ACA, Obesity, Uncategorized

Obesity and the ACA

Early in my career, I had the privilege of working in cardiac rehabilitation. I was an exercise physiologist, so much of my job included writing exercise prescriptions, teaching education classes (mostly on modifying lifestyle behaviors such as diet, stress and smoking) and individually counseling patients living with heart disease. In all of those years, what I didn’t do was ask any of my patients, not one of them, about the environment in which they lived. I didn’t ask about how often they shopped for groceries, or whether or not their neighborhood was safe. I didn’t ask if their local grocery had fresh fruits and vegetables, and whether or not they could afford them. I didn’t ask if they could afford all of the medications prescribed to them by their physician. The care I provided followed the guidelines of what I was taught, what we all were taught: exercise at least 30 minutes most days of the week, eat at least five servings of fruits and vegetables per day, reduce stress, quit smoking, take meds. Period.

Throughout my undergraduate and graduate education, not once did we discuss the influence of the environments in which we live on health. Nor did we discuss how to counsel and advise patients in the context of their home environment. Telling someone to go for a walk everyday when they live in a neighborhood with poorly maintained sidewalks, or in one that is plagued by crime, is absurd. I can only wonder about how many of my patients went home feeling despair or defeat because they did not know how to follow our recommendations due to their circumstances.

Over the past 15-20 years, research has taught us a lot about what causes obesity. At a societal level (so not in the context of your neighbor who enjoys too many cheeseburgers), our personal choices have very little to do with what is making us, the collective us, fat and sick. But first, a few facts (all stats from CDC):

  • 36.5% of Americans are obese
  • Non-hispanic blacks have the highest age-adjusted rates of obesity at 48.1%, followed by Hispanics at 42.5% and non-Hispanic Asians at 11.7%
  • Obesity rates are higher among middle age adults age 40-59 years (40.2%) and older adults age 60 and over (37.0%) than among younger adults age 20–39 (32.3%)
  • Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.
  • The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.
  • In 2012, more than one third of children and adolescents were overweight or obese.

Americans are fat. And getting fatter. But why? The social determinants of health (SDOH) tell us much about the insidious forces contributing to this epidemic. Social determinants of health are conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.

In looking at the pyramid above, the education I provided my patients was at the tippy-top. My advice, no matter how good it was, was not going to have much impact on the factors that contributed to their illness. Similarly, a physician telling their patient to lose 30 lbs is not likely to have much of an impact, if any, on that patient’s health status. That’s not to say that those conversations shouldn’t happen, because they should, but that can’t be our only approach.

The obesity epidemic in the United States will continue unchecked as long as our solutions continue focusing at the top of the pyramid. So, what do policy, systems and environmental approaches to reduce obesity look like? If educating people isn’t the solution, what is? This list is by no means exhaustive, but provides some context:

  • Interventions that address poverty – poor communities bear the enormous costs of disease (including obesity) at disproportional rates. Programs that stabilize those living in poverty and that support people as they transition to a more stable financial environment can have significant impacts on health.
  • Interventions that address housing – many people living in poverty reside in structures that are unsafe and unhealthy, riddled with mold and poor air quality. Working with city governments to improve codes and code enforcement, and working with landlords to improve living conditions can go a long way to improve conditions such as asthma. But wait a minute, I thought we were talking about obesity? We are…would you spend your free time being physically active if you had uncontrolled asthma due to your mold-ridden home?
  • Interventions that address inequities – despite what you might hear on certain news stations, all Americans aren’t equal. Great health disparities exist, and often they fall along racial and gender lines, and around how much money you make, where you live. Did you know there are communities in this country where living 10 miles at opposite ends of the same road means a ten-year difference in life expectancy? In some communities, the disparities between neighborhoods can be as great as 25 years. In many places, your zip code has more of an influence on your health status than any other variable.
  • Interventions that address community environments: Improving the built environment to encourage walking/running and biking. This can include building/improving sidewalks, adding bike lanes, improving safety and addressing play deserts. Increasing access to healthy, affordable foods by expanding farmers market initiatives, corner store initiatives, addressing food deserts, improving the nutritional value of food in schools, and examining/changing national food policies to incentivize healthy, whole foods.

So what does the Affordable Care Act (ACA) have to do with all of this? While many people are familiar with some of the hallmarks of the ACA such as free preventive care, the ability to keep children on a parent’s policy until age 26, and prohibiting discrimination due to gender or pre-existing conditions, what you might not know is that it also requires not-for-profit hospitals to conduct a community health needs assessment every three years. In addition to the needs assessments, hospitals must also develop a community health improvement plan and report progress annually. All of this is required for a hospital to maintain its non-profit status.

To develop the needs assessment, most hospitals utilize both an extensive review of primary and secondary data (this can include community surveys, hospital statistics such as emergency department utilization rates, heat maps by diagnosis, etc), in addition to more qualitative approaches such as focus groups and stakeholder meetings. In my community, the two non-profit hospitals have gone one step further, in that they’ve partnered with each other, the local health department and a community service organization to develop one needs assessment and implementation plan for the entire community. Nearly 50 organizations participated in the development of our community’s assessment and implementation plan.

In addition to the assessment and implementation plan, non-profit hospitals must divert a percentage of their funds for “community benefit”. In the past, much of these community benefit funds went to uncompensated care, meaning the funds the hospital spent to care for patients who were uninsured. As uncompensated care went down with more people being covered by insurance, the expectation is that these dollars would begin to flow out into the community to address needs identified in the assessment and to fund portions of the implementation plan.

Back to obesity…not surprisingly, many communities are identifying obesity as one of their top health concerns. Not only is it a prevalent, stubborn issue, but it is a co-factor in so many other conditions such as heart disease, diabetes, certain types of cancer, depression, etc. Many people believe that if we can crack the obesity nut, we will go a long way to solving some of the other persistent (and expensive) health issues plaguing Americans. The ACA created a framework for community partnership beyond anything that existed previously. Many hospitals are taking their assessments/plans seriously, dedicating significant staff time and funds to the efforts.

