Thursday, August 30, 2012

the ketogenic semi-elemental diet day 7: day one of zero carbs

Today was my first day of zero carbs, and I mean zilcho, because as you remember the only thing I am eating is coconut oil and unsweetened casein, 1650 calories, 79% fat and 21% protein.  So it's pretty easy to make sure you are not cheating when you are only swallowing coconut oil with a little protein powder in it.  Yuck.  So far I seem to be tolerating the casein well, which is always a question for those that cannot digest lactose. It turns out most of the lactose in milk is in the whey, not the casein, which is the milk protein.

I felt like crap for the first half of the day, in fact I could not bring myself to get on either bike, so I took Madison and Chloe to the Wiss and I trudged along clumsily as my limbs seemed to have forgotten the normally smooth motion of walking. It was all I could do to keep them in view as they galloped up and down the gorge chasing chipmunks, squirrels and the scent of deer with an exuberance I wished I could emulate.  We did discover a new trail which was exciting for all three of us.  When we returned to 3434 I could barely stoop down to wash and dry their furry bodies and I ushered their wagging tails into the house and slowly, painfully brought them their bowl of ice water.  Yes, ice water, that's what my hounds get after a hike in the heat.  Ice cubes are ice cream for dogs in the summer.

It was a glorious day, sunny and bright with low humidity, and all I wanted to do was work outside in the garden, but I was tired; my lower back was sore; my limbs felt like cast iron weights hanging from my frame and my legs burned like I was climbing the Monster when I ascended a flight of stairs.   Finally I took one of my 10-minute naps and afterward, suddenly, I felt somewhat normal.  No joke, I was such a total switch: I was much less tired, my mood lifted, and I actually was able to get some chores and blogging done.  I tested my blood ketones and they were up to 0.4, of course once AGAIN I had to use two strips because of the NovaMax Plus meter's faulty indicator which pissed me off but it does not take much to piss one off in this low-carb state.

I have not been sleeping well on this diet, either from the little bit of caffeine I drink in the morning or more likely from some metabolic shift that happens in ketosis.  I read on the forums that this is common for people trying low-carb.  Perhaps it is because I am eating only 1620 calories a day and still working out, so that is way below my maintenance level which I estimate to be somewhere in the neighborhood of 2500 calories a day.  Most of the time I am not hungry but on 1620 calories I do wake up in the middle of the night with a grumbling stomach.  It's not like I can sneak downstairs and open up a bag of Fritos.  My menu choices are coconut oil....and casein.  Kinda blows the whole midnight binge urge.  I never do that anyway.

This was the first day in many months that I did not have a bottle of kombucha, and it was sorely missed, but I really think that there is enough sugar remaining in my brew to keep me from becoming keto-adapted, so I suffered through it.  All in all, it was not a completely fruitless weekend because I did do a lot of cooking even though I can't eat the food yet.  Jack, our truckdriver, showed up at the office with two gigantic boxes of home-grown organic Jersey tomatoes from his garden again and I had to dehydrate them or make sauce or they would all have gone into the compost.   Anyway, I'm not sure how I got through it, but tomorrow, back to work, sans kombucha, my happy drink.  I swear the surge I get from the kombucha is the only thing that gets me through the workday sometimes, so that's going to be rough.  Not that any of this is a cakewalk.  Speaking of cake, when this all over I'm going to have to splurge a bit.  September is going to be the month of the restaurant:  Michael Schulson, Jose Garces, Stephen Starr and Michael Solomonov here I come!

Saturday, August 25, 2012

the ketogenic semi-elemental diet day six: so much for my weekend ride

Even at 6 I was pretty determined once I set my mind to something

Saturday August 11

So today I felt pretty crummy. On a typical Saturday morning I will do the TSV ride from the Art Museum which generally goes 3 to 4 hours. Today I was physically tired as has been the norm during this keto-adaptation and there was no way I would be able to hang on a group ride. So I dragged myself out anyway and rode up and down West River Drive for an hour solo. At first it seemed incomprehensible that I would be able to muster the energy to do anything but a weak recovery ride, but I had brought along my headphones and I turned up the music and pushed myself until I got in a solid endurance ride. By the end of the hour I was more than ready to climb the hill up back up into East Falls and the dogs were happy to see me returning so they could start following me around the house staring me down until I acquiesced and took them on their hike. Which was not easy either, but at least I got out there and got some exercise instead of moping around the house.
My blood ketones tested at .2 , which was better than yesterday but my ketones have been decreasing the past few days so obviously I am eating too many carbs. I seem to be caught in that no-mans-land where I am not eating enough carbs to fuel effective workouts or particularly effective cognitive functioning on the one hand, yet I'm still eating too many to encourage my body to keto-adapt and start producing more ketones so my brain stops competing with my skeletal muscles for glucose. When I look back over what I have eating, the only real culprit is my homemade kombucha, which I estimate to have anywhere from 20 to possibly as much as 40 grams of carbs per bottle.
Of course whenever you are dealing with a live cultured food it is difficult to quantify the exact number of calories or sugars in the bottle as the product is never quite "finished" until you drink it, and with kombucha the those numbers can change depending on many variables such as length of time it ferments, ambient temperature, strength of the sugar and tea at the outset, etc.  So after reading up on the bodybuilding forums from those who are experienced in ketogenic dieting, I decided that tomorrow I would go 100% carbless. No more kombucha and no honey whatsoever.  So I will be eating a liquid, semi-elemental diet consisting of 80% fat and 20% protein, yes, you heard that right, zero percent carbohydrate.

