Modern Paleo offers writings and other resources by Objectivists on the principles and practices of nutrition, fitness, and health most conducive to human flourishing.
Here are the highlights:
This Modern Paleo Blog contains writings on those topics by people who seek the best that modern life has to offer, informed by a broadly paleo approach. It is managed by Christian W., and its contributors are paleo-eating Objectivists. (Christian will introduce himself in the next few days.)
I've written a fairly detailed list of core paleo principles, each with a slew of links for additional reading.
We'll be adding more resources to Modern Paleo with time.
What does Modern Paleo advocate?
We -- the contributors to Modern Paleo -- advocate a "paleo" perspective on nutrition, fitness, and health. We use the evolutionary history of mankind, plus the best of modern science, as a broad framework to guide our daily choices about diet, exercise, supplementation, and medicine. The core of the paleo approach to health is the diet: we eschew grains, sugars, and modern vegetable oils in favor of high-quality meat, fish, eggs, and vegetables.
My philosophy, in essence, is the concept of man as a heroic being, with his own happiness as the moral purpose of his life, with productive achievement as his noblest activity, and reason as his only absolute.
We live by that philosophy. We do not seek to return to the past: we want to fully enjoy the amazing benefits of modern life. We do not cling to dogmas or submit to authority: we think and act for ourselves, based on our best grasp of the relevant facts. We do not sacrifice our judgment or our values to others, nor ask others to sacrifice to us. We seek the best for ourselves by producing and trading voluntarily with other rational, productive people. We reject government controls and welfare on principle: every person should be free to live as he pleases, so long as he respects the rights of others.
As a philosophy, Objectivism is silent on scientific questions about nutrition, fitness, and health. Yet we regard Objectivism as compatible with a paleo approach.
By Diana Hsieh @ 4:00 PM
Last weekend, Dr. Mary Dan Eades posted on the effects standing and moving while working, rather than remaining sedentary: You Could Stand To Lose a Few Pounds. She writes:
For quite some time now, this very idea -- standing more -- has been something that Mike [Eades] and I have discussed at length in our ongoing search for what changed in our lives (and the lives of our peers) during the quiet slide from 40 to 60. What happened that could account for the difficulty so many of us clearly experience in holding the line against weight gain (let alone losing weight) as we age, even in the face of a eating about the same amount of food and doing about the same amount of exercise as we did in our younger years.
Then Dr. Eades describes the vast difference in daily movement when working as doctors in a busy medical practice versus working as writers and researchers. Finally, she discusses how that might relate to a person's weight. It's not so simple, but standing versus sitting might be part of the picture.
Here's the comment I posted:
Funny, I just posted to OEvolve about working while standing yesterday... I suspect you've hit on the next paleo "let's try this" meme.
Normally, I'm not active like you were as a doctor, but my pattern is to move around a fair bit during the day, both inside and outside. However, when I was seriously hypothyroid this fall, I was sedentary in the way that Gary Taubes describes in obese people in Good Calories, Bad Calories: I simply didn't move unless really necessary. (Even walking across the room was a chore; walking for five minutes with the dog made me want to lay down to rest.) That lack of ordinary movement destroyed my conditioning in just a few weeks; the effect was far greater than just not working out regularly. So perhaps wiggling around in an ordinary way has a greater impact on our fitness than most people suppose.
In any case, I do want to try converting my workspace to standing, and I've temporarily rigged it up to do that. However, my feet don't seem to be up to the task yet. They're tired! I think I need to ease into it.
I'm none too fond of my desk, so I'd love to put together a new setup, preferably so that I can stand most of the time, but perhaps with a bar stool to allow me to sit if I'm tired.
I tried a temporary set-up with boxes last weekend, but that didn't work well. To do work, I need a desk-sized solid surface, so that I can deal with papers, books, notes, etc.
By Diana Hsieh @ 8:00 AM
Although I regard standard pet food as junk unsuitable for canine or feline consumption, I loved this ad for Pedigree:
As I might have mentioned before, I've been feeding my dogs and cats a prey-model raw diet for nearly two years, with excellent results. Despite my vet's worries about bacteria, I've had far fewer gastro-intestinal problems with raw food than I did with supposedly high-quality wet food and kibble. They're all fit and trim, and their teeth and coats are fabulous. You can learn more here:
Basically, a prey-model raw diet is the diet that dogs and cats are adapted by evolution to eat. And boy oh boy, do they ever love to eat it!
In terms of purchases, my staple is the super-convenient six-packs of good-quality chicken thighs at Costco for $1 per pound. They come four thighs per pack; Conrad eats two per feeding. I'll also buy pork and occasionally beef when on sale, almost always for $1 per pound or less. I like to add chicken backs to the mix, particularly for the cats. Sometimes I'll cut up a whole chicken. Oh, and I feed canned salmon from Costco once per week too.
To prepare that, I spend about thirty minutes cutting up and mixing meat, bones, and organ meats for the beasts while I watch television or listen to a podcast about once or twice per week. My biggest constraint is freezer space when I find some good meat on sale.
If raw feeding seems unworkable for your lifestyle, then you might try grain-free kibble and wet food. However, that's really quite expensive, particularly for a large dog. Also, if you have a carb-addicted dog or cat, the kibble might not be a good option. Our cat Oliver was growing obese on a standard diet, despite my attempts to limit his intake. (He was pretty grumpy about that!) On raw food -- eating as much as he wants -- he's perfectly trim. However, a few months ago, I put the cats on grain-free kibble and grain-free wet food for a few weeks. Oliver got fat rather quickly. Oh, and he'd routinely up-chuck his food in the morning -- on the carpet, of course. So raw is definitely the best option for Oliver. But Conrad and Elliot did fine on grain-free food.
If you switch to raw feeding, I strongly suggest reading a bit about it beforehand. You don't want to feed ground meat to cats, for example, as that reduces much-needed taurine. You want to feed only raw bones: cooked bones are dangerous because they're brittle. You don't want to neglect organ meats or bones. And you might need to gradually adjust cats to raw food, as they're often rather persnickety.
If you've been feeding raw, tell us about it in the comments!
By Diana Hsieh @ 8:00 PM
A few weeks ago, I took the iodine loading test and bromine test from Hakala Labs. I've been meaning to report my results, as they were pretty surprising, but I've just been too busy. First though, let me tell you about the test.
The test requires that you take a 50 mg dose of Iodoral, then you collect your urine for 24 hours. You send the lab a sample of that urine, along with a report of the total amount of urine collected. The lab reports back your iodine and bromine levels in a few days. (You can test just for iodine, if you like.)
The test was relatively easy to do. You have to be at home for 24 hours to take the test -- unless you wish to carry your jug of urine in a cooler to the grocery store. (No? I didn't think so.) The jug of urine has to be refrigerated, so going to the bathroom requires some advance planning. Next time, to make the process easier, I'll likely set up the jug in a cooler in the bathroom. Of course, you have to make sure to remember to collect every last drop of your urine. (That's harder than it sounds.) Oh, and I discovered that my bladder had just slightly more capacity than the 16 ounce cup provided. (That was awkward!)
I had to stop taking my usual 20 mg per day dose of iodine for the two days before the test. The results were surprising: my digestion became sluggish almost immediately, and I felt like a bloated whale again for the first time in weeks. That disappeared shortly after I took the 50 mg dose of iodine for the test.
When I took the test, I'd been taking more than one milligram doses of iodine in the form of Iosol and Lugol's for 19 days, working my way from 1.8 mg to 24.7 mg. On average, I took nearly 19 mg per day.
So ... without further ado ... what were my results?
I excreted 46.2 mg of the 50 mg loading dose, over 90%. That's supposed to mean that I'm totally iodine sufficient.
That result made no sense whatsoever to me. Clearly, I have been iodine deficient, based on the remarkable improvements I've felt from supplementing with iodine. Yet I'd not been supplementing long enough to reach whole-body sufficiency, as that takes about 3 months of 50 mg of iodine per day. Plus, I felt the effects of just two days without iodine. So I can't be sufficient.
So what in the heck was going on? Here's what the lab report says:
If you excrete 90% or more, and are not taking iodine supplementation, this may be caused by:
1. A symporter defect in which iodine is absorbed but not taken into the cells properly.
2. An iodine organification problem where the iodine gets into the cell but does not attach to the lipid complex for activation.
3. Bromide may be interfering with the body's utilization of iodine.
I'm not sure about the first two possibilities, but I did have my bromine levels checked. And I excreted 37.8 mg of bromine in that 24 hours. That's quite high: the upper normal value is 10 mg.
