Preface by Tawnee
Our guest author for this post is Julian Abel, a 58-year-old medical doctor in the UK. Julian and I started working together this year on a consultation basis (an alternative to full-time coaching that I offer), and his journey is not only inspiring but one that I feel is very important to highlight. His story shows the importance of the holistic approach to diet, fitness and lifestyle, and how improvements in all these areas will benefit fitness development, and also can literally be life-saving. In Julian’s case, we had to look to his health (and the medications he was on) to figure out the reason his aerobic base was suffering, and we found our answer.
Please note: With Julian being a medical doctor, I was comfortable in helping him safely wean off his medications, but with other clients I can only help in this process with supervision from a medical professional. Also, this article is not meant to be personal medical advice, and please consult with a professional before making any significant changes to your health plan.
Without further ado, enjoy Julian’s Journey in his own words…
Health cannot be measured. There is not a convenient number that you can put on it and say, “I am this healthy.” Nor can you say, “I am 100% healthy.” But you can measure your progress in building an aerobic base, which is related to health. This piece is about how I continue to discover what health is.
I am a 58-year-old doctor. I thought I was healthy. In the past, I have practised as a cranial osteopath and acupuncturist. I have been a meditator for decades. I have over 20 years of tai chi behind me. I run and I surf. A few years ago I read Born To Run by Chris McDougal and loved it, so when he published Natural Born Heroes, I read it avidly. I came across Phil Maffetone in that book and about a year ago got interested in aerobic base building. Although I had come across this concept before, I paid no attention to it. I bought a heartrate monitor and watch and was horrified to discover that my aerobic base was poor. I could barely run 13-minute miles at my MAF heart rate—180 minus my age, which at the time worked out to be 123 beats per minute. I was used to running 8-minute miles. I persisted in my training at MAF and did not improve.
I had a fairly long commute, driving 30 miles each way daily. So in addition to all the reading, I listened, a little obsessively, to podcasts and naturally looked up Phil Maffetone. Amongst the many podcasts he has done, I came across a number of interviews by Tawnee on Endurance Planet. I particularly liked her approach to the whole subject of training, with a flexible perspective on how health and fitness are related. I contacted Tawnee to see if she could give me some advice and support for my lack of progress in building an aerobic base.
What happened next was a little surprising for me. Tawnee wanted to see what my blood profile was. For a few years, I had been following the diet recommended by Michael Mosley, restricting calorie intake to 600 calories for 2 days per week. I felt healthier during these days and my lipid profile changed. My triglyceride levels came down from 2.6 mmol/litre in 2011 to 0.54 in 2013. [For those who are interested, rather than the total cholesterol level being an important predictor of heart disease, the measurement that is most relevant is the triglyceride to high-density lipoprotein (HDL) ratio.] However, in spite of these changes, I still had high blood pressure. Discussing this all with Tawnee, combined with further nerd-like research on my side, I changed my diet to low carb, high fat (LCHF). We went through my diet in some detail and I went on a modified autoimmune paleo diet (AIP) for a month (modified because I am vegetarian).
I also took a closer look at the medication I was on for blood pressure. I was taking an ACE inhibitor called ramipril. Looking in detail at its effect, I discovered that although some of the effects reduce blood pressure, some of them actually are opposite to what might be expected. Basically, we can think about raised blood pressure as an abnormal constriction of blood vessels. Here’s how the medical model treats this problem. First, unless a direct cause can be found, the doctor will assume your high blood pressure is due to genetics and bad luck (assuming your lifestyle is not so rubbish). The medical treatment model is simplistic: if you can dilate the blood vessels, everything will be fine. However, this is not the case.
What became clear to me was that although some of the effects of the ramipril dilate blood vessels, there are a series of other effects in the body—in tissues other than blood vessels—which actually stimulate the flight or fight response of adrenalin pathways. I realized that part of my problem of poor aerobic fitness was related to the medication! The takeaway: the gains I would get from improving my aerobic fitness—such as increased blood volume, increased development of slow twitch muscle fibres, more efficient fat burning pathways, increased mitochondrial health with increased metabolism of free radicals with consequent decreased blood pressure—were actually being inhibited by the very thing that was supposed to protect me from disease.