The other reason it dawned on me that I might want to quit my kombucha habit, arguably the only bright spot in my otherwise dreary days on this diet, is that the point of this semi-elemental diet to cure SIBO is to kill off all of the bacteria in my small intestine.  I figured that it might not be a good idea to be drinking a concoction populated by bacteria and yeasts that can survive at a very low PH since for the time being I'm trying to discourage anything from surviving in my small intestine.  So I had to quit the kombucha habit for the duration of the diet.
Tomorrow marks the first day of my final week, so it won't be long. This is pretty tough. The worst part for me is the mental health aspect; which is to say I'm normally a pretty happy person who takes the hard luck life sometimes throws at me in stride. Yes I'm hardworking and can be hyper-focused, and to others often seem like I need to relax more, but I really want this to be my last summer in Philadelphia and The Big Move is not going to happen if I don't make it happen.  So this summer has turned out different than most when I'm hosting dinner parties and being a bit more of a social butterfly. This summer I've been running around trying to hire contractors and get the house ready to put on the market in the fall, so yes I do spend a lot of time on the weekend doing chores. It's tough for someone who generally measures the success of a weekend by how many items I've checked off my list to be in a state where I don't have the energy to do anything at all, but I guess this forces me to slow down and do some reading and relaxing.  I made some more fish broth, coconut yogurt and bottled some kombucha, and then I settled into bed with a book and called it a day. Perhaps tomorrow will be easier.  I'm growing weary of this.  

Wednesday, August 22, 2012

the ketogenic semi-elemental diet day 5: almost halfway there

pretty much all I wanted to do all day
So I made it through the entire week of work feeling pretty much like a slug. Not quite as dramatic a slowing of all of my physiologic processes as the 9-day water fast had been but I still definitely felt a  strong need to conserve energy while I went about my daily activities.  Even sitting at a desk for the second half of the day was taxing; I was slouching in my chair and if I had to rise to grab anything I would practice economy of movement and wait until there were about five more reasons to get up before I begrudgingly lifted my butt off the chair.  So this is what it feels like to be lazy and tired all the time.  Life would not be worth living.

preparing to draw blood
the countdown
the dreaded E-4 error message
Last night, I had more weird dreams about food.  This morning I did get through a full gym workout, including swimming.  I dragged myself into the pool after my 30 min endurance warm-up on the stationary bike and hour lifting back, shoulders, triceps and core, but after a couple of laps where my arms felt as if they could not possibly push any more water suddenly I went on auto-pilot and really enjoyed the 20 minutes of laps.  It seems during this low-carb adaption phase I don't really enjoy working out but if I force myself to get on it I eventually can get through the workout as long as I try and avoid bouts of explosive power.  Obviously this is not what I would want to have to face long-term but I'm hoping this will change after a few weeks.

In other news I am having trouble with the Nova Max Plus blood glucose/ketone meter and tonight in my irritible state I called up Nova Customer Service to bitch that I was using two $4 ketone strips every time I tested because the meter was indicating that it had enough blood to perform the test but then halfway through the countdown it gives me an error message that I did not provide enough blood.  The first person I talked to was a total idiot and I asked her if she would please put me on the line with a supervisor or someone who was more familiar with the product. This person eventually called me back and I suggested to her that they needed to rewrite the manual that comes with the test kit.  Don't mess with me when I am low on glucose and ketones!  My test tonight came out at .1, which is terrible, no wonder today was so rough.  I have lost 10 pounds in 5 days though, which is a nice consolation prize, although I'm too tired to care right now.

Tomorrow is Saturday when I would normally go on a 3-4 hour road ride, and most of the time I am up front pulling pretty much the entire four hours.  I knew that was not going to be possible tomorrow, so I decided to ride by myself and see how long I could suffer through it.  In the meantime I have been continuing my research on ketogenic diets, and it seems that while it is generally accepted that you can do moderate intensity exercise on a low-carb diet, the experts certainly disagree as to whether or not there is any evidence that an endurance athlete who performs sports or events where there are sustained periods of intensity over lactate threshold (which require the anaerobic energy system) will be able to eventually adapt to the diet and not see a decrease in performance at those times.  As I mentioned in the previous post, Phinney's elite cyclists were only tested at 65% of VO2 Max.  Bob Seebohar recommends off-season fuel partitioning strategies minimizing the intake of dietary carbohydrate as well as strict adherence to training at no higher than endurance pace during the off-season to increase metabolic efficiency, which he defines as the ability to utilize fat to fuel exercise at increasing intensities, but he states that during pre-season training when intensity ramps up and during the race season itself, carbohydrate should be increased in order to fuel those increased anaerobic energy needs.  Loren Cordain in The Paleo Diet for Athletes recommends fueling with carbs before and after exercise, but keeping carbs low at other times in order to allow the body to adapt to using fat as fuel for when you are not exercising.

