Sunday, February 8, 2015

New Year, New Flare

Hello 2015. How is the New Year finding you? It's finding me on the mend, after a slow and insidious autoimmune flare-up. The thing about autoimmunity and flare-ups is that you can be sailing along feeling fine and then suddenly, you're dashed against the rocks and everything falls to pieces. Or, alternately, you don't realize that your ship is sinking until it becomes very obvious. The second type of scenario is the one that has been more frequently my experience and that was my recent experience.

Sometime last fall, my hair started shedding. It wasn't a big deal and I waited a bit to see if it was merely seasonal shedding. But, it wasn't. It kept shedding and shedding (I counted 90 hairs after a shower one day!). And around Thanksgiving, some insomnia started happening- the kind where you wake up after 5 hours and can't fall back to sleep. My skin wasn't quite as clear as it had been. Even my cellulite seemed to make a slight comeback, despite not having gained any appreciable weight (why does THAT have to be on of my inflammatory symptoms? Not fair.) My typing deteriorated and my word recall was a little off.

Other than these symptoms, I didn't have the sort of intense fatigue I often get during flares. I had days here and there, but no large blocks of major fatigue. Or any very acute inflammation, save for a few days that my neck and shoulders were inexplicably sore. When I become noticeably inflamed, my shoulders seem to be the main target and sometimes my hips/thighs.

I finally had some blood work done right around Christmas and it came back showing functional anemia- my iron wasn't super low, but certainly low enough to affect my health. My red blood cells were enlarged (megaloblastic anemia, caused by low B12, folate, or both). The anemias are most likely due to inflammation affecting absorption, or gut damage, OR gastric autoimmunity flaring up (I make parietal cell antibodies, which produce hydrochloric acid and intrinsic factor). By the way, if you have any sort of anemia, it's a pretty big deal-breaker for healing, since you need healthy and abundant red blood cells to carry oxygen throughout your body.

My C-reactive protein was very high, and my HDL was at the top of the range (yes, you can have too much "good" cholesterol). My doctor informed me that these two together indicated inflammation and an active autoimmune situation (as opposed to inflammation from an acute infection). My D levels had also climbed too high, but I'm positive that that was due to some mega-dosing I'd done in Nov. and Dec. fighting off some colds. Oops. Time to back off on the D3...

My thyroid numbers weren't too remarkable- I had hoped they might show something obvious, but they didn't. However, inflammation can cause thyroid hormone resistance at the cellular level, so that could certainly be at play. Finally, my kidneys weren't quite doing their job right, which was kind of alarming. My doctor assured me that it wasn't at the level of actual pathology, but that we still needed to do something about it, so she recommended I do a 5 day kidney detox, which she informed me had worked well for many of her patients.


As you can imagine, I wasn't too thrilled with these results, and they were a good nudge to get back on full Autoimmune Paleo again, which I did on New Year's Day. What do I think caused this frustrating flare? Honestly, I don't know for sure. My main guess is that something I re-introduced wasn't something I should've been eating. Potato is the main suspect, as I had tested positive for IgG antibodies to it last spring, but I hoped enough time and gut healing had passed to be able to tolerate it. Or maybe I encountered some gluten cross-contamination on vacation last Aug. but the symptoms took awhile to show up. I don't really get GI symptoms, so it can be hard to tell. I wish I knew the exact cause.

So, I immediately put myself back on methylcobalamin B12 lozenges (which I hadn't been taking), and added methylfolate to the mix to be on the safe side. My doc had me add a DHA fish oil supplement, as she was concerned that phospholipid antibodies, which can cause hair loss, could be acting up. Because they attack the cell membrane, DHA, which is found in the cell membrane is important and has a protective effect. Plus, it's also anti-inflammatory and important for the brain. I didn't want to supplement with iron, but I did start using a bit of organic blackstrap molasses, which so many people swear by for correcting anemia. I think it works so well due to all the other minerals/cofactors it contains. I also ramped up my gut health support.

My hair is still shedding somewhat, though not as severely, but I've actually been feeling pretty good this past week. My energy levels have been much more consistent and downright good, as opposed to just ok or off. My skin has cleared up a lot since being back on AIP. The best part is that my hubby decided to do it with me (he's THE. BEST.). He's even getting into some of the cooking! I've also lost the couple of pounds I gained from having Thanksgiving, my birthday, and Christmas all in a row. Two pounds were no big deal, but it's still nice to have them gone. My sleep is still spotty, but I am having more good nights with 8 hour stretches of uninterrupted sleep.

