Wednesday, 10 July 2019

Thoughts on the Fast 800 Diet


Having picked up Michael Mosley’s Fast 800 book a couple of months back I finally got around to reading it at the end of June. I’ve been toying with trying intermittent fasting for a while now, so this was kind of research. The approach centres on fasting, basically reducing calorific consumption down to 800 calories a day, with some additional elements of time restricted eating, basically eating within a certain ‘window’ of time each day to promote ketosis.

The recommended plan is a period of rapid weight loss (the Fast 800) by consuming just 800 calories a day for between two weeks and two months, followed by a less restrictive regime of intermittent fasting, whereby you fast a few days per week, and eat normally but healthily on the other days (the 5:2 diet). However, it accepts that sticking to Fast 800 for several weeks may not be practical or even advisable for everyone, so there is a degree of flexibility. Slower, but less intense weight loss options that are recommended include just doing the 5:2 or adding additional fast days without going the full Fast 800.

I decided that the full Fast 800 was unlikely to work for me, the severity of the restriction would be difficult to maintain, particularly at weekends. But fasting a few days a week, and doing time restricted eating on non-fast days was probably manageable. So, for the past two weeks I’ve been fasting around 3 to 3 and a half days per week. Basically, I’ve been fasting on Monday, Tuesday and Thursday, keeping my calories down to around 800. On Friday’s I’ve been fasting up until the evening but not sticking to 800 calorie limit (although still consuming less than a normal day). On Saturday, Sunday and Wednesday I try to consume all meals within an eight-hour window, typically noon till 8pm, although I have drunk the odd beer after this time. I chose these days because I’m in the office Monday, Tuesday, Thursday, Friday which helps restrict potential for snacking or large meals, whereas Wednesdays and the weekend have more temptations. 
   
So far, it’s gone pretty well, during the early fast days I did feel tired in the afternoons, and occasionally light headed (‘keto flu’ apparently), but it has gotten easier. I do feel mildly hungry for most of the day, but not as bad as I thought I might. The results are also encouraging, before I started I was weighing (on my scales) between 116.2kg and 116.8kg, this morning I was down to 113.0kg. I suspect the rate of loss will taper off, but if I can get town to between 111kg and 112kg for my next consultant appointment on 30th July I will be happy. After that I’ll consider moving to 5:2 plus time restricted healthy eating as a possible long-term pattern. It will also help that we’re going to attempt to change our diet as a whole family, so out with sweets and highly refined carbs and in with more complex carbs and fibre.

Wednesday, 3 July 2019

Goals update nine

One. Nothing.

Two. Things are going well, I'm now on week four of the new programme and running for longer than I'm walking. Last night I managed a total of sixteen minutes of jogging, in two three minute bursts and two five minute bursts. A combination of growing stamina and sense of pacing are the key. A couple of months ago I struggled with a minute and a half of jogging, now I can manage five.

Three. My weight has been bouncing around all over the place. Two weeks ago I weighed in at 115.8kg on my home scales, only to weigh in at 115.2kg on the GP scales three hours later. Last week I was 116.8kg at home despite feeling I hadn't done anything to warrant the rise.
I finally got round to reading Michael Mosley's 'Fast 800' book which I picked up a couple of months back, so I'm now giving intermittent fasting a shot, but I'll try and write something more about that later this week. At my annual health review last week my blood sugar levels were stable, and my cholesterol had improved slightly, the only worrying thing was that my eGFR came back at 23 which is lowest yet. I'll be having another test in about three weeks so I'll have a better view by the end of the month when I see the consultant again.

Four. Some light DAX work as part of a solution I'm prototyping in Azure Analysis Services.

Five. My wife and I discussed replacing the garage door in the next couple of months, but we've decided to leave the electrical supply for at least a year till we replace the decking in the garden. But I've got a list of other jobs I'm working my way through at the moment, so not had much time to plan this work in.

Six. Nothing.

Seven.
Nothing.

