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Biohacking Chronic Disease

Day 322 and 10x

One of my favorite hobbies used to be powerlifting. When I had to take time off to control my ankylosing spondylitis (it’s an inflammatory spinal condition) I was simply in too much pain to walk around the block let alone squat 250lbs. But as we’ve controlled my symptoms so efficiently I’ve been able to pick back up weightlifting this fall. I’m overjoyed as this represents full recovery to me.

I’ve been slowing introducing weight using the core barbel lifts using the Starting Strength method. It’s been a blast as I get to have beginner gains all over again after being sedentary. The biggest change in how I train compared to my time before managing a rheumatoid condition is timing my training around my recovery. I used Whoop and Welltory who both measure my HRV or or heart rate variability. It’s basically a measure of how well your autonomic nervous system is coping with stress and turns out to the best predictor of how well I will feel on any given day.

A recovery chart of my HRV with red marking the days I lifted.

I’ve noticed that lifting hits my HRV hard. And it takes time to get it back to a normal place. Sometimes several days. I absolutely cannot not push my recovery frame without making my HRV dip even worse. It’s fascinating to see how well correlated the two appear to be.

On days when my HRV dips my resting heart rate is noticeably worse and using an app like Welltory I can see much more stress I’m under and how damn active my sympathetic nervous system is at work. The stress of recovery is significant. And my symptoms will tend to flare. Pain and fatigue are noticeably worse.

Despite the evidence I have found it mentally challenging for me to trust this stress and recovery process. On bad days when my HRV dips I forget how well I felt on the good days which leads me to some emotional flailing. Instead of trusting the routine I’ll panic at how shitty I feel. I’ve got amnesia about how terrific & productive I can be.

I’ve got to learn to trust the numbers. Otherwise I’ll do stupid shit like push to get something done on a bad day. That activity will take hours of hemming and hawing and willpower and brute force. If I had just waited for a good day to get my shit done chances are the task will take me 5 minutes.

Forcing myself to abide by the recommendations of Whoop and Welltory gets me out of the cycle of flailing. Listening to the data can override my amnesia. If a bad HRV day happens I just don’t try to do ANYTHING. Because I know on a good HRV day I’ll be 1000x more productive. It’s a discipline I need.

Everyone has different capacity. Forcing yourself into the “industrially necessary” routine of a 9-5pm weekday only makes sense if you are in a bigger corporate system and must be reliable even if you are not performing at your best.

Freeing myself from the mentality of being available on a bourgeois schedule is challenging. I hate feeling like I disappoint people by not always being “on” and productive. I feel like availability & reliability matter more than outcome (which is occasionally true but not generally true). The reality is you can have 10x Julie or you can have consistent Julie. I’d pick 10x personally.

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Biohacking

Day 318 & Boring Health

The word wellness has become so comically performative that I cannot use it with a straight face. It would require so many disclaimers and apologies and contextual additions to move it beyond the associations with wealthy white women (thanks Gwyneth) it’s not worth the bother. But it’s also equally true most people do not feel well. The feeling of being healthy eludes us.

Our health degrades more quickly than we’d imagined, as if planned obsolescence wasn’t a term for software, but rather a term that describes our bodies as we move beyond our twenties. It feels intimidating to try to staunch the flow of time.

We acquiesce to our obligations, our stresses, our weaknesses and our limits. And our health degrades further. And with each turn of the wheel it seems even more impossible that we could feel any other way. But I promise you this does not have to be your life. You can feel well. I’ve come back from the brink of chronic disease. It is possible. It’s just all extremely boring and time consuming.

It’s hard work and it’s boring and repetitive and frankly your work won’t show results for months or even years. But you are not doomed to lose your health to outside forces simply as a consequence of time, stress or overwork. I’ve written a beginner’s guide to biohacking as well as an introduction to supplements. Anyone can pick up the basics and begin to improve how they feel. Just don’t expect miracles. And yes it’s a position of privilege to pursue most of it. But there are ways.

If you look at one of my typical days I split a third of my life into some type of preventive work. Just in case anyone ever wondered why I don’t socialize much. I put most of that time into my body.

I sleep a full eight hours. I meditate. I go to therapy and group every single week. I do full body compound lifting three times a week. I do steady state cardiovascular work an hour every day. Ok that’s just a fancy way of saying I talk long walks. I take my vitamins. I eat protein and vegetables. I stretch. None of that is privileged or even interesting. It is just slow boring work that builds over time.

