that the periods I relax my nutrition (last few weeks of cabin season and Thanksgiving-New Year's) will come with some additional body fat but I made it through those periods last year with increases under 10 lb, versus my historic 15-25+ lbs.

I'm going to keep my nutrition unchanged for the next 2-3 weeks. Mainly that's because I will have labs ordered by my doc on May 7 and I want them to be as comparable to the Function Health labs I'm in the middle of right now. 12 vials drawn yesterday and I think a similar number this morning. Then in a week or two I should have most of the results. But it's likely I'll drop another pound or two and bottom out around the time of my annual checkup. Then it will be time to change my regimen.

The main change will come in the protein macro category. The Nutrition Wars rage pretty fiercely on that topic. They go from as low as "no one ever needs more than 30-60g protein per day and any more than that will accelerate aging and death." to "muscle mass in older people is strongly correlated with longevity and older adults need as much as 1.0-1.2 g/pound of body weight along with consistent strength training to trigger the necessary anabolic processes to prevent/slow loss of lean mass." Being at the young edge of "older" in this context I would like to add another 10 lbs of lean mass before I hit the age where preserving what I have is about the best I can hope to accomplish. So my thoughts at the moment are to ramp up my protein intake significantly. That's the beauty of something like Function Health assuming I stick with it. I'll get a broad glimpse under the hood so that I can see who is right when it comes to me and protein.

[7Wannabe5]

The next phase of the plan is to build back up to about 170-175 by carefully adding lean mass.

Whew! You had me worried there for a minute before I read this bit. On the basis of my fairly long career of dating men approximately your height, weighing in from approximately 135 lbs to 255 lbs., with varying body fat/muscle percentiles/proportions, I believe that with this plan you will likely be zeroing in on maximization of Vigor.

[IlliniDave]

Whew! You had me worried there for a minute before I read this bit. On the basis of my fairly long career of dating men approximately your height, weighing in from approximately 135 lbs to 255 lbs., with varying body fat/muscle percentiles/proportions, I believe that with this plan you will likely be zeroing in on maximization of Vigor.

I'm not positive about vigor, but generally that's been the midpoint of a good range for me, what I weighed during my mid-late undergraduate years before lifestyle started taking its toll. For that reason my hypothesis is that it's the midpoint of my optimal set point. Of course I'll be testing that hypothesis with biomarkers and subjectively gauging how I feel. That's predicated on putting on 10 good lbs which will take some time. I can still put on 10 bad pounds effortlessly, and I'm prone to slacking off once I hit an interim goal. Fortunately I have more bloodwork in a couple weeks--the generic stuff for my primary care doc, so I'm motivated to be careful for a few more weeks, which should put the accomplishment in the rear view mirror. If not for that I'd probably be eating deep dish pizza and cupcakes for a few days, lol.

[Ego]

I'd heard of the Galleri before signing up with Function, but never gave it much thought. My understanding is that it much more accurate detecting later stage cancer than early, and of course early stage detection is much more advantageous. I'm not sure about its false positive rate.

I've always been skeptical of cancer screening in general. Vinay Prasad does a good job of explaining why full body scans should not be done. I believe the same argument holds for Galleri.
https://www.drvinayprasad.com/p/why-you ... whole-body

What’s the worst that could happen, you get a false scare, but are reassured later? That’s preferable to the alternative or missing a tumor and dying as a result.

The problem is that this model of cancer is naive and incorrect. I am going to offer a richer model, but I am also going to simplify so it is understandable. Imagine there are 3 types of tumors. They all look like the same cancer under the microscope.

All tumors start in a target organ (breast, lung or colon). The first grow slowly and are unlikely to shed cells elsewhere. These are not going to kill you in your natural life. You might feel them with your hand someday and cut them out, but even if you didn’t, you have nothing to worry about.

The second are those that spread microscopic cells very early on. Even if you find them when small, they have seeded other organs. There is almost nothing you can do to avoid dying by this cancer short of removing all your organs prophylactically— but then you have other issues. If you find this tumor and cut it out and take chemo— you still die of that cancer— but with a few more surgeries and more time on chemo than had you found it later.