Anthony Colpo, an independent researcher and cyclist who has written the books The Fat Loss Bible and The Great Cholesterol Con, wrote an article on his blog eviscerating the current research supporting a ketogenic diet for endurance athletes here, and it's a good read if you appreciate a man with a strong opinion who backs it up with strong science.  While I agree with him that there is no way I can train and race without carbs if I want to have optimal performance, there is another option that bodybuilders have been practicing for years called the Cyclical Ketogenic Diet, or CKD for short.  Typically on this plan you eat low-carb or no-carb from Sunday to Friday and then Saturday you enter what is called the carbohydrate loading phase or the "Carb-Up" to replenish your glycogen stores to fuel you through your harder workouts.  This could be an option for me once I am finished with this Semi-Elemental Foodless Fortnight.   I may have to change my training schedule a bit but I am willing to give it a try if it means I can still ride and train hard when I need to, but still maintain the benefits of keto-adaption.  I am not willing to suffer impaired performance all week, however, since my hard workouts are interspersed throughout so what can I say?  This is all pretty new territory for me so this Great Experiment will continue along with more research.  All bets are off until I am keto-adapted, because my brain is just not functioning at optimal levels for the time being.

Sunday, August 19, 2012

the ketogenic semi-elemental diet day 4: those first days low-carb are painful

breakfast lunch and dinner
Today is my early day at work, and I felt like total crap when I got up.  Got into work, had some tea  but nothing seemed to help, not even my incredible goddess kombucha.  I was exhausted and depressed, and my body refused to move, and the smallest movements took a ridiculous amount of effort.  Even walking was a chore, as my limbs felt stiff and uncoordinated.  My plan was to work until 12:30, stop and pick up the milk and eggs from the farm drop, meet with my contractor and then take the dogs to the Wiss to run, but honestly I could not see how I could possibly muster the strength to trail run my normal 5 mile route the way I was feeling.

I met with Bob soon after I got home and managed to lug the perishables up the front steps and put them in the fridge.  He showed up at my house early, which annoyed me, but then I have been incredibly irritable on this diet.

After the meeting, I had a cup of genmaicha tea, and I actually felt pretty good sitting there in the chair, so I ignored the heaviness in my limbs and allowed my mind to insist that we go to the park and at least try to run. So I laced up the ankle braces and the dogs were ecstatic, since they were wondering what was going on with me.  We drove to our usual spot in the Wissahickon, I put my headphones on, and I have NO IDEA how I did it, but with the help of some good tunes I ran with them for over an hour.  No I did not feel good.  And I did actually did walk up a couple of steep rocky hills that normally I  run up, but somehow I got the job done and I was really proud of myself.

My ketones tested at .4, which sucks, no wonder I feel so weak today.  The word I keep repeating is keto-adaptation.  I just have to get through this misery, and hopefully before the end of the two weeks I will feel better.  Continuing to exercise on a ketogenic diet, despite how difficult it is, is one of the ways you can shorten the time it takes to adapt supposedly.  That and keeping your protein intake moderate (around 20%) and your fat intake high, all of which I'm doing.  Hopefully tomorrow will be better.

Saturday, August 18, 2012

the ketogenic elemental diet day 3: going semi-elemental to avoid going semi-postal

my new blood ketone test meter and test strip
So today was only the third day of this experiment, and I felt a lot better than yesterday.  I actually felt somewhat normal, which I did not expect.  I decided to go the semi-elemental route because I could not stomach any more of the amino acid powder.  That stuff is clearly meant to be ingested via a feeding tube,  bypassing the taste buds.  Mixing the coconut oil in warm water and then adding in the scoop of casein and shaking it up produced a concoction that tasted vaguely like cappuccino foam, and with the addition of some salt (you need to eat a lot of salt while you are keto-adapting as your kidneys excrete a ton of sodium) it really was not that bad at all.  This I can do, I thought as the first one went down the hatch.

So I got up and went to the gym and actually had a pretty good leg workout, not nearly as lengthy as my normal one and with all of the plyometrics removed (there was no way I was getting any explosive power out of these legs today) but I got through it.  I also did shoulders and core, and I started with my usual half an hour on the stationary bike while I read the NY Times.  One thing I noticed with running and cycling while in this ketoadaption phase: when I first start I feel weak, but if I persevere and warm up a bit I am able to maintain an easy endurance pace for the duration of the half hour, although not without frequently thinking about quitting in all honesty, and that's not at all like me.

