We’re an n of 2

The scientific method involves proposing a hypothesis — e.g. “Drug A improves symptoms of Disease B” — and then designing an experiment, or study, to test it.

The “gold standard” studies are double blinded and placebo-controlled. Half of the subjects get the drug, and half get a placebo (or “sugar pill”) that has no expected effect. Neither the investigators nor the subjects know who is getting the real treatment. Then when the data are analyzed, it can be clear that any observed effect is the result of the drug, not wishful thinking.

And to reduce the likelihood that any observed difference is due to chance, scientists design their studies with a sufficiently large n, or number of subjects.

In an earlier post in this series, I conceded that I’m an n of 1. I’m an anecdote. Scientists tend to look down on anecdotal claims. Just because a low-carb diet and time-restricted feeding program has led to me losing 60 pounds doesn’t mean it will get the same results for you.

There could be something peculiar about me that led to this result. Perhaps it’s just a random coincidence. Or maybe just the fact that I had decided to pay attention and try to lose weight was the main factor, and the particulars of what I changed didn’t matter so much.

But together Lisa and I are an n of 2, and we’ve lost a total of 100 pounds on a low-carb diet with intermittent fasting or time-restricted feeding. And the weight loss for her didn’t really kick in until she went low-carb with intermittent fasting.

We’re also not alone. The n of those getting good results from a similar approach is much, much bigger.

And the reality is you can’t do a blinded study of a lifestyle intervention. If you’re switching from pizza and pasta to steak and eggs, you’re going to know it. And if you are going 12 hours a day or more without eating, you’ll know that too. There’s no placebo effect here.

I’m not sharing our stories to boast about our accomplishments. We did have to change what and when we ate, but it truly hasn’t felt like much of a sacrifice.

I’m sharing them because I’m frankly kind of mad that following official government policy (avoid fats, eat lots of “healthy whole grains”) made us fat.

The “eat less, move more” or “calories in, calories out” dogma is trite and simplistic, and doesn’t correspond with the reality of why we get fat.

In the 1950s and 60s nobody worked out. It was only in the early 70s that running and aerobics became “a thing.”

Obesity hasn’t tripled in the last few decades because people don’t move enough. If anything, people in recent decades have exercised much more than our parents and grandparents did.

Exercise is good and important, but its lack has not caused the obesity epidemic.

I’m sharing our stories because I’m pretty confident that among our social connections, and those we can reach through them, there are scores, or hundreds, or even thousands of people who feel as trapped and defeated as we did four years ago.

There is a better way, and there is hope for a reversal of metabolic syndrome. I want to point you to those from whom Lisa and I have learned this.

I’ve previously highlighted pioneers like Nina Teicholz, Tim Ferris, Dr. Jason Fung, Dr. William Davis and Dr. Robert Lustig who have revolutionized our thinking.

As I continue this series I plan to feature several others who also have given us important and life-changing information. Some of those include

I look forward to sharing what we’ve learned from these people and others, and the benefits we’ve seen from applying those lessons. I linked mostly to their Twitter accounts in the list above, in case you want to start following them before I get to writing about them.

Some of them are physicians, while others are Ph.D. researchers, and still others are scientific writers actively poring through the relevant research. They have applied the skepticism of the scientific method to the disastrous dietary dogma that has had such a negative record for the last five decades.

So while Lisa and I together are only an n of 2 and our experience is not definitive, we have seen good results in the last four years through applying what we’ve learned from these people and others.

What other scientific researchers, physicians or writers have you found helpful in understanding diet, lifestyle, weight loss and health? I’d appreciate your recommendations as I continue my journey of exploration.

See the whole series about my health journey. Follow along on FacebookTwitter and LinkedIn.

Lisa’s Weight Loss Journey

In addition to being my best friend for nearly 39 years and my wife for more than 35, Lisa Aase has been pursuing health improvement and weight loss with me since October 2016.

We started just after my middle daughter’s wedding, when neither of us felt good about the size of the fancy clothes we bought for the occasion.

