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

Where are you and where are you going?
Scott 2
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Scott 2 »

Hah, I like the spaceship imagery. That's fun.

Eating better and moving more definitely build upon each other. As the spiral escalates, it only gets easier.

Depending on your insurance, it's possible there's a no commitment gym membership benefit available. Mine had a coupon available for free enrollment. I can stop it at any time. The least expensive tier is $20/month - places like planet fitness. Bumping up to the $30 tier gives access to most park districts and chain gyms, similar to the silver sneakers program. It's very affordable and low hassle.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Scott 2 wrote:
Fri Feb 03, 2023 8:58 am
...Eating better and moving more definitely build upon each other. As the spiral escalates, it only gets easier...
I'll definitely look into that regarding the insurance. I'm hoping to get a little more synergy this go-around between nutrition and activity than I've experienced in the past. In days past cleaner eating tended to increase my capacity for activity, but not so much the desire. Seems a little different this time even though I'm on pretty much the same macro proportion regimen I always turn to. My current approach has been like the slogan, "feed the gut (bugs) and protect the liver". So it's just different choices/exclusions within the same framework. After a few months getting my gut in order I can adjust it to be more complementary to strength training and the like. I was a little skeptical of the whole gut health as a universal precursor but so far I'm intrigued enough to invest some more time in it. Welp, off to the rower.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

I kicked around the idea of making this its own thread or even gauging interest for a mastermind-type activity, but in the end opted to just dump it in here. When I nerd out over things I often like to write a tongue-in-cheek "manifesto" as a way to reinforce and organize the ideas, and preserve information. My 2023 obsession over nutrition has fallen into this bucket. Below is sort of the first installment. I intend to add to it for a time and include the additions in this journal. How much or little interest it generates (I find the topic fascinating, but that's just me) will dictate how long I will continue pasting the additions into here.

iDave's Rabbit Hole on Nutrition

Primary Goal

Following is a discussion of present situation, its implications, and general strategies for mitigation.

B.L.U.F
I have several medical markers that are unfavorable. Namely:
1. Body weight 30-40 lbs above optimal
2. Blood pressure in the stage 1 hypertension range
3. Cholesterol profile indicates problems (namely, triglyceride/HDL ratio in the 2.4-3.2 range)
4. ALT of 50 (0-55 reference range but should be < 25)
5. AST of 34 (0-34 reference range)
6. Fasting glucose 110 (should ideally be 70-90(?))
7. e-GFR of 69

Non-lab observations: frequently have heartburn, bloating, gas, occasional suspect energy levels, poor physical condition.

Discussion of Symptoms/Measures

The ALT reading suggests fatty liver disease and excessive fructose consumption. Somewhat elevated triglyceride levels also hints at excessive sugar/bad carb consumption. AST at high end of reference range may indicate a range of liver problems—it's a liver enzyme that can leak into the blood when the liver is under stress. Fasting glucose between 100 and 125 indicates “prediabetes”. e-GFR number indicates mild chronic kidney disease. High blood pressure could indicate a number of things: could be a symptom of being overweight and out-of-shape, could be causal for suboptimal kidney measures, could indicate atherosclerosis. List goes on.

How the Adventure Started

I went to the clinic in December 2022 to have an abscess treated and the PA ordered blood work since it had been more than a year (got off my regular annual cycle when I moved). The timing was in the midst of my annual holiday binge so my nutrition going in was atrocious. What caught my attention was that for the first time ever my fasting glucose was out of range. Despite that the PA who discussed the results with me indicated overall the array of test results were “pretty good” but the glucose measure kept nagging at me so I went down the rabbit hole of looking over all of the marginal items and researching the implications.

Summary of My Conclusions

I wound up disagreeing with the PA's conclusion. The Occam's Razor conclusion I reached is that there is one root cause that could plausibly result directly or indirectly in all the items I felt were concerning. Namely, so-called “metabolic syndrome”. The combination of my diet (especially in the weeks leading up to the blood work) and lifestyle pointed directly to this root cause. My numbers implied I was beginning to advance down this path.

Overarching Goal

As a result of my self-diagnosis my overarching goal is to reverse metabolic syndrome. I'll discuss it more later, but my conclusion after doing a lot of reading and podcast listening is that in large measure it is a nutrition issue, so the main thrust of my plan is revamping my nutrition. Activity level plays a secondary role so that is part of the plan too, although for me the motivation to retain an “active” recreational lifestyle over a longer time span is a bigger motivator to improve conditioning.

Expanding on the Goal

A hodgepodge of information follows that led to specific actions that I beileve give me a fighting chance to reverse metabolic syndrome. The “medical establishment” is unable to effectively treat it (conclusion based on it growing to epidemic proportions in recent decades) so much of my information comes from the dissenting voices in the medical/nutritional community.

