A Swan Dive Down the Rabbit Hole of MTHFR Mutation Discovery and Treatments

It's a really common saying - not just in CrossFit, but in life - "Don't compare yourself to others." It's incredibly sound advice, given the vastly differing histories and context that go into each person's development. Comparing your training to someone else's will rarely leave you feeling more confident about your progress, in large part because it's easier to spot someone else's biggest successes and harder to perceive their struggles, their setbacks, and the other countless inputs that they brought to the table.

However, I'll submit that in certain ways, comparison has helped me to realize that something was not right. In the last six months, I noticed that I had CrossFitting friends ten, twenty years older than me, who were recovering much more quickly from workouts -- despite the fact that I was usually eating a recovery-friendly whole food gluten free diet that strategically stacked my starchy carbohydrates with protein just after workouts.

I was diagnosed with hypothyroidism last year. While very low carb diets have been tied to thyroid problems in women, I regularly consumed a moderate and activity-appropriate amount of carbohydrates. I couldn't help but wonder if there was more to the picture than just lousy workout recovery and hypothyroidism. My doctor began ordering several labs for me to try and get to the bottom of my condition.

Then, this spring, just before going over the umpteenth lab results set with my doctor, a lightbulb flickered on in my head. I asked my primary care physician, an integrative medicine MD, if she thought it was worth testing me for gene mutations on the allele for methylenetetrahydrofolate reductase (henceforth MTHFR). The allele critically important because it is the blueprint for MTHFR, an enzyme which adds methyl groups to molecules. The name for this enzyme's methyl group management is called methylation, and methylation is critically important to a panoply of physiological functions, to include: metabolism and energy recruitment, epigenetics (turning genes "on" and "off"), neurological function (in part because of MTHFR's impact on neurotransmitters like serotonin) and neurological development, and susceptibility (including stress-related susceptibility) to intestinal inflammation and permeability, to name just a few. As you might guess, since methylation is so critical to these functions, its impairment is tied to a similarly long list of diseases and conditions.

I had seen chatter about MTHFR on Twitter for the last couple of years, usually in relationship to autoimmune conditions and autism spectrum or other neurological conditions. It had dawned on me, though, that since my youngest daughter is on the autism spectrum, she could be a MTHFR mutation carrier (and as it turns out, MTHFR mutations are found much more frequently in autistic kids)...and therefore as her parent, I was likely the carrier of at least one MTHFR mutation, too.

As it turns out, I'm a type of mutation carrier called compound heterozygous. It signifies that I carry one copy each of two different mutations, also known as polymorphisms. My mutations - A1298C and C677T, can together cause more damage than the sum of their individual impacts. My lab report tells me that, "Individuals who are compound heterozygous for the C677T and A1298C alleles, which produces a C677T/A1298C genotype, have according to some studies 40-50% reduced MTHFR enzyme activity in vitro and a biochemcial profile similar to that seen among C677T homozygotes with increased homocysteine levels and decreased folate levels." In other words, having one of each of those mutations hampers my MTHFR enzyme activity about as much as those with two copies (homozygous) of the most significant MTHFR mutation, C677T.

This lab work suddenly helped so much lock into place. Many of my suspicions finally had basis in reality. No wonder my recoveries were not lining up with my CrossFitting friends'; my genes meant I could possibly be clearing lactic acid from my muscles at roughly half the normal rate. Beside that relatively mundane inconvenience, I now must work with my doctor to measure and address homocysteine levels in my blood and my risk for several MTHFR-mutation-associated diseases - not just by considering targeted supplementation, but also by using a multi-pronged approach that includes my microbiome/gut health, stress, sleep, cortisol levels, and other aspects foundational to my physical and mental heath. Although I doubt the journey through MTHFR mutation management will be linear, I'm looking forward to testing, retesting, and continued coordination with my health care providers to address my body's needs.


Do you have an MTHFR mutation? How did you begin to tackle your body's unique needs?



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An Impromptu Interview on CrossFit, In My Dermatologist's Exam Room

This afternoon, I sat on the exam table at my regular skin cancer check, with my new dermatologist. 

She ran her fingertips over my arms and then arrived at the palm of my hands, startled.

"Oh, my! Why do you have such hard callouses on your hands?"

"I'm a weightlifter. I do CrossFit."