When these teams go looking for best practices to address the obesity epidemic, they immediately bump into the social determinants of health. Within the context of the social determinants, when they go back through their own primary data – heat maps of particular diagnoses such as asthma for example – they can begin to see very real patterns emerging in the community. As hospitals work to improve patient outcomes and reduce re-admissions (also an expectation of the ACA), these new approaches to care are vital, and great for the patient. The ACA was the foundation for all of this progress. No longer are hospitals only responsible for the patients that walk through their doors, they are responsible for the health of the community, just as health departments have been for decades. Only by looking for solutions outside hospital walls will they move the needle on such complex problems. In this situation, there are no losers.

In the doomsday scenario discussed by some Republicans, meaning a complete repeal without a replacement of the ACA, not only will many Americans have a reduction in coverage or lose their insurance altogether, communities will lose a transformative platform for change in how we approach community health. These new collaborations are in their very early stages and we’re several years away from knowing how powerful they might be. One thing is for certain though, communities will not solve complex health problems such as obesity by working in isolation, and unfortunately organizations often need a nudge to do the right thing. The ACA provided a powerful platform for improving community health and addressing obesity. On the hierarchy of bad things that would happen with a repeal, this might not feel as urgent, but for our vulnerable communities this is one of the better opportunities we have at making a real dent in the disparities that affect their health every single day.

People can’t make healthy choices when they live in communities that aren’t safe, that lack access to fresh, healthy, affordable foods, that lack safe places for walking, biking and other types of physical activity, when they reside in homes that are contaminated and when they face the multitude of challenges that accompany being poor in this country. Offering “personal responsibility” as a solution is irresponsible. The price we pay for poor health is obscene. Not only is it the  direct cost in medical bills, it is sick time at work, lost productivity, missed days at school. Until we recognize that solving these issues is going to take more than finger pointing, obesity rates and related health problems, will only increase. Gutting the ACA will add fuel to the fire.

Photo credit: Marty Barman
Uncategorized

Learning to Listen

One of the qualities possessed by most introverts is that of being a good listener. Generally speaking, I’d much rather hear someone else’s story than share my own. Like many things in life, it’s a continuum and there are times when I don’t take in a message as deeply as I should, but for the most part I tend to align with the stereotype of the attentive, empathetic introvert.

I’ve recently realized that there’s a hard stop with when it comes to my ability to listen. While I take great joy in listening to the stories of my friends, learning what’s important to them and what they value, I’m terrible at listening to myself. As I’ve struggled with my health the past few years, not much else has become as apparent.

I do a really good job of listening to other people’s thoughts about what I should do to get well. I listen to people tell me it will be fine and that things will go back to the way they used to be, when there’s absolutely nothing to suggest that they will (which really is fine…the past should never be the goal). I listen to people diminish my concerns, and let their perceptions influence my understanding of my own reality. A few days ago, I listened to one of my physicians disparage the doc that single-handedly pulled me out of the worst Hashi’s flare I’ve ever endured. It was that moment that made me realize that I need to stop listening to other people’s opinion quite as much, particularly when it comes to my wellbeing.

I know what I need to do to recover from the latest setback (not Hashi’s related, for better or worse). I know that it requires sacrifices I don’t want to make, which I think makes it easy for me to believe the stories other people tell, the picture they paint. Every time, I walk away questioning what I need to do, wondering if I’m being too rash, too dramatic, even though when I step back from the situation and view it objectively, I know I’m not.

My health-related challenges are a drop in the bucket compared to what some people endure. One of my favorite people on the planet is battling a devastating cancer, and my hubby nearly died in an accident a few years ago. While life isn’t what I thought it would be right now, I still have much for which I am grateful. It’s quite likely that I’ll recover from this latest setback, and while the future might look different from the past, that’s not necessarily a bad thing.

Through all of the bullshit of the last several years, what I’ve realized matters most to me is time. Time to spend with friends and family, time to be in the mountains with my most favorite person, time to hang out with my dog. I don’t have to run marathons to hang out with my friends that do (see recent weekend in Boston). I don’t have to have an “important” job title to make an impact. While I have a lot of frustration over the past few years, I can see much more clearly that which matters to me. I’m present in a way I wasn’t before.

So perhaps I have learned to listen to myself. Perhaps it’s a skill to be stretched and developed, just like any other. I don’t know that it will ever be easy for me to cut out the noise, but the clearer my priorities, the easier it becomes.

“I may not have gone where I intended to go, but I think I have ended up where I intended to be.” ~Douglas Noel Adams

Uncategorized

A Delicate Subject

Earlier this week, I was perusing Instagram when I came across a post by a food blogger that I follow. It was a picture of her infant daughter sitting on a beach with the caption “You don’t know what the expression ‘my heart is full’ means until you become a mama”. Instantly, my blood was boiling, which was annoying because generally that only happens when I’m on Facebook. Her post brought to the surface a few things I’ve been thinking about at length lately…what does it mean to be happy? What does it mean to be fulfilled? What does it meant to be successful? How does society influence what we perceive to be a good life? And why is being a parent the benchmark?

I’ve known since I was a kid that being a parent wasn’t for me. I dreamed of traveling, having a job that positively impacted others, spending time with my family, reading good books, sharing my home with dogs, sharing my life with someone (maybe), but never of having children. As a teenager, this would occasionally come up in conversation with adults (not my parents, who’ve never given two shits about whether or not I had kids) and they’d always assure me that I’d change my mind when I got older. Those assurances continued well into my 20s. Even as a youngster this struck me as insulting. What did it matter to them if I had kids? Why the need to be condescending? So what if I changed my mind? And so began 30+ years of “defending” my choice. An abbreviated list of comments made to me:

  • I’ll regret it.
  • Who will take care of me when I’m old?
  • I’m selfish.
  • I don’t know what it means to be happy/fulfilled.
  • I don’t know what it means to be tired/exhausted/in pain/challenged/etc.
  • I’m missing out.
  • My life is easy/simple.
  • When M was deployed, I was “lucky” that it was just me. Similarly, when he had his accident, I was “lucky” we didn’t have kids.
  • What does my husband think?

