Healthy flying - my tips for long-haul flight

When you fly long distance you are putting your body through some serious stress - not just the stress of organising the trip, getting to the airport, through check-in and security and then finding that you've forgotten your passport. No, I mean the physical stresses induced on your body by the act of flying. These include:

• Cosmic ionising radiation;
• Electromagnetic radiation (EMR) from the onboard avoinics;
• EMR from cell phones that haven't been switched off (or the thump when everyone switches their phones on after touch-down);
• Lower cabin pressure;
• Noise;
• Time-zone changes;
• Unnatural light/dark cycles;
• Sitting for hours on end;
• Airborne coughs and colds;
• Bad food,

Making sure you have a strategy and tools in place can make the difference at the other end. You want to be kicking ass as soon as possible after the flight.

Preparation

You should start to prepare yourself a few days in advance.

• Zinc - supplement for a week or so before the flight. Strengthens the immune system.
• [Edit Sept '15] Vitamins A, C, E. Use anti-oxidants before the trip to prepare the body for the oxidative stress of travel.
• [Edit Sept '15] Of course, eat well. Good quality protein (meat, fish, eggs) and veggies. Moderate carbs. Avoid party foods and too much alcohol.
• Sleep - make sure you are well rested before your trip, although this can be tricky as you tend to be a bit anxious/excited the night before.
• Choose your seat - either an aisle seat or one that is away from the sun. Don't sit over the wing exits, avoiding high EMF caused by electrical currents for the avionics.
• Magnesium - either as supplements, or as an Epsom Salts bath. Makes you calm and soothed.
• Chiropractor - go to see one before you leave. Get well adjusted before the trip. 
• [Edit Sept '15] Trying adaptogenic herbs - a blend of Rhodiola Rosea, Withania (Ashwagandha) and Gotu Kola. These are supposed to be very supportive for the stress effects of travel including jet lag. The first time I tried it I found it made me feel a bit drowsy, probably as the ashwagandha jumped on my cortisol. After that, I have only felt positive. Also/alternatively take a Ginkgo, Ginseng, Brahmi complex plus activate B-vitamins.
• For time-zone changes, start timzone adaptation before leaving. We naturally sleep in 90 minute cycles, so if you're travelling east then try to go to bed 90 minutes earlier, get up 90 minutes earlier. If you're travelling west, bump things the other way. That way you're already starting to adjust to the new timezone before you travel.

Travelling

Now onto the day of travel itself.

• Water - good quality spring water. Drink lots and lots. Then some more.
• Butter - helps to manage blood sugar levels and is a good snack food if the on-board food is crappy.
• Nasal spray - sometimes your sinuses get dry and stuffy.
• Shower - if you're travelling business class and have a stop-over. 

Managing radiation exposure

Radiation exposure is an issue, especially on long-haul flights. All international passengers from Australia are subjected to a full-body scan using millimeter radiation. A nice dose to start you off.
When you're in the air, you'll be receiving a higher-than-normal dose of cosmic radiation because you're high in the atmosphere. Managing radiation exposure is a big part of managing healthy and effective travel.

• Vitamin C - take vitamin C every 2-3 hours of the flight. Anti-oxidant.
• Vitamins A, C, E - every 12 hours. Anti-oxidants.
• Zinc - every 12 hours. Immune support.
• Anti-inflammatories - fish oil (high DHA), curcumin (Tumeric) capsules.
• CoQ10 - again, supports the anti-oxidant cycle.

Electromagnetic radiation

EMF increases your oxidative stress and planes are pretty bad because the metal tubes keeps EMF bouncing around the inside, you've got a lot of people in a small space, and planes have a lot of heavy duty electrical systems.

• Anti-static strap - earth yourself to the aircraft plane using an anti-static strap connected to the metal of your chair. 
• Or touch your bare foot against the metal foot rest.
• Avoid wifi if offered on the plane.
• Water and anti-oxidant support.

Sleep

• Get as much sleep as you can. I don't got for 'timing', I just prefer to rest as much as possible.
• Change your watch as soon as you get on the plane.
• Use ear plugs and eye shades.
• Noise is a major factor in making long-distance travel so tiring. Ear plugs or noise-cancelling headphones are very useful.
• Use a neck support.

Exercise

• Do air-squats when you go to the bathroom.
• Get up and walk around (if you're drinking enough water, you'll need to!)
• Recline your seat to minimise the 'pooling' of blood in your feet. 

Food

• I've tried the gluten-free offerings and they're pretty awful. I now just don't eat any glutened item on the plate. 
• Dark chocolate - a good snack food. 85% dark to minimse sugar. 
• Butter. Take on slab of good quality butter with you, in a zip-lock bag. Eat hunks of it, put it on your dinner etc.
• Meat or fish.
• Vegetables - especially green leafy veggies.
• Booze - yeah, they say to avoid it but I like a glass of wine. Don't go crazy.
• Avoid coffee - you don't need the caffeine buzz and it's probably crap quality anyway.
• Avoid sugar - increases oxidative stress and lethargy.

On arrival

• Continue to drink lots of water.
• Get some sunlight during daylight hours.
• Go for a walk or get some exercise and fresh air.
• Eat a decent evening meal - good meat and/or fish (surf and turf?), veggies, some carbs. Don't overdo it on the booze, maybe just a glass of wine.
• Melatonin spray for the first 2 or 3 nights to help over-come jet-lag.
• Take a good quality multi-vitamin.
• Sleep in a dark, cool room. [Edit Sept '15] Try taping black gaffer tape over standby lights e.g. on the TV in the room. Use ear-plugs.
• If you eat anything dodgy, take some charcoal.
• [Edit Sept '15] Grounding can be very beneficial. Try walking barefoot outdoors.
• [Edit Sept '15] Some beneficial herbal mental support, such as Ginkgo, Ginseng, Brahmi and adaptognic herbs like Ashwagandha, Rhodiola as a systemic tonic to help support the system after the stress of travel and timezone changes. 
• [Edit Sept '15] Neuro-supportive amino acids, such as Choline, L-Thianine, Creatine. I may try some L-Tryptophan at night-time.
• [Edit Sept '15] Acetyl-L-Carnitine is effective in supporting brain energy, so may include this in the mix.

Other reading

Hat-tip to these other writers on health tips for flying:

• Listen to this podcast - Dave Asprey, Jack Kruse.
• Ben Greenfield has a bunch of tips, also here.

