Sometimes I Forget How Far We’ve Come

Sometimes I forget.

Forget why we began this trip, this new RV life. How easy it is to get caught up in the middle of life — with all its ups and downs — and forget how far we’ve come.

But when I revisit pictures like this, I am reminded of how far we’ve come together as a family, in regards to our health, and how much we love each other.

These pictures were taken between 2014 and 2015, when my husband of almost 22 years, Darrell, [if interested, he has his own separate blog] was diagnosed with cancer, when we dreamed up the idea to reduce overall stress in our lives by quitting our traditional 9-5 jobs, stop paying for a mortgage for a SF Bay Area house we could barely afford, and live and travel the world together in a RV as a family.

There’s still some stress now, but it mostly stems from work-related and time-management stress as we both work on-the-road part-time chasing wi-fi.

But nowhere near the stress of worrying that you don’t have much time on this earth with the love of your life and your son and stepdaughter’s father, burdened with high costs and massive amounts of debt.

In 2014, when Darrell went into his regular General Practitioner’s for a cough that refused to disappear, he discovered something was  amiss when the chest x-ray technician gasped at the sheer size of the mass that appeared on his black and white screen. From there, it became a mystery game, a hunt to discover if he even had cancer, and if so, what kind.

Most importantly, we all wanted to know: How long did he have left to live?

We were at a loss as to what to do. Should Darrell turn vegetarian again? He had been vegetarian for over 15 years. I imagined the freezer full of Morningstar burgers and fake bacon. I had recently adopted a Paleo diet and it had already helped me come off all my meds, but I still had weight to lose. Other friends suggested juicing and the Gerson Therapy. Others suggested other alternative therapies. We didn’t know what to do, what to choose.

Only three years before, Steve Jobs had died and I read up on all kinds of diets and scenerios, imagining the worst outcomes possible. But then a good friend who followed a Paleo/Primal way of eating Darrell’s mentioned the ketogenic diet. “There’s talk that cancer feeds on sugar, on glucose,” he informed us while visiting from out of state.

A former biology/chemistry major, Darrell immediately latched onto the science and chemistry behind the ketogenic diet. It made sense. We began searching online and came across Ellen Davis, Dominic D’Agostino, and Miriam Kalamian. I immediately bought e-books and devoured everything I could on the subject. My sister, who had lovingly spent much of her time babysitting and helping me with my virtual assistant clients while we went to doctor appointments and during hospital stays for the two biopsies, introduced me to the audio book by Jimmy Moore: Keto Clarity. Later, I found Patricia Daly, Martina Slajerova, as well as Maria Emmerich.

In the meantime, as I learned how to cook and eat keto, I adapted many of the Paleo recipes I had from all the Paleo cookbooks I had amassed, such as Melissa Joulwan and Michelle Tam of Nom Nom Paleo. I encouraged Darrell to reach out to Miriam Kalamian for a Skype consultation, and he did. She was extremely helpful and encouraging, and I remember making my first mug cakes from recipes she had sent us, in addition to the ones I was making out of her e-book.

At first we didn’t know what type of cancer Darrell had. It was right before Thanksgiving in 2014, and Darrell’s fantastic oncologist in (Alta Bates Summit) Berkeley pulled some strings and found a doctor who would do a biopsy in Concord, at John Muir Hospital. That doctor speculated Darrell might have thymoma. Then there was talk among other doctors brought in that it could be a teratoma. We looked it up. Could Darrell’s tumor have teeth, have hair? Even through the despair, we found a moment to joke around. What if Darrell had a miniature clone growing inside his chest, where the tumor was located? That year, we skipped Thanksgiving, spending it in the hospital.

We were told Darrell needed to stay in the hospital for several days. He was fed orange juice, sandwiches, dessert. While Darrell had the biopsy which would take quite some time, per the doctor, my sister, my kid and I sat in the waiting room, taking turns playing the piano. We also spent some time in the chapel area, writing heartfelt notes, wishing and praying for the best possible outcome. The doctor at John Muir pulled me aside after the biopsy was over to inform me that he believed Darrell had a thymoma that would require open-heart surgery, chemo, and radiation. “He’s not going to be able to work anymore, not for some time. In fact, it will be hard,” he said gruffly, a doctor with not the best of bedside manners. And with that he was gone. I was left in tears, worried about my husband’s chest cut open, the danger around cutting near the aorta.  Later, I remember being comforted by my sister-in-law over the phone shortly after.

