I Took a Morning Walk

Almost

Today, I took “one third” of a morning walk. I am pleased, in fact ecstatic, with the progress that represents. I am trying to climb out of a deep physical hole, one more time. My autoimmune flare was a devastating experience. I felt as though I were going to die, even though I knew I was not. That flare took me, into the pits, physically.

The flare started in my mouth and for weeks I could not eat solid food. I dealt with that by relying on my Vitamix blender.The fatigue and muscle aches and joint pains were combined with sharp blinding headaches.

The flare was complicated by the fact when the first headache hit, my brain stopped sending signals to my limbs. I fell. I damaged my left knee. It is a complex structure including a metal and plastic prosthesis, a bone graft, and cerclage wiring which is now partially broken into tiny pieces.

This structure did not appreciate slamming down on a concrete subfloor covered by a thin layer of carpet. In addition, I sprained two toes on my left foot during the same fall. That left me without a (good) leg to stand on. (That’s a joke, smile).

Once the flare remitted, I started the process of rehabilitation, again. I tried going to aquatic physical therapy but we could not make the timing work. I am doing my rehab program in the instructional pool on my own. I know what I am supposed to do. The challenge is showing up and putting in the work.

I have not been bedridden. I have obtained and prepared my own food from the start. I sometimes go out to shop for groceries and to pick up my medicines. There are numerous supermarkets within my driving range. However, none of them offer items like “grassfed beef bones.” These l have delivered.   Once I was mobile, I started to going to the pool. I love the pool. 

Still, I missed my morning walks. So today I gave it a try. I am weak. I have lost much of the strength and muscle mass that I developed during my last rehab effort. I am in pain. Both legs are problematic. I waddle and limp. I can’t find a lack rhythm for my stride. There is no cadence that works for me. Nevertheless, I walked for 20 minutes. I consider that an accomplishment.

In addition to physical activity, I have been paying attention to nutrition. I have not strayed far from the Autoimmune Protocol (AIP). Homemade bone broth, cooked in an instant pot is an extremely important part of my recovery.

As hurricane Florence threatened Virginia, I experimented with cooking a whole chicken in the instant pot. I loved it. Today I ordered another whole free range chicken from Whole Foods. Free range chicken is expensive. However, I use every part of the chicken. I waste nothing. They were out of stock. I will search stores closer to me to find the best chicken available. I will continue to do the best that I can to eat clean.

I am trying to increase my strength, flexibility, and overall wellbeing  I am coping more effectively with stress than before the flare. I am engaged in the appropriate spiritual and religious activities. I am engaging in appropriate physical activity. I am eating an appropriate diet.  

I am celebrating my 72nd birthday day by starting the rehab process over again. I have started over again many times since my first autoimmune diagnosis 62 years ago. The birth defects have increased the difficulty level. Yet, I persist. To persist is my nature. I am not responsible for the outcome. I am responsible for the effort. Today I made an effort to walk. I am pleased by the effort. 

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DDT and Me

My favorite uncle “poisoning cotton” with only a thin cloth covering his nose and mouth in the summer of 1961 is a memory that comes to me unbidden and vividly. I did not believe that the pesticide could poison the insects in his cotton without also poisoning him. When he died in 1962, I blamed DDT and other pesticides used to fight the “cotton bugs.”

By the time DDT was first made available for the general public in 1945, scientific research ‘had already shown beyond doubt that this compound was dangerous for all animal life from insects to mammals,”… By 1945 it was well known that once mammals and people were exposed to DDT, the compound became stored in their body fat and could even be found in their milk. DDT had a way of hanging around, even inside human bodies.

Vallianatos, E. G., & Jenkins, M. K. (2015). Poison spring: The secret history of pollution and the EPA. New York: Bloomsbury Press, p. 75.

Reading Rachel Carson’s Silent Spring, published the same year that my uncle died, but to which I was not introduced until I was a college student, convinced me that I had been correct. This video is a brief introduction to the DDT story.

Watch “DDT: From Wonder Powder to Public Enemy” on YouTube

https://youtu.be/JX3BlJnMX00

In Silent Spring it was Rachel Carson who introduced the public to the idea that pesticides should be called “biocides.”[1]This work also introduced me to the idea that our governmental agencies would withhold, indeed suppress, scientific information that could save the lives of human beings, citizens.

When I observed the poor showing of the Alabama Blackbelt in the most recently released County Health Rankings, the potential role of pesticides and other environmental toxins came immediately to mind. Even though I am both a medical sociologist and a health and nutrition educator, I was overwhelmed, emotionally and intellectually, by the amount of information that I found. I can only read and write about in small bits. So, this is not a literature review submitted for peer review, it is a rant.

DDT (Dichlorodiphenyltrichloroethane) was introduced to the world as a potent insecticide in 1939. This synthetic organic compound was widely used during WWII and is credited with saving the lives of many members of the Armed Forces in areas where diseases spread by insects were the most dangerous threat to their lives. After the War it became the insecticide of choice for both agricultural and public health purposes. DDT was presented as having only positive benefits for humans.

This means that DDT was everywhere. It was sprayed on fields from airplanes, by machines, and by hand. It was sprayed on children in schools, parks, and swimming pools. Housewives spread it around their homes. And then, as pesticides still do, it drifted through the air to unintended sites (https://link.springer.com/chapter/10.1007/978-1-4612-9863-2_4).[2]

While articles questioning the safety of DDT started appearing in the 1950s, it was Rachel Carson’s best-selling work Silent Spring that brought the controversy to the American Public. Carson’s work has been the subject of many documentaries. If you search YouTube, you will find many relevant clips. This is a 44-minute presentation of  the controversy in its historical context, so “get your popcorn.” You might want to make sure that it is organic.

Watch “The Silent Spring of Rachel Carson – Rare Pre-EPA Look at America” on YouTube

 

According to The Pine River Statement: Human Health Consequences of DDT Use, there is a growing body of evidence that exposure to DDT and its breakdown product DDE may be associated with adverse health outcomes such as breast cancer, diabetes, decreased semen quality, spontaneous abortion, and impaired neurodevelopment in children. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737010/). Long term exposure to DDT is associated with liver cancer and pancreatic cancer (https://www.ncbi.nlm.nih.gov/pubmed/1573662z). The list goes on and on. I am positive that DDT has contributed to the death of many of my kin. I am also sure that it continues to impair our health.