The development of Electro-Magnetic Sensitivity (EMS)

Over the past few weeks, I have developed a sensitivity to electromagnetic radiation (EMR), a condition known as Electro-Magnetic Sensitivity (EMS). I have noted the development of minor symptoms before in the post "Examples of self-awareness" but I want to discuss how further symptoms have developed, what I'm currently experiencing and what I'm doing or have done to manage the situation.
This situation is concerning, annoying and inconvenient on a personal level, but also confronting and empowering. My eldest boy is going to high school in 5 months time. The school, like all the other schools in the area, have ipads and wifi deployed and used for every child in every lesson. The level of electromagnetic microwave radiation that he will be exposed to massively exceeds anything that we've witnessed before. That I have become personally aware of how low level exposure to EMR can affect my physical state means that I'm now on a crusade to address this situation before we start.

Development of symptoms

As you know from other posts on this blog, I've developed severe osteoarthritis in both hips. I suffered from Legg-Perthes disease as an adolescent, so my hips have been a problem for all of my adult life. By and large I've been able to manage the pain, discomfort and minor limping. 

March 2014 In March, all that changed as I suddenly found I was unable to walk, drive or get around after a mild session of physical therapy. X-rays and an MRI diagnosed that I had severe osteoarthritis in both hips. 

May 2014 A visit to an osteopath surgeon in May confirmed that I would require two total hip replacements. I've been managing this situation since then.

Osteoarthritis (OA) is usually described as a degenerative disease, caused by wear and tear on the cartilage, however in early August, about one month ago, I found an article by Dr Berard Presser where he describes it differently - "OA is not simply a matter of wear and tear; it's also a failure of the cartilage to repair itself." This cast my situation in a completely different light - the current status of my condition was dependent on how well my body was repairing cartilage damage. If I can identify factors that are interrupting the natural cartilage repair process and reduce them while at the same time enhancing factors that support cartilage repair then perhaps I can reverse some of the degeneration. All of this is detailed in the post "My Osteoarthritis Recovery Protocol".

August 2014 A key turning point was when I posted to the Jack Kruse forum. Dr Jack Kruse has some highly non-conventional opinions on the causes of modern diseases. While we can debate his scientific analysis and philosophy, nonetheless he is one of the only people that I have so far encountered that have any practical suggestions for supporting my recovery. As well as standard 'clean Paleo' dietary and lifestyle advice, the following specific recommendations were given:

• reduce EMF exposure and "ground" myself - EMF is dehydrating to the cartilage, bones and joints;
• drink plenty of non-fluoridated water - fluoride interrupts the structure of intracellular water, causing intracellular dehydration;
• eat plenty of DHA from fish, oysters and fish oil supplements;
• get plenty of sunlight.

The aspect of EMF avoidance and grounding was an area where I could make improvement. Since my diagnosis I have been avoiding carrying my phone in the front pocket of my jeans. I now have it on airplane mode most of the time. I improved my night-time 'grounding' by running a strip of metal tape directly on top of the sheets that is connected to a spike in the garden and sleeping with my skin touching it. I try to go the local park a couple of times a week and take a bare-foot walk on the grass. I made these changes about 3 or 4 weeks ago.

Sleeping grounded took a bit of persistence which I had not expected. I'd previously tried sleeping with a wrist anti-static strap connected to the earth wire in the house wiring but found my hand got unbearably numb and tingly midway through the night. I attributed that to cross-interference with the home power and stopped doing that. I have been sleeping with an earthed strip of metal tape under the sheet for a few months but not noticed much effect. But when I started sleeping with skin contact to the tape I found myself very tingly and numb by mid-way through the night. I had to disconnect the ground connection in order to get back to sleep. This continued for a few nights and then eased. I now sleep very peacefully on my ground strip. Another contributor on the Jack Kruse forum has felt a similar effect. Let's call it 'electro detox'.

Late August 2014 So I started sleeping properly grounded, got over the initial 'electro detox' and started carrying my phone in airplane mode. Then the first symptoms of electro-magnetic sensitivity (EMS) emerged. I could 'feel' the wifi in my hands when I was using my iphone and noted that sensation on August 19.

Then around 23 August, I noticed that I could 'feel' the wifi through my hands when I tried typing on my laptop. The sensation was quite unpleasant and I turned the wifi off and plugged the laptop directly into a router. 

At around that time, I noticed if I held my phone and turned it off airplane mode, I felt slight twitching in my hand and electric shocks in my arms.

On 27 August I flew up to Brisbane and back in one day. I flew both ways with my bare-skin foot touching the metal of the chair in front to ensure I was as 'earthed' as possible during the flight.  

At the end of the return flight we turned off the runway and the announcement came through that we could turn our phones back on. Obviously I did not but I immediately felt headache pressure in my head. The effect was immediate and quite uncomfortable.

Early September 2014 Monday 1 September I decided to disable the wifi on the router in the study after feeling significant skin discomfort after sitting next to it for an hour or so. This makes the study much more comfortable.

During the week I popped round to a colleagues desk. His phone was on the desk. After a few minutes I started to feel 'off' - headache, bad stomach, muddled thoughts. It improved when I walked away. 

I went to the supermarket. Near the tills I could feel pressure in my head which improved when I left the shop.

Over the past year or two, I've enjoyed listening to podcasts as I drive to and from work. I connect my phone to the car stereo via Bluetooth which is much less powerful than either cell phone or wifi, although it's in the same 2.4GHz range. I now notice skin discomfort when the phone connects via wifi, even if the cell and wifi is disabled. I now 'hard wire' the connection into the car. I no longer drive around with my phone switched on.

Last night (5 September) we drove to a friends' house. I carried my wife's bag on my knee. Her phone was in it. I developed a headache across the temples.

Managing the situation

Monitor symptoms and responses. The symptoms have gradually got worse, at first unnoticeable, then the odd thing here or there. Now that I'm confident that I'm experiencing real symptoms I can be more disciplined, however I've been noting my physical symptoms and now this post is a journal of the past few weeks. I'll try to be better disciplined from now on!

Sleep grounded. I think the symptoms are worse at the end of the day when I've been 'ungrounded'. I feel refreshed after sleeping on my earthing strip. I'll try to go for a bare-foot walk as often as I can or go for a lunchtime swim to discharge at work. I'll write a post showing how I've built my earthing system.