I was at about my all-time max of 265 pounds. Lisa doesn’t know exactly what she weighed at the time, because stepping on a scale wasn’t a positive experience. She does remember one reading of 185.

So we both resolved to try a diet, which started by getting rid of all added sugar. I’ve been telling my side of the story through this series, and for the most part it was a continual path of steady loss. Some diets worked better than others, but anything was an improvement over how I had been eating.

Lisa had some extra challenges in being post-menopausal and also having thyroid issues. When we did the Trim Health Mama plan, I lost 15 pounds in three months, while she lost three.

That was really hard for her, because she knew that previously she would have had much more significant results. I suggested that we try a different plan, and had been reading The 4-Hour Body by Tim Ferris, so we next tried his “slow carb” diet. She got better results with this, something like nine pounds in three months. It still felt frustratingly slow to her, but at least she could see some progress.

That’s when I listened to The Obesity Code by Dr. Jason Fung, and we began our 10-week experiment with alternate-day fasting. We learned that by having extended periods of low insulin through fasting we could enable our bodies to burn the ample fat we had stored.

Lisa and I found intermittent fasting (also sometimes called time-restricted feeding) both easier and much more effective than portion limitations. Instead of eating several small meals that never allowed insulin levels to decrease, we would skip breakfast and lunch every other day.

By the time we left for our 6,000-mile Wild West driving vacation in late July of 2018, we were both lighter than we had been for several years.

Having felt like we had accomplished our mission, for the next year or so we were not so diligent in managing our eating habits. I gained about 20 pounds, but was still almost 30 pounds below my peak.

Lisa probably gained a similar amount, but doesn’t know for certain. She had been scarred by her bathroom scale experience, so she didn’t weigh. But when she looked for a dress for our nephew’s wedding, she wasn’t happy with what she saw, and resolved to get serious.

This time she was confident that she knew what would work. Instead of alternate day fasting she would eat one low-carbohydrate meal a day, and to ensure that she wasn’t breaking her fast she switched to black coffee in the mornings starting in December 2019. Going low-carb also enabled her to get fat adapted, eliminating cravings.

She said she wasn’t going to weigh again until she felt good about how she looked, at which point the number on the scale wouldn’t matter so much.

Finally, on March 15 of this year she decided to step on the scale. She hoped to be under 160, which would represent a total loss of about 25 pounds.

She couldn’t quite believe what she saw. She weighed four times just to be sure. Instead of the hoped-for 158 or 159, the scale said… 152.6!

Since then, she’s lost 8 more pounds, and is under 145 for the first time in at least 25 years. In May, she began adding a little cream to her morning coffee without noticeably slowing her weight loss progress.

How does she know? Since May 19 she has been weighing every day, only missing once. A minor weight fluctuation that would have sapped her resolve three years ago is now just another data point in a long term trend that is going in the right direction.

And when our youngest son, John, was married on June 27, her dress was several sizes smaller:

Knowing how hard Lisa was working to lose weight four years ago, and how frustrated and disappointed she was at her slow progress, I’m so happy she has found that a low-carb diet with intermittent fasting gets better results with less effort.

See the whole series about my health journey. Follow along on FacebookTwitter and LinkedIn.

Best. Yogurt. Ever.

As I mentioned in my last post, Dr. William Davis has recommended a particular strain of bacteria, Lactobacillis reuteri, as having many health benefits.

He discussed those benefits in the video I embedded in that post, and now as promised here’s a video I produced that demonstrates how to make it.

You can read Dr. Davis’ instructions for making the yogurt (and read more about its benefits) on The Undoctored Blog, but I think the video above is helpful to show you step-by-step how to make it consistently and flawlessly.

Dr. Davis suggests you can make the yogurt by putting the liquid in a pan in the oven. He says you can just turn the oven up to 350ºF for 90 seconds, and then shut it off, repeating the cycle every few hours to keep the temperature between 100-110ºF.

In my experience that’s way too much work, and is susceptible to failure. If you forget to turn off the oven, you kill the bacteria. If you fail to turn on the oven at least once in the middle of the night, the whole mix can sour. I had a couple of flops in my first five batches using that method.

