How I optimized my health

Note: This is a continuation of previous blog posts on histamine intolerance (part 1, part 2, part 3) and another one post histamine intolerance.

Short health history

• 2000–2002: Asthma-like symptoms during running, which eventually made me quit competitive orienteering.
• 2004–2009: Insomnia, mostly in winter or after alcohol (1 beer was enough).
• 2010–2012: Moved to Sweden and soon experienced migraines with aura, for which I took many different pills and all of them only made it worse. Worst insomnia and stomach problems. Spent about 3 months on sick leave. Got diagnosed with histamine intolerance.
• 2013–2014: Antihistamine medication relieved a lot of symptoms, but I had to stop taking it regularly because of side-effects. Spent another few months on sick leave. (blog post, another blog post)
• 2015–2016: Stopped seeing doctors and started experimenting on myself. No longer histamine intolerant. (blog post)
• 2017–now: Steady progress, every year I could eat more food, exercise more, sleep better, etc. I’d rate my health at 95% now.

(Non-)Measurable improvements

I prefer improvements that are measurable. Some changes might not look like improvements, for example gaining weight is considered bad, but I consider it great, as the gain has been mostly muscles. Similarly for heart rate while running, the higher the rate, the faster I can run.

Metric	2012	2016	2020
Weight (kg)	67	73	82
Heart rate (BPM, orienteering race)	150	165	175
Falling asleep	2:00	24:00	22:30
Sleep length	5h	6h	6.5h+
Exercise per week	0.5×	1–2×	3–5×
Podcast listening speed	1.3×	1.4×	1.6×

I’ve also experienced improvements which are hard to quantify, for example better mental focus or not being tired in the afternoon. Even though these are hard to measure, they are very closely tied to sleep quality. If my sleep is great, I can also focus. In any case, here’s a list of other improvements.

• I can now eat milks proteins and more fiber.
• I can drink alcohol.
• Better mental focus, no crash after lunch.
• No painful migraines.

Not everything is perfect, though. Instead of taking too long to fall asleep I now sometimes wake up too early. See my Last.fm 2019 music stats, they start to pick up before 5 AM. My goal is to wake up at 5:30 AM.

Last.fm listening statistics for 2019

What worked

Since the last post in 2016, I’ve changed the following.

• Moved back to Central Europe from Sweden, so I get much more sunshine.
• I take fewer cold showers, because the shower water is not cold enough in Central Europe. I also practice less intermittent fasting, as I want to weigh more.
• I’ve switched my exercise focus from cardio (orienteering, biking, ultimate frisbee) to strength training. I’ve also stopped stretching—the only noticeable change from this is more free time.
• I’m now sleeping on a Japanese futon, the hardest bed on the market. It improved my sleep times and sleep quality.
• Most importantly, I’ve made my diet more consistent thanks to a slow cooker and a big freezer. Diet makes for at least 80% of the whole improvement, so it deserves its own section.

Diet details

Through experimenting with supplements, I discovered that I need to focus on the following essential nutrients.

• Vitamins: A, B*, D, K
• Minerals: Potassium, magnesium, salt, iodine, selenium, iron
• Amino acids: glycine
• Other: nitric oxide

Getting enough (and not too much) of these from food makes for a diet very close to Perfect Health Diet. Below is a sample of my diet from the COVID-19 “lockdown”, when it was the most consistent.

• Breakfast: 5 free-range eggs with pickled or fermented vegetables. Occasionally no breakfast.
• Lunch: vegetarian meal from the restaurant downstairs.
• Afternoon snack: dark chocolate, almonds, fruits, yogurt, protein bars.
• Dinner: grass-fed beef organs or bone broth. With vegetables or potatoes on the side.

I know, I know, this diet has a lot of vegetables which are environmentally costly. They contain very few calories, require a lot of water, land and nutrients. They also require refrigeration to remain fresh. However, picking a diet which balances personal health with ethical considerations is not an easy task. I think I need to first read famous moral philosophers such as Immanuel Kant, Jeremy Bentham or Peter Singer before I can form an opinion that I can share publicly.

