Tuesday, July 22, 2014

A Tough Day on AIP

Today was a tough day on the Autoimmune Protocol. Funny how yesterday was my best day yet... I had energy, was happy, and felt 'normal' for the first time in ages. Yesterday I biked 25 minutes, lifted weights for 35 minutes, swam for an hour straight, and walked a mile and a half, and I still felt great. I slept very well last night but today was not like yesterday. I had a headache, felt blah and tired, and had brain fog. I have been 100% on AIP all week, including today, but I really struggled this afternoon. At one point I felt like I HAD TO HAVE some coffee or some chocolate. I was rationalizing it in my head. Just one off day won't hurt... I could have the coffee with no cream. I could get extra dark chocolate. I could go through a fast food drive through and get 2 sausage egg cheese biscuits... then I snapped out of it, got myself an iced green tea, and went home. I made myself some grassfed beef meatballs (with salt, green onion, garlic, and cilantro added) and roasted broccolini and told myself how fortunate I am to have such good healthy food to eat. I made it through a tough day and am *so* glad I did not give in to my cravings.

I am keeping a food journal so I can keep an eye on how various foods may be affecting me. This will be even more important when I start reintroducing things in a month or two. For now, my daily intake is basically a lot of produce and meat with a side of avocado and coconut milk or coconut butter. In the fridge right now:


Plenty to choose from, and tomorrow I need to roast some chicken so I have that to grab when hungry.

Tomorrow will be a better day!

Monday, July 21, 2014

AIP Compliance and How I Feel

When I first started the Autoimmune Protocol, as you can see from my last post, I felt pretty crappy. It seemed impossible, and I felt so foggy and had a constant headache and couldn't even seem to gather myself to make a meal plan or pick out some recipes to try. I was pretty much winging it all last week, just throwing whatever AIP-compliant foods I had in the fridge and freezer into the oven or on a plate when I was hungry. I poached some wild salmon earlier in the week and whenever I was hungry and couldn't think of what to have, I'd just eat a piece of it cold. Before AIP, if I needed a little something to get me through, I'd grab a handful of nuts, or a slice of cheese, or have an iced decaf Americano with cream. Since I can't have any of those things now, I was drawing a blank. Cold salmon, a raw carrot or cucumber, or a piece of fruit (which is limited on this protocol) were my staples last week.

Here's how I felt during the first week of AIP: tired, achy, and just emotionally blah. My face was breaking out, I had a constant headache and it felt hard to think, and I had this very unusual, constant sinus drainage going on for days even though I am not sick. Well, as of yesterday all of that started to lighten up. And this morning, I am feeling great! No headache, more energy, happier, face clearing up, and nice clear sinuses! I took advantage of the mind clarity last night and sat down and planned out a few recipes to try this week and went shopping for the ingredients. Last night I made this: Coconut Curried Cauliflower with Kale. I threw in some boneless skinless chicken thighs. So good! And lots of leftovers.

autoimmune protocol paleo recipe curry AIP

I am going to have some tonight over some baked sweet potatoes for dinner. Other things I am eating:

Homemade breakfast sausage, which is just pastured ground pork seasoned with sea salt, black pepper, sage, garlic, and thyme. I made 8 patties from a pound of meat, froze them in layers on parchment paper, and stored in a Ziploc baggie in the freezer for quick breakfasts:

AIP autoimmune protocol paleo breakfast sausage recipe

Makes a nice meal with some baked acorn squash and apricots:

AIP breakfast sausage autoimmune paleo

Another easy breakfast is steamed butternut squash and apples mashed with cinnamon and coconut milk, topped with toasted coconut flakes:

AIP autoimmune paleo protocol breakfast cereal

Nice and warm, with plenty of leftovers to warm up and enjoy throughout the week.

I guess AIP eating isn't that boring after all!

This morning I went to the gym and lifted weights for about 35 minutes. Later, we'll be going back for a swim! Hope you are enjoying your day too.