Background

For more than a decade I've followed a pattern of fattening up for the winter during the holiday season then working to drop significant weight over the first 6 months of the year. Though not by design on my part, that sort of mimics what our hunter-gatherer ancestors likely would have encountered in colder climates. So I didn't worry too much about the seesawing weight until my lab numbers began to decline over the last handful of years. I always had success shedding the excess weight following a regimen that combined restricted carb intake and intermittent fasting (IF). Unknowingly, I was practicing IF for a long time before ever knowing it was “a thing”. Eating during the day slowed me down at work so I started skipping breakfast and, more often than not, lunch as well. Typically blood pressure and cholesterol would improve as weight decreased, although the cholesterol improvement became smaller over time. I should note that 2022 was the first year following that pattern/protocol that I didn't have the success I was accustomed to.

At the dawn of 2023 I hadn't done the deep dive on my lab results yet, so I started the year by reverting to the old formula. To me “restricted carb” meant mostly eliminating sugar, grains, and starchy vegetables from my diet with a “cheat” of something like pizza or spaghetti once every two weeks. As I consumed other information my plan began evolving in mid-January. By the end of January I had decided on my basic approach for 2023. However, I'm still open to making adjustments as information continues to pour in.

On Weight Loss

Weight loss is a goal for me, and I have an aggressive target set to lose 43 lbs relative to my New Year's weigh in before my first visit with a new primary care doctor on 5/12/23. But after the deep dive into my labs and the research I've done over the last month it is relegated to a secondary goal, with the primary goal being repair and restoration of my metabolism which will be measured at the time of my next blood panel by improvement in all the lab markers. Since weight loss and improved metabolic health tend to go hand-in-hand, and measuring body weight is easy, I'm tracking it closely with a reasonable expectation it's a proxy for all the other improvements I want to see. But I'm not trying to manage it specifically.

Metabolic Syndrome and it's Fallout

More and more emerging research points to the fact that most of the major Western diseases (heart disease, liver disease, kidney disease, type-II diabetes, dementia, and most cancer) aren't really diseases in their own right but later-stage symptoms of an underlying metabolic problems, and further these problems largely trace back to diet/nutrition. So my fundamental thesis pertaining to my own situation is that metabolic malady is what is the primary contributor to all my markers and symptoms of concern.

Metabolism and Hacking Mitochondria

I was introduced to these ideas by the books and talks of a guy named Steven Gundry. He was a heart surgeon, apparently fairly renowned in that field, who pivoted his career when he observed that patients who followed the “standard” lifestyle advice he gave them (which was aligned with the establishment guidance, AHA, NIH, etc.) continued to exhibit worsening health ala metabolic syndrome/heart disease. He also saw his own numbers worsening despite his own lifestyle conforming to all the expert guidelines. His practice now focuses largely on “gut health”, metabolism, and chronic inflammation—things that tend to go awry ahead of cardiac and other symptoms emerging.

There's a ton to say on this topic that maybe I'll talk more about later. At this point what is significant is that I am convinced enough of his findings (generally, I found they are confirmed by other authorities) that I am using his nutrition protocol as a basis for my 2023 regimen. It largely starts with repairing gut health via restoration of the microbiome. In short, that is largely a matter of consuming foods that feed the “good” members of the microbe community and avoiding certain foods that can be problematic for gut health.

Ketones

I have never followed a regimen that conforms to what people call a “ketogenic diet”, but by virtue of spending half of most years with a restricted carb intake and IF, ketogenesis has been part of it by design. The conventional wisdom on ketones had been that they were sort of a “super fuel” your body could turn to during lean times when glucose from dietary intake was in short supply. This has recently been shown to be false. While ketones can be used by most cells for fuel, they can't meet all the needs of all the cells well. Over the long term predominantly relying on ketogenic metabolism ultimately produces an inflammatory state and can result in serious muscle degradation. What the arguably more important role of ketones is that they've been shown to send a signal to mitochondria that it is time for them to repair/protect themselves (mitochondrial uncoupling) and to propagate (mitogenesis). For reasons I can't really speak to, those things in combination cause the mitochondria to convert more of their incoming energy into heat and less into ATP.

It should be apparent that long-term all-day carbohydrate grazing which keeps the body in perpetual glucogenesis is not a healthy state (just look at the US/Western obesity epidemic since the food pyramid was first released c. 1980). And long-term ketogenesis is not a good thing either. That suggests a combination might be optimal. During glucogenic periods the mitochondria are working hard and incurring wear and tear dealing with the influx of glucose, and during ketogenic periods mitochondria are repairing and increasing their ranks. That's sort of the gist of Gundry's “Keto Code” regimen. It uses a combination of “smart eating” and restricted daily eating windows (a type of IF) to allow the body to cycle back and forth between glucose-driven metabolism and ketone-driven metabolism to harvest the benefits of both and avoid the detrimental effects of either in excess, with the focus being centric to mitochondrial health.

