Fat-free Almost
by Joseph Woodard
I take medicine to lower my blood pressure. My blood cholesterol is too high and going higher, not lower. It seems I have two risk factors for heart disease. Age and too much worry are catching up with me.
My doctor at Kaiser passed me over to the care of a young pharmacist. "She has software to automatically notify cholesterol patients about blood tests and so forth. Great stuff. With over a thousand cholesterol patients on my hands, it's more than I can remember," he excused his lack of concentration on my problem.
I made an appointment and met the lady with great software.
It wasn't her programming that made her good. She spent more than a half an hour with me going over effects of diet and exercise. She stopped talking and listened if I spoke. She didn't mark time in her head the way my doctor does. She didn't look away and begin thinking about her next chore when I talked.
My doctor. I picked his name from list of Internists when I needed someone to help me navigate the medical bureaucracy. The M.D. Kaiser had assigned me three years before never saw me. His only communication was a form letter telling me he was leaving Kaiser. When my new doctor was monitoring the fat in my blood, he ordered a test in April and another in December only after I requested it. Even so I didn't get the results until mid-January when I met the pharmacist. Ten months after the first blood check that revealed my high cholesterol, I learned my cholesterol level was going up instead of down. After I was told the first indication of my new risk factor, I thought I was eating carefully and exercising as well as I should, but I had only the first data point to go by. I didn't hear about the second that indicated a bad trend for almost a year. Then it was clear I'd have to take stock of myself.
The lady with great software recommended that I should keep a diary, recording what I ate and how I exercised. I should also record the times I swallowed 500 milligram pills of inositol hexaniacinate, a form of the B-vitamin, niacin. Niacin helps flush excess fat, but the straight stuff, nicotinic acid, creates an unpleasant side effect, severe skin flushing. I never built up any tolerance for it in the year of trying after my doctor prescribed it. The sensation is unpredictable and, for me, very uncomfortable. The feeling is almost identical to heat flashes suffered by women going through menopause. On days when it affected me the worst, my partner, Dorothy, clapped me on the back while I sat sweating and itching and congratulated me for suffering nature's revenge. "It's about time men knew what we went through," she gloated. The hexaniacinate form of niacin is called "Flush-free". In December when my doctor mentioned that I could use that if I liked, I started and the menopausal symptoms stopped.
But, my pharmacist explained, the flush-free stuff can damage the liver. Of course, my doctor had mentioned that but dismissed it as not too risky. She furrowed her brow and ordered another blood test in two weeks.
The pharmacist would be checking me in two weeks, not ten months. To help save me money, she would correspond with me by email or talk on the phone. My doctor never once asked me about my opinion of health care expenses though I had mentioned I only worked six months last year. The pharmacist asked what I did, how I felt about my circumstance, what I ate, how often I exercised and how strenuously. She wanted to know about me. She wrote notes. She had a lot more than just a good software program.
Absent the dread of heat flashes, I regularly downed two five-hundred milligram doses of non-flush niacin every day. I began recording what I consumed and how I exercised in my new log.
In writing down what I ate, I also recorded the amount of fat, saturated fat, and cholesterol in foods that sported a nutritional label. I compared what I ate with a list of good and bad foods the pharmacist provided. I had to come under a fat bar. On a 2000 calorie a day diet, a handy figure, I should ingest no more than 65 grams of fat, including not more than 20 grams of saturated fat, and not more than 200 or 300 milligrams of cholesterol. This is not impossible to figure out since food labels are required to list the amounts of such things in a typical serving. Also, there is good fat and bad fat. Eating low on the food chain is better, veggies, grains, and beans. I should go light on eggs and try to eat low-fat dairy products if I drank milk and ate cheese. Frying is worse than baking or grilling because it puts oil in the food. Olive oil and corn oil are far better than meat fat, lard, and chocolate.
Each meal, each snack I wrote down, I tried to note the fat it contained, as best I could. Sweet potatoes don't come with a label, but the butter I put on them does. I cut way down on the butter. In the last two weeks, I've gobbled down no more than three pats of it.
In fact, the act of keeping the diet diary has affected me. The self-conscious task of writing what I eat has affected my appetite. I'm already recording the diary, keeping a mental log, when hunger jogs my memory and I begin to think about stuffing something in my mouth. Keeping the diary has changed what I prefer to eat. In only two weeks, I find I prefer certain things over others, not because I think they are good for me, which I do, but I have begun to desire them, out of pride, I suppose. I look forward to my tiny victories as I record that I ate the good things, not the bad. Previously I generally stocked my larder with things I believed might be better than others, but thought nothing of knocking off a bowl of ice cream, or two chocolate cookies, or ladling butter onto a steaming corn cob or pancakes. I viewed whipped cream as an innocent, occasional sin. I liked it, and still do. But I don't miss it, strangely enough. I guess, absent neurotic cravings, that the judicious has become the preferred. I may have equipped my superego with a benevolent whip.
I was never a big red meat eater. Now I definitely look forward to non-meat meals. I contemplate their permutations: salmon on steamed cous-cous with a nice green salad spiked with mandarin orange, balsamic vinegar, and honey dressing. Does that sound bad? No. Sounds great. I realize now that I haven't thought about a prime rib or New York cut at all. Some automatic censor deputized by that diary has tied blinders on my appetite.
We'll see if all this self-monitoring righteousness pays off. I'll know soon if I'm better off when I hear the results of last week's blood test. But I can feel the effects already. My abdominal muscles feel toned. A certain slackness around the jaw has tightened. While the loose skin around my neck is beginning to resemble crepe, I put that up to the inevitable. My goal is not beauty but a healthier life. When the appearance of youth dressed me better, I certainly didn't live better. Fortunately the pangs of sex have lessened. I'm willing to be ugly but healthy. If I'm to kick the bucket, I'd like to go like the old man in the joke who died at 96. Whatever he died from, it wasn't serious.
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