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.