Another very interesting topic is the interrelation between good gut microbes and mitochondria. Over the last decade the microbiome has been increasingly studied and among other things, when they are fed the right things, the microbes send chemical signals (so-called “post-biotics”) throughout the body which signal cells to enter certain operation modes, including signaling cell mitochondria to decouple (enter repair mode) and in some cases replicate. Plant polyphenols are especially important in this process. We used to think of them as antioxidants, and many of them do perform this function. But the more import role seems to be what happens after the gut bugs consume them. Our bodies absorb about 10% of ingested polyphenols and 90% are consumed by microbes in the gut. This places an emphasis on getting both large quantities and wide varieties of polyphenols into the diet.

The Downside of the Regimen (for me)

Gundry puts a lot of emphasis on removing harmful lectins from the diet. Lectins are proteins plants produce to deter predation by essentially poisoning any critter that decides to eat the plant. Chief among these are most “New World” plant foods—plants that humans and our pre-human ancestors did not co-evolve with, and “Old World” plants that did not enter the human diet until after agriculture appeared ~ 10K years ago. So that would include things like nearly all grains (especially whole grains), potatoes, legumes, peppers, tomatoes, squash, etc. Most people eat these things without showing any outward symptoms of malady, but Gundry's assertion is that by looking under the hood on his patients, adverse effects of these foods can often be spotted in inflammation markers and such. I love nearly all the foods excluded because of potentially problematic lectins, but for now I'm going to stick with the recommendations. So alas, no lentils. (Oh, the humanity!)

Side note: there is a hack to allow most except the seed grains back on the menu: pressure cooking. I have a few more weeks in the restrictive phase of the regimen then if I choose to I can start to slowly reintroduce some of those things prohibited because of potentially harmful lectins. I have a little pressure cooker inbound to experiment with.

Gundry is also a little more restrictive on animal protein consumption than I like. Similar to the issue with avoiding specific lectins, I'll go along with the program for now. There is also a strategy regarding fat types in the regimen, and a few hacks like strategic use of MCT oil. Some of those details are apt to come up later.

[To be continued]

Scott 2
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Scott 2 »

The nutrition changes sound tough, hardcore even. I couldn't sustain them. But my pool of will power is more like a shallow puddle.
IlliniDave wrote:
Sat Feb 11, 2023 12:46 pm
Weight loss is a goal for me, and I have an aggressive target set to lose 43 lbs relative to my New Year's weigh in before my first visit with a new primary care doctor on 5/12/23.
For what it's worth, a change like this would crush the synergy I find between nutrition and activity. You are talking a deficit greater than 1000 calories a day, for 5 months straight. IMO that's waaay too hard. Outside of the sheer determination required, it risks too much muscle loss. Even a 3:1 ratio of fat to lean mass (great in this scenario) would cost you 10lbs.


Are you collecting any process or performance data, beyond blood markers or weight? The lagging nature of blood markers can make them tough to act upon.

On the process side, I like cheap leading metrics, that will let me know what performance I can predict. Examples:
  • Food - calories, fiber, protein, fat, carbs
  • Activity - calories burned minus exercise, total calories burned
  • Drugs - Added sugar, caffeine, alcohol, THC
  • Cardio - Minutes over 120bpm HR, resting heart rate, blood pressure
  • Strength - Days per week, calculated max for my hardest set on my reference exercises
  • Sleep - hours per night, also quality if using a tracker
On the performance side, I like easily checked relative measures, comparing both to my baseline and age cohort. Examples:
  • Cardio - v02 max, Row times by distance, 5k run time, resting heart rate, blood pressure
  • Strength - Overhead press, front squat, trap bar deadlift - calculated maxes
Then I can turn it into an N of 1 engineering problem. What's my biggest outlier? What's the minimum effective dose to change it by 10%? I can focus my tracking on the leading process metrics. A month later, how's my target performance metric? How did I impair the others? v02 max costs me strength, for instance.

I like to take it easy, keeping as many options at possible unused. That way, when progress stalls, I have somewhere to go. It also makes the behavior sustainable long term. I don't care about next month's markers, only the 20 year aggregate.

Using metrics like these does carry some up front costs. $500 if you go nuts. My fitness pal is free for nutrition, but needs a $50 food scale. A $200 fitness tracker can give you activity and sleep. A $100 chest strap for accurate heart rate data. Home blood pressure is $100. You have the rower, the concept 2 logbook and v02 max calculators are free.