That’s why I decided to get a yogurt maker, which keeps the mix at a constant temperature with no need to pay attention to it. Since then I would guess I have made 50 batches or more, and haven’t had a single failure.

After getting the BioGaia tablets, which contain the bacteria, and inulin powder as a source of prebiotic fiber on which they feed, all you need is the liquid that will be turned into yogurt.

Dr. Davis says he uses half-and-half as his base, and also has made yogurt from almond milk or coconut milk. If you use almond milk, he says you need to add some sugar to your mix, in addition to the inulin.

Whole milk is another option, but my choice is a mix of half-and-half with heavy whipping cream, as you’ll see in the video. This is definitely not low-fat yogurt.

I have gotten great results by keeping the mix at 104ºF for 36 hours, and by putting some water in the yogurt maker it keeps the temperature more even throughout the jars. After they’re done, I put them in the refrigerator.

As you can see, this is the thickest yogurt you’re likely to find. It stands up straight.

When it’s time to eat, I take one of the jars from the refrigerator and spread it out in a dish, adding three more teaspoons of the inulin both to sweeten the yogurt and to provide some prebiotic fiber to feed the bacteria in my GI tract.

I think it tastes great plain, but I typically also top it with some fresh raspberries or blackberries.

This is a delicious dessert, and I think the benefits Dr. Davis cites seem to hold true for me. He says it has a powerful appetite-suppressant effect, and while I think my low-carb diet has helped me not experience cravings during my typical 18-hour fasting window, the yogurt could definitely be a contributing factor.

Dr. Davis also touts the skin-thickening and collagen-increasing properties of L. reuteri and this yogurt, which supposedly results in a more youthful appearance and faster wound healing. I found a picture that isn’t necessarily definitive in this regard, but it might give a clue.

The picture on the left is from January 2019, when I was just starting to make and eat the yogurt. I tried to duplicate the angle in the one on the right this evening, 16 months later. The horizontal forehead creases seem less pronounced to me, but you be the judge:

I think the oxytocin-enhancement benefits are real too, as I’ve been able to put on muscle mass through weightlifting.

Since I find it so delicious, and because research suggests benefits that my own experience tends to support, I plan to keep making this for Lisa and me for the long term.

If you try it, I’d love to hear about your experience.

See the whole series about my health journey. Follow along on FacebookTwitter and LinkedIn.

Of Lawn Care and Poop Transplants

One of the keys to health Dr. William Davis emphasizes in Undoctored is using probiotics and prebiotic fiber to cultivate healthy bowel flora.

He says one of the significant sources of our health problems is that the good bacteria are disrupted, sometimes by a course of antibiotics but for other reasons as well, and as a result harmful bacteria can take over.

This is not a fringe idea: I have seen related stories through my work at Mayo Clinic, as highlighted by this Q&A post on fecal transplant to fight Clostridium difficile infection.

You read that correctly: transplanting poop from someone else into a patient with C. diff can help to restore healthy bacterial balance in the large intestine!

It’s kind of like maintaining a healthy lawn. The best way to prevent weeds is to have lots of healthy grass growing, as my before and after from the last 25 days demonstrates:

One challenge we have in cultivating healthy bowel flora (as opposed to a healthy lawn) is that we don’t know exactly what an ideal mix of intestinal microorganisms is. In Undoctored, Dr. Davis discusses isolated tribes such as the Hadza in Tanzania and the Matses in Peru who have not been exposed to antibiotics and industrial chemicals. Although they’re on different continents, their bowel flora are strikingly similar.

But instead of pursuing a Hadza poop transplant, Dr. Davis recommends a six-week course of a probiotic supplement with at least a dozen different strains of bacteria and at least 50 billion colony forming units (CFUs), along with ingestion of probiotic fiber to enable their growth.

Several strains of bacteria have been shown beneficial, and by planting those seeds (just as I did with my grass seeds) and providing probiotic fiber, Dr. Davis says we can alleviate dysbiosis.

