50/50

I've spent the last week in Arizona with my parents. I went by myself this year, which was difficult. I missed Jeremy and the children desperately, but my dad is very sick with an advanced case of ulcerative colitis. I haven't seen him since before his diagnosis, so I was shocked by how pale, weak, and wasted he's become, from muscle loss and anemia. The smallest bit of activity wipes him out. He's practically house-bound at this point. Seeing him so sick and in so much pain and misery made me feel helpless and afraid.

I went to Arizona hoping to cheer up my dad and relieve the caretaking burden for my stepmother, but also to act as my dad's nutritionist. He's been waiting for weeks to be approved for a drug called Remicade, which is a last-ditch medication effort before a colectomy (surgical removal of the entire large intestine). He's been run through the wringer by his insurance company, but just before I arrived he was approved. Of course, his insurance will change at the beginning of the year, before he can begin the treatment, so he'll have to go through the whole process again.

My dad had a heart attack five years ago, at the age of 45. That makes two serious life-threatening diseases he's developed by the age of 50. After several years of interventionist medical care I think it's fair to say that my dad is fed up. He's been through many different medications, some established, some experimental, some of which have caused serious allergic reactions or side effects. Confusingly, some of his medications are treating conditions he doesn't have. He's taking statins, for example, even though he has never had high cholesterol. He's also taking a blood pressure medication, despite having never been hypertensive. He's part of a class-action lawsuit against a pharmaceutical company that neglected to report ulcers as a side effect of one of his medications; his doctor believes his ulcerative colitis might have developed as a result of that drug.

I was hesitant, but hopeful, as I approached my dad with nutrition recommendations. Surprisingly, his medical team has never discussed diet as a way to control the symptoms of UC. I say "surprisingly" because, although diet is not believed to be a cause of UC (which is an autoimmune disease), it's literally impossible to have a digestive disorder that is not impacted by food. His doctor told him that his case is too advanced to see improvement from what he eats. In my opinion, such an assertion should not be made until after the patient has made a serious effort to eat differently.

It's also my opinion that when the option to surgically remove a major organ is under serious consideration, every alternative should be tested before that happens. Ultimately, what my dad chooses to do with his body is his decision alone, and I recognize that he is in a desperate situation. But I hoped to offer some ideas that might diminish his symptoms, if only so he will be stronger before undergoing Remicade therapy (which attacks the immune system, with potentially fatal side effects) or be in a better frame of mind when considering bowel surgery.

I worried that I'd have to fight my dad on my recommendations, or that he would simply ignore me, but he was very open-minded. My suggestions included:

• drinking bone broth before meals, to balance the immune system and help restore the mucosal lining of the colon;
• having one or two protein shakes a day, made with coconut milk and gelatin (thanks to Facebook readers for the recommendation on gelatin, which is a good substitute for conventional protein powders);
• consuming 6 small meals instead of 3 big ones;
• replacing vegetable oils with coconut oil, olive oil, and real butter;
• eating grass-fed and pastured meats, cooked rare;
• having plenty of eggs as an easily digested protein source (and no more Egg Beaters, ferchrissake);
• switching to a whole-food iron supplement, combined with vitamin C and folate for absorption,
• a sublingual B-12 supplement to improve energy levels (especially because he takes statins),
• total avoidance of fast food and soda (seriously, that stuff causes diarrhea in people with normal digestion);
• cooking vegetables well to break down the fiber, and mostly avoiding cruciferous vegetables;
• skipping beans, seeds, and corn, which are very hard on the ulcerated colon; 
• elimination of gluten (I said he could try real sourdough bread on occasion);
• cutting back on whole grains, which are generally high in insoluble fiber; I made an exception for occasional oatmeal, which is mostly soluble fiber; and 
• relaxing; eating slowly; not being afraid to eat; pinpointing causes of stress in his life.

He seemed open to trying most of these ideas. I guess he must be even more desperate than I thought. When I look at this list and compare it to how he ate before his diagnosis, I'm floored by what a difference it would mean to his habits. If he's willing to commit to even a few of these changes, I think it could help relieve his symptoms.

I can't say that I don't harbor some resentment toward his doctors. I didn't realize it at the time, but a nutritionist or dietitian was not included as part of his medical team after his heart attack. He saw a dietitian after being air-lifted to the hospital (who told him to eat margarine and Egg Beaters, gag), but otherwise his diet has not been addressed. How can this be?

My dad hopes to stop some of his medications. Every time he sees his doctor he asks to quit something. But he's found, like most people, that it's nearly impossible to stop taking a drug once it's begun. If my dad manages to live a long life he could be on drugs for high cholesterol and drugs for hypertension and drugs for their accompanying side effects for thirty years. Never mind that he doesn't have high cholesterol or hypertension. Doctors are very reluctant to taper off a medication if it seems to be working, and it's certainly easy for a drug to seem to be working if the patient never had those conditions in the first place.

While visiting my grandparents, I noticed that my grandfather's legs are turning purple. He has diabetes, and he takes 26 medications and supplements every day. I asked him if he monitors his blood sugar and he said no. Instead he's taking ALLI, that popular new weight-loss drug. This drug was recommended by his dietitian, who claims that type 2 diabetes is genetic, has nothing to do with sugar consumption or metabolism, and can be managed by pooping out all the fat you eat.

He pulled out his bloodwork for me and I was shocked by what I saw. My grandfather is taking the maximum dosage of diabetes drugs three times a day. His blood shows liver toxicity, and his fasting glucose levels are not healthy. He takes a few different drugs for cholesterol and triglycerides, but his VLDL cholesterol is still too high and his triglycerides haven't budged significantly in ten years. He's not even benefiting from the drugs that are poisoning his liver.

So I broached the subject of approaching his health differently. I talked about cholesterol metabolism and the high percentage of refined grains and omega-6 fatty acids in his diet. I pointed out that a rational approach to drug therapy is to reconsider a medication that isn't working, and to weigh the costs and benefits of each drug. I mentioned that checking his blood sugar is an essential aspect of managing diabetes. I told him that moderate exercise is the single best way to address high blood sugar. I shared my experience of improving my health after measuring just under the limit of prediabetic.

At the end of our conversation he laughed and said, "See you next year!" I was hopeful that I had, at the very least, inspired a bit of skepticism.

The next day, he brought me a jar of marshmallow fluff, several gallons of which are delivered to my grandparents' house each winter (a New England delicacy, apparently). Now, I don't mind indulging in a few holiday treats, but a pound of air-fluffed corn syrup is where I draw the line. When I said no-thanks, he scoffed at my assertion that I shouldn't be consuming pure sugar. "That has nothing to do with your blood sugar," he said. "Besides, it has no cholesterol. Look, it's right here on the label! No cholesterol!"

One out of two ain't bad, I suppose...