No one ever tells you how time seems to slow down when you’re awaiting a cancer diagnosis. Especially around the holidays.

After about a week, the biopsy came back: Inconclusive. The doctor had cut around Darrell’s chest area and there still wasn’t an answer?? We were disappointed and angry.  So was Darrell’s oncologist. Apparently, he chewed out this doctor at John Muir who had recommended we go ahead and act as if this were a thymoma. Again, Darrell’s oncologist pulled some strings, and this time, sent him to Stanford, even though it was now close to Christmas. We were worried time was running out. Would we have time to shrink the seemingly unusually large tumor?

Our answers came easily at Stanford. This time, the doctor we were assigned to who did the biopsy was easygoing and made us feel at ease immediately, unlike the one at John Muir. He guessed it was lymphoma, not thymoma, and he was right. The biopsy was quick and easy, a short outpatient visit, and within a day or two, we found out Darrell was diagnosed with Hodgkin’s Lymphoma (Stage 2B). The doctor assured us that if there was a cancer to get, this was “a good one.” Again, we laughed. Relieved. But our oncologist was still concerned with the size of the three tumors (7, 3, and 2 cm). He had three near his heart, and the chemo would have to pass through his aorta. I worried about how fragile that area was, how fragile the heart can be. Would he be able to handle it? (A lesson learned here: Just because someone is an esteemed rock-star doctor, he may not know all the answers. You are your own best advocate when it comes to your own health. Don’t be afraid to get a second opinion.)

But at the same time, we were both ramping up the ketogenic diet, now following Miriam Kalamian’s advice in her book, along with other keto for cancer books out at that time in 2015. We bought a scale, Ketostix at first, used MyFitnessPal for macros, then the Precision Xtra to measure glucose and ketones, discovering Dr. Thomas N. Seyfried’s book that Darrell immediately downloaded onto his Kindle, a dense medical book that recommended that the GKI be as close to 1 as possible. I wrote a blog post for Heads Up Health, a client of mine, about how Darrell and I tracked his Glucose Ketones Index during his cancer, and still do, now in remission.  He included some fasting as well. To support Darrell, I decided to eat mostly keto too. I was also intrigued to see if it could help my moods as someone once diagnosed with Bipolar Type II, having read in Jimmy Moore’s book that the keto diet had the potential to help those suffering with this disorder. I had been off all meds–including asthma–simply reducing the amount of flour and sugar back in 2012, and was encouraged by what a Paleo/Primal diet could do. Also, my doctor had warned me that with my latest HBA1C, I was now diagnosed with prediabetes. (In 2016, we began tracking our health using Heads Up Health, enjoying the ability to import medical records from different labs and using the Analyzer graphing feature to see how far we’ve both come in terms of our health, motivating us to continue staying keto-adapted.)

The oncologist, radiologist and the nurses in the chemo infusion room all noticed how rapidly Darrell’s tumors were shrinking. They also remarked on Darrell’s lack of the usual symptoms post-chemo: no hair loss, no nausea. Even though all food Darrell ate tasted like metal, he enjoyed eating the mug cakes, the fat bombs, bone broth and all the keto food I made using a Paleo/Primal lens. We kept his net carbs really low, at 12 net carbs, weighing and measuring portions, afraid to eat too much protein then, due to gluconeogenesis. I pricked my finger alongside Darrell daily, checking our blood glucose and blood ketones (beta-hydroxybutrate/BHB), then making sure his GKI was low as possible. The fasts helped with the chemo, lowering insulin and raising ketones. “Whatever you’re doing, keep doing it!” One nurse smiled warmly at us after checking Darrell’s blood test results before beginning his hours-long infusion, seated in a lazy-boy-like recliner, his laptop still propped on his lap as he refused to quit working full-time. His employers were understanding, wanting him to take time off, but working gave Darrell something else to think about, and this was what he wanted then.