Saturday, July 19, 2014

Hashimoto's Thyroid and the Autoimmune Protocol Elimination Diet

As I mentioned in my update post a week ago, I was recently diagnosed with Hashimoto's Thyroiditis. I was kind of relieved when I got that diagnosis, because I've had symptoms of thyroid disease for a long time, but all my TSH blood tests were coming back normal. My regular doctor ordered the TSH every year: in 2012 it was 2.13, in 2013 it was 2.03, and this year it was 2.12 (standard range is 0.45 to 5.10). But some blog readers have, in the past, tipped me off in the comments by telling me there were more detailed, accurate thyroid function tests and that many people who have thyroid disease have a normal TSH. That turned out to be true for me as well. When I finally was referred to an endocrinologist, he looked at my symptoms:

thinning hair
difficulty losing weight/weight gain
chronic fatigue
"brain fog"
dry skin
and the biggest symptom for me, cold intolerance (I spent this winter in heavy sweaters with the heat turned up to 80 degrees and was STILL cold all the time... this was new).

He ran 4 or 5 tests, and then called and told me I had Hashimoto's. Apparently with this autoimmune disease, the body develops antibodies and starts attacking the thyroid tissue. This shows up in the thyroid peroxidase antibodies blood test; I did have the antibodies, and they are quite elevated. He also told me that once you have one autoimmune disease, you are at higher risk of developing another one, like lupus or rheumatoid arthritis, because the body has learned to attack itself and this cannot be cured. I also tested positive for HLA-B27, which "suggests a greater-than-average risk for developing or having certain autoimmune disorders. An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue." (source link).

Before we even had the results of the blood tests, the endocrinologist recommended an elimination diet (and I cringed. I have been very resistant to the idea of such a thing, like the Whole 30, because it is so restrictive and I thought I'd go off the rails). But this was different. This was no longer about weight loss. This was a recommendation for my health, because of all the symptoms I've been having. He wanted me to eliminate all traces of gluten and dairy, and possibly some other foods. Apparently the protein in gluten is very similar to the structure of thyroid tissue, so if your body is gluten intolerant and you eat gluten, your body may also start attacking your thyroid. You can read more about that here: The Gluten-Thyroid Connection.

So after the tests came back positive, I called and talked to a thyroid specialist about elimination diets and he explained the most problematic foods that may cause inflammation, such as nightshades, eggs, nuts, and processed foods. He also discussed with me the role of environmental toxins and stress in autoimmune disease (discussed more here). I bought two books to help me understand the whys and hows of these changes :Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, and The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body. Both are really great books full of information, if you want to learn more about these issues.

After making a list of all the things I was told to eliminate, I started doing some research online. That's when I found that this type of elimination diet for autoimmune diseases is called the "Autoimmune Protocol" or the "Autoimmune Paleo Protocol" (because it is like Paleo on steroids). There are lots of sites dedicated to following this protocol for people who have various autoimmune diseases; here are a few that explain the details: The Autoimmune Protocol, Paleo Approaches to Autoimmune Disease, and Changing Your Diet is the First Step in Addressing Hashimoto's. But basically, I am not allowed to eat anything. Kidding... sort of.

Here's a summary of stuff I have to eliminate. First, all gluten has to go, and probably forever because of the thyroid connection. Also no grains whatsoever... no rice, barley, wheat, oats, corn, etc. You can't have any legumes, so no beans, lentils, peas, peanuts, or soy products. As the endocrinologist stated, dairy is another one that might have to be be gone forever... including milk, cheese, butter, cream and all other dairy products. No refined sugar, no processed food chemicals, no artificial colors or flavors or sweeteners (including stevia) and no modern vegetable oils (canola, corn oil, etc). I think at this point you'd be considered Paleo, right?

Keep going. You can't have any eggs, so forget all those egg breakfasts. No nuts either, so ditch the almond milk, nut butters, macadamias, walnuts and other nuts as snacks. And no seeds, so forget seed butters, nut and seed oils, sesame products, pumpkin seeds etc. Also included in the seeds category is (gasp) coffee AND chocolate. This has been the hardest part for me. I loved having a cup of black coffee in the morning and a square of 88% dark chocolate after dinner... no more. Nothing with coffee or cocoa at all. But there's more! You have to eliminate nightshades, so no more tomatoes, peppers of any kind, eggplant, or white potatoes. This was pretty tough too... no salsa. No delicious garden tomatoes. And this also includes spices derived from peppers, so no chili powder or paprika, curry or cayenne (in fact there is a whole list of seed-based and pepper-based spices to avoid... makes things pretty bland IMO and also meaning you have to really read labels of any meats you buy like sausages). Finally, there's no alcohol and no NSAIDS so there are probably some headaches and joint pain in your future if you frequently use NSAIDS for pain relief.

