So it wasn’t so bad.
This is a follow up post to: Why My HIV Doctor Appointments are Stressful
I went to my doctor’s appointment and it was overall a positive experience. I told you I love my doctors, even if I was nervous about being outed as a Paleo/Ifer! But I may have found a working solution to this concern. More on that in a bit.
First the not-so-great news. When I first went these doctors in 2013 my CD-4 count was about 443. Now to give a reference, normal levels are 1,200 to 1,500. If you fall below 200 then you are classified as having AIDS. CD-4 count measures the current function of your immune system. The higher the number, the better your immune system is working. My numbers steadily progressed into the 500’s and then in 2015 jumped to 910. For some reason though, when I was tested in November 2015 my CD-4 count was 558. The newest test taken yesterday hasn’t been posted yet so I will update then.
*Update 2/08/2016 new blood work. My CD-4 count went down to 517.
I have experienced more routine illnesses this year than has been usual, but I didn’t think too much of it. Apparently my immune system has been struggling more to fight it all off than previously. They are not sure why yet, but sometimes this happens. It just means I have to be more careful for now until a plan is decided on. Maybe increase my medication dosage or try a new medication. So that was a little disappointing.
But there is a lot of better news! I recorded my routine numbers from 2014/2015 and the most recent numbers from my visit.
End of 2014/2015:
- Age: 32
- Weight: 210
- Body fat: 20%
- Triglycerides: 600
- Blood Pressure: 142/104
- Age: 33
- Weight: 175
- Body fat: 15%
- Triglycerides: 190
- Blood Pressure: 118/89
In 2014/2015 I was diagnosed with metabolic syndrome and as pre-diabetic. My glucose was in the high range. Now it is in the normal/low range. They were significantly worried about my heart, prescribed me blood pressure medicine and planned to prescribe me cholesterol medicine if the other numbers didn’t improve. My cholesterol then was 253 and yesterday it was 222. Overall Cholesterol ranges:
- Undesirable <200
- Borderline 200 – 239
- Desirable >240
My HDL cholesterol was 29 and yesterday it was 59.
- Undesirable <40
- Borderline 40 – 59
- Desirable >60
My LDL Cholesterol is 125. They didn’t measure this last time.
- Optimal <100
- Near Optimal <130
- Borderline High 130 – 159
- High 160 – 189
- Very High >=190
Read a fascinating looking into Cholesterol from Gary Taubes from 2008 in the New Your Times.
As I referenced in my previous post on doctor’s visits, Gary Taubes goes into great detail as to why worrying about Cholesterol might not be so important for men and certainly not for women. But fortunately my numbers look good by the approved standards. My doctor did discuss my overall cholesterol though and wants me to take a statin drug.
My blood pressure was the primary concern after managing my viral load and CD4 count. According to Heart.org I was in ‘High Blood Pressure/Hypertension Stage 2’ in 2015. Now I am in Prehypertension because the bottom number is over 80 but under 90. My doctors, however, said it was very good and I shouldn’t worry about it right now. They no longer think I need to be on medications.
My triglycerides were ‘impressively high’ as my doctor put it when I first came to them at 600. This, according to Mark from Mark’s Daily Apple, is pretty bad:
High triglycerides correlate strongly with low HDL and smaller, denser LDL. High triglycerides, then, could indicate more oxidized (or oxidizable) LDL. The triglycerides of most Primal eaters, especially those on the lower carb side of things, usually hover well below 100 mg/dl.
It seems like on this, my doctor and Mark agree. High triglycerides mean trouble. They just differ in cause and effect.
Mark: Are your triglycerides going down over time? That’s great. Is your HDL trending up? Also good.
The Mayo Clinic:
Cut back on calories. Remember that extra calories are converted to triglycerides and stored as fat. Reducing your calories will reduce triglycerides.
Choose healthier fats. Trade saturated fat found in meats for healthier monounsaturated fat found in plants, such as olive, peanut and canola oils. Substitute fish high in omega-3 fatty acids — such as mackerel and salmon — for red meat.