I've used this flare as an opportunity to step up my self care and commit to a 100 day "gong." A gong is a discipline that you commit to for 100 days and if you miss a day, you have to start over from the beginning. I chose qigong as my daily discipline, because I know that the more I do it, the more the health benefits will accumulate, especially in areas like energy, hormone balance, and sleep quality. I'm annoyed with myself that I wasn't doing it consistently before, but I'm also proud of myself that I'm making it happen. I'm now over a third of the way through my challenge and it's become a true part of my routine.

To keep myself on track, I made a list of all the things I'm doing right- I think it helps to remind yourself that you ARE doing a lot right- and also a list of things I could stand to do more of because I know I benefit from them. I look at this list daily, and it really helps. So, I'm on the upswing. I hope I keep improving. I'm going to be watching my symptoms like a hawk.

I will keep you posted.

Monday, November 17, 2014

A Little Check-In

Just thought I'd pop off a quick post to say hello and check in. This morning I awoke to a light dusting of snow on my fence and holly tree. How pretty! It's not quite wintery yet in Nashville- some trees still have colorful leaves- but it's finally cold and it feels like winter is encroaching.

I'm still trucking along on my functional medicine protocol. I'm not full autoimmune paleo, as I continue to test the waters with different foods and watch for symptoms. Some happy news: I can now tolerate chocolate without any sign of IBS, which is such a relief! I haven't been stuffing my face with it, but it's been heavenly to make a nice mug of hot cocoa or have a square of dark chocolate here and there. I've also added small amounts of almonds and walnuts back, but I haven't been eating many nuts in general. I find I don't seem to crave them as much as I used to. I've only occasionally been eating a small amount of nightshades. I don't think they affect me adversely. As for grains, I've mostly steered clear of them and plan on continuing to do so.

I still have the occasional minor skin breakout (though my skin remains much improved), so I have to troubleshoot the details there. My progesterone still looks to be low, so I have added a vitex product (Nature's Way Femaprin).

A neat discovery I accidentally made is that my body really likes SAM-e (S-adenosylmethionine). I had originally been taking 5-HTP to support serotonin, and then a bit of Seasonal Affective Disorder started to hit me, where I'd feel sad on dark or cloudy days. I did a little research and found that switching the timing of taking my 5-HTP to between 3-4 pm and then again at bed really made it work better.

Then, I ran out and I happened to have a bottle of Cell Food SAM-e liquid (which I had mistakenly ordered, thinking it was Cell Food liquid oxygen) and I remembered that SAM-e is used for mood disorders, so I thought I might as well save myself some money and try it for serotonin support. Well, not only did it help with that, but I quickly found myself feeling WAY more motivated and downright cheerful. As I have a history of low dopamine symptoms, this is so very welcome. I've been on dopamine support for ages, and it does help, but the SAM-e has had a dramatic effect. It has also given me more mental clarity. I hope it keeps working because my house is staying so much cleaner and I'm getting a lot more done.

And, finally, I'm reading a really cool book about the mind/body connection called "You Are The Placebo" by Joe Dispenza. It's fascinating and the premise is that if your mind can create placebo-based physical effects, then in understanding that process, it can be used to create healing. It makes sense: if our negative emotions and stress states can trigger inflammatory compounds and harmful epigenetic expression, can we mitigate these and reverse them by actively seeking to change the way our mind is wired so that positive mental and emotional processes produce healing epigenetic and hormonal signals? Just reading about the history of the placebo effect alone is fascinating.

I will continue to keep you posted and I have some autoimmune paleo recipes that need a little nailing down, but that I look forward to posting.


Tuesday, September 2, 2014

PIP Goes AIP (Autoimmune Paleo)

Happy September!
When I last posted back in the beginning of April, I'd just started the Autoimmune Paleo Diet (AIP, for short), and I'd also just started working with a functional medicine practitioner. This whole process has been so interesting and encouraging for me. I'm now nearly 5 months into the process and I've seen some big improvements that weren't happening on Paleo/Primal. I needed to dig deeper into my autoimmunity and blood work and my diet needed some tweaking. This post is a longer one, so sit back and dig in.

Functional medicine lab work time!

It had been a long time since I'd had any labs run, so the first order of business was doing some comprehensive blood work, as well as a series of Cyrex Labs arrays to look at my gut lining, gluten sensitivity, potential gluten crossreactive foods and food sensitivities, chemical/heavy metal autoimmunity, and multiple tissue autoimmunity. It cost me a pretty penny, but I'm absolutely glad I did it. I also filled out extensive symptom and neurotransmitter profile questionnaires.