When I read all of this I was SO BUMMED OUT. Basically, I can't eat anything! No more spinach mushroom omelets. No more roasted eggplant, or spaghetti squash with marinara sauce, or chili made with beans or tomatoes. No more cauliflower pizza, or deviled eggs, or chicken salad with mayo. No Greek yogurt with walnuts and blueberries. Oh it made me mad. But then I decided to focus on what I CAN eat.

I can have most vegetables (except nightshades) in any quantity. I can have lots of meat... preferably grass fed. I can have fish! I am encouraged to try to include organ meats (like liver, heart, and kidneys... I haven't yet) for their nutrition, and also to make and drink bone broth for healing. I can have quality fats like avocado, olive oil, and coconut oil. I can use pink or grey salt instead of table salt, and I can have fruits up to 20 grams of fructose per day. I am also encouraged to eat fermented foods like real, fermented sauerkraut, kombucha, and non-dairy kefir.

I started cutting things out immediately, starting with gluten. For the first week I spent a lot of time reading labels and finding gluten in everything! I also bought some gluten free cookies and realized just how much gluten free junk is out there! Tons of it! Next I cut that junk out along with the processed foods. I was already nearly soy free but had to dump my favorite green tea because it contains soy lecithin. I then cut the eggs out and the rest of the grains, including rice. I took it slow because I was going through some stressful life stuff, and didn't think I could handle cutting it all out at once... food is an emotional thing for me. Finally, I was down to just needing to cut out the coffee, some spices, a bit of dairy, chocolate, and tomatoes. I did that last weekend and have been 100% AIP compliant since.

And I hate it so far, and it sucks. I have not been very creative with my eating, so it's basically been:
homemade sausage (pastured ground pork and AIP compliant spices)
baked wild caught salmon
grass fed ground beef
cooked cabbage, asparagus, acorn squash, broccoli, butternut squash, and sweet potatoes
local peaches, plums, berries, and apricots
coconut oil, coconut butter, avocado
fermented sauerkraut, kombucha

For a family birthday we went out to a Mexican restaurant. Really, going out to eat is not happening anymore at all because I just don't want to risk cross contamination. But for this special occasion, I sat there watching the chips and salsa being eaten (that I can't have) and people eating all kinds of yummy cheesy stuff, beans, etc. But even the meats were marinated in spices, like paprika or other pepper based seasonings. So I explained to the waiter and I got this salad. This most pathetic salad I have ever eaten... a plate of iceberg and carrot shreds topped with the most plain, boring, seasonless chicken breast you ever saw. No dressing. I did ask for some fresh sliced avocado to perk it up a bit, but no lie... eating that was depressing. If I was only doing this for weight loss I would have bailed for the chips and salsa. But I am doing this for my health, for my future, and I am too scared to eat anything off the diet. So there it is, I am 100% compliant, but not loving it, and yes it sucks.

There are a lot of websites out there with AIP compliant recipes; I bought this book: The Autoimmune Paleo Cookbook and my goal this week is to make 5 recipes from it. There are websites, too, with plenty of recipes and ideas. I just need to open my mind and branch out and start cooking in a new way. I can do this.

By the way, I don't have to eat like this forever. The doctor said "a month or two" and the standard for this elimination diet seems to be a minimum of 30 days, longer if you feel good on it. Then you slowly reintroduce each of the forbidden foods one at a time and keep a journal watching for any negative reaction or effects. Anything that has a negative reaction has to be eliminated for longer, possibly forever. And the gluten? That has to stay gone because of the thyroid issue.

So I hate it, I won't pretend it is OMG so fun and delicious. Maybe it CAN be, I will find out. I am keeping a notebook of the foods I eat and how I feel. So far: nearly constant headache and sinus drainage, but also feeling calmer. I am also working on the lifestyle parts of healing autoimmune disease, including improving sleep quality, learning to deal with stress effectively (using meditation and other skills), exercising at least 30 minutes a day, and eliminating environmental toxins. More on that in another post!

