Saturday, February 27, 2010
By Diana Hsieh
Saturday, February 20, 2010
By Diana Hsieh
Raw milk sales are illegal with one exception: An individual with a written recommendation from a physician may purchase raw goat milk.
"So why do I feel so terrible, doctor?"
"According to your labs, you have a rare intestinal disorder. It's called Capralactinecessitis."
"Oh my gosh! Can it be treated?"
"Yes, but only if you drink milk that would kill a healthy person. I'll write a prescription."
By Diana Hsieh
I made beef brisket in the Sous Vide Supreme for dinner last week. It turned out great, so I thought I'd post out what I did.
Mostly, I used the instructions from Douglas Baldwin's uber-helpful Practical Guide to Sous Vide Cooking.
I brined the brisket in saltwater for a few hours, then seared it in a pan. I added the meat to the bag, then some garlic powder, dried thyme, some fresh-ground pepper, a bay leaf, a bit of ground cloves, a few sprigs of fresh rosemary, and one ice cube of beef stock. I vacuumed it up, then cooked it sous vide for about 28 hours at 165 F. When ready, I drained the juice, reserving about 2 cups (!) for later use, then reduced the remaining 1/2 cup in a saucepan to make a sauce. For thickness, I added some frozen blueberries to the pan, cooked them a bit, and then smashed them with my potato masher.
The meat was well done, yet flavorful and tender. Paul gave it two thumbs up.
A few notes:
- I'm not sure the searing was helpful; I'll skip that next time.
- The cube of beef stock definitely wasn't necessary, as it released lots of juice on its own, probably due to the brining.
- The "Practical Guide" recommends 176°F (80°C) for 24–36 hours. However, it notes that the French Laundry does 147°F (64°C) for 48 hours. I split the difference, but I think I'll try the French Laundry way next time.
The pain-in-the-butt part about sous vide cooking is that you have to experiment a little to find how to cook things exactly as you like them. Once you do, though, the advantage kicks in, which is that you can repeat ad infinitum and always get the same result.That's exactly why I try to keep good records of what I've done sous vide, whether it works well or needs some tweaking.
Saturday, February 13, 2010
By Diana Hsieh
By Diana Hsieh
Thanks to a hint from Travis on OEvolve, I recently made halibut in my Sous Vide Supreme. (I've cooked salmon sous vide before, using the same time and temperatures as below -- with great results.) Travis' description of "jaw-droppingly good" was not even remotely adequate!
I cooked two fillets -- with zest and juice from two clementines, plus about two teaspoons of rosemary, plus a bit of salt -- at 130 F for just a bit over an hour.
After removing the fish from the Sous Vide Supreme, I drained the juice from the bag into a small frying pan, reduced it by about half, removed it from the heat, then stirred in about a tablespoon of butter until melted. Meanwhile, I kept the fish in the bag, under a towel to stay warm. Then I served the fish, pouring the sauce on top.
It was spectacular. Every bite was perfectly meaty and delicate, just barely infused with the orange and rosemary flavors.
After making such a perfect meal -- but spending just about 15 minutes on it -- I really can't see the point of eating out! And that's not the first time I've had that thought with sous vide cooking. I'm so impressed with it.
Saturday, February 06, 2010
By Diana Hsieh
As a followup to my general discussion of thyroid function and body temperatures, I thought I'd report my own personal findings.
Since late December, I've taken my temperature three to four times per day with this basal thermometer. For greater accuracy, I don't take my temperatures for a half hour before or after eating or drinking, nor after exercise. I try to avoid breathing through my mouth (as of often do, as I have narrow nasal passages) for a while beforehand. I record the value and the time in the spreadsheet, then I calculate the average and the range each day.
During that time, my temperatures haven't changed much. That's not surprising. Even though I've seen a dramatic improvement in my other hypothyroid symptoms after starting high-dose iodine and desiccated thyroid in mid-January, I still feel cold -- not just in my hands and feet but in my innermost guts -- most of the time. Some other symptoms, like dry skin, as as bad as ever.
So let's get to the numbers. From December 21st to February 5th, my average temperature has been 96.76°F. The median is 96.85°F. The standard deviation is .69°F. The range is 4.40°F.
Here's the chart of temperature over time (click to enlarge):
Here's the chart of frequency of temperature values (click to enlarge):
As you can see, my temperature mostly ranges from 96.0°F to 97.2°F. That encompasses 68% of the readings (i.e. 101 of 148) -- meaning two standard deviations.