At times when I was younger, I was as guilty as the insensitive commenter. I’d agree that I was “lucky” we didn’t have kids when M was deployed; I’d agree that I was selfish; I’d agree that my life was easy because it’s just us. More recently, I’ve pushed back against such statements. Mostly because the older I get, the more I appreciate how freaking complicated and messy life is for everyone. No one has it easy, even if they tell you they do. I’m uncomfortable with parenting being the benchmark by which we measure emotions and experiences. In a broader context, I’m more interested in how we add-to the world, versus take-away-from, and while raising good kids would certainly be a big check mark in the add-to column, I don’t think it’s the only check nor do I buy in to an artificial hierarchy of contribution based on offspring.

As I got into my mid-late 30s, I began to realize that most of the cringe-worthy comments had more to do with the person who said them than me. (In many ways, getting older is such a wonderful blessing.) Some of it is innocent, in that people don’t realize they’re being insensitive. In other cases, I think my choice forced people to consider their own choices. I’ve had similar experiences recently when talking about my career…I’m no longer invested in climbing ladders, job titles or the amount of the paycheck and it doesn’t always resonate. (What I am invested in is spending time with my family and friends, hanging out with my dog, traveling, sleep (!!), and doing my part to make the world a better place.) I believe some people go through life following a path society expects…marriage, kids, career, house, etc, not because it’s their hearts’ desire, but because it’s just what people do. When confronted with someone who’s intentionally taken a different path, I think it can be discomfiting, which sometimes gets projected back to me. At 41, I’m ok with this. At 25, it just pissed me off, mostly because I didn’t understand. (Again, the blessings of age!)

We all have the challenge of sorting through the noise and determining what matters most to us. If we’re lucky, how we spend our time aligns closely with what we believe is important. Society tells us that success is 2.2 kids, having a job with a fancy title and a fat paycheck, and being skinny. For some that may very well be the definition of happiness and fulfillment. For others, it looks very different. May we all do the hard work of identifying our priorities and then doing everything we can to ensure how we spend our time aligns closely with those priorities. And if it doesn’t? It’s on us to make changes. For my part, I will work hard to not calibrate or qualify someone’s experience against my own…someone doesn’t need to have an autoimmune condition to know crushing fatigue, or be a marathoner to know hard work. Diminishing their experience doesn’t lift up mine. Also, I will cheer on those around me as they work to discover their own definition of happiness/fulfillment…because it’s kind of like the flight attendants say at the beginning of a flight, we must put on our own oxygen mask before helping others. If we are content and fulfilled, we are able to be more present for our loved ones and better-positioned to do more good in the world, which is really what it’s all about I think.

And about that Instagram post, it has since been taken down. Another follower and I both commented respectfully, and rather than respond and leave the post, she deleted it. Had she said “I didn’t know what the expression ‘my heart is full’ meant until I became a mama”, I would’ve scrolled right on by, but the moment she said that I don’t know what it means to have a full heart because I’m not a “mama”, she made it about me and all of her followers. And I wholeheartedly disagree with her statement…no pun intended. 🙂

“Your work is discover your world and then with all your heart give yourself to it.” ~Buddha

Sunrise over St. Joseph’s Bay, Cape San Blas, FL. Photo by Kim Barman
Whole30

A Misstep and a Restart – Whole30 Week 2 Recap

In so many ways, this was a really good week. And what went wrong has a lot to do with it.

The week started out as most do…a fridge full of food and plans for what I’d eat when (I’m a dedicated batch-cook). I knew I’d be cutting it close by Friday, as is usually the case, but considering that I can get a good salad from a restaurant down the street from my work in a pinch, I wasn’t too worried. Monday and Tuesday passed uneventfully. The cravings finally dropped off and in general, I was thinking about food much less frequently than the week before. My new routine of eating lunch at my desk at work, followed by brushing my teeth and then going for a walk, is a treat. We’ve had spectacular weather this week and getting outside for 20-30 minutes midday is such a pick-me-up. And brushing my teeth at work feels downright luxurious. I don’t miss gum anymore.

On Wednesday, I had a late afternoon doctor’s appt, that extended my day a bit and upset my new routine. She’s based in Chicago and I drive 75 minutes to see her in a small town halfway to the city. We went over my recent blood work and talked about how many illnesses I’ve had in the last two months, including all of the allergy trouble. She has a few theories about what might be up, but is starting with some more blood work to look for mold exposure and a few other things. I don’t expect she’ll find much, but am happy that she’s poking around. My thyroid antibodies are up a bit, the first time they’ve climbed since Jan. 2016. Progress in the wrong direction. It could be related to the other issues, it might not. I go back on March 8 for follow-up. After leaving her office, I really wanted to eat something I shouldn’t. It was the first time this week that the cravings hit hard, and it was so clear that it had everything to do with the appointment. So. Fascinating. The long drive home gave me time to talk myself out of making a bad decision and I survived the day unscathed. Huge win.

Thursday was uneventful and Friday is when things went sideways. I assisted a colleague at an event over the lunch hour as planned, but what I didn’t know is that she needed my help from morning through mid-afternoon. I snacked when I could through mid-morning and then due to the event, went without food until 2:30, when I finally left for lunch. It was the only day of the week that I didn’t have lunch with me. And it was the only day of the week when I couldn’t eat at a “normal” time or snack as needed. By the time I left to get food, I was crazy with hunger. I ended up at Chipotle with my face buried in a burrito bowl. I also had a Diet Coke. Neither were as good as I remembered, and it’d only been twelve days.  My stomach was upset the rest of the evening and the caffeine kept me up late. I’ve often wondered if I’m one of those people whose extra-sensitive to caffeine, and it seems I have my answer.

