Labs

Some updated labs this week.  First, some background information, for those not following along….In February 2015 I adopted a low carb Paleo diet as well as lots of supplements recommended by my advisers at Nourish Balance Thrive.  I felt great for a while but after a while started to have a lot of sugar cravings and my hair began falling out at an accelerated rate.  I also started feeling tired and stopped losing weight.  In September I started eating carbs again, and in the middle of December (about 10 days prior to these labs) I dropped fat way down to about 25g/day and kept carbs high at about 250-300g/day.

So how are things going?

Let’s take a look at the basic metabolic panel first (click to enlarge):

Metabolic Panel

Notable items:

  • HbA1C: 6.4 (high)
  • BUN/Creatinine Ratio 28 (high, but improved)
  • Carbon Dioxide – 28 (much improved)
  • ALT (liver enzymes) – 39 (worse)

Fasting blood sugar somewhat improved (honestly I’m happy if it’s under 110).  HbA1C would have been in the 5’s if I would have tested it during low carb, but currently it’s high (6.4).  Considering that it reflects an average blood sugar over the last 3 months I’m not surprised by this.  During one of the last 3 months I was eating relatively high fat and high carb and the same time and my blood sugars were trending up.  This was improving over the last several weeks when I eliminated most fat.  Still, it’s not good and is still in the diabetic range.   BUN/Creatinine ratio tends to go up when I’m eating a lot of meat, and meat has been my biggest source of protein these days.  CO2 – better, and important in Peat world.  ALT – worse.  Fatty liver caused by….the tablespoon of honey I’ve been putting in my tea?  The tablespoon of sugar I’m sprinkling over out-of-season berries?  High carbs?  Dunno.

Next – Lipid Panel:

Lipid Panel

AAAAAAaaaand here’s where we run into some more serious trouble:

Notable elements: everything.

Cholesterol still high but much improved over my low-carb labs.  Triglycerides.  Seriously?  Look that that monster.  477.  I haven’t been eating that much sugar – most of my carbs come from white rice.  So I’m pretty confused at this point what is actually causing my trigs to be that high.  I know sugar can do that but I didn’t know glucose did that.  Any biochemists out there care to enlighten me?  With high triglycerides seems to come a dropping of HDL cholesterol and imminent death.  If I don’t come back you’ll know why.

And finally, thyroid.  I only had TSH tested because that’s all my doc would order and thus all my insurance would pay for:

Thyroid

Hey look – my TSH is the best ever in the history of me.  Thank you for that, carbs.

So to summarize, I can’t continue on this way.  I eat low carb high fat and my thyroid suffers.  I eat high carb, low fat and my triglycerides skyrocket. High fat/high carb and I’ve got blood sugar problems.  High fiber causes depression via endotoxin poisoning (see here and here for just two of the many examples of this).

Perhaps the answer isn’t in my diet.

My doc called me the morning after these labs were processed and told me she wanted to make an appointment to discuss my labs. I feel like I’ve been called to the principal’s office.  My appointment is later today. I’m sure she’ll be pushing the Lipitor and the Metformin.  I’ve been giving a lot of thought over the last few days as to how I’ll be handling this.  I think what I’m going to do is start exercising daily and stop thinking so much about food.  I’ll do the best I can to follow a nutrient dense diet and let the macros take care of themselves – probably fewer carbs early in the day and more later in the day – while getting at least 45 minutes per day of exercise – a combination of walking/cardio and strength training.

I know the first week or two is the hardest.  I was an athlete the first half of my life, and a gym rat until about 8 years ago.  I just need to get over the initial resistance until it starts feeling good again.  No nazi trainers this time.  I’m just going to do it.

I’ve been phasing out the supplements I’ve been taking, and making more of an effort to get nutrition through food.  I’ll be continuing this.

My personal life is still a bit of a mess, but things are stable at the moment.  Stable enough to start taking better care of myself and start remembering who I am and what I’ve given up over the years.

Not Done. (And labs).

Yeah, I’ve decided to come out of retirement.

That last bout of depression was the worst I’ve experienced.  Not the longest, but the most severe.  I don’t know what’s going on with me.  Things are a bit better now.  Just milldly depressed. Thanks to friends who commented or emailed…I appreciate your support.  I really don’t mean to be this drama mama.  In real life I don’t seek the spotlight at all – I’m content for no one to notice me in the room.  I’m really not all that dramatic.  The blog is a reflection of what’s in my head though…it’s a side of me that no one in my real life gets to see. I guess there’s depression drama in my head.

I have a doctor’s appointment on Monday.  She’ll be checking the labs she ordered and seeing how this beta blocker is doing for my blood pressure.  I’ll also be talking to her about whatever the fuck it is in my abdomen that’s pushing against my ribcage for the last few months.  This might result in more (and expensive) tests, and that’s just going to have to be ok.