Ethical considerations aside, I think the Perfect Health Diet (PHD) is one of the easiest ways to get essential nutrients in optimal quantities. Some people might be able to make substitutions, but this diet should work for everyone. For example, PHD contains vitamin A mostly in the form of retinol and its esters. Another source are carotenoids, but they need to be converted first and some people have reduced conversion ability, such as myself. It’s a genetic mutation, so there’s not much you can do about it.

I wasn’t able to fix everything through the diet, though. For example, I need to supplement a lot of potassium. I went through 2.5 kg of potassium citrate in about a year, which makes for more than 2 grams of supplemented potassium per day. Some people say that modern food production reduces potassium content in our food. It could be also caused by poor absorption. It’s particularly annoying, as supplementing potassium is very tricky and cumbersome.

Histamine and methylation

I want to share one particular finding regarding histamine, perhaps it’s going to be useful to someone.

People diagnosed with histamine intolerance in Slovakia are given a brochure that emphasizes diamine oxidase (DAO) as the degradative enzyme of histamine in the body. However, other sources also mention histamine-N-methyltransferase (HNMT).

Once formed, histamine is either stored or rapidly inactivated by its primary degradative enzymes, histamine-N-methyltransferase or diamine oxidase.—Wikipedia

Consequently, flawed HNMT activity leads to chronic forms of histamine intolerance.—Wikipedia

In general, increased sensitivity against biogenic amines is due to a weakened enzymatic amine degradation caused by genetic or acquired impairment of MAO, DAO, histamine-N-methyltransferase (HNMT) function.—Histamine intolerance and dietary management: A complete review, 2016 paper by Martin, Brachero and Vilar.

Histamine is N^τ-methylated by HNMT, as the name histamine-N-methyltransferase suggests. In 2015, after reading about methylation, I have slowly made methylation-related changes to my diet with great results. Some time in 2016 or 2017 I’ve learned about the connection between methylation and histamine and made my diet even more strict, which led to even better results.

In the spirit of health bloggers, I’ll now conclude that my symptoms were fixed by methylation and HNMT. Post hoc ergo propter hoc. Haha, just kidding, I can do better!

My diet is now rich in B vitamins, magnesium, collagen, and many other nutrients. These have plenty of other effects, so it’s hard for me to judge causality. In any case, people having histamine-related problems could try it out and see if it helps. All of this made me curious why histamine intolerance patients aren’t told about HNMT but only about DAO. For example, HNMT is active in the central nervous system, where DAO is not present, so focusing purely on DAO might not improve all symptoms.

Interestingly, the histamine intolerance brochure given to patients was written by the producer of the DAO supplement, who wants people to buy their product and has an incentive to hide information about HNMT. I’d still give them the benefit of the doubt using Hanlon’s razor: “Never attribute to malice that which is adequately explained by stupidity”. In this case it could be my own stupidity, since I’m not an expert.

If you’ve made it this far and are interested in methylation-related dietary changes, check out Chris Masterjohn’s methylation guide and his presentation on Methylation, MTHFR, and Histamine.

Doubts about modern medicine

Over the years, my opinion of medicine became gradually worse. In 2011, I thought that I have a condition that’s hard to diagnose and treat. In 2014, I was questioning the Swedish public and private system. In 2016, I shared Robin Hanson’s proposal to cut medicine in half, but added that I’m not buying it yet. Well, now I’m totally buying it. We spend too much on medicine.

If you want to challenge your believes, I recommend reading Robin Hanson’s article or his book The Elephant in the Brain (together with Kevin Simler). I also recommend the article When Evidence Says No, But Doctors Say Yes by David Epstein.

The early phase of COVID-19 is a great illustration of these ideas. People assumed that enough ventilators would save us all. However, early data showed that survival rate on ventilators was somewhere between 3 to 35%. Ventilators and their operation are very expensive, requiring intensive care from nurses and doctors, but they only save few people. Ventilators are used at a very late stage of the sickness when they cannot do much. Preventive measures such as social distancing and face masks are cheaper and more effective. However, they require participation from everyone.