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Biohacking

Day 314 and Circadian Psych

I’ve been off since Daylight Savings on Sunday and I’m a little grumpy about it. All of my sleep metrics have been down by about 15%, which you wouldn’t think would make a dent in your day but somehow absolutely does. I’ve always been a winter person so I tell myself I don’t mind that it’s getting dark at 5pm but the adjustment is always brutal. Clearly my body minds.

I figure this will all pass in a few days but I resent the feeling of having my body not quite understand the rhythms of the day. It’s like having mild jet lag for no discernible reason. It messes with everything. The sun sets and I think oh it must be dinner time. Except it’s only 5pm and I just ate lunch a few hours ago.

It’s been combined with a few other changes in my routine which has probably compounded the issue. I tell myself I shouldn’t let it get to me. I keep trying to slide myself back to proper regimens. I am getting up at the same time even though it’s an hour earlier. I’m going to bed at the same time. And I’m sure it will pass. But god damn am I in a fucking foul mood. Your body really does keep the score.

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Biohacking Chronic Disease

Day 311 and Conspiracy Care

The current “news” cycle is up in arms about a football player taking medical advice from a podcaster. Depending on who you read this is either a very bad thing or a fight against woke mobs and cancel culture. If you have no idea what I’m talking about there is no reason to dive in further. Don’t upset yourself.

People take advice from people they trust, and sometimes we trust people we perceive as being smarter or even as having higher social status than us. Shortcuts are part of life. And if you have access to someone, say through a parasocial relationship like social media, that you perceive as being well equipped to solve problems you will probably listen to them. Which is a point Eric Weinstein made about Joe Rogan and healthcare that I think is especially salient.

I think we have to understand that people are also looking to Joe as a pass-through for concierge medicine. If you have brilliant Uber-rich people in your life you hear a lot about medicine you can’t afford. Whole body work ups. Multi day examinations. Lots of medical gear.

I didn’t used to have much health care. I went to free clinics and doctors who I could pay $50 cash to for antibiotics without a hassle. It’s probably little wonder that when I had real health care issues I wasn’t prepared for just how bad most care in America is even with health insurance. I thought I’d get good healthcare with a nice insurance plan. But it mostly sucks. I got dismissed, ignored and generally not diagnosed for almost a year. And then I figured out how wealthy people do medicine. And I began healing.

Holy shit is it night and day different what spending real money outside of your health insurance will do. Like Joe I get concierge care. And to the advice I get is pretty far off what you hear from a baseline healthcare practitioner like say the doctor who can only see you for 20 minutes and can’t risk anything that isn’t clearly proven and approved. But someone who doesn’t answer to a big hospital system? They turn out to be much more flexible and will help you work through the risk and reward (and also cost benefit) of a host of different tests, treatments, supplements, devices and diagnostics.

And over the course of about three years I went from functionally disabled and completely unable to work to, well, basically fine. Three years ago I could barely walk and now I’m back to powerlifting and hiking. But the sick thing is I am certain if I were a plebeian I would be on disability for life. I would have at best been prescribed pain medications and left to rot and potentially develop an addiction or two.

So is it any wonder that in a country with a mass chronic disease issue we’d look to wealthy proxies like Joe Rogan and imitate what he says is his care? Fuck no. It’s downright immoral and condescending to suggest that the victims of American healthcare systems shouldn’t try to help themselves. No one else is stepping up to pay for their healthcare.

What is a genuine issue is that without context and a team of professionals you might accidentally become a victim to conspiracy theories. Which is exactly what we’ve seen with a number of Americans. But the line between conspiracy and simply untested or unproven treatment is a lot blurrier than I expected. I had concerns I’d be taken advantage of by functional medicine doctors and holistic practitioners. And surprisingly that just didn’t happen. I was always given context, research, second opinions and supported in making as informed a decision as possible. Doctors are collaborative by nature and my team has encouraged me in my efforts to test and trial a lot.

This kind of care does not come cheap. I’ve spent close to $80,000 on concierge care services over the past year. This includes everything from diagnostics & testing to compound pharmacy and off label pharmaceuticals (get metformin just trust me), to a host of medical devices and treatments as well as the hourly cost of a primary care physician, a prescribing & case physician (it’s not uncommon for different doctors to do medicine management so as to monitor your entire case for interactions) and clinical nursing. Like I said, if I didn’t have money I would still be on disability. I’d estimate only 20% of my progress came from before I went to a more personalized approach. Medicare for all isn’t going to deliver you the kind of care I got.

I don’t really have a takeaway or solutions here. Most people don’t have complex chronic diseases nor do they have the need for the kind of last 20% health optimization that the billionaire class go in for either. But you can do a lot on your own. A lot of health is just preventative care.