Wednesday, 26 June 2019

Ingeus and Healthier You: a total shower of shit


In my last few posts I’ve mentioned all is not well with my referral to ‘Healthier You’ the not so early intervention diabetes programme. I’ve written before about the shambolic performance from Ingeus, the outsourced provider delivering the programme in my area, but having given it the benefit of the doubt several times I found thing only ever got worse.

A short summary of events: in late 2017 my GP referred me to this programme, he thought it would be helpful given my health issues and weight management difficulties. I didn’t hear anything for several months, I mentioned this to the practice nurse during a routine appointment, she did a little digging and uncovered I’d been rejected. But Ingeus hadn’t bothered to inform me, and nobody at the surgery had picked up on it. So, she helpfully got the referral raised again, a month or so later I got the letter inviting me to join and a few weeks later a phone call to arrange times.

According to the bumf, the programme would be delivered as group sessions around two hours long, starting with four weeks of weekly sessions and then nine months of monthly sessions. Sounded like a clinically charged-up version of Weight Watchers. The first advisor offered me sessions on a Tuesday afternoon, but I had to decline as they were nowhere near work and taking thirteen half days off was a bit of a stretch. But it was okay, they would find me an evening session, after all there will be loads of people like me who work during the day, people who could benefit from early intervention but find appointments during the day a challenge.

About eight months goes by without word, then I get a second call offering me a later afternoon slot, a little bit further away. I decline again, tell the advisor I’m waiting for an evening slot, they tell me they class late afternoon as an evening slot. I tell them it’s still not helpful as I need an actual evening slot, they confirm they can see this from my previous contact. I’m told they’ll have another go at finding me a genuine evening slot and someone will get back to me in a few weeks. 

Two months later a third advisor calls and admits that evening slots don’t exist and they think it’s best if I’m discharged from the programme so my GP can try to find something more appropriate. We have a slightly awkward conversation where he tactfully acknowledges the programme isn’t designed to support people who work during the day, without presenting this as a bit of a fuck up.
A few weeks after that I get a gratuitously inappropriate letter from Ingeus, packed with glib platitudes about how serious diabetes is, and expressing how sorry it is I’ve decided to leave the programme. What the fuck! 

Now, maybe the warning signs were always there, the failure to communicate the initial rejection, the extended wait for the non-existent evening slots being pretty clear indicators. But, perhaps the biggest warning sign was in the promotional bumf, the brochure is plastered with a diverse range of stock photos, but go to the patient case studies on the website and they are overwhelmingly older people, the type who are likely to be retired or semi-retired, not so much in the way of people who work full time and have young families to juggle.

I decided to complain to NHS England, firstly about the piss poor communications which meant it took a year and a half to get to the point where Ingeus, grudgingly, admitted it wasn’t able to support people who work during the day, and secondly about the stupidity of commissioning delivery from a provider unable to support a large chunk of the population for whom an early intervention programme could bring major benefits. Unfortunately, NHS England claims it didn’t commission the programme, which was a surprising given its website says it did (here and here). Maybe the NHS website has been hacked with fake news?

So now I’ve raised the same complaint with East Surrey Clinical Commissioning Group. I sent the letter over a week ago and haven’t heard anything back yet. I don’t have high expectations. I’m betting on a letter with some waffle about budgets being tight, brushing over why a small portion of it couldn’t be put towards people who need evening appointments, especially given the long-term cost saving to the NHS from doing early intervention properly. Or perhaps it’s deliberate, and it was always intended as early intervention for older people, but Ingeus just forgot to mention this when put together communications material?

However, I’ll end on a positive note. I had my annual check-up last week and my blood sugar levels are stable, even if they are still in the pre-diabetes range. I also have an appointment lined up next week with the diabetes lead nurse to discuss possible ways forward.

Saturday, 8 June 2019

Goals update eight


One. Didn’t hear anything back from Rusty Quill about my entry, but I wasn’t really expecting to given the number of entries they’ll have received. I’m trying to find some time to polish up my first script so I can get the ball rolling again.

