Conversing diet with the science deniers

I joined a large FB group called "The Great Cholesterol Conspiracy" ... wow.   I really am at a loss as to why in this day of the internet and easily searchable medical research via AI, people cling to these pseudo-scientific notions as widely represented by recent diet fads like carnivore, keto, etc...   You look at these individual's pages, they are a mix of FB influencer followers, conspiracy theorists, they are often research and scientifically challenged, are often people who have "turned their life around" with a new short term diet, and often fall into the anti-vax - RFK Jr. - MAHA - MAGA groups.  Their most common conspiracies are about vaccines, "Big Pharma", and generally mainstream science research ... often asserting they've been "lied to" or "victimized" in some way... by the gov't, drug industry, Fauci, etc... you name it, you get the idea.  

From what I've been able to discern from the "advice" they give me, is that their entire concept hinges around these assumed "truths":

If the Triglyceride / HDL ratio is favorable (low) it negates all other potential cardio vascular risk

This is what Claude AI says:  

If someone has a high LDL particle count (high ApoB or LDL-P) but a "good" TG/HDL ratio, that combination should not be read as low risk. Most lipidologists would treat the ApoB/LDL-P number as the dominant driver of atherosclerotic risk in that scenario and would not consider a favorable TG/HDL ratio reassuring enough to offset it. This is part of why ApoB (or LDL particle number via NMR) is increasingly recommended as a primary risk marker over ratios like TG/HDL, especially when the two disagree... No major RCT has shown that deliberately improving the TG/HDL ratio, in isolation, causally prevents CVD.

However, an unfavorable Triglyceride / HDL ratio can predict disease.  That doesn't mean a favorable TriG/HDL ratio can prevent heart disease in the presence of high LDL particle burden.  

The other thing is the idea that one diet - their carnivore / keto diet - benefits all people.   The dietary affect on blood lipids is highly individual and this statement is clearly false.  And the development of CVD is multi factored, involving inflammation, innate blood chemistry, and numerous risk factors (polygenic tendencies, Lp(a), etc..).   It is not solely diet.  

My general anecdotal observation - most people touting the carnivore diet are not 'athletic fit-for-life’ types.  They are formerly obese types that have ‘turned their life around.’    These are not people who have always maintained a life long normal BMI.  Very few of them have actually had CAC scans or advanced lipid profile testing.  The vast number of carnivore adherents been doing it less than 10 yrs, most less than 5 yrs.   It's clear, carnivore can be therapeutic in the short term and an effective way to lose weight. The success stories are mostly because of what meat replaces in the diet, rather than the meat / animal fat itself. 

The Mediterranean diet has by far the strongest, most direct random controlled trial evidence of any dietary pattern for cardiovascular prevention and longevity. The PREDIMED is a real, large-scale, multi-year randomized controlled trial with hard clinical endpoints (actual heart attacks, strokes, deaths) — not surrogate markers, not observational association, not mouse data. It's frequently cited alongside the older Lyon Diet Heart Study as the gold-standard evidence for any dietary cardiovascular intervention. This is a substantially stronger evidence base than exists for keto.   Some of longest lived cultures in the world eat a mediterranean diet and that is not anecdotal. Carnivore is a fad.  The longterm evidence on longevity and disease for keto diets is thin.  https://pmc.ncbi.nlm.nih.gov/articles/PMC12845189/

Claude AI:

Recently, a meta-analysis covering over 100 peer-reviewed studies found associations between keto diets and increased risk of heart disease, elevated LDL cholesterol, kidney problems, Alzheimer's disease, diabetes, cancer, worsened outcomes for people with existing chronic kidney disease due to the high protein load. .... The honest state of the science is: short-to-medium term (up to a few years) data is reasonably reassuring for most people regarding cardiac health, but a meaningful and growing body of peer review-level and mechanistic evidence — including new animal studies — raises real questions about longer-term effects on the liver, kidneys, bone, and lipid profile. This is a diet where individual lipid response varies enormously, so, checking your ApoB/lipid panel would be genuinely informative a risk picture on a keto diet... there's no randomized trial evidence showing that lowering the ratio (e.g., by raising HDL specifically) reduces cardiovascular events.           

https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.702802/full

So no, eating lots of animal fat to boost HDL isn't doesn't generally seem to prevent heart disease. 

 

Bike sprint, resistance, diet, life change

Doing bike sprints while seated is really a difficult thing, to not stand and engage the glutes, strongest muscles in the body.  Much more of a quad workout. However, that's what I'm doing during this healing phase of my workouts.  Still doing daily resistance, 24 pullups this morning.  Becoming routine.  Situps, ab wheel, pushups, dumbells, hanging abs are my routine.  Stopped doing the slant board squats for a while.  The 2.5 mile bike sprint was a 'seated' PR.  Almost a minute slower than my regular PR. 

2.5 mile seated mountain bike sprint - Laurel Branch Trl

Time - 10:09

Avg speed - 12.8 mph

Max HR - 165

HR over 156 - 4:07

Avg HR - 150 (inc 1 min recovery at end)

Decent workout but not the real max HR sweat dripper that I'm used to.  Really helps to have the glutes to get to that intensity.

Had a swim yesterday at Scott's party.  Also ate some party food like chips and brownies, ice cream, but not a lot.  Still 142.7 for today's weigh in.  