My low was 93.92°F on January 29th. I was sitting at my computer, on a heated pad, under a fleece blanket. I began taking my temperature as I felt myself growing colder and colder. When it got that low, I just couldn't do anything but sit. Then, as it began to rise back to 96°F, I began to feel better. Notably, that was after a few days of terrible stress over a friendship. That's reflected in the wild temperatures I got around that time in the first chart. (Perhaps my adrenal glands were going haywire.) Since then I've made a concerted effort to
chill out relax.
I hope to see a rise in body temperature -- and to feel a warm glow in my belly -- if my doctor increases my dose of desiccated thyroid from 1.0 to 1.5 grains with my next round of labs later this month.
Update: I forgot to mention something. When I ate the Standard American Diet, I felt mildly cold most of the time, not just in my hands and feet but in my core. My temperatures were also low, albeit not as low as they are now. When I began eating paleo, I was amazed to feel so much warmer. I didn't need the seat warmer in my car and my office; I wore lighter clothing around the house during the winter. It was fantastic! The only time I would feel cold was after I'd been fasting for about 20 hours or more. That's one reason why I'm pretty sure that I was mildly hypothyroid before I began eating paleo, even though my TSH was in the official normal range. (I'll say more about that in another post, however.)
By Diana Hsieh
One difficulty of diagnosing and treating hypothyroidism is that many of the standard symptoms are highly variable between individuals, not well-correlated with lab values, difficult to measure, and not unique to hypothyroidism. Doh!
One useful measure seems to be low body temperature. Janie Bowthorpe of Stop the Thyroid Madness has a whole page on body temperature. She writes:
Generally, the average temperature of an adult with a healthy thyroid and a healthy metabolism is 98.6 degrees Fahrenheit or 37.0 degrees Celsius, and that occurs around mid-afternoon or 3 pm. So if you take your mid-afternoon temp and find it in low 98's or even in the 97's, you have been given a strong clue that you may be hypothyroid. And a few report their mid-afternoon temp being in the 96's. BRRRR.Janie also thinks that fluctuating temperatures can be a sign of adrenal fatigue. That's a controversial diagnosis, but given the abysmal failure of the standard treatment of T4-only medication for so many people, I'm inclined to side with Janie's experience.
Another temperature clue is to take it before you rise from your bed in the morning. Dr. Broda Barnes, a doctor who paid attention to clinical presentation and prescribed Armour, found that a healthy before-rising morning basal temp should be between 97.8 - 98.2. If it's higher, you may be hyperthyroid, and if it's lower, you are most likely hypothyroid. He also recommended under-the-arm temperature testing, but patients have found oral to be just as effective.
Additionally, once you are on natural desiccated thyroid like Armour, and are consistently raising your doses, you will see your temps climb to healthy levels with increasing feel-good symptoms to match. In many patients, reaching 98.6 can happen before you are even on your optimal amount of Armour.
Dr. Davis also recommends using body temperature in the diagnosis and treatment of hypothyroidism. He writes:
Is there an at-home test you can do to gauge thyroid status?He recommends taking an oral basal temperature -- meaning as soon as you wake up, before you get out of bed or do anything. What temperature are you looking for?
Yes. Measure your temperature.
Unlike a snake or alligator that relies on the sun or its surroundings to regulate body temperature, you and I can internally regulate temperature. The hypothalamus-pituitary-thyroid glands are the organs involved in thermoregulation, body temperature regulation. While the system can break down anywhere in the sequence, as well as in other organs (e.g., adrenal), the thyroid is the weak link in the chain.
Thus, temperature assessment can serve as a useful gauge of thyroid adequacy. Unfortunately, temperature measurement as a reflection of thyroid function has not been well explored in clinical studies. It has also been subject to a good deal of unscientific discussions.
Though there are scant data on the distribution of oral temperatures correlated to thyroid function, we find that the often-suggested cutoff of 97.6 degrees Fahrenheit, or 36.4 C, seems to track well with symptoms and thyroid laboratory evaluation (TSH, free T3, and free T4). In other words, oral temp < 97.6 F correlates well with symptoms of fatigue, cold hands and feet, mental fogginess, along with high LDL cholesterol, all corrected or improved with thyroid replacement and return of temperature to 97.6 F.Of course, hypothyroidism is not equivalent to low body temperature -- any more than it's equivalent to high TSH. It's just one sign among many symptoms and signs. And I think it's a potentially useful sign.
However, I do have some questions about body temperature, some of which Richard Nikoley touched on in this post.
First, what's the optimal range of body temperature? How much does it vary between persons?