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Ego
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Ego »

IlliniDave wrote:
Sat Feb 11, 2023 12:46 pm
Namely, so-called “metabolic syndrome”.

Overarching Goal

As a result of my self-diagnosis my overarching goal is to reverse metabolic syndrome.
Looks like a great project. This morning I had a long conversation with a friend whose wife in a similar situation, at the very beginning of metabolic syndrome. They decided to tackle the problem together and had their concierge doctor prescribe constant blood glucose monitors to determine how they responded to different foods. They were surprised to find that they responded in very different ways - sometimes exactly opposite - to the same meals and portions. Their doctor suggested their microbiomes are at least partially responsible for the different responses and made some pro/prebiotic suggestions for the wife.

I look forward to following along with your project.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Scott 2 wrote:
Sat Feb 11, 2023 3:43 pm
The nutrition changes sound tough, hardcore even. I couldn't sustain them. But my pool of will power is more like a shallow puddle.

For what it's worth, a change like this would crush the synergy I find between nutrition and activity. You are talking a deficit greater than 1000 calories a day, for 5 months straight. IMO that's waaay too hard. Outside of the sheer determination required, it risks too much muscle loss. Even a 3:1 ratio of fat to lean mass (great in this scenario) would cost you 10lbs.

Are you collecting any process or performance data, beyond blood markers or weight? The lagging nature of blood markers can make them tough to act upon.
I think we are kindred spirits when it comes to gathering data!

Lots to unpack. Regarding calories, I don't count them, I just eat during my window, as much as I want while trying to be mindful of whether I'm actually still hungry. If I assume a generic 2500 cal/day baseline a deficit of 1000 isn't far off from the 30% reduction that is associated with longer healthy lifespan in some of the Blue Zones. That doesn't mean I want to make the current regimen (in it's strictest form) permanent. The regimen has multiple phases that lessen in strictness as metabolic markers improve.

Regarding the weight loss, it was a very aggressive goal. It's 2.5 lbs per week, which is the best I ever did back in my Crossfit days as a much younger dude. So I don't expect to achieve it, especially now that I've relegated it to secondary status. That said, as of yesterday I was not that far off from the weekly loss rate. However, weight loss is not a smooth linear process for me.

I don't want to sound melodramatic but I firmly believe I am already at least a few steps down the path of entering a decade or two of morbidity followed by an early grave. I'm at the sunset of my 50s so it's no longer a matter of starting to see some early warning signs that might indicate serious problems decades down the road, I'm seeing the onset of those serious problems now. I don't know what my window is to reverse the process. Maybe it is already too late, dunno. But it's definitely in the urgent-important quadrant.

For that reason metabolic health is king of the priorities and if pursuing it means I fall 20 lbs short of the ~5-month weight loss goal and/or lose some muscle mass, so be it. Those things can be addressed after a healthy metabolism is restored, and likely addressed better than trying to deal with them with a faltering metabolism. However, there are some synergies, just the causal factor is reversed from what we assume from conventional thinking. Losing weight does not result in improved metabolism, rather, improved metabolism results in weight loss. So I track weight loss as a weak surrogate for metabolic improvement.

Which is a decent segue into the topic of metrics. It should surprise no one that I have a dedicated spreadsheet for this endeavor, ha! You're right that it's a challenge trying to steer measures that require blood tests to measure directly because of their infrequency. It's exacerbated by not really having a primary care doc until mid-May. If I had one already established I could probably get her/him to order blood work every 3 months, and that's a topic I intend to take up on my establishment visit in May.

For now the two measures I have that are known to correlate with metabolic health are weight (measured daily) and blood pressure (measured twice daily). I didn't start tracking BP until Feb 1 so not much data there yet. For now about all I can do is stick with a nutrition plan for which there is a reasonable expectation of improved metabolic health (insulin control being the lever). From there I observe blood pressure and weight, and if they are trending favorably then I conclude it's reasonable to assume that improving metabolic health underpins the improvement. But I won't have any direct confirmation or refutation until the end of these five months.

As far as the process, at this stage I'm only using a crude quality of nutrition scale. 0 if I go off range and have a blatant cheat day. 1 if I'm mostly mindful of "bad carbs" but have a single small cheat. 2 if I consume no bad carbs per my traditional regimen but am outside the "keto code" regimen. 3 if I stick to the keto code nutritional restrictions but have an eating window of more than 6 hours, and 4 if I am in full compliance with the regimen. So far I haven't found any use for the data, but I have it.

On the fitness front my goals are pretty humble--just want to increase upper body strength enough to make wrangling the yak a little easier (something around 80 lbs is the weight I have to wrestle on and off the vehicle roof), and to improve cardio fitness enough to make long paddles a little easier, and longer walks/hikes a little more pleasant. Process-wise I track all my rowing and hiking/walking activities.