Because the rules of the Whole30 are crystal-clear about these things, I’m starting over. If I’m going to say I’m doing a Whole30, then it’s on me to follow the rules. The minute I start making up my own guidelines, it’s a different program. I want to complete this program. It’s clear that I need it and all of its ridiculous rules.

Friday’s episode was loaded with good information that will inform how I move forward:

  • Planning is critical. Looking back, I would have gone out for lunch on Thursday when my schedule was more flexible and brought my lunch on Friday when it wasn’t. Even without the extra hours assisting my colleague, I knew I was boxed in over the lunch hour. Having lunch with me would likely have been a game-changer.
  • All water, all of the time is boring me to tears. Even with essential oils. Having the soda was more out of boredom than anything else. I wasn’t craving it. During the time I couldn’t get to sleep on Friday evening, I researched Whole30 compliant beverages (thank you Pinterest!) and found some spritzers to make with meals. I made a pomegranate-lime spritzer with dinner last night and it was such a treat. That it was in a favorite wine glass didn’t hurt either. Problem solved.
  • Grains are not my friend. I was clearly affected by the burrito bowl, and not in a good way. There might come a time in the future when I can enjoy them without upset, but now is not that time. Getting that information a few weeks earlier than expected will only help me stay the course. And I can stop fantasizing about what I’m going to eat when this is done.
  • I can do this. I made it twelve days before things got weird, and I can point to exactly what went wrong. Being able to pick apart the situation and understand exactly how I ended up with a burrito bowl at 2:45 on a Friday afternoon is invaluable.

Other wins from the week:

  • I’m finally, FINALLY, getting back into a groove with running. I haven’t been sick since Feb. 1, and getting my diet dialed in gives me much more freedom on when I can run. I’ve enjoyed a few post-work runs this week, and the timing couldn’t have been better with our spring-like temps. I managed 12 miles for the week, the most since late Oct when I broke my foot. Granted, I used to run 12 miles on a given Wednesday, but this feels like significant progress.
  • The pomegranate-lime spritzer. It’s worth mentioning again.
  • Restarting means I was able to take some measurements and weigh myself. I traveled the weekend right before starting this two weeks ago and didn’t get a chance to do that previously. I took measurements in early January and already have made some progress since then, which is motivating and encouraging.
  • Between the lunch time strolls and walking Abby, I’ve been walking quite a bit. My days feel much more active.
  • This roasted beet, avocado and orange salad. Because I need to eat more greens, I’ve served it over mixed greens, but it’d be fine on its own. I can’t stop eating it. The three other recipes in the link are really good too.

Despite what happened on Friday, I’m really happy with the week. In many ways it took my focus off of just completing the program, and really owning that this needs to be a long-term lifestyle change. Intellectually, I’ve known that to be true, but after Friday I have definitive proof. So here’s to taking these 30 days to define a new normal. If these first two weeks are any indication, it will be yummy and satisfying.

PS THANK YOU to everyone who’s taken the time to follow along and offer words of support and encouragement. I’m so grateful for your kindness!

“The only real battle in life is between hanging on and letting go.”  ―Shannon L. Alder

 

Uncategorized

Welcome to the Shitshow – Whole30 Week 1 Recap

I made it to day seven…one full week without eating any grains, legumes, dairy, alcohol, added sugar, or artificial sweeteners. Not one sandwich, not one diet soda, not one bite of cheese, not one piece of gum. Because I don’t drink coffee or much tea, it also meant not having caffeine. Honestly, getting here feels like a miracle.

This week has been HARD. I had no illusions about how challenging it would be and there were days where it felt hour-to-hour. If it wasn’t a craving for a sandwich, it was a diet coke or a piece of gum. The cravings were everywhere, some of them more out of habit (I LOVE routine) than a particular desire for the food (which is insightful in-and-of itself). My sleep schedule has been a mess…I’ve been in bed by 8:30p three different evenings, by 9:00p the other three, and awake at 4:30a a handful of mornings. Some nights have been really restful, others not so much. Focusing at work in the afternoons nearly took an act of God.

But it’s not been all bad…since I can’t spend my lunch hour enjoying a sandwich at the little bakery around the corner from my office, I’ve been bringing my lunch, eating at my desk, and then going for a walk outside after I’m done eating. I’ve yet to find a route that allows me to avoid all of the smokers out on their own lunch breaks, and it doesn’t prevent the crash from not having a diet soda, but the fresh air makes me happy and it feels good to get some exercise in the middle of the day. Also, since I can’t have gum, I’m taking a toothbrush and toothpaste to leave at my desk at work. I never would have guessed that the Whole30 would lead to more tooth-brushing. I’ve been drinking a ton of water, and while I was well-hydrated before, I do think drinking primarily water for a few weeks is going to help flush my system of a whole bunch of crap. On the suggestion of a friend, I’ve been adding lemon essential oil to it sometimes, which provides welcome variety (thanks, Jenni!). Lastly, the bloat in my stomach is completely gone. I went into this with 20 lbs to lose, so there is no doubt that I need to make changes for the long haul, but my belly is noticeably flatter after just a week (I’m lookin’ at you, grains and dairy).

I’m fairly certain I wouldn’t have made it through the week without M, who did the heavy lifting with dinner several nights and gently reminded me more than once why I was doing this (I did A LOT of bitching mid-week…the “kill all the things” phase is legit). Initially, I would’ve preferred to start this when he was on a trip, just so he could avoid the first-week drama, but I’m really glad he ended up being home. Week two will be all me, but I feel prepared.