 

"Oh! I have heard of that! I attended a wedding over New Year's where the bride and groom and everyone at the reception were CrossFitters. That's how the bride and groom got together, in fact. What makes it different from any other workout?"

"Well, for me the main difference is the tightly knit community. If you are gone for even a couple of days you start to get messages from your CrossFit friends in your class saying, 'Hey, where are you?'"

"Class, like a time slot? You mean you show up at a specific time for a class? I thought it was just a free for all."

"Well, it might kinda get that way during open gym hours, but almost everybody regularly attends a designated class, like at 5 o'clock or 6 o'clock. I have been working out with some of the same people for as long as two or three years in our morning class slot. It's been a very positive experience for me. When I began, I was heading toward 220 lb. and sedentary. I could not climb stairs without getting winded!" 

"You started CrossFit in THAT kind of shape?"

I laugh. 

"It's OK to question my sanity. But I started with baby versions of the stuff I do now and worked my way up over a year, two years."

"People at that wedding were talking to me about it, but I thought it wasn't for someone my age."

"Well, we just celebrated the birthday of our box's oldest lady athlete, who is 60, and our oldest male athlete is 64, if I'm not mistaken."

She paused a moment to appreciate that.

"Where do you go to CrossFit?"

"I go to a box up north by the courthouse. But now there are, like, 5 or 6 boxes just in our immediate area."

"What did you call it? A box? Why a box?"

"We call it a box because the space is mostly empty, and we bring out our weights and organize them when it's time to work out. We do stuff without weights, too, like pushups and pullups."

"What about burpees? I hate burpees. And mountain climbers."

I laugh.

"Well, I hate them, too. And I hate running. But I kind of think of those as the broccoli of my workout."

She laughs.

"Do you run a lot?"

"Not great distances. Usually a quarter or half mile at a time, then we do some other stuff, then we'll run another quarter or half mile."

She returned to the task of my skin exam in earnest, but soon apologized for not properly introducing herself to me as I was a new patient.

"And I have just one more question. Did anybody push you into doing CrossFit, encourage you to do it? Tell you do to it? Or did you decide to do it by yourself?"

"Well, I kind of came into it backwards. I was cleaning up my diet and while I was doing that research online, I kept running into people talking about CrossFit, and I thought to myself, 'Maybe this is exactly what I need to get myself back in shape.'"

"Well, I have to hand it to you, that is really something else."

~

The above conversation had earlier today has been replicated as best as my memory can serve while composed to still make sense to my readers.

Why Would Women Want to Lift Heavy?

I posted this super-dazzling record-setting deadlift to a CrossFit friend's Facebook timeline. The lady doing the lift in the video - Ms. Kimberly Walford - deadlifted 562 lb. at 152 lb. body weight - just an enormous, almost inconceivable strength to body weight ratio.

My CrossFit friend and I both LOVE to deadlift, so it was a shared moment of geekery. One of her friends asked, in all sincerity, "Why would women want to lift 500 lb.?" I think she was not asking about the figure specifically, but trying to get at the heart of why any woman would pursue or achieve superlative strength.

----------

I have been thinking about her earnest question for a day now. I LOVE the chance to think over these things and for a moment appreciated how an outsider to CrossFit/lifting culture might ask, "Why?" I think it's a GREAT question. I know my parents are sometimes baffled listening to my (CrossFitting/lifting) brother and me as we wax nerdy on lifting personal records or skill achievements.

That said, lifting weights doesn't have to be an endeavor of crazy superlatives. You don't have to strive to hit some deadlift record to appreciate the health and functional benefits that a basic level of strength training provides. Modest resistance training benefits are a huge reason why some people aging into their 70s, 80s, 90s can still be spry and get around as well as they did in their 50s and 60s, while other aging peers lose the ability to bend over, squat, kneel, etc.

Once somebody learns their way around a barbell, though, it's not uncommon for them to get bitten by the bug to improve beyond the basic strength and functional fitness benefits. It's kind of like the difference between having learned how to pull together a basic meal that keeps you going (bologna sandwich on whole grain bread with carrot sticks) that will fill you up, and then wanting to learn how to prepare a meal with finesse (caramelizing onions to top stuffed pork chops next to a side of braised asparagus)...it's a difference between achieving functionality (the end is met in the weightlifting making daily life easier) and mastery (in which the pursuit of mastery is often a joy, too).

