Take advantage of services offered: treat yourself like a friend

Using myself as an object lesson once again, I’ll remind anyone with a less than perfectly functioning self to make use of the services that are offered to you. More than that, be proactive, and request what you need.

It’s amazing how many ways there are to make the trials of modern travel easier, but also amazing how loathe some of us can be to ask for help.

Today’s case in point: having a difficult joint act up while waiting in the Dublin Airport 51st & Green airside (past security) Lounge. This is a lovely, bright airport lounge. There are quite a few worse places to pass a few hours. Its design, meant to evoke the Neolithic tomb Newgrange, immediately made both myself and my husband think of 2001: A Space Odyssey when we (on separate occasions) entered.

Evocative–and attractive–as the long, white entry corridor is, it’s enough to strike fear into the heart (or knee, foot, hip) of an individual struggling to walk without pain. The toilets are 2/3 of the way down, back by the reception desk. Sigh.

I thought about going to ask for a wheelchair escort when the pain struck, then sat down, determined to ignore yet another annoying infirmity. Then I had this thought: if my husband were here, he would demand help for me, because he thinks I deserve it. And he’s right!

If I were watching a loved one struggle with pain, even mild pain, I would seek help, and I would insist s/he make use of it. Why should I do any less for myself?

Am I suggesting that I’m the center of the Universe, that everything revolves around me and my needs? Well, no. But I would argue that treating myself as less than I would a friend or casual acquaintance isn’t brave or valiant, it’s unloving and unwise.

Self advocacy doesn’t equate to self indulgence.

Considering antidepressant medication? Try vitamin B-12 first.

This isn’t medical advice. I’m not qualified* to offer that.

Vitamin bottle B12 - 1I am simply a self-educated consumer who lives with a chronic health condition. I’ve drawn my own conclusions from research done as an intelligent lay person, tempering it with common sense. I invite you to do the same.

Many of us diagnosed with autoimmune conditions, degenerative neurological diseases, and chronic pain will be prescribed antidepressants. There are fine reasons for this.

Some chronic pain responds positively to antidepressant medications. Given in lower doses than those prescribed for psychological reasons, side effects are often less as well.

Here’s a link to a (long, almost 2 hrs!) YouTube presentation by Dr. Dan Clauw, M.D. that offers a great explanation for the current understanding of why these drugs may help certain types of pain.

Depression is also a normal human response to learning you can expect to spend the rest of your life with constant pain or in a rapidly degenerating physical condition.

That is a depressing situation for any rational person to contemplate. Treating mental health problems is important, and I do not sit in judgement of anyone who takes pharmacological steps toward better self care.

If you are a danger to yourself, please seek immediate, aggressive care. Do whatever it takes to get well. Your life matters.

That said, I’ve recently learned that the major physical symptoms of depression mirror almost exactly those of a vitamin B-12 deficiency. Hmm…

Even patients with valid diagnoses of other conditions—here’s a study about multiple sclerosis, for example—often have other stuff going on in the body that can make symptoms worse. Large numbers of hospitalized, depressed patients have measurable Vitamin B-12 deficiencies.

It isn’t known yet whether B vitamin deficiencies help create conditions that allow us to develop disease, result from lifestyle responses to living with chronic illness, or are direct side effects/symptoms of disease processes.

I’d argue that the underlying mechanism doesn’t matter so much when we’re talking about supplementing with vitamin B-12.

Why? There is no known upper tolerable limit for safety for supplemental B-12. Say that in plain English? No one ever “overdosed” on this vitamin.

Here’s a link to a more reputable (than me) resource, a state university, for detailed mainstream medical information on the subject of Vitamin B-12. And another to a US government fact sheet on the vitamin for American consumers.

B-12 is water soluble. If you take too much to be used by your body, it will leave your system naturally via your urine. You might “waste” the vitamins you’ve bought and paid for, but odds are tiny** that they will hurt you in any appreciable way.

If someone is ready to prescribe antidepressants to a patient, that patient must have at least one medical doctor who could also be consulted about taking vitamin supplements. Ask your doctor before starting a new treatment, including Vitamin B-12, but, odds are, you will be told this is safe to try.

You may also hear that vitamin B-12 won’t help you. But, then again, antidepressants aren’t a guarantee either. They include a long list of side effects, some of which are very unpleasant. Those prescription pills can also be expensive.

Also, it’s just as unscientific to assume the vitamins won’t help you as to assume that they will.

I’ve come to realize that no one cares as much about my health outcomes as I myself do. With good insurance and caring doctors, I’m still left with unanswered questions and a merely tentative diagnosis for what causes my chronic pain and fatigue. Where stakes are low and scientific certainty is lacking, I choose to perform nutritional experiments upon myself.

If it is highly unlikely to hurt you, and it could help you, why not take some extra vitamins for a while and see if you feel better, too?