The third type of tumor is the tumor that starts in the target organ, and was going to spread, and going to kill you, but because you find it and cut it out, you live much longer than you otherwise would. This is what we want to find!

Now consider that all three are indistinguishable under the microscope. All get the same treatment— surgery, radiation, and chemotherapy.

The problem is that finding tumors #1 and #2 is not good for you. You are subject to surgery, radiation and chemotherapy that you don’t need. These interventions can improve survival when done appropriately, but when done on people who don’t need them, result in a net loss of survival. Your life is shorter and worse off if you got these treatments when you can’t benefit.

Finding #3 is great, and I wish we could find selectively.

[IlliniDave]

I've always been skeptical of cancer screening in general. Vinay Prasad does a good job of explaining why full body scans should not be done. I believe the same argument holds for Galleri.
https://www.drvinayprasad.com/p/why-you ... whole-body

Thanks, Ego, that was a good short read. I'll add a nuance to it. I coming around on a newer theory of cancer, that the majority are essentially metabolic in nature (though some are caused by environmental toxins). I've got plans to add what I hear is a very dense book by Thomas Seyfried on the topic to my off in the woods reading list. Forget the book's title at the moment. And with that theory of cancer's origin some new modes for treating it have been proposed that go under the term "metabolic therapy" or "press-pulse" and seek to exploit the "Warburg Effect." Cancer cells are cells whose mitochondria are so damaged they cannot use the Krebs Cycle to produce ATP, so they default to the more ancient mechanism of fermentation (glucose mostly, but glutamine as well). Their crazy growth rate make them fiends for glucose. Seyfried with others proposed a therapy that would use nutrition to eliminate blood glucose beyond the small amounts produced via gluconeogenesis in the liver. In other words, an utterly strict ketogenic regimen, combined with drugs to suppress glutamine, and essentially starve the cancer. It's only beginning to be used in glioblastoma because that's the one cancer no conventional treatment has been shown to make any difference with (usually measured in 5-year survival rate). And there's not much out there besides anecdotal case studies so far.

However, if I ever had reason to suspect I had cancer that's probably the route I'd take. For the first type maybe I get rid of a tumor that might not kill me (but may cause a lot of discomfort), without poisoning myself. In the second type maybe I die anyway, with the big final regret being to forgo cookies for the last months of life, which beats having the treatment destroy the quality of my remaining life and maybe even kill me before the cancer does (which is essentially what happened to my mom). But just maybe I halt the spread and starve out the source. In the third type, I'm in the same boat as the second. If it's a treatable cancer, it's possible I would opt for the conventional treatment using the metabolic therapy along with it (some evidence it increases the efficacy of conventional treatments) or follow up with it as a way to lower the odds of reappearance.

It's a topic I'll keep an eye on over time, but if it begins to take hold (unfortunately since there's not much money to be made in adopting it, it will be slow at best) having that option might make something like the Galleri test a step I would consider more strongly than I am at the moment.

[IlliniDave]

April Update, Slightly Early

Finances

Financially everything is okay, stash is down some do to the vagaries of the market. I was a little loose with spending, spent a little more on healthcare than normal (Function Health membership, purchased a Keto Mojo glucose/ketone meter), and started stocking up for summer at the hideout (mostly food items this month). I'm also beginning the process of replacing my wardrobe, something I intend to do gradually. Spending still comfortably below annuity income.

Health and Fitness

Unfortunately I don't have results back from my Function comprehensive annual biomarker tests yet. I'll have to update that topic later. It's mildly frustrating to have to wait this long. I'm used to having tests ordered (and I've been sent to the same lab in the recent past) and getting results often the same day. Maybe part of the discount is for accepting a lower priority reporting from the lab. I saw an estimate somewhere that if priced separately the annual battery of tests could cost $15K at the standard pricing of some labs. That might be a little pro-Function Health hyperbole, but since my normal insurance-covered labs tend to cost me in the neighborhood of $80-$100 after insurance (because of the deductible), I can believe $500 for two rounds of testing per year is about as cost effective as it would get.

