Getting Healthy

It has been most frustrating over the past years to watch my weight gradually climb – and every time I managed to lose five pounds, they’d all come right back and bring a friend. At one point I mentioned it to my rheumatologist, but she said it wasn’t a problem and she was more concerned about getting inflammation under control. But the cardiologist told me, “The computer says you need to lose about 30 pounds.”

Well, the computer was being conservative because it was more like 40-50 pounds that I wanted to lose. I tried counting carbs. I tried AIP. I half-heartedly tried a few other things (I could have stuck with them if they showed results, but gave up when they didn’t seem to work). Finally, I started researching nutritional theories. And while I’ve learned tons and feel a lot better, it wasn’t showing up on my scale.

Painful joints teach us to be efficient in motion. Instead of exercising faithfully and blithely running up and down stairs whenever the need hits, we learn to plan our activities carefully and send family members to fetch things for us. This can result in significantly reduced movement — which eventually leads to weight gain. At long last, I’m finally figuring out how to lose weight – not to be fixated on a number on the scale, but in an effort to improve my health as much as is reasonably possible given my sucky health challenges.

This year for my birthday my husband bought me some coaching sessions with a health coach (to be clear, this was not some passive-aggressive hint; I’ve been on this health coach’s wait-list for months; hubby is extremely supportive of doing whatever it’s going to take to get me healthy again). And I’m learning a few things.

Basal Metabolic Rate is a thing. I’d never heard of it. BMR estimates how many calories the body uses to maintain a baseline of life just sitting on the couch, not doing anything. So your BMR tells you how many calories you need to eat to live if you want everything to stay the same. As you add activity, you also need to fuel that activity so would need more calories. And if you don’t want everything to stay the same (you want to lose or gain weight), you would take in more or fewer calories than needed based on BMR. There are lots of free BMR calculators online and they all seem to have slightly different results. This is the one that provides results closest to what my health coach came up with.

Calories count. Perhaps this seems obvious to some people, but I’d had the vague impression that counting calories was outdated, and that it was more important to look at macro-nutrients and get the right proportion of protein:carbohydrates:fats. Turns out that these approaches are not mutually exclusive. We should be looking at both calories and macros. I’m not sure why so many people are emphasizing counting carbs without any acknowledgement of the role that calories play in the equation.

Restrict calories to lose weight. But how much? Conventional teaching says 3,500 calories equals one pound, so if you cut 500 calories per day, you should lose one pound per week. Stick with it for a year, and you’ll lose 52 pounds in that year. That’s the theory, but it doesn’t actually work that way in real life. In all honestly, I’d bet most people don’t know how many calories they’re eating to begin with, so have no gauge to determine what that -500 level would be. Add in the fact that different people have different metabolisms. I can see metabolism illustrated most clearly by looking out in my pasture. Our horses all eat the same thing; one is fine grazing in the pasture year-round, but one gets fat and will founder if we don’t pen him up and severely restrict what he eats (this type of horse is called an “easy keeper”), and another horse drops so much weight that his ribs stick out if we don’t supplement extra calories for him even though he eats all day long. So while that 3,500 number is an easy guideline to teach and cite, real people have real lives and real metabolisms that call for customization.

For my situation (other people would have their own unique situation), the health coach recommends eating about 250 calories a day below the BMR number. It comes down to eating nutrient-dense food, and not munching on empty calories.

Protein is essential. At my last session with the health coach, a follow-up after implementing his initial recommendations for a bit, I was told to increase my protein intake. It’s still something I’m trying to figure out. Apparently when we are trying to lose weight, our bodies are lazy and target the easy calories to burn, which means that we start to burn muscle instead of fat – not at all our goal! We need extra protein to build muscle and convince our bodies to burn fat stores instead. It sounds like precise recommendations vary based on personal genetics. For now, my goal is to get 30% of my calories from protein – which works out to a lot more protein that I’ve been eating!

Fat has a lot of calories! While fat makes things taste good, and makes us feel full, it hogs the calories. The rule of thumb is that proteins and carbs both have about 4 calories per gram, while fats have 9 calories per gram. It’s supposedly why fattier cuts of meat contain more calories than lean cuts of meat. It also explains why that healthy salad ends up having a not-so-healthy zillion calories when we add avocado and olives and salad dressing. So on the one hand we need fat to feel full, but on the other hand, too much fat will use up our entire day’s worth of calories without providing necessary vitamins and minerals. It’s worth taking the time to figure out how much you need, and skipping what’s not necessary.