This story is further complicated by my general mistrust in medicine, despite being a doctor. I had been persuaded to go on ramipril by a friend who was also my general practitioner. I had resisted doing this for a number of years. Drug trials are complex and often unreliable. Most of the major drug companies have been fined hundreds of millions of dollars for dishonest behaviour. For instance, a trial that has been funded by a drug company is four times more likely to produce a result in favour of the drug compared to independent funding. This basically means that these kinds of trials are not scientific and are untrustworthy.
Treatment of high blood pressure fits into this category and the information is conflicting, to say the least. The most recent review of treatment of high blood pressure concluded that aggressive management reduced the incidence of complications, but the number of people who needed to receive treatment to achieve this reduction was 1 in 250. Translation: 249 people would need to have aggressive medication management of their blood pressure without any improvement in their outcomes. This does not even take into account the harms that come from medication.
Another factor to consider in the unreliability of drug trails is the “health user effect” (a term from Mark Hyman). That is, if you are regularly being monitored by your doctor and you are paying close attention to your blood pressure, you are likely paying more attention to your overall health. Could this then be the reason why 1 in 250 people have a good effect from medication? What if people just payed attention to their lifestyles without having medication? I would like to see a trial of management of high blood pressure using a LCHF/high-quality food diet, aerobic base building exercise and lifestyle management to minimise stress and compare that to the use of antihypertensive agents. At the very least, people following this lifestyle protocol would feel better, lose weight, be more active and not have the side effects of medications.
Looking at all of these factors and going LCHF, I decided to come off my medication and pay more attention to the impact different foods were having on my energy levels and overall wellbeing. When first making these diet changes, I thought, “Great, I can eat plenty of cheese and nuts!” Tawnee cautioned against this and recommended supplementing my diet with omega-3 fats. Lo and behold, I did discover that nuts and dairy products actually made me quite tired, but my energy levels soared and I felt much better when following Tawnee’s suggestions.
I also cut out wheat from my diet and was careful about grains, whose sugar content is considerable. I would know I overdid it on rice if I became sleepy afterwards. The insulin response to food is critical. Sudden intake of easily absorbed carbohydrate, as with refined sugars and grains, causes a spike in insulin release. This switches off fat burning pathways and instead deposits fats into the tissues. It also causes further craving for carbs to keep the energy levels up. From there, it is easy to get caught in a spiral of trying to keep energy up with carbs and ending up sleeping!
By making all of these changes, I successfully weaned myself off the ramipril. I did this gradually and my last blood pressure reading was 130/90, having been 150/100 at one point. My success in lowering blood pressure has been wholly due to aerobic exercise, diet modification and paying more attention to sensible things like getting enough sleep and decreasing stress in my life.
I continue to discover more about myself. Doing regular MAF tests is a great way for me to get an overall picture of how I am feeling as well as look at my aerobic fitness. I have a long way to go. My progress is slow but I have years of overdoing it with a high-stress job. It is going to take time and is a good lesson in patience. I am showing signs of improvement with my latest MAF test being in the region of 12.15 miles per minute pace. Tawnee has been a great help and assuming I continue to improve, the plan is to run a marathon at a pace I don’t consider to be horrifically slow. Although MAF tests do not measure health, they do give a good clue when there is lack of progress, suggesting that there is something to be worked out. I really like the classification of stress that Phil Maffetone recommends: exercise stress (i.e. overtraining), biochemical stress (as in bad diet), and emotional stress from lifestyle. These are really useful handles for investigation. The biochemical pathways of action of overstress are common, and relate to fat burning ability, and the hypothalamic, pituitary, adrenal axis. The impact on the body varies from person to person, based on amongst other things genetic predisposition.
Final thoughts from Tawnee…
We are all individuals. The way I worked with Julian is different than how’d I work with a 20-something female athlete. We’re all going to respond to stress, food, medicine, and other factors differently. We all have different needs. And even qualified medical doctors like Julian must always be willing to question things, be willing to seek help from others and be open-minded to change. We have to be embrace healthy experimentation and learn to gauge our wellbeing intuitively—data can help, but wellness is more than data and test results at the end of the day. So whether this guest post helps you become more conscientious of your health or stress levels or gets you thinking about how you can become a better, more intuitive athlete, the bottom line is at the end of the day you have the power to understand and change your state of health and in doing so, doors will open—at any age!