I got home, took the dogs on a very long walk as it was a beautiful morning, made it into work at a decent hour and got through the monotony of that without snapping at anyone.  Mind you my limbs still feel heavy and I don't have my usualy energy or zest for sure but it's not insufferable like the last few days because my brain does not feel like it is constantly fighting my limbs for the available glucose.

My blood ketone meter arrived, and today my level as at .8 millimolar, which I was super psyched about since according to Phinney and Volek keto-adaptation for exercise starts to occur at .5.  Optimal range for an athlete would be in the 1.5-3.0 range.  So I feel like I am well on my way.

As for my weight, the 5 pounds I had gained the week I was on antibiotics is already gone, in fact I've lost 7 pounds in 3 days.  You do lose a lot of water when you first embark on a low-carb diet, and this one is hypocaloric and semi-elemental to boot.  Not to mention that I have my last liquid food at around 2:30 pm, and then don't eat again until 5 the next morning, so there is a healthy dose of Intermittent Fasting in there too.

Tonight I made fish broth, to substitute for the bone broth recommended on low-carb diets as well as on the elemental diet.  All those vegetables and fish provide needed nutrients I am missing while ingesting only coconut oil and casein, and when you have not eaten in half a day and your stomach is growling a hot cup of fish broth really does do the trick.  Trust me.

only the dogs eat meat in this house, so fish it will have to be

Wednesday, August 15, 2012

the ketogenic elemental diet day two: why ketogenic?

Devil's Pool, Wisshickon Valley Park this am
Tuesday August 7

veggies fermenting
Today was not nearly as bad as I thought it would be, all except for the "meals."  I felt weak in the am, so I decided not to workout, as Tuesdays are normally my CaTV indoor interval workout days on the trainer and I just could not imagine getting on the bike.  I did however, get up at 4:30 as usual and did a bunch of chores, including making kombucha and yogurt, and dehydrating the tomatos and shiitake mushrooms that would spoil during my Foodless Fortnight.  I straightened up the place and took the dogs on a long hike in the Wissahickon.  When one makes and comsumes cultured foods like kombucha,  kefir, yogurt and fermented vegetables, you really can't just blow them off for a couple of weeks while you attempt your latest wacko diet.  They are live organisms and need to be tended and fed.  But then I'm used to taking care of all manner of organisms, from my kombucha SCOBY to garden spiders to birds to the canine-shaped variety.

one of my gigantic Kombucha SCOBYs
So a major reason why so many try a low-carb diet and then quit is because they are unable to get through the keto-adaption phase, which takes anywhere from a couple of days to two weeks to a month.  In fact your body is always producing ketones, water-soluable compounds that are the byproduct of fatty acid breakdown in the liver, even when you are not on a low-carb diet, for instance during periods of intermittent fasting or strenuous exercise, both examples of events which require the brain to get a percentage of its fuel from this alternate fuel source, ketones, as blood levels of glucose drop.  However, according to Stephen Phinney in The Art and Science of Low Carbohydrate Living, blood ketones produced while eating a normal diet rarely exceed 0.1 millimolar.  Once you have restricted dietary carbohydrate to the point where your levels of blood ketones rise above 0.5 millimolar you are actually at the beginning of keto-adaptation, when you can perform more strenous exercise utilizing fatty acids as fuel.  And he should know, he has done studies on competitive cyclists showing no change in performance on a ketogenic diet, although these cyclists were tested during the ketogenic phase at a mere 60-65% of VO2 max, and let's face it, I go way over that for long periods on my weekend rides on the road and mountain bike and even in my short interval workouts.  Phinney makes the point that most of the studies used to support the supremacy of carbohydrate as an endurance fuel compare the much improved endurance shown by eating a carbohydrate rich-diet with the poor performance of subjects on a low-carbohydrate regimen derive at these results because the subjects are tested before they have been properly keto-adapted.

from pg 91 of The Art and Science of Low Carbohydrate Performance
Remember those charts on the treadmill at the gym?  Even when eating a normal diet, the mitochondria in your working muscle cells will derive most of their energy from fat when exercise intensity is less than 65% of VO2 Max.  Above that intensity level, the muscles draw on the glycogen stored in the muscles themselves as well as the liver, which in the average person is about 1300-2000 calories stored as carbohydrate.  This translates into a mere 2-3 hours riding at moderate intensity.  Of course those charts are oversimplified, because at any given point of time in a workout you are burning a portion of both fat and carbohydrate, and the point of Bob Seebohar's work with his athletes and now in his book is how beneficial it is to raise your metabolic efficiency point so you are able to burn fat at much higher intensities.  This has broad performance implications for athletes, because if you can tap into this unlimited fuel tank (your stored fat) even at race pace then you will not suffer from all of the issues that accompany the constant refueling of that small glucose tank, such as inconvenience and GI distress from the blood shunting effect.  He does not believe you need to follow a ketogenic diet to do this either; he shows you how with diet and training modifications in his book.  Phinney and Volek take this a step farther in their research, as they have done many studies showing the benefits of a low-carb diet on exercise performance as well as on human health in general.