Most money in medicine is spent on people over 60, when it’s too late for miracles. There are cheaper preventive measures such as exercise, good nutrition, better sleep, not smoking, etc., but these require participation from everyone.

I think it’s important to spread Robin Hanson’s message, but not because it would make us spend less money on medicine. The spending will continue, but perhaps people would start taking better care of their bodies if they knew that medicine can not do much.

Recommendations

There are many people in the better half of medicine and I have to thank them for a big part of my progress. I can recommend the following people for health advice. Some of their content is not free, but I highly recommend spending some money on valuable information.

• Chris Masterjohn might be the most knowledgeable person on micronutrients. I recommend his Cheat Sheet or Vitamins and Minerals 101 course/book.

• Barbell Medicine is run by two doctors who are great lifters. They have great content regarding exercise, though mostly strength training. I’ve successfully used their free and non-free training programs. Also, I highly recommend watching their lecture series on low back pain (part 1 and part 2).

• Slate Star Codex: Scott Alexander is a psychiatrist who blogs about a lot of topics, medicine being one of them.

• Stephan Guyenet is a neurobiologist blogging mostly about obesity but also other topics. Also see his old blog.

Conclusion

I wish there was one simple trick but I failed to find it. I’ve counted about 15 micronutrients that I need to be cautious about and 5 daily/weekly habits. And all of these need to be correctly dosed, which is a lot of work.

Hopefully this is my last post regarding health. It took a few years—almost 2 decades—but now I can live life to its fullest.

Review of The 4-Hour Body and Starting Strength

The 4-Hour Body by Tim Ferris

The 4-Hour Body is a book covering many topics around diet and exercise. Tim himself doesn’t recommend reading it from cover to cover, so I read about 2 thirds that were interesting to me.

The diet part is the longest. His recommendation to start the day with a high-protein meal is sound, I often do that myself (5 or 6 eggs). However, his obsession with insulin levels seems unnecessary (see Guyenet and Masterjohn). There’s plenty of people who lost a lot of weight on the diet, but I haven’t tried it, since I have the exact opposite problem.

I’ve tried the Occam’s protocol, which is a training program for maximal muscle gain. I ran it for 2 months and gained about 6 kilos of weight, some of which was fat but most was muscle. My rate of weight gain was lower than what Tim promised, which was most likely caused by the following two factors.

• I ran a few orienteering races while doing the program, but Tim doesn’t recommend any cardio. This was intentional on my side.
• I started eating as much protein as Tim suggested, but felt horrible. 7 days into the program, a blood test revealed that my kidneys couldn’t keep up with the protein intake. I immediately started eating less and then slowly increased protein intake, but I’ve started feeling strange “in the kidneys” again. This must have been the first time I was aware of my kidneys.

Part of the weight gain might have been regression to the mean, since people’s weight is typically the lowest at the end of the summer which is when I started the program. Regression to the mean could only explain half of the weight gain, though.

I’m convinced the program works, probably much better if you’re able to tolerate more protein. However, my biggest gripe is how Tim sells it. Tim likes to mention the 80/20 rule: you can get 80% of the results by only doing the important 20% of the effort. The title of the book comes from the 4 hours Tim spent in the gym during the month he gained an enormous amount of muscle mass.

The hard part of Occam’s protocol is eating enough protein and calories, which Tim mentions himself many times. I had to think constantly about food and when I managed to hit the protein target, I felt full, lethargic and overall terrible. It felt like 80% of effort for 80% of results.

When the 2 months ended, I switched to Starting Strength which in my opinion achieves what The 4-Hour Body tries to be. For example, Tim has a separate section on how to fix tight muscles by time-consuming exercises or expensive methods for which he flew to another city, but I managed to fix my tight hamstrings just by doing the exercises in Starting Strength. I got much more bang for the buck by following Starting Strength, but more on that in a separate review.

Over the years, I’ve listened to a couple of Tim’s podcasts and some of his interviews, but I have never become a big fan. After reading his book I think I know why. He's a great salesman, but the things he's selling aren't that good.