Since publishing Undoctored, Dr. Davis has become enthusiastic about significant benefits he has seen from one particular strain called Lactobacillus Reuteri. Here’s a scholarly article from another source highlighting its many benefits. In the video below, Dr. Davis describes several:

Dr. Davis has been writing about L. reuteri on his blog for a little over two years, including how he is making tasty yogurt to add it to his digestive system from the top end instead of the bottom.

I’ve been making this yogurt and Lisa and I have been eating it regularly for about 15 months. At minimum, it’s the best yogurt I’ve ever eaten. I also think it has definitely contributed to the health improvements Lisa and I have seen, including some major weight loss.

When we’re changing many variables, it’s hard to know exactly which changes are responsible for which health improvements, but I think this yogurt has played at least a supportive role.

In my next post I’ll include a video of how I make it, and some of the benefits we’ve experienced.

See the whole series about my health journey. Follow along on FacebookTwitter and LinkedIn.

Can you gain muscle mass in your 50s?

That was my question for my good friend, and our medical director for social media at Mayo Clinic, Dr. Farris Timimi.

It came up in one of our informal conversations about 18 months ago, as I was getting more serious about restoring and preserving health.

I had been reading about how loss of muscle mass is one of the big problems as we age. The medical term is sarcopenia. I read really depressing studies that told how muscle mass in the legs decreases by about 1% a year, and that strength is reduced even more.

So that’s why I asked the question. It was kind of like the question I had asked myself when I was at about 260 lbs., working out 30 minutes a day on an elliptical trainer, and not making much weight loss progress.

It’s kind of cool that in my job I get to have these conversations with Mayo Clinic doctors. And so I’m glad to share the answer with you:

“Yes, you can gain muscle, but it’s not as easy as when you’re younger.”

Armed with the understanding that even though the general trends in muscle mass in a population are downhill, it’s possible to reverse the decline even after 50, I started looking for guidance in how to do it.

That’s when I stumbled across a book recommendation I’m glad to be able to pass along to you: The Barbell Prescription.

This book was tremendously helpful for me, partly because I didn’t have a lot of experience with weightlifting. In my high school basketball days, it wasn’t generally recommended as it is today. The feeling back then was that it would affect your shooting touch. I focused on cardio.

This book emphasizes use of free weights, and four main barbell exercises:

  • Bench press
  • Overhead press
  • Squats
  • Deadlifts

Jonathon Sullivan and Andy Baker do a great job providing an overview of each and an introduction to good technique, along with an explanation of what happens when you stress your muscles through weightlifting and the indispensable role of rest and recovery.

They start with everything a novice needs to know, but also provide a program for those who want to continue and push further, with separate chapters for those in their 60s, 70s and beyond, as well as for females.

I had begun to do some weight training using machines at our local YMCA and following a variation of what Tim Ferriss calls Occam’s Protocol.

But after reading The Barbell Prescription I learned how much better free weights are, especially these big exercises with a barbell, because they involve so many muscles throughout the body.

Instead of pushing a weight through a fixed path as on a machine, you have to maintain control of a loaded bar, using scores of muscles instead of an isolated few.

After I had used the free weights at the YMCA consistently for several months and Lisa knew it wasn’t a fad, I went online and found a used weight set and bench for about $250, paying for it with about 4 months of savings from cancelling my Y membership.

In our current COVID-19 confinement, that has turned out to be a savvy move. In a future post I’ll show my home gym setup and routine, and some of the benefits.

But for now, I just want to definitely answer my opening question in the affirmative: in the last year my bench press maximum has increased 40% and my maximum deadlift is up 33%.

The original values weren’t all that impressive because I had been out of shape and a weightlifting novice.

But the point is that even past 50, with perhaps 90 minutes a week of lifting, you can make a noticeable difference in your body composition over a period of months.

Have you incorporated weight training in your fitness routine?

If so, what benefits have you seen?

If not, what questions do you have?

See the whole series about my health journey. Follow along on FacebookTwitter and LinkedIn.