With rowing I just log a description (hiit, aerobic, whatever), total time, ave cal/hr over that time (I use the Concept2 formula and adjust it for my current body weight). Immediately after finishing I throw on my BP cuff to measure heart rate. And for this segment of my journey I'm simply looking for improvements like being able to increase my cal/hr for a given rowing time, maintain higher heart rates for longer times, etc. I'm going to use a standard 2K row as a benchmark once or twice each month.

With hiking/walking just recording time and distance. In general I'm more of a stroller than a power walker, but I'm trying to be mindful of keeping a pace that would correspond to my "I have somewhere to be" stride rather than my "it's nice to absorb fresh air and natural surroundings" stride.

Overall I am tracking total time of "physical activity" each week, and shooting for 300 min/week minimum combined moderate-to-high intensity activity. That seems to be the threshold where exercise begins to complement a nutritional approach when looking at metabolic health.

I get some resistance training from the rower, but as far as working with the dumbbells and body weight stuff I'm just logging reps. I haven't ramped that aspect up to full swing yet, so measures could evolve. Any effort at all on that front will put me somewhat ahead of where I was last May when I bought the yak.

If the nutritional regimen is showing good results in May I can maintain it but shift focus a little more towards the fitness aspect. The rub is I will be up at the hideout soon afterwards, meaning I'll have to get a little creative. On the plus side I am typically much more active, especially outdoors. But I'll not have the luxury of being able to do an array of "gym" work that requires equipment. I do have a lot of big stones to move this summer, so I can probably make a game of that. It will also be a bit more difficult to follow the nutrition regimen because there's only one grocery within 50 miles, and it's small.

Likely all this will be rehashed in upcoming manifesto installments, with a good chance my approaches will evolve. You gave some great examples to to think about, especially when in time hopefully fitness can percolate higher up on the priority scale. Thank you.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Ego wrote:
Sat Feb 11, 2023 6:43 pm
Looks like a great project. This morning I had a long conversation with a friend whose wife in a similar situation, at the very beginning of metabolic syndrome. They decided to tackle the problem together and had their concierge doctor prescribe constant blood glucose monitors to determine how they responded to different foods. They were surprised to find that they responded in very different ways - sometimes exactly opposite - to the same meals and portions. Their doctor suggested their microbiomes are at least partially responsible for the different responses and made some pro/prebiotic suggestions for the wife.

I look forward to following along with your project.
A CGM is something I would love to add to my arsenal, and I intend to take it up on my establishment visit with my new primary care doc. I think those might be the single most powerful diagnostic tool an individual interested in staving off chronic "western" illness can employ. Unfortunately, n the US at least there are barriers to getting the devices. Somewhere I have the url for a research project, UK-based iirc, that provides people with CGMs free of charge (and since it's "officially" recognized research, an Rx is not needed in the US). Unfortunately their wait list is 18 months so while I'll probably sign up in the coming weeks, plan A is trying to get my doc to prescribe one. Insurance will cover it for some (inadequate) length of time, but I think it's important enough I'll go ahead and pay for it when coverage ends. It's also important enough that it might cause me to finally discard my old flip phone and sheepishly upgrade to a smart phone unless I can get my hands on one that will store data that I can later dump to my PC.

The reason they are important in my view is exactly what you mentioned--different individuals respond differently to different foods, both due to genetics (apparently), and current health status.

I intend to report on my progress here for a time at least. Even though for the most part ere-ers are an extremely healthy group, some day someone might find some of it useful or encouraging. I'm also interested to hear how things turn out for your friends wife, and him for that matter since he has access to a key indirect measure of metabolic health. It sounds like their concierge doctor is relatively enlightened on this topic. I'm hoping my primary care doc-to-be isn't too entrenched in conventional clinical practice with the Rx pad being the only response to any situation.

white belt
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by white belt »

Since you seem really focused on metrics, I would track your daily activity with a pedometer. It sounds like you already can track energy expenditure during your workouts, so it’s likely that any variation in daily activity level is due almost entirely to step count.

I know you don’t count calories, but I would strongly consider tracking macronutrient intake. The easiest way to accomplish this is by weighing your food. Even if you just continue eating the same stuff, this should give you a good deal more data to chew on (pun intended).

I know weight loss is more complicated than calories in, calories out. However, reducing the number of variables makes it much easier to figure out what works and doesn’t work for you.