Why would somebody want to lift 500 lb.? A lifting record that big goes way beyond making grocery shopping, toddler-wrangling, piano-moving, and other basics of life easier. It's a fire-in-the-belly passion thing -- the same fire that drives some people to paint unspeakably beautiful works of art, or to break records for high jumping, or to master playing a piano piece...in other words, such achievements are not required for life, but watching someone pull it off is something of a work of art and peak physicality, just one more way that humans can far exceed limits not because they need to, but because they willed themselves to dazzling lengths. It's not just achieving mastery, *but also* the pursuit of mastery that humans experience as a pleasure in and of itself.



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Constructing Real Plans To Avoid Excuses - Contingency Plan Edition

Welcome to 2015, folks.

I think it's completely normal to start the year with idealistic statements about how you will do better. You could set specific goals about your new daily routine, even.

How many of us have been there?

"I'm totally eating a salad every day for lunch."

"I'm going to work out 5 days a week."

"I'm going to drink 100 ounces of water each day."

...et cetera. I've definitely been in that planning zone many times over the years. Everything sounds so synergistic and awesome and foolproof. How hard can that daily workout and salad be? Some of us (me included, at least 7 times in the last 3 years) join our local gym's nutrition challenges in a bid for added accountability.

Where the hitch comes in: not having plan B. Sometimes, also for not having plan C, D, and E.

85 lb. thrusters at the Thanksgiving WOD.
So, while managing food choices
on days like these still takes effort,
thanks to CrossFit's "holiday workout"
culture, there's almost always a way to
break a sweat, even on holidays.

The last 6 weeks of the year are pretty easy for me to spot some chances for hiccups. We have TWO family birthdays during December, and with Halloween, Thanksgiving, and Christmas, I have learned to compensate for these pretty well - sometimes "going for it" in certain rare "this is living" moments, and more often choosing alternatives or abstaining when the treats on offer are not quite so worthwhile. It's pretty easy to let roughly 4 weeks each with a single day of feasting opportunities bleed into 4 straight weeks of feasting.

Your resolution progress is less likely to die because of your salad habit or workout habit goals per se; your resolution progress is more likely to meet an untimely end because of not planning for habit-wrecking contingency moments.

Contingency moments. Those are the moments that manage to catch you in a whirlwind of hunger, fatigue, emotion, social niceties, and whatever else might pitch in to weaken your resolve.

This moment could look different for a lot of people. For me, it could be coming home after an emotionally intense Individualized Education Program (IEP) meeting discussing my 5 year old daughter's needs at school. It could be getting 5 hours of bad sleep (many reasons why this might happen) instead of 8+ hours of quality sleep. It could be getting sidelined from a planned workout by a wonky shoulder that deserves to be rested.

For others, that contingency moment could come in the form of an adorable Girl Scout at one's doorstep selling cookies. (In my state, the cookie sales start in less than a month!) It could be a relative's birthday party. It could be school being cancelled because of weather - and a mom stuck home with kiddoes instead of making her midmorning gym run. It could be an unexpected day out or trip somewhere, and finding oneself confronted with delicious-looking local specialties.

There are contingency moments that you can  anticipate and plan - and contingency moments that will arise without warning.

The key to your success in making progress toward your eating and exercise goals is to be as prepared as possible for ALL contingencies.

I can hear the protests from the other side of the interwebz now.

"But how could I possibly be prepared for ALL contingencies? That's crazy talk! I'm not clairvoyant!"

The habit-wrecking moments will come whether you are prepared or not. Wouldn't you rather be somewhat ready for them when they do arrive? That way, if you find yourself with several weeks of contingency moments, you can face them confidently instead of losing ground on your new goals and habits.

First, talk yourself through the next 3 to 4 months of knowns. Once you've identified a "known contingency moment", you can develop workarounds and strategies to keep known contingencies from defeating your progress.

In my case, I know that the coming month will bring Girl Scouts through our neighborhoods and to the entryways of many local stores. Other sample "knowns":

• Annual cultural chocolatefests. You know that Valentine's Day (February 14) and Easter (Sunday, April 5) are coming, and that means being surrounded in stores and during social occasions by chocortunities (aka opportunities to snarf down loads of chocolate).
   