Starting Strength by Mark Rippetoe

Starting Strength is a beginner barbell program with only 5 exercises (squat, deadlift, over-head press, bench press and power clean). All exercises are explained in great detail—just the squat chapter has about 60 pages.

I didn’t run the Starting Strength linear progression exactly, but rather went with Phrak’s Greyskull LP Variant recommended on Reddit. The two programs are close enough: 4 out of the 5 exercises are the same and you also do 3 sets of 5 repetitions. Weight increases and deloading are the same too.

Starting Strength focuses on strength gain. However, the best part about doing the program were bonus improvements that I didn’t expect.

• Improved hamstrings flexibility: I suffered from tight hamstrings whenever I played hockey or rode a bike. I’ve tried massages, foam rolling, hot baths and stretching, always achieving only a short-term effect. Just before starting the program I couldn’t touch my toes and now I can press all my fingers against the ground (no palms yet). And no, stretching is not part of the program, so such a huge progress was very surprising to me.
• Much less muscle soreness: I used to have too much muscle soreness from my semi-regular sport training, but now that is not an issue anymore. I also don’t remember this being promised anywhere, so that’s another surprise.
• Muscle/weight gain: Even though it’s primary a strength program, I’ve gained about 1 kilogram per month on the program.
• More strength everywhere: I used to subconsciously search for things to lean against while standing. These days, standing is just easy. Also, free-ride skiing used to be very hard on my legs, but now it feels at least 3 times easier. This is not that surprising, as the exercises hit almost all the muscles.

In the end Starting Strength fulfills the goals of The 4-Hour Body much better, at least for me. Only 5 exercises packaged in a simple-to-follow program feel like the 20% of effort that bring me 80% of results. Yes, my hamstrings could get more flexible by doing more specific work, but as it is now it’s all good.

Note that Mark Rippetoe can be dogmatic, e.g. he repeatedly says in the book that the squat works your hamstrings a lot, but there’s now good scientific evidence that that’s not true. Starting Strength is a great start but it’s definitely not the end.

Conclusion

I’m now well in my 30s and I think now is the right time to get serious about health. Thanks to a lot of trial and error in the last 5 years, I’ve conquered regular insomnia and migraines. Barbell training is another great addition, especially the squat and deadlift feel like cheat codes to life.

The conventional thinking is that your health deteriorates with age but I’d like to keep improving as long as possible. What if there are more cheat codes to be discovered?

How I got much better

In the last 18 months, I stopped going to doctors and instead focused on self-experimentation. Many experiments failed, but overall it’s been a big success. Some symptoms are completely gone, some are still alive but few and far between, and some are thriving as well as for the last 15 years.

This post was supposed to be titled Living with histamine intolerance, part 4, but I don’t classify as histamine intolerant anymore. You can read parts 1, 2 and 3 to get better context, though.

Feel free to get inspiration from my experiments but remember that there are risks involved.

Life-style changes that worked

Sunlight

I always wondered why I felt better in the summer and worse in the winter. Each November my ability to exercise rapidly dropped, except when I spent autumn in sunny California and the symptoms were then postponed by two months.

I’ve tried spending every second in the Sun but it was very difficult to do in Sweden. Spending one week under the Arctic Sun didn’t do anything. Two days of kayaking helped a lot, but not as much as 3 hours of full-body sun bathing. Sunlight is the best cure against insomnia and bad sleep.

On the other hand, taking vitamin D in winter helps but doesn’t bring the full effect. It’s not so surprising, since sunlight does more to our skin than just vitamin D production and we’re only discovering those effects now.

Dietary changes

Diamine oxidase (DAO) is an enzyme that regulates histamine in our bodies. The only macronutrient increasing DAO concentrations in the intestinal lymph in rats is fat. In another study of rats, MCT oil increased DAO activity 2.5 times in the intestines.

Even though I’m not a rat, I had to try it out. Did it help? Maybe it did, maybe it didn’t. It’s true that my DAO levels are 3 times higher than before, but I have too little data to judge causality. An unexpected side-effect was a big decrease in headaches and migraines. This is perhaps not that surprising, since MCTs boost ketone production and ketogenic diets are therapeutic for a few neurological conditions.

