Some things just take awhile...
Breakfast of Champions!
 |
| Breakfast of Champions! |
Well, ok... maybe not "breakfast of champions" exactly. In my case it's more like "breakfast of survivors". Here's a gut-health message for the day.
Note: Much of what follows is my version of how I think I'm alive and well today when by all rights I ought to be dead because of my terrible diet. Definitely not medical advice/diagnosis for anyone else. Just my version of my own personal health.
It's
been since about Fall of 2013 that I had to make a dramatic dietary
change. My gallbladder was removed eleven years earlier about the start of Summer 2002-
I was 63 years old. We had cruised S from the Chesapeake via the ICW to
Stuart, Florida (shortly after 9/11 as it happens). At Stuart we turned West, passed thru Lake Okeechobee and on to
Ft Myers. It was in Ft Myers that a surgeon's bit of knife-wielding magic
ended the weird belly aches I'd had periodically since Feb 1984. So, how
long was that? Mmm... over 18 years of occasional belly pain which would
start in the upper right quadrant then slowly migrate to the lower
left quadrant. Then the belly ache would just... go away. Took a few hours. I made many
fruitless trips to the ER at Stanford Hospital in Palo Alto and to Sequoia Medical Group in Redwood City all to no avail.
Doctors did a number of medical procedures during those 18 years preceding that mid-2002 surgery. Healthcare professionals had poked, prodded, tested and variously tried to correct the issue. That included an unnecessary (my opinion) appendectomy at Stanford Hospital. "Unnecessary?" you query? Let me explain...
I retired 31 March 1995. In the wee small hours of 1 April (yup: April Fool's Day) I had yet another gut-pain episode. The Stanford Hospital ER doctor diagnosed it as an appendicitis and I had an appendectomy at Stanford Hospital. Before I was released from the hospital after the appendectomy I had yet another gut pain episode. The finest medical minds at Stanford Hospital were all "pissin' on the wrong bush" (a little Kentucky wisdom from friend and former co-worker Bob Hall; you have a way with words, Bob!).
Time marched on (as did the procession of belly aches). In Spring 2001 the Admiral and I took delivery of our new Gemini catamaran in a small town just South of Annapolis, MD. We spent the Summer preping the boat for cruising and eventually started our trip South to Florida in October 2001. That was in late Fall 2001- essentially within a few weeks of the 9-11 attack on the Trade Towers and the Pentagon.
Anyway, we traveled North out of Herrington Harbor on the Chesapeake to Annapolis, Maryland, found our way to the ICW then turned South. By late Spring we had worked our way to Ft Myers, Florida in late Spring 2002 and I celebrated by having to go
to the ER. Again. But this time was different cuz the pain didn't go away after about 3 or 4 hours.
It took the Lee County Memorial Hospital ER doctor - an osteopath (!) - less than 60 minutes to get X-ray images, run lab work and correctly
diagnose my then 18 year repetition of gut-pain. He said my problem was a blocked and inflamed bile duct. It
took him another 60 minutes to track down a surgeon to confirm I needed
surgery to remove the gallbladder. But first I needed about a week to get
the pancreas and bile duct infections under control so the surgeon could operate and remove the
gallbladder.
First a gastroenterologist had to clear the blockage. No clue what he did and I don't think I want to know (!) but it involved fiber-optics and no surgery sites. Presto! The pain disappeared. Again.
Turns out I had gallstones which would periodically block the bile duct (guess whose mother had issues with gall stones?!). The bile duct connects the gallbladder to the intestine. The gallbladder meters bile from the liver into the gut to allow proper digestion of fatty foods. It's also the place where gallstones form and collect. All that cholesterol I was eating (that I shouldn't!) ended up in the gallbladder. The cholesterol kinda looks like tiny grey beads. There's only so much room in the gall bladder for those tiny grey beads of cholesterol ('beads' is my word, not clinical), so eventually a few of them get packed together and become a gallstone. Apparently cleaning out excess cholesterol from the gallbladder isn't in anyone's medical playbook. From the NHS (a UK website):
So when you abuse the gallbladder as I had done the only choice when I originally wrote this in early 2024 was for a surgeon to remove the gall bladder. When the gallbladder is removed, I understand that the bile duct is then connected directly to the liver. That way bile flows into the intestine unrestricted from the liver whether you need it or not. That means there is no longer a surge of bile available when you eat a fatty meal. And if you're a meat eater as I was, nearly every meal can be a fatty meal.
