Wednesday, August 11, 2010

Concluding Thoughts

I woke up from my colonoscopy with my traditional confusion and disorientation. I recall the doctor walking up and saying that things looked fine and that they had removed a polyp. He let me take home the pictures from the polyp removal and his writeup about it. Nice guy.

I guess that polyp that my previous gastro thought might require surgery to remove had morphed into a non-problem over the past year. I compared the pictures from my 2009 colonoscopy and the polyp looked fairly different – in 2009 it was white and puffy, in 2010 it was the same color as everything else and looked smaller and denser. I have no idea if these statements make any sense or are even true, given that I’m just comparing pictures on a piece of paper, but there you have it.

I got a call from the doctor’s office yesterday saying that the polyp was benign and everything is fine. I should come back in a year for another colonoscopy.

So here I am. One year after embarking on what I thought was a fairly radical experiment, and the sum total of my medically noted results is “Everything looks fine.” Talk about an oddly deflating experience. On the one hand, this confirms that I am in a medicine free remission, that I am generally healthy and free of Crohn’s activity. That is massively good news and a confirmation of the Hypothesis. On the other… well, everything’s fine. Could just be a fluke. Who knows?

So with that little humbling thought, here are my takeaways from a year of very-low-carbohydrate, zero starch eating:

1) It appears to have been effective at maintaining remission. My first three or four months were quite turbulent and felt as if I was having a flare up, but I stuck with it and the reward is more than worth it. Or maybe I’m just lucky? Epistemic crisis here I come.

2) It is not hard to do, provided that one actually is interested in the outcome. I’ve been continually perplexed by the hangups people have about food and the preconceptions they refuse to let go of in the face of evidence like my lack of dying. How on earth can anyone say, “Oh there’s no way I could do that.” Seriously? There are people on this planet whose entire lives are spent in a brutal daily struggle for food that they eventually lose based on the arbitrary whims of an unfeeling universe, yet the idea of eating a calorically and nutritionally complete diet of meat, eggs and cheese for a year is inconceivable.

A lot of this has to do with not having any stake in the outcome of the experiment. It’s easy to not think through a statement about the diet if the only time you think about it is the once a month you happen to notice what I’m eating, and then make some idiotic claim about how it’d be impossible to handle. It’s not only not impossible, it’s trivial. You simply have to know some basic facts about why it’s a worthwhile approach, commit to a goal, and then do it. Perhaps I’m too impatient with other people’s frailties, but even that is hard to accept because I’m about as frail as they come. So why is it that this wasn’t a disastrously difficult experience for me despite the near unanimous outcry of how hard it must be?

People just don’t ever think about what it means to eat, about why they eat, or they just don’t care about their health enough to do so. If they did, they might find giving up certain foods to be fairly simple. Ignorance is bliss, I suppose. Of course, I was and likely still am one of the ignorant, but man oh man do I hope I wasn’t so blatant about it in the past.

3) Ebringer’s research really, really deserves more attention in the Crohn’s patient and research communities. Maybe I’m a fluky n=1 random event, but I doubt it. Browsing through the mainstream articles and forums is an incredibly depressing exercise in watching the conventional wisdom of “there is no cure, prepare to suffer” stifle people’s attempts to find relief. The CCFA’s criticism of the Specific Carbohydrate Diet was a ludicrous read - I hate conspiracy theories, but it’s like the mainstream doesn’t want there to be a way to manage the disease without constant medication, so anything that promises such must be attacked with tenuous logic and absurd “warnings” like “children might not get enough calories”. What?! Fearmongering bullshit at its worst.

4) Just try it. It’s one year of your life and it may improve every other year you ever live. We like to talk about putting in your time and making investments, but it’s rare that we have the opportunity to do so in our own lives with such a radical payoff. There is no guarantee of success, but there is a guarantee of failure if you do nothing.

I went back and reread my introduction post and I wanted to offer up some thoughts about how my perspective has changed since then.

I relied almost entirely on ethnographic observations to get me to this diet. The only modern clinical evidence I saw was Lutz’s claim of 80% remission with a low carb diet. While this was a happy outcome, I’m now much more leery of relying on such a shaky foundation for diet – I don’t think I posted anything that’s outright false in that introduction, but I far prefer the work of Ebringer as a foundation for low starch eating in inducing/maintaining Crohn’s remission to a collection of random observations about the general health of primitive populations.

Those biases eventually lead me to the “paleo diet” movement that is bouncing around the internets as we speak. Basically, the theory goes that since humans evolved over a time span of millennia, we should focus on eating the foods which most closely resemble those we evolved to eat, while avoiding those which are too recent for humanity to have adapted to. The closer to the present a food was invented or introduced into the pool, the more skepticism it should be viewed with.

I have my disagreements with various takes on paleo. I dislike the magical thinking and speculation that it seems to breed, the caveman metaphor, the constant optimum seeking and above all the orthodoxy of thought that any principled approach to eating engenders. However, I like the basic premise and I like how it provides a pretty simple and accurate mental model for selecting healthy food. Sure, maybe a given individual can tolerate gluten better than someone else, but they don’t really miss out on much by eating more meat instead of bread. And if they experiment and have no problems, hell, add it back in.

Generally speaking, I think I went through the process of being a new convert and now I’m back to being a relatively cynical skeptic with some new biases based on some new experiences. We’ll see how well that bears out.

So, that’s it. I did it. I ate pretty much an all meat diet for a full year. I did not die. I did not get scurvy or any evident deficiency. I ate a lot of cow and I’m in apparently good health.

I turned 26 this weekend and for the first birthday in about five years, I didn’t have to take four grams of pills.

Best present ever.

Tuesday, August 10, 2010

Final monthly roundup of measured data and analysis.

Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:
The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.
The "Weight Chart Daily Graph" worksheet shows the daily morning weight.
The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.
I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.

July was spent largely on vacation. My data for the month is thus somewhat sketchy, but generally speaking I was fine. We went hiking in the Adirondacks again (just like in August of last year) and once again I felt fine walking up mountains. Well, maybe fine is the wrong word – I was able to do it and fight through the pain of walking up the side of a mountain.
There’s not much to say. I feel fine. I weigh about 15 pounds more than I did when I started. My bowel movements are regular, healthy and I rarely get diarrhea. It’s been a year and I’m pretty sure I’m in a drug free remission. Success?
The final colonoscopy is scheduled for July 30th. I’ll find out then.

(Note: Posting this pretty late because I'm lazy. The next post will deal with the post-colonoscopy review and concluding thoughts)