The second big change in my diet was eating nose to tail – eating other parts of animals than just muscles. Organ meats are cheap, easy to cook and super-nutritious. Skin, bones and cartilage are rich in collagen, which seems to be beneficial for many. The nutritional wars concentrate too much on carbohydrates versus fat, while different proteins and amino acids are often ignored. That’s likely a big mistake.

I’ve changed other small things in my diet, but listing them all would need another full post. Luckily for you, someone made a nice infographic and wrote a book about my diet 4 years ago. After I found out about people copying my diet, I read the book and had a lot of Aha! moments. That being said, the book is overconfident at times and I’d be extra careful following their advice to the last word. Also check Scott Alexander’s critical review.

Probiotics

Abdominal pain has been my number one problem for years. I’ve consulted doctors and tried many things, but those brought minor improvements at best. With Lactobacillus plantarum, the pain was gone within hours. Bacillus coagulans was also helpful for better digestion, but I had to take it every day and was later able to achieve a superior effect with glycine-rich foods, so I stopped taking it.

While I swear by L. plantarum, I do believe that probiotics are mostly unnecessary. If you have to take them every day, there is probably a deeper problem that needs addressing.

Intermittent fasting

I’ve previously written about two stressors, cold showers and exercise, helping me cope with various symptoms. At about the same time I’ve started experimenting with another stressor: intermittent fasting. Surprisingly, fasted state is when I have the best focus and productivity. I usually skip breakfast and only eat within an 8–9 hour window, with a big lunch and a big dinner (or two).

Fasting is a stressor that requires caution, but an intuitive approach works well for me. When the body stops telling me “This is uncomfortobale, but I like it” and switches to “Are you trying to kill us?”, it’s time to listen and eat something.

Supplements

I don’t like using supplements, because I often forget to take them. However, they are a great tool for controlled experiments. For example, I’ve taken pure glycine for two weeks with great results and after that incorporated a lot of collagen into my diet (with the same results).

It’s all just placebo and correlation doesn’t imply causation!

If everything I’ve experienced is a placebo effect, where was it for the previous 4 years? Out of the 50+ lifestyle changes, prescription pills, supplements and probiotics I’ve tried, only about 15 worked. If there was placebo effect, it must have been negligible. However, the good ol’ regression to the mean (patients getting better on their own) definitely played a role. Then again, I’ve tried relying on it many times before and it was never sufficient on its own.

How do I know the interventions listed above helped? Either I’ve done sufficiently many experiments or the effect was so strong it’d be impossible to explain otherwise. For example, after taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly, strong abdominal pain started. Wikipedia lists gastrointestinal problems as the main adverse effect of NSAIDs and they are also known to disrupt gut flora. Nothing has helped me for years. Then one day I tried Lactobacillus plantarum and the pain was gone within hours. Fixing other stomach problems took another 10 months, but at least the pain was gone. Also, L. plantarum is one of the few probiotics that performs in medical trials on people and in other studies, animals benefited from probiotics after being given NSAIDs.

A true skeptic would say that correlation doesn’t imply causation and that such evidence is not sufficient. Many people don’t believe successful stories and dismiss any kind of evidence, often because it contradicts their beliefs.

Skeptics are right that no evidence is perfect and we can never be completely sure. I admit I didn’t use an identical twin as a control group and I didn’t double-blind my fasting experiments. However, my personal experiments showed that skeptics are as likely to be wrong as the people they criticize. I’m glad I didn’t listen too much to sites like QuackWatch and Science-Based Medicine, otherwise I would probably avoid probiotics, cholesterol and fat for no good reason.

The new skeptic movement reminds me of the disagreement between academic skeptics and Pyrrhonian skeptics 2 millennia ago in Greece. Academic skeptics claimed “Nothing can be known, not even this” while Pyrrhonians viewed them as too dogmatic. I’m siding with Pyrrhonians here and my advice is: be skeptical, especially of skeptics.

This post is getting too long, so let’s take a short break with classical music.