I feel like my life has entered a major transition as I've now committed to playing full solo concerts starting in Oct.  The lifestyle of a musician that I led for so many yrs is quite different than the lifestyle I led after the pandemic pushing toward athletic championships.  It actually got a bit unhealthy during the peak as a performer in my early 40s.  Was probably 10-12+ lbs heavier, didn't watch my diet as much, exercise wasn't a priority, occasionally ate poorly, spent a lot of time sitting and practicing, up late at night and drinking too much tea and coffee, even beer, occasional light use of cannabis - (which actually is proven helpful in the interpretive and creative process).  Also, performing itself is quite stressful.  When you say you're a guitarist, usually the next question is, 'are you in a band?'   There is no more difficult, challenging, and stressful situation for a guitarist than doing hour long SOLO classical concerts in an academic or concert series situation.  Period.  

I did find a shirtless photo of myself from that era before athletics when my life was only guitar.  I looked somewhat lean, but weak.   

This is about 24-25 yrs ago, (about age 41-42ish).   I was doing some very serious hiking then, so I wasn't by any means significantly overweight.  This photo was during a boat trip with Lisa at Fontana.  At one point, we did a 25 mile day hike with a nearly 5000' vertical climb, as well as a 16 miler with a 3300' climb in the same few day trip.   I couldn't come close to doing that today.  Only maybe if my life depended on it.  

The parallels between training as a sprinter and as a concert musician are really remarkable … “trust the process” as they say.  I haven’t played a full hour solo program in almost 8 yrs I think. (Shorter programs yes).  Now concerned with hand health, but that is generally ok.   Where athletics and music training differ is in time spent. Physical adaptations for the hands seem to take more daily time than relatively brief intense track workouts, because a lot of the practice is slow and methodical, and it’s every day.  Both are long term commitments taking months, not only in learning to execute, but doing it on the spot in a performance, which is more the mental aspect.    Not that it's impossible to do both as I did in 2015, but my 2015 tour was in the fall - off season for track.

Anyway, since I started this blog 15 yrs ago, it's going to remain about training, fitness, wellness, etc... and I'm going to begin at some point, moving my discussions on music to my somewhat neglected other blog which I started nearly 20 yrs as mostly an adventure, outdoors, travel, music, and photography blog.  https://tnparadise.blogspot.com/

I'm really liking my life right now.  Have settled into a pleasant routine where I stay up late and practice, sometimes go to the cathedral, wake up early and go back to sleep, usually getting out of bed by 9 or 10am, do a few scales on the guitar, do my pullups, pushups, a brief walk, weigh in on my scale, drink a liter of water, sit in the hot tub, get out and start my daily practicing ... which will go for hours.  I have my first coffee about noon and a light snack, usually Wasa crackers with fig jam mixed with psyllium husk.  I eat my main meal which is a large salad sometimes with fish, or chick peas.  Sometimes a vegetable stew with zucchini, cabbage, tomatoes, onions, garlic, basil from my small basil tree, and whatever other vegetables I have available.   Really low carb.    These types of main meals don't have enough calories to make it and I've been snacking on walnuts and blueberries, occasionally Wasa crackers of Royo bread with sunflower butter, and dried cranberries.   When I do eat meat, it's usually flounder, salmon, organic chicken breast.  I will also occasionally eat other types of fish like cod, shrimp.  So with a relatively narrow diet, it's not out of the possibility that I may have a folate or Vit B deficiency so I'm testing for that on Friday.  Easy to remedy.  Due to my CKD, I was told to be cautious with Vit C, and I did see my collagen supplement had 100mg of Vit C.  Should be ok.  

Living in nature and getting most of my vegetables from the local organic market, the low stress job, the commitment to health and fitness I have now should help make a healthier transition back into concert performance.  Older and wiser.  

seated biking, resistance, tests

Been doing daily resistance work and my weight has been good, in the 142s last few days.  In an effort to allow my knee to recover, I've eliminated hard standing bike sprints and hill climbs.  But, I've been doing the same biking but seated and not as much.  I do think this is compromising my V02 max but at least I'm pretty strong, yesterday another PR pullup set - 26 although the last one was a bit of a kip cheater.  The remarkable thing is that I have gained a bit of lean muscle mass without eating much protein.  

The last two 2.5 mile bike sprints in which I've stayed seated have been more than a minute off my PR of 9:21 for all out standing sprints.  The first one wasn't a strong effort.

Aug 1 (seated) bike sprint:

Time - 10:48

Avg speed - 12.5 mph

Max HR - 156

Avg HR - 143

Aug 4 (seated) bike sprint:

Time - 10:32

Avg speed - 13 mph

Max HR - 172 (178 spike 50 sec afterward)

Avg HR - 161

I had that weird spike after finishing this run, (178).  I think it's actually a sign of losing fitness.  

I only plan on doing such rides 2 or max 3x / week.  Really focusing on the rest and healing of my knee.  I am getting an off-loader brace and may experiment with using it on the bike, rower, hiking, stairmaster, etc...