So how did I do?  Metabolic panel first:

metabolic panel 7-1-14

The diet I’m currently following is 95% starch free – I’d say most days I eat none, every few days I might have a bite or two of something with starch in it.  Also, it’s 95% free of glucose and fructose.  Very little juice, fruit, or table sugar.  I’m eating mostly protein, fat, and vegetables, leaning harder on the vegetables and bone-broth based soups than I used to when low-carbing.  I’m getting most of my carbohydrate calories from milk (lactose) and vegetables, around 100g of carb a day.  My diet when I had these labs done was about 50% fat, and the rest split between carbohydrate and protein.  When I became severely depressed, I had eaten a couple of bananas (they’re high in potassium, trying to bring down blood pressure).  No more bananas. Stupid starch.

Ok, let’s see what’s changed over the last couple of months:

Blood sugar and Hb-A1C are a bit improved but still high.  Not high enough to be considered diabetic though (diabetic = 126 on the fasting glucose, and 6.5 on the Hb-A1C, according to the values that came with the labs).  The far right column on the chart is the current lab “normal” ranges, which vary a bit from the previous lab I used.  The doc ordered these, so I used their lab.

Carbon Dioxide (CO2) is better now, at 26.  I attribute this to bag breathing.  I haven’t done a lot of it, but for a week or so I did it once or twice a day, while trying to normalize my blood pressure. It didn’t help my blood pressure, but seems to have made a difference in CO2 level.  I’ll continue that once a day.  Traditionally people breathe into paper bags when they are hyperventilating – I’ve been using plastic gallon-sized “food and bread bags” from my local supermarket.  Not as noisy as paper, and not as rigid as Ziploc bags.  You just make a seal over your mouth and nose with the bag and breathe normally, in through the nose, out through the mouth, until it becomes a little difficult to breathe – at that point the oxygen is about depleted, and it’s time to stop.

BUN/Creatinine ratio is slowly dropping, probably because I don’t eat as much meat as I used to.  I still eat it every day, but it used to be every meal.  Now a lot of my protein comes from dairy and bone/oxtail broths and soups.

Everything else is unremarkable.

Ok, now for the lipid panel:

lipids

Again, this is about a month into eating 100-120g of carbohydrate daily, with very little fructose/glucose or starch in my diet.

  • Total cholesterol dropped almost 50 points.
  • Triglycerides almost halved.
  • HDL up from 30 to 42.
  • LDL able to be computed now.

I guess I don’t handle carbohydrates well.  More veggies, less carbs. When I eat this way I feel good.

The recent depression has been related to eating starches, as usual.  They’re off my plate permanently now.  Or until I can figure out why that happens and fix it.

Results and Changes

Had a lipid panel done today, about 2 weeks after my last one.  Over the past week I did the following:

  • Aimed for a 2:1 carbohydrate to protein ratio.  I found this difficult because I don’t particularly like sweet food, so I fell short some days.
  • Aimed for a 1:1 calcium to phosphorus ratio, because Ray Peat says.
  • Ate no starchy foods, getting all of my carbohydrates from sugar (fruit, honey, juice, and white sugar)
  • Maintained a lower-fat diet (averaged 59g fat/day or about 24% of total calories, on average).
  • Took niacinamide and aspirin 3x a day
  • Doubled thyroid supplement (Cynoplus, a combination T3/T4) from a very small dose -1/4 tablet (7.5mcg T3 / 30mcg T4) to two 1/4 tablets per day.

The results of today’s lipid panel:

  • Total Cholesterol: 316 (first time ever above 300).  Shouldn’t increased thyroid supplement decrease cholesterol?
  • Triglycerides: 495 (a 3% improvement. I’m not impressed.)
  • HDL Cholesterol: 30 (lowest ever)
  • LDL Cholesterol: Couldn’t be computed because Trigs were so high (this was the case last time too).

So, not great.

Here’s a handy chart showing my lipid panels over the last 2 years, along with brief notes about my diet during that time:

lipid panels

So you don’t have to turn your monitor on it’s side, here are the notes that correspond with the different testing dates:

3/27/2012 – Low Carb/Leptin Reset

11/14/2012 – Low Carb + Stress (Moved to a new state, started a new and very stressful job, was doing the Wiley Protocol and supplementing estrogen + progesterone).

6/19/2013 – Low Carb, without following any particular plan.  When I ate carbs they were in the form of starches from potatoes and rice, some vegetables, no fruit.

12/30/13 – Ray Peat, low sugar – around a 1:2 carb:protein ratio.  I was fiddling around with eating fruit, juice, and sugar but I was scared by the effect it was having on my blood sugar.  It was about this time I realized I was diabetic and was afraid of eating more carbohydrates.