The halides are a group of elements that share a similar size and shape. ... Fluoride, bromine, iodide, chloride and astatide make up this family. Iodine and chloride are the only halides that have therapeutic effects in the body. Bromide is a toxic element that has a chemical structure very similar to iodine. This similarity can cause bromine to bind to iodine receptors and possibly interfere with iodine transport in the body. Bromine is found in many food items such as bakery products, and some sodas, as well as many prescription items. In addition, bromine is found in many fire-retardant chemicals added to furniture, carpets, etc. Crops are sprayed with bromine as a fumigant for agriculture. When there is iodine deficiency present, bromine toxicity will be exacerbated. (Iodine, pg 82-3, citations omitted)
What are the effects of bromine on a person?
Bromine intoxication (i.e., bromism) has been shown to cause delirium, psychomotor retardation, schizophrenia, and hallucination. Subjects who ingest enough bromide feel dull and apathetic and have difficulty concentrating. Bromide can also cause severe depression, headaches, and irritability. It is unclear how much bromide must be absorbed before symptoms of bromism become apparent. Recent research has demonstrated that symptoms of bromide toxicity can be present even with low levels of bromide in the diet. (Iodine, pg 98, citations omitted)
Dull and apathetic? Difficulty concentrating? Depression? Gee, that sounds familiar! Those symptoms definitely improved with high dose iodine for me.
Also, Dr. Brownstein reports that fluoride has similar harmful effects on thyroid function. When added to drinking water, it doesn't affect rates of dental cavities. I'm dubious of its benefits when used topically, e.g. in toothpaste. My teeth and gums were in terrible shape, despite using a prescription-strength fluoride toothpaste for some years. I've enjoyed huge improvements in dental health with eating paleo, plus supplementing with cod liver oil and butter oil -- without that high-fluoride toothpast. So fluoride for dental health seems overrated, at best.
Exposure to high levels of bromine and fluoride in modern society might be why many people seem to need so much iodine -- about 12 mg per day as a maintenance dose -- for optimal health.
Notably, I'm definitely not endorsing these claims about the effects of bromine and fluoride and their relationship to iodine as the gospel truth. While they seem to fit my own experience, I'm hardly qualified to judge the underlying scientific claims. (I hate being a layperson, particularly where my very capacity to live a meaningful life is at stake!)
So... supposing that bromine and fluoride toxicity is a genuine problem for me, what do I do?
Mostly, I take my daily dose of iodine, in the form of Iosol and Lugol's. I'm currently varying between 24 and 50 mg per day, somewhat at random. Dr. Brownstein's tests of his patients show that high-dose iodine supplementation enables the body to excrete bromine over the course of several months, until levels fall to normal. Fluoride seems to be excreted with iodine supplementation too, but more quickly. Happily, that supplementation is super-easy and super-cheap.
As an extra preventative measure, I've been trying to identify and eliminate sources of fluoride and bromine in my diet and environment. We bought an under-sink reverse osmosis system for our drinking water. That filters out everything -- including the natural fluoride in our water (2 ppm average), as well as pesticides, herbicides, and the like. I've stopped brushing with toothpaste with fluoride. (I use what I used as a kid: baking soda.) Tea apparently contains some fluoride, but I don't think the cup per day that I drink poses much of a problem.
I've not been able to identify many clear sources of bromine in my diet or environment. It's in hair dye, and I've dyed my hair continuously for the past few years. (That's now stopped, at least temporarily.) I don't eat bread any longer, and I've never drunk Mountain Dew or other sodas. My father never used bromine in our swimming pool when I was a kid. I don't know whether it might be in our carpets or my clothing, but if so, I can't do much about that. I could switch to organic vegetables, but I'd like to avoid that hassle and expense, if possible. (But I hope to grow plentiful vegetables in my own garden this summer!)
I do wonder -- as a super-sketchy hypothesis -- whether my own fat stores might have been a major source of bromine. Bromine seems to be stored in fat tissue. Perhaps I'd accumulated it from various sources over the years, then retained it in fat tissue due to insufficient iodine intake. Losing about fifteen pounds over the course of six months in 2008 on a paleo diet might have released a good amount of bromine into active circulation in my body. Due to my super-low iodine intake at the time, I couldn't excrete it. Instead, it took the place of iodine in my body, and that interfered with thyroid function. Notably, I had low-grade symptoms of hypothyroidism before I switched to a paleo diet, so I'm sure that was in my future, but perhaps the bromine contributed to my hard crash this past fall. Mostly though... I have no clue!
In any case, I plan to repeat the iodine and bromine test in a few months. Hopefully, I'll see lower levels of bromine excretion and greater iodine uptake.
Dr. Davis, the Heart Scan Doc, is offering 30 minute, one-on-one video consultations. As I said on OEvolve: "I can't imagine that most people on this list would need that, as we're a pretty well-read, well-informed bunch. However, I can see that someone's less-informed mother, father, friend, or whatnot might benefit from it."
Does consumption of saturated fat reduce insulin sensitivity and thereby put us on the path to diabetes? The conventional wisdom is "Yes," but Stephan Guyenet looks at the relevant studies and finds that the answer is "No." So what does reduce insulin sensitivity? Sugar (particularly fructose) and magnesium deficiency seem to be two major culprits.
The fascists in Washington are seeking greater control over supplements and raw milk cheese. These *@&#% aren't content with forcing us to be poor and stupid: they want us to be sick and miserable too!
I'm delighted to report that Kelly Elmore has seen some remarkable improvement on desiccated thyroid and iodine. Here's her before post and after post. Lady Baker is also doing better on iodine alone, as she reports in her before post and after post. Hooray to feeling better!
Jimmy Moore put together a great post on Whole Foods' new program to promote low-fat, high-carb eating. He's right to be critical of the program, but I don't plan to boycott Whole Foods, as some others are doing. Whatever his errors on diet, John Mackie has earned my respect for his free-market opposition to Obamacare. Plus, Whole Foods doesn't plan to change its product offerings. If it does, then I'll shop elsewhere.
Since late December, I've taken my temperature three to four times per day with this basal thermometer. For greater accuracy, I don't take my temperatures for a half hour before or after eating or drinking, nor after exercise. I try to avoid breathing through my mouth (as of often do, as I have narrow nasal passages) for a while beforehand. I record the value and the time in the spreadsheet, then I calculate the average and the range each day.
During that time, my temperatures haven't changed much. That's not surprising. Even though I've seen a dramatic improvement in my other hypothyroid symptoms after starting high-dose iodine and desiccated thyroid in mid-January, I still feel cold -- not just in my hands and feet but in my innermost guts -- most of the time. Some other symptoms, like dry skin, as as bad as ever.
So let's get to the numbers. From December 21st to February 5th, my average temperature has been 96.76°F. The median is 96.85°F. The standard deviation is .69°F. The range is 4.40°F.
Here's the chart of temperature over time (click to enlarge):
Here's the chart of frequency of temperature values (click to enlarge):
As you can see, my temperature mostly ranges from 96.0°F to 97.2°F. That encompasses 68% of the readings (i.e. 101 of 148) -- meaning two standard deviations.
My low was 93.92°F on January 29th. I was sitting at my computer, on a heated pad, under a fleece blanket. I began taking my temperature as I felt myself growing colder and colder. When it got that low, I just couldn't do anything but sit. Then, as it began to rise back to 96°F, I began to feel better. Notably, that was after a few days of terrible stress over a friendship. That's reflected in the wild temperatures I got around that time in the first chart. (Perhaps my adrenal glands were going haywire.) Since then I've made a concerted effort to chill out relax.
I hope to see a rise in body temperature -- and to feel a warm glow in my belly -- if my doctor increases my dose of desiccated thyroid from 1.0 to 1.5 grains with my next round of labs later this month.
Update: I forgot to mention something. When I ate the Standard American Diet, I felt mildly cold most of the time, not just in my hands and feet but in my core. My temperatures were also low, albeit not as low as they are now. When I began eating paleo, I was amazed to feel so much warmer. I didn't need the seat warmer in my car and my office; I wore lighter clothing around the house during the winter. It was fantastic! The only time I would feel cold was after I'd been fasting for about 20 hours or more. That's one reason why I'm pretty sure that I was mildly hypothyroid before I began eating paleo, even though my TSH was in the official normal range. (I'll say more about that in another post, however.)
By Diana Hsieh @ 2:00 PM
One difficulty of diagnosing and treating hypothyroidism is that many of the standard symptoms are highly variable between individuals, not well-correlated with lab values, difficult to measure, and not unique to hypothyroidism. Doh!