During this time — several months — of weekly chemo infusions, Darrell stopped taking the BART train for fear of catching colds, compromising his immune system. Instead, he took a commuter bus near Oakland that brought him into San Francisco where he worked downtown for a FinTech company.

Although I know the treatment and oncologist helped, what Darrell and I both know today is that eating keto played a part in quality of life, and we feel it in our bones that it also helped in the rapid shrinking of the large tumors that resided in his chest.

Now it’s 2018 and in October, Darrell will have been in remission for three years. Even though much older now, we are both now in the best shape of our lives. Although not 100% compliant every single meal, we still incorporate keto eating and fasting into about 90% of our lives. What keeps us keto-adapted and in ketosis most of the time is tracking our health (e.g., blood ketones, blood glucose) with the Keto-Mojo (much more affordable blood ketone strips than Precision Xtra) and Heads Up Health (e.g., GKI, waist and hip measurements, weight, lab tests like the Hba1c), MCT oil, butter and ghee. And now almost three months in, we’re about to embark on a trip around the world in our RV, finally having the energy to exercise, to pursue our dreams. We recently sold our house in the SF Bay Area and downsized in the biggest way, leaving a 3K+ sq ft house for a 100 sq ft expedition vehicle/RV.

     

Life can still be stressful at times, but we have so much to look forward to now.

And with that, I cannot be more grateful.

How I Stayed Keto-Adapted on Vacation

Eating carbs on vacation while staying keto-adapted

Is it possible to stay keto-adapted on vacation?

For anyone who has been eating keto, it is pure joy to come back from a vacation and still be keto-adapted. In fact, our last vacation to Costa Rica started out with great intentions, but by the end of the trip, we had indulged in everything and completely fell off the wagon.

Now, there is absolutely nothing wrong with indulging on a vacation.

But what my husband and I both noticed was that every time we fell off the keto wagon due to indulgences related to travel or special occasions, it took a long time–sometimes, many months–for us to get on track again.

And because we’re both eating keto for our health, not just for weight loss, staying keto-adapted, as much as we can, is important to us. (My husband, now in remission from cancer–Oct 2018 will be three years–used keto specifically during his cancer from 2014 to 2016, as an adjunct to conventional treatment; I’m eating keto primarily for prediabetes and its impact on my mental health, namely anxiety and depression, and focus, having been diagnosed with Adult ADHD.)

So how did I manage to stay keto-adapted this time? Especially to a carb-laden destination full of temptations such as Taiwan?  As I have never accomplished this feat before on past vacations, I’ve decided to document what worked this time, in case I forget and need to jog my own memory.

First of all, what does it even mean to be keto-adapted (aka fat-adapted)? Dr. Stephen Phinney, who coined the term, “keto-adaptation” and wrote, along with Dr. Jeff Volek, the books,  The Art and Science of Low-Carbohydrate Living and The Art and Science of Low Carbohydrate Performance, has a great article to learn more about the science behind it.

From Phinney and Volek’s The Art and Science of Low-Carbohydrate Living (p.22):

Keto-adaptation is a term coined by Steve Phinney in 1980 to describe the process in which human metabolism switches over to using almost exclusively fat for fuel (i.e., a combination of fat burned directly and as ketones derived from fat). While well studied and documented mainly in the context of starvation, ketone metabolism is not well-understood by most physicians (let alone nutritionists, dietitians, trainers, and athletes) as an approach to improve health and performance. This is primarily due to the emphasis in standard nutrition training placed on dietary carbohydrates as the preferred fuel for physical performance.

Basically, it’s when your body switches from being a sugar/glucose burner to a fat/ketone burner. It’s when you’ve been compliant with a ketogenic diet, keeping your carbs low, fats high, and protein moderate. And the cravings for carbs (sweets, bread, pasta) go away. You find yourself being able to go for hours without wanting to eat. This can take a while, about several weeks or so, if not longer. You’re also, depending on your metabolic state, able to get away with eating some carbs once in a while, and easily get back into ketosis. At least, that’s what I experienced during this recent vacation in Taiwan.

