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Day 7 of Elimination Diet check in

            Well, I made it through 7 days of my elimination diet. So that is a week without (listed in descending order of difficulty): caffeine, alcohol, dairy, corn and corn-based things, gluten, and soy. And it really wasn’t too bad I must say. We had some really delicious meals, so I never went hungry or felt like I was missing out or suffering. The only two exceptions were that I went for a hard bike ride and didn’t ride as well as I would have liked, and one long day at work the only thing that I could find to eat was chicken breasts, literally everything else they had had at least one if not more things I was eliminating. But those were delicious chicken breasts and help me until I got home.                Overall, I feel pretty good though, and I really don’t miss a lot of those things (alcohol and caffeine excepted, of course,  since these have been a mainstay in my life since all this COVID stuff started. See cartoon below). I am working a lot this weekend, so that will have its own challenges, but I am looking forward to another week of healthy, yummy eating! I’ll check in again next week, until then be safe and healthy everyone!

Hello everyone, hope that you are all safe and healthy in these crazy times.   As I’m sure is the case with many of you, these times of social distancing and quarantine have led to some poor choices in my life.  Too much stress eating, too many “happy hour” cocktails, and way too little exercise have definitely taken its toll, and it’s time for a change.  It just so happens that my very talented wife just finished nutrition school and she has a few tricks up her sleeve to help turn things around.  Starting this weekend, we are going to do an elimination and cleanse diet.  This is where you cut out all the most inflammatory and unhealthy foods (alcohol, dairy, wheat, soy, etc..) from your diet and let your gut heal for a period of time;  3 weeks in our case.  Then you slowly add those items back in one at a time and see how you feel.  This allows you to determine which foods might be causing issues, in a very scientific way.  This kind of elimination diet is something that I have been interested in doing, and wanting to do, for a long time.   And that time is finally here.  I would hate to finish this pandemic worse than I started, my goal is going to be to finish strong and go back to work healthier than I was before all this craziness.  I expect that there will be some processed carb cravings, some sweet tooth longing, and maybe the thought that a cocktail sounds really good every day at 5 PM, and those are things that I am hoping this elimination diet will help fix for me. I will do my best to check in during the course of this diet and describe what it is like and then check in at the end, hopefully feeling better than I have in a while.  Stay safe and healthy everyone!

Another topic that has been interesting to me lately, and one that I wanted to dive a little more deeply into, is fiber in the diet.  I first started getting interested in fiber, and its role in health, a couple years ago in a very interesting way.  For my job, I do a decent amount of anesthesia for GI procedures, like upper and lower endoscopy, and I began to notice something.  It seemed to me like no matter what the GI issue was, one part of the solution was to increase the amount of fiber in the diet.  If you are constipated, have diarrhea, diverticulosis, irritable bowel syndrome, or abdominal pain adding fiber to the diet can help all of these problems.  Once I started reading more about fiber I realized that there was a whole other world of health benefits that come from fiber as well.

There are two different types of fiber, and they play different roles in the GI tract;  soluble and insoluble fiber.  Soluble fiber is found in oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. It is also found in psyllium, which is common in many fiber supplements.  Soluble fiber is converted to short chain fatty acids which feed your healthy gut bacteria and also forms a gel-like mass in the gut slowing down digestion.  This leaves you feeling full longer and explains why fiber can help with weight loss.  Soluble fiber also slows glucose uptake, which translates to lower insulin levels.   Insoluble fiber is found in foods such as wheat bran, dark-green leafy vegetables, and whole grains. It adds bulk to the stool and appears to help food pass more quickly through the stomach and intestines.  By speeding the transit of waste materials, it can help you maintain regular bowel movements.  It can absorb excess water if you are having loose stools and help with that, or can draw water into the bowel if the problem is constipation and hard stools.  It has many other benefits as well outside of transit through the intestines.   It also binds to toxins in the gut, which helps them be eliminated.  On top of all that, insoluble fiber stabilizes the pH of the gut, making it harder for potentially harmful microbes to set up shop.