4/19/14 – Ray Peat, high sugar – 2:1 carb:protein ratio – I decided to jump in with both feet and start eating more carbohydrates. When this test was done I was eating high fat (90-120g/day), high sugar (over 200g/day, some of which were starches), moderate protein (about 110-120g/day).  Pressure under my left ribcage was making me concerned that something might be wrong.

5/2/14 – Ray Peat – high sugar (2:1 carb:protein), low fat (around 25% of calories), taking niacinamide/aspirin/increased thyroid to address scary lab results.

According to this, my body (well, at least my lipid panel) responds best to a low carbohydrate diet, with minimized environmental stress.  I can tell you I didn’t feel great eating low carb after a while – I felt tired all the time, irritable.  But maybe that was because I wasn’t getting enough nutrition – I wasn’t tracking my food back then – vitamins/minerals were pretty much off the radar for me. I wasn’t eating liver or taking progesterone then.

Of course, other things were worse then.  My BUN/Creatinine ratio for example, got worse the longer I was on low carb, and improved since then.

BUN

Maybe eating too much meat is stressful on the kidneys after all?

Let’s look at thyroid:

thyroid

Seems sort of unrelated to sugar intake, actually, and more related to environmental stress. When I had the labs drawn in 12/2013 I was experimenting with resistant starch.  I think that was stressful on my body – I know it was stressful on my emotional state. So that may account for the increase in TSH last December.  I know TSH isn’t the ideal measure for thyroid function, according to many people…but Peat seems to think it’s a decent gross measure, so good enough.

And of great importance to me is my blood sugar.  Let’s see the data:

blood sugar

This is a crazy graph, right?  There was definitely an increase in fasting blood sugar when I started following Peat and adding carbohydrates to my diet, but that’s to be expected.  Anyone can have “well managed diabetes” with a low carb diet.  I wanted to actually FIX my diabetes, so I was experimenting with adding carbs back in to see what it would take to do that.  From the graph it looks like the best things I did for my blood sugar were bicycle for 30 minutes a day and eat a low-fat diet.

Holy crap!  Just like my conventional doctor told me!  Exercise and eat a low fat diet!

hahaha

It does seem my current supplements are confounding things.  The graph shows that eating a low-fat high sugar diet results in lower fasting blood sugar…but not if I add niacinamide, aspirin, and increase thyroid.  Hm…interesting.  If I was a patient person, and if I really loved sweet food, I’d probably just eliminate the supplements I’m taking and go back to high-sugar/low fat for a while to see if that trend continues.

I’m neither patient nor in love with sugar.

And considering that I’m STILL having hot flashes – even while sitting right here, right now, I’m going to stop taking niacinamide, aspirin, and thyroid.  One of them is bothering me.  Later on I may try to add them in one at a time and see what I can tolerate.

So to sum up: It looks like the best thing for my lipids is low-carb.  The best thing for my BUN/Creatinine is low meat.  The best thing for my thyroid is low-stress.  The best thing for my blood sugar is low fat and bicycling 30min a day on flat terrain.  The best thing for my enjoyment of life – to not have to eat so much sugar.  I really don’t look forward to it.

So what kind of diet is low-carb, low-meat, low-fat, and lower-sugar?  Maybe one with dairy (mostly low-fat), some lean meat, lots of vegetables, some fruit (when I feel like it).  Plus avoid stress and get exercise.

I still love Ray Peat – he gave me progesterone, Vitamin E, red lights, liver, vitamin K, dairy, raw carrots, and taught me that estrogen, PUFAs and serotonin are bad guys.  I’m continuing on with much of what he has to say.  Just less sugar.  More vegetables.  More exercise.

I might as well retire the blog.  I have nothing original to say anymore.

So there it is.  That’s my new plan.

Train Wreck

Fasting blood sugar this morning: 143.  Not awesome.

Weight steady for 6 days straight at exactly 207.5.

Still having hot flashes.  Is it possible it’s completely unrelated to the niacinamide/aspirin regimen I just started?  How could that be when the hot flashes started right after I started taking these supplements 3x a day?  Well, to be accurate they started 3 days after I started taking them, exactly when I increased the niacinamide to 250mg 3x/day from 100mg 3x/day.  They’re annoying now.  I can’t seem to correlate them to anything.  They happen in the middle of the night, right before eating, right after eating protein, right after eating sugar, an hour after eating sugar…If this was a stress response related to not enough sugar I think it would be prevented by eating it, right?

I’m starting to feel discouraged.

I started the niacinamide to address my ridiculously high triglyceride level.  However, various sources around the web say that niacin (NOT the non-flushing niacinamide) is more effective for this.  And apparently both niacin and niacinamide can cause higher blood sugar in diabetics (yup, got that too).  I feel like I’m completely fucked!  I mean, I’m trying to fix one thing and it’s making the other thing worse…and I’m not even sure it can possibly help the first thing, plus weird hot flashes.  WTF IS GOING ON WITH ME?