At work. I'm fortunate to work in a low density office and I'm at the edge of the office space. I have moved my PC further away from my seat. I do not sit near the wifi hotspot. I have my phone on airplane most of the time. I turn the cell phone on only once or twice a day for a few minutes (to check for voicemail and SMS) and make sure I walk away from it while it's enabled.

At home. Minimise wifi. I have hard-wired all the computers including this laptop, TVs etc. I sleep grounded.
There is still work to be done. We have 2 iPads. Our main phone is cordless although we do have a hard-wired phone. My wife needs her mobile phone to be switch on (she runs her own business and needs to be contactable). We have very poor mobile coverage. On the one hand, that means we're not highly exposed. On the other hand, any mobile phones in the house must transmit at very high power.

Keeping in touch. We got used to being contactable 24x7 by text or call. This is going to need some re-adjustment. We're trying to stop using iMessage, switching to Viber which has a desktop client. I check my mobile once or twice a day for SMS and voicemail (although I hate when I have to call up the voicemail service). This remains work-in-progress.

Major outstanding issues

Kids ipads. At home. You can't 'reverse tether' via bluetooth and no network-to-lightning connector exists. Wifi is the only option. This is a major problem. 

At school next year this is a truly frightening prospect. I have not yet found a single school that doesn't have a 1:1 ipad to child program in year 7 next year. I am arranging a meeting with the deputy principal to discuss my concerns. This will be a crusade!

Low Carb Down Under - Low Carb Nutrition event August 2014

I attended the LowCarbDownUnder.com.au event yesterday. It was an interesting event but it felt light-weight and didn't really address anything except high-level flag-waving for the low-carb approach. There wasn't really any discussion on negative impacts of following a low-carb diet and you would have left the event thinking there was only upside to doing so.
The presenters by and large did not seem to have the in-depth, up to date level of understanding of the US-based Paleo-istas like Robb Wolf, Paul Jaminet, Chris Kresser, Dave Asprey etc. There appears to be a need for some serious catch-up before next years event. I certainly hope they'll get someone with a counter opinion to even things out.

One interesting slide I'd like to mention was from Prof Tim Noakes:

Impact of Insulin Resistance to carb tolerance. Photo from https://twitter.com/MikkiWilliden

It shows how the degree of Insulin Resistance impacts the ability to tolerate carbohydrates. If you've been highly Insulin Resistant in the past (i.e. suffering from Metabolic Syndrome) then you will always have a lower tolerance to carbs. I asked Prof Noakes if Insulin Resistance ever normalises and he flat out said 'No, never'!
So the key take-away from that is to avoid developing Insulin Resistance because it will have a continuing life-long impact on your health and well-being even if you manage to normalise your body weight or reverse obesity.

Meeting Prof Tim Noakes at the Low Carb Down Under event,

On blood tests

From time to time I get asked 'I'm getting a checkup. What should blood tests should I ask for?'
I've spent time understanding what blood tests I wanted to see and what I should ask for from the doctor. I have noticed they don't always order the same set of tests, so don't assume that the GP will automatically order everything relevant if you ask for a checkup. Having said that, this is not a comprehensive list and I would expect there to be a bunch of other stuff on your test panel that's not covered here. This is just a set of things that I would want to make sure is included in a blood test based on my needs (male, mid-40s).
This is not medical advice. For that, ask your doctor.

Blood cell count

White blood cell count - if you're doing primal/paleo then expect your white blood cell count to be on the low end. This is good - it means your immune system is not in overdrive because of the crappy food you're eating.
Red blood cell count - I'm not so familiar with this but I believe (from Robb Wolf podcasts particularly) that it is preferable to have red blood cell count, haemoglobin, ferritin, iron levels on the lower end of the spectrum to reduce oxidative stress from iron overload. You may want to do your own research here but blood donation is considered a good thing. Unless you live in Australia and lived in the UK during the Mad Cow episode in which case you can't give blood.

Blood lipid panel

Tests - standard 'cholesterol' test - total cholesterol, HDL, LDL, triglycerides, fasting glucose.
Results - the LDL is just for laughs. If you're eating low glycemic index then your triglycerides should be low (below 100 mmol/L). If so, you can calculate your own, more accurate, LDL number using the 'Iranian' formula which is a better curve-fit at low triglyceride levels. An online calculator is here.
HDL to total cholesterol - desired ratio < 4.0.
Trigs to HDL - desired ratio < 2.0. This one is particularly important.

Note: the standard GP will freak out about high total cholesterol. Make your own mind up about this but I concluded this was the wrong thing to be worried about.
Cholesterol is involved in many healthy body functions, so in my opinion, it is more important to have healthy cholesterol than to worry about cholesterol levels. Which means unoxidized, light and fluffy LDL particles which come about by minimising oxidative stress, consuming enough saturated fats that there is good availability of raw materials for the body to produce fresh cholesterol as needed and maintaining a healthy liver that is able to maintain good cholesterol supply (both HDL and LDL).
Eat plenty of high quality, pasture raised ruminant animal fat (butter, cheese, fatty cuts). Eat plenty of avocado, olive oil, macadamia nuts. Eat plenty of high quality free range eggs. Eat plenty of fish, or fish oil.
Don't over-do it on poultry (high omega 6), other nuts.
Avoid vegetable oils and seeds.

Inflammatory markers

HBA1C and C-reactive protein. These really tell you about how well you're managing your blood sugar levels over time and your body's system inflammation.

Androgens

Total testosterone, free testosterone.
Sex Hormone Binding Globulin (SHBG)
Oestrogen, Progesterone.

Vitamin D

Although it's called a vitamin,  it's really a hormone. It's involved in many body functions including strong bone formation.
The best source of vitamin D is by getting plenty of sunlight, supported by plenty of high quality animal fats (vitamin D is synthesized from cholesterol). Avoid getting sun-burn by avoiding vegetable fats (no more fish and chips or donuts). Cod liver oil is also another good source.

Thyroid

If you're feeling like your energy is low, if you're usually cold, then you may want to get your thyroid levels checked. You need all of the following: TSH, T4, T3, rT3.
In Australia, they'll tell you that rT3 is not available on Medicare and wont' offer it as standard but ask for it anyway. I haven't been charged for it yet! Without this, you can't tell anything about your thyroid function.

Mineral levels

Iron levels - Ferritin. There is evidence that high iron levels can lead to oxidative stress (remember iron rusts easily!) so preferable to be on the lower end of the 'normal' range for iron levels. For men, if you can, consider giving blood regularly.
Magnesium. We don't get magnesium from the water supply like our ancestors did, so you may well consider supplementing magnesium.