Approximately 70% of your entire immune system lives in your gut, and it has a symbiotic relationship with the normal flora of bacteria that live there.  Therefore, it is no surprise that how and what you eat can greatly affect your health and wellness.  This is especially true for inflammation, both auto-immune disease and just generalized inflammation.  As you might guess, fiber can play a very important role in this process for better or for worse.  When the bacteria that normally live in your gut are fueled by plenty of soluble fiber, they produce compounds that help modulate your immune system and even improve brain health.  Those compounds help increase the number of regulatory T cells in your body, which are specialized immune cells which help prevent autoimmune responses.  Researchers have found that a high fiber diet is associated with a lower risk of premature death from all causes; this is likely secondary to its help in reducing chronic illnesses like type-2 Diabetes, heart disease, cancer, and stroke.  A high fiber diet has also been shown to cause reductions in cholesterol and blood pressure, help widespread inflammation, and improve insulin sensitivity.

With all these proven health benefits, I am sure the next question is: how much fiber should I take in on a daily basis?  The American Heart Association recommends 25 grams a day, but I think that is a minimum, and there really is no maximum as long as your body can handle it.  When you are increasing your fiber intake, it is best to do it gradually, if you increase too fast then you risk having some GI upset or other issues.  I typically eat 50-60 grams of fiber per day, although that is no easy task.  Or at least I have to make an effort to get that much fiber in every day.  But it became a lot easier once I designed a fiber shake that is full of soluble and insoluble fiber.  I drink one of these shakes 5-7 days a week, and when I miss a few days in a row I really notice a difference now in how I feel.  Here is my recipe for a fiber shake:

Jimmy Fiber Shake

1 TBS Organic Psyllium Husk Powder

1 TBS Benefiber Plus supplement

2 TBS PB2 peanut butter protein powder

2 TBS Organic baking cocoa

2 TBS Golden flax seed

2 TBS Organic Chia Seeds

Place about 1 cup water into blender, add all ingredients, and then blend and drink before it firms up.  Alternatively, you can let it sit in the fridge for a while and it will turn into pudding which you can then eat with a spoon.

This shake contains about 35 grams of fiber, which is a good mix of soluble and insoluble fibers.  It is very filling, so I tend to drink mine about a half hour before dinner, which helps me eat less at dinner and feel more full.  The shake does have a decent amount of carbs, but they are mostly unabsorbed carbs, and as such do not contribute to the net carbs for the day.  Hope you found this to be interesting or helpful, and until next time, may the fiber be with you.

 

 

Getting a good night’s sleep seems like it should be the easiest thing in the world, but to many, it isn’t easy at all.  Getting adequate and quality sleep is something that I have struggled with for a long time.  Taking forever to fall asleep, waking up in the middle of the night and not being able to go back to sleep, waking up feeling tired, not rested at all; these are all problems I used to have but I have made some big strides in sleeping, and it has made a huge difference in my life.  It takes a little work, but the benefits you can achieve are so worthwhile.

In his amazing book on sleep, Why We Sleep: Unlocking the Power of Sleep and Dreams, Matthew Walker breaks down how important sleep is and how to do it better.  Much of what I am writing is based on his book;  this is the Cliff notes version, plus my personal experiences.

The health benefits of sleeping consistently well and long enough, are greater than I ever realized, and should not be taken lightly.  From avoiding everyday ailments like colds and flus, to decreasing the risk of cardiovascular disease , diabetes, and Alzheimer’s disease, to playing a role in mood disorders like anxiety and depression, sleep really affects every aspect of health and wellness.  It has been shown that simply taking a sleep aid a few times a year increases your risk of getting cancer;  that’s how important sleep is to your immune system.  There are dozens of other examples as well of where adequate sleep is necessary for the proper functioning of the human body.  Equally as important, we have all gotten less sleep then we need at one time or another and realize how that affects our job, relationships, mood, and every aspect of our life that next day.

Sleep Hygiene

Human beings are the only animals on the planet who prioritize being awake over sleep, and it is very much to the detriment of our health and wellness. That is one of the most important changes to make for better sleep hygiene, to prioritize sleep. For a long time I kind of scoffed at the idea of sleep hygiene; I didn’t believe that it really made that much of a difference and BOY WAS I WRONG!!  Sleep has to be made a top priority, and you need to give yourself a consistent “sleep opportunity” every night.  That doesn’t mean you’re asleep for that whole time, but that you’re laying in bed doing your best to be asleep.  For me it is from 10 PM to 6 AM, and I have an alarm on my watch that goes off at 9:45 so I know I have 15 minutes to bedtime.  Here are the things I have found to be the cornerstone of good sleep hygiene which translates to good sleep.

