Reading Is Fundamental

This morning, I was in my car with a half hour to spare before my workday started, and I decided to try to thumb through my copy of "Face Your Fear," by Rabbi Shmuley Boteach. I don't know if I cannot focus on the words on the page because I have an issue or avoidance of the words, or if I need a new Rx in my glasses or something else is at play.

Admittedly, I am forever distracted.

So, I went to YouTube, in search of lectures and speeches by the rabbi, and I found this one in regards to honoring bad parents: https://youtu.be/HBTPPNYXCdQ, which I also shared with my sister.

Spoiler alert: even without watching this, I'm already doing pretty much what he suggests.

Tomorrow is another session with the new therapist, and I hope we are able to finish unpacking my issues with enough time to spare to actually start to "get to work" on things.

Still no movement on improving my sleep hygiene or getting back on the bike. Insurance approved the new CPAP, so there IS some microscopic movement going on. Progress. And still no movement on reading the "Feeling Good" book. 

Perhaps I should schedule an appointment today for an eye exam.

Other than all this, things are status quo. 

Light Reading: Advanced Glycation End Products

(Some notes from stuff I've read regarding advanced glycation end products.)

I've come to realize that pretty much all the food we eat is designed to not just sustain us, but also contribute to our ultimate demise via AGEs (things like homocysteine, or protein in our urine, for instance).  Cooked foods where the Maillard reaction takes place, even more so. It's overwhelming if you fall into the same rabbit hole I have.  

See also: The post I did on methylation, homocysteine etc. It's pretty useful, I think. And overwhelming, but more useful than overwhelming. YMMV.

Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704564/

Special note: Because a low or acidic pH arrests AGE development, new AGE formation in cooked meat was tested following exposure to acidic solutions (marinades) of lemon juice and vinegar.


Advanced glycation end-products: modifiable environmental factors profoundly mediate insulin resistance
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512899/

My Reading List (Are you sensing a theme?)

Here is an inventory of books I have read on my self-help journey.  

Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder
  
The Sociopath Next Door

The Places that Scare You: A Guide to Fearlessness in Difficult Times

Mindset: The New Psychology of Success
  
Will I Ever Be Good Enough?: Healing the Daughters of Narcissistic Mothers

Reinventing Your Life: The Breakthrough Program to End Negative Behavior and Feel Great Again

Face Your Fear: Living with Courage in an Age of Caution ** 
Feeling Good: The New Mood Therapy **

Anyone who knows me, knows the theme to this particular reading list. I view each book suggested to me as a life-line friends have given me along my path. I have derived a lot of benefit out of all of these books--some books more so than others, but there's something useful to be found in all of these books.

Regarding the two books at the end of the list, and why do they have asterisks?

The book, Face Your Fear, has been on my bookshelf for years, and this weekend in the course of doing an annual culling, I have spared this book from this year's culling. I opened up the book to where my bookmark was where I left it, and I immediately was hooked (again). I think enough time has elapsed from when I last started reading it, and I think I am more receptive to actually facing my fears. Rabbi Boteach is a great writer, so it will no doubt be a wise investment of time.

The last book on the list--well, there's a bit of a back story regarding this book--and a TWIST, an interesting development.

About five years ago (+/-), I sought out a consultation with a psychiatrist to see if they could test my brain chemistry. I was hitting rock bottom again, and before I entertained going back on antidepressants** again, I wanted to find out which particular neuro-chemical was out of whack. My thinking was that I didn't want to waste more time on a seratonin reuptake inhibitor, if let's say, my dopamine was the real culprit.

I was up front when I made the appointment about the nature of my consultation. They wasted my time. I sat there and was assessed, and wasted an hour (or more, if you factor in the time to go into NYC and back home again), only to be informed "we don't do that." The doctor then handed off a free copy of the book Feeling Good, and I was on my way.

At the time, I thumbed through the book, and scoffed at the idea of THINKING my way out of depression. I'm a smart woman. Surely, if it were possible, I would have figured it out by now, so why am I still struggling? 