Perhaps the most important things to remember about DDT include:

  • While not acutely poisonous, it “bioaccumulates” in the fatty tissues
  • It moves up the food chain
  • It is a Persistent Organic Pollutant (POP).

The persistence of deadly DDT is illustrated by the fact that even though it was banned in the US by the EPA in 1972, it is still found in the waters and fish of Alabama in 2018. The list of contaminants in Alabama fish include:

  • Chlordane – A chlorinated hydrocarbon used as a pesticide until it was banned in the late
  • DDT – Another chlorinated hydrocarbon, DDT was a widely used pesticide until it was banned in 1972.
  • Mercury- Manufacturers used mercury in the manufacturing of chlorine, caustic soda, urethane foam and other products. Mercury can also be produced by the burning of certain materials. Once in the environment, mercury is converted to methyl mercury, which is hazardous to humans.
  • PCBs- Previously used in the manufacture of electrical capacitors and transformers and in the pressure treatment of lumber, PCBs have been banned since 1979.

Not all DDT contamination was incidental or accidental. What happened to Triana, Alabama deserves special attention.[3] In 1978 the Tennessee Valley Association (TVA) reported extensive DDT contamination in the Huntsville Spring Branch-Indian Creek, a tributary of the Tennessee River. Contamination was also found on more than 1400 acres of the Wheeler National Wildlife Refuge, the largest and oldest national refuge in Alabama. Elevated levels of DDT have also been detected in wildlife in the area.

A 1979 CDC investigation found average DDT levels in residents of Triana, a rural, predominantly black community of about 600 people, nearly 10 times higher than the U.S. population. Between the late 1940s and early 1970s, an Olin Corporation chemical factory discharged approximately 400 tons of DDT and associated waste into the Tennessee River upstream from Triana.

In 1980, the Justice Department, at EPA’s request, sued Olin, asking them to clean up the contamination. In October 1981, the site was designated one of EPA’s top-priority hazardous waste sites for cleanup under the new Superfund program. Superfund is the $1.6 billion fund authorized under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) which gives EPA the resources to clean up abandoned hazardous waste sites. https://archive.epa.gov/epa/aboutepa/olin-agrees-clean-ddt-triana-alabama-area.html

In 1983 the Olin Corporation formally agreed to a multi-million dollar cleanup of DDT contamination around its former manufacturing facility and to provide for health care for the residents of the of Triana.

In another post, I will have more to say about the site where Olin produced DDT. It starts with the list of Superfund Sites in Alabama.

The list of Superfund Sites in Alabama is very educational.[4]

https://en.m.wikipedia.org/wiki/List_of_Superfund_sites_in_Alabama

Those of us who were born near the cotton fields, the piney woods, and the pesticide plants of Alabama following WWII should suspect that these toxins affected our health and the health of our children wherever they were born. Forty years after the use of DDT in the US was banned, it is still in the soil, the water, the fish of Alabama. DDT and the other contaminants should be seen as continuing to play a role in the high morbidity and mortality rate in the Blackbelt and among those born there during the heyday of DDT.

NOTES

  1. It would be decades before I understood that environmental pollutants play a role in activating genetic predispositions for autoimmunity. I was exposed to pesticides in Alabama and Arizona. In Alabama I was also exposed to the toxic products of pulp mills. In Arizona I was also exposed to the toxins involved in the mining and smelter of copper.
  2. Harrison, J. L. (2011). Pesticide drift and the pursuit of environmental justice. Cambridge, Mass: MIT Press.
  3. Triana has been discussed both in the popular press and the scientific literature.O’Neill, L. (1979). A DDT legacy [contamination of the Tennessee river near Triana, Alabama]. EPA Journal, 5, 10-11.High Serum Concentrations of DDT Residues – Triana, Alabama. (1979). Morbidity and Mortality Weekly Report, 28(11), 123-129.Rusiecki, J., Cash, C., Raines, L., Brinton, S., Zahm, T., Mason, A., . . . Hoover, L. (2006). Serum concentrations of organochlorine compounds and mammographic density in a highly exposed population in Triana, Alabama. Epidemiology, 17(6), S89.
  4. Don’t be mislead by my focus on Alabama. Check out the Superfund Sites in your state. I have lived in five states. They all have areas of significant contamination, at least one in every city or county where I resided. https://commons.wikimedia.org/wiki/File:Superfund_sites.svgSearch for Superfund Sites Where You Live – https://www.epa.gov/superfund/search-superfund-sites-where-you-live

 

FLARE!

I am recovering from an autoimmune flare. I have tried to understand what triggered this flare. The answers seem to be (1) allowing my stress bucket to overflow, (2) skipping my hydroxychloroquine, and (3) reintroducing red pepper flakes into my diet.

The dietary changes are easy to explain. After eight months working on the elimination phase of the Autoimmune Protocol (AIP), I decided to eat red pepper flakes. It was a simple recipe: garlic and red pepper flakes with spinach sautéed in olive oil. My body’s response to the dried red pepper flakes was swift and dramatic.

Soon after the meal my entire mouth was aflame. My digestive system expelled the meal with force. The pain shooting into my head was so intense that my sense of balance deserted me. While rushing to the bathroom, I slipped and fell. I landed so that my left knee, the one with the broken pieces of circlage wire, was reminded that under a thin layer of carpet there is a concrete subfloor. The toes on my left foot were bent in a direction that was more than uncomfortable and two of them were sprained.

The painfully inflamed tissues of my lips and mouth and the headache were soon joined by swollen tonsils, muscle aches and pains, and fatigue. As I focused on how to feed myself. I used the pressure cooking setting on my instant pot to make bone broth. I used my Vitamix to make smoothies and soups. It finally dawned on me that this was an autoimmune flare, probably Sjogrens Syndrome. This was followed by days in which my major activities were directed at moisturizing my eyes, mouth, and throat.

I have plenty of eye drops and gels. I tried several mouth moisturizers. Sugarless gum did help with the production of saliva. The most healing balm was vitamin E. I punctured the capsules and applied the contents directly to lips and gums. When I was focused on my own food and healing that left plenty of time to think about other autoimmune flare triggers.

My new ophthalmologist had given specific instructions for dealing with the dryness in my eyes. She had also left me with a fear of hydroxychloroquine toxicity. I am at risk for the irreversible damage because I have been taking the medication off and on for the past 30 years. The baseline test was inconclusive and I have an appointment with the retinal specialist in November. At some point after the baseline test, I made an unconscious decision to stop taking the medication. In retrospect that was probably not a very good idea.