1.  Make sleep a top priority and decide on a time to go to bed every night (weekday, weekend, no matter what) and to wake up.  Find one that works for you, if you are better late at night and can sleep in a little later then do that.  If you get up and work out in the morning, then go to bed a little earlier.  For me with my job and unpredictable schedule 10-6 seems to be best, but I am constantly re-evaluating.
2. Develop a routine that you follow every night before you go to bed.  This is the signal       to your body that it is time to start winding down.  For me, I brush my teeth, wash my face and do all those things, then I get into bed and read until 10.  It doesn’t have to be that routine exactly, but it is important to do the same thing every night.
3. Use your bed only for sleep and intimacy, not for hanging out or watching TV, or doing anything else.  Again, this makes getting into bed a signal to your body to go to sleep.
4. Have a caffeine curfew after which you don’t drink anymore caffeine.  It’s important to keep in mind that tea and foods like chocolate also contain caffeine, and limiting these foods later in the day is important.  Caffeine has a long half life and a late afternoon pick me up can keep you awake at night.  Mine is 3 PM although I try and not have any after 2 if possible.    If you’re feeling an afternoon slump, drink at least 8-16oz of water.  Hydrating your body may actually be what you need instead of another pick me up.
5. Avoid technology late at night:  the blue light emitted by phones, TVs, tablets, etc… keep your pineal gland from releasing melatonin.  This is a hormone that is essential in regulating the sleep-wake cycle.  Pay special attention to looking at your phone in bed, you are pointing that blue light right in your face and telling your brain it’s time to be awake.  There are glasses that you can get that block the blue light, and that’s what I use if I really need to look at technology late at night.  Another great option if you are having trouble staying off your phone, or the things on your phone that you are viewing tends to rev up your brain, instead of prepping you for sleep, is to put your phone in a different room at night.  Even on the counter next to your sink in your bathroom is better than right next to your bed.
6. Make sure your bedroom is optimized for sleep.  One very important factor is to have the correct temperature in your bedroom.  Before you can go to sleep, the body must lower its core temp, and having a cool bedroom helps that process.  Doing things that raise your core temp, like taking a hot shower or exercising late in the day, you actually make it harder for yourself to fall asleep.  I have 2 fans (3 in the summer) and a cooling mattress pad that have helped optimize my bedroom temperature.  Also, having a dark and quiet bedroom will help you fall asleep faster and sleep better.  If that means earplugs and a sleeping mask or blackout shades, the darker and quieter your room, the better chance you have of sleeping well.   And back to the bedtime routine, find what works for you as far as comfort and enabling your body to fall asleep and follow that same pattern every night.
7. Melatonin is an OTC (Over the counter) supplement you can take in the short term to help re-train your body and get on a better sleep schedule.  You will need to experiment with the proper dose for you.  Starting with anywhere from 1-4mg taken about an hour prior to when you want to be asleep is ideal.  Make sure that you have at least eight hours to sleep after you take the melatonin.  If you only have five hours before you have to get up, you may feel really groggy in the morning.  Recommend starting with 1 mg.
8. It is also important to realize that taking sleep-aids, although tempting, is not a healthy way to sleep.  That is anything from ambien to benadryl to alcohol.  These drugs disrupt the normal sleep architecture and so although you may be asleep, it’s not restful, restorative sleep.
9. There are a lot of sleep trackers out there that can give you good information about how you are sleeping.  I am a big believer that information is a good thing, and it makes it easier to make changes the more information you have.  The Apple and Garmin watches have sleep trackers, which seem to be OK.  There are several iphone apps that track sleep, but I do not have a lot of experience with them.  There is a ring you can wear that tracks sleep and seems to be the best sleep tracker commercially available.
10. Finally, it is important to realize that all of this is a process, not an instant fix,  and that these changes are not going to fix things overnight.  However, by doing these things consistently over time, your sleep will get better and better, until all of a sudden you realize you are sleeping better than you have in a long time.  If you miss a night, or a few nights, you have to  just keep on plugging away, to stay the course.  The habits you have now did not happen overnight, and will not be fixed overnight.