At any rate, when I was restricting all carbohydrates, (and fats and proteins for that matter), during my water fast I'm not sure how long it took me to enter ketosis but it seemed way longer than the 72 hour average for women that Joel Fuhrman mentions in Fasting and Eating for Health. And I was tired for 8 of the 9 days, I mean I felt terribly weak and listless.  So I'm not expecting too much, but this time I'm not flying blind, as I purchased a blood glucose and ketone test meter so I can test every day and see exactly where I am and how that corresponds to my symptoms.

The most incredible thing is I'm not hungry at all (maybe not so incredible when you see the choice I have for a meal)  I could barely choke down the second shake today, so I never bothered with the third one, which was probably OK since I did not workout.  I realized though, that tomorrow I'm going to have to go with Plan B, because I don't think I can stomach another one of those amino acid drinks.  Plan B is the Semi-Elemental diet, in which I replace the horrid amino acids with a scoop of casein, or milk protein.

So tomorrow, I'm going Semi-Elemental, which does not have the same medical studies to back up its efficacy in curing SIBO but I can't even look at that amino acid powder now without getting nauseous.  So onward to Day Three....

Monday, August 13, 2012

the ketogenic elemental diet day one

Monday August 6th, Ground Zero

So I had been fascinated by a paper published in Nutrition and Metabolism in August of 2004 called, "Ketogenic Diets and Physical Performance" by Stephen D Phinney who has been publishing books and papers on the benefits of low-carb diets for 35 years. Here is the abstract:

Impaired physical performance is a common but not obligate result of a low carbohydrate diet. Lessons from traditional Inuit culture indicate that time for adaptation, optimized sodium and potassium nutriture, and constraint of protein to 15–25 % of daily energy expenditure allow unimpaired endurance performance despite nutritional ketosis.

Dr. Phinney is probably the pioneer of ketogenic diets for athletes, and I just finished reading, The Art and Science of Low Carbohydrate Performance, which he co-wrote in 2012 with Jeff Volek. I have been interested in the manipulation of dietary carbohydrate dating back to my bodybuilding days when I read and re-read the late Negrita Jayde's book, Sliced, and drove my Italian mother crazy with my sudden dietary about-faces. This was back in the late eighties, and I was a skinny little college freshman who wanted to pack on some muscle mass but was frustrated even back then with my inability to "get cut." As my chosen sports evolved from track, lacrosse, and ice hockey to mountain biking and road cycling, I noticed an increasing intolerance to many carbohydrates as I became an elite athlete and "had" to eat more and more of them due to the demands of my training and racing. But eating a lot of carbohydrate- rich foods, even the healthy choices I have always preferred, has always made me feel lousy, gain weight, and suffer from GI consequences and impaired performance in races. I knew there had to be another way; I just did not buy that you had to glut yourself with sugar to feed the glycogen train to be able to train and compete at a high level. So it seems I have always been sensitive to carbohydrates, but I was fed the party line by my various coaches when I signed on to elite mountain bike racing, that is, to succeed in a sport where you were often burning over 2000 calories on training rides and races, you had to constantly feed the machine, and the fuel that you must use is high-glycemic index carbohydrate for the most part.

A few years back I read Stu Mittleman's book, Slow Burn: Slow Down, Burn Fat and Unlock the Energy Within, and that prompted me to begin gradually experimenting with removing the starchy carbs from my diet. I had long ago stopped eating bread and pasta as I deem them junk food, but remove the healthy grain dishes I (and my frequent athlete dinner guests) had grown to love, such as this or this from my diet, and not suffer from impaired performance? Enter Bob Seebohar and his book Metabolic Efficiency Training, which I bought while I was still being coached in 2010 and unsuccessfully tried to get my former coach to read. As a CAT-1 cyclist who clearly has no problems ingesting carbohydrates during events, he was not particularly interested in a lesson on the benefits of low-carb performance, even if the knowledge might benefit some of his athletes. At the same time I was having trouble getting my body more metabolically efficient using the methods that Seebohar recommends because I was so severely hypothyroid and my body was just not burning fat. In fact my body was not burning enough of anything to even raise my body temperature above 96.5. But that's another story.

