March 31, 2022

Health Check-in: Q1 2022

See here for v1 of this, which covered October 2020 through December 2021. Continually expanding that post and doing monthly updates both seemed like awful ideas. This is a quarterly update (January - March), but I may not post another one until the end of the year. It kind of depends on progress!

Where were we?

I ended December at 256.2 pounds. I was on the fence about the CoolDrift Versa and the Cool Fat Burner. I stuck with those for another couple of weeks, but haven't used them much in February or March. Ditto for all the fasting apps.

Where are we now?

I did my last March weigh-in this morning and was at 250.4 pounds. March has been pretty up and down, though – I hit 250 even at one point and was as high as 254 a few days ago.

What changed?

I mostly kept to the same protocols.

I swapped my morning skyr for plain Greek yogurt. I'd rather eat the full-fat stuff, but Costco doesn't sell full-fat plain yogurt and I don't always make it to the one random grocery store that sells plain whole milk skyr. It's not really plain yogurt, though. I bought some frozen cherries, and my current breakfast concoction is a handful of frozen cherries + 1 cup of yogurt + bee pollen + chia seeds. It's likely more calories than the prepackaged yogurts I was eating, but I like it.

I bought Ragnarock on the Oculus Quest in early February, and I've been mixing that in along with Beat Saber. I burn fewer calories overall (less full-body movement), but my heart rate goes a lot higher. I tend to average 140-150 bpm on Ragnarock compared to 110-120 bpm on Beat Saber.

For most of Jan/Feb/March, I've been doing:

  • ~20 minutes of weightlifting (still using the X3 bar)
  • ~20 minutes of Ragnarock
  • ~40 minutes of Beat Saber

I did a 4-week cycle of doing the X3 Bar every day during the week (not quite back to the 6/week program), but I didn't like it as much. I'm a creature of habit, and it was weird to not have the same exercises on the same day of the week.

My new Halo View broke in February and I switched back to my first-generation band. My steps immediately shot up by a few thousand a day, which tells me January wasn't actually a "low energy" month so much as a "different sensor" month. I liked being able to check heart rate in real-time, but the process on the Halo View was cumbersome. I've stuck with my "dumb band" and it's actually been a nice stress relief (can't constantly check the data).

I added a shitload of new supplements (see Uric Acid notes below), but I'm thinking about declaring supplement bankruptcy and starting over with just Omega-3s and Vitamin D.

Uric Acid

The last few months have been busy on the uric acid front. A couple of podcasts led me to some new books:

  • Drop Acid by David Perlmutter
  • Nature Wants Us to Be Fat by Richard Johnson
  • Unlocking the Keto Code by Steven Gundry

All of these books chip away at metabolic inflexibility from different angles. There's a lot of overlap between the three, but each one adds a bit more.

I'd specifically call out Nature Wants Us to Be Fat as the book that has most closely matched my experiences and best described why I couldn't lose weight for the first 10 months I was dieting. The specific protocols he calls for are almost exactly what I worked out myself through trial and error: intermittent fasting and a shitload of zone 2 cardio (my diet was already pretty clean). One new addition: dark chocolate, which I'm trying to work in once or twice a day instead of protein bars.

One other thing I got majorly wrong last year when I started taking Allopurinol again: sugar consumption isn't my (main) problem. My knowledge of uric acid through the end of last year said that it comes from four main places: seafood, organ meat, beer, and fructose.

Seafood gets me every summer on vacation, but I tend to steer clear of beer and fructose. I also don't eat a lot of packaged food, so I'm not too worried about hidden sugars (although I did get rid of my favorite salad dressing after reading those books).

It turns out my biggest enemy is likely not fructose, but glucose (through the polyol pathway). It turns out that if your body has too much glucose, it'll just convert the extra into fructose anyway. Salt and umami, the other good flavors, tend to occur in foods that help that process.

I suspect that my internal fructose generation is the reason my uric acid hasn't gone down much.

How do you fix it? I'm inching closer to ordering a continuous glucose monitor. I didn't think glucose was my problem, but uric acid can apparently be downstream of glucose. All three books call out keto as a way to shut this down (although ironically uric acid tends to go up on a keto diet), but keto diets aren't compatible with my family (rice or noodles or pasta pretty much every night).

The books did lead to a bunch of changes, though:

I bought a finger-prick uric acid tester and have been taking readings at least daily. Using the data from the finger tester, I shifted my allopurinol + supplements to the evening (after I eat carbs for dinner) instead of in the morning (when I've been fasting for 12 hours already). I added a shitload of new supplements: berberine, cinnamon extract, tart cherry extract, chlorella, pterostilbene, quercetin, and luteolin.

Tart cherry, chlorella, quercetin, and luteolin were all recommended in Drop Acid, but also showed up in Unlocking the Keto Code as mitochondrial uncouplers (turtles all the way down!).