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Ego
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Ego »

Frustrating that they gatekeep this stuff. Every so often I see CGM devices and sealed sensors in boxes of deadpeople stuff at the swap meet. The devices and (usually expired) sensors can often be found on craigslist by searching the name only. People have been known to use expired sensors by backdating the bluetooth device, which is extremely dangerous and I would never suggest anyone do anything so stupid.

Scott 2
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Scott 2 »

IlliniDave wrote:
Sun Feb 12, 2023 9:06 am
It should surprise no one that I have a dedicated spreadsheet for this endeavor, ha!
As one should! I have no doubt you'll show significant changes by May. I look forward to the results.

Muscle is a metabolic shock absorber. Strength training could be worth a little more attention, especially while running a calorie deficit. Since 80% of the mass is in our legs, hips and back, I throw most of my sets that way.

If you don't want to wait until May, you can order blood work online. You'd then go into a lab like Quest, just like if your doctor ordered it. Prices can be close to what you'd pay after insurance, especially if you shop around. Same with the continuous glucose monitor.

My longer term plan for healthcare, is to run a high deductible bronze plan, maybe even an HMO. Then I'm going to use the insurance savings to pay for proactive self-serve medical care. The downside of evidence based medicine, is our doctors are often just working off a flowchart. They find themselves with little leeway, especially in a larger medical system. For me, that's not much of a value add. I'd rather have the premium preventive care.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

white belt wrote:
Sun Feb 12, 2023 11:16 am
Since you seem really focused on metrics, I would track your daily activity with a pedometer. It sounds like you already can track energy expenditure during your workouts, so it’s likely that any variation in daily activity level is due almost entirely to step count.

I know you don’t count calories, but I would strongly consider tracking macronutrient intake. The easiest way to accomplish this is by weighing your food. Even if you just continue eating the same stuff, this should give you a good deal more data to chew on (pun intended).

I know weight loss is more complicated than calories in, calories out. However, reducing the number of variables makes it much easier to figure out what works and doesn’t work for you.
Thanks white belt. Yes I've thought about a step counter but for now have kicked that can down the road. I'm trying to keep my bookkeeping load streamlined so I don't lose sight of the ball. Going from being relatively sedentary for the last 4 months to 6-days a week of workouts and deliberate activity will swamp what I can glean from wrangling a few extra steps out of a day by parking in the back of the grocery parking lot instead of the front--something I do, btw, just don't have the intellectual energy to want track it.

A number of years back I spent a lot of time tracking macros in an effort to maximize performance in a Crossfit setting. Never was able to establish any exploitable correlations. The program I'm following when applied in clinical settings starts with 3 months of "eat any of these things" (emphasis on diversity within the list) and "don't eat any of those things". Even though it usually happens, there's no explicit attempt to lose weight. After three months the patient gets a new set of blood panels and with improvement the "eat any of these things" list grows. In time the follow-up interval lengthens until it's the standard annual interval. Any time there are setbacks and/or old symptoms reappear, attempts are made to id the culprit food item and eliminate it. To ease my overhead burden, in terms of what goes in, I'm just staying within the bounds of the regimen. It might be a good idea later as I approach the steady-state phases to start trying to be a little more precise about macros.

Yeah, calories in, calories out/a calorie is a calorie is one of the most destructive pieces of bad information perpetrated on us by the people we are told to trust. Gasoline has a lot of calories, but its poison. Many would argue that fructose, for example, belongs in the same category. I still run across people that get angry at me when I admit I don't buy those slogans at all. I have a very good understanding of the key variable for me losing weight--severely curbing intake of sugar, junk food, grains, starchy veggies. A good rule of thumb for me is if the ratio of fiber to total carbs is 1:3 (maybe 1:5) or higher, it's a "good carb". I have a few exceptions for foods (real foods) that violate that but have other benefits, most recently as pertains to gut/microbiome health. Ratios of protein and fat in the balance of my intake don't make much of a difference when looking at weight loss. For reasons not related to weight loss at all, this regimen is dominated by plant-based carb sources that meet my good carb criteria. This effort for me is much more focused on me staying alive and vigorous rather than looking good.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Scott 2 wrote:
Sun Feb 12, 2023 1:53 pm

Muscle is a metabolic shock absorber. Strength training could be worth a little more attention, especially while running a calorie deficit. Since 80% of the mass is in our legs, hips and back, I throw most of my sets that way.

... doctors are often just working off a flowchart. They find themselves with little leeway, especially in a larger medical system. For me, that's not much of a value add. I'd rather have the premium preventive care.
Regarding the first excerpt, that exactly why I enjoyed Olympic lifts so much. Legs, glutes/hips, and core are recruited into every lift. Although it's realtively low on the scale, one of the things I like about rowing is that it recruits those same muscle groups (rowing is sort of like a sideways squat).