At about this time a year ago, I was in the middle of searching for someone who could help me with my hypothyroid condition, as there were times when I was exercising and not eating much at all and I could not lose an ounce. So it was not hard for me to agree to remove any energy-dense high calorie foods from my diet because of my strong desire to get back to a leaner version of me. The research led me to study the Paleolithic diet, and I read most recently, The Paleo Diet for Athletes, A Nutritional Formula for Peak Athletic Performance by Loren Cordain. The problem with Paleo for me is that I do not eat meat, and I have no desire to start eating meat again until I am living out West and have access to freshly killed elk or the like; there is just no way I am eating factory-farmed anything. Luckily I still eat free-range eggs and wild-caught fish, but you can't eat many of the vegetarian sources of proteins on a Paleo or low-carb diet, because they often are accompanied by carbohydrate; for example tofu, seitan, tempeh, beans and nuts all have their fair share. The other issue is most are hard to digest, and while I was digesting beans just fine for awhile, since I became afflicted with SIBO, I really can't digest anything.

Anyway, like I said I was unsucessful in turning my body into a fat-burning machine in my attempts prior to this (although I did succeed in improving its metabolic efficiency somewhat) because, most likely, I was still eating too many carbs. I was eating these carbs in the morning before workouts just as recommended by Seebohar and even Cordain in The Paleo Diet for Athletes, but unlike in 2009, when I was not suffering from Wilson's Syndrome and perhaps because I was still eating meat, my timed carb doses were just enough to keep me from switching to fat-burning even at the lower endurance intensities. Anyway, the bottom line is I had a unique opportunity as I stated in the last post due to my impending "foodless fortnight" to control the exact number of calories and even the exact ratios of fats/carbohydrates and protein I was consuming. I could use the opportunity not only to restrict my calories but also to restrict my carbohydrates to jump-start the keto-adaptation process so I could perform efficiently on a low-carb diet once I started eating food again, even as an elite cyclist, runner, swimmer, and weight trainer. This controlled experiment was just too tantalizing to pass up.

what it looked like before I added the water...gross
So I shelled out $150 for the amino acids, and stocked up on Nutiva Coconut Oil and raw honey from the farm. I worked up a 71% fat, 9% carb, 20% protein "diet" which was nothing but....are you ready for this? Coconut oil, amino acids, and a teaspoon of honey. Three of those per day, plus some fish broth, a bottle of my homemade kombucha, and unlimited amounts of unsweetened tea.

So back to Monday morning, Day One of the keto-elemental diet. I got up at 4:30 am as usual, and by the time I got downstairs dressed for the gym it was 5. I mixed up the amino acids with the coconut oil and honey, and then decided it would be a good idea to add in some water and just drink it down, as I read the amino acids taste dreadful. So I walked over to the water cooler and stupidly added some chilled water, not remembering that coconut oil solidifies at temperatures below 76 degrees. So now I had to ingest clumps of cold coconut oil barely mixed with these terribly bitter amino acids and a trace amount of honey. It was totally disgusting, and it was all I could do not to gag. But I got it down, my eyes watering with the pure alienness of it all, and headed off to the gym. Normally, I would have had a cup of gluten-free oats with a scoop of raw protein, almond milk, some homemade coconut yogurt and fresh raspberries. I know, bummer.

Once there I really had no trouble getting through a full Monday workout: half an hour on the stationary bike at endurance pace, a little over an hour lifting chest, biceps, core, a hard 20 minute run on the treadmill and 15 minutes of stretching and using the foam roller on my legs. I still had plenty of glycogen in my system from yesterday. I would be lying if I said I did not "carbo-load" a little on Sunday, considering the experiment I knew I was about to undertake. Hey, I'm human after all. That slice of raw chocolate pie with walnut-coconut crust was pretty special. Ah the memories.

Towards the end of the day I did get a bit tired and irritable, but that has pretty much been how its been anyway since for the past 10 days I have been on the antibiotics, which really fatigue me especially at the end of the day, so it could have been a hangover from that.  And to be honest, sometimes my job just irritates me, but you knew that.

One day down, thirteen more to go.

Saturday, August 11, 2012

what you do when antibiotics don't cure your SIBO

the machine that performed my HBT

It's no secret that since 2008 I've had more than a few health issues that arguably are the reason I'm still here in Philadelphia. A broken collarbone, second degree heart block, a bike accident in which my leg was run over by a truck, a nasty perineal nodular induration, a severe form of hypothyroid called Wilson's Syndrome, a major shoulder reconstruction, a lacerated kidney, another concussion which required head staples, a pacemaker implantation, couple of broken ribs, and probably a few more I'm not thinking of right now because my brain is light on glucose. In the past year though, my IBS has flared up pretty badly to the point where it is really negatively impacting my quality of life. I inherited IBS from Mom's side of the family, but I always kept it under control through diet, exercise, adequate fluid intake, and avoidance of pasteurized dairy products. But about a year and a half ago the situation got much worse, and I found myself wondering what was going on. Certainly a lot of it was related to my hypothyroid condition, but even once that was under control there was little improvement. I decided it might be time to go back to a gastroenterologist to make sure there was nothing going on like cancer or some type of obstruction. You might remember I scheduled my colonoscopy smack in the middle of a 9 day water fast. I got the test, and everything was normal. They gave me some pharmaceuticals to try which did not work and which I would not have wanted to take long-term anyway. So as usual had to figure out this puzzle by myself.