Two. I’ve been keeping up the runs, and my stamina is definitely increasing. The decision to switch to the ‘Couch to 5k’ app from Public Health England was a good move, I’ve done the week one run four times and next week I’ll try week two for the first time.

Three. No real change in my weight, 116.2kg this week. I was supposed to have my annual medical review this coming Wednesday, but the lab at East Surrey Hospital fucked up the urine test, so it had to be moved back a week. The GP surgery called me on Friday afternoon to tell me the lab had refused to process my urine sample because the bottle was incorrectly labelled, there was no further information about what that actually meant, but it sounds like total bollocks. Not only do I remember completing the label on the bottle, but I sealed it in the sample bag which had a handy printout from the GP attached. Somehow they knew what the sample was, what it was for, who had ordered it, who it was from, and even knew when it was submitted because I had a blood test done at same time, but they couldn’t process my piss because some detail they already had available in front of them was apparently missing from the bottle. Fortunately, they did process the blood, so those labels must have been acceptable!

Four. I’ve started a DAX training course from Pluralsight, and next week I’ll be using it anger on my current project.

Five. The garage has had a bit of a tidy out, I did a couple of dump runs this morning. But there’s other stuff I need to do before I attempt to replace the door.

Six. Nothing.

Seven. Nothing.  

Thursday, 30 May 2019

Goals update seven


One. I’ve written a new story and submitted it to Rusty Quill’s 'Rusty Fears 2' competition. I doubt it will win, as there’s likely to be a lot of high-quality competition, but having a deadline forced me to complete the story. I’m not normally a fan of writing to a brief, but the theme was wide enough to allow me to interpret it in my own way. The bonus is that I can fit it into the mythical ‘universe’ I’m creating with some of my other stories.

Two. I’ve been pretty good recently, doing three runs most weeks. I can feel my stamina increasing, although I’ve been sticking to the week one programme. This week I’m going to shuffle thing up a bit by trying out a the ‘Couch to 5k’ app from Public Health England. I’m also going to try adding some strength exercises into the mix, which will hopefully move things along a bit.

Three. My weight has been bouncing around between 115.5kg and 116.5kg lately, with a lot of it seeming to be down to how big a meal I had the night before the weigh in. My referral to the ‘Healthier You’ programme has turned into a complete clusterfuck, but I’ll write a proper post about that. I have picked up a book on the 5:2 diet by Michael Mosley, but I haven’t had chance to read it yet.

Four. I’ve been doing some training on Azure Analysis Services as part of a project at work, there’ll be some DAX training as part of that.

Five. Nothing on the garage, I need to start doing some planning to replace the side door. But I’ve got a list of other DIY things to do this weekend.

Six. Nothing.

Seven. Nothing.  

Tuesday, 7 May 2019

Goals update six


No updates recently as I spent a good chunk of April on holiday in Florida, followed by Easter and a busy week or two when I went back to work.

One. Nothing recently, no time.

Two. I didn't do much for most of April as I was away. This past week or so I've been making attempts to get back into the swing of things. Post-Florida I picked up a cold, but it’s almost shifted now, and my stamina is slowly rebuilding.

Three. The holiday in Florida, followed by Easter celebrations back home pushed me up to 117kg. It wasn't so much that I binged on holiday, I was just a bit lax, a couple too many beers and cheeseburgers. I'm trying to get things back on track with more controlled eating habits, but it doesn't help there's a shitload of chocolate and sweets in the house at the moment. My next consultant appointment has been rescheduled again, from late May to late July, so I’ve got a bit of time, and I really want to be down to 113/114kg by then. Given this is the second postponement it did leave me wondering about how much intelligence goes into delaying appointments. And on the subject of delays; I had a phone call from 'Healthier You' before I went away, which I'll write about separately, but it’s fair to say it wasn't particularly helpful.

Four. Nothing.

Five. Nothing on the garage, but a number of other DIY tasks have cropped up. My wife and I bought a new divan style bed for our daughter from Ikea. It was a mission putting it together, it being incredibly heavy due to all the built-in storage. I also replaced another light switch in the bedroom, confirming my suspicion that the builder selected the shitist switches possible when he did the extension. 