I used to be a terrible sleeper, in part because of my job, and in part just because I was doing everything wrong in terms of sleep hygiene.  I was taking ambien a few times a week to help me sleep, looking at my phone in bed, drinking caffeine late into the day, and staying up later than I should have.  As a result I had very low energy, was sick quite a bit, and just did not feel good in general.  But I made a conscious effort to make these changes, and it has made my sleeping 180 degrees better.  I have not taken Ambien in almost a year, and I sleep better than I ever have.  There are still times I don’t sleep as well as I would like, but in general my sleep (and therefore the rest of my life) are so much better.

Further Reading/Information

1.  https://peterattiamd.com/matthewwalker1/    Part 1 of interview with sleep expert (amazingly insightful)
2. https://peterattiamd.com/matthewwalker2/    Part 2
3. https://peterattiamd.com/matthewwalker3/     Part 3
4. Sleep Smarter by Shawn Stevenson

 

It has been a really long time since I have posted anything, but I figured that now was as good a time as any.  Recently I have been looking back on my health journey, and how much things have changed since I started this blog.  When I first started, the goal was to become a better, faster bicyclist.  I thought that by fasting, and getting fat adapted, that I could achieve that.  In the last year, my focus has changed quite a bit however.  My focus went from being a faster, better bike rider to being a happier, healthier human being (who still loves to get out on the bike and tear it up!).  I put more focus on sleep because that is something that I have struggled with my entire adult life.  Part of it is because of my job, and working long hours and overnights, but a bigger part is what I do at night, and how I get ready for bed.  In the last year I stopped taking Ambien (I was taking it a couple times a week before to help sleep) and sleep better than I have ever in my entire life.  Another area of health I began to focus more on is nutrition.  Granted, some of this was not my choosing (my wife is in Nutrition School and that changed our eating habits quite a bit), but as I began to eat better I noticed a big change: I began to feel better too.  I am trying to view health and “fitness” in a holistic way instead of it meaning that I am able to ride my bike up a hill faster than I could before.  I will definitely do much more exploring on what that looks and feels like.  What this means to you, my faithful readers, is that I am going to try my best to put out blogs on these topics on as regular a basis as I can.  It will be topics that interest me, and that I can research, and hopefully will interest you and give you some food for thought.  I will definitely take requests as well, and am looking forward to the evolution of this site to mirror the transformation in my thinking and my life.  As always, thank you so much for reading!

As I look back on January, I did pretty well for my challenge to do something active every day.  There were a few days that I failed to do something, however.  The days that I wasn’t able to do something active was mostly work related;  meaning that I had planned on doing something after work and either got home too late, or was too tired from work to do anything.  Going forward, I am going to keep up my goal to do something active every day in February, but I am going to make a bigger effort to do my activity in the morning before work.  That is the only time of day that I have control over my schedule, the only protected time I have.

For my February challenge I thought I would change it up and do something for my mind instead of something for my physical being.  So this month, I will try to practice more mindfulness in my life.  The way that I am going to go about that is to either meditate or to do a yoga workout each and every day.  Being more mindful can be useful in every part of your life, both work and home life, and so I feel like this is a good focus for February.  I downloaded the excellent meditation app called Headspace, and I will use that for guided meditation.  They have so many categories to chose from, but I think I am going to focus on mindful eating and sleep.  These are 2 areas I think I could improve on, and so hopefully this month I will make some progress in these areas.

Also, as an aside, I found another benefit to the intermittent fasting when I went to the dentist today.  I have had a few cleanings since I started IF, and they have all been the easiest, most painless, and quickest cleanings I have ever had.  So do your teeth a favor and do some fasting!  Have a great February, go out there and accomplish all your goals!

Happy New Year 2019! Hope everyone had a great holiday season, and I hope that you are all ready to get back to it now!

It’s that time of year when I swear off all my bad habits, and promise to turn over a new leaf.  And this time I mean it, this time it’s going to stick!  Right, right, I’ve been there and done that for more than a few years now.