 I do a lot of research about health, nutrition, diet, exercise, and my various conditions, and this involves reading a lot of medical studies as well as books. Let's face it kids, if you really want to understand a subject, you can't just rely on the hit or miss information on all those websites out there. Sometimes you have to be willing to shell out a little coin to read a well-researched book, article or medical study. Thank God for my Ipad.

My symptoms? It seems as if everything I eat causes bloating about half an hour after I finish. This told me the problem was in my small intestine, and it did not take me long for me to self-diagnose with SIBO, or Small Intestinal Bacterial Overgrowth. The treatment for this syndrome of excess bacteria in the small bowel, which should not contain much bacteria at all, is either antibiotics, which I never take, or something called the elemental diet, which is basically a regimen of eating only "food" that is already broken down into micronutrients, so the bacteria have nothing to eat when the substance enters your small bowel, and they die of starvation. It is often used in hospitals for very ill patients who are being tube-fed.  I found out later why the only way one should ingest the elemental diet is via tube, which bypasses the taste buds.

So I called up my gastroenterologist Farzana Rashid, MD, at Penn Presbyterian, who is intelligent, has a good bedside manner, and happens to be young and female, so she does not have the ego of an older male doctor who might not appreciate my strong desire to co-manage my healthcare decisions. Not only that, but she agreed to perform the colonoscopy on me without anesthesia, something most doctors would protest against. I had read A New IBS Solution by Mark Pimental MD and was anxious to get a hydrogen breath test to confirm whether or not I indeed had SIBO before I would consent to take 2 pretty hardcore doses of antibiotics for 10 days.

After a phone call with her she did prescribe the test and I got it at the Perelman Center 3 weeks ago, and after a long discussion over the phone with Dr. Rashid, I convinced her that based on the latest research from Pimental's studies at Cedars Sinai, because my bacteria excrete methane as well as hydrogen I needed to take the combo of Rifaximin and Neomycin. Might as well knock them all dead with a one-two punch.

So she prescribed them, and they exhausted me for 10 days. Not to mention I gained 5 pounds of fluid which was not fun.  But the treatment did not work.  I was undaunted, because I had another ace up my sleeve.  It is what is known as the elemental diet.  I knew I had to do it, and really, if one can eat NO FOOD for 9 days, then how difficult could this be? Dr. Rashid said it is so extreme she has never been able to get any of her adult patients to try it, so they do not use it in her practice.  Hmmm, food for thought.

So you eat nothing but pre-digested macronutrients for 2 weeks.  There are commercially prepared formulas used in hospitals which are available to the public, but there was no way I was going to take Vivonex or Absorb Plus or any of the pre-made concoctions out there. Not only were they very expensive, but in the case of the Nestle Products the ingredients are of poor quality, and in the case of the Absorb Plus, the diet is too high in carbohydrate and contains no fats, because it is designed for people with Crohn's Disease. I'm going to be having nothing but 3 shakes a day, and if they are loaded with sugar then I will feel okay for a couple of hours and then I will be tired and starving when my blood sugar crashes due to the insulin spike.  And unfortunately when you have SIBO you have to use simple sugars during the elemental diet phase because they are digested quickly, high up in the small intestine.  If they are harder to digest and travel too far down the intestine undigested they feed the bacteria which reside further down the small bowel. No, I had to make the diet myself, and although Dr. Allison Siebecker does include a recipe on her website, even the higher fat option was not low carb enough to prevent the roller coaster of energy like I describe above.

After all, I realized that this dreadful foodless fortnight would be the PERFECT time to continue my experiment as to whether or not an endurance athlete really can thrive on a low-carb diet, or ketogentic diet. Especially one who does not eat meat. So why not make it a ketogenic elemental diet? keto-elemental diet? I mean dreadful is dreadful right? I'm all about combining my misery into an efficient as possible package, with admittedly mixed results. Stay tuned.

Tuesday, August 7, 2012

how to kill an infiniti part one and two

Accident #1 May 2012
Accident #2 June 2012
There is something about Thursdays. That's the day of the week I get into work before sunrise, leave at 1 to pick up the raw milk, eggs and chicken parts from the farm, food shop, do errands, and then take the dogs to Fairmount Park for a run or mountain bike ride. I finish early and have the whole night to do whatever I want: chores, cooking, writing, or lately maybe even meeting some stranger for expensive champagne at some swanky downtown hotel.

I was heading back home from Cadence with my repaired road bike on the back of the car and it had started to drizzle.  I was meeting one of my employees who had fought an hour and a half of traffic in the opposite direction from where he lived to meet me at my house to help me put my air conditioning units in my windows;  now that the two male persons who usually help me with this task have been conveniently ousted from my short list of friends.  He was young, and I had offered him a case of Blue Point Brewery's Toasted Lager, his favorite.