Having to deal with an autoimmune flare and decisions about medication forced me to deal with my need for a new rheumatologist. I like the one I have but he has moved his office to Colonial Heights and I hate driving on I95. He is also not an Anthem participating provider. So, I must pay what Medicare will not. Since it looks like I may be needing a rheumatologist more often, I have made an appointment with one at VCU Health. The idea of dealing with a new rheumatologist is almost as stressful as the idea of retinal damage.

I was spending long hours working and studying online. I had my first new batch of nutrition consultation clients in three years and I was highly motivated to provide high quality services while meeting all contractual obligations. I was engaging in professional development by taking a course on the human gut microbiome. I was working diligently on DNA genealogy and family history.

I was also working on my physical rehabilitation. I was taking 30 minute walks early in the morning and had also started physical therapy in the pool to help alleviate the pain from the arthritis in my hip. My physical and mental resources were spread very thin.

Then there were unexpected deposits in my stress bucket. Do I really need to say more than DMV? The bureaucracy made an error and I had to jump through hoops to not be fined for it. How about while I was standing in line at DMV, ADT called to say that my alarm was going off. The air conditioning stopped working. The compressor was frozen. When it defrosted there was a pool of water between that concrete subfloor and the carpet that is not yet completely dry. The heating elements in the oven died.

In other words, life just kept marching on while I needed to understand the two additional deposits that the ophthalmologist made into my stress bucket. While I may or may not have retinal damage from hydroxychloroquine, I definitely have two degenerative eye conditions. The diagnosis for the right eye is posterior vitreous detachment (PVD). The diagnosis for the left eye is asteroid hyalosis.

I now understand that PVD simply means that I am myopic, aging, and have already had cataract surgery. There is no treatment for the condition. If I experience an increased number of floaters or a curtain, that should be treated as an emergency. The asteroid hyalosis is not expected to cause any problems with my vision.

Unfortunately, these degenerative conditions which are considered to be relatively benign are interacting with preexisting conditions in ways that I find extremely uncomfortable. I am not blind. I am not going blind. I am extremely sensitive to glare, the kind of glare that comes from the screens of computing devices. After an hour or so my head starts to hurt badly and does not stop. The pain is severe enough that it interferes with my ability to use my brain to work, to study, and to manage musculoskeletal pain.

I have tried various types of filters on my devices. None of them alleviate the problem. I have worked with my optician to try various types of antiglare and light sensitive lenses. They also fail to solve the problem.

The bottom line is that if I want to reduce the frequency and intensity of the headaches, I must change my computer related behavior. As I have come to terms with the need to change my behavior, to drastically reduce my screen time, the level of stress in my bucket has been greatly reduced and the autoimmune flare has abated. Now, I must set some priorities.

There are people I love who fare better with me alive. You know how it works on planes. When the cabin pressure falls and the oxygen mask drops, the responsible adult raises their oxygen levels first. I am still a responsible adult. Whatever has distracted me from saving my own life first needs be removed from my agenda. As in “Girl, Bye.”

 

And Your Health Challenges Are?

I design opportunities for people with complex health challenges to make health promoting decisions about food intake and physical activity. This process involves, obtaining information about current health status, examining current decision making, and clarifying goals. I use the social ecological framework for nutrition and physical activity decisions to identify the types of interventions that will help them successfully achieve their goals. I refer them to appropriate practitioners.

I am going to write about each of these stages in turn, starting with obtaining information about current health status. My current form asks people to list each physician they have seen in the 18-month period prior to their first consultation with me, each test they have been given and its results, all their diagnoses, their prognoses, and their list of prescriptions.

WE WILL CALL YOU IF THERE IS A PROBLEM

As I explained in an earlier blog, many people cannot complete this form accurately. They visit a physician, they provide blood and/or urine, and they submit to various forms of imaging. Then they wait for a call that tells them their results were problematic in some way. They agree to a situation in which no immediate problem means not only no call but no information whatsoever.

I do not believe that this is in the health care consumer’s best interest. This is the first area in which I became a patient advocate. I advocated for myself. “It is my health. The tests were paid for by my insurance (for which I pay), so they are my results and I want them!”

THE 15 MINUTE OFFICE VISIT

Another problem is the general quickness of the typical office visit. It leads some physicians to filter and reduce how much they say during an office visit. They chart more information than they speak. Others throw around multiple diagnoses using medical terminology so rapidly that even an informed lay person has difficulty keeping up. I can’t be the only one who gets distracted or forgets.

COLLECTING THE DATA

Now, I either collect and organize this information for my clients or teach them how to do this for themselves. Collecting the data can be expensive, time consuming and frustrating. The creation of the “patient portal” has solved some of the problems with obtaining this type of information. They eliminate the initial charge for copies and sometimes provide much faster turn around time.

PATIENT PORTALS

But portals are far from perfect. They require computer skills, computer patience, and the ability to be both patient and persistent with the human beings on the other end. Portals, then, can still be time consuming and frustrating. That’s why people hire me.

I am prepared to deal with the frustrations of collecting and collating the medical data for people who hire me to do so. When we find errors in the data, I assist with getting corrections made. I provide the assembled data in a format or formats of their choosing. For those who avoid digital media, I present the data in three ring binders because they ease updating. For those who live in the digital world, I provide the collated and indexed records in the cloud and on USB.

EXAMPLES

This service was first requested by an exhausted family care giver when a sister agreed to take a turn caring for their mother. At the last moment she realized that much of her mother’s medical record was stored in her head. We worked to create a usable packet of information for her sister as well as do the paperwork and online forms that would allow the sister to request information from physicians and access portals. It has become one of the services that I provide most frequently, along with helping people learn how to do it for themselves.

Recently I provided this service for a delightful couple getting ready to enjoy their retirement with some long-range travel. They both needed records from Patient First, VCU Health, Bon Secours, and HCAVa. Individually they needed records from several different specialist health care providers. When the time came to decide how they would carry their records, she opted for a bracelet and he opted for dog tags.

On Saturday (August 4, 2018), I lead a workshop in which a group of Wisdom Warriors practiced accessing their patient portals for themselves. I learned as much from them as they did from me. If you have never been in a room with group of nonjudgmental older women discussing their health issues, you have no idea how much we laughed.

They congratulated me on the positive change in my fasting glucose levels since, I started the Autoimmune Protocol (AIP). They noticed the post surgery weight loss They wanted to know if I had experienced any other changes in health indicators. NO ASTHMA. NO RESPIRATORY INFECTIONS.