I mentioned prior that I finally made my 2023 weight goal of driving down to 165 to ensure I flush out as much visceral and organ fat as reasonably possible. I've ranged between 163.8 and 169.8 since 4/14. I've only been below 165 for two mornings in that stretch. Going from memory that puts me down 45-50 lb since my recent peak in late 2022. I'm going to maintain my present regimen until May 12 when I meet with my primary care doc just for the sake of consistency as whatever data that will be gathered is gathered. So I might expect to drop a few more pounds. I feel good so I'm not worried about slipping a little below my present weight.

Leading into my annual with my primary care doc I've started checking my blood pressure 3x/day (when I remember), each check consisting of 3 readings about a minute apart. Average across all the readings is <105/<65 with average heart rate <65. Some of the readings were <100/<60 which is mildly concerning assuming they are accurate. If I look across all the readings my highest sys/dia was 123/77 (those numbers did not come from the same reading, were cherry-picked across the whole set).

Since I started wearing the Oura ring in mid-January my sleep score has risen about 8.5% (looking at the average over the first ~month compared to the average over the last month or so. Qualitatively I consistently get "Good" scores with a few "Optimals" tossed in versus a pretty even split between "Good" and "Fair" to start with. I'd like to be Optimal every day of course, but I feel like I'm in a good enough place that my sleep is not degrading my well being. Since I first started wearing the ring I've averaged a hair over 6.5 hours actual sleep per night per its estimation. I'd like that to be higher. I'm curious to see whether an edge-of-the-wilderness milieu will change things.

While on the topic of Oura, I mentioned a few weeks back that my resilience scores were flagging, but recently I've been on a pretty steady upward trend. I've spent most of my time in the "Solid" range with a brief ebb down to the "Adequate" range, but on 4/28 I rose above "Solid" into "Strong". I still don't know what all goes into that scoring, just that it looks over the past month or so and compares an assessment of physiological stress to an assessment of physiological recovery. I'll just go on the naive assumption that an upward trend is a good thing.

So, given where I am in my bad fat shedding journey, it's getting to be time to start thinking about easing into a nutrition regimen for maintenance. That's why I bought the Keto Mojo--sort of a poor man's CGM. Based on a lot of exploration of the topic of insulin resistance, my regaining insulin sensitivity is a process that I can expect to lag (by years) the recovery of some of my other top-level biomarkers (weight, BP, fasting glucose, liver enzymes, etc.). So I will still have some constraints on my eating.

I've only had the meter a few days and some preliminary findings are:

1. I seem to have pretty good metabolic flexibility now. My ketone levels recover pretty quickly after eating (within a day). Early last year unless I was super low carb all the time I'd knock myself out of ketosis and it would take 3-7 days of renewed strict low carb/intermittent fasting to recover. From the data I've taken over the last handful of days, just prior to my first meal of the day my ketones have been consistently 2.0-2.3 mmol/L which is in the middle of what I understand is the optimal therapeutic zone. Postprandial they are < 1.0 mmol/L after a low glycemic meal. The point being that I can now snap back into ketosis within 24 hours reliably.

2. Don't have a lot of data yet, but it seems that my "fasting" glucose level with the meter ranges from 85-99. Medicine 2.0 says it should be 99 or less, medicine 3.0 seems to prefer under 90. I used quotes because it doesn't replicate the fasting conditions for blood work. The measurement comes later in the day, between noon and 2:00 PM, after I have coffee in the early morning and have engaged in some amount of physical activity: strength training and some medium intensity cardio and/or HIIT cardio typically. In a clinical fast setting the measurement comes ~3Hr after waking, no coffee, and no prior vigorous physical activity. One of these mornings I'm going to replicate the "Labs day" protocol to see what the meter says out of curiosity. But my thirst for knowledge runs up against the pleasure of my early morning large mug of coffee, and so far coffee keeps winning.

3. I still see evidence of insulin resistance. And example data set I took 4/24 was:

Pre first meal of day glucose: 85
1-hr after meal glucose: 95
2-hr after meal glucose: 99
3-hr after meal glucose: 102
4-hr after meal glucose: 99

(for me first meal means a fasting period of about 19-20 hours leading into the meal, ignoring coffee in the early morning)

The Medicine 2.0 assessment is that peak postprandial glucose of a healthy person should be < 140. Despite the coarse resulution, I apparently did well by that marker.