I'm thankful for those of you still here to listen to me and care how I am doing. I really appreciate your comments and positive thoughts. Hopefully the coming week will be easier!

Wednesday, July 16, 2014

Metabolic Testing: What's My Resting Metabolic Rate?

Back again with more details on my update! This is something I was always interested in but could never find access too until recently, so I hope you will find it interesting as well. This spring, I found out that a nearby hospital was offering a new service: metabolic testing. They'd purchased an indirect calorimeter... this one: the ReeVue Indirect Calorimeter. According to the website, here's how it works:

"ReeVue by KORR directly measures the concentration of oxygen breathed out by each patient.  The patient merely breathes through a simple mouthpiece as all the exhaled air is collected and analyzed.  Because there is a direct correlation between oxygen consumed and calories burned (4.813 calories for every milliliter of oxygen consumed), an accurate measurement of oxygen consumption is an effective measurement of calorie consumption."

This testing is very accurate and done in a medical setting. It was easy: you go in fasting (in the morning) and having not exercised in the past day (no problem!). They have you recline on a bed, dim the lights, play soothing music and tell you to relax for a few minutes. Then they put a tube in your mouth with a mouthpiece that seals the edges, and they put a clip on your nose and leave you to relax for ten minutes. She told me to just lie there, try not to move, think calming thoughts, breathe naturally.

When the test is completed, you get a printout:

At the bottom is the important stuff: the results of the metabolic testing. On the back of this sheet there are explanations of the results. It says: "Today we measured your RMR (resting metabolic rate). This is the number of calories your body would burn if you did nothing more than sit in a chair all day. This is similar to what is known as your Basal Metabolic Rate (BMR)." This measured number is also called the REE, or resting energy expenditure. My measured REE (RMR) was 1440 calories/day, much lower than predicted by the usual equations for a woman my age, height, and weight.

The explanation states "Many studies have been done to determine what is 'average' or 'normal' metabolism. Your metabolic rate has been compared to what is 'normal' for your age, height, weight, and sex." Predictive normal for a person with my stats is the center line. My metabolism is "Slow (-19%)."

The graphic (below) of energy balance shows an estimate of what I would burn with average activity and exercise. This would be 1440 calories (RMR) plus lifestyle and activity ("calories you burn performing your daily activities... working, playing, eating, etc") which is estimated at 432 calories, plus 150 calories burned during 30 minutes of moderate exercise per day, for a total of 2022 calories/day. Under "how much to eat" it shows my weight loss zone, WITH lifestyle activity and exercise, is 1152 to 1440 calories/day. And Maintenance Zone is 1440 to 1872 calories/day.

You know what, I am shocked. The test validated what I thought was going on for the past 2 years. I had really started to doubt myself and think I was wrong in what I'd believed all this time. I wondered if I was counting wrong or measuring wrong or making some mistake with my efforts. I had counted calories for weeks, months, and have blogged many times my frustrations at not losing weight when I was eating at a level that SHOULD give weight loss... gaining weight eating 1700 calories, maintaining at about 1500 calories, and only losing very slowly when I ate 1300 or less. Given that my activity level with the plantar fasciitis and torn tendon was pretty much "sitting in a chair all day," it finally makes sense. I was only burning about 1440 calories a day, so I could not lose weight eating at that level. I don't *like* the results... but it does make sense. In order to lose weight, I have to eat between 1152 and 1440 calories AND have an active lifestyle AND exercise 30 minutes/day. In fact, both the dietitian and the endocrinologist said that I should aim for 1100 calories per day, which is on the lower end of the "weight loss zone" recommendations, because I am just not as active as the 'average' person. And yes, that is *with* the 30 minutes of exercise per day... 1100.

