Weight Reduction
This post is about my personal challenges with weight, and managing it in light of a metabolic disorder. None of it is meant to be self indulgent or congratulatory, and I promise there are some geeky bits near the end for those patient enough to wade through the content or who want to skip to the end. Sorry for being boring, but not for being me. On with the story:
Back in the day I could have been considered a "bean pole." I was highly athletic, and though moderately muscular any of the definition was overshadowed by being wiry (though I eventually outgrew the designation "gangly," thank heavens). This is back when I could afford to be so physically active, and before the effects of the McArdle's disease steadily clamped down on the stamina. More importantly, it's when I was also getting sufficient rest to compensate for the effects of the activity I pursued regardless.
I got married, and gained the requisite 10-15 lbs. that generally comes with it, simply due to a change in lifestyle - eating more frequently, and in the company of others on a schedule of well prepared food rather than "when it suits me" and consisting of "whatever's around." Even with that gain though I was smack in the middle of the Healthy band of the BMI (though individual results vary depending on body type, I'm fortunate to be a good match for the algorithmic archetype). That weight stayed steady for another year.
Then: The Desk Job. In the interest of advancing my career and furthering the capabilities and savings of our family, I changed from the more free-form telecommuting gig to one that met those requirements but also required standard office attendance. I have no issue with the work, or with good work ethic, but I had been liberally making use of the telecommute arrangement to rest as necessary in order to recover from the day's strain. With the desk job, that luxury was forfeit. Ignorant of the specific nature of my disorder at the time, I didn't realize how disastrous this would be.
Seated at the console, plugging away on the code (Object Pascal cum Delphi RAD environment for MS IIS ISAPI filters on the MetaStorm e•Work product) I found myself wearied as usual, but unable to deal with it. I compensated by being exceptionally stubborn, and when that fell short, supplemented with anything available to increase my blood sugar (I was also drinking a lot of water, which I attributed to the poor transition from Washington's temperate and moist environment to the Utah dessert two years before - but probably only half of what I now know would be required. Whatever the case, whenever Rachelle called I seemed to be in the bathroom). This latter strategy came with predictable side effects, and in the course of five months I put on some 40 pounds.
The rapidity of weight gain was certainly off-putting and distressing, especially as the combined weight of the entire supplemental caloric intake during this time didn't seem to be adequate to account for the change. I did my best to stabilize and cut back on the snacks, suffering through the stupor instead, and plunging into another round of medical inquiry to find out why I was so tired so I could hopefully do something other than eat to manage energy levels - these of course were ineffectual. Later, changes in jobs, the production of very very cute children, and general demands of the conditions of life slowly edged the weight upward until finally peaking at about 250 lbs. (113kg), at the same time that the last vestiges of regular physical activity (Kishindo martial arts) feel by the wayside.
I was frustrated, to say the least, but also largely to blame - by putting myself and my needs very last, I was doing myself this dramatic (and visible) harm until it interfered with my ability to continue to serve my family. I was so bogged down, waking up exhausted (and frequently nauseous), barely pushing through the day, and repeating. Minor gains in understanding, not necessarily of my condition but my reaction to it, gave me some latitude for correction and over the course of about 2-3 years managed to move from 250 back down to about 220.
The most recent improvements have come from a very complete comprehension of the condition and my situation. The management strategy I'm pursuing now allows me to walk that thin line between capacity and injury, and to retain cognizance throughout even the long days (with few exceptions). Combined with that, I've been able to leverage the inability to utilize stored glucose energy to maximize natural ketosis (the same condition the Atkins and other low-carb diets attempt to induce artificially) and consume stored lipids instead - this time without the crippling side effects causing near-comatose stupor. This means that from the first day of the diet I've been able to realize dramatic results, as detailed below:
Down, down she goes!
The weight log starts in late January, testing out the Wii Fit I'd gotten the family for Christmas (but was unable to play with myself, having been separated from them). Return visits to the family explain the infrequent initial measurements, followed by my more permanent return in lat March. Throughout April and May I was completing my research into the effects and side effects of McArdle's before finally establishing the current regimen. This failed to produce any effects on the weight though, so I sought out the advice of my buddy Joel - the most successful dieter I've ever seen. Over the course of a year his appearance completely changed, to the point that when we were re-united for a get-together I recognized his wife, and wondered who the heck was with her. Thus was born the references to the "Sexy Sexy Joel Diet" (as the diet belonging to and responsible for Sexy Sexy Joel, as opposed to the old Joel).
