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I have kept up the Turtle Diary series for one chief purpose and one subsidiary purpose: its chief purpose was to explain to the world the details of just what life is like when you are a Turtle (TM.) Hop, skip, or crawl over the fold to get an insight into what I am talking about and what it means in physiological terms, NOW THAT I HAVE AN EXPLANATION that is.
The clever use of metaphor, literary allusion, and historical reference, as well as modern advances in nutritional science aside, there are some of us who just seem to be burrowed into a shell of adipose tissue from which we cannot ever appear to escape. And women have got it worse than men. One might conclude that it might have a chromosomal component, since the difference between women and men - is a Y chromosome, which chromosome, the 46th, actually determines the sex. However, the primary sex characteristics begin to develop in the fetus at the 4th week of gestation with the addition of particular enzymes. If the recently-isolated muellerian - named after some guy named Mueller who discovered it) enzyme is conferred, the fetus during early stage gestation, then a penis develops, testes grow, and then the adrenal cortex in the fetus adds the appropriate mix of pro-steroidal hormones to produce primary and secondary sex characteristics of a male during the gestational phase, and the encoding for pubertal development of secondary sex characteristics to create our adult forms. If the 46th chromosome is XX, then the urethra develops from the gestational cloaca into two channels, one for the urethra, a second for the vagina, and ovaries form rather than testes, and the uterus is formed as a single unit to house the ovarian follicles which are supposed to be released every 28 days after menarche until menopause.
But in some cases, this delicately balanced process - though conferring the proper genes es at week 4, does something different through a genetic process of missplacement, nonsense replacement, frameshift error, etc. (they have lots of cool names that make me wish I had become a geneticist) certain very common problems occur, mostly with the female fetus, called autosomal recessive gene abnormalities (now correlated to chimeric chromosome abnormalities on the 21st chromosome or the 11th chromosome.) Passed on from both the mother and the father (hence, recessive), and create for a good 1 in 10 women walking around today, an extremely annoying, shameful and embarrassing fertility problem known as polycystic ovarian syndrome. When I began to have these symptoms, there was no such thing as PCOS as a medical diagnosis. I just had cysts on my ovaries, told to take aspirin and wait it out. I took birth control - the old heavy-duty heavy-dose birth control pills, starting at age 18, and my life and health went completely out of control: because I was born with this genetic predisposition. Its relationship to Celiac disease and gluten sensitivity is not yet established. But I say, NOT YET.
Women who suffer from PCOS, as I will refer to it from here on out, not only have fertility problems (although many or most, with treatment can get pregnant - obviously, since an autosomal recessive gene abnormality would disappear rapidly if it could not be passed on, and instead its incidence is increasing. What are its classic symptoms? Insulin resistance, obesity, particularly the accumulation of belly fat in a male type of pattern (men accumulate fat around the torso generally, women around the hips, thighs and breasts. But these women - are different: MOST of them. Just as turtles come in different sizes, shapes, and colors, so do these human turtles: but in this instance, the turtles are ALL females, because males with the expressed gene, and with the more severe forms of this chromosomal disorder die either at birth or shortly thereafter, or succumb to early childhood diseases that are not fatal for other children. No surprise, this: the incidence of obesity among adult women is higher than it is among adult men.
But in my case, being I suppose, the Turtle Test Case, I have suspected, and now have clinical evidence warranting a differential diagnosis for a rare kind of gene abnormality which makes it so that so-called "normal" nutritional guidelines for dieting will be at least somewhat ineffective. My thyroid panel when it came back - was normal, so I do not have gluten-related Hashimoto's disease, nor do I have pernicious anemia nor other nutritional deficiencies related to malabsorption from gluten (something I had suspected.). In fact, my gliadin antibody test was negative as well, meaning that I have not mounted an immune response to one of the two proteins in gluten. SO WHAT THE HELL IS IT? Part of the answer is in PCOS, because I do have that problem, and since I am not seeking to regain fertility, I am not seeking treatment for that, nor would it help me as a so-called post-menopausal adult female. I've never wanted to have children. I started reading, and will be reviewing Colette Harris's practical book about her own journey to lose weight and regain her health with PCOS entitled "The PCOS Diet" which has some portion of the answer for me, and if you have PCOS it is a good read.