Generally, the average temperature of an adult with a healthy thyroid and a healthy metabolism is 98.6 degrees Fahrenheit or 37.0 degrees Celsius, and that occurs around mid-afternoon or 3 pm. So if you take your mid-afternoon temp and find it in low 98's or even in the 97's, you have been given a strong clue that you may be hypothyroid. And a few report their mid-afternoon temp being in the 96's. BRRRR.
Another temperature clue is to take it before you rise from your bed in the morning. Dr. Broda Barnes, a doctor who paid attention to clinical presentation and prescribed Armour, found that a healthy before-rising morning basal temp should be between 97.8 - 98.2. If it's higher, you may be hyperthyroid, and if it's lower, you are most likely hypothyroid. He also recommended under-the-arm temperature testing, but patients have found oral to be just as effective.
Additionally, once you are on natural desiccated thyroid like Armour, and are consistently raising your doses, you will see your temps climb to healthy levels with increasing feel-good symptoms to match. In many patients, reaching 98.6 can happen before you are even on your optimal amount of Armour.
Janie also thinks that fluctuating temperatures can be a sign of adrenal fatigue. That's a controversial diagnosis, but given the abysmal failure of the standard treatment of T4-only medication for so many people, I'm inclined to side with Janie's experience.
Dr. Davis also recommends using body temperature in the diagnosis and treatment of hypothyroidism. He writes:
Is there an at-home test you can do to gauge thyroid status?
Yes. Measure your temperature.
Unlike a snake or alligator that relies on the sun or its surroundings to regulate body temperature, you and I can internally regulate temperature. The hypothalamus-pituitary-thyroid glands are the organs involved in thermoregulation, body temperature regulation. While the system can break down anywhere in the sequence, as well as in other organs (e.g., adrenal), the thyroid is the weak link in the chain.
Thus, temperature assessment can serve as a useful gauge of thyroid adequacy. Unfortunately, temperature measurement as a reflection of thyroid function has not been well explored in clinical studies. It has also been subject to a good deal of unscientific discussions.
He recommends taking an oral basal temperature -- meaning as soon as you wake up, before you get out of bed or do anything. What temperature are you looking for?
Though there are scant data on the distribution of oral temperatures correlated to thyroid function, we find that the often-suggested cutoff of 97.6 degrees Fahrenheit, or 36.4 C, seems to track well with symptoms and thyroid laboratory evaluation (TSH, free T3, and free T4). In other words, oral temp < 97.6 F correlates well with symptoms of fatigue, cold hands and feet, mental fogginess, along with high LDL cholesterol, all corrected or improved with thyroid replacement and return of temperature to 97.6 F.
Of course, hypothyroidism is not equivalent to low body temperature -- any more than it's equivalent to high TSH. It's just one sign among many symptoms and signs. And I think it's a potentially useful sign.
However, I do have some questions about body temperature, some of which Richard Nikoley touched on in this post.
First, what's the optimal range of body temperature? How much does it vary between persons?
It's easy enough to determine average temperature in a population: just take a slew of temperatures. Determining optimal temperature is a whole new ball of wax -- particularly if many people suffer from undiagnosed hypothyroidism! Plus, the optimal body temperature of a person eating a high-carb vegetarian diet might differ markedly from a person eating a high-fat paleo diet. Similarly, the sedentary person might have a different optimal temperature than the avid crossfitter, marathoner, or weightlifter. And perhaps genetic origins matter too: Inuits might differ from Polynesians. Moreover, perhaps individuals with very similar backgrounds and lifestyles vary in their optimal temperature due to random features of their biology.
In short, knowing the average body temperatures and standard deviations of seemingly healthy people is a far cry from knowing your own optimal body temperature.
Most people think of a "normal" body temperature as an oral temperature of 98.6F. This is an average of normal body temperatures. Your temperature may actually be 1°F (0.6°C) or more above or below 98.6F. Also, your normal body temperature changes by as much as 1°F (0.6°C) throughout the day, depending on how active you are and the time of day. Body temperature is very sensitive to hormone levels and may be higher or lower when a woman is ovulating or having her menstrual period.
They also indicate that an oral temperature of less than 96F indicates low body temperature. (I've had plenty of temperatures below 96.0 lately, but I'll post on that separately.)
However, even the standard number of 98.6 is controversial. Here's a report from Harvard Medical School:
The 98.6° F "normal" benchmark for body temperature comes to us from Dr. Carl Wunderlich, a 19th-century German physician who collected and analyzed over a million armpit temperatures for 25,000 patients. Some of Wunderlich's observations have stood up over time, but his definition of normal has been debunked, says the April issue of the Harvard Health Letter. A study published years ago in the Journal of the American Medical Association found the average normal temperature for adults to be 98.2°, not 98.6°, and replaced the 100.4° fever mark with fever thresholds based on the time of day.
Now, researchers at Winthrop University Hospital in Mineola, N.Y., have found support for another temperature truism doctors have long recognized: Older people have lower temperatures. In a study of 150 older people with an average age of about 81, they found that the average temperature never reached 98.6°. These findings suggest that even when older people are ill, their body temperature may not reach levels that people recognize as fever. On the other hand, body temperatures that are too low (about 95°) can also be a sign of illness.
The bottom line is that individual variations in body temperature should be taken into account, reports the Harvard Health Letter. Ideally, you and your doctor should have enough temperature measurements at various times of day to establish a baseline for you. Short of this, recognize that 98.6° isn't the benchmark that we've long believed it to be.
So perhaps the best way to know your own optimal body temperature would be to record a series of body temperatures when you feel well with a good-quality thermometer. I wish I'd done that a year ago.
Second, how can a person get precise and accurate measurements of body temperature?
That's a harder problem than you might think! The article "Temperature measurement in paediatrics has an excellent discussion of the problems with the various methods of measurement. (I'm omitting the citations, as well as some material relevant only to children. You can find that in the article.)
Rectal thermometry: Rectal thermometry has traditionally been considered the gold standard for temperature measurement, but some studies have revealed limitations of this method. Rectal temperatures are slow to change in relation to changing core temperature, and they have been shown to stay elevated well after the patient's core temperature has begun to fall, and vice versa. Rectal readings are affected by the depth of a measurement, conditions affecting local blood flow and the presence of stool. Rectal perforation has been described, and without proper sterilization techniques, rectal thermometry has the capacity to spread contaminants that are commonly found in stool.
Axillary thermometry: While axillary [armpit] temperature is easy to measure (compared with oral or rectal measurements), it has been found to be an inaccurate estimate of core temperature in children. This type of measurement relies on the thermometer remaining directly in place over the axillary artery, and it is largely influenced by environmental conditions.
Oral thermometry: The sublingual site is easily accessible and reflects the temperature of the lingual arteries. However, oral temperature is easily influenced by the recent ingestion of food or drink and mouth breathing. Oral thermometry relies on the mouth remaining sealed, with the tongue depressed for 3 to 4 min ...
The only good news is that (high-quality, properly-functioning) digital thermometers are as accurate as mercury thermometers.
As I said to Richard Nikoley when he e-mailed me that link: "I suppose that the most accurate method is the coroner's liver temp, but I think I'd rather avoid that!"
I've been so busy lately that I haven't posted a lot, but that doesn't mean I haven't been thinking about posting. I've got a number of things I've been wanting to write about that I plan to have up as soon as the Colpo deal is finished. I want to add my two cents worth on a bunch of the problems some Paleo dieters seem to develop. And I've got a post cooking on the thyroid and iodine. One on fructose, and one on saturated fat. Plus the analysis of the next stupid study that will inevitably pop up and seize the imagination of the mainstream media types who will shout it from the rooftops.
Hooray! I'll definitely owe him the sous vide meatball that I promised him. Then again, he might prefer if I wrote up a post on how to make them. (I have no idea... but here's a hint.)
I know that I've been all gushy for Dr. Eades of late... but he deserves it! Dr. Eades -- as well as Dr. Davis and others -- have been extremely generous in their blogging. I've benefited so much from their medical experience -- not just in my abstract understanding of the relevant science but in my rubber-meets-the-road well-being. They've earned my respect and my gratitude in spades.
Now to the real point of this post. In requesting a post on thyroid problems, I sent Dr. Eades the following questions as fodder. I have my own preliminary views and suppositions about some of them, but I'm very interested in his answers. Here they are, with links added:
Why did you choose to put your patients on desiccated thyroid rather than T4-only meds?
What do you think of using synthetic T4 plus T3 rather than desiccated thyroid? (Kurt Harris claims that synthetic hormones are exactly identical to those in porcine thyroid, and that the addition of T3 is the sole reason why people do better on porcine thyroid than T4-only meds.)