Assuming your doctor said such a trial is safe, the only possible barrier is cost.

I picked up a bottle of store brand vitamin B-12 at wholesale giant Costco with 300 pills for $19. Each offered thousands of percent (20,833%) of the RDA***, making a bottle good for the better part of a year taking one per day.

That works out to $23.12 annually. Costco typically offers very good value.

At an expensive local vitamin specialty retailer, a three month supply (of 16,667% RDA pills) cost $16, coming out to about $64 per year. I suspect it would be hard to spend much more than this for these vitamins.

vitamin-bottle-b12-2.jpgThere are several forms of B-12 available, and both of these offerings are for the most expensive type, Methylcobalamin.

Some users have reported that the most common, cheaper form, Cyanocobalamin, doesn’t resolve their symptoms, but the Methylcobalamin form does. At less than $20 per bottle, it seems within financial reach of most Americans to do this self experiment with the potentially most effective version of the supplement.

My two sample bottles also both contain dissolving lozenges to be held under the tongue rather than swallowed and processed through the digestive system. Again, some argue that a sublingual or injected B-12 is more effective than a swallowed dose. I went out of my way to test this type of supplement, just in case, though science tends to think it is irrelevant for most.

In all of this, note that my primary interest is in clinical results, i.e., how I feel. It will be great if research comes to understand why and how B-12 or any other supplement improves patient outcomes. But I am not a working scientist.

The bottom line for how I make a decision about self-treatment comes down to whether or not I feel better, and at what risk.

The “clinically small” improvement of a group of MS study participants quoted above may be of only slight statistical significance, but when your function or your sense of well being has descended to, say, 25% of your old normal, well, then, 27% or 30% represents a win.

I don’t know what you should do to help yourself live a healthier life. I do have some opinions about which alternative health practices represent good risks worth a try for a person in pain. Perhaps this little experiment can ease some of yours, too.

Your body; your choices. Make them in good health.

*My education in both Biology and Chemistry ended in high school as my college science classes were limited to Physics courses. My major was Mathematical & Physical Sciences with a concentration in Computer Science.

Make no mistake that the side effects can be significant, however. They are also likely to affect your offspring, not just yourself. There are studies showing this in very obvious and less direct ways.

Powerful drugs are appropriate to treat significant illness, but I’d argue that they should be employed after milder alternatives have been tried and found insufficient.

Other sources, regarding. depression.and .neurological and psychiatric disorders

**There are some instances of allergic reactions to vitamin B-12, but I only read of such response to injections (shots), not over the counter vitamin pills. Reports of acne or skin rash in response to large dose vitamin pills do occur with some regularity.

You decide whether temporary skin issues are something that would stop you trying a larger dose of this vitamin for yourself.

***In most cases, we do NOT know the “optimal” level of vitamin intake. Vitamin B-12 reference ranges vary from 180-914 ng/L in the USA, 135-650 pmol/L (183-881 pg/mL) in Australia, and 500 – 1300 pg/mL. (ng/L=pg/mL, so no conversion necessary there.)

If you think this is an important thing for people to know, write to your government representatives and tell them you support basic nutrition research. Private companies have very little motivation to pay for this kind of work; there’s no resulting drug patent to fund the endeavor.

There’s a reason some public services, like infrastructure and basic research, are paid for by taxation. Otherwise, they simply aren’t available to all of us.

What I eat affects how I feel: consider an elimination diet for chronic pain

The Internet is full of dietary advice, much of which has as much basis in opinion as fact. I won’t try to define for you what constitutes healthy eating, but I can share an effective strategy for testing your own diet that could potentially improve your health and well-being.

You could feel healthier within weeks, and it is free

Twice in my life, I have undertaken “elimination diets.” I credit this process with measurably reducing symptoms that were severely impacting my quality of life. In my case, I was able to reduce migraine headache symptoms from daily to just a few episodes per year. More recently, I shifted constant, debilitating joint pain and fatigue associated with autoimmune disease to a still regular, but less incapacitating, condition.

In both cases, I was able to stop taking some preventative prescription drugs and take fewer pain relieving drugs (an objective and measurable result.) I also made myself feel better (a subjective improvement in my well-being.)

You don’t need to spend an extra penny to try it, and you should know within a month if it is going to work for you.

What is an elimination diet?

An elimination diet is not designed to eliminate weight and/or fat. This isn’t a weight loss diet. I think of it as a health gain diet; you could also consider it a symptom loss diet. I prefer to focus on the positive.

Reduce foods you eat to a “safe” list

Put simply, an elimination diet involves first reducing your diet to a limited list of foods known to be inoffensive. By inoffensive, I mean foods that are not commonly allergenic or irritating to the system. At this stage, you would eliminate any food you think might be triggering your own symptoms.