So, five years ago, in my annual culling, I got rid of Feeling Good. And in the course of a conversation recently (within the last 2-3 months) did I mention and suggest this book to a friend (a friend who had recommended at least two books on the above-mentioned reading list). So I re-read the editorial reviews and the customer reviews on Amazon, and decided I was too hasty in culling the book, and I ended up buying another copy. 

Right around the same time frame when I was suggesting the book to my friend**, I had a pretty horrible thing happen to me professionally and personally, and I realized I needed to dump my therapist of nine years, of which, I've posted about and alluded to within this blog as well as the blog devoted to my mom and other dysfunctional relatives.

January 3rd I did the deed, and dumped FIRED my therapist, and started a quest to find a new one. It took me two straight weeks of making calls and refining my search several times until I found the person who I hope will decide to continue on as my therapist.

Now for the twist: The type of CBT she utilizes is the one the book Feeling Good is based upon. 

So, while I am frustrated at the idea of my previous therapist holding me back for nine years, and I have nothing to show for all that time, no progress, no new job or an improved emotional or physical state; I *DID* have the POTENTIAL solution in my hot little hands FIVE YEARS AGO.

Confession: One of the many problems I have is my inability to finish things I start. Several of the books listed above I started and read 75-90% of the way through and got distracted or lost interest or or or... well, I am the queen of excuses. I think ultimately, my problem is that I have not made myself a big enough priority.

**It bears sharing, that I have gotten more therapeutic benefit out of my friendship with "S" than I got out of nine years with a professional therapist & social worker. I only hope that I have been as big of a support to him as he's been to me. Between his support, and the Maharajah--I honestly don't know where I'd be, and for whatever amount of wallowing I allow myself to do, it's a splinter's worth of what it'd be without these two valuable supports in my life. 

Notes Re: Methylation, Homocysteine, Betaine, etc

Homocysteine & Methylation "Take Aways" 
Note: Methylation = Complex combination of actions whereby Homocysteine + “Certain B Vitamins” (i.e., b6, b9 (folate), b12) + Betaine, SAM-e, Adenosine etc etc = (recycled into) Methiones 

(Image from Wikipedia)

1. Homocysteine can be recycled into methionine or converted into cysteine with the aid of certain B-vitamins;
2. Normal homocysteine levels should be less than 13, with the ideal range being between 6-8, with hyperhomocysteinemia Dx at over 15;
3. Homocysteine levels are typically higher in men than women, and levels elevate with age;
4. MCV greater than 95 can indicate a methylation problem;
5. Blood or urine methylmalonic acid test for b12 deficiency (may be ordered as a follow up to a standard b12 test);
6. Daily diet should include one cup a day of dark green leafy vegetables, and daily protein intake should be between 80-120 gm;
7. Reducing AGE (advanced glycation end products) by diet and or supplementation can potentially lower homocysteine levels (and protect the kidneys);
8. Supplementation: All B vitamins, but IN PARTICULAR emphasis on b6 (up to 250 mg) & b12 (500 mcg), plus more than 400 mcg (RDA) folate (unless person has cancer), choline (precursor to betaine*);
9. NOTE: If one were considering supplementing with betaine to lower homocysteine levels, the IDEAL formulation appears to be BETAINE ANHYDROUS *NOT* betaine hydrochloride;
10. Digestive diseases, caffeine, some meds (i.e. acid blockers, methotrexate, or HCTZ), and no doubt, malabsorptive bariatric surgeries can impact levels of B vitamins in blood;  

Interesting articles:
Betaine supplementation decreases plasma homocysteine in healthy adult participants: a meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610948/

Maximizing Methylation: The Key to Healthy Aging, by Mark Hyman MD http://drhyman.com/blog/2011/02/08/maximizing-methylation-the-key-to-healthy-aging-2/

Below the Radar: Advanced Glycation End Products that Detour “around the side” Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/

Lowering homocysteine levels with folic acid and B-vitamins do not reduce early atherosclerosis, but could interfere with cognitive decline and Alzheimer's disease https://www.ncbi.nlm.nih.gov/pubmed/23224755

BEETS & GREEN LEAFY VEGGIES & METHYLATION 
CONFLICT #1: Green, leafy veggies, lowers homocysteine yet elevates oxylates 
CONFLICT #2: Green, leafy veggies lowers homocysteine (which would lower risks for DVT, clots, stroke) yet they contain Vitamin K which would increase risks for DVT, clots, stroke. 