As I was trying to decide what to do this year I had a new idea.  Well, kind of a new idea, but this time it involves everyone reading this too.  A couple years ago, a good friend and myself decided that we would make one change every month, and stick with that change for at least the whole month.  If it was a good, sustainable change then I would keep it up, if not then I would only do it for a month.  Either way, at the end of 2019, I will have made some significant changes, and done so without having to change everything at once.  That is always my goal, to get better every year.  I’m hoping that some of you will join in and let me know how things are going with your change.  Also, I am sure I will be looking for some ideas of changes to make, especially as the year goes on.  I am more likely to stick to things if I am accountable to someone, so for this nest year I am going to be accountable to you all.

For January, I am going to start with something very basic and I plan to keep it up all year.  My January change is to do something active every day.  It doesn’t have to be an epic ride, it can be walking my dog, doing a little yoga practice, lifting some weights, etc.. The goal is just TO DO something active every day.  Sounds pretty easy and straightforward, right? I will post an update sometime during this month, and I hope to hear from some of you.  And as always, thanks for reading!

There are so many ways to look at yourself and determine how healthy you are.  Most of them are subjective (and maybe most important) like how you feel, how you sleep, how you exercise, how your clothes fit, etc… One of the best objective ways to look at your health is to check blood-work or labs and compare the values through time.

Since I started fasting and eating a more keto diet,  all of my subjective markers of health have improved:  I feel better than I have in as long as I can remember, and I exercise more and am more active than I have been in a long time.  However,  being a physician,  I wanted to know that I wasn’t hurting my body so I looked at my before and after lab values.  Luckily, I had a set of labs drawn before I started on this journey (it was actually the A1c value that led me to change my lifestyle and diet); and I just recently had a second set of labs drawn.  So here are the highlights from the 2 sets:

Lab	5/2/16	8/23/18
Total Cholesterol	200	189
LDL	117	112
HDL	62	64
Triglycerides	104	65
Hemoglobin A1c	5.9	5.5
Avg Blood Glucose	121	111
Protein Total	8	7.8
Albumin	4.8	4.9
Hemoglobin	17.5	17.1
Hematocrit	50.7	51.3

My cholesterol panel is very much improved.  The most surprising result was that my triglyceride level went down so much despite eating more steak, eggs, bacon and cheese than ever in my life (yummy!).  After looking at the literature, this is actually a common finding on low carb diets.  In the absence of excess carbohydrates, the body starts burning more fat and ketones for fuel, and the liver will be focused on forming sugar and ketones for energy rather than triglycerides for storage. As a result, triglyceride levels drop and blood sugar levels to normalize.  This fits with my decrease in hemoglobin A1c and average blood sugar as well.  My first A1c was pre-diabetic and the most recent was back in the normal range.  I included the protein, albumin, hemoglobin and hematocrit because those are markers of nutrition as well as other things.  Clearly I am not malnourished, based on my lab values, which are basically the same before and after changing my lifestyle and diet.

The second set of labs was drawn at the end of the summer, when I was less than strict on the keto diet due to big endurance events (the triple bypass bike ride and Denver century bike ride) and vacations and various celebrations over the summer.  I did continue my intermittent fasting practice through the summer, however.

All of this is reassuring to me that I am not hurting myself eating keto and fasting, and in fact am healthier (by labs) than I was before.  The decrease in A1c alone is enough of a health gain to keep me fasting and eating keto, and the improved cholesterol panel is (excuse the pun) “the icing on the cake”.

Hey everyone, it has been a long time since I have written a blog post, but now that summer is over, its time to get back to work.  There has been a lot of things going on, I have a lot of things to talk about, so here’s a few of the upcoming topics:

1.  I finally had labs drawn since I have started intermittent fasting and eating a keto diet lots to talk about there
2. Fiber and net carbs and how they affect fasting
3. exogenous ketones and their use
4. a new super-fuel I discovered that s changed how I ride

So stay tuned and thanks for reading.