For years, I have experienced allergenic asthma. Last year the wheezing started in the spring with the pollen. By August every section of my respiratory system was infected or inflamed. I had a sinus infection, an infection in my middle ear, bronchitis, and then pneumonia. Most of my energy went into simply trying to breathe. This year a mild reaction to pollen and dust mites and nothing more.

I believe that attempting to follow the AIP has resulted in the elimination of one or more food items that were triggering the asthma and leading to the extreme respiratory distress. I have hypothesized that the culprit is wheat. The ladies want to know how I plan to test the hypothesis. They have invited me to come back next month.

TRACKING TRIGGERS

I plan to start the next workshop by leading them through some tracking exercises. We will work on tracking food intake. This is the first step required to identify any food sensitivities and allergies that may trigger over enthusiastic immune systems.

ELIMINATING TRIGGERS

The next goal is to eliminate potential food triggers from the diet. The AIP is one of many elimination protocols. The key is to select a protocol and stick with it for the required length of time before reintroducing the potential triggers. Changing dietary styles can be difficult.

The elimination component of the AIP is working for me. My autoimmune conditions are in remission (the wolf pack is resting quietly even in the face of daily thunderstorms). I am no longer moving toward type 2 diabetes. And last, but not least, my killer t-cells have their weapons holstered and I have not experienced respiratory distress.

Your comments are invited and appreciated. If you would like to schedule a workshop or an individual consultation, contact me.

 

AIP Lowered My Blood Sugar Levels!

I am a health and nutrition educator, as well as a medical sociologist. I consult with both individuals and organizations on the creation of health and wellness programs. I am my most important client. While recovering from a recent spine surgery, I was Inspired by the philosophy of Miss Harriet Tubman as presented by GirlTrek.org. I am saving my own life first!

In designing a wellness program for myself, I started with two types of health conditions: those with which I was born (congenital) and those for which I inherited a genetic predisposition with expression influenced by lifestyle and environmental factors.[1]

I have inherited a genetic predisposition for type II diabetes.[2] I know that lifestyle factors, including physical activity and diet, can influence the expression of this genetic predisposition. This knowledge comes from the classroom at Hawthorn University and from life experiences.

In the early 1990s, the skin on my neck became much darker than the skin on my face. My primary care physician gave me explanations that were not logical. She claimed, for example, that the skin on my neck had always been darker or that the darker skin on my neck was the result of exposure to the sun.

I was born into a generation of women taught to treat their neck as part of their face. I knew my own neck. I also knew that neither my face nor my neck had been over exposed to sunlight since the late 1970s. I have lupus. I am photosensitive. I have permanent scars on my face to remind me of what happens when my skin is exposed to UV from sunlight. As a result, I learned to apply a 30 SPF moisturizer to my face every morning.

My insurance coverage was through an HMO. I had to write this physician a memorandum to get a referral to a dermatologist. Since my memo was included in my file, the dermatologist was ready for me as soon as she entered the room. She told me that the darkening of the skin on my neck was called acanthosis negricans and described it as a precursor to diabetes. I made some lifestyle changes and my neck returned to it’s normal color.

For the past nine years, I have been working with a primary care physician who orders bloodwork the week before an office visit. An important part of the office visit involves going over the results line by line. It is difficult to be in denial when you and your trusted physician are looking at the lab results and at each other. That is why, over the past few years, I have had the opportunity to see my fasting blood glucose levels slowly rising.[3]

After the failure of my hip flexors took me out of the pool and the undiagnosed cyst growing in my lumbar spine took away my ability to walk, my fasting blood sugar level started increasing more rapidly.

Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics) https://www.uptodate.com/contents/diabetes-mellitus-type-2-overview-beyond-the-basics?view=print#H4

When my fasting glucose level approached and then moved into the “impaired fasting glucose” stage[4], my primary care physician and I talked about dietary changes. I was already following a nutrient dense whole foods lifestyle so there were no sodas, processed, or sugar laden manufactured food like substances to remove. He suggested giving up beans. That was a difficult thing for a “beans and rice woman” like me to do. But I complied. Unfortunately, my blood sugar level continued to indicate that I was insulin resistant and at risk for diabetes.

After my spine surgery in December of 2017, I decided to try the Autoimmune Protocol (AIP). I started the AIP in January 2018. My approach to the AIP was to focus on the wide array of vegetables that were included rather than on those that needed to be eliminated. In March of 2018 my fasting blood glucose level and A1c were both within the normal range, just barely. But, just barely was enough for me to know that something about the AIP was having a positive impact on my health

06/27/2016 10/05/2016 01/25/2017 11/10/2017 3/23/2018
Glucose, serum, fasting 114 108 115 109 97*
A1c 5.5* 5.7 5.6* Not submitted 5.4*
*Indicates results within the “normal” range.

 

This motivates me to keep working with the AIP. I am also learning more about dietary lifestyles that overlap with the AIP. In the Plant Paradox, for example, Dr. Steven Gundry recommends removing from the diet many of the same foods that are eliminated in the AIP. Dr. Gundry recommends foregoing conventional dairy, many grains, legumes, and nightshades. His first emphasis is on the toxic impact lectins.[5]

Dr. Gundry’s second emphasis has become promoting his proprietary prebiotics blend. This video which introduces some of the main ideas from the book is a long commercial for this product. I recommend watching the video and visiting his website and reading his blogs. I offer one caveat. If you click on the link at the end of the video and provide your email address, you will become the target of aggressive marketing. I think that I can get the prebiotics that I need without spending so much money.

Dr. Steven Gundry: Cut Your Cravings

https://cutyourcravings.com/mvideo180626A.php?n=aff

I believe that this process is about taking responsibility for what I put in my mouth. If I choose to eat foods that do not impair my body’s ability to produce and respond to insulin the genetic predisposition to develop type II diabetes will not be expressed. I don’t think this is going to be easy. Given what I know about my anatomical and biochemical individuality, however, I think managing diabetes would be even more difficult. So, I intend to try.

If you are interested in these topics continue to follow me. If you want to know if I am successful in continuing to make dietary choices that do not lead to diabetes, then continue to follow me. If you are interested in finding the dietary lifestyle that works best for you, contact me. I can help you with that.

