Health Review 2009

Interesting year, 2009, personally, professionally, health-wise. After dabbling in low carb in prior years, with good results, I went whole hog. Lost nearly forty pounds during the year: started at 219 and flirting with 180 in recent weeks. Lean mass seems to have gone up, too. I've lost 6" from my waist, down to 34" for the first time in a couple decades. "Gratifying" would be a huge understatement. My BMI, fwiw, went from over 30 to 26. It might never get to the "optimal" range of under 25. (BMI is more useful as a population tracking metric than as an individual measure.) According to the magic scale my bodyfat percentage went from over 30% to under 19%. I don't put much stock in that, since it varies so widely day-to-day, but for trend tracking it's still useful. The mirror and clothing make for better measures.

It will be interesting to see how my thinking evolves over the next year.

Diet
After years of assuming low-fat, "complex" carbs was the way to go for health, and dismissing low-carb as a bunk, I finally started coming around by looking into it over the past couple of years. Gary Taubes' book, of course, was hugely influential in my thinking. (Seriously, the guy is an awesome science journalist. Even if you don't give a damn about diet, try one of his earlier books on bad physicists.) But I've gone beyond that, read other studies, articles, papers, blogs, watched lectures, and, most importantly, experimented on myself. If it didn't work, I wouldn't keep doing it. And it did work, brilliantly.

I generally stick to low-carb, aiming for very low-carb most days. Occasionally I carpet-bomb my liver with crap, just to keep it on its toes. Can't let it get too complacent. Current thinking: low-carb (i.e. high fat) is the best way to lose weight. I don't think constant ketogenesis is necessary for weight loss, but being adapted to it and near enough to drift in and out with ease is a good goal. As far as carbs go, avoid especially sugar and grains. For sugar, fructose is by far the worst, so anything with sucrose or HFCS should be avoided. Likewise fruit juice. If you want carbs, best to still avoid gluten grains (no wheat!) and sugar. Get carbs from vegetables. Avoid starch and starchy veg, but if you must, tubers and rice are much better than wheat and other gluten grains. Nuts are generally fine. Fruit in moderation if you like carbs. For a carb-heavy diet, low GI is good, low GL (glycemic load) is better, except wheat elimination should be a goal regardles. Fibre I'm undecided on. Studies are mixed on the issue. It looks better observationally than interventionally, and there are good arguments against overloading yourself with fibre supplements. Fats are a contentious issue. The best general rule is to try to get the omega-6/omega-3 ratio as low as possible. (Unless you move to Greenland and eat a strict diet of seal blubber and coldwater fish, you won't be in danger of getting the ratio "too" low.) Lots of interesting results follow from this simple rule, including choosing grass-fed meat over grain fed, eggs from pasture-raised chickens rather than from battery hens, and eating fish. The biggest thing to avoid is vegetable oil. Industrial seed oils, especially corn and soybean, are awful for you. Rapeseed/canola/safflower, and sunflower are really not much better. Even now that hydrogenated oils ("trans fats") have been shamed, the ubiquitous veg oils are still terribly bad. Olive oil is ok, although the cheaper heat-refined stuff is not that great. Cold-pressed is good. Some nut oils are good. Coconut oil I'm undecided on. Butter, lard, goose fat, I clearly like. I like dairy. Milk I avoid because of the sugars, but cream and cheese (and sometimes yogurt, full fat, unsweetened) I love. I avoid artificially sweetened foods for the most part. I think it's much better to keep my palate dialed down to a much lower sweetness calibration.

Plan for 2010 is to keep it up. I've got a nice layer of fat around my middle that could stand some further reduction. I'll stick with generall low-carb approach unless I have reason to change.

Exercise
To be clear, I lost most of the weight without any exercise. It was pretty much all diet. That said, I think exercise is wonderful and the benefits of getting some, regularly, are numerous and varied. The biggest mistake is thinking that exercise is the key to losing weight, and being disappointed if it doesn't have an impact in that regard, while ignoring the many real benefits. Exercise, have fun, and feel good.

After a decent fitness level in 2007, 2008 was a write-off. I started running again, back at square 1, at the end of April in 2009. First run was 20 minutes, with having to walk several times. By the end of the year, I'd gone over 13 miles in a training run and crushed my old personal record in 10k race. Faster, on the ground, than I've ever been at any point in life. I picked up swimming again in the last few months. Not tearing up the lanes, but got some fitness back. The biggest addition has been weight training, which I've added in the past six weeks or so. I've never been a big lifter, but have dabbled a couple times in the last decade. Last time was in 2004, though, for just a few weeks. I did a bit of weight training, on machines, back in the early 80s in my high school swimming days. Now I'm starting on free weights and I love it.