• Holiday Strategy: Know Treats Are Always There. Read Dallas and Melissa Hartwig's classic post, "Halloween Candy is Not Special." Remind yourself that you are a grown adult, and that most of the chocolate sold and served for these holidays is available year round.
   
• Holiday Strategy: Limited Mindful Indulgence. Decide for yourself if there is any single seasonally-limited treat that really makes life worth living for these holidays. Many people could go a lifetime without a marshmallow peep or creme egg, but for others, the idea of sitting down with a single creme egg in a quiet, appreciative moment, may be enough. Only you can decide whether you would be served by this moment of indulgence long term.
   
• Holiday Strategy: Request Supportive Gifts. Be deliberate and directly ask your main squeeze for a Valentine's treat or gift that doesn't wreck your progress. Instead of a giant box of chocolates, it could be a trip to the movies, a new jump rope or abmat, some high quality jerky, or some ultra high cacao content dark chocolate.
   
• The Birthday Celebration. You know that you have X birthdays that will be celebrated with friends and family in that time frame.
   
• Birthday Celebration Strategy: Healthier Options with Possible Mindful Indulgence. If you are helming one of these celebrations (that is, you are the parent of a child having a birthday), you can do a pretty sweet job of setting up a birthday party featuring reasonable choices. Deli meats, grapes, cheeses, veggie trays, and hummus with gluten free chips are all readily gobbled up by kid and adult partygoers alike, in my experience. Plan for yourself ahead of time whether and how much you would indulge in your kiddo's birthday cake, doing it with your long term goals factored into the analysis. I have done it many ways over the years (abstaining altogether or having just one piece of cake). Have an "escape hatch" plan for your remaining cake so that you don't have it calling your name in your kitchen for days afterwards. I have often sent leftover treats with my husband to work, as one example.
   
• Birthday Celebration Strategy: Moderation or Abstention. If it is a birthday of someone a little less close, in many cases you can probably politely abstain from treats with little trouble. You could plan to prepare yourself by eating some healthy fats, protein, and veggies before attending the celebration.
   

• The Field Trip. You know that your child has a field trip coming up that you'd love to chaperone, and that doing so will mean that your workout and healthy eating routine could be interrupted.
   
• Field Trip Strategy: Plan a short at-home mini workout to do early in the morning before you leave to join your child's trip at school.
   
• Field Trip Strategy: Plan your workout for that day on another day when you'd typically rest instead.
   
• Field Trip Strategy: Depending on what the field trip logistics allow, think about packing your own lunch or snacks with sensible eating options like jerky, baby carrots, macadamia nuts, etc.
   

Above you've seen how to strategize for some known contingency moments. Now to think about somewhat known contingency moments. What do I mean by these? I mean moments whose timing you can't know until they happen, but whose likelihood of occurrence is high.

• You know that odds are good, based on the last couple of school years, that your child(ren) will miss at least a few days of school owing to weather conditions. If you do not plan for this inevitability, when you are snowed in with nothing but leftover Valentine's chocolate and several unwatched seasons of Gilmore Girls on Netflix, you could be setting yourself up for a setback.
   
• Snow Day Strategy: Research Home Workouts. Search online for workouts that fit your home circumstances. Some people are equipped with complete home gyms, while at the other end of the spectrum others have their bodyweight only at their disposal. Workouts exist for all possibilities - for example, Dai Manuel's blog post featuring 92 bodyweight only workouts. The workouts do not have to be extreme or long - even if you are breaking a sweat for 10 or 15 minutes each day you are snowed in, that is a better way to stay on track than not working out at all!
   
• Snow Day Strategy: Find a Friend. If you have fitness minded friends within a short distance (ideally walking distance if roads are impassible), invite them over on a snow day to do a workout with you. It's amazing how much more motivated you'll feel if someone else is "suffering" the same way...and you'll both feel way better afterwards, when the endorphins have kicked in. Alternatively, you and the same friend could both shovel each other's driveways for an all-too-practical "partner workout".
   
• Snow Day Strategy: Keep your fridge and pantry well-stocked. Nonperishable options that will keep you from wrecking your food intake. Keep the fridge and freezer stocked with eggs, poultry, beef, and fish. In the pantry, emphasize high protein options like jerkies, packets of nut butters, and low-junk protein powders. Veggie-wise, canned vegetables and vegetable purees (think pumpkin, butternut squash, sweet potato) will come in handy to help make appetizing soups you can stir on the stove while watching the flakes fly outside.
   