Even though I began eating a keto diet in December 2014, when we first began using keto for my husband’s cancer, I had always had trouble becoming keto-adapted because I had a half-assed approach to keto eating. What this means is that I’d get into ketosis for a few days, then go have a pizza (the kind with a wheat crust) when stressed out, then attempt once more, battling the keto flu all over again.

But even with my half-assed, lazy, version of keto, I ended up reducing my HbA1C from a prediabetes level of 5.8% to a more “normal” number of 5.2% within a year. So it shows that some keto eating is better than none. Even if it’s the kind of keto eating where you never become keto-adapted, like how I was until recently, finally keto-adapted from August 2017 until now (March 2018). Although I’ve been keto-adapted before, it was never for long, and soon I had succumbed to carbs back again.  What finally helped me get keto-adapted this time–and actually stay this way–was having accountability.  In July 2017, I signed up for an early bird discount for Shawn Mynar’s Fat Burning Female Project ,  an online program with lots of support and advice on how to eat keto and become keto-adapted, aimed specifically for women. I loved Shawn’s approach of not focusing on the number on the scale, that weight was something that falls off once your body begins to truly heal. And she brings you down from carbs slowly, so your body isn’t shocked from going from high carbs to suddenly low. (Of course, you can get keto-adapted on your own, with discipline and compliance, but I’m someone who craves accountability, and this was, in my eyes, an investment in my health.)

Here’s an informative article by Amber O’Hearn on keto-adaptation. I especially love the section on “How to make keto-adaptation as quick and painless as possible.” Great tips for those trying this on their own.

GKI-fast-therapeutic-ketosis
My 8-Day Extended Fast, in Therapeutic Ketosis (GKI 1 or under)