I understand enough about epigenetics, to know that just because you have a gene does not mean that it must be expressed. I know enough about nutritional genomics to know that what you eat can influence your health. If you are still reproducing, then what you eat can influence the health of your descendants across future generations. Let’s take responsibility for our food choices.

NOTES

  1. In the past several posts, I have written about how I strive to be well given the challenging health conditions with which I born (congenital) and those which developed as the result of a genetic predisposition. I have written about scoliosis and the pain from the leg length discrepancy it produces. I have written about the congenital stenosis and spondylolisthesis in my lumbar spine which have, in conjunction with degenerative processes and a cyst, damaged the nerves that enervate the muscles of my shorter and smaller leg. I have written about the autoimmune diseases with which I live: lupus, Hashimoto’s, Sjogren’s Syndrome, etc.
  2. I knew this before my DNA was analyzed. According to members of my extended family, Type II diabetes, or “the sugar,” runs in our blood. Both of my parents were diagnosed with type II diabetes. I get emotional when I think of the family members that I have lost because of the complications of this disease. The cases in my family also seem to be following the national pattern in which people are experiencing the onset of the disease and its more serious complications earlier in life.I am familiar with the statistics, national trends, and the debates over causes because I have facilitated graduate level seminars on the sociology of food and nutrition offered through the sociology department at VCU.
  3. Most of my clients still get their blood drawn at the time of their office visit. Some still only get a phone call after a result is outside of the expected range. Some now have access to their lab results through “patient portals.” I assist these clients with accessing all the portals in which their health data are stored. I help them become comfortable with the way the data are presented. You do not need a medical degree to recognize a result that is changing over time in undesirable ways. Many specialists will only send a report to the primary care physician. Having access to a patient portal allows one to share the information with every member of the health care team.
  4. Impaired fasting glucose is defined as a fasting blood sugar level between 100 and 125 mg/dL (5.6 to 6.9 mmol/L).
  5. The process of reducing lectins in tomatoes took me back home to Alabama and watching my aunts go through the process of canning tomatoes. I will be trying to make a reduced lectin tomato sauce and seeing what happens when I include it in my diet. https://youtu.be/Qq0QXdql7Po

Hashimoto’s, Antidepressants, and My Philosophy as a Health Educator

 

THE HASHIMOTO’S EXPERIENCE

I was born with a genetic predisposition for thyroid disease. I knew this before I saw reports generated by analyses of my DNA. Both my father’s mother and my own mother had thyroid disease. My paternal grandmother’s goiter is clearly visible in the picture below. I saw my mother’s goiter with my own eyes but have no pictures from that period of her life.

 

As a child I hypothesized that their goiters were the result of insufficient levels of iodine. (Yes, I was that child. I spent my early childhood in a segregated community in the U.S. South without routine access to physicians.  My maternal grandmother was a healer. She allowed me to follow her around until I started asking inappropriate questions about sexual and reproductive issues. I paid attention. I think this is where I was introduced to the value of traditional knowledge and self-care. The more I learn from modern medical science, the more I know that my grandmother was a brilliant woman, even though she thought my curiosity about reproduction required an exorcism.)

 

My own experiences, as I spent decades coping with undiagnosed and misdiagnosed thyroid disease, do not support the “lack of sufficient iodine” hypothesis. Those were very difficult years characterized by a wide array of painful and energy draining symptoms. My thyroid disease was not diagnosed until the gland stopped functioning, knocked out by a medication prescribed for a condition that I do not have.

Hypothyroidism (underactive thyroid) https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

Many people with lupus have stories about the horrors they experienced before being diagnosed correctly. My initial lupus diagnosis came quickly. My horror stories revolve around years of undiagnosed and misdiagnosed Hashimoto’s Autoimmune Thyroiditis. I lost my left knee to Hashimoto’s at age 40. But the most nightmarish part of the experience was being misdiagnosed with bipolar disorder when the changes in my energy levels and moods were in fact caused by the Hashimoto’s.

Is it Mental Illness or Hashimoto’s Diseasehttps://www.holtorfmed.com/mental-illness-hashimotos-disease/.

These experiences also highlighted my genetically based hypersensitivity to antidepressants. Several years ago, decades after I knew better, I succumbed to pressure from a pain management physician to try Duloxetine as a treatment for neuropathic pain. I expected to experience a brief period of hypomania which would convince my physician that it was not a good idea for me to take the drug.

Duloxetine https://www.webmd.com/drugs/2/drug-91490/duloxetine-oral/details

Instead, the side effects were devastating. Not only did I experience a very unpleasant period of hypomania. I also experienced lightheadedness and a loss of balance. It was during this process that I fell and traumatically injured my brain. Even though I went to urgent care the day after my fall, it was more than a month before my traumatic brain injury was diagnosed.

Traumatic Brain Injuryhttps://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

Then I tried stopping the medication. The effects of Duloxetine withdrawal sent me into a life altering downward spiral. The “brain zaps” hit me hard. I reached out on Facebook. Instead of offering me help, most of my friends and relatives ignored me. A few made fun of me. (BUNDLE UP CHILDREN: SOME OF US LIVE IN A COLD, COLD WORLD).

Cymbalta Side Effectshttps://www.drugwatch.com/cymbalta/side-effects/

The physician who had prescribed the medication told me that what I claimed to be experiencing was impossible. He lashed out at me by telling me that I needed a psychiatrist. Since I am always open to that possibility, I called the psychiatrist who had been with me through the process of establishing that what appeared to be a mood disorder was in fact an autoimmune disorder of the endocrine system.

My former psychiatrist returned my call even though he was retired and was in the process of closing his office. His response was empowering.

“Ann, you do not need a new psychiatrist. You need a new pain management physician. You are an intelligent woman. No good physician is going to ignore what you have to say about your own medical history.”

I decided to tough the withdrawal out on my own. After talking to my daughter, who works in a microbiology laboratory, I bought myself a set of Norpro Mini Stainless-Steel Measuring Spoons – http://amzn.to/2MN7x2E and some Micro Scoops – https://amzn.to/2IgVFCV.  While dealing with a traumatic brain injury, the side effects of Duloxetine, and Duloxetine withdrawal symptoms, I used these tools to titrate off the drug by gradually removing beads from the capsules.

One of the things that I learned from this experience is to never take drugs prescribed by a physician who has not thoroughly studied and accepted  my medical history. This experience has also played an important role in the philosophy that I bring to my work as a health educator. I believe that people should know as much of their family health history as possible. They should be able to present that history in ways that health care professionals must respect. And they should be able to provide themselves with appropriate self-care. Maybe they need to consult with someone who has a graduate degree in health and nutrition education and some first-hand experience.