I was at a conference today and a music colleague asked me if I was retired from track I said probably but haven't made the decision 100% yet.   As I become more involved with preparing myself to play concerts again, I find the decision to walk away from track a bit easier.  It always tugs on me when I see colleagues racing but I am enjoying getting up in the morning with no knee pain, walking, and climbing stairs also with no pain.  If I do test the waters and try to run a little, it won't be for at least 5 to 8 weeks (late Sept/ Oct.).  I went to the track today and just stretched, no drills.  Avoided the temptation to run, although I felt I could have. 

As I am officially elderly now, I am most concerned with staying alive, well, and disease free.   Speaking of that, I had a major round of tests and with the help of Claude AI, I was able to refine some of my issues.  

Testing / wellness

I think the tests I had were a bit skewed by 2 consecutive meals of this high fiber protein fortified pasta I had not eaten previously - most affecting kidney and TriG readings.    Regarding the tests, I had the usual moderately high small molecule lipids: LDL (147), Triglycerides (162), ApoB (130), and too little HDL (40).   oxLDL was high (83), and kidney function low - GFR (58) due to high creatinine (1.36).  Also homocysteine was high (16.2).   AI suggests testing for folate and B12 insufficiency, which I plan to do next week.  That would explain these readings and be an easy fix.  I'm also going to repeat cystatin-C.  

On the plus side, my inflammation markers, and glucose / insulin handling is very good.   Both my inflammation markers hsCRP and IL-6 were optimal - below the minimum reference level - too low to measure.  Fasting glucose good (92), fasting insulin optimal (4.2), and HbA1c 5.5 - normal. 

Also, the innate lipid particle Lp(a) is optimal for me, below minimum reference level. 

So in general, a mixed bag.  I also found from my genome through Nebula Genomics, that I have a maximum (100%) polygenic tendency to develop high Apolipoprotein B.   This makes sense and is confirmed by numerous relatives with heart disease.   All of my testing, in particular my lipid fractionation tests, point to a very high risk assessment of cardio vascular disease, but fortunately not compounded by other factors such as inflammation, Lp(a), and high HbA1c.... not to mention no alcohol, no smoking, normal BP, low fat low carb diet etc...  It is very clear that animal fat is not the only issue in developing heart disease, it also is caused by sugar and carbs.  (Roya's younger brother is a vegan and had to have his heart stented due to heart disease).   

It is very likely that my 400m training over the past decade+ has kept me relatively disease free, not to mention the low carb diet.  Compared to the avg American, my diet is ridiculously clean.  About the worst things I eat are high fiber Wasa crackers with fig preserves which I mix with psyllium husk fiber, and Royo high carb bread (30 cal a slice).  Also occasional bowls of blueberries. I have a pretty big list of things I almost never eat... including common foods like pizza, chips, potatoes, butter, eggs, margarine, high fat dairy, fried food, boxed cereals, regular bread, regular rice, cookies, pies, baked goods, no beef or pork in 35 yrs.   I replaced skim milk with unsweetened almond milk.   The only fats I eat are small amounts of olive oil, walnuts, and sunflower seeds.  I use the allulose/monkfruit sweetener.  I even started filtering my espresso through paper to eliminate LDL increasing compounds like cafestol.  Low protein and occasional fish / chicken.  Sometimes go a week + vegan.  Somtetimes I will eat canned skinless boneless sardines in water.  

I will likely consider preventative medication, especially if I can get a CCTA scan to test for soft plaque and it is positive.  That is the goal of my next appt.  To make the case for a CCTA scan.  I have been resistant to drugs up until now, but now may be the time to consider it - considering my small molecule particle burden as shown by my Apolipoprotein B1/A ratio.

I'm really digging the incredible self pay pricing on Goodlabs.com test broker.   

To good health!

Bike sprint, pullups, fast

 I've been taking time off the bike until today, I couldn't stand it anymore I did a bike sprint but not full, effort.  I also have been doing the usual few exercises and I'm regularly able to do 21-23 pullups every morning.  Been walking a mile+ every morning including walking backward up hills.  

I'll see what the new ortho Dr. says about recovery next Tuesday.  

I'm fasting and purging for tomorrow's colonoscopy.  Yesterday ate a 'low residual' diet which was new to me.  Stuff I never eat, like simple carbs... specifically white rice and bananas.  That's the stuff I probably should have been eating before races instead of high fiber bread and cereals.  I should be able to drop close to 140 lbs by the time this is over.  I had to drink a 2 L of polyethylene glycol solution around 6 pm, then another 2 L at 1:00 am.   I'll be up most of the night.  Fun.

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 10:16

Avg speed - 13.3 mph

Max HR - 165

HR over 156 - 4:10

Avg HR - 150 (inc 1 min recovery at end)

I stayed seated most of the ride back, HR certainly wasn't up to what it normally is during this workout.  

Hard to tell if these types of rides are degrading to my knee.  The feels good afterward.  Sometime I get a slight soreness later in the night or next day but usually not.  Probably shouldn't do anything for a month with my legs, but I definitely would feel vulnerable to CV disease without pushing my HR, hard to do without legs.  Maybe be forced to swim only.  Water run at the most.  I'll see what the Dr. says but I'm sure less is more at this point.

Judging by the comments, some people don't apparently understand that 'jogging' - running with heel or midfoot strike is more damaging to my knee than high knee running, stairs, hills, or running with forefoot strike on the ball of the foot in sprint form.  FWIW, even when I raced 800s, my heel never touched the ground and I wore the same spikes as I would for a 100m race.  Anything faster than a 72 sec 400m is a sprint for someone over 60, and that would be about my slowest 400m split in any of the 800m races I ever ran, my slowest being 2:22.  Transitioning from high knee running gradually to full stride is the way I've been getting prepped for sprinting post injury.  