Finally, there is the example of the contingency moment you can't possibly anticipate. The "unknown unknowns", if I want to verge on meta. You can't plan specifically for these moments but you can do your best to stay equipped. I'm not exactly advocating building a giant back yard underground bunker of whole foods, but it can help to give yourself a little bit of backup in places you are most likely to run into "unknown contingency moments".

• Prepare yourself for unforeseen hanger and cravings. We are talking about that unpredictable moment you realize you would shake down strangers in the street if you thought they had brownies on their persons. Moments when your breakfast caught on fire or got accidentally eaten by your spouse and you're getting ready to go volunteer at your child's school for the entire morning.
   
• Travel and Traffic Strategy: Stock Your Car. This is a pretty great time of year for car stockage because the cold weather means much lower chances of anything going badly in your glove compartment. Jerky, nuts, and other higher-protein options are great to include. If you think there's too much of a chance of you casually eating your emergency stash in non-emergency moments by keeping it near the driver's seat, you can always pack the snacks in a bag and throw the bag in your trunk.
   
• Daily Life Cravings Management Strategy: Stock Your Purse or Laptop Bag. A Tanka bar or other whole food option in your purse or work bag might be the one thing that stands between you and that delicious-smelling fast food option on the way home, especially if you're trying to break old habits. The purse/computer bag standby is also great for meeting breaks at work, especially if you work in an office whose break room is always replete with doughnuts, candy, and/or pizza. Even a simple stash of something such as a can of tuna (with a pop-open tab) and an apple can work. When, for example, you've been unexpectedly trapped in an epic meeting for the last 3 hours, don't have time to hit your usual salad-selling locale, and will be stuck at your desk for the rest of the day, you'll thank yourself for carrying satisfying, whole-food-oriented options in your bag. Refueling with a mix of protein, carbs, and fat instead of simple carbohydrates will result in you feeling fuller and is likely to help you make it to lunchtime or dinnertime.
   
• Sudden Travel Strategy: Pre-Scouting Menus and Stores. Your job could suddenly send you on travel, or you may find yourself suddenly traveling to see an ill relative, or sadly, for a funeral. As soon as you know your route and destination, it can be very helpful to have at least 2 nationwide chain restaurants in mind whose menus you know how to exploit for healthy eating - an example of one of these for me would be Chipotle. Track down locations along your route and near your destination. You can also investigate local grocery shopping options that may suit your needs, depending on how close they are to your accommodations and how many days you'll be away from home. Having these eating out and grocery shopping strategies in place can go a long way to keeping you from making poor, spontaneous food decisions that will wreck your digestion and your progress.
   
• Prepare yourself for unforeseen workout interruptions. It could be an injury that keeps your main mode of working out off limits (such as the case of foot/ankle injuries and running), or that your location (gym, pool, etc.) closes for unforeseen reasons.
   
• Injury Strategy: Learn About Workarounds. If you can't run, maybe you can swim. If you can't deadlift, maybe you can squat. Letting an injury rehab (and please, consult a professional about your injury concerns and proposed workarounds) does not mean you need to do absolutely nothing in the meantime. If you work out at CrossFit gym or under the eye of another kind of trainer, be sure to describe your movement issues and ask for help substituting movements in your workouts.
   
• Workout Venue Closure Strategy: Learn Home Workouts. As discussed above in the "Snow Day" suggestions, home workouts can be tackled even with just bodyweight.
   
• Workout Venue Closure Strategy: Seek Other Venues. Have some "plan B" venues in your head that you know you could try out. It might be the pool, or an inexpensive gym (think Planet Fitness) that helps you fill in the gap.
   
• Sudden Travel Strategy: Travel Workouts. If you are gone for several days, you can make sure that your body still gets movement even while on the road. Your workouts can be the same as home workouts (including bodyweight workouts), or you might be lucky enough to take advantage of hotel gyms or other opportunities, such as visiting other CrossFit boxes as a drop-in. If you are dropping in at a box, be sure to make an effort to contact the box ahead of time, if at all possible, so that they know to expect you.

How are you planning ahead to manage those moments with habit-wrecking potential in 2015?



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