What do you think of the claim that a person can be hypothyroid despite basically normal lab results? What do you think about the concept of "Type 2 Hypothyroidism"?
Do you recommend dosing based on symptoms -- or by TSH?
Why do you think that hypothyroidism is so prevalent today? Why do you suspect that it affects more women than men?
What do you think of the standard view that any dose of iodine above a few hundred micrograms is dangerous, even potentially a cause of hypothyroidism? What is a standard safe dose? Is high-dose iodine dangerous for some people?
If a person suspects that they might be hypothyroid, what do you recommend that they do? Might iodine alone make a difference -- or stave off full-blown hypothyroidism?
By Diana Hsieh @ 8:00 AM
In prior posts, I've recommended this New Yorker article on the widespread problem of olive oil contamination: Slippery Business. That risk of contamination is one reason why I prefer to cook with coconut oil, lard, and butter.
This fascinating story about the possibility of massive government corruption of science might be a case when "toxic oil" was not to blame. In the early 1980s, a mysterious outbreak of illness in Spain left hundreds dead and thousands seriously injured. It was quickly blamed on contaminated cooking oil. In 1989, some oil producers were sent to prison, even though the supposed toxin in the oil was never identified. Similarly, as even supporters of the standard account admit, scientists haven't ever been able to reproduce the symptoms of the supposedly toxic oil in lab animals.
Even worse, even the epidemiological data looks like it was corrupted by a young government determined to quell the panic. The article says:
In order to demonstrate that the oil had caused the illness, government scientists needed to be able to show, for example, that families who had bought the oil were affected, whereas those who hadn't were not; that the aniline in the oil was indeed poisonous and that the victims were suffering from aniline poisoning; and, bearing in mind that such commercial cooking oil fraud had been widespread for years, just what had changed in the manufacturing process to cause the oil suddenly to become so poisonous. To this day, none of these basic conditions has been met.
You'll find the details in the article. The most fundamental problem is simply that the cause and the effects don't seem to match up: many sick people didn't consume the supposedly toxic oil, many oil-consuming people didn't become sick. And that's just for starters.
Do I know what happened here? Of course not. The article might be mere conspiracy-mongering; the author might be twisting the facts to manufacture doubt and controversy where none should exist. Or perhaps the author's complaints and doubts are completely justified. I can only say that, if the article is accurate in its basic information, the government's story doesn't merely smell fishy: it's stinks to high heaven.
The simple fact is that governments cannot be trusted with science. Scientists at the government trough are often quickly wedded to grand theories based on political pressure rather than evidence. Then, because they seek to maintain public trust above all else, they cling to those grand theories as dogmas, even as contrary data accumulates. In the process, they often cause serious harm to people by preventing them from living as well as they might -- or preventing them from living at all.
Essentially, to the extent that science is affected by political pressure, it works on the principle of stare decisis -- meaning "maintain what has been decided and do not alter that which has been established." To support their political paymasters, scientists must adhere to precedent, however wrong.
Of course, some scientists might be willing to buck political pressures, but they risk being marginalized or fired for speaking out. Others might be more remote from those pressures, and so able to do good work in quiet. But for any politically warm topic, I trust government science as much as I trust the State Science Institute on Rearden Metal -- meaning, not at all.
By Diana Hsieh @ 5:00 PM
After months of being lethargic, confused, fat, pained, and cold from my hypothyroidism, I'm finally on the mend! Although I'm not yet 100%, the turn-around was remarkable. Within just a few days, my worst symptoms of mental fog and lethargy were alleviated by rejecting the conventional treatment of synthetic T4 (e.g. Synthroid, levothyroxine) in favor of desiccated porcine thyroid plus high-dose iodine.
(Desiccated thyroid is dried pig thyroid; it contains the full range of natural hormones produced by the thyroid, not just T4. High-dose iodine means supplementing with 12.5 to 50 milligrams per day.)
When I was diagnosed as hypothyroid in early November, my TSH was only 3.23. That's barely abnormal, but I was suffering from most of the standard symptoms of hypothyroidism. (TSH above 2.5 suggests hypothyroidism.) My doctor put me on 50 micrograms of Synthroid, a synthetic version of the T4 hormone. Two months later, in early January, my TSH was down to 2.28, but my symptoms were somewhat worse. Also, my Free T3 and Free T4 were the same, still on the low end of the middle range.
Undoubtedly, I could have increased my Synthroid, eventually reducing my TSH to my doctor's target of around 1.0. Would I have felt any better at that point? Based on my experience on the drug for those two months -- when my lab values improved but my symptoms worsened -- I strongly suspect not. Instead, if I'd stayed on Synthroid, I likely would have been mentally and physically disabled for the rest of my life.
I'm not exaggerating. During those two months, I was unable to work, travel, or pursue any substantive projects. My weekly trip to the grocery store exhausted me, and I often couldn't muster the energy to slowly walk around the pastures with Conrad. My IQ felt about 20 points lower; I could only think at a very surface level. I was most definitely not flourishing. My mind and body seemed to be slowly shutting down.
Sadly, that's not an uncommon response to the standard regimen of T4-only medication. TSH might fall to normal levels, but the many debilitating symptoms of hypothyroidism remain. From what I've read in countless forums, too many doctors seem concerned only to treat the problem of high TSH, not the underlying problem of hypothyroidism. In particular, many doctors seem to ignore the fact that the body might not effectively convert the storage hormone T4 into the active hormone T3 -- or that tissues might not effectively use T3. Many patients on synthetic T4 medication complain to their doctor about their persistently raging hypothyroid symptoms, only to be summarily dismissed. After all, if the TSH is normal, all those classic hypothyroid symptoms simply must be due to something other than a poorly functioning thyroid -- like aging or poor diet or even hysteria. Or so they claim. (Such doctors equate hypothyroidism with elevated TSH, just as analytic philosophers equate concepts with definitions.)
The consequences of that mis-treatment are tragic. People suffer the degradation of living as a quasi-corpse for years and decades, unless they discover desiccated thyroid. (Or, in some cases, they suffer unless they find a way to return to desiccated thyroid, after some new doctor switched them from it to synthetic T4, often against their express wishes.) It's heartbreaking to read these stories. I know that, without dedicated and tenacious people like Janie Bowthorpe of Stop the Thyroid Madness, I could have suffered the same fate. Instead, I got off pretty easy with only two months of living as a semi-corpse on Synthroid.
At the time of my diagnosis of hypothyroidism in early November, I was aware that Synthroid might not work for me. However, given that I developed my hypothyroidism at the very height of a government-induced shortage of desiccated thyroid, I was willing to try it. Well, I got my answer by early January: Synthroid didn't do squat for me, except lower my TSH.
Happily, my excellent family practice doctor, Dr. Heble, was willing to switch me to one grain of desiccated thyroid, to see whether that might help. (One grain is the standard starting dose for desiccated thyroid, but it was an increase for me, based on this conversion chart.) By that time, I'd found a local source: Wise Compounding Pharmacy.
Just as I was making that switch from Synthroid to desiccated thyroid, I also began taking high-dose iodine, plus selenium. As I indicated in my first post on my hypothyroidism, I suspected that I might be deficient in iodine for three reasons.
Seafood is the primary natural dietary source of iodine, but I hated it until my mid-20s, and even now, I don't eat more than a serving per week.
Nearby oceans supply the soil of the east and west costs with iodine, but I've lived in the "goiter belt" for the last decade.
Then, perhaps tipping me over the edge, I switched from iodized salt to (low-iodine) sea salt when I began eating paleo in the summer of 2009.
(I'll say more on what I suspect about the origins of my hypothyroidism in another post, including its relationship to my lacto-paleo diet.)
Back in early December, I began cautiously supplementing with 150 micrograms of "Liqui-Kelp," gradually increasing that to 600 micrograms over the next month. (150 micrograms is the government's recommended daily allowance.) I never felt any positive results from doing that. However, during that time, I was reading about much, much higher doses of iodine -- between 12.5 and 50 milligrams -- as sometimes necessary for whole-body health, including improving thyroid function.
I was intrigued by that, but also very wary. Most doctors will say that milligram doses of iodine are dangerous. However, the claims of danger seem to be sketchy, seemingly based on poor-quality epidemiological studies. Plus, most people seem to be able to handle those milligram doses just fine, and many people see remarkable improvement on them. Also, from what I read in some standard medical sources, a person with a physically intact thyroid can handle that much iodine, but a person with a damaged thyroid (e.g. partly removed in surgery) will be unable to tolerate it. Also, some people with Hashimoto's do great on iodine, but others don't tolerate it well. So, with much trepidation, I decided to try milligram doses of iodine.