Anyway, hopefully my colon is ok.  Find out tomorrow.  

Back home - bike sprint, weights

 Back home in Sewanee.  Tied my PR today on this course.  Riding in between waves of severe thunderstorms.  About 2 hrs ago I was falling into my PM nap and a tornado warning siren went off, woke me up.  As usual, 'a hoax.'   Another wave expected around sunset.  

I hit it pretty hard and got to the turnaround by 5:00 flat.  So I pushed it hard.  Was unwilling to take the final downhill corner at breakneck speed so missed a PR.  

2.5 mile mountain bike sprint - Laurel Branch Trl

Time - 9:38

Avg speed - 14.2 mph

Max HR - 176

HR over 160 - 9:01 

HR over 170 - 3:50

Avg HR - 164 (inc 1 min recovery at end)

Higher HR than my previous PR run.  

Doing the resistance work - upper body and core in the morning.  This evening at the gym, leg curls, extensions, calves, leg press, chest, arms.  

Hell day tomorrow - 5 appts.  3 medical (MRCP scan, consult, cardio), 1 builder, 1 lesson.  I'll leave tomorrow at 7:20 and not return til the evening.  

Dinner:  Diced chicken breast, zucchini, celery, onion, garlic, stewed tomatoes, fresh basil.  No oil, cooked in tomato juice.  Less than 400 cal in 2 bowls, very low carb and very low fat.          

                                       

Bike climb, test results

First time out in the boat this yr and the weather was perfect, about 80º for the climb and about 60º at night.  I met Bill M. on the river and we did the ~1500' climb up the mtn, 13 miles round trip.  

I didn't really push hard, wanted to keep my HR under 170 as much as possible.  It wasn't fast.  My PR for the initial climb to the overlook is just under 32 min.   This was only about 41 min.  HR 160-170 for about 30m.  

Latest test results.

Weird that there was so much change from my previous results only a couple weeks ago.  Everything in these latest results were relatively normal.  

Here's a comparison of these tests:

Lipids and glucose - 4/11 vs 5/7:

Cholesterol:  229, 190

LDL: 160, 123

HDL: 49, 42

Ratio: 4.7, 4.52

Triglycerides: 92, 141

Glucose: 89, 100 

Kidney function (blood test)- 4/9 vs 4/24 vs 5/7

eGFR (blood - calc): 68, 57.82, 68.13

Creatinine: 1.17, 1.25, 1.20 

Cystatin-C: 1.00 

Kidney function (Urine Test) 5/7: 

eGFR: 76

Urine Creatinine: 46.2 mg/dl

Micro-Albumin: 0.7 mg/dl

Albumin/Creatinine ratio: 15.1

Everything else including liver enzymes, etc... all normal.  So I guess I'm ok.  I will press Dr for an angiography when I see him on Wed, in light of my brother's issues and the higher LDL and ratio.  

Bike sprints, diet and disease

Yesterday did the bike sprint intervals.  Today did the 2.5 mile sprint with hills.   Both hard.  I'm thinking these types of workouts plus strength are probably better than these 25 min hill climbs where my HR is over 170 for 15-16 minutes, over 180 for 2-3 min.  I still push it to the 170s but just for short duration.   Maybe do a hill climb once a month or so.  

Bike sprint intervals  - 4 x 400m w/ 2:30 rest  

max speed: 28.4, 27.5, 28.4, 28.5

Max HR - 173

 

------------------------------------- 

Bike sprint - 2.5 miles on Laurel Branch Trl

total time - 10:18 (tied PR)

Max HR - 179 

HR over 170 - 5:18 

Avg HR - 165

 

Going for a blood draw again this week.  Kidney function tests and week after, followup with my PCP, and will press him for an angiography.  

Diet and heart disease

My brother's latest determination of celiac artery blockage was called into question by one of his Drs because it was ultrasound based, so he's pressing for a more definitive test, a CT w/ contrast.

His Dr., a DO, is one of these Keto diet guys.  I'm all for low carb low sugar diet but to be extreme about it is not particularly sensible to me.   I get the low carb thing, carb = sugar. These keto bros / carnivores are totally into this idea that you can eat unlimited fat as long as you eat zero carbs and sugar. The fact is that it does work to lose weight, but for some people, this keto diet will cause heart disease if you’re a “responder” to dietary fat.  And you don't know if you are unless you test prolifically.  Not just standard lipid panels, but more advanced tests like lipid fractionation, apolipo ratios, Lp(a), inflammation, imaging like angiography, etc... CACs are good but not enough, same with lipid panels, and it's ridiculous to draw any conclusions from the once per year lipid panel... but better than nothing. Lipid panels are cheap. Just $23 at Ulta.  