His secret? Has nothing to do with all of those "By following these X simple rules!!1!" ads that are all over the internet, nor with fad products, "cleansing," etc. He wasn't even exercising - just following the old Weight Watchers™ formula for calculating caloric intake in terms of points (calories / 50 + ( grams of fat / 12 ) - ( min{ grams of fiber, 4 } / 5 ) ) and his allowance for consuming them. Using a calculator and log on his iPhone he followed the simple principles over time to great effect.
I adopted the same pattern, and am pleased to report that, per the graph above, have dropped 32 lbs. in the course of just over 3 months. At this rate I have another month and a half or so to meet my long term goals, after which I can settle into a maintenance pattern. Looking at the trend line it's very slowly leveling out. It also has that cyclical up-tick I'm at a loss to explain - though I also admit that I haven't gone into an in-depth analysis for them yet, as they are inconsequential to the average / long view.
For the geekiest bits: the point system, whatever its failings, works. In order to make sure all measurements are taken consistently, they've all been done within the same hour of the day, in the same general outfit (light sweats, t-shirt), immediately following my carefully metered exercise (metered to avoid undue metabolic or toxic distress) in the morning before any kind of intake. This does mean that I've artificially skewed the measurement to the lowest point in a day's fluctuation, but given that I'm moving 10-15 lbs. of water though my system throughout the course of a day it makes sense to take a low baseline, since the peak water retention will fluctuate unpredictably (or according to parameters and timings I'd rather than make explicable by mapping when there's an easier solution). Doing it the same way every day is what makes the biggest difference in collecting the samples, which allow me to apply a general trend analysis instead of a specific margin of error per day. All measurements have been taken on the Wii Fit in order to keep the analysis consistent and to provide a log of the output as well, which I have carefully transcribed and reproduced above using Perl's GD::Graph module.
I have several other observations as a result of the experience, mostly regarding psychology and sociological trends, which I'll save for another time. For now I'm excited for the day when I can stabilize enough to buy new pants (which I'd rather only do once, an account of being a cheapskate). Also, while it's true that I may have an unfair advantage due to the super-charged ketosis, Joel's experience demonstrates the viability of the approach without such an inside track (a track, I might add, that is not worth the side effects if it can be avoided).
Bon (pétit) apétit!
The Long Journey
I've written a lot about my health over the past few years, and my efforts to try and do something about it. Each little clue gave me new hope, into which I threw my full energy. I took every inch and reveled in it, moving as far as I could before inevitably declining once again (increased effort met with increased resistance). These were genuine steps forward though, rather than false starts: I lost weight, gained focus, and started sleeping better, so each time I was really complaining from a new place.
The biggest gains came from discovering sleep apnea, candidiasis, and suspicions of mitochondrial myopathy. None of these are naturally indicative of McArdle's Disease (the eventual diagnosis) though, nor are they typically concomitant. They didn't fall into their place in the puzzle until the picture was already becoming clear, when it all suddenly came together.
I should start by explaining a little about the condition. Glucose is the primary source of energy for nearly everything in the human body, the whole process referred to as "glycolysis." Most cells, especially muscle cells, have an internal reserve of it in a compact polymer-like form called glycogen. When demand for energy increases, molecules are trimmed off the end of the chain and made available to the mitochondria to do their business of converting it into active energy (adenosine triphosphate, for those taking notes).
This store of energy is pretty high - enough for 12-20 hours worth of activity before needing to be replenished. That replenishment happens on a regular, ongoing basis, to keep stores topped off whenever spare glucose is available, and any surplus is either excreted or converted into starches and stashed elsewhere. Normally this is enough to keep the body readily burning glucose between meals without running low - an exception would be fasting (more than a day), starvation, or extremely high demand: marathon runners, for example, can completely deplete glycogen stores after about 20 miles of continuous running, a phenomenon they refer to as "hitting the wall." At that point continued activity requires use of the stored fats as an alternative fuel, and risks damage to those tissues unable to do so.
McArdle's refers to a defect in or absence of myophosphorylase, which is a fancy name for "the enzyme that breaks glucose off the glycogen chain." This deficiency means that the primary source of stored energy is either completely off limits or so impaired as to be unable to meet the body's demand. This results in dramatic exercise intolerance, and in some cases cramping or seizing of muscle fibers (which require energy both to contract and relax) in a disparate and uncoordinated state so severe that they can actually rupture (rhabdomyolysis - this will be on the test), spilling their proteins into the blood and straining renal functions. Alternatively, the secondary fuel source based on fatty acids can be engaged (lipolysis).