My Osteoarthritis Recovery Protocol

I've turned up some really interesting aspects to osteoarthritis recently that's got me thinking - what if my osteoarthritis is not an end state, but instead can be resolved and recovered from? Wouldn't that be worth pursuing instead of merely resigning myself to surgery as the only option? As Dr Bernard Presser says in this article:

OA is not simply a matter of wear and tear; it's also a failure of the cartilage to repair itself.

Putting two and two together, I think I now have a clue what caused my acute episode of arthritis and I have put together this protocol to see if I can not only contain the decline but perhaps even reverse the disease and defer the need for hip replacement surgery.

Why did my arthritis get bad

Clue 1: The Paleo Solution podcast

During this podcast with Robb Wolf and Paul Jaminet [transcript here] they discussed how very low carbohydrate diets can impact the production of mucus. I'd previously heard of this causing, for instance, dry eyes and sinuses and even problems with destruction of the gut lining leading to leaky gut problems. Robb and Paul's discussion mentioned:

Paul Jaminet: When you're on a low carb diet, you excrete more things and it’s very easy to become dehydrated. It’s very easy to lose electrolytes and you’re not quite as robust because your body has to allocate the protein to make milk for the carbs. It lets go of some of the you know, building up extracellular matrix that it would have done if it had more carbs. You know, you don’t make quite as much mucus. Mucus is mostly glucose. 

Robb Wolf: And synovial fluids and all that like for your joints and all that stuff.

Paul Jaminet: Yeah that’s right.

I have been following a Paleo-style diet for the past couple of years. I have experienced great improvements in health, vitality and have achieved great weight loss. All of the information regarding Paleo and arthritis has been positive because of the high nutrient density plus low inflammatory load of the diet. Often Paleo is discussed along with high fat, low carb, very low carb and even nutritional ketosis (where the body switches to using fat molecules called ketones for fuel instead of carbohydrates). I am well fat-adapted and go in and out of ketosis, and have been enjoying improved mental performance plus weight loss as a consequence. I avoid gluten and bread, and if I eat carbs, I eat them in the evening - a few potatoes or sweet potatoes, a little rice, plenty of veggies. But not much carb.

So this discussion by Robb and Paul is the first I had heard that a low carb diet may lead to problems with joints.

Clue 2: A question to Paleohacks.com

My next stop was to ask this question on paleohacks.com. One answer said:

there's some speculation that VLC can "dry things out" 

Hmm, so there might be something in this worth following up. Could a low carb diet can impact the production of proteoglycans which are important for cartilage health, synovial fluid health etc.? If so, would it be possible to reverse the decline and even reverse some of the disease condition?

Next step, post a question to the forums of Dr Jack Kruse. Dr Kruse discusses dehydration at length although to me it sounds like he likes to use lots of fancy physics words out of context. Nonetheless, there could be something in it. 

Next step: stop the decline, reverse the damage

Perceived wisdom is that osteoarthritis is a progressive downhill decline; that there is no cure. I don't think that's accurate. I think it's fairer to say that OA is  a failure of the cartilage to repair itself. Now that puts a different spin on things.
What's the impact of a Paleo diet on OA? On its own a standard Paleo may help by reducing weight (reducing the pressure on the joints) and reducing systemic inflammation. But what I've learnt about Paleo is that with the *right* approach that many diseases can be addressed, for example Dr Terry Wahls recovery from Multiple Sclerosis, type-1 diabetics no longer requiring insulin etc. So is osteoarthritis really just a one-way downhill slide or can I figure out a protocol to arrest the decline and start healing? Well, I figure I've got 5 months before my scheduled hip replacement surgery to try my hardest. Let food be thy medicine.

So here it is - my recovery protocol. Some of it makes total sense, some of it is pretty far out. I got nothing to lose and everything to gain! 

Recovery protocol

The recovery protocol that I've put together as a consequence intends to:

• address the dehydration of the hip joint;
• minimise inflammation;
• prevent further damage from occurring;
• promote healing of the injury;
• be practical.

It is a combination of the following factors:

• nutrition;
• supplementation and medication;
• exercise and physical therapy;
• lifestyle factors.

Nutrition

Bulletproof Paleo, meaning:

• real food;
• gluten-free; no bread, flour, pastry etc
• minimal sugar, including limiting fruit intake;
• no 'vegetable oils' (sunflower, canola, soy bean oils etc);
• saturated fats (butter, coconut oil, lard, animal fats) from free-range, grass-fed animals;
• eggs from free-range pasture-raised chickens;
• fish and oysters; try to eat oysters a couple of times a week, fish regularly during the week;
• low inflammatory starches such as rice, potatoes, sweet potatoes; 
• minimal nuts (nuts are generally high in omega-6 fats), so Macadamia nuts mainly;
• liver once or twice a week;
• lots of vegetables;
• limited amounts of fruit but including berries.

But I've been following essentially this diet for the past couple of years, so what's different? The key difference that I'm experimenting with is increasing my carbohydrates. This means rice, potatoes, sweet potatoes, pumpkin or other starchy vegetables with lunch and dinner. Proteoglycans are essential for forming cartilage and bone and are a combination of protein and glucose. So starch and protein are essential for good bone formation.

Oysters are another thing I'm concentrating on eating a couple of times a week since they're full of zinc, iodine, omega-3 fats and all the cofactors to make these little nuggets of pure nutrition. And per Dr Presser's article, you need to eat some uncooked food sources.

Supplementation and medication

• Cod liver oil - 1 teaspoon morning and evening; EPA and DHA plus vitamin D, vitamin A. I don't take additional vitamin D but I do try to get as much sunlight as I can. I note that high intake of fish oil can be inflammatory (due to oxidation of polyunsaturated fats) but I don't think this is to excess given my current state;
• 1x aspirin in the morning to enhance the production of resolvins, could also use apple cider vinegar (1 teaspoon);
• Glucosamine 1500 with chondroitin and proline - 1 or 2 per day;
• MSM - 2 per day (morning and evening);
• Magnesium with Zinc and Selenium; 1 tablet per day in the evening;
• Vitamin C - regular dosing from multivitamins, fresh food and tablets (especially after swimming in a chlorinated pool);
• Bovine collagen powder or gelatin. I mix it into my morning coffee. Give your body the building blocks to repair the damaged tissues!
• Vitamin K2, appears to be something of a miracle cure, especially for strong bones. Weston A Price described "Activator X" as a missing nutrient in modern diets, linked with poor dental and bone health. But you can't get it easily in Australia (I've got some on order from iHerb.com). Alternative sources include hard cheese, especially Gouda and Edam (presumably there's a particular bacteria culture used in the production) and butter. That's what I'm eating at the moment;
• Vitamin E [20-Oct-2014].