My blood work didn't reveal anything too scary: an electrolyte imbalance, and high-ish iron (not hemachromatosis), which my doc felt indicated inflammation. However, she was concerned with my low blood pressure. My blood pressure has always been pretty low and no doctors or practitioners, holistic or otherwise, have ever mentioned that it's not a good thing. My doc explained that when blood pressure is too low, nutrients and glucose aren't able to be effectively delivered into the tissues (perfusion), and extremities (like my brain) might not have sufficient circulation. In fact, she felt that my neurotransmitter questionnaire indicated poor brain circulation resulting in lowered neurotransmitter levels. Poor circulation can be the main cause of cold extremities and brain fog. Read more here.

She put me on a supplement to increase circulation and endothelial nitric oxide (eNOS), which also works to modulate the immune system, which she has me take first thing in the morning, along with an adrenal supportive cream, and then do a few minutes of intense exercise to produce an opioid response (which dampens inflammatory cytokine production) and increase circulation/perfusion. So, there really is something to the idea of "getting your blood moving!"

I am also on a general immune modulation regimen involving curcumin/resveratrol, glutathione cream, and a formula to help the body recycle glutathione, as well as neurotransmitter support for GABA, serotonin, and dopamine. And, of course, there are gut health supplements and probiotics. I won't go into the particulars of all of the supplements because they're particular to me and might not be right for someone else.

We're working on my circadian rhythms, which, admittedly, I've never been the best about. In the morning, after taking my supplements and doing a few minutes of intense exercise to increase perfusion/circulation, I go outside and get some sunshine and take some time to read, do qigong, hang out with my cat, get my bare feet on the earth. In the evenings, I turn down the lights and, if I'm watching tv, I wear some blue-blocker glasses to reduce blue light exposure, which can tell your brain not to release enough melatonin.

The Cyrex tests helped me to troubleshoot my diet. Even though I already knew gluten was a problem for me, the Wheat/Gluten Proteome array, which is the most comprehensive gluten test available, showed that I had antibodies to gamma-gliadin, and transglutaminse 2 and 3, so it's an autoimmune gluten reaction- not something to mess around with. It's kind of nice to have the lab tests to prove gluten sensitivity, with all the gluten-free backlash going around.
I also learned that I cross-react to casein and whey proteins as if they were gluten. About half of people with gluten sensitivity also react to casein because the proteins are so similar in structure. Thankfully, the rest of the foods tested didn't show many sensitivities- just potato and soy.

The chemical and metal autoimmunity panel came back fine, as did the leaky gut panel (I'd been on Seacure for awhile), but the multiple autoimmunity panel showed all kinds of things going on. It was kind of like opening Pandora's box and seeing where you could potentially develop future disease. Pretty intense!

I had low level ("predictive") antibodies to a lot of tissues: thyroid (not surprising, as I have Hashimoto's), parietal cells, phospholipids, osteocytes, synapsin, ASCA/ANCA (anti-saccharomyces yeast antibodies, found in Crohn's and Ulcerative Colitis), and fibulin.
I also had much higher levels of antibodies to platelet glycoprotein, and alpha/beta tubulin, (the second one is commonly found in Hashimoto's). Whew!

It was a little overwhelming (and scary) seeing all of this, but if you know this information when the antibodies are only in the predictive range (which can indicate future disease development up to 10 years out), you can hopefully thwart the process from progressing. That's the thing about autoimmunity: it's progressive and rarely sticks to just one tissue, as my panel most definitely showed. I can't stress this enough: if you have any kind of autoimmune condition, you're likely to develop more if you don't intervene.

Now, on to the Autoimmune Paleo Diet front.

I started AIP at the beginning of April and I went all in immediately. I'd been dragging my feet about doing it, so having my doctor tell me to do it was a good thing. I'm much more compliant if the orders are coming from someone who is not me ;) For the first few days, I had a weird kind of fatigue and a hungry-no-matter-what feeling. It felt as though I was having food withdrawals (I'm going to guess from casein). It passed quickly, though. I got into the routine of not eating any dairy (except cultured ghee), eggs, nuts, seeds, alcohol, chocolate, and nightshades (grains and beans were already not something I ate on a regular basis). It was more of an adjustment than I initially realized, because so many condiments and spices I was used to using were now off limits. I've done Whole 30, but, let me tell you, Whole 30's got nothing on AIP! AIP is a whole other level of food vigilance. You get really used to it, though.

In order to cope with the restrictions and be kind to myself, I decided to add in some foods I don't normally eat a lot of- starchy foods like green and ripe plantains, more fruit than I'd normally eat, as well as a bit of dried fruit, which is something that normally never occurs to me to eat. Dried figs became my treat when I needed a treat. Or ripe plantains sauteed in casein-free ghee with cinnamon and homemade coconut milk caramel sauce.