The problem with tests like LDL or Lp(a)  - these are a few of many factors that *may* contribute to heart disease / atherosclerosis. The development of CVD is a very complex and individual process, as we can see with the wide range of anecdotal experiences.   Some have established heart disease yet live long lives. Some are affected by disease from lifestyle factors like diet, yet some aren't. Medical science observes general trends among the population, but there are always a lot of outliers on each end of the bell curve.  You can definitely lose weight on carnivore / keto,  usually by replacing carbs/sugar with protein and fat. Much of the confounding and conflicting data on the subject ignores the fact that there is no general rule for all people on affect of dietary fat. Different people are affected differently by dietary cholesterol as the process for atherosclerosis is complex and dependent on many factors -including genetic disposition. Frankly, looking at it any other way is tantamount to pushing an agenda, a hasty generalization, overly simplistic, or plain disingenuous.   Not much long term data on the results of carnivore / keto diets.  

Anecdotally, I've learned I am a dietary 'responder' to animal fat intake as I learned in 2021 on my brief 'egg diet.'   My brother and I are an interesting case study, albeit ... anecdotal.

A lot of this carnivore / keto diet stuff coming from social media influencers - some professionals - seems to follow the trend of the "RFK Jr - MAGA - bro-science - pseudo-masculine - vaccine science deniers" ... long on anecdotal trends and short term results, short on science and long term studies, and certainly not looking out for individual susceptibilities, and tailoring diet to the individuals based on known vulnerabilities.  They certainly push a lot of generalizations, questionable cherry picked "science," and not much info on longevity and long lived cultures - none of which are carnivore / keto.  I also think diet can be adjusted for athletic goals and training, and can vary and be optimized according to physical needs, time of year, activity level, and body type, etc...

Morning bike sprint, tests

Didn't do much today, just some pullups, and a morning bike sprint on my 2.5 mile course with hills.  Super beautiful here.  Best time of year.

2.5 mile bike sprint - Laurel Branch Trl

PR - 10:18

I went to my final appt with the oncologist that my PCP sent me to.  I did so mainly to get another free set of tests.  He basically said I don't have cancer and so long as I'm getting followup on my cysts, I don't need to see him.  He noted the genetic test had not produced risk factors (nor did the Grail test).  

I had the same tests I had 2 weeks ago and they were worse.  Not surprising because I let my diet go since Roya has left.  Instead of fresh vegetables and salads, been eating more fat like nuts, sunflower butter, chocolate, more sugars like fruit preserves on crackers and Royo bread.   

The good: my liver enzymes were fine, ALT, AST = 17, 20; glucose 86.  The bad:  My CA 19-9 was up 10 points to 64,  my eGFR was down 12 points to 58, my creatinine was borderline high (1.25), and my protein (6.2) and globulin (2.0) were low, chloride was high (108).  My albumin and everything else was normal, as was my CBC.   Dr. told me not to worry about the CA 19-9 unless it sky rockets into the hundreds.  The other seems to point to slow kidney function.  These eGFR readings are on the low side of typical for me however.  AI said my most significant reading is the low eGFR, and that the elevated CA 19-9 could be related to my reduced kidney function.

CMPs are cheap, $23.  CA19-9 are $45.  I'll test again at some point during my travels to ATL.  

Probably would be good to do another 60 hr fast at some point.  

Best time of year because I'm looking at the longest vacation time coming up.  Weather has been great. 

 

More hiking, resistance, test results

Friday did a 5.5 mile hike with Roya and Joe in the Shakerag trail, wildflower season at peak.  It had some hill climbs and was challenging.  Saturday did a resistance circuit at home including upper body, core, and legs.  This morning (Sunday) did a quick 2.5 mile bike sprint on my road with hills on my heavy mountain bike,  11:17, my PR since I just started doing this.  It's a good quick workout, HR avg 147.  

Was going to run hills today but will wait til tomorrow.  I ate too much last night and am too heavy to run, close to 148 this morning.  

My tests results were mixed, nothing exceptionally alarming or surprising.  The good: CEA is  2.4, normal.  CA19-9 down from 79 to 54 but still considered elevated.  CMP values all normal, eGFR 69, liver enzymes normal.   The bad:  Lipid panel shows I'm at risk.  Even after 3 days of light vegan eating, total cholesterol 229, LDL 160 and LDL particle number 2194 / peak size 210.9 - which is considered high risk.  On the plus side, HDL was up to 49 improving my ratio to 4.7 (from over 5). Triglycerides quite low at 92, glucose 89, and A1c at 5.6.   

Considering my brother's issues, I'm looking into having a MRA (MRI Angiogram) with contrast.  It's only $498 at the local hospital.  I found this rate on MDsave.com - a great resource for self pay procedures, it searches for the cheapest rate within a region.   All these small rural hospitals near where I live are the cheapest.  

Knee feeling pretty good after yesterday's resistance work.  

Hiking, test day, brother's surgery

Been hiking with Roya, no very strenuous training since I have a multitude of tests today.

Wildflowers at peak.

My brother had an angiogram with contrast.  It was a lucky thing.  He just got a new cardiologist and he only went in originally to deal with his wife's issue, which turned out to be not as serious.  It was suggested HE get tested while she was there.  After the angiogram, Dr. ordered an urgent heart catheterization and he was found to have 95% blockage of a right coronary artery. (She had zero blockage).  He received a stent.  His CAC scan was 56 and his CT angiogram with contrast suggested just 50% blockage.   Both tests understated his issue.   Heart catheterization surgery is really the only definitive measure of blockage.  CAC is just looking back at the disease already accumulated and the CAC number means little, more about the location of the calcification.  He was on Repatha and now on Plavix.  Seems that Repatha does nothing to reverse the damage / disease, just supposedly decreases risk.  The Dr. told him that he could have easily had a fatal heart attack, as our uncle did, without this procedure.  