Things I don't use or avoid:

• Avoid non-steroidal anti-inflammatories. If you need them then your diet is wrong. I have found that if I have chips or Doritos one day, I'll have stiff hips 2 days later. Vegetable oils are bad!!!
• Curcumin supplements - basically concentrated Turmeric. I haven't found these to help particularly and they're expensive.

Exercise and physical therapy

• Sunlight - I try to get outside every day and I go to the outdoor pool a couple of times a week, even during winter.
• Cold water immersion - currently doing about 10 minutes per day in 6'C water - very cold! This has several beneficial effects:
• It increases the production of glutathione (the master anti-oxidant) in the body;
• It shunts blood away from the extremities into the core, flushing capillaries with highly oxygenated blood;
• It improves cardiovascular elasticity, encouraging blood flow through parts of the body that may not otherwise receive good blood flow, such as bones and cartilage;
• It stimulates the mitochondria, a process called cold thermogenesis. With repeated exposure to cold, the body creates more mitochondria and improves the efficiency of existing mitochondria, which end up causing energy release and heat generation;
• Coverts white fat to Brown Adipose Tissue.
• Saunas - a couple of times per week until my heart rate has reached at least 130 bpm (resting heart rate < 60 bpm). Releases BDNF, Heat Stress Hormone, increase blood plasma volume, sensitises to endorphin (makes you feel good!) and all manner of other goodies - listen here;
• Red light therapy - using a red LED array, shine red light onto the hip area, again to try to stimulate mitochondrial function in the area and improve water circulation (increase the energy available to the molecules);
• Standing up straight. I have a desk job, meaning that I sit most of the day. My hip flexors (which connect the top of the thigh into the deep core stomach and lower back) were tight. I now focus on making sure I stand up 'properly' tall (straight through the hips) and stretch my hip flexors. There's videos on youtube for this.
• Walking, standing; again with good posture;
• Using a resistance band to do a deadlift like this. This has worked really well for me. The trick is to make sure you're doing this exercise with good form. Straight back, neutral head and neck, no strain in the arm, weight on your heels.If I find that I'm feeling stiff or that things are out of place, I have found this exercise to get everything back in line and ease things off.
• Chiropractor - you need every other part of your body properly aligned so that you're minimising undue stress on your musculo-skeletal system. A good chiropractor is a must.
• Swimming - I'm in my backyard pool every day and go to the local pool a couple of times a week.
• I can highly recommend the book "Heal Your Hips" by Robert Klapper. I've been doing the stretching exercises for about 3 weeks and feel great! Most interesting has been working on hip abduction (side-to-side opening) that has been hard for me for a while, as has leg circling to increase range of motion.[20-Oct-2014]
• Body-weight squats.[20-Oct-2014]

Things to avoid:

• Stretching the injured joint where it doesn't want to go. I think this is what caused my acute problem.
  [20-Oct-2014] See above - the 'Heal Your Hips' protocol has been great in this respect, so stretching is back on the positive list.
• Sudden impact or shock through the joint;
• Twisting or torsion in the joint;
• Sitting down for too long;
• Walking on rough or uneven surfaces;
• Cycling - I have heard good things but I'm find the traffic on the road intimidating.
  [20-Oct-2014] Last weekend I tried cycling on both days. It was nice to get out on the road and I could feel the lack of cardiovascular fitness as I tried to slog up the hill but the crouched over position didn't feel very good, .

Lifestyle factors

Water

This is an essential component to my protocol. Avoid fluoridated water. I haven't (yet) installed a Reverse Osmosis water filter, so instead I drink spring water at work and filtered rain water at home. 

This will sound woo-woo pseudo-science but... Cellular water is not just sloshing around, it is structured. Check out this mind-boggling presentation on structured water. Did you see those blood cells moving through tight capillaries? That's what you want to happen in your bones and cartilage. So drink the best, purest water.

Grounding or earthing

This also sounds like woo-woo pseudo-science, but I'm sure you've heard people talk about grounding or earthing. Standing barefoot on wet grass or sand is one way.

The body is an electromagnetic entity and so is the earth. In fact the earth resonates at 7.83Hz - the Schumann resonance - but we usually insulate ourselves from the earth with rubber-soled shoes, car tyres, carpets etc.

I am now grounding myself every night while I sleep by running a wire from a stake in the garden, via a 1Mohm resistor and a switch, to a strip of metal tape on my sheet. I included the switch because the first time I tried it, I woke up in the middle of the night tingling. Powerful stuff.

EMF exposure

Dr Jack Kruse is insistent that EMF exposure is highly dehydrating. So don't walk around with your cell phone in your hip pocket! 

The EMF sources to be aware of include:

• Smart meters - use WiMAX technology; very strong pulsed microwave emissions;
• Microwave ovens - just see what happens to that steak you left in there too long - it dries out. Microwave ovens tend to 'leak' somewhat;
• Cell phones - the worse the reception, the higher the radiation from that phone. Don't walk around with it in your pocket if you can avoid it. Turn it onto Airplane mode if you need to carry it with you - they can always leave a voicemail;
• Wifi - everything has wifi yet the French have banned wifi in schools due to health impact concerns. Make sure your router is not near your bedroom, don't take gadgets into your bedroom, if you do, turn them to Airplane mode.
• Bluetooth - this is pretty low-power energy and I'm not too concerned about it. Be aware that some health sensors use bluetooth though, and they're attached continuously to your body. Avoid that.

Circadian light exposure

Sleep in a properly dark room. Cover any LEDs or glowing lamps.

Minimise blue light at night like computers, laptops. Give yourself an hour or so before bedtime without a screen. Install F.Lux on your computers.

Metal detox

I've just completed a few weeks using Metal Free, a peptide metal chelator. Do this once a year.

Medical interventions

Hip replacement surgery

I am currently viewing hip replacement surgery as a final option if my plan doesn't work out. I have a date with a surgeon in a few months time. Let's see if we go ahead.

Stem cell therapy

This sounds interesting. One option available is by Regenexx where they extract bone marrow, isolate the stems cells via centrifuge and inject back directly into the joint capsule.