Six. Nothing.

Seven. Nothing.

Sunday, 17 March 2019

The coveting of Warlingham Village School

A long, off-topic post, but one I think offers some insight. I should make clear these are personal observations based on information in the public domain, conversations I’ve been exposed to and stuff I learned during my time in local politics. I have no dog in this fight beyond my former associations, that and a shit outcome will be a daily inconvenience. 


About six months ago Surrey County Council (SCC) floated the idea of demolishing a local primary school, Warlingham Village School. Rated ‘outstanding’ by Ofsted and a bedrock of the community for over a century, generations of locals have sent their kids there, so predictably a backlash ensued.


The rationale is that the school is oversubscribed and the current site is difficult to redevelop. SCC would ‘relocate’ it to a new build on the opposite side of the village. The proposed site being a recreation ground on Limpsfield Road currently designated green belt. This would deliver the new school places SCC claim are needed to meet future local demand. It took about thirty seconds for locals to notice some glaring problems with this narrative. 


Firstly, the claim about local demand for places is dubious. The existing school is oversubscribed, but SCC have failed to demonstrate this is a significant issue as there are at least five other primary schools within two miles. So, there’s little evidence of an overall shortage of places in the local vicinity. In fact, another primary school, Hamsey Green, on the side of the village SCC is proposing to relocate to, has confirmed it is currently undersubscribed. 


The claim the current school site cannot be redeveloped has also not been proven. Nobody is claiming it would be easy, but how much effort has been put into assessing it? Besides, Hamsey Green School has confirmed it is able to expand its intake without difficulty, there just isn’t sufficient demand for the places it already has. 


So where is SCC seeing this demand? Probably not in Warlingham! Other parts of Tandridge District may have shortages, particularly the southern parts on the other side of the M25. But, this proposal is of little benefit to those areas. My understanding is that the oversubscription at Warlingham Village primarily affects applications from outside the local area. The school at Hamsey Green, being on the London border, actually takes a lot of pupils from the neighbouring London Borough of Croydon, and the new site is likely to be similar given it’s geographically more accessible to Croydon than other parts of Surrey. 


Which brings us to another problem; traffic. Unless Hamsey Green gets the chop (which would make the whole exercise pointless), filling the additional surplus means places means transporting kids in to the village via its busiest road. The geography means public transport links to Croydon are far better than to neighbouring parts of Surrey, suggesting more cars entering the village on the school run each day if SCC really wants to address real shortages. 


A reasonable summary of affairs is that SCC wants to demolish a much loved, successful, local school, to generate what appears to be a massive oversupply of school places. Whilst the location of the proposed site means it will probably benefit kids from Croydon rather than resolving issues in other parts of Surrey! 


Why would anybody from SCC’s education department come up with such a plan? Obviously, they didn’t! The whole thing is euphemistically referred to as ‘a developer led initiative’, and is driven by opportunities in the local political landscape. 


Firstly, SCC is skint, really, really, skint and although Warlingham Village School is operated by the GLF academy chain, the land it sits on is owned by SCC and it would be worth a small fortune developed as housing. Parents opposing the scheme also believe the developers have designs on a big parcel of green belt land right behind it which would be worth even more, if weren’t for a pesky school in the way. 


Secondly, now is the best chance in years for developers to rip the Limpsfield Road recreation ground out of the green belt, and reap the windfall profits that would bring. Tandridge District Council (TDC), the local planning authority, is in the final stages of adopting a new local plan. It’s pretty much accepted that some green belt, which covers around 94% of the district, will be sacrificed to government pressure to pour concrete. (I could write pages about the Conservative Party’s sleazy relations with developers, about the wheezes used to force overdevelopment, about the economics of externalised costs and windfall profits, and about local plans and nimbys, but this post is already too long!) What matters is that releasing land from the green belt equals massive windfall profits to the lucky developer. 