How I Stayed Keto-Adapted on Vacation

  1. I used a glucometer and ketone meter. Every morning, I checked my fasting glucose and blood ketones, using my favorite new health device: the Keto-Mojo. (I love how the blood ketone strips are so much cheaper than the ones I used to buy for my Precision Xtra glucometer, allowing me to actually measure my ketones daily.) This is a great way to get immediate biofeedback, helping you make course corrections as needed. I don’t even check my weight regularly on a scale anymore (just once a month, relying on body measurements of waist, hip and how clothes fit more). And I don’t track my macros (I did at first, when first learning how to eat keto, though.) Now I just rely on three numbers daily: fasting glucose, ketones, and my GKI (glucose to ketones ratio), regularly tracking every morning. These numbers give me, as someone with prediabetes, an instantaneous idea of how I’m doing health-wise.
  2. I tracked my health to keep motivated and adjust as needed. I’m one of those weirdos that oscillates between analog and digital, preferring to first record my fasting glucose and ketones into my bullet journal health tracker, then log these numbers into Heads Up Health**, a health tracking site that is a phenomenal help for people like my husband and myself, who follow a keto and low-carb-high-fat (LCHF) lifestyle. Here you can easily enter your blood sugar numbers and ketones in the Dashboard and have your Glucose: Ketones Index (GKI) automatically calculated. This was a biomarker my husband tracked exclusively during his battle with cancer, following Dr. Thomas N. Seyfried‘s advice of keeping the GKI between 1 and 2. Recently we learned from a podcast with Thomas Seyfried with HVMN founder Geoffrey Woo [00:34:49] that when your GKI ratio is 1 or below, you’re in “Therapeutic Ketosis.” In Seyfried’s own words, “As I said in my book–Chapter 19–on cancer prevention…if you can get yourself down in therapeutic ketosis for three to five days, you’re blasting the crap out of these incipient tumor cells. Your body’s just going through and gobbling them up, eating them. So, before they can take off and start growing as a neoplasm, which is a dysregulated growth of cells, your body is killing them. So therapeutic ketosis, I always say, is a place to visit. But it’s nota place to live. You visit the zone periodically. But you don’t live in the zone.” (See graph where I fasted for 8 days, bringing my GKI under 1). Probably my favorite feature of Heads Up Health is the ability to graph your biomarkers using the Analyzer to notice trends. This allowed me to spot correlations between lack of sleep and high glucose, or too many carbs the day before and lowered ketones the following day. Seeing this on a graph helped me make course adjustments as needed.  
  3. The incorporation of fasting.  Fasting is a great tool to use to stay keto-adapted. For example, if my fasting glucose was higher than I wanted in the morning (and my blood ketones lower) because I ended up eating more carbs than I had anticipated, I can easily, bring the numbers where I want them to be the next day by fasting. If the numbers are looking pretty bad, I might opt for a 24 hour fast. If the numbers are close enough but could use some help, I might do some intermittent fasting, going for 16:8 (e.g., fast for 16 hours and eat within an 8 hour window). I also know that an extended fast can be done once the vacation is over, as a way to cleanse damaged cells (aka autophagy), which is highly protective as a way to prevent cancer, per Dr. Thomas N Seyfried, whose book my husband read when he first began using keto for his cancer, beginning December 2014 (see above mentioned podcast link). At least once a year, my husband and I aim to get into therapeutic ketosis, tracking and monitoring our GKI using the graphing/Analyzer feature in Heads Up Health.  I should also mention that being keto-adapted already makes fasting so much easier than when you’re not. You go into the fast padded with fat and don’t experience hunger cravings that you’d normally experience if you were to go from a Standard American Diet (high carbs, low fat) diet straight into fasting.
  4. Being keto-adapted already helped me finally understand what it means to “eat in moderation,” something people who don’t eat keto or low-carb love to say to you. (“Just eat in moderation! Live a little.”) But what they don’t get, is that for insulin resistant and metabolically challenged people such as myself, this advice doesn’t work. That is, UNTIL YOU ARE ACTUALLY KETO-ADAPTED. Then for the first time, I am truly able to understand what it means to “eat in moderation,” especially when it comes to refined carbohydrate-laden foods, such as many breads, cakes, cookies, and pasta. This time, being in Taiwan, I actually sampled pork dumplings, pork buns (xiao long bao), green onion pancakes, sugar-laden treats from the dessert bar at the hotel buffet, hash browns, and even Afternoon Tea savories and sweets. If you know me at all, I have never eaten like a bird. I’m one of those “All or None” folks who eat until every last morsel is gone. God forbid I waste food when so many in the world are starving! That’s the way I was raised, the way I’ve taught myself. You will rarely see me with leftovers. And I eat fast, practically inhaling the entire plate before you’ve even finished asking me a question during a meal.  So let me tell you: being keto-adapted allows something inside your mind and body to tell when you’ve eaten enough. Even some sugar-y thing. I’ve never had this capacity in my life before; I swear, this feels like a new-found super power! Now you don’t necessarily have to be fat-adapted to follow steps 1-3 above. But trust me: It’ll certainly make the process much easier.

Being keto-adapted is an amazing state of being. Your blood sugar levels are pretty even so you don’t get “hangry” as you once did when you were eating high carbs and low fat. And you just have energy and enthusiasm about life that just wasn’t there before, able to tackle things you’ve been putting off, trying new things you’d normally be afraid of, like selling your house and moving into a RV. Now my husband and I feel a sense of freedom and joy, excited about the life ahead of us with our family. With all that we’ve gone through, there’s one thing we know for sure: health is the ultimate wealth.

 

**Note: Before coming on board working part-time at Heads Up Health to help with writing and social media,  I had been avidly using it to track my own ketones, glucose, GKI, plus body composition measurements. I especially love how I’m able to centralize my medical records and blood tests such as my hbA1c, thyroid and cholesterol numbers, and track the data I’m self-collecting with devices like the  Keto-Mojo, apps like MyFitnessPal,  and wearables such as the Oura ring (I’ve preordered one because that’s a huge area in health I’d like to get better at: sleep.)

If interested, I wrote a blog post for Heads Up that detailed how my husband and I tracked his GKI during his battle with cancer, using the keto diet as an adjunct with conventional treatments. I also help maintain a keto for cancer resources page there.