I’ve shared a basic biohacking guide for beginners before. Replacing fat with lean muscle and getting your basic nutrient and fitness profile improved should do a lot for many of you (not true of chronic disease patients that’s complex). After you’ve done the basics on your fitness, body composition, and sleep hygiene for 3-6 months you can move on to supplements. You maybe surprise at what you learn and how much it deviates from what is common knowledge about health. Here is a little hack to save you time. Eat protein, lift weights and get sunlight. And stop looking down on people just trying to survive. That makes you feel better too.

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Biohacking

Day 307 and Cortisol

I had a couple nights of bad sleep. Because I’m the sort of dork who tracks, well, everything, I knew I had a crash coming my way. Naturally I took to Twitter to meet my biohacking needs and asked for tips on how to lower the stress hormone cortisol. And wow people must be stressed as hell as I got hundreds of responses.

Cortisol pumping constantly is what happens when you are in fight or flight stress mode. Being in a parasympathetic state is good sometimes because you can’t be stressed all the time. It will kill you.

Using a tracking app called Welltory that incorporates manual HRV readings and my Apple Watch this is what I looked like this morning. The red and choppy fluids are supposed to signify that I’m not doing well and losing energy.

So I started taking as many pieces of advice on the thread.

  • Meditated
  • Went outside for sun
  • Took extra vitamin C
  • Took ashwagandha
  • Sang to reset my cranial vagus nerve into parasympathetic
  • Used a Theragun to massage everything
  • Went for a walk in the woods
  • Took a cold shower
  • And then said fuck it and took a benzo because it’s not all holistic

All that effort seems to have paid off because a few hours later Welltory was telling me maybe I could use a little more stress in my life. I’d like to think it was the meditating and herbs but sometimes also pharmaceuticals.

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Biohacking

Day 303 and App Pressure

I refused to give in to peer pressure as a kid. I was way too much of a handful to ever let anyone else tell me what to do. Sadly this led to being constantly on the shit end of the girls in my classes because I didn’t like to play their games. I was terrible at respecting authority, and this included any kind of peer power structure.

Thankfully we moved every two years so I never had the suffer the consequences of being headstrong. Probably why I was so eager to thumb my nose at power. I didn’t think it was going to last for very long. So I never had to solve for it.

It turns out I should have learned to cope with peer pressure when I was younger. Instead of reflexively being against all kinds of authority, I should have learned when to accept (and when not) the input of people and systems who have power over me.

Why? Because now I don’t know when to say no. As an adult I am extremely susceptible to pressure from my applications. I opted into letting them have power over me and I have no idea how to say no to them. I’ve got a problem with application pressure because I didn’t learn how to deal with it as a kid. Ooops!

As part of my quest to regain my health I have become an avid biohacker. I track tons of metrics. I wear both an Apple Watch and a Whoop. I’ve use half a dozen different applications daily. But what I didn’t appreciate until recently is that the nudging state of my wellness apps is functionally just peer pressure.

My “Health” folder on my iPhone

And I give in to it every damn time. Welltory says I need to be active 10 hours today? I better go walk around the house. Apple Watch trends say I have fewer active minutes? Fuck I must be lazy. Gyroscope is reminding me I didn’t meditate? Oh no I am not zen enough! My applications are bullies and because I opted into it I feel like I’m a failure if I don’t say yes to everything. I guess it turns out you cannot escape life lessons.

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Biohacking

Day 302 and Lights Out

I’ve been a proponent of napping and mid day resting throughout the course of my recovery from chronic illness. Sometimes the only thing that stops inflammation is stopping your entire system. Rest and recovery is part of peak performance. But I was not expecting the sheer force of my desire for sleep to overcome me today. I was absolutely lights out.

I had a busy week with two major deadlines for portfolio companies along with a project for a friend who is a fellow investor. I’ve also been slowly restarting weight lifting again as I miss it as a hobby. Mix in a little frantic appointment frenzy and I’ve been busier than I’ve been since the before times. And by before times I mean before I crashed and burned with my ankylosing spondylitis not before times like before the pandemic.

Around 11am I went out for a hike to stretch my legs after my morning meetings. I only made it about halfway through when I realized I was tired. I came home and practically inhaled my lunch. I had planned to run errands and take calls but I could barely keep my eyes open. I got into bed at 12:45pm and I didn’t wake up again till around 4pm.

I’ve had this idea that wellness means I’ll never be tired again. I find myself incredibly indignant when I realize that healthy people get tired too. My fantasy that I’ll be able to work long hours and not pay any price for it remains a fantasy. Which makes me wonder if the rest of the world is exhausted all the time and I’m just unrealistic. Perhaps the norm is being on the brink of lights out all the time.

