Vision Quest

Last summer, pal J.T. and I spent a week canoeing down the Allagash. Afterwards, I noticed something strange: for a brief time, maybe a week or so, something about my vision was different. Better. Mostly I noticed it while driving on the interstate through rural Maine. I kept seeing things way back in the woods that I normally wouldn't have seen: an unusual shrub, a bit of bark texture on a tree, a distant leaf falling, a porcupine moving. A porcupine! The porcupine was what really hit me. I know with certainty that I wouldn't normally have seen that. Or noticed that. Or-- well, which was it? Seen, or noticed?

That is where my latest psycho-physical intellectual expedition began. I couldn't say whether I was seeing better, or noticing better, or both. I pondered what, on the canoe trip, could have changed my vision. Was it being outdoors, mostly? Was it being in so much daylight? Was it focusing more on distance, and less on near things (though I did do a lot of reading, at night)? Was it being in a canoe, with the entire world in motion for most of every day? Was it being on vacation, relaxed, unfindable by my patients? Was it the good company? Was it the Canadian whisky and chocolate puddings I'd consumed on the river?

Aside: My vision is horrid. I got glasses for myopia at age 8, and have worn them essentially every waking moment since. The prescriptions grew incrementally stronger, almost every year, for 30 years. I am long since past the point where, if it were not for corrective lenses, I would be "legally blind". A person with my vision could not possibly navigate the world normally. I have always considered myself extremely fortunate to live in this century, and in this society-- because if I lived in a time or place without opticians, I'm pretty sure I would be dead by now. The sense of having a severely defective body part (two of them, actually) has been a subtle but persistent part of my whole life. If my eyes were teeth, they would be sticking out of the mouth perpendicularly and useless for chewing. If they were legs, then would only bend halfway at the knees, or one would be 6 inches shorter than the other. Sometimes, it has made me angry-- but, because the problem can be "corrected" (and so miraculously well), and because so many others are walking around with the same problem, I never really considered it a "disability", or something to feel sorry for myself about.

Still, it has puzzled me enormously-- how did natural selection let this happen? How did my myopic ancestors manage to find each other in order to reproduce? How did my ancestors even survive long enough to reproduce? Why hasn't this been weeded out? Is there some unsung evolutionary advantage to being nearsighted, a silver lining like sickle cell anemia's protection against malaria? My dozens of past eye-care professionals have not been very interested in these questions. Mostly they have chalked my bad eyes up to, basically, "bad luck". The prevailing attitude has been, "Why worry too much about what caused the problem, when it's so simple to fix?"

Back to the post-canoe experience: Something was better. I realized that I could not at all say whether I was (physically) seeing better, or (mentally) perceiving better. I realized there might not be much difference. I thought about how the eyes are directly hard-wired to the brain with nerves almost half a centimeter thick. I thought of experiments in which people wearing distorting, inverting, or reversing lenses were able to adapt to seeing the world "normally" again. What else is possible?

This all led me to an obscure book by Aldous Huxley called The Art of Seeing, as well as unorthodox reading. I have a strange sense of optimism. More later.

Book Review, Weight Loss Experiment -- or, How a slightly flabby guy lost 20 pounds in 60 days without really trying

[If you want to see the weight- and fat-loss graphs before reading anything, scroll down first.]

Some months back, my pal 2 loaned me a copy of Tim Ferriss' book The 4-Hour Body. She knows of my experiments of living in a cold house, and thought I would be interested in a chapter of the book in which the author reviews the idea that chilling your body (e.g., by ice baths) can induce rapid fat loss. (Other people have postulated, from the other direction, that being too warm could a factor in the obesity epidemic). "The author," 2 said, "is a nutjob. But so are you, so you might like the book."

I left the book in a trunk for a month and didn't bother to open it until 2 asked for it back. After an hour of reading, I was intrigued. Mr. Ferriss immediately irritated the hell out of me with his cockiness, slangy phrasing, and name-dropping. But, I was drawn to some aspects of his personal approach to self-improvement: (1) Question dogma, (2) Experiment on everything, especially yourself, and (3) Data is critical.