It's easy enough to determine average temperature in a population: just take a slew of temperatures. Determining optimal temperature is a whole new ball of wax -- particularly if many people suffer from undiagnosed hypothyroidism! Plus, the optimal body temperature of a person eating a high-carb vegetarian diet might differ markedly from a person eating a high-fat paleo diet. Similarly, the sedentary person might have a different optimal temperature than the avid crossfitter, marathoner, or weightlifter. And perhaps genetic origins matter too: Inuits might differ from Polynesians. Moreover, perhaps individuals with very similar backgrounds and lifestyles vary in their optimal temperature due to random features of their biology.
In short, knowing the average body temperatures and standard deviations of seemingly healthy people is a far cry from knowing your own optimal body temperature.
Here's the standard view of normal body temperatures from WebMD:
Most people think of a "normal" body temperature as an oral temperature of 98.6F. This is an average of normal body temperatures. Your temperature may actually be 1°F (0.6°C) or more above or below 98.6F. Also, your normal body temperature changes by as much as 1°F (0.6°C) throughout the day, depending on how active you are and the time of day. Body temperature is very sensitive to hormone levels and may be higher or lower when a woman is ovulating or having her menstrual period.They also indicate that an oral temperature of less than 96F indicates low body temperature. (I've had plenty of temperatures below 96.0 lately, but I'll post on that separately.)
However, even the standard number of 98.6 is controversial. Here's a report from Harvard Medical School:
The 98.6° F "normal" benchmark for body temperature comes to us from Dr. Carl Wunderlich, a 19th-century German physician who collected and analyzed over a million armpit temperatures for 25,000 patients. Some of Wunderlich's observations have stood up over time, but his definition of normal has been debunked, says the April issue of the Harvard Health Letter. A study published years ago in the Journal of the American Medical Association found the average normal temperature for adults to be 98.2°, not 98.6°, and replaced the 100.4° fever mark with fever thresholds based on the time of day.So perhaps the best way to know your own optimal body temperature would be to record a series of body temperatures when you feel well with a good-quality thermometer. I wish I'd done that a year ago.
Now, researchers at Winthrop University Hospital in Mineola, N.Y., have found support for another temperature truism doctors have long recognized: Older people have lower temperatures. In a study of 150 older people with an average age of about 81, they found that the average temperature never reached 98.6°. These findings suggest that even when older people are ill, their body temperature may not reach levels that people recognize as fever. On the other hand, body temperatures that are too low (about 95°) can also be a sign of illness.
The bottom line is that individual variations in body temperature should be taken into account, reports the Harvard Health Letter. Ideally, you and your doctor should have enough temperature measurements at various times of day to establish a baseline for you. Short of this, recognize that 98.6° isn't the benchmark that we've long believed it to be.
Second, how can a person get precise and accurate measurements of body temperature?
That's a harder problem than you might think! The article "Temperature measurement in paediatrics has an excellent discussion of the problems with the various methods of measurement. (I'm omitting the citations, as well as some material relevant only to children. You can find that in the article.)
Rectal thermometry: Rectal thermometry has traditionally been considered the gold standard for temperature measurement, but some studies have revealed limitations of this method. Rectal temperatures are slow to change in relation to changing core temperature, and they have been shown to stay elevated well after the patient's core temperature has begun to fall, and vice versa. Rectal readings are affected by the depth of a measurement, conditions affecting local blood flow and the presence of stool. Rectal perforation has been described, and without proper sterilization techniques, rectal thermometry has the capacity to spread contaminants that are commonly found in stool.The only good news is that (high-quality, properly-functioning) digital thermometers are as accurate as mercury thermometers.
Axillary thermometry: While axillary [armpit] temperature is easy to measure (compared with oral or rectal measurements), it has been found to be an inaccurate estimate of core temperature in children. This type of measurement relies on the thermometer remaining directly in place over the axillary artery, and it is largely influenced by environmental conditions.
Oral thermometry: The sublingual site is easily accessible and reflects the temperature of the lingual arteries. However, oral temperature is easily influenced by the recent ingestion of food or drink and mouth breathing. Oral thermometry relies on the mouth remaining sealed, with the tongue depressed for 3 to 4 min ...
As I said to Richard Nikoley when he e-mailed me that link: "I suppose that the most accurate method is the coroner's liver temp, but I think I'd rather avoid that!"
As for my own body temperatures, I've posted that separately: Body Temperature: Personal Results.
By Diana Hsieh
I've been so busy lately that I haven't posted a lot, but that doesn't mean I haven't been thinking about posting. I've got a number of things I've been wanting to write about that I plan to have up as soon as the Colpo deal is finished. I want to add my two cents worth on a bunch of the problems some Paleo dieters seem to develop. And I've got a post cooking on the thyroid and iodine. One on fructose, and one on saturated fat. Plus the analysis of the next stupid study that will inevitably pop up and seize the imagination of the mainstream media types who will shout it from the rooftops.Hooray! I'll definitely owe him the sous vide meatball that I promised him. Then again, he might prefer if I wrote up a post on how to make them. (I have no idea... but here's a hint.)