Veggies matter and they’re not equally beneficial. We can’t eat tons of lean protein for all our calories. Not if we want to be healthy long-term. About 40% of our calories should come from carbohydrates. That means eating veggies, not roots nor grains, and limiting sugary fruits. The more I’m learning, I like the variety provided by Dr. Terry Wahls’ categories of produce. Dr.W recommends eating – every day:

  • Leafy greens like lettuce, spinach, kale, arugula, bok choi, and leafy tops from things like dandelion, chicory, turnips, radishes, and beets — these provide vitamins B, A, C, and K (Dr.W calls them Vitamin BACK).
  • Sulfur-rich foods like asparagus, alliums (onions, garlic, leeks…), brassicae (broccoli, cauliflower, kale, radishes, cabbage, Brussles sprouts, turnips…), and mushrooms.
  • Antioxidant-rich brightly-colored fruits and vegetables, getting at least three colors every day
    1. Red group: raspberries, strawberries, red huckleberries, tomatoes if tolerated (AIP omits all nightshades, including tomatoes), beets, red cabbage, cherries, red grapes, pink grapefruit, rhubarb, watermelon…
    2. Orange/Yellow group: squash & pumpkin, carrots, mango, papaya, apricots, peaches, nectarines, sweet potatoes, yams…
    3. Blue/Black/Purple group: blackberries, marionberries, blueberries, boysenberries, elderberries, dates, figs, plums, prunes, grapes, olives
    4. Green group: artichoke, celery, avocado, cucumber with skin, zucchini with skin, honeydew, kiwi, all the leafy greens

Dr. Wahls tries to make it easy and says to eat three cups from every category every day, but I think that’s just to make things easy and the exact quantities aren’t based on research (although I think the categories are). There’s no reason to think that a 6’4″ man and a 5’2″ woman have the same nutrient requirements, so there should not be a single blanket recommendation. It’s a good starting point, though, to recognize that we need a LOT more vegetables than most of us eat, and that we need a variety of foods to get a variety of vitamins.

Steak with mushroom-huckleberry sauce, green salad, and mashed cabbage.

I’m enjoying the challenge of planning meals that provide nutrients instead of just filling our stomachs (even if it is a bit of a challenge when we’re away from home). Instead of a “what should we eat?” approach, I choose a protein, varying from day-to-day what our protein source is, then try to round out the meal with a leafy green, a sulfur source, and something brightly colored – again, varying from day-to-day.

Keep track of everything that goes into your mouth. Apple has an app called Nutrients that I really like for looking at all the micronutrients in food, but for ease of use (ignoring micros), I like the free version of MyFitnessPal better. Take a minute to customize your setup: under goals MFP lets you enter your daily calorie goal, and then adjust the macro ratios to get the app to calculate how many grams of protein:carbs:fat that will work out to each day. Then, throughout the day, as you enter everything you eat, you can track your progress toward those nutrient goals. I’ve found it most helpful to enter things before I eat. Eating something and then entering it afterward can lead to, “Oops, I shouldn’t have eaten that” moments. Writing it down helps because 1) it helps to know what you’ve eaten, 2) there are times you won’t eat something you shouldn’t because you don’t want to have to write it down.

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Another tool I recently discovered and am finding interesting is called Body Weight Planner. It was referenced in a Today’s Dietician article titled “Farewell to the 3,500 Calorie Rule.” This tool can be found on the NIH’s website. Body Weight Planner lets you enter your current and target weight, current activity level, and date by which you want to lose the weight. It will then estimate how many calories you should be eating every day to reach that goal and provides a cute little graph estimating your progress.

The trend line is easy to see, and people can visualize that some folks will lose weight faster, while some will lose slower. Additionally, the graph shows pretty clearly the tendency that people have to celebrate with cake & ice cream when they finally reach their goal, bouncing up a few pounds.

If your goal is not realistic, Body Weight Planner tells you that, too. You can then take more time to lose the weight, or change your goal weight, or add some exercise. If you decide that you want to add some exercise, there’s a place to indicate that you intend to change: the “physical activity change” feature lets you add walking/cycling/jogging/swimming and then makes calculations to reflect your adjustment.

The results section tells you how many calories you should eat to maintain your current weight, given the activity level you entered. Obviously, if you enter inaccurate info, then your results won’t match up. It also tells how many calories to eat to lose at the indicated rate, and then says how many calories you’ll eat to maintain your goal weight.

The Resting Metabolic Rate calculated by this tool is fairly close to the BMR my health coach came up with. I fiddled with the timeline until the daily calories matched what my health coach recommended. If the model is accurate (and I stick with it), I should reach my goal weight by Christmas!

If you, too, are including weight loss in an effort to get healthier and want to buddy up, I’ve created a new MFP account and am WarmSocksOnMFP. Feel free to send me a friend request over there.

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Exercise is as big a challenge as planning healthy meals. For now, I’m sticking with exercises from my physical therapist. I’m hoping that at some point, my health coach can suggest exercises I can do at home that will spare my joints and spine, yet allow even more improved health.