Cinnamon is both an aldose reductase inhibitor (part of the polyol pathway) and slows down your digestion (which means smaller glucose spikes).

Berberine and pterostilbene are both popular longevity supplements (or, really metformin + resveratrol), but I came across them again while looking for supplements that inhibit aldose reductase or shut down the polyol pathway. I couldn't find any good studies showing that they were specifically used to combat uric acid, but it makes sense if they help lower blood glucose.

Very interestingly, Nature Wants Us to Be Fat calls out Vitamin C as something shouldn't take if you're trying to lose weight. I'll likely take it off my supplement list in April until I hit my target weight.

How's it going? So far the data is… mixed.

What I eat the night before seems to have more impact than any of the supplements, but I also started taking readings and supplements at the same time. The data is so spiky that it's hard to tell if any single thing is having an impact.

I'm thinking about dropping down to just vitamin D and omega-3s and adding back the different supplements 1-by-1 to see if they do anything.

Ultimately the uric acid should sort itself out if my weight drops low enough, so it might be a futile battle to try to lower it with drugs/supplements when I should just keep going on the weight loss… except that most of the "drop your uric acid" supplements are also "boost mitochondrial function" supplements.

I haven't decided what to do there yet.

Sprouts + Salad Dressing Tinkering

I'm currently reading The Sprout Book by Doug Evans. I heard him on a podcast, but Drop Acid also called out broccoli sprouts as a good thing for lowering uric acid. We're already eating salads for lunch most days, so I got a little sprouting kit and a pound of broccoli seeds. So far so good! I would say sprouts give me about 90% of the same joy as my Aerogarden, but it's way less work to clean/reset them once a week.

I love "interventions" that are super easy to fit into what I'm already doing.

Speaking of salads, I've been rotating between 3 main salad dressings:

  • Poppyseed
  • Lime + Red Curry + Soy Sauce
  • Ginger (Japanese Steakhouse Style)

The poppyseed dressing I've been using has a ton of sugar in it… so that one's out. (I found a Skinny Girl version that tastes about half as good).

The homemade lime dressing has way too much salt in it (which encourages the conversion of glucose to fructose)… so that one's out.

The ginger dressing is actually fine – super low sugar and it tastes good.

I added a new one to my rotation after reading Unlocking the Keto Code: MCT oil + cider vinegar + lemon juice in a 2:2:1 ratio.

Zone 2 vs VO2 Max

Two really interesting exercise podcasts came out within about a week of each other:

I would also point to Nature Wants Us to Be Fat and Unlocking the Keto Code as recent things on my mind that all point towards mitochondrial health.

I was worried that my hour of cardio a day would be bordering on too much, but my overtraining fear has pretty much gone away. Both Nature Wants Us to be Fat and the Huberman episode call out that there's not really an upper limit for zone 2 training. Dr. Galpin shits on zone 2 as not being real exercise, which is actually kind of comforting. It burns calories and it trains my mitochondria, but it's likely not doing bad things to my heart in the same way that an hour of HIIT training every day would do.

Beat Saber is barely zone 2 for me. By my math, my zone 2 range is 123-140 beats per minute. For an hour of Beat Saber, I've been averaging around 120 bpm. It's right on the edge, but it's clearly working for me. I might start pushing that hour out a bit longer if I can make myself get going earlier in the morning.

I ordered a Reebok Step (old school aerobics class stuff) with a plan to start doing some ankle mobility stuff and some HIIT routines (Tabata). Ragnarock can kind of double as VO2 max training (my heart rate has hit 180 on some of the faster songs), but it turns out I shouldn't do that before the zone 2 stuff or it blunts the effect of the zone 2 cardio.

I'd always heard I should do from hardest to easiest in terms of effort (for me: weights -> Ragnarock -> Beat Saber), but building up too much lactic acid before doing zone 2 can make you skip the fat burn zone entirely.

I'm going to play around in April with doing some Ragnarock or Tabata sets at the end of my cardio days or just flat-out move Ragnarock to VO2 max day (which is a new thing).

My current exercise routine hits strength (100 minutes) + zone 2 (240 minutes) + vo2 (60 minutes) + weekend fun time:

  • Resistance - X3 Bar - 20 minutes, M/T + Th/F
  • Zone 2 - Beat Saber - 1 hour, 4x week, M/T + Th/F after the strength stuff
  • VO2 - Tabata + Ragnarock - 1 hour, 1/week (W)

I'll likely dial that way down once I hit my weight target (currently still targeting 225 lbs… 25 to go!). One downside to this new routine is that Wednesday goes from my easy day to my worst day. It's going to take some time before I can work up to 8 Tabata sets – I did two sets yesterday and felt like I was dying.

I've been consuming hundreds of hours of health/fitness podcasts since last summer, but I've now mostly exhausted the back catalog. I have 3 or 4 that I keep up with now, but I'm excited to get back to nerdy business podcasts.