Self-experimentation and its risks

A while back my mom told me to drink a particular herbal tea to alleviate some of my symptoms. I replied with “If this herb was effective, it’d have performed well in scientific trials and doctors would have prescribed it to me.” The statement does make sense, but it involves many strong assumptions and often isn’t true.

As an example, there is a drug called ramelteon, which binds to the melatonin receptors and for all we know it has identical effects to melatonin and performs about the same as melatonin in clinical trials. A monthly supply of melatonin is about $5 while ramelteon costs $100, yet doctors prescribe ramelteon instead of melatonin. Or one time I asked a Swedish gastroenterologist about her opinion on L. plantarum and other probiotics. She told me I know more than her and I should keep trying. This is despite plenty of successful clinical trials, many done on Swedish universities.

The previous two examples were cures that proved themselves in trials. Using fat and MCT oil in particular to increase the production of DAO has only been tested on rats. Perhaps it also works on people, but as far as I know no experiment was done on people, so doctors wouldn’t recommend it.

Medicine seems to miss a lot of treatments, so self-experimentation might be worth it. It does bear a lot of risks, so I evaluated possible adverse effects and monitored my health. For example, I’ve closely monitored my cardiovascular risk factors and they stayed the same or improved. However, I don’t trust these tests completely. A comprehensive heart-disease blood test would include 5–7 different blood values, but despite so many numbers, its predicting power is limited. I believe that there is too much focus on lipoprotein particle size and soon a more important risk factor will be discovered, so I’m not pronouncing myself completely out of risk yet.

Blood tests are tricky to interpret for another reason. Some blood reference intervals are calculated so that exactly 95% people fall inside them and it’s not always clear if sick people are included or not (see here or here). Unfortunately, many doctors don’t know that and would diagnose you sick or healthy solely based on these arbitrary numbers. It reminds me of a TV discussion with someone complaining that poverty in the US has stayed exactly at 20% of the population for the last 100 years. This came as a big surprise, so the moderator asked about their definition of poverty. “It’s the poorest 20% of the population”, the first person said.

So I take blood tests and reference intervals with a grain of salt. Perhaps more important is tracking values over time and comparing them with a younger version of myself.

Disclaimer: While I don't have a lot of trust in medicine and doctors anymore, a world with doctors is much better than a world without them. Doctors are awesome at fixing anything acute or live-threatening. Next time I break my leg into six parts while skiing, I'm sure doctors will do a great job. It's the chronic conditions where my trust disappears.

Further reading

I recommend 3 blogs for anyone interested in health and medicine. And one crazy idea.

• Whole Health Source: Stephan Guyenet is a neurobiologist blogging mostly about obesity but also other topics. He was one of the scientific advisors of the Perfect Health Diet book, but he would disagree with parts of it and his diet is slightly different, too.
• slatestarcodex.com/tag/medicine: Scott Alexander—the best blogger on the Internet—is a psychiatrist by training and often blogs about problems in medicine, including drug discovery, life-cycle of medical ideas and how skeptics exaggerate their claims. This blog hasn’t affected my life-style but it pointed out the common problems and gave me arsenal to evaluate medicine.
• Mosaic: A non-profit website with awesome scientific journalism about anything life related. Again, I learned a lot from this website but it hasn’t affected my life-style.
• If you like crazy ideas, Robin Hanson suggests to cut health care spending in half, since spending on health care doesn’t correlate with health outcomes anyway. I’m not buying it yet but the idea is worth pondering, as are all Robin’s ideas.

I’ve also read other websites and watched a lot of YouTube videos, but it’s a minefield that is very difficult to navigate. Especially nutrition discussions are often worse than politics or gender, with people citing facts out of context, ignoring evidence and sticking to dogmas. For example, many people benefit from vegetarian or low-carb diets and then preach them as the healthiest diets for everyone. Perhaps they are helpful in certain situations, but that doesn’t mean everyone should follow them or that they are safe in the long term. And some people don’t benefit from any diet, so they become radical skeptics and question everything. Usually there is some truth in each dogma, but some people take them too far.

Maybe this post is also full of untrue dogmas, misrepresented scientific findings and without contradicting evidence. Only time will tell. I tried to do my best, though.