It so happened that at the same time, I was growing a bit displeased with my body habitus. For the first 3 decades of my life, I'd been blessed with the ability to eat anything and everything in sight while still remaining some version of "skinny". I cannot tell you how much ice cream has gone down my hatch. About age 30, though, this miracle started to ebb. At age 42, I was 25lbs heavier than in high school. I wasn't really concerned about the health implications-- I was still well within "normal" body mass-- but three things were bothering me: (1) I had small love handles bulging over my bike shorts; (2) I could feel my thighs touch in the shower, which had never been the case before; (3) As a stomach-sleeper, I was starting to feel like I had a half-deflated beach-ball under me while sleeping.

I decided to try out the 4-Hour Body "slow carb" diet, along with the author's other whacky low-effort strategies. It has been a remarkable success. Much beyond what I expected. Here I present first the data/results, then the methods, then some observations.

RESULTS

On Mr. Ferriss' insistence, I decided to measure my body fat during the experiment. I opted for the method of a Tanita scale which uses measurements of electrical impedance to estimate your % body fat (it also reads weight, in 0.1lb increments). This method can be variable with hydration level, and is considered more useful for monitoring your relative body fat over time than for getting an accurate single reading. But it's cheap and easy (going for a DEXA scan didn't really fit into my schedule or budget.)

So, starting four days before the experiment, and continuing through the next two months, I took daily readings of weight and body fat, always right after I woke up (post-pee, but before drinking or eating.) And here are the two beautiful graphs of what happened. First, simple weight in pounds:

So, right. I went from about 168lbs to 148lbs. With some ups and downs, but, in the macro, in an almost linear fashion. The red dot was the day the experiment commenced. The orange dots are my weight the mornings after "cheat days" (see below). Next, a graph of the scale's body fat readings:

Again, a pretty linear drop. Again, I was quite astonished that these things were changing with almost no actual effort on my part. I had not expected much; if had I not seen a clear trend within 10 days, I probably would have quit. But now, in only 8 weeks, I am back to the BMI I had 20 years ago. I feel really good. My three issues have all resolved. I'm amazed, and yes, even though Mr. Ferriss definitely does NOT need your money, I'm proselytizing for his book.

METHODS

If you're going to do this, you really need to read the book (only fourteen bucks on Amazon, or go to the library). I can't do justice to the detail, or the motivation, of the book. But I'll summarize the plan, to give you a sense of how simple it is at the core.

For eating, five rules: (1) ONE DAY A WEEK, EAT WHATEVER THE HELL YOU WANT. Really. On the other days: (2) No simple ("white") carbs-- no wheat, rice, sugar, corn, quinoa, potatoes, none of it. (3) Eat the same few meals over and over. These must consist of vegetables + legumes (beans or lentils) + protein (lean meat or eggs). (4) Don't drink anything with calories. Exception, for some reason, for 1-2 glasses of red wine nightly. Diet Coke okay (luckily) in moderation. (5) Don't eat fruit.

Beyond this, Mr. Ferriss offers other strategies that I employed selectively:

-- He promotes cinnamon for its salutary effects on blood glucose. I routinely added cinnamon to my coffee throughout the experiment (delicious, btw). Just today I discovered how good cinnamon + Diet Coke tastes. Wish I'd tried that earlier.

-- He discusses research on the GLUT-4 glucose transporter (discovered since I was in med school). GLUT-4 transports glucose into muscle cells, and may brought into action for a period of time after vigorous muscular contraction. So, Mr. Ferriss prescribes 60-90 seconds of vigorous exercise a few minutes before a meal, and ideally again about 90 minutes after (when blood glucose peaks). This helps move glucose into muscle cells, rather than (via insulin) into fat storage. To comply, I did as Mr. Ferriss suggests: a whacky series of air squats before each meal (sometimes in restaurant bathroom stalls, as he also did.)

-- He discusses some supplements that increase insulin sensitivity (policosanol, Alpha-lipoic acid, garlic extract, green tea flavanols.) I picked these up at Whole Foods, but used them only on "cheat days"-- and even then, not reliably.

The plan does not require you to keep track of or limit how much you eat (calorie-wise), and I didn't. It doesn't require any specific exercise, other than the 5-10 minutes a day of air-squats. I did about my usual amount of biking for this time of year, which amounted to an average of 6.75 miles/day over the two months. Pretty much no other exercise to speak of. I did not take any ice baths, either.

OBSERVATIONS

The first and most remarkable thing: I was never hungry. Really, just about never. In fact, I was less often hungry on this diet than I was when I ate my usual way. My "usual way" is actually quite "healthy", but much heavier on whole-wheat bread, granola, brown rice, and other carbs.