Another option is to isolate stem cells from adipose tissue.

Yet another option mentioned in info from the Mayo Clinic shows stem cells being delivered to the femur head by drilling from the outside of the femur [find reference...]

The problem I have with these therapies is that it's expensive and I'm not sure if it's effective or not. But maybe with everything else I'm doing, I stand a better chance than others (who aren't actively supporting repair and recovery)? I'll need to think about this some more.

On hip replacement - post-surgery recovery plan

In preparation of up-coming hip replacement surgery, here's my notes on a recovery plan to ensure that my recovery is as successful as possible.

Supplements

• I'll discuss all of this with the doctor before the surgery.
• Branched Chain Amino Acids (BCAAs). You can find them in the bodybuilder section of the health food store. Make sure your body has the building blocks for repairing muscles, soft tissues etc.
• Continue with Glucosamine, Chondroitin, MSM supplements
• Proteolytic enzymes - improve scar healing and to reduce the time for swelling to subside (see here). Take on an empty stomach. They break down excess fibrin and allow for more clearance of inflammation and a faster healing time
• Vitamin D - mainly from sun. Try to get sunlight every day on lots of the bod. I may even get my vitamin D levels checked beforehand to make sure I've got this 'in the zone'.
• Cod liver oil for Omega-3 and vitamin D.
• Vitamin C is important not only as an overall anti-oxidant (to counter the effects of being in hospital) but also to support collagen formation.
• A good multi-vitamin to make sure I'm getting Vitamins A, E, K2.
• Anti-oxidants. Consider some Bulletproof Glutathione, otherwise CoQ10, alpha-linoleic acid.
• Zinc to assist healing.
• Annual metal detox using a peptide chelator like Metal Free from BodyHealth.com
• Chlorella supplements?
• Probiotics to counter any anti-biotics they may give me.
• Arnica to reduce swelling.
• Maybe turmeric to reduce inflammation. 

Nutrition

• Intermittent fasting (IF), maybe fat-fasting. No protein or carbs until lunchtime. There's certainly evidence to suggest that IF is useful in spinal surgery recovery. I'll do more digging whether it's a good thing for skeletal surgery.
• Bovine collagen in the morning coffee. Give your body the building blocks to repair bones and connective tissues.
• Bone broths, lamb shanks, osso bucco etc. I'm thinking to make a whole load beforehand and freeze it.
• Decent, grass-fed meats - beef, lamb. Tissue healing and repair can temporarily increase your protein needs by about 50 percent.
• Eggs.
• Lots of leafy greens, salads, avocados etc. Veggies with every meal.
• Sauerkraut and/or kobucha - probiotics!
• Some prepared meals in the freezer.
• Butter, coconut oil and Bulletproof Brain Octane for postanesthetic brain recovery. Check the brain health post for more on this.
• Dark chocolate. The darker the better :-)
• Water. Make sure to have a good quality mineral water rather than fluoride-laced tap water.
• Avoid anything inflammatory such as sugar, deep-fried foods and vegetable oils, nightshades.

Training and recovery plan

This definitely starts with pre-surgery preparation. I've got another post in the works about my pre-surgery preparation including exercise, swimming, cold adaptation, saunas etc.

Post-surgery, here's the plan:

• Don't over-do it and go with the flow.
• An in-home physiotherapy program is included as part of the operation package. Hopefully this will be a local physio so I can keep follow-up as necessary.
• Chiropractor. I've been seeing an excellent chiropractor for the past 5 years or so and will want to get back to see him to help ensure good alignment and for him to help in the recovery and wellness process. 
• Swimming - luckily we have our own pool and it'll be summer so I should be able to get in the pool morning, noon and night. How long after the op can I get back in the pool? Will depend on wound healing but as soon as possible. Will work up to longer swimming over time.
• Walks, short to begin with but building up over time. 
• Exercise bike. I'm going to see if I can borrow one rather than having to buy one.
• Strength training using power bands. I'm having good results at the moment (pre-op) using a power band to do a 'deadlift'. It might sound like putting such a lot of load through the lower body would be a bad idea and I think that good form is essential. But it seems to make sure that everything is moving in the right way. When I'm stiff it can help reduce the pain. Nice straight back, neutral neck, take the strain through the 'posterior chain'.
• Ice for pain reduction, swelling reduction. 
• Option 1: Ice packs.
• Option 2: gel wraps like this.
• Option 3: Ice water cold therapy systems like this. 
• Red light therapy - stimulate wound healing.
• Saunas. Cause the release of Heat Stress Hormone, BDNF, dynorphin (an analgesic) and increasing sensitivity to endorphins (happy hormones). Also makes the body produce a greater volume of blood plasma.
• Electrostim. I've got an Omron HV-F127 Electronic Nerve Stimulator to help relieve pain and stimulate muscles.
• Grounding. You may have heard of grounding - connecting directly with the earth to reduce electrical charge on your body. It might sound like hippy nonsense but I have a grounding strip running beneath my sheets to bond me to earth as I sleep (with a 1 megaohm inline resistor so I don't get inadvertently zapped!)

While it's claimed that pulsed electro-magnetic therapy (PEMF) such as Earth Pulse can be beneficial in helping recovery for stress fractures etc, I don't fancy the idea of using PEMF close to a metal implant. 

Home preparation

• Bed hoist trapeze to help getting in and out of bed.
• Sock putter-onner (or just get the kids to help!)
• Raised toilet seat.
• Walker, walking stick, cane - already got.
• Phone charger next to bed (but airplane mode when sleeping). Laptop/iPad. 
• Home delivery. Probably Woolworths Online.
• Entertainment - NetFlix (plus GetFlix to unlock from Aus). I may need to 'up' the broadband limit.
• It'll be summer, so I'll make sure I've got a nice outdoor sitting arrangement so I can enjoy sunshine without getting burnt to a crisp!

Support, timing and work

I'm planning to have the operation after christmas, in the summer holidays. This will mean that the pressure will be off my wife who will be really busy in the run up to christmas. I know I'll be relying a great deal on her and the kids during my recovery so it needs to work for all of us.

Work-wise it's a quiet period as folks take holiday. 

The kids might get bored because I won't be out and about as much as usual. We'll think about this some more.

Putting it all together

That's a lot. I'm sure that when the time comes, things will change. Maybe I won't have time for it all, maybe I just can't be bothered. But at least I'm giving it good consideration beforehand to make sure I've got the best tools and thinking to help.