I have numerous Dr appointments this month, some I will not keep if my tests go well.  I'll be doing the GRAIL test, lipids, A1c, CMP, tumor markers.  Hope it goes well.  

Semester getting really busy, student concert Thurs then it gets a little easier.  

Expect to do a major hike on Friday, then resume training on the weekend with some biking and hill sprints.  

Finally below 145 lbs, thankfully.

Stadium stairs, spring is springing

Friday, very warm and mostly sunny at MTSU, 80º and I hit the stadium stairs just after 9:00am.  It was easier than last time.

Stretches

12 x Stadium stairs

I did these in sets of 5,3,2,2.  It was hard and I could've done another set but I decided to be conservative.  Knee is improving, better than it has been in months.  Mostly because no flat sprint training.   

Been doing the morning bike sprint workout on my road Tues and Wed.  It's really a good daily routine.  I can get the 2.5 mile bike ride with small hill climbs in done in 12 min on my heavy mtn bike.  Pushes my HR to mid 150s and is a good wake up workout.  On Wed, I forgot that I shouldn't workout before some of my tests so I put them off for a week.  

I've curbed my weight a bit, back to 145.2 after workout.  Just bought a huge supply of good fresh produce so it will be easier to eat better.  

Family heath issues... 

My mother received a hip replacement Mon, then she fell and had to go to the hospital Wed to check it out.  No damage, dodged a major disaster.  I was really pissed at my father for refusing my efforts to get her home health care under her long term care policy that they've paid huge $ into over 18 yrs.  

Then my brother finds out he has a 50% heart blockage that may require a stent, even though his CAC score was only 56.  He goes to have an invasive procedure on Tues.   I probably should be on statins myself.  Maybe my 2 zero CAC scores are a false sense of security?  I've noticed some PVC heart beats, usually on the days where I don't workout.  I read on a runners group about a guy who also had them and they made him wear a HR monitor over a week and found that he was afibing w/ HR up to 200, now I'm paranoid that it's happening to me during training, as my monitor has suggested.   I've written these readings off as anomalous.   

Anyway, happy to be home on this incredibly beautiful spring weekend.  Upper 70ºs tomorrow but then a moderating cool snap, only up to 60º on Sunday then really nice the rest of the week, 70º/50ºish.  Roya will be here Sunday.  Fortunately, she just got hired by a worldwide engineering firm where she can work from home, mostly.  Good pay but she was so happy to get the job, that she just accepted the offer, she certainly could've negotiated for more.  I can't relate to her work ethic since the job is not particularly fun, as mine is.  She needs structure I guess.  

It's azalea season in Atlanta (bottom photo below).   Here, we still don't have leaves on all the trees yet, still early, although wildflowers are rocking.  Here's from my Tues morning hike - Shakerag hollow, Sewanee.

Wildflowers in Sewanee -

Roya's azaleas - 

Fast completed - 63 hrs

I fasted from 9 pm Thurs - when I finished a few after dinner snacks at home, until past noon Sunday.  Of course I stayed completely hydrated through the fast, drinking water and herbal tea.  

About noon I had a meal from the Chinese buffet of dry lean chicken, kimchi, steamed white fish, a california roll, brocolli, and some ginger.  After a relatively large meal I was about 144.4 lbs so I may have been able to lose a few lbs.  Badly needed.  I'm going to try and keep eating clean and moderately so I can get back to the low 140s.  

I'm trying some new band work that I think will help my knee as well as the slant board squats.  

Seeing my kidney Dr tomorrow.  Going to ask him about the fasting and low oxalate diet, as well as the stomach pains I've been having (even though it's not his area).  Fortunately, they've subsided.

Spring break starts Friday.  I may try my first turf running in a while.  It's supposed to be hot, not warm, but hot... in the low 80ºs.  Haven't run a real interval workout on turf since Christmas.

bike climb

Beautiful Sat evening, 65º and clear.   After a day of auditions at MTSU, I did the Roark's Cove bike climb.  I took it easy, about the same as last time, just a few seconds faster.  I was hampered with a little abdominal pain, and I'm now 48 hrs into a 60 hr fast.  This I think will be my longest.  

Roark's cove bike climb

Total time - 25:19

Max HR -  183

HR over 170 - 4:51

HR over 180 - 0:25

Feeling pretty good, not really hungry.  Not too sore after the stadium stairs.  I'm quite a bit lighter than Thurs when I weighed 148.  141.9 after workout, and that's a bit deceiving as I still have the fat on my abdomen and back that wasn't there in Jan, its just that I'm empty.  It'll take weeks to lose the extra few.

I had read that fasting 36-72 hours promotes cellular renewal and promotes autophagy benefits.  

Who knows.  Maybe I'll do it again.  Interesting that even after a 48 hr fast, blood glucose is at 85.   Thought it would be less.

Seeing the kidney Dr on Monday.  I would like to start my collagen supplements again but not sure if I should.  I really do think it helped.

stadium stairs

Did stadium stairs this morning.  Only could muster 8.  Feel as if I were in better shape in Aug.  About 4 lbs lighter then.   I definitely felt it in my calves and thighs.  Will have to do more of these.  