A medicine 3.0 assessment would also add that a metabolically healthy person should return to baseline within 2-3 hours, some say within 90 minutes, which it appears I did not. In other words, the size of the glucose spike is important, but the length of the plateau is even more important. There's a lot of nuance though.

-the meal was low glycemic (hence not much potential for a glucose spike). It consisted of about 3oz dry cured meat (i.e., fermented), about 6oz crab meat, 2-3 cups of mixed greens (with EVOO and red wine vinegar), a small handful of hazel nuts, about a cup of artichoke hearts, 2 green onions, a couple oz of guacamole, a small cut up carrot, a cup or so of "beet kraut" (beets and a little carrot fermented ala sauerkraut).

-Much of it was mixed into a salad and it was all eaten pretty much together, which might have blunted the glucose spike somewhat more than if I ate all the plant stuff sans avocado and nuts solo. Mixing with protein and a little fat would tend to elongate the rise/plateau because of the blunted peak. And notably there was very little sugar or starch included. So maybe still being elevated for > 4 hours isn't so bad. Still, I'm going to assume for now that I have substantial residual insulin resistance. Once I get past my doctor visit I'll probably redo the experiment with a much higher glycemic feeding.

-Stress via cortisol will increase blood glucose, and although I don't recall feeling stressed during the window I was taking those readings, and Oura seemed to confirm I wasn't under a lot of physiological stress, it's possible that simply taking the measurements and seeing the numbers elevated my stress level (sort of mild white coat hyperglycemia, ha).

So, anyway, the jury is still out on my insulin resistance state. Some Medicine 3.0-style authorities identify fasting insulin as the best indicator of insulin resistance/sensitivity available, and when my Function Health data comes in I should get a snapshot of what that looks like.

I'm doing pretty good with other top level insulin resistance/sensitivity-related biomarkers: good BMI, good metabolic flexibility, good BP, decent activity level, no skin tags, etc. At last check in Nov '23 my next level down blood markers weren't bad: decent fasting glucose, decent cholesterol profile, and good liver enzymes. My Hb A1C was a little high compared to last May, but that was due to a deliberate/experimental relaxing of my nutrition regimen for the last month at the hideout and the first few weeks back home (I won't be doing that again!). I interpret how readily my Hb A1c jumped back up to the cusp of the accepted prediabetes threshold (Medicine 2.0) as residual insulin resistance, at least as of last November. I'll have a broader look under the hood when my Function results come in.

What it boils down to is that I'll have to continue a lifestyle (diet, exercise/activity, nutritional supplements, and good sleep cultivation) that keeps my insulin levels low enough to minimize the triggering of downstream effects of elevated insulin.

A person might say, "Geez, iDave. Quit harping about insulin resistance. So many things are going well why not just declare victory and quit finding things to pick at and worry about?" And that's fair. However, it just seems like insulin resistance is at the foundation of so many metabolic problems/diseases that I'm pretty convinced it is the most important item for me to keep tabs on and manage insofar as I can.

Okay, enough on all of that.

Life in general

Outside of my health obsession life is going pretty good. I'm still having a lot of fun with my guitars. I still can't fully explain "why now?" but I intend to enjoy it while I can. May will be a busy month, mostly getting ready to migrate up to the woods. I'll also have a glut of biomarker data to wallow in. I intend to turn my "research" somewhat more towards physical fitness, namely, how to optimize building lean mass in my age cohort. The contemporary wisdom back around the time I was dabbling in crossfit was to go through alternating periods of enormous consumption and heavy lifting followed by periods of caloric restriction in pursuit of leanness. I don't want to do that. Although improved, I don't think my metabolism is robust enough to handle that without doing damage. I want to find a reasonably simple single regimen that allows me to balance protecting my liver/feeding my gut and getting a little nutritional anabolic stimulus to offset aging biology.