My triglycerides have since lowered from 325 in Nov 2015 to 190 yesterday. Under 150 is the best, but I am no longer in the danger zone! My HDL is also increasing as my triglycerides decrease so I on the right path Mark describes! Both Mark and Gary Taubes in Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health indicate carbohydrates increase triglycerides.
So far I have working on intermittent fasting and trying to eat paleo/natural/less processed. I haven’t really focused on carb/protein/fat ratios so far. So if I eat nothing but gluten-free foods for example, I might keep my triglycerides too high and counter the good the other options are creating. I need to think of how the foods I choose affect my overall health as well as my weight loss goals and immediate sense of hunger satisfaction.
So what happened when I told them about my diet? Well…I only sort of told them. They were shocked by the improvement of my numbers, especially my blood pressure and naturally asked me what I was doing differently since they figured out I hadn’t requested a refill on my blood pressure medication. I sort of let them lead the conversation:
Doctor: ‘Sooo, what have you been doing differently?’
Me: ‘…well I have been changing my diet for a few months trying too…’
Doctor: ‘Lower calories, salt? Eat more veggies?’
Me: ‘…uh huh. *paused…cautiously, and you know, trying to limit my bread and sugars, cutting out soda…’
Doctor: ‘*nodding with approval…yes yes, see! Cut out all that fat and sugar and it has a positive impact! Just make sure to get enough good whole grains!’
Me: ‘*forced smile…sure. Ok. Uh huh.’
I did, however, approach the idea that I might be gluten-sensitive and to my surprise my doctor was receptive. I explained that after removing a lot of bread I felt a lot better and when I ate any bread I felt terrible. She nodded with concern and mentioned I might have an allergy. So we did a test. I am unsure of the result though. I just says my score is a 219 with a range of 40-600. I think you have to be outside those numbers. I will just wait till next checkup to see.
It seems that the results mattered more than the details. Although they still think I should keep medications in mind to really push me over the winning line, but didn’t push too hard when I redirected the conversation back to diet and exercise. I think if I showed up with troubling numbers it would matter a lot more what I was eating. Perhaps the positive outcomes of paleo/natural/IFing etc will eventually speak for themselves. We don’t have to nudge things. They just happen.
As always, I look at blood results as a snapshot of my body at that moment. You can only gauge progress or improvement through routine and predictable intervals with measurements you can follow. I think I need to consider this more carefully. I cannot remember how I ate, when I cheated or how often I ate any particular food type in the last month. How can I see a connection between my actions with my blood results?
I need to commit to recording my eating habits, exercise and other factors and see a routine doctor for routine work in-between my 3 to 6 month HIV appointments. While it is interesting to see the difference in a year, it would be better to see what changed in the last 3 months with a record of why.
I am also not too nervous or upset over my CD4 count either. Unless it remains low, I can always work to better my immune system through diet, sleep, stress and other methods. The medication I take to keep HIV in check can be adjusted and I will adjust to those changes. It is all something I can with as long as I have the drive to better tomorrow than I am today.
I call this a success overall.
Although many of the books I link to on the side column and discuss in my posts are extremely educational and helpful, one book and one author in particular significantly guided me in a way that I believe allowed me to get to this place today. Of course that would be Miss Melanie Avalon. I have praised her book The What When Wine Diet: Paleo and Intermittent Fasting for Health and Weight Loss, blog, youtube channel and personal guidance previously, but its because all of those things have significantly helped me. I am convinced intermittent fasting is the foundation of my improvement in terms of blood pressure with reducing breads and soda to thank for lowering my other numbers.
I recommend her so highly because her efforts empowered me to try something I thought was just too difficult. Now that I see such positive results from very spotty and inconsistent work, I am far more motivated to straight the lines and get on a permanent track.
Enough experimenting! I know what works now. Its time to get serious about this for my health and my future!