I only read the first couple of chapters of that, because I was digging deeper. But recent (i.e. 2002!!) a study in Turkey turned up a very high number, surprisingly so considering the previous belief that non-classical CAH (Congenital Adrenal Hyperplasia) was extremely rare, it is now known that CAH occurs in approximately 1 in 100 to 1 in 300 women, with an ethnic concentration in Turkish, Jewish (particularly Ashkenazi Jews from southern Europe) , and Moroccan ethnicities, Hispanics and Italians. But this is not a complete list: they only know what they have studied, and very few studies have been done on White Anglo Saxon Protestants as a cohort.
But I didn't really fit the common mold of the CAH profile as well; extensive hirsutism, high libido, male pattern baldness... eh? This previously-thought-to-be rare disease has a second manifestation only recently studied, called 11-beta. And the Turkish 2002 study revealed, voila, that of 100 studied cases of PCOS, 11 of them had 11-beta type CAH, an extremely rare form of adrenal disease.
I can tell you from what I know, not only am I an 11-b (I fit that profile to a T) but it also explains why I could never, ever lose weight except on the infamous Overeaters Anonymous Grey Sheet: because it is extremely low fat, and because the low intake level, by necessity, reduced salt intake massively. 11-betas concentrate salt and become hypertensive, sometimes in mid-adolescence. 11-betas turn nutritional fat into adipose tissue, and turn complex carbohydrates into adipose tissue rather than lean muscle. They are fat-creation engines and if they follow ANY traditional diet, it will fail.
I failed, too, and went to a dietician at the end of last month, where she cautiously (because she was clearly very baffled by my lack of weight loss and the mystery of my pristine food logs) suggested I lower my fat intake to the bare minimum, which is 30% of calorie intake. And when I did, I began to lose weight again, like clockwork, a pound a week.
My blood tests came back with low DHEA, a precursor adrenal enzyme that indicates the 11-beta condition and the possibility of CAH. My progesterone is too high. I am concentrating salt, get hypertensive when I consume dietary salt (I'm checking my pressure regularly throughout the day now and it fluctuates madly which is not clinically sensible) , even though I am eating under 3,000 mg of sodium in my diet. The only way I am going to lose weight and get rid of my excess fat is to go off the nutrition charts now, and drop down to below-RDA on salt, and way below RDA on fat content, because... that's the appropriate diet for me, and I have supporting clinical and test evidence.
This diary is already too long, but I have spent a huge amount of time mulling and researching and comparing with CAHSisters and downloading stuff from the CARES website. It is a huge relief to know that I'm not a lazy twinkie-eater who can't put down the snacks. The fact is, I never HAVE been and those who know me well also know that. Casual strangers don't, however, and I have suffered from the judgement and condemnation of people in every walk of society who don't know what a turtle goes through in trying to break through to the reality that a reason is a reason, and that sometimes only when the reasons are known, can solutions be found. No doctor would recommend the diet I am refining for myself. But once they learn about this, they may get a lesson from my blog.
I write this only for those people who have been defeated, over and over again, by traditional wisdom, traditional diets, new diets, fad diets, who are highly compliant and follow the plan and have gotten NO RESULTS. Like me. It is easy to try reducing your dietary sodium intake, and future Turtle Diaries are going to focus on high-fiber, low-sodium, ultra-low fat solutions which are good for any hypertensive, but the food plan itself is tailor-made to the 11-b turtle type. Don't go there unless all else has failed because as I say - no doctor would recommend this approach. But this is an experiment in progress, and while I am confident of results, it is still only an experiment.
I will close with an inspiring picture I took on a recent outing.
Upcoming diaries: please sign up to take a spot - this is a volunteer effort folks!
September 28
Mon AM - NC Dem
Mon PM - sychotic1
September 29
Tues AM - Clio2 (Kessler, Ch. 10)
Tues PM - ???
September 30
Weds AM - Edward Spurlock
Weds PM - ???
October 1
Thurs AM - A DC Wonk
Thurs PM - ???
October 2
Fri AM - ???
Fri PM - ???
October 3
Sat AM - ???
Sat PM - Edward Spurlock (Kessler, Ch. 11)
September 27
Sun AM - louisev - Turtle Diary
Sun PM - 1864 House
ETA: Thanks to cdkipp who pointed out I should be using the word "gene" instead of "chromosome" and should be using the term "sexual characteristics" instead of "sex" here. This turtle is no scientist.