On Monday, January 11th, I began taking Iosol and Lugol's, working my way up to about 16 milligrams by the end of the week -- over 100 times the government's RDA. I also began supplementing with 100 to 200 micrograms of selenium each day. (Selenium is essential for thyroid health, you probably don't want to take iodine without it, and you definitely don't want to take more than 400 micrograms per day. That upper limit seems well-established.)
(Note: I don't have any special reason for doing both types of iodine, except my own confusion. Lugol's -- or the tablet form Iodoral -- seems to be the preferred form, as it contains both iodine and potassium iodide. From what I've read, different tissues prefer those different forms. Iosol contains only iodine. The milligrams of iodine per drop for J.Crowe's Lugol's Solution is here.)
On Tuesday of that week, I began feeling better: I was able to run some errands, then attend Ari Armstrong's "Liberty in the Books" economics discussion group. That amazed me, as doing both would have been impossible just a week before. Then, on Wednesday, I switched to the desiccated thyroid. Over the next few days, I felt amazingly better. My brain fog lifted, and my lethargy disappeared. I could think again! I could concentrate! I danced around the house, singing silly songs! I wanted to exercise again! I had energy to burn! Life was good again!
Most amazingly, within just a few days on the milligram doses of iodine, a 16-month bout of totally mysterious amenorrhea came to an end. (Sorry, TMI, I know... but it's important.) I was totally floored; I never expected that kind of result, not so fast! By way of background, the problem started after I went off the birth control pill in October of 2008. My doctor did a battery of tests over the summer, but nothing seemed wrong, except that my estrogen levels were very low -- like menopausal. Initially, we thought the problem was just that my reproductive system went dormant with the shock of going off the pill after about fifteen years of nearly continuous use. Once the hypothyroidism cropped up, my doctor wondered whether there might be some connection. Hypothyroidism is known to cause menstrual problems, albeit usually causing too-heavy periods. Now I wonder what my iodine deficiency did to my estrogen levels, if that's what happened. (Oh, and I'm not the only one.)
Never in my life have I experienced such a dramatic turn-around in my health, mind, and mood as I experienced that week on iodine and desiccated thyroid. If I weren't a intransigent atheist, I would describe it as a miracle. That's what it felt like: I got my life back -- I got myself back -- in the span of just a few days.
However, I had an epistemic problem. Although I knew that the improvement began before I switched to desiccated thyroid, I wanted to sort out how much was due to the iodine supplementation versus the desiccated thyroid. So after three days on desiccated thyroid, I switched back to my old 50 microgram dose of Synthroid. I stayed on that for about five days -- enough time to allow the T3 of the desiccated thyroid to fully clear from my system.
During that time on iodine plus Synthroid, I definitely felt a decline in my energy and mental function, although I was still significantly better than when on Synthroid alone. I was eager to get back to the desiccated thyroid, and I perked up again when I switched back to it. Interestingly, I'm going without iodine today and tomorrow, to prepare for an iodine loading test on Monday. I'm definitely feeling a fuzzy-headed today, perhaps due to that lack of iodine intake.
Overall, I would say that I was functioning at about 50% while Synthroid, at about 75% while on Synthroid plus iodine, and now I'm at about 90% with desiccated thyroid plus iodine.
Oddly, my symptoms are not all better. Instead, my body's response has been somewhat mixed. My brain fog is gone, and my powers of memory and concentration are much better. I have tons more energy, such that I'm able to put in a day's work. Overall, my mental function and energy levels should be about 10% better, I think. I've stopped gaining weight, but I've not yet lost any weight. My digestion is definitely better: I'm not chronically bloated, and I'm able to skip a meal without disaster. My carpal tunnel is somewhat better, but still bothering me somewhat. However, my body temperatures are still quite low, averaging about 96.5 F. My skin is still terribly dry.
I'm also able to exercise -- but wowee, I am so out of shape! I'd been increasing sedentary for the last few months, such that I barely moved in December. Now I can exercise, but my muscles are shaky and then sore from even mild weightlifting. Also, I used to be unable to exert enough energy to get winded, but now my wind is the major limiting factor when I row on our rowing machine. That's good!
Also, my goiter -- the nodule in my thyroid -- seems to have shrunk considerably. Before, I could feel a squishy spot on my neck, and I could see a slight bulge in the mirror. Now that's all gone. I'll have an ultrasound recheck in late March, and I expect good results from that.
I'm going to have another thyroid lab panel done in early March, and I expect that I'll be increasing my desiccated thyroid dose to 1.5 grains then. Also, as I mentioned, I'm taking an iodine loading test on Monday. I'll be very curious to see my results; I expect that I'm still iodine deficient, and that I can and ought to increase my daily dose, perhaps up to 50 milligrams per day for a few months. Paul -- who has been supplementing with just the RDA of 150 micrograms for the past few weeks -- will be taking his test when he can, likely next weekend. I'll be very curious to compare my results with his.
I've come to wonder whether iodine might be like Vitamin D -- in the sense that the miniscule amounts recommended by the government might be sufficient to ward off obvious illness -- rickets, in the case of Vitamin D and goiter, in the case of iodine. Yet a much higher dose might be optimal. I'm definitely not recommending everyone start taking large doses of iodine. However, if you're suffering from the symptoms of hypothyroidism, you might investigate iodine. And for everyone else, I recommend that you make sure that you obtain the recommended 150 micrograms per day.
Mostly though, I'd like to see some solid research and writing on the subject. While I've learned a great deal from the sources I've read, I've been frustrated by the inconsistent quality thereof. I'm not competent to dig up and read the primary sources in the medical literature: I'm purely a consumer of secondary sources. That makes me exceedingly nervous, as I know just how inaccurate secondary sources can be!
I have serious reservations about the scientific judgment of some of the sources I've read on iodine and hypothyroidism -- even though I often found them fascinating and helpful. For example, Dr. David Brownstein wrote a fascinating little book on iodine -- Iodine: Why You Need It, Why You Can't Live Without It. (He's also the author of Overcoming Thyroid Disorders.) His collection of articles on iodine (often co-authored) looked good too... until I got to the belligerent argument for young-earth creationism. Seriously. I don't think that Brownstein is lying about the tests he's done and the results he's gotten, particularly given that others have reported similar results. Yet I simply cannot trust the medical judgment of someone who appeals to the Flood (!!) and Satan (!!) to explain why the soils of some inland areas are deficient in iodine.
Similarly, while I was super-intrigued by what I read in Dr. Mark Starr's book Hypothyroidism Type 2, I was dismayed to read on his web site that he practices homeopathy and "energetic medicine." I just can't regard that as anything better than mystical quackery. The only bright side is that nothing in the book seems to depend on -- or even hint at -- those views, so perhaps that's all separate from his views on hypothyroidism. However, once again, I simply can't trust his medical judgment.
My basic approach is to take whatever seems grounded in good empirical science from these folks, then then integrate it with my own experience and reliable reports from others. Happily, I can strongly recommend one very practical book on hypothyroidism, namely Janie Bowthorpe's Stop the Thyroid Madness. Mary Shomon's book Living Well with Hypothyroidism also has some helpful suggestions, particularly for dealing with doctors unwilling to prescribe desiccated thyroid. And I've often found myself searching the archives of various Yahoo Groups, particularly Coalition for Natural Desiccated Thyroid, Natural Thyroid Hormones, and Iodine.
Mostly, I'm just desperate for a good, juicy blog post from Dr. Eades on the subject of hypothyroidism, desiccated thyroid, and iodine supplementation. He's probably the only doctor (along with his excellent wife, MD) whose judgment I can fully trust on this topic. He's got the deep knowledge of the relevant biology; he's got the years of experience treating patients with hypothyroidism; and he's got a good working epistemology.
Happily, Dr. Eades dropped some useful hints in the comments of a blog post on Oprah's weight gain. He recommends an iodine loading test, plus Iodoral (12.5 to 50 milligrams) for people who are deficient. And he always used desiccated thyroid for his patients, not synthetic T4. I was so relieved to read that, as I felt like I was leaping about in the dark, particularly on the iodine.
So ... Dr. Eades ... will you write that blog post on iodine that you promised in those comments? Pretty please... with a deliciously tender sous vide meatball on top?
A handy flow chart for figuring out whether to eat the food that you just dropped on the floor.
Just because you're slender doesn't mean that you're healthy. People who are "skinny-fat" might be at greater risk of heart disease. Drs. Mike and Mary Dan Eades discuss the problem of such visceral fat -- and what to do about it -- in their excellent recent podcast interview with Jimmy Moore.