I haven’t even told you the best part yet.  For the last few months I’ve been feeling a sort of pressure under my left ribcage.  It had recently been turning into discomfort, and a little bit of pain throughout my upper torso. Research on the web suggested in might be an enlarged spleen, which can signal that other organs (like the liver) are having some kind of problem. That’s why I got labs done a couple weeks ago, including a complete blood count (CBC) – to look for elevated liver enzymes or other indicators that some organ might be struggling or fighting an infection or something.  After seeing those triglyceride numbers I was motivated to stop with the starches (again) and started eating a low fat diet – because hell, I’ve tried everything else, right?  (Well, and also because Ray Peat suggested it might be a key to lowering my blood sugar.)  Well, since I’ve been eating lower fat the pressure under my ribcage has gotten better – it’s not gone, but I’d say 75% improved, and the pain is gone.

I consulted Dr. Google again today, and it turns out high triglycerides can cause inflammation of the pancreas.  Definitely when trigs are SUPER high, like over 1000 mg/dL, but who knows – maybe when lower but still high (like me)?  Symptoms of pancreatitis: pain/pressure in upper abdomen, radiating to the back, as well as other things like nausea (which I didn’t have).  Holy crap – so now my pancreas is about to explode?  Recovery from mild pancreatitis involves a low-fat diet (maybe that’s why mine is helping?) and medication to reduce triglycerides.  Oh, and stop eating sugar and fat.

I’ve decided to get another fasting lipid panel done tomorrow, to see if I’m on the right track.  Our local health department will do it for $20, and you get the results right away….so I’ll be following up on this tomorrow.  If things are NOT even a tiny bit improved after abstaining from starches, eating lower fat, and taking niacinamide and aspirin 3x a day, I’ll be seriously reconsidering the path I’m on.  I FEEL better with a Ray Peat inspired diet, but if my labs continue to suck I’m going to have to change directions.

Here’s my diet breakdown today:

crono

Carb/Protein ratio and Calcium/phosphorus ratios were short of ideal today, and fat was a little too high.

And did I mention it really pisses me off that niacinamide raises blood sugar!?

Crap.

Plan of Attack

I’m very much back on track now…inspired by my last set of not-so-hot labs.

My short term goals are as follows:

Maintain a higher-carb, lower-fat diet in order to reverse my type 2 diabetes and reverse my abysmal lipid panel.  Rationale:

  • Lower fat to address high blood sugar (<20% of total calories, or in the neighborhood of 40-50g/day).  My dabbling in low-fat eating in the past month or two suggests that Ray Peat may be on to something when he talks about the Randle Cycle.  He says glucose oxidation is impaired by a high fat diet and/or fatty acids in the blood stream.
  • Higher carb in order to reduce stress hormones (namely, cortisol) (>250g carbohydrate) – Nearly all in the form of simple sugars – no starches, as those make me depressed, with the goal of eating at least a 2:1 carbohydrate:protein ratio.
  • High calcium intake (nonfat dairy, most likely), low phosphate intake (less meat).  I’m going to shoot for a 1:1 calcium:phosphate ratio.
  • I’m not going to make any effort to restrict calories.  That’s stressful and no fun.

Change my supplement routine to include the following:

  • Aspirin 100mg 3x/day
  • Niacinamide 100mg 3x/day
  • Vitamin K2 1mg 3x/day
  • Cynoplus (T3/T4 combo) increased from 1/4 tab daily to 1/4 tab 2x a day.  I may increase further in a few weeks, but that’s it for now.

The aspirin reduces inflammation.  Niacinamide inhibits the release of free fatty acids into the blood, and vitamin k2 ensures that blood clots normally despite the aspirin, and that calcium goes into the bones rather than the soft tissues.  Cynomel provides thyroid hormone that I don’t seem to be making enough of (evidence: total cholesterol of almost 300).  I’ll continue to take Vit D (5000 IU), Vitamin A (2500 IU), and Magnesium Glycinate.

Knowing that I have a tendency toward poor planning and then eating whatever’s available, I’m going to create some accountability for myself with this blog.  I’m going to post a screenshot of what I enter into Cronometer every day.  Here’s today:

Crono1

This will make it difficult for me to rationalize eating things that don’t support my goals.  Also it’ll force me to take a critical look at what I’m eating each day so I can learn from it and do better.  Today, still too much meat…instead of chicken breast I should have had more dairy or something with gelatin in it.  At the time I just wanted to stop feeling hungry – a big dose of meat does that well.  Time to learn new strategies.

Macro % today:

  • Protein: 30.9%
  • Carbs: 50.4%
  • Fat: 18.6%

More to report tomorrow.