An interesting side note here is that this is the primary intent of low-carb diets: by lowering the intake of glucose (and things easily synthesized into it by the metabolism), glycogen stores are exhausted and the body has no choice but to turn to lipids in order to remain functional. It's a hack, but a potentially effective one - your mileage may vary though, and not every system can handle the kind of stress this creates.
To point, too heavy a reliance on lipolysis floods the body with its waste products and increases the acidity of the blood (ketoacidosis). Healthy folks don't normally get to this point - diabetics can be affected in pretty nasty ways though. Those with McArdle's suffer a similar fate since the reliance on it is more absolute, and constant: this happens on regular diets without regard for carbohydrate intake. I had hit on a form of metabolic acidosis in my investigation earlier but had come to it from the wrong side, thinking that it was an inhibition of the mitochondria in making use of available oxygen, when in fact the mitochondria work wonderfully and are simply making-do with limited materials on hand. The effect is the same though: fatigue, memory disruption, stupor, and eventual unconsciousness.
Life on the Outside
I'm still having the occasional "less than stellar" day, but that has mostly to do with being out of shape and trying to do more than I once could. The results have been positive regardless, especially the lack of cumulative fatigue from exercise; every day the routine is getting a little easier.
Apparently during the years of reduced activity I relied heavily on my lead foot (right) for support, to the point of neglect on the left. As a result, the muscles in the lower left quadrant of the back are less developed than their right-hand counterparts, and while I'm not limping have still altered the pattern of my gait so as to not aggravate the disparity. This has led to some mild atrophy and loss of flexibility, which I'm attempting to address by altering my walk and intentionally shifting more responsibility off to the left. It takes some concentration, is a little weird, but after a full weekend of activity is already showing improvement.
Opportunities to work on the book remain fairly scarce and typically short, but I'm making progress nonetheless. The last main scene of Chapter 2 reached its conclusion last night, and after a couple rounds of editing will be committed to the manuscript. With a small lead-out scene and a short reflective conclusion I'll be into Chapter 3 where the tension just introduced launches the story forward.
One of the ill effects of being able to think clearly more often, however, is that I've become more aware of the significant amount of editing the book will require in order to have consistent voicing and good flow. I'm reworking some of what I've already penned in the interest of ongoing refinement, trying to fix those problems and concretely establish my own style. I won't go overboard though - I'm not trying to make it perfect out of the box, just correct the most glaring defects.
Obviously I've been continuing in my neglect to the blog (for the sake of the book). I do have some thoughts on upcoming posts though, if anyone would like to vote one way or the other:
- Hypnosis and Trauma
- Spending to Save: Investment and Return in IT Labor Economics
Now Leaving Week II
I've been trying something new for nearly two weeks now, specific to the management of my long-term cellular metabolic disorder. 2 weeks ago yesterday I was on the phone with my old buddy Dan in Washington, updating him on recent events and findings (Dan is doing well by the way, having given his notice at Clipper so he can apprentice full time under Rod Chappel). Some of the particular secondary symptoms sounded familiar to him, so he took a look through a homeopathic reference he had on hand and came up with: candida (apparently pronounced similar to "Canada").
In homeopathic circles, this normally helpful strain of yeast (present in the healthy colon, and responsible for keeping incoming pathogens at bay) is commonly blamed for a whole host of primarily gastrointestinal symptoms. On the web (scoured via Google, as always) it's fingered by nut jobs for just about everything the human body can suffer, usually accompanied by rants against "the establishment" and even calling for a boycott on the immunization of children. There is, however, some valid medical information to be found amidst the stream, referenced here from our good friend Wikipeda:
"Colonization of the gastrointestinal tract by C. albicans may result from taking antiacids[sic] or antihyperacidity drugs. This colonization may interfere with absorption of Coenzyme Q10.[3]"
That last bit really caught my eye. From having read up on the various causes and manifestations of sub-sets of mitochondrial myopathies I recognized the enzyme as one (out of five) critical for the aerobic respiration facilitated by mitochondria, the deficiency of which can cause the onset of the malady. The gastrointestinal upset associated also coincided well with the acid reflux (and other conditions) I've experienced and thought to be ancillary. Taken as evidence together with the indicators for the mitochondrial issue, I thought this just might be a smoking gun worthy of further investigation and started looking up treatment options.