You can go a long time without a gall bladder until age catches up with you. Then suddenly there isn't enough bile dribbling into the gut to do the job. In my case things had gone pretty well for 10 or so years post-surgery except I'd get a bit of indigestion after eating meat of most varieties. I made the acquaintance of a popular digestive aid named omeprazole. If I ate any meat I would have to take an omeprazole tab or else I'd be in pain from indigestion. 6 months into that adjustment I learned that omeprazole is habit forming; as I understand it you become dependent upon the omeprazole as part of digestion. Once again (there's a pattern here!) the Admiral came to my rescue.
After some digging she
learned the problem was eating meat without the body producing enough
bile to digest it. It's an age-related issue in that the body can't produce as much bile as it did when younger- for decades I
would eat pretty much anything on the menu. It's a dilemma.
The answer that works for me? Don't eat meat. This is when I was introduced to a new concept in eating called a vegetarian diet. "Me? A vegetarian? No &^^%$# way! I come from a long line of meat eaters and we have the heart disease to prove it!" Of course there's a backstory to go with that. I'm 86 years old as I write this; no male of my paternal genetic line before me ever made it to 84 years old:
- my father made it to 83 (heart attack)
- my grandfather made it to 83 (stroke)
- my great-grandfather died at age 41 (heart attack); and his father...
- my 2nd great-grandfather, died at about age 59-60.
And yes I've put together the family tree which confirms all this.
The solution really was pretty easy once I found the right doctor to help. I stopped eating meat from animals with legs. I do have cold-water fish a couple times per week- think salmon or tuna but there are other choices as well. If it comes from the offshore ocean it probably works for me.
This diet fits with the guidance I received from Dr. Randy Linde**. Dr. Linde was the endocrinologist managing my cholesterol issue after my carotid surgery. Mine is a unique carotid plaque caused by a little known form of cholesterol called lipoprotein-A (lpA). Dr. Linde explained in early 2000 that only about 10-11% of the US population are lucky enough to be bothered by it. It requires a special test as the 'normal' cholesterol test apparently doesn't pick it up. There are tests to measure it but unless you have a known issue they don't do the test. I have an issue so every time I have blood work, that gets measured. Requires a separate blood sample.
The Cleveland Clinic says:
Researchers have found that high levels of lipoprotein (a) can put you at a higher risk of heart and blood vessel disease.
Dr. Linde worked out a plan for me that involved adding folic acid (vitamin B6) to every meal plus time-release niacin tablets (vitamin B3) taken at bedtime. That latter vitamin B3 (I was prescribed 3 x 1,000 mg tabs of Niaspan) causes flushing (i.e. my face turns bright red) so the timing was to have all the flushing happen while I was asleep. Trust me on this: Niaspan is not for wimps.*** Thankfully the over-the-counter niacin product I take now is not as extreme and cost about $3,600 per year less (Niaspan cost had increased to $900 for a 90 day supply when I last got a 'script refilled in 2008).
The Admiral took on the chore of figuring out how I could eat without including meat other than salmon or tuna. We have a typical vegetarian diet with most of the protein from things like beans just like vegetarians have been doing for centuries. Pretty easy actually, except...
Breakfast was a challenge as I've also had a problem with lactose since early childhood. I could have simply used soy milk instead of cow's milk on the cereal but Frosted Flakes wasn't at the top of The Admiral's list of healthy breakfast choices. To paraphrase: "Sugar coated cereal made from highly processed wheat grain? I don't think so!"