MY GOALS AS A HEALTH EDUCATOR

To assist people with claiming their own health history.

To assist people with understanding the value of appropriate self-care.

STILL CARING FOR MYSELF

My health history dictates that each morning, as soon as I climb out of bed, I take my thyroid hormone replacements. The failure to take them has such severe repercussions that I have put a great deal of effort into building this habit. I require a replacement for T3 as well as the standard prescription for T4. And of course, I have my favorite books.

Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: A revolutionary breakthrough in understanding Hashimoto’s disease and hypothyroidism 

 

Stop the Thyroid Madness: A Patient Revolution Against Decades of Inferior Treatment

 

GRATITUDE AND COMMITMENT TO TRUTH

I still have pain and fatigue. I visit an ophthalmologist for routine hydroxychloroquine toxicity screenings. That is why my cataracts were diagnosed prior to surgery and why I was recently lectured on the need to provide better care for my dry eyes. Sjogren’s adds to the pain and fatigue and to steps in the daily routine of self-care.

However, given that I was born with several skeletal defects and that my genetic propensity for autoimmune diseases was triggered in 1956, I am grateful to still be alive, upright, and moving under my own power. This has been a life long war. I survive by confronting the issues realistically. I will not be bullied into a conspiracy of silence and denial. I will not be seduced in telling lies. I will speak my own truth.

If you think that every mention of pain is indicative of powerlessness, failure, and negativity, I could probably help you too.

 

When One Leg Is Shorter, Redux

 

One of my legs has always been longer than the other. The difference in the length of my legs has contributed to low back and sacroiliac pain and dysfunction. It has also played a role in hip, knee, and foot problems. These challenges contributed to the centrality of the pool in my physical activity. In 5-10 feet of water a minor leg length discrepancy has little meaning.

My ability to enjoy the water came crashing to a halt in 2015. I had fallen and injured my left arm from shoulder to wrist, including the joints associated with the thumb. I also injured my brain in the fall. I was left swimming a one-armed backstroke, a very ugly and inefficient way to move through the water.

However, it was the violent spasms in my hip flexors that pulled me from the water. Moving through the water was difficult having only one arm that worked as expected. When my hip flexors stopped functioning, the process transformed into dangerous and impossible. STARTING IN 2015, I POSTED ABOUT MY EXPERIENCES WITH THESE ISSUES ON THIS BLOG SITE. These blog posts became my official memory as I worked my way through the traumatic brain injury. 

For more than a year, I experimented with continued epidural steroid injections and tried different forms of physical therapy. None of them helped and several made the problems worse. I am not speaking of pain alone. I am also speaking of loss of functional capacity. If I could not “push through pain” I would have died several decades ago. This time I had reached a point where I could no longer will some of my muscles to work. My right leg was especially troublesome. It would buckle and drop me to the floor without warning.

One of my physical therapy routines aggravated debris from broken surgical wire around my left knee replacement. I experienced a brief resurgence in lupus symptoms followed by a severe allergic reaction to dust mites and infections in my lungs, sinuses, and middle ear. I was out of circulation for several months.

Once I had calmed the inflammation and infections in my respiratory system, I took this new muscle weakness symptom to my interventional pain management physician and my orthopedic surgeon. They decided that the problem was one that required the assistance of my neurosurgeon. The cyst that was visible on the MRI indicated that they were correct.

The surgery was performed six months ago. There is no longer a cyst compressing my spine and my right leg is no longer collapsing. I still have the standard symptoms from the compression of nerve roots in the lumbar spine: numbness, burning, tingling. I also have the challenge of sacroiliac syndrome. I am, nevertheless, excited to now be working on my long term physical rehabilitation.

This rehabilitation effort starts with compensating for my leg length discrepancy. Compensating for the leg length discrepancy has long been my responsibility. My orthopedic physical therapist once exclaimed that this was more art than science.

In my case, the difference between the length of the two legs is small in size but large in effect. For me, the most effective method for measuring the size of the difference that needs to be corrected is found in “clearly adjustable” products. I use heel lifts and I use foot lifts

These lifts are “micro adjustable.” I will remove, or add, one layer at a time until I have identified the height that reduces symptoms in the right buttock, hip, and leg without producing symptoms on the left side.

I will work slowly. The damage to the nerves in my right buttock, thigh, leg, and foot has resulted in significant muscle atrophy. It can take another full year to determine if any of the damaged nerves have regenerated enough to allow the muscles to gain strength.

In the meantime, I will continue to work on keeping the lupus in “technical “remission. I will stop ignoring the symptoms of Sjogren’s syndrome, and I will eat to promote systemic and metabolic wellness.

Lupus is a large, dangerous, and mysterious wolf with whom I have been forced to share a life for more than 50 years. I think of keeping lupus in remission as “keeping the wolf calm.” To accomplish this, I must:

  1. Avoid Ultraviolet Rays both from the sun and from florescent lighting.
  2. Stay attuned to changes in weather patterns, including temperature, humidity, and barometric pressure.
  3. Cope effectively with stress.
  4. Exercise appropriately for weight, strength, and mood.
  5. Eat a nutrient dense whole foods diet with anti-inflammatory properties.
  6. Take my daily hydroxychloroquine.

Dealing with Sjogren’s requires everything in the list above, plus keeping my eyes appropriately moisturized. Taking hydroxychloroquine requires being screened for toxicity by an ophthalmologist at least once a year. I prefer to be screened twice a year. I was screened recently and got a lecture because my eyes were too dry to indicate that I had been taking care of them properly. I have received the message.

I am a health and nutrition educator. Selecting, preparing and eating health promoting foods are activities that I enjoy. Unfortunately, my ability to do so is impacted by pain and fatigue and sometimes even I find myself reaching for foods that provide a quick mood fix. To avoid these impulses, I must focus on eating a nutrient dense whole foods diet with anti-inflammatory properties. Yes, it is worth mentioning twice.

Having autoimmune diagnoses and congenital structural defects does not render me immune from the health problems faced by everyone else in my demographic categories. It is past time for a visit with my gynecologist and my colon and rectal surgeon.