Autoimmunity & the COVID Vaccine

While I have enjoyed my 14-month vacation, I’m ready to start socializing again. And while I grieve for the businesses that have failed and the people who lost their jobs, as well as my son and all the other athletes/thespians/etc. who lost their senior year, I have loved getting to stay home instead of having to always be on the go. It’s been peaceful and relaxing, and I haven’t had to dream up excuses to get out of invitations. Since February 2020, aside from taking my youngest to college, the only places I have been are to doctor appointments and the grocery store. I did not have my family over for Thanksgiving or Christmas, and my mom’s 80th birthday party was virtual. I have not been to church in over a year. My weekly knitting group has continued to meet, but I have not attended. I don’t even have to drive to every doctor’s appointment, which saves me about two hours per visit thanks to virtual medicine! I love getting to stay home, but I don’t want to have to stay home. IF the vaccine is safe and effective (that’s a big if), people could start meeting together again. I might like to do that once in a while.

But do the benefits of this vaccine outweigh the risks? Never have any vaccines (even MMR) seemed so controversial as the COVID vaccines. We see people thrilled that a vaccine is finally available and who signed up as soon as they possibly could. We see others who vow they will never get the vaccine, no matter what. And there are people in the middle, who support the idea of a vaccine, but have questions and concerns about what’s currently available.

Full disclosure, I am in favor of vaccines (see Vaccines, Vaccine Safety, Is the Polio Vaccine Safe?, and Why I Got the H1N1 Vaccine). I have friends who are anti-vaxers and friends who are not. I have family members who believe they had C19 in the first wave, January 2020. I have family members who are in medical and nursing school so who have been able to provide different perspectives and better information than the media. I have friends and family members who have been vaccinated already, and I have friends and family members who say they will never be vaccinated. I’ve heard a lot of arguments on various sides of this issue.

Yesterday my family physician’s office phoned to recommend that I make an appointment for the vaccine. And I just don’t know. I support the idea of a vaccine. I’m just not convinced that the COVID vaccines are appropriate at this point.

  • Vaccines might not work for people who are immunocompromised. A study recently published in JAMA looked at a subset of immunocompromised patients – specifically, 436 transplant recipients – and tested for antibodies to see if the vaccine actually worked. Only 17% of patients developed antibodies, which doesn’t give me much hope that the vaccine is effective. It’s significant to note that of the 76 people who did develop antibodies, 69% had the Moderna vaccine and 31% had the Pfizer-BioNTech vaccine – we’re not told whether the full group of 436 had equal numbers of people receive the two different vaccines (and this was done before J&J’s vaccine was available so there is no data at all on that one). This was transplant recipients, not people with RA, so we don’t know if the same thing would apply to others. My doctor was not aware of this study and was going to do some research and then get back to me. They said that they’d call today, but I still haven’t heard anything.
  • At Washington University in St. Louis, they are doing a study that would be more applicable to people with RA, but those results are not available yet. Since results were estimated to be available in late February or early March, I’m curious why those results have not been released. Either the results support vaccination or they don’t. If they do, you’d think results would be published in an effort to persuade people.
  • There is no safety data yet. When they come out with a new flu vaccine every year, they use the same technology and just swap out the specific strain – so even though it’s a “new” vaccine, we have safety data from prior years and can trust that the vaccine is relatively safe. At least, that’s what we’re told. That’s not what they did with this vaccine. The companies that developed a COVID vaccine used entirely new technology. While manipulating RNA might be an exciting concept in the laboratory, we don’t generally use the world-wide public as a series of petri dishes; we have small-scale clinical trials first to establish efficacy and safety, then expand to get more data. That wasn’t done, and while I understand the definition of emergency, it hasn’t been demonstrated that an unproven vaccine is the most appropriate response to said emergency. In the past, some drugs and vaccines which went through a rigorous approval process were later pulled from the market due to safety concerns (for instance, in 1976, the swine flu vaccine caused an increased chance of GBS; in 1998, the rotavirus vaccine caused bowel obstructions in some infants). COVID vaccines haven’t even been through that rigorous process; they got emergency approval. We have no way of knowing twenty years down the road if it will turn out the vaccine was really safe. We don’t even have two-year data. I have no problem with people who are willing to be guinea pigs; my problem is with making the vaccine mandatory (which apparently some employers are talking of doing). Nobody should be compelled to get any vaccine until the safety data is conclusive.
  • We have no recourse if things go wrong. With some vaccines in the United States, people who can prove they were harmed by a vaccine can file a claim with the National Vaccine Injury Compensation Program. First, VICP keeps changing the rules to that program to disqualify the most common injuries, which means that people who are injured are often SOL. More pertinent to this discussion is the fact that the COVID vaccine doesn’t qualify for VICP. Instead, COVID would theoretically fall under the Countermeasures Injury Compensation Program. It appears that the goal of this program is to avoid paying claims, not to help people. To date, zero COVID claims have been paid. None. Nearly 2,000 of the people who received the COVID vaccine suddenly dropped dead within three days, yet all were ruled completely unrelated to the vaccine. And while I understand that there are those who will always try to take advantage and will file a claim in hopes of getting a windfall, I also have trouble believing that people who were already at death’s door bothered to go get vaccinated. The government has created a situation where people don’t trust that we’re being told the truth. Think about the GSWs that were counted as COVID deaths – just as they lied to make the numbers look worse, they can just as easily lie to get out of paying claims. And I understand that things can go wrong when we get sick, but that is very different than being harmed by something that is supposed to help you.