I know that I've been all gushy for Dr. Eades of late... but he deserves it! Dr. Eades -- as well as Dr. Davis and others -- have been extremely generous in their blogging. I've benefited so much from their medical experience -- not just in my abstract understanding of the relevant science but in my rubber-meets-the-road well-being. They've earned my respect and my gratitude in spades.
Now to the real point of this post. In requesting a post on thyroid problems, I sent Dr. Eades the following questions as fodder. I have my own preliminary views and suppositions about some of them, but I'm very interested in his answers. Here they are, with links added:
- Why did you choose to put your patients on desiccated thyroid rather than T4-only meds?
- What do you think of using synthetic T4 plus T3 rather than desiccated thyroid? (Kurt Harris claims that synthetic hormones are exactly identical to those in porcine thyroid, and that the addition of T3 is the sole reason why people do better on porcine thyroid than T4-only meds.)
- What do you think of the claim that a person can be hypothyroid despite basically normal lab results? What do you think about the concept of "Type 2 Hypothyroidism"?
- Do you recommend dosing based on symptoms -- or by TSH?
- Why do you think that hypothyroidism is so prevalent today? Why do you suspect that it affects more women than men?
- What do you think of the standard view that any dose of iodine above a few hundred micrograms is dangerous, even potentially a cause of hypothyroidism? What is a standard safe dose? Is high-dose iodine dangerous for some people?
- If a person suspects that they might be hypothyroid, what do you recommend that they do? Might iodine alone make a difference -- or stave off full-blown hypothyroidism?
- Do you think that a low-carb diet can somehow cause, reveal, exacerbate, or otherwise affect a thyroid problem? (Matt Stone claims that, as do others. [See the PaNu smackdown.]
- Do you think that adrenal fatigue is a genuine problem for some hypothyroid people? If so, what do you recommend doing to treat it?
- What sources do you recommend that people read if they have been diagnosed with or suspect they have hypothyroidism?
Friday, February 05, 2010
By Diana Hsieh
In prior posts, I've recommended this New Yorker article on the widespread problem of olive oil contamination: Slippery Business. That risk of contamination is one reason why I prefer to cook with coconut oil, lard, and butter.
This fascinating story about the possibility of massive government corruption of science might be a case when "toxic oil" was not to blame. In the early 1980s, a mysterious outbreak of illness in Spain left hundreds dead and thousands seriously injured. It was quickly blamed on contaminated cooking oil. In 1989, some oil producers were sent to prison, even though the supposed toxin in the oil was never identified. Similarly, as even supporters of the standard account admit, scientists haven't ever been able to reproduce the symptoms of the supposedly toxic oil in lab animals.
Even worse, even the epidemiological data looks like it was corrupted by a young government determined to quell the panic. The article says:
In order to demonstrate that the oil had caused the illness, government scientists needed to be able to show, for example, that families who had bought the oil were affected, whereas those who hadn't were not; that the aniline in the oil was indeed poisonous and that the victims were suffering from aniline poisoning; and, bearing in mind that such commercial cooking oil fraud had been widespread for years, just what had changed in the manufacturing process to cause the oil suddenly to become so poisonous. To this day, none of these basic conditions has been met.You'll find the details in the article. The most fundamental problem is simply that the cause and the effects don't seem to match up: many sick people didn't consume the supposedly toxic oil, many oil-consuming people didn't become sick. And that's just for starters.
Do I know what happened here? Of course not. The article might be mere conspiracy-mongering; the author might be twisting the facts to manufacture doubt and controversy where none should exist. Or perhaps the author's complaints and doubts are completely justified. I can only say that, if the article is accurate in its basic information, the government's story doesn't merely smell fishy: it's stinks to high heaven.
The simple fact is that governments cannot be trusted with science. Scientists at the government trough are often quickly wedded to grand theories based on political pressure rather than evidence. Then, because they seek to maintain public trust above all else, they cling to those grand theories as dogmas, even as contrary data accumulates. In the process, they often cause serious harm to people by preventing them from living as well as they might -- or preventing them from living at all.
Essentially, to the extent that science is affected by political pressure, it works on the principle of stare decisis -- meaning "maintain what has been decided and do not alter that which has been established." To support their political paymasters, scientists must adhere to precedent, however wrong.
Of course, some scientists might be willing to buck political pressures, but they risk being marginalized or fired for speaking out. Others might be more remote from those pressures, and so able to do good work in quiet. But for any politically warm topic, I trust government science as much as I trust the State Science Institute on Rearden Metal -- meaning, not at all.