Stretches, drills

MTSU stadium stairs x 8

Also, have been feeling a persistent mild to moderate abdominal pain in the area of stomach/ pancreas.  Was bothering me during this run but went away afterward.   Certainly worrisome.  Hadn't eaten since Thurs night.  

I think I'm going to try a fast.  I need to lose weight and it might be a good time.  Just water and herbal tea.  Let's see if I can make it from Thurs night to Sunday morning, 60 hrs.  We'll see.   

I think I'm going to get the Galleri Grail test, and another CA19-9 and CEA done in a few weeks.  Just curious if there is movement in these markers.  Genetic test was negative for known inherited mutations associated with cancer.  

Looks like beautiful spring weather for the next week and beyond.  

I was 148 lbs yesterday, 146.2 lbs after workout.  

rower again, master track book

Another rowing session.  Hard effort but not a pr.  

Concept 2 rower

4 x 500m w/ 1 min rest - 1:58, 2:04, 2:12, 2:09  (2:06 avg)

HR monitor said I peaked at 195 but I'm sure that was inaccurate.  Busy lately, but I felt I needed to get to the gym tonight.  Definitely have lost all that long sprint foundation I had gotten back by late Nov.  Knee is slightly better, progressing slowly.  Still probably won't try and run for a week or 2.

Was light this morning when I woke up 141.5.  

Monitoring potential health issues, had another scan this morning, Dr ordered, CT w/ contrast.  Due to weather emergency, probably won't have results til at least Mon or Tues.  

Major winter storm tomorrow.  My hometown in NY could get well over a foot of snow and below zero temperatures.  Here in Sewanee, snow tomorrow morning and freezing rain all day.  Not much snow here but 3-5" up the road in Murfreesboro.   Then rain on Sunday followed by maybe some brief wrap around snow and a very cold Monday with highs in the low 20ºs.  Schools are already closed for Monday.  If we lost power, I have only about 3-4 days of firewood - assuming burning 24 hours, so I'll save it for when I need it.  

Book:

Graham B is writing a book on Masters Track called, "Faster than you at 60."  Graham is a serious author, he writes for Forbes and his last book went to #1 on Amazon, so this might be pretty cool.  Graham competes in my age group, he made the finals of both the 200 and 400 in my '21 championship races. The book has 20 chapters about champion masters athletes over 60.  One of the chapters is on me and I just got the first draft.  It's quite good, honest, with many of both the successes and failures noted.  I think the book may be out by the end of the year. 

Bike climb

Yesterday did my first bike climb in a while.  Mild winter weather, low 60ºs.  Knee is better but not normal.  It's a fine line to know how much strengthening to do vs how much rest.  After 3 workout days in a row, it was still a bit stiff, indicating some swelling.  

Not a stellar time but a good workout. 

Roark's cove bike climb

23:49

Avg speed - 5.9 mph

Avg HR - 160

Max HR - 182

Not a super hard effort, HR stayed 153-169 for almost 14 min, 170s for 5:30.

Been trying some body weight yoga type exercises that combine strengthening with flexibility.  Some progress.  Slow improvement.  

Warm and rain the next 2 days then cold and sunny early next week.  Hoping to try some strides on turf on Tues.  We'll see.  

Weight and diet remain good.  Hanging about 141.5 lbs.  Have given up caffeine, both coffee and tea, no supplements. and I start the day with a liter of water with a shot of unsweetened cranberry juice.  Feel better.  

Really happy to be here in Sewanee with Roya.  This vacation is being tempered with dealing with health issues.  Health of my parents, Roya's G.I. issues continue (despite a neg C-diff b toxicity PCR test), and my own worries over tests past and upcoming.  Monday is a big test for me.  I feel fine but still have a minor cough.  Roya has booked a body scan but it's 3 weeks away and she's had persistent abdominal pain in one area.  Her GI just prescribed a battery of tests but she needs a scan asap imo, especially due to her family history.  All this coupled with the exceedingly dark political climate in the US right now has made it a bit dark for vacation time.  At least the stock market is still cranking.  

Anyway, enjoying really focusing on guitar.  I've made a comfy practice space in my tool shed where I can rip flamenco scales to my heart's content while Roya sleeps undisturbed in the house.  

.  

Rower, bike

Now one week since last running.  Sunday, did my first bike ride in a while.  Just a mountain bike sprint for a few miles up local hills.  Could tell I've lost fitness.  

Yesterday, went to the gym and did a set on the rower:

4 x 500m w/ 1 min rest - 2:03, 2:06, 2:11, 2:13

And did a few other weights.

Health concerns - Have had a cough for almost 11 days, it's better, but I just hope I didn't catch my fathers psuedomonas lung infection that he has had for decades.   I had some more tests yesterday but this cold/cough may skew the results.  

Roya tested positive for C-dif GDH antigen but negative for the toxins so her test was referred to PCR (DNA) testing to see if there are active C-dif toxins.  She's had gastric distress. 

Warmer and foggy in Sewanee today.  Normally, today would be a running day.  I will wait probably another week before I run again.  

150s on turf / tests

Did a brief tempo workout 3x150m, then ran a hard 150m, all on turf.   400m fitness isn't quite there, and I have to decide tomorrow if I'm going to race Sunday.   