Rheumatologists are told to talk with patients about getting vaccinated. ACR even published guidelines for that discussion. And I find it interesting that they acknowledge that lack of long-term safety data is a concern, they acknowledge that other conditions could be a factor, then rush right on to discuss how to coerce patients into getting vaccinated without ANY mention of how to address those concerns. Really? As a person who has had a bad reaction to a vaccine and who has numerous allergies including anaphylactic reaction to shrimp, I believe those concerns should be addressed instead of brushed aside. My mother had a long career in the medical field and ultimately had to retire early after developing a latex allergy; she’s understandably hesitant to be vaccinated. If someone has managed to make it over a year without getting sick, couldn’t the same precautions continue until we have a little more safety data on this brand new technology?

That’s just my thoughts. Part of me is tempted set aside all my misgivings and just make sure my will is updated so I can go get the shot. I’d prefer to see another year or two of safety data, but it would be nice to get back to seeing friends every once in a while.

International Foundation for Autoimmune & Inflammatory Arthritis has added a page to their website for answering questions that people might have about the vaccine. The slant there is pro-vaccine, not my I’m-just-not-sure. Go check it out.

Regardless of which way you choose, stay safe!

I Am Not Afraid

I am not afraid of being hit by a car.  That’s not to say that I would want it to happen; it’s just not something that I live in fear of.  Most of the time, I don’t even think about the possibility. Instead, when the situation warrants, I take precautions because I recognize that being hit by a car can be deadly.  Even when it’s not deadly, recovery from the injuries can be painful, time consuming, and expensive.  Therefore, I don’t play in the freeway. I look both ways before crossing the road.  Basically, I am careful to avoid situations that would increase the likelihood of my being hit by a car.

And I am not afraid of being infected with SARS-CoV-2 and contracting Covid-19, but it’s not something I would particularly want to happen any more than I want to be hit by a car.  I recognize that the disease can be deadly, and even when it’s not, recovery can be painful, time consuming, and expensive.  So I take reasonable precautions.  Basically, I am careful to avoid situations that would increase the likelihood of my being hit by disease.

There are times that it might be safe to play in the road.  For instance, when I was young, we lived on a cul de sac.  It was common for all the neighborhood kids to play in the road – running races, playing tag, kick-the-can, red-rover…  While playing, we all kept a look out; if a car turned onto our road, everyone shouted “CAR” and dashed into the nearest yard.  That was long ago.  I no longer live on a cul de sac.  Where I live now, the speed limit is 50 and nobody drives that slowly.  It would be foolish for kids to play in the road here.  Circumstances can affect what’s safe and what isn’t.  Cul de sac – maybe safe.  Major thoroughfare? Not so much.

Likewise, in disease prevention, circumstances can affect what’s safe behavior and what isn’t.  People who are young and healthy, eat a perfectly nutritious diet, and have a robust immune system might feel comfortable in groups of germy people – just like I was comfortable playing in the road as a child.  However, there are people who have health considerations that make it a bad idea to engage in risky behavior.

And guess what?  You don’t know just by looking at someone what their circumstances are.  That person who is staying home instead of getting together with friends?  Maybe that person has asthma.  Or diabetes.  Or has another health condition that means always taking extra precautions to avoid germs.  People should not need to divulge their medical history to others to avoid ridicule, and should not have to justify why they are taking steps to stay healthy – steps, by the way, that they may well have discussed with their team of physicians long before the events of 2020 ever hit.  Other circumstances are at play, too.  In some industries, if an employee gets sick, the county can shut down the business for a month.  One sick individual can put hundreds out of work.  It’s prudent for people to be cautious in their interactions and avoid those who are not careful about avoiding germs.

This year, I am having a peaceful Thanksgiving at home.  For the first time in over thirty years, nobody is invited to join us.  I will not be sad nor alone. I’ll be thankful for family who understand. Some of the folks who might have come have been gathering in groups, eating at restaurants, and choosing to live as if China did not let loose yet another disease on our world.  That is their prerogative.  For myself, I am choosing not to play in the freeway.  That doesn’t make me fearful.  It makes me prudent.