BEETS: Despite the fact that beets are high in betaine, which helps lower homocysteine levels in blood, they are ALSO high in oxylates, which elevates purines in the blood, which then elevates uric acid and contributes to gout inflammation. 

GREEN LEAFY VEGGIES: People who have blood clotting disorders (Leiden varieties, in particular), like myself should be wary of ingesting too much in the way of green leafy veggies, as they are also high in Vitamin K (“klottenfactor”) and can have a potential negative impact (i.e. clots, stroke, dvt, etc), and it’s this reason (as well as having had a gastric bypass) that I use a variety of supplements to make sure my needs are met. ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬

Notes on Benfotiamine (fat soluable, B1): 

Below the Radar: Advanced Glycation End Products that Detour “around the side” Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/ 

Effect of Benfotiamine on Advanced Glycation Endproducts and Markers of Endothelial Dysfunction and Inflammation in Diabetic Nephropathy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391239/

Almost 6 Years Out: Adventures in Post-Op RnY Blood Chemistry

I had my RnY bypass in 2011, and ever since then, several things have been weird. 

Over the past five almost six years, on occasion my RBC and Hematocrit would be a bit high. Next blood tests, back to normal. However, over the last year (so the last four blood tests, my RBC and Hematocrit has been high, a few points outside of normal range. Couple this up with my hereditary Factor Five Leiden Mutation, I'm always vigilant about minimizing my risks for clots, DVT and stroke. 

Three months ago I discontinued my iron supplement to see if that impacted anything. My iron levels all remained normal; however, my RBC and Hematocrit are still on the high side.
Additionally, my blood pressure (though treated with medication) hasn't really gone down all that much (not that it was super high, while medicated either, but I really want to get my bp down to 120/70, and before/after my bypass, it has remained around 138/80). My elevated bp is treated with an ACE inhibitor.

Another weirdness is, I've been watching my uric acid, for signs of gout. My normal is around 5; however, without changing ANYTHING, my uric acid on my last test jumped to a 6.3--I think a 7 is actually entering the realm of gout.

Up until about a week ago, in addition to a prenatal gummy multi vitamin I take (it doesn't contain iron, but does contain b12) I was blasting myself with KAL brand sublingual b12 spray, which contains 2500 mcg of b12 with each spritz. I was in the habit of blasting myself with two spritzes each day for a total intake of 5000 mcg daily.

For the last week I've been researching this, and managed to find some useful information on the topic, and I really feel that the nutritionists who counsel us as part of the surgical pre-screening process etc, should really be more well-read on the supplementation, especially since they all seem to tout the same top four items: iron, calcium, b12, and d3. Yet, I do not recall if I got any specific information about WHICH specific formulations are best for post-oppers, as well as dosing (the only thing I recall being specific was 2000 mg of calcium citrate daily).

Anyway, the Mayo Clinic's website provided some good information on the risks of b12, so, here are the caveats for b12:

1. If you have a blood clotting disorder--see a specialist to find out how much b12 is too much for your purposes. EXCESSIVE b12 coupled up with a blood clotting disorder could be dangerous.
2. If you are hypertensive and being treated with an ACE inhibitor, speak to whomever is treating you for your hypertension to find out how much b12 is too much for your purposes.
3. If you have elevated uric acid or actually have been diagnosed with GOUT, talk to whomever is treating you for your gout to find out how much b12 is too much--as too much b12 can exacerbate gout flares.
4. Not to sound alarmist, but excessive b12 can carry a cancer risk. How much is too much? I'm still looking into that! But this is just one of many articles regarding elevated b12 as markers for elevated (certain) cancer risks in legitimate medical journals:
   https://www.ncbi.nlm.nih.gov/pubmed/14636871