Not where I would like to be.  Even after 3 days off from running, still feel a slight amount of pain til I get warmed up.  

Stretches, drills, bands, 50m strides

Hoka rocket x2s on

3 x 150m on turf w/ 30 sec rest - 23.50, 24.17, 25.07

PT balance and strength exercises

150m on turf - 21.64

I was going to do 4 x 150m, faster, but these were too fast to complete 4X at my fitness level.  I bailed about halfway into #4.  My HR was in the mid 170s when I started rep #4, and a minute after while I was walking back, peaked at 185.  After another minute it was down to 137.  

I did some balance and strength exercises then ran a 150m at near race pace.  It felt pretty good, but I knew I wouldn't be able to survive 400m.

I'm going to see what it feels like tomorrow and if it doesn't swell or get stiff, go to the gym tomorrow night and do some starts.  If OK, I'll go.  Not expecting much.  

I am close to race weight, was 139.4 lbs after workout, but I ate a big dinner.

Doing the balance and strength exercises, I was struck at how much more difficult these were to do with my R surgical leg, not only because it's weaker, but because my L leg is dominant.  Try these exercises with both legs, you'll see what I mean.  Most people have a dominant leg.  Still a slight amount of knee pain when I do these.  Arthritis.  

Balance and strength exercises.  Try these with your non-dominant leg.  Not so easy.

--- 

Blood tests:

My latest blood work showed an alarming result. My CA19-9 level was well high (78) over the normal, which indicates, along with the imaging and family history (grandmother), a susceptibility to possible pancreatic or GI cancer. All this requires careful surveillance and retesting. The test result could have been spurious and influenced by a slightly high glucose (103) and some gastric distress (diarrhea).  It could even be something like heavy tea consumption, as one test correlated.  That certainly fits me!  Will certainly retest in a month.  Maybe get an MRI w/ contrast.  Fortunately, my liver enzymes AST/ALT are back to relative normal (22, 28).  So, I may start the collagen and glucosamine supplements. My knee was feeling better when I was on them. It was probably the niacin that caused the liver issue. 

No need to panic.  The Mayo Clinic says:  

Carbohydrate antigen 19-9 (CA 19-9) is neither specific nor sensitive enough to be used as a cancer screen.  Serum CA 19-9 levels should not be interpreted as absolute evidence of the presence or absence of malignant disease.

Stairs / blood work

Friday morning at the MTSU stadium for stairs.  I again one upped myself but won't likely try that again for a while.  I may not be able to do another stair session at MTSU til Dec 4, but I can always run hills in Sewanee.  In fact, I measured out distances of 100, 150, 200, and 250m on the steep at Roark's cove rd.  So, maybe next Friday I do some Halloween hills.

Weather at the stadium couldn't have been better, mid 50ºs and hazy sun.  No wind.  

Stretches, drills

15 x stadium stairs

It was tough.  I took a bathroom break at 10, and came back to do the last 5.  Last few I was sitting down for a brief rest in between.  I did start off with 6 consecutive.  Halfway up, there was a knee high gate that caused me to stop, step over, and lose momentum.  

I did my yearly testing blood work.  This was may yearly physical, so not the self testing from Ulta.  Lipids were pretty much the same as in Sept.:  Total Chol - 210;  LDL and TriG, both 140; HDL up a bit to 46, and fasting glucose - 82.  I'm not worried about my lipids, even though my ration is far from ideal at 4.59. 

I am worried about my liver.  My AST and ALT were up a lot compared to my pre op panel in Jan.  An increase from 21 and 26 - to - 60 and 61.   Never been that high in decades, and up so quickly.  All the rest of my liver function tests were normal and I'm asymptomatic, aside from the cyst detected.  

So, I'll see what the Dr says.   I may cut out the bergamot and niacin supplements and retest in a month or so.  Really inexplicable.  Makes me suspicious of the few supplements I am taking - collagen and a glucosamine complex.  Maybe contaminated?  Also, see what the MRI says.  My friend Al sent a note of caution about taking unnecessary action on such things.  An intervention like a biopsy or unnecessary surgery could make it worse.   Anyway, nothing pressing but bears watching.

My weight has been decent, generally around 143 and lighter after training. 

Today, Saturday, last warm day, I processed that dead tree I cut down on Tues into firewood.  

Stadium stairs

Sunny but not too hot, mid 70ºs at the MTSU Floyd Stadium.  Got there just as the football team was finishing.  It was hard.

Stretches, drills

12 x Stadium stair sprints 

Even with a lengthy bathroom break after 6x, and with sit down breaks every 2 or 3x, I was only able to get a dozen.  Could've gotten more but had a meeting to attend.  Probably good that I didn't do more.  Was feeling shaky after just 6.  

Unlike the previous session, I was really sore today, the day after.   Particularly calves, quads.  Typical morning back and knee soreness.  

Too heavy.  144 after workout.   Woke up at 146.5 lbs today.  

Health tests:

Fortunately, the AFP/AFP L3% and DCP tests came back with a good result, so I probably don't have liver cancer.  The AFP tests were down 15% from the June test and the DCP had a negligible result (0.3 ng/ml).  I booked a full body MRI cancer screening for Nov through Ezra.  Head to pelvis, all organs.