Regarding the second, it's even worse for doctors associated with larger practices/networks. Their performance evaluations are predicated on how closely they follow the play book (probably written by people funded by Big Pharma/Big Ag). For me, based on my December labs, the playbook will say: Rx for cholesterol, and eat more carbs; Rx for blood pressure, and eat more carbs; and Rx for fasting glucose, and eat more carbs; full stop. I of course will refuse, which then puts the doc on the spot as in theory she would get dinged for a patient she didn't get into the program. I've heard anecdotes of MD's "firing" patients who refuse the drugs because they don't want the hassle from the powers that be, but can't speak to the veracity.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Ego wrote:
Sun Feb 12, 2023 12:19 pm
Frustrating that they gatekeep this stuff. Every so often I see CGM devices and sealed sensors in boxes of deadpeople stuff at the swap meet. The devices and (usually expired) sensors can often be found on craigslist by searching the name only. People have been known to use expired sensors by backdating the bluetooth device, which is extremely dangerous and I would never suggest anyone do anything so stupid.
Ha, yeah, I'm not sticking anything into my skin that someone might have picked out of the trash somewhere. One of the mitigating side effects of being an oversaver who arguably overemphasized the FI dynamic is that I can pay the price in dollars for something like a CGM. They aren't cheap, but they are << than my deductible and OOP max, two thresholds I'd probably blow through every year if I wound up with multiple chronic conditions that require ongoing care.

ertyu
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by ertyu »

Some cholesterol meds have memory problems as a side effect. Saw it play out with my father. I don't remember the exact names of what he was prescribed but I do remember making a mental note. tl;dr: lifestyle interventions as you're doing beat rx any day. Good luck, I hope you're successful, I'll be following along, too

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

ertyu wrote:
Sun Feb 12, 2023 8:01 pm
Some cholesterol meds have memory problems as a side effect. Saw it play out with my father. I don't remember the exact names of what he was prescribed but I do remember making a mental note. tl;dr: lifestyle interventions as you're doing beat rx any day. Good luck, I hope you're successful, I'll be following along, too
Statins are the most common drugs prescribed for cholesterol. My understanding is they are basically anti-inflammatory drugs. Here is a list of side effects that are acknowledged by the establishment (Mayo Clinic in this case):

-Muscle pain/damage
-Liver damage (mine is functioning suboptimally, possibly already damaged)
-Increased blood pressure (mine's already elevated/high)
-Type II diabetes (I'm already prediabetic)
-Neurological damage incl. dementia.

I don't know how common any of these are. Also regarding liver issues, blood pressure, diabetes, and dementia--I would suggest the possibility that since for people with insulin resistance/metabolic syndrome, higher cholesterol is a companion symptom for all of those, I think it's likely that since statins do nothing to treat the root cause, those particular "side effects" might have little to do with the statins and more to do with the underlying problem going unaddressed and progressing as they would while the root cause is unaddressed irrespective of the statin.

There are other cholesterol lowering drugs besides statins which I think work by either blocking dietary cholesterol absorbtion (really not the issue with Metabolic Syndrome IMO) or by inhibiting the body's ability to produce cholesterol.

The only situation where I could be persuaded to medicate for cholesterol would be based on having an NMR Lipoprofile test that showed a concerning overabundance of the smallest size cholesterol particles. In excess they are bad news, and I think having too many of them is usually an inherited genetic trait. Since there is essentially no heart disease in my immediate family (parents and siblings) it is unlikely I have that issue lurking under the hood. But I'm going to lobby for the test, especially if meds are being pushed on me.

Married2aSwabian
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Married2aSwabian »

I can share a couple of keys that helped me tremendously:

About ten years ago, I read “Wheatbelly”. That book opened my eyes to the fact that diet is a HUGE factor. No matter how much you exercise, if you have a lousy diet it will catch up with you. Bread (especially with highly refined flour) is converted by the body into sugar. I cut out most types of bread, except German whole grain.

Around 2015 I cut out SUGAR. I ate as much as I wanted of things without it and still lost 15 pounds within three weeks! I dropped another five and have kept it off ever since - at healthy weight. It’s tricky, since sugar in all its bazillion forms is in almost everything in the US. Lots of label reading. Also, I went through some withdrawal symptoms for the first week or so. Alcohol is also converted to sugar in the body, so that’s not great either.

Lastly, I switched to vegetarian diet in 2016. DW and DD lead the way on this one. My total cholesterol went from 225 to 185 in less than one year. Doc said it was biggest improvement he’d ever seen without meds! After seven years, it’s stabilized around 165. Dropped another five pounds and have been steady around 160 ever since. DW read “Forks over Knives”. We watched the documentary. It’s worth a look. The China Study is Basis for it. Western / American diet is shit, but it’s very lucrative for both the food and big Pharma industries.