Things with my dad are going okay. His doc wants to start him on a drug to help slow his memory decline. It took us (mostly my sister and his IHHC provider) intervening with his doc to get to happen. I wasn't pushing that but I'm okay with it. My dad hates going to medical appointments and was in the habit of hiding issues from the doc. He's very open with all of us about his memory struggles, but has been fibbing to his doctor about it. Like all meds there are possible side effects. The one he's going to try is generally well-tolerated but my one sister is super wiggy about all that fine print stuff, so we've essentially got a vigil arranged to monitor him for a while once he starts it. Once people figured out that plaque was probably not the cause of various flavors of dementia attention has turned towards metabolic causes, and terms like "type III diabetes" and "insulin resistance of the brain" have appeared, which drives some of my concerns about insulin resistance and related items. There aren't a lot of great ways to exit life, but to me dementia seems like it would be among the worst.

Welp, there are still two more days in April after today but I'm going to drop this today rather than saving a draft since next week will be a little busy.

[Scott 2]

What's the level of precision you can expect out of the meter? The shifts you are looking at above are very small. Two other thoughts:

- moving raises blood sugar, they could be reasonably explained

- some sources suggest you want to exercise the system a little, keeping it elastic


For clothes - if you're not that picky, a couple hours in goodwill can trivially solve the problem. If your size is changing, it's cheap and low commitment. No reason to run around in ill fitting clothes.

[IlliniDave]

What's the level of precision you can expect out of the meter? The shifts you are looking at above are very small. Two other thoughts:

- moving raises blood sugar, they could be reasonably explained

- some sources suggest you want to exercise the system a little, keeping it elastic


For clothes - if you're not that picky, a couple hours in goodwill can trivially solve the problem. If your size is changing, it's cheap and low commitment. No reason to run around in ill fitting clothes.

Hey Scott,

The manufacturer claims 100% of readings are within +/- 15% of laboratory readings, 96% within +/- 10% across a fairly wide range of readings, ~40 to ~400. I did a control test on mine and it checked out, so presumably it's operating somewhere within those bounds. I'm going to check myself right before I go in for the blood draw for my primary doc in a couple weeks. Applying the extremes of those error bounds can completely change the implication of the results, of course.

Yes, I'm learning all sorts of things about glucose mobilization in digging around on this. Exercise does prompt the liver to release glucose stored in glycogen to replenish muscles that are burning through their local stores. And except for super strict keto (the kind a cancer patient would aim for) glucose is going to be part of the equation no matter how you slice things. In my case, at least by volume, probably 3/4 of what I eat is minimally processed plant food. Hopefully by exercising the system in a minimally stressful way (lower glycemic plants) eventually I'll ecover more and more. Having one's cells swimming in a sea of insulin continuously is the source of the problem.

Goodwill is on the radar for sure, lol, although I usually hit the animal rescue thrift stores first. I did find some close out jeans on Cabelas website for $15/pair that I bought. Here in the coming weeks I might be able to snag a deal at a local retailer as they try to get rid of their cold weather stuff.

[Scott 2]

I like this article, if you haven't seen it:

https://www.levelshealth.com/blog/what- ... mate-guide

Their table makes your readings look pretty good. My doctor argues optimal is too strict:



One thing the CGM made clear, is a glucose curve will show variance. It is how the body works. Peaks and valleys alone, do not implicate insulin resistance. The shape and magnitude of those curves is what matters. Within tolerances, it's unlikely harm accrues. It can be ok, or even useful, to eat high glycemic foods. A pastry mid-hike, is an efficient source of fuel.

[IlliniDave]

I like this article, if you haven't seen it:

https://www.levelshealth.com/blog/what- ... mate-guide

Their table makes your readings look pretty good. My doctor argues optimal is too strict:


One thing the CGM made clear, is a glucose curve will show variance. It is how the body works. Peaks and valleys alone, do not implicate insulin resistance. The shape and magnitude of those curves is what matters. Within tolerances, it's unlikely harm accrues. It can be ok, or even useful, to eat high glycemic foods. A pastry mid-hike, is an efficient source of fuel.

Thanks for that link. Levels is an entity I'm becoming more and more attuned to. That chart is handy.

Since this morning I got a glut of information from Function Health that I'm going to follow up on in another post shortly.

[IlliniDave]

Well, so today turned out to be the big day for receiving the large majority of my test results from Function Health.

I'll start with the good news: My biological age is 11 years younger than my chronological age based on their calculation from all the relevant biomarkers they use.