By Diana Hsieh @ 8:00 AM
You might be surprised to learn that New York City doesn't have a mayor. Yet it's true! New York City is governed by an armed nanny, Michael Bloomberg. He is determined to coerce adults into his vision of healthy living, without regard to their rights or the relevant science. His latest proposal concerns salt. The New York Timesreports:
First New York City required restaurants to cut out trans fat. Then it made restaurant chains post calorie counts on their menus. Now it wants to protect people from another health scourge: salt.
On Monday, the Bloomberg administration plans to unveil a broad new health initiative aimed at encouraging food manufacturers and restaurant chains across the country to curtail the amount of salt in their products.
...
The city's campaign against salt resembles its push to cut trans fat from restaurant foods, which began with a call for voluntary compliance. When that did not work, the city passed a law to force restaurants to eliminate trans fat.
But city officials said it would be difficult to legislate sodium reduction.
"There's not an easy regulatory fix," said Geoffrey Cowley, an associate health commissioner. "You would have to micromanage so many targets for so many different products."
Oh, don't worry about those pesky details! Nanny Bloomberg will do his very best to mandate salt reduction at the point of a gun when his "voluntary" scheme fails.
Back in April, John Tierney wrote an excellent op-ed for the New York Times about this proposal, likening it to an ill-founded experiment using the whole city as unwitting subjects. That's clearly immoral, particularly given that the case against salt -- not just for healthy people but even for people with heart disease -- is weak at best. Tierney writes:
First, a reduced-salt diet doesn't lower everyone's blood pressure. Some individuals' blood pressure can actually rise in response to less salt, and most people aren't affected much either way. The more notable drop in blood pressure tends to occur in some -- but by no means all -- people with hypertension, a condition that affects more than a quarter of American adults.
Second, even though lower blood pressure correlates with less heart disease, scientists haven't demonstrated that eating less salt leads to better health and longer life. The results from observational studies have too often been inconclusive and contradictory. After reviewing the literature for the Cochrane Collaboration in 2003, researchers from Copenhagen University concluded that "there is little evidence for long-term benefit from reducing salt intake."
Even worse, salt-reduction might kill people with heart disease:
In the past year, researchers led by Salvatore Paterna of the University of Palermo have reported one of the most rigorous experiments so far: a randomized clinical trial of heart patients who were put on different diets. Those on a low-sodium diet were more likely to be rehospitalized and to die, results that prompted the researchers to ask, "Is sodium an old enemy or a new friend?"
Moreover, salt might be the only source of iodine for many people. Of course, iodized salt isn't a great source of iodine, and much salt isn't iodized. Nonetheless, further salt reduction would likely only exacerbate the all-too-common iodine deficiency in America today. Such iodine deficiency can be a source of major health problems -- such as hypothyroidism, retardation in children, goiter, and possibly breast disease. Moreover -- surprise, surprise! -- hypothyroidism dramatically increases risk of heart disease -- the very condition that the Nanny of NYC seeks to reduce by limiting salt.
No, I won't call that an unintended consequence. Like the politicians determined to worsen the mortgage crisis with their good intentions, Nanny Statists like Bloomberg ought to know better. They deserve to be morally condemned in the strongest possible terms for the suffering and death they cause by their negligent exercise of force.
It's not going terribly well. For the moment, I'm doing somewhat better only because I've learned how to best limit my activities, so that I don't completely exhaust myself. That means doing very little, unfortunately. If I'm feeling well, I can work for about three hours each day -- maybe. Yet even then I'm pretty fuzzy-headed all the time. My powers of concentration and memory are pretty pathetic. I routinely forget what I'm supposed to be doing unless I write it down and keep it in sight. I wake up from eight hours of deep sleep like I just got four. That's how I feel all day.
For example, when preparing dinner last week, I was puzzled by the fact that I didn't seem to have any vegetables. They weren't on our plates, nor on the stove. "Oh well," I thought, "we have enough food." Then I wandered to the stove to stir the turkey stock I was making. I noticed something funny in stirring it, but only when I spooned up a small red potato did I remember that I'd put them in the stock to cook for dinner. (I don't make potatoes often, but they are an occasional treat for Paul.) Paul then joked that I'm like the man in Memento. He asked me not to take his picture and write "enemy" on it. That was damn funny... but not entirely inapt. At times, I've thought to myself, "Oh, so this is what it feels like to go senile."
Unfortunately, it's all-too-easy for me to overdo it, then render myself completely incapable of doing anything. Any kind of exercise -- even just ten minutes on the rowing machine -- kills me. This week, I was completely unable to muster the energy to work for two full days because I wore myself out on Tuesday. What did I do? I had a friend over for an informal brunch, a guy came to the house to replace my cracked windshield on my car, and then I went into town to run some errands, mostly just buying groceries at Whole Foods and Costco. That killed me for all of Wednesday -- much to my dismay and surprise.
On the plus side, I've found that instead of my normal feelings of too-exited overload in social gatherings, the company of friends energizes me into feeling pretty normal. So although I'm not keen on doing anything, I'm trying to be a bit more social than usual.
Also, I'm still gaining weight, even though I'm eating little. I can't fast or even skip a meal. My temperatures are steady around 96.5. And my skin is unbearably dry and itchy. However, I'm happy to report that I haven't had any problems with depression in the past few weeks. I think that limiting my activities has prevented those awful lows. That's huge, I must say. I can tolerate almost anything -- but not that.
Overall, I'm not really better than when I went on the Synthroid back in November. I might even be somewhat worse.
I'm hopeful, however. I've found a local compounding pharmacy able to provide me with dessicated thyroid, so I'm going to switch to that as soon as I get my thyroid hormones tested on January 5th.
Like Richard, I hate to seem like a luddite or primitivist, but honestly, I do want to try "The Unsoap Experiment." Ever since I read about it a few months ago on another blog, I've been unsoap-curious and nopoo-intrigued!
Of course, the natural reaction is to say, "Oh, but my hair is gross after just a day or two, I couldn't possibly do that!" However, from what I've read elsewhere, the standard day-after greasiness is a side-effect of shampooing. The scalp produces way more oil than it would otherwise, precisely because you're stripping off all the oils by shampooing daily. So you get caught in a vicious cycle.
You can think of it as similar to the effects of carbohydrate-withdrawal. In the short-term, a person used to the standard American diet might feel tired and foggy unless he eats tons of carbohydrates. Contrary to popular myth, that's not a good reason to reject low-carbohydrate eating. Instead, that result suggests that the person is seriously addicted to carbohydrates, and that he ought to eat far less of them. It's just a vicious-cycle hump to be gotten over, nothing more.
Of course, that might not be true for all people, but that's why Richard recommends trying soapless for at least a month.
Originally, I'd planned to wait on my own "Unsoap Experiment" until I got my thyroid problems under better control. However, then I realized that I might as well start now, since I'm basically incapable of doing anything substantial with my days.
So my Unsoap Experiment is in progress, as of December 31st. I've started by switching to nopoo, as per these instructions. Basically, I wash my hair with a baking soda solution, then condition it with a cider vinegar solution. For now, I'm still using a bit of soap on the critical bits -- just a purely olive-oil-based bar from "Kiss My Face." Also, in an attempt to combat my unbearably dry skin, I've taken to just using pure coconut oil as lotion. So far, the results are encouraging, but I'll post a more detailed report in a few weeks.
By Diana Hsieh @ 8:00 AM
Last Tuesday, my thyroid nodule was repeatedly poked for a biopsy. (My neck wasn't happy about that, I must admit!) The biopsy went fine, and results weren't so bad.
Initially, the pathologist's reading was basically, "maybe cancer, maybe not." That wasn't terribly helpful! The odds were very good that the nodule wasn't cancer. Yet that couldn't be ruled out, based on the mere look of the cells. The standard of care in such cases is to remove the nodule, along with the half the thyroid. Then the pathologist can perform the much easier task of examining a whole slice of tissue to determine whether it's composed of evil mutant cells or not. I wasn't too enthused about that, as you might imagine: I'm eager to get back to work. ("Good news, you didn't need the surgery! Now enjoy your weeks of recovery to full strength!")
Happily, we were able to get a second reading from a pathologist specializing in cytopathology. He's reasonably confident that the nodule is merely benign goiter, so we plan to simply do a recheck ultrasound in six months.
I'm not sure if the nodule and the hypothyroidism are related. However, I'm leaning toward the hypothesis that iodine deficiency might be the underlying cause, as discussed by Dr. Davis in this helpful article.