This week has forced me to confront every bad habit I have related to food, which is exactly what I need. Having my sister going through this right along with me has been a huge help…not letting her down is almost as much motivation as not letting myself down. In a lot of ways, it’s hard and miserable, but there’s no denying that my digestive system is happier. From what I’ve read, the cravings should diminish in another week or so. And there’s something called “tiger blood” in Whole30 circles that is supposed to be pretty amazing. That doesn’t show up until late in the process, but I’d love to feel that good. It’s been a while.

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A Reluctant Whole30

I hate rules. I dislike being put in a metaphorical box. And I am the worst with absolutions. I’m really good at doing things 95% of the time, but terrible at 100%. So why is this girl doing a Whole30, a program that requires complete adherence to the rules? You could say that I’m desperate…my several-year struggle with an autoimmune condition gone rogue is well-documented, as are the adverse effects on my well-being. And while I’ve made up a lot of ground on recovering from a crappy couple of years, I feel like I’m running at about 70% of my pre-2014 self. I still feel tired a lot, I’ve been getting sick frequently the last few months and I continue to carry 20 extra pounds. All three of these suggest strongly that I still have work to do.

A bit of background…most people who have an autoimmune condition also have an unhealthy gastrointestinal (GI) system. In fact, an unhealthy gut often precedes the onset of an autoimmune disorder. When the system works as it should, the insides of our intestines function essentially like the outside of the body, as it’s only through a very sophisticated barrier between the inside of the intestines and the circulatory system that certain molecules get through. So in this sense, the barrier is permeable in that it lets the good stuff through, but it also holds back all manner of toxins, bacteria, and pathogens. When the process works as it should, the digestive system breaks down the food so that the GI system can release the good stuff into the circulatory system and it can send the bad stuff on down the road (to the toilet).

In many cases before an autoimmune condition presents, this barrier breaks down. The permeability of the gut lining is increased, meaning some of the bad stuff slips through. As you’d expect, these invaders trigger an immune response, which can unleash a cascade of other reactions. Often times, a misbehaving immune system is a factor as well, but many studies show that the “leaky gut” comes first. (If you want to read more about intestinal permeability and autoimmunity, check out Sarah Ballantyne, Ph.D.’s website).

Much research is still being done to better understand what causes intestinal permeability in some people, but most scientists agree that environmental triggers are a significant factor, including stress and diet. When it comes to food, there is considerable research to suggest that grains, dairy and legumes are big offenders. (Again, check out Sarah Ballantyne’s site if you want to read more about this.) As a result, a paleo diet is often recommended by progressive medical providers as part of the treatment plan for an autoimmune condition.

Now back to the Whole30…for those that aren’t familiar with the program, it’s essentially a 30-day elimination diet that’s intended to be a reset of sorts. For 30-days, participants eat nutritious, whole foods – fruits, vegetables, nuts, seeds, seafood, and meat. They avoid grains, legumes, added sugar, artificial sweeteners (including no gum), alcohol and compliant paleo baked goods with the intent of breaking some bad habits, reducing inflammation, and learning how certain foods impact the body. To keep the focus on the process, not weighing oneself during the 30 days is also a rule. The rules are strict – no cheating, not even one bite, or you start over. This is where things usually start to break down for me.

I attempted a Whole30 not long after we moved back from Fort Collins in 2015. I didn’t make it all of the through the 30 days (see the part about sucking at absolutions), but I did make some significant changes and noticeably felt better. Life got in the way though, and the changes didn’t stick. Since then I’ve made several other half-hearted attempts at improving my diet, but they never last.

In January 2016, I started seeing a new physician, and she’s been encouraging me to address my diet since our first appointment. She’s a proponent of the Wahl’s protocol, which has a paleo foundation with emphasis on certain fruits and vegetables to support mitochondrial health. Dr. Wahl’s developed her protocol while suffering from severe multiple sclerosis, which is also an autoimmune condition. In my case, medication simply treats the thyroid damage caused by the autoimmune condition, not the rogue immune system, and it’s on me to address that component. Diet is a significant part of getting things back under control.

So in an effort to finally follow doctor’s orders and address the underlying issues fueling my autoimmune condition, I’m doing a Whole30, despite the program being exactly the opposite of what I’d prefer to do. My sister Megan is joining me, she’s a Whole30 veteran and all-around badass (my sister Erin is a badass too, for the record). I hope that the accountability of a partner will help me stay focused, and get me to follow the rules (for once). My motivation for doing it is 90% related to my health and 10% due to my desire to wear my old pants. I have some really cute clothes that I haven’t been able to wear for a while. I believe that my poor diet (poor compared to the recommendations of my doc) is the biggest roadblock between me and good health. Most of the population can eat a “normal” diet and be perfectly healthy, unfortunately I am not one of those people. It’s frustrating to acknowledge that I am a barrier to my own recovery. If I can’t get back to the level of health I had before this recent flare, I don’t want it to be because I won’t stop eating pizza.

Today (Feb. 6) is Day 1. I expect to feel like crap for 7-10 days while my body adapts to the lower-carb, sugar-free diet. I’ll miss my midday diet soda and the energy boost it provides. In exchange though, I expect to sleep better, have more energy, have increased focus and finally break some really bad habits (see the midday diet soda above). I hope to lose a few pounds, but that’s not my primary motivation. Also, I want to remind myself that I can do hard things.  Someday, I hope to be a marathon runner again, and remembering I can do hard things will be important.

To give myself the best chance of success, I’m sharing this post to have a reminder of why I’m doing this and to hold myself accountable. I’m also recommitting myself to my meditation practice and journaling throughout the 30 days. I have no doubt that my sister will finish this, I’d really like to finish it with her.