For the nutrition and supplements, I'll probably put together a chart so I don't have to think too much and can just go by the chart. I'll also check all this with the surgeon beforehand.

Any other thoughts or suggestions? Leave a comment below...

Update 22-Aug-2014

I just came across this great post on Bulletproofexec.com forums describing the effects that active post-operation management can have on recovery. This is exactly what I'm aiming to achieve. To quote:

My long awaited doctor's visit has finally arrived. "Holy Jesus!" the doctor exclaimed. "You are like some kind of superhero...like a wolverine or something." He ran to get his camera.

This is also an excellent post by Ben Greenfield on recovering 'like Wolverine'.

Mitigating the impact of anaesthetic on brain health

Brain support: from left to right: Natures Own High Potency  Brahmi complex, Vitamin C, Thompsons B-complex, Westgold butter, Melrose Cod Liver Oil, Celtic sea salt, coconut butter, Melrose MCT oil, Blooms MSM

Hat tip to this episode and this episode of Bulletproof Radio for bringing up the impact of anaesthetic on brain health.

In the episode with JJ Virgin, they discuss how she helped her son recover from a hit and run and how she recovered quickly from knee surgery.

In the other episode, Steven Fowkes and Dave Asprey discuss, amongst other things, anti-trauma compounds like DMSO that can be protective to the spine in case of a car accident for example.

The effects of anaesthetic on brain health

The administration of general anaesthetic during surgery can also have serious long-term effects on the neural systems in the body, especially the brain. In this post I'm going to investigate what I can about how to mitigate the impact since I've got some surgery coming up. It'll also be interesting to see what I manage to uncover because I've just heard of a friends' daughter who had an accident and was in surgery for 3 hours. Should we be concerned for post-anaesthetic impact and is there anything that she can do now to mitigate the effects?

Severity of anaesthetic

There are different severities of anaesthetic depending on the procedure. The most harmful to brain health is full general anaesthetic.
I believe for my procedure (total hip replacement) that a less severe anaesthetic regime is used, likely spinal block plus sedative. I have heard of people having this done without sedation but I'm not that game!

Bulletproof intermittent fasting

First things first. The brain runs really well on ketones which are produced by the breakdown of fatty acids. You can find plenty of information out there about ketogenic diets so I won't go into the details. Since I've been on a low carb high fat diet for a couple of years now I am fat adapted, so adopting a high-fat ketogenic diet post-surgery should work well. 

To get the maximum benefit will mean an extended 'fasting' period. In this case, I'll be looking at a 'fat fast'. That'll mean that I won't 'eat' until lunchtime and will just have coffee-plus-butter/coconut/MCT for breakfast. Maybe with some collagen powder mixed in.

Coconut oil

Coconut oil is well known for it's positive benefits for brain health. Look for an organic cold-pressed variety. There are plenty. Work your way up to 3-5 tablespoons a day (but do start slowly to avoid gastro upset and disaster-pants!)

[Link to podcast on coconut oil for treating dementia. ]

MCT oil

In addition to raw coconut oil I use MCT oil for mental performance. It's a fraction of coconut oil but is metabolised directly to ketones (and thence energy) and is included in Bulletproof Coffee. I use Melrose MCT oil.
There is a further refinement of MCT which isolates the C-10 fatty acids, most popular brand is Bulletproof Brain Octane which I've heard good things about. I may well give this a try beforehand to see if it's worth using over and above 'standard' MCT oil.

Omega-3

As we all 'know', fish oil is good for you. In fact it's DHA for the brain is the particular form. I'm using cod liver oil to help manage my osteoarthritis since it is also high in vitamin D. 

l-glutamine

 - phosphoserine [3 heaped teaspoons]
[More info to be figure out...]
L-glutamine is the main component of muscle. It's commonly used as a bodybuilding supplement to support muscle preservation when 'cutting'. May be useful post-op to keep muscle tone but doesn't look like it would have much of a brain-support function.

DMSO and MSM

MSM is a somewhat unproven supplement but is popping up as a remedy for arthritis pain. I use it along with my glucosamine/chondroitin supplement. The neuro-protective aspects of MSM are definitely controversial, however it is suggested that DMSO is beneficial in mitigating spinal trauma [DMSO is a solvent related to MSM]. From wikipedia:

The spectrum of biological effects of dimethyl sulfoxide (DMSO) and MSM differ, but those of DMSO may be mediated, at least in part, by MSM.^[

Choline

From wikipedia:

Choline is the precursor for acetylcholine, a neurotransmitter involved with memory; it’s an integral component of two important phospholipids; and the liver uses it to process fats and package lipids.

Dietary sources include liver, eggs, shellfish. Choline may also be used as a dietary supplement in the form of Alpha-GPC / Glycerol Phosphocholine. Suggested dosing (by JJ Virgin) is 3 times a day before and after surgery @ 2000 uGrams.
Will look at e.g. http://www.amazon.com/Now-Foods-Alpha-Veg-Capsules-60-Count/dp/B001RYKA3U/

Smart drugs

I'll do some more digging into this. Suggestion by Dave Asprey is:

piracetam or aniracetam protects your brain from low oxygen states.

and so can have a neuroprotective effect during anaesthetic. Obviously you'd want to know how you react to such substances before dropping them into the mix.

Herbal supplements

I've been enjoying improved mental function by taking a herbal compound of Ginkho,Ginseng, Brahmi once every few days and I shall continue to do so before and after the operation.

Pain relief

After major bone surgery, pain relief is essential. I'm not sure if any of the hard-core meds have any lasting neural impact. My thinking is that I won't be shy about using the pain medication but I won't take them for any longer than I have to and I'm going to do what I can to maximise my recovery post-operation to minimise my exposure to hard pain medications.

Anti-oxidants

If you're having anaesthetics then you're in a hospital environment. You may well be having x-rays and other imaging done, lots of oxidative stress. So a good supply of anti-oxidants is essential - Vitamin C, Co-Q10, alpha-linoleic acid, glutathione.

Vitamin B12

Vitamin B12 is essential for good neural condition so make sure to include a good vitamin B complex.

Others

An operation is a major stress on the body so your adrenals will be working hard. Make sure you're taking a good quality salt to support the adrenals to cope with the stress.

Physical therapies

Saunas and heat exposure can increase levels of Prolactin levels by 10-fold. Prolactin is involved in the process of myelination of nerve cells. Heat stress from a sauna increases brain-derived neurotrophic factor when combined with exercise. BDNF increases the growth of new brain cells and increases the survival of existing brain cells.