As for my hypothyroidism, I'm not feeling quite as bad as I was a few weeks ago, but I'm not feeling terribly well. I'm lethargic; I tire easily. I'm having trouble concentrating -- or even remembering what I said five minutes ago. My body temperatures are still low, and I'm cold. I'm still gaining weight. My carpal tunnel is still bothering me. I've not had the depression of a few weeks ago, thankfully. I'm definitely doing a bit better -- but only a bit. I'll have been on the Synthroid for three weeks as of Tuesday, so I'm going to speak to my doctor about increasing my dose -- if not switching to dessicated thyroid.
So for now, I'm still on a reduced schedule. My primary concern is to keep churning out new episodes of Explore Atlas Shrugged. You should consider anything else to be an unexpected bonus.
By Diana Hsieh @ 8:00 AM
The past few weeks have been a drag for me. I've just not been feeling right. I've been lethargic, even somewhat depressed. Based on those and other symptoms, I suspected thyroid problems. I was right. I've been diagnosed with mild hypothyroidism, plus a two-centimeter thyroid nodule.
My symptoms seem to have started in a clear way in early September, then accelerated hugely in early November. In short...
I've been generally lethargic, with far less energy than usual. I used to have tons of energy, since my change in diet last July. I would run up hills during six-hour hikes for fun. I would do jumping squats while waiting for meat to grill. I needed my daily workouts to burn off steam. That changed this fall. I didn't want to work out or exert myself. In late September, I was very easily worn out by the hiking that Paul and I did with my father. I didn't want to run around outside with Conrad.
I've gained weight. Much to my dismay, I've gained about eight pounds in eight weeks, despite eating in a way that should have kept my weight steady. (I feel enormous: it's awful.) Also, I found myself unable to fast: I've needed regular inputs of food to keep myself going or I would crash. The last time I tried fasting, I crashed hard around 23 hours. I was shaky and ill, with a blood sugar of only 54. My attempts to raise it by exercise were totally fruitless. Also, my digestive system hasn't been working right: it protests if I do so much as skip a single meal. (I won't inflict the specifics on you.)
I've lost muscle power. At OCON in early July, I was able to leg press 320 pounds. In mid-September, I was down to 210. By late October, I was down to 150. Given the slow-burn-type workouts I was doing this fall, my power should have been increasing, not declining rapidly.
I've been cold, cold, cold. Last winter, I was remarkably warm and toasty, thanks to my change in diet. This fall, I was freezing. My temperatures -- tested with a good basal thermometer -- have been in the 96s. Only rarely have I gotten into the 97s, and then only in the bottom half. (I have been in the upper half of the 95s, much to my astonishment.)
I suddenly developed severe carpal tunnel problems in early October, even though my desk is set up the same as ever. I've also had mysterious aches in my left elbow and neck for the past two months that never seemed to go away.
I've been depressed on occasion without cause. In general, I've felt deeply unmotivated and emotionally flat. I just don't care: I've lost my too-hot passions. I've also had some bizarre bouts of utterly inexplicable and pathetic misery -- like crying because the interior of my car stank like solvent for about two minutes after the mechanic returned it to me. Seriously, that's just dumb.
I've had difficulty concentrating. My productivity has declined hugely over the past few weeks, to the point where I'm barely able to do my one Atlas Shrugged podcast per week.
Strangely, apart from the depression and the carpal tunnel, these symptoms made me feel like I was back to eating loads of carbs and other junk. In fact, I've been eating as paleo-ish as ever. For many weeks, I just assumed that I was being lazy, gluttonous, and weak-willed. Despite all that I know, I found it remarkably easy to blame and flog myself.
However, as I became more depressed and flat, I realized that something was seriously amiss. Thanks to some excellent hints and prodding from Monica Hughes, I realized that so much of what I was feeling matched the standard symptoms of hypothyroidism. Oh, and I should mention that I've had problems sleeping (very unusual for me), my cholesterol has been rising (despite no change in diet), and I could feel a lump on my neck where my thyroid is. Also, I've got a solid family history of thyroid problems.
My doctor agreed to do a thyroid blood panel before I saw her on November 10th. (That was good; I hate doing results over the phone.) That bloodwork showed an elevated (and rising) TSH of 3.23, as well as somewhat low free T3 and T4. That, in addition to my symptoms, suggested early hypothyroidism.
So I'm now on a fairly low dose of Synthroid, i.e. synthetic T4. That medication takes a few weeks to take full effect, so we'll likely need to gradually adjust my dose based on my symptoms and lab values over the next year. (The aim is to get my TSH down to about 1.) I would have preferred desiccated thyroid over T4, as many people report far better results, due to getting the full range of thyroid hormones. However, thanks to the regulatory overlords at the FDA, that's been nearly impossible to obtain in the US for the past few months. If I'm not happy with the Synthroid, then I'll make the effort to obtain desiccated thyroid from overseas.
On the 17th, I had an ultrasound of my thyroid. The lump I felt on my neck turned out to be a two centimeter nodule. Frustratingly, it's not clear whether -- and in what way -- the hypothyroidism and the nodule are related. I wonder whether the underlying cause might be iodine deficiency, particularly given that I don't consume much iodized salt. (Dr. Davis, the Heart Scan Doc, has written quite a bit on this problem.) However, I'm pretty thoroughly confused by all that I've read on iodine and thyroid. I think I ought to supplement, but I fear doing more damage to my thyroid. (I'm now eating a bit of sea vegetable every day for its iodine content, but I'm not sure that's the right thing to do.)
I'm scheduled for an aspiration of my thyroid nodule on Monday. That should be an easy procedure. The nodule is not likely composed of evil mutant cancer cells, but it's worth checking. Plus, I figure that I ought to get whatever medical care I can before Obama can ration everything based on collective cost savings.
For the moment, I'm feeling somewhat better. Granted, I'm still lethargic, fat, pained, and cold. Life still sucks. However, life sucks less than it did a few weeks ago. Right now, I count that as a win.
My plan is to keep myself relatively quiet through this Thanksgiving week, then try to get back to work in earnest in the first week of December. November feels like a lost month for me, and I hate that. Hopefully, December will be a month of happy frolicking for me.
By Diana Hsieh @ 2:00 PM
Here's an unexpected demonstration of the power of philosophy, even amongst those completely oblivious to it. In this video, a rather ditzy vegan girl addresses the charge that vegans and vegetarians are guilty of killing tons of wild animals in the process of planting and harvesting crops. (It's true!)
The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. It is claimed that sometimes it is permissible to cause such a harm as a side effect (or "double effect") of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end. This reasoning is summarized with the claim that sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally.
How does that apply here? According to ditzy-vegan-girl, it's morally okay to do something wrong (like killing animals) as an unintended side effect of pursuing a good end (like eating veggies) but not okay to do that same wrong thing (killing animals) as a direct means to your ends (like eating meat).
Of course, the doctrine of double effect doesn't actually help her answer the moral charge here. The doctrine is a handy tool of rationalization for people with ethics so disconnected from reality that they simply must violate them to live. It's not a real ethical principle.
Ditzy-vegan-girl surely hasn't ever heard of the doctrine of double effect, yet she's using it all the same. That's the power of philosophy.
Three runners die during Detroit marathon. I used to admire marathon runners, thinking them to be at the peak of fitness. No more: such deaths are pretty common -- not because people haven't trained well enough, but apparently because they're doing so much damage to their bodies.
Statinators spill the beans: Dr. Michael Eades reads between the lines of a new study on niacin. The results? Statins might reduce LDL, but they don't do squat about plaque on the carotid arteries.
By Diana Hsieh @ 4:00 PM
I'm delighted to announce the creation of a new OList.com e-mail list for paleo-ish Objectivists (and lurkers) to share information and resources: OEvolve. You can sign up to the Google Group here, but please be sure to peruse this basic information on the list before doing so:
OEvolve @ OList.com
OEvolve is an informal private mailing list for Objectivists and others interested in the proper application of evolutionary principles to diet, fitness, and health. Its basic purpose is to facilitate discussion and information-sharing amongst Objectivists about the practical sciences of cooking, nutrition, fitness, health, and more.
Any Objectivist committed to eating an evolutionary-based diet may participate in OEvolve. Such diets encompass low-carb, paleo, and traditional diets -- including Cordain's Paleo Diet, Sears' Zone Diet, Eades' Protein Power, Weston A. Price's Traditional Diet, and all the myriad variations thereof. Any Objectivist seriously considering switching to such a diet is also welcome to subscribe and post. Moreover, non-Objectivist evolutionary eaters, as well as Objectivists merely curious about such diets, are welcome to subscribe to the list, but only as lurkers; they cannot post.