Hristo Botev
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Hristo Botev »

IlliniDave wrote:
Mon Feb 13, 2023 7:51 am
Have you considered scheduling an appointment with a dietitian, rather than trying to figure this all out on your own? This is my wife's outpatient side-gig (I'm not trying to sell her services; she's not licensed where you are), and most of her patients come to her from doctor referrals, especially from doctors who are of the more enlightened variety who will try and exhaust lifestyle fixes before prescribing medications like statins (or from exasperated doctors dealing with patients who are very reluctant to go on meds). I don't know what your insurance situation is, but often insurance will pay for monthly visits with a registered dietitian. From my limited understanding, in an outpatient setting a "good" dietitian will spend a good bit of time with you (my wife does 90 minutes for the initial visit) to get a complete picture (or as complete as the patient is forthcoming about) of what a patient usually eats, where the food comes from and how it is prepared and who prepares it, what the patient wants to accomplish and why, the patient's past history with diet, and so forth, and custom tailor a plan with the patient and then provide the patient with a level of accountability to better ensure that goals are met. I suppose it is somewhat similar to hiring a financial advisor or a strength coach; you probably can do it yourself, but likely less effectively.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Married2aSwabian wrote:
Mon Feb 13, 2023 9:26 am
I can share a couple of keys that helped me tremendously:
Thanks, M2aS. With this regimen I'm tinkering with wheat is out, along with oats, rye, most grains. As is sugar for the most part--in the final phase very moderate amounts of fruits/berries allowed when they are in season. I don't think vegetarian is in the cards for me. Like I mentioned in part one of the manifesto, it's pretty restrictive regarding animal protein. In the final two phases no more than 8 oz/day, and restrictions on the sourcing (beef grass fed and grass finished, chicken (and eggs) pastured only, humanely raised pork only, and all free of hormones and antibiotics. Wild caught fish and seafood only. I think some of that is driven by ideology but it's also driven by the priority of gut health in the program. I'm considering a 'piscatarian' approach augmented by eggs and a short list of cheeses.

IlliniDave
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by IlliniDave »

Hristo Botev wrote:
Mon Feb 13, 2023 10:42 am
Have you considered scheduling an appointment with a dietitian, rather than trying to figure this all out on your own?
Just last night I was Googling for local D.Os and nutritionists/dietitians. It would have to me a very enlightened/maverick one like your wife sounds to be. The gate-keepers who determine who can and can't dispense dietary and nutrition advice are defacto employees of Big Food and Big Ag. Any dietitian/nutritionist who follows the part line is of no use to me. I'm actually pretty confident about this nutrition regimen. It's one that's been advanced by a group of MDs who've had to pick up nutrition as a competence when they got frustrated that they'd been treating patients for decades and none of them got any better. But I'm keeping the nutritionist card in my back pocket in case any issues come up. The principles are pretty simple. No sugar, no grains, virtually no processed food, avoid lectins from plants a portion of the population exhibits sensitivity to, lots of prebiotic fiber, lots of polyphenols from a wide variety of plants, limited amounts of high quality animal protein. No counting calories or macros. Limited daily eating window Monday-Friday, ideally between 2 and 6 hours once one is adapted to it. Longer window on the weekends in the final phase once the gut is restored, signs of inflammation and insulin resistance gone, and healthy weight achieved.

Hristo Botev
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Re: A Journey of Mindfulness--the Remaking of Life in Midstream.

Post by Hristo Botev »

IlliniDave wrote:
Mon Feb 13, 2023 4:22 pm
The principles are pretty simple. No sugar, no grains, virtually no processed food, avoid lectins from plants a portion of the population exhibits sensitivity to, lots of prebiotic fiber, lots of polyphenols from a wide variety of plants, limited amounts of high quality animal protein. No counting calories or macros. Limited daily eating window Monday-Friday, ideally between 2 and 6 hours once one is adapted to it. Longer window on the weekends in the final phase once the gut is restored, signs of inflammation and insulin resistance gone, and healthy weight achieved.
I suspect my wife would tell you you are overthinking and overcomplicating it ;) If you are interested in some recommendations for "good" dietitians in your neck of the woods, DM me and I'll ask my wife if she can provide you some. She (used to be) pretty involved with the Academy of Nutrition and Dietetics (which has tons of its own problems, some of which I'm sure I've vented about on my own journal in the past), but as a result she has contacts across the country and I suspect she could point you in the right direction, if you're interested. That said, I'm as much of a "if they have letters after their name then you probably shouldn't trust them" as anyone (dietitians LOVE their letters after their names--I think my wife has 12), so whether a dietitian is going to walk the party line or not depends on what you mean by party line.

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