Photo credit: Marty Barman

 

Uncategorized

On Politics (But Without the Political)

1 Comment

Full disclosure – this is a post about politics that’s not about politics. There is no ranting, no bashing of any candidates, just my thoughts on the state of our political environment at the moment.

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The older I get, the more I’ve paid attention to politics. I think this is a natural course in life…with age comes a greater tendency to lift our heads to see the world around us. And while I’ve paid more attention to politics, I still sit on the sidelines. I vote, I read, but I’m not politically active. That might change in the future, but at this point, I feel more like a spectator than a participant.

As I’ve observed the most recent presidential election cycle, and the conversations surrounding it, I’ve become deeply worried for the collective us. I recognize that republicans and democrats have always viewed the world differently, this isn’t new. But what feels different to me is a complete communication void between those that are at opposite ends of the political spectrum. The void extends from our congressmen in DC to friends and neighbors. More recently, there’s not even a common understanding of what information is true (this is NOT a reference to the “alternative facts” comment, but a more general statement about the very different lenses through which people view the world and how we obtain our information). I perceive little effort to step back and hear a different perspective, to listen critically about why someone feels the way they do. This weekend was a perfect example of the echo chamber in which we all live.

On Friday, Donald Trump was inaugurated. Many Americans voted for him with high hopes for the change he can bring to our country. They were excited to see their candidate take office, an “outsider” who spoke their language. Most of the conversation on social media seemed to center around the size of the crowds. Granted, Trump and his administration did their part to fuel that dialogue, but from my perspective, it was the most inconsequential part of the day. It distracted from other things that happened over the weekend…Trump’s inaugural speech, his speech at the CIA. Regardless of whether or not we voted for him, we should all be listening closely to what he says, especially in these early days of his presidency. We all have the responsibility of holding our elected officials accountable, and that starts with listening to their messages unfiltered. It is not about taking shots at the president’s family, what his cake looked like, or what kind of relationship the president and first lady might have. Those are all distractions from the real work of our government.

On Saturday, there was a march in Washington and in other cities around the world. The people who marched had many personal reasons for marching, and they varied widely. The march was grounded in a liberal perspective, which means I wouldn’t expect the message to resonate with those of a more conservative viewpoint. I saw many posts in support of the march, and many others that mocked marchers, suggestions that congress should enact laws that limit protests (!!), and articles that “ranted” at those that marched. The right to peaceably assemble is part of the first amendment of our constitution. Even if a particular march or protest doesn’t reflect our own personal viewpoint, we should all celebrate and support the right of our fellow citizens to participate in this most American exercise. There will be a pro-life march in Washington on the 27th. I am not the target audience for that march as it is not my cause, but I strongly support those who will march. Protesting is important. Marching is important. Whether or not a particular protest or march resonates with our personal beliefs is not.

So, what’s next? Where does the collective we go from here? How do we move forward from this place? If we are to create a more inclusive, respectful political environment, how do we do that? My personal belief is that the acrimony in congress reflects that acrimony present in our society. If we change, congress will change. It won’t be fast, but change will happen. If I could make a to-do list for us, myself included, this is where I’d start. It is by no means all-inclusive (I’m essentially spit-balling at this point), and I welcome additional thoughts on how we can collectively move forward from this dark, divisive place.

  • Stop judging each other on the lowest common denominator. The majority of republicans are not racist, homophobic, gun-loving anti-feminists. The majority of liberals are not delicate flowers (i.e. snowflakes)  who live on welfare, expecting the government to fix all of their problems. In any group you’ll find assholes…whether that’s a political party, a group with a shared hobby such as runners, or a profession. We must resist the temptation to judge a collective based on the worst of that group.
  • Focus less on what others are doing and focus more on our own sphere of influence. Don’t support the platform of the march? Don’t march. Think the Affordable Care Act is the worst thing that ever happened? Work with your congress-people to advocate for change. Believe that Planned Parenthood provides critical healthcare to women living in poverty? Get involved in advocating for the organization’s survival. Lets find those things that matter to us, and work to change those things, without judgment towards those who share different views.
  • Have conversations with people we trust. Don’t understand why people are so passionate about the second amendment? Talk to people you know who are responsible gun-owners. Don’t understand why the LGBTQ community is concerned right now? Talk with people who are part of that community. Listen more, talk less. Even among those that share similar viewpoints, there is much to be learned through thoughtful dialogue. I recently had a conversation with two similarly-minded friends that reframed my view on a topic in which I thought I was well-grounded. I was grateful for the conversation, and appreciated the opportunity evolve my perspective.
  • Resist the urge to use labels when talking about those with different viewpoints. THIS IS VERY IMPORTANT.
  • Recognize that most have complicated belief systems. Very rarely are things as black-and-white as they seem. Even in the most hot-button of issues, most have nuanced views that can’t be well-articulated by a soundbite or meme. So many conversations are reductive. I believe that by walking away from the 1,000 shades of grey that lay in the middle of most any issue, we do ourselves a great disservice.
  • Get involved. Support candidates who reflect your beliefs. Help get them elected and communicate with them throughout their term. Volunteer for causes that resonate. Pivot away from things that don’t matter to you and towards the things that do.

I’m worried for us. I’ve observed more than a few friendships breakdown over this political season. This stuff matters, and it matters a lot, but so do the people in our lives. From this moment forward, I’m committed to building more bridges and listening more. When pushing back against a policy or candidate I disagree with, I’m committed to resisting thoughtfully, respectfully, and with grace. I recognize that this approach doesn’t resonate with everyone, and that’s groovy. But this will be my path forward.

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“Let us never negotiate out of fear. But let us never fear to negotiate.”
― John F. Kennedy, January 20, 1961

New Year's, Reflection, Transformation, Uncategorized

Reflections

I’ve never been one for New Year’s Resolutions. I’m of the mind that if there are changes to be made, one shouldn’t wait for a particular date on the calendar to make them. However, I do love the metaphorical clean-slate the new year provides. Even though Sunday is no different from Saturday, something about turning the page on another year can feel like opportunity.