Most of the ones published and referenced sufficiently to appear well in rankings are associated with said whackos, advocating intensive homeopathy and massive lifestyle changes for the sake of "personal balance." Now, I'm used to alernative medicines - I grew up near Seattle and there are quite a lot of them in the local culture (and the culture which gravitates there wanting to appear local). As a practitioner of martial arts I am aware of the flow of ki (or chi, depending on the country of origin for your discipline) and have been participant in and witness to events and activities which I have not been able to rationally attribute to anything else. However, I fall well short of believing that these things can be used to master the universe around oneself in dominant fashion - in fact, it is only through the utmost stillness and focus of mind and body that an awareness of the subtleties of flowing energy can be detected. Extrapolating from that into its potential influences on the physical world, there just isn't enough force to make a truly tangible or impactful difference. Thermodynamics and Newtonian laws simply tend to outweigh the whims of thought.
This calls for the introduction of an additional agent in order to affect change. Most candida specific treatments have glowing, amazing, miraculous testimonials attached to them, right before you reach the, "and now you can feel the same way with this astounding (and large, complex) regimen of supplements starting at only $64.99 a month!" The dominant products come from Japan, where the condition has been recognized and studied in greater detail and with more scientific acceptance, supposedly. I may be willing to give things a try, but I wasn't expecting to have to shell out for slick packaging around something which sounded suspiciously like snake oil; they sounded nice and official, explained well the effects they were addressing, but not from a position of pathology (didn't say how the symptoms and causes were connected), nor did they disclose the mechanisms by which they purportedly acted to adjust conditions: only that they restored a natural balance of intestinal flora. What really turned me off was the add-ons marketed along with it - chemistry which supposedly increased the ability of cells to take in oxygen. I know from experience that my own blood-oxygen saturation doesn't fall below 96%, and if that's not high enough to penetrate the membranes of the tissues which rely on oxygen for so much of their natural function, then no little pill was going to be able to make a difference (there is a condition under which the membranes become too thick, related to scleroderma, inhibiting the transport of oxygen across the barrier - and this wouldn't help that either).
In order to make a real difference, I prefer to appeal to empirically repeatable practices with as much well-founded theory behind them as possible. Boiled down to the very basic essence of the thing and then building up step-by-step thereafter until implementing the whole - or as much of that whole is truly required for the end result. I needed a small starting point and measurements of change over time.
As it turns out, candida albicans has a natural control agent already present in the body: lactobacillus acidophilus. If something disturbs the acidophilus (why candida is referred to in short by its genus, and acidophilus by its species, is beyond me) the candida is able to grow unchecked and will start in on its ambitious disruption. It so happens that 14 years ago I picked up a nasty intestinal parasite (probably amoebic) from some well water at my uncle's ranch in Colorado. The experience was not one I'd like to repeat or wish on most anyone, and I'll save you the specifics of why. This infestation, though resolved, likely was the catalyst that led to the destruction of the acidophilus and thus the "cat's away" scenario.
Bringing us now to the experiment: for the last 2 weeks I have been taking acidophilus supplements in a concentration of 4bn organisms (2 tablets with breakfast and dinner, less than $6 for 100 tablets) starting with my evening meal on Monday, January 29th. The next day, contrary to my expectations, I felt different: my peripheral tissues felt warmer, and less pained. I didn't know there was such a concentration of casual pain, but its absence suddenly shed light on the situation. Since then the affect has increased, and I've had enough presence of mind in the evenings to make real progress on my book (recently passing the 10,000 word mark - slow but steady progress, and seeing as how I still have the day job and the young kids, an impressive amount of work despite its seemingly languid pace). Everyone in the family has had the stomach flu except me, not in itself extraordinary as I'm typically resistant to these kinds of bugs, but remarkable in the amount of sleep disruption it's caused. I've been up to my elbows in buckets and bed clothes and had to spend multiple nights without the CPAP, and though tired and a little distracted the following days was able to function and have still been absent that nonspecific malaise from before. I get fatigued, but under different conditions and feeling far removed from the prior dragging near-paralysis that was for so long my constant companion.
I get hungry before I feel hypoglycemic, have been able to fast for the first time in probably a year, and no longer crave sugars (candida is also an anaerobic organism, so it was robbing the GI tract and blood of the glucose that was also my only sustenance). My next step is the introduction of coenzyme Q10 tablets to replace the depleted reserves (theorizing that the glucose is now reaching my cells, but that the aerobic processes is still inhibited), and after a week on that to begin phasing in mild exercise. The changes already have been profound.
For some reason I'm not resentful that after more than a decade of decline, such a simple remedy was available. I'm not saying that I'm done, or that this is a truly permanent magic bullet - but the improvement has been unprecedented by everything else thus far. I'll enjoy it while it lasts for what it is.