Clearly, I have a full agenda. You are invited to come on this journey with me. As a health and nutrition educator, it will be my pleasure to have you accompany me

Lupus Remission: Calming the Wolf

“From my perspective it seems that each person who has lupus starts from a different point and follows a unique set of pathways in developing lupus.” Thomas, Donald E. 2014. The lupus encyclopedia: a comprehensive guide for patients and families. Baltimore: Johns Hopkins University Press.

I was asked to explain how I arrived at a place where analyses of my blood find none of the abnormalities associated with lupus. According to the Lupus Foundation of America, the word “remission” is appropriate in this situation. I am “in remission on medication.” I take hydroxychloroquine and at present have no symptoms that can be seen solely as manifestations of lupus.

The Wolf that was once tearing my life apart is now resting quietly at the foot of my bed. I believe that the Wolf is quiet because I took charge of my health. I took charge of learning and doing what was best for me. I learned that many of my most painful symptoms were not caused by lupus. These symptoms were being caused by structural defects with which I was born. I learned to recognize what triggered lupus flares (an increase in the frequency and intensity of symptoms) in me. I learned to protect myself from the triggers. I avoid them or mitigate them impact.

Remember, this is my narrative. It is an attempt to describe my unique pathways. The uniqueness of each person’s experience in developing lupus is part of its continuing mystery. It is this uniqueness which makes lupus so difficult to diagnose and to treat. It is also this uniqueness which means that those patients who take charge of the disease(s) manifestations in their own life fare the best. We follow a unique set of pathways in developing lupus and we need unique, even if overlapping, pathways to remission.

DOES EVERYONE WITH LUPUS GO INTO REMISSION?

This is another question that the Lupus Foundation of America answers very clearly. The answer is a resounding “NO.”

https://resources.lupus.org/entry/does-everyone-go-into-remission

This is the paragraph which best describes my experience over the past 50 years.

“In some people, lupus will flare, become inactive (quiescent), and go into remission—this course of the disease may or may not occur regularly throughout their life.”

I understand that not everyone shares my experiences. I experienced my first autoimmune/chronic inflammatory disease, rheumatic fever, at age 10. My first serious lupus flare occurred after the birth of my first child, more than 50 years ago. The frequency and intensity of my lupus flares decreased after menopause. This indicates that in my case the sex hormone estrogen played a role in the severity of lupus.

Unfortunately, the years leading up to menopause were very difficult because none of my physicians recognized that I was also dealing with Hashimoto’s Autoimmune Thyroiditis.

By the time the hypothyroidism was diagnosed, both my thyroid gland and my ovaries were no longer working. I had also learned to identify other things that triggered lupus flares. These triggers arouse the Wolf in me.

 

WHAT TRIGGERS LUPUS FLARES IN ME?

Photosensitivity

I am extremely photosensitive. I am even sensitive to the UV from florescent lights. The sun is my enemy. I avoid it and protect myself from its UV rays as though my life depends on it. It does.

https://resources.lupus.org/topics/photosensitivity

Because I avoid exposure to UV, I MUST SUPPLEMENT VITAMIN D.

Barometric Pressure

I am also extremely sensitive to changes in seasons and weather patterns. The change from winter to spring and the change from fall to winter is traumatic every year. As a small child, I lived in a rural community where older people spoke of the impact of changing weather as “the rheumatism.” They did not have a physician who was a rheumatologist. I do.

I am especially sensitive to changes in barometric pressure. A change of 10 millibars can knock me off my feet. I live in the mid-Atlantic and once winter has finally changed into spring, I watch the weather reports and prepare for the summer storms as another matter of survival. I have barometric pressure apps on all my mobile devices.

When a “big storm” comes, I am going down. The electrical power will also go down. The first question is will I have all the supplies that I need until I am once again mobile. Needs include water, food, and medicine. The second question is do I have appropriate amusements. I like to keep my gas tank full because my automobile is a giant battery charger.

Other locales present other problems. I have lived in: Chicago (too cold), Southern California and Arizona (too much sunlight), the Gulf – of Mexico- Coast (too much sunlight and much too close the summer storms). People with lupus are sensitive to weather patterns. As my son announced at age three, “Where ever you go there is weather.” If you have lupus and you want to have a life, you must adapt to the weather patterns of the area in which you live. You must pay attention to them.

Foods

There are foods and food additives that increase my lupus symptoms. I avoid additives by avoiding packaged and processed foods. I consider much of what is sold in supermarkets to be manufactured food like substances, rather than food.

Like most people, even those without lupus, I feel better when I eat a nutrient dense whole foods diet. I have a strong preference for traditional dietary styles.

Before the rise of 24 hour minimarts, vending machines, and fast food delivery, traditional diets rooted in wholesome, seasonal ingredients nourished families all around the world. https://oldwayspt.org/traditional-diets

I know, however, that I am sensitive to some foods that are included in my preferred traditional nutrient dense diet. Attempting to identify the foods that most impact my health, I recently completed the elimination phase of the Autoimmune Protocol.

I am following the work of Dr. Sarah Ballantyne – The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body. Dr. Ballantyne believes that the Autoimmune Protocol will help people with lupus in several ways including increasing their energy. I think most people with lupus are looking for ways to stop being so tired all the time.

Sedentary Lifestyle

When I am forced to stay in the bed or to only move between my bed and a chair, the Wolf becomes unruly. I need exercise. Over the years, I have spent a great deal of time in physical therapy. When other people say that they are going to the gym, I am most likely headed out to work with my therapist.

Outside of physical therapy, I love the swimming pool. I would rather be at the beach. However, I am photosensitive. So, I get into the pool and visualize myself in the warm clear waters of an Island Paradise. I have been out of the pool for a while now. But getting back to the pool is one of my goals.

I am working on achieving that goal with the simplest exercise of all. I go for walks. I am five months post spine surgery and simply taking a walk is both demanding and satisfying. I tend to go for my walk around 6:00 am. In late May and early June, it is already light outside, but the UV rays are not yet prohibitive. Every step that I take is a battle. I am fighting this battle and I plan to win.

Stress

My other major trigger is stress. I have spent years studying stress and learning how to break the stress cycle. I have taken classes, participated in workshops, and worked one on one with teachers and therapists. I have skills.

Like everyone else in the world, I often find myself dealing with the “fight or flight” response. I often fight. Sometimes I flee. When I can neither fight nor flee, I (try to) FLOW. I FLOW through meditation, visualization, and expressive writing.

I FLOW into the kitchen. I love to cook.

I FLOW into reading. I love to learn. Learning helps me to take charge of my health.