The not-so-good news is the set of biomarkers they group under heart are not so good. Mostly it's cholesterol, which was up significantly from what is was in November. In addition since I had the fancy particle analysis done, my profile in that regard is not good. Too many of the small bad LDL particles.

I have not received the review/assessment from a human clinician yet, but all the markers come with some general information. In virtually every case when it came to the cholesterol-specific heart biomarkers, the most likely culprit was listed as (wait for it)--insulin resistance.

Ironically, my LPa (lipoprotein "little a") looked pretty good.

They have a feature that's still in alpha that generates an "action plan". Mine as it stands now is mostly focused on taking steps to improve my blood lipid profile via attacking insulin resistance and avoiding all the usual suspect foods that exacerbate it (sugar, starch, and processed food mainly), as well as seed oils, along with some supplement recommendations.

My fasting glucose was 85 which just meets the Levels recommendation Scott 2 put above. My fasting insulin seemed pretty good at 4.6 (optimal range per Function is 2-5, Medicine 2.0 says anything below 15.4 is okay).

So I'm at a loss. I'm very leery of statins but I'm more leery of heart disease, lol. Even though it appears I'm doing a pretty (but not off the charts great) job at managing blood sugar/insulin in an instantaneous sense, ir seems likely I still have something fairly serious going on under the hood. My thoughts pending the clinician review is to spend the next year dialing in even more diligently to manage things with nutrition, exercise, and supplements and monitor for progress. If none comes in that time I might capitulate and go on a statin (ugh). I'm wondering now if going on a binge of bad eating over the holidays would be enough to mess me up for several months. My pattern last years was rather poor cholesterol in May (per the basic tests) followed by much improved cholesterol (basic tests) in November, followed by a holiday binge of crap eating, followed by poor cholesterol (fancy tests) in late April, followed by ?? cholesterol after another 6 months of decent eating. In other words, does a sustained multi-week binge mess things up for the next 8 months or so? Seems implausible, but that's my best hope.

[Kipling]

IlliniDave, might I suggest you consider just taking the statins? It’s not you, it’s your genetic inheritance. It will likely slightly mess with your sleep pattern, and may cause some eczema issues. But you will much less likely be unexpectedly non-alive.

[Scott 2]

You can calculate HOMA-IR from the insulin and fasting glucose number, here:

https://www.mdcalc.com/calc/3120/homa-i ... resistance

I don't know if your diet would suppress expression of any insulin resistance, but those numbers look enviable. It's hard to believe you have more space for improvement. Adding muscle could make you more tolerant of high carb boluses. But it doesn't sound like those have been a factor.


I wonder if increased zone 2 exercise would change the cholesterol number? Like 3-5h a week, as confirmed by heart rate monitoring? Given the seasonality, activity seems like a plausible variable of interest.

Maybe saturated fat is another lever? Red meat, butter, etc.? Dunno how much of that you eat.

[Ego]

So I'm at a loss. I'm very leery of statins but I'm more leery of heart disease, lol. Even though it appears I'm doing a pretty (but not off the charts great) job at managing blood sugar/insulin in an instantaneous sense, ir seems likely I still have something fairly serious going on under the hood.

Sorry to hear it. Cholesterol should have gone down in conjunction with the weight loss. That is a bummer.

Everyone has their goto solution... and mine leads me to believe that the most obvious culprits are the saturated fats in animal foods. I acknowledge my extreme bias.

Perhaps consider transitioning to plant based whole foods? Maybe try it for a month and do another lipid panel. I believe the test costs about $60.

FWIW, I come from a long line of high-cholesterol, statin-gobblers. Both parents and all four grandparents.

Last check at 56 my levels were:
VLDL 13.2
LDL 81
Triglycerides 66
HDL 73

You've gone far enough down the nutrition rabbit hole that healthy things that once tasted like paste (tempeh) can begin to taste good when you imagine them lowering your cholesterol.

[Scott 2]

Diet's very personal, but my experience is similar to Ego's. Vegetarian for 20 years, numbers are comparable

Last check at 56 my levels were:

@Ego - how many hours a week of endurance exercise do you do? I think that's a key variable. IIRC, you are quite active.