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Biohacking Emotional Work

290 and Self Care

I’ve feel like I should have an entire category on the blog dedicated to “maintenance” as I’ve got loads of posts on my struggles to balance the activities of staying alive with well, the rest of my life.

All of the activities that go into keeping a human alive and functional are so damn time consuming. How does anyone ever get anything done when so much of life is dedicated to keeping our meat sacks from spiraling out? I’m pretty sure these are the things that actually make up life and I’m supposed to treasure this time in my body. But until I become as enlightened as the Buddha, I feel like this whole embodiment thing is just getting in the way of what I should be doing. My therapist likes to call this “human doing” instead of “human being” and I don’t love the joke.

I had a terrific day of doing things this Sunday. I woke up at 7am and didn’t finish all of the various routines and self care activities till 1pm. I went for an hour long walk (which is pleasurable since sunshine and mountain air but also low impact cardiovascular activity) I lifted weights (alright fine, I love squats). I meditated (mindfulness doesn’t count when you quantify it). I showered, shaved & washed my hair. I did the grocery shopping and meal planning for the week. I did three loads of laundry. I made lunch. I cleaned up. I juggled supplements (I’ve got a spreadsheet to track them all with 8am, 10am & 11am slots) which are completely separate from my medications (I have 7am and noon spots for those). And only then at 1pm did I finally get a chance to settle into work. There was so much work just to get to work.

And while I know all of those things that keep me balanced and healthy are the stuff of life, I also resent their necessity. I have elaborate fantasies about what other people get done with their time. Other people don’t need to exercise, meditate, take vitamins, or watch their nutrition right? Well alright I said it was a fantasy. If you also spent your Sunday doing chores and self care it would make me feel better to know that.

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Biohacking Chronic Disease

Day 287 and Routines

I haven’t figured out how to incorporate my routines into my busier workdays. I feel like I’ve written this blogpost at least 3-4 times but somehow I never seem to find balance easily when I make big changes to how I spend my time.

All the self care efforts that has become comfortable rhythms go by the wayside as soon as I add in new obligations. And then my body gets pissed that I’m not taking care of it and I get into the same pattern of two steps forward and one step back.

You’d think after experiencing this issue multiple times I’d be better at ramping change slowly but I remain the sort of person that loves to dive into shit head first.

After much enthusiasm and progress I’m writing todays post from a physically mediocre places. My stomach is upset. I am fighting off a migraine. My muscles are tense. I’m anxious about all of these symptoms turning into a messy cascade. So I’m turning to my pharmaceuticals, taking a mess of prescriptions, and going to bed. Maybe tomorrow is another chance to find a better balance.

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Biohacking Emotional Work

Day 211 and Laughter

I miss being able to enjoy time out in the world. You know that feeling when you’ve spent the last two hours at your favorite bar with your friends just talking about nothing? The ease that you feel being with your community and enjoying being together? The casual camaraderie and easy laughter that comes from no expectations time together has been lost to many of us. I miss it.

It doesn’t seem like those days are coming back for some of us in the near future. If I give too much thought to the impact of things like the pandemic I think I just spike my cortisol. That’s a stress hormone. The stress of reactivity is killing all of us. Constant panic over floods, heatwaves, outbreaks and all their downstream effects is overwhelming our capacity to live. And yes, granted a more globalized war with a changing climate is capable of killing us. But we don’t have to let futility do us in early. We can find our way into solutions. But only if we stay alive to do it.

I’ve been coping with apocalyptic nihilism by shitposting on Twitter. Yes I realize this is a popular upper class pundit class past time. I’ve got some self awareness. But it’s also the only thing that mimics being out socializing with your friends. And I think that’s worth a lot. Shitposting is good for the soul.

You don’t have to shitpost, but if you cannot find a way to lower your stress response, as we say in crypto, ngmi. Everything may be going to hell but you aren’t there yet. You’ve got a life to live, people to love and who love you, and a chance to be happy.

Fuck cortisol. It’s not good for you. That’s some metabolic poisoning eating away at you and you chose to let it kill you. There is no reason to give yourself unnecessary stress. Some stress is good. It makes you resilient. But stuff you opt into? Fuck that noise it’s only going to make you sick.

And despite whatever family trauma circuit you may be playing out in your head, YOU DO NOT DESERVE THAT SHIT. No I’m seriously disease and suffering aren’t a moral good. Everything might be rough but you need to find a laugh. It might just save your life.