This has been my pathway to remission. It has taken me years to calm the Wolf. I work very hard to keep her (Yes, she is female and alpha) quiet because I have other health issues with which I need to deal. Right now, lupus is not biggest problem in my life. It would only take one “quick trip to the store” without appropriate UV protection to change that. If I get distracted and start wandering around the farmers’ market, I could end the day hospitalized.

Doctors who care deeply about their patients know very well that it is the patients who take charge of their diseases who fare the best. Thomas, Donald E. 2014. The lupus encyclopedia: a comprehensive guide for patients and families. Baltimore: Johns Hopkins University Press.

Most of my posts have some connection to my journey through life as a person dealing with autoimmunity. I plan to connect the dots, eventually. I cannot say everything about my journey in a single post. Please be patient with me.

If you have specific questions, I will gladly point you to resources that offer answers. You can respond to this post in public or you can message me for a private conversation. And remember, I would love to hear your story. I would love to learn of the unique pathways that lead you into the lupus maze and how you plan to find your way back out. What awakened the Wolf in you? How do you calm the Wolf in you?

 

Need Nutrients? Try Bone Broths!

I first posted this blog 11-12-2013. I have reposted it here because bone broths are alsoimportant sources of nutrients and great taste in that Autoimmune Protocol (AIP).


chickenstock

Earlier today a friend asked me for my chicken stock recipe. I had to confess that the recipe did not belong to me but to Sally Fallon. Fallon shares her recipes for chicken, beef, and fish stock on the in the cookbook that she wrote with Mary Enig (Nourishing Tradiions: the cookbook that challenges politically correct nutrition and the diet dictocrats).

Fallon takes a position on almost every controversy that we consider when comparing the health benefits of dietary styles. She definitely believes that traditional animal broths and stocks provide a basis for both tasteful cuisine and good health.

Because Fallon challenges conventional nutritional knowledge so strongly, and provides so many instructions for creating health enhancing traditional foods, there are many websites and blogs that discuss her viewpoints and her recipes. My favorite site is the Nourishing Cook. The creator of this site, Kim Knoch, has set as her goal to cook every recipe in Nourishing Traditions. as her goal. I enjoy reading about her successes and her failures, as well as to how her family responds to each attempt. But what brought Kim to my mind today is her reason for being so committed to nutrient dense foods.

Nutrient-dense eating is personally important to me because I need all of the nutrients that I can get. I had weight loss surgery in 2001 and lost 200 pounds, and as a result of that became severely anemic and had a shortage of other vitamins and minerals in my blood. ‘Nourishing Traditions‘ got my eating back on track. I made sure that everything that I put in my mouth was the best quality that it could be. It worked, and my anemia has been corrected and my vitamin/mineral levels are normal, partly due to the methods that I talk about in this blog. http://thenourishingcook.com/about-2/

Like Kim my friend has had weight loss surgery and is anemic and dealing with other nutritional deficits. My friend also has lupus.  She needs all of the health enhancing nutrients that she can get. Like Kim my friend must cook for a husband as well as for herself. I think that she will enjoy reading about how Kim fits meal planning into a life that includes a husband, two teenagers, a full time job, and even playing in an orc tohestra, while keeping stress at a level that is manageable.

Bone broths are the starting points for many nutritious and delicious recipes. And because they are easy to cook they are a great place to start when considering the benefits of a traditional dietary lifestyle.


People with autoimmune conditions also need all of the nutrients that they can get. Bone broth is both highly nutritious and tasty.

Broth is Beautiful

In 2013 I was still living in my house and had lots of freezer space. I only made bone broth several times a year. Now that I have downsized, I make it more often and  in smaller quantities. I have been trying slow cooker recipes. I do not yet have a favorite. Do you have a favorite bone broth recipe for slow cookers? If so, please share.

 

 

Vegetables and the AIP

 

For years I have lived a nutrient dense whole foods dietary lifestyle. My customary approach to food was disrupted by the growth of a cyst on my spine and the surgery to remove it.  While recovering (or not recovering) from the spine surgery, I decided to transition to the Autoimmune Protocol (AIP), slowly. Chronologically, I am 71 years old. Physiologically, I am much older. I approach most things slowly.

I knew that the basis of the AIP in the Paleolithic dietary style meant that I must eliminate grains. I also knew, from reading the early work of Wahls, that I would also need to eliminate legumes and nightshades from my diet.

The first question that I asked was what plant foods can I have on the AIP and how much of them may I eat.  I quickly discovered that vegetables and fruits are very important in the AIP. Because of the nutrients they contribute (fiber, vitamins, minerals, antioxidants), vegetables are not generally limited on the AIP.

My first step into the AIP required that I was getting plenty of vegetables at each meal.

 

In the Paleo Approach: Reverse Autoimmune Disease and Heal Your Body, Ballantyne describes the nutritional benefits of leafy vegetables and writes, “Eat as many and as much of these leafy vegetables as you like, ideally with every meal.”

 

Ballantyne also makes it clear that I am free to choose other nonstarchy vegetables such as broccoli, cauliflower, and Brussels sprouts.

 

 

 

 

 

With the few already mentioned exceptions, I am free to choose from roots, tubers, and bulbs.

The bulbs of the aromatic alliums are also valued on the AIP. In addition, I can also choose from “vegetable like fruits” and have some choices from among sea vegetables. These I will discuss later. The bottom line is that transitioning to the AIP did not require me to give up vegetables.

In fact, Ballantyne does not mention a serving limitation until she gets to fruit.

You just have to make sure that your daily fructose intake is between ten and twenty grams—that’s about two to five servings of fruit a day.

She, of course, offers a table that shows the amount of fructose in various fruits. I also used the Nutrient List of the USDA Food Composition Databases. I realized that on those days when I eat whole fruit that is relatively high in fructose, I need to eat only 2-3 rather than five servings.

The AIP is a 30-day elimination diet. After the 30 days there is a period of reintroduction. I have eliminated coffee for more than 30 days. I was well on my way to making the other eliminations when I slipped on, or rather into, a bowel of vegetables with noodles hidden on the bottom. I have now started again.

The only food to which I have had a reaction during this time is beets! I love beets. I have eaten them all my life. The last two times that I ate them I developed a very unwelcome digestive issue. That requires additional investigation.

I have also continued to use Ted’s Pain Cream. It has greatly reduced the pain signals being transmitted along healthy nerves from tissues that have healed. This has allowed me to sleep longer and that has been very refreshing.