While I’ll not spend the last few days of the year making lists of things to change about my life, the last few years, I’ve been more intentional about taking a look back. About taking stock of the year that’s closing, remembering the good, honoring the bad. It’s a habit that started with my running logs, I think. I love adding up mileage totals for the year, looking back over race results, considering the effectiveness of my training, comparing the totals and results. Since I’ve been unwell the past three years, that exercise hasn’t been as fruitful. I’ve been running and racing much less, and the results of the races I do run are expectedly mediocre. So, I’ve found my mind wandering and expanding the exercise to a more holistic inventory. I value acknowledging the light and the dark, as it is the contrast of experiences that sharpen the focus.

Compared to 2015, which I’ve come to refer to as a forest fire, 2016 was pretty solid. A bit of context…for me, a forest fire represents a year when everything goes wrong, to the point where every narrative you’d written for yourself gets burned to the ground. To complete and total ashes. We all experience forest fires at some time or another. Enough things come undone to the point where the path you’d envisioned for yourself is so clearly not where you’re meant to be, or not even possible anymore. Like an actual fire in the forest, this tearing down creates space for a rebirth and makes room for experiences that wouldn’t have happened without a major reorientation. Growth of a different kind. My fire was personal-illness of a family member and continued major challenges with my autoimmune condition- and professional. But, without 2015, there is no 2016. And if 2015 was a forest fire, 2016 was sunshine on blackened trees, delicate flowers poking up through scarred earth.

Highs

In January, I found a new physician. By the end of 2015, I was as sick as I’d ever been with my Hashi’s and starting to feel like there was no way out. But I took a chance on a physician based in Chicago, a functional medicine M.D. who, according to her profile, specialized in holistic approaches to managing autoimmune conditions. My expectations were low, but I was getting nowhere with western medicine and had nothing to lose. Twelve months later, I’m thisclose to remission. I have a doc who not only has deep knowledge of my condition and how to treat it, but who lives with it too. She’s a true partner in healing.

With my not-one-minute-too-soon recovery, we took several trips. Nothing makes me happier than wandering around in the wilderness with my most-favorite person. We visited Breck in February, Zion National Park and St. George in May, and made two trips with my family to our favorite beach this summer (Cape San Blas, FL).  Also, I met some of my running friends in New Hampshire for a relay in September. Thanks to what I suspect was food poisoning, my running was crap (literally), but the weekend spectacular. Side note – Zion stole my heart. If you haven’t been there, put it at the top of your list, you won’t regret it.

Professionally, fall brought a new, unexpected job opportunity and I begin working for the local health department in early November. I love my work, have wonderful colleagues and get to make good use of the knowledge gained during the challenging two years at my job in Fort Collins. The stress from that job is what triggered the flare of the autoimmune condition, but it’s also a wonderful kind of alchemy, because without that work, I wouldn’t be at the health department. Funny how that works.

Lows

With much gratitude for all that was good in 2016, I leave this year missing a piece of my heart. In early August, we said good-bye to our sweet Sadey, our trusty companion of 15 years. We knew her time was short this summer, but losing her left a void that will never be filled. I miss her velvety ears, her begging for butt scratches, the pacing on the hardwood to get our attention. We’d only been married three years when we brought her home, and in her sweet, quiet way she taught us how to be better humans. I’m so grateful she was ours.

I closed out the year with a freak accident, breaking a bone in my foot on a trail run with my sister. I spent several weeks on crutches followed by several more in a boot. I broke my foot 10 days before starting my new job. BAD TIMING. Once I was finally liberated from the boot, I came down with a lingering head cold, from which I recovered only to get the stomach flu. Other than a few random workouts squeezed in between bouts of illness, I’ve been sedentary for two months. I’m a great candidate for a Couch to 5k program. 🙂

2017

As I mentioned, I’m not one for resolutions, but I do have some intentions for the coming year:

  • Continue towards remission with the autoimmune condition. I need to make the dietary changes my doc recommended a year ago, which will go a long way towards getting me over this last hurdle. My procrastination on this is unexplainable, but typical.
  • Reclaim my identity as a runner. I haven’t run regularly since the end of October and it’s making me a bit crazy in the head. I hope to run lots and lots of miles in 2017.
  • More adventures. A few are already scheduled…we’re going to Breck in a few weeks where we’ll be taking a snowmobiling tour for the first time (in addition to skiing and snowshoeing), and I’m attending the Wilder running and writing retreat in Oregon in May. (Still totally geeking out about the retreat!!)
  • Take chances. The last few years have unintentionally been about getting really uncomfortable. Good stuff has come from it and I want to be mindful about continuing to take risks. Growth and transformation is hard, but so completely worth the discomfort.
  • Be present. As an introvert who lives in her head, it’s really easy for me to go about my days totally distracted. I’ve been working to be more present in whatever I’m doing, whether that’s talking with a friend, cooking food for the week, working on a puzzle, or sitting in a meeting. It’s REALLY hard. But important, I think. Put down the phone, turn off the TV. There’s so much I don’t want to miss.

Whatever your approach for the new year, may you spend it with the people you love the most. Wishing you health and happiness in 2017!

 

General

Everyone’s an A-hole

As I drove to work on Wednesday morning, I witnessed four different people run four different red lights. These were the first four stop lights I came to that morning. Beyond forcing me to consider the safety of my six-mile commute, it got me thinking…when did we become such jerks? When you start paying attention, you quickly realize we’ve turned into a bunch of selfish, distracted punks.