In late 2016 TDC put out a 'call for sites' to owners of green belt who wanted it assessed for potential development under the proposed local plan. Lots of pastures, playing fields and golf courses were submitted; including some land banked precisely in hope of such opportunity. The proposed school site was lucky enough to be selected in 'Category 2: Green Belt Sites within an Area for Further Investigation'. This doesn’t mean the site will be released, it is still green belt, but it made it a much softer target. (And it appears the developer is pretty much treating this particular jackpot as a banker, which could be simple overconfidence or a sign of something more fetid). 


Developing green belt requires 'exceptional circumstances' be demonstrated, a somewhat ambiguous designation in planning law that basically sets the bar above any general merit of a scheme. The opportunity to make windfall profits is not an exceptional circumstance, nor is a general demand for housing. Exceptional circumstances are when there is no other way of delivering a demonstrated need, where all reasonable alternatives have been explored and ruled out. 


A confirmed ‘need’ for more school places is probably as good a stab at ‘exceptional circumstances’ as can be found in this case; ‘somebody needs to think of the children’! That said, to swing it the decision-making process will need to avoid looking too closely at the basis for local need, and then ignore the more obvious alternatives I've already hinted at. However, from previous experience, the ‘presumption in favour of development’ may well bend to routes in planning law that bypass any such ground truth. I’ve also no doubt that some in that process can be incentivised, by one means or another, to turn a blind eye to inconvenient facts (I won't exactly be shocked if local hearsay that the deal has already been stitched up turns out to be true). 


A remit of the new local plan is addressing infrastructure needs, and school places could fall under this. Although I don’t believe there is any specific local requirement identified, nor any prescription that a supply of new places should be located where they are genuinely needed. As far as local authority box ticking is concerned, building a school in an area where it’s not needed, is probably just as good as building one where it really is needed. A new school could be lauded as a great achievement by SCC even as a glut of excess places are filled by kids from Croydon and the problem for Surrey kids remains unresolved (by law SCC cannot bar London kids from taking them). 


For the developer of the Limpsfield Road site the advantages are obvious. Without the school it would probably take much longer to get the site out of the green belt, but once out it can develop the rest of the site for residential use. Outright residential development would probably be more lucrative, and would mitigate the overdevelopment squeeze that comes as standard with such schemes, but the need to fit in a school pretty much makes overdevelopment on the rest of the site inevitable. To make matters worse it’s been suggested it will be given over to yet more of the ‘later living’ retirement hutches that are increasingly scabbing over the village, changing its character for the worse (I could do another post on this disease; its economic drivers and implications for the local community). 


Proper residential development, homes for local families as opposed to retirement communities, would probably the second-best outcome for the local community, the best outcome being retaining the recreation ground. However, a similar site exists close by, the former Shelton Leisure ground. It’s in the same category but is likely to be released for development first. It has the advantage of being land banked several years ago when the business folded, by securing the perimeter and preventing its use, the owners have a much stronger case for claiming it’s redundant as a recreation ground and should be concreted at the first available opportunity. There's a whole schtick now being pushed by developer shills to 'reimagine' these types of sites as 'low grade' green belt or 'scrub land' fit only for concreting (pushing the Overton window in the direction of windfall profits).


For SCC the objective appears to be to cash in the current school site, tap into capital funding sources for new school places, and cut a mutually beneficial deal with the developer of the Limpsfield Road site in return for the ‘exceptional circumstances’ needed to kick start the whole programme. This plan is even more lucrative if the parcel of green belt behind the school is part of the package. (Although, if the green belt behind the school is a viable target for development it begs the question of why the school itself cannot expand on to it?) 


I’m sure over the next few months there will be plenty of charlatans advocating for the SCC and the developer, claiming how demolishing a community asset, concreting green belt and choking the village with additional traffic is just what the community needs, but any credible assessment needs to highlight the distorting incentive of windfall on such claims. Would a developer give over a brownfield site in Warlingham for such a development? Unlikely! Would SCC normally build a new school in an area which already has a surplus of places and much easier alternatives? Not a chance!