After four solid months, I'm now in a phase of playing with some reintroductions. Some have gone well (black pepper, coffee, a few seed-based spices, small amounts of wine, and eggs), and some haven't. I've learned that chocolate, which I never noticed to be an issue before AIP, has consistently induced IBS symptoms the following day after every attempt I've made with it. Doesn't matter the form it's in- if it's chocolate, my gut will be rumbling the next day. This is disappointing, not to mention weird, since I've never had IBS before, but chocolate is on the list of IBS trigger foods. Sometimes you really have no idea how a food affects you until you haven't eaten it in months and your system has had a chance to settle down.

When I was on vacation a month ago, I jumped protocol and ate a lot of nightshades in a short amount of time due to eating out (not recommended, though!). I didn't notice any reactions to them, which was surprising because I also had my annual summer insomnia bout happening. For me, lack of sleep usually increases muscular inflammation, but I didn't notice any. I'd still like to give nightshades a proper reintroduction, though.

I hope that as I continue to heal I'll have more successful reintroductions. I was encouraged after chatting with some other AIP'ers who told me stories of failed initial reintroductions only to later be able to eat those foods with no problems. Maybe there's still hope for me and chocolate...

Improvements and progress:

So, after all of the tweaks, am I seeing improvements in my health? Why, yes, I am! I still have a way to go, but the improvements have been substantial enough that it's been more than enough motivation for me to continue on this particular path. Here are the improvements I've experienced:

-Better skin. My skin has always had some degree of breakouts and, though ditching gluten and going paleo eliminated my cystic acne, it didn't eliminate my breakouts, though they were certainly diminished. I felt ok about my skin, but there was room for improvement. On AIP, my skin clarity has improved quite a lot. I now rarely break out on my shoulder blades or across my chest (not that these were bad breakouts, but they were fairly frequent) and the breakouts I do get are so minor- just a tiny little blemish here and there- no angry red monsters.

-Weight loss. This has been really thrilling! Over the autumn and winter, I'd slowly gone up in weight and size and I wasn't eating any differently than I'd been eating. This followed the big autoimmune flare I had at the end of last summer. Even though I've never been truly overweight, when my weight starts climbing, I know it's usually related to my Hashimoto's. That's a scary thing, knowing that your weight is being controlled by your immune system and that little gland in your neck, rather than diet and exercise. So many of you with Hashimoto's know what I'm talking about! Anyway, this extra weight was not budging easily, despite adding more exercise.

After starting AIP, the weight slowly but surely melted off, at about a pound a week, without watching what I ate or even exercising much. Granted, it's not the fastest weight loss ever, but it was so exciting to feel like it was happening because my body was working better! As of today, I'm down 17 pounds, most of which I lost in the first 3 months. I've especially lost a lot of belly fat, which is where I tend to gain. I've lost 3.5 inches of belly fat. Whoohoo! Even though I have a little vanity belly fat I'd still like to lose, I'm now at a size and weight that feels good to me.

-Cellulite. Ok, so this one's pretty exciting. I've always had some cellulite, but it never bothered me until my late 20's when it suddenly got more severe. After going paleo, I was disappointed that I wasn't one of those women who magically lost their cellulite. In fact, it seemed to be getting more severe and spreading across a larger area of skin for the past couple of years. Even the skin on my inner forearms would dimple if I squeezed it. Having slender arms, this was disturbing, as if maybe there was an inflammatory process going on (my forearms certainly didn't have excess fat). I wondered if my collagen was breaking down, or if it could really be myxedema accumulating beneath my skin, or if my fat cells were just inflamed.

Anyway, even before I lost a significant amount of weight, I noticed that my legs were looking smoother. They've continued to improve to the point that now I'd say my cellulite is pretty mild. I feel so much better about it. My inner forearms no longer dimple when I pinch the skin. I don't know exactly what caused the improvement, but I'd guess that the combination of eliminating dairy and other inflammatory foods, weight loss, and collagen supportive foods like bone broths and collagen hydrolysate powder have all worked their magic together.

-Better muscle tone. This one is fascinating to me. I've never had naturally great muscle tone. I'm a classic ectomorph, long and lanky at 5'9". I've definitely been skinny-fat or just plain skinny. Muscle tone has always taken some work to come by. Switching from vegetarianism/veganism to paleo made it easier for me to gain muscle, which was nice. Now, for some reason, I seem to have better muscle tone despite infrequent workouts (though I do a fair amount of walking). I have muscle definition that I've only ever previously had after months of working out. I've never really had a line of muscle definition down the outside of my thigh before, and now I do! My guess is that my muscles weren't getting enough nutrients due to poor profusion and maybe poor absorption (remember those parietal cell antibodies? They attack HCl-producing cells in the stomach). At any rate, I'm really enjoying my sudden muscle tone.