I did get carb cravings now and then-- but I could tell they were more psychological than physical. I missed bread a lot. But it wasn't so bad.

Plus, whatever I felt I was missing, I knew I could have on Cheat Day-- which was never more than 6 days away. My day for cheating was Saturdays. On Saturdays I didn't go out of my way to seriously binge, but I didn't hold back. I ate stacks of banana pancakes with syrup, I ate danishes, I had lattés, I drank many beers and gin & tonics, I ate halves-of-pizzas, I had big sandwiches with mayo and whole bags of cheezy-poofs.

I typically gained 3-4lbs on Cheat Day, showing up as a huge spike on the weight graph-- but less notable on the body fat graph, suggesting it was mostly water retention. Invariably, the weight came off again after. Every day-before-cheat-day was lower than the previous day-before-cheat-day. It was hugely, hugely motivating to have this level of data to reinforce that going on was worthwhile. (You might think it could all be done faster without cheat days. Two reasons this is not true: first, you'll go bonkers and quit, and second, according to Mr. Ferriss' theories, you might actually need one day a week to "convince your body that you aren't starving" and keep the weight loss from halting.)

Outside of sanctioned Cheat Days, I cheated very little. Once or twice I substituted a no-sugar mohito for a glass of wine. Once or twice I had a forbidden beer on a Friday night. A few times I mistakenly ate bits of fruit that came with a salad or whatever. But I was 95% compliant.

In the book, Mr. Ferriss advises people to eat canned beans and lentils, for convenience. Normally I do use canned beans, but with the quantity of beans I was headed for these months, I switched to cooking up my own from bulk dried. Soak a pound or two Saturday night, boil them Sunday morning, and then you've got enough in the fridge for the week.

What I ate:

Breakfast: Always the same. One egg, about 1/3 cup additional egg whites, a cup of chopped frozen spinach, mustard greens, or other veggies, and about 1/2 cup black beans. Occasionally a bit of bacon in there. Mixed up with salt, pepper, seasonings, fried up with a splash of olive oil. Water with a splash of lime, and coffee.

Lunch: Typically some sort of salad with sliced chicken and beans (I kept a tupperware of beans at work to add to whatever I found for a salad.) Diet Coke.

Dinner: Some staples were fish tacos (using romaine lettuce leaves as a taco shell), turkey & bean chili, chicken curry, lentil stew or dhal, grilled fish & veggies... pretty much what I'd be eating anyway, just minus the bread/rice/corn/beer. (I did take up the wine option, though. And occasionally I substituted a sugar-free mohito.)

Snacks: Almonds, celery with some peanut butter... not much. I didn't really feel much need to snack.

So, that's it. If you have a few pounds to lose, and don't mind having people think you're kind of odd, you should try this.

Should Have Antique Plates

Today is the third day of commuting on the new-antique bike. Yesterday, at a slow corner on the bike path, a man coming the other way on one of those crazy folding bikes with tiny wheels flagged me down, evidently just to look at the Raleigh. "How many speeds do you have?", he asked. "At the moment", I replied, "four that work, and one that doesn't". "Wow", he said in a tone of voice I generally reserve for admiring large wooden boats built before the Hoover administration , "A Sturmey-Archer five...." Yessir. And 80% functional, too.

Patient Scrabble™

I've been in private practice now for three years. Strangely, I still don't have any clients with last names beginning with E, I, J, Q, U, X, or Y. If you know of anyone with one of these surnames, please inquire whether they need a psychiatrist. I'm trying to complete my file-cabinet alphabet.

Equally strangely, I have a dozen clients with "W" last names. And they aren't all the same family.

I can haz new bike

I'm pretty excited about this. It's older than me. It has five gears, internal, in a peculiar arrangement. It's a really pleasant ride-- a feeling I don't think I've had on a bike since "10 speeds" became the must-have fashion.

Xmas

All I want for Christmas. I'll probably lose my two front teeth, so that's what I'll be asking for next year. Thanks Santa!

Slight Dilemma of the Burbs

Since the recent move, I now find myself in a situation where going to Wal-Mart for a needed item (say, a piece of rope) is a 1.5 mile round-trip drive (or scoot, or bike, or walk), while going to the nearest independent-ish hardware merchant for the same thing involves 10 miles round-trip. Which is the better choice?