To refresh your memory from my last post, ketosis is the metabolic state in which some to all of the energy a body needs is derived from ketone bodies in the blood, as opposed to glycolysis where blood glucose is used to provide energy.  People often confuse diabetic ketoacidosis (DKA), which is a dangerous medical condition, with ketosis, which is a desirable state where your body is using your fat stores as fuel.  Ketoacidosis is a condition that can occur in Type I Diabetes and requires a triad of findings:  1.  high blood ketones (10-20 mmol/L or higher), 2. high blood glucose or sugars (often in the 300-500s) and 3. high blood acidity, or low blood pH.  Ketoacidosis requires hospitalization and medical treatment by a doctor, and can even be life threatening.  When you eat a low carb, moderate protein, high fat diet (a ketogenic diet), then your insulin and glycogen levels drop enough that your liver starts making ketone bodies from the breakdown of fat.  This is ketosis, and is characterized by blood ketone bodies (typically 0.5-3 mmol/L), low blood glucose, and a normal blood acidity.  So really the only thing in common between ketosis and ketoacidosis is blood ketones, and the levels of ketones in DKA is much higher than in ketosis.

How can you get into ketosis?  The best way to get into ketosis is to eat a ketogenic diet, as described in my earlier post.  When you are first starting to eat like this, the most painful and most important thing, is to keep your carbs as low as possible.  I ate between 20-40 grams of net carbohydrates a day when I was starting.  This allows your insulin levels to fall and your glycogen stores to get depleted.  The first couple weeks are critical, can be difficult, and the best way to go about it is to jump right in.  During this time I kept track of every single thing I ate so I knew exactly how many grams of carbohydrate I was consuming, and I also avoided all alcohol.  One common pitfall during this time is to eat too much protein, while you are cutting back on carbs.  If you consume too much protein then your insulin levels will rise,  and it can keep you out of ketosis.  It is best to focus on high quality saturated fats as the majority of your diet which will make you feel full, and help get you into ketosis.   Fasting is another thing you can do to help get into ketosis.  During fasting insulin levels and blood sugars drop very low and it forces your body to start burning fat for fuel.  This pressures your body to start manufacturing the different machinery (enzymes, transport proteins, etc…) that allow it to utilize your fat stores.  So, once you train your body to get into ketosis, if you fast you do not need to be as strict on the carbohydrate restriction to stay in ketosis since you have longer periods of low insulin.  A final thing that helps you get into ketosis is fasted exercise.  This is low intensity cardio that can help your body switch over to ketosis by also pressuring it to use fat for fuel.

Another common question i get is “How do I know if I am in ketosis?”.  There are several ways to have a good idea, but really only one way to know for sure.  The way to know for sure is to get a ketone meter of some type that will test you for ketones.  The most common and least expensive is the urine strips.  These test for acetoacetate (one of three ketone bodies) in the urine.  There are a couple of problems with these strips however.  One is that the ketone body they measure is not the one the body is using the most for energy, that one is Beta-hydrxybutyrate or βHB.  The strips are not as sensitive either, and so you must have a large amount of ketones in your urine before they show up positive.  This is probably because they are meant for diabetics who are worried about DKA.  The second ketone measurement tool is the blood ketone meter.  This measures βHB and is very sensitive.  It does require that you buy a meter and strips, which can be kind of expensive ($30 for the meter and about $0.50 per strip is what I pay), but gives you fast and accurate results.  This is the method I used when I was starting my ketogenic journey.  The third way to measure ketones is a breath test, which is a new technology.  The breath test measures acetate which we exhale when in ketosis.  This requires a big financial investment in the beginning, but then there is nothing else to buy like strips.  It is very sensitive, but acetone is also not the most important ketone body for energy utilization. It is important to check ketone levels more frequently when you’re first starting to get into ketosis, and after a while you can tell by how you feel that you are in ketosis.  you shouldn’t be surprised if it takes a couple of weeks to get into ketosis, after all you have spent most of your life in the glycolytic pathway.  The changes that need to happen do not occur overnight, but over time.  Stick with it, it is so very worth it!

The thing that surprised me the most about ketosis is what a fragile state it is.  A big carbo bingeing night was enough to keep me out of ketosis for days.  When I first started, I was also surprised that the more time you spend in ketosis, the easier it is for your body to get back into ketosis when you fall out of it.  The big carbo filled nights that would keep me out of ketosis for days at the beginning would now only keep me out of ketosis for a day.

Here is the recipe for the best Brussel Sprouts you’ll ever eat!!

Yummy Keto Brussel Sprouts