Re-introduce different foods one at a time

After a period (typically around three weeks) on the very restrictive diet, you re-introduce new foods one at a time into your meals and see if symptoms recur or increase. If you feel worse, you remove the offensive (or “trigger”) food again and go on to the next test food. Ideally, you wait a day or two after being “triggered”/negatively affected so your body can return to a neutral state.

Continue this process until you have tested the foods you prefer

You continue this process until your diet includes everything you prefer to eat (excluding trigger foods!) Speaking again from my own experience, it took me a few months to recover from almost daily migraines; I experienced profound relief on day four of my elimination diet for autoimmune disease symptoms.

Elimination Diet food picture - 1

I began with a low-fat, vegan diet of exclusively cooked foods, mostly vegetables. Olive oil was my only fat. I included rice, quinoa, and black beans. I avoided foods that I previously ate the most frequently.

What foods are safe to start an elimination diet?

The first time I did an elimination diet, my primary care doctor gave me a “migraine diet” that I used as a starting point. On my second go ’round, I consulted with a nutritionist recommended by my regular physician to compile a food list for myself based upon a website and a book I regarded as trustworthy.

I used the book, The Elimination Diet by Segersten and Malterre. I borrowed it from my library and read the whole thing, but you don’t need the book to try this technique. This couple does offer many useful resources as free printables on their website, however, and they do a nice job providing a thorough blueprint for those who don’t want to do a lot of planning for themselves.

The point of this intervention is to find out, for yourself, how specific foods affect you.

If you don’t know which foods to start with, begin with a recommended diet from a professional—either your own health provider, or a list from a book or website whose credentials you trust.

An elimination diet is a short-term experiment

Perhaps the most vital thing to know about this diet is that it is never meant to be permanent. I hate the experience of working through an elimination diet, especially those early, very limited weeks, but I like the results enough to commit to a few weeks of deprivation to feel much better.

If you undertake this process and finish up with a long list of foods you plan to permanently eliminate, I strongly encourage you to consult a dietician or doctor to ensure your nutritional needs will be met. In my case, only a few key foods seem to be responsible for a majority of my current symptoms.

Look beyond the usual suspects

Perhaps the most interesting thing I learned in my most recent elimination diet phase was that two common foods I’d barely suspected give me the most trouble. I won’t name them because it’s easy to label foods as “bad” and then proselytize for others to avoid them.

Please do your own experiment and find your own best diet. My two “bad foods” are not any of the foods so popularly demonized these days. (Hint: neither of them is a grain or gluten!)

Your long term diet should be healthy and sustainable

I’ve learned that other foods—some of which are commonly listed as likely triggers—affect my symptoms, too, but they do so in a more gradual, symptoms-building-up sort of way.

For example, I can include some dairy and some organic wheat in my diet and live pretty comfortably. I don’t eat freely of these foods, limiting them to special occasions, but I enjoy life a lot more. Allowing these, in moderation, means more excitement and variety in my meals, which is another factor in long term, emotional well-being.

The myth of “the” healthy diet

My two dietary interventions happened about 20 years apart and resulted in the adoption of somewhat different “ideal diets” each time. The biggest similarity between the two situations was the process.

Did I misinterpret my results the first time I did an elimination diet? Have my needs changed? Has food itself changed? All of these are possible.

It is really difficult to do great studies on human nutrition. To put it very simply, this is because:

  1. There’s no expensive product to market afterwards, so no one wants to pay for long term, well controlled studies of large groups, and
  2. People have really complex lives so it’s hard to design great studies that give straightforward results.

For this reason, I take every bit of nutrition advice with a grain of salt, and I try to stay very open-minded as new research is published. I think it is likely that different people have unique dietary needs based upon lifestyle and genetics, the same way we are susceptible to different injuries and diseases. I think we probably need different nutritional inputs at different stages of life.

I also believe that the adoption of modern, processed foods has likely affected human health in currently unknowable ways. After all, “traditional diets” sustained us for thousands of years, and they differed around the world. What are the odds that one very specific diet could optimize health for all individual human beings?

In the USA, our doctors typically receive little to no training in nutrition. They can advise us when we need to lose weight, or tell us to “eat a healthy diet,” but they aren’t necessarily in a better position than we are ourselves to create a specific blueprint for what we should feed ourselves.

I advocate this particular approach to health through nutrition experimentation because I have personally experienced success with it, twice. It is also free, costing more in time and commitment than financial outlay. You will have to do some planning to successfully undertake an elimination diet.

I don’t believe that we are responsible for every ailment that befalls us. Sometimes, we get hit with an unlucky break, in health as with the rest of life. But here is an opportunity to shift the odds back in our favor by putting in a bit of effort.

If you are suffering, consider trying an elimination diet. The most you have to lose is a little time—and the enjoyment of a few favorite meals—over a few weeks. What you stand to gain is good health.

Have you tried, or considered, an elimination diet? What were your results?