OEvolve is managed by Monica Hughes. Monica received an MSc and PhD in forest pathology and mycology from State University of New York, College of Environmental Science and Forestry (SUNY-ESF) in 2008. She is the founder of Free Agriculture - Restore Markets (FA/RM). She can be reached at monicabeth10@gmail.com.
Subscription
To join the OEvolve mailing list as a poster, you must meet two criteria:
You must be an Objectivist, meaning that you agree with and live by the principles of Ayn Rand's philosophy of Objectivism as best you understand them. Newcomers to Objectivism are just as welcome as old-timers. Please do not subscribe if you consider yourself to be a libertarian (or associate with the Libertarian Party), advocate revising Objectivism (like David Kelley's "open system"), or associate with the dishonest pseudo-advocates of Objectivism (most notably David Kelley, Nathaniel Branden, Barbara Branden, and Chris Sciabarra).
You must eat some form of evolutionary-based diet -- or be in the process of seriously considering or working on doing so.
To join the OEvolve mailing list as a lurker, you need only meet either the first or the second criterion. Please indicate that you wish to only lurk when requesting to join the list. If you are confused or doubtful about the subscription criteria, please contact the list manager Monica Hughes.
Do you wish to join OEvolve? To do so, you must request a subscription via this web form. The OEvolve list is managed through Google Groups, so subscribing requires an account with Google. (It's free and easy to create.) In requesting a subscription, you will be asked to confirm that you meet the criteria for membership.
After you subscribe, please feel free to post an introduction, including your name, location, and a bit about your interest in evolutionary-based health.
List Rules
The OEvolve list has a few basic rules:
Please be friendly or at least civil in posts to the list. Subscribers who behave like asses, such as by insulting other list members or attacking Objectivist intellectuals, will be removed from the list.
Please respect the purpose of the list. Subscribers who prove disruptive to the basic purpose of the list -- such as by attempting to arguing against Objectivist positions or posting on irrelevant topics -- will be unsubscribed or subject to moderation.
Also, just as a reminder, the other four lists in my ever-growing OList.com empire are:
OActivists: OActivists is an informal e-mail list for Objectivists committed to fostering positive cultural and political change. Its purpose is to facilitate and encourage effective advocacy of Objectivist ideas in non-Objectivist forums by facilitating communication with other Objectivist activists. Posts to the list alert subscribers to opportunities to speak out, recommend sources of information, discuss effective arguments and principled strategies, reproduce op-eds and letters written by subscribers, announce events, and more.
OBloggers: OBloggers is an informal mailing list for Objectivist bloggers. Its basic purpose is to facilitate communication about matters of mutual interest, such as upcoming events, posts of interest, best blogging practices, and the like.
OAcademics: OAcademics is a forum for Objectivist academics to discuss teaching, research, coursework, dissertations, job prospects, publication, and all other aspects of life in (or after) academia. The list is basically a means of sharing knowledge and experience as ever more Objectivists enter academia.
OGrownups: OGrownups is an informal mailing list for Objectivists interested in raising and educating children well. Its basic purpose is to facilitate discussion about child development, discipline techniques, education methods, parenting resources, and more.
By Greg Perkins @ 1:00 PM
I started looking into CrossFit after seeing it mentioned by various health/fitness guys I've learned a lot from -- like Richard Nickoley, Mark Sisson, and Art De Vany, who talk about the value of mixing things up, using high intensity, intervals, resistance training and such. I liked what I was finding in the methodology and was intrigued at its potential, so I was eager for an opportunity to try CrossFit in a way that includes the coaching I knew I would need to not hurt my middle-aged self. (Sure, it's free if you do it at home, but who goes out on their own and just starts doing Olympic-style lifts? Not me!) Happily, a couple of months ago Tammy and I noticed that a CrossFit gym was about to open near our house. We checked it out and took the plunge! So far, it's been very cool.
Before giving reports from the front and breaking out the obligatory pictures of progress, let's start with a little about what CrossFit is. The headquarters site says
CrossFit is the principal strength and conditioning program for many police academies and tactical operations teams, military special operations units, champion martial artists, and hundreds of other elite and professional athletes worldwide.
Our program delivers a fitness that is, by design, broad, general, and inclusive. Our specialty is not specializing. Combat, survival, many sports, and life reward this kind of fitness and, on average, punish the specialist.
And in a CrossFit Foundations article, creator Greg Glassman writes, "CrossFit is a core strength and conditioning program. We have designed our program to elicit as broad an adaptational response as possible. CrossFit is not a specialized fitness program but a deliberate attempt to optimize physical competence in each of ten recognized fitness domains. They are Cardiovascular and Respiratory endurance, Stamina, Strength, Flexibility, Power, Speed, Coordination, Agility, Balance, and Accuracy."
Of course, I'm not a Navy SEAL, a stick-fighting champion, or a fireman -- but developing serious competence in all of these domains, and therefore a powerful "ready state," would be awfully useful for the sorts of play I like to engage in: mountain biking, summit-scrambling, snowboarding, maybe a spontaneous half-marathon hill run or whatever else Tammy or my friends might want to draw me into. And it would come in handy for those (hopefully vanishingly) rare times when Stuff Happens -- plus as I age, maintaining as much physical capacity as possible would be invaluable for health and autonomy.
There's a lot of empirical observation and some pretty good epistemology behind various aspects that I can go into later, but today I'll just share the central CrossFit prescription for efficiently achieving that broad, general, and inclusive fitness: constantly varied functional movement performed at high intensity. Every element of that is essential. Glassman breaks it down in a brief article on Understanding CrossFit:
Functional movements are universal motor recruitment patterns; they are performed in a wave of contraction from core to extremity; and they are compound movements -- i.e., they are multi-joint. They are natural, effective, and efficient locomotors of body and external objects. [Author's note: Examples include squats, pullups, situps, jumping, running, throwing, lifts like deadlift and clean & jerk and overhead press. They are elemental movements, used in lots of activities.] But no aspect of functional movements is more important than their capacity to move large loads over long distances, and to do so quickly. Collectively, these three attributes (load, distance, and speed) uniquely qualify functional movements for the production of high power. Intensity is defined exactly as power, and intensity is the independent variable most commonly associated with maximizing favorable adaptation to exercise.
Recognizing that the breadth and depth of a program’s stimulus will determine the breadth and depth of the adaptation it elicits, our prescription of functionality and intensity is constantly varied. We believe that preparation for random physical challenges -- i.e., unknown and unknowable events -- is at odds with fixed, predictable, and routine regimens. [emphasis and paragraph break mine]
Plateauing is not easy when the adaptational response never has a fixed target -- plus, the novelty of not knowing what will be coming next keeps us from getting bored. As sick as it might sound, it actually becomes a fun adventure to show up at the gym not knowing what challenge we'll be hit with! One day it's a 5k run or row for time; another day it's finding the maximum weights you can deadlift, press, and back-squat; on another it is a butt-kicking, lung-searing sequence of a dozen varied exercises done for time (here's one we were given a week or two ago, as demonstrated by a bunch of uber-fit trainers at a certification: [wmv][mov]).
CrossFit turns fitness itself into a sport by making general fitness quantifiable, setting standards, and measuring performance in a very visible way. So people get to see their own development, have fun competing with themselves and their buddies in some sense, get encouragement in a group setting, and so on. This all goes toward motivation and intensity (making it fun to show up, and keeping you engaged in the work when it's soooo hard).
Turning fitness into a sport also makes the CrossFit Games possible. The Games are a proving ground for demonstrating general fitness, and a way to draw attention to those who might have a more effective training method. Elite athletes train all year and show up to compete -- but what's special about this competition is that they have to train while not knowing exactly what the events will be. They only know they will be tested in some way that is broad and brutal enough to differentiate the fittest person. So the athletes have to focus on developing that well-rounded, inclusive fitness to win. The rest of us get to marvel, and learn.
Then we throw ourselves into tomorrow's unknown workout. Three.. Two.. One.. GO!
Some links:
"What is CrossFit" is a one-page promotional summary from an affiliate gym's website.
The Okinawa Speech is a video of a great talk by CrossFit's founder, Coach Greg Glassman. He presents the the origins of the CrossFit definition of fitness, the development of the training methodology, addresses safety, efficacy and efficiency, and a lot more. Worth the time.
"God's Workout" in NY Times Magazine made me laugh (and of course I have seen no dangerous, macho behavior, nor any cultlike attitude -- in fact, I've only seen the opposite on both counts).
"The Truth About Crossfit" is a pretty good perspective piece by a fitness writer, fun to read, from a big bodybuilding site/magazine (though it has some goofiness, like defending another of their writers who apparently had some sort of tussle with CrossFit's founder, Glassman).
E-mail Diana Hsieh
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