Actually "help me" is a bit of a misnomer as all I really do is clear a path in the basement so the chosen male person can carry the AC units between all the crap I have amassed in my 10 years at 3434. I become a cheerleader during the process, as I can't handle those unwieldy things myself. I go to the gym to lift weights for God's sake....and to keep in shape so I can lure young men to help me move heavy objects. God help me when I have to move whatever is left of my crap across the country to the new farm.

As I drive along Henry Avenue towards East Falls I passed through the intersection at Hermit Lane and there was a road to my right, Barnes, that cars had to turn across my lane to enter. They had their own lane, and there was a lot of traffic along Henry Avenue going both ways. As I rounded the bend in the road there were a few cars turning in front of me and I slowed in case some jerk decided to make the jump as I got closer. Two cars did, and next in line was a blue Ford Taurus. From several hundred feet away I saw him inching forward. But then it seemed he saw me coming because his car stopped; so I took my foot off the brake and proceeded on my way. To my shock and horror he decided to gun it across the intersection as an afterthought, obviously forgetting he was driving a car whose power-to-weight ratio made it too heavy to get out of its own way.

Tony minutes after the accident inspecting his car

I slammed on my brakes and steered the car into the only place I could go, the oncoming traffic, which luckily also had two lanes and there was no one coming in the one immediately to my left. I did everything I could to avoid a collision, but his Taurus circa 2005 was too geriatric for its owner's aggressive driving so his rear hit my passenger side light, bumper, and quarter panel and smashed up my pristine little car quite nicely. I was PISSED.

 I glanced to the side to see that he had indeed pulled over on Barnes street and thus I would not be compelled to unleash a high-speed chase through the streets of Roxborough (you scoff, but I did that once), then I nonchalantly turned my car, its molecules still jostling  from the impact, 300 degrees and pulled up behind him on the side street.  For a few seconds,  I was the only vehicle moving, as the entire intersection had stilled to a stunned silence from that telltale smash and crunch of metal that every driver hates to hear.  I jumped out of my car and strode up to Mr. Taurus.  After I told him what a complete idiot he was I calmed down and called the police, my fingers trembling as I hit my phone's touch screen and wondered how best to play it to the 911 dispatcher so as to get a response.   I will spare you the details of the ineptitude of the operators on the phone but since half the dispatchers don't know the new policy I will spell it out for you here: unless there are injured parties or a car needing towing from the scene, the PPD does not show up, even though for the first hour they might even tell you they are on their way, which is why we waited there so long.
the scene

The best part about this story is that after I called back and got the straight scoop about the policy Taurus agreed to lead the way to the local District 5 station. As I followed behind him, he rolled through not one but two stop signs. However the piece de resistance was while making the left into the police station, he cut in front of a car going straight just as he had done to me.   The exasperated driver who had the right of way even put his hand through his sunroof and gestured to Taurus to "just go for gods sake."

So that was the first one. My insurance company paid to have my car put back together less my 500 deductible which I should get back once it is determined that the liability for the accident should rest squarely on Taurus, whose name, it turns out, is actually Tony. This might have been accomplished by now but it takes several months for the Philadelphia police department to send out a copy of the police report.

Less than a month later I was minding my own business driving back to my house, again on Thursday, and as I was ambling along Ridge Avenue under the twin bridges I had to slow down because there was a large Coor's Light truck blocking my lane.  John Kenney, the owner of East Falls Beverage, who has, in fact, delivered kegs to 3434 parties a few times (remember the 8.2% Troegenator and the mayhem that keg engendered?) was having trouble with his little green forklift and it had gotten stuck on the curb.  He gassed it  to try and release it at the very moment I was slowing to a stop behind the truck he was unloading, and the vehicle lurched forward right into my path.  The tines of the forklift shown in the picture above sliced open the entire front quarter-panel and passenger side door of my car  like a can of sardines, yep, the same side that had been replaced a few week's earlier.  I was incredulous.  I got out of the car muttering something to John along the lines of I had just gotten the car back from Infiniti of Ardmore and this could NOT be happening.
like a can of sardines
Well, I will spare you the details, but because that happened the week before the July 4th holiday, it seemed to take forever for his business insurance to admit liability and send the damn check, I actually had to pay out of pocket to get my car back.  I even had to race the Summer Sizzler by shoving my Yeti sideways into the back seat of my rental Nissan Altima.  In 98 degree heat.  That sucked.

So the dogs and I are happy to have the car back for our frequent trips to the park, but I have to say this is just another reason I am looking forward to living somewhere with a lot less population density.  I'm really running out of reasons to stay here anymore.  I'm trying to be Buddhist, and experience everything in my soon-to-be-former-home of Philadelphia with a Beginner's Mind, but it is really challenging now, because I am just so impatient for "what's next" to begin already.  ONWARD.

Devil's Pool, Wissahickon Valley Park, this morning