My current thinking is that resistance training of some form is the best for health, if you only do one thing. But really, whatever exercise you enjoy is better than none. For non-resistance training, some sort of weight-bearing relatively unintense activity (hiking is perfect), interspersed with occasional sprints (bursts of high-intensity) is ideal for health and longevity. Resistance-training is important for anti-aging. There are many kinds. Again, finding the right fit is more important than finding the optimal program. The "body by science" or "slow burn" approaches seem useful for people who prefer a truly minimal time investment (but potentially needing hands-on management). A lot of people love Crossfit. Seems a bit cultish to me at its worst, but for fitness it looks great if the approach resonates with you. At a minimum, everyone should dabble in at least a bit of bodyweight exercises (e.g. pushups). Military-style training seems to be popular here. Lots of intensity and bodyweight stuff, and the fun of a group. Looks a bit like crossfit without the weights.

For 2010, I'm going to continue with the weights. I will probably ease back on the running. Swimming I'll continue a little bit. Swimming's hard because it takes so much time. Like cycling in some ways, but a lot more overhead. Not sure if I'll do any more running races this year, or maybe get back into triathlon, or possibly look into cyclocross in the fall. Skiing, definitely. Fitness definitely helps there.

Supplements, Vitamins, Etc.
I've tried a variety of supplements this year. I've toned it down the last few months. Some thoughts.
Vitamin D (D3, in oil/gelcap form): almost everyone should take this
Magnesium (in citrate): I like tap water, but ours has no magnesium. Good idea for anyone to consider supplementation, variety of benefits.
Those are what I consider the most important. The others:
omega-3, in fish oil capsules: another thing worth considering for general use. I was on a fairly high dose, of 3g of EPA+DHA per day, and have now reduced to 900-1200 mg omega-3 per day. Anti-inflammatory, good for the heart.
Potassium (in citrate): I tried this to help with nighttime lower leg cramping. Not sure it helped at all. But it's a very small dose and I still take some when I think of it. Serum potassium levels were good last time I was tested.
iodine (in kelp tablets): single kelp tablet, containing 150mcg of iodine, just to keep the ol' thyroid happy. Tiny dose, cheap, harmless.
CoQ10: tried 90mg in divided doses to help lower blood pressure. Not sure it had any effect. Weight loss and exercise both have more impact. By my observations, my blood pressure tracks with stress, not diet or supplements. No reason to continue this once the jar runs out.
l-arginine: started for blood pressure lowering impact (did seem to have a modest effect) and to help normalize endothelial function. Have a bit left, which I use mornings before weight workouts, but won't continue when it's gone.
Vitamin-C: tried this for a while but seems pointless or possibly counterproductive, so stopped.
vitamin-B complex: occasional use, generally after drinking or for an energy boost before a big exercise day
melatonin: small dose, sublingual, very occasional use to help with sleep, especially during or after international travel to try to get onto or back onto schedule

Plan for 2010: continue with vitamin D, definitely. Also magnesium. Probably kelp (iodine) and sometimes potassium, but not religiously. Will continue with lower dose of fish oil as well. I'd like to try creatine as I get more into the weights program.

Bloodwork & Other Metrics
The bad news: high LDL. I haven't decided how much I care. I can't get a particle count here. My LDL-C is most likely vastly overstated (it's calculated, and does not do well for people with low triglycerides and high HDL, which is what I have, which is good, nor does it do well for people with a preponderonce of large LDL, which is what I have, which is better than having small LDL). My trigs are down to 62, which is great (using "american" units here), and my HDL is up to 97, also excellent. My calculated LDL-C is 217. Even overshot, this is pretty high. Nonstandard calculators suggest something on the order of 180 might be more accurate. Honestly, I'd still rather that was lower, but I'm not willing to go on the statins. Very low trigs and high HDL are both good news. The good news with LDL is that the subfractions profile is good:
LDL I 58.2%
LDL IIa 17.7%
LDL IIb 12.3%
LDL IIIa 7.1%
LDL IIIb 2.3%
LDL IVa 1.9%
LDL IVb 0.6%
That means is pretty much all large LDL and almost no small, dense LDL. Does that matter? Maybe I'll find out someday.

The other bad news: I have a nonzero calcium score (CAC), a measure of coronary arterial hard plaque. In absolute terms, the score is low, 43, but in percentile terms for my age group, it's not good. I've got family history going against me here, which is why it was good to get a scan early.

The rest, in addition to low trigs, very high HDL, is all good news. My liver function tests (e.g. ALP, AST, ALT) are excellent. They had always been good in prior years, but now I'm getting the best measures ever. Kidney function excellent. Vitamin D levels normalized to 63, very good. Fasting glucose (last time I checked, was 83), fasting insuling, hsCRP, all good. HbA1c good, at 5.5, but I'd like to see that keep coming down.

Blood pressure has come down as well. In terms of change over the year, LDL is the only risk measure that moved in the "wrong" direction. Everything else -- blood pressure, HDL, triglycerides, various lipid ratios, weight, waist size, etc. -- has been moving in the "right" direction. I'd prefer perfection, but I'm pretty happy regardless.

Plan for 2010: I'd like to get an LDL particle count at some point, and check back on HbA1C. Definitely going to get another heart scan, at the 18-month mark from the first one. The extent to which it's changed in that time will tell me more than the absolute score in isolation. That will be far more interesting than any lipid profiles. I'll break out the finger sticks from time to time to check the blood glucose. Depending on the results of the next heart scan, I may decide to make changes to my diet.

Should be an interesting year all-around.