One definition of respect is “a feeling of admiring someone or something that is good, valuable, important”. What strikes me about the definition is the inherent assumption of value or importance. When considering how we interact with each other, in so many instances, we say the exact opposite with our words and actions. When we run the red light because we’re in a hurry or not paying attention, we’re essentially saying to the other people at the intersection “I don’t value you or your safety”. When we argue impatiently with on some random person on Facebook, we’re saying “you’re not important enough for me to consider my words”. The breakdown of civility is having deep implications, as evidenced by our complete inability to have fruitful dialogue about hard things. When we can’t drive across town without respecting one another, how on earth do we imagine we can discuss something as challenging and complicated as access to healthcare or climate change, or a topic as polarizing as a woman’s right to choose?

If you walk into any coffee shop on a given day, often times you’ll see at least half of the patrons buried in their devices, whether that’s a computer or a phone. Regularly, these folks are seated with other people who are similarly engaged. I’ve wondered about the consequences of this shift. How much has the transition in how we communicate influenced how we treat one another? How has the evolution in how we make connections influenced how we communicate?  And how does this environment reinforce the “me” culture that appears to be doing us in?

In a society void of respect, having compassion for those who’ve walked a different path is impossible. I can’t be concerned for your well-being if I don’t value you as a human. My not taking the time to understand a community’s unique challenges demonstrates that I don’t find them to be important enough to warrant careful consideration. When someone says “poor people just need to work harder” that’s the message, for when you take the time to understand how institutionalized poverty is in our country, you quickly realize how escaping it is so much more than just “working harder”. Are there lazy people who are poor? No doubt. Is that an excuse to devalue the experiences of families living in poverty? Absolutely not.

The culture we’ve created has dangerous consequences. The election of Donald Trump is one extreme. Selfishness was essentially the heart of his campaign…”Screw the rest of the world, America comes first; this country is in a terrible place and I am the only one who can save you.” My neighbor who can’t wait his turn at a four-way stop is the other. I’m not sure how we evolve from this. My personal resistance includes driving as though I give a shit about others on the road, making eye contact and small talk with strangers in public (I loathe small talk…this is a bigger deal than it should be), being very careful about how and where I engage in conversations on difficult topics, and putting down the phone/computer more often. Also, I’m trying to listen more than I talk. As an introvert, this comes easy to me, but I’m listening harder, listening more to understand. Perhaps if we all extend a bit more kindness, a bit more grace, we can change the energy of the world around us.

“Respect was invented to cover the empty place where love should be.” ~Leo Tolstoy

Running, Uncategorized

Starting Over

“Do not go where the path may lead, go instead where there is no path and leave a trail.” ~ Ralph Waldo Emerson

As I sit here, four days out of a boot from an avulsion fracture of the cuboid bone in my right foot, I find myself consumed with thoughts about running. It’s coming up on seven weeks since I first injured my foot…a long time for a runner to not be running.

This injury comes on the heels of a terrible two-and-a-half year stretch for me as a runner. In the spring of 2014, I began to have trouble with what I now know was the start of a serious flare of my autoimmune condition (Hashimoto’s Thyroiditis). It would be six months before I got some insight as to what was happening, another 15 months after that (January 2016) before I found a doc who could help get my immune system under control. I haven’t set a PR of consequence since fall of 2013. That was also the last time I really felt like myself. Seems like a lifetime ago.

So here I sit. Coming off of a big injury at the tail end of a terrible couple of years. After getting over my initial anger about the injury (it came at a terrible time…we had to cancel a much-anticipated trip to Zion National Park – quite possibly my favorite place on Earth, and I started a new job on crutches), I’ve landed in a place that’s incredibly liberating. I can finally let go of any shred of the past, as any tiny bit of fitness I thought had stayed with me the last few years is certainly gone now. And after running five Boston Marathons in a row, more than I ever dreamed would be possible for this girl of modest talent, I’m now coming into the second year in a row where I don’t have a qualifier. No race has brought more joy and pride than what I felt standing in the starting corral in Hopkinton. But letting go of that expectation, that goal, has been liberating too.

2017 will be a year of rebuilding. Not only do I have an injury to rehabilitate from, but I have three years of illness to recover from as well. My November lab results were the best numbers I’ve had since my Hashi’s spun out of control in 2014. Things still aren’t “normal”, but they’re close. Close enough that I wake up with ease most mornings, even if I don’t want to actually get up (because who wants to get out of bed in the cold dark of December); close enough that for the first time in years I’m not cold all of the time; close enough that my brain works most days; close enough that it feels safe to set goals again.

While the marathon is my first love, the race that captured my heart, I plan to wait at least another year before attempting the distance. The last marathon I ran was Boston in April 2015, eons ago for someone who typically runs three-to-four per year. The race was a disaster (and not just because the weather was terrible), just like the several marathons before it had been. I’ll spend the first half of the year focusing short distances, 10k or less. If the summer goes well, I’ll try a half marathon in the fall, but I’m content to run nothing but 5ks and 10ks if that’s what it takes to get well again. And besides, the faster I get now, the faster my return marathon will be. 🙂

Why does this matter? Because as any runner knows, running is freedom. Running isn’t about the running at all. It’s about setting a goal and having the discipline to chase it. It’s about accomplishing things you never felt you could (see the five Boston Marathons mentioned above). It’s about spending time with your friends, whether it’s a short run on a random Tuesday night, or a weekend trip out of town. It’s time to clear your head, to make sense of all of the bullish!t. It’s quite possible that all of these words are on this page because this runner can’t run.

Any runner who’s been injured, or had a long layoff that wasn’t of their choosing, knows this feeling, this place. This experience isn’t unique. The challenges of the past few years have been moderated by the encouragement and commiseration of friends who’ve had their own go at this game. I know that I’ll be back. Things won’t be the same as they were before, but then again they never are. We only fool ourselves into thinking such. So I’m biding my time, hopeful for the future. I’ll leave you with a little ditty from one of my favorite bands, which sums it up nicely.

https://www.youtube.com/watch?v=4PkcfQtibmU