I feel more confident about how well I know my body after having this testing done. This information will be very useful for me in the future when I am done with my elimination diet and start counting calories again. I think in the future, as I become more active and build muscle and lose fat, I will go back and have this testing done again when I am closer to my goal weight to see if I am able to speed up my metabolism. And yes, I think, and my endocrinologist believes, that eating 900 calories a day for such an extended period of time as well as being so inactive this year contributed to such a slow metabolism. Thinking back, I really wish I had just done Medifast for that first 8 months when I lost 59 pounds, and then gradually and slowly increased both my calories and my exercise. It would have been a lot easier to do at 175 pounds than it is now, and my metabolism would have probably been fine. My mistake was to keep going back to Medifast over and over, cutting my calories super low while not exercising much. Lesson learned, and I hope you learn from my mistakes so you don't have to live through them.

Sunday, July 13, 2014

Things That Happened

Since it's been a couple of months since I've blogged, I thought I'd give a little update about what has been going on in my life this spring and summer. I'll try to be concise. I am going to just cover the 'big stuff" and will get into some diet, health, and exercise details over the next few blog posts.

Shortly after I stopped blogging, I had another set of cortisone shots in my feet for the plantar fasciitis. The doctor said it was okay since it had been almost a year since my last set of shots, and again he did a very low dose. I had immediate, almost total relief from the pain that lasted for weeks! But strangely, the skin at one of the 3 injection sites began to peel off... layer after layer of thick, wide strips of skin. Then, the actual injection point on my left foot became a little red hole, and the tissue around it began to degrade, forming a pit where my heel felt mushy and dented in. Apparently this is a not-too-common side effect of steroid injections. I began massaging it several times daily with coconut oil (which is anti-bacterial and very healing), and in about a week the skin stopped peeling and the little red hole went away. There is still a mushy "dent" where tissue is missing. I am not getting anymore steroid shots. (And yes, after about 7 weeks, the plantar fasciitis came back. It's rather mild though compared to how it used to be, and not affecting me too much. The shower chair went to the garage and has not come back!).

One of my kids had a medical crisis, so I've spent a lot of time over the past few weeks driving to and from the hospital and dealing with doctors and specialists. It's ongoing, and stressful, and affects my self-care and my eating (stress eating is a siren call to me). If you've read my blog for long, you know I don't really share much about my kids anymore out of respect for their privacy (I'm not a Mommy Blogger after all... I believe each child's story is their own to share if and when and with whomever they choose) so I leave this in the most general terms... but it's affected me and made me look hard at how I cope with stress. I have started seeing a (new) counselor for help with this and am learning meditation as a coping skill.

Some other things have happened that I will just give the basics on right now, but will share more details in later posts. Here, in no particular order, are some things I've done or experienced over the past couple of months.

- I found out that a nearby hospital had purchased equipment for metabolic testing. I was able to go and have my resting metabolic rate measured and had my metabolism assessed.

- I went to an endocrinologist and, through blood tests, was diagnosed with thyroid disease: Hashimoto's thyroiditis, which is an autoimmune disease. The doctor who diagnosed me prescribed Synthroid and recommended an elimination diet.

- I spoke with another specialist and got further recommendations regarding diet, and used this information along with the elimination diet information to formulate a new way of eating. I then found out it wasn't very 'new' after all... it's called the Autoimmune Protocol.

- I have gradually changed my diet in a very drastic way... much more on that to come. I have eliminated about 90% of what is recommended and am cutting out the remaining 10% in the coming week, including specific spices and the last traces of dairy.

- I found through research that there is a lot more to autoimmune disease and recovery than just diet; I have made and am still making lifestyle changes also to better my health.

-I was finally able to join a gym with a pool and a handicapped-accessible entrance so that I could get to and from the pool easily (when I was having severe plantar fasciitis). I have been swimming regularly with my daughter.

- I had some serious symptoms that sent me to the doctor and ended in a uterine biopsy. This was a very stressful time for me but thankfully the pathology report came back negative for cancer. I later had an ultrasound that ended with a surgery recommendation.

- We are now part of a loving church family where we were welcomed with open arms and I am able to feed the spiritual part of me in a low-pressure, non-judgmental place. It's been a relief that I didn't even know I needed.

Overall, I have had some wonderful happy times and some truly awful times so far this summer, with kids graduating, birthdays, concerts and recitals, sickness and sadness, joy, pain, travel, relaxation, and plenty of hard work. I am so blessed to have the family that I have. I am using the experiences, information and new focus of the past few months to change my life... moving forward from the anger, pain and disappointment into a time of hope and healing.

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