For further thought

Will GABA help? https://www.upgradedself.com/bulletproof-gabawave 

Changelog

2-Aug-2014: First published.

17-Aug-2014: Added note on the potential use of sauna.

Examples of self-awareness

Since I started my biohacking experiments, I've become aware of the effect that everyday activities has on my performance, mood, energy levels etc. The problem is that the result of a particular activity may not manifest immediately but only after a period of time. I'll give you a couple of recent examples of where I'm starting to correlate things which in the past may have passed me by. It's very interesting!

The post-sushi energy crash

A few weeks ago I needed a quick lunch. I normally have some kind of salad but didn't have time to prepare one, so I grabbed a pack of sushi instead. About 45 minutes later I was in a meeting and noticed that I was having trouble focussing, that my energy and concentration had dipped. If I have a salad for lunch I don't get that. This is the post-carb crash we've all heard about.

I used to have a lot more carbs in my diet and most evenings I would nod off on the sofa after dinner. Now I no longer think this is 'just what happens' but is directly related to what I had to eat before.

29-July-2014: Spring water and wifi

A few months ago I switched to drinking only spring water after listening to Dr Jack Kruze. One of his top recommendations for higher performance is to install a Reverse Osmosis water filter to get rid of fluoride and chlorine from the water supply. These are alleged to impact the structure of water in the body, impacting performance and wellness. And fluoride in the water is alleged to impact thyroid healthy by competing for absorption with iodine.
Before investing in a RO water filter I wanted to see if I could tell any difference, so for 3 or 4 weeks we drank only spring water at home and at work. After a while I noticed that I could feel tingling in my fingers while I was using my iphone - I could feel the wifi and cellular signals. That was about 3 months ago.
Since then we've gone back to plain old 'council pop' out of the tap and I no longer can feel the EMF from the phone.
I'll switch back to using spring water and see if I notice the effect again. I'll report back.

29-July-2014: A night with the boys

At the weekend I played poker with the boys. On Sunday night I noticed that my arthritis was bad and that my hips were stiff and still were the next morning. During the card evening we ate some crappy food like Doritos and chips with artificial flavourings and additives. I drank a bunch of wine. The following morning I felt OK because I'm taking lots of anti-oxidant supplements so I wasn't hung over; my liver was able to deal with the immediate aftermath. But the other stuff has taken a couple of days to work through my system and I think it's that which has led to a flair up in my symptoms.
Saturday night: bender
Sunday morning: not bad
Sunday night: stiff, tired.
Monday: stiff. Took a sauna at lunchtime which helped. Very tired in the evening.
Tuesday: 84% sleep quality. Early morning phone call. Average energy.
I'll see if I notice any similar correlation next time things get bad.

19-August-2014: Feel the wifi

I've been drinking primarily non-tap water for the past couple of weeks, either bottled spring water or filtered rain water. I still have a couple of cups of tea with mains water at work but that's about it. Once again, I can feel the tingle of EMF - wifi and cellular signal - in my fingers from my phone! 

I now have my phone in 'airplane' mode with just the wifi enabled for most of the day. I turn the wifi off if I need to put the phone in my pocket.

In fairness, I've also been sleeping 'grounded' for the past couple of weeks too. I'll write a separate post about that, however it's worth noting that the first few nights I couldn't sleep through the night due to tingling and numbness, then I would wake up feeling 'buzzed', but the past few nights I've slept very soundly. Has this also increased my ability to sense EMF?

Technology that works

My wife runs a small retail / hospitality business called The Deli Platter, located in the wonderful Dandenong Ranges near Melbourne. Go visit. They've got beautiful food and it's a great day out.
To help us run that business, and having a partner who's a techno-geek (i.e. me), of course we use technology. I've done a lot of work to try to come up with cost-effective and robust solutions for various day-to-day tasks, so I thought it would be useful to share some of the tools that we use. Since cost control is important, many of these tools are free. There are, of course, any number of paid services so being able to set up a whole bunch of IT solutions that don't have a heavy price tag attached is great. There are also some things that I've got no problem paying for.
The IT and software world is going more and more towards paying by the month for subscription services. The problem with this from a consumer point of view is, of course, that these costs start to mount up and they're on-going. So finding cheap or free alternatives that offer the functionality and robustness necessary to base business processes on them has been an interesting challenge.
OK, here goes...

• Domain name: every business these days needs it's own place on the 'net. I registered thedeliplatter.com.au using Cheaper Domains. At $35 for 2 years including DNS hosting, I haven't found anywhere cheaper for Australian domain names.
• Email: none other than Google for Business. Free, custom domain, mobile integration, plenty of storage. Just what you want. Oh, and calendars, contact lists etc.
• Web hosting. I spent a bunch of times trying to figure how to do this cheaply by creating a website from static files and serving them from an Amazon S3 bucket. But the better solution turned out to be much easier, and cheaper too. We use weebly.com to host www.thedeliplatter.com.au and it's been great so far. Nice templates, easy setup, fast. We don't do much eCommerce, so their free service is perfectly adequate for us. I've got no problem that the weebly logo is displayed at the bottom of the page.
• Social media: Facebook, Instagram, Twitter. Obvious really. And the Pages ipad app to keep these multiple locations fed and watered.
• Document management: Dropbox. Takes care of backups, version management, availability etc.
• Business processes: Zoho Creator. Rather than trying to juggle spreadsheets, Creator lets you create simple database apps through the browser with a drag-and-drop interface. And because it's all online, it can be accessed from PCs and mobile devices alike, again without the worry of managing backups, versions etc. Great, and free up to 1000 records (which is actually quite a lot).
• Monitoring the premises. Of course we have cloud-connected cameras monitoring the premises, in our case DLink day/night cameras were a good, inexpensive option. I did try sensr.net for image storage and playback but at $15 a month this seemed pretty steep for what it does.
  The other great development has been using Ninja Blocks. These cool devices from a Sydney-based start-up let you monitor and control devices wirelessly. In our case we have wireless thermometers in each main fridge. They send temperature and humidity records to the NinjaBlock website where rules run. If they detect that the temperature is too high during the evening or at night, I get an SMS, because it usually means that the fridge is playing up. Much better than finding ruined stock the next morning. Cheap to buy and easy to set up. 

Do you use other services that really tick the 'bang for buck' box? If so, leave a comment.