-Energy. This is still touch-and-go, but I've started to have more energy. I noticed an increase after adding a thiamine (B1) supplement to my regimen, based on this article by Dr. Izabella Wentz, detailing a study that found that thiamine relieved fatigue in Hashimoto's patients. I still have off days and random drops in energy, but I've also had more really good days. I'm learning to monitor what kinds of things are likely to drain my energy, such as sitting in front of the computer too long, not eating enough calories, having draining conversations, stress, etc, and which are helpful for increasing my energy (time outside barefoot on the earth, getting to bed earlier, qigong, doing an inspiring activity...).

Room for improvement:

I'm committed to this path long term, which has really helped me to surrender to the process and let go of feeling like I should have reached a place of balanced health by now. I have my impatient moments and bad days, but it's ok.

As I progress, I'm hoping that my hormones will improve. I can tell I'm still low in progesterone by my often short cycles. There is still room for improvement with my sleep quality- it's not terrible, but I'd like to sleep more soundly. My doc thinks that some midbrain overactivation is probably at play regarding that. Even though I have nothing close to the kind of brain fog I used to have, my brain's clarity still could use a boost at times. Maybe once I stop making synapsin antibodies, my synapses can do their job properly.

Digestion/elimination is the final area I'd like to see more improvements. I am doing gut/brain exercises that restore signalling to the vagus nerve, which connects the brain and gut. These include gargling, singing loudly, and gagging (fun, I know!). All of these can get those signals moving again. I just have to remember to do them daily, which is easy to forget.

I'll be writing more about autoimmune healing and lifestyle in upcoming posts and I'll be posting recipes and reviewing some great books that I've read in recent months, including The Autoimmune Paleo Cookbook, and Why Isn't My Brain Working. Stay tuned!


Thursday, April 3, 2014

Garlic-Thyme Mahi With Balsamic Fennel Sauté

Happy Spring!
I've been gone from the blog since December, but now I'm ready to get back to it. A week ago, I started the Autoimmune Paleo diet, at the request of my new functional medicine doctor. I'd been thinking of trying it for a long time, but had been dragging my feet about jumping all in. My doctor's orders coincided with receiving a copy of The Autoimmune Paleo Cookbook in the mail, generous courtesy of the author, Micky Trescott, (review soon to come!) so it was the perfect timing to start. I was kind of surprised by how intense my withdrawal symptoms were for the first two days: headaches, fatigue, ravenous hunger no matter what I ate... Thank goodness that didn't last long.

It hasn't been too much of a learning curve adapting to the food restrictions, but I definitely miss my eggs, grass-fed butter, black pepper, mustard, and almond butter! And chocolate, of course. I'm getting the Cyrex Labs Array #4 done soon, so I'll know for sure which foods I cross-react to as if they were gluten. Although you can reverse a lot of food sensitivities by healing your gut, gluten cross-reactivities are a whole other thing, since they happen at the gut level and actually cause leaky gut. You have to avoid those foods since it's a much more serious immune reaction.

Anyway, back to cooking. Last night I made a lovely and easy autoimmune paleo compliant entree that was just plain yummy and super easy and, for once, I'm posting it in a timely manner! As per usual, I didn't measure anything, but I doubt you can screw this one up too much. The balsamic fennel adds a gentle sweetness and crunch that pairs nicely with the seasoned mahi.

Garlic-Thyme Mahi with Balsamic Fennel Sauté

Serves 4

Aprox. 1 lb mahi-mahi fillets
2 fennel bulbs
Solid cooking fat (I don't recommend coconut oil)
Balsamic vinegar
Granulated garlic (not garlic powder)
Dried thyme
Fresh Italian parsley (optional)

Notes: I cooked the fennel first, as it takes slightly longer than the fish.

Slice the fennel bulb into thick slices (as if you were slicing celery). Heat cooking fat on medium and add fennel and sauté until softened. Sprinkle with a little balsamic vinegar to taste at the end of cooking. Set aside.

Pat the mahi fillets dry and season generously to taste with the garlic, thyme, and salt. Heat cooking fat in a pan on med-high heat cook the fish until just cooked through (usually just a few minutes on each side). Serve atop the fennel and finish with minced parsley.