So instead I was introduced to the veggie 'smoothie' as seen in the image at the top. The smoothie includes soy milk plus fruit, veggies and some grains. That has replaced my old favorite Frosted Flakes and whole milk starting in about 2013. But with all the other things the Admiral does it was a bridge too far. So several years ago I took over making breakfast.
Btw, if you're a vegetarian who adds fish to your diet as we do, it's my understanding you are properly a 'pescetarian', i.e. someone who eats fish along with their veggies. From Wikipedia:
Pescetarianism (/ˌpɛskəˈtɛəri.ənɪzəm/ PESK-ə-TAIR-ee-ə-niz-əm; sometimes spelled pescatarianism)[1] is a dietary practice in which seafood is the only source of meat in an otherwise vegetarian diet.[2] The inclusion of other animal products, such as eggs and dairy, is optional. According to research conducted from 2017 to 2018, approximately 3% of adults worldwide are pescetarian.
And from livestrong.com comes this insight into cold water fish. That list of safe cold water fish could have been created by my endocrinologist, Dr. Randy Linde of Stanford University (he is/was a clinician, researcher and lecturer). As I mentioned above, he was the one who got me on this dietary path; a pescatarian diet was not at all what he had in mind, but then I didn't have an issue with meat and dairy in early 2000.
But there are some concerns with a pescatarian diet which relate to pollution of our oceans...
Cold water fish is a powerhouse of nutrition. However, some varieties are high in mercury and environmental toxins and may pose health risks. Salmon, tuna, Atlantic mackerel, cod, sardines and canned light tuna are considered safe and can be consumed up to three times per week.
The fish Dr. Linde wanted me to eat is salmon. A pescatarian diet was no hardship at all since I ate salmon frequently. To be clear, it was not Dr. Linde's idea that I go to a vegetarian diet. That happened solely because I could no longer properly digest meat from from 2- or 4-legged critters thanks to not having my gallbladder. Once I was on that track, however, I felt so good it was a no-brainer to stay the course.
And yes, that's coffee in the Starbucks cup in the photo above. I limit myself to that one 10 oz cup per day. In the good ol' days when I was still working at Lockheed I was drinking coffee all day long- perhaps 30-40 oz of coffee per day. Not a great plan. But I survived that better than the crappy snacks in the vending machines and the fat in the cafeteria food.
Incidentally all that coffee I was drinking at work was causing atrial fibrillations. Now after years of limiting my coffee uptake to 10 oz per day those fibrillations seem to have disappeared from my cardiogram. I'll have to confirm that with Dr. Myer then next time I see him but I think I'm right about that. So, I must reluctantly say: "Kids, if your mother says 'coffee's not good for you', I'm afraid she's probably right".
-----------------------------
* My take on "You don't need a gallbladder,..." is 'yeah right!' If I want to eat meat, no longer have my gallbladder, am over 65-70 years old, and have eaten a lot of fatty foods my whole life, all I need to do is accept the horrible belly ache which follows! And, yeah- everyone is different, so your mileage may vary.
-----
** Dr. Randy Linde professor emeritus at Stanford University. He's a hero in this story. Along with the ER doctor in Fort Myers, Florida. I wish I could recall his name (!), but I do recall he was an osteopath.
-----
*** Niaspan is a prescription product and was initially covered by my health insurance. Then the price went to $900 every 90 days and my health insurance would no longer cover it: "it's a vitamin and isn't covered".
There are, however, generic time-release niacin products available over the counter. So as an experiment I switched to an over-the-counter product from Rugby. I get tested annually and my results are pretty much the same in that LDL levels are properly in the 'normal' range as are levels of lipoprotein-A. So I have continued to take Rugby time-release niacin instead of Niaspan for many years.
At least part of the reason they stopped covering the Niaspan is connected to AMA guidance which suggests you can control lipoprotein-A by simply taking a statin (a cholesterol drug). But that didn't work for me- probably cuz I'm in that 10% group who have a problem with LPA. LPA isn't normally tested in most bloodwork unless they know the patient has a problem with LPA- which begs the question 'how do you know a patient has a problem with LPA unless you test for it'?
-----
Comments
Post a Comment